Intervention with Microfinance for AIDS & Gender Equity

The IMAGE Study is a research initiative that seeks to evaluate the potential role of a microfinance-based poverty alleviation and empowerment strategy in behaviour change and the prevention of HIV and gender based violence. The IMAGE intervention combines community level access to a poverty targeted micro-lending scheme (TCP) with a two phase Participatory Learning and Action Curriculum for loan recipients ("Sisters for Life"). The IMAGE Study is an integrated, prospective, randomized, matched community intervention trial that seeks to thoroughly examine the impact of this social intervention that addresses poverty and gender-based inequalities on social, behavioural and biological outcomes - including HIV incidence. The study is based in 8 villages in the Sekhukhuneland District of Limpopo Province.

To download the full article of IMAGE Study published in the Lancet 368 1973-1983 2006 click here

Development finance, social captial and HIV - Pronyk PhD 2.02MB

IMAGE New York Review Feb 2007 2.12MB

Mail and Guardian IMAGE study Dec/01/2006

Pronyk Kim IMAGE Study CBC radio interview Jan 07 27.7MB

Lancet Podcast with Dr PM pronyk (14.5MB MP3)

Image conceptual framework figure (55kb)

Map of IMAGE site (287kb)

IMAGE Study Video (97MB MPEG file)

Beat It Video (71 MB MPEG file)

1. The IMAGE Intervention

IMAGE = Microfinance (TCP) Sisters for Life

i. Microfinance

Microfinance (MF) initiatives expand access to credit and savings services for the development of income generating projects among disadvantaged groups, particularly women. Several studies have demonstrated enhanced autonomy and resilience among women participants - where newly acquired economic and business skills translate to improvements in self-esteem, larger social networks, and wider control over household decision-making. Documented health impacts include improvements in educational status and the nutritional status of children.

The Small Enterprise Foundation (SEF)

The Small Enterprise Foundation (SEF) is a South African microfinance NGO, that has been operating in the Limpopo Province for a decade. SEF s Tshomishano Credit Programme (TCP) has developed a strategy to meet the unique social and cultural environment of rural South Africa. By utilising participatory wealth ranking methods, SEF identifies and recruits the most economically disadvantaged members of a community - whose households are often overlooked in more conventional MF programmes.

Group lending involves the provision of loans are given to groups of five women for the purposes of developing income-generating projects. While individual women run projects, the members of a group act as guarantors of one another s loans. All five women must repay together to move up to the next loan cycle. Eight groups of five women comprise one loan centre. Loan centres meet fortnightly to repay loans, discuss business ideas and apply for new loans.

Visit Small Enterprise Foundation (SEF) website

ii. Sisters-for-life training

The Sisters-for-Life (SFL) curriculum is an attempt to integrate training on gender and HIV into social networks formed as part of the microfinance programme. The Sisters-for-Life program comprises 2 phases:

  • Phase 1 is a structured series of 10 training sessions
  • Phase 2 is an open-ended program that aims to support participants in developing and implementing responses appropriate to their own communities.

The Phase 1 training takes place as ten 1-hour sessions held during regular microfinance centre meetings. The curriculum is based on participatory learning and action principles and has been developed and piloted specifically for the IMAGE study context. It covers a broad range of issues that have been identified as priorities for rural women.

Topics include:

  • gender roles, gender inequality, and culture
  • the body, sexuality, and gender based violence
  • communication and relationships
  • HIV transmission and prevention

Sessions are structured to give participants an opportunity to strengthen confidence and skills relating to communication, critical thinking and leadership. Moreover, they are designed to complement microfinance values and principles such as mutual respect, personal responsibility, and group solidarity. Throughout Phase 1, participants are encouraged to identify both obstacles and opportunities for engaging with men and youth in their communities.

The orientation of Phase 2 is toward collective action. In Phase 2, key women who have been identified in the previous phase as natural leaders are brought together for further training on leadership and community mobilization. Taking these skills back to their respective centres, they are responsible for developing an Action Plan with their centres, with the aim of implementing what they regard as appropriate responses to priority issues. In this phase, SFL facilitators continue their relationship with the centres, this time using the one-hour sessions to provide support and guidance for the Action Plan.

For a detailed description of the theoretical basis of the Sisters-for-Life programme, download Intervention Monograph (2.67mb) or text-only Intervention Monograph (163kb).

For a detailed overview of the Sisters-for-life curriculum, download SFL Phase 1 training manual (856kb),download Natural Leaders manual (712KB), download SFL training manual Phase 2 (515KB): community mobilization

2. The IMAGE Study

The IMAGE study aims to generate a significant understanding of the links between poverty, gender inequities and migration and the spread of HIV in South Africa, and in particular the role of the IMAGE intervention in addressing the epidemic. The evaluation will focus on comparing:

  • IMAGE participants
  • young people living with IMAGE participants
  • the communities in which IMAGE operates

with appropriate control groups. Extensive qualitative data collection will contribute to a thorough understanding of process.

For a detailed description of the theoretical basis for the IMAGE study, and the Evaluation Methodology, download IMAGE Evaluation Monograph (2.39mb) or text-only Evaluation Monograph (645kb).

The IMAGE Study has been reviewed and registered with The Lancet

RADAR, The intervention with Microfinance for AIDS and Gender Equity Study (IMAGE Study): an integrated community-randomised trial of a structural intervention to prevent HIV and gender-based violence in South Africa . 03PRT/24. The Lancet Protocol Reviews, 2004

Download full IMAGE Study Lancet protocol (642 KB)

The following evaluation tools are also available to download:

Field work training manuals:

3. Access to IMAGE Study Databases

The IMAGE databases represent an important, population based data source on HIV in rural South Africa. It is the aim of the IMAGE programme to maximize access to data collected as part of the programme. Quantitative databases will be made available for review and secondary analysis in collaboration with RADAR. In order to access this data, please fill in the contact details below and submit to James Hargreaves at

Name, Position, Institution, Address, Tele, Fax, Email, and the Purpose of request (review, secondary data analysis).

(NOTE: all fields must be filled in order to receive any information)

4. Related Research (for download)

International AIDS Conference abstracts 2002-2006(35KB)

Pronyk PM, Morison LA, Euripidou E, Phetla G, Hargreaves JR, Kim JC, Watts C, Porter JDH The association between structural factors and HIV prevalence in rural South Africa. IMAGE Study Working paper no.1(69KB)

Pronyk PM, Kim JC, Hargreaves JR, Morison L, Makhubele MB, Watts C, Porter JDH. Integrating Microfinance and HIV prevention - perspectives and emerging lessons from rural South Africa, Small Enterprise Development, September 2005, 16(3): pp. 26-38.(127KB)

Bonel CP, Hargreaves JR, Strange V, Pronyk PM. Should structural interventions be evaluated using RCTs? The case of HIV prevention. Social Science and Medicine 2006(171KB)

Kim JC, Watts C. Gaining a foothold: Tackling poverty, gender inequality and HIV/AIDS in Africa. British Medical Journal October 2005, 769-772.(109KB)

Hargreaves JR, Morison LA, Gear JSS, Kim JC, Porter JDH, Watts C, Pronyk PM. Hearing the voices of the poor: Assigning poverty lines on the basis of local perceptions of poverty; a quantitative analysis of qualitative data from participatory wealth ranking in rural South Africa. IMAGE Study Working paper no.2(132KB)

Pronyk PM. Social Capital and the HIV/AIDS epidemic in rural South Africa - The New Magic Bullet? Doctoral Upgrading Document, London School of Hygiene and Tropical Medicine, Sept 2002. (353kb)

Hargreaves JR. Livelihood aspects of the household environment and the sexual behaviour and risk of HIV infection of unmarried adolescents and young adults in rural South Africa. Doctoral Upgrading Document, London School of Hygiene and Tropical Medicine, Aug 2002. (199kb)

Hargreaves JR. The social epidemiology of HIV infection: a study among unmarried young people in rural South Africa in 2001. Doctoral Thesis, London School of Hygiene and Tropical Medicine, 2005.