Livelihood program improves perceived mental health of people living with HIV in Kenya

Shamba Maisha participant watering crops

photo by David LaChapelle 

While food insecurity and poverty worsen mental health outcomes for people living with HIV, there has been little research targeting those barriers as ways to improve mental health. Addressing underlying determinants of health may be critical to ensuring better mental and physical health.

New research from the Shamba Maisha study, supported by the National Institutes of Health,  explored how a livelihood program impacted perceived mental health among people living with HIV in Migori County, Kenya. This region has the highest HIV prevalence and a high burden of depression. A group of experts in agriculture, development and HIV-related health designed an intervention with 3 components: a low-cost water pump that allowed irrigation of crops year-round; training on sustainable farming practices and financial management; and loan vouchers worth $150 (US) to purchase the pump, seeds, fertilizer and other farming implements.

Participants in the program described multiple aspects of mental health that improved, including reduced stress, fewer symptoms of anxiety, improved mood and more hopefulness for the future. Many also linked improvements in their HIV-related health to the improvements in their mental health.

Researchers identified a few key mechanisms for these changes:

  • Improved food security reduces anxiety and depressive symptoms. As one 30-year-old woman told interviewers, “When one is full they are more rational, but when one is hungry they get anxious and stressed, leading to depression.” Another young mother said she was able to “eat and laugh happily” with her family.
  • Productive farming routines reduced depressive and worrisome thoughts. Staying engaged and busy helped participants reduce stress. A 40-year-old woman described how “something funny about stress is that if you are just seated idle is when it increases, but when you are busy doing something your thoughts are reduced and the stress also goes down.”
  • Reframed social identities. The program helped participants have higher self-esteem and feel more hopeful about their future. As one man said, the identity of being “someone who is working” was a positive shift in social identity. Their changes in economic standing also changed their social standing, and they felt more interconnected with their communities.

This research supports the idea that livelihood programs may be an important avenue to improve mental health for people living with HIV by addressing social and structural drivers like poverty, food security and social connection.