ASSESSING BARRIERS AND FACILITATORS OF IMPLEMENTING AN INTEGRATED HIV PREVENTION AND PROPERTY RIGHTS PROGRAM IN WESTERN KENYA

Abstract

Despite the recognized need for structural HIV prevention interventions, few scientific programs have integrated women’s property and inheritance rights with HIV prevention and treatment. The current study focused on a community-led land and property rights intervention that was implemented in two rural areas of Western Kenya with high HIV prevalence rates (24–30%). The program was designed to respond to women’s property rights violations in order to reduce HIV risk at the local level. Through in-depth interviews with twenty program leaders, we identified several facilitators to program implementation, including the leadership of home-based HIV caregivers and involvement of traditional leaders in mediating property rights disputes. We also identified the voluntary basis of the intervention and its lack of integration with the formal justice system as implementation barriers. Our findings can guide future research and design of structural HIV prevention strategies that integrate women’s economic empowerment through property and inheritance rights.

Research in HIV prevention increasingly recognizes that individual-level behavioral and biomedical interventions need to be supplemented with structural approaches that address the contextual factors affecting HIV risk and vulnerability (Gupta, Parkhurst, Ogden, Aggleton, & Mahal, 2008). In the global HIV epidemic, economic underdevelopment and gender inequalities are two commonly identified structural drivers of disease transmission (Parker, Easton, & Klein, 2000). Women and girls continue to be disproportionately impacted in developing countries, where heterosexual sex is the dominant mode of transmission, and females are on average twice as likely to be infected with HIV than their male counterparts (Joint United Nations Programme on HIV/AIDS; UNAIDS, 2010). In the context of poverty, women’s economic disempowerment relative to men has meant that women’s personal resources, including their sexuality, take on economic potential, and can lead to sexually risky behaviors such as early sexual debut, multiple sexual relationships, and transactional or commercial sex (Gillespie, Kadiyala, & Greener, 2007). Economic asymmetries are also reinforced by entrenched gender norms and cultural practices, such that women are further constrained in their ability to negotiate safer sex and are thereby more vulnerable to HIV infection (Hallman, 2004).

HIV prevention efforts that intervene on economic disempowerment and gender relations have frequently focused on income generation and credit expansion, such as microfinance. These programs have experienced some success in terms of the impact on women’s empowerment and on health outcomes (Dunbar et al., 2010; Pronyk et al., 2008; Schuler & Hashemi, 1994). However, focusing on income alone as an HIV prevention strategy overlooks the importance of productive assets such as land and property (Garikipati, 2008; Weinhardt et al., 2009). Access to, rights in, and control over land and property can provide women with a more secure means of livelihood, prevent food insecurity, and improve household bargaining power (Agarwal, 1994; Walker, 2002). Women’s ownership of land and housing has also been shown to be mitigative, if not protective, against domestic violence, a known risk factor for HIV (Gupta, 2006; Swaminathan, Walker, & Rugadya, 2008). Securing property rights for women thus has the potential to reduce HIV risk and vulnerability and mitigate the impact of AIDS.

The HIV/AIDS epidemic intersects with women’s property and inheritance rights on multiple levels, with implications for the physical, economic, and social well being of women and their families. Under customary practices in sub-Saharan Africa, women depend on men through marriage, family, and kinship for access to land and housing (Walsh, 2005). In the post-colonial context of land tenure reform where often only male heads of households hold land titles, women’s customary land use agreements are frequently disrupted by the death of a husband or patriarch, particularly when coupled with stigma against widows in HIV-affected households. Here, women become disinherited or denied their claim to family property by in-laws, vulnerable to property grabbing or stripped of their existing resources and assets, and even violently evicted from their marital homes where they are forced to migrate to slums, beaches, and markets (Izumi, 2006). While several countries in the region have adopted legislations that recognize women’s equal rights to land and property, gaps in statutory implementation—including inadequate interpretation and enforcement of legislation, and lack of knowledge and means to access legal mechanisms—continue to prevent women from securing land tenure (Strickland, 2004). The practical inaccessibility of the land statutes, in turn, has led local officials and traditional leaders who preside over informal land dispute resolution to continue relying on customary practices that deny women access to and control over land and property (FIDA & IWHRC, 2009). These trends can worsen women’s poverty and exacerbate women’s HIV risks through the loss of shelter and social support systems, diminished agricultural production and livelihood strategies, and migration to areas where women exchange sex for goods, food, housing, or money (Aliber & Walker, 2006).

Despite the known links between women’s land tenure and HIV/AIDS, limited progress has been made in the HIV science base to integrate property rights and HIV prevention interventions. To date, a number of nongovernmental and community-based organizations are engaged in efforts to secure women’s property and inheritance rights in the context of the HIV/AIDS epidemic, ranging from educating and sensitizing the public on women’s property rights, building the capacity of local leaders and institutions to address property rights violations, and training community-based paralegals to improve access to legal resources and advice (Knox et al., 2007). Such programs, however, often lack academic collaborators and have not been evaluated through systematic research methodologies. Given the gaps in statutory law and implementation, community-based interventions that engage with local practices and institutions are especially critical in addressing context specific obstacles to women’s land tenure (Paradza, 2011). Research on these initiatives is thus an important first step in conceptualizing an integrated property rights and HIV prevention program.

The current work focuses on a community-led land and property rights intervention in two rural areas in Kenya—Kakamega in Western Province, and Kendu Bay in Nyanza Province. These two areas represent some of the worst HIV-affected regions in Kenya with sero-prevalence rates of 24% and 30%, respectively; these rates are significantly higher than the overall national average of 7.4% (National Coordinating Agency for Population and Development; NCAPD; 2005a, 2005b; National AIDS and STI Control Program; NASCOP; 2008). The heightened HIV burden in these regions is coupled with widespread exclusion of women from land and property ownership, where women contribute 80% of the agricultural labor but own only 5% of the land across the country (Federation of Women Lawyers-Kenya & Internal Women’s Human Rights Clinic at Georgetown University Law Center; FIDA & IWHRC, 2009). Prior to the promulgation of the new Kenyan Constitution in 2010 that included a gender-equitable framework for land rights, several statutory laws already existed to formalize women’s rights to land succession and ownership; however, these laws had limited enforcement. In this context, we ask: what are the barriers and facilitators to implementing a community-led mechanism that focuses on reducing HIV risk by protecting and enhancing women’s access to and control over land and property? We present in-depth interview data collected from program leaders, and discuss practical lessons for future research focused on structural HIV/AIDS prevention interventions that integrate women’s property rights as their focus.

METHODS

STUDY SETTING

Grassroots Organization Operating Together in Sisterhood (GROOTS)-Kenya was founded in 1995 after the 4th UN Conference on Women in Beijing to increase the involvement and visibility of grassroots women in community development and governance. In 2005, GROOTS-Kenya developed its flagship women and property program, known as the Community Land and Property Watch Dog Model, in response to growing community concerns that women were being property stripped and disinherited in their communities, particularly in households affected by HIV/AIDS. The model is operationalized as Watch Dog Groups (WDG) on the local level and is comprised of volunteer women and men, including community health workers, traditional leaders, trained paralegals, and government stakeholders. The WDG monitors women’s disinheritance locally, mediates land disputes within the family, refers unresolved cases to formal adjudication mechanisms, and raises awareness of women’s land tenure and property rights. The WDG also educates women, men, and communities about how property rights violations shape HIV risks, and offers tailored strategies to reduce HIV risks and maintain HIV/AIDS care. WDGs have since been established in more than 30 locations in central and western Kenya, and altogether have managed more than 200 cases of women’s property rights violations (Grassroots Organization Operating Together in Sisterhood; GROOTS, 2008).

PARTICIPANTS

This project is part of a larger research study that examines the impact of the WDG program on land ownership as well as HIV and violence outcomes. The research is a collaborative effort between the University of California at San Francisco (UCSF), the Kenyan Medical Research Institute (KEMRI), and GROOTS-Kenya. In the current study, we draw on in-depth interviews with 20 women and men who led the development and implementation of the program (see Table 1). Inclusion criteria included: being male or female, and being integrally involved in the development and implementation of this program. The sample size of 20 represents the large majority of the full population of leaders involved in the development and implementation of this program. For their participation, each interviewee received reimbursement for transportation, in accordance with the ethical guidelines provided for research studies within Kenya. Ethical approval for this study was obtained from the KEMRI Ethics Review Committee, and the UCSF Institutional Review Board. Data collection took place between January and April 2011.

TABLE 1.

Demographic Characteristics of Study Participants

f		N = 20	%
Age	20–30	3	15
	30–39	3	15
	40–49	9	45
	50–59	3	15
	60+	2	10
Gender	Female	14	70
	Male	6	30
Marital Status	Not married	3	15
	Married	14	70
	Widowed	3	15

PROCEDURE

Twenty individual, in-depth, semi-structured interviews were conducted in English, Kiswahili, and local languages of Dholuo or Luhya by Kenyan research assistants. To minimize bias, interviewers were hired from the local communities in which the Watch Dog Model was based, but were external to the program and to GROOTS-Kenya. Interviewers were trained for 2.5 days in qualitative research methods and ethics and human subjects principles. Interviews were audio-recorded after written informed consent was obtained from participants. Interview questions were translated from English into the local language; interview content was first transcribed into local languages then into English. Domains within the interviews focused on understanding the barriers and facilitators to implementing this program in order to identify key lessons for future structural initiatives focused on HIV, domestic violence, and property ownership. Interviews explored the development and implementation of the program and the perceived benefits and challenges of the strategies used to assist women to secure land and property ownership. Interviews lasted between 1.5 and 2.5 hours.

DATA ANALYSIS

Interviews were transcribed and translated from audio recordings. To begin the coding process, two researchers extracted excerpts of the transcribed interviews relating to the barriers and facilitators of implementing the model. After reviewing these excerpts, we generated a codebook and an analytical matrix, as is suggested by Lofland and Lofland (1995) in order to examine recurrent themes and patterns related to the domains of interest. Any inconsistencies in coding were discussed between two of the authors and instances of a lack of concordance were taken to a senior researcher for resolution. During the coding process, four facilitators and two barriers were identified, and these themes form the basis for the results section that follows. To facilitate the analysis, we used Dedoose, a qualitative data analysis software program.

RESULTS

FACILITATORS

Four main themes emerged from the interviews as facilitators to the implementation of the Community Land and Property Watch Dog Model: (1) harnessing the leadership of home-based HIV caregivers; (2) garnering multi-sectoral support for an integrated HIV/AIDS and property rights program; (3) involving traditional leaders in mediating and preventing property rights violations; and (4) capitalizing on the national land tenure reform to form a community property rights program.

Harnessing the Leadership of Home-Based HIV Caregivers

Almost all respondents agreed that the grassroots leadership of home-based caregivers (HBCs) was a key facilitator to implementing the Watch Dog Model. As community health workers providing care in HIV-affected households, HBCs were among the first to witness the intersecting impact of HIV/AIDS and women’s property rights violations, including property grabbing and disinheritance. Their intimate knowledge of widows being displaced from their homesteads at the cost of livelihoods and health maintenance made them effective whistleblowers and advocates for integrating women’s property rights as a necessary priority in HIV/AIDS care:

By the time we were visiting door-to-door, care giving for the women, though you support somebody to adhere to drugs, you may come back the other day and find that she is not there. We were meeting with GROOTS Kenya once a year to plan for our communities, it’s when we raised the issue. We said, we have a problem, we can’t do [HIV treatment] follow up very well, women are being chased away from their homes… What can we do? (Woman, age 55, emphasis added)

Given their personal ties to the affected communities, HBCs naturally formed the core leadership in implementing a timely and accessible intervention for their HIV patients facing asset stripping and eviction:

We were doing this because we are community health workers first; our [job] was to sensitize people about HIV/AIDS, and while we were doing that, we came to learn that we had so many cases about disinheritance…this is when we decided it is better for us to form a group of Watch Dog in order to protect our people, you see, therefore there is no way you can disconnect us from the person, the case of property inheritance. (Man, age 48)

Respondents reflected on the indispensable role of HBCs in conceiving and leading the intervention, and were hopeful that the experiences of HBCs elsewhere could also inform the development and implementation of an integrated HIV prevention and property rights program in other communities:

Through the work of the caregivers, we were able to understand exactly what has been happening to the right to property…telling the community it’s not about being HIV [positive] that you accept to be thrown out. That would only happen if there’s a strong network of caregivers within a region…. Not all organizations that are working in these regions have been able to put in place mechanisms like the WDG…. So I think [HBCs] may be able to assist in strengthening the link between HIV and property. (Woman, age 34)

Garnering Government and Multi-Sectoral Support for an Integrated HIV/AIDS and Property Rights Program

Many respondents cited their partnership with the local government as another important facilitator of program implementation. From the outset, WDG leaders sought support from the Provincial Administration (PA), especially at the level of district officers, chiefs, and assistant chiefs, given its historical¹ role in supervising central government ministries and coordinating programs and policies at the local level. WDGs secured the attention of the PA and its divisions by emphasizing the multi-sectoral impact of women’s property rights violations both on poverty and on HIV transmission:

WDGs brings together all the stakeholders [in the PA] to understand that there is a problem and relating it with HIV/AIDS: we are chasing these women from home…they are living in shanty houses in the market, where our sons go…and these women may be HIV positive and soliciting their food from sex…by having [several] sexual partners, HIV is spreading in our community. WDGs are not addressing it as only an issue affecting women or an issue affecting land, it is an issue affecting health—so that even the Ministry of Health can come in and say, “we need to support this.” (Woman, age 42)

Having established a shared commitment to HIV prevention, WDGs appealed to the PA to strengthen the monitoring and reporting of women’s land grievances. Since the PA traditionally oversaw the referral and resolution of land matters within the local justice system, WDG leaders were cautious not to undermine the PA’s authority. Instead, they framed the program mission as complementary to the local government’s mandate:

When we began the initiative, [we] had to go explain to the PA it is because we want to reduce HIV/AIDS infections. If you go to them mentioning things that women are not accessing, you will not be able to relate to them positively…So the language is, let us support our PA, because we have maybe just one assistant chief who is taking care of about 16,000 people, if you look at a [disinheritance] case this side, one is also waiting on the other side…so the Watch Dog Group, we are coming to complement your work as the PA. (Woman, age 28)

With the PA as a strategic partner, WDG members better navigated the complex administrative procedures and adjudication mechanisms on behalf of disinherited women. WDGs also benefited from the PA’s logistical support, including access to office space at local government quarters, as well as community outreach venues:

Our chiefs hold barazas [Kiswahili: community meetings] almost every week or two weeks and we would use these barazas as the platform for WDG members to educate the community [about HIV/AIDS and women’s property rights]. If we want to organize for a bigger forum, we could also use the chief to call the forum, because the community will respond quickly to him more than they would do to us. (Woman, age 53)

Involving Traditional Leaders in Mediating and Preventing Property Rights Violations

Many respondents identified the involvement of traditional leaders, including village elders or opinion leaders, as a key facilitator in implementing the community-based property rights intervention. In the local justice system, traditional leaders presided over informal mechanisms for dispute resolution, where they arbitrated land grievances according to customary law. WDG leaders appealed to traditional leaders as they did provincial administrators, relating the importance of curbing women’s disinheritance to the community priority of HIV prevention. The resulting buy-in was essential to building the WDGs’ caseload as traditional leaders identified and referred women’s property rights violations to the program. Furthermore, traditional leaders enabled WDGs to mediate land disputes within the family and ensure an acceptable resolution for women:

A woman can come and report to the WDG that “I have been chased away”…. the first step we must take is look for the opinion leader in order to know is he aware that this woman has been sent out of the home…. He knows the family very well, he knows how they are, he knows the woman. When we have gone there with the opinion leader, we sit down with the family and collect information, we are there to understand and support them. But they are the ones to say “we agree, we will do this”…. It’s usually good for them to agree and come up with a solution because they live in the same compound, in the same land. (Woman, age 55)

Beyond the short-term impact of restoring women’s access to their marital property, respondents added that the involvement of village elders and opinion leaders in the WDG has helped shift the underlying gender-discriminatory beliefs that prevent women from gaining control and ownership of land and property:

The village elders [were] key to us because as we were intervening, we also realized that we needed to gradually change the negative cultural practices that were exposing women to this kind of dispossession…. We have been able to use these men who are part of this model to start transforming the attitudes of other men within the community. They actually reach out to men in their own social circles. So they are able to speak about these issues…gradually then you also see other men trying to change their cultural practices. (Woman, age 28)

Capitalizing on National Land Tenure Reform to Form a Community Property Rights Program

Many respondents underscored that the broader context of land tenure reform increasingly formalized the need for community-led property rights interventions, and shaped the strategic design of the Watch Dog Model. The ratification of a unified National Land Policy in 2009 followed by the adoption of a new Kenyan constitution in 2010 established an extensive framework for gender equitable land policies and omitted older legal exemptions that permitted gender discriminatory customary practices. For the HIV prevention community, the spirit of land tenure reform culminated in the National AIDS Control Council’s recognition that the insecurity of women’s inheritance rights contributed to the root causes of HIV vulnerability, and that community-based programming would be critical to HIV prevention efforts on the local level (2009).

Despite these landmark reforms, respondents observed that Kenya’s historical fragmentation of land laws continue to confuse stakeholders in the local justice system and contribute to their ongoing mishandling of land disputes:

The old Constitution had, let’s say, the Succession Law, the Land Act, the Titled Act, the Acquisition and Degradation of Land Act, and there was the Government Land Act. The Land Act says the woman cannot have land by herself, and the Titled Deed Act says the woman who is married can own land…There were so many…and people tend not to understand their law, unless we used a lot of time trying to teach the community, to sensitize them of the law. (Woman, age 49)

In this context, the Watch Dog Model was strategically designed to deploy legally informed mediation and arbitration practices by training paralegals, who would then educate and monitor local leaders in their handling of women’s property inheritance and ownership cases. The WDG partnered with existing legal aid groups to train community members in paralegal knowledge and skills:

We worked to build the capacities of the women so they would be able to intervene without fear…help them understand what exactly are these provisions for the rights of women in the Constitution…and we also mainstreamed a number of men within those communities to form paralegals. Some paralegals had been trained by other organizations but did not work…so they organized themselves within WDGs, where we now have the paralegals, the chiefs, traditional leaders, and women leaders to bring all this knowledge together. (Woman, age 34)

This community-based paralegal model was a particularly acceptable alternative for rural women who otherwise lacked access to legal resources and counsel:

Most of the women now feel like they have a place where they can go when they have an issue. They used to fear, but now they have a structure in the community that can speak to them in their own language…other than the big lawyers who just tell you about the law and ask somebody to translate for you. (Woman, age 28)

BARRIERS

Although the Watch Dog Model had been successfully implemented in different regions across Kenya, respondents discussed two main barriers that remain in the way of the program’s long term success, namely: the resource constraints of a voluntary program, and the lack of integration between the formal legal system and the community-led land disputes mediation mechanism.

Resource Constraints of a Voluntary Program

Most respondents agreed that the voluntary basis of the Watch Dog Model can be a significant barrier to implementation. Program founders emphasized the importance of community volunteerism in leading and sustaining a grassroots intervention:

Surely if you look at the Watch Dog Model, it is just a community land mechanism… the women care givers and the paralegals are just people from the community. It’s voluntarism work, not being paid by anybody; it’s you crying for your community, when you see them suffering…. We just came up because we want to change our community for some years to come…even if we die, there will still be changes especially for women and orphans. (Woman, age 55)

However, WDG leaders were concerned about the practical challenges in supporting and retaining volunteers. Especially in the rural context where most WDGs operate, volunteers have little capacity to shoulder the costs implicit in their everyday work. A program leader described various financial burdens that weigh on WDG volunteers:

What is still not working well is that we are rural people and we don’t have anything. We are volunteers; if a case needs money, we sit down and ask ourselves where we will get the money. There are places where we go for several days before a case is resolved. We also offer food to women who have been chased away with their children and don’t have anything to eat. We even get money from our pockets. (Woman, age 63)

Lack of Integration Between Formal and Informal Systems of Justice

Another barrier to the implementation of the Watch Dog Model is the lack of integration between formal legal systems and community-led mechanisms for securing land tenure. Although the new National Land Policy and Constitution encourage the use of informal community systems that attempt to secure women’s land ownership, respondents working within the existing justice systems described how numerous stakeholders have not kept pace with reform:

There is very little awareness of what the informal justice system is all about and how we can be able to contribute towards access to [formal] justice…when you talk to, for example, a lawyer about the informal justice system, they will immediately think of the traditional informal system which is the process of arbitration, reconciliation, and mediation. Right, but, there are other forms, other non-traditional forms of informal justice system…. The WDG model, the paralegal system, is a form of informal justice system. (Woman, age 28)

When advocating for women whose property rights claims require further arbitration in the judicial court, WDG leaders struggled with operating this novel community-led justice mechanism to expedite the lengthy, costly process of securing legal counsel and documentation. They point out lack of integration with the formal justice system as one important reason for this struggle:

We need to have the judges and magistrates on a dialogue table…they are the people we really want…we have most of the legal institutions as our partners but not the judges. And this is why most of our cases now have stuck in court…even as you go there and say you are a member of the WDG, nobody will listen to you, the judge doesn’t even have time to listen to you. (Woman, age 53)

CUMULATIVE EXPERIENCE

Despite barriers to implementing the Watch Dog Model, respondents perceived that the community-led intervention has made significant impact at the intersection of women’s property rights and HIV/AIDS. Our other published work has focused on the impact that this program has had on HIV risk, treatment outcomes, and violence against women (Dworkin et al., 2012). Internal tracking of property and inheritance cases cumulatively handled by the WDG has shown that success of remitting more than half of the women victims to their marital property and inheritance (Grassroots Organization Operating Together in Sisterhood, 2008). WDG leaders noted the impact of the intervention in their region:

Seven or eight years ago we had a lot of problems with disinheritance. But since the Watch Dog started working, this community has seen a lot of changes. We have solved a lot of cases. When you see some people trying to take property, you will hear people telling him, “Leave it alone or you will be [reported] by the WDG.” Women now know and stand for their rights. They have the courage to say something. (Woman, age 63)

Some WDG leaders who have gone on to become provincial administrators in their communities note the same level of impact:

By the time we formed the WDG, we used to have open forums at the shopping centers, at the markets, and we educate the community, not only women…about the proper documents you should be having to get this and that property. Right now, even we have women who own land and have title deeds there; before women used not to have title deeds…And at the same time, we teach them about how to prevent HIV/AIDS, causes of HIV/AIDS, and…we refer them to the necessary health centers. (Woman, age 38)

While no rigorous evaluation has been implemented to determine the impact of this program on HIV risks or treatment outcomes, future academic/CBO collaboration is in process that is focused on assessing these impacts.

DISCUSSION

In order to lay the groundwork for a study that tests land and property rights as an HIV risk reduction mechanism, we sought to understand the development and implementation of an innovative, community-based, integrated women’s property rights and HIV prevention program. Through in-depth interviews with program leaders, we elicited facilitators, barriers, and suggestions for improving the implementation of the Community Land and Property Watch Dog Model. Facilitators included: home-based HIV caregivers as core program leaders; local government support in building program capacity; traditional leaders as key stakeholders in mediating and preventing right violations; and concurrent national land tenure reform supporting a paralegal-led community mediation mechanism. We also identified two implementation barriers: constraints of a volunteer-led intervention in the context of rural poverty, and challenges to case resolution given the lack of integration with actors in the formal justice system.

Little research in the HIV prevention science base to date has involved a rigorous examination of community-led efforts that address the reciprocal impact of HIV/AIDS on women’s property rights and inheritance. Preliminary qualitative data from this study responds to the gaps in structural HIV prevention research and provides an understanding of the barriers and facilitators of implementing an HIV prevention strategy that secures women’s access to and control of land and property. While this is a small qualitative study, we did find consistency with the existing HIV prevention literature that the utilization of community health workers is critical to strengthening prevention efforts in resource-limited settings, and that adequate training and remuneration is necessary to develop their capacity (Jerome & Ivers, 2010). The predominance of women among community health workers in this intervention also attests to the importance of harnessing women’s agencies in innovating HIV prevention in their local contexts (Paradza, 2011). Furthermore, programs that engage traditional leaders in the community may be particularly promising for other sub-Saharan African nations where local land tenure and inheritance practices largely follow customary instead of statutory provisions. Here, village elders and opinion leaders have influence not only on the outcomes of family land disputes in their communities, but also on the customary norms that underlie women’s inequitable access to and control over land and property. Last, this intervention was implemented in a vibrant policy environment that supports innovations targeting women’s property rights and HIV/AIDS vulnerability. While the political support for structural HIV prevention responses is variable across nations, training paralegals to lead an alternative land dispute mediation mechanism on the local level reveals the potential of novel community driven justice mechanisms in poor, rural communities.

Our study has several limitations. First, all of the respondents in our sample were internal to the program of interest, and therefore, response bias is an inherent limitation given their personal investment in the development and implementation of the program being studied. To reduce this response bias, we hired interviewers who were external to the program and utilized a large number of interview probes and follow-up questions to ensure consistency and accuracy in responses. Second, while our sample size of twenty is nearly large enough to allow for data saturation in a qualitative study (Charmaz, 2006), it is not fully representative of all staff and volunteers who have contributed to the implementation of this program. Third, our results are not generalizable to all regions in Kenya that have a high sero-prevalence rate nor to all programs that work at the intersection of property rights and HIV prevention.

Still, as scholars have noted, “innovative [local] interventions have been implemented but have not been shared with a wider audience; there is therefore a need for research and policy to catch up with these experiences on the ground to better understand them, to disseminate the key lessons” (Strickland, 2004). Given the importance but dearth of research in this area, we have elucidated some of the factors and conditions that can assist with designing and implementing similar community-based programs in other regions. We recognize as well that other models are certainly worth exploring, including those aimed at the analysis and reform of law, or promoting the judicial capacity of actors in the formal justice system.

Further research is needed to bolster this type of programming with evidence-based HIV prevention practices and to test the effect of the intervention on individual and community level HIV risk and vulnerability. Ultimately, testing the impact of an integrated property rights and HIV prevention program against our best evidence-based HIV prevention strategies would also help to discern the efficacy of this structural intervention approach relative to other HIV prevention approaches. Building upon the local expertise of CBOs is imperative for designing efforts that meet the 6th Millennium Development Goal of combating HIV and AIDS. Now is the time to translate findings from novel programs such as these into targeted research and policy agendas within HIV prevention.