The Social Context of HIV: The Addressing the Balance of Burden in AIDS (ABBA) Project

ABBA examined the social context of prevention, treatment, and care, and the effects of HIV and AIDS on vulnerable populations throughout sub-Saharan Africa.

The Issue

Despite decades of investment in HIV prevention, socially vulnerable populations in Africa remain underserved, including people living with HIV and AIDS, orphans and vulnerable children, adolescents, persons with disabilities, and health workers. Members of these groups often cannot access services because of physical, socioeconomic, and cultural barriers. In many cases, existing interventions are inadequate.

The Addressing the Balance of Burden in AIDS (ABBA) research consortium was established to improve health, education, livelihood opportunities, and quality of life among these vulnerable populations. From 2006 to 2012, the six partners in the consortium examined the social, economic, and institutional factors that increase people’s vulnerability to HIV in Ethiopia, Ghana, Kenya, Lesotho, Malawi, South Africa, Swaziland, and Uganda. The Population Council was the lead organization for research and management from 2009 to 2012.

The Progress

Members of the ABBA consortium conducted more than 20 studies focusing on vulnerable populations that:

  • Identified the vulnerabilities of orphans and other vulnerable children, persons with disabilities, and adolescent girls, highlighting the need for specific HIV and AIDS programs for these groups.
  • Built the capacity of service providers, local program managers, educators, students, and civil society and research partners to conduct research, communicate research results, and address the needs of vulnerable populations.
  • Produced new evidence on the influence of social, economic, and institutional factors on HIV risk to inform programs and policies for vulnerable populations.

To ensure that the consortium’s research agenda remained relevant, key government and civil society stakeholders were engaged as partners throughout the project. These stakeholders helped determine the research agenda, identified appropriate channels for communicating progress and results, and aided in the formulation of new policy recommendations.

The Impact

ABBA research results have informed programs in health, education, and other sectors throughout sub-Saharan Africa. Notable results include:

  • A disability review tool developed to analyze the national strategic plans of 18 countries and assess the degree to which persons with disabilities were included in the HIV and AIDS responses. Results from the analysis influenced new national strategic plans in Kenya, Zambia, and Zimbabwe.
  • In KwaZulu-Natal, South Africa, researchers found that providing social, health, and financial skills to adolescents reduced HIV risk behaviors and increased their financial and social inclusion. This approach is being considered for implementation by the KwaZulu-Natal Department of Education and the National Community Works Programme.
  • In Malawi, research exploring the challenges health workers face in accessing HIV services, and the psychological and health burdens resulting from the fear of contracting HIV in their daily work, motivated the Ministry of Health to expand a “care of carers” policy. It also developed a government-sponsored program to improve health care workers’ access to services for HIV testing, treatment, and care and support.
  • In South Africa and Swaziland, research investigating the likely health impacts and stakeholder support for a “Zero Infection Month”—encouraging a month of sexual abstinence among all citizens—indicated high interest in the idea. Swaziland is considering experimenting with this approach in public health campaigns.

Results from ABBA have been disseminated widely and continue to influence policy and service delivery throughout sub-Saharan Africa.

Principal Investigator

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