Marginalization and community perception of HIV care, treatment, and support on Mfangano Island, Kenya

Annie Chang, Kathryn J. Fiorella, Matthew D. Hickey, Chas Salmen, Elizabeth A. Bukusi, Craig R. Cohen, Colette L. Auerswald

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: In rural sub-Saharan Africa (SSA), the human immunodeficiency virus (HIV)/AIDS pandemic has exerted effects on nearly every aspect of life. Yet despite the pan-demic’s near ubiquitous impacts, major barriers to HIV care, treatment, and support persist. Compounding the barriers to care is the incredible complexity and diversity of experience across different sociocultural contexts. Objectives: This exploratory community-based participatory study aimed to generate an explanatory model about how geographic and socioeconomic marginalization shape community perception of HIV care, treatment, and support among rural communities of Mfangano Island, Kenya. Methods: Twelve focus groups with a total of 105 participants were conducted as a part of a mixed-methods cross-sectional health study. Results: Study findings are organized within an ecological framework with the following themes: readiness at the individual level, social capital at the household level, and collective efficacy at the community level. Potential solutions were also described within this framework; enabling encouragement at the individual level, enhancing productivity at the household level, and addressing underlying socioeconomic inequities at the community level. Conclusions: HIV-related consequences at the individual, household, and community levels have adversely affected how Mfangano communities respond to the HIV/AIDS epidemic. Community-based strategies are needed to address interrelated inequities at multiple levels. Changing community perception may overcome HIV stigma to enable individual readiness to seek care. Access to care and treatment enhances productivity and hence social capital in HIV-affected households. Addressing socioeconomic inequities at the community level increases access to social and instrumental support and, thus, may decrease risk and vulnerability for HIV/AIDS.

Original languageEnglish (US)
Pages (from-to)121-133
Number of pages13
JournalProgress in Community Health Partnerships: Research, Education, and Action
Issue number2
StatePublished - Jun 1 2018

Bibliographical note

Publisher Copyright:
© 2018 Johns Hopkins University Press.


  • Africa
  • Community health partnerships
  • Community health research
  • Community-based participatory research (CBPR)
  • Health disparities
  • Health promotion
  • Hiv/aids
  • Poverty
  • Rural health
  • Rural population


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