Economic Empowerment for Enhanced Health Equity: A Qualitative Study of Women Living with HIV in Wakiso District,Uganda

Globally, new HIV infections have been decreasing since approximately 2009 (UNAIDS, 2020). HIV-related deaths have also been decreasing since 2004 thanks to improvements and access to Antiretroviral Therapy (ART) (UNAIDS, 2020). Despite these gains, countries in the Global South have struggled to contain the pandemic, and women have experienced much of the burden. Among women and girls of reproductive age, HIV/AIDS is the leading cause of death globally. According to a 2020 UNAIDS report, women and girls in sub-Saharan Africa are much more likely to be infected with HIV than men, accounting for 59% of new infections in the area. Though some improvement in the HIV/AIDS pandemic effect on women in Uganda has been made, the disease continues to punish women there disproportionately. A study conducted by the Ministry of Health (MOH) found that 7.5% of women in the country are living with HIV compared to 4.3% of men (Uganda Ministry of Health, 2017).

Researchers have noted that gender-related health disparities in HIV outcomes could be related to economic inequality. A study based on the experiences of women living with HIV from 17 countries, found that women had less access to financial resources than men, leading to barriers to their engagement in HIV care. Those barriers include practical difficulties such as getting to clinics to receive treatment, paying for childcare, and paying for medicines. Women in a study published by the International Center for Research on Women (ICRW) frequently cited being fired from their jobs due to discrimination stemming from the stigma of their HIV status, which made it difficult to afford the costs associated with accessing and staying on treatment (Golla et al., 2018).

The intersections of sexual health and gender compound the experience of poverty for women in many parts of the world. In their comparison between HIV and COVID-19 pandemics, Along and Blackstock (2023) have called for health justice to mitigate these effects on the most vulnerable. They explain that systems of oppression like racism and homophobia cause inequities in health, and that the solution is to redistribute power and resources to the most affected to improve health outcomes. Those resources can include financial security, political power, and access to care. The oppression experienced by women living with HIV requires a health justice approach if health equity is to be achieved.

In addition to HIV stigma and health disparities, women in Sub-Saharan Africa face unique economic hardships. Many women provide home-based care for low wages, reducing their earning capacity and placing unrealistic demands on their resources, thereby increasing their economic vulnerability. Due to gender role stratification frequent in these patriarchal communities, women are often responsible for family food and housing budgets, but typically have limited time to work or may receive low wages leading to them to depend on men for Kameeza-a traditional maintenance/allowance fee from a husband. Kim and others (2007) refer to the HIV pandemic as a disease of inequality often associated with economic and gender disparities that negatively impact health including HIV and Interpersonal Violence (IPV) risk. Given their economic and social vulnerabilities, the women living with HIV in Sub-Saharan Africa are significantly overstressed (Tanzarn & Bishop-Sambrook, 2003).

HIV disproportionately affects women across the global South due to their vulnerability stemming from their unequal cultural, social, and economic status. Inequitable laws, harmful traditional practices and unequal power dynamics between men and women disadvantage women (UNAIDS, 2017). The HIV pandemic is not only driven by gender inequality, but is also entrenched in economic inequality, leaving women more vulnerable to its impacts (UNAIDS, 2020). Ugandan societies are patriarchal, which limits the ability of women to be in control of decisions related to the physical and financial resources of the family. For instance, in Uganda, women need the consent of a male partner to access sexual health and reproductive services, positioning them to be less in control of their sexual health decision making (UNAIDS, 2019), and the resulting outcomes. In addition, they experience many types of interconnected social and economic barriers such as accessing funds for transportation to clinics, high-cost childcare and education fees and unpaid labor demands. In a study that examined data from the 2016 Uganda Demographic Health Survey, researchers found that socio-economic and cultural factors led to malnourishment in women of reproductive age in Uganda citing poverty and regional inequalities as determinants of poor health (Sserwanja et al., 2020).

The property rights of women are a barrier that affects their socio-economic status and consequently their health and wellness. Although women have statutory legal rights to own property due to changes in the Uganda National Land Policy outlawing discrimination, the customary laws of Uganda can supersede statutory laws, making this difficult to enforce (IGAD, 2021). The result is that despite having official rights to own land, women in Uganda have been reported to own only approximately 7% of the land. This is a stark contrast to the labor that women contribute to the food supply in the county, which is estimated to be 80%. The ownership vs labor share discrepancy is due to customary laws and marriage practices that make it unlikely for women in Uganda to inherit land from a spouse. The practice of polygamy and couples commonly engaging in domestic partnerships rather than formal marriages recognized by the government are contributing factors to land ownership inequality. According to the Uganda Association of Women Lawyers, women can only inherit 15% of land upon the death of a spouse or father, and in the case of plural marriages, all the wives share that 15%. Those in domestic partnerships (not marriage recognized by the Uganda government) cannot inherit land upon the death of a spouse (IGAD, 2021).

One area of Uganda that has been heavily impacted by the HIV pandemic is the Wakiso district. According to a 2017 population and housing census report, Wakiso district had a total number of 2,128,142 households of which 40% were female-headed (UBOS, 2018). The ability of those affected by HIV to provide for their families’ needs was limited by their physical and social capacity to meet them (Namara-Wamanga et al., 2013). The district has one of the highest prevalence rates of HIV in Uganda (9.9%) compared to the regional prevalence of 8.5% (Uganda Ministry of Health, 2017). The higher prevalence is attributed to the peri-urban nature of the district, where the environmental and behavioral factors increase vulnerability of individuals to high-risk sexual health practices (Namara-Wamanga et al., 2013). Some environmental factors that increase sexual health risk include the lacking or inadequate infrastructure that makes accessing healthcare facilities difficult. The growing community suffers from poor road and bridge conditions, lack of clean water sources, and deferred maintenance in healthcare facilities. Shortages in healthcare staff and essential medications also act as barriers to adequate healthcare including difficulty accessing HIV medications. Medically supervised births in facilities are rare even when medically necessary. The child death and infant mortality rates are above the national average at 94/1000 vs 76/1000 respectively (Namara-Wamanga et al., 2013). To put this rate in perspective, the Centers for Disease Control and Prevention reports the U.S. infant mortality rate in 2020 was 5.4/1000 (CDC, 2023).

Factors that affect women's HIV health and overall wellness outcomes are often related to behavioral practices routed in patriarchal beliefs about property and finances. In Wakiso, women who become heads of households upon the death of their spouses, on whom they have traditionally been forced to depend, are also in danger of losing ownership of their land and assets when a male partner dies of AIDS. The Uganda Bureau of Statistics explains that a deceased spouse's family members can use patriarchal cultural beliefs and laws that allow male relatives to strip widows of their financial assets, rendering them more vulnerable to economic hardship and HIV wellness barriers (UBOS, 2018).

The dynamics of the local fishing communities in the area have contributed to high HIV risk due to the seasonal nature of the work. The risk factors include commercial sex trade and inadequate access to sexual and reproductive healthcare facilities specializing in preventing and treating HIV due to the distance between treatment sites and commercial fishing areas (Kwagonza et al., 2020). In a survey about comprehensive knowledge of HIV prevention, fishermen in rural areas that were isolated from healthcare facilities reported lower rates of knowledge. This lower knowledge contributes to higher risk behaviors that make women partners and sex workers more vulnerable to being infected and undertreated for HIV (Kwagonza et al., 2020).

Studies show that women living with HIV tend to be vulnerable to poverty and lack the economic access needed to sustain their livelihoods (Kabeer, 2012 & Najjuma, 2015). Evidence suggests that economic empowerment strategies may contribute to some improvements in the wellbeing of women (Dworkin & Blankeship, 2009; Krenz, Gilbert & Mandayam, 2014). The resources, assets, skills, and social connections forged out of economic empowerment interventions can help to improve resilience – the ability to recover from the effects of HIV (Loevinsohn & Gillespie, 2003), and improve wellbeing. While there is much literature on the connection between HIV and economics, the existing research is largely limited to examining microcredit through external interventions. External interventions include things like grants and funding paid to recipients or agencies that do not include internal participation in planning and organization with recipients/participants. Some have criticized the concept of economic empowerment as a means of supporting economic growth through capitalist endeavors that both ignore the socio-political context of women in poverty and benefit them in limited ways (Schech & Vas Dev, 2007). This external focus limits opportunities for inclusion from those who will understand how to best benefit from the programs and funding – the women themselves (Barnes et al., 2003; Beck, 2017; Goetz & Gupta, 1996; Kabeer et al., 2012; Longuet et al., 2009; Neumayer & Soysa, 2010). Little research has concentrated on the economic empowerment of women living with HIV themselves as agents of change. Hence, a deeper understanding is needed about the role that economic strategies among women living with HIV may play as part of the solution to HIV health disparities in Uganda.

Conceptual Framework

This phenomenological study of participants’ experiences in savings and loaning groups for women living with HIV draws inspiration from an economic empowerment framework. Feminists advocate for gender equality, and economic empowerment has been described as a “direct path towards gender equality, poverty eradication and inclusive growth” for women in Southern African regions (UNWomen, 2022). The World Bank has been concerned with ending poverty through economic empowerment programs for vulnerable women but has been limited to capitalist viewpoints that focus on market access only with little regard for addressing the inequalities of women or the freedom of their occupational choices (Schech & Vas Dev, 2007). Some factors affecting women's economic inequality in Uganda include gendered care and domestic labor norms resulting in women's unpaid labor. Farm labor is a topic of interest in economic development for women because farm labor has been traditionally considered part of domestic labor in the region. Domestic labor though largely unpaid has contributed to the economy for the predominant benefit of the male relatives of women, resulting in income and wealth inequality. Economic empowerment initiatives focus on changing both the cultural norms and policies relating to labor practices to improve the economic well-being of women through educational and financial interventions.

There are a variety of ways in which gender inequality affects women living with HIV in Uganda specifically, and they include denial of inheritance and property rights, social exclusion, stigma, shame, economic inequality, unemployment, and underemployment (Najjuma, 2015). However, economic and health risks can be mitigated to improve HIV risk and health outcomes for women in the context of economic distress and scarcity. Economic empowerment programs improve the lives of women by encouraging them to improve their financial and consequently their social status (Jennings, Ssewamala & Nabunya, 2016).

Women's economic empowerment can be defined as “the ability to succeed and advance economically and the power to make and act on economic decisions” (Golla et al., 2018, p. 4). The gender-related aspects of economic empowerment stem from patriarchal beliefs about women's place in the broader community and therefore the market. Their visibility in the community and in financial transactions are directly tied their personal and economic power affecting their ability to make decisions about money or participate in business transactions. Kabeer (1999) further defines economic empowerment as the ability to make strategic choices where that ability did not previously exist. They suggest that resources and agency, in addition to achievements, are the outcomes of the empowerment process. Kabeer (1999) further asserts that economic empowerment is the process by which those who have been denied the ability to make strategic life choices acquire such ability. It is a process that entails not only what people do with the acquired ability, but also how they make choices to influence or enhance their own lives and those of others as well as how one can tell when this ability has been acquired. Others have defined economic empowerment as the ability to make and act on decisions that involve the control over and allocation of financial resources (Golla et al., 2018; Zoynul & Fahmida, 2013). The foundation of creating a life with opportunities includes the ability to freely choose one's path in life in accordance with one's distinctive talents and abilities.

The notion of agency is essential in the empowerment process. The term ‘agent’ is employed in this study to denote someone who acts and brings about change. We agree with Sen that a person can improve her overall wellbeing through her personal capabilities and vision but only within the context of her environmental restrictions. The opposite of a person with agency is someone who is forced, oppressed, or passive (Sen, 1999). This agency, in the context of the removal of oppression and restriction, can expand the horizons of concern beyond a person's own well-being to include concerns such as solidarity with others in mutual saving through a collective mindset.

According to policy research funded by the World Bank Group, agency is the capacity to make decisions about one's own life and act on them to achieve a desirable outcome, free of violence, retribution, or fear (Fox & Romero, 2017). This promotes gender equality (Sen, 2005) in all economic domains and interactions, and encourages participation in other forms of collective action (Fox & Romero, 2017). Collective agency thus emphasizes that individuals are seen as agents in the construction of social change to improve their wellbeing and the wellbeing of others. This is a departure from an individual, narrow perspective, which had limited women's empowerment to influence over household expenditures only (Fox & Romero, 2017). While the spaces for agency vary, economic empowerment envisages women's voices and participation in processes that improve livelihoods and mitigate adverse effects of gender-based economic inequality, including poor health outcomes for women living with HIV and their communities.

Women living with HIV who are economically empowered can increase resilience and position their agency to enhance their well-being and manage adversities caused by the disease. Access to financial resources is critical for creating a strong base of social and economic resiliency and contributes to enhanced quality of life (Negash, 2006). The resources resulting from economic empowerment efforts may help to improve the resilience of women living with HIV to improve their health status by reducing their dependence on male relatives to access healthcare services. Those resources include ownership of land, equipment, livestock, and other business assets as well as access to services like childcare, transportation and education for themselves and their children. Women with the means to conduct and profit from business enterprises are freer to attend to their preventative sexual and reproductive health (preventing pregnancies, promoting safe childbirth, preventing HIV and other sexually transmitted diseases) by accessing clinic visits, but also by avoiding sex work as a means of economic stability.

Economic empowerment has been applied to social work interventions aimed at improving the well-being of women in previous studies. A study conducted in Western Australia utilized financial literacy education as a means of empowering domestic and family violence victims in a refugee camp and found that the physical health symptoms related to financial worry of the women were improved (Warren et al., 2019). In a longitudinal study of an economic empowerment intervention for adolescents in Uganda, researchers noted improvements in ART update, financial status, and school enrolment as a result of mentorship, business education and savings matching.

Economic distress and scarcity faced by women living with HIV are overarching factors that make them vulnerable to stress and trauma. Economic empowerment promotes an adaptive response among women living with HIV to survive as well as thrive after diagnosis. An economic empowerment framework addresses the unique financial issues faced by women living with HIV in Uganda by increasing their financial capacity and therefore reducing gender-based oppression steeped in patriarchal power imbalances. The notion that thriving with a disease that is associated with stigma and health disparities could be accomplished through financial rather than purely psychological means inspired us to explore the experiences of how participation in community saving and loaning groups affected women participants in Uganda. Our specific research question was “What are the experiences of women living with HIV who participated in economic empowerment groups?”

Methods

This study was carried out between 2018 and 2020 in the Wakiso district of Uganda. We employed a phenomenological approach including focus groups, individual participant interviews, key informant interviews and field observations (Creswell, 2007). Our goal was to describe the experiences of women who were engaged in economic empowerment activities aimed at mitigating the financial effects of living with HIV. The choice of Wakiso was strategically based on its geographic positioning. Specifically, it triples as an urban, peri-urban and rural location, which allowed the researchers to report findings from these three different types of settings. Wakiso district health office trains Village Health Teams and community social workers to engage people living with HIV to improve care access and provide HIV health information (Namara-Wamanga et al., 2013).

Findings

The findings of this study describe the experiences of women living with HIV who were engaged in economic empowerment groups. We present themes, listed in Table 1, which are enriched with direct quotes from the participants and field photos. These themes illustrate the experiences of participating in economic empowerment groups. They center around social inclusion, financial literacy, HIV health resiliency, stigma reduction, and gender justice. Considering the challenges of patriarchy and living with HIV, the participants faced adversities such as stigma, fear, gender inequality, shame, and hopelessness, (Najjuma, 2015). Those adversities are difficult to overcome in the context of economic scarcity. However, the women described how they improved their economic positions to mitigate the adverse effects of living with HIV. This reflects the resilience and agency among the women whose voices are represented by these findings.

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Table 1.

The Experiences in Saving and Loaning Groups for Women Living with HIV in Uganda.

Themes	Quotes
Economic Empowerment among Women Living with HIV was Accomplished through Mutual Saving and Loaning Groups	“…I mobilized colleagues with whom we collected…I started with very little money…which multiplied.”
The Economic Empowerment Groups helped to Bridge Social Networks and Improve Social Inclusion among the Women	“We generate cards every year for people to contribute…we organize… that makes everyone happy.”
Mentorship in Financial Literacy was Beneficial to Group Members	“Getting better markets for the sale of their products has broadened women's income.”
Group Participation Fostered Emotional and HIV Health Resilience for Women Living with HIV	“We are not sick. The virus is sleeping.
Reduction of Stigma Resulting from Improved Financial Status	“We are now community leaders. We ignored the fear of being marked HIV positive and we participate directly in leadership.”
Property Rights and Property Improvements Resulting from Participation in the Economic Empowerment Groups	“…I did not know that even an HIV positive woman can own property…”
Gender Justice was Sought by the Women who Participated in the Economic Empowerment Groups	“We are no longer dreaming of ‘kameeza’…we make our own money.”

Economic Empowerment among Women Living with HIV Was Accomplished Through Mutual Saving and Loaning Groups

The women who participated in the study described navigating the economic constraints of living with HIV by mobilizing financial resources through mutual saving and loaning groups with other women. They described organizing themselves into groups to increase mutual savings with the opportunity to borrow from the group as needed. They paid a membership fee to join the group, which formed the initial source of capital. The members established their own rules for borrowing and received assistance in financial planning and HIV management from social workers and community health workers. The members continued to contribute to the group funds until an agreed upon date when they were shared between members. They invested in businesses, education, and property to improve their wellbeing. Women got small loans from their groups in the form of capital illustrated by a photo of a bag of money, which they could use to personally invest in their small businesses and agricultural resources to gain financial independence. (Figure 1: Savings Bags) In a focus group discussion about improving HIV outcomes and overcoming barriers to accessing care, one woman indicated; “We talk about HIV impacts on our homes, and we also get the solution by generating the money in the group.” Another woman shared her experiences of saving and loaning indicating “the financial burden had been heavy…medical related expenses sunk the family budget…I mobilized colleagues with whom we collected…I started with very little money…which multiplied.”

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Figure 1.

Social fund and savings bags used by participants.

General savings and loaning rules were established by each group collectively and are described by some of the women who participated in the groups, including savings requirements, and vetting of loan applicants. Some women also described specific funds. “In addition, they save for social fund commonly known to them as ‘Munno mukabi’…It is only accessed upon a member presenting a challenge to a group, such as, when a member loses a child, mother, father, or spouse.” Some of the special funds were used for education of children, including this description: “Also for Education fund – Members who pay fees for their children can save money and borrow for education purposes.”

The women in the study appreciated the absence of a requirement of collateral to access the loans, which enabled them to have quick access to funds saved by other group members. One participant commented: “We borrow the money from the group, depending on the need of each individual. We do not pay a lot of interest when we return the money.”

Mentorship in Financial Literacy Was Beneficial to Group Members

Social workers from non-profit and government agencies sometimes took on roles to educate the women in the savings and loaning groups around financial literacy. They trained the women in financial skills that allowed them to make informed decisions about managing finances, saving, budgeting, and investing the resources they mobilized. The women who participated in the groups reported that such training was crucial. “When we generate the money, we also discuss what businesses we are able to do.” The on-site training provided by social workers included social skills, business management, investment, counting, banking, budgeting, and documentation skills. The women were also trained in posting income, profits, and losses and defining terms of individual ‘shares’ of group assets. Participants in focus groups reported that after such training, some external agencies also provided useful financial materials. “They supported us with a metal safety box, blue counter books for recording, pens, rulers, padlocks, ledger books, stamps and inkpads.” (Figure 2: Safety Box).

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Figure 2.

Safety box used by saving and loaning groups.

Some participants established workspaces near their homes to start small businesses, which was convenient for them. (Figure 3: Village Market). One woman proudly stated, “We are able to decide on what, where, how, and when to start a business.” After the women had acquired financial assets, social workers guided them to choose viable businesses, based on their location, and facilitated their ongoing training in businesses development. One of the community counselor key informants described the process:

We introduce to the women business selection, planning, and management skills, and let them understand the process of business startup, management, and monitoring. We analyze the environment where women would want to establish their businesses. Some of the factors to consider are availability of market, transport accessibility, nature of customers and government policies relating to taxation of business, among others. They can identify which ventures they can consider in starting up a business.

Women valued these skills and supplies, which gave them the confidence to continue to save small amounts of money and sustained their aim of investing in their businesses. One woman described that she had developed multiple skills in knitting baskets (Figure 4: Crafts Marketed by Women) and she subsequently trained others, which sustained her income. Those involved in knitting noted that:

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Figure 3.

Village market in front of a participant's homestead.

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Figure 4.

Crafts made by participants to sell to foreign markets.

We have better markets for the products and more income from baskets, because those who train us in craft and knitting work linked us to foreign ‘white markets’ where we have been able to earn better from our sales compared to local markets.

The link to external markets in the U.S. and Europe was another opportunity accessed by the participants, as emphasized by a key informant who stated, “Getting better markets for the sale of their products has broadened women's income.”

Discussion

This study aimed to provide a rich and descriptive understanding of the experiences of women in the Wakiso district of Uganda who are living with HIV and participating in economic empowerment programs with social workers and other health care workers. To describe their experiences, a qualitative study was conducted utilizing interviews and field observations. Participants’ positive experiences including improved financial independence, social inclusion and HIV health improvements resulting from the economic empowerment processes were described in the findings. The findings were illustrated with direct quotes and images that illustrated the economic empowerment and savings and loaning group participation of the women living with HIV in the study.

These findings are similar to previous studies outlining the efforts of social workers and other community organizations focused on the economic empowerment of women (Beck, 2017; Dworkin & Blankeship, 2009; Jennings et al., 2016). The experience of social, financial and household equality was notably similar to previous studies of economic empowerment groups for women in the Global South, as discussed in a qualitative article about a microfinance intervention in India (Krenz, Gilbert & Mandayam, 2014; Warren et al., 2019). In an article exploring projects aimed at empowering women to improve wellbeing, Beck (2017) suggested we adjust our understanding of women's agency to include the agency women exercise when they engage in empowerment projects themselves.

This article provides new insights into the nature of women-led groups that expand on the agency of members by capitalizing on their unique interests, social connections, and desire to support one another in their communities. This expands on the practice of providing microfinance loans without educational or collaborative components. This matters because gender-based economic oppression thrives on restricting financial power and control of women to maintain the patriarchal status quo. It is necessary to reposition that power in the hands and pockets of women to improve gender equality and subsequent HIV health outcomes for women in vulnerable communities.

The study examined the effect of an economic empowerment intervention conducted by social workers collaboratively with women living with HIV who were struggling economically. The empowerment groups provided training, counseling, financial literacy education, financial assistance and exposure to resources and opportunities that allowed them to earn a decent income, while maintaining control over their choice of work. The freedom of choice and control over work choices has been highlighted as an important aspect of economic empowerment interventions since the World Bank called for them as a means of combatting poverty in the Global South. Some neoliberal models of economic empowerment entice vulnerable women into capitalist traps involving predatory bank loans or low-wage jobs that ultimately benefit multinational corporations (Power, 2020). This was a more collaborative approach where social workers provided support to the women in their own businesses, and also partnered with other social work organizations and extension workers to provide support services to achieve economic stability. This allowed the women to earn a fair income and remove the barriers they faced from the stigma of living with HIV.

In a state of economic scarcity, the women in this study faced a myriad of disadvantages while living with HIV including stigma, hopelessness, limited access to credit, and patriarchal limitations on property and asset ownership. Despite these challenges, they embraced economic empowerment with impressive levels of engagement as a means to overcome the economic, social, and health effects of living with HIV. The participants engaged in saving and loaning in their communities to improve their personal, familial and community financial and social status. They bridged social networks with the support of social workers and other community health workers, who also mentored them in financial literacy, fostered social connections and addressed their health needs (Najjuma, 2016). The groups served to create economic initiatives, foster new projects, and supported their goals of investing in businesses to support themselves and their families. The connection to external valuable markets also boosted women's income. The women in this study leveraged their agency (Sen, 1999), and by improving their economic wellbeing, they increased their individual freedom to make decisions related to the HIV health outcomes.

Researchers have argued that the empowerment process is enhanced by supportive services, including financial education, training, and social support services (Kabeer, Mahmud & Castro, 2012). In our study, savings and loaning groups helped build connections and increased women's capacity to fight HIV at the individual, family, and community levels. The women who participated reported their collective efforts to empower themselves economically as a means of managing adversities due to living with HIV. The efforts made by the women and their social work collaborators can be considered a form of health justice as it reduced the problem of poverty caused by intersecting systems of oppression (sexism, HIV stigma) by redistributing resources including wealth and social status (Along & Blackstock, 2023).

Despite experiencing stigma in their communities, study participants highlighted the importance of seeing themselves as learning to manage a chronic illness rather than identifying as sick. They were highly motivated to participate in economic empowerment because they desired financial independence and the ability to care for their own health and the well-being of family and community members. The increased economic power among the women gave them the confidence to also improve their social status and inclusion. This expanded to election into leadership positions, invitations as motivational speakers, and as chief guests at social events as a result of their improved standing in the community. According to Sen (2005) when wellbeing is enhanced, women can be dynamic promoters of social transformation in their communities.

Findings from this study revealed that despite the economic hardships they experienced, women living with HIV benefited from acquiring financial independence and in turn supported other women's economic empowerment. They used economic empowerment as means of increasing equality, such as acquiring, allocating, and selling assets and improving property and education access (Negash, 2006). Their collective efforts led to success that traditionally had been recognized as male-only domains in their culture.

The women in the study played powerful roles in both the household and the community by exercising their agency to counter the patriarchal hierarchies and gender inequality that women living with HIV in Uganda often face. Poverty and denial of women's inheritance and property rights are major obstacles to victory over the virus of HIV, and the path around these obstacles seems to have been made easier by economic empowerment programs.

Enhanced economic empowerment is a prime factor in reducing gender inequality and central to realizing the rights of women, particularly regarding property ownership (Duflo, 2012; Kabeer, 2012). The positive effects of property ownership for women were evident in the findings of the current study, as in previous studies in developing countries. Enhancing women's economic resources not only contributes to their economic power, but also may reduce male violence against them (UNAIDS, 2021). In their scoping review of 14 countries, Leddy, Weiss & Yam (2019) found that Gender Based Violence impeded women's uptake of HIV prevention and therapeutics, making them more vulnerable to the disease than men. This highlights the importance of supportive and empowering services for women who are vulnerable to HIV by social workers and other community health workers. To know whether economic empowerment services offered by social workers are effective at protecting women from these intersections of vulnerability, we recommend that a quantitative intervention study be conducted as a follow-up to these findings. It will be important for future studies to flesh out whether it is most beneficial to encourage women to seek economic equality through private business ventures within a capitalist framework or if unintended consequences of competition and scarcity will ultimately reduce the gains in gender-based economic equality over time.

Conclusion

The women who participated in this study utilized the tools of economic empowerment to help them overcome adversities due to HIV by utilizing their inherent and collective strengths. While economic empowerment may not guarantee enhanced livelihoods, especially in the face of patriarchy, it was still a vital component of the fight against HIV in the study communities.

This research contributes to the literature by providing a detailed account of women's voices and experiences of economic empowerment, with the potential to inform social workers developing innovative curriculums for economic empowerment, and promoting collaborations with communities that can be generated out of practical women's experiences.

This study centers the power of decision making about the nature of the economic empowerment intervention and desired outcomes with the women themselves. HIV research in Social Work tends to highlight interventions that ignore the economic needs of women that are the result of deeply engrained social inequities. When women are economically oppressed and dependent on the men who infected them with HIV, a solution that reduces poverty in a manner that recenters power is essential. These findings demonstrate that women can gain financial security despite financial distress and oppressive social climates and can contribute to strengthening their communities and sustainable development. Social workers in communities where HIV has caused extreme hardships for women may want to consider augmenting the typical HIV health and social interventions with economic empowerment programs aimed at improving the status of women. More study is needed to determine if the positive feedback from women in Uganda translates to other areas of the world that are similarly affected by the HIV pandemic.