Researchers in Malawi tested a program that taught couples living with HIV how to save money and strengthen their relationships. The program included setting up savings accounts and classes about managing finances and improving communication. After 15 months, couples who participated in the program were significantly less likely to experience severe food shortages compared to those who received standard care. This suggests that helping people build financial skills and stronger relationships may be an effective way to reduce hunger among people living with HIV in Africa.

The Quick Take

  • What they studied: Whether a program teaching money management and relationship skills could help reduce severe hunger in couples where both partners have HIV
  • Who participated: 78 couples (156 people total) living with HIV in Malawi, average age 43 years, mostly with primary school education, married for about 14 years on average, and many struggling with both alcohol use and food insecurity
  • Key finding: Couples who completed the money management and relationship program had a 19% lower chance of experiencing severe food shortages 15 months later compared to couples receiving standard care
  • What it means for you: If you or someone you know is living with HIV and struggling to afford food, programs that teach financial skills and strengthen family relationships may help. However, this was a small study, so larger research is needed to confirm these results work broadly.

The Research Details

This was a randomized controlled trial, which is considered one of the strongest types of research. Researchers randomly divided 78 couples into two groups: one group received the Mlambe intervention (a 10-month program with savings accounts, financial training, and relationship counseling), while the other group received standard HIV care. Both groups were measured at the start, after 10 months, and after 15 months to see how much their food security improved.

The researchers used a specific tool called the Household Food Insecurity Access Scale to measure how much food insecurity each couple experienced. This tool asks questions about whether people had enough food to eat and categorizes them into four levels: food secure, mildly food insecure, moderately food insecure, and severely food insecure.

The study took place in three different settings in Malawi: an urban hospital, a rural community, and a health center in between urban and rural areas. This helped researchers see if the program worked in different types of communities.

This research approach is important because it compares two groups directly, which helps prove that the program itself (not other factors) caused the improvement. By randomly assigning couples to groups, researchers reduced the chance that differences between groups would affect the results. The fact that they measured people multiple times over 15 months also shows whether benefits lasted or appeared over time.

This study has some strengths: it used random assignment, measured outcomes multiple times, and was published in a peer-reviewed journal. However, it’s a pilot study with a relatively small number of participants (78 couples), which means results should be viewed as promising but not definitive. The researchers themselves note that a larger, full-scale study is needed to confirm these findings. The study also focused specifically on couples with unhealthy alcohol use, so results may not apply to all people living with HIV.

What the Results Show

At the 15-month follow-up, couples in the Mlambe intervention program had significantly lower rates of severe food insecurity compared to the control group. Specifically, the intervention group had a 19% lower odds of experiencing severe food insecurity (the statistical measure was OR = 0.81). This means the program appeared to help people avoid the most severe forms of hunger.

Interestingly, at the 10-month mark (right after the intervention ended), there was no significant difference between the two groups. This suggests that the benefits of the program took time to develop—perhaps because it took several months for couples to build up savings and see the financial benefits of their improved money management skills.

At baseline, more than half of all participants (57.1%) were experiencing severe food insecurity, showing how serious the hunger problem was in this population. The fact that the intervention reduced this is meaningful for people living with HIV who face both health challenges and economic hardship.

The study found that 91.6% of participants were HIV-positive, and 53.3% reported unhealthy alcohol use at baseline. These high rates show that the program was reaching people facing multiple challenges. The program’s focus on both economic empowerment and relationship strengthening appears to have addressed interconnected problems—financial stress often damages relationships, and strong relationships can support better financial decisions.

Limited research has examined whether economic empowerment programs specifically help reduce food insecurity among people living with HIV in sub-Saharan Africa. This study fills an important gap by showing that integrated programs addressing both money and relationships may be more effective than programs focusing on just one area. The findings align with broader research suggesting that poverty and food insecurity are major barriers to HIV treatment success.

This was a relatively small pilot study with only 78 couples, which limits how much we can generalize the findings. The study only included couples in Malawi, so results may not apply to other countries or regions. The program was specifically designed for couples with unhealthy alcohol use, so it’s unclear if it would work the same way for other groups of people living with HIV. Additionally, the study didn’t measure some other important outcomes like medication adherence or health improvements. Finally, researchers note that a larger, full-scale study is needed to confirm these promising initial results.

The Bottom Line

Based on this research, economic empowerment programs that combine financial literacy training, savings support, and relationship strengthening show promise for reducing severe food insecurity among couples living with HIV (moderate confidence level—this is a small pilot study). The program appears most relevant for couples dealing with both HIV and alcohol-related challenges. Benefits appear to develop over time rather than immediately, so commitment to the full program is important.

This research is most relevant to: couples living with HIV who struggle with food insecurity, public health organizations in sub-Saharan Africa designing HIV support programs, and policymakers considering how to address interconnected health and economic challenges. People living with HIV in other regions may find the approach helpful, though results may differ. This is less directly applicable to individuals without HIV or those not experiencing food insecurity.

Based on this study, benefits took 15 months to become clearly visible, with no significant improvements at the 10-month mark. This suggests that people should expect to participate in such a program for at least several months before seeing major changes in food security. Building savings and changing financial habits takes time.

Want to Apply This Research?

  • Track weekly food security by logging: (1) number of days with adequate meals, (2) instances of skipping meals due to lack of money, and (3) household savings balance. This creates a simple weekly scorecard showing progress over months.
  • Users could set a specific savings goal (even small amounts like $2-5 weekly), log deposits when made, and receive reminders about financial literacy lessons. The app could also prompt couples to complete one relationship-strengthening activity weekly (like a 10-minute conversation about finances or goals).
  • Create a 15-month tracking dashboard showing: cumulative savings growth, food security trend line, and relationship check-in completion rate. Monthly summaries would help users see long-term progress, since benefits may not appear immediately but should accumulate over time.

This research describes a pilot study with a small number of participants in Malawi and should not be considered definitive medical or nutritional advice. If you are living with HIV and experiencing food insecurity, please consult with your healthcare provider, social worker, or local HIV support organization about programs and resources available in your area. The findings suggest that integrated economic and relationship programs may help, but individual results will vary. This information is for educational purposes and does not replace professional medical or financial counseling.