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Introduction: Plasmablastic lymphoma (PBL) is an uncommon and aggressive large B-cell lymphoma commonly diagnosed in human immunodeficiency viruses -positive patients. Oral cavity is the most commonly PBL affected site. Most oral PBLs presented as asymptomatic swellings, frequently associated with ulcerations and bleeding. Most cases lacked B-symptoms, suggesting a more local involvement of the disease. No standard treatment is yet for oral PBL. Five-year survival rate recorded no more than 33.5%. Patient concerns: A 39-year-old male presented to Dental Clinic with 1 month swelling of the oral cavity, in absence of any other symptoms or signs. He followed antibiotic therapy just on suspicion of an oral abscess and later oral surgical treatment on suspicion of bone neoplasm. Diagnosis: Surgical specimen analysis highlighted a diffuse infiltrate of large-sized atypical cells with plasmablastic appearance and plasma cell phenotype. Oral cavity PBL was diagnosed. Blood tests recorded mild lymphopenia and positive human immunodeficiency viruses serology. Interventions: Patient underwent chemotherapy including intrathecal methotrexate prophylaxis, in addition to a highly active antiretroviral therapy. Outcomes: At 12 months from diagnosis, patient recorded complete hematological remission. Conclusions: Oral PBL diagnosis requires a high level of suspicion and awareness both by physicians and pathologists. They should be aware of the extent of such disease which is often mistaken as oral abscess or infected tooth, thus leading to delay the most appropriate diagnostic evaluation. As PBL is an aggressive non-Hodgkin lymphoma, a delayed diagnosis might negatively impact on both treatment and survival.

ABSTARCT: During HIV infection, specific responses exhibited by CD8+ T cells are crucial to establish an early, effective, and sustained viral control, preventing severe immune alterations and organ dysfunction. Several CD8+ T cells subsets have been identified, exhibiting differences in terms of activation, functional profile, and ability to limit HIV replication. Some of the most important CD8+ T cells subsets associated with viral control, production of potent antiviral molecules, and strong polyfunctional responses include Th1-like cytokine pattern and Tc17 cells. In addition, the expression of specific activation markers has been also associated with a more effective response of CD8+ T cells, as evidenced in HLA-DR+ CD38- cells. CD8+ T cells in both, peripheral blood and gut mucosa, are particularly important in individuals with a resistant phenotype, including HIV-exposed seronegative individuals (HESNs), long-term non-progressors (LTNPs) and HIV-controllers. Although the role of CD8+ T cells has been extensively explored in the context of an established HIV-1 infection, the presence of HIV-specific cells with effector abilities and a defined functional profile in HESNs, remain poorly understood. Here, we reviewed studies carried out on different subpopulations of CD8+ T cells in relation with natural resistance to HIV infection and progression. Keywords: CD8+ T cells subpopulations, HIV infection, Natural resistance to HIV, spontaneous control of HIV replication, antiviral immune response

Introduction & Objective: Oral lesions have important diagnostic and prognostic roles in HIV infected patients. It seems that HAART reduces the prevalence of oral lesions. The aim of the present study was to evaluate the prevalence of oral lesions in HIV infected patients on/not on HAART. Materials & Methods: In this retrospective study, 40 HIV infected patients receiving HAART and 40 who were not on HAART were evaluated in Behavioral Consultation Center in Kermanshah. The diagnosis of the oral lesions was recorded by using established presump-tive clinical criteria. Data were gathered and analyzed using SPSS version 16 by chi-square test. Results: In the current study 80 HIV infected patients with mean age of 38.86 were chosen. 72.5% and 27.5% of participants were male and female respectively. The most common le-sions in those receiving HAART were hairy leukoplakia, hairy tongue and oral pigmentation. However the prevalence of these lesions had declined in comparison to those who were not on HAART but the difference was not significant (P>0.05). Although comparing lesions in the two groups showed no significant difference, the total number of lesions significantly reduced in patients receiving HAART (P=0.046) Conclusion: According to the results of the present study using anti retroviral therapy leaded to reduction in the oral lesions in HIV infected patients. However, more research in this field seems necessary. (Sci J Hamadan Univ Med Sci 2013; 20 (3):215-222)

Los microsporidios son protozoos intracelulares obligados, implicados en procesos de diarrea persistente en pacientes con sida, aunque no son exclusivos de este grupo de pacientes. La prevalencia de microsporidios en diferentes países varía entre 8% y 52%. En nuestro medio no se conoce su frecuencia, por lo que este trabajo se propuso determinar la frecuencia de microsporidiosis intestinal en pacientes positivos para VIH, mediante la prueba del Gram cromotropo rápido (quick hot Gram) y la PCR; para esto se realizó un estudio prospectivo, descriptivo, con una población intencional de todos los pacientes positivos para VIH remitidos al Laboratorio del Grupo Interdisciplinario para el Estudio de las Parasitosis Intestinales por las diferentes instituciones de atención de pacientes positivos para VIH de Medellín en el periodo comprendido entre agosto de 2001 y septiembre de 2002. Se hizo una encuesta clínico-epidemiológica y se practicaron análisis coprológicos seriados que incluían examen directo, por concentración y tinciones especiales para coccidias y microsporidios intestinales; además, se solicitó recuento de linfocitos TCD4+ y carga viral. Se estudiaron 103 pacientes en edades comprendidas entre 2 y 74 años; el 70% (72/103) presentaba diarrea al ingreso al estudio; la mayoría (83,5%) fueron hombres. La frecuencia global de microsporidiosis intestinal fue de 3,9% (4/103); se encontraron tres pacientes positivos para Enterocytozoon bieneusi y uno con Encephalitozoon intestinalis; otras parasitosis intestinales representaron el 39,8%. La frecuencia de microsporidiosis en este estudio fue relativamente baja; además, como era de esperarse, la mayoría de los casos de microsporidios estuvieron asociados con diarrea prolongada y recuentos de LTCD4+ menores de 100 cél/?l y cargas virales superiores a 100.000 copias (3/4).

Resumen en español: "Esta investigación tuvo como objetivo principal estudiar los significados de la maternidad en mujeres que viven con VIH/SIDA atendidas en el Hospital de las Culturas en la ciudad de San Cristóbal de Las Casas, en el estado de Chiapas. Se partió del supuesto del VIH y el sida como padecimientos estigmatizados, cargados de sentidos morales cuya presencia representa un punto de quiebre en la trayectoria de vida de las personas. Su diagnóstico enfrenta a las personas a esas significaciones y sus consecuencias trascienden a esferas de la vida social, se producen cambios, se redefinen y replantean proyectos y valores. En este contexto, la maternidad puede convertirse en un espacio de conflicto, donde confluyen diferentes discursos y simbolizaciones sobre la enfermedad y el estigma. Se realizaron entrevistas a ocho mujeres en diferente situación de maternidad que acudían a los Servicios de Atención Integral (SAI) del hospital. Los resultados indicaron tensiones y contradicciones respecto a la maternidad con la presencia del VIH. Los ideales que suponen que la ilusión de ser madres corresponde a todas las mujeres, que una madre da todo por sus hijos, que la maternidad es una función casi exclusiva de las mujeres y hacen del cuidado una tarea primordial, entran en contradicción al pensar en la transmisión del VIH. La presencia del VIH o el sida replantea lo idealizado de la maternidad, debido a la transmisión, a la posible relación con una sexualidad promiscua, a la idea de la muerte y la medicalización. "

Everyday social dynamics and cultural drivers of women’s experiences with HIV/AIDS: voices from Buhaya, Tanzania is based on ethnographic research conducted in the village of Nsisha in northwestern Tanzania. Like most households in this region, Nsisha has been indirectly or directly affected by HIV/AIDS, meaning that either household members have been infected by HIV/AIDS, or households have absorbed children from their extended family and clan who have been orphaned by HIV/AIDS. In whole, the tiers of research and the in-depth questions asked and detailed answers recorded yield four different cross-sectional analyses of the ‘ecology’ of poverty and HIV/AIDS in Buhaya: (1) one which cuts across social stratification within the community, arguing who has more social capital and how this affects their vulnerability; (2) a second which focuses primarily on food and agricultural issues, and more specifically – bananas; (3) a third cross sectional category which centers on climate factors; (4) and a fourth and final category for this thesis which cuts across age categories and focuses on the social variation of widowhood.

Everyday social dynamics and cultural drivers of women’s experiences with HIV/AIDS: voices from Buhaya, Tanzania is based on ethnographic research conducted in the village of Nsisha in northwestern Tanzania. Like most households in this region, Nsisha has been indirectly or directly affected by HIV/AIDS, meaning that either household members have been infected by HIV/AIDS, or households have absorbed children from their extended family and clan who have been orphaned by HIV/AIDS. In whole, the tiers of research and the in-depth questions asked and detailed answers recorded yield four different cross-sectional analyses of the ‘ecology’ of poverty and HIV/AIDS in Buhaya: (1) one which cuts across social stratification within the community, arguing who has more social capital and how this affects their vulnerability; (2) a second which focuses primarily on food and agricultural issues, and more specifically – bananas; (3) a third cross sectional category which centers on climate factors; (4) and a fourth and final category for this thesis which cuts across age categories and focuses on the social variation of widowhood.

in Colombia there are 87 different indigenous groups which represent 3.4% of the country’s population and there is limited knowledge in this population about the presence of HIV, other STDs and in general about Sexual and Reproductive Health (SRH). Also, because of the poverty, marginalization and acculturation in which indigenous people live in Colombia, it is very important to investigate and intervene this reality. The Objective of this study was to identify and measure knowledge and risk behaviors about HIV and SRH n an indigenous reservation in the Antioquia department during 2012. Methods: a cross-sectional study was conducted. A total of 43 residents older than 15 years of age were asked about their HIV knowledge, risk behaviorsand general knowledge about SRH. The project was approved by community leaders and a research ethics committee. Data analysis included simple frequency distributions and a comparison of participant’sknowledge according to their history of previous SRH education. Results: most people had not heard before about HIV or AIDS and have little knowledge about the mechanisms of virus transmission. On the other hand, most people accept and had previous experience with differentbirth control methods, condom use was low. Conclusions: the low levels of knowledge and development of educational programs about SRHin this and other indigenous communities in Colombia, increase the risk of indigenous people for HIV and other STDs. This is a reality that deserves careful attention from the perspective of HIV prevention and health promotion. RESUMEN: Introducción: en Colombia existen 87 pueblos indígenas, que corresponden al 3,4% de la población nacional, donde se conoce muy poco sobre la presencia del VIH, otras enfermedades por Infección de Transmisión Sexual (ITS), y en general sobre su Salud Sexual y Reproductiva (SSR). Así que investigar e intervenir sobre esta realidad es pertinente ante la situación de pobreza, dificultades en la salud y aculturación en que viven la mayoría de los indígenas, que los pone en riesgo de infectarse por VIH y otras ITS. El objetivo de este estudio es identificar y medir conocimientos y comportamientos de riesgo para VIH y SSR, en un resguardo indígena del departamento de Antioquia durante 2012. Métodos: se realizó un estudio transversal para investigar los conocimientos sobre VIH y comportamientos asociados, en un grupo de 43 personas mayores de 15 años. La participación fue voluntaria y el proyecto tuvo la aprobación de la comunidad y del Comité de Bioética de la Facultad Nacional de Salud Pública. El análisis incluyó distribución de frecuencias y se establecieron diferencias en las respuestas de los participantes, según su previa capacitación en el tema. Resultados: la mayoría de las personas no han oído hablar del VIH o del SIDA y desconocen sobre los mecanismos de transmisión del virus. Por otra parte es una comunidad que acepta y accede a diferentes tipos de anticonceptivos, pero poco el condón. Conclusión: el desconocimiento y la deficiencia de programas educativos en SSR en esta y otras comunidades indígenas en Colombia, se convierten en factores de riesgo para VIH y otras ITS. Esta es una realidad a la que es necesario prestarle atención desde la perspectiva de la prevención del VIH y la promoción de la salud.

Background: The nutritional status of HIV-infected children is reported to be poor. Diarrhoea and acute respiratory infections tend to be more common and severe in HIV-infected children than in uninfected ones. Deficiencies of micronutrients may result in poor growth and increased risk of diarrhoea and respiratory infections. Micronutrient deficiencies are common in HIV-infected children. The poor growth, diarrhoea and respiratory infections seen in HIV-infected children may be partly due to micronutrient deficiencies. The studies in this thesis had two main objectives: (1) to evaluate the effect of short-term (during hospitalization) and long-term (6 months) multi-micronutrient supplementation on episodes of diarrhoea and respiratory infections in HIV-infected children who are not yet on antiretroviral therapy (ART), and (2) to assess the effects of long-term multi-micronutrient supplementation on appetite and growth performance of HIV-infected who are not on ART. Methods and results: Four studies were conducted. Initially a cross-sectional study was performed in which the duration of hospitalization, weight, length, micronutrient status and appetite of HIV-infected children admitted with diarrhoea or pneumonia was compared with the results of HIV-uninfected children. Duration of hospitalization was 2.8 days (52%) longer in HIV-infected children. Appetite as measured by amount of test food eaten (g per kg body weight) was 26% poorer in HIV-infected children. Mean length-for-age Z-scores were lower in HIV-infected children; there was no difference in level of wasting. Subsequently multi-micronutrient supplementation studies were performed, one short-term and two long-term studies. The effect of supplementation on the duration of hospitalization in HIV-infected children with diarrhoea or pneumonia was assessed in the short-term study. One long-term study assessed the supplement’s impact on growth and frequency of episodes of diarrhoea and of pneumonia in HIV-infected children. The other evaluated the effect of the supplement on the appetite of these children. The supplement contained vitamins A, B complex, C, D, E and folic acid, and the minerals copper, iron, selenium and zinc at levels based on recommended dietary allowances. In the short-term supplementation study HIV-infected children aged 4-24 months who were hospitalized with pneumonia or diarrhoea received the supplement or a placebo until discharge from hospital. The duration of hospitalization was 1.7 days (19%) shorter in the supplement group. Long-term multi-micronutrient supplementation improved the weight-for-age and weight-for-height Z-scores of HIV-infected children aged 4-24 months by 0.4 over the 6-month period. There was no improvement in stunting. Children in the supplement group had substantially fewer episodes of respiratory symptoms per month than the placebo group (0.66 ± 0.51) per month vs (1.01 ± 0.67) (P < 0.05) and marginally fewer episodes of diarrhoea per month (0.25 ± 0.31) vs (0.36 ± 0.36) (P = 0.09). There was no effect on CD4 lymphocytes. Long-term supplementation with micronutrients had benefits on the appetite of HIV-infected children aged 6-24 months as well. Improvements in amount of test food eaten over the 6-month period were much higher among children who received the supplement (4.7 ± 14.7 g/kg body weight) than the changes in those who received the placebo (-1.4 ± 11.6 g/kg body weight). Conclusion: Multi-micronutrient supplementation reduces the duration of diarrhoea and of pneumonia and incidence of diarrhoea and of respiratory symptoms in HIV-infected children who are not yet on ART. Multi-micronutrient supplementation also improves appetite and weight in these children but not height. The results of these studies indicate that multi-micronutrient supplementation should be considered in HIV-infected infant and young children who have not commenced ART.

Background: The nutritional status of HIV-infected children is reported to be poor. Diarrhoea and acute respiratory infections tend to be more common and severe in HIV-infected children than in uninfected ones. Deficiencies of micronutrients may result in poor growth and increased risk of diarrhoea and respiratory infections. Micronutrient deficiencies are common in HIV-infected children. The poor growth, diarrhoea and respiratory infections seen in HIV-infected children may be partly due to micronutrient deficiencies. The studies in this thesis had two main objectives: (1) to evaluate the effect of short-term (during hospitalization) and long-term (6 months) multi-micronutrient supplementation on episodes of diarrhoea and respiratory infections in HIV-infected children who are not yet on antiretroviral therapy (ART), and (2) to assess the effects of long-term multi-micronutrient supplementation on appetite and growth performance of HIV-infected who are not on ART. Methods and results: Four studies were conducted. Initially a cross-sectional study was performed in which the duration of hospitalization, weight, length, micronutrient status and appetite of HIV-infected children admitted with diarrhoea or pneumonia was compared with the results of HIV-uninfected children. Duration of hospitalization was 2.8 days (52%) longer in HIV-infected children. Appetite as measured by amount of test food eaten (g per kg body weight) was 26% poorer in HIV-infected children. Mean length-for-age Z-scores were lower in HIV-infected children; there was no difference in level of wasting. Subsequently multi-micronutrient supplementation studies were performed, one short-term and two long-term studies. The effect of supplementation on the duration of hospitalization in HIV-infected children with diarrhoea or pneumonia was assessed in the short-term study. One long-term study assessed the supplement’s impact on growth and frequency of episodes of diarrhoea and of pneumonia in HIV-infected children. The other evaluated the effect of the supplement on the appetite of these children. The supplement contained vitamins A, B complex, C, D, E and folic acid, and the minerals copper, iron, selenium and zinc at levels based on recommended dietary allowances. In the short-term supplementation study HIV-infected children aged 4-24 months who were hospitalized with pneumonia or diarrhoea received the supplement or a placebo until discharge from hospital. The duration of hospitalization was 1.7 days (19%) shorter in the supplement group. Long-term multi-micronutrient supplementation improved the weight-for-age and weight-for-height Z-scores of HIV-infected children aged 4-24 months by 0.4 over the 6-month period. There was no improvement in stunting. Children in the supplement group had substantially fewer episodes of respiratory symptoms per month than the placebo group (0.66 ± 0.51) per month vs (1.01 ± 0.67) (P < 0.05) and marginally fewer episodes of diarrhoea per month (0.25 ± 0.31) vs (0.36 ± 0.36) (P = 0.09). There was no effect on CD4 lymphocytes. Long-term supplementation with micronutrients had benefits on the appetite of HIV-infected children aged 6-24 months as well. Improvements in amount of test food eaten over the 6-month period were much higher among children who received the supplement (4.7 ± 14.7 g/kg body weight) than the changes in those who received the placebo (-1.4 ± 11.6 g/kg body weight). Conclusion: Multi-micronutrient supplementation reduces the duration of diarrhoea and of pneumonia and incidence of diarrhoea and of respiratory symptoms in HIV-infected children who are not yet on ART. Multi-micronutrient supplementation also improves appetite and weight in these children but not height. The results of these studies indicate that multi-micronutrient supplementation should be considered in HIV-infected infant and young children who have not commenced ART.

This thesis deals with the effectiveness and the capability of microfinance institutions in enhancing women’s livelihood and empowerment, and mitigating the effects of HIV and AIDS on affected women and their households in Côte d’Ivoire. This study was carried out within the framework of the AWLAE (African Women Leaders in Agriculture and Environment) Project. The AWLAE project addresses the theme of the role of women in food systems and effects of HIV and AIDS on rural livelihoods. Microfinance has been recognized as a significant means of economic development in developing countries, especially in Africa where most of the economies are based on agriculture. Microfinance as a credit institution is seen as one of the relevant tools that can provide small loans for poor people especially women who have no access to formal banks. Therefore MFIs have attracted more attention from governments, NGOs, researchers and civil servants since the microcredit summit in 1997 and the nomination of the year 2005 as the International Year of Microcredit by the United Nations General Assembly. Studies have shown that the effects of MFIs on women’s activities differ between countries and between regions within countries according to factors including the environment, and the socio-demographic characteristics of the beneficiaries. This heterogeneity renders the effects of MFIs inconclusive and explains the necessity and the relevance to conduct this empirical study in Côte d’Ivoire. The objective of this study is to gain insight into women’s needs in terms of support for economic activities and empowerment in rural areas and the way in which MFIs address these needs. Specifically, the study aims at assessing whether microfinance services provided for women in Côte d’Ivoire fit their needs in terms of improving their incomes, productivity, decision-making power, human and social capital. Special attention is paid to HIV-affected women. To achieve these objectives, the study tends to respond to four main research questions: 1) What are women’s needs for credit in rural areas? 2) How do women have access to MFI credit in rural areas? 3) What are the effects of participation in microfinance programs on women’s practical and strategic gender needs? 4) What is the relationship between microfinance programs and women coping with HIV/AIDS? These research questions lead to the formulation of hypotheses that are confirmed or rejected. This study uses both a theoretical and empirical approach that represents the interaction of women’s livelihood, microfinance and HIV and AIDS. The empirical analysis consists of an in-depth analysis of microfinance institutions and a survey analysis applied to cross-sectional data collected from 440 women in the Abengourou region located in the Central Eastern part of Côte d’Ivoire. The sample was divided into four categories of women as follows: Non-HIV affected women with and without MFI credit; HIV-affected women with and without credit. This study gives a descriptive analysis of the study country, and the response of the state to promote the microfinance sector and to mitigate the effects of HIV and AIDS on the individual, household and communities in Côte d’Ivoire. Women in the Abengourou region are basically involved in agriculture from which they earn their livelihood and the opportunity to produce food for household consumption. The type of activities carried by women depends on their access to credit. Those who have no access to MFI loans were mainly engaged in farm activities while women with access to credit were mainly traders. They were also able to undertake both agricultural and trade activities. From these results, it appears that women in rural areas need MFI credit for trade purposes and to a lesser extent for agricultural activities. This study found a significant relation between savings and credit, meaning that access to MFI credit was fundamentally conditioned on the provision of savings from the borrowers that most of the rural population did not have. MFIs use savings as collateral to prevent defaults. In addition, MFI membership and the type of activity are also important to obtain MFI credit. Furthermore, access to MFI credit depends on factors linked to the characteristics of female borrowers including, marital status, wealth status of the household, ethnicity and the empowerment of women, and trade activity. These determinants positively affect the probability of obtaining MFI credit in rural areas. The study reveals that MFIs prefer to finance trade activity rather than agricultural activity as the latter is seen as risky and associated with unpredictable income. The use of the propensity score matching method led to the following results. MFIs are found to be effective in enhancing a set of variables including income, the level of farm production, human and social capital. MFI credit has enhanced women’s decision-making power within the households too. However, women’s access and use of MFI credit in rural areas did not significantly increase the value of women’s assets but it did significantly enhance the value of household assets. This result on the value of women’s assets did not confirm the findings of several studies which indicated that the provision of credit enables women to build up and improve the value of their assets (Rahman, 2004; Mayoux, 1999, Van Maanen, 2004). The result also suggested that female borrowers were more likely to use their income earned not to build their own assets, but to contribute to the improvement of the household standard of living. Doing so enables these women to achieve more power in fulfilling their practical and strategic gender needs within the household as indicated by the findings of this study. The effectiveness of MFIs in providing loans for women in rural areas is measured by the loan repayment which is an important indicator for MFI practitioners. It gives insight into the capability of the credit institution to insure its sustainability and to increase its outreach. From our analysis, loan repayment among female borrowers generally was not successful as some borrowers had difficulties to pay back their MFI loan. The non-repayment is mainly explained by the diversion of loans from investment purposes, which has to do with the lack of women’s control over loans. For MFIs, the diversion of loans can endanger their functioning and sustainability and therefore their effectiveness in rural areas. However, this study found the low repayment performance of female borrowers to be contradictory to the positive effect of MFI credit on women’s income and the positive return on investment they achieved. Hence, this study suggests that in addition to the diversion of loans, non-repayment might be linked to other factors especially the unwillingness of the borrowers to repay their loan. The analysis of the interaction between HIV/AIDS, women’s livelihood and MFIs reveals on the one hand that HIV and AIDS negatively affects both human and physical capital of households through morbidity and mortality. The morbidity of affected women results in a direct negative impact on their livelihood activities and an indirect effect on their income and loan repayment. HIV/AIDS has an impact on the morbidity of household members that leads to the loss of family labour, which is difficult to replace due to lack of resources. In addition, the morbidity results in a drop in the level of education as children are forced to stay at home due to illness. On the other hand, the negative effects of HIV and AIDS on female borrowers entail an indirect effect on MFIs through the incapability of affected borrowers to generate more money and inability to payback their loans. This result essentially has to do with the diversion of loans to meet medical expenditures and the process of the provision of loans that appears to be flawed. In line with this deficiency, the functioning and the effectiveness of MFIs to support and extend their outreach among HIV-affected individuals or households are threatened. This study contributes to the existing findings about the socio-economic role of MFIs to support women generating their livelihood. It gives empirical findings in the case of rural areas in Côte d’Ivoire. Such study was not done since the implementation of microfinance institutions in the Abengourou region. The study reveals that the activities carried by women can be influenced by their need to have access to MFIs. This means that women will choose to undertake a particular activity to fit the preferences of microfinance institutions. Another important contribution of this study is to empirically link women’s empowerment to their access to MFI credit. The study reveals that women’s empowerment regarding the demand for and the use of credit make them more reliable and give them more opportunity to obtain MFI credit. With regard to HIV, this study highlights the diversity and the specificity of the way HIV-affected individuals are financially supported by credit institutions. To conclude, the study provides some policy recommendations and interventions in order to make MFIs more effective in offering financial services to individuals and households in general and women in particular in rural areas. Specifically we recommend the provision of loans taking into account the needs of borrowers with respect to the special nature of their activities to be financed. MFIs need subsidies from the state or other potential donors to reinforce the capacity building of MFI credit officers through training and to support the transaction costs linked to the provision of small loans. Doing so will help them to better understand and serve the rural population living in an environment which seems to be complex. The study also recommends further study to be conducted in order to explore the long-run effects of MFI credit in rural Côte d’Ivoire.

This thesis deals with the effectiveness and the capability of microfinance institutions in enhancing women’s livelihood and empowerment, and mitigating the effects of HIV and AIDS on affected women and their households in Côte d’Ivoire. This study was carried out within the framework of the AWLAE (African Women Leaders in Agriculture and Environment) Project. The AWLAE project addresses the theme of the role of women in food systems and effects of HIV and AIDS on rural livelihoods. Microfinance has been recognized as a significant means of economic development in developing countries, especially in Africa where most of the economies are based on agriculture. Microfinance as a credit institution is seen as one of the relevant tools that can provide small loans for poor people especially women who have no access to formal banks. Therefore MFIs have attracted more attention from governments, NGOs, researchers and civil servants since the microcredit summit in 1997 and the nomination of the year 2005 as the International Year of Microcredit by the United Nations General Assembly. Studies have shown that the effects of MFIs on women’s activities differ between countries and between regions within countries according to factors including the environment, and the socio-demographic characteristics of the beneficiaries. This heterogeneity renders the effects of MFIs inconclusive and explains the necessity and the relevance to conduct this empirical study in Côte d’Ivoire. The objective of this study is to gain insight into women’s needs in terms of support for economic activities and empowerment in rural areas and the way in which MFIs address these needs. Specifically, the study aims at assessing whether microfinance services provided for women in Côte d’Ivoire fit their needs in terms of improving their incomes, productivity, decision-making power, human and social capital. Special attention is paid to HIV-affected women. To achieve these objectives, the study tends to respond to four main research questions: 1) What are women’s needs for credit in rural areas? 2) How do women have access to MFI credit in rural areas? 3) What are the effects of participation in microfinance programs on women’s practical and strategic gender needs? 4) What is the relationship between microfinance programs and women coping with HIV/AIDS? These research questions lead to the formulation of hypotheses that are confirmed or rejected. This study uses both a theoretical and empirical approach that represents the interaction of women’s livelihood, microfinance and HIV and AIDS. The empirical analysis consists of an in-depth analysis of microfinance institutions and a survey analysis applied to cross-sectional data collected from 440 women in the Abengourou region located in the Central Eastern part of Côte d’Ivoire. The sample was divided into four categories of women as follows: Non-HIV affected women with and without MFI credit; HIV-affected women with and without credit. This study gives a descriptive analysis of the study country, and the response of the state to promote the microfinance sector and to mitigate the effects of HIV and AIDS on the individual, household and communities in Côte d’Ivoire. Women in the Abengourou region are basically involved in agriculture from which they earn their livelihood and the opportunity to produce food for household consumption. The type of activities carried by women depends on their access to credit. Those who have no access to MFI loans were mainly engaged in farm activities while women with access to credit were mainly traders. They were also able to undertake both agricultural and trade activities. From these results, it appears that women in rural areas need MFI credit for trade purposes and to a lesser extent for agricultural activities. This study found a significant relation between savings and credit, meaning that access to MFI credit was fundamentally conditioned on the provision of savings from the borrowers that most of the rural population did not have. MFIs use savings as collateral to prevent defaults. In addition, MFI membership and the type of activity are also important to obtain MFI credit. Furthermore, access to MFI credit depends on factors linked to the characteristics of female borrowers including, marital status, wealth status of the household, ethnicity and the empowerment of women, and trade activity. These determinants positively affect the probability of obtaining MFI credit in rural areas. The study reveals that MFIs prefer to finance trade activity rather than agricultural activity as the latter is seen as risky and associated with unpredictable income. The use of the propensity score matching method led to the following results. MFIs are found to be effective in enhancing a set of variables including income, the level of farm production, human and social capital. MFI credit has enhanced women’s decision-making power within the households too. However, women’s access and use of MFI credit in rural areas did not significantly increase the value of women’s assets but it did significantly enhance the value of household assets. This result on the value of women’s assets did not confirm the findings of several studies which indicated that the provision of credit enables women to build up and improve the value of their assets (Rahman, 2004; Mayoux, 1999, Van Maanen, 2004). The result also suggested that female borrowers were more likely to use their income earned not to build their own assets, but to contribute to the improvement of the household standard of living. Doing so enables these women to achieve more power in fulfilling their practical and strategic gender needs within the household as indicated by the findings of this study. The effectiveness of MFIs in providing loans for women in rural areas is measured by the loan repayment which is an important indicator for MFI practitioners. It gives insight into the capability of the credit institution to insure its sustainability and to increase its outreach. From our analysis, loan repayment among female borrowers generally was not successful as some borrowers had difficulties to pay back their MFI loan. The non-repayment is mainly explained by the diversion of loans from investment purposes, which has to do with the lack of women’s control over loans. For MFIs, the diversion of loans can endanger their functioning and sustainability and therefore their effectiveness in rural areas. However, this study found the low repayment performance of female borrowers to be contradictory to the positive effect of MFI credit on women’s income and the positive return on investment they achieved. Hence, this study suggests that in addition to the diversion of loans, non-repayment might be linked to other factors especially the unwillingness of the borrowers to repay their loan. The analysis of the interaction between HIV/AIDS, women’s livelihood and MFIs reveals on the one hand that HIV and AIDS negatively affects both human and physical capital of households through morbidity and mortality. The morbidity of affected women results in a direct negative impact on their livelihood activities and an indirect effect on their income and loan repayment. HIV/AIDS has an impact on the morbidity of household members that leads to the loss of family labour, which is difficult to replace due to lack of resources. In addition, the morbidity results in a drop in the level of education as children are forced to stay at home due to illness. On the other hand, the negative effects of HIV and AIDS on female borrowers entail an indirect effect on MFIs through the incapability of affected borrowers to generate more money and inability to payback their loans. This result essentially has to do with the diversion of loans to meet medical expenditures and the process of the provision of loans that appears to be flawed. In line with this deficiency, the functioning and the effectiveness of MFIs to support and extend their outreach among HIV-affected individuals or households are threatened. This study contributes to the existing findings about the socio-economic role of MFIs to support women generating their livelihood. It gives empirical findings in the case of rural areas in Côte d’Ivoire. Such study was not done since the implementation of microfinance institutions in the Abengourou region. The study reveals that the activities carried by women can be influenced by their need to have access to MFIs. This means that women will choose to undertake a particular activity to fit the preferences of microfinance institutions. Another important contribution of this study is to empirically link women’s empowerment to their access to MFI credit. The study reveals that women’s empowerment regarding the demand for and the use of credit make them more reliable and give them more opportunity to obtain MFI credit. With regard to HIV, this study highlights the diversity and the specificity of the way HIV-affected individuals are financially supported by credit institutions. To conclude, the study provides some policy recommendations and interventions in order to make MFIs more effective in offering financial services to individuals and households in general and women in particular in rural areas. Specifically we recommend the provision of loans taking into account the needs of borrowers with respect to the special nature of their activities to be financed. MFIs need subsidies from the state or other potential donors to reinforce the capacity building of MFI credit officers through training and to support the transaction costs linked to the provision of small loans. Doing so will help them to better understand and serve the rural population living in an environment which seems to be complex. The study also recommends further study to be conducted in order to explore the long-run effects of MFI credit in rural Côte d’Ivoire.