This longitudinal qualitative study sought to
understand how and why a livelihood intervention affected
the health and health behaviors of HIV-infected Kenyan
adults. The intervention included a microfinance loan,
agricultural and financial training, and a human-powered
water pump. In-depth interviews were conducted at two
time points with intervention and control participants and
program staff. We double coded interviews (n = 117) and
used thematic content analysis of transcripts following an
integrative inductive–deductive approach. Intervention
participants described improvements in HIV health,
including increased CD4 counts and energy, improved viral
suppression, and fewer HIV-related symptoms. Better
health was linked to improved clinic attendance and ART
adherence through several mechanisms: (1) reductions in
food insecurity and abject hunger; (2) improved financial
stability; (3) improved productivity which enhanced social
support; (4) better control over work situations; and, (5)
renewed desire to prioritize their own health. Livelihood
interventions may improve health by influencing upstream
determinants of health behavior including food security
and poverty.