Preventing HIV & Empowering Adolescent Girls & Young Women in South Africa - PHI / CDC

Though I was born in the U.S., my parents raised and educated me in Kenya because they wanted me to be rooted in family and culture. A part of my family’s tradition was to visit my grandparents in the rural village of Kamwosor. One summer, my grandmother became sick with typhoid because of drinking contaminated water. The following year in school, I learned about water-borne diseases. It was an “aha!” moment for me. This knowledge motivated me to develop a Water, Sanitation, and Hygiene Project for the residents in my grandmother’s rural community in Kamwosor, Kenya. It was also the beginning of my passion for public health.

“One summer, my grandmother became sick with typhoid because of drinking contaminated water. The following year in school, I learned about water-borne diseases… This knowledge motivated me to develop a Water, Sanitation, and Hygiene Project for the residents in my grandmother’s rural community in Kamwosor, Kenya. It was also the beginning of my passion for public health.”

Although I knew I wanted to pursue a career in public health, I didn’t know how to go about it as I didn’t have any young female role models in the health field. This was partly because the Kenyan education system was prescribed and structured with a significant focus on performing well in standardized tests. However, things changed when I joined high school as the school I was attending decided to implement a one-week personal and professional development seminar.

One of the speakers who stood out to me was a young woman who had just graduated from a top university in the U.S. and landed a fantastic job with a health-related company. This young woman was well-spoken, confident, knowledgeable, beautiful, and charismatic. A true definition of black girl magic! She also had a similar background to many of us attending the seminar, which made her even more relatable. I remember listening to her keenly with a lot of admiration and enthusiasm. I wrote down all the advice she shared with us, particularly the tips I needed to succeed in both school and life. I remember how grateful I was to have a role model to learn as this experience helped me hone in my career path after high school. This experience also formed a strong foundation for my appreciation and willingness to seek mentorship throughout my schooling and postgraduate training.

DREAMS PROGRAM, CDC SOUTH AFRICA                        

The author with a DREAMS participant

I remember how excited I was when I was selected to be a PHI/CDC Global Epidemiology Fellow for the Determined Resilient Empowered AIDS-Free Mentored and Safe (DREAMS) program for CDC South Africa. This was a perfect fit as I was passionate about public health and working with young people, particularly adolescent girls and young women (AGYW). Through the experiences I had had receiving mentorship, I had made it my life goal to encourage and empower all the AGYW I came across. Therefore, I was looking forward to sharing all the knowledge and tools I had with the AGYW in the DREAMS program so they could make a difference in their own lives and their communities.

Developing the vision board project and adapting it for HIV prevention came from my previous experiences with creating vision boards and background in scientific research. Every year since I could remember, I always created a vision board on my birthday to guide my new year. During the vision board process, I would reflect on my previous year, mainly things I did well and areas I needed to improve. I then realized that this was a very effective way of holding myself accountable to my goals and also create actionable steps that would lead me to accomplish my dreams. I also learned that this process enabled me to assess my life holistically, thereby allowing me to use an all-rounded approach in evaluating and developing goals for my new year.

Example Vision Board

Currently, there is an increasing need for better and creative ways to deliver comprehensive and holistic HIV prevention methods. Once I realized this need, I decided to explore ways to adapt vision boards for HIV prevention programming. After conducting some research, I learned that vision boards and guided imagery are interventions mostly used as therapeutic techniques in counseling, which use a behavioral therapy framework^1,2. Guided imagery is a powerful technique in which the individual uses all their senses to create positive mental images of themselves, enabling them to overcome challenges and develop healthier coping mechanisms^2,4. A vision board is a creative display of pictures, words, metaphors, quotes, drawings, and objects that present “an excellent way to engaging clients in identifying, defining, and clarifying what they want in their lives”⁶.

“Currently, there is an increasing need for better and creative ways to deliver comprehensive and holistic HIV prevention methods.”

The author with a DREAMS participant

I learned that the process of developing goals during a vision board activity needed to be intuitive and reflective, whereby the individual required to deeply explore essential aspects in their lives that they wanted to highlight using imagery. Some of the goals covered in a vision board are typically related to health and fitness; family, love, and friendship; career and ambition; self-esteem and self-worth; service and generosity; spirituality and knowledge; prosperity and entrepreneurship. The use of vision boards and guided imagery is currently limited to counseling. However, I saw the opportunity of using them to help AGYW identify critical aspects of their lives; visualize and develop specific, measurable, attainable, relevant, and timely (SMART) goals; and actively create steps to achieve those goals¹.

Vision boards and guided imagery have shown to be useful in helping individuals overcome a difficult task, facilitate disclosure, and even in addressing psychological problems such as insomnia and depression^1,2. Moreover, imagery has shown to be influential in creating a physiological change and providing motivation for new behaviors⁶. I realized that incorporating the vision board activity in Safe Spaces, one of the DREAMS structured interventions, would empower AGYW to develop individual SMART goals using imagery. Subsequently, this would inspire them to create the life they visualized while ensuring they were following their HIV prevention plan.

GIRLS CLUB & EMPOWERING WOMEN IN SOUTH AFRICA

Girls Clubs is an evidence-based intervention that is currently being implemented in the South Africa DREAMS program by the Center’s for Diseases Control and Prevention (CDC) under Community Media Trust (CMT). The toolkit implemented in Girls Clubs includes sessions from CMT’s Girls Club curriculum complemented with the Desmond Tutu Health Foundation curriculum titled ‘Women of Worth.’ Social, Cognitive, Health and Economic Assets (or strength-building courses) are covered in Girls Clubs:

The author with a DREAMS participant

We conducted a pilot of the vision board project during a two-day workshop with sixteen AGYW and five mentors in the district of eKurhuleni, Gauteng province. The AGYW and Implementing Partners (IPs) who attended the workshop enjoyed the vision board activity and had excellent feedback, which we used to improve the vision board project. In a follow-up survey, the AGYW in attendance mentioned the workshop helped them identify their purpose in life and develop actionable steps towards achieving their goals and dreams in life.

ADJUSTING THE PROGRAM POST COVID-19

Despite COVID-19 affecting the roll-out the vision board project across all our DREAMS districts, we were determined to see the vision board project to completion. Therefore, I explored different online platforms we could use to roll-out our project, taking into consideration accessibility, cost-effectiveness, efficiency, and effectiveness. In the end, we decided to use the apps Zoom to conduct the training and Canva to create the vision board. We did several virtual workshops with our IPs, and so far we have trained about sixty CMT mentors, Girls’ Club facilitators, and project coordinators. The feedback from the virtual workshops has also been very positive, and we recently conducted a follow-up call to improve our vision board curriculum and address any technical issues on roll-out. I have also been providing continuous mentorship and support to the DREAMS ambassadors from the two-day workshop in eKurhuleni to ensure that they are still on track to achieving their goals.

“The feedback from the virtual workshops has also been very positive, and we recently conducted a follow-up call to improve our vision board curriculum and address any technical issues on roll-out.”

Girl Power in South Africa!

Participating in the PHI/CDC Global Health Fellowship Program has been a life changing experience as I have had the opportunity to pursue my passion of working with young people, particularly AGYW. I have also had the chance to grow professionally by developing skills such as the implementation of evidence-based interventions and services, quality assessment of clinical programs through routine site visits, and provision of data-related technical assistance to Implementing Partners (IPs). I have learned that working hand in hand with the community members in the communities we serve ensures comprehensive disease prevention, health promotion, access to, and equity within health services. I have also learned the importance of mentorship and support of young people from a young age. I believe that the mentorship I received while in high school and throughout my schooling and postgraduate degree has given me the knowledge, skills, and experience to make an impact on the lives of other young people I meet in life.

“Participating in the PHI/CDC Global Health Fellowship Program has been a life changing experience… I have learned that working hand in hand with the community members in the communities we serve ensures comprehensive disease prevention, health promotion, access to, and equity within health services.”

REFERENCES

1. Burton, Lisa; Lent, Jonathan. Journal of Creativity in Mental Health. Jan-Mar2016, Vol. 11, Issue 1, p52-65. 14p. 2 Black and White Photographs. DOI: 10.1080/15401383.2015.1092901.
2. Kress V, Adamson N, DeMarco C, Paylo M, Zoldan C. The Use of Guided Imagery as an Intervention in Addressing Nonsuicidal Self-Injury. Journal of Creativity in Mental Health. 2013;8(1):35-47. DOI:10.1080/15401383.2013.763683.
3. Utay, J., and Miller, M.2006. Guided imagery as an effective therapeutic technique: A brief review of its history and efficacy research. Journal of Instructional Psychology, 33: 40–43.
4. https://www.healthjourneys.com/guided-imagery-101
5. Mosley, S. (2010, Fall). Using a person-centered vision board in counseling. North Carolina. Perspectives, 3, 28–33.
6. Witmer JM, Young ME. The Silent Partner: Uses of Imagery in Counseling. Journal of Counseling & Development. 1985;64(3):187. DOI:10.1002/j.1556-6676.1985.tb01068.x.

Learn more about CDC South Africa here. All photos used above are courtesy of Jepkoech J. Kottutt, MPH.