'My Living Positively' Handbook

Review by: Shanaaz Kapery Randeria

Wits Reproductive Health & HIV InstituteMy Living Positively Handbook

 

I have been using the ‘My Living positively’ Handbook for many years with adolescents and younger children. Adolescent open weekly support groups are run on Thursdays and a pre-teen support group is now running very successfully on Tuesdays at the facility I am employed at.

The adolescent weekly support group is available to HIV positive clinic patients (13-21 years old) who have been disclosed to.

The pre-adolescent (9-12 years old) weekly support groups are available to all pre-adolescent HIV positive patients regardless of their knowledge of their HIV status.

The psychosocial programs that I develop and implement are:

  • Rights-based
  • Developmentally informed
  • Child/ youth-friendly

The rights that the pre-adolescent group members are most often aware of are the rights to:

•             Basic needs

•             Education

•             Leisure and play

•             Clean environment

•             Good health care and services

The accompanying responsibilities of individuals to maximise the benefit from these rights are always discussed.

An area of concern, especially with adolescents, is adherence to ARV’s. Developmentally, adolescents are extremely vulnerable to default from their ARV treatment. During the adolescent stage important developmental tasks include: formation of an identity, including a sexual identity, identifying with a peer group, emotional detachment from significant adults, conceptualising their role in an adult world which includes a career and a family of their own. Adolescence is the stage of sexual debut for most. In addition to being on the threshold of adulthood, which brings with it various adult roles and responsibilities to be fulfilled, adolescents have to accept that their sexuality has come under attack as a result of being HIV positive.

The role of culture in HIV transmission is being acknowledged. The influence of culture is an important and pervasive aspect in the lives of Africans (Hodgson, 1999). Health and ideas about disease and illness are intricately interwoven with our culture. It stands to reason that in order to address HIV/AIDS challenges, that culture should be recognized as an important component of interventions.

The ‘My Living Positively’ handbook lends itself to a lot of creative uses with children and adolescents.

Specific instances where I have utilised it to stimulate discussion includes

  • ‘What happens to my body without help?’ (pp. 22-23)

The adolescent group had to find their own metaphors to depict the relationship between

their health, HIV and ARV’s.

Metaphors by the adolescents

ARV

My health

Snake in a   hole that emerges at time ARV’s are to be taken

Snake can’t   come out of hole to bite me

airtime

Cell phone   can be used to make calls

  1. and sunshine
  1. flowers to grow

Petrol

Allows a car   to drive

Food

Gives the   body and brain energy

Policeman

Catching a   robber

The pre-adolescent discussion on the role of culture and adherence was introduced with the help of ‘My Living Positively’ handbook (p. 38): the role of traditional healers. Two languages are commonly spoken by support group members viz. Sotho and Zulu. The Sotho word for traditional healer is ‘ngaka’ and the Zulu word is ‘sangoma’. The value of culture in our daily lives and for the functioning of our family was discussed. In addition, the importance of adhering to medication, and not mixing it with traditional medication was discussed. The effects of mixing western and traditional medication in particular were addressed including the effects of doing so.

The pre-adolescent weekly support group is open to all patients at the clinic regardless of whether they are disclosed to or not. HIV and ARV’s are therefore not specifically discussed. In a plight to ‘normalise’ living with HIV as a chronic long-term condition (similar to diabetes for instance), HIV is discussed as a one of many organisms that can make one susceptible to illnesses like TB.

Drawing of ARV’s (pre-adolescent)

The responsibility of adhering to medication is one of the responsibilities that the group acknowledges as important to give validity to the right to good basic health care. Recognising the medication children take is one of the ways in which they can gain a sense of pride in themselves. This seemingly simple task, of recognizing medication, also imparts a sense of taking responsibility for ‘my health’. The range of children’s ARV’s will be displayed and each group member will identify those they take. Using Art therapy, they will draw their medication (p. 36) and we will then discuss healthy ‘positive’ living focusing on : healthy eating habits, rest, exercise, reducing stress and taking medication-these are 5 basic steps to staying healthy regardless of HIV status.

AIDS orphans are at a higher risk for adverse mental health outcomes, in particular anxiety depression and PTSD (Cluver et al, 2009). Loneliness is another feeling that HIV orphans and youth commonly experience (Davis, 1990). These adverse mental health conditions and feelings are sometimes self-imposed.

In African culture, it is unacceptable for a child/adolescent to challenge an adult. Children and adolescents are typically expected to be seen and not heard.The support group provides a safe and nurturing environment where children and adolescents’ right to be heard are encouraged and respected. Acknowledging feelings and safe and effective ways of expressing them are always practised. It is also important that they recognize others’ feelings in order to navigate safe and effective communication with the significant adults in their lives. Children and sometimes adolescents as well do not necessarily have the appropriate vocabulary to state or even identify their feelings. Pictures or a list of feelings given to the group members (p. 31) are good for stimulating games and discussions about feelings. A game that is popular with the pre-adolescent group is for a member to demonstrate a facial expression of a feeling and the group has to correctly guess the feeling.

Feelings: Collage of feeling Happy

Reference:

Cluver, L., Gardner, F., Operario, D. (2009) ‘Poverty and Psychological Health among AIDS- orphaned children in Cape Town, South Africa AIDS care 21(6) pp. 732-741

Davis, D.B. (1990) ‘Loneliness in Children and Adolescents’ Comprehensive Paediatric Nursing vol 13 pp. 59-69

Hodgson, I.J. (1999) ‘Myth and HIV: The role of cultural narrative in the construction of HIV/AIDS’ National HIV Nurses Conference June 1999 Available from: http://www.brad.ac.uk/staff/ijhodgson/summaries/Publications/culture_myth_hiv.htm (Accessed: 24 July 2012)

gia vang hom nay , dich vu seo , tap chi me va be , bao ve viet nam , bao ve viet nam , bao ve viet nam , bao ve viet nam , bao ve viet nam , suc khoe , thoi trang nam 2014 , suc khoe 2014 , shop thoi trang , tin tuc thoi trang phim le , hi tech , tin cong nghe , cong nghe , thoi su , tin moi , thoi trang , the gioi smartphone , cong nghe , may tinh bang gia re , dien thoai , su kien , game mobile , nghe si viet , the gioi nhac , nha cai , dien dan bong da , best bookies, clevermart.vn , goldcare.vn , phonereview.vn , tinhangngay.vn , sieuthisachnoi.com , doctruyentranh.tv , sieuthismartphone.vn , kinhthongminh.org , thietbithongminh.tv , sieuthithietbiso.org ,