Partnerships work to improve life in South Africa

October 28, 2008

Penn State faculty work with colleagues in a country where the prevalence of HIV/AIDS is the highest in the world

Mitchell’s Plain is a large, sprawling township near Cape Town in South Africa. It contains monotonous rows of houses built about 20 years ago for the "coloured" population — one of the racial groups designated under the aApartheid system to refer to people of mixed-race. A community marked by high unemployment and poverty, there are public schools here that lock the doors during the day and are surrounded by barbed wire to keep out gangs; daily realities among students include drug addiction, pregnancy and HIV/AIDS.

Despite some grim conditions in Mitchell's Plain, there is plenty to be positive about: Thanks to a Penn State-led initiative and dedicated partners, youth in the area have reported they are less likely to start drinking, less likely to smoke and have an increased knowledge of condom use. Now the program, HealthWise, tested over the last five years at four schools, is so popular that it is being expanded to nearly 60 additional schools.

"Teachers loved it, principals loved it and the kids found it palatable," said Edward Smith, director of evaluation research in the Prevention Research Center for the Promotion of Human Development in Penn State's College of Health and Human Development (HHD) and primary investigator of the program with Linda Caldwell, professor of recreation, park and tourism management in HHD.

Smith added, "Teachers are convinced that the program has changed the school atmosphere and created a sense of school spirit."

Caldwell is quick to point out that the program would not have been successful without their South African colleagues. "It is a match made in heaven," she said. "They initiated the project, and we conceptualized it together. We had the ability to get funding, but they do the hard work and carry it out on a daily basis."

Mitchell’s Plain is just one community working with faculty from HHD in a larger collaborative effort with South African research partners to promote equity in health. "We are committed to focusing on historically disadvantaged institutions and communities in South Africa," said Collins O. Airhihenbuwa, head of the Department of Biobehavioral Health (BBH), who is working on a capacity building and research project in the Western Cape province of South Africa.

Youth learn to problem solve

Funded by the National Institute on Drug Abuse, HealthWise is a school-based curriculum that aims to reduce drug use and risky sexual behavior by focusing on health promotion and healthy use of leisure time. The initiative is in response to the need for HIV/AIDS intervention and prevention efforts in South Africa, where prevalence of the epidemic is the highest in the world. There are 1,500 new HIV infections daily in South Africa, and 60 percent of all new infections occur in people ages 15–25.

The program grew out of an effort started in 2000 by Penn State's Children, Youth and Families Consortium, led by Karen Bierman, to bring together people across the campus system to work with colleagues in South Africa whose focus was risk reduction and health promotion among youth.

"There's a saying in South Africa: If you're not infected with the disease, you are affected by it," said Smith, "through a relative or friend having it."

HealthWise — adapted for South African youth from U.S. programs — is based on the theory that boredom during free time increases the potential for risky behaviors. Despite a large billboard over the sports and recreation center in Mitchell's Plain proclaiming: "Getting the Nation to Play," it has remained a challenge for adults to get youth to participate in organized activities — with kids preferring to hang out in the streets.

"Kids become bored in their free time. Where there is poverty and a lack of resources, there is not a lot to do," said Caldwell. "HealthWise teaches kids how to problem solve about what they can do with what they have."

The two-year curriculum begins in eighth grade and, in addition to providing factual health-related information, it engages the youth in activities such as scavenger hunts, role-playing and open discussion. For example, in a scavenger hunt, kids might be asked to go find the library, swimming pool and health care clinic. A role-playing activity might ask kids to think about what they would do in a situation that could turn risky, such as if they were home alone.

"After participating, one group of youth decided to start a hiking club," said Caldwell. "There is really no obvious place for them to hike, but they came together to think about how they could still do it." Also, youth development specialists and students were inspired to start a drama club, with the help of the local University of the Western Cape.

The feedback has been completely positive. For example: "We can really see growth within our learners, that they are aware of the challenges that are facing our community," said one principal.

"People have respect for this program, and the presence of the program affects what happens at the school, such as the issues around teenage pregnancy," said a participant.

"Lessons are taught to learners (about) dealing with anger and anxiety. … Instead of getting angry, they know how to control their anger. It has contributed in a broader sense, after school, to extramural activities," said a teacher.

"It's incredibly gratifying to hear their enthusiasm," said Caldwell. Also fulfilling is the fact that program will reach 18,000 kids at public school with its expansion. “We’re training not only the students, but also the teachers to think differently,” she added.

Creating more openness

Another Penn State project — led by Airhihenbuwa — is also focused on the power of positive thought in the context of HIV/AIDS. This project went beyond Mitchell’s Plain to cover several disadvantaged communities of South Africa.

Feelings of shame related to having HIV/AIDS can cause rifts in families and communities. For example — people may use their fingers when eating, and when a person has HIV, he or she might not be called to the table because of the way they eat, experiencing rejection. Or, a woman in a family expresses her identity by cooking for the family. When she tests positive for HIV the family tells her she can’t cook for them anymore, and she is demoralized.

Airhihenbuwa's recently completed five-year effort (Smith and Rhonda BeLue, assistant professor of health policy and administration, are co-investigators) involved training faculty and historically disadvantaged students at the University of the Western Cape in Cape Town and the University of Limpopo in Polokwane to engage in conversations with community members  — youth groups and health care workers — to try to understand the notion of HIV/AIDS stigma and craft interventions to reduce that stigma. Research in Cape Town was conducted in three communities: Khayelitsha, Gugulethu and Mitchell’s Plain; research in Polokwane was conducted in the Limpopo province.

"The idea is to train more South Africans who are directly involved in developing solutions. The place to go for that is where young minds are cultivated — at the university," explained Airhihenbuwa. "The goal is to create more openness and more willingness to be tested and help the community find culturally positive ways to express love and acceptance."

Funded by the National Institute of Mental Health, the project is called "Capacity Building for Research on HIV Stigma in South Africa."

Airhihenbuwa first approached Olive Shisana, who is now the chief executive officer of the Human Sciences Research Council, with the project, and then in turn the universities. Penn State and the Human Sciences Research Council, in collaboration with faculty from the universities, selected graduate students to mentor on the project. Workshops for the South African faculty were held at Penn State and then in South Africa for the students.

Previously, the students had little actual contact with the community for research. "We trained them to have a different way of engaging with the community, and that changed the way they look at the community and how they look at research," said Airhihenbuwa.

The effort was successful. "I was enriched by the task of facilitating groups," said University of the Western Cape graduate student J. P. Mokwena. "The most interesting thing for me was that … participants would see things differently."

Leickness Simbayi of the Human Sciences Research Council appreciated the collaboration between the universities. "The networking has been fantastic," he said. A total of 30 black and "coloured" South African graduate students were trained.

Airhihenbuwa is currently working on a grant to assist students and faculty mentors with the intervention phase of the project.

Students gain opportunity

The interest in such projects is increasing in the College of Health and Human Development, not only among faculty but also students. To meet this need, BBH hopes to offer a minor in global health. The minor is part of the college’s strategic plan and is expected to be offered starting in 2009.

BBH programs already in place demonstrate how working abroad can be a life-changing experience. For example, for eight years BBH has offered a program for underrepresented U.S. minority undergraduate and graduate students to support research training each summer at places including South Africa, Tanzania, France and Switzerland. The program, which has trained more than 100 minority and underrepresented students nationally, is led by Gary King and funded by the National Center on Minority Health and Health Disparities of the National Institutes of Health.

"My interest is no longer one dimensional," said former participant Pernell Jones. "Working with people from other countries has taught me how to relate and convey my thoughts with respect."

Eni Njoh, a trainee in 2007, said, "I am able to understand ideas and concepts discussed in class on a completely different level than my classmates. I (can) relate to the material I learn in class due to my hands-on experience."

This story is from the fall issue of Penn State Outreach magazine. Go to to view the magazine online.

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Last Updated November 18, 2010