TALC (Teens and Parents Learning to Communicate)
TALC enhances adolescents’ ability to cope with the issues that arise when living with an HIV/AIDS-infected parents. Without support, teens have trouble handling their social, behavioral, and mental health tasks in an HIV-affected family. Dr. Rotheram’s TALC intervention has successfully reduced HIV-affected adolescents’ mental health and behavioral problems, improving their coping as well as the family’s parenting skills and of the skills of the new caregivers of bereaved youth. TALC was funded by the National Institute of Mental Health (NIMH) and is now a cornerstone in an NIH-funded exploration of family communication and HIV/AIDS status.
Philani Plus (+)
Dr. Rotheram’s efforts with new mothers, babies, and families in South Africa represent her drive to make sure that families get access to the types of science that can help them by connecting vulnerable people with their surrounding communities.
The Philani program for child nutrition has blossomed into Philani Plus (+), another paradigm-shifting initiative in which peer mothers use mobile phones and home visits to support families’ problem solving to create health solutions addressing nutrition, alcohol use, depression, and HIV. Home visits by community health workers (CHWs) can get help to people for whom clinics are not a realistic option, whether due to access difficulties, human resource shortages, or use restrictions. The Philani Plus (+) Intervention Program builds upon the original Philani CHW home-visiting Intervention Program for maternal and child nutrition by integrating content and activities to address HIV, alcohol use, and depression.
Masihambisane: HIV+ mothers
South Africa has the highest number of people living with HIV and up to 40-60% of pregnant women in the Kwa-Zulu-Natal region are HIV positive. Mothers living with HIV often get health care and information from Prevention of Mother-to-Child Transmission (PMTCT) programs, but these interventions don’t usually address the daily struggles of maintaining their family’s physical and mental health. Dr. Rotheram created a program that promotes physical and mental health self-care during pregnancy then shifts focus to preparing and caring for the baby. She implemented this program in the Kwa-Zulu province, using peer mothers as community health workers and mobile phones to collect routine information, complete questionnaires and remain in contact with participants over time. Both these disruptive innovations resulted in better health and well-being for mothers, babies, and families. Dr. Rotheram focused the technological and peer efforts on pregnant women in part because pregnancy and neonatal phases are times of upheaval when habits and routines change dramatically, offering a perfect opportunity for dramatic positive health changes. Dr. Rotheram hypothesizes that mothers living with HIV who participate in the intervention will demonstrate significantly improved health-related knowledge, behaviors, and support than HIV positive mothers who don’t receive the intervention.
Mentor Mothers Zithulele (MMZ)
Mentor Mothers Zithulele (MMZ) was initiated in 2010 to pilot Philani’s outreach model in a remote rural area of the Eastern Cape at the site of a mission hospital, in the still underdeveloped former Transkei. Zithulele is acknowledged to be in one of the poorest areas in South Africa. Unemployment is well over 90%, and most families live in dire poverty. HIV and TB are extremely prevalent.
MMZ utilizes the positive deviant model developed in the Philani program, and mentors instruct new mothers in the community on nutrition, breastfeeding support, HIV and basic child health. The Mentor Mothers visit over 2,000 households in Zithulele through house-to-house visits. They support families to access grants, provide nutrition education, and refer children to health services where needed. In the near-absence of social worker input in the area, they address issues of neglect and alcohol abuse, often assisting in the child’s transfer to the care of a relative where needed. Where child-headed households are identified, Mentor Mothers provide crucial support to ensure access to social grants and proper nutrition.
Although the program has many challenges ahead of it, our experience suggests that the Mentor Mothers model can work in a rural area as well as in a township, and that it offers the possibility of better health to those living in seriously underdeveloped and under resourced settings.
HIV can be a difficult reality for families, especially for children with HIV-positive parents. While Thailand has a relatively low HIV rate overall, 1 in 4 elderly adults in Thailand will raise an AIDS orphan. While in Chang Rai and Korat, Thailand, Dr. Rotheram noted differences between Thai and American treatment of public health issues, including a family-based culture that could be a great source of support for people living with HIV, if they could more easily disclose without risk of stigma. People living with HIV in Thailand have the benefit of powerful public health advocates and deeply committed families yet they face multiple stressors including disclosure, stigma, and other challenges of maintaining health, mental health, and positive family relationships.
Dr. Rotheram designed the Family-to-Family (F2F) intervention to help children affected by HIV to cope with their family situation. To address this, Dr. Rotheram designed and implemented an intervention that focused on 1) healthy mind, 2) healthy body, 3) healthy family relationships, and 4) social and community integration. As with all her interventions, she carefully designed this program in a systematic manner, collaborating with Thai people who were directly affected in order to ensure the success, cultural relevance, and sustainability of her work. This model builds on proven components of other successful interventions and tailors them to the Thai culture, where a highly educated and health-forward population uses meditation and family-focused techniques to create wellness. Dr. Rotheram’s solution helps Thai families builds skills for establishing supportive community relationships with other families affected by HIV. Implementation of her program delivered substantial improvement in quality of live in people living with HIV in that area.