Late diagnosis of HIV in women in Greater Manchester, by Sheree Powell (MSc Public Health 2021)

When I started the Public Health Masters programme, I knew that I was going to do my dissertation on a sexual health related issue. Working in sexual health for several years I knew there were a few issues that needed research. One such topic that concerned me was the low HIV screening uptake from women had taken priority.  The issue seemed small because it had never been discussed during meetings or conferences that I had been to or watched, until I found a document that confirmed that women feel marginalised in HIV related care. The report was named ‘Invisible no longer’ and was authored by the Sophia Forum and Terrance Higgins Trust (2018). It helped me to brainstorm: (1) the aim of my dissertation; (2) how I wanted to collect the data; and (3) who I wanted to interview. During this time, I felt I won a quarter of the battle as I gradually searched for relevant details to eventually discuss with my supervisor.

A few months before any dissertation-related work was required, the lecturers organised a visit from Salford City Council public health to identify: (1) who has a project that may be helpful to them (2) provide a project or idea to those who did not have one. I liked the fact the lecturers were getting the class involved in work that could be used externally, as well as a chance to work with an organisation.

Photo by Lukas Blazek on Unsplash

I remember being excited to start my project as I watched my idea develop over the weeks and months before even writing the first line of my literature review! My aim was to identify the barriers and facilitators of women testing for HIV outside of maternity services in the UK, since evidence demonstrated women were not screening for HIV as much as men, nor were they being offered the test as frequently. Witnessing the lack of HIV testing for women first hand, I had a feeling it could be a result of a mixture of things such as the lack of HIV health promotion for women or women having a low perception of HIV risk as well as stigma. I really wanted to collect evidence to understand why women had such a low testing uptake, but to get there I knew I needed to speak to women who were HIV positive and I knew that could be a challenge since women are rarely approached for HIV related research.

Photo by Joel Muniz  on Unsplash

Understanding what I wanted to achieve was one thing but putting a project together was another! This is why a supervisor is very important. Your supervisor will help you to structure your project to maximise data collection as well as ideas and providing you with the necessary support you need. Don’t forget the library can help you with using journal databases so you can expand your search terms! I found that service incredibly helpful as I tried to focus on research from western countries.

Writing my dissertation started during COVID-19. Working on the frontline I now attempted to balance university work, home life (what was left of it) and work. It was incredibly hard and my headspace was all over the place. My supervisor and the university were incredibly supportive during this time and I am very thankful. As the first wave passed it was time to collect data and I ended up hitting a few hurdles for a number of reasons, but I had my supervisor to support me during this process and I was keen to understand the complexities of women testing for HIV kept    me going.

Finishing the project I could not be more proud of myself, especially completing it in such an uncertain time! I never felt unsupported. Some of my classmates became friends and we supported each other. One thing I was ecstatic about is sending my report to the Sophia Forum and receiving feedback! That is rewarding in itself!  In the end my project did not continue with Salford Council as COVID-19 erupted, but It did not stop me from sending my report to organisations who I felt who be interested to read my findings. I gained further feedback from them also, which ended up being submitted to an All Party Parliamentary Group HIV testing inquiry! Mega happy! Coming to the end of my blogging time, I want to say If you already have a project in mind in the early days of the course (1) brain dump as much things as possible (OneNote helped me to organise my brain chaos) and (2) gradually search for relevant things, at this stage you don’t have to worry about narrowing it down; just have an understanding of the topic, find out if it has been researched already and think about what your project could do differently (if it has previously been researched). Later on in the course you can discuss your project with your supervisor, where you can begin to narrow your ideas if necessary. Some things you may keep and others you may not, but what you have may form a framework for your dissertation, which can be half of the battle—well maybe a quarter of the battle! If you do not have a project I would recommend to find something that will keep your interest! There may be times when you do not want to write and it may sound cliché but my passion kept me going!

Day three and four in Uganda–training the teachers

By Penny Cook

Team work

The Teams4U motto is ‘real people making a real difference’, and one of the aims of the programme is to give the volunteers a life-changing experience. Some of the volunteers already knew each other and have done this trip before; others, like me, are new. It is amazing how quickly everyone has bonded and started to work as a real team. See my previous post for more information about the interventions. The games that we play with the children during the morning continue to be enormous fun, both for the volunteers and the children. The ‘Develop with dignity’ element has been refined and developed as we go along. The team members that deliver this element include a doctor, a nurse, a teacher as well as me. The final team member is a social worker from the local area. Fortuitously between us we have a combination of relevant skills, knowledge and experience.

Training the teachers
On day three, our usual format of our day was to be extended–after the main school programme, we went to a different school where we delivered a training session to all the senior female Primary 6 teachers in the district. The Head of Education in the district is a big supporter of the programme, and has strongly encouraged the teachers to come and facilitated their journey to the school where the training is to take place. P6 children are the target of the intervention–they can range in age from 12 up to 17 (because those who do not pass their exams do not move up to the next class). Whilst this was going on, other Team4U members did games, stories and face painting with the school children.

In the classroom with the teachers
In the classroom with the teachers

For the train the trainer session we decided to give an overview of our aims and then present the same material as we present to the children to the teachers, so that they could see exactly how we delivered the intervention. It seemed to go well and was enjoyable from my perspective. At the end we asked the teachers for their views and feedback. We had a long discussion about the other contexts of the child’s life, and how for some children there is a lack of encouragement to go to school. Some are given no money to buy the necessary equipment, many have no food for the middle of the day. Teachers commented that some children were spending the time away from school, with neither the school nor the parents knowing where they are. This potentially puts girls in situations where they are at risk of rape. Teachers often saw their school girls alone after dark–again this is risky. The teachers felt that we needed an intervention for parents, a suggestion that we agreed to take back for consideration. We had a long discussion about whether the intervention was aimed at the right age, and while there was a feeling that some children at that age were innocent (and it was tempting to ask why they needed to know about sex and condoms), there was general acceptance that children of this age can and do get pregnant. We heard a shocking story of a 9 year old girl who had given birth recently.

 

Mud huts
On the way home we stopped and visited one of the little mud hut settlements in a very rural area. A father showed us around. He allowed us to see into each hut: the smallest was where there was a simple fireplace made of stones on the floor. The cook pot rests upon stones, and the smoke is chokingly thick. Three children were in one of the other huts and the father had his own hut. His wife and baby slept in a different hut.

Children wearing gifts of school dresses brought by one of the volunteers © Penny Cook
Children wearing gifts of school dresses brought by one of the volunteers © Penny Cook

Cooking pot © Penny Cook
Cooking pot © Penny Cook

 

 

 

 

 

 

 

 

 

Day four and a Ministerial visit

The Games in the morning were great–the smile and excitement on the girls’ faces when they had a ball in their hands was just a picture, and it is so hard to put into words the satisfaction that we get from doing this. It seems to be reciprocated! The headmaster of today’s school made a special effort to tell us how important this visit was for him and the school, and a senior teacher told us that they will be adopting the games to play with the children every Monday from now on. I loved the pink uniforms in this school!

Playing games
Playing games

 

 

 

 

 

 

In this school many children received a school lunch, for which the parents have to make a modest payment. We learned that in some schools parents do not pay for lunches, and nor do they send food from home. School days are from 8am until 5pm in Uganda, which is a long time to go without food.

School dinners
School dinners

 

 

 

 

 

 

 

Other Team activities proceded as usual including the HIV counselling and testing. We have tested hundreds of people this week, both school children and their parents, and it is really good to be able to report that we have found very few people with HIV. About 7% of adults are estimated to be living with HIV in Uganda. Substantial progress has been made with testing and treating HIV, so that between the years of 2005 and 2013 the number of Aids-related deaths dropped by 19%.

Taking a small drop of blood for HIV testing
Taking a small drop of blood for HIV testing

 

 

 

 

 

 

 

In the afternoon were were honoured with a visit from Vaughan Gethin (Cabinet Secretary for Health, Wellbeing and Sport, Welsh Government) and Jon Townley (from Wales for Africa).  They were able to see Teams4U at their best, with an action-packed afternoon of HIV/AIDS & TB testing, Reproductive & Sexual Health Education, our Develop with Dignity programme; and of course, the smiles of hundreds of children having enormous fun with our enthusiastic volunteers!

L to R: Ben Omoding (T4U), Vaughan Gething (Welsh Gov), Penny Cook, Jon Townley (Wales for Africa), Ciara O'Donnell (volunteer), Father Deogratias Tembo, Sarah Sankey (volunteer), Dave Cooke (T4U founder)
L to R: Ben Omoding (T4U), Vaughan Gething (Welsh Gov), Penny Cook, Jon Townley (Wales for Africa), Ciara O’Donnell (volunteer), Father Deogratias Tembo, Sarah Sankey (volunteer), Dave Cooke (T4U founder)