Holmes, Leah

School of Public Health - International Health


South Africa

South Africa-Multi-level determinants of uptake and adherence to a novel women-empowered HIV prevention strategy

Witkoppen Health and Welfare Centre is running an implementation study focused on HIV prevention for adolescent girls and young women (AGYW) in Johannesburg. AGYW attending clinic or community-based venues and testing HIV negative are recruited to participcate in a study offering them HIV self-testing kits for their male partners, as well as pre-exposure prophlyaxis (PrEP) for AGYW who perceive themselves to be at high risk for HIV infection. Embedded within the DREAMS Innovations grant, is an NIH study assessing qualitatively barriers and facilitators to completion of each step of the HIV prevention cascade for partner testing and PrEP. This is an exciting multi-component HIV prevention study that includes both opportunities for quantiatve and qualitative research experience.

PI Mentor: Sheree Schwartz

The reality of my expirience in Johannesburg far exceeded my expectations. The women I worked with were extremely resilient and they epitomize how powerful community-driven approaches to development can be. After living and working in South Africa for five months, these women became my family, and, thanks to them, I learned the nuances of South African culture and I was encouraged to view adversity and privilege from a different perspective. 

During my time there, I was involved in two studies that aimed to understand the barriers and facilitators adolescent girls and young women (AGYW) face in initiating and adhering to a combination of HIV prevention interventions. The two interventions included (1) secondary distribution HIV self-testing and (2) oral pre-exposure prophylaxis. One of my roles was to assist with recruitment, enrollment, and data collection for one study that quantitatively assessed these questions and my other role involved overseeing and conducting the data analysis for a qualitative study that also addressed these questions. One aspect of my practicum that I loved was my involvement within the implementation portion of the program. This allowed me to travel to informal settlement sites to assist with HIV testing, study recruitment, and data collection. It is one thing to read about the challenges that individuals of a certain population and certain area face, but to be in the community, interact with the people living there, and observe their living conditions gave a whole new perspective. 

Some challenges I faced were one, not being able to speak the local languages. While English is a compulsory language in South Africa, there are twelve official languages. While I could communicate with everyone in English, most of my co-workers, and most of the research participants did not speak English as their first language. A lot of informal conversations happened in one of the twelve languages which made it very difficult to pick up on local dialects. Additionally, since I did not speak these languages, I could not conduct the in-depth interviews for the qualitative study. This forced me to creative and develop a method for communicating essential qualitative skills, ethics, and data concerns to the local researchers who were conducting the interviews. Fortunately, the researchers we worked with were extremely open and welcomed any feedback from me, the local team, and my superiors, which made it a comfortable environment to share feedback and constructive criticism. Another challenge I faced was safety. Before arriving in Johannesburg, I had heard a lot of negative things about the city, specifically around crime. While a lot of that was true, I that this made the expirience very humbling and made you constantly recognize the different dimensions of privilege. 

This expirience has shaped my plans for the next step in my academic and career trajectory. I loved being involved in research and realized that this type of work satisfies my curiosity. I also realized that I was intrigued by the work the nurses and counsellors did and that a more clinical career might be something I pursue later in my career. Overall, this expirience really helped solidify where I want to focus my research and career interests going forward and has provided me with the skills to confidently work on public health programs in the future.

Leah (right) with community liaison officer (Gloria) from Witkoppen Health and Welfare Center at a DREAMS Innovations recruitment site in Cosmo City, northern Johannesburg


Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

August 2019



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