Guan, Xuefan

School of Public Health



Sharing our Story: Visual Communications for Sauti Project

Tanzania's HIV prevalence in the general population is down from 7% in 2003/4 to 5% in 2016/17. The ongoing scale-up of antiretroviral therapy and prevention of mother-to-child transmission of HIV services, rapid scale-up of the national voluntary medical male circumcision program, and an increasing modern contraceptive prevalence rate (17% in 1999 to 27% in 2010 to 38% in 2015/16) are just a few of the successes.

In hotspots across the country, however, HIV incidence remains unacceptably high (up to 39% for certain Key and Vulnerable Population [KVP] groups) and the achievements made in the general population have not translated into progress for all. Tanzania is facing a heterogeneous HIV epidemic in which KVPs are disproportionally affected and underserved by HIV and Family Planning (FP) programs. This is largely because of these groups' social, economic and legal status, and ongoing stigma and discrimination. The epidemiology shows that Tanzania's fight for an AIDS-free generation cannot be won if these key and vulnerable populations are left behind.

Sauti is a five-year (2015-2020) United States Agency for International Development (USAID) funded health project implemented by Jhpiego - an affiliate of Johns Hopkins University, in partnership with EngenderHealth, Pact, and NIMR/Mwanza. Sauti Project supports the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and the Tanzania Commission for AIDS (TACAIDS) to operationalize the new National Guidelines for Comprehensive Package of HIV Interventions for Key Populations and works from the community to health facility level to improve access to quality HIV prevention, treatment and care, and FP services. KVPs include female sex workers (FSWs), men who have sex with men (MSM), adolescent girls and young women (AGYW), and partners of female sex workers (PFSW), etc.

The goal of Sauti is to contribute to the improved health status for all Tanzanians through a sustained reduction in new HIV infections in Tanzania in support of the Government of the United Republic of Tanzania's commitment to HIV prevention. Sauti's vision is that all KVPs - in program communities participate in a core package of tailored, client-centered combination (biomedical, behavioral and structural) HIV prevention, and FP services, with strong linkages to care, treatment and other services. In addition, the project stimulates community dialogue around stigma, discrimination and gender-inequitable social norms, to round out the package of services.

PI Mentor: Lauren Borsa

For my GHEFP experience, I worked at Jhpiego on their Sauti-DREAMS project in Dar es Salaam, Tanzania. I mainly helped them develop a video story of Sauti-DREAMS project and also design other visual communication materials such as infographics and brochures. In sub-Saharan Africa, adolescent girls and young women are 3 times more likely to be infected with HIV, and more vulnerable to gender inequitable norms, gender-based violence, lack of educational opportunities or access to healthcare resources and so on. The Sauti-DREAMS project helps those vulnerable population to protect themselves from HIV and be more educated, determined, resilient and safe women.

Living and working in Tanzania was challenging at the beginning but was delightful later and became an unforgettable experience. For the first few days in country, I was not used to their working schedule and pace.  Their local staff usually went for lunch around 1 pm and sometimes many staffs had a relaxing lunch break together for one or two hours and then got back to work. They seemed to work in a relatively slow pace comparing to that in the U.S. or China, but they also had clear and organized schedule. Another challenge was the language. Although local staff and many local people can speak English, they prefer to use their own language-Swahili in their daily life. I felt a little bit frustrated at the beginning because everyone in the office spoke Swahili, and I was not able to understand their conversation at all. What’s more, the language barrier made the fieldwork difficult and inefficient. One main visual communication product I developed was a video story of the project, which included some interviews of project Beneficiaries and stakeholders. Since I didn’t speak nor understand Swahili, my colleague had to translate everything for me when I was recording interviews in the field to make sure that we got all necessary contents. The language barrier also made the video post-production difficult, in which my colleague had to translate all interviews sentence by sentence into English so that I could edit video and add English subtitles according. This also created a lot of misinterpretation and misunderstanding.

Although there were a few challenges, I was able to learn how to work in global settings and I gained many important skills that will help my in future career development. During my field placement, I had opportunity to learn some Swahili language with local people, and learn their cultures, their perspectives of health and their experiences when we hang out together. Going into the intervention areas to interview local adolescent girls and young women provided me a great opportunity to go out of my comfort zone of only sitting at the office, and to learn more about how the project’s target population lives and what the project has brought to them. What surprised me the most was that those girls were living in positive and cheerful lives even though some of them were HIV positive. They were very open and willing to talk about their own stories in front of my camera. I remember some of them said that they want to educate more girls who are like them and help them become more independent and stronger.

This summer in Tanzania gave me valuable assets in global health field and makes me think more of working on the health communication side to help develop more accessible and acceptable interventions in global settings as I saw that many female especially young women and adolescent girls are still not well-educated, protected, not having equal rights compared to their male counterparts in many developing countries,. I want to develop more video stories in my future career to encourage more healthcare stakeholders to reach out to vulnerable groups.  If I get a chance to work in another global health project in the future, I would be more open, proactive and quicker to get into local lives. 

I am recording an interview at one of the intervention regions with a local healthcare provider who is providing family planning counseling and HIV prevention tools to adolescent girls and young women.  My colleagues are translating and interpreting our conversations.

This is a group photo with our project’s local beneficiaries. These young girls are vulnerable, but they are living in positive attitudes because they are learning how to protect themselves and becoming more resilient, educated, and independent by joining the project groups.

This is the road in front of our office, which I walked on every day. This is a relatively well-developed area. 

 Sunrise is the most peaceful and pure moment of a day. 

I traveled to Serengeti National Park on a weekend when I was in Tanzania. The experience was amazing and impressive. I saw many wild animals in a close distance, and I felt that all of my negative feelings (stress, anger, sad etc.) were purified by this land. 


October 2022




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