There are two key challenges facing South Africa’s public health system.
- Increasingly high prevalence of HIV among the adolescent population, where currently over 15% of young women and 5% of young men aged 15-24 in South Africa are infected with HIV.1
- An increasing burden of mental illness, where nearly 1 in 3 South Africans will suffer from a mental disorder in his or her lifetime – a higher prevalence than any low-or middle-income country and the third-biggest contributor to the national burden of disease.2-3
Project Khuluma recognizes that these challenges are intertwined, and tackles them through mobile support groups.4 On one hand, HIV/AIDS affected and infected adolescents may be at increased risk of mental health problems and distress caused by stigma and social isolation.5-7 On the other hand, depression and other mental health disorders can lead to poor treatment adherence8.
The Khuluma model is a social approach to mental illness that brings together two concepts – the power of small support groups, and the power of mHealth – in an integrated platform, which breaks down barriers to create a support group that is accessible, anonymous, immediate and age appropriate. It provides a platform for participants to correct misconceptions about their illness and receive accurate information. It also provides a space where participants feel free to discuss medical adherence and disclose details of their condition.
Khuluma was set up to break down the following barriers to support groups:
Stigma and discrimination
Despite nation-wide campaigns in South Africa, many fear disclosing their chronic illness or HIV status and experience stigma and discrimination in the communities that they live in.
Access (finding the time to attend a support group)
HIV-positive adolescents can have complex lives, with regular visits to clinics and hospitals to pick up their medication and check-ups, along with attending school and fulfilling responsibilities at home.
Social Isolation (finding support groups tailored to adolescents)
If they are lucky enough to have access to support groups at their clinic or hospital, the groups tend to cover a wide age range, making it challenging to bring up age-appropriate topics.
Funds (having the necessary funds such as transport costs available to attend)
Details of the Khuluma model
- There is a maximum of 15 people per support group
- The support groups run for a period of three months, each day, after school hours
- The facilitator brings up a ‘topic of the day’ to generate a conversation within the groups
- Guest speakers are also invited to run facilitated discussions on specific topics such as nutrition, education, careers advice or sexual health
- 40 000 unique messages were sent, with an average of 6 SMS’s a day per participant
An extract from an SMS conversation:
- Facilitator: If you are HIV positive and you have sex with someone who is also positive do you still need to use protection - like a condom?
- Participant one: I dnt knw.
- Participant two: No he is negative
- Facilitator: Even if both partners are HIV positive they can still be infected with slightly different strains of the virus. So always use a condom.
- Participant two: That is new.