Reported impact of creativity in the Wakakosha (‘You’re Worth It’) internal stigma intervention for young people living with HIV in Harare, Zimbabwe

Abstract

Internal stigma (negative judgements towards oneself) continues to be a barrier to HIV treatment, managementandcare,andhasglobal public health consequences. People liv ing with HIV (PLHIV) who report internal stigma are less likely to seek care, adhere to treatment and can experience increased depression and lower quality of life. The Waka kosha (‘You’re Worth It’) programme sought to reduce internal stigma among young PLHIVusing inquiry-based stress reduction (IBSR), a cognitive and awareness-based methodology. This sub-study focused on creativity, exploring how it promotes young PLHIV’s well-being. We analysed individual interviews (n = 14), focus groups (n = 3), poems(n=5),songs(n=2)andself-compassion letters (n = 38) and 23activity journals from November2021toMarch2022,utilising inductive thematic analysis to identify themes across the data. Creativity saturated the Wakakosha intervention through modali ties such as drawing, colouring, body mapping, music and letter writing. These engaged participants and gave them a space in which to shift their internal stigmatising beliefs, and helped them in multiple ways including: facilitating emotional regulation, self-acceptance, self-compassion, self-worth and body positivity. Creativity also enhanced participants’ self-image and allowed them to see their own abilities. Music improved the therapeutic environment by helping participants focus, emote, retain messages and connect within the group setting. Letters to self/others allowed participants to let go of stigma towards themselves and the circumstances of their infection. Tools such as drawing and body mapping assisted participants with emotional recognition and expression. This sub-study provided insight into the potential of creativity, when integrated into an IBSR intervention, in counteracting internal stigma. Ongoing replication is needed to continue to evolve best practices for internal stigma interventions. Future work should use more structured and specific interviews with participants regarding their creative processes.