Skip to main content

Table 1 The Amagugu intervention detailing the six steps, purpose of the steps, materials and activities and session goals

From: Maternal HIV disclosure to HIV-uninfected children in rural South Africa: a pilot study of a family-based intervention

Session/Visit Description Purpose Materials and activities Session goals
1: Positive parenting One-on-one counselling session between mother and lay counsellor which takes place by arrangement at the home Assess mothers' readiness to disclose, offer psycho-education on disclosure steps, communicate pros and cons of disclosure, encourage an informed decision to participate and proceed with disclosure My intervention steps poster Increase mothers’ knowledge about age-appropriate disclosure
A3 illustrated colour poster
My intervention calendar Increase mothers' understanding of risks and benefits of disclosure
A5 illustrated colour card
2: Positive families Family visit co-facilitated by the counsellor and mother - family invited by the mother (either biological or socially-defined members); not an HIV specific activity as children are present Engage family members in a fun family process, create a sense of belonging and pride, use a strengths-based model, communicate respect for culture and values, introduce concept of play-for-communication and materials My family tree Increase family awareness of parenting aims of the intervention
A2 family tree poster with 14 illustrated sticker characters Encourage a sense of belonging among all family members
3: Positive life stories One-on-one counselling session between mother and counsellor using artwork and narrative therapy activities Improve emotional well-being of the mother in preparation for disclosure; use ‘head, hands and heart’ model to maintain empathy and introduce concepts of emotional work; use artwork to facilitate positive experiences of love, relationships and to unpack the story of becoming HIV infected and living with HIV; dispel myths and misperceptions about HIV and offer HIV information My life story Mother feels supported, respected and understood by the counsellor
A4 paper, artwork materials Mother constructs a family/parenting narrative
My HIV story Mother more emotionally contained and able to focus on the child
A4 illustrated HIV story telling exercise Mother has confidence in her HIV specific knowledge
4: Positive practices One-on-one training session to personalise 5-step disclosure intervention and practise using role-play Offer specific guidance on planning and preparing the disclosure event (time, place and people) Talk and play reminder Mother increases her understanding of what is age-appropriate and is confident to talk about HIV in a child-friendly way
A5 illustrated colour card
Teach the 5- step process and what each step offers the child Family life line Mother develops and practises her own talking points, has a language to use in approaching disclosure
A4 card artwork and stickers
Demonstrate the 5-step disclosure intervention and teach age-appropriate activities and games HIV body map Reduce mothers' anxiety about ‘dreaded questions’ by developing child friendly and age-appropriate answers
A4 HIV body map game with stickers
Through practice ensure that mother is skilled, confident, and feels enabled to undertake disclosure using the intervention tools and materials. Playing cards Mother understands child’s needs for information, activity, reassurance and comfort
A7 10 matching pairs playing card set
Help mother develop her own child and family personalised materials Safety hand Mother is confident to proceed with disclosure
A4 card and pens for artwork
Allow for role playing, practice and development of personal talking points Family treasures story book
A5 illustrated 14 page English-Zulu story book
5: Positive planning One-on-one training session to train mother on health promotion activities and to prepare for a joint parent-child clinic visit Encourage mothers to move beyond disclosure and increase health promotion and the child’s access to a health support network and improve custody planning. Demonstrate clinic visit games and activities and encourage mother to take the child on a clinic visit, empower mother to advocate for her own and her child’s health care needs, counsel around fears and stigma Clinic visit reminder Mothers move beyond disclosure to health promotion and planning
A5 illustrated colour card
Name tag Mother is able to advocate for her and her children’s health rights
A8 name tag with beaded strap
Clinic check list Mother ensures that HIV treatment is demystified and personalised for the child
A4 “I-spy” game
My care circle (health) Health care environment becomes familiar
A4 illustrated card with health care contact information Increase child’s participation
Child has increased understanding of healthy sexuality
6: Positive futures Family session facilitated by mother and attended by counsellor, provides mother and children opportunities to share intervention learning and achievements Reinforce play-for-communication, teach mothers basic skills for developmental play, provide positive reinforcement for emotional sharing, allows the child to participate, develop self efficacy and pride around intervention achievements Uthando doll Mothers have increased understanding about how children use play to communicate
Handmade ethnically appropriate doll
My care circle (custody) Children feel valued and rewarded for participation
A4 illustrated card with emergency care contact information