As an artist who has worked in a variety of settings, countries, and languages, I know one thing for sure: images can communicate what words cannot. Arts theorist Douglas Crimp took this assumption one step further in his famous 1987 pronouncement,"[A]rt does have the power to save lives." His words were referred to over and over in the world of arts activism, particularly during the AIDS outbreak in the United States.

As I began my training in public health, this concept stuck with me, and it did not take long to notice that indeed, many successful prevention efforts were based on the ability to communicate clearly, succinctly, and perhaps most importantly, in a way that people would internalize. However, Crimp and many others since have asserted that art can be much more than a tool used simply to educate; art can also stimulate policy change at community and institutional levels.

During my time as a UNC-IntraHealth fellow, I have had the chance to work on IntraHealth’s USAID-funded Central America Capacity Project, which shares the goal mentioned above of creating change in policy and practice to strengthen the quality of care and improve the quality of life for people living with HIV/AIDS and most-at-risk populations . One strategy in meeting this goal is to strengthen the local continuum of care (CoC) networks supported by the project. These networks include health care workers, civil society members, government officials, and other community members who come together to collaboratively make changes in HIV prevention, support, and care services in their geographic areas.

My fellowship provided an opportunity for IntraHealth staff to consider using photovoice—an approach that would complement the Optimizing Performance and Quality method currently being used by the project to increase the impact of the CoC networks on the national HIV response in Guatemala. The photovoice methodology is an innovative, participatory process developed by Dr. Caroline Wang that is used to identify problems and solutions at the community, system, and interpersonal levels. Photovoice enables community members to:

• Use photography to identify and record their community’s strengths and struggles
• Explain their experiences through critical reflection and group dialogue
• Use their visual images and accompanying stories to reach policy- and decision-makers.

Photovoice has been used in a variety of countries to address varying health issues, and a careful review of projects that had used the method convinced IntraHealth's staff that photovoice could potentially improve basic HIV clinical and preventive services provided through the CoC networks. As a result of the participatory process of identifying problems, solutions, and action steps, policies and practices at community and institutional levels can be more freely critiqued and changed.

Staff from IntraHealth’s office in Guatemala and I worked together to pilot a small-scale photovoice project from June 15-20 with participants from three different CoC networks operating in different parts of the country.

The workshop included six participants from diverse personal and professional backgrounds: a psychologist, a health promoter, a support group leader, two transgender female sex workers, and a government worker living with HIV for nine years. On the first day, participants learned basic camera use and photographic techniques, discussed ethics related to photography and the topic of HIV, and immediately set out to take pictures that represented their personal experiences and work within a network. The following days were dedicated to a structured and intense discussion of the stories illustrated in their photographs and reflection on common themes revealed relevant to their participation in the CoC network, using the photovoice SHOWED acronym:

S – What is SEEN here?
H – What is really HAPPENING?
O – How does this related to OUR lives/work?
W – WHY are things this way?
E – How would this image EDUCATE/EMPOWER people?
D – What can I DO about it?

By the end of the workshop, each participant had identified concrete and specific actions to improve their work. One of the participants, a psychologist at the regional hospital, used a picture of a loved one sitting by a tombstone to discuss the challenge of providing family members of patients with the appropriate support and proposed a local campaign that would help educate families on how to support and care for their HIV-positive loved ones.

I had the opportunity to see some participants hold their very own digital camera for the first time, watch them come back eager to share, get carried away in a two-hour discussion about stigma and discrimination, and witness six individuals present their experience and photographs to high-level officials. As a facilitator, I got a small glimpse of the transformational power of the arts that Crimp, Wang, and others refer to. It was challenging to try out such a participatory, process-oriented method in a project that is highly concerned with tangible changes in services. However, the pilot pushed the boundaries of staff members’ and participants’ ability to communicate clearly and concisely without any of their usual tools. It pushed us all to think about how picking up a camera truly could be a small step toward reaching our results.