HIV - the virus that causes AIDS - affects more than 30 million people worldwide. About half of them are women. An HIV diagnosis can lead not just to debilitating medical problems but also to social stigma and isolation.
However, a unique photography project is giving some HIV-positive women a new way to look at their disease and its challenges.
University of Missouri-Columbia researcher Michelle Teti has been doing HIV prevention work in the United States for about 10 years and was struck by what she saw as a mismatch between what public health programs offered and what HIV-positive women said they needed.
"Sometimes HIV wasn?t even the biggest priority. They might not have had housing. They might have been in violent relationships," says Teti. "So I decided to kind of take a step back and find ways to let women identify their health priorities, and identify problems, and identify solutions."
With the help of health organizations in Philadelphia, Pennsylvania and St. Louis, Missouri, Teti recruited HIV-positive women to participate in a photography project. She gave them digital cameras, taught them how to use them, and sent them out to photograph their lives.
Some women took pictures of themselves. Others photographed people in their support networks, or specific challenges they were facing, like substandard housing. And many, Teti says, used the photographs to show how they had worked to change their lives after being diagnosed with HIV.
"A lot of women - when they found out they were living with this virus - felt kind of desperate or hopeless, and a lot of women described a transition, or transformation, to a place where they were more hopeful and healthy."
That was the case with 26-year-old St. Louis resident Tamika Taylor Jackson, who learned she was HIV-positive in December 2001. Her husband left her while she was in the hospital. Then the bank foreclosed on Jackson's house, leaving her with three young children, and nowhere to live.
"When I first was diagnosed, it was a very hard and emotional thing for me," says Jackson. "And some of the closest people that I thought would be there for me was not there for me because they thought I was just a big disease, a big germ."
Jackson used the photography project to show how she has transformed her life since her diagnosis. She took pictures of the houses she?s lived in, her medications and the spiritual books she reads for inspiration.
Jackson also took pictures of her shoes. Not real shoes to wear, but miniature ceramic ones, in brightly-colored patterns. She has about a dozen of them, prominently displayed on shelves near her front door.
"Every time I?ve accomplished something, I always go out and find a shoe to reward myself with. I?ve made progress, I?ve stepped up, I?ve achieved something, so I?m going to go find me a shoe."
The first one was a gold boot.
"And I purchased that when I realized to myself that, 'OK, I want a divorce.' Then came, I believe, the zebra-striped shoe at the top."
Another shoe was for finding a place to live.
A yellow shoe represents the time during which she met her boyfriend. Jackson bought a shoe when she found a better house, got a job, bought a car, and she bought a shoe when she moved into the home she lives in with her children today.
Researcher Michelle Teti hopes all the women in the photography project can hold on to that feeling of positive transformation.
"They?re just really strong women and really just committed to being healthy and being better," says Teti, "and this process allows them to reflect on that."
Participating in the photography project, she adds, can give HIV-positive women a new way to look at their lives, to figure out what they may still want to change, and to congratulate themselves for what they?ve done right.