Faculty Spotlight - Gary Harper

Gary Harper, PhD, MPH, is a Professor in the Department of Health Behavior and Health Education. Dr. Harper's research and community work have focused on the health promotion needs of adolescents who experience varying degrees of oppression and marginalization, especially gay/bisexual male youth and youth of color, with a focus on giving voice to the social justice needs of young people both in the U.S. and in Kenya.

What has been your career path in global health up until now?

I got into global public health a bit by accident. Before I came to the University of Michigan, I taught at DePaul University for 17 years. In December 2004, the university took a trip to Kenya to see how we could share resources and develop new projects there. During that first trip, I met with a group of nuns in rural Kenya who were working in a small health center, and who wanted to know if I could help with HIV prevention work.  I was able to do some strategic planning, meeting, and training with them. I was also asked by a group of young people to do an HIV prevention workshop, which I held for 35 adolescents who had come from up to two hours away to attend. That got me excited about the potential for the work we could accomplish.

During that same trip, I met with people from Centers for Disease Control and Prevention about ways to connect with projects in Kenya. They were starting a PEPFAR project on capacity-building through the Catholic Church for school-based prevention programs. I was especially interested in the capacity-building component. So it was a combination of the personal connection I made with rural villagers and the opportunity to do this work that got me into global health.

What prepared you to work in global health once you discovered it?

I’d been doing HIV prevention work since 1985. I had a long history of domestic work in HIV, all of which was in collaboration with community-based organizations, particularly community-based participatory research. I was also doing a lot of service delivery, not just research, involving front-line HIV prevention. Having that hands-on, on-the-ground experience was extremely beneficial.

What research projects are you currently undertaking?

Too many! In Kenya, I have one project funded through the University of Michigan Global Public Health Initiative and the African Studies Center that’s a study of risk and resiliency factors among young men who have sex with men in western Kenya. We are quantitatively testing a socio-ecological model that we developed through a series of community collaborations working with LGBT community members and health educators, through a computer-assisted self-administered survey.

A group of us has also been working with the University of Nairobi on adapting a U.S. intervention for adolescents living with HIV, to be appropriate for adolescents newly-diagnosed with HIV in Kenya. A couple of MPH students are conducting secondary data analysis of the focus groups that we ran there, and we’re getting ready to re-submit a grant application on that project.

My major long-term project is relating to an HIV prevention program for school-age children (11-14) through Catholic schools in Kenya. We just finished up a large-scale evaluation and have also recently received data to look at school-wide effects of the intervention. The intervention is about more than just HIV – it’s a youth-centered interactive learning model about helping children make responsible choices relating to sexuality, substance abuse, and family, etc. Anecdotally, we’re learning that the school itself is changing, and changing the learning model for children.  The study is a case-control study between schools, looking at data over five or more years relating to pregnancy rates, school violence, dropout rates, school performance, etc. We’ve set up a sustainable system through capacity-building, with the intervention delivered by volunteer teachers and a train-the-trainer, so that we can be removed from the project and it can still continue.

In Kenya, I also do a lot of public health practice work. A group of us run a 501(c)(3) international NGO called the Rafiki Collaborative. We do what I consider true capacity-building - working on the ground, with organizations. This includes grant writing, organizational development, and fundraisers to help provide resources for the programs. For example, one project works with a youth empowerment agency called Youth for Life. Their Girl Empowerment Project provides pads for girls who are menstruating so they can go to school, and it teaches them sexual and reproductive health skills with a female empowerment perspective.  I’m also working with LGBT organizations around activism and human rights.

I’ve also been working in Botswana for the past couple of years, with an organization called Murang. They‘re a group of social workers who provide a range of services to children and families affected by HIV and other psychosocial and mental health issues. With that, I’ve been working with Children’s Place International, which is based in Chicago, to develop a manual to help service providers work with adolescents to provide psychosocial services. We took a U.S.-developed manual on family conflict and communication, and worked with folks in Botswana on a cultural adaptation of the manual. It’s now a national curriculum for providing psychosocial services to adolescents. The project is wrapping up, but we’re trying to find more money for it.

Lastly, we’re in the beginning stages of some work in Zambia. We had two MPH students who spent the summer there working with the Elizabeth Glaser Pediatric AIDS Foundation, along with Children’s Place International, to develop a curriculum that will help adolescents living with HIV with psychosocial and medical adjustment. We’re currently in the process of getting more funding to develop the curriculum.

What advice do you have for students who’d like to get involved in global public health work or research?

The first thing is to do your homework. You need to learn about the country’s culture and their history. You need to understand the politics of the country you’re working in, and what their social systems and social structures are like. Otherwise, it’s a point of privilege to go in without doing your homework and expect people there to teach you.

People also need to be aware that global health work is hard, both physically and emotionally. Don’t do the work because it’s cool or fun. You need to do it because you care about supporting people in resource-poor settings. You need to have a passion for doing it, and it helps to have a strong social justice orientation.

You have to be highly adaptable, and you need to be able to think fast on your feet. You have to be used to things not going the way you planned them to. Timelines are readjusted on a weekly basis, and there’s always a glitch, so you have to be comfortable with ambiguity and with change.

It’s important to spend some time engaging in self-reflection, and to think about why you’re doing this work. What is your motivation? Why are you doing global public health work? Is it because you think it’s cool? You really have to think about it very seriously.

You have to think about your power and your privilege. It’s very critical in different settings to work to break down power differentials. The U.S. has such a history of bringing foreign aid to these countries, that people may say anything they think you want to hear because they need the money so badly. You really need to work to examine and breakdown these issues. It’s about cultural humility. I talk about that a lot when I teach, and it’s even more critical when working on a global scale.   

Students need to keep in mind that not everyone needs to do global health work. That introspective piece is incredibly critical. You have the potential to do a lot of damage if you’re ill-equipped for it – both to yourself and to the people you’re supposed to help.

As students, what can we do to prepare for global health work in terms of skills or coursework?

It’s good to have skills on how to develop, evaluate and implement programs, as well as financial and fiscal management skills. A lot of times, you end up doing a little bit of everything when you’re there on the ground. You also need to be able to understand non-profit management and organizational dynamics. A lot of work you’ll do will be with NGOs, and if you’re in capacity-building, you need to have a sense of how organizations work and function, how to do strategic planning, and how to help organizations develop a mission, vision, and objectives.

Understanding cross-cultural communication is extremely important. If you’re targeting a specific region/country, take a class on the history and politics of the area, or the economic dynamics. For example, a lot of people want to work in sub-Saharan Africa, but know nothing about the history of it. Finally, religion can often play a really strong role many places – you need to know and understand that.  

Are there more opportunities for students to engage in your projects, currently or in the future? What skills would they need, and what could they expect to learn?

In Kenya, we have a lot of qualitative data, for students who are interested in qualitative data analysis. We’ll also be getting more quantitative data sets. In Zambia, depending on what happens, there would be opportunities to help with developing the intervention manual.

For data analysis, it’s good to have qualitative and quantitative analysis skills. For the intervention development, students would ideally have experience working with adolescents living with HIV, or in health promotion/health education programs.

In terms of public health practice, students could be involved in short-term work. Our purpose is capacity-building, so developing or running workshops, strategic planning, or organizational assessments is where students would be the most helpful.

Learn more about Professor Harper’s work

Written 12/6/2013