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Published by GTZ Basic Education Programme, P O Box 31131, Lilongwe 3, Malawi GTZ 2009 The choice, presentation of facts contained and opinions expressed in this manual are responsibility of the editor and the conributors and do not necessarily represent the views of GTZ. Any part of the manual including illustrations may be duplicated, photocopied, reproduced or adapted for non-profit purposes without permission from GTZ, as long as sources are acknowledged.
Dedication
This manual is dedicated to the thousands of Malawians, who have participated as peer leaders and group members, in the Mzake ndi mzake peer group education for HIV and AIDS prevention project. We have included hundreds of their observations and quotations. Their contributions have greatly enriched this publication.
Acknowledgements
This book is a complete revision and expansion of the first edition of Mzake ndi mzake and it would be impossible to name the hundreds of people who have helped to create it, but we must single out a few for special recognition. We give thanks to the creators of the first edition of Mzake ndi Mzake which was developed from the work of Kathleen and James Norr and Chrissie Kaponda, with the assistance of the health professionals of the Kamuzu College of Nursing. The Mzake ndi mzake peer groups contributed ideas and suggestions for this edition: Lilongwe Primary Teacher Training College Blantyre Primary Teacher Training College Karonga Primary Teacher Training College Kasungu Primary Teacher Training College St Joseph Primary Teacher Training College Maria Tsvere, GTZ consultant and lecturer in HIV and AIDS at Chinoyi University, Zimbabwe led the first revision workshop. Venencia Kabwila, formerly manager of the GTZ HIV and AIDS programme. Sindisiwe Kabwila, former GTZ HIV and AIDS mainstreaming advisor, planned and directed and the revision. Lillian Muyunda Byers, Acting Country Director, International HIV/AIDS Alliance, Lusaka, Zambia contributed scores of activities and observations. Andy V Byers, GTZ consultant, redesigned and expanded the original draft of Mzake ndi mzake by including activities drawn from his publications Exploring Religion and Morality (Oxford University Press) and The Science Teachers Handbook (Heinemann). He illustrated this edition with his own drawings and those of Isaiah Mphande, Paul Ndunguru, Madalitso Chauluka and Rawlings Demba. Wilfried Goertler, former GTZ Team leader who initiated and encouraged the revision process. Georg Mades, Malawi GTZ Team leader, whose quiet determination and unflinching support brought this book into being.
Contents
Introduction ............................................................................................ What it means to be a peer educator ..................................................... How to use the manual .......................................................................... How to conduct a session ....................................................................... 11 12 13 14
Unit 2
2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24
Unit 5
5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9
Condoms .................................................................................... Assignment review ......................................................................... If a man can carry a condom why cant a woman?....................... How strong is a condom?............................................................... Dont condoms have holes in them that allow HIV through? ..... Condoms are not romantic ............................................................ Sex with a condom is like eating a sweet inside the wrapper ...... Can condoms come off and remain inside a woman? ................. But we never use condoms dont you trust me?........................... But I love you, why use a condom? .............................................
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5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24
Condoms can cause impotence, cancer and TB! ........................... Semen is necessary to help a baby develop properly ................... Condoms are only used by prostitutes and the unfaithful ........... Doesnt promoting condom use encourages promiscuity? .......... Can I wash the condom and use it again? ..................................... Preparing to demonstrate how to use condoms ........................... How to select and store condoms .................................................. How to use a male condom correctly ............................................ The female condom ...................................................................... How to use the female condom correctly ..................................... The lifeboat game: values and condoms ....................................... Role play: Advising a friend about safer sex ................................. Role play: Talking about prevention of STIs ................................ Role play: Dispelling false beliefs about condoms ........................ Assignment: Discussing condoms with a partner or friend ........
71 71 72 72 72 73 73 74 75 76 77 78 78 79 79
Unit 6
6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13
Talking with your partner about HIV .................................. Assignment review ......................................................................... Barriers to communication about safer sex ................................... What is needed to change risky behaviour? .................................. Communicating with your partner about safer sex ..................... How does an aggressive partner behave? ..................................... How does a passive partner behave? ............................................ How does an assertive partner behave? ........................................ Responding to an aggressive partner ............................................ Finding a mutually acceptable solution ......................................... Can condoms be an enjoyable part of your love life? ................... Role play: Talking about safe sex with a new partner ................... Alcohol drinking or drug use and sexuality ................................. Assignment .....................................................................................
80 80 80 82 82 83 83 83 84 85 86 87 88 89
Unit 7 HIV and AIDS testing and ARV drug treatment ............. 90
7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 Assignment review ......................................................................... What happens when you go for VCT? .......................................... What are some reasons for not going through VCT? ................... What are the advantages of going through VCT? ........................ Why is counselling an important part of VCT? .......................... What is the clinical approach to diagnosing AIDS? ..................... What is the laboratory test approach? .......................................... What are the advantages of finding out you are HIV negative? .. What are the advantages of testing with your partner if you learn that both of you are HIV positive? ................................ 7.10 What are the advantages of testing with your partner if you learn that one of you is HIV positive and the other one is not? ... 7.11 Where can I go for a free VCT? ..................................................... 7.12 What are ARVs ? ............................................................................ 90 91 91 91 92 93 93 94 94 95 95 96
7.13 What are the four groups of ARV drugs and why do we need to use four of them? ....................................................................... 7.14 What must we know about ARVs if we want to use them? ......... 7.15 When should a person start taking ARVs? .................................... 7.16 What happens before someone starts taking ARVs? .................... 7.17 Where can people get ARVs? ........................................................ 7.18 What is HIV resistance to ARVs? .................................................. 7.19 How can we reduce the rate of resistance to ARVs? ..................... 7.20 What challenges are faced by people taking ARVs? .....................
96 97 98 98 98 99 99 100
Unit 9
9.1 Assignment review ....................................................................... 129 9.2 How do different people react when learning they are HIV+?..... 129 9.3 What causes stress for people living positively with HIV?............ 130
9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19
Living positively with HIV and AIDS ........................................... HIV and nutrition: Eating positively ............................................ Which food groups should be used by PLWHA? ........................ Which medicinal plants can b used by PLWHA?......................... How can foods relieve common symptoms of HIV/AIDS? ......... Which recipes can be used to alleviate diarrhoea?........................ HIV and hygiene: positively clean ................................................ Does spirituality strengthen the immune system?....................... Deep breathing and quiet time ..................................................... Role play: Talking about living positively with HIV and AIDS ... Succession planning ...................................................................... What things should you put in your own will? ........................... What things should you put in your own memory book? .......... What things should you put in your own memory box? ........... Why is home-based care so important? ........................................ When should a family start home-based care for PLWHA?.........
131 132 133 134 135 136 137 138 139 139 140 141 141 141 142 142
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Introduction
Welcome to Mzake ndi mzake, the peer group HIV and AIDS education project. Although this book is aimed at peer educators, we hope that it will also serve as a useful sourcebook for others interested in educating themselves and others. Today, peoples health is threatened by HIV and AIDS. Worldwide, just 1 in every 5 people at risk of being infected with HIV, has access to basic prevention services. This book has been produced to equip peer educators, with knowledge and skills to enable them to disseminate information on STIs, HIV and AIDS. This will help them to develop the attitudes needed to encourage positive behaviour change. We hope it will assist in going further than the basic messages of ABC for HIV prevention. It is essential to go beyond the ABC of HIV, because a present many people still dont abstain from unprotected sex, they arent faithful to their partners and rarely if ever use a condom. After going through the activities, it is hoped that you will be able to: explain the basic facts about human sexuality, STIs, HIV and AIDS protect yourself and others from HIV and AIDS by changing any behaviours that put people at risk help yourself and others in your community to avoid getting infected by STIs, HIV and developing AIDS describe how a wide variety of social factors influence the spread of HIV and AIDS encourage yourself and others in your community, to live positively with or without HIV and AIDS When working in small groups of friends, people feel more comfortable about sensitive and personal concerns. Many people also trust information that is suggested by their friends. They often develop a sense of responsibility and ownership when carrying out an action planned and developed by their peers. It is often easier to contemplate and support successful behaviour change within such a group. Please remember, that this manual is not a substitute for professional medical advice. Peer group members and the community members they reach, should regularly consult their doctors or qualified medical health practitioners in matters relating to their health, particularly in respect to symptoms and treatment which require diagnosis or medical attention. It is essential that people who have been exposed to the risk of HIV, and their sexual partners, seek professional medical diagnosis and treatment.
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You will learn how to become a peer educator by working through the book. By using it as a guide, you will practice conducting peer group sessions. Finally, when you have completed the training, you will be awarded a certificate of recognition as a qualified peer educator. After certification, you will be able to work with groups of interested people in your institution, workplace or community.
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Collect the resources you will require and organise other related logistics. If you are going to use a resource persons make sure they are available Decide on a simple introduction to the session. Introductions can be in the form of a song, dance, poem, quotation (point to ponder), poster or another art form When are you going to work individually, in pairs or larger groups? How big will your working groups be and where will they sit? Consider using an ice breaker to keep groups alive and reduce any tension. Let group members discuss what they already know about the topic or activity before reading the list of peers suggestions One of the most satisfying parts of being in a peer group is when one, or more, people in the group can accurately explain a topic or answer the question, so never read the points for discussion before opening the floor to your group Some activities later in the book, do not have a statement asking you to discuss a topic, this is because it is assumed that the group will decide what to do next Check all the bullet points mentioned in an activity Bullet points for discussion are listed to help you make sure that a great variety of ideas are considered You may not agree with all the points suggested Hundreds of points were suggested by previous peer group members and that is why you will notice that they often read as if spoken by different people Admit when you are not sure of something that you may be asked about If you are not sure of an answer you can say something like, Does anybody in the group know an answer? then say, Iam not sure about that, but we should try to find out before the next session. Avoid imposing your own views or beliefs on the group, no matter how valued they may be If peer group members have a heated argument on a topic and cannot agree on something, and this is holding up the session, then say something like, Well, lets agree to differ on this particular point and move on. Alright? Some discussions are private and sensitive and you may feel uncomfortable at times Move and talk in a way that makes you feel comfortable. Some things you will talk about in peer group meetings are confidential so peoples names and certain topics should never be discussed outside of the meetings When asking questions, pause long enough to allow people to think, before you yourself give answers or continue talking Collect feedback on the session by using the evaluation questions. Before ending a session, ensure that members are clear about the place and starting time of the next session.
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More than the ABC of HIV: You are familiar with the ABC message for HIV prevention. By the end of the course you will have created your own A-Z of HIV prevention, treatment, care and support. See page 157 for ideas for your A-Z of HIV. Create and include messages about protecting vulnerable groups from HIV. Groups such as pregnant women, unborn babies, new-born babies and the impoverished. See page 103 for a full list of groups that are at risk and need assistance.
PICK-AND-MIX ACTIVITIES: Some peer group members will know a great deal about HIV and AIDS, while others may not. As a group or as individuals, you can cover the units or activities in any order. The manual is designed so that, if you wish to, you can pick-and-mix activities that may deal with related topics, which are of particular relevance to you or your group. Keep track of your individual and group progress. Whenever you complete an activity put a tick in the box on the contents page. USE A VARIETY OF TEACHING/FACILITATING TECHNIQUES: Discussions are important, but many activities can be covered by using debate, games, drama, drawing, song, dance, story and poetry. See page 162 for more ideas. TALULAR IDEAS: Adding TALULAR (Teaching And Learning Using Locally Available Resources) ideas to group activities will enrich the experiences of perticipants. See page 164 for an introduction to TALULAR. PRIVATE STUDY & ASSIGNMENTS: The whole group may decide to select some activities as assignments or for private study, to be carried out between the meetings. This will mean that more of the group time is available to cover the issues that are considered particularly important. Points to ponder.... Messages..... Log book... Can you work out why certain suggestions are marked with a while others are marked with a cross
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Learning outcomes
By the end of this unit, you will be able to: state a few facts about each other briefly explain the extent of the HIV and AIDS pandemic describe the impact of HIV and AIDS explain the importance of HIV and AIDS prevention assess your level of knowledge of basic information about HIV and AIDS
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After everyone has finished, ask participants to put their papers in two bags or boxes. One bag labelled for hopes or expectations and one labelled for fears. Ask one or two participants to post the fears and another one or two to post the hopes or expectations. They may also be grouped lying flat on a table top if agreed. Let the participants view the two sets of papers and talk casually about their observations.
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False True False False False True False False False False False False False False False True False True True True
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Activity 1.6
HIV is the virus that causes AIDS. AIDS is not a virus nor a disease. A person only has AIDS, when HIV has damaged their immune system so much, that their body is too weak to fight off even ordinary diseases. So, what is HIV? Here is one description. The
Activity 1.7
Special white blood cells, called CD4 T cells, help to protect our body against infection
When germs enter our body the CD4 T cells fight and usually kill them
CD 4T cells help to kill the germs and keep our bodies strong and healthy
HIV is powerful. When it gets into our body it searches for the CD4 T cells and attacks them. It enters the CD4 T cells and can now control them.
The CD4 T cells are then changed into HIV copying factories. When the new HIV copies escape into the blood, they search for more healthy CD4 T cells to attack
If HIV keeps killing every CD4 T cell it enters, eventually our body is too weak to fight off even ordinary germs and it shows symptoms of many diseases
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Acquired = it enters from outside your body and Immune = your bodys ability to fight infection Deficiency = gets too weak and Syndrome = you show symptoms of having not
just one illness but many Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? The immune system is a collection of cells which defend our body against infection When we are HIV free the bodys immune system can cope with most infections Part of our immune system are the white blood cells, which have the ability to identify and work together in order to fight off most harmful viruses or bacteria There are two important types of white blood cells, B-Cells and T-Cells. One type of T cells called CD4 T cells is important in the fight against HIV. They are often called helper T cells When HIV enters the blood, our CD4 T cells make HIV antibodies (chemicals), to fight the infection Being HIV-positive means that the HIV antibodies are present in your body There is no way to remove HIV from a body or to kill HIV Unfortunately the HIV antibodies cannot successfully fight and kill the HIV A person could be HIV+ for over 10 years before their body starts to weaken and become unable to fight off most diseases When HIV gets into the blood of a person, it attacks white blood cells, but it is especially attracted to CD4 T cells, which it attacks and enters, then it reproduces by making many copies of itself. When the HIV copies leave the cell they spread round the body attacking and taking over more CD4 T cells It is like a defending army losing soldiers while the attacking HIV army is growing Some HIV infected CD4 T cells are identified as dangerous and killed by B cells Without enough CD4 T cells, the body is unable to defend itself As the viral load (the number of HIV copies) increases, the CD4 T cell count decreases The two types of HIV are called HIV-1 and HIV-2 (Malawi has mainly HIV-1) Both types cause AIDS although HIV-2 is less virolent than HIV-1 HIV can mutate (change) when it reproduces and it now has at least 9 subtypes A CD4 (T-cell) count below 350 to 400 cells mm3 marks the onset of opportunistic infections
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Read the following facts about HIV and AIDS Discuss the implications of the information for HIV prevention, treatment, support and care Share you ideas The term epidemic is the rapid spread of a disease among many people in the same place. A pandemic means it occurs over a whole continent or the whole world. AIDS is a pandemic. Points for your discussion, debate, drawing, song, story, play, poem, poster etc Since the start of the HIV/AIDS pandemic over 25 million people have died due to AIDS related illnesses. Sexual transmission accounts for over 85% of all HIV/AIDS infections. Over 4 million new infections were reported last year with over 2 million of those in sub-saharan Africa. Almost 40 million people in the world are living with HIV and over 25 million of those live in Sub-Sahara Africa. Africa has over 12 million children who have been orphaned by AIDS. Anti-retroviral treatment (ART) is prolonging the lives of millions of people who are HIV+, but not everyone who needs them can get them.
Activity 1.9
Problems encountered collecting data on HIV and AIDS from around the world Data collected about HIV and AIDS can give us part of the picture, but may be inaccurate. Research shows that many cases of HIV infection are not reported because many infected people do not go for HIV tests. An increase in the number of diagnosed cases of HIV in Malawi, does not necessarily mean that more people are getting infected with HIV. It might mean that more people are going for HIV tests, because they have become more available, or that stigmatisation of people who are living with HIV has declined, or more people are willing to get tested. Figures based on gender and age may reflect a group that is more willing to be tested than an other. For example more women than men in Malawi undergo Voluntary Counselling and Testing (VCT).
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Activity 1.10
Ask the group to review the following information. Over 11 million Malawians are not infected with HIV. The prevalence rate is just over 14% this means about 86 out of every 100 Malawians are HIV negative. Nearly 1,000,000 persons who are infected with HIV, but still look and feel healthy, 850 000 are adults above 15 years and over 500 000 of these are women. Because HIV infection is spread mostly through sexual activity, people between 15 and 49 years of age are the most infected. Malawi has almost 800,000 orphans. Infection rates are higher in urban areas, where 1 of 5 adults may be infected. Only 34% female and 41% male adults are aware of how they can prevent themselves from HIV infection. In 2008, AIDS -related deaths have dropped by when compared to 2003. Out of 159,111 people who went onto ARVs in 2004, 106,547 are still alive. Peer group members should note any new statistics appearing in the media.
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Activity 1.15
Discuss which of the issues mentioned in activitites 1.12, 1.13 and 1.14, are particularly relevant to school-age children. Points for your discussion, debate, drawing, song, story, play, poem, poster etc What points have peer group members suggested? Orphaned by AIDS or infected with HIV/AIDS Often need to care for sick parents or siblings Trauma related to illness and death of family member The traditional extended family support system is being over-stretched Lower motivation due to loss of support from a disintegrating extended family Need for children to work Discrimination and stigma they can suffer in school due to infection of themselves or death of family members Early marriage in the case of girl children Child-headed family and caring for younger siblings Child is the bread-winner
Preparing for behaviour change Read through the point to ponder and discuss it with friends and family. Point to ponder: If the word development means good change, what changes do you want to see in your personal life, family life, community life and national life that will help.
Evaluation
Evaluations can be carried out after each session or at the end of each unit. Use the evaluation questions on page 166 and record the results in an exercise book or on plain paper for filing. Be sure to indicate the date, unit number, number of members, and your name in the record. Remember to mention which activities were carried out and your own feelings about the unit.
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Unit 2
Introduction
Why is behaviour change an important part of HIV prevention, treatment, support and care? It is because HIV and AIDS is destroying the things we value most in life. Our extended families are breaking down. Sickness and funerals are robbing us of loved ones, hard earned wealth and our traditional lifestyle. Children are orphaned, out of school and many are on the streets. Families and communities are struggling to keep going. This is why it is important for each one of us to identify what we consider the most valuable things in our lives and do everything we can to protect them. The activities look at the life skills necessary for a person to identify risky behaviours which need changing, successfully change the behaviour or support others in the community who are trying to do so.
Learning outcomes
By the end of this unit, you will be able to: list the most important things in your life identify negative behaviours in society that need changing explain why a persons values play an important part in behaviour change describe the character qualities you most value in a good person describe how values are acquired and developed explain how people make choices in life describe the different stages of behaviour change explain why making some decisions are not easy explain how a person can build their self esteem explain how a person can develop self-control state the importance of empathy in behaviour change describe how group identities can unite and divide societies define and differentiate between a persons rights and their responsibilities
Activity 2.2 What are the most important things in your life?
If we asked people around the world this question, what do you think they would say? Here are some of their suggestions: Youre only young once. So, you should go out and have fun, fun, and more fun! I want my share of the good things in life. I want a big car, big house and money! I want to get to heaven, so my life is lived in order to earn my place in paradise Seeing my grandchildren growing up and succeeding Babies. I want to have children, then my life will mean something I will use any means possible to feed, clothe, shelter and educate my children I really dont know, I havent thought about it much. I am sure I will think about this question when I am older I want to learn absolutely everything I can about this amazing thing called life I just dont care about questions like that, I just need a few drinks
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What are the most important things in your life? When we asked groups of people that question, we got a long list of ideas. Here is the list we compiled. The items are listed in no particular order of importance. The most important things in life are: Marriage Children Family Religion Own house Own car Love Friends Enjoyment Money Sex Studying Being happy Staying healthy Career success Boyfriend or girlfriend Democracy and freedom Fashionable clothes Football and other sports Travelling abroad Peace (no conflict or war) Doing what I want to do Doing good My community My country The Earth (our environment) .................................................................. Work by yourself Write the heading The most important things in my life, and then choose the ten things that you think are the most important in your life Put a number 1 next to the one you think is the most important Put a number 2 next to your second choice Number your other choices until you have put a number next to all of them
Activity 2.3 What are the most important things in life for your group?
Choose someone to read out the list shown above Write the list on the board before the voting starts As each item on the list is read out, you should silently raise your hand if that item is in your top ten The vote counters should add up the numbers of hands raised for each item and write the scores on the chalk board After the whole list of things has been read out, the counters will announce which are the most important things in life according to the class opinion poll What are the five most important headings? Points to ponder Owning more and more things will never make you completely happy Sometimes you have to do things that you dont enjoy The most enjoyable things that you want to do can damage your body, mind and spirit We need to develop the strength to make the right choices and stick to them
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I am empowered (eg. I feel that I have talents and can achieve things)
Things that make us feel good about ourselves, can build our self-esteem and empowers us Every person is born with an special variety of talents, as they develop these talents and enjoy the feeling of success, this builds self-esteem If we leave some talents underdeveloped or unused we can feel depressed and this lowers self-esteem
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Activity 2.5
Now we are going to look at ways of strengthening our relationships or connections with other people. Malawis main religions teach that everyone is unique and special, but we only become fully human when we mix and interact with other human beings. How far do you think that people with no religious beliefs share this viewpoint? Points for your discussion, debate, drawing, song, story, play, poem, poster etc Here are some suggestions: If I want to be treated as unique and special I must learn to treat other people as unique and special too Unfortunately, we humans can find it very difficult to live peacefully together for a long time If we are to enjoy good relationships we must always consider the thoughts and feelings of others
Activity 2.6
Empathy is the ability to imagine what another person is feeling and thinking. If you can imagine what a person is feeling or thinking you might understand why they behave as they do. Points for your discussion, debate, drawing, song, story, play, poem, poster etc Here are some suggestions: One of the best ways to develop empathy is to imagine that you are standing in someone elses shoes or walking a mile in someones shoes By developing empathy we can try to share other peoples feelings such as fear, sadness, joy and happiness If we learn how to empathise it may help us to become more compassionate towards other people Christianity, Islam and Traditional Religion consider compassion to be one of the most important virtues Like other virtues empathy to others does not develop straight away and may need to be practicedbefore it becomes a habit You may wish to combine this activity with activity 2.25 on page 42.
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Activity 2.7
We love to call our country the warm heart of Africa. As a nation we value the idea of a kind and generous heart. Many foreign visitors comment on how much they enjoy being in the country. Many names that we give children reflect the traditional values we would like to see in our children.
But some of the good things that made us the warm heart of Africa are changing. Points for your discussion, debate, drawing, song, story, play, poem, poster etc Look at what some people are saying about Malawi today: People are forgetting our traditional values thats why things are going wrong HIV and AIDS are destroying family and community life HIV is harming our efforts to develop into a 21st century nation HIV is spreading because of a decay Malawis moral standards Corruption is playing a part in keeping thousands of Malawians in poverty AIDS is not just about abstinence, faithfulness and condoms. Poverty and gender inequalities are complicating our fight against HIV and AIDS Children are not getting the right sexual reproductive health lessons they need a new sort which includes moral education Teachers, preachers and politicians are not the role models they used to be Which statements do you agree with? Which ones do you disagree with? Which ones are you not sure about? Discuss your answers with the group
Source: Times
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Before we look at behaviour change for action against HIV infection, we need to look at behaviour in general. How would you define the terms good behaviour and bad behaviour. Here are two suggestions: Good behaviours are the actions that we believe to be right, just, fair, positive, constructive and true. Bad behaviours are the actions that we believe to be wrong, unjust, unfair, negative, destructive and false Describe some of the bad behaviours in our society that you would like to change. Points for your discussion, debate, drawing, song, story, play, poem, poster etc Alcoholism and drink induced negative behaviour Illicit sexual activities like pre-marital sex, adultery, under age sex and spousal rape Smoking chamba and taking drugs leading to addiction Prejudice and discrimination against minority groups (eg people with disabilities) Using power and position to influence employment interviews, school places etc Over-eating to the point of being overweight or obese, even though many people in the country go hungry and are under-nourished Petty stealing of small things from the work place Not being polite to someone because you believe you have more status Not speaking out or taking action when a neighbour (male or female) is subjected to gender based violence Allowing boys to play while girls fetch water, wash, cook and clean the house Favouring a son or boy child over a daughter or girl child Lying about where you have been and what you have been doing Telling someone you love them when what you want is sexual intercourse Avoiding doing a very important job by doing a less important task Accepting bribes in the form of money, gifts or favours Overspending on luxuries when orphans and street children are struggling nearby Going to worship regularly, but not living a truly religious lifestyle Staying silent about girls being sold or given as child brides Exam leakage Points to ponder What we think and believe greatly influences how we behave. Why do some people behave in a negative way, even though they know and want to do the right thing? Think about how all sorts of negative behaviours can affect the spread of HIV.
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Here is a list of good character qualities or virtues found in communities all over the world. Some words have similar or overlapping meanings. Look through the words, choose your own top ten virtues, the ones that a person like yourself should display. Points for your discussion, debate, drawing, song, story, play, poem, poster etc I am a good person if I am: 1 Caring: show affection and concern for other people 2 Chaste: do not have sex except with the person to whom I am married 3 Compassionate: feel or share the suffering of others and want to help them 4 Courteous: show good manners 5 Courageous: ready to face and endure great difficulties, danger, pain or suffering 6 Forgiving: ready and willing to forgive 7 Generous: ready to give freely or share 8 Gentle: kind; careful; not rough or violent 9 Hard working: works hard to improve personal, family and community life 10 Honest and truthful: ready to tell the truth, not lying, cheating or stealing 11 Hopeful: confident of future success 12 Humble or modest: not openly proud or boastful 13 Just: behave in a fair and correct way 14 Kind: show concern for the feelings of others in a gentle and friendly way 15 Loyal or faithful: true to my religion, partner, family, friends and people 16 Loving: feel and show love to one or more (partner, children, family, God etc) 17 Merciful: show a forgiving attitude towards someone that I could hurt 18 Obedient: obey fair rules and laws 19 Patient: accept annoyance, suffering and delays without anger 20 Prudent: act wisely or carefully when planning for the future, especially money 21 Resourceful: good at finding ways out of difficulties or creative ways to do things 22 Respectful: show respect and admiration 23 Responsible: reliable or sensible when carrying out a duty or task 24 Temperate or self-controlled: able to control excessive behaviour, especially anger and the amount I eat and drink, drinking little or no alcohol 25 Tolerant: accept that people have the right to hold different beliefs to my own 26 Trustworthy: able to be trusted, reliable Which of these values do you think are important in traditional African culture?
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Activity 2.11 What are the major virtues and vices in society?
Compare your findings from the last activity with the lists shown below. Christian virtues The seven Christian virtues are: 1 Justice. You treat all people fairly 2 Courage. You are ready to face and endure pain, suffering and trouble 3 Prudence. You plan carefully and wisely for the future 4 Temperance. You control your desires 5 Faith. You are true to your religion 6 Hope. You are confident of future success 7 Love. Christians consider this the greatest virtue of all Islamic virtues slam values all of the above virtues, but believes that only by practicing the 5 pillars of Islam can a believer develop the right attitude of mind, body and soul inorder to face any moral choice. The five pillar of Islam are: 1 Faith. Declare that there is no God but Allah and that Muhammed is his prophet 2 Prayer. Pray five times daily 3 Charity. Every year Muslims gives at least 2% of their savings to the poor 4 Fasting during the month of Ramadan 5 Pilgrimage to Makkah once in a life time if circumstances allow The seven deadly sins (vices) The seven deadly sins were identified by Christians as the most serious threats to society and the chances of a individual getting a place in heaven. For religious believers, a sin is anything that goes against Gods teachings. The 7 deadly sins are: 1 Pride. Arrogance; having an inflated opinion of yourself; being big-headed 2 Anger. Strong feeling of displeasure which may lead to loud or violent behaviour 3 Envy. Jealousy; wanting what someone else has or to be like someone else 4 Lust. Greed for sex; sexual desire, but with no love involved 5 Gluttony. Greed for food and drink 6 Avarice. Greed for power and wealth 7 Laziness. Finding excuses and ways to avoid doing important work
Point to ponder Our streets are now filled with street kids... smoking, taking drugs, stealing, sleeping in tunnels and eating dirty food... it is breeding a generation that will be uncontrollable... they will have no human heart and will be prepared to kill to get what they want! Discuss.
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Points for your discussion, debate, drawing, song, story, play, poem, poster etc Here are some suggestions: Giving people a list of rules to follow works only so far, if other members of a community openly break societys rules in full view of others In traditional life, umunthu, is the person showing moyo wangwiro (good spiritual health) or moyo wabwino (good living) Traditionally, the ancestors are considered role models and are rememebered because of their good lives, and there is no real afterlife for badly the behaved People develop virtues and vices and turn them into habits, by following the example of role models around them. Not only what these role models say but more especially what they do Teaching by examples which stress responsibility and self-control (discipline) People, especially children, copy or imitate the actions of older community members Muslims consider Muhammed to be the best role model (Uswatun Hasanah) Christians say that people can see the character of Jesus in the loving actions of good Christians and the young should model this sort of behaviour You may want to possess a virtue but it can only be made a full part of your life through practice, practice and more practice If you wish to be brave you must practice being brave, starting with small acts of bravery and building up to greater acts by making bravery part of your character How could you help a child to learn to be kind and generous? Try to become wise by making good decisions based on knowledge and experience It is said that if you want to become wise you must examine your emotions, thoughts and behaviours in order to discover your personal virtues and vices Point to ponder a) Whoever is granted wisdom has indeed been granted wealth abundant (The Quran) b) Wisdom is more valuable than jewels (The Bible)
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When we decide what we think is right and what we think is wrong, we have made a moral decision. As we grow up and then grow older, we learn that life is all about making the right choices or decisions. Every choice we make has one or more consequences. Some choices may be very easy to make, while others are very hard. Points for your discussion, debate, drawing, song, story, play, poem, poster etc People all over the world use the same methods when making choices. Here are some of the different ways in which people decide what is the right thing to do: 1 I obey Gods laws. Most religions have a set of rules and laws that are believed to have come from God. Believers are expected to obey the laws of their religion. One rule appears in all the major world religions. Compare the following versions of what is called the golden rule. Christianity - Treat other people as you would like them to treat you Traditional - Do for others what you want them to do for you Islam - Nobody truly believes, until he wishes for his brother what he wishes for himself Buddhism - Act towards other people as you would act towards yourself Sikhism - What you consider for yourself, so consider for others Hinduism - Do nothing to others, which would cause pain when done to you 2 I am not religious, but I always follow the golden rule 3 I am a good citizen and always obey all laws 4 I will do anything to avoid punishment or pain 5 I follow cultural tradition 6 I think about myself first, my pleasure, possessions and position 7 I do whatever will please my peers, constitutants and tribe 8 I copy older members of my family and community 9 I only help those who can help me 10 I do it because it feels like the right thing to do 11 I rebel, against a society where I am poor, marginalised, without hope Discuss whether you use one or more of these reasons when deciding what to do Can you list any reasons why people find it hard to follow the golden rule?
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and I am glad people cant read my mind! I have to fight my selfish thoughts and urges all the time! Sometimes its so very hard to behave in a good, fair and kind way
A vice will stay a living, breathing, ugly part of you until you yourself destroy it! Have you ever had the same sort of thoughts and feelings? Describe one occasion when you struggled to make a decision.
Activity 2.19 When free will clashes with the golden rule
The major religions in Malawi say that God has given human beings free will. Nonrelgious people often believe that they have free will, but it is not a gift from anyone. Points for your discussion, debate, drawing, song, story, play, poem, poster etc If I have free will it means that I am the one who has to choose between good and b a d thoughts, words and deeds I am the only one who can control my feelings, thoughts, words and actions You have freedom of choice. In a one-party state or dictatorship choice may be limited, in a developing democracy more and more choices become available A selfish or self-centred person might say something like, I do what I want to do, my feelings and needs are the priority. Are there any times when selfishness would be justified? If I am selfless I think more of other peoples feelings and needs than my own The golden rule reminds us that, even if we have to care for others, we must love and care for ourselves as well, because if we dont love and care for ourselves we will not be able to care effectively for others!
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Points to ponder
Individuals, couples, groups, institutions, communities and governments all can and do use this process to promote development, which is positive change. Discuss. Pick out some of todays key issues and discuss how behaviour change has been successfully promoted. Some issues could be gender, democracy, crime, orphans and vulnerable children, malaria, primary education and of course HIV and AIDS.
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Points for your discussion, debate, drawing, song, story, play, poem, poster etc What are some of the things that can be used to unite or divide people? Age: between old and young HIV: between HIV+ and HIV free Gender: between male and female Colour: between black and white Lifestyle: between rich and poor Education: between educated and uneducated Tribe: between your tribe and mine Region: between north and south Politics: between UDF and DPP Religion: between your religion and mine Nationality: between Malawians and other nationalities Laws: between criminals and their victims Sport: between fans of different teams Disability: between able-bodied and disabled Music: between rap and gospel Fashion: between traditional and modern Beauty: between those who are thought beautiful and those who are not
Points to ponder
It is not the obvious things that divide human beings. It is not colour nor race nor religion, it is our envyof those who have more than us and our fear of anyone who is different. Discuss. I just dont like them, I have never liked them. In fact my father and grandfather hated them as well and warned me about them on numerous occasions. Discuss.
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Activity 2.24 How do prejudice, stigma and discrimination divide people? Point to ponder
It is often easier to blame our problems on outsiders like foreigners and the underclass than see that the solution is in our own hands. Discuss.
Prejudice
We are prejudiced if we prejudge before we know all the facts We can prejudge individual people and groups of people Prejudice happens in our minds and involves our feelings and our thoughts
Stigma
In olden times, in different parts of the world, slaves and criminals were often marked on the skin with a tatoo or branded with a hot iron The Greeks called this mark stigma. It was like a label that the slave or criminal carried everywhere and could be seen by everyone they came into contact with. The mark showed they were different, it made them outsiders from society When we stigmatise, we are now acting on our prejudice When we stigmatise ,we are pointing the first finger of our prejudices When we stigmatise, we are labelling someone as being different to ourselves and we make them outsiders Stigmatizing involves feelings, thoughts and behaviour. Stigmatizing can develop into a serious form of negative discrimination
Activity 2.25 Assignment: Standing in someone elses shoes During a typical day we meet all sorts of people at markets, in shops, on the road and at work. It is often easy for people to discriminate against others they meet,
especially in a situation where a dangerous disease is preading in our community. Observe the different types of people you meet or pass by Imagine what it would be like to live as some of the people you meet Choose four people from the list shown and write short notes, a poem or a song describing the life of each of your choices You can start each description with the words, What would my life be like if I was a refugee or displaced person rich person person of the opposite sex male street child prisoner female street child poor student needing school fees unemployed single mother person of a different race or colour president of Malawi
Evauation. Use the questions on page 166 and enter the results in your log book. 42
Unit 3
HIV +
Introduction
The drawing above is adapted from a well known cartoon. What point do you think it is trying to communicate? The drawing is pointing out that sex and love can make people feel, think and act in ways that could be described as crazy. If HIV is now a danger to people forming sexual relationships, then it affects billions of men and women all over the world - including ourselves and our children - and it is essential to study it in greater detail. In order to recognise our feelings, thoughts and actions concerning sex and affection, we must understand the relationship between love, sex and sexuality. This will help us to respect our own feelings as well as the feelings of others which may influence how humans behave.
Learning outcomes
By the end of this unit you should be able to: explain the terms sex and sexuality describe elements of human sexuality describe factors that influence sexuality discuss some of the physical and psychological changes which take place during adolescence explain how sexuality can affect behaviour describe the features of the female reproductive system describe the features of the male reproductive system list some of the reasons why people have sexual relationships answer some of the most frequently asked questions about sex and sexuality
As you work through this unit on sex and sexuality, remember that love is considered to be a significant part of most sexual relationships. Look at the types of love mentioned below and discuss how they may relate to discussions on sex and sexuality. Love of objects and experiences - I love eating chicken; I love drinking beer; I love dancing Love of family and friends - I love my grandmother; I love my old friend so much Love of husband/wife (partner) - My wife/husband has always been my one true love Love which is unconditional - I try to love other human beings without conditions
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Activity 3.6 Sex, love and behaviour change in adolescents and adults
As children grow into teenagers and towards adulthood, parents, relatives, community leaders, teachers and others become concerned that the young will work hard, stay out of trouble and grow into successful members of society. The issue of sex before marriage worries adults, and they often sternly warn both boys and particularly girls, against sex that can bring unwanted pregnancy and HIV into the family home and the shame that would result. In many societies around the world, this has meant that sex has often been given a bad name, labelled as dirty or something whispered about, but never freely talked about in any great detail. Here are some things that people have said about sex and love, that might influence our view of sex, our sexual behaviour and any possible behaviour change to be made by ourselves or others. Read the statements through and think about whether you share the view or disagree with it. Spend only ten minutes or so on the activity and resist the temptation to impose your own ideas on others, agree to differ and move on. 1 2 Sex is beautiful, special and essential for human survival They way I love my wife is completely different to the way I love my children, the way I love God is so different to the way I love football andeating chicken with nsima. It so gets confusing, having one word for so many feelings! Sex without love is animal lust, rats do it, pigs do it even cockroaches do it Sex between two people can be wonderful, exciting and enjoyable experience, but they dont need to be married or even love each other Sex is just for making babies Love making is to make babies from love Sex is about giving and sharing rather than taking or having Sex should bring loving partners closer together Sex should be love-making and love is always more than just sex-making Sex should make both partners smile and feel happy Sex is to be enjoyed by both men and women Sex education films which show enjoyable ways to make love are useful to a society Sex in pornographic films is a corrupting influence on society Boys talk of love when what they want is sex, while girls use sex because what they really want is love If parents really love their children they would talk to them about sex and not leave them find out fromtheir possibly misinformed peers
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Did you find that this activity created a lot of heated discussion and debate? Well, anything that creates such energy is useful, especially if we can focus efforts on the fight against HIV.
Points to ponder. HIV is passed on by sex, and sex and love are also the most powerful tools we have to use in HIV prevention, treatment, care and support. Discuss When I make love for the very first time, I want it to be a very special event. I want to remember it for the rest of my life. Or is that too much to ask for? Discuss 46
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Activity 3.10 What should we call the male and female reproductive parts?
This activity contains terms that may be offensive to some people, or be censored from mainstream media. In order for peer groups to be effective they have to discuss what terms are use for male and female genitalia (private parts). What names do you use to for the male and female private parts? When do people use the scientific names? List all the different names you can think of, that are used for the male and female genitalia - see page 169 Discuss which terms could be used with different peer group audiences What words would you use with children?
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Activity 3.11 Over thirty reasons why people have sexual relationships
There are many reasons why people form sexual relationships. Read the list of reasons why men and women form sexual relationships. If you are in a group circle let each person read a line each until you finish the list Decide which of the reasons are good and make you feel happy and which are bad reasons which make you feel sad or angry? Points for your discussion, debate, drawing, song, story, play, poem, poster etc I have this sexual relationship because I want to: 1 give and receive love in a very special way 2 get special treatment and promotion (eg. workplace, school, college, services) 3 have a baby 4 discover the fireworks that go with sex thats in hollywood films and in other media 5 fulfil one of Gods purposes for marriage 6 obey my husband who says that my duty is to have sex with him whenever he wishes 7 prove my manhood (or womanhood) 8 get money, fashion clothes and gifts 9 get a fresh experience, my wife (or husband) is not as tasty as she was when we met 10 show my husband (or wife) that if he can be unfaithful so can I 11 please my teacher so he gives me good marks 12 get or keep my job 13 make good friends with this person who could give me a much better quality of life 14 prove my independence and sample what this sex thing is all about 15 be released from this police station cell without being charged 16 get this influential person to help me afterwards 17 release the tensions in my body 18 be cleansed after my husbands death (kupita kufa) 19 be initiated into womanhood (kuchotsa fumbi) 20 have a temporay husband replacement (mbulo) 21 have a change of wife (chimwanamaye) 22 have a baby and my husband cannot give us one (fisi) 23 get accepted...feel loved...become more popular...cure my loneliness and depression 24 stay alive after these men have finished raping me 25 fulfil my loving same-sex relationship in a special way like mixed-sex couples do 26 feed my family, because I am unemployed at the moment 27 to be cured from AIDS and I have been told this child virgin will cure me 28 have two wives, polygamy is allowed in our culture 29 stay in my uncles house where he feeds and clothes me because I am an orphan 30 hold on to my partner 31 be protected from violent people in this prison 32 be protected from the other street children who frighten me 33 show this person I am the boss and I have the power! Point to ponder A sexual relationship may have little to do with love and affection, but be more about establishing power within the relationship. It can be almost impossible for some people to say, No! Discuss.
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7 Who has more enjoyment when having sex, the man or the woman It is not easy to say who has more enjoyment when having sex, because the extent of enjoyment a man or woman has depends on both of the people involved. The most important thing about having sex is that both the man and woman try to satisfy each other to the maximum extent. If both seriously try to satisfy their partner, both will get a lot of enjoyment from having sex. In earlier times, many men thought that it is only the womens task to satisfy the mans desire, and often women did not get much enjoyment from having sex. This is not how it should be. Nowadays things have changed, because men have started to realise that having sex is more enjoyable if both partners try to satisfy each other. This is why sexual intercourse is called making love. 8 Do women have orgasms? Yes, women also have orgasms when having sex. A woman reaching an orgasm when having sex feels a very special excitement and well-being in her body. Men usually ejaculate when they reach their orgasm. Women can have one or more orgasm while having sex. Some women experience multiple orgasms which do not need to be caused by intercourse, but can be stimulated by stroking and touching parts of her body especially the clitoris and vagina. 9 What is the easiest way for a man or woman to have an orgasm? The most important things is that both partners are ready to have sex. This means that they love and respect each other, and that they are physically and mentally ready to make love. Not being ready to have sex, for example if you fear pregnancy, or STIs, may hinder you from reaching an orgasm. If both partners are ready, whether or not you reach an orgasm depends on the way you go about having sex. You should make sure that you have agreed together upon ways of having sex, which bring the most enjoyment and satisfaction to both of you. Indeed, millions of people around the world enjoy foreplay which involves cuddling and touching before full penetrative sex. Every woman and every man has certain parts of the body, which are very sensitive to touching. Foreplay can increase the chances of reaching an orgasm for both women and men. 10 What can be done if someone cannot have an erection or an orgasm? Sometimes a man cannot get an erection or ejaculate when having sex. This can be for different reasons. To have an erection and ejaculate requires energy, therefore anything which reduces the physical energy of a man, such as stress, sickness, alcohol abuse, drug abuse, smoking or feeling hungry can hinder the man ejaculating properly. Action to reverse these conditions should be taken. Other important reasons could be not being ready to have sex or not really being in love. Gentle, loving, sexual foreplay can help bring about an erection for the man and assist both partners to an orgasm. 11 Can a penis get stuck when penetrating a vagina? No, because the vagina is made from very elastic skin. The vagina can expand sufficiently for giving birth to a child, where it may expand as much as ten to twelve centimetres in diameter. So, even if you have a big penis, it cannot get stuck in a vagina.
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12 Should a womans vagina be dry during sexual intercourse? No, a womans body naturally produces lubrication during fore-play. This lubrication makes intercourse easier and there is less risk of damaging the delicate membranes. Traditional medicines or herbs should never be put into the vagina to make it dry, because they can damage the tissues and increase the risk of HIV infection. 13 Why do men usually take the initiative towards having sex? Studies have shown that in many places in the world, boys and men take the initiative to have sex, this is said to be because of social and biological factors. Men are often the leaders in the family and community, they are bigger and stronger and they can get sexually excited very quickly. It is commonly accepted that men often have an orgasm before women do. Today, it is becoming more acceptable for women to take the initiative as well as men. The cartoon shows Taxina drawn by late Vic Kasinja.
14 How soon can a couple have sexual relations after a woman has a baby? Usually 4-6 weeks. A woman can have sexual relations as soon as she has no pain or discomfort and feels ready to do so. Some women have little desire for sexual relations just after giving birth. It is not harmful to the babys health to have sexual relations while the baby is still nursing. Some local beliefs are the traditional ways of making sure women do not get pregnant too soon. Sexual intercourse has no harmful effects on a womans milk. 15 Is it all right to have sexual intercourse during menstruation? Yes, but it is advisable to use a condom. A woman cannot get pregnant during menstruation even if a condom is not used. Sexual relations during menstruation can be messy, but it is not physically harmful for either men or women, unless one or more partners is infected with an STI. However, some people find the idea unacceptable. 16 What is masturbation and is it wrong? Orgasms can be achieved through masturbation. For example the man can rub his penis, or the woman can rub her clitoris to reach an orgasm. Masturbation is a safe way of satisfying the feeling of wanting to have sex. It has no negative health consequences. It will not cause a person to have future problems having sex with a partner and it does not cause blindness nor weaken the sexual organs. Remember, religions often have clear teachings on whether masturbation is acceptable or not, check with your religious leaders if in doubt.
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17 Does a woman need semen to improve her health and beauty? Some people believe that women require semen for their health, especially so they will have beautiful skin. If you look at the diagram of a womans body, you will see that semen goes only into the vagina. It has no way to reach the skin. So putting on lotion will give smooth soft skin, but sexual intercourse cannot affect the skin. This question is still being debated by scientists. 18 What are the consequences of anal sexual intercourse? The main problem with having anal sex is that there is an even higher risk of infecting one another with STIs and HIV/AIDS. To have anal sex is dangerous, because their are no fluids to lubricate penetration and the skin in vulnerable. Therefore it is very easy to get small injuries, which do not cause pain but which also enhance the chance of transmitting diseases. If you decide to have anal sex use a condom. Homosexually is illegal in Malawi and against the teachings of the main faiths. 19 What is oral sex and is it safe? Oral sex is using your mouth to stimulate your partners genitalia. Oral sex on male genitalia is called falatio. Oral sex on female genitalia is called cunnilingus. If partners have no STIs, especially HIV, there is no health hazard. While some women enjoy falatio, others do not like receiving sperm in the mouth, others find it unpleasant. Religions often have clear teachings on whether oral sex is acceptable or not and you should check with your religious leader if you are concerned. 20 Why should men take on greater responsibility in reducing HIV infection? Men are slow in seeking health care and do not easily cope with illness in the way women often do. They take greater risks regarding alcohol abuse and casual sexual intercourse. Men need to take greater responsibility to protect themselves, their partners, and future children.
Evaluation. Evaluate the unit or your chosen selecton of activities by using the
questions on page 166.
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Learning outcomes
By the end of this unit you should be able to: identify which body fluids contain the HIV describe how people get infected with HIV describe how to prevent HIV infection explain how HIV/AIDS not transmitted describe some signs or symptoms of STIs describe some of the complications resulting from sexually transmitted infections describe what you would do if you got an STI explain how infection by other STIs can increase our chances of HIV infection calculate how many people you may have shared sexual body fluids with explain the ABC of HIV prevention define the terms safe sex and safer sex list the factors that put men at risk of STIs and especially HIV infection list the factors that put women at risk of STIs and especially HIV infection describe why young girls may be vulnerable to HIV infection
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Activity 4.4 How to prevent HIV infection through body fluid contact
What strategies would you use to prevent yourself from becoming HIV infected via contact with blood and other fluids? We have marked the peer group members suggestions with symbols ( & ) and we hope that this will help to show the things that are dangerous and the things that are safe to do. Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? The HIV virus can live for only a very brief time outside the human body, so the risk is quite small. But if any HIV contaminated fluids like blood, come into contact with the blood in your body you are at risk Sharp objects, like needles for injections or razor blades, that have been used by a person with HIV can transmit the virus, because a small amount of blood may remain on the blade or point To prevent the risk of HIV infection from sharp objects, use only new needles and razor blades or be sure they have been properly sterilized. Health clinics use disposable needles or sterilize them so that injections at the clinic and hospitals are safe Ear piercing, tattoos, traditional medical cutting, ritual procedures such as circumcision and self-injecting drug abuse, should be with new or properly sterilized equipment for each person Sharing a toothbrush can also put you at risk, especially if there are cuts, sores or gum bleeds in the mouth During violent gender-based disputes there is a danger of HIV infection if both people involved have open wounds or are bleeding Violent contact sports like boxing and wrestling if blood mixes through open cuts Traditional birth attendants, mothers and babies are at risk if one has cuts or sores There is a risk when the same cloth is used to wipe both bodies after sexual intercourse, this is because both vaginal fluids, semen and possibly blood may be on the cloth There are risks when caring for a person living with AIDS (PLWA) because of open wounds, bleeding and open bowel issues - we will deal with these issues in greater detail in unit 9 which starts on page 129 The risk of getting HIV from unprotected sexual relations is much greater than the risk of getting HIV while caring for a person living with HIV You may be at risk of contracting other diseases such as tuberculosis (TB) from a PLWHA If the person has TB, check with a doctor or clinic about protecting yourself and family because TB can be treated effectively In an accident or emergency, where a person has been cut a plastic bag can be used as a substitute for medical gloves. The risk is not great unless you yourself have open wounds on your body. Blood transfusions are unlikely to give you HIV, because blood is tested before use
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Disease
Gonorrhea
Cause
a bacterium called Gonococcus
Symptoms in Men
discharge from the penis pain when urinating genital itching urethra constriction
Symptoms in Women
bad (foul) smell vaginal discharge pain when urinating lower abdominal pain due to pelvic inflamation itching of the vulva infectious genital ulcer fever itching in the vagina swollen lymph glands bleeding from vagina pain in pelvic area profuse vaginal discharge vaginal pain vaginal itching bad smell painful sexual intercourse vaginal discharge vulva irritation reddened vulva vaginal swelling vaginal sores vaginal discharges
Syphilis
Trichomonisasis
no visible signs that lead to problem called urethritis increased itching sores and itching of penis
Candidacies
Fungus
Chancroid (mabomu)
Points for your discussion, debate, drawing, song, story, play, poem, poster etc Brain damage which may lead to madness or insanity Infertility in both men and women. Miscarriages by pregnant women Death of babies, before, during or after birth Blindness in infants if not treated well in pregnancy Pelvic Inflammatory Disease (PID) in women - Mbulu Nearly all STIs are treatable by clinics, rather than by traditional healers, who often treat only the symptom and not the cause of the infection
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Activity 4.8 Are there other ways for people get STIs?
Like HIV, some of these diseases are also spread by ways other than sexual contact. Look at the list of STIs on the last page and discuss how they could be transmitted. Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? STIs are caused by different micro-organisms and have different signs and symptoms Newly born babies can be infected whilst in the womb or during birth or during breast-feeding by their HIV positive mothers Kissing, sharing a toilet, razors, bath cloths and towels can transmit some STIs Open sores on the genitals and around the mouth are often very highly infectious So, it is imperative that people with STIs get immediate treatment and do not pass the disease on to others
Activity 4.9
STIs do not go away on their own, they must be treated by medical professionals. You can easily spread the STI to others. If you though you had an STI what would you do? Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? Go to the clinic if you or your partner has any of these symptoms, even if the symptoms seem to have gone away Do not stop your treatment early even if the symptoms seem to have gone Until both of you finish your treatment, you need to abstain or use condoms during sex If either of you has had sex with another partner now or recently, that person also needs to be treated Attend all follow up medical sessions Be very hygienically clean and careful so that you do not pass on the STI
Activity 4.10 How can other STIs increase our chances of HIV infection?
Review this topic by discussings what you have already learned. Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? If a person already has another STI, especially an open sore in the genital area, that person can more easily get infected with HIV To become infected, the HIV virus must enter your bloodstream, if there is an open sore or cut in the genital area, this is more likely to happen. If one gets infected with HIV, some STIs (genital herpes and warts) becomes more frequent, some STIs become aggressive and respond poorly to treatment. STIs like genital herpes and syphilis, depress the immune system making it easier for HIV to attack a person with STI at a single encounter. Prevention of STI infection therefore reduces the spread of HIV in a community To reduce the chance of getting HIV have all STIs treated as soon as possible Encourage others in the community to get tested for STIs and treated
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Activity 4.11 How many people will Cecilia share body fluids with?
People sometimes forget that a new partner may have had a previous partner. Discuss the diagram on page 61. Read the following case study and make a list of the people mentioned. Then create a diagram to work out a possible chain of infection. How many people may put Cecilia at risk of HIV infection? Today is Cecilias wedding day. She is a very religious, young woman who is marrying George, her first serious boyfriend. She is a virgin who has saved herself for her future husband. George attends the same place of worship as Cecilia and has had only one serious sexual relationship with Monica. He has never been tested for HIV, because he knows Monica is not promiscuous. This is because Monica has had sex with just one other man, Kondwani. Kondwani, is very good looking and is very attractive to girls and older women. Last year, at school he was seduced by Mrs Mwape, his teacher. They did not use a condom. Mrs Mwape had never done this sort of thing before, she was a virgin when she had married her husband. Mr Mwape, an accountant, is regularly called to workshops by the lake. He enjoys the pleasures of sex workers. Mr Mwape and his friends at the bar, often joke that he must have played around with over thirty of the sex workers in the ten years in his job. Mary, one of the prostitutes, had been forced into sex work by her violent husband. She had started three years ago, just after her marriage. Like the other prostitutes Mary could have sex with up to ten men a day, with local men, workshop attenders and foreign tourists. Marys husband has never stayed faithful to her for long. He drinks and when drunk he has sex with young and old sexworkers. Locals make fun of him because he often has sex with Chikondi, a kind hearted prostitute who is well over 50 years old. When Cecilia and George begin a sexual relationship how many people may be involved?
Activity 4.12 How many people have you shared body fluids with?
This is a private activity you may do as an assignment. Look at the picture on the next page. Could you represent your sex life in the same way by using simple little drawings? This is one way of assessing your risk of HIV infection. Select a drawing or shape, to represent people that you have had sex with You may wish to use boxes or bubbles Use only initials and dates if you prefer Put a if you think that person was an HIV risk to you for any reason Put a if you think that person was not an HIV risk to you for any reason Finally consider your behaviour and decide if you should change it at all Go for VCT if you are at all concerned!
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Point to ponder
Only one person had HIV to start with, but how many could be infected now? Discuss 61
A = abstain from sexual intercourse B = be faithful to one uninfected life-long partner C = use condoms correctly and consistently
Activity 4.14 What is safer sex?
The term safe sex and safer sex mean different things to different people. Safer sex is said to involve physical contacts, which do not allow the penetration of the penis into the vagina. There are many ways in which people can have an enjoyable, sexual relationship and stay safer from both HIV and an unwanted pregnancy. Read through the statements below and decide whether the advice may work for you and your partner or other people. They are all sexual activities with no contact with semen, vaginal fluids or other body fluids. Points for your discussion, debate, drawing, song, story, play, poem, poster etc 1 The safest sex is no sex at all, until after both VCT and marriage 2 I play with my partners hair slowly moving my fingers gently over his scalp 3 When his fingers move up and down my arms, barely touching my body hairs it sends ripples of excitement all over me...then our fingers play together 4 My fingers trace patterns on his forehead, cheeks and gently explore his ears, followed by the eyebrows and then I start kissing him starting with his hands 5 We like to touch skin with different things like a flower, a feather, our hair, small stones, coins, drops of water, slices of fruits and sweets...its very sexual 6 We keep our clothes on and enjoy touching and stroking through our clothes, because its safe and we have barriers up against temptation...we hold hands and hug a a lot 7 We keep our clothes on but can press our private areas together and move...its safe sex 8 We allow ourselves to be naked above the waist, but remove nothing else, apart from shoes and socks. We can kiss and touch only uncovered places, nowhere else 9 I really enjoy doing a strip dance for him. I never remove my pants...I move sensually and peal off my clothes...I enjoy him looking at my body, but no intercourse until VCT! 10 We can stand, sit or lie down in all sorts of different ways...we take turns removing clothes down to our underwear 11 I do masturbate to an orgasm and I think it helps control my behaviour 12 I wear shorts and she wears a swimsuit or underwear, which we never take off... ...touching the private parts for long time... I suppose its mutual masturbation 13 We tell each other sexy stories, including all the exciting details of what is happening 14 We shouldnt talk about this sort of issue as it may encourage people to experiment Points to ponder Safe sex involves making rules and trust. Trusting that both partners will keep to those rules. There is sexual freedom up to a limit, but a limit not to be crossed. Discuss Both safe sex and unsafe sex begin in the mind and that is the best place to stop them both until after both VCT and marriage. Discuss
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Activity 4.15
After carefully considering the consequences, a couple should consider the following points before having a full sexual relationship. Your safety depends on both your behaviour and your partners behaviour efore having sexual intercourse without a condom, you need to: 1) Use condoms for three months 2) both get treatment for any STDs 3) both have a blood test that shows you are HIV free 4) be completely faithful to each other or use condoms in any outside relationship You may combine this introduction with Activity 4.14.
Activity 4.16
You may wish to combine this activity with others. This is a very good ice-breaker or introductory activity. You will need Cups which represent the human body Water which represents healthy human body fluids Starch solution which represents infected body fluids containing HIV Iodine solution which represents an HIV test Behaviour cards. These are small pieces of paper with the following five letters on A (abstain) B (always be faithful) U (unfaithful partner) S (sexually active )
Suggested method Explain what sort of behaviour each letter represents Ask each participant to pick a paper at random Give one or two participants a quarter cup of weak starch solution (HIV+) Give all others a quarter cup of plain water Ask participants to mix the contents of their cups according to the behaviour shown on the paper To mixing represents sexual intercourse between two people, which mixes body fluids To represent sexual intercourse pour the contents of one cup into the another, mix and then divide the contents equally between the two cups Stop the activity when most of the participants have mixed body fluids with others Represent the HIV test, by putting a few drops of iodine solution into each cup. If the solution goes dark then it means starch (HIV) is present in the cup How could you develop this idea further?
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Activity 4.17 What factors put men at risk of STIs and HIV infection?
What factors put men at risk of STIs and HIV infection? Ask the group to think about the behaviour of men in their community. The best male role models in a society, who hold firm views about correct behaviour are at lower risk than the poor role models. Points for your discussion, debate, drawing, song, story, play, poem, poster etc We have marked the peer group members suggestions with the symbol because this activity concentrates on identifying dangerous behaviours that can be changed. Which dangerous behaviours put men at risk? Wanting to prove their manhood Belief that girls and young women dont have HIV Not abstaining when a sexual partner is menstruating or is in latter period of pregnancy Men who abstain from having sex with their wife during her menstruation, believes it is culturally acceptable to go out with other women. Unfaithfulness by wives Casual sex with multiple partners Homosexual relationships Wanting to show off wealth through sex Using sex as source of power If accused of being impotent, men have sex with other women to prove or disprove the allegations. Looking for sex to gain experience Traditional view of women as sex objects to be used and then discarded Performing widow cleansing ritual with a late relatives widow Men selected to act as fisi during girl-child initiation Infection by blood on an unclean blade during the circumcision of a boy-child
The late Brian Haras cartoons often used humour to carry important messages
Showing off to peers, by bragging about manhood and conquests Drinking alcohol in a bar frequented by sex workers
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Activity 4.18 What factors put women at risk of STIs and HIV infection?
What biological and social factors put women at risk of HIV and AIDS? Points for your discussion, debate, drawing, song, story, play, poem, poster etc We have marked the peer group members suggestions with the symbol because this activity concentrates on identifying dangerous behaviours that can be changed. What have peer group members suggested? Early marriage of primary school-age girls puts them at risk, because their reproductive organs are not fully developed and smaller than a grown woman There is a lot of pressure on woman to have sex with boyfriends to prove their faithfulness Older men with money (sugar-daddies) tempt young girls to exchange sex for gifts or money Poverty can force women to become sex workers in order to support their families. Employers can pressure women employees to give them sexual favours Some women use sexual favours to rise in an organisation Sex within marriage is considered as simply a duty and a condition for having children, instead of as a source of mutual pleasure and bonding Some men are sexually unfaithful, they can bring HIV and AIDS into a marriage Women put herbs and other agents in the vagina to cause dryness, heat and tightness. These substances may cause inflammation and open sores in the vagina making it easier for HIV to mix with body fluids Women are the primary care-givers at homes with people living with HIV and AIDS. This puts them at risk of infection from blood and other body fluids Wife inheritance, where a relative inherits a dead relatives wife When an impotent man hires fisi to have sex with his wife Widow cleansing through sexual intercourse Proverbs like Mamuna ndi mwana, which means that a man is a child, so he has an excuse for any sexual infidelity Men say they love a woman when what they really want is sex, a woman will often have sex with a man when what she really wants is his love Women are vulnerable to HIV infection because of gender inequalities and lack of power within sexual relationships
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School girls - their friends being sold for cows (Source: Nation May 31, 07)
Points for your discussion, debate, drawing, song, story, play, poem, poster etc How widespread in your area, are events similar to those described in the article? Peer group members suggested that the following points were very important. Men often choose younger women as sexual partners and its not easy for a young woman to talk assertively with an older man. Early marriage, where the older husband controls the sex life of the couple due to the respect and expected unquestioning obedience of his younger wife You can combine this activity with the next one if you wish, but group members have suggested that school age girls are particularly vulnerable.
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Activity 4.20
What are the factors that put young people at particular risk of HIV infection? We have marked the peer group members suggestions with the symbol because this activity concentrates on identifying dangerous behaviours that can be changed. Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? Young people can experience rapid mood changes and become very emotional, this can lead to stress, depression, aggression and wild behaviour Research shows that youth interaction between mental health and HIV/AIDS increases the risk of them developing mental disorders Elders who carry out the initiation may not be well informed about how young people can prevent HIV and AIDS, STIs and early pregnancy Anxiety disorders in youths can lead to reckless sexual behaviour during which they are exposed to HIV Youths often dont want to listen to lectures on behaviour from adults. They experience new strong sexual urges and attraction to the opposite sex They may have day dreams or sexual fantasies which they want to act out They need more independence from their parents and this can lead them into unsafe situations Negative peer pressure can influence them act in dangerous ways and do things just to impress the group Influenced by negative role models they see on TV or in films They want to try new things and take risks and this can lead to infection, injury or death Drinking alcohol and smoking chamba Early unsafe sexual relationships In some parts of Malawi, young people start having sex at a very young ages Half of all women have sex before the age 15 and half of all men before 16 Unemployment and the lack of community activities that interest them can leave youths with lots of time on their hands Lack of accurate information Lack of communication with parents or caregivers. Parents may not feel comfortable talking to their children about sex
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Unit 5
Condoms
Introduction
Many doctors and health workers see condoms as a key weapon in fighting the pandemic of HIV and AIDS. Other people view the situation in a completely different way. Some religious leaders are openly opposed to the use of condoms as they blame them for encouraging promiscuous behaviour. Others say that condoms interfer with the natural process of conception. In your peer group you will probably have conflicting views, but we believe it is valuable for all students and teachers to know more about condoms. Discussing condom use does not mean that a person is going to use one.
Learning outcomes
At the end of this unit, you should be able to: explain how condoms protect against HIV and STIs correctly use and dispose of a female and a male condom. be comfortable when discussing and teaching others about importance of using condoms
Assignment 5.2 If a man can carry a condom why cant a woman carry one?
What message do you think the cartoon is sending out? Points for your discussion Study the picture and consider the following questions. What is happening in this picture? Does this happen in Malawi? Why do you think that the man is surprised? What do you think of the womans statement? Discuss the situation in pairs and then as a full peer group Some peer group members believe that the woman is perfectly correct in carrying a condom, because she is protecting both herself and her husband. Do you agree? Some peer group members believe that the both partners are correct in carrying condoms, because they are protecting each other. Do you agree? Many activities in this unit will deal with the practical, social and moral issues related to condom use.
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Activity 5.4 Dont condoms have tiny holes which allow the HIV through?
Peer group members have suggested that you could say: Condoms, like everything else, do have pores and holes but they are too tiny to see Research shows that these pores are too tiny to let the HIV virus go through Under normal use there is no leakage In scientific stress tests, condoms have been filled with over a bucket full of water before showing any signs of leaking - that is a considerably larger volume than the average penis - some condom critics fail to mention the fact that scientific testers often fill condoms with over 4 litres of water More importantly, there are many couples where one partner is known to be infected and the other is not infected. Studies show that the HIV negative partner did not contract HIV or other STIs when those couples used condoms consistently. But if couples did not use condoms at all or used them inconsistently, many of the partners who were HIV negative became infected. Condoms do not offer 100% protection, but they offer over 98% protection and this greatly reduces the risk of HIV infection by sexual contact. Points to ponder a) If you cant abstain or be faithful, use a condom to save the life of your partner and future children. Do not kill your own partner by unsafe sex. Discuss b) If condoms give 98% protection against HIV infection that is better than the 0% protection if you dont wear one. Discuss
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Activity 5.6 Sex with a condom is like eating a sweet inside the wrapper
Your partner says, Sex with a condom is no good because there is no skin-to-skin contact, its like eating a sweet inside the wrapper or wearing a raincoat in the shower? Peer group members have suggested that you could say: If two people have sex without a condom they risk sharing a lot more than a good time...how can we enjoy sex when we are worried about AIDS? We can have sex without a condom someday, if we both get tested and find out that we are both HIV negative and we agree to be completely faithful I dont think its time to have a baby right now
Activity 5.7 Can condoms come off and can remain inside the woman?
Peer group members have suggested that you could say: The condom will not usually come off if the man withdraws his penis carefully, holding the top of the condom right after climax so the penis is still erect People all over the world have used condoms safely for over 100 years Condoms are the safest of all family planning methods for both the man and the woman If a condom did come off during intercourse, the woman would be able to reach it with her finger, and take it out of her vagina. This is because, at the top of a womans vagina, there is only a very tiny opening to her uterus (womb). A condom cannot enter the womb. When a woman is in labour, this opening gets bigger to let the baby out. But when a woman is not in labour, this opening is always tiny, a condom could not possibly get through it.
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Activity 5.8
But weve never used condoms before, dont you trust me?
Peer group members have suggested that you could say: It is not a matter of trust, it is a matter of health. Condoms are important for our health, until we both get tested It is important that we are both protected. Maybe we should be more careful, because we havent been for VCT yet We can still prevent infection or re-infection, because if one of us is HIV positive, getting more viruses can weaken the person more I want to protect myself from pregnancy We should start using condoms now so that we wont be at any risk
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Activity 5.12 Condoms are only used by prostitutes and the unfaithful
Peer group members have suggested that you could say: Condoms protect from pregnancy and HIV or other STIs. Your regular partner or spouse deserves this sort of protection too Many religious people around the world use condoms, but many do not Prostitutes are fellow human beings - if they consider condoms essential for their wellbeing then others should consider the idea Abstaining from sexual activity is the only way to be absolutely safe from getting HIV through sexual contact Point to ponder Everytime a prostitute uses a condom she is acting not only to protect herself, but she also protects her client, his family, his community and the economy of the nation! Discuss
Activity 5.13
Peer group members have suggested that you could say: If two HIV negative people are both completely faithful they can have unprotected sex, but the reality in Malawi today is that sadly many of us cannot depend on abstinence or faithfulness Condoms do not promote sex outside marriage. Condoms are not widely used in Malawi, but HIV and AIDS continue to spread. Many people do not use condoms, but they also do not abstain before marriage, nor do they remain faithful People can control their own behaviour but they cannot control their partners behaviour, nor change their own or their partners past behaviours. So they should be able to use condoms to protect their future health Most partners have not been tested and many people have had risky relationships in the past Many people who say condoms should not be used do consider using them In a democracy, people should have full information about family planning The HIV and AIDS epidemic is so serious that we need to encourage the use of condoms as a public health and development issue Point to ponder I am not prepared to take the risk with my daughters life. I shall educate her about condoms and how to use them properly. She will not die from ignorance! Discuss
Activity 5.14
What have peer group members suggested? No, only use the condom once, 1 round 1 condom, 3 rounds 3 condoms Point to ponder If you are sitting on the bed with your love, it is may be too late to ask where you can buy a condoms. Discuss
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Activity 5.20
Conduct the life saving boat game. This will let participants critically examine the options they could adopt to save their life and the lives of others.
If I am to stay safe from HIV, I may have to get into a different lifeboat Do the following Use chalk to draw three boats and label them as abstinence, be faithful and use a condom Ask peers to assume different roles - professional sex workers, truck drivers, professionals like doctors, newly weds, army personnel, office secretaries, church believer, experimenting youth, a person who drinks, two lovers who have just met on the ship, a church elder etc Read the following to the participants Imagine your character is in a ship which is sinking There are three life saving boats at your disposal the abstinence boat, the be faithful boat and the use a condom boat Move into the boat that you would prefer to save your characters life - act quickly before the ship sinks. Give time for the participants to move into the boats of their choice Let the participants in each boat defend their choices Summarise the findings from the game Adapt or improve the game for different audiences Point to ponder Look at the advert for condoms on the right. It was used in the United States. Do you think such a message would work in Malawi? Give at least one reason for your decision Points to Ponder Is a person who knows that they are HIV+ but refuses to wear a condom guilty of premeditated murder? Discuss What would you say to a religious person who is HIV+ but refuses to wear a condom? Discuss
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Background Two good friends, George and Kondwani, have known each other since primary school days. They meet at the bus stop and start to talk. They were out at a bar, drinking together last night. George had to study for his examinations and returned home early. Kondwani stayed on and got very drunk leaving the bar with a woman who is known to have had many partners. George wants to help Kondwani avoid getting HIV through this behaviour. Continue the conversation between George and Kondwani. After the role play. The people who play George and Kondwani should stay in role during the discussion. What other ways could you develop this role play?
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Review the stages of behaviour change from page 40 Find out what things may stop your peers/friends from talking about safe sex and condom use with a friend or a partner Identify the stages of behaviour change that a person would pass through in order to reach the point of using
condoms consistently during a sexual relationship Find out what aspects related to alcohol use could hinder consistent behaviour change Prepare to share your findings with the group at the next meeting Evaluation. Use the questions on page 166 to evaluate the activities from this unit.
Point to ponder It takes courage for couples to actually discuss using a condom. The condom and the discussion are the easy parts, the barrier is that we are not yet brave enough! Discuss
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Unit 6
Introduction
Millions of people know what they can do to keep from getting infected wth HIV, yet many do not practice abstinence or safer sex. This unit looks at the issues surrounding communication between partners on HIV. It will consider some of the barriers to effective communication and the ways in which these barriers can be removed.
Learning outcomes
By the end of this unit you should be able to: explain the different stages that people may need to go through in order to use condoms consistently during sexual relationships identify the barriers to communicating about safer sex describe how gender affects discussions on preventing thE spread of STIs identify what is needed to make people change their behaviour practice ways to communicate with a partner about safer sex, sexuality, HIV and AIDS explain how condoms may become an enjoyable part of sexual relationship identify the issues raised by alcohol, drug use and sexuality
Activity 6.1 Assignment review: In order to change your behaviour and begin using condoms consistently, the following stages may be used:
1 Pre-contemplation - You have not considered that you are at risk and need to use condoms 2 Contemplation You become aware of the risk and subsequent need to use condoms 3 Preparation You begin to think about using condoms in the next few months 4 Action You use condoms consistently for fewer than six months 5 Maintenance You use condoms consistently for six months or more 6 Relapse You may begin to use condoms less consistently or stop
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Individual reasons
What are some of the reasons an individual finds it hard to change risky behaviour? Look back at pages 64-67 to review some of the earlier activities linked to this topic. How do these reasons create barriers to communication? Points for your discussion, debate, drawing, song, story, play, poem, poster etc Which individual reasons can create barriers to communication about safer sex? Enjoy having unprotected or natural sexual relations. Want to have a baby but have not been for VCT Fear they are already infected, so there is nothing to lose Dont wan to admit that they drink too much or use drugs so they do things they never intend to do Life is short anyway, so they do not want to lose any fun Believe they are not going to have sex, so dont prepare Peer pressure
2 Couple or relationship reasons
Which relationship reasons can create barriers to communication about safer sex or changing risky behaviour? Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? Cannot communicate openly, especially about sexual matters Too shy to raise the matter of safe sex with a partner Talking about safer sex raises difficult issues between you and your partner Fear a partner will think they are not faithful if they talk about HIV prevention Have different goals in life, so they cannot agree on what to do - for example, a man may want to have extra partners while a woman wants him to be faithful Have unequal power relationships, so that the wife fears physical or emotional abuse Lack of respect from one partner for another - one partner may be the underdog 3 Social and cultural reasons Sexual activities are enjoyable, and many of us dont like to change activities that give us pleasure. Many social or cultural factors affect conversationss about sexual matters. Points to ponder Two of the barriers to effective communication are the difficulty of talking openly about sex and gender inequality. Discuss If I went for VCT without telling my wife, I am not sure if I would tell her of my visit if I had been found HIV negative. Discuss If a villagers wife started talking to her husband about using a condom he would suspect that she was having an affair. Discuss
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Activity 6.6
How would you describe the behaviour of an passive partner? Points for discussion - bring up if not mentioned What have peer group members suggested? Use body language that shows lack of confidence or fear; like slumping over; a soft voice; not making eye contact and submissive gestures Present their ideas timidly or keep silent Agree with their partner to end disagreement, even if they dont like what their partner suggests If this happens frequently, they can feel resentful, unhappy and they lose confidence in themselves and their partner The work of a person who suffers within a relationship can be affected
Activity 6.7
How would you describe the behaviour of assertive (but respectful) partner? Points for discussion - bring up if not mentioned What have peer group members suggested? Use body language that shows respect to others Very rarely lose their temper or get angry Standing relaxed and straight, using a moderate voice, looking directly at their partner and using friendly gestures Present their own ideas and feelings confidently and clearly without shouting Listen carefully and make sure they know what their partner thinks and feels Try to find a plan that both partners can accept Identify people in national and local life who show assertiveness and use them a good examples Do you think that compromise plays an important part in a relationship involving two assertive people?
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Activity 6.9
Sometimes it can be difficult to agree when both partners feel very strongly about their opinions. How can we compromise or find a solution that is acceptable to both? Points for discussion - bring up if not mentioned - add new ideas you discover What have peer group members suggested? They can find a middle path that gives each of them some of what is important to them They can agree that they will follow one of their ideas this time, and the other persons idea next time They could agree that one of them will make decisions about one area of life, and the other will decide about another area of life - for example, the man will decide about clothes and the woman about furnishings. But it may be better for both to be involved in both issues Even if partners do not come up with an ideal solution, knowing that they have tried and have listened to each other makes them feel glad to be together Make a list of the statements that could be used during a discussion which reaches a mutually agreed conclusion - write down the exact words that will be spoken and test them out on peer group members If you believe that you personally need to practice making these sort of statements, why not find a place where you can be alone. Then speak the words out loud - try them at home speaking into a mirror. Study the cartoon shown below and swer the following questions: a) How do you think the message relates to conversations between sexual partners about HIV and AIDS? b) How do you think its message relates to the fight against the HIV pandemic?
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Activity 6.11 Role play: Talking about safer sex with a new partner
Introduce the role play with the briefground brief. Different people should read the different thoughts and words of the players. Start the role play by using Chisomo and Mphatsos words, and continue by making up your own. Background to the role play Chisomo, is a first year teacher trainee student. She meets Mphatso at a party given by a mutual friend. They have known each other since secondary school, but they havent met in a long time. Tonight they are really attracted to each other. They have been dancing all night and having a wonderful time talking together. Mphatso is thinking: Chisomo is beautiful, elegant and so hot! She smiles a lot and is still here with me I think sex with her will be better than with both my other lady friends I really want her tonight, but I have never used a condom and I am not really sure how to! I want to play safe but how do I bring up the topic? if i mention condoms shell think I believe shes infected or even worse, that I sleep with every girl I date! Chisomo is thinking: I loved being with him hes so handsome, strong and intelligent I dont have a boyfriend maybe he is the one, let me find out Men expect you to sleep with them as an appreciation of a good date, but HIV worries me, is he HIV+? I wonder what hed be like in bed - now Chisomo stop those thoughts right now! Well, in Mzake ndi Mzake we learned how to put on the male condom correctly But maybe I could convince him to use a condom But that would make me appear cheap, wouldnt it? Maybe I will just abstain until I know him better The role-play begins: Chisomo: I have really enjoyed myself tonight. Mphasto, I am so glad that I have met you again after so long. Mphatso: Chisomo, this partys breaking up. Can I walk you home, or maybe we can stop somewhere to talk some more? After the role play Did each actor/partner communicate clearly? What style did they use? Did the partners succeed in developing a plan that would protect them both from STDs, HIV infection? What else could have been said? How could this role play be adapted?
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What discourages excessive drinking of alcohol? What have peer group members suggested? The first step is for the person to admit that they have such a problem - the next step is to want to change the situation Use the behaviour change ideas on page 40 to make a plan for giving up alcohol Accept that drinking alcohol is a form of selfishness where the drinker is the one who alone enjoys that drink Accept that drinking alcohol uses money that could be better spent on other things - family food, school fees, transport, pension, health issues etc Learn more about Alcoholics Anonymous (AA) a worldwide organisation helping recovering alcoholics and how you can join - stories and tips at www.aa.org Couples who are open and honest with each other find it easier to tackle a problem like alcoholism or drug addiction People who have kicked the habit of drinking can act as mentors for others Faith groups can provide confidential support for members struggling to do so Women can counsel friends - traditionally women are expected to either not drink alcohol or drink only a little on special occasions Men can help each other by spending leisure time in places where beer is not sold Taking up sports or other active leisure pursuits can replace the trip to the bar as the main social activity People living with HIV and AIDS are discouraged from drinking alcohol as it can weaken the immune system Pray both individually and in groups for the spiritual strength to beat the addiction Family and friends who will stick by you and keep encouraging you to give up Counselling the drinker of the consequences of drinking on individual, family and community Never ever stop trying to give up your addiction to alcohol - others have succeeded and so will you! Malawi Times
Activity 6.13 Assignment: Talking about safer sex with your partner
Talk with your partner about sex and what is safe and satisfying for both of you - what each partner find particularly enjoyable? If you do not currently have a partner, talk (or role play) with a friend or neighbour Make a list of things that you will do to protect yourself and your partner from getting HIV and STIs
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Unit 7
Introduction
A person who is living with HIV (PLWH) may look perfectly normal, before they develop AIDS. Only an HIV test can tell whether a person is carrying the virus or not. AIDS is diagnosed using mainly clinical observation or using laboratory tests along with observation. If a person knows their sero-status (whether they are HIV+ or not ) then they can plan ahead and start anti-retroviral treatment (ART) when it is appropriate. ART is proving very successful in Malawi. You may wish to look back at the diagram on page 19 before starting this unit.
IMPORTANT: Since this manual was published new drugs and new methods of testing and treatment may have been introduced. So you should always listen to the most current medical advice from your health professional.
Learning outcomes
By the end of this unit you will be able to: describe what happens when you go for VCT state some of the reasons why people do not go for VCT list some of the advantages of going through VCT explain why counselling is an important part of VCT describe the clinical approach to diagnosing AIDS describe the laboratory test approach list the advantages of finding out if you are HIV negative describe where you can go for free VCT explain what ARVs are list the groups of ARV drugs describe what we must know about ARVs if we want to use them describe what happens before someone starts taking ARVs list places where people can get ARVs list some of the challenges faced by people taking ARVs
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Activity 7.3 What are some reasons for not going through VCT?
Discuss and list all the disadvantages there could be to being tested for HIV. Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? Not wanting to know that you have a serious disease Not wanting others to react negatively if they learn you are HIV positive Fear that if people see you going to be tested they will assume you are positive Fear of losing your partner or not having a future partner if you are HIV positive
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Activity 7.5
Counselling before and after VCT is very important. Many people go through a mourning process when they hear they have HIV or AIDS, it is as if they are mourning for themselves. They may feel as if they had lost their beloved wife, mother, father, child or dearest friend all rolled into one. In order to reach a position of living positively with HIV a person will probably have to go through the stages of mourning shown below. The 8 stages of the mourning process are: 1 Shock .............When first hearing the news that they are HIV+, people can go into shock. Shock is an intense emotional and physical reaction to devasting news. This is similar to shock after a physical accident; feelings of hysteria, numbness, an ability to think and act clearly. They may be unable to take in any more information or to respond to counselling. 2 Denial ............ Denial is linked to shock, it is a deep seated inability or refusal to take in the information. This might continue after the initial shock has worn off. Continued denial becomes problematic as it blocks appropriate behaviour change towards coping and living positively 3 Anger ............ Feeling as if you have been singled out for this terrible situation. Wanting to blame someone else. This anger may be directed at a spouse, the opposite sex, children, God or members of the community. 4 Bargaining .. The person prays or begs supernatural powers or medical staff to change the diagnosis. This often includes pledges to change behaviour. 5 Guilt ...............The person starts to blame themself for the situation. This often greatly reduces self-esteem and concern for all those who are directly or indirectly affected. The amount of guilt the person feels may be far greater than expected. 6 Depression.. Deep sadness, helplessness, which stops many ordinary activities, with low self esteem and loss of hope. This may be linked to loss and fear: eg loss of job, loss of loving relationships, loss of having children, loss of control. Fear of stigma, rejection, loneliness and death, or leaving dependents without support. At this stage PLWHA may give up and contemplate suicide or believe they have nothing to lose if they go back to dangerous sexual behaviour. 7 Acceptance.. No longer feeling overwhelmed; recognising that the situation cannot be changed and beginning to come to terms with living with HIV. 8 Coping ......... Adjusting to the new life situation and getting back to normal as far as possible. This means rebuilding self esteem, coping with life, and planning effectively for the future by adopting appropriate behaviour change. The best form of coping is living positively with HIV, where hope for the future is continually reinforced through positive actions. If a family member or friend was in an early stage of mourning for themself what could you do? Is giving information enough? Point to ponder The families and friends of PLWHA, play a very important role in helping them through the mourning process to the coping stage. Discuss
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Activity 7.8 What are the advantages of finding out you are HIV negative?
Ask any group members who have been tested, to describe their feeling before, during and after the test. Then discuss the advantages of a couple discovering that they are both HIV free. Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? Means past partners may be safe too Feel relieved you dont have to inform your partner if you have been unfaithful If I am HIV free this will encourage me to do careful planning for the future Helps decide to practice abstinence or safer sex in the future You can make informed decisions about marriage, pregnancy, and sexual relationships If you are both completely faithful, you can have sex without using a condom You can plan to have a baby knowing that the baby will not be infected with HIV
Activity 7.9 What are the advantages of going for VCT with your partner if you learn that both of you are HIV positive?
What are the advantages of going for VCT with your partner, especialy if you learn that both of you are HIV positive? Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? You can take good care of each other and stay healthy as long as possible Learn more about ARVs and the ART available in the community You can become a role model to other couples, showing them how to live positively with HIV and AIDS Plan to have regular tests speedy treatment for other illnesses Practice safer sex or abstinence so you will not re-infect each other Plan for the future for both of yourselves and your family eg pregnancy and succession planning which helps protect the family if you die (see page 140-1 ) Join or set up a self-help group for PLWHA
Point to ponder Knowing whether you are HIV positive or negative means that you can get on with the rest of your life and live it positively! Discuss
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Activity 7.10 What are the advantages of testing with your partner if you learn that one of you is HIV positive and the other one is not?
If partners go for VCT together and one is positive and the other is negative, what do you think could happen? What would be the disadvantages? Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? It may cause an argument over the assumed unfaithfulness of the HIV+ partner Partners can be careful to protect the negative partner from infection Couples decide to abstain or practice only non-penetrative sex(kissing, hugging, etc) to avoid the risk of infecting the other partner Some couples continue to have sexual relations with each other using condoms - many couples have done this, and when they ALWAYS use condom, the person who is HIV negative remains negative You can be behave carefully to protect the negative partner from infectionre You can be role model and show other couples how to live positively with HIV and AIDS
Point to ponder I dont want to go for VCT at the local health centre, because people will see me going inside and then the gossip will begin. Discuss
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Activity 7.13 What are the four groups of ARV drugs and why do we need to use four of them?
There are four groups of anti-retroviral drugs and each attacks HIV in a different way. Each of the four groups acts during a different time in the life cycle of the virus. These are the four most popular ARV drugs used at present: 1 Entry Inhibitors In order for HIV to enter the human cell, it has to attach itself the surface of the cell first and then move into the cell. This group of drugs interfere with process and prevent HIV from entering the human cell. 2 Nukes or Nucleoside Analogue Reverse Transcriptase Inhibitors or Nukes These slow down the reproduction of the virus by blocking the action of the enzyme (reverse transcriptase) which is essential to the virus being absorbed into the host cell, where it can reproduce itself using the cells own genetic material - they ensure that the HIV copies are poor or faulty. 3 Non-nukes or NonNucleoside Reverse Transcriptase Inhibitors Inactivates the transcription of the RNA (of the HIV) into the human cell DNA. 4 Protease Inhibitors These interfere with the enzyme (protease) needed in the final stage HIV copying by causing the production of immature viruses. These drugs are used in a combination so they: reduce HIV mutation boost the immune system by decreasing the resistance to a particular drug stop or delay the conditions favourable for the opportunistic infections The HAART combination uses the last three groups of drugs. Any one or two of them can also be used alone. If you take HAART, you need to regularly check on the effect of the treatment on your CD4 cell count and your viral load - the CD4 cell count measures how strong your immune system is
IMPORTANT: Since this manual was published new drugs and new methods of testing and treatment may have been introduced. So you should always listen to the most current medical advice from your health professional.
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Activity 7.14 What must we know about ARVs if we want to use them?
Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? Find out if a member of the group who is on ARVs, will lead the discussion or describe their personal experiences The activity works well by using a real case study Medication should be taken exactly as prescribed You must be able to adhere to treatment regime. Change your lifestyle so you can more easily stick to the routine Missed doses should be taken as close as possible to the scheduled time, if it is not possible then the regular amount at the next scheduled time Bottles, glasses, medicine spoons should be kept separate from other medication equipment to keep uniformity of doses and avoiding accidental use by family members Drugs should be stored as prescribed - your must work out how to store and carry your drugs during the work routine or travels Find or ask for support from people who know about your HIV status or ARVs Understand the possible side effects of proposed treatment and let your friends or partners know about these
Point to ponder Your lifestyle changes when you start taking ARVs regularly. Its as if I am in training, like an athlete, making sure my life is disciplined and focused. Discuss
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Activity 7.20
Ex-president of the USA, Bill Clinton has said, AIDS is no longer a death sentence for those who can get the medicines. Now its up to the politicians to create the comprehensive strategies to better treat the disease. Discuss the quotation from Bill Clinton Identify problems faced by people taking ARVs in the community. What problems could be encountered at work, school and other places? Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have health professionals have suggested? Problems associated with treatment include: - Difficulty monitoring treatment effectively - Difficulty in distribution of drugs - Difficulty in sticking to treatment regiment - Development of resistance Some people come late to treatment because of denial - they have problems accepting they could be HIV+ Some people develop strong side effects so a drug combination is not workable Some people fail to respond to drugs due to drug resistant strains of HIV Some people cannot access regular drug treatment for HIV infection Black market drugs cannot be trusted - you cannot be sure what they are Some religious leaders try to persuade people taking ARVs to stop and look to be cured through prayer Others may feel traditional medicines are better than ARVs - if this was true the makes of these medicines would be millionaires People may hide their ARVs and take them in secret and not disclose their status Discuss other difficulties with drug treatment.
Talk to your family members or friends about what you have learnt today Find out how much they know about anti-retroviral drugs Make sure you tell them that since the introduction of ART, figures are changing. People still die, especially during the first few months of treatment, but when we compare the figures with those that are surviving, there are many more survivors. Find out where people are getting ARV drugs and what challenges they are facing in using and managing the treatments Prepare for the next session by looking at what your community is doing to fight the spread of HIV
Evaluation
Evaluate the activities in this unit by going through the questions on page 166 and record the results in your learning log.
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Introduction
There is an traditional African saying, When spider webs unite, they can tie up a lion. This illustrates the special power in community action that can mobilise people and resources, which is unique. Nearly all national social initiatives rely upon some form of community action. In this unit we will look at the many different ways communities can work together to fight the spread of HIV.
Learning outcomes
By the end of this unit you should be able to: describe how all adults have the right to protect their health either by abstaining or by having safer sex describe ways to protect groups who are at risk of HIV infection list the factors in our society which encourage the spread of HIV describe cultural practices that increase the risk of HIV infection explain why Malawian laws do not allow nkhanza describe Malawis National HIV/AIDS policy describe ways to protect widows from HIV infection describe ways to protect young girls from HIV infection describe ways to protect women and men from HIV infection explain the work of teacher networks fighting HIV : TLIPO identify other networks fighting HIV describe how Malawis sex industry can spread HIV/AIDS explain why education is called a vaccine against HIV explain why staying silent on homosexuality may help spread HIV/AIDS describe one global approach to HIV prevention explain why people who spend time in prison are at risk explain how trafficking for sexploitation spread HIV and AIDS
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Activity 8.3 Ways to protect groups who are at risk of HIV infection
Identify the people in your community are at risk. Look at all the different members of a community and how they could be put at risk of HIV. You may want to refer to page 49, where over thirty reasons for having a sexual relationship are listed. Points for your discussion, debate, drawing, poem, poster, story, song etc Do you think the following are at higher risk? If so how would you work to protect each group from abuse and risk of HIV? Boarding secondary school pupils and boarder at college or university Unborn baby of an HIV+ mother Professional at a workshop away from home Long distance lorry driver Sugar-daddy and sugar mummy Cross-border trader Health worker Child labourers or seasonal worker Orphan with no means of support Orphan living with relatives Refugee or displaced person School child House servant Sex worker Street child or youth Police officer Prisoner Adolescent Widow Tourist
Activity 8.4 Which factors in our society encourage the spread of HIV?
The points listed below may overlap, so you can combine some of them if you wish. Which factors encourage the spread of HIV? Rank the following in order of 1st place, 2nd, 3rd, 4th, 5th to 10th: Condoms Prostitution Unemployment and poverty Homosexuality Lack of a full primary education Gender inequalities Pornography Power relationships within the family, school, workplace and community life in general Traditional cultural practices Sunday Times, Mar 2, 2008 by Agnes Mizere Witchcraft, sorcery or evil supernatural forces Lack of information about HIV and AIDS Westernisation and consumerism culture Lack of effective moral education Injectable drug and alcohol abuse Lack of communication about sexual matters, between partners and between adults and children Compare your list with the lists made by other members of the group.
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Activity 8.5 Cultural practices that increase the risk of HIV infection
You may wish to combine this activity with the next one. Review some of the cultural practices in our society which increase the risk of married couples contracting HIV.
Decisions to change any of these practices may involve the whole community or the most important leaders in the community to meet and act.
Points for your discussion, debate, song, poem etc What have peer group members suggested? Wife replacement (kusunga mwamuna) Temporary husband replacement (mbulo) Husband and wife exchange (chimwanamwayi) Widow inheritance (chokolo) Sex with the girl-child coming of age (kusasa fumbi) Sex with the boy-child coming of age Early marriage Death cleansing (kulowa/kupita kufa) Menstruation cleansing (kuthintsa mchele) Polygamy - since there is contact with a number of sexual partners within each marriage, the risk of infection if one partner becomes infected Extra-marital affairs Forced marital sex Seasonal marriages Lack of communication on issues related to sex and HIV/AIDS Myth that sex with a virgin is safe or can cure a person from HIV and AIDS Dominant position of men in society and within all types of marriage, leaves many women powerless to negotiate safe sex even if they suspect their husband may be infected. Because men usually have control over when, where and how sex takes place, women dont have much decision making power concerning sex
This cartoon appeared on the front page of The Sunday Times, in March 2008. The Malawi Traditional Healers Association threatened to march to parliament. The Hon. Secretary for Nutrition and HIV/AIDS had said, I have not said its a witchdoctors law. We want to protect people from healers who use albinos, people with disabilities and virgins as zizimba to treat AIDS. Read the policy on page 106.
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Point to ponder It will take at least a generation to get rid of nkhanza from the villages. Discuss
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Activity 8.9 What are some of the causes of stigma and discrimination?
Why are certain people in our communities stigmatised? What causes stigmatising? Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested as causes of stigma? Lack of recognition that stigma actually exists Ignorance, lack of information on causes and modes of transmission, that leads to irrational risky behaviour Myths and fears about HIV transmission When HIV infection is viewed as punishment for immoral behaviour then nobody wishes to be associated with PLWA Self-interested people trying to create a divide between the healthy and those who are not so healthy Mass media images portraying PLWA as defenceless, weak and dying - images of thin diseased AIDS babies in adverts for charities People who are infected with HIV remind us that we are all at risk unless we practice prevention - this may scare us
Point to ponder When there is an unwanted pregnancy in your community, who usually carries most of the blame? Discuss
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What forms of stigma have people experienced in colleges and communities. If you have time, group the examples to show any patterns of behaviour. Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? Stigma attached to occupation, family, tribe, race, religion, appearance or looks Treating people from different region or tribal groups badly Physical and social isolation from peers, family or community members Being left out of decision making that concerns family or even yourself Getting to hear gossip, condemnations and name calling by fellow students, family members and community members Self blaming and self isolation Refused employment, membership of benefits schemes Some insurance companies refuse to offer life insurances In the past, many people are refused proper health care, especially bed space in hospitals A whole family being isolated by community PLWA and their families suffer when people react negatively to them Being tested without consent Breaking of confidentiality (privacy) of medical records Negative reactions of others make some people afraid to get tested or to tell others if they are infected - testing helps people plan their futures and protect their loved ones from also getting HIV and AIDS Hiding HIV and AIDS from neighbours makes people less aware of the need for taking action against the HIV and AIDS epidemic in Malawi. Cause someone to feel unwanted and depressed, and contemplate commit suicide Point to ponder If stigmatizing - of any type - is allowed to continue openly in any place, it will eventually create an angry, unhappy, and unjust community. Discuss
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Activity 8.12 Role-play: Helping to reduce stigma about HIV and AIDS
How do you think it feels to suffer stigma and discrimination because you are HIV+? This role play asks you to look at how we might react in a situation where someone is being stigmatized and discriminated against. Background Abigail is a student teacher from the village of Kapesi. William, is her uncle. He is a very important man in a nearby community. And a successful businessman who enjoys speaking his mind. During a visit to her village, William makes a negative remark about a family whose son died from AIDS. Abigail wants to reduce negative attitudes without quarrelling with her uncle. William Abigail William Abigail Let all these promiscuous people die from AIDS. It is their punishment for breaking our traditional codes of behaviour What do you mean uncle? After they die out, the good people will be left and we can create a new better future for this community (What could she say?)
After the role play What did Abigail says next? How did you feel about what was said? What was it like to role play being the uncle? Did Abigail manage to successfully challenge her uncles views in a way that will not create family quarrels?
Point to ponder Cartoons depicting the disappointing activities of an unfaithful husband reveal the addictive nature of extra-marital sex, but may not promote behaviour change. Discuss
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Activity 8.18
Review the reasons why women are vulnerable to infection and identify actions which could protect them from HIV. We have listed the positive steps that can be taken to protect both women and men together because they often overlap. Sometimes there is a way a man can protect himself and his partner, another time there is a way a woman can protect herself and her partner. Points for your discussion, debate, drawing, song, story, play, poem, poster etc What positive actions have peer group members suggested? Encourage girls and women to accept their equal status under the constitution this also means that boys and men should not necessarily bear the whole burden of funding and decision making in relationships Promote assertiveness rather than aggression or passivity among boys and girls Encourage community members to join or establish positive-action groups for community development Partners should be role models - observers learn more from what they see others doing, than from what they hear others tell them to do Talk to your partner about how HIV and AIDS is spread and is not spread Talk with relatives, friends and neighbours about HIV and AIDS Empower girls and women through education and counselling Speak out against spousal abuse, male-on-female and female-on-male - abused males often fail to speak out because of shame, but are at risk Report men who hit their partners to the police - it is often hard to communicate with someone who physically or sexually abuses a partner Report incidents of gender-based violence to the police or tradtional authority Campaign for or establish victim support groups in your community Eliminate gender-based violence from your community by voting in politicians who make it part of their election manifesto Things are changing fast and we have more women in positions of power, as politicians, principals, police officers and defence force Educate both men and woman on human rights and discuss how these may be influenced by religious beliefs Keep girls in school as long as possible - this has many positive effects on society. When educated girls grow up to be women they will know the facts about HIV and are empowered to live a healthier more prosperous lifestyle Encourage succession planning and will-making to stop property grabbing Counsel family, friends and collegues who have an addiction to alcohol or violence Assist abusive alcoholics to get help through counselling and other support Speak out or campaign against spousal abuse, child abuse and child labour Educate unemployed women on condom use and identify sources of condoms Educate the elderly about HIV and AIDS - they are often care givers of PLWHA Form peer groups for unemployed women for HIV education for sprevention Point to ponder The elderly must be included and educated about the risks of HIV. Discuss
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Activity 8.19 More ways a community can protect itself from HIV infection
Identify community actions which would protect members from HIV. Many of the suggestions mentioned overlap with the actions you may have brought up in earler activities. Check off the ideas against what you already know. Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? A community full of positive role models is the best action to take Talk openly about HIV and AIDS and the need to support PLWA Diplomatically challenge and correct people who make incorrect comments about HIV/AIDS issues or discriminate against PLWHA Christian and Muslim beliefs strongly condemn stigmatising the sick or weak. Religious leaders, like Jesus and Muhammed showed that the marginalised of society were one of their main concerns. We should emulate them Discuss the fact that thousands of people living with HIV are not promiscuous Ensure the community can provide or support voluntary counselling and testing (VCT) programmes and ART education Treat the girl child with respect and work against stereotyping Help persons living with HIV and AIDS and their families or carers Form peer groups for youth-to-youth, elder-to-elder, widow-to-widow educators Provide information about HIV and STIs prevention to community the peer groups Support the different peer HIV education groups and use them to train future traditional marriage counsellors on HIV Campaign for reform of any pre-marriage counselling techniques which involve unsafe sexual activities Put up HIV awareness posters around the community Tell everyone in the community that HIV+ mothers can have HIV negative babies if the proper procedures are followed Encourage income generating activities for unemployed, unmarried or widowed Speak out against community practices that encourage the spread of HIV and STIs such as sugar daddies or sugar mommies or traditional practices like child labour, circumcision, initiation and under-age marriages Identify places where risky situations are common, eg beer halls and discos Talk to local bar owners about banning the young, sex-workers, drug dealers from their establishments Organise support for sex-workers in your community, encouraging those who cannot give up to use condom Point to ponder The spread of HIV and AIDS has given women a reason to speak out, and this has had unexpected benefits such as greater equality within sexual relationships. Discuss
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Patricia is a sex worker in Blantyre. Here is part of her story as told by Wonderful Hunga in the Daily Times in Oct.08 Points for your discussion, debate, drawing, song, story, play, poem, poster etc I cant go back home. Nobody can help me. My grandparents are too poor. Patricia is wiggling her waist as she strolls... the tavern is the busiest place... music is blaring... people are dancing... sipping their beers... I got myself here some months ago... my mum passed away... things became difficult at home... I packed up and left... I wanted to do my own thing Welcome to Malawis sex industry. Patricia is not alone. Sex work is a trend in Malawi, and it is especially affecting young women... forced to engage in sex work or transactional sex in exchange for survival items such as food, protection and money... Although illegal... women congregate at nightclubs and bars and sell their bodies in order to survive. Some begin work at 14 or 15. It is survival sex. Women like Patricia earn anywhere from K1,000 to K140 per day depending on the type of customer and place. So, everyday they are risking their lives, health and dignity for these incomes... Some male customers refuse to put on a condom... the majority of those infected with HIV in Malawi are women... Gender equalities, which stem from cultural beliefs... put woman at greater risk... It continues despite Malawi is bound by the principles of the UN Charter, the Universal Declaration of Human Rights, the Convention on the Elimination of All Forms of Discrimination Against Women and the Convention on the Rights of the Child. All these treaties discourage discrimination on the basis of gender. Patricia always uses a condom. She says it is to guard against pregancy not HIV/ AIDS... young girls have proven to be especially vulnerable to sexual violence, or to being trafficked or coerced into sex work... Patricia recalls such violence... I was ambushed... he wanted to kill me... he grabbed me by the neck... I screamed and ran away. It was just around 11pm... Since then I refuse to be taken to anybodys place... We tell each other... this guy did this and that and dont ever accept him. Like many sex workers in Malawi, Patricia admits to a history of violence in previous relationships. No, I reject love relationships. No, I dont want to get married. Somebody once abused me and that was enough... He was jealous. He beat me up when I was late from the market for no reason... He called me a whore... But, eh, he was abusive. If I came late from drawing water, he would beat me up. That was slavery, so I kicked him out of my house... life is better as a bar girl or sex worker than at the hands of an abusive boyfriend or husband... I will marry but not now. Im enjoying my life. That lover really abused me. Point to ponder Poverty turned Patricia into a prostitute. What else could she have done? Discuss
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They said I was the most beautiful young woman in the village. They told my mother I would get a good job in SouthAfrica. Id have a good life and be able to send money home. My mum agreed as they were such a nicely dressed man and woman... and the money was needed. We travelled a long way, but when we got to the city there was no housemaids job... then the man came shouting that he needed me to pay back the money owed to him for transport, clothes, accommodation and food... He said I owed him hundreds of dollars! I told him I had nothing. He said if I had no money he would make me work at a nearby hotel until I had paid off all that I owed him. At the hotel he made me wear a very short shirt and low cut top and high heeled shoes. I now knew how I was to get his money back. I was so embarrassed and refused. I never expected what happened next. He took me into a room, beat me all over my body and violently raped me... I was bleeding... I was a virgin and had never known a man... It hurt so much... I cried and cried... two more men came in and raped me... I still refused to sell myself... so they took all my clothes and locked me in the room. Over the next week I was beaten and raped so many times I could never count. I worried about HIV as none of the men used a condom... They said I would starve and die in the room if I didnt agree. No one would ever know what happened to me. If I agreed I could send money home to my mother and relatives and help them as planned. So, I agreed to become a sex worker. Me! A regular church-goer and choir member. The man is now my pimp. He takes me to places where men want company, finds me clients (Johns) and protects me. The clients pay well but my pimp takes most and his repayments. Hotels know us and my pimp arranges my rooms... he gets a cheap rate. In primary school I had dreamed of being a teacher, doctor even our MP... How did this happen? Will I ever pay off my debt? Am I HIV+? Will ever see Malawi again? Points for discussion In your opinion, which of these people has committed the most serious offence? 1 Grace (prostitute) 2 The John (client) who pays and uses the prostitute 3 The pimp (or madam) who controls and makes money from the prostitute 4 The person who rents the client and prostitute a bedroom In some countries prostitution is legal for those over the age of consent (eg Holland). In other countries a third time offender may be sentenced to death for prostitution (eg Sudan). In other countries prostitution is not illegal, but living off the earnings of a prostitute is a crime. While in Germany prostitution is a legal business and sex workers have their own unions and pay tax to the government on what they earn. Point to ponder The issue of prostitution and HIV in Malawi will not be resolved by silence. Unless we start to discuss more openly the part played by all those in the sex industry: prostitute; client; pimp/madam and traffickers, we are in serious danger as a society. Discuss
Graces story
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Select four positive statements from the passage that you would like to share with others Select four negative statements that identify issues that need addressed Malawi is addressing some of the issues through the Safe Schools initiative, how far are you aware of its achievements? If you were the President or the Minister of Education, what would you do in order to make the best use of education as a vaccine against HIV?
Point to ponder We must encourage behaviour change in the home, in the work place and at school. Discuss.
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Points to ponder from Malawian newspapers Policeman rapes a male prisoner held in police cell Man raped by fellow inmates while in prison Uncle sodomises nephew School boy caught sodomising a friend at boarding school Tourists pay for homo-sexual sex with locals Points to ponder Talking about homosexuality is a taboo that needs to be addressed now! Discuss.
Homosexuality is illegal in Malawi, but in August 2008, the Malawi Gay Rights Body was formed to protect the rights of gay citizens. Is this right? Will it help fight HIV? Discuss.
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Activity 8.26 How are people who spend time in prison put at risk?
The Malawi Human Rights Commission and other international human rights groups, have produced reports showing that many prisoners rights to health and life are being abused. Many of the problems and solutions are outlined below. Points for your discussion, debate, drawing, song, story, play, poem, poster etc Many prisoners have little knowledge about HIV transmission and AIDS care. Prisoners share razors or razor blades can cause HIV cross-infection. Rape of both female and male prisoners by other inmates - especially the young and new prisoners - in some cases gang rape. Rape is about power not just sex. Rape by police officers while in holding cells at police stations - police officers raping both females and males in detention Prisoners exchanging sexual favours for food, freedom or protection from violence Overcrowded and unhealthy living conditions spread diseases like STIs, scabies, TB and prevent prisoners living positively Poor nutrition leaves prsonersvbodies unable to fight opportunistic infections Shortage of medicines, medical facilities and proper nutrition Shortage of transport for hospital referrals Lack of access to education on HIV and ART or a regular supply of ARV drugs Poor medical care for patients suffering from STIs and other infections Greater protection of inmates from intimidation and violence especially rape More funding for prisons and free distribution of condoms to inmates HIV/AIDS education for prisoners and officers, possibly through peer groups Reduce number of prisoners per cell Campaign for a new prison building programme and expansion Education on ARVs and regular distribution of ARVs to prisoners LWHA More funding for medicines, medical facilities and nutrition More funding for transport for emergency referrals to hospital Establish more prison farms with a wider variety of animals and plant breeds Complementary basic education programmes to improve education levels Education programmes on income generation and rehabilitation Banja La Mtsogolo ran The Health For Prisons Initiative from 2005-8, which focused on sexual and reproductive health programmes for prisoners Point to ponder Once a prisoner is released he has completed his sentence, his debt to society is paid off, but if he became HIV positive in prison doesnt society now owe him compensation? Discuss.
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Activity 8.27 How does trafficking for sexploitation spreads HIV and AIDS?
A report for the United States government stated: As unimaginable as it seems, slavery and bondage still persist in the early 21st century. Millions of people around the world still suffer in silence in slave-like situations of forced labor and commercial sexual exploitation from which they cannot free themselves. Trafficking in persons is one of the greatest human rights challenges of our time. Read the following article and carry out the activities that follow.
Points for your discussion, debate, drawing, song, story, play, poem, poster etc Pick out five or six sentences from the passage that you think carry the most important points Who should stop people trafficking? What can you and your peer group do to help stop trafficking? What can communities do to support victims of people trafficking? What do you think are the best ways in which to eradicate people trafficking?
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Activity 8.28
A report by the Population Reference Bureau in 2007 said: As the HIV epidemic progresses, the elderly must be counted and educated about the risks of HIV. Here are some more extracts from the report: Of the estimated 40 million people living with HIV, the vast majority are adults in their prime working years, but as this middle generation dies of AIDS, a generation of young children and a generation of elderly ages 50 and older are left behind. Despite extensive amounts of research on the AIDS epidemic, little attention has been given to the impact of HIV/AIDS on the elderly in developing countries. It highlights the following areas of concern Caring for families and ARVs. Some elderly take on the care of their adult children or relatives who are sick. More elderly are also assuming the role of caretaker for their grandchildren and other orphaned children. Expanding access to antiretroviral therapy will likely decrease deaths of adult children and delay serious illness. As a result, parents may change how they help - instead of providing terminal stage care, they may help ensure adherence to demanding regimes of medications. Economic impact. Old age, declining health status, and caretaking responsibilities at home compromise older peoples ability to earn an income. Health consequences. In developing countries where family support systems exist, elderly people who care for their adult children or relatives often receive material support from other relatives. In Malawi, for example, intergenerational support networks exist between adult children and their parents and also with maternal and paternal aunts and uncles. Attitudes. Community reactions toward those living with HIV as well as toward their caregivers have generally been positive or neutral, despite widely held assumptions to the contrary. Educational campaigns and knowledge about HIV have likely alleviated fears about casual transmission, thus contributing to lower levels of stigma Despite their considerable caretaking role, the elderly still remain largely hidden from the international HIV/AIDS agenda. Because it is assumed that they are not at risk of contracting HIV, the elderly have received minimal program and policy attention. Older people are not only at risk of infection, but their income and health may also be adversely affected when they take on the role of caregiver. Particularly important in the context of increasing access to antiretroviral therapy is determining the potential of older parents in encouraging treatment and monitoring adherence and how increased access to these drug regimes alters the consequences of having an HIV-infected son or daughter.
Points for your discussion, debate, drawing, song, story, play, poem, poster etc The Mzake ndi mzake peer education programme covers prevention, treatment, care and support. How far do you think that the elderly are involved in all of the four aspects of HIV/AIDS programmes in your community?
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Is daddy your special friend Yes, because he helped to make you! Will I find a special friend to be happy with and make babies? Mother Yes, I hope you will find a good man to marry. But you have to grow up into a woman first Girl child Why cant little girls have babies too? Mother Babies grow inside the mummy and a little girls baby hole is not big enough to let the baby out Girl child Does every girl and woman have a baby hole? Mother Yes, thats one of the things that makes us special. There a lots of things about us that make us special Girl child Are boys special too? Mother They are special too, for lots of reasons Girl child What makes boys special? Use role play to continue this conversation
Activity 8.30 Role play: Discussing sex education for young children
Introduce the role play with the brief overview found below. Background to the role play Two mothers, Christine and Ada, are concerned about their children because they are growing up rapidly. They have just finished listening to a radio programmme that talked about the importance of preventing child sexual abuse, early sexual activities and HIV infection. They both want their children learn how to lead healthy lives. The role play begins Christine How am I going to tell my son the facts of life? Ada And how am I going to tell my daughter the important things she needs to know, to keep her safe from HIV/AIDS and pregnancy? Christine Should we leave it until the initiation, that is the traditional way isnt it? Ada Children can be sexually active in primary school, I am not so sure we should leave it until initiation, that is too late! Christine What would you say to your daughter if she asked about sex and babies? Ada What would you say to your son if he asked you why he has a penis*? (* substitute a traditional term if appropriate) Christine Who should we ask? The elders, religious leader, teacher or nurse? After the role play How old should children be when they start learning about sex? Who should teach the children about sex? Does life skills education at school provide enough information and skills? Where could parents and community elders get information about reproductive health and child sexual abuse to share with their children?
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Activity 8.31
Continue the previous role-play Choose whether your role play will involve a young boy or a young girl Try to use the exact words that could be used when talking to the young person The role play begins Adult You may have heard some boys talking about sex Child Some boys say that everyone who has sex will die of AIDS After the role play In what other ways could you have started this conversation? Were the explanations clear and simple? Did the conversation mention sexual feelings and values? Will the child feel that they can come to the adult for more advice at a later date?
Activity 8.32
You may combine this activity with earlier role plays if you wish. Look back at pages 65-67, 104 and 111 for source material. Background to the role play Edina should be baby sitting, but she runs out of the house. Her uncle looks out of the window as she races past her older brother George. The role play begins: George Whats wrong with you? Edina Nothing. Its just uncle wanting to tickle me again George You shouldnt let him touch you that way After the role play What did George say to Edina and what did he do? Describe or act out, four different endings to this play Which ending seemed to bring the most satisfying conclusion to the situation?
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Learning outcomes
By the end of the unit you should be able to: describe how different people may react when learning that they are HIV+ explain how reducing stress can help a person live postively with HIV describe ways of living positively with HIV and AIDS explain the importance of eating positively identify foods which should be used by PLWHA identify medicinal plants that can be used by PLWHA describe how some foods can relieve the common symptoms of HIV/AIDS describe natural remedies that can be used to alleviate diarrhoea explain the importance of hygiene for a PLWHA explain how spirituality may strengthen the immune system carry out succession planning explain why home-based care is important identify the time when a family may begin home-based care for PLWA
Activity 9.2 How do people react when learning they are living with HIV?
By the time you reach this unit you will have a lot of ideas on how to answer this question. The focus of the activity in this unit move away from the negative responses and looking at the the vaiety of positive responses. Why is it important for a PLWHA to share feelings and concerns with others? Who would you confide in if you were HIV+? Why did you select that person?
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Activity 9.3 What causes stress for people living postively with HIV?
What sort of things could cause stress to people with HIV infection? What have peer group members suggested? Receiving an HIV positive result Others being told of someones HIV status without their consent Thinking how community members will react to the news that you are HIV+ Having inadequate finances to support family Being unable to afford medical treatment and drugs Being unable to afford school fees for children Fewer relatives to look after children if you die Fear for childrens future Loss of employment and opportunities Loss of friends and isolation Rejection by some community members Fear of dying Death of loves ones, a spouse or a child What problems does stress cause for PLWHA? What have peer group members suggested? Stress often blocks our minds with negative thoughts and this can stop us doing other important or essential tasks It makes us feel that we have had enough - we want to escape from the problem, to get away so we can be stress free again - sometimes suicide is contemplated Stress can blind us to the many alternative choices and sap us of the energy to do any thing at all People may look only at a problem and not the opportunities or circumstances around the problem People focus on their condition and forget that there is lot they can do to improve their lives People living with HIV/AIDS can develop stress related illnesses which weaken the immune system, which is then more vulnerable to opportunistic infectionss Living a positive lifestyle can greatly reduce the stress experienced by PLWHA You may wish to go through activity 9.11 and 9.12 next - they are concerned with methods of stress relief. Point to ponder The greatest amount of stress for a PLWHA is caused by having a pessimistic outlook on life. Discuss
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by Carmen Aspinell
The way foods are classified in Malawi has changed. The diagram above, shows the new food groupings. Can you identify the 6 food groups shown in the drawing? Recommended eating habits for people living with HIV and AIDS Eat a variety of foods from all of the food groups Choose small, frequent meals of foods that are easily tolerated by the body - so eat small meals (4-5) instead of 3 big meals Snacks are foods eaten between meals and help fill the energy gap and are a way of giving children or people living with HIV extra food Try to eat less meat and fat Increase amount of fruit and vegetables in the diet Avoid skipping meals or eating only when you are hungry Try to keep your weight constant Listen to your body, because some foods make symptoms worse Inform health care workers if some foods make you ill Use fresh food and try eating raw fruit and vegetables or cook them on low heat, steam or bake them - remember that boiling destroys many vitamins Consult your health care worker or doctor before taking vitamin tablets Avoid coffee and dont eat too many processed foods
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Point to ponder By relieving many of the uncomfortable symptoms of AIDS, natural remedies play a significant part in helping people to live more positively. Discuss
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Activity 9.9
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Points for your discussion, debate, drawing, song, story, play, poem, poster etc Peer group members with religious faith and others with no faith, have suggested these ways of strengthening the immune system: It is important to use your faith to help you live positively, by asking for advice from your religious leader or advisor People of faith, believe that humans have a mind, body and a spirit A religious person believes that as well as working to strengthen the mind and the body, they can strengthen the spirit and this improves personal well-being Attending regular services or holding a house meeting at home, where fellowship and worship take place and spiritual matters are discussed Faith is not just about thoughts and words, but more about feelings - so, share your feelings with your family, friends and fellow believers Find ways to show your love for God, your family and your fellow human being and develop a love for all creation Giving and receiving love makes your immune system stronger Be thankful for the beautiful things in the world around you and this will make you feel better Identify passages from your holy book that lift the spirit and then write some down on pieces of paper, so that you can carry them with you, to read or share Develop respect for people you meet and accept them as fellow travellers through life who are born, are living and will one day die Smile and share smiles with others, because smiling lifts both the spirits of the smiler and the people who are smiled at Think about your life from childhood to present day - make a list of your favourite experiences, share them with friends and relatives and then thank God for those special times
Point to ponder If I exercise my mind and body for health reasons, shouldnt I exercise my spirit too? Discuss
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Deep breathing is something you can easily teach peers. Try this exercise to see how relaxing deep breathing can be: Close your eyes Now count 1, 2, 3 as you breathe in through your nose Hold your breath and count 1, 2, 3 Breathe out counting 1, 2, 3 You need to do this activity at least three times - get to the point where you can feel yourself relax as you do it It may not happen the first time you try it - its a skill you develop
Quiet time
You can also encourage peers to set aside a quiet time each day for meditation and prayer. Try this exercise for meditation: Choose one simple word to focus on - this will help to block-out other stressful thoughts from your mind The shorter the word the better - eg. peace, joy, calm, cool, love, happiness By choosing a peaceful and calming word, the mind will become more peaceful A religious person may mediate on the 99 names for God or the life of Jesus It is your individual meditation word - so, experiment with different words In a quiet place, think of your word over and over again - it should be a word that makes you feel good, relaxed and comfortable
Activity 9.13 Role play: Talking about living positively with HIV and AIDS
John and his wife, Rebecca, have loved each other since they married ten years ago. Rebecca has been reading about people living positively with HIV and knows a great deal about the topic, but she has never mentioned this to John. Background to the role play John is thinking How can a person like me, go for VCT and be HIV positive, maybe the test is wrong! I am a dead man and have probably sentenced my wife to die too! What will they say at church and work when they find out? This diarrhoea is going on too long, is it full blown AIDS already? I think Ill find a quiet place well away from here, commit suicide and save my family the embarrassment The play begins: Rebecca comes in and sees that her husband, John, is almost in tears Rebecca Is something wrong husband? A problem shared is a problem halved. John Just one problem my dear, but I think I can handle the issue by myself Continue the role play and afterwards, discuss any interesting points raised.
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What would encourage succession planning? Encourage succession planning in a number of different ways, including: counselling HIV positive parents or guardians, regarding telling their children about their test results. creating memory books or boxes. These consist of a book or box which describes and remembers a persons life. They may focus on specific events or periods within a persons life. Memory boxes may be used to hold important documents, such as birth certificates and wills. What would you put in a memory box? support to appoint a standby guardian. This person will take on the responsibilities of a parent for a child if the parent is no longer able to do this. training of guardians. education legal matters including practical support to write wills. assistance with school fees and supplies. training in ways of generating income and funds to get activities started. community sensitization on needs of AIDS-affected children. Why is succession planning important? Benefits of encouraging succession planning include an increase in the number of: guardians appointed before a parent dies parents who tell their children the results of their HIV test - this is particularly true where those children are over the age of 12 years wills written, which protect loved ones Experience has shown that a project has benefits beyond the area in which it operates. This is because people within the project area share the benefits with those outside the area.
Activity 9.16 What things would you write in your memory book?
Who will read your memory book after your death? What special memories would you write in the book? What special messages would you include? You could include a list of your favourite music, foods, places, books, prayers, books etc
Activity 9.17 What things would you put in your memory box?
Put in some of your favourite photographs and letters Special souvenirs, diaries or journals, books, jewelry etc What other special things would you leave for others?s
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Activity 9.19 When should a family start home based care of PLWA?
When a family knows that a relative is living with HIV, they must be made aware that a time may come when they will no longer be able to look after themselves. If peer group members have personal experiences of caring for a PLWA, give them an opportunity to tell their stories. Points for your discussion, debate, drawing, song, story, play, poem, poster etc Peer group members have suggested As HIV weakens the immune system the patient starts to get opportunistic, but treatable illnesses requiring frequent visits to the clinic or hospital Later on the person then becomes chronically ill, and is no longer able to work and do daily life activities At the advanced stage of AIDS, hospitalisation may no longer be effective and useful or desired by the person who is ill The person now requires support services through home-based care and the family now has to take over
Evaluation. Evaluate the unit by using the questions on page 166. 142
Unit 10
Introduction
Educating caregivers
This short unit, aims to bring together what you have already learned about HIV and AIDS, and focus it upon the important role of the care giver. It is essential to educate the people looking after those members of our communities living with HIV or AIDS. In Malawi carers are found in hospitals, clinics and in our homes. They are often the relatives of PLWHA - the spouses, grandparents, children or neighbours of the patient. By educating first line caregivers it is hoped that their health will be protected and their work will be made more effective.
Learning outcomes
By the end of the unit you will be able to: describe some of the concerns of the caregivers of people living with HIV/AIDS describe how healthworkers can help families with PLWHA practice ways of helping care givers prevent HIV infection explain the role of counselling in home-based care describe the different forms of counselling available in Malawi practice ways of reducing opportunistic infections affecting PLWHA
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Activity 10.6 How can health professionals help families with PLWA?
What sort of help should people expect from a health professional? In an ideal world every PLWA in Malawi could expect the very best treatment. Unfortunately, our health professionals are under a lot of pressure, with time and medicines often in short supply. But, we must always remember that health workers are the experts in the HIV AIDS field and they must always be consulted before traditional healers or self-medication. Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? Hospitals need to provide family members with sanitary facilities for toileting, bathing, cooking, doing laundry and waste disposal so that guardians do not spread infection Health workers need to teach families how to use universal precautions so they can care for their relatives without spreading infections Family members and caregivers also need some basic supplies to provide safe care, including hand washing facilities and gloves When health workers use gloves, it helps family members understand that using gloves (or plastic bags) and taking other precautions does not mean a lack of love and respect When health workers have a positive, non-blaming attitude, it helps reduce the feelings of shame or stigma associated with HIV and AIDS The National Council of Nurses and Midwives of Malawi (NMCM) is mandated to develop, maintain, monitor, evaluate and control the profession of nursing and midwifery and encourages the public to report any form of malpractice and negligence - everyone should help NMCM achieve this goal
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Activity 10.7 What can care-givers do in the fight against HIV and AIDS?
Health professionals and other caregivers are intimately involved in the fight against HIV/AIDS, and their personal experiences are an invaluable resource for community action. This activity can be combined with 10.5 and 10.6. Points for your discussion, debate, drawing, song, story, play, poem, poster etc What have peer group members suggested? Provide counselling or opportunities to chat informally Share basic information about HIV and AIDS Join or create support groups and networks of PLWHA Take part in home-based care education activities Community mobilisation for better health services Provide guidelines for individual patient management Help people get access to essential drugs Provide specialist bed services for AIDS management Arrange support for children orphaned or children living with HIV and AIDS Encourage people to behave responsibly even when living with HIV and AIDS
Evaluation. Evaluate the unit by using the questions on page 166. 147
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Activity 11.6 Role play: Partners talking about having an HIV free baby
In the role play a couple are discussing the best way to have a baby that is HIV free. Background Mwayi and Taylor are planning to get married and start a family. When they first started going together they used condoms, but they stopped using condoms because they trusted each other. Through peer group meetings they have learned about the Prevention of Mother-to-Child Transmission of HIV (PMTCT). Mwayi really wants to be a mother She is worried about having unprotected sex She does not want to take a chance on having a baby that is infected with HIV She worries that if Taylor finds out that she is infected with HIV then he will leave her Taylor is worried, because he had several partners before Mwayi - but he really wants to be a father He feels that there is no point in getting tested now because they already had unprotected sex The play begins: Mwayi and Taylor are sitting together listening to music Taylor How many children do you want? Mwayi, one day Id like to be a grandfather. Mwayi Two children, a boy and a girl. Id like two healthy children, thats why we should plan carefully for the future. After the role play What have peer group members suggested? Preventing babies being infected through MTCT, means that couples and their families could produce HIV free children - this gives fresh hope to familes hit by HIV who feel that their name or history will be lost Both parents should take joint responsibility in order to prevent MTCT Involving men in PMTCT helps to involve men in feeding programmes as well Partners should both go for VCT - the only way people can be sure After VCT it is easier to make decisions about sex, marriage and children Use condoms for three months and then have a blood test for HIV and AIDS If the blood test confirms that both you and your partner do not have HIV and AIDS, you can have unprotected sex with each other until pregnancy occurs You and your partner must not have sex with other partners, or always use condoms with other partners, to avoid the possibility of becoming infected Point to ponder If a man and a woman are both HIV positive, and wish to have an HIV free child, then they must both closely follow medical advice. Discuss Conclusion. The last learning activity of the Mzake ndi mzake course involves using our A to Z of HIV as a quick revision tool. Go through the A to Z and use song, dance and poetry to celebrate successfully completing the course.
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A
Useful starter words: ask; always; assert; avoid; all; abstain; attitudes; adultery; ARVs; alcohol
C
Useful starter words: choose; caregivers; child; clubs; classroom; courage; circumcision; change
Abject poverty leaves millions of people more vulnerable to HIV infection and other health problems... help relieve poverty 2 Abstain 3 Adultery can kill 4 Aged grandparents caring for orphans may need your help and education about HIV 5 Agree-to-differ if an HIV prevention strategy is being hotly debated. 6 Alcohol can alter your feelings and thoughts, and they influence your actions 7 Anal sex is a very high risk and illegal 8 Aroused sexual passions can be dangerous... keep control of them 9 ART works for most people but not for all 10 Assert yourself and help other to do so
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Caesarian births save many new babies Chaste - do not have sex except with the person to whom you are married 3 Correct and consistent use of condoms 4 Child protection officers are now at work in Malawi 5 Clinics are special places 6 Colleges and schools should be safe places free from abuse 7 Counselling plays an important part 8 Condoms should be used by every prostitute and every one of the clients 9 Condoms should only be used once 10 CHBC - Community Home-Based Care
D
Useful starter words: do; dont; delay; daughters; discrimination;
Always abstain!
B
Useful starter words: boys; babies; become; bad; behave; beliefs; birth; babies; blood; body fluids
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Delay your first sexual activity Dont do dry sex - where medicines are put in the vagina can kill both partners Dont let anyone touch your private parts - except a nurse or doctor Dont self-medicate when on ARVs
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Be faithful Break the silence over HIV and AIDS Be careful with Body fluids Boys and girls both need to know the true facts of life about love and sex 5 Bed nets to combat malaria 6 Bars can be dangerous places 7 Behaviour change may be hard 8 Bar owners have a part to play 9 Birth certificates protect children 10 Babies should be born in a clinic/hospital
G
Useful starter words: girls; get; government; good
J
Useful starter words: join; joke; justice for;
G1 G2 G3 G4 G5 G6 G7 G8 G9 G10
Get tested for HIV Generosity can fight poverty and HIV Girls need encouragement to be assertive Girls should delay first sexual encounter Grooming small children for sex is wrong Grow vegetables and fruits to eat Greater involvement of PLWHA Genital sores should be treated now! Genital parts are special and private Grow in confidence and self-discipline
J1 J2
J3 J4 J5 J6 J7 J8
H
Useful starter words: help; halt; hope; home; happiness
Join together to spread the information Joke about your HIV, talk to it. Positive living and these ARVs will keep you (HIV) locked up in my body. You will never escape from me HIV! Just say NO to unprotected sex Join together to fight HIV and AIDS Join local networks to national networks, Join house visits and house religious services for PLWA Joke about things in life - humour and smiling makes life feel better Jesus would not leave PLWA to suffer and die alone - will you?
K
Useful starter words: kill; keep; know;
H1 H2 H3 H4
Homeless people are vulnerable to HIV Halt Human trafficking Handle and dispose of condoms carefully Help Homeless girls from becoming Hookers (sex workers) H5 Help PLWHA and their families and carers H6 Humans spread HIV not by witchcraft H7 Hold the hand of your HIV+ friend and let the fingers speak of your friendship H8 Home-based care is very important H9 Homosexuality can spread HIV H10 Hope Is Vital when PLWHA
K1 K2 K3 K4
Know your sero status - go for VCT Know how to stay safe from HIV Keep VCT test results confidential Keep good company in safe surrounding if you are at risk of being tempted K5 Keep faithful K6 Keep hoping for new medicines to make life easier K7 Keep taking your ARVs as prescribed K8 Keep HIV from reproducing - take ARVs K9 Keep your trousers zipped (men) K10 Keep your legs crossed (women)
L I
Useful starter words: if; improve; information; imagine; infant; identify; inmates; infections
Useful starter words:leaders; let; listen; life; live; love; look; liberate; laws
I1 Imagine an HIV and AIDS free Malawi I2 Information on HIV is essential for all I3 Identify human traffickers of children and adults for sex I4 Income generating activities help I5 Improve the well-being of the poor and give them more life choices I6 Innocent people may be blamed for bringing HIV into the relationship I7 Impoverished communities are at great risk I8 Ignorance spreads HIV and AIDS I9 Imagine the best things you could do to fight HIV in Malawi... then talk them over with others... and act I10 Injecting drugs can spread HIV
L1 L2 L3 L4 L5 L6 L7 L8 L9
Let all discussions on HIV be peaceful Learn all you can about HIV Liberate child labourers Love without prejudice Life is precious, protect it! Literacy helps defeat HIV Live positively with HIV+ Loose morals can make you lose your life Listen to the bereaved... encourage them to celebrate the life of the deceased. L10 Let only your marriage partner be your only sexual partner
M
Useful starter words: mothers; men; man; make; Malawi; Muhammed would; myths
O
Useful starter words: only; orphans; open; over; oppose; organise; orgasms
M1 Malawians have a duty to fight poverty which encourages the spread of HIV M2 Malawi is star in the fight against AIDS (headline in Daily Times 18 Aug 2008) M3 Man-to-man talks between boys and their fathers about sex and HIV, can really help in the fight M4 Most people living with HIV were not promiscuous M5 Memory boxes or books bring great happiness to those left behind after a bereavement M6 Mother-To-Child-Transmission of HIV can be prevented by following the correct procedures M7 Malnurished people cannot fight off infections and are more vulnerable to HIV M8 Malnurishment contributes to the spread of HIV we must address it - if we fight malnutrition of the poor, we fight HIV M9 Most cases of child sexual abuse and rape are carried out by people the victim knows M10 Mothers breast Milk exclusively for six months for new born HIV free babies
O1 Open and frank talk about HIV and AIDS O2 Openly say if a relative died of AIDS O3 Organise to fight any discrimination against PLWHA O4 Over seventy percent of human traffickers in Malawi are no prosecuted O5 Oppose child brides O6 Only drink in bars where there are no sex workers O7 Orgasms are important for both partners O8 Orphans are vulnerable O9 Oral Rehydration Solution (ORS) saves lives (see page ) O10 Opportunistic Infections must be treated promptly O11 Only One faithful partner for life
P
Useful starter words: put; prevent; proper; parents; partners; poverty; poor; powerless; power: play; prosecute;
N
Useful starter words: no!; never; new mothers;
N1 No condom no sex! N2 No traditional Malawian medicines can cure AIDS - but there are local medicines which ease the symptoms of HIV N3 No sex until marriage or VCT! N4 Never put local medicines in the vagina to make it dry N5 Non-penetrative sex is safe sex N6 No sex is safer sex N7 Nations budgets should have the needs of the poor at its heart - Need can spread HIV N8 Never put your penis into the vagina of someone who is not your wife N9 Nevariprim during childbirth (check for any new drugs being used locally) N10 Nobody has ever died from abstinence. Try it!
P1 Poverty Prevention is an important factor in Preventing the spread of HIV P2 Peer education on HIV and AIDS does make a difference P3 People living with HIV and AIDS have the same rights as everyone else P4 Prevent mother-to-child transmission of HIV learn the facts and tell others P5 Prisons can spread HIV, Protect inmates and officers through peer education P6 Partners should learn how to open up and talk about sex and HIV P7 Property grabbing is a crime - stamp it out in your community by making wills P8 Power relationship need to change especially those connected with gender P9 Professional medical advice is important P10 Pray with or for all those infected or affected
Q
Useful starter words: question; quote; quiz;
S
Useful starter words:sons; stop; speak out; share; stigma; safe; sex; schools; street-children
Question traditional practices that put people at risk 2 Quiz - create a quiz from these messages 3 Quote from the holy books - the messages that bring courage, love, compassion and response to the fight against HIV 4 Question the community that allows full sexual intercourse to be part of girls initiation 5 Quit those bad habits! 6 Question if he really does love you, if hes pressuring you for sex before marriage 7 Qualify as a HIV/AIDS peer educator 8 Quietly and forcefully say, No! 9 Question your own beliefs and behaviour 10 eQuality of opportunity for all citizens
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Stop early marriages and child-brides Stop Stigmatizing PLWHA Sex is beautiful, with the right person, at the right time, and in the right place 4 Sex Should be Safe and pleasurable for men and women 5 Street children need our protection 6 Schools must treat boys and girls equally 7 Stigma feeds the Spread of HIV 8 Succession planning is vital 9 Spread Safe Sex 10 STIs (STDs) must be treated Swiftly
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Religious groups of all faiths should work together in the fight against HIV and AIDS 2 Role model by living positively and helping others to do so 3 Refugees are very vulnerable 4 Religious leaders must know accurate facts - and share them with their community 5 Remember to carry a condom if you cannot abstain or be faithful 6 Rural communities need the information about HIV just as urban areas do 7 Refuse sex before marriage or before VCT 8 Review your behaviour regularly 9 Read for pleasure and for learning about HIV/AIDS issues and development 10 Report teachers sexually abusing their students
Train Traditional birth attendents Talk openly about about irradicating stigma from society 3 Traditional customs may put people at risk 4 Translate these messages into local languages when speaking in a local setting 5 Temptations can be overcome 6 Temperance helps us behave well 7 Think Twice before you act, especially if you have been drinking 8 Teacher support groups are important 9 TB is the most opportunistic infection 10 Tatooing and body marking can be very dangerous
U
Starter words: umunthu would; unprotected
X
Useful starter words: seX;
Unprotected sex with an HIV+ person is responsible for 90% of all HIV infections 2 Umunthu - the role model to aspire to 3 U should try to be Umunthu 4 Unmarried people should wait before sex 5 Unemployment can breed desperation and encourage risky behaviour 6 Uneducated, Unemployed, Unskilled, and the Unloved, take more risks 7 UDHR: Universal Declaration of Human Rights (1948) 8 UNAIDS: United Nations Joint programme on HIV/AIDS 9 UNICEF: United Nations Childrens Fund 10 Unitedand Unable to stop fighting HIV
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seX workers need educated seXploitation of human being infringes their human rights seX is to be enjoyed within a lifelong relationship with one faithful partner seX that is safe and within marriage eXplore the many different ways you and your partner can stay safe from HIV eXpose aduts who have seX with children eXchange marriage vows before you eXchange body fluids eXamine your values and behaviour
Y
Useful starter words: you; your; youths; young;
V
Useful starter words: voices; volunteer; VCT; value; virtue; vice; virgin; vagina
Voluntary Counselling and Testing before and during marriage 2 Vote for candidates who are part of the fight against HIV 3 Virgins are Vulnerable 4 Values are the key to behaviour change 5 Vices can make you Vulnerable 6 Volunteer to help the Vulnerable 7 Voices of the poor, Voices of women and Voices of PLWA should be listened to more 8 Violent partners put people at risk 9 Vulnerable children are at risk of HIV 10 Voice your fears and hopes
You can stop any risky behaviour if you really want to! 2 You may have a vice that puts you at risk. So, you are the one who must make the change! 3 Your partner and children may be at risk if you have casual sex partners 4 Your marriage is worth more than a one night stand 5 You can get pregnant when you have sex for the first time 6 You cant be cured by having sex with a virgin 7 Behaviour change begins with You! 8 Youths need education for protection 9 Young children should not marry 10 Your Young ones need information
W
Useful starter words: women; widows; wash
Z
Useful starter words: zero
1 2 3 4 5 6 7 8 9 10
Want to make that important behaviour change so much that you change We cannot ban Workshops because of the risk of HIV infection - Want to abstain Women Will be empowered What do you think Jesus would do to fight HIV/AIDS? When people are really in love they can and Will Wait until after marriage or VCT Wills protect the Widowed and the childen Witchcraft cannot cure AIDS Wives club meetings can assist Work place HIV education is needed Welcome positive behaviour changes
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Zero tolerance for sexual abuse anywhere! Zero tolerance for initiation practices that put children at risk of HIV infection... adapt or stop it Zero tolerance for body cutting and tatooing using an unsafe blade Zero tolerance for spousal abuse Zero tolerance in my marriage if my partner has sex with some who is not me!
Facilitation techniques
The aim of this programme is to help group members to learn , share what they know and apply what they have learnt. A peer leader or the group as a whole, can choose the best teaching and learning techniques to be used during a session. It should be remembered that when working with adults it may be necessary to use a variety of different techniques. Adults often resent being told what to do, they may learn more from discussions with their peers. They are often highly motivated if they can see the training as relevant and composed of a variety of different activites. They often learn more by developing their own ideas, than from just listening to the ideas of others. So, interactive methods are suitable for teaching and training adults. Before each session, ask the following questions: Who are you working with? Which activities are you going to go through? Where will the group work? When will the group meet? How will you teach/facilitate the selected activities? Peers can decide how each activity will be completed and when people will work as: individuals pairs small groups whole group Mzake ndi mzake peer group members have suggested the following techniques: 1 Discussion - This is the consideration of a question in an open and often informal debate. Group discussions can be used to generate a lot of ideas and opinions, share information and facts under the guidance of a facilitator. 2 Lecturette - Lecturettes are short lectures. A lecture is an oral presentation intended to transmit knowledge and procedure that often have to be memorized. 3 Presentation is the practice of showing and explaining the content of a topic to an audience or learner. It can be illustrated with models, posters, slide shows etc. 4 Question and answer - Group work or as a checklist for individual work 5 Demonstration is used to reinforce theory, by showing exactly what should or could happen in a situation. It helps to pass on both skills and knowledge, and show procedures that may be difficult to describe in words alone. It can help both the demonstrator and the audience to recognise future problems that may arise and where opportunities for improvement exist. 6 Research is a systematic inquiry or investigation into a subject in order to discover or revise facts, ideas or procedures. Research results can then be presented
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in a detailed and accurate manner to the group. 7 Diary or journal writing - Members may wish to keep a diary or help a PLWHA to do so. This diary may be a very useful source of ideas for the group sessions. 8 Story telling and story writing - The story can be true or ficticious, in prose or verse. It is designed to interest, amuse and instruct the audience. Case studies and extracts form life stories are particularly useful in open peer group work. 9 Proverb - A short memorable saying that expresses simply and effectively some commoplace truth or useful thought. Often of unknown or ancient origin, traditional proverbs focus on a teaching point or moral. 10 Poetry reading and writing - Poetry is a way in which we can get in touch with our inner feelings and then share those feelings with others. Poetry can also be found in drama, hymns, song lyrics, rap and chants as well as in prose. Look at the A-Z of HIV on page 157 for ideas. You can also use ideas as slogans on posters and charts. 11 Singing and song writing - Traditional songs can be adapted as icebreakers to pass on simple messages. Songs can also be used to open and close a session. Look at pages 157 to 161 to find new words to fit with well known tunes. 12 Music - Adapt well known tunes from traditional and religious sources for use in HIV education. Find out who can play a musical instrument. Drumming is a significant part of using and developing music for dance. 13 Dancing and dance developing - Traditional dances can be adapted to carry important messages. New dances can be developed by group members. Dancing can be integrated into dramas and story-telling. 14 Drama and drama development - Drama allows participants to use words and actions to tell serious stories to an audience. Peer groups can focus on issues they may face in everyday life and gives the opportunity to generate possible solutions. Unlike our role-plays, drama is rehearsed. 15 Roleplay - In a role play, members are given a situation and a little background. the chose actors continue the play. Actors can develop their own ending and remain in their roles for the first part of discussions that follow. This can help people to gain an insight into behaviour and feelings and look at, and practice life skills necessary to prevent HIV infection. The actors often answer questions in their roles before they de-role. A general discussion follows after they de-role. 16 Writing replies to imaginary Problem page letters about HIV and AIDS Most magazines have a problem page, where readers letters are printed and an expert writes a reply giving advice. Group members can both write and reply to real or specially created problems. 17 Drawing or cartooning - Make use of the groups drawing skills by working together to design posters and cartoons on HIV education. 18 Educational visits - Some people caring for someone living with HIV and AIDS may have created a successful caring environment in their home. With the patients permission the group may find an on-site visit both interesting and enlightening. 19 and 20 Writing speeches and newspaper briefings - Members can assist religious, traditional and civic leaders when they are asked to speak about HIV and AIDS. Short statements, like or A-Z on page 157 may be useful for sound bites.
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One participant should represent the human body while others represent white blood cells (WBC), which protect the body from infection by germs, represented by a third group of participants. Choose one participant to represent HIV. Ask participants to act out the spread of HIV HIV knocks out the white blood cells so they can no longer protect the body The body is now open to attack by germs of all kinds (eg. TB, diarrhoea) Eventually the body is overcome by diseases which are normally not fatal Adapt the drama to suit participants of different ages and educational background
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Make a model baby from a bottle, can or gourd The main opening of the container represents the mouth of the baby Put two holes in the bottom of the container - a large hole to represent the anus and a small hole to represent where urine leaves the body Put two stoppers in the lower holes Fill the baby with water to represent a healthy hydrated body Remove the smaller stopper (cork) and water will be lost slowly Remove the large stopper to illustrate how diarrhoea can cause severe loss of water Water lost through the holes can only be replaced through the mouth If more water is lost than is taken in dehydration occurs and this can be fatal, especially in small babies
Dehydration caused by diarrhoea is probably the biggest killer of children in today Our bodies need water to function normally, but we also need essential electrolytes like sodium and potassium - these are lost in diarrhoea and must be replaced The ORS drink (oral rehydration solution) is used to save lives by replacing some of the lost electrolytes For smaller amounts of the drink put a pinch of salt into a cup of clean water and add 8-10 pinches of sugar Consult a health professional if diarrhoea persists
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Chalkboard
The chalkboard will the most readily available teaching and learning resource for many peer groups. Here are a few tips that may improve the effectiveness of boardwork. Untidy presentation encourages untidy work from learners Divide a large chalkboard into smaller sections Write clearly - do not add too many flourishes to writing style Underline headings and key statements Do not write toomany words in upper case When dusting a board pull the dust to the side If you wash a board, let it dry and then pat the surface with a duster - chalk can react with water making it hard to rub off Boards are useful for presenting group feedback and lists Floors and table surfaces can be used as writing surfaces
Chalk can be sharpened with a knife like a pencil Experiment using other surfaces like tables and floors (both inside and outside)
Experiment with different types of string and thread, length of string and ways of attaching the ends of strings to supports.
Stick a flap or tail on the back of pictures and this will help to hold them in place.
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The board can be displayed in a variety of different ways. It can be free-standing or hung on a wall or support. Experiment with different angles and techniques.
Carrying handles can be made from rope or cloth strips. Protect the outer surfaces by paint or by covering them with plastic. Design a zigzag board to fit your own particular needs.
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We have marked the peer group members suggestions with the
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Evaluation questions
The aim of this programme is to help group members to learn, share what they know and apply what they have learnt. After each sesion go through the questions suggested by peer group members:
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Did you start the session on time? Which unit or activities did you cover in this session? Have you put a mark next to them in the contents section of this manual? 3 Was the introduction clear? 4 Was the content clear? If your answer was No, give reasons for your answer so that it help future planning. 5 Did the group use a variety of teaching and learning techniques, such as question and answer, pair and group work, lecture, song, poetry, role play, visits etc? 6 Did you feel comfortable or uncomfortable during the session? If so, talk about these feelings and the need to talk about sexual activity within the peer group. 7 Have you made a note of interesting or useful ideas that could be added or adapted to the units or activities in this manual. 8 Have the group or individuals chosen activities or topics as assignments? 9 Have members set an agreed date and time for the next meeting? 10 Do group members know the activities that will form the core of the work for the next meeting? Remind members that activities can be added to the core if the group thinks that they are important. Peer groups are free to add other questions to this list. There may be some people in your group who find it difficult to discuss the sensitive issues in this programme. They may decide not to continue the training. If so thank them for attending and tell them they would be welcome to return or join another group later. Did the group manage the do if people find the discussion of HIV and AIDS or partner sexual relationship issues upsetting? Be sure to emphasize the positive messages about protection from HIV and AIDS. However, for those who continue the training, you probably should not change the later units. Always remember to be sensitive to peoples discomfort in discussing these important issues.
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Glossary of terms
AIDS: Acquired Immune Deficiency Syndrome; this is the stage where a person who lives with HIV becomes very weak and his or her immune system cannot fight illnesses very well anymore. This happens when a persons T-cell count decreases to about 200. Usually this happens about 6 to 8 years after getting HIV. When HIV and other illnesses such as tuberculosis, cancer or pneumonia enter ther body when it is weak from HIV, we call it AIDS. AIDS related illness: an illness that a person living with AIDS gets because HIV has seriously weakened their immune system. TB can be an AIDS related illness antibody: a chemical made by your body. It is one of the main ways in which your body fights HIV and other illnesses...substance produced by the human immune system that reacts to antigens antigen: that identifying feature on organisms and foreign tissues that triggers the immune system to produce antibodies ART: anti-retroviral treatment ARVs: anti-retrovirals; medicines used to fight HIV. ARVs are used at the AIDS stage of infection. There are different types of ARVs. each type fights HIV differently. Usually, a person takes two or three types of ARVs to fight HIV. This is called combinationtherapy or HAART. asymptomatic stage: the period between becoming infected with HIV and becoming ill that ranges from a few week to as many as 8 to 10 years incubation period: period between the time of infection and becoming ill due to HIV CD4 cell count: a count of the number of T-cells in a small amount of you blood, which shows the measure of how strong your immune system is. chronic: a situation or an illness which goes on for a long time without being curable, eg HIV is a chronic condition as there is no cure; one has to live with it for a long time. combination-therapy: a combination of two or more drugs taken by a person to fight HIV infection. See ARVs and HAART coping: a process of adjusting to new life situation and getting back to near normal as possible. That means regaining hope, self esteem, self confidence, planning and going on with life, making appropriate behaviour changes and regaining hope. depression: deep sadness, helplessness, coupled with low self esteem and loss of hope that is linked with fear of rejection, loneliness, loss of control fear of stigma, blame suffering and death and leaving dependents without support. epidemic: Large outbreak of a disease, AIDS is an epidemic fundamental rights: your basic human rights under the Bill of Rights in the Constitution. generic drugs: drugs that replace well-known drugs HAART: stops HIV from multiplying and reduces viral load in the blood. helper T-cell: cells that are a very important part of the immune system, they fight germs that invade the body. Helper T-cells are the main kind of cells that HIV attacks. HIV test: a test to see if there are antibodies in a persons blood. HIV anitibodies will only be in your blood if you have HIV. It can take up to six months for the body to make antibodies so it is important for some one who tests HIV-negative, to be tested again after six months. HIV status: whether a person is HIV- positive or HIV-negative. You can only know this if you take an HIV/AIDS test.
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PLWHA, People living with HIV and AIDS: when you have tested positive or have developed AIDS then you are said to be living with HIV and AIDS immune system: the system in your body which uses all knids of different cells to fight infection by germs. opportunistic infections: an infection that attacks people with weaker immune systems, TB, herpes are opportunistic infections pandemic: large outbreak that is at local level. AIDS is a pandemic in Malawi seroconvertion: occurs when there are enough HIV antibodies in your blood that can be detected by an HIV test which imply that you are changing from being HIV negative to HIV positive in that test stress: competing issues with limited ability to accomplish them which leads to mental, spiritual tiredness, frustration and a threatening feeling and eventual depression T-cell count: same as the CD4 or helper T-cell count. A test to see how many T-cells are in a small amount of blood. To see how strong the immune system is. A healthy person may have 800 to 1000 cell count. window period: the time it takes for a body to make HIV-antibodies; usually this is only a week or so, but can be up to six months from the time of infection.the time between infection and the possible detection of antibodies to HIV vaccine: a medication that is normally taken as an injection to prepare your bodys immune system to recognize and protect itself against a virus or disease viral load: the amount of HIV in your body. The number of HIV viruses present in your blood; a test is done to find out what your viral load is. A count higher than 100,000 is considered a high viral load.
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Office of the President and Cabinet (2005), HIV/AIDS Research strategy for Malawi 2005-07, Lilongwe Open Society Initiative for Southern Africa (2007), Amplifying Voices: a series of digital stories (CD), Johannesberg, OSISA Orr, Neil M (2005), Positive health: Living positively with HIV, Cape town, Double Storey. Pridmore, Pat et al (2006), The role of open, distance and flexible learning in HIV/AIDS prevention.., London, DFID Slattery, Hugh (2004), HIV/AIDS A call for action: responding as Christians, Nairobi, Paulines Steinberg, Abraham et al (2002), Religion and education for HIV/AIDS prevention: an Jewish view, Paris, UNESCO/IBE UNAIDS (1999) AIDS and HIV infection: Information for United Nations employees and their families, Geneva. UNAIDS (2006) Global facts and figures, Geneva. UNAIDS (2006) Fact sheet on sub-Saharan Africa, Geneva. UNAIDS (2006) Report on the global AIDS epidemic, Geneva. UNDP (2002) Impact of HIV/AIDS on human resources in Malawi public sector: UNDP UNESCO (2002) Education for HIV/AIDS prevention, Paris, IBE Vack, Dale le (2005), Gods golden acre: a biography of Heather Reynolds, Oxford, Monarch World Health Organisation (2001), Prevention of Mother to child transmission of HIV: Selection and use of Nevirapine, Technical notes, Geneva.
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The Mzake ndi Mzake peer educators manual has been developed specifically for those people who wish to enhance their life skills by participating in AIDS prevention programmes as peer educators. This manual is not intended as a substitute for medical advice. Peer group members and the communities members they reach should regularly consult their doctors or qualified medical health practitioners in matters relating to their health, particularly in respect to symptoms and treatment which require diagnosis or medical attention. It is essential that people who have been exposed to the risk of HIV, and their sexual partners seek proper medical diagnosis and treatment. The aims of the manual The manual was developed to equip peer educators with knowledge and life skills to enable them to disseminate information on STIs, HIV and AIDS and develop skills and attitudes in their peers that will consequently influence positive behavioural change. After going through the manual it is hoped that you will be able to: explain basic facts about human sexuality, STIs and HIV and AIDS protect yourself and others from HIV and AIDS by changing any behaviours that put people at risk help yourself and others in your community avoid getting infected by STIs, HIV and developing AIDS encourage yourself and others in your community to live positively with HIV and AIDS.
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