FOUR TRAINING MODULES FOR THE JN+/LACCASO PREVENTION WITH POSITIVES PROJECT

INTRODUCTION THE BASICS OF HIV & HOW IT AFFECTS THE IMMUNE SYSTEM MODULE ONE MANAGING DISCLOSURE MODULE TWO OPPORTUNISTIC INFECTIONS MODULE THREE ANTIRETROVIAL TREATMENT & SIDE EFFECTS MODULE FOUR POSITIVE PREVENTION

Compiled by: Gail Hoad for JN+/LACCASO Submitted: August 2009

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CONTENTS Pg.

Introduction to the Training Modules Opening Session Introductory Session: The Basics of HIV & How it Affects the Immune System Module One-MANAGING DISCLOSURE Lesson 1.1 Deciding to Disclose: Benefits and Challenges Lesson 1.2 Deciding Who to Disclose to Lesson 1.3 How to Disclose Module Two-OPPORTUNISTIC INFECTIONS Lesson 2.1 What are Opportunistic Infections? Lesson 2.2 Common Opportunistic Infections Lesson 2.3 Coping with Opportunistic Infections Module Three-ANTI-RETROVIRAL TREATMENT AND SIDE EFFECTS Lesson 3.1 What is Anti-Retroviral Treatment and How Does it Work? Lesson 3.2 Benefits and Side Effects of ARV Treatment Lesson 3.3 Treatment Adherence Module Four-POSITIVE PREVENTION Lesson 4.1 What is Positive Prevention? Lesson 4.2 Benefits of Positive Prevention Lesson 4.3 Practising Positive Prevention

2 3

7 10 12

14 16 20

22 25 30

33 36 38

Introduction to the Training Modules The Jamaican Network of Seropositives has identified funding, through collaboration with the Latin America and the Caribbean Council of Aids Service Organisations (LACASSO), to familiarise HIV positive persons with information on the challenges and risks associated with unprotected sexual activities, with the intention that the information can be disseminated among their peers. In order to do this, a series of four training modules and associated training activities have been developed and will be implemented to familiarise eighteen HIV positive persons with the principles of Positive Prevention in a two-day residential workshop. Scope of the Modules Managing Disclosure Opportunistic Infections ARV Treatment and Side Effects Principles of Prevention with Positives The modules are targeted at a low literacy population and have been developed with this in mind. The learning materials and activities associated with the modules aim at being creative, culturally relevant, easy to understand, user friendly and visually pleasing/stimulating. Structure of Modules Each Module covers a key topic cited above under the Scope of Modules: Each topic will have three related learning sessions with associated lesson plans for each session. Lesson plans will also have associated handouts and/or activity sheets for peer education/sharing. Outside of the four modules there will be one introductory learning session and lesson plan on The Basics of HIV & How it Affects the Immune System. This is to ensure that participants are fully prepared and have the basic background information needed to effectively cover the material in the four modules. There are therefore thirteen lesson plans - one for each learning session. The training modules and lesson plans are developed for the use of the facilitator and trainers for delivery during the learning sessions which will take place over a twoday period in a residential workshop. The associated handouts and/or activity sheets for peer education/sharing are designed for the use of the 18 PLHIV participants for their own learning and for sharing information with their peers. These will be illustrated, easy to use, easy to understand and culturally relevant. It is expected however that the facilitator/trainer will discuss the use of these handouts or sheets with the participants and give them tips on how to effectively use these tools with their peers.

OPENING SESSION The facilitator will introduce self and members of the team. The facilitator will explain topics to be covered over the two days, how they are organised, why these topics are being covered, as well as the methodology for delivery and expectations from participants. The programme will begin with an icebreaker activity. Below are two ideas for this activity. The facilitator may choose to use his or her own icebreaker activity. Version One Ask team members to pair off and learn about each other in five minutes and then introduce their partners to us telling us THREE things: their name what they want to get from the training the information that they think they would like most to learn to share with support group members/other PLHIV Facilitator will record the last two pieces of information as expectations on a posted flip chart paper. Version Two Fears and Hopes in a Hat Distribute two post-its in two different colours to each participant. Ask each person to record their main hope/wish for the workshop (on the yellow post it) and their fear about the workshop (on the pink post it). Put all in a hat and shake. Ask each participant to each take a pink and yellow post it written by someone else. Have each participant read out the hope/wish first and post these on the expectations on a flip chart paper labelled HOPES/EXPECTATIONS. Have each participant read out the fear. Ask the participant to say why they say the person might have this fear and what advice they would give to this person to try to reduce or remove this fear. Post on a flip chart paper labelled FEARS. Ask each participant to remember their fears and to remove their fear if they feel it is being reduced/addressed during the workshop. The facilitator will ask participants to set ground rules and these will be recorded and on a posted flip chart paper which will remain in a highly visible position in the room for the duration of the workshop.

INTRODUCTORY SESSION Lesson - The Basics of HIV & How it Affects the Immune System Objectives At the end of the 45 minute session participants should be able to: 1. Correctly explain the difference between HIV and AIDS 2. Correctly identify and explain the four main modes of HIV transmission 3. Correctly explain how HIV affects the immune system and its action on CD4 cells 4. Correctly explain the window period in HIV infection and the implications for an HIV test result during this period Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard Overhead Projector PowerPoint Presentation for Lesson One (to be developed by facilitator) Teaching Aids Facilitators Tool How HIV Affects the Body Handout on the modes of transmission How A Person gets HIV Student Activity Sheet You cant get AIDS by Handout on the Window Period

Literature Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society) School Health Education to Prevent AIDS and STDs A Resource Package for Curriculum Planners - (UNESCO/WHO/UNAIDS); 1996 Facts for Life (UNICEF)

Key Steps in the Lesson: 1. Ask for a volunteer from among the participants to explain the difference between HIV and AIDS. 2. Acknowledge responses and clarify/reinforce/correct if needed: The acronym HIV stands for Human Immuno-deficiency Virus. HIV is the virus that causes AIDS. A virus is a small germ that causes infection and needs a host cell to live in and grow and reproduce. HIV is a virus that affects humans, causing a deficiency/ shortage in the immune system. The immune system is the system that protects the body by fighting off diseases and infections. HIV is the virus that causes AIDS. The acronym AIDS stands for Acquired Immune Deficiency Syndrome ACQUIRED (a disease that a person gets or is infected with) IMMUNE DEFICIENCY (a weakness or shortage in the immune system which fights disease) SYNDROME (a number of symptoms or sicknesses) HIV weakens the immune system to a point where it is difficult for the body to fight off infections, other germs. This is what leads to the development of various sicknesses or symptoms and to AIDS. It is important to stress the difference between HIV and AIDS. Being HIV positive does not mean that you have AIDS. You do not get AIDS from another person. Only HIV can be transmitted between people. AIDS is a condition that develops later in people who are HIV positive. 3. Ask participants to get into three groups and do a simple diagram which would illustrate this difference to someone. Imagine that they had just a few minutes to do a drawing which would show the difference between HIV and AIDS (10 minutes). Have each group post their drawings and explain. Acknowledge, clarify, correct where necessary.

4. How does HIV affect a persons health? Use PowerPoint slides to illustrate. See Facilitators Tool 1 Lesson One: HOW HIV AFFECTS THE BODY for information
to be delivered.

5. How is HIV transmitted? Use PowerPoint slides to illustrate. HIV is transmitted

only if a body fluid which is capable of transmitting HIV enters the bloodstream of another person. The body fluids which can transmit HIV are blood, semen, vaginal fluids and breastmilk. These body fluids that can carry the virus all have CD4 cells in them.

6. Modes of transmission unprotected sexual intercourse (anal, vaginal and oral);

mother to child transmission (during pregnancy, labour or breastfeeding); blood

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to blood transmission such as sharing needles or syringes or accidental blood to blood exposure. 7. HIV is not transmitted the way a cold or flu is transmitted. Although HIV is present in small amounts in saliva (spit), tears (eye water), vomit, urine and faeces it is NOT transmitted via these body fluids. 8. Distribute handout onHow A Person gets HIV and review information with participants. Distribute activity sheet You cant get AIDS by and ask participants to complete it. 9. Ask students to identify the only sure way to know ones HIV status. Acknowledge responses and reinforce correct answer to be tested. Explain that the test to determine ones HIV status is commonly known as an HIV test. This is a test of a blood sample or a swab of cells from inside the cheek. The blood or the cells are tested using a specific test. This test looks for the antibodies (special chemicals) which the bodys white blood cells produce in reaction to HIV. So the test is actually for the antibodies which are produced when HIV is present in the body. A positive test result shows that a person is infected with HIV. Sometimes however a person is HIV positive but tests negative. This is because the body can take up to three months after infection to produce the antibodies in reaction to HIV. Because the body takes some time to start producing the antibodies, the test can show negative if a person has been recently infected i.e. over the past three or so months. There will be no antibodies showing up on the test result because the test is done too early. This first three or so month period in which the HIV infected persons body is not producing antibodies is called the window period. In this window period the person can still pass on the virus to others and after the window period is finished the HIV test will show a positive result. 10. Distribute Handout on the Window Period and ask two participants to come up and explain the window period to the group. 11. Ask participants if there are any questions. Encourage questions and comments. Clarify points raised. Ask participants if there are any areas which they do not understand or do not feel confident that they could explain to other persons e.g. persons in a support group. Explore in a discussion. 15 Minute Break before the start of Module One recommended

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MODULE ONE MANAGING DISCLOSURE Lesson 1.1 - Deciding to Disclose: Benefits and Challenges Objectives At the end of the 30 minute session participants should be able to: 1. Define/explain the concept of disclosure 2. Identify and explain at least four benefits of disclosure 3. Identify and explain at least two barriers/challenges to disclosure for a PLHIV Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard Flipchart paper and markers for group work Teaching Aids Scenarios Cherrys Choice; Davids Decision; Tinas Test

Literature Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society)

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*In this session participants will use the three scenarios to either do a short skit/drama presentation or to draw/illustrate on flip chart paper how or if one of the three characters disclosed, who they chose to disclose to, why, who they chose not to disclose to and why and the possible positive and negative consequences of their decision
Key Steps in the Lesson: 1. Tell participants that this session and the next two sessions will be dealing with issues around disclosure. Ask people what they think this word means and how they feel about it. Acknowledge responses and provide definition: Disclosure is simply telling someone your HIV status. It is deciding to share this information with someone else 2. Emphasise to participants that disclosure is completely up to the individual. You are the one to decide who you want to tell your HIV status. This is why doctors and contact investigators can only contact persons identified by a PLHIV as past or present partners. They cannot name the PLHIV as that would be disclosing a specific individuals status. It is wrong for anyone to disclose someone elses status without their full agreement. 3. Ask if there are any questions related to this information. Acknowledge, respond, discuss where necessary. Indicate that the other two sessions will also be dealing with disclosure in-depth. 4. Ask participants to get into three groups of six persons each. Have a member of each group select a scenario. Tell each group that they must read the scenario and in the next ten minutes develop a short skit (5 mins. or less) about, or draw the story on, the person in the scenario as it relates to disclosure. They must answer the following five questions in their skit or drawing and story: Did the character decide to disclose his or her status to any particular person? Why? Did the character decide not to disclose his or her status to any particular person? Why? What happened when the character disclosed or did not disclose? What were the benefits of disclosing/not disclosing? What were the challenges caused by disclosing/not disclosing? 5. Each group will have five minutes to present their story. After all three presentations have participants give feedback. 6. Ask group to identify the benefits to disclosure, based on the scenarios and their own knowledge. Record these on flip chart paper. 7. Then ask group to identify some challenges to disclosure from the scenarios and from their own experiences and knowledge. Record answers on another flip chart paper.

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8. Ask group, based on benefits identified, to develop some arguments that could help people who face these challenges to disclose when they decide to disclose. Record responses. 9. Emphasise benefits of disclosure including: emotional support; being able to discuss and practise safer sex with partner; sharing problems and challenges with someone else; support in treatment e.g. in taking medication and accessing health care services.

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MODULE ONE-MANAGING DISCLOSURE Lesson 1.2- Deciding Who to Disclose to Objectives At the end of the 30 minute session participants should be able to: 1. Identify and explain their rights re disclosure 2. Identify and explain their responsibilities re disclosure 3. Understand and explain the concept of disclosure to health care professionals in a care and treatment setting Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard Flip chart paper with markers Masking Tape

Teaching Aids Disclosure Chart with clip art pictures Literature Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society)

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Key Steps in the Lesson 1. Following up on the previous session, draw up the following chart on the whiteboard/on flip chart paper Needs to Know Useful/Helpful for Does not Need to Not sure if they them to Know Know should know

2. Disseminate labelled pictures of the following key persons doctor, nurse, pharmacist, mother, father, partner, brother, sister, children, pastor, church group, co-workers, neighbour. Ask participants to use tape to put the pictures where they think they should go under the four columns in the chart. 3. After participants mount the pictures, ask the following questions about disclosure: Who do you feel needs to know your status/a PLHIVs status? Explain why Who do you feel it would be useful/helpful for them to know? Explain why. Who does not need to know? Explain why. 4. Discuss issues raised in the chart. Re-emphasise the importance of the care and treatment team in the hospital and clinic knowing a clients status and the fact they may share this information with each other. Re-emphasise benefits of disclosure to someone trusted and supportive. 5. Discuss an individuals possible responsibilities regarding disclosing his or her HIV status. Which of these responsibilities are linked to the persons who need to know? Ask participants to share their views. Discuss responsibilities related to protecting and taking care of ones own health, protecting others from infection.

Stress that disclosure of your HIV status to your partner is the first step in reducing the risk of transmission during sexual activity. This is a very sensitive issue and you might need to discuss it with a counsellor, doctor, social worker or someone else before taking action
6. Emphasise that disclosure is totally up to the individual. Each person has the right to decide if he/she will disclose, who he/she will disclose to and when he/she will disclose his or her status. These are an individuals rights. Also emphasise and explain that deciding who to disclose to is dependent on each individual and their particular circumstances.

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MODULE ONE MANAGING DISCLOSURE Lesson 1.3- How to Disclose Objectives At the end of the 30 minute session participants should be able to: Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard Flip chart paper with markers

Teaching Aids ----------------Literature Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society)

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Key Steps in the Lesson: 1. Following up on the last point of the previous session, point out that how and when to disclose depends very much upon individual circumstances. 2. Ask participants to identify some key issues that will affect how a person discloses his or her status. Ensure the following are included type of relationship with intimate partner, relationship with family members, type of home environment, if the person has children, type of community environment, risk of violence or threat to safety if there is disclosure. 3. Ask participants to get into three groups and identify persons/institutions they would recommend to PLHIV as support systems for disclosure. (10 mins.) Ask each group to list these on flip chart paper, present their recommendations and explain. 4. Discuss presentations. Clarify issues and correct where necessary

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MODULE TWO OPPORTUNISTIC INFECTIONS Lesson 2.1- What are opportunistic infections (O.I.s)? Objectives At the end of the 45 minute session participants should be able to: 1. Define Opportunistic Infections 2. Explain why PLHIV are vulnerable to Opportunistic Infections 3. Explain the link between HIV infection and the occurrence of Opportunistic Infections

Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard Flip chart paper Crayons Coloured Markers Cartridge Paper/Construction Paper Glue/Paste (3) Scissors (3 pairs) Teaching Aids ------------------Literature Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society) Understanding Opportunistic Infections, designed and produced by Sunburst Communications

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Key Steps in the Lesson: 1. Ask a participant to review to the group, how HIV affects the immune system and what the implications are for the bodys ability to fight off germs and infection. Ask other participants to feel free to help in the explanation, to add points, clarify etc. when the person has spoken. 2. Explain to participants that as the CD4 cell count drops, the immune system is less able to fight the organisms that cause disease in the body. In a weaker immune system, there are fewer of these soldier cells to warn about and fight off invading infections and germs. 3. With a weaker immune system, the body is more at risk for various

infections. These infections are called Opportunistic Infections because they take the opportunity to attack the body when the immune system is weak/they take advantage of the immune systems weakness to attack the body and take root. These Opportunistic Infections
are often called O.I (the acronym or shortened version of the words). 4. Divide participants into three groups. Distribute flip chart paper, markers, crayons, construction/cartridge paper, glue and scissors to each group. Ask each group to make a chart that shows how the fall in CD4 cells weakens the bodys immune system and causes opportunistic infections to occur. Tell them not to use scientific terms but to use examples that anyone can understand e.g. soldiers fighting, a house that is not maintained/in disrepair, a business place that is not properly secured; a tree/plant and termites etc; a car that has mechanical problems/is not maintained etc. 5. Tell participants to ensure that their chart has the three main points regarding HIV infection and opportunistic infections Fall in CD4 cells Weakened Immune System Attack by Opportunistic Infections 6. Give 25 minutes to do chart and 10 minutes to present. Discuss presentations acknowledge, clarify, correct where necessary. Ask participants to again explain the link between HIV infection and Opportunistic Infections and why PLHIV are vulnerable to HIV infection.

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MODULE TWO OPPORTUNISTIC INFECTIONS Lesson 2.2- Common Opportunistic Infections (O.I.s)

Objectives At the end of the 50 minute session participants should be able to: 1. Identify at least four common Opportunistic Infections 2. Identify some signs of Opportunistic Infections 3. Understand how to prevent and deal with at least four common Opportunistic Infections Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard Overhead Projector

Teaching Aids PowerPoint presentation- to be developed by facilitator Literature Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society) Understanding Opportunistic Infections, designed and produced by Sunburst Communications

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Key Steps in the Lesson: 1. Following up on the points in the last lessons, share with participants that PLHIV are particularly susceptible to/ prone to get some types of opportunistic infections. 2. Introduce the PowerPoint presentation to share some information on eight key opportunistic infections. Take questions and comments after each slide. Stress that you are not a medical professional and that if there are medical questions you will have to refer to a doctor or nurse for the correct and accurate response and get back to the participants with answers later, possibly on the following day: 3. Slide One Thrush or Candidiasis. It is an infection caused by a fungus. Where does it occur: Usually occurs in the mouth, throat or vagina. What does it look like: Usually looks like a thick, white or whitish patch that grows in the affected area. Under the patch is red and sore. What does it feel like: The area may feel sore; there can be itchiness or burning. If it is in the mouth or throat the person may have difficulty swallowing What can be done to prevent and treat it: Avoid hot and spicy foods; Avoid citrus (like limes, oranges and grapefruits); Avoid alcohol and tobacco as they irritate the mouth and gums; Brush teeth, tongue and gums often with a SOFT toothbrush. Doctors may prescribe a cream, suppositories or gargles for treatment. 4. Slide Two Tuberculosis (TB). It is a bacterial infection Where does it occur: TB usually attacks the lungs (in the chest). It can however attack other tissues in the body and even cause meningitis when it affects tissues around the brain. What does it look like: TB is difficult to diagnose because the infection is inside on internal organs and tissues. It can be diagnosed with a chest X-ray, a test of your phlegm (spit that you cough up) or a skin test. What does it feel like: Persons with TB might have the following symptoms cough, weight loss, night sweats, tiredness, fever, swollen lymph nodes (wax and canal). What can be done to prevent and treat it: Try to avoid close exposure to people with active TB. Doctors say everyone who is HIV positive and who tests positive for exposure to TB should be treated. Treatment goes on for six to 24 months. 5. Slide Three Shingles. It is an infection caused by a virus. Where does it occur: It breaks out on the skin as a rash; causes pain on the chest and/or back and/or around the nose and eyes. What does it look like: It looks like chicken pox because it is caused by the same virus. A rash appears on the skin, usually on the upper part of the body (torso) chest, stomach and back. The rash forms blisters filled with fluid. These later burst and form scabs. The rash is often on just one side of the body.

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What does it feel like: Before the rash breaks out there is usually itching,
numbness, tingling or pain on the chest or back and/or around the nose and eyes. What can be done to prevent and treat it: Medical treatment is needed. This is usually a pill, or intravenously (injection) in severe cases i.e. if the outbreak is very bad. Blisters should not be scratched as this can cause a skin infection to develop. 6. Slide Four Cryptosporidiosis (Crypto). It is severe stomach problems caused by a parasite in contaminated food or water Where does it occur: In the stomach What does it look and feel like: Severe and chronic diarrhoea (running belly). Symptoms include nausea, vomiting and stomach cramps. What can be done to prevent and treat it: The best protection is cleanliness including regular hand washing, ensuring meals are prepared in a clean environment, purifying or boiling water before drinking, avoiding contact with animal and human waste, not swallowing water when swimming, avoiding raw oysters which also carry the parasite. It cannot be cured but anti-retrovirals can decrease or get rid of Crypto symptoms by raising CD4 cell count and therefore raising the bodys ability to fight this parasite. 7. Slide Five Cytomegalovirus (CMV). It is a bad eye infection caused by a virus Where does it occur: It can occur anywhere but is commonly found in the retina (a part of the eye), the nervous system, the colon (the end part of the intestine) or the oesophagus (gullet or food pipe leading from throat to stomach). What does it look and feel like: Blurry vision, dark spots in front of the eyes and blind spots in the line of vision. What can be done to prevent and treat it: Tell your doctor immediately if you have any of these symptoms. He may refer you to an eye specialist (ophthalmologist). There are drugs available for treating CMV. 8. Slide Six Pneumocystis Pneumonia (PCP) Is an infection caused by a fungus Where does it occur: In the lungs What does it look and feel like: Fever, dry cough, tiredness, shortness of breath What can be done to prevent and treat it: Tell your doctor immediately if you have any of these symptoms. Medications are available to treat PCP. The best way to prevent PCP is good ARV therapy. 9. Slide Seven Toxoplasmosis (Toxo) -Is caused by a parasite commonly found in raw or undercooked meat, cat faeces, and soil (dirt) Where does it occur: It can affect the heart, liver, brain and eyes. What does it look and feel like: There may be flu-like symptoms and swollen lymph nodes (wax and canal), muscle pain, fever, headache, confusion/disorientation, tremors (shaking and trembling) and seizures (fits).

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What can be done to prevent and treat it: Wash all fruits and vegetable properly;
Cook meat properly; Avoid cat waste (if you have a cat, ask someone else to clean up after the cat for you). ARV therapy is the best way to prevent Toxo. 10. Emphasise to participants that only a qualified health professional can give a diagnosis about a disease and recommend treatment. If they share information about OIs, they should always make referrals to a doctor or nurse or clinic if a person has a medical condition. 15-20 Minute Break before the Start of the Next Session Recommended

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MODULE TWO OPPORTUNISTIC INFECTIONS Lesson 2.3- Coping with Opportunistic Infections (O.I.s)

Objectives At the end of the 20 minute session participants should be able to: 1. Explain how to prevent and deal with at least four common Opportunistic Infections Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard Overhead Projector PowerPoint presentation 1 Writing Pad, 3 Envelopes, Pens Teaching Aids The Doctor is Out activity sheets Opportunistic Infections handout Literature Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society) Understanding Opportunistic Infections, designed and produced by Sunburst Communications

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Key Steps in the Lesson: 1. Following up on the points in the last lessons, ask participants how comfortable they would feel giving basic information not medical advice or a diagnosis on opportunistic infections. 2. Introduce activity to practice these skills through The Doctor is Out activity sheets. Disseminate the three sheets, enclosed in stamped envelopes, to groups of six among participants. Tell them we are pretending these are from PLHIV who have concerns and who have written to the doctor. The doctor is out but his secretary has asked you to give some layman assistance (not medical assistance) to these persons. In groups write a response to each letter telling the person what they should do next and if possible some simple, non-medical actions they can take to take care of themselves. 3. If possible groups can complete their activities at the end of the session and present to larger group for feedback, corrections, clarification etc. If there is no time or energy levels are low, they can complete the activity as homework and present on the following morning. 4. At the end of the session, distribute Handout on Opportunistic Infections. Review the information if time and participants energy levels permit.

END OF DAY ONE

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MODULE THREE ANTIRETROVIAL TREATMENT & SIDE EFFECTS Lesson 3.1- What is Antiretroviral Treatment and How does it Work?

Objectives At the end of the 45 minute session participants should be able to: 1. Define antiretroviral treatment/therapy 2. Explain the action of antiretroviral treatment on HIV

Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard Overhead Projector PowerPoint presentation Teaching Aids CD4 Count Handout Literature WebMD - http://www.webmd.com/hiv-aids/cd4-count-what-does-it-mean Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society) Positive Handbook Guide to Combination Therapy; i-Base, July 2004

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Key steps in Lesson 1. Tell participants that while there is no cure for HIV, there is treatment that seeks to control the spread of the virus in different ways. Because HIV is incurable, treatment is an option that all PLHIV must consider. 2. Anti-retroviral treatment/antiretroviral drugs (ARVs) are drugs that stop HIV from reproducing. 3. Ask for a volunteer to remind us how HIV uses the CD4 cell to reproduce. Acknowledge response, comment, clarify, correct if necessary. 4. Taking HIV drugs exactly as prescribed will reduce the virus in your body to small amounts. This allows your immune system to recover and get stronger by itself. Please note that no drug can remove the virus from a persons body. This is why there is no cure for HIV. Anti-retrovirals only lessen the amount of the virus in your body. This means that a person taking anti-retrovirals can still pass the virus on to others. 5. In every country that uses Antiretrovirals/HAART there is a big drop in AIDSrelated deaths and illnesses. The treatment works for men, women and children. 6. In order to start treatment in Jamaica, you will do a CD4 test. This test shows how much damage HIV has done to your immune system by giving the doctor information on your CD4 count. Even though it is important for general monitoring, this test is also used to decide when you are to start treatment. 7. Your CD4 count is reported as the number of CD4 cells in a cubic millimeter of your blood. A normal CD4 count is from 500 to 1,500 cells per cubic millimeter (a small amount) of blood. In general, HIV disease is progressing if the CD4 count is going down. This means the immune system is getting weaker and you are more likely to get sick. 8. Soon after a person becomes infected, the CD4 count falls. It then recovers. However over a period of time it falls again more slowly, usually over several years. 9. In some people, CD4 counts can drop dramatically, even going down to zero. The test does not always correspond with how well you are feeling. For example, some people can have high CD4 counts and do poorly. Others can have low CD4 counts and have few complications. 10. In Jamaica, a CD4 count of 350 in a person with HIV is a guide/signal to start treatment. Some doctors start ARV treatment later at a CD4 count of 250 or 200. 11. Once you start taking ARVs your CD4 count should start to rise if the treatment is working/is effective.

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12. Distribute copies of the CD4 Count Handout and go through the information on the handout with participants. Ask if there are any questions. Take questions and respond. Discuss. 13. All ARVs work to stop HIV from reproducing/replicating. Different types of ARVs work to do this in different ways. 14. The ARVS are combinations of drugs which work together to fight HIV. They only work if you take them in the way that the doctor says, at the times they are supposed to be taken. If you miss doses or are late in taking them, then they may not work at all or may only work for a very short time. HIV is a difficult disease to treat so you have to follow the doctors instructions about the ARV treatment very carefully.

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MODULE THREE ANTIRETROVIAL TREATMENT & SIDE EFFECTS Lesson 3.2 - Benefits and Side Effects of ARV Treatment

Objectives At the end of the 45 minute session participants should be able to: 1. Identify four benefits of ARVs 2. Identify at least four side effects of ARVs 3. Identify and explain at least four ways to cope with side effects

Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard Overhead Projector Teaching Aids Side Effects Handout PowerPoint presentation Literature WebMD - http://www.webmd.com/hiv-aids/cd4-count-what-does-it-mean Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society) Positive Handbook Guide to Combination Therapy; i-Base, July 2004 Avoiding and Managing Side Effects; i-Base, February 2005 Anti-Retroviral Therapy: Managing the Side Effects; Sunburst Communications

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Key Steps in the Lesson 1. Point out to participants that almost all medications have benefits helpful things that they are supposed to do to improve our health and the well being of our bodies. Many medications also have side effects unintended or unplanned effects on our bodies. 2. ARVs are very powerful medications and they have benefits as well as side effects. 3. Ask participants, based on previous session, what some of the benefits of ARVs are. Acknowledge, discuss, clarify, correct where necessary. Ensure that the following benefits are highlighted: Taking ARVs exactly as prescribed will reduce the virus in your body to tiny amounts When ARVs reduce the virus in your body, your immune system is able to recover and get stronger by itself. When your immune system is stronger your body is able to fight off opportunistic infections better Better physical health can contribute to your improved emotional and mental health. You will feel better emotionally because you feel better physically 4. Side Effects Side effects are uncomfortable feelings that can happen when you start taking ARVs. 5. Most drugs in general have side effects of some sort. Not everyone taking a drug will experience the same effects and to the same extent. Some people might experience no side effects or very little side effects, while others may experience strong side effects. Side effects usually go away after your body gets used to the ARVs. 6. Many people worry about side effects when starting ARV treatment. It is good to know what to expect in terms of side effects BEFORE taking the drugs so that you can prepare yourself. When you are prescribed ARVs, ask your doctor or nurse or pharmacist or adherence counsellor about side effects you can expect. 7. Usually side effects improve or lessen or go away after the first few weeks or months. Sometimes they dont and you will have to talk to your doctor about this. The doctor may give you other medications to help with the side effects. 8. Remember, as we said in a previous session, it is important that always you take your ARVs in the way the doctor prescribed and at the time he/she prescribed them. You must stick to or adhere to your schedule to take your medication. This is called Adherence. Adherence is needed if the ARVs are to work properly to reduce HIV in your body. If the side effects are affecting how you take the medication/are affecting your adherence, you MUST tell your doctor right away.

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9. When taking ARVs you should report any side effects to your doctor. Especially if you have stomach pains or cramps, nausea, vomiting or your skin and eyes start to get yellow. 10. Use power point slides to cover the following: Common Side Effects of ARVs: Diarrhoea

What to Do: Eat small meals daily instead of a few big meals Drink plenty of liquids between meals to replace the fluids you lose through diarrhoea, but dont drink liquids with your meals Make sure the water you drink is clean and boiled Eat foods rich in potassium (fish, chicken, bananas and potatoes) to reduce the potassium you lose through diarrhoea Try to reduce milk and milk products in your diet Avoid foods that are hot, spicy, greasy or high in sugar Avoid caffeine (which is found in coffee, tea, cola and many energy drinks). Go to the doctor if: You see blood in the diarrhoea You are having running belly more than four times a day You also have a fever You are thirsty but cannot eat or drink properly
Nausea and Vomiting

What to Do: Make sure you eat when you take your ARV medication Eat small meals daily instead of a few big meals Eat sitting up at a table instead of lying down in bed or on a couch and dont lie down right after eating Eat dry crackers to settle the stomach Drink ginger or mint tea to settle the stomach. You can also try ginger or mint sweets Avoid things that irritate the stomach such as liquor, smoking and aspirin Avoid foods that are hot, spicy, greasy or strong smelling If cooking smells bother you make sure you leave the windows open while cooking and try to get the kitchen aired out as much as possible Go to the doctor if: You have sharp stomach pains or cramps You see blood in your vomit You also have fever Vomiting lasts more than a day, does not go away or gets worse If you are thirsty but cannot eat or drink properly

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Tiredness (Fatigue)

What to Do: Get a little exercise Take vitamins to boost your energy Eat a balanced diet Get enough sleep Go to the doctor if: You feel too tired to eat or move You cannot swallow or eat enough to keep your strength up
Anaemia (Weak blood; lack of iron)

What to Do: Eat fish, meat and chicken Eat a lot of dark green leafy vegetables like callaloo and pak choi Eat a lot of peas and beans Take iron supplements Go to the doctor if: You have been feeling tired for 3 or more weeks and are getting more tired If your feet are swelling
Skin Rash

What to Do: Bathe often and use soaps or shower gels that do not have strong perfumes or lots of dye Use cool water to bathe as hot water might irritate your rash Keep your skin clean and dry Stay out of the sun if you have a rash Use calamine lotion (a special pink lotion) to soothe your itching Go to the doctor if: These side effects continue The rash becomes infected or sore
Hair Loss & Dry Skin and Lips

What to Do: Dont use dye/colouring on your hair Dont strain your hair with braids, extensions or tight cornrows Drink plenty of liquids Use good skin moisturisers Make sure your diet is good Take vitamins Use a lip balm or lip gloss for dry or chapped lips Go to the doctor if: Side effects continue for a long time

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Feeling Dizzy

What to Do: Sit down/rest until the dizzy feelings pass Dont try to lift anything too heavy or move too quickly Take the medication just before you go to sleep, that is at a time when you will not need to be alert and active Go to the doctor if: Side effects continue for a long time
Unusual or Bad Dreams or Feeling Sad, Depressed or Anxious

What to Do: Talk about your feelings with others including your doctor or nurse Try to do something that makes you happy and calm before going to sleep Reduce fatty/oily/greasy meals Avoid alcohol Go to the doctor if: Side effects continue for a long time You cannot tolerate these dreams or feelings You have thoughts about suicide or very sad, depressed feelings You feel very angry or very scared
Tingling or Pain in Hands and Feet

What to Do: Walk a little but not too much Dont stand up for very long periods Massage feet in warm water Wear loose fitting/comfortable socks and shoes (not tight) Ask the doctor to recommend a painkiller to relieve the pain and swelling Go to the doctor if: The tingling continues The pain is affecting your walking
Fat Loss or Fat Gain/Accumulation in certain parts of the body

What to Do: Eating food with more fibre may help control fat gain around the belly Try diet and exercise * This is a side effect that is difficult to reverse and is often regarded as a permanent change
11. Introduce the Handout on Side Effects and How to Cope and quickly review with participants as a tool to use to share information on this topic with peers.

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MODULE THREE ANTIRETROVIAL TREATMENT & SIDE EFFECTS Lesson 3.3 Treatment Adherence

Objectives At the end of the 50 minute session participants should be able to: 1. Define Treatment Adherence 2. Explain why treatment adherence is important for a PLHIV 3. List at least three benefits of treatment adherence 4. Develop ways of sharing treatment adherence information for individuals with low literacy Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard Flip chart paper Coloured markers Construction Paper/Cartridge Paper Glue Scissors Teaching Aids Scenarios for Ensuring Adherence (included in lesson plan below) Literature WebMD - http://www.webmd.com/hiv-aids/cd4-count-what-does-it-mean Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society) Positive Handbook Guide to Combination Therapy; i-Base, July 2004

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Key Steps in the Lesson: 1. Remind participants that in previous sessions we had already mentioned the word Adherence. Ask if anyone wants to remind us what this means. Reinforce the fact that it is important that always you take your ARVs in the way the doctor prescribed and at the time he/she prescribed them. You must stick to or adhere to your schedule to take your medication. This is called Adherence. Adherence is needed if the ARVs are to work properly to reduce HIV in your body. 2. Adherence also includes following any special diet restrictions, for example if it is to be taken with meals or after meals or with a lot of water. 3. Benefits of Adherence Ask participants to share what they see as some of the benefits of adherence. Ensure the following are included: longer life better quality life improved physical health possibly improved emotional health strengthened immune system higher CD4 count possibly more effective and helpful relationship with your health care providers 5. Adherence is important because with ARV medication you need to take all at the correct times in the correct ways or nothing. Taking just a little bit or taking it incorrectly can cause serious problems. HIV can quickly become resistant to the ARVs if they are not entering your body at the right time in the right ways!!! 6. Who can help you adhere? Your doctor make sure you understand exactly how to take the ARVs before you leave the clinic or doctors office. Ask him or her to explain more than once and in simpler ways if you do not understand. Ask about side effects too so that you are prepared for these if they happen. Try to know the names of your medication. Your nurse The nurse can also help you understand how to take the medication and what is needed to take the medication The adherence counsellor Every treatment site has adherence counsellors whose job is to help people on ARVs take their medication correctly and on time The pharmacist is the one who dispenses the medication. You can also ask them to explain the instructions on how to take the medication. Close family or friends They can remind you when and how to take your medication and make sure you are getting the right foods to take them 7. How can you help someone who cannot read and is a bit afraid of the doctor and the clinic to adhere? Ask participants to share ideas with you. Disseminate markers, paper, glue and scissors. Tell participants to get into groups of three for the activity. Ask them to be as creative as possible and to use their imaginations to think of EFFECTIVE and EASY ways to get people to adhere based on the following scenarios:

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Suppose the person has pills of different colours and shapes. The person needs to take 1 pink pill three times daily, two white pills after the evening meal and one capsule right before bed. Design a quick diagram/chart that he/she could use to remember when to take what pills and how many to take?

Suppose the person has problems remembering to take their pills at different times of the day. The person needs to take 1 in the morning and 2 at nights before bed. Design a quick diagram/chart to help him/her remember when to take what pills?

What reminder systems could people use to tell them it is time to take their ARVs? Make a list and draw pictures of some devices/things that can remind the person about the times to take his/her pills.

*Provide each group with flip chart paper and coloured markers for this activity. Review and discuss the results of the group activity.

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MODULE FOUR POSITIVE PREVENTION Lesson 4.1 What is Positive Prevention Objectives At the end of the 30 minute session participants should be able to: 1. Define Positive Prevention 2. Identify the three key elements/components of positive prevention in HIV prevention, treatment and care: Safer Sex (Oral, Anal and Vaginal); Preventing Mother to Child Transmission; Preventing Blood to Blood Transmission Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard

Teaching Aids Literature Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society) PMTCT+: Integrating Treatment Care and Support with Prevention of Mother to Child Transmission of HIV Services Implementation Guidelines for Heath Care Workers; National HIV/STI Control Programme/MOH Jamaica June 2006 School Health Education to Prevent AIDS and STDs A Resource Package for Curriculum Planners - (UNESCO/WHO/UNAIDS); 1996

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Key Steps in the Lesson: 1. Positive Prevention is about what HIV positive people can do to prevent HIV transmission. Positive prevention is about preventing new infections in persons who do not have HIV and preventing re-infection in persons who are HIV positive. It is about what a person living with HV can do to prevent HIV transmission. 2. Re-infection can occur when a person who is HIV positive gets a new strain or type of HIV from another person with the virus. This of course only makes the stress on your body and your health worse. When two infected persons have unprotected sex they could also be passing more of the virus on to each other increasing the amount of HIV in their bodies. 3. Ask a volunteer to remind participants about what we covered in the first lesson about the ways HIV can be transmitted. 4. List these on flip chart paper. For each way, ask participants what can be done by an HIV positive person to PREVENT transmission. 5. Ensure that the following areas are covered: Safer Sex: Oral, Anal or Vaginal Sex

Disclosing ones HIV status to ones partner is an important step in positive

prevention. This way both parties can be informed and make the safest decisions during sex. This is often a difficult and sensitive issue. You may need to seek the help of a counsellor. It is usually better however to plan ahead how to do this and not wait until the last minute when things are gone very far e.g. when you are both in the bedroom or just about to have sex. If a person may become abusive or violent upon disclosure it is probably best to do this with other persons around/with another persons support and/or in a public area where other people are nearby.

Negotiating safer sex This means being in a position to discuss and negotiate with your partner how to protect both of you. This may be difficult in a relationship where one partner dominates the other physically and emotionally or is abusive and controlling. It can also be difficult if one partner is dependent on the other financially or emotionally. Use of a male latex condom or use of a female polyurethane condom. A
lubricant can help reduce the risk of a condom tearing because of friction. Both parties must know how to use the condom properly and in some cases condom use may have to be negotiated. If a partner does not like the condom or is not used to it, you may have to find ways to convince them to use you may discuss the importance of protection against HIV infection and other STIs or protection against unwanted pregnancy. You can also think of ways to make condom use fun and sexy. For oral sex you can cut the male condom lengthwise to place over the vaginal area or anus.

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Prevention of Mother to Child Transmission (during pregnancy, labour or breastfeeding) Jamaica has a very strong Prevention of Mother to Child Transmission programme in the public health care system.

To reduce the risk during pregnancy and labour

Under this programme, if a positive woman is pregnant she will be provided with a special ARV that can help reduce the risk of transmission to her unborn baby. She must ensure all her health care providers are aware of her status so that she can get the care and treatment she needs. If the woman is already on ARVs she needs to notify her health care provider as soon as she becomes pregnant/knows she is pregnant because there may be changes in her medication. The baby will also be provided with a special medication to help reduce the risk of transmission

To reduce the risk of transmission caused by breastfeeding

Mothers are counselled to avoid breastfeeding Infant formula substitute (baby feed) is provided free of cost to mothers for the first three months of the babys life Mothers who use formula should not use breastfeeding at all as mixed feeding increases the risk of HIV transmission. The option is either NO BREASTFEEDING (safest option) or ONLY BREASTFEEDING FOR THE SHORTEST TIME POSSIBLE (first two/three months of babys life) Reducing blood to blood transmission which occurs through accidental blood to blood exposure or sharing needles or syringes Do not perform sexual activities that will result in either person bleeding Ensure that cuts or wounds are covered Use rubber/plastic gloves and be careful when you clean up areas or objects (such as sheets, towels etc.) soiled with body fluids Ensure that waste/garbage that is soiled with body fluids/waste is securely tied up in a double plastic bag and disposed of properly or burnt Use soapy water with bleach to clean areas or objects soiled with body fluids If you use illegal drugs do not share needles (not very relevant in Jamaica)

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MODULE FOUR POSITIVE PREVENTION Lesson 4.2 Benefits of Positive Prevention Objectives At the end of the 20 minute session participants should be able to: 1. List at least four benefits of positive prevention Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard

Teaching Aids Scenarios for Positive Prevention (included in Lesson Plan outline) Literature Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society) PMTCT+: Integrating Treatment Care and Support with Prevention of Mother to Child Transmission of HIV Services Implementation Guidelines for Heath Care Workers; National HIV/STI Control Programme/MOH Jamaica June 2006 School Health Education to Prevent AIDS and STDs A Resource Package for Curriculum Planners - (UNESCO/WHO/UNAIDS); 1996

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1.

Key Steps in the Lesson: Ask participants to get into three or four groups and do the following activity to brainstorm on the benefits of Positive Prevention. Using the following scenarios ask participants to come up with key arguments to persuade someone living with HIV about the benefits of positive prevention. Discuss participants suggestions. Clarify and correct where necessary.

2.

Instructions to participants: Read the scenarios and make a list of benefits which you would use to persuade the individuals in the scenarios to employ positive prevention methods. Discuss the benefits cited and the arguments that would be used. Give
feedback.

June is a pregnant 26 year old woman who has just found out she is HIV positive. She did the HIV test as a part of all the blood tests she was asked to do by the clinic because she is pregnant. She is worried that her baby will definitely be HIV positive. She thinks she will transmit HIV to the baby by even caring for it after it is born. WHAT ADVICE CAN YOU GIVE HER ABOUT POSITIVE PREVENTION & PREGNANT WOMEN? WHAT ARE THE BENEFITS OF POSITIVE PREVENTION FOR HER?

Michelle and Mark are both HIV positive and in a sexual relationship. Mark thinks they do not need to use a condom because they are both positive anyway and Michelle is on family planning so she will not get pregnant. WHAT ADVICE CAN YOU GIVE MICHELLE AND MARK HER ABOUT POSITIVE PREVENTION & SAFER SEX? WHAT ARE THE BENEFITS OF POSITIVE PREVENTION FOR THEM? Steve is HIV positive and at times when he is not very well his sister Karen comes to his house and takes care of him. He sometimes has small sores or cuts that are bleeding and blood gets on his sheets and pillow cases that his sister washes. Steve is worried about Karen being exposed to HIV by helping him clean up and by tidying him as well. WHAT ADVICE CAN YOU GIVE STEVE AND KAREN ABOUT POSITIVE PREVENTION & REDUCING BLOOD TO BLOOD TRANSMISSION? WHAT ARE THE BENEFITS OF POSITIVE PREVENTION FOR THEM?

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MODULE FOUR POSITIVE PREVENTION Lesson 4.3 Practising Positive Prevention Objectives At the end of the 20 minute session participants should be able to: 1. Explain how to put information given on the three key elements/ components of positive prevention into practice 2. Do condom demonstrations correctly (male and female condoms)

Attitudes Participants should have accepted their status and feel comfortable with disclosing their status within the training group. They should also be comfortable enough to discuss issues relating to sexuality and sexual behaviour, be willing to listen to information on HIV/AIDS and to discuss/share their opinions with others in an atmosphere of openness and mutual respect. They should also be prepared to share the information they learn with their peers. Tools and Equipment Blackboard/Whiteboard Chalk/Markers for whiteboard

Teaching Aids Condoms (male and female) & Dildos Samples of water-based lubricants Handout on the Right Way to Use Condoms Handout on the Female Condom

Literature Healthy Living Manual, 4th Edition, 2009 (British Columbia Persons With AIDS Society) PMTCT+: Integrating Treatment Care and Support with Prevention of Mother to Child Transmission of HIV Services Implementation Guidelines for Heath Care Workers; National HIV/STI Control Programme/MOH Jamaica June 2006 School Health Education to Prevent AIDS and STDs A Resource Package for Curriculum Planners - (UNESCO/WHO/UNAIDS); 1996

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Key Steps in the Lesson: This session will briefly explore key information to be shared about elements of positive prevention:

Prevention of Mother to Child Transmission.

The first and most important step in this area of positive prevention is for the pregnant woman to disclose her HIV status to her health care providers doctors and nurses at both clinic and hospital. Explain that some women living with HIV who become pregnant may feel that they will be judged by providers who think they should not become pregnant or may be afraid of the reaction of doctors and nurses. It is important to remember however that PMTCT services in clinics and hospitals are in place for exactly this type of situation so it is clear that the Health Ministry has recognised the needs of PLHIV in this situation. Make sure you use the service provided for you despite any negative reactions from individuals. In general too, providers want to see people using the services because this makes their job much easier. Pregnant women who are positive MUST follow doctors and nurses instructions. If they are referred to special clinics and services they must go. These services are all to protect the health of the mother and the health of the child. Make sure your status is known in preparation for labour. It is critical at this time that health care providers take steps to protect your health, the babys health and their own health. Be prepared for alternative baby feeding options. In hospital when you are given formula, it will be in a cup not a nipple bottle as it has been found that nipple bottles harbour more germs and are harder to sterilise than cups. Ask for advice in using the cup to feed baby. The nurse and other staff at clinic can tell you beforehand how to do this. Also prepare yourself for any questions from other people about why you are not breastfeeding. Prepare yourself to handle or dismiss these questions so you do not feel pressured to breastfeed and put your baby at risk. Make sure to know how you can access the formula provided by the Ministry free of cost Ask nurse or doctor about the medication your baby will get and the tests he or she must take to ensure he or she is not HIV positive. Make sure you know how often the baby will do these tests. If you do not understand the information ask them to break it down more for you until it is clear. Do not feel ashamed to ask. There is no shame in trying to learn more.

Preventing Accidental Blood to Blood Exposure

Keep open cuts and wounds or sores covered at all times Do not try to donate blood if you know you are HIV positive If you have someone who helps you take care of yourself and your home make sure you and that person take the necessary precautions:

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Use bleach and water to clean up accidental spills of body fluids or waste containing body fluids Tie up waste materials which have been in contact with body fluids such as old rubber gloves or cloth or paper in a double plastic bag to dispose of or burn these materials Make sure there is no risk of blood to blood exposure between yourself and your caregiver - some basic precautions to ensure this are the use of plastic gloves for cleaning up or handling body fluids and proper disposal of waste with body fluids.

Prevention of Transmission via Condom Use/Safer Sex

Review the steps to correct condom use with participants for both the male and female condom Distribute Condom Use handouts and review information Cover the use of water-based lubricant to reduce the risk of breakage of condom Do condom demonstrations with both male and female condoms. Ask participants to do condom demonstrations to practise skills learnt

* Facilitator to conduct evaluation exercise/activity for the workshop

END OF DAY TWO