Home

“train the trainers” manual - Mobility International USA

Contents

1. Mainstream Gender into the Kenya National HIV amp AIDS Strategic Plan Page 12 16 gt www womenandaids unaids org Report on the Global AIDS Epidemic December 2006 African Union of the Blind HIVeLAIDS Train the Trainers Manual 17 18 silently with the constant fear of infection Women s open sexual system Women have an open system as compared to men They have more openings i e the vaginal urinal and anal openings Seminal fluid will tend to rest here longer Women s genital area also has very soft skin which can easily tear creating openings for HIV entry The mucosal nature of their genital area allows for HIV entry more easily Female cutting or circumcision These practices although slowly dying is still prominent in many African communities the Sharing of cutting equipment can easily spread the virus Wife inheritance and cleansing ceremonies This custom lives on in many African cultures For example in some cultures when a man dies another man or brother from the homestead would inherit all that belonged to the deceased including his Through this the infected wife infects the brother to the deceased who in turn infects his wives if he is polygamous During funeral ceremonies the wife of the deceased may be required to have sex with the deceased older brother or uncles Sexual abuse and rape Unfortunately most women do not report sexual abuse and rape cases and therefore cannot get post exposure pr
2. Sharing an infected needle for ear piercing or tattooing Sharing an infected needle for drug injection and or immunizations Re using infected instruments for circumcision nfected and unsteralized instruments used in dental work Medical workers can get infected through a needle prick from someone who is HIV infected Handling infected blood with an open wound n the birthing process from the infected blood of a mother to the new baby African Union of the Blind HIVeLAIDS Train the Trainers Manual 25 2 Mother To Child Transmission of HIV M T C T MTCT occurs During pregnancy through the placenta Through blood contamination during childbirth Through breastfeeding MTCT can be reduced By using anti retroviral therapy for mother and baby Drug commonly used is called Nevirapine By medically cleansing the vagina By avoiding unnecessary rupture of membranes during the birthing process By avoiding an episiotomy when it is not necessary By minimizing trauma to the foetus by avoiding procedures such as foetal scalp monitoring forceps delivery and vacuum extraction each which may cause tears By carrying out a caesarian section if possible Handout MTCT AND INFANT FEEDING Get the Facts All women considering pregnancy or who are already pregnant or breastfeeding should know that breastfeeding carries a risk of HIV transmission to the baby Women with HIV infecti
3. 87 6 Ready to change The responsibility of a peer educator at this stage is to tell client the benefit of using services 7 Trail assessment of new behaviour The responsibility of peer educator to a client at this stage is to provide an opportunity to practice new skills and reinforce what the client will do to continue the new behaviour 8 Sustained behaviour change The responsibility of a peer educator to a client at this stage is to tell the client they are doing the right thing Create an environment that promotes the new behaviour and encourage them to follow through A Peer educator can also encourage the person to join a group of people with similar experiences This will encourage sustained behaviour change Step 3 Inform participants that behaviour change is a process It takes time for people to move from one stage to another as listed above Step 4 Explain to participants to understand Behaviour Change Communication BCC has many different but related roles to play in HIV and AIDS programming An effective BCC strategy should e Increase knowledge by making sure that all people have the basic facts about HIV and AIDS in the language or medium they understand e Promote essential attitude change It can lead to appropriate attitudinal changes about for example perceived personal risk of HIV infection greater open mindedness about gender roles and increasing the basic rights of those vulnerable to and affected by HI
4. False True 44 With proper medical treatment all STIs except HIV can be cured There are two types of herpes One herpes zoster is not sexually transmitted The other is genital herpes and is an STI It is caused by a virus and currently cannot be cured Condoms are the most effective safeguard against the spread of Abstinence from sexual intercourse is the best way to prevent the spread of STIs Condoms used with spermicide are the next best thing but only abstinence is 100 effective Using condoms will help prevent the spread of STIs Condoms can help prevent the spread of STIs but they must be used correctly Condoms are not 100 effective because of improper use They occasionally break or come off during intercourse when not used properly The organisms that cause STIs can only enter the body through either the woman s vagina or the man s penis STI bacteria and viruses can enter the body through any mucus membranes including the vagina penis anus mouth and in some cases the eyes HIV can also enter the body when injected into the bloodstream from shared needles Women who have regular PAP smears will also find out if they have the most common STIs The Pap smear is a test specifically designed to detect cervical cancer or pre cancerous cells It will detect HPV one STI and candidiasis a yeast infection but it will not indicate the presence of other STIs You cannot contract an STI by masturbating
5. MUB NGO NLC List of Abbreviations and Acronyms Acquired Immune Deficiency Syndrome Association Nationale Des Aveugles Du Cameroun Anti Retroviral Therapy Anti Retrovirals AIDS Service Organisation Behaviour Change Communication Community Based Organisation Cluster of Differentiation 4 Deoxyribonucleic Acid Faith Based Organisation Ghana Association of the Blind Greater Involvement of People Living with HIV amp AIDS Home Based Care Human Immuno deficiency Virus Human Papilomma Virus Information Education and Communication Kenya Union of the Blind Mother to Child Transmission Malawi Union of the Blind Non Governmental Organisation National Lobby Committee African Union of the Blind HIVeLAIDS Train the Trainers Manual Ol Opportunistic Infection STIS Sexually Transmitted Infections TB Tuberculosis TOT Trainer of Trainers VCT Voluntary Counseling and Testing VIP Visually Impaired Person PID Pelvic Inflammatory Disease PMTCT Prevention of Mother to Child Transmission RNA Ribonucleic Acid RUB Rwanda Union of the Blind TLB Tanzania League of the Blind African Union of the Blind HIVeLAIDS Train the Trainers Manual 10 Introduction Rationale for this manual It is appreciated that there are a great number of Peer Education training manuals These manuals however do not include training methods that are friendly to blind and partially sighted persons This manual deliberately inc
6. Train the Trainers Manual 81 Gather all the resources to the patients reach II Explain to the family members and the patient what you want to do III Close the curtains doors and windows to provide privacy IV Undress the patient and cover them with a sheet Expose only the area you want to clean V Put the patient in a suitable position protecting the bed with a plastic sheet VI Place the basin of warm water on the chair where he can reach Vil Permit the patient to wash him her self Leave the room for a short time VIII When the patient has finished wash their back and feet Cut the nails Spread the bed and comb her hair IX Clean the materials and items used and remove them from the area X Pour the water away XI Clean the dirty clothes and hang them XII Wash and dry your hands If the patient is unconscious or too weak to move Gather all the resources you need to bath them involve family members and the patient s privacy must be observed Mouth care Keeping the mouth clean helps to prevent diseases and sore gums The care giver helps to attend to the mouth in order to promote the flow of saliva The items needed for mouth care include gloves cups water tooth paste brush piece of cloth Vaseline cotton wool and a spoon For a conscious patient Prepare the items needed 11 Wash and dry your hands Ill Explain to the patient what you want to do IV Place the towel piece of cloth or plastic paper
7. 1 Participants will understand the concept of Behaviour Change Communication 2 Participants will know the role of a Peer Educator in Behaviour Change Communication Process Step 1 Begin by defining Behaviour Change Communication BCC as the process by which information and skills are shared and disseminated to people in the specific target audience with the intention of influencing them to adopt sustained changes in sexual behaviour or attitude or to engage in other health seeking behaviour Step 2 Explain the process of behaviour change and the role of Peer Educators in BCC as follows Stages of behaviour change 1 Unaware The responsibility of peer educator to a client at this stage to provide basic information 2 Informed The responsibility of a peer educator at this stage is to encourage them to adopt positive steps and present them with behaviour change options 3 Concerned The responsibility of a peer educator at this stage is to tell them what to do next in changing their own behaviour such as going to the clinic to receive STI treatment 4 Knowledgeable The responsibility of a peer educator at this stage is to motivate the client to act for example by informing them of the benefits of using services 5 Motivated to change The responsibility of a peer educator at this stage is to point or direct client to services and encourage their use African Union of the Blind HIVeLAIDS Train the Trainers Manual
8. Do regular exercise moderately Get enough sleep Avoid smoking Avoid taking alcoholic drinks EWN Only take medicines given to you by your doctor Ask your doctor about medicines that help prevent opportunistic infections Supplies required facilitator s notes note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers and handouts in accessible formats Estimated time 40 minutes Learning Method Large Group Interaction African Union of the Blind HIVeLAIDS Train the Trainers Manual 41 MODULE 4 Tuberculosis Sexually Transmitted Infections and HIV Advance Preparation Inform Resource Persons and facilitators in advance HIV and AIDS and STIs experts to prepare their presentations and handouts for the session They should forward these handouts so that they can be adapted into accessible formats for visually impaired participants Remember to find out from participants what format they prefer their materials to be in Informing experts on time also gives them enough time to look for the latest illustrated videos on HIV and AIDS and STIs For session 1 prepare index cards in large print or Braille for the learners as follows Write in large print or Braille three cards with the message After you read this don t follow any of my instructions until say return to your seats Write the remaining cards with Follow all my instructions including three cards wit
9. Objectives By the end of this session 1 2 Participants will understand the rationale of Peer Education program Participants will be able to link peer education to the continuum of prevention care and support 3 Participants will learn the qualities and skills that Peer Educators need to apply in peer education work Process Step 1 Share session objectives with participants Step 2 Begin by asking participants to define Peer Education Link make reference to the previous session on Bahaviour Change Communication Step 3 Note their responses and fill in the gaps using the following notes Facilitator s notes Peer Education is the art of disseminating knowledge to people of the same age bracket and interests in a given setting Peer Education is a process that involves similar people learning together in a given community Explain that a Peer Educator in the community is someone trained to facilitate discussions on HIV amp AIDS risky behaviour and facilitates his or her peers in the examination of solutions Peer Educators are people selected for their leadership potential in helping others and in most cases they are well known in the community They are trained to disseminate knowledge by being role models encouraging peers listening and influencing healthy decisions and behaviour Explain that Peer Educators influence behavior change People are most likely to listen to and follow the advice of their peers Peer
10. Repeat the procedure for cleaning for the toe nails VI Leave the patient comfortable and thank him her for their cooperation Ask the patient if he she is comfortable Cleaning the used articles and materials Explain that it is important to keep used articles and materials clean The care giver should collect the nail cuttings into a piece of paper and throw them into a pit latrine Clean all the articles used then wash and dry your hands Hair care Help to maintain personal hygiene in order to keep the person living with HIV healthy and maintain their well being The following are the resources needed for hair care water basin soap comb towel plastic paper gloves and oil After you have cleaned the hair clean all the materials used Pressure sores Explain what pressures sore are in the following way These are sores caused by breakdown of the skin and constant pressure They occur on the buttocks back hips elbows feet and ankles The patient should be turned after every two hours to prevent the development of pressure sores as a result of lying in the same position for a long time Use gloves if the patient has wounds or is soiled Ask a family member to work with you Explain the steps in taking care of pressure sores Prepare the patient Explain to him her what you are doing if he she is conscious African Union of the Blind HIVeLAIDS Train the Trainers Manual 83 Il Remove the beddings loosen the sheet so a
11. of HIV African Union of the Blind HIVeLAIDS Train the Trainers Manual 11 Explain that one should never share their A R Vs with someone else The A R Vs will not be of help in the body if not taken as recommended by the doctor If you share they won t work for you or the other person Step 7 Emphasize that ARVs must be accompanied by proper nutrition and moderate exercise Step 8 Conclude by saying that a person taking ARVSs is not alone There are over a million people around the world taking A R Vs Everyday you too can take them successfully Supplies required facilitator s quick notes note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers Learning Method Large Group Interaction Estimated time 60 minutes African Union of the Blind HIVeLAIDS Train the Trainers Manual 78 Session IIl Care and support for people living with AI DS Home Based Care Objectives By the end of this session 1 Participants will discuss and understand comprehensive care and support 2 Participants will learn how to take of someone living with AIDS at home Process 1 Introduce the title of the session and share the objectives with participants 2 Find out from participants if they understand the following e What home based care is e How we take care of someone with AIDS at home e What the advantages of Home based Care are Step 1 Begin by explaining that home based c
12. permanent markers Estimated time 30 minutes Learning Method Small group and Large Group Interaction African Union of the Blind HIVeLAIDS Train the Trainers Manual 15 16 Session IIl Gender roles and HI V amp AI DS Objectives By the end of this session participants will 1 Be able to define and understand the term gender 2 3 Be able to note the interconnection between gender dynamics and HIV amp AIDS Propose ways by which visually impaired men and women can reduce their risk for HIV infection Process na ae Share session objectives with the participants Inform participants that this is an interactive session Ask participants to define gender and list some common gender stereotypes Note their responses on a flip chart and fill in any gaps using the following information Facilitator s notes The term gender refers to the social relationships between men and women and the way that relationship is made by society In other words gender is how we are shaped after we are born into society Gender also refers to the roles that women and men acquire by virtue of their sex Women and men play different roles in society These roles are shaped by social ideological historical religious and economic determinants However it must be acknowledged that gender definitions are in a constant state of flux in response to changing social and economic conditions For example in times many women have taken o
13. www avert org condoms African Union of the Blind HIVeLAIDS Train the Trainers Manual 60 61 the vulva at the entrance to the vagina This ring acts as a guide during penetration and it also stops the sheath getting stuck inside the vagina Step 3 Female condoms have different brand names in different countries They have a lubricant on the inside but additional lubrication can be used if need be Procedure of using a female condom 1 2 Open the package carefully Choose a position that is comfortable for insertion squat raise one leg sit or lie down Make sure the condom is lubricated enough Make sure the inner ring is at the closed end of the sheath and hold the sheath with the open end hanging down Squeeze the inner ring with thumb and middle finger so it becomes long and narrow and then insert the inner ring and sheath into the vaginal opening Gently insert the inner ring into the vagina and feel it go up Place the index finger inside the condom and push the inner ring as far as it will go Make sure the condom is inserted straight and is not twisted inside the vagina The outer ring should remain on the outside of the vagina The penis should be guided into the condom in order to ensure that the penis does not slip into the vagina outside the condom 10 Use enough lubricant so that the condom stays in place during sex Note 1 2 The female cond
14. End this session using the following discussion points Discussion Points 1 What are the three most effective ways to avoid STIs Answers 1 Be faithful to one partner who is also faithful to you 2 Use condoms every time you have any kind of intercourse and 3 Abstain from sexual intercourse of any kind 2 What three things should you do if you think that you have been infected with an STI Answers 1 Seek proper medical treatment right away 2 Inform your sexual partner s and 3 Abstain from sexual contact until there is no evidence of infection and you have finished all the prescribed medicine 3 How could you raise the issue of condom use with your partner if you were about to have sexual intercourse with a partner you cared about How would you feel if your partner brought up condom use when you were about to have sex What would you say to him or her Handout Sexually Transmitted Infections Facts True or False 1 A person can always tell if she or he has an STI 30 minutes False People can and do have STI without having any symptoms Women often have STIs without symptoms because their reproductive organs are internal but men infected with some diseases like Chlamydia also may have no symptoms People infected with HIV generally have no symptoms for some time even years after infection African Union of the Blind HIVeLAIDS Train the Trainers Manual False STI s False True False
15. a brief illness similar to a cold or the flu An average of 5 10 years later symptoms such as weight loss yeast infections night sweats swollen lymph glands persistent cough diarrhoea fatigue and loss of appetite may begin to occur Damage People with HIV infection eventually develop AIDS and become ill with one or more serious diseases called referred to in module 3 session 4 as opportunistic infections that target individuals whose immunity has been weakened The long term outcome is gradual debilitation and ultimately death Supplies required facilitator s notes and handouts in accessible formats note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers Estimated time 100 minutes Learning Method Large Group Interaction African Union of the Blind HIVeLAIDS Train the Trainers Manual 50 Teaching Aids materials Illustrated video show on STIs Flip Charts amp permanent markers note taker writing frame if trainer is blind partially sighted recorded audio cassettes Handouts Handout 4 1 Sexually Transmitted Infections Handout 4 2 How do STIs transmit HI V African Union of the Blind HIVeLAIDS Train the Trainers Manual 51 Session IIl ls there a connection between TB STIs and HIV Objective By the end of this session participants should be able to Understand the connection between TB STIs and HIV Process 1 Share the specific obj
16. as though you are going to wash them Stir with a heavy stick Boil for ten minutes rinse and hang them to dry Handling body fluids Body fluids include pus blood urine stool vomit semen vaginal fluids and saliva Precaution Explain that a care giver should always wear gloves to prevent direct contact with fluids Visually impaired care givers can get assistance from a trusted friend or family member to ensure they do not expose themselves to contamination Any materials that are to be used should be kept clean and any material used should be burned buried or thrown in a pit latrine Fresh blood pus from wounds should be carefully handled to prevent contamination and infection spread by these fluids Resources needed for this exercise include gloves container for soiled clothes water clean clothes pad cotton wool bandages soap If body fluids spill on the floor they should be cleaned immediately to avoid contamination Step 7 Psycho spiritual care and social support Emphasis that psycho spiritual care and social support is very important for any person with a chronic illness this includes people living with AIDS Explain to the participants that home based care presents the best opportunity to offer to the person living with AIDS psycho spiritual care and social support Family friends and community are the best health care givers e Ask the participants why this may be so e Note their responses and explain that famil
17. body clean 2 Wearing shoes to avoid small injuries that may result in infections 3 Brushing your teeth after eating 4 Washing your hands with soap after going to the toilet Opportunistic infections can be avoided by using and drinking clean water therefore 1 Draw water from recommended sources such as taps clean wells or running rivers Use clean containers such as buckets pots or cooking oil containers Avoid contaminating the water by washing hands in it Boil water until it steams hot Boiling water for at least at 15 minutes kills most infectious organisms 5 Store in a clean covered container re ee tad African Union of the Blind HIVeLAIDS Train the Trainers Manual 39 6 Draw and drink water with clean cups Opportunistic infections can be avoided by observing cleanliness when preparing and serving food through 1 Washing your hands with soap and plenty of clean water before you start preparing food 2 Washing fruits and vegetables before you start to eat or to cook them Peel them if possible 3 Using a clean table or chopping board to prepare the food 4 Serving food and water in clean and well dried utensils e g bowls plates spoons and glasses Opportunistic infections can be avoided by observing cleanliness when preparing and storing food 1 Ensure that meat is well cooked i e until it is no longer pink in the center 2 Wash eating utensils and dry them in the sun or with a c
18. by presenting and explaining the following information Trainer s notes HIV is the virus that causes AIDS HUMAN HIV affects only humans The HIV virus does not live in animals toilets insects like mosquitoes cups or spoons or on bed sheets or towels that people who have HIV might have used I MMUNO DEFFICIENCY HIV virus attacks weakens and eventually destroys the immune system Immuno deficiency refers to the breakdown of the human body s immune system The immune system is the body s resistance for fighting off infections The immune system is usually able to defend the body against many infections except HIV VIRUS viruses are small micro organisms that live and reproduce within larger cells Once inside viruses manipulate the functions of these larger cells for their own Survival and growth The HIV virus lives and reproduces in the human body AIDS means Acquired Immune Deficiency Syndrome ACQUIRED means to get a disease of infection which is not inherited but comes from outside the body IMMUNO the body s natural ability to defend itself against infection and disease DEFICIENCY refers to the fact that the body s immune system is weakened and therefore the body has a more difficult time protecting itself from infections African Union of the Blind HIVeLAIDS Train the Trainers Training Manual 21 22 SYNDROME This is a medical term that refers to a set or collection of specific signs and symptom
19. house that is well maintained lasts longer a person who takes good care of the body will live longer That is why it is important to protect your body from opportunistic infections Handout Understanding opportunistic infections What visually impaired peer educators need to know Infections that attack the body when its immune system is weak are called opportunistic infections This is because the body is not able to fight off germs that it normally could African Union of the Blind HIVeLAIDS Train the Trainers Manual 38 were it not so weak Any infectious disease can become opportunistic from T B to oral thrush to skin diseases Some Signs and Symptoms of Opportunistic Infections include 1 Feeling dizzy 2 Pain when swallowing 3 Trouble breathing 4 Frequent or very bad headaches 5 Problems seeing 6 Feeling more and more tired 7 Fever or feeling hot for more than a day 8 Your sweat soaks your bed 9 Shaking chills 10 Problems with balance walking or speech 11 Loss of weight for no reason 12 More than four watery or soft bowel movements a day 13 Vomiting 14 Sore mouth or tongue 15 Stiff neck 16 mood changes depression 17 Loss of appetite 18 Other more serious opportunistic infections include Tuberculosis Kaposi s Sarcoma a form of skin cancer pneumonia Opportunistic infections can be avoided by taking care of one s hygiene through 1 Taking baths everyday to keep your
20. or burning sensation when they urinate and or a watery or milky discharge from the urethra Females Seventy five percent of women have no symptoms for women with symptoms these may include abnormal vaginal discharge irregular vaginal bleeding abdominal or pelvic pain accompanied by nausea and fever May also cause painful urination blood in the urine or a frequent urge to urinate Diagnosis A sample of genital excretions is cultured to detect Chlamydia Damage If left untreated Chlamydia may cause severe complications urethritis in men and pelvic inflammatory disease PID in women If untreated PID often leads to infertility If a baby s eyes become infected the baby can become blind if left untreated I Gonorrhoea Symptoms May occur 2 to 10 days after contact with infected person Males A cloudy thick greyish yellow pus like discharge from the penis and a burning sensation during urination Some males show no signs Many young boys and men mistakenly believe that having an STI is a rite of passage to manhood Females Usually show no signs Some women have a pus like vaginal discharge irregular bleeding painful urination and lower abdominal pain 2 to 10 days after contact Damage Sterility pelvic inflammatory disease PID in women which can recur even after the gonorrhoea and original PID have been cured A baby can become blind if infected Diagnosis The client should inform the health worker of all points of sex
21. or by holding hands talking walking or dancing with a partner STIs are only spread by close sexual contact with an infected person Anyone can be infected by having oral anal or vaginal intercourse with a partner who is infected In the case of HIV a person can be infected by sharing needles with an infected partner or getting a transfusion with infected blood African Union of the Blind HIVeLAIDS Train the Trainers Manual False 11 False 12 True 45 Practicing good personal hygiene after having intercourse should be encouraged While personal cleanliness alone cannot prevent STIS washing away you and your partner s body fluids right after intercourse is good hygiene Washing does not however prevent pregnancy or stop HIV from entering the body through the mucus membranes in the mouth anus penis or vagina It is possible to contract some STIs from kissing It is rare but possible to be infected by syphilis through kissing if the infected person has chancres small sores in or around the mouth The herpes virus can also be spread by kissing if active lesions are present The most important thing to do if you suspect you have been infected by an STI is to inform your partner s The most important thing to do is to seek immediate medical treatment Symptoms of an STI may never appear or may go away after a short time but the infection continues inside the person s body She or he can suffer se
22. the Blind HIVeLAIDS Train the Trainers Manual 34 Session IIl Stages of HIV progression Objective By the end of this session participants will be able to Describe the stages of HIV virus progression Understand the symptoms and conditions in the various phases of HIV progression Process 1 Introduce the title of the session and share the objective of this session to participants 2 Ask participants to give examples of opportunistic infections that they know of 3 Present some notes on the various stages of HIV virus progression as follows 4 Ask participants if they have any queries or issues to be clarified Facilitor s note and Handout Phases of Infection 1 Primary Infection Phase This is the stage where a person s HIV status changes from HIV negative to HIV positive It usually occurs 4 8 weeks after an individual has been infected with HIV About 30 60 of people infected with HIV will develop a flu like illness which lasts 1 2 weeks Symptoms include sore throat headache mild fever tiredness muscle and joint pains swelling of lymph nodes Because of the rapid unchecked multiplication of the virus there are many viruses in the body 2 Silent Stage In this stage the body recognizes the infection as a threat and responds by producing a large number of antibodies The body s response results in a drop of the number of viruses in the body and the rise in the number of CD4 cells Th
23. to buy expensive food Eat a balanced diet eat at least three times a day or more often if you need to African Union of the Blind HIVSIAIDS Train the Trainers Manual 12 Opportunistic infections Seek medical treatment promptly for any illness or opportunistic infections you may have Avoid getting infections such as T B other chest infections and S T Ds Protect yourself from getting malaria and colds Involve your friends and family in helping you to prevent diseases Most people who are HIV positive do not need antiretroviral therapy A R T A healthy diet and lifestyle is all they need Talk to your doctor about treatment options Exercise Exercise regularly Walking cultivating the garden and even housework are some exercises you can do However do not strain yourself You should get enough rest as well Practice safer sex Abstain if possible If you cannot stick to one partner and use condoms every time you have sex Persuade him or her to also get tested so both of you are aware of each others HIV status Should you want to have children seek the help of a counselor on your options Get involved Talk about being HIV positive to other visually impaired people and other people in the community as well and how they can prevent infection Speak out in your associations organisations of the blind church and community In particular educate other visually impaired persons and encourage them to get tested A
24. to help you remember when to take your medicine Plan ahead for how you will take the A R T when you are at work If you travel away from home pack more tablets than you need This will give you enough tablets if you stay away longer Step 5 A R Vs do not cure HIV Clarify that if some is on the therapy they can still give HIV to someone else A R Vs only reduce the amount of viruses in the blood they does not eliminate them A R V s do not prevent re infection from HIV If you are taking A R Vs you can still get HIV again with a different type of the virus This is called re infection This may make your immune system weaker Protect yourself from more HIV While you are taking A R Vs continue to protect yourself and others by using a condom or not having sex Remember by engaging in unprotected sex you can still infect others or get re infected yourself Step 6 A R Vs and Pregnancy Explain that while the decision to have a baby rests on you and your partner it is very important to tell your doctor if you are pregnant or want to have a baby He or she can provide you with appropriate advice You can get pregnant while you are using A R Vs If this happens there is a small chance that you will give HIV to your baby unless you and the baby are given special medicines Visually impaired persons planning to have children can talk to a doctor and ask about a program called Prevention of Mother to Child Transmission P M T C T
25. to income generating projects for Peer Educators e Clearly defined goals and objectives e Capacity building e Coordination and networking e Managerial process a management information system that includes feedback on the activities of Peer Educators e Direct involvement of peer educators in all aspects of the programme e Multi sectoral approach and integration with other sectors e An enabling environment Visually impaired Peer Educators must be accorded the necessary support by their organisations Supplies required facilitator s notes note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers Learning Method Large Group Interaction small group disccussions Estimated time 40 minutes African Union of the Blind HIVeLAIDS Train the Trainers Manual 95 Appendices Appendix 1 Bibliography 1 10 Double Exposure Disability and HIV AIDS in sub Saharan Africa A thesis submitted to the University of Manchester for the degree of M A in Poverty Conflict and Reconstruction in the Faculty of Social Sciences and Law 2004 Jacinta M Sweeney Institute for Development Policy and Management IDPM HIV AIDS and Disability Capturing Hidden Voices April 2004 The World Bank and Yale University Global Survey on HIV AIDS and Disability Disability and HIV amp AIDS Including persons with disabilities in HIV amp AIDS programs 2006 SHIA Program Kenya solidari
26. viruses and the number of CD4 cells is below 200 per millimeter of blood Supplies required facilitator s notes and handout in accessible formats Estimated time 40 minutes Learning Method Large Group Interaction African Union of the Blind HIVeLAIDS Train the Trainers Manual 37 Session IV Understanding Opportunistic I nfections Objective By the end of this session participants will be able to Define and understand the meaning of opportunistic infections Describe and list some examples of common opportunistic infections Process 1 Introduce the title of the session and share the objective of this session to participants 2 Ask participants define what opportunistic infections are 3 Note their responses 4 Present some notes and clarify any differences on the opportunistic infections as follows 5 Ask participants if they have any queries or issues to be clarified Facilitor s notes An Opportunistic Infection Ol is a disease that takes advantage of the weak body immune system Note that in the previous session we learnt that opportunistic infections begin to invade the body of a person infected with HIV during the major symptomatic stage of HIV progression Opportunistic infections enter a weakened body the way the rain enters a house that is falling apart Opportunistic infections cause serious problems when a person s immune system is weakened by HIV and AIDS Just as a
27. what the accommodation facilities are like 3 Plan to work in a circle Working in a circle or U shape allows for the most effective communication and interaction between participants and the facilitator and among participants themselves 4 Materials Develop a guide that will enable participants to conduct small group trainings among their peers in their communities Plan ahead to have all materials put into accessible formats for Peer Educators and blind and partially sighted beneficiaries in the community Remember to find out what format is preferred by each participant Accessible formats include Braille large print and audio Also note that some participants will require their materials to be in soft copy because they can read them using adaptive technology in their computers African Union of the Blind HIVeLAIDS Train the Trainers Manual 13 MODULE 1 Human Sexuality Gender roles and HIV amp AI DS Session Human sexuality Session objectives By the end of this session participants will be 1 Familiar with human sexuality 2 Able to define and differentiate between sex and sexuality 3 Comfortable to talk about sexuality issues 4 Comfortable enough to refer to human sexual organs by their real names 5 Able to define and understand sexual and reproductive health 6 Able to understand the meaning of sexual freedom Process 1 Share session objectives with participants and inform them that this is an inter
28. 0 of the persons usual body weight the person feels tired most of the time In this stage a person usually has between 50 and 500 CD4 cells per millimeter of blood He she is still able to carry out his daily activities 4 Major symptomatic stage and the beginning of opportunistic diseases As HIV progresses 1 The number of CD4 cells decreases 2 The number of viruses in the body increases 3 More and more AIDS symptoms begin to develop in the body The higher the viral load the faster the patient moves towards full blown AIDS and death The number of CD4 cells is very low and the number of viruses becomes very high Major symptoms and opportunistic diseases infections begin to appear as the immune system continues to deteriorate 5 AIDS defining conditions stage In this stage a person is moving towards AIDS Also in this stage symptoms become more and more as compared to before and they become much more serious Patients African Union of the Blind HIVeLAIDS Train the Trainers Manual 36 become infected by rare and unusual diseases that do not respond to antibiotics The immune system is much damaged and more persistent and untreatable opportunistic conditions begin to show The person is usually bedridden for more than 50 of the day Patients usually die within 2 years unless they are treated with Anti Retroviral Therapy and opportunistic infections are prevented In this stage a person usually has a very high number of
29. 1 At home and within the community 2 At clinic for medical problems where is a lot of privacy 3 Within the patients home This is a patient who does not need isolation Standard guidelines fro controlling infection should be followed Home based care training promotes compassionate care for a person living with HIV In home based care 1 The patient is encouraged to live life normally 2 The care giver should keep confidentiality He she should not reveal the private matters of the patient 3 Show love to the patients by bathing and feeding them Love makes the patient have hope 4 Material support and donation of clothes food and drugs make the patient feel loved and cared for 5 Give the patient time to express his her views and to make their own choices 6 The care giver enlightens the patient on good nutrition Step 4 Basic home nursing skills Define nursing as follows nursing is an act of assisting individuals it includes values and aspects of personal hygiene such as bathing and nail care Qualities of a home based care giver 1 Good communicator 2 Courageous 3 Empathetic 4 Observant and able to monitor the client African Union of the Blind HIVeLAIDS Train the Trainers Manual See 80 Friendly Gives his her own time Caring Humble and gentle How to handle person during home based care 1 2 ct Lar et Introduce yourself Be punctual if you tell the client you will come at a particul
30. 30 11 00 Tea Break 11 00 1 00 developing an Action Plan for community trainings 1 00 2 00 Lunch 2 00 4 00 Closing END African Union of the Blind HIVLAIDS Train the Trainers Manual Canada cnib vision health vision hope sant visuelle une vision pour l avenir
31. AFRICAN UNION OF UNION AFRICAINE D TABLE OF CONTENTS FOrEWO Oimoen n rua saat E aO tare Acknowledgements s ssas saesae ae eme taetae emera eese List of Abbreviations and ACrony MS s s s u Introduction MODULE 1 Session l Session II Session III MODULE 2 Session l Session II Session III Session IV MODULE 3 Session l Session II Session III Session IV Human Sexuality Gender roles and HI V amp AI DS HUMAN sexuality s a a s asese asseta s etas rm meena r mme Exploring sexuality and blindness Dispelling the myths and misconceptions Gender roles and HIVGAIDS 0 2 0 cece een eee Basic facts about HI V amp AlI DS HIV and me personal and community attitudes and values towards HIV AIDS and illness Define and differentiate between HIV and AIDS Methods of HIV transmiSSION 0 0c0cuen ene Impact of HIV amp AIDS in the community Understanding the HIV Virus The Human IMMUNE System m s sasssa eseat mu How the HIV virus invades the immune system Stages of HIV progression m s m esasa emea eaen Understanding Opportunistic Infections African Union of the Blind HIVeLAIDS Train the Trainers Manual Pg 5 Pg 6 7 Pg 8 9 Pg 10 12 Pg 13 14 Pg 15 Pg 15 18 Pg 19 20 Pg 21 23 Pg 24 27 Pg 28 Pg 29 31 Pg 32 33 Pg 34 36 Pg 37 40 MODULE 4 Session I Session II Ses
32. HIV Handshakes touching swimming or bathing with an infected person Sharing utensils cups plates spoons with an infected person toilet seats Mosquito bites Using an infected person s towels and clothes Sitting next to an infected person Talking and having a casual conversation with someone who is infected with HIV Sharing a bed with an infected person HIV cannot live outside the body In order to survive the virus needs the food supply of the cells in body fluids Supplies required note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers Handouts Methods of Transmission MTCT and Infant Feeding in accessible format Estimated time 60 minutes Learning Method Large Group Interaction African Union of the Blind HIVeLAIDS Train the Trainers Manual 28 Session II Impact of HIV amp AI DS in the community Objective By the end of this session participants will be able to Understand the impact HIV amp AIDS has had in our communities Understand the role they can play to reduce the impact of HIV amp AIDS in our communities Process 1 Introduce the title of the session and share the objective of this session to participants Inform participants that this is a small group activity Ask participants to list the impact of HIV amp AIDS in their communities Ask participants to select a group representative to present their lis
33. The process takes 15 to 20 minutes This is done after the test The client is first assessed for readiness to receive the results This is done depending on the result received If negative Discuss the window period Explore the implications of being HIV negative Review risk reduction Refer appropriately Give out condoms if requested Offer space for any questions Encourage follow up counseling If positive Explore and acknowledge the person s fears and feelings Explore and identify immediate concerns Revisit risk reduction Discuss medical follow up care and referral to appropriate services Discuss positive living Allow room for questions and check that information is understood Help the person to establish priorities and plan of action Encourage follow up counseling NOTE VCT is person centred that is it focuses on each person s unique issues and circumstances related to HIV risk VCT is based on the risk reduction model and the intervention is designed to reduce risk not necessarily eliminate it The emphasis of VCT is to initiate small incremental behaviour change steps to reduce risk Step 7 Ask participants if they know the meaning of the term window period Note their responses clarify and explain the term using the following information African Union of the Blind HIVeLAIDS Train the Trainers Manual 69 Facilitator s notes Explaining window period If the infected person
34. V and AIDS It can also encourage visually impaired persons to visit mainstream HIV amp AIDS service organisations to seek HIV amp AIDS prevention treatment care and Support services e Stimulate community dialogue on the underlying factors that contribute to the epidemic such as risk behaviour risk setting and the environment that creates these conditions e Promote advocacy to ensure that policy makers and opinion leaders approach the epidemic seriously Advocacy takes place at all levels from the local community to the national level 6 Peer to Peer HIV amp AIDS Peer Educators Trainers Guide for IMPACT Implementing Agencies Page 95 African Union of the Blind HIVeLAIDS Train the Trainers Manual 88 e Reduce stigma and discrimination through effective communication on HIV and AIDS An effective BCC strategy can greatly reduce stigma and discrimination among visually impaired persons Visually impaired Peer Educators should continuously educate themselves and others about HIV amp AIDS They should also target other people in their communities This will help to raise awareness that HIV amp AIDS infected and affects visually impaired persons in the community Step 5 Explain that there are different methods employed in a Bahaviour change Communication strategy There are a number of methods that are used to communicate information to others These include Group discussions Role plays Lecture Drama Audio vis
35. acilitator s notes Qualities of a good Peer Educator a Excellent communication skills b Approachable and easy to talk to c Well respected d A problem solver e A good planner and well organized f A team player Step 6 Conclude by saying that visually impaired Peer Educators are generally trained to African Union of the Blind HIVeELAIDS Train the Trainers Manual 92 a Provide one to one counseling b Conduct advocacy and influence visually impaired women and men to access mainstream HIV amp AIDS programming c Facilitate discussions on risky behaviour and other risk settings d Disseminate basic facts on HIV amp AIDS and other sexually transmitted infections repeated infections and treatment failure and motivate them to seek prompt and competent treatment delivered by competent health workers in their community e Make referrals to services such as HIV counseling and testing Anti Retroviral Therapy prevention of mother to child HIV transmission orphan care and treatment for tuberculosis and other opportunistic infections f Link visually impaired people infected by HIV to support groups in their community g Promote HIV prevention through abstinence mutual fidelity or condom use h Demonstrate and teach condom use skills to visually impaired people in their communities Supplies required facilitator s quick notes note taker writing frame if trainer is blind partially sighted flip chart
36. across the patient s chest and under the chin V Bring all materials within his reach Provide the tooth brush stick with paste and water in a cup Offer container onto while rinsing the mouth If the patient is unconscious I Put on the gloves or plastic bag I1 Wind some cotton wool around the spoon to make a swab or fold a piece of cloth to clean gently between the lips and upper gums and between the lips and lower gums the roof of the mouth tongue floor of the mouth and lips III Move the swab from back to the front of the mouth in each area and change the cotton wool when necessary African Union of the Blind HIVeLAIDS Train the Trainers Manual 82 IV Gently brush the teeth rinse apply Vaseline to the lips if dry and leave the patient comfortable V Clear the place and throw away the cotton Nail care Explain that keeping the finger nails and toe nails clean and neatly trimmed should be done for the following reasons it reduces the collection of germs and prevents self injury Resources for nail care include soap water in a basin towel Vaseline lotion Explain the steps to follow in nail care as follows Prepare the patient by explaining the procedure Obtain the patient s permission to trim the nails II Gently wash the hands with soap and water scrub the nails with brush rinse and dry the hands using clean cloth towel Ill Trim the nails with a razor IV Apply Vaseline or lotion to both hands V
37. active session 2 Ask participants to define sex and sexuality 3 Note their responses and fill in the gaps using the following notes Facilitator s notes Sexuality refers to everything that has to do with being sexual maleness and femaleness It also includes intellectual social spiritual and moral parts of our being It includes the ability to make choices and the responsibility of the consequences of our choices Sexuality is how an individual thinks feels and acts about his her own body and that of others It is the totality of an individual as they are expressed Sexuality has components such as e Sensuality This is about how people see themselves and how they feel about their body This includes a sense of attractiveness and how it is displayed through dressing dancing and other features e Intimacy includes such things as friendship and sexual intercourse e Sexual identity indicates maleness and femaleness e Sexual behaviour and reproductive health is the process of reproduction and the care and maintenance of reproductive organs African Union of the Blind HIVeLAIDS Train the Trainers Manual 14 e Sex refers to whether a person is either male or being female This is defined by our physical features such as a man s penis and a female s vagina and breasts e Sex refers to the biological differences between men and women These differences are natural because they are given from birth e Sex also r
38. ain to participants to feel the zigzag edges These edges are used to tear the packet 2 Place condom on the tip of an erect penis penile model 3 Squeeze air out of tip of condom 4 Roll condom down penis penile model 5 Smooth out air bubbles 6 With condom on insert penis into the vagina for sexual intercourse 7 After ejaculation hold on to condom at the base of the penis 8 Withdraw from vagina while still erect 9 Remove condom from penis 0 Tie condom to prevent spills or leaks 1 Dispose condom safely African Union of the Blind HIVeLAIDS Train the Trainers Manual 58 59 Point to note before using a male condom 1 Ask the condom provider for the expiry date of the condom 2 cy Do not use condom after expiry date Condoms should be stored in a cool dry and dark place Heat light and humidity all damage rubber The Condom User U Nhe DON lis 8 Must make sure the condom size is correct Must use a water based lubricant e g KY jelly Vaseline baby oil cooking oil margarine are all oil based and will cause the condom to break if used Must put the condom correctly on the male penis before sexual intercourse Must not take off the condom before sex is finished Must not use the condom again Must leave some space at the end of the condom when putting it on and not breaking when taking it off Must take off the condom before the erection is lost Some reasons why condoms fai
39. amp permanent markers Learning Method Large Group Interaction small group disccussions Estimated time 45 minutes African Union of the Blind HIVeLAIDS Train the Trainers Manual 93 Session II How to motivate Peer Educators and sustain a Peer Education program in organizations of visually impaired persons Objectives By the end of this session 1 Lead participants in understanding possible approaches that will ensure sustainability in peer education 2 Lead participants in suggesting specific efforts to enhance the sustainability of HIV amp AIDS training and Peer Education programmes in their own organisations Process 1 Inform participants that this will be a small group activity 2 Form them into two groups of 10 each 3 Tell the groups to identify factors that can hinder effective Peer Education and propose innovations to improve peer education Each group presents to all participants Note the presentations and add to this discussion using the following notes bem Facilitator s notes Factors that hinder effective Peer Education e Lack of resources to get the message out materials finances transport etc e Poor grasp of a community s language e Lack of skills to create innovative messages and presentations e Lack of personal motivation both Peer educators and their clients due to a lack of materials and the means to do their jobs e Socio cultural and religious factors Suggested innovatio
40. and you will not be able to work any more Do not be too hard on yourself Take time to reflect You are human Acceptance This is the stage now you start confiding in some friends and relatives You may be looking for information understanding and support Be aware that many other people could be in the same situation Try and open up you may make a lifetime friend Remember AIDS is now just another chronic disease that can be managed with medication and a healthy lifestyle just like diabetes and other chronic diseases Step 4 Explain some steps to help someone living positively with HIV using the notes below Get more information on HIV so that you will be able to reduce your worries and make positive decisions about your life especially how to protect yourself and your family Dealing with depression Laughing with people helps strengthen your body and is very healthy Try and not be alone Be in the company of your friends and talk about your situation If you need more help see a counselor Continue to work if possible Work will keep you busy and your mind occupied You will be able to provide for yourself and your family and that will leave you with a high self esteem that you are able to do something Diet Good nutrition is very important A lot of traditional foods here in Africa contain vital vitamins and food nutrients Green leafy vegetables and fruits are particularly good for your body You can eat well without having
41. ant in the condom is water base which is unlikely to cause irritation Only in a small number of cases does skin irritation occur Condoms make a man lose erection impotence Condoms themselves do not cause this Instead the problem may be physical or emotional in the mind due to embarrassment HIV can pass through a condom Although HIV is small it cannot pass through an unbroken latex condom Condoms can prevent HIV and other S T Ds and are the only known barrier method to these infections outside of abstinence What contributes to failure eS Inconsistent and incorrect use Poor storage Use of expired condoms Poor handling resulting in breakages e g long nails or tearing Female condom Step 1 Explain to participants that the female condom is a thin sheath or pouch worn by a woman during sex It entirely lines the vagina and helps to prevent pregnancy and sexually transmitted diseases STDs including HIV Step 2 The female condom is a polyurethane sheath or pouch about 17cm 6 5 inches in length At each end there is a flexible ring At the closed end of the sheath the flexible ring is inserted into the vagina to hold the female condom in place At the other open end of the sheath the ring stays outside 4 CDC 2003 Male latex condoms and sexually transmitted diseases Fact sheet for public health personnel O O CDC 1999 Condoms and their use in preventing HIV infection and other STDs September
42. ants and he says GIVE ME ONE e He runs back tries to open it and rips the condom So he runs back to get another one Because the woman will not have sex When he comes back he fumbles with the condom it falls on the ground and it gets African Union of the Blind HIVeLAIDS Train the Trainers Manual 57 58 dirty By this time the woman gets angry and impatient and says she wants to go home Step 11 Ask the audience what was happening in the skit drama Step 12 Note their responses moderate the discussion and explain that it is important for men and women to talk about condoms together The decision whether to use or not use condoms is made by both sexual partners Talking about condoms learning about condoms and handling condoms can be difficult and embarrassing Comfort must be learned Talking about learning about and handling condoms becomes comfortable and natural with practice Sexually Transmitted Infections including HIV are preventable Condoms if used correctly and consistently will prevent STIs and HIV Step 13 Demonstrate male condom use as follows Note e That for this session to be most useful to visually impaired participant the facilitator needs to issue each participant one penile model and one male condom e Explain each step slowly ensuring that all participants follow Have sighted assistants to help Procedure of using a male condom m Remove condom from packet without damaging it Expl
43. ar time be there at that time Treat the patient with respect dignity with sensitivity and kindness Do not blame or discriminate the client Patient privacy must be respected Strict and absolute confidentiality is required Be accepting and dependable Do not judge the moral values of your patient The care giver can learn about their patient in the following ways 1 Have the power of observation The care giver can prevent a lot of problems by being aware of the following things and report to the doctor in case of any abnormalities I Patient s mood happy jumpy sad Il Look at the color of their eyes Ill Eyes should be white IV observe whether they have any skin rashes blisters V body temperature VI ulcers VII breathing sometimes a patient would breath too fast or slow noisy Step 5 How to give care to a person living with AIDS at home Explain how to give care in the following way Bed bathing Explain that the reason to bathe the patient is to ensure personal hygiene get rid of harmful bacteria and to refresh the patient Outline the resources required for bathing the patient as follows Gloves or plastic bags large basin warm water towels soap container for dirty beddings tooth brush paste razor blade scissors comb chair clean clothes Explain that if the person is conscious and able to move the care giver should inform the patient what they will do African Union of the Blind HIVeLAIDS
44. are is the care given to persons infected by HIV AIDS It extends from the hospital or health facilities to the patients home through family participation and community involvement within available resources Home based care has four main components 1 Clinical Care 2 Nursing care 3 Counselling and physical spiritual care 4 Social Support Step 2 Explain the various components as follows Clinical Care 1 Includes care to promote and maintain good health hygiene and nutrition 2 Early diagnosis rationed treatment and fall up care of HIV related illness Nursing care Includes care and promotion of living Counselling and physical spiritual care 1 Includes reducing stress and anxiety 2 Promote positive living 3 Helps individuals in making informed decisions on HIV testing African Union of the Blind HIVeLAIDS Train the Trainers Manual 79 4 Helps individuals make plans for the future and behaviour change while involving sexual partners in such decisions Social Support 1 Includes information about referral services and support groups 2 Includes information on welfare services 3 Legal advice for individuals and their families 4 Provision of material assistance Step 3 Who provides care and where 1 The patient provides his her care if not very sick 2 Family members friends and community members 3 Health workers community based workers and traditional healers The principal areas for home based
45. as However it is a useful resource to AFUB member organizations in Africa Other major Peer Education Manuals have been useful references in the preparation of this manual A list of bibliography websites and key reference materials that have been useful in the development of content and useful handouts for participants have been provided in the appendices at the end How to use this manual Trainers can select one module to conduct stand alone trainings A sample training program including all the modules has been provided in the appendices This training program has been tested and used before in conducting Peer Education training workshops for visually impaired participants Trainers can use this program in their trainings or can use it as a guide to develop their Peer Education training programs African Union of the Blind HIVeLAIDS Train the Trainers Manual 11 Target Audience This manual is for use by Trainers of Trainers i e trainers of visually impaired Peer Educators It has been developed to provide awareness and training on HIV amp AIDS prevention treatment care and support and to equip blind and partially sighted participants with Peer Educations skills It is hoped that blind and partially sighted participants will become effective Peer Educators in training other visually impaired persons in their communities Another expected major outcome of this manual and training activities herein is to sensitize facilitators a
46. ated the sore will disappear and a skin rush will develop often on the hands and soles of feet 3 6 weeks after the chancre appears It then usually disappears Other symptoms may include hair loss sore throat fatigue or mild fever Damage If left untreated after a rash appears it can eventually after many years cause heart failure blindness and damage to the brain and spinal cord Diagnosis Health worker examines chancre site throat eyes heart lungs and abdomen performs a microscopic examination of chancre pus and a blood test Or the health worker follows the syndromic approach and treats via a diagnosis observation of symptoms V Human Papilloma Virus There are many types of HPVs In human beings they cause different diseases depending on the type A Genital Warts Symptoms Genital warts are the result of a virus spread during sexual contact They often grow together in little clusters on and inside the genitals anus and throat Depending on location they can be pink brown or grey and soft or small hard and yellowish grey Damage Genital warts disfigure the genitals and are ugly looking It is however possible to treat them without having permanent damage They are not common African Union of the Blind HIVeLAIDS Train the Trainers Manual 48 Diagnosis Usually made by direct eye exam A nurse or doctor may ask for other laboratory investigations when not certain about the diagnosis B Cancer of the
47. ator s notes VCT involves the following steps Or Ea ee A decision to take the test Pre test counselling Blood taking HIV testing Post test counselling Follow up service African Union of the Blind HIVeLAIDS Train the Trainers Manual 67 The procedures of VCT 1 Pretest counselling This is counseling done before the HIV test It involves e Assessing one s risk of contracting HIV e Discussion on the test and expected results e Thinking through the possible results e Discussing basic HIV facts e Discussing risk reduction methods e Process takes 15 to 20 minutes 2 Testing e This is done using the rapid test kits e They look for HIV virus antibodies These kinds of tests are commonly used in a VCT centre e They are called rapid because they work fast e The process takes 15 to 20 minutes Possible Test Results Negative results e Means that no HIV was not found in the given sample e Also referred to as sero negative e Could be that one is in the window period Positive result e HIV was present in the sample and that one is infected e Also referred to as sero positive African Union of the Blind HIVeLAIDS Train the Trainers Manual 68 Discordant result That one test is positive and the other is negative If this happens a tie breaker has to be used This means that something went wrong in the testing time The test then has to be repeated 3 Post test counseling
48. bjective By the end of this session participants will be able to Describe and understand the human immune system Describe and understand how the immune system works to defend the body Process 1 Introduce the title of the session and share the objective of this session to participants 2 Inform participants that this is a small group activity 3 Participants will read and discuss the text provided in their small groups This text is illustrates how the human immune system works 4 After participants read and discuss the text facilitators should ask them to answer the questions below 5 Ask participants to choose a representative to read out the answers to their questions to the large group 6 Note participants responses and how they demonstrate their understanding of how the immune system works 7 Clarify any differences and explain any concepts that participants do not understand Handout ANALOGY OF HOW THE HUMAN IMMUNE SYSTEM WORKS Let s imagine that the body is a mining company that has to be protected from invaders who want to harm the company Meet the security people working in this company which is called the body Mr Phagocyte a type of white blood cell is the company s spy While he is doing his rounds and removing dust and smoke particles he sees a really bad customer the flu virus Mr Phagocyte immediately calls the company s public relations officer Mr Macrophage another white bloo
49. can Union of the Blind HIVeLAIDS Train the Trainers Manual 52 2 You don t protect yourself when handling blood 3 Your partner has sex with others 4 You drink beer or other kinds of alcohol 5 You masturbate yourself 13 You don t always use a condom for sexual intercourse 14 You don t know if your partner is HIV or has an STI 15 You never have unsafe injections or tattoos Handout 20 Questions to Ask Yourself if You Think You Are at Risk 1 Do you have a wife husband girlfriend boyfriend Yes No __ 2 How many partners have you had in the last 6 months 3 How often do you have a new partner 4 What concerns if any did you have about having sex with this person 5 How concerned are you that you could become infected with HIV from this partner African Union of the Blind HIVeLAIDS Train the Trainers Manual 53 6 Would you have engaged in this same behavior if you knew this person had HIV 7 Would knowing have made a difference 8 Where do you meet your partners 9 How well do you know your partners 10 How often do you use condoms 11 With what partners are you more or less likely to use a condom 12 How do you decide with which partners to use condoms 13 How does drinking alcohol influence your decision to have sex 14 Do you know if your partner has had sex with anyone else 17 Have you and your partner talked about HIV STD risk 18 Have you discussed whether eit
50. ce a best practice model which can be practised in other countries in Africa African Union of the Blind HIVeLAIDS Train the Trainers Manual Acknowledgements AFUB thanks the following for their enormous contribution to the production of this manual First and foremost the Canadian International Development Agency CIDA for its financial Support which made possible to implement the AFUB HIV amp AIDS Awareness and Training Project for blind and partially sighted persons in Africa Many thanks go to the Canadian National Institute for the Blind CNIB for co financing the project and for the technical support to AFUB throughout the two years of the project All the Trainers and Facilitators National Organisations of the Blind in Cameroon Ghana Kenya Malawi Rwanda and Tanzania and the HIV amp AIDS Service Organisations in respective countries that made contributions to the content of this manual and for their involvement in training workshops in six AFUB member organisations associations Cameroon 1 Association Nationale Des Aveugles Du Cameroun ANAC 2 Cameroon National Association of People Living with HIV amp AIDS R seau Nationale des Personnes vivant avec VIH amp SIDA du Cameroon Ghana 3 Ghana Association of the Blind GAB 4 Ghana Office West Africa Program on the Control of AIDS and Sexually Transmitted Infections WAPCAS Kenya Kenya Union of the Blind KUB Kenya AIDS NGO Consortium KANCO Na
51. cervix Symptoms Early precancerous changes on the cervix are usually without symptoms However established cancer presents a vaginal discharge usually foul smelling or irregular bleeding especially during intercourse This disease is rare in adolescents and occurs later in life Damage Although early cancer is curable later cancer cannot be cured Cervical cancer will soread and damage other body organs if left untreated It eventually leads to death Diagnosis Precancerous changes in the cervix can be detected through regular pap smears Established cancer can be seen by the naked eye using a speculum Diagnosis is confirmed by taking pieces of suspicious tissue for laboratory examination Vi Pelvic Inflammatory Disease PID An infection that affects the fallopian tubes uterine lining and or ovaries It is usually caused by sexually transmitted diseases that enter the reproductive system through the cervix and which have not been treated Chlamydia or gonorrhoea Symptoms While the symptoms vary from person to person the most common identifying factor is pain in the pelvic regions Other symptoms may include frequent urination and or burning with urination sudden fevers nausea or vomiting abnormal vaginal discharge and or pain or bleeding after intercourse Damage If left untreated PID can cause infertility or ectopic pregnancy This is where the fertilised egg attaches itself to the fallopian tubes Diagnosis n orde
52. d cell to come and check out the situation Mr Macrophage confiscates the invaders identity document the antigen He then takes this information to the company s most important person in the company the company s CEO Mr CD4 Mr CD4 takes one look at the identity and immediately recognizes the flu African Union of the Blind HIVeLAIDS Train the Trainers Manual 30 virus He realizes that the company is in trouble and that he should immediately give command to attack Mr CD4 joins forces with Mr Macrophage and together they activate the body s defense system They call more CD4 cells phagocytes to the scene and they send messages to B white cells and T white cells to join them ready for attack While the white blood cells are getting ready the flu virus is hiding in the body s cells where it tries to multiply itself as quickly as it can Killer T White blood cells drive the flu virus out of its hiding place while this is happening B White blood cells are busy manufacturing antibodies Antibodies grab the exposed flu viruses cling to them and make them easy targets for the phagocytes to attack puncture and destroy them When all the viruses are destroyed the company the body now slowly begins to return to normal once again Once the situation is under control a special type of white blood cell called Suppressor T white blood cell orders the B white blood cell to stop manufacturing the antibodies and also orders the
53. dvantages of the female condom in the following way 1 The outer ring is visible outside the vagina which can make some women feel self conscious 2 The female condoms can make noises during intercourse adding more lubricant can lessen this problem 3 Some women find the female condom hard to insert and to remove 4 It is expensive and relatively limited in availability in many countries African Union of the Blind HIVeLAIDS Train the Trainers Manual 62 63 Can I reuse the female condom It is believed that limited availability and high cost have led some women to reuse female condoms in some countries The World Health Organisation WHO recommends use of a new male or female condom for every act of intercourse WHO does not recommend or promote reuse of female condoms but has released a document together with guidelines and advice for programme managers who may consider reuse of female condoms in local settings Step 6 Discuss with participants some tips of how they as visually impaired persons can interact with condoms more effectively Note their points from the discussion and add that other than asking the shopkeeper pharmacist to inform him her what the expiry date on the condom is A visually impaired person can detect if a condom has expired if it feels sticky or if it very dry i e lubrication has dried out you shouldn t use it as the packaging has probably been damaged A visually impaired person can
54. e mmune System Objective By the end of this session participants will be able to Have some understanding on the structure of the CD4 cell Understand how the HIV virus attacks the immune system Understand why HIV is so dangerous to the body Process 1 2 3 Introduce the title of the session and share the objective of this session to participants Remind participants of the CD4 cell that they came across when they were learning about the human immune system Presents some short notes on how the HIV virus attacks the body as follows Facilitor s notes and handout Step 1 The HIV virus attaches to the CD4 cell s receptor Step 2 The CD4 cell and the HIV virus join membranes Step 3 The HIV virus injects its RNA into the CD4 cell Step 4 The viral RNA is changed into viral DNA through a process called reverse transcriptase Step 5 The viral DNA joins with the cell s DNA at the centre or core of the cell causing it to produce more viral RNA Step 6 The viral RNA produces more HIV viruses Step 7 The new viruses break free from the CD4 cell killing it and infecting ONOUS more cells ASk participants if they have any queries or issues that need to be clarified Note their questions and respond accordingly ASk participants why they think the HIV virus is dangerous to the body Note their responses Clarify and explain any differences using the following notes Afr
55. earning Method It would be most preferred to have a facilitator living positively with HIV to conduct this session This also goes a long way in promoting Greater Involvement of People Living with HIV GI PA African Union of the Blind HIVeLAIDS Train the Trainers Manual 75 Session II Anti Retroviral Therapy ART Objectives By the end of this session 1 Participants will be able to have some information about Anti Retroviral Therapy 2 Participants will be able to understand the use of Anti Retroviral Therapy in the management treatment of HIV amp AI DS Process Step 1 Introduce the title of the session and share the objectives with participants Step 2 Find out if participants know what A R T and ARVs mean Note their responses and clarify that A R T is the technical term for AIDS treatment The full name of A R T is Antiretroviral Therapy The drugs involved are called Anti retrovirals abbreviated as A R V s If your immune system is very weak the doctor may advice you to consider taking A R V s Explain that if your immune system is still strong there may be no need for A R V s A visually impaired person living with HIV can talk to a doctor for advice Most people living with HIV just need to live a healthy lifestyle exercise and avoid opportunistic infections Ask your doctor how to do this Step 3 How A R V s works Explain that different drugs work differently Some prevent HIV virus from entering the c
56. ective of this exercise 2 Organize participants into three groups Ask each group to come up with e 10 reasons why knowing about STIs is important e The connections between STIs TB and HIV 3 Ask the groups to select one person to share their reasons Each new presenter from the subsequent groups should only add new points to those already made 4 Note the presentations 5 Make some of the points that are listed in the following sections Facilitators quick notes How do other Sexually Transmitted I nfections promote the transmission of HIV Two types of STI s contribute to the transmission of HIV One type causes ulcers on the genitalia or external sexual organs these are syphilis chancroid and herpes simplex Type 2 The other type which includes gonorrhoea Chlamydia and trichomoniasis causes injury and inflammation redness pain heat irritation of the delicate tissues of the external sexual organs When HIV infected individuals are co infected with ulcer causing STI s their genital ulcers usually also contain HIV The ulcers bleed easily during sexual intercourse readily releasing HIV onto the mucous membranes of their partners vaginas cervixes and or rectum Handout Am I at risk Participants will answer each question by writing Y for yes N for no or U for unsure or don t know Braille or provide these questions in Large Print 1 You hug kiss or massage your partner spouse friend Afri
57. efers to the act of having intercourse between a man and a woman 4 Explain that many people have difficulties or feel embarrassed to talk about sex and sexual body parts 5 Ask participants to name both the male and female body parts and other terms that have to do with sex Ask participants to put aside their fears of saying taboo words during this exercise explaining that we must learn to talk about various sexual parts of the body and different sexual acts in order to protect our health Facilitator s notes e Vagina breasts menstruation sperm penis intercourse labia minora labia majora clitoris anus semen vaginal fluids orgasm climax pleasure STI HIV amp AIDS masturbation condoms woman who has various sexual partners man who has various sexual partners etc e Explain that human beings express their sexuality differently and that all people have different sexual prefers and experiences e Explain that menstruation is a monthly bleeding that takes place when the egg is not fertilized Each month the uterus prepares a lining of blood and tissue in case the fertilisation of the egg takes place If no fertilisation occurs the lining is shed through the vagina along with the unfertilized egg During and shortly after menstruation the cervix is opened and the vagina wall is soft and can easily be bruised It should be noted that if there is sexual activity with an infected person during this period and the sex is un
58. egin to recognize the need to take action Process Share the title of this session with the participants Introduce the objectives of this session to participants Inform participants that this is a small group activity Form participants into their small groups of five persons each Inform participants to create in their small groups a 4 line story of how someone got infected with HIV Group 1 A teacher friend Group 2 A pastor religious leader Group 3 A lover a man living his family to work in the city Group 4 A commercial sex worker 6 Each group will select a representative to present their story the facilitator will then ask the rest of the participants how they feel about that story using the scale below Sympathetic somewhat sympathetic non sympathetic 7 Facilitator should note the responses and reactions from the large group as representatives of each group present their story 8 Participants will then explore some typical attitudes in the community regarding HIVS amp AIDS Denial Fear Depression Acceptance and Action African Union of the Blind HIVeLAIDS Train the Trainers Manual 19 20 Trainer s notes and participants Handout Denial Many people still do not believe HIV is present in our communities Stigma is high among many people People talk in low tones about HIV and AIDS Fear We fear HIV and do not want anything to do with it We think it is another person s probl
59. ell others prevent it from multiplying once it is inside the cell Thus A R V s slow down the virus so that fewer viruses attack the immune system Currently ARVs come in the form of only 1 tablet All these drugs have been combined into one pill that is easy to take A R V s helps the immune system get strong so it can keep out opportunistic infections Just like repairing a house to keep out the rain When people take A R Vs they get sick less often and feel better for longer periods of time CD4 test Even if you do not feel sick your doctor may advise you to take a CD4 test This test measures the strength of your immune system After this test is done the doctor is able to advise you on how to keep your body healthy African Union of the Blind HIVeLAIDS Train the Trainers Manual 76 Step 4 Making a commitment to A R Vs Explain that someone should start A R Vs only when they are ready to make a life long commitment Stopping and starting and missing tablets stops them from working A counselor will advice on how to adhere to therapy Device a way to help you remember to take your medicines As is the case with other medicines people may inquire why you are taking them It is your choice who if anyone to inform At the same time it can help to have someone you trust a family member or friend to help you cope with HIV and to remind you to take your medicine You can also use your talking watch with an alarm
60. em Depression We get frustrated as we hear how people are getting infected and dying from AIDS related conditions Acceptance and action This is the phase where people and their communities come to terms that HIV is real we talk about it openly and take measures to prevent ourselves our families and those around us from getting infected We reach out to those living with HIV and provide and support to those who need it Supplies required A list four line Stories Estimated time 20 minutes Learning Method Small group and Large Group Interaction NOTE Facilitators should note that any materials or handouts presented to blind and partially sighted persons must be put into accessible formats i e braille large print or audio Participants will make their preferred format known before hand Remember to ask participants before hand what their preferred format would be African Union of the Blind HIVeLAIDS Train the Trainers Manual 20 21 Session Il Define and differentiate between HIV and AIDS Objective By the end of this session participants will be able to Define and differentiate HIV amp AIDS Understand the importance of knowing the difference between HIV amp AIDS Process AUN Introduce the title of the session and share the objective of this session to participants Ask participants to define and explain the terms HIV and AIDS Note their responses Clarify the difference and explain
61. ere is a massive battle going on inside the body The virus is still active in the body but there are no outward symptoms of disease HIV test is the only way to know if one is infected The body mounts an effective counter attack on virus by deploying multiple white blood cells to fight the infection and prevent the virus from multiplying African Union of the Blind HIVeLAIDS Train the Trainers Manual 35 The virus is infecting and destroying many CD4 cells but the body s immune system is back to normal and replaces the destroyed CD4 cells and restricts the rapid multiplication of the virus During this time there are many CD4 cells in the body and few viruses In this stage a person has between 500 and 800 CD4 cells per mm of blood This stage may last anywhere from 3 10 years 3 Minor Symptoms Stage After a few years the body begins to lose the battle and it s unable to replace CD4 cells and other virus fighting cells as quickly as they are being destroyed by the HIV virus Both the quality and quantity of the CD4 cells and other virus fighting cells produced go down and the virus level starts to rise This stage begins when the person infected begins to display some of the following symptoms Mild to moderate swelling of lymph nodes in the neck armpits and groin occasional fever skin rashes very itchy skin fungal nail infections mouth ulcers chest problems that keep coming back weight loss of up to 1
62. ess Step 1 Step 2 Step 3 Step 4 Explore feelings attitudes and perceptions about condoms Demonstrate correct female and male condom application Describe care use and disposal of condoms Describe advantages and disadvantages of using condoms Distinguish fact and myths about condoms and condom use Demonstrate partner negotiation for condom use Discuss ways by which visually impaired persons can interact with condoms more effectively Explain to participants that you are going to play the condom line up game Ask everyone to join you in an open field or a Spacious room Ask participants to stand in a circle but if you are in a room could ask the group to sit in a circle Explain the task that you will give one or two cards with the steps in condom use to each participant Ask the learners to arrange the cards in a logical sequence Ask the group to let the person who feels that the step in their card is the first one to start the discussions by explaining to the large group the reason s they believe so Each person should determine in a sequence when the step they hold should be applied Note the sequence for each group Provoke members to explore all aspects in each step and finally the sequence should appear as shown in the table below African Union of the Blind HIVeELAIDS Train the Trainers Manual 56 Handout Condom Line up exercise Card Get a male condom from the facilitator Card Practise on
63. ferred format would be African Union of the Blind HIVeLAIDS Train the Trainers Manual 23 24 Session III Methods of HIV Transmission Objectives By the end of this session participants will Have information and understanding of how the HIV virus is transmitted Have information and understanding of how HIV is not transmitted Process oN O Introduce the title of the session and share the objective of this session to participants Inform participants that you will begin with a small group activity Each small group of five people will have 10 minutes to prepare a small skit drama on how the HIV virus can be transmitted Ask each group to present their skit drama to the large group After each of the groups has presented their skits drama ask the large group what method of HIV transmission they think the group was presenting Note their responses and write them on a flip chat Read all these responses out aloud to the large group ASk participants to state other methods of HIV transmission that they know of and that were not presented during the group skits dramas Note their responses 10 Clarify any differences and explain by presenting and explaining the following information Trainer s notes and participants Handout The HIV virus is primarily spread through direct contact with infected body fluids There are three main methods of transmission 1 Blood on blood contact
64. h a small c in the upper right hand corner one card with a small z and one card with a small x For Session B prepare index cards or slips of paper with a Myth or Fact Statement For Session E prepare three signs that say High risk Low risk No risk Objective By the end of this session participants will be able to Define STIs Give examples of STIs Process 1 Introduce the title of the session and share the objective to participants 2 Ask participants to define STIs 3 Note their responses 4 Present some notes and clarify any differences as follows African Union of the Blind HIVeLAIDS Train the Trainers Manual 42 5 Explain that STIs are infections that are spread through sexual contact through an exchange of body fluids such as semen vaginal fluids and blood and through contact with infected skin Also explain that high rates of HIV infection are paralleled by high STI rates 6 Ask learners if they know the common signs and symptoms of STIs in both men and women List their responses on the flip chart and read them out aloud for them to hear Then present the following points on the common signs and symptoms of STIs and explain as you present Signs of STIs in Men Signs of STIs in Women A wound or sore ulcers rash or a discharge from the Blisters on or around the penis vagina that is thick itchy or has a funny smell or colour A discharge like pus from the penis
65. habits and behavior in order to accommodate living with the disease 4 People living positively see the physician as a collaborator and take an active part in decisions related to their own treatment There is a sense of personal responsibility for health and a belief that they personally can influence the outcome of the disease 5 People living positively show a commitment to life there are unfulfilled goals dreams and unfinished business that they commit themselves to 6 People living positively find meaning and purpose in life and even in the disease itself 7 People living positively have usually had a previous experience with overcoming a life threatening illness or overcoming previous difficult situations and events 8 People living positively report the importance of support and information from other persons with HIV and furthermore are usually involved in active service to other persons with HIV 9 People living positively are assertive can say NO and withdraw from involvements when self care becomes necessary African Union of the Blind HIVeLAIDS Train the Trainers Manual 74 10 People living positively develop an ability to listen to their own body and to sensitively care for it and to communicate openly about their concerns without feeling selfish Supplies required facilitator s quick notes Handout Principles of positive living in Braille large print Estimated time 100 minutes L
66. has an HIV test soon after becoming infected the antibodies may not yet show up in the blood test This is because the person s body might not have produced antibodies or the person does not yet have sufficient antibodies in his her blood to show on the blood test Although this infected person has had an HIV test the test can come back HIV negative meaning the antibodies are not detected Step 8 Explore with the participants ways in which VCT can be made more accessible to blind and partially sighted persons Supplies required facilitator s quick notes note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers Estimated time 100 minutes Learning Method Large Group Interaction African Union of the Blind HIVeLAIDS Train the Trainers Manual 70 MODULE 5 MANAGEMENT OF HIV amp AI DS Session I Living with HIV Objectives By the end of this session 1 Understand the concept of positive living with HIV 2 Understand the needs of persons living with HIV Process Step 1 Step 2 Step 3 Introduce the title of the session and share the objectives with participants Go through the feelings that come with testing positive for HIV Note participants responses and explain that once someone has tested positive for HIV they need to talk to a counselor The counselor will listen to your fears and anxieties and will give you support and information on how to care fo
67. her of you had been HIV tested 19 How did you and your current partner decide to stop using condoms 20 Have you ever been diagnosed with an STD When was that Handout Six Connections between Tuberculosis and HIV 1 Before the late 1980s Tuberculosis was considered to be at the brink of elimination Then new HIV related TB cases and multi drug resistant tuberculosis began appearing 2 Most TB patients in high HIV prevalent countries are infected with HIV 3 Today HIV is known to be an important risk factor contributing to the development of active TB from latent TB infection 4 HIV also makes individuals with a recent TB infection more likely to progress rapidly to active TB disease 5 Increasing TB cases put more pressure on medical resources thereby reducing the availability of adequate medical facilities 6 HIV related stigma may prevent TB patients from seeking medical care African Union of the Blind HIVeLAIDS Train the Trainers Manual 54 Supplies required facilitator s notes and handouts in accessible formats note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers Estimated time 40 minutes Learning Method Large Group Interaction African Union of the Blind HIVeLAIDS Train the Trainers Manual 55 MODULE 5 PREVENTION OF HIV INFECTION Session I Condom use Objectives By the end of this session the participants will be able to Proc
68. ical checkup and treatment for any breast problems and treat any case of thrush in the infant Feeding the baby on breast milk only significantly reduces the risk of HIV transmission After six months the mother should stop breastfeeding it directly and only give other food and drinks 3 Sexual Contact The most frequent way HIV infects people is through sexual contact Mainly through full private part sex when body fluids are mixed Unprotected heterosexual and homosexual intercourse carries the risk for HIV transmission Sexual activities that have no risk low risk some risk and high risk of HIV infection No risk Abstinence avoidance of sex Erotic massage Hugging and body rubbing Dry kissing Bathing or showering together with someone infected with HIV Masturbation Mutual masturbation Sexual fantasies Personal sex toys Low risk Oral sex with a man wearing a condom Oral sex with a woman wearing a female condom Some risk Oral sex with a man or woman without condoms Vaginal penetrative sex with a condom Anal penetrative sex with a condom African Union of the Blind HIVeLAIDS Train the Trainers Manual 27 High risk Vaginal penetrative sex without a condom Anal penetrative sex without a condom very high risk Sharing uncovered sex toys Contact with infected menstrual blood HIV is not transmitted through the following ways Hugging someone who is infected with
69. ican Union of the Blind HIVeLAIDS Train the Trainers Manual 33 Facilitator s notes Why the HIV virus is so dangerous to the body The virus hijacks the most important defensive cell and turns it into a factory to reproduce itself HIV attacks the CD4 cell and forces it to manufacture more HIV viruses The CD4 cells are unable to do what they are supposed to do to organize and coordinate the body s defense system Antibodies are formed to fight the disease but many are rendered ineffective as the HIV viruses hide inside the CD4 cells themselves The virus mutates very quickly As it mutates it changes its outer layer fooling the body into thinking that this is not the target it is looking for It is very difficult for the body to fight something it does not recognize as a threat The health of an infected individual depends on the condition of their immune system at any given time A healthy adult has a CD4 count of around 1000 1200 per milliliter of blood This count varies from person to person depending on several factors As a person gets infected with HIV and the disease progresses it is possible to determine the extent of the progression of the disease by checking the CD4 count Supplies required facilitator s notes note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers Estimated time 40 minutes Learning Method Large Group Interaction African Union of
70. ication has been developed by African Union of the Blind AFUB as part of its HIV amp AIDS Awareness and Training Project October 2005 September 2007 The manual is to be used as a guide during awareness and training seminars for blind and partially sighted persons in Africa The project has been implemented by AFUB through its member national organizations associations of the blind in six countries in Africa These countries are Cameroon Ghana Kenya Malawi Rwanda and Tanzania The project was funded and supported by the Canadian Government through the Canadian International Development Agency CIDA and the Canadian National Institute for the Blind CNIB The overall objective of this project has been to promote the total inclusion and participation of blind and partially sighted persons into HIV amp AIDS programs in their communities The activities that were carried out in order to achieve this objective include training 20 blind and partially sighted persons as Peer Educators in each of the six countries creating a National Lobby Committee NLC in each of the six project countries developing a training manual that includes methods of training that are suitable for training blind and partially sighted persons and conducting HIV amp AIDS awareness and training to at least 3 000 blind and partially sighted persons at the grassroots level Lessons learned and best practices identified have been incorporated in the manual so as to develop and enhan
71. ics and other forms of misuse of antibiotics black and reds and others in treating STIs reduce their effectiveness in fighting infection and damage the body Over time the STI targeted can become immune to the antibiotic while the person s general health can be dangerously compromised Antibiotics are serious medications to be prescribed for specific purposes and are not to be taken lightly 10 Some STIs have no symptoms That is a person can have an STI and not know it 11 Many girls and women with STIs have no symptoms 12 Mothers can pass some STIs on to their newborn babies Some STIs can their affect babies eyes 13 The condom does not offer protection against several STIs 14 STIs affect not only the sexual organs they can also infect the area around the mouth and around the rectum the behind or anus AuUBWNE Supplies required note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers Handout 2 Defining HIV and AIDS African Union of the Blind HIVeLAIDS Train the Trainers Training Manual 22 23 Estimated time 40 minutes Learning Method Large Group Interaction NOTE Facilitators should note that any materials or handouts presented to blind and partially sighted persons must be put into accessible formats i e braille large print or audio Participants will make their preferred format known before hand Remember to ask participants before hand what their pre
72. ins to heal Memory T and memory B Cells They always remember the disease causing agent so that next time it attacks the body they stop it before other white blood cells are informed Facilitator s notes Immunity and the role of the CD4 Cell in the Immune System Immunity The ability to attack or overcome infection by invading disease causing germs Immunity is based on the proper functioning of the body s immune system Types of immunity include 1 Acquired immunity Received though vaccination and immunization 2 Natural immunity what a baby inherits from its mother at birth White blood cells defend the body against infections and disease causing germs There are different types of white blood cells each of them has a role to play and they work together as a team to remove disease causing organisms from the body The CD4 cell is a type of white blood cell that has a central role in the functioning of the human immune system It organizes and coordinates the other types of white blood cells the immune system Supplies required Facilitator s notes note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers handout out in Braille large print audio formats Estimated time 60 minutes Learning Method Large Group Interaction small group activity African Union of the Blind HIVeLAIDS Train the Trainers Manual 32 Session II How the HIV virus invades th
73. l U APUNE If a condom tears before or during intercourse then it will fail to perform its task If semen pours while removing it Manufacturers defect If air gets into a condom it may tear during sex If the penis comes into contact with the vagina before a placement of a condom Myths and misconceptions about the male condom 1 Condoms reduce pleasure Condoms may reduce feeling for the man but with peace of mind one is likely to relax and enjoy sex to the fullest It may take longer to ejaculate which may make sex more enjoyable Condoms break easily If worn properly stored under the right temperature and used within the expiration date condoms do not break easily Condoms have small holes and can allow semen to filter though There are no small holes Latex rubber is very tight rubber which cannot allow sperm or other small things like HIV to go though This has been proven though laboratory tests and has not been found to be porous African Union of the Blind HIVeLAIDS Train the Trainers Manual 59 60 Condoms are not effective Condoms are 98 effective when used correctly and at all acts of intercourse The failure rate is usually attributed to the other factors like poor storage and inconsistent use The condom has been researched widely among couples where one partner is infected with HIV and the other is not It has proven effective in preventing infection Condoms irritate the skin The lubric
74. lean dish cloth 3 Cover food or put it in a cupboard or refrigerator away from flies Opportunistic infections can be avoided by maintaining cleanliness around domestic and farm animals 1 Keep animals and pets outdoors 2 Ask someone else if possible to clean up after animals especially cats dogs chickens and other birds 3 Always wash your hands after handling pets and other animals 4 Avoid contact with young animals especially animals with diarrhoea Opportunistic infections can be avoided by keeping safe outdoors through 1 Washing your hands with soap after working in the farm to get rid germs that can cause opportunistic infections 2 Avoid swallowing water anywhere you swim This water may be contaminated with germs that can cause opportunistic infections Protect yourself from HIV re infection 1 If you have unprotected sex you can be infected with a different strain of HIV even if you are already HIV positive This is called re infection 2 Antiretroviral Therapy A R T does not protect against HIV re infection African Union of the Blind HIVeLAIDS Train the Trainers Manual 40 3 If you get re infected again with a different strain of HIV your immune system gets weaker 4 Protect yourself and your partner always use a condom or don t have sex Take good care of your body There are a number of ways of keeping your body healthy and avoiding opportunistic infections Eat a balanced diet
75. lso educate your family members both children and adults As an HIV positive person you may feel you are not ready to go public This is fine you should not feel coerced But try and not make things worse by speaking negatively about others who are affected or infected Sometimes silence can be more helpful than harmful words Where they exist join a support group for visually impaired people living with HIV Advocate for the formation of one if none exists Such groups can welcome both HIV positive and HIV negative members whether sighted or not and need not be just for those who are infected African Union of the Blind HIVSIAIDS Train the Trainers Manual 73 Where to get more information Persons living with HIV and AIDS can adopt a healthier lifestyle and good eating habits to live positively To learn how to live positively If you or anyone you know is living with HIV and AIDS contact your nearest hospital health centre dispensary or clinic or VCT centre and talk to your health provider Handout 5 Principles of positive living 1 People living positively understand and accept the reality of the AIDS diagnosis but also refuse to believe that the syndrome is an automatic imminent death sentence 2 People living positively believe that they can cope actively with the disease and refuse to succumb to a helpless hopeless state 3 People living positively make appropriate individualized adjustments in personal
76. lts 18 years old and above VCT is exceptionally also for those are below 18 years but above 12 years old who are at risk of HIV for example those who are pregnant or sexually active It is not to find out who is HIV positive within the community It is not to compile statistics on HIV infection in the community It is not mandatory testing Employment Visa and or for insurance Step 4 Ask participants to list benefits of VCT that they know of Step 5 Note their responses clarify and add using the following points Facilitator s notes Why is VCT important Step 6 Reduce stigma If people are able to get good information and if they consider their own risk taking they are less likely to stigmatize others Stigma is fear and ignorance about HIV If people know they are HIV negative and have accurate information about HIV they are more likely to protect themselves in future If people know they are HIV positive and have accurate information about HIV they are more likely to adopt to safer sex and so reduce transmission to others If pregnant women know they are HIV positive they take early steps to reduce the risk of passing on the Virus to their baby If people know they are HIV positive they can seek early access to care such as for opportunistic infections and Tuberculosis and therefore reduce their likelihood of ill health Explain the process of Voluntary Counseling and Testing to the participants as follows Facilit
77. ludes training methods that ensure that blind and partially sighted persons participate effectively in HIV amp AI DS Peer Education trainings It also provides guidance on how to make HIV amp AIDS Information Education and Communication IEC materials and other training resources into accessible formats i e Braille large print or audio It is hoped that this will be a great resource for both visually impaired and sighted trainers of trainers who are involved in HIV amp AIDS training About this Manual This manual consists of seven modules The modules have been arranged in sequence in a way that enables participants to build on the knowledge acquired Each module contains several sessions each with specific and clear objectives Strategies of how trainers facilitators can modify training activities to suit the needs of visually impaired participants have been outlined in each session Sexuality prevention of HIV management of HIV amp AIDS and care amp support of people living with HIV amp AIDS are the major themes around which this training manual has been developed Special attention has been given to issues around gender roles and HIV amp AIDS and the risks of HIV infection to visually impaired women Participatory approaches to learning and training have been applied in the preparation of this manual to ensure effective learning This manual does not and cannot cover all variations and emerging trends in all the HIV amp AIDS thematic are
78. nd TOT trainers from mainstream HIV amp AIDS service organisations on the needs of blind and partially sighted persons in as far as HIV amp AIDS programs are concerned It is hoped that these facilitators and TOT trainers will be sensitized on the strategies and methods of how to make HIV amp AIDS programs accessible to blind and partially sighted participants Six HIV amp AIDS awareness and training workshops for visually impaired persons have been conducted using this manual and the sample training program in Cameroon Ghana Kenya Malawi Rwanda and Tanzania A total of 28 TOT and facilitators from mainstream HIV amp AIDS service organisations attended and facilitated in these workshops Training techniques At the start of each day the trainer facilitator should ask one of the participants to recap the previous day s sessions This helps the participants to link up and help the participants gain more knowledge and understanding on the topics and issues being covered Use activities and teasers to remove boredom and monotony during training sessions Select activities and games that are suitable for visually impaired persons In the attempt to mainstream blindness issues into HIV amp AIDS Awareness and Training programs it is also important to invite facilitators trainers and experts from mainstream HIV amp AIDS Service Organisations Planning for the Training Workshop Here is a simple way to plan for your training workshop and to share
79. ns to improve Peer Education e Use a participatory methodology that lets clients decide the way and manner in which they get information e Explore cost sharing and networking with mainstream NGOs and organisations of visually impaired persons e Use the appropriate local language in presentations and materials If you cannot speak the language look for a local translator e Carry out continuous evaluation of the modes of communication This will help to improve the quality of training methods e Provide incentives and opportunities to motivate peer educators such as participation in conferences workshops etc African Union of the Blind HIVeELAIDS Train the Trainers Manual 94 e Solicit the support of opinion leaders and influential people in the community Issues of sustainability e Ownership Organisations of the visually impaired must own the HIV amp AIDS Peer Education Programs that they initiate e Incentives e Training or re training of Peer Educators and organisations of the visually impaired for sustainability e Adaptability of the training manual Organisations of the visually impaired and their Peer Educators should give suggestions contributions and modifications on this manual For example is the manual user friendly does it address issues of visually impaired men and women e Economic empowerment It would be important for organisations of visually impaired persons to link their HIV amp AIDS initiatives
80. oing to do III Ensure the privacy of the patient IV Pour warm water and make it soapy with mild soap V Place plastic paper under the part where the pressure sores are and expose Wash around the edge of the sores first then wash from the centre to the end till clean For each wiping use separate cloths If the sore is dry leave it open to the air Rinse the area with soapy water VI Change the patient s position from time to time Clear the materials used in dressing the sores Strengthen the bed remove the gloves Wash the soiled clothes with soap and water boiling for a short time Hang them in the sun to dry If the sore is very bad and the care giver cannot manage it she should inform the supervisor trainer for they will refer further care Check the patient for all parts that may be swollen This could be boils Where gloves if there is pus Cover the African Union of the Blind HIVeLAIDS Train the Trainers Manual 84 lump with a piece of cloth that is loosely tied If the lump becomes painful a health worker or trainer should be seen Step 6 Decontamination procedure Explain that decontamination involves removing harmful substances from a place 1 Care givers should exercise caution and protect the hands with gloves 2 Rinse soiled items in cold water pour water in the latrine 3 Soak the items in cold water and bleaching agent for 10 minutes 4 Put soiled items into a large pot of water with some soap or detergent
81. om should not be used at the same time as a male condom because the friction between the two condoms may cause the condoms to break If the condom slips during intercourse or if it enters the vagina then you should stop immediately and take the female condom out Then insert a new one and add extra lubricant to the opening of the sheath or on the penis African Union of the Blind HIVeLAIDS Train the Trainers Manual 61 62 3 To remove the condom twist the outer ring or frame gently and then pull the condom out keeping the sperm inside 4 Wrap the condom in the package or in tissue and throw it away 5 Do not put it into the toilet Step 4 Explain the benefits of the female condom in the following way 1 It offers opportunity for women to share the responsibility for condom use with their partners 2 A woman may be able to use the female condom if her partner refuses to use the male condom 3 The female condom will protect against most STDs and pregnancy if used correctly 4 The female condom can be inserted up to 8 hours before intercourse so as not to interfere with the moment 5 Female condoms are made of polyurethane which can be used with oil based as well as water based lubricants No special storage requirements are needed because polyurethane is not affected by changes in temperature and dampness In addition these materials are thin and conduct heat well so sensation is preserved Step 5 Explain the disa
82. on have the virus in both their blood and considerable amount in the breast milk If HIV positive women have access to breastfeeding alternatives and the means to use them the risk of illness and death from HIV and other infections can be kept to a minimum Keep in mind that HIV positive women may face stigma from their families and communities if they do not breastfeed their babies If breastfeeding alternatives are not available the health risk to infants who are not breastfed is six times greater than the health risk to those who are so breastfeeding remains the better option The risk of MTCT of HIV during breastfeeding is greater when an HIV positive woman does not exclusively breastfeed for the first six months or if complications develop e g mastitis cracked and bloody nipples from poor breastfeeding techniques Risk of transmission also increases if the mother becomes infected with HIV while breastfeeding African Union of the Blind HIVeLAIDS Train the Trainers Manual 26 The duration of breastfeeding is also associated with the level of transmission risk after six months the risk of HIV transmission may be greater than the benefits of breastfeeding If no other options are available for infant feeding women should continue breastfeeding exclusively for six months During this six months period the baby should not be fed or made to drink other foods and drinks During this period the mother should seek prompt med
83. ophylaxis which is an ARV treatment after an assault They live with the emotional psychological and physical torture usually when they find out their status as positive it is impossible to reverse the situation Some communities believe that sleeping with a virgin if you are positive will cure you from the disease This leaves many girls to suffer at the hands of those seeking a cure in ignorance Blind and partially sighted women face even a great risk when it comes to sexual abuse and rape Lack of knowledge on HIV Increasing the level of knowledge among women and the girl child on HIV amp AIDS is probably the beginning of solving many of the problems the woman is facing today Visually impaired women must have access to Supplies required note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers facilitator s notes handout on Gender roles and HI V amp AIDS in accessible formats for the participants Estimated time 40 minutes Learning Method Small group and Large Group Interaction African Union of the Blind HIVeLAIDS Train the Trainers Manual 18 19 MODULE 2 Basic facts about HI V amp AI DS Session l HIV and me Personal and community attitudes and values towards HIV AIDS and illness Objectives By the end of this session participants will Examine their attitude towards HIV amp AIDS Begin to appreciate that HIV amp AIDS is our and not their problem and b
84. ormation in a simple easy to understand manner and clarify difficult information African Union of the Blind HIVeLAIDS Train the Trainers Manual 89 e Show confidence Participants will believe what you inform them if you as a facilitator exudes enthusiasm and self confidence e Make good use of communication materials For example use audio materials tapes to explain a point phenomenon This will help you to break monotony especially if you are using the lecture method to deliver some information e Note down responses from group discussions and read them out loud to the participants This enables them to follow the discussions more effectively Listen to the peer and respond to feedback appropriately Hold the group s attention and encourage the group to actively participate Make the peers feel comfortable Set up a comfortable environment When workings with visually impaired participants ensure that there are no barriers items that block pathways as these could cause injuries e Talk less ask more questions e Acknowledge good responses Supplies required facilitator s quick notes note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers Learning Method Large Group Interaction small group disccussions Estimated time 60 minutes African Union of the Blind HIVeLAIDS Train the Trainers Manual 90 Session II Qualities and competencies of a Peer Educator
85. out sex 4 Inform participants that Gender stereotypes expose women and men to the risk of HIV infection It is important to note that HIV and AIDS has had a bigger impact on women that it has had on men Blind and partially sighted women face double expose to HIV infection because first they are women and secondly because they have a disability 5 Inform participants that between 12 and 13 women are infected with HIV for every 10 men More young girls are infected at a tender age than men Their death leaves many orphans or dysfunctional families Some contributing factors to high HIV infection rates among women include Lack of economic empowerment Most women in Africa depend on the man as the soul bread winner of the house Due to this they have to give in to all his sexual demands although he might be having multiple partners Poverty Prostitution is a way of earning a living by exposing the women involved to high risk of infection At the moment girls of very young age are exposing themselves to this kind of life style in order to make ends meet Young campus girls who have finished school but have no jobs have resorted to prostitution as a way of earning a living Poverty has forced many mothers to sell their bodies in order to get a meal for their children Poverty throws these women in the way of HIV amp AI DS Lack of negotiation power Sometimes women have been beaten for asking their men to use condoms They suffer
86. pain in the lower abdomen Pain or a burning feeling when passing pain or a burning urine feeling when passing urine Pain during sexual intercourse pain during sexual intercourse Pain and swelling of the testicles abnormal irregular bleeding from the vagina Abnormal swelling or growths on abnormal swelling or the genitals growths in the genitals 7 Now divide the group into four teams or fewer depending upon number of participants Ask each team to stand in one corner of the room Explain that you are going to play a game and the team with the most points wins Give the following instructions for the game Each team will draw a statement from the basket provide the statements in Braille or large print for visually impaired participants The team must decide if the statement is true or false One team member reads the statement and gives the team s answer If the answer is correct the team scores two points If they can explain why the answer is correct they get an extra point If the team cannot explain their answer another team can try for the extra African Union of the Blind HIVeLAIDS Train the Trainers Manual 43 point When all statements have been answered announce the winning team Agree with the larger group how to motivate the winning group 8 Distribute Handout 4 1 and 4 2 on Sexually Transmitted Infections and tell the learners to read through it during their free time and ask any questions
87. phagocytes to stop the attack But this incident is not forgotten Memory T and Memory B cells will always remember Mr Flu virus and any of his relatives if they ever again try to invade the company these memory cells will recognize them immediately and stop them in their tracks The company now is immune to attacks by Mr Flu virus Small Group exercise 1 Explain how the body s immune system works 2 Describe the immune system in one sentence Summary of how the body s I mmune System works Phagocytes body s spy looks out for any invaders and takes information to macrophage Macrophage Takes the identity of the disease causing agent to the CD4 cell CD4 Cell Is the commander in chief of the white blood cells Organizes the rest of the white blood cells and gives the command to attack disease causing germs Killer T Cells drive the disease causing agent out of its hiding place B Cells Manufacture antibodies these act like sign posts to mark the disease causing agents so that phagocytes attack and destroy them Phagocytes Attack and destroy the disease causing agents African Union of the Blind HIVeLAIDS Train the Trainers Manual 31 Suppressor T cells Orders the B cells to stop the manufacture of antibodies and also orders the phagocytes to stop the attack once the disease causing agent has been destroyed Phagocytes They clean up the dirt and destroyed cells after the attack Then the body beg
88. protected there is a much higher risk of transmission of HIV Supplies required note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers facilitator s notes Estimated time 40 minutes Learning Method Small group and Large Group Interaction African Union of the Blind HIVeLAIDS Train the Trainers Manual 15 Session II Exploring sexuality and blindness Dispelling the myths and misconceptions Objectives By the end of this session participants will be able to 1 Identify and clear the myths surrounding sexuality and blindness Process Share session objective with participants Inform participants that this is an interactive group discussion Ask participants to share their experiences about sexuality and blindness Note their responses and share them out as follows pe re e Visually impaired persons are not sexually active therefore they cannot be infected with HIV e Visually impaired persons do not need information on HIV amp AIDS and reproductive health e If you have sex with a blind woman you will get cured of HIV infection 5 Inform participants that it is important to clear and dispel myths surrounding sexuality and blindness Participants should educate others in the community This will help reduce the risk of infection among visually impaired men and women Supplies required note taker writing frame if trainer is blind partially sighted flip chart amp
89. r to make a diagnosis it is necessary to determine the original source of the infection It can also be diagnosed and treated via reported symptoms VII Yeast Infections Monilia Candida or Fungus Note These infections are often NOT transmitted sexually Symptoms A yeast infection caused by an imbalance of the vaginal organisms Females Itching burning dryness of the vagina whitish and lumpy cottage cheese like discharge that smells like yeast African Union of the Blind HIVeLAIDS Train the Trainers Manual 49 Males Inflammation of the penis Diagnosis Microscopic analysis of vaginal secretions Treatment Locally applied cream or vaginal insertions VIII Trichomoniasis Symptoms A vaginal infection that is most often contracted through intercourse but can also be transmitted through moist objects such as wet clothing towels washcloths and so on Females A burning sensation at urination and an odorous foamy discharge along with a reddening and swelling of the vaginal opening Males Usually have no symptoms but might have a slight discharge itching and or lesions Damage Can cause urinary infections Diagnosis Usually diagnosed by microscopic analysis of vaginal discharge IX HIV and AIDS HIV amp AIDS as discussed earlier in modules 2 amp 3 Kindly refer to these modules on facts about HIV amp AIDS and how HIV is transmitted Symptoms One to two months after infection some people experience
90. r yourself You can come back to talk to a counselor any time you feel like talking to someone Talking to a counselor is part of the follow up counseling that was discussed in module 4 session II on post test counseling Explain that before getting to the stage of accepting once HIV positive status a person may go through all or some of these stages They happen at different times in different people These stages include the following Denial It s common to deny your status the first time you hear about your results It is also common to be gripped with confusion and fear Speak to your counselor about how to cope with these emotions Anger You become angry and hate yourself and everybody around you Take a deep breath in and out a few times to give yourself enough air to cope with the stress Do not rush into decisions which will put you in a worse situation like wanting to avenge yourself by having unprotected sex with anyone on sight African Union of the Blind HIVeELAIDS Train the Trainers Manual 71 Depression Withdrawal Sometimes you may go into withdrawal and not want to talk to anyone You may become depressed and worry about many things how long you have to live who will care for your children what you will do if your immediate family and community find out You may fear that others will stigmatize you the community will discriminate against your family you will not be able to afford food and medication
91. re Vulnerable to HIV than men 2004 report on the global AIDS epidemic Page 40 2 http www cnib ca eng publications pamphlets accessible_ev ents 3 www unaids org 4 www who int hiv 5 www avert org 6 www aidsalliance org 7 www fhi org African Union of the Blind HIVLAIDS Train the Trainers Manual Appendix 2 97 Sample training Program SAMPLE PROGRAM FOR HIV amp AIDS AWARENESS amp TRAINING WORKSHOP FOR BLIND AND PARTIALLY SIGHTED PERSONS 6 45 8 00 8 00 8 45 8 45 9 15 9 15 9 30 10 00 11 30 11 30 11 45 Session 1 11 45 1 00 1 00 200 Session 2 2 00 3 30 3 30 4 00 4 00 5 00 Activity Facilitator DAY 1 Breakfast Registration of participants Participants seated in the seminar hall Introductions and ice breaking group formation Launch of the Training workshop Tea Break Introduction to training Personal Expectations Training Objectives Lunch Introduction to HIV amp AI DS Methods of Transmission PMCT Impact of HIV amp AIDS in our communities Tea Break Continuation of session 2 African Union of the Blind HIVLAIDS Train the Trainers Manual 6 45 7 45 7 45 8 00 8 00 8 15 Session 3 8 15 9 30 Session 4 9 30 10 30 10 30 11 00 Session 5 11 00 1 00 1 00 2 00 Session 6 2 00 3 30 3 30 4 00 4 00 5 00 6 45 7 45 7 45 8 00 8 00 8 15 Session 7 8 15 10 30 10 30 11 00 Session 8 11 00 1 00 98 DAY 2 Breakfast Pa
92. rious physical damage and can continue to infect others Once medical treatment is begun the person or a health care provider can inform sexual partners In the meantime it is also important for the infected person to abstain from any sexual contact until the treatment has been completed Only people who have intercourse can contract an STI Infants can contract STIs such as syphilis gonorrhoea and HIV infection in the uterus and during the birth process or during breastfeeding A woman using oral contraceptives should still insist that her casual partner use a condom to protect against STIs Oral contraceptives do not prevent STIS so a condom would be necessary for protection unless both partners know they are faithful to one another and are currently infection free Handout Sexually Transmitted I nfections Chlamydia Symptoms Although it is very prevalent today Chlamydia is difficult to diagnose because the disease often coexists with others In addition to gender specific symptoms African Union of the Blind HIVeLAIDS Train the Trainers Manual 46 described below the eyes may become infected producing redness itching and irritation Infection of eyes can result from an infected person touching her or his genitals and then her or his eyes A mother can infect her baby s eyes during delivery if she is infected Males Twenty five percent of men have no symptoms when they have symptoms men may experience a painful
93. rticipants seated in the seminar hall Recap of previous day s sessions HIV amp the immune system Sexuality Blindness and HIV amp AIDS Tea Break Condom use Lunch Testing for HIV Counseling and Testing VCT Centre Tea Break Continuation of session 6 DAY 3 Breakfast Participants seated in the seminar hall Recap of previous day s sessions Living with and Management of HI V amp AIDS GI PA Tea Break Home Based Care African Union of the Blind HIVLAIDS Train the Trainers Manual 1 00 2 00 Session 9 2 00 4 00 4 00 5 00 6 45 7 45 7 45 8 00 8 00 8 15 Session 10 8 15 10 30 10 30 11 00 Session 11 11 00 1 00 Communication 1 00 2 00 Session 12 2 00 3 30 3 30 5 00 6 45 7 45 7 45 8 00 8 00 8 15 8 15 10 30 99 Lunch Role Play on HIV transmission Tea Break DAY 4 Breakfast Participants seated in the seminar hall Recap of previous day s sessions Peer Education Strategies motivating Peer Educators Experiences Tea Break Qualities of a Peer Educator Counseling Self Esteem Negotiation Lunch accommodating the needs of blind and partially sighted people into HIV amp AIDS Programs Rwanda Experience RUB Continuation of session 12 DAY 5 Breakfast Participants seated in the seminar hall Recap of previous day s sessions Evaluation of Training Post training evaluation African Union of the Blind HIVLAIDS Train the Trainers Manual 100 10
94. s also have greater influence on each other than non peers a significant factor in lending credibility to behaviour change messages Note that Peers are African Union of the Blind HIVSIAIDS Train the Trainers Manual 91 a People with whom you have similar interests b People of similar age bracket usually within a five year range c People of similar world view d People whose views on issues almost always mirror your own e People you are likely to imitate and listen f People who grew up with you g People who share the same experiences e The main purpose of Peer Education is to proactively train and educate on all issues surrounding HIV amp AIDS awareness prevention treatment care and support in both formal and informal settings Step 4 Role of Peer Educators in our organizations and in the communities we live in include the following a To influence healthy decisions and behaviors b To promote the welfare of their peers c To offer lay counseling and support To listen to their peers d To boost the self esteem of their peers e To make referrals to appropriate health welfare and psycho social facilitators Step 5 Examine the qualities of a Peer Educators as follows First begin by forming participants into two groups Ask them to list down the qualities and skills of a good visually impaired Peer Educator Note their responses and fill in the gaps using the following information F
95. s of a disease For example in the case of a person who has AIDS syndrome includes unusual weight loss more than 10 percent of normal body weight fever persistent dry cough excessive tiredness diarrhoea for more than a month swelling of the lymph nodes respiratory tract infections including pneumonia thrush tuberculosis night sweats stroke Handout Twenty Important Points about STIs and HIV HIV is a sexually transmitted infection HIV and many STIs are caused by germs during sexual acts Other STIs for example gonorrhea and Chlamydia are caused by bacteria Some STIs are more infectious at certain stages of the infection Many STIs can be cured There is no cure for the STI called HIV Genital herpes is another STI for which there is no cure 7 Using home remedies or self treating with pills can be dangerous STIs that can be cured but are not treated professionally do not go away Untreated STIs can lead to serious health problems Some like syphilis can lead to death 8 Because different bacteria and germs cause different STIs they need to be treated differently When a doctor prescribes treatment after an examination it is important to take the full treatment even after the signs of the infection seem to have disappeared Remember that not all STIS can be seen or felt And some STIs show up sometimes but don t show up at other times Someone can have an STI and not know it 9 The overuse of antibiot
96. s to allow the patient to move freely Ill Turning the patient in the bed bring one hand and leg across to the side of the patient s face IV One person brings the patient s shoulder on the other while the other rolls the pillow lift the patient to the centre of the bed adjust the pillow under the cheek and put the patients hands in a comfortable position bend the legs slightly remake the bed leave the patient comfortable clean the articles used disposing those that will not be used again V Wash and dry your hands VI Patients are emotionally very vulnerable and can be hurt by careless remarks and uncaring behaviors When care giver is taking care of a patient he should take note of the following I Caring behaviour Gentleness appropriate smile sense of responsibility ask open ended questions listen actively positive body language Il Uncaring behaviour Rudeness roughness shouting ignoring blaming language negative body language To prevent pressure sores from becoming worse or infected to promote healing and reduce suffering of the patient apply pawpaw fruit juice on the sores twice or thrice daily Honey and sugar mixture is used to kill germs and speeds the healing Requirements for caring for pressure sores Gloves stool chair container basin plastic paper and piece of cloth Steps to follow I Collect all the items to be used place them near the bed Il Explain to the patient if conscious what you are g
97. sion III MODULE 5 Session Session II MODULE 6 Session I Session II Session III MODULE 7 Session l Session II Session III TB STIs and HIV What are SDS Cove citiwnnncdtaseeweweedivebeduekid abode General Symptoms Of STIS 0 0cususenenenenen Is there a connection between TB STS and AV 2 iiss veda vicdivesaueeiadiiee te eecedes Prevention of HIV infection Demonstrating Condom USe s s s eseese eee eae eee toe meem Encouraging Voluntary Counseling And Testing s s m meneminemineminemimenmiminmimenemenen Management of HIV amp AI DS Living with HIV a uaea em eaae nae emen e emam Anti Retroviral Therapy ART 0 0 006 Care and support for las mene with AIDS Home Based Care ee or er E Behaviour Change Communication What is Behaviour Change Communication Qualities and competencies of a Peer Educator How to motivate Peer Educators and sustain a Peer Education program in organizations of visually impaired PersoOns 0s0cnen African Union of the Blind HIVeLAIDS Train the Trainers Manual Pg 41 Pg 42 50 Pg 51 54 Pg 55 64 Pg 65 69 Pg 70 74 Pg 75 77 Pg 78 85 Pg 86 89 Pg 90 92 Pg 93 94 Appendices BIbliOgrapniy icici eucanieen eee enciuleaewc Pg 95 96 Sample Training Program acusucueneuemeuenememenaes Pg 97 100 African Union of the Blind HIVeLAIDS Train the Trainers Manual Foreword This publ
98. t Note their presentations and compare and contrast them Put the lists on a flip chart and inform participants that the list will be made available into accessible formats after the session Facilitator s notes The following are some of the impacts of HIV amp AIDS in the community After participants make their presentations the facilitator can read to them some of the aspects that they may have left out Many orphans have been left behind as a result of their parents dying of AIDS related illnesses Many workplaces have lost skilled employees and managers as a result of the HIV amp AIDS scourge Many hospitals have been overwhelmed by patients suffering from HIV amp AIDS related cases New approaches in the provision of care support and treatment of HIV amp AIDS Such as Home Based and community approaches HIV amp AIDS has provided employment to many people Such as skilled HIV amp AIDS counselors program managers and community mobilisers Life expectancy in many countries has been greatly reduced as a result of HIV amp AI DS Supplies required note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers facilitator s notes Estimated time 40 minutes Learning Method Small group and Large Group Interaction African Union of the Blind HIVeLAIDS Train the Trainers Manual 29 MODULE 3 Understanding the HIV Virus Session The Human Immune System O
99. tell if condom in good condition also moves around easily while it is inside the wrapper How can protect myself from getting infected with HIV HIV is a disease that can be prevented There are three ways you can protect yourself from getting infected with HIV These methods are known as the ABCs of safer sex Abstinence This is total avoidance of sex Total avoidance of sex is the surest way to avoid getting infected with HIV This is because there is no risk involved Fidelity This means being faithful to one uninfected sexual partner Condom use This means using a condom each and every time you have sexual intercourse WHO 2002 The safety and feasibility of female condom reuse Report of a WHO consultation African Union of the Blind HIVeLAIDS Train the Trainers Manual 63 64 Supplies required facilitator s quick notes Materials note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers and masking tapes Braille large print cards with the steps sample female and male condoms penile for each participant and pelvic models Estimated time 120 minutes Learning Method Large Group Interaction African Union of the Blind HIVeLAIDS Train the Trainers Manual 64 65 Session II Voluntary Counseling amp Testing VCT Counseling and Testing for HIV Objectives By the end of this session Find out participant s experiences as regards VCT par
100. therefore from reaching the egg Explain that male condoms are usually made out of latex while female condoms are made out of polyurethane material Condoms come in a variety of shapes Most have a reservoir tip although some do have a plain tip Explain that there also are some condoms that are ribbed that is they have bumps which increase sensation for both partners They also have different brand names in different countries The lubrication on condoms also varies Some are not lubricated at all some are lubricated with a silicon substance and some have a water based lubricant The lubrication on condoms helps to make the condom easier to put on and more comfortable to use Some condoms also contain a spermicide known as Nonoxynol 9 Explain that a spermicidal lubricant helps to provide additional protection if some semen happens to leak out of the condom This help to reduce likelihood of pregnancy Inform participants that we are going to have a skit drama Ask for two volunteers from the audience One male and one female Instructions for the skit drama Should take about 15 minutes e Tell the man to assume he has seen an attractive woman e The man wants to have sex with the woman and begs her for it e The woman says that they should use a condom That s the only way they have sex e The man reaches to his pocket and finds the condom is dried out He runs to the shop to get another one The shopkeeper asks him which one he w
101. ticipants will know what an HIV test is Participants will have answers to the question why test Participants will understand the concept window period Participants will be motivated to go for an HIV test and encourage other visually impaired persons to do so too Participants will discuss ways that visually impaired persons can access VCT services more easily 7 Participants will appreciate that knowing one s HIV status is an important step in the fight against HIV amp AIDS Gi ee D Process Step 1 Introduce the title of the session and share the objectives with participants Step 2 Ask participants to volunteer to share their experiences as regards VCT Note You want to find out whether they know what VCT means whether they have ever been to a VCT centre you also want to find out whether they felt welcomed and if the services were modified to suit their needs as visually impaired people Step 3 Ask participants in the define VCT Note their response clarify and add other points sing the following notes VCT stands for Voluntary Counselling and Testing All these activities are confidential VCT assists individuals to make better decisions about sexual behaviour and so reduce the risks of getting infected or of transmitting HIV What is VCT not e Itis not for clinical diagnosis It is not a medical event African Union of the Blind HIVeLAIDS Train the Trainers Manual 66 It is generally for adu
102. tional AIDS Control Council NACC National AIDS and STIs Control Program NASCOP National Organisation of Peer Educators NOPE Kenya O OND U Malawi 10 Malawi Union of the Blind MUB 11 Malawi AIDS Counseling and Resource Organisation MACRO 12 National AIDS Commission NAC 13 Malawi Network of People Living with HIV amp AIDS Manet plus 14 National Association for People Living with HIV amp AIDS in Malawi NAPHAM Rwanda 15 Rwanda Union of the Blind RUB 16 Anti blindness and physical disability program Ministry of Health 17 Local Division Head Masaka 18 Rwanda Masaka Clinic and VCT Centre African Union of the Blind HIVeLAIDS Train the Trainers Manual 19 Masaka Rehabilitation Centre for the Blind MRCB 20 Tanzania League of the Blind TLB 21 African Medical and research Foundation AMREF Tanzania 22 Focus Girl Child and Women s Development Kibaha Tanzania 23 HIV amp AIDS Community Program Kibaha Town Council 24 Service Health and Development for People Living Positively with HIV amp AIDS SHDEPHA Last but not least many thanks go to all AFUB board members staff and volunteers for their support during the production of this manual and training resource materials herein African Union of the Blind HIVeLAIDS Train the Trainers Manual AIDS ANAC ART ARVs ASO BCC CBO CD4 DNA FBO GAB GIPA HBC HIV HPV IEC KUB MTCT
103. ty human rights inclusion Disability and HIV amp AI DS Including persons with disabilities in HIV amp AIDS programs 2006 SHIA Program Rwanda solidarity human rights inclusion Disability and HIV amp AIDS Including persons with disabilities in HIVSAIDS programs 2006 SHIA Program Tanzania solidarity human rights inclusion Peer Education Training of Trainers Manual Youth Peer Education Electronic Resource 2002 Peer to Peer HIV AIDS Peer Educators Trainers Guide for IMPACT Implementing Agencies Peer Education and HIV AIDS Concepts uses and challenges UNAIDS Best Practice Collection December 1999 Gender HIV AIDS and rights A training manual for the media IPS Inter Press Service International Association www ipsnews net and www ipsenespanol orgq Understanding and Challenging HIV Stigma Toolkit for Action Trainers Guide September 2003 Ross Kidd and Sue Clay International Centre for Research on Women ICRW African Union of the Blind HIVLAIDS Train the Trainers Manual 96 11 How to create an Effective Peer Education Project Guidelines for AIDS Prevention Projects AIDS Control and Prevention Al DSCAP Behaviour Change Communication Unit Family Health I nternational FHI 12 Overcoming HIV amp AIDS AIDS The next Agenda 2004 UNAIDS report on the global AIDS epidemic Useful references and websites 1 The impact of AIDS on People and Societies Women are mo
104. ual contact genitals or mouth Males Medical practitioner examines genitals mouth and or anus for signs of irritation soreness or discharge and may take a bacteria culture from any infected area if lab equipment is available Females Medical practitioner examines genitals mouth lymph glands and cervical discharges and takes a bacterial culture from any infected area Note These days African Union of the Blind HIVeLAIDS Train the Trainers Manual 47 many health workers diagnose based on symptoms and a flow chart that advises them what medication to prescribe for which symptoms This is true for most STIs but HIV AND AIDS is one important exception Ill Genital Herpes Symptoms Caused by the herpes simplex virus and transmitted through direct skin to skin contact during vaginal anal or oral sex Although some people have no symptoms most experience an itching tingling or burning sensation often developing into painful blister like lesions on or around genitals or in anus first symptoms appear 2 10 days after exposure and last 2 3 weeks Some people have no symptoms Damage Recurring outbreaks of the painful blister occur in one third of those who contract herpes Herpes may increase the risk of cervical cancer and can be transmitted to a baby during child birth IV Syphilis Symptoms Painless chancre sore on or in genitals anus mouth or throat Appears 10 days to three months after contracted If left untre
105. ual presentation One to one method Demonstrations Most of these methods are suitable for training visually impaired persons However it should be noted that visual presentations are not accessible to them When working with visually impaired adults it is vital that you use a variety of methods You must also consider the goal or desired outcome of each session and match the method to the goal Many times you need to use several strategies to achieve your goal Effective delivery of information requires the facilitator to e Be enthusiastic about the information training you are about to deliver e Becalm and relaxed e Use simple and appropriate language Do not be afraid to use sight words like see or look this is not offensive to visually impaired persons e Provide clear guidance and instructions e Speak loudly Visually impaired persons cannot see you they cannot see the gestures you are making hence they rely on listening e Present materials at a good pace so that participants are able to follow e Present accurate information If you are unsure about certain issues kindly inform the participants You can further inform them that you will research on it and get back to them at a later date with information that you are certain about e Present information that will be of interest to the peer It would be prudent to use examples that are relevant to the environment of the participants e Present well organized inf
106. ver as head of households after their husbands have gone to war Gender stereotypes are socially constructed beliefs about men and women Gender stereotypes about women and men can expose them to the risk of HIV infection The following are examples of gender stereotypes a It is a sign of manhood for a man to be able to have full control of relationships b Females are brought up to believe that males are superior in all soheres of life and should be the masters in sexual relationships Gender HIV amp AIDS and Rights A training manual for the media Page 21 African Union of the Blind HIVeLAIDS Train the Trainers Manual 16 17 c Traditional cultural practices and the patriarchal behaviour of men and boys make women and girls subservient and more vulnerable to HIV infection d It is difficult for a woman to say no to a man who is determined to have sex e In some communities girls are expected to be virgins until marriage Parents prefer their daughters to be ignorant about sexual issues f Gender based cultural expectations assign sexual prowess to males and sexual subservience to females It is prestigious for males to have multiple sexual partners This exposes both males and females to HIV infection g Males are vulnerable to HIV infection through masculinity norms that expect them to be knowledgeable about sex Such norms make it difficult for males to admit lack of knowledge or to seek information ab
107. with peer educators 1 Plan for 20 people per workshop Experience has taught us that 20 is a good number First you will be sitting in a full circle or a half circle and a group larger than 20 will pose space problems Even if you do have the space to accommodate more than 20 people they may not be able to hear each other clearly because they will be sitting too far apart African Union of the Blind HIVeLAIDS Train the Trainers Manual 12 Another reason to stay with a maximum of 20 participants is that each peer educator can have several opportunities to talk during the workshop period As a result of talking they will grow in confidence and improve their communication skills The facilitator and the group will have a better sense of each peer educator and his or her capacities 2 The workshop venue When you begin to consider the question of where the workshop will take place Your workshop need not be inside a building You will also want to make sure that you choose a place that people will not have too much trouble getting to and from especially when you know participants are visually impaired persons The workshop venue should be pleasant clean cool and airy Dirty and poorly ventilated training environments make learning difficult if not impossible It is also very disrespectful to participants who are being asked to do serious and important work Make sure that you visit the training venue beforehand so you know exactly
108. y friends and community are already known to the person living with AIDS hence the person may feel more comfortable with them This is the greatest advantage of home based care The person living with AIDS is taken care of in an environment that he is already used to his her home by people who care and show him her love African Union of the Blind HIVeLAIDS Train the Trainers Manual 85 Care givers can help someone to cope with negative feelings by listening talking and spending time with them Step 8 Referral for clinical care Explain to the participants that if the person falls sick they should be referred to the clinic hospital Referral for clinical care provides continuity for the needed care it also provides linkage between the clinic and the patient and to provide support for him her Step 9 Conclude by distributing to the participants the handout on basic Home Based Care skills for Care givers Remember to note the preferred format for each participant Supplies required facilitator s quick notes note taker writing frame if trainer is blind partially sighted flip chart amp permanent markers Learning Method Large Group Interaction small group disccussions Estimated time 120 minutes African Union of the Blind HIVeLAIDS Train the Trainers Manual 86 MODULE 7 Behaviour Change Communication Session l What is Behaviour Change Communication BCC Objectives By the end of this session
109. your own Play with it Card Check the expire date Card Buy a condom Card Store the condom Card Meet someone you feel attracted to Card Take contact flirt and show interest Card Agree to have sex Card Agree to use condom Card Hug kiss and cuddle Card Undressing Card Foreplay Card Oral sex Card Erection Card Lubrication Card Carefully open condom wrapper Card Put condom on top of penis Card Squeeze out the air in the small reservoir Card Roll the condom down to base of penis Card Roll down the condom further Card Penetration Card Intercourse Card Orgasm Card Ejaculation Card Loss of erection Card Hold condom on to base of penis Card Withdraw penis Card Dispose condom Card Hug kiss and cuddle African Union of the Blind HIVeLAIDS Train the Trainers Manual Step 5 Step 6 Step 7 Step 8 Step 9 Step 10 57 Facilitators notes Explain that the condom is named after a 17 Century British Colonel who was supposed to have invented it Initially it was used to prevent conception among the army in Britain However with the advent of STIs the condom has been a significant item in the prevention of STIs Tell the learners that the condom is a protective sheath worn on the male penis or inserted into the female vagina if it is a female condom The condom is a mechanical barrier against the sperm keeping it from coming into contact with the inside of the vagina and

Download Pdf Manuals

Related Search

Related Contents

User Manual - Audio Authority  Frein à Disque Pneumatique SN5  Dossier de candidature  Samsung SGH-E810 คู่มือการใช้งาน  R0E000010ACB00 User`s Manual  Sharp LC-42LE771K 42" Full HD 3D compatibility Wi-Fi Titanic LED TV    AudioSource Stereo Amplifier SS THREE User's Manual  \lESPRESSO. - Seattle Coffee Gear  

Copyright © All rights reserved. Failed to retrieve file