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KENYA METHODIST UNIVERSITY HSCI 225 SEMINAR ON HIV/AIDS COURSE OUTLINE

Unit 1 FACTS ABOUT HIV/AIDS Topic 1: Topic 2: Topic 3: Topic 4: Topic !: The nature of HIV/AID Common symptoms of HIV/AIDS Transmission of HIV/AIDS Pre ention of HIV/AIDS Transmission "n#erstan#in$ sti$ma an# #iscrimination

Topic %:

HIV/AIDS an# &utrition

UNIT 11 Topic 1 Topic 2 Topic 3

HIV/AIDS PROFILES HIV/AIDS situation in 'enya( Statistics an# Impact )*o+a*, -e$iona* an# &ationa* statistics ).' po*icies an# frame/or0 of Action to fi$ht HIV/AIDS

UNIT II1: Topic 1: Topic 2: Topic 3:

WORKING WITH PEOPLE LIVING WITH HIV/AIDS "n#erstan#in$ peop*e *i in$ /ith HIV/AIDS Principles of Home - based care Support for orphans an# other u*nera+*e chi*#ren

UNIT IV Topic 1

SEMINAR PRESENTATIONS ON HIV/AIDS and Busin ss S !"#$ Impact miti$ation mechanism an# strate$ies: A case of 12Is in 'enya

Topic 2

HIV/AIDS and Business Sector Students !roup "or#$

The ).' Po*icy frame/or0 on HIV/AIDS on 3usiness an# 4or0p*ace Impact of HIV/AIDS on 3usiness sector HIV/AIDS po*icies an# practices of arious companies 5 At *east 2i e companies fro arious sectors e6$6 +an0in$, manufacturin$ 7 .pportunities for stu#ents of +usiness stu#ies8 Consu*tancies, research etc -ecommen#ations for further stu#ies 1ainstreamin$ of HIV/AIDS at 4or0 p*ace

Uni" 1 FACTS ABOUT HIV/AIDS

Purpose: To enable %ou ac&uire #no'led(e of basic facts about

HIV/AIDS

Objectives:

At t*e end of t*is topic %ou s*ould be able to: !i+e t*e full meanin( of t*e abbre+iation HIV/AIDS Describe '*at *appens '*en HIV enters a *uman bod% Describe t*e response of a *uman bein( under attac# b% HIV t*e pro(ression from HIV to AIDS$ Describe t*e response of a *uman bein( in+aded b% ot*er +iruses and bacteria

T#%i! 1& T' na"u$ #( HIV/AIDS 1 D (ini"i#n HIV, H Human I Immunodeficienc% V- Virus AIDS , A Ac&uired I Immune D Deficienc% S S%ndrome 2) Mu*"i%*i!a"i#n #( "' +i$us in "' 'u,an '#s" "*en t*e +irus enters t*e *uman bod%. it aims for t*e '*ite blood cells t*e T-cells$- T*e +irus is in(ested b% t*e *ost '*ite cell '*ere it attac#s t*e nucleus- T*e infected *ost cell t*en be(ins to manufacture +iral particles- T*ese particles. called virions. are disc*ar(ed

into t*e bod% fluids and t*e blood- T*e virions enter ot*er '*ite cells and so continue to multipl%- T*ese '*ite cells continue to manufacture +iral particles-) D ( ns $ s%#ns #( "' indi+idua* T*e bod% *as a natural 'a% of defendin( itself from infections- T*ere are special cells. the white blood cells t*at attac# and #ill different #inds of bacteria or +iruses t*at ma% enter t*e bod% to cause an infection- Some speciali0ed '*ite blood cells also render t*e tas# of #illin( t*ese 1in+aders2 easier b% secretin( c*emical substances called antibodies to neutrali0e t*em- T*e bod% s%stem under attac# b% a +irus produces antibodies to neutrali0e t*em- T*e bod% s%stem under attac# b% +irus produces antibodies to fi(*t t*e +irus- Some +iruses are o+er-po'ered. but HIV continues to multipl% in t*e *ost cells. and t*at is '*% t*e disease is incurable- T*e speciali0ed '*ite cells are #no'n as t*e T/-cells- T*e T/ 3 cells in+aded b% t*e HIV +irus e+entuall% succumbs and dies4 as t*e infection pro(resses. t*eir numbers decrease. and bod% immune s%stems (et 'ea#er- T*e bod% cells from t*en on'ards *a+e a permanent parasite. HIV.) T' /0ind#0 % $i#d1 T*e window period refers to t*e period bet'een infection and t*e production of anti bodies b% t*e *ost under attac#- Durin( t*is time. t*e +iruses are multipl%in( in t*e bod%. but t*e% cannot be detected because t*e antibodies are too fe' in number or are not %et present- T*is can ran(e from 5 'ee#s to 12 'ee#s- 6ac* bacterium or +irus induces t*e bod% to produce a +er% specific #ind of antibod%- T*e HIV antibodies are specific onl% to HIV5) Di(( $ n! 2 "0 n 'a+in3 AIDS and 2 in3 HIV %#si"i+ "*en a person tests positi+e for HIV. t*is means t*at t*e person *as been in contact 'it* HIV. and t*e immune s%stem *as produced antibodies a(ainst it- T*at person is said to *a+e under(one sero-con+ersion- Before sero-con+ersion. *e tested ne(ati+e and after serocon+ersion *e is HIV-positi+e- T*e person usuall% appears 'ell and ma% not be sic#l%

at all. and *e is asymptomatic. As t*e bod% continues to fi(*t t*e HIV infection. t*e bod% (ets 'ea#ened. and e+entuall% cannot defend itself from an% #ind of diseaseHe be(ins to s*o' si(ns of opportunistic infections. li#e fun(al infections of t*e s#in. mout* and t*roat. diarr*ea. 'ei(*t loss. pulmonar% tuberculosis. and fre&uent fe+er- T*e person is symptomatic and *as AIDS- T*e person 'it* AIDS succumbs to all #inds of infections. infections t*at people 'it*out HIV can deal 'it* easil%4) Di(( $ n! s in "i, *a%s 2 "0 n in( !"i#n and ,ani( s"a"i#n #( AIDS) T*ere are se+eral factors t*at influence *o' soon someone pro(resses from HIV infection to AIDS- T*e (enetic ma#e-up of t*e indi+idual and t*e nutritional status *as a (reat influence4 as a result. some people *a+e stron(er natural resistance t*an ot*erIf t*e indi+idual is under constant attac# from different #inds of (erms and infection. t*e bod% 'ill offer less resistance to t*e +irus and 'ill e+entuall% be o+er-po'ered- 8or e9ample. people li+in( in an en+ironment 'it* fre&uent t*reat of malnutrition. malaria and ot*er parasites soon 'ear out t*eir immune s%stems and ma% pro(ress to AIDS faster t*an people li+in( in a less c*allen(in( en+ironment- T*e nutritional status of an indi+idual contributes to *o' t*e immune s%stem responds to an infection- A 'ell-nouris*ed person 'ill put up more resistance to t*e HIV +irus t*en a poorl% nouris*ed person- Because of different factors. t*e time bet'een initial infection and actual presentation of AIDS can +ar% bet'een 2 and 1: %ears5) Cu$a2* 2a!" $ia* in( !"i#ns and n#n6!u$a2* +i$a* in( !"i#ns) A bacterium is muc* lar(er t*an a +irus- T*e (enetic material of bacteria does not control *ost cell as t*e HIV +irus does- T*e *uman bod% can completel% destro% bacteria. especiall% 'it* aid of antibiotics- Ho'e+er. t*ere are no antibiotics '*ic* can #ill a +irusT*e current antiretro+iral dru(s can onl% stop a +irus from multipl%in(Highlights:

7ind#0 % $i#d& ;on( incubation period of HIV infection 'it* no s%mptoms and a ne(ati+e HIV antibod% test. but t*e person *arborin( HIV *as t*e capacit% to infect anot*er person-

Sero 8%#si"i+ & A person 'it* HIV antibodies. and can be detected in t*e laborator%4 t*e person ma% be as%mptomatic. and feels 'ell-

S9,%"#,a"i! s"a3 & T*e person 'it* HIV starts s*o'in( si(ns t*at t*e bod% defense s%stem is (ettin( 'ea# and can be attac#ed b% an% disease. and t*at is AIDS-

T#%i! 2& C#,,#n s9,%"#,s #( HIV/AIDS Objective: <ou s*ould be able do describe common s%mptoms of HIV/AIDSAIDS 'as first called 1Slim2 in Africa because loss of bod% 'ei(*t is one on t*e main s%mptom of AIDS- People 'it* HIV/AIDS *a+e a +ariet% of s%mptoms affectin( all parts of t*e bod%- People 'it*out HIV/AIDs can *a+e t*ese s%mptoms too- People ma% *a+e TB or *erpes 0oster s*in(les$ or c*ronic diarr*ea 'it*out *a+in( HIV infection. but if t*e% *a+e HIV infection. t*ese illness and s%mptoms are li#el% to become more fre&uent or se+ereT*e "orld Healt* =r(ani0ation "H=$ *as described t*e patterns of s%mptoms t*at *elp to define AIDS in adults and c*ildren see bo9 belo'$-6+en if some one meets t*ese clinical criteria. t*e% s*ould be tested for HIV to confirm since TB. cancer. malnutrition and ot*ers conditions can cause similar s%mptomsC#,,#n s9,%"#,s #( HIV/AIDS : n $a* s9,%"#,s !eneral malaise ;oss of 'ei(*t Pain S'ollen (lands

:as"$#in" s"ina* "$a!" Diarr*ea Difficult% in s'allo'in( Poor appetite Sore mout*

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S'ellin( of t*e limbs Hair loss S;in and 'ai$ Itc*in( Boils @as*es. ulcerations. 'ounds

?ausea and +omitin( Abdominal pain C n"$a* n $+#us s9s" , Headac*e Aemor% loss and confusion Tin(lin( and numbness of limbs

Infections due to bacteria. fun(i and +iruses Bon+ulsions. confusion. coma Diffuse *air loss. t*innin( of t*e *air. earl% "ea#ness of one side of t*e bod% (ra%in( causes of *air c*an(e ran(es from An9iet% and depression nutritional imbalance to c*emot*erap%. infection and HIV itself$ C' s" 8e+er Bou(* B*est pain TB Herpes 0oster s*in(les$ Aenin(itis : ni"a*ia Disc*ar(e Clcers Pain on passin( urine

Difficult% in breat*in(

Si3ns #( AIDS in Adu*"s Ma<#$ si3ns Cne9pected 1:D 'ei(*t loss in less t*an 1 mont* Persistent diarr*oea for o+er 1 mont* 8e+er o+er 1mont*

Min#$ si3ns Bou(* for o+er 1 mont* !eneral Pruritic dermatitis @ecurrent *erpes 0oster Bandidiasis t*rus*$ of t*e mout*

!enerali0ed enlar(ed l%mp* nodes Disseminated pro(ressi+e *erpes simple9

The presence of at least 2 major and 2 minor signs is enough to diagnose AIDS in Adults Si3ns #( AIDS in C'i*d$ n Ma<#$ si3ns "ei(*t loss or abnormall% slo' (ro't* B*ronic diarr*oea for o+er 1 mont* 8e+er o+er 1 mont*

Min#$ si3ns @ecurrent common infections li#e otitis media. p*ar%n(itis. tonsillitis etc !enerali0ed enlar(ed l%mp* nodes !eneral pruritic dermatitis Bandidiasis t*rus*$ of t*e mout* or t*roat Bou(* for o+er 1 mont* Bonfirmed maternal HIV infection

!: The presence of at least 2 major and 2 minor signs is enough to diagnose AIDS in a child in the absence of "no#n cause of immuno$suppression%

T#%i! -& T$ans,issi#n #( HIV/AIDS Objective: <ou s*ould be able to describe t*e +arious routes of transmission of HIV1) T' $ a$ - ,#d s #( "$ans,issi#n #( HIV

1- S =ual: Cnprotected intercourse +a(inal. oral. anal$ 'it* an infected person- In Gen%a. t*is is t*e most common mode of transmission 2- C#n"a!" 0i"' 2*##d #$ #"' $ 2#d9 (*uids : Transfusion of blood products from an infected person donor4 use of contaminated instruments suc* as needles. s%rin(es. #ni+es or blades includin( instruments in circumcision of bot* male and female. s#in piercin(. scarification. traditional *ealin( and ot*er traditional practices$)- F$#, an in( !" d ,#"' $ "# a !'i*d - T*is 'ill *appen in 'omb. durin( labor. at birt* or t*rou(* breastfeedin(NB HIV is not transmitted through casual contact with another person. This includes holding hands, hugging, kissing, sharing ood and drink or transmitted by mos!uitoes or biting insects. It is important to show normal care and a ection to people living with HIV"#I$% 2) M9"'s and Mis!#n! %"i#ns Because of lac# of #no'led(e. people *a+e ima(ined t*at t*ere are ot*er routes of transmission- It is important to #no' t*ese m%t*s so as to be able to pro+ide t*e correct informationT#%i! .& P$ + n"i#n #( HIV/AIDS T$ans,issi#n &%': Social (accination O2< !"i+ : B% t*e end of t*e topic. %ou s*ould be able to describe '*at is meant b% 1 s#!ia* +a!!ina"i#n2 a(ainst HIV/AIDSIn Africa. se9 accounts for about >:D of all t*e HIV transmission. '*ile mot*er-to 3 c*ild transmission accounts for 2:D and contaminated piercin( instruments 1:D- Se9ual be*a+ior is social acti+it% determined b% t*e +alues and norms of a particular societ%Individual, amily, and community behavior that prevent the spread o HIV " #I$% should

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be identi ied and promoted, while behavior that increases the risks o HIV"#I$% should be challenged and stopped- If indi+iduals. families and societ% ta#e a collecti+e responsibilit% of modif%in( and controllin( se9ual be*a+ior. t*en t*e battle a(ainst HIV/AIDS 'ill be 'on- Abstinence and bein( fait*fulness s*ould be promoted &% 2: P$ + n"i#n #( ,#"' $ 8 "# !'i*d "$ans,issi#n #( HIV and % dia"$i! AIDS-

O2< !"i+ s: At t*e end of t*is topic. %ou s*ould be able to: Describe *o' transmission of HIV from mot*er 3 to c*ild can be pre+entedDemonstrate an understandin( of #e% issues rele+ant to mot*er-to 3c*ild transmission ATBT$ in counselin( couples and indi+iduals Describe ot*er 'a%s t*rou(* '*ic* c*ildren can be infected 'it* HIV/AIDS69plain t*e (uidelines for clinical dia(nosis of c*ildren li+in( 'it* HIV/AIDS-

About 2:D of all HIV/AIDS cases are due to infection from mot*er to c*ild4 t*is occurs t*rou(* t*e placenta. from t*e birt* canal at deli+er%. or from breast mil#- 7 to 1: percent of HIV infected 'omen 'ill pass t*e +irus to t*eir babies durin( pre(nanc%4 1: to 2: percent 'ill pass t*e +irus durin( deli+er%4 and 1:to 2: percent 'ill pass t*e +irus o+er t*e course of 2 %ears of breastfeedin(- 6arl% #no'led(e of t*e mot*erHs HIV status and t*at of t*e fat*er 'ill en*ance t*e application of timel% pre+enti+e measures- Gno'in( t*e HIV status of prospecti+e parents before t*e% decide to procreate 'ill reduce t*e ris# of ATBTIntrauterine transmission can be reduced to 2D if antiretro+iral dru(s are used from t*e 1/ t* 'ee# of t*e pre(nanc% to at least 5 'ee#s after birt*- 6t*ical issues surroundin( t*e use of antiretro+iral dru(s include pro*ibiti+e costs. duration of t*erap% for t*e mot*er up to 5 'ee#s onl% in de+elopin( countries$. and continuin( or discontinuin( breastfeedin(@educin( t*e ris# of transmission durin( labour and deli+er% can be ac*ie+ed b% modif%in( obstetrical practices- Pre+entin( anemia in pre(nanc% can reduce t*e ris# of t*e mot*er bein( infected t*rou(* blood transfusion- A+ailin( famil% plannin( information. includin( 11

t*e use of condoms. can reduce transmission in couples if one partner is alread% HIV positi+eDiagnosing pediatrics AIDS: Antibod% HIV testin( is not used for dia(nosin( pediatrics AIDS before 1E mont*s of a(e4 t*is is because of t*e presence of maternal antibodies in t*e bab%T*e dia(nosis is based mainl% on clinical s%mptoms before a(e 1E mont*s or in settin(s '*ere access to dia(nostic tests is limited- Accordin( to "H= (uidelines. an% c*ild presentin( 'it* an% ) of t*e follo'in( conditions is suspected to *a+e AIDS 2 or more episodes of pneumonia in t*e past 2 mont*s 1 or more episodes of persistent diarr*ea in t*e past 2 mont*s A parent 'it* tuberculosis =ral candidiasis t*rus*$ 6nlar(ed l%mp* nodes in t'o or more sites "ei(*t fallin( for 2 consecuti+e mont*s-

B*ronic cou(* and c*ronic fe+er are ot*er common s%mptoms in c*ildren 'it* AIDSPediatric transmission of HI()AIDS 1- A c*ild cannot be infected 'it* HIV/AIDS e+en if *e /s*e is se9uall% abused*alse: A c*ild. if abused b% a person '*o is HIV positi+e. ris#s bein( infected 'it* t*e +irus2- An% B*ild '*o is HIV positi+e can infect ot*er c*ildren '*ile pla%in( 'it* t*emFa*s : =rdinar% pla% 'ill not e9pose ot*er c*ildren. but if t*e c*ild is inIured and s bleedin( t*en t*ere is a ris#-

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)- A c*ild '*o is HIV positi+e s*ould not sleep in t*e same bed 'it* ot*er c*ildren because s*arin( beds can infect ot*er c*ildrenTrue: Its is better for c*ildren to sleep in separate beds- Some c*ildren ma% actuall% initiate se9ual pla% as earl% 7 %ears old- Crine can contain t*e +irus. alt*ou(* t*is *as not been scientificall% pro+en as one of t*e #no' routes of transmission of HIV/AIDS/- If an AIDS parent '*o *as open s#in lesions *u(s a c*ild t*ere is a ris# of infectin( t*at c*ildTrue: An% contact 'it* bod% secretions s*ould be a+oided- "*at do %ou t*in# of t*is +erse. ;e+iticus 17:11J 7- An unborn c*ild *as a ):D ris# of bein( infected 'it* HIV if t*e mot*er is HIV positi+e T$u : About ):D of HIV positi+e mot*ers 'ill infect babies t*rou(* t*e placenta or at birt*5- All babies born to HIV positi+e mot*ers 'ill test positi+e for t*e antibod% HIV testFa*s : Some ma% test positi+e at birt*. but if t*e mot*erHs antibodies did not cross t*e placenta to reac* t*e bab%. t*en t*e bab% ma% test positi+e-

>- All babies '*o are born to HIV positi+e mot*ers and '*o test HIV positi+e at birt* definitel% *a+e HIV infection-

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Fa*s : =nl% ):D of babies born to HIV positi+e mot*ers definitel% *a+e HIV- About >:D are spared- T*e HIV test conducted at birt* is an antibod% test. and t*e antibodies could *a+e come from t*e mot*er- T*e c*ild 'ill *a+e HIV infection if t*e +irus entered t*e bab% *a+e come from t*e mot*er- T*e c*ild 'ill *a+e HIV infection if t*e +irus entered t*e bab% t*rou(* t*e placenta or durin( labour. and if t*e mot*er decides to breast feed bab%- T*e true state of t*e bab% at birt* can be detected if a direct test for t*e +irus is done. one t*at detects +irus or +iral particlesCnfortunatel% t*is is e9tremel% sop*isticated and e9pensi+e- T*erefore. some babies '*o test positi+e for antibodies at birt* ma% become ne(ati+e once t*e antibodies from t*e mot*er are eliminated from t*e bab%Hs blood s%stem and all furt*er contact 'it* t*e +irus remo+edTo rule out pediatric HIV. t*e antibod% test must be performed at t*e a(e of 12-1E mont*sE- Deli+erin( b% caesarean section 'ill reduce t*e ris# of t*e bab% bein( infected 'it* t*e HIV +irus from an HIV positi+e mot*erTrue: 69perience *as pro+ed t*isF- Deli+er% t*rou(* t*e +a(ina 'ill reduce t*e ris# of HIV infection of t*e bab% since t*ere is less blood in+ol+ed8alse: 69perience *as pro+ed t*at +a(inal deli+er% increases t*e ris#. especiall% if t*e placenta ba( of 'ater$ bro#e before labour1:- Boilin( t*e breast mil# of an HIV positi+e mot*er before (i+in( to t*e bab% 'ill reduce ris#s of infection t*rou(* breast mil#True: T*e +irus is +er% sensiti+e to *eat and 'ill be destro%ed b% it. but t*is is a rat*er difficult and tedious procedure-

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11- T*e onl% sure 'a% to rule out possibilities of mot*ers infectin( t*eir c*ildren 'it* t*e HIV +irus is b% *a+in( fat*ers and mot*ers test for HIV '*en e9pectin( or plannin( to *a+e a bab%True: Pre-pre(nanc% counselin( to #no' HIV status is ideal- Pre+enti+e measures can be ta#en so t*at ris# of c*ild infection is (reatl% reduced-

12- Prolon(ed breastfeedin( for up to 2 %ears 'ill increase c*ances of t*e bab% bein( infected 'it* t*e HIV b% 1: to 2: percentTrue: @esearc* *as pro+ed t*is 1)- A pre(nant 'oman *as an added ris# of HIV infection if s*e is anemic or e9periences se+ere *emorr*a(eTrue: Anemia in pre(nanc% can necessitate blood transfusion- Blood transfusion is ris#% e+en '*en t*e blood tests HIV ne(ati+e 1/- 8amil% plannin( and t*e use of t*e condom 'ill reduce t*e pre+alence of pediatric AIDS True: ?o pre(nanc%. no bab% 17- Treatment of an HIV positi+e mot*er 'ill not reduce t*e ris# of t*e bab% bein( infected8alse: T*is *as been s*o'n to reduce t*e ris# from 2D to 1:D especiall% in 6urope-

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15- "ounds on t*e nipple of a breastfeedin( mot*er 'ill increase t*e ris# of t*e c*ild bein( infected 'it* t*e HIV +irusTrue: T*is is because blood fluids from t*e 'ound 'ill contaminate t*e mil#-

.)-& Objectives:

Ea$*9 and (( !"i+ ,ana3 , n" #( s =ua**9 "$ans,i"" d in( !"i#ns B% t*e end of t*is topic. %ou s*ould be able to:-

69plain t*e relations*ip bet'een HIV and se9uall%-transmitted infections STIs$ Describe t*e different s%ndromes of STIs 69plain t*e importance of earl% dia(nosis. treatment and earl% referrals of STIs ;ist t*e referral centers for STI mana(ement 69plain t*e four Bs of s%ndrome mana(ement of STIs 69plain t*e contro+ersies surroundin( condom use in HIV / AIDS / STI mana(ement 'it*in t*e B*ristian milieu

Ans#er true or false 1A person can *a+e an STD 'it*out an% s%mptom or si(n T$u : T*is is particularl% true for 'omen- Some STDs ma% present s%mptoms +er% briefl% in t*eir earl% sta(es4 t*e s%mptoms t*en disappear. but t*e infection persists- In men. some STIs e-(- B*lam%dia$ *a+e no s%mptoms2A B*ristian 'ife cannot *a+e an STD

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Fa*s : If t*ere is infidelit% in t*e couple. one can (et an STD Hebre' 1):/. Aat*e' 17:1F2:$ )All STDs e9cept HIV can be cured 'it* proper treatment Fa*s : =t*er +iral infections suc* as *erpes cannot be cured/Va(inal disc*ar(e in a 'oman means t*at s*e definitel% *as an STD Fa*s : It ma% not be an infection 7Se9 'it* a +ir(in 'ill cure an STD of an old man Fa*s : T*is is a m%t*- Se9ual acti+it% of an% #ind cannot cure an% STD 5T*e best t*in( to do if %ou suspect an STD is to inform %our se9ual partnerFa*s : T*e first t*in( to do is to see# treatment and follo' it t*orou(*l%>=nl% people '*o *a+e intercourse can contract an STD Fa*s : Infants can contract STIs e-(- s%p*ilis '*ile still in t*e 'omb. or (onorr*ea at birt* from t*e birt* canal E"ife cleansin( can e9pose one to STDs and e+en HIV T$u : A +illa(e cleanser cleans t*e entire +illa(e4 *e is a li+in( reser+oir of STIs in t*e +illa(e FIt is better to remo+e t*e curse from t*e famil% '*en one loses a *usband t*an to abandon tradition-

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Fa*s & B*ristians *a+e no curse- B*rist *as ta#en a'a% t*eir curses in t*e cross at Bal+ar%2 1Bursed is t*e one '*o *an(s on a tree2 !alatians ):1)$1:A married B*ristian man s*ould use a condom '*en *e suspects t*at *e *as an STD T$u : He s*ould discuss *is fears 'it* *is 'ife and t*e couple s*ould use a condom 11It is impossible for an African man to be fait*ful to one se9ual partner Fa*s : B*rist (i+e po'er to all *is c*ildren to do t*e ri(*t t*in( Ko*n 1:12$+ommon se,uall- transmitted diseases STI S9,%"#,s and C#ns >u n! s STI HIV and AIDS SYMPTOMS -S%mptoms be(in se+eral mont*s to %ears after infection and ma% include: - <ou can (i+e HIV to %our - Persistent tiredness - ;oss of o+er 1:D of bod% 'ei(*t %ou s*are a needle- Persistent diarr*ea - Persistent fe+er :#n#$$' a - S%mptoms be(in 2-21 da%s after infection - Disc*ar(e from penis or +a(ina -Ban be passed from pre(nant 'oman to *er unborn c*ild - Dama(e to reproducti+e or(ans - Sterilit% se9ual partner or someone 'it* '*om CONSE?UENCES - T*ere is no cure-

- Pain/burnin( sensation durin( urination - Blindness in babies of

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or bo'el mo+ement - Difficult% urinatin(

infected mot*ers

- ;o'er abdominal pain pel+ic area$ - <ou can (i+e (onorr*ea to - Aost 'omen and some men *a+e no s%mptoms %our se9ual partner - Heart trouble. blindness. s#in disease. art*ritis S9%'i*is 1s" S"a3 S%mptoms be(in 1-12 'ee#s after Infection - Painless. open sore on t*e mout* or se9 or(an - Sore (oes a'a% after 1-7 'ee#s 2nd S"a3 - S%mptoms be(in 1-5 mont*s after sore - Heart disease. brain dama(e. appears: - ?on-itc*% ras* on t*e bod% - 8lu-li#e s%mptoms H $% s S%mptoms be(in 2-): da%s after Infection -Painful blister-li#e lesions on or painful blister occur in 7:D - 8lu-li#e feelin(s - Itc*in( and burnin( around t*e se9 or(ans before t*e blisters appear - Blisters last 1-) 'ee#s - Blisters disappear but t*e indi+idual still *as *erpes of t*ose '*o contract *erpes - Aa% be transmitted to se9ual partner - Aa% be transmitted to a bab% durin( c*ildbirt*- Aa% increase t*e ris# of - @ecurrin( outbrea#s of around t*e (enitals or in anus or mout* blindness. deat* -Ban be passed from pre(nant 'oman to *er unborn c*ild T*ere is no cure for *erpes - Increased ris# of ectopic pre(nanc% - <ou can (i+e s%p*ilis to %our se9ual partner

1F

- Blisters ma% recur C'*a,9dia S%mptoms be(in > - 21 da%s after Infection -Disc*ar(e from t*e se9 or(ans - Burnin( or pain '*ile urinatin( - Cnusual bleedin( from t*e +a(ina - Pain in t*e pel+ic area Aost 'omen and some men *a+e no S%mptoms : ni"a* 7a$"s

cer+ical cancer - <ou can (i+e B*lam%dia to %our se9ual partner - Dama(e to reproducti+e or(ans - Sterilit% - Passed from mot*er to c*ild durin( c*ildbirt*

Baused b% t*e *uman papilloma+irus - Some strains are associated HPV$ 'it* cer+ical cancer and t*ese strains ma% not produce +isible 'arts - Ban be detected b% Pap smear durin( (%necolo(ic e9am - Ban be remo+ed b% p*%sical or c*emical means but +irus cannot be cured and 'ards often reappear-

some ot*er (enital cancers Small painless fles*% bumps on and - Inside t*e (enitals and t*roat- =ften no +isible s%mptoms

H %a"i"is B

Spread b% se9. e9posure to infected Blood and to c*ild durin( pre(nanc% or deli+er%

Ban de+elop c*ronic li+er disease-

- Aild initial s%mptoms4 *eadac*e and - Bauses inflammation of li+er fati(ue - ;ater s%mptoms: dar# urine. and sometimes leads to li+er failure and deat*

2:

abdominal pain. Iaundice

- =ften no +isible s%mptoms

- ?o cure

.).&

V#*un"a$9 C#uns *in3 and T s"in3 (#$ HIV / AIDS B% t*e end of t*is. %ou s*ould be able to:-

Objectives:

69plain '*at +oluntar% counselin( and testin( VBT$ includes Demonstrate t*e capacit% to conduct pre-and post-test counselin( -

Demonstrate t*e capacit% to establis* support ser+ices for t*ose '*o 'ant VBT-

Fa!"s "# ;n#0&6 It *as been s*o'n t*at '*en t*ere are benefits to testin( for HIV. suc* as access to antiretro+iral dru(s and dru(s for treatin( opportunistic infections. more people +olunteer to #no' t*eir HIV status- An HIV positi+e antibod% test means t*at t*e person *as been in contact 'it* t*e HIV +irus so t*at t*e bod% *as produced enou(* antibodies to be detectedSuc* a person can infect ot*ers if t*e bod% fluids semen. +a(inal fluid. breast mil#. blood. and blood products$ come in contact 'it* anot*er indi+idual- T*e HIV positi+e person can pro(ress to full blo'n AIDS in a fe' %ears- An indi+idual can be infected 'it* t*e +irus but ma% not *a+e produced enou(* antibodies to be detected in t*e laborator%- T*ou(* t*e HIV test is ne(ati+e. t*e person could be in t*e 'indo' period- T*e test s*ould be repeated in ) to 5 mont*s- Aost ne'borns of HIV positi+e mot*ers 'ill positi+e because of passi+e immunit% antibodies from t*e mot*er$ at birt*- If suc* a bab% escaped bein( infected in t*e 'omb and t*e mot*er does not breast feed. t*en t*e bab% ma% e+entuall% test ne(ati+e once t*e mot*erHs antibodies are all eliminated- If t*e bod% tests positi+e persistentl% at 1221

1E mont*s of a(e. t*en t*e c*ances are t*at t*e bab% 'as infected in t*e 'omb or durin( deli+er%Pre-test counselin( and post-test counselin( *elp a person ma#e an informed decision on t*e option to test or not and *elp t*e person cope 'it* t*e conse&uences of a positi+e or ne(ati+e HIV test result- A positi+e test can be life c*an(in( and people (enerall% need support- Gno'led(e of centers t*at conduct VBT is important so t*at persons see#in( suc* ser+ices can be referred t*ere- It is important to identif% support ser+ices for persons testin( positi+e B*urc*. famil%. friendHs communit% and people li+in( 'it* HIV / AIDS P;"HA$It is also +er% important to maintain confidentialit% re(ardin( t*e HIV status of a personT*e +alue of support (roups for t*ose '*o *a+e decided to ma#e t*eir HIV status public s*ould be emp*asi0ed-

C#uns *in3 %$#! ss

ote: Pre-test and post-test counselin( and an e+entual follo'-up plan for bot* positi+e and ne(ati+e outcomes must accompan% all HIV testin(T*is topic d'ells mostl% on pre-test and post-test HIV / AIDS counselin(- T*e follo'in( is a ris# assessment (uide- T*is 'ill enable %ou to assess t*e ris# of an indi+idual in %our communit% and sc*ool so t*at %ou can determine t*e need for pre-test counselin(Hi3' Ris;s B 'a+i#$ (#$ Adu*"s and T na3 $s& Se9 'it* more t*an one personA 'ido' '*o *as Iust under(one a cleansin( ceremon%A %oun( bo% or (irl '*o 'as a +ictim of rape anal. oral. or +ir(inal$A (roup of bo%s forced a (irl to *a+e se9 'it* t*em on t*e 'a% from sc*oolA *usband or 'ife *as Iust died from TB. menin(itis. malaria. or t%p*oidA manHs first 'ife or anot*er 'ife *as Iust died in anot*er to'n-

22

T'o c*ildren in a famil% died one after t*e ot*er before t*e% 'ere 7 %ears old A 'ifeHs first *usband died a %ear a(o A *usband li+es in ?airobi or Aombasa and onl% comes *ome once in ) mont*sA 'ife li+es in t*e +illa(e and t*e *usband li+es in t*e to'n4 t*e% see eac* ot*er once in a mont*A person dia(nosed 'it* TBA person 'ent for a dance/funeral 5 mont*s a(o and a'o#e t*e mornin( after 'it* a stran(er in t*e bedA person '*o recei+ed a blood transfusion in an emer(enc% operation-

Hi3'6$is; ass ss, n" (#$ !'i*d$ n& A mot*er died around t*e time of birt* of a c*ild and after a prolon(ed illnessT*e mot*er of a c*ild is al'a%s illA c*ild is al'a%s illA fat*er or mot*er *as c*ronic cou(* and *as lost 'ei(*t=lder siblin(s *a+e died recentl%A mot*er died a fe' mont*s after c*ildbirt*4 s*e ne+er reco+ered full% after c*ild birt*A mot*er *as a c*ronic itc*in( s#in conditionA mot*er is a 'ido'=ne of t*e parents is #no'n to *a+e more t*an one se9ual partnerA %oun( (irl or bo% 'ent t*rou(* (roup ritual circumcision 2 %ears a(oA %oun( bo% or (irl recentl% *ad t*e ears piercedA c*ild *ad an accident and recei+ed untested blood in a transfusion to sa+e lifeA %oun( teena(er *as used inIectable dru(s-

Hand Ou" 1& P$ 6" s" !#uns *in3 s ssi#n 3uid

2)

In"$#du!"i#n Pu$%#s #( !#uns *in3 1- 6stablis* reasons for 'antin( test or reasons or referral for testin(2- Assess t*e ris# of t*e person re&uestin( pre-test counselin()- Discuss t*e plans after t*e results: If positi+e t*en '*at. if ne(ati+e. t*en '*atJ /- Assess t*e suicidal ris# or t*e ris# or intention of infectin( ot*ers7- Discuss notification of partner. famil% members. emplo%er etc5- Discuss t*e possibilit% of affiliation to a (roup of persons '*o *a+e +olunteered to tests for HIV>- !i+e t*e client an acti+e c*oice to (o for t*e tests or notE- Pro+ide t*e client 'it* a referral note to a testin( centre. if %ou do not do t*e test %ourselfF- Discuss potential discrimination follo'in( outcome of results1:- Discuss confidentialit%11- Sc*edule a pot 3 test counselin( session '*en t*e results come outI,%#$"an" 3uid *in s Be friendl%. considerate and non-Iud(mental- 8ollo' t*e #e% obIecti+es %ou intend to discuss- T*e time bet'een pre-test and post-test counselin( s*ould be minimi0ed so as to reduce an9iet% Hand #u" 2& P#s" 8 " s" !#uns *in3 3uid O2< !"i+ s 1- To assist t*e client to cope 'it* test results2- To assist t*e client to ma#e future plansP$ s n"a"i#n %$#! ss&

2/

1- @ead out or (i+e t*e results to t*e client 2- 6ncoura(e client to s*are initial feelin(s reactions$)- Blarif% t*e results4 e9plain '*at t*e results mean to t*e client /- Discuss t*e implication to t*e client and to ot*ers: 8amil%. friends. and collea(ues at 'or#7- 6stablis* follo'-up counselin( plan. includin( (roup counselin( and informin( lo+ed ones spouses$5- Possibilit% of access to treatment A@T$ and dru(s for opportunistic infections>- 6stablis* a follo' up action plan: If positi+e. discuss *o' to sta% *ealt*%. rest. medication. referrals. and anti-retro+iral dru(s Pre+ent spread to ot*ers: spouses. c*ildren etc Partner notification confidentialit%$ Affiliation to a care (roup of P;"HA or ot*er support s%stemsIf ne(ati+e. discuss need for a second test and importance of reducin( or eliminatin( all *i(* 3 ris# be*a+iorSu%%#$" 3$#u%s (#$ "'#s 0'# 0an" "# ,a; "' i$ HIV s"a"us %u2*i!Objective: <ou s*ould *a+e an increased understandin( of (roup support for t*ose '*o 'ould li#e to #no' t*eir HIV statusFa!"s "# ;n#0& People tend to feel more secure in a (roup. especiall% 'it* similar interests or one t*at is bound to(et*er b% some common bond- T*is could be a same se9 (roup. a 'omenHs c*urc* (roup. 'ido's. (uardians etc- T*is ma% *elp in desti(mati0ation of HIV/AIDS amon( t*e members of sc*ool. t*e c*urc* or communit%- It ma% eas% to start a (roup of persons '*ose past lifest%le e9posed t*em. or t*eir spouses. to t*e ris# of HIV/AIDST#%i! 5& Cnderstandin( sti(ma and discrimination& 27

Fa!" "# ;n#0 8rom t*e start of t*e AIDS epidemic. sti(ma and discrimination *a+e fuelled t*e transmission of HIV and *a+e (reatl% increased t*e ne(ati+e impact associated 'it* t*e epidemic- HIV 3 related sti(ma and discrimination continue to be manifest in e+er% countr% and re(ion of t*e 'orld. creatin( maIor barriers to pre+entin( furt*er infection. alle+iatin( impact and pro+idin( ade&uate care. support and treatmentT*e sti(ma associated 'it* AIDS *as silenced open discussion. bot* of its causes and of appropriate responses- Visibilit% and openness about AIDS are prere&uisites for t*e successful mobili0ation of (o+ernment. communities and indi+iduals to respond to t*e epidemic- Boncealment encoura(es denial t*at t*ere is a problem and dela%s ur(ent actionIt causes people li+in( 'it* HIV to be seen as a LproblemH. rat*er t*an as a solution to containin( and mana(in( t*e epidemicSti(mati0ation associated 'it* AIDS is underpinned b% man% factors. includin( lac# of understandin( of t*e illness. misconceptions about *o' HIV is transmitted. lac# of access to treatment. irresponsible media reportin( on t*e epidemic. t*e incurabilit% of AIDS. and preIudice and fears relatin( to a number of sociall% sensiti+e issues includin( se9ualit%. disease and deat*. and dru( useSti(ma can lead to discrimination and ot*er +iolations of *uman ri(*ts '*ic* affect t*e 'ell-bein( of people li+in( 'it* HIV in fundamental 'a%s- In countries all o+er t*e 'orld. t*ere are 'ell-documented cases of people li+in( 'it* HIV bein( denied t*e ri(*t to *ealt*care. 'or#. education. and freedom of mo+ement. amon( ot*ers!lobal consensus on t*e importance of tac#lin( AIDS 3 related sti(ma and discrimination is *i(*li(*ted b% t*e Declaration of Bommitment adopted b% t*e Cnited ?ations !eneral Assembl% Special Session on HIV/AIDS in Kune 2::1- T*e Declaration states t*at confrontin( sti(ma and discrimination is a prere&uisite for effecti+e pre+ention and care.

25

and reaffirms t*at discrimination on t*e (rounds of oneHs HIV status is a +iolation of *uman ri(*ts?ot onl% is HIV-related discrimination a *uman ri(*ts +iolation. but it is also necessar% to address suc* discrimination and sti(ma in order to ac*ie+e public *ealt* (oals and o+ercome t*e epidemic- @esponses to HIV and AIDS can be placed alon( a continuum of pre+ention. care and treatment. and t*e ne(ati+e effects of sti(ma and discrimination can be seen on eac* of t*ese aspects of t*e response- Ideall%. people s*ould be able to see# and recei+e +oluntar% and confidential counselin( and testin( to identif% t*eir HIV status 'it*out fear of repercussionsT*ose '*o test HIV 3 ne(ati+e s*ould recei+e a+ailable treatment and care. and pre+ention counselin( to protect ot*ers from infection and t*emsel+es from re-infection- People li+in( 'it* HIV and AIDS s*ould be able to li+e openl% and e9perience to ot*ers. t*ereb% aidin( pre+ention. care and treatment efforts-

Prevention

Identification of serostatus Prevetation-to-care continuum

Harm reduction

Care and support

8i(ure 1: T*e pre+ention to care to treatment continuum Based on Aac?eil and Anderson 1FEE. Bus0a 1FFF$ A sti(mati0in( social en+ironment poses barriers at all sta(es of t*is c%cle b% +irtue of bein(. b% definition. non-supporti+e-

2>

HIV 3related sti(ma and discrimination undermine pre+ention efforts b% ma#in( people afraid to find out '*et*er or not t*e% are infected. to see# out information about *o' to reduce t*eir ris# of e9posure to HIV. and to c*an(e t*eir be*a+ior to more safe be*a+ior lest t*is raise suspicion about t*eir HIV status- T*us. sti(ma and discrimination undermine t*e abilit% of indi+iduals and communities to protect t*emsel+es- T*e fear of sti(ma and discrimination also discoura(es people li+in( 'it* HIV from disclosin( t*eir HIV infection and results from fear of sti(ma and discrimination causes people to ima(ine t*at t*e% are not t*emsel+es at ris# of HIV infectionT*e sti(ma and discrimination associated 'it* HIV and AIDS also mean t*at people li+in( 'it* HIV and AIDS are muc* less li#el% to recei+e care and support- 6+en t*ose not actuall% infected but associated 'it* t*e infected. suc* as spouses. c*ildren. and care(i+ers. suffer sti(ma and discrimination- T*is sti(ma and discrimination needlessl% increase t*e personal sufferin( associated 'it* t*e diseaseT*e s*ame associated 'it* AIDS 3 a manifestation of sti(ma t*at *as been described b% some 'riters as Linternali0edH sti(ma 3 ma% also pre+ent people li+in( 'it* HIV from see#in( treatment. care and support and e9ercisin( ot*er ri(*ts. suc* as 'or#in(. attendin( sc*ool. etc- Suc* s*ame can *a+e a po'erful ps%c*olo(ical influence o+er *o' people 'it* HIV see t*emsel+es and adIust to t*eir status. ma#in( t*em +ulnerable to blame. depression and self-imposed isolationT*is ma% be e9acerbated in cases '*ere indi+iduals are members of particular (roups t*at are alread% isolated and sti(mati0ed . suc* as inIectin( dru( users. men '*o *a+e se9 'it* men. and se9 'or#ers. or mi(rants- In settin(s '*ere medical care is a+ailable. sti(ma ma% increase t*e difficult% of ad*erin( to treatment re(imensT*ese patterns of non-disclosure and difficult% in see#in( treatment. care and support t*emsel+es feed sti(ma and discrimination. reinforcin( t*e c%cle- T*is is because stereot%pes and fear are perpetuated '*en communities often onl% reco(ni0e people li+in( 'it* HIV reinforce t*e sti(mati0ation of t*ese alread%-+ulnerable indi+iduals- ?on-

2E

disclosure of HIV 3 infection 'it*in families often leads to lac# of for'ard plannin(. lea+in( orp*ans and ot*er berea+ed dependents economicall% depri+ed once t*e bread 'inner dies and often mar(inali0ed. if t*eir association 'it* AIDS becomes #no'nUnd $s"andin3 s"i3,a and dis!$i,ina"i#n& F#$,s and !#n" ="s In order to identif% potential solutions to HIV 3 related sti(ma and sti(ma and discrimination. it is necessar% to understand '*at is meant b% t*ese concepts. to describe *o' t*e% are manifested. and to anal%0e t*e relations*ips bet'een t*em.hat is Stigma/ Sti(ma *as been described as a d%namic process of de+aluation t*at Lsi(nificantl% discreditsH an indi+idual in t*e e%es of ot*ers- T*e &ualities to '*ic* sti(ma ad*eres can be &uite arbitrar% 3 for e9ample. s#in colour. manner of spea#in(. or se9ual preference "it*in particular cultures or settin(s. certain attributes are sei0ed upon and defined b% ot*ers as discreditable or un'ort*%HIV-related sti(ma is multi-la%ered. tendin( to build upon and reinforce ne(ati+e connotations t*rou(* t*e association of HIV and AIDS 'it* alread%-mar(inali0ed be*a+ior. fears of outsiders and ot*er'ise +ulnerable (roups. suc* as prisoners and mi(rantsIndi+iduals li+in( 'it* HIV are often belie+ed to deser+e t*eir HIV-positi+e status as a result of *a+in( done somet*in( L'ron(H- B% attributin( blame to particular indi+iduals and (roups t*at are 1different2. ot*ers can absol+e t*emsel+es from ac#no'led(in( t*eir o'n ris#. confrontin( *is problem and carin( for t*ose affected-

Ima(es of people li+in( 'it* HIV in t*e print and +isual media ma% reinforce blame b% usin( lan(ua(e t*at su((ests t*at HIV is a L'omanHs diseaseH. a LIun#ieHs diseaseH. an

2F

LAfrican diseaseH. or a L(a% pla(ueH- @eli(ious ideas of sin can also *elp to sustain and reinforce a perception t*at HIV infection is a punis*ment for de+iant be*a+iorSti(ma is e9pressed in lan(ua(e- Since t*e be(innin( of t*e epidemic. t*e po'erful metap*ors associatin( HIV 'it* deat*. (uilt and punis*ment. crime. *orror and Lot*ernessH *a+e compounded and le(itimated sti(mati0ation- T*is #ind of lan(ua(e deri+es from. and contributes to. anot*er aspect underpinnin( blame and distancin(: peopleHs fear of t*e outcomes of HIV infection 3 in particular. t*e *i(* fatalit% rates especiall% '*ere treatment is not 'idel% accessible$. fear related to transmission. or fear stemmin( from 'itnessin( t*e +isible debilitation of ad+anced AIDSSti(ma is deepl% rooted. operatin( 'it*in t*e +alues of e+er%da% life- Alt*ou(* ima(es associated 'it* AIDS +ar%. t*e% are patterned so as to ensure t*at AIDS 3related sti(mas pla%s into. and reinforces. social ine&ualities- T*ese ine&ualities particularl% include t*ose lin#ed to (ender. race and et*nicit%. and se9ualit%- T*us. for e9ample. men and 'omen are often not dealt 'it* in t*e same 'a% '*en infected or belie+ed to be infected b% HIV: a 'oman is more li#el% to be blamed e+en '*en t*e source of *er infection is *er *usband. and infected 'oman ma% be less li#el% to be accepted b% t*eir communitiesT*is process is lin#ed to lon(-standin( (ender ine&ualities underpinned b% ideas about masculinit% and femininit% t*at *a+e *istoricall% resulted in 'omen bein( blamed for transmission of se9uall% transmitted infections of all #inds. and *a+e (uilt imputed to t*em our of assumed L Promiscuit%H- Similarl%. t*e attribution of blame to *omose9ual and trans(ender people builds on lon(-standin( sti(mati0ation related to assumptions about t*eir lifest%les and se9ual practices- @acial and et*nic stereot%pin( also underpins AIDS 3 related sti(ma- T*e epidemic *as been c*aracteri0ed. for e9ample. b% racist assumptions about LAfrican se9ualit%H and perceptions in t*e de+elopin( 'orld of t*e "estHs Limmoral be*a+iorH- 8inall%. t*e +ulnerabilit% to HIV of communities li+in( in po+ert% *as reinforced t*e e9istin( sti(mati0ation of t*ose people '*o are economicall% mar(inali0ed-

):

T*rou(* t*ese associations. sti(ma is lin#ed to po'er and domination t*rou(*out societ% as a '*ole. creatin( and reinforcin( ine&ualit% '*ereb% some (roups are made to feel superior and ot*ers de+alued- T*e association of HIV 'it* alread% 3 sti(mati0ed (roups and practices intensifies t*ese pre-e9istin( ine&ualities. reinforcin( t*e production and reproduction of ine&uitable po'er relations- Pre-e9istin( sti(ma compounds HIV-related sti(ma. not simpl% because alread% 3 sti(mati0ed (roups are furt*er sti(mati0ed t*rou(* association 'it* HIV. but also because indi+iduals li+in( 'it* HIV ma% be assumed to belon( to mar(inali0ed (roupsFi3u$ -& T' !i$!* #( s"i3,a"i@a"i#n and ,a$3ina*i@a"i#n Are seen as responsible

Sex workers, injecting drug users, and other mar(inali0ed (roups

Are seen

HIV/AI S

Peop!e !iving with HIV and AI

Adapted from Par#er @- and A((leton P- 2::2$

HIV-related sti(mati0ation. t*en. is a process b% '*ic* people li+in( 'it* HIV are discredited- It ma% affect bot* t*ose infected or suspected of bein( infected b% HIV and t*ose affected b% AIDS b% association. suc* as orp*ans or t*e c*ildren and families of people li+in( 'it* HIVSti(mati0ation can also occur on anot*er le+el- People li+in( 'it* HIV ma% t*emsel+es internali0e t*e ne(ati+e responses and reaction of ot*ers 3 a process t*at can result in '*at some people *a+e called self- or Linternali0edH sti(mati0ation. Self-sti(mati0ation *as lin#s

)1

to '*at some 'riters *a+e described as LfeltH. as opposed to enactedH. sti(ma. in t*at it primaril% affects an indi+idualHs or affected communit%Hs sense of pride and 'ort*8or people li+in( 'it* HIV. t*is ma% be manifested in feelin(s of s*ame. self-blame. and 'ort*lessness. '*ic*. combined 'it* feelin(s of bein( isolated from societ%. can lead to depression. self-imposed 'it*dra'al and e+en suicidal feelin(s.hat is discrimination/ "*en sti(ma is acted upon. t*e result is discrimination- Discrimination consists of actions or omissions t*at are deri+ed from sti(ma and directed to'ards t*ose indi+iduals '*o are sti(mati0edDiscrimination. as defined b% C?AIDS 2:::$ in t*e Protocol for Identification of Discrimination A(ainst People ;i+in( 'it* HIV. refers to an% form of arbitrar% distinction. e9clusion. or restriction affectin( a person. usuall% but not onl% b% +irtue of an in*erent personal c*aracteristic or percei+ed belon(in( to a particular (roup 3 in t*e case of HIV and AIDS. a personHs confirmed or suspected HIV 3 positi+e status 3 irrespecti+e of '*et*er or not t*ere is an% Iustification for t*ese measuresAIDS-related discrimination ma% occur at +arious le+els- T*ere is discrimination occurrin( in famil% and communit% settin(s. '*ic* *as been described b% some 'riters as Lenacted sti(maH- T*is is '*at indi+iduals do eit*er deliberatel% or b% omission so as to *arm ot*ers and den% to t*em ser+ices or entitlements- 69amples of t*is #ind of discrimination a(ainst people li+in( 'it* HIV include: ostraci0ation. suc* as t*e practice of forcin( 'omen to return to t*eir #in upon bein( dia(nosed HIV 3 positi+e. follo'in( t*e first si(ns of illness. or after t*eir partners *a+e died of AIDS4 s*unnin( and a+oidin( e+er%da% contact4 +erbal *arassment4 p*%sical +iolence4 +erbal discreditin( and blamin(4 (ossip4 and denial of traditional funeral ritesT*en t*ere is discrimination occurrin( in institutional settin(s 3 in particular. in 'or# places. *ealt*-care ser+ices. prisons. educational institutions and social 3 'elfare settin(sSuc* discrimination cr%stalli0es enacted sti(ma in institutional policies and practices t*at

)2

discriminate a(ainst people li+in( 'it* HIV. or indeed in t*e lac# of anti-discriminator% policies or procedures of redress- 69amples of t*is #ind of discrimination a(ainst people li+in( 'it* HIV include t*e follo'in( Healt* 3care ser+ices: @educed standard of care. denial of access to care and treatment. HIV testin( 'it*out consent. breac*es of confidentialit% includin( identif%in( someone as HIV - positi+e to relati+es and outside a(encies. ne(ati+e attitudes and de(radin( practices b% *ealt*-care 'or#ers "or#place: Denial of emplo%ment based on HIV 3 positi+e status. compulsor% HIV testin(. e9clusion of HIV 3 positi+e indi+iduals from pension sc*emes or medical benefits-

Schools: Denial of entr% to HIV 3 affected c*ildren. or dismissal of teac*ers Prisons: Aandator% se(re(ation of HIV 3 positi+e indi+iduals. e9clusion form collecti+e acti+ities-

At a national le+el. discrimination can reflect sti(ma t*at *as been officiall% sanctioned or le(itimi0ed t*rou(* e9istin( la's and policies. and enacted in practices and procedures- T*ese ma% result in t*e furt*er sti(mati0ation of people li+in( 'it* HIV and. in turn. le(itimate discriminationA si(nificant number of countries. for e9ample. *a+e enacted le(islation 'it* a +ie' to restrictin( t*e ri(*ts of HIV 3 affected indi+iduals and (roups- T*ese actions include: T*e compulsor% screenin( and testin( of (roups and indi+iduals4

))

 T*e pro*ibition of people li+in( 'it* HIV from certain occupations and t%pes of emplo%ments4 Isolation. detention and compulsor% medical e9amination. treatment of infected persons4 and ;imitations on international tra+el and mi(ration includin( mandator% HIV testin( for t*ose see#in( 'or# permits and t*e deportation of HIV 3 positi+e forei(nersDiscrimination also occurs t*rou(* omission. suc* as t*e absence of. or failure to implement la's. policies and procedures t*at offer redress and safe(uard t*e ri(*ts of people-

T#%i! 4& HIV/AIDS and Nu"$i"i#n

Fa!"s #n HIV/AIDS and Nu"$i"i#n T*e nutritional status of an indi+idual affects *is immunit% and conse&uentl% *is capacit% to respond to infectionA person '*o is poorl% nouris*ed 'ill be a fre&uent +ictim of infections- Cnfortunatel%. t*is is t*e case of man% c*ildren and adults in AfricaHIV depletes t*e nutritional status of t*e indi+idual and t*e poor nutritional status &uic#ens t*e pro(ression from HIV infection to full blo'n AIDS- T*is is because HIV depletes t*e bod% of essential nutrients includin( micronutrients t*at are essential in bod% defense or immunit%Gno'in( t*at (ood nutrition 'ill *elp in prolon(in( t*e period bet'een as%mptomatic and s%mptomatic sta(es of HIV infection. it 'ill be *elpful to (o for VBT so as to benefit from nutritional counselin( tooT*e pre(nant 'oman '*o #no's *er HIV status 'ill (o for antiretro+iral dru(s and can reduce t*e c*ances of passin( t*e +irus to *er unborn c*ild4 s*e can also benefit form

)/

breastfeedin( counselin(. and c*ose to breastfeed or not- Some of t*e options include e9pressin( breast mil# and *eatin( it up to destro% t*e +irus. or usin( formula mil#Her *usband 'ould also reduce t*e c*ances of ATBT if *e also c*ooses to (o for VBT1=nl% an untested mot*er and an untested fat*er 'ill (i+e t*eir c*ild HIV/AIDS2-

Hand 8 #u"& Nu"$i"i#na* Ad+i! S9,%"#,s 8e+er and loss of appetite Su33 s" d s"$a" 39 Drin# *i(* 3 ener(%. *i(* protein li&uids and fruit Iuice6at small portions of soft. preferred foods 'it* a pleasin( aroma and te9ture t*rou(*out t t*e da%6at nutritious snac#s '*ene+er possible Sore mout* and t*roat Drin# li&uids oftenA+oid citrus fruits tomato. and spic% foods A+oid +er% s'eet foods Drin# *i(* 3ener(%. *i(*-protein li&uids 'it* a stra' 6at foods at room temperature or cooler 6at t*ic# smoot* foods suc* as puddin(. porrid(e. mas*ed ?ausea and +omitin( potato. mas*ed carrots or ot*er non-acidic +e(etables and fruits6at small snac#s t*rou(*out t*e da% and a+oid lar(e meals 6at crac#ers. toast and ot*er plain. dr% foodsA+oid food t*at *as a stron( aroma Drin# diluted fruit Iuices. ot*er li&uids. and soup ;oose bo'els 6at simple boiled foods. suc* as porrid(e. potato. beans6at bananas. mas*ed fruits. soft rice. porrid(e 6at smaller meals more often 6liminate dair% products to see if t*e% are t*e causeDecrease *i(* 3fat foodsDonHt eat food 'it* insoluble fibre rou(*a(e$ 8at mal-absorption Drin# li&uids often6liminate oils. butter. mar(arine. and foods t*at contain or 'ere )7

prepared 'it* t*em6at onl% lean meats Se+ere Diarr*oea 6at fruit and +e(etables and ot*er lo'-fate foodsDrin# li&uids fre&uentl% Drin# oral re*%dration solution Drin# diluted Iuices 8ati(ue. ;et*ar(% 6at bananas. mas*ed fruits. soft rice. and porrid(eHa+e someone pre-coo# foods to a+oid ener(% and time spent in preparation care 'it* re-*eatin($6at fres* fruits t*at do not re&uire preparation 6at snac# foods often t*rou(* out t*e da% Drin# *i(* ener(%. *i(* protein li&uidsSet aside time eac* da% for eatin(#dapted rom &oods '()))*. Taken rom HIV"#I$% and nutrition

UNIT 11 TOPIC 1

HIV/AIDS PROFILES HIV/AIDS si"ua"i#n in K n9a6 S"a"is"i!s and I,%a!"

HIV/AIDS pandemic *as continued to c*allen(e all ot*er in+estments in *uman capacit% de+elopment. especiall% in sub-Sa*aran Africa- In Gen%a. in+estment in areas suc* as education and trainin(. *ealt*. and economic reco+er% are se+erel% constrained b% t*e spread of HIV/AIDS- As epidemic matures into t*e deat*-p*ase in Gen%a. increased morbidit%. increased e9penditure on AIDS related illnesses. *i(* rates of orp*ans and e+entual deat* of able bodied and educated %oun( people depri+e t*e nation off *uman capitalT*e Gen%a HIV adult pre+alence rate *as dropped from 1/D as at 2::1 to t*e current 7-1D 2::5$- T*is ne' rate consists of rou(* a+era(es of /-:D and E-)D for rural and urban infections respecti+el%- Across t*e board. 'omen are more susceptible to increasin( +ulnerabilities laced 'it* po+ert%- Amon( *i(*er ris# (roups. t'ice as man% 'omen t*an men are infected-

)5

Na"i#na* HIV %$ +a* n! (#$ 2AA4 P$ +a* n! B Adults 17-/F Total ran(e$ Aale 8emale Crban @ural Adults 7:M B*ildren :-1/ T#"a* 7-1 /-5-7-E )-7 5-> E-) /-: Nu,2 $ HIVC F/).::: >::.:::-1.2::.:::$ )2:.::: 51/.::: /::.::: 7)/.::: 77.::: 1:2.::: 1DAE1DAAA

Es"i,a" d Adu*" HIV %$ +a* n! 29 %$#+in! in 2AA4 P$#+in! ?airobi Bentral Boast 6astern ?ort* 6astern ?%an0a @ift Valle% "estern Total Nu,2 $ HIVC 1F>.::: F5.::: F).::: >2.::: F.::: 1E).::: 1>1.::: 112.::: F)/.::: P$ +a* n! T#"a* 1:-1 /-1 7-F 2-E 1-/ >-E )-E 7-) 7-1 Ma* E-: 1-> 7-: 1-1 :-F 5-1 2-5 /-2 )-7 ( ,a* 12-) 5-7 5-F /-/ 1-E F-5 /-F 5-/ 5->

Despite t*e noted pro(ress in reduction in pre+alence. t*ere e9ist c*allen(es t*at 'ill need to be addressed- T*ese include unc*an(in( se9ual be*a+ior amon( maIorit% of Gen%ans and resource constrains bot* at t*e national and famil% le+els. increasin( need for palliati+e care as maIorit% of t*ose in t*e last sta(es of disease are bedridden$4 increasin( need for support and care of orp*ansSpecificall%4

)>

1-7A pre(nant 'omen need testin( to determine t*eir HIV status 5E.::: need treatment to pre+ent mot*er to c*ild transmission 2).::: c*ildren need A@T and 2::.::: need cotrimo9a0ole prop*%la9is /):.::: adults need A@T 2-/A orp*ans need care and support from t*eir e9tended families and communities

T*ese c*allen(es cannot be left to t*e (o+ernment alone- All sectors of t*e societ% 'ill need to contribute- T*e c*urc* is a #e% pla%er in t*e ne9t p*ase of t*e fi(*t a(ainst HIV/AIDS- 6+en t*ou(* indications are t*at pre+alence rate is on t*e decline. researc* indicates t*at infection amon( certain +ulnerable (roups *as eit*er remained *i(* or increasedT*e Gen%a ?ational AIDS Strate(ic Plan G?ASP II$ identifies inIectin( dru( users IDC$ to *a+e a pre+alence rate of up to >:D1 and BS" Bommercial Se9 "or#ers$ up to />D in certain (eo(rap*ical areas2$- "*ile ?airobi *as pre+alence rate of ED. *er informal settlements *a+e pre+alent rate of 17-):DS#!i#6 !#n#,i! i,%a!" #( HIV/AIDS in K n9a Impact at Indi+idual le+el

Impact at famil% le+el

Impact at communit% le+el

S#, #( "' i,%a!" in!*ud s

1

Healt* ;ifespan @eduction on production capacit% Increased mortalit% and morbidit%

See for e9ample situational anal%sis b% Susan Berc#ele( in 2::/See Hot Spots mappin( alon( t*e Aombasa-?airobi-Gampla Hi(*'a% report ?o+ember 2::7$-

)E

Und $s"andin3 "' i,%a!" #( HIV/AIDS usin3 "0# di, nsi#ns 1- Sector re+ie' HIV/AIDS undermines de+elopment across all sectors of t*e econom% A(riculture Healt* 6ducation

2- Poor people and HIV/AIDS "*% are poor people more +ulnerable to HIV/AIDS TOPIC 2 :*#2a*D R 3i#na* and Na"i#na* s"a"is"i!s 1EE5 1-2A 1-1A 25:.::: 1)-)A )A 2AA5 1-FA 1-FA /::.::: 22-/A E-1A

In" $na"i#na* AIDS 1EF5 s#!i "96USA N#$"' A, $i!a S#u"' A, $i!a N#$"' A($i!a Su26Sa'a$an A($i!a Asia 52:.::: 1/:.::: F/: >::.::: 22:

C?AIDS/"H=-Aa% 2::5

TOPIC -

:OK P#*i!i s and F$a, 0#$; #( A!"i#n "# (i3'" HIV/AIDS Gin!*udin3

su!! ss s and (ai*u$ sH HIV/AIDS spread rapidl% in 1FF:s reac*in( a pre+alence rate of bet'een 2:-):D in some areas- T*e pre+alence rate later decline in some areas but remain stable in ot*er areas ?ational pre+alence in 1FF/ for instance 'as >D- T*is reduction 'as due to a number of factors mainl%4 Be*a+ior c*an(e. Bondom use. and ;ater a(e at first se9)F

T*e ?ational @esponse 1- In 1FFF. t*e !o# declared HIV/AIDS a national disaster- T*is lead to t*e establis*ment of ?ABB 2- T*e ?ABB de+eloped t*e Gen%a ?stional HIV/AIDS strate(ic plan 2:::-:7 '*ic* set out a multisectoral response to t*e epidemic T*e implementation of t*is strate(ic plan reali0ed some ac*ie+ements but also faced some obstacles- "*at are t*ese ac*ie+ements and obstaclesJ )- ;ater t*e Gen%a ?ational AIDS strate(ic plan 2::7/5-:F/2: 'as de+eloped buildin( on t*e past e9periences- "*at are core principles of t*is planJ UNIT III& 7#$;in3 0i"' P #%* Li+in3 0i"' HIV/AIDS

Objectives: <ou s*ould be able to: Demonstrate an understandin( of t*e issues of concern for people li+in( 'it* HIV/AIDS P;"HA$ Demonstrate t*e capacit% to pro+ide assistance to P;"HA at +arious sta(es . from t*e time of dia(nosis to full3blo'n AIDS Describe t*e principle of 1*ome-based care2

Support for orp*ans and ot*er +ulnerable c*ildren

T#%i! 1& Und $s"andin3 % #%* *i+in3 0i"' HIV/AIDS

Fa!"s "# ;n#0& /:

Support to an indi+idual after confirmation of HIV status results is crucial- Support (roups are useful for counselin( and material benefits to members- It is important to ma#e lifest%le adIustments so as to prolon( life and reduce opportunistic infections- T*is includes nutrition. fertilit% a'areness and education- T*e follo'in( issues need to be addressed: Aana(ement of opportunistic infections =t*er treatment options Home-based care/+isit c*ec#list Succession plan: "ritin( a 'ill. plannin( for foster *omes for c*ildren Bommunit%/sc*ool/c*urc*/famil% support Spiritual Support Bounselin( s#ills inter-personal communication$-

Special (roups of P;"HA. include: B*ildren !uardians Sin(les Parents *usband. 'ife$ AIDS orp*ans t*eir basic needs$-

Fa!"s "# ;n#0 B% December 2:::. about one out of e+er% fi+e person in Africa 'ere carr%in( t*e HIV +irus- "e li+e 'it* it dail% and interact 'it* people '*o *a+e t*e +irus- "*en one (oes +oluntaril% for t*e HIV test. t*e results ma% un+eil '*at man% people fear to #no'- People li+in( 'it* HIV/AIDS P;"HA$ are t*ose '*o *a+e c*osen to li+e in t*e li(*t. #no'in( t*eir real HIV situation- T*e (reatest ad+anta(e of #no'in( oneHs HIV status is t*at necessar% lifest%le adIustments can be made to cope 'it* t*e condition and actuall% prolon( life-

/1

T#%i! 2& P$in!i%* s #( '#, 6 2as d !a$ People 'it* HIV can (enerall% lead *ealt*% li+es- =ccasionall% t*e% 'ill (et sic#. but often t*e% can (et cared for at *ome- Sendin( a famil% member to *ospital can be a drain on famil% resources- People 'it* AIDS can be cared for at *ome 'it* medical support. sometimes more effecti+el% t*an t*e% 'ould be in *ospital-

: n $a* !a$
Geep t*e patient clean and dr% in an air% room t*at recei+es suns*ine at sunrise and sunsetSoa# soiled linen and clot*es in bleac* for 2:minutes or boil t*em for 2: minutes4 'as* and dr% in t*e sunIf possible. care(i+ers s*ould 'ear late9 (lo+es '*en attendin( to patients 'it* open 'ounds or '*en c*an(in( soiled clot*s and beddin(If multi-+itamins are a+ailable. (i+e dail%-

Pain Mana3 , n" At t*e be(innin(. most AIDS patients 'ill respond to mild pain#illers li#e paracetamol. but as illness pro(resses. t*e% ma% need stron(er pain#illers to (et relief- T*e care(i+er s*ould consult 'it* a trained *ealt* pro+ider '*o 'ill ad+ise on an% c*an(e in medicationF + $ See# *elp from a *ealt* 'or#er to find out t*e real cause of fe+er- T*e care(i+er can spon(e t*e patient 'it* a cool to'el and (i+e plent% of fluidsDia$$' a If t*e patient *as fre&uent li&uid stool. t*is can lead to de*%dration- Soiled linen s*ould be remo+ed and disinfected!i+e plent% of fluids- =ne can prepare *ome-made oral fluids: Boiled rice 'ater. or carrot soup- To prepare oral fluids. boil to(et*er 1 litre of 'ater. *alf a teaspoon of salt. 2 spoonfuls of su(ar4 add Iuice from one lemon. and (i+e to t*e patient to drin# fre&uentl%T*e patient s*ould drin# 2-) litres dail%/2

Nu"$i"i#na* Ad+i! Specific conditions 'ill re&uire specific foods- @efer to t*e section on nutrition ad+ice on t*e #ind of food to eat '*en certain AIDS s%mptoms present7 i3'" *#ss T*e patient s*ould eat a *i(* calorie diet: mai0e meal. rice. sor(*um4 plent% of proteins. (roundnuts. mil#. meat. fis*. fruits and +e(etables. especiall% (reen leaf% +e(etables. *alf boiled-

S#$ s and u*! $

Blean 'it* boiled salt% 'ater and soap- If (entian +iolet is a+ailable. appl% locall%If sore is deep. appl% (ranulated su(ar t'ice dail%4 t*is 'ill promote *ealin( after cleanin(If t*e s#in continues to *a+e blisters. refer t*e sic# person to t*e nearest trained *ealt* pro+ider. preferabl% t*e one '*o *as been seein( t*e patient=ral t*rus* t*ic# '*ite coatin( on t*e (ums. Ia's and ton(ue$: Blean 'it* soda 'ater solution and appl% (entian +iolet if a+ailable-

S + $ C#u3' If t*ere is persistent cou(*. see# medical attention- If t*e co u(* is producti+e *a+e t*e patient t*ro'n up t*e sputum into a tin containin( a disinfectant fluid-

Mana3 , n" #( 2#d9 (*uids

Bod% fluids include urine. blood. faeces. sputum. pus. +omit. menstrual blood. and after birt*- Dispose of t*em as soon as possible in a pit latrine- T*e care(i+er s*ould 'ear (lo+es '*en cleansin( t*ese secretions from t*e patientA+oid contact 'it* e%es and open 'ounds- T*e care(i+er s*ould *a+e t*e *abit of 'as*in( *ands 'it* soap and clean 'ater after eac* contact or e9posure to bod% fluids-

/)

T' ;i" (#$ '#, 6 2as d !a$ A care #it s*ould include t*e follo'in(: (lo+es disposable (lo+es or plastic ba(s$. bar soap. plastic s*eets. to'els. nail clippers. (entiam +iolet. cotton 'ool. calamine lotion for itc*in( s#in. face to'els. to'els. petroleum (el. paracetamol for pain reliefPs9!'#*#3i!a* Ca$ (#$ "' PL7HA and "' (a,i*9 It is emotionall% +er% ta9in( for a famil% to care for a terminall% ill relati+e- T*e care(i+er can (et burnt out and depressed. especiall% if t*e care(i+er is a c*ild- T*e care(i+er 'ill re(ularl% need some time a'a% from t*is responsibilit%- Sc*ool. communit% and c*urc* members 'ill offer (ood ser+ices if t*e% +olunteer relief care Depression is common in t*e P;"HA. and patience alon( 'it* tender lo+in( care$ from t*e care(i+er is all t*at ma% be needed Visits from friends and relati+es often c*eer t*e famil%. alt*ou(* to'ards t*e last da%s. some P;"HA do not appreciate +isits @emo+e mirrors from t*e bedroom of t*e P;"HA as depression ma% follo' t*e reali0ation of massi+e 'ei(*t lossAn"i$ "$#+i$a* d$u3s 8ollo' medical instructionsT#%i! -& Su%%#$" (#$ #$%'ans and #"' $ +u*n $a2* !'i*d$ n Fa!"s "# ;n#0 B*ildren need different t%pes of support as t*e% (ro' up: T*e% *a+e basic *uman needs suc* as food. clot*es and *ousin( T*e% need basic *uman needs suc* as food. clot*es and *ousin( T*e% need lo+e and emotional support as t*e% (ro' up T*e% re&uire *ealt*care and education //

Ho'e+er. orp*ans ma% find t*e% do not recei+e all t*ese t*in(s- An orp*an is a c*ild '*o *as lost at least one parent before t*e% are 1E %ears old- T*e% *a+e no-one to care for t*em6+en if t*e% do. t*e% mi(*t not feel as lo+ed as t*e biolo(ical c*ildren of t*e adults t*e% li+e 'it*- T*e% mi(*t not benefit form t*e same &ualit% of education. nutrition and *ealt*care as ot*er c*ildren in t*e *ouse*old- T*e% ma% lose contact 'it* t*eir 'ider famil% if t*e% li+e 'it* nei(*bors- T*e% ma% lose contact 'it* friends in t*eir communit% if t*e% mo+e a'a% to li+e 'it* e9tended famil%- T*is means t*e% lose t*eir support net'or#s and feel insecure- "*en c*ildren lose parents t*e% need emotional support to *elp t*em deal 'it* t*eir (riefC'i*d$ n #$%'an d 29 AIDs a$ d#u2*9 disad+an"a3 d) T*e% ma% face discrimination in t*eir communit% or in t*e famil% t*e% (o to li+e 'it*. eit*er because t*e% are lin#ed 'it* people 'it* AIDS or because people are suspicious t*e% *a+e HIV t*emsel+es- T*is can result in emotional difficulties for t*e orp*an and a lac# of support for t*em from t*e 'ider communit% T*e% can be e9*austed from carin( for t*eir sic# parents. bot* emotionall% and p*%sicall% T*e% ma% *a+e contracted HIV from t*eir mot*ers and *a+e specific *ealt*care needsT*ere are a number of options for care to ensure t*at orp*ans due to AIDS do not end up li+in( on t*e streets- T*e c*ild could !o to li+e 'it* e9tended famil%. eit*er 'it*in t*e communit%. if t*e% are financiall% able to care for anot*er c*ild Be loo#ed after b% order siblin(s!o into institutional care- T*is s*ould onl% be an option '*ere t*ere is no alternati+e- In (eneral. orp*ana(es do not meet t*e lon(- term de+elopmental needs of c*ildren- T*e% are also e9pensi+e to run O$%'ans 0'# *i+ 0i"' $ *a"i+ s #$ n i3'2#$s

/7

=rp*ans re&uire different t%pes of support- Some t%pes of support can be (i+en b% t*e famil% t*at t*e% (o to li+e 'it*- B*urc*es and de+elopment or(ani0ations can pro+ide t%pes of support t*at *ouse*olds cannot pro+ide- T*e% also *a+e a role in supportin( *ouse*olds t*at ta#e in orp*ans- 8or e9amples: Ps9!'#*#3i!a* su%%#$"& 8amilies mi(*t need *elp dealin( 'it* t*e ps%c*olo(ical problems t*at orp*an face- T*e orp*ans mi(*t find it difficult to settle in ne' surroundin(s- T*e% mi(*t not be able to cope 'it* t*e deat* of t*eir parents- 8amilies mi(*t need ad+ice if t*e c*ild is not concentratin( at sc*ool or is pla%in( truantFinan!ia* su%%#$": B*ildren can be e9pensi+e to care for- 8amilies '*o ta#e in orp*ans ma% need financial support. particularl% if t*e c*ildren are to attend sc*ool- T*is could ta#e t*e form in income-(eneratin( proIects or credit and loans sc*emesTi, a0a9: ;oo#in( after c*ildren can be stressful. particularl% if t*e% are not biolo(ical c*ildren and *a+e not (ro'n up 'it*in t*e *ouse*old- B*urc*es or de+elopmental or(ani0ations could pro+ide respite care. per*aps once a 'ee#. in order to (i+e foster parents some time a'a% from t*e c*ildren or time to carr% out acti+itiesP$#" !"i#n& Some families ma% ta#e in orp*ans out of dut% to t*eir relati+es and not +alue t*em in t*e 'a% t*e% +alue t*eir o'n c*ildren- B*ildren or de+elopment or(ani0ations could ta#e steps to ensure orp*ans are not e9ploited or abused b% t*eir ne' families or ot*er members of communit%7a9s "# $ du! "' n 3a"i+ i,%a!" #( $ s ""* , n"s #( #$%'ans Ta; !'i*d$ n "# +isi" "' %*a! and % #%* 2 (#$ 'and& B*ildren ma% t*en be less an9ious about mo+in( A**#0 !'#i! : If c*ildren can c*oose '*om t*e% li+e 'it*. it is less li#el% t*at t*e% 'ill end up li+in( on t*e streets because t*e% are *app% 'it* t*eir ne' famil%"*ere appropriate. (i+e c*ildren t*e option to sta% '*ere t*e% are-

/5

S'a$ in(#$,a"i#n& Tell c*ildren about '*% t*e% need to mo+e and about t*e cause of illness and deat* in t*eir families) Ena2* !'i*d$ n "# ,ain"ain *in;s 'it* t*eir families and communities En!#u$a3 !#,,uni"9 su%%#$" so t*at t*e ne' famil% is not burdened- 8or e9ample. t*e% could reduce sc*ool fees or s*are food Su%%#$" '#us '#*ds& If costs of carin( for orp*ans 'ere reduced. suc* as sc*oolin(. c*ildren mi(*t be more readil% accepted into ne' *ouse*olds- T*is 'ould enable t*em to sta% 'it* close relati+es suc* as (randparents

Si2*in3 !a$ As t*e AIDS epidemic and po+ert% increases. it becomes more difficult for e9tended families and *ouse*olds in t*e communit% to ta#e in orp*ans- Siblin( care ma% be ne9t best option- Ps%c*olo(icall% it is better for c*ildren to sta% in t*eir *ome 'it* t*eir o'n immediate famil% members- =rp*ans '*o are sent to li+e 'it* ot*er families are often separated form t*eir siblin(s- Siblin( care allo's t*em to (ro' up in familiar surroundin(s and continue attendin( t*e same sc*oolHo'e+er t*ere are a number of issues t*at mi(*t affect t*e &ualit% of t*at care- B% considerin( t*ese issues. 'e can t*in# about *o' 'e mi(*t support t*emA3 #( si2*in3& T*e siblin( carers need to be old enou(* to ta#e responsibilit% for t*eir %oun(er siblin(s- T*e% need to be able to (i+e emotional support and financial securit%T*e %oun(er t*e siblin(s t*e more care t*e% 'ill need- =lder siblin(s ma% *a+e to lea+e sc*ool or 'ait to find emplo%mentFinan!ia* issu s& =lder siblin(s need to find 'a%s of pa%in( for food. clot*es. *ousin(. *ealt* care and education- "*ile c*ildren ma% *a+e 'or#ed to supplement t*eir parentsH income. t*e% *a+e to ta#e on t*e 'orr% of financial insecurit% '*en t*eir parents dieL 3a* issu s& B*ildren mi(*t not le(all% be able to be t*e main carers for t*eir %oun(er siblin(s- AdultsH siblin(s ma% not le(all% be able to adopt t*eir %oun(er siblin(s- T*e

/>

c*ildren mi(*t not le(all% be able to adopt t*eir %oun(er siblin(s- T*e c*ildren mi(*t not be able to #eep t*eir propert% '*en t*eir parents die- Aembers of t*e e9tended famil% ma% come to ta#e propert% but refuse to loo# after t*e orp*ansT' $ a$ "' $ (#$ a nu,2 $ #( 0a9s in 0'i!' !'i*d6' ad d '#us '#*ds !an 2 su%%#$" d) @e(ularl% spend time listenin( to c*ildren enablin( t*em to e9press t*eir +ie'sIdentit% people in t*e communit% '*om t*e c*ildren trust. to '*om t*e% can turn for ad+ice and support 6nsue *ealt* 'or#ers ma#e *ome +isits to t*e c*ildren to pro+ide information about HIV pre+ention. pro+ide care for c*ildren 'it* HIV and AIDS and to o+ersee t*e (eneral *ealt* of t*e c*ildren Pro+ide tec*nical trainin( for older siblin(s to enable t*em find 'or# easil%- T*is could in+ol+e settin( up an apprentices*ip sc*eme 'it* local businesses Pro+ide fle9ible education to enable older siblin(s to ta#e it in turns to care for %oun(er siblin(s. or to 'or#. '*ile still (oin( to sc*ool to sc*ool- T*is could in+ol+e e+enin( classes 6nsure t*at t*e c*ildren are in+ol+ed in communit% acti+ities and decision 3ma#in(T*is is important because c*ild-*eaded *ouse*olds ma% become in+isible 'it*in communities. eit*er because t*e parents are no lon(er acti+e in communit% or because sti(ma means t*at t*e communit% denies t*eir e9istence Help c*ildren protect t*eir ri(*ts to propert% b% trainin( t*em in t*eir ri(*ts and *elpin( t*em to access le(al assistance Barr% out ad+ocac% 'or# to (ain t*eir ri(*t for siblin( adoption Pre+entin( c*ild abuse and e9ploitation

Su%%#$"in3 #*d $ !a$ $s #$ #$%'ans

/E

Aost people 'it* HIV and AIDS are bet'een t*e a(es of 17 and /F %ears- T*ese people usuall% *a+e c*ildren- "*en t*e% become ill and die. t*e burden of care for t*e c*ildren can fall on older members of t*e famil%- In Sout* Africa and C(anda. /:D of c*ildren orp*aned b% AIDs li+e 'it* t*eir (randparents- In Nimbab'e it is o+er t*is is o+er 7:DT*is option is usuall% better for t*e c*ildren t*an alternati+es because t*e c*ild is able to li+e in familiar surrounds and maintain some stabilit%- In man% cultures. %oun( people *a+e muc* respect for t*eir elders- =lder people are t*erefore in (ood position to educate and counsel %oun( people about HIV and AIDS- Ho'e+er. older people e9perience a number of disad+anta(es '*ic* can impact t*eir abilit% to carr% out t*is important role: T*e% are more li#el% to be poor- T*is means t*e% ma% not be able to afford to support t*e c*ildren financiall% T*e% are often unable to read and 'rite and ma% onl% spea# a local lan(ua(e- T*is limits t*eir access to information about pre+ention "*ile t*eir abilit% to continue famil% traditions can pro+ide stabilit% for t*e orp*ans. some of t*ese traditions mi(*t in+ol+e practices '*ic* encoura(e t*e spread of HIVO*d $ !a$ $s !an 2 su%%#$" d in "' (#**#0in3 0a9s& Income support t*rou(* pensions or (rants for foster carers. communit% credit sc*emes. income-(eneratin( proIects. reducin( sc*ool fees Pro+ision of information about pre+ention and care usin( appropriate met*odsPro+in( ps%c*osocial support suc* as opportunities for t*em to discuss issues 'it* t*eir peers 6nsurin( t*eir in+ol+ement in communit% acti+ities and decision 3ma#in(-

UNIT IV

SEMINAR PRESENTATIONS ON HIV/AIDS and Busin ss S !"#$ /F

Topic 1 Topic 2

Impact miti(ation mec*anism and strate(ies: A case of A8Is in Gen%a HIV/AIDS and Business Sector Students !roup "or#$

T*e !=G Polic% frame'or# on HIV/AIDS on Business and "or#place Impact of HIV/AIDS on Business sector HIV/AIDS policies and practices of +arious companies from +arious sectors e-(- ban#in(. manufacturin( $ =pportunities for students of business studies4 Bonsultancies. researc* etc @ecommendations for furt*er studies Aainstreamin( of HIV/AIDS at "or# placeAt least 8i+e companies

7: