REVISEDR2L Peer Education Facilitation Guide Under Revision

A Facilitation Guide
for ‘Right 2 Life’ Peer Educators
Revised Version 2009

‘Right 2 Life’ Peer Educators
Facilitation Guide
© 2009 VSO Jitolee and NOPE

LIST OF ABBREVIATIONS AND ACRONYMS
AIDS Acquired Immune Deficiency Syndrome
ANC Antenatal Care
ARVs Anti Retrovirals
ART Anti Retroviral Therapy
BCC Behaviour Change Communication
CCC Comprehensive Care Centre / Clinic
CD4 Cluster of Differentiation 4
DNA Deoxyribonucleic Acid
HAART Highly Active Antiretroviral Therapy
HCBC Home and Community-Based Care
HIV Human Immuno-deficiency Virus
FKE Federation of Kenya Employers
IEC Information, Education and Communication
ILO International Labour Organization
NM Nanometre
NOPE National Organization of Peer Educators
OIs Opportunistic Infections
PEP Post Exposure Prophylaxis
PLWH Person Living with HIV
PMTCT Prevention of Mother to Child Transmission
RNA Ribonucleic Acid
R2L Right to Life
STDs Sexually Transmitted Diseases
STIs Sexually Transmitted Infections
TB Tuberculosis
WHO World Health Organization
VCT Voluntary Counseling and Testing
VMMC Voluntary adult Male Medical Circumcision
VSOJ Voluntary Service Overseas Jitolee
TABLE OF CONTENTS
List of Abbreviations and Acronyms

Glossary of Terms
Foreword
Purpose of the Facilitation Guide
Assumptions
Roles and Responsibilities of a Peer Educator
Planning for a successful Peer Education Activity
Starting and Managing a quality Peer Education session
Session Item Page
Section 1: IDENTIFYING LEARNING NEEDS AMONG PEERS

Session 1 Values and Beliefs about HIV, AIDS and Sexuality
Session 2 Talking about Sexuality and Sex Words
Session 3 Understanding Male and Female genitalia
Section 2: SEXUALLY TRANSMITTED INFECTIONS (STIs)

Session 4 Overview of STIs
Session 5 Exploring STIs
Session 6 Names, Signs and Symptoms of STIs
Session 7 Referring peers for STIs management services
Section 3: UNDERSTANDING WHAT HIV IS

Session 8 What is HIV?
Session 9 Discussing exposure, infection and progression of HIV
Session 10 Understanding the size of the Virus
Session 11 Understanding HIV and the body immunity
Session 12 Understanding the body immune system
Session 13 Modes of HIV transmission
Session 14 How HIV cannot be transmitted
Section 4: WHEN HIV PROGRESSES TO AIDS

Session 15 Understanding Opportunistic Infections
Session 16 Exploring the relationship between TB and HIV
Session 17 What is AIDS?
Session 18 Difference between HIV and AIDS
Session 19 Coping with the challenges from HIV and AIDS
Session 20 Caring for Persons Living With AIDS
Session 21 Preventing re-infection with HIV
Section 5: DELAYING THE ONSET OF AIDS

Session 22: Needs of Persons Living with HIV
Session 23: ARVs and HIV treatment
Session 24: Importance of adherence to ARVs in HIV management
Session 25: Exploring the possible side effects of ARVs
Session 26: The role of social support groups in HIV Care and Support
Session 27: Exploring the role of community in giving love and life
Session 28: Disclosing HIV positive status to the family
Session 29: Exploring the role of the family in providing care and support
Session 30: The role of proper nutrition in HIV management
Session 31: Exploring Healthy eating
Session: 32: Changing lifestyles to delay the onset of AIDS
Section 6: HIV COUNSELLING AND TESTING

Session 33: Responding to HIV positive status
Session 34: Facts about HIV Counselling and Testing (HCT)
Session 35: Common types of HIV tests
Session 36: HIV counselling and testing for PMTCT
Section 7: PREVENTION OF STIs AND HIV

Session 37 Codes on condoms
Session 38 Facts, Rumours and Opinions about condoms
Session 39 Practicing giving correct and consistent instructions
Session 40 Practicing using condoms
Session 41 Evaluating Risky and Non-Risky Behavior
Section 8: GENDER HIV AND HEALTH

Session 42 Gender timetable and gender relations
Session 43 Gender and socio-cultural practices
Session 44 Gender and stereotypes
Session 45 Gender stereotypes and relationships
Session 46 Sexual abuse and exploitation
Session 47 Exploring date or acquaintance rape
Session 48 Preventing date or Acquaintance rape
Section 9: HIV AND AIDS RELATED STIGMA

Session 49 Naming the Problem
Session 50 Exploring causes of Stigma
Session 51 Exploring effects of Stigma
Session 52 Exploring Stigma and the family
Session 53 Exploring Stigma among Children
Section 10: REPRODUCTIVE HEALTH AND GENERAL WELLNESS

Session 54 Introduction to contraception and birth spacing
Session 55 Understanding the importance of antenatal care
Session 56 Exploring general wellness
Section 11: EXPLORING HIV WORKPLACE POLICY AND PROGRAM

Session 57 Understanding the workplace HIV, AIDS & Wellness programme
Session 58 Understanding the workplace HIV, AIDS & Wellness policy
Session 59 Reaching out to the community
ANNEXES
Annex 1 Malaria and HIV
Annex 2 TB link with HIV
Annex 3 The concept of palliative care
Annex 4 Picture code: Family Care and Support
Annex 5 Picture Code: Code on Condoms
Annex 6 Picture Code: Condom Negotiation
Annex 7 Picture code: Domestic Violence
Annex 8 Picture Code: Sexual Exploitation
Annex 9 Picture Code: Date or Acquaintance rape
Annex 10 Danger signs of date or acquaintance rape
Annex 11 Contraceptive methods
Annex 12 Monitoring and Reporting
Annex 13 Picture Code: Men and Women at the bar
Annex 14 ILO/FKE Code of conduct on HIV and AIDS at the place of work
Annex 15 Sample of Ice-Breakers and participatory games
Annex 16 Functions of Male and Female Genitalia
Annex 17 Peer Educators‘ weekly session report format
Annex 18 Bibliography
GLOSSARY OF TERMS
Acute illness: An illness, such as pneumonia, that begins suddenly and usually is of short
duration. Many acute illnesses can be cured by medical treatment.
Antenatal Care (ANC): Care of a pregnant woman and her unborn child or fetus before
delivery.
Antibody: A substance that is produced by the body‘s immune system as part of its
response to fighting infections.
CD 4 Cells: These cells have molecules called CD4 on its surface. These "helper" cells
initiate the body's response to invading micro-organisms such as viruses. CD4 Cells - The
Key to HIV Replication. HIV is a retrovirus, meaning it needs cells from a "host" in order
to make more copies of itself (replication). In the case of HIV, CD4 cells are the host
cells that aid HIV in replication. HIV attaches to the CD4 cells, allowing the virus to
enter and infect the CD4 cells, damaging them in the process. The fewer functioning CD4
cells, the weaker the immune system and therefore the more vulnerable a person is to
infections and illnesses.
Chronic Disease: A disease lasting a long time, or recurring often.
Condom/Femidom: A sheath used to cover the penis or inserted in the vagina during
sexual intercourse to prevent semen from entering a woman. This protection is worn to
reduce the risk of sexually transmitted diseases including HIV and AIDS in both men and
women.
Combination ARV therapy: Use of three or more antiretroviral medications to more

effectively combat HIV disease and suppress viral load.
Disability: Any restriction or lack of ability to perform an activity in the manner or range
considered normal for a human being.
Disclosure: Sharing of HIV status with others. Most people believe that disclosure of HIV
infection should be encouraged. Yet many people infected with HIV avoid disclosing
their HIV status for fear that doing so will subject them to unfair treatment and stigma.
Benefits of disclosure include: encouraging partner(s) to be HIV tested; preventing the
spread of HIV to partner(s); and receiving support from partner(s), family, and/or
friend(s).
Discrimination: An act or behaviour based on prejudice. Discrimination is a way of

expressing, either on purpose or inadvertently, stigmatizing thoughts.
Epidemic: A disease affecting or tending to affect a disproportionately large number of

individuals within a population, community, or region at the same time.
Exclusive breastfeeding: Providing breast milk only (including expressed breast milk),
and no other food or drink, including water. The only exceptions are drops or syrups
consisting of vitamins, mineral supplements, or medicines.
Healthcare provider: A doctor, nurse, midwife, programme manager or others whose

activities include working directly with patients or clients in a healthcare setting. This
term also refers to as healthcare worker.
Helper T Cells: 'T cells' belong to a group of white blood cells known as lymphocytes,
and play a central role in cell-mediated immunity. They can be distinguished from other
lymphocyte types, such as B cells and natural killer cells by the presence of a special
receptor on their cell surface called T cell receptors (TCR). The abbreviation T, in T
cell, stands for thymus, since this is the principal organ responsible for the T cell's
maturation. Several different subsets of T cells have been discovered, each with a
distinct function.
Herpes: A virus that causes sores in the mouth, on the genitals, or elsewhere on the
body.
Heterosexuality: Sexual attraction of individuals of different sex.
High-risk groups: Refers to individuals at greatest risk of contracting a particular

disease.
HIV rapid test: A simple test for detecting HIV antibodies in blood or other body fluids
that produces results in less than 30 minutes.
Home and Community-Based Care: This is an integrated, comprehensive, continuum of

care for people infected with HIV as well as other disabling or terminal diseases.
Homosexuality: sexual attraction for individuals of the same sex
Immune system: A collection of cells and proteins that works to protect the body from
potentially harmful, infectious micro-organisms, such as bacteria, viruses and fungi.
Immuno-compromised: Having a weak or damaged immune system as measured by a

low CD4 count. Also, see Immuno-suppressed below.
Immuno-suppressed: When the body‘s immune function is damaged and incapable of

performing its normal functions. Immunosuppression may occur due to certain drugs
(e.g., in chemotherapy) or because of certain diseases such as HIV infection.
Incidences: The number of new cases e.g. new HIV infections
Infant who is HIV-exposed: Infant born to a mother infected with HIV and exposed to
HIV through pregnancy, in childbirth and or during breast–feeding.
Infection: Invasion and growth of germs in the body.
Medication adherence: Taking medicine exactly as recommended by a healthcare

provider without missing doses.
Monitoring: Routine tracking of information or indicators about a programme and its

intended outputs through record keeping and regular reporting.
Mother-to-child transmission (MTCT) of HIV: Transmission of HIV from a woman

infected with HIV to her child during pregnancy, childbirth and breastfeeding. MTCT is
also referred to as vertical transmission or prenatal transmission.
Opportunistic Infection (OI): A disease caused by a micro-organism that does not

normally cause illness in a person with a healthy immune system. However an OI may
cause serious disease when the immune system is weakened.
Palliative care: Any care provided to relieve pain, but not necessarily to cure a disease.
Pandemic: A disease occurring over a wide geographic area and affecting an exceptionally
high proportion of the population i.e., malaria, HIV and AIDS.
Post-Exposure Prophylaxis (PEP): Short-term use of ARV drugs following HIV exposure such
as a percutaneous injury (e.g., a needle stick or cut with a sharp object) or contact of
mucous membrane or non-intact skin (e.g., exposed skin that is chapped, abraded, or
afflicted with dermatitis) with blood, tissue, or other body fluids containing visible blood
to reduce the likelihood of infection.
Postnatal care: Care for a mother and infant in the 6 weeks following birth. Postnatal care
is vital for ensuring that mother and child remain healthy and should include prevention,
early detection, and treatment of complications and disease. Guidance and support of
infant feeding and maternal nutrition, family planning, childhood immunizations and
referrals to needed services provide continuity of care.
Prevalence: A measure of the total burden of disease, including new and old infections.
Prophylaxis: Treatment to prevent the onset of a particular disease (primary prophylaxis) or

recurrence of symptoms in an existing infection that has been brought under control
(secondary prophylaxis). PMTCT prophylaxis refers to using antiretroviral drugs to reduce
HIV transmission from mother to infant.
Re-infection: To be infected for the second time by the same germ.
Replacement feeding: The process of feeding infants who are receiving no breast milk with a
diet that provides the nutrients infants need until the age at which they can be fully fed on
family foods.
Safer sex: Ways to have sex that reduce the risk of acquiring or transmitting HIV and other
STDs such as use of a latex condom or other barrier. See Unprotected Sex.
Seropositive: A blood test result that indicates infection. A test can indicate the presence
of antibodies to an organism (antibody positive) or the presence of the organism or its
proteins (antigen positive).
Side effect: Unintended action or effect of a medication or treatment.
Stigma: Refers to all unfavourable attitudes and beliefs directed toward people living with
HIV and AIDS (PLWH) or those perceived to be infected, as well as their significant others
and loved ones, close associates, social groups, and communities.
Universal precautions: A simple set of effective practices designed to protect health

workers and patients from infection with a range of pathogens including blood borne
viruses. These practices are used when caring for all patients regardless of diagnosis.
Viral load: The amount of HIV in the blood.
Viral resistance: Changes in the genetic makeup of HIV that decreases the effectiveness of
antiretroviral drugs. Usually occurs in response to drug treatment especially when there is
incomplete treatment or poor adherence to appropriate treatment.
Wet-nursing: Breastfeeding of an infant by someone other than the infant‘s mother.
Window period: The period between the onset of infection with HIV and the appearance of
detectable antibodies to the virus. The window period lasts for 4 to 6 weeks but
occasionally up to 3 months after HIV exposure.
Foreword
―HIV&AIDS is not just a public health issue; it is a workplace issue, a development

challenge and the source of widespread insecurity...The workplace must be on the front
line of the fight against HIV&AIDS‖.
VSO Jitolee has recognized the need to strengthen our partners‘ resilience against
HIV&AIDS within the workplace. This realization has been actualized by the
implementation of the ‗Right 2 Life‟ HIV&AIDS Workplace Project, funded by the Royal
Dutch Government. The core goal of this project is to increase the capacity of VSO Jitolee
partners to respond to the organizational impacts of HIV&AIDS. This project is co-
implemented by the National Organisation of Peer Educators (NOPE).
This is a revised guide for workplace Peer education activities and is as a result of a
collaborative exercise of adapting existing materials and approaches, carried out by Mark
Rabudi, Martin Muchoki, Mary Kuira of NOPE, and Kennedy Mambo and Charles Maloba of
VSO Jitolee. The work of the USAID funded IMPACT project is acknowledged, as well as the
Bridges of Hope publications. The revised facilitation guide draws heavily from the earlier
Right to Life version and is mainly informed by the implementation of the Right 2 Life
project within the following VSO J partners:
1. Anglican Church of Kenya - Kitui Diocese

2. Children of God Relief Institute
3. Kisumu Urban Apostolate Programme
4. Great Lake University of Kisumu
5. African Union of the Blind
6. Bombolulu Workshops and Cultural Centre
7. Anglican Church of Kenya - Western Region Christian Community Services
8. Masaku School for the Physically Disabled
9. Holy Rosary College
10. Kenya Institute of Special Education
11. Association of the Physically Disabled of Kenya - Nairobi
12. Kenya Acorn Project
13. Catholic Diocese of Homabay
14. Mtongwe Community Initiative
15. Muslim Education and Welfare Association
16. Hope World Wide Kenya
17. Ngolanya Community Aid Programme
18. Help Self Help Centre
19. Western Education Advocacy and Empowerment Programme
20. International Child Support
21. Youth Alive! Kenya
22. United Disabled Persons of Kenya
23. National Council for Persons With Disabilities
24. Strengthening Community Partnership and Empowerment
25. Moving the Goal Posts
26. Maridadi Fabrics
27. Rachels Development
Peer education is a core component of successful HIV&AIDS workplace interventions, and

this guide is intended to support the role and the activities of Focal Persons and Peer
Educators trained under the VSO Jitolee ‗Right 2 Life‘ project, and to be used as a key
resource in the promotion of creative and innovative ways to empower staff amongst VSO
Jitolee partner organizations in their efforts to challenge the impacts of HIV&AIDS within
their workplaces and beyond.
It is our hope that ‗Right 2 Life‘ peer educators and focal persons read this Facilitation
Guide, use and build on it, to promote energy, enthusiasm and commitment within their
workplaces, and reverse the tide of HIV&AIDS impacts amongst colleagues and community
members.
The financial support from the Royal Dutch Government supported the development and
printing of this Facilitation Guide, and is warmly recognized.
Makena Mwobobia Ben Ngutu Philip Mbugua
Head of Programmes Executive Director Director

VSO Jitolee VSO Jitolee NOPE
PURPOSE OF THE FACILITATION GUIDE
The purpose of this facilitation guide is to support the Peer Educators when carrying out
their sessions within their roles as workplace peer educators hence agents of Behaviour
Change. The guide therefore adds value to the efforts of Peer Educators in preventing STIs
including HIV, motivating behaviour change among Peers and helping in eliminating stigma
and discrimination of PLWH and those living with AIDS.
Objectives
The objectives attainable through the facilitation guide include:
• To generate dialogue within places of work and at community level.
• To facilitate exploration of attitudes, values and beliefs around HIV and AIDS.
• To infuse Behaviour Change Theories and Effective Communication methodologies
into Peer Education practices
The VSOJ R2L project uses Peer Education, which forms the underlying approach for all
interventions in behaviour change projects worldwide. Peer Education borrows much from
Theories of Popular Education, Non-classroom /Adult Learning and the various Theories of
Behaviour Change. Popular Education builds on the works of Paulo Freire, Malcolm
Knowles, Kurt Lewin and Eric Berne among others.
Guiding Principles
The project is guided by principles of exploration of attitudes, values and personal beliefs,
as it relates to HIV and AIDS and other health concerns. The right to accurate and
accessible information upon which to make informed decisions about health, irrespective
of gender, disability or HIV status also guides the processes in this guide.
Peer educators can transmit accurate, balanced, and factual information using
participatory methods to engage, challenge, and confront Peers to reflect and develop
their own appropriate responses to HIV and AIDS.
Why the guide?

Most publications developed for use within peer education programmes are meant for
trainers. However, with the increasing demand for peer education interventions, Peer
Educators need support materials that package their needs. This guide will assist Peer
Educators prepare their sessions, during the implementation of activities, and in
monitoring and evaluating their own sessions.
Used within a peer education training programme, the guide is also meant to reduce the
amount of hands-on support requirements of a coordinator during the subsequent peer
education sessions.
13
ASSUMPTIONS
The users of this facilitation guide would have gone at least through an initial training as a
Peer Educator, thus being able to use the information and methodologies with the
required tact and confidence. This background is a prerequisite for all users and provides
insight on which part of the guide is for peers and the parts for own use for reference
(annexes and peer educators notes).
New knowledge needs continuous reinforcement. People‘s needs in education also change
with time. Peer Education Training should be a continuous process that would further
make easier the use of this guide. This phase is herein referred to as upgrading or
refresher training. By the time of the second training the Peer Educator would have gained
enough experience in using the Problem Posing methods and other sources of information
hence the need to reaffirm the control of sessions through the following:
 higher quality facilitation skills,

 use of the discussion tools and
 monitoring of both attitudinal and behavioural changes through the continuum of
change.
The first round of peer education training is therefore a START and should best be
complimented by regular updates and an upgrading training which facilitates effective and
successful application of the Theories in Popular Education and Behaviour Change coupled
with more sensitivity to the feelings of peers during such sessions.
The R2L puts emphasis on constant monitoring of peer education activities so that the
sessions are timely and both peer educators and peers are enthusiastic about attending.
This would enhance their performances in their workplace programme and their
confidence in handling the sessions in this guide.
Some of the exercises and activities related to this guide may not be disability friendly but
in the spirit of full inclusion all should be involved. Facilitators are supposed to consider
having sign language interpreters where applicable as part of the resources required to
deliver sessions.
All the names and locations used in this guide do not represent real life situations but only
for the purposes of this guide. Should this be included?
ROLES AND RESPONSIBILITIES OF A PEER EDUCATOR
Who is a Peer Educator?
Peer educators are trained people who assist others in their peer group. Peer Educators in
the context of sexual health provide information to assist their peers to make decisions
about HIV management, STIs and other related health issues through one-to- one discussion
or small group settings. Peer education focuses on behaviour change and is an important
activity in HIV and AIDS programmes.
What are the roles of a Peer Educator?
• Refer peers to appropriate services for STIs, treatment, general counseling or

voluntary counseling and testing for HIV, care and support services.
• Distribute or avail condoms.
• Mobilize peers for various activities or actions e.g. World AIDS Day.
• Fill out report forms on peer education activities.
• Attend monthly supervisory meetings with workplace HIV coordinator to discuss
past activities and plan for the subsequent months.
• Recruit peers to attend Peer education sessions.
• Organize and hold regular group sessions with peers on topics related to health,
sexuality, and social issues, STIs, HIV and AIDS using participatory methods.
• Hold one-to-one sessions with peers to discuss problems or issues that they bring
up.
What support does a Peer Educator Expect?
From workplace HIV coordinator:

• Condom and other commodity supplies
• Leadership
• Information e.g. on referral service points, community initiatives, etc.
• Developing, acquisition and distribution of IEC Materials
• Knowledge and skills for handling sensitive topics
From workplace (Management)

• A place to meet.
• Time /permission to attend meetings and trainings
• Time to hold activities including supervisory meetings
• Moral Support
• Motivation and incentives
• Support with materials for activities
• Budgetary support
From Workplace (Peers)

 Moral support
 Active participation in sessions and meetings
 Feedback on the programme
PLANNING FOR A SUCCESSFUL PEER EDUCATION SESSION
When planning for a session it is important to consider the following factors:

• Identify topic and draw session objectives
• Invite peers and set the appropriate venue and time of sessions (Consider timings
when there is less interference with planned work schedules or durations
allowed by the policy of the workplace for such sessions).
• Set an appropriate venue. The venue should allow for free and active
participation by peers. It should not call for costs like transport or hire of chairs
every time one has sessions. Incase there is need to use video or film, consider
availability of power supply and possible security for the electronic equipment.
Consider accessibility by disabled persons or the need for sign language.
• Consider comfort of the peers. The venue should not be so hot or so cold that
participants become uncomfortable.
• Collect the materials you will use during the session. Put together any index
cards, flipcharts, session aids you will require to make your session successful.
• Agree with the co-facilitator/monitor on which sessions each of you will lead to
make co-facilitation flowing and enjoyable.
• Get your report formats ready for capturing questions and number of
participants at the session.
STARTING AND MANAGING A QUALITY PEER EDUCATION SESSION
Welcome
The most conventional type of welcome appropriate to the particular group should be
used. Introducing a guest speaker would enhance more trust from the participants hence
more likelihood of opening up during the session. This could also be the time for workplace
Heads of Departments, Supervisors or Community Leaders to show support for the session
by introducing or starting it off in the most appropriate way. The welcome forms a very
important part of Peer Education activities but should not take more than four minutes lest
the session becomes very formal and less participatory.
1.Starting the session
A session could take the following format:
• Facilitate an introductory game for names and possible designations and

locations (especially in case of group where the participants are new to one
another).
• Carry out an icebreaker: very important for the participants to open up, relax
and get them ready for learning. Such games are provided in annex 14 of this
guide.
Ice breakers or energizers are games that help people to get to know each other and to
relax could be used by Facilitators. These games help participants get to know each other,
increase energy or enthusiasm levels, encourage team building and makes people think
about a specific issue.
Things to consider when using Energizers:
• Try to use energizers frequently during a session, whenever people look sleepy
or tired or to create a natural break from formal sessions and between sessions.
• Try to choose games that are appropriate for the local context, for example,
thinking carefully about games that involve touch, particularly of different body
parts.
• Try to select games in which everyone can participate and be sensitive to the
needs and circumstances of the group. For example, some of these games may
exclude people with disabilities, such as difficulty walking or hearing, or people
with different levels of comfort with literacy.
• Try to ensure the safety of the group, particularly with games that involve
running. For example, try to make sure that there is enough space and that the
floor is clear.
• Try not to use only competitive games but also include ones that encourage
team building.
• Try to avoid energizers going on for too long. Keep them short and move on to
the next planned session when everyone has had a chance to move about and
wake up!
2. Middle
Hold the discussion by carrying out the planned session. This actually forms the ―meat‖ or
the ―heart‖ of the meeting. Carry out the tasks for education. This is where the code,
discussion, or demonstrations are involved. This part should be as participatory as possible,
hence the need for adequate preparation by the Peer educator. Harvest question and key
concerns (but not necessarily answering them during the session).
3. Ending the session
This refers to the part where the meeting is brought to an end/a close. You could do
something that ends the meeting formally and help the participants to make a transition
from the meeting while thinking about the discussions.
At this point, you could show where condoms are for those who want, talk to peers on one-
to-one basis for more personal touch, refer peers for more information and services, and
show them how to get you whenever they have questions that they would need to discuss.
Harvest question and key concerns (these could form grounds for one-to-one session,
referrals or subsequent group sessions).
Section 1: IDENTIFYING LEARNING NEEDS AMONG PEERS
Session 1: VALUES AND BELIEFS ABOUT HIV, AIDS AND SEXUALITY
Objective
The session is not to persuade participants to believe one way or the other. It helps people
to start reflecting on their own values and beliefs and attitudes around HIV, AIDS and
Sexuality. The discussions and explorations encourage participants to begin analyzing the
possible reasons for such values and beliefs and their consequences.
Resources: Index Cards written: Strongly Agree, Agree, Strongly Disagree, Disagree.
Duration: 45 minutes
Methodology: Values Voting Exercise
Process
Step 1: Put signs around the room-„Agree‟, „Strongly agree‟, „Disagree‟, and „Strongly
disagree‟. Provide four different face cards in case of participants with hearing
impairment to enhance understanding.
Step 2: Tell the participants that you are going to read one statement at a time.
Step 3: Each individual will Agree, Strongly agree, Disagree, Strongly disagree with the
statement (note that there is no position for ―I do not know‖).
Step 4: They should then move to the sign that corresponds with their decision or lift the
face card of their choice.
Step 5: Read any of the statements below and add any of your choice, one at a time:
• People with AIDS should not have sex.

• A person with AIDS has himself to blame.
• I cannot work near someone with HIV.
• People with HIV and AIDS should be isolated.
• AIDS is a punishment for immoral behaviour.
• Life is not worth living if one has AIDS.
• People with disability cannot enjoy sex.
• Only promiscuous people get HIV.
• Sex workers are to blame for the spread of HIV.
• Women wear mini skirts to provoke men.
• People with disability are least affected by HIV.
• Real men don‟t cry.
Step 6: Ask a few individuals from each position under each sign to share the reasons for
choosing such positions. Alternatively, ask each of the groups to quickly discuss
their reasons for standing there and ask one person to report.
Note to the Peer educator
Use probing and challenging techniques to make the session participatory and to enable
participants to think further about the statements while avoiding strong conflicting
statements that could result in shouting matches. In the event that there are participants
who pick a middle ground (e.g. neither Agree nor Disagree) help them to pick a position.
Step 7: Summarize the session by explaining the following:
a. Everyone has values and beliefs on all aspects of life.

b. The values come from families, communities, peers, Religion and learning
institutions.
c. Values and beliefs influence attitudes and affect how we look at issues
including HIV and sexuality. This explains why there were different opinions
on the statements.
d. There is need to evaluate our attitudes and beliefs to reduce the incidences
of stigma against those of us infected by HIV or affected by any sexuality
concern.
Session 2: TALKING ABOUT SEXUALITY AND SEX WORDS
Objective
The session helps participants in lowering embarrassment in using sexuality terms and
getting information that involve using sex words from peers. Developing this comfort is
very necessary for Peer Education and other sessions on Sexuality, STIs and AIDS.
Resources: Flipcharts or pieces of paper or writing surfaces (different coloured) marker

pens or Chalks.
Duration: 40 Minutes
Methodology: Group discussion
Process
Step 1: Explain to the group that they are going to agree on the appropriate terms for
words that people often find difficult to discuss in public.
Step 2: Explain that one of the main modes of HIV transmission is through unprotected sex
with an infected partner. This makes it necessary to talk about sexual attitudes,
male and female body parts, and sexual acts during the activities.
Step 3: Distribute to each group one of the four lists of words as follows:
21
Group 1 Group 2 Group 3 Group 4
Vagina Anus Masturbation Testicles
Sexual Intercourse Oral sex Orgasm Anal sex
Breasts Semen Ejaculation Vaginal fluids
Male Condom Penis Foreplay Homosexuality
Female Condom Libido Buttocks Lesbianism
Sperms Clitoris
Step 4:Explain to the groups that they need to think of all (accepted and unacceptable) local
and slang terms used by their peers. They should list the words next to each term
on the flipchart or board using different colour pens. Tell them to write the
different terminologies in a table as below:
Example of Group 2 table:
Step 5 Rotate the flipcharts until each group gets to add other words that the first initial
group left out. Rotate the work until each group gets the flipcharts and the words
they started with.
Peer Educators are always required to use culturally accepted terms with each group and
to be sensitive to age variations and religious values during the session.
Session 3: UNDERSTANDING MALE AND FEMALE GENITALIA
Objective
Increase participant‘s knowledge of their sexual body parts and state the functions of each
part.
Resources: Flip charts, marker, diagram with male and female genitalia, pens.
Methodology: Group discussions
Process
Step 1: Explain to the group that they are going to talk about sex parts that people
often find difficult to discuss even when infected with an STI or after an
incidence of sexual molestation.
Step 2:Explain that one of the main modes of HIV transmission is through unprotected
sex with an infected partner. This makes it necessary to talk about male and
female body parts and sexual acts during the Peer Education activities.
Step 3: Divide the larger group into three smaller Groups. If the groups used during the
discussions on sex words are three then they should be retained. Give the
smaller groups tasks as below:
Group 1: Draw the internal organs that make up the female genitalia. Label
the parts and state the functions of each part.
Group 2: Draw the external organs that make up the female genitalia. Label
the parts and state the functions of each part.
Group 3: Draw the internal and external organs that make up the male
genitalia. Label the parts and state the functions of each part.
Step 4: Let the groups choose one person to present their work. Ask the rest of the
participants for any reaction about the presentations and make clarifications as
necessary. Ensure that all participants agree over the correct names and
functions of the labelled parts.
Step 5: Provide the male and female diagrams and summarize the session by explaining
that the names of the parts are very important in the subsequent discussion on
Sexually Transmitted Infections. Refer to annex 16 of this guide to explain the
diagrams.
Diagram 1: Male Genitalia
Diagram 2: Female Genitalia

Section 2: SEXUALLY TRANSMITTED INFECTIONS:
PREVENTION, MANAGEMENT AND REFERRAL SERVICES
Goal
One major objective of Peer Education activities is prevention and prompt treatment of
Sexually Transmitted Infections. If left uncontrolled, Sexually Transmitted Infections
significantly increase the risk of HIV infections. Increasing treatment of curable STIs has
proved to be an effective strategy for reducing incidences of HIV and AIDS. STIs also have
devastating health effects especially for women.
Session 4: OVERVIEW OF STIs
Objective
Participants review the common STIs in their locality and the relationship between STIs
and HIV infections.
Resources
i. Folded papers with STI statements (see below in bold). One statement on each
paper
ii. A basket, box or hat to put the papers in
iii. A newsprint or surface to write on
iv. Branded condoms
Methodology: True or False Game
Process
Step 1 Tell the participants that we are going to discuss STIs
Step 2 Introduce the word STIs and discuss the meaning with the participants
Peer Educator‟s Note:

S- Sexually T- Transmitted I- Infections
Some people use the term STD (Sexually Transmitted Diseases) but not all
these infections make people to look diseased. The term infections hence
covers a wider range of the Sex related conditions.
HIV is considered an STI and AIDS a disease. However, explain that we are
considering the classic STIs here as HIV and AIDS will be handled more in-depth
in later activities.
Step 3 Divide the participants into two groups. Explain that we are going to play a
game on STIs and the team with most points gets a prize.
Step 4 Give the instructions below:

• Each team will draw a statement from the basket; the team has to
decide whether the statement is true or false by discussing among
themselves.
• One team member then reads the statement and gives the team‘s answer.
• If the team is correct they score two points. If they explain the answer
correctly they get an extra point.
• If the answer is incorrect, they get no point.
• If the other team gets the answer they earn that extra point.
Step 5 Continue with the game until all statements have been picked from the basket.
Step 6 Announce the winning team. Reward them with an appropriate material like
branded condoms, branded pens, key holders and reading materials. Stress that
everybody participated hence won and that there is no loser.
STIs STATEMENTS
1. A person can always tell if he/she has an STI.

False: People can have STIs without having any symptoms. This happens
most often in women because their sexual anatomy is internal. Some STIs
like Chlamydia also may show no symptoms (as Chlamydia causes no
discomfort). People who have HIV generally have no symptoms for a very
long time after the infection.
2. With proper medical treatment, all STIs except HIV can be cured.
False: Herpes, one of the STIs cannot be cured at present.
3. The organism that causes STIs can only enter the body through either
the woman‟s vagina or the man‟s penis.
False: Organisms that cause STIs can enter the body through any mucus
membranes including the anus, penis, vagina, mouth, eyes, and through
open skin. Syphilis and HIV can also enter the body when injected into the
blood stream from shared needles. Gonorrhoea can enter the body of a
newborn baby through the eyes. Candidiasis, a fungal infection, can enter
the body through the mouth or anus during oral or anal intercourse
respectively.
4. You cannot contract an STI by holding hands, talking, walking or dancing

with someone with an STI.
True: Most STIs are spread through sexual acts or contacts with body fluids
of infected person.
5. Many curable STIs, if left untreated, can cause severe complications.

True. Some complications can lead to infertility. A baby could become blind
if untreated for Chlamydia or Gonorrhoea. Others like syphilis can lead to
failures or damage of vital body organs like heart, brain, kidney or bones.
6. People who have STIs should not have unprotected sexual intercourse,
because they are more likely to contract another STI or transmit the one
they have.
True: Infection with an STI makes a person more likely to contract or
transmit HIV and other STIs, especially when the STI causes open sores,
usually referred to as genital ulcers. These increase the risk of HIV infection
by 3 - 10 times.
Session 5: EXPLORING STIs
Objective
The session is to help begin a series of discussions on STIs using role-play as one of the
participatory methodologies called codes.
Peer Educator‟s notes:

Codes are presentations of significant happenings in the community that are used to
raise strong feelings among the community members. This could be a picture, role-
play, ten-minute drama, a story, a song, case study, or other. The code poses the
problem or question, but not the solution or answer. It is usually used at the
beginning of the activity then followed by a sequence of carefully planned questions
(the Five Exploratory Questions) as demonstrated below.
Resources and advance preparations: Identify three volunteers to prepare the role-
play in step two below.
Methodology: 1-minute role play
Process
Step 1 Ask: What does the acronym STI stand for?

Let the participants brainstorm for a short time. Make sure they
explain that STIs refers to Sexually Transmitted Infections.
Step 2 Explain that the term Venereal Diseases then Sexually Transmitted
Diseases (STDs) had been used before the advent of painless infections
that do not cause pain were included among the sexually transmitted
health concerns.
Step 3 Tell the participants that they will watch a role-play and later discuss
issues from it.
Step 4 Ask for three volunteers to perform this one-minute role-play:
Anne is taken to the clinic by her friend. The clinic worker examines
her and tell her that she has an STI. The clinic worker asks Anne to
bring her partner for treatment. Anne becomes sad. She tells the clinic
worker that it is impossible.
Step 5 Ask participants the following questions in succession (making sure each
question is thoroughly answered before moving to the next one):
• What did you see happening in the role-play?
• What causes STIs in our community?
• What problems do such infections cause?
• How do such situations happen in our community? Is there any
experience similar to the one in the role-play among us here?
• What can we do to reduce the problems likely to occur
from such happenings?
Step 6 Close the session by summarizing and mentioning some of the problems
related to STIs that came from the group. These could include breakage
of relationships, denial, and other matters that rise when we start talking
about STIs.
Step 7 Tell the participants that the subsequent sessions would involve
discussions on STIs.
Session 6: NAMES, SIGNS AND SYMPTOMS OF STIs
Objectives
i. Participants name the common STIs in their locality.
ii. Participants explore how to identify STIs.
Resources
i. Audiovisual set
ii. Silent Epidemic Video
iii. Flip chart with the list of STIs as per step 1 below
iv. Handout with names of STIs as per step 1, general signs as per step 2
v. Flip chart with ―Possible Complications of Untreated STIs‖ as per step 4
vi. Markers
Methodology: Video and Group discussions
Process
Step 1 Tell the group that the session will involve watching a video that
they would later discuss
Step 2 Show a video on STIs (for example, ‗Silent Epidemic‘)
Step 3 Divide the larger group into 3 smaller groups and ask them to discuss
and present the following:
Group 1: Common STIs found in our community giving their local

names as they are known in your community
Group 2: Common Signs and symptoms of STIs in both males and
females
Group 3: Possible complications of untreated STIs stating the related
STIs
Notes to the peer educator:

The list by group 1 should include the following STIs.
Gonorrhoea Hepatitis B
Chlamydia Syphilis
Herpes genitalia Genital warts
Trichomoniasis Candidiasis
Granuloma Inguinale Chancroid
The list by Group 2 should include the following:
Signs in Females Signs in Males

 Irregular bleeding  Discharge from penis (green, yellow, pus-like)
 General signs occurring in BOTH males and
 Lower abdominal/pelvic pain females
 Abnormal vaginal discharge
(white yellow, green, frothy,
bubbly, curd-like, pus-like, and  Painful urination, difficulty urinating, urinating
odorous) more often
 Swelling and/or itching of the  Swollen and painful glands/lymph nodes in the
vagina; swelling of the cervix groin
 Blisters and open sores (ulcers) on the genitals;
 Painful or difficult intercourse painful or non-painful
 Nodules under the skin
 Warts in the genital area
 Non-itchy rash on limbs
 Itching or tingling sensation in the genital area
 Flu-like symptoms (headache, malaise,
nausea, vomiting)
 Fever or chills
 Sores in the mouth

Signs of STIs in infants born to infected mothers include:

 Conjunctivitis
 Pneumonia
The list by Group 3 should include the following:
Possible Complications of untreated STIs

• Infertility
• Blindness
• Pelvic Inflammatory Disease
• Cervical Cancer
• Transmission of infection to newborn
• Increased risk of HIV infection
Step 4 Ask participants to explain why there are more signs among men than in
women, and why STIs are easily detected in males than in men.
Step 5 Mark a star next to ―Increased risk of HIV infection‖ and tell participants
the following:
Some STIs can increase the risk of HIV transmission by 3 -10 times. HIV
infection may also increase transmission of some STIs. This is due to the
open sores caused by STIs that cause genital ulcers.
Step 6 Ask for someone to tell the large group how they would explain the
relationship between STIs and HIV to a peer in local language. Correct any
misinformation.
Step 7 Ask participants for any questions on STI signs, symptoms and
complications.
Session 7: REFERRING PEERS FOR STIs MANAGEMENT SERVICES
Objective
Participants and peer educators evaluate how to apply their knowledge of STI
symptoms, transmission, prevention and treatment to a practical situation.
Resources:
i. A flip chart with information as per step 2
ii. A flip chart with information as per step 9
iii. One set of cards for each table group as per step 5
Process
Step 1 Tell participants that having reviewed names, symptoms and

complications of STIs, that they will now study transmission,
prevention, and treatment and referral of STIs.
Step 2 Show the chart with the following information and read it.
(Three effective ways to prevent Sexually Transmitted Infections)
• Use condoms correctly every single time you have any kind
of sexual intercourse.
• Reduce the number of sexual partners.
• Seek prompt treatment of any symptoms of STIs in yourself and/or
your partner form a qualified health practitioner.
Step 3 Divide the larger group into two smaller groups and tell them that we
will now do an exercise to learn more about how STIs (not including
HIV and AIDS) should be treated, once someone suspects they have an
STI.
Step 4 Distribute a set of cards to each smaller group. Make sure the cards are
well mixed up. Each card has one sentence on it as follows in step 5
below. Alternatively, draw pictures on the cards and explain the
sentences as appropriate.
Step 5 Read through one set of cards to the larger group.
Card 1: Go to a health clinic for follow-up visits or checkups as

requested by health care provider, especially if the symptoms
don‟t go away.
Card 2: Abstain from sexual contact or use a condom until there is no
evidence of infection and you have finished all the prescribed
medicine.
Card 3: Sexual partner(s) should be told and treated to prevent re-
infection or new STI infections.
Card 4: Go to a health clinic for diagnosis and treatment to prevent
further spread.
Card 5:Take prescribed medications as directed until all of the
medication is gone. Do not share the medicine with a partner
or anyone else.
Step 6 Give the following learning task to the smaller groups:
If someone is infected with an STI, what is the best order of actions

to take? Put your cards in the correct order of actions you would take.
Step 7 Tell the groups to arrange themselves in order of the actions that they
would take. Congratulate any group who put their cards in a logical
order. The order could be (4, 5, 3, 2, 1 or 4, 5, 2, 3, 1)
Step 8 Ask the participants to state where they can get STI treatment
services locally. Write the list on the flip chart.
Step 9 Conclude the session by showing the flipchart as below and reading it
loud:
Transmission of STIs
• STIs are spread mainly by sexual intercourse (including
vaginal, anal or oral).
• Other methods of transmission are possible depending on the type
of STI. Most of these methods require direct contact of mucous
membranes or open cuts, sores with areas of the body containing
infected blood, semen or vaginal secretions. An example is that
infected mothers can infect their babies‟ eyes during delivery.
• Some blood-borne STIs, including HIV, can be transmitted by
sharing contaminated needles or other skin piercing tools,
transfusion with infected blood, and or passed from an infected
mother to her unborn child.
Peer Educators Note:

Because the session on STIs is a very critical aspect in HIV management check and pre
determine the facts as you conclude the session
Section 3: UNDERSTANDING WHAT HIV IS
Goal
The goal of this section is to enhance understanding on the HIV infection process,
transmission and ways of prevention. The participants will also be able to differentiate
between exposure and infection, HIV and AIDS, and be able to analyze the needs of Persons
Living with HIV.
Session 8: WHAT IS HIV?
Objective
By the end of the session participants will have defined HIV and described how it looks
like.
Resources: Flip chart and marker pens
Methodology: Brainstorm
Process
Step 1 Ask the group in random to explain on what they know about the origin of
HIV. Explain that HIV is with among us and we need to deal with it irrespective
of where it came from.
Step 2 Ask: What does HIV stand for?

Write the responses from the participants on a flipchart making sure they state
that it stands for Human Immuno-deficiency Virus.
Step 3 Ask: Why is it referred to as HIV?

Allow the participants to brainstorm then explain that HIV affects only human
beings and that there are similar viral infections affecting other animals e.g.
SIV for Simians monkeys, Bovine (B) IV for cows, Felines (F) IV affecting the cat
family, Avian (A) IV affects birds etc.
Step 4 Ask the participants: What does the term Immunodeficiency stand for?
Expect: Immunodeficiency is a combination of two words, immune and
deficiency. It refers to deficiency of the immune response hence failing to
protect the body against infections.
Step 5 Ask the participants to give examples of microorganisms. Expect: Bacteria,

Fungi, protozoa, plasmodium and virus. Explain that HIV is a type of a
microorganism that affects the human immune System.
Session 9: DISCUSSING EXPOSURE, INFECTION AND PROGRESSION OF HIV
Objectives
i. Participants distinguish between exposure to; and infection with HIV.
ii. To understand how fast HIV can spread among a group of people in the community.
Resources and advance Preparations: Familiarize yourself with the game by internalizing
the steps as outlined below. Prepare a flipchart with HIV prevalence as in step 7 below.
Methodology: Bush fire
Note to the peer educator:

The session should be carried out using very simple language to discuss otherwise scientific
and medical issues. Note that persons with disabilities participate in the discussions if they
may not be physically involved in the game.
Process
Step 1 Ask the known as participants to make a circle with their eyes closed.
Explain that you will tap one participant on the shoulder. The person
touched will play the role of a person infected with HIV and will be known
as ‗Participant A‟ in the game.
Step 2 Ask the participants to open their eyes, explain to them that you tapped
one person on the shoulder, and explain that the tapping of the shoulder
meant ‗the person was infected with HIV.‘
Step 3 Ask the participants to mingle and shake hands with at least three other
participants within the group. Tell ‗Participant A‟, whose shoulder was
tapped, to gently scratch the palm of any three people he or she greets.
The three participants scratched by ‗Participant A‟ should then do the
same to the others that they shake hands with.
Step 4 Stop the game after one minute of the handshakes. Ask ‗Participant A‟
(who was tapped on the shoulder) to step into the middle of the circle and
say how they felt after realizing that they were ‗infected‘ with HIV. Ask,
―how do you feel now that you know you were infecting others?‖
Step 5 Ask ‗Participant A‟ to call whose hands he/she scratched to step into the
middle of the circle. Tell all participants who were eventually scratched to
step into the circle and explain how it felt when they realized that they
had been ‗exposed‘ to HIV.
Step 6 Remind the participants that HIV does not spread through handshakes and
that in the game, the handshakes only symbolized how easy and quickly HIV
can spread among a group of people in the community.
Step 7 Show the participants the HIV prevalence chart below and explain that the
game above explains the rise in number of persons infected with HIV in the
world as illustrated in the chart and table below:
Diagram 3: The Global HIV prevalence trends
Diagram 4: Kenya Estimated Adult HIV prevalence by Province (KAIS 2007)
Province Prevalence
Total (%) Male (%) Female (%) M: F Ratio
Nairobi 9.4 6.6 10.7 1.5

Central 3.8 3.5 4.0 3.8
Coast 7.9 6.1 9.2 1.4
Eastern 4.7 2.5 6.4 4
N. Eastern 1.0 1.1 1.0 2
Nyanza 15.3 12.0 17.7 1.6
Rift Valley 7.0 5.5 8.2 1.9
Western 5.1 4.3 5.7 1.5
Total 7.4 5.6 8.7 1.9
Facilitator can also explore some of the reasons as to why women are more infected by
HIV as the statistics show.
Session 10: UNDERSTANDING THE SIZE OF THE VIRUS
Objectives
i. The session is to introduce HIV and an explanation of its size
ii. Participants raise consciousness that HIV can be prevented
Resources: Index cards, assorted marker pens, flipchart or overhead projector with HIV
structure as in step 13 below, 3 sets of 10 index cards.
Methodology: Brainstorm, Size comparison Game
Note: In this session avoid terms DNA, RNA, CD4 nucleus or similar terminologies
Methodology: Size comparison Game
Process
Step 1 Ask: How big is HIV?
Step 2 Explain: A nanometre is one – billionth of a meter the short ways of writing
nanometres is NM. HIV is between 100-125 NM; the average human cell is 200,000
nm in size.
Step 3 Keep all the placards in a large bag and arrange the participants to make a ‗U‘
formation.
Step 4 Give participants numbers each within 1 to 10 as above and distribute the placards
among them at random and explain that each participant has a number
representing a micro-organism 1 to 10. Explain again what a Nanometre is, 1
millimetre divided into a million parts.
Step 5 Tell participants with number 1 to write the word human sperm (number 1 in the
table below) and its size (3000 Nm) on the index cards.
Step 6 Repeat the instruction to participants with cards numbered 2, 3, 4, 5, up to 10

until you have the numbers as in the table below:
1 2 3 4 5
Human sperm Ordinary human White blood cell Red blood cell Gonorrhoea
3000 Nm cell 2000 Nm 80,000 Nm 50,000 Nm 800 NM
HIV Polio Hepatitis B HIV Chlamydia
100 Nm 60 Nm 40 Nm 125 Nm Trichomatis
200 NM
6 7 8 9 10
Note to Peer Educators:

An alternative would be to distribute the cards to the participants and give them
numbers 1-10. Tell the participants each participant to write the names and sizes
of microorganisms as above.
Step 7 Tell the participants to read their placards loud stating the name and size of the
microorganism on it.
Step 8 Tell the participants to compare the size on their placards with the size on the
placard to their right. If the size on their card is bigger, they exchange with the
fellow participant.
Step 9 Tell them to repeat the process until the smallest placards are on their left and
the largest ones on the right side of the room.
Step 10 Go around the group from the right. Identify each cluster of microorganisms and
have participants read the name and the size of the microorganism.
Step 11 Move around the group, as you proceed, compare the size of smaller
microorganisms with larger ones.
Step 12 Point out that HIV is among the smallest microorganisms, but that polio and
hepatitis B are even smaller while white blood cells and human sperm cells are
larger than HIV.
Note: Reinforce that HIV is much smaller but cannot live outside the medium of
transmission. Further reinforce the myth around the size of the virus and
pores of condoms.
Step 13 Ask: What is the shape of HIV?

Expect or explain; as appropriate: HIV consists of round cells with chemicals
bumps outside and a small quantity of chemicals in the centre, on its surface is
bumps made up of various chemicals. At the centre of the shell is a small
quantity of chemicals. Show the flipchart or overhead with the HIV cell structure
as below:
Diagram 5: HIV Cell structure

Session 11: UNDERSTANDING HIV AND THE BODY IMMUNITY
Objectives
i. The session is to introduce the body defence system.
ii. Participants improve the quality of information on the HIV lifecycle.
Resources: 16 index cards, flipchart, marker pens,
Methodology: Analogy
Process
Step 1: Ask: How does a country like Kenya defend itself from external enemies? Clarify
and record the responses from the participants as in a table as below:
Role/Function Country Defence Unit Equal Body Defence Unit

Detecting enemies Patrol cops & national The helper T4 cells also
security intelligence referred to as CD4 cells or
services helper T cells, detects the
invading pathogens
Sounding alarm Signal cops Helper T cells
Mobilizing and producing The department of The thymus gland
specific antibodies defence
Attacking the enemies Specific armed forces – The specific antibodies
Army, Navy or Air Force mostly with CD4 receptors
Note: Explain appropriately the terms in the table.
Step 2: Explain: The body, like a country uses a defence system that detects invading
germs (pathogens), sounds an alarm and then mobilizes an attack. The Helper T4
Cells detects the invading pathogens. They are part of the body‘s defence system
that is made up of the white blood cells.
Step 3: Explain: The antibodies that are specific to the pathogen then attack the invading
germs. The helper T cells hence do not fight the germs but interference with them
makes the body incapable of detecting the germ and producing specific antibodies
to fight the germs.
Step 4: Explain: The Helper T 4 cells use a key and lock mechanism to detect pathogens.
Every pathogen has a unique chemical marking on its surface that locks onto the
receptors of the Helper T4 cells that is designed to match it. Hence for each
different type of pathogen a brigade of Helper T4 Cells whose receptors have a
corresponding chemical marking exists and consequently mobilizing the antibody
to attack the pathogen.
Step 5 Ask: Can somebody have antibodies without having HIV?

Conclude the session by explaining that:
• In the white blood cells, HIV finds the body with no capacity to
produce the requisite immune response. Usually, it takes between
6 weeks to 18 weeks to produce an immune response to a new
pathogen.
• Antibodies are manufactured in the lymph glands and results to
swelling and aches in the neck, armpit and groin.
• The Helper T4 Cells are manufactured in the thymus glands.
Someone can have such antibodies after immunization or
vaccination.
Note: The above session is still reinforced with the following session.
Session 12: UNDERSTANDING THE BODY IMMUNE SYSTEM
Objective
To enhance understanding of participants on what happens when HIV gets into the body.
Resources: Index cards marked HIV (3 cards), HIV antibodies (3 cards), Helper T cells (3
cards), and Lymph glands (3 cards), 12 participants, index cards or plain papers with the
five stages in HIV life cycle as in step 5 below and another set of five cards with
descriptions of each stage.
Methodology: Brainstorm, Simulation game
Process
Step 1 Tell the participants that the session will involve an exploration of what
happens when HIV enters into the body.
Step 2 Ask: What happens when HIV enters the body?

Write the responses from the participants then explain the HIV life cycle
(replication process) as below:
Explain: On entering the body, the HIV life cycle takes the following path:
i. Fusion: The HIV virus attaches itself to the CD 4 receptors of the

Helper T 4 cell.
ii. Budding: The virus then punctures the surface of the Helper T 4 cell
and dissolves its protein coating leaving a string of chemicals referred
to as RNA (Ribonucleic Acid).
iii. Reverse Transcriptions: The Viral RNA, which is a mirror replica of the
Helper T4 cell‘s DNA, is converted through an enzyme called Reverse
transcriptase so as to resemble the DNA. The conversion allows it to
transcribe on the DNA to facilitate the next process.
iv. Integration: This is the process of the RNA being integrated into the
DNA through the use of an enzyme called integrease. This process
allows for alteration of the genetical functions of the cell. Instead of
copying more Helper T cells, it starts the production of the virions. The
copies produced are not complete without the protein coating, hence
the next stage.
v. Assembling: This is the final stage where the enzyme protease is used
to cut into required sizes the protein strands to assemble the virions.
Once this is done, the production of million copies is completed and
the process continues with more immune cells attacked, and destroyed
in the process.
Step 3 Divide the larger group of participants in two smaller groups and tell each group
to move to one different side of the room.
Step 4 Put the cards with the steps on a table between both groups and tell the groups
that they will choose one person at a time to pick a card form the table, read it
loud, state the stage in the HIV life cycle (whether 1,2,3,4 or 5) and explain what
happens at that stage.
Step 5 Continue with the game until you asses that the participants have understood the
stages in HIV life cycle then continue with the session as in the following steps.
Step 6 Ask for twelve (12) volunteers to be in the game and tell the rest to watch
carefully as they will be involved in evaluating the game at some stages.
Step 7 Divide the 12 volunteers into four smaller groups and give each small group
members index cards marked HIV, HIV antibodies and Helper T Cells, and Lymph
glands.
Step 8 State that the centre of the room will represent a human body and ask the
participants with the index cards marked HIV Antibody to stand behind those with
index cards marked Lymph glands.
Step 9 Instruct the group marked Helper T Cells to patrol around the body as they detect
enemies like HIV.
Step 10 Call the participants with cards marked HIV characters to enter the body one by
one. You can clap to symbolize their entry into the body
Step 11 Tell the group marked Helper T Cell to hold HIV from behind once they detect it.
Tell to send a signal by shouting danger whenever this happens.
Step 12 Tell the antibodies to come in immediately they hear the danger signal. Tell them
to hold any HIV held from behind and pass any that is holding Helper T from the
behind.
Step 13 Pause the game at various intervals and ask the participants to state their
observations at each point then continue the game until you observe that the
participants have understood how the immune system works at times of
infection.
Session 13: MODES OF HIV TRANSMISSION
Objectives
i. Participants explore the three common modes of HIV transmission
ii. Participants explore the existence of HIV in various body fluids
Resources and advance preparations: Read and familiarize yourself with the modes of HIV
transmission in Step 5. Prepare two peer educators who will enact the role -play in step 2
below. Replace the names used with the ones common in your locality. Flipchart and
marker pens.
Methodology: Role-play
Process
Step 1 Tell the participants that you will begin this session by watching and
discussing a role-play.
Step 2 Invite two peers to perform the one-minute role-play narrated below:
Lucy is married to Osewe whom she got a baby boy with. Osewe is working
in one of the biggest banks in the country. The baby fell ill frequently. On
this day, Lucy visits a doctor to find out the exact cause of the child‟s
illness. After several tests, the doctor explains that the baby is HIV
positive. The doctor advises Lucy and Osewe to go for a HIV test. During
the couple counseling Osewe explains that his friends introduced him to
several women when he was still in high school. At times, they would share
the women. The wife stands up shaking her head puzzled.
Step 3 Use the questions below to guide discussions. Ensure peers discuss each
question adequately before moving to the next.
 What did you see happening in the role-play?
 What problems can such situations cause?
 What would you do if this happened to you?
 What solutions can we provide to such situations?
Step 4 Ask: What are the body gateways through which harmful microorganisms
can enter the body? List the responses on the flipchart stating that the
body has several gateways through which a germ can enter and effect.
These include: Mouth, Anus, Urethra, Penis, Eyes, Ears, Vagina, Skin
Step 5 Explain: Infection can happen if the above have broken skin, cuts, bruises or
any form of direct contact to the blood stream with infected body fluid.
Step 6 Ask: What are the common modes of HIV transmission? Expect: There are
three major modes of HIV transmission.
• Unprotected sex with an infected person (Most common of HIV cases
world wide)
• From an infected mother to her child
i. During pregnancy (in case of illness or accidents that make the
placenta less effective in protecting the unborn baby).
ii. During childbirth
iii. During breastfeeding
• Direct injection or transfusion with infected blood or blood products.
Step 7 Ask: Where in the body is HIV found? Expect or explain as appropriate:
 HIV is most commonly found in blood and semen.
 Present in quantities sufficient to cause infection in Vaginal
secretions, fluids between bone joints and around muscles and breast
milk.
 Seldom found in Saliva, tears and urine.
 Has never been found in sweat.
Step 8: Ask: Can a person be infected when handling a body of a person who has died
of AIDS?
Expect: It has been often held that HIV cannot survive outside a human body.
However, precaution is supposed to be taken since it is known that HIV can
live in wet blood and flesh.
Session 14: HOW HIV CANNOT BE TRANSMITTED
Objectives
i. To explain ways in which HIV is not transmitted.
ii. Participants explore how fragile HIV is.
Resources and advance Preparations: Read and familiarize yourself with the modes of HIV
transmission in Step 6 in previous session. Prepare two peers who will enact the role-play
in step 2 below. Replace the names used with the ones common in your locality.
Process
Step 1 Tell the participants that you will begin this session by watching and
discussing a role-play.
Juma, who is HIV positive, is discussing his HIV positive status with a
colleague, Paul. Paul asks him if he had discussed with another person and
he agrees. They enter the staff restaurant for lunch and just as they sit,
the colleagues who are at the table walk away. Juma is shocked at the
behaviour of colleagues and complains to the section supervisor who is just
entering the dining hall. Immediately, one of the employees also comes to
the supervisor complaining, “One of us is carrying the dangerous virus
called HIV. He will spread it to all of us if we continue working together
and sharing a table”. The supervisor is undecided on how to handle the
situation.
Step 3 Use the questions below to guide discussions (ensure peers discuss each
question adequately before moving to the next).

 What problem can such behaviours cause?
 What solutions can we provide to such situations?
Step 4 Summarize the session by clarifying that HIV is not transmitted through the
following ways:
 Sharing utensils e.g. tea cups, plates, spoons, etc

 Sharing office and office facilities like computers, telephones, and
toilets among others.
 Shaking hands
 Insect bites
 Hugging one another
 Living in the same room
Section 4: WHEN HIV PROGRESSES TO AIDS
Session 15: UNDERSTANDING OPPORTUNISTIC INFECTIONS (OIs)
Objective
Participants to explain what Opportunistic Infections (OIs) are and describe the common
types of opportunistic infections in their community.
Resources and advance preparations: Read any information on Opportunistic Infections in

advance. Read and comprehend the story in Step 2 below.
Methodology: Story telling (You can use other methods like brainstorming, buzz groups or
discussions)
Process
Step 1 Tell the participants that you will begin this session by listening to a story and
later discussing it.
Step 2 Narrate the story below to the participants:
Charles and Harry tested positive for HIV six years ago. Last year Charles
got a fungal infection on his skin and soon afterwards started experiencing
severe coughing. Harry advised Charles to seek treatment but he refused.
He argued that he would die anyway since there is no cure for AIDS whose
symptoms he had started exhibiting. Harry told Charles that the symptoms
can be cured. Charles stated that it was the first time he was experiencing
the symptoms anyway. That is why he felt his time had reached. “After all
everyone will die” he remarked. Later, Harry too developed symptoms
similar to Charles‟ - fungal infections on his tongue and heat flashes at
night.
Step 3 Ask the participants the following questions:

 What symptoms were the characters referring to?
 What problems do Opportunistic Infections cause?
 What solutions can we provide to such problems?
Step 4 Conclude the session by highlighting the following points:

 Infections that affect people with weakened immunity are called
Opportunistic Infections (OIs).
 People with reduced immunity are vulnerable to opportunistic
infections and malaria because they have reduced immunity.
 People suffering from Opportunistic Infections should seek early
treatment.
Session 16: EXPLORING THE RELATIONSHIP BETWEEN TUBERCULOSIS (TB) AND HIV
Objective
Participants to understand and explain the relationship between TB and HIV.
Resources and advance Preparations: Read information in annex 2, TB Link with HIV prior
to this session. Write each TRUE or FALSE statement in the next page on a strip of paper.
Do not provide the answers on these strips. You also need to prepare a list of common
myths and misconceptions about TB in your community.
Methodology: True or False game
Process
Step 1Tell peers that this session will be a true or false debate game. Position
the two pieces of paper with the signs TRUE & FALSE separately on the
ground.
Step 2Divide the participants into two smaller groups. Explain that in the
debate, TRUE will refer to a proven, evidence-based fact. FALSE refers to
any incorrect information on the issues on TB and HIV.
Step 3Put the statements into a basket or spread them on a table with the
written side facing down. Give out opportunities to one team at a time to
select one person to pick one strip of paper and read out the statements to
the other team.
Step 4The other team should select one team member to state whether the
statement is TRUE or FALSE and give and explanation for their position. Use
the statements below (the correct answers are given for your reference
only).
Step 5 After taking each statement through the steps the co-facilitator will
re-read out the statement from the handout and state the answer and the
explanation. The co- facilitator will also state the distribution of the scores
between the two teams
Step 6When all statements have been done with, announce the winning team
and give it the prize you had brought for this purpose.
Step 7Conclude the session by highlighting that:

 TB is a common Opportunistic Infection among People Living
with HIV.
 It is important for individuals to seek TB screening and
treatment. Family members play an important role in helping a
person adhere to TB treatment as instructed by doctors.
 If one member of a family has been diagnosed with TB, it is
recommended that all the family members be screened for TB.
 TB screening and treatment is available in all public health
institutions at no cost.
 “TB ina Tiba” TB is curable even among people infected with HIV.
Note: You can use annex 2 as a handout for the participants.
TRUE OR FALSE STATEMENTS ON TB
1. TB is a disease that attacks the lungs but can affect almost any part of
the body.
True: When the lung disease becomes ―active‖, the symptoms include a
cough that lasts for more than two or three weeks, weight loss, loss of
appetite, fever, night sweats and coughing up blood.
2. TB is spread through the air.

True: TB is spread through droplets in the air after infected people cough
or sneeze. People nearby, if exposed long enough, may breathe in bacteria
in the droplets and become infected.
3. TB is incurable (cannot be cured) if the person is HIV positive.

False: TB is curable, even in people living with HIV. Direct Observed
Therapy (DOT) is the internationally recommended strategy for TB control.
4. All people living with HIV have TB.

False: Approximately one-third of the people living with HIV & AIDS
worldwide have developed TB.
5. People living with HIV develop TB faster than those who are HIV
negative.
True: In a given year people with HIV are more likely develop TB up than
HIV-negative people. TB is actually one of the earliest opportunistic
infections to occur among people living with HIV.
6. TB is inherited from parent to child.

False: TB is not a hereditary disease. It is an airborne disease that easily
infects people sharing environments or living quarters with poor ventilation.
This makes it possible for TB to infect members of a family unit at the same
time.
Session 17: WHAT IS AIDS?
Objectives
i. Participants define the meaning of AIDS.
ii. Participants discuss the Opportunistic Infections associated with AIDS.
iii. Participants explore means of delaying AIDS.
Resources and advance Preparations: Read the information on step 1 below.
Process
Step 1 Ask: What kind of infections does a person get as HIV begins leading to AIDS
Expect or Explain as appropriate: As a person immune‘s system begins to
weaken because of HIV infection, that person begins acquiring infections that
he or she might have otherwise resisted. These infections are called
opportunistic infections. Some common opportunistic infections include:
 Gastro - enteritis
 Encephalitis (brain abscess)
 Candidiasis (thrush, a fungal infection of the mouth or vagina)
 Meningitis.
 Pneumonia.
 Herpes
 Kaposis sarcoma or other forms of skin cancer (dermatitis)
 Tuberculosis.
 Thrush (anal or oral)
 Severe Diarhoea
 Severe weight loss
Step 2 Ask: When do opportunistic infections occur after infection?

Explain: As the body grows weaker and weaker, at sometime it will lose
the power to be able to fight other disease and sickness. This is when you
start to feel and look very sick. The stage is called AIDS (Acquired Immune
Deficiency Syndrome).
Step 3 Ask: Do we have a cure for AIDS?

Explain: There is no cure at present, for AIDS. There are some medicines
available in Kenya as well as other countries that can delay the progression
from HIV to AIDS. They are referred to as the Highly Active Antiretroviral
Therapy (HAART) due to the way they work together in a combination.
Step 4 Ask: Where do Opportunistic Infection and cancers occur?

Expect: Symptomatic HIV infection is mainly caused by the emergence of
Opportunistic Infection and cancers that normally the immune system
would prevent. This can occur in almost any part of the body.
Step 5 Ask: So when do we say someone has AIDS?

Explain: After years of living with HIV, a person starts getting
constitutional symptoms more frequently as the immune system continues
to weaken. At this stage the person will be more vulnerable to various
opportunistic infections. Such infection could rage from fungal infection
and colds to diseases like TB or cancer. Although the person is HIV positive
and will remain so, the Opportunistic infections conditions can be treated
and sometimes cured.
Peer educator‟s Notes:
When HIV leads to AIDS sometime even a small cold can be dangerous to a
person with HIV because their body cannot fight it like it used to when they
were healthy. This condition is called AIDS. Eventually, the person with
AIDS will die of one of the diseases that his body cannot fight. This is often
why it may seem often that people do not die from AIDS but some other
sickness that could not be cured because of HIV.
Step 6 Conclude the session by explaining that:

Acute symptomatic HIV infection phase in HIV progression is often
characterized by several diseases. Treatment for specific infection or
cancer is often carried out but the underplaying cause is the action of HIV
as it weakens the immune system. Unless HIV progression itself is slowed
down, the symptoms of immune suppression will continue to worsen.
Session 18: DIFFERENCE BETWEEN HIV AND AIDS
Objectives
i. To further the understanding of the difference between HIV and AIDS.
ii. To enhance an understanding of the importance of nutrition and other
factors in delaying the onset of AIDS from HIV.
Resources: Flipcharts or writing board, markers, overheard or flipchart with HIV

progression chart as in step 8 below.
Process
Step 1 Ask: Does a person with HIV always have AIDS?

Expect: No. A person with HIV does not always have AIDS. There are
distinctions between HIV and AIDS. This could be seen in the table below.
Step 2 Ask: What is the difference between HIV and AIDS hence a Person Living
With HIV (PLWH) and another Person Living With AIDS (PLWA)?
Step 3 List the responses from participants in the table as below and make sure they
include:
HIV AIDS
1. HIV is a virus 1. AIDS is a ―disease‖ or condition
2. A person with AIDS may have the symptoms of many
diseases that he/she has acquired (syndrome) such as TB,
2. HIV has no symptoms meningitis, and skin cancer.
3. A HIV positive person who does not have AIDS may 3. A person with AIDS may be weak, and reduced in body
feel and look perfectly healthy. mass. He or she may feel and look sick.
4. The immune system of a person with AIDS is rapidly
4. A person with HIV who does not have AIDS may growing less and less effective at protecting his/ her
have an active immune system. body.
5. An HIV positive person may continue with daily 5. A person with AIDS might be weak hence unable to
routines and work to support family. work and carry out the routine tasks.
S
tep 5 Ask
Note: It is possible for a person to move from AIDS stage to stage of Living with
HIV.
Step 4 Ask: Is it better therefore to refer to either the infection or disease as HIV and
AIDS or simply HIV or AIDS as appropriate? Allow Participants to share their
views and experiences. Use the discussion to evaluate whether they have
understood the differences between HIV and AIDS.
Step 5 Explain: HIV and AIDS might have been joined together in earlier days of the
epidemic to help people to understand that HIV leads to a condition known
as AIDS. However, joining the two terms together makes it difficult for
people to understand the difference between the two terms.
Step 6 Ask: How long does it take a person with HIV to develop AIDS?
Let participants share their experiences and lessons learnt from the
previous sessions.
Step 7 Use the HIV progression chart on a flipchart as below to summarize the
session.
Primary
1200 Infection
Constitutional OI Symptoms
1000
OIs
CD4
Apparent latency phase
Count 800
Per
3
mm 600
400
200
0
0 3 6 9 12 1 2 3 4 5 6 7 8 9 10 11
Months Years
CD4 Viral Load

• When a person tests positive, he/she does not have HIV and AIDS. He/
she only has HIV at this point.
• Only HIV can be prevented, however, the onset of AIDS can be delayed.
• Saying HIV and AIDS prevention makes no sense and therefore has no
meaning.
• To limit stigma, we should therefore be careful when using the terms
interchangeably. One acceptable way of using the terms could be as in
―HIV prevention and AIDS control‖.
Session 19: COPING WITH CHALLENGES FROM HIV AND AIDS
Objective
To explore ways of coping with the challenges posed by HIV and AIDS in the community.
Resources and advance Preparations: Familiarize yourself with the Video clip titled ―It‘s
not Easy‖ and prepare the scenario where Suna (the main character) shares his HIV status
with his partner and colleagues at the workplace and later mobilizes community members
to initiate HIV programme activities at the workplace.
Methodology: Experience sharing by PLWH or Video discussion
Note: The facilitator generates a discussion on the sharing by the PLWH. If the suggested
video clip is shown, then follow the following steps:
Process
Step 1 Tell the participants that you will begin this session by watching and discussing
a video scenario.
Step 2 Show the video scenario then ask the participants the following questions after
it ends:
 What did you see happening in the video?

 What problem does this cause?
Step 3 Use the points below to conclude the session:

 Storytelling and other traditional ways of preserving family
memories/history help members and especially children, to cope
with the AIDS challenge.
 Educating families on how to care for infected loved ones enhances
the capacity to cope with situations that might arise when a member
has HIV or AIDS.
 Creating forums for sharing experiences among affected families can
enhance their coping abilities.
 Planning for the remaining spouse and children is equally important in
helping them cope with challenges thereafter.
 Persons Living with HIV can also join community support groups to
learn how other persons facing similar challenges are coping.
 Persons Living with HIV and AIDS can also keep diaries and journals
where they record their experiences
 Financial support for children and dependants should also be planned
for
Session 20: CARING FOR PERSONS LIVING WITH AIDS
Objective
To educate participants on importance of care and support for Persons Living with AIDS.
Resources: Picture codes on annex 4,
Methodology: Picture code discussion
Process
Step 1 Tell the participants that you will begin this session by exploring a picture and using
it to discuss the topic of the day.
Note: Try to explain what is in the picture code incase some of the participants are
visually impaired and also know how to ask the questions as in step 2 so that everybody
contributes equally.
Step 2 Distribute copies of the picture ensuring that every participant is near one
then ask the participants the following questions:
 What did you see happening in the picture?

 What problem does a person with HIV face if not taken care of?
 What solutions can we provide to eliminate such problems?
Step 3 Ask: Why is it advisable to wear surgical latex gloves when attending to a sick
person living with HIV and AIDS?
If participants say to prevent infection, clarify that that is stigmatizing. Explain that more
often the gloves are meant to prevent bacterial and fungal infections from reaching the
person – it is to protect the person from being infected by the everyday germs carried by
the caregiver.
Step 4 Conclude by explaining that as community members we need to:

 Spend time with the persons living with AIDS to show love and genuine concern.
 Encourage the person living with AIDS to eat appropriately.
 Ensure that the house and the environment are clean to prevent hygiene-related
problems.
 Reassure and link the individual to spiritual, material and legal support among
other needs.
 Remind the person to take their medicine as prescribed by the health care
provider.
Session 21: PREVENTING RE-INFECTION WITH HIV
Objective
To explain the meaning of re-infection with HIV and explore modes of preventing re-
infection.
Resources and advance Preparations: Familiarize yourself with the terminologies

infection, re-infection and co-infection. Identify two participants in advance to prepare a
role-play using the story line below:
Process
Step 1 Tell the participants that you will begin this session by watching role-play and
later discussing it.
Omah approaches his friend Seth to seek advice on how to advise a

colleague who recently tested HIV positive and insists on unprotected sex
arguing that, having been infected it wouldn‟t make a difference. Seth
tells Omah to inform the colleague that there are chances of increasing
the amount of viruses in the body in what is referred to as re-infection.
Omah inquires about re-infection and Seth explains to him and states the
consequences of re-infection with HIV. Omah is surprised.
Step 3 Freeze the role-play and ask the participants the following questions:
 What is re-infection with HIV?
 What problem can re-infection cause?
 What would you do if this friend came to you with a similar question?

 There are different strains of HIV in Africa; HIV 1 and HIV 2
 Both strains of HIV are transmitted in the same way and lead to AIDS.
 Re-infection refers to entry of with more HIV into the body system.
It can also mean being infected with another strain.
 Re-infection causes faster weakening of the immune system.
It is advisable for partners who both have HIV to use a condom to avoid increasing the
chances of re-infection or contracting different types and strains of HIV.
Section 5: DELAYING THE ONSET OF AIDS
Session 22: NEEDS OF PERSONS LIVING WITH HIV
Objective
Participants explore the needs of PLWH.
Resources: Flip charts and marker pens, Sign language expert for the deaf.
Methodology: Brainstorming
Process
Step 1 Ask participants to explore their knowledge on living with HIV means
Step 2 Ask: What can a person do to improve his or her chances of delaying AIDS? List the
suggestions on a flip chart as in the table below. Write the suggestions from the
participants on a flip chart.
Step 3 Divide the larger group of participants into four smaller groups. Give them the task
of discussing and presenting on the needs of person living with HIV under physical needs,
spiritual needs, social needs and emotional needs.
The lists should have the following:
Group 1: Physical/physiological needs. Group 2: Spiritual needs

• Proper Nutrition • Religion, conflict resolution.
• Access to spiritual services (which include voluntary
• Clean water tasks).
• Healthy sex.
• Appropriate spiritual nourishment for general feeling
• Shelter and clothes. of well-being.
• Exercising regularly.
• Enough Rest
• Avoiding re-infection of HIV and other illnesses.
• Seeking prompt treatment for
Opportunistic Infections
Group 3: Social /sociological needs Group 4: Emotional needs

• Job, dignity. • Understanding, empathy.
• Identity, Acceptance. • Comfort, counseling.
• Love from the family and colleagues at work for
a sense of belonging • Reassurance. Etc
• Managing stress effectively.
• Seeking proper advice when planning to have a
baby.
Peer Educator’s notes:

Paying attention to only one area of need may not help in delaying the onset of AIDS
but rather a holistic approach to spiritual, physical, emotional and social needs.
Session 23: ARVs AND HIV TREATMENT
Objectives
i. To introduce what are ARVs to participants.
ii. Participants discuss the role of ARVs in delaying onset of AIDS.
Resources and advance preparation: Read notes on ARVs before the session. Reading
through this session will be important before facilitating it with peers.
Process
Step 1 Ask: What is HIV treatment?

Expect or explain as appropriate: This refers to the use of drugs to keep an
HIV positive person healthy hence delaying the onset of AIDS. These drugs
are commonly known as ARVs.
Step 2 Ask: When is it advisable for one to start on ARVs?

Explain: The person and the medical service provider should consider
several factors in deciding when to start drug therapy. As discussed above,
the viral load and CD4 (Helper T4) cell count will help determine whether
the person should consider treatment.
Step 3 Ask: What should one keep in mind before starting treatment?
Explain: One should keep in mind that once he/she begins drug treatment,
it may need to continue for the rest of life. One also needs to consider how
well he/she will be able to follow the treatment plan, and weigh the known
benefits and potential risks of drug therapy.
Step 4 Ask: What are the benefits of starting early drug

treatment? Expect:
 It becomes easier to achieve and maintain control of viral load.
 Less risk of drug resistance if viral load is undetectable.
 Delay or prevent a weakened immune system.
Step 5 Ask: What are the potential Risks of starting early treatment?
Explain:
 Potential for serious side effects (For more information on side
effects see session 26).
 Earlier development of drug resistance if viral load is not undetectable.
 Possible limitation of future therapy options.
 Negative effects on quality of life resulting from drug regimens.
Step 6 Ask: What are the benefits of delayed drug treatment?

Expect:
57
 Avoid negative effects on quality of life resulting from drug regimens.
 Avoid side effects (drug toxicities).
 Less risk of drug resistance.
 Preserve future drug options.
Step 7 Ask: What are the Risks of delaying treatment?

Expect:
• Possible permanent immune system damage from HIV virus.
• Possible difficulty with controlling viral load.
Step 8 Ask: If my doctor and I decide to delay treating my HIV infection, will I need
to have my viral load and CD4 cell count tested again?
Expect: Yes. HIV-infected persons who have not started drug therapy should
have a viral load test every 3 – 4 months and a CD4 cell count every 3 – 6
months. Talk to your doctor about how often you should be tested.
Step 9 Ask: Does everyone infected by HIV need ARVs?

Use the responses from the participants and add appropriate information to
conclude the session by explaining that:
Not everyone infected by HIV needs ARVs. There are several factors that
determine whether one is to start ARV or not. Such factors include the
following:
a) ARVs is Not an emergency treatment

• Starting the treatment depends on the viral load, immune cell
count and the health factors of the individual.
• In Kenya the treatment is mostly started at CD4 cell count of 200
or presence of Opportunistic Infections. However, the health care
provider will guide the decision on whether to start the treatment
or not.
b) Treat Opportunistic Infections first

 ARVs from part of the comprehensive care programme. All who
require ARVs should first be on TB treatment if they have TB.
• In case of OIs, it is always advisable to treat the OI first before
starting on ARVs.
• Most of Opportunistic Infections are simple to treat.
c) ARVs is only one part of HIV Care
• Optimize nutrition
• Maintain hygiene
• Take care of all other areas of need (see session 23)
Conclude the session by saying that not everyone who is HIV positive is
required to take ARVs.
Session 24: IMPORTANCE OF ADHERENCE TO ARVs IN HIV TREATMENT
Objective
Participants explore the importance of treatment adherence in maximizing the effectiveness
of ARVs in HIV treatment.
Resources and advance preparations: Read notes on ARVs before the session as stated in
step 2 below. Reading through this session will be important before facilitating.
Methodology: Brainstorming and mini-lecture
Process
Step 1 Ask: What do you understand by the term adherence counseling?

Let the participants brainstorm on the term and then summarize their
contributions by explaining that medication adherence counseling refers to
assistance provided to help one in taking medicine exactly as recommended
by a healthcare provider without missing doses or other medical
appointments.
Step 2 Explain the following using a mini-lecture method: Before deciding to start on
ARVs, a person should thoroughly understand the following aspects of
treatment:
a) The overall goals of ARV:

• Prolong and improve quality of life of PLHA (clinical goal)
• Suppress viral replication (virological):
• Reduce viral load as much as possible for as long as possible
• Halt and reverse disease progression
• Prevent and/or reduce resistant variants
• Achieve quantitative and qualitative immune reconstitution (immunologic
goal)
• Rational sequencing of drugs while preserving options, minimizing side
effects, toxicity and maximizing adherence (therapeutic goal)
• Reduce transmission: mother-to-child, sexual transmission (epidemiologic
goal)
• Reduce stigma (social goal)
b) The Treatment outcomes: The treatment outcome of ART can be seen

under
 Short-term; benefits take 6 to 8 weeks
 Mid-term; it takes 3– 4 months to be sure the drugs are still
effective.
 Long-term; Life-long
c) Adhering to taking drugs and medical appointments has been found

to be an important determinant of outcome of ARVs and is a crucial
component in
 Maintaining therapeutic drug levels
 Reducing the risk of drug resistance
d) Adherence counseling is essential. Patients should be able to demonstrate
an understanding of:
 Importance of strict adherence
 Their ability to access and afford drugs for a long term for
the process is life-long
For more information refer to the WHO guidelines on ARVs
Step 3 Summarize the session on ARVs by explaining that ART drugs do not and cannot
cure HIV, however, they help in delaying the onset of AIDS hence helping in
delaying death from AIDS altogether.
Session 25: EXPLORING THE POSSIBLE NEGATIVE SIDE EFFECTS OF ARVs
Objective
Participants explore the importance of ARVs, how to minimize their negative side effects and
maximize on their effectiveness.
Resources and advance preparations: Read notes on ARVs before the session as in previous
session. Reading through this session will be important before facilitating it with peers.
Methodology: Brainstorm and experience sharing
Process
Step 1 Ask: What have you had people say to be the possible side effects of ARVs?
Expect experiences from the community including the following: The
medications can cause some side effects. These range from fever, rashes,
dizziness, baldness, diarrhoea, development of paunch (protruding of belly),
diabetes, to liver or kidney suppressions (pancreatitis and reabsorbing of uric
acid back to the skin at times).
Step 2 Explain: One may experience negative side effects (drug toxicities) when
he/she takes HIV drugs. Some of these side effects are serious, even life
threatening, so we may have to change drugs. Possible negative side effects of
ARVs include the following:
• Liver problems
• Diabetes
• Fat maldistribution (Lipidostrophy syndrome)
• High cholesterol
• Increased bleeding in patients with haemophilia
• Decreased bone density
• Skin conditions
• Fever
• Nausea
• Fatigue
• Hepatitis
• Hallucination
Step 3 Conclude the session by explaining that people on medication for any other
health conditions are always advised to discuss with the health care provider
before starting on ARVs to minimize such negative side effects when the drugs
interact.
Session 26: THE ROLE OF SOCIAL SUPPORT GROUPS IN HIV CARE AND SUPPORT
Objective
To create awareness on the importance of community support groups
Resources and advance Preparations: Prepare a list of social support groups around where
you work and familiarize yourself with the role-play ―Shared Hope as in step 2 below‖.
Methodology: Role-play (facilitator can freeze the role play during key dramatic moments to
generate discussions with participants.
Process
Step 1 Tell peers that you will start this session by watching a role-play. Tell them to be
attentive so as to identify the issues they may want to discuss later.
Step 2 Invite the participants to enact the role-play below:
Jane has just come from a HIV Voluntary Counseling and testing centre. She is
sobbing and shocked at the result. She bangs the door to the residence that
she is sharing with Anne. Anne asks her what the problem is but she continues
crying. After a period of probing Jane painfully explains to Anne where she
has just come and that she tested positive then she breaks down crying
stating that all her hopes are gone. She states her fear that Anne would even
not be comfortable staying with her. Anne tells Jane to calm down stating
that she also felt the same the first tie she tested positive but she has now
come to terms with her status. Jane is surprised and stops crying.
Step 3 Ask the questions below at the end of the role-play:

• What did/can you see happening in the role-play?
• What problem can lack of such social support cause among PLWH?
• What are the consequences?
• What would you do if this happened to you?
• What solutions can we provide to such problems?
Step 4 You can also include the following questions to enhance the discussion:
• What forms of support were offered to the person infected with HIV in
the Role-play?
• What is the importance of social support to persons infected or affected
by HIV?
• What support groups exist in your area?
• How do the social support groups work?
• How have they helped infected or affected persons to cope with
the HIV situations in our community?
• A supportive environment for discussing feelings about HIV status or any
long-term illness is essential for emotional balance and immune
reconstitution and development.
• Support groups provide opportunities for gathering information and
getting appropriate linkages for health-care and other forms of
support.
• Support groups are some of the community structures that enhance a
collective response to coping with the HIV & AIDS challenge.
• Through support group activities, infected and affected members of the
community can access on-going support including counseling, treatment,
care, legal support and other forms of support.
• Collaborate with nearest CCCs for support groups.
Session 27: EXPLORING ROLE OF COMMUNITY IN GIVING LOVE AND LIFE
Objective: To introduce participants to the role of community support
Resources and advance preparation: Read and understand the facilitation steps for the
method here. You can practice it beforehand with fellow peer educators. You need two
pieces of one metre-long plank of wood, pictures of sea animals, pictures of beautiful islands
or dream holiday destinations.
Methodology: Love and life game
Process
Step 1 Introducing the bridges: Introduce the exercise as a fun activity in

which everyone can participate.
Step 2 Present the setting to the participants thus: Imagine this area is a big river
with some hungry crocodiles and other dangerous creatures in it. You have to cross the
river using this bridge, by putting one foot in front of the other so that with each Step,
the heel of your front foot touches the toe of your back foot. Place the dream islands at
the furthest end of the river.
Step 3 Demonstrate this yourself, starting at one end of the plank.
Step 4 Explain to the participants: This is a dangerous river to cross, so

we should encourage them on the way, and when someone crosses
successfully, everyone should celebrate with them by doing the LOVE LIFE sign
or making the appropriate sounds. Demonstrate with hand movements and the
sounds as shown below here and tell participants to repeat. ―Do it with me…
LOVE… LIFE. Every time you succeed at this exercise, or anything else for
that matter, we will celebrate it with the LOVE LIFE sign and sounds‖.
Diagram 6: The Love Life Signs
LOVE LIFE
(Whistles) (Ululations)
(Note: These signs and sounds should have positive meanings, and should not
be connected with politics. If they have political, negative or other meanings
in your country, then change them, and create your own).
Step 5 Participants try crossing the bridges

• Get all willing participants to try crossing the full length of the bridge,
heel to toe all the way, and going to the end. When someone succeeds,
get them to do the LOVE LIFE sign or sound, and encourage everyone to
celebrate and do the LOVE LIFE sign or sound with them.
• When the willing participants have tried crossing the bridge, congratulate
those who got across safely while assuring those who could not make it to
the dream island that another bridge will help them get across safely.
Lay the other plank of wood on the ground about one foot apart from the
first one and tell the participants to try crossing once more using the 2
bridges.
Step 6 Interpreting the exercise above: Use the following questions as a guide to
facilitate discussion:
• What do you think the items presented? (Refer to the crocodiles and other hid den
creatures, first bridge, second bridge, the river, the dream island, the other participant,
signs, sounds, etc).
Expect: They can represent HIV and AIDS as the key answers. The other Sexually Transmitted
Infections (STIs) like gonorrhoea and syphilis, and other difficulties and dangers faced in life
are also part of the hidden creatures. The crocodiles and sharks show the danger that is
hidden can bite you without you knowing.
• How did it feel when you fell? When you crossed safely?
• How did it feel to hear or see the signs or sounds of Life/love from
your col leagues?

The bridges represented ways of preventing HIV, preventing re-infection or
delaying the onset of AIDS.
Session 28: DISCLOSING HIV POSITIVE STATUS
Objective
To encourage disclosure of HIV positive status
Resources and advance Preparations: Familiarize yourself with the video tape Scenarios
from Africa clip titled The Uncle or a relevant one in your locality. Watch the clip in
advance to ensure you understand the particular storyline/clip on disclosure. Have a
TV/DVD set and the Video/DVD tape.
Methodology: Video Discussion
Process
Step 1 Tell the participants that you will begin this session by watching and discussing
a video scenario.
Step 2 Show the video then ask the participants the following questions when it
ends:
• What did you see happening in the video?
• What problems do Persons living with HIV face that stops them from
disclosing their status in the community?
• What problems can lack of disclosure cause?

• Disclosure can help one to cope well with HIV status. However, the
family might not easily cope with the fact that one of their own is
infected with HIV.
• In case of difficulties from the family, one can get assistance from a
counselor within the community to prepare the family in advance
before disclosing the person‘s HIV positive status.
• It is also important for one to weigh the environment before
disclosing HIV positive status to colleagues at work. However, one
is under no obligation to disclose such status to colleagues at the
place of work unless it would be of help to the employer,
colleagues and self
• Love and care by family and friends is essential in coping with a HIV
positive status. If opening up will not contribute to this love, it is
important to wait until the family members are ready.
• The community strives to find ways of reducing the rate of stigma

when more people disclose their HIV positive status.
Session 29: EXPLORING THE ROLE OF THE COMMUNITY/WORKPLACE IN
PROVIDING CARE AND SUPPORT
Objective
Participants explore the role of community/workplace members in sustaining behaviour
change and supporting PLWH
Resources: 2 planks of wood (Bridges), pictures of sea animals, pictures of beautiful

holiday destinations or dream islands.
Methodology: Journey of Life game
Process
Step 1 Focusing on the future:

Let the participants try to walk across one bridge each time making sure one
foot is in front of the other with the toe of the hind foot touching the heel of
the front one. (Demonstrate this yourself as in the game in session 32). Get
everyone willing to try doing this.
Step 2 Ask: What should you focus on to help you cross the bridges?
Expect: The future/ambition/island
Step 3 Ask participants: When you were trying to cross the bridge, was it easier
when you kept looking at the crocodiles, or when you focused on where you
wanted to get to at the end of the bridges?
Expect or Explain as appropriate: Most people find it easier to stay balanced and
cross safely when they focus on the far end of the bridge, where the dream island
is positioned. When they focus on the crocodiles, they tend to fall off.
Step 4 Ask the participants: What does this mean to you:

Expect: Being faithful to my spouse irrespective of the temptations outside,
avoiding peer pressure, planning expenses together at home, adhering to
treatment, etc.
Step 5 Once participants have answered, say:

―If we focus on the problems of life, the water and the crocodiles, we are more
likely to fall into the problems. In our journey through life, it is more helpful to
focus on where we want to get to and how we want our future to be
irrespective of health status.‖
Step 6 Mobilizing community/workplace support

Let the participants who fell into the sea to try crossing the bridge once more.
This time, support the person (e.g. by holding the hand) as he/she crosses the
bridge.
Step 7 Ask:
• What helped you to cross safely on the bridges?
• How does this relate to real life when one is infected with HIV?
Step 8 Conclude the session by adding the following ideas if participants do not
come up with them in step 8 above:
• It helps to focus on the bridge & where you want to get to in life;
if you focus on the problems of life, the water & the crocodiles;
you are more likely to fall in.
• Removing shoes and leaving our bags behind makes it easier to
cross safely – in real life there may be things we need to remove
and get rid of to stay safe, for example a particular relationship
that puts pressure on us to have risky sex.
• Being sober – if you are drunk or using drugs, you are much
more likely to fall in.
• Having 2 bridges makes it a lot easier – if you know about and
you are able to make use of the different choices available to
you, it is easier.
Session 30: THE ROLE OF PROPER NUTRITION IN MANAGING HIV TREATMENT
Objective
The session increases the knowledge of the participants on proper nutrition.
Resources and advance preparation: Handout with meals that have different food
categories as in step 4 below. To include an annex on nutritional chart from NOPE
Methodology: Brainstorm, Group discussion
Process
Step 1 Ask the participants to mention some of the food they know, which are
available locally.
• What vegetables do you usually eat?
• What fruit do you usually eat?
• What flavouring do you usually add to your foods?
• What legumes, meat, fish, and milk or egg products do you usually
eat?
• What energy rich foods (such as fats, oils, sugar) do you use?
Step 2 Divide the larger group into two smaller groups and give them the
following learning tasks:
• Group 1: Make a diagram or drawing of a nutritious mixed
meal guide for an adult from your community/workplace.
• Group 2: Make a diagram or drawing of a nutritious mixed meal
guide for a child from your community/workplace.
Step 3 Ask the groups to present their diagrams or drawings to the large group
and explain their choices. After each presentation, ask for comments
or suggestions from others.
Step 4 Explain the following: It is good for everybody to eat regularly and to
have a diet mixed well to make it balanced to maintain the body
immunity. This is even more important for people with HIV in boosting
the body immunity. This means eating a variety of foods each day,
including:
• Protein (e.g. meat / chicken / fish / eggs /beans, peas or lentils)
• Fruits
• Vegetables
• Grains and Nuts (e.g. bread, rice, sorghum, maize, cereal,
pasta, sesame, sun flower or pumpkin seeds)
• Dairy Products (e.g. milk, cheese, yoghurt)
Step 5 Conclude the session by explaining the following to the large group:
• Children and adults with AIDS may have many illnesses, and they
may become very thin and wasted. This is partly because the
AIDS virus infects the gut, causing diarrhoea and partly because
AIDS patients have many other infections, which reduce their
appetites.
• In the early stages of HIV infection, before AIDS develops, eating
nutritious meals may help a person to stay well for longer.
• Breastfeeding a baby with HIV may prevent other infections, so
that he or she survives longer.
• When an adult or child with HIV starts to become ill with AIDS,
good feeding may help them to feel better. It may help them to
resist other infections, which make AIDS worse. Good feeding
cannot prevent AIDS or wasting, but it may slow down the illness.
There is no special food to cure HIV or AIDS.
• Proper nutrition is important for ARVs to work well.
Session 31: EXPLORING HEALTHY EATING
Objective
Participants practice designing nutritious meals with foods available in their
communities.
Resources: Handout with meals that different members of the family need and food
to avoid avoid food that will cause severe health problems. Alternatively, arrange for
a nutritionist to facilitate this session as a guest speaker.
Methodology: Group discussion, Brainstorm
Process
Step 1 Introduce what makes a healthy diet:

Ask Participants if there is a difference in diet for people with
and without HIV Explain that:
• People living with HIV should increase their daily food rations
intake. The reason is that a person with HIV has got a constant
infection, which the body is dealing with, and it therefore needs
more food and vitamins.
• It is important to clean your food and cook it properly - meat
should be well cooked. Drink only clean water and lots of it.
Note to the peer educator:

A food supplement has as its base a potent multiple vitamin and
mineral source that will supply a basic level of all the nutrients
important for human functions. This type of supplement should be
used with normal nutritious diet and should not replace the regular
nutritional foods we eat.
Step 2 Explain what foods people with HIV should avoid: People with HIV should
avoid too much sugar, fried foods and spicy foods. Use the table 7
below:
Table 7: Foods to avoid
Category Details
• Sugar encourages the growth of unhealthy fungus (e.g. Candida / Thrush) on
Sugar various areas of your body.
• More than 20 teaspoons of sugar per day (including sweets and other food rich in
sugar) reduces the number of fighter cells in your body by half. This can cause severe
health problems such as severe weight loss, diarrhoea, fatigue, and out breaks of
infections
• It is very difficult for your stomach to digest fried food. This can lead to stomach
Fried food upsets and diarrhoea.
• Spicy food - such as curry, peppers and chillies – can irritate your stomach and
Spicy food cause diarrhoea. You can eat such food, but be careful not to eat too much of it
Canned / Processed or
refined food • Canned foods have a lower nutritional value
Step 3 Developing a healthy menu for one day:

Divide the larger group into small groups of 4 - 6 people. Based on this
information, ask participants, in small groups, to discuss and create a
healthy ‗menu for one day‘, using only inexpensive, locally available foods,
which they would all be happy to eat.
Step 4 Each small group should then present, discuss and share their ideas for
what would in their community/workplace be a healthy, affordable menu.
Step 5 Exploring Vitamin and mineral supplements: Explain that:

As well as a balanced diet, people living with HIV benefit from additional
minerals and vitamins to help their body fight the HIV. Particularly
important ones are Selenium, Zinc, Vitamin A, Vitamin C and Vitamin B12.
Some of these you can get by eating particular foods. For example,
someone living with HIV can get enough Vitamin A by eating 3 or 4 raw
carrots a day.
Step 6 Summarize the session by explaining that there are several ways
that proper nutrition can help HIV-positive people remain healthy.
Use the information below to explain the following functions of healthy
eating in HIV management:
Containing HIV:
The ongoing presence of the virus means that the immune system must
always be providing the immune cells and chemicals required to fight it.
Since those cells and chemicals are created from nutrients, a steady supply
is a must for the body‘s contribution to viral control.
Protecting the body:

Any damage to the body caused by HIV or AIDS-related infections – and by
the body‘s immune response to the infection must be repaired. Nutrients
are the actual building materials with which the body creates and repairs
itself, so there is an ongoing need for those materials.
Improving quality of life:

Good nutrition is a must for feeling well. Optimal levels of nutrients are
required for good energy and overall well-being, and for the prevention or
the management of the many symptoms that nutrient deficiencies can
cause e.g., fatigue, appetite loss, skin problems, weight loss, mental
changes (like memory problems or difficulty concentrating), nerve damage,
muscle cramps, depression, anxiety, and many others. In addition, the
presence of adequate levels of certain nutrients may actually help prevent
and help reverse certain drug side effects. Thus, nutrients are an important
tool for helping people to feel better and maintain a higher quality of life.
Managing co-infections:
Many HIV positive people also have other chronic infections to deal with,
including hepatitis C and/or hepatitis B. For people with HIV and hepatitis
co- infection all of the above is doubled in importance since the body must
handle more than one chronic infection, and has a particular need to
support the liver, and prevent it from being damaged.
Session 32: CHANGING OF LIFESTYLES TO DELAY ONSET OF AIDS
Objective
Participants to understand the essence of behaviour change in relation to HIV and
AIDS.
Resources: Flip charts and marker pens, preparation on how to facilitate the AIDS
walk session. Prepare a participant to play the role of an uninfected person as in the
AIDS walk simulation below.
Methodology: AIDS walk simulation
Process
Step 1 Tell the participants that one way of delaying the onset of AIDS is to
change lifestyles from the ones that would enhance speed of HIV progression.
Tell them that the session will involve exploring the changes using a simulation
game called AIDS walk.
Step 2 Get one volunteer to play role-play uninfected person, while you role-
play a HIV positive person and stand in one line in front of the rest of the
participants. Explain to the participants that you will play the role of someone who is
HIV positive, while the volunteer will play the role of someone who does not know
his/her HIV status.
Step 3 Take one step forward both of you. Explain that both became sick but
with common cold (bend a bit to signify ill health). Explain that you went for
treatment, while the other person became fine due to strong immunity (both stand
upright).
Step 4 Both of you take one step forward once more. Ask the participants to
explain what would happen if both of you started coughing (both bend) and while you
went to the hospital; the other person did not and continued smoking and taking
alcohol (volunteer bends as you remain upright).
Step 5 Both of you take one step forward again. Ask the participants to explain
other behaviours or lifestyles that one needs to change especially when one is
infected with HIV and might speed progression to AIDS if not changed. Explain that as
time went on you went for regular medical check-ups, changed from those
behaviours hence became stronger while the volunteer eventually knew s/he had no
HIV hence did not change lifestyle (volunteer bends more).
Step 6 Take one step forward while the volunteer does not. Ask the participants to
explain why the volunteer could not move this time. Make sure either they state or you
explain that s/he became more ill probably the cough was due to TB.
Step 7 Take one more step ahead while the volunteer still remains at the former position.
Ask the participants to explain what could have happened at that time. Once they
mention that the other person could have died, tell the volunteer to go down (col-
lapse) and explain that due to the TB and the lifestyle, the person died while you
continue to live on.
Step 8 Take one more step ahead. Ask the participants to explain for how long they think you
will continue living now that you had confirmed your status and changed your
lifestyle. Explain that persons living with HIV can live for a long time so long as they
are ready to change lifestyles and implement advice from the health care providers.
Step 9 Thank the volunteer and tell him/her to return to the seat. Ask the participants if they
have any questions. Harvest the questions and handle them as appropriate.
Section 6: HIV COUNSELING AND TESTING
Session 33: RESPONDING TO HIV POSITIVE STATUS
Objective
To explore the range of emotions that a person may go through after confirming their
HIV positive status.
Resources and advance Preparations: Talk to a HIV counseling and testing service
provider to enquire about the variety of ways in which people react to their test
result especially upon testing HIV positive. Also read the information in step 4 below.
Mobilize a minimum of six participants and give each of then a reaction as in step 4
below to rehearse and prepare to enact during the session. Arrange for sitting
facilities for the session to be successful. Book a formal venue for the session. Sign
language expert for the deaf.
Methodology: Simulation game - continuum of testing
Process
Step 1 Tell the participants that you are going to explore the emotional
changes that a person undergoes as he or she slowly comes to terms
with the knowledge of HIV positive status.
Step 2 Explain to the participants that people who have learned that they
have a life-threatening medical condition have often exhibited some
common reactions that will be reflected in the session.
Step 3 Ask the six volunteers to sit in a semi-circle facing the other
participants.
Step 4 Explain to the six volunteers that each of them represents the same
person at the different stages of reacting to confirmed HIV positive
status. Explain the emotional stages as below:
• Shock – Condition of stun manifested verbally or non-verbally
through lack of expression, sweat, crying, dry mouth, agitation, etc
• Denial - Refusal to accept the situation: “It cannot be me, the test
kits are wrong”.
• Anger- Blaming other people for the situation. Vengeance or
Revenge.
• Depression - Going into seclusion. Feeling and wanting to be alone.
• Negotiation- Bargaining with God and the community pleading for
more time or a change of the status.
• Sublimation – Transferring all the energy and attention to another
thing. Many persons indulge in other activities other than what
exposed their life to danger like drinking alcohol, smoking, etc.
• Acceptance - Coming into terms with the situation regardless of
the outcomes. Always manifested in PLWH sharing their status with
someone they trust.
Step 5 Ask one volunteer at a time to enact the particular emotional stage in
the person‘s process of reacting to knowledge of HIV positive status.
Ask the rest of the participants to comment on the emotion displayed
by each of the volunteers at each stage. Ask them to explain how one
can move from that stage to a more positive one.
Step 6 Summarize the session by explaining that:

• The reactions after HIV test vary from one person to another and do
not occur in any established sequence.
• Also explain that it is not the duty of the counselor to force people
to react in a particular way.
• By accepting our HIV positive status, we give ourselves a chance to
improve the quality of our lives.
Note: The emotional feelings are not sequential all the time.
Session 34: FACTS ABOUT HIV COUNSELING AND TESTING
Objective
Participants explore the process of Voluntary HIV Counseling and Testing.
Resources: Marker pens/chalks, flipcharts/chalkboards, Sign language expert for the

deaf
Methodology: Experience sharing, Brainstorm
Process
Step 1 Ask: What does VCT stand for? Expect:

Voluntary- This means that no person can be tested without his or her
informed consent.
Counseling- Before getting the test, the person and the counselor
have a discussion on the HIV Test and the possible implications of
knowing ones serostatus are explained. This way a person‘s consent is
informed – he or she has the information needed to consent to the test
(pre-test counseling). After getting the test a person and the health
worker have another discussion where test result is explained and the
information, support, referral and encouragement to reduce the risk
behaviour is given (post-test counseling).
Testing- Refers to testing for either the virus or antibodies. In Kenya,
the VCT sites test for antibodies specific to HIV. A small amount of
blood from a person is tested for HIV antibodies (what the body
produces to fight HIV). If a blood sample tests positive for both the tests
the result is pronounced HIV positive and the opposite is true.
Step 2 Ask: If there is anybody who experienced VCT, what are the levels of
counseling available during VCT process and what happens at each level
entail?
Expect:
Pre-test counseling includes:
• Basic facts about HIV infection and AIDS.
• Meaning of HIV tests, including the window period.
• Personal risk assessment.
• Exploration of potential support from family and friends.
• Exploration of behaviour change.
• HIV testing procedures at the site.
Post-test counseling for those who test HIV positive includes:
• Maintaining positive attitudes,
• Avoiding additional exposure to the virus and other STIs,
• Taking good care of themselves medically,
• Eating a good diet,
• Joining organizations of PLWH and other social support groups.
• Referrals to additional services such as, social, legal and spiritual.
Post-test counseling for those who test HIV negative includes:
• Maintaining the negative status
• Avoiding exposure to the virus and other STIs,
• Taking good care of themselves medically in case of an STI infection,
• Referrals to sources of information on condom use, etc.
Step 3 Ask: What is the Window Period?

Expect: This is the time between when a person is infected by HIV and the
time the HIV antibodies in the person‘s serum can be detected during the
testing process. This period ranges on average between 6 to 18 weeks after
infection
Step 4 Ask: Who qualifies for VCT? Explain:

• VCT is for the people who want to know their health status i.e. whether
one is infected or not with HIV virus.
• Couples, partners, and people joining new relationship can do the test if
they so wish. Anyone age 18 or over can use VCT services.
• Those who are below the age of 18 and married, have children and are
sexually active are considered as mature minors can also use the
service.
• Anyone serious about behaviour change should receive counseling.
• Those with more than one serious partner should seek counseling.
• Those diagnosed with sexually transmitted diseases or tuberculosis
need counseling.
• Anyone who is 18 and over can freely request counseling.
• A couple before starting a relationship, before marriage, for pregnancy
planning should seek counseling.
44
• Youth between 15 and 18 can be served if they are ‗mature minors‘
and already engaging in risky behaviour. Counselors need to judge
carefully.
• Children under 15 should be served only with parental consent and
also if there is clear benefit to the child.
Step 5 Ask: Who Should Provide VCT?

Explain the following as a conclusion to the session:
• All VCT providers must be trained and approved in VCT counseling
and service delivery.
• VCT counselors should be carefully selected and their duties
adjusted so they can concentrate on VCT services.
• VCT counselors should abide by the VCT code of conduct and ethics
and have their certificates displayed at the service facility.
Types of VCT services:

 Static Site VCT service – stand alone
 Mobile/Outreaches VCT services
 Facility based VCT services – attached to a hospital or a health care facility
 Door-to-Door – home – based VCT
Session 35: COMMON TYPES OF HIV TESTS
Objective
Participants explore and understand the types of HIV tests available in the
community.
Process
Step 1 Introduce the session by reviewing the previous session on VCT.
Step 2 Ask: Is there anyone here who can share with us any other test for
HIV they attended that was not VCT? Let the participants share
their experiences.
Step 3 Explain: There are other tests that are used common when testing
for HIV. Many people confuse every HIV test for VCT but the
opposite is true. The following are other tests available that do
not fall under VCT:
Diagnostic Counseling and Testing:

There are times when a medical care provider might want to know
the medical issues affecting an individual especially after a long time
of management that seems not to identify the exact problem. Such
test is referred to as diagnostic tests. This type of test is also
commonly referred to as Provider Initiated Counseling and Testing
(PICT) when the provider advises the client to take a test that is
accompanied by counseling.
Mandatory Or Compulsory Tests:

There are some conditions set by some organizations that an
individual has to meet before getting either benefits or tasks within
the organization or establishment. Such conditions make the tests to
be compulsory or mandatory, on the individual as per the
requirements of the organization but are not necessarily legal. These
include:
a) Pre-employment tests
b) Tests prior to being given visas or documents for traveling to a
country
c) Prior to weddings as demanded by religious leaders
d) Testing for PMTCT (In cases of refusal by the mother)
Step 4 Explain that the mandatory tests might include counseling but consent
of the person to be tested is not given due importance.
Types of HIV testing Kits:

 Determine test kit- level of accuracy 99.9% is currently used as first test.
 Bioline line test kit (Level of accuracy-99%) is used as second test to confirm
positive results only
 Unigold test kits- Level of accuracy 99.9% is used as tiebreaker
 Polymerase Chain Reaction (PCR) - Is commonly used for testing children age
less 18 months. This test looks for the virus instead of the antibodies to HIV.
Session 36: HIV COUNSELLING AND TESTING FOR PREVENTION OF

MOTHER- TO- CHILD TRANSMISSION
Objective
Participants explore the role of PMTCT in HIV prevention.
Resources: A flip chart with information on PMTCT as in step 5 below
Methodology: Brainstorming
Process
Step 1 Ask: What can a mother with HIV do to protect the child from infection?
Explore the question with the participants and make sure their
suggestions include the following:
• Taking a HIV test and knowing HIV status.
• Getting regular prenatal care.
• Adhering to your HIV drug treatment plan.
• Adopting either exclusive breastfeeding.
• Adopting formula feeding (which poses a risk of infections from
hygiene and gastrointestinal infections).
• Involving the male partner in the antenatal care and HIV testing
process.
Step 2 Ask: How can a mother who is HIV positive be helped after delivery?
Explore the ways of assisting such a mother with the participants
making sure that the ways include the following:
• Continuing routine health care including pap smears and
monitoring for vaginal infections.
• Monitoring and treatment of opportunistic infections, malaria and
TB.
• Referring for antiretroviral treatment when indicated.
• Providing infant-feeding support.
• Monitoring for signs and symptoms of postnatal infection such as:
a. Burning sensation when urinating
b. Fever
c. Cough, shortness of breath
d. Severe lower abdominal tenderness
e. Redness, pus or drainage from any incisions
Step 3 Explain: After delivery, knowledge of HIV status can help the mother
who is infected with HIV to:
• Choose safer infant-feeding options.
• Initiate ARV prophylaxis for the infant.
• Access HIV treatment and care for herself
Step 4 Ask: What is exclusive Breastfeeding?

Expect: The mother gives her infant only breast milk except for drops or
syrups consisting of vitamins, mineral supplements, or medicines. The
exclusively breastfed child receives no food or drink other than breast milk
- not even water.
Step 5 Ask: What would be the best steps to take among the HIV negative mothers
or mothers with unknown HIV status?
Explore with the participants that for HIV negative mothers and mothers
with unknown HIV status:
• Breastfeeding exclusively for the first six months of life.
• After the infant reaches 6 months of age, introduce foods that provide
sufficient nutritional balance and are safe.
• Continue breastfeeding for up to 2 years or longer.
Step 6 Conclude the session by explaining the following:

• Mothers who are HIV positive should exclusively breastfeed when
replacement feeding is not an option.
• Discontinue breastfeeding as soon as feasible. There is no evidence
indicating a specific time for early stopping of breastfeeding - it
depends on each mother‘s individual situation.
• All mothers who are HIV-positive should receive infant-feeding
counseling from nearest paediatricians and nutritionists.
• Avoid all breastfeeding if replacement feeding is acceptable, feasible,
affordable, sustainable, and safe.
Section 7: STIs/ HIV PREVENTION AND RISK REDUCTION

Goal
Increasing the use of condoms is one of the main goals of many prevention strategies.
The subsequent sessions cover areas around attitudes, knowledge and skills in condom
use.
Objectives
i. The participants to identify HIV and STIs risk behaviours and how they can be
reduced.
ii. To increase knowledge and skills in using Condoms for STIs and HIV prevention.
Session 37: CODES ON CONDOMS
Objective
The session begins dialogue on difficult issues that people face in using condoms.
Some of the issues may include communication between husbands and wives, using
condoms in marriage set-ups, alcohol and condom use, and violence around condom
use.
Resources: Picture code in annex 5 and 6 as in step 1 below.
Duration: 30 Minutes.
Methodology: Picture Codes
Process
Step 1 Picture codes: Either one with a woman with laundry, a sex worker with a
Condom, or Violence against a woman.
Step 2 Alternatively (instead of a picture code) prepare a group to do either of

the following role-plays. The larger group should be told to watch the
role play keenly.
• A man comes home and greets his wife. The wife explains that she has
learnt from a peer educator about HIV and AIDS. She says that the peer
educator has told her to use a condom to prevent getting HIV and other
STIs .The man gets angry saying that condoms are not reliable, and
furthermore why should he use them with his own wife?
• Jane is an experienced sex worker. She visits a bar where she meets a man
who buys her alcoholic drinks. The man gets drunk and asks her to go to
the lodge for the night. Jane agrees and they move off to the room. When
Jane suggests using a condom, the man becomes violent and starts beating
her, shouting that she must now pay for the drinks he bought her.
• A man walks over to a sex worker. They negotiate a rate. She takes out a
condom he frowns, and tells her he will pay her double if she does not use
a condom. Double or no client? She accepts.
 A husband and wife meet and greet each other. The husband works far away
and has not been home for the last six months. The couple decides to have
sex. In the bedroom, the woman produces a condom and explains that it will
protect them against HIV and STIs. The man angrily accuses the wife of not
trusting him and threatens to beat her. He walks out, saying he is going for a
beer. The wife pleads with him not to go.
Step 3 Ask the following questions after showing the picture or after the role-
play ends.
• What did you see happening in the picture?
• Why does this happen in our community?
• What problems can this cause?
• How does this happen in our community/is there an experience
that occurred in our community similar to this?
• What can we do to solve such problems?
Session 38: FACTS, RUMORS AND OPINIONS ABOUT CONDOMS
Objectives
i. Participants to critically think about information they have heard or will hear
on condoms so that they can develop possible negotiation skills and statements
of assertiveness.
ii. The session also prepares peers to respond to other whenever they cite
unfounded information on condoms.
Resources: Cards written Facts, Rumours, Opinions as in step 1 below
Methodology: Values Voting Exercise
Process
Step 1 Tell participants that they are going to play Facts, Opinions and Rumours game
with statements about Condoms.
Step 2 Explore with the participants the meanings of Facts, Opinions and
Rumours. Explain that
 Fact - refers to scientifically tested and proven matter.
 Rumour - refers to existing information that may or may not be
true and you might never establish their source.
 Opinion - refers to a view of an individual with a doubtful
accuracy.
Step 3 Tell the participants that you will mention some statements and they
will decide whether the statements are Facts, Rumours or Opinions. Tell
them that they will move to the sign of their choice to show their position
on the statements.
Step 4 Tell participants that you will read some statements, one at a time.
They should decide whether the statement is Fact, Rumour or Opinion and
show their decision by moving to the sign that shows their position on the
statements. Alternatively tell them to show their position by making an
appropriate physical sign or sound.
Step 5 Use five or six of the statements below for this exercises, which is
participatory and carried out in a way similar to the one of Facts, Opinions,
Rumours on HIV and AIDS.
Step 6 Alternatively different positions can be demarcated as Facts,

Rumours, Opinions and participants to move to these places or show the
sign of their choices as the statement is read.
• Sex with a condom is not real sex.

• Condoms prevent STIs and HIV.
• Condoms always burst.
• Condoms can get lost inside a woman.
• Only men should carry Condoms.
• Condoms prevent pregnancy.
• Condoms are laced with HIV.
• Putting a condom on is fun and sensual.
• Using three condoms is safer than one.
• Condoms are only for use with a casual partner.
• Female condoms are uncomfortable.
• Sex is not pleasurable with a condom.
• Condoms are embarrassing.
• Condoms cost too much.
• Condoms are for sex workers.
• Condoms cause irritation and pain.
• With condoms you do not feel close to your partner.
• Female condoms are better than male condoms.
• HIV can pass through the pores in a condom.
Step 7 Let the participants correct each other and share their differences in
answers. Maximize the use of challenging techniques to make the
sessions very participatory without leaving them to generate into
confrontations and word matches.
Step 8 You could ask the group the following questions to probe further on
the discussion:
• Why do you think such rumours exist?
• What are some of the consequences of such rumours and opinions?
• What do you think is the best way to approach and talk to
someone who believes that a rumour is a fact?
Session 39: PRACTICING GIVING CORRECT AND CONSISTENT INSTRUCTIONS
Objectives
The session always goes together with the one on practicing to use condoms.
i. Participants increase knowledge and skills in condom use.
ii. Participants also learn what Correctly and Consistently means
iii. Participants practice using Condoms by putting them on Penile Models
Resources:
i. Four Sheets of plain paper.
ii. Large supply of Condoms (male and female)
iii. Penis Models (enough for participants or half their number)
iv. Flip chart with words CORRECTLY and CONSISTENTLY written with definitions:
Methodology: Paper folding Game
Process
Step 1 Show the flip chart with the words CORRECTLY and CONSISTENTLY
written. Ask the participants what they think the two words mean while
noting their suggestions on a flip chart.
Step 2 Summarize the suggestions from the participants into one statement
for each. Lead the participants through a mini lecture on the meaning of
two words (see resources above).
CORRECTLY: Means in the right way
CONSISTENTLY: Means every time someone has sexual intercourse. Not
Sometimes but Everytime.
Step 3 Tell the participants that we are going to begin the session by playing a
game on folding pieces of paper.
Step 4 Ask four people to move out in front of other participants. Ask all of
them to close their eyes (or blindfold them) and let them promise to keep
their eyes closed.
Step 5 Tell the large group that silence is a necessity for this exercise and
no one is to ask questions until the exercise ends.
Step 6 Give each of the four volunteers one piece of paper then give them the
following instructions step by step:
• Fold your paper into half lengthwise
• Tear off the bottom right hand corner of the paper
• Fold the paper into half again
• Tear off the lower left-hand corner
Step 7 Ask the four volunteer to open their eyes. Tell them to display their
papers to the entire group. (Expectation: It is very unlikely that the
papers would be the same).
Step 8 Ask the participants these questions:
• What do we learn from this game?
• What does this tell us about educating peers on using Condoms?
Step 9 Conclude the session by explaining that: We often think we are saying
something clearly to someone, only to find out later that what we said
or meant with what they did were quite different. This is why we use
Penile Models and practice several times.
Session 40: PRACTICING USING CONDOMS
Objectives
i. Participants practice using condoms correctly
ii. Participants define the terms consistently
Resources: Condom demo cards as in step 1 below, penile models, condoms
Method: Condom demonstration game / dance
Process
Step 1 Ask the participants to stand in one large semi- circle. Give the
participants one card each and ask them to read their card loud while
showing it to the group. (You can use Swahili statements or read the
cards as appropriate).
Card: Check expiry date or date of manufacture

Card: Discuss condom use with partner
Card: Have Condom with you
Card: Have an erection
Card: Open condom wrapper carefully
Card: Squeeze air out from tip of Condom
Card: Roll condom on erect penis all the way down to the base
Card: Intercourse
Card: Hugging and Fondling
Card: Ejaculation
Card: Withdraw penis from partner, holding onto condom at the base
Card: Be careful not to spill semen
Card: Remove condom from penis
Card: Hugging and Fondling
Card: Penis gets soft
Card: Throw Condom away in a place where children won‘t find it or
touch it e.g. pit latrine
Card: Open another condom (if you have sex again)
Step 2 Ask the participants to discuss the statements on their cards then form
a line in the correct order so that their cards describe the step-by-step use of a
condom.
Step 3 When they finish, ask the rest of the participants to comment on the
order. Let the participants make any changes that are necessary. Be sure that
the final order is correct.
Step 4 Ask the participants to tape their statements in that final order and
thank them (use the agreed group method of appreciating) asking them to sit.
Step 5 Now take a condom and a penis model and stand in front of
the group where everyone can see you. Let the group read the steps in
the way they were arranged and do the demonstration, explaining
every detail as you do so.
Step 6 Ask the participants to find a friend or sit in pairs. Give each pair
pieces of condom and a penis model. Ask them to take turns practicing or
demonstrating how top use the condom correctly.
Step 7 Ask one participant to act as a judge. Take the judge

around the room to observe the demonstrations by the pairs. Let the
judge pick the pair that has done it most skillfully.
Step 8 Ask the pair to demonstrate in front of the whole group.

The rest of the participants should ask any question on the
demonstration and suggest any improvement.
Step 9 Ask the following questions:
 What was easy or difficult in demonstrating Condom use?

• What could we do in relationships or peer groups to reduce
the difficulties in demonstrating condom use?
Step 10 Make sure the condoms are not left lying around the place. Put the ones
used during the demonstration in a dustbin or box to be disposed later
in the correct way.
Step 11 Conclude the session by asking the participants the following

questions:
• Where do we get our condoms here?
• What disposal methods are the most appropriate in our
community here and what makes them the most appropriate?
Session 41: EVALUATING RISKY AND NON-RISKY BEHAVIOR
Objectives
The session is to give participants practice in analyzing what behaviours, sexual and
non-sexual behaviours and the degree of HIV risk associable with each behaviour.
Resources
i. Three signs on the wall written ―No Risk‖, ―Low Risk‖, and ―High Risk‖. For
low literacy groups use faces that symbolize these categories.
ii. Behaviour cards reading:

• Abstinence
• Touching
• Hugging
• Massaging
• Masturbation
• Rubbing bodies together
• Social kissing (dry kissing)
• Having sex with a virgin
• Kissing or licking where there are no genitals or sores
• Talking about sex and fantasies
• Bathing together
• Having sex with a holy person
• Virginal intercourse with a condom
• Having sex with a person with disability
• Oral intercourse without a condom or latex barrier
• Anal intercourse without condom
• Having sex while drunk
• Sharing Intravenous drug needles
• Any activity that allows blood to blood contact
• Sharing a toilet or kitchen
• Having sex once a month
• Having many sexual partners
• Having sexual intercourse and an STI
• Having a partner with many sexual partners
• Sharing sex objects like vibrators or pelvic models
• Mutual masturbation
• Watching pornography
• Smoking bhang
Methodology: Brainstorm and discussion
Process
Step 1 Distribute the behaviour cards to each participant, reading each

card aloud.
Step 2 Tell the participants that each card describes a sexual behaviour
and they will decide on which category of behaviour their card
belongs.
Step 3 Show the participants signs on each part of the wall and explain
what they mean
• No Risk - No or very little chance of HIV transmission
• Low Risk – Some or reduced risk of HIV transmission
• High Risk - High risk of HIV transmission
Step 4 Let the participants decide under which category of behaviour on

their card belongs and they should tape the cards they have
under the categories of choice.
Step 5 When all have taped their cards, review each card, one at a time
with the large group and discuss whether or not the card is at the
right place (category of behaviour) or not.
Step 6 Show the participants a flipchart with a summarized version of the

information as below:
Explain the following:

a) Safer Sexual Behaviours:
• Complete abstinence is the surest way of avoiding
infection through sex. Is it likely with adults?
• Strict mutual faithfulness is another surest way between
two people who are in a relationship or have never had sex
before is another surest way
b) Risk of HIV infection can be reduced by:

• Using clean and sterilized needles and not sharing needles.
• Using condoms correctly and consistently.
• Reducing the number of sexual partners.
• Seeking prompt treatment of STIs, notifying partners and
having them treated.
• Seeking PEP services immediately one is exposed to HIV.
• Observing universal care precautions when cleaning or
dressing an open wound.
• Getting to know your HIV status.
Section 8: GENDER, HIV AND GENERAL HEALTH

Introduction
Gender refers to social differences used to define being male or female. They are
social because they are based on cultural values, attitudes, roles, practices and
characteristics that are used to define one as either male or female. Gender
differences are socially constructed roles that tell us what is expected from a woman
or a man in a certain social context, time and culture. Also, it has to do with how we
think, feel and belief about the concept of masculinity and femininity. The roles
allocated to either gender by the community have an element of invisible contract
that regulates power and decision-making. It is sustained and reconstructed by both
men and women. This status is protected by and cannot easily be changed by BOTH
women and men. It is a common knowledge that gender inequality is the main
problem affecting HIV and AIDS prevention because power relations in sexual
relationships can allow or stop people from using the knowledge and skills they have
acquired to protect themselves against HIV transmission.
Session 42: GENDER TIMETABLE & GENDER RELATIONS
Objectives
By the end of this session the participants should be able to:
i. Participants discuss gender in relation to spread of HIV and AIDS.
ii. Participants describe gender roles.
Resources: Flipcharts, marker pens
Methodology: Group Discussion
Process
Step 1 Ask the participants: What is the definition of gender? Sex?

Expect: Gender: Are socially constructed differences between males
and females. You are not born with your gender identification hence it
can be changed. It also refers to everything a` person says or does,
consciously or unconsciously, to express maleness or femaleness.
Sex: is biological, you are either born a male or female. The term is
also used to refer to sexual intercourse.
Step 2 Divide the participants into 2 groups of different sexes (males and
females). Explain the task; each group will share what they usually do
during a non-working day and have a general agreement on the
activities that are performed by the group.
Step 3 Ask the groups to make a timetable for that day in a typical male‘s
/female‘s day. Each group should choose someone to present their
work at plenary. Walk to the groups to ensure that they outline the
events for the entire day, allocating time accordingly.
Step 4 Ask each group to paste their work on the wall and let the group
representative present the timetable at plenary. Allow comments and observations
from the other group members have as they listen to what the opposite group has
presented.
Step 5 Lead the participants in quantifying the time that is not allocated to
leisure activities in the 2 timetables. Explore with the participants the
different scenarios that come out.
Step 6 Wrap up the session by explaining the following:

• Women are more infected with HIV than men. The roles of
women in managing the effects of HIV are also more
pronounced than those of men due to their social role of
providing for and caring for the sick family members.
• In addressing the needs of a society towards their health
situation especially aspects of reproductive health, the gender
concerns need to be considered.
Session 43: GENDER AND SOCIO-CULTURAL PRACTICES
Objectives
i. To explore how gender is related to socio-cultural practices.
ii. To explore the relationship between socio-cultural practices and HIV infection.
Resources: Flipcharts, marker pens, information on alternative rites of passage

Process
Step 1 Begin the session by writing the words ―Society and Culture‖. Ask
learners to try to define the two terms separately. From the participants‘
suggestions develop one working definition for the terms.
Step 2 Ask the participants to give a variety of examples of socio-cultural

practices. The following points should come out:
• Widow/er cleansing during inheritance

• Circumcision
• Dowry/bride price
• Polygamy
Step 3 Divide the participants into three groups to discuss and present how each
of the socio-cultural practices (polygamy, Widow cleansing and
circumcision) may lead to the spread of HIV and AIDS. Tell them to
share their responses with the large group.
Step 4 Ask the large group to explain how each of their communities has
responded to each of the practices discussed in step 2 above.
Step 5 Share with the entire group that some communities have developed
alternative rites of passage for female circumcision. Also explain that
some communities have developed alternatives to widow cleansing by
eliminating the sexual aspect in it.
Session 44: GENDER AND STEREOTYPES
Objective
Participants explore the various forms of stereotypes that exist in Gender roles
Resources
i. Index cards or Visualization in participatory presentations (VIPP) cards
ii. Flip Chart and markers or alternatives
iii. Flipcharts each written separately:
• Men may believe that to be masculine they should...
• Women may believe that to be feminine they should...
Methodology: Group discussion, brainstorm
Note: Consider defusing any tribal inclinations that may come from these stereotypes
Process
Step 1 Ask: What people say about Kikuyus, Luos, Kambas, Merus, Kisiis, Luhyas,
Maasais, etc (use the dialects or tribes in your country). List the
responses from the participants on a flip chart or chalkboard.
Step 2 Ask: What do you think about these statements? Wait for participants to
say that they are stereotypes.
Step 3 Ask the participants to recall the definitions of the terms ―sex‖, ―gender‖
(see session 43). Tell them also to define the term ―stereotype‖ in
relation to traditional practices and the spread of HIV. Confirm the
definitions are as hereunder:
Stereotype: The belief that all people that belong to a certain group-
gender, age, tribe - do, or should, act alike; does not allow for
individuality.
Step 4 Ask the participants to give examples of gender roles and stereotypes and
write these on the flip chart/newsprint.
Step 5 Explain that stereotypes also influence:

• The way we feel about ourselves.
• How we behave.
• What we believe we can do.
• What goals we set for ourselves.
Step 6 Divide the larger group into two and smaller groups based on gender.
Give the female group the assignment 1 and the male group the
second assignment as below and tell them to write their responses on
the separate sheets of newsprint:
• Group 1: Men may believe that to be masculine they should...
• Group 2: Women may believe that to be feminine they should...
Add any of the following if omitted by the participants:
Men may believe that to be masculine they should:

• Be in control and appear unemotional
• Be the dominant partner in a relationship
• Exert pressure or force on their sexual partners
• Become sexually active early and have many partners
• Work in careers that are mechanical or analytical
• Assume responsibility as the `head of the family‘
• Achieve status by having many children and by earning lots of
money
• Take risks to prove their manhood
• Resolve conflicts with violence
• Show they can drink a lot
• Avoid traditionally `female‘ work in the home and work place.
Women may believe that to be feminine they should:
• Be emotionally sensitive and vulnerable;
• Submit to the wishes and demands of a sexual partner;
• Have many children, regardless of personal wishes;
• Meet the needs of others before their own;
• Be physically attractive by someone else‘s standards;
• Tolerate sexually harassing behaviour without complaint;
• Assume responsibility for violence, sexual assault or rape;
• Avoid non-traditional careers in maths or in the sciences.
Step 7: Conclude the session by pointing out the following to the participants:
• If we believe that we are limited in what we can do with our
lives because of our gender, then we will probably set different
goals for themselves.
• Because gender roles can severely limit our expectations of
ourselves, as well as the goals we hope to achieve, it is
important that we become more aware of them. It is by being
aware of them that we may be able to overcome some of these
`stereotypical‘ ways of thinking.
Session 45: GENDER STEREOTYPES AND RELATIONSHIPS
Objective
Participants explore how gender stereotypes affect the HIV and AIDS situation.
Resources and advance preparations: Picture code on domestic violence as in annex

Process
Step 1 Tell the participants that the session would involve discussions on a
picture code
Step 2 Distribute copies of the picture code among the participants making sure that
all participants have seen them then ask them the following questions:
• What did you see happening in the picture?

• Why do such things happen in our community?
• What problems can be caused by gender-based violence?
Step 3 Divide the larger group of participants into two small groups of males
and females. Ask each group to come up with as many endings as they can for
the following sentences:
• Male groups--- I‘m glad I‘m a man because:
• Female groups-- I‘m glad I‘m a woman because:
Step 4 Ask the groups to put their responses on index. Allow about 10 minutes for this
activity. Then ask the groups to think of as many ending as they can for the following
sentences:
• Male groups--- If I were a woman, I could...
• Female groups--- If I were a man, I could...
Step 5 Direct everyone‘s attention to the responses and ask if there are any
stereotypes or are they true characteristics of all women? Men? Draw a
line through any responses the group concludes are stereotypes.
Step 6 Explain to the participants that gender roles can affect our relationships.
Explain that this next activity will explore situations where gender
roles and stereotypes could affect goals, decisions and relationships.
Discussion Points
1. Are there negative consequences for a young woman who limits

herself to traditionally female roles? Of a young man limiting
himself to traditionally male roles?
2. What happens in our society when a woman behaves in ways

traditionally thought of as `male?‘ What about a man who
behaves in ways traditionally perceived as `female?‘
3. What evidence do we have that gender roles are changing here in
our community?
4. What are some of the ways changing gender roles have affected
relationships between men and women in the family, social
settings and work place?
Session 46: SEXUAL ABUSE AND EXPLOITATION
Objectives
i. Participants describe the different forms of sexual abuse common in their
community
ii. Participants describe ways of dealing with sexual abuse including date rape,
domestic sexual abuse, incest and family violence.
Resources: Flipcharts or writing board, video/CD called ―Tough Choices‖ cued at the
scene where a man laces the drink of a young girl in a bar and later exploits her
sexually, markers or chalk. In case lacking, use picture on annex 8.
Methodology: Video discussion, experience sharing or picture code discussion
Process
Step 1 Tell the participants that the session would involve discussions on a
video or a picture
Step 2 Show the picture or cued video to the participants making sure that all
participants have seen them then ask them the following questions:
• What did you see happening in the video?
• What problems can be caused by gender-based violence?
• How else does this happen in our community/is there an
experience that occurred in our community similar to this?
Step 3 Divide the participants into gender groups and assigns the following
groups task.
• Identify forms/kinds of abuse sexual (social, physical, emotional
etc) that occur in our community and workplace
• List the common causes of such abuses
• List the tell-tell signs of the different forms of abuse
• State the solutions to sexual abuse in our community/workplace
Step 4 Let each group present its work at plenary and allow reactions from the
other groups. Ensure that the common types of abuse that are directly
or indirectly linked to risk of HIV infection come up; (such as rape,
date and acquaintance forms of rape, incest, child abuse, domestic
violence, wife battering, husband battering, alcohol abuse etc).
Step 5 Explain the following to the participants:

• When adults use children sexually it violates the child‘s rights.
• Researches show that many sexual problems in adult life can
be explained by undesirable childhood sexual experiences.
Step 6 Conclude the session by explaining the following to the participants

• One of the factors contributing to sexual abuse is the lack of
social power by women in relationships. For example, women
might not be able to suggest use of condoms for protection
against sexually transmitted infections or unwanted pregnancy
to their partners.
• The stigma of women carrying condoms is a limitation against
safer sex practices.
• Other social factors that exert pressure to both men and
women on how the society expects men and women to express
sexuality also affect how women participate in gender
relations.
• Sexual abuse is often perpetrated by people we know.
Session 47: EXPLORING DATE OR ACQUAINTANCE RAPE
Introduction
Anyone can be a victim of rape, men or women, boys or girls. However, men commit
rape against women in most incidences. This can also be in relationships that already
exist hence referred to as date or acquaintance rape. Emphasize that when a person
is forced to have intercourse against her or his will, it is always rape or sexual assault,
regardless of the circumstances, and it is illegal.
Objectives
i. Participants define date or acquaintance rape
ii. Participants explore ways of avoiding/preventing date rape
Peer Educators‟ Tip:

Exercise a great deal of sensitivity when conducting sexuality education
sessions on abuse; always be open to the possibility that someone in the
group could have experienced some kind or form of abuse and that will
be signalled in some way. The person may need private counseling or
help.
Resources and advance preparations: Picture codes in annex 9, read the notes in
annex 10 on acquaintance rape in advance.

Process
Step 1 Write the following sentence on newsprint or the board: ‗Young men learn
violence. Young women learn to accept it‘.
Step 2 Ask the participants to brainstorm on whether they agree or disagree with
the sentence. Tell them to support their opinions with examples.
Step 3 Ask what the crime is called that occurs when a partner in an existing romantic
relationship forces another to have sex. If no one answers correctly write
`acquaintance rape/date rape‘ on the flipchart or board then clarify as below:
Acquaintance rape (also known as date rape) is forced sexual activity by someone the
person has an intimate relationship with.
Step 4 Distribute photocopies of the picture code in annex 9 to the participants

making sure that each participant is near one then ask them the following questions in
succession:
• What do you see happening in the picture?

• What problems can be caused by acquaintance rape?
• If rape is so common, why is there so little talk about it?
• Why do you think there is so much physical abuse in relationships
among sexual partners?
Step 5 Conclude the session by explaining the following points, if they were
missed:
• Rape, whether by a stranger or an acquaintance, is an act of
aggression that uses sex to show the victim that the rapist has
power.
• Books and movies often suggest that women are turned on by the
force of rape and may even fall in love with the rapist, but a
victim of rape never experiences the act in a positive way, even
in a date situation in which the beginning of the sexual
encounter was pleasant.
• Alcohol and/or drugs are very often involved when acquaintances
rape occurs.
Being drunk or high makes women less able to set clear sexual
boundaries and men less inclined to listen to, or abide by, those
boundaries.
• Nothing a woman does -- using drugs or alcohol, going to ―risky‖
places, wearing mini-skirts or other ―Indecent style‖ clothing,
kissing and sexually touching or even having previously had sexual
relationship with a man -- gives a man the right to force her to
have intercourse against her will.
• Men have greater difficulty in sharing incidences of rape against
them.
Note: Peer Educator can refer to the Sexual Offenses Act
Session 48: PREVENTING DATE OR ACQUAINTANCE RAPE
Objective
Participants describe ways of preventing date rapes.
Resources and advance preparations: Flipcharts, marker pens, participants prepared

to enact the role-play in step 2 below. Read information on Acquaintance rape in
annex 10 in advance.
Process
Step 1 Tell the participants that the session will involve watching a role-play and
answering some questions later.
Step 2 Ask the volunteers you had prepared to enact the role-play below
emphasizing on what they would do to prevent a sexual activity from
taking place by ‗communicating directly‘ and ‗backing up the words
with body actions.‘ Encourage the rest of the participants to ‗coach‘
volunteers in the role-play on the strong verbal and nonverbal
communications skills to use.
A man and his lady visitor are sitting in a room. The man tells the
lady several nice things about her. He later asks her for sex. The
woman states that she was just visiting and proposes some other
time. The man becomes impatient and asks why she dressed that way
and came alone if she was not ready for sex. The woman starts to feel
nervous and wants to leave but the man holds her back. The man tries
to pull the woman towards the bedroom and the woman is shocked. A
struggle ensures.
Step 3 Tell the participants in the role-play to pause at some points by saying
freeze then ask the participants the following questions:
• What did you see happening in the role-play?
• What are the factors that cause rape in our community?
• What problems do rape cause?
• What if you do all the right things and are unable to stop your
date from raping or assaulting you? Does that mean you didn‘t
try hard enough? What should you do?
(Possible response: Whenever rape occurs, regardless of what was or

was not said or done to prevent it, it is never the victim‘s fault. If you
are raped, get help immediately and do not feel guilty. Assist the
court system to have the rapist convicted.)
• What three messages would you give to community members

about men who force women into sex?
• What are some of the things you have heard people say about
women who have been raped and how do you feel about the
things these people say?
• What precautions can women take against stranger rape?
(Answers: Responses may include: Be alert to the surroundings;
avoid dark, lonely places at night; keep doors and windows
locked; keep a loud whistle on a key ring; take a self defence
class; walk in groups.)
• What are some things that women can do to help prevent date
rape? (See annex
10)
• How can we identify the signs of potential rape?
Answers may include: too much sexual demand,
threats, etc. (See annex 10)
Section 9: HIV RELATED STIGMA AND DISCRIMINATION
Session 49: NAMING THE PROBLEM
Introduction
This section introduces the concept of HIV related stigma and provides an opportunity
for learners to identify what stigma is, and how individuals stigmatize others with HIV
and AIDS. The section helps learners to recognize and articulate some of the emotions
that accompany stigma and how stigma affects children and adults with HIV.
Objective
To explore different types of stigma and discrimination in the society
Resources and advance Preparations: Prepare a whistle, flip charts, markers, and
red cards for each participant. Identify or ask for a participant who is good at reading
and let him/her prepare to read the story line as in Step 2 below.
Methodology: Storytelling
Process
Step 1 Tell participants that you are going to explore the ways in which stigma
and discrimination are manifested in the community using a story.
Step 2 Let the participant identified read the following story aloud while the
rest should identify the instances of stigma and discrimination in the
story.
Joseph is a star midfielder in the company football club. His dazzling

skills have earned him the nickname „Dribbler Joe‟ or “DJ” and made
him a favourite of the club‟s male and female supporters. One day
during training, the team‟s coach realized that Joseph coughed
persistently and could not play for the usual 90 minutes without
complaining of fatigue and burning chest.
“You need to go for a check-up” the coach told him. The test
confirmed that Joe was developing tuberculosis. “I knew that, I will
not be surprised if it is the virus,” his reserve remarked when the
coach informed the team of Joseph‟s situation “He is dying. He thinks
that football and girls must go together” the reserve retorted.
Joe would have to miss two matches to undergo treatment. He
refused to eat and within one week he had lost a lot of weight and
looked frail. He isolated himself from his friends. The doctors urged
him to eat regularly, but he declined until his coach pleaded with
him.
When Joseph requested to be included in the line-up in the
subsequent game, his team-mates refused, saying he was HIV positive
and would infect them if they came into contact with him. He
appealed to the coach, who was also unable to make a decision, citing
club rules. Joseph later received a call from the team patron who
explained that the team‟s policy was strict about the behaviour and
conduct of its players and that it was Joseph‟s fault to have been
taken ill. “You are always seen in the company of girls after every
match,” remarked the patron. Joseph reflected on this and decided
to go for a HIV test. At the reception room Joe was impatient and
could not stick to the queue. “My status cannot allow me to stay in
such a queue,” he told the patients he found at the queue.
The test indicated that Joe was negative. However, he was asked to
go back for another test after three months. At the VCT centre, he
was introduced to the Post-Test club VCT counselor. DJ retorted,”
That‟s a club for people with HIV. Who said I have HIV?”
Step 3 Hand out a red card to each participant. Tell them that they will be
required to flash out the red cards any time they hear a case of stigma
or discrimination in the story
Step 4 Repeat the story for the last time and explain to the peers that as you go
through the scenario, they should raise their red cards each time they
hear any form of stigma or discrimination.
Step 5 Each time a card is raised, pause the story and ask the participants
raising the card to explain how the stigma or discrimination
manifested itself at that instance. Ask the participant raising the card
to describe the type of stigma identified.
Step 6 Conclude the session by explaining the following forms of stigma.

Alternatively, confirm that the definitions given by the participants
match the descriptions of stigma as below:
• Indirect /subconscious stigma: Deep feelings one can have,
which makes one feels disrespected or unloved;
• Trying to avoid any form of perceived risk as part of human
nature
• Direct stigma: Being blamed for health status that they
deserve it; People running away from you because of a
disease you have.
• Self-stigma — the desire to be accorded special status or favours
due to health status.
• Feeling ashamed because of one‘s HIV or other health status
• Reversal stigma: Stigma/discrimination of others because they
are not infected or they have not gone for a test.
Session 50: EXPLORING CAUSES OF STIGMA
Objectives
i. Participants explore the causes of stigma
ii. Participants start exploring how to handle stigma
Resources and Advance preparation: Rehearse and prepare for facilitating the
sinking boat game as in the process below.
Methodology: Life-saving boat game, experience sharing

Process
`Step 1 Tell the participants to form a loose circle and explain to them the
session will involve a game called the life-saving boat.
The game:
Explain to the participants that they are on a ship, which is sinking.
They have to getinto lifeboats, but the carrying capacity of the boats
is limited and you are the lifeguard. Tell the participants to move
around the room at random and pay attention to the capacities of the
boats you will state. Continuously say “the boat is sinking” while the
participants respond “sinking”. At random, state the boat capacity of
choice (e.g. in groups of 3, 5, 2 or 1). Each time the boat capacity is
stated, the participants should form groups of 3, 5, 2 or 1 as stated.
Eliminate those who have drowned - groups that are bigger or smaller
than the number announced. Continue with the game each time
announcing a new number so that regrouping is necessary until there
is only one small group left.
Step 2 End the game and explore it with the participants using the talking
points below:
• Everyone laughed when the first person made a mistake. Ask the
person who made the mistake—―How did that make you feel?‖
[Expect: Embarrassed, angry, stigmatized, the laughter made me
feel bad…]
Step 3 Ask the participants: What makes people to stigmatize others?

Make sure the suggestions from the participants include the points
below as causes of stigma:
• Fear
a. Fear of infection, fear of the unknown, general fear of
death
b. Scary images in earlier campaigns against AIDS instilled
fear thus fuelling stigmatisation.
• Moralistic views
a. The view that Persons Living with HIV are sinners,
promiscuous, unfaithful, and people who ―sleep around‖,
b. AIDS is portrayed by religion as punishment for immoral
behaviour
• Misconceptions and lack of knowledge
a. Lack of knowledge on risky and non-risky behaviours.
b. Lack of knowledge on the difference between HIV and
AIDS resulting in failure to appreciate that people living
with HIV & AIDS can be productive and useful to their
families.
c. Denial exists especially when communities view infected
persons as having broken some taboos.
• Gender and economic status
a. Women are more stigmatized than men. They are
regarded as prostitutes hence are more likely to be
infected.
b. AIDS is viewed as a poor person‘s disease.
Steps 4 Conclude the session by explaining any other cause of stigma not
mentioned by the participants. State that the subsequent session will
involve further explorations about stigma and discrimination
Session 51: EXPLORING EFFECTS OF STIGMA
Objective
To explore ways of reducing stigma against persons infected with HIV or affected by
HIV.
Resources: Flip charts and marker pens

Methodology: Life-saving Boat game, experience sharing
Process
Step 1 Involve the participants in the sinking boat game as in session 51

above.
Step 2 Explore the effects of Stigma in the community using the questions
below:
• What did you see happening in the game?
• What are the general effects of stigma and discrimination in the
community?
• What can we do to reduce the effects of stigma in the
community?
• What are the effects of stigma on persons living with HIV?
The responses might include the following as possible effects on PLWH
• Loss of job, friends and self-confidence

• Becomes withdrawn and depressed—may start drinking
excessively.
• Lots of worry, isolation and self-isolation
• Attempted suicide
• Anger or violence against partner and the community
• Explore more from participants
Step 3 Conclude the session using the following discussion points.
1. What prevents PLWH from feeling good about themselves?

2. Why is it important for PLWH to feel good about themselves?
3. How can PLWH be assisted to live positively by family
members? Friends? Colleagues?
4. Who carries the greatest burden of care and how you can
share the burden more? How can fellow caregivers support
each other?
Session 52: EXPLORING STIGMA AND THE FAMILY
Objective
To explore how stigma affects the family and modes of reducing stigma at family
levels.
Resources: Flip charts and marker pens
Process
Step 1 Divide the larger group into three smaller groups. One group should
discuss what the immediate effects are, the second group should
discuss what the longer term effects are and the third group should
discuss what the effects on the family member living with HIV. Allow
about 10 minutes for this and then share their responses. The
following points should come out:
Group 1: Likely immediate effects on the family on finding out that

one of them has HIV.
• Shock
• Anger
• Disappointment
• Worry
• Grief
• Sorrow
• Fear of caring for PLWH
• Burden
• Fear of infection
• Fear of neighbours finding out and being stigmatised
• Family denial - refuse to accept results
• Family inaction - don‘t know what to do
• Hatred within family
• Blaming - I told him/her not to go out with other
women/men
Group 2: Likely longer term effects on the family

• Conflicts within the family
• Divorce or separation
• Heavy burden on the caregivers (usually women) leading
to burnout
• Loss of income and money problems
• Children drop out of school and may become orphans
• Widows
• Sexual cleansing
• Property grabbing
Step 2 Ask the participants to stand in a circle and tell them we are going to tell
a story and each person has to add on a line or two. Start a story
about a person living with HIV. Set the scene and then ‗pass‘ the story
to the next learner. Each person makes up a couple of lines to develop
the story - and then the next person takes over the story.
Step 3 Monitor how the story develops. At any point, change the direction of the
story. Make sure you cover some ideas about the PLWH being
productive (working, building a house, helping someone) and being
involved in decision-making. Once you have gone round the circle
(depending on how big it is) ask learners to sit down and summarize
what happened in the story by making the following points:
• PLWH can lead long and productive lives.
• They can make a big contribution to their families, jobs, and
communities.
• The ability to contribute should be recognized and valued.
Things Persons Living with HIV can do to lead long and productive lives include:
• Getting love and care from those around them;
• Successful disclosure to partners, family members, and friends;
• Getting treatment for their infections as early as possible;
• Getting Antiretroviral Treatment, if it is provided or they can
afford it;
• Practicing safe sex to avoid getting more HIV into their bodies;
• Eating well, avoiding too much alcohol and avoiding stress;
• Carry on working and normal life.
Step 4 Conclude this session by harvesting questions from the participants,

inviting them for one-to-one talks and filling in the report form.
Session 53: EXPLORING STIGMA AMONG CHILDREN
Objective
To explore effects of HIV-related stigma on children
Resources: Flip charts, assorted marker pens, flipchart with key messages as in step 4
below, character cards of chief, village elder, child, pastor/priest/imam, etc.
Methodology: Fishbowl exercise, Experience sharing
Process
Step 1 Explain that children are often stigmatized (sometimes unknowingly and
sometimes deliberately) by adults, and that HIV related stigma takes
many forms.
Step 2 Tell the participants to sit in two circles. One (smaller one) circle will be
inside another (the larger one). Tell them that the discussion will be
on stigma among children and ways of reducing such stigma.
Step 3 Tell the participants that you will be the moderator of the discussion
while the ones inside will be various characters in the community (e.g.
chief, village elder, parent, child, etc).
Step 4 Introduce the discussion and ask each of the community leaders (in the
inner circle) to make their contributions to the discussion. Moderate
the discussion making sure that each person talks. You can use the
following discussion points:
• What prevents children living with HIV from feeling good about
themselves?
• How does stigma manifest among children?
• How can such children be assisted to live positively by family
members? Friends? Colleagues?
• Who carries the greatest burden in a family having one member
living with HIV and how can we share the burden more?
• How can fellow children support each other?
• How can we reduce HIV –related stigma among such form
families affected with HIV or children infected with HIV?
Step 5 Ask participants in the outer circle to listen to the statements by the
community leaders (inner circle). In case one of them is not
contributing well to the discussion, any participant in the outer circle
can join the community leadership by touching the leader on the
shoulder hence taking over their positions.
Step 6 Continue with the discussion using facilitation methods and appropriate
questioning techniques until all questions above have been exhausted.
The following points should come out:

• Children may be blamed for their parents‘ death (this is an
especially strong belief in some parts of Africa where orphans are
seen as being born ―unlucky‖).
• Children may be excluded from school, from families and from

communities because of fear of infection if there is HIV in their
family.
• Orphans are often treated differently from other children in

families and accused of carrying on their parents ―bad
behaviour‖.
• Street children are seen as dirty and ―out of control‖ (though

many are on the streets because their parents have died from
AIDS).
Step 7 Ask the participants to state the key messages they have learned
about stigma. In addition to what they said, show the following flipchart with
these messages:
• We are all responsible for challenging stigma and discrimination, not just per
sons infected with HIV
• Be a Role Model and apply what you have learned in your own lives. Think about
the words you use and how you treat PLWH and try to change how you think and
act.
• Share what you have learned. After the session, tell others what you have
learned and get them talking about stigma and how to change it.
• Challenge stigma when you see it in your homes, workplaces, and communities.
Speak out, name the problem and let people know that stigma hurts.
• Saying ―stigma is wrong or bad‖ is not enough. Help people move to action—
agree on what needs to be done, develop a plan and then do it.
• Think big. Start small! The problem might look so big. But if we start acting
now, our contribution will contribute to the larger fight and we will manage it
faster than expected!!!
Section 10: REPRODUCTIVE HEALTH AND GENERAL WELLNESS
Session 54: INTRODUCTION TO CONTRACEPTION AND BIRTH SPACING
Introduction
When facilitating a sexuality session, peer educators should not exclude information
on contraception, especially among women, men and young people. The number of
children one has can create financial burden on an individual therefore enhancing
vulnerability to infection if one has to use sex as a means of income. In the
workplace, there would be issues on the HR about the number of partners going on
maternal/paternal leave.
Objective
Participants explore various ways of preventing pregnancy and how to access
contraceptive methods.
Resources/Advance preparations: Prior to this session, set up the ‗contraceptive

shop‘ by arranging separately various sample contraceptives with clear labels for each
category i.e. hormonal methods, IUCDs, barrier methods and permanent methods.
You also need a medical and health service provider e.g. a nurse in advance
Process
Step 1 Place sets of newsprints on opposite side of the room, a set for each
category of the contraceptives, with the following titles:
• Questions about contraceptives,
• Common misconceptions about contraceptives.
Step 2 Explain to the participants that they will take a ‗gallery walk‘ in
the contraceptive mall‘ and that they are free to touch and discuss about
the various commodities found in the ‗shop‘
Step 3 Ask participants to note in the labelled flip charts any questions,
or misconceptions about contraceptives that they may have heard in
their communities.
Step 4 Allow 20 minutes gallery walk, interaction and discussions on the

various contraceptives the participants will find in the ‗shop‘.
Move around the room with the co-facilitator (the health service
provider) and note the questions or issues the learners may have
regarding the contraceptives.
Step 5 Once all participants have had a chance to touch and see the various
methods, hang up the flip charts with questions or misconceptions and
explain the role of contraception in preventing unplanned pregnancies,
teenage abortions and the reducing the risk of HIV infections. Refer to
annex 11.
Session 55: UNDERSTANDING THE IMPORTANCE OF ANTENATAL CARE
Objective
Participants understand the importance of facility-based antenatal care during among
expectant mothers.
Resources: Antenatal Care provider. Explore other literature on ANC for more
knowledge.
Methodology: Brainstorm, Experience sharing
Process
Step 1 Invite the participants to the session and explain to them that there would be
a visitor to assist in answering their questions during the session.
Step 2 Ask for a participant who has recently attended an antenatal session
and invite them to share what happens at the antenatal care facilities. Ask:
What is screened during ANC? Make sure responses from the participants
include the following:
• Malaria
• TB Exposure
• HIV
• Tetanus (pepo punda)
Step 3 Ask: What are the likely causes of miscarriages among pregnant
women if not prevented identified and managed in time? Make sure the
suggestions include the following:
• STIs
• Malaria
• Accident
• Nature
Step 4 Ask: What are the signs that could indicate likely health dangers
during pregnancy?
Explore the danger signs including the following:
 Any bleeding from the vagina
• Severe headaches
• Swelling on the face
• Loss of consciousness
• Convulsions /fits
• High fever
• Abnormal vaginal discharge
• Abdominal pains /stomach ache
• Genital ulcers
• Painful urination
• Pale arms or whiteness of the eye
• Difficult in breathing
Baby not moving after 3 or 4 months
• Candidiasis
Step 5 Give the ANC provider time to respond to questions from participants and
explain the role of ANC in HIV prevention and management including Prevention of
Mother-To-Child Transmission (PMTCT).
Step 6 Conclude the session by explaining that a couple should visit an

antenatal care clinic at least four times during the period of
pregnancy and as advised by the health care provider.
Session 56: EXPLORING GENERAL WELLNESS
Objective
Participants explore the importance of general wellness and hygiene in managing HIV.
Resources and advance preparations:

i. Flip chart with information as per step 3
ii. Flip chart with information as per step 5
Duration: 50 minutes.
Process
Step 1 Tell participants that there is a saying in Swahili which explains why it
is more important to prevent disease rather than to spend time, money and
other resources to cure a disease. ―Prevention is better than cure‖.
Step 2 Tell participants that prevention or keeping well is an important step

for people with HIV to stay better longer.
Step 3 Divide the large group into two smaller groups. Ask each group to
discuss and present on the following questions:
Group 1: What should we do to promote
 Personal hygiene
 Physical health
 Sanitation in our homes and at the workplace?
Group 2: What should we do for:
 Proper nutrition and
 Prevention of communicable diseases in our homes and at the
workplace?
Step 4 After each group presentation ask the following question:
• How realistic do you think the list was?
Step 5 Conclude the session by summarizing what each list had on promoting
employee wellness making sure that you include the following.
Habits that improve Wellness
Personal Hygiene: Bathing daily

Washing and comb hair often
Cut nails
Wash hands before preparing and eating meals
Wash hands after going to the latrine
Brush teeth after each meal and before going to
bed
Wash bed sheets and clothing frequently
Sanitation in homes & Ventilate the house

Communities: Dispose of waste matter properly
Use a latrine
Drink clean water
Sweep and clean house
Prevent mosquitoes from breeding around the
areas of residence
Nutrition: Eat mixed meals

Keep insects and pests away from food
Store food in clean places
Drink alcohol in moderation or stop if on
medication
Stop Smoking or don‘t smoke
Recreation: Get adequate exercise
Relaxation: Get adequate sleep and rest
Communicable Disease: Get children immunized

Avoid close contact with other people when you
are ill with communicable infections
Seek medical care if you are sick
Sleep under Insecticide Treated Nets
(ITNs)
Section 11: HIV AND AIDS WORKPLACE PROGRAMME AND

POLICY
Session 57: UNDERSTANDING THE WORKPLACE HIV AND AIDS AND WELLNESS
PROGRAMME
Objective
Employees understand the issues covered by the HIV, AIDS and wellness
program at the workplace.
Resources and Advance preparation: Liaise with the coordinator for co-facilitator
preferably from either the human resources department or the employee relations
section. Prepare a list of the elements of your workplace program. Flip charts, marker
pens or alternatives
Process
Step 1 Tell the participants that the session of the day would involve
brainstorming over the HIV, AIDS and wellness program the place of work.
Step 2 Ask: What are the elements of our HIV and AIDS program? List the
responses from the participants in a flipchart, noting down any
misconception or uncertainty from among them.
Step 3 Explain to the participants the elements of the existing program.

Invite the co- facilitator to give input and respond to the questions asked
by the participants. Tell the participants to continue noting down issues
they may want clarified further. Make sure that the discussion includes
explanations on the following:
• Workplace position on Confidentiality
• Prevention activities
• Referral for information and services
• Peer Education
• Counseling support
• Treatment and care services
• An active policy guiding the program activities
• Commitment and leadership by the Management
• The employee assistance mechanisms in place
Step 4 Explain to the participants that they can see any peer educator in their
sections in case they have any questions or concerns.
Step 5 Conclude the session by asking the participants the following questions as
appropriate:
• What are the contents of our company HIV and AIDS programme?
• What issues do you feel are not adequately covered by the
programme?
Session 58: UNDERSTANDING THE WORKPLACE HIV, AIDS AND WELLNESS POLICY
Objective
Employees understand the HIV & AIDS workplace policy and its importance.
Resources and Preparations: Read, understand and prepare copies of your workplace
HIV and AIDS policy summary, printed pocketsize versions (if available), or use the
notes in annex 4. Discuss the contents of the policy with a representative from the
human resource department or relevant department. Give two participants the role-
play in step 2 to prepare in advance of the session.
Process
Step 1 Tell the participants that the session of the day will involve a discussion
on the AIDS and wellness policy at the place of work.
Step 2 Invite the two participants to enact the role-play narrated below:
It is lunch break. Two employees are advising an apprentice on how

HIV and AIDS issues are handled at their workplace. The man states
that he was tested before being employed while the lady states she
was not. The man states that she wasn‟t tested because she is a lady
but should pay in one way or another at some point during her
employment. This irritates the lady and she stands as if to walk away
when a peer educator arrives.
The lady asks the peer educator about the company position on pre-
employment testing and the peer educator explains. He tells them
that the company advocates for VCT and explains VCT. They agree to
visit a nearby VCT site to get further explanation. Lunchtime over,
they have to get back to work.
Step 3 Ask the participants the following questions:

• What did you see happening in the role- play?
• What problems can employees face if they do not know about the
policy?
• What issues do you feel are not adequately covered by the policy?
Step 4 Distribute the copies of the summary or printed version of the HIV & AIDS
policy and tell the participants that they can see any peer educator in
their sections in case they have any questions that wanted addressed.
Step 5 Conclude the activity by explaining the role of employees stipulated in

the policy. Invite them to see you on one-to-one in case of issues they
want addressed better through the policy.
Session 59: REACHING OUT TO THE COMMUNITY
Objective
To improve the comprehensive response to HIV and AIDS among stakeholders.
Resources and advance Preparations

i. Identify the venue for the community outreach. This could be a staff canteen,
specific hall or identified open-air sites where you can accommodate spouses
of the employees and other community members.
ii. Mobilize resources necessary for the community outreach including transport,
IEC materials for distribution, Public Address system, lunch for the peer
educators, etc.
iii. Contact the necessary local or provincial authorities for permission to use the
venue if necessary. You could liaise with the neighbouring workplaces for a
joint community outreach.
iv. Agree on the facilitation process with fellow peer educators and distribute roles
for the activity appropriately.
Methodology: Role-play/Drama
Process
Step 1 Welcome the community members to the activity. Introduce the

workplace officials present and fellow peer educators.
Step 2 Give the community leaders present time to welcome your team to the
venue as appropriate.
Step 3 Carry out an icebreaker involving the community members at the venue.
This will help them to open up, relax and get them ready for learning.
Use any appropriate icebreaker in annex 15.
Step 4 Invite the peer educators to present a role-play, drama or song on the
topic of the day. The following topics are suitable for community
outreach activities:
• Understanding VCT
• Common STI‘s
• Overcoming stigma and discrimination
• Caring for people living with AIDS
• Meals preparation using local readily available foods
Examples of role-plays you could use:
• A man arrives home from along journey that he says took several
days. His wife welcomes him and tells him how the days have been
long without him. They share all the niceties and they look happy.
The wife gives him something to eat to “drive away the fatigue and
the look of exhaustion on his face” as she puts it. He tells his wife
to get the present he bought her from the bag. She happily takes
the bag and removes things from it then she suddenly screams. She
turns to the husband carrying condoms. The man looks shocked with
open mouth.
• `Two women are washing utensils at the common tap. Another comes
and greets them also intending to join them in the washing.
Immediately she put her utensils down the other women move theirs
aside looking at her with scornful eyes. The woman ignores them but
one of them tells her, “Please don‟t mix the waters. Who does not
know that HIV can survive in water?” The woman tries to ignore them
but the second woman picks her utensils and tells her, “You have to
look for another plot. We cannot even go to work. Our children will
play with yours”. And the argument continues. The woman is angered
and depressed. She laments loud in pain.
Step 5 After the role-play ask the community members the following
questions to guide a discussion:
• What did you see happening in the play?
• What problems could such situations cause to our community?
What are some of the situations similar to the one in the story in our
community? Ask the participants for experiences from the community to
• domesticate the (issues on condoms)
What solutions can we provide to reduce such occurrences in our
• community?
Step 6 Invite the participants to ask questions and key concerns (but not
necessarily answering them during the session) and tell your co-facilitator to
note them down. These questions should form grounds for one-to-one
session, referrals or subsequent activities in the community.
Step 7 End the activity formally. Invite those present for one-to-one talks,
explain to them where to go for more information and services, and explain
to them how to get to a peer educator for information.
Step 8 Thank the participants for attending the activity. Give the community
or workplace leader time to close the activity and invite the community
members for the next activity.
ANNEXES
Annex 1: MALARIA
What is malaria?
Malaria is a vector-borne infectious disease caused by protozoan parasites of the genus
Plasmodium. It is one of the most common infectious diseases and an enormous public-
health problem. The most serious forms of the disease are caused by Plasmodium
falciparum and Plasmodium vivax, but other related species (Plasmodium ovale,
Plasmodium malariae, and sometimes Plasmodium knowlesi) can also infect humans. This
group of human-pathogenic Plasmodium species is usually referred to as malaria parasites.
Where do we find Malaria in the world?

It is widespread in tropical and subtropical regions, including parts of the Americas, Asia,
and Africa. Each year, it causes disease in approximately 650 million people and kills
between one and three million, most of them young children in Sub-Saharan Africa. Ninety
percent (90%) of the world‘s malaria cases occur in Africa. Malaria occurs in over 100
countries and territories.
More than 40% of the people in the world are at risk. Large areas of Central and South
America,
Hispaniola (Haiti and the Dominican Republic), Africa, the Indian subcontinent, Southeast
Asia, the Middle East, and Oceania are considered malaria-risk areas (an area of the world
that has malaria).
Brief History:
Malaria has infected humans for over 50,000 years, and may have been a human pathogen
for the entire history of our species. Indeed, close relatives of the human malaria parasites
remain common in chimpanzees, our closest relatives. References to the unique periodic
fevers of malaria are found throughout recorded history, beginning in 2700 BC in China.
The term malaria originates from Medieval Italian: mala aria — ―bad air‖; and the disease
was formerly called ague or marsh fever due to its association with swamps.
How does one get malaria?

Humans get malaria from the bite of a malaria-infected mosquito. When a mosquito bites
an infected person, it ingests microscopic malaria parasites found in the person‘s blood.
The malaria parasite must grow in the mosquito for a week or more before infection can be
passed to another person. If, after a week, the mosquito then bites another person, the
parasites go from the mosquito‘s mouth into the person‘s blood. The parasites then travel
to the person‘s liver, enter the liver‘s cells, grow and multiply. During this time when the
parasites are in the liver, the person has not yet felt sick. The parasites leave the liver and
enter red blood cells; this may take as little as 8 days or as many as several months. Once
inside the red blood cells, the parasites grow and multiply. The red blood cells burst,
freeing the parasites to attack other red blood cells. Toxins from the parasite are also
released into the blood, making the person feel sick.
If a mosquito bites this person while the parasites are in his or her blood, it will ingest the
tiny parasites. After a week or more, the mosquito can infect another person.
What are the symptoms of Malaria?
Symptoms of malaria include fever and flu-like illness, including shaking chills, headache,
muscle aches, and tiredness. Nausea, vomiting, and diarrhoea may also occur. Malaria may
cause anemia and jaundice (yellow colouring of the skin and eyes) because of the loss of
red blood cells. Infection with one type of malaria, P. falciparum, if not promptly treated,
may cause kidney failure, seizures, mental confusion, coma, and death.
Is there a vaccine for malaria?

No vaccine is currently available for malaria; preventative drugs must be taken
continuously to reduce the risk of infection. These prophylactic drug treatments are often
too expensive for most people living in endemic areas. Most adults from endemic areas
have a degree of long-term recurrent infection and also of partial resistance; the
resistance reduces with time and such adults may become susceptible to severe malaria if
they have spent a significant amount of time in non-endemic areas. They are strongly
recommended to take full precautions if they return to an endemic area.
Malaria infections are treated through the use of antimalarial drugs, such as quinine or
artemisinin derivatives, although drug resistance is increasingly common. Chloroquine
resistance is widespread in Africa.
Why are there more malaria outbreaks in Africa?

Malaria outbreaks are being reported in some locations of Africa that had been previously
thought to be at elevations too high for malaria transmission, such as the highlands of
Kenya. Some scientists hypothesize this is due to climatic change, while others hypothesize
that this is due to human migration. Also, malaria has resurged in certain locations of
Africa that had previously had effective control programs, such as Madagascar, South
Africa, and Zanzibar.
How soon will a person feel sick after being bitten by an infected mosquito?
For most people, symptoms begin 10 days to 4 weeks after infection, although a person
may feel ill as early as 8 days or up to 1 year later. Two kinds of malaria, P. vivax and P.
ovale, can relapse; some parasites can rest in the liver for several months up to 4 years
after a person is bitten by an infected mosquito. When these parasites come out of
hibernation and begin invading red blood cells, the person will become sick.
How is malaria diagnosed?

Malaria is diagnosed by looking for the parasites in a drop of blood. Blood will be put onto a
microscope slide and stained so that the parasites will be visible under a microscope.
Any traveller who becomes ill with a fever or flu-like illness while travelling and up to 1
year after returning home should immediately seek professional medical care. You should
tell your health care provider that you have been travelling in a malaria-risk area.
Who is at risk for malaria?

Persons living in and travellers to, any area of the world where malaria is transmitted may
become infected.
Malaria Life Cycle:
Life cycle of Plasmodium falciparum
(© DPDx: CDC‘s web site for laboratory identification of parasites)
What is the treatment for malaria?

Malaria can be cured with prescription drugs. The type of drugs and length of treatment
depend on which kind of malaria is diagnosed, where the patient was infected, the age of
the patient, and how severely ill the patient was at start of treatment.
How can malaria and other travel-related illnesses be prevented?

• Visit your health care provider 4-6 weeks before foreign travel for any
necessary vaccinations and a prescription for an antimalarial drug
• Prevent mosquito and other insect bites. Use insect repellent on exposed
skin and flying insect spray in the room where you sleep
• Wear long pants and long-sleeved shirts, especially from dusk to dawn. This
is the time when mosquitoes that spread malaria bite
• Sleep under a mosquito bed net that has been dipped in permethrin
insecticide if you are not living in screened or air-conditioned housing
• Incase one is infected with malaria, seek prompt medical attention from a
qualified health service provider and take your antimalarial drug exactly on
schedule without Malaria in Kenya: Climate and altitude determinants of
malaria transmission in Kenya
These variations in climate impact upon the distribution of malaria vectors. The effects of
temperature on the transmission cycle are manifold, but its specific effect on incubation
duration of the eggs and mosquito survival is the most important (Onori & Grab 1980). The
relationships below 18oC transmission is unlikely because few adult mosquitoes (0.28%)
survive the 56 days required for reproduction at that temperature, and also because
mosquito abundance is limited by long larval duration. At 22oC the life cycle is completed
in less than three weeks and mosquito survival is sufficiently high (15%) for the
transmission cycle to be completed. So temperature below 18oC is generally considered
unsuitable, whilst above 22oC conditions are suitable for stable transmission.
What causes Malaria?
Malaria is caused by a one-celled parasite called a plasmodium. Female Anopheles
mosquitoes pick up the parasite from infected people when they bite to obtain blood
needed to nurture their eggs. Inside the mosquito the parasites begin to reproduce. When
the mosquito bites again, the parasites mix with its saliva and pass into the blood of the
person being bitten.
How many types of Malaria are there?

There are four types of malaria: Plasmodium vivax, P. malariae, P. ovale and P.
falciparum. P. vivax and P. falciparum are the most common forms.
Falciparum malaria—the most deadly type—is most common in sub-Saharan Africa, where it
causes nearly a million deaths a year. Once in the human body, the parasites multiply in
the liver, and then infect red blood cells.
What can I do to control Malaria at my place of work and community?

Key interventions to control malaria include: prompt and effective treatment with
artemisinin-based combination therapies; use of insecticidal nets by people at risk; and
indoor residual spraying with insecticide to control the vector mosquitoes.
Do all mosquitoes transmit malaria?

Only certain species of mosquitoes of the Anopheles genus—and only females of those
species— can transmit malaria.
Summary of Key Facts

• From egg to adult anopheles takes seven to 21 days, depending on temperature.
• The female needs a blood meal for each batch of eggs.
• She lays about 100 eggs in water at two or three day intervals.
• Eggs take two to three days to hatch.
• Larvae grow rapidly, passing through three moults in three days.
• After the third moult, the larva becomes a pupa.
• After two to three days, the adult emerges.
• Mating is the first activity of the newly hatched adult.
• The female mates only once, storing sperm for all subsequent egg production.
Why is it important to combine Malaria drugs?

In most parts of the world, falciparum malaria has become resistant to conventional
treatment, such as chloroquine, sulfadoxine-pyrimethamine, and other antimalarial
medicines used on their own. This is why WHO recommends that countries use a
combination of drugs to fight malaria.
What is the best treatment against Malaria?

The combination of artemisinin derivatives with another effective antimalarial medicine
(artemisinin-based combination therapies or ACTs), is currently the most effective
treatment for falciparum malaria – the most lethal form of the disease. Over the past
decade, the use of ACTs has become more and more widespread. They produce a very
rapid therapeutic response and are well
Remember: MALARIA IS BOTH PREVENTABLE AND CURABLE

Annex 2: TUBERCULOSIS LINK WITH HIV
What is TB?
Tuberculosis is a disease that usually attacks the lungs but can affect almost any part of
the body. A person infected with TB does not necessarily feel ill – and such cases are
known as silent or ―latent‖ infections. When the lung disease becomes ―active‖, the
symptoms include cough that last for more than two or three weeks, weight loss, and loss
of appetite, fever, night sweats and coughing up blood.
What causes TB?

TB is caused by the bacterium Mycobacterium tuberculosis. The bacterium can cause
disease in any part of the body, but it normally enters the body though the lungs and
resides there.
How is TB spread?
TB is spread from an infectious person to a vulnerable person through the air. Like the
common cold, TB is spread through aerosolized droplets after infected people cough,
sneeze or even speak. People nearby, if exposed long enough, may breathe in bacteria in
the droplets and become infected. When a person breathes in TB bacteria, the bacteria
settle in the lungs.
Is TB treatable?
Yes. TB is curable, even in people living with HIV. Direct Observed Therapy (DOTS) is the
internationally recommended strategy for TB control. DOTS treatment uses a variety of
powerful antibiotics in different ways over a long period to attack bacteria and ensure
their eradication. However, some strains of bacteria have now acquired resistance to one
or more of the antibiotics commonly used to treat them; these are known as drug-resistant
strains.
Is TB a growing concern for our community?

Yes. TB has always been a public health concern in Sub-Saharan Africa but HIV and AIDS
have worsened the situation. It is estimated that one-third of the 40 million people living
with HIV and AIDS worldwide are co-infected with TB. People with HIV are up to 50 times
more likely to develop TB in a given year than HIV-negative people. Another aspect of the
resurgence of TB is the development of drug-resistant strains.
What are the links between HIV and TB?

HIV and AIDS and TB are so closely connected that the term ―co-epidemic‖ or ―dual
epidemic‖ is often used to describe their relationship. The intersecting epidemic is often
denoted as TB/HIV or HIV/TB. HIV affects the immune system and increases the likelihood
of people acquiring new TB infection. It also promotes both the progression of latent TB
infection to active disease and relapse of the disease in previously treated patients. TB is
one of the leading causes of death in HIV infected people.
How many people are co-infected with TB and HIV?

It is estimated that one-third of the 40 million people living with HIV & AIDS worldwide are
co-infected with TB. Furthermore, without proper treatment, approximately 90% of those
living with HIV die within months of contracting TB. The majority of people who are
infected with both TB and HIV live in sub-Saharan Africa.
What is the impact of co-infection with TB and HIV?
Each disease speeds up the progress of the other, and TB considerably shortens the survival
of people with HIV and AIDS. TB kills up to half of all AIDS patients worldwide. People who
are HIV positive and infected with TB are up to 50 times more likely to develop active TB in
a given year than people who are HIV negative. HIV infection is the most potent risk factor
for converting latent TB into active TB, while TB bacteria accelerate the progress of AIDS
infection in the patient. Many people infected with HIV in developing countries develop TB
as the first manifestation of AIDS. The two diseases represent a deadly combination, since
they more destructive together than either disease alone.
• TB is harder to treat in HIV positive people.
• TB progresses faster in HIV- infected people.
• TB in HIV-positive people is almost certain to be fatal if undiagnosed or
left untreated.
• TB occurs earlier in the course of HIV infection than many other
opportunistic infections.
TB and HIV collaborative testing

HIV positive people can easily be screened for TB; if they are infected they can be given
prophylactic treatment to prevent development of the disease or curative drugs if they
already have the disease. TB patients can be offered an HIV test; indeed, research shows
that TB patients are more likely to accept HIV testing than the general population. This
means TB programmes can make a major contribution to identifying eligible candidates for
ARV treatment.
What we do to combat the spread of TB?

The internationally recommended strategy to control TB, known as DOTS, has five
components:
• Political commitment to sustained TB control
• Access to quality-assured TB sputum microscopy
• Standardized short-course chemotherapy, including direct observation
of treat ment
• An uninterrupted supply of drugs
• A standardized recording and reporting system, enabling
assessment of out come in all patients
(Source: World Health Organization TB/HIV project)
Annex 3: THE CONCEPT OF PALLIATIVE CARE
The concept of palliative care grew out of pain relief and comfort measures for cancer
patients. Since AIDS is a fatal disease with many curable manifestations, the distinction
between active, curative treatment and palliation is blurred. As a result, current
definitions of palliative care define this medical care service as a more holistic one that
begins earlier in the course of a chronic, fatal medical condition.
The World Health Organization defines palliative care as ―...the active total care of
patients whose disease is not responsive to curative treatment. Control of pain, of other
symptoms, and of psychological, social, and spiritual problems is paramount. The goal of
palliative care is achievement of the best quality of life for patients and their families.
Palliative care affirms life and regards dying as a normal process, neither hastens nor
postpones death, provides relief from pain and other distressing symptoms, integrates the
psychological and spiritual aspects of care, offers a support system to help family cope
during the patient‘s illness and in their own bereavement.
Even without the impact of the AIDS epidemic, the health systems in many African
countries are barely coping with the burden of diseases such as malaria, bacterial
pneumonia, TB and diarrhoea diseases. The numbers of doctors and nurses are grossly
inadequate, medications and supplies are in extremely short supply and are often diverted
from Ministry of Health hospitals to private clinics. Deaths among medical personnel due to
AIDS have exacerbated the situation, and shortages of medical personnel can be expected
to worsen. In Malawi, for example, an estimated 70,000 new AIDS cases occur annually.
Over 50 percent of the beds on medical wards are occupied by patients who are HIV+ in
most of the countries targeted for the Global AIDS Program. Existing health infrastructures
are totally inadequate to provide in-hospital care for AIDS patients, and thus there is great
pressure on hospital personnel to discharge AIDS patients quickly, with little or no
treatment.
To cope with this crisis, many nations have encouraged ―home-based care‖ (HBC) for
persons with an HIV or AIDS diagnosis. Many programs have been developed, and some
provide good models that ease suffering and improve quality of life. For example, the
Chikankata Hospital program in Zambia provides both hospital care and an intensive
program of follow-up in the community. The AIDS Support Organization (TASO) in Uganda
has established eight-day care centres that provide medical treatment, counselling, and
food supplements for AIDS patients, plus a limited program of home care. Unfortunately, in
many countries, home and community-based care programs are very weak and provide few
services. Links to local health centres and hospitals are poor, and HBC volunteers have
little or no access to any drugs for palliative care. Diagnosis of tuberculosis and other
opportunistic infections is often ignored. Training of HBC volunteers often over-emphasizes
―counselling‖ and does not provide them with practical skills in home nursing. Food
supplement programs are either not available or very inadequate, and lack of food for
patients and their children is a serious problem. Annex 4: Picture Code of a family caring
for a sick person.
Annex 4: FAMILY CARE AND SUPPORT
107
Annex 5: CODE ON CONDOMS
108
Annex 6: CONDOM NEGOTIATION
109
Annex 7: DOMESTIC VIOLENCE
110
Annex 8: SEXUAL EXPLOITATION
111
Annex 9: DATE OR ACQUAINTANCE RAPE
112
Annex 10: DANGER SIGNS OF LIKELY DATE OR ACQUAINTANCE RAPE
The following are some actions and attitudes to watch out for. If your partner or
acquaintance engages in any of these behaviours, it may be a warning sign that the partner
is potentially abusive.
1. Threats. Verbal or physical threats to force you into sexual activity you do not
want. Threats such as: ―If you don‘t have sex with me, I‘ll break up with you‖
or ―I‘ll beat you up.‖
2. Jealousy. Constantly demands to know where you are and who you will be with.
Watch out for someone who gets very jealous easily, even of your friendships.
3. Criticism. Disapproval or scolding about your actions, your clothing, your

friends and so on.
4. Controlling. Failure to acknowledge your needs or wants, and/or not letting go

when you try to pull away.
5. Anger or violence. Frequent and noticeable anger or violent acts, including over
small disagreements possibly with threats to hurt you or people you know. She
or he may later apologize for the behaviour, but that does not change the fact
of the abuse.
6. Verbal abuse. Jokes, tones or insults about your physical appearance or your
gender, or constant criticism.
7. Manipulation. There are many ways in which people can be manipulative in an

abusive way. For example, she or he could intentionally try to upset you by
flirting with other people. Pay attention to how your date feels about the roles
of men and women, especially in relationships.
8. Isolation/seclusion. When a partner insists on two of you being alone. When

first dating someone, go out with other people or groups rather than alone.
PREVENTING ACQUAINTANCE RAPE:

There are ways that you can help to protect yourself against the possibility of acquaintance
or date rape. The best thing you can do is trust your instinct! If you feel uncomfortable
with a situation or threatened by someone, get to a safe place as soon as possible
1. Do not be alone before you‘re ready. It‘s a good idea to go out in group dates
with friends, especially when dating someone new. Don‘t go out as a couple
until you have gotten to know each other. Avoid secluded places including
someone‘s home when parents or adults are not at home, your friend‘s home,
empty buildings, or bushes.
2. Keep others informed. Always make sure that someone knows where you are
going and when you will be home. Carry a friend‘s phone number with you to
call if you need help.
3. Split the cost of the date: If you go to a concert movie or restaurant, split the
cost in order to prevent your date from thinking that you ―owe‖ sexual favours
in return. If you do not have money, eat what you can afford at home.
4. Think about your sexual limits. Before going out on a date, think about what
you want to do, and do not want to do. A decision to be sexual in anyway
should be made together and never forced. Remember that no matter the
circumstances, you have the right to choose when, with whom and how you
want to relate to sexually.
5. Be clear with your date about your sexual limits. Give the message that ―no‖
means ―NO‖, not ―try harder for a ‗yes.‖
6. Trust your instincts. If you feel pressured or threatened in any way, do not
hesitate to say what you feel. Leave if necessary. Trust your feelings - if you
begin to feel nervous or uncomfortable about the way things are going, do
something about it right away. Let your date know how you feel and get away
from the situation to a place where you feel more comfortable.
7. If your date tries to force you to do anything, say no loudly and clearly. Yell, if
necessary, and resist in any way you can, including fighting back and running
away.
8. Do not worry about being polite. Communicate clearly and directly about your
limits on sexual behaviour. Say something like ―I will do…but I will not…‖
9. Avoid sending mixed messages. It‘s okay to want to be intimate with someone
and it‘s okay not to want to be intimate. Decide what you want sexually and
do not act confused about it.
Other ways: Other ways to protect yourself in case of such incidences include:
• Be careful as such attackers might be violent and ready to use any weapon at
times of resistance.
• Use your fingers and fingernails. Stab them as hard as you can into the
attacker‘s eyes.
• Use your knee to give a hard kick to the attacker‘s private parts. If you kick
hard enough, this will hurt him a lot, causing him to double over in pain. Then
run away.
• If the person is on top of you, holding your face down on the ground, use your
heel to kick him in the bones of the lower back, just at the top of the
buttocks.
• If you are being overpowered, relax and try to fool the attacker into
carelesness.
Then stab the eyes or kick him in the groin or under the belly if a lady.
Annex 11: CONTRACEPTIVE METHODS
HORMONAL METHODS
Oral pills
This pill is a contraceptive tablet that contains either a combination of the hormones
oestrogen and progestin (COC) or progestin only (POP). There are two kinds of packets –
those with 21 pill and 28 pills. The hormone from the pill is released into the woman‘s
bloodstream. It prevents the egg from coming out of the ovary and prevents an egg from
being fertilized by the male sperm. Almost 100% effective if taken correctly; as used
commonly, pills are 92% effective.
Emergency Contraceptive Pills

The Emergency Contraceptive Pill (ECP) is a contraceptive tablet or tablets that can be
taken after unprotected intercourse to prevent pregnancy. The hormone from the pill is
released into the woman‘s bloodstream. It prevents an egg from coming out of the ovary
and/ or prevents an egg from being fertilized by the male sperm. Approximately 85%
effective, the sooner after unprotected intercourse ECPs are used, the more effective they
are.
Injection
Several injectable hormonal methods of contraception are available. Depo- Provera and
Noristerat contain progestin only and are commonly available. They must be injected every
two or three months depending on the method chosen. There is a third injectable which
contains oestrogen and progestrin. It is known as Norigynon and is given once a month. It is
not very commonly used in Kenya. It stops the woman‘s egg from going to the womb. It
also thickens cervical mucus to prevent sperm from entering the womb. 99 out of 100
women using Depo-
Provera will not get pregnant if they use it correctly. It is 97% effective in typical use.
Implants
Sub dermal implants. One of two rods containing contraceptive hormone are inserted under
the skin of a woman‘s upper arm depending on the implant chosen. Suppresses ovulation in
many cycles, makes the cervical mucus so thick that sperm cannot pass through it. 99%
effective in typical use.
Intra Uterine Contraceptive Device (IUCD)

Most IUCDs being inserted today are shaped like a TI with copper wires or bands on the
plastic stem and arms. Copper T380A is used and widely available in Kenya in public health
facilities. Other types of IUCDs available in the private sector include Multiload- MLCu-375
and Mirena, which is a hormonal IUCD. IUCD Prevents fertilization by creating a local
inflammatory reaction that is believed to be enhanced by the copper released in the uterus
and fallopian tubes. This effect impairs the viability of the sperm and interferes with the
sperm movement, making fertilization almost impossible.
BARRIER METHODS
Jelly, Foaming Tablets and Spermicide are the various barrier methods for contraception.
These are applied just before sex or used together with a diaphragm. The chemicals kill or
damage the sperm or make them unable to move toward the egg. Out of 100 women, 70
will not get pregnant. Safer if a man uses a condom.
Diaphragm
Diaphragm is another barriers method that is a thin piece of rubber. It is placed in the
woman‘s vagina to cover the opening leading into her womb. It blocks sperm from entering
the womb. It is used with spermicide. The chemical in the spermicide kills the sperm. Out
of 100 women using the diaphragm, 80 will not get pregnant.
Male and Female Condoms
Male condoms are thin sheaths made of rubber, vinyl or natural products. Female condoms
are thin sheaths of polyurethane plastic with polyurethane rings at both ends.
The male condom is put on an erect penis just before sex. The female condom is
inserted in the vagina before intercourse. They both prevent sperm from gaining access to
the female reproductive tract and prevent many microorganisms that may cause STIs,
including HIV from passing from one partner to another. If used consistently, 97% effective.
As commonly used, 85% effective.
NATURAL METHODS
Calendar
A woman counts calendar days to identify the start and end of the fertile time in her
menstrual cycle. The couple avoids sex during the ‗fertile time‘ or uses condoms. Has a
high failure rate. Of 100 women, 20 will get pregnant in one year. It depends on
cooperation of the couple and is
easier if woman‘s cycle is always the same.
Billings
This method checks the increasing amount of cervical mucus from the womb. Increased
mucus indicates that the egg is being released, at which point the woman can get
pregnant. Use a condom if having sex on these days. Avoid sex or use condoms during the
woman‘s cycle when she is likely to get pregnant. It has high failure rate. It highly depends
on the cooperation of the couple.
Basal Body Temperature
The woman is taught how to take her body temperature, either orally, rectally or vaginally
at the same time each morning before getting out of bed. A rise in temperature indicates
that the egg is being released from the ovary.
Avoiding sex or use condoms on the days when the woman is likely to get pregnant. Has
high failure rate and depends on cooperation of the couple. It is easier if woman‘s cycle is
always the same.
Lactation Amenorrhea Method (LAM)

A temporary method of family planning based on the absence of ovulation resulting from
exclusive breastfeeding. LAM provides natural protection against pregnancy when all of
these conditions are met: A mother is fully or nearly fully breastfeeding; the baby is less
than six months old; the mother has not resumed her menstrual bleeding (i.e., she is
‗amenorrhoeic.). The LAM method is a family planning method based on the physiology of
breastfeeding. If a breastfeeding woman meets the three LAM criteria, her risk of
pregnancy in the first 6 months after childbirth is about 2%, or 1 in 50.
PERMANENT METHODS
Sterilization- Tubal Ligation

Tubal Ligation (tying tubes) is an operation done in the hospital. There are several kinds of
operations. They are called laparoscopy, or minilap or tubes can be tied during caesarean
section or other abdominal surgery. It involves tying and cutting of the fallopian tubes in
order to prevent the egg from travelling from the ovaries to the uterus. With the tubes
blocked, the woman‘s egg cannot meet the man‘s sperm. Out of 100 women, 99 will not
get pregnant.
Sterilization – Vasectomy
Vasectomy involves tying the Vas Deferens (man‘s tubes that carry the sperm) so that no
sperm can pass through. The man‘s sperm tubes are cut and tied. This stops the sperms
from mixing with the sex fluid. The ejaculate has no sperm in it. Out of 100 men, 99 will
not get their partners pregnant.
Annex 12: MONITORING AND REPORTING
What is Monitoring?
Monitoring is an activity that involves peer educators, coordinators and the funding
organization in closely keeping track of the performance of the program in relation to
achieving the initial objectives.
Why Monitoring?
Monitoring helps programs to be successful and Peer Educators to be proud of their
work. It helps answer some questions like:
• How well is the Peer Education Program working?
• What might be some of the problems the program is experiencing?
• How best can we solve these problems?
• How far has the organization gone in knowledge, attitudes and behaviours?
• What else do we need to add to our program to make it comprehensive for care
of AIDS?
Other reasons for monitoring are:

To measure that activities are completed and targets are met.
i. Monitoring the progress and achievements of the programme as it is
implemented creates accountability by making sure that the activities
involved take place as planned.
ii. It also ensures that the activities reach their targets (such reaching a
certain number of peers in certain duration).
iii. It makes sure that sufficient data are collected for the final outcome evaluation.
To determine the outcome of the program:

i. A structured evaluation would be handy in creating perceptions about the
effects/ impact of
a program.
ii. However, informal feedback and other anecdotal evidences from employees
and community members can also offer such perceptions.
iii. It is essential to know whether or not the program has an impact and either
change its focus or justify its continuation
To adapt strategies as needed

Monitoring and evaluation allows staff to examine which program components were
most successful and which need improvement, and adapt programme strategies in
order to reach their goals more appropriately.
To get such information, Peer educators and focal persons fill out reports and hand
them to the appropriate coordinator after the session (mostly on weekly basis). The
forms are then analyzed to answer the above questions.
(See Peer Educator‟s Weekly session Report)
1. Quantitative data
These are defined in numeric terms including percentages, averages and
increases/rises. Quantitative data answer questions such as how many and how much
and are best gathered through the monitoring forms, surveys and medical records.
The quantitative indicators could be seen in:

a) The increase in participation in Peer Education sessions and usage of
resource centres by peers (increase in health information seeking)
b) The rise in condom uptake
c) Increase in reported condom use

d) The rise in number of peers seeking VCT, STI diagnosis and treatment,
Counselling, and other health services
e) The rise in number of people sharing their HIV status with Peers whether positive
or negative.
2.Qualitative Data
These can be best described in terms of perceptions, implications, feelings, opinions and
reasons. Qualitative data address why and are gathered through group activities, one-to-
one talks and in-depth interviews.
The qualitative indicators could be seen in:

a) The level of questions (are rhetorical, knowledge based or personal)
b) The level of experiences shared: Are they spontaneous or coerced- how free are
the peers in sharing personal experiences and how personal are the experiences
c) The quality of answers coming from peers- shows an increase in the level of
knowledge.
Annex 13: MEN AND WOMEN AT THE BAR
Annex 14: THE NATIONAL CODE OF CONDUCT ON HIV AND AIDS AT PLACES OF WORK:
The Guiding Principles:
• Recognition of HIV and AIDS as a workplace issue: HIV and AIDS is a workplace
issue, not only because it affects the workforce, but also because the workplace
can play a vital role in limiting the spread and effects of the epidemic.
• Non-discrimination based on perceived or real HIV status: There should be no

discrimination or stigmatization against workers on the basis of real or perceived
HIV status.
• Gender: The gender dimensions of HIV and AIDS ought to be recognized by all.
Women are more vulnerable to HIV infection than men. More equal gender
relations and the empowerment of women are vital to preventing the spread of
HIV infection and enabling women to cope with HIV and AIDS.
• Creation of a Healthy work environment: Provision of a healthy and safe work

environment is a prerequisite in risk reduction including HIV transmission and/or
acquisition. It is the responsibility of every employer to provide staff with this in
fulfillment of the provisions of the Occupational Safety and Health Act (OSHA)
2007, and the Occupational Safety and health Convention, 1981 (No. 155).
• Social dialogue: A successful HIV and AIDS policy and program requires
cooperation, trust and dialogue between employers, workers, and governments.
• Pre-employment Screening of prospective staff and/or those in service: HIV

and AIDS screening should not be required of job applicants or persons in
employment, and testing for HIV should not be carried out at the workplace
except as specified in this code.
• Confidentiality: Access to personal data relating to a worker‘s HIV status is

bound by the rules relating to confidentiality consistent with the Employment
Act, 2007, the National HIV testing and Counseling Guidelines and the ILO‘s Code
of Practice on the protection of workers‘ personal data, 1997.
• Continuation of the employment relationship: HIV infection is not a cause for

termination of employment. Persons with HIV-related illnesses should be able to
work for as long as medically fit in appropriate conditions. Retirement should be
in line with the HR policies or when a medical practitioner certifies the
individual as medically unfit to keep working.
• HIV Prevention interventions: Non-governmental organizations (NGOs) and

other service providers are in a unique position to promote prevention efforts
through information and education; and support changes in attitudes and
behaviour. All messages and interventions developed should be easy for all to
understand to make informed choices.
• Treatment, Care and Support: All HIV infected staff and their dependants
should be provided with affordable treatment by the employer, and where this is
not possible, these individuals are supported and encouraged to seek care ad
treatment from a public health facility. It is the responsibility of the employer
to do this and for the staff to access these services when provided.
• Meaningful Involvement of PLWH in HIV Interventions: Meaningful involvement

of PLWH helps to reduce stigma and discrimination, motivate and equip them to
reduce their own risk of HIV transmission as well as that of contracting other
STIs
Annex 15: SAMPLES OF ICEBREAKERS AND INTRODUCTION GAMES
1. Coconut
The facilitator shows the group how to spell out C-O-C-O-N-U-T by using full movements of
the arms and the body. All participants then try this together using a rhythm of a common
song to make it possible to change speed each time you repeat the exercise.
2. Dancing on paper
Facilitators prepare equal sized sheets of newspaper or cloth. Participants split into pairs.
Each pair is given either a piece of newspaper or cloth. They dance while the facilitator
plays music or claps. When the music or clapping stops, each pair must stand on their sheet
of newspaper or cloth. The next time the music or clapping stops, the pair has to fold their
paper or cloth in half before standing on it. After several rounds, the paper or cloth
becomes very small by being folded again and again. It is increasingly difficult for two
people to stand on. Pairs that have any part of their body on the floor are ‗out‘ of the
game. The game continues until there is a winning pair.
3. Find someone wearing...

Ask participants to walk around loosely, shaking their limbs and generally relaxing. After a
short while, the facilitator shouts out ―Find someone...‖ and names an article of clothing.
The participants have to rush to stand close to the person described. Repeat this exercise
several times using different types of clothing.
4. Football cheering
The group pretends that they are attending a football game. The facilitator allocates
specific cheers to various sections of the circle, such as ‗Pass‘, ‗Kick‘, ‗Dribble‘ or
‗Header‘. When the facilitator points at a section, that section shouts their cheer. When
the facilitator raises his/her hands in the air, everyone shouts ―Goal!‖
5. Fruit salad
The facilitator divides the participants into an equal number of three to four fruits, such as
oranges and bananas. Participants then sit on chairs in a circle. One person must stand in
the centre of the circle of chairs. The facilitator shouts out the name of one of the fruits,
such as ‗oranges‘, and all of the oranges must change places with one another. The person
who is standing in the middle tries to take one of their places as they move, leaving
another person in the middle without a chair. The new person in the middle shouts another
fruit and the game continues. A call of ‗fruit salad‘ means that everyone has to change
seats.
6. Group statues
Ask the group to move around the room, loosely swinging their arms and gently relaxing
their heads and necks. After a short while, shout out a word. The group must form
themselves into statues that describe the word. For example, the facilitator shouts
―peace‖. All the participants have to instantly adopt, without talking, poses that show
what ‗peace‘ means to them. Repeat the exercise several times.
7. Killer wink
Before the game starts, ask someone to be the ‗the killer‘ and ask them to keep their
identity a secret. Explain that one person among the group is the killer and they can kill
people by winking at them. Everyone then walks around the room in different directions,
keeping eye contact with everyone they pass. If the killer winks at you, you have to play
dead. Everyone has to try to guess who the killer is.
8. Move to the spot

Ask everyone to choose a particular spot in the room. They start the game by standing on
their ‗spot‘. Instruct people to walk around the room and carry out a particular action, for
example, hopping, saying hello to everyone wearing blue, walking backwards, smiling at
ladies only, etc. When the facilitator says, ―Stop‖, everyone must run to his or her original
spots. The person who reaches their place first is the next leader and can instruct the
group to do what they wish.
9. “Prrr” and “Pukutu”

Ask everyone to imagine two birds. One calls ‗prrr‘ and the other calls ‗pukutu‘. If you call
out ‗prrr‘, all the participants need to stand on their toes and move their elbows out
sideways, as if they were a bird ruffling its wings. If you call out ‗pukutu‘, everyone has to
stay still and not move a feather.
10. Taxi rides

Ask participants to pretend that they are getting into taxis. The taxis can only hold a
certain number of people, such as two, four, or eight. When the taxis stop, the
participants have to run to get into the right sized groups. This is a useful game for
randomly dividing participants into groups.
11. Tide‟s in/tide‟s out

Draw a line representing the seashore and ask participants to stand behind the line. When
the facilitator shouts ―Tide‘s out!‖, everyone jumps forwards over the line.
When the leader shouts ―Tide‘s in!‖, everyone jumps backwards over the line. If the
facilitator shouts ―Tide‘s out!‖ twice in a row, participants who move have to drop out of
the game.
Annex 16: FUNCTIONS OF MALE AND FEMALE GENITALIA
The Vulva is the external sexual organ of women. The above view (A) shows the external
view of the female vulva as normally seen when the woman is standing up. View (B) shows
the vulva when it is opened, and from the top down one can clearly see the Veneris Mons,
clitoral hood, clitoris, and labia minora.
Vulva
The external female genitals are collectively referred to as The Vulva. All of the words
below are part of the vulva.
Mons Veneris
The mons veneris, Latin for ―hill of Venus‖ (Roman Goddess of love) is the pad of fatty
tissue that covers the pubic bone below the abdomen but above the labia. The mons is
sexually sensitive in some women and protects the pubic bone from the impact of sexual
intercourse.
Labia Majora
The labia majora are the outer lips of the vulva, pads of fatty tissue that wrap around the
vulva from the mons to the perineum. These labia are usually covered with pubic hair, and
contain numerous sweat and oil glands, and it has been suggested that the scent from
these are sexually arousing.
Labia Minora
The labia minora are the inner lips of the vulva, thin stretches of tissue within the labia
majora that fold and protect the vagina, urethra, and clitoris. The appearance of labia
minora can vary widely, from tiny lips that hide between the labia majora to large lips that
protrude. The most common metaphor for the labia minora is that of a flower. Both the
inner and outer labia are quite sensitive to touch and pressure.
Clitoris
The clitoris, visible in picture (B) as the small white oval between the top of the labia
minora and the clitoral hood, is a small body of spongy tissue that is highly sexually
sensitive. Only the tip or glans of the clitoris shows externally, but the organ itself is
elongated and branched into two forks, the crura, which extend downward along the rim of
the vaginal opening toward the perineum. Thus the clitoris is much larger than most peole
think it is -- about 4‖ long, on average. The clitoral glans or external tip of the cltoris is
protected by the prepuce, or clitoral hood, a covering of tissue similar to the foreskin of
the male penis. During sexual excitement, the clitoris may extend and the hood retracts to
make the clitoral glans more accessible. On some women the clitoral glans is very small;
other women may have large clitori that the hood does not completely cover.
Urethra
The opening to the urethra is just below the clitoris. It is not related to sex or
reproduction, but is instead the passage for urine. The urethra is connected to the bladder.
Because the urethra is so close to the anus, women should always wipe themselves from
front to back to avoid infecting the vagina and urethra with bacteria.
Hymen
The above illustrations show the area between the labia minora. From top to bottom can
be clearly seen the clitoris, urethral opening, and vaginal opening. It is a membrane that
partially covers the opening. The hymen is the traditional ―symbol‖ of virginity, although
being a very thin membrane; it can be torn by vigorous exercise or the insertion of a
tampon. Illustration D shows an imperforate hymen that completely closes the vagina; this
rare condition requires surgical intervention to provide for a normal flow of blood once
menstruation begins. Illustration E is of a vagina in a post-partum woman (one who has
given birth).
Perineum
The perineum is the short stretch of skin starting at the bottom of the vulva and extending
to the anus. The perineum in women often tears during birth to accomodate passage of the
child, and this is apparently natural. Some physicians may cut the perineum preemptively
on the grounds that the ―tearing‖ may be more harmful than a precise scalpel, but
statistics show that such cutting in fact may increase the potential for infection.
Vagina
The vagina extends from the vaginal opening to the cervix, the opening to the uterus. The
vagina serves as the receptacle for the penis during sexual intercourse, and as the birth
canal through which the baby passes during labor. The average vaginal canal is three inches
long, possibly four in women who have given birth. This may seem short in relation to the
penis, but during sexual arousal the cervix will lift upwards and the fornix (see illustration)
may extend upwards into the body as long as necessary to receive the penis. After
intercourse, the contraction of the vagina will allow the cervix to rest inside the fornix,
which in its relaxed state is a bowl-shaped fitting perfect for the pooling of semen. At
either side of the vaginal opening are the Bartholin‘s glands, which produce small amounts
of lubricating fluid, apparently to keep the inner labia moist during periods of sexual
excitement. Further within are the hymen glands, which secrete lubricant for the length of
the vaginal canal.
“G-Spot”
The word is in quotes because there is still some debate as to the existance or purpose of
the G- spot. In the illustration above, what is indicated as the g-spot in fact points to a
region known as the Skenes glands, the purpose of which are unknown. Despite the
controversy, one fact remains-- there are many women who claim that pressure on this
region of the vagina is extremely pleasurable.
Usually, two fingers are used, and because the spot is deep within the tissue, some
pressure may be needed. Also, because the Skenes glands are alongside the bladder, some
women may found that the increased pressure makes them feel as if they need to urinate.
Cervix
The cervix is the opening to the uterus. It varies in diameter from 1 to 3 millimeters,
depending upon the time in the menstrual cycle the measurement is taken. The cervix is
sometimes plugged with cervical mucous to protect the cervix from infection; during
ovulation, this mucous becomes a thin fluid to permit the passage of sperm.
Uterus
The uterus, or womb, is the main female internal reproductive organ. The inner lining of
the uterus is called the endometrium, which grows and changes during the menstrual cycle
to prepare to receive a fertilized egg, and sheds a layer at the end of every menstrual
cycle if fertilization does not happen. The uterus is lined with powerful muscles to push
the child out during labour.
Ovaries
The ovaries perform two functions: the production of estrogen and progesterone, the
female sex hormones, and the production of mature ova, or eggs. At birth, the ovaries
contain nearly 400,000 ova, and those are all she will ever have. However, that is far more
than she will need, since during an average lifespan she will go through about 500
menstrual cycles. After maturing, the single egg travels down the fallopian tube, a journey
of three or four days-- this is the period during which a woman is fertile and pregnancy
may occur. Eggs that are not fertilized are expelled during menstruation.
FREQUENTLY ANSWERED QUESTIONS
What is the G-Spot?

The Grafenberg spot, or G-spot, is an area located within the anterior (or front) wall of the
vagina, about one centimetre from the surface and one-third to one-half way in from the
vaginal opening (see illustration and text). It is reported to consist of a system of glands
(Skene‘s glands) and ducts that surround the urethra (Heath, 1984). Some authors write
that you must press ―deeply‖ into the tissue with two fingers to reach it with any
effectiveness.
The significance of the G-spot is that some women (about half) report that it is a highly
sensitive area that under the right conditions can be very pleasurable if stimulated. For
some women, it can be a primary source of stimulation leading to orgasm during
intercourse. Other women report no particular stimulation, and some say that it feels as if
they need to urinate.
The G-Spot has been linked to the phenomenon known as female ejaculation. To date,
there is little data about female ejaculation, although there is some speculation that it is
the product of the Skene‘s glands.
What is Toxic Shock Syndrome?

Toxic Shock Syndrome (TSS) is a rare but serious illness that can occur in men, women and
children. About half the number of cases reported is associated with using tampons and
affect a tiny number of women every year-- only about 1 out of every 1.5 million women
who have periods. TSS can occasionally be fatal.
Toxic Shock Syndrome can be treated successfully providing it is recognised quickly, and
most young people make a full recovery. Younger people may be more at risk from the
bacteria that are believed to cause this rare condition because their immune system may
not be fully developed. In the unlikely event that you have these symptoms during your
period--a high fever (over 102F or 39C), rash, vomiting, diarrhoea, sore throat, dizziness or
fainting - you must remove your tampon and consult your doctor immediately. These
symptoms can be early warning signs of TSS, which can develop very quickly and may seem
like flu to begin with.
Do not worry about wasting the doctor‘s time and remember to say you have been wearing
a tampon. Do not use tampons again without checking first with your doctor.
By using tampons correctly and following the advice below, you will reduce the risk of
developing TSS.
REMEMBER
• Always wash your hands before and after insertion and removal of a tampon.
• Always remove the used tampon before inserting a new one.
• Always remember to remove the last tampon at the end of your period.
• Never use 2 tampons at once.
• Tampons should only be used when you have a period.
FUNCTIONS OF THE MALE GENITALIA
Penis
The penis (shaft) and scrotum (balls) are the external sexual organs of men.
Glans
The glans is clearly visible in illustration (A) as the head of the penis. The glans is usually
covered by the prepuce unless the penis is erect, except in circumcised men, whose
foreskin has been surgically removed. The glans is highly sensitive, as is the corona that
connects the glans to the shaft of the penis.
Corona
The ‗crown,‘ a ridge of flesh demarcating where the head of the penis and the shaft join.
Frenulum, Frenum
A thin strip of flesh on the underside of the penis that connects the shaft to the head
Foreskin, Prepuce
A roll of skin that covers the head of the penis. It is rich in nerve endings. Surgical excision
(removal) of the foreskin of men is called circumcision.
Urethra, Meatus
The opening at the tip of the penis to allow the passage of both urine and semen
Smegma
A substance with the texture of cheese secreted by glands on each side of the fraenulum in
uncircumcised men
Scrotum
The scrotum is a sac that hangs behind and below the penis, and contains the testes
(testicles), the male sexual glands. The scrotum‘s primary function is to maintain the
testes at approximately 34 C, the temperature at which the testes most effectively
produce sperm.
Testes, Testicles
The male sexual glands, the two testes within the scrotum produce sperm and
testosterone. Within each testis is a kilometer of ducts called the seminiferous tubules, the
organs which generate sperm. Each testicle produces nearly 150 million sperm every 24
hours.
Epididymis
The epididymis is a ‗holding pen‘ where sperm produced by the seminiferous tubules
mature. The sperm wait here until ejaculation or nocturnal emission.
Vas Deferens
The ducts leading from the epididymis to the seminal vesicles. These are the ducts that
are cut during the procedure known as vasectomy.
Seminal Vesicles
The seminal vesicles produce semen, a fluid that activates and protects the sperm after it
has left the penis during ejaculation
Prostate Gland
Also produces a fluid that makes up the semen. The prostate gland also squeezes shut the
urethral duct to the bladder, thus preventing urine from mixing with the semen and
disturbing the pH balance required by sperm.
Corpa Cavernosa
The corpora cavernosa are the two spongy bodies of erectile tissue on either side of the
penis that become engorged with blood from arteries in the penis thus causing erection.
Ejaculatory Ducts
The path through the seminal glands where semen travels during ejaculation.
Cowper‟s Glands
The Cowper‘s glands secrete a small amount of pre-ejaculate fluid prior to orgasm. This
fluid neutralizes the acidity within the urethra itself.
FREQUENTLY ANSWERED QUESTIONS
What‟s the average size of the penis? What are the extremes?
According to the book Mandens Krop (which is translated from English, but does not give
the original title) the average is 15cm and 90% are between 13 and 18cm.
Is penis size important?

This is probably one of the most frequently asked questions on alt.sex, and that‘s a shame,
because it‘s really a pointless question. Penis size is important if and only if you think it is.
If you have sex with men and you desire a large penis, then penis size is important to you,
and only to you. If you feel your penis should be larger, then penis size is important to you,
and only to you.
Many women report that too many men are hung up on the size of their penises. The vagina
is only eight to thirteen centimeters long, and even a small penis can touch every square
centimeter within the vagina.
Can penis size be increased?

Yes. There are two surgical procedures to increase penis size-- the Bihari Procedure, and
Fat Injection.
The Bihari Procedure consists of cutting the ligament that secures the base of the penis to
the body. This gives between one-half and two inches of increased length to the penis;
however, because the penis is no longer anchored to the body an erection no longer points
‗up.‘
Fat Injection is the process of removing fat from the backs of the thighs and injecting it
into the body of the penis to make the penis thicker. Because the body rejects a significant
portion of the injection this procedure may need to be repeated several times and each
operation carries with it a severe risk of infection.
How do I measure my penis?

According to Harold Reed, M.D., director of the Reed Centre for Ambulatory Urological
Surgery in Bay Harbor, Florida, this is the correct way to measure the length of your penis:
First, while standing, get an erection. Okay, now gently angle your, er, equipment down
until it is parallel to the floor. Set your ruler against your pubic bone just above the base of
the penis, and measure to the tip. Thats how the doctors do it.
My penis bends down (or left, or right). Is there something wrong with it?
One-quarter of all penises bend in some direction and some bend downward even when
erect. Unless the bend is severe or causes you pain, there is nothing wrong or abnormal
about your penis. It should not interfere with sexual intercourse. Some people report that
a downward-bending penis is easier to fellate.
In rare cases a condition called Peyrone‘s Syndrome can arise from childhood diseases. This
condition is caused by scarring on one of the two corpora cavernosa within the penis,
stunting its effectiveness during erection and causing the penis to bend almost 90 degrees
in that direction. If you feel this may be the case, consult a urologist.
What is circumcision and why is it done?

Male circumcision is the surgical removal of the foreskin from the penis. When performed
in a hospital, it is usually done shortly after birth by a doctor or midwife. Circumcisions are
also given to Jewish boys by a mohel in a ceremony eight days after birth. Some Islamic
boys are circumcised when they are older, around age 12. The majority of American boys
are circumcised. Common reasons for circumcision include: Religious beliefs; better
hygiene, ―normal‖ or ―better‖ appearance, and ―his penis should look like his father‘s.‖
Common reasons against circumcision include: It is no longer necessary for hygienic
reasons; it is a painful, barbaric practice; there is a possibility of infection or surgical
error; destruction of sexual tissue reduces sexual sensitivity; ―normal‖ or ―better‖
appearance; and ―his penis should look like his father‘s.‖
What are blue balls?

Blue Balls is a real condition! The ―correct‖ term for blue balls is epididymitis, which is an
inflammation of the epididymis.
In simple terms blue balls occurs when the epididymis get blocked up with sperm that have
left the testis but not the penis. The vas deferns are the conduit for the sperm from the
testis to the urethra. When they get blocked you get pain. Why blue balls and not ―swollen
balls,‖ well maybe the connotation is that you balls have the ―blues‖, or maybe its because
with all that swelling some of the blood flow is restricted enough to cause some blueing of
the area because of pooling blood.
Why is the prostate mentioned so often during discussions of anal sex?

The prostate is about the size of a walnut in a normal man, and is immediately behind the
recta wall about three centimetres inside the anus. It can be felt by placing one finger
within the anus and feeling along the anterior wall for a round bulb. For some men,
touching or rubbing this spot is extremely pleasurable; a rare few can even orgasm through
this technique. Others report that the touch is painful or makes them feel as if they need
to urinate.
Annex 17: PEER EDUCATOR‟S WEEKLY SESSION REPORT
1. NAME OF ORGANIZATION:_________________________________________________
2. PEER EDUCATOR:____________________________________________________
3. Details of Sessions: Community Outreach  Peers  1:1
Date:______________Department/Prog/Site/Region/Workshop:_____________________
Facilitated by:_________________________Co-facilitator:__________________________
Start time:___________________________End time:_______________________________
Group:_______________________________Topic:__________________________________
4. Attendance Details:
Total number of Participants:_________________Males:_________Females:___________
Number attending for the first time:____________________________________________
5. Session Details
Method(s) used:______________________________________________________________
Any IEC materials distributed during the session:__________________________________
Key Questions and Concerns:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
________________________________________
6. Since your last session:

Qty Male Female
Number of 1:1 discussions conducted
Number of VCT referrals
Number of STI referrals
Number of OI referrals
Number of TB referrals
Number of HBC referrals
Number of PMTCT referrals
Number of CCC referrals
Number of referrals for General counseling
Number of condoms distributed
Number of referrals on condoms
Referrals for other health concerns
Date of Submission:_______________Signature of the Focal Person: ____________

Annex 18: BIBLIOGRAPHY
1) Steps in Establishing a workplace HIV and AIDS program. An Advocacy Package for
Managers: By National Organization of Peer Educators (NOPE).
2) How to create an effective Peer education project: (Guidelines for AIDS
prevention projects). FHI- AIDSCAP
3) Bulletin of the World Health Organization 2002, 80 (12): TB and HIV
4) Participatory Peer Education for HIV and AIDS Prevention.
A manual for Trainers of Peer Educators: By Programme for Appropriate Technology
in Health (PATH). FHI- IMPACT (Implementing AIDS Prevention and Care Project)
Project-2000.
5) How to be an IMPACT Peer Educator.
A manual for Peer Educators: By programme for Appropriate Technology
in Health (PATH)-2002.
6) TB and HIV. A clinical Manual: By Dermot Maher. WHO/TB/96.200
7) Workplace HIV and AIDS programs. An action guide for Managers: By Family
Health interna tional (FHI)-USAID
8) AIDS Africa - Continent in crisis. By Helen Jackson: SAFAIDS.
9) Understanding Human Behaviour: By James V. McConnell and Ronald P. Philip Chalk.
10) Discussion Guides for Peer Educators: FHI IMPACT Project – USAID
11) ILO Website: Essentials of a workplace HIV and AIDS program.
12) Peer Education Facilitation Guide: A handout for workplace Peer Educators.
National Organiza tion of Peer Educators (NOPE).
13) Behavior Change Communication: A strategy Development and Implementation
Manual – Fam ily Health International IMPACT project (2003).
14) Lessons on Disclosure or Testimonials: www.aidsmeds.com
15) The Guide to Living With HIV Infection: Johns Hopkins AIDS Clinic, John Hopkins
University. March 2005.
16) Guidelines to Antiretroviral Therapy in Kenya: GOK Ministry of Health.
17) Protocol for the Identification of Discrimination against People Living with HIV:
(UNAIDS 2000).
18) Establishing a HIV and AIDS Workplace Programs, An Advocacy Package For
Managers: By National Organization Of Peer Educators (NOPE 2005), Kenya.
19) Implementing The ILO Code Of Practice On HIV/AIDS And The World Of Work: An
Education and Training Manual – ILO.
20) 2002 ―Good Practice Note on HIV/AIDS‖: IFC Against AIDS.
21) Monitoring BCC Activities: Family Health International (FHI)
22) National Life Planning Skills Manual: UNFPA Kenya Country Office
23) Handout for HIV and AIDS Education at the Workplace: ILO
24) Pretty, J. & Guiltjt, I (1995). Participatory Learning and Action. London:
International Institute for Environment and Development.
25) Renner, P. (19994). The Art Of Teaching Adults: How To Become An Exceptional
Instructor And Facilitator. Vancouver, Canada: Training Associates.
26) Dian, S.S. Pam, F. & Rolf, S. (1998). Facilitation Skills: An Introductory Guide
Project concern International, Social IMPACT, Progressive Life Center Zambia.
27) Home and Community-Based Care for People Living with HIV/AIDS:
NASCOP/Ministry of Health, May 2008
Notes
National Organisation of Peer Educators VSO Jitolee
Riverside Drive, Westlands 5th Floor, Timau Plaza
P.o. Box 10498 Nairobi 00100 Argwings Kodhek Road
Tel: (+254-20) 4451201/2 P.o. Box 49843 Nairobi 00100
Fax: (+254-20) 4444354 Tel: (+254-20) 3871378/823
email: nope@iconnect.co.ke Fax: (+254-20) 3876013
www.nope.or.ke email: vsojitolee@vsoint.org
www.vsojitolee.org

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A Facilitation Guide

for ‘Right 2 Life’ Peer Educators

Revised Version 2009

© 2009 VSO Jitolee and NOPE

List of Abbreviations and Acronyms

Session Item Page

Section 1: IDENTIFYING LEARNING NEEDS AMONG PEERS

Section 2: SEXUALLY TRANSMITTED INFECTIONS (STIs)

Section 3: UNDERSTANDING WHAT HIV IS

Section 4: WHEN HIV PROGRESSES TO AIDS

Section 5: DELAYING THE ONSET OF AIDS

Section 6: HIV COUNSELLING AND TESTING

Section 7: PREVENTION OF STIs AND HIV

Section 8: GENDER HIV AND HEALTH

Section 9: HIV AND AIDS RELATED STIGMA

Section 10: REPRODUCTIVE HEALTH AND GENERAL WELLNESS

Section 11: EXPLORING HIV WORKPLACE POLICY AND PROGRAM

Chronic Disease: A disease lasting a long time, or recurring often.

Combination ARV therapy: Use of three or more antiretroviral medications to more

Discrimination: An act or behaviour based on prejudice. Discrimination is a way of

Epidemic: A disease affecting or tending to affect a disproportionately large number of

Healthcare provider: A doctor, nurse, midwife, programme manager or others whose

Heterosexuality: Sexual attraction of individuals of different sex.

High-risk groups: Refers to individuals at greatest risk of contracting a particular

Home and Community-Based Care: This is an integrated, comprehensive, continuum of

Homosexuality: sexual attraction for individuals of the same sex

Immuno-compromised: Having a weak or damaged immune system as measured by a

Immuno-suppressed: When the body‘s immune function is damaged and incapable of

Incidences: The number of new cases e.g. new HIV infections

Infection: Invasion and growth of germs in the body.

Medication adherence: Taking medicine exactly as recommended by a healthcare

Monitoring: Routine tracking of information or indicators about a programme and its

Mother-to-child transmission (MTCT) of HIV: Transmission of HIV from a woman

Opportunistic Infection (OI): A disease caused by a micro-organism that does not

Prophylaxis: Treatment to prevent the onset of a particular disease (primary prophylaxis) or

Re-infection: To be infected for the second time by the same germ.

Side effect: Unintended action or effect of a medication or treatment.

Universal precautions: A simple set of effective practices designed to protect health

Viral load: The amount of HIV in the blood.

―HIV&AIDS is not just a public health issue; it is a workplace issue, a development

1. Anglican Church of Kenya - Kitui Diocese

Peer education is a core component of successful HIV&AIDS workplace interventions, and

Makena Mwobobia Ben Ngutu Philip Mbugua

Head of Programmes Executive Director Director

Why the guide?

 higher quality facilitation skills,

Who is a Peer Educator?

What are the roles of a Peer Educator?

• Refer peers to appropriate services for STIs, treatment, general counseling or

What support does a Peer Educator Expect?

From workplace HIV coordinator:

From workplace (Management)

From Workplace (Peers)

When planning for a session it is important to consider the following factors:

STARTING AND MANAGING A QUALITY PEER EDUCATION SESSION

1.Starting the session

A session could take the following format:

• Facilitate an introductory game for names and possible designations and

Things to consider when using Energizers:

3. Ending the session

Session 1: VALUES AND BELIEFS ABOUT HIV, AIDS AND SEXUALITY

Methodology: Values Voting Exercise

• People with AIDS should not have sex.

Step 7: Summarize the session by explaining the following: