HIV/AIDS PREVENTION FOR WOMEN AT A HIGHER RISK.misaccess.psi.org/bcc_catalog/web/files/CSW Curriculum.pdf · for new users. Modules one to five contain a number of exercises that

HIV/AIDS PREVENTION

FOR WOMEN AT A HIGHER RISK.

EXECUTIVE SUMMARY This training curriculum is designed to equip facilitators with knowledge and skills necessary to conduct peer educator trainings among sex workers, and for use by peer educators as a reference and guide for their sessions. The manual provides commercial sex workers with social cognitive life skills, values and practices they need to lead healthy lives. The curriculum is divided into modules, with each module containing a number of group exercises and games that a facilitator can use to explain technical concepts in an easy way. The exercises are divided into simple steps that are easy to follow, making it possible for easy facilitation even for new users. Modules one to five contain a number of exercises that highlight Life skills such as self-esteem, communication, negotiation skills as well as reproductive health basics. These life skills encourage participants to look inwardly about themselves and find coping strengths to overcome challenges to adopting healthy behaviors. The first exercises help facilitators to establish trust with the group, confidentiality, and develop ground rules Modules six through eight highlight the dynamics of HIV transmission and prevention, STIs, family planning options available for commercial sex workers, and concepts of risky behaviors and how to avoid them. Module nine through thirteen discuss condoms use in details, with exercises that enable participants to practice and increase their ability to negotiate, discuss and use condoms even in difficult circumstances. Also in this section is discussed a number of issues that influence the ability of the sex workers to not to use condoms, such influence of alcohol and drugs, prejudices etc.

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TABLE OF CONTENTS

Executive summary………………………………………………………………………………………2 How to lead a peer education session …………………………………………………………………5 Monitoring and evaluation……………………………………………………………………………….7 Peer education training ………………………………………………………………………………….15 MODULE 1: LISTENING AND COMMUNICATION SKILLS… …………………………………….16 EXERCISE 1.1: EXPECTATIONS………………………………………………………………………16 EXERCISE 1.2: ESTABLISHING TRUST AND CONFIDENTIALITY……………………………….17 EXERCISE 1.3: GROUND RULES……………………………………………………………………..17 EXERCISE 1.4: LISTENING PAIRS……………………………………………………………………18 EXERCISE 1.5: BODY LANGUAGE……………………………………………………………………18 EXERCISE 1.6: NEGOTIATING SAFER SEX…………………………………………………………19 EXERCISE 1.7: SKILS FOR NEGOTIATION………………………………………………………….21 EXERCISE 1.8: ACTIVE LISTENING…………………………………………………………………..22 EXERCISE 1.9: MUTUAL DECISION MAKING……………………………………………………….23 EXERCISE 1.10: QUESTION ASKING………………………………………………………………...24 EXERCISE 1.11: NEGOTIATING SAFER SEX……………………………………………………….24 EXERCISE 1.12: FINDING BALANCE IN RELATIONSHIPS………………………………………..25 MODULE 2: SELF-ESTEEM…………………………………………………………………………….19 EXERCISE 2.1: LOOKING INWARD…………………………………………………………………...27 EXERCISE 2.2: STONE SOUP…………………………………………………………………………28 MODULE 3: REPRODUCTIVE HEALTH……………………………………………………………..30 EXERCISE 3.1: LANGUAGE OF SEX……………………………………………………………….30 EXERCISE 3.2: FEMALE AND MALE BODY PARTS AND FUNCTIONS……………………….31 MODULE 4: OUR PERCEPTIONS …………………………………………………………………….32 EXERCISE 4.1: FIXED POSITIONS…………………………………………………………………..32 EXERCISE 4.2 : IDEAL IMAGES AND PERSONNAL DESTROYERS…………………………...33 EXERCISE 4.3 :PRIORITISING PROBLEMS………………………………………………………..34

MODULE 5: LIFE SKILLS………………………………………………………………………………36 EXERCISE 5.1: I’ STATEMENTS………………………………………………………………………36 EXERCISE 5.2: SAYING NO………………………………………………………………….………...37 EXERCISE 5.3: STEPS TO DELIVER AN ASSERTIVE MESSAGE……………………………….37 MODULE 6: STIs AND HIV/AIDS………………………………………………………………………39 EXERCISE 6.1: COMMON MYTHS…………………………………………………………………….39 EXERCISE 6.2: OVERVIEW OF STIs………………………………………………………………….40 EXERCISE 6.3: INFORMATION ABOUT HIV/AIDS……………………………………………...…..40 EXERCISE 6.4: TRANSMISSION OF HIV AND STIs………………………..………………………42 EXERCISE 6.5: PRVENTION OF HIV AND STIs…………………………………………….….…...42 EXERCISE 6.6: REVIEW OF COMMON MYTHS…………………………………………………….43 EXERCISE 6.7: WOMEN AND HIV/AIDS…………………………………..…………………………44 EXERCISE 6.8: CONTACT TRACING…………………………………..…………………………….45 EXERCISE 6.9: STI TRUE OR FALSE…………………………………..…………………………….46 EXERCISE 6.10: STI NAMES AND SYMPTOMS..………………………………..…………………48 EXERCISE 6.11: TREATING STI EXERCISE…………………………………..……………………49 EXERCISE 6.12: STI BOX GAME…………………………………..………………………………….51

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EXERCISE 6.13: STI CIRCLE GAME………………………………..……………………………….54

MODULE 7 :RISK BEHAVIOURS……………………………………………………………………..53 EXERCISE 7.1 : THE DANGER GAME……………………………………………………………….53 EXERCISE 7.2: SCRATCH CHAIN…………………………………..………………………………..56 EXERCISE 7.3: GLOVE GAME…………………………………..………………………………….…56 EXERCISE 7.4: PERSONAL RISK ASSSESSMENT…………………………………..……………58 EXERCISE 7.5: BEAN GAME…………………………………..………………………………………59 MODULE 8 : FAMILY PLANNING……………………………………………………………………..61 EXERCISE 8.1 : TYPES OF CONTRACEPTIVES…………………………………………………....61 EXERCISE 8.2 : HOW TO USE CONTRACEPTIVES………………………………………………..61

MODULE 9: CONDOM DISCUSSION…………………………………………………………………63 QUESTIONS TO ASK……………………………………………………………………………………63 EXERCISE 9.1: DEMONSTRATION ON CONDOM USE………………………………..………….66 EXERCISE 9.2: CORRECT AND CONSISTENT CONDOM USE……………………………..……67 EXERCISE 9.3: CONSISTENT CONDOM USE EXERCISE…..………………………………….…68 EXERCISE 9.4: ADVANTAGES AND DISADVANTAGES OF CONDOM USE…………………...69 EXERCISE 9.5: DEMONSTRATION ON CONDOM RELIABILITY………………………………....70 EXERCISE 9.6: CONDOM FACTS AND ROMOURS………..………………………………….…...71 EXERCISE 9.7: CONDOM RELAY GAME…………………………………..………………………..72 EXERCISE 9.8: CONDOM EXCUSES………………………..………………………………….……73 EXERCISE 9.9: CONDOM DO’S AND DON’TS……………..………………………………….……74

MODULE 10: LOVE……………………………………………………………………………………..76 EXERCISE 10.1: SITTING ON KNEES……………………………………………………………….76 EXERCISE 10.2: SPIDER WEB……………………………………………………………………….76

MODULE 11: PREJUDICE…………………………………………………………………………….78 EXERCISE 11.1: PASS THE PICTURE………………………………………………………………78 EXERCISE 11.2: TAKING RISKS……………………………………………………………………..79 EXERCISE 11.3: WHO IS LABELING WHOM?……………………………………………………..79 EXERCISE 11.4: HOPES AND FEARS………………………………………………………………81

MODULE 12: ALCOHOL AND DRUG ABUSE…………………………………………………..…83 EXERCISE 12. 1:ONE-MINUTE ALCOHOL ROLE-PLAY…………………………………………83 EXERCISE 12. 2:ALCOHOL AND CSW……………………………………………………………..85 Bibliography……………………………………………………………………………………………86

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EXERCISE A

HOW TO LEAD A PEER EDUCATION SESSION OBJECTIVE To improve skills for peer education BACKGROUND The more the peer educators develop their skills, the more effective they will be in their work. This session allows them to practice conducting a peer education session. MATERIALS Flip chart and paper or blackboard (optional) TIME 1 hour INSTRUCTIONS STEP 1 Ask participants to divide into groups of 5–10. STEP 2 Have each group choose one person to act as the peer educator. STEP 3 Ask the chosen peer educators of the groups to role-play how they would approach a group of sex workers. They can choose any topic related to HIV/AIDS they want. The others in the group will act as the peers. Some suggestions for topics:

• The importance of condoms to HIV/AIDS prevention • How HIV is spread from one person to another • Why sex workers are vulnerable to HIV/AIDS.

STEP 4 Let each group come forward and enact the situations they have created. STEP 5 Discuss with participants and remind them of the factors that they must bear in mind when meeting a group for the first time:

• Greet the group • Introduce themselves • Explain why they have come.

STEP 6 Write out and explain to participants some of the things they should remember when facilitating a group of peers:

• Be punctual at sessions. • Have fun playing the games in a relaxed manner. • Do not be judgmental and remember that everyone has his/her own views and beliefs. • Try not to tell the group/person what to do. Rather, ask them questions so that they can

deduce their own answers. • If your group is tired or loses attention during the session, then exercise or sing a song

before you continue, or reschedule the meeting. STEP 7

Review the important points and ask for feedback from the participants. Ask if they have any questions. EXERCISE B Skills for asking questions OBJECTIVE To increase skills in leading discussions through effective question-asking BACKGROUND Probing questions are used to obtain information that is needed to communicate effectively. Often participants in peer education sessions will provide short answers or even try to give you the answer they think you want to hear. A peer educator who is skilled at asking probing questions is more able to get to the reality of a situation and encourage frank and open discussion. MATERIALS None TIME 20 minutes INSTRUCTIONS STEP 1 Tell the peer educators why developing skills for asking probing questions is important. Ask them to provide some examples of probing questions such as:

• Could you tell me more about that? • What made you do that? • How did you feel when that happened? • Why do you think that is important?

STEP 2 Explain to peer educators that an open-ended question is a question that does not require a “yes” or “no” answer. Open-ended questions are useful to peers to get discussions started. Open-ended questions cannot be answered in a few words and usually begin with “how”, “why” or “could”. STEP 3 Point out that closed-ended questions ask for only a simple answer that does not require any reflection on the listener’s part. Answers to such questions are usually brief (“Yes” or “No”) and questions usually begin with “is”, “are” or “do”. Ask each peer educator in turn to answer the following questions:

• Do you like rice? • Do you drink beer? • Are you enjoying this training?

STEP 4 Now ask each peer educator in turn to answer the following open-ended questions:

• What are your favorite foods? • What do you think of beer drinking? • How could this training be improved? • Why do you think men are different from women?

STEP 5 Remind participants that open-ended questions are more valuable than closed-ended ones because they increase participants’ involvement in peer education sessions.

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Monitoring and Evaluation BASIC FACTS ON MONITORING AND EVALUATION Two main topics are covered in this section. The first focuses on reporting to the peer education supervisor, holding meetings with focal persons such as decision-makers, program planners and supervisors, and the use of diaries and notebooks, or activity monitoring forms. The second topic discusses collecting information: types of data (qualitative and quantitative) and quarterly report monitoring. The exercises in this section are for peer educators and not peer beneficiaries, and are to help you get acquainted with the monitoring forms. All the work you will be doing as a peer educator is appreciated and is valuable. We would like to know what you have done so as to appreciate and evaluate the impact. To track down all activities various forms have been designed and it is of paramount importance that you learn what is required of you when feeling them. What is monitoring and evaluation? One of the biggest challenges with peer education programs is determining whether they are working or not. There is a wide array of methods and approaches for collecting information to determine whether the peer education program is working and risk-taking behavior is being reduced. Reasons to monitor peer educators include:

• Helps motivate the peer educators. • Identifies any performance gaps. • Reviews how the peer educators respond to difficulties encountered. • Assures the objectives and practices followed by the peer educators are in

line with the project’s objectives. The following steps are to be followed:

1. Identify the information to be collected. 2. Use the designed reporting system. 3. Familiarize with the Indicators to monitor the progress and assess the actual impact

of the program such as: • Number of individuals referred by the peer educators to a nearby health

facility for treatment of sexually transmitted infections (STIs) and opportunistic infections or for voluntary counseling and testing (VCT)

• Number of condoms sold or supplied by the peer educators and used by the peers

• Amount of educational material distributed by peer educators to their peers • Anecdotal experiences narrated by the peer educators • Acknowledgement/recognition of the peer educators’ services by randomly

selected peers.

4. Informal approaches to supervision and monitoring including: • Observation (simply watching peer educators in action) • Interaction with participants and feedback from peer educators • Focus group discussions • System for providing feedback to peer educators.

5. Formal approaches including: • Spot checks • Monthly peer educators’ meetings • Routine refresher training for the peer educators • KAP survey

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6. Impact indicators for the peer education program including: • Number of STI cases treated by qualified medical practitioners • Number of socially marketed condoms sold by peer educators • Number of attendees to STI services from the target group • Percentage of individuals within the target population that used a condom in

the last casual sexual relationship. 7. Means of verification:

• Referral slips • Information on STI cases treated, as collected from private and government

medical practitioners • Reports from social marketing condom outlets and peer educators.

How will the monitoring and evaluation be done? Train peer educators well in monitoring As peer educators you have the responsibility of keeping track of your own activities and reporting to supervisors and, ultimately, program planners. Because you are on the front lines you have the responsibility of monitoring the changes in behavior of the peer beneficiaries and reporting them. In order to get good results you must be aware of your role and you will be trained and motivated to carry it out. Reporting forms We have designed simple reporting formats that make it easy to collect and interpret results. There are three sample forms in the exercise, which show:

a) The monthly activity record; b) The monthly data collection form; c) The condom stock card.

In addition, each peer educator can keep a small pocketsize notebook and diary that provides more details on each session and lists appointments. Peer educators are encouraged to initially organize five meetings per month and increase gradually. Hold monthly supervision meetings Peer educators shall hold monthly meetings with the peer education supervisors or amongst themselves. The supervisor/coordinator is responsible for reviewing the impact of the process and should identify and invite pertinent personnel to attend meetings where this information can be shared. This identification process should be at the discretion of the peer educator but should include decision-makers, program planners and high-ranking officers. The forum is used to share experiences, events, problems, progress, causes of problems and potential solutions. Issues on the agenda might include a review of HIV/AIDS activities, submission of monthly reports and drawing up an action plan. The supervisor collects the data, and if possible compiles them into meaningful statistics. In summary Peer educators should hold monthly meetings with supervisors to focus on the following:

• Share experiences and learn from each other • Update peers with HIV/AIDS information and events • Highlight problems and seek ways to solve them • Practice role-plays/presentations.

Regular meetings necessary Supervision and monitoring of peer educators is best achieved through regular meetings to take note of any new changes as well as reviewing progress to identify weaknesses/strengths and check performance. Each peer educator will have ongoing meetings with their supervisors, to draw up plans, schedule sessions and assess progress.

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Supervisors compile report The supervisor should compile a quarterly report for monitoring. Implementation of the HIV/AIDS program must be monitored to highlight progress of STI/VCT assessments, condom promotion/distribution, and health talks, house visits and counseling sessions with peers. Record keeping Record keeping is an important tool as it helps to gauge the performance of peer educators and also assess the progress of the program. How are peer educators monitored?

• Field support visits. The project coordinator lists the sex workers to be visited, taking note of their schedule, and arranges for a visit by appointment.

• Regular visits to take note of any new changes. • Record review to identify weaknesses/strengths and check performance. • Spot checks are done randomly without planning in order to follow up and check

activities. This helps peer educators to be alert and active. Ongoing training in the field based on areas that need improvement is also arranged.

• Quarterly reports: These reports are compiled by the project coordinator against four key tasks:

a) Implementation of HIV/AIDS program: this highlights progress of STI/VCT assessments and condom promotion/distribution.

b) Training program: in accordance with the performance guidelines. c) Supervision: monitoring visits to focal persons/peer educators. d) Monitoring and evaluation:

Evaluations should answer questions such as:

• Did the intervention reach the desired number of individuals? • How many peers were trained? • To what extent are people living with HIV/AIDS involved in training? • Were training activities implemented the way they had been intended? • Which specific interventions work best? Under what circumstances? • What components did not work? What went wrong? • Where should more efforts be placed? • What can be improved?

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EXERCISE B Evaluating and monitoring forms OBJECTIVE To learn more about what is required of peer educators in terms of monitoring and evaluation and become familiar with sample reporting forms. Peer educators should have a better understanding of what information it is important to collect, how to plan their activities and the importance of coordination. BACKGROUND The peer educators have an important role in providing the eyes and ears for the progress the peer education effort is making since they are on the front lines. MATERIALS Sample reporting forms, flip chart and paper or blackboard (optional) TIME 45 minutes INSTRUCTION STEP 1 Distribute the sample evaluation forms to participants and briefly explain how to record the following information:

• Monthly activity record: provides details on and tracks peer education activities. • Monthly data collection form: elicits feedback on condom distribution, numbers referred

for STI treatment and VCT. • Condom stock card: source of information for monitoring flow of condoms through the

system. • Peer educator’s diary: assists the peer educator in keeping his/her own individual records

and in recording promptly. STEP TWO Ask participants the following questions and write their responses on a flip chart or blackboard if possible:

• What do you think of the evaluation forms? • Was there anything confusing about the forms? • Why do you think it is important to fill out forms like these? • What do you think the information collected on the forms would be used for? • Why do you think it is important to provide correct information on the forms?

STEP THREE Provide a summing-up of the points made by the participants.

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SAMPLE EVALUATION FORMS

Monthly Activity Form

Month:………………………… Name of Peer educator…………………… Location:……………………… Name of Supervisor………………………

Date Topic Presentation Method

Number of Peers reached Comments

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Monthly Data Collection Form Month:………………………… Name of Peer educator…………………… Location:……………………… Name of Supervisor………………………

Week Number provided with condoms

Number of referrals

Reasons for Referrals

Male Female

Week 1

Week 2

Week 3

Week 4

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Condom stock cards Month:………………………… Name of Peer educator…………………… Location:……………………… Name of Supervisor………………………

Opening balance:……………………

Week Number of Packets distributed Balance Week 1

Week 2

Week 3

Week 4

Total

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Peer educators’ diary Month:………………………… Name of Peer educator…………………… Location:……………………… Name of Supervisor………………………

Date

Type of meeting (group or one-to-one)

Place of meeting

Time of meeting

Number of peer beneficiaries present

Number of male participants present

Number of female participants present

Method of presentation

Topic(s)

Number of people provided with condoms

Number referred for STI treatment

Number referred for VCT

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THE PEER EDUCATORS TRAINING Objectives The objectives for the CSW peer educators’ training will be based on the following objectives of the program, grouped under two categories (risk reduction and condom use). The program aims at increasing the proportion of CSW who; Risk Reduction

• Believe they are at high risk of contracting HIV, from x to y (by 15%.) • Believe that HIV is not a punishment from God, from x to y (by 15%.) • Believe that they can avoid HIV by using condoms consistently and

correctly, from x to y (by 10%.) Condoms

• Believe they are able to negotiate condom use with their regular and casual partners, from x to y (by 5%.)

• Report always or almost always using condoms with casual and regular partners, from x to y (by 15%.)

By the end of the training, the peer educators will:

1. Be able to explain the CSW peer education program, (including their role as peer educators, purpose of the program, monitoring the program activities, etc).

2. Be comfortable using the “Peer Education” curriculum to carry out peer education.

3. Become more knowledgeable about HIV/AIDS prevention and STIs (personal risk assessment and condom use, condom negotiation)

4. Have the skills to lead participatory exercises, during peer outreach activities.

5. Have developed their work plans

MODULE 1

LISTENING AND COMMUNICATION SKILLS

Goal:

• To help a peer group form itself and to help participants develop skills of listening and analysisof communication and co-operation.

Objectives:

• Share expectations of the training program • Define ‘trust’ and ‘confidentiality’ in the context of the training program • Agree on a set of ground rules for group interaction • List the qualities involved in good listening skills • Understand the role of body language in communication • Establish a plan for giving and receiving social support during the training program

Exercise 1.1: Expectations Objective: Share expectations of the training program Materials required: Blank half-sheets of paper or cards, pens/pencils, tape, flipchart or chalkboard Duration: 15 minutes Instructions:

1. Give each person two blank half-sheet of paper and a pen. Ask each person to write (or draw) two expectations that they have for the training program.

2. As each person finishes writing, the facilitator should tape each piece of paper onto the

board or flipchart under the heading, “Expectations”. After everyone has given their expectations, the facilitator should add his or hers.

3. Briefly review the list of expectations. Ask participants to decide together whether all are

within the scope of the training program. If there are different ‘themes’, cluster the expectations according to these.

4. Post this list on the wall and refer back to it throughout the training program.

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Exercise1. 2: Establishing trust and confidentiality Objective: Define ‘trust’ and ‘confidentiality’ in the context of the training program. Materials required: Blackboard or flipchart, chalk or markers Duration: 25 minutes Instructions:

1. Ask the group to divide into small groups (3-5 people) and to discuss amongst themselves for a few minutes the following situation: Imagine that they have some kind of health or social problem that they feel embarrassed about. They want to seek some advice from a friend or from a health worker. What qualities would they look for in the person whose advice they seek? They should not mention the name of the person to whom they would turn; they should just concentrate on the qualities of that person.

2. Call everyone back into the large group and ask each group to describe the qualities that

were discussed. As each group lists a quality, write it on the blackboard or flipchart. 3. When everyone has finished, review the list together. Point out that we all seek the same

kinds of qualities in people to whom we want to turn when in need, and that we all have secrets or embarrassing feelings that we would like to share with someone else who we feel could reassure or help us.

4. Finally, explain to the group that our greatest source of learning comes from our shared

experiences, and the more that we feel we can trust each other; the more we are all likely to learn from one another’s experiences. Encourage everyone to think carefully before talking about details of your discussions outside the workshop.

Exercise 1.3: Ground rules Objective: Agree on a set of ground rules for group interaction Materials required: Flipchart paper and markers Duration: 20 minutes Instructions:

1. Explain that this is the group’s time together and that in order to make the best of this time, it is useful for everyone to agree to some group rules. Ask participants to suggest rules they think might be appropriate. As rules are suggested, write them on the flipchart or blackboard.

2. Once all of the rules have been written down on the flip chart, ask the group to go

through them again together. Does everyone agree on these rules? 3. Encourage the participants to try to stick to these rules and ask them to remind you and

one another if you or any of them err from them. 4. Post the flip chart paper in an area that is easy to see. If there is no permanent area, ask

one participant to take responsibility for the flip chart. Ask her/him to bring it to each of your meetings so that you always have it on hand to refer to.

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Exercise1. 4: Listening Pairs Objective: List the qualities involved in good listening skills Materials required: None Duration: 25 minutes Instructions:

1. Ask the participants to divide into pairs. One person of each pair should begin by describing to the other an event in his or her life that made him/her feel very happy. The listener should say nothing, but should concentrate hard on hearing what is being said.

2. After two minutes, tell the speakers to continue describing the event, but tell the listeners

to stop listening. S/he might yawn, look elsewhere, turn around, whistle, or anything else s/he likes besides listening to the speaker.

3. After two minutes, call time. Tell the speaker and the listener to change roles and repeat the exercise.

4. Ask participants to describe first how they felt as speakers, comparing the experience of

telling their story to a willing listener and telling it to a bad listener. Then ask participants to describe and compare how they felt as good and bad listeners.

5. Ask participants to describe some of the body language that listeners used to

communicate interest or disinterest in the story that was being told (examples might include eye contact, open body posture, nodding of the head, or smiling to communicate interest; turning away, crossing the arms, lack of eye contact, interrupting, or fidgeting to communicate disinterest).

Exercise1. 5: Body Language Objective: Understand the role of body language in communication Materials required: None Duration: 35 minutes Instructions:

1. Ask participants to divide into pairs (different ones than in the previous exercise). Tell each pair to think of a discussion that one of them has had with someone else, which has developed into an argument. The pair should first establish the two characters and their relationship through mime. They should then re-enact the argument between them also as a mime, only using their bodies and faces (no words). Give the pairs ten minutes to do this.

2. Choose two pairs whose scenes looked particularly clear. Ask the first pair to re-enact

their scene for the large group. 3. Ask the rest of the participants to tell the story of this pair’s argument. It does not matter

if the audience doesn’t know the details; the point is how easy it can be to understand what is happening simply by observing body language.

4. Repeat this exercise with the second pair whom you have picked out. 5. Brainstorm with the participants about the kinds of emotion we can communicate with our

bodies, such as pleasure, dejection, anger, submission, strength, weakness, power and so on. Ask each person who volunteers an emotion to show appropriate body language as well.

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6. Point out how different eye levels of positions between people can make a big difference

to communication and to power between people; i.e., teachers standing up while their pupils are sitting down, elders sitting on chairs while others stand up or sit below them, shopkeepers behind their counters while customers wait to ask them for goods. Ask participants to give examples of this from their own experience, describing each time whether the person who is higher or lower, or behind or in front, has more power and why.

7. Finish by asking participants to start thinking about the way that they use their own

bodies to say things to one another over the next few days and weeks. Encourage them to think about how they might use their bodies differently in different contexts, in order to convey different messages to people.

Exercise 1.6 Guidelines for Negotiating Safer Sex

OBJECTIVE : To improve skills for communicating with sexual partners about STI and HIV prevention.

MATERIALS : Pen and notepaper

TIME 30 minutes Instructions STEP 1 Then have the participants divide into small groups or pair off. STEP 2 Ask one person in each group or pair to be the note taker. Assign each group or pair one of the scenarios and related questions listed below. Ask participants to review and discuss their scenario, answer the questions and develop responses to the questions and/or appropriate strategies. A strategy is simply an action that is deliberately planned out beforehand. The note taker should write down the responses and strategies developed. Scenario A: This is Sarah’s first visit outside of her country and it’s also the first time she has ever been in another country. Sarah is surprised and overwhelmed by the amount of diversity in her new home environment (cultural, religious), not just in the local population. It has been very stressful for Sarah trying to adjust to so many different types of people and this new environment. She has formed a friendship with Lydia, another new person in the country. They’re going to a nearby beach and are very much looking forward to it. Since they want to make new friends with the gentlemen around there. Sarah and Lydia are in a social club drinking, after spending a great day on the beach. Sarah meets Peter at the club. They dance and talk and Peter can tell just by the way Sarah smiles and touches him that she’s sexually interested in him. Sarah invites Peter back to her place. Peter is worried about HIV and other STIs and wants to use a condom. After they get to Sarah’s apartment, they begin to move towards intimacy. They have this conversation: PETER: “I should tell you now that it’s very important to me to use condoms. I have some with me.” SARAH: “Why do you want to use those things? You don’t need it with me. I take birth control pills!” PETER: “Well, I think it might be a good idea…”

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SARAH: “But Peter, it feels so much better without a condom.” Questions to ask participants:

What should Peter do? What should Peter say to Sarah? If Peter wants to use a condom, what should he tell Sarah? If you were in Peter’s situation, what would you do?

Scenario B: Jennifer has been in sex worker for over 3 years. She has been using condoms sometimes and other times she doesn’t. She onetime suffered from a bad STI that made her lose business for a longtime. After getting treatment she vowed never to have sex without a condom. Now she is also broke and is need of lots of money for her problems. However all the clients coming to her for sex don’t want to use condoms. John, a client, has insisted he wants her but without a condom and although she has attempted to convince him, that live sex is more expensive, he is willing to pay. Questions to ask participants:

What should Jennifer do? What should Jennifer say to John? If you were in Jennifer’s situation, what would you do? How could Jennifer convince John to use condoms?

Scenario C: Sarah and Mohammed have been having sex together for several weeks. They both wanted to use condoms in the beginning. Just before starting to make love Sarah whispered in Mohammed’s ear that she wanted him to “go in live” this time. Mohammed was refused and put on the condom. Sarah was very upset with this. She considered this a sign that Mohammed didn’t trust her. She even accused him of thinking that she was a prostitute and that she didn’t want to see him again. Mohammed said she really did care for her and it was because of that he wanted to use condoms. Questions to ask participants:

What did you see happening in this story? Is trust or honesty enough to protect people from HIV? Do you think the girl was right in suggesting they stop using condoms? How did Mohammed try to resolve the problem? Develop possible responses and strategies Mohammed to use to effectively negotiate

safer sex with Sarah. Scenario D: Robert and Anna have been married for 2 months. Robert is a turn boy and has been away from home on a safari for six months. Since he does not make so much money, he leaves Anna with little money that cannot sustain her so she needs to look for more money. Anna being unemployed, she resorts to commercial sex. Though they have never talked about it, Robert is sure that Anna has sex with other men while he is away. He is also quite sure that she doesn’t use condoms because he has heard her cursing condoms when they are advertised on the radio. He is concerned that she may have picked up an STI or HIV could infect him. He knows that his wife will never agree to use condoms with him. But he hopes to convince her to use them until they both go for voluntary HIV testing and counseling. Then if they are both negative they could have unprotected sex again without worry. Questions to ask participants:

What did you see happening in this story? Do you think the husband was right to ask his wife go for testing? Why? What do you think her reaction will be? What could Robert do to get his wife to take the test?

STEP 3

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Ask one person from each group or pair to summarize the strategies that they identified in response to their scenario. Offer additional responses (if appropriate) to emphasize prevention of HIV/STIs. STEP 4 Make a list of all the responses and strategies that were suggested and ask the participants to judge, which are realistic, which would be easy to follow, and those which are very difficult. Exercise: 1.7 Developing Skills for Negotiation

OBJECTIVE :To improve skills for getting partners to accept and practice safer sex

MATERIALS : None

TIME :20 minutes INSTRUCTIONS STEP 1 Present the following sentences to the participants as examples of Diplomacy, Negotiation or Action: (Diplomacy)

I love you very much and that is why I want to use condoms. You are very attractive to me and I want very much to be with you but I feel more

comfortable with condoms. I understand your negative feelings about condoms. But let’s at least try them.

(Negotiation) I would like to give to give you an extra little gift if you agree to use condoms. Let’s try condoms for a month and decide then what we will do. Let’s try the female condom and see if we like it better than the male condom.

(Action)

I am putting the condom on now. Let’s just try it. Here is a shop. I’m going to buy some condoms. Let’s put the condom on while touching.

STEP 4 Ask the participants to add to the list.

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Exercise: 1.8: Active Listening Exercise

OBJECTIVE : To improve skills for being attentive to partners

MATERIALS :None

TIME : 15 minutes INSTRUCTIONS STEP 1 Have each participant take a partner. In each pair, one will be the speaker and one will be the listener. STEP 2 Tell speaker to talk for 2 minutes non-stop about a recent problem she has faced. The listener should not interrupt, but should pay close attention and be an active listener (nodding the head, leaning forwards and making eye contact). STEP 3 After two minutes, the listener tries to retell the speaker’s story back to the speaker. STEP 4 Ask the all the participants to comment on their experience. Ask the following questions to stimulate the discussion: How did it feel to be a listener? How did it feel to be a speaker? How did it feel to talk for several minutes without being interrupted? Did the listener find it difficult to listen? Why? Why not? Were the listeners able to explain most of what the speaker said? Why or why not?

STEP 5 Summarize by making the following points about how to listen effectively:

By concentrating on the speaker By being interested in what is being said By paying attention By avoiding distractions By being patient By not interrupting the speaker By listening with your eyes, ears and mind.

STEP 6 Ask the participants if better listening skills would be useful in their relationships with their partners.

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Exercise 1.9: Mutual Decision-Making

OBJECTIVE :To better understand how men and women make decisions, which affect their sexual behavior.

MATERIALS :None

TIME : 20 minutes Instructions STEP 1 Read the following role-play description to participants: Mary and John want to have sex. Mary suggests using condoms, but John is against it. John says that he is clean. He says that he hasn’t had sex with anyone in six months. Mary answers that as far as she knows, she is also disease-free. But she explains that she still wants to use a condom since they might have an infection and not know it. John says that condoms are fake and unnatural. Mary says that she will help him to put it on and that they can make it enjoyable through foreplay. STEP 2 Point out that Mary and John decided that the consequences of sex without condoms were much worse than the feeling that sex with condoms might not be comfortable. A solution where both people can benefit was found. Point out the following negotiation requirements:

Each person is able to express herself or himself Each person listens to the other There is time to discuss opinions and options Both people are respectful Both recognize the feelings that the other person may be having Someone is willing to compromise

STEP 3 Ask participants to give some examples of negotiation requirements that were illustrated in the story of Mary and John. (Examples might include: the couple took time to consider different opinions before having sex; Mary recognized John’s discomfort and tried to suggest ways they could make the option of condoms more appealing to both of them.) STEP 4 Ask participants to think of a situation in their own lives where negotiation was necessary. Ask them the following questions:

How easy or difficult would it be to use negotiation steps and principles in this situation? What would be easy?

What would be difficult? How might things have changed if you had used negotiation steps or principles?

STEP 5 When you finish discussing the answers for STEP 4, ask these questions to the large group:

Describe a situation involving risky sexual behaviors where negotiation could help. Describe a situation involving risky sexual behavior where negotiation would be difficult.

STEP 6 End the session by summarizing the important points about negotiation that were discussed by participants.

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Exercise 1.10: Question Asking Exercise OBJECTIVE: To increase skills for showing empathy by asking questions. . MATERIALS: None TIME: 15 minutes INSTRUCTIONS STEP 1 Introduce to the participants the importance of showing interest in what our partners are thinking and feeling by asking thoughtful questions. Provide the following as examples of questions that demonstrate an interest in and empathy for another person:

How do you feel? What do you think? Could you explain that more? Why do you feel that way? What made you come to that conclusion? How are you feeling? Can we talk some more about this?

STEP 2 Ask the participants to suggest other questions that can be asked which demonstrate interest in and empathy for another person. Exercise 1.11: Negotiating Safer Sex

OBJECTIVE :To give participants the opportunity to practice negotiating safer sex

MATERIALS : None

TIME :15 minutes per story Instructions STEP 1 Tell participants that they are going to practice negotiating safer sex by acting out different scenarios. Assign acting parts from the scenario to the women in the group. If there are only women in the group, have some women play the parts of both men and women. Have each group rehearse the improvised dialog for 5 to 10 minutes. Story 1: A woman was given a free female condom by a health worker and told it could be used to space births and that it is more popular than the male condom with both men and women. During an intimate moment with her husband, she takes out the female condom and suggests to her husband that they try it. He explodes with rage over the idea that they use any kind of condom. He accuses her of being a prostitute and even mentions grounds for divorce. Story 2: Jane is an experienced commercial sex worker (prostitute). She visits a bar where she meets a young man who buys her alcoholic drinks. The young man gets drunk and asks Jane to go to the lodge for the night. Jane agrees and they go 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 has bought her. Story 3:

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A man walks up to a Commercial Sex Worker (prostitute). 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. She considers her choice of earning twice the money or losing the client. She decides to accept. Story 4: A husband comes home after being away for a month. He and his wife decide to have sex. He proposes that they use a condom until they can get tested for HIV. The wife becomes angry and yells at her husband, asking him if he thinks that she is HIV positive. STEP 2 Have the role-plays presented one at a time and ask the participants the following questions after each presentation to stimulate a discussion:

What do you see happening in this story? Why does this happen? What problems does it cause? Has this happened to you or people you know? How would you describe the relationship between the people in the stories and their

ability to communicate? STEP 3 In summary, point out the common features that came out during the role-playing and the discussions that followed. Some points might be: it is difficult to compromise; it is hard to listen if you are angry; men and women often do not feel equal during negotiations; money influences judgment) Exercise1.12: Finding Balance in Relationships OBJECTIVE: To create a better understanding of the different ways that people may react in relationships. MATERIALS: None TIME: 45 minutes Instructions STEP 1 Share with the participants the following information in either written form or by reading it out loud to them. Aggressiveness DEFINITION: Expressing your own feelings, opinions or desires in a way that threatens or punishes the other person. In other words, you are imposing your will while denying the other person’s rights. FEATURES: Dominating, shouting, demanding, not listening to others, fighting, smashing objects RESULTS: Alienates the other person. Cuts off communication. Escalates the intensity. Reduces opportunity for compromise. Leads to increased physical violence. Assertiveness: DEFINITION: Telling someone exactly what you want in a way that does not seem rude or threatening to them. Standing up for your rights without endangering the rights of others. FEATURES: Balanced approach. Knowing what you want to say.

Use words like “I feel” or “I think” Look the person in the eye No whining or sarcasm

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RESULTS: Less chance of being dominated. Prepares the ground for compromise. Avoids escalating the dispute. Passiveness DEFINITION: Giving in to the will of others. Hoping to get what you want without asking for it. Leaving it to others to guess what your needs are. FEATURES: Submissive. Talking quietly. Avoiding disagreement. Hide face with hands. Leave the room. RESULTS: Gives partner impression he or she can always get their way. Allows for domination. STEP 2 Read the following list of statements to participants and have them identify them as Aggressive, Assertive or Passive. Going to the bar

“You are so stupid going out night after night to that bar. You are going to bring evil to our house.”

“When you come home at night after going to the bar I feel disappointed. I would like to see more of you and am worried about not having enough money for food for the children.”

“Don’t forget your hat. I will see you in the morning if not before.” Raising a hot topic

“You are a thorn in my side with all your questions. I am fed up and not going to take this anymore. You deserve a beating.”

“I think I understand what you are saying. I have a different view. Let’s discuss this some more to find some way to compromise.”

“You know best. I should have known better. Whatever you want.” HIV testing

“HIV testing is for prostitutes just like you. Clean people don’t need testing. “I understand that people want to know if they are infected or not. I have never thought

about getting a test before. It is scary for me.” “I don’t know much about testing and have no opinion one way or the other.”

Discussing family affairs

“I don’t know why I ever married you. It has only been a series of disappointments.” “I am so happy with the three beautiful children we have made together. There are some

things I feel that we should discuss about the future.” “I promised to love, honor and obey you in our marriage vows.”

STEP 3 Point out to participants that in each of the examples above, the first statement is aggressive, the second one is assertive and the third one is passive.

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MODULE 2: SELF-ESTEEM

Goal:

To help participants to think about their personal qualities, likes and talents, and to see how thosecharacteristics enrich the rest of the community.

Objectives:

Define the term ‘self-esteem. List ten personal, unique characteristics. Draw a picture of a talent or an accomplishment and share it with the group. Picture visually the way in which an individual enriches the entire community.

Exercise 2.1: Looking Inward Objective: Define the term ‘self-esteem’; list ten personal, unique characteristics Materials required: pens, paper, flipchart/chalkboard, markers/chalk, resource packets. Duration: 30 minutes Instructions:

1. Ask participants to think about the word ‘self-esteem’. What does it mean? Write a list of their answers on the board. Use the following questions to generate discussion: how might someone with a high self-esteem act? What about someone with a low self-esteem? Do you think it’s possible for someone to change? How?

2. Let’s take a few minutes to look at our own self-images. Each of us has a combination of

likes, dislikes, talents and even faults that is completely unique and that will never appear again on this earth in exactly the same combination in someone else. What are some of the unique qualities that each of us possesses?

3. Give each participant a piece of paper and a pen. Tell them to number the paper from

one to ten. Explain that you will read a question or phrase, and then will give them several minutes to think of a response and write it on their papers. Emphasize that no one will see this paper; it is for them to keep.

4. Read the following questions one at a time, pausing for several minutes between each

question as necessary (move on to the next question when it seems that everyone has had enough time to think and respond).

I am … (complete the phrase) What activity do you enjoy doing more than any other? Which of your physical characteristics do you like the most? What quality is most important to you in a friend? What accomplishment are you most proud of in your life? If you could change one thing about yourself, what would that be? If you could learn one new thing, what would that be? What piece of advice would you give to someone younger than you? If you could fulfil one dream, what would that dream be? If you could change yourself into an animal, which animal would you choose and

why?

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5. Ask if anyone wants to share anything they’ve written. Was anyone surprised by his or

her responses? Did they learn anything about themselves? Why is getting to know oneself an important aspect of self-esteem?

Exercise 2.2: Stone Soup Objective: Draw a picture of a talent or an accomplishment and share it with the group; picture visually the way in which an individual enriches the entire community. Materials required: pens and paper, a flipchart/chalkboard and marker/chalk, tape, crayons or coloured markers if possible Duration: 30 minutes Instructions:

1. Explain that we are now going to think about how each person’s unique qualities enrich the community as a whole. Tell the following story:

Once upon a time, somewhere in Africa, there was a great famine in which people jealously hoarded whatever food they could find, hiding it even from their friends and neighbours. One day a wandering stranger came into a village and began asking questions as if he planned to stay for the night. "There's not a bite to eat in the whole village," he was told. "Better keep moving on."

"Oh, I have everything I need," he said. "In fact, I was thinking of making some stone soup to share with all of you." He pulled a marmite from his bag, filled it with water, and built a fire under it. Then, with great ceremony, he drew an ordinary-looking stone from a velvet bag and dropped it into the water.

By now, hearing the rumour of food, most of the villagers had come to the square or watched from their windows. As the stranger sniffed the "broth" and licked his lips in anticipation, hunger began to overcome their scepticism. "Ahh," the stranger said to himself rather loudly, "I do like a tasty stone soup. Of course, stone soup with potatoes -- that's hard to beat."

Soon a villager approached hesitantly, holding a few potatoes he'd retrieved from their hiding place, and added them to the pot. "Capital!" cried the stranger. "You know, I once had stone soup with potatoes and a bit of beef as well, and it was fit for a king."

The village butcher, who was listening nearby, hurried away and came back a few minutes later with a bit of beef. “Wonderful!” said the stranger. “If only we had a few onions, this would be the best stone soup ever made!” Several minutes later, another villager approached and handed the stranger some onions to add to the soup. The stranger, smiling broadly, took the lid off the pot and sniffed with appreciation. “Amazing! The only thing that could make this stone soup any better would be a few carrots.” Another villager ran off and returned a few minutes later with some carrots, and so it went, through cabbage, mushrooms, salt, and so on, until there was indeed a delicious meal for all. The villagers offered the stranger a great deal of money for the magic stone, but he refused to sell and travelled on the next day.

2. Ask the group what they think the story means. What does the soup signify? What would the soup have been like if no one had contributed anything? Was there an ingredient that was more valuable than the others, or were they all-important? (The moral is that by working together, with everyone contributing what he or she can, a greater good is achieved).

3. Give each participant a blank piece of paper and either some crayons (if available) or any

other writing instrument. Tell them that we are going to create our own “stone soup”.

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Each person is to think of something that he or she is proud of or good at (it can be something that they have already written on their papers, or something else) and express (draw or write) that quality on his or her papers. Reassure them that it can be anything; perhaps someone is an excellent football player or a good cook, maybe another person is a good listener or is very good at encouraging others. Each person is to think of one thing that they can contribute to our group’s “stone soup”.

4. While the participants are working, the facilitator should draw a picture of a large pot on

the flipchart or blackboard. S/he should also draw his/her contribution on a separate piece of paper and tape it up inside the pot. As each person finishes, hand him/her a piece of tape and ask the person to add her contribution to the pot.

5. When the pot is “full”, take a few minutes to go over what each person contributed. Ask

everyone what they think of the “stone soup” they created. Does this have implications in real life, outside of this course?

6. Finish the exercise by asking everyone to take their personal papers home and to think

about the responses they gave. Ask them to add anything they might think of later, and to consider whether any of the qualities they listed have implications for the rest of their community. If possible, keep the “stone soup” posted for the duration of the course.

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MODULE 3 REPRODUCTIVE HEALTH

Goal:

♦ To provide basic knowledge of reproductive health and to encourage participants to thinkabout the consequences of early pregnancy.

Objectives:

• Clarify locally acceptable terminology • Describe personal values and attitudes about sex • Accurately identify and describe male and female sexual organs and their functions • Describe the processes of sperm production, ovulation, menstruation and fertilisation • Describe the value placed on pregnancy, children and families in the participants’ community • Discuss consequences of pregnancy to commercial sex workers.

Exercise 3.1: The language of sex Objective: To clarify locally acceptable terminology and to describe personal values and attitudes about sex. Materials required: Flipchart/chalkboard, markers/chalk, paper and pens/pencils Duration: 25 minutes Instructions:

1. Divide participants into small groups (3 to 4 participants each) 2. Write the following terms on the flipchart or chalkboard and read them to the groups:

• Vagina • Penis • Intercourse • Oral sex • Semen • Vaginal fluids • Orgasm • Masturbation • Withdrawal (withdrawal of the penis from the vagina before ejaculation) • Anal sex • Breasts • Testicles • Buttocks

3. Ask the small groups to make a list of local or slang names for the terms (allot about 10 minutes). Ask the small groups to select a spokesperson to record ideas and report them to the large group.

4. Ask all the participants to return to the large group. 5. Record the local/slang names offered by the spokespersons. After the list of local terms

has been recorded, use the following questions to generate discussion (allot about 15 minutes):

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• Have you heard all of the terms? • Are there any other terms you think should be added? • Which words have a negative meaning? • Why might that be? • Who uses the different words and in what situations?

6. Review the important points and ask for feedback from the participants.

NOTE: Some people may be uncomfortable talking about parts of the female and/or male anatomy. This exercise is designed to make the group feel more comfortable by establishing a common ‘language’ (set of terms) for topics that are often considered taboo. When appropriate, the facilitator should attempt to use the local or slang terms with the participants.

Exercise 3.2: Female and Male Body Parts and Functions Objective: Accurately identify and describe male and female sexual organs and their functions Materials required: Flipchart/chalkboard, markers/chalk, paper and pens/pencils, participants’ resource packets, large illustrations. Duration: 35 minutes Instructions:

1. Ask participants to remain in their small groups and to open to the female anatomy section of their resource packets. Using the list of local/slang terms they just created, ask them to pencil in the names of each body part.

2. Ask participants to briefly describe what each organ does. They may wish to read aloud

the descriptions provided in the resource packet. Clarify any misconceptions. 3. Repeat the exercise with the male anatomy. 4. Using the female anatomy, male anatomy, and Stages of the Menstrual Cycle illustrations

in the resource packet describe the process by which an egg either becomes fertilised or passes through the body without becoming fertilised.

5. Clarify the reproductive processes (menstrual cycle, ovulation, sperm production, and

pregnancy) in males and females using both medical terms and local or slang terms as appropriate.

6. Review the important points and ask for feedback from the participants.

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MODULE 4 OUR PERCEPTIONS

Ex Ai

Dean Ins 1.

2.

3.

4. 5. 6.

7.

Fe

Purpose: To help participants recognize how much perception influences our judgments of othersand ourselves. Time needed: 3 hours Materials needed: Pack of 100 small plain index cards, 7 small packs of strongly colored crayons, Iroll of flip chart paper, I roll of sticky tape, 1 pack of chalk, 1 note book, 1 pen. (If cards are tooexpensive, you can use bits of paper, cut to size. But the card is a bit stronger and therefore easier touse) Participants: Four separate peer groups. Special Information: Don’t forget to read before you begin.

ercise 4.1: Fixed positions ms:

To encourage participants to realize that our perspectives on things are based on who we are and our own experiences.

♦

♦ To encourage people to be less judgmental about the actions of others.

scription: Participants stand in a circle and comment about what they see, from different gles, of someone standing in the middle.

tructions:

Form a circle and ask one participant to stand in the middle. Ask him/her to stand still facing the same way through the questions and answers that are to follow.

Explain to all participants that you are going to ask some questions. Ask everyone at all times to answer according to what they can actually see from their own position not what they know is there.

Ask some one standing in front of the person in the middle. “ How many eyes has she/he got?”

Ask someone standing behind the person in the middle the same question.

Ask someone standing directly to the side of the person in the middle of the same question.

Then place someone else in the middle and choosing, say, the arms this time, run through the same questions with three different people.

Finally ask one participant to walk round the whole circle, looking at the person in the middle and perceiving him/her from all angles. Ask the walker to give a running commentary on what she is seeing and how her/ his vision of the person in the middle changes.

edback and Discussion

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Ask the participant to consider how our perspectives on a situation shape out understanding of it. How can we give ourselves a more complete picture of the time? In what way can we relate this exercise to our every day experience? Exercise 4.2: Ideal images and personal destroyers Aims: To explore peoples’ perceptions of the ideal man, the ideal woman and how these ideal images vary from their own reality. Description: Introduction from the facilitator, followed by a drawing exercise and discussions. Talking about destroyers in commercial sex work • Ask them to describe their perception of a perfect woman • After a few minutes of small group discussion, ask the participants to re-form a large circle

and share with the large group their ideas of a perfect woman • Next, ask the participants to re-inform into the same group of three our four and discuss how

easy they find it actually to live up to their expectations, which their society has for them. Encourage the participants to go on to consider what a normal young woman is mostly likely to be like.

• After a few more minutes, ask the group to re-form a large circle with the whole group what

their real experiences are like. Feedback and discussion: The idea of this exercise is to help people to appreciate that we all have ideal images of how we are supposed to behave and there is always a gap between our images and reality. We all find our images hard to live up to at times. It can often be reassuring to realize this and to appreciate that we can all feel this at times. Some ideal images can actually be personal destroyers. For instance, if people believe that “a woman’s place is in the home”, this can often be used as an excuse to take girls out of school early. Similarly the belief that “real men drink ten bottles of beer a night” can result in a man drinking far more than he feels happy with, or than this and to make their own comments about the way some of the examples they have already mentioned can be personal destroyers for them.

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Exercise 4. 3: Prioritizing Problems Materials needed: The index cards, chalk, notebook and pen for you. Aims: To enable participants to prioritize their own concerns about sex and related issues. Description: Participants are asked to sort cards according to their perceived urgency. Instructions: 1. Explain that it is often helpful for people to think about which problems or concerns they find

most pressing and which less so. Suggest that the participants could now divide up the problem cards into different categories, such as: Issues they would like to be dealt with now, issues they would like to be dealt with soon, issues they would like to be dealt with later.

2. Suggest that the participants form the cards into four different parallel lines on the ground in

the middle, one for each category above (and with all the cards which present good aspects of sex). They should decide for themselves which line is which. Lines could be marked out with a stick if the ground is soft or with chalk if it is hard.

3. Once everyone has agreed which line represents which category, hand out cards to several

groups of different participants, so that everyone becomes involved in distributing the cards between the four piles. Listen to the discussions, which they have about the distribution, especially regarding any disputes over which line to place any card in. This will help you to understand a lot about people’s perceptions and priorities

4. Record in a notebook the numbers of the cards sorted in each line, for future reference. 5. Explain that you have learnt a lot together about their needs and concerns – as well as what

they enjoy about sex! Suggest that, if they wanted to, they could together present their health problems to a health clinic staff. This information could help these staff to provide a better service to community members. Suggest that there could perhaps also be issues that they might like to discuss at the monthly peer educators’ meeting. Perhaps participants could identify together someone with whom they could take up their immediate concerns, and decide who should go to inform this person.

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MODULE 5 LIFE SKILLS

Skills needed by an individual in order to operate effectively in society in an active way. Aims of life skills Life skills education aims at promoting the following abilities.

• Enable CSWs make positive health changes in their lives • To enable CSWs make informed decisions about their lives

• Help CSWs practicing health behaviors on streets, slums and in the community

• To enable CSWs recognise and avoid risky health situations and behaviors.

Categories of life skills Skills of knowing and living with oneself • Self-awareness: knowing one’s strength, weaknesses, emotional potential and position in life

and being able to accept who you are. • Self-esteem: accepting oneself and being proud of what one is which brings about self-

confidence. • Coping with emotions: Is the ability to control feelings in response to internal or external

stimuli. Emotions include fear, love, shyness and desire to be accepted. • Coping with stress: Ability to deal with problems such as; lack of a family, broken

relationship, death of close friend or relative, lack of food, police harassment and not to use drugs.

• Assertiveness: Knowing what one wants and how to get without being aggressive or using

drugs. Skills of knowing and living with others • Friendship formation: Being able to get people who will be mutually beneficial in a positive

way. • Empathy: Putting oneself in some other person’s position or shoes, walk a mile in them and

then that person to proceed. • Non-violent conflict resolution: Consider options, which yield best possible results without

using violence. • Peer resistance: Resisting negative peer pressure without necessarily losing your friends • Negotiation: Ability to bargain without them feeling that you have infringed on their rights • Effective Communication: Being able to come up with new ways and ideas of doing things

or overcoming situations.

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Skills of making effective decision • Creative thinking: Being able to come up with new ways and ideas of doing things or

overcoming situations. • Critical thinking: Ability to think through situations so as to take appropriate decisions

concerning people or one’s environment. • Decision-making: Being able to look at options and choosing the best alternatives. A

decision is not necessarily right. • Problem solving: Solving problems in an acceptable way. Benefits of life skills education • Enables CSWs have greater control over their own lives. • Promotes positive health behaviors in pregnancy and high risk of HIV/STI transmission.

Exercise 5. 1: “I” statements

Objective: .To show how it is possible to face someone with whom you have a Problem without either antagonising them or withdrawing from the Problem. To practice making non-judgmental statements, and using a structure that can open rather than close discussion of a difficulty. Materials required: None Duration: 20 minutes Instructions:

1. Introduce the idea of ‘I’ statements to the participants by reviewing ‘Information for ‘I’ Statements Exercise’ in the resource packet. Point out that ‘I’ statements can be used at work, at the market, with friends, family, or any time that you feel that your needs are not being met. However, in this exercise, we will continue to use sexual health examples.

2. Remaining in his or her small groups of three, ask each participant to prepare one ‘I’

statement that relates to a relationship problem (not necessarily real). Perhaps they wish to express a desire to decide about safer sex, or perhaps they aren’t comfortable with the way their boy/girlfriend treats them. Ask participants to share their ‘I’ statements with their group partners, who should help to make their statements clear and clean.

3. Ask for a few examples from the participants, giving people an opportunity to comment

on them and to offer suggestions as to how they might be improved.

4. Ask why might ‘I’ statements be important. Turn to one of the participants and say angrily, “You’re never on time!! You always make me wait and I’m sick of it!” Now say calmly, “I feel like I spend a lot of time waiting for you. What can we do to fix this situation? I don’t like it.” Ask the person you spoke to how he felt about the first accusation, and the second. Which would probably be more effective in a dialogue?

5. Ask all participants to commit themselves to making one ‘I’ statement to somebody

before the next session

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Exercise 5. 2: Role-play “Saying No” Aims: To help participants consider one-way in which they can handle clients who don’t want to use condoms during sexual intercourse Description: Role-play and discussion Instructions:

1. Explain to participants that we are going to have a role play showing a situation where one group of young women being able to say no to unprotected sex and another which cannot easily say no to unprotected sex.

2. Tell them that as they are watching they should think about this in relation to their life

experiences.

3. End the role play

4. Ask the participants to summarise what they have heard in the role-play.

5. Point out that shouting no very fiercely can also be a very powerful way of building confidence.

Some people may think you are behaving aggressively towards the customer. Point out that women often find it difficult to make it clear when they really mean “no” in as clear a manner as they possibly could. Therefore the young women’s group were practising saying no in as clear a manner as they possibly could. Once they have achieved this, they then gain more confidence in themselves and can learn next how to say it in a way, which is still very clear, but less aggressive, and perhaps more appropriate for this kind of situation. Your own participants will have the chance to practice this themselves in a later exercise. Nevertheless if one is being attacked, she needs to have the confidence to know that she can say no as fiercely and in as determined a manner as possible. This exercise is good for confidence building.

Exercise 5. 3: Steps to Deliver an Assertive Message Objective: Identify the steps to an assertive message; and develop assertive messages in a variety of situations. Materials required: flipchart/blackboard; markers/chalk Duration: 60 minutes NOTE: Facilitator should write three scenarios on the board for participants to refer to. Instructions:

1. Explain that the participants have been practising two elements of delivering an assertive message – body language and ‘I’ statements. Being assertive is not always easy, especially at first, and it will take a lot of practice. However, the more you practice, the easier and more natural it becomes. In this exercise we will practice delivering assertive messages using a simple four-step formula. Point to ‘Steps to Deliver an Assertive Message’ in the resource packet and review the information with participants. Note the ‘I’ statements suggested in the table, and remind the participants of the importance of using their bodies as well as their words to communicate.

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2. Next, use the following scenario to develop assertive messages with the whole group. This will help the group to understand the steps and prepare them for the pair work to follow:

“One of your customers is paying you a large sum of money if you agree to have unprotected sex with him. You do not want to have unprotected sex with him because you do not know his status nonetheless you do not want to lose him however you decide to bargain for condom use”.

3. After reading the situation aloud and making sure it is clear, go through each step with

the group and ask for suggestions on the ‘messages’. It is helpful to write the steps on the board or flip chart, and then fill in a message for each step.

4. Once the group understands the process, ask them to break into pairs. Have the

participants count off, 1-3. Each person’s number corresponds to one of the numbered scenarios (see below). After reading the scenario, each person will write out assertive messages following the steps on the board or flipchart. Then each person will share the messages with their partners, getting any advice and making any changes that they might decide together. Lastly, the pair will act out each situation with each other and practice delivering their assertive messages.

5. The facilitator should go around to each pair to ensure that the instructions are clear.

Assist people as needed. Allow at least 30 minutes for this part of the exercise. After each pair practices two different situations, invite interested pairs to come up in front of the group and act out their assertive messages. Use these situations to spark discussion and create many different approaches to these assertive messages.

6. Summarise the activity by reviewing the important points and asking for feedback.

ASSERTIVENESS SCENARIOS Develop more assertive scenarios with the participants.

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MODULE 6 STIs and HIV/AIDS

Goal: To provide information regarding HIV (transmission and prevention), different types of STIs and most common symptoms. Objectives:

• Examine common myths related to HIV/AIDS • Describe the types of STIs (curable and incurable) • Understand the importance of seeking prompt, appropriate care and identify accessible,

affordable sites where high-quality care is available • Describe in general terms what HIV does to the human body • Know several local HIV test sites, the testing procedures, cost, and limitation of the tests • Identify several methods of prevention

Exercise 6.1: Common Myths Objective: Examine common myths related to HIV/AIDS Materials required: flipchart paper/chalkboard, markers/chalk, half-sheets of paper or cards, pens/pencils, tape Duration: 15 minutes Instructions:

1. Give each participant two or three cards or half-sheets of paper and ask them to write two or three main things they know or have heard (true or untrue) about STIs and HIV. They should write one statement per piece of paper.

2. In the meantime, the facilitator should draw a line down the centre of the flipchart or chalkboard. Label one side “Myths” and the other side “Facts”. As people finish writing, collect the papers.

3. Read aloud the first paper. Ask participants to decide whether it is a myth or fact. Tape

the paper under the appropriate heading and proceed to the next one. Anything that cannot be decided should be taped in the middle (draw a question mark above this). Explain that they will be learning a lot about STIs and HIV and that we will come back to this exercise at the end of the session.

4. Ask if there is anything else that anyone would like to add, myth or fact, to the board

before we continue.

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Exercise 6.2: Overview of STIs Objective: Describe the types of STIs (curable and incurable) Materials required: flipchart paper/chalkboard, markers/chalk, and resource packets. Duration: 20 minutes Instructions:

1. Conduct a brief lecture and discussion of the information on ‘what are STIs?’ outlined in the resource packet and answer questions throughout the session.

2. Ask participants to give the common names and symptoms of the following STIs (be sure

to emphasise that sometimes there are no symptoms): • Gonorrhoea • Syphilis • Chlamydia • Hepatitis B • HIV/AIDS (emphasise that someone who is HIV+ does not have any visible

symptoms. Refer to the ‘Who has HIV/AIDS’ illustration in the resource packet. As the disease progresses to full-blown AIDS, s/he will show these common symptoms. Refer to the ‘Symptoms of HIV/AIDS Infection’ in the resource packet)

3. Discuss each suggestion and add it to a list (recorded on blackboard or flipchart) 4. Using the information given in the resource packet on ‘symptoms of STIs’, suggest and

discuss other symptoms if not offered by participants. 5. Review the important points and ask for feedback.

Exercise 6.3: Information about HIV/AIDS Objective: Describe in general terms what HIV does to the human body; know several local HIV test sites, the testing procedures, cost, and limitation of the tests Materials required: flipchart paper/chalkboard, markers/chalk Duration: 25 minutes Instructions:

1. Begin by playing the elephant game. Ask for one volunteer to stand in the front of the room. This person is the baby elephant.

2. Ask for six more volunteers. These volunteers are the adult elephants. Their job is to

protect the baby elephant. They should form a circle and join hands around the baby elephant. To show them the importance of their job, the facilitator should try to hit the baby elephant – you will find that the adult elephants quickly get the point and close ranks to avoid attack. The adult elephants should stand very close to the baby elephant.

3. Now, ask for four or five more volunteers. These people are the lions. Their job will be to

attack the baby elephant (just touch – if they manage to touch the baby elephant, this counts as an attack).

4. When the facilitator says ‘Go!’, the lions should try to attack the baby elephant. Let this

go on for about 30 seconds – until the baby elephant has at least one contact from the lions – but the baby elephant should not be hurt.

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5. Now ask the following questions (the volunteers should stay where they are):

• What is the baby elephant? What does the baby elephant represent?

Answer: The baby elephant is the human body.

• What are the adult elephants?

Answer: The adult elephants are the immune system. Their job is to protect the body from invading diseases.

• What are the lions?

Answer: (There may be a few people who say that the lions are HIV. That is not so; ask another person to try to tell you the meaning of the lions). The lion stands for the diseases, illnesses and infections that attack a person’s body.

6. The facilitator now goes to each of the lion volunteers, one by one. Say, ‘these diseases, such as tuberculosis (touch the first volunteer), malaria (touch the second), diarrhoea (touch the third), and cholera (touch the fourth) may attack the human body, but are they usually able to kill the human body? The answer should be ‘no’. Diseases or germs attack the human body every day, but the immune system (point to the adult elephants) manages to fight them off and protect the body. The human body might get sick (such as the hit or kick that the baby elephant suffered) but it does not die, because the immune system is strong.

7. The facilitator continues, ‘but suppose I am HIV. I come to this body (the baby elephant),

and I attack and kill the immune system.’ At this point, the facilitator should touch all but two of the adult elephant volunteers and ask them to sit down. Touch each person as you remove them, acting as if HIV is killing the immune system. The facilitator continues, ‘Now, will the baby elephant be protected? Will the human body be safe with the immune system gone?’ Next the facilitator should again tell the lions to attack (touch only) on the word ‘Go!’ The lions are able to easily get to the baby elephant this time! Stop it before too much damage is done.

8. Summarise the idea that HIV has killed the immune system. This lack of an immune

system makes it possible for diseases like tuberculosis, diarrhoea, and so forth, to actually kill the person, rather than just make the person sick.

9. To be sure people have understood, ask ‘Does HIV kill the person?’ They should say,

‘No, the diseases killed the person.’ Ask someone to tell you the difference between HIV and AIDS.

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Exercise 6.4: Transmission of STIs and HIV Objective: Describe the modes of transmission for STIs and HIV Materials required: flipchart paper/chalkboard, markers/chalk, and resource packets. Duration: 20 minutes Instructions:

1. Conduct short talk on the transmission of STIs using the information on ‘Transmission of STIs’ in the resource packet.

2. Answer questions posed by participants throughout the presentation and discussion. 3. Record important points on the blackboard or flipchart. 4. Review the important points and ask for feedback from the participants.

Exercise 6.5: Prevention of STIs and HIV Objective: Illustrate how quickly HIV is spread; identify several methods of prevention Materials required: flipchart paper/chalkboard, markers/chalk, and resource packets Duration: 25 minutes Instructions:

1. Suppose there are 12 people playing the game. Make 12 small cards: three will have a red ‘X’ on the card, four will have a ‘C’ on the card, and the other five will have black spots.

2. Every participant should receive one card. They are not to look at their cards. They

should keep their cards folded in their hands. Tell the participants that they should move around the room and greet three people. They should remember whom they greeted and should not look at anyone’s card.

3. After the greetings, ask everyone to sit down. Now, each person should look at his/her

cards. On a flip chart, put a red X. Ask everyone who has a red X to stand. Inform the group that these people have HIV. Ask the group to take a good look at the people standing. Anyone who greeted the people should also stand up. These people are also infected. Now, tell everyone to take a good look at everyone standing. Anyone who has greeted those standing must also stand up. All those standing are infected with HIV. Continue with this a few times until just about everyone is standing.

4. Put a ‘C’ on the flip chart. Ask if anyone has this symbol on his or her card. Tell these

people that they can sit down. Tell the group that these people have used a condom. They are not infected. Anyone who was ‘infected’ by one of these people who used a condom may also sit down.

5. Ask the group what we learn from this game. Put their answers on the flipchart or

blackboard. Possible answers will be:

• HIV can be transmitted very quickly and easily • You cannot tell if someone has HIV • Using a condom can reduce your risk of HIV • Having contact with one person is the same as having contact with all of the

partners of that person.

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6. Ask the people with the red ‘X’ how they felt to discover that they were HIV positive. Ask the people with the ‘C’ how it felt not to be infected at all and to sit down.

7. Last, ask the group how they could have avoided infection in this game, other than using

condoms. Possible answers will be:

• They could have refused to play (abstinence) • They could have insisted on seeing their partner’s cards (testing) • They could have only greeted one partner (risk reduction – being faithful).

Remind the group that they must check the card before being faithful with that partner (testing).

Exercise 6.6: Review of common myths (Kituufu Vs Kikyamu) Objective: Clarify facts and myths about HIV. Materials required: Posters and markers Duration: 30 minutes Instructions:

1. Tape one poster that says “Kituufu” on one side of the room and the one that says “Kikyamu” on the other side of the room.

2. Have participants stand in the middle of the room. 3. Read a myth or a fact out loud and ask the participants to go stand under the sign that

reflects their answer. For example, those who think the statement is false will go stand under the “Kikyamu” sign and those who think it is true will go stand under the “Kituufu” sign.

4. Ask a couple of people to justify their answer and try to convince as many people over to

their side.

5. Go to the next statement and repeat steps 2 – 4.

Facts (True) 1. Although expensive, there are medicines that can slow down HIV progression. 2. Women are 4-6 times more vulnerable to HIV infection than their male counterparts 3. Although treatments to slow the progression of HIV/AIDS exist, there is no cure for AIDS. 4. Although HIV transmission is a risk for everyone, sex worker stand higher risks of getting

HIV 5. If a pregnant woman has a sexually transmitted infection (STI), her unborn child can be

harmed by it. 6. HIV+ people can still live normal, healthy lives. 7. It is possible for an HIV+ woman to have an HIV- child 8. If there is genital contact between the penis and vagina you can get infected with HIV or

STIs even if there is no penetration. 9. HIV testing is for the benefit of the one testing 10. A healthy looking client, whether young or old can have HIV. 11. Babies can get infected with HIV from drinking their HIV+ mother’s breast milk. 12. My body and health is my responsibility. 13. If HIV positive, using condoms all the time helps one live healthier and longer

Myths (which are False) 1. Those who are HIV positive don’t need to use condoms, they are already unfortunate 2. Since everyone who has AIDS, dies of AIDS, it is better not to know if you have it.

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3. Being HIV positive is the same as having AIDS 4. You can be cured of HIV by having sex with a virgin. 5. If a customer has paid so much money, he has the right to have live sex. 6. Only prostitutes get infected with HIV. 7. Taking a man’s money, gifts and material things gives him the right to control you. 8. No one has AIDS in Uganda. 9. Traditional healers (or religious leaders) in our country have a cure for AIDS for all

people. 14. AIDS is a disease of immoral people; only the people who sleep around get HIV 15. It has recently been proven that HIV does not cause AIDS. 16. Having unprotected sex once cannot cause HIV infection. 17. Not having sex can cause cancer. 18. After both partners test negative for HIV, they can have sex without a condom. 19. If a man withdraws before ejaculation, you can’t get HIV. 20. Sexual styles that don’t involve penetration are a good way to avoid HIV for customers

who don’t want to use condoms.

Exercise 6.7: Women and HIV/AIDS Objective: List three biological factors, which might put girls/women at higher risk for contracting HIV. List five social or cultural factors which might put girls/women at higher risk for contracting HIV; list three ways that participants can reduce their vulnerability or help their female partners, friends or family members from being at risk. Materials required: flipchart/chalkboard, markers/chalk Duration: 25 minutes Instructions: 1. Give participants this statistic: In Uganda, out of the 1.5 million people infected with

HIV/AIDS, ¾ are women. 2. Why do they think that women are more vulnerable to HIV infection than men? Ask them to

brainstorm everything they can think of, and list this on the flipchart/chalkboard. Cluster their responses under two different columns, ‘biological reasons’ and ‘social/cultural reasons’. In general, their lists may look like this:

• Lack of economic power • Lack of decision-making power regarding how many children she chooses to have,

how many wives her husband should have, whether or not she wants to get married and to whom

• Concern for the welfare of her children • Lack of negotiating power regarding use of condoms or choice to have sexual

relations. • Lack of legal recourse • Poverty/shame that results from widowhood or divorce • The amount and type of dowry that determines her worth • Less emphasis is placed on education and job opportunities for girls than for boys

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• Lack of female-controlled prevention methods (condoms are worn by man) • Desire to have children • Rape and sexual abuse • Women receive more bodily fluid than men during the sex act • Cultural practices such as early marriage (before a girl’s body is mature) or ‘dry sex’

(using natural substances to dry out the vagina before sex) can cause the vagina to tear, making a girl more vulnerable to HIV infection

• Female sexual organs are internal, which means that women may not know whether

they have an STI 3. Next, ask participants what they think they might be able to do to reduce their own

vulnerability (as girls) or the vulnerability of their female partners, friends and family? List this on a separate sheet of paper.

4. Ask participants for additional comments and feedback. What did they learn from this

exercise? Exercise 6.8: Contact tracing exercise OBJECTIVE To increase understanding of the importance of rapid treatment of STIs by both participants and the their partners. MATERIALS None TIME 30 minutes INSTRUCTIONS STEP 1 Ask for volunteers to act out the parts of the STI clinic client and the clinic worker. STEP 2 Ask the volunteer participants to perform a one-minute role play following this story line: Betty finally gets the courage to go to the sick bay and check out a discharge that was coming from her vagina and an itchy rush that had come up around the surrounding areas of the vagina. The clinic worker examines her and tells her she is suffering from an STI. The clinic worker tells her to bring in her husband and any other sexual partners for treatment. Betty is very embarrassed and worried. She tells the clinic worker that she really thinks this will be impossible. She explains that it is very important to keep the Sexually Transmitted Infection from spreading to others. STEP 3 Ask the participants the following questions. (Make sure that each question is thoroughly answered before moving onto the next one.) What is happening here? Why does this happen? What problem does this cause? Does this happen with people you know? When it happens what can be done? Why is it important to treat people with STIs and their partners?

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STEP 4 Close the session by summarizing some of the issues raised by the participants (such as examples from their relationships, poor communications between couples, personal denial, and overwhelming embarrassment). Exercise 6.9: STI True or False Exercise OBJECTIVE: To learn the basic facts about STIs MATERIALS: None TIME: 15 minutes INSTRUCTIONS STEP 1 Either read the statements one by one or write them out beforehand on folded papers (one statement per paper). If they are written out, have the participants chose a statement. STEP 2 Introduce the activity by explaining that we are now going to discuss facts about Sexually Transmitted Infections and write out the words STI on a piece of paper or flip chart. Explain that the letters stand for: S – sexually T – Transmitted I – Infections Explain that some people use the term STDs (Sexually Transmitted Diseases). STEP 3 Carefully explain that HIV and AIDS are considered STIs, but that in this section, we will mostly be talking about “classic” STIs – that is, all STIs except HIV and AIDS. HIV and AIDS will be dealt with in detail in later sessions. Tell them that you will always clearly indicate when you are talking about STIs including HIV and AIDS, or when you are talking about STIs, excluding HIV and AIDS. STEP 4 Divide the participants into two teams. Ask each team to stand together, across from the opposing team. Explain that they will play the game and that the team with the most points wins. Choose a scorekeeper STEP 5 Give the following instructions to the participants: Each team will draw a statement from the basket or have a question read out. The team must decide if the statement is true or false by discussing it together. Then, one team member should read the statement and state the team’s answer. If the team is correct, they score two points. If they can explain why the answer is correct, they get one extra point. If the team is incorrect, they gain no points. Offer the explanation for the right answer after each incorrect response. a) A person can always tell if she or he has an STI. (False. People can and do have STIs without having any symptoms. This happens most often to women because their sexual body parts are internal. However, men infected with some STIs such as Chlamydia also may have no symptoms. People who are infected with HIV generally have no symptoms for a long time, sometimes years, after infection.) b) With proper medical treatment, all STIs except HIV can be cured. (False. Herpes, an STI caused by a virus, cannot be cured at the present time.) c) The organisms that cause STIs can only enter the body through either the woman’s vagina or the man’s penis.

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(False. STI bacteria and viruses can enter the body through any mucus membranes, including the vagina, penis, anus, mouth and in some cases the eyes. HIV can also enter the body when injected into the bloodstream from shared needles.) d) You cannot contract STIs by holding hands, talking, walking or dancing with a partner. (True. Most STIs are spread by close sexual contact with an infected person.) e) Many curable STIs, if left untreated, can cause severe complications. (True. Some complications can lead to infertility in women. If a baby’s eyes are infected by Chlamydia and not treated, the baby can become blind. Other complications can lead to heart failure or damage to the brain.) f) People who have an STI should not have unprotected sexual intercourse, because they are more likely to contract or transmit the HIV infection. (True. This is because infection with STIs makes a person more likely to contract or transmit HIV, especially when the other STIs have caused open sores. The inflamed areas act like an open window allowing the HIV to enter.) g) It is impossible for STIs to penetrate through a condom if it is properly used and doesn’t break. (True. The small particles that cause STIs cannot penetrate latex (male condoms) or polyurethane (female condoms). STEP 6 Play the game until all statements have been drawn from the basket. Have the scorekeeper announce who the winning team is. You can distribute condoms or other materials as a prize to the winning team members.

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Exercise 6.10: Names and Symptoms of STIs OBJECTIVE: To familiarize participants with the different STIs, symptoms and problems that result if they are left untreated. MATERIALS: Flip chart, chalkboard or sheet of paper TIME: 45 minutes INSTRUCTIONS STEP 1 Peer educator should read section “6.0 Basic Facts on Sexually Transmitted Infections” for background information. STEP 2 Write the following list of STIs on a flip chart, chalkboard or sheet of paper before starting the exercise. Beside the medical name for the STI, leave space for the commonly used name for the same STI in slang or local languages. STIs Common / local language name Gonorrhea Syphilis Herpes Genital warts Candidiasis (thrush) Chancroid Granuloma inguinale Chlamydia Genital warts Hepatitis B Trichomoniasis STEP 3 Show participants the list of STIs. Read each name, one at a time, and ask participants to give the common or local names for this STI. Point out that though HIV is also a sexually transmitted infection but we are not including it in this exercise. STEP 4 Clarify that these signs and symptoms DO NOT include the signs and symptoms of AIDS. Remind them that many people with STIs do not have any signs of symptoms and that people can be infected with more than one STI. Signs in Males: Discharge from penis (green, yellow, pus-like) Painful urination, difficulty urinating, urinating more often Swollen and painful glands/lymph nodes in the groin Blisters and open sores (ulcers) on the genitals; 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 in Females:

Irregular bleeding Lower abdominal/pelvic pain Abnormal vaginal discharges (white yellow, green, frothy, bubbly, curd-like, pus-like, and

odorous).

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Swelling and/or itching of the vagina; swelling of the cervix. Painful or difficult intercourse

STEP 5 Ask participants to list the STIs which they consider to be the most common among them. STEP 6 Ask the participants to describe any STIs they themselves (or close friends or relatives) have had and what the symptoms were. STEP 7 Tell participants that untreated STIs can eventually cause serious, sometimes life-threatening, complications. Read through the list of complications of untreated STIs (that should be written, if possible, on a flip chart, chalk board or piece of paper):

Infertility Blindness Pelvic Inflammatory Disease Cervical Cancer Transmission of infection to newborn Increased risk of HIV infection

STEP 8 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 related to the open sores of genital ulcers and other STIs. STEP 9 Ask participants whether they have any questions on STI signs, symptoms and complications. Look for the answers in section 5: Basic Facts on STIs.

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Exercise 6.11: Treating STIs Exercise

OBJECTIVE : To increase understanding of the importance of seeking professional treatment of STIs.

MATERIALS : Sheets of paper

TIME :1 hour INSTRUCTIONS STEP 1 On three different sheets of paper, write one of the following statements:

a) I thought I had an STI. But now, thank God, my symptoms are gone. I don’t have to worry anymore.

b) I’m sure I have an STI. But I got some antibiotics from the chemists so I’m feeling better. I didn’t even have to finish all the medicine.

c) My male partner has a discharge. Since I have no symptoms, I’m sure I didn’t get it. I think I might have an STI but I have no courage to go to the clinic.

STEP 2 Tell the participants that it is possible to have an STI and be able to transmit it to other people and show no symptoms. Give one piece of paper to each group and ask them to read through their problem situation carefully. Ask them to imagine that it was one of their friends who had this situation. Ask them to consider what advice they would give to their friend. STEP 3 Have each group tell the other groups what advice they would give their friend. Here are some points to add if the groups did not raise them. a) I thought I had an STI. But now, thank God, my symptoms are gone. I don’t have to worry anymore. It is possible for an STI to be contracted and show symptoms which later disappear. This does not mean that you are not still carrying the STI and are able to infect others with it. Go to the clinic and get checked. You should use condoms so that you don’t get another STI.

b) I’m sure I have an STI. But I got some antibiotics from the chemists so I’m feeling better. I didn’t even have to finish all the medicine.

Not taking all the prescribed antibiotics is bad because although the symptoms have stopped, you may still have the STI.

Stopping the antibiotic half way through its course makes STI stronger and the antibiotic weaker.

You paid for the antibiotic. You should get your money’s worth and use it all c) My male partner has a discharge. Since I have no symptoms, I’m sure I didn’t get it. I think I might have an STI but I have no courage to go to the clinic.

You can have an STI and show no symptoms You might have given the STI to your partner You should get the courage to go to the clinic for a check up You should be concerned that you or your partner is having unprotected sex with

someone else. You should be using condoms. STEP 4 Ask the participants what they think the lessons of this exercise might be. They should mention the following:

You can have an STI without showing symptoms and pass it on to others You should take the full treatment prescribed to treat STIs You should use condoms in the future to avoid getting STIs again You should go to a clinic for proper treatment when you suspect you might have

contracted an STI.

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Exercise 6.12: STI Box Game

OBJECTIVE : To create a better understanding of how easily STIs can be spread.

MATERIALS : Index cards of sheets of paper.

TIME : 30 minutes INSTRUCTIONS STEP 1 Get a small cardboard box and put a sheet of paper inside with the words “Sexually Transmitted Infection” written on it. (If no box can be found, this game can be played with just the sheet of paper, which is folded in half so that the words are hidden.). Prepare two other sheets of paper with the word “Condom” written on them and fold them in half so the word cannot be read. STEP 2 Give two sheets of paper folded in half with the word “Condom” written on them. Give oneto one male and another to one female participant and tell them to put the paper in a pocket. (if there are only women participating, divide the group into half and have half be men and the other half play the parts of women). STEP 3 Give the box or folded sheet of paper with the words “Sexually Transmitted Infection” to another randomly chosen man. Then tell him to pass it to a randomly chosen woman. The woman passes it randomly to a man, who passes it randomly to a woman, and so on, for a few minutes. STEP 4 Ask everybody who has touched the box to step forward. Ask those who were given the sheets of paper with “Condom” written on them to take them out and read the word aloud. Ask them to stand separately from the others who touched the box. Then ask one participant to open the box and the sheet of paper and to read what was written on it out loud to everybody. STEP 5 Ask the audience what the point of the game was. The facilitator guides the discussion towards an answer, which emphasizes how easily a chain of STI transmission is created and how rapidly STI can spread from one person to another until a majority of people in a group are exposed. Also point out that those who had the “condom” sheet, although they touched the box or sheet of paper (symbolizing exposure to the STI), they did not contract it.

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Exercise 6.13: STI Circle Game

OBJECTIVE : To increase understanding of how easily STIs are spread and explore different prevention options.

MATERIALS : Index cards or sheets of paper.

TIME : 20 minutes INSTRUCTIONS STEP 1 Write on the word “Abstinence” on one sheet of paper or index card. Write “Mutually faithful” on a second sheet “Uses condoms” on a third, “Unprotected sex with many partners” on a fourth and “STI” on the fifth. STEP 2 Select four participants and give each of them a sheet of paper by pinning it onto their uniforms, attaching a string and hanging it around their necks or having them hold the paper in their hands. STEP 3 Ask for five participants to choose the sheets or cards. Give one the “STI” paper and tell them to make sure what is written on the paper can be seen by others. Hand out the other papers and tell the four other volunteers not to look at what is written and not to show others. STEP 4 Blindfold the participant with the “STI” paper and put him/her in the middle of a circle formed by the other four volunteers. STEP 5 The facilitator spins the volunteer with the STI card around until he or she is disorientated and then asks the volunteer to choose another volunteer from the circle. The new volunteer reads what is written on the paper and shows it to all the participants. Ask that person if he or she feels vulnerable to the STI because of what is written on the paper. STEP 6 Point out that those who are mutually faithful to their partners, abstain and use condoms regularly are much less vulnerable to STIs. Those who have unprotected sexual relations with many different partners are very vulnerable. STEP 7 The volunteer who is chosen does not leave the game, which is repeated for approximately five rounds. Other participants participate fully in each round, are commended for correct answers and each explanation is discussed by the audience as a whole. Simple prizes, such as condoms or AIDS literature may be given to volunteers and to others who answer questions well.

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MODULE 7 RISKY BEHAVIOURS

Aims:

♦ To help participants reflect on their own behaviors with regard to risk taking in life in general Description: Individual reflection Instructions: Explain to participants that when people have problems or seem confused or scared, we like to haveclear, simple answers to things. However, we have seen how our lives are full of uncertainty and thatthey are going to do an exercise which will help us to think about how we handle risk in general andthat easy solutions are rarely available. Explain that we are now going to do an exercise, which willhelp us to think about how we handle risk in general in our lives.

Exercise 7.1: The Danger Game Objetives:

To learn which sexual activities are high danger, low danger and no danger for HIV/AIDS or STDs.

♦

♦

♦ ♦ ♦

♦

To understand that there are many enjoyable things that we can do without having sex (intercourse).

Instructions:

Take three papers or cards and write on them: High danger, low danger and no danger Draw a line on the floor Put the HIGH DANGER card at the end of the line and the NO DANGER card at the other end, with a LOW DANGER card in the middle. Copy out the 19 activities from the list below;

The sex activities - Sex through the anus without a condom - Vagina sex if the girl is taking a contraceptive pill - Licking or sucking of each others private parts - Sex through the anus using a condom - Vaginal sex using a condom - Rubbing penis between the girl’s legs - Touching each others private parts - Deep kissing - Caressing - Hugging - Vaginal sex without a condom - Having protected sex standing up - Masturbating each other - Kissing - Massage - Holding hands - Having unprotected sex for the first time - Rubbing your private parts against each others body - Stroking your partner’s ears and neck

Introduction:

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We know that HIV/AIDS is spread mainly by sex. We also know that not having sex, sticking to one faithful partner, or using a condom are ways to prevent HIV spreading. But if a person doesn’t want to have sex, are there any other enjoyable things they can do together, that are safe? In fact there are many things that people can do that are enjoyable. We are going to play a game now to help us learn which things are dangerous, because they have high danger for HIV, which things have small, low danger, and which things have no danger at all. The Danger Game To play the game, we need to get into pairs. So everyone should find a friend.

If you have a large group divide into four pairs ♦ ♦

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♦ ♦

Give out activity papers to all the pairs. It is OK if some pairs have more than one paper.

1. Explain that you will give out activity papers, which have different things written on them that people like to do.

2. Ask participants to read the papers in their pairs and can ask you for clarification if

needed. Ask them to agree as a pair whether the activity on their paper is high danger for spreading HIV, low danger and no danger.

3. When you have decided, you can put the activity paper down on the danger line on the

floor.

4. Ask them to put the papers under the places where they think it fits. If it the activity is high danger, put the danger at the HIGH DANGER end of the line. If you think it is no danger, put it at the other end, and if you think there is some small danger, put it some where in the middle of the line.

Give time for pairs to talk and put their papers down on the line.

Have a look at where the papers are. Do you think they are in the right place?

Let people answer Correct any wrong answers

Move any papers that are in the wrong place (check below for correct order) Does anyone have any questions about any of these activities written on the papers? Do we know any other names for any of these activities, in our own languages, or English or slang? Can anyone think of any other safe activities that a man and woman can do together? HIGH DANGER • Sex through the anus without using a condom • Vaginal sex without a condom • Vaginal sex • Having unprotected sex for the first time

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LOW DANGER • Sex through the anus using a condom • Vaginal sex using a condom • Having protected sex standing up • Licking or sucking each other’s private parts • Rubbing penis between the girl’s legs • Rubbing your private parts against the other’s body • Masturbating each other (If no contact genital to genital contact) • Touching each other’s private parts • Deep kissing • Kissing NO DANGER • Caressing • Hugging • Massage • Holding hands • Stroking your partner’s ears and neck Safer sex If you decide to have sex, make sure it is safer sex, to protect yourself and your partner from unwanted pregnancy, Sexually Transmitted Infections and AIDS. Safer sex includes:

Always using a condom ♦ ♦ ♦ ♦

Masturbating with each other Touching each other Kissing and cuddling

Deep kissing is when you kiss each other on the mouth with your mouths open, and putting your tongue inside the other person’s mouth. Caressing is when you touch the other person in a gentle, loving way, on their hands, arms, shoulders, head or private parts. Massage is a special way of touching another person which rubs their muscles andmakes them fel relaxed. Lovers massage each other sometimes, and so do Doctors and Nurses, even sports physiotherapists, when a player is injured. Unsafe sex. Unsafe sex is anything that lets blood, sperm or vaginal fluid get inside the other person’s body. So that includes Oral sex and vaginal sex without a condom ; but the most dangerous is anal sex. Anal sex is very dangerous because the inside of the anus is not very strong, and the skin in there is easily damaged and cut if the penis is put inside another person’s anus ; it is damaged much more easliy than the skin inside the vagina. The vagina does not tear as easily as the anus because it produces fluid to lubricate it during sex.

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Exercise 7.2 : HIV Scratch Chain Exercises. Objective To better understand how quickly HIV can spread. Materials: None Time: 20 minutes INSTRUCTIONS STEP 1 Have participants stand in a circle with their eyes closed. Tell them that one person will be designated by the peer educator to be infected with HIV. That person will be given a tap on the shoulder. STEP 2 Get the participants to shake hands with three different people and tell the infected person to scratch the palm of three people he or she shakes hands with. STEP 3 After all the hand shaking is complete ask the person who was tapped on the shoulder to step into the middle of the circle and to say how they felt when they realized they were to be the one infected with HIV. Ask them how they felt about infecting others. Ask those who had their hands scratched by that person to step into the middle of the circle. Ask them how it felt when they realized that they had been infected. Exercise 7.3 Glove Game Objective: To create a better understanding of how HIV is spread and of the impact of protection and abstinence, as well as get participants to reflect on Voluntary Counseling and Testing. Materials: Small pieces of paper (sheets of paper torn into 4 parts) Time: 45 minutes Instructions STEP 1 Prepare small slips of paper so that you have a number equal to three less than the total number of participants. (For example, if you have 20 participants, prepare 17 slips of paper) Put the slips into a hat or bowl. Prepare three additional slips of paper with the following instructions: G – Wear a glove on your right hand during rounds 1 and 2 of the activity G – Wear a glove on your right hand during rounds 3 and 4 of the activity A – During the game, if somebody tries to shake your hand, apologies and explain to them that you don’t shake hands STEP 2 Before the game begins, and without other participants seeing you, take aside three participants and give each of them one of the slips of paper with special instructions. Provide gloves to the two participants with the ‘G’ slips of paper. Instruct them that when you come around with the hat or bowl, they should pretend to pick a slip of paper, but not actually pick one. Caution the participants not to let anybody else know you have spoken to them. STEP 3 Instruct participants to number a second sheet of paper vertically from 1 to 4. Ask each participant to choose a slip of paper from the bowl or hat and put it in his or her pocket. Emphasize that no one should look at his or her slip of paper until the end of the exercise. STEP 4

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Ask the participants to find a partner (if there are an odd number of participants, the facilitator can join the game). They should greet their partner, shake hands, and write the partner’s name on line number one of their paper. STEP 5 Instruct them to now move around and find another partner. Again, they should greet their partner, shake hands, and write the partner’s name on line number two of their paper. Repeat until everybody has shaken hands with four different people, and has written the four names on their paper. STEP 6 Ask everybody to take his or her seats. Ask if anyone wants to have an HIV test to find out his or her sero status and why. Ask others who don’t want, why they don’t. STEP 7 They should now take out their slips of paper and look at them. Ask the person with the ‘X’ to come forward. Explain that in this game, this person is infected with HIV. Ask everybody to look at line 1 of their paper. If the infected person’s name is on line 1 of their paper they should come forward. Ask each person who comes forward if they were wearing a glove when they shook hands with the infected person. If they were not wearing a glove, they should join the “infected person” and stand in the middle. If they were wearing a glove they should return to their seats. STEP 8 Now ask everybody to look at line 2 of their paper. Anybody who has the name of any of the people standing in the middle on line 2 should come forward. Unless they were wearing a glove, they should join the people (standing or sitting) in the middle. STEP 9 Now ask everybody to look at line 3 of their paper. Anybody who has the name of any of the people standing in the middle should come forward and join them, unless they were wearing a glove when they shook hands. STEP 10 Now ask everybody to look at line 4 of their paper. Anybody who has the name of any of the people standing in the middle should come forward and join them, unless they were wearing a glove when they shook hands. STEP 11 Ask participants what the handshake represented (answer: sexual intercourse). Ask participants to take note of the number of participants who became infected from only one person with HIV. This demonstrates how rapidly the disease can spread, and the multiplier effect. How did they feel when they saw the number of people who ended up in the middle? STEP 12 Ask the person who had the ‘A’ on their sheet to come forward. Explain that the ‘A’ represented abstinence. Ask this participant how they felt when they could not join in the hand shaking. Was it difficult? How did others feel when this person refused to shake hands? STEP 13 Ask what the glove represented (answer: condom). Find out if either of the people wearing gloves became infected. If so, use this to make the point that one must use condoms every time they have sex in order to be protected from infection with STIs and HIV. Ask the two participants who wore the gloves how they felt when they shook hands. How did their partners feel? STEP 14 Ask the people who were not infected: How was your behavior different from those who became infected? How did you end up not becoming infected? How did you feel about those who became infected? STEP 15

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Ask the people who were infected: What are you thinking now that you realize you may be infected? What could you have done differently to protect yourself? Would you tell anybody that you might be infected? Whom? Would you tell your sexual partner(s)? What support would you need at this stage and to whom would you turn? STEP 16 Be sure to mention that this has only been a game and that the person with the ‘X’ is, of course, not infected with HIV. Also be sure to emphasize that HIV/AIDS cannot be transmitted by a handshake or prevented by wearing a glove). The selection of slips from the bowl or hat was random. Each handshake represented a round of unprotected sex. You are at risk from even one instance of unprotected sex. Exercise 7.4: Personal Risk Assessment Exercise OBJECTIVE: To increase awareness of an individual’s personal risk from HIV infection MATERIALS: Sheets of paper TIME: 45 minutes INSTRUCTIONS STEP 1 Get participants to mark one point on a piece of paper for each of the following questions to which they answer “yes”:

a) Have you ever had sex without a condom? b) Have you had sex without a condom with a man who was not a mutually faithful partner? c) While you were married, have you ever had sex without a condom with a man who is not

your husband? d) Have you ever engaged in unprotected sex in exchange for letting a man paying you a lot

of money? e) Have you ever had a sexually transmitted infection (such as gonorrhea, syphilis or

others?) f) Have you ever been so drunk you don’t remember having sex? g) Have you ever treated an STI without consulting a health professional? h) Have you had sex without a condom with more than 15 men during your lifetime? i) Have you ever had a blood transfusion? j) Did you ever have sex without a condom with a man you just met? k) Have you ever had one or more new sexual partners in the period of a month and not

used a condom in each case? l) Have you ever been paid money for sex? m) Have you ever had anal sex without a condom? n) Did your husband ever have sex with another woman before you were married? o) Do you desire sex more after drinking alcohol? p) Have you ever had sex with a schoolboy and not used a condom? q) Have you ever forced a man to have sex against his will?

STEP 2 Have the participants add up their scores and explain the consequences of the following categories their point totals place them in. Between 12 and 18 points Extremely high risk; Consideration should be given to having an HIV test. Between 6 and 12 points High risk; Serious consideration should be given to increased condom use and reflecting on behavior choices. Between 0 and 6 points You are less at risk but still at risk.

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STEP 3 Ask participants to each make a list of things they do that put them at risk for HIV infection and actions they personally can take to change those behaviors. (For example: One risk is having sex with a sex worker. The behavior change might be to use a condom in those relationships.) Exercise7.5 Wildfire Exercise OBJECTIVE: To decrease the perceived distance between uniformed forces personnel and the HIV/AIDS epidemic. It also intends to instill a sense of empathy and understanding for those people living with HIV/AIDS. MATERIALS: None TIME: 45 minutes INSTRUCTIONS

STEP 1 Have the participants sit in one circle. Ask them to close their eyes. Explain that you will be going around the circle and will tap two or three people on the shoulder. The person that is tapped will be considered HIV positive for the purpose of the exercise. (If you have participants who are HIV+, you should consult with them and ask them to help to facilitate the exercise.)

STEP 2 Ask participants to stand up and walk around. They should shake the hands of no more than three people.

STEP 3 Once seated again, ask those individuals whose shoulders you tapped to raise their hands. Ask those individuals who shook hands with the tapped individuals to raise their hands. Ask the next level to raise their hands (those who shook hands with an individual who shook hands with the first people tapped).

STEP 4 Explain to the group that you cannot get HIV from shaking hands, but that, for this exercise, we will assume that high risk behavior took place and that each of the individuals whose hands were raised were exposed to the virus. Ask those who were tapped how they felt.

STEP 5 Ask those who have been exposed whether or not they would like to go for an HIV test. Those who do not want to go should explain why.

STEP 6 Those who opt for a test should come forward and collect a folded piece of paper. (These will be prepared ahead of time). The paper will have either ‘’’negative’’ or ‘’positive’’ on it.

STEP 7 Ask each individual how they feel about their test result and how the result will impact on their lives.

Exercise 7.6 The Bean Game OBJECTIVE: To create an understanding of how fast HIV can be spread and how hard it is for someone to tell who is HIV positive and who is not. MATERIALS: Envelopes, White beans, Red beans. TIME: 30 Minutes

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INSTRUCTIONS. STEP 1. Get as many envelopes as the number of participants. Put white beans in all of them except one envelope in which you put red beans. Put these envelopes under the seats of the participants and ask them to take their seats. STEP 2. Explain to the participants that in this game, they will donate some gifts from their envelopes to those of other participants without looking in any of the envelopes. When the game starts, they will exchange gifts (beans) among participants. STEP 3. Ask them then to pick up the envelopes under their seats even without knowing what is in the envelopes, and let them start moving around while exchanging the contents in their envelopes. Ask the participants to greet their neighbors and request to give them some “gift”. They should do this from one person to the next. STEP 4. When they have moved around the room for a while, ask them to stop and take their seats, and then tell them that the white beans mean that those are HIV negative and the red beans mean HIV positive. STEP 5. Ask those who want to know what is inside their envelopes to put up their hands and those who do not want to know to give their envelopes to you. STEP 6. Then ask the rest to open their envelopes and see what they have inside. Ask those with only white beans to raise their hands up. These are HIV negative. Ask them how they felt when they didn’t find red beans in their envelopes. STEP 7. Ask those with some red beans to raise their hands up. These are HIV positive. Ask them how they felt when they found red beans in their envelopes. STEP 8. Ask each individual about how they feel and those who never wanted to see inside their envelopes why they feared to.

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MODULE 8 FAMILY PLANNING

Aims ♦ ♦ ♦ ♦

To explore the different types of pregnacy prevention. The most convenient method. The best method for avoiding HIV/AIDS, STDs. The possible problems related to the different pregnancy prevention methods.

Materials needed : Penis modles, pelivic modles, male and female codoms, pills, norplant implant, depoprovera, spermicides, foaming tablets and interuterian device. Duration : 3 hours Decription : The modules prepares participants to aviod unwanted pregnacies and get the best choice ofwhat family planning method to use. Instructions : Put participants into groups of four and inform them that you are to discuss one type of eachmethod of family planning. Through out the exercise each group is expected to know how that particularmethod is used ,the advantages and disadvantage of the selected method.

Exercise 8.1 : Types of contraceptives

1. Ask participants to name the different types of contraceptives as you list them on the flip chart/board.

2. In case any of these is not mentioned, bring it up. (Pills, condoms, norplant, depo provera, intera-uterian device, foam tablets, lactation amenorrhoea, spermicides, withdrawal/coitus interrupts and emergency contraception)

Exercise 8. 2 : How to use each type, advantages and disadvantages Pills Widely used and highly effective if someone knows how to use it. Involves taking a pill daily for 21 days and does not require consent from the partner. Requirements : Commitment,may need a place to hide the pills for some CSWs and may be expensive to some. Advantages • Periods are regular and may occur during withdrawal period. • Reduce menstrual blood loss • Good for people with dysmenorrhoea or premenstrual tension. • Very effective –99.9% effective if taken properly.

DISADVANTAGES • Spotting, nausea and vomiting within the first three months. • May cause headache. • Effectiveness depends on client remembering to take pill everyday.

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• Does not protect against sexually transmitted diseases. Norplant Plastic capsules put under the skin of the arm. Prevents pregnancy upto 5 years but can be taken out if you decide to have a baby. Requirements : Administerd by a trained health worker Advantages • Requires no further action on the part of the person for the period of five years. • Provides privacy where family is concerned. Disadvantages • It must be put under the skin by a trained medical personnel • Does not protect against sexually transmitted diseases. • It’s expensive. Depo-provera This is a progestin only injectable contraceptive method given as a dose of 150 mg every 12 weeks. It is 99.9% effective. Requirement : It must be given a by a trained health worker and must be taken every three months. Advantages • It is given once every three months. • Provides privacy where family is concerned. • It is relatively cheap. Disadvantages • Causes undesirable side effects like weight gain, headaches, spotting, prolonged menses. • It requires a trained health worker to administer it yet one requires privacy and confidentiality. Emergency Contraception This is a method of contraception that is used to prevent pregnancy in case of unprotected sex. How it works Oral contraceptives prevent the release of the ovum, interfere with implantation. Who can use emergency contraception Any woman can use emrgency contraception if she not already pregnant. When to start using emergency contaception • Oral contraceptive must be started within 72 hours after unprotected sex. • Intra uterine device anytime upto 5 days after unprotected sex. Applicability to women Emergency contraception is safe for women. Women who frequently engage in sexual intercourse should be advised to use a regular method of contraception that protects them against spread of sexually transmitted diseases.

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MODULE 9 CONDOM USE

Materials needed: Dildos, Penis models etc: Condoms, a minimum of two for each participant. Tubes of K-Y jelly, or other locally available, water based lubricant, or spermicide. Description: This exercise enables participants who are interested in learning about condom usage to practice and discuss it openly together. You study some condoms together and discuss how to see if they’re recently made, how to put one on and how to dispose off safely. Instructions: Sit in a circle with the participants and explain that you are now going to show one another how to use a condom. Throughout this whole exercise, encourage participants as much as possible to tell one another the answers to your and their own questions. Ask those who know something about condoms already to join in and share their knowledge with the others. Only provide the answer to a question yourself if they don’t know it, or if you think it isn’t accurate enough. This means that most of the talking in this exercise should as much as possible, be amongst your participants and not from you. QUESTIONS TO ASK

• What are condoms?

“ They are made of rubber and are very strong. They are tested in the factory by being stretched and filled with water, to check that they are completely watertight. A condom is worn on a man’s penis. A condom will top his sperm or other fluids coming into contact with the woman’s vaginal fluids. So she will not be able to get pregnant and if either the man or the woman has sexually transmitted disease, it cannot be passed between them. (You could fill a condom carefully with water, to show its watertight qualities to everyone)

• What is the most important thing about a condom? “To be sure you have one before you need it!” (Hold the condoms up)

• How can you tell if a condom packet looks and feels good or not. Packet looks and feels good or not?

“If you a choice, choose pre- lubricated condoms, that comes in sealed wrappers and packaged so that light doesn’t reach them”. (Help everyone to feel how the condom feels lubricated inside the still sealed wrapper)

Did you ever imagine you would sit in a circle with your friends and learn how to use a condom?

Aim: To show participants how to use a condom properly and to let them try for themselves on amodel.

• How do you open the wrapper?

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• What do you look for with a condom?

• What can damage condoms?

• How many times can you use one condom?

• When do you put the condom on?

• What do you do if the penis is uncircumcised?

• How do you put the condom on?

“Carefully, so that the condom does not tear. Use the notch at the (Encourage everyone to do this)

“ Check that it is not discolored or sticky or brittle or damaged”. (Encourage them to inspect it gently.)

“ Oil base lubricants, such as Vaseline, damage condoms. Only use water based ones, such as KY jelly or glycerin or spermicide. Lubricants may need to be used if the condom has no lubricants themselves. However, if both partners make sure that the woman is properly aroused at the start, then her vagina will be moist enough and no extra lubrication will be needed” (You may need to add here an explanation about the importance of fore play in enabling a woman to feel properly aroused. For instance, participants may be unclear about the role of the clitoris in sexual arousal and sexual satisfaction for most women. However, it is important to stress that during foreplay, the penis should not come into contact with the vagina. Also, show a tube of KY jelly, or other water-based lubricant if locally used or available)

“Once only. Each time you have sex, you must use a new, unused condom on the penis before it enters the vagina.”

“ Only when the penis is erect.” (Produce one banana for each participant: penis models. Distribute them round the group, but ask them to wait before putting the condom on.)

“Pull the fore skin of the penis back before putting on the condom”. (If you have a penis model show how this can be done)

“ Squeeze the tip, closed end of the condom first. This leaves a small empty space, to hold the semen. Then unroll the condom down the length of the penis all the way to the base.” (Demonstrate this with your condom. Encourage everyone else to have a go.)

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Then you can enjoy yourself! Condoms can help a man a delay ejaculation. Many men find that they reach an orgasm before their partners have been satisfied. Condoms can help men to delay this. • What happens if the condom tears during sex?

• What do you do after ejaculation?

• How do you dispose off a condom?

• Where is the best place to store your condoms?

• What else can a condom protect against, other than HIV?

“This is less likely to happen if the condom is good quality and if you have put it on properly. However, it does occasionally happen. The best thing to do is to withdraw the penis immediately and put on a new condom. Be careful with very vigorous prolonged sex – if the woman becomes dry, more water- based lubricant or spermicide can be added.”

“After ejaculation, before the penis goes soft, hold on to the bottom of the condom as you pull the penis out, so that the condom does not slip off, then take off the condom carefully without spilling semen”. (Demonstrate this and encouraged participants to copy you.)

“Wrap the condom in paper (such as news paper) or in a piece of cloth or leaf until you can dispose of it in a toilet, or a pit latrine or by burying or burning it. Then, if you wipe yourself after sex, remember to use separate cloths. Condoms should be disposed of away from where children or animals can find them and play with them. Where is a situation place here for you to dispose of them?” (Wrap up the condom in something easily locally.)

“ If possible, in a cool, dark, dry place. Heat, light and humidity can damage condoms. Where would be the best place you could store condoms here?

“Condoms protect against all kinds of STDs, including Gonorrhea and syphilis. Hey also protect against unwanted pregnancy.”

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Exercise 9.1: Demonstrating Correct Condom Use OBJECTIVE: To provide participants with the opportunity to practice using condoms. MATERIALS: Condoms, wooden models of a penis, broom handles or bananas. TIME: 30 minutes INSTRUCTIONS STEP 1 Use a wooden model of a penis to demonstrate how a condom is put on. If such models are not available, other similarly shaped objects like a banana or the end of a broom handle can be used. If this is not possible the condom can be rolled by one hand down one or two fingers on the other hand. STEP 2 Explain that sex workers need to protect themselves and, if used correctly, condoms provide excellent protection. STEP 3 Using your model, demonstrate how to place a condom on it highlighting the following points:

a) Check the expiry date and look for signs of wear such as discolored, torn or brittle wrappers. Do not use condoms, which have passed the expiry date or seem old.

b) Check also for the manufacture date and add on 3 years. If more than three years have passed since manufacture that may not be a good condom.

c) Tear the package carefully along one side. Don’t use teeth or fingernails. This helps to avoid damaging the condom inside.

d) Hold the tip of the condom between a finger and thumb of one hand and squeeze out all the air.

e) Place the condom on the end of the penis and unroll the condom down the length of the penis by pushing down on the round rim of the condom. (If this is difficult, the condom is “inside-out”. Turn the condom the other way around, take hold of the other side of the tip and unroll it.

f) When the rim of the condom is at the base of the penis (near the pubic hair) penetration can begin.

g) After intercourse and ejaculation, hold the rim of the condom and pull the penis out before it gets soft. Tie the condom in a knot sealing in the semen or sperm.

h) Dispose of the condom in a safe place. Use a new condom for any other round. STEP 4 Hand out condoms to each of the participants. Have each participant practice putting the condom on the model and recite aloud each of the steps as they go. Ask the participants who are observing to point out any difficulties or omitted steps. If the group of participants is very large, they can be divided up into groups of five and practice then report what has happened. STEP 5 List the most common difficulties encountered. Ask the participants to suggest how these problems might be solved. Some common problems include:

Trying to roll the condom down when it is “inside-out” The condom is not rolled down all the way The condom is placed crookedly on the model The user is too rough when opening the package or uses teeth to open it The air in the tip is not squeezed out

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Exercise 9.2: Correct and consistent use exercise OBJECTIVE: To practice manipulating condoms MATERIALS: Sheets of paper or index cards TIME: 45 minutes Instructions STEP 1 Beforehand, prepare sheets of paper or index cards. Write one of the following phrases on each sheet or card: Card: Check expiry date and date of manufacture Card: Have condoms with you Card: Discuss condom use with partner Card: Have an erection Card: Open the condom wrapper carefully Card: Squeeze out air from tip of condom Card: Roll condom on erect penis all the way down to the base Card: Intercourse Card: Ejaculation Card: Withdraw penis from partner, holding onto condom at base Card: Be careful not to spill semen Card: Remove condom from penis Card: Penis gets soft Card: Tie up the condom and throw it away in places where children won’t find it Card: Open another condom (if you have sex again). STEP 2 Mix the cards up in a random order and have each participant, in turn, choose a card then read their card and show it to the group. (With non-literate groups, read the cards for them). Ask the participants to then tape it on a wall or lay it out on the floor in the correct order so that the cards describe the step-by-step use of a condom. STEP 3 When all the cards are placed, ask the participants to comment on the order. Make any necessary changes. Be sure that the final line-up is correct. STEP 4 Ask the participants the following questions: What might happen when condoms are not used correctly? What are the consequences of this? What was it like using condoms for the first time? What is it like now?

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Exercise 9.3: Consistent Condom Use Exercise OBJECTIVE To create an understanding of the importance of using condoms consistently MATERIALS: None TIME: 45 minutes INSTRUCTIONS STEP 1 Tell the group that you will discuss the term “consistently.” Explain that this means “doing something regularly or all the time.” Ask the participants why they think it might be important to use condoms consistently. Point out that it is impossible to tell if someone is infected with HIV or an STI. The only way to feel safe is to use condoms all the time. STEP 2 Read the following statements and ask the participants after each one to state whether or not they think the behavior shows “consistent” use of condoms. Story A: Lydia a sex worker at Speak Hotel always used condoms because she feared to be infected with STIs, and HIV infections. But one day, a man was paying her extra money so she decided to go without a condom. Story B: Though Harriet never discussed it with her husband, he knew that when she was away for several parties with her girl friends, she would be with other men. Harriet did not want to infect her husband with anything she picked up when she had sex with the other women. As a result, she always used condoms whenever she had sex with the other men she met. She was certain that her husband did not have sex with other women. One time, a man she had been having sex with for several months wanted her to stop using condoms, but she refused. One time she was having sex with a man she didn’t know very well and the condom broke. They didn’t have another one, so she continued having sex figuring that she had already been having sex without protection and it wouldn’t make any difference now. STEP 3 Tell the participants that the correct answer is that NONE of the people featured in the stories used condoms consistently. Harriet was the least at risk because she used condoms in all her relationships outside her marriage. However, she did allow herself to have unprotected sex that one time.

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Exercise 9.4: Advantages and Disadvantages of Condom Use OBJECTIVE: To better understand why some people refuse to use condoms and examine ways of overcoming those obstacles. MATERIALS: Sheets of flip chart paper or sheets of paper TIME: 1 hour INSTRUCTIONS STEP 1 Tape two sheets of flip chart paper to a wall with the word “advantages” written on one and “disadvantages” written on the other. (The exercise can be done using two sheets of paper if flip chart paper is not available or with no paper at all.) STEP 2 Ask a participant to suggest an “advantage of using condoms” and write it down. Ask another participant to suggest a “disadvantage of using condoms” and write it down. Stop when all the participants have made a suggestion or when no one can think of any more. STEP 3 Examine the list and suggest discussing the disadvantages. (You might share this list with participants even if they did not bring up the disadvantages). Here are some commonly listed disadvantages and discussion points: • Condoms reduce sensation (Condoms do not eliminate sensation, although they change it.) • Condoms are unreliable (If used correctly and consistently, condoms provide good protection) • Condoms are expensive (Condoms are cheap compared to the cost of treating STIs, unwanted pregnancies and lost wages to AIDS-related illnesses) • Condoms cause erection loss (That problem usually stops after you get used to condoms) • Putting on condoms interrupts the flow of passion (Have your partner put them on) • Genital area itches after condom use (Wash it with soap and water) STEP 4 Examine the list and suggest discussing the advantages. Here are some commonly listed advantages:

Reduces worry about getting HIV/AIDS and dying prematurely Condom protects people from getting an STI, which may cause infertility Reduces the risk of facing the responsibility of parenthood resulting from an unwanted

pregnancy Can make sex last longer by delaying the male orgasm No penis is too big or too small for a condom HIV cannot leak through condoms.

Most condoms are lubricated which helps if a woman’s vagina is too dry.

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Exercise 9.5 Demonstrating the Reliability of Condoms OBJECTIVE: To overcome lack of confidence in the reliability of condoms. MATERIALS: Condoms, water, 2 buckets, cup. TIME: 30 minutes INSTRUCTIONS STEP 1 Obtain two buckets. Fill one with water. STEP 2 Open a condom and slowly pour water in it with a cup. Keep the condom at the bottom of the bucket. After filling the condom with at least a litre of water tie the top, making a kind of water balloon. (Practice this exercise before doing it in front of participants to determine how much water must be poured to expand the condom to a large size without breaking it. If a condom breaks, take out another one and try again.) STEP 3 Ask participants what they have learned from this. Point out that condoms are very strong and can fit any size of penis. They can contain a large volume of water without breaking. STEP 4 Take another condom out of the package, blow it up like a balloon and tie the top. Hand out a condom to each participant and have them blow up their condoms. Add some humor to the exercise by asking the participants if any of them has a penis so large it won’t fit into a condom. STEP 5 Have the participants take turns filling condoms with water.

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Exercise 9.6 Condom Facts, Opinions and Rumors OBJECTIVE: To allow each participant to separate facts, opinions and rumors about condoms MATERIALS: None TIME: 30 minutes INSTRUCTIONS STEP 1 Choose five or six statements from the list below that you feel are the most important ones for the participants to consider. Feel free to add any other false rumors that you might have heard. STEP 2 Tell participants that they are going to play the “Fact, Opinion and Rumor” game and that they will be asked to categorize statements about condoms. When a statement is read, they have to indicate their opinion with the following signals: Fact: Raise one arm. Opinion: Put both your hands on your head. Rumor: Cross your arms in front of your body. STEP 3 Read the following statements one at a time. Allow the participants to make their signals (they might need to practice them a few times at first). Ask several participants why they chose a particular physical signal for each sentence. (Let the participants correct each other if there are differences in their answers). Sex with a condom isn’t “real sex” (Opinion) Condoms prevent STIs and HIV (Fact) Condoms always break (Rumor) Condoms can get lost inside a woman (Rumor) Condoms prevent pregnancy (Fact) Condoms are laced with HIV (Rumor) Condoms mean you are unfaithful (Opinion) Putting condoms on can be sensual (Fact) Condoms are only for casual partners (Opinion) Using condoms is easy (Fact) Sex isn’t pleasurable with a condom (Opinion) Lubricated condoms feel good (Opinion) Condoms are embarrassing (Opinion) Condoms are for sex workers (Opinion) Condoms cost too much (Opinion) Condoms cause irritation and pain (Rumor) You don’t feel close to your partner (Opinion) Condoms show care for your partner (Fact) Condoms increase promiscuity (Opinion) Condoms are unnecessary in a steady mutually faithful relationship (Fact) Condoms are made out of latex rubber (Fact) One size of condoms fits all (Fact) Poor quality condoms are sent to Africa (Rumor) Condoms are tested electronically (Fact) Condoms can be blown up into balloons as big as a football (Fact) Condoms cut off circulation of blood and can strangle a penis (Rumor) You can’t tell if a condom is broken until it is withdrawn and see whether it has (Fact) STEP 4

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Take one example of a clear false rumor (such as “condoms are laced with HIV”) and ask the large group the following questions:

Why do you think rumors like this exist? What are some of the consequences of rumors?

(Depending on their answers, you may want to provide examples that mention fear, ignorance, strong beliefs, and denial.) STEP 5 Select examples of a clear opinion, both negative and positive (such as “using a condom doesn’t let you feel close to your partner”, and “condoms shows care for your partner”.) Ask the participants the following questions:

How are these opinions different from facts? Are opinions true or false? Why or why not?

Exercise 9.7 Condom Relay Game OBJECTIVE: To practice manipulating condoms MATERIALS: Condoms, wooden models of a penis or bananas TIME: 30 minutes INSTRUCTIONS STEP 1 Demonstrate how to put a condom on correctly, at each point indicating key steps and potential errors. The steps include: take it out of the wrapping; place it on the model with the reservoir tip up; roll down the full length of model; squeeze the air out of the reservoir tip; unroll and tie it up. STEP 2 Hand out condoms to all participants. Then divide them into groups of five. If there is only one wooden penis model, calculate the time it takes for each team (one after the other) to unwrap the condom and roll it down the model, then take it off and tie it up. Each team member keeps trying until they follow the steps correctly. If there is more than one model (or bananas) available, the groups can compete against each other at the same time. STEP 3 Simple prizes such as condoms or pamphlets on HIV may be given to volunteers on the winning relay team. Point out that many of the difficulties encountered by the teams were caused because participants were in a big hurry to win. Point out that when putting on a condom for use in sexual relations, it is important not to rush and that it is done correctly.

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Exercise 9.8 Condoms Excuses Exercise OBJECTIVE: To get participants to examine the reasons why they don’t use condoms. MATERIALS: Sheets of paper or sheets of flip chart paper or chalkboard (optional) TIME: 30 minutes INSTRUCTIONS STEP 1 Have the participants consider the list of excuses and identify the ones, which they consider to be the most common. List them on a piece of paper, a flip chart or chalkboard if possible. STEP 2 For the first excuse, provide them with the three responses. For the excuses that are mentioned, ask participants if they can think of any replies before offering the responses listed below. STEP 3 Ask them if they think the responses are realistic and could be used by people like them. EXCUSE 1: You think I have a disease. a) I don’t want either of us to take a chance of getting HIV. b) Many people infected with HIV have no symptoms at all. c) Neither of us probably has a disease, but isn’t it better to be sure? EXCUSE 2: But condoms don’t work. a) They’re OK if we use them the right way. b) Condoms may even be fun. c) I have never had a condom break. EXCUSE 3: They spoil the mood. a) It will be OK once we’re used to them. b) Why don’t you try condoms a few times and see? c) But it would make me feel more relaxed if I felt safe. EXCUSE 4: They don’t feel good. a) But we know condoms can protect us. b) I know you don’t like the idea but condoms are so important now. c) Think about the fun we are going to have and not the condom. EXCUSE 5: They make me feel cheap and dirty. a) These days condoms have become a way of life for everyone. You would be Surprised how many people use them. b) You know I care for you and respect you. That’s what’s important. c) I want to use condoms because I don’t want you to get pregnant before you want to. There is nothing cheap and dirty about that. EXCUSE 6: I’m already using pills for birth control. a) We have to use condoms as well because the pill doesn’t stop infections. b) That doesn’t help against HIV and STI. c) Too bad – no condoms, no sex. EXCUSE 7: I’d be embarrassed. a) It won’t be so awkward after the first time. b) I’ll buy them, so we’ll have them next time. c) Embarrassment never killed anyone. EXCUSE 8: They cost too much. a) When it comes to our health we shouldn’t think about the cost. b) I can pay for them.

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Exercise 9.9 Do’s and Don’ts of Condom Use Exercise OBJECTIVE: To increase understanding of how to reduce the chances of a condom breaking MATERIALS: Sheets of paper or, if available, flip chart paper or chalk board. TIME: 30 minutes INSTRUCTIONS STEP 1 Write the following list on flip chart paper, a sheet of paper or chalkboard, or simply read them out. Read through the whole list one time. Then read each item on the list one at a time and ask participants to indicate (on a piece of paper or orally) if this action should or should not be taken by marking “Do” or “Don’t” in a list. a) Store condoms in the sun or in a humid warm place. b) Use condoms with dry and brittle wrappers. c) Use condoms after the expiry date on the package is past. d) Use a condom every time you have sexual intercourse. e) Take two condoms with you just in case. f) Use two condoms to double your protection. g) Put a condom over the tip of the penis and roll it down half way. h) Use coconut oil, cooking oil or other oily products to lubricate the condom. i) Use the same condom only once. j) Rub water or saliva on the condom to make it wetter or more slippery. k) Have sex for a little while and then put on the condom. l) Use condoms when the rubber is dry or stiff. m) Take your time when putting on a condom. n) Always carry a condom with you when you go out. STEP 2 Read each item again and have participants give their responses, explaining why they chose each one. Share with them the information in the brackets below if they don’t mention it themselves. a) Store condoms in the sun or in a humid warm place. (Don’t because improper storage increases the chance of breakage) b) Use condoms with dry and brittle wrappers. (Don’t because using older condoms increases the chance of breakage) c) Use condoms after the expiry date on the package is past. (Don’t because using older condoms increases the chance of breakage) d) Use a condom every time you have sexual intercourse. (Do because you will feel well protected) e) Take two condoms with you just in case. (Do because you never know when you might need more than one or need to lend one to a friend) f) Use two condoms to double your protection. (Don’t because two reduces the sensation and one, properly used, is sufficient) g) Put a condom over the tip of the penis and roll it down half way. (Don’t because if the condom is not unrolled to the pubic hair, it could slip off) h) Use coconut oil, cooking oil or other oily products to lubricate the condom. (Don’t because oil-based products make condoms weak and increase breakage) i) Use the same condom only once. (Reusing the same condom increases the chance of breakage) j) Rub water or saliva on the condom to make it wetter or more slippery. (Do because water based lubricants don’t make condoms weak) k) Have intercourse for a little while and then put on the condom. (Don’t because any intercourse without a condom is risky) l) Use condoms when the rubber is dry or stiff. (Don’t because older condoms tend to break easily)

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m) Take your time when putting on a condom. (Do because condoms that are put on incorrectly tend to break more often) n) Always carry a condom with you when you go out. (Do because you might not be able to know in advance if you will have sex.)

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MODULE 10 LOVE

Exercise 10.1: Sitting on Knees Aims: Fun exercise to bring together and encourage trust and cooperation. Description: Everyone sits on one another’s knees in a circle. Instructions:

1. Ask everyone to stand closely in a circle, you included. Then everyone should turn to their right, so that people in the circle are facing the back of someone else.

2. Ask everyone to put their hands on their shoulders of the person in front of them. Explain

that you are going to call out “1,2,3, SIT!” Everyone should call out slowly with you. On the word “sit”, everyone should carefully sit down on the lap of the person behind him or her, still holding on to the shoulders of the person in front of him or her.

3. This really works, but takes care! If your group is really brave, you can all try to shuffle

around in the circle together in this position!

4. This is a fun exercise and creates a good feeling amongst everyone. Afterwards, ask participants how it felt to do this. Did they think they were going to be able to? How does the exercise relate to real life experiences?

Exercise 10.2: Spider’s Web Materials needed: Ball of string Objectives: Energizer and to remind everyone that they are each an important part of the group Description: A ball of string is unraveled and held taut by everyone, like a Spider’s web. Instructions:

1. Make sure everyone is sitting in a circle. Produce a big ball of string. Hold on to the end of the string, and then roll it across the ground to someone sitting opposite you, saying his/her name as you roll it to him/her. Keep holding to your end tightly.

2. Ask the participant to hold on to the string, so that it makes a taut line on the ground

between you both. Then ask him/her to roll the ball back across the circle, across the ground, to someone else, saying that new person’s name as it rolls to him/her.

3. Everyone keeps on with this, until the circle is full of taut lines criss-crossing the circle.

Each person should be holding on tightly to a bit of string. The ball of string should finally be rolled back to you, so that you hold the beginning and the end of the string.

4. Next ask everyone to look at how the string connects you all, like a spider’s web. You are

all dependent on one another to keep this web firm and supportive. If anyone were to take their hand away from the web, that part of it would collapse.

5. Ask people to suggest how the spider’s web exercise relates to our real lives.

6. After few comments, ask everyone to lay their piece of string down on the ground, gather

up the string in a loose pile, so that it can be rewound later. Ask everyone to think about

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our dependence on one another – and our need to support one another – during the course of today’s session.

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MODULE 11 PREJUDICE

Purpose: To challenge the judgments, which we make about one another. Exercise 11.1: Pass the Picture Materials needed: Flip chart, marker pens. Objective: Fun warm up game, to illustrate different peoples’ perceptions of what they hear. Description: A picture is drawn and described in words to others, who try to reproduce it. Instructions:

1. Ask for five volunteers to leave the training area for a few minutes, until they are called back.

2. Bring out a piece of flip chart paper and ask the remaining people to agree on a picture

and for two or three people to draw it. It could include, say, a person, a house, a tree and some animals. Do not make it too complicated.

3. Then hide the picture and ask someone to call the five volunteers back to the group.

4. One volunteer is then shown the picture. This volunteer must then describe the picture in

words to the second volunteer, who in turn describes it to the third volunteer and so on.

5. When the fifth volunteer has heard a description of the picture, she/he should be handed a new piece of flip chart paper and some marker pens. She or he should try to draw the picture, as she/he understands it to look from the description. She/ he should then try to draw the picture as she/ he understands it to look from the description. She should receive no help from the rest of the group.

6. When she/he has finished the picture, compare it with the original picture. There should

be some interesting differences!

7. Thank the five volunteers for their willingness to help. Point out that it is often much harder than we suppose for us all to understand things in the same way.

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Exercise 11. 2: Taking Risks Objectives: To help participants to reflect on their own behavior with regard to risk-taking in life in general. Description: Individual reflection, followed by paired listening. Instructions:

1. Explain to participants that when people have problems or seem confused or scared, we like to have clear, simple answers to things. However, we have seen how our lives are full of uncertainty and that easy solutions are rarely available. Explain that we are now going to do an exercise, which will help us to think about how we handle risk in general in our own lives.

2. Ask participants to work alone first and consider the following for a few minutes.

Think about your life and identify any occasion when you took a risk. It may be something quite trivial or it may have had great significance.

• What factor influenced your decision to take a risk? • What were your feelings at the time? • What was the outcome of taking that risk? Was it positive or negative? • Are you generally a risk taker? • How do you view risk taking in others? • What impact does this have for your attitudes towards HIV/AIDS?

3. After few minutes, ask participants to choose a partner and share with them the situation.

Encourage them to do this listening exercise- each person taking a turn to talk and a turn to listen. Give them a few minutes each.

4. Call everyone back into the full circle. Encourage them to draw out any general observations on risk- taking behavior and any ways in which it relates to HIV/AIDS.

Exercise 11. 3: Who’s labeling whom? Materials needed: Cards, Markers, sticky tape. Objectives: To develop awareness of differences and harms of “labeling”. Description: People greet one another according to the kind of label that is being worn Instructions:

1. For this exercise, you need as many cards as there are people in the group,

including one for yourself. Distribute the cards, so that each person has one. Pass round the crayons too. Then ask everyone round the circle to your left to draw a face of someone with a good quality on his or her card. You could give suggestions, such as a generous person, someone who is kind and caring, someone who is a good listener, someone who is always cheerful: and so on. It is up to each person to decide for himself or herself what quality they want to draw.

2. Then ask everyone round the circle to your right to draw a face of someone with a bad quality. For instance, their face could be of a liar, a thief, a selfish person, a murderer, an adulterer, a wife beater and so on.

3. When everyone has drawn their card, ask each person to hold up their card in turn and show it to the rest of the group, explaining the quality of face they have drawn.

4. Then ask everyone to pass his or her cards to you and shuffle them so that they are all mixed up.

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5. Next, leaving the cards in a pile, ask everyone to stand up and to move round the

circle, greeting ten or so others warmly as they normally would.

6. Then, ask each person to come to you in turn. You should then take a card from the pile and stick it with sticky tape to the back of the first person, without letting him or her see what is drawn on it. Tell everyone not to tell one another what the picture on their back shows.

7. Continue this with the rest of the cards, not letting them be seen by others, until you have stuck them on everyone’s back.

8. Ask someone else to stick the last card on your own back: try to choose a card with negative quality for yourself, if you can!

9. When everyone has a card attached to their back, ask them to stand and move around again, greeting one another. This time, however, the style of their greeting should depend on their reaction to the kind of label, which they see on the back of the person they are greeting. So if for, instance, they are greeting someone with a “liar” label, they should show their dislike of liars in their face and movement as they greet that person. If they meet other people whom they would like to make friends with, they can stay closer to them. NB: If they can’t remember what the picture on the back of someone means, and then they should treat that person with caution.

10. After everyone has greeted one another again, and moved into groups of friends, ask them to come and sit down again in a circle, leaving their labels on.

11. Then ask the group the following questions:

• How did you feel during the first meeting with your friends? • How did you feel during the second meeting? • Did others treat you differently? How? • How did that make you feel?

12. Next, ask everyone to reach round to his or her labels and take them off, so that

they can see how they have been labeled. Clear up any uncertainties that people may have about the meaning of their labels.

13. Then ask:

• What have we learnt from this exercise? • How can we relate this lesson to AIDS in our community? • Why is this exercise so relevant to prevention of AIDS and care for people

with AIDS?

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Exercise 11.4: Role play: “ Hopes and fears: Commercial sex” Aims: To explore possible futures of commercial sex workers Description: Participants volunteer to act out the Role-play about commercial sex workers in a community. Instructions:

1. Say that while they are watching, you would like them to think about the situation of these

commercial sex workers in comparison with other commercial sex workers in their community.

2. Explain that after the Role play there will be a chance to talk about what they have seen.

3. After the role-play ask participants to summarize the hopes and difficulties or fears of

each of the two commercial sex workers.

4. In what ways are the situations of these commercial sex workers relevant to their sexual health?

5. What are the hopes and fears of commercial sex workers in your own community? In

what ways are they similar to or different from those of the two commercial sex workers in the role-play?

6. Can you suggest what could be done in your community to improve the future for

commercial sex workers?

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MODULE 12 ALCOHOL AND DRUG ABUSE

Aims: To help participants consider the advantages and drawbacks of drinking alcohol and using drugs Reasons for drug and alcohol use

Ask participants to cite out reasons for their use of drug and alcohol. Let them enact the last time they took alcohol and discuss the following issues What are the good things about drinking alcohol? What are the bad things about drinking alcohol? How do they relate alcohol with HIV/AIDS? What can they do to help their situation? What would they expect from the community?

(Encourage participants to brainstorm the questions and find a compromise) Effects of alcohol and drug abuse As a person moves into a regular pattern of drug abuse, the drug takes center stage of the person’s life. Drugs become the emotional and social focus at the expense of other interests and activities. There is decline in initiative, drive and interest in drug free activities. This gradually leads to social, emotional and physical problems. Loss of control and the breakdown of close relationships may lead to feelings of self doubt, poor self-esteem, guilt, anxiety and sadness, all leading to further drug abuse as an escape. Tolerance and dependence accompany this process. These terms are described below. Tolerance: The repeated use of a drug leads to changes in the brain and nervous system so that the user needs more of the drug in order to get the expected effect. This is the basis of drug tolerance. Dependence: Drug dependence is an emotional and sometimes a physical need experienced by the drug abuser. The drug abuser or alcohol dependent person feels a compulsion to take the drug on a regular basis, to feel its effects and to avoid discomfort of its absence. Physical dependence on any drug can be treated in a detoxification program (“detox”). However, psychological dependence is much harder to treat – this is the principal challenge for you as a counselor. Addiction: Addiction is the physical and psychological habit or feeling of need, which comes from repeated use of a drug. Drug abusers often continue to feel the need and desire for drugs after they have been treated for drug dependence ( “detoxification”). Withdrawal: In a drug dependent person, it is necessary to take the drug in order to maintain normal body function. When the drug is not taken, the person suffers from physical and mental discomforts as a result. The fear of suffering from withdrawal is like an emotional prison, which makes the addict feel trapped and controlled by the drug. If, initially, drugs are taken to experience particular sensations, in the later stages they are used to avoid suffering the unpleasant effects of withdrawal. Consequences of alcohol and drug abuse As a drug counselor, it is important for you to consider both the unintended and intended consequences of drug use. Many of us think that our job is to inform young people and drug abusers of the dangers of drugs in order to make them change their ways. Unfortunately, this is not enough as people have all kinds of ideas and feelings about the desirable effects of drugs. The drug user may feel that drugs help him or her to have fun, to have courage, to be accepted, to be grown up or to feel better. He may feel that the drug is a trusted friend, especially if people or society’s promises have betrayed him.

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The negative health consequences of drug abuse are many and varied, involving the body, mind and emotions. A major and growing consideration is the contribution of drug abuse to the spread of HIV/AIDS. Intoxication with drugs leads to risky sexual behavior that could be a major contributing factor to the rapid spread of this dreaded condition. Injecting drug abusers who share needles can also infect each other with HIV/AIDS (blood –to- blood). Infections common to drug addicts include viral hepatitis, chest, heart, kidney infections and abscesses. Other physical effects on women may include hormonal changes leading to menstrual irregularity, infertility, and negative effects on fetal growth and development for the growing child. Effects on the brain lead to emotional instability, poor impulse control and mental difficulties. For example, regular use of cannabis impairs fine memory functions. Habitual drug abuse saps both physical and mental vitality, causing the user to be less productive in all areas of life. It affects the senses in such a way that social and emotional cues are blunted. Drug addiction may lead to stunting of social and emotional development in young people.

Exercise 13.1 One minute Alcohol Role- Play Objective: To examine different situations in which alcohol has impaired judgment and brought out aggressive behavior Materials: None TIME 20 minutes per story Instructions STEP 1 Choose participants to play the roles of the people featured in the stories (if the group is all women, have some of the women play the parts of men). STEP 2 Read aloud the story or have the participants read it to themselves. Ask the participants to pretend they are characters in the story and invent one-minute conversations. STEP 3 After the dramatization, ask the other participants to comment on what they have seen. Some questions that can be used to stimulate discussion are included after each scenario. Story 1: Poor Judgment Two friends doing sex work go to a new town for the first time. The meet a group of 4 men in a popular bar and they manage to build rapport with them. The men buy them lots of beers and all get drunk. The men take advantage of their misjudgment and take them to a lodge to have group sex with them, with neither condoms nor money. Questions for discussion after the role-play

What did you see happening in this play? Why are the girls taking alcohol? Why are the men drinking so much? What are the good things about drinking alcohol? What are the bad things about drinking alcohol? When people drink too much, who is to blame and why? What role does alcohol tend to play in influencing sexual behavior? What might be the consequences? What are consequences related to STIs and HIV? How does this situation happen with sex workers What could be done to change this situation?

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Story 2: Lucky Day? A woman in sex work lands a quick deal with an expensive client who furnishes her with so much money even before the sex. After a few beers they go to a hotel where they have protected sex because the woman insists. After a few sexual rounds, they take more alcohol and this time the girl is drunk. She insists though that they use condoms but the man takes it off without her knowledge because she is drunk. After the unprotected sex, the client takes all the money he had given her, as she half-consciously lies in bed. She finds out in the morning that she was used just because of too much drinking.

What did you see happening in this play? Is this situation realistic? Why does this situation occur? What problems can it cause? When it happens in your situation, what problems does it cause? What could be done to change this situation?

Story 3: Festival Day It is Valentines Day and there is a big festival in town. There are many customers and sex workers don’t accept those who don’t want condoms. A drunken man is trying to persuade the woman to have sex with him. She is trying without success to negotiate the use of a condom with the drunken man.

What did you see happening in this play? Is this situation realistic? Why does this situation occur? Why do you think the man doesn’t want to use condoms? Do you think the fact that he is drunk is affecting his judgment? What do you think will happen next? What could be done to change this situation?

Story 4: Skin Tax Two policemen arrest a sex worker, and are negotiating so much money for her to be released. Because she doesn’t have the money, they ask for her to have sex with them, or else she goes to prison. She is not opposed to the idea but she wants to protect her life with condoms. The policemen are a little drunk and just can’t understand. They say they want a skin tax (skin to skin)

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Exercise 13.2 Alcohol and Commercial sex workers.

OBJECTIVE : To reflect on the external influences on alcohol consumption

MATERIALS : None

TIME : 30 minutes INSTRUCTIONS STEP 1 Ask participants to list all the positive things associated with alcohol and write them on a sheet of paper, blackboard or flip chart paper. The list may include things like: feel good; escape worries; more sociable and less timid, reduces stress; and a way of celebrating a special event. STEP 2 Ask participants to list all the negative things associated with alcohol and write them on a sheet of paper, blackboard or flip chart paper. The list may include things like: feel sick; headache next day; physical abuse of others; uses up money; and forget to use condoms. STEP 3 Ask participants to list the special circumstances that make Commercial sex workers vulnerable to alcohol consumption and write them on a sheet of paper, blackboard or flip chart paper. The list may include things like:

• Isolation • Boredom • Separation from families • High tension and danger • Peer pressure

STEP 4 Ask each of the participants to consider their own circumstances and ask the following questions:

• What do you like about drinking alcohol? • How does alcohol make you feel? • How does drinking too much alcohol make you feel? • How does drinking too much alcohol affect your judgment? • Have you noticed that it is hard to stop once you have started drinking alcohol?

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Bibliography 1. Stepping Stones, a training package on HIV/AIDS, communication and relationship skills, pg.

31-40 2. STD/AIDS Peer Educator Training Manual: A complete guide for trainers of peer educators in

the prevention of STDs including HIV/AIDS. 3. UNDCP Drug Counselor’s Handbook: A practical guide for everyday use. 4. UYDEL Peer-to-Peer Pocket Book. 5. Happy Health and Safe Learning activities on growing up, relationships, sexual health,

HIV/AIDS and STDs and Life skills; Anti AIDS project Family Health Trust Zambia

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