Resource Materials by AVSI Uganda

RESOURCE MATERIALS FOR COMMUNITY DIALOGUE Facilitatorâ&#x20AC;&#x2122;s Guide

This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of Sustainable Comprehensive Responses for Vulnerable Children and their Families (SCORE) project and do not necessarily reďŹ&#x201A;ect the views of USAID or the United States Government.

Table of Contents OVERVIEW ................................................................................................................................................... 4 TOPIC ONE .................................................................................................................................................. 5 Alcohol abuse.............................................................................................................................................. 5 TOPIC TWO................................................................................................................................................ 12 Promotion of personal hygiene for VC Households ............................................................................ 12 TOPIC THREE ............................................................................................................................................. 15 Practical ways to make water safe .......................................................................................................... 16 TOPIC FOUR .............................................................................................................................................. 19 Home-based management of common childhood diseases ............................................................. 19 TOPIC FIVE ................................................................................................................................................. 24 Communicating with children................................................................................................................. 24 TOPIC SIX ................................................................................................................................................... 28 HIV/AIDS .................................................................................................................................................... 28 TOPIC SEVEN ............................................................................................................................................. 31 Elimination of Mother to Child Transmission of HIV/AIDS (EMTCT) .................................................. 31 TOPIC EIGHT .............................................................................................................................................. 33 Domestic violence .................................................................................................................................... 33 TOPIC NINE ............................................................................................................................................... 38 Stigma and Discrimination ...................................................................................................................... 38 TOPIC TEN ................................................................................................................................................. 40 Will Making ................................................................................................................................................ 40

FOREWORD

I am delighted to introduce to you this publication which provides some guidance and important resource materials that can be used during all community education sessions. I believe this publication will contribute towards maintaining a standard that will lead to effective community dialogues.

Massimo Lowicki Zucca

OVERVIEW This manual is designed as a guidance document with resource materials on different topics that can be used at different community dialogues in the communities. Each topic has a brief overview of content/ achievement objectives and a well laid out discussion guide on a specific topic This guide however is not entirely exhaustive of all topics or of all issues that may need to be discussed therefore facilitators should use it as a reference document to which they can add different aspects in different topics to ensure a successful community education activity.

TOPIC ONE

Alcohol abuse Content: 1. What is alcoholism?, Some signs of Alcoholism 2. Causes of alcoholism 3. Effects of alcoholism 4. How do you know if someone has an alcohol problem? 5. What can people do to stop abusing alcohol? Background Alcohol is a problem in many communities. Abuse of alcohol can contribute to poverty, illness, domestic violence and child abuse in a household. OVC service providers may find it difficult to help a household if the family is facing alcohol problems. Service providers should know these basic facts about alcohol and have some resources to help households affected by alcohol abuse. 1. What is alcoholism? TO Alcoholism is a disease. People who are affected often show the following signs: Some signs of Alcoholism • • • •

Craving: They feel a strong need, or urge to drink. Poor self-control: They are unable to limit their drinking. Physical dependence: They experience nausea, sweating, shakiness, and anxiety, when alcohol use is stopped, or after a period of heavy drinking. Tolerance: They need to consume larger and larger amounts of alcohol in order to feel its effects.

What are the causes of alcohol abuse? • Peer pressure • Fit in the group • Boredom • Gain self confidence • Kill time • Kill thirst • Addiction • Illegal production – makes alcohol supply so high and easy to access • Media • Advertisements 5

• •

Culture Style

What are the effects of alcohol abuse? Show the picture below to participants and discuss what they see as some of the effects of Alcohol abuse on the body Ask participants Are there any other effects of alcohol that they are aware of? Discuss these together Then ask, if there is any participant who would be willing to have their body destroyed in such a manner on account of alcohol Then show the same picture as below, but this time with the words written on –detailing the effects on each body part

Alcohol and the liver Demonstration activity Get a glass of alcohol and a glass of water, put a small piece of liver in each of the glasses with alcohol and water respectively and watch what happens. Discuss with the community members the effects of alcohol on the liver based on what they have observed Other important effects of Alcohol abuse Children who live in households where alcohol is abused face the following risks: • Violence • Sexual abuse and exposure to HIV and sexually transmitted infections • Psychological and emotional problems from the lack of structure and discipline in their household • Lack of basic necessities such as food and clothing if their parent or guardian is unable to work • Health hazards, including accidents and injuries • Lack of parental guidance or supervision since parent or guardian may be forgetful or even unconscious for long periods of time. • Children may copy their parent or guardian’s behavior and begin alcohol abuse. • Isolation and stigma from the community. Other general effects include: • Poverty • Loss of a job • Unemployment • Being disrespected in the community • Domestic violence • Ill health • Broken marriages • HIV/AIDS • Stigma and isolation etc What are the dangers of alcohol to children who drink? 9

• • •

Effects of alcohol are stronger on young people because of their smaller size and tolerance. Alcohol can interfere with normal growth and development. Drinking can make people do things they would normally consider wrong or dangerous.

How can you know if someone has an alcohol problem? Alcohol Line game: Instructions • Step on the line if you know at least 3 types of alcohol • Step on the line if you know someone who drinks alcohol • Step on the line if you have ever been in the company of any one who drinks • Step on the line if you live in a household where alcohol is brewed for sale • Step on the line if you have ever drank (including tasting) alcohol • Remain on the line if you have felt that you should cut down on your drinking • Step on the line if you have ever felt annoyed because someone criticized you for drinking a lot • Step on the line if you have ever felt bad or guilty about your drinking • Step on the line if you have ever had a drink first thing in the morning to calm your nerves or to get rid of a hangover Often people who have drinking problems don’t realize it or refuse to accept it. However, if the person will honestly answer the following questions, and answers ‘YES” to any of them, it can indicate that the problem is serious. 1. 2. 3. 4.

Have you ever felt you should cut down on your drinking? Have people annoyed you by criticizing your drinking? Have you ever felt bad or guilty about your drinking? Have you ever had a drink first thing in the morning to calm your nerves or to get rid of a hangover? What can people do to stop alcohol abuse? • • • •

Take a firm decision to stop consuming alcohol. Learn to say “No!” Explain that you want to lead a healthy lifestyle and be in position to reach your ambitions in life. Do not keep friends who will pressurize you to consume alcohol; instead get friends who will have a positive impact in your life. Change your habits and lifestyle to avoid temptations. 10

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Do not brew alcohol at home even if the intention is business. This is not a good foundation for raising children as an environment Set targets (e.g. not drinking for 1 week) and reward yourself when you achieve your target. If you fail, start again. It is difficult to stop completely on the first try. Get support from district resource people or groups. Your local health unit or Community organizations and/or community development Officer may be able to refer you to a support group such as Alcoholics Anonymous (AA) in your area. One such example is the serenity center.

Serenity Centre Serenity Centre is an NGO providing treatment individuals and families suffering from addictive illness and substance abuse. It is also involved in sensitizing and educating the general public on the dangers of alcohol/drug abuse. It has limited residential treatment program and undertakes outreach activities in educational institutions, and other organized institutions. Address Plot 39 Yokana Mukasa Road, Kawuku. P.O. Box 31749, Clock tower, Kampala (U). Tel: +256 (0)772 561 144 Email: serenityc@africaonline.co.ug

TOPIC TWO Promotion of personal hygiene for VC Households What is personal hygiene? Personal hygiene is the basic concept of cleaning, grooming and caring for our bodies. Personal hygiene involves those practices performed by an individual to care for one's bodily health and wellbeing, through cleanliness. Examples of personal hygiene practices: • Bathe every day using clean water, soap and a sponge. Be sure to clean arm pits and sexual organs. • Wash hands before every meal and after using the toilet. • Wash clothes and keep them clean, especially underwear, knickers and brassieres, handkerchiefs and stockings. • Brush the teeth and tongue using a toothbrush and tooth paste every morning and after every meal. This prevents tooth decay and bad smell. • Keep fingernails and hair short and clean. • Wash and comb hair regularly to prevent lice. • Cut nails regularly to keep them short and cleaning OVC Benefits of good hygiene:

Consequences of poor hygiene:

• • • • • •

•

Prevents bad body smell or odor Prevents eye and skin infections Prevents tooth decay Keeps skin clean and prevents pimples Prevents contracting some diseases Prevents passing on some diseases

Increased risk of: • Eye diseases. • Lice • Jiggers • Pubic lice. • Dandruff. • Ring worm. • Bad smell. • Rashes and itching. • Bacteria and fungal growth.

Home hygiene What is home hygiene? Home hygiene pertains to the hygiene practices that prevent or minimize disease and the spreading of disease in home (domestic) and in everyday life settings such as social settings, public transport, the work place, public places etc. Hygiene in home and everyday life settings plays an important part in preventing spread of infectious diseases. It includes procedures used in a variety of domestic situations such as hand hygiene, respiratory hygiene, food and water hygiene, general home hygiene(hygiene of environmental sites and surfaces), care of domestic animals, and home healthcare (the care of those who are at greater risk of infection). Maintaining a hygienic home environment Children and their caregivers may need guidance about the importance of a clean home environment to support good health. A clean home helps to prevent illnesses caused by germs and parasites. Everyone can take steps to keep the homestead clean and prevent illness, since many measures are cheap and affordable. These include: •

• • • • •

Keeping the home environment clean by sweeping the house and compound; and washing all dirty utensils and clothes. Constructing a proper latrine and keeping it clean and covered. Putting water and soap outside the latrine for use to wash hands after using the latrine. Constructing a drying rack for dishes. Keeping animals away from the cooking area and water source. Purifying drinking water and storing it when it is covered. It is notable that lack of safe water remains a major problem for most households in Uganda. Drinking unclean water can cause diarrhea, cholera, worms and other illnesses.

The case of diarrhea as a result of poor hygiene

Home management of diarrhea Since diarrhea takes water and food substances out of the body, it can lead to dehydration and death if it is not managed well. Try to: • Replace lost fluids with oral re-hydration salts (ORS). • Let the child eat small amounts of foods that will not irritate the stomach, like banana, rice and dry bread. • The child should be given oral re-hydration salts as soon as the diarrhea starts. Below are instructions for preparing oral re-hydration salts: TO If you use a packet of ORS from the pharmacy: • Wash hands with soap and water. • Mix the ORS packet in one liter of boiled and cooled drinking water. • Give to the child as often as she or he has diarrhea. If you want to locally make ORS at home: • Wash your hands with soap and water. • Mix together 1 liter of clean drinking water, four thumb-and finger pinches of salt, and two handfuls of sugar.

TOPIC THREE

Practical ways to make water safe Storage and settlement: If you have no other choices, the simplest way to improve water quality is to store it in a clean, closed container for at least one day. Solids and some germs will settle at the bottom of the container. Water nearer to the top of the Container after one full day will be safer to drink. Disadvantages: The water will not be completely safe to drink. Filtering: Pour your water through a clean, folded piece of cotton cloth into a clean container. This will help remove solids and Guinea worm. Disadvantages: The water will not be completely safe to drink. Boiling: Boiling is the most commonly recommended way of purifying water. Boiling water for 1 minute kills most germs, including cholera. The most common recommendation, however, is to boil the water for 10-12 minutes. After boiling, the water will be safe to drink. Disadvantages: Uses up wood or other fuel; takes time. Chemical treatment: Treating water with chemicals like chlorine (JIK) and iodine is one of the most effective ways to kill germs and make the water safe. The main challenge with chemical treatment is being sure of putting in the right amount. If the dose is too high, the water will taste bad. If the dose is too low, it will fail to kill the germs. Talk to your nearest field officer/social worker, community Development Office for instructions on how to treat water correctly with chemicals. Disadvantages: Chemicals can be costly or hard to find; measuring the right dose can be difficult. Storing water after treatment: After treating your water, you need to store it safely to keep it clean. • Store water in a container with a narrow opening that can be closed or covered, not an open bucket. • Avoid previously-used containers that may have held poisonous chemicals. • Keep the container covered to protect it from dust, animals, birds, or insects. • Do not put hands, cups or anything else into the water, especially when drawing water. Use a container from which water must be poured and clean the container at least once a week

TOPIC FOUR

Home-based management of common childhood diseases Caregivers should be able to recognize when a child is taken ill and know the first steps to manage the illness. Giving the child appropriate care at home right away can keep the child’s condition from getting worse and help the recovery take place more quickly. Sometimes it may take some time to access medical care at a health unit, so home management of the illness helps keep the child stable in the meantime. Early signs of illness Common signs of illness in children are: • Loss of appetite (the child does not eat well). • High temperature (the child’s body will be hotter than normal). • Sweating. • Crying frequently. • Lack of interest in playing. • Weakness. • Feeling cold and shaking. Home management of fever Fever remains the most common concern for which parents bring their child to the emergency department. Fever has traditionally been defined as a rectal temperature over 100.4 F or 38.0 C or most commonly axillary (armpit) temperature above 99ºF (37.2ºC Temperatures measured at other sites are usually lower) Fever itself is not life-threatening unless it is extremely and persistently high, such as greater than 107 F (41.6 C) when measured rectally. Fever may indicate the presence of a serious illness, but usually a fever is caused by common infections which are not serious. The part of the brain called the hypothalamus controls body temperature. The hypothalamus increases the body's temperature as a way to fight the infection. However, many conditions other than infections may cause a fever. Causes of fever include the following: • Bacterial infections • Viral infections • Medications • Illicit drugs • Illnesses related to heat exposure

An attack of fever may cause the child’s body to be hot. If the fever is very high, it may lead to convulsions or fits. When the child has fever: • • • •

Remove the child’s clothes and cool the body using a piece of cloth soaked in warm water, so as to lower the body temperature. Give the child plenty of fluids to drink. If possible, give a dose of Paracetamol tablets. If the body temperature does not go down, or if the child has a convulsion, take the child to the nearest health unit.

Home management of diarrhea Diarrheal disease is the second leading cause of death in children under five years old, and is responsible for killing around 760 000 children every year. Diarrhea can last several days, and can leave the body without the water and salts that are necessary for survival. Most people who die from diarrhea actually die from severe dehydration and fluid loss. Children who are malnourished or have impaired immunity as well as people living with HIV are most at risk of life-threatening diarrhea. Diarrhea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not diarrhea, nor is the passing of loose, "pasty" stools by breastfed babies. Diarrhea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene. There are three clinical types of diarrhea: • • •

acute watery diarrhea – lasts several hours or days, and includes cholera; acute bloody diarrhea – also called dysentery; and Persistent diarrhea – lasts 14 days or longer.

Causes Infection: Diarrhea is a symptom of infections caused by a host of bacterial, viral and parasitic organisms, most of which are spread by faeces-contaminated water. Infection is more common when there is a shortage of adequate sanitation and hygiene and safe 20

water for drinking, cooking and cleaning. Rotavirus and Escherichia coli are the two most common etiological agents of diarrhea in developing countries. Malnutrition: Children who die from diarrhea often suffer from underlying malnutrition, which makes them more vulnerable to diarrhea. Each diarrheal episode, in turn, makes their malnutrition even worse. Diarrhea is a leading cause of malnutrition in children under five years old. Source: Water contaminated with human faeces, for example, from sewage, septic tanks and latrines, is of particular concern. Animal faeces also contain microorganisms that can cause diarrhea. Other causes: Diarrheal disease can also spread from person-to-person, aggravated by poor personal hygiene. Food is another major cause of diarrhea when it is prepared or stored in unhygienic conditions. Water can contaminate food during irrigation. Fish and seafood from polluted water may also contribute to the disease. Since diarrhea takes water and food substances out of the body, it can lead to dehydration and death if it is not managed well. Recognizing Dehydration Dehydration is one of the most worrisome complications of diarrhea in children. Mild diarrhea usually doesn't cause significant fluid loss, but moderate or severe diarrhea can. Severe dehydration is dangerous; it can cause seizures, brain damage, even death. Know the signs of dehydration. Call your doctor if your child has: • Dizziness and light-headedness • Dry, sticky mouth • Dark yellow urine, or very little or no urine • Few or no tears when crying • Cool, dry skin • Lack of energy Managing diarrhea • • • •

Replace lost fluids with oral re-hydration salts (ORS). Let the child eat small amounts of foods that will not irritate the stomach, like banana, rice and dry bread. The child should be given oral re-hydration salts as soon as the diarrhea starts. Consulting a health professional, in particular for management of persistent diarrhea or when there is blood in stool or if there are signs of dehydration.

Below are instructions for preparing oral re-hydration salts. This can be used to educate households. 21

• TOOL � Preparing oral re-hydration salts to If you use a packet of ORS from the pharmacy: • • •

Wash hands with soap and water. Mix the ORS packet in one liter of boiled and cooled drinking water. Give to the child as often as she or he has diarrhea.

If you want to locally make ORS at home: • Wash your hands with soap and water. • Mix together 1 liter of clean drinking water, four thumb-and finger pinches of salt, and two handfuls of sugar. Prevention and treatment of malaria Malaria is an infection of the blood caused by a parasite spread by mosquitoes. Malaria can affect the brain and lead to fits and unconsciousness. If left untreated, it can cause death. People living with HIV/AIDS are especially at risk. To prevent malaria in the household: • Sleep under a mosquito net (preferably insecticide-treated net). • Destroy mosquito breeding places such as stagnant water, old pits and broken bottles. • Education in recognizing the symptoms of malaria has reduced the number of cases in some areas of the East Africa by as much as 20%. Recognizing the disease in the early stages can also stop the disease from becoming a killer. Education can also inform people to cover over areas of stagnant, still water e.g. Water Tanks which are ideal breeding grounds for the parasite and mosquito, thus cutting down the risk of the transmission between people. This is most put in practice in urban areas where there are large centers of population in a confined space and transmission would be most likely in these areas. Treatment of malaria is best done at the health center, where a blood test can be done to be sure it is malaria. It is important to follow the advice from the health worker and give the proper dosage - too much can be deadly, while too little will not cure the disease.

Common childhood immunizable diseases Immunization is the best way to prevent a number of dangerous diseases for children. It saves many children’s lives. Serious childhood illnesses which are preventable by immunization include tuberculosis, polio, diphtheria, whooping cough, tetanus (lockjaw), and measles. 22

NOTE: • Parents and caregivers of children should make sure to have young children immunized in their first year of life. Some vaccinations need more than one dose in order to work, so it is very important to follow the complete schedule • Bring children for immunization at birth, 6 weeks, 10 weeks, 14 weeks, and 9 months of age. • Each child should have an immunization card from the health facility. • It is important to keep this card in a safe place since it is an important record of when the child next needs to be immunized. Schools also require children to have an up-to-date immunization card in order to enroll in school.

TOPIC FIVE Communicating with children At the end of this topic participants will be able to: 1. Explain basic communication with children 2. Explain the principles of communication with children 3. Describe barriers to communication with children 4. Explain different practical ways used in communication with children 5. Demonstrate knowledge and skills necessary to communicate with children. What’s so different about communication with children? · Children are unique… they are not small adults · They have physical, psychosocial and spiritual needs that are different and our responses need to be different than those we would give to adults. · Effective care requires us to understand these differences… OL � Tips for communicating with children Principles for Communicating with Children 1. Trust Trust is important and both the child and the parent/guardian/caregiver need to be able to trust those who are caring for them. 2. Honesty NEVER lie to a child! A child’s trust in those who are caring for him can be destroyed, future care will be feared and a child’s anxiety increased! 3. Respect Respect children for who they are with a non-judgmental attitude. Do not ignore the child’s viewpoint and feelings. 4. Attitude Speak with the child and not to the child 5. Our Own Feelings Be careful of your own feelings: children are very perceptive to the attitudes of those around them. They pick up on the distress and anxiety of those around them. 6. Participatory Approach Include children in their care Teach them about the problem they may be encountering Encourage them to make decisions when appropriate 7. Unconditional Care Treat children equally regardless of gender, background, socio-economic status. Treat each child as an individual 8. Patience 24

Communicating well with sick children takes time; develop patience and make the time you have with the child COUNT. 9. Touch Can convey more than words in terms of comfort and reassurance BUT Be conscious that it can also be misused (male/female) 10. Family Involvement Ensure that close family or other significant adults in the family are involved in the care of the child. Barriers to Communicating with Children Communication barriers refer to anything that negatively affects effective communication between two or more people. Examples of some of these barriers are: · Language e.g. Jargon · Culture e.g. children are there to be seen and not to be heard · Skills · Knowledge · Age · Power/authority · Adult figure · Method of choice e.g. using verbal or written instead of play and drawing · Information over load Practical ways of Communicating with Children ·

Using drawings to facilitate communication: Drawings enable children to communicate their emotional state without having to put it into words. · Give children pencils, colors, paper etc. · Ask the children to draw something related to the issue you would like them to explore. For example, “Draw a picture of a time you were sick.” · Gently follow up by asking the children to describe what is happening in their drawings. · Use open-ended questions to encourage them to talk more about what they have drawn and why. For example, “How do the people in the drawing feel

about what is happening?”

Using stories to facilitate communication: Telling stories can help children to resolve problems. When children are finding it difficult to talk about painful issues, listening to a story about someone in a similar situation can be very comforting. When you use stories, it is helpful to remember the following: o Use a familiar story to communicate a message to the child. o Avoid using real names or events 25

o At the end of the story, encourage the child to talk about what happened. For example, ask about the message of the story to check that the child has understood it. o Ask the children to make up their own stories, based on a topic that you give them. For example, “Tell me a story about a little girl who lives in your

village.”

Using play to facilitate communication: Playing is an important way that children explore their feelings about events and make sense of their world. When children play, they act out certain roles, which help us to understand what they are feeling. o Give the child a variety of play materials (things like boxes, string, sticks that are locally available). o Ask the children to show you parts of their life using the play materials. For example: “Show me what you like to do with your family.” While the child is using the objects to show you, you can also ask him or her to describe to you what is happening. o Follow and observe what the child is doing and do not take over the play. Make comments if you want to check understanding, for example: say “I see that the mama doll is so sick that she cannot get out of bed” and see if the child disagrees. o If the child stops and cannot go on, ask him or her questions such as, “What is happening next?” or “Tell me about this person.” These questions

Physical touch e.g. a cuddle, pat, hug; most children of any age will respond to a cuddle.

Practical Attitudes · Honesty speaks louder than words! · Love: let the child know that s/he is still valued, still love and is still special. · Become like a child! · Listen carefully with interest: Focus on the current situation. Do not focus on earlier mistakes. “I feel that right now you want me to just listen to you.” · Be gentle, kind and encouraging: Recognize the child’s efforts. “You have worked

so long and hard on this activity.”

· · · · ·

If a child is dishonest, listen and try to understand why: Talk about how you feel about the child’s situation or actions. “I feel…” “I’m disappointed when… Help children to solve problems: Encourage the child to find solutions to problems. “It’s your choice.” “What can I do to help you? Involve children in play activities to help them express their feelings: Help the child recognize his/her emotions. “It sounds like you were really disappointed… Do not lecture or teach, but be a helper: Reassure the child that he/she can find the right solutions. “I know that you will be responsible.” Encourage: Focus on the positive. “You can do it.” “You make me happy when…” 26

Encourage expression of feelings: Ask more questions when you are not sure. “Tell

me more about…”

Exercise scenarios Scenario A · You are taking care of a 3-year-old child; he/she is misbehaving and throwing a tantrum, how do you communicate with the child? Scenario B · You find 3 children quarreling. One is very unhappy, almost in tears. How would you intervene? Scenario C · You are passing the school and you notice that children are taunting another child and name calling. You know the child is HIV+ and this is the reason for the problem. How would you deal with the situation? Scenario D · Three children ages 3, 5 and 7 are playing a hide and seek game. The 3-year-old asks you, ‘Aunt, can you play with us?” You are very busy and tired after a long day at work. Scenario E · A child comes to your office looking very scared and suspicious. How do you communicate with the child?

TOPIC SIX HIV/AIDS Objectives: At the end of this session, community members will be able to: 1. 2. 3. 4. 5.

Define HIV and AIDS and how they are related. Explains ways HIV/AIDs can be transmitted. Describe the ways HIV can and cannot be transmitted. List ways to prevent the transmission of HIV. Explain the relationship of HIV/AIDS and TB screening and the Importance of early screening and treatment

Ask participants – what does HIV/AIDS stand for? Clarify that HIV stands for: Human Immunodeficiency (lack of protection against diseases) Virus (germ) Your body has a natural defense system that fights diseases. This is called your “immune system”. HIV is a virus that weakens the body’s immune system. As time passes, the immune system is unable to protect you from diseases and you may develop serious illnesses Clarify that AIDS stands for: Acquired (something you get). Immune (refers to the body’s defense system that fights diseases) Deficiency (weakened immune system). Syndrome (group of signs and symptoms of illnesses that result from HIV infection). When your body’s immune system is very weak from HIV, you can easily be attacked by different diseases. Some of the common diseases are: · · ·

Thrush (Oral sores) Skin rashes Herpes Infections 28

· · · ·

Diarrhea that lasts more than one month Chest diseases - like Tuberculosis (TB) Diseases that affect the brain Cancers

Ask participants to brainstorm on the different ways HIV/AIDs can be transmitted. Responses can look like the following: • • •

Unprotected sexual intercourse with an HIV positive person-this is how most people get HIV. Mother to Child - from an infected mother to her child. This is the second most common way to get HIV in Uganda. Being exposed to infected blood: • Blood transfusion with HIV infected blood • Being cut or pricked with needles, syringes, razor blades, knives that have been contaminated with blood from an HIV positive person.

Ask participants to also discuss the ways in which HIV/AIDS CANNOT be transmitted · · · · · · ·

Sharing water or preparing and eating foods together Sharing cups, glasses, plates, telephones, or other utensils Witchcraft or curses Coughing or sneezing Being bitten by an insect like mosquitoes, bedbugs, houseflies Touching or hugging Kissing Going to a public bath/pool Using a public toilet Shaking hands Working or going to school with a person who is HIV infected.

What are the ways to prevent transmission of HIV? ABC + A = Abstinence B = Be faithful to your sexual partner C = Use of condom consistently and correctly + = knowing your (you and your partner(s)) HIV status Note: It is important to know your partner(s) status and not assume they are positive OR negative. Note also that there are cases where one partner can be HIV positive, the other can be HIV negative this is called a discordant couple. This happens in nearly one half of the couples where one partner is positive. 29

The other ways of preventing HIV/AIDS transmission are: · · ·

Not sharing razor blades, needles, and other sharp things. Practice safe sex (use a condom) and seek early treatment when you have any other sexually transmitted diseases. For HIV positive women, as soon as you know that you are pregnant, go for antenatal care to get Elimination of mother to child transmission of HIV/AIDS counseling and services. (EMTCT)

NOTE: HIV has no cure; however there is available treatment and care at health facilities that can be accessed with health facilities where ART is provided. An HIV test is an initial start to finding out if one is HIV positive or not. All

TOPIC SEVEN Elimination of Mother to Child Transmission of HIV/AIDS (EMTCT) Objectives: At the end of this session, community members will be able to: 1. Explain how Mother to Child Transmission (MTCT) occurs 2. Explain EMTCT 3. Explain the ways to Eliminate Mother to Child Transmission (EMTCT) of HIV Introduce the topic, “Mother to Child Transmission of HIV” as follows: Normally, in pregnancy there are three important things to remember: 1. HIV is carried in the blood and the sexual fluids. The male sperm and the female egg do not contain HIV. Therefore, at the time of creating the baby, the baby is HIV negative even if both parents have HIV. 2. Mother’s and baby’s blood usually does not mix during pregnancy. 3. The placenta that feeds the baby acts like a sieve. It filters out all things including HIV and only fine things like salt, water, nutrients and antibodies pass to the baby unless the placenta is damaged. A damaged placenta can allow HIV to enter into the baby’s blood. This is partly the reason why some HIV positive women deliver HIV infected babies. The most common causes of damage to the placenta are malaria, syphilis, injuries, excessive drugs, etc. As many as 70 out of 100 women who are HIV positive will give birth to HIV negative babies. Therefore, only 30 out of 100 babies will get HIV from their mothers. Using question and answer method ask participants how is HIV transmitted from mother to child? Responses should include: 1. During pregnancy: HIV can cross from the mother to the baby through the placenta. This happens in a few cases where the placenta is damaged. 2. During labor and delivery: Babies can come into direct contact with the mother’s blood during labor and delivery. This is the most critical period when HIV transmission to the baby occurs. 3. During Breast feeding: Some babies get infected during breastfeeding especially when there are breast problems like cracked nipples, infected breasts or sores in the baby’s mouth. 31

What are the ways to eliminate Mother to Child Transmission (MTCT) of HIV Ask and discuss: How can an HIV positive pregnant woman prevent transmission of HIV to her child? · · · · ·

Start attending antenatal clinic as early as a mother realizes that she is pregnant or misses her menstrual period as early as 3 months of pregnancy and attend at least four times during the pregnancy. The mother must protect herself during sexual intercourse to avoid getting HIV reinfected and infecting others. It is important to use condoms consistently during pregnancy and breastfeeding. A mother should take ARV prophylaxis or treatment from 3 and half months through pregnancy labor, delivery and breastfeeding according to the national guidelines. The baby must be given the recommended ARVs as per the guidelines Use the recommended infant feeding options – contact a nearby health facility to find out how you can feed your baby safely

Ask and Discuss: What are the risks of pregnancy to an HIV positive woman and her baby? For the mother · There is an increased risk of pregnancy complications such as anemia and bleeding · Increased occurrence of opportunistic infections · Increased risk of dying during labor, delivery and postnatal. For the baby: · Abnormal babies: premature, low birth weight, congenital abnormalities · Increased risk of neonatal deaths · Increased infections · Increased risks of being orphans

TOPIC EIGHT Domestic violence

Objectives: At the end of this session, participants will be able to: 1. 2. 3. 4. 5. 6. 7.

Define domestic violence Explain the forms of domestic violence List causes of domestic violence Discuss myths and misconceptions about domestic violence Explain the cycle of domestic violence Identify ways to break the cycle of domestic violence Know where to refer Victims of domestic violence for appropriate services

Definition of Domestic Violence Ask participants to brainstorm on the meaning of domestic violence? Responses should look like this: · ·

It is any act of abuse that results in physical, sexual, economic or psychological harm or suffering within the family. Domestic violence also includes threats of abuse. Explain that domestic violence of men against women is much more common than the reverse.

Ask participants what is meant by a survivor of domestic violence? Responses should include: ·

“Survivor is a person who has suffered domestic violence and is able to overcome the violence.”

Forms of Domestic Violence A. Physical abuse to include: • Hitting, kicking, slapping, pulling hair • Throwing objects • Using a weapon • Choking • Burning (acid) B. Sexual abuse to include: • Refusing safer sex • Coercion, Grabbing, Forced Sex, Sexual harassment C. Emotional • Threatening, controlling Humiliating, insulting, criticizing Shouting • Jealousy • Silence • Threatening to destroy family property • Taking the children away from either partner D. Economic abuse • Denying inheritance of property • Taking earnings • Stopping her from working • Refusing ownership of property • Bride price • Withholding money E. verbal abuse • Using abusive words. Explain that most of the time different forms of abuse occur together and sometimes one leads to another. Many women do not talk about it and keep it a secret because of shame, isolation, fear, depression, and low self-esteem due to cultural and religious beliefs Reasons for Domestic Violence Ask and discuss the reasons for domestic violence? • • •

Power and control Traditional gender roles Cultural practices 34

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Women’s low status, Women’s inequality. Religious beliefs

Myths and Misconceptions about Domestic Violence

Ask and discuss: If the participants think the following statements are true or false? and How can you help correct some of the misconceptions? True Battered women deserve to be beaten

Not True Not True

Nobody deserves to be beaten. There is no excuse for violence. Only unsuccessful men beat their wives Men who beat wives can be found in all professions, races, cultures, and religion. It is found among rich and poor, educated and illiterate, young and old.

Not True

Only poor and uneducated women are abused (see above) Men beat their wives because they love them Abuse is motivated by a desire to control and not love Battered women can always leave home There are many reasons why a woman cannot leave home such as economic dependence, fear of loss of children, not wanting to be seen as breaking up the family, hard to admit marriage has failed, have no where to go.

Not True Not True

Not True

The cycle of domestic violence Explain that domestic violence often follows a pattern. The pattern is:

Phase 1: Tension Builds: Man may begin to get angry, agitated, minor battering incidents occur; tension escalates. Phase 2: Violent Episode: Man loses control, blames woman for provoking him. Uncontrollable discharge of tension results in acute battering. Man may even deny abuse. Phase 3 Honeymoon: Abuser apologizes for abuse; some beg forgiveness or show sorrows. Abuser may promise it will never happen again. Blames victim for provoking the abuse or denies abuse occurred. Minimizing, denying or claiming the abuse wasn't as bad as victim claims Phase 4: Calm: CALM before the tension starts again. Abuses slow or stop. Abuser acts like the abuse never happened. Promises made during honeymoon stage may be met. Abuser may give gifts to victim. Victim believes or wants to believe the abuse is over or the abuser will change. Note: â&#x20AC;˘ â&#x20AC;˘

Often the cycle of violence is portrayed as 3 steps: tension, acting out and honeymoon phases, where the Honeymoon and Calm phase are seen as one. Explain that these phases usually repeat themselves, often becoming more and more frequent.

Ask any participant who has ever seen this type of pattern to share the experience?

Breaking the Cycle of Violence Ask and discuss on how woman/man can break the cycle of violence? Responses should include; â&#x20AC;˘

Join a support group; find friends, family, and relatives, church members that can help. 36

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Talk with the partner and discuss the pattern of their relationship or the cycle of violence. State that this cannot happen again and try to work out solutions Make a plan about choices available which may include: o Create a safety plan with other women/men experiencing abuse and identify a place to go if in danger. o Find some financial support or income generating activity. o Enlist the help of community leaders or other respected members in the community to talk to your partner o Become aware of legal action to take to prevent domestic violence.

Ask participants to brainstorm on what an abuser can do to break the cycle of violence? Responses should include: • •

• • • • • • •

Recognize that his violence is a problem for the relationship Recognize that children who witness violence between parents learn that violence is an acceptable way of resolving conflict. (Many men who are abusers in their current relationship are likely to have witnessed violence as children in their own homes.) Stop denying behavior or blaming the victim for the violence Learn techniques to manage anger and emotions Avoid things that trigger the violent act Avoid alcohol and drugs or friends who impair his goal to be violence free Seek help from people you trust Make a public commitment in front of a friend or other family member that not to use violence as a means of resolving conflict. Talk to a partner about other frustrations in his life that contribute to his behavior

Key Message • • •

Not to keep silent about domestic violence Seek medical and legal assistance Offer psychosocial support to victims of domestic violence

TOPIC NINE Stigma and Discrimination Objectives: At the end of this session, participants will be able to: 1. Define the terms stigma and discrimination 2. Discuss types of stigma and discrimination 3. Discuss the effects of stigma and discrimination 4. Discuss strategies for reducing stigma and discrimination Definition of stigma and discrimination Ask and discuss: What is stigma?

What is stigma as it relates to HIV/ AIDS?

Responses include: • •

“Stigma refers to unfavorable attitudes and beliefs by one ‘s self or directed towards someone or something” For example, stigma toward disabled people. “HIV/AIDS related stigma refers to all unfavorable attitudes and beliefs directed towards PHAs and toward their significant others, loved ones, close associates, social groups and communities.”

Types of Stigma Explain: There are two types of stigma; these are internal and external stigma. Internal Stigma or self-stigmatization is a person’s own negative feelings and beliefs about having HIV/AIDS and his/her own behavior reflecting these feelings. Examples of internal stigma • • • • • • • •

Self-isolation: e.g. Ritah refuses to go to school, stays home Depression Self-pity and low self esteem Feeling bitter Aggressiveness towards others Suicidal feelings Condemning self and GOD irresponsible sexual behavior External stigma is that which is expressed by the community

Examples of external stigma: • • • • • •

Isolation Gossiping Using persons living with AIDS as an example of bad behavior in their talks and sermons by religious leaders Separating eating utensils Composing negative songs about PHAs Refusing to share things with PHAs

Effects of stigma and discrimination • • • • • • • •

Fear of disclosing results to their partner/s, families, friends, etc. Fear of delivering in the health facility Fear of using replacement feeding Fear of accessing treatment at the health facility Domestic violence e.g. rape, defilement Isolation Loss of self confidence Poor adherence

Strategies for Reducing Stigma and Discrimination Discuss the ways to address stigma and discrimination • • • • • •

Join peer and community support groups to find friends in the same situation and learn to accept your own status. Sensitize religious leaders about stigma in religious settings. Educate, through testimonies, the key people in the community e.g. teachers, religious leaders, etc Become involved in national and local initiatives. Advocate for policies and laws that address the human rights of PHAs Sensitize the community on stigma and discrimination

Key Message • •

Any body can be infected or affected by HIV/AIDs Disclosure and Acceptability

TOPIC TEN Will Making Objectives: At the end of this session, participants will be able to: 1. 2. 3. 4. 5.

Explain what a will is Articulate the importance of making a will List the basic elements of a will Know who to go to make a will Know where to keep a will safely

Ask participants: Why they want to know about will making? What are their expectations of making a will?

Define a Will Ask participants to brainstorm on the meaning of a will? A will is a legal document declaring a person’s wishes regarding the disposal of their property when they die or a legally executed document which explains how and to whom a person would like his or her property distributed after death.

Importance of a Will Ask and discuss: Who should make a will? Response: Everyone

Ask and discuss: Why should we make wills? • •

Most often we leave our loved ones helpless when we die; a will is the only way in which a person can ensure that their property will be divided according to their wishes after their death Inconvenience and unpleasant situations of heirs squabbling over who gets what could easily arise if there is no will. 40

• •

A will is the only way in which a person can ensure that their property will be divided according to their wishes after their death. Without a will, the wrong people may inherit and it may not be possible to effect the wishes expressed while the deceased was alive.

Brainstorm: What are the reasons why most people do not make wills? • •

Many women have not been involved in making wills because of the cultural prejudice that they do not own property, now; women own property and thus need to start making wills. People never want to accept death as it is and thus never prepare for it

Keeping a Will Ask and discuss: Where should a will be kept for safety purposes • • • • • •

Make sure that someone you trust can access your will after your death Keep with a trusted friend or relative (who is not named as a beneficiary in the will) If you have a lawyer, have him/her retain a copy with a note stating where the original can be found. Bank Local leaders Religious leaders

Will making is a legal process; therefore there should always be a link to a legal authority

Where to go to make a will •

List the organizations and individuals around you who can help you make a will (FIDA, Religious and local leaders, elders in the family and counselors)

Conclude: Plan ahead: The end of your life is something you probably do not want to dwell on, but thinking about what will happen to your loved ones and your assets and personal possessions is important. Making sure you’ve done all you can to make their lives easier will give you peace of mind. And once your will is drafted, you won’t have to think about it again unless something significant in your life changes e.g acquire or loss of property or get more children. 41

Key Message Planning for your family is very important, making a will ensures that your wishes are respected

Below is an example of a will format

AVSI FOUNDATION IN UGANDA Plot 1119 Ggaba Road P.O. Box 6785, Kampala, Uganda Tel: +256 312 501604 Email: communication.uganda@avsi.org Email: secretariat.score@avsi.org Website: http://uganda.avsi.org SCORE website: www.score.or.ug

ITALY Via Legnone 4, 20158 Milan, Italy Tel: +39.02.67.49.881 | Fax: +39.02.67.49.00.56 Email: milano@avsi.org www.avsi.org AVSI-USA DC Area Office 8730 Georgia Avenue, Suite 512 Silver Spring, MD 20910 Tel: +1-301-589-9009 Email: infoavsi-usa@avsi.org