Peer Education Toolkit with Resources by Cape Peninsula University of Technology

Peer Education Toolkit

1 2 3 4 5 6

HIV Unit

8 9 10 11 12

PEER EDUCATION MONITORING & EVALUATION TOOLS 14

Young Women Empowerment

15 16 17

Amajita’s Men’s Programme

All peer educators on social media are requested to LIKE THE PAGES and get AT LEAST 10 of their friends to like the pages. Identify two champions per programme per campus.

Acknowledgement The CPUT HIV and AIDS Unit would like to thank all internal and external stakeholders who have allowed us to make use of their resources in compiling this toolkit. We also like to thank the service provider who developed this toolkit.

The content of the toolkit comprises of the following • Introduction to peer education programme • How to use this toolkit? • How can I benefit from peer education programme? • Journey of a peer educator (including contact details of CPUT Fundani CHED Student Learning Unit) • First Year Guide 2020 (including YWE, Amajita’s, SafeZone • Student Guide-Roadmap to Your Social, Mental and Physical Wellbeing • Responsible Love campaign messages: Voices of 2020 Peer Educators • Gender-based violence support • Mental Health support • Higher Health: A training resource manual • ON QUE resources • Peer Education Monitoring and Evaluation Tools

Welcome to CPUT HIV and AIDS Unit Peer Education Programme Introduction to peer education programme Along with other divisions in Student Affairs, we aim at developing young responsible and well-groomed graduates and future leaders. One of the ways we do this is through the peer education training program, a one-year training program where students volunteer to be trained to educate their peers on many issues that affect them throughout their years as a student. They also learn facilitation skills, ability to do public speaking and knowledge of basic health-related matters and non-discrimination against those affected by HIV, STIs, TB, mental health, substance abuse and gender-based violence. Peer educators are trained to disseminate information to their peers in such a way that their peers will further share the information. We educate peer educators to guard against sharing fake and incorrect information that may be harmful to their peers. How to use this toolkit? We have compiled a toolkit comprising of adaptable resources to enables peer educators to understand their role, to learn and to use the information to plan and conduct peer-peer activities. Peer educators are requested to make use of the toolkit. How do I benefit from peer education programme? As part of the program, you learn to balance your time, a very important skill to acquire. Your participation in various activities and programs and how you want to participate is completely up to you. Remember your reason for being here is to study and obtain a qualification. That is important to us. Peer education programme has the potential to help you enrich your own experiences and add to your CV when you leave CPUT to pursue a career after graduation.

Division of Student Affairs

Peer Education Programme Learn. Inspire. Nurture. Acknowledge.

What are the benefits? Gain knowledge and skills on general sexual and reproductive health and social justice issues. Develop interpersonal networking and communication skills. Events management and project operational skills. Enhancing creativity and marketing abilities. Group work skills and leadership. Engage in community outreach projects. Developing an ethos of volunteerism and good citizenship.

Receive a recognition certificate at the end of the year. SIGN UP TODAY! 021 460 4253

+27 (0)21 959 6767 info@cput.ac.za www.cput.ac.za

At h l o n e

Athlone

B e l lv i l l e

Bellville

HIVunit@cput.ac.za

@cput @wearecput www.facebook.com/cput.ac.za

DISTRICT SIX

G e o rg e

George

G ra n g e r B a y

Granger Bay

M o w bra y

Mowbray

Wellington

W o rc e s t e r

Worcester

Journey of a CPUT HIV and AIDS Unit Peer Educator

Recruitment Process Interviews & Selection

Peer education interventions/activities Training: attend compulsory training to qualify as a peer educator Provided with ongoing mentoring, support, opportunity to attend invaluable training for further development during your free time during the year Conduct peer education interventions/activities through social mobilization Participate in student development activities and training

Submit evidence of interventions/activities you conducted and participated on Activity log sheets Condom demonstration log sheets Attendance registers Participants satisfactory survey forms if needed

At the end of the journey you receive Certificate of Completion Special Award (s) based on your performance Skills to help you enrich your own experiences and add to your CV when you leave CPUT to pursue a career after graduation. ONCE APEER EDUCATOR ALWAYS APEER EDUCATOR

Your personal and academic goals are, and always will be, our greatest priority and we want you to do the same. Please make use of the CPUT academic support services provided by FUNDANI CHED Student Learning Unit (SLU). Below are the SLU contact details

NB: THE CPUT HIV AND AIDS UNIT PLEAD THAT YOU COMMIT AND ENSURE THAT YOU MAINTAIN A HEALTHY BALANCE BETWEEN YOUR PARTICIPATION IN PEER EDUCATION PROGRAMME AND STUDIES.

Recruitment process Each year, students are requested to send to the Peer Education Officer their CVs and motivation letter stating why they should be selected to serve as peer educators. Interviews are conducted and successful students are selected. Peer education training Selected students attend an interactive 3-5-day training conducted by internal and external trainers in order to qualify as peer educators. The training is compulsory and empowers peer educators to educate their peers on many issues that affect them throughout their years as a student. The training content covers the following key themes: • Gender • Leadership and Personal Development • Mental Health including Dealing with crisis • HIV/AIDS • Covid-19 • Gender-based violence and first responder • Introduction to E-Portfolio Development • Academic Support Services (See below contacts of FUNDANI CHED Student Learning Unit • Facilitation methods • Induction: expectations, implementation plan, M&E, reporting: participants’ attendance registers, activity log sheets & condom sheets. • Social media programs awareness (Amajita’s SafeZone, YWE programs) Peer educators are provided with ongoing mentoring and support through the year. During their free time, peer educators are able to attend invaluable training session such as Social media & ethics and many more for further development. Peer education interventions/activities Through the year, peer educators conduct various interventions/activities through peer-peer social mobilization. They used various methods and tools such as discussion groups, WhatsApp discussion groups, webinar sessions, Information Education and Communication (IEC) materials, pamphlets, educational & marketing posters and videos to educate their peers on various health and social justice issues. Monitoring and Evaluation (M&E) Ongoing monitoring is conducted to assess the performance of peer educators. On a monthly basis, peer educators submit activity log sheets and condom distribution as evidence of their activities. After each intervention/activity, peer educators submit attendance register of participants they reached as evidence and for reporting purpose. Sometimes, they include participants satisfactory survey forms if needed. Peer education monitoring & evaluation tool, is a tool used to keep track of all peer educators’ activities by monitoring individual’s performance through the submission of log sheets and condom distribution sheets during the year. Peer educators’ detailed involvement is captured through activities done and we then give them points based on a particular campaign or activity they were part of. A peer educator who was involved in most activities is likely to walk away with junior peer educator of the year award if the person is junior peer educator (meaning they have only served for one year). A senior peer educator of the year would be someone who is serving for a second time in the peer education programme and has performed very well based on the activities done during that year. Other award categories such as change agent of the year is based on how the peer educator worked during a year and their impact to others in their campus and other peer educators of other campuses. The condom distributor of the year is recorded as the person who distributes the most condoms as recorded in condom distribution forms. Peer mentor of the year is person serving for three years and has shown leadership in mentoring the group and is acknowledged by peer educators and we see this by reading reflections and from that persons’ log sheet. Role model of the year is nominated by peer educators and the peer educator with the most nominations wins the 2

award but we verify from the M & E if the nominee has submitted their activity log sheet as point of reference. Best performing campus or Campus of the year is done by adding up all points of peer educators based on activities done then we divided based on the number of peer educators in that campus after that the campus with the highest average will win the award. See activity log sheet, condom distribution form, attendance register for participants, discussion group evaluation form for participants, peer education monitoring and evaluation tool Evaluation: At the end of the programme, an overall evaluation of peer educators experience regarding their participation in peer programme is conducted. Award Ceremony At the end of the year, we host the Peer Education Award ceremony where each student who participated receive a certificate for successfully completing the training. You also stand a chance to win one or more of the following award categories with awesome prices: • Junior Peer Educator of the Year • Senior Peer Educator of the Year • Role Model of the Year • Change Agent of the Year • Mentor of the Year (senior peer educators) • Condom distributor of the Year • Best Performing Campus of the Year

Firstyear Guide

2020

YOUR PASSPORT TO STUDENT LIFE

When you made the decision to accept your place with us, you said yes to so much more than just a higher education.

Firstyear Guide 2020

Welcome to CPUT When you made the decision to accept your place with us, you said yes to so much more than just a higher education. You join a thriving community of close to 40 000 staff and students who are spread across this province pursuing diplomas, degrees and postgraduate qualifications in a variety of disciplines that fill critical societal needs. As a CPUT student, you have accepted the responsibility of preparing yourself to take your rightful place in building the future of this country. The foundation of that will be laid during Work Integrated and Service Learning projects which you will be embarking on in due course – because everything we do at CPUT must be for the betterment of the community and society at large. CPUT is a relatively young institution, having been

Dr Chris Nhalpo VICE-CHANCELLOR

established as a result of a merger between the former Cape and Peninsula Technikons in 2005. Since then, we have seen thousands of students graduate, made history by launching Africa’s first nanosatellite and later its second, rolled out new qualifications, revamped our campuses, and filed a number of exceptional patents. Exceptional innovations are borne in our high-tech laboratories, research and IT facilities and well-resourced libraries. These will all be at your disposal now. You also have access to a wide range of academic support services – use these wisely to ensure you do not lag behind but instead stay ahead of the pack. Thank you for choosing CPUT as your academic partner. With your enthusiasm and our experience. I look forward to the day in the not-to-distant future when I cap you at your graduation.

Firstyear Guide 2020

Welcome from the Dean of Students On behalf of the CPUT SRC, I would like to take this opportunity to formally congratulate and welcome all students who have been admitted into the various programmes at our prestigious institution. At CPUT we pledge to be your partners in your quest to reach your full academic and personal goals. As a first-year student, you are at the starting point of a race that leads you to the rest of your successful life. Being a first-year student does come with its challenges and I encourage you to make use of the support structures that are readily available to you. Our duty as the SRC is to represent individual students and the Student Community at large in order to protect and advance their interests. Guided by our constitution, our duty is to help promote and maintain an atmosphere of academic excellence; inculcate sensitivity to the norms and standards of the world of work; create

Ms Prem Coopoo 2

coopooprem@cput.ac.za

a platform for students to articulate and express their views, interests and aspirations; maintain a continuous community link; and oppose inhumane treatment. You can access the SRC at all campuses – each campus has its own Local SRC which is at your disposal to deal with your day-to-day issues. The Central SRC, which I head as the President, makes representations on behalf of students and the Student Community to Council, the Senate, Institutional Forum and other bodies and offices of the University. We also ensure that young leaders with bright new ideas emerge from this group so we can pass the baton of student leadership to the next generation. At CPUT, we not only pride ourselves on our various National Diploma and Degree programmes, but we also offer various extra-curricular activities to make sure you get the best out of your time here. Additionally, we endeavour to foster social values and principles of personal excellence and care for others.

As a first-year student, you are at the starting point of a race that leads you to the rest of your successful life.

As you familiarise yourselves with our campus, we hope you will feel our strong sense of community. We hope you are as proud of CPUT as we are of you for making this your home for the coming years. You are the heart of this institution, and we look forward to watching your knowledge and talents flourish during your time with us. I hereby wish you all a very happy and academically fulfilling journey ahead, and an outstanding stay at our beloved CPUT. Have fun!

First irstFyear 2020 year Guide

Your passport to student life

Guide 2020 Who funds the SRC? You, the student, which is why you have to take ownership and ensure that your money is wisely spent.

Who elects the SRC? Any registered CPUT student (Part-time, full-time and short course students).

What does the SRC stand for?

Why should you vote? To choose responsible, accountable and wellrespected student leaders that will represent ALL CPUT students.

Student Representative Council

Why do we need an SRC? To look after student needs and interests, and to represent students on various university structures, such as the University Council and Senate.

src How do you stand for the SRC?

Why get involved? Because it is your money, your university and your responsibility! Do your part and ensure responsible, accountable, transparent and respected leadership on all our campuses.

• You have to be a student for at least one academic year. • You have to have an average of 65% to stand for the SRC. • You may have no prior convictions internally against you (ie. not be found guilty of transgressing the institutional rules or code of conduct, be they academic, non-academic or residence rules). • You may have no prior convictions externally against you.

Your passport to student life

CSRC President Mr Sikhulule Mpetsheni

Bellville LSRC Chairperson Mr Lutho Xakayi

SRC

President & Chairpersons

District Six LSRC Chairperson Ms Wendy Kondlo

2020

Mowbray LSRC Chairperson Mr Siyasamkela Nyezi

Athlone LSRC Chairperson Mr Thobile Tshefu

Wellington LSRC Chairperson Mr Toyer Hefca

Firstyear Guide 2020

FACULTY OF APPLIED SCIENCES

Message from the Dean I wish to warmly welcome you to the Faculty of Applied Sciences at CPUT. Our vision is to be the Faculty of choice for Science and Technology Education in Africa, and we welcome you aboard as we strive steadily towards achieving that vision. The Faculty has eight academic Departments, which together offer 13 Programmes of study, and you have been admitted into one of them to join a family of about 3 000 students enrolled in this Faculty. You must not feel overwhelmed by being in such a big family, as we have several structures, activities and programmes to support your academic endeavours to achieve success and be employable after your education in this Faculty. Some of these programmes include the “First-year Experience (FYE)”, Extended Curriculum Programmes (ECP), Work Integrated Learning (WIL) and the Language Support programme. Please make the most of such opportunities to support your success at CPUT. As a Faculty, we offer a wide range of undergraduate and postgraduate qualifications (from Diploma to Masters and Doctoral levels) and have a strong Research and Innovation ethos, which includes the hosting of a variety of Research entities (Groups, Units, Centres, etc.) and a Technology Station, as part of the University’s strategic drive in Research, Technology and Innovation. I welcome those of you who are joining us for postgraduate study, and encourage the new undergraduate students to think ahead towards research and postgraduate study. With you joining us as students, we are confident of moving towards our vision. Once again, I welcome you to the Faculty.

Prof Joseph I Kioko 6

6 kiokoj@cput.ac.za

Your passport student life FACULTY OFto BUSINESS

AND MANAGEMENT SCIENCES

Message from the Dean Welcome to CPUT and the vibrant Faculty of Business and Management Sciences! We are absolutely delighted that you have made the choice to join CPUT as a student in our Faculty of Business and Management Sciences (FBMS), a major faculty within CPUT. As you continue on your journey, we are proud to be your partner in your quest to reach your goals of intellectual growth, self-discovery and personal development. We are proud of our achievements over the years, and continue to strive to provide academic excellence; operating at the cutting edge of our disciplines; and creating and disseminating knowledge through high level research. Our students are taught by academics who are actively engaged in industry, ensuring high programmatic relevance; and who are pushing forward the boundaries of discipline-specific knowledge. Our faculty works hard to create a caring and supportive culture and an affirming environment that values and celebrates diversity through respecting and celebrating individual differences.

Prof Paul E Green greenp@cput.ac.za

Firstyear Guide 2020

Your passport to student life FACULTY OF BUSINESS AND MANAGEMENT SCIENCES

We are proud to be your partner in your quest to reach your goals of intellectual growth, self-discovery and personal development. You will have the opportunity to meet, interact with and learn from young people who come from very different social, economic, geographic, linguistic and cultural backgrounds. It is this diversity that we embrace, as it is key to innovation and academic excellence. We also endeavour to live our values that we cherish deeply in an institutional environment that is supportive and welcoming to all. The FBMS Orientation Programme is designed not only to provide you with course-related information, but is also meant to expose you to the wide array of services and opportunities provided within our Faculty and CPUT. You will also have the opportunity to learn about strategies for successfully integrating into university life; getting involved in campus activities and making wise choices; together with receiving valuable, practical information on policies and programmes in support of your overall success. The overarching goal of this programme is to set you up for academic success, helping and supporting you to realise your dreams, goals and aspirations. We wish you much success with your studies!

FACULTY OF EDUCATION Your passport to student life

Message from the Dean Dear incoming faculty student, on behalf of the faculty staff - management, support and academic - I congratulate you on your successful completion of Matric, and admission to our university. We are honoured that you have chosen our faculty for your training and development as an educator. We trust that your journey with us to your career as an educator will be a pleasant one. The Faculty offers a wide choice of specialisation areas for education students of all levels. Please familiarise yourself with the choices, and make sure you are registered for your preferred specialisation. We have committed lecturers to inspire and assist you on this journey. The team of staff and students in the first-year student welcome and orientation programme are crucial in your preparation for studies at our university. Please pay close attention to their guidance, and take advantage of the services they offer you. Please do not hesitate to ask when unsure about any matter related to your registration and studies. The Faculty Office and your academic Departmental Office (HOD and secretary) are useful resources to you, especially at this stage. I wish you success in your studies, as well as memorable and fulfilling experiences, socially and otherwise, as a student at CPUT.

Prof Thobeka Mda mdat@cput.ac.za

irst Firstyear Guide 2020

FACULTY OFtoENGINEERING Your passport student life

AND THE BUILT ENVIRONMENT

Message from the Acting Dean The Faculty of Engineering & the Built Environment is the second largest faculty at CPUT, and prides itself in its position as the flagship faculty of a university of technology. The faculty is host to some 7 400 students, of whom about 400 are postgraduate students. Our academic staff is just short of 200. We are host to fully accredited academic programmes in eight departments. The faculty has, for the past number of years, made great strides in the establishment and further development of various research entities in the institution through which our contribution to the institutional RTI (Research, Technology & Innovation) focus areas are effected. These entities include: • The French-South African Technology Institute (FSATI) which incorporates the African Space Innovation Centre (ASIC) • The Centre for Substation Automation and Energy Management Systems (CSAEMS) • The Centre for Power Electronic Systems (CDPES) • The Centre for Instrumentation Research (CIR) • The Product Lifecycle Management Competency Centre (PLMCC) • The Flow Process and Rheology Centre • The Centre for Community Water & Sanitation Research The faculty is also host to two TIA (The Technology Innovation Agency) Technology Stations, namely the Adaptronics Advanced Manufacturing Technology Laboratory (AMTL) and the

Clothing and Textiles Technology Station, as well as the recently opened first renewable energy training facility in South Africa, Saretec. Apart from this, the faculty has accepted the challenge of unpacking the technologies of the Fourth Industrial Revolution in both our teaching and our research offering. We are currently building capacity in relevant areas related to Water, Renewable Energy and Engineering Education. We are perhaps best known for our satellite engineering programme which launched Africa’s first nanosatellite in 2013, followed by a second launch at the end of 2018, that will be used for various national objectives. Our staff is friendly and focused on assisting our prospective students, especially those who have been disadvantaged, in finding their home and performing to their potential in this critical skill in the South African industrial landscape. Prospective students are welcome to engage with the relevant departments, our Advancement Officer, as well as directly with my office.

Prof Mellet Moll mollcm@cput.ac.za

Firstyear Guide 2020

FACULTY OF HEALTH AND WELLNESS SCIENCES

Message from the Dean A warm welcome is extended to those who are starting their academic life and to those who are here to gain additional/higher qualifications. May you enjoy your time with us in a faculty acknowledged nationally and internationally as offering high quality programmes in a wide range of professions. You are one of approximately 3 000 undergraduate and 150 postgraduate students that come from all parts of South Africa and from many countries in Africa. You will be taught by excellent academic staff members in six departments; Biomedical, Dental, Emergency Medical, Nursing, Medical Imaging and Therapeutic, Ophthalmic and Wellness Sciences. Your work placements will be arranged through strong partnerships with the Western Cape Department of Health, the National Health Laboratory Service, and a number of private health providers. Our programmes are designed to encourage each student to reach their full potential. All who graduate with a qualification from this faculty will have the knowledge, professional competencies, attributes and values to enable you to enter professional practice and serve society. I encouraged you to seek guidance and assistance from the department, faculty and institutional infrastructure as early as possible, as this support is in place to help you succeed. The faculty’s research responds to problems and needs relevant to health, wellness, health care and higher education in South Africa, Africa and globally. As a faculty we exemplify and build on the CPUT vision of being a research led teaching institution, such that our undergraduate students benefit from teaching supported by current research and our postgraduate students have access to supervisors who are active researchers.

Prof Penelope Engel-Hills 12

engelhillsp@cput.ac.za

FACULTY OFto student life Your passport INFORMATICS & DESIGN

Message from the Dean We are very glad that you have chosen to partner with us to realise your career goals, but I would like to remind you that it is as much your responsibility as it is ours to make a success of your time here. To ensure success I have three pieces of advice for you. Be sure to keep them close to your heart. They are, make the right friends; get to know your lecturers; and do some academic work. Your friends are the most important assets that you will collect in your university career. Thanks to social media, they will be there for the rest of your life. Your friends are the ones who will call you in the morning if you have overslept after working all night for a deadline. Your friends are the ones who will take you home if you partied too much. Your friends are the ones who will support you when things go wrong. But, if you make the wrong friends, they will teach you to abuse the wrong substances, to miss important classes, and to develop an uncaring attitude to your work. Make sure you chose the first type. Your lecturers are your primary customers. They pay you with a currency called ‘marks’. Make sure you keep your customers happy. You will find that sometimes two lecturers have completely opposing expectations of what you should deliver. This is normal. In life, you will get customers with directly opposing

Prof Johannes Cronje cronjej@cput.ac.za

Firstyear Guide 2020

FACULTY OF INFORMATICS & DESIGN

Make the right friends, get to know your lecturers and submit your work on time. wishes. Spend your time at university to learn how to be client focused. But, sometimes customers are quite happy to be convinced otherwise. Similarly, test the boundaries with your lecturers. See if you can surprise them, and see if they can be happy surprises. Finally, you are here to learn to work independently. So do dome work. In all of the disciplines in this faculty, inspiration takes time and often the inspiration only comes once the deadline is too close to complete. If you submit work of a low quality, we have something to work with to help you improve. If you submit nothing, then we have nothing to work on. NEVER MISS A DEADLINE. If you miss any deadline at any time of your

career with us, remember that you have to provide evidence of a good reason for missing that deadline. But remember that, no matter how solid that evidence is, once you miss a deadline, you forfeit the expectation of graduating in the minimum time. Once you have missed a deadline, we have to deal with numerous rules and exceptions, and these often take longer to resolve than is needed for you to graduate on time. So, three simple rules: Make the right friends, get to know your lecturers and submit your work on time. We are here to assist with all three. And we hope that your experience at CPUT will stand you in good stead for the rest of your life.

Your passport to student life

Student Affairs & Services 15

Firstyear Guide 2020

ON OUR

Your passport to student life

CAMPUS! Your passport to student life

Firstyear Guide 2020

Sport and Sport Development 18

Student Affairs Sport offers a variety of sport codes for both the competitive sportsman, as well as recreational sportsmen and women. We offer the following competitive sport codes on the different campuses. Sport code

District Six Campus

Football Volleyball

•

Basketball Rugby Cricket Squash Badminton Karate Judo Aerobics

•

Tennis Boxing Chess

•

Body building Athletics

•

Bellville Campus

Wellington Campus

• • • • • • • • • • • • • • •

•

Swimming Hockey Golf

•

Table tennis Dance sport Supa pool Cycling

•

• • • • • •

• • • • • • •

• • • • • • • • 19

Firstyear Guide 2020

SPORT AND to SPORT DEVELOPMENT Your passport student life

We also offer the following recreational sporting codes for those of you that are not competitive athletes Sport code

District Six Campus

Inter-residence netball league

•

Inter-residence football league

•

Weight loss programme

Bellville Campus

Wellington Campus

• •

•

• •

Rock climbing Learn to swim Learn to surf

•

Zumba classes Hip hop

•

Sport clinics Kick boxing

•

Apart from all the sport codes, DSA sport also offers you information and workshops on healthy eating, the danger of tobacco, alcohol and drugs, how to overcome addictions, and assistance in weight loss programmes.

Contact your Student Affairs Office and ask to speak to a Sport Development Officer on your campus for any enquiries.

Arts and Culture & Student Development 21

Firstyear Guide 2020

Arts and Your passport to student life Culture & Student Development

The DSA is instrumental in providing a wide variety of extra mural activities, mostly free of charge, that will enhance your student life. Workshops, arts and culture activities, events, leadership training, seminars, conferences, off-campus tours, training student radio, environmental awareness campaigns and female advancement programmes.

Workshops (free of charge for all registered students) • • • • •

Public speaking Entrepreneurship Extended orientation programme Financial literacy Etiquette and grooming

• • • • •

Diversity training Ethical Leadership workshops/ seminars Leadership skills Self defense classes Time management workshops

• • • •

Women’s Day events Informal sport days Picnic on the lawn Radio training: DJ, programming, marketing, etc. Inter-faith gatherings Human Rights Day festivals A variety of outreach/ CSI programmes An extended orientation programme addressing students’ long-term, holistic developmental needs.

student activitieS • • • • • • • • • •

Market days and lunch hour concerts Performing arts initiatives GBV interventions Nelson Mandela Day celebrations World Refugee Day awareness campaigns World Aids Day interventions Disability rights awareness days Beach and mountain cleanups Environmental campaigns Off-campus student tours e.g. cultural festivals, SATICA choir festival, etc.

For dates and bookings, contact

• • • •

groblera@cput.ac.za

haram@cput.ac.za

Student governance Student Governance activities include meeting skills, leadership training for executive members of student clubs and societies, as well as SRC training. For dates and bookings of any of the above mentioned activities, please go to your Student Affairs Office and speak to the relevant Student Development Officer on your campus.

uni fm We broadcast to the Bellville and District Six campuses, and stream live on the Internet. Visit the CPUT Recruitment home page for new staff for and click the various media on the live channels is done at the beginning of streaming link each year. to listen.

Student media Student media is responsible for communication with students. They aim to keep you informed on what is happening outside your classroom, and to entertain you. Student communication is undertaken through:

• • • •

UNI FM (our in-house radio station) Facebook Twitter Live streaming of CPUT events and signage screens placed at strategic points on campus.

Follow us on Facebook and Twitter for all news, pictures and videos on your events and programmes. Search for “cputstudents”. UNI FM is our own in-house CPUT radio station.

CPUT Student #cputstudents

CPUT Student

@cput

Firstyear Guide 2020

Student clubs & societies 24

The DSA has a variety of student-run clubs and societies on most of our campuses. STUDENT STRUCTURE/ Club

District Six Campus

Wellington Campus

African Spiritual Longings and Belongings (ASLABS) Anglican Student Society (ANSOC) Assemblies of God

Bellville Campus

Mowbray & Athlone Campuses

• • •

•

Associates for Operation of God Movement on Campus (AOGMC)

•

Association of International Students (AIS)

•

Career Exhibition Organisation (CEO)

Christian Student Powerhouse (CSP)

• • •

Economic Freedom Fighters Student Command (EFFSC)

•

Elohim Society (Elohim Soc)

•

Christian Revival (CRF)

Entrepreneurship, Leadership and Community Engagement (Enactus)

•

Greener Campus Initiative (GCI)

•

• • •

• •

God Seed Sowers Student Ministry (GSSM)

•

Gospel Pillars International (GPI)

•

Harvest House Youth with a Mission (HHYWAM)

•

Firstyear Guide 2020 STUDENT STRUCTURE/ Club His People

STUDENT CLUBS & SOCIETIES

District Six Campus

Wellington Campus

• •

House of Praise (HOP)

•

Jesus Christ to all Languages Ministries (JTL)

•

Light House Chapel International (LCI)

Muslim Student Association (MSA)

• • • •

Pan African Student Charter Organisation (PASCO)

•

Lions Heart (LION) Methodist Student Society (Methsoc)

Pan Africanist Student Movement of Azania (PASMA)

•

• • •

Planet Shakers Church (PSC) Redemption Centre International (RCI)

Students’ Christian Organisation (SCO)

• •

South African Students Congress (SASCO)

•

SADA

Mowbray & Athlone Campuses

•

Hope for Students (HFS)

International Student Societies

Bellville Campus

• •

•

STUDENT STRUCTURE/ Club

District Six Campus

Wellington Campus

Bellville Campus

Seventh Day Adventist Student Movement (SDASM)

•

South African Institution of Civil Engineering (SAICE)

•

Students Christian Organisation (SCO)

•

Twelve Apostles Church in Christ Student Organisation (TACCSO)

•

Twelve Apostles Students Association (TASA)

•

Young Mens’ Christian Association (YMCA)

Mowbray & Athlone Campuses

•

Zion Christian Church Student Fellowship (ZCCSF)

•

In order to join one of the structures, you have to make contact with the chairperson via your Student Affairs office on your campus.

pay a membership fee at the cashiers under the account of the structure

submit your name and all contact details to your chairperson.

ensure that you are a registered CPUT student, full- or pat-time

Firstyear Guide 2020

Student Life & Residential Services Bellville Campus central office staff Name & Surname

Central Offfice

Telephone

Zandile Jacobs

HOD

021 959 6658

Javern Zondagh

Admin Assistant

021 959 6334

Mawande Mfecande

Placement Officer

021 959 6126

Residence Coordinators & Supervisors Zukiswa Nyalasa

Freedom Square 1

021 959 6232

Jacob Ranyao

Freedom Square 2

021 959 6333

Tembisile Faniso

De Beers

021 959 6547

Bulelwa Dlephu

Anglo

021 959 6484

Siyabonga Tyandela

Heroes House

021 959 6364

Emelda Peterson

MGR 1

021 959 6327

Lwazi Ndlabu

MGR 1

021 959 6482

Mxolisi Ngcwabe

MGR 2

021 959 6364

Funeka Plaatjies

Richard Sacco

021 959 6405

Lungile Nsibande

Richard Sacco

021 959 6330

Sharon Du Plessis

Post Graduate

021 959 6885

Zainab Ebrahim

Nico Malan

021 684 1361

Anele Mkondweni

De Goede Hoop

021 949 9374

Zukiswa Kama

New Residence

021 959 8679

DISTRICT SIX Campus central office staff Name & Surname

Central Offfice

Telephone

Chris Williams

HOD

021 460 3870

Ntombininzi Mahleza

Admin Assistant

021 460 3871

Chantal Botes

Placement Officer

021 460 4274

Alicia Smit

Data Capturer

021 460 3329

Residence Coordinators & Supervisors Xolani Matabeni

Cape Suits

021 460 3910

Muzi Cebekhulu

Catsville

021 464 7261

Thobeka Zuma

Catsville

021 464 7213

Asandiswa Mkutuka

Catsville and Viljoenhof

021 680 1558

Vuyiswa Cindi

City Edge

021 460 3699

Chumani Mashwanyela

DTL and J&B House

021 460 7247

Nobuntu Vuba

EWR

021 423 2308

Alfonce Ngasirmoi Fundiswa Lumane

Sandenburg Hanover and South Point (10 & 12 Plein St.)

021 460 3510 021 460 3692

Athenkosi Bucwa

South Point (New Mkt Junction)

021 460 3910

Bonile Peter

St Peters

021 448 9677

Mawande Nandi

Viljoenhof

021 680 1558

Anele Mkondweni

De Goede Hoop

021 949 9374

Zukiswa Kama

New Residence

021 959 8679

WELLINGTON Campus Name & Surname

Central Offfice

Telephone

Fulu Netshidzati

House Bliss and House Navarre

021 864 5231

Anina Van der Westhuizen

House Bliss

021 864 5231

Terence De Wet

House Meiring

021 864 5239

Alta Olivier

House Meiring

021 864 5239

Judy Moletsane

House Murray & Wouter Malan

021 864 5241

Firstyear Guide 2020

Campus Health Services The Campus Health Services is here to help you stay healthy so that you can focus on your studies. We offer a comprehensive, easily accessible health service where you can find assistance for a range of health concerns.

What services can you access at the Campus Clinics? • • • • • • • •

General medical consultations TB-DOTS supervision Reproductive health HIV counselling and testing Treatment of sexually transmitted infections Treatment of minor injuries/ ailments ARV DECANTING Site at Bellville Campus VMMC (Voluntary Medical Male Circumcision)

How to make an appointment Appointments must be made at the Campus Clinic.

Campus Clinics are open Mondays to Fridays from 8am - 4pm. To make an appointment, you will need the following: • Your student card, or • Proof of registration • Identity document/ passport

What does it cost? You will receive one free consultation each month. Additional visits in the same month will cost R10. If you request a specific procedure, then you will have to carry that cost. Reproductive health services, HIV counselling and testing, and follow-ups requested by the doctor/nurse are free of charge.

How do you make a payment? All payments must be made at the cashiers in the Administration Building. Please bring the receipt to the Campus Clinic.

Healthcare services can be accessed at the following CPUT Campus Clinics district six campus Administration Building, 2nd Level, Room 2.900 +27 (0)21 460 3405

bellville campus New Library Extension, Ground Floor +27 (0)21 959 6403

mowbray campus Administration Building, Ground Floor +27 (0)21 680 1555

wellington campus Administration Building, Room A29, Ground Floor +27 (0)21 864 5522

Firstyear Guide 2020

HIV/AIDS Unit HIV/AIDS Unit Services The HIV/AIDS Unit is a student support service promoting and empowering students through health and wellness programmes including HIV, STI and TB screening, Gender Diversity, Good Citizenship and Social Justice Awareness. Through our programmes we want you to make healthy lifestyle choices that can help you reach your dreams, and eventually make an active contribution towards the economy of your country after graduation. Programmes and services: • Awareness Campaigns (HIV, STI, TB, Gender-based Violence, Amajita’s Mens and Young Women Empowerment Programmes, Mental Health) • Peer Education Programme • Wellness Mobile Services across campuses • Care and support of students living with HIV • Curriculum integration of HIV, STI, TB and social justice issues • Community Outreach Programme • Research • Internship and Volunteer Programme

DIVISION OF STUDENT AFFAIRS

Where to seek help in cases of Gender-based Violence Report any gender-based violence related incidents to Campus Protection Services at your nearest campus, or call one of the following numbers:

021 959 6550/ 6301 060 980 0286

Empowering young women on: Reproductive Health & Wellness Leadership & Personal Development Entrepreneurship Championed by the HIV/AIDS Unit

HIVUnit@cput.ac.za

+27 (0)21 959 6767 info@cput.ac.za www.cput.ac.za

AT H L O N E

B E L LV I L L E

@cput @wearecput www.facebook.com/cput.ac.za

DISTRICT SIX

GEORGE

G R A N G E R B AY

M O W B R AY

WELLINGTON

WORCESTER

Firstyear Guide 2020 DIVISION OF STUDENT AFFAIRS

Safe Zone

...PEOPLE WITH HIV

Feel free to contact us for more information.

SAFE ZONE ...GENDER BASED VIOLENCE

...MENTAL HEALTH

ZERO DISCRIMINATION

AGAINST

...PEOPLE WITH DISABILITY

#beyouandproud

Our Contact Details 0214604253

...Diverse Sexual Orientation

CPUT is a safe space for all students, and we uphold our Human Rights documented in the Constitution of South Africa. Contact us should you require more information about our LGBTQIA+ program, and Care and Support programme for students affected by HIV. We support Student Counselling Services and Campus Health Services with regards to Mental Health Services to our students.

HIVUnit@cput.ac.za

Head of the HIV/AIDS Unit maraisme@cput.ac.za CAMPUS CLINIC Cape Town +27 21 460 3405 MgedeziF@cput.ac.za Location Administration Building, Level 2, Room 2.900

CPUT DISABILITY UNIT Cape Town +27 21 460 9071 disabilityunit@cput.ac.za

STUDENT COUNSELLING Cape Town +27 21 460 3237 oliveran@cput.ac.za

Bellville +27 21 959 6964

Bellville +27 21 959 6182

Follow us on Facebook and Instagram... Bellville +27 21 959 6403 RobertsonS@cput.ac.za Location New Library Extension, Ground floor

CPUT HIV Unit Western Cape Young Women Leading the Change +27 (0)21 959 6767 info@cput.ac.za www.cput.ac.za

AT H L O N E

B E L LV I L L E

@cput @wearecput www.facebook.com/cput.ac.za

DISTRICT SIX

GEORGE

G R A N G E R B AY

M O W B R AY

WELLINGTON

WORCESTER

Student Counselling Student Counselling is a student support service promoting student wellness. This department offers support in various forms to ensure your success during the years that you are with us. We want you to feel that your dream is within your reach, and we will support you in every way we can. Services Student Counselling can assist you in achieving these goals by offering the following free services to registered students, amongst others: • Individual counselling • Career counselling • Skills development • Wellness programmes • Academic support and advocacy • Welfare services • Resource support services

Our Contact Details

CPUT Student Counselling

district six campus Room 2.700, 2nd Floor, Admin Building

+27 (0)21 460 3237

bellville campus Ground Floor, Library Building New Extension

+27 (0)21 959 6182

MOWBRAY CAMPUS Room 2.06, Ground Floor, Barkley Davies Building

+27 (0)21 680 1574

WELLINGTON CAMPUS Room A17, Extension to Admin Building

+27 (0)21 864 5201

Firstyear Guide 2020

Disability Unit We aim to empower and support students with disabilities and other special needs to reach their full potential in an inclusive academic environment. Our Services: • To provide information on applications, enrolment, special accommodations and bursaries • To provide individual academic support • To provide adaptive study materials and assistive technology • To arrange alternative assessment and examination methods • Liaise with academic staff and staff from other support services units • To promote universal access • To provide information on employment possibilities, equity and non-discrimination When applying for exam concessions please note the following:

We also have our own Computer Labs We provide the following specialised software programmes: JAWS – For the blind ZoomText – for visually impaired Dragon – Speech-ToText Claro Suite – for visual and learning disabilities

Our Contact Details

district six campus Atrium, 2nd floor, Admin Building

+27 (0)21 460 9071

bellville campus Ground Floor, IT Centre

+27 (0)21 959 6403

OTHER campusES Contact us for an appointment and visit to your campus

disabilityunit@cput.ac.za

Firstyear Guide 2020

Student Affairs offices on your campus DISTRICT SIX CAMPUS

Student Affairs Offices Student Centre, 4th Level +27 (0) 21 460 3149 +27 (0) 21 460 3720 SPORT & SPORT DEVELOPMENT Multi-purpose Hall, 2nd Level +27 (0) 21 460 3844 +27 (0) 21 460 3845

BELLVILLE CAMPUS

New Library Extension, Ground Floor +27 (0) 21 959 6637 SPORT & SPORT DEVELOPMENT Major Sports Hall, First Floor +27 (0) 21 959 6335

MOWBRAY CAMPUS

STUDENT REPRESENTATIVE COUNCIL AND STUDENT STRUCTURES New Gymnasium, Room 110

wellington CAMPUS

STUDENT GOVERNANCE F Block, Room F2A +27 (0) 21 864 5247 SPORT DEVELOPMENT F Block, Room F2A and F2B +27 (0) 21 864 5507

Emergency Numbers STATE AMBULANCE SERVICES State Ambulance Emergencies

10177

Police Flying Squad

10111

Fire Brigade (Back/ Neck injuries)

021 535 1100

POISON INFORMATION CENTRE Red Cross

021 689 5227

Tygerberg Hospital

021 931 6129

PRIVATE AMBULANCES Emergency services after hours

021 950 8989

Western Cape Paramedics

0800 225 599

STATE HOSPITALS Groote Schuur (Dr Stein FP)

021 404 9111

Trauma Unit

021 404 4112

Psychiatric Emergency Unit

021 404 2175

Medical Emergency Unit

021 404 4141

CAMPUS SECURITY Bellville Campus

021 959 6301

District Six Campus

021 460 3122

CAMPUS CLINICS Bellville Campus

021 959 6403

District Six Campus

021 460 3405

Mowbray Campus

021 680 1555

Wellington Campus

021 864 5278

Your passport to student life

+27 21 959 6767 info@cput.ac.za www.cput.ac.za @cput @wearecput www.facebook.com/cput.ac.za

+27 21 959 6767 info@cput.ac.za www.cput.ac.za @cput @wearecput www.facebook.com/cput.ac.za At h l o n e

B e l lv i l l e

DISTRICT SIX

G e o rg e

G ra n g e r B ay

M o w bray

Wellington

W o rc e s t e r

STUDENT GUIDE Roadmap to your social, mental AND physical wellbeing Dr Hilda Vember

Dr Rugira Marie Modeste

Ms Melanie Marais

Ms Heidi Wichman

Mr Naythan Kayser

Ms Rene Williams

STUDENT GUIDE Roadmap to Your Social, Mental and Physical Wellbeing

Dr Hilda Vember Senior Lecturer: Department of Nursing Science Dr Rugira Marie Modeste Senior Lecturer Research: Department of Nursing Science Ms Melanie Marais HIV/AIDS Coordinator: HIV/AIDS Unit Ms Heidi Wichman Student Counsellor: Student Counselling Department Mr Naythan Kayser Peer Education Officer: HIV/AIDS Unit Ms Rene Williams Administrative Assistant: HIV/AIDS Unit

Permission is granted to use the Cape Peninsula University of Technology Student Wellness Guide solely for educational purposes and not for financial gain.

Roadmap to your social, mental and physical wellbeing

Foreword My journey as a student at the Cape Peninsula University of Technology encompassed a lot of soul searching, properly and thoroughly getting to know myself. I came fresh from matric thinking that I had my life together… not! I was never ready for the disappointments that life had in store for me, but who is? I experienced fear of failure, but realised that when fear has gone, there is nothing, and only I remain; and you must let it pass over you and through you, so that you may be liberated. I faced numerous challenges – financial, academic and social. I grew as an individual. It was difficult, but I was determined to succeed. I had a vision and held myself responsible for taking poor and good decisions; and today I rest assured, knowing that those decisions shaped me, into the young woman that I am today. When I decided to be part of the HIV/AIDs Unit programme, not only was I ready and willing to expand myself to my fullest capacity, I was giving myself the opportunity to learn more about my surroundings. I grew up in a bubble, thinking that life was all peachy and I had limited information about HIV/AIDS, STDs, as well about common difficulties young people face in society. I immersed myself in the great pool of information that the HIV/AIDS Unit provided where I learned different perspectives of thinking, where I learned more about humanity, and about true compassion for others. Often over the years, I have listened to stories from people about their experiences in university, about their childhoods, aspirations, and relations with their family and future colleagues. Time and time again, I realized one thing: many students go through more or less the same roadmap, facing many decisions to make and challenges to overcome, and we have one common need: the need to be heard and seen in our most real and true form. Get to know who you truly are; just do what works for you, because there will always be someone who thinks differently. Learn to bring people into your world and be open-minded to experience other people’s worlds too. Love them even if you are different and know that when you truly know yourself, you become unshakable and indestructible. Nothing in life is to be feared. What is important is just to be understood, to develop resilience, tenacity, to use support systems and self-love, as these are the true keys to success. Use the opportunity to equip yourself through reading this booklet. I love its holistic approach, covering areas of importance to every student. - Thokgamo Dineo-Dintle Maretela Civil Engineering student & 2015-2016 HIV Peer Educator

CPUT

STUDENT GUIDE

Acknowledgements Our university would like to acknowledge the Department of Higher Education and Training and the National Skills Fund for the funding made available through the Higher Education and Training HIV/AIDS Programme’s (HEAIDS) HIV curriculum Integration Project. Professor Anthony Staak Deputy Vice Chancellor: Teaching and Learning, Cape Peninsula University of Technology Ms Managa Pillay Senior Programme Manager: Curriculum and Research, HEAIDS Dr Paulette Powell Technical and Capacity Support Consultant, HEAIDS CPUT Nursing Department CPUT Student Counselling CPUT HIV/Aids Unit Dr Jenny Wright Editor Ms Bridgette Hunt Graphic design

Abbreviations AIDS

Acquired Immuno Deficiency Syndrome

MSM

Men having sex with men

ART

Antiretroviral Therapy

PEP

Post Exposure Prophylaxis

CD4

Cluster of Differentiation 4

PMTCT

Prevention-Mother-To-Child-Transmission

CPUT

Cape Peninsula University of Technology

PrEP

Pre-Exposure Prophylaxis

Curriculum Vitae

RNA

Ribonucleic Acid

DNA

Deoxyribonucleic acid

SANAC

South African National AIDS Council

DOH

Department of Health

STI

Sexually Transmitted Infection

FDA

Food and Drug Administration

TB-DOTS

Tuberculosis Direct observed therapy

GBV

Gender-based violence

TSA

Testicular Self-Examination

HEAIDS Higher Education and Training HIV/AIDS Programme HCW

Healthcare Workers

HIV

Human Immunodeficiency Virus

UNAIDS Joint United Nations Programme on HIV/AIDS

HPV

Human Papilloma Virus

VMMC

Voluntary Medical Male Circumcision

LGBTQI Lesbian, Gay, Bisexual, Transsexual, Queer, Intersex

WAVAW

Women against violence against women

WHO

World Health Organization

Medical male circumcision

WRVH

World Report on Violence and Health

MMC

TVET Technical and Vocational Education and Training

Roadmap to your social, mental and physical wellbeing

Contents 4

Student Life and First Year Experience Welcome to student life Support provided at your institution

Good Citizenship Introduction to good citizenship Core values Overview of this chapter and expected learning outcomes Rules and policies Your country’s constitution Highlighting Chapter Two of the Constitution of South Africa, 1996 A Bill of Responsibilities for the Youth of South Africa Conclusion

Men’s Health Introduction The empowerment of men Why is men’s health so important? Common Health Issues Sexually transmitted infections (STIs) Treatments of Sexually Transmitted Infections Men and testing for Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) Medical male circumcision (MMC) Gender-based violence and HIV Condom use How to use a condom

Women’s Health Introduction Challenges faced by women Overview of chapter and learning outcomes Interventions to improve women’s health Family planning/ Contraception

Gender-based Violence Introduction Signs of an abusive relationship The cycle of violence Rape and rape culture How to get help when experiencing GBV Conclusion Places to get help and more information

A Student’s Road to Healthy Living Introduction to a healthy lifestyle What are the basic things I need to do to live a healthy life? Overview of this chapter and expected learning outcomes Common healthscreenings that can be offered at your campus

The Basics of HIV Introduction to HIV and AIDS HIV and AIDS and the immune system Important steps of HIV infection What is the role of antiretroviral treatment? Myths about HIV The link between HIV and Sexually Transmitted Infections (STIs) The link between HIV and tuberculosis (TB) Sexual violence and the risk of HIV transmission HIV and STI prevention Modes of HIV infectIon HIV prevention strategies HIV and the economy Workplace injuries Some other facts about HIV

Sexual Diversity Biological sex My friend/family member has come out as lesbian/ gay/bisexual LGBTQIQ (Lesbian, Gay, Bisexual, Transsexual, Queer, Intersex and Questioning) Myths and facts about LGBTI People Case studies: Understanding sexual diversity Support services for young LGBTI people Conclusion

Stigma and Discrimination Analysing stigma against key populations Case studies of people living with HIV New bill to criminalise hate crimes and hate speech Social media and stigma and discrimination Conclusion

10 Your Journey as a Tertiary Student Boosting your career prospects Make connections Use the Internet Join a club Branding yourself Cultivate proficiencies Gain experience Preparing your curriculum vitae Big NOs when submitting CVs What must accompany a good CV When drafting a CV the following headings are important Preparing for a job interview

CPUT

STUDENT GUIDE

Student Life and First Year Experience

Welcome to student life ‘Student life’ is the term that refers to the time when most students leave their home for the first time to go and study at an institution of higher learning. It is also the stage where a Grade 12 learner who has had no responsibility in life besides their academic work suddenly has to face the adult world with unfamiliar freedom: they need to take responsibility for their own life and sexuality. During this period of unaccustomed freedom (a critical stage of one’s life), a student needs to learn and acquire adequate knowledge to conduct themselves in an ethical and professional manner, not forgetting the core values that assisted them to get to university. A stu d new ent w ith f free oun d dom

If you are reading this, you are probably a new student and this is the beginning of a time for fulfilling your long-held dreams (‘dream the impossible dreams’) and you will no doubt begin by setting targets to reach your end goal – your degree!!!

This time is probably one of the most important parts of your life, as it is a time where you, as a student, are carefree and do not have any responsibility besides focusing on your academic studies, while your character is being built at the same time. nt justme The a d cho ol to s fro m might feel ity univers rwhelming o ve

This is also the phase when adolescents make the transition into young adulthood. You will, at times, feel that you are stranded and lonely, far away from home and no-one seems to care; and everyone just minds their own business. It is

then that you may feel like giving up, as you cannot find your feet. You may even experience a barrier with language and find it difficult to grasp new concepts in class, especially if the medium of teaching is not your mother tongue; but do know that you are not alone. Seek help and find out what support services are at your campus.

Remember with freedom comes responsibility! Don’t s is o tress, thro n the w help u g supp h stu d ay o rt s e er vic nt es

Support provided at your institution In terms of academic support, Higher Education Institutions (HEIs) have a centre which specifically focuses on additional support for students who find it challenging to cope with their first year. These departments are usually called an Academic Support Centre and form part of the academic structure of the institution. They provide support in terms of improvement of mathematics competence, assisting students with their academic literacy, and student mentorship (in terms of peer-to-peer mentoring and tutorial support).

Department of Student Affairs The Department of Student Affairs is mainly responsible for support to students outside of their academic field. It has different Departments and Units providing the following services:

Roadmap to your social, mental and physical wellbeing

Health & Wellness Cluster

Student Health Clinic

The Health & Wellness cluster refers to different departments within the Department of Student Affairs. It includes departments such as Student Counselling, Student Health Clinic, Disability Unit and the HIV & AIDS Unit. These departments help you cope with academic, physical, social, emotional and spiritual wellness needs.

This clinic provides primary health care to registered students who are attended to by professional nursing sisters and can make an appointment with the medical doctor as well. Services offered are: • Curative treatment for ill students/patients (basic medication) • Prevention / treatment of chronic illness (or referrals) • Reproductive health (family planning, cancer screening) • TB–DOTS supervision • Provider Initiated HIV Counselling & Testing (PICT) • Wound dressing and assistance with minor injuries • Treatments for sexually transmitted diseases • First aid and emergency health care • Voluntary medical male circumcision

Student Counselling This unit offers assistance, focusing on students’ mental health and wellbeing. These services offered by professional, registered psychologists and interns are the following: They offer the following services: • Individual counselling: This is confidential one-onone counselling for an hour with a psychologist or welfare officer to assist you; • Career counselling/planning: This is offered if you feel unsure of your course; if you are unhappy with the course you are studying; if you need guidance in making a choice for advanced studies; or if you want to learn more about your personal strengths and weaknesses; • Skills development workshops: Workshops are offered to assist you in coping with student life, time management, learning and studying skills, stress management, etc.

Important contact numbers Cape Town Campus Room 2.700, 2nd level Administration Building +27 21 460 3237 Bellville Campus Ground level, New Extension to the Library Building +27 21 959 6182 Mowbray Campus Ground level, Barkley Davies Building, Mowbray +27 21 680 1574 Wellington Campus Extension to Administration Building +27 21 864 5206 Athlone Campus Room 116, C Block +27 21 684 1242

Important contact numbers Bellville campus +27 21 959 6403 +27 21 959 6123 New Library Extension, Ground floor Cape Town campus +27 21 460 3405 +27 21 460 3638 Administration Building, Level 2, Room 2.900 Mowbray campus +27 21 680 1555 Administration Building, Ground floor Wellington campus +27 21 864 5522 Administration Building, Ground floor, Room A29

Disability Unit This unit provides an integrated and inclusive learning experience to students who are physically challenged. They offer services such as: • Advocacy and advice on any disability related matters; • Consultative and counselling service to students with disabilities; • Assistive technological services; screenings, training and support to students on variety of assistive devices, technologies and software available in computer labs;

CPUT

STUDENT GUIDE

• • • • • • • •

Adaptive text arrangements: conversion of study material into accessible formats; Academic support to students with learning disabilities; Psycho-social support to students with disabilities; Test and examination concession applications (relevant medical report required); Orientation and mobility training; Referral for recommended textbooks in electronic or audio format; South African sign language interpreter service; Accessible study venues and computer lab.

Important numbers Cape Town Campus Atrium, 2nd level Administration Building +27 21 460 9071 Bellville Campus Ground floor, IT Centre Building +27 21 953 8438

HIV/AIDS Office This office focuses on awareness, advocacy and HIV prevention services, including: • Awareness Campaigns: to empower students and staff with knowledge on HIV & AIDS, STIs, TB, other women’s and men’s health-related matters; GenderBased Violence (GBV), Stigma & Discrimination; • Peer Education: This is a service whereby selected students are trained as volunteers to help with peerto-peer training on various topics to assist with the awareness programmes and interventions; • HIV Counselling & Testing (HCT): Routine HCT is provided on a voluntary basis to the student and staff population; • Mobile Wellness Unit visits all campuses to bring the services to all students; • Care & Support: Clients tested HIV positive are provided with the necessary support and referred where necessary; • Condom Promotion: The service includes the distribution of condoms and lubrication as well as education on correct usage of condoms; • Curricular Integration: Faculties are provided with support with the infusion of HIV into their curricula; • Workshops: Free workshops are offered to members of the student community on various topics.

• •

Community engagement including schools, TVET colleges and public places Internships: Students obtain invaluable work experience in the HIV/AIDS Unit

Important contact numbers Cape Town Campus Administration Building, Floor 2, Room 2.500A +27 21 460 4253/2 +27 21 959 6828 HIVunit@cput.ac.za CPUTHIVUnit National AIDS Helpline 0800 012 322 National HIV HCW Hotline 0800 212 506 Suicide Helpline 0800 708 090 (Toll free) Robbie Nurock (Cape Town) 89 Buitenkant Street, Cape Town +27 21 461 1124 Community Health Centre (Bellville) Kassesvlei Road, Bellville +27 21 951 2326

Student development Student development focuses on leadership development and capacity building of students. Besides

Roadmap to your social, mental and physical wellbeing

academic performance being the main priority of students at universities, this department also develops students by helping them obtain additional life skills to equip them to perform optimally in all spheres of life. By developing their leadership skills, students are able to excel in student structures, not only at the university, but also on a broader level both nationally and internationally.

Arts & Culture These activities range from social events to performing arts, debating, religious interaction and first year socialising programmes. Contact the departments below should you wish to find out more about the different sport codes and other extramural activities on campus.

Important numbers Important numbers Cape Town Campus Room 4.17, Student Centre, Cape +27 21 460 3499 Bellville Campus New Library Extension, Bellville +27 21 959 6010

Student Governance This division is responsible for the coordination of activities and support to the Student Representative Council (SRC) and its affiliated student societies. The SRC is the highest student governance structure at the university and it manages student matters and represents the interests of students on university and national forums.

Cape Town Campus Sports +27 21 460 3844 Wellington Campus Sports +27 21 864 5247 Bellville Campus Sports +27 21 959 6319/ 6377 Cape Town Campus SDO: Arts & Culture +27 21 460 3149

Useful RESOURCES

The SRC plays a key role in the coordination of organised student life and must ensure that the extracurricular programme contributes to the overall development of students.

Cape Peninsula University of Technology Available: http://www.cput.ac.za/ 22 March 2017

The SRC also fulfils an important communication function - on the one hand conveying student needs and interests to the university management, and on the other hand, reporting progress to the student community.

http://www.cput.ac.za/students/life/clinics

http://www.cput.ac.za/students/life/hiv http://www.cput.ac.za/students/life/counselling

http://www.cput.ac.za/students/life/development http://www.cput.ac.za/students/life/sport http://www.cput.ac.za/students/life/activities

Sports Department The Sports Department offers both competitive and recreational sporting codes and caters for all types of sports men and women. In addition to this, it also offer information and workshops on healthy lifestyle issues such as healthy eating, how to overcome addictions, weight loss programmes, etc.

http://www.cput.ac.za/services/disability

CPUT

STUDENT GUIDE

Good Citizenship Overview of this chapter and expected learning outcomes After going through this chapter, you should: • understand the concept of good citizenship; • know how to integrate the concept of good citizenship into your everyday life; • understand the concepts of core values and discipline; • understand the importance of good conduct as a student and in the workplace; • apply your human rights and understand your responsibility to act on your human rights; and • respect and honour the human rights of other citizens.

Introduction to good citizenship Good citizenship is important for the overall wellbeing of society. A good citizen is a person who obeys the laws of his or her country, contributes to society and uses wisdom with every decision taken. Key concepts like respect, responsibility, honesty and helpfulness are important when describing what good citizenship means. It also means to take responsibility for your own decisions. Good citizens care for their environment and assist those who cannot help themselves. They obey the laws of their country. When you are a contributing citizen, you are respectful of others’ feelings, beliefs and constitutional rights. Lastly, a responsible citizen doesn’t discriminate against another human being, regardless of race, gender, sexual orientation or socio-economic status.

Activity Tell a story about a time you had to tell the truth but found it difficult to do so. Tell a story about a time you had to take responsibility for what you had done. Tell a story about a time you had to say ‘no’ to a friend. Tell a story about someone you have a lot of respect for.

Core values A core value is something that defines you as a good citizen or a good person. It is how you brand yourself and how you want to be known as a good citizen. Examples of enacting core values are: • You deal with others in a spirit of Ubuntu; • You value excellence; and • You deal with others with respect.

Activity Now that you know what a core value is, do the following exercise to demonstrate your awareness of your personal core values: My personal core values are: My family’s core values are: My institution or school’s core values are: How do these core values differ from one another and what are the similarities between them?

Roadmap to your social, mental and physical wellbeing

Rules and policies Are you planning to start your own company one day? When you plan to start your own company, it normally starts with a vision. Along with that vision, there is a drive to bring a solution to a problem, or meet the needs of society. For that company to achieve its objectives, you will need to employ people that will represent you in the best possible way. All employers have to abide by the laws of the country. In South Africa, these laws are set out in the Basic Conditions of Employment and Labour Relations Act. The Recruitment Process: As an employer, you will draft a job description according to the needs of the company and advertise a vacant position. Once you receive all the CVs, a shortlisting is done to accommodate the most suitable candidates for the position (sometimes up to 6-8 candidates). You will have a panel that will do the interviews, after which the most suitable candidate will be selected. The next step will be to determine whether what the applicant wrote in the CV and shared in the interview, correlates with references.

Activity Now that you know more about a Code of Conduct, find out if your higher education institution / school has a code of conduct for students. Answer these questions: What is it called? Why do you think it is important for students to have a Code of Conduct? How does a Code of Conduct tie in with good citizenship? List at least 3 workplace policies. Why is an HIV Policy important in the workplace?

Activity Share personal stories about a time when you demonstrated good citizenship. For example:

An offer will be made to the most suitable candidate; and once she or he accepts the offer, they will sign an employment contract that will stipulate the employer’s responsibility and theirs, as a newly appointed employee. A newly appointed employee will also be required to sign a Code of Conduct that stipulates how they are expected to behave.

I was friendly to a new student from a different country.

Any employer has a Disciplinary Procedure that specifies the process followed when an employee has not adhered to the Code of Conduct employment contract or company policies. Employees may also follow a Grievance Procedure in cases where they are grieved by any situation within the workplace. Following a grievance procedure is important, because this is a formal and proper way of ensuring that an employee’s concerns are attended to.

I follow the rules of the road.

The employer is responsible to do induction training, introduce the employee to the company and its policies, business / work process and standard operating procedures or guidelines. The policies are rules that are put in place for the smooth running of operations and to guide employees. Guidelines or standard operating procedures outline how things should be done.

I helped clean up the class. I assisted a fellow student with food. I walked away from a fight. I said “no” when a friend asked me to steal another student’s money. I found a cell phone on campus and handed it in to my lecturer or campus security. Describe what would happen if there were no rules or laws at: Home University Traffic Discuss why rules / policies are important and define the consequences if they are broken.

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Now that you have a basic understanding of good citizenship, complete the following exercise about the responsibilities of a good citizen: being a good citizen

Your country’s constitution Good citizenship is about knowing my responsibility and exercising it. It is also important to know what factors contribute to poor citizenship so that we know how to avoid these. The South African Constitution is the most important law of the country.

not being a good citizen

Any other laws must align with this constitution. The Constitution explains what our rights and responsibilities are. Although we have many rights, those rights should not infringe on the rights of others. The next section of this chapter will deal with the South African Constitution.

Highlighting Chapter Two of the Constitution of South Africa, 1996 Chapter Two of the Constitution of South Africa contains the Bill of Rights, a human rights charter that protects the civil, political and socio-economic rights of all people in South Africa. The rights in the Bill apply to all law, including the common law, and binds all branches of the government, including the national executive, Parliament, the judiciary, provincial governments and municipal councils. Some provisions, such as those prohibiting unfair discrimination, also apply to the actions of private persons. South Africa’s first Bill of Rights was contained in Chapter 3 of the transitional Constitution of 1993, which was drawn up as part of the negotiations to end apartheid. This “interim Bill of Rights”, which came into force on 27 April 1994 (the date of the first non-racial election), was largely limited to civil and political rights (negative rights).[1] The current Bill of Rights, which replaced it on 4 February 1997 (the commencement date of the final Constitution), retained all of these rights and added a number of new positive economic, social and cultural rights. Although Section Two already provides for the supremacy of the Constitution over all laws and government actions, Section Eight explicitly states that the Bill of Rights applies to all law and binds all branches and organs of government. It further states that the provisions of the Bill also bind private parties to the extent that they are applicable, given the nature of the rights in question, and require the courts to develop the common law to this effect. Finally, Section Eight extends the benefits of the Bill of Rights to juristic persons, taking into account the nature of the rights and the juristic persons in question. Thus, for example, the right to human dignity and the right to health care clearly only apply to actual human beings, while the right to freedom of expression and the right to property apply also to corporations.

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My responsibility in ensuring the right to equality Section 9 of Chapter 2 in the Constitution The Section starts with: “Everyone is equal before the law and has the right to equal protection and benefit of the law. Equality includes the full and equal enjoyment of all rights and freedoms. To promote the achievement of equality, legislative and other measures designed to protect or advance persons, or categories of persons, disadvantaged by unfair discrimination may be taken.” The Section, like the Universal Declaration of Human Rights, prohibits all discrimination but specifically lists the following grounds “race, gender, sex, pregnancy, marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion, conscience, belief, culture, language and birth.” This list is more extensive than the equality provisions in most human rights instruments; and noteworthy is the distinction between “gender” and “sex”, the inclusion of “pregnancy”, the distinction between “race” and “colour”, and the inclusion of “age” and “disability”.

As South Africans, we all have rights to protect us and to see to our basic needs as humans. These rights are a privilege and, as a progressive and diverse country, we are also tasked with responsibilities to act on these rights and to practise these rights to respect and honour the rights of our fellow citizens.

A Bill of Responsibilities for the Youth of South Africa Preamble I accept the call to responsibility that comes with the many rights and freedoms that I have been privileged to inherit from the sacrifice and suffering of those who came before me. I appreciate that the rights enshrined in the Constitution of the Republic of South Africa are inseparable from my duties and responsibilities to others. Therefore I accept that with every right comes a set of responsibilities. This Bill outlines the responsibilities that flow from each of the rights enshrined in the Constitution of the Republic of South Africa.

The right to equality places on me the responsibility to: • treat every person equally and fairly; and • not discriminate unfairly against anyone on the basis of race, gender, religion, nationality, ethnic or social origin, disability, culture, language, status or appearance.

My responsibility in ensuring the right to human dignity The right to human dignity places on me the responsibility to: • treat people with reverence, respect and dignity; and • be kind, compassionate and sensitive to every human being, including greeting them warmly and speaking to them courteously.

My responsibility in ensuring the right to life The right to life places on me the responsibility to: • protect and defend the lives of others; • not endanger the lives of others by carrying dangerous weapons or by acting recklessly or disobeying our rules and laws; and • live a healthy life, by exercising, eating correctly, by not smoking, not abusing alcohol, nor taking drugs, nor indulging in irresponsible behaviour that may result in my being infected or infecting others with communicable diseases such as HIV and AIDS.

My responsibility in ensuring the right to family or parental care This right expects me to: • honour and respect my parents, and to help them; • be kind and loyal to my family, to my brothers and sisters, my grandparents and all my relatives; and • recognise that love means long-term commitment, and the responsibility to establish strong and loving families.

My responsibility in ensuring the right to education The right to education places on me the responsibility to: • attend school regularly, to learn, and to work hard; • cooperate respectfully with teachers and fellow learners; and • adhere to the rules and the Code of Conduct of the school; and concurrently places on my parents and caregivers the responsibility to: • ensure that I attend school and receive their support. and places on my teachers the responsibility to: • promote and reflect the culture of learning and teaching in giving effect to this right.

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My responsibility in ensuring the right to work This right carries with it the responsibility for all learners, parents, caregivers and teachers to: • work hard and do our best in everything we do; • recognise that living a good and successful life involves hard work, and that anything worthwhile only comes with effort; • prevent children being exposed to child labour.

My responsibility in ensuring the right to freedom and security of the person The right is upheld by my taking responsibility for: • not hurting, bullying, or intimidating others, or allowing others to do so and • solving any conflict in a peaceful manner.

My responsibility in ensuring the right to own property

My responsibility in ensuring the right to citizenship The right to citizenship expects that each of us will be good and loyal South African citizens. This means that we are responsible for: • obeying the laws of our country; • ensuring that others do so as well; and • contributing in every possible way to making South Africa a great country.

My responsibility in ensuring the right to freedom of expression The right to free expression is not unlimited, and does not allow us to: • express views which advocate hatred, or are based on prejudices with regard to race, ethnicity, gender or religion; and

The right to own property places on me the responsibility to: • respect the property of others; • take pride in and protect both private and public property, and not to take what belongs to others; and • be honest and fair (and for those who have, to give generously to charity and good causes).

We must therefore take responsibility to ensure this right is not abused by ourselves or others: we must not tell or spread lies, and must help to ensure that others are not insulted or have their feelings hurt.

My responsibility in ensuring the right to freedom of religion, belief and opinion

I accept the call of this Bill of Responsibilities, and commit to taking my rightful place as an active, responsible citizen of South Africa. By assuming these responsibilities I will contribute to building the kind of society which will make me proud to be a South African.

The right to freedom of conscience requires me to: • allow others to choose and practise the religion of their choice, and to hold their own beliefs and opinions, without fear or prejudice; and • respect the beliefs and opinions of others, and their right to express these, even when we may strongly disagree with these beliefs and opinions. (That is what it means to be a free democracy.)

My responsibility in ensuring the right to live in a safe environment This right assumes the responsibility to: • promote sustainable development, and the conservation and preservation of the natural environment; • protect animal and plant-life, as well as the responsibility to prevent pollution, to avoid littering, and to ensure that our homes, schools, streets and other public places are kept neat and tidy; and • to ensure that, in the context of climate change, we do not waste scarce resources like water and electricity.

Conclusion

Roadmap to your social, mental and physical wellbeing

Activity Please read the following case study and then answer the questions that follow. Safiq is a 24-year-old Muslim student who actively practises his faith and follows his daily prayer rituals. Recently he was placed in a double room at residence and expressed to his new roommate how he practises his faith, etc. The roommate was at first fine with the situation, but lately this roommate has been making very hurtful comments regarding Safiq’s religion. He has threatened to report Safiq for being a disturbance and also stealing from him, just to get him removed from his room. When Safiq studies, his roommate switches off the lights and tells him to go and study somewhere else as he wants to sleep. Further, his roommate has blatantly told Safiq that he hates Muslims and sees them all as terrorists. Safiq is afraid to report this, as he does not want to get his roommate in trouble or lose his room in residence. List the basic human rights of Safiq that are being violated. What would you do if you were Safiq? Which of Safiq’s human rights should he practise to get out of this situation? What disciplinary steps do you think should be taken against his roommate?

References Cockrell, A. 1997. The South African Bill of Rights and the ‘Duck/Rabbit’. Modern Law Review, 60(4):513537. Davies, l. n.d. 20 Ideas for teaching citizenship to children. http://www.kellybear.com/TeacherArticles/ TeacherTip27.html [7 March 2017]. Dickson, B. 1999. Human rights in the 21st century. Amnesty International Lecture, Queen’s University, Belfast, 11 November. Government of South Africa. Bill of Rights. 15 January 1996. No. 108 of 1996 https://www.westerncape.gov.za/legislation/bill-rights-chapter-2-constitution-republic-south-africa [7 March 2017] Hopkins, G. 2015. Teaching good citizenship’s five themes. Available at: http://www.educationworld. com/a_curr/curr008.shtml [7 March 2017]. South African Department of Education. 2009. A Bill of Responsibilities for the Youth of South Africa. http:// www.gov.za/sites/www.gov.za/files/gcis_documents/poster_2009.pdf [7 March 2017]

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A Student’s Road to Healthy Living Overview of this chapter and expected learning outcomes After going through the chapter, you should : • understand how to look after your health; • understand how important it is to do regular health check-ups; • understand how to prevent and control obesity, high blood pressure, high cholesterol and diabetes; and understand the link between healthy living and academic performance.

Introduction to a healthy lifestyle

What are the basic things I need to do to live a healthy life?

Many conditions like strokes, heart conditions, diabetes and certain cancers could have been prevented if people took care of their health or at least went for regular check-ups.

•

In other words, high blood pressure or high cholesterol levels in your blood or diabetes can lead to a stroke. Your brain controls your thinking, emotions, movement and senses. When it gets hurt through a stroke (when a blood vessel bursts because of high blood pressure, or get blocked), certain parts of the brain stop working. The same can be said of a heart attack: when the blood vessels that supply the heart with oxygen get blocked, you can have a heart attack that could be fatal. Obesity is another condition that can lead to health complications. The good news is that when you adopt a healthy lifestyle and go for regular check-ups at least once a year, you can prevent a number of these diseases.

Watch what you eat or drink. A balanced meal consists of proteins (meat, poultry, fish, eggs, etc.), vitamins (from vegetables, fruits) and carbohydrates (maize, bread, rice, etc.) . Unhealthy food (greasy food, or food with high sugar content) is not good for your body.

Fruits Vegetables

Water

Grains Protein

Roadmap to your social, mental and physical wellbeing

•

Blood cholesterol levels determine how much cholesterol (fat) content is in your blood. This can be done through testing a small drop of blood from a finger prick.

•

Blood pressure is the pressure of the blood inside your arteries (veins) caused by the contraction of the heart muscle. Your blood pressure is either normal, high (known as hypertensive) or low (hypotensive). Our emotions or stress levels impact our blood pressure. In other words, when we are calm, our pulse rate and blood pressure tend to be normal; when we are stressed, our pulse rate and blood pressure tend to increase.

•

Body mass index is a measure to determine if you are over- or under-weight. This will be determined through a simple calculation after measuring your height and weight.

Important to know Unhealthy food is not necessarily cheaper! For example, compare the cost of an apple versus a chocolate or fries.

•

Do regular exercises (at least once a week, preferably more often). Always walk up the stairs instead of taking a lift (unless there are many floors and you are carrying heavy objects, of course!). Walk instead of taking a bus if the distance is not too great.

•

Water is freely available. Drink at least 6-8 glasses of clean water every day.

•

Dental care is important. Simply brush your teeth twice a day (mornings and evenings) and visit your dentist at least once a year. Good dental care prevents bad breath and certain oral infections. It also helps you to keep your teeth into your old age. Regular health checkups. When your campus has a health awareness day, make use of the opportunity to check your body mass index (to see if you are under or overweight), blood pressure, blood sugar and cholesterol levels; and don’t forget to get to know your HIV status.

•

Have a look at the chapters that focus on men’s and women’s health for more information.

•

Last but not least, listen to your body. When it is tired, give it rest. When it is thirsty, give it plenty of water. When it is stressed, manage it. When it is not feeling well, visit your doctor or campus clinic.

Reflection Now that you know the importance of living healthy, why do you think it is important to focus on your own health? How does a healthy lifestyle impact your academic performance?

Common health screenings that can be offered at your campus •

Blood sugar levels determine how much sugar content is in your blood. This can be done through testing a small drop of blood from a finger prick.

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Reflection What did I learn from this chapter?

Looking forward My plan of action List the three most important actions you can take to adopt a healthy lifestyle: 1. I can

2. I can

3. I can

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The Basics of HIV Overview of this chapter and expected learning outcomes After going through the chapter, you should: • understand the basics of HIV; • understand the link between HIV, STIs and TB; • understand how high risk behaviour among students can contribute to HIV infection; and • understand the impact of HIV on the economy

Introduction to HIV and AIDS Can you explain the difference between HIV and AIDS? It is quite simple. HIV is the abbreviation for Human Immuno Virus; in other words, HIV is a virus that targets the human immune system. Once the virus enters your body and infects the CD4 cells, you are known to be infected with HIV; but that does not mean you have AIDS, so

be careful when referring to someone as ‘having AIDS’. AIDS is the abbreviation for acquired immune deficiency syndrome. In other words, once your immune system is depleted, there are no more CD4 cells to fight the virus and your body is open to all kinds of infections. The good news is that antiretroviral treatment (ART) blocks the HIV virus from further attacking your immune system. When this happens, your immune system gets a chance to repair itself. Fortunately, you no longer have to wait for your CD4 cell count to drop before you can start treatment. You can now start ART immediately after testing HIV positive.

Activity HIV prevalence exercise Research the HIV infection rate of the top five countries in the world. (Search on WHO and UNAIDS sites.) Country

HIV infection rate 2000 HIV infection rate 2012 HIV infection rate 2015 Current HIV infection rate

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Bruce Jones Design Inc. 2009

After completing the previous table on page 17, answer the following questions: • Identify the country with the highest HIV infection rate. What do you think are the contributing factors for the HIV infection rate in that country? • Identify the country where there has been an increase in the rate of HIV infection. • What is your country doing to reduce the HIV infection rate? Do you think it is working? Explain your answer.

HIV and AIDS and the immune system The human body is built to protect itself. Your skin is your first level of protection. You therefore cannot get infected with HIV by shaking hands or kissing someone living with HIV. It is not possible for an organism to enter your body when your skin is intact (in other words, unbroken skin). However when the skin is damaged through an injury, for example, your body is immediately exposed to an invasion of organisms like bacteria or viruses. This is when the next level of protection kicks in and your white blood cells act as the “army” of the body. There is one important white blood cell known as T-lymphocyte or the CD4 cell. This cell sends important messages to alert your immune system of invading viruses or bacteria. It is also the target point of the HI-virus. When HIV infects your CD4 cells the following happens: Multiplication of HIV – Here HIV uses the CD4 cell as a host to produce more viruses. A viral load test is a blood test that determines how many of the HI-viruses are in your body. Reduction in CD4 cell count – As the CD4 cells are invaded by the HI-virus, your CD4 cell count goes down. Without the CD4 cell, HIV is unable to multiply.

Important steps of HIV infection See the HIV Life cycle on the next page HIV gains access through an open wound/cut (can be very small cuts that cannot be seen with the naked eye) Binding - HIV binds to the CD4 cell wall Fusion - The virus membrane fuses with the CD4 membrane Uncoating - The contents of the virus are deposited within the CD4 cell. (There are 3 important enzymes: Reverse transcriptase, integrase and protease + viral RNA.) Reverse transcription - Viral RNA is changed to Viral DNA with the help of the enzyme Reverse transcriptase. Integration - The Viral DNA enters the nucleas (core) of the CD4 cell and attaches itself to the CD4 DNA that cannot identify the Viral DNA as an invader. Then thousands of immature viruses are produced. Translation - The Viral DNA (infected CD4 DNA) uses protease to change it to Viral RNA.

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Assembly - The Viral RNA + viral proteins assemble (including the 3 important enzymes). Budding – The assembled parts of the newly formed HI-virus buds out from the infected CD4 cell wall.

What is the role of antiretroviral treatment? Antiretroviral treatment blocks most processes of HIV infection, preventing the virus from producing more viruses. When this happens, the virus is suppressed to a level of undetectable.

Maturation - The virus matures and looks for a CD4 cell, enters it, then starts the cycle of HIV infection.

REMEMBER

Aidsinfo (2017) Aidsinfo (2017)

Activity: Based on this information What do you think could happen if someone living with HIV stopped drinking their tablets/medicine? Explain your answer in a group. N.B.: Antiretroviral treatment can also be used to prevent HIV infection in the form of Pre-exposure prophylaxis (PreP) and post exposure prophylaxis (PEP): Prep is antiretroviral treatment used by an HIV negative sexual partner to prevent possible HIV transmission from an HIV positive sexual partner, for example, in cases of sex workers, discordant couples (one partner is HIV negative and the other partners is HIV positive). PEP is used in cases where someone has been exposed to the bodily fluids of another person, for example, in cases of rape or accidental injury like needle prick injury. It is important that antiretroviral treatment starts as soon as possible, or within a maximum of 72 hours after possible infection. It is safest to start ASAP.

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Myths about HIV There are still many myths around HIV. Many of us know family members and friends living with HIV. Myths can interfere in many people’s decisions to use treatment, to use protection or to infect others.

Activity: Reflection What does the term ‘myth’ mean to you?

Can you think of a few myths related to HIV?

Which of these myths are true and which are untrue? Explain your answers.

The link between HIV and Sexually Transmitted Infections (STIs) HIV is considered a sexually transmitted infection (STI), because it is transmitted through unsafe sex. Unsafe sex means having unprotected sex with your partner: in other words, without using a condom. There are several sexually transmitted infections like herpes simplex, genital warts, gonorrhoea, trichomoniasis, syphilis, etc. that increase your risk of contracting HIV when you have an STI and have unprotected sex with a partner who is HIV positive. Read more about STIs in Chapters 7 and 8).

The link between HIV and STIs When there is an infection in the genital area, there is swelling and redness causing the infected area to bruise and bleed easily during sex, providing direct access for the HI-virus. Symptoms of STIs: • Foul smell from the genital area • Abnormal discharge or “drop” • Pelvic pain • Burning urination • Ulcer or sores in the genital and anal area • Genital warts • Skin rash

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The link between HIV and tuberculosis (TB) Tuberculosis is known as an infectious disease caused by bacterium mycobacterium tuberculosis (TB) and generally affects the lungs. It can also affect other parts of the body. When HIV positive, your immune system is compromised, making you more susceptible to contracting TB. When you have TB, you are at risk to someone living with HIV. Remember: TB is an airborne disease and can be spread through speaking, sneezing and coughing.

Do you have at least two of these symptoms? Go and have yourself checked out.

IMPORTANT: Anyone can contract TB. Having TB does not mean you are HIV positive. TB is a treatable disease and can be cured!

REMEMBER! Wash your hands regularly. When coughing, hold the back of your hand against your mouth. Working and living in well ventilated rooms or areas is IMPORTANT!

Common symptoms of TB: • Persistent cough for longer than two weeks • Night sweats • Weight loss • Productive blood staining cough (haemoptysis) Aidsinfo (2017)

Activity Why do you think the Western Cape has the highest TB infection rate in the world? Research will assist with your answer. (Useful resources: Google Scholar, WHO, UNAIDS, SA DoH) Test your risk of contracting HIV or STIs Read through the questions below and circle the relevant risk level How often do you drink alcohol? I do not drink alcohol I occasionally drink alcohol I frequently drink alcohol

High risk High risk High risk

Low risk Low risk Low risk

No risk No risk No risk

How often do you take recreational drugs (tik, cocaine, crack, pot, dagga, etc.)? I do not use drugs High risk Low risk I occasionally use one of these drugs High risk Low risk I frequently use two or more of these drugs High risk Low risk

No risk No risk No risk

Are you, or a person you had sex with, circumcised? Yes No I don’t know

High risk High risk High risk

Low risk Low risk Low risk

No risk No risk No risk

Do you use a condom when having sex with your partner? I always use a condom High risk I occasionally use a condom High risk I never use a condom High risk

Low risk Low risk Low risk

No risk No risk No risk

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Do you know your partner’s HIV status? Yes No I don’t know

High risk High risk High risk

Low risk Low risk Low risk

No risk No risk No risk

When last did you go for an HIV test? Less than a year ago More than a year ago Never been for a test

High risk High risk High risk

Low risk Low risk Low risk

No risk No risk No risk

How old is your sex partner? Older than me My age Younger than me

High risk High risk High risk

Low risk Low risk Low risk

No risk No risk No risk

Have you ever had sex with a “blesser” in exchange for goods or money? High risk Yes High risk No

Low risk Low risk

No risk No risk

Do you have any STI symptoms? Yes No

High risk High risk

Low risk Low risk

No risk No risk

What are your sexual practices? Abstinence Penis to vaginal sex Having sex with sex toys Penis to anal sex Finger to vaginal sex Oral sex

High risk High risk High risk High risk High risk High risk

Low risk Low risk Low risk Low risk Low risk Low risk

No risk No risk No risk No risk No risk No risk

Sexual violence and the risk of HIV transmission Research the link between intimate-partner violence and HIV transmission. Find and study an article on a recent gender-based violence incident. • Was the incident intimate-partner related? • What do you think could have been done to avoid the incident?

Have a group discussion/debate on the following topic: Why does South Africa have such a huge problem with sexual and gender-based violence; and what, in your opinion, can be done to address it? How do you think the issue of “Rape Culture” can be addressed at Higher Education Institutions? (Use your institution’s ‘Sexual Harassment Policy’ to assist you.) What role do you think graduates can play to address intimate partner violence in society?

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High risk behaviour amongst students at your campus Activity: Reflection What does the term ‘high risk behaviour’ mean to you?

What acts do you think would qualify as high risk behaviour?

What actions would you take to address high risk behaviour amongst students?

Confidentiality activity (Source unknown) The facilitator hands out a small piece of paper to you and your class. Each of you is asked to write down your deepest secret. Fold it into a small wad and hand it to the person next to you, who then needs to hold it in their hand without unfolding it. Answer the following questions: • What went through your mind when asked to do this task? • Were you comfortable to hand the folded paper to the person next to you? Why? • What did you expect the person to do with your secret? • How do you associate this activity with someone trusting you with their HIV positive status?

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HIV and STI prevention Safer sex Condom use Did you know... That a condom is the only contraceptive that can • Prevent you from impregnating your partner? • Protect you from contracting STIs or HIV? That the Choice condoms, provided by the state, undergo stringent tests by the South African Bureau of Standards to ensure that that they are safe and reliable? That a condom can only be used once and should then be disposed of by wrapping it in toilet paper, before throwing it away?

Correctly number the steps from 1-10 on how to correctly use a male condom (find the correct answer on last page in the book)

Did you know that a male condom can be used as a finger condom?

Move the condom down inside the packaging and tear the package carefully. Do not use your teeth or nails to do this. Throw the used condom away. You can wrap it up in toilet paper and throw it in the rubbish bin. Check the expiry date on the condom; and make sure the package is sealed and that no air is escaping. Roll the condom to the base of the penis near the testicles. Roll down the condom about a centimetre to see which way is the right side. Hold the tip of the condom to leave space for the semen and to keep air bubbles out. If the penis is uncut (uncircumcised), pull the foreskin back first. Make sure the penis is erect. When pulling out, hold the condom at the base near the testicles so that it doesn’t slip off. Put the lube on the tip of the condom once it is on. For both vaginal and anal sex, use only water-based lubrication, such as KY Jelly.

Important to know HIV can enter the body through: • •

• • •

The lining of the anus or rectum The lining of the vagina and/or cervix (mouth of the womb) The opening to the penis Mouth sores or bleeding gums Cuts or sores on the body

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The female condom Female condoms can be inserted any time up to eight hours before sexual intercourse. See the instructions opposite.

outer ring add extra lubricant if wanted

Blood and body fluid spilling • • • •

Wear appropriate personal protective wear (gloves, mask); Cover the spill with paper towel; Carefully pour 1:10 bleach around the edges and onto the spill and allow to stand for 10 minutes; Use a paper towel to clean up the spill from the edges to the centre and discard into a hazardous waste container.

inner ring at the bottom

inner ring

open end

Activity Your friend accidentally got injured and is bleeding. How will you assist your friend without putting yourself at risk?

Modes of HIV infecTIon

D pubic bone

Photocredit: Avert

HIV is found in VERY LOW concentration - or is ABSENT - in saliva, sweat, tears and urine

HIV is found in MEDIUM concentration in anal secretions

HIV is found in HIGH concentration in blood, semen, vaginal secretions, menstrual fluid and breast milk

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HIV prevention strategies The ABC (Abstain, Be Faithful and Condomise) strategy is no longer regarded as an effective approach to prevent HIV infection. There are up to 10 HIV prevention methods (see the list that follows). A collective or combination approach to HIV prevention is more effective than a single approach.

Being faithful – Although this is not a guarantee, it is important to know your HIV status and be faithful to the same partner. Having multiple sexual partnerships is a huge risk for HIV and STI transmission.

Regular condom use during sex – Condoms act as a barrier against HIV infection. When used correctly and 100% of the time, condoms will prevent exposure to the HI-virus and protect you from contracting HIV or STIs.

HIV counselling and testing – Getting to know your HIV status is very important, because if you are tested HIV positive, you will be referred for further care and antiretroviral treatment. If you test HIV negative and were exposed to someone’s bodily fluids less than three months ago, you will be asked to return for another HIV test within 3 months after your last exposure to that person’s bodily fluids.

Abstinence - This is the only guarantee that you won’t contract HIV or STIs, but there are other risks of contracting HIV and that is through needle prick injuries, being exposed to bodily fluids through assisting, for example, at accident scenes, through using drug users’ contaminated needles, etc. The use of gloves can prevent work-related injuries like cleaning up someone’s bodily fluids. Discarding contaminated materials the correct way will prevent risk of exposure to bodily fluids or needle prick injuries.

Treatment of sexually transmitted infections and other vaginal inflammation not caused by STIs. When the vagina or penis is infected with an STI or there is vaginal inflammation, the risk of lacerations is much higher, creating an entry point for the HI-virus. When an infection is treated, the risk is lower.

Voluntary Medical Male Circumcision – This is the full removal of the foreskin. When an HIV negative male is fully circumcised, his risk of contracting HIV is up to 60% lower. Other health benefits include lowered risk of certain STIs; and being circumcised is more hygienic and reduces his female partner’s risk of contracting cervical cancer.

Post exposure prophylaxis (PEP) – This is antiretroviral treatment taken after a person was accidentally (or intentionally) exposed to another person’s bodily fluids, varying from semen to vaginal fluids or blood. NB: This treatment must start within 48 to 72 hours after exposure.

Prevention of Mother to child transmission – This is also known as PMTCT and is a method used to reduce the risk of HIV transmission from a mother who is infected with HIV to an infant. HIV can be transmitted from a mother to an infant before, during, and after labour.

Pre-exposure prophylaxis – This is also known as PrEP and is an antiretroviral treatment that involves taking a pill every day and is used by people who are at risk of contracting HIV. The pill contains two drugs, tenofovir and emtricitabine, known as truvada.

10. Microbicide ring (Dapivirine) – This is a matrix ring (silicon) that is inserted inside the vagina. The ring consists of an antiretroviral drug referred to as Dapivirine that is slowly released in the vaginal area with the objective of preventing HIV transmission. Recent study findings have proven that the ring reduces a female partner’s risk of contracting HIV by up to 30%. The ring is not available as yet and still needs approval from the USA FDA and SA Medicine Control Council before it can be made available.

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Number each from 1 to 10 Which of the 10 prevention strategies would you use for …? (You can select more than one.) A pregnant woman Someone who, for example, was exposed to another person’s bodily fluids, injured themselves while assisting on an accident scene, or was raped? Drug users who inject themselves with drugs Sexually active individuals Female partners who have difficulty negotiating condom use with their partners

Choosing the right HIV awareness method for the right audience

Workshops can normally last for few hours (3 to 6 hours). Interactive activities, icebreakers, short educational videoclips and regular short breaks are important when conducting a workshop. Keep presentation slides to a minumum. Allow participants to present group activities and remember to let them complete an evaluation form to help you improve your sessions. Door-to-door visiting is a good way of speaking to small groups of people. Remember safety first. This method works for reaching people who do not attend events. Taking pamplets and informational leaflets is important so you can leave these behind in cases where people do not have time to listen to you. Pamplets and posters must be interesting, appealing, short and to the point. Avoid too much jargon and speak to the audience.

Talks and discussion groups at campus residences, churches, organisations, schools. These should not be longer than 20 minutes and leave time for lots of questions. Introduce an interesting topic that affects the youth, like social justice, sexual and genderbased violence, teenage pregnancy or the blesser phenomenon. If you don’t have the answer to a question, write down the question and find out. Avoid giving inaccurate answers. Plays, music and songs are effective ways of educating people who do not like to sit in a workshop or lecture room. This works well for youth groups and schools. Competitions can be used as effective way to draw people.

News articles and radio can be used for educational stories, short talks, columns and radio interviews. Addressing assemblies or community meetings. Here you can make short speeches to empower and educate larger groups of people. Make short introductory speeches covering the key issues you want to carry over. Talk facts and avoid reading speeches off a paper. Allow an opportunty for questions. Always remember that people can ‘read’ if you are honest, well informed and sincere when adressing them.

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HIV and the economy HIV has a ripple effect on the economy. Any economy requires people to drive it. When people are unable to work due to illhealth, it impacts the economy. A lot can, however, be done to reverse the impact of HIV on the economy.

Activity: Reflection Write down three examples that show the impact of HIV in a workplace. Example

What would be some signs to look out for?

What could you do to manage this situation?

e.g. Productivity

The employee’s productivity decreases.

Offer assistance through and employee assistance programme

Workplace injuries A workplace injury is something that occur in relation to employment. Some workplace injuries are high risk, some are low risk and some no risk at all. Certain workplace injuries can increase your risk of contracting

HIV. A good example is that of nurse, dentist or any health care worker that is exposed to contaminated needles or bodily fluids. Remember there are infections like hepatitis B that are highly contagious through a needle prick injury.

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Complete the table below, and indicate in which category these workplace injuries fall. Workplace

Level of risk (No risk, Low risk, high risk)citizen

Type of workplace injuries

Prevention strategy

Construction Management Nursing, Dentistry Hospitality industry Radiography Business Emergency Medical Services Education Engineering

Some other facts about HIV

Photocredit: AidsInfo (2017)

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Reflection What did I learn from this chapter?

Looking forward My plan of action List the three most important actions you can take to make a difference at your campus community. 1. I can

2. I can

3. I can

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REFERENCES Aidsinfo. 2017 HIV Life Cycle. https://aidsinfo.nih.gov/education-materials/glossary/814/budding [22 March 2017] Jenkins J. 2001. The dynamics of Icebreakers. Available: http://www.albany.edu/cpr/gf/resources/Icebreakersand-Introductions.htm[24Mar17)

useful resources World Health Organisation website: http://www.who.int/hiv/en/ UNAIDS website: http://www.unaids.org/ HIV replication- https://www.youtube.com/watch?v=mzfnxCEsck4 HIV infection & prevention- https://www.youtube.com/watch?v=Eqxu3jjh3LE Blesser phenomena- https://youtu.be/nKA7FLYc-GM 2015 Peer Educator Conference https://www.youtube.com/watch?v=Cyv77cS7UPg 2016 Peer Educator Conference https://www.youtube.com/watch?v=RUmVDDoDBMk Avert. https://www.cabsa.org.za/book/export/html/1098

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Stigma and Discrimination THE AIM of this chapter IS: • • •

to create an awareness of stigma and discrimination; and to expose students to possible situations/scenarios of discrimination to display various platforms in which stigma and discrimination can take place

People can be stigmatized or discriminated against for various reasons. In most cases, this stigmatization or discrimination occurs when a person presents with a physical, emotional, spiritual or moral difference when, compared to the ‘norm’. The most instinctive thing for many people is then to see the other person’s difference as ‘abnormal’ and then discriminate against the person in wider circumstances beyond the situation where the original difference was noticed. Stigma and discrimination occur in different forms and can be practised on various platforms, like at work, in school and in sports teams. Stigma occurs when a person or a group of people are devalued because they are associated with a certain disease, behaviour or practice. The effects of these can be even worse for groups who are already marginalized because of their gender, sexuality, ethnicity, or their substance abuse. Often, those who stigmatize people living with HIV falsely believe that the virus is highly contagious and that they could easily become infected. When that happens, others start to view people with HIV as a threat and, as a result, those living with the virus become isolated – within their homes, in public, or in their workplaces.

Activity: Think of a situation or scenario in your own life where you felt you were unfairly treated, then answer these questions: • What was the situation? • Did you have any control over the situation? • How did you feel when it occurred?

People living with HIV are further stigmatized by others’ assumptions about their moral integrity – such as the belief that they became infected with HIV because they chose to take part in risky behaviour. Because women are held to a different moral standard than men in many countries, women are often disproportionately blamed for the spread of HIV in their communities. In the end, stigma and discrimination undermine global efforts to prevent HIV transmission and provide care and treatment services to people living with HIV. Among marginalized or ‘key populations’ most at risk of HIV – like adolescent girls, men who have sex with men, sex workers, or people who inject drugs – stigma and discrimination impede access to and uptake of HIV services.

Roadmap to your social, mental and physical wellbeing

Stigma and discrimination also hinder people living with HIV from telling their partners about their status, for fear of being abandoned, ostracized or physically abused. Additionally, HIV-related stigma affects people’s ability to earn a living, making it even more difficult for people living with HIV to lift themselves out of poverty. Ultimately, stigma and discrimination infringe upon people’s basic human rights.

Analysing stigma against key populations MSM (Men who have Sex with Men) Stigmatized for: not getting married; not being a ‘real man’; being effeminate; using effeminate gestures; the way they speak; the way they dress; being different. Where? School; work; in the family; cafés and bars; religious spaces public ceremonies; local neighbourhood; police station; prisons. Why? Lack of understanding; fear of difference; cultural beliefs; religious beliefs; holding certain judgments about the difference; laws that punish same-sex acts. Effects: isolation; suicide; anger; unwanted or forced marriage; risk-taking; poverty; unemployment.

Where? Health facilities; family; community; workplace. Why? Fear; moral judgments; traditional beliefs. Effects: depression; loss of employment; suicide.

The different types of stigmatization External stigmatization is the way others regard People living with HIV (PLHIV). It is displayed through attitudes or actions aimed at PLHIV, including insults, rejection, avoidance, intolerance, stereotyping, discrimination, and physical violence.

Sex workers Stigmatized for: having multiple partners; earning money from sex; living a ‘reckless’ life; not conforming to societal norms. Where? Family; clinic; bars; in the streets. Why? Moral judgments; cultural beliefs. Effects: living a secret life; suffering violence; depression; children stigmatized; avoidance of attending the clinic; being ostracised from local community and society; no marriage prospects.

People who inject drugs Stigmatized for: being seen to be putting their lives in danger; being irresponsible. Where? Home; clinic; in public; school. Why? Fear that they are out of control; seen as not caring; seen as dangerous or rule-breakers. Effects: further drug use; increased vulnerability to risk-taking; isolation; avoidance of seeking treatment.

People living with HIV Stigmatized for: being ‘careless’; being ‘promiscuous’; being ‘immoral’.

Internalized stigmatization happens when PLHIV begin to believe the negative things that those around them say or think. It can also be seen as thoughts and behaviours resulting from the person’s own negative thoughts about him/herself based on his/her HIV status. Anticipated stigmatization is the anticipation or expectation that one will be treated differently or poorly because of the stigmatized identity of PLHIV as a group. Lastly, “courtesy stigmatization” is the stigmatization a person perceives or experiences due to his or her association with a stigmatized individual or group.

Stigma on top of stigma HIV-related stigmatization often happens together with other forms of social stigmatization as a result of race, gender and class-based inequalities, engaging in sex work, having non-normative gender identities or sexualities, religious persecution, xenophobia, drug use, mental and/or physical disability, disease, and so forth. This increases both the exclusion and devaluation of PLHIV leading to double or multiple stigma (i.e., “super-stigmatization”).

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Case studies of people living with HIV Vuyo Vuyo is 22 years old and has been with his boyfriend for the last two years. He has recently tested HIV positive and has decided not to tell his boyfriend yet. He has been given information about re-infection, and he also wants to protect his boyfriend, so he needs to start using condoms. However, he doesn’t know how to start talking to him about it.

Melissa Melissa is 19 years old and is the youngest member of a new support group for people living with HIV. She is keen to represent young people who are HIV positive, but feels that sometimes she is not taken seriously by older group members. She finds it difficult to speak in meetings when everyone talks loudly. Although she is thinking of leaving the group for this reason, she would rather stay involved in it because she cannot talk about HIV to her friends.

Ibrahim Ibrahim is 20 years old and is living with HIV. He was rejected by his family and has been selling sex to men in the capital city for the last nine months to make ends meet. He often attends group meetings for MSM led by peer educators from a local NGO, but he has not told anyone there that he is HIV positive. He wishes he could be more open and talk to someone about his situation, but does not know where to start.

Zahara Zahara is a 23-year-old sex worker who is HIV positive. She is taking antiretroviral drugs and is very healthy. She always uses condoms with her clients but not with her boyfriend, who refuses to use them. Zahara is now worrying that she may be pregnant. She does not know whether to tell her boyfriend, and wonders how she will survive if she needs to

Shaun Shaun is 20 years old and has recently found out that he is HIV positive. He has been seeing his new partner for just one month. He would like to tell his partner about the HIV result but is worried about what might happen. He is falling in love, and the thought of his partner leaving him has given him sleepless nights. He doesn’t know what to do.

• • •

• • • •

How can Vuyo start talking about condoms? Do you think Vuyo should tell his boyfriend about being positive? If so, how? If not, why not? If Vuyo lived in your area/campus, what types of services could Vuyo go to for support?

Why do you think the rest of the group do not take Melissa seriously? What tips could you give Melissa to help her be heard in the group? What particular issues do young people face when they are living with HIV that older people may not recognise? Are there any services available specifically for young people in your area?

He fears they may reject him from the group because he is HIV positive. • What do you think are some of the reasons that Ibrahim has not told anyone in his peer education group about being HIV positive? • What can NGOs do to help people in Ibrahim’s situation to be open about their status? • Are there any services in your area that could support someone like Ibrahim?

stop working as a sex worker. She doesn’t trust her boyfriend as he is unreliable. • Why do you think Zahara does not use condoms with her boyfriend? • What tips would you give Zahara to tell her boyfriend about being pregnant?

• • •

Do you think Shaun should tell his new partner about being HIV positive? If so, why? If not, why not? Do you know anyone who has been in this situation? If so, discuss. What role do you think NGOs or other service providers can play in supporting someone in Shaun’s situation?

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New bill to criminalise hate crimes and hate speech

Photo: Flickr.com/Alisdare Hickson

PARLIAMENT - Cabinet on Thursday announced it had given the green light for a new bill which would make hate crimes and hate speech criminal offences to be published for public comment. “The bill seeks to create the offences of hate crimes and hate speech and to put in place measures to prevent and combat these offences,” said Minister in the Presidency Jeff Radebe while briefing journalists on Wednesday’s fortnightly cabinet meeting. “The aim is to address the increasing number of racial incidents and to further address other types of criminal conduct motivated by bias, prejudice or intolerance in the form of hate crimes and hate speech, which have occurred in the recent past.” The bill, which was first drafted to only make provision for hate crimes, was later amended after several instances of hate speech via social media which caused an outcry among South Africans. This included KwaZulu-Natal real estate agent Penny Sparrow calling black people monkeys in a Facebook post which made headlines and saw dozens of complaints being lodged with the South African Human Rights Commission. The Prevention and Combating of Hate Crimes and Hate Speech Bill will create offences for several forms of discrimination, including on the basis of race, gender, sexual orientation, religion and nationality. Africa News Agency

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Social media and stigma and discrimination These days, social media and the Internet have taken over our daily lives. We display our thoughts and feelings about various issues on various platforms and put ourselves at risk of being labelled as sexist, homophobic, racist and generally insensitive towards other people. How you depict yourself on social media regarding various issues can be viewed as stigmatising of and discrimination against other people. Consider this example:

if they can learn to hate, they can be taught to love, for love comes more naturally to the human heart than its opposite.” Our way of life has become always to look at others and what they are doing wrong or to think, ‘That’s not normal’. It has become natural to seek the difference and abnormality in others for us which helps us to feel more ‘normal’. The question is, who decides what is normal and who determines who is normal? The solution and answer is very simple: it lies in the inclusion and acceptance of all in the human race. We should condition ourselves to thinking that it is actually abnormal to hate and discriminate against others based on the colour of their skin or any other personal trait. Indeed, it should be become more normal to love than to hate.

REFERENCES Brown , L., Trujillo,L., Macintyrye, K. (2001). Interventions to reduce HIV/Aids stigma : What have we learned?. Brown, L., Trujillo, L., Macintyre, K. 2001. Interventions to reduce HIV/Aids stigma: What have we learned? Louisiana: The Population Council Inc. Chiya, C., Chonta, M., Clay, S. & Hernandez, J. 2013. ‘Understanding and challenging HIV stigma: toolkit for action’. International HIV/AIDS Alliance. Goldbach, J., Amaro, H., Vega, W., Walter, W. 2015. The grand challenge of promoting equality by addressing social stigma. Grand Challenge for Social work initiative, working paper no. 18. Baltimore, MD: American Academy of Social Work and Social Welfare. Most recently, the news has been buzzing with cases where people expressed hate speech on various social media platforms. Most of these cases were racially inclined, but in so many cases, people utter hate speech towards LGBTI people and even people that are HIV positive. The consequence of these hateful acts can be legal prosecution and in most cases being suspended from one’s university, work or school. No form of hate speech can or must be tolerated and we should all come to terms with the reality that we live in a diverse and multicultural country.

Conclusion Nelson Mandela once said: “No one is born hating another person because of the colour of his skin, or his background, or his religion. People must learn to hate, and

Smita, P., Brady, M., Carter, M., Fernandez, R., Lamore, L., Meulbroek, M., Ohayon, M., Platteau, T., Rehberg, P., Rockstroh, J. & Thompson, M. 2012. HIV-related stigma within communities of gay men: a literature review. Aids Care, 24(3-4): 405-412. https://www.ncbi. nlm.nih.gov/pubmed/22117138 [5 April 2017]. doi: 10.1080/09540121.2011.613910

Useful RESOURCES http://www.enca.com/south-africa/new-bill-to-criminalisehate-crimes-and-hate-speech http://www.dispatchlive.co.za/news/2017/03/12/yusufambramjee-lays-criminal-charges-man-hate-speechsocial-media/ http://www.theguardian.com/world/2013/dec/22/pr-execfired-racist-tweet-aods-africa-apology

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Sexual Diversity THE AIM of this chapter IS: • • •

To create a sense of inclusivity amongst the student population To create an understanding of all aspects of sexual diversity To establish sensitivity amongst students in regards to the LGBTIQA community

‘Sexual diversity’ is an inclusive term that encapsulates various sexual orientations, identities and sexual relationships. It is an umbrella term that gives understanding and meaning to your gender, sexual preferences and how you engage sexually with others. Every person has their own sexual identity that is made up of a combination of three inter-related factors – biological sex, sexual orientation and gender. These factors combined determine the sexual identity of a person.

Biological sex Male (InterseX) Female Most people are born biologically either male or female. However, even biologically, there are exceptions when people are born intersex. This means they are born either of indeterminate sex (with male and female genitals or undeveloped genitals) or are affected by hormonal conditions due to internal ovarian tissue (in boys) or testicular tissue (in girls). Most often, surgical intervention gives intersex individuals a female genital identity, as this is often easier than constructing male genitalia. Intersex does not indicate a specific sexual orientation – it reflects biological features. An intersex person may be heterosexual, homosexual or bisexual.

women. Gender concerns men and women, including conceptions of both femininity and masculinity. The difference between ‘gender’ and ‘sex’ is that the latter refers only to biological differences. Gender does not mean focusing solely on women or females, but rather on the inequalities between males and females, and should not be confused with feminism or women’s studies. Analyses of gender differences often show a disadvantaged and weaker position of women and girls in social, political, economic, legal, educational and physical issues. This is why there is a tendency for gender discussions and interventions to focus on correcting these imbalances by specifically targeting women and girls.

Gender identity FEMININE (TRANSGENDER) MASCULINE Gender identity relates to cultural customs and social roles. Gender roles are socially defined and will determine acceptable behaviours and roles for women and men. In patriarchal societies, a masculine gender identity usually assumes relative power over a feminine gender identity.

Gender ‘Gender’ refers to the socially-constructed roles of and relationships between men and

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Activity: Act like a man … Act like a woman! List all the characteristics and behaviours society expects from men and women: MEN

WOMEN

After doing the above activity please discuss the following questions: • Could it be difficult for a woman to be expected to behave in this manner? Why? • What emotions are women not allowed to express? • How can social norms and expectations to “at like a woman” have a negative impact on a woman’s sexual reproductive health? Can women actually live outside the box? Is it possible for women to challenge and change existing gender roles?

Sexuality Sexuality is an expression of who we are as human beings. It includes all our thoughts, behaviours and feelings of being male or female, of being in love and attracted to particular people. This includes being in a relationship, being intimate and having sexual contact with another person. The concept of sexuality begins before birth and is determined by various influencing factors within your life. A person’s upbringing, including their morals, values, religion and culture, has a huge impact on the way somebody expresses themselves sexually.

Sexual orientation The basic model of sexual orientation is that people are heterosexual or homosexual – heterosexual means sexually and emotionally attracted to people of the opposite sex and homosexual to the same sex. HETEROSEXUAL (BISEXUAL) HOMOSEXUAL

Over time, everyone knows whether they are mainly sexually attracted to people of the same or the opposite sex. This usually happens by adulthood, but it may shift over time and some individuals may never be certain. A significant number of people, irrespective of culture or social norms, may be sexually attracted to people of both sexes. This is often referred to as being bisexual. Such people may form long-lasting, intimate and loving relationships with people of either sex.

Roadmap to your social, mental and physical wellbeing

Sexual identity and orientation Transgender people challenge traditional cultural concepts of gender and experience a conflict between their biological sex (usually assigned at birth) and their

gender identity. For example, a man who is transgender may choose to dress as a woman or to assume a lifestyle generally associated with being female. Being transgender does not define the person’s sexual orientation and a transgender person may be attracted to either men or women, or both.

Things to remember: •

People may or may not express their sexual orientation/ identity in their behaviours, sexually or otherwise. YOU CAN NEVER ASSUME ANOTHER PERSON’S SEXUAL ORIENTATION;

•

Some people may regularly have sex with others of the same sex, without seeing themselves as lesbian or gay or bisexual (whether due to cultural, religious or personal reasons);

•

Gender identity/ presentation has got nothing to do with being lesbian or gay. Most lesbian women consider themselves as women and, similarly, most gay men consider themselves to be men;

•

Do not assume that when a man is feminine and subscribes to certain female gender roles that he is gay, or when a woman is masculine and subscribes to certain male gender roles that she is lesbian. GENDER ROLES DO NOT DEFINE SEXUAL ORIENTATION;

•

Being transsexual has got nothing to do with being lesbian or gay. Transsexual people can be heterosexual, lesbian, gay or bisexual;

•

Intersex is a biological variant and NOT a sexual orientation, nor does it refer to sexual behaviour.

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My friend/family member has come out as lesbian/gay/bisexual Think about how you felt about them before they told you - ask yourself why this would change just because they are attracted to people of the same gender or both genders. Who they are attracted to doesn’t change who they are as a person.It’s okay to let the person know that it might take you time to get used to the idea, but that you will do your best to support them. It’s also okay to ask questions, as this shows that you are taking them seriously. At the same time, try and be sensitive about how they are feeling – it’s not easy coming out to someone close to you. Sometimes it can be easy to dismiss a young friend or family member who comes out as ‘just going through a phase’ – but most people who come out have put a lot of thought into it before telling someone, so it is important to take it seriously. Try and let the person explore their sexuality without trying to change or pressure them. Understanding gender and sexuality can become a complicated and overwhelming endeavour. We form opinions and decisions based on our learned experiences and the norms to which we have been exposed. Gender, as well as sexual expression, in most cases is a taboo subject that gets overlooked, hence not many of us have a point of reference or understanding when it comes to these aspects of human nature. The best way to try and understand these concepts is to break them down into simple categories, see illustrations opposite.

Roadmap to your social, mental and physical wellbeing

LGBTQIQ ( Lesbian, Gay, Bisexual, Transsexual, Queer, Intersex and Questioning) Terms and definitions Please note that the following terms and their definitions are not necessarily universally accepted. Variations exist both within and outside LGBTQIQ communities in the usage and interpretation of these terms. The following list of terms and definitions is taken from the Georgia State University and University of Georgia Safe Zone Facilitator Manual Term

Definition

Sexual Identity

This is how we identify ourselves. Such labels include lesbian, gay, bisexual, pansexual, straight, heterosexual, etc. This term refers to a person’s emotional, physical, romantic and sexual attraction.

Gay

Generally, this term refers to a male who is physically, emotionally, and/or spiritually attracted to other males. It may also refer to females who are attracted to other females. It is also sometimes considered an umbrella term.

Lesbian

A female who is physically, emotionally, and/or spiritually attracted to other females.

Bisexual

A person who is physically, emotionally and/or spiritually attracted to persons of the same or opposite sex.

Heterosexual

A person who is sexually, emotionally and/or spiritually attracted to member(s) of the opposite sex.

Questioning

A term used to describe an individual who is not yet certain of their sexual identity.

Asexual

A person who does not desire intimate emotional and/or sexual relationships with other people.

Pansexual (Omnisexual)

An individual who is sexually, emotionally and/or spiritually attracted to people, regardless of their gender identity or biological sex. This individual could be open to someone who is male, female, transgender, intersex, or GenderQueer.

Down Low

A label adopted by some African Americans to describe men who seek same sex relations but do not necessarily identify themselves as gay or bisexual.

Closeted

The opposite of being “out,” meaning that one’s sexual identity is concealed, or one is presumed to be heterosexual.

Coming Out

Generally, this denotes the act of telling someone that one is lesbian, gay, bisexual, transgender or another sexual identity.

Outing Someone

To declare someone’s sexual identity publicly without their permission.

Gender

A complicated set of sociocultural practices whereby human bodies are transformed into “men” and “women.” This refers to that which society deems “masculine” or “feminine.”

Gender Expression

This refers to an individual’s characteristics and behaviours, such as appearance, dress, mannerisms, speech patterns and social interactions that are perceived as masculine or feminine.

Drag Queen

A term usually reserved for individuals who identify themselves as gay men and who cross-dress for entertainment purposes.

Drag King

A term usually reserved for individuals who identify themselves as lesbians and who cross-dress for entertainment purposes.

Cross Dresser

An individual who dresses in clothing that is culturally associated with members of the “other” sex. Most of these individuals are heterosexual and participate in this activity on a part-time basis.

Gender Identity

This is the individual’s internal, deeply felt sense of being male, female, or something other, or in-between.

Transgender

A range of behaviours, expressions, and identifications that challenge the pervasive binary gender system. This is an umbrella term that can be used to describe people whose gender expression is non-conforming and/or whose gender identity is different from their birth assigned gender.

Cisgender

This refers to the situation when an individual’s biological sex and gender identity match. For example, this term describes a woman who is born biologically female and identifies as a woman. It is used as the opposite of the term transgender.

Gender Confirming Efforts

This term is replacing ‘sex reassignment surgery’ (SRS) and covers the full range of measures individuals may select to confirm their gender identity. This term takes into account the number of procedures associated with transitioning, including genital surgery, breast augmentation or reduction, hysterectomy and hormone therapy.

Sex

This is our “packaging” and is determined by our chromosomes (XX for females and XY for males) and our external and internal genitalia. About 1.7% of the population can be defined as born with both biological aspects of both sexes.

Intersex

Formerly addressed as ‘hermaphrodites’, individuals to whom this term is ascribed are born with some combination of ambiguous genitalia. About 1.7% of the population can be defined as born with both biological aspects of each sex. Some individuals participate in a movement that seeks to halt paediatric surgery and hormone treatments that attempt to normalise infants into the traditional “male” and “female” roles.

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Term

Definition

Transsexual

This describes individuals who do not identify with their birth-assigned genders and sometimes alter or align their bodies surgically and/or hormonally.

Homophobia

This is an irrational fear and hatred of all those individuals who transgress, violate, or blur the dominant gender categories in a given society. These attitudes lead to massive discrimination and oppression against the trans, drag, and intersex communities.

Heterosexism

There is a discriminatory assumption that people are, or should be, attracted to the people of the other sex. This assumption circulates anti-gay attitudes by promoting a value system and stereotypes that appear to justify prejudice and discrimination.

Hate Crime

This is any criminal act in which the targeted individual is chosen simply because of his or her affiliation to a minority group. In some states, hate crimesarry an additional penalty beyond the standard penalty for assault, murder, etc…

Myths and facts about LGBTI People

pressure to be heterosexual. This is often at great cost to self, because basic feelings haven’t changed.

Being gay is contagious

Sexual orientation emerges for most people in early adolescence without any prior sexual experience; and some people report trying over many years to change their sexual orientation from homosexual to heterosexual with no success. For these reasons, psychologists don’t consider sexual orientation for most people to be a conscious choice that can be changed voluntarily. The American Psychological Association has made several official statements that conversion therapy is unethical.

Most LGB individuals were raised by straight parents. Sexual orientation is most likely determined by genetics.

Gay people recruit others to be gay Sexual orientation can’t be changed. Gay people are attracted to other gays. This myth may come from the fact that many gay people don’t come out until they older, when they meet someone to whom they are attracted. This doesn’t mean that they weren’t gay before, just that they hadn’t come out yet. Gay people do not sexually stalk straight individuals for casual sex. There are specific gender roles in gay relationships There are a variety of forms of gay relationships, just as heterosexual relationships. Sometimes there may be specific roles for each person, sometimes these roles are very flexible. Original butch/femme roles may have come from imitating heterosexual roles.

Gay men want to look like women and lesbians want to look like men Some gay men do enjoy wearing women’s clothes, but most don’t. Most conform to cultural expectations for men’s dress. Lesbians usually do not want to look like men. Their choice of dress is more often determined by comfort and, possibly, by rebelling against stereotyped ideas of what women should look like. Some lesbians enjoy dressing in very feminine clothing.

Gay people could change if they want to Research has repeatedly shown this is not true - that sexual orientation is something we are born with. Examples of people who claim to have changed their orientation usually indicate someone who has changed their behaviour in response to internal or external

Therapy could cure homosexuality Treatments that claim to cure homosexuality are just successful in coercing heterosexual behaviour - you cannot change a person’s inner feelings about their basic orientation.

People are gay because they were sexually abused Most people who were sexually abused do not take on a gay identity. Gay and lesbian people, just as heterosexuals, may have been abused, but this has no relation to their sexual orientation. Straight women who have been sexually abused by men may have difficulty relating to men, but this does not mean they are lesbians.

Gay people do not have stable or long relationships Even though gay and lesbian relationships do not have the social supports which heterosexual relationships have, many gays and lesbians form long-term, monogamous, stable relationships and consider themselves to have a lifetime commitment to each other. Many heterosexual people have trouble forming stable relationships; so do some gay, lesbian and bisexual people.

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Case studies: Understanding GENDER and sexual diversity

Caster Simenya

Caster Simenya is a well-known South African athlete who came under the public eye in 2009 for the questioning of her gender. According to media reports, Caster was subjected to a gender testing to determine whether she was male or female. The test that was ordered by the International Association of Athletes,

Rupaul Charles

Rupaul Charles is a famous drag superstar and is the face and founder of the television sensation, Rupaul’s

Caitlyn Jenner

Caitlyn Jenner was born as Bruce Jenner. Bruce Jenner was a typical male who identified as a heterosexual male who was attracted to females and subscribed to many dominant male activities and characteristics. Bruce Jenner was a well-known

determined that she was intersex, in other words considered as both male and female, a condition known as a sexual development disorder. This was a very difficult time that she said she prefer to forget and focus on the future. Caster grew up as a woman and married her female partner in 2017. In an interview with BBC Sport’s Smith, Caster says about the publics view of her: ‘I think they understand me as I am. I am not a fake. I am natural. I am just being Caster. I don’t want to be someone I don’t want to be. I don’t want to be someone people want me to be. I just want to be me. I was born like this. I don’t want any changes.”. Her gender identity did not determine her sexual orientation and Caster’s sexual attraction was not probed by her gender nor sex. This example gives us a clear understanding that sex and gender are two concepts that have a closer relation to one another and sexuality, while sexual orientation is a concept that strictly has to do with your attraction and sexual attraction towards another.

Drag Race. Rupaul was born a male and, as a child, subscribed to most activities and characteristics of the male gender identity. Rupaul also shows a different dimension of gender expression when he embraces his alter ego and drags into a female persona. This persona is not a permanent expression, but is seen as an artistic expression of gender. Rupaul identifies as a gay man when in and out of drag, as his gender is always male and his sexual attraction is towards the same sex. Rupaul’s gender expression teaches us that there are born males that at times express themselves as female but have no desire to make this a permanent arrangement and still embrace their masculinity and male sex.

athlete and enjoyed fast cars and sports in general. According to Bruce in a TV interview that, as a male, he overcompensated with his macho masculine activities owing to the internal conflict he had, longing to express himself as a female. He would secretly cross-dress but never openly exposed himself. In 2015, Brace decided to undergo gender re-affirming surgery to start his process to transition to become a female. He is now known as Caitlyn Jenner. Caitlyn Jenner is a female who is sexually attracted to females, the exact same sexual orientation as Bruce Jenner. From the case of Caitlyn Jenner, we can learn that heterosexual males can also have the desire to express themselves as females and, in some cases, they want to make this a permanent arrangement, so transition to become a female. Further, we also learn that your gender expression does not determine your sexual attraction and orientation, and these two concepts are totally independent from each other.

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Support services for young LGBTI people Students seeking support can contact the following organisations and community services Cape Town Triangle Project www.triangle.org.za (021) 686 1475

Northern Cape LEGBO Northern Cape (Kimberly) www.legbo.org (073) 626 3346

LGBTI religious groups Islam The Inner Circle (Cape Town) www.theinnercircle.org.za (021) 761 0037

Christianity Metropolitan Community Churches (Johannesburg, Cape Town, Pretoria) www.mccchurch.org.za

Judaism Jewish Outlook www.jewishoutlook.org.za (076) 215 8600

Forum for the Empowerment of Women www.few.org.za (011) 403 1907/(011) 403 1907

The Durban Lesbian and Gay Community and Health Centre www.gaycentre.org.za (031) 312 7402

Transgender information and support Gender DynamiX (Athlone) www.genderdynamix.org.za (021) 633 5287 Lesbian and Gay Equality Project info@equality.org.za (011) 487 3810/1 Gauteng

OUT Well-Being Pretoria www.out.org.za (012) 430 3272

The Gay and Lesbian Archives in Memory (GALA) www.gala.co.za (011) 717 4239

Coalition of African Lesbians www.cal.org.za (011) 4030 004 KwaZulu-Natal

The Gay and Lesbian Network (Pietermaritzburg) www.gaylesbiankzn.org (033) 342 6165/(033) 342 6500

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Conclusion Gender sex and sexuality has never been an easy topic to understand or comprehend. The best way to understand this is by focusing on the person as their sexuality or sexual orientation is just one aspect of the person. If all else fails, as South Africans, we should

always be mindful that we are governed by a constitution that stipulates all people living within the country will be treated equal and not discriminated against based on their race or sexual orientation etc. The diversity of our country includes all sexualities and sexual orientations and these individuals should feel safe and secure citizens of our progressive and inclusive country.

REFERENCES Adam, M., Bell, LA. & Griffin, P. 2000. Teaching for diversity and social justice. London: Routledge. Engender Health. 2001. Men as partners: a program for supplementing the training of life skills educators. Second ed. Johannesburg, South Africa. https://www.engenderhealth.org/pubs/gender/ppasa-manual.php [5 April 2017]. HEAIDS. 2010. HIV/AIDS prevention good practice: strategies for Public Higher Education Institutions (HEIs) in South Africa. Pretoria: Higher Education South Africa. Potgieter, C. & Reygan, F. 2014. Representations of LGBTI identities in textbooks and the Development of antihomophobia materials and a training module. In Francis, D. (ed.), Sexuality, Society & Pedagogy, 97-107. Bloemfontein: SUN MeDIA. Boseley, S. 20 August 2009. What determines Caster Semenya’s sex? The Guardian. https://www. theguardian.com/world/2009/aug/20/what-sex-is-caster-semenya [10 April 2017] Layng, K. 11 January 2016. RuPaul Andre Charles. Prezi. https://prezi.com/vheoqoq0qocc/rupaul-andrecharles/ [10 April 2017] Smith, B. 20 May 2015. Caster Semenya: ‘What I dream of is to become Olympic champion.’ BBC Sport. Athletics. http://www.bbc.com/sport/athletics/32805695 [10 April 2017] Yaniv, O, 10 September 2009. Caster Semenya, forced to take a gender test, is a woman...and a man. Daily News. http://www.nydailynews.com/news/world/caster-semenya-forced-gender-test-woman-manarticle-1.176427. [10 April 2017] Weisman, A. 25 April 2015. Bruce Jenner: ‘I’m not gay, I’m heterosexual.’ Business Insider. http://www. businessinsider.com/bruce-jenner-im-not-gay-im-heterosexual-2015-4 [10 April 2017]

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Men’s Health The aim of this chapter is to encourage men to utilise various health services, including reproductive health services. It also will allow males to empower themselves to protect themselves against infections.

Introduction According to Kariem and Kariem (2008), the main driver of the HIV/AIDS epidemic in South Africa is sexual behaviour. Amongst men who are sexually active between the ages of 15 and 24 years, 23 % reported multiple partners. A growing body of evidence also suggests that men are far less likely than women to access HIV services. Men’s reluctance to use these HIV services significantly undermines prevention and treatment efforts (Peacock, et al., 2008). Sexual behaviour is shaped by personal, interpersonal, environmental, cultural and structural forces. During a survey by Kariem and Kariem in 2008, they found that 43% - 80 % of females and males had not used a condom during their last sexual activity. The HIV/AIDS pandemic demands that both males and females should take responsibility to stem the tide of the spread of HIV/AIDS.

The empowerment of men The Higher Education HIV/AIDS Programme (HEAIDS), in collaboration with other stakeholders like the South African National AIDS Council (SANAC), the Department of Health, the Department of Higher Education and Training, USAID/PEPFAR, CDC, Johns Hopkins Health and Education in South Africa (JHHESA), Sonke Gender Justice, UNICEF, IDMT, the United Nations

System in South Africa and more than forty other civil society partners working in the field of HIV prevention and Health, has embarked on a national programme across all universities and TVET colleges to reach out to all male students.

The goal is to: • Empower males to take responsibility regarding high risk sexual behaviour associated with multiple and concurrent sexual partners, and alcohol and drug abuse; and • Promote HIV testing • Other important issues that would be addressed through these empowerment campaigns, are gender-based violence, male involvement in Prevention Mother to Child Transmission (PMTCT), and healthseeking behaviours in general.

The campaign used Interpersonal communication, Mass Media and Advocacy to reach its audiences. Television and the medium of radio and print media were also utilised. Other activities included advocacy initiatives targeting all levels of government, traditional leaders, civil society, faith-based and opinion leaders within communities around social constructions of men and male responsibilities (HEAIDS, 2013).

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Why is men’s health so important? The following factors contribute to men’s health, besides the biological factors that constitute who men are: • • • • • • • •

•

The health of men and boys cannot be separated from the ideas of what it means to be a man; Men’s health and wellness does not receive enough attention; Men take the decision regarding their sexual partners; Men decide on multiple sexual partners; Men as well as women report men’s resistance to the use of condoms; Men as well as women report men’s resistance to HIV testing; Cultural and traditional ideas impact on behaviour modification and lifestyle management; Alcohol and substance abuse influence men’s attitude regarding sexual behaviour, particularly intimate partner violence; and Men do not always show interest in family health issues.

•

The normal permeability and function of the membranes that surround cells.

A diet high in saturated fats tends to increase blood cholesterol levels, whereas a diet high in unsaturated fats tends to lower blood cholesterol levels. Although some cholesterol is obtained from the diet, most cholesterol is made in the liver and other tissues. The treatment of elevated cholesterol in the blood involves: • Diet • Weight loss • Regular exercise • Medication Important to know: • Check your cholesterol regularly, beginning at age 18 years and thereafter every 5 years; • Control your blood pressure. Regular exercise, at least 30 minutes daily, plus a reasonable diet intake containing low fat and enough fibre, will control your cholesterol and high blood pressure. Also, consume more vegetables and fruit; • Do not smoke! Both cigarettes and other smoked substances are harmful.

Common Health Issues The following are common physical and mental health ailments that are prevalent in men. It is however important to know that these conditions are not only limited to men.

Physical ailments High cholesterol “Cholesterol is a compound of the sterol type found in most body tissues. Cholesterol and its derivatives are important elements of cell membranes, but high concentrations in the blood are thought to promote certain health related conditions. Cholesterol is associated with an increased risk for heart and blood vessel disease. Cholesterol is essential to: • The formation of bile acids, vitamin D, progesterone, estrogens (estradiol, estrone, estriol), androgens (androsterone, testosterone), mineralocorticoid hormones (aldosterone, corticosterone), and glucocorticoid hormones (cortisol).

Diabetes This is one of the silent killers in men (WHO, 2016) because diabetes does not present with symptoms immediately, but can take a long period to manifest. Eventually blood sugar levels increase and finally spill over into the urine. The following are the most common symptoms to look out for: • Extensive thirst • Erectile dysfunction • Frequent or increased urination • Staying hungry, even after having had a meal • Feeling tired all the time • Blurry vision • Sores or cuts that takes very long to heal • Unintended weight loss • Irritability and mood swings Consult your doctor or campus health clinic immediately, if you have some of these symptoms continuously.

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Lung cancer This remains a threat to men’s health. It is a terrible disease. It grows and spreads early, even before it grows large enough to cause symptoms or even before it can be seen on an X-ray. Lung cancer is generally more common in men. Tobacco is the single biggest cause of cancer. A high intake of alcohol has also been known to contribute to throat, liver, mouth and breast cancer. Lung and testicular cancers are most common in men.

Risks factors are as follows: • Tobacco use • Alcohol use • Unhealthy diets • Lack of physical activity • Infections from Hepatitis B and C and the Human Papilloma Virus

Testicular cancer This cancer is more common in younger men aged 18 to 35. All men should do a self-check once a month after a bath or shower. This type of cancer is curable when detected early. Here’s what to do: Step 1: It’s best to do a TSE during or right after a hot shower or bath. The scrotum (skin that covers the testicles) is most relaxed then, which makes it easier to examine the testicles. Step 2: Examine one testicle at a time. Use both hands to gently roll each testicle (with slight pressure) between your fingers. Place your thumbs over the top of your testicle, with the index and middle fingers of each

Lumps or swelling may not be cancer, but they should be checked by your doctor as soon as possible. Testicular cancer is almost always curable if it is caught and treated earl (Figueroa, 2016). Prostate cancer is one of the leading cancers in men. Early diagnosis can assist in the successful treatment and beating of the disease.

hand behind the testicle, and then roll it between your fingers. Step 3: You should be able to feel the epididymis (the sperm-carrying tube), which feels soft, rope-like, and slightly tender to pressure, and is located at the top of the back part of each testicle. This is a normal lump. Step 4: Remember that one testicle (usually the right one) is slightly larger than the other for most guys — this is also normal. Step 5: When examining each testicle, feel for any lumps or bumps along the front or sides. Lumps may be as small as a piece of rice or a pea. Step 6: If you notice any swelling, lumps, or changes in the size or colour of a testicle, or if you have any pain or achy areas in your groin, let your doctor know right away.

Visit your nearest clinic or student health service should you experience the following symptoms: • Blood in the urine • Needing to urinate more often than usual • Weak or interrupted urine flow • Pain or burning feeling while urinating • Unable to urinate • Constant pain in the lower back, pelvis and upper thighs

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Mental ailments Depression and suicide Clinical depression is the more severe form of depression, also known as major depression or major depressive disorder. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure. This low feeling and lack of self-worth can cause a disturbance in your entire body and mind. Common complaints include: • Depressed mood; • Loss of interest or pleasure in activities you used to enjoy; • Lack of energy and fatigue; • Feelings of guilt, hopelessness and worthlessness. Suicide prevention Suicide doesn’t just happen without symptoms: a person may talk to a friend about taking his/her life. If you think you might be depressed, reach out to any friend, your doctor, student health or counselling on your campus. If you think someone is at immediate risk of selfharm or hurting another person, do the following: • Call 911 or your local emergency number; • Stay with the person until help arrives; • Remove any guns, knives, medications, or other things that may cause harm; • Listen, but don’t judge, argue, threaten or yell. If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255. Referral Sources: National Suicide Prevention Lifeline Substance Abuse and Mental Health Services Administration Alcohol and substance abuse Although this is a problem that is common among men, it is important to note that this is not limited to men only. In the Prevention of and Treatment for Substance Abuse Act, 2008 (Act No. 70 of 2008) “substances” means chemicals, psychoactive substances that are prone to be abused, including tobacco, alcohol, over the counter drugs, prescription drugs and substances listed in the Drug and Trafficking Act, 1992 (Act No. 140 of 1992).

Substance dependency When it becomes difficult or impossible for someone to stop taking a substance without help after having taken it regularly for a period of time, the person is known to be substance dependent. Dependency may be psychological, physical or both. According to the South African Department of Social Development: • Approximately 270 991 South African citizens are problem drug users exclusive of alcohol and a further 1.97 million citizens are problem alcohol users. A higher number of citizens who use substances have serious health and socioeconomic problems. • Alcohol abuse is one of the biggest killers of South Africans and it costs the country R38 billion a year. South Africans (15 years and older) consumed an average of 8.2 litres of pure alcohol per annum which is well above the African continental average of 6.0 litres. • The problem of substance abuse can be attributed to a combination of factors such as experimentation, boredom, peer pressure, lack of recreational facilities, being surrounded by people who abuse substances, poverty and unemployment. • Offenders sentenced for drug-related crimes represented 2% of the total sentenced offender population of 115 753 in 2009. There was a gradual increase in drug-related crimes in all provinces for 2012 -2013 whereas statistics for 2012-2013 show a 13% increase in drug related crimes across South Africa .

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Activity What are the most common substances used by youth in South Africa? What are the signs of substance abuse? What is the impact of alcohol and substance abuse?

See the interventions recommended by the Department of Social Development and give your opinion: • Not all students will be willing or able to benefit from programmes aimed at the prevention of substance abuse • The majority of students either do not use substances or are using moderately and we should build on that to influence others. • Social functions arranged for students should be carefully planned to reduce the abuse of substances. • Student leaders should set the example to other students in terms of their own use of substances. • Information sessions should be held to inform students on the dangers of substance abuse and to recognise illegal substances offered to them (pamphlets/ hand-outs could add value)

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• •

Skills development workshops should be held to teach students on how they should deal with stress and peer pressure on the campuses. Students should realise that their substance abuse patterns may influence their futures in a negative way. Enhance healthy lifestyles including sport and recreational activities On-going monitoring either by the hostel management or tutors could assist in cases whether treatment interventions are required Referral of students for professional assistance to those requiring treatment interventions Establishing of support groups for those who require support in maintaining sobriety.

For help contact your campus student counselling or call this 24 hour toll free number 0800 and SMS number 121314.

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Sexually transmitted infections (STIs) Besides HIV/AIDS, there are many other infectious diseases which all young men and women should be informed and educated about. These include all the following:

Syphilis (also known as “vuil siek”)

If you are sexually active and have any of these symptoms, visit your healthcare provider: Vaginal or penal discharge Foul smell Ulcer or sores in or around the vagina, penis or anus Difficulty in urinating Itching in the genital area (penis, vagina, anus)

have any symptoms! Both gonorrhoea and chlamydia are spread by coming into contact with the discharge. Both gonorrhoea and chlamydia can be transmitted from genitals to mouth and from mouth to genitals during oral sex that is unprotected. If a woman is not treated for either of these diseases, it could lead to a severe infection in her reproductive organs which could cause infertility.

Images: MedicineNet (2017)

Symptoms: • Losing patches of hair • Losing eyebrows • A rash on the body (anywhere on the body)

Other symptoms are: • Men and women often complain of a vaginal or penal discharge; • Frequent urination, or burning when they urinate; • In gonorrhoea, the discharge is often white; • In chlamydia, the discharge is usually clear.

Genital warts Gonorrhoea (Also known as “drop”)

Images: MedicineNet (2017) Images: MedicineNet (2017)

Symptoms: Gonorrhoea and chlamydia are both caused by bacteria and are easily treated. The symptoms of gonorrhoea and chlamydia are very similar. Very often, people infected with gonorrhoea or chlamydia may not

Some people only have one or two warts. When these growths are located directly in the genital area, they are usually soft-to-the-touch and can either be raised or flat. Most of the time, genital warts appear in moist areas (e.g., in or around the vagina, anus or groin or on the penis) and do not cause discomfort or pain.

Roadmap to your social, mental and physical wellbeing

Anal warts Anal warts (also called “condyloma acuminata”) are a condition that affects the area around and inside the anus. They may also affect the skin of the genital area (Lowne, 2016). • They first appear as tiny spots or growths, perhaps as small as the head of a pin, and may grow quite large and cover the entire anal area; They usually appear as a flesh or brownish colour; • Usually, they do not cause pain or discomfort and you may be unaware that the warts are present. Can I protect myself from getting sexually transmitted infections (STI’s)? The safest way to protect yourself from getting exposed to Human Papilloma Virus (HPV) or any other STD, is to use safe sex techniques: • Abstain from sexual contact with individuals who have anal (or genital) warts; • Since many individuals may be unaware that they suffer from this condition, sexual abstinence is safest; • Use condom protection; • Limit sexual contact to a single partner (this will reduce the contagious virus that causes warts); • Using condoms whenever having any kind of intercourse may reduce, but not completely eliminate, the risk of HPV infection, as HPV is spread by skin-to-skin contact and can live in areas not covered by a condom; • Be aware of a discharge and/or a feeling of a lump or mass in the anal area.

Pubic lice

other coarse body hair, such as hair on the legs, armpits, moustache, beard, eyebrows, or eyelashes. Lice found on the head are generally head lice, not pubic lice. Signs and symptoms of pubic lice: • Signs and symptoms of pubic lice include itching in the genital area and visible nits (lice eggs) or crawling lice; • Pubic lice usually spread through sexual contact and are most common in adults (WebMD Partners in Health, 2016). Pubic lice found on children may be a sign of sexual exposure or abuse. Pubic lice may be spread by close personal contact or contact with articles such as clothing, bed linens, or towels that have been used by an infected person.

Treatments of Sexually Transmitted Infections Do not try to treat an STI yourself. These diseases are contagious and serious. You must seek medical advice. Bacterial STIs can be cured with antibiotics. Viral STIs cannot be cured, but you can manage symptoms with medication. There is a vaccine against hepatitis B, but it will not help if you already have the disease. If you are given antibiotics to treat an STI, it is important that you take all of the medication prescribed to you, even if the symptoms go away. Also, do not take someone else’s medication to treat your infection as it may make it more difficult to treat.

Here are some specific treatments: HIV/AIDS: Since HIV is not curable, treatment focuses on keeping HIV levels in check. Antiretroviral drugs are the standard therapy for HIV infection, and usually you will be given several drugs to take, a so-called drug “cocktail.” Talk to your doctor about when you should begin antiretroviral therapy.

Images: MedicineNet (2017)

Pubic lice (also called crab lice or “crabs”) are parasitic insects found primarily in the pubic or genital area of humans. Pubic lice may occasionally be found on

Chlamydia and gonorrhoea: These STIs are treated with antibiotics. You should begin taking them if tests show you have the infection or if you have been exposed to it, even though you may not have symptoms. Your sexual partners will also have to be treated, regardless of whether they have symptoms. Certain strains of

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gonorrhoea have become resistant to some antibiotics, so you may have to take more than one drug to fight gonorrhoea. Failure to treat these infections can result in permanent damage to your reproductive organs and a woman’s inability to get pregnant. Syphilis: Antibiotics are used to treat syphilis. Early treatment is crucial to prevent the bacteria from spreading to and damaging other organs. Genital herpes: Once you are infected with genital herpes, the virus remains in your body for life. After the first outbreak, herpes may flare up several times per year, but these flare ups may lessen over time. Antiviral medication such as Acyclovir can help reduce the length and severity of both the initial and subsequent outbreaks. If you have outbreaks often, you may want to use suppressive therapy. In suppressive therapy, your doctor prescribes medication for you to take every day, to prevent you from getting an outbreak (WebMD Partners in Health, 2016).

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• • •

strong - HIV cannot touch me!” Their belief that their partner/s (females) test regularly and they rely on this testing on which to base their standing; Men prefer to go to traditional healers for help; Men do not want to discuss their private lives with female health workers at the community clinics; They will not allow HIV to take away their status and power as a man.

Medical male circumcision (MMC) Traditionally, boys are circumcised without painkillers, while medical facilities use analgesics as well as certain hygienic protocols when conducting a circumcision. Nowadays, medical circumcisions are done throughout South Africa at health facilities such as clinics and hospitals giving more males the option to undergo medical male circumcision.

It is of utmost importance that you prevent these STIs, as they are also predisposing factors for HIV/AIDS.

Men and testing for Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) Images: TB/HIV Care Association (2017)

The fact that men are reluctant to participate in HIV, counselling and testing (HCT) means that men are over 30% more likely to die of HIV/AIDS-related infections than women. The following factors are known regarding why men are reluctant to test: • Fear that a positive diagnosis would compel them to change their lifestyle, which may include the consumption of alcohol, substance abuse and engaging in sexual activity with multiple partners; • Refusal or reluctance to consult with health care workers at health clinics; • Fear that health care workers will gossip about them; • Fear that the community might see them entering a health facility; • Fear that if they are tested positive, they would lose respect from other men in the same community; • The belief that “real men” do not use a condom and therefore do not get sick: “I am a man, I am

NATURAL PENIS

CIRCUMCISED PENIS

Images: Healthwise Staff (2016)

•

The MMC campaign is an important element of an increasingly comprehensive HIV/AIDS programme in the higher education and training sector

Roadmap to your social, mental and physical wellbeing

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that is being driven by the Higher Education HIV/ AIDS Programme (HEAIDS), which also champions HIV counselling and testing and other prevention, treatment and support services. Medical male circumcision is now firmly considered an effective HIV prevention measure, which reduces the risk of acquiring HIV by about 60%. Evidence shows that the inner skin of the foreskin is more likely to absorb HIV than any other skin, as it is more prone to small tears during sex. There are also cells within the foreskin that attract the HI virus (HEAIDS, 2013).

Benefits • Keeps the penis clean and maintains hygiene; • Reduces risks of infection by 60%; • Reduces risks from some STIs, particularly those that form wounds; • Prevents unretractable foreskin; • Prevents the problem of the foreskin being pulled back; • Prevents urinary tract infections; • Reduce the risks of penile and cervical cancer. Currently, the campus health clinic on the Bellville campus, offers this service and all men are encouraged to consult the nurse practitioner or the medical practitioner. For more information, contact your campus health clinic.

Gender-based violence and HIV The following are contributing factors to genderbased violence:

Alcohol and drug abuse • •

• • •

The abuse of alcohol and drugs often leads to violent behaviour; Violent behaviour can cause tremendous stress and conflict in families, particularly when money is spent on alcohol and substances instead of necessities; Arguments may finally lead to violence; and men in particular resort to violence in order to get their quick fix; Where men assume they have authority over women, women are made to feel inferior to men; When boys are reared as if they are superior to women, they can become abusive when this power is challenged by women;

•

Men/boys are therefore more likely to believe that it is okay to beat women and that they have the right to force them to have sex against their will.

Low self-esteem • • •

This develops when a person thinks that they are not valued or are less important than others; When people are at this level, they normally become very unhappy with themselves; This unhappiness may also lead to such people feeling insecure and they may resort to violent behaviour to gain power over others (to make them feel more powerful).

Poor anger management • • • •

Anger could be the cause of violent behaviour; Extreme anger is a learnt behaviour; It is important to learn how to manage anger and to deal with conflict appropriately; and Not to resort to violence to resolve conflict.

Jealousy • •

•

This is known to be a frequent cause of violence; If a man feels threatened by his partner’s achievements or her /his attraction to other partners, this may result in violent behaviour; Jealousy can be self-destructive and lead to murder or suicide.

Condom use Do you know the following facts? • That a condom is the only contraceptive that can prevent you from impregnating your partner? • That condom use if the only way to protect you from contracting STIs or HIV? • That the Choice condoms, provided by the state, undergo stringent tests by the South African Bureau of Standards to ensure that that they are safe and reliable; • That a condom can only be used once and then should be disposed of by wrapping it in toilet paper, before throwing it away.

It is important that condoms are being used correctly. The following illustrations will provide the steps for the correct usage/application of a condom.

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How to use a condom Activity A young male final year university student, Dan, lived ‘the good life’ as a student during his first three years. He indulged in excessive drinking of alcohol and smoking cigarettes. He also had multiple partners and was previously during his first and second year of studies, treated for STIs. For the last six months, Dan has been in a monogamous relationship with Tandi. He is now quite serious about looking after his health and sexuality, as he claims that he very much loves Tandi, a second year student. Both Dan and Tandi have visited the student health centre for Tandi’s contraception. Please answer the following questions: • What did Dan do to put himself at risk? • What should he and his partner do together to live a healthy and risk-free life? • What advice would you give Dan in order for him to look after his mental health as well?

Men, look after your health and keep your sexuality healthy!!!! Job Aids/Tools

REFERENCES Healthwise Staff. 2016. Circumcision. https://myhealth.alberta.ca/Health/pages/conditions. aspx?hwid=hw142449 [7 April 2017]. Kariem, S.S. & Kariem, Q. (eds). 2008. HIV/AIDS in South Africa. Cape Town: Creda Communications. Ghadgepatil, S.S., Gupta, S. Sharma, Y.K. 2015. Clinicoepidemiological study of different types of warts. Dermatology Research and Practice, Vol. 2016, Article ID 7989817, 4 pages. http://dx.doi. org/10.1155/2016/7989817 [7 April 2017]. Sharma, Y.K. 2015. Clinicoepidemiological study of different types of warts. Dermatology Research and Practice, Vol. 2016, Article ID 7989817, 4 pages. http://dx.doi.org/10.1155/2016/7989817 [7 April 2017]. WebMD. 2017. High cholesterol in men. HYPERLINK “http://www.webmd.com/men/guide/high-cholesterol” \l “1-1” http://www.webmd.com/men/guide/high-cholesterol#1-1 [7 December 2016]. World Health Organisation (WHO). 2016. Global report on diabetes. Geneva: World Health Organisation. http:// apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf [7 April 2017].

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Women’s Health Overview of chapter and learning outcomes This chapter will present issues related to women’s health, allowing you to explore and reflect on challenges that women face, and how women’s health can be improved, allowing you to achieve the following outcomes: • You will be able to identify the various challenges faced by women and their relevance in your own community and personal life; • You will be able to discuss relevant and appropriate interventions that can be applied to facilitate improvement of women’s health; and • You will be able to discuss the value of family planning for women’s health.

Introduction In many societies, including South Africa, girls and women are faced with many challenges that have a negative impact on their health. As a society, we have a responsibility to mitigate such challenges to enhance and improve the health of women and girls.

Challenges faced by women Activity What are the challenges particular to women in your community? Form a group of 5 members. Think of the community where you grew up, where you live/d, where you attended school (and attend university), and discuss the challenges that are particular to women and how these challenges can be addressed.

Challenge

How to address the challenge

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As you may have found in your discussion, women face a number of challenges, and many health needs for women are not addressed. In that regard, the World Health Organization (WHO) has noted ten top issues that are challenges for women, namely: cancer, reproductive health, maternal health, HIV, STIs, violence against women, mental health, noncommunicable diseases, being young, and getting old.

In your groups, relook at the activity on the previous page and the table below, and identify any issue that was not discussed. In addition, discuss further how each of the top issues identified as challenges for women affects women differently from men, and discuss more suggestions on how to mitigate such challenges.

Challenges

HOW THESE affect women

Suggestions to mitigate the challenge: Provision of:

Cancer

On an annual basis, about a million women are dying of breast and cervical cancers

Screening programmes: breast selfexamination & PAP smear; human papilloma vaccine.

Challenges related to women’s reproductive and maternal health (Limited access to contraception due to restricted availability or lack of awareness)

High risk of unsafe sex, unplanned pregnancy, disruption in studies, financial stress following unplanned and teenage pregnancy, etc.

Health education related to safe sexual behaviour; options for contraception, youth-friendly health services, provision of health care services, empowerment and mentoring of young girls, social support, etc.

Human Immunodeficiency Virus (HIV)

More women are infected with HIV; they carry the greater burden of HIV, higher risk of infection for young women, sexual violence against women, inability to negotiate for safe sex, delayed access to treatment, limited availability of female condoms

Health education related to safe sexual behaviour; empowerment and mentoring of young girls.

Sexually Transmitted Infections (STIs)

High rate of STIs among women, increase in stillbirth and neonatal death, emotional effects following stillbirth or neonatal death, increased risk of HIV infection, possible consequences on reproductive system

Health education related to safe sexual behaviour; empowerment and mentoring of young girls, youth friendly health services, provision of health care services

Violence against women

Physical and sexual violence, long-term consequences of the violence (physical, social, mental), increased risk of HIV and STIs, poverty if one decides to leave partner.

Empowerment and mentoring of young girls, youth-friendly health services, provision of health care services, social support, and community involvement in the fight against violence.

Roadmap to your social, mental and physical wellbeing

Challenges

HOW THESE affect women

Suggestions to mitigate the challenge: Provision of:

Disturbances in mental health (postnatal depression, suicide, substance abuse)

More women suffer mental health problems Increased vulnerability to abuse and engagement in unsafe behaviour, lack of selfesteem and self-confidence, difficulty coping with life, relationships, responsibilities; lack of motivation to better own life

Provision of screening service, including screening for post-natal depression, provision of support services, health education.

Non-communicable diseases

Mortality and morbidity related to malnutrition (obesity, anorexia, bulimia), lack of activity, smoking and substance abuse

Health education for healthy living, empowerment and mentoring of young girls, social support

Challenges associated with being young (bullying; peer pressure)

Possibility to being bullied with no resources to protect oneself, and resulting mental health problems, peer pressure to engage in unsafe sexual behaviour and resulting teenage pregnancy (annually, 13 million teenagers give birth) high risk of HIV and STI infections and violence, unsafe abortion, complications related to teenage pregnancy

Health education for healthy living, empowerment and mentoring of young girls, sexual and reproductive health, social support, career advice.

Challenges associated with getting old

Limited ability to look after themselves, their children and grandchildren, violence and abuse by younger family members, illnesses, and poverty.

Social support, community involvement, provision of health care services.

It is important to be able to identify potential and actual health problems for women, as well as the various challenges that can exacerbate their health problems. Furthermore, it is important to identify and minimise the impact of societal structures that can contribute to the worsening of women’s health. In addition to the identification of such health problems and contributing factors, one needs to implement interventions that will facilitate the improvement of women’s health.

Interventions to improve women’s health Recommended screening programmes for women Screening programmes are beneficial for the health of the population, as early diagnosis provides opportunity for early treatment which can result in the prevention of severe negative health outcomes for many of the health problems experienced. Breast cancer and cervical cancer are the

main cancers affecting women in South Africa, with an age-standardised incidence rate being documented at 41.5 and 31.7 per 100 000 women in 2012 for breast and cervical cancer respectively. Screening programmes for women include breast self- and clinical examination, PAP smear test, pregnancy test and HIV test. Breast cancer It is documented that, worldwide, about 1.67 million women developed breast cancer in 2012. Breast cancer is the most common type of cancer affecting women, and the burden is increasing. Early diagnosis of breast cancer increases survival chances. Monthly breast selfexamination facilitates early breast cancer diagnosis. For women who have no symptom or high risk of breast cancer, clinical breast examination (mammogram) should be done on an annual basis from the age of 40. Knowing the risk factors for breast cancer will facilitate awareness and breast self-examination practices. There are numerous risk factors for breast cancer, and each individual needs to assess her own risk.

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Activity Form a group of 5 and discuss each risk factor listed in the table below. Is there any risk that may be applicable to you or someone you know? Tick the risk that you can identify for yourself and for someone you know. Breast cancer risk

Explanation of the risk

Sex

Being a female. More women develop breast cancer than men, and it may be related to the oestrogen and progesterone hormones.

Age

As one grows older, the risk for breast cancer increases, e.g., about 75% of breast cancers occur after 50 years of age.

Family history

If a family member has had breast cancer, a women’s breast cancer risk is doubled. The closer the relationship (mother, sister), the higher the risk. About 5% to 10% cases of breast cancer cases are hereditary

Breast density

Dense breasts (having less fatty tissues and more glandular and fibrous tissues) have an increased risk of breast cancer.

Benign breast conditions

Any medical illness related to the breast: conditions such as cysts and infection of the breast, have an increase risk, due to related cell abnormalities

Being overweight

Being overweight or obese is related to increased risk of breast cancer.

Pregnancy history

Not having had a child, or having a child after 30 years, is slightly related to increase in breast cancer risk.

Breastfeeding

Breastfeeding for about 2 years lowers the risk of breast cancer, and this may be due to reduced number of menstrual cycles. Many women are not able to breastfeed for very long time.

Lack of exercise

Lack of physical activity is related to increased risk of breast cancer.

Drinking alcohol

Increased alcohol consumption is linked to increased risk of breast cancer.

Hormone therapy

Use of oestrogen and progesterone therapy after menopause increases the risk of breast cancer.

Early menstruation Prolonged exposure to oestrogen and (before 12yrs) and progesterone hormones contribute to an /or late menopause increase in breast cancer risk (after 55yrs) Oral contraceptives

Use of oral contraceptives is associated with a slight increase in breast cancer.

Is it a risk for Is it a risk myself? for someone I know?

Roadmap to your social, mental and physical wellbeing

Breast self-examination One of the screening activities is breast selfexamination, and can be done by women themselves in the comfort of their homes. This can be done standing in front of a mirror first. The picture below shows the steps to follow when doing a breast self-examination:

Figure 8.1

SexInfo Online, 2013. Breast cancer

Warning signs for breast cancer When doing breast self-examination, the woman needs to know the abnormalities to check for. This will provide opportunity for early consultation with a health care provider who will continue with the required care. If you notice any of these symptoms depicted in the following pictures, you should consult a health care provider for further assessment:

Figure 8.2: Warning signs of breast cancer (Cancer Association of South Africa, 2016a)

Cervical cancer In South Africa, cervical cancer (cancer of the cervix) affects about 2% of women. Worldwide, in 2012 it was documented that cervical cancer was the 4th most common cancer and the 4th most common cause of cancer death in women. Considering that cervical cancer may progress to invasive cancer over a period of 10 to 20 years, having regular screening allows detection of abnormalities early enough to be able to prevent the cervical cancer from spreading. The screening is called a Pap smear, and should be done at least every three years for all women who are 25 years and older. The government services offer Pap smear screening for women aged 30 years at 10-year intervals, provided there are no additional risks. Cervical cancer is caused by the Human Papilloma Virus (HPV) and can be prevented through HPV vaccination for primary prevention for girls aged 9 years and can be given to women up to the age of 45 years. HPV is a group of more than 150 viruses that are related. HPV is sexually transmitted, and can be passed even when the infected person does not display any of the signs and symptoms. HPV has been documented as the most common STI around the world, for most sexually active people. The prevalence is higher in women under the age of 25 year, and the proportion is higher in women living with HIV. In South Africa, the National Department of Health has started school wide vaccination campaigns, and the HPV vaccine is offered free of charge to girls from Grade 4 to create immunity before they are exposed to the virus.

Warning signs for gynaecologic cancer • Abdominal vaginal discharge or bleeding • Pelvic pain or pressure • Abdominal and back pain • Passing urine frequently • Itching and burning of vulva • Changes in vulva colour or skin such as a rash, sores or warts

Risk factors for cervical cancer There are several factors that increase the women’s risk of getting cervical cancer. The table below highlights the risks, and you are required to reflect on whether the risk may apply to you or someone you know.

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Activity Looking at the following risk factors for cervical cancer, is there any risk that may be applicable to you or someone you know? Tick the risk that you can identify for yourself and for a person that you may know. Cervical cancer risk Having a Human Papilloma Virus (HPV) infection: some types of HPV are linked to cancers, and 2/3 of cervical cancers are reported to be caused by HPV 16 and HPV18 Having first full term pregnancy for women under 17 years, and first sexual encounter before age of 18 years Having many sexual partners Smoking tobacco products increases one’s risk: women who smoke are more susceptible to cervical cancer than women who do not smoke. Using oral contraceptives for longer than 5 years. It is documented that the risk goes back to normal after stopping for about 10 years Having a weakened immune system Poor economic status: some women may not be able to afford regular Pap smears or have limited access to screening and early treatment Sexual partners who have multiple partners or who participate in high-risk sexual activity Having three or more children. This is linked to continued unprotected sex, with increase in possible exposure to HPV Failure always to use barrier methods during sexual intercourse Ineffective management and treatment of sexually transmitted infections (STIs)

Is it a risk for myself? Is it a risk for someone I know?

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Family planning/ Contraception Having a child is considered a blessing for many people. That blessing comes with a lot of responsibilities and adjustments for the parents, especially for the mother who will carry the baby for 9 months. It is important that women can make plans related to the timing of having a child, to ensure physical, psychological, emotional and financial readiness. A woman needs to be physically mature to be able to deal with the physical stress that goes with being pregnant and childbirth. Many young girls who fall pregnant when they are still young and unprepared risk not being able to continue with their schooling, which keeps them in the cycle of poverty. Being able to provide for the needs of a child requires sufficient financial means and, when these are not available, the new mother’s well-being is compromised, in addition to the well-being of the baby. It is advised that women receive family planning services, so that they may plan their pregnancy in a situation that will promote good health. The provision of family planning services includes the provision of

Western Cape Government, 2016. Contraception

contraception. There are various contraception options: as a pill (tablet) that must be taken every day; as an injection that can be given every two or three months; as an implant that can provide protection for a period of three years; or as an intrauterine device. These methods basically work by changing the levels of oestrogen and progesterone in the body, thus preventing fertilisation and pregnancy, either by stopping the egg from fusing with the sperm, or making the uterine wall an unfavourable environment for implantation. All women should know that these types of contraception are available and provided for free in all public health care services.

Key concepts in this chapter Having completed this section, how will you explain the following concepts to your fellow student? CONCEPT

YOUR EXPLANATION

Breast clinical examination

Breast self-examination

Cervical cancer

Contraception

Pap smear test

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Reflection Having completed this section on Women’s Health, reflect on the most important aspects that you have learnt in this chapter and your action plan to improve women health. What did I learn from this chapter?

Looking forward My plan of action List the three most important actions you can take to promote women’s health 1. I can

2. I can

3. I can

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REFERENCES American Cancer Society, 2016a. Breast cancer. [Online] Available at: http://www.cancer.org/cancer/ breastcancer/detailedguide/breast-cancer-risk-factors. American Cancer Society, 2016b. What Are the Risk Factors for Cervical Cancer? [Online] Available at: https:// www.cancer.org/cancer/cervical-cancer/causes-risks-prevention/risk-factors.html [Accessed 16 March 2017]. Breastcancer.org, 2016. Breast Self-Exam (BSE): The Five Steps of a Breast Self-Exam. [Online]. Available at: http://www.breastcancer.org/symptoms/testing/types/self_exam/bse_steps [Accessed 5 December 2016]. Bustreo, F., 2015. Ten top issues for women’s health. [Online]. Available at: http://www.who.int/life-course/news/ commentaries/2015-intl-womens-day/en/ [Accessed 5 December 2016]. Bustreo, F., Knaul, F.M., Bhadelia, A., Beard, J. and Carvalho, I.A.D., 2012. Women’s health beyond reproduction: meeting the challenges. Bulletin of the World Health Organization, 90(7), pp.478-478A. Cancer Association of South Africa (CANSA), 2015. Fact Sheet on Breast Cancer in Women. [Online]. Available at: http://www.cansa.org.za/files/2016/09/Fact-Sheet-Breast-Cancer-Women-NCR-2011-web-Sept-2016.pdf [Accessed 15 March 2017]. Cancer Association of South Africa (CANSA), 2016b. Women’s health - Women and Cancer. [Online] Available at: http://www.cansa.org.za/womens-health/ [Accessed 6 December 2016]. Cancer Association of South Africa, 2016a. Women’s health - Breast cancer. [Online] Available at: http://www. cansa.org.za/files/2016/09/Womens-Health-Info-graphic-BREAST-ENG.pdf [Accessed 6 December 2016]. Centers for Disease Control and Prevention, 2014. Gynecologic Cancers. [Online] Available at: https://www.cdc. gov/cancer/cervical/basic_info/risk_factors.htm [Accessed 16 March 2017]. Centers for Disease Control and Prevention, 2016. Human Papillomavirus (HPV) - What is HPV. [Online] Available at: https://www.cdc.gov/hpv/parents/whatishpv.html [Accessed 29 January 2017]. Ferlay, J., Soerjomataram, I., Ervik, M., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., Parkin, D.M., Forman, D. and Bray, F., 2014. GLOBOCAN 2012 v1. 0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. 2013, Lyon, France: International Agency for Research on Cancer. Marie Stopes South Africa, 2016. Types Of Contraception & How They Work. [Online] Available at: http://www. mariestopes.org.za/types-contraception-work/ [Accessed 6 December 2016]. Mohamed, H.A.E.A., Ibrahim, Y.M., Lamadah, S.M., Hassan, M. and El-Magd, A., 2016. Application of the Health Belief Model for Breast Cancer Screening and Implementation of Breast Self-Examination Educational Program for Female Students of Selected Medical and Non-Medical Faculties at Umm al Qura University. Life Science Journal, 13(5), pp. 21-33. Ritcher, K., 2015. Implementation of HPV vaccination in South Africa. Pretoria: Public Health Association of South Africa, pp. 1-4.Available at: https://www.phasa.org.za/wp-content/uploads/2015/02/Richter_ Implementation-of-HPV_article-4.pdf [Accessed 22 January 2017] SexInfo Online, 2013. Breast cancer. [Online] Available at: http://www.soc.ucsb.edu/sexinfo/article/breast-cancer [Accessed 16 March2017]. Stewart, B. & Wild, C. P., 2014. World cancer report 2014, Lyon: World Health Organization. Western Cape Government, 2016. Contraception (family planning). [Online] Available at: https://www. westerncape.gov.za/service/contraception-family-planning [Accessed 22 January 2017].

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Gender-based Violence The aim of the chapter is to help you understand what gender-based violence (GBV) is, to introduce you to the various types of gender-based violence, to give you information which would help you to recognise when you are in a violent relationship, and to provide some guidance in terms of how to manage this type of situation.

Introduction

on Violence and Health (WRWV,2002:5), describes violence as follows: “The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal development or deprivation”

Alexas Fotos/ Pixabay Burundian Anglicans establish safe house for victims of gender based violence (2016)

The negative impact of violence on lives is indisputable. Violence is considered by most people to be limited to physical acts. This, however, is a misperception which can lead to many acts of violence being normalised or discounted. The World Report

The WRVH further divides violence into: • self-directed violence – Here the perpetrator and victim are the same, e.g., suicide, self-abuse. • interpersonal violence – This relates to violence between individuals e.g., child maltreatment, intimate partner violence, assault by strangers, etc. These individuals can be known to each other or they can be unknown. • collective violence –This relates to violence perpetrated by large groups of individuals.

Answer the following questions pertaining to GBV. What is gender-based violence? What does the term gender-based violence mean to you? What acts do you think would qualify as GBV violence?

Roadmap to your social, mental and physical wellbeing

Gender-based violence is the physical, sexual or psychological suffering of mostly a female partner, whether occurring in public or in private. This can include threats, coercion and/or deprivation of freedom.

Gender-based violence therefore forms part of the category of interpersonal violence. Some of the myths associated with gender-based violence (GBV) include: • Victims of GBV provoke the abuse through their inappropriate behaviour. • Most women are abused by strangers. Women are safe when they are home.

• • •

GBV happens only to poor and marginalised women. GBV is not common in industrialised countries. Men cannot control themselves. Violence is simply a part of their nature.

Regarding each of the above: 1: The tendency to blame the victim is precisely the kind of attitude that has the potential to cause harm to a survivor of violence. 2: Studies consistently show that most women who experience GBV are abused by people they know; often the perpetrators are those they trust and love. 3 GBV happens among people of all socioeconomic backgrounds.

Have you heard any of these myths? Which one/two have you heard most often?

Signs of an abusive relationship It is important to understand the difference between a healthy relationship and an abusive one. Here is a table which might help you to evaluate whether you are in an abusive relationship.

Do you…

Does your partner…

Feel afraid of your partner much of the time?

Humiliate or yell at you?

Avoid certain topics out of fear of angering your partner

Criticise you and put you down?

Feel that you can’t do anything right for your partner?

Treat you so badly that you’re embarrassed for your friends or family?

Believe that you deserve to be hurt or mistreated?

Ignore or put down your opinions or accomplishments/

Wonder if you’re the one who is crazy?

Blame you for their abusive behaviour?

Feel emotionally numb or helpless?

See you as property or a sex object rather than as a person?

Your partner’s violent behaviour or threats: does he/she …

Your partner’s controlling behaviour: does he/she …

Have a bad and unpredictable temper?

Act excessively jealous and possessive?

Hurt you, or threaten to hurt or kill you?

Control where you go or what you do?

Threaten to take your children away or harm them?

Keep you from seeing your friends or family?

Threaten to commit suicide if you leave?

Limit your access to money, the phone or the car?

Force you to have sex?

Constantly check up on you?

Destroy your belongings?

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The cycle of violence Research indicates that perpetrators of gender-based violence follow a similar pattern in the manner in which they perpetrate the violence within a relationship. The following diagram explains this cycle.

Various authors have categorised and described such violence. The United Nations General Assembly (1993), for example, divides this violence into physical, sexual, psychological and economic forms, with examples: Such behavior includes: • Physical: acts of physical aggression, such as slapping, hitting, strangling, kicking and beating • Psychological: isolation, verbal aggression, verbal abuse, intimidation, constant belittling and humiliating • Sexual: forced intercourse and other forms of sexual coercion, using threats, etc. • Economic: withholding funds, controlling victim’s access to health care, employment, etc. Examples: • Physical: slapping, kicking, burning, strangling; • Sexual: coerced sex through force, threats, etc.; • Psychological: isolation, verbal aggression, humiliation, stalking; • Economic: withholding funds, controlling victim’s access to health care, employment, etc.

Gals (2012)

Types of gender-based violence There are various types of gender-based violence. These will be discussed separately. Types of gender-based violence include: • Intimate partner violence (physical, sexual, psychological, economic) • Sexual coercion • Childhood sexual abuse • Rape • Trafficking • Female Genital Mutilation • Honour killings • Dowry deaths

(The United Nations General Assembly 1993)

Sexual coercion Heise, Moore and Toubia (1995:6) explain this:

… the act of forcing (or attempting to force) another individual, through violence, threats, verbal insistence, deception, cultural expectations, or economic circumstance to engage in sexual behavior against his or her will. As such it includes a wide range of behaviors from violent forcible rape to more contested areas that require young women to marry and sexually service men not of their choosing. Sexual abuse

(The United Nations General Assembly 1993)

Intimate partner violence According to Bott et al, (2005, 9) intimate partner violence can be defined as “Any behavior within an intimate relationship that causes physical, psychological or sexual harm.”

This is unwanted sexual activity, with perpetrators using force, making threats or taking advantage of victims not able to give consent. Most victims and perpetrators know each other. Immediate reactions to sexual abuse include shock, fear or disbelief. Longterm symptoms include anxiety, fear, or post-traumatic stress disorder.

Roadmap to your social, mental and physical wellbeing

Rape and rape culture

Photography: Chase Carter Everyday Feminism (2014)

Rape is a violent crime in which a person uses sexual acts to intentionally harm and hurt another. The Criminal Law (Sexual Offences and Related Matters Amendment Act, Act 32 of 2007) has been in effect in South Africa since 16 December 2007. This law states that it is a crime to intentionally commit a sexual act with another person without that person’s consent. The formal definition of rape that is presently used by our legal system is:

Any person who unlawfully and intentionally commits an act of sexual penetration with a complainant, without the consent of the complainant, is guilty of the offence of rape.

It is very important to understand what the word “consent” means. According to the law, even if you indicated consent to the rapist in some way, for example by saying ‘yes’ or by not resisting, there is no consent or permission granted to a sexual act under these circumstances: • • • •

if you are forced into a sexual act by violence; if you are drunk, drugged, asleep or unconscious; if you are younger than 12 or mentally challenged; if you are forced into consent by your boss, teacher or lecturer.

Rape culture Universities around the world have become instrumental in highlighting the issue of rape culture. ‘Rape culture’ is a term that was coined by feminists in the USA in the 1970s (WAVAW, 2017). The WAVAW website defines rape culture as: … a complex set of beliefs that encourages male sexual aggression and supports violence against women. It is a society where violence is seen as sexy and sexuality as violent. In a rape culture, women perceive a continuum of threatened violence that ranges from sexual remarks to sexual touching to rape itself. A rape culture condones physical and emotional terrorism against women as the norm … in a rape culture both men and women assume that sexual violence is a fact of life, inevitable – however, much of what we accept as inevitable is in fact the expression of various attitudes that can change. Rape culture is a setting in which rape is pervasive and normalised due to societal attitudes about gender and sexuality. The following behaviours are considered to be a part of rape culture: • Victim blaming, • Sexual objectification, • Trivialising rape, • Denial of widespread rape, • Refusing to acknowledge the harm caused by some forms of sexual violence • Or a combination of these. (WAVAW, 2017)

Rape culture is prevalent on South African university campuses.

How is a rape culture perpetuated in society and on university campuses? Read the following quote: ‘Rape culture includes jokes, TV, music, advertising, legal jargon, laws, words and imagery that make violence against women and sexual coercion seem so normal that people believe that rape is inevitable. Rather than viewing the culture of rape as a problem to change people in rape culture, think about the persistence of rape as ‘just the way things are’.

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Activity In your own words explain what consent means:

Some everyday examples: • Ridiculously lenient sentences for sexual assault; • People who believe that girls ‘allow themselves to be raped’; • Substituting the word ‘sex’ for ‘rape’ as if they are the same thing; • Sexual assault prevention education programmes that focus on women being told to take measures to prevent rape, instead of men being told not to rape; • Publicly defending celebrities accused of rape just because they are celebrities and ignoring or denouncing what the victim has to say. It is vital that we all work towards eliminating a rape culture in our environments and especially on our campuses. In the event that either you or someone you know is raped it is important to know what steps to take. The following is a guideline (Rape Crisis, 2017):

Steps to take after rape: 1. Go to a safe place as soon as possible; 2. Tell the first person you see and trust - take their name and number; 3. If you are badly hurt, go straight to the doctor or hospital - the police can be called to the hospital if you want to report the rape; 4. If you fear that you could have been exposed to HIV, it is important to receive medical attention within 72 hours; 5. Decide whether you want to report the rape to the police. You may not feel like making the decision so soon after the rape. However, the sooner a doctor examines you, the more likely she/he is to find evidence, like blood, bruising, hair, semen and saliva.

When reporting a rape: A few things to remember: • You have the right to speak to a female police officer; • There are officers from the Family Violence, Child Abuse and Sexual Offences unit (FCSU) who are specially trained to deal with rape incidents; • At some police stations, there is a Victim Support Room where volunteers from the community will take you. This is a private and safe space to make your statement; • It is advisable to bring a friend or family member along with you; • It is possible to report a rape, but not lay a charge. It is still very important for you to seek medical attention as soon as possible; • The police are not allowed to tell you to come back the next day - the police should take any survivor directly to a public health facility. If this is not done, call Rape Crisis immediately. When laying a charge, this is very important: • You need to preserve evidence of the rape, so • do not throw away your clothes, • do not wash yourself, • do not eat or drink anything; • Keep clothes and other evidence in a PAPER bag - plastic may destroy evidence; • If you need to use the bathroom, keep any toilet paper and other sanitary material; • If you were drugged, you need to have a blood and urine test within 24 hours; • No police officer can tell you that you cannot lay a charge, or that you do not hav enough proof you can lay a charge at any time as there is no restriction period for rape;

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Female genital mutilation • • •

An officer will investigate your case - he/she will be your investigating officer; Your case will be assigned a police case number, also called a CAS number; Make sure you get the name and contact details of the investigating officer.

This is the cutting, partial or total removal, of the external female genitalia for cultural, religious or other non-medical reasons. It is usually performed on girls between the ages of 4 and 10 and is also known as female circumcision (Unicef, 2016). Girls and women are subjected to health risks, which have life-threatening consequences, based on false beliefs that have nothing whatever to do with religious or medical teachings.

Recovery from rape It is recommended that you seek support from a counsellor, therapist, psychologist or services such as the Rape Crisis Centre and other support services.

“Blesser” relationships

It is important to realise that the feelings you experience after being raped are a completely natural response to a terrible event. You are not going mad, nor are you over-reacting - no matter who tells you so.

Human Trafficking

Photo: eNCA / Lenyaro Sello (2016)

The term “blesser” in South Africa has become synonymous with someone who blesses a partner with money and gifts. The Blesser is perhaps similar in many ways to the traditional ‘sugar daddy’ (Adams, 2016). This relationship essentially involves the exchange of sex and sexual favours for money/ gifts etc.

Getty images/Stockphoto (2015)

Human trafficking is a type of gender-based violence which is often not seen by the public as such. It refers to the recruitment, transportation, transfer, harbouring or receipt of persons by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power, or of a position of vulnerability, or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour (UNODC 2017)

How to get help when experiencing GBV The following guidelines have been suggested (CPUT Student Counselling Guideline, unpublished) For yourself: • Realise that help is available. Ask for it! Remember you are not alone! • Educate yourself regarding your rights. • If you think your life is in danger, don’t hesitate or question your sanity etc. ACT! • Develop a safety plan. • Get a protection order

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For a friend: • Don’t ignore ask if something is wrong. • Express concern • Listen and validate • Offer help • Support his/her decisions

If a friend approached you and asked for help with a boyfriend who was physically and sexually violent with her, what would you do to help this friend?

Don’t … • Wait for him/her to come to you • Judge or blame • Pressure him/her • Give advice • Place conditions on your support

Conclusion The topic of GBV is a complex one with many aspects which are never spoken about due to various reasons. It is hoped that by completing this chapter you, the student, will have a better understanding

of GBV, what constitutes GBV and what actions to take when you or a fellow student is confronted with this type of violence. Contact details for various organisations are provided below.

Places to get help and more information Rape Crisis Cape Town Trust Other resources related to Rape Crisis Observatory Counselling line

+27 (0)21 447 1467 +27 (0)21 447 9762

Athlone Counselling line

+27 (0)21 684 1180 +27 (0)21 633 9229

Khayelitsha Counselling line

+27 (0)21 361 9228 +27 (0)21 361 9085

Student Counselling Centres on the respective university campuses

www.rapecrisis.org.za rapecrisis.mobi info@rapecrisis.org.za @RapeCrisis on Twitter http://www.facebook.com/rapecrisiscapetown Lifeline Counselling line

021 4611111

Student Health Clinics on the respective university campuses

Roadmap to your social, mental and physical wellbeing

REFERENCES Adams, S. 2016. Blessers: a new generation of South African sugar daddies. The South African. http://www. thesouthafrican.com/blessers-a-new-generation-of-south-african-sugar-daddies/ [17 March 2017]. Sello L. 2016. Blesser Industry should be regulated. 17 July. Africa News Agency. http://www.enca.com/southafrica/blesser-industry-should-be-regulated [7 April 2017]. Bott, S, Morrison, A. & Ellsberg, M. 2005. Preventing and responding to gender-based violence in middle and low-income countries: a global review and analysis. The World Bank Policy Research Working Paper 3618. http://www.worldbank.org/en/search?q=Bott%2C+S%2C+Morrison%2C+A.+%26+Ellsberg.+2005&currentT ab=1 [7 April 2017]. Clowes, L., Shefer, T., Fouten, E., Vergnani, T. & Jacobs, J. 2009. Coercive sexual practices and gender-based violence on a university campus. Agenda: Empowering Women for Gender Equity, 80: 22-32. Department of Justice, South Africa. 2007. Criminal law (sexual offences and related matters), Amendment Act 32 of 2007. http://www.justice.gov.za/legislation/acts/2007-032.pdf [17 March 2017]. Gals. 2012. The cycle of abuse. www.galsusa.org/cycle-of-abuse.php [22 March 2017] Heise, L., Moore, K. & Toubia, N. 1995. Sexual coercion and reproductive health: a focus on research. New York: The Population Council. Pelser, A. & De Kock, C. 2000. Violence in South Africa: a note on some trends in the 1990s. Acta Criminologica, 13(1): 80-94. Saltzman, L.E., Fanslow, J.L., McMahon, P.M. & Shelley, G.A. 1999. Intimate partner violence surveillance: uniform definitions and recommended data elements. Version 1.0. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Rape Crisis: Cape Town Trust. 2017. The Road to Recovery: You and Rape. http://rapecrisis.org.za/wp-content/ uploads/2015/10/English.pdf [17 March 2017]. Krug, E.G., Dahlberg, L.L., Mercy, J.A., Zwi, A.B. & Lozano, R. (eds). 2002. The world report on violence and health. Geneva: World Health Organisation. http://www.who.int/violence_injury_prevention/violence/world_report/ en/ [22 March 2017] Ridgway, S. 2014. Everyday Feminism. 10 March. http://everydayfeminism.com/2014/03/examples-of-rapeculture/ [22 March 2017] Schneider, D. 2015. Human trafficking spreads through Wisconsin. http://www.greenbaypressgazette.com/story/ news/local/2015/06/06/human-trafficking-spreading-wisconsin/28573869/ [22 March 2017] United Nations: General Assembly. 1993. Declaration on the Elimination of Violence against Women, Article 1: 48/104 http://www.un.org/documents/ga/res/48/a48r104.htm [17 March 2017]. UNICEF. 2016. Current status and progress. September. //data.unicef.org/topic/child-protection/female-genitalmutilation-and-cutting/# Updated UNODC. 2017. https://www.unodc.org/unodc/en/human-trafficking/what-is-human-trafficking.html [22 March 2017] Alexas Fotos/ Pixabay. 2016. Burundian Anglicans establish safe house for victims of gender based violence. 2016. https://www.google.co.za/search?q=gender-based+violence+south+african+government+images

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Your Journey as a Tertiary Student After going through this chapter, you should: • • • •

be able to create clear goals for yourself understand the concept and importance of branding yourself understand the importance of gaining experience prepare your own curriculum vitae (CV)

Your chances of success at university will be greatly improved by having clear academic and personal goals. A successful senior student shared her story:

If you don’t know where you are going, you will probably end up somewhere else. Lawrence J. Peter

“By identifying and investing in my goals from day one, I achieved my degree in the three-year period. My marks for first year were in the 50s but this increased to 60s in the second year and included a few 70s in the final year. I am pleased that my plan worked for me.” The “YES YOU CAN” slogan will also help you to achieve this level of success if you put your mind to it. Identifying your goals is important, but certainly not enough. A goal without a clear plan of action is wishful thinking. Let us explore simple ways to make your dreams come true.

tip

Define your goals Think about exactly what you want to achieve and decide on a deadline for achieving these specific goals. It is important to be clear on which of your goals are short-term, medium-term and long-term. The next step is to write down all your goals to keep track of your progress. The SMART principle is a useful tool to ensure your goals are clear and realistic.

Roadmap to your social, mental and physical wellbeing

tip

Believe in your goals

tip

Plan the steps

Be clear on why these goals are important to you and how achieving them will improve your life. Identify the internal and external motivators for achieving your goals. Reflect on how much time and energy you are prepared to invest in achieving your goals.

Write down the steps to reach each goal: - the actions needed, with smaller manageable tasks; - resources and support systems you have in place; and - possible obstacles along the way and what you will do to address each. For example, a senior student would plan a balanced weekly timetable to allow for adequate time for working on assignments, preparing for tests, pre-reading for lectures, compiling lecture notes, relaxation and sleep. Clearly identify the number of hours per day you will invest in the various tasks. Then you can give it a test-run for a week to check if it is a realistic plan or not. If not, revise your plan to make it more manageable.

tip

Review your progress regularly You can have strikingly written goals laminated and pasted on your wall, but it will be of little value if you never read them. Regularly read your goals and the action plans to measure your progress. By reviewing your progress, you will determine whether you are on track or stagnating. If you meet your target results, acknowledge your accomplishments. If you are not making progress, reflect on why your targeted goals are not being met and what you can do to achieve them.

Consider joining a peer education programme or any other extramural programme at your institution where you get recognition for your contribution through obtaining a certificate that you can use to boost your CV.

Boosting your career prospects There was a time when having a degree guaranteed you a worthwhile job. Today, and for better or worse, that is no longer the case. We live in a time where previously obscure terms like Emotional Intelligence (EQ) and soft skills have become workplace needs; where job applicants need to display resourcefulness and ingenuity from the interview room onwards. Today’s young graduates and job seekers are having to provide more than just a certificate as an

Without goals and plans to reach them, you are like a ship that has set sail with no destination. Fitzhugh Dodson indication of their job worthiness. Today’s employers are looking for more. Of course, becoming a hot property in the job market requires a long-term investment in yourself and careful planning. Ideally, you should start working at it sooner rather than later.

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STUDENT GUIDE

The first question is, where does one start? Once you have a good idea of what industry or field you wish to enter, you need to take three important steps: •

•

Create a network of contacts and mentors who will help you position yourself within the industry or field that you are entering; Cultivate proficiencies that will make you stand out among the many graduates who will be applying for jobs at the same time as you; Gain experience that will enhance the knowledge that you are gaining in your chosen academic field.

Make connections One of the most important rules for any job seeker is to make connections. You are more likely to land a job through networking (it’s who you know) than by your credentials alone. Getting to know other students in your field, getting to know lecturers and professors, joining professional organisations, working part-time or volunteering in your field — these are all excellent ways to create opportunities for future jobs. Network with everybody.

strong, well-managed online presence not only allows you to connect with people of interest to you, but also tells prospective employers that you are an energetic, well-adjusted individual with good social skills. However, remember that what you publish on social media cannot be undone. It’s very important that you guard your personal reputation to ensure that no unwanted pictures or entries are attached to your sites or your name. Blogs are a great way of practising your writing skills and sharing your insights and thoughts about interesting subjects. Discuss your targeted industry frequently and, where possible, add helpful information. Understand the ethos of the new media environment: it‘s about adding value, sharing knowledge, skills and insights, and connecting with others responsibly. If you do this well, future employers will see you as somebody who has a passion for life-long learning and keeping up with trends, while also having the desire to share your knowledge.

Don’t make the mistake of thinking your peers can‘t contribute to your future success. Make sure your fellow students and friends are aware of your job plans. You might connect with a few that are interested in getting a similar job and can assist you in the process. This may lead to some competition, but you are more likely to gain than lose through sharing ideas and information. Impress your lecturers and get to know them through campus activities. Lecturers and professors are experts in their field, and are sources of great advice and sought-after references. Find a mentor. There are many people who wish to make a contribution to South Africa‘s young people. Connect with these kinds of people, ask them to mentor you and then spend a couple of hours a month with them. They will be able to give you advice about life, your studies and the direction in which you want to take your career.

Use the Internet Create a presence online by making use of social media like Twitter, Facebook and LinkedIn. A

While you are developing your writing skills, consider getting yourself published. You may have written a really good academic paper, so why not rewrite it for publication online or in a magazine? You may not be paid for it, but the value lies in building your profile and being noticed. Consider building yourself a simple website using one of the many freeware programmes available on the Internet. If you manage this carefully and keep it updated, it could be highly beneficial. Be careful, though, not to take any of this to the point where you come across as egocentric. Add the occasional podcast to your blog or website. Interviews with others in your industry provide great content for a podcast.

Roadmap to your social, mental and physical wellbeing

What was the key issue of this post?

What is your opinion of it?

Join a club One of the most powerful ways of connecting with other people is through hobbies, sports and cultural activities. The best way of doing this is to join an organisation, association or club. Find one that you can enjoy being a part of and use these events to find common ground with people. In almost every job application, you will be required to demonstrate your ability to work with others. A good way of doing this is to display your sportsmanship. This doesn‘t mean that you have to be an exceptional athlete. It simply means being part of a team that meets to play sport regularly. The same goes for the arts. There are numerous opportunities for artists and musicians to showcase their talents locally. Take part in community art exhibitions or play in a local shopping mall. Better still, join community organisations that help disadvantaged youth access their creativity.

Branding yourself Define your brand Think about how you want to brand yourself. Use words such as ‘flexible’, ‘visionary’, ‘collaborative’, ‘resourceful’, ‘forward-thinking’, ‘visionary’, ‘diplomatic’, ‘intuitive’, ‘ethical’, and ‘genuine’ to describe YOU.

Create brand awareness through networking Connect with other young professionals in your industry by using social networks and commenting on their pages and blogs. Networking is a great way to become known in your industry.

The 3 Cs of branding Clarity, Consistency, Constancy. Be clear about who you are and who you are not and remain visible to your target audience.

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Get feedback from family, friends, fellow students, anywhere. Ask them what your main brand attributes and key strengths are. If they can easily tell you, then you’ve succeeded in branding YOU. Good luck!

• •

Reflection Branding yourself If you were competing for a job, why would you want the interviewer to appoint you for the job?

•

really eye-catching photographs for publications, websites and your own social media sites. Also get to know how to use tools like Flickr, which is great for anyone who wants to create a visual portfolio of his or her work. A first aid course, which will ensure that you take a leadership role during crisis situations. A course involving your creativity — art, poetry, needlework, woodwork, etc. Read widely: online, books, journals, magazines, newspapers. Being knowledgeable about your subject matter and having a good level of general knowledge is a necessity.

Gain experience

Graduates with a good range of skills — both job-related and social — are more likely to get the nod than those with a limited repertoire of proficiencies.

It is important to gain at least some work experience — whether as a volunteer, intern or parttime employee — as it gives employers an indication that you understand the world of work and company culture. It also suggests that you are willing to invest in yourself and your community. What you learn in the course of doing some kind of work while at university will help you develop the professional and social talents you’ll need throughout your life. But, remember, it is important to do relevant work. Think about getting a job that will teach you skills you can use in the future. Don’t take on a position as a plumber’s assistant doing physical labour if you intend to become an accountant. Know what basic skills you will need in your chosen career and find a job to help strengthen them. Internships give you an impressive addition to your resume. If a job recruiter sees that you have successfully completed an internship and that you have received a job reference from an important person in that company, you will likely be given greater consideration. Don’t wait for an internship.

To boost your personal value, consider doing one or more of the following: • An advanced computer course which, for example, makes you an Excel or PowerPoint expert. • A business writing-skills course, which teaches you how to take minutes, write good reports, letters and e-mails, write speeches, etc. • Joining a public speaking organisation such as Toastmasters, which will help you to become an inspiring and powerful public speaker. • A photographic course, which will help you take

Volunteer particularly for non-profit organisations (NGOs) in your field and for causes that really matter to you. Volunteer work can and should be included in a resume as it demonstrates your skills, how you use them successfully in productive work, your work ethic, and your willingness to help. Although there is no doubt that the job market has become incredibly competitive, it is also true that graduates have never had as many tools at their disposal to boost their prospects. Establishing one‘s reputation as a solid figure in a chosen career path has never been easier. All you have to do is take the initiative!

What can you contribute towards the growth of the company?

Cultivate proficiencies

Roadmap to your social, mental and physical wellbeing

Preparing your curriculum vitae A CV is the first impression you create about yourself to a potential employer.

Big NOs when submitting CVs • • • • • • •

Spelling errors Using incorrect tenses Using somebody else’s email addresses and other contact information Dishonesty Lack of cleanliness (creases, food or coffee marks etc.) Outdated information Employment gaps (state why you were unemployed and what you did- don’t leave gaps)

What must accompany a good CV Cover letter Recently certified copies of you identity document and certificates of all your qualifications

When drafting a CV the following headings are important Personal information date of birth identity number physical address email address contact number drivers’ licence code A personal statement- how you sell yourself Highlights and qualifications- start with your highest qualification first Work experience-start with the most recent work experience Employer name Your job title Period worked there Key responsibilities Achievements (notable contributions) Work Personal Skills Hobbies and interests Contactable references

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STUDENT GUIDE

Activity Draft your own CV Personal Information

Personal Statement

Highlights AND Qualifications University or College

School

Work Experience Company

Key responsibilities

Job title

Year (period from and to)

Reasons for leaving

Achievements

Work

Personal

Skills

Hobbies AND Interests

References

Roadmap to your social, mental and physical wellbeing

Preparing for a job interview Do’s

DoNT’s

Understand the job requirements

Don’t answer questions with a “yes” or “no”. Elaborate briefly on your answer

Do research about the potential employer and consider possible interview questions

Do not lie in your interview

Be well prepared

Do not make derogatory remarks about your current or previous employer or colleagues

Dress smart

Do not ask about salary or employment benefits unless the interviewer bring it up

Be on time

Do not over-answer questions

Make eye contact

Do not let your discouragement show if you get the impression that the interview is not going well

Smile Greet the interviewer by shaking hands Wait until you are offered a chair before seating Sit up straight and comfortable Make them realise why they need you Be confident Prepare examples which demonstrate your uniqueness and work etiquette Convey factual and sincere points Prepare one or two questions- it shows your interest in the employer Follow up

Your end goal

Every beginning has an end. You are in the best time of your life. Make wise choices. Use support systems to help you achieve your end goal, your graduation day. Good luck!

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STUDENT GUIDE

What did I learn from this chapter?

Looking forward My plan of action List the three most important actions you can take to adopt a healthy lifestyle: 1. To achieve my goals I need to do the following:

2. List the factors that could interfere with your plans to complete your studies in the required time:

3. List your action items to ensure you achieve your goals and objectives:

Roadmap to your social, mental and physical wellbeing

REFERENCES How to brand yourself. https://brandyourself.com/info/seo/how_to_brand_yourself [2April 2017] Johnson E. 2014. Business marketing. How to brand yourself. http://www.success.com/article/how-to-brandyourself [27 March 2017] South African Government. 2017. Compiling a curriculum vitae. http://www.gov.za/issues/compiling-curriculumvitae-0 [27 March 2017] South Africa News. 2017. Top five ways to boost your career in 2017. http://southafricanews.org/top-5-ways-toboost-your-career-in-2017/ [27 March 2017] Hofmeyer, A. 2015. Take caution before posting: social media and defamation. Dispute resolution matters. Cliff Dekker Hofmeyer. https://www.cliffedekkerhofmeyr.com/en/news/publications/2015/dispute-resolution/disputeresolution-matters-13-august-take-caution-before-posting-social-media-and-defamation.html [27 March 2017].

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NOTES

Roadmap to your social, mental and physical wellbeing

Answers How to use a male condom correctly: Move the condom down inside the packaging and tear the package carefully. Do not use your teeth or nails to do this 2 Throw the used condom away. You can wrap it up in toilet paper and throw it in the rubbish bin 10 Check the expiry date on the condom, make sure the package is sealed and that no air is escaping 1 Roll the condom to the base of the penis near the testicles 7 Roll down the condom about a centimeter to see which way is the right side 4 Hold the tip of the condom to leave space for the semen and to keep air bubbles out 6 If the penis is uncut (uncircumcised), pull the foreskin back first 5 Make sure the penis is erect 3 When pulling out, hold the condom at the base near the testicles so that it doesn’t slip off 9 Put the lube on the tip of the condom once it is on. For both vaginal and anal sex, use only water-based lubrication such as KY jelly 8

+27 21 959 6767 info@cput.ac.za www.cput.ac.za www.facebook.com/cput.ac.za @cput @wearecput

c re a t i ng futures

Collated & compiled by Nelisiwe Maleka: 08 February 2020

#CHANGE AGENTS #RESPONSIBLE LOVE CAMPAIGN 24 SEVEN VOICES OF 2020 PEER EDUCATORS AFTER ATTENDING TRAINING ON 20-24 JANUARY 2020 SELF-LOVE

HEALTHY RELATIONSHIP

Responsible Love is Holding a positive image Self-appreciation Self-respect values Caring for your own happiness & being able to share with your partner

Responsible Love is Honest Genuine Trustworthy Patient Kind Generous Caring Thoughtful Considerate Humble Forgiving Laughter Fun Happiness Commitment

EQUALITY, NO VIOLENCE & NO TO GENDER BASED VIOLENCE Responsible love is Consent Understanding the word, NO! Safe space created between two lovers Inclusive respecting rights of gender diversity Protecting yourself & people you love Maintaining peace and love at all times Keeping in mind safety and health of your lover Protection & respecting your partner and other people Respecting of each other’s values, morals & dreams Taking into consideration psychological, physical and emotional wellbeing of each other Setting priorities, goals, fix small problems as they rise without fighting Self-controlled & dealing with anger

RISK REDUCTION & HCT

HUMANITY & GOOD CITIZENSHIP

Responsible Love is Educating & protecting each other from HIV/AIDS & STIs Having one partner Knowing your partner’s HIV status Getting tested for HIV together with your partner

Responsible Love is Having your loved one’s best at heart Being responsible in your family Selflessly service & helping others without any expectation in return Supporting other people Taking care of everyone around you When you feel a need to help people, friends and family Being genuine & honestly care for other people Loving others unconditionally Seeing good in others Loving your neighbor as yourself

Collated & compiled by Nelisiwe Maleka: 08 February 2020

SELF-LOVE

HEALTHY RELATIONSHIP Responsible Love is Loving your partner Sharing love Loving unconditional Showing interest in other person Taking care of someone you love Portraying affection & protections of one another Supporting & helping each other during difficult times Completing each other’s aspects where the other one lacks Making informed choices together with your partner Taking responsibility for your action Giving hope & courage Responsible Love is Compromising & accommodative without changing who you are

EQUALITY, NO VIOLENCE & RISK REDUCTION & HCT GENDER BASED VIOLENCE Responsible Love has power to listen Responsible Love is Creating a space for partners to be willing to open up to each other Open communication Being able to work problems out Forgiving & NOT resentful Maintaining healthy mental & physical growth

HUMANITY & GOOD CITIZENSHIP

Responsible Love Does NOT rejoice at wrongdoing but rejoice with truth NOT harming your wellbeing and of the next person

Responsible Love is NOT only saying I love you but showing action NOT boastful but encourages NOT being selfish NOT being rude

#WeAr eCPUT #NoMeansNo #St opAbuse #EndFemi ci de #SaveLi ves

Counsel l i ng, Cr i si si nt er vent i on &Suppor t

Ref er r al st o heal t hpr of essi onal s andot her psychosoci al

MENTAL HEALTH SUPPORT THE

HOUR student & staff

helpline

Contact Student Counseling at Student-counselling@cput.ac.za

Toll-free call

0800 36 36 36

Toll-free telephonic – or SMS – counselling, crisis intervention and support Referrals to mental health professionals and other psychosocial resources Provide help when needed in 11 official languages

SMS

43336

ACKNOWLEDGEMENTS

This manual has been made possible by the efforts and expertise of the following dedicated contributors, key stakeholders, and organisations that are committed to supporting HIGHER HEALTH’s programmes in the higher education sector: •

The HIGHER HEALTH Project Team (including Stephanie Joos-Vandewalle and Anuysha Naidu) led by the CEO, Dr Ramneek Ahluwalia.

•

Funders: The Department of Higher Education and Training (DHET) and the National Skills Fund.

•

Service Provider: The contracted service provider, Wildflower Projects, who developed this Manual.

•

Contributions: Our appreciation goes to the universities and TVET students and staff from various campuses who participated and gave input, as well as Ms Managa Pillay, the ex-Technical Advisor to HIGHER HEALTH.

Permission is granted to use the HIGHER HEALTH Training Resource Manual for educational and training purposes only and not for financial gain. HIGHER HEALTH: A Training Resource Manual

CONTENTS

Chapter 1: First Things First

Chapter 2: Sexual and Reproductive Health

Chapter 3: Sexual and Gender Diversity

Chapter 4: Gender-based Violence

Chapter 5: Mental Health

Chapter 6: Disability

109

Chapter 7: Alcohol and Drug Abuse Preventon

119

Chapter 8: Health and Human Rights

135

Chapter 9: Facilitation Guide and Peer Education Guidelines

151

HIGHER HEALTH: A Training Resource Manual

ACRONYMS

5Cs

Consent, Confidentiality, Counselling, Correct Results, and Connection

ADAP

Alcohol and Drug Abuse Prevention

AIDS

Acquired Immunodeficiency Syndrome

ANC

Antenatal Care

ART

Antiretroviral Treatment

ARV

Antiretroviral

BBBEE

Broad-Based Black Economic Empowerment

CCMA

Commission for Conciliation, Mediation and Arbitration

CD4

Cluster of Differentiation 4

CEDAW

Convention on the Elimination of all Forms of Discrimination Against Women

CICT

Client-initiated Counselling and Testing

DFID

Department for International Development

DHET

Department of Higher Education and Training

DNA

Deoxyribonucleic Acid

DOH

Department of Health

DOJCD

Department of Justice and Constitutional Development

DOTS

Directly Observed Treatment Short Course

DRTB

Drug-Resistant TB

DSD

Department of Social Development

DVA

Domestic Violence Act

EEA

Employment Equity Act

EFV

Efavirenz (ARV)

European Union

FDC

Fixed Dose Combination

FGM

Female Genital Mutilation

FTC

Emtricitabine (ARV)

FTF

First Things First

GAD

Generalised Anxiety Disorder

GBV

Gender-Based Violence

HCT

HIV Counselling and Testing

HEI

Higher Education Institution

HIGHER HEALTH

Higher Education Health, Wellness and Development Centre

HIV

Human Immunodeficiency Virus

HPV

Human Papillomavirus

HSV-2

Herpes Simplex Virus Type 2

HTS

HIV Testing Services

INDS

Integrated National Disability Strategy

IPV

Intimate Partner Violence

ISSSASA

Increasing Services for Survivors of Sexual Assault in South Africa

IUD

Intrauterine Device

LGBTQI+

Lesbian, Gay, Bisexual, Trans-gender, Queer, Intersex, plus Others

Life Orientation

LRA

Labour Relations Act

LTBI

Latent Tuberculosis Infection

MDR

Multi-Drug Resistant

MMC

Medical Male Circumcision

MRC

South African Medical Research Council

MTCT

Mother-to-Child Transmission

NCD

Non-Communicable Disease

HIGHER HEALTH: A Training Resource Manual

NDOH

National Department of Health

NPA

National Prosecuting Authority

NPC

Non-Profit Company

NSP

National Strategic Plan

OCD

Obsessive Compulsive Disorder

Opportunistic Infection

PCR

Polymerase Chain Reaction

Peer Educator (this general term may refer to any person who is using this manual to conduct peer education activities or training)

PEP

Post-Exposure Prophylaxis

PEPUDA

Promotion of Equality and Prevention of Unfair Discrimination Amendment Act

PICT

Provider-Initiated HIV Counselling and Testing

PID

Pelvic Inflammatory Disease

PLWHA

People Living With HIV and AIDS

PMTCT

Prevention of Mother-to-Child Transmission

PrEP

Pre-Exposure Prophylaxis

PSET

Post-School Education and Training

PTSD

Post-Traumatic Stress Disorder

PWD

Person with a Disability

PWID

People Who Inject Drugs

PWUD

People Who Use Drugs

Q&A

Questions and Answers

Quality Assurance

RNA

Ribonucleic Acid

Reverse Transcriptase

South Africa

SACPO

South Africa College Principals Organisation

SANAC

South African National AIDS Council

SGBV

Sexual and Gender-Based Violence

SOCA

Sexual Offences and Communities Affairs

SRH

Sexual and Reproductive Health

SRHR

Sexual and Reproductive Health and Rights

STD

Sexually Transmitted Disease

STI

Sexually Transmitted Infection

TasP

Treatment as Prevention

Tuberculosis

TCC

Thuthuzela Care Centre

TDF

Tenofovir (ARV)

TOP

Termination of Pregnancy

TST

Tuberculin Skin Test (Mantoux Skin Test)

TVET

Technical and Vocational Education and Training

United Nations

UNAIDS

UN Programme on HIV/AIDS

UNESCO

UN Educational, Scientific and Cultural Organization

UNCRPD

UN Convention on the Rights of Persons with Disabilities

USAf

Universities South Africa

VMMC

Voluntary Medical Male Circumcision

WHO

World Health Organization

WPRPD

White Paper on the Rights of Persons with Disabilities

XDR

Extensively Drug Resistant HIGHER HEALTH: A Training Resource Manual

H I G H E R H E A LT H P R O G R A M M E INTRODUCTION The Higher Education and Training Health Wellness and Development Centre (HIGHER HEALTH, formerly known as HEAIDS) is an implementing agency of the Department of Higher Education and Training (DHET), working under the governance of Universities South Africa (USAf), the representative body of the 26 South African public higher education institutions (HEIs) and the South Africa College Principals Organisation (SACPO), the representative of the 50 South African public technical and vocational education and training (TVET) colleges. HIGHER HEALTH is a non-profit company (NPC) that supports HEIs and TVET colleges in responding to student health, wellness and development. Young South African students face many health and wellness challenges, which include HIV, TB, and STI infections, unplanned pregnancies, gender-based violence (GBV), mental ill-health, cancers, chronic conditions, such as diabetes and hypertension, gender identity and disability challenges, and substance abuse. HIGHER HEALTH is skilled in facilitating both first and second curriculum activities in the form of peer-to-peer education and inclassroom interventions through the integration of general health and wellness including HIV, TB, STIs, sexual and reproductive health (SRH), and other health and social challenges within the core function of the post-school education mandates. This is being done successfully across over 420 campuses countrywide. Students are capacitated each year through day-to-day campus activities and the HIGHER HEALTH second curriculum peer education programme, enabling them to engage at a peer-to-peer level. These engagements also serve as a tool for HIGHER HEALTH to undertake demand creation as well as for the recruitment of young people opting for a wide spectrum of services that includes: •

HIV testing services (HTS);

•

Medical male circumcision (MMC);

•

Contraception;

•

Pre-exposure prophylaxis (PrEP);

•

Non-communicable diseases (NCDs); and

•

Antiretroviral treatment (ART) for HIV positive young people, including the development of adherence clubs.

We have now also included GBV and mental health on-site psychosocial support services as part of the comprehensive package of services. The target population for HIGHER HEALTH is primarily young people between the ages of 15-35, which constitutes the largest proportion of the population within higher education. The HIGHER HEALTH focus is aligned to the White Paper of the DHET, the National Development Plan 2030, and the National Strategic Plan (NSP 2017-2022). HIGHER HEALTH’s mission is characterised by five main pillars, where these pillars are supported by a number of communication and awareness initiatives using conferences, workshops, campus and community radio stations, forms of social media, and printed media in a variety of forms. The five main pillars are: •

Engaging in wide-ranging resource mobilisation for its activities and operations

HIGHER HEALTH is committed to resource mobilisation from a diverse set of funders including government departments at national and provincial level, institutions in the post-school education and training (PSET) system, and international and national donor agencies. Such resource mobilisation covers monetary and “in-kind” resources, as well as services and service capacity, provided to HIGHER HEALTH. •

Monitoring and evaluating its impact in the field of student health, wellness, and development

HIGHER HEALTH recognises the importance of consistent monitoring and evaluation of its programmes and activities with a view to improvement and enhanced impact. To this end, HIGHER HEALTH has instituted improved systems and practices regarding the collection, analysis and interpretation of data at a number of decision-making levels. In fulfilling its mission, HIGHER HEALTH is committed to constant self- evaluation as well as evaluation by all its stakeholders and collaborative partners. HIGHER HEALTH: A Training Resource Manual

•

Developing and establishing capacity within PSET institutions in the field of student health, wellness and development

HIGHER HEALTH is committed to bringing its programmes and activities to students in the PSET system. This is pursued through strengthening existing campus-based structures, measures and programmes established by institutions to improve the overall and holistic health and wellness levels of students by, among others, building institutional capacities for the development and expansion of these measures and programmes, improving the levels of effectiveness and efficiency of these interventions, and ensuring their longer term sustainability.

•

Overseeing the implementation of relevant service delivery programmes

HIGHER HEALTH oversees the implementation of initiatives aimed at the cross-curricular inclusion of relevant health- and wellnessrelated knowledge in the formal education and training programmes of public sector PSET institutions. These initiatives, often referred to as first curriculum initiatives, aim to train and equip teaching and learning staff in the development, inclusion, and delivery of appropriate health and wellness information in their specific curricular knowledge areas. Second curriculum initiatives concern measures, programmes, and activities that fall outside the first curriculum of formal education and training programmes. These mainly involve training students to function as peers in appropriate mentorship roles for the benefit of their fellow students. In addition, facilitating the provision of nursing, social work, and psychosocial services on campuses where such services do not yet exist, and strengthening these services where they are not functioning optimally, form important aspects of HIGHER HEALTH’s second curriculum activities. •

Stimulating co-ordination of role-players and stakeholders

HIGHER HEALTH pursues its activities through stimulating co-ordination, impactful and wide-ranging partnerships and collaborative arrangements with national government departments, such as the DHET, Department of Health (DOH), Department of Social Welfare and Development, provincial DOHs, national and international funding agencies working within the broad field of human and social development, national and regional structures in the various sectors of our PSET system, institutions in the PSET system, and relevant structures on campuses.

HIGHER HEALTH IMPLEMENTATION MODEL

HIGHER HEALTH: A Training Resource Manual

M I S S I O N A N D V I S I O N S TAT E M E N T

MISSION

VISION

HIGHER HEALTH is inspired by the possibility of

HIGHER HEALTH’s vision is to be a primary

a country where the great majority of students at

instrument in our public PSET systems in improving

our PSET institutions, such as universities, TVET

study success rates and completions of students

colleges and other post-school colleges, undertake

through enhanced levels of overall and holistic

their studies having sound levels of overall and

health and wellness.

holistic health and wellness. Such high levels of overall and holistic health and wellness contribute to them completing their studies successfully without unnecessarily prolonging them. In so doing, HIGHER HEALTH contributes to the development of the competencies and levels of maturity required in students in order to pursue fruitful careers and also to enable them to contribute to their families and their communities in achieving greater social and economic security.

HIGHER HEALTH: A Training Resource Manual

Peer-to-Peer Education •

Information Dissemination

•

Dialogues

•

Health & Wellness Campaigns

•

In-class Knowledge & Engagement Future Beats Campus & Community Radio Programme

Social Mobilisation •

Awareness & Skills Development

•

Demand Creation

•

Recruitment for Screening, Testing, Treatment, Care & Support

Health, Wellness and Development Services •

Testing & Screening: First Things First & Routine Services

•

Risk-screening and Assessment

•

Linkage to Treatment, Care & Support

•

Adherence Monitoring through Follow-up, Adherence Support Groups, Survivor Clubs & Safe Zones

HOW TO USE THIS MANUAL

HIGHER HEALTH: A Training Resource Manual

The HIGHER HEALTH Training Resource Manual is divided into eight chapters. Each chapter contains a number of lessons which can be facilitated as standalone topics or focus areas. Chapter Nine is a facilitator’s guide to training and peer education . CHAPTER ONE: FIRST THINGS FIRST

CHAPTER FOUR: GENDER-BASED VIOLENCE

First Things First (FTF) is a HIGHER HEALTH programme that aims to increase knowledge and eliminate misinformation around communicable and non-communicable diseases. The primary goal of FTF is to encourage health-seeking behaviour and enhancement of quality of life in young people through regular testing and/or screening for major ailments, such as HIV, TB and sexually transmitted infections (STIs), cancer and cardiovascular risk factors, among others.

The key focus of this chapter is to clearly define what is meant by sexual and reproductive health and rights (SRHR) and responsibilities. It aims to encourage the use of SRH services and to empower young women in protecting themselves.

The FTF chapter presents three lessons: 1. Overview of the FTF Programme 2. HIV and AIDS 3. TB Red Zones: 1. HIV 2. Safer Sex 3. TB CHAPTER TWO: SEXUAL AND REPRODUCTIVE HEALTH The key focus of this chapter is to support young people to become personally and socially competent in managing their sexual and reproductive health and well-being. The Sexual and Reproductive Health (SRH) chapter presents two lessons: 1. Sexual Health 2. Reproductive Health Red Zones: 1. Sexually Transmitted Infections (STIs) 2. Unplanned Pregnancy CHAPTER THREE: SEXUAL AND GENDER DIVERSITY The key focus of this chapter is to provide information to enhance understanding of issues and challenges concerning the lesbian, gay, bisexual, transgender, queer, intersex, and other gender and sexuality forms not mentioned here (LGBTQI+) community and review accurate and relevant information about each of the key health risks pertaining to LGBTQI+ persons.

The Gender-Based Violence (GBV) chapter has one lesson: 1. Gender-Based Violence Red Zones: 1. Domestic Violence 2. Gender-Based Violence CHAPTER FIVE: MENTAL HEALTH The key focus of this chapter is on creating awareness among students about risks and symptoms of mental illness, and when, how, and where to refer someone for treatment. The Mental Health chapter presents three lessons: 1. Self-Awareness 2. Identifying Red Zones: Mental Health 3. Creating Safety Networks Red Zones: 1. Mental Health 2. Stress CHAPTER SIX: DISABILITY The key focus of this chapter is to equip trainees with accurate knowledge and information regarding people with disabilities (PWDs) so that they may educate peers and address discriminatory attitudes and ignorance in respect of disabilities. The Disability chapter presents one lesson: 1. Understanding Disability

The Sexual and Gender Diversity chapter presents four lessons: 1. Introduction to Sexuality 2. Coming Out 3. Attitudes and Self-Awareness 4. LGBTQI+ Health

HIGHER HEALTH: A Training Resource Manual

CHAPTER SEVEN: ALCOHOL AND DRUG ABUSE PREVENTION The key focus of this chapter is to expose peers to information pertaining to alcohol and drug use/abuse that can lead to better health outcomes and ultimately influence students to reduce alcohol and drug use/abuse. The Alcohol and Drug Abuse Prevention (ADAP) chapter presents three lessons: 1. Overview of ADAP 2. Health Issues Related to ADAP 3. Alcohol and Drug Abuse – The Effects on Mind, Body, Soul. Red Zone: 1. Substance Abuse CHAPTER EIGHT: HEALTH AND HUMAN RIGHTS The key focus of this chapter is to identify the relationship between health and rights where students have control over and can decide freely and responsibly on matters related to their SRH free of coercion, discrimination, and violence. CHAPTER NINE: FACILITATION GUIDE AND PEER EDUCATION GUIDELINES The key focus of this chapter is to provide theories, principals, techniques and guidelines for effective activity facilitation and peer education training. MATERIALS NEEDED Materials required for activities in each of the chapters are set out separately for each activity. The list below suggests standard materials that will be required for all chapters: • Flipcharts • Coloured marker pens • Activity hand outs • Fact sheet hand outs • Cards of varying sizes • Pens Notebooks •

HIGHER HEALTH: A Training Resource Manual

Chapter 1 FIRST THINGS FIRST

FIRST THINGS FIRST HIGHER HEALTH: A Training Resource Manual

HIGHER HEALTH: A Training Resource Manual

Chapter one has three lessons which focus on the areas shown in the diagram below.

HIV and AIDS

FTF

• • • • •

Understand health and illness Know the stats Know the trends, patterns and risk factors Know the consequences of your behaviour Know what to do to manage your health

Education Family Relationships Career and job Income and future prospects

• •

Know the facts

Know yourself

•

Know your goals

HIGHER HEALTH: A Training Resource Manual

Know your challenges and obstacles

• •

Your unique identity What are your strengths, values and skills? What are your weaknesses and vulnerabilities? What are your needs?

What are the risks you face? What stands in your way?

AIM First Things First (FTF) is a HIGHER HEALTH programme

The FTF Programme specifically targets the issues cited in the following diagram.

that aims to increase knowledge and eliminate misinformation around communicable and non-communicable diseases. The primary goal of FTF is to encourage health-seeking behaviour and enhancement of quality of life in young people through regular testing and/or screening for major aliments such as HIV, TB, STIs, cancer and cardiovascular risk factors, among others. OVERALL OBJECTIVES By the end of this module, participants will: •

Be clear about the goals and objectives of the FTF programme.

•

Understand the importance of and need for testing and screening on a regular basis.

•

Have a clear definition of each of the three health risk areas outlined above.

•

Demonstrate an understanding of the facts around

LESSON ONE: OVERVIEW OF THE FTF PROGRAMME

causes, symptoms, treatment and preventive measures for HIV, TB and STIs. •

Be equipped with factual information on health risks to encourage informed decision making and health-seeking behaviour.

•

Be equipped to know how and where to get help or additional information on each of the areas.

Aim: To give participants a clear understanding of the FTF programme and to agree on their roles and responsibilities in FTF. Time:

30 minutes

Lesson Objectives: On completion of this lesson, participants should demonstrate INTRODUCTION: FIRST THINGS FIRST PROGRAMME HIGHER HEALTH advocates the FTF model. This model promotes that the first priority of every young South African is to look after their health. The vision of the programme is to build a culture where youths buy in to the concept that early detection saves lives. This would mean that they regularly: •

Screen and become educated in order to detect disease early.

•

Prioritise early detection through community or institution testing/care and support.

an enhanced understanding of: •

The purpose and goals of the FTF programme.

•

Why FTF is necessary and important.

•

The roles and responsibilities of peer educators and peers in FTF.

Procedure •

Introduce yourself and your role in the project.

•

Ask participants what they know about FTF.

•

Ask why FTF is necessary and fill in gaps after all group input has been given.

In this way, the programme contributes to the UN Programme on HIV/AIDS (UNAIDS) target of 90-90-90 with the key objective of reducing the rate of students becoming infected. The goal of the 90-90-90 target is to ensure that 90% of all people living with HIV know their HIV status; 90% of those who are diagnosed with HIV receive antiretroviral (ARV) therapy; and as a result, 90% of those on treatment attain viral suppression. This would help to bring us closer to attaining zero new HIV infections by 2030.

HIGHER HEALTH: A Training Resource Manual

number rolled will ask the group in play a question from the

LESSON TWO: HIV AIDS

sheet they have (for example, if you roll number six, the group with sheet number six).

Aim:

If they answer correctly, they will be allowed to move the

If they do not know the answer or answer incorrectly, they

All other aspects of the game “snakes and ladders” will

To increase, refresh and update participants’ knowledge regarding all aspects of HIV/AIDS transmission, prevention,

same number of places as the number they rolled.

treatment, and HIV counselling and testing (HCT) protocols. Time:

90 minutes (two activities)

will remain in the same place on the board. apply as the teams move across the board.

Lesson Objectives:

On completion of this lesson, participants should demonstrate increased understanding of:

The team that has progressed furthest on the board when the time for the activity is up wins the game.

10. Allocate 35 minutes for this activity.

•

HIV the disease

•

Impact on the immune system

•

Life cycle of the virus

•

Stages and progression of the disease

•

Transmission of HIV

concepts and exchange with one another to enrich your

•

How HIV is transmitted

knowledge bank.

•

How HIV is NOT transmitted

•

HIV prevention

Discussion Questions

•

Lifestyle and behaviour

•

Why is it important to know this information?

•

Pre-exposure prophylaxis (PrEP)

•

What does it mean for you right now?

•

Post-exposure prophylaxis (PEP)

•

Prevention of mother-to-child transmission (PMTCT)

•

HIV testing services

KEY MESSAGES

•

Pre- and post-test counselling

•

TB screening

It is important to know your HIV status so that you can protect

•

Human rights and HIV

•

Legislation

•

Stigma and discrimination

11. On completion of the activity, conclude by encouraging students to continue playing the game as a homework exercise to master all relevant information. 12. Task: Create your own dictionary or glossary of terms and

your own health and the health of your partner(s). •

HIV is preventable, through avoiding contact with other people’s body fluids such as blood and sexual fluids.

•

If a person is infected with HIV, there is a four- to 12-week period where they may not know that they have the virus

Purpose of activities

(the window period), but the virus is very active and can

To review baseline knowledge, create opportunities to clarify

easily pass to other people at this time.

myths and misconceptions, and empower participants with

•

knowledge and skills regarding HIV and AIDS.

It is important to know your HIV status so that you can protect your own health and the health of your partner(s).

To illustrate how quickly HIV can spread, and how correct, consistent condom use can stop its spread.

•

HIV and AIDS can be managed and treated so that people with HIV can live happy, healthy and productive lives.

To show the importance of knowing your HIV status and empower participants to get tested.

The South African government has embarked on a deliberate effort to scale up HIV testing services (HTS) and strengthen

ROLL THE DICE

its quality at all health facilities and non-health sites. With

Time: One hour

public health facilities in South Africa, the proportion of people

increasing availability of quality HTS and its uptake in all

Divide the class into six small groups.

who have ever had an HIV test and are aware of their status

Distribute one dice and a “snakes and ladders” game board

increased from 50% in 2008 to 66.5% in 2014. In addition, the

per group.

2014 data showed that 92.3% South Africans are aware of HTS (randomly

services, and 66.2% had actually utilised them in the previous

assigning one per group) containing questions related to

year. There is a global initiative to accelerate universal access to

understanding HIV.

HIV prevention, treatment, care and support services for people

Groups take turns to roll the dice.

living with HIV and AIDS (PLWHA). The main entry point for

The group with the sheet number corresponding to the

the HIV continuum of care is through HTS, which has become

Distribute

sheets

numbered

one

HIGHER HEALTH: A Training Resource Manual

six

increasingly available. South Africa has more than 4 000 public health facilities offering provider-initiated counselling and testing (PICT) and client-initiated counselling and testing (CICT). In addition, HTS is also available through non-medical sites and the private sector.

The window period is the period after infection by the HI Virus when sero-conversion is taking place and antibodies have not test negative (because it is looking for the antibodies), even

Advocacy for sexual and reproductive health and rights (SRHR):

What is the window period?

yet formed. As a result, an HIV antibody test at this time will

Further Resources •

Roll of #2

https://www.ippf.org/sites/default/files/web_

young_people_as_advocates.pdf •

SRHR language: https://choiceforyouth.org/srhr/

•

https://catalogue.safaids.net/sites/default/files/publications/ Young4Real_Information_Services_Advocacy_Training_ Handbook.pd

RESOURCES FOR THE ACTIVITY: ROLL THE DICE Roll of #1 What is HIV? Human Immunodeficiency Virus (HIV) is a virus that targets CD4 cells in the human immune system. Without treatment, it would lead to severe immune deficiency (AIDS), high viral loads, and eventual death. What is AIDS? Acquired Immunodeficiency Syndrome (AIDS) is a condition resulting from HIV infection (Acquired), the immune system is depleted of CD4 cells to the point of becoming deficient (Immunodeficiency), and unable to protect the body from infection and invasion by a myriad of infections at the same time (Syndrome). What is the difference between exposure and infection in relation to HIV? Exposure is where one has come into contact with the virus but has not been confirmed as being infected. At this point, infection can also be prevented (PEP). Infection is where the virus has entered the body and replicated to the point where prevention is no longer possible. Name the three fluid types that can transmit HIV. Sexual fluids (semen and vaginal fluids), blood, and breast milk. What is an opportunistic infection (OI)? An OI is an infection that is able to invade the body because it is immune-compromised (low CD4 cell count) and, therefore, unable to protect itself. In another words, OIs take the opportunity to enter the body when its defences are low.

though the person may, in fact, be infected. This period during which the formation of antibodies is taking place is called the window period. What is a viral load? A viral load quantifies the amount of virus in the body and, therefore, indicates the level of infection. In other words, someone with a high viral load is likely to be showing symptoms (symptomatic) and very ill. They are also likely to have a low CD4 count because it is when the CD4 count is low that OIs enter the body and increase the viral load. What is sero-conversion? Sero-conversion is the period of time during which HIV antibodies develop and become detectable. Sero-conversion generally takes place within a few weeks of initial infection. It is often, but not always, accompanied by flu-like symptoms, including fever, rash, muscle aches and swollen lymph nodes. Roll of #3 HIV cannot be transmitted from one person to the other if the infected person is showing no symptoms (asymptomatic) (T/F). False If both partners are HIV infected, it is not necessary to use a condom (T/F). False If an HIV antibody test is used to diagnose an infant under 18 months, the baby’s HIV status can change if retested when he/she is older than 18 months (T/F). True: Babies carry their mother’s antibodies for the first 18 months. If they are born to an HIV-positive mother, they will inherit the HIV antibodies, which will show as HIV positive in an antibody test, EVEN IF THE BABY IS HIV-NEGATIVE. After 18 months, their own immune systems will kick in and, if tested again, an uninfected baby will test negative, even though they may have tested positive when they were under 18 months of age. People with disabilities (PWDs) are “safer” from HIV than able-bodied individuals because PWDs are “asexual”. False: PWDs are far more vulnerable to sexual abuse than are their peers, especially those with developmental disabilities. They are therefore disempowered and at high risk for rape, unsafe sex, and other forms of sexual abuse which also places them at high risk for HIV. They are also at risk because of the “virginity myth” that HIV can be cured by having sex with a virgin because it is often assumed that they are virgins because they are disabled.

HIGHER HEALTH: A Training Resource Manual

Roll of #4

Sometimes the copies change a little bit, and the ARV drugs

What is a CD4 cell?

will not be as effective against them.

A cluster of differentiation 4 (CD4) cell is a white blood cell that

Your strain of HIV may become resistant to the ARVs, so even

plays a crucial role in the immune system.

if you decide to take them again at a later stage, they might

What is PEP?

not work. If HIV becomes drug-resistant, and you accidentally

PEP is Post (after) Exposure (having contact with the virus)

pass the virus on to another person, that person will find that

Prophylaxis (prevention). PEP is a type of anti-retroviral

the drugs do not work for them either.

(ARV). If it is a person’s first exposure to the virus and PEP

For these reasons, it is vital not only to take your medication

is administered within 72 hours of exposure, it may prevent

faithfully, but also to comply with the instructions exactly.

the virus from replicating sufficiently to infect the person. PEP

What is ARV adherence?

is a short-term ARV treatment that reduces the likelihood of

Adherence is the most effective way to ensure viral suppression

HIV infection after exposure to HIV-infected blood or sexual

(when the virus is undetectable). Adherence is about taking

contact with an HIV-positive person. The drug regimen for

the ARVs as directed by the health worker. It is defined as a

PEP consists of a combination of ARV medications that are

patient’s ability to follow a treatment plan, take medications

taken over a period of four weeks.

at prescribed times and frequencies, and follow restrictions

What is PrEP?

regarding food and other medications.

PrEP is Pre (before) Exposure (having contact with the virus)

Which partner is at a higher risk of contracting HIV during

Prophylaxis (prevention). It involves the use of anti-HIV

heterosexual intercourse and why?

medications to keep HIV-negative people from becoming

Women are two to four times more likely to get infected with

infected. PrEP has been shown to be safe and effective

HIV through unprotected vaginal sex than men, due to the

at preventing HIV infection. Truvada is currently the only

following reasons:

treatment approved for use as a PrEP. Truvada is a single pill

•

Women, as the recipients of semen, are exposed to

that is a combination of two anti-HIV drugs, tenofovir (TDF)

semen for a longer time (while semen remains in the body

and emtricitabine (FTC). PrEP is for HIV-negative adults and

of a woman for a few hours, a man is exposed to the body

adolescents who are at very high risk for getting HIV from

fluids of a woman for only a short time).

sex (such as sex workers) or injection drug use. The current

•

guidelines also recommend that PrEP be considered for people who are HIV-negative and in an on-going sexual relationship

the concentration of HIV in vaginal fluids. •

with an HIV-positive partner. Research suggests that PrEP

Women possess a larger surface area of mucosa (the thin lining of the vagina and cervix), which is exposed to

is highly efficacious in preventing the sexual transmission of HIV, as long as the drugs are taken regularly and as directed.

The concentration of HIV in semen is much higher than

their partner’s secretions during sexual intercourse. •

Many women have cervical or vaginal conditions such as

However, PrEP does not prevent other sexually transmitted

STIs, erosions, open sores and infections that facilitate

infections (STIs) or pregnancy. It is recommended that PrEP

the transmission of HIV.

be taken in conjunction with other methods of prevention.

•

Many women practise “dry” sex, and they cause damage

Apart from PEP and PrEP, mention two other strategies

or infection to the vaginal walls. “Dry” sex is a cultural

for prevention that you are aware of.

practice where women use herbs or other substances –

ARVs taken by an HIV-positive woman during pregnancy and

such as liquid bleach (Jik) or washing powder – to dry out

childbirth for the prevention of mother-to-child transmission

their vaginas for the benefit of some men who believe that

(PMCT); ARVs taken by an HIV-positive person for treatment

a dry vagina is a sign of faithfulness, or to heighten their

as prevention (TasP); safer sex practices; or abstinence.

sexual pleasure. This practice is painful and extremely

Roll of #5

dangerous because it increases the risk of HIV infection.

What is drug resistance?

•

In simple terms, drug resistance refers to the ability of disease-

during or immediately after menstruation because of the

causing germs—such as bacteria and viruses—to continue multiplying despite the presence of drugs that usually kill them.

Transmission of HIV is more likely to occur just before, large, raw area of the inner uterine lining that is exposed.

•

Younger women are especially vulnerable to HIV infection

With HIV, drug resistance is caused by changes (mutations) in

because their genital tracts are not yet fully mature, their

the virus’ genetic structure. Missing medication doses leads to

vaginal secretions are not as copious, and because they

an increased risk of resistance.

are more prone to lacerations or tears of the vaginal

If you miss medication doses, if the drugs are stopped, or not

lining. There is also evidence to suggest that women

taken at the right time each day, the HIV takes advantage of

once again become more vulnerable to HIV infection after

this and starts to make copies of itself again.

menopause.

HIGHER HEALTH: A Training Resource Manual

•

Women often practise anal sex to avoid pregnancy, to

Are you in the red?

maintain “virginity”, or because their male partners prefer

Zone Check: HIV

anal sex.

Are you having unprotected sex?

Disempowerment often makes women more vulnerable

Did you have unprotected sex in the last 24 hours?

Do you have only one sexual partner?

Do you have difficulty convincing your partner to use a condom?

Do you believe that you don’t need to use a condom because you (or your partner) are using contraception?

Do you know your HIV status?

Do you know your partner’s HIV status?

Do you think it is possible that you may have been exposed to HIV?

to HIV infection, especially in societies where the status of women is lower than men. Women in such situations have little or no control over their sex lives, and they are not in a position to negotiate safer sex practices because they fear violence and abandonment should they try to do so. Women from low socio-economic backgrounds are often driven to prostitution, and they are particularly vulnerable to rape. Roll of #6 Name four different groups of micro-organisms that cause STIs. Bacterial STIs may be found in one part of the body. If you go to the clinic, the health worker may give you medication that can treat and cure the STI. Examples of STIs that are caused by bacteria include diseases such as Gonorrhoea, Chlamydia, and Syphilis.

Yes

If any of your answers place you on a red square, you are in the RED ZONE. This means that you are at risk for HIV. Ask your HIGHER HEALTH Campus Coordinator for help with HIV Testing Services and support as soon as possible. It is important to know your HIV status so that you can protect yourself whether you are positive or negative

Viral STIs attack systems in the body. They often invade the whole body and its cells. They can be treated, but not cured. Some examples are Hepatitis B, HIV, Genital Herpes (HSV-2), and Genital Warts (HPV). Fungal STIs are caused by fungi, which are like plants, and they usually grow on or in the top layer of skin. They are not always passed on by having sex with someone, and they can be cured. Parasitic STIs are caused by parasites, which are creatures that live off another being’s body. Think of a parasite as a little bug that lives off a human, but cannot always be seen by the naked eye. These STIs that are caused by parasites are passed from person-to-person during sexual activity. What types of STIs are incurable? Viral STIs. Name three ways to reduce the risk of mother-to-child transmission (MTCT). ARVs, C-Section delivery, and exclusive breastfeeding while the mother is on ARVs. Why is HIV antibody testing not recommended for infants under 18 months? Test results would reflect the mother’s HIV status because the test will detect the mother’s HIV antibodies until the baby develops its own immune system at 18 months. In order to

AN UNUSUAL STI: HUMAN IMMUNODEFICIENCY VIRUS (HIV) WHAT IS THE HI VIRUS AND HOW DOES IT INFECT THE BODY? HIV is a virus that attacks the human immune system. Once infected, there is no cure, so you will have the virus in your body for the rest of your life, or until a cure is found. The virus targets the white blood cells in the immune system, specifically the CD4 cells. These cells play a very important role in protecting the body against disease and infection. If you don’t know you have the virus, it stays in your body, silently destroying your CD4 cells all the time, while you believe you are healthy and well because there are no symptoms for four to six years.

know the baby’s status, one would need to do a polymerase chain reaction (PCR) antigen test, which will test for the antigen (virus) and not the antibody.

HIGHER HEALTH: A Training Resource Manual

WHAT ARE THE STAGES AND SYMPTOMS OF THE DISEASE AND HOW DOES IT AFFECT THE IMMUNE SYSTEM? CLINICAL STAGES OF HIV-AIDS STAGE 1

STAGE 2

STAGE 3

STAGE 4

Asymptomatic (No symptoms of HIV disease)

Mild symptoms

Advanced symptoms

Severe symptoms (AIDS)

Short flu -like illness occurs 1-6 weeks after infection

Average: 10 yrs Mild symptoms

The immune system deteriorates

Rapid decline in the number of CD4 T cells

HIV in blood drops to very low levels

Opportunistic infections (OI) start to appear

Opportunistic infections become severe and cancer my develop

Infected person can infect other people

Antibodies are detectable in the blood

HOW IS HIV PASSED ON FROM ONE PERSON TO ANOTHER?

For HIV to spread, there needs to be THREE factors present

ENTRY POINT A place for the virus to enter the uninfected person’s body. This could be a cut or break in the skin or an opening

EXIT POINT A place for the virus to leave the infected person This could be a cut or break in the skin or an opening

A BODY FLUID IN WHCH HIV VIRUS CAN LIVE A fluid to transport the virus and allow it to remain alive in the body

There are body fluids in which the virus can live and make copies of itself. These fluids must come into contact with an uninfected person’s body fluids through sexual contact, an entry point in the skin, infected needles, or from mother to child. HIGHER HEALTH: A Training Resource Manual

HOW HIV IS NOT TRANSMITTED

NEGOTIATING WITH YOUR PARTNER FOR SAFER SEX

Preventing the sexual transmission of HIV requires using condoms each and every time you have sex. Talking about safer sex with a partner is not always easy, as it often raises questions about trust, and may raise suspicion between a couple. It is important to introduce the topic at a relaxed time, not during a fight and not when the couple is aroused and already ready to have sex. A good idea is to have some strategies or pre-planned phrases to start the conversation. Some ideas on negotiating for safer sex are discussed below. NON-VERBAL NEGOTIATION Sometimes less direct approaches are as effective in promoting the use of safer sex practices as more direct, verbal suggestions. Non-verbal strategies include:

•

Strategically placing a condom on a pillow.

•

Placing a safer sex pamphlet in view to initiate discussion or to “drop a hint”.

•

Seduction (i.e., putting the condom on your partner).

•

Use flattery (“Ooo, we’ll need to use an extra-large condom!”).

HIGHER HEALTH: A Training Resource Manual

It’s also useful to start a conversation about the issue early on in the relationship, as explained in the table below. Technique

Why

Suggestion

Express your feelings using “I” statements

A “YOU” message, for example, “You need to use a condom because I don’t want you giving me some life threatening disease…” comes across as accusing and blaming. This is likely to trigger anger or resistance. “I messages” are about what you feel and think, and you avoid demanding, blaming, or finger pointing.

Instead, you could say: “I want to use a condom because I believe protecting our health and safety is a priority...”, or “I feel strongly about taking responsibility for my actions…”, and “My reasons are...”

Focus on interests, not positions

By exploring your partner’s interests, you will discover the real issue at hand. Avoid saying “So you’re refusing to use a condom…?” (Taking a position). That tone or style of question will start an argument that is not likely to end well.

Instead, say: “I would be really happy to talk more about why you don’t want to…” A person may not want to use condoms because he/she is concerned that their enjoyment (interest) will be affected. You can then address this concern with appropriate suggestions.

Listen to and acknowledge your partner’s concerns

In this way you let them know their needs are important to you too. Avoid saying: “So you don’t care about my feelings”, or “This relationship is all about you and your needs.”

Instead, say: “So you’re worried that it will spoil the moment and disrupt everything…? I understand what you’re saying, and I want us to enjoy our time together. Could we try... so we could avoid that situation, still have pleasure and be safe.”

Give your partner time Pushing or rushing creates pressures and leads to to think about what you resistance. Avoid stopping in the middle of a moment of passion and insisting on looking for a condom. It are saying; don’t rush will result in anger and frustration.

You don’t need to make a final decision during your first discussion

Safer sex is a big topic and a critical aspect of any relationship.

Instead, talk about it early on, just as the relationship starts to get physical, so that you are both clear about the terms of your sexual relationship. Have the discussion before you find yourself in the middle of the sexual act! Take your time, and if you need, decide together when you will continue the conversation.

REMEMBER: Anyone can get HIV, but you can take steps to protect yourself from HIV infection. The only way to know whether or not you have the virus is to test regularly for HIV. Are you in the red? Zone Check: Safer Sex I CANNOT talk to my partner about using condoms/I am not practising safer sex with my partner because: 1.

He/she will think I am cheating and will not trust me anymore

My partner will not enjoy sexual intercourse with me anymore

He/she will leave me to have sex with someone else

My partner makes those decisions and has control over when and how we have sex

My partner may beat me if I suggest such a thing

I am scared and/or embarrassed to bring up the topic of protection

I have only one partner so I’m not at risk in any way

I trust my partner

We can stop in time so there’s no risk or need for protection

Yes

If any of your answers place you on a red square, you are in the RED ZONE. This means you are at risk for HIV and STIs. Ask your HIGHER HEALTH Campus Coordinator for help with counselling, contraception and safer sex options and further support as soon as possible.

HIGHER HEALTH: A Training Resource Manual

WHAT YOU NEED TO KNOW ABOUT HIV TESTING SERVICES (HTS)

HIV counselling and testing (HCT) is now referred to as HIV testing services (HTS) to embrace the full range of services that should be provided together with HIV testing. These services are described below in more detail.

Counselling

Linkage to Care

Clinical and Support Services

Coordination with Laboratory Services

In the early years when there was no treatment for HIV, and widespread stigma and discrimination existed, it was difficult to see the benefits of testing as clearly as we see it now. But that was many years ago. HIV testing today is the crucial entry point for all HIV services, including both prevention and treatment. When someone tests and learns that they are HIV positive, there is an opportunity to get access to life-saving treatment, take care of their health and well-being and that of their loved ones. For those who test HIV negative, there is an opportunity to stop and think about their level of risk and make important life decisions about which HIV prevention options are the best fit for them. The South African government has made a determined effort to make HTS available as widely as possible. Strategies have been put in place to strengthen the quality of HTS at all health facilities and non-health sites. With HTS now available in all public health facilities in South Africa, the numbers of people who have ever had an HIV test and are aware of their status have increased significantly. There is a movement across the world to accelerate universal access to HIV prevention, treatment, care and support services for people living with HIV and AIDS (PLWHA). The main entry point for HIV treatment, care and support is through HTS, which is now also available on your campuses. South Africa has adopted the UNAIDS’ 90–90–90 strategy, which calls for 90% of all people living with HIV to be diagnosed; 90% of eligible people with diagnosed HIV to receive ART; and 90% of those on ART to have a suppressed viral load by 2020. THE 5Cs The 5Cs (Consent, Confidentiality, Counselling, Correct Results, Connection) are the foundation of effective HTS. 1. CONSENT People who receive testing must consent to be tested and counselled. Clients or patients must be informed of the process for HTS and of their right to decline testing. 2. CONFIDENTIALITY Discussions between the HTS provider and the client should not be disclosed to anyone without the express consent of the person being tested. Shared confidentiality with a partner or family members or trusted others must be encouraged. 3. COUNSELLING Pre-test information can be shared in a group setting, but a private setting must be provided for individuals who have questions that they do not wish to share with others. HIV testing must be followed by appropriate high-quality post-test counselling. 4. CORRECT RESULTS Quality assurance (QA) mechanisms are essential to ensure that people receive the correct diagnosis. 5. CONNECTION Linkage to prevention, treatment and care services and effective and appropriate follow-up should be provided. 22

HIGHER HEALTH: A Training Resource Manual

Higher education-based HTS will be offered continually to all

as adolescents and young people who are at very high risk for

young people attending universities and TVET colleges, as well

getting HIV. PrEP is currently being piloted for use in students

as to the staff at these institutions. As this is a high-risk group,

and this is likely to roll out to TVETs in the near future, as part of a

HTS providers should ensure that as many young people as

DOH prevention roll out strategy to students. Research suggests

possible are voluntarily tested. These are aligned to the National

that PrEP is highly effective in preventing the sexual transmission

HTS Programme. Outreach services should also target HEIs and

of HIV, as long as the drugs are taken regularly, as directed.

all HIV testing conducted in these settings shall be reported to the

However, PrEP does not prevent other STIs or pregnancy. It is

local health office. An HIV test can be done at any doctor, clinic or

recommended that PrEP be used together with other methods of

hospital, and is voluntary. Counselling before drawing blood (pre-

preventing HIV and STI transmission and pregnancy.

test) and after giving the result (post-test) is standard practice and required by law in South Africa. Counselling allows the patient to ask any questions, and to prepare for the possibility of a positive result. By law, the results of an HIV test are confidential, and may not be disclosed by the healthcare professional to anybody other than the patient. If a person tests positive for HIV, they will require additional counselling on living with HIV, options about disclosure, and possibly treatment adherence counselling. CAN medication be used to prevent HIV infection?

Post-exposure prophylaxis (PEP) PEP is Post Exposure Prophylaxis. Post (meaning after), Exposure (meaning having had contact with the virus), and Prophylaxis (meaning prevention). PEP is where medication is used to prevent infection after someone has been exposed to the virus, for example, through unprotected sex with an infected individual, rape where the perpetrator may be positive, a needle prick injury in a healthcare setting, etc. If it is the person’s first exposure to the virus, and PEP (which consists of ARVs) is administered within 72 hours of exposure, it may prevent the virus

Get tested and talk to your partner about HIV

from replicating sufficiently to infect the person. To be effective, PEP must be started within three days (72 hours) after possible exposure to HIV. PEP involves taking HIV medicines each day

Discuss HIV testing before you have sex

Oral sex is much less risky than anal or vaginal sex

If you’re sexually active, practice low-risk sexual behaviour

Use a condom correctly every time you have vaginal, anal, or oral sex

Get tested and treated for STIs and request that your partner(s) get tested and treated too

Avoid injectable drugs. But if you do, use only sterile equipment and water, and never share your equipment with anyone

Yes, HIV medicines are also used for pre- and post-exposure prophylaxis (PrEP and PEP, respectively) and to prevent motherto-child transmission (MTCT) of HIV. Pre-Exposure Prophylaxis (PrEP) PrEP is Pre-Exposure Prophylaxis. Pre (meaning before),

for 28 days. PEP is a short-term ART that reduces the likelihood of HIV infection after exposure to HIV-infected blood or sexual contact with an HIV-positive person or someone who may have HIV. The drug regimen for PEP consists of a combination of ARV mediations that are taken for a period of four weeks. Prevention of mother-to-child transmission of HIV (PMTCT) Pregnant HIV-infected women take HIV medicines during pregnancy and childbirth to reduce the risk of passing HIV to their babies. Their new-born babies also receive HIV medicine for six weeks after birth. The HIV medicine reduces the risk of infection from any HIV that may have entered a baby’s body during childbirth. PMTCT programmes provide ART to HIV-positive pregnant women to stop their infants from acquiring the virus. Without treatment, the likelihood of HIV passing from mother-tochild is 15% to 45%. However, ART and other effective PMTCT interventions can reduce this risk to below 5%.1

Exposure (meaning contact with the virus), and Prophylaxis (meaning prevention). It involves the use of ARVs to keep HIVnegative people negative. PrEP has been shown to be safe and effective at preventing HIV infection. Truvada is currently the only ARV approved for use as a PrEP. Truvada is administered as a single pill, but it in fact contains a combination of two ARV drugs. PrEP is meant to be used by those who may be at high risk for getting HIV. This includes HIV-negative adults in ongoing sexual relationships with HIV-positive partners, as well HIGHER HEALTH: A Training Resource Manual

World Health Organization (WHO). “PMTCT strategic

vision 2010-2015: Preventing mother-to-child transmission of HIV.” WHO, Geneva, 2010. 23

Mother to child transmission

HIV +

Pregnancy

Labour & Delivery

Breastfeeding

The Anatomy (physical structure) of the HIV virus

Steps in the HIV replication cycle

HIGHER HEALTH: A Training Resource Manual

What is a Fixed Dose Combination (FDC) ARV? •

FDC is a combination of two or more active drugs in a single pill.

•

The FDC ARV is a single tablet which contains a combination of tenofovir (TDF), emtricitabine (FTC), and efavirenz (EFV).

•

This means they are able to block the action of more than one HI virus at three different points at the same time. Antiretroviral (ARV) Drugs: How they Work

KEY MESSAGES THE IMMUNE SYSTEM RECOGNISES AND DESTROYS ANTIGENS (HARMFUL FOREIGN SUBSTANCES WHICH CAUSE ILLNESS AND DISEASE). A VIRUS IS AN EXAMPLE OF AN ANTIGEN. •

An immune response is when the immune system responds to the presence of “enemies” and makes antibodies to fight off diseases.

•

Antibodies are proteins in the blood that act as “weapons” to protect against future attacks from harmful substances (antigens).

•

The job of the antibody is to bind with antigens and immobilise them so that the T “killer” cells from the immune system can destroy and remove the foreign substances from the body.

•

With the HI Virus, it takes the body a long time to realise that they are in the body because of the integration of the viral DNA with the DNA of the CD4 cell.

•

This gives the virus enough time to replicate and produce millions of viruses before it is detected.

•

“Killer” T cells can only act if activated by the CD4 commander cell.

•

HIV is so powerful because it disables the CD4 cells so that they cannot give this command to the “killer” T cells to destroy the virus.

•

This allows invading antigens to remain in the body and weaken the immune system.

HIGHER HEALTH: A Training Resource Manual

Myths about HIV transmission, prevention and treatment

Myth

Fact

Myth No. 1: I can get HIV by being around HIV-positive people

HIV is not spread through touching or hugging, sneezing, coughing or breathing the same air or being in the same room as an infected person.

Myth No. 2: HIV is no longer a problem because drugs and medication are easily available

ARVs are easily available and accessible in our country now. But this does not mean we should be careless or reckless or take unnecessary risks. Because there is no known cure, once you start, you have to be on treatment for the rest of your life. This can lead to your body becoming used to the drugs and the drugs not working anymore. What’s more, sometimes you get tired of taking medication every day, and you may miss doses. If you miss doses, you can become resistant and also create a new and stronger virus that cannot be treated by the same drugs. This creates a problem for everyone. Also, because of the urgency of having to provide treatment, there’s not enough time to conduct longterm research to know the long-term impact and possible side effects of the drugs. As it stands, many of these drugs have side-effects that impact on the quality of life.

Myth No. 3: Mosquitoes can carry and spread the HI virus from one person to another

HIV is a HUMAN virus and, therefore, requires human DNA to survive. Thus the virus would not survive long enough for the mosquito to carry it from one person to another. Mosquitos also do not inject blood into people. Finally, several studies show no evidence to support this – even in areas with lots of mosquitoes and cases of HIV.

Myth No. 4: HIV is a death sentence

There are people throughout the world living with HIV for more than 20 years. HIV is currently treatable, even though it’s not yet curable. Treatment, together with choosing to live a healthy and risk-free lifestyle, will ensure: The life expectancy of HIV-positive individuals increases to almost that of a healthy uninfected person. Infected people live much longer, normal, and productive lives.

Myth No. 5: HIV is a man-made virus being used by governments to decrease minority population groups

There is no proof or evidence to support this theory. On the contrary, governments throughout the world spend a significant portion of their budget on HIV care, support and treatment

Myth No. 6: Only gay men and users of injectable drugs are at risk of HIV infection. Straight men are safe

Evidence shows a higher rate of infection among heterosexual men compared to gay men. HIV is about lifestyle and risk, rather than about specific sectors of the population.

Myth No. 7: If you’re on treatment, you cannot transmit the virus or become re-infected

Even with treatment, the virus remains in the body. For as long as that is the case, you can transmit the virus, and you can become re-infected with the same strain or infected with a new strain of HIV.

Myth No. 8: If both partners in a relationship are HIV positive there’s no need to practice safer sex

Practising safer sex is important to prevent reinfection or infection with a different strain. Repeated exposure to the virus increases your viral load and may make treatment less effective.

Myth No. 9: If my partner is HIVpositive, I’m sure I’d know

The only way to know if someone is HIV is through testing.

Myth No. 10: You’re safe from HIV infection if you practice oral sex

Oral sex is safer than other types of sex, but it is still possible to transmit the virus if there are entry and exit points for infected body fluids.

HIGHER HEALTH: A Training Resource Manual

LESSON THREE: TUBERCULOSIS (TB)

ASK YOUR HEALTH WORKER Purpose of activity:

Aim:

•

To define and describe Tuberculosis (TB) and its relationship

To provide participants with the opportunity to demonstrate what they know about TB.

to HIV and AIDS.

•

Learning Outcomes

To assess the level of baseline knowledge of participants and fill in the gaps about TB.

Lesson Outcomes:

•

To provide a non-threatening way to learn.

By the end of this lesson, participants should:

•

To demonstrate interesting, informal and safe ways for

•

Know what TB is.

•

Know the signs, symptoms, risks and treatment of

discussion and debate on TB.

different types of TB.

Requirements: Leader’s Resource – TB Q&A

•

Understand what a latent TB infection.

Time: 45 minutes

•

Know the signs and symptoms of active TB disease.

Planning Notes:

•

Be familiar with how drug-resistant TB is created.

•

Know the relationship between TB and HIV.

lead this session with you and to provide an opportunity

•

Understand the importance of adherence to the treatment

for participants to become familiar with information about

regimen and the consequence of non-adherence.

the clinic. Knowing a friendly face at a local clinic may

Know the challenges related to diagnosis and the

make it easier for them to go there when they need health

relationship to HIV in this regard.

services.

•

Read Leader’s Resource: TB Q&A.

Introduce the lesson and explain that it is important for

•

Cut out the questions only.

participants to know the risks of being infected with TB,

•

Fold the strips and place them in a container.

how TB is transmitted, and what to do to if you have

Obtain pamphlets on TB from a local health department or a

symptoms of TB.

family planning clinic. Display the pamphlets and information

Procedure 1.

Acknowledge

that

participants

may

already

from the clinic in a prominent area of the room.

have

knowledge and access to information about TB. 3.

Explain that it is for this very reason that they will be given

DISCUSSION QUESTIONS

the opportunity to demonstrate what they know as well as 4. 5.

Invite a practitioner from a local TB or health clinic to co-

learn some new information about TB.

•

What is the difference between MDR and XDR TB?

Divide the group into two and have the first group carry

•

What is DOTS, and why do we use this strategy?

their chairs and sit in a circle.

•

What is the link between HIV and TB?

The second group should sit in a circle around the first group.

Place one chair in the middle of the inner circle.

The inner circle is the “health workers”, and the outer circle is the community members visiting the clinic.

Members of the outer circle will be given pieces of paper

KEY MESSAGES •

TB is a preventable and curable disease.

•

South Africa is estimated by the World Health Organization (WHO) to have the world’s third-largest TB burden and an

with questions or concerns relating to TB. 9.

exceptionally high rate of multi-drug resistant (MDR) and

Members of the outer circle will have turns to go into the centre and choose a “health worker” to address their concern about TB.

extensively drug-resistant (XDR) TB cases. •

and pose a greater risk of infection to people in close

10. If the chosen health worker cannot answer their concern,

contact with the infected person. These strains more often

they can discuss with other health workers and provide an answer. 11. Conclude the activity using the Discussion Questions provided.

Drug-resistant strains are expensive and difficult to treat,

can lead to treatment failure and death. •

TB cases have become almost five times more severe than they should be due to HIV and AIDS.

•

Antiretroviral drugs (ARVs) do not cure TB, and TB drugs don’t cure HIV.

•

This is why it is very important that people know their HIV status and get tested for TB and HIV regularly.

HIGHER HEALTH: A Training Resource Manual

Resource for TB Activity: TB Q&A

WHAT ARE THE TESTS FOR TB? 1.

WHAT IS TB? Tuberculosis (TB) is a disease caused by germs that are spread

skin test, shows if a person has been infected. 2.

the air when a person with TB of

enough test for many people, and it is not used frequently. 3.

speaks,

sings.

People nearby may breathe in these

bacteria

and

become

infected. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. A person with TB can die if they do not get treatment. Other symptoms of TB depend on the parts of the body affected. With TB of the lungs, symptoms also can include coughing, chest pain, and coughing up blood WHAT CAUSES TB? TB is caused by the bacterium Mycobacterium tuberculosis. The bacterium can cause disease in any part of the body, but it normally enters the body through the lungs and resides there. HOW IS TB SPREAD?

A chest x-ray is given if the TST shows that a person has been infected. The x-ray shows if any damage has been

the lungs or throat coughs, sneezes,

QuantiFERON is a blood test for diagnosing latent TB infections (LTBIs). However, it is not yet an accurate

from person to person through the air. The bacteria escape into

The tuberculin skin test (TST), also called the Mantoux

done to the lungs. 4.

A sputum test shows if there are TB germs in a person’s lungs. Sputum is phlegm from deep inside the lungs.

WHO SHOULD GET TESTED FOR TB? •

A person who has symptoms of active TB disease.

•

A person who has been exposed to someone (a family member, friend, or co-worker) who has active TB disease.

•

A person who has HIV infection or certain medical illnesses such as diabetes or chronic kidney failure.

•

A person who is taking steroid or other immunesuppressing drugs for chronic medical conditions.

•

A person who lives or works in a homeless shelter, prison, hospital, nursing home, or another similar group setting.

TB can be cured, even in people living with HIV. Directly Observed

Treatment

Short

Course

(DOTS)

the

internationally recommended strategy for TB control. This means that the person with TB should have a buddy (friend or family member) that observes them taking the medication. This is done to provide support and help them remember to take the treatment because, if they miss doses, it can make their TB virus stronger and more powerful so that it becomes resistant to the treatment. This is how drug-resistant TB strains are formed. DOTS treatment uses a variety of powerful antibiotics in different ways over a long period to attack bacteria and make sure that they are destroyed. Treatment has been shown to prolong the life of people living with HIV by at least two years. It

TB is spread through the air from one person to another. The bacteria come out into the air when a person with active TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected. When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain. TB in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious. People with active TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and co-workers or schoolmates.

is important that people who have the disease are identified at the earliest possible stage so that they can receive treatment, contacts (people exposed to them while they were infectious) can be traced so that they too can be tested for TB, and measures can be taken to minimise the risk to others. However, some strains of bacteria have now become resistant to one or more of the antibiotics commonly used to treat them; these are known as drug-resistant strains. HOW IMPORTANT IS TREATMENT? If people with active TB disease do not take their medication, they can become seriously ill, they can develop germs that are resistant to the TB medications, and may even die. But people with active TB disease can be cured if they have proper medical treatment and take their medication as prescribed

HIGHER HEALTH: A Training Resource Manual

SIGNS, SYMPTOMS, RISKS AND TREATMENT OF DIFFERENT TYPES OF TB There are many different types of TB that are commonly treated in South Africa. Some of these will be mentioned below. Latent (sleeping) TB infection When somebody who has TB of the lungs coughs or sneezes and the germs are released into the atmosphere, they may enter the bodies of people who are nearby. People who have many CD4 cells have strong immune systems, so they are able to fight the bacteria to stop them from growing. In such cases, the bacteria are not strong enough to make the person sick, but they stay in the body even though they are not active. This is called latent TB infection (LTBI). In other words, the germs are asleep but alive in the body. People with LTBI: •

Have no symptoms,

•

Don’t feel sick,

•

Can’t spread TB to others, but

•

Will test positive if they have a TB blood test.

In many people who have strong immune systems, this sleeping infection (latent TB) never awakens. In these people, the TB bacteria can remain inactive for a lifetime without making them sick. However, in other people, especially people who have weak immune systems, the bacteria wakes up and grows strong when there are not enough “soldiers” (healthy white blood cells and other immune system components) to protect the body. They multiply, cause TB disease, and then the person becomes sick and starts showing symptoms. What are signs and symptoms of active TB disease? TB bacteria become active if the immune system can’t stop them from growing. The active bacteria begin to multiply in the body and cause active TB disease. The germs attack the body and destroy important cells and body tissue. The person starts to feel sick and show symptoms. Symptoms of TB depend on where in the body the TB bacteria are growing. TB in the lungs may cause symptoms such as shown below. Other symptoms of active TB disease are:

TB can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, signs and symptoms vary according to the organs involved. For example, TB of the spine may give you back pain, and TB in your kidneys might cause blood in your urine.

HIGHER HEALTH: A Training Resource Manual

What is drug-resistant TB?

What is the relationship between TB and HIV?

If you have active TB and the TB drugs that the health worker

People with suppressed immunity are more likely to develop

or clinic gives you do not work, then we say the germs are

active TB than those with normal immunity. Between 50% and

resistant to the medication. In other words, they are stronger

60% of untreated HIV-positive people infected with a latent TB

than the medication and have found ways to fight the drugs.

infection will go on to develop the active disease. The annual risk of TB in an untreated HIV-positive person is 10% compared

This is another reason TB remains a major killer. Drug-resistant

to a lifetime risk of 10% in a healthy individual.

strains of TB come about when an antibiotic fails to kill all of the

Immunosuppressive conditions, such as silicosis, diabetes

germs it targets. Since the first antibiotics were used to fight TB

mellitus, and prolonged use of corticosteroids and other

more than 60 years ago, some TB germs have found ways to

immunosuppressive drugs, also increase the risk of progression

survive, they are able to duplicate themselves and, therefore,

to active TB. Since the 1980s, the number of cases of TB has

make more that are stronger and can beat the medication.

increased dramatically because of the spread of HIV, the virus

Drugs for treating TB have been used for many decades, and

that causes AIDS. Infection with HIV suppresses the immune

resistance to the medicines is growing.

system, making it difficult for the body to fight TB bacteria. As a result, people with HIV are many times more likely to get TB

The main cause of drug resistance is not taking the medication

and to progress from latent to active disease than people who

properly (missing doses). When people do this, we say that

aren’t HIV positive.

they are not adhering to treatment. It is becoming more common that people who get TB for the first time are getting

Adherence to the treatment regimen and the

infected with the drug-resistant strain of TB. This is very scary

consequence of non-adherence

because drug-resistant TB (DRTB) is much harder to treat.

Adherence means taking your pills the number of times you

A patient may have to take as many as 14 600 pills over a

are supposed to without missing doses. Earlier we said that

two-year period – as well as a painful daily injection for the

drug-resistant TB (DRTB) comes about when the antibiotic

first six months. The treatment also has many side effects,

does not succeed in killing off all the germs, and some of the

including nausea, vomiting, hallucinations (seeing things that

germs survive and become stronger because they can now

are not real or not really there), diarrhoea, suicidal feelings,

fight the antibiotic and win. This happens mainly when people

and even deafness. HIV and TB are a powerful “killer” team,

miss doses because then there is not enough of the antibiotic

each helping speed the other’s progress. Someone who is

to kill all the germs. The serious results of allowing your body

living with HIV and TB is much more likely to become sick with

to grow resistant germs have been explained already. It is

active TB.

important to realise that when this happens, it puts the infected person, their families and the entire community at risk. It also

Some TB bacteria have developed resistance to the most

makes health workers helpless because the medication does

commonly used treatments, such as isoniazid and rifampin.

not work anymore.

Some strains of TB have also developed resistance to drugs less commonly used in TB treatment. These medications are often used to treat infections that are resistant to the more commonly used drugs. How DOES ONE get drug-resistant TB? There are two ways that people get DRTB. Firstly, people get DRTB when their TB treatment is not right. This can be for a number of reasons, including that patients miss medication doses and don’t take their medication the way the healthcare worker explains to them, the wrong TB drugs are prescribed, or TB drugs that are used for the treatment are not strong enough for the strain of virus that is being treated. The Second means happens when DRTB is passed on from one person to another.

HIGHER HEALTH: A Training Resource Manual

References

Are you in the RED? Zone Check: TB

Yes

Avert. “HIV and AIDS in South Africa.” Avert, 2019. Available at:

https://www.avert.org/professionals/hiv-around-world/sub-

Have you had a persistent cough with thick phlegm (mucus) for two weeks or more?

Are you HIV positive and have been coughing as well?

Have you experienced high temperatures/ fever for more than two weeks?

“Tuberculosis.” CDC, 2018. Available at: http://www.cdc.gov/tb

Have you experienced night sweats that leave you dripping wet?

Dutta, SS. “History of Tuberculosis.” News Medical, 2019.

Have you noticed that you’ve been losing weight without trying to (more than 1.5 kg in a month)?

Tuberculosis.aspx

Do you feel tired all the time?

Do you know/live with someone who is experiencing these symptoms?

If any of your answers place you on a red square, you are in the RED ZONE. This means that you are at risk for TB. Ask your HIGHER HEALTH Campus Coordinator for help with TB screening, testing, treatment and support as soon as possible.

saharan-africa/south-africa#sthash.orBk85Rd.dp Centers

Available

for

Disease

at:

Control

and

Prevention

(CDC).

http://www.news-medical.net/health/History-of-

HEAIDS. “Students and staff at tertiary institutions at risk of TB.” HEAIDS, 2015. Available at: http://heaids.org.za/news/studentsand-staff-at-tertiary-institutions-at-risk-of-tb National Department of Health (NDOH). “South African National TB Management Guidelines 2014.” NDOH, 2014. Available at: http://www.tbonline.info/media/uploads/documents/ntcp_adult_ tb-guidelines-27.5.2014.pdf Mayo Clinic. “Tuberculosis.” Mayo Clinic, 2019. Available at: http://www.mayoclinic.org/diseases-conditions/tuberculosis/ symptoms-causes/dxc-20188557 SANAC. “National Strategic Plan on HIV, STIs and TB 20122016.” SANAC, 2011. Available at: www.health.gov.za/docs/ strategic/2012/NSPfull.pdf StatsSA. “Mortality and causes of death in South Africa, 2013: Findings from death notification.” StatsSA, December 2014. Available at: http://beta2.statssa.gov.za/publications/P03093/ P030932013.pdf WHO. “Tuberculosis Fact Sheet No. 104.” WHO, October 2014. Available at: http://www.who.int/mediacentre/factsheets/fs104/ en

HIGHER HEALTH: A Training Resource Manual

Chapter 2 SEXUAL AND REPRODUCTIVE HEALTH

HIGHER HEALTH: A Training Resource Manual

Introduction and Overview

Aim

Prevention and treatment of sexual and reproductive health (SRH)

The key focus of the chapter is to support young people to

issues requires a thorough understanding of the psychological

become personally and socially competent in managing their

and social contexts in which they occur, as well as the biological

sexual and reproductive health and well-being

and diagnostic aspects of SRH and well-being. Introducing reproductive health education at schools and post-schooling

What is Sexual and Reproductive Health?

institutions can have many benefits. These programmes can help prevent early pregnancy, HIV/AIDS and STIs, as well as various cancers. Lecturers can also refer students to local health or counselling services when appropriate. By providing reproductive health education early, it is possible to encourage the formation of healthy sexual attitudes and practices. This is easier than changing well-established unhealthy habits later. Note to facilitators •

A peer educator’s own values should not interfere with teaching reproductive health, for example, if their religious beliefs prohibit termination of pregnancy (TOP) this should not preclude them from assuming a neutral stance when discussing the issue in a group or workshop setting.

•

Use respectful terms and avoid hurtful language, particularly in regard to sexually active young people, and those who do not conform to conventional gender and social norms.

•

Topics related to reproductive health — for example, TOP — may raise disturbing or intense feelings. Students should not feel pressured to disclose information about their own experiences.

•

Peer educators should be aware of their capacity to provide support to students. Should students choose to access such support, it is crucial to respect their confidentiality.

•

Be prepared to manage sensitive issues, and to challenge discriminatory attitudes. Here are some tips: --

Prepare yourself to discuss the issues without feeling uncomfortable.

Get as much information as possible on what potentially sensitive areas may be so that you can work out strategies to bring them out and handle them effectively.

Build an open atmosphere in which participants feel comfortable talking about these issues.

Encourage open and frank discussion and commend participants who display openness.

Observe the group’s body language to help you decide when to probe an issue further and when to back off. When people do not want to discuss something, they may avoid eye contact or fold their arms across their chest.

According

the

World

Health

Organization

(WHO), sexual and reproductive health (SRH) is a state of physical, emotional, mental and social well-being in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction or infirmity (illness). Therefore, a positive approach to sexuality and reproduction should recognise the part played by pleasurable sexual relationships, trust and communication in promoting self-esteem and overall well-being. All individuals have a right to make decisions governing their bodies, sexuality and reproductive well-being, on condition that these decisions do not infringe on the rights of others. This includes the right to access education and information, services and healthcare on sexual and reproductive health and rights (SRHR). SRHR are basic human rights for everyone and are fundamental to the development conditions of any population. SRHR also seeks to ensure that users of the material, including peer educators and students, are informed of legislation and policy pertaining to SRHR. The training of peer educators will be designed to familiarise them with the methodology and provide them with opportunity to discuss how they can use and adapt the resources in the tool-kit for working with students. The facilitators will be able to share their own perspectives and experiences where it will help to modify the tool kit to meet their needs.

HIGHER HEALTH: A Training Resource Manual

THIS CHAPTER SEEKS TO:

Activities and tasks Discuss why this topic is important

Define relevant terminology

Identify SRH as an umbrella for issues that affect men, women and LGBTI individuals alike

Support young people to manage their sexual and reproductive health

Match that! Quiz: Is that a fact? Instructions for the flow of the activities and tasks (sexual health) •

Introduce the module on SRH by asking the question: “What do we mean by the terms Sexual and Reproductive

LESSON ONE: SEXUAL HEALTH Aim To explore all aspects of sexual health and well-being, including a healthy lifestyle, sexual rights and responsibilities, as well as risks and consequences associated with lifestyle and sexual

Health?” •

Note all responses on the flip chart.

•

Ask “What is sexual health?” and note responses on the flipchart.

•

Instruct students on the procedure for the activity “match that”, as provided below. Explain that the activity will

behaviour.

explore other terms relevant to the core content of the

Lesson Objectives

entire module.

By the end of this lesson, peer educators will: •

Understand what is meant by sexual health and wellbeing and why this topic is important.

•

Understand relevant terms and concepts pertaining to Sexual and Reproductive Health (SRH).

•

Have explored several aspects of sexual behaviour, including consequences of high-risk practices:

•

STIs (risks, prevention, treatment, care and support),

•

Sexual consent,

•

Sexual decision-making,

•

Safer sex, and

•

Access to and availability of treatment, care and support.

•

Understand the concepts of adherence and resistance.

•

Know the different types of STIs and how they contribute

Activity 1: Match that! a.

into two smaller groups (equal in number if possible). b. c.

•

Be familiar with available resources and know-how to access health services.

Planning Notes •

Prepare and review instructions for activities.

•

Ensure that preparation for the activities is completed timeously.

activity below). d.

Sexual health, including sexual well-being.

•

Terminology and acronyms specific to SRH.

•

Four categories of STIs.

•

Education and prevention.

•

Treatment, care and support.

Instruct students to read out aloud what is written on their card.

If it is a term, the person from the opposing team with a matching definition should put their hand up and read the definition aloud. The facilitator will confirm whether it is “a match”.

Continue until all terms and definitions have been matched.

Allocate 10-12 minutes for this activity.

Conclude the session by giving each student a handout containing all terms and definitions discussed.

On completion of this activity, conclude the lesson on terms, concepts and definitions by encouraging students

Lesson content •

Distribute cards with terms and concepts to one group and cards with definitions to the other group (see resources for

Be aware of the need for compliance and health monitoring.

Instruct each group to stand in a line side by side facing the other group.

to increasing the risk of HIV infection. •

Divide the class into groups of six, then divide each group

to master all relevant terms and definitions. j.

Task: Create your own dictionary or glossary of terms and concepts and exchange with each other to enrich your knowledge bank.

Time allocation 2 hours 30 minutes

HIGHER HEALTH: A Training Resource Manual

RESOURCE FOR THE ACTIVITY: MATCH THAT!

There are human rights that recognise the basic right of all couples and individuals to:

REPRODUCTIVE RIGHTS

•

Decide freely and responsibly the number, spacing and timing of their children

•

have the information and means to do so,

•

attain the highest standard of sexual and reproductive health, and

•

make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents...”

GENDER IDENTITY

CONSENT

How a person perceives themselves - as a man, as a woman, or other. When someone clearly and voluntarily agrees to do something, fully understanding the consequences of their decision, and they do so without coercion, such as the use of force or threats to their safety and does so without being drunk, drugged or deceived.

GENDER ROLE

Norms of expected behaviour for men and women assigned primarily on basis of biological sex; a sociological construct, which varies from culture to culture. Violence against another person because of their gender. The violence can be physical,

G E N D E R - B A S E D sexual, psychological, economic or cultural. While this type of violence is largely experienced VIOLENCE

as violence against women, it can affect all people, including men, and gay, lesbian, transgender, queer and intersex (LGBTQI) persons. “These rights are usually understood as the right of all people, regardless of their nationality, age, sex, gender, health or HIV status, to make informed and free choices with regard to their

SRHR

own sexuality and reproductive well-being, on condition that these decisions do not infringe on the rights of others. This includes the right to access education and information, services and healthcare. They are considered to be a basic human rights for everyone and are fundamental to development conditions of any population”

SEXUAL RIGHTS

RAPE

The right of individuals to control their own bodies and their sexuality without discrimination, coercion, or violence. Non-consensual penetration, however slight, of the vagina, anus or mouth by a penis, any other body part or object. Unwanted or obscene remarks, including verbal and non-verbal conduct. Examples include

SEXUAL HARASSMENT

touching, unwelcome jokes, whistling, rude gestures, unwanted questions about sex life, requests for sex, staring at your body in an offensive way, or promising rewards in exchange for sexual favours, to name a few.

10. SEXUALITY 11. RAPE CULTURE

This term is about understanding one’s own sexual feelings and attractions one might feel towards others. It is not about whom we have sex with, but who we are sexually attracted to. The social or cultural practices and beliefs that allow for rape and sexual violence to be normalised, accepted and expected. The direction of one’s sexual interest toward members of certain sexes. Can involve fantasy,

12. SEXUAL ORIENTATION

behaviour, and self-identification; a person’s general makeup or alignment in terms of partner attraction. Includes (among others) a same-sex orientation, male-female orientation, a bisexual orientation, and a pansexual orientation.

HIGHER HEALTH: A Training Resource Manual

DISCUSSION QUESTIONS 1.

How did it feel to learn new and different terminology?

Why is it important to know this information?

What does language have to do with actual behaviour, practices and actions?

KEY MESSAGES •

Terms and concepts change and adapt in accordance with new strategies and information.

•

New terminology emerges regularly.

•

Keeping abreast with information is empowering because it ensures progressive thinking, standards and developments.

Allow a five-minute break 1. 2.

Introduce the next lesson. Explain that it is important for participants to know the risks of sexually transmitted infections (STIs), how they’re transmitted, and what to do to reduce that risk.

Acknowledge that participants may already have knowledge and access to information about STIs.

Explain that it is for this very reason that they will be given the opportunity, in the form of a quiz, to demonstrate what they know as well as learn some new information about STIs.

Activity 2: Is that a fact? Time: 45 mins •

Divide the group into four teams and have each team move to different corners of the room.

•

Tell participants that their team will play against the others in a game and the team with the most points wins.

•

Go over the instructions for the game.

•

Each team will draw a statement about STIs. The team must consider the statement and decide whether the statement is true or false.

•

If their answer is correct, the team scores two points. If the team can also explain why the answer is correct, they get an extra point.

•

If the team cannot correctly explain the answer, another team can try for the extra point.

•

Have someone from the first team draw a statement and confer with his/her team members to decide whether it is true or false. Ask the team member who drew the statement to declare whether the team has agreed that the statement is either true or false.

•

Ask the team to explain the statement and award an extra point if the explanation is correct. If not, allow any other team to try for the extra point.

•

As the game progresses, use the Fact Sheet (leader’s resource) and the content section in this lesson to provide additional information about the statements. Conclude the activity using the Discussion Questions provided for extra points.

•

Add up points and announce first, second, third, and fourth places.

HIGHER HEALTH: A Training Resource Manual

RESOURCE FOR THE ACTIVITY: IS THAT A FACT? #

STATEMENT 2 points

TRUE

FALSE

EXPLANATION 1 Point

A person can always tell if she/he has an STI.

People can and do have STIs without having any symptoms. Women often have STIs without symptoms because their reproductive organs are internal. However, men infected with some STIs, such as chlamydia, also may have no symptoms. People infected with HIV, the virus that causes AIDS, generally have no symptoms for some time, even years, after infection.

With appropriate medical treatment, all STIs, except HIV, can be cured.

Herpes and human papillomavirus (HPV) (genital warts) are STIs caused by viruses. Neither can be cured at the present time.

The organisms that cause STIs can only enter the body through a woman’s vagina or a man’s penis.

STI bacteria and STI viruses can enter the body through any mucous 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 IV drug needles, or when an open wound comes into contact with infected blood.

Women who have regular Pap smears will also find out at that time if they have an STI.

The Pap smear is a test specifically for cancer and/or pre-cancerous conditions of the cervix. It may occasionally detect herpes infection, but it will not indicate the presence of other STIs. A woman who thinks she may have been exposed to an STI must be honest with her health practitioner and ask for STI tests.

Teens can receive testing and treatment for STIs without parents being notified.

STIs are a new medical problem that emerged with HIV.

STIs can cause major health problems, and some STIs may cause conditions that result in death.

Only people who have vaginal, anal, or oral intercourse can be infected with an STI.

Infants can contract some STIs, such as an HIV infection and herpes, during pregnancy and/or birth. Also, some STIs, as we have noted before, can be spread by close sexual contact that does not include vaginal, anal, or oral intercourse.

It does not hurt to delay STI testing and treatment after you think you have been infected.

Once an STI infects a person, it begins damaging his/her health. If someone waits weeks or months before getting tested and beginning treatment, his/ her health may be permanently damaged. Treatment may be unable to reverse this damage. In addition, the infected person can spread an STI to sexual partners.

In South Africa, teens can receive confidential testing and treatment at public health clinics. Confidential testing and treatment for STIs are available for youths as young as 12 years old. Confidential means that no one other than the teen and their healthcare provider may find out about the testing and treatment. Many community health clinics provide STI tests and treatment at no cost. X

HIGHER HEALTH: A Training Resource Manual

STIs have existed since people began recording their history. There is evidence of medical damage caused by STIs in ancient writings, art, and skeletal remains. Writers of the Old Testament, Egyptian writers from the time of the pharaohs, and the famous Greek physician Hippocrates all mention symptoms of diseases and suffering caused by what we know today to have been STIs. Researchers and physicians began to find cures for most STIs during the 20th century. However, some STIs, such as herpes and genital warts, still cannot be cured. HIV infection, which can be spread through sexual contact, injures the immune system until Acquired Immunodeficiency Syndrome (AIDS) results. AIDS is fatal. Genital warts may be related to cervical cancer, which, if not treated, may become invasive and result in a woman’s death. Genital herpes can blind a person and otherwise injure babies born when infected women have open herpes lesions. Some STIs, such as gonorrhoea and chlamydia, can cause pelvic inflammatory disease (PID). If untreated, PID may cause sterility, heart disease, and/or death. Untreated syphilis can result in brain damage and death in infected people and, when infants are born to infected women, syphilis can cause severe retardation in infants.

10.

Even if a woman is using oral contraceptives, she and her sexual partner should use latex condoms or dental dams to protect against infection with STIs, including HIV.

Oral contraceptives do not protect against STIs, so a condom or other barrier protection, such as a dental dam, is still necessary for protection against STIs, including HIV.

11.

Washing the genitals immediately after having sexual intercourse may help prevent some STIs.

However, personal cleanliness alone cannot prevent STIs. Washing will not prevent HIV from entering the body.

12.

It is possible to get some STIs from kissing.

It is rare, but it is possible to be infected with syphilis through kissing if the infected person has chancres (small sores) in or around the mouth. Herpes can also be spread by kissing if a person has herpes lesions around the mouth.

13.

Oral intercourse is a safe way to have sexual intercourse if you do not want to get a disease.

It is possible to be infected with HIV, gonorrhoea, syphilis, and herpes from oral intercourse.

14.

People usually know they have an STI within two to five days after being infected.

Many people never have symptoms, and others may not have symptoms for weeks or years after being infected. HIV infection may not show symptoms for years, but the infected person is capable of infecting others during that time.

15.

It is important to inform your sexual partner(s) if you suspect you have been infected with an STI.

The most important thing to do is to seek immediate testing and get treatment if the test results are positive (meaning you have an STI). Symptoms of an STI may never appear or may disappear after a short time, but the infection remains in the body. She/he can suffer serious physical damage and continue to infect others. Once treatment is begun, sexual partners should be informed. In the meantime, it is important to abstain from any sexual contact.

What is Sexual Health? The definition of Sexual Health is contained within the definition of SRH as “a state of physical, mental and social well-being in relation to sexuality”, which requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences free of coercion, discrimination and violence. This means that sexual health is not just about our bodies, it is about our mental and emotional state, as well as our sense of belonging in society. There isn’t a “one size fits all” definition of sexual health. Different cultures and societies have different ideas of what it means to be “sexually healthy”. It is important to understand that sexual health is more than avoiding disease. It is about sexual health, as defined above by the WHO. • Enjoyment of sexual relations without exploitation, oppression or abuse. • Safe, planned pregnancy and childbirth. • Absence and avoidance of STIs, including HIV.

HIGHER HEALTH: A Training Resource Manual

Sexual behaviour and sexual health Our sexual health has a clear relationship with our sexual behaviour. If we take risks related to our sexual behaviour, for example, these risks have consequences. Examples of high-risk behaviours are shown in the diagram below.

Becoming sexually active under the age of 18

Having many sexual partners

Inconsistent or incorrect condom use

Having sex whilst under the influence of alcohol or drugs

Sexual violence

Having unprotected sex

Having unprotected sex with a stranger

Health Effects of Sexual Behaviour Risky sexual behaviours can lead to many negative health-related consequences, especially STIs and unplanned pregnancies. Poor sexual health can have many effects on an individual as well as a relationship. Unplanned and unintended pregnancies (will be discussed in more detail under reproductive health) Unplanned and unintended pregnancies can result in young mothers needing to sacrifice their education, which can create dependence on others to provide for the family economically. In such situations, women become vulnerable and have no power in their relationships. This can place them at great risk of being abused and exploited which, in turn, places them at risk in terms of their sexual health. STIs, including HIV Vulnerability, economic dependence, and lack of power in sexual relationships make it difficult for women to negotiate safer sex or have control over sexual decision-making. In such situations, women are at high risk for STIs, including HIV.

SEXUALLY TRANSMITTED INFECTIONS (STIS)

Key issues •

What are STIs?

•

Signs, symptoms and treatment options of different STIs.

•

Myths associated with STIs.

•

The relationship between STIs and HIV.

•

The importance of notifying relevant present and past partners when an STI is diagnosed.

HIGHER HEALTH: A Training Resource Manual

What are STIs? A Sexually Transmitted Infection, or STI, is an infection passed from one person to another person through sexual contact. STIs are spread from one person to another, mainly through unprotected sexual contact. If you have an STI and it is not treated, it can make you very sick. The worrying thing is that STIs sometimes don’t have symptoms, which means you or your partner may have an STI and not know it. STIs can be caused by a virus, bacteria, fungus or parasite. Having an STI can cause the body to lose some of the immune cells (soldiers) that keep the body strong and protect it from other dangerous infections. As a result, our immune system could become weak and allow other infections to enter the body at the same time. If an STI is not treated, it can result in serious long-term health problems, such as infertility, cancer, long-term pain, and even death. It can also be passed from a pregnant mother to her baby. There are FOUR possible STI families Bacterial STIs may be found in one part of the body. If you go to the clinic, the health worker may give you medication that can treat and cure the STI. Examples of STIs that are caused by bacteria include diseases such as Gonorrhoea, Chlamydia and Syphillis. Viral STIs attack systems in the body. They invade the whole body and its cells. They can be treated but not cured. Some examples are Hepatitis B, HIV Genital Herpes (HSV-2) and Genital Warts (HPV). Fungi are like plants and they usually grow on or in the top layer of the skin. They are not always passed on by having sex with someone, and they can be cured. A parasite is a creature that lives off another being’s body. Think of a parasite as a little bug that cannot always be seen by the naked eye. These STIs that are caused by parasites are passed from person-to-person during sexual activity.

General symptoms Some of these STIs and their symptoms can be permanent and can cause chronic pain, emotional distress, infertility, and even DEATH. Some STIs can show no symptoms.

HIGHER HEALTH: A Training Resource Manual

How can I prevent becoming infected with an STI? •

Abstaining from vaginal, oral, or anal sex is the best way to prevent an STI. However, if you are sexually active, you can protect yourself and lower your risk of getting an STI with the following steps: --

Use condoms. It is important to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like pills, injections, implants, or diaphragms, will not protect you from STIs.

Get vaccinated. There are vaccines to protect against HPV and Hepatitis B.

Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test before you have sex.

Be faithful. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other.

Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.

Do not douche. Douching is washing the inside of the vagina with water or other mixtures of fluids. Most douches are sold as pre-packaged mixes of water and vinegar, baking soda, or iodine. You squirt the douche upward into your vagina. The water mixture then comes back out through your vagina. Douching is different from washing the outside of your vagina during a bath or shower, which will not harm your vagina. But, douching can lead to many different health problems. It removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting STIs.

Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behaviour, may put you at risk of sexual assault, and possible exposure to STIs.

Explore other forms of sexual pleasure.

Delay sexual activity.

DISCUSSION QUESTIONS RAPID FIRE... IN 30 SECS (First group to ring the bell can answer) What are the signs and symptoms of STIs? Redness or soreness of the genitals; pain when urinating (mostly among males); strong-smelling or cloudy urine; unusual discharge from the penis or vagina; sores or blisters on or around the genitals, mouth, or anus; a sexual partner with such symptoms. What are the most effective ways to avoid STIs? 1) Abstaining from vaginal, anal, and oral intercourse; and 2) using latex condoms every time you have any kind of sexual intercourse. What three things should you do if you are worried that you have been infected with an STI? 1) Seek medical testing and treatment right away; 2) inform your sexual partner(s); and 3) abstain from sexual contact at least until there is no evidence of infection and under the guidance of a healthcare worker. Men who have sex with men can use condoms to protect themselves and their partners from most STIs. What can women who have sex with women use? Barriers, such as squares of latex called dental dams, latex condoms which have been cut open, or plastic wrap to cover the vulva and form a barrier so body fluids cannot be exchanged.

KEY MESSAGES

•

STIs are infections that are spread from person to person through intimate sexual contact.

•

They can be dangerous and easily spread, and it is hard to tell just by looking if somebody has an STI.

•

There are four different types of STI: those caused by a virus, those caused by bacteria, those caused by a parasite, and those HIGHER HEALTH: A Training Resource Manual

caused by a fungus. •

If an STI is left untreated, it can result in serious long-term health problems, such as infertility, cancer, long-term pain, and death, and can be passed from a pregnant mother to her baby. Viral STIs are systemic and invade the whole body and its cells. They are treatable, but not curable, and include Hepatitis B, HIV,

•

Genital Herpes (HSV-2), and Genital Warts (HPV). •

Bacterial STIs are localised to one part of the body, are curable by antibiotics, and include diseases such as Chlamydia, Gonorrhoea, and Syphilis.

•

Fungal infections commonly grow on or in the top layer of skin, are not always sexually transmitted, and are curable.

•

Other infections of the genital areas, which can be cured with antibiotics or topical creams, include Pubic Lice, Trichomoniasis, and Thrush (Candida), other inflammations of the vagina caused by organisms such as bacteria or yeast, and irritations from chemicals in creams, sprays, or clothing.

Testing and treatment for STIs •

If you have symptoms, you should go to your healthcare provider for a check-up.

•

Testing for STIs includes taking a urine sample, taking a swab of the vagina or penis for secretions, examining sores or bumps on the genitals, or doing a blood test. Managing an STI includes the following steps: --

Counselling for the individual, so they understand the STI and its spread and treatment;

Condom use for any future sexual encounters, to prevent the spread of the STI;

Compliance with treatment that is given to the patient at the clinic; and

Contacting previous sexual partners to advise them to get tested – it is their right to know as they have the responsibility to treat it and not spread it.

Are you in the Red? Zone Check: Sexually Transmitted Infections 1.

Are you using a condom if/when you’re having sex?

Do you have an unusual bad smell or coloured liquid coming from your vagina or penis?

Do you have any rash, bumps, sores or blisters around your genitals with or without pain?

Do you have genital warts?

Do you have an itchy penis, vagina or anus?

Do you experience a burning sensation when urinating?

Yes

If any of your answers place you on a red square, you are in the RED ZONE. This means that you are at risk for having a STI. Ask your HIGHER HEALTH Campus Coordinator for help with STI screening, testing, treatment and support as soon as possible.

HIGHER HEALTH: A Training Resource Manual

Preparation for the lesson

LESSON TWO: REPRODUCTIVE HEALTH

To prepare, facilitators should: •

Aim •

To know what constitutes Reproductive Health and explore issues around family planning, particularly in relation to women, ways of preventing an unwanted pregnancy, and contraception.

the content. •

By the end of this lesson, peer educators will know:

•

What family planning is.

•

The benefits of family planning.

•

Methods of contraception.

•

The risks and consequences of unplanned pregnancies.

•

Interrogating termination of pregnancy (TOP), including

activity. •

Activities and tasks

•

The case for safer sex practices.

•

Why screening tests are important as part of reproductive health.

Planning Notes Read content and check for any updates in legislation and policy.

•

Crossword activity (in pairs)

•

Bag of dreams activity (in pairs)

Methods: •

Game

•

Reflection and introspection

•

Paired discussion and reflection

•

Simulation

Instructions for flow of the activities AND tasks 1.

Prepare and review instructions for activities.

•

Ensure that preparation for the activities is completed timeously.

What do we mean by “Reproductive Health”?

Why do we need to include this topic in the life orientation (LO) or life skills curriculum?

LESSON CONTENT brainstorm

Introduce the lesson on Reproductive Health by asking the following questions:

•

Plenary

Be aware that it is not possible to cover every detail in the be provided with handouts to supplement class activities.

legislation.

•

Familiarise themselves with how best to execute the

time allocated. At the end of the session, students should

•

Read through the lesson and familiarise themselves with

baseline

understanding

health, it is important to understand which body parts are

reproductive health. •

Reproductive system crossword puzzle.

•

Bag of dreams activity.

•

Group discussion and feedback. --

Family planning

Safer sex and contraception

Contraceptive methods

Unplanned pregnancy

Termination of pregnancy (TOP)

Screening for cancer

Time:

Explain that, to begin the discussion on reproductive involved in sexual and reproductive health.

Explain that the first activity, therefore, will focus on the biology of sexual and reproductive health.

Divide students into pairs using the “pick me” cards.

Hand out the “Reproductive System Crossword Puzzle” to each pair.

Teams have 10 minutes to complete the activity.

When the 10 minutes are up, instruct pairs to stay where they are for the plenary discussion.

Quickly go through the answers for the activity.

Instruct them as described below.

2 hours Material needed for the lesson:

•

Flip chart and markers

•

Pick me cards to divide into pairs

•

Reproductive Health crossword

•

Bag of dreams (zip lock bags with message)

HIGHER HEALTH: A Training Resource Manual

RESOURCE FOR THE ACTIVITY REPRODUCTIVE SYSTEM CROSSWORD PUZZLE Time: 10 minutes Read each clue and fill in the correct answer. Your answer must fit into the correct number of boxes. Where a vertical answer crosses with a horizontal answer, they will share a box with the same letter. Across 5. The place where a baby develops. 7. Forceful release of semen from the penis. 8. Time in life when a woman’s menstruation ends. 9. Ducts connecting the ovaries to the uterus where fertilisation takes place (two words). Down 1. Passing of semen during sleep (two words). 2. Release of an egg from an ovary. 3. Place where sperm is produced. 4. A thick fluid that is discharged from the penis during ejaculation. 6. The process by which a child’s body develops toward becoming an adult body and being able to reproduce. 7. Hardening of the penis.

Answer key Across: 5. uterus; 7. ejaculation; 8. menopause; 9. Fallopian tubes. Down: 1. wet dream; 2. ovulation; 3. testicle; 4. semen; 6. puberty; 7. erection. Adapted from My Changing Body, courtesy of Institute for Reproductive Health. www.irh.org Upon completion of the exercise, leave the participants in the same pairs and instruct them as below for the next activity.

HIGHER HEALTH: A Training Resource Manual

BAG OF DREAMS Time: 30 minutes 1.

Discuss with your partner your dreams for your future (five minutes per person)

Where do you see yourself in the future? Do you have a skill, talent or resources that could make you well-known in your field?

Imagine there were no obstacles and, with your partner, make plans for yourself regarding your career, job, family, home, travel, etc.?

Hand out one “bag” to one person per pair.

Instruct student with the bag to a read message in the bag.

The message to females will read: “You receive a message that your pregnancy test came back positive…”

The message to males will read: “You receive a phone call from your girlfriend to say that she is pregnant…”

What does this mean for you right now (practically and financially)?

How will this impact on the dreams and plans you have for yourself?

What will change?

Why are you in this situation?

What are your options going forward?

For the next activity, combine two pairs into a group.

Instruct groups to discuss the following:

Group Three: Testicular Cancer a.

do it? b.

Mention risk factors.

Danger signs (practice screening questions).

Treatment.

Group Four: Prostate Cancer a.

do it? Mention risk factors.

Danger signs (practise screening questions).

Treatment.

Group Five: Breast Cancer a. b.

Mention risk factors.

Danger signs (practice screening questions).

Treatment.

10. In the plenary, facilitate a discussion based on feedback from all groups. 11. On completion of the activity, conclude by encouraging students to “Feel, THINK, and Act” as opposed to “Feel, ACT, and then Think”. 12. Task: Create your own dictionary or glossary of terms and concepts and exchange with one another to enrich your knowledge bank.

DISCUSSION QUESTIONS

What are the benefits of family planning?

•

List the five main types or categories of contraception?

•

What is the legal age for termination of pregnancy (TOP),

What is “dual protection”?

Reasons young people have difficulty negotiating safer sex.

Group Two: Cervical Cancer a.

do it?

•

Mention risk factors.

Danger signs (practice screening questions).

Treatment.

Reproductive health is crucial to our overall health and Understanding sexuality and SRH is a pre-requisite to becoming sexually active.

•

Readiness for sex is crucial to understand.

•

Being sexually active involves sexual rights and responsibilities.

Why is this screening test important? How often should you

What does it mean for you right now?

well-being.

Group One B: Reasons why young people may not use contraception.

Why is it important to know this information?

KEY MESSAGES •

Why is this screening test important? How often should you do it?

What is family planning?

and when is it safe?

Why is this screening test important? How often should you

Group One A: a.

Why is this screening test important? How often should you

•

Regular screening is important to prevent various cancers of the reproductive health system.

HIGHER HEALTH: A Training Resource Manual

What you need to know about reproductive health Background and motivation Prevention and treatment of sexual and reproductive health (SRH) issues requires a thorough understanding of the psychological and social contexts in which they occur as well as the biological and diagnostic aspects of SRH and wellbeing. Introducing reproductive health education at schools and post-schooling institutions can have added benefits. These programmes can help prevent early pregnancy, HIV/ AIDS and STIs, as well as various cancers. Lecturers can also refer students to local health or counselling services when appropriate. By providing reproductive health education early, it is possible to encourage the formation of healthy sexual attitudes and practices. This is easier than changing wellestablished unhealthy habits later.

Planning for pregnancy or contraception can be done by couples together, where women and men talk openly with their partners about their wish to have children, or their wish to delay or prevent having children. It can also be done individually, where a person makes a choice about contraception alone. It is important to think and talk about contraception before having sex to avoid unplanned pregnancy and to avoid HIV and other STIs. Why is Family Planning necessary AND important? Many unwanted pregnancies can be prevented if both partners agree not only to have safer sex but also to prevent unwanted pregnancy. There are many family planning methods providing sexually active men and women with different options to choose from. Family planning is the responsibility of both partners in a relationship.

What is family planning? Family Planning is about planning for pregnancy: •

How many children to have.

What are the benefits of

•

When to have these children.

family planning?

•

Who to have children with.

• It allows women to make

•

How to provide adequately for children.

decisions about when to

•

Prevention of pregnancy (contraception).

have children, who to have

•

Planning for pregnancy (conception).

them with, and how to provide adequately for children when they are born.

Unplanned pregnancies • • •

•

Unplanned pregnancies can have negative effects on the health of a woman, as well as having an impact on

girl.

the whole family. Unplanned pregnancies may result in

Cause financial stress including not being able to afford

parents not being able to afford the cost of having a child,

the cost of having a child.

as well as the other children in the family suffering from

Existing or new children in the family suffering from

hunger, neglect or abandonment.

hunger, neglect or abandonment. •

•

Can have negative effects on the health of a woman or

•

Impacts the whole family. Cause pregnant teenagers to be at high risk of:

Family planning allows couples to have planned families so that every child that they have is a wanted pregnancy.

•

It allows spacing between children so that the women

Premature labour and delivery,

have the opportunity to recover from one pregnancy

Anaemia,

before having another child. Too many pregnancies or

Pre-eclampsia, and

pregnancies that are closely spaced can cause major

Having a baby with a low birth weight.

health problems for women, including a shortage of essential nutrients such as iron and folate, stress, and

Too many pregnancies or pregnancies that are closely

complications with the uterus. There are also risks for

spaced can cause major health problems for women,

the baby, including low birth weight, premature birth, and

including: •

A shortage of essential nutrients such as iron and folate

developmental problems. •

In certain women where pregnancy would cause harm to

(Vitamin B),

her or the child’s well-being, it is a good method to prevent

•

Stress, and

pregnancy.

•

Complications with the uterus.

•

Family planning can prevent unplanned pregnancies.

There are also risks for the baby, including:

Unplanned pregnancies among teenagers have a higher

•

Low birth weight,

risk of premature labour and delivery, anaemia, pre-

•

Premature birth, and

eclampsia, and having a baby with a low birth weight.

•

Developmental problems.

•

Family planning allows for partners to engage in sexual activity without conceiving a baby.

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Are you in the Red? Zone Check: Unplanned Pregnancy You are NOT ON CONTRACEPTION because you

Yes

Are having unprotected sex but do not think you are at risk of pregnancy

Don’t have sex often enough to get pregnant

Want to have a baby so that your boyfriend will marry you

Are embarrassed to ask for information about contraception

You and your partner are ready/planning to have a baby

Don’t have access to contraception

Feel pressure from your partner or family to get pregnant

Are scared your partner will reject you if you talk about family planning

The FIVE main types or categories of contraception

Are scared of side effects of contraception (e.g. weight gain)

These include male and female condoms and diaphragms.

10. Fear that sex will feel different or less pleasurable If any of your answers place you on a red square, you are in the RED ZONE. This means you are at risk for unplanned pregnancy. Ask your HIGHER HEALTH Campus Coordinator for help with pregnancy testing, counselling, contraception and support as soon as possible.

Barrier methods prevent sperm from getting inside the woman.

Hormonal methods are those that prevent eggs from being released inside the woman’s uterus by altering hormone levels. These include pills, injectables, emergency contraception, and implants. Long-term methods have to be provided at a health clinic by a trained nurse or doctor. These include intrauterine devices

Contraception and Family Planning What is contraception?

(IUDs) and implants. Permanent methods like male and female sterilisation require

“Contra” means “against” and “ception” means “to conceive”. So

surgery. These methods are not usually recommended for

contraception involves the use of different devices, medicines,

young people who may change their minds about wanting to

sexual practices, or surgical procedures to prevent pregnancy.

have children in the future. Permanent methods are best for

There are many different contraceptive methods that are freely

adults who have already had children and know that they do

available at clinics around the country. Some methods are

not want to have any more.

more effective than others. Any person can use contraception, including those who are HIV positive. People who are on

Natural methods do not require any materials (i.e., the

antiretroviral therapy (ART) or any other medication should

withdrawal method, and the “rhythm method” which is when

consult a healthcare practitioner to discuss the best method

the woman learns to recognise when she is fertile and avoids

for them, as some medicines and contraceptive methods do

having sex during that time). In general, natural methods do not

not work well together

work as well as the modern methods listed above. They require great self-control. The rhythm method only works well when a woman has very regular periods. In some places, people use traditional methods. These are mostly herbs that are given to prevent pregnancy. They are not reliable because the dosage is not controlled and they have not been scientifically proven to work.

HIGHER HEALTH: A Training Resource Manual

KEY MESSAGES •

Always use condoms consistently and correctly.

•

Condoms will prevent HIV, other STIs, AND pregnancy.

•

You may want to use a second method of contraception for additional protection from undesired pregnancy.

•

If a condom is not used correctly, consider emergency

•

Use a new condom for each sex act and check the expiry

contraception as soon as possible. date. •

After ejaculation, hold condom and remove the penis from the vagina.

•

Throw used condoms away properly.

•

Give condoms or explain where to buy or get them.

Emergency Contraception What is emergency contraception? Emergency contraception is a safe way to prevent pregnancy after unprotected sex. There are a few types of emergency contraception, and some work better than others. There are two ways to prevent pregnancy after you have unprotected sex: •

Option 1: An IUD can be inserted within 120 hours (five days) after having unprotected sex. This is the most effective type of emergency contraception.

•

Option 2: The emergency contraceptive pill (also known as the morning-after pill) can be taken within 120 hours (five days) after having unprotected sex.

HIGHER HEALTH: A Training Resource Manual

The morning-after pill

Reasons why young people may not use contraception

•

Ella is a type of “morning-after” pill that you can only get with a prescription.

HIV. They think: “It can’t happen to me” or “I don’t have

There are also Plan B, One Step, Take Action, My Way,

sex often enough to get pregnant or contract an STI or

AfterPill, and others. • •

You can buy these morning-after pills over the counter

HIV”. •

health services, or are embarrassed to ask for information

These types of morning-after pills work best when you

or required services. •

sex, but you can take them up to five days afterwards.

(television, radio, etc.). •

•

Contraceptive methods are not available or are too expensive.

pregnancy if:

•

They do not have access to accurate information at home, in school, in the community, or from media sources

The sooner you take them, the better they work.

You can use emergency contraception to prevent •

They do not have access to youth-friendly reproductive

without a prescription in most pharmacies. take them within 72 hours (three days) after unprotected •

They do not think they are at risk of pregnancy, STIs or

You didn’t use a condom or other birth control method

•

Denial: “My partner would never expose me to any risk”.

when you had vaginal sex.

•

They feel pressure from their boyfriend or family to get pregnant.

You messed up your regular birth control (forgot to take your birth control pills, change your patch or ring, or get

•

They are scared their partner will reject them.

your shot on time) and had vaginal sex.

•

They are scared of side effects (e.g., fear of hormonal side

Your condom broke or slipped off after ejaculation

effects associated with ‘the pill’, or fear that sex will feel

(coming).

different with a condom).

•

Your partner didn’t pull out in time.

•

They feel embarrassed.

•

You were forced to have unprotected vaginal sex.

•

A doctor or nurse at the clinic has a judgemental attitude.

•

They do not know how to negotiate condom use with their

Don’t use two different kinds of morning-after pill (like Plan B

partner.

and Ella) at the same time or within five days of each other, because they may counteract each other and not work at all.

•

They have inaccurate information, for example, thinking

And don’t take more than one dose of any type of morning-

that a girl cannot get pregnant if she is menstruating, or

after pill – it won’t give you extra protection from pregnancy,

that a girl cannot get pregnant when she has sex for the

but it can make you feel sick.

first time.

KEY MESSAGES Always use condoms •

sex • •

those decisions.

vagina. Condoms can be inserted up to eight hours ahead of time.

•

When finished, the woman must move away from her partner and take care not to spill semen on the vaginal

•

The condom should be thrown away properly, in a bin or

Young people may believe that if they suggest having safer sex, their partners will think they do not trust them.

•

Young people may be scared or embarrassed to bring up the topic of protection.

opening. •

Young women may not have control over when and how they have sex because their male partners may make

Condoms should be inserted before the penis touches the

•

They may not have the right communication skills to talk about protection with their partners.

Couples should use a new condom for each act of intercourse.

•

Reasons young people have difficulty negotiating safer

•

Young people may want to get pregnant. Young women

trash can as appropriate.

might believe that it is a way to stay in a relationship. For

Female condoms are more expensive than male condoms

young men, getting a girlfriend pregnant may be a way to prove their manhood.

and may be less widely available. •

Sometimes, young women who feel a lack of love in

For people living with HIV: Remember to apply the same

their lives think that having a baby assures them of

measures, even if you are on ART and you and your partner

unconditional love.

are both HIV positive

HIGHER HEALTH: A Training Resource Manual

•

Young mothers are at a higher risk of complications during pregnancy because they are not fully developed, and their bodies may not be ready to handle pregnancy or to give birth.

•

Young mothers may face problems such as obstructed labour, long labour, anaemia, pre-eclampsia (a condition that pregnant women develop marked by high blood pressure which they never experienced before), a high

What is “dual protection”? Dual protection means preventing STIs, HIV and unwanted pregnancy at the same time. Dual protection includes: •

Using male or female condoms with another contraceptive method such as the oral contraceptive pill.

•

Using male or female condoms alone.

•

Abstinence (not having sex at all).

level of protein in their urine, and often swelling in the feet, legs, and hands. This may cause impaired kidney and liver function, blood clotting problems, pulmonary oedema (fluid on the lungs), seizures and, in severe forms or if untreated, maternal and infant death, or hypertension during pregnancy. •

Young mothers may also suffer the consequences of unsafe abortion, spontaneous abortion, stillbirth, and premature birth.

•

Adolescents younger than 17 often have not reached physical maturity, and their pelvises may be too narrow to accommodate a baby’s head.

•

KEY MESSAGES •

Reproductive health is crucial to our overall health and well-being.

•

Understanding sexuality and SRHR is a pre-requisite to becoming sexually active.

•

Readiness for sex is crucial to understand.

•

Being sexually active involves sexual rights and responsibilities.

•

Regular screening is important to prevent various cancers of the reproductive health system.

Pregnancy often means the end of formal education for girls, as they may have to drop out when they become pregnant.

•

Pregnancy changes a girl’s career options, her future opportunities, and may limit her marriage choices.

•

Unmarried mothers sometimes have to take low-paid and risky jobs, or become sex workers to support their children.

•

Sometimes the partner refuses to take responsibility for the pregnancy, which makes things much harder for the young mother and child.

•

Young parents are often not ready to raise a child which, in some cases, can lead to problems like child abuse or neglect.

•

Early marriages that happen because of an unplanned pregnancy are often unhappy and unstable.

•

What options are there for unplanned pregnancies, and what are the implications of each of these?

•

Termination of pregnancy (TOP): psychological issues of stress, anxiety, guilt, depression, and medical issues.

•

Having the baby:

•

Adoption: psychological issues of stress, anxiety, guilt, depression, and medical issues.

•

Foster care: psychological issues of stress, anxiety, guilt, depression, and medical issues.

•

Keeping the baby: financial, practical, education, support, and lifestyle change issues.

HIGHER HEALTH: A Training Resource Manual

Chapter 3 SEXUAL AND GENDER DIVERSITY

HIGHER HEALTH: A Training Resource Manual

SEXUAL AND GENDER DIVERSITY

Introduction and Overview

Note to facilitators •

Remain neutral and avoid imposing your personal values on students.

•

Use respectful terms and avoid hurtful language, particularly with regard to same-sex attraction, sexually active youths, and young people who do not conform to conventional gender norms.

•

Topics related to LGBTQI+ health, for example, stigma and discrimination from healthcare workers, vulnerability for HIV, and access to appropriate services may raise disturbing or intense feelings. Students should not feel pressured to disclose information about their own experiences.

•

support to students. Should students choose to access

Our institutions of learning have not really taught us much on the topic of gender and sexual diversity. What we know comes largely from our families and communities, and is influenced by

Peer educators should be aware of their capacity to provide such support, it is crucial to respect their confidentiality.

•

Be prepared to manage sensitive issues, and to challenge stigmatising attitudes. Here are some tips:

how we are socialised. From an early age, we learn that boys

and girls belong to two separate “worlds” and that these worlds

Prepare yourself to discuss the issues without feeling uncomfortable.

must never converge. For example, when buying gifts for our

friends and relatives’ newborn babies, it is difficult to resist the

Get as much information as possible on what potentially sensitive areas may be so that you can

temptation to buy pink clothes for girls and blue clothes for boys.

work out strategies to bring them out and handle them

Girls are taught to submit to men while boys are socialised to be

effectively.

dominant over women, and even made to believe that this might

feel natural. It is nothing but a consequence of being gendered

Build an open atmosphere in which participants feel comfortable talking about these issues. However, also

– a social construct.

remain vigilant about risks of stigma and discrimination from the target group itself towards those who may feel

From the moment we are born, we are inundated with messages,

encouraged to “come out” in these sessions.

spoken and unspoken, about different types of people. Often we

learn stereotypes and prejudices without even realising it. Some

Encourage open and frank discussion and commend participants who display openness.

of these messages may have been about ourselves and what

we are “supposed to” or “not supposed to” be. What were the

Observe the group’s body language to help you decide when to probe further on an issue and when to back

earliest messages you received about people who are lesbian,

off. When people do not want to discuss something,

gay, bisexual, transgender, queer, or intersex (plus other

they may avoid eye contact or fold their arms across

sexualities not listed here) (LGBTQI+), and where did they come

their chest.

from? Were they positive, negative or neutral? Understanding the messages we receive can help us identify our own beliefs and biases that we can then challenge, helping to make us

Overall aim

stronger allies. Even though it becomes difficult to discuss issues

To provide information to enhance understanding of issues and

of gender and sexuality, this chapter aims to process these often difficult conversations by helping both peer educators and students to become gender and sexuality sensitised, so that we may start forging safer and friendlier environments for gender

challenges concerning the LGBTQI+ community and review accurate and relevant information about each of the key health risks pertaining to LGBTQI+ persons.

and sexual minorities.

Overall objectives

“In too many countries, lesbian, gay, bisexual, transgender

This chapter seeks to:

and intersex people are among the poorest, most marginalized

•

and sexual diversity.

members of society... Studies show that gay and lesbian people suffer disproportionate discrimination and abuse” – Former UN Secretary-General Ban Ki-Moon.

HIGHER HEALTH: A Training Resource Manual

Provide peer educators with an understanding of gender

•

Enhance the understanding of the complexity of human sexuality.

•

Examine personal, cultural, and historical influences on human sexuality.

•

Sensitise peer educators to LGBTQI+ issues (coming out, coming to terms with sexual identity and sexual orientation).

•

Address myths and misconceptions to mitigate stigma and discrimination of gay and lesbian people and those belonging to other sexual and gender minority groups.

•

Promote understanding and insight into the health consequences of prejudice and discriminatory behaviour,

Activity One: Sexuality and Orientation: To review where LGBTQI+ issues fit within the broader context of human sexuality. Requirements Copies of the Sexual Activity handout for groups. Instructions for the flow of the activities

such as hate crimes. •

Foster awareness of general and specific issues pertaining

•

Introduce the lesson.

to health needs, challenges and risks faced by the LGBTQI+

•

Divide participants into pairs.

community.

•

Distribute a copy of the Sexuality and Orientation Activity handout to each pair.

Chapter content

•

sexual activity with a kind of sexual orientation that they

By the end of this module, peer educators will: Understand relevant terms and concepts pertaining to

•

human sexuality.

feel best fits the sexual activity (10 mins). •

orientations.

sexual orientation, sexual identity, and sexual practices and behaviour. Have had opportunity to debate and discuss human

•

sexuality with a focus on gender and sexual diversity. •

Be sensitised to the emotional and psychological aspects of “coming out”.

•

Be aware of stigma and discrimination within the context of gender and sexual diversity.

LESSON ONE: SEXUALITY Aim: To review where LGBTQI+ issues fit within the broader context of human sexuality. Lesson objectives By the end of this lesson, peer educators will: •

Know the meaning of human sexuality.

•

Be familiar with terminology related to human sexuality.

•

Understand where LGBTQI+ sexuality fits within the context of human sexuality.

Planning notes •

Prepare and review instructions for activities.

•

Ensure that preparation for the activities is completed timeously.

Lesson content •

Sexual health, including sexual well-being.

•

Terminology and acronyms specific to SRH.

•

Four categories of STIs.

•

Education and prevention.

•

Treatment, care and support.

Once the time is up, ask pairs to give feedback on the various sexual activities and their matching sexual

Understand the differences between biological sex, gender,

•

Ask them to populate the handout by matching a particular

Note to facilitators: The outcome of the activity should be that there is no heterosexual or homosexual sex. From this activity, the conclusion should be that sex is between two bodies, not sexual orientations, because we are not heterosexual or homosexual based on who we have sex with, or how we practice sex, but on who we are attracted to. Activity Two: Human Sexuality Quadrant Requirements •

A flipchart and pens.

•

Copies of the human sexuality handout for groups.

Instructions for the flow of the activities a.

For the next activity, divide participants into groups.

Distribute copies of the handout on human sexuality to groups.

Instruct them to complete the diagram in the handout by filling in the different categories of human sexuality (20 mins).

Go through the diagram in plenary inviting different groups to give input on aspects that are missing.

Process the activity using the discussion questions below.

On completion of the activity, conclude the lesson by encouraging students to master all relevant terms and definitions.

TIME ALLOCATION 50 minutes

HIGHER HEALTH: A Training Resource Manual

RESOURCE FOR ACTIVITY ONE: SEXUAL ACTIVITY AND ORIENTATION

DISCUSSION QUESTIONS •

How did it feel to learn new and different terminology?

•

Why is it important to know this information?

•

Was anyone uncomfortable with the discussion?

•

Why were people uncomfortable?

Kissing

•

How does socialisation impact on sexuality?

Flirting

•

Did you learn anything new?

•

How do you feel about what you learnt?

Hugging

Sexual Activity

Heterosexual Gay Couple Couple

Lesbian Bisexual Couple Couple

Masturbation Vaginal sex

KEY MESSAGES

Anal sex

•

Oral sex

Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and in thoughts, fantasies, desires, beliefs, attitudes, values,

RESOURCE FOR ACTIVITY ONE: HUMAN SEXUALITY QUADRANT

behaviours, practices, roles and relationships.

Sex

Gender

Sexual Orientation

Sexual Behaviour

reproduction. Sexuality is experienced and expressed

•

Sexuality includes five interrelated, components: biological sex, gender (identity and expression), sexual orientation, sexual identity, and sexual practice or behaviour.

•

Biological sex refers to the scientific concept that categorises individuals as either male or female.

•

Biologically male: has a penis, testicles, XY chromosomes, and produces testosterone.

•

Biologically

female:

has

vagina,

ovaries,

chromosomes, and produces oestrogen. •

Intersex people are born with chromosomes, external genitalia, and/or internal reproductive systems that do not fit the “typical” definition of either male or female.

•

Sexual orientation is the way in which one expresses oneself sexually in relation to others. The three sexual orientations are: homosexual, bisexual, and heterosexual (straight). --

A person’s gender role is largely culturally and socially determined.

Gender identity is a person’s deeply felt individual

experience of gender (man ßà woman), which may or may not correspond with the sex assigned at birth.

Gender expression is the way in which a person’s sense of gender manifests itself, usually as an extension of the person’s gender identity.

Sexual identity is how one thinks of oneself in terms of who one is romantically or sexually attracted.

Sexual practice and behaviour are the manner in which humans experience and express their sexuality.

Understanding Human Sexuality Why is it important to understand human sexuality and sexual behaviour? Human behaviour, particularly sexual behaviour, is complex. Therefore, an introductory understanding of human sexuality will provide the necessary background required to understand sexual minorities better. By exploring human sexuality, individuals are often exposed to the vast spectrum of human behaviour that naturally exists among our societies and, in

Resource for Activity One: Sexual Activity and Orientation

HIGHER HEALTH: A Training Resource Manual

so doing, offers a new lens through which to consider sexual minorities and their place in society. 59

What is Human Sexuality

What is intersex? Intersex people are born with chromosomes, external genitalia,

According to the WHO, the working definition of sexuality

and/or internal reproductive organs that do not fit clearly into

is:

either sex category of male or female.

A central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual

Historically, intersex individuals are surgically altered soon

orientation, eroticism, pleasure, intimacy and reproduction.

after birth to appear more definitely male or female. These

Sexuality is experienced and expressed in thoughts, fantasies,

surgeries often have serious complications that can affect

desires, beliefs, attitudes, values, behaviours, practices,

individuals for the remainder of their lives. Specifically, these

roles and relationships. While sexuality can include all of

“corrective” surgeries remove any choice intersex individuals

these dimensions, not all of them are always experienced

have in deciding their sex, which can leave many mentally and

or expressed. Sexuality is influenced by the interaction of

emotionally traumatised. Intersexuality challenges the notion

biological, psychological, social, economic, political, cultural,

that human sex is binary (either male or female). Intersexuality

ethical, legal, historical and religious and spiritual factors.

shows that biological human sex is actually a spectrum with male on one end, female on the other end, and a variety of

Society has a tendency to put people into boxes which often

inter-sexualities in the middle. Caster Semenya is an example

don’t take into account the fact that we are all unique beings.

of such a case.

Just as we have a unique fingerprint, we also have a unique social and sexual identity. One can never know someone’s sexual identity based on their biological sex, gender identity, gender role, sexual orientation, or sexual behaviour. Furthermore, society looks at sex, sexual orientation and especially gender as binary concepts (either/or; one or the other), for example, male or female. However, male and female or man-ness and woman-ness are at different ends of a spectrum with many other possibilities in between. The more we learn, the more we realise that, when it comes to human sexuality, there are no basic rules or prescriptions that can apply to all. What follows is a description of each dimension.

What is gender? A person’s gender refers to attitudes, feelings, and behaviours that society associates with the biological sexes. Gender identity A person’s gender identity refers to how that individual feels and thinks about themselves as a man or a woman. It is common to confuse “sex” and “gender”, but they do not refer to the same thing. Sex is a biological concept, while gender is Biological sex Biological sex categorises individuals based on certain

a social construct, that is, an idea, philosophy, or belief that is built or “constructed” by society rather than nature.

Gender Identity

characteristics like their chromosomes, internal and external genitalia, and their hormonal profile. A person’s sex is usually categorised as either male or female. Biologically male: has a penis, testicles, XY chromosomes, and produces testosterone. Biologically female: has a vagina, ovaries, XX chromosomes,

Woman

Genderqueer

Man

Cisgender (often abbreviated to cis) is a term for people whose gender identity matches the sex that they were assigned at birth.

and produces oestrogen. 60

HIGHER HEALTH: A Training Resource Manual

sex.

What is transgender? Transgender is a broad term that refers to individuals whose gender, their self-identification as a man or woman, does not match their biological sex. Transgender people have a very intense experience of their gender being different from that assigned by birth. Transgender people sometimes seek medical treatment to bring their body and gender identity

Homosexual refers to an individual who has romantic, sexual, intellectual, and intimate feelings towards others of the same sex. There are two homosexual identities: gay and lesbian. Gay - A gay man is someone who has romantic, sexual, intellectual and intimate feelings for, or a love relationship with another man (or men), and identifies as gay.

closer into alignment.

Lesbian - A lesbian is a woman who has romantic, sexual,

Transitioning broadly refers to the act of changing genders

another woman (or women), and identifies as lesbian.

intellectual and intimate feelings for, or a love relationship with

to fit a person’s gender identity. For example, the baby girl described above would most likely “transition” to living life as a man. Transitioning can take many forms. For some

Bisexual refers to an individual who has romantic, sexual, intellectual, and intimate feelings towards others of the same sex as well as the opposite sex.

transgender individuals, it may include hormone treatment, surgery, or simply adjusting their clothing and role within their community. Gender expression Gender expression is how we show ourselves to the world through clothes, hair, and behaviour styles. Because gender is assigned many physical things, and even activities, it’s possible to express yourself through various preferences in a way that aligns with who you feel you really are. The most common gender association example is the colour pink for girls and the colour blue for boys.

Gender Expression Feminine

Androgynous

Masculine

What is sexual orientation?

What is sexual identity? Sexual identity is how one thinks of oneself in terms of to whom one is romantically or sexually attracted. Sexual identity may also refer to sexual orientation identity. What is sexual behaviour? Sexual behaviour is the way in which individuals experience their sexuality. All people, no matter their sexual orientation, use various body parts to experience sexual pleasure, on their own or with others. Sexual behaviour may be influenced by an individual’s biological sex, sexual orientation, sexual identity, or gender. LGBTQI In summary, sexuality and gender diverse persons are often

Sexual orientation is part of identity and includes sexual attraction as well as emotional, romantic, and intellectual attraction. Essentially, sexual orientation encompasses all of a person’s intimate psychological and physical feelings towards others. There are three main types of sexual orientation:

referred to with the acronym LGBTI. LGBTI is an umbrella term that refers to a diverse group of people who “are clustered together in one abbreviation due to similarities in experience of marginalisation, exclusion, discrimination, and victimisation in a heteronormative and heterosexist society.”

heterosexuality, homosexuality, and bisexuality. Heterosexual refers to an individual who has romantic, sexual, intellectual, and intimate feelings towards others of the opposite HIGHER HEALTH: A Training Resource Manual

Lesson content

Lesbian

SEXUAL ORIENTATION Gay

Bisexual

•

Understanding what is meant by “coming out”.

•

The six stages of coming out.

•

Guidelines for coming out.

T Trans* Gender Identity and Expression Q Queer

TIME ALLOCATION

Activity One: Secrets and Closets

Intersex

Biological Sex

Trans* people generally self-identify with a gender that does not correspond to the sex assigned to them at birth. The term trans* is used with an asterisk at the end to signify that “trans-” may be followed in a number of different terms (e.g., “transsexual,” “transgender,” and “transvestite”). The asterisk also acknowledges other gender identification categories and social gender roles, such as genderqueer and androgynous,

60 minutes

Requirements Flipchart and koki pens. Instructions for the flow of the activities 1.

Give each participant a small piece of paper.

Ask participants individually to think about a secret or something they have never told anyone and write it down

among others.

on the piece of paper provided. This must be something which if anyone found out about would cause discomfort,

LESSON TWO: COMING OUT Coming out is a process of understanding, accepting, and valuing one’s sexual orientation and identity. It involves both exploring one’s identity and sharing this identity with others. Coming out can be a very difficult process. Our society strongly enforces codes of behaviour regarding sexual orientation and gender identity, and most people receive the message that they must be heterosexual and act according to society’s definition of their gender. This message is also communicated through cultural norms and values about sex, sexuality and gender. For LGBTQI persons, there may be a sense of being different or of not fitting into the roles expected of you by your family, friends, workplace or greater society. Coming out involves facing societal responses and attitudes toward LGBTQI people. Aim: To sensitise peer educators to the challenges faced by the

embarrassment or shame for the participant. 3.

secret and write it down. Hint: the idea with the piece of paper is to make participants think you will share the secrets they write down with the rest of the group. This will, however, not be asked from them. Rather, the exercise is designed to make them reflect and interrogate themselves. There is a possibility that participants will refuse to write down a secret. If participants do not write down a secret, use this after the activity by including a question like: Why did you not want to write down your secret? 4. a.

Know the meaning of “coming out”.

•

The stages of coming out.

•

The challenges related to facing the issues related to sexual diversity.

•

Some guidelines for students and others who are considering coming out.

Planning notes •

Prepare and review instructions for activities.

•

Ensure that preparation for the activities is completed timeously.

How did you feel doing the exercise? Why did you feel that way?

Note their responses on a flipchart, black board or white board, focusing more on the words they use to describe their feelings. Words that might be used are “scared”,

Lesson objectives •

Ask them the following questions (give them time to respond):

LGBTQI youth during their emerging sexuality. By the end of this lesson, peer educators will:

Give participants up to two minutes to think about their

uncomfortable”, “guilty”, etc. c.

What did you think I was going to ask you to do after thinking about your secret? (They will likely say they expected the facilitator to write down and share their secrets.)

If I had asked you to write down and share your secrets, how would that have made you feel?

Again, write their responses on a flipchart, focusing more on the words they use to describe their feelings. Words that might be used are “worried”, “judged”, “stigmatised”, etc.

HIGHER HEALTH: A Training Resource Manual

Now relate the discussion to other people who might be facing some of the problems mentioned above, and ask

For most people, it takes time to know who they are. 2.

the participants to put themselves in others’ shoes. Ask them: •

How do you think a person would feel if their secret came out and society discriminated against them?

•

What can we do better to make other people comfortable with “coming out”?

Highlight how vulnerable people with such secrets are, and the level of internal stigma they face (stigmatising themselves) before they are even stigmatised by society.

Focus the discussion on coming out, and emphasise that we all want to come out of our “closets” in different ways, but it is not an easy thing to do because of societal

It is okay to be confused or to be uncertain about whether or how to come out.

Remind the person: 3.

That they are not alone. There are many others with the same questions and concerns that one may have.

There are also people and institutions that can support or mentor those who need such support. It’s important to find the help needed from the resources available. At the end of this chapter, are some resources and contact details that may be helpful.

COMING OUT!

prejudice and discrimination. Move the discussion to focus on acceptable values by asking the participants to come up with a set of values they want to use and adhere to in the context of today’s session. This might include values such as “honesty”, “non-judgmental”, “respect”, etc. Write down these values on a flipchart and open a discussion around them. Ask the following questions: 1.

Why are these values important for you?

Can we use these values outside of this workshop? How so? Give examples.

How do we deal with a person who does not adhere to our values? Why do we treat them that way? Can we treat them any better? Can we accept a person who holds different values?

Note to facilitators Make participants aware that values clarification does not tell you what values you should live by, but provides you with a method that lets you discover what values you do live by. What gives our life its meaning and relevance are our values. When examined, we discover that they are the principles or standards upon which we base our decisions about how we want to live our lives now and in the future. Our choices, whether we are aware of it or not, reflect our values. Values are not transmitted or taught, but learnt directly from an individual’s life experiences. They develop, grow and change through interaction with the self, the environment, and other people. The process is dynamic, and throughout the course of life, values can change. Peer educators Remember: 1.

For gay, lesbian, bisexual, transgender and queer people, the coming out process can be both difficult and liberating.

HIGHER HEALTH: A Training Resource Manual

The Six Stages of Coming out

In 1979, Vivian Cass7 developed a model for coming out which is now known as the Cass Theory. It is a six-stage model that describes the developmental process individuals go through as they consider and then acquire a homosexual identity. This model includes lesbian, gay and bisexual identities. It is important to let your students know that they might find themselves in one of these stages. They just have to know that what they are experiencing is completely normal and that

Stage Three – Identity Tolerance

many, many others have had similar experiences.

Your acceptance of your homosexuality increases, and

http://patrickgarvin.com/blog/?p=312

distress concerning your sexual orientation decreases, you

Cass, V.C. (1979). Homosexuality identity formation: A

theoretical model. Journal of homosexuality, 4(3), 219-235.

you begin to tolerate this identity. Although confusion and may feel increased isolation and alienation, as your selfconcept becomes markedly different from broader society’s expectations of you. In this stage, you often begin to seek out positive relationships with other gays or lesbians, and begin to embrace your sexual orientation.

Stage Four – Identity Acceptance You have resolved most of the questions concerning your Stage One – Identifying Confusion

sexual identity, and have accepted yourself as homosexual.

At the beginning of a person’s coming out process is a period

You have increasing contact with the LGB community.

where that person begins to question their heterosexual identity. This typically happens when a person realises that they are attracted to members of the same sex. You begin to wonder whether you may be homosexual. Along with other thoughts and feelings, you may experience denial and confusion.

Stage Five – Identity Pride You begin to feel pride in being part of the LGB community and immerse yourself into LGB culture. In turn, you have less contact with the heterosexual community. Sometimes you may Stage Two – Identity Comparison

actually feel angry with or reject the heterosexual community.

This is a dark and lonely stage marked by anxiety and depression. The mental struggle is about trying to figure out what it means to be gay or lesbian, etc. You accept the possibility that you may be gay and face the social isolation that can occur with this new identity.

HIGHER HEALTH: A Training Resource Manual

As peer educators, it is important to examine one’s personal attitudes and to become more self-aware so that if changes need to take place, one becomes aware and vigilant about one’s thoughts, actions and behaviour. Aim: To sensitise peer educators to their own attitudes and feelings regarding issues pertaining to sexual and gender diversity. Stage Six – Identity Synthesis You no longer see your sexual identity as being separate from other aspects of yourself. It becomes integrated so that it is just part of your whole identity. The anger you may have felt toward the heterosexual community or the intense pride you may have felt in being homosexual decreases, and you can be your whole self with others from both groups. You feel more congruence between your public self and your private self.

Lesson objectives By the end of this lesson, peer educators will: •

Have had the opportunity to introspect and become aware of their own attitudes regarding LGBTQI issues. Have

•

Pick someone who you feel is very supportive to be the first person you come out to.

When you come out, think about what you want to say and choose the time and place carefully based on what will be safest and most supportive context.

Be prepared for an initially negative reaction from some people. Some individuals need more time than others to adjust to what they have heard from you.

Don’t give up hope if you do not initially get the reaction you wanted. Remember that you have the right to be who you are, and to be out and open about all important aspects of your identity, including your sexual orientation. In no case is another person’s rejection evidence of your lack of worth or value.

If you have already come out to others whom you trust,

debate

and

discuss

various

perspectives around sexuality. Address myths, misconceptions and stereotypes relating to

•

the LGBTQI+ community. •

Be able to understand how homophobia and transphobia affect everyone.

For students and others who are thinking about coming out, consider the following:

opportunities

Planning notes •

Prepare and review instructions for activities.

•

Ensure that preparation for the activities is completed timeously.

Notes for facilitator Positive and negative answers can come from this activity. Try not to be judgemental, but use the suggested discussion questions to make people reflect and aware of the effects of not clarifying myths, misconceptions and stereotypes (no safe space, no support…). This also relates to the topic of how peer educators can help, support and be allies. Lesson content •

Myths and misconceptions.

•

Challenging stigma and discrimination.

alert them that you are coming out, and make time to talk

Time allocation:

afterward about how things went. Find trusted allies who

30 minutes

can help you cope with your experiences. 6.

Get support and use the resources available to you.

Activity One: Sentence Completion

LESSON THREE: ATTITUDES AND SELF-AWARENESS

Requirements

Despite the Constitution and other laws that protect the rights of LGBTQI+ communities, many face high levels of social stigma and homophobic violence as a result of traditional and conservative attitudes within the general population. LGBTQI+ individuals continue to experience many forms of discrimination,

Flipchart and koki pens. Sentences. Handout: Myth information. Instructions for the flow of the activities a.

sentences one-by-one, and that participants will be called

stigmatisation, and even violence and victimisation – including sexual abuse and rape, hate speech, domestic violence, and physical abuse or assault.

HIGHER HEALTH: A Training Resource Manual

Explain to the participants that you will read incomplete upon to finish the sentences spontaneously.

Make sure to clarify whose turn it is before you read a sentence. 65

Mention that there is no right or wrong answer.

Read the provided sentences one-by-one.

Repeat until everyone has had their turn.

Facilitate a plenary discussion using discussion questions

•

Becoming knowledgeable, accepting, and comfortable with this topic before teaching it. If you cannot be, identify someone to teach in your place and carefully screen them.

•

provided.

Considering carefully how the institutional community (lecturers, students, religious leaders, and others) may feel about sexual orientation which is an extremely sensitive topic, and working with them to avoid negative

DISCUSSION QUESTIONS

reactions. •

Preparing this topic carefully, but not being overly hesitant

How did you feel during this activity?

Would anyone like to comment on what they just said?

about addressing it. If you meet a lot of resistance, work to

If there are no LGBTQI+ persons in the room that you are

educate other stakeholders before undertaking work with

aware of, ask: “How do you think LGBTQI+ individuals feel

the target group.

after hearing (some) of the answers?” OR, if persons are in the room who openly identify under the LGBTQI+ umbrella,

RESOURCE FOR ACTIVITY ONE: SENTENCES

ask them how the answers made them feel. 4.

If many of the answers reflect misconceptions or prejudice,

ask: “What can we do to change this?” à learn the facts to debunk myths and misconceptions.

•

If I found out my colleague is bisexual, I would…

•

If a close friend of mine who I assumed was straight told me (s)he was gay/lesbian and was attracted to me, I would feel…

KEY MESSAGES

•

wearing clothing items meant for females and/or makeup,

For the peer education programme, destigmatising LGBTQI+ students means: •

Establishing a safe and supportive environment.

•

Objecting to and eliminating jokes and humour that put down or portray LGBTQI+ people in stereotypical ways.

•

Countering statements about sexual orientation or gender identity that are not relevant to decisions or evaluations being made regarding awards, selections, nominations or appointments.

•

Inviting “out” professionals to conduct seminars and provide guest lectures on LGBTQI+ topics and other topics of their expertise.

•

Not forcing LGBTQI+ people out of the closet or to “come out”. The process of coming out is one of enlarging a series of concentric circles and is very individual. Initially, the process should be in control of the individual until (and if) they consider it public knowledge.

•

If a male friend of mine that I regularly go out with started I would…

•

When I think of two people of the same sex making love to each other, I feel…

•

If I found out my child’s teacher was gay or lesbian, I would…

•

When I meet a trans* person, I feel or I would….

•

When I think about children who are being raised by lesbian or gay couples, I feel…

•

What I admire about gay people is…

•

What I don’t like about gay people is…

•

Lesbian or gay people make me uncomfortable when…

•

As a parent, if I learnt my child was lesbian or gay, I would…

•

In my culture or home town, lesbian, gay, bisexual or trans* individuals are…

•

If I found out my partner was intersex, I would…

•

If I found out I flirted with someone who is trans*, I would…

Not including sexual orientation or gender identity

LESSON FOUR: LGBTQI + HEALTH

information in letters of reference, or answering specific or implied questions without first clarifying how “out” the person chooses to be in the specific process in question.

Aim:

Because your environment may be safe, it does not mean

To review the issues related to LGBTQI+ health, including regular

all environments are safe.

screening, and the various health conditions that LGBTQI+

•

Recruiting and contracting LGBTQI+ peer educators.

persons are at risk for.

•

Viewing LGBTQI+ identity as a positive form of diversity that is desired in a multicultural setting.

Time: 35 minutes

HIGHER HEALTH: A Training Resource Manual

Lesson objectives On completion of this lesson, participants should: •

Know the health issues for LGBTQI+ persons, as identified by the WHO.

•

KEY MESSAGES •

individuals from accessing testing, prevention and

Be familiar with screening tests available for both

treatment services, and seeking support from friends and

communicable diseases (that can be passed from one person to another) and non-communicable diseases. •

Be familiar with the various health challenges that LGBTQI+ persons face.

Purpose of activities •

To provide information on relevant issues pertaining to LGBTQI+ health.

•

To provide opportunities for participants to demonstrate existing knowledge.

•

To use methods that are interesting and enable participants to understand the risks and consequences of issues such as stigma and discrimination in terms of LGBTQI+ health. Activities Group: Discussion and brainstorming Objective To create opportunities for participants to become informed of key issues related to LGBTQI+ health. Requirements: Flipchart paper, markers Time: 20 minutes Instructions for the flow of activities: 1.

Introduce the subject of LGBTQI+ health, and ask: “So what’s different about LGBTQI+ health?”

Note all points on the flipchart.

Facilitate the popcorn exercise, i.e., people randomly “pop up” and say one thing they learnt from the lesson.

Summarise the lesson using the discussion questions provided.

There are many reasons that prevent LGBTQI+

family. •

Factors that can negatively impact on LGBTQI+ individuals’ health, well-being and ability to receive appropriate care: --

Homophobia and transphobia;

Stigma (negative and usually unfair beliefs);

Discrimination (unfairly treating a person or group of people differently);

Lack of access to culturally and orientationappropriate medical and support services;

Heightened concerns about confidentiality;

Fear of losing one’s job; and

Fear of talking about one’s sexual practices or orientation.

These factors make LGBTQI+ individual more vulnerable to:

Higher rates of HIV and other sexually transmitted diseases (STDs);

Tobacco, alcohol and drug use and abuse; and

Depression.

As elaborated on in previous chapters, multiple and overlapping forms of stigma and discrimination diminish the ability of LGBTQI+ individuals to realise their right to access healthcare. Failure to access appropriate healthcare services timeously to prevent or mitigate diseases and illnesses and receive treatment makes LGBTQI+ persons particularly vulnerable, especially in the context of HIV. Further, if health service providers are not sensitised or trained regarding the special health needs of LGBTQI+ individuals, the cycle of invisibility and discrimination is already in full swing. In South Africa, parts of the LGBTQI+ community are either identified as key or vulnerable populations for HIV and STIs

DISCUSSION QUESTIONS •

Ask participants if they have any further questions about LGBTQI+ Health.

•

Did they learn anything new?

•

Did new information change the way they think about LGBTQI+ health and the community?

•

How did the information impact them?

(National Strategic Plan (NSP) for HIV, TB and STIs: 20172022). Despite South Africa’s generalised HIV and TB epidemics and high STI rates, some groups are much more heavily affected than the general population and need special attention. Addressing the health needs of key and vulnerable populations is of utmost importance to tackle the generalised HIV epidemic. According to the South African National LGBTI HIV Framework, 2017-2022: Many factors contribute to the vulnerability of LGBTI people to HIV, TB and STIs. Stigma and discrimination based on sexual

HIGHER HEALTH: A Training Resource Manual

orientation and gender identity and expression, as well as

•

Fear of talking about one’s sexual practices or orientation.

lack of knowledge about LGBTI health needs, prevents sexual minorities from accessing the necessary prevention, care and

These factors make LGBTQI+ individuals more vulnerable to:

sexual health services in the public system. Social stigma

•

Higher rates of HIV and other STDs.

is linked to poor mental health outcomes as well as sexual

•

Tobacco, alcohol and drug use and abuse.

and other violence perpetrated against LGBTI people, and

•

Depression.

diminished economic opportunities. Other contributing factors include misinformation about HIV and STI prevention among

The CDC recommends sexually active gay, bisexual, and other

LGBTI people, unavailability of HIV, STIs, and TB prevention

men who have sex with men test for:

commodities, high-risk sexual behaviours, and drug use and

•

HIV at least once a year.

alcohol abuse. Historical racial and socioeconomic inequalities

•

Syphilis.

exacerbate the vulnerability of many LGBTI people, particularly

•

Hepatitis B.

in areas where LGBTI-competent services are unavailable.

•

Chlamydia and gonorrhoea of the rectum, if you’ve had

While very little is known about TB among LGBTI groups in South Africa, it is likely that many of the above-mentioned factors

receptive or penetrative anal sex in the past year. •

also contribute to TB vulnerability.

Chlamydia and gonorrhoea of the penis (urethra), if you have had penetrative anal sex (been on the “top”), or received oral sex in the past year.

The new strategy aims to provide the basis for more inclusive

•

Gonorrhoea of the throat, if you’ve given oral sex (your

services so that LGBTQI+ communities have “the necessary

mouth on your partner’s penis, vagina, or anus) in the past

tools to realise their health and human rights goals.” More

year.

inclusive health services and health education will prevent new HIV infections among LGBTQI+ communities and will increase

Why are screening tests important?

the access and education of LGBTQI+ individuals who are living

Screening means prevention! It’s that simple. There are

with HIV because LGBTQI+ individuals do not have to fear that

different types of prevention, as described below.

they are being stigmatised or discriminated against by clinic staff and health workers.

PRIMARY PREVENTION means that checking on your health regularly can help to prevent you from getting serious life-

Fear is still prevalent, however, and it prevents LGBTQI+

threatening or less serious illnesses.

individuals from seeking needed health services, such as ART, thereby delaying access to life-saving prevention, care and

SECONDARY PREVENTION means that if you screen and

treatment services. LGBTQI+ youth are at increased risk for

find you’ve already been infected with some virus or have

being abandoned by their families and rejected, and barred from

developed a life-threatening condition, you can get treatment

accessing schools, all of which undermine their ability to learn

and manage your lifestyle to prevent it from becoming more

and develop the skills that are necessary for a productive life as

serious.

an adult. TERTIARY PREVENTION means that when you’ve caught In summary, factors that can negatively impact on LGBTQI+

it too late and it’s already serious, you can get treatment to

individuals’ health, well-being and ability to receive appropriate

manage pain and side-effects.

care are: •

Homophobia (negative attitudes and feelings toward homosexuality or people who are identified or perceived as being lesbian, gay or bisexual).

•

Transphobia (discrimination, prejudice and violence trans people face based on their gender identity).

•

Stigma (negative and usually unfair beliefs).

•

Discrimination (unfairly treating a person or group of people differently).

•

Lack of access to culturally and orientation-appropriate medical and support services.

•

Heightened concerns about confidentiality.

•

Fear of losing one’s job. HIGHER HEALTH: A Training Resource Manual

What services are available to LGBTQI+ individuals?

This includes but is not limited to:

Health service providers must be trained and sensitised

•

HIV counselling and testing (HCT),

regarding the special needs of LGBTQI+ individuals to

•

Sexually transmitted infection (STI) screenings and

be able to provide health services that are free of stigma

treatment,

and discrimination, and tailored to the needs of LGBTQI+

•

Tuberculosis (TB) screenings,

individuals. This means, for example, making Pre-Exposure

•

PrEP and Provision of post-exposure prophylaxis (PEP),

Prophylaxis (PrEP) available to all gay and bisexual men,

•

Anti-retroviral treatment (ART),

or considering issues of substance abuse or mental health

•

HIV management (CD4 and viral load),

issues during health tests and screenings, as these are

•

Pap smear,

coping mechanisms to deal with stigma and discrimination.

•

Basic wound care and clean needles and syringes,

LGBTQI+ individuals have the same rights as anyone else to

•

General medical, sexual health and safer sex consultations,

make use of health services.

•

Individual and couples’ counselling, and

•

Condoms and lubrication.

HIGHER HEALTH: A Training Resource Manual

References Brown, B., Duby, Z., & Van Dyk, D. “Health care provision for men who have sex with men, sex workers, and people who use drugs: An introductory manual for health care workers in South Africa.” Desmond Tutu HIV Foundation, 2013. Adapted from: Poteat, T. http://www.cdc.gov/lgbthealth Garofalo, R., et al., Sexual orientation and risk of suicide attempts among a representative sample of youth. Archives of Paediatrics and Adolescent Medicine, 1999, 153(5): 487. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Healthy People 2010: Final Review.” DOH and Human Services Centers for Disease, 2012. Beyrer, C., et al., The expanding epidemics of HIV type 1 among men who have sex with men in low-and middle-income countries: Diversity and consistency. Epidemiologic Reviews, 2010, 32(1): 137-151. UNAIDS, “Meeting the HIV treatment and health needs of gay men and other men who have sex with men.” Meeting Report from UNAIDS Policy and Strategy Consultation, 2013, Geneva. Homosexuality and labour laws in SA: http://www.labour.gov.za/DOL/act/section_detail. jsp?legislationId=5954&actId=8191&sectionId=8327 Promotion of Equality and Prevention of Unfair Discrimination Act, 2000 (PEPUDA or the Equality Act, Act No. 4 of 2000). Same sex civil marriage. http://www.dha.gov.za/documents/act17.pdf OUT! Well-being, Train the trainer manual – Understanding Human Sexuality. https://www.out.org.za/index.php/library/manuals# The AIDS and Rights Alliance for Southern Africa (ARASA). “Sexual orientation, gender identity, HIV and human rights. An advocacy toolkit”, 2015. http://www.arasa.info/files/8414/3860/4501/ARASA_Toolkit_full_web.pdf DHET. “Policy framework for the realisation of social inclusion in post-school education and training institutions.” DHET, 2016. http:// www.dhet.gov.za/SiteAssets/Latest%20News/2017/january/Gazetted-Policy-Framework-for-the-Realisation-of-Social-Inclusion-inPSET-No40496-Notice-no-1560.pdf SANAC. “National Strategic Plan (NSP) for HIV, TB and STIs: 2017-2022.” http://sanac.org.za/wp-content/uploads/2017/05/NSP_ FullDocument_FINAL.pdf SANAC. “The South African National LGBTI HIV Framework, 2017-2022.” http://sanac.org.za/wp-content/uploads/2016/07/J6917_ LGBTI_Booklet_LR.pd http://itspronouncedmetrosexual.com Gender Dynamix, Advancing Transgender Human Rights. https://www.genderdynamix.org.za/resources

HIGHER HEALTH: A Training Resource Manual

Chapter 4 GENDER-BASED VIOLENCE

HIGHER HEALTH: A Training Resource Manual

GENDER-BASED VIOLENCE

Introduction and Overview

and the Centre for Public Mental Health on IPV reveal that: •

Every eight hours (on average), a woman dies at the hands of an intimate partner in South Africa. IPV is the most common form of violence experienced by

•

South African women and is the leading cause of death among South African women. •

More women are killed by their current or former intimate male partner in South Africa than in any other country in the world.

•

Victims remain hesitant to disclose their situation because of the stigma attached to IPV. Those who do report incidents often deal with public servants who fail to detect their problem or deny that it exists.

•

Of pregnant women, 36-40% experience physical IPV, and 15-19% experience sexual IPV. The violence increases the risk for the baby, which could be born pre-term and with a

Gender-based violence (GBV) is a global phenomenon and

low birth weight.

one of the most widespread violations of human rights, with a significant impact on physical, psychological, sexual and reproductive health. Evidence reveals that, although men and women (including individuals of varying sexual orientations) are affected by GBV, women and girls are disproportionately affected and bear the brunt of these severe human rights violations collectively at all stages of their lives. GBV is a mirror that reflects the gender stereotyping in society and the pattern of unequal social relations created by patriarchal cultures. Men and women do not experience the same forms of violence, nor do they experience violence to the same extent. In contrast to men, women have been more likely to be blamed for much of the violence inflicted upon them, which has also not historically been regarded as criminal, nor provided with effective legal remedies.

According to Professor Rachel Jewkes, the prevalence of GBV among young adults in HEIs in SA is alarming: •

Students comprised 1 in 10 rapes of adults reported to SAPS in 2012, i.e. 2600 reported cases.

•

Under-reporting of rape to the police is estimated to be in the region of 23 400.

•

65 000 per annum is the true number of rapes among students.

•

A third of women experience physical partner violence.

While these inferences can be made to underscore the problem in higher education, it is also important to acknowledge that there are gaps in data and further research is necessary to understand the true extent of the problem at universities and colleges.

GBV also perpetuates vulnerability while compromising the

GBV in HEIs in South Africa

health, safety, and autonomy of survivors, keeping them trapped

While some data is lacking for GBV in higher education, the

in a cycle of violence and abuse. GBV is a complex issue and, to address the situation effectively, it is crucial to ensure that efficient and functional support systems are available to provide survivors with immediate care and safety. Such support must include quality mental, physical, and sexual and reproductive health (SRH) services; protection and shelter; and social and justice services. WHO statistics reflect that 35% of women worldwide experienced either physical or sexual intimate partner violence (IPV), or nonpartner sexual violence, and we know that in South Africa the problem is even more severe, with high levels of violence being

sector is a microcosm of the broader society that it draws its students and staff from. GBV has plagued the PSET system for quite some time and, in recent years, more cases of rape and murder of women students have been reported. Most of these crimes against women are perpetrated by men who are well known to the victims as partners, former partners, or fellow students. Sexual harassment, “sex for marks”, as well as violations against gender minority groups have taken a prominent place in discussion and dialogues on the issue.

a prominent historical feature. Statistics from studies by the Medical Research Council (MRC)

HIGHER HEALTH: A Training Resource Manual

GBV has also been linked to various other issues such as drug and alcohol abuse, abuse of people with disabilities (PWDs), abuse of gender diverse people, safety of students and staff on campuses and in student residences, and mental health problems, such as depression and trauma on the part of

institutions are therefore a critical entry point for identifying GBV, and empowering young women with skills and techniques to reclaim their power base and find ways to prevent and/or stand up against GBV.

victims and their families.

Particularly

As such, students and student activists have called for

service, namely, promoting and teaching protective behaviours

deliberate action through protest action against unsafe environments, demanding gender transformation in institutions and deliberate response strategies and prevention work in relation to GBV. The Higher Education GBV Policy And Strategy Framework The Higher Education Health Wellness and Development Centre (HIGHER HEALTH, formerly known as HEAIDS), on behalf of the DHET, has developed a GBV Policy and Strategy Framework to respond to GBV as it impacts on staff and students at its university and college campuses. The Framework will guide a response strategy that will give direction to managing

post-schooling

institutions,

where

adult

relationships are generally forged, it is crucial to offer a twofold and prevention strategies as well as offering services where survivors of violence may access treatment, support and care. In recognising the complexities and sensitivities in responding to GBV, the Framework emphasises the principles and objectives described below against which GBV programming and responses may be framed. Principles Rights-based: The values and rights contained in the Constitution

must

underpin

all

policy

processes

and

procedures. At a minimum, these must actively seek to give

and responding to GBV critically.

concrete expression to the rights to equality, dignity, freedom

The policy recognises that GBV manifests in the following ways

integrity.

in institutions and is thus framed to address these issues: i.

Grading or rating of appearance by verbal comments, wolfwhistling, or other noises.

ii.

Stalking and repeated unwanted requests for dates.

iii.

Derogatory comments, including in relation to people’s gender non-conformity.

iv.

The use of work (either academic or administrative) as an excuse for inappropriate, private meetings.

Rape.

vi.

Sexual assault.

vii. Physical assaults by intimate partners, or against individuals perceived as gender nonconforming. viii. Requests or demands for sex in exchange for improved marks, accommodation in residences, or other needs and benefits. ix.

Spying, or intruding upon women in residences while bathing or dressing.

Streaking and flashing.

xi.

In the case of abusive relationships, preventing or interfering with a partner’s studies, including by withholding fees.

and security of the person, and bodily and psychological Comprehensive and multi-faceted approaches to GBV: PSET institutions’ responses to GBV cannot focus on one aspect or manifestation of the problem alone. Even though the nature of the response may differ, all forms of GBV must be responded to. Furthermore, interventions to address GBV must be multi-faceted, comprising complaints’ processes and procedures; support to complainants; and (where possible) assistance to the perpetrator in changing their behaviour. Comprehensive and multi-faceted approaches to GBV prevention: PSET institutions’ responses to GBV must include comprehensive prevention, education and information about GBV policies; and programmes, including social mobilisation activities and campaigns, intended to promote safety on campus and prevent GBV. Specialisation: Responding to GBV requires specialised knowledge and skills. All staff and students involved in addressing GBV in any way must be skilled and gendersensitive, receive ongoing training, and conduct their work in accordance with clear guidelines, protocols and codes of ethics. Programmes and other responses must reject ideologies that

xii. Murder by an intimate partner.

excuse or justify men’s violence or blame complainants.

These various abuses can occur between students, between

confidentiality and privacy of the complainant whose safety

staff and students, as well as between staff. They may also be

Confidentiality: All responses to GBV must maintain the and physical and psychological needs must be prioritised.

perpetrated by third parties such as visitors to campus, or on-site contractors. As a primary and/or secondary prevention strategy, educational 74

HIGHER HEALTH: A Training Resource Manual

Complainant-centred: Assistance to the complainant must

•

Capacity development of institutional staff at every

support and encourage their sense of personal control, which

campus, including all staff involved in direct and indirect

includes respecting the complainant’s informed decision at

support to victims.

every stage of the process. Reporting, investigative or support

•

staff must offer comprehensive information about all processes

Capacity development of peer-to-peer mobilisers to advance the programming and uptake of the same.

and options in a manner which is non-judgmental, appropriate,

•

clear and sensitive to the complainant in terms of language,

Technical support in setting up disciplinary tribunals and capacity development of members at every campus level.

culture, disability, gender and sexuality.

•

Zero tolerance: Policies must contain a clear statement by the

Linkage to care and support – psycho-social support for the victim across every campus.

university or college rejecting all forms of GBV. This message

•

Development of call centre and other technology-based applications.

must not be diluted or made ambiguous by the policy referring to false complaints, or procedures for dealing with allegedly

•

false complaints. Should investigations yield evidence of

Safer Campus Programme – campus safety audits, campus infrastructure, Red zones, and access control (to

false complaints, these can be dealt with in the same way

draw from the UN Women – Safer Cities tool kit).

misconduct is ordinarily dealt with.

•

Accountability: Implementation of the policy must be

Life Orientation (LO) in the classroom through the formal curriculum, and capacity development of teaching staff.

routinely monitored and evaluated, and senior managers held accountable for its effective implementation. This includes

The efficient delivery of this Framework and GBV prevention

maintaining documentation and records in accordance

programming will be supported by leadership and extensive

with health, police and legal requirements and the need for

resource mobilisation as an enabling pillar for this work.

confidentiality, security and choice. Best practice in violence prevention in higher education: Objectives

At TVET or university level, there is a need to:

The Framework outlines four objectives that speaks to the

•

• •

Establishing just, specialised procedures for the reporting,

•

Assess GBV threats on campus and respond proactively.

investigation and resolution of complaints.

•

Support victims and respond timeously and appropriately to GBV.

Providing comprehensive, specialised support and other assistance to complainants of GBV.

•

Create an environment of zero tolerance to gender discrimination and violence.

effective management, response and prevention of GBV.

•

becoming victims, and seek assistance when GBV occurs.

Promoting the safety of all students and staff by putting in place comprehensive prevention programmes intended to

Empower women to protect and prevent themselves

•

Empower men to embrace equitable and respectful gender relations and recognise that violence is not an option.

raise awareness of policies and services addressing GBV, as well as other measures aimed at preventing incidents of •

•

GBV in the PSET sector.

What works for prevention?

Ensuring the effective implementation of policy and

A strong university and TVET policy framework for prevention

programmes through attention to budgeting; monitoring and

and response.

evaluation; and the creation of a system of accountability.

•

Assess the threat: What policies, practices, and systems

Establishing national structures and mechanisms intended

create GBV risks? Do we know when it is occurring? Where,

to enable PSET institutions’ implementation of their

when, and impacting whom?

institutions’ policies.

•

New directions for protecting women from sexual assault. For example, combining gender empowerment and selfdefence.

Programme Elements Programme implementation will be comprehensive, harnessing

•

Interventions with men. Workshop-based interventions do

the strengths and capabilities of existing health, wellness

work. For example, Stepping Stones implemented with

and development initiatives being led through the HIGHER

youths in a school in the Eastern Cape reduced perpetration

HEALTH Centre.

by men for up to two years after the programme (Jewkes et

•

al., 2008).

A national PSET GBV Education, Awareness and Prevention Campaign.

•

Strengthening the capacity of peer educators to identify and

Institutional-level policy development and implementation

support survivors of violence is crucial to the prevention of

strategies.

and response to GBV.

HIGHER HEALTH: A Training Resource Manual

LESSON PLAN: GENDER-BASED VIOLENCE Aim To clearly define what is meant by Sexual and Reproductive Health rights and responsibilities

Note to Peer Educators: Be prepared for the sensitive nature of the topic. •

Ensure that the approach to facilitating is neutral and nonjudgemental. Anticipate that there may be awkwardness or discomfort

•

with the subject matter. •

Pay attention to your use of language: ensure that it is

Learning Outcomes

simple, accessible, easy to understand, and relevant to the

By the end of this lesson participants should be able to:

context of the students.

•

Explain what gender-based violence (GBV) is.

•

Describe who is most at risk for GBV.

•

List the forms and nature of GBV.

•

Identify risk factors for GBV.

•

Explain causes of GBV.

•

Describe the link between GBV and HIV.

•

Identify and counter myths surrounding GBV.

•

Describe health outcomes of GBV.

•

Outline prevention strategies in the SA context.

Background/ Motivation South African law protects people’s SRHR. It is therefore important for students to know that sexual and reproductive rights exist, and that people have control over and can decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health free of coercion, discrimination and violence. These rights are embedded in the South African Constitution and in South Africa’s commitment to implement international human rights

Lesson Content •

What is GBV?

•

Who is most at risk for GBV?

•

Forms and nature of GBV.

•

Risk factors for GBV.

•

Causes of GBV.

•

GBV and HIV.

•

Myths surrounding GBV.

•

Health outcomes of GBV.

•

Prevention strategies in the SA context.

treaties. The relationship between health and rights is important for students to know because they are primarily young people at their peak of sexuality, and their approach to sexual health requires a positive and respectful outlook. To be sexually healthy, people need to be able to have pleasurable and safe sexual experiences free of coercion, discrimination and violence. They need access to sexual health information and services. For people to have and keep their sexual health, their sexual rights must be respected, protected and fulfilled. The expected outcome of the session is to impart accurate

Time:

knowledge as a vehicle to opening debate and discussion on

150 minutes

this subject as well as to assess students’ baseline knowledge of rights, responsibilities and resources (services, support

Material needed for the lesson:

structures and legislation).

Flip chart and markers

One’s sexual rights are often violated when GBV occurs, and

Copies of case study

thus it is important to understand one’s rights.

Preparation for the lesson:

Activities and tasks

In this session, the Peer Educator will use interactive methods

•

Case study: Introducing the subject with a case study

to access the baseline knowledge of the students as well as

presents an excellent point of entry for teaching students

tap into the attitudes and behaviour patterns of students in respect of SRHR. To prepare, peer educators should: •

Read and understand the reference notes to get a

about sexual and reproductive rights. •

Group exercises

•

Games

thorough grasp of the subject content. •

Familiarise themselves with the suggested format and instruction guidelines for the activities.

•

Read and familiarise themselves with the prepared material.

•

Anticipate questions that may arise.

•

Print any handouts that may be required.

Methods: •

Brainstorming

•

Questioning

•

Group exercises: --

Small group discussion of prepared questions

Case Study

HIGHER HEALTH: A Training Resource Manual

Instructions for flow of the activities/tasks 1.

Introduce lesson on GBV

Ask “What do we understand by the term gender-based violence?”

Note responses on the flip chart and encourage discussion

Divide group into smaller discussion groups:

What is GBV?

Who is most at risk for GBV?

Where does GBV happen?

How many types of GBV do you know?

Allow 15 minutes for completion of the exercise, and then discuss the responses to the questions in the plenary using the notes provided below as a guide.

KEY MESSAGES •

services, including sexual and reproductive healthcare for everyone. •

rights (SRHR) laws, policies and guidelines, which are described below. •

signed and ratified, including the: --

Introduce the activity as per the instructions outlined

---

the scenario. c.

Which of Tessa’s sexual and reproductive health rights have

What are Tessa’s rights as a survivor of sexual violence?

What options are available to Tessa’s mum?

What are the challenges that may prevent Tessa’s mum

on Population (September 1994). •

•

Hand out copies of the red zone on GBV

•

Allow the class to complete the screening individually and anonymously then and hand it back. For this exercise, they are only required to state whether they are male or female.

•

Facilitate a plenary discussion on GBV.

Touching,

Jokes and innuendos of a sexual nature,

Persistent probing about personal and intimate

Rude and inappropriate comments or gestures,

Unwelcome advances of a sexual nature, and

Leering or staring at your body in an offensive way.

information related to one’s sex life,

Allow 30 minutes for completion of the exercise, and then reconvene as a class

Sexual harassment is any kind of sexual behaviour that makes you feel uncomfortable, including:

from exercising her options? •

International consensus agreements, including the Programme of Action of the International Conference

been violated? d.

UN Convention on the Rights of Persons with Disabilities (UNCRPD, 2006), and

the following questions Identify and name three types of sexual violence evident in

Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW, 1979),

Read the case study to the class and instruct them to answer

UN Convention on the Rights of the Child (UNCRC, 1989),

Begin by dividing the class into three groups:

What is happening in the scenario?

A human rights approach to sexuality and reproduction is reflected in the international treaties that South Africa has

Explain that the next activity may be sensitive and emotive

International law also supports a human rights approach to sexuality and reproduction.

•

below 8.

These fundamental, constitutional rights are reflected in South Africa’s many sexual and reproductive health and

but is important to discuss 7.

The Constitution guarantees the right to healthcare

•

Sexual harassment can happen anywhere.

•

Sometimes sexual violence is implicit (difficult to see) so we need to trust our instincts.

•

How we see and accept, or challenge violence affects

•

It is up to each person individually to make changes in

others around us. their own environment if they would like to see a world

DISCUSSION QUESTIONS •

What surprised you in this lesson?

•

What made an impact on you?

•

Do you think these situations are real?

with less violence. •

There are steps you can take if your rights or those of somebody you know have been violated.

RESOURCE FOR GROUP ACTIVITY: TOUCH ME NOT (CASE STUDY) Time Required: 15 minutes

HIGHER HEALTH: A Training Resource Manual

Part One:

Part two

It’s the start of the new semester and Tessa is first in class

Tessa feels troubled as she walks home the following day.

eagerly waiting for the IT lecture to begin. Mr Vee is an

There’s a pit of anxiety in her tummy as she contemplates her

excellent lecturer and for the first time she actually “gets it”.

options. Deep in thought, she reaches home and suddenly

This semester she is certain she could top the class again!

becomes aware of muffled screams and sounds of breaking glass. She feels the familiar sense of panic “Oh no… he must

Tessa greets Mr Vee enthusiastically, he smiles and tells her

be drinking again. She rushes in and bumps into her step-

she’s looking really good. She thanks him shyly and smiles

father…he looks enraged. He shoves her out of the way and

back. Later, Mr Vee walks past Tessa and drops his pen on

leaves slamming the door shut behind him. Tessa rushes to

her desk. His hands lightly brush across her breasts as he

her mother’s bedroom to find her bleeding on the floor sobbing.

leans across to pick up his pen. She recoils in shock, and he

“Mum, mum…what happened?” “He said I was flirting with the

apologises but winks and smiles.

taxi driver”, her mum answers in a feeble whisper struggling to breathe, her face contorted in pain…. Distraught, Tessa

Later that week, Tessa bumps into Mr Vee in the corridor, and

rushes next door to ask her neighbour for help.

he asks if she’s free to assist him with some administrative work. Tessa is flattered and agrees to help. When she arrives at his office, he invites her to sit and then sits beside her to “show her what needed to be done”. She feels a twinge of discomfort at his closeness, but brushes it away thinking she’s being silly. As they work, she suddenly feels his hand sliding under her skirt. She jumps up in shock and says she has to leave, or she’ll be late for her next lecture. Tessa feels tense and decidedly awkward at the thought of Mr Vee’s lecture the following day. She is quiet and distant in class the next day and can feel Mr Vee’s eyes on her. As she gets up to leave, she is nervous and anxious because Mr Vee is standing at the door chatting with students. As she passes him, he grabs her arm and leans into her, looking directly down her cleavage. “What’s up young lady? You were very quiet today,” He says. Tessa hurriedly answers that she is ok and breaks free, rushing out so that she is not left alone. Two weeks later, Tessa receives a call from Mr Vee. He explains that he would like her to assist him with administrative tasks on two afternoons per week. In return, he says he is sure she will receive the IT yearend award because of the commitment she demonstrates. She explains that she has too much work and would be unable to assist. He says it is a real pity, especially as there are three students competing for the prize. “What do you mean?” she asks, confused. He laughs and says, “Work it out young lady, you’re intelligent…”

Part three The following day, Tessa gets off the bus to walk a few hundred meters to college. The rain is falling heavily and an icy wind is blowing. A car pulls up silently next to her. It’s Mr Vee. “C’mon, get in young lady, I’ll give you a ride. She gets in quickly thinking “it’s okay- the college is just around the corner. She feels a twinge of alarm as Mr Vee drives past the college smiling and chatting all the while. “Mr Vee, I have a first lecture- where are you going? Please drop me off…He laughs and continues to the end of the road towards the deserted park. “It’s okay Tessa, you don’t have to pretend…I know what you want. I want it too.. “Oh my God, no, please no… let me out.” He laughs and pulls into a dark shaded area of the park. Frantically she tries to open the locked car door. He pushes her gently back into the seat, smiling and whispering endearments all the while. Her body trapped beneath him, she continues to struggle. What is happening in the scenario? Answer: Various forms of sexual violence Identify and name three types of sexual violence evident in the scenario Answer: Sexual Harassment; Intimate partner violence/domestic violence; rape Which of Tessa’s sexual and reproductive health rights have been violated? Answer: The right to be treated with dignity and respect, the right to freedom and security; the right to control over her own body; the right to say “no”, the right to safer sex, the right to life (HIV/ STIs); the right to choose (unplanned pregnancy) What are Tessa’s rights as a “survivor” of sexual violence? PEP, HTS, TOP (if necessary); legal recourse. What options are available to Tessa’s mum? Report to police and charge with assault; interdict, legal action. What are the challenges that may prevent Tessa’s mum from

HIGHER HEALTH: A Training Resource Manual

exercising her options?

Gender-Based Violence: “Gender-based violence is an

Disempowerment; economic dependence; fear for her life

umbrella term for any harm that is perpetrated against a person’s

Important definitions

gender roles. Around the world, gender-based violence almost

The definitions below are provided in an effort to standardise

always has a greater negative impact on women and girls.

the way in which GBV is understood within humanitarian

For this reason the term gender-based violence is often used

settings in order to promote more useful data collection,

interchangeably with the term “violence against women.” One

dialogue, and action.

reason the term “gender-based violence” is often considered

will, and that results from power inequities that are based on

preferable to other terms that describe violence against women Gender: Refers to the social differences between men and

is that it highlights the relationship between women’s subordinate

women that are learnt, and though deeply rooted in every

status in society and their increased vulnerability to violence.

culture, are changeable over time, and have wide variations

However, it is important to remember that in some cases

both within and between cultures.

men and boys may also be victims of gender-based violence.

Violent Episode: An act or series of acts of violence or

Violence may be physical, sexual, psychological, economic, or socio-cultural. Categories of perpetrators may include family

abuse by one perpetrator or group of perpetrators. May

members, community members, and/or those acting on behalf

involve multiple types of violence (physical, sexual, emotional,

of cultural, religious, or state institutions” (RHRC Consortium,

economic, socio-cultural); and may involve repetition of

2004, page 11).

violence over a period of minutes, hours, or days. Survivor: Person who has experienced violence or other abuse. Secondary Survivor: Person impacted by the experience of GBV inflicted upon the survivor. May include family members or others close to the survivor. Perpetrator: Person, group, or institution that directly inflicts or otherwise supports violence or other abuse inflicted on another against her/his will. Intimate Partner: Includes current or former spouses (legal and common law), non-marital partners (boyfriend, girlfriend, same-sex partner, dating partner). Intimate partners may or may not be cohabitating and the relationship need not involve sexual activities. Minor: Person under the age of 18, according to the UN Convention on the Rights of the Child (UNCRC).

VIOLENCE AGAINST WOMEN IS GENDER-BASED: IT DOES NOT OCCUR T O W O M E N R A N D O M LY.

(Gender-based Violence Tools Manual. Compiled by the Reproductive Health Response in Conflict (RHRC) Consortium. UNHCR, UNFPA, the Center for Health and Gender Equity, and WHO. February 2004)

What is Gender-Based Violence? “Gender-based violence (GBV) is the general term used to capture violence that occurs as a result of the normative role expectations associated with each gender, along with the unequal power relationships between the two genders, within the context of a specific society.” (Bloom 2008, p. 14).

HIGHER HEALTH: A Training Resource Manual

From these international definitions, we may understand the term

Who is most at risk for GBV?

GBV as follows: GBV is •

a structural problem that is deeply embedded in unequal power relationships between men and women

•

perpetuated by harmful social and cultural expectations about gender roles

•

associated with being a woman or being a man, a girl or a boy

•

a mechanism for enforcing and sustaining gender inequality

•

a means to send a message to women and girls that they are worth less than others and that they do not have control over their own lives and bodies

This has direct consequences on: •

health

•

employment

•

participation in social and political life (Kelly 2005)

Where does GBV happen?

GBV is most often directed at women and girls as the obvious bearers of the female and feminine. LGBTQI+ individuals may also experience GBV, including based on being gender nonconforming and/or not practising heterosexuality. Violence may also be used to feminise men, or undermine their masculinity, ensuring that they are not exempt from some forms of GBV either. The use of violence to institute and maintain forms of gender relations is also influenced in complex ways by perpetrators’ ideas about their victim’s race, disability, social class and citizenship status, among other factors. These factors similarly influence how others respond to instances of GBV, as well as individuals’ access to helpful resources. GENDER-BASED VIOLENCE POLICY AND STRATEGY FRAMEWORK FOR THE POST-SCHOOL EDUCATION AND TRAINING SECTOR, April 2019.

Gender-based violence in South Africa According to the Alberton Record, an online news website, “South Africa has one of the world’s highest gender based violence rates in the world, some experts say it is comparable to countries that are at war.” September 6, 2019 (https:// albertonrecord.co.za/) The article goes on to say that “a report by Statistics SA shows that femicide (the murder of women on the basis of their gender) is 5 times higher than the global average. This means that in South Africa, women are 5 times more likely to be killed due to gender-based violence committed by men. Up to 40% of South African women have experienced sexual and/or physical interpersonal violence in their lifetime (http://www.saferspaces.org.za/) Gender-based violence in South Africa has various drivers, including, for example, rigid notions of masculinity that condone violent behaviour towards women and children, the socio-economic situation of many women that makes them dependent on their male partners or a patriarchal, conservative understanding of gender roles.

Form and Nature The primary inequality that gives rise to GBV is the power inequality between women and men. The majority of perpetrators of GBV are men. However, despite the fact that no society is free from it, male violence against women varies in degree and intensity according to the specific circumstances. Many men choose to reject dominant stereotypes of violent, controlling masculinity.

HIGHER HEALTH: A Training Resource Manual

Types of GBV include:

Economic Violence •

Used to deny and control a woman’s access to resources, including time, money, transportation, food or clothing. Acts of economic violence include:

•

prohibiting an individual from working

•

excluding them from financial decision making in the family

•

withholding money or financial information

•

refusing to pay bills or maintenance for her or the children; and

•

destroying jointly owned assets

Sources: adapted from Warshaw/Ganley 1996, WHO 2003, WHO 2013 Risk Factors for GBV (Ecological Framework) It is widely understood that GBV - be it in the form of isolated acts or systematic patterns of violence - is not caused by any single factor. Rather, it is a combination of several factors that increase the risk of a man committing violence and the risk of a woman experiencing violence.

Physical Violence Physical force that results in bodily injury, pain, or impairment. The severity of injury ranges from minimal tissue damage,

Individual level

broken bones to permanent injury and death.

Perpetration by men

Victimization by women

Demographics: • Low income • Low education

Demographics: • Young age • Low education • Separated/ divorced marital status

Child maltreatment • Sexual abuse • Inter-parental violence

Child maltreatment • Inter-parental violence

Mental disorder • Anti-social personality disorders

Mental disorder • Depression

Substance abuse: • Harmful use of alcohol • Illicit drug use

Acceptance of violence

Sexual Violence According to WHO 2002, cited in WHO 2013, sexual violence refers to any sexual act or attempt to obtain a sexual act using force, unwanted sexual comments or advances trafficking, or otherwise directed against a person’s sexuality, using force in any setting, including, home and work. Examples of include: •

rape, other forms of sexual assault

•

sexual harassment

•

trafficking for the purpose of sexual exploitation

•

forced exposure to pornography

•

forced pregnancy, forced sterilisation, forced abortion

•

forced marriage, early/child marriage

•

female genital mutilation (FGM)

•

virginity testing

•

incest

Psychological Violence Acts of psychological violence include: •

threats of violence through words or actions (e.g. through humiliating and insulting comments

•

isolation (e.g. through locking her up in the house, forcing

•

Societal level

• Traditional gender and social norms supportive of violence

IPV is a pattern of abusive behaviours used by one partner

or former romantic involvement, for example dating, previously dating, on again/off again, married, divorced, living together or apart. IPV can occur between people of any gender identity or sexual orientation, and can include manipulation, threats, or the actual use of physical, sexual,

mother, threatening to take children away, or kidnapping

HIGHER HEALTH: A Training Resource Manual

• Weak community sanctions • Poverty

intimate relationship. This includes people with any current

a child, forcing children to watch attacks against their

children as well as violence against women

• Weak community sanctions • Poverty

to maintain power and control over another partner in an

use of children to control or hurt (e.g. through attacking

the child). These acts constitute both, violence against

Community level

Intimate Partner Violence (IPV) and Family Violence.

her to quit her job or prohibiting her from seeing a doctor) •

Multiple partners /infidelity • Low resistance to peer pressure

Domestic Violence is an umbrella term that encompasses both

stalking or displaying weapons) •

Relationship level

emotional, verbal, psychological, or financial abuse. •

Family Violence is any abusive behaviour that occurs between members of a family or household who are not 81

involved in a romantic relationship. This includes chosen

harm (threats, insults, being humiliated or talked down to), by

family as well as people related by blood, marriage, foster

members of their own family, acquaintances, and/or strangers

care, adoption or any other familial relationships. Family

in the home, community, TVET college. The purpose of these

violence can include threats or the actual use of physical,

questions is to assess your experiences of gender based

sexual, emotional, verbal, psychological, or financial abuse.

violence. Your responses can help us identify with you the most appropriate health and protection services.

Are you in the red? Zone Check: Domestic Violence 1.

Are you in a relationship with a jealous and/ or possessive partner or family member?

Do you feel dominated and controlled by someone you live with?

Do you feel anxious and afraid when your partner/a family member is in your presence?

Are you always trying to please your partner/ family member to keep the peace?

Does your partner/family member isolate you by keeping you away from family and friends/ your support network?

Do you feel put down/criticised and/ or humiliated in public by someone you live with?

Does your partner /a family member force sexual acts upon you that you’re not comfortable with?

Do you feel bullied, harassed, physically harmed or pushed around and abused by someone in your home?

Does your partner/a family member control all decisions about money, relationships/ friendships, and personal life decisions (job/ studies)?

Yes No

10. Are you anxious or depressed, have lost confidence, or become unusually quiet due to being in a relationship you’re afraid to leave? 11. Are you reluctant to leave the children alone with your partner or a family member?

Are you in the red? Zone Check: Gender-based Violence (GBV) 1.

In the past 12 months, have you been threatened with physical or sexual violence by someone in your home or outside of your home?

Have you ever been hit, punched, kicked, slapped, choked, hurt with a weapon, or otherwise physically hurt by someone in your house or outside of your house?

Have you been forced to have sex against your will?

Were you ever forced to have sex in exchange for a “reward” [such as food,, a job, a place at the college, good test and exam marks, money to support your family]

Were you ever forced to have sex because you or someone in your family would be in physical danger if you refused?

Were you ever physically forced or made to feel that you had to become pregnant or get married against your will?

Has anyone ever forced you to lose a pregnancy (i.e. forced you take medication, go to a clinic, or physically hurt you to lose your pregnancy)?

Are you always trying to please someone to keep him/her calm and prevent them from harming you some way?

At any point were you forced into a marriage or relationship with someone?

12. Have you ever been threatened with harm or death by someone you live with?

10. Does someone in your home or outside of your home isolate you by keeping you away from your family and friends/support network

If any of your answers place you on a red square, you are in the RED ZONE. This means you are at risk for domestic violence and abuse. Ask your HIGHER HEALTH Campus Coordinator for help with counselling, care and support as soon as possible.

12. Are you being harassed/stalked, bullied, or victimised by someone in your home or outside of your home?

GBV is a traumatic experience for both men and women. This RED ZONE is asking about different types of GBV that women/ girls/LGBTQI may experience. This could include physical violence (hitting, punching, being kicked, slapped, choked,

Yes No

11. Are you being put down/criticised, or humiliated in public?

If any of your answers place you on a red square, you are in the RED ZONE. This means you are at risk for gender-based violence and abuse. Ask your HIGHER HEALTH Campus Coordinator for help with counselling, care and support as soon as possible.

hurt with a weapon, or otherwise physically hurt), sexual violence (rape, sexual slavery, human trafficking) psychological 82

HIGHER HEALTH: A Training Resource Manual

Myths surrounding GBV Myths and stereotypical attitudes about GBV shape the way in which society perceives and responds to violence perpetrated against women. Such myths and attitudes are harmful as they tend to blame the survivors for the violence, rather than holding perpetrators responsible for their behaviour Myth 1: Individuals allow intimate partner intimate violence to happen to them and if they really want to, they can leave their abusive partners. Facts: In no case does anyone deserve to be abused. As explained in several theories on the dynamics of violent relationships, such as the Stockholm Syndrome or the Power and Control Wheel, perpetrators use a combination of tactics of control and abuse that make it very difficult for victims to escape the violence. It is also important to understand that people who experience violence from an intimate partner and seek to leave the relationship in order to ensure their own and their children’s safety paradoxically face an increased risk of escalating violence. Intimate partners are also prevented from leaving violent relationships due to feelings of shame and guilt, lack of safe spaces, fear of others getting involved or hurt, or the belief that home is the best place for children. It is particularly difficult for male victims to leave abusive relationships for fear of being ridiculed and stigmatised for “allowing” the abuse (adapted from Hagemeister et al., 2003). Myth 2: Conflicts and Discord are a normal part of any relationship Facts: “Everybody can lose control,” is a commonly used excuse to justify intimate partner violence (IPV). However, violence is not about “losing” control – rather, it is about “gaining” control through the use of threats, intimidation, and violence, as demonstrated by the Power and Control Wheel. Violence in a relationship is not normal - it is a manifestation of unequal power relations within a relationship. Myth 3: Men and women are equally violent to each other. Facts: The majority of those affected by GBV, in particular IPV, are women and girls. Worldwide, almost half (47%) of all female victims of homicide in 2012 were killed by their intimate partners or family members, compared to less than 6% of male homicide victims. According to EU-wide data, 67% of physical violence and 97% of sexual violence perpetrated against women is committed by men. This fact is also confirmed by research from a study from Moldova which shows that the perpetrators of violence against women are often family members, the overwhelming majority being husbands or former husbands (73.4%), followed by fathers or stepfathers (13.7%) Myth 4: Domestic violence happens only to a certain type of person. Facts: GBV is a global problem of pandemic proportions. 35% of all women worldwide have experienced either physical and/ or sexual violence from an intimate partner or sexual violence from a non-partner (WHO et al., 2013). While a number of factors may increase the risk of women experiencing GBV, domestic violence can affect anyone –man or woman-, irrespective of socioeconomic status, educational achievements, ethnic origin, religion or sexual orientation Myth 5: GBV only includes physical abuse (hitting, punching, biting, slapping, pushing, etc.). Facts: Physical abuse is just one form of violence. GBV also includes sexual, mental, psychological, emotional and economic abuse. Some studies show that psychological abuse and humiliation is often considered more devastating than physical assault (Casey 1988, cited in Heise et al., 1994). Myth 6: GBV is caused by substance abuse such as alcohol and/or drugs. Facts: While substance abuse is present in many domestic violence cases and may lower inhibitions, it is a contributing factor, not the cause of violence, neither should alcohol or drug abuse be used to justify violence. Not all perpetrators of violence use drugs or alcohol, and not all those who use drugs or alcohol are violent Myth 7: Violence should be tolerated to keep the family together. Facts: Every individual has the right to safety, dignity and a life free of violence. Every survivor of GBV has the right of selfdetermination- they can decide to stay with the abusive partner or to leave and either way they are entitled to support and protection from the state. The argument that victims should stay in an abusive relationship is often justified for the well-being of the children. However, it is well established that the safety and health of children are negatively affected when children experience or witness violence Myth 8: Domestic violence is a private family matter, in which the state has no right to intervene. Facts: Violence is a human rights violation, no matter whether it occurs in the family or in the public sphere. Under international human rights law such as the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) or the Istanbul Convention, governments are not only expected to eliminate all forms of violence, they are obligated to do so.

HIGHER HEALTH: A Training Resource Manual

Myth 9: Sex workers cannot experience rape. Facts: International definitions of rape and other forms of sexual assault (WHO 2013) focus on the type of violent acts committed, without consideration of who is the perpetrator or the survivor. Accordingly, anyone who forces another into a sexual act against their will and without their consent, is committing rape, regardless of what the victim’s occupation is Myth 10: a man cannot rape his wife. Facts: As mentioned earlier, rape is defined by an action and not by the identity of the perpetrator or the survivor. Accordingly, any forced sexual intercourse is rape, irrespective of whether the woman survivor is married to the perpetrator or not. What can be done to prevent GBV? • EMPOWER the disempowered! If they feel physically stronger they feel mentally and psychologically stronger. • Offer onsite sexual and gender-based violence (SGBV) services: Psychosocial support. • Access to counselling and tangible assistance.• • Self-defence: being able to defend oneself makes one feel psychologically and mentally stronger and more empowered. GBV happens to those without power – prevention is about giving back and taking back one’s power. Victor Lyalko, a reputed martial arts master, described the most effective methods of selfdefence to help women if they are attacked.

Below are some of the easiest and most effective moves for different situations. Anyone can do these no matter how big or heavy the attacker is. 1. For starters, memorise the most vulnerable places

2. The simplest and most effective moves

It doesn’t matter how big or heavy your

attacker

because

you

can

anyone

beat you

know where the most vulnerable spots are. The main ones are the eyes, nose, throat,

chest,

knees, and groin.

One of the best moves that will make any giant whimper or drop to their knees is grabbing the wrist. Grab the little finger and ring finger with one hand, and the middle and index finger with the

You can attack in any way you want, but to be on the safe side, you need to remember that the most effective moves are aimed at these areas.

other and bend the wrist forward. If you can’t grab your opponent’s hand, hit them with a fist or with a finger between the collarbones or, if it is a man, into his Adam’s apple. This will allow you to disorient your opponent enough that it will take him a long time to come back to his senses.

HIGHER HEALTH: A Training Resource Manual

3. If you were grabbed from the front:

If you were grabbed from the front and you can’t lift your hands, The most obvious area for an attack on a male attacker is the groin. All self-defence courses advise aiming for this area.

do the following: move your hands forward and make a fist in front of your pelvis. This will create enough room between you

and the attacker. Hitting this area will literally paralyse the attacker and you will After that, hit the attacker’s nose with your forehead. This will have just enough time to escape. make the attacker move away from you. Now hit him in the groin with your knee. 4. How to free your hands:

If there is still some room between you and the attacker, there is a way you can protect yourself using your palm. Straighten your left arm and hit the attacker on the chin and nose with your right arm. Then again, in the case of a male, hit him in the groin. In the case of a female, hit her on the breasts and in the vagina. This way the attacker will be disoriented for a long time and they won’t be able to move. HIGHER HEALTH: A Training Resource Manual

You can easily escape a stronghold if you remember the “rule of thumb”: rotate your arm to the side of the attacker’s thumb. If they’re holding your arm tightly, rotate your wrist toward the thumb. When your arm is under the attacker’s, pull your arm as strongly as you can.

5. If you were grabbed from behind:

6. If you approached and grabbed from the side:

Attackers often come from the back because this is the easiest An elbow hit is one of the most dangerous hits in all kinds of martial arts. This is exactly the hit you need if you are approached way to hold the victim’s arms so that they can’t move them. To set yourself free, quickly bend back and try to hit the attacker from the side. with the back of your head. It’s OK if you can’t do it: the point is Hit the attacker’s temple, jaw, or nose with an arched move. After to make the attacker put one of his legs forward.

this, the attacker will take a few steps back. Now hit them in the

Now quickly bend down, grab his/her leg and get up pulling it belly or chest. Elbow hits are so strong that they will disorient with you. Now the attacker will lose balance and you will be able any opponent. to drop even the biggest opponent. 7. If you were pushed against a wall: It happens very often that attackers try to corner their victims or push them against a wall. In this situation, it’s necessary to remember the most vulnerable places and hit one of them depending on your position. •

If both of the attacker’s arms are up, then straighten your palm and hit him/her in the armpit.

•

If one of your arms is down, there is a chance you can hit the opponent in the chest, neck, or jaw.

•

But one of the most effective and powerful hits is a hit with your head. Squat a little to be lower than the opponent. Then quickly jump up and hit them in the jaw with your forehead. This move will instantly disorient the attacker and give you a chance to escape.

HIGHER HEALTH: A Training Resource Manual

There are three categories of prevention intervention that can be adopted, namely:

• • • • • •

Address GBV before it occurs to prevent it happening Targeted action must be aimed at behavioural issues and reducing risk Teach protective behaviours Build confidence and selfesteem from an early age/ stage Teach assertiveness skills Encourage self-reliance and economic independence by: -- Encouraging particularly young women to stay in school -- Discouraging early sexual debut -- Counselling and education on unplanned pregnancy prevention and options -- Teaching entrepeurnarial skills

•

• • • •

Primary prevention

Deal with the short-term consequences, e.g., treatment, counselling on options, self-preservation, protective behaviours, and restoring the sense of self immediately after the violence has occurred to prevent further incidents Rebuild the emotional and psychological infrastructure of the person Identify sources of help and support for those who feel at risk or are in danger Help them identify ways to decrease dependence on the perpetrator Attempt to identify and address the root causes of their vulnerability that places them at risk

•

Tertiary prevention focuses on long-term interventions after the violence has occurred in order to address lasting consequences, including perpetrator counselling interventions

Secondary prevention

Tertiary prevention

Across South Africa there are many organisations working towards preventing the root causes of GBV. The “What Works to Prevent Violence” programme is a global initiative, which is funded by the British Department for International Development (DFID) and coordinated by the MRC, currently supports research on a number of South African interventions in this regard. The programme aims to provide evidence on what makes these interventions successful and how they can be replicated, adapted and scaled up. The primary objectives of preventive programme’s objectives were as follows:

Reflect on social norms that impact on GBV

Address risk factors for violence

Encourage positive relationships

Address contributing factors such as unemployment and substance abuse

Confront harmful aspects of masculinity

Promote non-violent ways of conflict resolution

Improve stress management

Strengthen relationship skills

Improve psychological well-being of young people

Teach value-based decision making

Promotion sexual health

Develop livelihoods strategies

HIGHER HEALTH: A Training Resource Manual

School and post-school based programmes target young people at a primary preventative level to:

What can Peer Educators do to help? Peer educators can do an Institutional Mapping Assessment Are there individuals in the institution / host community that are known to be a threat to vulnerable groups? Are there aervices available to address gender-based violence or sexual assault / rape? Where are they? Who do students trust to help them deal with gender-based violence or sexual assault / rape? Where are the health / psycho-social support services located? Are there any support groups or resource centers in the college or host community? Ehere should students go to address security concerns or issues? Are there places in the community that are regarded as safe places for students to go if they’re at risk / in danger?

Peer educators can offer:

Validation

nonjudgemental support

listening without pressuring the survivor to talk

non-intrusive response to concerns

practical care and support

information about resources

increased access to safety options

Confidentiality

mobilisation of social support

HIGHER HEALTH: A Training Resource Manual

Do’s

Don’ts

Take the initiative to ask about violence – do not wait for the person Don’t ask about violence in the presence of a partner, family member or friend. Remember that the patient’s safety is to bring it up. This shows that you take personal responsibility for paramount. the situation, and it helps to build trust Emphasise that violence is not their fault and that the perpetrator is Don’t blame the woman. Avoid questions such as “Why responsible for their behaviour. do you stay with him?” “Did you have an argument before violence happened?” “What were you doing out alone?” “What were you wearing?” Instead, reinforce that GBV cannot be tolerated. Explain that the information will remain confidential and inform them about any limitations to confidentiality.

Disclose to other health care workers without her consent

Use eye contact and focus all attention on the survivor

Avoid passive listening and non-commenting. This may make her think that you do not believe her and that she is wrong, and the perpetrator is right Avoid doing paper work at the same time.

Be aware of your body language. How you stand and hold your arms and head, the nature of your expression and tone of voice all convey a clear message about how you perceive the situation.

Avoid body language conveying the message of irritation, disbelief, dislike, or anger toward the survivor.

Show a non-judgemental and supportive attitude and validate what he/she is saying. Use supportive statements, such as “I am sorry that this happened to you” or “You really have been through a lot” which may encourage them to disclose more information.

Do not judge a survivor’s behaviour based on culture or religion.

Use a kind, calm and gentle voice to reassure the survivor. Emphasise options and resources available. Try to find adequate services together with the survivor. Leave “the door” open for him/ her to come back to you.

Avoid giving the impression that you’re uncomfortable dealing with the issue

Carefully listen to their experience and assure them that their feelings are justified

Ask too many questions or she will feel like she’s being interrogated

Show that you believe their story.

Do not cross question and expect proof/evidence to corroborate her story If doubtful, document your doubts and evidence they are based on.

Be patient with woman and girl survivors of GBV, keeping in mind that they are in a state of crisis and may have contradictory feelings.

Don’t pressure her to disclose. If she does not disclose, tell her it’s okay but that she can call at any time. Explain to her that she can come back for further assistance.

HIGHER HEALTH: A Training Resource Manual

Chapter 5 MENTAL HEALTH

HIGHER HEALTH: A Training Resource Manual

M E N T A L H E A LT H Note to facilitators

Introduction and Overview

Peer educators should be aware of their capacity to provide limited support to students in respect of mental health issues. Should students choose to access such support, it is crucial to respect their confidentiality. Be aware of your own issues and mental state. If you are currently experiencing problems yourself, refer the case to someone else. Be prepared to manage sensitive issues. Here are some tips: •

Know that your limited training only enables you to provide crisis intervention and refer students for more help.

•

Prepare students for the need for a referral to a professional.

•

Prepare yourself to discuss the issues without feeling uncomfortable about managing emotions.

• Young people in a post-schooling setting are at a stage where they are faced with many choices, challenges and stressful

unconditional support and acceptance. •

situations, all of which impact on their mental and physical wellbeing. At this life stage, peer influence is exceptionally strong.

Build an open atmosphere in which students feel comfortable talking about these issues.

•

Hence peer counselling can help create positive peer pressure to normalise healthy behaviour.

Prepare yourself for the need to listen mostly, and offer

Encourage open and frank discussion so you will be able to refer them appropriately.

•

Observe body language to help you decide when to probe further on an issue and when to back off.

This

chapter

provides

interesting

sessions

review

•

communication skills and acquire basic helping techniques. It

When people do not want to discuss something, they may avoid eye contact or fold their arms across their chest.

describes the basic principles and process of counselling and how this has a major impact on young people.

Aim: To create awareness among students about risks and

Among the student population, studies show that one in four

symptoms of mental illness and when, how and where to refer

students have a diagnosable mental illness, of which 40% do not seek help. The five most common mental health problems that

them.

students face are depression, anxiety, suicide, eating disorders,

Overall objectives of the chapter:

and substance abuse. This module will talk about the important symptoms to be aware of and when and how to seek help. It is important to remember that, if left untreated, many of these issues can become unbearable to the point that daily living becomes a challenge. So whether you or a friend you are concerned about are experiencing these issues, you should take action as soon as possible. Getting help will ultimately lead to a happier and healthier life.

By the end of this module, participants will: •

Have more information about depression, anxiety, stress and eating disorders.

•

Understand the importance of and need for self-awareness regarding their own mental health.

•

Have a clear definition of each of the mental health risk areas outlined above.

•

Demonstrate an understanding of the facts around causes, symptoms, treatment and preventive measures for specific mental health challenges.

•

Be equipped with factual information on mental health risks to encourage informed decision-making and health-seeking behaviour.

•

Have an opportunity to practice basic counselling skills.

•

Be equipped to know how and where to refer peers for help or additional information on each of the areas.

HIGHER HEALTH: A Training Resource Manual

Activity One: Silent Questionnaire

Purpose of activities: •

To provide an opportunity for students to be involved in a

Instructions for the flow of activities

self-awareness exercise to get a sense of their own mental

wellbeing. •

enable participants to tap into their own mental and

To provide opportunity for students to conduct basic self-

emotional states.

assessments regarding various mental conditions.

To equip participants with basic counselling skills.

•

Mental health content: areas:

Anxiety

Stress

Eating disorders

Play soft music in the background.

Ask questions (see resource sheet) for participants to

Observe their reactions to the questions.

When the exercise is done, ask them to open their eyes.

DISCUSSION QUESTIONS

Self-awareness exercises

•

silently answer in their heads.

Mental illnesses: Depression

•

Self-assessment tests

•

Basic counselling skills

•

Referrals

Aim: To create awareness among students about their own mental illness and when, how and where to find help and support. Time:

Why is it important to know this information?

•

What does it mean for you right now?

KEY MESSAGES •

Optimal mental health is crucial to optimal functioning.

•

Mental illness can be invisible to others as well as ourselves.

•

Lesson objectives

•

On completion of this lesson, participants should: Know how to get in touch with their own mental and Understand how mental state impacts work, relationships and functionality.: Planning notes •

Prepare and review instructions for activities.

•

Ensure preparation for the activities is completed timeously. Lesson content: Self-awareness exercise

Our mental state affects our psychological well-being, our emotions, and our behaviour.

•

Our mental state affects our work and relationships, be it positive or negative.

RESOURCE FOR ACTIVITY ONE: SILENT QUESTIONNAIRE 1.

Think of three people in your life who are closest to you. When was the last time you told them you loved them?

When was the last time anyone said they loved you?

Have you experienced the death of a loved one in the last year?

Are you in a relationship right now? • If yes, rate your relationship on a scale of 1 to 10.

20 minutes

Often we’re not aware that our mental state is compromised.

emotional state.

Time:

Ask how they experienced the exercise and what insights

•

20 minutes

•

Ask which question made the biggest impact. did they gain.

LESSON ONE: SELF-AWARENESS

•

Their eyes should remain closed for the duration of the exercise.

The module has three lessons, which focus on the following

Inform participants that they should make themselves comfortable and close their eyes.

•

Explain that you will be doing an opening exercise to

• If no, rate your sense of self-worth on a scale of 1 to 10. 5.

Rate your physical health on a scale of 1 to 10.

Rate your mental health on a scale of 1 to 10.

Rate your emotional health on a scale of 1 to 10.

Rate your spiritual health on a scale of 1 to 10. HIGHER HEALTH: A Training Resource Manual

Activity One: Individual Self-Assessments

Rate your energy levels on a scale of 1 to 10.

10. Rate your ability to sleep well on a scale of 1 to 10. Think of your three greatest strengths… How are you using

Instructions for the flow of activities

them?

Explain to participants that you will be handing out selfassessment forms.

11. Think of your three greatest weaknesses… What are you 2.

doing about them?

Instruct participants to complete the forms individually and as honestly as possible.

12. If you had to get sick today, who will care for you? 3.

13. Think of someone you confide in and share your secrets

Explain that the exercise is for them alone and they won’t have to share their scores with the class unless they wish

with. What would you do if you lost them?

to.

14. Imagine you visited the doctor and were told that all your 4.

blood tests came back and you have a rare, untreatable

Read through the instructions on the form to ensure that everything is clear.

form of cancer. You have two months at the most. What 5.

aspects of your life would you change?

Give participants 10 minutes to complete the first form and 5 minutes to score.

LESSON TWO: IDENTIFYING RED ZONES

Once they’ve completed the first form, hand out the second form.

Follow the same procedure.

Mental health Aim:

DISCUSSION QUESTIONS

To create awareness among students about their own mental illness and when, how and where to find help and support.

•

Ask how they experienced the exercise and what insights

Time: 45 minutes (two activities)

did they gain. •

Why is it important to know this information?

•

What does it mean for you right now?

Lesson objectives On completion of this lesson, participants should: •

Get in touch with their own mental and emotional state.

•

Understand how mental state impacts work, relationships and functionality.

Planning notes •

Prepare and review instructions for activities.

•

Ensure that preparation for the activities is completed timeously. Lesson content Self-assessment exercise Time: 45 minute

KEY MESSAGES •

Optimal mental health is crucial to optimal functioning.

•

Mental illness is invisible to others as well as ourselves.

•

Often we’re not aware that our mental state is compromised.

•

Our mental state affects our psychological well-being, our emotions, and our behaviour.

•

Our mental state affects our work and relationships, be it positive or negative.

RESOURCE FOR ACTIVITY ONE: DEPRESSION SELF-ASSESSMENT Periodic blue moods, grief from loss, or mild sadness are normal occurrences for nearly everyone. When these feelings become more intense and last longer, it could be a sign of more serious depression. Difficult life events, family history and genetics, severe stress, trauma, major loss, and excess alcohol or drug use can all lead to a higher risk of depression which doesn’t lift and may require counselling and/or medication. Depression can be treated successfully. Here is a simple quiz that will help you to make some initial decisions about next steps. You may want to speak to a professional about your symptoms.

HIGHER HEALTH: A Training Resource Manual

Note that this self-assessment quiz is not a diagnostic tool. It is simply one way to help you to begin thinking about your current mood and symptoms. We urge you to share your responses with a licensed professional. The questionnaire is provided by E4 Health Inc.© www.e4healthinc.com 1.

I have seen a steady change in my appetite and eating patterns, such as a loss of appetite or eating much more Yes

than normal. 2.

I have lost interest in activities that I typically enjoy.

Yes

Sometimes I just feel like crying.

Yes

I am having difficulty sleeping, e.g., sleeping too much, waking very early in the morning, and/or having difficulty Yes

falling and staying asleep. 5.

I have had more thoughts about dying and suicide. Sometimes I feel as if people would be better off without me Yes

in their lives. 6.

I feel as if I have very little energy.

Yes

I am having more difficulty concentrating on things.

Yes

I have little interest in sexual intimacy.

Yes

I get much more irritable or angry lately.

Yes

10. The future seems bleak to me.

Now count up the number of “Yes” answers. If you have answered “Yes” to three or more of these questions, there is a good chance that you may be experiencing some type of depression. However, even one “Yes” answer could signal serious depression that requires professional help. We suggest that you discuss your answers with a licensed counsellor by calling E4 Health. Remember, there are different types of depression and different levels of severity. Obtaining an accurate diagnosis from a professional is a necessary first step in order to match an appropriate treatment. Are you in the Red? Zone Check: Mental Health

Yes

Have you lost interest and motivation in activities you used to enjoy?

Are you struggling to cope with daily activities (feel listless and without energy)?

Do you avoid people, have difficulty making conversation and dread social events (family functions/gatherings with friends)?

Do you think about and plan different ways to kill yourself?

Have your sleeping patterns changed where you’re either sleeping too much or not being able to sleep at all?

Are you hearing, feeling, or seeing things that other people cannot?

Are you feeling anxious all the time (knot in your tummy, dry mouth, clammy hands) and have no idea why you feel that way?

Do you sometimes have panic attacks (feel like you can’t breathe, need air, experience feelings of terror) without knowing why?

Do you have flashbacks (vivid memories and visions; reliving the event) of something bad that happened to you?

10. Are you feeling tired and without energy or unnaturally excited with too much energy? 11. Do you experience changing eating habits from having a loss of appetite to binge eating (eating huge amounts of food in one sitting)? 12. Do you constantly feel and think that other people are trying to control you, are talking about you or trying to kill you? If any of your answers place you on a red square, you are in the RED ZONE. This means you may be at risk for mental illness. Ask your HIGHER HEALTH Campus Coordinator for help with counselling, care, treatment and support as soon as possible.

HIGHER HEALTH: A Training Resource Manual

RESOURCE FOR ACTIVITY ONE: ANXIETY SELF-ASSESSMENT This following questionnaire is called the GAD-7 screening tool. It can help you find out if you might have an anxiety disorder that needs treatment. It calculates how many common symptoms you have and, based on your answers, suggests where you might be on a scale from mild to severe anxiety. GAD stands for “Generalised Anxiety Disorder”, and there are seven questions in the tool. Choose one answer for each of the seven questions below. Several days

Nearly More every than half the day days

Over the last two weeks, how often have you been bothered by the following problems?

Not at all

1. Feeling nervous, anxious or on edge

2. Not being able to stop or control worrying

3. Worrying too much about different things

4. Trouble relaxing

Here are some questions to ask yourself: Are you experiencing anxious or worrisome thoughts on a daily basis? Are you plagued by fears others perceive as unfounded or irrational? Do you avoid everyday social activities because they cause you anxiety? Do you experience sudden heart-pounding panic attacks? Is your anxiety interfering with your schoolwork, social life and family? Are you in the Red? Zone Check: Stress 1.

Do you have frequent headaches?

Do you have difficulty sleeping for more than 3 nights in a row?

Do you have chronic back or neck pain and muscle tension?

Have you been feeling light headed, faint or dizzy?

Do you have sweaty palms, dry mouth and rapid heart rate?

Do you feel uninterested and have low energy?

5. Being so restless that it’s hard to sit still

Are you feeling irritable and snappy?

6. Becoming easily annoyed or irritable

Are you feeling overwhelmed?

Are you forgetful?

7. Feeling afraid, as if something awful might happen

Add up your results for each column Total score (add column totals together) What your total score means

Yes

10. Do you have difficulty concentrating? 11. Do you have chronic constipation or diarrhoea? 12. Do you find yourself getting sick all the time? If any of your answers place you on a red square, you are in the RED ZONE. This means you are at risk of being too stressed. Ask your HIGHER HEALTH Campus Coordinator for help with counselling, care and support as soon as possible.

Your total score is a guide to how severe an anxiety disorder may be: •

0 to 4 = mild anxiety

•

5 to 9 = moderate anxiety

•

10 to 14 = moderately severe anxiety

•

15 to 21 = severe anxiety

If your score is 10 or higher, or if you feel that anxiety is affecting your daily life, call your doctor. The GAD-7 was developed by Robert, L. et al., 1995-2018,

DEPRESSION VERSUS ANXIETY What is depression Depression is a common but serious illness and, if left untreated, can lead to suicide. It can make you feel helpless and hopeless, making it difficult to work, study, sleep, eat and complete basic everyday tasks. Depression is caused by a combination of factors which lead to a chemical imbalance in our brains. Because of this, the symptoms may not be the same for each person.

Healthwise Incorporated© This information does not replace the advice of a doctor. Healthwise Incorporated disclaims any warranty or liability for your use of this information.

HIGHER HEALTH: A Training Resource Manual

What causes depression? To understand depression, it is important to understand what causes this disorder in the first place. The WHO states that depression is a complicated combination of various psychological, environmental (connected to social and family environment), and biological factors.

How can you tell if you or someone else is depressed? For a diagnosis of major depressive disorder, a person needs to have experienced five or more of these symptoms for at least two weeks. Sadness

Self-critic

Chronic fatigue

Withdraw from others

Anger

Impaired Memory

Lack of energy

Neglect health/ studies

Emotions

Thoughts

Physical

Guilt

Confusion

Anxiety

Thoughts of Death

Mood swings

Weight gain/ loss

Behaviour

Demotivated

Substance abuse

Neglect self

Sleeping too much or too litttle

What are the complications of depression? If left untreated, depression can get worse and can result in complications which will affect every area of your life, including the emotional, mental, behavioural, and physical aspects. The complications can include substance addiction, panic attacks, anxiety, and suicide.: How to manage depression Get enough sleep

Exercise regularly

Talk to someone you trust

Take time to relax

Change your diet

HIGHER HEALTH: A Training Resource Manual

What is anxiety?

Everyone feels anxious at some point in their life, whether it’s writing an exam, going on a date for the first time, speaking in front of people, or doing something that has risk associated with it. Anxiety starts out as stress, and it is useful to have some stress because it keeps us stay alert, quickens our reflexes, and keeps us energised and focused. In a normal situation, it usually settles once the stressful situation has passed. When it does not settle and you remain in a state of heightened stress, it turns into anxiety. Anxiety, therefore, is when those feelings of stress don’t go away, and you can’t seem to control them. People who experience constant anxiety find it difficult to cope with normal daily life. Characteristics of anxiety: •

Can be very intense and hard to control.

•

Can last for weeks, months or over many years.

•

Negatively affect your thoughts, behaviour and general health.

•

Leave you feeling distressed and not enjoying life.

Anxiety can cause physical symptoms like pain, a pounding heart, or stomach cramps. For some people, these physical symptoms are their main concern. Anxiety can also affect other areas of your life – like your ability to cope, or perform at work), and can affect your relationships with friends, peers, or loved ones. What are the signs and symptoms to look out for?

HIGHER HEALTH: A Training Resource Manual

Most common types of anxiety Generalised Anxiety Disorder (GAD) is when people worry all the time about different things. The anxiety is not just one specific issue and any one situation that triggers the anxiety can cause an avalanche of anxiety that can be hard to control and it can impact all parts of one’s daily life. Recognising the signs: One of the most important things to remember about anxiety disorders is that brief and occasional flashes of anxious feelings or behaviour do not automatically indicate a mental illness. •

Are you experiencing anxious thoughts on a daily basis?

•

Are you overcome by fears others cannot identify with?

•

Do you avoid everyday social activities because they cause you anxiety?

•

Do you experience sudden heart-pounding panic attacks?

•

Is your anxiety interfering with your schoolwork, social life and family?

If the anxious feelings persist, or if they begin to manifest in obsessive behaviour or an overwhelming sense of fear or phobias, it is time to seek help for yourself or your peer. Obsessive Compulsive Disorder (OCD) is when a person has unwanted, ongoing thoughts, feelings, and ideas which cause anxiety. So they then carry out actions to reduce the anxiety or get rid of those thoughts. For example, one might have an excessive and abnormal fear of germs. The person may try to relieve the anxiety through repeated hand washing or avoiding touching things like money or escalator rails. They may know these thoughts are unreasonable but be unable to stop them. When OCD is severe and left untreated, it can be very distressing, and get in the way of work, college and normal life at home. Post-Traumatic Stress Disorder (PTSD) is a reaction to a highly stressful event when a person feels very unsafe or threatened. These are unusual experiences, such as a violent attack (verbal, physical or sexual), accidents, or a natural disaster. The symptoms usually include irritability, anxiety, severe panic attacks, flashbacks, repeated nightmares, and avoiding situations that might bring back memories of the event. Panic Disorder is when a person has panic attacks. These are intense feelings of anxiety along with the kind of physical symptoms and overwhelming sensations you would have if you were in great danger, like a pounding heart, feeling faint, sweating, shaky limbs, nausea, chest pains, breathing discomfort, and feelings of losing control. The symptoms rise and peak rapidly. The effects can be so severe that people experiencing panic attacks can believe they are dying. However, despite being frightening and “very real”, they are not life-threatening. Phobias are intense uncontrollable fears that are not always based on logic or facts. The fear can be so great that the person goes to great lengths to avoid something, even if it’s harmless. For example, social phobia is fear of being judged or embarrassed in public or even noticed. Another common type is claustrophobia, which is a fear of small closed spaces. It can be extremely disabling and frightening to the extent that people may fear using lifts or bathrooms, going into caves, or even medical procedures that involve dark closed spaces.

ANXIETY versus

100

DEPRESSION

A person suffering from anxiety will feel apprehensive about one’s future and will have troubled thoughts

A person suffering from depression will feel hopeless about the future and will imagine worst case scenarios

Anxiety can lead to depression

Depression can lead a person to suicide

Bodily symptoms will occur only after an intense attack

A huge trigger may not be needed to develop characteristic physical changes

Patients will often display a flight or fight response; their bodies will often look tense and rigid

Patients will appear hopeless, drained and energy-less; will experience changes in sleeping pattern, appetite and social interactions

HIGHER HEALTH: A Training Resource Manual

RESOURCE FOR ACTIVITY ONE: EATING DISORDER SELF-ASSESSMENT RATING

I have eating habits that are different from those of my family and friends

Often

Sometimes

Rarely

Never

I cannot go through the day without worrying about what I will / will not eat

Almost Sometimes Always

Rarely

Never

I prefer to eat alone or when I am sure that no one will see me

Often

Sometimes

Rarely

Never

I make excuses (e.g. “I already ate”, “I am not feeling well”, etc.) so that I will not have to eat with friends and family

Often

Sometimes

Rarely

Never

I have uncontrollable eating binges during which I consume large amounts of food and afterwards I make myself vomit

Never

Less than 1-6 x a once a week week

Once or more a day

I cut my food into tiny pieces, I hide it so people will think I ate it, I chew and spitt it out without swallowing it

Often

Sometimes

Rarely

Never

I’ll keep hidden stashes of food in my room

Often

Sometimes

Rarely

Never

I become angry when others show interest in what I eat and pressure me to eat more

Often

Sometimes

Rarely

Never

I am afraid that no one would understand my fears about food and eating, so I keep these things to myself

Often

Sometimes

Rarely

Never

10. I go through long periods of time without eating (fasting) or eating very little as means of weight control

Often

Sometimes

Rarely

Never

11. My friends tell me I am thin, but I do not believe them because I feel fat

Often

Sometimes

Rarely

Never

12. I would panic if I got on the scale and found that I had gained weight

Almost Sometimes Always

Rarely

Never

13. I use laxatives or diuretics as a means of weight control.

Never

Rarely

Sometimes On a regular basis

14. I have an overwhelming fear of gaining weight

True

False

15. I exercise excessively to try to lose weight and become anxious if I miss a workout

True

False

16. It is very important that I am thinner than all of my friends

Almost Sometimes Always

17. I am unable to maintain a weight that is considered healthy and consistent with my build, age and height

True

False

18. (Females only) My menstrual period has stopped or become irregular due to no known medical reasons

True

False

19. I can spend hours reading books or magazines about dieting, exercising, fitness, or calorie counting

Often

Sometimes

20. I have felt depressed and irritable lately, and spend most of my time alone

True

False

21. I tend to be a perfectionist, I am not satisfied unless things are perfect

Often

Sometimes

Rarely

Never

Rarely

Never

Rarely

Never

Total Score

COLUMN TOTALS How are the results scored? 38 or less – Strong tendencies toward anorexia nervosa 39 to 50 – Strong tendencies toward bulimia nervosa 50 to 60 – Weight conscious. May or may not have tendencies toward an eating disorder. Not likely to have anorexia or bulimia nervosa. May have tendencies toward compulsive overeating, obesity, or binge-eating disorder. Over 60 – Extremely unlikely to have anorexia nervosa or bulimia nervosa, however, scoring over 60 does not rule out tendencies toward compulsive eating, binge-eating disorder, or obesity. HIGHER HEALTH: A Training Resource Manual

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If you scored below 50, it would be wise for you to seek more information about anorexia nervosa and bulimia nervosa and contact a counsellor, peer educator, lecturer, or doctor in order to find out if you have an eating disorder and, if you do, talk about what kind of assistance would be best for you. If you scored between 50 and 60, it would be a good idea for you to talk to a counsellor, pastor, teacher, or physician in order to find out if you have an eating disorder and, if you do, how to get some help. If you scored over 60, but have questions and concerns about the way you eat and/or your weight, it would be a good idea for you to talk to a counsellor, pastor, teacher, or physician in order to determine if you have an eating disorder and, if you do, how to get some help. https://casapalmera.com/assessments/eatingdisorder-self-assessment? Many young people develop eating disorders but do

Eating disorders Eating disorders commonly affect both men and women between the ages of 12 and 25 years of age. Many develop eating disorders during their college or university years and do not seek help or do not realise how bad the disorder is. Eating disorders lead to extreme behaviours, thoughts and attitudes to do with food and can lead to death if left untreated. The main types of eating disorders

not understand just how dangerous they are and do not seek help or treatment for them. There are many other serious complications of eating disorders, including brain damage, bone loss, and death. Some of the signs to look out for if you or a friend are suffering from an eating disorder are: Brain & Nerves (Can’t think right, fear of gaining weight, sad, moody, irritable, bad memory, fainting, changes in brain chemistry)

EATING DISORDERS

Hair (Hair thins and gets brittle)

Anorexia Nervosa

Bulimia Nervosa

Dangerously underweight

May be of normal weight or

Obsessed with being thin Distorted body image Intense fear of weight gain

slightly overweight Repeated episodes of binging and purging to prevent weight gain Worried about weight and feels lackof control over such episodes

Binge eating/ purging type Regularly engages in binge eating and purges through self-induced vomiting; laxatives or other medication 102

Restriciting type Limit their intake of food to consume because they see themselves as overweight, even when they are underweight Focus on calorie intake The goal is always rapid weight loss

Heart (Low blood pressure, slow heart rate, fluttering of the heart (palpitations), heart failure) Blood (Anemia and other blood problems) Skin (Bruise easily, dry skin, growth of fine hair all over body, get cold easily, yellow skin, nails get brittle) Kidneys (Kidney stones, kidney failure) Muscles and Joints (Weak muscles, swollen joints, fractures, osteoporosis)

Purges through self- induced vomiting; laxatives or other medication

Tries to lose weight through fasting or excessive exercising

Intestines (Constipation, bloating) Hormones (Periods stop, bone loss, problems growing, trouble getting pregnant, if pregnant - higher risk for miscarriage, having a C-section, baby with low birthweight, and post partum depression) Body Fluids (Low potassium, magnesium and sodium)

HIGHER HEALTH: A Training Resource Manual

If you believe you or a friend may be developing an eating disorder, it is vital that you seek help as soon as possible. Eating disorders and body image are sensitive issues, so it is important to remain non-judgemental when approaching your friend if you suspect they may have a problem. There are, however, many treatments and programmes available that can help people suffering from eating disorders, so seeking professional help will lead to a healthier and happier life. Suicide Students are particularly at risk for suicide as college can be a stressful time for young people, and it is a phase of life where many things are happening at the same time. It is the time of awakening in terms of sexuality, relationships and selfawareness. It is also the time when new relationships start and most breakups happen. Because of raging hormones at this stage and age, all feelings and emotions (good and bad) are intensified and magnified. Body image is also a key issue in this phase of life. In addition, the workload is high, making friends and fitting in is stressful, and the pressure to succeed can become too much to cope with for many people. If the right steps are not taken to deal with the stress of studying, feelings of guilt, depression and hopelessness can take over your life. Depression, anxiety and suicide are closely linked, so it is important to know when to reach out for help and to know that there is always another way out and that suicide is not the only or the right option. If you are worried about a friend or peer being suicidal, you should seek help immediately. The best people to handle these kinds of situations are trained professionals, so contact your campus support or healthcare provider as soon as possible. Some of the warning signs to look out for in friends and peers that could help you save a life are:

Suicide is completely preventable, and the underlying conditions that may be causing it are treatable. There is always another way out, and it is important to remember that there will always be someone who can help you. What can peer educators do? If you believe someone may have an anxiety disorder, be an active listener when they are feeling stressed or anxious and help them research next steps. Avoid criticising or belittling the severity of their anxious symptoms and encourage coping strategies that avoid the issues or cause further anxiety. Encourage your friend to visit your campus healthcare centre and seek help from a professional. If your friend is reluctant to seek treatment, you can consult a mental healthcare provider for suggestions moving forward. Look out for these common suicidal warning signs in your peers: •

Depression, negative change in mood, and a sense of hopelessness.

•

Talk of suicide, wanting to die, or dropping hints about suicidal thoughts.

•

Abrupt change in personality and behaviour.

•

Extreme physical and emotional pain.

•

Drop in academic performance.

•

Avoiding friends or social activities.

•

Sudden calmness after a long period of depression.

Severe depression •

Anxiety and devastation from a broken relationship or lost

•

Family mental health history.

•

Feelings of failure and hopelessness.

loved one.

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Level of Risk

Risk factors

Action plan for peer educators 1.

Low Risk

------

Occasional suicidal thoughts Minimal external risk factors No previous suicide attempts No specific plan / intention or means Support and other protective factors are in place

2. 3.

1. 2.

Moderate Risk

-------

Suicidal thoughts Some risk factors Suicidal plan with some detail Means are available (access to weapon / medication etc) Vague intention to act Some protective factors are in place

3. 4. 5. 6. 7.

High Risk

---------

104

Suicidal thoughts Previous suicide attempt Numerous risk factors Clear and detailed suicidal plan Immediate intent to act Means are available and lethal (access to weapon/ medication etc) Social isolation Limited support in place

1. 2. 3. 4. 5.

Observe and remain vigilant for changes in mood or circumstances Take note of deterioration in mental state/ changes in behaviour Agree beforehand on what to do if the student feels a crisis coming on (crisis plan and support / emergency numbers) Consult with Peers and Peer Mentor Refer to doctor for further assessment Remain vigilant and provide telephonic support Schedule follow up appointment within a week Monitor mood and risk until student is stable Agree on written safety management plan Get permission to inform significant others (best friend/ partner / family) Consult Peer Mentor immediately Refer for urgent psychiatric assessment / intervention Remain vigilant and provide telephonic support Agree on written safety management plan Get permission to inform significant others (best friend / partner / family)

HIGHER HEALTH: A Training Resource Manual

LESSON THREE: CREATING SAFETY NETWORKS

to reflect on the following issues: --

Aim:

students in crisis. 45 minutes (two activities)

relationships.

initiate

helping

What was that like for the counsellors and the peers?

Identify all the strategies of initiating helping

Helping skills for peer educators

Learn basic skills to assist peers with problems.

Skilled peer counsellors need to have and use the following basic principles and code of ethics:

Planning Notes

•

Prepare and review instructions for activities.

•

Ensure that preparation for the activities is completed timeously.

Peer educators need to be able to develop skills to connect with, listen to and communicate with peers in the best interests of the person being helped. Peer educators are in a position of influence with respect to

•

the people they are helping.

Lesson content

They need to be careful not to exploit the trust and

•

Role play

•

Application of skills

vulnerability of their peers who come for help. •

Peer educators need to respect the confidentiality and privacy of the people they are helping. They need to inform

Time:

those they are helping about any situations when they are

45 minutes

required to break confidentiality and privacy. •

Activity One: Helping Skills

Peer educators should not disclose information except where they are given information that involves risk to the safety of self, or other/s, self-harm, abuse, violence, or

Instructions for the flow of activities

criminal behaviour.

Explain to participants that they will be put into pairs for

•

Peer educators must recognise their personal limitations

this next activity. the

group

and refer students for appropriate assistance for students in in

half.

Identify

one

half

“COUNSELLORS” and the remaining half as “PEERS”. 3.

counsellor

conversation, use of questions, etc

Become familiar with principles and ethics of helping

Divide

the

introducing themselves, “joining” comments, general

On completion of this lesson, participants should:

did

conversations together with the participants, such as

Lesson Objectives

How

conversation?

Time:

•

What did you do? How did you feel when the counsellor approached you?

To equip peer educators with skills to intervene and assist

•

After they complete this part of the exercise, ask the peer

crisis or with professional therapeutic needs. •

Peer educators should not help or advise about problems

Ask the peers to imagine they have heard some

outside their recognised area of knowledge and training.

distressing news or had a distressing experience (break up of relationship, failed exam, or moving away to another province). It may even be something real if they feel comfortable talking about it. 4.

Ask both the counsellors and the peers to wander around the room in any direction.

When a counsellor passes a peer, the counsellor stops to join the peer and tries to find out if there is a problem, and if they want to talk about it.

Ask the counsellor to end the conversation as soon as the

Basic counselling skills for peer counsellors •

foundation for counselling is to: •

Show that you understand and care.

•

Build trust.

•

Give useful, correct information, and help in understanding what this information means.

•

Help make choices based on clear information, the nature of the situation, and the needs and feelings of the student

peer has told them about the problem. and the counsellor should not explore the problem more fully at this stage.

Everyone can learn good counselling skills. The

or client. •

Help them remember what to do.

Although counselling is a skill that can be learnt and improved with practice, it is important to realise when a problem or situation is beyond your experience and ability. Be familiar with HIGHER HEALTH: A Training Resource Manual

105

other services and refer peers as needed. How to start a conversation and find out if there is a problem Joining •

Mention what you noticed about the person. For example: “You look worried”, or “I get the sense that you’re feeling quite anxious.”

•

Ask a question showing interest and beginning with: “Can you tell me more about what seems to be troubling you?”

•

Acknowledge that you have heard their answer by sharing your own feelings or concerns about the situation. For example: “I am sorry to hear that”, “I feel a bit like that too”, or “Breaking up with your boyfriend must feel like your world is falling apart.”

•

Invite the other person to talk or to choose not to. For example: “Would it help to talk over it or not?”, or “Are you okay to talk more about this issue?”

Finding out about the problem •

Find out what the other person wants from you. For example: “How can I help you?”

•

Ask about the problem. For example: “What can you tell me about the problem?”, “What can you tell me about the thing that has upset you?”, or “What can you tell me about the fight with your mother?”

• •

Ask open questions and listen carefully to the answers to find out more.

• •

Maybe ask further questions. If things get tense or there are awkward long pauses, change the subject for a little while and then come back to the discussion. Let the other person change the subject if they want to and then come back to the discussion.

Suggestions for actively participating in the conversation When exploring the problem, you can decide when to use open or closed questions in a conversation. For a conversation to run smoothly and comfortably, you will also need to respond by actively participating in the conversation rather than just using questions. SHORT RESPONSES (minimal encouragers) Let the person talking know you are interested and are listening by saying things like: “…uh, uh”, “…yes”, “…wow”, “…true”, “…really”, etc.

Self-disclosure Sometimes they will tell you something which is similar to an experience of yours, and you may wish to disclose something about yourself that may be helpful. Giving back similar information to what the other person has revealed can be helpful. Putting yourself in the other person’s shoes for a minute and connecting with what you would have thought or felt then sharing that experience can be useful. However, be careful not to overshare, as this may compromise your boundaries and objectivity. You must always remain aware that you’re in a “helping relationship” not a “friendship”. Supportive statements Supportive statements can indicate your agreement with the other person’s situation. They provide an opportunity for you to affirm and reassure the other person. Examples: “Yeah, I can imagine how tough that must have been.” “It seems you’ve had a really hard time.” “It is possible for something like that to happen to anyone.” Unhelpful supporting comments Supporting comments can sometimes be helpful. However, in some instances, supporting comments can be unhelpful and make things worse. Playing down or making light of the other person’s worry. For example: “Never mind…”, “Everything will be different by next week; you’ll get over it.” Telling a person who is obviously upset, “Don’t be upset, it’s just a small thing. Everything is all right” won’t be helpful. Some statements are not useful when the other person is so upset that they aren’t ready or able to hear anything positive, or when your expression of support is inappropriate, such as the example below. “Hey… Heard your abusive ex-boyfriend is working at your brother’s school. That would make it convenient if he’s changed and you wanted to get back together…” Basic Counselling Process The counselling process has elements that are implemented in step-by-step approaches. The six (6) elements of the counselling process can be remembered with the letters in the word GATHER. Not everyone will need to be counselled in this order, and not everyone will need all six GATHER steps. Some may need a step repeated. Counselling can change to fit individual

106

HIGHER HEALTH: A Training Resource Manual

needs.

What the Peer Counsellor does

How the other person responds

Intitiates the conversation

Person begins to tell their story

Listens using short responses

Person knows the Peer counsellor is listening

Uses self disclosure where appropriate

Person feels equal in the helping relationship

Uses open questions to get a better picture

Person feels able to talk more about their troubles

Checks out that they have got the story right

Person knows the Peer counsellor understands

Identifies the main problem

Problem comes into focus

Continue by inviting the person to explore options and choices

Feels able to take some action

In conclusion It is important to take your mental health seriously and to seek G – GREET them and give your full attention immediately; be polite, friendly, and respectful; tell them that you will not tell others what they say. A – ASK QUESTIONS about their reasons for coming to you. Help them identify the decisions they face; keep questions open, simple, and brief; look at them; ask them what they want to do; show your interest and understanding at all times; and avoid judgments and opinions. T – TALK to them about their choices. Assist them to explore the options they have and the pros and cons of each option. To make informed choices and good decisions, people need clear,

help if you think you or a friend is at risk. If someone you’re related to has suffered from a mental illness, know that your genetics could be a factor in your development of a mental condition. Research your mental health treatment options on campus, and get involved with support groups, or consult your student health centre to learn more about student wellness. Take charge of your life on campus, and take the first step towards a healthy college career.

accurate and specific information about their options that relates

Emergency lines

Contact number

to their own lives.

Dr Reddy’s Help Line

0800 21 22 23

H – HELP them choose based on the pros and cons of each

Cipla 24-hour Mental Health Helpline

0800 456 789

Pharmadynamics Police and Trauma Line

0800 20 50 26

option. Explain that the choice is theirs; offer suggestions, but do not make decisions for them; encourage them to think about their future plans; help them think about the results of their options. Finally, ask, “What have you decided to do?” Then help them work out how they can do what they have decided. What would be the immediate next step? E – EXPLAIN what to do next. After they made their decision, explain what additional support services that are available to

Adcock Ingram Depression and Anxiety 0800 70 80 90 Helpline Destiny Helpline for Youth and Students

0800 41 42 43

Attention Deficit Hyperactivity Disorder 0800 55 44 33 (ADHD) Helpline Department of Social Development (DSD) 0800 12 13 14

them, and let them know they can come back anytime.

Substance Abuse Line 24-hour helpline

SMS 32312

R – RETURN, encourage them to return for a follow-up and

Suicide Crisis Line

0800 567 567

agree on a time. Ask if they have any questions or anything else

South African Depression and Anxiety 011 234 4837

to discuss.

Group (SADAG) Mental Health Line Akeso Psychiatric Response Unit, 24 0861 435 787 Hours

HIGHER HEALTH: A Training Resource Manual

107

SADAG has an office in Durban with the support of Psychiatrist Dr Suvira Ramlall and Clinical Psychologist Suntosh Pillay. The offices are based in Life St Joseph’s Hospital in Durban and are managed by Lynn Norton. The Kwazulu-Natal (KZN) Branch is deeply committed to: •

Launching new support groups.

•

Workshops on aspects of mental health.

•

School talks on suicide prevention.

•

Corporate wellness for KZN companies.

Support Groups To find a Support Group in your area, please phone SADAG on 0800 21 22 23.

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HIGHER HEALTH: A Training Resource Manual

Chapter 6 DISABILITY

HIGHER HEALTH: A Training Resource Manual

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HIGHER HEALTH: A Training Resource Manual

DISABILITY

Introduction and Overview

Different models are used to explain disability. The early understanding of disability focused on impairment and equated disability with a deficiency in the individual. This limiting medical definition influenced measures that resulted in policies and practices that excluded persons with disabilities (PWDs) from mainstream society for decades (medical model). The social model focuses on the abilities of PWDs rather than on their inabilities. It assesses the impact that the environment has on the full participation, inclusion and acceptance of persons with disabilities as part of mainstream society. It shows us how disability is a result of the interaction between social and environmental barriers and people with impairments. What we should be doing is adapting our environments, attitudes and

Understanding Disability

organisations to enable or accommodate people with certain impairments. Instead, a lot of the time we expect PWDs to

There are many different definitions and interpretations of the

adapt to our environments in order to fit in. This limits their

term “disability”. One way to understand it is to look at the

ability to function properly and participate equally in society.

word as an “umbrella” term for multiple concepts. Most of the

This definition describes the relationship between an individual

definitions and explanations of the term have the following

and their environmental factors. Below is a visual model to help

aspects in common:

understand this concept.

•

They describe the presence of an impairment.

•

They mention certain limitations which prevent someone from being able to participate equally in society.

•

Indicate that the focus should be on the abilities of a person

•

There is mention of a lack of access to opportunities due to

rather than their disabilities. environmental factors as well as discrimination in society. •

Disability can be permanent or temporary.

Models of disability

HIGHER HEALTH: A Training Resource Manual

111

Types of disabilities

It is important to remember that there are different types of disabilities and that people can have more than one disability at the same time. Some disabilities can’t be seen, and some are more obvious. Either way, all disabilities can impact on a person’s ability to study or work. Just like everyone else, each person with a disability is an individual and will have their own specific needs and their own experience of what it is like to live with a disability.

Aim The key focus of the chapter is to equip peer educators with accurate knowledge and information regarding PWDs so that they may educate peers and address discriminatory attitudes and ignorance in respect of disability.

LESSON ONE: UNDERSTANDING DISABILITY Aim To create awareness of how disability is experienced by PWDs and the impact of ignorance and discrimination. Lesson objectives By the end of this lesson, peer educators will: •

Access experiential understanding of how disability is experienced.

•

Develop self-awareness regarding their own attitudes towards disability and PWDs.

•

Have knowledge of challenges experienced with different types of disabilities.

Planning Notes •

Prepare and review instructions for activities.

•

Ensure that preparation for the activities is completed timeously. Lesson Content •

Activities on visual impairment, hearing impairment, and autism.

Time Allocation 2 hours 30 minutes Material needed for the lesson

112

•

Hand-outs

•

Flip chart and koki pens

•

Card or piece of paper

•

Book or any piece of writing HIGHER HEALTH: A Training Resource Manual

problems. Instructions for the flow of the lesson •

Introduce the lesson by saying: “There are many different

DISCUSSION QUESTIONS

types of disability. Some are obvious, and others are not so

How did it feel to have so much going on?

obvious. Some people may have more than one disability.

How did you wish to react?

Different disabilities will impact a person’s involvement

Were you able to concentrate on the paragraph being read?

in study or work in different ways. People who have the

What might have helped?

same type of disability will not experience their disability in the same way. It is important to remember that every

Activity Two

person with a disability is an individual who will have their

Note to facilitators

own specific experiences and disability-related needs as they interact with the environment.” •

Start the session with Activity One.

•

Divide the class into groups of five. Explain that each person in the group will be assigned a task. Explain the task as outlined below and instruct them to start when you give the signal.

Activity One •

•

• •

Hearing impairments include everything from not being able to hear certain sounds to being totally deaf. In most cases, hearing loss doesn’t simply mean that sounds are not loud enough. It usually means that sounds are garbled or unclear. A hearing aid may make speech louder, but usually it will not make speech clearer. Materials needed •

Lists with words and sentences

•

Pen and paper

Person #1 – You will play the part of a person with autism. Your job is to try and listen to what Person #5 is reading

Instructions

to you so you can be tested on the material. Try to ignore

•

Put people into pairs.

everyone else.

•

Provide one person (Person A) in each pair with a page

Person #2 – Stand behind the student playing the part of

with the following instructions:

the person with autism. Rub the edge of an index card (or

piece of cardboard) against the back of their neck. You

Read the list of words as follows: move your mouth

do not need to rub hard, but keep doing it over and over.

but make NO sounds and do not move your hands.

Person #3 – Grab a book (any book will do), lean close to

Say each word only once. After each word, give

Person #1, and read in a loud voice the entire time.

your partner time to write down the word. --

Person #4 – Pat Person #1 on the head and shoulder the Person #5 – Using a normal voice, read the paragraph

•

Next, the partner/s (Person B) will be provided with a page with the following instructions:

(provided by the facilitator) to Person #1. Then ask them

•

Wordlist: ship, Jim, chimp, punk, mud, bun, jeer, cheer, jib, chip.

entire time. •

Don’t let your partner (Person B) see this page!

questions about what you read. Do NOT try to drown out

Read the sentences below to your partner (Person A). Move

the other noises.

your mouth, but make NO sounds and don’t move your hands.

Have all the students in the group take a turn being

Say each sentence only once. Give your partner time to write

Person #1 before you discuss it.

each one down.

Discuss disabilities, their impacts, and adjustments with

Sentences

the participants (of some selected disabilities). Note to facilitators Activity One can demonstrate how the brain of a person with a learning disability or a disability like autism may work, and what kind of challenges this can pose to learning in a nonaccommodating learning environment. This activity is designed to show how people with autism are bothered by things most people don’t notice. People with autism often are extra sensitive to noise, movement and even things like background noises most of us don’t notice. Remember, however, that not everyone with autism has these specific problems, they may have different

HIGHER HEALTH: A Training Resource Manual

•

Would you like tea or coffee?

•

Do you take sugar?

•

Here’s the milk for your cereal.

•

Would you like more toast?

Allow 15 minutes for the exercise in pairs, then have everyone return to the main group. •

Second round: This time tell your partner (really talking) that you will read sentences about breakfast. Now silently (moving your mouth but making NO sounds) read the same sentences as before. This time you can use your hands if you want. Give your partner time to write down what you said. Check how many were right this time. 113

DISCUSSION QUESTIONS 1.

How did you experience the activities?

What did you observe and learn?

What was different in the second round of the second exercise?

How would this influence your future actions and behaviour?

Behaviour and attitude regarding disability It is important to remember that PWDs are people, so you should treat them as such. There are certain behaviours and actions that are inappropriate or disrespectful, and we need to avoid these when interacting with PWDs. The following are some examples of common inappropriate behaviour.

Activity Three: Learning disabilities Note to facilitators There are many kinds of learning disabilities, and they can range from mild to severe problems. This activity gives a general idea of what it is like to struggle against what your brain may be telling you. Materials needed •

Colour printout of the paper.

Instructions They must read the COLOUR the word is written in, not the word itself. Afterward, discuss how your brain wants to read the actual word. Even when you can make yourself do it correctly, you have to read much slower than normal.

Terms to avoid retarded handicapped able-bodies physically challenged differently abled This is an example of how difficult it is for students with learning disabilities to get through the day. Their brain understands what needs to be done, but they have to struggle to make it come out right. Not being able to do this activity correctly does not mean you are not smart. It just means that your brain wants to do something different.

So what would be the appropriate way to behave? •

Treat all people as equals.

•

Speak directly to the person and not to their friend or peer.

•

Respect people and do not pity them.

•

Speak normally (same pitch and volume), but speak a little slower if someone has a hearing impairment.

DISCUSSION QUESTIONS

•

Do not stare.

•

Make eye contact and be friendly.

How did you experience the activities?

•

Ask how you can help before making assumptions.

What were the problems? What would have helped?

•

Allow enough time for communication.

What did you observe and learn?

•

Do not tease or make fun of people – treat others as you would like to be treated.

•

114

Use appropriate language and do not stereotype.

HIGHER HEALTH: A Training Resource Manual

Discrimination

Sexual health and the disabled

What is Discrimination? Our world has a lot of diversity. There are religious people, nonreligious people, tall and short people, people with long hair, others with short hair, women, men, young girls, young boys, elderly people, babies in strollers, people with dogs, people wearing hoods, short skirts, tight dresses or suits, people with different skin colours, speaking different languages, and so on. Some people have some disability, and others do not have any disability. We are all very different. Discrimination is when a person or group of people are treated differently and unfairly based on certain characteristics they may have, e.g., race, gender, or disability. Discrimination against people who belong to a certain group is against the

Women and disability

law. All people should be provided with equal opportunity and

PWDs are often discriminated against when it comes to

have the right not to be discriminated against.

accessing sexual and reproductive health (SRH) services. It has been said that to be a woman with a disability is to be

Disability discrimination means treating someone unfairly

doubly marginalised. Among obstacles faced particularly by

because of their disability. There are increasing numbers of

women are the following:

people with disabilities (PWDs) in our society and changing

•

Maternal morbidity and mortality: Women with disabilities

negative attitudes in communities is essential in order to get rid

are less likely to receive general information on SRH, and

of discrimination. Understanding disability and how to accept

are less likely to have access to family planning services.

people with different needs is also important. The Bill of Rights

Furthermore, should they become pregnant, they are also

in our Constitution protects the rights of PWDs and condemns

less likely than their non-disabled peers to have access

unfair discrimination against people on the basis of disability.

to prenatal, labour and delivery, and post-natal services. •

Physical, attitudinal and information barriers frequently exist. Often community-level midwifery staff will not see women with disabilities, arguing that the birthing process needs the help of a specialist, or will need a Caesarean section, which is not necessarily the case. Of equal concern is the fact that in many places women with disabilities are routinely turned away from such services should they seek help, often being told that they should not be pregnant, or scolded because they have decided to have a child.

•

Furthermore, in a number of societies, if a child is born with a disability, it is assumed that the mother has been unfaithful or has otherwise sinned or is bewitched. She suffers significantly as a result of this assumption.

•

Even without such stigma, the physical, mental and financial stresses, coupled with social isolation, result in rates of divorce and desertion twice as high among mothers of children with disabilities compared to their peers who do not have children with disabilities. There are a number of ramifications of this – most striking, a cycle of increasing poverty.

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115

Men and disability Men with disabilities also face gender-related issues: •

Five actions towards full inclusion of the sexual and reproductive health of persons with a disability

SRH education: In many societies, while women receive instruction about SRH either at home or in school, young

1. Establish partnerships

men are left to pick up information “on the streets”, or casually, through other men’s comments, jokes and 5. Promote research

innuendoes. Young men with disabilities are often shielded from even this information, unreliable and incomplete

2. Raise awareness

as it may be. Young men with mental and intellectual

Full inclusion of persons with disabilities

impairments are particularly likely to be deprived of SRH information. •

Sexual exploitation: It is widely believed that men are not sexually abused. This is not true, however. In particular,

4. Policy, laws, budgets

men with disabilities are susceptible to sexual abuse, from both male and female perpetrators. Accessible abuse

3. Reach and serve

reporting channels and effective intervention programmes are as important for men with disabilities as they are for women with disabilities. Lifecycle approach Like everyone else, persons with disabilities have SRH needs throughout their lives, and these needs change over one’s lifetime. Different age groups face different challenges. For example, adolescents go through puberty and require information about the changes in their bodies and emotions, and about the choices they face concerning SRH-related behaviour. Adolescents with disabilities need to know all this information, but they also may need special preparation concerning sexual abuse and violence and the right to protection from it. It is important to assure that SRH services are friendly to youths with disabilities. On reaching the age for having a family, women and couples with disabilities, like everyone else, have the right to decide whether and when to have children and a right to sound, unbiased information on which to base these decisions. Healthcare providers owe all clients, whether they have disabilities or not, encouragement, support, and appropriate services over the years – both when they want to have children and when they want to avoid pregnancy. Mental health and psychological needs within SRH care Mental health is related to many aspects of SRH. These include,

Contraception considerations for the disabled Contraception options should be discussed with all women with disabilities. Considerations involve: •

contraception method. •

The actual or potential conditions of the woman.

•

The amount of assistance available to and required by the woman.

•

Her lifestyle and self-care needs.

•

Her goals for pregnancy.

When making recommendations and prescribing contraception, it is important to determine if the method can be administered when needed by the woman or coordinated with home or partner assistance. •

Consider side-effects of the contraception method.

•

Consider effects on menstruation.

•

Consider need for protection from STIs.

•

Consider costs.

•

Consider need for legal consent.

Progestin-only pills Advantages --

of loss and guilt after miscarriage, stillbirth, or unsafe abortion. For PWDs, social barriers may increase the chances of mental health difficulties in these circumstances. It is crucial to pay close attention to the mental health or psychological wellbeing

An alternative for those who have contraindications to oestrogen-containing contraception.

among others, perinatal depression and suicide, mental health and psychological consequences of GBV or HIV/AIDS, feelings

The physical and pharmacological interaction of the

Disadvantages --

Irregular bleeding.

Must be taken at the same time daily or efficacy is affected.

Some anticonvulsants decrease effectiveness (Beck, 1990).

of PWDs, their families, and other care providers.

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HIGHER HEALTH: A Training Resource Manual

The intrauterine device or IUD •

•

the Post-school Education and Training System. http://

IUDs provide excellent long-term, reversible contraception,

www.dhet.gov.za/SiteAssets/Gazettes/Approved%20

and can be a good choice for many women with disabilities. •

There are two main types of IUDs currently being used:

•

The Copper T IUD is a non-hormonal contraceptive that can remain in place for 10 years. There is some risk of increased

Strategic%20Disability%20Policy%20Framework%20 Layout220518.pdf •

disability. Discrimination against PWDs continues since

The progestin-containing IUD has the benefit of decreased

there are no consequences for failing to implement the

menstrual flow to amenorrhea after the first few months of

legislation and policies, with the result that mainstreaming

use. It may be an ideal method of contraception as well

of disability in all areas of life is lagging behind (DSD,

as menstrual regulation for women with menstrual flow

2015).

management problems. The

•

IUD

may

used

women

risk

for

thromboembolism, who have other barriers to oestrogencontaining contraception, and for those who have difficulty in remembering or administering daily contraception. Patient positioning for IUD insertion may be difficult for

•

some women with contractures or spasms, or for those women who cannot cooperate with a pelvic exam. In some

The South African Constitution (Act 108 of 1996) outlaws all forms of discrimination, including those based on

cramping and heavy menses. •

DHET. Strategic Policy Framework on Disability for

International Documents •

UN Convention on the Rights of Persons with Disabilities (UNCRPD). 2006. http://www.un.org/disability

•

UN 2015 Sustainable Development Goals. http://www. un.org/sustainabledevelopment

•

Link between the Sustainable Development Goals and the UNCRPD. https://www.globaldisabilityrightsnow.org/

instances, difficult insertions may require anaesthesia.

infographics/link-between-sustainable-developmentgoals-and-crpd

Summary

•

What you need to know about disability awareness

related domains. As the functioning and disability of an

Globally, PWDs are marginalised and excluded from full

individual occur in a context, the ICF also includes a list

participation in society. In South Africa, PWDs face multiple

of environmental factors. The ICF is the WHO framework

forms of discrimination in various social spheres, including in

for measuring health and disability at both individual and

respect of access to healthcare services, employment and education.

population levels. http://www.who.int/classifications/icf/en •

years and older were classified as disabled in 2015. A larger

Eastern Cape (6.8%) presented the highest prevalence of

•

Functioning,

Useful webpages Higher

StatsSA. 2011. “Stats in brief: August 2011.” Pretoria: StatsSA.

•

South African Legislation and Policy Documents

Videos

•

WHO, 2011.

•

Classiﬁcation

WHO. “World report on disability.” Geneva, Switzerland:

disability in the country.”

•

“International

2001.

percentage of women (5.5%) than men (4.7%) were classified as disabled. North West (7.4%), Northern Cape (7.1%) and

WHO.

Disability and Health: ICF.” Geneva, Switzerland: WHO,

StatsSA’s General Household Survey 2015 (2016) sets out relevant demographics: “5.1% of South Africans aged 5

The International Classification of Functioning, Disability and Health (ICF) is a classification of health and health-

and

Further

Education

Disability

Services

Association, https://www.hedsa.org.za Disability Info South Africa, http://disabilityinfosa.co.za

Department of Labour. 1998. Employment Equity Act (Act

Things not to say to someone who uses a wheelchair (BBC

55 of 1998) (EEA). https://www.acts.co.za/employment-

video short) https://www.youtube.com/watch?v=1RLTtk9Mc14

equity-act-1998/index.html

Things not to say to a blind person (BBC video short) https://

Department of Labour. 2003. Technical Assistance

www.youtube.com/watch?v=SarMSwv_aHI

Guidelines on the Employment of People with Disabilities.

Things not to say to a blind person (BBC video short) https://

Pretoria: Government Publishers.

www.youtube.com/watch?v=ykW4tYbRgo8

Department of Labour. 1998. Employment Equity Act (Act

Things not to say to a person with cerebral palsy (BBC video

55 of 1998) (EEA). https://www.acts.co.za/employment-

short) https://www.youtube.com/watch?v=kohcRR3VXyY

equity-act-1998/index.html

Things not to say to an autistic person (BBC video short) https://

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117

www.youtube.com/watch?v=d69tTXOvRq4 Things not to say to someone with depression (BBC video short) https://www.youtube.com/watch?v=d69tTXOvRq4 After facilitating a class or lesson on disability and inclusion (or a class where disability and inclusion was part of) as well as discrimination and stereotyping of PWDs, facilitators can show one of the videos to close the lesson or the topic. It is a fun way to close the lesson and reflect on the content that students learnt, as well as their own attitude towards the topic. Plan 10 minutes for the viewing of the short video and the debriefing of students. Ask students the following about the BBC videos: •

Were any of the statements surprising after learning more about disability?

•

Before today’s class, would you have asked similar questions (that are prejudiced)?

•

Would you refrain from asking a person with a disability certain (prejudicial) questions after today’s class?

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Chapter 7 ALCOHOL AND DRUG ABUSE PREVENTION

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120

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ALCOHOL AND DRUG ABUSE PREVENTION

LESSON ONE: OVERVIEW OF ADAP Aim To provide an overview of issues related to ADAP. Time 30 minutes Lesson Objectives •

To provide information on the rationale, goals and key definitions pertaining to alcohol and drugs. To provide information on key approaches and strategies to

•

reduce alcohol and drug use and abuse. Aim The aim of the module is to expose peers to information pertaining to alcohol and drug use and abuse that can lead to better health outcomes and ultimately influence students to reduce alcohol and drug use and abuse.

Purpose of Activities •

use and abuse. •

To empower participants with knowledge and skills to educate their peers on ADAP.

By the end of the lesson, participants will: •

To provide updated and relevant information on substance

Activity: Plenary Discussion

Have knowledge about drug terms, classification and

Objective:

the social, psychological, and physiological impact of

To ensure that participants know essential facts about ADAP.

substance use and abuse. • • •

Have information about key health issues relating to

Materials:

alcohol and drug use and abuse.

A flipchart and pens.

Be able to identify risks and dangers surrounding alcohol and drug use and abuse.

Time:

Have information on key concepts pertaining to ADAP,

45 minutes

such as addiction, overdose, craving, withdrawal and •

relapse.

Planning Notes

Understand the link between ADAP and communicable

•

diseases such as HIV, TB and STIs. •

Know the association between mental illness and ADAP.

•

Be aware of key behavioural interventions pertaining to

•

pertaining to ADAP. •

Consider ways to make the session interactive.

harm minimisation and risk reduction.

Procedure

Have reinforced existing knowledge, positive attitudes

•

and values and pro-social, healthy skills and behaviour. •

Familiarise yourself with all the necessary issues

as well as harm minimisation, and the rationale and key

Be educated on how to prevent or reduce myths and

issues pertaining to alcohol and drug use and abuse.

misinformation, negative attitudes and risky behaviours.

The module has three lessons which focus on the following •

Overview of ADAP (rationale, goals and key definitions).

•

Health issues related to ADAP.

•

Alcohol and drug abuse- The effects on mind, body and soul

•

Invite comments, questions, etc.

•

Facilitate a plenary discussion using the discussion questions provided.

Module Content targeted areas:

Facilitate a buzz session on what ADAP education is,

DISCUSSION QUESTIONS •

Discuss whether any new information was covered.

•

Discuss general attitudes and responses to individuals who use and abuse alcohol and/or drugs.

•

What would be the impact of discriminating against these individuals?

•

What do you understand by the phrase: “Alcohol is a disease”?

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Harm minimisation offers three major strategies

What is alcohol and drug education?

Demand reduction – education not to use or use less.

Supply reduction – laws, including school policies, to limit availability.

Harm reduction – use safely, use safer substances.

Understanding substance use and abuse •

A drug is any substance, other than food, which is taken to change the way your body or mind functions.

•

Alcohol and tobacco are the most commonly abused drugs.

•

Drugs can be legal, or illegal.

•

They can be helpful, or harmful.

•

Drugs may come from doctors or pharmacies.

•

Some drugs can only be obtained with a written prescription from a doctor.

•

your garden. (For example, digitalis, a powerful drug

Alcohol and drug education is defined as: “educational

given to persons who have heart disease, comes from the

programmes, policies, guidelines and procedures that contribute to the achievement of broader public health goals of preventing and reducing alcohol and drug use and substance related harm to individuals and society” (Ballard and Robertson, 1999).

foxglove, a common garden flower.) •

A drug is called harmful if it is used incorrectly (abused) to the extent that it interferes with your normal life.

•

You develop drug tolerance when your body becomes used to the drug you are taking to the point that you must

Among young adults, there is a definite predisposition to risk

take more of the drug to get the effect from it that you

related to the following characteristics:

want.

•

Young, feeling of being invincible.

•

Prone to experimentation.

•

No longer considered to be minors – legal access.

•

The desire to have fun, be free, take risks, and shed

•

Legal drugs that are often abused are nicotine, caffeine, and alcohol.

inhibitions is high. •

Some drugs can be obtained from plants that grow in

Post-school institutions are high-stress environments.

Why do people use alcohol and drugs? A person may begin to use substances such as alcohol or drugs because of the intense and very appealing feelings they produce. These feelings, such as wellbeing, elation, happiness,

Goals of Alcohol and drug education

ecstasy, excitement, and joy, can help some individuals

•

Reduce the level of use.

overcome the negative circumstances they experience. They

•

Delay the uptake of alcohol and particular drugs.

can also give them courage and confidence to do things that

•

Reduce the harmful use of alcohol and drugs.

normally create anxiety, or enhance their performance, e.g.,

•

Minimise the harm associated with the use of alcohol and

in sport.

drugs. For others, alcohol and drug use may form a significant part of What does harm minimisation mean? Harm

minimisation

has

the

important

their social lives and, therefore, they may use in order to fit in role

keeping

and be accepted. In some cases, it may not be a choice. For

communication about substance use open to those who may be

example, a young and disempowered partner may be forced

currently using. The goal of minimising harm respects human

to use. Others may get involved because they deal or sell on

rights, equity and discrimination issues that influence acceptance

behalf of dealers to earn money, and still others may have been

of people living with AIDS and the treatment of drug users.

lured in to “try it for fun” and then developed a dependency.

Harm minimisation accepts that, despite our best efforts, some will choose to use alcohol and drugs, even some illicit drugs. It does not mean that alcohol or drug use is encouraged or promoted. 122

What is alcohol? Alcohol is a drug. It is classified as a depressant, meaning that it slows down vital functions, resulting in slurred speech, unsteady movement, disturbed perceptions, and an inability HIGHER HEALTH: A Training Resource Manual

to react quickly. It is a drug that reduces a person’s ability to

order to get to a previous level of intoxication. Alcoholism

think rationally and distorts their judgment. It can also trigger

is a progression, a long road of deterioration during

depressive episodes in individuals experiencing some type of life

which the cumulative impact gets progressively worse.

challenge or problem (breakup of a relationship, divorce, death of a loved one, unemployment, etc.) The amount of alcohol one drinks determines the type of effect. Most people drink for the relaxation effect, such as a beer or glass of wine taken to “loosen up”. But if a person consumes more than the body can handle, they then experience alcohol’s depressant effect, and start to lose coordination and control. Alcohol is absorbed into the bloodstream through small blood vessels in the walls of the stomach and small intestine. Within minutes of drinking alcohol, it travels from the stomach to the brain, where it quickly produces its effects, slowing the action of nerve cells. Approximately 20% of alcohol is absorbed through the stomach. Most of the remaining 80% is absorbed through the small intestine. Alcohol is also carried by the bloodstream to the liver, which eliminates the alcohol from the blood through the process of metabolism, where it is converted to a nontoxic substance. The liver can only metabolise a certain amount of alcohol at a time, leaving the excess circulating throughout the body. Thus the intensity of the effect on the body is directly related to the amount consumed. When the amount of alcohol in the blood

How does alcohol affect the body? Binge drinking and continued alcohol use in large amounts are associated with many health problems, including: •

Unintentional injuries such as car crashes, falls, burns, drowning, and firearm injuries.

•

Sexual assault and domestic violence

•

Increased on-the-job injuries and loss of productivity.

•

Increased family problems, and broken relationships.

•

Alcohol poisoning,

•

Increased risk for HIV, as well as HIV transmission to others.

•

High blood pressure, stroke, and other heart-related diseases.

•

Liver disease.

•

Nerve damage,

•

Sexual problems.

•

Permanent damage to the brain.

•

Vitamin B1 deficiency, which can lead to a disorder characterised by amnesia, apathy, and disorientation.

•

Ulcers.

•

Gastritis (inflammation of stomach walls).

•

Cancer of the mouth and throat.

exceeds a certain level, the respiratory (breathing) system slows down markedly, and can cause a coma or death because oxygen no longer reaches the brain. Binge drinking is the practice of consuming large quantities of alcohol in a single session, usually defined as five or more drinks at one time for a man, or four or more drinks at one time for a woman. Binge drinking is a common practice by youth under the age of 21. Alcohol

dependence

(alcoholism)

consists

four

symptoms: • •

Craving: a strong need, or compulsion, to drink. Loss of control: the inability to limit one’s drinking on any given occasion.

•

Physical dependence: withdrawal symptoms, such as nausea, sweating, shakiness and anxiety occur when alcohol use is stopped after a period of heavy drinking. Serious dependence can lead to life-threatening withdrawal symptoms, including convulsions, starting eight to twelve hours after the last drink. The delirium tremens (DTs) begins three to four days later, where the person becomes extremely agitated, shakes, hallucinates and loses touch with reality.

•

Tolerance: the need to drink greater amounts of alcohol in

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123

Alcohol and drugs in SA STIMULANTS/UPPERS Stimulants, such as cocaine, speed up the central nervous system. People using stimulants may feel happy and excited and have more energy, better concentration or motivation. However, once the drug is out of the system, it creates restlessness and a sense of agitation and irritation. Stimulants make it difficult to sleep. Users feel the urge to take it again to settle the restlessness and to “feel good” again. Repeated use leads to addiction and overdose, which can cause heart attacks, exhaustion, seizures, and severe disorientation. DEPRESSANTS/DOWNERS Depressants are drugs like opiates (e.g., heroin) and sedatives (e.g., Valium and alcohol) which slow down the central nervous system. People using depressants may feel happy and content, as well as sleepy and relaxed. Depressants often slow down bodily functions, such as breathing and heart rate and may make it hard to speak (slurred speech) or move properly in large enough doses, in which case they may be harmful. A person who overdoses on a depressant will experience breathing that can become life-threateningly slow or stop altogether, leading to heart failure. HALLUCINOGENS Hallucinogens change the way people see, hear, feel or think. There are three main groups of hallucinogens: psychedelics, dissociatives and deliriants. Each group has different effects. They may cause hallucinations, when a person imagines something that is not really

ILLEGAL

there. Drug/Substance

Type

Street names

Method of use

Cannabis

Downer, Relaxant, Depressant

Marijuana, Dagga, Weed, Zol, Ganja, Spliu

Smoke, eat

Heroin

Opiate, Downer, Relaxant, Depressant

Gear, Smack, H, Horse, Brown

Inject, smoke

Cannabis and heroin and/or other substance mixtures

Downer, Relaxant

Nyaope, Whoonga

Usually smoked

Methaqualone (Mandrax)

Downer, Barbiturate

Buttons, White pipe

Smoke, ingest, inject

Cocaine or Crack cocaine

Upper, Stimulant, Amphetamine

Coke, Charlie

Snort, inject

E, Pills

Tablet (ingest), snort, inject

Ecstasy / MDMA Methamphetamine

Crystal Meth, Crystal, Tik, Ice Ingest, inject, smoke, snort

Methcathinone

Cat, Khat

Smoke, ingest, snort

Acid

Ingest

Mushrooms

Magic Mushrooms, Shrooms

Ingest

Ketamine

K, Special K

Snort, ingest

LEGAL

LSD

124

Psychotropic, Hallucinogen

Caffeine

Upper, Stimulant

Coffee, tea, energy drinks

Nicotine

Relaxant

Cigarettes, nicotine patches, e-cigarette, pens, vape

Alcohol

Downer, Relaxant

Booze, Drink, Dop, Liquor

HIGHER HEALTH: A Training Resource Manual

Alcohol & Drug Use Q&A Guide Q1: What are alcohol and drug dependence? Answer: Alcohol and drug dependence is a complex and often chronic brain disease. It occurs when the use of a substance dominates a person’s life and becomes a compulsive behaviour that is hard to control. When a person who uses substances is experiencing dependence, they have extreme difficulty in resisting the urge to use despite the negative consequences and harmful effects. Q2: What are cravings? Answer: Cravings are strong memories that are linked to the effect of alcohol or drugs on the brain and can cause strong physiological effects. Q3: Why do some PWID share needles? Answer: According to recent South African research, injecting alone or in pairs is more common than group injecting. For those PWID who do share needles and syringes or use non-sterile equipment, their reasons for sharing vary. In most cases, poverty is cited by PWID as a key reason for sharing needles and syringes. Q4: What is an overdose? Answer: People who use drugs (PWUD) are also vulnerable to overdose, which occurs when they take too much of a drug in a single episode of injecting or using. This can happen if a PWUD increases the quantity of the drug they are using, but also if they use the same quantity of a stronger drug. Q5: What are the consequences of overdosing? Answer: Overdosing can have significant consequences, including death. For PWUD, accessing care to manage an overdose can be challenging because of fear of being arrested or otherwise becoming involved in the criminal justice system after disclosing their drug use to a healthcare worker. There is also very little information available for PWUD on what to do if an overdose occurs, and often the healthcare system is not capacitated to manage such a situation. Q6: What are the signs of an overdose? Answer: One of the clearest signs that someone is overdosing is that their face or lips will turn blue. They may also look very pale; be very limp; be able to breathe and look at you, but not be able to talk; be breathing, but very slowly and shallowly; or stop breathing altogether. They may have a slow pulse (heartbeat) or no pulse at all; foam at the mouth; vomit; shake or have a seizure; complain of chest pain, pressure, tightness, or shortness of breath; or suddenly collapse and become unconscious. You have about four minutes from the time your lips turn blue to coma. If a person stops breathing, it can take only a few minutes for them to die. Just waiting for them to “get over it” is the worst thing you can do if someone is overdosing. Immediate action must be taken to help them survive. Q7: What is withdrawal? Answer: Withdrawal occurs when an alcoholic or PWUD suddenly stops using the substance upon which he or she has become dependent. This usually results in a number of physical and mental withdrawal symptoms, including abdominal cramps, muscle spasms, vomiting, chills, high fever, restlessness, irritability or depression. PWUD commonly call withdrawal “getting sick”. The symptoms of withdrawal are very intense, leading users to do whatever is needed to remove these symptoms. Shaking and tremors are common during severe withdrawal. Q8: What is a relapse? Answer: A relapse occurs when a PWUD or alcoholic begins using again after having successfully stopped using for a period of time. Relapse is common and is a normal part of recovery. Alcohol and drug use is highly addictive, and it can often take a number of attempts before a user can stop.

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125

to present on the various topics allocated on the previous

LESSON TWO: HEALTH ISSUES RELATED TO ADAP

•

Invite comments, questions etc.

Aim

•

Facilitate a plenary discussion using the discussion

day (five minutes to present).

To provide an overview of alcohol and drug abuse prevention

questions provided.

(ADAP) issues and show their link to health. Time

DISCUSSION QUESTIONS

30 minutes Lesson Objectives •

To provide information on various health conditions and demonstrate the impact of substance use/abuse.

•

To highlight risks and responsibilities relating to alcohol and drug use/abuse.

• •

Discuss whether any new information was covered.

•

Ask how participants felt about what they learnt in the session. Discuss the issue of ADAP and behaviour change.

•

To provide comprehensive information on substance use

KEY MESSAGES

and abuse and their impact on health.

Alcohol and drug use and abuse can:

•

Impact on existing health conditions.

•

Create new health conditions.

•

Be aggravated by health conditions.

Young people are at high risk:

•

Due to peer pressure.

•

In high-stress environments where there is pressure to

To empower participants with the required knowledge to enable them to educate their peers on ADAP.

Purpose of Activities •

To provide opportunities for participants to do self-study.

•

To give participants a chance to demonstrate their understanding of the link between alcohol and drug use and health. Activity One: Self-study Objectives: To ensure that participants know essential facts about ADAP. To assess the ability of participants to transfer knowledge clearly and accurately. Requirements:

achieve or perform. 3.

There is a high correlation between risk for transmission of HIV and other STIs and alcohol and drug use/abuse.

Behaviour change is difficult and cannot happen overnight. There are various stages in the model for behaviour change.

The health issues related to ADAP Tuberculosis

A flipchart and pens

The use/abuse of injected drugs is associated with increased

Time:

drug users/abusers are likely due to other risk factors for TB

rates of TB infection. Increased TB disease rates among

60 minutes

disease, such as being in prison, homelessness, and poverty.

Planning Notes

(PWID) living with HIV.

•

Familiarise yourself with all the necessary issues pertaining to ADAP.

•

Allocate topics to groups to prepare: --

Group 1: Relationship between mental illness and drug use.

Group 2: Risks and responsibilities regarding injecting drug use.

Group 3: Other common infections related to alcohol and drug use including HIV and Hepatitis C.

Procedure • 126

•

Allow groups to prepare for fifteen minutes and invite groups

TB is a leading cause of death among people who inject drugs

Mental Illness & Drug Use Not all people who use/abuse drugs and alcohol are mentally ill, although mental illness does have a strong association with alcohol and drug use/abuse. In some cases, mental illness may already be present before an individual becomes a user/abuser. In this situation, mental illness may be one of the factors that lead individuals to drug use as a method of coping. In other cases, mental illness may result from drug use/abuse since some drugs manipulate the brain. Also, for some, alcohol or drug use stressors, such as homelessness or unemployment, can lead to mental illness. HIGHER HEALTH: A Training Resource Manual

Depression and Anxiety Depression can prevent substance users/abusers from taking their medication as the doctor instructed them to (e.g., missing doses, taking too few or too many), or even prevent them from going to a healthcare facility. Anxiety can lead to unwillingness to interact with others, which may include healthcare service providers. Also, a user/abuser may show signs of a behavioural disorder, act out in a clinic setting, and become challenging to treat. Individuals who are experiencing a mental illness may, therefore, be more difficult to treat for HIV and other issues. Anxiety is a normal emotion in everyday life and is closely related to fear. Anxiety can become a mental illness when it is prolonged, feels never-ending, or when the anxiety becomes out of control and affects an individual’s daily functioning. Signs and symptoms of anxiety may include excessive worry, fear, feelings of uneasiness, tightness in the chest, difficulty breathing, heart palpitations, dizziness, light-headedness, nausea, diarrhoea, and excessive sweating. At the extreme, anxiety can often lead to panic (or a panic attack) where a person experiences intense stress and a sense of not being in control. A special type of anxiety disorder that may be related to alcohol and drug use is social anxiety disorder. When someone suffers from social anxiety, they experience intense fear, panic or stress while engaging in everyday social situations. It can create feelings of humiliation, embarrassment and judgement. Social anxiety may include symptoms such as sweating, blushing, trembling, nausea, and stammering. An individual who is experiencing social anxiety may be more likely to use drugs or alcohol to help them cope, and less likely to seek healthcare services because of fear of being judged by healthcare staff. Anxiety can also be caused by drug use/abuse, particularly the use/abuse of stimulants such as cocaine. What about the use of non-sterile injecting equipment? Non-sterile injecting equipment refers to the re-use of previously used injecting equipment to inject a drug. The association between using non-sterile injecting equipment or sharing needles and HIV infection is a strong one. There are a few methods for sharing injection drugs and equipment, all of which can lead to contamination of the injection equipment by HIV and other infections. What are the side-effects of injecting drug use? Because the drugs go directly into the bloodstream when injected, the effects are more intense and addictive – and so are the risks for overdosing. There are also many social, physical and mental consequences of using injection drugs. For example, injecting HIGHER HEALTH: A Training Resource Manual

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drug use is much more addictive than other forms of drug use,

PHLEBITIS

creating physical dependence, and often leading to more severe

Phlebitis results in the development of track marks along the

withdrawal symptoms than when non-injection users stop taking

veins where the drug is injected. Track marks are actually

the drug.

damaged or infected veins that can lead to the formation of blood clots.

In addition to the high risk for overdosing, injecting drug use can result in damage to the arteries and scarring of the veins.

HIV, Hepatitis C and other infections

Bacteria can also cause infections at injection sites. A common

PWID can easily get bacterial infections that travel through the

effect is skin irritation or itching that is relieved by scratching.

blood because they may use unsterilised injection equipment

Some injectable drugs, such as heroin, make you throw up.

or share needles when they inject drugs. In these situations,

Users sometimes judge the strength of the dose by the force of

they may become infected if they use a needle, syringe, or

their nausea or urge to throw up.

other equipment that is contaminated with bacteria, viruses and/or other foreign material.

DEPRESSANT DRUGS, like opiates (e.g., heroin) and sedatives (e.g. Valium and alcohol), slow down the body’s functions. A

These infections can lead to a variety of illnesses and can cause

person who

death of drug users, their sexual partners, and their children

overdoses on a depressant will experience breathing that can

through mother-to-child transmission. Drug use can increase

become life-threateningly slow or stop altogether, leading to

sexual risk because it can affect judgment and decision-

heart failure.

making as well as lower inhibitions during sexual activity. For example, cocaine use can sustain an enhanced period of

STIMULANT DRUGS, such as cocaine and speed, can cause a

sexual activity but also dries out the mucous membranes, and

person who has overdosed to have a heart attack or experience

the long duration of sex might cause bleeding due to bruising

cardiac arrest, collapse from exhaustion, have a seizure, or

and small cuts.

become so disoriented that they accidentally hurt themselves.

Discrimination and stigma surrounding alcohol and drug

Other common infections

use/abuse have been reported as barriers to accessing HIV

PWID may also experience the following common infections.

testing services (HTS) and other medical services in South Africa, which adds to the overall vulnerability of people who

ABSCESSES AND ULCERS

use alcohol and drugs. Fear often prevents these individuals

PWID may be affected by abscesses or ulcers around the

from seeking help, not only because of the legal aspects,

areas of their bodies where they inject, usually the arms or legs.

but also because of a lack of easy access to treatment and

Abscesses may be difficult to heal. Ulcers are generally not deep

medication.

and can heal with good wound care and antibiotics. SEPTICAEMIA Septicaemia is a life-threatening infection of the blood resulting from the presence of certain bacteria. Symptoms of septicaemia include high fever, shivers, headache, and possibly convulsions.

Women who inject drugs: Risks and vulnerabilities Studies from around the world show that: •

50% higher than among men who inject. •

foreign matter that may enter the bloodstream of injecting drug

equipment from their male partners. •

CELLULITIS Cellulitis is a common bacterial skin infection that can affect

Women are more likely to be injected by their male partner and being injected by another person or being helped to

users through injection. Endocarditis symptoms include irregular heartbeats and chest pain.

Many women begin injecting drugs in the context of sexual relationships, and they often borrow or share injecting

ENDOCARDITIS Endocarditis is an inflammation of the heart due to infection from

The average HIV prevalence among women who inject is

inject is a predictor of HIV infection. •

Women are more likely to be the last person to use shared injecting equipment.

•

Women who inject drugs are often dependent on their sexual partners to obtain drugs, which compromises their

PWID. Cellulitis shows up as an inflammation of the skin.

ability to negotiate safer sex or safe injecting practices. •

Women who inject drugs have lower access to services than men who inject drugs.

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Lesson Objectives

Sexually transmitted infections

•

There is a lot of education and information about the importance

To educate through participative peer-led action learning, as well as to develop skills amongst peer educators

of protecting against HIV and human papillomavirus

•

(HPV) infection (the world’s most common STI). But it is

To provide an opportunity for participants to express personal opinions about alcohol and drug use/abuse.

also important to do a better job of preventing and treating

•

diseases like gonorrhoea, chlamydia and syphilis. These are all STIs. There are more than 200,000 stillbirths and babies

To empower participants to consider ways of avoiding risk

Activity One: Getting the “dope” on alcohol and drugs

dying in the womb every year, as well as deaths of over 90

Objectives:

000 newborns because of not treating syphilis.

To expose participants to information on how the use of alcohol and drugs can cause physical, psychological, legal

STIs are common among people who use drugs and alcohol,

and financial harm.

especially infections such as herpes simplex virus type 2 (HSV-2, HPV, gonorrhoea, chlamydia, and syphilis. Large

Requirements:

numbers of sexual partners and frequent unprotected sex are

Fact sheets: handouts

common among this group, which increases their risk for STIs. Untreated STIs also increase the HIV risk and contributes to

Time:

their transmission within communities.

45 minutes Planning Notes Study the drug facts sheets. Procedure Facilitate a plennery discussion using the discussion questions provided.

DISCUSSION QUESTIONS •

What did you learn about risks and dangers?

•

What did you learn about health?

•

How did the activity impact on you?

•

Did the information have the power to influence choices that the people make?

LESSON THREE: ALCOHOL AND DRUG ABUSE - THE EFFECTS ON MIND, BODY AND SOUL Aim

KEY MESSAGES 1.

or mentally requires the drug to function normally 2.

can be done to help. Time 45 minutes

Drug dependence is a chronic relapsing mental illness, not simply a behaviour that can be changed through

To provide participants with information regarding the social, mental and psychological impact of alcholo and drugs and what

Drug dependence occurs when a person physically and/

councilling alone. 3.

When an individual is dependent on a drug and the drug is stopped abruptly, they may experience withdrawl symptoms

Drug dependence can also be identified when an indivdual experiences disturbance in their psychological functioning such as difficulty in concentrating, anxiety, depression, irritability, insomnia, headaches and muscle cramps.

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RESOURES FOR ACTIVITY ONE Common signs and symptoms of alcohol and/or drug abuse Physical symptoms and signs

Behavioural symptoms and signs

Psychological symptoms and signs

• Red eyes or dilated or pinpoint pupils

• Drop in attendance and lack of interest

• Unexplained change in personality,

• Changes in appetite

in work or school

• Changes in sleep patterns

attitude and behaviour

• Unexplained need for money that leads

• Sudden weight loss or gain

• Mood swings, irritability, angry

to borrowing and stealing

• Deterioration of physical appearance • Skin manifestations such as abscesses or ulcers

outbursts or unexplained excitement

• Engaging in secretive or suspicious

• Periods of unusual hyperactivity,

behaviour

agitation or giddiness

• Sudden changes in friends, favourite

• Needle marks or puncture wounds on skin from injecting

• Lack of motivation and ambition

hang outs, and hobbies

• Appears lethargic or spaced out

• Frequently getting into trouble (fights,

• Appears fearful, anxious or paranoid

accidents, illegal activities)

with no reason

• Possession of drug gear or paraphernalia Behavioural risk for alcohol and/or drug abuse

130

Individual Risks

Societal Risks

Environmental Risks

Structural Risks

• • • • • • • • • •

• • • • • • •

• • • • • •

• Lack of access to justice / police support • Lack of access to health care • Difficult to get employment • Illegality of behaviours • Punitive legislation • Lack of access to commodities: lubricant; clean injecting equipment

Unprotected sex Substance use Substance use while having sex Sharing injecting needles Multiple partners Low self-esteem Disinhibition Depression Internal stigma Lack of information

Stigma Discrimination Prejudice Social Norms Family expectations Homophobia Heteronormativity • Penile-vaginal normativity • Cultural/ Religious beliefs

Dangerous places Invisibility Badly lit High levels of crime Having to hide Having to buy drugs from dangerous place/ person • Having to sell sex in dangerous place • High level of violence • Unhygienic conditions

HIGHER HEALTH: A Training Resource Manual

Are you in the red?

commitment to change.

Zone Check: Substance Abuse

Yes

Are you concerned about your use of drugs and alcohol at times?

Stage #3: Preparation

Have you tried to stop using or cut down the amount of substances you use on your own but you have not been successful?

behaviour. They weigh options and select techniques for

Are your family members and loved ones concerned about your use of alcohol and drugs ?

confidence and commitment to change; and having the intention

At this stage, people accept responsibility to change their behavioural change. Characteristics of this stage include: developing a plan to make the needed changes; building to change within one month. We might describe this person as willing to change and anticipating

Do you have legal, financial and relationship issues which are directly and indirectly related to your usage of alcohol and drugs?

of the benefits of

change. Stage #4: Action

Are you unable to function normally without taking alcohol or drugs or feel extremely down when you don’t take them?

At this stage, people begin behavioural change efforts. Although

Has your usage of drugs and alcohol affected your work performance negatively?

of this stage include: consciously choosing new behaviour;

these change efforts are self-directed, outside help may be sought. This might include rehab or therapy. Characteristics learning to overcome tendencies toward unwanted behaviour;

If any of your answers place you in a red square, you in the RED ZONE. This might mean you are at risk for substance abuse and addiction. Ask your HIGHER HEALTH Campus Coordinator for help with counselling, care and support as soon as possible.

and engaging in change actions for less than six months. We

Behavioural and psychological interventions for ADAP

People in the maintenance stage have mastered the ability to

might describe this person as embracing change and gaining momentum. Stage #5: Maintenance sustain new behaviour with minimal effort. They have established

Motivation for change: the stages of change model

new behavioural patterns and self-control. Characteristics of this

In Changing for Good (1994), Prochaska and DiClemente

stage include: remaining alert to high-risk situations; maintaining

describe the six stages of change: Stage

#1:

Pre-contemplation

a focus on relapse prevention; and behavioural change that has been sustained for six months. We might describe this person

(before

the

impact

understood) People at this stage may not see the consequences of addiction as important enough compared to the benefits. As a result, at this stage, they demonstrate a lack of interest in wanting or needing to change, and having no plan or intention to change.

as persevering and consolidating their change efforts. They are integrating change into the way they live their life. Stage #6: Termination At the termination stage, people have adopted a new self-image consistent with desired behaviour and lifestyle. They do not

We might describe this person as unaware.

react to temptation in any situation. Characteristics of this stage

Stage #2: Contemplation (thinking about the impact)

a healthier and happier life. The relapse prevention plan has

People in the contemplation stage are starting to see or realise the impact of substance use on their actions or behaviour. However, they are still conflicted about whether it is necessary or worthwhile to change. The individual in this stage is thinking about and wanting to change, but not sure if they can change or will be able to commit to change. They lack the confidence and commitment to change behaviour, but have the intention to change at some point. We might describe this person as aware and open to change.

include confidence; enjoying self-control; and appreciation of evolved into the pursuit of a meaningful and healthy lifestyle. As such, relapse into the former way of life becomes almost unthinkable. Note: Relapse to a prior stage can occur anywhere during this process. For example, someone in the action stage may move back to the contemplation or pre-contemplation stage (Horvath, A. et al., http://www.amhc.org/1408-addictions/article/48541types-of-evidenced-based- effective-treatments-for-addiction).

Between stage 2 and 3: A decision is made. People realise that the negative consequences of their behaviour outweigh the positives. They choose to change their behaviour. They make a HIGHER HEALTH: A Training Resource Manual

131

Promoting HIV/TB/STI Testing and Screening Treatment •

Each engagement with people who use drugs and alcohol

cookers, spoons or filters with other drug users, or use

offers an opportunity to educate and increase their

new injecting equipment every time. If you use new

awareness of HIV risks and the prevention tools available

injection equipment every time, you cannot catch viral

to them. Peer educators should take this opportunity to provide facts and support to these individuals. •

Peer educators should educate by dispelling common

infections such as HIV through needle sharing. 4.

injection equipment every time, you cannot catch viral

example, it is a common misconception that HIV-positive

infections such as HIV, unless someone else has used

individuals do not face any risk if they are re-exposed as HIV reinfection and, unfortunately, it can significantly reduce future treatment options as well as increase a client’s viral load. •

People who use drugs and alcohol should be aware and educated about the dangers of infecting other people in their community.

•

If an individual is HIV-positive, they risk infecting their sexual partners and anyone with whom they may be

If you need to re-use any equipment, use your own injecting equipment every time. If you re-use your own

misconceptions or myths associated with HIV. For

to HIV after they have become infected. This is known

If you cannot stop injecting drugs, do not share needles,

your equipment without your knowledge. 5.

If you need to re-use any equipment and you believe you need to use someone else’s equipment, then clean needles by an approved method. There is some risk for HIV transmission after needle cleaning, but cleaning in an approved manner will reduce the likelihood of transmission.

What peer educators can do

sharing injection equipment. Harm Reduction Strategies Help reduce risks that individuals may face when using

•

drugs or alcohol, and not necessarily promote abstinence from using. •

Aim to make it safer for those who continue to use alcohol and drugs to reduce the risk of becoming infected with or transmitting HIV.

•

Can be effective methods for reducing the spread of HIV among PWID.

•

Not only support PWID in improving their health, but also provide services that can support the broader community.

•

Support the development of trusting relationships between users and peer educators as these interventions are nonstigmatising.

•

Take a neutral stance on drug use. In this way, healthcare workers are able to actively address the health risks that people who use drugs and alcohol face, particularly HIV infection, and support them in accessing care without stigmatising or isolating them. Hierarchy for injecting drug use Understanding the following levels of risk can be a useful tool when supporting PWID in reducing their risk: 1.

You will not get infections from sharing needles if you stop or never start injecting drugs.

If you cannot stop using drugs, use them in any way except injecting. If you do not inject drugs, you cannot catch infections through needle sharing.

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Principles of good practice in ADAP Education ADAP Education must involve trained facilitator / Peer Educator •

Peer educators must have specific knowledge of the students and the learning context.

•

Peer educators are best placed to identify and respond to the needs of students and to coordinate drug education with other activities.

•

Selected external resources are recommended for use where appropriate. ADAP programmes should have sequence, progression and continuity Health messages must be regular, timely and come from a credible source.

Education messages should be consistent and coherent, and based on student needs Programmes must be linked to the overall goal of prevention and harm reduction through behaviour change. •

They must be in line with broader policies and practices that reinforce programme objectives to maximise the potential for

•

They must provide information about the harmful long-term effects of drug use as well as demonstrate an understanding of the

success. perceived benefits for users in order to demonstrate empathy and understanding of the challenges for users. Effective ADAP education programmes •

Include a balance of knowledge, attitudes and skills.

•

Are participant-centred.

•

Contribute to long-term positive outcomes in the health curriculum.

•

Should reflect an understanding of characteristics of the individual, the social context, the drug, and the interrelationship of these factors.

• •

Involve students at both the planning and implementation stages. Respond to developmental, gender, cultural, language, socio-economic and lifestyle differences relevant to the levels of student drug use.

•

Address the motivations for drug use derived from influences such as culture and gender.

•

Involve a collaborative approach to reinforce desired behaviours.

•

Provide a supportive environment for programmes.

The emphasis of education should be on substance use likely to occur in the target group and use that causes the most harm to the individual and society. Tips for Risk Reduction Counselling •

Do what is possible first: Emphasis on short-term pragmatic goals (for example, preventing HIV transmission in a specific circumstance) over long-term idealistic goals (for example, overall reduction in harm/risk from drug use).

•

Small changes are easier than big changes. Establishment of a scale of means to achieving specific goals, for example, a hierarchy of risks.

•

Say the same thing many times in many ways. Use multiple strategies to achieve goals.

•

Give clients the tools they need and provision of the means to accomplish risk reduction, for example, condoms and sterile needles and syringes.

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Knowledge, attitudes, values and skills for peer educators involved in ADAP programs Knowledge General: knowledge about alcohol and drugs (composition, legality, effects) Social, emotional, physical and financial impact Current issues, policies, protocols and laws Current trends in use and abuse (local and global)

Attitudes

Values analysis and clarification skills

Skills Empathy Active Listening Giving and receiving feedback

Warmth, empathy, genuineness

Skills for identifying important influences on values and attitudes, and aligning values, attitudes and behaviour

Respect

Non-judgmental

Conviction regarding the legitimacy of the issues

Non-discriminatory

Care and compassion

Unconditional acceptance

Available resources Knowledge of addiction

Coping skills Self-control skills Coping with (peer) pressure

Decision-making skills Time management skills Assertion and refusal skills

Dealing with emotions: grief, anxiety

Belief in the potential to change

Critical and creative thinking skills

Dealing with difficult situations: conflict, loss, abuse trauma

Understanding of social disadvantage

Problem-solving skills

Help-seeking skills

No stereotyping

Skills for assessing risks Skills for informationgathering and generating alternatives Group management skills Facilitation skills

References •

Brown, B., Duby, Z., and Van Dyk, D. “Health Care Provision for Men who have Sex with Men, Sex Workers, and People who use Drugs: An Introductory Manual for Health Care Workers in South Africa.” The Desmond Tutu HIV Foundation 2013. Adapted from Poteat, T. Revised May 2012.

•

Ballard, R. and Robertson, T. “Review of Drug Education in Schools, Education Queensland, Brisbane,” 1999, Drug info sheets: http://www.drugfreeworld.org/drugfacts

•

Harm Reduction Coalition. “Getting off right: A safety manual for injection drug users,” New York, http://harmreduction.org/drugsand-drug-users/drugtools/getting-off-right

•

Anderson, L. “The acute effects of cannabis intoxication National Drug Strategy,” Monograph Series No. 25. US Drug Enforcement Administration Cannabis Information. The Substance Abuse and Mental Health Services Administration. National Institute on Drug Abuse.

•

International HIV/AIDS Alliance, “HIV and drug use: Community responses to injecting drug use and HIV – Good Practice Guide,” 2010.

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Chapter 8 HEALTH AND HUMAN RIGHTS

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CHAPTER 8: HEALTH AND HUMAN RIGHTS The relationship between health and rights Sexual and reproductive rights exist when all people have control over and can decide freely and responsibly on matters related to their sexuality, including their sexual and reproductive health (SRH), free of coercion, discrimination and violence. These rights are embedded in the South African Constitution and in South Africa’s commitment to implement international human rights treaties. Sexual health requires a positive and respectful approach to a person’s sexuality and sexual relationships. To be sexually healthy, people need to be able to have pleasurable and safe sexual experiences, free of coercion, discrimination and violence. They need to have access to sexual health information and services. For people to have and keep their sexual health, their sexual rights must be respected, protected and fulfilled. Reproductive health requires that a person can reproduce and has the freedom to decide if, when and how often to do so. This implies that all people have the right to be informed about reproduction. They have the right to access contraception that is safe, effective, affordable, acceptable, and of their choosing, and to safe termination of pregnancy (TOP). All people have the right to healthcare services that will enable women to go safely through pregnancy and childbirth and will give couples the best chance of having a healthy baby. South African law protects people’s sexual and reproductive health and rights (SRHR).

South Africa’s Constitution refers to sexual and reproductive rights in three places •

The equality clause (s.9.3), which forbids discrimination on the grounds of sex, gender and sexual orientation;

•

Section 27. 1. A, which states that “Everyone has the right to have access to health care services, including reproductive health care”; and

•

Section 12 dealing with “freedom and security of the person”.

These rights in relation to SRH include the rights to access information (frequently manifest in health professionals’ obtaining informed consent for medical procedures following adequate counselling), education, dignity, and for our bodily integrity to be respected. Everyone in South Africa has the right to choose to engage in pleasurable, safer sexual experiences free from violence, and to choose whether they would like to reproduce and, if so, the number of offspring they would like to have.

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137

The Constitution also guarantees the rights to healthcare

Sexual harassment is any kind of sexual behaviour that makes

services, including sexual and reproductive healthcare for

you feel uncomfortable, including:

everyone. These fundamental, constitutional rights are reflected

•

Touching,

in South Africa’s many SRHR laws, policies and guidelines,

•

Jokes and innuendos of a sexual nature,

which are described below.

•

Persistent probing about personal and intimate information related to one’s sex life,

International law also supports a human rights approach

•

Rude and inappropriate comments or gestures,

to sexuality and reproduction

•

Unwelcome advances of a sexual nature, and

A human rights approach to sexuality and reproduction is

•

Leering or staring at your body in an offensive way.

also reflected in the international treaties that South Africa has signed and ratified, including the UN Convention on

Sexual harassment can happen anywhere, but is often happens

the Rights of the Child (UNCRC, 1989), Convention of the

in the workplace. In South Africa, the Labour Relations Act

Elimination of all Forms of Discrimination Against Women

(LRA) is the main act that deals with sexual harassment in the

(CEDAW, 1979), and Convention on the Rights of Persons

workplace. It has a Code of Good Practice on Sexual Harassment

with Disabilities (UNCRPD, 2006), as well as international

that sets out the best ways to deal with complaints about sexual

consensus agreements, including the Programme of Action of

harassment.

the International Conference on Population. Labour Rights

Guiding Principles

According to the LRA, sexual harassment is an unfair labour

•

Strong and visible ownership

•

Integrated services at the district level

•

A human rights approach

•

Meeting diverse needs

•

Care for the caregivers

•

Intersectoral collaboration

practice and, if it happens to you, you can ask your employer to deal with it. You have the right to:

Barriers to achieving SRHR in South Africa •

Poverty

•

Violence: defining violence and its impact

•

Stigma and discrimination

•

Service delivery in the public sector

•

To report sexual harassment without fear of victimisation Have your complaint treated seriously and confidentially

What to do if you are Sexually Harassed? You can deal with sexual harassment in an informal or formal way.

requests for sexual favours, and other verbal or physical conduct of a sexual nature”. This may happen in the following contexts: In exchange for an individual’s employment, education,

Informal Ways of taking informal action include: •

The acceptance or refusal of such advances is used as a factor in decisions affecting an individual’s employment, creates

environment

intimidating,

for

the

hostile

individual.

studentsexualmisconductpolicy.umich.edu)

Requesting assistance from a third party that you trust (friend or colleague) to accompany you when you talk to the perpetrator.

•

Writing to the person about the behaviour and specifying the actions or words that cause discomfort and requesting that

education, living environment, etc. behaviour

Talking to the person to address the behaviour and actions that make you feel uncomfortable.

•

living environment, or participation in a community.

offensive

Be treated equally, and not to be discriminated against

•

Lack of information for planning, monitoring and decision-

The

•

(ill-treatment).

Sexual harassment is defined as “unwelcome sexual advances,

•

Be treated with dignity and respect at work.

•

Sexual Harassment

•

A workplace that is free from sexual harassment.

•

because of race, gender or HIV status.

making

•

it stops. In this instance, it is important to send the letter by

registered mail and keep a copy of the letter so that you can

(http://

prove that you sent it. •

Requesting assistance from a third party to speak to the abuser, for example, the shop steward or a work colleague.

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HIGHER HEALTH: A Training Resource Manual

Formal

•

The Domestic Violence Act (Act No. 116, 1998) (DVA).

Where a formal procedure has been chosen by the aggrieved, a

•

The Criminal Law Sexual Offences and Related Matters

formal procedure for resolving the grievance should be available

Amendment Act (Act No. 32, 2007).

and should:

•

Firearms Control Act (Act No. 60, 2000).

•

Specify to whom the employee should lodge the grievance.

•

The Children’s Act (Act No. 38, 2005).

•

Make reference to timeframes which allow the grievance to

•

National Policy Guidelines on Victim Empowerment.

be dealt with expeditiously.

•

National Instructions on Domestic Violence.

Provide that if the case is not resolved satisfactorily, the

•

National Policy Framework on the Management of Sexual

•

issue can be dealt with in terms of the dispute procedures

Offences.

contained in item 7(7) of the Code of Good Practice on

•

National Instructions on Sexual Offences.

Sexual Harassment.

•

National Directives and Instruction on Conducting a Forensic Examination on Survivors of Sexual Offences in terms of the Criminal Law Sexual Offences and Related

Investigation and disciplinary action •

•

Matters Amendment Act (Act No. 32, 2007).

Care should be taken to ensure that the person reporting sexual harassment is not stigmatised, ostracised or

•

The Victims Charter (2004).

disadvantaged during the investigation. Care should

•

National Management Guidelines for Sexual Assault (2003).

also be taken and that the position of other parties is not

•

Court System and Case Flow Management.

prejudiced if the grievance is found to be unwarranted.

•

Family Violence Child Protection and Sexual Offences (FCS) investigation units at the SAPS.

The Code of Good Practice provides that an employee may be dismissed for serious misconduct or repeated

•

offences. Serious incidents of sexual harassment or

It is worth noting that while there might be various laws,

continued harassment after warnings are dismissible

policies and frameworks in place, enforcement of these is often

offences (Schedule 8 of this Act).

inadequate (WHO, 2014).

In cases of persistent harassment or single incidents of serious misconduct, employers ought to follow the

The prevalence of GBV in South Africa

procedures set out in the Code of Practice contained in

When interpreting statistics on the prevalence of GBV, it is

Schedule 8 of this Act.

important to be aware that under-reporting is likely for a number

The range of disciplinary sanctions to which employees

of reasons that include:

will be liable should be clearly stated, and it should also

•

ostracism

be made clear that it will be a disciplinary offence to victimise or retaliate against an employee who, in good

•

The perpetrator is known (family member, powerful figure, religious leader)

faith, lodges a grievance of sexual harassment. •

Shame, embarrassment and fear of humiliation and

A victim of sexual assault has the right to press

•

Self-blame

separate criminal and/or civil charges against an alleged

•

Inappropriate societal norms that blame the victim, etc.

perpetrator, and the legal rights of the victim are in no way

(Kim and Motsei, 2002; Parliamentary Research Unit, 2013;

limited by this code.

NACOSA, 2015; SAHRC, 2015).

Should a complaint of alleged sexual harassment not be satisfactorily resolved by the internal procedures

Research on gender-based and sexual violence indicates that

set out above, either party may within 30 days of the

victims and survivors may be subjected to GBV repeatedly

dispute having arisen, refer the matter to the Commission

throughout their lives. (Weideman, 2008). Surveys conducted

for Conciliation, Mediation and Arbitration (CCMA) for

in four South African provinces in 2008 and 2010 showed the

conciliation in accordance with the provisions of section

following:

135 of this Act. Should the dispute remain unresolved,

•

More than 80% of respondents believed that “women should

either party may refer the dispute to the Labour Court

obey their husbands”, or that “women need their husbands’

within 30 days of receipt of the certificate issued by the

permission” to do things they need to do.

commissioner in terms of section 135(5).

•

50% believed that “men should share the work around the house with women”.

Gender-based violence

•

choice about whether or not to have sexual intercourse with

South Africa has a number of responses addressing GBV. This

their partners.

is a comprehensive list of legislative and policy frameworks to address and combat the prevalence of GBV in South Africa. HIGHER HEALTH: A Training Resource Manual

The majority of female respondents did not think they had a

•

It was disturbing that as many as 40% thought “beating was 139

•

a sign of love”.

survivors of violence in a variety of ways (for instance, medical

Unequal power relations that arise from a male-dominated

help, psychosocial support, and shelter). Prevention initiatives

society and a bias towards heterosexuality also have

look at how GBV can be prevented from happening. Response

implications for the prevalence, type and responses to

services can, in turn, contribute towards preventing violence

violence. (Jewkes, n.d.; NACOSA, 2015)

from occurring or reoccurring.

Even though laws, policies and various codes and charters

Dealing With Stigma And Discrimination

are in place, they are not sufficiently enforced (WHO, 2014).

Definitions

The Increasing Services for Survivors of Sexual Assault in

Stigma: “When we have a negative attitude toward people

South Africa (ISSSASA) Programme funded by USAID is a

who we think are different, or not ‘normal’ or ‘right’. For

coming together of leading South African organisations –

example, stigma can mean not valuing people living with HIV

Foundation for Professional Development, Soul City Institute,

(PLHIV) or people associated with PLHIV, or people we think

Sonke Gender Justice Network, and the South African Medical

are homosexual” (https://www.avert.org).

Research Council (MRC). The primary intention is to improve

To stigmatise someone: Labelling a person and seeing them

service provision and community awareness of services for

as inferior (less than or below others) because of something

survivors of sexual assault in South Africa, which has one of

about them, or something you assume about them (e.g.,

the highest rates of GBV in the world.

because of their job, because they are poor, because they

The South African Government relies on the Sexual Offences

have a disease, etc.). Often people stigmatise others because

and Community Affairs (SOCA) unit of the National Prosecuting

they do not have accurate information and knowledge, and

Authority (NPA) to lead the fight against sexual violence.

this leads to fear.

USAID has worked with the NPA and SOCA for almost a

Discrimination: Treating someone unfairly or differently from

decade to establish the Thuthuzela Care Centre (TCC) model.

others because they are different in some way (for example,

TCCs provide a wide range of services to survivors of GBV,

because a person has HIV). Discrimination is the action that

including emergency medical care, psychosocial counselling,

often follows stigma.

post-exposure prophylaxis (PEP), HIV testing and counselling, and assistance with case reporting and court preparation in an

Key points about stigma and discrimination

integrated and victim-friendly manner. The TCC model seeks to

All over the world, stigma and discrimination are some of the

streamline the care process for GBV survivors by establishing

biggest challenges affecting all sorts of people, including PLHIV,

effective linkages between various service providers and

people living with a disability, and homosexuals. Stigma and

government stakeholders, and to improve legal services by

discrimination make it hard for people to feel accepted within

reducing time-to-court and increasing the conviction rate.

society, to access services such as SRHR, STI and HIV services, and communicate about the challenges they face. Stigma and

What do we do?

discrimination can also prevent young people from accessing

South Africa is a signatory to a number of international treaties

community-based services, such as food support. We have all

on GBV, and has a strong legislative framework, for example, the

felt rejected or isolated at some point in our lives. We have also

DVA (1998), Sexual Offences Act (2007), and the Prevention and

all probably rejected or isolated another person, or group of

Combatting of Trafficking in Human Persons (2013) Act.

people, because we thought of them as different.

Much of our effort in South Africa has been focused on response. However, our response efforts need to be supported

Different kinds of stigma

and complemented by prevention programming and policy

Stigma toward others: Rejecting or isolating other people

development. By addressing the underlying, interlinked causes

because they are different or because they are seen as different

of GBV, we can work towards preventing it from happening in

(e.g. being isolated by peers at school or being abandoned by

the first place.

friends).

Addressing GBV is complicated and needs a multilevel response

Self-stigma: When a person adopts the cruel and hurtful views

from all stakeholders, including government, civil society and

that others may have of them. In other words, when a person

other citizens. There is growing recognition in South Africa of the

begins to see themselves in a negative way because of the way

magnitude and impact of GBV and of the need to strengthen the

others see them, or because of the way they perceive others

response across sectors.

to think. Self-stigma can lead people to isolate themselves from their families and communities (e.g., someone is HIV-positive

140

Approaches to addressing GBV can be divided into response

and is afraid of “giving the disease” to their family, so they keep

and prevention. Response services aim to support and help

to themselves, eat meals alone, and use separate cups and HIGHER HEALTH: A Training Resource Manual

plates). Secondary stigma: When people are stigmatised by their association with someone else, for example, the family member of an HIV-positive individual may also be stigmatised by the community. Secondary stigma may affect doctors and nurses at HIV clinics, family members or caregivers of PLHIV, and even SRHR champions. There are different forms of discrimination, including: •

Facing violence at home or in the community.

•

Not being able to attend school or social functions.

•

Being expelled from school.

•

Not being able to get a job.

•

Being isolated or shunned by the family or community.

•

Not having access to quality healthcare or other services.

•

Being rejected from a church, mosque, or temple.

•

Police harassment.

•

Verbal discrimination: gossiping, taunting, scolding.

•

Physical discrimination: insisting that a person uses separate eating utensils or sleeps in a separate living space.

Stigma and discrimination prevent good access to SRH services and to STI and HIV prevention, care, and treatment services for many people. Stigma and discrimination around HIV, people living with a disability, young people’s SRH, and people with different sexualities impact on everyone. Stigma and discrimination can: •

Prevent people from getting an HIV test and from accessing ART.

•

Stop people from openly acknowledging their sexuality.

•

Make it hard for people to tell their partner(s) their HIV or STI test results.

•

Make it hard for people to suggest safer sex practices to their partner(s).

•

Cause anxiety, stress, and depression.

•

Make it hard for parents to disclose their HIV status to their

mostly unwanted, complications of unsafe abortions, and complications of pregnancy and childbirth. Adolescents lack easy access to quality and friendly healthcare, including STI services, safe abortion services, antenatal care (ANC), and skilled attendance during delivery, which result in higher rates of maternal and perinatal mortality. Other specific reproductive health problems experienced by adolescents are being subjected to harmful cultural practices including female genital mutilation (FGM), early forced marriage, and sexual violence and abuse, including coerced sex, incest, defilement and rape, which increase their risk of STIs, including HIV. Generally, adolescents and youths lack relevant, accurate information on sex, sexuality and reproductive health. In some instances, they are subjected to sex tourism. Unsafe abortions This was said to be rampant among adolescents and youths, especially in universities and other technical colleges. Sometimes, arising from abortions, foetuses are collected from dustbins in universities. Most girls do not seek safe abortion services, including post-abortion care, as they fear gossip, ostracism, stigma and discrimination, and breach of confidentiality. What is the legal age for TOP and when is it safe? Termination of pregnancy (TOP), commonly referred to as an abortion, is legal in South Africa from the age of 12 years old without parental consent. This law was passed because many young and underage girls who were sexually active became pregnant and were seeking unsafe back-street abortions. Currently, the practice is done at some clinics. If a woman requests it, and it is not done at the community clinic, she must be referred to a centre that offers TOP. When does she qualify for a TOP?

Who can give informed consent?

One request of a pregnant woman (the woman must ask for a TOP)

Informed consent from the pregnant woman

13 to 20 weeks

• If having the baby could harm the woman’s body or affect her mental state • If she cannot afford to have the baby because she does not have enough money, or if having the baby would affect her relationships with her family and community • iIf the baby is not growing normally • If the pregnancy is a result of rape or incest

Informed consent from the pregnant woman

Prevent young people from discussing their SRH needs Make people afraid of knowing their HIV status, meaning Make young people afraid to ask for advice on contraceptives, resulting in unintended pregnancy, or HIV or STI infection.

•

challenges. These include early pregnancies, which are

Up to 12 weeks

access to ART is delayed. •

Adolescents and youths face several reproductive health

exclusively or for pregnant women to access PMTCT

with parents or from visiting the local clinic. •

Adolescents and Youths

Make it hard for breastfeeding mothers to breastfeed services.

•

vulnerable and marginalised groups

How far pregnant is she?

children. •

Sexual and Reproductive Health Rights (SRHR) of

Result in low-quality services at clinics and hospitals, making it less likely that people will access the care they need.

HIGHER HEALTH: A Training Resource Manual

141

How far pregnant is she? After 20weeks

When does she qualify for a TOP? If the pregnancy would: • be dangerous to the woman’s life • affect the normal growth of the baby • cause a risk of the baby being hurt

Who can give informed consent?

•

The right to respect for private and family life.

•

The right to benefit from scientific progress.

•

The right to freedom of expression.

Informed consent from the pregnant woman

The Rights Of Disabled People To Sexual And Reproductive Health Advocating for equal access to mainstream SRH services and a positive, healthy understanding of sexuality requires a multi-faceted approach that goes beyond the social model of disability. It requires a perspective that acknowledges the intersections between disability, gender, race, sexual orientation, age, socio-economic status and other factors, but does not privilege one over another. A human rights-based approach can accommodate all the above-mentioned factors because it is premised on the inherent dignity and equality of all persons. International human rights documents, treaties, conventions and standards provide the platform from which disabled people’s rights to SRH can be realised. Harmful myths and stereotypes regarding sexuality and disability Various conflicting myths with respect to sexuality and disability prevail in society which perpetuate and reinforce the marginalisation and discrimination of people with disabilities (PWDs). Examples of some myths include: •

All PWDs have the same needs.

•

All PWDs are heterosexual.

•

All PWDs are asexual or hypersexual.

•

Information and education about sex will encourage “inappropriate” sexual behaviour.

•

Intellectually disabled people are incapable of understanding sexuality.

•

Physically disabled people are unable to have sex.

•

PWDs cannot or should not be parents.

•

PWDs should be “grateful” for any type of sexual relationship.

Sexual and reproductive health rights (SRHR) for people with a disability In order to understand the SRHR of PWDs, we must start with the acknowledgement that all people have a right to their own sexuality. The right to sexuality and SRH for every person can be found in the following human rights principles: •

The right to equality and non-discrimination.

•

The right to marry and found a family.

•

The right to reproductive health, including family planning and maternal health services, information and education.

• 142

The right to physical integrity. HIGHER HEALTH: A Training Resource Manual

These rights are recognised in international treaties and

blind, deaf or have intellectual or cognitive impairments.

conventions such as the European Convention on Human Rights; Universal Declaration on Human Rights; International Covenant

For instance, health information displayed on the boards of

on Civil and Political Rights; Convention on the Elimination of All

health facilities cannot be read by those who are blind, yet,

Forms of Discrimination Against Women (CEDAW); International

the government and/or the health providers do not provide

Covenant on Economic, Social and Cultural Rights; Beijing

health information in Braille formats. Similarly, health facilities

Platform for Action; and International Conference on Population

have not invested in sign language interpreters – this makes

and Development.

communication between health providers and the deaf a challenge.

Lack of informed consent PWDs have complained that healthcare providers performed

It appears that there are no specific SRH programmes targeting

medical procedures on them without obtaining their consent.

PWDs, despite these people having special SRH needs.

For instance, a woman with a disability narrated how she

Generally, PWDs are denied basic facts and information about

underwent a hysterectomy without her consent. When she

themselves and how to protect themselves from STIs and HIV/

inquired from the surgeon why this irreversible procedure was

AIDS. There are no well-coordinated efforts to reach PWDs with

carried out without her consent, the surgeon stated that PWDs

contraceptives or STI and HIV/AIDS prevention and care.

should not have children because they have no potential to adequately bring up the children. Some disabled women

Disability Rights

said they were subjected to forced abortions by caregivers

Background:

or relatives who were responsible for the pregnancy to avoid

Protecting and promoting the human rights of PWDs is an

embarrassment at home.

underlying principle in all the articles of the Convention on

At community, family or health facilities levels, PWDs are

the Rights of Persons with Disabilities (UNCRPD). Article 4

excluded from decision-making processes, and are always

commits State parties to ensure and promote the full realisation

required to follow instructions without questioning. Family and

of all human rights and the fundamental freedom for all PWDs

community members justify this act by arguing that PWDs are

without discrimination of any kind on the basis of disability,

vulnerable, delicate and helpless, and need sympathy. The

and to protect all persons against the violation of their human

legal system has been unable to offer PWDs redress since

rights.

some of them are highly dependent on third parties to access legal services or relevant information on their behalf.

An erroneous perception exists among some HEIs that current legislation does not create enforceable rights for students with

Difficulties in accessing health facilities due to physical

disabilities. Very few SA institutions have started to understand

infrastructure

and/or put measures in place to ensure integrated learning

People with physical disabilities often find it difficult to access

and education methodologies and processes. Disability Units

healthcare facilities owing to the lack of suitable ramps (metallic

or Disability Rights Units (DUs or DRUs) must move beyond

ramps are too slippery, dangerous and difficult to use when one is

the built environment, technology and assistive devices to

using a wheelchair or crutches). The distances between service

interrogate the learning and teaching methodologies at their

areas within health facilities are also prohibitive, especially in the

institutions. Any future service delivery model developed by

absence of paved paths. Inside clinics, the height of examination

role players for DUs/DRUs needs to be built on the premise

couches and delivery beds can make it difficult to get onto them.

of human rights, universal access design and consumerism approaches. This section will focus on discrimination in the

Abuse and mistreatment

context of disability and how legislation supports students with

Women with disabilities often experience abuse and mistreatment by health workers because of not following instructions (which they could not hear or respond quickly enough to).

disabilities. A quick chronological overview: •

white paper set out a variety of government policy positions

Difficulties in accessing information The blind and deaf face serious challenges when it comes to access to information. Yet, healthcare providers and facilities

on disability. •

not in friendly formats that can be accessed by those who are HIGHER HEALTH: A Training Resource Manual

South Africa is a party to the UNCRPD, as well as the Optional Protocol to the Convention, signed on 30 March

have not designed methods to facilitate communication with them. The modes of communication in most health facilities are

The 1997 Integrated National Disability Strategy (INDS)

2007, and ratified on 30 November 2007. •

From 2009 to 2014, a Ministry and Department of Women, 143

Children and Persons with Disabilities existed. When the

needs of such persons.

Ministry and Department were closed in 2014, responsibility

•

for matters relating to disability passed to the Department of

Following a review of the PEPUDA, numerous suggestions were

Social Development (DSD).

made for its improvement. The PEPUDA Amendment Bill is, at

The DSD’s 2015 White Paper on the Rights of Persons with

the time of writing, being drafted by the Department of Justice

Disabilities (WPRPD) updated and supplemented the 1997

and Constitutional Development (DOJCD).

INDS by integrating the provisions of the UNCRPD and its Optional Protocol.

Another important act is the Employment Equity Act (EEA). The EEA was passed in order to promote equal opportunity and

South African Legal and Policy Framework

fair treatment in employment through the elimination of unfair

Section 9 of the Constitution prohibits unfair discrimination on the

discrimination. The EEA promotes substantive equality through

basis of disability. Discrimination on these grounds is presumed

the implementation of affirmative action to ensure redress and

to be unfair unless it has been shown to be otherwise. Section

equitable representation in the workforce.

9 of the Constitution further allows for positive measures to be taken to promote the achievement of equality for categories

The Broad-Based Black Economic Empowerment (BBBEE) Act,

of persons previously disadvantaged by unfair discrimination,

53 of 2003, and the BBBEE Amendment Act, 55 of 2013, are

which includes PWDs.

reflections of the EEA and provide practical legislative definitions and policies to realise substantive equality.

Chapter 2 of the South African Constitution, Bill of Rights, Section 9, Equality

In terms of the applicable policy framework, the DSD circulated

(3) The state may not unfairly discriminate directly or indirectly

the WPRPD in 2016. It provides clarity on various issues,

against anyone on one or more grounds, including race,

including the development of standard operating procedures for

gender, sex, pregnancy, marital status, ethnic or social origin,

mainstreaming disability; it sets out the norms and standards in

colour, sexual orientation, age, disability, religion, conscience,

terms of which discriminatory barriers should be removed; and it

belief, culture, language and birth.

broadly outlines stakeholder responsibilities.

(4) No person may unfairly discriminate directly or indirectly against anyone on one or more grounds in terms of subsection

Strategic Policy Framework on Disability for the Post-

(3). National legislation must be enacted to prevent or prohibit

School Education and Training System

unfair discrimination.

In the first half of 2018, the DHET finalised the Strategic Policy

Various statutes aim to give effect to the constitutional right

Framework on Disability for the Post-School Education and

to equality, the most prominent of which are the Promotion of

Training (PSET) System.

Equality and Prevention of Unfair Discrimination Amendment Act

The South African Government saw the need to develop the

(PEPUDA), and the Employment Equity Act, 55 of 1998 (EEA).

policy framework to make institutions of higher education and training inclusive. The policy framework “is necessary to guide

The PEPUDA is the national legislation mandated by section 9(4)

the improvement of access to and success at PSET institutions

of the Constitution, and thus enjoys special constitutional status.

and programmes [including in private institutions] for people

Significantly, the Act recognises the need to address systemic

with disabilities”. The strategic policy framework aims to create

discrimination, and specifically aims at the “eradication of social

“an enabling and empowering environment across the PSET

and economic inequalities.”

system. This includes, but is not limited to setting norms and standards for the inclusion of students and staff with disabilities

Section 9 of the PEPUDA prohibits unfair discrimination on the

in all aspects of university, college and skills development

grounds of disability, including:

life, including academic studies, culture, social life, sport and

Denying or removing from any person who has a disability,

accommodation.”

any supporting or enabling facility necessary for their b.

144

functioning in society.

The National Strategic Plan on HIV, TB and STIs: 2017-2022

Contravening the code of practice or regulations of the South

The National Strategic Plan (NSP): 2017-2022 is the country’s

African Bureau of Standards that govern environmental

fourth master plan that outlines how the country will respond to

accessibility.

the prevention and treatment of HIV/AIDS, TB and STIs over the

Failing to eliminate obstacles that unfairly limit or restrict

next five years. It seeks to improve on the achievements of the

persons with disabilities from enjoying equal opportunities

last plan (NSP 2012-2016), which massively scaled up South

or failing to take steps to reasonably accommodate the

Africa’s anti-retroviral treatment (ART) programme and reduced HIGHER HEALTH: A Training Resource Manual

the MTCT rate to just 1.5%. As a peer educator, you need to be aware of this strategic plan. It is important to note that in the original NSP, PWDs were to a large extent excluded from the proposed action plan. This has been corrected to some extent by disability sector representatives to the Civil Society Forum of the South African National AIDS Council (SANAC). PWDs were identified as a vulnerable population for HIV and STIs. Vulnerable populations are much more affected than the general population and need special attention. Furthermore, they are often highly marginalised, which diminishes their access to health information and deters them from seeking services. This violates the SRH rights of PWDs. HIV-positive PWDs often face the double stigma of disability and HIV. International and Regional Legal Frameworks South Africa ratified the UNCRPD and its Optional Protocol without any reservations in 2007, and it subsequently entered into force on 3 May 2008. The UNCRPD sets out a broad range of rights – ranging from civil and political rights to social, economic and cultural rights – of PWDs in an effort to enhance the lives of this group. Although the African Charter on Human and Peoples’ Rights does not exclusively deal with disability, it addresses the rights of PWDs in article 18(4), which provides that the aged and the disabled have the right to “special measures of protection” in keeping with their physical or moral needs. In February 2016, the African Commission on Human and Peoples’ Rights adopted the Draft African Protocol on the Rights of Persons with Disabilities, which aims to address continued exclusion, harmful practices, and discrimination affecting those with disabilities, especially women, children, and the elderly. Closely related to affirmative action, and especially significant in relation to disability, is the concept of reasonable accommodation. The UNCRPD defines reasonable accommodation as “necessary and appropriate modification and adjustments not imposing a disproportionate or undue burden, where needed in a particular case, to ensure to persons with disabilities the enjoyment or exercise on an equal basis with others of all human rights and fundamental freedoms.” In terms of the PEPUDA and the UNCRPD, failure to reasonably accommodate vulnerable groups amounts to unfair discrimination on the grounds of disability. Reasonable accommodation is further defined in the EEA as “any modification or adjustment to a job or to the working environment that will enable a person from a designated group to have access to or participate or advance in employment.” As explained by former Chief Justice Langa, “At its core is the notion that sometimes the community, whether it is the State, an employer or a school, must take positive measures and possibly incur additional hardship or expense in order to allow all people HIGHER HEALTH: A Training Resource Manual

145

to participate and enjoy all their rights equally. It ensures that we

The decision to add a universal human rights instrument specific

do not relegate people to the margins of society because they do

to PWDs was borne of the fact that, despite being theoretically

not or cannot conform to certain social norms.”1

entitled to all human rights, PWDs are still, in practice, denied those basic rights and fundamental freedoms that most people

Disability Discrimination

take for granted (UN, 2007).

Disability discrimination is the unfair treatment of people because of their disability.

The UN General Assembly adopted the UNCRPD in 2006.

Changing community attitudes is vital in eliminating discrimination.

The UNCRPD is a particularly useful advocacy tool because

The rising number of PWDs and the transition of PWDs into

Articles 23 and 25 provide explicit rights to sexuality and sexual

the community has helped to increase the understanding and

health services for PWDs. Article 23 – Respect for home and the

acceptance of people with different needs.

family states:

This is reflected in legislation that helps to protect the rights

•

Parties shall take effective and appropriate measures to

of all PWDs to participate in all aspects of community life. The

eliminate discrimination against persons with disabilities

National Constitution’s chapter two, “Bill of Rights” explicitly

in all matters relating to marriage, family, parenthood and

prohibits unfair discrimination against people on the basis of

relationships, on an equal basis with others so as to ensure

disability or health status.

that: a.

The right of all persons with disabilities who are of

Types of Discrimination

marriageable age to marry and to found a family on the

Discrimination can be direct or indirect.

basis of free and full consent of the intending spouses is

Direct discrimination occurs when someone is treated unfairly

recognised.

and is disadvantaged because of a personal characteristic or

The rights of persons with disabilities to decide freely and

behaviour that is protected under South African law. Direct

responsibly on the number and spacing of their children and

discrimination occurs when a person or group is harassed

to have access to age-appropriate information, reproductive

or excluded because of a personal characteristic, or treated

and family planning education are recognised, and the

less favourably than another person in the same or similar

means necessary to enable them to exercise these rights

circumstances.

are provided. c.

Indirect discrimination occurs when treating everyone the

Persons with disabilities, including children, retain their fertility on an equal basis with others.

same way disadvantages someone because of a personal characteristic. It occurs where a rule, work practice or decision

Impact Of Stigma And Discrimination On The Health Of

is made that applies to all people equally and appears to be

The Lgbtqi+ Population

non-discriminatory, but which in practice substantially reduces

•

the chances of a particular person or group of people from complying with it.

LGBTQI+ persons report fear of and may avoid accessing healthcare services for various reasons.

•

They fear unfair and discriminatory treatment at the hands of health service providers with limited understanding

Indirect discrimination appears to be equal treatment, but is unfair

of sexual orientation, gender identity, and transgender

on certain people because of a particular personal characteristic.

issues.

This is sometimes called systemic discrimination.

•

This leads to prejudice, mistrust, discriminatory treatment, denial of healthcare, and even abuse.

For indirect discrimination to be unlawful, it must also be

•

unreasonable. Examples of indirect discrimination: A recruitment

regarding their HIV status, sexual orientation, or gender

or promotion based on seniority or length of service may indirectly discriminate against women applicants because women are

They express fears relating to disclosure of information identity.

•

A Human Rights Watch (HRW) report documented denial

more likely to have taken career breaks to accommodate family

of healthcare, verbal abuse, harassment and violations

responsibilities. Selection criteria requiring a specific number of

of confidentiality of men who have sex with men, gay

years of previous experience may also constitute indirect age

men, transgender men, and intersex persons in Tanzania.

discrimination.

As a result, LGBTQI+ persons may not seek out health

UNCRPD

services that they need.

MEC for Education: Kwazulu-Natal and Others v Pillay

2008 (1) SA 474 (CC) para 73. 146

HIGHER HEALTH: A Training Resource Manual

•

As a result of criminal laws, stigma and discrimination and the general “invisibility” of LGBTQI+ populations in some countries, health information and services are not designed to meet specific healthcare needs relating to LGBTQI+ person’s sexual orientation and gender identity.

•

Many health facilities and service providers fail to understand and have outdated approaches to gender identity and expression.

•

to provide access to education and information about HIV, or treatment, and care and support services further fuels the HIV/ AIDS epidemic. These elements are essential components of an effective response to HIV/AIDS, which is hampered if these rights are not respected. •

What is a human rights approach to HIV and AIDS?

•

The right to education, free association, information and, most importantly, non-discrimination are recognised and

Healthcare services fail to provide appropriate SRH services for LGBTQI+ populations, such as appropriate barrier methods for lesbian, gay, bisexual, transgender or intersex persons (e.g., condoms with lubricants for men who have sex with men), hormone replacement therapy,

upheld. •

infected with HIV. •

The infected and affected are protected from discrimination, treated with dignity, and provided with access to treatment,

or gender-affirming surgery. This further discourages access to healthcare.

An open and supportive environment exists for those

care and support. •

HIV and AIDS are de-stigmatised.

HIV and AIDS: Health And Human Rights

In these circumstances, individuals are more likely to seek testing

There is a clear link between human rights and the spread and

in order to know their status. In turn, those people who are HIV-

impact of HIV on individuals and communities around the world.

positive may deal with their status more effectively by seeking

The disregard for human rights contributes to the spread of the

and receiving treatment and psychosocial support, and by taking

disease. This can be seen in the differences in incidence and

measures to prevent transmission to others, thus reducing the

spread of HIV among certain groups, which include women

impact of HIV on themselves and on others in society.

and children, those who are poverty-stricken, the lesbian, gay, bisexual, transgender and intersex (LGBTI) community, injecting

HIV testing and human rights

drug users, sex workers, and other stigmatised or disempowered

A human rights-based approach to HTS ensures that the essential

groups.

elements of the programme are aimed towards the realisation of rights and that those rights are used as standards. HTS must be

The relationship between HIV/AIDS and human rights is

offered in a way that is consistent with the rights described in the

highlighted in three areas

Constitution of South Africa and in the Children’s Act. It must be

Increased vulnerability: Groups who are unable to realise their

ethical and be conducted within a supportive environment.

social, cultural, economic and political rights are more vulnerable to contracting HIV. For example, individuals who are denied the

Some important human rights are described below

right to freedom of association and access to information may

•

not be able to freely discuss issues related to HIV, disclose their

All personal information concerning a client, their health status,

status, get treatment, join support groups, or take preventive

treatment, or stay in a health establishment must be kept

measures to protect themselves from HIV infection.

confidential, unless ordered by a court of law or done so for the

Right to privacy and confidentiality

advancement of the client’s care and treatment after following Discrimination and stigma: Stigma and discrimination may

the necessary procedure.

obstruct access to treatment and may prevent individuals from

•

seeking treatment, care and support which, in turn, contributes

Clients have the right to refuse HIV testing, without compromising

to the vulnerability of others to infection. The result is that those

their access to standard healthcare. There shall be no mandatory

most needing information, education and counselling will not

HIV testing, and all testing shall remain voluntary with informed

benefit even where such services are available.

consent, even when the services are initiated by the service

Right to refuse HIV testing

provider. Prevents an effective response: Strategies to address the

•

epidemic are hampered in an environment where human

Informed consent refers to a person being given relevant and

rights are not respected. For example, discrimination and

appropriate information about an HIV test, and based on that

stigmatisation drive the affected groups underground. This

information, given an opportunity to either accept or refuse to

means that prevention efforts do not reach these groups, and

do the HIV test. Informed consent should always be in written

thus increases their vulnerability to HIV. Likewise, the failure

form and signed by the client and the healthcare provider only to

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147

avoid unintended disclosure of results. •

Requirements of informed consent

The information that clients and patients require in order to give their informed consent may vary based on the service delivery approach and setting, but should generally include information about: •

Benefits and implications of knowing one’s status and reasons for recommending HTS.

•

Client’s right to withdraw consent at any stage of the process.

•

Availability of follow-up treatment, care and support, and prevention services.

•

Importance of disclosure, partner/family testing, and availability of couple’s HTS.

•

HTS process and procedures.

HIV-Related Stigma In some communities, people who are HIV-positive or have AIDS are made to feel ashamed. No one in the community will associate with them, and they think the family of someone who has HIV/AIDS has disgraced the community. Thousands of HIV-positive people hide their status. They are frightened of rejection by friends, family, and neighbours, even though HIV/AIDS is not passed from one person to another through casual contact. Many people with AIDS and their families do not ask for help from their communities because of the shame and disgrace they are made to feel. This can make it very difficult for someone with AIDS to get the help and treatment they need, even though there are medicines available that allow people with AIDS to live longer, healthier lives.

Appendix 1: South Africa’s Sexual Rights Charter South Africa’s Constitution says that women and men must be treated equally and fairly. It also says that no one has the right to control or dominate another person. Both women and men are sexual beings with equal rights in their relationships. However, many people are not able to enjoy these rights. We know this because South Africa has very high levels of: •

Rape, including date rape, marital rape and incest

•

Domestic violence

•

HIV and AIDS

•

Teenage pregnancy

If we follow the sexual rights and responsibilities in this Charter, our country will be less violent, safer and happier for all. The right to enjoy sex in sexual relationships, you have the right to: •

Enjoy sex just for the pleasure of it

•

Enjoy sex right up into old age

•

Be treated as an equal sexual partner

•

Be treated with dignity and respect

•

Express your desires, needs and concerns and be listened to

•

Be the one to initiate sex

•

Choose your sexual partner, whether they are the same or the opposite sex

You too have the responsibility to respect the rights of your sexual partner. The right to safer sex Safer sex is a way of having sex that protects you from sexually transmitted infections (STIs), including HIV/AIDS, and from unwanted pregnancy. It is therefore your right to: •

Have a clinic or healthcare centre nearby that can offer you safe and reliable ways to protect yourself from unwanted pregnancy.

•

Be given the correct information about safer sex, so that you can choose how you want to have sex.

•

Have access to affordable healthcare.

•

Be treated by healthcare workers in a respectful, caring and sensitive way.

•

Use male or female condoms to protect yourself from STIs, including HIV.

• You have the responsibility to protect yourself and your partner. The right to say “NO” You have the right to: ♦ Say “no” and “stop” if you do not want to go ahead with sex. ♦ Be listened to and respected.

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Other sexual rights

Appendix 2: organisations involved in advocating for the rights of

We also have the right to:

marginalised groups

•

Laws, policies and practices that do not discriminate against anyone, especially not against women, gays, lesbians, young people, people with disabilities, and people living with HIV/AIDS.

•

More job opportunities so that people are not forced into commercial sex work.

•

Specially

trained,

professional

and

caring services. How will the goals of this Charter be achieved? To achieve this Charter’s goals, you need to: •

Understand and practise your sexual rights

and

responsibilities

your

relationships. •

Acknowledge the rights of others, especially women.

•

See that government, business, civil society organisations, communities, and households promote and uphold the rights in this Charter. The South African Government signed an international agreement from the Fourth World Conference on Women held in Beijing in 1995. The agreement supports all the rights in this Charter. The government is therefore committed to promoting these rights.

How can you make sure that everyone in your home, community and workplace is able to enjoy the rights and accept the responsibilities in this Charter? https://www.google.com/ www.wits.ac.za%2FmediaFsexrightscharter. pdf

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Chapter 9 FACILITATION GUIDE AND PEER EDUCATION GUIDELINES

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FACILITATION GUIDE AND PEER EDUCATION GUIDELINES

Theoretical Framework

In the Context of the Higher Education Sector

THEORIES OF RELEVANCE

A programme that does not have a comprehensive approach, including all four IMBR concepts, probably lacks the essential

Behaviour change theories attempt to address the debates

components for reducing risk behaviour and promoting

that surround the nature of behaviour change. At the heart of

healthier lifestyles. A programme might, for example, explain

these debates are questions about how the individual functions

to young people the need for contraception and describe

in society, and how that society inﬂuences the individual’s

contraceptive methods, but it might fail to demonstrate their

behaviour.

proper use. Participants would then be informed about what to do, but not how to do it. Other programmes might inform

Behaviour change theories can be divided into two broad

participants of the “what” and the “how” of certain healthy

categories that address these debates. These categories can

behaviours, but not give them strong emotional or intellectual

be summarised as those that focus on individual psychological

reasons as to why they would want to practice such behaviours.

processes, and those that focus on community or societal

As an example, even if a young person knows that safer sex

changes.

may prevent the spread of HIV, he or she might still need to be motivated to practice safer sex.

Theories of Individual Behaviour Change Individual

behaviour

change

theories

suggest

that

the

components necessary for an individual to change behaviour include an ability to explore personal attitudes, beliefs and intentions; an understanding of personal risk; and the knowledge and opportunity to practice skills that will reduce the possibility of risk and the practice of risk-taking behaviours.

THE IMBR MODEL: INFORMATION, MOTIVATION, BEHAVIOURAL SKILLS AND RESOURCES The Information, Motivation, Behavioural Skills and Resources (IMBR) model addresses health-related behaviour in a way that is comprehensive and clear, and that can be applied to and across different cultures. Peer education in the context of the

Although resources can be considered part of “information”, it is important to provide young people with information about where to access appropriate resources or services beyond the scope of peer education sessions. Such resources might include, for example, youth-friendly clinics, counselling services, HIV/STI and pregnancy testing, care programmes, and commodities (such as condoms and contraceptives).

THEORY OF REASONED ACTION The theory of reasoned action states that the intention or desire to adopt a new behaviour is inﬂuenced both by the individuals’ beliefs (i.e., family norms) and the community standards to which the individual is exposed.

IMBR model focuses on:

Therefore, the intention of a person to adopt a recommended

•

about the consequences of the behaviour. For example, a young

Information (the “what”) relating to knowledge and facts relevant to the focus of the project, for example, HIV or wellness management.

•

Motivation (the “why”) relating to the risks and beneﬁts pertaining to lifestyle choices and behaviour.

•

Behavioural skills (the “how”) that involve transferring skills that empower peers to make healthy, responsible choices that reduce risk.

behaviour is determined by the person’s attitudes and beliefs woman who thinks that using contraception will have positive results for her will have a positive attitude towards contraceptive use. The person’s subjective or personal viewpoint about an issue is also inﬂuenced by signiﬁcant others and by the norms or standards in their community or culture. This is based on what others think one should do, and whether important individuals approve or disapprove of the behaviour.

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In the Context of the Higher Education Sector

Theories of individual behaviour change have come under criticism when applied in non-western contexts. Social conditions

For students, the relevance lies in the following:

in these contexts often determine that individuals do not have

•

Subjective beliefs and norms are shaped by the education

the personal power or efﬁcacy to carry out decisions that they

input and especially by the methods employed to deliver

might have made on an individual level.

crucial messages. • •

Young people’s attitudes are highly influenced by their

An additional problem is that non-consensual sex is prevalent in

perceptions of what their peers do and think.

South Africa. Where rape is common, an individual has no power

Young people are highly motivated by the expectations of

to protect him or herself from HIV infection. Cultural patterns

respected individuals.

and behaviours may also render these theories inappropriate. In many non-western contexts, notions of health are more closely

Clearly, for behaviour change to occur, information, skills,

tied to the health of the community, rather than that of the

motivation, and resources need to be in place, but factors such

individual. Examples include practices such as virginity testing

as cultural heritage and socio-economic status undermine the

and ritual circumcision in which a strong traditional heritage

outcomes of even the best intervention efforts.

overrides rationality.

HEALTH BELIEF MODEL

SOCIAL BEHAVIOUR CHANGE THEORIES

The health belief model was developed in the early 1950s by

Social behaviour change theories address some of the concerns

social psychologists Godfrey Hochbaum, Stephen Kegels, and

raised by the inadequacies of the individual models, and they

Irwin Rosenstock. It was used to explain and predict health

place more emphasis on “the interactive relationship of behaviour

behaviour, mainly through perceived susceptibility, perceived

in its social, cultural, and economic dimension” (UNAIDS, 1999:

barriers, and perceived beneﬁts. That is, if a person desires a

8). These theories recognise the important role that societal

particular health outcome, he or she will take actions to help

norms play in determining an individual’s behaviour, and they

bring about that outcome. Hence, the health belief model feeds

view the individual in the context of a particular community.

into the peer education strategy by inﬂuencing perceptions through persuasive messaging. This model suggests that if a

These theories argue that to change the behaviour of the

person has a desire to avoid illness or to get well (value), and

individual, the behaviour of the entire community needs to

the belief that a speciﬁc health action would prevent illness

change to ensure group support for individuals who wish

(expectancy), then a positive behavioural action would be taken

to adopt new behaviours.

towards that behaviour. Unfortunately, this model of behaviour change does not sufﬁciently take into account factors like habits, attitudes, and emotions. Although the health belief model is useful, the effects of a number of factors on behaviour (culture, social inﬂuence, socio-economic status, personal experiences, etc.) need to be considered if the model is to be integrated into peer education work.

SOCIAL LEARNING THEORY Social learning theory, as outlined by the American psychologist Albert Bandura, suggests that people learn through direct experiences, i.e., watching the actions of others. Bandura’s theory also suggests that learning occurs through the observation of role models, as well as through training that develops self-

In the Context of the Higher Education Sector

efﬁcacy, for example, through practising responses to simulated

The health belief model’s most relevant concept is that of

situations. The theory takes into account the social nature of

perceived barriers, or a person’s opinion of the tangible and psychological costs of the advised action. In this regard, a

individual behaviour change. Viewing the actions of others can allow insight into the consequences of one’s own actions.

facilitator could reduce perceived barriers through reassurance, correction of misinformation, incentives, and assistance. For example, if a young person does not seek healthcare at the

THE SOCIAL NETWORK THEORY

local clinic because they feel that their conﬁdentiality will not

Wolf, Tawﬁk, and Bond, proponents of the social network theory,

be respected, the facilitator may provide information about a

suggest that the persuasiveness of one’s social network plays a

youth-friendly service, thus helping to overcome this barrier to

vital role in behaviour modiﬁcation or change.

accessing proper healthcare.

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In the Context of the Higher Education Sector

The inclusion of interactive experimental learning activities

The relevance of this theory is obvious. Many

is extremely important, and facilitators can be important role

advocates of peer education claim that the (horizontal) process

models in this regard. The implication for the classroom is that

of peers talking among themselves and determining a course

training be made as interactive and experiential as possible.

of action is key to the successful behavior change.

A further implication is that facilitators are visible,

The theory suggests that this will enable participants to come

and their actions and attitudes are emulated by their peers.

up with the ideas and solutions, which they will then own. This

This theory implies that the choice of facilitator is critical, and

increases the likelihood that cognitive restrucutring will take

it is also important to check whether or not selected facilitators

place and, more significantly, that behaviour change will take

are comfortable being viewed as role models.

place.

DIFFUSION OF INNOVATIONS THEORY

TRANSLATING THEORY INTO PRACTICE

The diffusion of innovation theory (Ryan and Gross, 1943, in

Whether you are providing training of trainers (ToT), training

Rogers, 1983) proposes that gatekeepers and opinion leaders

of peer educators, or peer education sessions with the target

in a particular community may have the power to inﬂuence

population, there are some basic methodological considerations

the behaviour of others. This implies that an innovation (a

for translating the theory into practice.

new behaviour) can be ﬁltered down through leaders. Like the social network theory, this theory emphasises that leaders

Most important are learning based on experience and observation

and respected individuals inﬂuence norms by disseminating

(experiential learning), and the use of interactive methodologies

information through one-to-one contact and in group discussions.

and drama.

THEORY OF PARTICIPATORY EDUCATION

EXPERIENTIAL LEARNING There is an ancient proverb that says:

Adult educator Paulo Freire proposes that the full participation

Tell me… I forget, show me… I remember, involve me… I

and empowerment of the people affected by a problem is

understand.

essential in order to enact change. Hence, peer educators are themselves a part of the target group, and the primary strategy employed is to enable cognitive restructuring to take place so

“Involving” the participants in a training workshop in an active

that people may be empowered to take charge of their lives.

way that incorporates their own experience is essential. Such

Participatory education concepts are based on Paulo Freire’s

developing their skills with immediate feedback. It also gives

critique of education in Brazil in the 1970s. Freire suggested that the “banking” concept of learning, where learners are empty vessels to be ﬁlled with knowledge, was both inappropriate and ineffective, particularly with adult learners. He proposed

experiential learning gives the trainees an opportunity to begin them the opportunity to participate in many of the training exercises and techniques ﬁrst-hand, before they engage other students in such exercises.

that education be viewed as a participative facilitated process,

USE OF ROLE PLAY

whereby learners build on their own prior knowledge and

Facilitation uses a range of interactive techniques, including

experience to develop a conscious and critical view of the world.

brainstorming, small-group discussions, case studies, quizzes, etc. Another commonly used and highly interactive technique is

The process of Freire’s methodology is action-reﬂection praxis,

role play. Effective and believable role play is a technique that

where participants are encouraged to take a step back from

can help achieve several major objectives of a health education

their lives and their practices and examine them objectively to

programme. Role play can do the following:

develop a critical consciousness of what they see. This reﬂection offers the perspective and strength to re-engage in action and continue the cycle.

•

Provide information. Role play is an attractive way to deliver information through humour and real-life drama. It permits educators to dramatise the myths that people spread and show how to break them down. In role play, people can explore problems that they might feel uncomfortable

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155

discussing in real life. •

Create motivation. Role play can effectively dramatise life’s external situational pressures (life stressors) and difﬁcult psychosocial situations, which are sometimes the consequences of poor decision-making and risky behaviour. It can bring to life the realities of, for example, getting an unwanted positive pregnancy test result, testing positive for STIs or HIV, etc. They can demonstrate the difﬁculties of having to disclose sensitive and painful information to a loved one. Strong role play engages the hearts and minds of the audience, and can motivate them to change their attitudes on certain issues.

•

Build skills. When done well, role play has the potential to shape behaviour. It can demonstrate various skills, such as negotiation, refusal, decision-making, and practical expertise (for example, how to use a condom correctly).

•

Create links to resources. Role play can provide an opportunity to inform the audience about the services that exist in the community, or to discuss their characteristics, for example, whether they are accessible to young people, whether they respect their right to conﬁdentiality, etc.

The ToT proposed in this manual is based on an experiential learning model that uses highly interactive techniques. The model includes four elements: direct experience (an activity in which learners create an experience), reﬂection on the experience, generalisation (lessons learned), and application of lessons learned. It can be summarised in a diagram as shown below.

DIRECT EXPERIENCE: TRAINER INTRODUCES THE ACTIVITY OR EXERCISE AND EXPLAINS HOW IT IS DONE PARTICIPATION Trainees participate in: • Brainstorming • Role play and story-telling • Small group discussion • Case studies • Games and drawing pictures

APPLICATION Next steps, trainer gives suggestions and trainees discuss: • How the new knowledge and skills can be useful in their lives • How to overcome difﬁculties in using the knowledge and skills • Plan follow-up to use the knowledge and skills

REFLECTIONS Thoughts and feelings, trainer guides discussion: • Answer questions • Share reactions to activity • Identify key results

GENERALISATION Lessons learnt, trainer gives information, draws out similarities and differences, and summarises. Trainees participate in: • Presenting their results • Drawing general conclusions

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ADULT LEARNING PRINCIPLES PRINCIPLES OF ADULT LEARNING Adult learners are unique. They are people with years of experience; they have established values, beliefs, and opinions; and they have a deep need to be self-directing. This component explains adult learning principles and styles. A comprehensive understanding of adult learning principles is critical to developing

content will be useful to them. 4. ADULTS ARE GOAL-ORIENTED Adults primarily participate in learning programmes to achieve a particular goal. Therefore, they appreciate an educational programme that is organised and has clearly deﬁned learning objectives. These need to be communicated early on in the course.

successful education programmes that result in participant engagement and the facilitation of learning. Adults have special needs and requirements as learners. 1. ADULTS ARE AUTONOMOUS AND SELF-DIRECTED Adults need to be free to direct their own learning. If the learning engagement is classroom-based, the facilitator must actively involve adult participants in the learning process. Speciﬁcally, they have to be sure to act as facilitators, guiding participants to their own knowledge rather than supplying them with all of the answers. They should allow participants to assume responsibility for their learning and engage them in discussions, presentations, and group-based tasks. If the learning engagement is an

5. ADULTS ARE PROBLEM-ORIENTED AND WANT TO APPLY WHAT THEY LEARN Adult learners want to be able to apply their learning to their work or personal life immediately. Using examples to help them see the connection between classroom theories and practical application, utilising problem-solving activities as part of the learning experience, and creating action plans together with learners are important concepts that enable real-life application. 6. ADULTS ARE MOTIVATED BY INTRINSIC AND EXTRINSIC FACTORS

e-Learning course, it should be designed to allow participants to

Learning is driven by participant motivation. The more motivated

explore topics in greater detail and choose from multiple learning

someone is to participate in training, the more likely they are

activities.

to learn and retain information. Adults are motivated by both

2. ADULTS BRING KNOWLEDGE AND EXPERIENCE TO EACH LEARNING ACTIVITY

internal and external factors. During the ﬁrst few weeks on the job, adults are highly motivated to learn. Similarly, motivation is high when they are faced with learning a new work process or

Adults have accumulated a wealth of life experience and

approach to a problem. However, as they become more familiar

knowledge. This may include family memories, work-related

with the content, motivation to learn may decrease until a speciﬁc

experiences, and previous education. Linking new material in a

need arises.

course to learners’ existing knowledge and experience creates a powerful and relevant learning experience. Relating theories

7. ADULTS ARE PRESSED FOR TIME

and concepts to the participants and recognising the value of

In today’s fast-paced world, adults have to juggle demanding

experience in learning are two important factors to keep in mind.

jobs, family responsibilities, and community commitments. Even if they are highly motivated to learn, the pressures of life often

3. ADULTS NEED LEARNING TO BE RELEVANT AND PRACTICAL Every day, the human brain takes in an endless number of sensory inputs. As the brain processes these inputs, it identifies information it deems relevant. Relevancy increases the likelihood of information being retained. Adults must see a reason for learning something, and the learning must be applicable to their work or other responsibilities for it to be valuable to them.

limit the time many adults can invest in learning. Therefore, in many cases, learning must be available when it is convenient for the learner and delivered in manageable sections or chunks. These may come in the form of modularised e-Learning programs, podcasts, webcasts, or may be strategically delivered through informal training initiatives. 8. ADULTS HAVE DIFFERENT LEARNING STYLES A learning style refers to how a person learns, categorises,

Therefore, learning engagements must identify objectives for

and processes new content. Each person may have multiple

adult participants before the course begins. By nature, most

preferred learning styles. In training, each of these styles should

adults are practical about their learning.

be considered when delivering content.

Typically, they will focus on the aspects of a programme most useful to them in their work. Participants must know how the HIGHER HEALTH: A Training Resource Manual

157

SUMMARY

VISUAL LEARNERS

A principle, philosophers say, is the beginning of action. In order

Visual learners like to learn through written language, such as

to facilitate actions that result in learning among adults, it is

reading and writing tasks. They may remember what has been

critical to have a fundamental knowledge of all of the principles,

written down, even if they do not read it more than once. They

as well as an understanding of how to implement them, in the

like to write down directions and pay better attention to lectures

design of learning and training initiatives. Learners use all three

if they watch them. Learners who are visual-spatial usually do

modalities to receive and learn new information and experiences.

better with charts, demonstrations, videos, and other visual

However, according to the visual, auditory, and kinaesthetic

materials. They easily visualise faces and places by using their

(VAK) or modality theory, one or two of these receiving styles

imagination and seldom get lost in new surroundings. To integrate

are normally dominant. This dominant style deﬁnes the best way

this style into the learning environment, try the following:

for a person to learn new information by ﬁltering out what is to

•

Use graphs, charts, illustrations, slides, or other visual aids.

be learned. This style may not always to be the same for some

•

Include outlines, concept maps, agendas, handouts, etc. for

tasks. The learner may prefer one style of learning for one task,

reading and taking notes.

and a combination of others for a different task.

•

Classically, our learning style is forced upon us through life in the

•

Leave blank space in handouts for note-taking.

following manner:

•

Invite questions to help them stay alert in auditory

Include plenty of content in handouts to reread after the learning session.

•

From pre-school to Grade 3, new information is presented to us kinaesthetically.

•

In Grade 4 to 8, information is visually presented.

•

From Grade 9 to tertiary level and on into the business

environments. •

presented. •

environment, information is presented to us mostly through auditory means, such as lectures.

Post ﬂip charts to show what will come and what has been Emphasise key points to indicate to learners when to take notes.

•

Eliminate potential distractions.

•

Supplement textual information with illustrations whenever

According to the VAK theorists, we need to present information

possible.

using all three styles. This allows all learners the opportunity to become involved, no matter what their preferred style may be.

KINAESTHETIC LEARNERS Kinaesthetic learners do best while touching and moving. This

RECOGNISING AND IMPLEMENTING THE THREE STYLES AUDITORY LEARNERS Auditory learners often perform better by talking about, discussing and hearing what was said. To integrate this style into the learning environment, you can do the following: •

Begin new material with a brief explanation of what is coming.

•

Conclude with a summary of what has been covered. This is the old adage of “tell them what they are going to learn, teach them, and tell them what they have learnt.”

•

Use the Socratic method of questioning learners to draw as much information from them as possible and then ﬁll in the gaps with your own expertise.

•

Include auditory activities, such as brainstorming, buzz groups, or the game Jeopardy. Leave plenty of time to

learning style happens through two sub-channels: kinaesthetic (movement) and tactile (touch). These learners tend to lose concentration if there is little or no external stimulation or movement. When listening to lectures, they may want to take notes for the sake of moving their hands. When reading, they like to scan the material ﬁrst (to get the big picture), and then focus in on the details. They typically use coloured highlighters and take notes by drawing pictures, diagrams, or doodling. To integrate this style into the learning environment, use activities that get the learners up and moving, such as the following: •

Use role play and drama.

•

Set tasks for the learners.

•

Play music, when appropriate, during activities.

•

Use coloured markers to emphasise key points on ﬂip charts or white boards.

•

Give frequent stretch breaks (brain breaks).

•

Guide learners through a visualisation of complex tasks.

debrief activities. This allows learners to make connections between what they learnt and how it applies to their situation.

158

•

Have the learners verbalise the questions.

•

Develop a dialogue between yourself and the learners. HIGHER HEALTH: A Training Resource Manual

sensitive to the needs and circumstances of the group. For

THE ENERGY CYCLE UNDERSTANDING YOUR PERSONAL ENERGY CYCLE

example, some games may exclude people with disabilities. •

that involve running. For example, make sure that there is

An important aspect of productivity concerns what time of day you select to work on which activities. Everyone has a natural

enough space and that the ﬂoor is clear. •

time during the day when they are “UP” (prime time), and a natural time when they are “DOWN” (down time). During prime

Ensure the safety of the group, particularly with games

Try not to use only competitive games, but also include ones that encourage team-building.

•

Avoid energisers that are too long. Keep them short and

time, your brain is “on”, your batteries are charged, and you are

move on to the next planned activity when everyone has

able to focus. During down time, your brain feels “slow”, and it is

had a chance to move about and wake up.

difﬁcult to get through your work. First, let’s chart your personal energy levels. Get out a piece of paper and draw a big “L” for a graph with a vertical and a horizontal axis. Mark the vertical axis “0” to “100” in increments of 10 to represent your energy level as a percentage. Mark the horizontal axis with your work hours in one-hour increments. When you arrive at training in the morning, draw a dot where energy intersects with time to indicate how you feel in terms of your energy level. As the day progresses, draw a series of dots horizontally to show how your energy ebbs and ﬂows. Then connect the dots and analyse your line chart. Draw a horizontal dotted line across your line drawing at about the 75% energy level mark. The section above this line represents your peak productivity zone. Write the exact time ranges when you are in the peak productivity zone to the side of your graph. These are your “expensive” hours, compared to other times during the day, because your brain is capable of doing higher-

FACILITATION Facilitation is a way of working with people. It enables and empowers people to learn skills, think critically and creatively, and ultimately realise their own potential. In the role of facilitator, one does not perform the task, provide solutions or teach. Facilitators use a particular set of skills in a process which allows the individual or group to reach their decision, set their goal, or

level activities in that range.

learn a skill.

It’s important to know when you are in prime time, because

Facilitation is a developmental educational method which

you can get so much more done.

encourages people to share ideas, resources, opinions, and

During this time, the key is to focus on:

ways of satisfying those needs. Through facilitation, group

Important tasks

Critical decisions

Problem solving

Complex thought

Things to consider when using energising activities: •

Use energisers frequently during a training session, whenever people look sleepy or tired, or to create a natural break between activities.

•

Choose games that are appropriate for the local context. Think carefully, for example, about games that involve touch, particularly of different body parts.

•

Select games in which everybody can participate, and be

HIGHER HEALTH: A Training Resource Manual

to think critically in order to identify needs and ﬁnd effective members come to value and develop their own expertise and skills. Facilitation involves many facets of interaction between individuals, such

as clariﬁcation, conﬂict management, and

planning. It can be learnt and developed through practice and supervision. An openness to constant learning and development is necessary for anyone seeking to improve their facilitation skills. A facilitator helps people decide what they want to accomplish, reminds them of their responsibility in achieving it, and encourages and helps them to complete an agreed task or activity. The facilitator ensures that the needs of individuals within the group are recognised, acknowledged, and responded to; this is seen as an integral part of the task at hand and not superﬂuous to it. 159

In some settings, the facilitator plays an objective role by

value in relation to behaviour, for example: “That seems to have

asking questions, encouraging responses, and enabling group

worked well for you is…”

members to discuss, respond and reach a conclusion. In other situations, they may stimulate group members to create solutions

Sharing

to problems they have identiﬁed by offering suggestions or

Encouraging the sharing of past and present feelings and those

creating simulations which the group can practise. In facilitation,

about future events with a question such as: “Does anyone else

there is an equal emphasis on achieving the task and on the

feel this way?”

process involved in that achievement. Directive Facilitators use a wide range of styles with groups, depending

Guiding members as they explore their feelings and begin to

on the task, activity, people involved, time available and needs of

express them, for example: “Let’s take a few moments to gather

the group members. The various styles enable particular matters

our thoughts and think about how this event has affected the

to be addressed most effectively, and facilitators should be able

group.”

to modify their style to meet the group’s needs. For the task at hand, a facilitator’s approach and role may be one or a combination of the following: Directive Giving people information or instructing them how to do something, for example: “This is how to develop a work plan.” Exploratory Asking questions, encouraging people to speak about their experiences and ideas, for example: “What did you ﬁnd useful in the last peer education session you were part of?”

FACILITATION TECHNIQUES The facilitator guiding a discussion Facilitators have the unique role of needing to portray leadership, while allowing participants to take charge and stamp their ownership on the process. In other words, the facilitator strives to demonstrate the paradox of leading by following. So, in guiding discussions, one needs to resist the impulse to provide all the answers and inputs. Instead, facilitators are required to lead the discussion by non-directive positioning and the asking of strategic questions designed to foster critical thinking. Facilitators thus provide a catalyst for cognitive restructuring.

Delegating

ASKING PROBING QUESTIONS

Assigning tasks, roles, or functions to individuals. For example,

Questioning is a technique that facilitators must use with caution.

in planning a facilitation training session with a group, some organisational tasks may need to be shared. Participative Taking part in discussion, sharing personal experiences and

One needs to be careful not to come across as interrogating. Questions must be subtle and thought-provoking, and hold the inherent potential to stimulate debate, discussion, and personal growth.

encouraging others to do the same, for example: “The ﬁrst time I

CREATING A LEARNER-CENTRED ETHOS

ever did a skills-sharing workshop like this was…” During the learning process, a facilitator’s approach or role may involve a combination of facilitation styles Interpretive

Facilitators need to be committed to making the course learnercentred. This provides an opportunity to model skills that enable participants to own the process and take charge of discussions, while still maintaining control without being controlling or

Assisting participants to verbalise a contribution or helping

authoritative. This would demonstrate to peer educators

someone to ﬁnd the words to express what they mean.

appropriate techniques to listen patiently and respond to the concerns of their peers, while resisting the impulse to tell them

Cathartic

what to do or not to do.

Encouraging and modelling the expressions of feelings and emotions as they emerge by asking a question such as: “And was that a very painful time?” Evaluative Assessing what someone says, or providing a statement of 160

Techniques to foster such a context include:

ENCOURAGING INTERACTION •

During training, interact at least once with every participant individually. HIGHER HEALTH: A Training Resource Manual

•

Motivate, manage, and encourage participants to interact

Trainers are advised to adhere to the prescribed methodology

with you by being approachable and attentive, and reaching

to ensure attainment of training goals, objectives, and envisaged

out particularly to those who appear disengaged, difﬁdent,

outcomes. As a trainer, you are required to facilitate, not teach.

or introverted. This will help them overcome shyness, gain

You are required to:

conﬁdence, feel valued and accepted, and increase the

•

likelihood of them engaging and becoming invested in the

•

Control the process in a non-directive way.

goals and objectives of the course.

•

Make learning happen.

Make an effort to learn participants’ names early on in the

•

Set the stage and provide the props to create the conditions

course, and use their names whenever it is appropriate. Use

for “ah-ha” moments to occur.

their names when you invite participants to speak or answer

•

Make participants feel “in charge” of the process.

questions, and when you refer to their comments or thank

•

Provide the triggers that allow participants to make the

Be available, approachable, and accessible to participants

•

Act as a catalyst for participants to grow in conﬁdence.

during training. Remain in the room, and encourage them

•

Allow participants to take ownership of ideas and “solutions”.

them. This will make them feel valued and respected. •

necessary connections.

to come to you with their concerns or if they need clarity on anything.

LIMITATIONS OF FACILITATION Facilitation has its limitations. Facilitated groups are not therapy

REINFORCING PARTICIPANTS’ EFFORTS •

Take care not to seem authoritative or threatening.

•

Be careful not to use facial expressions or comments that could make participants feel ridiculed, embarrassed, or humiliated.

•

Be patient and accommodating when asking or answering questions.

•

Be attentive and show interest in what participants say.

•

For example, encourage focus by making non-threatening

groups. Personal development groups may be led by facilitators who are also trained in the use of other, more speciﬁc skills such as organisational development or community development. Gaining consensus on the purpose of each group is important, so that appropriate and relevant boundaries can be developed and maintained.

GROUP MANAGEMENT KNOW-IT-ALLS, TALKERS, AND BULLIES: MANAGING HECKLERS

eye contact, use minimal encouragers, ask for clarity or •

•

more information, or afﬁrm their contribution.

It is sometimes said that “there is one in every group”. A difﬁcult

Praise or thank participants who make an effort, including,

person makes the trainer’s job a challenge at best. Learning how

for example, when they try hard, ask for an explanation or

to manage those participants who don’t want to be in training

clarity regarding an unclear or confusing point, participate

is an essential skill for trainers. This section explores handling

in a group discussion, or provide assistance and support to

difﬁcult people and how to turn them into active participants in

fellow participants.

the learning process.

Model appropriate communication skills (open questions, tuning into non-verbal cues, showing empathy, and using

Groups are dynamic. It is fascinating how individuals in a group

good listening skills).

interact and form a pattern of interaction. A group can sometimes take on a singular identity. The

YOUR ROLE AS A TRAINER DELIVERING THE TRAINING A useful way to begin preparing is to review the material. Such a review might consist of a walkthrough of each lesson including preparation, gathering and organising the material, tools, and equipment (assessment tools, handouts, slides, ﬂipchart and pens, and projector) needed for the workshop, as well as reviewing all relevant policies, protocols and guidelines. This will provide you with a clear mental image of how each lesson’s methods and materials support the speciﬁed objectives. Having

study of these interaction patterns is called “group dynamics” An examination of both content and process within a group can speak volumes about the work, impact, and effectiveness of a facilitator. An examination of content would, for example, be the teaching of the peer educator content and skills. An examination of process is done by exploring what is happening in the group, both for the facilitator and individual members. In other words, is there conﬂict, dominance, bullying, or a clique formation?

such an image ﬁrmly in mind can save on preparation time. HIGHER HEALTH: A Training Resource Manual

161

From the facilitator’s point of view, by exploring the work of

NON-VERBAL INTERACTION EXAMPLES

groups at these levels, they acquire a more complete picture

•

Facial expressions and posture.

of the group and its dynamic. An understanding of this two-

•

Assumptions based on gender.

tier analysis can assist the facilitator when they are planning

•

Assumptions about a person’s social class.

sessions and designing exercises and effective interventions.

•

Perceptions of a person’s racial or ethnic background.

•

How and when a person chooses to sit, move, or hold

TO BE EFFECTIVE, A FACILITATOR MUST:

themselves.

•

Recognise both individual and group needs.

•

Be able to identify and recognise the needs, roles and

How the facilitator interacts with group members strongly

resistance of group members.

inﬂuences the group process. It is not only what the facilitator

Distinguish between what is happening because of the

says, but how they behave that is important. People take in

facilitator and what is happening because of the group’s

messages (verbal and non-verbal) from one another all the time.

make-up.

The non-verbal can either enhance or contradict a point being

Have a clearer view of how certain conﬂicts or difﬁculties

communicated. Saying you are not angry, while clearly giving

may be resolved.

off the body language of a stiff back and hurt expression are

•

Be aware that self-awareness is critical.

contradictory signals.

•

Be clear about where their involvement and commitment to

•

a group begins and ends. In this way, the facilitator takes

Remember:

care of her/himself. • •

You have got to be on the balcony and in the dance

Be mindful that it is important not to fulﬁl unreasonable expectations which the group may have.

One needs to be constantly self-aware and reﬂecting on one’s

Challenge and work with negative projections within the

own feelings, emotions, and attitude. Facilitators are human

group.

beings who have been socialised within a particular context. It can be difﬁcult to eliminate ideas, assumptions, beliefs of, and

COMMUNICATING WITH THE GROUP

perhaps prejudices against, other people. However, observing

When interacting with the group, the facilitator must remember

responses, behaviours and attitudes from group members in

that a two-way process of transmitting and receiving information

relation to oneself is a valuable barometer to gauge one’s own

is in operation. Both sender and receiver interpret messages

attitude, behaviour, and responses.

in different ways, depending on a number of factors such as class, ethnic background, gender, sexual orientation, and age.

It is the facilitator’s job to recognise how these assumptions

A facilitator’s interaction with group members is both verbal

operate, negatively and positively, within the group. It is also the

and non-verbal. The verbal interactions are stated openly using

facilitator’s role to work at challenging and diluting the negative

speech. The non-verbal aspects are not stated in speech, but

impacts of any prejudice within a group. The facilitator’s ability

are transmitted in other ways, such as in body language. Both

and readiness to challenge negative effects of social prejudice is

have a powerful effect on the group, and a facilitator needs to

an important indicator to group members, i.e., that this behaviour

be aware of the impact he or she can have as a result of the

is not to be tolerated. The facilitator can encourage the group

position they hold within a group.

members to create a group contract which excludes prejudices, stereotyping, or discrimination by agreeing that these are all

VERBAL INTERACTION EXAMPLES

to be challenged. This creates a safe space outside of which

•

members agree to leave their negative beliefs and values.

Comments to people: “You are very brave to say that” (I wouldn’t have said that).

• • •

Expressions of values and attitudes: “I really like strong

Overcoming the fear of speaking before a group:

women” (If you are not strong, I don’t like you).

•

Know your material well.

Volume and tone of voice (loud-aggressive, intimidating;

•

Practice your material.

soft-passive, weak, lacking in conﬁdence).

•

Use participatory techniques.

Revealing political agenda by excluding or including certain

•

Learn participants’ names and use them.

beliefs: “The unemployed have only themselves to blame”;

•

Establish your credibility early.

“I believe that while it is hard, we need to work towards

•

Use eye contact to establish rapport.

including and accepting homosexuals” (discriminatory).

•

Exhibit your preparation in advance (via handouts, etc.).

•

Anticipate potential problems and prepare reasonable responses.

162

HIGHER HEALTH: A Training Resource Manual

•

Check the facilities and equipment in advance.

•

Feelings of insecurity may arise for facilitators.

•

Obtain information about the group in advance.

•

One co-facilitator may dominate.

•

Convince yourself to relax (breathe deeply, meditate, talk

•

Rivalry between co-facilitators may develop.

to yourself).

•

Vague deﬁnitions and unclear delineation of responsibilities

•

Prepare an outline and follow it.

•

Manage

your

appearance

may cause problems between co-facilitators. (dress

comfortably

and

appropriately).

Remember:

•

Rest so that you are physically and psychologically alert.

•

Use your own style (don’t imitate someone else).

•

Use your own words.

•

Plan your work together.

•

Put yourself in your trainees’ shoes (they’re asking, “What’s

•

Decide how sections of the session will be shared.

in it for me?”).

•

Discuss how the session will be divided between both of

Choose to work with someone whose values are similar to your own.

•

Assume they’re on your side (not antagonistic or hostile).

•

Provide an overview of the workshop.

•

Decide who will take which section.

•

Accept some fears as being good (energising stress vs.

•

Consider how to behave when the other person is facilitating.

destructive).

•

Decide whether to leave the room, participate, or remain

•

Identify your fears, categorise them as controllable or uncontrollable, and confront them.

•

you.

silent. •

Give special emphasis to the ﬁrst ﬁve minutes (super preparation).

•

Imagine yourself as a good speaker (self-fulﬁlling prophecy).

•

Practice responses to tough questions or situations.

•

Create an informal setting.

Plan to let the group know the session or programme will be jointly facilitated.

•

Decide what to do when one person wants to interrupt the other.

•

Allow some ﬂexibility so that non-threatening, nonchallenging contributions may be welcomed by the other partner (for instance, if one facilitator has forgotten

CO-FACILITATION: WORKING WITH A PARTNER

something, or if one facilitator has a different experience

The technique of working with a partner can be rewarding for a group and its facilitators, but it is a practice which requires

that could be usefully shared). •

Support each other during the session – offer appropriate

planning and periodic evaluation with the co-worker if it is to

feedback and provide a second voice to the facilitator if you

yield results. Co-facilitation has advantages and disadvantages.

detect resistance or dissidence from the group.

Not everyone wants to or is ready to co-facilitate. If a facilitator

•

Agree never to side with the group against your co-facilitator.

chooses to co-facilitate, it is crucial to plan how the two will share

•

After the session, evaluate both performances jointly.

the work, how they can best support each other, and that they

•

Give positive and critical feedback on how the two facilitators

learn to communicate effectively. It must never be forgotten that the focus of co-facilitation remains the needs of the group.

might improve their work together. •

Plan the next session on the basis of the previous one.

Co-facilitation may be used as a training mechanism for one individual in the co-facilitating pair. While this works well, care must be taken that the group does not lose out by time or energy being directed towards the co-facilitator. ADVANTAGES OF CO-FACILITATION: •

Eases the pressure of full responsibility.

•

Allows for joint planning, evaluation, and feedback.

•

Brings different experiences and attributes to the group.

•

Means a greater sharing of skills, resources, and energy.

•

Enables less experienced facilitators to develop skills.

DISADVANTAGES OF CO-FACILITATION: •

Joint planning, evaluation, and feedback are timeconsuming.

•

Co-facilitators can be “played off against each other”.

•

One co-facilitator may get on better with the group.

HIGHER HEALTH: A Training Resource Manual

163

FACILITATOR COMPETENCY MODEL Desired Competency

Demonstrated Proﬁciency (in another area of life or work, or as a facilitator if currently a trainer)

Application as a Facilitator

Technically Current, Capable and Open to Learning

Engaged in life-long learning. Picks up on the need to change personal and interpersonal behaviour quickly. Seeks feedback. Picks up on verbal and non-verbal cues regarding their impact on others, and adjusts.

Shares personal successes and failures to enhance participant learning. Applies experience as a peer mentor to facilitate excellent learning and experience for participants. Remains current in and shows ability to apply knowledge to the learning experience.

Capable of Creating an Environment for Learning

Creates a positive and safe atmosphere for participants to experiment and enhance personal learning. Expresses thoughts, feelings, and ideas in a clear, concise, and compelling manner. Adjusts style to engage participants. Assesses learning needs and adjusts as necessary.

Demonstrates an approach that values different learning styles (visual, experiential, auditory) as well as backgrounds and experience (industry vs. academia). Brings personal background and experience as a peer mentor, onsite experiences, etc., that contribute to participant understanding. Makes appropriate judgements that demonstrate competence in delivering experiential learning.

Additional for lead facilitators: Manages the front of the room – has an engaging presentation style and platform skills. Promotes a successful experience in training and facilitating experiential adult learning. Promotes a successful experience in leading other trainers.

Additional for lead facilitators: Demonstrates an ability to lead support facilitators. Treats facilitators as valued members of the training team. Intervenes as necessary to ensure facilitators are fully contributing members of the training team, enhancing the learning of participants.

Builds trust. Listens and places input into context. Maintains an open mind and avoids personal bias. Finds common ground and gets cooperation easily. Diffuses tense situations. Displays cultural sensitivity. Communicates well.

Provides constructive feedback to assist in learning. Deals tactfully with participants who don’t complete training requirements. Makes an objective evaluation of a participant’s potential peer educator. Effectively communicates concerns to individuals and/ or appropriate parties.

Interpersonally Skilled

RECOMMENDED AND SUGGESTED GROUND RULES 1. Respect

Give undivided attention to the person who has the floor. Inappropriate laughter or comments are not acceptable.

2. Confidentiality

What we share in this group will remain in this group.

3. Openness

We will be as open and honest as possible, but we won’t disclose or discuss others’ (family, neighbours’, friends’) personal or private issues or lives. It is okay to discuss situations as general examples, but we won’t use names or other identification. For example, we won’t say, “My older sister did…”

4. Non-judgmental Approach

We can disagree with another person’s point of view or behaviour without judging or putting them down.

5. Sensitivity to Diversity

We will remember that members in the group may differ in many ways, including cultural background and/or sexual orientation. We will be careful about making insensitive or careless remarks.

6. Right to Pass

It is always okay to pass, i.e., to say, “I’d rather not do this activity”, or “I don’t want to answer that question”.

7. Anonymity

It is okay to ask a question anonymously (using the suggestion or comment box), and the coordinator will respond to all questions.

8. Unconditional Acceptance

We must accept every member of the group unconditionally and without bias, judgement or unfair expectations.

9. Have a Good Time The FTF programme is also about coming together as a community and enjoying working with each other. 10. Rule of Two Feet 164

If your two feet take you out of the room while the facilitation is in session, you forfeit the right to have information repeated. You must take the responsibility to catch up so you don’t disrupt the group process. HIGHER HEALTH: A Training Resource Manual

PRINCIPLES AND VALUES OF FACILITATION: Bearing in mind that the ToT facilitation stage is an opportunity for facilitators to model all desired facilitation behaviours, it is imperative that they demonstrate, verbally and non-verbally, their commitment to the following principles: •

Listening: Facilitation entails listening to what people are saying and noticing what they are not saying verbally. This includes being aware of verbal and non-verbal means of communication.

•

Confidentiality: In order to participate fully, participants must be confident that everything of relevance can be discussed freely without inappropriate disclosure by the facilitator/s outside the group. Groups normally set the parameters of confidentiality at the outset.

•

Respect: A facilitator must acknowledge and respect every participant. It is crucial to be assertive when required to prevent dominant and/or aggressive participants from undermining the basic respect that should be accorded to each individual in the group.

•

Equality: Every participant has an equal right to contribute, inﬂuence, and determine the direction of the group. Facilitators have the responsibility to encourage participation and gate-keep dominant participants with this in mind.

•

The value of personal experience: Participation and sharing of personal experience should be afﬁrmed. Every participant’s contribution to a discussion or skill-sharing activity from this perspective is equally valid and valuable.

•

Agreed goals: Participants must be encouraged to agree on a common vision and goal for the programme to mark their ownership of the process. Facilitators need to manage group consensus to this end.

•

Group process: Facilitation requires giving attention to how the group operates. This includes attempting to resolve conﬂict or challenges that might arise in the group relating to individual members that may impact the group dynamic.

•

Trust and safety: Participants should not fear ostracism, discrimination, or judgement related to their personal views or lifestyle. Facilitators must model qualities such as warmth, empathy and genuineness, a non-judgemental attitude, and the skill of neutrality. They are therefore compelled to

•

Participation: Consultation with group members on direction, pace, content and method, with an openness to change, is vital. Facilitation succeeds when there is a consistent consultative ethos, combined with a genuine belief in the value of encouraging trainees to own the process through participation, interaction, and feedback.

IMPORTANT TEACHING AND LEARNING PRINCIPLES IMMEDIACY Enable participants to identify how they can use their knowledge, skills, and attitudes in the real and immediate context. EXPERIENCE Kinaesthetic learning (learning by doing) is known as the most effective way to learn a skill. Hence, facilitators need to create opportunities to engage participants in an appropriate activity, and then enable them to make the necessary connections for the purpose of application.

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165

APPROACHES AND METHODOLOGIES FOR TRAINING ADULTS

Buzz Session

Buzz sessions are highly interactive sessions that involve small-group discussions. These sessions are designed to stimulate thinking, and draw on the collective experirnce of the audience.

• Introductory presentation introduce an issue or task to the audience • Audience divides into small groups to discuss • Groups report back on key ideas or findings from their discussion

Simulation

A mode of instruction that relies on imitating or estimating how an event, process, skill or behaviour might occur in a real situation. This format is best used when content can be conveyed through a single example, which can be replicated on-site.

• Introductory presentation introduce an issue or task to the audience • Audience divides into small groups to discuss • Groups report back on key ideas or findings from their discussion

Case Study

An intense analysis of a situation providing participants with realistic, complex, and contextually rich situations. This format is best used when content can be through a dilemma, conflict, or problem that must be negotiated.

• Real-lie scenario is presented • Audience is asked to consider a scenario either individually or in small groups • Debrief is conducted and key learnings discussed

Controversy Panel

Two or more views on a controversial issues are presented and debated. A moderator may challenge panelists and sharpen the focus of discussion. This format is best used when a few varied perspectives can be included in a session.

• Panelists are chosen preconference and given the topic for discussion • On site, panelists are asked questions by a moderator and the audience • Audience feedback is encouraged

Flipped Classroom

Participants are provided with access to new content before the conference in order to participate in more active learning and discussion of the content during their session. This format allows participants to receive more coaching from faculty.

• Pre-work is sent to participants prior to the start of the session • Pre-work is discussed during the session. Learning is evaluated through group discussion and exercises • Presenters encourage feedback and coaching

Highly didactic session with minimal attendee participation. This format is best used when a large amount of content can be conveyed with minimal interaction.

• Use a break technique to engage and involve listeners (i.e. self-test, talk to your neighbour) • Ensure that 10 to 15 minutes are allocated for Q&A at the end of the session

Lecture

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HIGHER HEALTH: A Training Resource Manual

APPROACHES AND METHODOLOGIES FOR TRAINING ADULTS

Rapid Fire

Storyboard Walkaround

Rapid fire sessions consist of multiple, fast-paced presentations on the same topic. These sessions are designed to keep the information ﬂowing and the audience fully engaged.

• Consists of one moderator and four presenters • Each presentation is exactly 10 minutes with no more than 10 slides • Each presentation is followed by ﬁve minutes of Q&A facilitated by the moderator

An interactive session that allows attendees to learn on their feet. Presenters will guide a group of participants through a set of improvement projects on a common topic, and provide an opportunity for discussion.

• Consists of one moderator and four presenters • Improvement projects are presented through storyboards (no AV) • Moderator facilitates Q&A to generate discussion and feedback on projects

RECRUITMENT OF PEER EDUCATORS The peer educator recruitment process should follow the steps described below.

STEP 1: IDENTIFY SOURCES AND CHANNELS FOR RECRUITING PEER EDUCATORS Where will you get them from? How will you ﬁnd them? It is important to develop a plan to identify recruitment sources (staff recommendations, student leaders, peer nominations) and •

Observe the target group to ﬁnd the natural leaders.

•

Conduct awareness and education programmes and identify those who demonstrate interest.

•

Call for volunteers to assist at FTF activations and observe candidates who show passion and promise.

•

Talk to the members of the target group about who they feel most comfortable talking to about HIV and STIs.

STEP 2: ADVERTISE THE SCOPE OF ACTIVITIES PEER EDUCATORS WOULD BE REQUIRED TO DO •

Conduct informal, small-group discussions about health and wellness, including sexual and reproductive health.

•

Organise and conduct formal group discussions with peers about lifestyle and behaviour change.

•

Hold regular meetings.

•

Distribute educational materials.

•

Display posters and other educational materials.

•

Present video/DVD screenings.

•

Design and develop educational materials.

•

Perform in dramas.

•

Participate in special events, for example, World AIDS Day, sporting carnivals.

•

Be engaged in activities to motivate and support behaviour change and build skills.

•

Talk to peers one-to-one.

•

Teach peers how to do a personal risk assessment.

•

Teach peers how to negotiate safe sex (including condom use).

•

Recommend or refer peers for HIV and STI testing.

•

Provide referrals to specialist services for clients requiring more substantial information or support.

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167

RECRUITMENT STRATEGIES

project team should not expect members of the target group to share all the same characteristics, attitudes, beliefs, values, and

•

Built-in incentives.

practices. In composing the selection criteria, you could choose

•

Make the advertisements easy to understand.

from the elements listed below.

•

Allow sufﬁcient time for interested people to consider the

•

advertisement and apply.

Successful candidates must:

Provide contact details, such as a phone number, so that

•

Be members of the intended target group.

interested people can obtain further information if they need

•

Be understanding of and relate to the target group.

it.

•

Be acceptable to and respected by the “host community”, in

STEP1: INVITE INTERESTED INDIVIDUALS TO APPLY

this instance, the institution. •

Design a simple form for completion by interested applicants.

Be motivated to work on reducing the impact of HIV and STIs.

The effort to obtain, complete, and submit the form already

•

Be non-judgemental and compassionate.

indicates enthusiasm and commitment. The form should ask

•

Be able to communicate effectively, and educate and

why applicants are interested, what characteristics and qualities

persuade others.

they possess that might make them effective peer educators,

•

Be honest and able to maintain conﬁdentiality.

year of study, availability for training, availability to execute peer

•

Be a strong role model for the behaviour they seek to

educator duties (how many hours per week), desire to commit,

promote in others, and have self-conﬁdence and leadership

period available to be appointed, etc.

STEP 2: COMPILE A SHORTLIST

qualities. •

engage with their peers and establish rapport, and be able

Based on responses, compile a shortlist of suitable candidates. Selecting and keeping peer educators are two factors that are

Have strong interpersonal communication skills, be able to to listen and reﬂect.

•

crucial to the success of a peer education project. One study of

Be comfortable talking about sexual, personal and taboo topics, or be able to develop that quality during training.

peer education projects found that a key challenge was selecting

•

Be able to work in a team.

peer educators who are acceptable to both project staff and to

•

Possess, or be able to develop, public speaking skills.

community members (Horizons 2000, p. 16). In this context, the

•

Be able to control and facilitate a group

implication would be ﬁnding students who are popular among

•

Be reliable and able to commit to the work programme,

the staff and student community. The study also highlighted

which may include after-hours work.

the following key characteristics to look for when selecting peer educators: •

Conﬁdence

•

Technical competency

•

Communication skills

•

Compassion

STEP 2: IDENTIFY THE NUMBER OF EDUCATORS THAT THE PROJECT NEEDS

PEER

Select the required number from the candidates shortlisted during recruitment.

STEP 3: COMPOSE AN INTERVIEW PANEL Set up a panel consisting of programme managers and members

SELECTION OF PEER EDUCATORS

of the target group. The selection of peer educators needs to

STEP 1: DECIDE ON CRITERIA FOR PEER EDUCATOR SELECTION

it is important to remember the principles of involving both

Programme managers must ﬁrst construct a consensus-driven criteria list for selecting peer educators. In a post-school context, criteria must include availability, gender, desire and motivation, popularity, reputation among staff and students, acceptability by target audience, previous experience, personal traits (behaviour, team player, volunteer spirit, potential for leadership, etc.), and other characteristics deemed relevant for a particular programme. In selection, one must consider the diversity of the target group and ﬁnd peer educators who are representative of the range. A

168

be an inclusive process. When arranging the selection process, stakeholders and members of the target group in key stages of the project’s activities – which include the stage of selecting peer educators. Ensure gender balance on the panel. The next few steps discussed in this section are necessary to arrange the selection process.

STEP 4: MEET BEFOREHAND TO PREPARE FOR THE INTERVIEWS Arrange selection criteria, compose questions, and prepare sheets for recording comments and scores on each criterion for each interviewee. HIGHER HEALTH: A Training Resource Manual

STEP 5: ORGANISE LOGISTICS •

Arrange a room for interviews.

2. STRUCTURE AGENDA AND TIME TO MEET TRAINING NEEDS

•

Contact short-listed applicants and schedule interview

The training must be carried out so that modules are given

times, allowing enough time for each interview.

appropriate time, according to relevance and trainees’ levels of

Inform candidates if they need to prepare a short talk or

knowledge and skills. Avoid overloading trainees. Include time

presentation.

for evaluation, summary, and planning future tasks.

•

STEP 6: CONDUCT INTERVIEWS

Tips:

Ensure that the process is informal and not intimidating.

•

Plan for adequate time, especially for participatory activities. If the schedule cannot be followed as planned, make

STEP 7: SELECT CANDIDATES

adjustments as soon as possible, prioritising activities to

The basis of the selection criteria for peer educators is an analysis

ensure there is time for the most important of them.

of the target group, and the skills and personal features needed

•

to create a relationship to work with them. Seek a balanced team

Maintain balance between unanticipated discussions and the need to keep on schedule to accomplish the critical

of peer educators representing the important criteria across the

objectives of the training.

group. Individual educators do not have to meet all criteria.

•

Select some charismatic facilitators, some organised and low-

•

Vary the type and pace of activities, paying attention to the tempo of the day.

key observers, and some sensitive communicators.

Peer educators need a minimum level of knowledge and skills, so that they can transmit accurate information on the topics for which they are being trained.

STEP 8: INFORM SELECTED CANDIDATES Contact and inform selected candidates.

3. PROVIDE RELEVANT MATERIALS AND HANDOUTS Participants must be provided with materials in advance and

STEP 9: CONVENE A MEETING OF SELECTED CANDIDATES

during the sessions, as appropriate, including practical handouts

Convene a meeting of selected candidates at the earliest

materials should be provided at the conclusion of the training.

and materials for exercises. Copies of reference and review

available opportunity. Tips:

STEP 10: SCHEDULE TRAINING OF SELECTED CANDIDATES

•

Set a date for training as soon as possible.

•

Be a model of good planning and provide useful, professional materials in a timely and orderly way. Use notebook binders, colour-coding, and other means to keep materials organised and easy to access.

TRAINING 1. ARRANGE FOR APPROPRIATELY SIZED GROUPS Keeping the size of the trainee group between 15 and 20, as appropriate for the trainer, allows for effective participation, offers opportunities for leadership and skills practice, and allows for full interaction among peers and trainers. Tips: •

Even when the training group is a manageable size, it can often be helpful to divide into smaller sub-groups during exercises to allow trainees to practise new skills.

•

Training in “waves” (new groups start the training programme every few months) can solve the problem of group size, and also capture new recruits in a timely way.

4. USE INTERACTIVE, PARTICIPATORY, AND SKILLS DEVELOPMENT APPROACHES The training should model approaches that maximise trainee participation, such as interactive exercises, opportunities to practise new (or important existing) skills, and role play situations peer educators may encounter. Tips: •

Ensure that peer educators are given ample time to practise skills during the training.

5. IMPLEMENT TOOLS AND METHODS TO EVALUATE TRAINING AND TRAINING PARTICIPANTS Mechanisms for assessing trainees’ knowledge and skills development must be in place at the onset of training (as a baseline), and they should be used at the conclusion of the training (post-training evaluation). Tools should be available for trainees to evaluate the training.

HIGHER HEALTH: A Training Resource Manual

169

Tips: •

Seek expert assistance in developing tools to assess trainees’ progress and the training itself, including facilitator performance. Use these results to redesign training as necessary.

•

Place a reasonable focus on M&E of the training itself, and look towards future M&E efforts to address ongoing assessment of peer educators’ skill acquisition and performance.

•

In addition to using pre- and post-tests to determine whether peer educators have acquired the necessary knowledge and skills, it is useful to have trainees complete an evaluation at the end of the training. In this way, they can help identify strengths and weaknesses of the training, as well as topics about which they would like refresher courses and updates.

6. DISCUSS ETHICAL ISSUES Ethical issues that are likely to arise in connection with peer educators’ activities – such as conﬁdentiality, power balance, and gender equity – must be discussed as part of the training. Tips: •

Ensure that topics are considered in light of the most pressing, relevant concerns.

•

Talk about ethical issues among the programme planners before training commences.

•

Consider working with a team of staff and peer educators to develop a code of ethics for the programme.

PLANNING CYCLE

170

HIGHER HEALTH: A Training Resource Manual

expectations of stakeholders as well as the target population

SUPERVISION 1. SUPERVISORS MUST HAVE BEEN TRAINED IN SUPERVISION SKILLS, PROGRAMME EXPECTATIONS, AND PEER EDUCATION CONTENT AND APPROACHES Tips: • •

(peers). •

Support mechanisms are needed to address motivation, stress, and burnout among peer educators.

4. MANAGE THE GROUP DYNAMIC AND ENCOURAGE TEAM-BUILDING

Supervisors of peer educators must be aware of the

Supervisors must manage the group dynamic, encourage

importance of team-building.

team-building, promote a safe environment, and stay aware of

Supervisors need to be sensitive to group dynamics, aware

personal relationships.

of their own values and attitudes, and perceptive about psychological issues faced by peer educators. •

Supervisors must periodically review programme plans

Tips: •

and objectives to make sure their oversight complies with

Supervisors must monitor individual behaviour, personal interactions, and the group dynamic overall, intervening

programme goals.

early if problems surface.

2. ENSURE THAT PEER EDUCATORS ARE WELL PREPARED

•

Training and group supervision meetings should retain a climate of safety, fun, and teamwork. Icebreakers and other activities, some of them physical, are important teambuilding tools and should not be discarded for lack of time.

Supervisors must ensure that peer educators have received

•

It is necessary, not unprofessional, for peer educators and

adequate preparation, through training and skills acquisition and

supervisors to use group sessions to address upsetting

practice, before they begin their work. Updates in knowledge

issues, with appropriate concern for emotional safety.

and skills must be provided as needed.

•

amount and nature of gossip. They might specify conditions

Tips: •

•

under which supervisors must be told immediately about the

After the initial training, supervisors should track performance

conduct of a peer educator, and other conditions in which the

and requests for assistance, and schedule timely refresher

proper procedure is to talk directly with the offending person,

courses or other ways to meet identiﬁed needs.

rather than involve supervisors, unless the behaviour is not

Some supervisory activities should take place in the ﬁeld, once the peer educators have begun their work.

•

Programme managers are wise to develop rules that limit the

remedied. •

Supervisors must share supervisory responsibilities with

Weekly meetings should be held, in which peer educators

peer educators, and involve them as active participants in

lead activities in front of the programme staff on various

the supervision process, with feedback regularly invited.

reproductive health issues that they choose, organise, and develop. This will provide opportunities for improving their facilitation and communication skills, updating their

Tips: •

knowledge on reproductive health issues, and formulating their attitudes and ethics as peer educators.

Supervisors must continually reinforce peer educator motivation, monitor

limitations

(personal

professional),

what the supervisee wants and needs to learn. •

3. CONTINUALLY REINFORCE MOTIVATION AND ETHICAL BEHAVIOUR

Supervisors and supervisees should explicitly agree on Supervisors and peer educators should look at programme outcomes when considering how supervision or supervisory activities can be changed to improve programme results.

•

Ideally, peer educators should be active participants in their own supervision.

reinforce

compliance with the code of ethics, and monitor sensitivity to gender and cultural concerns. Supervisors must promote opportunities for personal development. Tips: •

Motivating peer educators and reinforcing compliance with ethical standards requires a balance between realistically accepting young people’s behaviour and managing external

HIGHER HEALTH: A Training Resource Manual

171

LEARN SKILLS TO GIVE CONSTRUCTIVE CRITICISM

ASK – TELL – ASK

WHY IS GIVING FEEDBACK AN INTEGRAL PART OF SUPERVISION SKILLS? he role of the peer mentor as a supervisor is to guide peer educators to perform their tasks and roles effectively

WHAT HAPPENS WITHOUT PROPER FEEDBACK? •

Mistakes

•

Failure to meet goals and targets

•

Disrepute about the programme and programme personnel

•

Internal and/or external ﬁghting

•

End users suffer impact

•

Funding may be withdrawn

WHAT ARE THE KEYS TO EFFECTIVE FEEDBACK? •

Don’t make assumptions

•

Ask question to clarify issues

•

Keep your focus in the conversation

•

Focus on behaviour, not the person

Feedback is an important cog in communication skills, in both personal and professional contexts. Effective feedback helps us in negotiation, meetings, interviewing, building consensus, etc.

TRAINERS’ COUCH

Below are the two recommended feedback techniques

ANSWERS TO THE TOUGHEST QUESTIONS

SANDWICH FEEDBACK to help managers who are ill at ease with providing corrective

WHAT DO YOU DO WHEN YOU DON’T KNOW THE ANSWER?

feedback. The sandwich feedback method consists of praise,

People may come up with some excellent questions and

followed by corrective feedback, followed by more praise. In

comments or ask for an opinion for which you may have no

other words, the sandwich feedback method involves corrective

easy answer. Sometimes you just don’t know. Sometimes, it is

feedback “sandwiched” between two “layers” of praise.

possible to ﬁnd the answer if you have the time to do research.

The sandwich feedback technique is a three-step procedure

At other times, the answer is complex and might depend on the situation. •

Don’t try to provide an answer if you don’t know it. It’s ﬁne not to know. It’s NOT ﬁne to try to fake your way through it, because they WILL know, and you will damage your credibility.

•

Rather say: “I’m not sure”, or “I haven’t really thought about that, but it’s a good question”, and then throw it back to the group: “What do others think?”

HOW DO YOU KEEP TRAINING FRESH AND INTERESTING TO THE TRAINEE? Remember that if you, the trainer, are bored with your training, YOU will bore your trainees. In most instances, one cannot 172

HIGHER HEALTH: A Training Resource Manual

alter the core content, but what you can do is experiment with

some groups, here are some tips:

different approaches, methods, techniques and strategies, use energisers and games, update the information, etc.

•

For questions and comments that are relevant, but probably not of interest to other group members, suggest the person

WHAT IF YOUR PARTICIPANTS JUST AREN’T RESPONDING?

talk to you at break or right after the workshop. •

For questions and comments that are not constructive, lead

Try different innovative techniques to get people to participate,

the discussion astray or, as sometimes happens, show a

such as ﬁsh bowl, post-its, small groups, individual written work,

hidden agenda, it is useful to recognise that the person

etc.

is passionate about the comment, but that you can’t do anything about the situation they might be describing. For

DEALING WITH A RESISTANT PARTICIPANT

example, they may bring up institutional management that

This is a common issue in training. Here are some possible

is unsupportive, or a gripe about somebody. In this situation,

responses, using examples that might occur in a session, and

indicate that the group needs to focus on things that they

techniques for dealing with difﬁcult participants:

have some control over, which is their own behaviour and

•

“You probably know your context better than I do, so you can

actions, so the group should get back to that. In this way,

pick and choose what seems to work for you. The only thing

you can return to the agenda.

I’d suggest is that you give it a try. Or, if it’s uncomfortable for you for whatever reason, don’t use it. You don’t need to use all the techniques to succeed.” •

•

“That’s ﬁne. Is there any way to change the technique

REFERENCES

in such a way so that you’d be more conﬁdent about it

United Nations Population Fund (UNFPA) and Family Health

working?” This is a technique that involves throwing back

International (FHI). Training of Trainers Peer Education and

the comment, and getting the commenter to think a little

HIV/AIDS: Concepts, uses and challenges. Report of a

more deeply.

consultation cosponsored by UNAIDS Geneva, Switzerland,

A similar response is: “Do you have some ideas about what

1999.

will work for your particular situation?” •

Or, invite the rest of the group to comment. “Let’s see

Peer

whether others in the group feel the same or differently

challenges. Report of a consultation cosponsored by UNAIDS

about this. Do you think this might work?” (to the group).

Geneva, Switzerland, 1999.

Sometimes you’ll get one person who is particularly sceptical

Education

and

HIV/AIDS:

Concepts,

uses

and

Shoemaker et al., 1998; Flanagan et al., 1996.

regarding the content. Typical comments include: “Well, that won’t work for me”, or “If someone said that to me, I’d hate it.”

Adamchak S. Youth peer education in reproductive health and HIV/AIDS. Youth issues paper 7.

The general rule to follow here is to take the path of least resistance:

United Nations Population Fund and Youth Peer Education

•

Give participants the “freedom” to disagree.

Network (Y-PEER). 220 East 42nd Street, 18th Floor, New

•

Never pressure or try to convince participants to use a

York, NY 10017, USA

particular technique, but suggest that it’s up to them and that they might be surprised if they try it out. •

Open up the discussion to the group by asking: “It’s OK if you’re uncomfortable using this, but I’m wondering what others think. Can you see this working?”

HOW CAN A TRAINER REFOCUS A TRAINING SESSION ONCE IT’S GONE OFF TRACK? REFOCUSING BACK TO THE AGENDA Sometimes it’s necessary to cut short discussions due to time constraints, or because the comment or question is somewhat off-topic. If you feel the need to do that, and it’s likely you will for HIGHER HEALTH: A Training Resource Manual

173

What are the symptoms of COVID-19 infection? If you have a fever, cough or difficulty breathing, seek medical attention.

Most common

Sometimes

Aches and pains

Dry cough

Fever

Runny nose

Sore throat

Tiredness

To learn more visit: www.higherhealth.ac.za Runny nose Fever www.sacoronavirus.co.za emergency hotline 0800 029 999 @HIGHERHEALTHSA 0600 11 0 000

@HIGHERHEALTHSA

healthcheck.higherhealth.ac.za

What is COVID-19

RUNNY NOSE

DIFFICULTY BREATHING

Stay away from coughing people

Wash your hands

Use a cloth face mask when in public, and a medical mask if you or a family member is sick

Don’t touch your face

Novel coronavirus Coronaviruses are a large family of viruses which may cause illness in animals or in humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases. In late 2019, a new type of coronavirus, SARS CoV-2, began making people sick with flu-like symptoms. The disease is called COVID-19.The virus spreads easily and has now affected almost every country in the world.

To learn more visit: www.higherhealth.ac.za www.sacoronavirus.co.za emergency hotline 0800 029 999 @HIGHERHEALTHSA 0600 11 0 000

@HIGHERHEALTHSA

healthcheck.higherhealth.ac.za

IF YOU

STEPS TO TAKE

or someone in your home might have been exposed feel healthy but have been travelling or not kept your distance have been diagnosed with COVID-19, await test results, or have symptoms such as cough, fever or shortness of breath

Self-Monitor Be alert for symptoms such as fever, cough or shortness of breath. Self-quarantine Self-monitor, stay home for 14 days and stay away from anyone who is immunocompromised, has a pre-existing medical condition, or is over the age of 65. Self-Isolate Stay in a specific area and away from other people, read important information about caring for yourself. self-monitor taking temperature twice daily

have not kept your distance from a patient with COVID-19 or patient with a respiratory disease

To learn more visit: www.higherhealth.ac.za www.sacoronavirus.co.za emergency hotline 0800 029 999 @HIGHERHEALTHSA 0600 11 0 000

@HIGHERHEALTHSA

healthcheck.higherhealth.ac.za

First Things First – practice other good health habits including taking ARVs or other medication as prescribed. Be a source of factual information on COVID-19 – check, share and correct. Know how to recognise COVID-19 - fever, cough or shortness of breath. Play your part to prevent the spread of COVID-19 wash your hands, cover your cough and keep your distance.

Be a campus champion: help defeat COVID-19

To learn more visit: www.higherhealth.ac.za www.sacoronavirus.co.za emergency hotline 0800 029 999 @HIGHERHEALTHSA 0600 11 0 000

@HIGHERHEALTHSA

healthcheck.higherhealth.ac.za

What is quarantine and what is self-isolation? Self-isolation means staying home by choice if you might have been exposed to COVID-19 to stop the spread of the virus.

Quarantine

means to separate and restrict the movement or activities of someone who is infected or who may not be ill but who may have been exposed to infection to stop the spread of COVID-19. This may be at home or at a community-based facility.

To learn more visit: www.higherhealth.ac.za www.sacoronavirus.co.za emergency hotline 0800 029 999 @HIGHERHEALTHSA 0600 11 0 000

@HIGHERHEALTHSA

healthcheck.higherhealth.ac.za

Social distancing

Keep your distance physically to stop the spread and stay healthy

metres 2 t s a le t a Stay her people t o m o r f y a aw

r in Do not gathe

groups

Stay out of crowded

places and avoid mass

gatherings

But stay in touch with

friends and family

To learn more visit: www.higherhealth.ac.za www.sacoronavirus.co.za emergency hotline 0800 029 999 @HIGHERHEALTHSA 0600 11 0 000

@HIGHERHEALTHSA

healthcheck.higherhealth.ac.za

Product of Student Counselling

RELAXATION TECHNIQUES

Student Counselling (021) 460 3237 District Six (021) 959 6182 Bellville Author: Gabrielle Williams Truidi-lee Barkhuizen Jessica Munnik Editor: Heidi Wichman

RELAXATION TECHNIQUES When we are under pressure and facing challenges that we don’t know how to cope with, stress and anxiety can become overwhelming. The COVID 19 worldwide pandemic has created a massive amount of stress, resulting on psychological difficulties for many people. There are ways that we can treat our stress levels, however, so that we can feel better and have more rational thoughts. This is a list of techniques that may work for you. BREATHING TECHNIQUES DEEP BREATHING HAS MANY BENEFITS − Slows down your heart rate − Reduces blood pressure − Relaxes muscles − Promotes mental clarity − Reduces tension

CHAIR BREATHING − Make sure you are sitting comfortably on a chair. Both feet on the ground. − Close your eyes if you feel comfortable to do so. − Take your arms around the chair so that you are able to cross your arms behind the back rest of the chair. − This will open up your diaphragm. − Take a deep breath in (8 sec), − Hold it in for 8 seconds − Blow out for 9 seconds − Do this while you have a quick break. − Try and repeat a few times (ideal time would be 15 minutes – but anything is better than nothing).

DIAPHRAGMATIC BREATHING − Find a comfortable, quiet place to sit or lie down. You can try it sitting in a chair, sitting cross-legged, or lying on your back.

− If you are sitting in a chair, your knees should be bent and your head, neck and shoulders, relaxed. − If you are lying down, you can place a small pillow under your head and one under your knees or you can keep your knees bent. − Start by placing one hand on your upper chest (diaphragm). − Place the other hand below your ribcage (right above the bellybutton. − Breath in through your nose – the air should move downward so that you feel your stomach rise with your hand. The hand on your chest should remain relatively still. − Let your belly relax – you should feel the hand going down. − Exhale slowly through pursed lips while the hand on your chest remains still. *It might feel a little awkward at first since most of us are used to breathing with our chest. Repeat 5 to 10 times. ALTERNATE NOSTRIL BREATHING − Close your right nostril with your thumb. Breathe in through left nostril (4 sec). − Close left nostril with ring finger – close both briefly. − Open right nostril breath out (6 sec). − Breathe in through the right nostril (count 4). − Close the right nostril with thumb. Close both briefly. − Open left nostril – breath out (6 sec). − Repeat 6 to 8 times.

MINDFULNESS Mindfulness is a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting your feelings, thoughts, and bodily sensations, used as a therapeutic technique. THE RAIN TECHNIQUE R-Recognize what’s going on, what is troubling you? 1. Ask yourself “what am I feeling inside of me?” 2. Be courageous when asking yourself this question. A-Allow yourself to feel your emotions, experience your thoughts and sensations.

1. When we have unpleasant experiences we tend to react in different ways. We could be numbing ourselves to the feelings we experiencing. We could ignore our feelings by focusing our attention elsewhere or we focus on judgment, whether it’s directed at ourselves or others. 2. Take this time of allowance to be bold and as vulnerable as possible with yourself by just experiencing your feelings. Prevent yourself from resisting the experiences of your emotions I-Investigate your emotions through self-kindness 1. Pause and ask yourself, “What does my thought and emotions want from me?” “What am I feeling?” “Why am I feeling/thinking this?” “What are the thoughts and emotions experiencing within my body right now”. 2. Be intentional when you ask these questions and do so by being kind towards yourself, be connected to everything you feeling by being kind to your heart. N-Natural Loving Awareness 1. We become naturally aware of ourselves when we feel fully connected to ourselves. By completing the first three stages you have become naturally aware of yourself. When doing so we live in full openness of where we are presently in our thoughts and our emotions and do so lovingly. 2. Be in a loving relationship with your natural awareness. Example: I have sad emotions and sad thoughts but looking deep within me they are not who I am, they are simply an extension of me. Progressive Muscle Relaxation Progressive muscle relaxation (PMR) is an anxiety-reduction technique which involves alternating tension and relaxation in all of the body's major muscle groups. When we are under great amounts of stress, our muscles are under constant stress. By practicing PMR, you will learn how a relaxed muscle feels different to a tense one.

•

Lying down or sitting in a chair, focus on lengthening and deepening your breath. Focus on the inhalation and exhalation making the breath smooth and deep.

•

Now tighten both fists and tighten your forearms and biceps.

•

Hold the tension for five or six seconds.

•

Now relax the muscles.

•

When you relax the tension, do it suddenly, as if you are turning off a light.

•

Concentrate on the feelings of relaxation in your arms for 15 or 20 seconds.

•

Now tense the muscles of your face and tense your jaw.

•

Hold it for five or six seconds.

•

Now relax and concentrate on the relaxation for fifteen or twenty seconds.

•

Now arch your back and press out your stomach as you take a deep breath.

•

Hold it and relax.

•

Now tense your thighs and calves and buttocks … Hold … and now relax. Concentrate on the feelings of relaxation throughout your body, breathing slowly and deeply.

Stimulate the Vagus Nerve The vagus nerve is the longest nerve in your body. It connects your brain to many important organs throughout the body, including the gut (intestines, stomach), heart and lungs. The vagus nerve is also a key part of your parasympathetic “rest and digest” nervous system. It influences your breathing, digestive function and heart rate, all of which can have a huge impact on your mental health. But what you really need to pay special attention to is the "tone" of your vagus nerve. Vagal tone is an internal biological process that represents the activity of the vagus nerve. Increasing your vagal tone activates the parasympathetic nervous system, and having higher vagal tone means that your body can relax faster after stress. There are various ways that you can stimulate it to help you calm down. SPLASH COLD WATER ON YOUR FACE Splash cold water from the bottom of your chin up to the top of your head. The cold temperature is effective in stimulating the vagus nerve. You could even have a cold shower if you are feeling particularly overwhelmed or drink a glass of ice-cold water

GARGLE The vagus nerve activates the muscles in the back of the throat that allows you to gargle. When you gargle these muscles are contracted, which activates the vagus nerve and simulate the gastrointestinal tract. Can’t gargle? Try humming, chanting or singing really loudly to yourself. BUTTERFLY HUG Give yourself a butterfly hug. You can do this by wrapping your arms around yourself in a nice tight hug that each hand touches the shoulder. You can then start to move your hands like the wing of a butterfly, rubbing your hands up and down your arms. DANCE Moving your body in any way is a very effective way to activate the vagus nerve and creates a feeling of safety within your nervous system. NAME AND DRAIN Naming your experience out loud, such as “I’m feeling scared / / confused / overwhelmed” is a great way to provide a sense of safety to your nervous system. It is important to acknowledge these feelings, as they are your body’s way of letting you know that there is a threat un the environment. GET A MASSAGE The vagus nerve can also be stimulated by massaging several specific areas of the body. Foot massages (reflexology) have been shown to increase vagal modulation and heart rate variability and decrease the “fight or flight” sympathetic response.

References Brach, T. (2019). Feeling Overwhelmed? Remember “RAIN.” Retrieved from https://mrsmindfulness.com/r-n-four-step-process-using-mindfulnessdifficult-times/ Accessed April 29, 2020 Cleveland Clinic. (2018). Diaphragmatic Breathing. Retrieved from https://my.clevelandclinic.org/health/articles/9445-diaphragmatic-breathing Accessed 4 May 2020 Fallis, J. (2017). How to stimulate your vagus nerve for better mental health. Retrieved from https://sass.uottawa.ca/sites/sass.uottawa.ca/files/how_to_stimulate_your_vagus _nerve_for_better_mental_health_1.pdf Accessed 30 April 2020 Fasolo, A. (2020). 6 Psychologist-approved hacks for calming your nervous system, and mind. Retrieved from https://www.bodyandsoul.com.au/mind-body/wellbeing/6psychologistapproved-hacks-for-calming-your-nervous-system-and-mind/newsstory/4d9d9e977c369ef471684f3508b3401c Accessed 30 April 2020 Gentry, E. & Rhoton, R. (2018). Trauma Competency for the 21st century, the empowerment & resilience structure. Retrieved from https://www.udemy.com/course/certified-clinical-trauma-specialist-individual-cctsi/learn/lecture/12855738?start=15#questions Accessed 25 April 2020 Hazlett-Stevens, H., & Craske, M. G. (2003). Breathing retraining and diaphragmatic breathing techniques. Cognotive Behavior Therapy applying emperically supported techniques in your practice. Jerath, R., Crawford, M. W., Barnes, V. A., & Harden, K. (2015). Self-Regulation of Breathing as a Primary Treatment for Anxiety. Applied Psychophysiology Biofeedback, 40(2), 107–115. https://doi.org/10.1007/s10484-015-9279-8 Valenza, M. C., Valenza-Peña, G., Torres-Sánchez, I., González-Jiménez, E., CondeValero, A., & Valenza-Demet, G. (2014). Effectiveness of controlled breathing techniques on anxiety and depression in hospitalized patients with COPD: A randomized clinical trial. Respiratory Care, 59(2), 209–215. https://doi.org/10.4187/respcare.02565 Yogatailor. (2017). 3 Types of Controlled Breathing Exercises and How to Do Them. Retrieved from http://www.yogatailor.com/blog/Accessed 4 May 2020

You could also get more information on Student Counselling’s web page at http://www.cput.ac.za/students/life/counselling or follow the Blog at http://www.cput.ac.za/blogs/ for related posts and articles.

What this book is all about My name is Timothy Hebblewhite and I have been working in the HIV and AIDS field for over 20 years. One of the main focuses of this book is to assist people who have tested HIV positive to be able to live longer; I believe that once you know your HIV status, the journey begins to create a longer life so that we are able to reach our aspirations. Much of the information you will read in this book is not new, but seeing it on paper might just spark an understanding of the importance of looking after yourself. I also want this book to be user friendly enough to be able to assist anyone who needs some help when feeling ill or coping with a serious illness.

SOME THOUGHTS ABOUT “POSITIVE LIFE” Many problems can be resolved when people work together and give each other help and support The care a person receives is frequently the most important part of his or her treatment One of the greatest diseases is to be nobody to anybody. In life every second is a once off experience. Live it to its best, for you will never have it over again. The person who eats well does not need extra vitamins I would like to thank you for going through this book and hope that it has been of some help to you and those that you care for. Take care and regards

Timothy R Hebblewhite

www.onquehiv.co.za

No matter how we think about it, being told you are HIV positive is a traumatic experience, and as with any trauma, it takes time to be able to deal with it. No one has the right to say to someone “Just accept that you are HIV and move on”. Most people will carry their HIV status with them forever and will move their emotions around to accommodate this information. The only way of coming to terms with your status is to share it with someone, being able to say the words, “I am HIV positive” is the first step to managing your status. You need to be selective when disclosing your status and consider what value this disclosure has in your life. If you know that you will get care and support, then disclose, if you fear rejection, then be careful. Once you have completed this step, the information gathering starts. As part of the process of getting to know as much as you can about this disease, knowing what is happening in your own body, will help you to cope with what lies ahead. If you are on a medical aid or can afford a private doctor, you need to have your CD4 count done (this will show you how strong or weak your immune system is) as well as a viral load (this will show how many viruses there are in your blood). These tests can also be done at some state hospitals and should be done at least once a year.

Here are some basics that will help:          

What is HIV? What is Aids? What is being sick? What is the immune system? What can be done to increase immunity? What diet is good? What about staying well (future)? What about sex and marriage? What about support for the family? What about a will and dying?

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What is HIV? It is a virus which is transmitted from one Human to another, this virus destroys the Immune system (fighting cells) What is Aids? This is when you have almost no Immune System left (fighting cells) and your body cannot protect you from disease, this will cause you to get very sick. It is not Aids that kills you, but other diseases that infect your body. What is being sick? There are many different types of sicknesses that might invade the body, these sicknesses will be different from person to person. What will happen is that a combination of sickness will cause the immune system to fail and this eventually leads to death. What is transmission? This is the way that you “pass” the virus from one person to another. You cannot pass the virus on by casual contact, there must be blood/semen/vaginal fluid and there must be an opening for the fluid to go into. What is the Immune system? This is the body’s protection unit if you cut yourself or have an infection, the immune system will repair the damage. The immune system can go up or down. What about Religion? Each person’s religion needs to be respected and it is not the purpose of this booklet to tell you to believe in this or that, however what you believe could strengthen your resolve and make you feel better and help you fight this disease. What about Sex and Marriage? There is no reason why someone who is HIV+ cannot have sex. Even if both partners are positive, they must still use condoms in order not to re-infect each other. HIV does not prevent anyone from getting married or maintaining a relationship with their partner. What about support for the Family? People who are providing the support, also need support. There is a lot of tension and stress in caring for someone who has HIV/Aids and release needs to be found. Family support groups are also available and you should encourage your family to join one of these.

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HEALTH ISSUES How to examine a sick person In order to correctly help somebody who is ill it is important to establish what the illness is. This can only be done through questions. Here are some questions and signs and symptoms to look out for. What bothers you right now?  What makes you feel ?…  How and when did this sickness begin?  Have you had this trouble before or has someone in your family or neighborhood had it? General conditions of Health     

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Colour of person i.e. yellowy colour Temperature of person – take the temperature of the person to establish if they are running a fever or not. Breathing/Respiration – if breathing is shallow or high Pulse – take the pulse (adults 60 – 80 per minute, children 80 – 100 per minute and babies 100 – 140 per minute) Overall conditions of body i.e. any lesions, sores over the body, general wasting, whether the patient suffers from spasms, restlessness, or is hyperactive and noisy. Check blood pressure (normal – 120 over 80) CARE Guidelines for care

The comfort of a sick person The environment in which the person stays as well as their own personal space and environment is important. Liquids In nearly every sickness, liquids need to be taken constantly. Personal cleanliness and hygiene It is important that the person be clean and tidy in order to maintain dignity. Correct Food Nutrition plays an important part in recovery and a balanced diet needs to be maintained as far as possible. This does not necessarily mean only food but liquids as well.

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Communication and Dialogue Communication and dialogue between the patient and caregiver is of utmost importance. This is the only way to establish whether there is recovery from the illness or not. Rest and Relieving stress It is important for the patient to rest as much as possible and to keep stress levels as low as possible. Stress is one of the highest immune debilitating factors in any illness. Environment One of the most important factors in the environment is cleanliness and hygiene. Overall conditions of living are important to take note of i.e. prevention of bacterial infection.

Creating an objective: One of the ways that you can strengthen your immune system is to create daily objectives and then to reward yourself for these. What you will reach with this goal setting is to focus on the goal and not the disease as well as be able to reward yourself for achieving the goal. The example given is a basic one and can be adapted to accommodate your own life. Every day you have to make 2000 soldiers to increase your immune system. Award the following ‘PLUS’ points: Each meal = 250 Every hour slept = 50 A walk for 30 minutes = 200 Chatting to someone = 100 Shower or bath = 100 Brush your teeth = 25 Watching TV or listening to the radio = 100 Glass of water = 50 Subtract the following ‘MINUS’ points: Every cigarette after 5 = - 50 Every alcoholic drink after 1 = -100 No exercise = -200 An argument = - 500 If you did not eat one of your three meals = - 250 If you did not bath or shower = - 100 If you did not brush your teeth = -50

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You can make a list of things that you want to do for that day and as you do them, give yourself the points, you should ALWAYS try to have MORE points than you wanted. The more difficult things to avoid get higher points, such as smoking and drinking

A legacy…. What is a legacy? a legacy is something that is left behind when someone dies. A legacy could be in the form of material goods or just a memory. We all strive to leave something good of ourselves behind. Take ten minutes and go for a walk or sit quietly by yourself and consider what you will leave behind one day. If those that you love had to get together and discuss who you were as a person, what would they say? This thought process will help you to create a legacy. If you will be remembered as someone who did not care or was miserable your whole life, that should be unacceptable and you would need to decide if that is what you want. The gift of knowing what your legacy should be, is that you can create it every day of your life and if you struggle to do it on your own, find someone in your life that you can share this with and they will be able to guide you in the right direction when you are moving away from your legacy. You are welcome to write your legacy in this book and keep it as a reminder.

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NUTRITION The nutrients in our food To understand the principles of healthy food, it is important to learn about the nutrient composition of our food. We can divide the food we eat into four different food groups according to the most important nutrients it contains:  food rich in carbohydrates  food rich in fat  food rich in proteins  food rich in vitamins and minerals Food rich in carbohydrates and fat for energy Grains, like maize, wheat, millet, sorghum, rice and barley, potato, sweet potato, cassava, yam and legumes (beans and peas) are rich in carbohydrates (starch) as are sugars. They provide the body with energy. Food rich in carbohydrates is usually easy to digest and cheap. Oil, butter and margarine, fatty meat, chicken, fatty fish, peanut butter, nuts and seeds are rich in fats. Just like carbohydrates fats provide the body with energy, but fats can cause digestive problems. Food rich in proteins Meat, chicken, liver, fish, ants, caterpillars, milk, cheese, egg, beans, lentils, soya beans, ground nuts, peas, seeds and nuts are rich in proteins. Proteins build and repair the body. Proteins play an important role in the immune system. Proteins are made up of amino acids. Animal food products, like meat, milk and eggs will provide a range of amino acids the human body needs. Vegetable protein sources like legumes (beans, lentils, peas, round nuts etc.) do not provide the full range. Therefore they should be varied or combined with other (vegetable) protein sources. Good combinations are legumes with grains, milk or nuts. Food rich in vitamins and minerals Vegetables like green leaves, cabbage, pumpkin, tomato, squash, green beans, peas, avocado pear, carrot and fruits, like mango, orange guava, banana, marula, mulberries, mazhanje, baobab fruits, peach, pineapple, apple, paw-paw, plum, passion fruit, and lemon provide the body with vitamins and minerals. There are at least 17 different vitamins and 14 different minerals. Each one has a special use in the body. The body cannot work properly if any one is missing. Each of the vegetables or fruits is rich only in a few vitamins or minerals, so it is important to eat a variety. Vary in colour and vary in shape (leaves, fruits, roots). Dark green and orange or red vegetables and fruits are best.

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Balance Good nutrition includes a balance of proteins, fats, carbohydrates, vitamins and minerals. No single food contains every nutrient you need. A healthy meal is made up of at least one food item from each of the different food groups; so One food item providing energy One food item providing proteins One food item providing vitamins and minerals Guidelines for safe food handling Always wash your hands with soap before and after touching food. Keep hot foods hot and cold foods cold. Don’t eat food after the “best before” date has expired. Be extremely careful with left-overs. Do not eat leftovers unless put in the fridge immediately. Store food for not more than one day and boil before eating. Cook all animal products like meat, fish, eggs at high temperatures till well done because cooking destroys harmful bacteria. Do not eat soft boiled eggs. Only use plastic or Formica cutting boards for cutting raw and cooked animal products like meat. Wooden cutting boards cannot be adequately cleaned. Wash utensils and surfaces where you placed animal products before handling other foods. Use bleach to clean all working surfaces. Put meat, poultry or fish in plastic bags before putting them into your shopping basket and put them in the bottom to stop them from dripping on other food. Thoroughly wash fruits and vegetables that are to be eaten raw in order to remove bacteria from the skin. Cut off bruised parts. If it is not possible to wash them properly peel the skin off.

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FOOD RELATED ISSUES Lack of Appetite Lack of appetite is caused by chronic infections like diarrhea or mouth sores. Lack of appetite is a symptom of malnutrition and depression. Lack of appetite shows in different ways:  Not feeling hungry  feeling hungry but easily satisfied, not able to eat much  pain upon eating If you lack appetite you often do not eat enough food. This is dangerous as you need healthy food to be able to fight infections. The only way to cure lack of appetite is to eat! Suggestions to stimulate eating Follow the suggestions mentioned below to stimulate eating. Do not prepare food yourself, or stay near the kitchen. The smell of food may satisfy you. Eating is a social event. Do not stay alone in your bed with your food. Eat together with you family and friends, or ask them to join you at your bedside. Eat only healthy food. Junk food and cold drinks satisfy your appetite but do not provide you with the nutrients that you need. Drink a lot, but do not drink during or just before meals as this will fill your stomach. Sit straight up when eating, or lean a little backward on some pillows. This removes pressure from your stomach. Do not lie down until 20 minutes after eating to avoid vomiting. Chicken/vegetables soups, porridge and fruits like bananas are usually tolerated best. If you feel nauseous, lemon juice in hot water or tea (without milk) can help. It also helps for a dry mouth. If you are nauseous do not eat fatty food. Some medicines, especially for cancer and TB, can cause a change of taste. Fruits, especially sour fruits like orange and pineapple will taste nice. Exercise and fresh air stimulate appetite.

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Weight It is important to weigh yourself each week and keep records. You want to make sure you maintain weight. It is possible that you think you are not losing weight, while in fact you really are. If you are losing some weight, try to find out the reason. If you do not have a scale, make an arrangement with your pharmacy or clinic to weigh yourself regularly. Weight Gain To stop weight loss we have to treat the cause of the problem first. Do the following:  Stop Diarrhea – check infections, eat easily digestible food  Treat infections – get medical treatment. Adjust food intake – eat soft liquid food if you have mouth sores, increase protein content in the diet Once the diarrhea is under control and the infections are treated you have to stop the process of body wasting and try to reverse some of the body breakdown mechanisms. This may take a long time depending on the state of malnutrition. You should be careful with fat and slowly introduce it in your diet. Protein content of the food should be increased to try to rebuild some depleted sources. The energy content of the food should be increased by eating more carbohydrates (starchy food). Exercise Regular exercise is important to the healthy functioning of your body. It strengthens your muscles and this helps to strengthen your immunity. If you need to gain weight, then along with eating more, you also have to exercise. If you don’t, the extra you eat becomes a padding of fat. That is not very helpful because you need stored protein to resist infections. Exercise also increases your appetite and personal sense of well being. Walking, jogging, swimming and dancing are good ways to exercise.

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Guidelines for weight gain *

Introduce one new food item at a time. If this item causes diarrhea, then stop eating it. * Increase protein content of the food by adding beans, peas, lentils, eggs, fish, meat etc. Split peas are good to start. Add peanut butter to your porridge. * Slowly increase the fat content of your food. * Increase the energy content of your food by eating a high carbohydrate and high protein diet. * Carefully introduce milk products. Fermented products like yoghurt are more easily digestible. * Most vegetables and fruits can be eaten. First time you eat them just eat a little. Avocado pear, dark leafy greens, beetroots and mangos are very nutritious. Useful recipes for weight gain Pumpkin * Pumpkin, peanut butter Boil 1 cup of chopped pumpkin in water with a pinch of salt for 30 minutes till very soft. Add 2 tablespoons of peanut butter and mash. Eat on its own or with rice for extra energy. Rice and spinach soup * Rice, spinach, peanut butter Boil the rice with 4 cups of water for every cup of rice for 40 minutes. Add chopped spinach and 2 table spoons of peanut butter when the rice is cooked. Stir and cook slowly for 10 more minutes. Pea Soup * Split peas, rice, carrot, onion, salt, thyme, bay leaf, parsley Boil split peas with rice in water and a pinch of salt. Add chopped carrot and onion. Add green herbs. Cook slowly for one hour till soft. Mash stirring vigorously with a whisk or masher. For a change cook a piece of sausage with the soup and cut in pieces. Beef broth * Beef, water, carrot, onion, thyme, parsley, pepper, salt Boil beef with chopped vegetables, water and herbs till beef is well cooked (about 90 minutes)

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White flour sauce * 1 Tablespoon of margarine, 1 tablespoon of flour, 1 cup of milk Melt butter over medium heat. Remove pan from heat and mix in flour. Return to heat and stir till cooked. Slowly add milk or broth and whisk until smooth and thickened. Mix the sauce with the boiled beef from the broth or mix the sauce with any cooked vegetables or peas.

Mixed beans with spinach * 1 cup of mixed beans, 4 tomatoes, spinach or other green leaves, 1 clove of garlic, 2 onions, pepper, salt. Boil beans in water with a pinch of salt. Fry chopped onions and garlic in a little margarine or oil. Add chopped tomatoes, boiled beans and bring to boil. Add chopped spinach or other green leaves, cover and boil slowly until the leaves are soft. Eat with rice. Food to improve digestion Fermented food In our intestines bacteria lives that helps us to digest food. Antibiotics, cancer treatment, TB treatment (=antibiotics) destroy bacteria, both bad and good ones. Therefore treatment with antibiotics can cause digestive problems or diarrhoea. Fermenting makes food easier to digest. This is good for digestive problems, especially diarrhoea and thrush. To restore good bacteria in the digestive tract it helps to eat cultured or fermented food products. Eat the drinks/foods listed below as a medicine, three cups a day, before or with meals when on antibiotic treatment. Continue for two weeks. * Sour water. * Sour porridge * Yoghurt, unsweetened * Sprouts

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Sprouting Sprouts are germinating seeds, which are starting to grow into a new plant. Sprouting increases the vitamin, mineral and protein content of the food that you germinate. Method  Soak seeds for 6 – 12 hours and drain off water.  Keep the seeds in an open container (jam jar), cover with mosquito mesh or cheese cloth.  Rinse (add water and drain off) three times a day or more when hot.  When ready add to soups, stews, salads, or have on bread.

Lentils Mung beans Wheat Maize

Amount 1 cup ½ cup 1 cup 1 cup

soak 12 hours 12 hours 12 hours 12hours

grow 2-4 days 2-4 days (dark) 2-3 days 3-4 days

Other food to improve digestion Lemon and orange skin contain pectin. It helps to absorb fat. Add grated skin to your soups and stews. You can even add a little to porridge for taste. Lemon juice helps digestion of fat. Squeeze some lemon juice in your soups and stews. Paw-Paw helps to improve the digestion of meat protein. Add paw-paw to dishes with meat. Recipes Sour water is good for diarrhoea, thrush and ulcers and helps digestion when on antibiotic treatment. Sour water has a strong smell. Sour water * Use any grain, millet, sorghum or barley Wash the grain and soak 1 cup of grain with 3 cups of boiled and cooled water. Cover tightly in plastic container and leave for 2-3 days. The sour water is ready when it forms bubbles. Strain the water and keep in a cool place. A second and third batch of sour water can be made from the same grain. Add new boiled and cooled water. After 1 day it will be ready.

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Fevers When a fever goes up higher than 40 degrees Celsius it must be lowered at once. The following are useful guidelines:  Put a person in a cool place and remove all clothing  Fan him/her  Pour cool water not cold water over him/ her  Give him/her plenty of cold water to drink  Give medicines to bring down fever, aspirins seem to work well. Shock Signs of Shock  Weak, rapid pulse  Cold sweat and paleness  Damp skin  Mental confusion  Weakness, loss of consciousness  Low blood pressure, blood pressure drops dangerously low What to do to prevent or treat shock  Have the person lie down, with his feet together and his head down  Stop any bleeding  If the person feels cold cover him/her with a blanket  If conscious and able to drink give water or other fluids  The “sugar water” theory does help  Talk to him or her and establish consciousness  Treat the wound if any  If she/he is in pain give aspirin (must not contain sedative such as codeine).  Keep calm and reassure person.

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Dehydration Some HIV/Aids patients could die from diarrhea because they have a lack of water in their bodies. Signs of dehydration: Thirst is often the very early sign of dehydration. Little or no urine or urine is dark yellow Sudden weight loss Dry mouth Sagging in of soft spots in infants Sunken tearless eyes Loss of elasticity or stretchiness of the skin Prevention and treatment of Dehydration     

When a person has watery diarrhea act quickly. Give lots of liquid to drink Keep giving food and to babies give breast milk often Even if the person vomits do not stop giving fluids. Not all the fluids are vomited. Warning: If dehydration gets worse or any other danger signs appear go for medical assistance

Home recipe for re-hydration drink 1L clean water ½ teaspoons sugar Caution: Before adding the sugar taste the drink and make sure it is less salty than tears. Home recipe for re-hydration drink for some-one who is not eating 1L clean water ½ teaspoon salt 8 heaped teaspoons powered cereal Boil for 5 – 7 minutes; allow to form a liquid and watery porridge. Cool quickly and give to child that is ill.

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Diarrhea When you have watery stools, more than two twice a day, you have diarrhea. Diarrhea is more common and more dangerous in poorly nourished people. Diarrhea has many causes. Sometimes special treatment is needed. Most diarrheas can be treated successfully in the home, even if you are not sure of the exact cause of the diarrhea. The main causes of diarrhea        

Poor nutrition. This weakens the person and makes diarrhea from other causes more frequent or worse. Virus infection or “intestinal flu” An infection in the gut caused by germs like bacteria or amoebas. Worm infections Infections outside the gut like ear infections, especially in children Malaria Food poisoning Inability to digest milk (in severely malnourished people) Side effects of certain medicines such as antibiotics Eating too much unripe fruit Eating greasy foods

For most cases of diarrhea no medicine is needed. If the diarrhea is severe, the biggest danger is dehydration. If the diarrhea lasts a long time, the biggest danger is malnutrition. So the most important part of treatment has to do with enough liquids and the right food.

It is better not to use anti-diarrhea medicines (like Imodium). These medicines, often with kaolin and pectin act like plugs; they make the diarrhea thicker and less frequent, but do not correct dehydration or control infection. The infected material that needs to come out of the gut will stay longer in the body. Antibiotics are useful in cases of diarrhea with blood or when accompanied by a fever. When there is no fever or no blood these medicines should not be used. They can make the diarrhea worse.

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It is very important to make every effort to control diarrhea. Drink a lot of fluids to prevent dehydration and adjust your diet. Sugar-salt-solution, broth, diluted orange juice and barley or rice water are good drinks to restore the salts lost through the diarrhea. To prepare sugar-salt-solution add 6 level tablespoons of sugar and ½ level teaspoon of salt to 750ml of clean water, stir well till the sugar and salt are dissolved. Drink as often as possible, at least every time you pass a stool. Get medical treatment if you have diarrhea and a fever develops (for more than 6 hours), if blood appears in the stool (dysentery), if diarrhea lasts more than 4 days and is not getting better, or if you are very sick, weak or malnourished.

Guidelines in case of diarrhea        

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Eat soft, mashed, liquid foods that are easy to eat and swallow, like porridge and soup. Eat small meals, 5 or more per day. Drink a lot of water to prevent dehydration. Eat food that is low in fat. Do not add cooking oil and margarine. Cut away the visible fat off meat or skin off chicken. Boil rather than fry. Eat starchy food that is high in carbohydrates to provide energy like rice, potatoes, maize, and bread. Eat refined foods like white rice, white bread, pasta. Avoid milk and milk products. Eat soft fruits and vegetables like banana, paw-paw, watermelon, pumpkin, squash, potatoes and carrots. These provide the necessary vitamins and minerals. Avoid strong or acidic fruits and vegetables like onion, tomatoes and pineapple. Do not use hot spices like curry. Prepare fresh food from fresh ingredients. Do not store prepared food and risk food poisoning.

Rice porridge * Rice, salt, cinnamon, sugar Boil the rice with 3 cups of water for every cup of rice. Add a little salt. Cook slowly for one hour. Add sugar and cinnamon when serving.

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Carrot Soup * Carrots, salt, cinnamon, water Chop carrots. Bring to boil in water and cook slowly until soft. Mash the carrots. Add a pinch of salt and ground cinnamon. Pumpkin Stew * Pumpkin or butternut, beef Boil beef with chopped pumpkin. Cook slowly until the beef and pumpkin is very soft. Mash the vegetables with a whisk or masher. Cut the beef in small pieces and add to the pumpkin. You can boil mealie meal with the stew to add carbohydrates for energy. Rice soup * Rice, water, salt 1 cup of rice to 4 cups of water and salt. Cover the pot and cook slowly for one hour. You can make different rice soups by adding other ingredients like: - Grated carrot and cinnamon - Finely chopped garlic, chopped liver and grated pumpkin. Bean Broth * Beans, salt Boil the beans with more water than usual, until they are well cooked. Drink the bean broth or use it to make other soups. Serve the beans to family members that do not have diarrhea. You can boil the broth with mealie meal for more energy. Chicken soup * Chicken, squash, pasta (macaroni, spaghetti or noodles) Boil pasta until it is very soft. Boil chicken and squash in water and salt. Cook Slowly until very soft. Mash the vegetables with a whisk or masher and cut the chicken in small pieces. Add the boiled pasta. For an exotic change add pieces of paw-paw or banana to the soup and boil for a few more minutes. Potato soup * Potatoes, carrots, thyme and salt Cut potatoes and carrots in small pieces and boil in water with salt. Cook slowly till very soft. Mash the vegetables. For a change add some fat free minced meat to the vegetables and boil as above.

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TIP:

If your soup turns out too thin: mix 1 spoon of corn flour (Super fine) with a little water. Add to the soup and heat till boiling. Weight loss is serious in people with HIV and Aids, it is a sign the disease is taking over. Serious weight loss (10 % of body weight in 2 months) is generally associated with the onset of clinical. Think of food as fuel, which is used to make your body operate. If you consume less energy than your body needs, your body will adapt to the lack of fuel and slow down its processes to conserve that fuel. If you eat less than you need, you will: * Feel cold, especially hands and feet * Get dry skin and hair, body rashes and itching * feel a fullness and swelling of the hands and feet, rings and Shoes will feel tight, due to edema or water retention * Suffer dizziness and light headedness * Have a pulse rate below 60 * feel depressed * feel tired and weak * experience lack of appetite

WARNING: No greasy foods, alcoholic drinks or raw fruits VOMITING Danger signs with vomiting Dehydration Severe vomiting that lasts for more than 24 hours Violent vomiting especially if it is a deep green or brown and smells of faeces Constant pain in the gut Vomiting of blood To help control vomiting Eat nothing while vomiting is severe. Sip cola drink, ginger ale or some herbal teas like chamomile. For dehydration give small frequent sips of cola, tea or re-hydration drink. If vomiting does not stop use a vomit control medicine like Promethazine

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Headaches and Migraines A migraine is a severe throbbing headache often on one side of the head only. To stop migraines do the following at the first signs: Take two aspirins with a cup of strong coffee or black tea Lie down in a dark quiet place and try and relax WARNING: Do not use during pregnancy Sinus Trouble Signs:  Pain in the face above and below the eyes  Thick pus or mucus in the nose often with a bad smell  Fever (sometimes)  Certain teeth may hurt Treatment:  Drink a lot water  Sniff a little salt water into the nose  Put hot compress on the face  Use decongestant nose drops If the person does not get better, seek medical assistance PREVENTION: When you get a cold or stuffy nose keep your nose clear. PNEUMONIA Signs:  Sudden chills and then high fever  Rapid shallow breathing with little grunts, sometimes wheezing  fever  Cough (often with yellow rust colored or bloody mucus)  Chest pains  Person looks very ill  Cold sores often appear on the face or lips TREATMENT  For pneumonia, treatment with antibiotics can make a difference between life and death  Give aspirin to lower the temperature and lessen the pain  Give plenty of liquids. If the person will not eat give him/her liquid food or re-hydration drink.  Ease the cough by giving the person lots of water and having them breathe plenty of hot water vapors.  If the person is wheezing an anti-asthmatic medicine may help.

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Sore mouth A sore mouth is caused by infections in the mouth. Although eating is more difficult, the need for nutrients is higher because of the infection. It is important to adjust the food you eat in order to get enough food and prevent weight loss. Guidelines for mouth sores Avoid foods that irritate like: * Spicy foods: chilies, curries * Acid foods: oranges, pineapple, vinegar and cold drinks * Foods that need a lot of chewing * Food that is sticky like white bread with peanut butter * Very hot and very cold food For relief: * Chew on a piece of tomato, green mango or chonjwa leaves. This helps to relieve the pain. * Eat soft mashed foods, like avocados, squash, pumpkin, yoghurt, mince, paw-paw and bananas. * Drink nutrient rich liquids such as vegetable juices, soups and Fruit juices. * Rinse your mouth with cinnamon tea. ¼ teaspoon of powdered Cinnamon in 1 cup of boiling water. Cover and allow cooling. * Rinse your mouth with garlic tea. 2 chopped cloves in 1 cup of boiling water. Cover and allow cooling

Candida/thrush

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Candida is a yeast infection. An outbreak of Candida is a sign of poor resistance. It shows as thrush in mouth with white spots on the gums and on the sides of the tongue, burning, swelling and redness of the mouth. This not only causes taste changes but can also be responsible for pain when eating and swallowing. Thrush can also occur in the vagina. In the bowel it causes poor absorption and weakness. Guidelines for treatment of Candida * Try thyme teas, as mouth wash, or pour it onto your vagina * Try to increase body temperature by eating more protein rich food. Temperatures may be low because of eating too little food. * Use warming spices such as cinnamon, ginger or rosemary. Prepare teas or use the spices when cooking your food. * Use garlic: - In the mouth: It is best to chew the peeled clove. - In the vagina: Insert a whole peeled crushed clove. - In the bowel: Swallow a crushed clove as a pill or make garlic tea: Chop 2 cloves of garlic. Bring to boil with 1 cup of water and boil slowly for 5 minutes. Add parsley if you wish. Use of garlic helps for many infections such as Candida, herpes, and gut infection. When you have an infection take 5-6 cloves per day, for 3-4 days. For example 1 cup of garlic tea with 2 cloves three times a day. Or just chew the cloves and swallow. To prevent infections use 1 clove of garlic every day!

Skin Problems

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Some skin problems are caused by diseases that affect the skin like ringworm, or warts. Other skin problems are signs of disease that affect the whole body such as rash or measles or sore dry patches of pellagra caused by under nutrition. Certain kinds of sores or skin conditions may be signs of serious diseases like TB or syphilis. Candida and Herpes zoster are signs of poor immune response.

Poor skin condition can be caused by lack of vitamin A (found in yellow and orange vegetables, green vegetables, liver and garlic) or Vitamin B6 (found in germ, whole grains, seeds and nuts, banana and green leafy vegetables. Although many skin problems need specific treatment, there are general measures that often help. Guidelines for skin problems * If the area is hot and painful: - treat it with heat. Put hot moist cloths on it. Raise the affected area. * If the area itches: - treat it with cold. Put cold wet cloths on it. - apply slices of tomato, leave for one hour, and then allow the affected skin to dry. Next morning rinse gently with clean water. Continue every day until improvement. - tie the skin of paw-paw fruits on the area. * If the area is usually exposed to the sun: - cover it against sunlight (long sleeves, hat). * If the area is normally covered with clothes: - expose it to sunlight, for 20 minutes 2 or 3 times a day. * In case of open wounds: - apply the slime of aloe by pressing a freshly cut part of the plant on the wounds (also in case of herpes). When the wound is infected rub the plant in the wound to clear the puss. * Herpes zoster can be suppressed by eating oats porridge daily. * An itchy skin can be a sign of weight loss.

Colds, flu and cough

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Colds and flu are common virus infections that may cause a runny nose, cough, sore throat and sometimes fever. Colds and flu almost always go away without medicine. It is not necessary to use penicillin, or other antibiotics, as they will not help.  Drink plenty of water and get enough rest.  Paracetamol helps lower fever and relieves headaches.  No special diet is needed. However fruit juices like orange juice are helpful.  Use a handkerchief when sneezing to prevent infecting others, and stay away from babies. If a cold lasts more than a week, or if a person has fever, or coughs up a lot of mucus, see a doctor as an antibiotic may be needed. Coughing is not a sickness by itself but a sign of many different sicknesses that affect the throat or lungs. Coughing is the body’s way of cleaning the breathing system and getting rid of mucus and germs in the throat or lungs. So when a cough produces mucus, don’t take medicine to stop the cough, rather do something to help loosen and bring up the mucus. To loosen the mucus: * Drink lots of water * Breath hot vapors. Take a pot with very hot water and cover your head with a towel. Breathe the vapors deeply for 10 minutes, two times a day. You can add eucalyptus (gum), mint or thyme leaves or vaporub, but hot water works just as well alone. * Onions are good for colds, coughs and blocked noses. Before going to sleep cut an onion in pieces and put next to your bed. * Cough syrup for adults Mix one part of honey with one part of lemon juice and one part of cane spirit 40 %. Shake or stir well. * Cough syrup for children Mix one part of honey with one part of lemon juice. Shake or stir well. * Cough syrup with plant extract Add 30 ml of lemon juice in a clean 100ml bottle. Add plant extract: 20ml of adults, 10ml for children. Fill up the bottle with honey. Close the bottle and shake well. Use a large syringe (Without a needle, from the pharmacy) to measure the amounts.

Recipes for colds

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Onion tea for blocked and runny noses Put one quarter of an onion in a cup of boiling water. Cover and leave for 5 minutes. Strain. Drink 1 cup three times a day. Ginger-cinnamon tea for chesty colds or TB Add ½ teaspoon of chopped fresh ginger to 1 cup of boiling water. Boil slowly for 10 minutes. Add ¼ teaspoon of ground cinnamon. Cover and allow to stand for 5 minutes. Strain the tea. Drink 1 cup three times a day. Start drinking the tea as soon as you feel the cold coming. Thyme tea for dry cough Add ¼ teaspoon of dried thyme leaves to 1 cup of boiling water. Cover and leave for 5 minutes. Strain the tea. Drink 1 cup three times a day. Guava tea for persistent cough Add one guava, one lemon and one eucalyptus leaf to 1 cup of boiling water. Cover and allow to stand for 5 minutes. Take a sip three times a day. Lemon tea for flu Squeeze a lemon. Add the juice to ½ cup boiling water. Add sugar if you like. Drink as hot as possible, 1 cup three times a day. Eucalyptus extract for sore throat Fill up an empty beer bottle with leaves of eucalyptus (gum tree). Press well with a knitting needle or stick to get in as many leaves as possible. Fill up with alcohol 40 % (for example cane spirit). Press with the knitting needle to get the air out. Close the bottle. Leave in a dark place for two weeks. Strain off the alcohol/plant extract. Use 3 drops of extract on the back of the tongue in case of a sore throat. It disinfects the throat. Start using the extract as soon as you feel a sore throat coming. Continue to use the drops every 2-3 hours until you feel no more pain. You can use the extract to prepare cough syrup. Thyme extract for sore throat Use 20 grams of dried thyme leaves (1 refill packet). Add 100ml of alcohol 40 % (for example cane spirit). Keep in a closed bottle in a dark place for two weeks. Strain off the alcohol. Use 3 drops of extract on the back of the tongue in case of a sore throat. Thyme has antiseptic properties. Start using the extract as soon as you feel a sore throat coming. Continue using the drops 2-3 hours until you feel no more pain. You can also use the extract to prepare cough syrup. Bed sores

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Bed sores are caused by a break in the skin where there has been constant pressure applied. Sores form over the bony areas of the body as well as the hips, back, elbows, feet and buttocks. Treatment:  Get out of bed as much as possible  Change position every two hours  Use soft sheets and padding  Wash and dry the body well  Air dry sheets in the sun  Straighten the sheets Stress: Signs of stress Stress can manifest itself in a wide range of signs and symptoms, psychological, behavioural and physical. Here are some signs:  Loss of confidence and self-esteem  A tendency to withdraw – both from clients and from colleagues  Loss of sensitivity in dealing with clients  Loss of quality in performance of work  Irritability  Difficulty getting on with people  Tearfulness  Loss of interest in and commitment to work  Loss of punctuality and neglect of duties  Feelings of inadequacy, helplessness and guilt  Loss of concentration  Sleeplessness  Excessive fatigue  Depression  Bowel disturbance  Many of these feelings are not of themselves unhealthy, but they become so if they are neglected or suppressed and allowed to accumulate.

What are the causes of stress and burnout?

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 Financial hardship  Stigma associated with HIV and Aids  Secrecy and fear of disclosing your HIV status  Oppressive workloads  The fact that Aids is incurable  Unmet needs of children  Lack of space and privacy in work environment  What can you do to relieve stress and burnout?  Sort out your financial trouble and make arrangements if needed  Disclose your status to those who will offer you care and support  Negotiate your workload to make it more manageable  Start planning your future as far as possible  Make provision for your children  Take time out as far as possible for yourself  Start a hobby and keep yourself busy  Create a diary or journal for your children or partner  BREATHE !!!!! Who can help me? Create a list of partners and additional resources that are available within your area.. The following should be part of your list: Aids organisations Aids friendly doctors & churches Chemists & clinics Dept of health & local hospital Taxi/transport

USEFUL HERBS

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Benefits found by some people living with HIV and Aids Aloe Helps relieve constipation How to use: Use as extract; boil and drink the concentrated water. To be used in limited amounts; stop immediately if it causes cramps or diarrhea. Basil Helps relieve nausea and aids digestion; has an antiseptic function for mouth sores. How to use: Add to food to treat nausea and digestive problems. Use as gargle for mouth sores. Cardamom Helps with digestive problems, pain, diarrhea, nausea, vomiting and loss of appetite. How to use: Add to food during cooking or prepare as tea Cayenne Stimulates appetite, helps fight infection, and heals ulcers and intestine inflammation How to use Add a pinch to cooked or raw foods. For an energizing drink add to fruit juice or water Chamomile Helps digestion and provides relief for nausea How to use: Prepare tea from the leaves and flowers and drink several cups throughout the day

Cinnamon

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Good for colds and for weakness after colds or flu. Also used when feeling cold, for diarrhea and nausea. Stimulates appetite. Gently stimulates digestive juices encouraging bowel movements. How to use Either add to meals or in tea, particularly ginger cinnamon tea for chesty colds or tuberculosis Cloves Stimulate appetite, help weak digestion, diarrhea, nausea and vomiting How to use Use in soups, stews, warmed fruit juice and tea Coriander Helps to increase appetite and reduce flatulence. Controls bacteria and fungi How to use Add herb to meals Eucalyptus Has an antibacterial function, particularly for lungs and during bronchitis. Eucalyptus oil from leaves increases the blood flow and reduces the symptoms of inflammation. How to use Prepare tea from the leaves of extract Fennel Helps to increase appetite, combat flatulence and expel gas How to use Add as spice in foods or prepare tea from the seeds. Use in limited amounts Garlic Has antibacterial, antiviral antifungal function, particularly in the gut, intestines, lungs and vagina. Helps digestion and feeling of weakness. Also good for thrush, throat infections, herpes and diarrhea. How to use Prepare in tea or energy drink or use in food Ginger

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Improves digestion, energizes, relieves diarrhea and stimulates appetite. Used for treating common colds, flu and nausea. How to use Use either as a spice in meals or prepare a ginger tea Lemon Is antibacterial and helps digestion How to use Add lemon juice to food or drinks Lemon grass Has a calming effect as well as soothing digestion and alleviating stress How to use Use as tea Mint Has an anti-inflammatory effect How to use Use as tea or gargle for mouth sores. Chew mint leaves to aid digestion. Parsley Reduces intestinal colic. Stimulates stomach secretions and activities and produces a feeling of hunger. The seed is used to remove excess water from the body How to use Add raw or cooked to food Peppermint May help nausea. Reduces colic (abdominal pain and cramps), helps control diarrhea and stops vomiting. Used for relieving tension and sleeplessness How to use Prepare as tea by boiling the leaves for about ten minutes. Add to food. (Peppermint can easily be grown in the garden and or in a pot near the house)

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IMPORTANT VITAMINS AND MINERALS FOR PEOPLE LIVING WITH HIV AND AIDS Vitamin A Makes white blood cells – essential for vision, healthy skin and mucosa, teeth and bone development. Protects against infection associated with accelerated HIV progression. Source All yellow and orange fruit and vegetables, dark green leafy vegetables, alfalfa, liver, oily fish, diary products and egg yolks Thiamine Vitamin B1 Important for energy, metabolism, supports appetite and nervous system functions Source Whole-grain cereals, beans, meat and poultry and fish Riboflavin Vitamin B2 Important for energy metabolism, supports health and integrity of skin, nervous and digestive systems Source Milk, fish, eggs, meat, poultry, peanuts, whole-grain cereals Vitamin B6 Facilitates metabolism and absorption of fats and proteins, helps to make red blood cells. Source Sweet potatoes, white beans, maize, avocados, cabbage, whole-grain cereals, seeds, brazil nuts, walnuts, eggs, leafy green vegetables, alfalfa, banana, legumes, meat and fish

Folate

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Required for building new cells, especially red blood cells and gastrointestinal cells Source Liver, red meat, green leafy vegetables, fish, oysters, legumes, groundnuts, oilseeds, whole-grain cereals, egg yolks and avocados Vitamin B12 Important for new cell development and maintenance of the nerve cells Source Red meat, fish, poultry, seafood, sardines, cheese, eggs, milk, wholegrain cereals, and seaweed Vitamin C Helps the body to use calcium and other nutrients to build bones and blood vessel walls. Increases iron absorption. Increases resistance to infection and acts as an antioxidant. Important for protein metabolism. Source Citrus fruits (such as baobab, guava, oranges and lemons) cabbage, green leaves, tomatoes, sweet peppers, potatoes, yams and cooking plantains. Vitamin C is lost when food is cut up, reheated or left standing after cooking Vitamin E Protects cell structures and facilitates resistance to disease Source Leafy vegetables, vegetables oils, peanuts, egg yolks, dark green vegetables, nuts and seeds, whole-grain cereals

Calcium Builds strong teeth and bones, aids heart and muscle functions, blood clotting and pressure Source Milk, green leaves, shrimps, dried fish (with bones), nuts, beans and peas

Iodine

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Ensures the development and proper functioning of the brain and the nervous system Source Fish, seafood, milk and salt with iodine Iron Transports oxygen to the blood, eliminates old red blood cells and builds new cells Source Red meat, poultry, liver, fish, seafood, eggs, peanuts, beans, some cereals, green leafy vegetables, seeds, whole grain cereals, dried fruit and alfalfa Magnesium Strengthens the muscles and is important for proper functioning of the nervous system. Involved in bone development and teeth maintenance Source Cereals, dark green vegetables, seafood, nuts and legumes. selenium Zinc Reinforces the immune system, facilitates digestion and transports vitamin A Source Meat, chicken, fish, cereals, leafy green vegetables, seafood, oysters, nuts, pumpkin seeds, milk liver, whole-grain cereals, egg yolks, garlic and legumes.

What about a Will?

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There are two types of wills. 1. Living Will This will is drawn up by a person while they are healthy and it states that the doctor has the right to stop all mechanical assistance to life once the patient is considered medically dead. 2. Last Will and Testament This is a document drawn up with Legal Assistance. This states what will be done with the estate of the deceased. Making a Will A will is a document you write to say what should happen to your things when you are dead. Your Will makes sure there are no arguments or fighting over the things your own. These are the things that should be in your Will: Full personal details     

Your full names, age, identity number and permanent address. Your marital status and whether you are married in or out of community of property, or you are in a customary marriage. Names, sex and ages of children, whether they are single or married. Details of relatives, other people or groups who you write about in your Will. The name and details of the person who will take care of your Will. This Executor will divide your things after you have died. They must do what you have asked for in your Will. This person could also have Power of Attorney. It can be a person whose name is in your Will to receive something.

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A will is a legal document A piece of paper that is legal means that everyone has to obey what is written down. But there are very important things to do to make sure it is legal.

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Write everything down, or get someone you trust to write it down for you. This person’s name must not be in your Will. Sign every page. If you cannot write you could put an X instead of the signature. But it would be better to ask someone to sign for you. If you choose someone to sign for you, you must do this in front of a Commissioner of Oaths, such as a policeman. You must sign your Will in front of two witnesses, older than 14 years. They must also sign the Will. All of you must sign in front of one another. A witness cannot be someone whose name is written in Will and who will get something when you die. Witnesses only sign to say that they were there and signed your Will at the same time as you. The witness does not have to read the Will. They do not need to know what you wrote in the Will. You do not need their advice on whose names to put in the Will, or what you should give to different people.

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Example of a Will MY WILL Only a person older than 16 can write a Will. They must understand fully what the Will means. Date …22nd March 2020 ……………………………………………………………………………………………………… I …John Smith ……………………………………………………………………………………………(my name) Say that this is my Will. Identity number or date of birth 123456789 40th April 2020……………………………………………………………. Address ……2 Long St Cape Town ………………………………………………………………………………………………. ………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………….. Married or single ………married ……………………………………………………………………………… Names, sex and ages of children: …………………………………………………………. …………………Mary, female 10 years James, male 5 years ……………………………………………………………………………………… …………………………………………………………………………………………………………………..

This is my last Will, and it replaces any other Will I have.

2. I would like ……Angela Carr……………………………………………… (Name of person) To take care of my Will after I have died.

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I would like the Master of the High Court or his representative to sort out my Estate. If my Estate is worth more than R50 000, l would like:

…………Peter JONES ……………………………………………………………..(Name of person) to be my Executor. (Estate means my home, belongings, money and everything I own)

I would like to give my Estate to:

………ANN SMITH……………………………………………………(name of person/people) 5.

I would like to give these special things (items) to these people:

My CD COLLECTION ………to ……..ROBERT PRINCE who lives at 11 FIR STREET CAPE TOWN…….. …………….(address) My (item) ………to …….. (name of person) ………… who lives at…….. …………….(address) My (item) ………to …….. (name of person) ………… who lives at…….. …………….(address)

Signature Witness 1: ………………………………………………………………………………. Signature Witness 2: ………………………………………………………………………………. My signature or initial : …………………………………………………………………………..

Example of a Will

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MY WILL

Date ………………………………………………………………………………………………………… I ……………………………………………………………………………………………… Say that this is my Will. Identity number or date of birth ……………………………………………………………. Address ……………………………………………………………………………………………………. ………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………….. Married or single ……………………………………………………………………………………… Names, sex and ages of children: …………………………………………………………. ………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………..

This is my last Will, and it replaces any other Will I have.

I would like …………………………………………………… to take care of my Will after I have died.

I would like the Master of the High Court or his representative to sort out my Estate. If my Estate is worth more than R50 000, l would like: ……………………………………………………………………….. to be my Executor.

I would like to give my Estate to:

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…………………………………………………………… 5.

I would like to give these special things (items) to these people: My ….………to ……..………… who lives at…………………………………………… My ………….to ……..………… who lives at………………………………………… My ….………to ……..………… who lives at…………………………………………… My ………….to ……..………… who lives at…………………………………………

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NOTES

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QUESTION & ANSWERS ARV’s

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WHAT EXACTLY ARE ARV’s? ARV’s control the replication process of the HI virus, which attacks your immune system by making fake copies of your DNA so it seems like a normal part of your body, fooling it into thinking that the HIV particles are friendly and so don’t need to be attacked like other viruses. This process causes the virus replication to slow down considerably, therefore allowing your immune system more time to fight infections.

ARE ARV’s A CURE? Antiretroviral’s (ARVs) only extend life, these drugs are NOT a cure for HIV and/or AIDS. ARVs can, in some cases, extend the life of somebody living with HIV for as much as eight to 12 years or longer, but there is still no cure for HIV and one can still eventually die from AIDS-related causes.

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WHY IS THERE NO CURE? HIV is very smart – not only can it fool your body into thinking that it is friendly, so that your T-helper cells (white blood cells) let down their guard, but it can also change its form. This means that every time a new drug is found to treat the disease, the virus changes (or mutates) so the drug is no longer effective in slowing the virus down.

TYPES OF ARV’s? Epivir/Abacavir/atazanavir/Atripla/3TC/AZT/Cobicistat/Darunav ir/Combivir/d4T/ddI/fosamprenavir/dolutegravir/efavirenz/elvit egravir/etravirine Eviplera /FTC (emtricitabine)/Genvoya/emtircitabine/Kaletra/Kivexa/ maraviroc/nevirapine/raltegravir/Rezolsta/rilpivirine/ritonavir/s aquinavir/Stribild/T-20/tenofovir alafenamide/tenofovir DF/tipranavir/Triumeq/Trizivir/ Truvada

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MYTHS AND LIES

. Myth 1: You can stop and start your ARVs ARVs are a lifelong commitment. If you stop taking them, you are likely to get sicker than before. During the period that you stop taking your medication, you give HIV a chance to become resistant to the ARV drug combination you are taking and that regimen may not work for you again.

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MYTHS AND LIES Myth2: Once you have become resistant to your ARVs, there is nothing doctors can do for you HIV can become resistant to your ARV regimen when you interrupt your treatment or fail to take your drugs at a set time every day. In such cases, it is possible to replace your ARV combination with a new regimen that will still work for you. It will, however, have more side effects and cost more. All patience start with 1st line regime and if they become resistant move to 2nd line regime. If they them become resistant they will move to the last line regime, which is not as effective. Myth 3: ARVS give you a thin face and deform your body This is not true, some of the older (and discontinued ARV’s) did have body changing side effects, but they are no longer in use. . www.onquehiv.co.za

MYTHS AND LIES Myth 4: ARVs drive you mad Efavirenz can causes people to have bizarre dreams and makes them feel dizzy and drowsy. Some people have interpreted these side effects as the onset of insanity. These reactions usually disappear within three weeks of starting to take the treatment. Myth 5: You cannot take ARVs and TB treatment together Everyone who is infected with HIV and has TB has to take ARVs. If you developed TB before starting your ARV medication, the TB treatment has to be started two weeks ahead of the ARVs. This gives your body the chance to first adjust to the TB drugs. If you have been on ARVs for a while and the treatment is effective, you are unlikely to develop HIV-related illnesses including TB. But if you do, you can take the TB treatment immediately, as your body has already adjusted to the ARVs. . www.onquehiv.co.za

MYTHS AND LIES Myth 6: Babies cannot take ARVs Babies can take special ARV syrups from as early as two weeks of age. Government guidelines require all babies infected with HIV to be put on ARVs immediately. In the state sector, infants are usually tested for HIV only at six weeks, when their mothers take them to the clinic for vaccinations. In the private healthcare industry, this happens at four weeks. However, if the child falls ill shortly after birth, the baby can get tested for HIV immediately. Without preventative treatment during pregnancy, a mother has a 40% chance of transmitting HIV to her baby. Prevention-of-mother-to-child transmission of HIV programs have reduced the risk to 2%. All of the Myths and Lies courtesy of Mia Malan Discovery Health Journalism Centre at Rhodes University

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WHAT IS UNDETECTABLE? Undetectable is when the viral load cannot be detected. This does not mean that the virus is not in the body, it just means that the virus load is so low that it cannot be detected.

HOW LONG BEFORE UNDETECTABLE? If the ARV’s are taken as prescribed and adherence is 100% then the viral load could become undetected after about one month. PLEASE NOTE that this is not true for everyone, due to the fact that different people respond differently to medication, in some cases it could take more than 3 months

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WHAT IS ADHERENCE? Adherence is a word used to describe taking your drugs exactly as prescribed. This includes: ✓Taking them at the right time. ✓Following advice to take with or without food. ✓Avoiding any drug interactions. It will make sure that all the drugs in your combination are at high enough levels to control HIV for 24 hours a day. If these levels drop too low it increases the risk of resistance.

WHY ADHERE? If you do not take the medication as prescribed, the virus has the ability to mutate, this means that the medication does not work and that if you try to take a similar type of medication, then this will not work either. There are only 4 types of medication. If you are resistant to two of these types, then the treatment won’t work effectively. Even missing one or two doses a week can cause some drugs to fail, especially when starting treatment www.onquehiv.co.za

TIPS TO ADHERE ✓Start treatment when you can adjust to the changes (28 days). ✓Create or download and adherence diary : http://ibase.info/guides/starting/adherence-diary ✓ 30 minutes either side of the hour is max for taking your meds. ✓Get support (reminders) to help you through the first month. ✓Find out what is involved before you choose your treatment: How many tablets/How big are they/How often do you need to take them/How exact do you have to be with timing/ Are there food restrictions? ✓Use a weekly pill box. Then you can see if you miss a dose ✓Set reminders on your phone or PC to take your meds ✓If you travel, take additional drugs with you in case flights or other arrangements change. ✓Keep an emergency supply where you might need them – at work or a friend’s house etc. Ask your clinic or doctor first.

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WHAT IF I FORGET TO TAKE MY ARV’s? There is a difference between an occasional missed dose and regularly forgetting on a daily or weekly basis.

Be strict with yourself to assess how adherent you are. If your adherence is not good, you need more support. There may be an easier combination. You need a regimen that you can follow everyday. This includes both during the weekend and in the different situations involved in life. Taking days off treatment is a risky way to use HIV drugs. If you realise you have missed a dose, take it as soon as you remember, BUT, if you only realise when you’re going to take your next dose, do not take a double dose.

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WHAT ABOUT SIDE EFFECTS AND ADHERENCE? GO TO YOUR CLINIC OR DOCTOR IMMEDIATELY!!! Write down (or get someone to do it for you) what side effects you have and when you have them. Be as specific as possible ( don’t just say “pain in my side”) Your clinic or Dr can change your treatment if possible. In some cases, treatment may be stopped.

CAN I DRINK ALCOHOL WITH ARV’s? Drinking alcohol will not affect your viral load or CD4 count. Excessive alcohol use can damage the liver that filters drugs from the blood so if the liver is damaged then the body has trouble with the HIV treatments. Excessive alcohol use can mean that people on medication may forget to take their treatment. Moderate alcohol use should not be a problem. It is your decision if you don’t want to drink anymore but it should be because it is what you want to do rather than because you are HIV positive. www.onquehiv.co.za

SIDE EFFECTS BACKGROUND Most medicines you take can cause side effects. Some side effects may be mild while other may be more severe, or even life threatening. Side effect could get worse the longer you keep taking the drug. It’s also possible for other medications you take to interact with your ARV’s that is why, when you start taking any new drug, you should tell your doctor and pharmacist about all the other medicines you take — even drugs you buy over the counter without a prescription

HOW LONG DO THE SIDE EFFECTS LAST? It varies from person to person, some side effects may last for a couple of days, while others might last for months. It takes the body at least 28 days to get used to some medications. If side effects persist, contact your doctor or clinic.

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WHAT SIDE EFFECTS AND COPING: Central nervous system effects Some ARVs cause neurological and psychological symptoms dizziness, abnormal dreams, poor concentration, anxiety & depression. These side effects can have a significant impact on your day-to-day life. Most people find that CNS symptoms go away within 6 weeks after starting the medication. How to cope Where possible (FDC) it is probably best to take your medication at night before bed. Also try to start your drug regimen before a weekend break from work or a short vacation to give you some time to adapt. Avoiding stimulants, like caffeine and recreational drugs, can help ward off anxiety or insomnia. Regular exercise, medication and relaxation can also help minimize these symptoms. If you're having trouble sleeping, a short course of prescription sleeping aids can help you rest during the first few days.

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WHAT SIDE EFFECTS AND COPING: Depression and anxiety can be a little harder to manage because it's sometimes difficult to tell if they're caused by the medication, HIV itself, or other factors, like genetics or stress. If you think you may be suffering from either of these conditions, talk to your doctor. He or she will perform a thorough evaluation and may recommend psychotherapy and/or medication. In some cases, when your doctor suspects your HIV medication is aggravating these symptoms, it may be best to switch to another drug or drug class. Skin disorder and rashes. Mild rash is a common side effect, and usually clears up quickly without harm. However, if you experience rash in the first few weeks of treatment, or if you experience rash combined with fever, blistering, facial swelling, or aches, consult a doctor immediately. Treatments for rash include: avoiding hot showers or baths; using mild detergents and soaps; wearing cool fibres, like cotton; and using skin moisturizers. www.onquehiv.co.za

WHAT SIDE EFFECTS AND COPING: Kidney problems Kidneys maintain the balance of liquid and electrolytes in your body and are responsible for eliminating toxins and certain medications.HIV can damage kidney cells directly, as can certain ARVs. Other risk factors are age, a family history of kidney disease, co-infection with hepatitis B or C, diabetes and high blood pressure.Kidney disease can be acute or chronic. Things like infection, kidney stones or a reaction to medication can lead to an acute (sudden and temporary) kidney problem. How to cope People with HIV should be monitored carefully with regular kidney function tests, and these should be done more frequently in people who have one or more of the risk factors noted above. If your kidney function is being affected by your medication, the dose may be adjusted or the medication stopped entirely and replaced with another drug.

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WHAT SIDE EFFECTS AND COPING: Weight loss or weight gain Some of the ARV’s could lead to weight gain or weight loss. The most important consideration is if the weight gain or loss is due to the medication or the mental health of the person. Some people who have a life threatening illness can overeat or stop eating due to depression. How to cope Write down what you eat and when you eat it. Review this diary once a week to see if there are fluctuations in your eating habit. If your food intake remains the same for 3 weeks and you are still loosing or gaining weight, consult your clinic or doctor. You might be referred to a dietician to look at a meal plan. DO NOT GO ON A DIET (this includes FAD diets such as ‘Banting’) WITHOUT CONSULTING YOUR DOCTOR

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THERAPY INTERRUPTION Discontinuation of antiretroviral therapy (ART) may result in viral rebound, immune decompensation, and clinical progression. Planned interruptions of ART are not generally recommended. Unplanned interruption of ART may occur under certain circumstances.

Short-Term Therapy Interruptions Reasons for short-term interruption (days to weeks) of ART vary and may include drug toxicity; intercurrent illnesses that preclude oral intake, such as gastroenteritis or pancreatitis; surgical procedures; or interrupted access to drugs. Stopping ART for a short time (i.e., less than 1 to 2 days) because of a medical/surgical procedure can usually be done by holding all drugs in the regimen.

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THERAPY INTERRUPTION Planned Long-Term Therapy Interruptions Planned long-term therapy interruptions are not recommended outside of controlled clinical trials. If therapy must be discontinued, patients should be aware of and understand the risks of viral rebound, acute retroviral syndrome, increased risk of HIV transmission, decline of CD4 count, HIV disease progression, development of minor HIVassociated manifestations such as oral thrush or serious nonAIDS complications (e.g., renal, cardiac, hepatic, or neurologic complications), development of drug resistance. Patients should be counselled about the need for close clinical and laboratory monitoring during therapy interruptions.

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References: 1.

Holkmann Olsen C, Mocroft A, Kirk O, et al. Interruption of combination antiretroviral therapy and risk of clinical disease progression to AIDS or death. HIV Med. 2007;8(2):96104. Available at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citatio n&list_uids=17352766. Kousignian I, Abgrall S, Grabar S, et al. Maintaining antiretroviral therapy reduces the risk of AIDS-defining events in patients with uncontrolled viral replication and profound immunodeficiency. Clin Infect Dis. 2008;46(2):296-304. Available at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citatio n&list_uids=18171266. Danel C, Moh R, Minga A, et al. CD4-guided structured antiretroviral treatment interruption strategy in HIV-infected adults in west Africa (Trivacan ANRS 1269 trial): a randomised trial. Lancet. 2006;367(9527):1981-1989. Available at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstra ctPlus&list_uids=16782488&itool=iconabstr&query_hl=147&itool=pubmed_docsum. DART Trial Team DTT. Fixed duration interruptions are inferior to continuous treatment in African adults starting therapy with CD4 cell counts < 200 cells/microl. AIDS. 2008;22(2):237-247. Available at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citatio n&list_uids=18097226. El-Sadr WM, Lundgren JD, Neaton JD, et al. CD4+ count-guided interruption of antiretroviral treatment.N Engl J Med. 2006;355(22):2283-2296. Available at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citatio n&list_uids=17135583.

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TRAIN THE TRAINER www.onquehiv.co.za

HIV VS AIDS www.onquehiv.co.za

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TRANSMISSION OF HIV THE FACTS AND THE MYTHS www.onquehiv.co.za

THE FORMULA This formula is an easy way to

establish the transmission of HIV and is geared toward high risk activity and not high risk groups

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THE ACTION ✓ Sex

Any type of sex with anyone ✓ Blood mixing

Traditional circumcision/cultural /blood transfusion/ iv drug use ✓ Vertical transmission

Normally passed on from mother to child during the birth process and/or after birth www.onquehiv.co.za

www.onquehiv.co.za

THE FLUID WHERE THE VIRUS ‘HIDES’

Blood Semen

Vaginal fluid Breast milk www.onquehiv.co.za

THE KEY There must be an ‘opening’ where the virus can enter the body This opening must be one that you are not born with

Openings you are not born with are cuts and tears in or on the skin

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PUTTING THE FORMULA TOGETHER There must be a yes with the action

Sex

Blood mix Mother to child There must be a yes with the fluid

Blood

Semen Vaginal fluid There must be a yes with the opening

The opening must be one that you are not born

with

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PREVENTION OF HIV

TRANSMISSION www.onquehiv.co.za

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PREVENTION IS DONE BY CLOSING THE OPENING YOU ARE NOT BORN WITH ✓

Prevent blood mix

✓ ABC of sex ✓ Prevent re-infection

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1) Put a drop or two of lubricant inside the condom. 2) If not circumcised, pull back the foreskin before rolling on the condom.

3) Place the rolled condom over the tip of the hard penis. 4) Leave a half-inch space at the tip to collect semen. 5) Pinch the air out of the tip with one hand. (Friction against air bubbles causes most condom breaks.) 6) Unroll the condom over the penis with the other hand. www.onquehiv.co.za

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THE VIRUS AND THE SOLDIERS For the first 3 months the virus grows inside his body. The body then makes soldiers (anti-bodies) to fight against the virus.

An HIV test does not look for the virus but for the antibodies, in other words if John got infected this morning 7 o’clock and goes for and Aids test next week his test will be negative. If he goes in 4 months time his test will be positive. If John got HIV this morning 7 o’clock after 3 months the soldiers come and the war begins. This war will take place for approximately 7 years. The war stage is called HIV (human with virus inside). www.onquehiv.co.za

THE VIRUS AND THE SOLDIERS Most people find out their HIV status during the AIDS phase.

If John found out his HIV status early he could have done 2 things: Increase his immune system ✓eating properly ✓reduce stress ✓living healthy ✓exercise www.onquehiv.co.za

THE VIRUS AND THE SOLDIERS 2. He could protect his virus against other viruses. If john gets flu, he then has his own HIV and the flu fighting against his immune system. If John does not use a condom during sex he could be re-infected with a different type of HIV.

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THE VIRUS AND THE SOLDIERS John 1 = Thinks he is HIV negative but got infected this morning 7 o’clock, 7½ years later John dies. John 2 = Also got infected this morning 7 o’clock, found out his status early, grew his soldiers and protected his virus and stayed HIV Positive for 14 – 18 years. Then John goes into AIDS and takes his AIDS treatment which confuses the virus for 6 - 12 years. John 2 – life expectancy is 25 years +. www.onquehiv.co.za

TIMELINE FROM DAY ONE ➢ There are ‘long term’ survivors that have

lived with HIV for more than 20 years. ➢ On average the estimated life span of a baby

being born HIV positive in South Africa is 4 years. ➢ The decrease in lifespan with a baby is due

to a weak immune system and the access to nutrition and clean water. ➢ The lifespan of any human infected with

HIV can be increased if care is taken to live a healthy lifestyle. www.onquehiv.co.za

TIMELINE FROM DAY ONE ➢ Due to the mutation of the virus strains, it is

possible to have a Multi-Drug-Resistant virus that can decrease the lifespan from 10 to 6 years. ➢ The earlier the HIV status of the person is

known, the sooner something can be done to manage their wellness.

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REPLICATION OF THE VIRUS

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CD4 or Host cell HIV

HIV

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REPLICATION OF THE VIRUS ✓ It is believed that replication can take place within two

hours of infection

✓ Replication will take place for the first 23 days ✓ This period - before the antibodies generation - is called

the window period

✓ The World Health Organisation recommends that the

window period be taken at 3 months

✓ Average of 1 billion CD4 cells made and destroyed daily ✓ Average of 100 million to 10 billion viruses made and destroyed daily ✓ 5000 viruses can fit on to the head of a pin www.onquehiv.co.za

HOW DOES THE VIRUS WORK? ✓ Virus needs an entry point

✓ Affinity (attraction) to T4 cells ✓ Integration (climbing inside T4) ✓ Replication (making copies of itself) ✓ Budding out (spreads in the body) ✓ Retrovirus is a permanent infection

✓ Lenti-virus acts slow

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TREATMENT AND

MEDICATION www.onquehiv.co.za

www.onquehiv.co.za

POSITIVE LIFE ✓Get enough rest and sleep

✓Lower stress levels ✓ Reduce smoking ✓ Drink less alcohol

✓ Eat healthy food (especially fresh fruit and

vegetables) ✓ Exercise (but don’t overstress the body) ✓ Avoid unnecessary medication ✓ Develop a positive attitude ✓ Keep busy or start a hobby ✓ Strengthen spiritual ties ✓ Communicate around issues www.onquehiv.co.za

TYPES OF TREATMENT AND MEDICATION Chemical medication * AZT

* Stocrin

* Combivir

* Nevirapine

* 3TC

* ABT378

* DdC

* Viracept

* D4t

* Hivid

* Crixivan

* Viramue www.onquehiv.co.za

TYPES OF TREATMENT AND MEDICATION Alternative medication • Oxygen therapy • Traditional healing • Acupuncture • Homeopathic treatment • Spiritual healing • Home-based care www.onquehiv.co.za

4+ ARV

AIDS MEDICATION

5+ Side effect meds

App 18 Tablets per Day

Supper

Breakfast

5+ Side effect meds

4+ ARV

18h00

8h00

8 Glasses of water per day COST (per month per patient) Generic (Copy) Medication:

R600 – R1200

Ethical (Patent) Medication: R3500 - R4500 Drug resistant strains www.onquehiv.co.za

FACTS ON ADHERENCE At 95% compliant = 78% efficacy

At 90% compliant = 48% efficacy At 70% compliant = 18% efficacy

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MEDICAL TREATMENT Potential side effects of antiretroviral medication: Nausea /Indigestion/Vomiting /Diarrhea Constipation /Dry mouth /Insomnia /Headaches /Skin rashes /Allergies/Mouth ulcers/ Hallucinations /Abdominal pain /Hypersensitivity/ Pancreatitis /Low blood pressure. Abnormalities in liver and/or kidney function. Peripheral neuropathy (numbness, tingling or pain in hands or feet) Muscle degeneration. Suppression of bone marrow www.onquehiv.co.za

MEDICATION DOSAGE •Average of 210 pills per month •Average of 8 pills per day •Average of two doses a day {am & pm}

•FDC (fixed dose combination has been launched in SA. 1 tablet once a day. •Some pills need to be taken with or without meals or water www.onquehiv.co.za

HIV& AIDS AND THE LAW www.onquehiv.co.za

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THE DIFFERENCE BETWEEN ETHICAL AND LEGAL Ethical = what would be nice to have or do Legal = what the law says we must do The law around HIV/AIDS is quite specific and is governed by other laws. The first port of call is to establish what laws pertain to notification. www.onquehiv.co.za

WHAT IS ETHICAL? • Ethical is when you have a moral

obligation to do something • It could also be a case of the right thing to do

WHAT IS LEGAL?

•If any person disregards the law of our land

then their action is not legal • The law states that the action must be wilful • Not knowing what is legal and not legal is the

responsibility of each individual www.onquehiv.co.za

WHAT IS NOTIFICATION? • Notification is when a particular disease or

infection needs to be disclosed due to the fact that the condition is communicable (can be transmitted through social contact) • Small pox is a notifiable disease

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WHAT IS CONFIDENTIALITY? • Confidentiality is the right that each

person has to keep information regarding themselves private • The new constitution grants each

person the right to: Privacy Free association Non discrimination

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WHO CAN AND SHOULD YOU TELL? By law you do not have to tell anyone, but there are legal consequences if you do not tell some people: ✓ Your partner if you are having

unprotected sex ✓ Your life insurance company ✓ Your medical aid ✓ You are entitled to tell anyone that you like,

but that is your choice www.onquehiv.co.za

WHY SHOULD YOU TELL? • In some cases it might be necessary to disclose

your status • If you wilfully infect your partner, you can face

criminal charges • You might also want to tell your doctor if you

are not responding to particular treatment • You might want to disclose if you feel that you

could receive better support

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HIV TESTING www.onquehiv.co.za

HIV TESTING • Pre-employment testing has been scrapped in

South Africa • Insurance testing may be done with the

consent of the client, if the client does not want to be tested, the broker may refuse the life cover • Voluntary testing is done with consent from

the client • Diagnostic testing may only be done with the

informed consent of the client www.onquehiv.co.za

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WHAT DO YOU NEED? 4 C’S ✓ C = Consent must be given in writing when testing is done ✓ C = Confidentiality must be assured at all times ✓ C = Counselling must be given in the form of pre and post test counselling ✓ C = Consequences must be looked into before the test is done

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TYPES OF TESTS Screening tests ➢ Elisa ➢ Access ➢ Rapid ➢ Western blot These tests look for the antibody that fights the virus Confirmatory tests ❖ PCR (DNA) ❖ P24 These tests look for the virus

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POSITIVE VS NEGATIVE ➢ HIV+ does not necessarily mean that the

person has full-blown AIDS ➢ The test cannot say from whom or when the

virus was transmitted ➢ The most important factor with a positive

result is the availability of support ➢ A negative result does not mean that the

person is immune to HIV ➢ A negative result is not a licence www.onquehiv.co.za

THE GRIEF SYNDROME ▪ Shock (numbness no facts retained) ▪ Denial (‘not me’) ▪ Isolation (leave me alone)

▪ Anger (guilt and blaming) ▪ Bargaining (with god or doctor ‘if - then’) ▪ Depression (a clinical state) ▪ Acceptance (I now have to deal with this)

▪ Hope (I will get through this) ▪ Recovery (with HIV/AIDS this step is not given by a

counselor) www.onquehiv.co.za

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THE

AIDS MEMORIAL QUILT www.onquehiv.co.za

www.onquehiv.co.za

THE AIDS QUILT • The AIDS quilt was started in 1981 in America • The concept of the quilt is to remember

someone after they have died of AIDS • The quilt panels are used as displays in

churches and workplaces to remember the person who has died of AIDS • The quilts go a long way to break the silence of

AIDS

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THE AIDS QUILT • Quilts are made on a 1m x 2m piece of material

that will depict aspects of the persons life. A story is told on the panels of how this person is remembered. If they were a smoker, then the brand of cigarettes will be drawn on the panel. If the person had a favorite saying then this too can be placed on the quilt. • A photo can be placed on the quilt, but this has to be done with permission. Objects of clothing and sentimental trinkets can also be placed on the quilt. Panels do not have to be the prescribed size, smaller panels can be stitched to make a big panel. www.onquehiv.co.za

THE AIDS QUILT • A person should be nominated to tell the story

of the person who has died of AIDS. The rest of the group would then decide who will do what on the quilt. • Your group does not have to be artists to make

a quilt.

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THE AIDS QUILT Some tools to make a quilt: • Material 1m x 2m • Paint (even house paint) • Brushes & toothbrush • Sponges & potatoes • Needle and thread • Pens/pencils/crayons • Chalk and koki’s • Loose pieces of cloth • Objects of remembrance www.onquehiv.co.za

THE CYCLE OF TRAUMA www.onquehiv.co.za

THE GRIEF SYNDROME Shock

Numbness - retain little facts

Denial “Not Me”

Isolation Alone and frightened

Anger How could ? Be so stupid

Guilt I did something wrong www.onquehiv.co.za

THE GRIEF SYNDROME Blaming “Why me ?”

Bargaining With God / Doctor / Other = “If - Then” Depression Clinical state

Acceptance I have to live with this Recovery and Hope It gets better in time www.onquehiv.co.za

WHAT IS A LEGACY A LEGACY IS SOMETHING THAT IS LEFT BEHIND WHEN SOMEONE DIES. A LEGACY COULD BE IN THE FORM OF MATERIAL GOODS OR JUST A MEMORY. WE ALL STRIVE TO LEAVE SOMETHING GOOD OF OURSELVES BEHIND.

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KEEPING MY HOME AND BODY CLEAN www.onquehiv.co.za

KEEP IT CLEAN TO CLEAN CLOTHING OR SHEETS STAINED WITH BLOOD, DIARRHOEA OR OTHER BODY FLUIDS: KEEP SEPARATE FROM OTHER WASHING

AVOID TOUCHING THE STAINED AREA RINSE OFF ANY BLOOD OR DIARRHOEA WITH WATER WASH IN SOAPY WATER OR A WEAK BLEACH SOLUTION AND HANG OUT TO DRY AS YOU WOULD ALL YOUR WASHING.

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KEEP IT CLEAN CLEAN UP URINE, BLOOD OR DIARRHOEA WITH WARM SOAPY WATER OR A WEAK BLEACH SOLUTION.

USE GLOVES, A PIECE OF PAPER, PLASTIC, TO HANDLE SOILED CLOTHES OR BEDDING. DISPOSE OF ALL RUBBISH PROPERLY. THIS MAY MEAN BURNING OR BURYING. DO NOT THROW AWAY SHEETS AND CLOTHING BECAUSE THEY ARE STAINED. THEY CAN BE EASILY CLEANED.

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KEEPING IT CLEAN ALWAYS USE CLEAN WATER FOR DRINKING AND COOKING EGGS, MEAT AND SHELLFISH = WELL COOKED WASH ALL FRUIT AND VEGETABLES CLEAN THE COOKING AREA AND CUTTING BOARD WITH SOAP AND CLEAN WATER DO NOT RE-FREEZE MELTED FOODS PROTECT FOOD FROM INSECTS, RATS AND OTHER ANIMALS STORE ALL FOOD AND WATER IN A CLEAN, COOL PLACE AND KEEP CONTAINERS COVERED. www.onquehiv.co.za

KEEPING MY TUMMY CLEAN KEEPING THE TUMMY CLEAN THE IMMUNE SYSTEM TO FIGHT.

SOME OF THE WAYS OF DOING THIS IS AS FOLLOWS: DRINK LOTS OF CLEAN WATER EAT PUMPKIN SEEDS EATS 4 RAW CARROTS A DAY EATS GARLIC www.onquehiv.co.za

CLEANLINESS IN EATING AND DRINKING IDEALLY ALL WATER THAT IS NOT PURE WATER SYSTEM SHOULD BE BOILED BEFORE DRINKING. DO NOT LET FLIES OR OTHER INSECTS CRAWL ON FOOD AS THEY COULD CARRY GERMS BEFORE EATING FOOD THAT HAS FALLEN TO THE GROUND WASH IT WELL

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CLEANLINESS IN EATING AND DRINKING ONLY EAT MEAT THAT IS WELL COOKED. DO NOT EAT FOOD THAT IS OLD OR SMELLS BAD, AS IT MAY BE POISONOUS. PEOPLE WITH FLU, TUBERCULOSIS OR COLDS NEED TO EAT SEPARATELY FROM OTHERS AND PLATES AND UTENSILS NEED TO BE BOILED AND CLEANED THOROUGHLY.

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I DON’T FEEL WELL! www.onquehiv.co.za

HOW TO EXAMINE A SICK PERSON IN ORDER TO CORRECTLY HELP SOMEBODY THAT IS ILL IT IS IMPORTANT TO ESTABLISH WHAT THE ILLNESS IS. THIS CAN ONLY BE DONE THROUGH QUESTIONS.

HERE ARE SOME QUESTIONS AND SIGNS & SYMPTOMS TO LOOK OUT FOR. www.onquehiv.co.za

HOW TO EXAMINE A SICK PERSON WHAT MAKES YOU FEEL …. HOW & WHEN DID THIS BEGIN? HAVE YOU HAD THIS TROUBLE BEFORE OR HAS SOMEONE IN YOUR FAMILY OR NEIGHBORHOOD HAD IT?

TELL ME EXACTLY WHAT IS WRONG? www.onquehiv.co.za

GENERAL CONDITIONS OF HEALTH CHECK THE OVERALL CONDITION OF BODY, ANY LESIONS OR SORES OVER THE BODY GENERAL WASTING WHETHER THE PATIENT SUFFERS FROM SPASMS, RESTLESSNESS, OR IS HYPERACTIVE AND NOISY.

CHECK BLOOD PRESSURE (NORMAL - 120 OVER 80). www.onquehiv.co.za

GENERAL CONDITIONS OF HEALTH •

BREATHING / RESPIRATION - IF BREATHING IS SHALLOW OR HIGH PULSE - TAKE THE PULSE ADULTS PULSE 60 - 80 PER MINUTE CHILDREN 80 - 110 PER MINUTE

BABIES 100 -130 PER MINUTE www.onquehiv.co.za

COMMON CURES TO COMMON AILMENTS www.onquehiv.co.za

FEVERS WHEN A FEVER GOES UP HIGHER THAN 40 DEGREES CELSIUS IT MUST BE LOWERED AT ONCE. THE FOLLOWING ARE GUIDELINES: ✓ PUT A PERSON IN A COOL PLACE AND REMOVE ALL CLOTHING ✓ FAN HIM / HER ✓ POUR COOL WATER NOT COLD WATER OVER HIM / HER ✓ GIVE HIM / HER PLENTY OF COLD WATER TO DRINK ✓ GIVE MEDICINES TO BRING DOWN THE FEVER, ✓ASPIRINS SEEM TO WORK WELL. www.onquehiv.co.za

FEVERS Normal body temperature varies amongst people, but the average is 98.6 degrees Fahrenheit (37 degrees Centigrade). If the temperature is 99 to 100 degrees Fahrenheit, this may represent a low-grade fever. Body temperature of 100 degrees Fahrenheit or above is classified as fever.

Alternative Names: Elevated temperature; Hypothermia; Pyrexia www.onquehiv.co.za

SHOCK ✓SIGNS OF SHOCK: ✓ WEAK, RAPID PULSE ✓ COLD SWEAT AND PALENESS ✓ DAMP SKIN ✓ MENTAL CONFUSION ✓WEAKNESS, LOSS OF CONSCIOUSNESS ✓ LOW BLOOD PRESSURE, BLOOD PRESSURE DROPS DANGEROUSLY LOW www.onquehiv.co.za

WHAT TO DO TO PREVENT OR TREAT SHOCK HAVE THE PERSON LIE DOWN, WITH HIS FEET TOGETHER AND HIS HEAD DOWN STOP ANY BLEEDING IF THE PERSON FEELS COLD COVER HIM / HER WITH A BLANKET

IF CONSCIOUS AND ABLE TO DRINK GIVE WATER OR OTHER FLUIDS www.onquehiv.co.za

WHAT TO DO TO PREVENT OR TREAT SHOCK TALK TO HIM OR HER AND ESTABLISH CONCISENESS

TREAT THE WOUND IF ANY IF SHE/ HE IS IN PAIN GIVE ASPIRIN (MUST NOT CONTAIN SEDATIVE SUCH AS CODEINE). KEEP CALM AND REASSURE PERSON.

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DEHYDRATION Some patients could die from diarrhea because they have a lack of water in their bodies. SIGNS OF DEHYDRATION: ✓THIRST IS OFTEN THE FIRST VERY EARLY SIGN OF DEHYDRATION ✓LITTLE OR NO URINE, OR DARK YELLOW ✓SUDDEN WEIGHT LOSS ✓DRY MOUTH ✓ SAGGING IN OF SOFT SPOTS IN INFANTS ✓SUNKEN TEARLESS EYES ✓LOSS OF ELASTICITY OR STRETCHINESS OF THE SKIN

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PREVENTION AND TREATMENT OF DEHYDRATION ✓WHEN A PERSON HAS WATERY DIARRHEA ACT QUICKLY. ✓GIVE LOTS OF LIQUID TO DRINK ✓KEEP GIVING FOOD AND TO BABIES GIVE BREAST MILK OFTEN ✓EVEN IF THE PERSON VOMITS DO NOT STOP GIVING FLUIDS. NOT ALL THE FLUIDS ARE VOMITED. ✓WARNING: IF DEHYDRATION GETS WORSE OR OTHER DANGER SIGNS ✓APPEAR GO FOR MEDICAL ASSISTANCE

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PREVENTION AND TREATMENT OF DEHYDRATION HOME RECIPE FOR RE-HYDRATION DRINK ✓ 1L CLEAN WATER ✓1/2 TEASPOON SALT ✓8 TEASPOONS SUGAR CAUTION: BEFORE ADDING THE SUGAR TASTE THE DRINK AND MAKE SURE IT IS LESS SALTY THAN TEARS

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PREVENTION AND TREATMENT OF DEHYDRATION HOME RECIPE FOR RE-HYDRATION DRINK FOR SOME-ONE WHO IS NOT EATING 1L CLEAN WATER 1/2 TEASPOON SALT 8 HEAPED TEASPOONS POWERED CEREAL BOIL FOR 5 - 7 MINUTES, ALLOW FORMING A LIQUID AND WATERY PORRIDGE. COOL QUICKLY AND GIVE TO CHILD OR PERSON THAT IS ILL. www.onquehiv.co.za

DIARRHEA AND DYSENTERY MAIN CAUSES OF DIARRHEA: POOR NUTRITION SHORTAGE OF WATER AND UNCLEAN CONDITIONS VIRUS INFECTION OR INTESTINAL FLU BACTERIAL INFECTION INFECTIONS OUTSIDE THE GUT I.E. TONSILLITIS, EAR INFECTION MALARIA FOOD POISON www.onquehiv.co.za

DIARRHEA AND DYSENTERY MAIN CAUSES OF DIARRHEA: ➢ INABILITY TO DIGEST DAIRY PRODUCTS ➢INABILITY TO DIGEST FOOD THAT IS NEW ESPECIALLY APPLICABLE TO BABIES ➢ALLERGIES TO CERTAIN FOODS I.E. SEA FOOD ➢ SIDE EFFECTS TO CERTAIN MEDICATIONS ➢IRRITATING OR POISONOUS PLANTS ➢ EATING TOO MUCH FRUIT OR FATTY FOODS www.onquehiv.co.za

FOODS FOR A PERSON WITH DIARRHEA: WHEN A PERSON DIARRHEA, THEY MUST DRINK. WATERY MUSH OR BROTH OF RICE, MAIZE OR POTATOES RICE WATER WITH SOME MASHED RICE OR POTATOES. MEAT, EGGS, OR BEAN BROTH REHYDRATION DRINK OR SWEET DRINK BREAST MILK FOR BABIES THE OBJECT IS TO BIND THE STOMACH WARNING: NO GREASY FOODS, ALCOHOLIC DRINKS OR RAW FRUITS www.onquehiv.co.za

SKIN PROBLEMS SIGNS: ✓RASHES ✓ITCHING SKIN ✓PAINFUL SORES IN THE SKIN ✓INCREASE DRYNESS OF THE SKIN ✓SLOW HEALING OF WOUNDS ✓BOILS AND ABSCESSES

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SKIN PROBLEMS CAUSES: ➢YEAST INFECTION {THRUSH} ➢FUNGAL INFECTION {RINGWORM} ➢BACTERIAL INFECTION ➢SHINGLES ➢POOR HYGIENE ➢ALLERGIC REACTION ➢BED SORES ➢ECZEMA OR KAPOSI SARCOMA

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SKIN PROBLEMS TREATMENT: ✓COOL THE SKIN DOWN IF THERE IS ITCHING ✓TRY TO PREVENT SCRATCHING ✓WASH THE INFECTED AREA WITH SOAP AND WATER ✓CUT THE CLIENTS NAILS SHORT

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SKIN PROBLEMS TREATMENT: ✓CALAMINE LOTION CAN BE USED ✓DO NOT LET THE SKIN GET HOT ✓SOME SOAPS AND DETERGENTS CAN CAUSE MORE SORES, MONITOR THIS AND CHANGE IF NEED BE ✓USE TRADITIONAL HERBS THAN CAN CURE SOME INFECTIONS ✓ANTI HISTAMINE CAN ALSO RELIEVE SOME IRRITATIONS www.onquehiv.co.za

BED SORES BED SORES ARE CAUSED BY A BREAK IN THE SKIN WHERE THERE HAS BEEN CONSTANT PRESSURE APPLIED TO. SORES FORM OVER THE BONY AREAS OF THE BODY TREATMENT: ✓GET OUT OF BED AS MUCH AS POSSIBLE ✓CHANGE POSITION EVERY TWO HOURS ✓USE SOFT SHEETS AND PADDING ✓WASH AND DRY THE BODY WELL ✓AIR DRY SHEETS IN THE SUN ✓STRAIGHTEN THE SHEETS ✓USE CUSHIONS UNDER BONY BODY PARTS www.onquehiv.co.za

MOUTH AND THROAT SIGNS: THRUSH = WHITE PATCHES WITH RED SURROUNDS IN THE MOUTH AND THROAT ORAL HERPES SIMPLEX = BLISTERS AND SORES ON THE LIPS MALNUTRITION = SORES ON THE MOUTH DENTAL PROBLEMS = GUM INFECTIONS AND VERY BAD BREATH KAPOSI SARCOMA OF THE MOUTH AND THROAT = DARK RED BLOOD BLISTERS IN THE MOUTH AND THROAT

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MOUTH AND THROAT TREATMENT: ✓EAT HEALTHY FOOD AND TAKE SUPPLEMENTS IF NEED BE ✓RINSE MOUTH AND THROAT OUT WITH WARM SALTY WATER ✓EAT SOFT FOODS NOT HARD OR CRUNCHY ✓EAT BLAND NOT SPICY FOODS ✓USE A STRAW TO SWALLOW SOUPS AND DRINKS ✓COLD FOODS CAN NUMB THE MOUTH ✓LEMON WATER CAN HELP WITH THRUSH

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MOUTH AND THROAT TREATMENT: A SOLUTION OF GENTIAN VIOLET CAN BE USED FOR THRUSH AND SORES ON THE LIPS AND MOUTH: USE ONE TEASPOON OF GENTIAN VIOLET CRYSTALS WITH HALF A LITER OF WATER. GENTLY RUB THIS SOLUTION ON THE SORES TOOTHPASTE CAN BE MADE BY MIXING ONE TEASPOON OF BICARBONATE SODA AND ONE TEASPOON OF SALT AND THEN WETTING IT ON A TOOTHBRUSH TO MAKE A PASTE www.onquehiv.co.za

VOMITING DANGER SIGNS WITH VOMITING:

DEHYDRATION SEVERE VOMITING THAT LASTS FOR MORE THAN 24 HOURS VIOLENT VOMITING ESPECIALLY IF IT IS A DEEP GREEN OR BROWN AND SMELLS OF FECES CONSTANT PAIN IN THE GUT VOMITING OF BLOOD

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VOMITING TO HELP CONTROL VOMITING: EAT NOTHING WHILE VOMITING IS SEVERE. SIP COLA DRINK OR GINGER ALE OR SOME HERBAL TEAS LIKE CHAMOMILE MIGHT HELP. FOR DEHYDRATION GIVE SMALL FREQUENT SIPS OF COLA, TEA OR REHYDRATION DRINK. IF VOMITING DOESN'T STOP USE A VOMIT SEE A DOCTOR www.onquehiv.co.za

HEADACHES AND MIGRAINES A MIGRAINE IS A SEVERE THROBBING HEADACHE OFTEN ON ONE SIDE OF THE HEAD ONLY. TO STOP MIGRAINES DO THE FOLLOWING AT THE FIRST SIGNS: ✓TAKE TWO ASPIRINS WITH A CUP OF STRONG COFFEE OR BLACK TEA ✓LIE DOWN IN A DARK QUIET PLACE AND TRY TO RELAX

✓FOR BAD MIGRAINE HEADACHES OBTAIN PILLS WITH CAFFEINE. TAKE TWO PILLS AT FIRST AND ONE PILL EVERY 30 MIN UNTIL THE PAIN GOES AWAY. DO NOT TAKE MORE THAN 6 PILLS IN ONE DAY. www.onquehiv.co.za

SINUS TROUBLE SIGNS: PAIN IN THE FACE ABOVE & BELOW THE EYES THICK PUS OR MUCUS IN THE NOSE OFTEN WITH A BAD SMELL FEVER (SOMETIMES) CERTAIN TEETH MAY HURT TREATMENT: ✓DRINK A LOT WATER ✓SNIFF A LITTLE SALT WATER INTO THE NOSE ✓PUT HOT COMPRESS ON THE FACE ✓USE DECONGESTANT NOSE DROPS ✓USE AN ANTIBIOTIC I.E. AMPICILLIN IF THE PERSON DOES NOT GET BETTER, SEEK MEDICAL ASSISTANCE www.onquehiv.co.za

COUGHING COUGHING IS NOT A SICKNESS IN ITSELF BUT IS A SIGN OF MANY DIFFERENT ILLNESSES THAT AFFECT THE THROAT, LUNGS OR BRONCHI. SOME OF THE DIFFERENT KINDS OF COUGH: ➢DRY COUGH WITH LITTLE OR NO PHLEGM ➢COLDS OR FLU ➢WORMS - WHEN PASSING THROUGH THE LUNGS ➢MEASLES ➢SMOKERS COUGH ➢ASTHMA www.onquehiv.co.za

COUGHING COUGH WITH PHLEGM: ✓BRONCHITIS ✓PNEUMONIA ✓ASTHMA ✓SMOKERS COUGH WHEN GETTING UP IN THE MORNING

COUGH WITH A WHEEZE OR WHOOP OR TROUBLE WITH BREATHING: ✓ASTHMA ✓WHOOPING COUGH ✓DIPHTHERIA ✓COULD BE A HEART PROBLEM OR SOMETHING STUCK IN THE THROAT www.onquehiv.co.za

TREATMENT FOR COUGH TO LOOSEN MUCUS AND EASE ANY KIND OF COUGH DRINK LOTS OF WATER BREATHE HOT WATER VAPORS I.E. STEAM MAKE UP A SYRUP OF: 1 PART HONEY 1 PART LEMON JUICE 1 PART RUM OR BRANDY TAKE A TEASPOON EVERY 2 - 3 HOURS IN A GLASS OF HOT WATER

IF THE COUGH PERSIST MAKE SURE THAT THE PATIENT RECEIVES TREATMENT FROM A DOCTOR. www.onquehiv.co.za

PNEUMONIA SIGNS: ✓SUDDEN CHILLS AND THEN HIGH FEVER ✓RAPID SHALLOW BREATHING WITH LITTLE GRUNTS SOMETIMES WHEEZING

✓FEVER ✓COUGH (OFTEN WITH YELLOW RUST COLORED OR BLOODY MUCUS) ✓CHEST PAINS

✓PERSON LOOKS VERY ILL ✓COLD SORES OFTEN APPEAR ON THE FACE OR LIPS www.onquehiv.co.za

TREATMENT OF PNEUMONIA ✓FOR PNEUMONIA TREATMENT WITH ANTIBIOTICS CAN MAKE A DIFFERENCE BETWEEN LIFE AND DEATH ✓GIVE ASPIRIN TO LOWER THE TEMPERATURE AND LESSEN THE PAIN ✓GIVE PLENTY OF LIQUIDS. IF THE PERSON WILL NOT EAT GIVE THE HIM/ HER LIQUID FOOD OR REHYDRATION DRINK. ✓EASE THE COUGH BY GIVING LOTS OF WATER AND HAVING THEM BREATH PLENTY HOT WATER VAPORS ✓IF THE PERSON IS WHEEZING AN ANTIASTHMATIC MEDICINE MAY HELP. www.onquehiv.co.za

A LIST OF MEDICATIONS www.onquehiv.co.za

MEDICATION USED FOR TREATING SYMPTOMS INFECTIONS: ANTIBIOTICS FEVER: ASPIRIN OR PARACETAMOL

DIARRHEA: REHYDRATION SALTS ANTIBIOTICS ANTIMOTILITY MEDICINES SKIN PROBLEMS: CALAMINE LOTION GENTIAN VIOLET POTASSIUM PERMANGANATE www.onquehiv.co.za

MEDICATION USED FOR TREATING SYMPTOMS YEAST INFECTIONS {ORAL & VAGINAL}: GENTIAN VIOLET KETOCONAZOLE NYSTATIN CLOTRIMAZOLE NUTRITION: VITAMINS AND MINERAL SUPPLEMENTS NAUSEA AND VOMITING: ANTI-EMETICS PAIN: ASPIRIN OR PARACETAMOL www.onquehiv.co.za

DAILY ADDITIVE HERE ARE SOME VITAMINS AND SUPPLEMENTS THAT CAN ALSO BE TAKEN: ✓VITAMIN A RE {CARROTS} ✓ZINC {TABLETS} ✓VITAMIN C {ORANGES} ✓VITAMIN B12 {TABLET OR MEAT} ✓SELENIUM {TABLET OR PRO-NUTRO}

✓POTASSIUM {BANANAS} www.onquehiv.co.za

TAKING OF MEDICATION If the person has to take medicines Make sure they know: ✓Which medicines to take ✓How to take the medicines

✓Which side effects to watch for ✓To take all the medicine.

www.onquehiv.co.za

GLOSSARY OF WORKING WORDS www.onquehiv.co.za

GLOSSARY ➢ AIDS = A disease linked to HIV that breaks down the fighting

ability of the body

➢ ACTIVIST = someone who goes out and takes action for what they

believe in

➢ AWARENESS = how much ‘people’ know about a certain subject ➢ ADVOCACY = The ability for YOU to get the people who work

with and above you to help you to fight your cause

➢ CAPACITY = how much ability do you/organisation have to do a

certain task

➢ CONFIDENTIALITY = when NO one needs to know something

that is private

➢ CONTRACT = A document or agreement with someone or body to

do a certain task

➢ DISABILITY = when a person is inflicted with a physical or

mental illness

www.onquehiv.co.za

GLOSSARY ➢ DISCLOSURE = When a person/s tell someone or a group something

that pertains to themselves

➢ DISCRIMINATION = When a person/s do not give someone an

opportunity due to their own beliefs or prejudice

➢ DISSEMINATION = Spreading information to other people ➢ EQUALITY = For ALL people to be seen EQUAL ➢ EPIDEMIC = When a large amount of people have the same illness ➢ EMPOWERMENT = giving people the tools (such as information) to

perform a certain task

➢ FUNDING = The financial need or availability of money for a

project

➢ GOAL = The end result of work done

➢ HUMAN RESOURCES = The people that work for a company or

organisation

➢ INTERVENTION = when someone takes action to reach the end goal

www.onquehiv.co.za

GLOSSARY ➢ LABOUR = The work force ➢ MANDATE = when a person or body gives you permission to do a

certain task

➢ MOBILIZATION = To get a person or group to move to action

around a certain issue

➢ NGO = Non Governmental Organisation ➢ NEGOTIATING = To discuss an issue with relevant parties to reach

a common understanding

➢ NETWORK = The bringing in of people who work in the same field

➢ PANDEMIC = When a large population of a country has the same

disease

➢ POLICY = A working document for ALL people to gain the common

goal as set out in the policy

➢ PARTNERSHIPS = The building of friends and experts to support

the overall cause

www.onquehiv.co.za

GLOSSARY ➢ PORTFOLIO = The position a person has in an organisation ➢ PREAMBLE = The introduction to a document ➢ RESOURCES = The manpower of information that is available to

complete a task

➢ RURAL = these are areas that are wide spread and have very few

resources

➢ STATISTICS = when figures are put to a task ( ➢ STIGMA = when a bad connotation is applied to a disease or person ➢ SOLIDARITY = when a person/s believe in a common cause ➢ SENTINEL SITES = specific areas where testing or evaluation

was/is done

➢ TESTING = when a group of people are tested with the same criteria ➢ URBAN = these are areas that have a high population and are well

resourced

➢ WORKSHOP = bringing a group of interested people together to

work on a common issue

www.onquehiv.co.za

RESOURCES ▪ www.onquehiv.co.za ▪ www.thebody.com ▪ www.redribbon.co.za ▪ www.tht.org.uk ▪ www.cdc.com ▪ Aids Helpline: 0800012322

▪ On-Que : timothy@onquehiv.co.za

www.onquehiv.co.za

CREDITS MMI FOUNDATION On-Que Training & Development Consultants Statistics South Africa Actuarial Society of South Africa UNAIDS

Jhanne Hebblewhite-Peters

www.onquehiv.co.za

HIV/AIDS Unit Peer Education Programme Activities Log sheet Name & Surname: ____________________________________ Date

Time In

Time Out

Description of activity

Intervention /Topic

Campus / Residence

Total students reached

Completed form received by: ____________________________________ Signature_________________________ Date__________________________

PEER EDUCATION CONDOMS DISTRIBUTION FORM Name & Surname: ______________________________

Residence________________________________

Distribution location e.g.: Block E, Toilets & TV rooms Date Received E.g. 01/01/2020

Quantity Received 6000

Quantity Distributed 1000

Distribution Location

Distribution date

Ground floor toilet

10/01/2020

Signature

Completed form received by: ________________________________ Signature: ______________________________________Date__________________

CPUT Peer Education Programme Intervention: Date: Duration: Venue or Online platform:

Student Name & Surname

Topic(s): Facilitator(s): Campus:

Student

Age

Number

r 15 - 24 25+

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

Gende

Campus

Discussion Group Evaluation Gender: ___________ Age: ______

Course & Year of Study: _____________________________

Campus & Venue: __________________________________

1.How would you rate the performance of the facilitator(s) of the discussion group? Good Average Poor 2. Would you recommend the discussion group to other students?

Yes

3. Please rate the overall quality of the discussion group Good Average Poor 4. What have you learnt during the discussion group? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 5.What did you like most about the discussion group? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 6.What did you NOT like about the discussion group? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 7.Please provide suggestions on what can be done to improve the discussion group __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 8. Please provide any comments __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________

Peer educator Monitoring and Evaluation Tool

How to use create a Meeting/Training/Discussion Group via Teams Get all the email addresses of people you want to invite Step 1: Click New Items (next to New Email) Step 2: Click on Teams Meeting Step 3: Enter email addresses of people you are inviting, then enter subject of the meeting/training/discussion group, then enter date and start time and end time (using the drop down arrows) Step 4: Send The link will be below the email and will look like this:

Join Microsoft Teams Meeting : “You click on it” You can copy the Microsoft Teams link and share via WhatsApp with people you would like to participate.

Joining the meeting/training/discussion group on the day You and invited people have to click on the link on the day 5 minutes before or at the time of the meeting/training/discussion group to join The link will look like this:

Join Microsoft Teams Meeting : “You click on it”