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LOOKING AFTER OURSELVES, LOOKING OUT FOR EACH OTHER: HIV/AIDS booklet for peer educators working with most-at-risk young people
Disclaimer: This manual was developed for use by peer educators trained to work with young people who have increased HIV risk such as those who engage in unprotected sex with multiple partners and those who inject drugs.
Dear peer educator, This booklet aims to help you with your task of preventing the spread of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) among members of your peer groups. It is not, however, an extensive guide, as it contains only the key points you learned from your training. Use the pictures and illustrations to explain important points. Do not just hand this booklet to your peers. You need to explain the topics to them so they can have a better grasp of the issues. Keep in mind that this booklet contains rich information that cannot be internalized in one discussion. Hence, give your peers enough time to think and ask questions during your educational sessions. Uderstanding the information contained in this booklet is only part of your peers’ protection against HIV. They also have to be equipped with skills and confidence, access
to services, as well as motivation and regular reminders on why it is important to stay safe. Encourage your peers to visit the organization for which you volunteer. They can go to a social hygiene clinic for information and testing, or attend youth programs where they can make new friends, have fun, and learn more, all at the same time! Your work is important - you help people stay healthy and maybe even save their lives. Your peers may look up to you as a role model who knows how to take care of himself/herself and has all the answers. Be conscious of the responsibility. Admit that staying safe is hard and that no one has all the answers. Thank you for your important work! Through young people like you, there is hope for a healthier and safer future for the Filipino youth.
HIV Human Can be passed only from person to person. Immunodeficiency Weakening of the immune system. Virus A virus that attacks the immune system.
AIDS Acquired Comes from someone else. Immune Deficiency Weakens the immune system. Syndrome Has a range of symptoms. If a person has AIDS, that means the virus has almost destroyed his/her immune system. This makes the person more vulnerable to other diseases. The immune system fights diseases by producing antibodies. These antibodies are specifically designed to recognize and fight bacteria, virus or other germs that attack our bodies. HIV weakens the immune system and, overtime, reduces the body’s ability to fight diseases.
HIV negative You don’t have the virus
HIV positive The virus is in a person’s body. A person may look and feel healthy, but he/she will not know he/she has the virus unless he/ she gets an HIV blood test.
How can I tell her I have HIV? He looks healthy; he can’t have any diseases, can he?
Transmission: HIV is spread in 3 ways
1. UNPROTECTED SEX Vaginal or anal sex without using condoms.
I might catch and spread HIV if I don’t use a condom.
Sex with my boyfriend without a condom could be just as risky as sex with other guys.
I’ve had sex without a condom with different people. I could be spreading HIV without knowing it.
Transmission: HIV is spread in 3 ways
2. BLOOD TO BLOOD Transfusion of infected blood or sharing infected needles.
This is not a clean needle. I might catch HIV or Hepatitis C.
Transmission: HIV is spread in 3 ways
3. MOTHER TO CHILD During pregnancy, childbirth or breastfeeding if the mother is infected.
Our baby can get HIV or syphilis if I’m infected.
FOR HIV TO BE TRANSMITTED... It must pass from an infected person.... One person must already have the virus, and the body fluids infected with the virus must have a way to leave their body. The body fluids that can carry the virus are semen, vaginal fluids, blood and breast milk. ....into the bloodstream of an uninfected person The body fluid from the infected person must be able to enter the bloodstream of the other person. It usually does this through the thin skin inside the vagina, the anus or the head of the penis; through small cuts or abrasions in the skin, or; straight into the vein when people share needles and syringes for injecting drugs.
VAGINAL SEX (penis - vagina)
Vaginal sex is VERY HIGH RISK if you don’t use a condom. Semen (and the fluids a penis starts to produce as soon as the man is aroused) and vaginal fluids can all contain HIV. The skin inside the vagina and on the head of the penis is very thin, and the virus can easily pass through it. During sex, any tiny cut or abrasion either partner may have increases the risk. There doesn’t have to be blood for transmission to occur. Having a man withdraw (pull out) his penis before he ejaculates (cums) does not make sexual intercourse safe. The virus may have already been passed earlier on.
ANAL SEX (penis - anus)
Anal sex is VERY HIGH RISK if you don’t use a condom. The skin inside the anus is very thin. The virus can pass straight through it during sex. The skin can also tear very easily during sex, adding to the risk. The risk is the same whether i t i s two men, or one man and one woman, having anal sex. Like in vaginal s e x , w i t h d r aw i ng the pe n i s b e for e ejaculation does not make anal sex safe. The anus does not have a natural lubricant unlike the vagina. Using a waterbased lubricant on a condom makes it less likely to break, and feels better for both partners. The lubricant must be meant for use with condoms. Do not use oils, shampoo, moisturizer or anything else that might feel a bit like water-based lubricant. These things can weaken the condom.
ORAL SEX (mouth - penis or vagina)
Using a condom during oral sex protects both partners from STIs that can be passed on orally. Oral sex without a condom carries LOW RISK for HIV transmission, as long as there are no cuts or sores in the person’s mouth, and no blood either from the mouth or the penis or vagina. For this reason, some people choose to have oral rather than vaginal or anal sex if condoms are not available.
MASTURBATION
Masturbation - carries no risk for HIV.
HOW DO I KNOW IF SOMEONE IS INFECTED WITH HIV?
It is impossible to tell that a person has the virus just by looking at them. HIV-positive people take a long time to become sick with AIDS. During that long period, they look and feel perfectly fine. Unless they get tested, they will not know that they have HIV. The only way to know if one is infected is through an HIV blood test. Anyone can have the virus, even those who look clean, healthy, handsome, pretty and well-dressed. Young and old, rich or poor, can catch the virus. All of them can all pass it on to another person through unsafe sex, sharing needles, or from a mother to a child through pregnancy.
STAY STAY SAFE SAFE We can all avoid HIV and AIDS. Here’s how –
ABSTAIN
Don’t have sex. Delay having your first sexual experience as long as possible. Have sexual pleasure that does not involve penetration, like kissing.
B E FAITHFUL
Have just one partner, in a mutually monogamous relationship.
USE
C ONDOMS
Every time you have vaginal or anal intercourse.
D ON’T SHARE NEEDLES Don’t use drugs. Don’t inject drugs. If you inject, use a new needle and syringe each time you inject.
NOT NOT SAFE SAFE Unsafe practices and myths: Choosing partners solely on the basis of clean and healthy looks Inspecting a man’s penis to see if it looks healthy Withdrawal or pulling out ones penis from the vagina or anus before ejaculation, thinking this will not transmit HIV Thinking one can only get HIV from foreigners Belief that having anal sex with women is safer than vaginal sex Cleaning a syringe with just water
YOU CANNOT GET HIV FROM... MOSQUITOES
I can pass on malaria and dengue, but not HIV. HUGGING
Hugging is completely safe.
KISSING
I’m glad that we can still kiss.
YOU CANNOT GET HIV FROM...
HOLDING HANDS
SHARING OF FOOD AND UTENSILS I can’t catch HIV from saliva.
USE CONDOMS EVERY TIME CONDOM USE DOESN’T JUST HAPPEN. IT TAKES PLANNING, COMMITMENT, AND CLEAR THINKING. Decide for yourself that you will have protected sex, especially anal or vaginal. Say no to sex without condoms – clearly and directly. State firmly and clearly that your life and health are more important than the sexual relationship. Ensure that condoms are available and that your partner has agreed to use one before any sexual activity starts.
Adapted from FHI Peer-to-Peer Trainers Guide
Persuade your partner that you will make putting on and using a condom very exciting. Tell your partner that you are taking this stand for his/her safety, as well as your own. Suggest that there are other ways to have sexual pleasure without penetrative sex. Always be careful of situations that you may be unable to handle. Wherever possible, avoid them or have a clear plan of how you can get away.
USING A CONDOM
1. Check the expiry date
2. Open the package carefully and remove the condom.
3. Check that the condom is not inside out (that is, the tip is pointing the right way).
4. Squeeze the tip of the condom.
5. Place the condom on the head of the penis and roll it down to the base.
6. Hold on to the rim of the condom as the still-erect penis is withdrawn.
7. Tie a knot at the end of the condom and dispose safely.
Reducing the risk of HIV or syphilis transmission from parents to children Let’s take the HIV and syphilis test and, if needed, take any medicine the doctor prescribes.
If you are pregnant or thinking of getting pregnant: • Get tested for HIV and syphilis at your social hygiene clinic or health center. • Go back to the clinic or center to receive the test results. If you find out you have HIV or syphilis, take action. Normally, Syphilis can be easily cured at your social hygiene clinic or health center. For HIV, • Go to the hospital recommended by your doctor or to the Prevention of Mother-To-Child Transmission of HIV (PMTCT) site to access the necessary services, including delivery, counseling and medication. • Six to eight weeks after delivery, return with your baby to the same hospital to get your baby tested and get medication if needed. • Feel free to contact a local support group, for example, Babae Plus.
Reducing the risk of HIV transmission from drug use
If you share needles even once, you might get HIV and more likely, HEPATITIS C.
If possible, DO NOT USE DRUGS AT ALL. When you’re affected by drugs, it’s much harder to look after yourself, such as using condoms. If you use drugs, the best way to stay safe is DON’T INJECT DRUGS. It is not the drug that carries HIV but the small amount of blood left in the syringe and needle. When people share them, even a tiny amount of blood could carry the virus. If you inject drugs, you must use a NEW needle that is just for your personal use. If this is not possible, use a needle that has been PROPERLY CLEANED.
Cleaning needles Prepare three containers such as cut plastic water bottles, one for each step. For use in Steps 1 and 3, fill two containers with fresh, clean, tap water. For use in Step 2, fill the other one with pure bleach.
For step 1:
Fresh clean water
For step 2: Pure bleach (undiluted/ full-strength bleach, 5.25% hypochlorite)
For step 3:
Fresh clean water
Cleaning needles Step 1: Rinse with water 3x Draw up water into the syringe
Shake the syringe to loosen the blood. Then squirt the water out. Repeat 2 times.
Remember: Do not squirt onto the water container so as not to contaminate the cleaning agent. The same goes for the other two steps.
Step 2: Rinse with bleach 2x Fill the syringe with bleach and leave for at least 30 seconds.
Cleaning needles
Squirt out and repeat.
Important: Pure bleach (5.25% hypochlorite) should destroy HIV after 30 seconds. For bleach to kill Hepatitis B virus, it must be left in the syringe for two minutes. It is not known whether bleach can kill Hepatitis C virus even after two minutes.
Step 3: Rinse with water 6x Fill the syringe with water and squirt out. Repeat five times to rinse off all of the bleach.
Do not reuse the water and container in Step 1, as these may be contaminated with blood.
HEPATITIS C Hepatitis C (Hep C) is a virus that is mainly transmitted through blood during drug injection. Hep C is very common among injecting drug users in the Philippines. This means sharing needles and syringes even once makes a person likely to catch the virus. H ep C i s easier to ca tch during injection. Even a tiny amount of blood in a syringe is enough to pass on Hep C. This is why it is best to always use a new syringe, or one just for your personal use. Anyone infected with Hep C can pass it on to other people. Not everyone becomes sick from the disease, and most people with Hep C will look perfectly healthy. After several years with the virus, some people will have serious liver problems, and a minority of them will die. At the moment there is no cure for Hep C, but there are treatments available to reduce the risk of becoming seriously ill.
What are STIs? Sexually transmitted infections (STIs) are sometimes known as sexually transmitted diseases. Some STIs are caused by viruses and cannot be cured. Others are caused by bacteria, fungi or small animals, and all of these can be cured with proper treatment. Some common STIs are syphilis, gonorrhea, herpes, genital warts and pubic lice. Common Symptoms of STIs STIs have a range of symptoms, but many have no symptoms at all especially for girls and women. They can damage your health and your body without your knowledge. If left untreated, the symptoms of some STIs go away. Unfortunately, this doesn’t mean that the disease has gone. It is still in you. You can still pass it on. And, it is still doing you harm. Other times, the STI might progress until it looks like the ones in these photos:
Genital Warts
Syphilis
Gonorrhea
Herpes
Pain passing urine
Yellowish / abnormal Discharge
Pain
Severe itchiness
Abdominal pain
Ulcerations
So what will I do if I think I have an STI
I better ask the doctor for advice about my symptoms.
Get tested. Visit a social hygiene clinic for proper diagnosis and treatment. Do not be embarrassed to see a doctor. Most STIs can be cured, and others can be treated to reduce the symptoms. Having an untreated STI also increases your risk of catching HIV. • Do not put raw meat or chemicals into the genitals, drink soaps or shampoos, insert chemicals into your vagina or anus, and/or soak your penis in something. • You cannot get rid of your own disease by passing it on to others through sex. • Do not take antibiotics intended for another person or another disease. These will just build resistance of diseases to the medicine.
Am I at risk of HIV or STI?
Do I engage in unprotected sex relationship with more than one partner? Does my partner have any other sexual partners? Do I or my partner have signs or symptoms referring to possible STI? Do I or my partner use drugs and share injection equipment?
“YES�
If you answered to any of the above, then you might have a risk of getting HIV or STIs. Go to a local health center for proper diagnosis, treatment, or referral.
SEXUAL RIGHTS AND RESPONSIBILITIES No matter who we are, or how old we are, we all have rights and we all have responsibilities. When it comes to sex, we have the right to: Have sex only when we want to Never feel pressured into having sex Choose the types of sexual activity we will and will not have Be respected for the choices we make Have the information we need to know about HIV, STIs, and how to protect ourselves Access the services and resources we need for protection, testing and treatment; and, Decide how we use our own body.
With our rights come responsibilities: Respect the rights of others Look after our body and health, and that of our partner.
If you are young and sexually active, but sometimes you don’t want to have sex, then you have the right to say no. Even if you have accepted money or gifts from people in the past in exchange for sex, you have the right to help and support so that it does not happen again. Tal k to an adult you can tru st – a parent or other relative, a social worker, or a neighbor – and ask for the help you need. If an adult is paying you for sex, it is he/she is the one doing wrong, not you. This is true for both female and male.
Remember: You decide how you use your body.
THERE IS NO CURE FOR HIV and AIDS Scientists say they cannot tell when a cure for HIV/AIDS will be discovered.
THERE IS NO VACCINE FOR HIV As of now, there is no known effective vaccine that can prevent HIV.
THERE ARE GOOD TREATMENTS AVAILABLE Doctors can give infected people medicines that slow down HIV by many years and keep them healthy for longer period. However, this is not a cure. They still have the virus and can still pass it on. They must take the medicines every day for the rest of their lives.
CARING FOR SOMEONE WITH HIV Now that we know how HIV is passed and how to avoid getting infected, we do not need to be scared of someone who has the virus. People living with HIV need medical support and treatment to stay well. Like everybody else, they also need the love and care of friends and family. People with HIV or AIDS should not be discriminated against or treated badly, and should be given the same opportunities as everybody else to enjoy life to the fullest. We should all try to avoid HIV, but not the persons who have them.
WHERE CAN I GET HELP? HOTLINE AND CONTACT NUMBERS* Philippine National AIDS Council Secretariat
Department of Health 3rd Floor, Bldg 15 San Lazaro Compound, Sta. Cruz, Manila Tel Nos. (02) 743.0512 and (02) 743 8301 with ext. nos. 2551/2553
DOH National AIDS and STI Prevention and Control Program
San Lazaro Compound, Sta. Cruz, Manila Tel. Nos. (02) 651-7800 with ext. nos. 2350 to 2354
San Lazaro Hospital
Quiricada St., Sta. Cruz, Manila Tel Nos. (02) 732-3776 to 78 / (02) 732-3125
Research Institute for Tropical Medicine (RITM)
Department of Health Compound, FILINVEST Corporate City, Alabang, 1781 Muntinlupa City, 1781 Philippines Tel No. (02) 807-2628 loc. 208
Philippine General Hospital
Taft Avenue, Manila Tel Nos. (02) 521-8450 / (632) 554-8400
Lunduyan para sa Pagpapalaganap, Pagtataguyod, Pagtatanggol ng Karapatang Pambata Foundation, Inc. 17-17A Casmer Apartment, Del Pilar corner Don Jose St. Bgy. San Roque, Cubao, 1109 Quezon City Tel Nos. (02) 421-4953 / (02) 913-3464
Positive Action Foundation Phils. Inc. ( PAFPI )
2613 Dian St. Malate, Manila Philippines 1004 Tel No. (02) 832-6239 / (02) 404-2911
* UNICEF and DOH accept no responsibility for the content of these websites and information from these hotlines.
Pinoy Plus Association, Inc.
c/o Remedios AIDS Foundation, Inc. 1066 Remedios cor. Singalong Sts, Malate, 1004 Manila Tel Nos. (02) 524-0924 / (02) 524-4507 Hotline No: 0921-5465758
Babae Plus Support group of women living with HIV 2615 Dian Street, Malate, Manila Tel Nos. (02) 404-2911 / (02) 528-4531 Email: babaeplus@gmail.com
“Dial a Friend� Hotline Foundation for Adolescent Development, Inc. (FAD) 1066 Remedios cor. San Bartolome Sts., Malate, Manila Tel Nos. (02) 525-1743 / (02) 525-1881 / (02) 525-0428 (Monday-Friday, 9 am-6 pm) Target population: 13-24 year olds Free phone call from within Metro Manila Websites for frequently asked questions www.avert.org/faq1.htm www.thebody.com/index/whatis/faqs.html www.aids.org/info/FAQs.html www.teenfad.ph/ Website for HIV Statistics, Philippines Department of Health www.doh.gov.ph
peer educators HIV/AIDS booklet for young people risk working with most-at-
2012