WITH HOPE AND HELP Manual For People with HIV/AIDS
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- Title
- WITH HOPE AND HELP Manual For People with HIV/AIDS
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For facilitators and positive people groups
„
accompany the video "With Hope and Help"
^r^M^manual provides information and positive advice
--
WITH HOPE AND HELP
MANUAL FOR PEOPLE WITH Hiy/AIDS
I•
A
“With Hope
and Help
Manual For People with HIV/AIDS
This manual was compiled by the Education and Counselling
specialist stafffrom the Albion Street Centre, Sydney
in conjunction with the Counselling Staff of
Bamrasnaradura Hospital, Nonthaburi with assistance from
the UNICEF Regional Office for East Asia and the Pacific.
To accompany the
video 'With Hope
and Help”
This manual provides
information and advice
for people with
HIV/AIDS on a wide
range of issues that
have proved to be of
great concern for HIV
positive people. As
well, the manual
includes individual and
group activities which
explore strategies for
living well with HIV.
*****
*****
©9
z JU V ii
ALBION STREET CENTRE
1
•
WITH HOPE AND HELP
MANUAL FOR PEOPLE WITH HIV/AIDS
Acknowledgments
((With Hope
and Help
Foreword.................................................
About this vidio.......................................
How to get the most out of this manual
How to get the most out of this video...
Finding Out.............................................
Keeping Well...........................................
Being Sick...............................................
Mental Health..........................................
Nutrition..................................................
Herbal Medicine.....................................
Employment...........................................
Love, Sex and Intimacy.........................
Families.......... i.......................................
Disclosure.......i.......................................
Facing Prejudice....................................
Transmission..........................................
..3
..4
..6
..7
12
13
17
.18
20
24
26
29
38
40
45
47
2
A great many people and
many organisations
contributed to the process of
developing these materials.
We would like to thank the
people living with HIV/AIDS,
the school children and
students, the young people
in workplaces and
communities, members of
various communities who
sacrificed their time to
discuss the video with our
production team. We would
also like to thank the
participating organisations,
both those who were
represented on the project
committee and contributed
to the brainstorm process
and those who organised
meetings with various target
audiences:
AIDS Project of the European Union
Asian Development Bank
Association for the Advancement of
Children
Banglamung Hospital
Duang Prateep Foundation
Candlelight Club
CARE International, Thailand
Clear Skies Project
Family Health International
Foundation for Increasing Capability of
Populace
Gillette, Thailand, Limited
Hyatt Erawan Hotel
Jardine Mathieson, Thailand Limited
Living Films
Minprasart School
Nawamintrachuthit Secondary School
NGO Coalition On AIDS
Nestle, Thailand Limited
Panat Nikom Hospital
Pearl S. Buck Charitable Foundation
Regent Hotel
San Pa Tong Hospital
Thai Business Coalition on AIDS
Thai Red Cross AIDS Program
Thai Spectacles Factory
Wednesday Friends Club
White Dove Association
YMCA
• WITH HOPE AND HELP •
MANUAL FOR PEOPLE WITH HIV/AIDS
©
©
©
©
Foreword
None of us deserves to be excluded from society
because we have an illness or even just the germ of
an illness in our bodies. This is the kind of exclusion
people with HIV and AIDS are now experiencing.
Those who imagine that they themselves are far
removed from such a plight are the very ones busy
excluding and discriminating against people with HIV
and AIDS. Such people lack true understanding.
True understanding is the best cure society can
provide to solve the very worst of problems. Everyone
fears pain and suffering. We all fear death even more.
But, most of all, people fear the living death which is
caused when a person is excluded from the society in
which they have lived their life.
This manual which accompanies the “With Hope and
Help” video has been designed to give group leaders
ideas and direction to run activities and discussions.
The manual adckesses
es njisci
rriisconceptiQrfcs about people
sick wjtR'Alds.
ids. The manual
who have HIV .^nd thpSe" sicl
will be used witNoroups^f^ der^ in society and with
communities so/majjl pycan gain a true
understandinj/of wha: it reaJJ* means to have HIV.
This is the sort of und Xgt^fiding that will open the
gates of loving kindness and will be folio1
byil
best help and support possible.
If you have HIV, the manual will help byUd yoor selfawareness and increase your understerfdin/ of your
situation, which will lead to better careZrf your
physical and mental health. It will entourage you to
help out friends who are in the same situation. Being
independent and caring for yourself is tremendously
empowering. If you are able to helplyour friends and
society as well, this can give you life-giving hope arid
strength.
\ /
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What the world needs ndv^/fs understanding. We all
need to understand ourselves, our fellow human
beings, and our society. From this, loving kindness will
proceed. If we can do this, the world will certainly
become a happier, more peaceful place.
Dr Chaowalit Natpratan
Director,
Communicable Disease Control Office, Region 10
3
1
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© ©
©
©
©
© ©
© © ©
©
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© ©
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© © ©
© ©©
©
©
©
•
WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
“With Hope
and Help
About this video...
“With Hope and Help” is a 35 minutes video about HIV and
AIDS. This inspiring video features intimate interviews with
long term survivors confronting the epidemic throughout
Thailand.
The aim of this video is to promote community support and
acceptance of people with HIV/AIDS. The HIV positive
people in the video can show communities that people with
HIV/AIDS are ordinary people struggling to maintain their
health and well-being, despite having a serious health
problem.
What audiences wanted
to know about the video
• Is it true?
This video is a documentary. The people in this video are
not actors. They are not reading from scripts, either. They
are real people, who have been brave enough to stand up
and talk to us about living with HIV/AIDS. The film maker
interviewed a total of forty people with HIV/AIDS for this
video, but not all of their stories were used. (You can see
the faces of all forty people during the credits at the end).
• Does everyone on the video have HIV/AIDS?
There are a few people talking on the video who don’t have
the virus. These include a monk, a nurse, a doctor, a
herbalist, a nutritionist and a traditional medicine doctor,
who are all involved in helping people with HIV/AIDS and
working with communities to understand their needs.
• How come they are all from the North?
The HIV positive men and women in this video are from all
parts of Thailand: from cities, towns and villages in
the countryside. You may see places you recognise in the
backgrounds. There are also a number of people in the
video from the North of Thailand. This is because the North
was the first region in Thailand to be seriously affected by
HIV/AIDS. Now, there are more and more people in the
North East and Central and Southern Regions who are
also affected by HIV/AIDS. The people in this video hope
that people everywhere will be able to learn from their
experience.
4
This documentary was
made possible through
generous grants from :
Care International
Thailand; The
Australian Government
through AusAID;
The European Union
(ECAIDS) through
Mahidol University's
Asian Institute for
Health Development
and UN Thailand Theme
Group on AIDS
(UNICEF, UNDP,
UNFPA, UNESCO,
WHO, World Bank).
•
WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
• How come they don’t look sick?
The people with HIV/AIDS in the video are healthy and
happy now. But as you will see and hear, they have all
been through difficult times. Some of them have been
seriously ill. Because HIV weakens people’s immune
systems, people with the virus can get a great many
infections (called opportunistic infections). Many of these
opportunistic infections can be treated. That is why the
people in the video who were sick, look so healthy now,
because they have received treatment of various kinds.
Positive people need to take good care of their health and
in this video, you will find some ideas for doing just that.
• How come they don’t seem to have problems like
other people with HIV/AIDS you hear about?
At first, the people with HIV/AIDS in the video all had a lot
of problems. Sometimes families and communities rejected
people with HIV/AIDS and treated them badly. They were
scared to go near a person with HIV/AIDS. But, as time
went on, more people understood that AIDS doesn’t jump
from person to person like a flea and that they could still
eat with people with the virus and care for them if they
were sick. Now, the people with HIV/AIDS in the video are
able to lead full and happy lives as productive members of
society, thanks to the support received from friends,
relatives and community members, as well as their own
determination.
• What can we do to help?
We can support our friends, neighbours, workmates and
family members with HIV/AIDS. We can give them
encouragement and we can try to make sure everyone
knows what HIV is really like. There are still some people
who don’t understand about the virus and who have trouble
accepting people with HIV/AIDS. This can lead to people
with the virus being treated unfairly, or with hostility, in their
homes, in their work or in their communities. We can try to
inform communities so that they change their attitude.
In the kit that follows: “With Hope and Help: For people
with HIV/AIDS”, you will find additional information and
learning activities to enhance the message of the video for
use with HIV positive people. The materials in the “With
Hope and Help” series are:
With Hope and Help, Manual For Communities
With Hope and Help, Manual For People With HIV/AIDS
With Hope and Help, Manual on Self-Care, For People With
HIV/AIDS and their Carers.
All materials in this series are available in Thai and English.
Please contact UNICEF EAPRO for distribution details on
2805931, extension HIV/AIDS Unit.
5
“ AIDS is not
something that
should divide and
isolate us, one from
another, but
something that
should bring us
together.”
Prasert Dechaboon
•
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
How to get the
most out of
this manual
About this manual...
This manual was designed to promote the effective
dissemination of the message of the documentary film
“With Hope and Help” to a wide ranging population. The
content, activities and advice that have been collected in
this volume are intended to give people with HIV/AIDS
alternatives and to inspire them to live with hope. The
video was also designed to enable people in society,
whether they be young people or the general population, or
people providing services to people living with HIV/AIDS, to
better understand the feelings and needs of people with
HIV/AIDS.
One part of the process we used in designing this manual
was to run discussion groups to find out what points
interested our audiences, what questions they had, and
what experiences and advice about living with HIV/AIDS
they wished to share. We used this feedback to select
additional information and develop activities. We hope this
manual will assist people to have a positive and realistic
approach to problem solving, as well as learning to live
with the HIV virus on a day to day level. The manual was
focus tested in a draft form with the range of target groups.
We even developed some advice on how to best use this
manual to promote discussion and to engage participants
in active learning through activities.
Who can use this manual?
This manual is especially aimed at group leaders or
facilitators to use with groups of people with HIV/AIDS. The
group leader or facilitator may be an HIV positive peer
educator, a teacher, a health worker, a volunteer or an
interested HIV positive member of the group.
Viewers will get the most out of this video if it is
followed by discussion and activities which explore
viewers’ reactions to the messages in the video. It is
easier to conduct discussion and activities if the video
is presented by a group leader or facilitator.
6
•
IN THIS MANUAL...
Topics with background
information and
activities:
Finding Out
Keeping Well
Being Sick
Mental Health
Nutrition
Herbal medicine
Employment
Love, Sex and
Intimacy
Families
Disclosure
Facing Prejudice
Transmission
If you have limited time
to spend with the
group, we recommend
asking the group to
prioritise the
discussion/activity
topics. EG: Choices
could be conducting
the activity “Disclosure”
which covers a number
of significant issues,
followed by “Facing
Prejudice”
or
“Love, Sex and
Intimacy”
or
“Keeping Well”,
depending on the
needs and interests of
the group.
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
•
How to get the most
out of this video
Before viewers arrive
to see the video...
TOOLS:
Time and Place
If you’re showing the video during the day, try and pick a
spot that is as dark and shady as possible. Indoors is best,
but if that is not possible, spend a little time finding the
least reflective position for the screen. Videos often look
their best at night, when the picture and colour stand out
more.
Caution
Don’t operate during thunderstorms as
equipment may be damaged.
Distractions
If your viewers are busy senior executives in their offices
or children during their playtime you may find that the
executives want to keep on working and the children want
to keep on playing!
Unless viewers are very, very interested in the topic they
will be distracted if the video is shown somewhere where
there are frequent interruptions or people coming and
going. Try to find somewhere quiet where people can
concentrate on the video.
Planning
Plan what you will do when the video is over.
In the following pages we give suggestions as to activities
you might like to do with the group. However, the group
may have its own ideas on what topic they are interested in
pursuing. Get them to arrange the list of topics in order of
priority. Background information sheets are provided for
each topic. Where appropriate we have designed activities
to encourage group participation. Use the activity sheets to
get the group started with discussions.
7
Videos need
electricity or a
generator, to
operate. Check that
the place you want to
show the video has
power and a VCR
and TV in working
order.
Before viewers
arrive, make sure
equipment is
working, that the
video is tuned,
connected correctly
to the TV etc.
When you start the
video, check that
people at the back
can see and hear.
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
•
Before you show
the video...
Preparing yourself
Make sure you know who will be viewing the video, how
old viewers will be, what level of education they have, how
much experience they have of HIV/AIDS.
Community Groups:
It is increasingly likely that general community groups will
include either positive people who chose not to disclose
their status or relatives of people who have HIV or are sick
or have died. Group leaders may try and remember to
include these perspectives in their presentation. Some
terms that were used in Government campaigns early in
the epidemic can offend people with HIV/AIDS or make
them upset. Avoid phrases like “Only promiscuous people
get AIDS”. Emphasising the difference between “innocent
victims” like wives and children and “guilty” people who
may have acquired HIV through drug use or sex outside
marriage, can make people feel rejected and excluded.
You need to:
have seen the video;
have a good idea what issues your group will be
interested in and what issues you want to highlight;
know how long each activity takes. There are many
activities in this manual and you will not be able to do
them all in one session;
have ideas on how you will conduct the session: how
you will move from viewing to discussion; whether you
will break up into small groups after the video etc.;
have any handouts ready to give out after the session
(if you give these out before the session people will
spend first five minutes of the video reading handout);
know who the relevant contacts are in your area. You
can use these contacts to refer people to, if they need
further support or information;
prepare participants by telling them the questions you
will be asking them after they have viewed the video.
For instance...
“After you’ve watched the video I want you to tell me
who your favourite person was.”
8
Preparing
your
audience
On a practical level:
Viewers need to know the
video takes 35 minutes and
how long you want them to
stay afterwards, as well as
what the video is about and
where it comes from. Go
through page4-5 “About this
video”, beforehand.
People are more likely to be
interested in the video if
they feel it is relevant to
them. To make it relevant,
introduce the video with a
story about a local incident,
or ask participants if they
know any stories about
people with HIV/AIDS or
give the local statistics on
HIV.
On an emotional level:
Group members are likely to
experience a range of
different feelings and
thoughts as they watch the
video and in the discussions
that follow. It’s helpful if you,
the facilitator, can prepare
the group for this.
Inform the group that
previous experience has
shown that some people
may become distressed
as they watch the video
and compare their own
situations to those
people sharing their
stories in the video.
Inform the group that
they can debrief about
the different feelings
and thoughts they
experience following the
viewing of the video.
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
During the video...
Problems can occur!
• Viewers can ignore the video completely.
In this case it may be better to switch it off and talk
about the topic instead.
• Some viewers may watch and others not.
In this case you may ask the group whether they want
to keep watching or come to an arrangement that
allows those who want to continue and take part in
discussion to do so, while others can leave or find
something else to do.
• Pay attention to the body language of participants.
You may notice participants who are moved or
upset by the material, or they may quietly leave.
HIV/AIDS raises lots of sensitive issues. Sometimes,
as the facilitator, it’s hard to know what to do when
people react strongly to the video. That’s why we have
included some suggestions for ways you can help
follow-up participant’s needs in the sections entitled
”De-briefing” below.
• Some people may feel they need to discuss taking
a test for HIV antibodies.
You should have contacts they need and be prepared
to refer them to an appropriate testing place , where
pre and post test counselling is available.
9
•
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
•
After the video...
Before you carry on with discussion or other activities you
may give the group time to explore the feelings and
thoughts raised by the video. Many group members may
have not had previous opportunities to explore these
feelings and thoughts. Some people may feel sad or angry.
It is important not to joke about people’s reactions or try to
force them to feel better. Instead allow them to experience
these feelings and thoughts in a supportive environment
that can assist them to cope with their reactions in a
productive manner.
Exploring Feelings
Only one or two
people are upset:
Ask the person if they
would like to discuss
their feelings within the
group or whether they
would prefer to talk with
you individually after
the group or in a break;
OR
Ask the group to spend some quiet time considering their
feelings.
• Let group members express their feelings:
You may choose to go around the group and ask each
member to give one or two words that best describes their
reaction to the video.
• Acknowledge the feelings expressed:
“So it seems there is a range of feelings in the group after
watching the video...”
“It seems that while there are a range of feelings in the
group, many people are feeling ....”
“I can see some group members are
WHAT TO DO
WHEN...
(upset, sad)”
• Normalise these reactions:
Let the viewers know that you understand why someone
might feel that way. For instance:
“These feelings are understandable given the stories we
have heard and the many issues related to HIV.”
“These feelings are a normal reaction to HIV issues.”
• Viewers who don’t want to talk about feelings:
Viewers may also not demonstrate any signs of being
upset or affected by the video, especially in a larger group.
You may describe some responses that other people have
had and acknowledge that in a large group it’s hard to talk
about feelings. For instance:
“Some people watching the video felt sad when they saw
K. Pimjai and her family, because they felt that their family
wasn’t like that...”
You may then move on to the activities.
10
Approach the person
after the group or in the
break, express your
concern about them
and ask if they would
like to spend some time
talking with you.
• No-one is
particularly upset:
Move on to discussion,
or start one of the
activities we suggest,
on the topic that the
group is most
interested in...
• More than two
people are still
upset:
Continue with the de
briefing techniques on
the next page.
You can also come
back to the de
briefing section at
any time. It’s often a
good idea to run
through it right at the
end of the session to
make sure everyone
is ok to go home.
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
After the video... de-briefing
•
CONTACTS
Strategies for Feeling Better
Ask the group to consider what strategies or ‘plan of action’
can help them deal with some of the uncomfortable
feelings they may have experienced.
You may choose to again go around the group asking
each member to share a ‘strategy’ or course of action
or activity they find useful for them when they are
upset, angry, worried, etc.
As the facilitator, you may need to add some strategies
to those generated by the group if they are having
difficulty, like: talking to someone, phoning a friend,
reading, exercising, eating or drinking something nice,
watching television, listening to music, doing something
they enjoy.
You may just open this issue for group discussion.
You may decide to ask them to break into pairs or small
groups to discuss this.
Are participants ready and
able to go home?
De-briefing/exploring feelings
Reassess how people are feeling - you may again choose
to go around the group and ask each group member to use
one or two words to express their current feelings.
If group members continue to show distress you will need
to discuss whether they are able to return home safely.
★ Check how group members intend getting home.
★ Alternative arrangements may need to be made to
ensure people’s safety, eg. people may be too
distressed to ride motorbikes or drive.
★ For some people it may be helpful to delay their return
home - have a cup of tea, go for a walk.
★ You can also use the contact list to suggest places to
go for help.
11
It is essential that you
have a list of available
contacts in your area
so you can refer
group members for
further assistance
and professional
support as required.
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Finding Out
For many people finding out they have the virus is a
big shock.
Like any serious health problem, it takes a while for a
person to adjust to the news that they have the virus.
Immediately after hearing the news some people don’t
take in information and advice. They need time for the
message to sink in. Others can’t believe that they
have such a virus.
For a long time people didn’t understand about the
virus and how it affects the body. In the early days of
the HIV/AIDS epidemic, many people were confused
and thought that if you contracted the virus, you had
to get sick and die instantly.
People can remember all these messages when they
are told they have contracted the virus and this can be
a very anxious time for them.
In fact, it is not true that people with HIV become sick
or die a short time after contracting the virus. In this
video you have just seen, there are many people, men
and women, old and young who have had the virus for
years and years. The man who has had the virus for
longest in the video has had it twelve years. Others
have known they have been infected for eight and
nine years.
As one woman said
“I’ve been positive for 8 years now, its not just
one or 2 days you know.”
In America there is a long term survivors group for
people with HIV who’ve lived up to 20 years without
even getting sick.
QUIZ QUESTION
What’s the greatest number of years
that someone in the video has lived
knowing that they had the virus???
12
•
“When the doctor
told me I was
infected, I just
laughed! How could
I be infected, I’m
young and
healthy...”
HIV positive woman
“Whether you’re
men or women,
young or old, you’ite
not going to die
tomorrow! It all
depends on your
attitude and state of
mind. You can live
for decades, look at
me! I have been
infected for 9 years
now.”
HIV positive woman
“I’ve fallen down,
but I’ve picked
myself up every
time. It has taught
me so well so that if
I’m down, I won’t be
down forever. Why?
Because of my state
of mind.”
HIV positive artist
•
WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
•
Keeping Well
In the video, Prasert, the leader of the Association of
People with HIV/AIDS in the North looks pretty
healthy. As he tells us, he has not always been so
well...
“Actually, I’ve been sick before, in fact I’ve
been hospitalised 3 times, the last time it looked
like I was at the point of no return. People who
saw me thought I was surely going to die.”
Like many people with the virus Prasert has been
vulnerable to ‘opportunistic infections’. An
opportunistic infection is any disease or germ that
gets an opportunity to infect people when their
immune system is not working well.
“I am a pretty strong
person, I’m not easy
to scare. But we
can’t fight this
disease with our
minds alone. We
have to take care of
our bodies as well.”
Young HIV positive
man, Northern Thailand
There are many viruses and germs which live in
healthy bodies or which we are exposed to regularly in
daily life. A healthy immune system keeps these
viruses and germs from making us sick, but because
HIV weakens the immune system, it gives some
viruses and germs an opportunity to make people
sick.
The kinds of opportunistic infections a person with HIV
can contract vary according to the germs they have
been exposed to in the past and any new germs or
diseases they come into contact with.
Very common opportunistic infections that people with
HIV/AIDS get include: lung diseases like pneumonia
and TB, and fungal infections from thrush to
cryptococcal meningitis. Some of these are mild and
easily treated. Others require more intensive
treatment.
Prasert was seeing a doctor regularly so that his
illnesses were detected early and were able to be
treated.
13
“With the
encouragement of
one person and then
another their health
slowly improves.”
Nurse Siriporn
Aksornsophapun
•
WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Keeping Well
Many people with HIV may go for years without any
symptoms. During this time you won’t need a lot of
medical attention. However, you should still have
regular health check-ups, usually every three to four
months. During these regular health check-ups your
doctor will be able to measure your general health and
to look for any effects HIV may be having on your
health.
That’s why health check ups are a good idea for
people with HIV, even when they feel quite well. All
healthy people get occasional minor illnesses like
colds and headaches. If you see a doctor regularly,
you can also be reassured about symptoms like these
that are unrelated to HIV.
The way health check-ups are conducted varies from
place to place according to the facilities, equipment
available and medical staff available. During a check
up the doctor or health care worker should take your
history and give you a physical examination. While the
doctor or health care worker is “taking your history”
you can tell them about any symptoms you may have.
During the physical examination, the doctor or health
care worker will be looking to detect any early signs of
the disease and treat them.
A
REGULAR
HEALTH
CHECK-UPS
can include:
1
★ History taking
★ Physical
examination
and
★ Laboratory
tests
Physical Examination
Often includes some of
the following:
★ Weight
★ Temperature
★ Blood pressure
★ Mouth examination
★ Head and neck
examination
★ Lymph nodes
In some places laboratory testing facilities are
available and you may have a blood test or a sputum
test or a chest X-ray if the person performing the
examination considers these necessary. In other
places you will be referred elsewhere for laboratory
testing.
You may need to try different health care centres or
clinics to get the best treatment. You can ask the
doctor or health worker questions. Sometimes you
need to write down questions so you don’t forget them
when you are actually having your check-up.
Often people who know they are HIV positive and are
well, take steps to improve their general health
through exercising regularly, eating healthy food, and
reducing alcohol and tobacco consumption and/or
using traditional therapies in preventing disease,
reducing stress and boosting their immune system.
(We discuss these therapies on Page 24).
14
•
★ Chest examination
★ Abdominal
examination
F
•
WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Keeping Well
Activity Sheet
ANUSORN
Anusorn found out he was HIV positive some years
ago. He didn’t visit the doctor for many years. After
putting up with a persistent cough for some time he
went to OPD at the local hospital. After a couple of
days Anusorn was diagnosed with a serious lung
infection called PCP.
•
Could Anusorn have done anything to help
prevent this situation?
•
Why do you think Anusorn didn’t go to the
doctor?
•
irftesr
Preparation
Photocopy the page
and cut out case
studies. If you are
going to be using them
again you could glue
them onto cardboard or
cover them with plastic.
Activity
Break up group into
smaller groups of 3-5
and give copies of the
case study cards to the
groups. Ask them to
spend ten minutes
discussing the question
and then return to the
larger group to
summarise the
discussion and
answers to the
questions.
TUPTIM
Tuptim had HIV but didn’t monitor her health by
visiting the doctor for regular check-ups. Each time
she got a headache she thought it might be
cryptococcal meningitis. The worry caused her more
headaches. When she finally did visit the doctor,
Tuptim found that she did not have crypto, but some
problems with her posture at work. He gave her some
exercises to do, she changed the way she sat in her
chair at work and she had traditional massage. After a
few days her headaches disappeared.
•
Why did Tuptim think her headaches were
Cryptococcal Meningitis?
•
What could have helped Tuptim?
15
After obtaining
responses from the
group on each
question, the facilitator
should refer to the
suggestions in the
following activity sheet
to make sure all
aspects of the
questions have been
discussed, adding to
participants comments
on each question, if
necessary.
• WITH HOPE AND HELP
MANUAL FOR PEOPLE WITH HIV/AIDS
Q: Why did Tuptim
think her headaches
were Cryptococcal
Meningitis?
Keeping Well
Activity Sheet
Group may come up with
any of the following points. If
they do not, facilitator may
mention these:
It is true that headaches
are a symptom of
Cryptococcal Meningitis,
particularly, when they
persist over a number of
days, and should be
checked out by a
doctor.
Case Study 1: Anusorn
Anusorn found out he was HIV positive some years ago. He
didn’t visit the doctor for many years. After putting up with a
persistent cough for some time he went to OPD at the local
hospital. After a couple of days Anusorn was diagnosed with a
serious lung infection called PCP.
Q: Could Anusorn have done anything to help prevent
this situation?
Hopefully group will come up with the suggestions below: A) that
he could have been diagnosed and treated earlier or B) could
have been given a preventative medicine to stop it developing.
Tuptim may not have
known that most people
with HIV remain well for
years after they have
got the virus. It is
normal to get minor
illnesses like colds or
headaches or muscle
strain.
Facilitator’s Remarks should include the following.
If Anusorn had been regularly visiting a doctor to monitor his
health, he could have been given preventative medicines for
PCP which may have prevented this episode. If any infection
had developed it would have been picked up earlier and better
treated.
People with HIV often
think that any symptom
they get is a sign of a
serious illness or related
to their HIV infection. In
fact, people with HIV
may still get other
common health
problems like anybody
else.
Q: Why do you think Anusorn didn’t go to the doctor?
The group may come up with several answers, such as: he
thought if he wasn’t sick, there was no point in going; he didn’t
have enough money; he feared that doctors would discriminate
against him or be rude to him; he was too scared to go in case it
was bad news.
Facilitator’s Remarks should include the following:
There are many reasons why HIV positive people do not want to
go to the doctor’s . We have heard some of them. One is that
Anusorn didn’t understand the value of visiting the doctor. The
others are reasons to do with the health service. Not all health
services are equally good. Some doctors may still discriminate
against people with HIV. Some people with HIV say that doctors
do not want to give them a physical examination. Sometimes it is
worth going to different health services until you find one that
suits your needs.
■ Case History 2: Tuptim
Q: What could have
helped Tuptim?
!
I Tuptim had HIV but didn’t monitor her health by visiting the
! doctor for regular check-ups. Each time she got a headache she
; thought it might be cryptococcal meningitis. The worry caused
I her more headaches. When she finally did visit the doctor,
I Tuptim found that she did not have crypto, but some problems
! with her posture at work. He referred her to a physiotherapist
; who gave her some exercises to do, she changed the way she
I sat in her chair at work and she had traditional massage. After a
I few days, her headaches disappeared.
16
I
;
|
.
;
;
I
If Tuptim had been
visiting the doctor
regularly she may have
been more confident
that she was in good
health and able to
consider other reasons
for her headaches.
She may have been
over-anxious and
stressed because of her
HIV status. As well as
visiting the doctor
Tuptim could try other
ways to reduce stress in
her life.
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
•
Being Sick
When people who haven’t previously had any
symptoms become sick, it can be a great shock.
Some people have said that becoming ill can be as
great an adjustment as getting a positive blood test. In
addition to the worries and anxieties being sick can
raise, the person also has to cope with their physical
symptoms, such as feeling ill or tired, having eating
problems, diarrhoea, coughing, fevers or pain.
For a lot of people with HIV, physical health problems
are made worse by anxiety about issues like
disclosure. Some physical symptoms, like skin
diseases, have become very strongly associated with
AIDS. Positive people can be very upset when these
symptoms appear, because they are then exposed to
the fear and prejudice of people around them.
Early AIDS campaigns in many countries presented
an alarming picture of AIDS symptoms. Posters
showing severe cases of oral thrush, herpes, wasting
and tuberculosis conveyed the message that having
any one of these symptoms meant that you were in
“final stage’ AIDS and would die very soon. However,
this is not necessarily the case. As you have seen
from the video, Prasert and the man in the striped
shirt had severe illnesses but made good recoveries.
In particular skin diseases that are common in people
with HIV are generally not serious and often clear up
quickly. Even blisters or sores that look awful at first,
can dry up in a week or two. Doctors can provide the
appropriate creams and ointments to help healing.
Another disease that can be upsetting to HIV positive
people is Tuberculosis or TB. This is because, unlike,
HIV/AIDS, TB can be transmitted by prolonged close
contact with a person with TB. This is worrying for
people with HIV who may be concerned about family
and friends. However, what many people don’t realise
is that, with effective treatment for TB, a person may
be no longer infectious. Further, most people in
Thailand have been exposed to TB already. For a
person with a healthy immune system, TB is not easy
to catch. The most important thing for HIV positive
people is to get treatment quickly for TB. It is also
possible to get preventative treatment- that is to take
medicine which prevents you getting sick with TB.
17
“I may get sores, my
health may
deteriorate, but
keeping my will
power is the most
important.
I have been able to
pull myself together
because of my
morale and my
friends. Because of
these things Pm here
speaking to you
now.”
HIV positive artist,
Northern Thailand
•
WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Mental
HEAL TH
•
EXERCISING
Mental health means “having a life that is happy as a result
of your way of thinking, your view of the world and your
view of yourself’1. This is very important for all people, and
with the social and economic stress of modern times, it’s
becoming harder to achieve. This is what an HIV positive
man living in Bangkok has to say about stress:
“People ask me how I can live here in Bangkok,
with the congestion and the traffic and the cost
of living as high as it is. The truth is about 90%
of people, living in Bangkok suffer from stress.
They are stressed by the traffic and by the chaos
of travelling to and from work. If you ask me
how I’ve been able to survive with all that stress
on top of having HIV, well, I was stressed before
I found out that I was infected. But I’ve realised
that stress makes only my condition worse. I get
fevers and herpes, my body deteriorates and I
can’t sleep, food loses all its taste. So I ask
myself, what’s the point of getting stressed?”
STRESS
There are lots of ways of dealing with stress. Phra Kru
Sophon makes a few suggestions in the video. He says:
“If you know you have HIV you should try and
take care of your health... get plenty of exercise
and plenty of sleep, make peace with yourself
and know you still have a chance to live a long
time.”
Phra Kru Sophon from Wat Doi Saket
On the right and on the next page you will find suggestions
for sleeping, exercising, meditation and what to do if you
feel sad.
1 Dr. Prawate Tantipipatanaskul, Suan Prung Hospital,
Chiengmai
18
Exercise at the right
level is good for your
muscles, your joints,
your heart and lungs,
your circulation and
respiratory system. It
can reduce stress and
help you sleep.
Health professionals
generally recommend
that you exercise at
least 3 times a week
for 15-30 minutes at a
time.
Exercise should
conducted
in
stages:
• Warm-up
• Exercise and
• Rest and relax
be
3
If you’re
new
to
exercise take it easy
at first. Do gentle
exercise to begin with
like walking, yoga or
swimming.
Make sure exercise is
appropriate to your
age
and
physical
state.
EXERCISE
should be:
- Easy
• Fun
- Convenient
Something
you choose
to do
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
•
SLEEP
KEEPING BUSY
Sleep is a great way for the body to rest and relax.
However, many people find it hardest to sleep at times
when they need it most, when they are stressed or
facing a lot of problems. Some people get into a
pattern of not being able to sleep, perhaps not being
able to get to sleep at night or oversleeping.
There are mental
health benefits to
keeping busy or
being active:
Some simple things that may help you sleep better
include:
• Get up at the same time every day.
• Avoid sleeping during the day.
• Reduce tea and coffee intake and other caffeine
drinks like ‘Coke’ or ‘Krating Dang’.
• Do not lie awake for more than 30 minutes, get up
and find a relaxing activity.
• Try relaxation exercises.
•
Activity distracts
people from
problems and
negative thoughts.
•
Activity can
motivate people:
the more they do ,
the more they feel
like doing.
•
Activity can help
people think more
clearly.
•
Family and friends
can help you plan
useful or
enjoyable and
affordable
activities: like
cooking,
gardening, going
to market,
exercising, visiting
friends and
relatives.
MEDITATION
Many people in the video also espouse the practice
of meditation. Meditation is beneficial on many levels,
physiologically, spiritually and mentally. Many temples
today run lay meditation courses. Some are
particularly focused on the needs of people with HIV.
If you have never seriously practiced meditation it
might be best to attend a course first, whether it’s a
general one or one particularly for people with HIV.
Some people find that the peaceful atmosphere at
temples and meditation centres is a good antidote to
the stress of modern living. Many people with HIV find
that their appetite improves and that they gain weight
after attending courses.
FEELING SAD
Some people do not have a problem with stress but
often experience feeling sad, low or even “down”.
These feelings are normal and are felt by many
people during different stages of the disease.
Sometimes people need a period of time to
understand their problems, to come to terms with
them and to think of ways of coping with them.
If possible, talk about these feelings with a good
listener, someone who is supportive who can help you
understand what is happening to you. You may be
able to talk these through with a good friend, family
member or counsellor.
19
“Try to be optimistic
and create a positive
environment in
which to live. Don’t
despair and don’t sit
around doing
nothing. Don’t think
about your situation
too much. Do
whatever it takes to
keep busy.”
HIV positive woman
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WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Nutrition
One way that a lot of the people in the video have
chosen to maintain their health is through healthy
eating. As Dr. Maitreya Suitthajit says on the video:
“Food is medicine... Try to find food that even
in small portions contains a lot of nutrition.”
People’s nutritional needs vary a lot, especially those
of people with HIV. Vitamin pills or tonics are no
substitute for healthy eating.
Well people
In the non-symptomatic years people with HIV benefit
from a nutritious or balanced diet . This means eating
a variety of foods each day to supply the body with the
nutrients it needs. Nutrients are the components of
food and include: proteins, carbohydrates, fats,
minerals, dietary fibre and water. No one food
contains all the nutrients you need. Certain types of
foods contain similar nutrients and can be grouped
into 5 main groups called “The Five Food Groups”.
You should have something from each group each
day, although more from some groups than others. An
easier way of thinking about it is the “Healthy Diet
Pyramid”: You need to:
Eat MOST: fruit, vegetables, cereals like rice and flour
foods like noodles
Eat MODERATELY: fish, lean meat, poultry, legumes,
nuts
Eat LEAST: oil, butter, sugar, coconut cream
Eating a good range of foods makes expensive
vitamin supplements unnecessary.
Some common ingredients in foods are also used as
herbal medicines. Your favourite dish could be a great
source of nutrition and a traditional medicine! Herbal
medicines used in cooking include lemon grass,
galingal, basil and ginger.
Traditional diets
Some traditional therapies advise particular diets and
stipulate foods to avoid. If you are on one of these
diets you should make sure that what you eat still
20
•
provides you with all
the nutrients your body
needs. For instance, if
you can’t eat seafood,
then make sure you eat
fresh water fish and
pork, eggs and soy
beans and tofu to keep
up your protein. If you
are on a vegetarian diet
then you need to pay
particular attention to
protein and calcium.
Soy beans, bean curd,
soy bean milk, cow’s
milk and yoghurt are
good sources of
protein. Cow’s milk
contains calcium and
so do dark green leafy
vegetables.
Sometimes people with
symptomatic HIV
develop specific
nutritional problems.
These need to be
addressed on a case
by case basis. Different
opportunistic infections
may lead to particular
eating problems.
Common ones are
chewing and
swallowing difficulties
due to throat and
mouth infections, loss
of appetite, diarrhoea
and weight loss. See
the next page for some
suggestions to help
with these.
“Just like me when I
eat these days I also
eat for the virus in
my body. I eat so this
virus and I can live
in harmony.”
HIV positive man, Bangkok
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Nutrition
Mtothy
Activity Sheet
Is what you eat healthy?
Ask everyone in the group to remember what they ate
over the last 24 hours and to write it down.
Then ask them to go through the foods and see if they
can work out what category the food fits into.
•
Did you eat something from each of the three food
groups shown in the “Healthy Diet Pyramid”?
•
Which of the three groups did you eat most of?
Eat LEAST:
oil, butter, sugar,
coconut cream
Eat MODERATELY:
fish, lean meat, poultry,
legumes, nuts
Eat MOST:
fruit, vegetables, cereals like rice
and flour foods like noodles
•
Which of the three groups did you eat least of?
J
21
- SOCH,
Koranbuva
Bangauxe
•
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
When illness
affects eating
Chewing and
swallowing
difficulties
Weight Loss
There are three food groups you should concentrate
on to build up your weight. Increase each in turn:
★ Protein
★ Energy foods (Starch and Sugar)
★ Fats and oils
Step 1.
First try and add more protein to your diet: Fish, pork,
chicken, beef, eggs, beans, tofu, soy bean milk and
cow’s milk all contain protein.
Step 2:
Then add energy foods, foods with starch and sugar
like rice, noodles, bread or cakes and fruit.
Then lastly add fats and oils, like milk, coconut milk,
coconut custards, deep fried foods.
Try and eat only food and drinks that are nutritious.
Don’t fill up on water, drink milk or fruit juice or
coconut juice.
Try and keep snack food and a milk drink (cows milk,
soy milk or yoghurt drinks) by you at all times.
Step 3. Add extra protein to food you already eat,
such as adding egg to everything possible, adding
extra dried skim milk powder to Ovaltine or Milo.
Loss of appetite
Here are some suggestions to help you eat more.
★ If you don’t feel hungry, try and eat a little, often.
★ Choose food that’s high in calories to give you
energy, like fried bananas, peanuts or fruit juice.
★ Avoid food or drink that’s filling but low in calories,
like water or Diet Coke.
★ Check and see that it’s not your medicine that’s
making you feel sick.
★ Try and make mealtimes enjoyable: play music,
eat with friends, try and make your food look
pretty.
22
★ Try to eat only soft,
smooth foods like
eggs, steamed fish,
Ho
Mok,
tofu,
blended
fruits,
banana
puddings
and
coconut
custards, icecream.
★
Cut up food very
finely
before
cooking to reduce
time taken to chew.
★
With noodle soup,
cut
up
glass
noodles or other
noodles in one or
two inch lengths to
prevent choking.
★ Thicken
sauces to
make then viscous
and
easy
to
swallow. You can
even add a little
agar-agar powder to
soups to make them
slippery like jelly.
★ Avoid hard crunchy
food.
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
What to eat when
you have ...
Diarrhoea
Diarrhoea means that you produce runny stools
more than three times a day. You may have
vomiting and stomach ache as well.
Dehydration
Dehydration which is caused by diarrhoea can be very
dangerous. You must replace the water and salts that
your body loses in diarrhoea by drinking water with
salt in it, broth, coconut juice, weak cordial or oral
rehydration mixture. You can make this yourself by
adding 1/2 teaspoon of salt, and 2 tablespoons of
sugar to 750cc of boiled water.
Minerals
Your body loses a lot of minerals as well, in particular,
potassium, which is found in bananas, tomatoes,
oranges , coconut juice and fruit juice. You should try
and eat some of these foods everyday.
If you have severe diarrhoea you should avoid:
Fatty foods - your body will not be able to absorb
fats and oils.
★ Milk - lactose can cause diarrhoea.
★ Fibrous foods - these may make diarrhoea worse.
★ Alcohol and caffeine - these make diarrhoea
worse.
★
If you have diarrhoea for more than 2-3 days you
should see a doctor or a nutritionist to ask for
treatment or nutrition supplements.
When your symptoms clear up you should be able to
eat normally again within the week.
23
•
•
WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Herbal
MEDICINE
Traditional herbal medicines can be a valuable
resource for people with HIV. The ingredients in
traditional medicine are often cheap and some can be
easily prepared. Today many people choose to
combine traditional treatment with modern, they may
take herbal medicines but they also see a modern
doctor at the same time...
“Our hospital’s basic approach to healing
combines emotional encouragement with the
introduction of herbal medicines as tonics.
Presently we’re using medicinal herbs as
tonics... They increase the patient’s appetite
and activate the immune system. They stimulate
resistance enabling the patient to fight disease.
Modern medicines are used to attack and kill
the virus. Here we treat patients with a
combination of methods.”
Dr. Thara Onchomchant MD, Phaya Meng Rai Hospital
Modern doctors and pharmacists are now researching
and refining many traditional medicines. People with
HIV will find that a number of books have been written
about herbal medicines and HIV/AIDS. As well,
magazines like "Folk Doctor” also provide up-to-date
information on the latest advances in herbal medicine,
with a particular focus on HIV. Newsletters of positive
associations like Naam Chiwit and others also contain
information on herbal medicines and HIV/AIDS. We
do not have room to give detailed information on the
range of herbal medicines (See box for the traditional
use of the three medicines named in the video).
Don’t forget to inform your doctor if you are taking
herbal medicines! They sometimes cause side
effects or may interfere with other medications.
Let the doctor know how they are helping you.
With herbal medicines, as with any other
medicine, you need to be well informed and
choose them carefully. (See Exercise: Using
Complementary Therapies p.25)
24
•
Here is some
information that the
Communicable
Disease Control Office
in Chiengmai has
published on three of
the herbal medicines
mentioned in the video.
Five roots medicine
The traditional formula for
“Benjalokwichien “ or Five
Roots is used for fevers
where patient has head
ache and aching joints. It is
made up of Chingchee,
Kontana, Ya Nang, Tao Yai
Mom and Madeuh
Choompon (in rainy season,
use bark or wood of plant,
in dry season use roots),
Take equal quantities of all
five herbs, wash and cover
with water, boil over low
flame until reduced by two
thirds. Drink a glass of liquid
remaining 4 times a day,
before meals and before
bed.
Bo-ra-pet
Traditionally, Borapet can be
used for loss of appetite, where
the patient cannot eat at all or
eats very little, and is losing
weight... It can be chopped
up, dried and ground to a
powder, then mixed with
honey to form pellets, one is
taken before meals.
Fa-talai-joan
Traditionally used for chronic
fever (often combined with
upset stomach and headache).
Infuse one or two fresh plant
tips in warm water as a drink.
High in potassium.
Herbal medicine must be
prescribed by a Licensed
Traditional Practitioner.
Ref:Holistic Self Health Care
CDC 10, Chiengmai MOPH
1997
•
WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Herbal
MEDICINE
Activity Sheet
Herbal Medicine is still medicine. We need to be sure
that all medicines we use are safe and do not contain
harmful substances. We also need to be sure that
people are not making false promises about particular
medicines and are not tricking us into paying a lot of
money for ineffective treatment.
Write a list of all the herbal treatments the group
knows of on a big sheet of paper.
Then ask the group to answer the following questions
in turn about each one:
Has this therapy stood the test of time?
★ Has it been used over a long period with no ill
effects?
Have there been any experiments done on the
therapies to show they work?
★ Increasingly, there is scientific research into the
properties of traditional herbal medicines, often
conducted by Government bodies and University
Pharmacy faculties.
★ You should try and find firm evidence that the
medicine is safe to take and contains no harmful
substances or additives, like steroids. These
substances are sometimes added without being on
the label.
Does this therapy work for people with HIV or for
people who have a weaker immune system?
★ If you know a number of people with HIV who have
taken it consult them, ask around. Making a
decision to take any medicine based on the
experience of just one or two other people is not
very reliable. Ask about side effects. See if it has
worked well on people in your condition.
25
•
Has it been
hygienically
prepared?
Hygiene is very
important for people
with impaired immune
systems. Cooked or
boiled herbal
preparations should not
be left unrefrigerated
for too long. Herbs can
go mouldy or have
been picked from
unhygienic places too!
How much does the
therapy cost?
★ Very expensive
therapies are more
often sold to help
the seller get rich
than because they
contain rare or
precious
ingredients. (More
expensive does not
necessarily mean
better.)
Is it prescribed by a
licensed traditional
doctor?
The licensing of
traditional doctors is a
way of protecting the
public against fraud
and quackery.
Traditional Doctors also
have to pass exams.
• WITH HOPE AND HELP •
MANUAL FOR PEOPLE WITH HIV/AIDS
Employment
Many viewers have told us that their favourite
person on the video was the old ironsmith, a man
of 60. Viewers, young and old, admired his
determination and his dedication to his heavy
manual work. In fact, in the video the old
ironsmith’s son tells us the one thing which makes
his father sick is stopping work.
Should I work?
If you are healthy and able to work then give
serious consideration to continuing to work. Many
people misunderstand the nature of HIV/AIDS and
think that they need to protect their health by
resting and not working. While this is certainly
true for people who have serious opportunistic
infections, it is usually unnecessary for people who
are well to stop working.
Should I tell anyone at work that I have HIV?
You do not need to inform anyone of your HIV
status in the normal course of events.
Unless you are quite sure that there will be no
repercussions and that you will not receive
prejudiced treatment, it is unwise to disclose HIV
status in your workplace.
What if I get sick?
Being ill may mean you have to take sick leave on
occasion. People in the work place may also ask
you about your health. If you recover and can
continue in your work and your employer is happy
for you to continue then by all means: Continue
Working! Many people find it helpful to lead as
normal a life as you can when you are well. Work
keeps you busy and active as well as earning an
income.
26
•
“If you ask dad to
stop working he says
no. If he doesn’t
work he gets sick. If
he stops for 3 or 4
days, he loses his
strength completely.
If he keeps working
he stays strong and
healthy. It’s hard to
believe but it’s true.”
Ironsmith’s son
“I am HIV positive,
but I’m still
perfectly healthy, so,
of course I can still
work. But if I don’t
work, and have
nothing to do, I get
stressed out. When I
have work to do, I
lose myself in my
job, and I feel much
better.”
Young HIV positive
woman
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Employment
“If you have work to do, it doesn’t matter what
your co-workers say about you. Don’t pay
attention to that at all. If your boss is willing to
keep you on, then by all means, keep working.”
HIV positive artist
Under Pressure?
You may feel under pressure to resign because you
are taking so much sick leave or because other
workers are gossiping about you. If you have a
supportive personnel manager or a boss you can
trust, then it is well worth talking to the personnel
manager or your boss in confidence at this point.
Your employer may be happy to change your job
or your shift in a way that makes it easier for you
to continue working. Knowing that you have your
employers support will make it easier to deal with
gossip. It is also part of a manager’s responsibility
to address problems of this kind in the workplace.
Managers can organise training on HIV/AIDS or
educate staff in other ways.
Brainstorm
Before you consider the discussion points on these
pages, or, as part of the next activity, you may like
to ask the group these questions:
• Whether members wish to work or not?
• Whether they would like to continue working if
they are symptomatic?
• What problems or obstacles they might face in
each case?
• What possible solutions are there?
• Where they could turn for help?
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WITH HOPE AND HELP
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MANUAL FOR PEOPLE WITH HIV/AIDS
Employment
Activity Sheet
Divide participants into small groups. Give out copies of the
case histories, one to each group. Ask them to read aloud
the histories and discuss the questions. Then ask them to
present their conclusions to the whole group.
Case History 1: Chalerm
Chalerm, a very competent worker at a prestigious Hotel,
had a number of HIV related illnesses. He had not disclosed!
to anyone that he was HIV positive. He began taking more \
and more sick leave. His friends at work noticed that he
was often sick and kept asking him what was wrong.
Chalerm began to feel ashamed and guilty, so he gave
notice. He told the personnel manager he was going back to]
the country to be with his parents and work the farm.
What do you think of Chalerm’s actions?
Did he have any alternatives?
What would you do if it were you?
How could his friends at work have helped him?
Could his personnel manager have helped him in
any way?
Case History 2: Somchart
Somchart was an older man in the civil service. He began to
have symptoms which his colleagues thought were HIV
related, possibly because they had all heard stories about
his lifestyle and how he liked to go out partying with his
friends. Somchart began spending a lot of time at the
doctors. He told his colleagues he had a lung condition. He
was also losing weight. His colleagues, who were
convinced he had AIDS, kept asking him about his health,
and suggesting that he should take time off. Each time,
Somchart would say that he was fine and able to keep
working. Finally, a colleague asked him to his face if he
had AIDS. Somchart looked him in the eye and said “I
don’t have AIDS. I am able to work.” He kept on working
until he became seriously ill and died.
What do you think of Somchart’s actions?
Did he have any alternatives?
What would you do if it were you?
28
Were his colleagues
really trying to help
him?
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• WITH HOPE AND HELP • MANUAL FOR PEOPLE WITH HIV/AIDS •
Love, Sex and
Intimacy
“In my opinion re-marriage is a good thing,
because love is a good thing.”
HIV positive young man
Having HIV does not change people’s need
for love and intimacy in sexual relationships.
In this video we hear from two couples who
talk about their relationships. One couple is
made up of two HIV positive people who met
and got married, each knowing the other
person was HIV positive. Prasert and Lamai
feel the fact that they were both positive has
meant that they are better able to understand
each other than most couples.
The other couple to talk about their
relationship are the artist and his partner. She
is HIV negative and he is HIV positive, yet
they continue to have a relationship which is
mutually supportive.
For both couples these relationships have
been an important source of comfort and
strength, have helped them feel more positive
about life and helped them maintain their
health.
Some people think that HIV positive people
should not form relationships or get married
after they know they are HIV positive because
their lives will become harder, instead of
easier, if they have to care for a partner as
well as themselves. This may or may not be
the case but the decision here should be left
to the participants in the relationship to decide.
29
“I’m thinking back
to when we met, 3 or
4 years ago. At that
time, people didn’t
really understand
us. But we kept
struggling until they
did. All along I
believe we had to
prove that people
with HIV have the
right to live like
everybody else... If
people aren’t ready
they shouldn’t get
married. But if they
are going to get
married, they must
learn to understand
each other, to see
into each other’s
hearts and to learn
to share their lives
together.
But the thing that
makes me most
proud is that we are
one of the first
couples with HIV to
marry, and we let
everyone around us
know that we are
positive. It’s a good
feeling not to have to
keep any secrets
from anyone.”
Prasert Dechaboon
WITH HOPE AND HELP
MANUAL FOR PEOPLE WITH HIV/AIDS •
Love, Sex and
Intimacy
'Effigy
X,’. 7
Another question that many people are
troubled by is whether HIV positive people
should have babies. The situation for HIV
positive women who are pregnant or wish to
get pregnant has changed dramatically in the
last few years. New treatments, such as the
use of AZT by pregnant women, are available
to reduce the risk of transmission from mother
to child.
J
f
When we were preparing this manual we
found that most people we spoke to were
confused about transmission from mother to
child. People thought that every child born to
an HIV positive mother would have HIV.
In fact, even without the new treatments only
about a third of babies born to HIV positive
mothers will be positive. When breast feeding
is withheld, drug treatments can reduce this
number by between 50 - 67%, depending on
the drug therapy used. When drug is used in
combination with other treatments like
caesarian section, the transmission rate will
be lower and could go down to 0%.
However, this question is just one of a number
of issues for women with HIV who are
pregnant or wish to become pregnant to think
about.
Talking to a counsellor, doctor, or to other
positive women may help them clarify these
issues.
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• WITH HOPE AND HELP
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MANUAL FOR PEOPLE WITH HIV/AIDS
Love, Sex and
Intimacy
HOW HIV CAN BE SPREAD
•
WHAT IS SAFE
SEX?
Safe sex can stop a
body fluid that contains
HIV from entering your
body or from leaving
your body and entering
another person’s body.
This kind of sex can be
a lot of fun!
We all think we know the three ways HIV
Transmission can occur:
• Through Sex : unprotected sexual intercourse,
(which can be penis/vagina sex; penis/anus sex)
or oral sex.
• Sharing needles or syringes which carry the blood
of an infected person into the blood stream of
another.
Here are some ways
you can have safe sex:
Rubbing together
Kissing and hugging
Massage and touching
• From mother with HIV to baby during pregnancy,
birth or breast feeding.
Mutual Masturbation
Some people may think that because we have HIV
our sexual needs automatically cease. This is not
true, most people with HIV continue to experience
sexual needs and feelings in the same way as other
people. Although, sometimes worry and stress can
have an impact on people’s sexual feelings.
Using a condom with
water based lubricant
every time you have
sexual intercourse.
Condoms need to be
used properly (See
below).
PROTECTION
What is really very important for us as positive people
to know is how to protect ourselves and others,
through SAFE SEX and SAFE INJECTING.
• Open the packet
carefully to avoid
damaging the condom.
It is also important to know how we can prevent the
virus being passed on TO OUR CHILDREN
THROUGH PREGNANCY, BIRTH and BREAST
FEEDING. We cover these issues in this section.
• Squeeze the air out of
the top of the condom
before rolling it on
(bubbles of air can
make it break).
Safe Sex:
• If uncircumcised pull the
foreskin back before
fitting the condom.
• Safe Sex prevents us transmitting the virus to
others.
• Safe Sex prevents us from being re-infected with a
different strain of the virus.
• Safe Sex prevents other sexually transmitted
diseases.
35
• Use water based
lubricant on the outside
of the condom.
• Hold the condom at the
base while withdrawing
penis after ejaculation.
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WITH HOPE AND HELP
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MANUAL FOR PEOPLE WITH HIV/AIDS
Love, Sex and
Intimacy
SAFE BEHAVIOURS
There have been a lot of education campaigns about
condoms. One advertisement people often remember
compares an apple skin, a car tarpaulin and a
condom, because they all protect things, skin protects
the apple, tarpaulin protects the car and condom
protects the person. But using condoms isn’t always
easy.
People complain about loss of sensation. This can be
reduced if you make putting on the condom fun and
sexy and if a sexual partner continues to touch or lick
the condom-covered penis before penetration.
Another common problem is not having one handy.
It’s good to keep condoms in the rooms where you
make love or carry one on your person. If you don’t
have a condom, oral sex is safer than intercourse or
you can try another form of non-penetrative sex.
SAFE INJECTING
Again, people may think that because we are HIV
positive we will never feel the need to use drugs
again. Some people will continue to use drugs. The
most important thing in these circumstances is to
make sure we protect ourselves and others.
Getting someone else’s blood into your bloodstream
is the most efficient way of getting HIV. Sharing
needles and syringes can pass on HIV, Hepatitis and
other infections.
So how can you use drugs safely?
• It’s not what you use it’s how you use it
Heroin can be safe, if you smoke it or snort it.
Even prescribed drugs from a doctor can be
dangerous if injected with shared needles.
36
•
SAFE USING
Means ALWAYS using
a new needle and
syringe.
If you can’t get a clean
needle and syringe
then and ONLY then,
clean a used one
thoroughly.
Cleaning is not 100%
safe but it’s better to
clean than not to.
CLEANING
SYRINGES
• Fill the syringe with
clean cold water.
Shake to remove all
blood. Then squirt
down the drain. Do
this twice.
• Completely fill the
syringe with bleach.
Shake for 30
seconds to clean it.
Then squirt down
the drain. Do this
twice (use fresh
high strength
bleach).
• Fill the equipment
with clean, cold
water again to rinse
away the bleach.
Do this twice. After
injecting, rinse your
syringe with clean
cold water
immediately.
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WITH HOPE AND HELP
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MANUAL FOR PEOPLE WITH HIV/AIDS
•
Love, Sex and Intimacy
Activity Sheet
The safe sex game
Draw up a chart like this:
Body Fluids
Ask the group:
• What are all the body fluids you have ever
heard of?
Write down all suggestions: sweat, spit, semen,
mucous, urine, vaginal fluids etc.
In the next column write “entry points or holes”.
Body Fluids
Entry points or
Holes
Ask the group:
HIV is present in
sufficient quantities
to transmit the virus
in semen and blood
and vaginal fluids and
breast milk. HIV is not
present in sufficient
quantities to transmit
the virus in saliva,
sweat, vomit, tears,
urine, faeces,
mucous.
Mark on the board
which fluids are low
risk, no risk, high risk.
Then ask:
What are all the entry points or holes you have
ever heard of?
Write down all suggestions: anus, vagina, puncture
due to needle injection, mouth, cuts, penis, eyes,
ears, nose.
•
In the next column write “Sexual activities”.
• What holes can
HIV get in?
Use this information to
assess the answers:
• What are all the sexual activities you have ever
heard of?
Write down all suggestions: masturbation, receptive
vaginal intercourse, receptive anal intercourse,
insertive vaginal intercourse, insertive anal
intercourse, licking, kissing, etc.
To transmit the virus,
body fluid containing
sufficient quantities
of the virus to infect
must enter the blood
stream through a hole
like a needle puncture
or through mucous
membranes in the
lining of the vagina,
rectum or urethra
(pee-hole in a man’s
penis).
• Now, go through the list in column one and ask
What are high risk body fluids that carry HIV in
sufficient quantities to transmit the virus?
You can assess and correct their answers according
to this information:
Then ask the group to
assess the sexual
activities listed as:
“no risk”, “some risk”
and “high risk”.
Body Fluids
Entry points or
Holes
Sexual activities
Ask the group:
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• WITH HOPE AND HELP •
MANUAL FOR PEOPLE WITH HIV/AIDS
Families
Family support is valued by a great many people.
People need their families especially when they are
unwell or having hard times. HIV/AIDS presents some
challenges to families.
One step at a time
Usually families need time to adjust to the news that a
family member has HIV, just as the person who has
the virus does. Some peoples’ families are warm and
supportive right from the word go. But more
commonly, families go through a period of adjusting.
This does not usually happen overnight and can take
a long time. This can be a very difficult time for
positive people.
Building acceptance
In the video it looks like everybody’s mothers and
fathers have been supportive all along. But in most
cases, families take time to find out about AIDS. At
first they may not understand about transmission.
Sure, they know the facts about transmission, but
deep down they might still feel doubtful about whether
they can catch AIDS through casual contact. Families
need to understand what Pimjai’s mother says. HIV is
not like a flea, it doesn’t jump out at people, or jump
from one person to another.
This manual has included a detailed section on how
HIV is transmitted for families and communities to
read. Give it to your family and friends.
Another thing that can really help is learning by
example. If your family can see someone else who is
behaving normally towards a positive friend or family
member, it may help reassure them, that their fears
are just that: fears, like a child’s fear of the dark, not
based on fact.
Perhaps you can ask another person, a parent of
another positive person, or a doctor or counsellor,
whom your family members trust to talk to them.
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MANUAL FOR PEOPLE WITH HIV/AIDS
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Families
Families who don’t understand HIV
Today, there are many people who still don’t
understand about HIV. There are people who firmly
believe that it is very contagious or that only bad
people can get HIV. Families may feel ashamed or
embarrassed that someone in their family has HIV.
They may be worried about what other people will
say. Some people with HIV have been rejected by
their families for these reasons. Being rejected is very
painful. People often feel isolated at these times.
Others experience acceptance from the start and yet
others experience rejection at first, but over time (and
this can take weeks, months or years) their families
come to accept family members with HIV.
Families of choice
Not everybody is close to their families. Today people
often move away from families to work or study. Some
people might have a lifestyle that’s different from their
family’s.
Workmates or friends can come to take the place of
family. Gay and lesbian people often think of their gay
and lesbian friends as their families. The support of
these chosen families is important too.
For people with HIV who don’t have family support,
peer support groups can be very important. In these
groups people with HIV can get together to talk with
people who are facing the same problems.
“There’s a sense of community here that’s not
easy to find. If I wasn’t infected I don’t know if
I ever would have found true friends.”
“When we get
together in a group
like this, there are
200, sometimes 500
of us. We sing, we
eat together and we
hold hands. We help
each other any way
we can.”
Girl in white shirt
“I’ve been infected
for about 5 years.
My health is good
right now. I’m doing
fine. We are not
alone in this world.
There are lots of
others ready to open
their arms to us.
Nowadays I feel a lot
of warmth. There
are a lot of people
standing by to help
me.”
HIV positive young
woman, Northern
Thailand
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• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Disclosure
A lot of people do not really understand about
HIV/AIDS. Although there has been a lot of education
and advertising about HIV over the years, people still
have misunderstandings about the nature of the virus.
In some cases, they can repeat the facts from the
television ads but they don’t really believe them. In
other cases the education campaigns have even
confused people further. This means that there is still
a lot of ignorance and prejudice about HIV.
Society in general has often been very judgemental
about people with HIV, not realising that people with
HIV are just ordinary people, like anybody else going
through hard times and dealing with a serious health
problem. That’s one of the main reasons disclosing
their HIV status is such a big issue for people who are
HIV positive.
But it is also very hard to live with a serious health
problem and try to keep it a secret. That’s also very
stressful for positive people. It can often be a huge
relief to tell someone, especially someone who can be
trusted.
Whether or not to disclose is a difficult and personal
decision. People generally do not want to risk their
status becoming known to people they don’t trust or
know. This is because, they may experience rejection
or discrimination as a result. Some people may
choose to become a member of an association of
positive people but not tell their parents or to tell their
family but not their workmates.
Sometimes in disclosing, a positive person can get
support that they would not otherwise receive. This
can be support from family members or individuals,
from professionals, from government (like social
welfare support) or from friends or peers in the same
situation.
40
•
“I’m completely
open about my
condition in my
community. I talk
with the villagers. I
visit friends in the
village who are sick.
I also help with rural
development work,
like finding work in
the village for people
who are infected, eg.
we teach them to
breed ducks and
chicken. That way,
the villagers can see
that people with HIV
can still benefit their
communities, that
they still can work
and that they can
help others. That
makes a big
difference in the way
villagers think of
people with HIV.”
Lamai Dechaboon
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MANUAL FOR PEOPLE WITH HIV/AIDS
Disclosure
Educating communities
In the video you will see people who have decided to
tell not just one or two people but to be completely
public and open about having HIV.
Many of these people had support from family and
friends, which has enabled them to have the strength
to go public. Others have chosen to be open about
their condition in order to help educate their
community. This is very helpful in reducing ignorance
and prejudice for communities. Then, they can see for
themselves that people with HIV are just ordinary
people. Like the man in the striped shirt says in the
video: “I don’t have scales or horns, I’m no different
than other people”.
Relationships
Telling your current partner or an ex-partner that you
are HIV positive is probably, one of the hardest
situations HIV positive people face. Another
challenging situation is telling someone you would like
to become your sexual partner, that you are HIV
positive.
However, there are many people who have disclosed
under these conditions. There are people who’ve had
to face rejection in this situation. There are also
people who have met and fallen in love and disclosed
their status and gone on to become sexual partners or
get married. In the video there is one couple, Prasert
and Lamai who met and married knowing they were
both HIV positive.
Another couple, the artist and his wife are still married
and living together, even though they found out, after
they were married, that one of them was HIV positive
and one was HIV negative. There have also been
many other couples where both partners knew that
one was positive and one negative but got married.
Clearly, there is a huge range of possible outcomes
when a person with HIV discloses their HIV status.
The exercises and activities on the following pages
may help you explore some of the issues around
disclosure.
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• WITH HOPE AND HELP
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MANUAL FOR PEOPLE WITH HIV/AIDS
Disclosure
Activity Sheet
WHO, WHEN, HOW & WHAT TO TELL (1 hour)
Exercise 1: (20-30 minutes)
The pictures that tell a story
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• WITH HOPE AND HELP
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MANUAL FOR PEOPLE WITH HIV/AIDS
Disclosure
Activity Sheet
WHO, WHEN, HOW & WHAT TO TELL (1 hour)
Exercise 1: (20-30 minutes)
The pictures that tell a story
Brainstorm what “disclosure” means to the group.
Show participants the picture page and ask them to
spend a few minutes looking at the pictures. Ask each
person to choose the image that best expresses what
“disclosure” means to them.
Go round the group and ask them which picture they
chose and why. This can take about five to ten
minutes per person.
At this stage the pictures may trigger discussion and
participants may naturally begin to discuss the
questions below. In this case the facilitator simply has
to keep the discussion on the subject and check that
all questions below have been addressed, (perhaps
by asking the group one of the questions if they go off
the topic). The facilitator should also ensure that
everyone has seen the pictures and had the chance
to speak.
If the discussion does not flow naturally at this point,
try returning to the exercises below.
Exercise 2.
Who?
(10 minutes)
Ask group to help think of all the kinds of people they
could possibly disclose to: From family to relevant
health professionals including people they might not
want to disclose to like members of the public,
shopkeepers, hairdressers and media.
Write the list up on a sheet of paper.
43
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• WITH HOPE AND HELP
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MANUAL FOR PEOPLE WITH HIV/AIDS
Disclosure
Activity Sheet
'
•
f
Exercise 3 (15-20 minutes)
Exercise 5
(15-20 minutes)
Why Disclose?
Reactions
“If you are not open, if your condition is still
secret, you should ask yourself why your status
must be hidden. If you cannot find a good
reason, then by all means open up. There’s so
little to lose and so much to gain.”
Most people will react
strongly to news of
someone close to them
being positive. Their
reactions may range
from denial, shock,
anger, disbelief,
amusement to tears, or
all of the above. At first
they may be thinking
about themselves, then
they may turn to think
about you.
Nurse Siriporn Aksornsophapun
“We should have a reason for wanting to open
up, you should not open up if you’re not ready
to. If, in your heart, you’re not ready to come
out, it’s alright to keep it a secret until you are.
That way, you can really help other people
when you do tell them, but you should really
know your reasons before you do.”
Discussion Questions
Young HIV positive man with glasses
Discussion Questions
In the video these two people presented some different
ideas on disclosure. From your experience,
Whose advice would you take? Why?
• What are some reasons for disclosing?
• What are some reasons for not disclosing?
• Ideas for good ways to disclose?
• Can other people help you disclose?
• From the list in exercise 2, who would it benefit you to
disclose to?
Exercise 4. (10 minutes)
How, When, Where
Ask the group to explore ways they think they might
disclose to the people ticked on the list in exercise 3,
from an unplanned casual conversation to appearing
on TV to having to fill in forms.:.
Write up the list on a sheet of paper.
44
• Ask what you might
expect people close
to you to feel?
• Ask how people
who aren’t so close
might react? You
can go back to the
list of people you
might tell, pick a
couple and ask
what the group
thinks the hair
dresser’s reaction
will be or the
doctor’s or the
mother’s?
• Ask how the group
thinks they could
help the people to
whom they’ve
disclosed?
•
WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Facing
Prejudice
“There’s no discrimination in our house. No one
tries to separate me from anyone else because
I’m infected.”
HIV positive artist
Prejudice is when you treat a group of people unjustly
on the basis of some perceived difference, such as
income, race, gender or HIV status.
People with HIV are ordinary people who happen to
have contracted a virus and may need care or
treatment if they become ill. The virus is not easily
caught through everyday contact or being near
someone who has it. They can work and live with
other people.
However, many people do not understand this. They
think people with HIV should not work or live with
other people. In some cases, if employers find out that
someone has HIV, they will be asked to leave work or
be given the sack. Landlords may refuse to let houses
to people who are HIV positive. Schools may refuse to
take children with HIV. Neighbours and friends may
stop visiting a house if they find out the people there
are HIV positive. Doctors may refuse to touch people
who are HIV positive. This is unfair treatment. The
people who are doing these unfair things are
prejudiced against people with HIV. They mistakenly
believe that people with HIV are a danger to society.
Some people also believe that people with HIV must
have done something bad or they would not have
HIV. This is a complicated issue, but nobody deserves
to get HIV. Of course, normally when we sell people a
drink or rent them a room we do not ask about their
sexual history or if they have ever used drugs, these
are personal matters. But when it comes to people
with HIV everyone wants to find out about their
personal lives. That is not fair.
45
•
“My family lives
normally and
happily together...
Our house is a
meeting point, with
all kinds of people
coming and going.
Everyone eats and
drinks together.
...villagers,
neighbours and
friends understand
me... and accept me
as I am. They tell
me: ‘You’re
infected, ok. If you
can take part in
what we’re doing
...come and join
us!”’
HIV positive artist
“In order to face the
AIDS crisis, people
everywhere should
join hands. We must
understand the
situation of those
who have AIDS. We
should not scorn
people. We should
support them. We
should not ridicule,
blame or abandon
each other. With
compassion we will
see our way
through.”
Phra Kru Sophon, Doi
Saket Temple
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WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Facing
Prejudice
“I don’t have scales or horns, I’m no different
than other people. I have the same rights as
anybody else.”
HIV positive man in striped shirt
Human rights are the rights of all people to be treated
as equal in human worth and dignity. The parameters
of these rights may be set by law, custom and social
regulation. People with HIV /AIDS have no more
rights than other people. However, all people,
including people with HIV/AIDS, should respect each
other’s human rights in the following ways:
•
•
•
Encourage people to respect each other’s rights,
and to treat others as they themselves would wish
to be treated;
Make sure that education and access to health
care are available to everyone;
Educate people to help them overcome the fears,
ignorance and prejudices that lead them to abuse
the rights of others.
We should protect each other’s human rights in the
following ways:
• Support and defend people whose rights are
threatened or abused;
• Remedy and compensate for abuses when they
occur;
• Work to change the conditions of poverty,
powerlessness and dependence that make people
vulnerable to abuse of their rights.
The rights of people with HIV which are often abused
include the following: the right to care and treatment
equal to that received by people with other health
conditions; the right to employment- not to be sacked
or refused employment because of HIV status; to
participate in community activity; to take out life
insurance; to receive social welfare; to travel; to
receive an education; to confidentiality as to HIV test
results; to live.
46
•
Rights to Care and
Treatment
In many countries laws
have been changed or
new laws introduced in
response to AIDS. Laws
can protect people from
discrimination, although
in some cases laws have
been used to limit the
human rights of people
with HIV.
When there seems to
have been an abuse of
rights the thing to
understand is what a
person’s human rights
are. An HIV positive
person does not have
special rights above
others.
Seeking Solutions
When there is an abuse
of rights, the law is not
the only means of
redress. The following
means are also helpful.
•
•
•
•
Trying to create
understanding
Education
Negotiation
Organising and
lobbing.
International bodies
working for the human
rights of positive people:
• The United Nations,
• The International
Federation of Red
Cross and Red
Crescent Societies,
• The Global Network
of Positive People
National government
and non-government
agencies may also work
on the rights of positive
people. Find out who is
taking action in this
area in your country.
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Transmission
“It’s not like an insect. It just doesn’t jump
from one person to the next.”
Pimjai’s mother
“I’ve been doing this work for a long time now, I
share my whole life with them. We eat together all
the time. I’m not scared, because I know very well
that you cannot catch it like that.”
Flower shop owner
There are only three ways HIV can be transmitted.
These days every school child can tell you the three
ways HIV/AIDS is transmitted and because people
see them so often, they have become bored and no
longer hear or see that information when they look at
or listen to it.
Still, there are only 3 fluids that transmit HIV(See box).
Perhaps because this information is so widely known,
it may help to think about the virus in different ways:
There are 4 principles to HIV transmission:
1. EXIT - the virus must exit the body of an infected
person.
2. SURVIVE - the virus must be in conditions in
which it can survive.
3. ENTER - the virus must enter the blood stream of
another person.
4. SUFFICIENT -there must be sufficient quantities
of the virus present to cause infection.
ALL FOUR MUST BE PRESENT
FOR HIV TO BE TRANSMITTED!
Sometimes, families or friends who care for people
with HIV at home are worried about catching HIV
from the sick person.
If you are worried about accidentally exposing others
to HIV/AIDS you need to understand HIV transmission
in detail. In the next page we give you some ways to
assess what is a risk for HIV transmission and what is
not.
47
•
How HIV can
be spread
• Through Sex :
- unprotected
sexual intercourse,
which can be
penis/vagina sex;
penis/anus sex,
- oral sex (although
this is less risky)
The fluids that
transmit HIV in this
case are sexual
secretions from
vagina and penis.
• Sharing needles or
syringes which
carry the blood of
an infected person
into the blood
stream of another.
The fluid that
transmits HIV in this
case is blood.
• From mother with
HIV to baby during
pregnancy, birth or
breast feeding.
The fluids that
transmit HIV in this
case are blood and
breast milk.
Fluids that
transmit HIV:
• Sexual secretions
(semen and
vaginal fluid)
• Blood
• Breast Milk
• WITH HOPE AND HELP
•
MANUAL FOR PEOPLE WITH HIV/AIDS
Transmission
ASSESSING ACCIDENTAL EXPOSURE
What happens if someone accidentally gets blood
on their skin?
An incident where blood from an HIV positive person,
falls on to the unbroken skin of an HIV negative
person is not regarded as dangerous. HIV cannot
enter the blood stream of the uninfected person
through their skin! Accidentally getting blood on skin
is a good example of how you can use the four
principles to assess whether something is risky:
1. Did the virus exit the body of the person with HIV?
Yes, in the form of blood.
2. Was the virus in conditions where it could survive
for long?
No, the virus is fragile and could not survive for long
on skin, also in this case, it would be quickly washed
off.
3. Did the virus enter another person’s body?
No, the unbroken skin did not allow the virus to get
into the uninfected person’s blood stream.
4. Was the virus in sufficient quantity to transmit?
Yes, blood contains HIV virus in sufficient quantity to
transmit HIV, if it can get into a person’s bloodstream.
ONLY TWO OF THE FOUR CONDITIONS ARE
PRESENT THEREFORE THE INCIDENT COULD
NOT TRANSMIT HIV.
In overseas countries, hospitals have very strict rules
about infection control. In Australia, hospitals have a
set of guidelines on how to assess an incident which
could allow HIV to pass from one person to another.
But, if a Nurse has an accident at work, for instance, if
blood from a person with HIV splashes onto the
Nurse’s unbroken skin - all they have to do is - wash
it off with ordinary soap and water! The Australian
nurse gets no treatment in this case. That is because
the medical authorities are so sure that blood on skin
poses no risk to anyone. However, because blood
does contain HIV virus in sufficient quantities to
transmit it, it is still wise to be careful around blood.
(Nurses wear gloves for any procedure they expect
will involve blood from anybody).
48
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QUESTIONNAIRE
May we request cooperation from facilitators who have used this manual with your target groups to
answer the questionnaire. Your responses will be valuable to improve the manual. Please send
the completed questionnaire to UNICEF EAPRO, HIV/AIDS Unit, 19 Phra Athit Rd., Bangkok
10200.
1. You are a
(Please tick)
Volunteer
Community educator
MOPH staff
Peer educator
Youth group leader
Positive people group leader
Teacher
Others
2. You work with what group.
Rural communities
Slum dwellers
Students
Out-of-school youth
Others
MOPH staff
Community leaders
Employers
Employees
3. Which part(s) of the manual did you read? List Contents (Please Tick)
Accepting people withHerbal
HIV/AIDS
Medicine
Finding Out
Employment
Keeping Well
Love, Sex & Intimacy
Being Sick
Families
Mental Health
Disclosure
Nutrition
Transmission
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4. Did you use the manual when you were showing the video to a group?
5. What particular group did you last show the video to/use the manual with?
Rural communities
Slum dwellers
Students
Out-of-school youth
Others
MOPH staff
Community leaders
Employers
Employees
6. Which part of the manual did you and your target groups find most useful?
Useful to you
Useful to your target groups
Yes
No
7. Which part of the manual did you and your target groups find least useful?
Least useful to you
Least useful to your target groups
8. (Manual for Communities) Did using this manual assist your target group to better accept
people with HIV/AIDS?
8. (Manual for Positive People) Did using the manual help your target group? If so, please say,
from your observation, what they found helpful.
9. What other kinds of information or activities should be included in the manual?
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