12331.pdf
Media
- extracted text
-
i^* ■"/? '•''
■n'fi’i rtm ftm
(2005-2012)
I
■
Material for
Book Na- 3
■-ftft
'a
Iz -
'■*
’' '
rwW
rX^'ilv
...
HIV/AIDS and AR lrV/
r ft
' #s
•X
■■
.
■
?--ll
•'ft
• ? £8 SR
«51
’THmg- vPTFt
Ministry of Health and
Family Welfare
Government of India
?
•l
Reading Material
for ASHA
Book Nd-3
Family Planning, RU/STIs &
HIV/AIDS and ARSH
JULY, 2006
C'obfe
Ministry of Health and
Family Welfare
Government of India
oW kW’'/ VWf OO
HUJulIflr
71^1 7JP?Ff WI
(2005-2012)
Ji
V_ —
>«—r
i NO
Z(
-I
«
CtNlR£
&A N G
intents
iagi
(fl
♦
111
Particulars
S. No,
Acknowledgements
5
1.
Introduction
7
2.
Preventing Unwanted Pregnancies
9
3.
RTIs/STIs
21
4.
HIV/AIDS
25
5.
Adolescence: The Period of Growing Up
28
6.
Helping Adolescent Girls to Take Care of
31
Themselves During Menstruation
i
Page Nos.
/Jal
"Wi ft
Numerous people have contributed to the development of this reading
material for ASHA. We acknowledge the contribution of the Mentoring
Group of ASHA and other experts who have given their suggestions,
valuable time and labour to bring out this reading material for ASHA.
We are especially grateful to Shri Prasanna Hota, Secretary, Health &
Family Welfare, Smt. S. Jalaja, Additional Secretary, Shri B.P. Sharma, Joint
Secretary and Dr. D.C. Jain, Additional Director (Public Health, NICD) for
their encouragement, constant support and guidance.
We would like to thank United Nations Population Fund (UNFPA) and
National Institute of Health & Family Welfare (NIHFW), for rendering support
in organizing the reading material. We also acknowledge the important
contribution of Dr. Dinesh Agarwal, Technical Adviser (Reproductive Health),
UNFPA, India.
I gratefully acknowledge the hard labour and sincere efforts put in by
my colleagues Dr. Manoj Kumar, Assistant Commissioner (Training) and
Dr. Himanshu Bhushan, Assistant Commissioner (Maternal Health).
,
Dr. Narika Namshum
Deputy Commissioner
Training Division
Ministry of Health & Family Welfare
Government of India
July 2006
1
TnirodiA.cti.o^
..........
I •
Jll 11
fig ■
Book no. 1 helped you to familiarize yourself with your partners in your
work in the village. In Book no. 2 you have learnt in general about your
roles, simple measures to promote health and prevent diseases among
women and children in your village. You have learnt in somewhat greater
detail about maternal and child health care including newborn care and
nutrition. In this book you will learn in detail about how to prevent
unwanted pregnancy, the various methods that are available, the merits
of each method, the side effects that need to be watched for and advice
that needs to be given. You would also be learning about what advice to
give to women and men. who have complaints suggestive of reproductive
tract infections or sexually transmitted infections. This book will also
build on your information on the causes, transmission and prevention
of HIV/AIDS.
You know very well that there are many adolescents and young boys and
girls in your village. In general, they may appear to be healthy, but they
need advice and counselling for developing healthy habits. They may also
need health care for some of the common problems. Also in some parts
of our country, marriage takes place at an early age, so that pregnancy
and child-bearing happens early in their life. Hence adolescent girls need
to get proper care in pregnancy and childbirth. Adolescents need to be
8
READING MATERIAL FOR ASHA
told about the ill effects of early marriage and pregnancy. Over a period
of time you will succeed in making sure that no girl below the age of
18 gets married. Adolescents also need knoweldge and skills to promote
their health and prevent diseases.
This book will help you in counselling the couples and individuals about
family planning and how and when to get the services.
T
<1
‘Rsv&ntin^
What is family planning?
Many couples want to either limit the number of children in the family or
wish to wait for some time before having children. Similarly newly married
couples may like to delay having children for two to three years.
There are several ways by which couples can plan their family's size
Benefits of family planning
Using any family planning method for preventing pregnancies can lead to
following benefits for the health of mother and children in the family.
Mother
■
■
■
Women with four or more children have greater risk of death during
childbirth.
Similarly older women have more problems during childbirth.
If adolescent girls get married early i.e. before 18 years they start having
children too soon. These girls are more likely to have complications or
can die during childbirth. Also children born to these mothers have
low birth weight and more likely to die in the first year.
10
READING MATERIAL FOR ASHA
Children
za
■
If a woman has children too close i.e. less than 36 months interval,
her own health and her children's health suffer.
Family with fewer children will be able to take better care of them,
including their educational attainments, growth and development.
♦
Other benefits
■ Some contraceptives i.e. condoms (both male and female condom) help
in protecting against infections of genital tract including HIV/AIDS as
well as preventing unwanted pregnancies.
■ Some methods are good to regulate irregular bleeding from uterus.
Use of family planning methods will allow women to exercise their
B
right over their own bodies. If they do not wish to have more children
then they can use contraceptives with discretion.
Different family planning methods
Pregnancies are caused by the union of egg produced by the woman and
the sperm by the man. The egg (which later grows into a baby after union
with the sperm) is produced inside the womb of the woman. When a sexual
union between man and woman takes place, sperms released to the vagina
of woman swim toward the egg in the womb. Union of egg and one of the
sperms results in pregnancy. The walls of the womb provide nourishment
to the egg. The egg unites with the sperm and grows into a baby.
There are five main types of family planning methods:
Barrier methods
If the sperm does not reach the egg, pregnancy can.be avoided. For
example, when a man uses a condom, the sperm 'remains inside the
condom only. Therefore, the sperms are not able to reach the egg inside
the womb. Thus pregnancy is prevented.
Sperm
Sperm enters the egg
and unites with it
Woman
Egg
Fetus, which grows into
a baby
*
Hormonal methods •
This prevents the woman's
ovary from releasing an egg,
make it harder for the sperm
to reach the egg, and keep
the lining of the womb from
supporting a pregnancy. For
example Mala N tablets.
PREVENTING UNWANTED PREGNANCIES
IUDs
These are devices inserted inside the womb. They prevent the egg and
sperms from fusing and also prevent implantation.
Natural methods
These help a woman to know when she is fertile, so that she can avoid
having sex at that time.
Permanent methods
These are operations, which prevent a man or a woman to have any more
children in future.
Barrier methods
You will be provided with condoms for distribution to women who need
them. Women are shy to buy them from the market. Many do not know
how to use them and where to keep them.
Condoms (Nirodh)
■
Prevent unwanted pregnancy and sexually transmitted infections
including HIV/AIDS
■
■
A new condom is to be used each time during sex
Correct and consistent use of condoms is essential to prevent unwanted
pregnancies
How to use condom?
You will be shown how condoms could be used
11
12
READING MATERIAL FOR ASHA
■
■
■
Dispose off the condom properly.
Keep condoms in cool, dry place and away from sunlight.
Keep a stock of condoms and show how to use them, and make
condoms available.
What you have to do:
■
Advise families to use condom as a family planning method. Also explain
that condoms prevent sexually transmitted infections.
■
■
Make condoms available to all those who wish to use them.
If the situation is suitable, you can show the couple how condom is used.
Use a flip chart and a condom piece. Sometimes you will have to show it
to the woman and ask her to share it with her husband.
Some myths and doubts about condoms need to be answered. The
■
■
■
misconceptions are:
Condoms reduce pleasure of sex.
• A condom user is an "easy" person.
If not properly used, condoms can burst during use. In that case, advise
to use emergency contraceptive pills.
The female condom is now available in cities, so that even women can use
a condom. That is helpful when men are unwilling to put on condoms and
it empowers women in risky sex situations.
Hormonal methods
Oral contraceptive pills
I-.
Iftii
Ror
.gSs
Oral contraceptives come in cycle packs of
28 pills. Only the first 21 of them contain
hormones. The other seven pills contain iron
supplements. One pill has to be taken each
day. The iron supplement pills are taken
after completing 21 hormone pills. Since
most women are anaemic, the iron tablets
are also helpful. These pills do not interrupt
the sexual activity. Above all, unlike condom,
OCR is a woman-controlled contraceptive
method. There are several brands available
.
PREVENTING UNWANTED PREGNANCIES
in the market. Our ANM and PHCs have supply of
MALA-N. You could keep a supply of these pills.
How to use OC
Start the pill from any of first seven days of start
of menstrual bleeding' and continue until the pack
finishes. Start a new pack again. Taken regularly,
the pifl is almost 100 percent effective in preventing
pregnancy. These pills do not cause abortion.
' ‘
If a woman forgets a day’s dose she should take
both the missed ahd regular tablets together. But one must not miss it
for more than two days. If missed for two days, advise her to take pills
as soon as she remembers. She can continue taking the pill each day
until the pack is finished and also use a condom for sex until seven
hormonal pills are taken in a row.
You should always mention about the common side effects of oral
contraceptives such as nausea, mild headache, tenderness of breasts,
spotting between periods and sometimes-irregular periods. Explain that
these side effects are not signs of any serious disease. These usually
become less or stop in three months.
You should 'help women in getting examined by ANM/Medical Officer,
before starting oral pills. You should give monthly supplies to women who
have started oral pills after consultation with ANM/Medical Officer.
Emergency Contraceptive Pills (ECP)
Emergency contraceptive pills are pills to be taken within 72 hours of
unprotected sex. These pills are taken only in some emergency situations.
These pills are especially useful for those women who have been subjected
to unprotected sex, slippage or bursting of condoms during sex or sexual
violence.
These pills are to be taken as soon as possible after
unprotected sexual exposure preferably within 72 hours.
These pills will also not work if the woman is already
pregnant. She should take two tablets within an interval
of 12 hours.
t tisict as soon as pOMioie
unprotected sex.
Take the second tablet 12 hours
•her you take the first tablet
13
14
READING MATERIAL FOR ASHA
Next monthly bleeding will take place within 14 days of scheduled day
of monthly bleeding. These pills are now available at health centres and
also at pharmacy shops. No prescription is needed to buy them. They are
available as EC pills in the programme. Several commercial and social
marketing brands are also available.
.
ECPs, taken as per instructions, provide protection against unwanted
pregnancy. Discourage repeated use of ECP and advise for choosing a
contraceptive method. ECPs do not protect against infections like STI and
HIV/AIDS.
9
What you should do:
■
■
■
You are a depot holder for OCPs (Mala N)
You should explain all methods to the women and help them in making
choices
Start Mala N tablets after consulting with ANM/doctor that the woman is
eligible for OCPs
Tell her about side effects and when/where to approach a service
provider
Also provide information about ECPs and where these pills are available
Copper-T
This is a small T-shaped intra-uterine device (IUD). It is made of pliable
plastic with fine copper wire wound around its stem. Two plastic threads
hang by its stem. After insertion into the womb, Copper-T stays in place
and is effective for a maximum of ten years. Some Copper-T devices
available in the market are effective for shorter duration also.
How does the Copper-T work?
Copper-T works mainly by preventing sperms and egg from
meeting. IUD makes it hard for sperm to move through
the woman's reproductive tract and reduces ability of
the sperm to fertilize the egg. Possibly it also prevents
implantation.
PREVENTING UNWANTED PREGNANCIES
Copper-T can be used
■ Within seven days of last menstrual period
■ After six weeks of child birth - This is the best time
■ Only trained nurses and doctors should insert Copper-T
■ Copper-T should be inserted only at health centres or hospitals
■ Women can get Copper-T removed any time on demand
Copper-T is generally safe to use. However it is very critical that proper
hygiene is maintained. Advise women to have check-up once after one
month, then after three months and then once a year.
Copper-T cannot be inserted at home because stringent cleanliness is
needed during Copper-T insertion. The woman can go home immediately
after putting Copper-T.
Women should learn how to check the presence of Copper-T. Sometimes
its gets expelled out of the womb. It is easy to learn technique of feeling
the nylon threads in vagina. Copper-T cannot escape the womb and go
up. It can be easily removed by a nurse with a gentle pull. Some women
have pain and bleeding after inserting Copper-T. It stops after few cycles.
If the condition does not improve then Copper-T can be removed. There
are no after-effects if Copper-T is inserted after six weeks of delivery.
Removal
Copper-T should be removed after 10 years or earlier if woman wishes to
have a child, or when she develops heavy bleeding, lower abdominal pain,
or severe backache. You should help women in getting Copper-T removed
at an appropriate facility.
15
16
READING MATERIAL FOR ASHA
Your responsibilities:
■
■
■
M
■
■
■
■
■
Counsel women about FP methods including Copper-T
Explain to them about the duration of protection and who can do insertion
Accompany the woman to the nearest health centre for insertion
Advise women on proper hygiene and cleanliness
Educate women on natural family planning methods
Talk about benefits of family planning to couples and individuals, boys
and girls at different occasions. These issues can also be discussed in the
meetings of self-help groups, adolescent groups. Include information about
prevention of RTIs/HIV/AIDS-also. Dispel any rumours or mis-conceptions
about contraceptives in villages
Find out the facilities where FP services are available such as NSV and
female sterilization
Accompany desirous men and women to,a facility where sterilization
services are provided. In some states there are monetary incentives for
those motivating or accompanying sterilization or Copper-T acceptor
Help nurse didi to contact women wanting to have a Copper-T insertion
Promote male participation in family planning
Natural methods
There are also natural ways of preventing pregnancies. However, the
woman has to learn many things that happen to her body during the
menstrual cycle to adopt this method. Awareness of fertility means that a
woman learns how to tell when the fertile period of her menstrual cycle
starts and ends. Generally menstrual cycle of a woman lasts for 28 days. A
woman is likely to be pregnant is she has sex during the fertile days (days t ,
8-19 of the cycle). The natural method of fertility control includes:
1.
2.
3.
4.
Avoid having sex
Withdrawal
Safe period method
Cervical mucus method
4
K
PREVENTING UNWANTED PREGNANCIES
Safe period
Women with menstrual cycle between 26 and
32 days can prevent pregnancy by avoiding
unprotected sexual intercourse on days 8 to 19,
taking the day of starting of menstrual cycle as
day one. You should know more about standard
days method from your ANM.
Cervical mucus method
The opening of the womb of the woman has a
sticky fluid called cervical mucus. Typically the mucus is thin and sticky
for two days before and after ovulation, which allows
for easy passage of the sperm. This is the fertile period.
In other days the mucus is thick, dry and breaks on
stretching. These days are infertile.
These natural methods need a lot of self-control and
have a very high failure rate. Therefore it is advisable
to adopt other contraceptive methods that have
low failure rate in case the woman does not desire
pregnancy.
However, fertility awareness of a woman is desirable in case of couples
with the problem of infertility to increase their chances of conception in
many cases.
Your responsibilities:
■
■
4
Talk about fertility awareness in the meetings of women's groups.
With ovulation awareness a woman can choose to conceive or avoid
conception in that cycle.'However, it is essential to caution the couple on
!
■
I ■
■
the high failure rate of this method.
If a woman has not conceived so far, fertility awareness can help in timing
the sexual intercourse and increase their chance of conception.
For contraception, the couple needs avoiding sexual intercourse in fertile
period.
17
18
READING MATERIAL FOR ASHA
Lactational Amenorrhea Method
Breastfeeding under certain conditions can prevent
the ovaries from releasing eggs. This method does
not cost anything, but it is most effective for
only the first six months after childbirth.
How to use breastfeeding for preventing
pregnancy?
n
If baby is less than six months old.
ra
If the woman has not had monthly bleeding
after giving birth.
IR
If the woman is exclusively breast feeding
the baby, (not even water) and feeding the baby whenever she/he is
hungry, with not more than six hours between feedings, day and night.
The baby does not sleep throughout the night without feeding.
Use another method of family planning as soon as any of the following
things happen:
■ Baby is more than six months old, or
■ Monthly bleeding starts, or
M
Baby starts taking other kinds of milk or other foods, or starts sleeping
for more than six hours during the night
Your responsibilities:
HI
■
■
Communicate messages on the Lactational Amenorrhea Method during
meetings
Explain to women about three conditions necessary for practicing Lactational
Amenorrhea Method
Assist the women for contraceptive method if she is not conforming to
three conditions.
■
PREVENTING UNWANTED PREGNANCIES
Permanent methods
Vasectomy (male sterilization)
This is a very small operation for permanently preventing childbirth.
Vasectomy requires less time and not much trouble for men. No hospital
stay is necessary.
There' are two methods for vasectomy
■ Conventional vasectomy
■ No scalpel vasectomy
Conventional -vasectomy
The procedure takes a few minutes and the person can go home in an
hour. An experienced doctor uses a scalpel to make a small slit in the
scrotum, and finds the vas on each side. The vas is tied and cut to stop
the sperms from reaching the semen sac. One stitch is required.
No scalpel vasectomy
The no-scalpel method uses only a needle puncture to complete the
process. No stitch is required. So no need to come back for stitch removal.
This method is becoming popular. Now doctors are being trained in
this new technique. There are less side effects of NSV as compared to
conventional vasectomy. This is a safe and easy method and requires only
10-15 minutes.
Men commonly think that vasectomy causes weakness - in work and
sexual life. This is not true and there is no evidence about it so far. The
testicles are not even touched in vasectomy. It is the testicles that secrete
hormones and regulate sexual functions. Vasectomy does not affect this
any way. There is a need to popularize vasectomy.
Why sometimes pregnancy occurs after vasectomy?
After vasectomy three months are needed to make the semen sperm-free.
A condom has to be used during this period This point is often ignored by
men and conception can take place. Condom use for three months after
vasectomy can prevent chances of pregnancy.
19
20
READING MATERIAL FOR ASHA
Tubectomy (female sterilization)
Tying and cutting the tubes that carry eggs (egg-tubes) is tubectomy. There
are several ways of doing this procedure. In many states this operation
is done using laparoscope (doorbeen). It blocks the meeting of ovum and
sperms. This is a popular sterilization method in India.
Two methods of tubectomy
Mini-Laparotomy is the conventional method
This involves opening the abdomen through a small incision and operating
by hand. Local anaesthesia is given by injection.
The mini-lap method needs hospitalization for two days. It is useful for
post-childbirth tubectomy, when the womb is still high in the abdomen
and easy to reach.
Laparoscopy
This involves inserting a laparoscope into the abdomen and applying tight
plastic rings on the tubes. Laparoscopy can only be performed when the
womb returns to its normal size and position (at least six weeks after
childbirth).
Although tubectomy performed by an experienced surgeon is usually
successful, laproscopic sterilization may sometimes fail.
Complications are rare in case of tubectomy; sometimes there may be
internal bleeding, infections, and possible tubal (ectopic) pregnancy later
if a tube happens to reopen.
In cases of major complications attributable to sterilization, failure and
unlikely event of death, you should help in accessing compensation
available as per FP insurance scheme. You will get more information
from your ANM.
Reversing sterilization (recanalization)
For all practical purposes, sterilization operations are permanent procedures.
But, in unusual circumstances like death of all children, recanalization to
join the cut ends of tubes together can be adopted by the couple. But in
both men and women, only one in four such procedures succeed. These
facilities are available in big hospitals only.
4
Ifeict
3
1
In-fectwn.5
STIs?
What are RTIs/STIs and how are they spread?
Many women suffer sexual infection, including abnormal discharges
through the vagina, ulcers and sores in the genital region and pelvic
infections. Men also generally have sexual infections.
Reproductive Tract Infections (RTIs) are infections of the reproductive
organs that are caused by various germs. Though RTIs can occur both in
men and women, they are more common in women, because their body
structure and functions make it easier for germs to enter.
A
RTIs that spread through sexual contact are called Sexually Transmitted
Infections (STIs). Reproductive organs can also get infected because of
trauma during delivery, unhygienic practices during delivery and abortions,
as well as overgrowth of germs normally found in the vagina. Poor general
health, poor genital hygiene and early start of sexual activity are all
factors that can make women prone to these infections.
Many women suffer from reproductive health problems. Women are more
vulnerable to these infections due to biological factors. Unequal power
relations in matters of sex i.e. sexual violence, non-use of condoms by
men also expose women to risk.
22
READING MATERIAL FOR ASHA
Why are these diseases not addressed?
Women are usually too shy and unwilling to talk about problems such as
abnormal vaginal discharge and genital ulcers. They have been taught to
silently suffer problems related to sex. There is also a fear that if a woman
is found to have RTIs, especially STDs, she will be labelled a 'loose woman'.
There is a reluctance to seek medical treatment because of inadequate sex
education and less access to medical care. The 'decision-makers' at home,
like the mother-in-law, would allow a woman to be taken to a health
worker if she suffers from pregnancy-related problems or infertility, but
not for seemingly 'trivial' symptoms like excessive.vaginal discharge. Even
our health system does not adequately respond to these needs.
RTIs have been badly neglected because they do not kill the person directly.
They usually remain inside a woman's body, giving her chronic abdominal
and back pain or making her infertile. Many women keep oh suffering
and remain silent.
Symptoms of RTIs
In woman
Abnormal vaginal discharge, which has bad smell and more quantity
than usual
■ Ulcers or sores over the external genitals
■ Lower abdominal pain because of pelvic infection
In man
■ Discharge from the penis
■ Ulcers ■
The presence of RTIs/STIs could also be indicated in men and women by
the presence of:
• Pain or bleeding during intercourse
• Painful swelling in the groin
•
Burning pain on passing urine
• Itching around the genitals
Unless treated early, RTIs/STIs can lead to several complications, ranging
from pelvic inflammatory disease (PID) and infertility, to increased risk of
HIV infections, ectopic pregnancy, cancer of the cervix and death. There
can be pregnancy-related complications like premature deliveries, low
REPRODUCTIVE TRACT INFECTIONS (RTIS) INCLUDING SEXUALLY TRANSMITTED INFECTIONS (STIS)
birth weight babies, stillbirths, abortions or birth defects. Newborns can
also get eye infection from the mother's birth canal, eventually leading
to blindness and pneumonia.
Abnormal vaginal discharge
Usually discharge can be normal if it is for short time and without other
symptoms like itching or pain. Most women have
normal discharge during inter-menstrual period, and
pregnancy. It is normal to have a small amount of
discharge or wetness that comes from the vagina. A
change in the amount, colour and smell may mean
an infection. Many infections of reproductive tract
in women show as foul smelling or bloody-yellow,
greenish or curdy discharge.
Causes of abnormal vaginal discharge
ii
Lack of genital hygiene, especially during
menstruation can facilitate infections.
■
Use of unclean instruments during delivery, abortions by unauthorized
■
providers.
Sex without condoms especially when partner is suffering from some
infections.
It is important to remember that these infections are easily preventable
and curable.
Preventing infections
■
■
Advise women and families to have deliveries in hospitals only.
Deliveries should be conducted by skilled persons only.
■
■
Abortions at registered hospitals only.
Maintenance of genital hygiene during menstruation.
■
Avoiding unsafe sex by use of condoms - women can't always insist
on condom use by partner. They need to learn negotiation skills for
condom use. Availability of female condoms may also save women in
such situations.
Women should be encouraged to.seek treatment from qualified providers.
You can help women get services by going with them to PHC/hospital
in city. Women generally feel shy and awkward to talk about it.
Complete treatment as advised by a qualified doctor is a must.
The partner should also receive treatment in cases of STIs. Women
■
■
23
24
READING MATERIAL FOR ASHA
especially find it difficult to convince their husbands to get treatment
as well and use condoms. You should counsel the family (including
her husband) and seek the help of ANM/MO wherever required.
Sexually Transmitted Infection (STI) in men
The urethral discharge
The complaint of urethral discharge is very common in men. Germs are
the only cause of any pus from urethra. The most common germ causes
yellow/white pus bead in the morning before first urine is passed. It is
not always painful. Untreated, it causes bad kinks in the urethra and
chronic infection. Men with such a complaint should consult a qualified
doctor immediately.
Prevention
■
For prevention, the best policy is to avoid multiple sex partners, or
■
risky sex behaviour.
Early and complete treatment cures the infection and stops the spread
H
to the next partner.
Sex is best avoided during treatment.
Educate people on this illness and remove undue fears about them.
This may save them hundreds and thousands of rupees.
It is important to examine and treat the spouse or partner, as he/she
will be infected also.
The spouse/partner may already have had this infection and illness in form
of vaginal discharge and burning during urination. The infection may get
inside the womb and cause pain and fever. It may become chronic if not
treated early and properly. Therefore, always ask for any complaints, which
the woman partner may have.
Your responsibilities:
.
A
■
Raise awareness about the causation, transmission and prevention of RTIs
■
■
and STIs.
Emphasize the importance of early treatment and partner management.
Distribute condoms and emphasize on promotion of condom and safer sex
behaviour.
n
4
HrAIDS
If
_4
EIHI ■
HIV is an infection
A very minute organism causes HIV. A person having HIV germs in the
blood is considered as HIV positive. One cannot tell if a person is having
HIV infection, as this cannot be identified without a blood test. HIV can
be transmitted through following routes:
■ Through'unprotected sexual intercourse (vaginal, anal) with a person
■
I
*
■
■
having infection.
Through blood transfusion when blood is taken from HIV positive
individual.
Through contaminated needles used previously in an HIV positive
person.
From HIV positive pregnant woman to child during delivery or
afterwards.
HIV is not transmitted by
■
■
■
Touching and kissing a person
Playing, swimming together
Using common bathrooms and toilets
■
■
Mosquito bites
Sharing other utility items
26
READING MATERIAL FOR ASHA
Risky sexual behaviour
The main cause of HIV/AIDS spread is risky sexual behaviour. Sex with
many partners without use of condom is risky sexual behaviour. It is not
only due to having sex with many but also because many people stay away
from homes and families for long periods of time, e.g. truck drivers.
Women are more affected by HIV/AIDS in India as this is directly related to
her economic and social status and gender inequalities. The existing social
and gender norms have great impact on sexual activity and risk behaviour
of men and women, which affect women more than ''men. Women also
find it difficult to motivate their partners to use condoms or approach
services for treatment of infections.
In our country more than 85 percent of HIV transmissions take' place
through the sexual route. There are no "high risk groups" but there are
some people who have high-risk behaviour. HIV/AIDS can strike anybody
depending on your behaviour.
The window period
After exposure to risky situations, HIV test will be positive only after 612 weeks. This is the window period. So one has to wait for this period
to get an HIV test done.
AIDS is the disease
AIDS may occur many years after getting HIV positive, but the person is
infected during this period. AIDS is a serious disease without permanent
cure, though we have some medicines to reduce its severity. Suggestive
symptoms of AIDS:
KI
Continuous weight loss.
Persisting diarrhoea.
■ Repeated fever or illness lasting more than one month.
■ The minor features include chronic cough, itching, rash on body and
genitals, oral thrush (fungal infection), bubos, and illnesses coming
too often.
There is stigma associated with AIDS and often women suffering from AIDS
have been abandoned by their families. We can help in removing stigma
about AIDS. We can also help the patients to get in touch with support
network for HIV positive people.
HIV/AIDS
You can help in preventing HIV/AIDS
Prevention of HIV/AIDS is the only effective way of escape through this
deadly disease. Following points are important:
■ Creating awareness in community about risk and causation and advising
■
men and women to avoid sex with many persons.
Consistent and correct use of condoms to prevent infection.
■
Counsel for HIV testing.
Women are caregivers for the family. When they are HIV positive, they may
not get the required family support and care. Counselling for the family
is very important. Emphasize use of condom and partner management,
early detection and treatment of STIs. In some hospitals there are special
services for pregnant women. This involves counselling, blood tests and
provision of drugs to HIV positive mothers. This will reduce the risk of
infection to the baby. Awareness among adolescent boys and girls about
healthy family life including sex education is important.
Blood testing facilities are available at most district hospitals. Here blood
test for HIV/AIDS is done along with counselling services.
Role & responsibilities of ASHA:
■
Raise awareness about, causation, transmission and prevention of
■
■
HIV/AIDS
Promote use of condom as a method of dual protection
Counsel persons having risky sexual behaviour to undergo HIV/AIDS testing
■
at nearby VCTC
Assist HIV positive/AIDS patients to access ART
27
I
5
'P&ri.od of ftrotring Up
Adolescence is a period of rapid physical and emotional development. This
period starts around 10 years of age and extending till 19 years.
a This is the period of rapid growth and development.
H
They experience changes in their bodies and minds during this time.
It is important that you give due attention to the health of adolescents,
as the health'and productivity of the nation depends on them.
As part of growing up, adolescents will go through puberty. Puberty is the
time in life when the body undergoes changes from that of a child to an
adult. You already know about the chemicals in the body called hormones
cause these changes. Because there are so many changes happening during
puberty, adolescents find it difficult to adjust to these changes and often
they need support.
Not only does the body change, but the emotions
of adolescents change too. How they think and feel
about themselves, family and friends may seem
different. As adolescents go through puberty, they
like to take important decisions for themselves,
take on more responsibilities and become more
independent.
• ’
A
ADOLESCENCE: THE PERIOD OF GROWING UP
Changes in girls
Changes in boys
Breasts: In most girls, puberty starts
with breast growth. When breasts start
Body size: Arms, legs, hands and feet may
grow faster than the rest of the body.
29
__________
to develop, one may notice small, tender
lumps under one or both nipples that will
Body shape: Adolescents will get taller
get bigger over the next few years. When
and shoulders will get broader. They will
gain a lot of weight. During this time,
many boys experience swelling under
their nipples. This may cause them to
worry that they are growing breasts.
During puberty, muscles will also get
breasts first begin to develop, it is not
unusual for one breast to be larger than
the other. However, as they develop, they
will be alike in size and shape.
Hair: Soft hair will start to grow in the
pubic area (the area between legs). This
hair will eventually become thick and
very curly. Hair grows under the arms
bigger.
Voice: Voice will get deeper. This may
start with voice cracking.
and on the legs.
Body shape: Hips get wider and waist
will get smaller. Body will also begin to
build up fat in the stomach, buttocks,
Hair: Hair will appear under arms, on
legs and face, and above penis. Chest
hair may appear during puberty or later,
although not all men have chest hair.
and legs. This is normal and gives body
the curves of a woman.
Skin: Skin may get more oily and may
sweat more.
Body size: Arms, legs, hands, and feet
may-grow faster than the rest of the
body.
Skin: Skin may get more oily. This is
because glands are growing too. Almost
all teenagers get acne at one time or
another.
Menstruation: During this period
menstrual cycle, or "period" begin. Most
girls get their periods between 9 and 16
years of age.
Penis: Penis and testes will get larger.
Boys get erections due to an increase in
sex hormones. Erections occur when the
penis gets stiff and hard - sometimes
for no reason. This is normal. Body will
also begin to produce sperm during
puberty. This means that during an
erection, adolescents may also experience
ejaculation. This occurs when semen
(made up of sperm and other fluids) is
released through the penis. This could
happen during sleep. This is called a
nocturnal emission or "wet dream."
30
READING MATERIAL FOR ASHA
Your responsibilities:
■
■
■
■
■
■
Young people may have several questions about their body, sex and sexuality,
and how to remain healthy. Sexuality refers to expression of sexual feelings.
There is attraction towards opposite sex. They need information, and
services.
You should inform and help the adolescents in getting services through the
nearest government hospital, i.e., for health care and also during pregnancy,
institutional delivery, access to contraceptives and services for RTIs/STIs
and menstrual problems.
Males also need information-and advice.
You may like to visit schools and talk to the young on these issues.
Alternatively, you can plan the visit of nurse didi to come to school and
talk to the adolescents.
If there are any adolescent groups in the village, you should meet them
periodically. You may provide information on health issues and seek their
cooperation and support in our health work. You may also be required to
go with them to the sub-centre or PHC for health services.
■
Adolescents need support in the community. You can talk to Panchayat
■
members, teachers, parents, local leaders and SHG members to provide
information on the subject.
You need to find out if Anganwadi Centres run a programme for adolescent
girls: called Kishori Shakti Yojana. Adolescent girls receive more food under
this scheme.
■
Talk with adolescents in the meetings of Nehru Yuva Kendra Sangathan
(NYKS), Yuvati Mandals and other youth groups on promoting health and
preventing diseases.
.•
T-;
-r
<
6
AdoUsc^nt
(Sjirle to '[d^
■ tia
during
Vfl&n$tru.ation
Staying clean
Generally girls living in small towns and cities use sanitary pads for
protection during menstrual period, if they can afford them. These are
readymade soft cotton pads worn inside the underwear to catch the blood
as it leaves the vagina. These pads should not be reused. Some girls prefer
to make their own pads out of folded cloth or wads of cotton. These pads
must always be clean and dry when worn. They should be changed several
times a day and disposed of by burning outdoors in a large empty tin. If
cloth is used, they should be washed well with soap and water and dried in
the sun. Sun light is the cheapest disinfectant
available in nature.
In villages there are certain restrictions imposed
on adolescents during menstruation. Those
restrictions (Don’ts), which are harmful should
be discouraged, such as not taking bath during
menstruation or not doing any physical work.
It is advisable to wash outer genitals well with
water every day to remove any blood that is left.
-^LIBRARY
z
and
A TtON
0-f
32
READING MATERIAL FOR ASHA
Changes in bleeding
Sometimes, the ovary does not release an egg. When this happens, the
body makes less hormone, which can cause changes in how often and how
much a woman bleeds. Girls whose monthly bleeding has just begun - or
women who have recently stopped breastfeeding - may bleed only every
few months, or have very little or too much bleeding. Their cycles usually
become more regular with time. Women using hormonal family planning,
sometimes have bleeding in the middle of the month.
»
Older women who have not yet gone through menopause may have heavier t t
bleeding or bleed more often than when they were younger. As they get
closer to menopause, they may stop having monthly bleeding for a few
months and then have it again.
Pain with monthly bleeding
During monthly bleeding the womb squeezes in order to push out the
lining. The squeezing can cause pain in the lower belly or lower back,
sometimes called cramps. The pain may begin before bleeding starts or
just after it starts.
Tips for taking care
■
a
a
a
a
Do exercise, walk and run
Rub your lower belly. This helps the tight muscles to relax.
Fill a plastic bottle or some other container with hot water and place
it on your lower belly or lower back. Or, use a thick cloth you have
soaked in hot water.
Drink tea with ginger. Women in your community may know of other
remedies that work for this kind of pain.
Take a mild medicine for pain with doctor's advice.
Pre-menstrual syndrome (PMS)
Some women and girls feel uncomfortable one or two weeks
before their monthly bleeding begins. They may have one or
more of a group of signs that are known as pre-menstrual
syndrome (PMS). Women who have PMS may notice:
■ Sore breasts
■ A full feeling in the lower belly
■ Constipation (when you cannot pass stool)
■ Feeling extra tired
»
•
u
r
HELPING ADOLESCENT GIRLS TO TAKE CARE OF THEMSELVES DURING MENSTRUATION
■
Sore muscles, especially in the lower back or belly
A change in the wetness of the vagina
Oiliness or spots (pimples) on the face
■
■
Feelings that are especially strong or hard to control
Craving for certain foods and increased hunger and thirst.
Many women' have at least one of these signs each month and some
women may have all of them. A woman may have different signs from
one month to the next. For many women, the days before the start of
their bleeding is a time of unrest. But some women say they feel more
creative and able to get things done. These symptoms disappear within a
few days after the start of the menstrual period.
i Roles and responsibilities of ASHA:
Advise to
■ Eat less salt. Salt makes the body to keep extra water inside, which gives
■
the full feeling in the womb.
Try to avoid caffeine (found in coffee, tea and some soft drinks like
cola)
Try eating whole grains, dalia, soyabean, peanuts, fresh fish, meat, milk
or other foods that are high in protein. When body uses these foods, it
also gets rid of any extra water, so that belly feels less full and light.
33
Not viewed