By Jim Crawford,2014-01-10 22:52
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    DURATION: 270 minutes (4 hours, 30 minutes)


    By the end of this Module, participants will be able to:

    ? Understand the “recipe” for positive living for individuals and

    families; ? Support clients to have a healthy mind;

    ? Recognize common signs of anxiety and depression and provide

    basic counseling and referrals;

    ? Support clients to have a healthy body;

    ? Help clients and their partners practice safer sex and prevent

    new HIV infections;

    ? Help clients prevent and seek care for sexually transmitted


    ? Work with clients to actively participate in their own care and

    advocate for themselves (and their children) as a part of positive



    Session 10.1: Introduction: The Recipe for Positive Living

    Session 10.2: Healthy Mind

    Session 10.3: Healthy Body

    Session 10.4: Safer Sex

    Session 10.5: Preventing and Treating Sexually Transmitted

    Infections (STIs)

    Session 10.6: Helping Clients Be Active Participants in Their Own


    Session 10.7: Classroom Practicum on Positive Living

    Session 10.8: Module Summary

    Comprehensive Peer Educator Training Curriculum: Trainer Manual 10-1


    ? Brainstorming

    ? Large group discussion

    ? Interactive trainer presentation

    ? Small group work

    ? Snowballing

    ? Return demonstration

    ? Case studies


    ? Flip chart

    ? Markers

    ? Male and female condoms

    ? Penis and vagina models ? Tape or Bostik

    ? Small pieces of paper

    ? Case study cards for Session 10.7


    ? Read through the entire Module and make sure you are familiar

    with the training methodologies and content.

    ? Collect male and female condoms, penis and vaginal models, and

    other supplies listed above. ? Prepare the case study cards for Session 10.7.

    10-2 Module 10

SESSION 10.1: Introduction: The Recipe for Positive

    Living (20 minutes)


    Methodologies: Brainstorming, Large Group Discussion, Interactive

    Trainer Presentation

    Step 1: Review the Module learning objectives. Step 2: Tape many pieces of flip chart paper along one wall of the training room, so that

    there is one continuous sheet of paper. Tell participants that this is an open

    “graffiti wall.”

     Ask participants to think how they or people they know live positively with HIV.

    Give each participant a marker and ask everyone to get up and write what it

    means to live positively with HIV on the graffiti wall. Encourage participants to be

    creative use words, drawings, songs, etc. to express what it means to live

    positively with HIV.

     After about 10 minutes, review what has been written on the graffiti wall as a

    large group. Remind participants that Peer Educators can be role models to help

    clients live positively with HIV.

    Step 3: Write the “recipe for positive living” on flip chart.


    with actions for a


    = A LONG, HEALTHY LIFE Step 4: Ask participants to discuss what the different “ingredients” in the “recipe” mean

    and fill in using the content below, if needed.


    ? Positive living means having a positive outlook to living and life. It also means living

    responsibly with HIV and preventing new infections.

    ? People living with HIV can live full and healthy lives if they take care of themselves,

    access care and treatment and feel supported to make healthy choices.

    ? Families can also live positively with HIV, by supporting and taking care of each other.

    ? Positive living includes:

    - Keeping the mind healthy

    - Keeping the body healthy

    - Keeping the soul healthy

    - Preventing new HIV infections

    - Keeping the whole family healthy.

    Comprehensive Peer Educator Training Curriculum: Trainer Manual 10-3

? Peer Educators play a key role in helping other PLHIV live positively and following the

    recipe for positive living:”


    with actions for a


    = A LONG, HEALTHY LIFE 10-4 Module 10

SESSION 10.2: Healthy Mind (35 minutes)


    Methodologies: Brainstorming, Interactive Trainer Presentation,

    Large Group Discussion, Small Group Work

    Step 1: Ask participants to brainstorm about times when clients may need extra support

    to cope with their feelings. Record responses on flip chart. Then ask participants

    to brainstorm about the ways people living with HIV can keep their minds

    healthy and be happy, even during difficult times. Record responses on flip chart.

    Step 2: Write the words “ANXIETY” and “DEPRESSION” on two separate pieces of flip

    chart (or use local words that make more sense). Ask participants what they

    have heard about or know about these words. Since these are clinical terms,

    participants may not know them, although they will know many of the signs and

    symptoms. Explain using the content below. Step 3: Ask participants to turn to the person sitting next to them. Ask each pair to

    spend about 10 minutes discussing if they or anyone they know have had anxiety

    or depression. The pairs can discuss these questions:

    ? How did it make them feel?

    ? What were the signs?

    ? What helped them to feel better? Step 4: Bring the large group back together and, using the content below to fill in as

    needed, lead a discussion about the signs of anxiety and depression and what

    Peer Educators can do to help clients have a healthy mind and live positively with


    Step 5: Remind participants that Peer Educators are not trained counselors and that they

    should always consult with members of the multidisciplinary team, especially

    trained counselors or social workers, if they think a client needs additional

    support, is hopeless, or is thinking about taking her or his own life. Review the

    information on when a client needs professional help and support from the

    content below.


    Helping clients have healthy minds

    Peer Educators can help people deal with their feelings about HIV. Clients will often need extra

    support in dealing with their feelings:

    ? After learning they or a family member are HIV-positive

    ? When preparing to disclose to friends or family members

    ? When preparing to disclose to a child

    ? When starting ART

    ? When they become pregnant

    Comprehensive Peer Educator Training Curriculum: Trainer Manual 10-5

    ? When they are about to lose a loved one or are grieving the lost of a loved one

    ? When they face stigma, discrimination or violence

    ? And many other times…

These are all important times for Peer Educators to provide emotional support, but ongoing

    support is also needed to help people live positively with HIV in the long term.

Helping clients with anxiety and depression

    Anxiety and depression are common reactions to living with HIV, especially when people are not

    feeling well and do not get the support they need from family, friends, health care providers and

    their community. Our mental health and our physical health are closely related this is why

    helping people deal with anxiety and depression can help with positive living.

    Key Definitions: Anxiety and Depression

    Anxiety is when you feel nervous, have a lot of fear, or do not want to do things that you normally enjoy. Sometimes people also use the word “stress” to describe their feelings of


Depression is when you feel very sad and hopeless.

Signs of anxiety:

    ? Cannot eat

    ? Cannot breathe

    ? Shaking and sweating

    ? Heart pounding fast

    ? Tingling in the hands or feet

    ? Cannot sleep

    ? Cannot concentrate on anything

    ? Feel “jumpy” or “stressed”

    ? Feel worried about many things

Signs of depression:

    ? Feel like you just do not know what to do (helpless or hopeless)

    ? Really tired with no energy

    ? Cannot find good in anything

    ? Do not enjoy the things you used to

    ? Sleep too much or not enough

    ? Get angry for no reason

    ? Cannot eat or eat too much

    ? Do not feel like being social with friends or family

    ? Do not feel like having sex

    ? Talk about running away

    ? Think about suicide (killing yourself)

What to do when you think a client has anxiety or depression:

    Peer Educators can watch for signs of anxiety and depression in their clients. Peer Educators are

    not trained counselors, but they may be able to provide some basic advice to clients on how to

    deal with feelings of anxiety or depression. Peer Educators should always consult with other

    members of the multidisciplinary team if they think a client might be anxious or depressed.

    10-6 Module 10

Peer Educators can also:

    ? Provide continuous supportive counseling to clients so they feel “heard.” Use good

    communication skills, such as reflection.

    ? Encourage the person to join a PLHIV association and a support group to meet other

    people living positively with HIV.

    ? Link the person with community support services, like groups that provide spiritual

    support, counseling, home care or nutritional support.

    ? Remind clients that they should not use alcohol or drugs because this will only make

    things worse.

    ? Make a plan with clients to stay hopeful and feel good again.

    ? Encourage clients to continue any religious or spiritual practices that make them feel


    ? Talk with family members (if the client says it is okay to do so) they may be discouraged

    and need support, too. Remind them to provide ongoing support and love to the person.

    ? Remind clients that their feelings are normal and they will feel better.

    ? Talk with a professional counselor or social worker about the client’s symptoms and next

    steps. Give your client a referral to meet with a counselor or social worker.

    ? Symptoms of anxiety and depression can also be due to a medical illness, so it is

    important for clients to have a check-up with the doctor or nurse.

When the Peer Educator needs to make a referral:

    Peer Educators should be aware of danger signs that anxiety and depression may be very serious

    or out of control and consult with the clinic doctors, nurses, social worker, community-based

    counselors and spiritual advisors immediately. Remember the principles of shared confidentiality

    when doing this.

Peer Educators should seek help from other members of the multidisciplinary team

    right away when:

    ? Clients might hurt themselves or another person.

    ? The depression is so bad that clients are thinking about killing themselves.

    ? The family cannot cope with the person any more and wants to throw her or him out.

    ? Clients cannot eat or sleep (may be due to side effects of ARVs like efavirenz, but

    may also be anxiety or depression).

    ? There is any kind of emotional crisis.

Peer Educators can help people find hope and joy, accept their situation, and want to

    live for the future!

Comprehensive Peer Educator Training Curriculum: Trainer Manual 10-7

SESSION 10.3: Healthy Body (40 minutes)


    Methodologies: Snowballing, Large Group Discussion

Step 1: Introduce the session by telling participants that we will do an activity about

    keeping our bodies healthy. Break participants into groups of 4.

     Note: trainers should adapt the group sizes depending on how many participants

    are in the training.

     Give each group 2 pieces of flip chart paper and a marker. Ask each group to

    write “HEALTHY” on one flip chart and “UNHEALTHY” on the other. Ask the

    groups to list as many behaviors they can think of that PLHIV should do to keep

    their bodies healthy on the “HEALTHY” flip chart and things that PLHIV should

    avoid on the “UNHEALTHY” flip chart. Give the groups 10 minutes.

    Step 2: After 10 minutes, have each group of 4 join another group of 4. Ask the groups

    to review and combine their lists onto 2 new pieces of flip chart paper (with the

    same titles). Participants should not write down each answer more than once.

    Step 3: Then have the groups of 8 join another group of 8 and combine lists as before.

    Keep going until there is one large group and a final list of healthy and unhealthy

    behaviors. Ask for a participant to read through each list to the group. Fill in as

    needed from the content below. Step 4: Ask Peer Educators what challenges they have faced in keeping their bodies

    healthy and practicing healthy behaviors. Discuss how Peer Educators can help

    clients keep their bodies healthy.


    Healthy behaviors:

    There are many things PLHIV can do to keep their bodies healthy and live positively with HIV,


    ? Use condoms and practice safer sex, every time.

    ? Get STIs treated right away and tell your partner to get them treated, too.

    ? Get a TB test and treat TB right away.

    ? Use a family planning method if you want to limit or space children.

    ? Go to the hospital or clinic for check-ups, lab tests and to pick up medicines. Never miss

    an appointment.

    ? Take medicines the right way (at the right time, the right number, etc.).

    ? Tell the nurse and doctor if there are any changes, even small ones, in your health.

    ? Stay busy and active.

    ? Get enough rest.

    ? Get sunlight and breathe fresh air every day.

    10-8 Module 10

    ? Sleep and rest under a treated mosquito net if you live in a place with malaria. ? Join a PLHIV association and a support group and talk about things openly. ? Exercise or stretch every day to stay healthy. If bedridden, have a family member help

    with stretches to keep blood flowing and prevent bedsores.

    ? Stay clean wash regularly and wash hands often, especially after going to the toilet and

    before making food.

    ? Eat enough good food and take multivitamins (there is more about nutrition in Advanced

    Module 17). ? Boil drinking water to make sure it is clean.

    ? Cook food well to get rid of germs.

    ? Wash raw fruits and vegetables well with clean water.

    ? Keep the house and compound clean, including getting rid of any still water and garbage. ? Use a germ-killing bleach solution (like Jik, Barakina or Gentian Violet) diluted with

    water to keep household surfaces clean.

    Unhealthy behaviors:

    Peer Educators should talk about avoiding practices or behaviors that are not healthy. These


    ? Drinking too much alcohol

    ? Using drugs

    ? Smoking

    ? Sharing medicines or stopping them without talking to the doctor ? Having unsafe sex

    ? Avoiding social contact and staying alone too much

    ? Missing appointments at the clinic

    ? Taking traditional medicines that you have not discussed with the doctor ? Eating too many sugary or fatty foods

    ? Not eating enough good foods.

    Comprehensive Peer Educator Training Curriculum: Trainer Manual 10-9

SESSION 10.4: Safer Sex (60 minutes)


    Methodologies: Large Group Discussion, Interactive Trainer

    Presentation, Small Group Work, Return Demonstration Step 1: Start the session by saying the following statements out loud and asking

    participants to discuss:

    ? People living with HIV have the right to a healthy sexual life.

    ? People living with HIV have a responsibility to protect their sexual partners.

    ? Everyone has a right to a healthy sexual life and it is our responsibility to protect our

    sexual partner(s) by practicing safer sex.

    Step 2: Ask participants what is meant by the term “safer sex” and why it is an important

    part of living positively with HIV. Discuss what we can do to practice safer sex.

    Record answers on flip chart and fill in, as needed, from the content below.

     Explain that Peer Educators need to help clients and their families feel

    comfortable talking about safer sex.

    Step 3: Tape male and female condoms on the wall and hand out small sheets of paper

    to participants. Ask them to write common myths about condoms on the papers

    and to tape them on the wall next to the condoms. Some examples could include

    that condoms cause HIV or that condoms are only for sex workers.

     Discuss why people have these myths and what Peer Educators can do to make

    sure people have the correct information about condoms. Step 4: Demonstrate male and female condom use to participants, using the penis and

    vagina models. Explain each step simply and carefully. Use the content and

    illustrations below as a guide.

    Step 5: Ask participants to break into groups of 3 and practice demonstrating male and

    female condom use, making sure to explain each step along the way, as if they

    were teaching a client. The trainers should circulate around the room to provide


    Step 6: Have participants stay in their groups of 3 after the condom demonstration

    activity. Ask each group to come up with one reason that people say they do not

    want to use condoms. Ask the group to say their reason out loud and discuss

    what a Peer Educator could advise a client that feels that way (or whose partner

    feels that way).

    Step 7: Lead an interactive presentation on the role Peer Educators can play in helping

    clients to negotiate condom use with their partner(s), using the content below.

10-10 Module 10

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