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ACTION WITH YOUTH - HIV/AIDS AND STD
( By International Federation of Red Cross and Red Crescent Societies )

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Values/attitudes activities

“I am proud of...”

Objective

To help young people develop feelings of self-esteem

Time

60 minutes

Materials needed

1 questionnaire per participant (see next page)

Method

1. Introduce the activity with a short discussion on how people look at themselves in different ways.

2. Next, ask the participants to fill in a small questionnaire. Highlight the fact that they should do this spontaneously and be very honest with themselves. As an example, you might first give your own answers to the questions.

3. Allow five minutes to fill in the questionnaire.

4. Ask a first volunteer to read his/her answers. The group then makes their own comments. Often, friends will mention additional qualities or skills to the list.

5. After several volunteers have read their answers, try to come to the following conclusions:


Each of us has good qualities or special talents or skills, but we are not always aware of them.

Often, people behave in ways that match their opinions of themselves. For example, if you don’t have much confidence in yourself, you will not accept the challenge of a difficult task. But if you are aware of the real qualities you have, you will feel self-confident and stronger and taking decisions will be easier.









This activity requires a good group atmosphere.


Questionnaire sheet – one copy for each participant

Questionnaire “I’m proud of...”






















QUESTIONS


ANSWERS


1. Can you think of a task that was not at all easy, and that you were able to carry out successfully?



2. Can you think of something you have made by hand yourself and that you are very proud of?



3. You usually have a good feeling when someone else appreciates what you do. Can you give an example of something you did that was highly appreciated by someone else?



4. What aspect of your character do you like most?



5. Can you think of a decision you made for yourself which was not easy?



Male or female, does it make a difference?

Objective

To explore gender roles and their influence on behaviour and relationships

Time

45 minutes

Technique

Group discussion

Materials needed

4 large pieces of chart paper Pens

Method

1. Divide the participants in four equal groups. Each group gets a large piece of paper and pens. Each group has a different task:


Group 1 is asked to make a list of all the advantages of being a girl/woman.

Group 2 is asked to make a list of all the disadvantages of being a girl/woman.

Group 3 is asked to make a list of all the advantages of being a boy/man.

Group 4 is asked to make a list of all the disadvantages of being a boy/man.


2. One participant of each group reports on the findings of his/her group. The group may react.

3. Ask the participants to think of how these gender roles apply to their own lives, their relationships and their expectations for the future.

4. To close the activity ask the participants to think of what they can do to change the gender roles they don’t like.








This activity offers an opportunity to discuss traditional gender roles: the behaviour, responsibilities and rights of men and women, in relationships, at home, at work, in society, etc. In mixed groups (boy/girl) especially, you can expect animated discussions on this issue!


Drugs and risks

Objectives

To raise awareness of the consequences of drug use

To raise awareness of the risk of HIV infection related to drug use

Time

60 minutes

Technique

Brainstorming Case study Group discussion

Materials needed

Flip chart and pen

Method

1. Tell the group you are going to hold a brainstorming session on drugs, and they should discuss together the drugs they think young people are exposed to and may be using. List the reactions on a flip chart. Even if tobacco and alcohol are not mentioned by the group, add them to the flip chart.

2. Ask participants which are, in their opinion, the drugs that present a high risk for HIV infection.








The expected answer to this question is drugs that are injected present unacceptably high risks. Discuss why. If necessary, give additional information on the transmission of the virus through sharing infected needles and syringes. (See Section 1.) Also make the point that alcohol and other drugs can affect your judgement, making you more likely to have sex or share needles.


3. If you have not planned activity 23, Dear Aunt Maggie, in your programme, you may now use letter 3 of that activity as a case study for this activity (see p. 118).







A young man reports


Last Saturday, I went out dancing in town. I felt very sad because my girlfriend is dating someone else. At the dance, I had too much to drink. Then a guy offered me a new drug, injected straight into your veins. He persuaded me to try it saying that it relieves tension but is not addictive. I shared his needle to inject the drug... Now I am terrified I might have AIDS.



Read the text aloud and discuss this case, by asking questions such as:

Which drugs did this young man use?


First alcohol, then a drug which had to be injected

Why did he inject drugs?


To forget about his sorrow n He was under pressure from another guy

Can you think of other reasons why people start to use drugs?


Pressure from commercials/ads (alcohol, tobacco)

Influence of role models (for example, film stars who smoke, drink alcohol, etc.)

Curiosity (a typical attitude in youngsters)

To relax (alcohol, tranquilizers)

To avoid physical pain or psychological problems (narcotics, such as heroin, morphine, opium)

To stimulate, to make you energetic (caffeine, cocaine, speed, amphetamines)

To reinforce physical power (for example, sportsmen who use steroids)


What could be the consequences of drug injection for the young man in this case?


Infection with HIV
Addiction, if he uses the drug repeatedly

4. Ask participants to think of five good reasons for not using drugs.

Sample of reactions:


I want to be responsible for what I do
It is bad for my health
It is illegal
There are other ways to relax and have a good time
There are better ways to solve problems
I want to avoid any risk connected with HIV infection

5. Ask participants what they have learnt and review the most important points (for example, drugs can keep someone from thinking clearly and can push people to irresponsible and risky behaviour; sharing drug-injection equipment presents a very high risk of getting infected with HIV).

No sex now

Objective

To help young people consider that choosing not to be sexually active at the present time is a viable alternative

Time

30 minutes

Technique

Brainstorming Group discussion

Materials needed

Board, pen/chalk

Method

1. Write the heading ‘No sex now’ on the board and draw two columns, headed ‘Advantages’ and ‘Disadvantages’.

2. Ask the participants to brainstorm in small groups on the advantages and disadvantages of deciding not to have a sexual relationship.

3. Conclude with a discussion involving the whole group, highlighting the main points raised in the brainstorming session.

4. At the end of the activity, ask what they have learned. Did their responses match with what you hoped they would learn?

Sample of reactions:



















Advantages


Disadvantages


Feeling of pride and self-control


May lose girlfriend/boyfriend


Sticking to one’s own morality


Friends may make fun saying you don’t dare to have sex


No worries about unwanted pregnancy


You miss the physical pleasure of sex


No fear of STD


No guilt feelings, especially if/when the relationship ends









If your group is predominantly illiterate, you can have this brainstorming session without writing reactions on the board. After this activity you could organize a role play on saying “no”. See the skills activities later in this section.


A story with a gap

Objectives

To identify situations in which young people might be at risk To find ways of dealing with pressure in risky situations

Time

30 minutes

Technique

Story with a gap

Materials needed

Two pictures, if possible on poster format (see illustration below and poster on p. 138)

Method

1. Hold up picture A in a position where it can be seen clearly by all participants. The picture shows a man, standing next to his smart car, calling to a young girl outside a night club. Ask the group to describe what they see in the picture.

2. Show the group picture B and ask them to suggest what may have happened between the two scenes.


Picture A

3. Guide the group through a series of questions which are designed to raise discussion and promote dialogue:


Why is this happening?
Does this happen in real life?
What problems does it lead to?
What are the root causes of the problem?
What can be done to prevent such a situation?

4. Summarize what has been said in the discussion.

See also: Pictures and photographs under Techniques for educational activities (Appendix I).


Picture B

Mary is in love

Objective

To identify and discuss attitudes and values regarding risky behaviour

Time

60 minutes

Technique

Case study

Materials needed

None

Method

1. Read the case study to your group slowly and carefully. In place of Mary use a local name, taking care not to use the name of anyone in the group.

2. Let the group members decide on the following choices Mary has: n Take no notice of what she overheard; it doesn’t matter what Bob has done in the past. n Forget about Bob because a relationship with him might be too risky. n Buy condoms in preparation for a possible future relationship with Bob. n Decide that if she has a relationship with the boy she will practice safer sex and use contraception.

3. Get the group to reach a consensus on the ‘best’ course of action for Mary or discuss various choices she can make.








Encourage the group to look at the kind of value judgements they have made and the reasons for making these judgements. Leading an activity in which there are no right or wrong answers can be difficult. Try to let the members of your group do most of the talking. The process of having them talk, listen and think about the issues is the goal.








Case study


Mary thinks she is in love with Bob, a boy at school. He is such a handsome boy! She is not concentrating on her school work and is eating very little. And now Bob has asked her to go out with him on Saturday night! The same day Mary overhears a conversation where she learns that Bob has had many sexual partners.










If you would like to use other case studies to discuss with your group, refer to the stories described in Section 1, How does AIDS affect people’s lives? (see p. 24). You can also write your own stories, better adapted to the local situation and culture.


“Do you agree?”

Objective

To explore a person’s own values and attitudes related to HIV/AIDS

Time

60 minutes

Technique

Values voting

Materials needed

Three large pieces of chart paper with one of the following written on each: Agree; Disagree; Not sure/confused








If your group is predominantly illiterate, use coloured signs on each piece of paper: green for ‘Agree’, red for ‘Disagree’ and orange for ‘Not sure/confused’. This activity is not suitable for very young people, as it requires a certain maturity.


Preparation

Put the pieces of chart paper in three corners of the room.

Method

1. Ask participants to stand together in the middle of the room.

2. Explain that you will read out some controversial statements relating to HIV/AIDS. After you read one statement, the participants should go immediately to the paper which best describes their response to it. Emphasize the importance of responding to first reactions and acting accordingly.

3. When the participants have responded to one statement, ask a volunteer in each corner to explain why he or she is standing there. After three volunteers have explained their viewpoint, the other participants may react.

4. After listening to the different points of view, ask the participants to move to the position that best expresses their feelings now.

5. At the end of all statements, the following issues/questions can be taken up for discussion:


What did you feel like when thinking about these statements?

How did you feel about exposing your values to other participants, especially when you were in the minority ?

Was it easy to change your stand?









You will find below the points to be emphasized concerning each statement, which will help you lead the discussion.


Suggested statements:

1. “Those infected with HIV have only themselves to blame.”

2. “Clean needles should be made available on request to drug users who inject their drugs.”

3. “Condoms should be freely available to all, regardless of age.”

4. “Prostitution should be banned to prevent the spread of HIV/AIDS.”

5. “An HIV-infected woman should not get pregnant.”

6. “Young people should have access to STD/HIV counselling and treatment.”

Points to be emphasized in the discussion

1.“Those infected with HIV have only themselves to blame.”

Often people with HIV/AIDS are divided into the ‘innocent victims’ and the ‘guilty’. Babies with HIV, those infected with untreated blood, spouses of infected men are seen as ‘innocent’ victims deserving sympathy, while the ‘guilty’, e.g., prostitutes, homosexuals, intravenous-drug users, are seen as deserving to die. It is important to emphasize that alternative lifestyles (e.g., homosexuality, prostitution) are not really a matter of choice, even if they seem to be. Today, rather than expecting some people to give up their lifestyle, preventive behaviour for all is the most effective way to control HIV/AIDS. Society can, however, make it easier for some to adopt safer behaviour by specific steps, e.g., providing condoms, alternative occupations, clean needles, counselling services, etc.

2.“Clean needles should be made available on request to drug users who inject their drugs.”

The effort to control the spread of HIV among people who inject drugs is greatly complicated by the fact that the taking of drugs, other than tobacco and alcohol, is almost universally condemned. In many countries, harsh laws and effective policing drive drug users beyond the reach of health and social services. AIDS brought a new urgency to the debate about how best to deal with drugs. In many countries, needle-exchange programmes have proved to be highly effective in reducing the level of needle sharing among drug users. The emphasis of these programmes is to minimize the harm done by drug injecting –particularly the threat of HIV infection. They have also proved to be effective entry-points to other services, such as help and advice on health care, housing, finance and law. In the broader context of drug use and drug addiction, needle-exchange programmes are only part of the answer to a highly complex problem.

3.“Condoms should be freely available to all, regardless of age.”

In the absence of either a vaccine or cure, condoms have a vital role in the fight against AIDS. When used properly, condoms significantly reduce the risk of transmitting HIV between sexual partners. Nowadays, most societies agree that promotion of condoms is a priority and that they should be made widely available at affordable prices. When it comes to promotion of condoms among young unmarried people, many societies have moral objections and focus their message on sexual abstinence until marriage. Young people need guidance and encouragement to postpone sex. But it would be na�ve and even dangerous to deny that young people are sexually active.

While considering the merits of ‘No sex now!’, they must also learn how to avoid risky sexual behaviour and they must know about condoms and how to use them even before they become sexually involved. It needs to be emphasized that the free availability of condoms will not increase sexual activity among young people.

4.“Prostitution should be banned to prevent the spread of HIV/AIDS.”

First, it has to be remembered that in many countries prostitution is illegal. Nevertheless we cannot deny that prostitution exists everywhere and is a centuries’-old profession. The banning of prostitution would drive commercial sex workers underground and make them inaccessible to health care and prevention programmes. It is obvious that such a policy puts people at an increased risk of becoming infected and would make the AIDS pandemic worse. Commercial sex workers are traditionally very concerned about sex-related health care but are often forced into risky situations. Evaluations from many parts of the world have shown voluntary increases in condom use among prostitutes. The problem is that practising condom use often depends on the prostitutes’ clients. Therefore, according to public health experts, addressing prevention messages to both prostitutes and their clients is a much more effective strategy than any policy to ban prostitution.

5.“An HIV-infected woman should not get pregnant.”

An HIV-positive woman who considers pregnancy needs clear information and appropriate counselling. She must be informed about the chance that the baby will be infected too and that pregnancy may increase the risk of developing AIDS. Some infected women want to have a baby more than ever while they still feel well. Sometimes there is social pressure on women to bear children. Where possible, decisions about avoiding a pregnancy or about preparing for a possibly infected child should involve both parents, and the partner of the HIV-infected woman should be included in counselling sessions. It is recommended that a decision should never be imposed but that women, and their partners, should be advised very clearly about the risk of having an infected baby and should be supported in making their own choice.

6.“Young people should have access to STD/HIV counselling and treatment.”

There is growing evidence that young people are at risk from a number of sexual health problems, such as teenage pregnancy, abortion, infection with HIV and other STD. It should be remembered that about half of all new HIV infections occur in young people aged 15 to 24. To help combat these problems, it is obvious that young people need access to key services such as family planning and STD clinics. All too often, however, young people are unable to benefit from these services. One of the reasons for this may be the judgmental attitude of adults towards adolescents who are sexually active. It is, therefore, urgent to make health services more accessible, affordable and youth-friendly. A major criterion for a youth-friendly service is confidentiality. When discussing this, it should be emphasized that Articles 17 and 24 of the Convention on the Rights of the Child specifically mention that access to information and to health and medical services are basic rights of young people.

What do I have a right to?

Objectives

To identify situations in which basic human rights are violated To explore a person’s own values regarding people with HIV/AIDS

Time

60 minutes

Technique

Brainstorming Group discussion

Materials needed

A flip chart, pen

A large piece of paper on which a list of human rights is written (see page 99) Cards on which case studies are written (see pages 102-103) Enough copies of the sheet with a selection of Rights of the Child (see pages 104-105)

Method

1. Let the group know you are going to talk about AIDS and human rights.

2. Have a brainstorming session on the topic: “Which human rights does everyone have?” List the responses on the flip chart. Ask the group if children have special rights. Can they mention some? Why do children need special rights?








The purpose is not to enumerate a complete list of all human rights. The idea to be stressed is that all human beings are equal in having a number of rights upon which the United Nations agreed. Children, by reason of their special needs and vulnerability, need special protection. Therefore, the Convention of the Rights of the Child was adopted in 1989 by the United Nations. On pages 104-105 you will find a number of these special rights of children that are relevant to HIV/AIDS.


3. Explain that, in the context of HIV/AIDS, some human rights have often been violated. People affected with HIV/AIDS are, for example, often stigmatized or discriminated against. Tell the group that, together, you are going to discuss such violations of human rights. Put a list of the human rights most relevant to HIV/AIDS (see page 99) in a place where the whole group can see it, and put the case-study cards (see pages 102-103) on a table in the middle of the circle of participants. Ask a volunteer to pick up one of the cards and to read the text aloud. Ask the group which of the human right(s) listed is (are) violated in this case. Discuss the responses.

4. Continue with a second case study. When you come to case 5, you may distribute the sheet with a number of children’s rights (pages 104-105) so that participants can have a closer look at the content of the articles.








This sheet only lists articles that are relevant to HIV/AIDS. If you would like to develop more activities with your group on the issue of children’s rights, we recommend the activities outlined in the UNICEF manual It’s only right (see: Resource list). This manual also contains the 54 articles of the full Convention of the Rights of the Child.


5. When all the case studies have been discussed, ask the group to think of what they could do to prevent human rights violations in the context of HIV/AIDS in their community.

Some human rights relevant to HIV/AIDS


The right to non-discrimination and equality before the law

The right to health

The right to privacy

The right to work

The right to social security

The right to equal access to education

The right to marry and have a family

The right to be protected against cruel, inhuman or degrading treatment or punishment

Rights of the Child: e.g., the right to education and to information, the right to protection against economic or sexual exploitation, the right to protection against child labour, the right to protection against separation from parents or the right to the highest standard of health and medical care.



Figure

Facts to emphasize

Case 1

Human rights violated:


The right to marry: This couple’s right to get married has been denied on the basis of the HIV status of one of the partners.

The right to privacy: Strictly private medical information is passed on to members of the community.


Case 2

Human rights violated:


The right to privacy: Jane was tested for HIV without her consent. Furthermore, the test’s result was passed on to third parties in country Y and the University of Z.

The right to education: Jane is refused access to university.


Case 3

Human rights violated:


The right to privacy: The result of an HIV test is passed on to the insurance company.

The right to social security, assistance and welfare: Mr J.K. is denied health insurance and thus reimbursement of his drugs.


Case 4

Human rights violated:


The right to non-discrimination:. A group of people is discriminated against, first, because they are forced to undergo testing (while others are not) and, second, because they are forced to give up their work if they are found to be HIV-positive.

The right to privacy: This is an example of compulsory testing without the consent of the people being tested.

The right to work (although it should be noted that this argument cannot be used in countries where sex work is illegal).









Note that in all the above cases, the right to non-discrimination is violated on the basis of the HIV status of people.


Case 5

The following rights of children are violated:


The right to protection against separation from parents: Wittaya is separated from her parents against her will. The only exception to this right is when competent authorities determine that such a separation is necessary.

The right to be protected against sale, trafficking and abduction: Wittaya is sold to a brothel keeper.

The right to protection against sexual/economic exploitation: Wittaya is forced to work as a prostitute. This is not an exceptional case. Worldwide, more than one million children are compelled to enter the sex trade every year.

The right to be protected against child labour: Even if Wittaya had been employed as a maid, as promised to her parents, this would have been a case of child labour because of Wittaya’s young age.

The right to education: At the age of 12, Wittaya has the right to go to school instead of working. And she also has the right to leisure!

The right to the highest standard of health and medical care: Wittaya was not allowed to see a doctor, although she was ill. Moreover, she is exposed to a high risk of being infected with HIV and other STD.


When talking about testing, it may be useful to explain the different types of testing for HIV:

Compulsory testing

Forcing someone to undergo medical testing of any kind is called compulsory testing. Compulsory testing is always an invasion of privacy, and thus a violation of human rights. Prejudice underlies a demand for compulsory testing of certain groups (such as sex workers, homosexuals, intravenous-drug users or foreign workers): they are seen as the ones ‘responsible’ for AIDS. A dangerous side-effect of such compulsory testing is that people outside the stigmatized ‘tested’ groups think they are not at risk, and so fail to protect themselves and others from infection. Moreover, in order to avoid testing, some people who are at risk of HIV infection go underground. Compulsory testing actually promotes the spread of the virus.

Mandatory testing

Testing is mandatory if people have to be tested before they can participate in a process or activity which is not itself absolutely necessary. For example, if an HIV test is obligatory before travelling to certain foreign countries, it is considered mandatory because no one is obliged to travel, but to do so an HIV test is essential. In mandatory testing, great care must be taken to ensure that people are not in fact ‘forced’ to undergo the test. Mandatory testing makes sense only in certain situations, such as blood donation for transfusion, or semen and organ donation.

Voluntary testing

To be effective, both testing and counselling must be offered, not imposed. When they have been appropriately counselled and tested, people who know their HIV status can seek health care and also help others to stay uninfected. Studies show that voluntary testing and counselling, particularly of couples, can help reduce HIV risk behaviour.

Case studies







Case 1


Rajesh, 21 years old, has just completed his studies and has asked his long-time girlfriend Aarathi to marry him. She has accepted. Rajesh is HIV-positive and Aarathi is aware of this. As is the procedure in their culture before a wedding can take place, the uncles have to consent. A month before the wedding, one of Aarathi’s uncles, a medical doctor, informs her family that Rajesh once donated his blood and it was found to be HIV-positive. Therefore, Rajesh cannot marry his niece. Both Rajesh and Aarathi are devastated by the fact that her uncle has told most of the community about Rajesh’s HIV status, and also that he has withheld his consent for their marriage









Case 2


Jane, a 17-year-old student has been awarded a scholarship to go and study law in country Y at the University of Z. She is very excited about this opportunity. She informs her family and her friends. Two weeks before she leaves, Jane’s sponsor tells her that the university wants her to have a medical test at a specified clinic. At the clinic, blood and urine samples are taken. Jane is not informed about the type of tests that are being conducted. A few days later, Jane receives a letter that her scholarship has been cancelled because the tests show that she is HIV-positive and country Y does not grant visas to people with HIV. Also, the University of Z does not enrol students who are HIV-positive









Case 3


Mr J.K. is 37 years old and works in a bank. He has been seropositive for several years. As his health deteriorates, his doctor prescribes a treatment using a combination of several drugs. The bank has a health insurance programme for its employees. Even though Mr J.K. paid into the programme long before he discovered his HIV infection, the insurance company refuses to reimburse his drugs. Because of his HIV-positive status, they even threaten to cancel his insurance contract









Case 4


To reduce the rate of HIV infections, the local authorities have decided that all commercial sex workers of the city will be tested for HIV without prior, informed consent. Sex workers found to be infected would be prohibited from continuing their work








Case 5

Wittaya grew up in a poor village in northern Thailand. A year ago, when she was 12 years old, a man promised her parents that he could find a job for her as a maid in a family in Bangkok. In fact, Wittaya was sold to a brothel keeper and forced into prostitution. She is never allowed to leave the brothel and she has had no contact with her family since she left the village. A few weeks ago, Wittaya had a high fever, but the brothel keeper only gave her some medicine and didn’t consult a doctor



These are only some of your rights.... (....you have many more!)


These are only some of your rights.... (....you have many more!) (cont)


Note: The articles described here are unofficial summaries of the main provisions in the Convention on the Rights of the Child.
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