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close this bookSchool Health Education to Prevent AIDS and Sexually Transmitted Diseases (STD) : Handbook for Curriculum Planners (UNESCO - WHO, 1994, 88 p.)
close this folderA. Designing the programme
View the document(introduction...)
View the documentIntroduction
View the documentProgramme model
View the documentMaking a situation assessment
View the documentDefining the type of programme
View the documentSelecting objectives
View the documentMaking a curriculum plan
View the documentPlanning for material production
View the documentDeveloping the students’ activities
View the documentParticipation of parents and family members
View the documentInvolvement of peer leaders
View the documentDeveloping the teachers’ guide
View the documentValidating the curriculum
View the documentPlanning for teacher training
View the documentDesigning the programme evaluation

Programme model

Many programmes for the prevention of AIDS and other STD focus only on bio-medical information such as the virus that causes AIDS, the immune system, signs and symptoms of AIDS, treatment. It is now well known that this type of knowledge is not enough to convince young people to adopt positive, healthy behaviours that prevent HIV/AIDS/STD. They need the motivation to act and the skills to translate knowledge into practice.1

1 School Health Education to Prevent AIDS and STD

Infection with HIV and STD occurs in specific risk situations or scenarios: a girl is pressured into having sex with her boyfriend or an older man; a syringe with drugs is offered to a friend; friends pressure a boy to join them for a night out with bar girls. Young people in these situations need to have knowledge and skills to make healthy responses... how to say “no”, how to propose alternatives, how to evaluate risks. If they receive only information on the immune system in their AIDS course, they will be poorly prepared to deal with real-life situations. Remember:

“The goal of AIDS/STD education is to promote behaviour that prevents the transmission of HIV/STD” and not merely to increase knowledge about AIDS.

A programme on HIV/AIDS/STD should increase knowledge, develop skills, promote positive and responsible attitudes, and provide motivational supports.

· Knowledge

Information that will help students decide what behaviours are healthy and responsible includes: ways HIV/STD are transmitted and not transmitted; the long asymptomatic period of HIV; personal vulnerability to HIV/STD; means of protection from HIV/STD; sources of help, if needed; and how to care for people in the family who have AIDS.

· Skill development

The skills relevant to HIV/AIDS preventive behaviours are: self-awareness; decision making; assertiveness to resist pressure to use drugs or to have sex; negotiation skills to ensure safer sex; and practical skills for effective condom use. These skills are best taught through rehearsal or role-play of real-life situations that might put young people at risk for HIV/STD.

· Attitudes

Attitudes derive from beliefs, feelings and values. HIV/AIDS/STD education should promote: positive attitudes towards delaying sex; personal responsibility; condoms as a means of protection; confronting prejudice; being supportive, tolerant and compassionate towards people with HIV and AIDS; and sensible attitudes about drug use, multiple partners and violent and abusive relationships.

· Motivational supports

Even a well-informed and skilled person needs to be motivated to initiate and maintain safe practices. A realistic perception of the student’s own risk and of the benefits of adopting preventive behaviour is closely related to motivation. Peer reinforcement and support for healthy actions is crucial, as peer norms are powerful motivators of young people’s behaviour. Programmes that use peer leaders are effective because peers are likely to be more familiar with youth language and culture. Parents and family members can also motivate and reinforce the objectives of the programme and should be encouraged to play a part in their child’s sexuality education.

Remembering that responsible behaviour is the key to prevention, the following 11 objectives are considered as a minimal requirement for any effective programme on HIV/AIDS/STD.

At the end of the programme, students will be able to:

1. Differentiate between HIV, AIDS, STD
2. Identify ways in which HIV can be transmitted
3. Identify ways in which HIV/STD are not transmitted
4. Rank methods of HIV/STD prevention for effectiveness
5. Identify sources of help in the community
6. Discuss reasons for delaying sexual intercourse
7. Respond assertively to pressures for sexual intercourse
8. Discuss reasons and methods for having protected sex if/when sexually active
9. Respond assertively to pressures for unprotected sex
10. Identify ways of showing compassion and solidarity towards people with HIV/AIDS
11. Care for people with AIDS in the family and community.

The programme units

The programme proposed in this package consists of four units, for which a number of classroom activities (with related teacher guides for each activity) are offered. The units are designed for different levels of knowledge, attitude, skill and motivation development.

Unit 1 - Basic knowledge of HIV/AIDS/STD

The major emphasis in this unit is on: what are HIV, AIDS, and STD; transmission; protection; and sources of help. Approximately 25% of the total classroom time should be devoted to this unit. The unit covers objectives 1 to 5.

Unit 2 - Responsible behaviour: delaying sex

Students, particularly at early ages, should be encouraged not to have sexual intercourse. Delaying sex to an older age usually results in more mature decisions about contraception and protected sex. Students need to discuss the reasons for delaying sexual intercourse, and learn how to resist pressures for unwanted sex. Assertive communication skills should be learned through role-play of real-life situations that young people may encounter. They may also learn that affection can be shown in ways other than sexual intercourse. Objectives 6 and 7 are covered in this unit.

Unit 3 - Responsible behaviour: protected sex

Some, perhaps many students may already be sexually active at the time they learn about AIDS in this programme. Others will need to know how to protect themselves in the future, when they will be sexually active. Using a condom every time one has sexual intercourse is a very effective way to avoid infection with HIV/STD. Teaching students about contraception and condoms does not mean encouraging them to have sex; young people are exposed to information about condoms through a variety of sources (friends, media, condoms displayed in shops, etc.), and need to have information and skills on how to use them correctly. Objectives 8 and 9 are covered in this unit.

Units 2 and 3 on responsible behaviour should take approximately 50% of the total classroom time given to the HIV/AIDS/STD programme. This is because these two units are mostly concerned with developing skills, and this takes up more classroom time than learning facts.


Figure

Unit 4 - Care and support for people with HIV/AIDS

Many young people will come in contact with people with HIV and AIDS, perhaps in their own family or community. They need to learn tolerance, compassion and ways to care for and support them. Planners need to remember that people with AIDS may spend time in the hospital for treatment of acute conditions, but they are likely to live at home most of the time. Unit 4 covers objectives 10 and 11 and should take approximately 25% of the total classroom time allotted for the programme.

For each unit, a number of student activities are proposed. Curriculum planners will select those most relevant, and adapt them to local requirements. Here is an overview of the activities proposed.

Unit 1 - Basic knowledge on HIV/AIDS/STD

Activity

Rationale

Description

1. HIV/AIDS/STD basic questions and answers

Basic information about HIV/AIDS/STD is essential to understand other concepts of the programme.

Informational (illustrated). A number of young people ask questions about HIV/AIDS/STD. The answers are given in “bubble” blocks.

2. Looking into AIDS

A pre-test to determine student knowledge is useful to both students and teachers.

Participatory. A short true-false test with a category rating scale at the end. Can stand independently or as a follow-up to Activity 1.

3. HIV/AIDS/STD What do they mean?

Students learn definitions best when they can relate personally to the situation. A personal story illustrating the definitions is an effective learning tool.

Participatory. Students take definitions from a “Grab Bag” and place them in the correct box. A story illustrates the definitions.

4. How a person gets HIV

Information on how the AIDS virus (HIV) is transmitted is essential to protection.

Informational. Three ways of acquiring HIV are described; the information is well illustrated.

5. You can’t get AIDS by...

As well as knowing how HIV is transmitted, it is important to know how it is not acquired. This reduces irrational fears about the disease.

Informational with some participation. Students are asked to identify pictures of how HIV is not transmitted.

6. What do you believe?

This short test is an effective way of learning about the spread and non-spread of HIV, and provides rapid feedback to the students.

Participatory. A true-false test of 20 questions allows students to test their knowledge on transmission.

7. What would you do?

Stories about people’s lifestyles, their risk of HIV and what they can do to prevent the spread, is an effective way to make risk situations realistic.

Participatory. Three stories followed by questions and a risk continuum encourage students to look at transmission from a realistic perspective.

8. What is your risk?

Students become more familiar with risk behaviours by classifying them as No Risk; Low Risk; High Risk. They also need to evaluate their personal level of susceptibility based on their own risk behaviours.

Participatory. Students evaluate 16 different behaviours and classify them as No Risk; Low Risk; High Risk. They also assess their own vulnerability on a scale of 1 to 10.

9. Are you at risk?

Similar to activity 8 but adds the element of multiple risk behaviours.

Participatory (small groups). Part 1 is similar to activity 8 but involves 36 different behaviours (6 per group). Part 2 portrays four different life-styles each with multiple risk behaviours that are rated from highest risk to lowest risk. Part 3 asks students to assess their personal vulnerability to HIV/AIDS/STD.

10. Protect yourself against AIDS

Students need to learn about specific means of protection.

Informational. Outlines four methods of protection from HIV/AIDS/STD in a visual presentation.

11. Dear Doctor Sue

Doctors are effective agents for conveying information about protection because of their high credibility with young people. Dear Dr. Sue letters are motivational devices for conveying this information.

Participatory. Three letters involving protection are presented. Students use the “Doctor’s Bag” to get help in answering the letters.

12. Which is safer?

Students need to know the different ways of protecting themselves but they also need to know that some methods are better than others.

Participatory. Six patterns of sexual behaviour are presented and students are asked to rank them from most safe to least safe. They are to list problems with the methods that might cause a person to get HIV

13. What happens with HIV infection?

Students learn: the window period; time from infection to AIDS; AIDS to death; signs and symptoms; and infectivity.

Informational (graphically with illustrations). Outlines signs and symptoms and progression of HIV to death.

14. How do you know if you have HIV/AIDS?

It is important to know that a person with HIV:

- may have no signs or symptoms for a long time
- can infect others during this time

- gradually gets sicker and sicker and eventually dies.

Participatory. Involves three stories of people with HIV and/or AIDS. Asks specific questions about each story.

15. Testing for HIV

Basic information with regard to testing is needed by some students.

Informational. A student asks a doctor basic questions on testing. A “bubble” illustration is used to give the questions and receive the answers.

16. Test: what you know about testing

To recall information and understand concepts about testing, a “matching” test is provided.

Participatory. A matching test of 10 items and a category rating scale for correct answers help students understand concepts of testing.

17. AIDS help Who? Where?

Information on help sources for HIV/AIDS/STD is essential to this programme. Some students develop AFRAIDS (Acute Fear Regarding AIDS) and need help or counselling.

Participatory. Four different situations are presented through short case studies. Students are asked what type of help is needed and where they might find that in their community.

18. You be the doctor

Information about the following topics is important:

- drug use and impairment of judgement
- abstaining from drug needle use
- clean needle use for injecting drugs

- method of sterilizing unclean needles.

Participatory. Four situations involving drug or needle use are presented. Students are asked to give advice from the doctor’s kit and provide reasons for that advice.

19. Are you a responsible person?

As a summary to this unit, students are asked a number of behaviour and behavioural intent questions. Behavioural intent indications may be good indicators of behaviour.

Participatory. Twelve behaviour and behavioural intent questions are asked and students respond with “yes”, “no” and “not sure”. A score is provided at the end to determine their personal degree of responsibility.

Unit 2 - Responsible behaviour - delaying sex (abstinence)

Activity

Rationale

Description

1. Reasons to say NO

It is important to stress that there are a variety of reasons for delaying sex.

Informational (illustrated). 10 reasons for delaying sex are given. Students participate by providing the four most common reasons for young people to delay sex.

2. To delay or not to delay

Students need an opportunity to explore reasons for not having sex, and reasons why some people choose to have sex.

Participatory. An open-ended story is presented in which students explain the reasons given for having sex. Students then choose three reasons (from 10) for the male to say “no” and three for the female to say “no”.

3. “Lines” and more “lines”

Students need practice in responding to typical lines that are used to pressure individuals to have sex.

Participatory. Ten lines are given and students respond with the most appropriate response from a list of 14.

4. Guidelines: help to delay sex

Students need to know that they are not alone in delaying sex. They also need help in their decision to delay sex.

Informational (illustrated). 14 suggestions are given to help students maintain their decision to delay sex. Students are asked to indicate which ones would be easy or difficult for them.

5. What to do?

Students need practice in using “the guidelines” for delaying sex with real-life examples.

Participatory. Three case studies are provided and students are asked to give advice that would help each person to delay sex.

6. Affection without sex?

It is unreasonable to expect young people not to show affection during this stage of their lives. It is important to provide suggestions for alternative ways of showing affection for those who wish to delay sex.

Informational/participatory. Two hearts provide spaces for young people to explore additional ways (some are provided for them) to be affectionate without having sex.

7. What’s next?

Physical affection can be very sexually arousing. The more sexually arousing the activity is, the more likely it will eventually lead to sex. Establishing limits and knowing when to express these limits is very important for young people.

Participatory. Students are asked to rank seven physical behaviours from least to most physical. Questions are asked about limits - who; where; when.

8. Am I assertive?

Definitions of assertive, passive and aggressive behaviours are necessary to understand the verbal and non-verbal aspects of being an assertive person.

Informational (illustrated). Three people display the verbal and non-verbal characteristics of being assertive, passive and aggressive.

9. Who’s assertive?

Recognizing assertive, passive and aggressive behaviours in real-life is necessary for a person who wants to be assertive.

Participatory. Two stories provide opportunities for students to identify the different types of behaviour.

10. Assertive messages

Students must learn specific steps to being assertive and practise those through behavioural rehearsal with actual situations involving HIV/AIDS/STD.

Informational (illustrated). A four-step approach to being assertive is demonstrated by means of a short case study.

11. Your assertive message (class)

An example of an assertive message developed by the whole class, makes it easier for individual students to develop their own message.

Participatory. Another case study is used to encourage the class to suggest an assertive message using the four-step approach.

12. Your assertive message (individual)

Students must be provided with an opportunity to develop their own message.

Participatory. A choice of three case studies is provided for each student to develop a personal assertive message, using the four-step approach.

13. Responding to persuasion (demonstration)

It is extremely important that students learn to deal with people who try to distract or pressure them by persuasion to do something they think they should not do.

Informational. Ideas are given, first to deal with those who distract you from an assertive message and second, to handle those who pressure a person to do something they do not want to do.

14. Responding to persuasion (class activity)

An example of returning to your message following a distraction and dealing with persuasion makes it easier for students to learn to deal with these problems when they develop their own strategies.

Participatory. Students learn, as a class, to return to their message if distracted. They also learn to delay, bargain or refuse if another person tries to get them to do something they do not want to do.

15. Responding to persuasion (individual)

Students learn how to deal with distracting statements and how to be assertive when someone is pressuring them to do something they do not want to do.

Participatory. Students provide their own message for distracting and persuasive statements made by another person.

16. You decide

Young men and boys often have different ideas about delaying sex from young women and girls. Most of these ideas need to be explored and some of them need to be changed.

Participatory. Students are asked to respond with true or false to a number of statements dealing with gender differences. They are then asked whether these differences are right or wrong. Finally, they are asked to restate the differences in a positive way.

17. Dealing with threats and violence

Women need to be aware of situations that may lead to violent sex and of individuals who may put them in such situations. They also need to learn ways of avoiding or dealing with pressures and threats to have sex.

Participatory. A case study with questions allows students to explore the many problems that may arise, and some possible solutions, when a person insists on maintaining abstinence in the face of violence and threats.

18. Being assertive every day

Students need to practise assertive skills that have been developed in the classroom in everyday life.

Participatory. Students are asked to develop a plan for being assertive outside the classroom. The plan (life management skills) involves setting goals, time lines, benefits and rewards and contract signing. They are asked to make notes on their thoughts and feelings about the activity.

Unit 3 - Responsible behaviour - protected sex

Activity

Rationale

Description

1. The condom

Information about condoms is necessary for effective use.

Informational: (illustrated) Provides essential information about condoms and condom use.

2. Arguments people use against using condoms

Although one partner may have developed positive attitudes toward condom use, they may have to deal with a partner who has negative attitudes towards condoms.

Participatory: Three responses are offered to each of 10 negative arguments about condom use. Students must select the best response for each argument.

3. How to use a condom (explanation/demonstration)

One of the most important factors in condom failure is inexperience with its proper use. Therefore, an understanding of effective use of a condom is essential.

Informational (illustrated): A humorous but informational illustration of the proper steps in condom use is presented to the students.

4. Condom practice

The use of a model penis or other types of models to practise using a condom properly is an important activity for young people. Those who feel confident about using a condom, without appearing foolish are more likely to buy and use a condom.

Participatory (in small groups): A model penis and enough condoms for each student in the group are distributed. Using a “task card”, students who wish to, follow the steps for proper condom use on the model.

5. No to unprotected sex (demonstration)

Using the skills learned in Unit 2 on assertive behaviour, students need to practise assertive messages to a partner who does not want to use a condom or doesn’t have one to use.

Informational (illustrated): Students are shown the assertive steps of delay, bargain and refuse when a partner refuses to use a condom or persuades someone to have sex without one.

6. No to unprotected sex (class participation)

Same as Activity 5

Participation (class): the whole class participates in delay, bargain and refusal messages for a situation where a partner is embarrassed to use a condom.

7. No to unprotected sex (individual participation)

Same as Activity 5

Participation (individual): Each person develops an assertive message with delay, bargain and refusal messages for a situation where a partner does not have a condom but wants to have sex.

Unit 4 - Care and support

Activity

Rationale

Description

1. Who discriminates?

People who are HIV positive or are living with AIDS are in many cases subject to discrimination. Young people need to be aware of discrimination and how it is expressed.

Informational/Participatory. A definition of discrimination is provided and students must provide answers to unfinished statements about discriminatory actions toward people with AIDS.

2. The story of two communities

It is important to feel what it is like to be discriminated against. This can be accomplished partially by reflecting on comments made by a person living with AIDS.

Participatory. Presents the experience of a young person living with AIDS in a very prejudiced and discriminatory community, and in a very tolerant and helpful community. Students are asked to select comments that are most hurtful and those that are most helpful.

3. Why compassion?

People who have compassion towards themselves and others are very much needed in this society. Recognizing the value of compassion is an important beginning.

Participatory. Students are asked to add to three reasons for compassion. They are then asked to discuss questions on compassion.

4. What could you do?

Students need to know ways to be compassionate and when and how to intervene.

Participatory. Students are asked to choose from a list of ways to show compassion, those that they could use to show compassion to two people - a mother with AIDS and Dwari - a schoolmate.

5. How to’s of care giving

Students may have a person with AIDS in the family or neighbourhood. It is important that they know the basic norms of hygiene and home care, and that they learn ways of helping the person to cope.

Informational (illustrated). Two concepts are developed on how to provide emotional and physical care for a person with AIDS.

6. How to keep yourself safe

If you are providing care for a person with AIDS, you need to know how to care for and protect yourself.

Informational. A number of ways to protect yourself, medically and emotionally, are demonstrated in this activity.

7. What do you know?

It is useful to review information that is received passively for recall and understanding.

Participatory. A matching and a true-false test provide students with an opportunity to review information from activity 5.

8. Support for responsible behaviour

It is important to encourage young people to support peers who value abstinence or those who have made the decision to use safer sex practices (i.e. condoms) or who have shown tolerance and compassion to a person living with AIDS.

Participatory. A number of scenarios provide opportunities to support those people who have made the decision to adopt responsible, tolerant and caring behaviours.

9. Compassion, tolerance, and support

Compassion, tolerance and support mean little to young people unless they are given the opportunity to practise these behaviours in everyday situations.

Participatory. Students select from a list they have made, a situation where they can show compassion, tolerance or support. They write an action plan and journal on what happened and how they felt about the experience.

The following are the main steps in developing a curriculum for HIV/AIDS/STD education:

1. Making a situation assessment
2. Defining the type of programme
3. Selecting objectives
4. Making a curriculum plan
5. Planning for material production
6. Developing students’ activities
7. Developing the teachers’ guide
8. Validating the curriculum
9. Planning for teacher training
10. Designing the programme’s evaluation.

Participation of parents and families in a HIV/AIDS/STD school programme, and involving peer leaders, are issues to be considered in the design of a curriculum.