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close this bookSchool Health Education to Prevent AIDS and Sexually Transmitted Diseases (STD) : Teachers' Guide (UNESCO - WHO, 1994, 117 p.)
View the document(introduction...)
View the documentAcknowledgments
View the documentIntroduction
View the document1. The programme
View the document2. Teaching methods
View the document3. The classroom atmosphere
View the document4. Peer leaders
View the document5. Participation of parents and family members
View the document6. Test items for student evaluation
View the document7. Questions on HIV/AIDS/STD
Open this folder and view contentsUnit 1. Basic knowledge on HIV/AIDS/STD
Open this folder and view contentsUnit 2. Responsible behaviour: delaying sex
Open this folder and view contentsUnit 3. Responsible behaviour: protected sex
Open this folder and view contentsUnit 4. Care and support
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7. Questions on HIV/AIDS/STD


Figure

1. What is AIDS?

- AIDS stands for Acquired (not inborn, passed from person to person, including from mother to baby); Immune (relating to the body’s immune system, which provides protection from disease-causing germs); Deficiency (lack of response by the immune system to germs); Syndrome (a number of signs and symptoms indicating a particular disease or condition).

- AIDS is caused by a virus, called HIV (human immunodeficiency virus) which attacks and, over time, destroys the body’s immune system.

- A person has AIDS when the virus has done enough damage to the immune system to allow infections and cancers to develop.

- These infections, cancers etc. make the person ill and lead to his/her death. At present, there is no vaccine or cure for AIDS.

2. What do we know about HIV?

- HIV, like other viruses, is very small, too small to be seen with an ordinary microscope. Viruses cause all sorts of diseases from flu (influenza) to herpes to some kinds of cancer.

- To reproduce, HIV must enter a body cell which in this case is an immune cell. By interfering with the cells that protect us against infection, HIV leaves the body poorly protected against the particular types of diseases which these cells normally deal with.

- Infections that develop because HIV has weakened the immune system are called “opportunistic infections”. These include: respiratory infections e.g. tuberculosis; Pneumocystis carinii pneumonia; gastro-intestinal infections e.g. candidiasis in the mouth or diarrhoea; and brain infections e.g. toxoplasmosis or cryptococcal meningitis.

- Some people may also develop cancers, e.g. Kaposi sarcoma, a cancer which often causes red skin lesions.

3. What is an STD?

- STD stands for sexually transmitted disease or diseases. Many different STD have been identified. The most common STD include: gonorrhoea, chlamydia, syphilis, trichomonas, genital warts, chancroid, genital herpes, hepatitis B and HIV infection.

- STD are caused by viruses, bacteria, and parasites. Viruses cause a number of STD, including genital warts, hepatitis B and genital herpes. Bacteria cause STD such as gonorrhoea and syphilis. Scabies, trichomonas and pubic lice are parasite STD.

- Most STD can be cured.

- Certain STD infections, if not treated soon enough, can lead to long-lasting health problems in both males and females, e.g. damage to the reproductive organs so that a woman is no longer able to have children, cancer of the cervix, heart and brain damage, and possibly death.

- In many STD, the early symptoms are often difficult to recognize, and many people ignore them until more severe damage is done. This is especially true for women. This makes early diagnosis and treatment difficult.

- An abnormal discharge from the penis, anus or vagina; burning on urination; pain in the abdominal or groin area with a fever; pain during sex; and rashes, blisters or sores on the genitals, are all possible symptoms of STD. If a person experiences any of the above symptoms, they should stop having sexual intercourse and go to a clinic or hospital for a check-up.

4. What are antibodies?

- The body’s defense system (immune system) develops germ fighters, called antibodies to fight off and destroy various viruses and germs that invade the body.

- The presence of particular antibodies in a person’s blood indicates that the person has been exposed to that infection. For example, when a blood test reveals that the antibodies to HIV are present in the blood, it means that the person is infected with HIV.

5. What is the “window” period?

- This is the time that the body takes to produce measurable amounts of antibodies after infection. For HIV, this period is usually 2-12 weeks; in rare instances it may be longer.

- This means that if an HIV antibody test is taken during the “window” period it will be negative since the blood test is looking for antibodies that have not yet developed. But that person is already HIV-infected and can transmit HIV to others.

- People taking the test are advised, if the result is negative, to return for a re-test in 3 months by which time if the person had been infected, the antibodies are almost certain to have developed (they should avoid risk behaviours during the 3 months).

- The most common test for HIV/antibodies is called the ELISA test.

6. What does the asymptomatic period mean?

- The asymptomatic period is the period of time between infection and the beginning of signs and symptoms related to AIDS.

- This varies from person to person for HIV/AIDS. It may be as short as 6 months or as long as 10 years or more.

- People usually have an asymptomatic period of several years in which they may have swollen lymph nodes but no other complaints. Then, they may start to develop symptoms like oral thrush or night sweats. It may then still take years before they develop full-blown AIDS. The period between the development of full-blown AIDS and death may be as short as 6 months or as long as 2 years or more.

- During the asymptomatic period there may be no evidence that the person is sick; however, HIV-related illnesses can occur regularly over many months or years before full-blown AIDS develops.

- During the asymptomatic period (as well as during the symptomatic period), the person is infectious - that is, can pass HIV on to others.

7. What are the symptoms of AIDS?

- This question must be approached with caution in any specific case, since it is often difficult to determine if the symptoms actually mean onset of AIDS or if they are simply symptoms of other conditions. People develop signs and symptoms of their HIV infection before they develop what has been defined as AIDS. AIDS is the final and most severe phase of HIV infection and leads to death.

- The obvious signs and symptoms are indications of an opportunistic disease such as tuberculosis or pneumonia. However, associated findings might include: recent, unexplained weight loss; fever for more than one month; diarrhoea for more than one month; genital or anal ulcers for more than one month; cough for more than one month; nerve complaints; enlarged lymph nodes; skin infections that are severe or recur.

8. Are there drugs and vaccines to treat AIDS?

- There are drugs that are effective against many of the infections associated with AIDS. These drugs are not a cure for AIDS but they can postpone symptoms or death.

- A few drugs have been able to inhibit the multiplication of HIV in infected persons. These drugs do not eliminate the virus from the body but may be useful in prolonging life in patients who are infected with HIV.

- To date, there is some optimism over the development of a vaccine to protect against the disease. Part of the difficulty is that there are many strains of HIV. Even within the same person the virus can change over time. Work is proceeding on this, but safe, effective vaccines are likely to take many years to develop.

9. How do you get HIV?

- HIV can be found in body fluids like blood, semen, vaginal fluids, and breast milk.

- Any practice which allows the penetration of the virus from these fluids through the skin or mucous membranes and into the bloodstream of another person can cause HIV infection.

- The skin normally is a barrier to this type of penetration, but this barrier can be broken. Breaks in the skin include such minor things as cuts, abrasions, sores and ulcers.

HIV is transmitted from person to person in 3 major ways:

i) When semen or vaginal fluid from an infected person comes in contact with the mucous lining (membranes) of the vagina, penis or rectum and the virus moves into the bloodstream.
ii) When the skin is penetrated by a needle, or other skin-piercing instruments (e.g. razor or tattooing instrument), and that instrument has blood on it from an HIV-infected person. Sharing the same syringe and needle among injecting drug users is particularly risky for transmission. Any unsterile syringes and needles can transmit infection.
iii) HIV may also be transmitted from an infected mother to her baby, either through the placenta before birth, during birth, or, in some cases, through breast milk after birth.

Note that:

- For medical reasons, it may be important for a person to receive a blood transfusion. If the blood donor is HIV-infected, there is a high chance that the virus would be transmitted through the blood. However, most countries now test donated blood for HIV and the chance of being infected in this way is very small.

- Deep wet kissing has a very low risk of transmitting HIV. However, there is a slight risk if there are cuts or abrasions in the mouth.

- Although the risk of infection is very low, it is advisable not to share toothbrushes.

10. How you don’t get HIV

- HIV is not transmitted by touch, coughing and sneezing, cutlery, glasses, cups and food, swimming pools, towels, toilet seats, pets, mosquitoes and other insects, baths or showers.

- Nurses, and other health service staff, who come in close contact with patients’ body fluids, are trained to take precautions as part of the hospital routine.

11. How can one avoid infection?

- A person who does not engage in sexual intercourse and does not inject drugs (or who uses clean, sterile needles/syringes for such injections) has almost no chance of contracting HIV or other STD.

- Being married or not having sex before marriage cannot by themselves protect against HIV. Many people have believed this and have been infected by their partners. (This is especially true for many women for whom the only risk factor was having sex with their husband/partner.)

- People who are mutually faithful (i.e. they only have sex with each other) are not at risk of HIV/STD by sexual means provided that both are HIV-negative at the start of their relationship and that neither gets infected through blood (transfusion, injecting drugs with unclean needle/syringe).

- People who use a condom correctly every time they have sex protect themselves from HIV/STD infection.

- Washing after sexual intercourse does not help to prevent HIV infection.

12. Do sexually transmitted diseases increase your chance of getting HIV?

- There is strong evidence that other sexually transmitted diseases put a person at a greater risk of getting and transmitting HIV. This may occur because of sores and breaks in the skin or mucous membranes that often occur with STD.

- If you suspect you may have acquired or been exposed to an STD, you should seek medical advice.

- A person who has an STD should be aware that if they are having unprotected sexual intercourse, they are at an even higher risk of getting HIV.

13. What do “safe sex” and “protected sex” mean?

Because of the risk of HIV/AIDS, it is necessary to be very clear about the sexual practices which are known to carry a risk of HIV transmission and those which do not.

A) Safe sex activities (no risk)

- Practising the following activities will prevent a partner’s blood, semen or vaginal secretions from getting into contact with your blood and thereby prevents transmission of HIV: masturbation, massage, rubbing, hugging, touching genitals.

B) Low-risk sex activities

- Using a condom correctly and consistently during sexual intercourse, will reduce the risk of infection with HIV and other STD, Latex condoms have been demonstrated to be an effective protection against HIV, STD, as well as pregnancy. Incorrect use of condoms reduces their effectiveness, e.g. they may break. Sexual intercourse with a condom is called “protected sex”.

- While only a small number of people have contracted HIV through these means, the following activities are considered to carry some risk:


· fellatio (mouth on penis without taking semen into the mouth);
· cunnilingus (mouth on vagina);
· anilingus (mouth on anus); and
· deep wet kissing.

C) Unsafe sexual activities

- Practising the following activities is a definite risk:


· anal sex (penis in rectum) without a condom;
· vaginal sex (penis in vagina) without a condom;
· any sex act that makes you bleed;
· semen (or blood) taken into the mouth during oral-genital sex.

14. What is affection without sex (non-penetrative sex)?

There are many ways of showing affection and enjoying sexual pleasure like touching, massage, mutual masturbation. In many cultures, penetration is regarded as the only way of having sex. However, alternatives to penetrative sex are often enjoyed by women and men alike.

15. Do some people have a high likelihood of getting HIV?

Yes. It depends on a person’s behaviour. Some behaviours/activities carry a higher risk of getting HIV than others. These include:

- Having many different sexual partners.

- Practising unsafe sexual activities, e.g. have sexual intercourse without a condom (see above).

- Having sex when you have other sexually transmitted diseases.

- Sharing needles and syringes for injecting drug use.


Some situations which are beyond an individual’s control can put them at risk. These include:

- Receiving injections with needles that are not cleaned or sterilized properly.

- Receiving blood transfusions with blood that has not been tested.

16. Are men and women equally vulnerable physiologically to HIV infection?

Women are slightly more vulnerable physiologically to HIV infection than men. The area of mucous membrane exposed during intercourse is much larger in the woman than in the man, and the mucous membrane surface of the vagina (compared to the penis) can more easily be penetrated by virus. Very young women are more vulnerable than women in the 18-45 year age group; their immature cervix and relatively low vaginal mucus production present less of a barrier to HIV. Women are becoming infected at younger ages than men. This is partly because many young women marry or have sex with men older than themselves, who have already had a number of partners, and partly because of their biological vulnerability.

17. Do you have to have many sexual partners to get infected with HIV/STD?

Even one contact with a person infected with HIV is enough to transmit the infection. However, the risk of getting infected with HIV increases with the number of sexual partners and the number of sexual acts. The presence of an STD (e.g. genital ulcers) in a sexual partner increases the risk of transmission of HIV.

18. Questions on transmission:

a) Is HIV spread by prostitutes and their clients?

Prostitutes and their clients, like any other people with many sexual partners, run the risk of getting infected by their partners. They may then pass the infection to many others. If a prostitute insists on using a condom every time she or he has sex, the risk of infection for her and the partner will be sharply reduced. Many prostitutes have replaced penetrative sex with safer practices, further reducing the risk of infection. Unfortunately clients often refuse to wear condoms and the women are not in a position to insist.

b) If a woman is menstruating is there a greater risk of getting infected with HIV (for her partner and for herself)?

Menstrual blood from HIV-infected women does contain the virus. Infection would be dependent on whether the menstrual blood had contact with the sexual partner’s bloodstream. A woman who is menstruating is likely to be at a higher risk for HIV through sexual intercourse.

c) Can you get infected by blood transfusion or by blood products?

Recommended standard practice for all transfusion services is to test and exclude from use all blood and blood products that are “seropositive” i.e. contain antibodies to HIV. In most countries, efforts have been made to test all blood donations for HIV/since 1985.

There is a very small chance that an occasional transfusion may contain the virus since an HIV-infected donor might have been in the “window” period (test negative) when giving blood.

You cannot get HIV from donating blood.

d) What happens to a baby born to a woman with HIV infection?

- The baby may be born infected with the virus. An infected mother can also pass the infection to her baby during breast-feeding after childbirth.

- About 20-40 percent of babies born to infected mothers will acquire the HIV virus. Some of those will develop AIDS during the first year of life. The majority of HIV-infected babies will not survive to their second birthday. However, some may survive up to 7 years or even longer.

- It serves little purpose to test babies born to HIV-infected mothers for HIV antibodies at birth. There are likely to be many false positive results because antibodies from the mother are still circulating in the baby’s bloodstream. Only at 18 months or older, can an antibody test result be regarded as reliable.


e) Does breast-feeding transmit HIV?

Breast milk of an HIV-infected mother contains HIV which can be transmitted to the baby. However, because of the benefits of breast-feeding, the World Health Organization recommends that in situations where infectious disease and malnutrition are the main cause of infant deaths, and the infant mortality rate is high, mothers should breast-feed their babies, even if they are known to be infected with HIV, as the risk to the baby is less than the risks involved in artificial feeding.

19. Can needles, knives and other instruments transmit HIV?

Yes. Any instruments that cut the skin or puncture the skin can collect small amounts of blood that can be passed on if used again by another person without being sterilized. Avoid tattooing, ear piercing, acupuncture, blood-letting ceremonies or sharing razors unless you are absolutely sure the instruments being used are sterilized or boiled in water.

20. How is HIV transmitted with injection needles and syringes?

- Small amounts of blood remain in the needle and syringe after use. If someone else then uses that needle and syringe, any blood left in the syringe or needle will be injected into their bloodstream. If the first user was infected with HIV, then the second person may now also be infected.

- Only a very small amount of blood is needed for transmission to occur. Sharing needles and syringes used for anything - medicines or heroin, cocaine, amphetamines {speed} and even water can spread HIV. It is not what is put into the syringe that transmits HIV, but the blood that remains in the needle and syringe.

- Some countries have needle and syringe exchange programmes (used needles and syringes are exchanged for new ones) for injecting drug users. Those who cannot stop injecting drugs can join these programmes to avoid HIV transmission.

- If people are not in a position to use a new needle and syringe, the equipment can be boiled or, if boiling is not possible, cleaned in the following way:


· Rinse the syringe out with clean, cold water at least twice (not hot water). Squirt the used water down the drain.

· Rinse the syringe out at least twice with fresh, household bleach, squirting the used bleach down the drain.

· Rinse it out again, at least twice with clean, cold water to get rid of the bleach.


- Be extremely careful if you come across a needle or syringe in a park or street. Dispose of it safely without touching it with unprotected fingers.

21. Can you get HIV from contact sports where bleeding may occur?

- There is no evidence that any person participating in any sports activity has become infected with HIV/from, or has transmitted HIV to, other participants.

- It is possible that transmission could occur if an HIV-infected athlete had a bleeding wound that came in contact with a cut in the skin or mucous membrane of another person. Even in such an unlikely event, however, the risk of transmission would be very low.

- Given this small possibility, it would be wise in contact sports where bleeding might occur (such as boxing) to follow these procedures:


1) cleanse any cut with antiseptic and cover it well;

2) if bleeding occurs, stop activity and wait until the bleeding has stopped and then cleanse and treat it with an antiseptic and cover it securely;

3) latex gloves should always be worn when treating injured people.

22. Do mosquitoes or other insects spread HIV?

- The evidence clearly shows that HIV is not spread by mosquitoes and other insects. For example, bedbugs, lice and fleas in the households of people infected with HIV do not spread the virus to the other people living in these households.

- If mosquitoes were responsible for spreading HIV, then people of all ages would be infected. In fact, children before puberty are rarely infected, unless they were born to infected mothers or had a transfusion with infected blood.

- We know that HIV lives in some cells of the human body but that it does not live in the cells of insects. Therefore, mosquitoes and other insects are not a suitable home for HIV.

- HIV is not like the malaria parasite which lives very well in the mosquito and spreads to people when mosquitoes bite, because it is in the fluid that the mosquito injects.

23. When should one be tested for HIV?

Remember you need to be tested twice (see above).

There are advantages and disadvantages to being tested for HIV. It is a decision that should not be taken lightly and the implications of positive and negative outcomes should be faced in advance with the assistance of an HIV/AIDS counsellor.

A) Advantages of being tested:

If you are infected with HIV...


- You can receive early treatment and perhaps live longer.

- You can make decisions to take good care of yourself.

- You can develop a good emotional support system in the early stages of the disease.

- You can use new medications as they develop.

- Knowing that babies can be born with HIV, you can make decisions about whether you wish to get pregnant.

- You can inform your partner(s) that you have HIV.

- You can abstain from sex or use a condom during sex.

- You can avoid sharing items that come in contact with blood - razors, tweezers, needles, and syringes.

- You will decide not to donate blood and other tissues.


If you are not infected, you will be relieved to know the result and will want to protect yourself in the future.

B) Disadvantages of being tested:


- Learning that a person is infected with HIV can be very distressing. The degree of distress depends on how well the person is prepared for the news; how well the person is supported by family and friends; and, on the person’s cultural and religious attitudes towards illness and death.

- A person who learns he/she is infected with HIV is likely to suffer from feelings of uncertainty, fear, loss, grief, depression, denial and anxiety; the person must make a variety of adjustments.

- Partners and family are likely to suffer from the consequences of HIV testing as well as the infected person, whether they are also infected or not.

- A person who has tested positive for HIV may be discriminated against if the information is revealed.


C) Some important points about knowing one’s HIV status:

- A person with HIV has the opportunity to make others more aware of the disease and to fight for tolerance and compassion for people with AIDS.

- However, they should think carefully about revealing their status since misunderstanding and discrimination do exist and may affect them and those they love.

- In many situations, families are the main source of care and support and the type of care and support for HIV-infected people may change depending on the stage of infection. This situation requires counselling for family members as well as for the person infected with HIV.

- All medical information, including HIV/AIDS status should be kept confidential.

- HIV-infected workers or students should not be discriminated against.

- HIV infection alone does not limit fitness to study or to work.

- HIV infection should not be a cause for termination of employment or schooling.

- At work or school, as elsewhere, HIV-infected people have a responsibility to behave in ways that do not put others at risk of infection.

- Donating blood is a very irresponsible way to find out one’s HIV status. If you want to be tested, consult your health care provider who will refer you to the appropriate counsellor.


D) HIV testing should always be preceded by counselling, which includes:

- Information about the test procedure and the many factors involved in testing, including emotional, social and medical consequences of a positive or negative result. Advantages and disadvantages of testing should be discussed and the decision to be tested should be made after careful consideration of all factors.

E) HIV test results should always be given with counselling which consists of a talk between the individual and the counsellor aimed at discussing the test result.

- If the result is negative, the counsellor will discuss the importance of prevention of HIV/STD in detail with the person in order to reduce his/her risks of infection in the future. The discussion will cover not only the methods available but the person’s individual situation, concerns and attitudes which may influence whether or not these methods are feasible and/or acceptable and will be used.

- If the result is positive, the counsellor will discuss with the person all the above in order that he/she avoid infecting his/her partner (or children), but also in order that he/she avoid reinfecting him or herself (which may hasten progression of the disease). In addition to this, the major task for the counsellor will be to offer compassion, support and practical advice, including referral to appropriate medical services, to the person to enable him/her to cope with stress and anxiety and to make personal decisions. Follow-up sessions to ensure meaningful, consistent and long-term support will be necessary.


F) If testing and/or counselling is not available:

One should discuss one’s risk factors with someone knowledgeable and still make decisions to use condoms or to abstain from sexual intercourse and avoid pregnancy.

24. How can one identify a person with HIV?

- It is not possible to know by physical appearance that a person has HIV, because the virus may remain in the body for many years without causing any symptoms or signs.

- Only a blood test taken after the “window” period can tell if a person has HIV.

25. What happens if you live close to someone with AIDS?

Living near someone who has AIDS or who is infected with HIV will not give you HIV. You can live quite safely in the same room with someone who has AIDS, provided that he or she is not your sexual partner and that you take precautions in handling body/fluids (blood in particular).