Peer Educator Diary

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2 Exercise: “What do we know?” ... Welcome to the Positive Action at work Peer Educator Diary. ..... educators we all know these facts, but we must find ways to.
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Peer Educator Diary

Positive Action at work Ideas & resources

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Positive Action at work Peer Educator Diary 3

Contents Introduction – how to use this diary A

Tackling stigma page. 6

B

Working with our peers page. 8

C

Topics to cover page. 10 1 2 3 4 5 6 7

Reach one, teach one...

HIV and AIDS basic facts Exercise: “What do we know?” Exercise: “Where is the risk?” HIV at work Active HIV prevention The HIV test HIV treatment

D

Diary pages page. 23

E

Evaluation and monitoring forms page. 25

F

Accompanying posters: page. 28 HIV and AIDS: the facts HIV at work I am You don’t know We talk He cares Sexually Transmitted Infections - STIs No condom? The HIV test World AIDS Day HIV & AIDS information session “Thank you”

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Positive Action at work Peer Educator Diary 4

Positive Action at work Peer Educator Diary 5

Introduction how to use this diary Welcome to the Positive Action at work Peer Educator Diary. We recognise the critical role peer educators play in the workplace response to HIV and AIDS. This publication is designed to support peer educators in their difficult work and as you look at it you will realise that it is much more than just a diary. It should give you ideas for workplace activities, valuable information you will need when covering certain topics and advice on working with groups of co-workers, as well as showing how and why you can record your experiences as a peer educator. he Positive Action at work project is all about helping companies to implement their comprehensive policies on HIV and AIDS – policies that cover care and treatment as well as education and prevention. Of course there are many challenges in making policies like these work on the ground and they cannot all be solved by peer education. But, properly supported, peer educators can help tackle stigma and discrimination – very real barriers to access to care and treatment for employees and their families. This diary and the accompanying set of posters have been designed to help you tackle stigma at the same time as you promote all other aspects of your employer’s HIV and AIDS policy.

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If your employer does not provide or pay for ARV treatment for employees there will be some sections of this document that you may wish to modify as it has been written to improve take-up of treatment where it is offered. This document has five other sections which should all be helpful in different ways: Tackling stigma explores the ways stigma affects people living with HIV and AIDS and how we can all work to overcome it. Working with our peers helps you understand how to get your message across whether you are dealing with one person or 100.

Topics to cover sets out objectives and targets for a series of topics that peer educators need to cover if they are to support a comprehensive HIV and AIDS policy. For each topic there is at least one presentation or activity that you can use or adapt for your co-workers. Diary pages are for your record of your interactions with co-workers, somewhere for you to note the informal questions you are asked as well as the formal sessions you organise. You will need to photocopy the blank diary pages so you have some for each topic or each month. Finally there are the twelve A3 colour posters that accompany this diary and fifteen stickers. Each poster supports one or more of the topics covered and their use is explained as this diary progresses.

All of these materials have been developed with the help of peer educators working in real companies, particularly the dedicated team at GSK Kenya, but we would like your comments and suggestions so that we can continue to improve them. There is an evaluation form – in section E – please return it to us. Other resources are being added to the Positive Action at work web pages, so please check the site for other ideas and support materials. Good luck with your peer education – please let us know how you are getting on!

www.gsk.com/positiveaction/ at-work.htm

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Circle of Stigma

Positive Action at work Peer Educator Diary 6

A) Tackling stigma

Stigma

Discrimination

What is stigma? Where does it come from? Stigma is a big problem. Because we live in communities and rely on other people it has become very important to us that we are accepted and included. When society at large or our own small groups of friends or colleagues begin to exclude us for some reason it is at best very hurtful, at worst it makes our lives impossible to live. Sometimes we exclude ourselves because we feel bad about ourselves or expect others to react badly to us: the effects of that can be equally isolating. hen this happens because of common attitudes towards something about us or towards something we have done, this is stigma. Traditionally society stigmatises behaviour that is viewed as bad or immoral, like rape. But that stigma rubs off on the rapist, on the person who has been raped, on their families and maybe their friends too. In a very lazy way, society sometimes turns away from or persecutes everyone involved. Today society stigmatises behaviour and people for many reasons – often the majority will stigmatize a minority just because they are different, and are happy to use any excuse they can.

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We have spent years telling people that AIDS is bad and something they should be fearful of. In the days when AIDS was not so visible in our societies this seemed the only way to make people listen. Of course AIDS is bad – disease is not good! But we also had to tell people that HIV is

transmitted by sexual intercourse, by sharing dirty needles, and that AIDS eventually kills you. Sex, drugs and death – taboo subjects often viewed through a veil of fear, rumour and superstition. HIV and AIDS are hard to understand when you have been given all the facts: add fear, rumour and superstition and it becomes even harder. So there has been stigma about HIV and AIDS growing for a long time. And there has been very real discrimination against people living with HIV and AIDS and their families. So much so that the isolation of selfstigma may seem better to them than the potential judgements, victimisation, and violence of family, neighbours, colleagues and others who we normally rely on.

Stigma is an obstacle: it makes HIV prevention work harder; it reduces the take-up of voluntary HIV counselling and testing; it denies access to support, care and treatment for people living with HIV and AIDS and people affected by HIV and AIDS. Stigma fuels prejudice and can lead to discrimination. When people affected by HIV or AIDS see that prejudice or discrimination in action it fuels or reinforces their selfstigma, with the damaging consequence that they are less likely to access support, services and treatment. We cannot ignore stigma so we must deal with it somehow. Everyone who rejects the stigmatisation of HIV and AIDS contributes to the solution. Even though we are working with small groups of people – our co-workers and our families – what we do can challenge stigma and help to end it.

Internal Stigma The Policy Project

What can peer educators do? 









Recognise our own power – for bad as well as good Involve people living with HIV and AIDS in our work Be confident of our facts and our methods Acknowledge and challenge the fears and misconceptions about HIV and AIDS Present real and positive models of life with HIV and life with AIDS

What causes stigma?     

Lack of accurate information Fear of infection and death Fear of association Moral judgements Beliefs or attitudes

How stigma can be demonstrated by others  Name-calling and insults  Exclusion from family and friendship groups  Gossip and rumour mongering  Victimisation at school or at work  Refusal to care or treat at home or in hospital  Refusal to use condoms or allow others to use them

How self-stigma can be demonstrated  Try to hide illnesses or concerns  Avoid company, family and friends  Become withdrawn and isolated  Deny HIV or AIDS by avoiding HIV services  Deny HIV or AIDS by stigmatising others The effects stigma can have  Loss of work due to sacking or staying at home  Homeless due to lack of money or discrimination by landlord  Truant or school dropout due to bullying  Prolonged STIs from avoidance of diagnosis and treatment  Opportunistic infections due to avoidance of healthcare or discrimination by nurses or doctors  Injury or murder  Depression, alcohol abuse  Reckless, unsafe behaviour  Suicide

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Positive Action at work Peer Educator Diary 8

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B) Working with our peers Peer education has many benefits. Because our peers are people with whom we have much in common – by definition we are of similar status, age or employment – they should find us approachable and the discussions we have can be open. But when we give our peers information or challenge their misconceptions it is important that we can show that we are qualified to do this. Our employers need to make the credentials of their workplace peer educators known. For example, how long was our initial training and who conducted it? What is the authority of our information? We are like our peers in many respects, except for the specific role we have volunteered to play – and in that we must have credibility. ducation is a broad term – it means much more than giving knowledge or information. As we will see from the objectives of the learning modules later, good peer education has to be about changing attitudes and behaviour. People obtain information about HIV and AIDS from many different sources. One employee survey found that most employees use the media to get their information, while the minority (less than one in five) had information from a medical practitioner or from their employer. 96% said they found that information about HIV and AIDS was difficult to obtain. A good peer educator programme can change that and help people to use the information wisely.

E

Our initial training as peer educators should equip us with some of the skills to do the job, but if we have no experience of training or leading groups it can still be a daunting task. When employers recruit peer educators they should be looking for certain strengths, but it is also important to have different kinds of people in the role. The strengths and skills listed here are all important, but not every peer educator has to have all of them!

Peer educators should be:     

Approachable Trustworthy Self-aware Sensitive Good listeners

Peer educators can learn to:     

Speak to groups Handle difficult questions Challenge misconceptions Lead activities and exercises Refer urgent or difficult cases

Below are four of the most popular ways to work as a peer educator. The six topics in this guide can be covered using a combination of these techniques. Remember that peer education is a team effort, so if we all have different strengths and skills we should be able to run an excellent programme as long as we help each other out by working together on different approaches. Of course we do all need to try new things – that way we can grow into our roles – but by working together we can learn from each other, give each other feedback and gain the confidence to experiment.

FOUR WAYS TO WORK

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Unsolicited one to one

The presentation

The exercise

Open question time

Some of our most important work is not planned: when a co-worker approaches us with a question or to discuss a problem it proves that we are accepted in our role. It is very important to respond positively to this approach so, although we cannot plan each one, we should decide in advance how best to deal with different kinds of enquiry. What do we say when the approach is inconvenient at that time? Where can we hold the conversation if it is sensitive or confidential? What materials can we give to co-workers to take away? How do we refer them if we cannot help them ourselves? Develop an approach in discussion with fellow peer educators.

Sometimes a short presentation is the best way to deliver information. It could be followed by questions, a discussion or an exercise, but there are many ways to make a presentation and all of them require preparation. We can make presentations in pairs. We can use posters, flipcharts, overhead slides, power point, video, audiotape and even live drama or music. But some of the best presentations keep things very simple and short. If we are given 20 minutes for a session it is better to spend only 10 minutes talking to the group so that 10 minutes are left for discussion or questions.

We all learn in different ways, but one of the best ways to learn is by doing something. So if we have been given some information in a presentation, we will understand and remember it better if we then have to use it in an exercise. Or an exercise can give us the chance to discover something for ourselves. There are a few basic forms of training exercise, and this diary demonstrates some of them – try them out with fellow peer educators or try to devise new ones. Remember to take anonymous questions on cards after at least some sessions (see “Questions out of the hat” in C6 The HIV test).

In some workplaces it is necessary to establish a regular time when peer educators are available to answer questions – maybe for a short period after work one day each week or during a certain lunch break. Peer educators could do this on our own or in pairs, but it is important that all parts of the workforce have some opportunity to approach their own peer educator. If we run a short session on a specific topic we can promote the next open question time a few days later as an opportunity for further questions. But these question times should not always be at the same time or in the same place – some people might not be able to attend so varying the options is important.

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Positive Action at work Peer Educator Diary 10

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The facts about HIV and AIDS, 1

C) Topics to Cover

Why are we here today?

1. This is my starting point today – why are we here? 





1. HIV and AIDS basic facts Employees need the basic facts about HIV and AIDS. As peer educators we all know these facts, but we must find ways to make our peers as sure of them as we are. We must also overcome the fears and prejudices that stop people accepting and acting on these facts. PowerPoint version of a model presentation can be downloaded from www.gsk/positiveaction/at-work.htm. But you can make the presentation using your own slides, flipchart or other format (see page XX).

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The short (ten minute) presentation can be extended: with an exercise “What do we know?” and another “Where is the risk?” If you are able to gather information about the epidemic locally and present this with information on the global epidemic you can help your peers to put their personal experience into a global context. This approach is used by the Nairobibased organisation the Movement of Men Against AIDS in Kenya (MMAAK) to help people understand that the progress of the global epidemic and their own behaviour are linked; that their own actions can and do make a difference.

Objectives Presentation: The facts about HIV and AIDS After this presentation the group should be able to explain the difference between HIV and AIDS, understand how HIV is transmitted and the effect it has on the immune system, realise the challenges of remaining healthy with HIV infection and that we should support people living with HIV and AIDS. Exercise: “What do we know” After this exercise the group should have a better grasp of the facts about HIV and AIDS and be more confident talking about those. Exercise: “Where is the risk” After this exercise the group should be more aware of the difference between their perception of risk, actual risk and how they respond to it.

Presentation: The HIV and AIDS epidemic After this presentation the group should be aware of the extent of the global epidemic and the relationship between their behaviour, HIV infection and the statistics and the importance of VCT.







Is it because HIV and AIDS are very important? Because we want to know more about them? Because we think we know some things about HIV and AIDS – but there are things we are not sure about? Because we have worries about HIV and AIDS – and it is hard to talk about that? Because we want to know what happens to us when we contract HIV? Because we want to protect ourselves from contracting HIV?

Maybe it’s all of these. We have ten minutes, so we can only start to achieve these things. But there will be other times when we can say and do more. And any of us can talk with our Peer Educators whenever we can find a time and a place to do that.

The facts about HIV and AIDS, 2

Resources The two exercises require different resources which are listed below. You can copy the slides shown for the presentations or turn them into larger poster pages. Use the four posters HIV and AIDS: the facts, I am, You don’t know and We talk to generate discussion around these topics. Remember to make your Diary record!

HIV = Human Immunodeficiency Virus

AIDS = Acquired Immune Deficiency Syndrome

2. HIV stands for the Human Immunodeficiency Virus – what does that name tell us?  It only affects humans – we cannot contract it from animals  It creates a deficiency in our immune system  It is a virus, a tiny organism that needs to get into your blood to reproduce and thrive.

AIDS stands for the Acquired Immune Deficiency Syndrome – what does that name mean?  It is an acquired condition – so it is not hereditary  It is indicated by deficiency or failure of the immune system  It is a syndrome – a collection of symptoms, not just one simple illness. The facts about HIV and AIDS, 3

4. An infected person has HIV in their blood – that is where the virus reproduces itself, and that is where it damages the cells that work for the immune system. HIV is also found in semen, vaginal secretions and breast milk. For someone who is not HIV+ to become infected, one of these body fluids from an infected person must get into their blood stream. How can this happen? The facts about HIV and AIDS, 5

HIV

AIDS

3.Someone who is infected with HIV can show no serious symptoms for many years. You cannot tell someone is infected simply by looking at them. Over this time the HIV is damaging the body’s immune system, and the infected person can pass on the virus in certain body fluids. The only way to know if you are infected or not is to take an HIV test. You are said to have AIDS once the immune system is beginning to fail and you succumb to one of a range of so-called opportunistic infections. These are illnesses that take advantage of the state of your immune system – normally you would be able to fight them off, but now they can make you seriously ill or kill you. People living with HIV can delay or avoid these AIDS illnesses in many ways including combination anti-retroviral therapy. HIV plus an opportunistic infection = AIDS. One of these infections on its own, without HIV infection is not AIDS. The facts about HIV and AIDS, 4 HIV infection HIV in Blood Semen Vaginal fluid Breast milk is infectious • Tears, saliva and sweat are safe • Urine, faeces and vomit do not contain HIV unless they contain infected blood

HIV infection can occur from • Sexual intercourse – vaginal and anal • Infected blood – injection or blood transfusion • Mother to baby – before, during or after birth

5. There are only a few ways that HIV can get into our blood stream. Once blood or another body fluid is dried HIV cannot survive. But there are some common activities that can pass HIV from one person to another. Sex, where there is penetration of the vagina or the anus with the penis carries a very high risk. It is possible to have sex once and become infected. Using a condom can prevent this kind of infection. Oral sex carries a lower risk – but cuts or sores in the mouth or gums can provide a route for transmission. If you are injected with infected blood you may become infected: equipment that can carry blood should be sterilised in between patients or customers. Babies born to HIV+ mothers will sometimes be infected – but not always. Sometimes infection happens in the womb; sometimes it can happen during the birth; sometimes it happens during breast-feeding when the infant’s gut and throat are not fully matured.

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The facts about HIV and AIDS, 6 Your immune system is better than any doctor - it protects you from all kinds of infections everyday. You can take care of it by eating and sleeping well and avoiding stress.

6. The immune system Our immune systems are complex and important: we rely on them to fight off infections. Just how strong our immune system is at any one time depends on lots of factors: having a poor state of health; not having a good diet; being tired or run down; being stressed, all of these can depress our immune systems. But if our diet improves, if we get enough sleep, the stress is removed and our general health improves, so does the state of our immune system.

The facts about HIV and AIDS, 7 Living with HIV Someone living with HIV can maintain good health for many years Without an HIV test it is impossible to know for sure that you are infected But HIV slowly damages the immune system making you more vulnerable

7. How long you can live with HIV before it makes you ill depends on your lifestyle: whether you can afford good food, to have enough rest and sleep - the things that help the immune system.

2. Exercise: “What do we know?”

But someone living with HIV won’t know they are HIV+ unless they have an HIV test. During the time they are “asymptomatic” - in other words they have no symptoms related to their infection - someone can still infect others in the ways described earlier. Although people living with HIV can remain apparently healthy for many years (anything from 5 to 15 years after infection) during this time HIV is weakening the immune system. Once it has become much weaker, the immune system will fail to fight off infections that would not normally pose a problem. Many of these, called Opportunistic Infections, are the conditions that add up to AIDS. Remember, HIV infection, PLUS an Opportunistic Infection = AIDS

RESOURCES: small cards with the questions shown below. A flipchart or board will help you record the responses.

There is no cure for HIV infection. But HIV treatment, using a combination of antiretroviral (ARV) drugs, can control HIV so that it stops attacking the immune system. But the ARV treatment should not be stopped or interrupted, because HIV will begin to grow and attack the immune system once more. However, if the drugs are taken properly, the immune system can recover and the patient should begin to enjoy good health which can last for many years.

This short exercise gives your peers the chance to use some of the information they have been given in your presentation. You can adapt this for use after any of your presentations. In pairs or groups of three the participants each consider a question that can be answered using the information from the presentation. Write the questions on small cards

A “line” of rope etc.; “high risk” and “no risk” cards; activity cards

8. Unless you take an HIV test you cannot be sure of your HIV status. Because the results can change your life it is important to have the pretest counselling that is offered. If you find out that you are NOT infected you can take steps to protect yourself from infection in the future. If you find out you are HIV positive you will be able to take steps to maintain your health - take care over your diet, avoid stress, and access the care and treatment that may be available. Post-test counselling will help you to think about the implications of your test results, whether they are negative or positive.

and hand one card to someone in each group. Allow a few minutes for them to agree their answers, then ask each group in turn to share their question and the answers. Discuss as a large group and allow others to clarify areas of uncertainty before summarising the most accurate responses. The more questions you use the longer this exercise takes. It is okay for several pairs or groups to address the same questions. Notice that these questions address stigma by focusing on positive interventions.

Question 1 What could you do to help a friend who is HIV+ to stay healthy? Question 2 What are the ways to avoid sexual transmission of HIV? Question 3 Why is it safe to work with someone who is HIV+? Question 4 How does remaining in employment help someone living with HIV to stay healthy?

3. Exercise: “Where is the risk?” RESOURCES:

HIV reproduces by taking over the blood cells that fight disease and using them to make copies of itself. So as the HIV grows, the helper cells decrease. If you are HIV+ it is very important to do all the things that help all of our immune systems to perform well: get enough sleep; eat well; avoid stress. Because although your immune system is under attack from HIV, it can still fight back.

Positive Action at work Peer Educator Diary 13

Before this exercise begins the group must have had the information about HIV transmission: what body fluids contain dangerous levels of HIV and what activities carry a risk of HIV transmission. This exercise requires the group to consider many different activities and decide how much of a risk they represent. You need a line on the ground (a line in the flooring or a piece of string or rope) as long as the space allows. Label one end of the line “No risk” and the other “High risk” with large cards. You need to prepare other smaller cards that represent the activities (with words and/or pictures). At least six members of the group should get a card – if your group is no more than 12 try to give everyone a card, even if the activities have to be repeated.

To start, gather the group, standing to the side of the line. Select a member of the group and ask them to state their activity. Not everyone will know what is involved in every activity, so at this point explain the true nature of it. Next ask the person who holds the card to stand at the point on the line that they believe represents the level of risk of HIV infection that this activity holds.



Some may give a factually inaccurate explanation, in which case you can correct them and ask them to re-assess the risk and reposition themselves.



Others may give accurate explanations – eg “Faeces can sometimes contain blood” – but have taken up a position that does not reflect the true risk – eg “High risk”

Then ask the rest of the group to stand at whatever point they believe best represents the risk. There will probably be some disagreement, so ask people at different places to explain why they believe they are right. For example:



After two or three people have spoken and you are confident the group has the relevant facts you can give them the opportunity to move, to change their position.



Finally, place yourself where you see the true risk and explain why, if necessary. We are not told the HIV status of the baby – which reflects life, as its status may not be known for some time. So to assess risk we should assume the child is HIV+. For example changing the nappy poses no risk if there is no blood present. If there is blood then there is still only a very low (Continued )

ACTIVITY ON THE CARD: “Changing the nappy (diaper) of the infant of an HIV+ mother” 

Once the group have taken their places you must ask people in different positions on the line of risk to explain why they are there.

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Positive Action at work Peer Educator Diary 14 (Continued from page 13) risk if you use gloves or cover any cuts you have on your hands as a precaution. 

If debate continues between “No risk” and “Very low risk” ask if the level of risk that they perceive would be sufficient for them to avoid that activity.

LEVEL OF RISK Low

You can continue the exercise asking for people with different activities, or nominating them. This involves lots of movement, which is good, but make sure it does not go on too long as some of your group may tire of standing sooner than others. On page 31 are suggestions for activities for the other cards. When you have discussed as many cards as you can, ask the group to

Positive Action at work Peer Educator Diary 15 sit around you as they did before this exercise started. The question they have all addressed is how do we perceive risk, in this case the risk of HIV infection? But it is even more important to make people realise that, all too often, we ignore some risks and overreact to others – regardless of how serious the risk is. Use a flipchart or overhead slide to show:

OUR EXCUSES High

Smoking

I will give up – one day

Jay walking

Everybody does it Running red lights

Only if I’m in a hurry

Unprotected sex

Once can’t hurt – or My partner’s okay – or I hate condoms

We all take risks everyday. Some would say that without risk there would be no excitement in their lives. But some risks are not worth taking. Even the people who sky dive from aeroplanes for a hobby check their parachutes before they use them. It’s the same with sex.

4. HIV and AIDS at work One of the peer educators’ strongest weapons against stigma is the employer’s HIV and AIDS policy. Although the policy may not mention stigma it is important to realise how it can be used against stigma.

The majority of HIV infections are sexual, so those could all be avoided: know your HIV status and make no assumptions about that of your partner - and act accordingly or use a condom anyway.

Cards for exercise “Where is the risk?” (See page 31 for photocopying template)

AANNAALL E D IINNTTEERR I S G SIDE CCOOUURRS N O L SEE G ( ( A N N N O O G ALO ING C C N O O I N N K D D V OOM M)) ORAL N LLIIVINSG WOORRKINSG O S E R X (NO W A PE SON /AID S HIV+ R HIV AID E P MOTH A ITH HIV/ ER W ITH DEEP W DEEPKISSING KISSIN (OF G( MOU MOUTTHS) OF HS)

Think about the strengths of your employer’s policy. If it has been drawn up with regard to some of the guidelines now available (for example from the Global Business Coalition on HIV/AIDS and the ILO) then those strengths should reflect the ones listed here:

More specifically, the policy (or accompanying guidelines) might detail some or all of the following as recommended actions or practices: 

 







It demonstrates commitment at the highest level to address HIV and AIDS It is inclusive – employees have been consulted, perhaps through their trade union, as it has been drawn up It clarifies what the employer will do about HIV and AIDS for all employees It sets out what will be done for employees living with HIV or AIDS (or members of employees’ families who are living with HIV or AIDS)







Remove any discrimination against people living with HIV or AIDS from practices and policies Measure employees’ knowledge, attitudes and practices in relation to HIV and AIDS Prevent HIV infections through education, condom distribution, and STI treatment Promote VCT to employees and improve local access to VCT services Expand medical treatment to cover opportunistic infections and ARV treatment

If your managers and supervisors have been properly briefed on this policy and had their own training on HIV and AIDS they should be supportive of your efforts as a Peer Educator. They can play an important role by enabling employees to attend your sessions, by attending some of these themselves and by

promoting sessions at meetings, briefings and other employee announcements. This is especially important in reinforcing efforts to tackle stigma and discrimination: although employees affected by HIV and AIDS may fear a negative reaction from any co-worker, it is the potential discrimination they could suffer from their supervisor or manager that they fear most. We can also help by reminding employees of the benefits of keeping people living with HIV at work, properly supported and with access to care and treatment. If the policy is delivered fully, people living with HIV at work will require less time off due to ill health and remain active and supportive co-workers and friends for longer. This is better for all of us. Three of the posters that accompany this pack can be used to generate informal discussion of these workrelated issues: HIV at work; You don’t know; and I am.

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Positive Action at work Peer Educator Diary 16

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5. HIV prevention Let’s be active Much of your work as a Peer Educator is focused on helping to prevent new HIV infections. Because we have to tackle stigma at the same time we have to avoid using people’s fear of infection or negatively portraying HIV or AIDS in ways that will increase stigma or discrimination. Instead we must demonstrate the humanity of living with AIDS, use images of people living with HIV/AIDS in positive ways and start to make people feel more comfortable about discussing this infection, responding to it and to those affected by it. eople cannot avoid HIV by reacting negatively – they must actively do something. For example, although abstinence or not having sex may seem like a negative reaction it is probably the result of a great effort to resist the desire or temptation to have sex, something that requires strength. Similarly, adopting condom use and attending a VCT centre are difficult, active commitments.

P

Our sessions should leave people feeling that there is something they can do. We must also demonstrate how they can do these things. It may seem easier not to do it, but getting over the embarrassment of handling and discussing condoms in a group of colleagues can kick start all sorts of improvements in confidence, technique and understanding that could make it much easier for people to introduce condoms into their own sex lives. Remember how stigma leads to discrimination and that leads to selfstigma? Stigma is working hard against our prevention efforts. In the diagram opposite you can see

how HIV-related stigma is reinforced by the pre-existing stigma that relates to how HIV infection is acquired, who is thought to be affected and how society treats them. When the stigma is enacted in relation to people affected by HIV and AIDS, by their identification, distancing them, avoiding them, and rejecting them it undermines our HIV prevention efforts – people turn away from the message and avoid anything that acknowledges they too could be at risk of infection. To acknowledge that would be to acknowledge that they too could be at risk of HIV-related stigma. So we give information, we show how things work and we encourage people to do the hardest thing of all – to change. They may need to change their attitudes or their behaviour or both. But what is certain is that this is not a quick or straightforward process. We must constantly repeat our underlying messages, find new ways to reinforce them and never be satisfied until we see the evidence of change in the individuals, the groups and the culture that we are working with.

Presentation: Condom use Objectives – after the session the group should be able to  Explain role condoms can play in preventing STIs and HIV  Identify and challenge stigma and misconceptions about condoms  Demonstrate correct way to put on condoms  Increase reliability of condoms by good practice  Obtain condoms from a reliable source Resources – condoms, demonstrator, female condoms, demonstrator, water based lubricant(s) (KY jelly), oil based lubricant (baby oil), spermicidal cream, condom dispenser(s), condom leaflet, condom posters (including female condom poster, “No condom – no way”, STI poster) The group – consider organising single sex groups for this session. The bigger the group the less chance there is for everyone to join in, but you can run this with a large group if necessary.

Pre-existing Stigma

HIV-related Stigma

Enacted Stigma

Pre-existing Stigma  Deviation from the norm  Inferiority  Promiscuity  Poverty  Gender, Race, Sexual orientation HIV-related Stigma Disease of immortality  Dirty  Exaggerated danger  Imminent death 

Enacted Stigma  Identification  Distancing  Avoidance  Rejection

The Policy Project

The session – this is an interactive session that requires at least half an hour. Two peer educators could run this together. A shorter session for a larger group could omit the hands-on practice.

Introduction Condoms work well as a barrier protection against pregnancy, HIV - the virus that causes AIDS - and other sexually transmitted infections (STIs). But the condoms must be of good quality (undamaged) and must be used properly. This session explains: the benefits of using condoms, and how to use them properly.

But first let’s find out what we think of condoms! What do we know about condoms? Pose some questions to the group. Invite answers on cards, from pairs, or just verbally from the whole group. 

   

“What do you know about condoms?” “How do they work?” “Are they reliable?” “Who uses condoms?” “What would your friends/parents/spouse think of you using condoms?”

Capture the responses as a list – write them on flipchart paper or pin the cards to a board. Advantages and disadvantages The responses may be factual – “Condoms are made of latex rubber”  They may be negative, about disadvantages – “Condoms can break” “My husband wouldn’t want us to use condoms” “It is embarrassing to talk about this” 



And some may be positive, about advantages – “Condoms prevent STIs” “Condoms prevent unwanted pregnancy” “Condoms are easy to carry around” “Condoms are cheap”

Ask the group to help you split their responses into these two categories: advantages and disadvantages. Some facts might be advantages or disadvantages – and sometimes it may be hard to agree which – so have a third list for these if there is no agreement. During the session you will need to address all the points that have been made. We will start with the negative opinions that reflect stigma.

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Stigma

How to use a condom

Some of the responses probably reflect the stigma attached to condoms or people who use them, for example:  “If you use condoms people will think you are promiscuous or loose”  “People use condoms when they think they have an STI or HIV”  “If she wants me to use a condom she must have been unfaithful” Ask the group if they recognise these opinions and the others that might have been suggested. Then ask them what the effect of these opinions can be – record these as a new list – The effects of stigma. For example: “I would be embarrassed to buy condoms, so I cannot use them”  “I could not be seen carrying condoms”  “I could never ask a partner to use a condom – what would he think of me?”  “I would not be able to protect myself from pregnancy/STIs/HIV”  “My partner rejected me because I insisted we use a condom” 

Now you can tell the group: Today we will learn what is fact about condoms and what is fiction. We will think about the advantages and the disadvantages of condoms. And we can begin to decide if the advantages outweigh the disadvantages… Let’s talk about sex There are lots of good things about sex! But there can also be bad things, including consequences we never intended. But because of the good things it is easy to forget about those consequences and the steps we can take to avoid them. Sometimes we forget because we are drunk, sometimes because we are too excited, and sometimes we

don’t actually forget but we are worried that we might be rejected and lose this person’s affections. These can all be reasons we don’t use condoms. Or perhaps we don’t understand the risks and the protection that condoms can offer.

Pregnancy Of course, the prospect of bringing a new life into the world is miraculous and joyful – but the joy may turn to woe (for a while at least) if the pregnancy was not planned or wanted. Using a condom correctly can be up to 98% effective in preventing pregnancy - a big reduction. But if you don’t use a condom each time you have sex, or you don’t use it the right way you won’t get that much protection. Using a spermicide (cream or jelly) with the condom is advised as this increases its effectiveness as a contraceptive.

Sexually Transmitted Infections There are at least 25 infections that are transmitted by sexual intercourse – sexually transmitted infections or STIs. They are passed on by the bodily contact during sex. Because some of them lead to open sores and around the genitals they can greatly increase the risk of HIV infection. Most can be treated fairly simply, so if you think you have an STI don’t just ignore it, get it treated. But you can reduce the risks of contracting some of the most serious STIs by correct condom use. This a major advantage to using condoms. Correct condom use can protect you from gonorrhea, trichomoniasis and chlamydia.

The 2002 CDC STI Treatment Guidelines state “When used consistently and correctly, male latex condoms are effective in preventing the sexual transmission of human immunodeficiency virus (HIV) infection and can reduce the risk for other STIs (ie, gonorrhea, chlamydia, and trichomoniasis). However, because condoms do not cover all exposed areas, they are likely to be more effective in preventing infections transmitted by fluids from mucosal surfaces (eg, gonorrhea, chlamydia, trichomoniasis, and HIV) than in preventing those transmitted by skin-to-skin contact (eg, herpes simplex virus [HSV], human papillomavirus [HPV], syphilis, and chancroid).”

HIV and AIDS HIV is the virus that causes AIDS. HIV can be prevented in the same way that pregnancy and some STIs can be prevented – by using condoms. It is far better to prevent HIV infection than to try to treat it: there is still no cure for HIV or AIDS. The presence of another sexually transmitted infection often makes it easier to then contract HIV. If you are sexually active it makes sense to have a sexual health check up at least once a year to be sure that any STIs are treated.

Unwrap one of the condoms to demonstrate the following points:  Most condoms are made of a latex material that is very strong even though it is very thin. (Stretch the condom on your fingers to show this)  The latex acts as a barrier to sperm, to the agents that cause many of the commonest STIs and to HIV, the Human Immunodeficiency Virus. (You could inflate two of the condoms to show there are no holes – use non-lubricated condoms)



Although the latex is strong it can be damaged, so it is important to take good care of your condoms:  Do not let condoms get too hot  Keep them away from sharp objects  Only use a condom from a sealed packet check its expiry or “use by” date (show this on the packet)



Never use oil-based lubricant (at this point you could smear some baby oil on one of the inflated condoms and put it to one side – within a few minutes it should burst, demonstrating how oil weakens the latex. If it doesn’t, apply a little pressure to the area.)

TEN STEPS TO USING CONDOMS PROPERLY

10 Even if you have used condoms before you should pay careful attention. Condoms used properly are less likely to fail in their job. If you have not used them before it is sensible to practise on your own so you feel more comfortable when you use one with a partner. For them to offer you and your partner protection against infections you need to use one each time you have penetrative sex – whether this is with the vagina or the anus.

Anal sex can transmit HIV and other STIs so it should not be thought of as a safe alternative to vaginal intercourse. Anal sex requires extra lubrication, especially when a condom is used. Because latex condoms are damaged by oils you should be sure to use a water-based lubricant. Do not use lubricant on the inside of the condom as this will make it more likely to slip off. Never use two condoms at once – the friction of them rubbing against each other could cause them to break. One is enough. Begin the demonstration – make the following points in turn:

1 You will need to put the condom on before your penis has been in contact with your partner’s vaginal area or anus. 2 You cannot unroll the condom onto your penis until it is hard.

3 Unwrap the condom with care – don’t tear it with your teeth or a fingernail.

4 The condom will only unroll one way – make sure it is the right way round before placing it on the end of your penis (try it on your fingers first).

5 Squeeze out any trapped air in the end of the condom – this is where the sperm will go when you ejaculate. 6 Unroll the condom gently down the full length of your penis only – don’t try to stretch it over your testicles.

7 Make sure the condom stays in position during sex – if it comes off throw it away and put on a new condom. Check it is still in position occasionally.

8 When withdrawing from your partner hold the condom in position – when the penis becomes soft the condom is more likely to slip off so withdraw while the penis is still hard. 9 Keep the penis and the used condom clear from contact with your partner.

10 Dispose of the condom by wrapping it in paper and placing it in a bin – it cannot be used again.

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There are many different brands of condom – show some different packets. Not all condoms are made of latex – some are made of polyurethane which is equally effective. But some are made of animal skin – these do not protect against HIV or the other STIs.

pregnancy. You can buy spermicide separately as the amount on a condom is very small. If you or your partner experience any irritation when using condoms you may have a reaction to the latex or to the spermicide – try an alternative type of condom or consult a pharmacist or doctor.

Condoms sometimes come coated with a spermicide. This destroys sperm and decreases the risk of

Positive Action at work Peer Educator Diary 21

Now ask the group to practise this with the demonstrators provided and take any questions. Tell them that there will be plenty more condoms distributed at the end of the session. If you are going to promote the female condom continue with this next demonstration – if not, perhaps because the female condom is not available, go straight to the review session at the end.

Now we know that they are reliable as long as we take care and use them properly but “I am too embarrassed to buy condoms” – needs to be thrown back to the group, and hope for some positive responses: 

 

This is too important to let embarrassment stop you – life and death You can pick them up here at work Lots of us use them – the embarrassment doesn’t last!

THE FEMALE CONDOM

If you have a very long list just pick the most important ones. Then turn to the advantages. If you don’t have all of these ask for more suggestions, and add any final ones of your own at the end:

Remind the group that we can all challenge stigma – we should try not to make assumptions, or force people to do things they are not happy with. But nor should we be forced to do things we don’t want to do.

They are easy to obtain, relatively inexpensive, and discreet to carry There is a great variety available so you can find one that suits you and your partner The condom can be part of sexual foreplay and both partners can participate Condoms protect against HIV, other STIs and unintended pregnancy When used with the right lubricant, sensitivity can be increased Men can gain greater ejaculatory control It protects against infertility (some STIs may lead to infertility) If you are not worried about STI and pregnancy, sex is more relaxed and therefore more pleasurable Female condoms give more control to the woman, with the same protection

Distribute the condom leaflets and describe the location of the workplace condom dispensers – show one to the group.Thank the group for their participation and let them know what their peer educators are planning next.









The female condom is an alternative to the condom that offers the same protection – it is the only female contraception that offers protection against STIs, HIV and unwanted pregnancy. Show the condom in its wrapping. This is the first condom that can be worn by women. Because it is still very new it is not always available in all locations.



If you have it, use the Female Condom poster to demonstrate how to insert the condom into the vagina or show the page of illustrations opposite. You may decide to use a vagina demonstrator.



1 Let’s unwrap the condom. Tear the package at the notch on the top corner – do not use scissors or a knife to open!

4 Place the index or forefinger on the inside of the condom and push the inner ring up as far as it will go. Make sure the sheath is not twisted. The outer ring should remain on the outside of the vagina.







2 Hold the sheath at the closed end, grasping the flexible inner ring between the thumb and the forefinger or middle finger – squeeze the ring so it becomes longer and narrower.

3 You need to choose a comfortable position – squat, raise one leg or lie down. Make sure the condom is sufficiently lubricated. Gently insert the inner ring into the vagina – you should feel the ring go up and move into place. This can be done some time in advance, before any foreplay, but must be done before your partner’s penis has any contact with the vaginal area.

As with the male condom, each female condom should only be used once. Now, if appropriate, ask the group to practise this with the demonstrators provided and take any questions. Tell them that there will be plenty more female condoms distributed at the end of the session.

Condom use – review session Let’s think about where we started today. We came up with advantages and disadvantages of condoms. We also thought about the stigma that can be attached to condoms and what effects this has. Then we looked at the facts about condoms [and the female condom].

5 When you are ready, gently guide your partner’s penis into the sheath’s opening with your hand to make sure it enters properly – be sure that the penis does not slide between the sheath and vaginal wall, but enters the outer ring of the female condom. 6 As soon as you are ready after sex has finished, hold and twist the outer ring and gently pull the condom out. Try to do this before you stand up. Wrap the condom in paper or plastic and put it in the dustbin, NOT the toilet.

I want to finish with a review of the advantages and the disadvantages. First of all the disadvantages – look back the list and run through each disadvantage and see if it has been answered or needs to be addressed, for example “Condoms are unreliable” – has been answered.

Don’t forget to make an entry about this session in your Peer Educator Diary for feedback and / or sharing with your next educator group meeting.

6. The HIV test Preparation Be sure you understand the organisation’s policy on HIV testing.

Why talk about VCT? Peer Educators are asked to talk to co-workers about the HIV test so that: 

Check:  there will be no screening (blanket testing) of employees or job applicants  the availability (and cost) of high quality voluntary counselling and testing (VCT) locally  whether the organisation will cover costs of VCT, and whether this is for employees only or for dependants also  any history of, or plans for, anonymous testing (surveillance) in the workplace









 



employees will better understand the test and its implications employees (and their dependants) will know where VCT is available workers do not fear discrimination due to their HIV status the stigma of the HIV test is removed or reduced more of our employees will take the test (when appropriate) those who need it will be counselled more of our employees will know their HIV status and request support as necessary through earlier support, care and treatment, employees will live fuller, longer lives

Key testing facts Thanks to your sessions your colleagues should understand the following: Where to go for a test, whether or not it is free, and what counselling to expect  The nature of confidentiality they can expect  The type of tests used locally – are they blood or saliva tests?  That the “HIV” test is for antibodies, which may not register for as long as three months after infection  Taking one test, receiving a “negative” result – no HIV – does not mean they will not be infected in the future if their behaviour exposes them to risk, or that they have not been infected in the previous three months (Continued ) 

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(Continued from page 21) Knowing your status means you can act in the future aware of the consequences: if you are HIV positive and you don’t use condoms for sex you are putting your partner(s) at risk; if you are HIV negative and you don’t use condoms you may not remain negative. If you test HIV positive, what is the procedure for accessing the care and support promised by the employer’s HIV/AIDS Policy? Thanks to the care and support available from your employer, a colleague who tests HIV positive can access care and treatment as soon as it is deemed necessary – which maybe soon after testing, a long time later or somewhere in between. But that decision can be made in their best interests and with their involvement. What can we discuss (one-to-one or in small groups)? Employees may have many questions about the HIV test that they are reluctant to ask. Using the poster “The HIV test” is one way to introduce the subject. The poster itself can suggest several important points for discussion, for example: 









Who is he? Could he work here? Why / why not? What does he mean – “My choice, my life”? He looks happy. Why do you think he is happy? Is he better off knowing if he is HIV+? Why / why not? Is this just about him? Is he married or does he have a girlfriend, or children?

Why does our employer want to promote VCT?  What is the employer’s policy on VCT / confidentiality / HIV care and treatment?  Where did he take his test, and when? These discussion points give you the opportunity to hear what colleagues currently know or believe – use your knowledge and understanding to clarify any confusion or challenge any misconceptions. Record your experiences in the Diary Pages. 

Presentation: Demystifying VCT Discussions like those outlined above will be easier if you can have some expert input, perhaps in the form of a presentation from the manager or a counsellor from your local VCT provider. They should be prepared to visit your premises and make a presentation of about thirty minutes with questions. Let them know your objectives for the session, the context of the rest of your work and how you would like to handle questions.

Objectives To increase uptake of VCT by employees and their families. After this presentation the group should have a more realistic idea of what would be required of them if they went for VCT: where is the facility; what time is it open; do you need an appointment; what does pre-test and post-test





counselling involve; what type of test is used; how long do the results take; do they provide other services and so on?

Methods Let your invited speaker know where they will be presenting, what equipment you can supply, how many will attend. Suggest that you will take anonymous questions “from the hat” (see below) to be sure employees’ concerns are addressed. Invite them to bring any materials they have that promote their services.

Exercise – “Questions from the hat” This is an excellent way of making sure that questions are asked on even the most embarrassing subject. Distribute small pieces of paper and pens or pencils among the group so everyone has some. Say you will take in ALL the pieces of paper later, so everyone can write their question down and know it will be anonymous. All the papers should be collected in a box or “hat”. When you need them, select papers from the box and, if appropriate, pose the questions they contain. At the VCT presentation these questions will be asked of the guest speaker. If you use this method at one of your own sessions you could first throw the question back to the group for answers and then clarify (if necessary) from the front.

7. HIV treatment Understanding HIV treatment and knowing that it is available both help to remove some of the stigma of HIV and AIDS. As Peer Educators you need to ensure that: All employees understand HIV treatment Employees living with HIV or with family members living with HIV should be aware of the access to treatment offered by your employer The ten minute presentation can be used on its own or built into a longer training session. It focuses on anti-retroviral treatment. You can download it as a PowerPoint presentation from

HIV treatment, 4

HIV uses the cells to make copies of itself

www.gsk/positiveaction/ at-work.htm. (or copy pages xx to xx to create your own OHP’s) There is much more information on all aspects of HIV treatment available from these specialist websites: www.aidsmap.com www.thebody.com www.aegis.com

In preparation for your presentation make sure you know how to answer the following questions – or build the information into your presentation: Q. Is ARV treatment available to me as an employee at no charge? And to my family? Q. Who do I talk to about accessing ARV treatment? Q. How does the company maintain confidentiality around ARV treatment? Q. What happens if an employee on treatment leaves the company? Q. What happens when dependent children on treatment grow up?

D) Diary pages These pages are designed to help you record your successes as well as any difficulties you encounter. Your peer educator group should meet periodically and give you the opportunity to exchange these experiences: sometimes you will identify subjects on which the whole group requires more training or a new approach; other times you will be able to help each other clarify facts or devise strategies for dealing with certain challenges. y

Copy the template over the page to form a diary, or copy out its headings in your own journal.

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05

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25

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Positive Action at work Peer Educator Diary 25 Month

Topic

Preparation Did the Peer Educators prepare as a group? Was there any aspect of the policy or of the topic that remained unclear to you after you had attempted to prepare? Record those here and if this was resolved, how.

Opportunities to engage your peers and what was / was not achieved 

On what dates did you focus on this topic?



What kinds of opportunities were there to talk about it – organised meetings, informal gatherings (eg at lunch), one-to-one conversations, others?



How many people were you able to talk with about the topic and related issues?



What issues did people raise with you? How did you deal with these?



Did you use any resources to stimulate discussion? What? How was that helpful?



What are the outstanding issues relating to this topic that still need to be addressed?



What other, possibly unrelated issues did coworkers raise with you during this time?Did any employees make specific requests or demands during this time?



Did you refer any employees to internal or external sources of information / services?



Please record any other notable occurrence or problem that you wish to recall, for yourself or for the group.

Peer Educator group meeting notes

E) Evaluation and monitoring forms These materials, and the others produced by Positive Action at work, will be under review until the end of 2006. It is very important that those of you who use these tools in the workplace – or elsewhere – provide some feedback to help us to improve them or make them more relevant to your region. Some of these questions are multiple-choice – please circle the answer you agree with most. You can post us the form, fax it or e-mail your response (download the form at www.gsk.com/positiveaction/at-work.htm). The second sheet can be used to evaluate your own sessions – invite your participants to fill these out after presentations and/or

Thank you for your help

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Diary Evaluation form 1

Peer Educators and HIV and AIDS materials for the workplace

Have the following been done at your place of work?

Please Circle

1.1 Finding HIV materials for the workplace has been: very easy / quite easy / quite hard / very hard

2.11 The Positive Action at work posters have been displayed

YES / NO

1.2 Our peer educators have been active for: a few months / a year / several years

2.12 The HIV and AIDS: the facts and/or Condoms leaflets have been distributed

YES / NO

1.3 We give presentations to our peers: never / once a year / twice a year / more often ………..

2.13 Condoms are available free to employees

YES / NO

1.4 We run interactive sessions/exercises: never / once a year / twice a year / more often …….

2.14 Female condoms are available free to employees

YES / NO

2

2.15 Do you agree that stigma is a barrier to HIV prevention, care and treatment?

The Positive Action at work Peer Educator Diary

2.1 How did you obtain the Diary? ……………………………………………………………………… 2.16 Has the Peer Educator Diary helped you to address stigma in your work as a Peer Educator? If so, how? 2.2 Is the design of the Diary clear and helpful?

Yes, very / Yes, quite / Not very / Not at all

2.3 How useful was each section of the Diary? 2.17 What has been the biggest challenge to you in your work as a Peer Educator? Very useful

Quite useful

Not very useful

Not at all useful

A Tackling stigma B Working with our peers

2.18 If you can, please suggest any local agencies that would find the Positive Action at work materials useful – please give contact information.

C Topics to cover 1 HIV and AIDS basic facts 2 Exercise: What do we know 3 Exercise: Where is the risk 4 HIV at work 5 HIV prevention

Thank you for taking the time to respond. If you wish, please give some or all of your contact details below.

6 The HIV test 7 HIV treatment D Diary Pages F The posters

POST Positive Action at work Evaluation NAT 196 Old Street London EC1V 9FR United Kingdom

YOUR DETAILS

FAX +44 (0) 20 7216 0111

Company

E-MAIL [email protected]

Location

Name

E-mail / Tel

2.4 What was the most useful part of the Diary? Why? 2.5 What was the least useful part of the Diary? Why? 2.6 What would you ADD to improve the Diary?

2.7 What would you CHANGE to improve the Diary?

2.8 Please list any words you could not use with your groups and suggest the alternatives.

2.9 Was there anything in the Diary that was not relevant or appropriate because of your country of location? If so, what? 2.10 Have you visited the Positive Action at work web pages or used materials from there?

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Employee evaluation form Thank you for attending this Peer Educator session on HIV and AIDS. It would help us to maintain and improve the quality of our programme if you would take a few minutes to fill out this form to let us know what you thought of the session. Thank you! Session title / topic Date

Location

1 Before you came here Have you attended HIV/AIDS sessions at work before?

YES / NO

How did you hear about this session? (circle one if it applies) Poster / Announcement to workers / From a co-worker / Other:

Each original Peer Educator Diary is distributed with a set of twelve A3 colour posters for the workplace. If you are using a photocopy of the Diary you may find that whoever acquired the original for your workplace still has the posters or knows where to get more locally. The designs can be downloaded from www.gsk.com/positiveaction/at-work.htm Of the twelve posters, one is a “shell poster” that can be photocopied and written on to publicise future HIV and AIDS presentations or sessions, one is a reminder to the workforce of the good job that the peer educators do (and a recruitment tool); the other ten either give information or challenge views on HIV and AIDS. If they can be displayed at times when the Peer Educators will cover the same issues in some way, then they may help to stimulate interest and discussion.

Had you seen any of the following before attending this session? (tick as many as apply)

  

F) Posters

Poster on this topic in your workplace

Some posters could be displayed on a semi-permanent basis, but beware of them becoming almost invisible because people get so used to them being there. It might be better to swap them around periodically, even when they are of constant interest.

Leaflet on this topic from work Other information on this topic – please specify what and where

2 Today’s session Was the information in today’s session presented clearly?

YES / NO

Did it contain information you did not previously know?

YES / NO

Has the session made you think differently about this topic to how you thought before?

YES / NO

Has the session left you with any questions on this topic which have NOT been answered?

YES / NO

HIV and AIDS: the facts This gives the basic facts of transmission and is relevant at any time.

HIV at work This poster announces or reinforces your employer’s HIV policy. It deserves permanent display.

What was the most memorable thing about this session?

What would have made this session better than it was?

3 The future Who will you discuss this session or topic with now? Co-workers / Friends / Family / No-one / Other:

Will you seek any further information or advice on this topic?

YES / NO

If yes, where from? Peer Educators / HR Department / Other people at work / Friends / Family / Medical professionals (nurse, doctor, VCT centre) Will you do anything differently as a result of this session (eg talk with family about this, change my behaviour etc.)? If so, what?

YES / NO

I am A positive image of a woman who refuses to be defined by her HIV infection: all her roles – daughter, mother, wife, employee – are listed above being HIV+. People can and should continue to live their lives and conduct their business after an HIV diagnosis as before.

You don’t know The poster challenges people to think how their behaviour can make it easier for others to live with HIV – extend the hand of friendship, include people, don’t assume everyone is negative etc.

Sexually Transmitted Infections – STIs Use this to raise awareness of STIs, local clinics and any sessions you will be running. Could be used in conjunction with condom promotion or distribution, eg in toilets.

We talk Encourages employees to take the lessons of HIV education home. Challenges heads of families to address issues of sexuality, HIV and AIDS.

No condom? This figure could be a role model for condom use. Could give details of where to get condoms.

He cares Provides a positive image of abstinence without attributing this to any particular moral code.

The HIV test Be prepared to discuss why he is “better off knowing”. Add local VCT information.

World AIDS Day Use this to help you promote anything you are doing to mark World AIDS Day, especially any community projects like the ones pictured.