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Peer Educators

Guide Booklet

Working with children andyoung people affectedby HIV/AIDS


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Peer Educators Guide Booklet

Working With Children And

Young People Affected By

Hiv/aids

Prepared by:

Melina Laukka & Dorcus Asiimwe, social workers

Kawempe Youth Development Association (KYDA)

BOX: 71976 Clock Tower, Kampala

Tel: +256 414 69 11 82 ,+256 752 36 83 32

Email: [email protected]

September 2010

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FOREWORD

HIV / AIDS has infected and affected many

people in Uganda. There have been promising

results from preventing further spread and

supporting HIV/AIDS patients through

community activities. It has been indicatedthat community based volunteers (including

peer educators) are relevant to both

communities and institutions. They have

several functions in the community, such as

providing services that are more relevant to

the needs of the poor and underserved

populations, following up their clients at home

regularly, identifying health and psychosocial

problems early, and making well- timed and

suitable referrals. The use of community based

volunteers is also less expensive and reaches a

bigger area, which ensures that those who are

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vulnerable are reached by services (Government

of Uganda, 2010.)

This guide is supposed to give basic

information about HIV/AIDS while providing

basic knowledge and a framework to peer

educators on how work with people infected

and affected by HIV/AIDS. The main focus is on

children and young people, aged from five to

nineteen, and their families or care givers.

This guide booklet is based on facts from a

workshop organized by Kawempe Youth

Development Association (KYDA) and

literature about HIV/AIDS. The overall

objective of the work shop was for Peer

Educators to gain basic counseling and helpingskills for children living with HIV/AIDS. It was

th thorganized from 6 to 10 August 2010 in

conjunction with trainers from The Aids

Support Organization (TASO) and KawempeHealth Center.

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ACKNOWLEDGEMENT

KYDA wishes to acknowledge the financial

support from the Stephen Lewis Foundation

(SLF) of Canada that enabled the

development of this peer educator's guide.

The Administration highly gives gratitude to

Mr. Otal McBernard the Executive Director

KYDA, Dr. Kasozi Francis In -Charge

Buwambo Health Centre IV, Ms. Nakabugo

Gorret M.A (Sociology) Trainer and Mrs.

Sendaula Sarah Counselor positive living and

Nutrition in children Kawempe Health Centre

for their moral and technical input into this

guide. This guide was also type setted,

compiled and made it a reality by full

commitment and efforts from Melina Laukka

and Asiimwe Dorcus social workers from

KYDA. Their hard work is highly indebted.

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KYDA is further grateful to the community HIV

+ Children Peer Educators for providing

information on various topics, participation insharing of testimonies, materials development

workshop and the actual training were the ideas

for this guide were conceived. We are equally

delighted for their relentless efforts and wisecontributions without which this guide probably

would not have seen the light of the sun.

KYDA handsomely extends its sincere thanks to

all those not mentioned but dully contributed tothe timey completion of this Peer User Guide

Booklet, May God reward them handsomely.

Mr. Otal McBernard

Director of KYDA (Team Leader)

Kawempe

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The technical team which actively

participated in preparation of this Peer

educator's guide booklet comprised of;

1. Mr. Otal McBernard Director KYDA

(Team Leader)

2. Dr.Kasozi Francis In-Charge Buwambo

Health Centre IV.

3. Ms.Nakabugo GorretChild and

Adolescent Counselor

Trainer (TASO). Kanyanya.

4. Ms. Sendaula Sarah Nutrition specialist

for HIV+ Children,

Kawempe. Health centre.

Other KYDA Staff:

5. Ms. Kiwuka Josephine Project officer.

6. Ms. Laukka Melina Repportuers to the

committee.

7. Ms.Asiimwe Dorcus

8. Mr. Kabuye.k. Shaban Counselor for

children KYDA.

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CONTENTS

Forewords 2

Acknowledgment 4

1. Basic facts about HIV/AIDS 8

2. Peer Educator 9

2.1. Peer educators' main tasks and

basic skills in dealing with children

3. HIV/AIDS care and support 14

3.1. Stigma faced by children

and how to handle stigma

3.2. Positive living for children

3.3. Peer to peer counseling

3.4. Nutrition and HIV

4. How to work in practice 26

4.1. Community mobilization

4.2. Home visiting

?4.3. Recording and report writing 30

?4.4. Referral 32

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1. Basic facts about HIV/AIDS

Terms:

HIV = Human Immune-deficiency Virus

AIDS= Acquired Immune DeficiencySyndrome

ART = Anti-retroviral Therapy

Fast facts:

33.4 million people live with HIV/AIDSworldwide.

30 million people live with HIV/AIDS in

low- and middle-income countries

67 percent of all people living with

HIV/AIDS are in sub-Saharan Africa2.1 million children with HIV/AIDS

worldwide at the end of 2008 and 1.8

million of them lived in sub-Saharan

Africa at the end of 2007

Two million people died from HIV/AIDSworldwide in 2008

2.7 million people were newly infected

with HIV worldwide in 2008 and

430 000 of them were children under 15

years.

[Source: WHO 2009]

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Statistics in Uganda:

The current HIV prevalence in Uganda

is estimated at 6.4% among adults and

0.7% among children.HIV prevalence is higher in urban areas

(10% prevalence) than rural areas

(6%)

The number of new infections was

estimated 111,000 in the year 2008The number of annual AIDS deaths was

61,000 in the year 2008

Women are excessively affected,

accounting for 57% of all adults living

with HIV. Ugandan women tend tomarry and become sexually active at a

younger age than their male

counterparts. They often have older

and more sexually experienced

partners. This (plus various biological

and social factors) puts young women

at greater risk of infection [Source:

Government of Uganda 2010]

2. Peer Educator

Peer Educator, also called as a Community

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Educator, is a person who is living in the same

circumstances as others. These kinds of

circumstances are for example age, gender,

culture, subculture, ethnicity and place of

residence. When it comes specifically to

HIV/AIDS, a good peer educator has a wide

knowledge base about the disease and owns

various methods of passing it to the

community. A good peer educator workingwith HIV/AIDS affected and infected children

often holds some, or all, of the following

characteristics:

Be well informed and holds a basic

information about HIV/AIDS

Be able to transfer the information to

others

Have some basics counseling skills and

love working with children.

Committed to working with children.

Should avoid stigmatizing and

judgment

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Be open minded

Good communication- and interpersonal

skills

Good listener and holds confidentiality

Empathetic and emotionally strong

Approachable

Owns self-respect

2.1. Peer educators main tasks and

basic skills in dealing with children

Peer educators working with HIV/AIDS positive

children have the following tasks a head of

them:

Developing activity plans.

Being updated with information

regarding HIV/AIDS among children.

Mobilizing communities for HIV/AIDS

r e l a t e d a c t i v i t i e s .

e.g. counseling and testing.

Working as a link between community

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members and service providers.

Indentifying HIV/AIDS related problems

of children and bringing them to the

awareness of supervisors e.g.

counselors and social workers.

Providing home care to children.

Monitoring positive children and making

proper referrals.

Keeping and maintaining records for

report writing.

To put those tasks in practice it is important to

h a v e g o o d c o m m u n i c a t i o n s k i l l s .

Communication is the process of sending and

receiving messages so that both people

understand the messages as intended.

Everybody has their own way to communicate

with other people but it is good to be aware of

the fact that there exists both verbal and non

verbal communication as shown below on the

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table. You have to observe both.

Before taking an action peer educator should

gather information about the task and set the

goals and plan how to fulfill those tasks

Verbal communication

- Face to face

communication

- Spoken language

Non verbal Communication

- Facial expression- Using hands and eyes- Sitting and standingpostures

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It also matters how you, as a peer educator,

approach children and young people affected

by HIV/AIDS. You can use active listening

(paying attention), checking understanding,

asking and answering questions as basic skills

of effective communication.

What to be considered in order to

achieve effective listening:

S Sitting Position


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R Relaxed R

Be Open O

L Lean forward towards the person L

E Keep Eye contact with the peer E

S Sit near the peer S

People living with HIV/AIDS have a wide range

of care and support needs. Peer educators

helping skills can be used to provide emotional

support and empowerment to the person inneed. Helping refers to a situation of peer

educator assisting parents/guardians and

children to overcome understand or cope with

a problem in their lives. This can be donethrough encouragement and emotional

support. However, in order to support peers,

peer educators need to first establish trust

from the children and their parents. Trust is

3. HIV/AIDS care and support

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essential for building a relationship

between the peer educators and the

children.

When children and youngsters are diagnosed

with HIV/AIDS, they often face stigma from the

people around them and even from themselves. The disease may be associated with

ways of behavior that are considered socially

unacceptable by many people and therefore

HIV infection is widely stigmatized. In other

words, stigma means negative thoughts aboutthe children based on their HIV status. Many

have been thrown out of homes, rejected by

family and friends, and some have even been

killed. A child or young person may also end up

doing self stigmatizing themselves throughthinking or feeling negatively about him/her

self based on perceived beliefs that other

people threat them negatively. It can lead to

school drop outs, unemployment, low self-

esteem, family breaks ups, depression andeven suicide. It is therefore vital to address HIV

3.1. Stigma faced by children and how to handle stigma

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stigma in order to improve the quality of lives of

children with HIV/AIDS.

Stigma may occur in different areas in life. It

may be caused by the following situations:

Fear of taking responsibility of young

people through blaming them about

their status.

Lack of protective laws to protect people

against being stigmatized.

Lack of treatment and support.

Ignorance about the causes of

HIV/AIDS.

Religious and cultural beliefs that

surrounds HIV/AIDS.

Stigma can be handled in the following

ways:

Counseling for the infected children and

youngsters together with their family or

caretaker.By showing love and care.

Giving Peer support.

Encouraging children and young people

through educating them about stigma.

Positive living involves a life style that fosters3.2. Positive living for children

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physical, mental and spiritual health.

Positive Living is:

When a person develops a positive

outlook towards his/her life.It involves adopting practices and

lifestyles that aims at improving the

quality of life and reducing the

transmission of HIV.

These behaviors are meant to delayprogression from HIV to AIDS by

keeping the childs immunity high.

How to achieve positive living:

Frequently necessary.

Supporting adherence to septrin to

prevent infections.

Provide adequate nutrition.

Immunization.

Promote the regular monitoring ofgrowth and development.

Prevention of infections like malaria.

Facilitate social support, peers, siblings.

Providing all the basic needs.

Emotional support and counseling.

Love and belonging.

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Safe water and hygiene,

hygiene.

Providing education.

Providing ART.

The great majority of people with AIDS in low

and middle-income countries are cared for at

home, since health services are beyond the

reach of large proportions of the population.

Community care and support groups have

sprung up almost everywhere in the world where

the AIDS epidemic has appeared and it has

shown good results through providing comfort

and hope to people living with, or affected by,

HIV. When it comes to children's /young people's

well being, peer to peer networks are significant.

Person can get support through hearing from

other peers, who are in the same situation or

through sharing their experiences. And if there

arises need for counseling, then fellow peers can

environmental

3.3. Peer to peer counseling

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be easier to approach. Below are some of the

principles to follow in peer counseling:

Keep confidentiality of client's

information.

Do not judge clients and be sensitive to

client's feelings.

Respect client's decision.

Be trusted and truthful.

Recognize your l imitat ions in

counseling. Recognize your own

resources and potential; you don't have

to know everything.

Understand the context of the situation

and respond appropriately.

Accept the client as she/he is.

Recognize each adolescent's unique

qualities. Everybody has their own way

to cope in the difficult situations.

Give correct information; too much

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information at once can confuse clients.

Give information, not advice.

Use clear and simple language

.

Good nutrition plays an important role in

maintaining the health of people living with

HIV. Adequate nutrition is essential to

maintain a person's immune system, tosustain healthy levels of physical activity, and

for a quality of life. Adequate nutrition is also

necessary for optimal benefits if receiving

antiretroviral therapy.

When it comes particularly to children with

HIV/AIDS it is good to keep in mind that they

are like other children; their bodies are

especially sensitive to nutrition. All childrenmust eat well to grow properly. On top of the

normal demands of growth, HIV-positive

children must cope with the extra demands that

the virus places on their bodies.

3.4. Nutrition and HIV

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Facing these demands can sometimes be hard

to the family or care givers. As a parent or

guardian of a child with HIV, it is easy to worryabout your child's nutritional needs. Children

living with a HIV can easily have a poor

appetite and have little interest in food and

they can feel full quickly. Therefore, they ofteneat very slowly and tend to be picky eaters.

This can sometimes make meals very difficult.

They are also suffering from the same

problems like adults with HIV, such as,diarrhea, nausea and metabolic problems,

which make it even harder for them to eat.

When children grow into their teenage years,

the challenges continue, when they became

more independent and when they have more

responsibility for their chronic condition.

HIV-positive children should have ongoing

nutritional care at a pediatric centre to make

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sure they stay healthy and grow properly. If

growth is slow, boosting nutrition will be a vital

part

of the treatment plan. The first step will beto change the child's diet to increase calories

and protein. Thus, a lot of things can be done at

home. One of the peer educator's tasks is to

provide accurate information about nutrition tothe families and to young people.

Importance of good nutrition to people with

HIV/AIDS:

It prevents malnutrition and improves

their quality of life.

It strengthens the immune system and

reduces the duration of illness.

It improves the effectiveness of

medication in the treatment of illness.

It provides energy, nutrients and

improves the physical performance of

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the body.

It delays the progression of HIV/AIDS.

How children get malnourished? :

Through eating food of poor quality.

Through eating inadequate variety of

foods.

Through long lasting illnesses.

Through loss of appetite.

Through poor hygiene and sanitation.

Through inadequate care for those

who are most likely to be affected by

malnutrition.

Inability to access the kind of food

and health care that meet their needs

(e.g. result from the poverty or

resources for social and health care)

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How to eat when suffering from HIV/AIDS? :

Have at least three meals and two

snacks in a day.

Increase consumption of foods from all

groups.

Add a little sugar or oil to food or

drinks.

Chew food well.

Rinse mouth regularly with boiled salty

water (to kill bacteria's)

How to deal with loss of appetite? :

Eat meals and snacks frequently at

regular intervals.

Use favorite foods and spices to boost

appetite.

Avoid strong smelling foods if they

affects your appetite.

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Avoid alcohol, smoking, drugs or

medicines that are not prescribed by

your health worker.

Ask your family and friends to prepare

meals for you.

Have meals in the company of friends

or relatives.

Exercise regularly (e.g. walking,

cycling, house hold duties)

Avoid drinks high in sugar.

Drink plenty of boiled or treated

water.

Eat after taking medication (Note:Take the health workers advice)

Deworm at regular intervals.

4. How to work in practice

4.1. Community mobilization

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Community mobilization is a process of

bringing people together for a desired purpose.

Community mobilization is typically plannedand organized for people to participate and

evaluate their activities for self reliance and

sustainability. Peer educators can try to

mobilize the community in various ways suchas drumming, posters, announcements, letter

writing, home visiting and through mass

media.

Community mobilization has the followingadvantages:

Brings people together.

It facilitates work to be done.

People realize the need for collective

effort.

Activities are sustained and therefore

people can build up commitments.

People learn from each other.

Saves time and money.

Results appear in a short time.

Builds a sense of belonging.

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Peer educators can more easily reach people

and mobilize them in the places that they gather

together. Those places may be:

Churches.

Clubs.

Social gatherings.

Funerals.

Community meetings.

4.2. Home visiting

In order to communicate and reach families in

local communities, it is important to also provide

help to homes through home visiting. Even

though peer educators organize meetings,

clients may not get enough information out of

them. They may not open up in a group or they

may even fail to come. Hence, home visiting is

necessary in caring and supporting children and

care givers.

Importance of home visiting:

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It gives clear assessment of the needs

of children and caregivers within their

local environment.

It gives an opportunity to children and

their families within a relaxed and in a

common setting.

It helps to identify children who require

referral for other services.

It reduces fear and eliminates

discrimination and stigmatization

within the family and community.

It promotes behavior change for

children, families and communities.

It fosters acceptability and positive

living among children, families and

communities.

Issues to consider in home visiting:

Transport.

Funds.

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Human resources e.g. people trained to

do the home visiting.

Time.IEC ( In fo rmat i on Educa t i on

Communication) materials.

Steps taken in conducting a home visit:

Announce arrival.Settle down.

Exchange greetings.

Introduce your self ( Your name, where

is your organization located, your role)Introduce purpose of the visit.

Carry out intended activity.

Set goals for the next visit.

Summarize the visit.

Thank people you have visited.

Make appointment for next visit.

Make records if possible.

Say good bye.

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4.3. Recording and report writing

Recording:

In any intervention, record keeping is a critical

step since it provides information for follow up,

provides accountability and keeps track of

activities done by peer educators in the

community.

Methods used in record keeping:

Report writing.

Documentaries.

Filing.

Stores.

Library.Record keeping has the following advantages:

Helps us to monitor and evaluate

progress.

Records act as references.

They help us remember what we havedone.

Record keeping helps in planning and

noticing the best practices.

It increases accountability.

After recording what you have done and

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how you have worked with a client, you

write a report. A Report can be a spoken

or written account of something heard,

seen or done.

Characteristics of a good report:

Concise and precise.

Straight to the point.

Short sentences.

Clear to the reader.

Simple language.

Flow of ideas.

Target the readers' attention.

Write it soon after meeting a client to

memorize.

Remember to update records.

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4.4. Referral

Place to contact/ get more information and

help:

MU-JHU CARE LTD/PEER PSYCHOSOCIALSUPPORT GROUPS (Makerere University Medical

School, P.O. Box 23491, Kampala)

The John Hopkins University (P.O. Box

23491, Kampala)

Reproductive Health Uganda(RHU)Former Family Planning Association of

Uganda(FPAU), Plot 2 Katego Road Off

Kira Road P.O. Box 10746, Kampala

MILDMAY UGANDA, Transforming HIV

care (Entebbe Road P.O. Box 24985)TASO, The AIDS support organization

(Kanyanya, P.O. Box 10443, Kampala)

BAYLOR COLLEGE OF MEDICINE:

CHILDREN'S FOUNDATION UGANDA

(Mulago Hospital P.O. Box 72052, Clock Tower)

KASANGATI HEALTH CENTRE.

BUWAMBO HEALTH CENTRE.

KAWANDA HEALTH CENTRE.

KAWEMPE HEALTH CENTRE.

KAWEMPE YOUTH DEVELOPMENT

ASSOCIATION (KYDA)

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GLOSSARY

Alcohol/drug dependency: The use of non-

sterile injecting drug equipment is one of the

most efficient modes of HIV transmission and

remains one of the critical activities fuelling

HIV epidemics among drug users. Other

dependencies such as alcohol and non-

injecting drugs may also create vulnerabilities

to transmission and infection.

Bereavement Support: Support for people

dealing with grief due to the loss of a loved one.

Care for Orphans and Vulnerable

Children: Support and guidance for children

under the age of 18 who have lost parents

and/or caregivers, and children who are at risk

of abuse, mistreatment, or exploitation.

Child headed house hold: House hold where

everyone who are living there are younger than

18 years old.

Education and Vocational Training:

Learning new skills and/or taking classes.

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Food Security and Nutrition: The

availability of food and one's access to it. A

household is considered food secure when its

occupants do not live in hunger or fear of

starvation.

Gender: Addressing widely held beliefs,

expectations, customs and practices within a

society that define 'masculine' and 'feminine'

attributes, behaviors and roles and

responsibilities.

Grand Mothers/ Guardians: Maternal or

paternal grandparent or guardian, who looks

after, protects or is legally appointed to

manage the affairs of another person, such as

a child.

HIV Prevention and Behavior Change:

Transmission of HIV is mediated directly by

human behavior, therefore changing

behaviors' that enable HIV transmission.

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Health workers/Caregivers: Hospital/clinic

staff, public health, health outreach workers,

family and community caregivers.

HIV Testing and Counseling: HIV tests are

used to detect the presence of the human

immunodeficiency virus in serum, saliva, or

urine. As per UNAIDS/WHO guidelines all

testing, whether client or provider-initiated

should be conducted under the conditions of the

Three Cs: involve informed consent, be

confidential, and include counseling.

HIV and Disability: Addressing the unique

risks of HIV for people with disabilities. This may

include physical barriers to access appropriate

HIV prevention and support services, as well as

vulnerability in the community because of

limited livelihood opportunities and/or stigma

and discrimination.

HIV + children: Children living with HIV/AIDS.

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Home-Based Care Any form of holistic home-

based care given to those in need, and which

strengthens the capacity of and support for

community health workers. Such care includes

physical, psychosocial, palliative, and spiritual

activities.

Medical access, diagnostics, medical care:

Obstacles to medical access include the cost for

ARV treatment, as well as the health

infrastructure required to deliver ARV's and

provide diagnostic services. Access to

treatment depends not only on financial and

human resources but also on people who need

them being aware of their HIV status,

knowledgeable about treatment, and

empowered to seek it.

Orphans and vulnerable children: These are

children who suffer from physical, mental or

environmental stress that is based on a set of

:

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criteria/standards bear substantive risks when

compared to other children.

Opportunistic Infections: Illnesses causedby various organisms, some of which usually do

not cause disease in persons with healthy

immune systems. For example, Tuberculosis is

the leading HIV-associated opportunisticinfection in developing countries.

People living with HIV and AIDS (PLWA):

Those who have been diagnosed with

HIV/AIDS.Persons with Disabilities: Those who have

some disability or infirmity (physical and/or

mental)

Palliative Care: An approach which improves

the quality of life of patients and their families

facing life-threatening illness, through the

prevention, assessment and treatment of pain

and other physical, psychosocial and spiritual

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problems.

Psychosocial Support: Support to address

the ongoing psychological and social problemsof people living with HIV or AIDS, their

partners, families and caregivers.

Positive prevention: Is a strategy that aims

at contributing to the reduction of HIVtransmission by building the capacity of people

having AIDS and the general community to

scale up HIV/ STI prevention.

P o v e r t y A l l e v i a t i o n / E c o n o m i c

Livelihoods/ Income Generation:

Processes that seek to reduce the level of

poverty in a community, or amongst a group of

people or individuals. Programs are aimed at

decreasing economic poverty through

economic development and income generating

activities.

Prevention of vertical transmission

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(PMTCT): Prevention of transmission of HIV

from mother to fetus or baby during pregnancy or

birth.Protection: Efforts to keep PLWHA, their

partners, families and caregivers safe. For

example efforts to provide legal or human rights

protection for PLWHA.

Public outreach: Efforts by individuals in an

organization or group to connect its ideas or

practices to the general public. Activities typically

take on an educational component but may

conceive their outreach strategy as a two-way

street in which outreach is framed as

engagement rather than solely dissemination or

education.

Sexual and Reproductive Health and Family

Planning: Addressing the reproductive

processes, functions and systems at all stages of

life, is aimed at enabling men and women to have

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responsible, satisfying and safe sex lives, as

well as the capacity and freedom to plan if, when

and how often to have children.Shelter and Material support: Provision of

housing or monetary support which may take

the form of government benefits, food, clothing,

furnishings, medical equipment, transportationetc.

Stigma and discrimination: AddressingHIV

infection as widely stigmatized and that people

living with the virus are frequently subject to

discrimination and human rights abuses based

on their positive status.

Street children: Includes children who work in

the streets and markets of cities selling or

begging, and live with their families, as well as

homeless children who work, live and sleep in

the streets, often lacking any contact with their

families.

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Treatment access, readiness, and

adherence: Addressing barriers to accessing

treatment and providing education, support andcounseling to support informed choices about

treatment options and access to and adherence

with prescribed treatments.

Training: Any classes, field training, skillsbuilding workshops and mentoring.

Target groups: This refers to the persons that

the resource

Youth: Persons between the ages of 15 and 24years of age (based on UN definition).

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Acronyms

AIDS= Acquired Immune Deficiency SyndromeART = Anti-retroviral Therapy

ARV = Anti- viral drugs

HIV = Human Immune-deficiency Virus

IEC = Information Education Communication

PLWHA = People living with HIV and AIDS

PMTCT = Prevention of mother to child

transmission

STI = Sexually transmitted infections

UN = United Nations

WHO = World Health Organization

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References

Peer User Pocket Book, Drug Abuse: Peer-to-

Peer Prevention Program, UYDEL (2003).

Peer educators training Manual organized by

KYDA in partnership with trainers from TASO andth thKawempe health centre (6 10 of September

2010). (un published)

Positive Prevention Counseling, A Training

Course for Peer Educators, Participants' notes

(2007).UNGASS COUNTRY PROGRESS REPORT

UGANDA, January 2008-December 2009.

Government of Uganda (2010).

http://www.avert.org/aids-uganda.htm

http://www.catie.ca/ng_e.nsf(A Practical

Guide to Nutrition for People Living with HIV)

http://www.unaids.org

http://www.who.int/en/

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Kawempe Youth Development Association(KYDA)

Located Jinja Kawempe Zone A Near St.benard P/sPO Box: 71976 Clock Tower Kampala

kyda peer book educator

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