INERELA+ Sierra Leone Training Manual. Welcome Explain that this workshop is not a sermon, that the sessions need to be as interactive as possible and that questions are welcome at any time. The ground rules are that everybody is allowed to speak, everyone’s opinion is valid there is mutual respect shown to all. Prayers Introduction to who INERELA are: INERELA+ is an international, interfaith network of religious leaders - both lay and ordained, women and men -- living with or personally affected by HIV. It is recognized that religious leaders have a unique authority that plays a central role in providing moral and ethical guidance within their communities; indeed their public opinions can influence entire nations. INERELA+ looks to empower its members to use their positions of respect within their faith communities in a way that breaks silence, challenges stigma and provides delivery of evidenced-based prevention, care and treatment services. Show Slide of breaking down the name. I nternational N Etwork of RE ligious L eaders living with or personally affected by HIV and A ids Action: ask the participants to describe what is the traditional religious attitude towards HIV . Write answers on a flipchart. Compare to the prepared presentation. Show slide of Traditional religious attitude towards HIV -Aids is God’s punishment for sin -This is not our problem -Nobody in our faith community has Aids -Them vs us -Hiv related to immorality -Relious leaders looked to as”Bastion of perfect religious living” Therefore greater stigma for hiv+ religious leaders INERELA+ formed as a response to these attitudes and from the testimony of Canon Gideon Byamugisha of Uganda. Canon Gideon Byumgisha was the first religious leader in Africa to openly declare that he was HIV positive. INERELA+ was formed in Johannesburg South Africa and helps to coordinate the global network. In Sierra Leone INERELA+ began with a Christian Aid retreat for religious leaders living with personally affected by HIV. First funded in january 2007. INERELA+ Sierra Leone exists for the following reasons. INERELA+ Sierra Leone's mission is simple. We seek to mobilise PLHIV , both infected and affected faith leaders and their communities to be an effective, powerful, multi- faith force that contributes to a reduction in HIV transmission and improves the quality of life for people living with HIV. Show Slide Of Why Inerela Exist INERELA+ Sierra Leone exists to: To help PLHIV overcome self stigma and to break silence. Is to reach out to religious leaders living with or personally affected by HIV To stimulate the response of faith communities to HIV, ending societal and faith specific stigma and discrimination. To advocate and engage in compassionate and effective HIV prevention, care, treatment and support. To support our members to live positively. To work towards a Sierra Leone where HIV infection and stigma related death is completely prevented and eradicated. How INERELA+ Sierra Leone works: Runs trainings for religious leader Provides resources for religious leaders to use within their own communities Action: Encourage and ask questions about INERELA. Ask everybody to introduce themselves/ Icebreaker 15 mins 1. Give Everybody a small piece of paper and ask them to write down on their paper what they expect from the training and on another sheet what they fear about talking about HIV 2. Get the religious leaders to talk to one another 3. - and form groups based upon the similarities of their answers 4. As a group to explain what they hope to learn and what they fear. Quick KAP survey (20 mins) Show slide HIV the basics and beyond. H uman I mmunodeficiency V irus A cquire I mmuno D efficiency S yndrom. What Does The Virus Do In The Body Show slide on White Blood Cells defending the body The white blood cells serves as our body defence, it protect our body from sicknesses and . Show slide of HIV virus attacking the WBC. When the HIV virus enters the body it attacks the immune(wbc) system . Show slide of the dead white blood cell when the hiv kills the white blood cells,the body is left unprotected and vulnerable to various infections Show slide of the body vulnerable to infection .When two or more sicknesses are shown then that person is said to have AIDS. WHAT IS HIV 1 and 2 HIV 1 -Is found all over the world -It is more aggressive -More violent -more common than hiv2 even in areas where hiv 2 is present Hiv 2 -Found only in west Africa -Less aggressive - Less violent -Less common than hiv1 even where there is epidemic. In Sierra Leone 91% of those living with virus have HIV- 1 only, 4.5% were living with HIV both HIV-1 and HIV-2 and 4.5% HIV-2 How do people contract the Virus? Action 1. Ask the religious leaders to shout out the ways that HIV can be transmitted. 2. Even if they are wrong write them down onto a flipchart page. 3. When they are through- lead a discussion on each point- dispelling each myth. Show slide of the body fluids that can transmit the virus. There are only four body fluids that can transmit the virus. 1. Body fluid Semen Vaginal Fluid Breast Milk Blood Notes on Breast feeding. A breast feeding mother who has HIV can pass the virus to her baby through her breast milk. UNAIDS estimates that 30-35% of children acquire HIV infection through breastfeeding from positive mothers who are not seeking medication. However, breast milk has many benefits for the baby as it provides a good source of nutrition and protects from other infections. The alternative to breastfeeding for HIV positive women is formula feeding. This is not possible for many women because SMA milk is simply too expensive. Even when SMA milk is affordable, clean water is needed to mix the formula and the bottles required for feeding need to be sterilised. Dirty water can lead to diarrhoea which can be very serious in baby and can often result in death. Clean water is a problem in many communities, and sometimes families may not have the fuel to build a fire to boil water to purify it. If formula and clean water are not available, studies suggest that the benefits of breatfeeding outweigh the risk of HIV transmission . It is important to note that where clean water is available , breast milk and formula feeding at the same time can increase the likelihood of HIV passing from a mother to her child and so doing both is not recommended, Show slide of how HIV is not transmitted. HIV is not transmitted through: Eating with people Sleeping together. Sharing the same toilet. Mosquitoes bites Playing together Shaking hands/ hugging Condoms. Kissing Preaching from the same pulpit!! Show slide of what AIDS is AIDS Is a collection of illnesses due to the weakness of the immune system. AIDS is a condition which is brought by hiv when it is not properly manage. AIDS is curable AIDS is preventable and manageable. HIV messaging game 1. Get the participants to sit in a circle. 2. Think of a phrase to whisper beforehand such as “many people around here like eating bananas” or “ the sun at this time of year is very hot” 3. Whisper this quietly to your next door neighbour and ask him/her to whisper it quietly to the next person 4. This should be repeated until the phrase has been whispered around the whole circle. Each person should only whisper what they heard and are not allowed to ask for the phrase to be repeated. 5. When the phrase has gone all the way around, ask the last person who received the message to announce what they have heard. 6. Then announce the message that you originally started with. The messages should be quite different. Point out how easy it is for messages to be confused, and misunderstood. Show slide of the old ABC message: The INERELA+ Sierra Leone approach to HIV. SAVE The old message of ABC is damaging and stigmatizing: A- Abstain B- Be Faithful C- Condomize Or as it is taught. A- Abstain If you cannot Abstain at least B - Be faithful. If you cannot be faithful at least C- Use a condom If you cannot use a condom then D- Die Explain this is how a message can be misunderstood. Explain how it causes stigmas because all it talks about is.. Sex ABC focuses on one single mode of transmission and seems to attribute blame. Show SAVE SLIDE THE INERELA+ Sierra Leone approach focuses on SAVE! Show Safer practices slide S- Safer Practices Abstinence, Faithfulness, Condoms, blood screening, sterile needles, sterile equipment, prevention of mother to child transmission. All of these safer practices are of equal importance to one another! Show available medication slide A- Available Medication The medication for HIV is anti retro viral drugs (ARV) When taken consistently ARV medication reduces the virus in the body to tiny amounts and allows the person to live a normal and healthy life. How the drugs work? ARV drugs work by stopping the virus from making copies of itself. This brings the amount of virus sometimes down to an undetectable level and allows the bodies immune system (soldiers) to recover and become strong again. Are the drugs a cure? The current drugs are a treatment but they are not a cure. They stop the progression of the virus and allow the immune system to recover. But you will still be HIV positive. This is because HIV hides in cells that are “resting” or “asleep” in the body. These cells are not reached by the current drugs. Currently once you start taking ARV medication you will need to keep taking them for the rest of your life. However, newer drugs in the future may be easier to take and more effective. This means that you still may still get to die of old age rather than from HIV. It may also mean that you are alive when we find a cure- and this is something that is good to aim for. INERELA+ Sierra Leone advocates that ARV medication is available to all who require it, but also insist that the medication be made available for the opportunistic infections that are associated with HIV. As wells as clean water and nutritious food. Show Voluntary counselling and testing slide V- voluntary counselling and testing. The majority of those people who are living with HIV are unaware of their status. This puts themselves and others at high risk. Without knowing your status you are unable to make informed decisions about your sexual life, and are unable to access the ARV medication that will help control the virus. Show Empowerment slide Empowerment: Knowledge is power. If people know and understand the facts of HIV they are more likely to make informed decisions that can protect themselves and others. Empowerment of women is especially key to stopping HIV. Inaccurate information and ignorance, are two of the greatest factors driving HIV related stigma and discrimination. Education also includes information on good nutrition, stress management and the need for physical exercise. Correct, non –judgemental information must be disseminated to all. This can only assist people to live positively whatever their HIV status and help to break down the barriers that HIV has erected between people and within communities. After all, we must not forget that HIV is just a virus, Stigma has no place in an urgent matter of public health. Action: ask for questions. Show slide positive living. Positive living Positive living is about taking the attitude that you can live a full and positive life with HIV. Form the right relationship with yourself. Take a positive attitude. I AM strong, I CAN be Healthy, I WILL live with the virus. Eat well– nutritious foods, drink clean water, fresh fruit and vegetables Try to avoid– alcohol, drugs, sugar and caffeine. These damage the immune system. Try to exercise– this boosts the immune system. Avoid stress– this damages the immune system. Listen to your doctor and adhere to ARV medication. Follow all safer practices– Take the attitude that HIV stops with me. Make time for spiritual reflection—How does my HIV status affect my relationship with God? Ask the participants to take 10 minutes to reflect on how they feel that HIV reflects on their relationship with god. If people want to speak at the end give them time Show slide positive relations with your neighbour. Form the right relationship with your Neighbour Don’t hide away– get involved. Join your local support groups (NETHIPS, AHPREL+ etc) Become active in your community Make yourself available to others- you have a unique understanding.. Promote HIV awareness within your religious community. But allow others to minister to you. Show slide on disclusure Disclosure Disclosure is an entirely personal affair. There is not set method in disclosing nor should there be any pressure to disclose. You alone are able to judge whether you feel that you want to disclose or not. Ask the participants to discuss and write down what they see the potential benefits or drawbacks are for disclosing. When discussion is through compare to the printed slides/ Show slide on the benefits of disclosing. The Potential Benefits of Disclosure are; A free conscience A weight off your shoulders Access to care, support and love. Access to counselling. The ability to be a positive agent of hope and change within your community. When people do not understand something they often eact negatively. Thus the potential problems with disclosing are: Relationship problems with your: Spouse, Family, Friends, Community Members, Colleagues and Employers. Be prepared to become the victim of local gossip. You must however be prepared for negative or hostile responses. But you also must allow others to express their feelings. Other people’s level of HIV knowledge may not be as great as yours so be patient and careful in your explanations. Given time you can work issues out. You have to decide for yourself if it is the right thing to disclose your status. Show slide on the stages of disclosure. The Stages of Disclosure. Is the negative attitudes from people that cause fear, shame ,isolation, denial ect. because of somebody’s condition(HIV/AIDS positive people). Many of the negative attitudes towards people living with HIV are as a result of ignorance about how HIV is spread. However, stigma has been made worse by the view that HIV is somehow self-inflicted through people’s choices of behaviour. Churches /Mosques have sometimes made this worse by preaching about HIV only in relation to sin. When you have considering disclosing. Think of the 4‘W’s Who you plan to disclose to. Consider first disclosing to someone you feel that you can trust and who you feel will help to support you. This for example can be your spouse, a good friend or immediate family. What you are planning to disclose. Consider that in disclosing your HIV status you are revealing scary information that some people will not be able to handle. You will need to be careful in explaining clearly what HIV is. When is the most appropriate time to disclose? Consider your timing , there is no rush to disclose. Make sure you choose a time and setting that you are comfortable with, and that you are prepared mentally for a potentially hurtful response. Why you are choosing to disclose now. Consider why you feel the need to disclose now. What has changed? What are the benefits of disclosing now? Again take time to address any questions that the group might have. STIGMA AND DISCRIMINATION STIGMA AND DISCRIMINATION a definition Is the negative attitudes from people that cause fear, shame ,isolation, denial ect. because of somebody’s condition(HIV/AIDS positive people). Many of the negative attitudes towards people living with HIV are as a result of ignorance about how HIV is spread. However, stigma has been made worse by the view that HIV is somehow self-inflicted through people’s choices of behaviour. Churches /Mosques have sometimes made this worse by preaching about HIV only in relation to sin. Everybody in the room describes a time when they have been stigmatised. Then describe a time when they have stigmatised somebody else. Split into three groups. One group looks at what causes stigma One group looks at the ways that people are stigmatized One group looks at how those are stigmatized feel. All report back. Show slide the damaging effects of stigma and discrimination What are the damaging effects of Stigma and discrimination It frustrates prevention care and treatment efforts. Fear and shame associated with it keeps people from Learning or disclosing their HIV status Changing their behaviours for self protection and protection of others Caring for those who are HIV positive. Seeking and utilizing information, skills and services related to HIV and AIDS. It intensifies emotional pain and suffering Negates/ reduces life chances of the stigmatized. Show slide societal stigma TYPES OF STIGMA Societal stigma People fail to understand HIV, and change their behaviour towards somebody who is HIV positive. People automatically associated HIV with Sex and general immorality. An attitude that HIV positives somehow deserve their status. Negative conduct towards those people who are HIV positive. The signs of societal stigma are: Pointing fingers, unkind whispers and gossip. Hurting statements Rejection isolation and starvation Denying/ withholding love care support and treatment Torture (mental, spiritual, physical) Physical Violence & killing Mistreatment of an HIV positive persons friends and family Show slide self stigma The consequence of societal stigma is Self Stigma. The shame of societal stigma causes suffering for those who are living with the virus. It causes: A failure to accept themselves A tendency to over blame themselves A belief that they are incompetent, useless or very dangerous. That they are destined to dying soon. That they have sinned and cannot ever be forgiven or accepted. The signs of Self-stigma are: Feelings of shame, guilt & self hate Denial, depression and withdrawal Self destructive behaviour and tendencies. Suicidal thoughts because of their HIV status Show slide reactions to stigma Reactions to Stigma . Denial- People refuse to accept their HIV status or refuse to test for fear of the damaging effects of Stigma and discrimination The impact of stigma is felt as it: Drives the AIDS epidemic underground People die from preventable, postpone able and manageable conditions. People continue to be infected, sick, bereaved, widowed and orphaned needlessly. Quality and Quantity of life is reduced. Action: lead a focused discussion on how INERELA+ Sierra Leone and specifically religious leaders can make a stand against stigma and discrimination. Show slide on how stigma can be defeated. To fight stigma we must. Develop & expand congregational responses to HIV. Promoting awareness that is non judgemental, caring and compassionate. Be role models. To change attitudes we must live positively Overcome our own negative fears and self stigma We must preach to restore hope and to create a safe environment for PLHIV within our own religious communities and congregations. Become part of the advocacy against stigma. Revisit religious language, doctrines and public messages. Repair the damage done by previous religious statements. Affirm and support ministry of people infected or affected on all levels. Show conclusion slide. Lead a discussion on what has been told. Hand out the documents. Ask each participant what they plan to do with their own congregations. Ask participants to re fill in KAP survey.