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Is It Likely to Contract Hiv from Sleeping with Someone Once - DOC

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					                            HIV BASIC CARE DRAMA BRIEF
                     A Branded and Generic Communications Campaign

   1. Project Background
   In collaboration with CDC, PSI has developed a HIV care and support IEC/BCC program
   designed to reduce morbidity and mortality and improve quality of life for PLWHA. There
   are 2 key messages included in this intervention:

           (i)    How to prevent opportunistic infections
           (ii)   How to prevent the transmission of HIV to others.

   The basic Care Package IEC/BCC materials and activities are designed to offer care and
   support to PLWHA by providing accurate and quality information counselling and
   commodities that will help them live a longer and healthier life.


   2. Brand Positioning and Market Standing

       Product: Positive Living is the brand for the Basic Care Package. The Basic Care IEC
        materials are all branded with this logo.
       Functional Attributes: correct and consistent use of cotrimoxazole prophylaxis
        decreases diarrhoea by 32%, malaria by 73%, hospitalisations by 43% and mortality
        by 47%.
       Emotional Benefits: Even if you have HIV/AIDS you can still live positively by
        consistently and correctly using the components of the Basic Care Package, and
        prevent transmission to those you love.

   3.   Brand Personality
       Positive
       Safe
       Healthy
       Essential

   4. Target Audience(s)
    People living with HIV/AIDs (PLWHA)
    Health Workers: They are important change agents in promoting accurate risk
      awareness and behaviour change.

   5. Specific Objective(s)
    To decrease morbidity and mortality in PLWHA due to opportunistic infections.
    To promote positive living for PLWHA, including awareness and correct and
      consistent use of cotrimoxazole prophylaxis, malaria prevention, safe water and
      “Prevention with Positives” counselling (including disclosure, discordance, couple
      testing, safer sex and condom us, family planning and PMTCT).

   6. Overall Campaign Objective(s)/Purpose
    To promote awareness of the benefits of consistent and correct use of cotrimoxazole
      everyday, sleeping under an insecticide treated net every night, drinking safe water
      and taking action to prevent the transmission of HIV to others by abstaining or using
      a condom during sexual intercourse and accessing PMTCT services.




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   7. Obstacles
    Stigma – PLWHA may be afraid to access the Basic Care Package (live positively)
      because they fear stigma and discrimination by the community
    Remembering to take cotrimoxazole everyday can be challenging (difficult to
      remember, may have side effects, treatment fatigue)
    Treated water may have a chemical (chlorine like) smell
    Sleeping under an ITN might be difficult (concerned about insecticide, it is too hot,
      too expensive)
    Why should I tell my partner my HIV status or encourage them to test? If I am
      positive they must be positive.
    If I am HIV positive, I will have an HIV positive baby.
    PLWHA don’t know where to access services and products in the basic care package


   8. “For Me Statement”
      “As a PLWHA, I need to live positively to have a longer and healthier life.”


   9. Key Promise
      “If as a PLWHA, you use the components of the basic care package correctly
       and consistently, you will a longer and healthier life “


   10. Support Statements
    Cotrimoxazole prophylaxis is recommended by UNAIDS and WHO for all PLWHA,
      and has proven to be cost – effective, sustainable and lifesaving intervention for
      PLWHA around the world. The correct and consistent use of cotrimoxazole
      prophylaxis decreases diarrhoea by 32%, malaria by 73%, hospitalisations by 43%
      and mortality by 47%.
    Correct and consistent use of point-of-use water systems have been proven to
      reduce diarrhoeal incidence by 32% in PLWHA.
    PLWHA are 2 times more likely to contract malaria and 3 times more likely to die
      from it. Sleeping under an insecticide treated net every night reduces the incidence
      of malaria by 50%. The insecticides used in ITNs are safe for humans and are
      approved by WHO, MOH and NDA.
    Even if one partner tests positive for HIV, there is a good chance (30%) that the other
      partner is negative. But the only way to know is to test together and share the
      results.
    HIV can be transmitted from mother to child during pregnancy and birth and even
      after birth, but using prevention of mother to child transmission services can reduce
      the risk of HIV transmission from an HIV positive mother to her unborn child.
    Basic Care services and products can be obtained for free from select health centers.
      See your local health provider for details.

   11. Tone of the Message
    Supportive
    Encouraging
    Informative
    Simple, clear and non-stigmatising




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   12. Media/Requirement
    Drama script of no longer than 45 mins. Format of drama should be as follows:
         - Introduction (What is the basic care package? Why do PLWHA need it?
         - Drama (detailed relay of components of the BCP, availability, how these
            components should be used) – Musical traditional dance should be part of the
            drama to maintain attention of the audience.
         - Q & A (on all aspects of the BCP from the audience)


   13. Creative Considerations
    The Drama will be translated into English, Luganda, Luo and the 4Rs


   14. Deliverables
    Creative concepts with detailed budget             Mar 1, 2005
    PSI selection of script                            Mar 4, 2005
    PSI selection of agency                            Mar 11, 2005
    Pilot of Drama Presentation                        Apr 1, 2005



Appendix 1:   Basic Care Package - Messages
Appendix 2:   Background Information – PSI Uganda
Appendix 3:   Background Information – Basic Care Package
Appendix 4:   Positive Living Logo




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                       Appendix 1: Basic Care Package: Messages


COTRIMOXAZOLE:

Summary:

      For all adults and children living with HIV, taking cotrimoxazole everyday can prevent
       illness and prolong life.
      Cotrimoxazole is a common antibiotic that is sold by many brand names but the
       medication is the same.
      Cotrimoxazole is not expensive and is widely available in Uganda.

Key Message:

“I take cotrimoxazole everyday to prevent illness and prolong my life.”

                  “I take cotrimoxazole everyday to protect me from illness and prolong my
                   life.”
                  What is cotrimoxazole? Cotrimoxazole is an antibiotic, commonly sold in
                   Uganda as Septrin®, that has helped people living with HIV all over the
                   world live longer and healthier lives. WHO/UNAIDS and the Ministry of
                   Health recommend cotrimoxazole prophylaxis for people living with HIV.
                  What does it do? If you are living with HIV, taking cotrimoxazole everyday
                   can prevent illnesses, like malaria and diarrhoea, and help you live longer.
                  What dosage do I need and how often do I need to take it? Before
                   starting cotrimoxazole prophylaxis, you must first test positive for HIV and
                   then you should talk to your health provider. Your provider will advise you
                   if cotrimoxazole is right for you and recommend the correct daily dosage
                   for you.
                  Why do I need to take cotrimoxazole daily? To prevent illness and
                   prolong life cotrimoxazole should be taken everyday.
                  Is it expensive? Cotrimoxazole is not expensive! It costs on average 2,000
                   UGS for 1 full month of treatment.
                  Where can I get cotrimoxazole? Cotrimoxazole is widely available in
                   pharmacies and clinics. It is sold by many brand names such as
                   Septrin®, Unitrim®, Mortin®, Cortimal® and Cotrim®. Regardless of the
                   brand name the medication is the same.
                  How do I find out more about cotrimoxazole prophylaxis? Ask your health
                   care provider for more information or visit an HIV/AIDS support
                   organization near you.

“Protect your body from illness and live longer – take cotrimoxazole everyday for life. Ask
your health provider for more details.”


 MALARIA:

Summary:

      People living with HIV have a higher risk of contracting malaria.
      Malaria can be very severe for people living with HIV.
      Protect yourself and your family from malaria by always sleeping under a long-
       lasting, insecticide-treated bed net (ITN).



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Key Message:

 “My health provider told me that because I am HIV-positive, I am at high risk for malaria.
To protect ourselves from malaria, my family and I always sleep under insecticide- treated
bed nets (ITNs).”

                 “My health provider told me that because I am HIV-positive, I am at higher
                  risk for malaria. To protect ourselves from malaria, my family and I
                  always sleep under insecticide-treated mosquito nets.”
                 Why is preventing malaria important? Malaria can be severe for people
                  living with HIV because the body’s immune system is often too weak to
                  fight malaria. Research indicates that people living with HIV are twice
                  more likely to catch malaria, and three times more likely to die from it.
                 How can I prevent malaria? Malaria can be prevented by always sleeping
                  under an insecticide-treated mosquito net.
                 How do I use an insecticide-treated mosquito net? Tie the insecticide-
                  treated mosquito net above the bed or the sleeping mat and use it every
                  night during the year. When using an insecticide-treated mosquito net,
                  roll it down to cover the whole bed or sleeping mat and if necessary, tuck
                  it under the mattress or sleeping mat, taking care to ensure that there are
                  no openings to allow mosquitoes inside.
                 What is the difference between a long-lasting insecticide-treated mosquito
                  net and a normal insecticide treated net? Both types of mosquito nets are
                  effective in preventing the transmission of malaria; however, a long-lasting
                  insecticide-treated mosquito net does not need to be re-treated. A normal
                  insecticide-treated mosquito net needs to be retreated with an insecticide
                  treatment at least two times per year.
                 How safe is the insecticide used in insecticide-treated mosquito nets?
                  The Ministry of Health and the World Health Organization have approved
                  the use of insecticide-treated mosquito nets. Insecticides used to treat
                  insecticide-treated mosquito nets are safe for human beings but are
                  deadly for insects like mosquitoes, bed bugs and head lice.
                 “Protect yourself and your family from malaria by always sleeping under
                  an insecticide-treated mosquito net.”

SAFE WATER AND DIARRHOEA PREVENTION

Summary:

      Always treat your drinking water to kill germs that cause diarrhoea and illness.
       Untreated water can contain germs, even if it looks clear.
      Store your drinking water in a safe water vessel.
      Wash your hands with soap after using the toilet and before preparing or eating food.


Key Messages:

“My doctor warned me that diarrhoea can be dangerous when you have HIV. To protect
myself and my family from diarrhoea, we treat our drinking water and always wash our
hands after using the toilet.”




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                  “My health provider warned me that diarrhoea can be dangerous when
                   you have HIV. To protect myself and my family from diarrhoea, we treat
                   our drinking water with WaterGuard and store it in a safe water vessel.”
                  Why is preventing diarrhoea important? Diarrhoea can be dangerous for
                   people living with HIV because the body’s immune system is often too
                   weak to fight the germs that cause diarrhoea. Untreated water can
                   contain germs that can cause diarrhoea, even if the water looks clear.
                  How can I prevent diarrhoea? Diarrhoea can be prevented by always
                   treating your drinking water with WaterGuard. WaterGuard is a water
                   purification solution that kills the germs that cause diarrhoea, making your
                   water safe to drink without boiling.
                  Where can I find WaterGuard? WaterGuard can be found in clinics,
                   pharmacies and drug shops.
                  How do I use WaterGuard?
                        Add 1 capful of WaterGuard to 20 liter vessel full of un-boiled
                           water
                        Cover the vessel and shake thoroughly until the WaterGuard is
                           completely mixed with the water
                        Wait for 30 minutes before using the water
                        After 30 minutes your WaterGuard treated water is free of germs
                           and safe to drink
                  How should I store my treated water? Store your treated water in a clean
                   safe water storage vessel to prevent recontamination.
                  What else can I do to prevent diarrhoea? Always wash your hands with
                   soap before preparing or eating food and after using the toilet.

“Prevent diarrhoea by always treating your drinking water with WaterGuard and storing it in a
safe water vessel – everyday for life.”



PREVENTION WITH POSITIVES

Summary:

      Support your partner to get an HIV test. If you are HIV-positive, there is a good
       chance that your partner could be HIV-negative.
      Abstain from sex or practice safer sex by always using a condom.
      Avoid unintended pregnancy by using family planning methods.

If you become pregnant, use prevention of mother-to-child transmission (PMTCT) services


Key Messages:

“When I tested positive for HIV, I was afraid to tell my wife and I was worried that I might
have infected her. But I learned that she had a good chance of not yet being infected, so I
decided to talk honestly with her.”

“When John told me that he tested positive for HIV, I was very upset and scared that I might
have HIV too. We decided to go and test as a couple. The counsellor taught us many
things about positive living.”




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                  Support your partner to get an HIV test. It is important to know that even
                   if one partner tests positive for HIV, there is a good chance (30%) that the
                   other partner is HIV negative. Once you both know your status, you can
                   make responsible choices about healthier living for you and your family.
                  Protect your partner from HIV. If you are living with HIV, protect your
                   partner by abstaining from sex or always using a condom. If you are
                   living with HIV and have a sexually transmitted infection (STI), there is an
                   increased risk of passing HIV to your sexual partner.
                  Avoid unintended pregnancy by using family planning methods. If you are
                   living with HIV, avoid unintended pregnancy because the virus can be
                   transmitted to your unborn child. If you and your partner still chose to
                   have a baby, ask your health provider about how to prevent mother to
                   child transmission (PMTCT) of HIV. PMTCT services are available in
                   most antenatal clinics.
                  See your health provider for more details.
                  “Support your partner to test for HIV and use abstinence, condoms, family
                   planning and PMTCT to protect the ones you love from HIV.”




Basic Care Package Summary:

1. By taking cotrimoxazole everyday for life, we can live a healthier and longer life.
2. By sleeping under an insecticide-treated bed net every night, we can prevent malaria
   that can be severe for someone living with HIV.
3. By treating our drinking water and storing it in a safe water vessel, as well as washing
   our hands with soap after using the toilet and before handling food, we can prevent
   diarrhoea which can be life threatening for someone living with HIV.
4. By supporting our partners to test for HIV, practicing safer sex, and using family planning
   and prevention of mother to child transmission services – we can protect those we love
   from HIV.

Take these steps today, for you and your family to live healthier and longer lives –
everyday for life.




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                       Appendix 2: Background Information – PSI


Who is PSI Uganda?
PSI Uganda is a non-profit organization funded by USAID, working under the mandate of the
Ministry of Health. PSI Uganda employs over 60 local staff and prides itself on training and
human development from the inside out. We promote the good health of all Ugandans,
using social marketing and behaviour change communications.

PSI Uganda’s Mission Statement
PSI Uganda serves the essential health needs of all Ugandans, with a focus on vulnerable
populations. We strive to provide quality health products and services to the widest number
of people possible. PSI Uganda ensures these essential health products and services are
made available, accessible, affordable and desirable.

What is Social Marketing?
 Social marketing is the provision of essential health products, services and behaviour
  change communications.
 Commercial marketing techniques are used to distribute products to an existing retail
  sector.
 The products are subsidized to make them affordable to the majority of low-income
  consumers.
 The products are advertised through various media channels to educate and inform
  consumers about the benefits of their use.
 Behaviour change communications, both branded and generic, are used to complement
  these activities to communicate difficult health messages.

Areas of Intervention
PSI Uganda works in the areas of:

1. HIV/AIDS Prevention, including the promotion of the ABC’s (Abstinence, Be faithful, and
   use a Condom), early and effective STI treatment, prevention of mother-to-child
   transmission (PMTCT) and voluntary counselling and testing (VCT)
2. Family Planning and promotion of informed choice of contraceptive methods
3. Malaria prevention and early treatment amongst pregnant women and children
4. Safe water point-of-use treatment systems to reduce levels of morbidity and mortality
   due to diarrhoea and waterborne disease

PSI Uganda is an innovative organization that uses proven methodologies to promote
healthy behaviour change for the overall promotion of good health in Uganda. PSI Uganda
strives to deepen the health impact in these three areas and is currently expanding its
activities to include care and support initiatives for People Living with HIV/AIDS (PLWHA).




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                   Appendix 3: Background Information – HIV Basic Care.


HIV BASIC CARE AND PALLIATIVE CARE

(Goal, Purpose, Outputs, Specific Deliverables and Target Populations of PSI Uganda’s IEC and
Social Marketing for People Living with HIV/AIDS)

The Goal of this project is to reduce morbidity and mortality among People Living with
HIV/AIDS (PLWHAs) in Uganda, to enable them to lead healthier, longer lives.

The Purpose of this project is to increase use of HIV Basic Care and Palliative Care products
and services to PLWHA in Uganda.


TARGET GROUPS:

The Primary Target Group for this project is People Living with HIV/AIDS in Uganda.
According to the Ministry of Health in 2002, there are approximately 1 million1 PLWHAs in
Uganda. With few ARV drugs available to PLWHAs2, and with limited access to affordable
health care, PLWHAs need simple, practicable solutions for improving their health and
extending their lives. TASO, Uganda’s largest HIV/AIDS care and support organization,
estimates that the average education level of its clients is limited to primary education levels
(71%),3 and very few of them know of products or health measures that will help them fend
off illness or opportunistic infections. This information is assumed to hold true for client
populations of other post-test and support groups.

To reach this primary population, PSI Uganda will work with TASO and other organizations
that support PLWHAs, including faith-based groups and post-test clubs. Some examples of
these organizations include Mildmay, Reach-Out, AIC, and the Philly Lutaya Initiative, We
will enlist the help of TASO and other partners to identify and locate their members so that
we may begin distributing information and IEC materials to these members, and may begin
working with their providers, counsellors and support people to ensure that all understand
the role of Basic Care and Palliative Care products and services. Between 30,000 and
40,000 people currently count themselves as TASO clients, with new clients and new TASO
sites being added regularly4. In addition, AIC’s post-test clubs and the Philly Lutaya Initiative
count more than 2,000 people as members.5 Though it is difficult to determine how many
PLWHAs are supported through faith-based organizations, PSI estimates that as many as
50,000 draw on the services of their local and community churches and mosques for help in
coping with their disease. CDC Uganda predicts that a minimum of 200,000 PLWHAs will
eventually benefit from the Basic Care and Palliative Care Packages.

PSI Uganda will develop materials to target PLWHAs with messages of how they can
improve their quality of life, and live longer with HIV/AIDS. These materials will be simple,
pictorial and easy to understand, and produced in multiple local languages. Examples of
such materials are brochures given to all clients of both VCT and post-test organizations,


1
  This figure is based on Ministry of Health estimates published in the 2002 STD Control Program Report.
2
  An estimated 10,000 Ugandans are currently receiving ART. Source: Antiretroviral Treatment Policy for
Uganda (Draft), Ministry of Health, Kampala, April 2003, p.2.
3
  TASO Annual Report Data (Draft), 2003. Contact: Robert Ochai, Director of Program Support and
Evaluation, TASO.
4
  TASO Annual Report Data (Draft), 2003. Contact: Robert Ochai, Director of Program Support and
Evaluation, TASO.
5
  Post-Test Club/Philly Lutaya Initiative Department, AIDS Information Center, Kampala, 2004.


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posters to be displayed in all these sites where PLWHAs access health services or
information, and billboards advertising the message that there are things people can do to
live longer and live better with HIV. PSI’s partner, Straight Talk, will develop a radio
campaign that will target PLWHAs in a number of languages and will cover the entire country
with messages about how to live well with HIV.

The secondary Target Groups for this project are health care providers and counsellors.
TASO has more than 220 medical staff and counsellors, and AIC employs 53 counsellors
and health providers. In addition, FBOs like the organization Reach Out, who serves an
estimated 1,150 clients,6 have moved increasingly to support PLWHAs with counselling as
well as health care and treatment of opportunistic infections. None of these providers or
counsellors currently has quality IEC materials to share with clients, and few have been
trained in important aspects of the Basic Care or Palliative Care packages, such as the
provision of cotrimoxazole prophylaxis to PLWHAs, or the necessity of treating home
drinking water in order to avoid diarrhea. PSI Uganda will develop materials in conjunction
with the Ministry of Health, instructing providers in details of care and support options for
PLWHAs. In addition, PSI Uganda will create brochures, flipcharts, and other useful
teaching tools for providers to use when dealing with their HIV positive clients. Through its
existing medical detailing force, PSI will also distribute provider information to the more than
3,033 health providers currently reached through PSI training and information on HIV best
practices.

The tertiary Target Group for this project is caregivers and government. Many PLWHAs rely
on their family members or their community to help them when they are sick, and to take
care of them when they cannot afford or are not willing to go to a health facility. PSI Uganda
will work with family members and other caregivers of PLWHAs to ensure that these support
people understand the many elements of Basic and Palliative Care, and know where and
how to access these products, services and information. In addition, PSI will work with
relevant government ministries and officials to educate and sensitize these groups about the
benefits of Basic and Palliative Care for people with HIV/AIDS




6
    Reach Out: Mbuya Parish Initiative Quarterly Report, June 2004, p.3.


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             Appendix 4: Positive Living Logo




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