Module: POSITIVE LIVING

Introduction The media are key gate keepers 1in the dissemination of vital information to the general public. This training module has been developed in recognition of this, and is therefore designed to equip members of the press including journalists, presenters, editors, and station managers, with knowledge on the meaning and importance of “Positive Living” to People Living with HIV (PLHIV).

By the end of the training, participants should understand the meaning and importance of positive living, be able to cite positive living practices, and be confident enough to speak with authority on the topic.

Module: “POSITIVE LIVING”

Preparation Time: 2-3 hours

Preparation Tips for Facilitator:

 Don’t go a step further until you have thoroughly read the Facilitator’s Notes and the Fact or Fiction Statements. Be well prepared and plan each session in advance. Make a note of all the materials you need including brochures, booklets, marker pens, Manila paper e.t.c and make sure you bring them all with you.

 Arrive early so you can welcome the participants.

 Prepare the room where the training will take place so that it is comfortable for all participants and allows for movement since each module includes at least one participatory exercise.

 Stick to the facts and ensure that personal issues are avoided. Make this stand very clear before you start the session.

 Encourage all participants to join in and take part in the training, including those who are silent.

 Set clear ground rules and expectations around participation, confidentiality and listening.

 Be conscious of your own feelings and fears around the topics you are going to discuss.

Duration: One hour

1 Media gate keepers include; editors, owners/proprietors, talk show hosts, journalists and correspondents. Page 1 of 14 Number of Participants: 10-15 Methodology:  Participatory Activity- Fact/ Fiction Game  Brainstorming-Definition of “Positive Living”

Materials Needed:  Positive Living fact sheet  Radio diaries on positive living  Positive Prevention brochure  Malaria and HIV Brochure  Nutrition and HIV Brochure  Diarrhea brochure  ART Basic Facts booklet and brochure

GOAL To increase knowledge of “Positive Living” among media gate keepers and enable them report/comment on “Positive Living” for PLHIV correctly and accurately.

OBJECTIVES By the end of the one-hour training session, participants will;-

 Be able to explain the meaning and importance of “Positive Living.”

 Understand and be able to explain “Positive Living” behaviors and practices.

 Appreciate the importance of delaying treatment by people who have HIV and are not on medication.

 Understand the importance of treatment adherence for people with HIV, who are already on medication.

 Be confident in their ability to speak / write / report/articulate issues on “Positive Living” during their work.

PROCEDURE

Welcome and Introductions: Briefly introduce yourself, the training goals and objectives for the session, and the training agenda.

STEP ONE: Introduction to “Positive Living” Methodology: Lecture Duration: 5 minutes

of 14 1. Inform participants that you are about to explore a topic that is sensitive since it is dealing with people who have HIV and are aware of their status.

2. Participants should therefore clearly note that the major aim of this discussion is to understand the term “Positive Living” and the practices surrounding it.

STEP TWO: Definition of “Positive Living” Methodology: Large Group Brainstorming Duration: 15 Minutes

1. Write the phrase “Positive Living” and place it on the wall.

2. Ask participants to write words or short phrases on Manila paper that they think of when they hear the phrase “Positive Living.”

3. Ask them to come and stick up what they have written next to the phrase “positive living’

4. After they have given their answers pin up the word with the correct definition of “Positive Living.”

5. Point out any differences between this definition and the participant’s submissions. This will aid you in knowing their pre-understanding of the subject.

6. Summarize by explaining the following about the meaning of positive living:

KEY CONTENT: “ Positive Living” means taking care of your health and body, when you have HIV.

Emotional well being is an important part of “Positive Living,” as a person needs to believe that they can live a normal, productive and healthy life with HIV, to be able to successfully follow positive living practices.

To live positively, people living with HIV need to take certain measures to preserve their health and well being. Whether the individual is on Anti retroviral Treatment (ART), or has not yet started, it is important to follow positive living practices for a healthier and longer life.

Positive living practices include the following;-

of 14  Joining a peer support group or club to with other people who have tested positive. Sharing experiences can help the person maintain a positive attitude.  Eating a nutritious diet

 Taking medication on time if they have started ART.

 Even if they have not started ART, taking a drug called septrin every day which helps to prevent opportunistic infections and delay the need for ARVS.

 Once on medication, make sure you adhere to it.

 Avoid unhealthy practices such as smoking and drinking excessive alcohol.

 Using clean boiled water to drink and cook. Exercise regularly to keep fit and strong.

 Sleeping under a long lasting insecticide treated mosquito net every night to avoid Malaria

 Paying regular visits to the health center for routine check

 If a woman with HIV is pregnant, she should seek prevention of Mother to Child Transmission (PMTCT) services to prevent her child from contracting the HIV virus.

 Using a condom each and every time they have sex.

7. Show above and other illustrations of ““Positive Living”” practices on a power point. You can also display hard copies of the above materials.

8. Ask participants if they have any questions or need anything clarified about the definition of “Positive Living.”

STEP THREE: Fact or Fiction Game Methodology: Participatory Activity – Game Duration: 30 Minutes

Note to Facilitator Please read the Facilitators Notes carefully before the session and especially before this game so that you have adequate information about “Positive Living” to handle any questions that arises.

1. Tell participants that you are now going to explore the issue of “Positive Living” further using a game called Fact or Fiction. Page 4 of 14 2. Through this activity, you will decide which of the views raised about positive living are true or false.

3. Remind participants that inspite of their personal feelings about HIV the answers in the game are based on true facts.

4. Emphasize the point that the aim of the session is to inform them about “Positive Living” and the behaviors that are to be promoted.

5. Ask all the participants to leave their seats and stand in a circle.

6. Explain the following instructions for the game:

a. Statements are going to be read to them and they need to decide whether it is Fact (true) or Fiction (false) or they Don’t Know.

b. For statements they think are Fact, they should raise both hands.

c. For statements they think are Fiction, they should not raise any hand at all.

d. For statements where they Do NOT Know, they should turn around and face away from the circle.

7. For every statement read, ask at least 1 or 2 people from any of the 3 categories why they chose that particular answer. Encourage short and fast answers.

8. Finally, read the correct answer to them and comment on any misconceptions.

KEY CONTENT: See Fact of Fiction Statements Attached.

9. Remind them that the aim of the session was to provide adequate information for them to better report on the issue and to form their own opinions based on fact.

STEP FIVE: Evaluation of Learning Methodology: Group Feedback Duration: 10 Minutes

1. Tell participants that you are going to do a quick evaluation of the session by asking them a few questions.

2. Tell them to give quick answers.

of 14 KEY CONTENT:

3. Ask participants what they learned as a result of the training. Probe for the following:

 Correct definitions of “Positive Living.”

 Correct and comprehensive explanations of “Positive Living” practices

 Understanding of the concepts surrounding delaying the need for ART

 Correct knowledge on the importance of adherence to ARVs for those already on medication.

4. Ask participants whether or not they feel confident enough to speak or report on positive living. Address any concerns they might have by clarifying any issues related to the training and what was covered.

5. To conclude, hand out positive living materials to all participants including;

 Positive living fact sheet.

 TB, Nutrition, Malaria, positive prevention and diarrhea brochures.

 ART Basic facts brochure and booklet.

of 14 TRUE OR FALSE STATEMENTS

1. STATEMENT: “Positive Living” is a term used to refer to HIV positive people who know how to take ANSWER: TRUE care of themselves It is important to take care of oneself when HIV positive. Having HIV does not mean one is going to die immediately! It means having a good attitude towards life and carrying out healthy practices to avoid getting sick. 2. STATEMENT: Living positively is a state of mind. As long as you are happy and optimistic, you can ANSWER: FALSE stay healthy. Being happy is not enough. Living positively is about both mind and body. One must also take the initiative to maintain physical well being through good nutrition, preventing opportunistic infections and adhering to medication e.t.c one must also take the initiative to always be healthy. 3. STATEMENT: You must spend a lot of money to stay healthy and be able to follow positive living ANSWER: FALSE practices. This is not necessarily true. Staying healthy is a about the lifestyle choices that you adopt and there are always economical options and alternatives. For instance if you cannot afford to go to a gym or health club, you can take a jog or walk regularly around your neighborhood. You can also maintain a health and balanced diet by buying nutritious foods that are in season and are readily available and therefore likely to be cheaper. You can even grow some of your own. If you are on ART, you can access free drugs from anumebr of public sector clinics as well as other support programs. Inquire about this from a health facility. 4. STATEMENT: Eating a lot of food of any type is a “Positive Living” Practice. ANSWER: FALSE It is the quality of foods rather than the quantity that is important in “Positive Living.” There are those that must be eaten vital to eaten such as vegetables and fruits and others that are unhealthy and hazardous to one’s health must be avoided such as oily foods and fatty foods. 5. STATEMENT: Once you have HIV, there is no particular reason why you should pay attention to ANSWER: FALSE other less dangerous diseases like malaria It is of extreme importance that a person with HIV takes deliberate steps to avoid falling sick. Diseases such as diarrhea, malaria and TB, weaken their immune system further and puts them at risk of developing full blown AIDS. It is therefore vital that PLHIV take measures to avoid what are called opportunistic infections (OIS) which can reduce their CD 4 count and raise the HIV in their body making them more sick and vulnerable to contracting AIDS. So in the case of malaria, one must sleep under a long lasting insecticide treated mosquito net every night. 6. STATEMENT: A person living with HIV only needs to stay on medication until they feel healthy again. ANSWER: FALSE Once a person with HIV starts medication or Anti Retroviral Therapy (ART) they must take these drugs every day for the rest of

of 14 their lives. This is called adherence. Missing doses or stopping has serious implications. This is because the HIV virus can become resistant to the drugs, making it difficult to manage. If you cannon manage HIV / AIDS you will die quicker. 7. STATEMENT: As soon as you discover you have HIV, you must begin treatment ANSWER: It depends… Once a person tests HIV +, they must go and see a health care provider. Tests will be done to establish the status of the virus in their body. This is called a CD$ count. Many people may have a high enough CD$ count for them not to have to start on treatment with ARVS. They can continue to stay healthy and delay the need for treatment through “Positive Living.” If a person’s CD4 count is too low, they will need to start on treatment. Nevertheless BOTH those on and off treatment will need to adopt “Positive Living” practices to stay healthy. Either way, the person must take care of themselves and continue going for regular check ups to ensure that they are healthy. One should not just begin taking ARVs unless it has been approved by a medical doctor.

6. STATEMENT: If my partner and I are HIV positive already, we do not have to use a condom or protect ANSWER: It ourselves when having sex. depends…

Sexual contact between two HIV infected people most certainly requires a condom. Different strains or types of HIV can be passed between two HIV infected people, making treatment of the infection even more difficult. This passing on of one strain of HIV from one infected person to another is called re infection.

Names:...... Job Title......

Media House...... District......

Pre and post training test: Positive Living 1. What do you understand by the term “Positive Living” for people living with HIV?

of 14 Positive living means taking care of your health and body when you have HIV. Emotional wellbeing is also an important part of Positive Living as a person needs to believe that they can live a normal, productive and healthy life with HIV, to be able to successfully follow Positive Living practices. 2. Briefly outline some of the “positive living” practises or behaviours that you know.

1. Eating a variety of foods 2. Paying regular visits to the health centre for routine check-ups. 3. Taking medication on time if they have started ART and adhering to them. 4. Taking a drug called Septrin or Cotramox every day, to prevent diarrhoea and pneumonia. 5. Using only clean boiled water to cook and drink. 6. Sleeping under an Insecticide Treated Net (ITNs) every night to avoid malaria. 7. Using a condom correctly each and every time they have sex. 8. If a woman with HIV is pregnant, she should seek Prevention of Mother to Child Transmission (PMTCT) services to prevent her child from contracting the HIV virus. 9. Practicing family planning to avoid unwanted pregnancies. 10. Avoiding alcohol and smoking 11. Telling one's family that they have HIV and encouraging their partners and children to test.

3. In your view, why is it important for people living with HIV to practice “positive living” practices/behaviours? It is important for people living with HIV to practice positive living practices because HIV attacks one’s immune system, making the body weak and easy for one to fall sick from anything the body is attacked with. If PLHIVs follow these positive living practices they will prevent themselves from diseases and they will keep their immunity levels high therefore delaying the progression from HIV to AIDS.

4. What is the relationship between “positive living” and Anti Retroviral Therapy (ART)?

According to MOH, 1 million people live with HIV/AIDS in Uganda, of these 370,000 are in need of ARVs. With 140,000 new infections annually the number of people who require treatment continues to increase. This has been a challenge with funding for ARVs thus MOH has called for a focus on interventions that keep PLHIVs healthy before initiation on ARVs / while on ARVs.

of 14 FACILITATOR’S NOTICE

POSITIVE LIVING FACT SHEET Positive living is taking care of your body and emotions when you have HIV. It includes believing you can live a normal, healthy life and carrying out positive living practices.

If already on medication, the individual must adhere to their medication and take care of their body. If not on medication, the individual can delay on starting treatment if advised by a medical professional.

Whether the individual is on ARVs (Anti-retroviral), treatment or has not yet started, he/she must carry out the positive living practices to ensure they live a long, healthy life.

These practices include the following:  Eating nutritious foods.  Taking their medication on time.  Exercising their body.  Having enough sleep and rest.  Thinking positively to remain spiritually and emotionally healthy.  Paying regular visits to the health centre for routine checkups.  Having sex with a condom correctly and consistently.  Using clean, boiled water to cook and drink.  Avoid concurrent sexual partnerships.

The purpose behind living positively is to live healthy and avoid getting opportunistic infections such as TB and malaria. This is because when a person with HIV gets sick, he/she is more exposed to AIDS and their immunity is reduced and susceptible to other diseases.

It is advised that the individual also joins a support club with peers who also have HIV to share experiences so that they are encouraged to live positively.

If a woman with HIV is pregnant, she should seek PMTCT (Prevention of Mother to Child Transmission) services to prevent her child from contracting the HIV virus.

of 14 I CAN Live a Healthy Life

What does being HIV positive really mean? If you are someone who is HIV positive, it means that you have the human immunodeficiency virus (HIV) living in your body.

Is it possible to remove HIV from your body? No. Once you are infected with HIV, it is not possible to have the virus removed from your body.

The immune system removes most viruses and bacteria that enter the body to make you ill. Unfortunately, HIV is one of the few viruses that the immune system cannot remove from the body.

There are no drugs available that can remove HIV from the body. The only available HIV drugs, also known as ART, can only help to keep the amount of HIV in the body low. Only health care professionals can decide when a person with HIV can start ART.

Is it possible to be healthy if you are HIV positive? Yes, you can be healthy and productive even if you are HIV positive. You can do this by looking after yourself by: 1) Keeping your immune system strong 2) Keeping the amount of HIV in your body low

It is important to have a strong immune system because it will help keep other bacteria and viruses that can make you ill out of your body. If your immune system is weak, you are more likely to get ill and as a result the amount of HIV in your body will increase. A strong immune system will keep the amount of HIV in your body low.

What you can do to be healthy if you are HIV positive You can maintain a strong immune system and keep the amount of HIV in your body low by living positively.

There are 3 main things you can do to live positively:

1) Accept that you are HIV positive Finding out that you are HIV positive may be very difficult to accept at first. It may be an illness that you have heard a lot about, but never believed that it would happen to you. Knowing your status is the first big step towards living positively because you can start doing all the right things to keep yourself healthy.

2) Know that it is possible to live a healthy life Knowing how to maintain a strong immune system and keeping the amount of HIV in your body low can help you to live a healthy, long and productive life. By keeping your body healthy, you will be able to do all the things someone who is not infected with HIV can do.

of 14  You can look healthy  You can continue to work  You can continue to study  You can look after your children  You can play sports

3) Decide to live a healthy and fulfilling life by:

a) Disclosing your status to people who are close to you Disclosing your HIV status to friends and those close to you e.g. family members will help you very much. They will support and help you to live positively. Some things they can help you with may include:  Listening to you about how you feel  Accompanying you to your hospital or health centre for check-ups  Helping you remember to take your ART medicines, if you are on ART  Helping you prepare your food  Helping you deal with discrimination faced from others

b) Eating a healthy diet as much as possible Eating healthy foods is a very important part of living positively with HIV. Good nutrition will help you keep your immune system strong and the amount of HIV in your body low. Eating well does not mean you need to eat expensive foods. There are many cheap/affordable healthy foods available in the market that you can buy. To help you have a healthy diet, some of the healthiest foods available are listed in the tables below. The foods with an asterisk (*) beside them are foods that are especially good for you.

CEREALS Tef *Wheat LEGUMES Barley (Gebs) *Kidney beans Corn (Beqqollo) *Lentils ( Missir kick) Sorghum (Mashyilla) *Peas (ater kick)

VEGETABLES MEATS AND ANIMAL *Ethiopian kale (Gommen) PRODUCTS *Sweet potato (Sikkwar *Beef dinnich) Mutton *Onion (Qeyy Shinkurt) Goat meat Tomato Chicken Carrot *Milk Cabbage (Tiquill gommen) *Eggs

of 14 HEALTHY SNACKS FRUITS *Split wheat (kinche) *Avocado *Thick porridge (aja) *Banana (Muz) *Spiced Ethiopian pita *Mango (chechebsa) Orange (birtukan) Beso firfir Lemon (lomi) Beso juice Pineapple (ananas) Kitta Ambasha Nifro Kolo c) Getting enough sleep and rest Being tired, anxious, worried or depressed can weaken your immune system. For this reason, try to rest and sleep as much as possible and avoid situations that make you anxious and depressed.

d) Exercising regularly Exercising is another very important part of maintaining health and a strong body. Making exercise a part of your daily activities is the easiest way to include exercise in your life, and it is important even if you do not have much time. For instance, you could walk instead of using public transport, or you could take the stairs instead of using the lift. You could also try to get involved with sports that you enjoy, for example, football, volleyball and running.

e) Keeping yourself and your environment clean Keeping yourself, your home and work environments clean, will help you avoid opportunistic infections. Opportunistic infections are infections that attack the body when the immune system is weak. Usually HIV positive people start getting opportunistic infections when the amount of HIV in their body increases. You should wash your body at least once a day if you can. You should also sweep and mop the areas you live and work in at least once a week.

f) Avoiding harmful behaviours Drinking alcohol, smoking, marijuana and taking other drugs may weaken your immune system. For this reason it is best if you avoid such behaviours. If you cannot stop completely, you should try and reduce your consumption substantially. It is very important to talk to your doctor about your drinking, smoking and other habits.

g) Practicing safe sex During unprotected sexual intercourse, you can get other sexually transmitted infections (STI), give HIV to an uninfected partner, or get re-infected with HIV if the person your partner is also HIV positive. HIV re-infection is when someone who is HIV positive gets infected again with more HIV. Re-infection increases the amount of HIV in a person’s body and consequently weakens the immune system. A person with a weak immune system will experience more opportunistic infections.

You can avoid getting infected with STIs and re-infected with HIV by:  Abstaining from sexual activity. This is the best way to avoid re-infection. Page 13 of 14  Practicing safer sex by using a condom correctly every time you have sex

h) Having regular check-ups at your hospital or health centre One of the things you need to do when you are HIV positive is to get regular check-ups at your hospital or health centre. Monitoring your health will help you and your doctor understand the progress of HIV in your body. It is very important to know if your immune system is still strong or if it is getting weakened by HIV. Regular medical checkups therefore will help prevent and mage Opportunistic Infections such as Tuberculosis and Malaria. If you find out that your immune system is weak, you need to pay special attention to living positively. Your doctor may suggest for you to start taking ART, if you are not already doing so.

i) Talking openly with your doctor about your health In order for your doctor or health provider to provide you with all the help that you need, you need to tell him/her exactly how you feel. You need to work together in order to decide what you need to do for you to maintain your health.

Living positively is something that you can do. If you decide to live positively, you will stay healthy because you will be in control of the HIV in your body and your life. This will make you feel stronger and will also help your immune system stay strong.