M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s T. .ABLE...... OF. . . .CONTENT......
i. TECHNICAL CONTENT MANUAL
Activity 1- Overview of Opportunistic Infections...... 1
Activity 2- Symptoms of Opportunistic Infections.…………………. 4
Activity 3- Opportunistic Infection: Malaria...... 7
Activity 4- Opportunistic Infection: Tuberculosis..…………………. 11
Activity 5- Health Worker-Patient Role Play.………………………. 16
Activity 6- Healthy Body, Healthy Home, Health Food.……………. 19
Activity 7- Video Activity…………………………………………… 24
ii. CREATIVE SCRIPTS
Activity 1- Overview of Opportunistic Infections...... 26
Activity 2- Symptoms of Opportunistic Infections.………………… 30
Activity 3- Opportunistic Infection: Malaria...... 33
Activity 4- Opportunistic Infection: Tuberculosis..…………………. 38
Activity 5- Health Worker-Patient Role Play.……………………….. 43
Activity 6- Healthy Body, Healthy Home, Health Food.……………. 48
Activity 7- Video Activity…………………………………………….. 54
I ......
TECHNICAL CONTENT MANUAL
Module 6 OPPORTUNISTIC INFECTIONS
Activity 1 - Overview Of Opportunistic Infections
Objectives l To define opportunistic infections l To understand how the immune system works for someone with HIV, and the impact of OIs on the immune system. l Identify Malaria and TB as the most common OIs for PLHIV
Time l 30 minutes
Materials l CD Player l “My Life” CD (Disc 6) Track 1: Overview of Opportunistic Infections
Facilitator lHealth worker or NGO worker
Preparation Familiarize yourself with the topics of OIs and the immune system. Make sure the cassette player and the tape operate well.
HOW TO RUN THIS ACTIVITY lFacilitator: Start the activity. Greet and welcome everyone in the meeting.
Facilitator: tell participants that Today we will talk about the different diseases or infections that are most common among persons living with HIV.
Ask participants: What are some of the different illnesses PLHIV usually develop? Encourage them to use their own language of the common names they call the diseases.
1 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Possible Responses: When the body becomes very weak from HIV, PLHIV have to be more careful with their health because ordinary diseases are more dangerous when you are HIV+. Some diseases that should be taken very seriously include the following: l Infections and Tumors l Tuberculosis l Malaria l Diarrhea l White creamy substance in the mouth, throat, stomach, vagina and anus (Candida or Thrush) l Skin Cancer (Kaposi's Sarcoma, cervical cancer in women) l Various kinds of Pneumonia
Ask participants: What are some of the signs of illnesses PLHIV usually develop? Encourage them to use their own language of the common names they call the diseases.
Possible Responses: l Losing a lot of weight l Muscle pains l Mouth sores l Skin conditions l Mental and emotional confusion (Dementia, memory loss, hallucinations)) l Breathing difficulties (pneumonia, bronchitis)
Ask participants: What is an opportunistic infection?
Possible Answer
An opportunistic infection (OI) is any infection that takes advantage of a weakened immune system to cause disease. It attacks the body when it is weak and can not fight infections.
Ask participants: What is the immune system?
Possible answers: The immune system works to defend the body against attacks by germs. l CD4 cells are the cells that protect us from illness.
...... 2 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
As the immune system weakens, the body loses the ability to fight disease like malaria or tuberculosis.
Ask participants: What happens with the immune system and HIV virus?
Possible answers: (definitely pre-test this section to see if people understand it) l HIV takes over CD4 cells and turns them into virus factories that produce thousands of copies and eventually destroys the CD4 cells. l When the body has few CD4 cells left, the person is more likely to get sick from small infections and minor diseases. l Most people who die of AIDS die from the infections that the body can no longer control.
Tell participants: We are going to talk about the immune system and use a house metaphor to understand the impact of HIV on the immune system.
Divide participants into small groups and have them discuss the following: “What happens to a house during a heavy rain?”
Bring them back together and share responses.
Possible Responses: l If rain falls down on a house with a solid roof, then the house protects us from the rain. l If rain falls down on a house with the roof that is falling apart, then the house cannot protect us from the rain and we get wet.
Ask participants: “What happens to the body's defenses against ordinary infections?”
Possible Responses: l If the immune system is strong, the body can fight illness and remain health. l If our body has a weak immune system, then it cannot protect us from infection and one gets ill and can not fight the infection. l It is very important to recognize symptoms early and seek treatment and care. l PLHIV should not wait with symptoms or signs of infection. They must seek treatment early.
3 ...... Module 6: Opportunistic Infections Activity 2- Symptoms Of Opportunistic Infections
Objectives l To recognize the signs/symptoms of OIs. l To recognize the importance of promptly seeking care and treatment from health providers. l To identify symptoms of Malaria and TB, the two most important OIs among PLHIV in Ghana.
Time l 30 minutes
Materials l “My Life” CD (Disc 6) Track 2: Symptoms of Opportunistic Infections l CD Player l OI Symptom Cards (1.Diarrhea, 2.Fever & Chills, 3.Headaches & Dizziness, 4.Mouth Ulcers, Sore Throat, and Pain Swallowing, 5. Coughing and Difficulty Breathing, 5. 6. Nausea & Vomiting, 7. Itchy Skin and Rash)
Facilitator Health worker or NGO worker
Preparation l Familiarize yourself with the 7 OI symptoms cards
HOW TO RUN THIS ACTIVITY
Facilitator: Tell participants that today we will talk about the importance of recognizing the signs and symptoms of infection in our body. Once we recognize the symptoms, we need to seek treatment early from a health provider to prevent the infection from getting worse.
Tell participants we will play a Game of Charades on symptoms of OIs
l Divide the group into two teams: A and B. l Have the 7 OI symptom cards at hand l Explain the rules: l One person has to "act out" the OI symptom without speaking.
...... 4 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
l Other members of the team try to guess the symptom. l The objective is for your team to guess as quickly as possible. l Team A chooses one person to act. Have that person come to the front of the room. l Give him or her one card with the OI symptom. l That person acts out the chosen symptom, and his/her team guesses the symptom. A correct guess gives the team one point. l If Team A does not guess correctly within 30 seconds, Team B has the chance to guess and steal the point. l If neither team guesses correctly, the person who picked the card can share the correct answer. No team gets a point. l Then Team B gets to act and guess. l Teams switch off until there are no more cards. l The team with the most points wins. l Ask participants: What are the most common signs and symptoms of OI in PLHIV ?
Possible Answers: l Diarrhea l Nausea and vomiting l Fevers and Chills l Headaches and dizziness l Mouth ulcers, sore throat pain swallowing l Coughing and difficulty breathing l Itchy skin and Rash l Weight loss, weakness l Sweating at night l Purple spots on the skin l Mental confusion, hallucinations, seizures
Ask participants: What do you know about Malaria and TB, the most common opportunistic infections that affect PLHIV?
Possible Answers: l Malaria is made worse when the person is weak from HIV. l Coughing for 2 weeks or more, coughing up blood, chest pains, unintentional weight loss in last 3 months, loss of appetite, fever for more than a week & night sweats can be TB. l Need a sputum test to confirm TB. 5 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
l TB Tests are available for free at most clinics. l Need a test to confirm Malaria. l It is very important to recognize symptoms early and seek treatment and cure. l Do not wait with symptoms or signs, seek treatment early.
Ask participants:
What are the best things PLHIV can do after recognizing the signs of illness or infections in our body?
Possible answers: l It is very important to recognize symptoms early and seek treatment and cure. l Do not wait with symptoms or signs, seek treatment early. l Seeking prompt care and treatment can save your life. l Coughing for 2 weeks or more, coughing up blood, chest pains, unintentional weight loss in last 3 months, loss of appetite, fever for more than a week & night sweats can be TB. l Fever and chills can be Malaria. l Go to health center and ask for Malaria or TB test. l Need a test to confirm Malaria or TB. l Start treatment as soon as possible. l Malaria and TB can be cured.
...... 6 Module 6: Opportunistic Infections Activity 3- Opportunistic Infection: Malaria
Objectives l Identify Malaria as one of the most common OI among PLWHIV and the need for prompt treatment and care. l To understand symptoms and effects of malaria in a person who is HIV- positive. l To understand the importance of early detection and treatment with effective medication in a person who is HIV positive. .
Time l 30 minutes
Materials l ”My Life” CD (Disc 6) Track 3: Opportunistic Infection: Malaria l CD Player
Facilitator Health worker or NGO worker
Preparation l Listen to the CD recording about Mercy and malaria. l Make sure that you have batteries, and that the CD player works.
HOW TO RUN THIS ACTIVITY
Facilitator Tell participants:
We will talk about Malaria, one of the most common infections that affect PLHIV. It is very important for an HIV-positive person to seek diagnosis and treatment for Malaria as soon as the symptoms appear, as it can save their life.
Tell participants: Please share a story about Malaria that they have or have seen in family, friends, co- workers, etc. l Local names are fine.
7 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Facilitator Start the CD, listen to story of Mercy.
Mercy has been HIV-positive for a few years now, and she has been feeling well. Two weeks ago she visited her parent's village outside the city, and enjoyed spending time with her parents talking in the backyard. She got many mosquito bites from her visit. Early this week she experienced a fever, headache, and the chills. She thought it was a cold and so was not too concerned, but today she still has not gotten better. Now she feels very tired and nauseous when she eats anything. She is sweating a lot at night too. She went to the nearby drug shop and bought a few pills of medicine that a friend told her was very good for treating fever. She felt better for awhile, but then started feeling weak and the fever returned, along with pains in her joints. Her husband Kweku was very worried about her and took her to the health clinic.
At the health clinic, Dr. Yeboah examined her and asked about her symptoms. He asked her if she has traveled anywhere in the past two weeks. Mercy told Dr. Yeboah that she visited her parents in the countryside a few weeks ago. He asked her if she slept under an insecticide treated mosquito net. She said no, the family did not have enough nets for everyone. He asked her if she used any mosquito repellent or covered her body when she was outside. She said no, she did not use any mosquito repellent or cover her body. Dr. Yeboah did a malaria test and confirmed that Mercy had malaria. When Mercy heard that she had malaria she got scared, especially about the cost to treat it. But Dr. Yeboah assured her that the cost of the medicines he will recommend is less expensive than if she delays treatment and gets even more ill. The medicine he recommends is what will help her get better and be strong again if she follows the treatment instructions.
Dr. Yeboah reminded Mercy that malaria is one of the main causes of death for HIV- positive people in Africa, so it is very important to visit a health center right away to get the right treatment as soon as the first malaria symptoms appear and to not delay or try out different drugs. Seeing a doctor or nurse at a health center without any delay can save lives.
Facilitator l Ask the following questions: 1. What were Mercy's symptoms?
Answer: Fever, headaches and chills tiredness and nauseous and sweating a lot at night.
...... 8 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
2. What are the symptoms of Malaria in a PLHIV?
Answer: dizziness, rapid heart beat, shortness of breath, repeated periods of chills, shaking and shivering, fever and sweating, pain in the joints, vomiting, headache, flu- like symptoms. Sometimes you may not have all the symptoms such as chills, headaches or muscle aches.
3. How long did it take for the symptoms to appear?
Answer: Two Weeks Malaria symptoms will occur at least six to nine days after being bitten by an infected mosquito.
4. Why is it important for Mercy to seek care from a health professional soon after having the first malaria symptoms?
Answer: Malaria can be a severe, potentially fatal disease especially in PLWHIV
5. How did Mercy get malaria?
Answer: The germ is carried from one person to another by mosquito.
6. What could Mercy have done to prevent herself from getting malaria?
Answer: l Cover arms, legs, neck and other parts of her body, particularly after the sun goes down. l Sleep under an insecticide-treated mosquito net every night. l Use mosquito spray inside her house. l Use mosquito repellent cream (Odomos). l Empty pools of water where mosquitoes can lay eggs. l Clear bushes around her house.
7. What is the treatment for malaria?
Answer: Treatment using anti-malarial medications should be started as soon as possible, within 24 hours of symptoms.
Visit a health facility to get tested for Malaria and proper drug information. A list of recommended facilities in your area will be provided to your support group.
9 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Malaria can be treated with the right medicines that should be recommended by a doctor or nurse.
Malaria medicines to choose: Since malaria can be very severe in PLHIV, it is important to use an effective medicine. The best modern drugs are known as “ACTs” (artesunate combination therapies). In Ghana, the most commonly available and affordable ACT is “Artesunate/Amodiaquine.” If the case is severe, the medical staff will most likely recommend quinine. In a severe case, the patient may need to be put on admission and given intravenous medications.
Drugs to avoid: Chloroquine is not longer effective and should not be used if other options are available. The parasite has developed resistance to chloroquine. Some of the locally available herbal remedies have some effect against malaria, but they are generally not recommended because of variable dosing, uncertain quality, and impurities. Fansidar (“SP”) is used for prevention in pregnancy, but it not recommended for treating people who are ill with malaria.
...... 10 Module 6: Opportunistic Infections Activity 4- Opportunistic Infection: Tuberculosis
Objectives l To identify TB as one of the most common OI among PLWHIV and the need for prompt treatment and care. l To understand the importance of early detection, treatment, and prevention of TB. l To understand the transmission, symptoms and effects of tuberculosis (TB) in a person who is HIV-positive.
Time l 30 minutes
Materials l “My Life” CD (Disc 6) Track 4: Opportunistic Infection: Tuberculosis l CD Player Life” CD (Disc 5) Track 5: Male Condom Demonstration
Facilitator Health worker or NGO worker
Preparation l Listen to the CD recording about TB and Gracie's story. l Obtain more information about TB if needed. l Make sure that the CD player is working.
HOW TO RUN THIS ACTIVITY
Facilitator Tell participants we will be discussing Tuberculosis, one of the most common infections that affects PLHIV. Tuberculosis is know as TB Explain that it is very important for an HIV-positive person to seek treatment as soon as the symptoms appear, as it can save one's life.
Facilitator Start the CD listen to the story of Gracie l Play the CD… Gracie is 30 years old. She recently found out she is HIV-positive and has not told anyone in her family about her HIV status. In the past 3 months she has been taking care of her parents who are getting old. Recently, Gracie has lost
11 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
some weight and started feeling sick. Last night she could not sleep; she was sweating and her head felt hot. In the last two weeks, she has been coughing a lot but this morning she coughed up some blood .Although she does not feel well, she continues to take care of her parents and help in the house. Gracie's brother Kofi has heard her coughing in the last few weeks. This morning when he came to see his mother and noticed that Gracie was asleep sitting next to her, Kofi tried to wake her up, but she was very weak. Kofi felt that something was wrong with her, that she had a fever and begged Gracie to go to the health clinic. The next morning Gracie went to the health clinic. Nurse Asante talked with Gracie and examined her and ordered a sputum test. When the results of the test came back, Nurse Asante confirmed that Gracie had TB and she needed to start treatment immediately. Nurse Asante told her that it was very important that she follow the instructions for taking the different medication to cure the TB infection and that the treatment will take six months. She was told that TB treatment in Ghana is free. Gracie was surprised to find out from Nurse Asante that TB kills more people with HIV than any other disease. Gracie is glad to know that drugs will help her, but she has to follow the treatment every day and take all the medications because if she stops the treatment, then TB will become drug resistant to the medications. She asked Nurse Asante about how to protect other in her family from getting TB. Nurse Asante told Gracie that TB is spread through the air when someone with active TB coughs or sneezes on someone else. She suggested that Gracie and her family should cover their mouths when coughing or their noses when sneezing, and open windows at home for fresh air to move around. Nurse Asante also recommended that Gracie's family should go to a health clinic to check if they have TB or not. Nurse Asante also recommended that Gracie's infant niece Rose should get a BCG vaccine at the health clinic and be screened for TB. If the infant has TB, she should start TB treatment. If she does not have TB, the infant should get treatment to prevent TB. The medicine is called Isonazid Rose will take it for 6 months to prevent her from developing TB disease.
Facilitator l Ask the following questions:
1. What were Gracie's symptoms?
Answer: Cough, for more then two or three weeks, weight loss, fever, coughing up of sputum (material from the lungs) and/or blood, and shortness of breath, weakness, chills.
...... 12 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
2. What are common TB symptoms?
Answer: Cough for more then two or three weeks, weight loss, fever, coughing up of sputum (material from the lungs) and/or blood, chest pains, shortness of breath, weakness, night sweats, tiredness or loss of menstrual periods.
3. Why is it important for Gracie to seek care from a health professional soon after having TB symptoms?
Answer: l TB kills more people with HIV than any other disease. l Seeking prompt care and treatment can save your life and that of other in the community. l If left untreated, cases of active TB can result in continued spread of TB and the community and death.
4. How did Gracie get TB?
Answer: l Persons may have dormant TB infection in their body and remain well for a long time, l Due to HIV the dormant TB is reactivated causing TB disease. l In non-HIV cases, after lengthy exposure or close contact with a person with active TB in their lungs or throat l TB bacteria can spread from person to person through coughs, sneezes, and breathing, l Most AIDS-related deaths in Ghana are due to TB.
5. What could she have done to prevent herself from getting TB?
Answer: l All PLHIV need to get screened for TB every 6 months using a national approved screening tool. PLHIV without active TB disease should be given a TB medicine called Isonaizid for 6 months to prevent them from having active TB disease. l This medicine can protect PLWH from getting TB. l BCG vaccine offers some protection from developing active tuberculosis, especially in infants and children.
13 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
6. What is the treatment to cure TB?
Answer: l TB treatment lasts for 6 months for people who have TB for the first time l TB treatment is effective if the person takes all the doses as prescribed and recommended by a qualified health worker l TB is curable in PLHIV just as for TB patients without HIV. l TB treatment for persons having TB for the first time now consists of only tablets and no injection. TB treatment is given according to the patient's body weight.
PLHIV may be designated as TB treatment supporters for their peers on TB treatment. TB treatment supporters could supervise the patient every day to ensure they have swallowed their prescribed medicine to ensure cure and completion of treatment. They could also support and encourage their peers to report problems with TB treatment to health clinics.
7. What happens if you stop TB treatment?
Answer: l If a person stops taking the medication before the period is over, some TB germs will remain. l The next time the person gets TB, the medicine will not work as well. This is called drug resistance. l Antiretroviral therapy in TB patients may need to be delayed until a patient has completed two months of TB treatment or at the end of TB treatment. But if the patient is very ill ART may be started earlier than two months to avoid death. If the patient is already on ART and later develops TB, both treatments should continue as normal.
8. How can she prevent spreading TB to others in her family?
Answer: l TB is spread to others when a person infected with TB coughs, sneezes, spits or talks l TB germs travel in the air, infecting other people in the area. l People who spend a long time in a small room with little fresh air can infect each other. l Try to open a window so that there is fresh air all the time.
...... 14 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s l Cover the mouth and nose when coughing and sneezing. l Seeking early TB test and TB treatment also helps prevent TB spread. l When a person infected with TB is treated with TB medicine, they can no longer infect other people.
8. Why should Gracie tell her family about her TB? How should she go about doing it?
Answer: Gracie should inform her family that she has TB because: l Her family members need to also get tested for TB. l If she feels uneasy telling them, she may need to ask for help from a friend, a family member who she can confide in, or the health worker.
15 ...... Module 6: Opportunistic Infections Activity 5- Health Worker-patient Role Play
Objectives l To gain basic skills in communicating assertively with health workers after recognizing OI symptoms
Time l 45 minutes
Materials l Health Worker and Patient Role cards of Queen Mother/King l “My Life” CD (Disc 6) Track 5:Health Worker- Patient Role Play l CD Player
Facilitator Health worker or NGO worker
Preparation l Make sure you have all of the above-listed materials with you. l Read through the activity and understand where you will be using each of the materials.
HOW TO RUN THIS ACTIVITY
Facilitator: Today we will discuss about effective ways to communicate with a Health Worker: l OIs can be cured with the right medical treatment. It is very important to start early treatment to reduce possibility of lasting damage to your health, including death. This is especially critical for people living with HIV.
Divide participants into small groups Ask participants to discuss: If you experience OI symptoms, what information do you need to share with health providers when we go to the health center?
Possible information to share with a health worker: l Be honest about your habits and activities. Your health worker needs to know l Give some personal information to figure out your risk for OIs and what tests you might need...... 16 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s l If your health worker does not know the complete picture, he or she might not be able to offer proper advice and care. l You may want to share the following: l Sexual history, condom use l Describe any symptoms you might have l Any possibility you might be pregnant
Ask participants to discuss: What questions we need to ask health worker? Possible questions to ask a health worker: l Ask questions and ask your health worker to explain again if you don't understand something. You may want to ask some of these questions: l What do you think I have? l Will you test me today? If yes, what tests do I need and when can I get the results? l How can I prevent transmission to others? l How can I prevent it from happening in the future? l What is the treatment for what I have or the symptoms? l What medication do I need to take and how much does it cost? l What are the instructions for the medication? l Are there any side effects? l Are there alternatives to medications (i.e. lifestyle changes)?
FACILITATOR: Discussion on Communication Style of a Queen Mother/King: l Show the group the flashcards of the QUEEN MOTHER and the KING. l Divide group into two smaller groups and give each group one card l Ask volunteers in the group what QUEEN MOTHERS and KINGS are like and how do they behave in front of other people? (See possible responses below.)
Possible Answers: Emphasize that if we behave like QUEEN MOTHERS and KINGS with health workers, it means we will confidently tell the health workers about our problems, ask the questions that we need to ask, and use our voices, our faces, and our body language in a way that makes people feel respect for us.
Possible answers for acting like a QUEEN MOTHER/KING: l Body language: Even without opening our mouths, our bodies can talk for us. Body language expresses how we feel about ourselves and what we are thinking. Our body language might influence how others will treat us.
17 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
l Keep your shoulders squared and your chin up. l Act confident even if you don't feel it. l Voice: Use a clear, calm voice. Make sure that your voice is loud enough to be heard. Try to be brief and concise in your language. l Know what you want: Make sure you know what you would like out of the interaction. Know before you go into your meeting the type of information you would like to get. Don't be afraid to state your goals and ask questions. It's easier for people to give you what you want if they know what you want.
Role Play: l Divide the group into pairs. l One person will play the patient role as the QUEEN MOTHER/KING and the other person will play the Health Worker role. l Have the pair develop a role play with the patient who might have some malaria symptoms and is seeking help from a health worker. The role play should contain: l The patient asking key questions to the health worker l The health provider giving instruction to the patient on treatment l The patient talking assertively to the health worker throughout the role play l After the first role play is done, then have the pair switch roles. Now the health worker is the patient. l Have the pair develop a role play with the patient who might have TB symptoms and is seeking help from a health worker. l Encourage the pairs to give each other feedback. l Visit each pair, observe the role plays, and give feedback when appropriate.
...... 18 Module 6: Opportunistic Infections Activity 6- Healthy Body, Healthy Home And Healthy Food
Objectives l To understand specific ways for preventing infection in the home. l Recognize that PLHIV need to be more careful with their health and to recognize symptoms of illness soon and seek treatment soon
Time l 45 minutes
Materials l CD Player l ”My Life” CD (Disc 6) Track 6: Healthy Body, Healthy Home, and Healthy Food
Preparation Familiarize yourself with ways to prevent infection in the home.
HOW TO RUN THIS ACTIVITY
Sharing Stories on Infection Prevention at home.
(Adapted from I-TECH's “Caring for Someone with HIV/AIDS: A Home-Based Care Book” and FHI's “Understanding Opportunistic Infections”)
Facilitator on CD: We will listen to the first story of preventing infections by keeping our body healthy.
Story of Healthy Body: Kobina l Kobina is 30 years old he has been HIV Positive for three years now. He has been working as a taxi driver for about one year. One of the things that are very important to Kobina is keeping as healthy as possible, so he can work and make money to support his family. He believes he has to do everything he can to protect himself from getting sick. Keeping his body healthy means practicing certain simple things every day. As soon as he rises up, he takes a bath with soap and water. He brushes his teeth and he always wears shoes or sandals to avoid small injuries. Because he spends most of his time in his car, with the windows open, Kobina uses mosquito repellent cream and he keeps arms and neck covered as well as his legs and other parts of the body,
19 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
particularly after the sun goes down. He does this to protect himself from Malaria, one of the most common Ois.
When Kobina is home, he sleeps under a mosquito net every night. He also washes his hands with soap and water before and after meals and especially after going to the toilet. Sometimes he likes to work in the garden so he also washes his hands when he has finished doing his work in the garden. Kobina also covers his mouth when he sneezes or coughs because he know that is how others can get sick, especially TB as it is also one of the most common illnesses among persons living with HIV. Kobina keeps the window of his taxi always open in case some of his passengers may be coughing. Kobina also cleans his car inside and out often so he keeps some rags, water and soap in the trunk and when he is waiting for customers, he cleans the steering wheel and also his hands as he knows that hand washing is a very good way to avoid illness.
Facilitator on CD Tell participants to divide into small groups and ask them to discuss the following question:
l What are some of the things we need to do to keep our body healthy?
Bring Groups together and ask for volunteers to share responses. Possible Answers:
Healthy Body: l Wash your hands before cooking, eating, feeding another person and caring for a baby. l Wash your hands with soap after going to the toilet, changing baby diapers and working in the fields or garden. l Bathe your body every day with soap and water to keep it clean. l Wear shoes/sandals to avoid small injuries. l Brush your teeth after meals and when you are out of bed in the morning. l Cover your mouth when coughing or sneezing. l Sleep under an insecticide-treated mosquito net. l Cover arms, legs, neck and other parts of the body, particularly after the sun goes down. l Use mosquito repellent cream.
...... 20 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Tell participants: We will now listen to the second story of preventing infections at home.
Story of Rose's Healthy Home l Rose lives at the end of a quiet street with her school age children. She is 39 years old and has been HIV Positive since January. She was very worried about her results for a few months but now has decided to do as much as she can to keep herself and her family free of illness. She remembered that Nurse Helen said that there are several things to do at home to help her and her family stay healthy.
She has always kept her house clean and Rose sweeps regularly. She likes to open windows to keep the house well ventilated too. She boils drinking water until it steams hot. She also soaks blood-stained or soiled materials in bleach solution for 20 minutes and then washes them in soapy water.
Rose wears plastic bags on her hands when she is handling soiled materials or waste e.g. stool. She knows that Malaria is a very common illness so she bought mosquito nets for herself and for her children. Outside the house she empties pools of water so that mosquitoes do not breed. Rose is very proud that her house is clean and says that there is no room for illness in her house!
Tell participants: Divide into small groups and ask them to discuss: l What are some of the things we can do to keep our home healthy?
Bring Groups together and ask for volunteers to share responses.
Possible Answers: Healthy Home: l Boil drinking water until it steams hot. l Clean and sweep regularly. l Keep home well-ventilated. l Always sleep under mosquito nets at night and/or spray inside the home. l Empty pools of water where mosquitoes breed. l Wear rubber globes or plastic bags on our hands when handling soiled materials or waste e.g. stool. l Put soiled bandages, clothes, etc. into containers lined with thick plastic bags, and tie them. l Soak blood-stained or soiled materials in bleach solution for 20 minutes and then wash in soapy water. 21 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Tell participants: We will listen to the third story of preventing infections by keeping our food healthy.
Story of Eleanor's Healthy Food l Eleanor is 29 years old and has been cooking since she was a small girl. She learned from her mom how to prepare the best FuFu and her family enjoys the food she prepares very much and she has learned to prepare food in a healthy way to keep her family healthy too. Eleanor starts by washing her hands with soap and water before preparing food. She also washes fruits and vegetables before cooking and before eating them. Before she starts to prepare the food, she cleans the table and the chopping board and when she cooks meat, she keeps cooking it until it is no longer red. When the food is ready Eleanor eats with her family and keeps the food covered so flies cannot land on it. After the meal, her sister and her children help her to wash all cups, bowls, plates and utensils, so they are ready to use them at the next meal. Eleonore is most happy when she cooks for her family as they all eat all the food and tell her it is the best !!!!!!
Tell participants: Divide into small groups and discuss: l What are some of the things we need to do to keep our food healthy?
Bring Groups together and ask for volunteers to share responses.
Possible Answers: Healthy Food: l Wash your hands with soap and water before preparing food. l Wash fruits and vegetables before you start to cook or to eat them. l Wash cups, bowls, plates, utensils, etc. l Use a clean table or chopping board to prepare the food. l Cook meat until no longer red. l Keep food covered so flies cannot land on it.
Tell participants: Divide into small groups and discuss: l Why is it important that PLHIV go to seek care and treatment soon after having infection symptoms?
Bring Groups together and ask for volunteers to share responses
...... 22 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Possible Answers: l Seek Prompt Care and Treatment from Health Provider. l It is important to recognize symptoms that can tell of infection in our body. l Any infection can weaken our immune system. l Do not wait to seek care soon after the symptoms appear. l Do not wait to see what will happen with the symptoms, seek care soon. l PLHIV take longer for their immune system to recover from illness. l Seek care and treatment soon so you can get better sooner.
23 ...... Module 6: Opportunistic Infections Activity 7- Video Activity
Objectives l Use a video to increase understanding of other Opportunistic Infections such as: l HIV and the Immune system l OIs of the Mouth l OIs of the skin l OIs of the Respiratory System l OIs of the Nervous System
Time l 15-30 minutes per video l 15 minutes discussion time after the video is shown
Materials l DVD l “Siyayinqoba Beat It! HIV” DVD Episode 9: OI's of the Skin Episode 10: OI's of the Nervous System Episode 11: OI's of the mouth Episode 12: OI's of the Respiratory System l Module 6 Discussion Guide
Preparation If you are showing a video, make sure that you have reserved a DVD for the space. On the day of the session, come early and test out the equipment. Familiarize yourself with the topics of OIs and the immune system.
How to run this activity l Introductory Discussion of OI to be discussed today (mention specific OI to be discussed). l Ask participants to share information they have about the OI that is being discussed. l Encourage them to use their own language of the common names they call the disease. l Tell participants that they will watch a movie about a specific OI.
After the video there will be a discussion.
...... 24 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Have Discussion Guide Questions available to use immediately after watching the video. Ask Questions from Discussion guide. Participants respond to questions in small groups or in plenary. l Ask participants what was a surprising and new piece of information. l Ask participants if they have any questions or concerns.
25 ...... CREATIVE SCRIPT *This information can also be found as an audio recording on the “My Life” CD (Disc 6)
Module 6: Opportunistic Infections Activity 1: Overview Of Opportunistic Infections
SFX: Music Score up and down
Facilitator VO: Welcome to the first activity in Module 6. In this activity, we will define opportunistic infections and know which types of illnesses are most common for people living with HIV. We will also discuss the immune system of someone living with HIV and the impact of opportunistic infections on the immune system. This activity will generate a lot of questions and requires a qualified health worker who can be the facilitator. Please make sure that you have arranged to have a nurse or doctor at your group meeting when you discuss opportunistic infections. A contact list of NGOs and friendly health facilities to help you find a health worker is provided inside of this activity.
When your moderator hears this bell….
FX: Bell rings
Facilitator VO: that means it is time to stop the tape and begin discussions. When the discussion is over, your moderator will push play to continue the activity.
Now, who can name some illnesses that are common for people living with HIV?
SFX: bell rings to signify commencement of discussion.
Facilitator VO: Thank you very much. I'm sure you were able to come up with quite a few illnesses. When the body becomes weak many types of diseases can attack it. Some of the illnesses that people living with HIV should take very seriously are:
l Infections and Tumors l Tuberculosis l Malaria. l Diarrhea l A white creamy substance in their mouth, throat, stomach, vagina or anus. This illness is called Candida or Thrush
...... 26 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s l Skin Cancer l For women, cervical cancer l And Pneumonia
Facilitator VO: Does anyone have any questions about the illnesses I just listed?
SFX: bell rings to allow time for questions and discussion.
SFX: Music up and down.
Facilitator VO: Now that we listed the illnesses, can we list some of the signs of illnesses that people living with HIV often develop?
SFX: bell rings to signify commencement of discussion. Facilitator VO: I'm sure you were able to identify many signs of illnesses. Some that you might have mentioned are: l Muscle pains l Loss of weight l Mouth sores l Problems with your skin l Mental and emotional confusion l Problems breathing Now, who can tell me what an opportunistic infection is?
SFX: bell rings to signify commencement of discussion.
Facilitator VO: Let me give you a very clear and simple definition of an opportunistic infection. An opportunistic infection is any infection that takes advantage of your weakened immune system to cause an illness. An opportunistic infection attacks the body when it is weak and when it can not fight back. Does anyone have any questions?
SFX: bell rings to signify time for questions and discussion.
Facilitator VO: Now that we understand opportunistic infections, I want to ask you what is an immune system?
SFX: bell rings to signify commencement of discussion.
27 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Facilitator VO: I'm sure you now know that the immune system works to defend the body against attacks by germs. As the immune system weakens, the body loses the ability to fight illnesses like malaria or tuberculosis.
I have another question for you. What happens between the immune system and HIV?
SFX: bell rings to signify commencement of discussion.
Facilitator VO: Let me explain what happens between the immune system and HIV. This gets a little complicated so listen carefully. CD4 cells are cells that are part of the immune system and they protect us from illnesses. Now, when HIV comes into a body it takes over the CD4 cells and turns them into factories that produce more HIV. So over time, HIV can take over most of the CD4 cells in a body. When the body only has a few CD4 cells left it can't defend itself from attacks from germs and the body is likely to get very sick from even small illnesses. Most people who die of AIDS, die from illnesses that the body can no longer fight.
That was a lot to try to understand so let me use the example of a house in the rain to help you understand the impact of HIV on the immune system. What happens to a person inside a house during heavy rain?
SFX: bell rings to signify beginning of discussion.
Facilitator VO: Well done. You probably said that if the house has a solid roof, then the house will protect you from the rain.
But if the house has a roof that is falling apart, then the house cannot protect us from the rain.
Now let's apply this to our immune system. What happens to our body when a germ comes along?
SFX: bell rings to signify beginning of discussion. Facilitator VO: If our body has a strong immune system the body can fight the germ and stay healthy. But if our body has a weak immune system, then it cannot protect us from outside germs. And the germs can cause illnesses.
Does anyone have any questions about HIV and the immune system?
...... 28 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
SFX: bell rings to signify time for questions and discussion.
Facilitator VO: Remember, it is very important to recognize the signs of illnesses early and seek proper treatment and care. Never wait to get treatment if you think you are sick.
Whenever you need additional help or have questions, you can use a cell phone to text the word “HELP” to 1406. This is the number for the Text Me Flash Me Helpline for people living with HIV. A friendly counsellor will call you back within 24 hours to talk with you over the phone. This helpline is open everyday, except on Saturdays, Sundays and holidays.
This brings us to the end of our first activity about opportunistic infections. I hope to see you soon!
SFX: music up and down
29 ...... Module 6: Opportunistic Infections Activity 2: Symptoms Of Opportunistic Infections
SFX: music up and down
Facilitator VO: Welcome my friends to the second activity in module 6. In this activity we will learn about the symptoms of Opportunistic Infections and how important it is to promptly seek care and treatment from health providers. This activity will generate a lot of questions and requires a qualified health worker who can be the facilitator. Please make sure that you have arranged to have a nurse or doctor at your group meeting when you discuss opportunistic infections. A contact list of NGOs and friendly health facilities to help you find a health worker is provided inside of this module.
When your moderator hears this bell….
FX: Bell rings
Facilitator VO: that means it is time to stop the tape and begin discussions or an activity in a small group. When the discussion or activity is over, your moderator will push play to continue the activity. Your moderator will need to have a set of cards with symptoms of opportunistic infections on them for this activity.
SFX: Music up and down.
Now we are going to play a game which will help you to quickly identify symptoms of Opportunistic Infections. First we will divide into two teams: team A and team B. Divide into 2 teams now. I will give you the rest of the instructions after you have divided into 2 teams.
SFX: bell rings for group to divide into 2 teams.
Facilitator VO: Each team will select one person who will stand in front of their team and be the actor. Your moderator will show the actor a card with a symptom of an Opportunistic Infection on it. The actor will have 30 seconds to act out this symptom while the other members of the team try to guess what the symptom is. A correct guess gives the team one point.
If the team can not guess what the symptom is in 30 seconds the other team will be given the chance to guess the symptom and snatch the point.
...... 30 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
If neither of the teams is able to guess the correct answer, the actor will tell the whole group what the symptom is. In this case neither team gets a point.
After team A finishes acting and guessing team B gets to act and guess. The teams switch off until the moderator has no more symptom cards. The team with the most points at the end wins the game.
SFX: bell rings for game to begin.
Facilitator VO: Well done. I'm sure that during the game you correctly guessed what many of the symptoms of opportunistic infections are. The symptoms on the cards are some of the most common symptoms of opportunistic infecions. Let me mention these symptoms again and a few others. They are: 1. Diarrhea 2. Fevers and Chills 3. Headaches and Dizziness 4. Mouth ulcers and sore throat 5. Coughing and breathing difficulty 6. Nausea and Vomiting 7. Itchy skin and Rash 8. Weight loss and weakness 9. Sweating at night 10. Purple spots on the skin 11. Mental confusion like seeing things and 12. Seizures
SFX: music up and down
Facilitator VO: Malaria and tuberculosis are the most common opportunistic infections that affect people living with HIV. Now let's take a few minutes to share what we know about malaria and tuberculosis.
SFX: bell rings to signify beginning of discussion.
Facilitator VO: In your discussion, I'm sure you realized that malaria and tuberculosis are even worse when a person is weak from HIV. A high fever and chills could be malaria. Coughing for 2 weeks or more, coughing up blood, chest pains and weight loss could be TB. You need to take a test from a health facility to confirm if you have TB or malaria. TB tests are available for free at most clinics.
31 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
It is very important to recognize symptoms early so you can get the tests you need and then receive the proper treatment and care from a health facility.
Now, if you recognize some signs of illnesses in your body what should you do?
SFX: bell rings to signify beginning of discussions
Facilitator VO: I hope you were able to come up with all the correct responses. Knowing what to do when you recognize signs of illness could save your life. I will give you a list of the best things you can do after you recognize signs of illness: 1. Go to a health facility immediately. Do not wait to see if your health gets better or worse. 2. Ask to be tested for malaria and TB 3. Get the proper treatment you need for the illness 4. Start taking the proper treatment immediately 5. Remember, malaria and TB can be cured
SFX: music up and down
Facilitator VO: Whenever you need additional help or have questions, you can use a cell phone to text the word “HELP” to 1406. This is the number for the Text Me Flash Me Helpline for people living with HIV. A friendly counsellor will call you back within 24 hours to talk with you over the phone. This helpline is open everyday, except on Saturdays, Sundays and holidays.
Thank you for your time today. I hope you had fun acting out the symptoms of Opportunistic Infections and that you now will recognize them quickly and seek treatment immediately. I look forward to working with you in the next activity.
SFX: music up and out.
...... 32 Module 6: Opportunistic Infections Activity 3: Opportunistic Infection: Malaria
SFX: music up and down
Facilitator VO: Welcome to activity number 3 in Module 6. After this activity you will be able to identify malaria as one of the most common opportunistic infections for people living with HIV. You will also know the symptoms and effects of malaria in a person who is HIV-positive and understand the importance of early detection and treatment of malaria. This activity will generate a lot of questions and requires a qualified health worker who can be the facilitator. Please make sure that you have arranged to have a nurse or doctor at your group meeting when you discuss opportunistic infections. A contact list of NGOs and friendly health facilities to help you find a health worker is provided inside of this activity.
When your moderator hears this bell….
FX: Bell rings
Facilitator VO: that means it is time to stop the tape and begin discussions or an activity in a small group. When the discussion or activity is over, your moderator will push play to continue the activity.
SFX: Music up and down.
Facilitator VO: To start off, let's share with the group any stories you have about you or your friends or family members getting malaria.
SFX: bell rings to signify commencement of discussion.
Facilitator VO: Malaria is the most common illness that affects people living with HIV in Ghana. It is very important for you to go to the health facility to get a malaria test and receive the proper treatment as soon as the first signs appear. It can save your life.
Now let's listen to Mercy's story about malaria and afterwards I will have some questions for you.
SFX: music up and down
33 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Mercy: My name is Mercy and I have been HIV-positive for a few years now. I have been in good health. Two weeks ago I visited my parent's village outside the city, and I enjoyed spending time with them talking in the backyard. There were lots of mosquitoes, though, and I had a few bites during my visit. Early this week I experienced a fever, headache, and the chills. I thought it was a cold and so was not too concerned, but today I still have not gotten better. Now I feel very tired and nauseous when I eat anything. I sweat a lot at night too. So, I went to the nearby drug shop and bought a few pills of medicine that a friend told me was very good for treating fever. I felt better for a while, but then I started feeling weak and the fever returned, along with pains in my joints. My husband, Kweku was very worried about me and took me to the health clinic.
SFX: hospital ambience
Doc: Mercy, I'm glad you came to see me today. I have a few questions for you. Have you traveled anywhere in the past two weeks?
Mercy: Yes doctor, I went to visit my parents in the village a few weeks ago. Doc: and while you were there, did you sleep under a mosquito net?
Mercy: no please. My family did not have enough nets for everyone. Doc: but did you use a mosquito repellant or did you cover yourself while you were outside?
Mercy: no doctor, I did not use any mosquito repellent or cover my body.
Doc: Hmm, looks like I will need to give you a test to see if you have malaria.
SFX: music up and down
Doc: Mercy, you have malaria.
Mercy: Eih Doctor! What am I going to do? And I don't have the amount of money to treat it?
Doc: don't you worry. The medicines will not cost that much if you don't delay treatment. But if you do delay treatment and you will get even more ill and you will require more expensive drugs to treat you. So its best to treat it now. These drugs will help you get better and you will be strong again if you follow the treatment instructions.
...... 34 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Mercy: I hear you doc. I'll follow all of the instructions.
Doc: You have to remember that malaria is one of the main causes of death to HIV positive people in Africa. So it is very important to visit a health centre immediately as soon as the first malaria symptoms appear. You should not delay at all or try out different drugs. Seeing a doctor, nurse or a health worker right away could save your life.
SFX: music up and down
Facilitator VO: Now I have a few questions for you. First, what were Mercy's symptoms? And what are the symptoms of malaria?
SFX: bell rings for the group to answer and discuss
Facilitator VO: I'm sure you came up with quite a few symptoms. Mercy's symptoms were fever, headaches, chills, tiredness, nausea, sweating a lot at night and pains in her joints. Other symptoms of malaria could be dizziness, rapid heart beat, shortness of breath, shaking, and vomiting.
Facilitator VO: My second question is, How long did it take for the symptoms to appear?
SFX: bell rings for the group to answer and discuss
Facilitator VO: I hope you came up with the right answers. Malaria symptoms will occur about six to nine days after being bitten by an infected mosquito.
Facilitator VO: My next question for you is, Why is it important for Mercy to seek care from a health professional soon after having the first malaria symptoms?
SFX: bell rings for the group to answer and discuss
Facilitator VO: It is important for Mercy to seek immediate care because malaria can be a severe and even deadly disease. It is especially dangerous for people living with HIV.
Now let's move on to the next question, How did Mercy get malaria? SFX: bell rings for the group to answer and discuss
35 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Facilitator VO: I'm guessing the group was able to come up with the correct answer for this one. Mercy got malaria from a mosquito. The malaria germ is carried from one person to another by a mosquito. Mercy was probably bitten by a mosquito carrying the malaria germ while she was visiting her family in the village.
Just two more questions to go. What could Mercy have done to prevent herself from getting malaria?
SFX: bell rings for the group to answer and discuss
Facilitator VO: I'm sure you were able to identify several ways Mercy could have prevented malaria. Some things she could have done are: l cover her arms, legs, neck and other parts of her body. This is particularly important after the sun goes down since the mosquito is very active during these hours. l She could sleep under an insecticide-treated mosquito net l or use a mosquito spray inside the house. l She also could use a mosquito repellant cream like Odomos.
Now for our final question, What is the treatment for malaria?
SFX: bell rings for the group to answer and discuss
Facilitator VO: You may have come up with many answers but listen carefully because there is only one correct course of action for treating malaria. First, you should start treating malaria within 24 hours of the first symptoms. So it is important to visit a health facility immediately to get tested for malaria and receive proper information from a doctor or nurse about the drugs you need to treat malaria.
The most effective and affordable drug for malaria in Ghana is Artesunate- Amodiaquine. If the malaria is very severe, the doctor or nurse may recommend quinine.
For malaria in Ghana you should not take Chloroquine as it is no longer very powerful against malaria. The malaria parasite has learned to fight back against Chloroquine.
Fansidar is sometimes used for prevention of malaria during pregnancy, but it not usually recommended for treating people who are already ill with malaria.
Herbal remedies are also not recommended for malaria.
...... 36 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Does anyone have any questions about the correct steps to treat malaria? Remember to make sure to ask a nurse or a health worker if you have symptoms of malaria. Do not try to treat this disease on your own!
SFX: bell rings for the group to ask questions and discuss
Facilitator VO: Whenever you need additional help or have questions, you can use a cell phone to text the word “HELP” to 1406. This is the number for the Text Me Flash Me Helpline for people living with HIV. A friendly counsellor will call you back within 24 hours to talk with you over the phone. This helpline is open everyday, except on Saturdays, Sundays and holidays.
Also, ask your support group leader for a list of recommended facilities in your area to treat malaria.
This brings us to the end of this activity on malaria. I hope you have a better understanding of malaria and how you can prevent and treat it. See you in the next activity.
SFX: music up and out.
37 ...... Module 6: Opportunistic Infections Activity 4: Opportunistic Infections- Tuberculosis
SFX: music up and down.
Facilitator VO: Welcome to activity number 4 in the module about opportunistic infections. In the last activity we discussed malaria, one of the most common opportunistic infections for people living with HIV. Now we will talk about tuberculosis also called TB, another common opportunistic infections among people living with HIV. After this activity you will know the signs of TB and you will understand the importance of quickly detecting these signs so you can immediately go for treatment. You will also learn how TB is transmitted, how to prevent TB and the impact of TB on someone who is HIV-positive.
This activity will generate a lot of questions and requires a qualified health worker who can be the facilitator. Please make sure that you have arranged to have a nurse or doctor at your group meeting when you discuss opportunistic infections. A contact list of NGOs and friendly health facilities to help you find a health worker is provided inside of this activity.
When your moderator hears this bell….
FX: Bell rings
Facilitator VO: that means it is time to stop the tape and begin discussions. When the discussion is over, your moderator will push play to continue the activity.
To learn more about TB we will listen to Gracie's story. After her story I will have some questions for you about Gracie and TB.
SFX: music up and down.
Gracie: My name is Gracie and I am 30 years old. I recently found out I am HIV-positive and I have not told anyone in my family about my HIV status. In the past 3 months I have been taking care of my sick father. Recently I started feeling sick, too. Last night I could not sleep; I was sweating and my head felt hot.
In the last two weeks, I have been coughing a lot but this morning I coughed up some blood. I also had a hard time breathing, and I felt pains in my chest. Although I do not
...... 38 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s feel well, I must continue to take care of my father. My brother Kofi has heard me coughing and became very worried about me this morning. He came to see our father and noticed that I was asleep sitting next to our father. Kofi tried to wake me up, but I was very weak and could not get up.
Kofi: Gracie, you are not well. You have to go to the clinic for some medical attention.
Gracie: Okay, okay Kofi I will go tomorrow morning
SFX: hospital ambience
Nurse Asante: Thank you more coming this morning Grace. After talking with you I think you need to take a TB test. Please go to the lab for the test and then come back to see me.
SFX: hospital ambience Gracie: Hello Nurse Asante. The lab technician gave me the results to bring back to you.
Nurse Asante: Gracie, from these test results I can see that you have got TB. You need to start medication immediately. The treatment lasts for 6 months. And in Ghana, the treatment for TB is free. It is very important that you follow the instructions for taking the medication to cure the TB infection. You know, TB kills more people with HIV than any other illness.
Gracie: Eeh! I did not know that!
Nurse Asante: But the drugs will help you stay healthy and if taken properly will cure the TB. Don't you worry.
Gracie: (breaths a sigh of relief) aah ok. But, what about my father and the other members of my family? How can I protect them from getting TB?
Nurse Asante: TB is spread through the air when someone with active TB coughs or sneezes on someone else. You should cover your mouth when coughing and also cover your nose when sneezing. Also open the windows at home for fresh air to move around. Tell all your family members to go to a health clinic to check if they have TB or not.
Gracie: I also have an infant niece living with me. Does she have to be tested?
39 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Nurse Asante: Please bring her to the clinic so that we can give her a BCG vaccination and screen her for TB. It is very important that all your family members get tested for TB as soon as possible so that they don't infect other people with TB and so that they can be cured.
SFX: music up and down.
Facilitator VO: Now I have some questions for you about Gracie's story. My first questions are, What were Gracie's symptoms? And What are some other symptoms of TB?
SFX: bell rings signifying the start of answers and discussions
Facilitator VO: Well done. I'm sure you talked about Gracie's symptoms being a cough for more than two weeks, weight loss, fever, coughing up blood, shortness of breath, weakness, and chills.
Some other symptoms of TB are chest pains, coughing up of sputum-which is a material from the lungs, and diarrhea.
Now my next question for you is: Why is it important for Gracie to seek care from a health professional soon after having TB symptoms?
SFX: bell rings signifying the start of answers and discussions
Facilitator VO: It is important to seek medical care from a health professional soon after having TB symptoms because TB kills more people with HIV than any other illness. Seeking prompt care and treatment can save your life. If left untreated, you can continue to spread TB to other people in your family and community.
Facilitator VO: Now, let me ask you: How did Gracie get TB?
SFX: bell rings signifying the start of answers and discussions
Facilitator VO: By now you are probably aware of how TB is transmitted. But, let me repeat it quickly anyway. The TB spreads from person to person through coughs, sneezes, and breathing. We don't know whose cough or sneeze spread TB to Gracie but we know she originally go TB in this manner. A person can have TB in their system and not even know it. But when an immune system is weakened, like with people who are HIV-positive, the TB can gain strength and reappear.
...... 40 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Let's move on to our next question: What could Gracie have done to prevent herself from getting TB?
SFX: bell rings signifying the start of answers and discussions
Facilitator VO: Well done. People living with HIV who do not have TB should be given a TB medicine called Isonaizid for 6 months. This medicine can protect people who are HIV-positive from getting TB. There is also a vaccine called BCG vaccine that helps to protect infants and children from getting TB.
Everyone with HIV should be tested for TB every 6 months. Ask a nurse or doctor about getting screened for TB.
But if we do get TB, what is the treatment to cure TB?
SFX: bell rings signifying the start of answers and discussions
Facilitator VO: TB is curable for people living with HIV so it is important to know about the treatment. The treatment lasts for 6 months for people who have TB for the first time and is only effective if all the tablets are taken as instructed by your doctor or nurse. Your doctor or nurse will determine the correct dose for you based on you body weight.
Ask your support group leader how you can become a PLHIV treatment supporter for a peer with TB. A treatment supporter watches to make sure that the peer correctly takes their medicine every day and encourages their peers to report any problems with the TB medicine to the health center. Support and encouragement from a peer can make a big difference in someone's life.
My next question is: How can Gracie prevent spreading TB to others in her family?
SFX: bell rings signifying the start of answers and discussions
Facilitator VO: Again, TB is spread when a person with TB coughs, sneezes, or spits. The TB germs travel in the air and infect other people. Opening windows so that there is fresh air in a room can help prevent TB. A person with TB should always cover their mouth and nose when coughing or sneezing. Most importantly, a person with TB should get tested and treated right away. Once a person is treated with TB medicine they can no longer spread TB to other people.
41 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
My final questions for you are: Why should Gracie tell her family about her TB? And What advice would you give Grace when telling her family?
SFX: bell rings signifying the start of answers and discussions
Facilitator VO: I'm sure you advised Gracie to tell her family that she has TB. She should advise her family members so that they can also get tested for TB. If she feels uneasy telling them, she may need to ask for help from a friend, a family member who she can confide in, or the health worker.
SFX: music up and down
Facilitator VO: I'm sure you have learnt a lot about TB from this activity. Whenever you need additional help or have questions, you can use a cell phone to text the word “HELP” to 1406. This is the number for the Text Me Flash Me Helpline for people living with HIV. A friendly counsellor will call you back within 24 hours to talk with you over the phone. This helpline is open everyday, except on Saturdays, Sundays and holidays.
I'm looking forward to the next activity with you!
SFX: music up and out.
...... 42 Module 6: Opportunistic Infections Activity 5: Health Worker-patient Role Play
Facilitator VO: Hello, welcome to the 5th activity in the Opportunistic Infections Module. Your moderator will need to make sure he or she has the Queen Mother and Chief Cards for this activity. When your moderator hears this bell….
FX: Bell rings
Facilitator VO: that means it is time to stop the tape and begin discussions or an activity in a small group. When the discussion or activity is over, your moderator will push play to continue the activity.
This activity will generate a lot of questions and requires a qualified health worker who can be the facilitator. Please make sure that you have arranged to have a nurse or doctor at your group meeting when you discuss opportunistic infections. A contact list of NGOs and friendly health facilities to help you find a health worker is provided inside of this activity.
The main objective of this activity is to gain basic skills to talk confidently, with health workers, as if you were a Queen Mother or a Traditional King, especially when you go to the clinic with signs of an opportunistic infection.
We will be discussing how to share information with a health worker and how to ask a health worker questions. But, before we begin, you must know that: l Opportunistic infections can be cured with the right medical treatment. That is why it is important to seek treatment right away. Seeking treatment immediately decreases the chances of permanent damage to your body or even death. This is especially critical for people living with HIV. l Sharing the correct information with the health worker when you experience signs of an opportunistic infection can help you to return to full health more quickly.
Now, let's divide into small groups and discuss what types of information you think needs to be shared with a health worker when you go to a health clinic with signs of an opportunistic infection. After you have finished your discussions in your smaller groups, your moderator will lead you in sharing your ideas with the larger group.
FX: Bell rings, signaling that it's time to pause the tape, so discussions can begin.
43 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Facilitator VO: I'm sure you had some interesting conversation. I want to give you a few points to remember when sharing information with a health worker: l Be honest about your habits and activities. Your health worker needs to know the truth. l Give some personal information; this will help the health worker to figure out your risk for opportunistic infections and what tests you might need. If your health worker does not know the complete picture, he or she might not be able to offer proper advice and care. l You may want to share information on your sexual history and condom use. l Be sure to describe any symptoms you might have. l And finally, let the health worker know if you are pregnant.
Are there any questions or anything you want to discuss about what I just said?
FX: Bell rings, signaling that it's time to pause the tape, so discussions can begin.
Facilitator VO: Let's move on. In your small groups, discuss some questions you need to ask a health worker when you visit the clinic.
FX: Bell rings, signaling that it's time to pause the tape, so discussions can begin.
Facilitator VO: Did you come up with a lot of questions to ask your health worker if you don't understand something? Please share the questions your small group thought of with the larger group.
FX: Bell rings, signaling that it's time to pause the tape, so small groups can share the questions they came up with, with the larger group.
Facilitator VO: Let's listen to some of the questions you may want to ask.
FX: music up and down
FVO: Maame Nurse, what disease do I have?
MVO: Do I need to do a test? What test will I need to do? How do I get the results of the tests?
FVO: How do I avoid transmitting this disease? How do I prevent my family and friends from getting the disease from me? How do I protect myself from getting this disease in the future?
...... 44 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
MVO: Could you tell me what drugs I need to take? What drug or drugs would you recommend I take? What drug would you prescribe for me? How much do they cost? How much should I expect to spend on the drugs?
FVO: Sir, could you tell me how to take this medicine? Could you please tell me what the instructions for this drug are? I can't read them.
MVO: Are there any side effects to these drugs? Since there are a number of side effects, I'd like to know if there are any alternatives for me. Isn't there anything else I can do to cure it apart from taking drugs? Are there any changes I need to make to my lifestyle in order to treat this disease? Are there any changes I need to make to my lifestyle in order to prevent this disease from coming back?
FVO: I don't understand the instructions you gave for taking this drug. Could you go through it again with me?
FX: music up and out.
Facilitator VO: Your moderator will now hold up two cards; one with a picture of a queen mother and one with the picture of a chief, a traditional king. Divide into two groups. One group should receive the card with the queen mother and the other group should receive the care with the chief.
FX: Bell rings, signaling that it's time to pause the tape, so groups can break up.
Facilitator VO: In your groups look at the card of the Queen mother or Chief. Discuss what they are like and how they behave in front of other people.
FX: Bell rings, signaling that it's time to pause the tape, so discussions can begin.
Facilitator VO: When interacting with health workers, we should act like Queen Mothers and Chiefs. We should be able to confidently tell health workers about our problems, ask health workers the questions we need answers to and use our voices, our faces and our body in a way that make people feel respect for us. Even without opening your mouth, your body can speak for you. Your body language expresses how you feel about yourself and what you are thinking. Your body language will influence how others will treat you. Think about how Queen Mothers and Chiefs behave and how their bodies speak for them.
45 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Here are a couple of tips on how to act like a Queen Mother or Chief with your body and voice: l Keep your shoulders squared and your chin up. l Act confident even if you don't feel it. l Use a clear voice. Make sure that your voice is loud enough to be heard. Try to be brief and concise in your language
Also know what you want before you visit the clinic. Know the type of information you would like to get. Don't be afraid to state your goals and ask questions to the health worker. It's easier for people to give you what you want if they know what you want. You will be surprised at the results!
Now, let's listen to an interaction between a health worker and a patient who acts like a Queen Mother.
FX: music up and down.
FVO: Doctor, what disease do I have?
MVO: I think you have malaria
FVO: I see. Are my symptoms typical of malaria?
MVO: Yes, they are… fever, chills, and loss of appetite…
FVO: Do I need to take a test?
MVO: Yes, I'd like you do a test.
FVO: Right now? When will I get my results?
MVO: Yes, you should do it right now. Come back this afternoon, by which time the tests would be in.
FVO: If the test is positive, will you give me some drugs to treat it?
MVO: Certainly. But, we should do the test first and then based on the results, we'll discuss how best to treat this.
FX: music up and out.
...... 46 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Facilitator VO: Now it's our turn to practice acting like a chief or queen mother with a health worker. First, let's divide into pairs and choose one person to be the health worker and one person to be the patient.
FX: Bell rings; signaling that it's time to pause the tape, so groups can divide into pairs and assign each other roles.
Facilitator VO: Now that we are in pairs and know our parts, I'll explain how the role play will work. During the role play: l The patient has TB symptoms and must ask key questions to the health worker. l The health provider must give instruction to the patient on treatment and answer questions from the patient. l The patient needs to act like a Queen Mother or Chief.
After your pair has finished your role play give each other feedback on what worked well and what did not work well. Then switch roles. So now the health worker becomes the patient and the patient becomes the health worker.
Your moderator will be walking around as you practice and making suggestions and comments about your role plays.
FX: Bell rings, signaling that it's time to pause the tape, pairs practice their roles plays.
Facilitator VO: I hope you had fun acting out your role plays. If you ever get nervous or afraid when you go to the clinic, remember these role plays. Acting like a Chief or Queen Mother will prompt health workers to give you the respect you deserve.
47 ...... Module 6: Opportunistic Infections Activity 6: Healthy Body, Healthy Home And Healthy Food
Facilitator VO: Hello, welcome to activity 6 in the opportunistic infections module. In this session we will talk about a Healthy Body, a Healthy Home and Healthy Food. You will learn some simple ways you can prevent illnesses in your home. By the end of this activity you will also understand that people living with HIV need to be more careful with their health.
This activity may generate a lot of questions. If possible, try to have an NGO project officer, a Model of Hope or a health worker at your group meeting when you discuss healthy living. A contact list of NGOs and friendly health facilities to help you find a health worker is provided inside of this activity.
When your moderator hears this bell….
FX: Bell rings
Facilitator VO: that means it is time to stop the tape and form smaller groups and begin discussions. When the discussion is over, your moderator will push play to continue the activity.
SFX: music up and down.
Facilitator VO: We will now listen to our first of three stories. After each story I will have some questions for you. Kobina tells us the first story about how he keeps his body healthy.
SFX: music up and down.
Kobina: My name is Kobina and I am a 39 year old taxi driver. I have been HIV positive for three years now. It is very important for me to keep healthy because I need to work to support my family. Therefore I do everything I can to protect myself from getting sick.
To keep my body healthy I have to practice a few simple things everyday. When I wake up, I take my bath with soap and water and then brush my teeth. I wear sandals or shoes every day so as to prevent small injuries.
SFX: street ambience with cars and horns. People talking on the street.
...... 48 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Kobina: because I spend most of my time in the car with all the windows open, I use a mosquito repellant cream to avoid mosquito bites, I am especially careful when the sun goes down. Additionally, I put on clothes that cover parts of my body such as my neck, arms and legs. This protects me from malaria, one of the most common Opportunistic Infections.
I also keep some rags, soap and water in my car's trunk. So I can periodically clean my car inside and out. I also clean the steering wheel and my hands whenever I am waiting for passengers or free. I believe that hand washing is a good way to avoid illness. I also keep the windows of my taxi open in case my passengers are coughing.
When I am home I always wash my hands with soap and water before I eat, after I visit the toilet or after working outside.
Whenever I sneeze or cough I cover my mouth and my nose because I know that if I do not do that I put the people around me at risk of getting sick. Tuberculosis is one of the most common infections that an HIV positive person like me is likely to have. So, covering my mouth ensures that I protect those around me.
SFX: music up and down.
Facilitator VO: Please divide yourselves into smaller groups and I will give you a question to discuss.
SFX: bell rings for groups to be formed.
Facilitator VO: Okay, now that we are in small groups I will give you your first question: What are some of the things we need to do to keep our body healthy?
SFX: bell rings signifying the start of answers and discussions
Facilitator VO: Now let's come together and share our ideas. One volunteer from each group can tell everyone what your group discussed.
SFX: bell rings signifying the start of answers and discussions
Facilitator VO: From the discussions we have realized that there are some simple things we can do every day to stay healthy. Some of these simple things are as follows; l Wash your hands before cooking, eating, feeding another person and caring for a baby. l Wash your hands with soap after going to the toilet, changing baby diapers and working in the fields or garden.
49 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
l Bathe your body every day with soap and water to keep it clean. l Wear shoes or sandals to avoid small injuries. l Brush your teeth after meals and when you are out of bed in the morning. Cover your mouth when coughing or sneezing. l Sleep under an insecticide-treated mosquito net. l Cover your arms, legs, neck and other parts of the body, particularly after the sun goes down. l Use mosquito repellent cream.
Does anyone have any questions?
SFX: bell rings for any questions to be asked
Facilitator VO: We will now listen to the second story. Rose tells us her story about how she keeps a health home.
Rose: I am Rose and I have been HIV positive since January. I live at the end of a quiet street with my two lovely children Kojo and Esi who are 8 and 5 years old. I am 39 years and I was really worried for a few months after I found out that I was HV positive. But I have now decided I will do what I can to keep my home a healthy home. Nurse Helen told me several things I could do at home to help me and my family to stay healthy. I always keep the house clean and I sweep regularly. I keep the windows open to keep fresh air flowing in the house. I boil my drinking water until it steams hot. Whenever there are soiled materials or blood stained clothes I soak them in bleach solution for 20 minutes before I wash them in soapy water. I always wear plastic bags on my hands before I handle any soiled materials or waste.
I know Malaria is a very common and dangerous illness to people living with HIV, so I bought insecticide treated mosquito nets for myself and my children. I make sure that pools of water outside of the house are emptied so that mosquitoes do not breed in them. I can proudly say that my home is clean and there is no room for illness in my house!
SFX: music up and down
Facilitator VO: Lovely story. Let's break back into our smaller groups and discuss the following question: What are some of the things we can do to keep our home healthy?
SFX: bell rings signifying the start of answers and discussions
Facilitator VO: Now let's come together again and share our ideas.
SFX: bell rings for the group to share their ideas
...... 50 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Facilitator VO: I hope you remember and practice all of the great ideas you shared to keep you homes healthy. Here is a summary of some ways to keep you home health: l Boil drinking water until it steams hot. l Clean and sweep regularly. l Keep your house well-ventilated. l Always sleep under an insecticide treated mosquito net and use mosquito spray inside the house. l Empty pools of water where mosquitoes breed. l Wear rubber gloves or plastic bags on our hands when handling soiled materials or waste l Put soiled bandages or clothes into containers lined with thick plastic bags, and tie them. l Soak blood-stained or soiled materials in bleach solution for 20 minutes and then wash in soapy water.
SFX: music up and down
Facilitator VO: We will now listen to Eleanor tell us the third story about healthy food.
SFX: music up and down
Eleanor: I am 29 years old and my name is Eleanor. I love cooking and have done it since I was a little girl. I learnt from my mom how to prepare the best FuFu and my family enjoys the food I prepare very much. I have been HIV positive for a few years now. Because I am HIV-positive I learned to prepare food in a healthy way to keep myself and my family healthy. I start by washing my hands with soap and water before preparing food. I also wash fruits and vegetables before cooking and before eating them. Before I start to prepare the food, I clean the table and the chopping board. When I cook meat, I keep cooking it until it is no longer red. When the food is ready I eat with my family and I keep the food covered so flies cannot land on it. After the meal, my sister and my children help me to wash all cups, bowls, plates and utensils, so they are ready to be used at the next meal. It is my delight when I cook for my family, as they eat all the food and tell me it is the best!!!!!!
SFX : music up and down.
Facilitator VO: Please work in your small groups to answer this question: What are some of the things we need to do to keep our food healthy?
SFX: bell rings signifying the start of answers and discussions
Facilitator VO: Now let's come together and share our ideas. One volunteer from each group can tell everyone what your group discussed.
51 ...... M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
SFX: bell rings for the group to share their ideas
Facilitator VO: Well done. Now you know that some of the necessary things you have to do to keep your food healthy are to: l Wash your hands with soap and water before preparing food. l Wash fruits and vegetables before you start to cook or to eat them. l Wash cups, bowls, plates, utensils, etc. l Use a clean table or chopping board to prepare the food. l Cook meat until no longer red. l Keep food covered so flies cannot land on it.
SFX: music up and down
Facilitator VO: The last question I would like the small groups to discuss is: Why is it important that people living with HIV seek care and treatment soon after having infection symptoms?
SFX: bell rings signifying the start of answers and discussions
Facilitator VO: Now let's share our ideas with the larger group. Select one person from each group to explain how you answered the question.
SFX: bell rings for the group to share their ideas
Facilitator VO: Let's recap why it is important for PLHIV to seek care and treatment immediately after they recognize signs of illness. It is important to recognize symptoms and go to the clinic immediately because any illness can weaken our immune systems. If we go to the clinic right away we can stop small illnesses from become serious or even deadly illnesses. Immediate treatment means we will feel better sooner.
So please, go to the clinic as soon as symptoms appear. Do not wait to see what will happen with the symptoms. You could be putting your life at risk.
SFX: music up and down.
Facilitator VO: It has been a very interesting session. I hope you remember all we have discussed. Keep a healthy body, a healthy home and healthy food so you can stay free of illnesses.
...... 52 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
If you have more questions you can text “HELP” to 1406. This is the number for the texting service for people living with HIV. A friendly counsellor will call you back within 24 hours to talk with you over the phone. This hotline is open everyday, except on Saturdays, Sundays and holidays.
See you in the next activity.
SFX: music up and out.
53 ...... Module 6: Opportunistic Infections Activity 7: Video Activity
Facilitator VO: Hello, welcome to the final activity in module 6 about Opportunistic Infections. Today we are going to do something different. We will be watching a video to help you gain a deeper understand of Opportunistic Infections.
This activity will generate a lot of questions and requires a qualified health worker who can be the facilitator. Please make sure that you have arranged to have a nurse or doctor at your group meeting when you discuss opportunistic infections. A contact list of NGOs and friendly health facilities to help you find a health worker is provided inside of this activity.
When your moderator hears this bell….
FX: Bell rings
Facilitator VO: that means it is time to stop the tape and form smaller groups and begin discussions. When the discussion is over, your moderator will push play to continue the activity.
Let's get started.
SFX: Music up and down
Facilitators VO: Your moderator will give you a brief introduction into the opportunistic infection that will be shown in the video. After this introduction, the moderator will show the video. Your moderator should have a discussion guide that will be used in the discussion following the video. So I will now hand it over to the moderator to introduce and play the video.
SFX: bell rings for the video to be started and the discussion to ensue following the video
Facilitator VO: I hope you were able to learn a lot from the video and discussion. I have a few more questions for you: What new pieces of information did you gain from the video?
SFX: bell rings for commencing discussion
Facilitator VO: I have one more question, Do you have any questions or concerns from the videos you watched?
SFX: bell rings for discussion to begin ...... 54 M O D U L E 6 : O p p o r t u n i s t i c I n f e c t i o n s
Facilitator VO: I hope you had fun watching and learning from these videos. I believe this is an excellent way to help us gain a better understanding of opportunistic infections.
Please remember, a healthy body, a healthy home and healthy food will help keep you free from illness. Also remember to seek advice from a health care provider as soon as you experience any signs of illnesses. It could save your life!
If you have more questions you can text “HELP” to 1406. This is the number for the texting service for people living with HIV. A friendly counsellor will call you back within 24 hours to talk with you over the phone. This hotline is open everyday, except on Saturdays, Sundays and holidays.
SFX: music up and out.
55 ......