Responding to HIV and AIDS a Toolkit for Youth Peer E D U C a T O R S Responding to HIV and AIDS, a Toolkit for Youth Peer Educators

Responding to HIV and AIDS A toolkit for youth peer e d u c a t o r s Responding to HIV and AIDS, a toolkit for youth peer educators. Developed and produced for the Council for World Mission by the World Association for Christian Communication Copyright The copyright is jointly held by the World Association for Christian Communication (WACC) and the Council for World Mission (CWM) Copyright acknowledgement The toolkit will be freely available for use, copy and adaptation provided appropriate acknowledgement to both the Council for World Mission (CWM) and the World Association for Christian Communication (WACC) is given. Cover images: Sean Hawkey, Lavinia Mohr, John Gevers, Evan Roberts, Eli Shams. Layout: Alex Hawkey

Page 2 Responding to HIV and AIDS. A toolkit for youth peer educators. Responding to HIV and AIDS A toolkit for youth peer educators

Developed and produced for the Council for World Mission by the World Association for Christian Communication

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 3 Contents

Preface Introduction Using the toolkit 1

Section I: Introduction to HIV and AIDS 3 Sex, reproductive health and sexual behaviour 3 Basic Information about HIV and AIDS 11 The transmission of HIV 13 Signs and symptoms of HIV and AIDS 15 Prevention of HIV 16 Treatment of HIV 19 Voluntary counselling and testing 21 Myths and realities around HIV and AIDS 23

Section II: Overview of HIV and AIDS 28 Global statistics 28 Regional statistics 29 Statistics in countries of CWM member churches 32 Access to anti-retroviral therapies 35 International HIV and AIDS declarations and goals 37 International programmes of action against HIV and AIDS 37 National programmes of action against HIV and AIDS 38

Section III: Factors that impact on the spread of HIV and AIDS 40 Poverty 40 Cultural practices 42 Attitudes of churches and religious leaders towards HIV and AIDS 45 Theological interpretation 48 Conﬂict and violence 53

Section IV: Gender and HIV 56 Gender inequality and HIV and AIDS 56

Section V: The impact of HIV and AIDS on people and society 62

Section VI: Stigma and discrimination 65 What is stigma and where can it be found 65 Language and stigma 69 Impact of stigma and discrimination on the spread of HIV 71 Denial of human rights 76

Section VII: The response of the churches to HIV and AIDS 78

Section VIII: Response of the Council for World Mission 81 HIV and AIDS policy and strategy guidelines 81

Page 4 Responding to HIV and AIDS. A toolkit for youth peer educators. Section IX: Being an inclusive community 84 Creating a compassionate congregation 84 Reaching out 86 Learning from people living with or aﬀected by HIV and AIDS 89

Section X: Communication approaches 91 What is communication? 91

Section XI: Communication tools 92 Theatre 92 Music and song 97 Dance 100 Posters 102 Video and audiovisual media 104 Mass media 108 Community radio 111 Cartoons and comics 113 Story-telling Sermons 117 Puppets 118 Fashion 120 Internet 121 Church magazines 125 Testimonies 127 Seminars, conferences and workshops 129 Competitions 131 Sport 132 Photography 133

Section XIII: Case studies 135 Testimonies, workshops, video, radio and visual aids 135 Participatory video 138 Posters 140 Participatory photography 142 Street theatre 144 The internet 146 Sport 148 Street theatre 150 Cartoons 152

References 153

Appendices 155 Appendix 1. CWM HIV and AIDS Policy and Strategy Guidelines 155 Appendix 2. UNESCO guidelines on language and content in HIV and AIDS related materials 167 Appendix 3. UNAIDS’ Editor’s Notes for authors 207

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 5 Preface

At its Trustee Body meeting in 2005, the community of 31 churches worldwide that make up the membership of the Council for World Mission (CWM) approved a set of guidelines for an HIV and AIDS Policy and Strategy. CWM then asked the World Association for Christian Communication (WACC) to develop an HIV/AIDS toolkit for young peer educators to enable them to take a lead role in their respective churches in generating “Generating awareness awareness and understanding of HIV and AIDS and in developing and understanding of appropriate strategies to effect behaviour change. HIV and AIDS” In developing the toolkit we are grateful to the contributions of colleagues around the world and within WACC. In particular we would like to thank and acknowledge the contributions from Joyce Steiner, Christian Council of Ghana; Ayoko Wilson, Ecumenical HIV/AIDS Initiative in Africa (EHAIA) of the World Council of Churches, Ghana; Tendai Chikuku, Ecumenical Documentation and Information Centre in Southern Africa (EDICISA), Zimbabwe; Stella Etemesi, Senior Communication Officer, All Africa Conference of Churches (AACC), Kenya; Judith Smith Vialva, Director Southern Africa Media and Gender Institute, South Africa; Oghai Abungwo, Communications Department, Presbyterian Church of the Cameroon and David Lin, Anna Turley, María Teresa Aguirre, Philip Lee, Myriam Horngren, Ken Mpopo, Gregory Bonet, Lavinia Mohr and Gisèle Langendries of WACC. We are also grateful to Elizabeth Joy and Louise Gleich at the Council for World Mission for their support, encouragement and patience. We have drawn extensively on documentation and statistics from UNAIDS, WHO, The World Council of Churches and the Ecumenical Advocacy Alliance (EAA) as well as various publications and reports from the Johns Hopkins University Centre for Communications Programs, The Centre for Development and Population Activities, Washington and AVERT. We publicly acknowledge this debt. We are particularly grateful to the great cartoonist, Gado, for allowing us to use his cartoons and demonstrating the power and effectiveness of his medium in communicating messages about HIV and AIDS.

David Blagbrough and Julienne Munyaneza

World Association for Christian Communication

March 2007

Page 6 Responding to HIV and AIDS. A toolkit for youth peer educators. Introduction

We are immensely pleased that the Council for World Mission (CWM) and the World Association for Christian Communication could come together and embark on this publication. In 2005, CWM, wanting to build on information sharing and networking with like-minded organisations, was happy to entrust WACC with the development of this HIV and AIDS Toolkit. The CWM Trustee Body supported the move towards working in partnership with ecumenical organisations and gave the CWM executive such a directive by adopting the new HIV and AIDS Policy and Strategy Guidelines in 2005. CWM’S Global Youth Convention in June 2004 at Johannesburg, South Africa, brought together about 150 youth representing the CWM member churches as well as ecumenical organisations. The youth participants were moved by the intensity of devastation the HIV pandemic was bringing upon communities in different parts of the world. Inspired by the Bible studies, community exposures and the sharing through presentations, skits, and discussions, the participants committed themselves to addressing this issue at a deeper level as they strongly felt that HIV and AIDS was the one issue that affected youth everywhere. The Mission Education unit is happy to fulfil the request of the participants of the Global Youth Convention in June 2004 to equip them to be peer educators in the process of combating HIV and AIDS. Thus the main audience for this toolkit will be the youth members of CWM churches and the communities in which they live. We hope that this toolkit will be instrumental in bringing about awareness of HIV and AIDS, clarify facts and myths about HIV and AIDS, and address the issues of stigma related to HIV and AIDS. The main purpose of this toolkit is to enable the CWM member Churches to become “AIDS competent “ communities where the love of our Triune God – the Creator, Liberator and Sanctifier -will be experienced by every individual whether living with or affected by HIV and AIDS and involved in God’s mission to affirm God’s love, care and providence. We believe that as brothers and sisters of our community are living with or affected by HIV and AIDS, we, too, as a global community of churches, are also living with or affected by HIV and AIDS. Together we will address this problem through God’s love for us and our love for one another. We will remember God’s promises in the following verses and march ahead with hope and faith: “ Tell them that I, the Sovereign Lord, am saying to them: I am going to put breath into you and bring you back to life. I will give you sinews and muscles, and cover you with skin. I will put breath into you and bring you back to life. Then you will know that I am the Lord.” - Ezekiel 37:5- 6 As we use this toolkit, we need to go beyond the immediate issues and look at factors such as poverty, gender, power and others that have an impact in enabling the HIV pandemic to spread its tentacles. We acknowledge that all awareness about HIV and AIDS and all theoretical as well as practical knowledge on sexuality, safe sex, using condoms etc will not help us to

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 7 respond effectively to HIV and AIDS unless we pledge to bring about a behavioural change as individuals and communities. There is no use in acquiring knowledge on why and how to use a condom or be loyal or abstain from having unsafe sex as long as the threat of rape is round the corner. The churches are also challenged to address these issues by enabling church leaders to talk about HIV and AIDS in their sermons and pastoral work. We are well aware how difficult it is in several communities to talk openly about sex and sexuality. However, we need to promote a change in the mindset of all who think they can use sex as a weapon to dehumanise or punish people. So changes in our perceptions about who we are and how we need to relate to people around us with respect, will bring about behavioural change and redemption to children and young people, especially young girls and women. We are also happy to inform you that a facilitators manual will be accompanying this toolkit. We hope that all the youth from our CWM member churches will find this useful. As you begin to use this toolkit, we would appreciate any comments you have which may then be fed into future editions of the handbook. On behalf of the Council for World Mission, especially Rev. Dr. Des van der Water, the General Secretary, who extended his solidarity and support to this project, I express our deep felt gratitude and appreciation to David Blagbrough and Julienne Munyaneza for this excellent toolkit. They have taken a lot of effort to take our concerns on board in bringing out this toolkit. They have also beautifully brought in the important aspects of the CWM HIV and AIDS Policy and Strategy Guidelines into this toolkit making our actions more relevant to what we believe and confess. I also take this opportunity to thank Joanna Cornish and Louise Gleich, programme assistants in the Mission Education unit, for their contributions to the development of the toolkit. We had memorable brainstorming sessions and the successive meetings with David and Julienne in taking this project forward. I am sure that their efforts will go a long way in equipping our youth to be very good peer educators. May God bless us, our churches and our communities, as we serve God in our own contexts to become “AIDS competent” communities. As CWM celebrates 30 years of its mission, especially in this triennium when it proclaims God’s love through the theme, “Take home the good news”, may we become instruments that can take home the good news to every part of the world. Just as the person possessed with demons was healed and could go back to his home and community with good news, may we be healed from our infirmities, wrong information about HIV and AIDS, and the wrong attitude of excluding people living with or affected by this disease. Every one of us irrespective of whether or not we are living with or affected by HIV and AIDS is in need of healing and we hope that this toolkit will help us to move forward in being healed and enable us to TAKE HOME THE GOOD NEWS and build AIDS competent communities!

Elizabeth Joy

Executive Secretary for Mission Education

June 2007

Page 8 Responding to HIV and AIDS. A toolkit for youth peer educators. Using the Toolkit

1. Introduction

The purpose of the HIV and AIDS toolkit is to provide church members with the appropriate knowledge, information and skills to produce ‘AIDS competent’ communities by: • Providing basic information about HIV and AIDS. • Examining factors that impact on the spread of HIV and AIDS including religious, cultural and traditional practices . • Highlighting HIV and AIDS as a gendered phenomenon. • Examining the impact of HIV and AIDS on society. • Emphasising stigma and discrimination associated with HIV and AIDS. • Reinforcing the need to implement the CWM HIV and AIDS policy. • Identifying appropriate methodologies to communicate messages and information. • Providing case studies of communication techniques used in WACC and other HIV and AIDS projects to encourage the development of locally relevant communication techniques.

2. Structure of toolkit The toolkit is divided into four parts: 2.1. Issues around HIV and AIDS

Each issue is analysed separately, but in like manner. The analysis begins with basic information around the issue and then endeavours to root their understanding through a series of individual or group activities. The ﬁnal part of each analysis, entitled ‘action ideas’, identiﬁes a number of practical ways or activities in which the church or community might address the issue and thereby contribute to an ‘AIDS competent’ society. These activities provide a useful means of evaluating the success of the training, a focus for follow up activity and a means of assessing the record of member churches in implementing the agreed policy and strategy guidelines. 2.2. Communication tools

This section oﬀers a brief explanation of the most common communication tools available to churches and communities for generating greater awareness and understanding of issues around HIV and AIDS. Guidance is also provided on the most eﬀective use of these communication tools in putting over messages about HIV and AIDS.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 9 2.3. Case studies

The case studies illustrate how diﬀerent communication tools have been used to tackle speciﬁc issues around HIV and AIDS. The case studies also demonstrate the importance of matching the ‘tool’ to both the message and the target audience. 2.4. The appendix

This contains a selected bibliography as well as publications from UNESCO and UNAIDS which provide useful guidance on terminology and language use. Though there is some overlap between the two publications, the one from UNESCO is of more general use whilst that from UNAIDS is speciﬁcally directed towards the needs of editors.

3. Peer educators’ manual A separate manual has been produced for use by the peer educators. This will provide detailed comments and explanatory notes against each of the sections – somewhat in the form of a teacher’s or facilitator’s guide – together with occasional pedagogic advice.

Page 10 Responding to HIV and AIDS. A toolkit for youth peer educators. Introduction to Section I HIV and AIDS

Sex, reproductive health and sexual behaviour

We …..believe that the taboos against speaking openly about sexuality, especially in the context of church life, needs to be challenged, especially in view of a silence that promotes the stigmatisation of people living with the virus, discourages many from being tested, and compounds the spread of the disease, for which there is no cure.1 We encourage the CWM member churches and regions to encourage local churches/parishes/congregations and, in particular, parents to assume responsibility to ensure that adequate and appropriate sex education is given to their young people/children.2

1. Situation • In most societies sex and sexuality are taboo subjects and only cause embarrassment when discussed • Sex and reproductive health education are often inadequately covered in schools leaving young people with only a limited understanding of sex and sexual behaviour • HIV is mainly transmitted through a sexual act. It is therefore important to have a good understanding of sex and safer sex 2. Outcome To be able to talk freely, knowledgably and without embarrassment about sex, reproduction and sexual behaviour

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 11 3. Objectives • To be familiar with the male and female anatomy • To identify sexual body parts and use sexual words accurately and without embarrassment • To understand the reproductive process • To be familiar with the male and female condoms • To differentiate between different forms of sexual expression 4. Definitions 4.1. Sexuality

This term is widely used in the literature and is a fundamental part of being human, one that is worthy of dignity and respect. It has been deﬁned as Encompassing the sexual knowledge, beliefs, attitudes and values and behaviours of individuals3 It involves the anatomy, physiology and biochemistry of the sexual response system; identity, orientation, roles and personality; and thoughts, feelings, and relationships. Sexuality is inﬂuenced by ethical, spiritual, cultural and moral concerns. 4.2. Reproductive health

Reproductive health is about the reproductive processes, functions and systems at all stages of life. It is aimed at enabling men and women to have responsible, satisfying and safe sex lives, and the capacity and freedom to plan if, when and how often to have children. This requires knowledge, life- skills, and access to specialist services. An important focus for reproductive health services is adolescents, who have a special need for care and support during the transition to adulthood and the initiation of sexual relationships. Their needs have never been more important than since the coming of AIDS. 4.3. Heterosexual

Attraction towards members of the opposite sex 4.4. Homosexual

Attraction towards members of the same sex: Homosexuals of both sexes are also known as ‘gays’. Female homosexuals are known as ‘lesbians’ 4.5. Bisexual

A man or woman who feels both homosexual and heterosexual attractions

Page 12 Responding to HIV and AIDS. A toolkit for youth peer educators. 5. Biology of the reproductive system 5.1. Female anatomy4 • The ovaries contain unfertilised eggs that after puberty are released on average about once every 28 days. This process is known as ovulation. • If the egg is not fertilised, i.e. does not come into contact with a sperm, it will move out of the body along with the blood lining of the uterus. This is called the menstrual cycle and occurs on average around every 28 days. • Ovulation usually occurs around 14 days before the next menstrual ﬂow occurs. • The vagina, a canal leading from the uterus, is where semen is deposited by the male during sexual intercourse. If the woman is ovulating at the time of sexual intercourse and the sperm make it into the fallopian tubes, the egg will be fertilised. The fertilised egg will then move into the uterus and attach itself to the uterine wall where it will begin to develop.

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Vulva The name for the external genital area including the clitoris, labia and outer covering Vagina An elastic, muscular canal that intends upwards and backwards from the vulva to the uterus Cervix The neck of the uterus A thick walled hollow organ between the bladder and rectum, made up of two parts, the body Uterus (or womb) and the cervix. The foetus (baby) develops in the uterus Two tubes about 4 inches in length that extend from the uterus to the ovaries. The tubes Fallopian tubes provide a passage for the male sperm to reach the female egg. Fertilisation takes place in the tubes Ovaries The organs from where the eggs are released The female counterpart of the penis. It contains tissues that become erect during sexual stimulation. It is the most sensitive part of the female genitalia. Clitoris In some cultures the clitoris is removed through female circumcision. This practice is widely condemned.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 13 Penis Male organ through which sperm passes and for urinating Semen Fluid that contains the sperm or seeds for reproduction Testicles Organ that produces and stores the sperm Scrotum The sack on the outer side of the body that holds the testicles Seminal Vesicles Glands that secrete most of the liquid contained in the semen Vas deferens Tubes that provide the passage for the sperm from the testicles to the urethra on ejaculation Prostate Gland that opens into the urethra and secretes a fluid that becomes part of the semen

5.2. Male anatomy • The male reproductive system enables a man to have sexual intercourse and to fertilize eggs with sperm. • Sperm is produced and stored in the testicles, a pair of oval-shaped glands suspended in a pouch called the scrotum. • During sexual intercourse the sperm is discharged from the penis into the female vagina where it moves towards the uterus and the fallopian tubes.

Page 14 Responding to HIV and AIDS. A toolkit for youth peer educators. 6. Condoms5 Condoms are the only form of protection which can both help to stop the transmission of sexually transmitted diseases such as HIV and prevent pregnancy. They are available for both men and women. 6.1. Male condoms • The 'male' condom is a sheath or covering made of latex or polyurethane which fits over a man's penis, and which is closed at one end. A small number of people have an allergic reaction to latex and can use polyurethane condoms. • Polyurethane condoms are thinner than latex condoms and therefore increase sensitivity and though slightly less reliable and more expensive than latex condoms, they are considered more agreeable in both feel and appearance. • Condoms come in a variety of shapes, colours lengths and widths. Some are ribbed to increase sensation for both partners and others are flavoured to make oral sex more enjoyable. • The brand names will be different in each country. Wherever possible use those that have been properly tested and have a recognised quality mark. • Always check the expiry date on the condom package and that the latter is in good condition. • Condoms should always be used during sexual intercourse. • The same condom should never be used twice. • The condom should be placed on the erect penis and before any contact is made with the partner’s body. • If the man is not circumcised, the foreskin should be pulled back before rolling on the condom.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 15 • Care should be taken that the condom remains in place during sexual intercourse, that it does not slip or break • After ejaculation the rim of the condom should be held at the base of the penis whilst the penis is removed from the vagina. The penis should be removed before it completely loses its erection. • The condom should be removed before the penis softens and properly disposed of. • Sometimes using a condom without lubrication creates problems including the possibility of it slipping or tearing. If lubricants are to be used then they must be water based. Lubricants made of oil should not be used as they damage condoms.

6.2. Female condoms • The female condom is a polyurethane sheath with ﬂexible rings at both ends one of which is closed. • The open end covers the area around the opening of the vagina. The condom lines the vagina and helps to prevent pregnancy and sexually transmitted diseases (STDs) including HIV. • The closed end of the sheath is inserted into the vagina. The other open end of the sheath stays outside the vulva at the entrance to the vagina. And is kept in place by the ﬂexible ring. • It can be inserted up to 8 hours before sexual intercourse, but should only be used once. • The female condom can be expensive and in some countries is not always available. It is however actively promoted in South Africa, Ghana and Zimbabwe. • Using the female condom enables a woman to have greater control of her body particularly if her partner refuses to use the male condom. 7. Activities 7.1. Breaking the ice: what we know about sex6

Divide into single sex groups, identify a volunteer to record the discussion and in your groups recall • when you first heard the word ‘sex’. How old were you and how did you feel about discussing the subject?7 • when you first asked someone about sex and under what circumstances did you do this? How did the person react? • what issues inhibit discussion about sex and sexuality and in what situations did these occur? For example teachers may skip the chapter on reproduction and ask students to study at home or before marriage a girl may be told that her future husband “will know what to do” • what cultural or traditional practices, if any, reinforce the dominance of the male in a sexual relationship? • Bring the two groups together and ask the volunteers to report back. Freely discuss the findings. Note any similarities between the experiences of young men and young women.

Page 16 Responding to HIV and AIDS. A toolkit for youth peer educators. 7.2. Breaking the ice: what we do not know about sex

Working together, discuss issues and information about sex and sexuality that you lacked as a child and adolescent. Reflect on whether • having that information was important • the information was available from elsewhere • the guidance or information provided at school was adequate • you would have felt differently about sex or about yourself had you had that information • What information about sex and sexuality do you still lack? 7.3. How individuals deal with a partner’s reluctance to use condoms will vary. Some may find it difficult to talk about using condoms while others may regard it as an unwelcome intrusion. Working in small groups, suggest possible answers to the various excuses.8

Excuse Answer 1.1 Don’t you trust me? 1.2 It does not feel as good with a condom 1.3 I am afraid to ask him to use a condom. He’ll think I don’t trust him 1.4 I can’t feel a thing when I wear a condom 1.5 I don’t stay hard when I put on a condom 1.6 I don’t have a condom with me 1.7 It’s up to him... it’s his decision 1.8 I’m on the pill, you don’t need a condom 1.9 It just isn’t as sensitive and I can’t feel a thing 1.10 Putting it on interrupts everything 1.11 I guess you don’t really love me 1.12 I will pull out in time 1.13 But I love you 1.14 Just this once 1.15 You are treating me like a prostitute: these aren’t for couples who love each other

Can you think of other excuses? What would be your answers?

Excuse Answer

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 17 8. Action Ideas Having access to reliable information about sex and sexuality is one of the elements in creating a society that is able and prepared to tackle the spread of HIV and AIDS. In many communities around the world, both in the north and south, information is either not available or where it is there is often a reluctance to access it. 8.1. In mixed groups of three or four, develop an ideal sex and reproductive health education curriculum that addresses some of the issues discussed earlier. 8.2. Working in collaboration with the head teacher, chair of governors and the church leaders, compare this with the curriculum used at your local church or community school. 8.3. In talking to teachers and students identify strengths and weaknesses in the current curriculum and its implementation and agree ways in which the situation might be improved

Page 18 Responding to HIV and AIDS. A toolkit for youth peer educators. Basic information about HIV and AIDS

HIV and AIDS is not just a global crisis – it is a major challenge to the church in our time, a new “kairos” of mission imperative, a “right moment” of God’s call that challenges us to demonstrate a Christ-like, compassionate response.9 1. Situation • Accurate knowledge and information about HIV and AIDS is critical in reducing the spread of HIV - Lack of knowledge and information about HIV and AIDS kills. • The percentage of women and girls who have access to information about HIV and AIDS is very low. • Education is one of the most effective approaches to prevent the spread of HIV and AIDS and to mitigate the impact of the epidemic. 2. Outcome A broad understanding of HIV and AIDS, its causes, and how it is transmitted and prevented. 3. Objectives • To define HIV and AIDS and the differences between the two. • To know how HIV can be transmitted and understand the risks associated with different types of sex. • To look at how HIV can be prevented. • To learn about current methods and approaches to the treatment of HIV and AIDS. • To get to know the myths and realities around HIV and AIDS. • To understand the importance of sex and reproductive education.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 19 4. Deﬁnitions 4.1. HIV

HIV is a virus and stands for: ��

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As a virus, HIV attacks, weakens and destroys the natural defences of the body. 4.2. AIDS

AIDS is a condition and stands for: ��

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AIDS is not a disease, but is the condition resulting from infection by HIV in which the weakened body becomes susceptible to infections and diseases called ‘opportunistic infections.’10 It is the end stage of HIV infection. 4.3. HIV+ (HIV positive)

The term used to describe someone infected by the HIV virus. 4.4. STI

Sexually Transmitted Infections. Sometimes these infections are known as STDs or Sexually Transmitted Diseases.11 They can increase vulnerability to HIV. 4.5. ARV

AntiRetroViral drugs are used in the treatment of HIV and AIDS. 4.6. Microbicides

Drugs used to prevent or reduce risk of infection from sexually transmitted infections. A microbicide has not yet been developed that protects against HIV.

Page 20 Responding to HIV and AIDS. A toolkit for youth peer educators. The transmission of HIV 1. Introduction The HIV virus is found in body fluids. When these are infected, the ones likely to have the highest concentrations of the virus are • Blood • Semen • Vaginal fluids • Breast milk HIV is passed on from an infected person by three basic routes • Sexual • Blood borne • Mother to child The potential for infection will vary according to circumstance and the way it is passed on. For HIV to be passed on the virus must • have an entry point into the blood stream • be present in large enough quantities 2. Sexual transmission HIV can be passed from an infected partner to an uninfected partner through unprotected male to male, male to female or female to female sexual intercourse whether vaginal, oral or anal. • Vaginal sex is where the male penis is put into the vagina. For an HIV+ male the HIV virus will be in the semen while for an HIV+ woman it will be in the vaginal fluid. During sex the virus moves from the infected person to the healthy person. • Oral sex is where the penis is put into the mouth of the male or female partner or the male or female partner licks the vagina. The virus can be passed on through cuts or open sores in the lining of the mouth • Anal sex occurs when the penis is put into the anus. The lining of the anus is thin and easily gets small tears during anal sex. The HIV virus then enters the torn lining and infects the healthy person.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 21 3. Blood borne transmission There are a number of ways in which the HIV virus is passed on through blood. These are • Blood transfusion through the use of HIV infected blood in blood transfusions. • Sharing contaminated needles by drug users or the continued use of the same needle by health workers. • Sharing contaminated sharp items. Traditional practices such as male circumcision and female genital mutilation involving the multiple use of contaminated instruments are signification sources of transmission in some parts of the world. • With all, the risk of infection is very high. 4. Mother-to-child transmission. A woman infected by HIV may pass on the virus to her child • in the womb during the pregnancy, • during birth, • through breastfeeding. The risk of infection is around 25% though this can be reduced if the mother is given Anti Retro Viral treatment (ARV) 5. Activities 5.1. Identify means by which HIV can be passed on • Divide the participants into groups of three or four. • Distribute ‘transmission cards’. • Ask the groups to discuss the activity listed on each card and whether it can transmit HIV. • Using a flip chart or equivalent draw two columns entitled ‘Can Transmit‘ and ‘Cannot Transmit’ and write the relevant activity from the card into the appropriate list. 5.2. Assess the risks involved with different ways of passing on HIV • Using the using the pyramid below write in the activities linked with different levels of risk.

NO RISK

LOW RISK

MEDIUM RISK

HIGH RISK

Page 22 Responding to HIV and AIDS. A toolkit for youth peer educators. Signs and symptoms of HIV and AIDS 1. Introduction HIV is not like malaria or meningitis, which have distinctive symptoms and for which treatments are available. HIV gradually destroys the body’s immune system and makes the person more and more vulnerable to other infections. A person with HIV may be well or look well for many years but then begins to suffer from a range of very general complaints similar to many other conditions such as • chest infections • diarrhoea • tiredness • weight loss Eventually, these complaints become more frequent and more severe and include • weight loss becomes impossible to ignore • persistent fever • persistent tiredness • persistent diarrhoea • attacks of shingles It becomes increasingly difficult to live a normal life, and the person will now be described as suffering from AIDS. 2. Who gets HIV? Anyone can be infected by HIV. The virus • is ageless: old and young can get it; • knows no gender: women and men can get it; • does not discriminate by colour or nationality; • does not know the difference between the illiterate and educated; • does not know the difference between rich and poor; • does not favour one religion over another: for the virus, non -Christians, Christians and those with no faith are one and the same; • cannot distinguish between lay people and clergy;

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 23 • AIDS knows no geographic boundaries, though its impact in parts of Africa has been particularly severe.

Decidedly AIDS is the evil of the century.12

Page 24 Responding to HIV and AIDS. A toolkit for youth peer educators. Prevention of HIV13

In the belief that “prevention is better than cure” we encourage the promotion of responsible sex. This should take into consideration all aspects – physical, mental and spiritual consequences of the two individuals involved in the sex act. We recognise that the strategy which advocates the use of condoms by those who are not able to maintain either abstinence of faithfulness is controversial. However, instead of avoiding the issue, we encourage honest and open debate on this point.14

1. Introduction Any eﬀort to establish a programme to prevent the spread of HIV needs to consider issues of poverty, education, information, gender inequality, stigma and discrimination, and cultural and traditional practices. These will be covered separately. In this section we shall be looking speciﬁcally at practical ways in which people, particularly young people, can protect themselves from HIV. The means of prevention will vary according to how the virus was passed on. 2. Outcome Young people will have understanding on how to protect themselves and others from HIV. 3. Objectives • To be familiar with ways of preventing the three principal means of transmission of HIV. • To understand the notion of safer sex. • To be familiar with the advantages and disadvantages of ABC. • To understand the importance of personal responsibility. • To identify and use an appropriate communication tool to promote safer sex. 4. Prevention of sexual transmission Sex with an HIV infected person is the most frequent cause of passing on the virus. Avoiding, or at least minimising, the potential for HIV infection can be achieved in the following ways • Avoiding any form of sex until marriage. • Avoiding sex without a condom and whether male or female, using it correctly.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 25 • Using a microbicide cream gel or foam, during vaginal or anal sex, may help to reduce infection from sexually transmitted diseases which in turn may lower the vulnerability to HIV. • Being faithful to one partner and not having sex with multiple partners. 4.1. ABC Campaign

The means of preventing the spread of HIV at an individual level listed above form the basis of the ABC Campaign - Abstinence, Be faithful, and use Condoms. Whilst the ABC campaign can contribute to reducing the transmission of the virus, it needs to be recognised that • abstinence may not be an option for women and girls. • women and girls may have no control over the use of condoms. • microbicides may not be available to women and girls and they may have only limited control over their use. • being faithful does not necessarily prevent transmission if the other partner is infected. 5. Blood borne transmission of HIV • make certain that any blood used in transmission has been tested for and free from the HIV virus. • do not share a syringe with an intravenous drug user. Indeed, never share a syringe with another person. • when offered medical treatment involving an intravenous injection, make certain that needle and syringe are sterile. • avoid unprotected contact with blood. • use disposable gloves when providing treatment. • during traditional practices such as male circumcision, excision, face markings avoid using the same materials for many people and always sterilize instruments after each use. • when blood is spilled always clean with disinfectant. • do not leave knives or sharp objects hanging around in the home. 6. Prevention of mother to child transmission • treating HIV+ mothers with ARVs reduces risk of mother to child transmission. • encouraging HIV+ mothers to use bottled milk rather than breast feeding, though this, too, can create problems. • regular and effective monitoring of the pregnancy and labour by qualified and experienced midwives and doctors to reduce the impact of rupturing membranes during labour.

Page 26 Responding to HIV and AIDS. A toolkit for youth peer educators. 7. Activities 7.1. Identify and explore individual responsibility in the prevention of HIV • Divide the participants into two groups, male and female. • The female group to put together a small play about family life and how as women and girls they may have little or no control over their sexual life. • Meanwhile the male participants to put together a similar performance around the pressures on young men to have early sex and how they deal with it. • The two groups to come together and present their productions in turn.15 • Discuss and list the issues raised. How should these issues be resolved? • How useful was this communication tool? 7.2. Develop appropriate materials or activities relevant to your community to promote safer sex • Divide into groups of 4 or 5. • Identify a particular issue to be addressed. • Agree and develop a poster, programme, dance, radio programme game etc to highlight the issues and how it can lead to a reduction in the spread of HIV and AIDS. • Bring the groups together again and share and discuss your work. • Vote for the most effective presentation. 8. Action Ideas Although there is a wealth of material on the prevention of HIV available, having material that directs itself to the specific needs of your church or community may not be so easy to find. Drawing on the presentations made in the activities may overcome this. 8.1. Develop a plan for using the most effective presentation – or another one if you so wish – in promoting safer sex in your church or community. 8.2. Implement the plan.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 27 Treatment of HIV

1. Current situation • There is currently no cure for HIV. • Anti retroviral treatments (ARVs) are available that can prolong the period of ‘normal’ healthy life, but these are expensive and not widely available. • There is evidence to suggest that the onset of AIDS can be delayed and its severity mitigated by: • Good nutrition, a reasonable quality of life, a positive attitude and belonging to a supportive community. • Good basic health backed up by the availability of standard treatments for opportunistic infections such as pneumonia and tuberculosis. 2. Availability of treatment 2.1. In Europe and North America, where health care is adequate and drugs are available HIV is no longer a terminal condition.

Page 28 Responding to HIV and AIDS. A toolkit for youth peer educators. 2.2. In low and middle-income countries - especially in sub-Saharan Africa – where 95% of all HIV-infected people live HIV is generally fatal since: • access to treatment is limited or just not available. Where it is available treatment is very expensive despite the continued fall in the price of ARVs. • poverty, malnutrition and hopelessness hasten the progress of the disease.16 • adequate and effective primary health care is not available. • basic antibiotics and other drugs used in the treatment of debilitating complaints arising from AIDS such as diarrhoea or in the treatment of opportunistic diseases such as TB are often not available or their supply is erratic. • health infrastructures are often inadequate with few people trained to provide the treatment. • stigma and discrimination discourage people from seeking treatment. 3. What should be our response? • public information and education are important elements in widening access, alongside efforts to build or strengthen the health services. • need to minimise stigma, encourage openness about HIV status, and improve knowledge about treatment. • campaign for universal access to life saving drugs for HIV and AIDS.17 4. Activities 4.1. Identify locations for medical treatment and purchase of drugs in the immediate community and assess effectiveness. • In groups of three or four, draw a map of the locality. • On the map position hospitals, healing and medical centres, pharmacists etc and other relevant services. • List groups most at risk of HIV, estimate their numbers and identify their locations. • Discuss whether available services are known and adequate and how they might be improved. Identify those in a position to bring about change. 4.2. Identify the level of availability and cost of ARVs, antibiotics and other drugs. • Estimate the percentage of the population that has access to these medicines. • What can be done to improve supply and lower cost?

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 29 5. Action Ideas In many parts of the world, the faith based community is involved in the provision of medical services or has close contact with policy makers and others that do. Highlighting the need to improve the level, quality and access to services both with respect to the treatment of HIV and ‘opportunistic’ diseases, could therefore contribute to delaying the onset of AIDS and improving the quality of life of those persons who are HIV+. 5.1. Identify ways in which the church or your community might take to address any inadequacies in the provision of the health care. 5.2. Establish contact with individuals and NGOs campaigning for cheaper drugs for treating HIV and AIDS and identify speciﬁc ways in which you might contribute to the campaign 5.3. If your church has no policy on issues of treatment, or if you feel they are inadequate, develop a possible policy for submission to the church leaders. 5.4. Develop an appropriate communication tool – poster, play, video etc – to promote treatment and treatment centres.

Page 30 Responding to HIV and AIDS. A toolkit for youth peer educators. Voluntary Counselling and Testing (VCT)

We commit ourselves to engaging more actively in preventing new HIV and AIDS infections within our own families, churches and communities.18

1. Statement • Voluntary HIV counselling and testing (VCT) is recognised as an important tool for HIV prevention. • Fear of testing positive and concerns about confidentiality are barriers to VCT. • Stigma is attached to visiting VCT centres which in turn discourages their use. 2. Outcomes Greater acceptability of VCT within the church and community. 3. Objectives • To understand what is meant by Voluntary Counselling and Testing. • To recognise the importance of VCT to HIV prevention. • To be familiar with the benefits of VCT. 4. Definitions 4.1. Voluntary HIV Counselling and Testing (VCT)

Is a several layered approach for a person to determine their HIV status. • Pre – test counselling to enable the individual to make an informed choice about being tested for HIV. This includes both advantages and disadvantages. • The test itself. • Post test counselling which may also include the counselling of couples and families. • Long term supportive counselling. Increasingly there is an additional component of ‘treatment’.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 31

5. VCT Services • Access to HIV tests is a key strategy in many HIV prevention programmes. In many countries, however, VCT services are not always available locally. • The process is entirely voluntary and conﬁdential. • Stigma is attached to visiting a VCT centre. There is a perception that visitor has somehow been ‘sinful’. As a result, many are unwilling to go for counselling and testing because of the perceived shame it brings. • The diagnosis of HIV is made by testing antibodies against HIV. • Everyone should be encouraged to undergo VCT. 6. Beneﬁts of VCT • Knowing their HIV status enables those tested HIV-positive to gain early access to HIV/AIDS care, treatment and support; • Ensure pregnant women tested positive are able to have access to interventions that prevent transmission of the virus to their infants; • Those tested HIV-negative are encouraged to adopt safer sex; • By reducing the element of denial, VCTs encourager greater openness about HIV and AIDS; • VCTs interface between prevention, care and treatment and serve as entry points to HIV/AIDS care and support. 95% of people living with HIV do not know they are infected.

Page 32 Responding to HIV and AIDS. A toolkit for youth peer educators. 7. Activities 7.1. Divide into groups and list the benefits of VCT to • Those who test negative • Those who test positive Share the results in plenary session 7.2. Ask whether anyone has undergone VCT. If so, ask them to • Outline their feelings before hand • Explain what finally persuaded them to go • Give details of what is involved 7.3. If none of the participants has undergone VCT, either • Organise a visit to a VCT centre • Or ask someone else who has been through the process to speak • Or get a health worker and counsellor from the centre to speak 8. Action Ideas Breaking down the stigma associated with undergoing VCT and visiting a centre is crucial in any effort to reduce transmission of HIV. 8.1. In your church, persuade your pastor to announce that he will be visiting a VCT centre and would welcome others to join him. 8.2. In the build up to this announcement, prepare the congregation with a mini campaign about VCT using all the communication tools at your disposal. 8.3. Publicise the visit widely and evaluate the impact through media coverage, and surveys among church members.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 33 Myths and realities around HIV and AIDS

1. Introduction There are many myths around both the transmission and prevention of HIV and AIDS. They have their roots in fear and ignorance. Separating myth from reality is important. 19 2. Myths 2.1. You can be cured of HIV and AIDS if you have sex with a virgin.20

False. Having sex with a virgin greatly increases the risk of transmitting HIV to young girls and boys and also places them at risk of coercive sex and rape. The origins of this myth are not clear, but are based on an idealised female character of virgin purity, and it reinforces the idea of the male as a predator. 2.2. Mosquitoes can transmit HIV and AIDS. False. Mosquitoes do not transmit HIV, but because they may take blood from more than one person, it is often believed that they can do so. The fact is that the HIV virus can only survive in a human. Once it is taken in by a mosquito, the virus dies. 3. Realities 3.1. Although many people do not have access to expensive drugs to treat HIV and AIDS, there are medicines that can be used to slow down the disease and to keep us healthier longer

True. Medicines used to treat infections such as tuberculosis, malaria and sexually transmitted infections can help us to remain healthier for a longer time with HIV and AIDS. It is very important to promptly seek treatment for illness: doing so helps to keep the body stay strong to ﬁght the HIV infection. 3.2. You cannot know whether someone is HIV+ by simply looking at them

True. The only way to determine whether someone is HIV+ is by an HIV antibody test. 4. Activities 4.1. Explore the range of myths and realities about HIV and AIDS and distinguish between them

Page 34 Responding to HIV and AIDS. A toolkit for youth peer educators. Divide into groups of two or three, against each statement indicate whether the following actions or behaviours put you at risk of being infected by the HIV virus. Where appropriate state the reasons why.

No. Behaviour/action Yes No Why?

1 Sitting next to a person who has HIV21

2 Using a phone which was used by someone with HIV

3 Breastfeeding when mother is HIV+

4 Sitting on a toilet seat vacated by someone with HIV

5 Being next to a person with HIV who coughs or sneezes near you

6 Sharing razor blades

7 Kissing an HIV+ person on the cheek

8 Drinking from the same glass

9 Touching an HIV+ person who is crying

10 Getting a tattoo

11 Eating food cooked by someone who is HIV+

12 Having sex with someone who has a sexually transmitted disease

13 Swimming in a public swimming pool

14 Breastfeeding when mother is not HIV+

15 Sleeping with someone with HIV but without having sex

16 Hugging a person who is HIV+

17 Playing a ball game with a student, who has AIDS

18 Getting an injection from a traditional healer

19 Using a public latrine

20 Having a massage

21 Self masturbation

22 Working with someone who is HIV+

23 Spitting

24 Having sex without using a condom

Having sex with my partners who are not infected with HIV and give them 25 some of my virus, then my own viral load will go down

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 35 4.2. Indicate which of these statements is true or false

No Statement True False Why? 1 HIV and AIDS affects adults, not children 2 The effect of the HIV/AIDS crisis on children is confined to Africa 3 You cannot get HIV from having sex standing up 4 Blood-sucking insects transmit HIV Condoms are un-African. AIDS has grown so fast because of the 5 availability of condoms 6 Those with HIV are being punished by God 7 Condoms don’t stop AIDS22 8 Washing after sex prevents HIV 9 Abstinence is a 100% effective means of HIV prevention Condoms transmit HIV, are filled with the virus. Condoms have 10 tiny holes through which HIV can pass 11 Children orphaned by AIDS should only live in orphanages23 12 If I am faithful I can never get HIV and AIDS 13 There are no men who have sex with men in my country You cannot get HIV from having sex when the women is having 14 her period If you are HIV+ and pregnant, it does not mean your child will 15 get HIV 16 Drug users spread HIV Homosexuals are responsible for the spread of HIV and AIDS 17 internationally

4.3. List local myths about HIV and AIDS, its transmission and prevention

5. Action Ideas Overcoming myths about HIV and AIDS is a critical part of reducing stigma and discrimination and levels of transmission of the virus 5.1. Devise a board game e.g. like Ludo or Snakes and Ladders or one that is common locally, that can be used by young people as apart of a campaign to address local myths around HIV and AIDS. 5.2. Test it and introduce it as one of the social activities in your church or community.

Page 36 Responding to HIV and AIDS. A toolkit for youth peer educators. Section II Overview of the geography and statistics of HIV

1 . Situation HIV and AIDS is the The HIV pandemic is a recent phenomenon and was ﬁrst identiﬁed in 1981 number one cause of death The size of the problem is demonstrated by the in Africa and has moved up • escalating numbers of people living with or dying from HIV and AIDS; to the fourth place among all • high infection rates among young adults; causes of death worldwide24 • growing numbers of unsupported survivors including elderly parents and grandparents as well as orphaned children; • the impact on all aspects of society by the loss of skilled and productive people; • task of keeping pace with replacing skilled key workers lost through HIV and • the urgency of the problem is demonstrated by the rapid increase in the number of infections in all but a very few countries in the developing world.

2 . Outcome To be able to see the local HIV situation for CWM member churches in the context the national and global problem and to understand the importance of working together to prevent the spread of the virus.

3 . Objectives • To be familiar with the global and national scale of the HIV pandemic. • To be aware of where the HIV virus hits hardest i.e. the high risk groups. • To be aware of national and international eﬀorts to reduce the spread and impact of the HIV virus.

4 . Global statistics The total number of adults and children living with HIV and AIDS at the end of 2006 was estimated at 39.5 million25 - over double the number in 1995. • The 2006 estimates show Adults 37.2 million Women 17.7 million Children under 15 year 2.3 million

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 37 • The proportion of women aﬀected by HIV and AIDS is rising, particularly in Sub Saharan Africa and Oceania. In Sub Saharan Africa, for example, 59% of all adults infected with HIV are women. • Women are disproportionately aﬀected by HIV. In South Africa, for example, young women are four time more likely to be infected with HIV than young men. • 13.3 million of all women living with HIV come from sub- Saharan Africa. • In 2006 there were 4.3 million new HIV infections worldwide. Of this number 3.2 million were from sub-Saharan Africa. • 90% of the new HIV cases are occurring in Latin America, Africa, Asia and the Caribbean. • In 2006 63% of all persons infected with HIV were living in sub-Saharan Africa. • Worldwide, one in every 100 adults aged 15 to 49 is HIV infected. • There are approximately 16,000 new infections every day, many of them teenagers. • In 2006 around 2.9 million people died from AIDS related diseases of whom around 380,000 were children. 72% of all adult and children deaths due to AIDS were in sub-Saharan Africa. • In addition to the 5 million children who have been infected with the HIV virus, some 15 million children under age 18 have lost one or both parents to AIDS. The vast majority more than 12 million are in sub- Saharan Africa. • Despite advances in HIV treatment and access to antiretroviral drugs, the number of AIDS orphans is projected to exceed 25 million by the end of the decade. Some people, including former President of South Africa, Nelson Mandela, claim that AIDS has killed more people than all the wars put together. Whether true or not, it is clear that countries are being devastated by the virus and whole villages have been wiped out. Behind all these statistics there are names and faces, individual stories of women and men, youth and children, whose life situations, cultural practices, the silence of leaders and churches and the crushing reality of poverty make them vulnerable.

Page 38 Responding to HIV and AIDS. A toolkit for youth peer educators. 5 . Regional statistics26 5.1 People living with HIV, December 2006

5.2 Percentage of adult population living with HIV by region, December 2006

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 39 5.3 Percentage of women living with HIV

5.4 New HIV infections and deaths from AIDS related diseases 6 . HIV Statistics in countries of CWM member churches27

6.1 The Caribbean28

6.2 Asia29 6.3 . Oceania30

6.4 . Africa

Page 42 Responding to HIV and AIDS. A toolkit for youth peer educators. 6.5 . Europe

6.6 . Percentage of 15-19 year olds living with HIV and AIDS in the countries of CWM member churches 31

40.00 37.30

35.00

30.00

25.00 24.60 21.50 21.30 20.00 16.50 Percentage

15.00 14.20 12.10

10.00

5.00 3.00 2.50 1.70 1.20 0.90 0.60 0.30 0.20 0.20 0.00 0.10 0.10 0.10 0.10

r r i a g a a d ia a re a w e ia ia e s K n ica n e e n sh d o n a u b ica b w d U a o r in la e n m p a sca l iq i fr b n ya K o u a d I n a a a b m A m a la u m K e la g sw g M a a b r G g f G Z g ya t a m h Z e Ja n o n M in o d N t im th o c w w a S B a za u Z e H li e e B o o b N N M M S N u a p u e p R a P

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 43 7. Access to Anti-RetroViral therapies (ARVs)

7.1 . Situation • ARVs do not eradicate the virus. They help patients to resist and recover from opportunistic infections as a result of AIDS. At the end of 2005 an estimated 6,500,000 people in low - and middle-income countries were in need of antiretroviral (ARV) treatment for AIDS32. Of these, only 20% were receiving it. • There are major global disparities over access to ARV therapies as illustrated by the tables below.

7.2 . Access to ARV therapies in low and medium income countries by region33 People receiving People needing Treatment coverage Region treatment treatment in December 2006 in December 2006 in 2006 Sub-Saharan Africa 1,340,000 4,800,000 28% Latin America and the Caribbean 355,000 490,000 72% East, South and South-East Asia 280,000 1,500,000 19% Europe and Central Asia 35,000 230,000 15% North Africa and the Middle East 5,000 77,000 6% All developing and 2,015,000 7,100,000 28% transitional countries34

Page 44 Responding to HIV and AIDS. A toolkit for youth peer educators. 7.3 . Access to ARV therapies in countries of CWM member churches35

People receiving Country People needing Treatment coverage treatment in treatment in 2005 in December 2005 December 2005 Bangladesh <200 <1,000 1% Botswana 67,000-77,000 84,000 85% Guyana 1,000-1,500 2,500 50% India 36,000-67,000 785,000 7% Jamaica 1,500 2,600 56% Kiribati Malawi 31,000-35,000 169,000 20% Myanmar 2,500-4,500 50,000 7% Nauru The Netherlands 6,730 Papua New Guinea <500 2,000 15% Samoa Solomon Islands South Africa 178,000-235,000 983,000 21% Tuvalu United Kingdom36 36,000 Zambia 45,000-52,000 183,000 27% Zimbabwe 22,000-27,000 321,000 8%

8 . International HIV and AIDS Declarations and Goals

8.1 . Declaration of Commitment on HIV/AIDS, 2001 • Adopted unanimously by UN member states to acknowledge that the AIDS epidemic constitutes a “global emergency and one of the most formidable challenges to human life and dignity.” • The Declaration of Commitment covers ten priorities, from prevention to treatment to funding. 8.2 . Millennium Development Goals (MDGs) • Adopted by all the world’s countries and leading development institutions. • One of the eight development aims to halt and begin to reverse the spread of HIV and AIDS by 2015. • Other goals include halving extreme poverty and providing universal primary education also by 2015.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 45 9 . International programmes of action against HIV and AIDS There are a number of major international initiatives to tackle the spread of HIV and AIDS. 9.1 . UNAIDS • UNAIDS, the Joint United Nations Programme on HIV/AIDS, brings together the efforts and resources of ten UN system organizations to the global AIDS response. These include UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank. • Based in Geneva, the UNAIDS secretariat works on the ground in more than 75 countries. • UNAIDS supports nationally led responses to HIV and AIDS and coordinates the HIV and AIDS work of its partners in the UN system, civil society, donors, the private sector etc. • UNAIDS focuses on leadership and advocacy, strategic information and technical support, tracking monitoring and evaluation, civil society engagement and mobilization of resources. 9.2 . The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) • An independent public-private partnership established in 2001 at the initiative of the UN Secretary General, Kofi Annan, to raise funds and pool money from governments, businesses and individuals around the world, and channel it into grant programmes to fight AIDS, TB and Malaria. • More than 120 nations have benefited from Global Fund money: 61% of the money goes to Africa, 23% to Asia, the Middle East and North Africa, and 16% Latin America, the Caribbean and Europe. • 40% of funding is currently being spent on HIV and AIDS, 27% is being used to fight Malaria and 27% is going on TB programmes, with the remainder being spent on general health system strengthening. • Any country wishing to receive funding from the Global Fund must establish a Country Coordinating Mechnism(CCM) through which applications for funding are submitted. 9.3 . All by 2010

Programme and campaign supported by all UN members to ensure as near as possible universal access to ARV treatment worldwide by 2010. 9.4 . President’s Emergency Plan for AIDS Relief (PEPFAR)

A U.S. ﬁve year $15 billion global initiative to combat the HIV/AIDS epidemic. The majority of funds being utilized for treatment.

10 . National programmes of action against HIV and AIDS 10.1 . National AIDS Commissions • Established in all countries wishing to receive support from the Global Fund. • The National Commissions are the Country Coordinating Mechanisms and implement, coordinate and monitor monies from the Global Fund.

Page 46 Responding to HIV and AIDS. A toolkit for youth peer educators. • The National Commissions are made up of a broad range of representatives from government agencies, NGOs (Non Governmental Organisations), local community and faith-based organisations, individuals working in the ﬁeld and private sector institutions. • It is important that CWM member churches work with or are represented on the CCM.

11 . Activities 11.1 . In small groups discuss what the graphs and tables tell us about the sheer scale of the epidemic and its impact on communities? * Which are the most significant at risk groups and why? 11.2 . How do the national statistics reflect the situation in your community? • Are there significant differences? If so why? • Are there local Voluntary Counselling and Treatment Centres? Are they located where they need to be? • How accessible are ARV therapies? • What has been the impact of HIV and AIDS on your church membership, schools, health services etc? 11.3 . What would your church be able to achieve through membership of or representation on the National AIDS Commission or its equivalent in your country? 11.4 . Each statistic represents human suffering, what stories can you share with the group about your experience of HIV and AIDS in the community in which you live.

12 . Action Ideas Having reliable data and knowing the network of individuals and organisations involved in HIV and AIDS activity is critical in developing plans and programmes to tackle the spread of the virus. 12.1 . Find out whether your church is linked to or involved with the work of the National AIDS Commission or its equivalent. If not, identify how you can ensure full participation. If the church is a member, how can you improve its impact? 12.2 . Produce a detailed profile of your district, village or community – or review and modify an existing one - with data about the incidence of HIV. 12.3 . Produce a play, a radio broadcast, video, photo competition, poster etc based on interviews with people living with and affected by HIV and AIDS on the lack of access to ARV therapies in your district and how this is affecting their lives. Your production should be seen as part of a potential campaign for improving access ARV therapies.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 47 Section III Factors that impact on the spread of HIV We have identiﬁed poverty and basic human rights as a challenge and have prioritised the concerns of women and youth37

Poverty 1. Statement • Poverty is not a pre condition of HIV and does not cause AIDS. • Poverty oﬀers an environment in which HIV can ﬂourish. • Poverty and HIV and AIDS reinforce each other.

2. Outcomes An understanding of the complex inter relationship between poverty and HIV and AIDS

3. Objectives • To define poverty. • To examine how poverty fuels the spread of HIV. • To examine how the spread of HIV and AIDS can make people and communities poorer. • To examine how poverty affects people living with and affected by AIDS. • To explore the response of the local faith based community to poverty.

4. Deﬁnitions

Poverty cannot simply be seen in terms of an extreme lack of material wealth. It is also about non-material things such as human dignity and the lack of access to the basic human rights of health, employment, justice, education, communication, social inclusion etc.

Page 48 Responding to HIV and AIDS. A toolkit for youth peer educators. 5. The impact of poverty on HIV and AIDS • Poverty results in less formal education and inability to access information etc about HIV and AIDS. • Inability to pay for ARV therapies thus increasing susceptibility to the onset AIDS. • Inability to buy condoms thus reducing protection from HIV. • Poverty leads to migration and an increase in the risk of HIV. • Poverty can force women into prostitution with a high risk of catching HIV. • Poverty can lead to poor health infrastructure and lack of access to treatment for STDs. • Poverty leads to malnutrition and weakens the immune system. 38

6. The impact of HIV and AIDS on poverty • Weakens the ability of farmers to manage land thus decreasing AIDS deepens poverty agricultural productivity. ‘In Southern Africa today, famine and HIV/ and increases inequalities AIDS are locked in a terrible embrace. As HIV/AIDS decimates the at every level, household, workforce, crops dwindle and food security plunges’.40 community, regional and • With death and illness of key professional workers such as nurses, doctors 39 and teachers, the health and education services are undermined. sectoral. • Death and illness from HIV and AIDS leaves large numbers of dependent relatives without access to income or resources and leads to impoverishment. • Undermines eﬀorts at poverty reduction. • Increases stigma and discrimination and social exclusion thus inhibiting ability to play a full role in social and economic life of the community. • Death is expensive!

7. Activities 7.1. Divide into small groups and identify at least two detailed stories – or case studies - from your community that show how

• poverty fuels HIV and AIDS • HIV and AIDS increases poverty What was the response of the church in each case? In plenary session, share the examples with the entire group. What lessons can we learn from these examples? 7.2. Schools have a major role in generating awareness of HIV and AIDS among children. In small groups discuss the following

• What happens to those children who cannot attend school due to poverty?

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 49 • What do you think your church should do to raise awareness of HIV and AIDS for such children? • What communication tools would you use to achieve this purpose? Come together in plenary session and share your results. Record the discussion

8. Action Ideas 8.1. Compile and edit the stories/case studies from the ﬁrst activity and produce as a small publication for circulation to members of your church or as an insert in the church magazine. 8.2. Using appropriate communication tools, Implement a programme within your church to raise awareness of HIV and AIDS among children unable to attend school.

Page 50 Responding to HIV and AIDS. A toolkit for youth peer educators. Cultural Practices We encourage the CWM member churches and regions to address cultural attitudes…41

1. Situation • Some traditional and cultural practices can aﬀect the transmission, prevention and treatment of HIV and AIDS. • Culture can aﬀect the way people perceive particular issues. • To have an impact, any intervention programme must take into account local cultural dynamics. • Certain diseases, particularly HIV and TB are, in some religio-cultural contexts, diagnosed in terms of sin, curses and activities of evil powers. • Many cultural practices disproportionately expose women and girls to the risk of HIV infection.

2. Outcome Understand how traditional and cultural practices may contribute to HIV transmission.

3. Objectives • To deﬁne culture and cultural practices. • To Identify a range of cultural practices and assess their part in the transmission, prevention or treatment of HIV and AIDS. • To examine ways in which the church might counteract those traditional and cultural practices that adversely aﬀect the spread of HIV.

4. Deﬁnitions 4.1. Culture

Culture can be deﬁned as an integrated set of behaviours, practices, beliefs and values that are characteristic of any member of a particular group. It includes everything that a group of people thinks, says or does. Culture deﬁnes the individual. 4.2. Cultural and traditional practices

Cultural practices comprise the ways people do particular things in a given culture.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 51 5. Background There are many elements that define a person’s culture – language, religion, nationality etc. But there can be differences between members of the same culture as much as there can be similarities between members of different cultures. Persons from different cultures, for example, may share the same sexual orientation. Culture often affects the way people look at certain issues. In rural communities for example a large family means greater security and extra hands to work on the farm. Urban society, on the other hand, may find having a large family an economic drain on scarce resources. The city dwellers therefore might be more enthusiastic about family planning than their rural counterparts. These different worldviews also lead to some diseases, particularly HIV and TB, being diagnosed in terms of sin or mystical or supernatural causes. They are seen as ‘spiritual diseases’ which therefore demand ‘spiritual solutions’. These may take the form of worship at traditional shrines, diviner’s courts, healing and deliverance camps. This refusal to acknowledge the true nature of the diseases can only hasten the onset of full blown AIDS.42 Many societies are patriarchal in structure and social norms centre on that which is good for the man and not for the woman. This leaves women very little power in their relationships. They may, for example, be unable to insist on the use of condom thus increasing their vulnerability to catching HIV.

6. Activities 6.1. In groups of 4-5 participants, identify local or national cultural and traditional practices that might be signiﬁcant in the spread of HIV.

• Using a ﬂip chart list the cultural practices. • Against each list how it impacts on HIV transmission and prevention. • Indicate also which practice is very local and which is more widespread throughout the country. • Identify which practices have a greater tendency to expose women and girls to HIV infection. • Share your results in a plenary session. 6.2. In the same groups devise a story line around one cultural practice that led to a young woman being infected with HIV.

• With this story line develop a short play for presentation to the group. • If possible record each presentation or in audio, video or through the preparation of a script. 6.3. Discuss within the group how your church can speak out against damaging cultural practices

• What is the current position of the church and its leadership to these practices? • How can religious leaders dialogue with those, such as traditional leaders and traditional healers, who are the custodians of these practices?

Page 52 Responding to HIV and AIDS. A toolkit for youth peer educators. 7. Action Ideas 7.1. The small plays you developed in the activity section about cultural practices leading to a young woman being infected with HIV could be used the basis of a local campaign to highlight the issue within your community.

• Revise and develop some of these small plays and perform them in your church, school, community centre, youth club etc. • Undertake an evaluation of the impact of the plays. • If relevant, and the opportunity and facilities exist, make an audio or video recording for broadcast over the local community media. • If appropriate and relevant use the performances as a basis of a campaign to eﬀect attitudinal change and reduce or eradicate the continuance of such practices.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 53 Attitudes of churches and religious leaders towards HIV and AIDS

We encourage the CWM member churches to formulate HIV and AIDS policy statements aﬃrming that the disease is not a punishment from God, and that the pandemic needs to be seen within the greater context of a sinful world and a fallen humanity to which God has sent God’s own son, not to condemn, but to save the world43.

1. Situation • Religious leaders and the faith community have an important and critical role in reducing the spread of HIV. • There is a general perception, particularly in parts of Africa, that the response of the faith community to the issue of HIV and AIDS has been inadequate and in some cases has even made the problem worse.44 • Faith-based organisations are often among the relatively few institutions trusted by the population at large and generally integrated into the wider community.

2. Outcome A greater resolve by church leaders to take a leadership role in eﬀorts to reduce the spread and impact of HIV and AIDS and to speak openly and regularly about the virus and its impact on society.

3. Objectives • To identify attitudes and beliefs held by church leaders that encourage the spread of HIV. • To examine ways in which church leaders can take a leadership role in eﬀorts to tackle the spread of HIV and AIDS.

Page 54 Responding to HIV and AIDS. A toolkit for youth peer educators. • To identify elements of a local church policy towards HIV and AIDS and develop a strategy for its implementation.

4. Silence kills Many church and community leaders round the world are unwilling to address the issue of HIV and AIDS. They • are silent and their silence kills, • have problems in speaking openly about sex in their churches, • often regard HIV and AIDS as punishment for sinful activity, • reject the use of condoms, • are openly hostile to people of a diﬀerent sexual orientation, • simply associate HIV and AIDS with sex outside marriage, same sex relationships and drug addiction. And yet churches are in a powerful position to take a lead in tackling the spread of HIV.45 They • are grass roots organisations, • serve the people and respond to their needs, • are committed to the total well being of their communities, • are educators, • health providers, • a voice for the poor and marginalised, • can draw on committed and dedicated volunteers, • have the structures, resources, programmes and networks to make a diﬀerence, • can and do step in when government fails.

5. What should be the response of the church and its leaders? • become more aware of HIV transmission, prevention, treatment and care. • promote improved sex education in their schools and informal and other education programmes. • use sermons to talk about HIV and AIDS and saving lives. • speak about HIV and AIDS at marriages, christenings and funerals. • be open and willing to discuss and advocate the use of condoms to prevent the spread of HIV. Remember that though condoms can occasionally break, vows of abstinence break far more easily! • welcome those people living with and aﬀected by HIV and AIDS into the church. Do as Jesus did: listen to their stories and provide a place of acceptance, of safety, of refuge, and of healing.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 55 • ensure that all members of the church – particularly the young and those people living with are HIV and AIDS – are involved in the church’s mission of HIV prevention, treatment and care. • condemn marital rape and domestic violence. • clarify their position with regard to cultural practices that expose people to infection. • overcome gender discrimination: ensure that women are equally represented in all decision making councils. • commit the church to the development of a local HIV and AIDS policy and strategy.

6. Activities 6.1. As a group discuss the current attitude of your church to HIV and AIDS. For example

• How involved is the pastor? • Has sex or sexuality ever been discussed in church settings? • Are people who are HIV+ welcomed in the church? Has a HIV+ person ever spoken to the church? Do people living with or aﬀected by HIV and AIDS play a leading role in your church? If not why not? • Does your church have its own policy towards HIV and AIDS? 6.2. In small groups

• identify at least four speciﬁc ways in which your church can and should respond to HIV and AIDS. • outline how these might be achieved. • Review and collate the responses in a plenary session and agree a list of critical actions.

7. Action Ideas In its document, HIV and AIDS, Policy and Strategy Guidelines, the Council for World mission encourages regions to develop their own HIV and AIDS policies. It is clearly important that individual churches contribute to and own such policies. 7.1. In collaboration with others in your church, including church elders, women and people living with and aﬀected by HIV and AIDS,

• develop a draft policy on HIV and AIDS for the church. • agree the policy with the pastor and church elders. • submit the policy for consideration by the regional head of the denomination. If such a policy already exists, revalidate it with your groups of elders, women and members of the church who are living with or aﬀected by HIV and AIDS. 7.2. Starting with your policy statement

Page 56 Responding to HIV and AIDS. A toolkit for youth peer educators. • outline a clearly deﬁned strategy of how that policy might be implemented, • where appropriate implement the strategy, • After one year, review the policy and strategy and note any signiﬁcant improvement in the way the church and church leaders deal with HIV and AIDS. 7.3. Design and implement marketing strategy to promote the policy of your church towards HIV and AIDS. Think carefully about the communication tools you would use.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 57 Theological interpretation

We encourage CWM member churches and regions to adopt theological/missiological positions and practical approaches in relation to those infected and aﬀected by HIV and AIDS that are premised on the purpose of God’s redeeming love for all, and on biblically-based principles of inclusion, compassion, justice, accountability and responsiveness.46

1. Situation 1.1. Churches and religious leaders have used narrow theological interpretation of the Bible to

• pronounce harsh moral judgements on those living with or affected by HIV and AIDS. • support exclusion and promote stigma and discrimination which in turn encourage the spread of HIV and AIDS. • support patriarchy and gender inequality. • condemn those of a different sexual orientation. 1.2. Churches and religious leaders have been at the forefront of efforts to reduce the spread and impact of HIV and AIDS.

2. Outcomes An understanding of a theological framework that enables churches, their leaders and congregations to develop more positive and loving approaches to HIV and AIDS particularly around issues of stigma and discrimination.47

3. Objectives • To identify themes that need to be addressed in a theological reﬂection on HIV and AIDS related stigma and discrimination. • To examine each theme brieﬂy. • To examine to what extent these themes have been embraced by each church.

4. An alternative theological approach Stigma and discrimination48 make a signiﬁcant contribution to the spreading of HIV and AIDS. Many pastors or priests, though by no means all, either

Page 58 Responding to HIV and AIDS. A toolkit for youth peer educators. directly or implicitly, have encouraged stigma and discrimination in their teachings, behaviour and attitudes. In doing so they have often drawn on a narrow interpretation of Biblical texts. The Windhoek Declaration oﬀers an alternative approach to addressing HIV and AIDS and identiﬁes a number of theological themes that need to be addressed when thinking about HIV and AIDS related stigma. These include 4.1. God and Creation:

• God is not vindictive: God is a God of compassion who delights in creation. • HIV is a virus, not a divine punishment for sin. “…..neither this (blind) man nor his parent’s sinned” (John9.3) • God delights in our differences and in variety. • God created us as sexual human beings and sexual orientation is an expression of both that and of our differences. • God wants us to celebrate the gift of sexuality through which God’s creation unfolds. • Men and women are created equally. • Control or abuse of the sexuality of women or the vulnerable by men is an offence both against God and against God’s creation. 4.2. Interpreting the Bible

• The Bible tells the story of God’s ongoing concern for creation and humanity through His love and justice. • Any interpretation of the Scriptures must reflect today’s social context, cultural traditions and realities. • Jesus exhorted his followers to include the vulnerable and stigmatised - the lepers, Samaritans, menstruating women, those with physical and emotional difficulties - in their lives. Today He would include those people living with and affected by HIV and AIDS. • God’s abiding concern is for our well being: no passage from Scripture should therefore be used to undermine or diminish this concern. 4.3. Sin

In the context of HIV and AIDS related stigma there are a number of diﬀerent elements of ‘sin’. 4.3.1. The sin of stigmatising

All human beings were created in the image of God. To stigmatise an individual is to reject the image of God in the other which, in itself, is a sin against God. 4.3.2. The association between sexuality and sin

• There is a widely held assumption that HIV is always contracted as a result of what is perceived as ‘sinful’ sexual relations and the additional tendency to regard sexual sin as the gravest of all sins.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 59 • Although HIV transmission in the majority of cases occurs as a result of sexual activity such sexual activity is not inherently sinful. For the responsible use of sex and sexuality is part of God’s creation and is to be celebrated and enjoyed. 4.3.3. HIV and AIDS as punishment for sin

• It is wrong to interpret HIV and AIDS, or indeed any other disease or disaster, as God’s punishment for sin. • A reading of the Book of Job makes clear that God’s punishment for personal sin was no more the cause of his suffering than it would be for people living with or affected by HIV and AIDS. • Any claim that HIV and AIDS is God’s punishment for personal sin is contrary to the healing narratives of the gospels. 4.4. Suffering

• Suffering as an unavoidable destiny of individuals, a punishment for sin, or a virtue have no place in Christian theology. • Christianity challenges the social structures that cause suffering. • Jesus showed compassion for the suffering of individuals and a determination to help and empower them. 4.5. Covenantal Justice

• The biblical concept of Covenant implies a reciprocal and binding relationship between God and human beings which should be mirrored in the relationships that human beings have with one another. • The implication of the Biblical Covenant is that we should help one another, particularly the powerless, the poor, the marginalised and the sick especially those living with or aﬀected by HIV an AIDS. • Although engaging the symptoms and condemning the causes of poverty, the Churches need to ﬁnd ways of addressing its structural roots which often lie in both national and international political, social and economic policies, the globalisation of business, political corruption etc. • Regardless of geography, culture or traditions, the Churches of the world must work together to address HIV and AIDS recognising their unity in the Body of Christ. 4.6. Truth and truth-telling

• Stigma, and with it the spread of HIV, is fuelled by silence and denial. Truth is often sacriﬁced as a result of fear of stigma and discrimination. • Jesus taught that truth sets us free and that we should teach and practice truth. But disclosure of the truth, for example being HIV+, is a fearsome and risky undertaking. • Churches have often condoned silence and denial, but now need to break that silence through strong prophetic and moral leadership. Failure to do so would be hypocrisy and Jesus condemned hypocrisy among religious leaders. • There is a need therefore for religious leaders to speak about the ‘truths’ of HIV and AIDS.

Page 60 Responding to HIV and AIDS. A toolkit for youth peer educators. The one truth that Jesus’ life and ministry made it clear that God is a God of: • Resurrection, not death. • Health, not disease. • Peace, not turmoil • Hope, not despair. • Freedom, not bondage. 4.7. The Church as a healing, Inclusive and accompanying Community

• Jesus preached inclusion and the Church, as a community of disciples of Jesus Christ, should be a sanctuary, a refuge, a safe place for the stigmatised and excluded, particularly those living with and affected by HIV and AIDS. • People living with and affected by HIV and AIDS should be included in all aspects of the church’s life for it is through them that attitudes can change and fear conquered. • Sharing the experience of living with and affected by HIV and AIDS can offer insights into the meaning of suffering and the nature of God, that can only enrich the lives and spirituality of the whole worshipping community. • The Christ of the Gospel narratives provides a paradigm for accompaniment, human relationships and Christian healing. These themes have been embraced by the Council for World Mission in its five missiological principles that shape its approach to HIV and AIDS49. These have been summarised as • Fullness of life for all. • Extending God’s reign. • Restoring relationships. • An act of justice. • Inclusive community. Implementation of the Windhoek declaration requires that clergy and those who teach in theological seminaries must be fully informed about HIV and AIDS, be prepared to confront issues around HIV and AIDS with sound theological argument and acknowledge that if the church is the body of Christ, then when “one member of the body is in pain, the whole body feels that pain.”50

5. Activities 5.1. In small groups discuss the extent to which the Windhoek themes and the CWM missiological principles have been adopted by your church.

• Can you ﬁnd additional Biblical references in support of the theme and principles? • On what occasions and how regularly does the pastor or priest speak only about HIV and AIDS?

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 61 • How are women treated in your church? Are they involved in decision making processes? • How do you engage with people living with or aﬀected by HIV and AIDS in your church?

6. Action Ideas Generating greater awareness and understanding of HIV and AIDS among religious leaders, underpinned by sound theological argument, are crucial in enabling them to play a strong leadership role in eﬀorts to reduce the spread of HIV. 6.1. Design, develop and organise a short workshop for religious leaders in your community on issues around HIV and AIDS giving emphasis to an interpretation of scripture consistent with the CWM missiological principles and the Windhoek themes.

• Identify a director for the workshop possibly seeking advice from the local National AIDS Commission, Council of Churches, local seminaries or, where it exists, the regional office of the Ecumenical HIV and AIDS Initiative in Africa(EHAIA). • Someone from ANERELA + might be able to play a major facilitating role. • Involve both women and people living with and affected by HIV and AIDS. • Think about the different communication tools you might want to use: video, testimonies, stories etc. • Identify a possible output for the workshop such as a framework for the development of sermons round HIV and AIDS.

Page 62 Responding to HIV and AIDS. A toolkit for youth peer educators. Conﬂict and violence

The acute lack of HIV/AIDS knowledge in conflict situations increases vulnerability to infection, denies young people access to vital information and leads to discrimination. Although correct information is not sufficient for behaviour change, it is a necessary precondition. Low awareness is partly due to the fact that conflict undermines awareness raising and prevention efforts, and partly because, even where awareness is high, the daily realities of life under conflict can diminish the perceived risk of HIV infection.51

1. Situation • Armed conflict creates the ideal conditions for HIV/AIDS to spread. • Armed conflict intensifies the effects of poverty, powerlessness and social instability and makes people more vulnerable to HIV and AIDS. • Sexual and gender based violence increases in conflict and post conflict situations.

2. Outcome An awareness and understanding of the complex relationship between armed conﬂict and the spread of HIV including the role of sexual and gender based violence.

3. Objectives • To identify factors created by armed conflict that contribute to the spread of HIV and AIDS. • To make the connection between armed conflict, poverty and increased vulnerability to HIV and AIDS particularly among of women and children. • To understand how sexual and gender based violence increases the likelihood of spreading sexually transmitted infections and HIV and AIDS. • To identify actions by the faith based community that have addressed the impact of armed conflict on the spread of HIV and AIDS and examine their success. • To look at media representations of conflict situations and their role in making conditions worse or better

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 63 4. Deﬁnitions 4.1. Sexual and gender based violence52

Sexual and gender based violence is violence committed against females and males because of the way a society assigns roles and expectations based on gender.53

5. Background Conflict and violence facilitate the spread of HIV by leading to • Break up of families and communities leaving women and children at greater risk of violence. • Mass displacement of people and their relocation in crowded camps for refugees and internally displaced people bringing populations with different levels of HIV prevalence in contact with each other. • Migration of people from rural to urban areas to escape conflicts or disasters puts pressures on health infrastructures. The collapse of adequate supplies hampers HIV and AIDS prevention efforts. • Rape and sexual violence, including rape used as a weapon of war by armed forces against civilians. This is exacerbated by impunity for crimes of sexual violence and exploitation. • Severe impoverishment leaving women and girls with few alternatives but to barter sex for basic needs and even survival. • Break-down of the school, health and communication systems used to counter HIV transmission. • Increased risk of transmission of HIV through transfusion of contaminated blood. • Limited access to condoms and treatment for sexually transmitted infections. • Sexual harassment by military forces, peacekeepers, and other armed groups.

6. Activities 6.1. Divide into small groups. Allocate one of the following questions to each group and ask them to prepare their responses on a ﬂip chart

6.1.1. What other factors contribute to • lack of access to basic needs, • collapse of healthcare systems, • people’s vulnerability? 6.1.2. How are children aﬀected by • conﬂict, • the HIV epidemic, • displacement?

Page 64 Responding to HIV and AIDS. A toolkit for youth peer educators. 6.1.3. What is the impact of conflict and HIV and AIDS on • human and civil rights, • the state’s ability to govern the country, • local communities? 6.1.4. In crisis situations how have the churches and or community leaders responded to the challenge of HIV and AIDS? 6.1.5. How have mass media or community media covered the crisis? Recruit a volunteer from each group to present your findings in plenary session. In reviewing the responses try to identify the most critical factors that contribute to the spread and impact of HIV in a crisis situation. 6.2. Divide into three groups. One representing the churches, other community leaders and the third local and national media. You are in a situation of imminent crisis, possibly conflict, but are aware that as a group you have a role in defusing the situation and preventing it from getting worse.

• Prepare a detailed plan as to the actions you might take to achieve this. • How would you communicate your plan to the people?

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 65 Section IV Gender and HIV Gender Inequality and HIV Poverty and gender inequalities are major factors in accelerating the spread of ….HIV … epidemic.54

1. Situation • The present rate of HIV infection is greatest among women and girls. • In Africa, where the epidemic is most severe, young women are three times more likely to be infected than young men. • In addition to being a health and development issue, HIV is also intimately linked to gender inequality. 2. Outcome A full understanding of how gender inequalities contribute to the spread of HIV and how they might be addressed. 3. Objectives • To define ‘gender’ and ‘gender inequality’. • To explore the different social roles of men and women. • To list the causes of vulnerability of women and girls to HIV . • To examine the effectiveness of current strategies to the vulnerability of women and girls to HIV. • To identify other possible strategies for reducing the vulnerability of women and girls to HIV. • To identify two or more issues that each church or community can address and to develop an appropriate implementation plan.

4. Deﬁnitions55 4.1. Gender

Gender refers to the socially determined ideas and practices of what it is to be female or male. 56 4.2. Gender inequality

Gender inequality refers to women not having the same opportunities in life as men, including the ability to participate in the public sphere. 5. Gender Roles Men and women play diﬀerent social roles. What these roles are will vary from community to community though doubtless there will be a number

Page 66 Responding to HIV and AIDS. A toolkit for youth peer educators. of common threads. These roles inevitably impact on the lives of men and women sometimes in relation to HIV and AIDS. What then are these roles? 6. Activities 6.1. Identify the diﬀerent social roles of men and women.

• Divide up into groups of no more than six. • Draw a large chart similar to Table 1 and discuss and list in turn the roles of men an women in relation to the economy, community, family and sexual relations. • List in a positive and negative way how these roles affect, and are affected by, HIV and AIDS. 6.2. Discuss how the roles of men and women in your church and how these affect, and are affected by, HIV and AIDS.

• List these roles in a separate column on the chart. • List in a positive and negative way how the roles of men and women in your church affect and are affected by HIV and AIDS. 6.3. In a plenary session, discuss issue of who has most power in the economy, community, church, family and sexual relations and how the power structure relates to vulnerability. 7. Why are women and girls vulnerable? The vulnerability of women and girls to HIV has many reasons, including inadequate knowledge about the disease, insufficient access to sexual and reproductive health and educational services, inability to negotiate safer sex due to gender discrimination and imbalances of power, and a lack of female-controlled HIV prevention methods, such as the female condom and microbicides. Women’s and girls’ vulnerability to HIV is also compounded by the violation of their human rights. As long as women and girls are unable to exercise education, property rights, freedom from violence and economic security, they will remain the most at risk from the HIV virus. Women and girls therefore need to reclaim their human rights. 8. Activities 8.1. Examine the reasons why women are at greater risk of infection than men.

• Divide into pairs and on separate pieces of paper write down causes of this inequality – one on each piece of paper.57 • Discuss results and their significance with the full group. • Discuss and agree potential broad categories and write on card and stick on wall. 58 • Group results in different categories by fixing under each heading. See Table 2 as an example.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 67 Table 1: Roles of men and women in a Village in Zimbabwe59

Economy Community Family Sexual relations Positive effects Negative Effects

To provide Powerless to To provide extra practical To do the To obey control when to labour in the support e.g. to cooking and husband’s have sex fields orphans cleaning desires about sex Powerless to To earn small To help To provide Can ensure the control if a Women amount of neighbours who practical care for To not express wellbeing of condom is used extra income, the children pleasure or pain children are sick about sex e.g. by selling To nurse Double burden vegetables in To share news members who To produce of looking after the market and information children and with others are sick children working

To be the main To be involved To decide when breadwinner in politics and where, how and make decisions To act as head of with whom to More partners To decide how household have sex increase his risk much money To represent the Can have as of HIV to give to the village To provide moral To decide many sexual Men guidance and Heavy family To manage the punishment whether to use a partners as he village condom wishes responsibility To decide on any To take the to provide for big expenditures To manage the family to church To decide to get family for the family development help or not e.g. e.g. school fees committee for an STI

Table 2 Categories and causes of gender inequality

Cultural Poverty Educational Social Religious Subjugation of Poverty leads women to Girls often denied women based Wife inheritance engage in unsafe sex for education and access Vulnerable to violence on inappropriate money, housing food or to information on sex and rape scriptural education and HIV interpretation

Girls first in line as Men can have more careers for those in Church policy on than one sexual partner, Women excluded from family with AIDS Marry early often to contraception is but not women inheritance system leading to withdrawal older men variable from school

Reluctance/inability to Limited employment ask sexual male partner opportunities to use a condom

Page 68 Responding to HIV and AIDS. A toolkit for youth peer educators. 9. What should be the response to this situation? 9.1. There is no one overall response to reducing the vulnerability of women. Each approach or strategy has problems. 9.2. The ABC slogan - Abstain, Be faithful, use a Condom - is the main- stay of many HIV prevention programs. But when

• abstaining or insisting on the use of a condom where rape and other forms of sexual violence are widespread is not realistic. • between one fifth and a half of all girls and young women around the world report that their first sexual encounter was forced. • only 11 percent of women in Zambia believed they have the right to ask a husband to use a condom. this strategy by itself is neither realistic nor sufficient. 9.3. Nor does marriage necessarily provide the answer for

• in many parts of the world the majority of women are married by age 20 and have higher rates of HIV than their unmarried, sexually active peers. • in poor households, the presence of an AIDS patient can absorb a third of all household labour, most of it by women and family income is reduced. • in households affected by HIV and AIDS, declining family income causes children to be withdrawn from school and girls are usually the first to go. Across Africa, for example, formal school participation is declining. 9.4. To address HIV and AIDS effectively, there is a need to understand how women are contracting the virus and why. 9.5. A comprehensive strategy is needed to

• boost girls' access to education, • strengthen legal protection for women's property and inheritance rights, • combat sexual harassment and violence against women and girls, • ensure women have access to HIV care and prevention services. 10. Role of men Tackling these inequalities is not just a matter for women - men must also be fully involved. To start with, men need to declare zero tolerance for violence against women. They must become committed to their daughters’ education and help alleviate the burden of care. In short, women and men must work together to promote and protect the human rights of all women and girls and to confront the poverty and gender inequalities that fuel the epidemic. 11. Activities 11.1. As a group discuss the positive and negative aspects of the ABC strategy as far as women are concerned. 11.2. In smaller groups or three or four, and with reference to the issues identiﬁed in Table 2 identify additional actions that need to be taken to reduce the vulnerability of women and girls to HIV and AIDS.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 69 12. Action ideas The nature of gender inequality within CWM member churches and how it is manifest will vary. It would be most surprising, however, to ﬁnd a church or community for which such inequality does not exist. Acknowledging gender inequality exists, that it reinforces the spread of HIV and AIDS and that there are concrete measures that can be taken to reduce its impact is critical. 12.1. Identify and record actions that can be taken by your church or community to address a minimum of two speciﬁc causes of gender inequality. 12.2. Prepare an outline plan for implementing these actions including a clear set of objectives, a time frame, resources required, people to be involved and method of evaluation. 12.3. Prepare a documentary – video, audio or photographic – exhibition that highlights issues of gender inequality. Use this in a campaign to create awareness of the need for gender equality.

Page 70 Responding to HIV and AIDS. A toolkit for youth peer educators. The impact of HIV and AIDS on people and society HIV …… has imposed a heavy burden on families, communities and economies. The misery and devastation already caused by HIV and AIDS is enormous, but it is likely that the future impact will be even greater, as the list of signiﬁcantly aﬀected countries continues to grow. 60

1. Situation • HIV and AIDS has aﬀected families and households, agricultural sustainability, business and industry, the health and education sectors and economic growth. • AIDS has eradicated decades of progress in combating mortality and undermined achievements in raising the standard of living in many countries.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 71 2. Outcome To understand that AIDS both kills and has an impact on every aspect of society. 3. Objectives • To examine the impact of HIV and AIDS on society and across key sectors of the economy. • To examine the wider impact of HIV and AIDS on local communities. 4. Impact on people and society HIV and AIDS will have an impact on population, households, agriculture, education health, business and industry and the economy in general. The impact on two of these areas is illustrated below. 4.1. Population

• Until the mid nineties, the life expectancy in most low and middle income countries had increased. • Since 1995 average life expectancy has declined in 38 countries in which HIV is widespread. * If HIV continues to spread at current levels, some of the most aﬀected countries will see • a decline in the overall population, • a move towards an uneven distribution of population as HIV tends to aﬀect young adults, particularly women more than other sectors of the population, • About 100 million AIDS related deaths are projected by 2025 in the 38 sub Saharan African countries hardest hit by HIV,

Life expectancy at birth in selected most affected countries

Botswana 40 South Africa Swaziland

Years Zambia 30 Zimbabwe

0 1980-85 1985-90 1990-95 1995-00 2000-05 2005-10 Period

Page 72 Responding to HIV and AIDS. A toolkit for youth peer educators. • By 2025 it is projected that AIDS related diseases will cause 31 million additional deaths in India and 18 million in China. 4.2. Households and families

* When a family member develops AIDS, the whole family is affected • the family could break up, • children may be sent to live with relative or even abandoned. * Where the breadwinner is ill or dies from an AIDS related disease the family will suffer financially and impoverishment as a result of • loss of earnings. • increased cost of medical care. * Impoverishment leads to a reduction in food consumption and malnutrition * The pressure on women and girls is especially acute. In addition to being at greatest risk from HIV, • as the carers in the family their burden increases when the male head of the household becomes ill, • those widowed by AIDS may lose their land, property and inheritance, • as the providers of food women, widowed or living with HIV, may be unable to cope, causing the family to suffer, • in reduced circumstances, women may be compelled to undertake transactional sex in exchange for food etc to meet the needs of their family and children. The increasing number of children orphaned by AIDS related diseases – in sub Saharan Africa alone this is projected to rise from 11 million in 2004 to 22 million in 2010 –may • overwhelm the traditional support system, • place an additional burden on already poor households fostering orphans. 5. Activities 5.1. Divide into five groups with each group taking one of the areas below

• Health services • Agriculture • Education • Business and industry • Economic growth List the likely impact of HIV and AIDS on each area. In plenary session, share the results with the whole group and produce a consolidated list

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 73 5.2. Using the results obtained in the above activity, ask each group to

• Identify speciﬁc examples from your community of the impact of HIV and AIDS. • How would you reduce their impact ? 5.3. In Oceania in 2006, 47% of adults living with HIV were women. In several southern African countries, more than three quarters of all young people living with HIV are women and girls.

Women and girls are contracting HIV infections at a higher rate than men and boys in many parts of the world and are therefore more at risk of HIV and AIDS related poverty. Regional HIV statistics for women living with HIV are given below.61

Percent of Adults (15+) Region living with HIV who are women 2006 Sub-Saharan Africa 59 North Africa and Middle East 48 South and Southeast Asia 29 East Asia 29 Oceania 47 Latin America 31 Caribbean 50 Eastern Europe and Central Asia 28 Western and Central Europe 29 North America 26

• What does the increasing infection rate among women mean for your community and country? • What do you think the impact will be?

Page 74 Responding to HIV and AIDS. A toolkit for youth peer educators. Section VI Stigma and

discrimination 62 The stigma and discrimination attached to HIV and AIDS aﬀect those infected as well as their families and especially any dependents ………Silence, stigma and discrimination are at the heart of the unjust relationship which alienates individuals, families and communities associated with HIV and AIDS.63

What is stigma and where can it be found? 1. Statements • Stigma is a major barrier in dealing effectively with HIV and AIDS and contributes to the spread of the virus. • Stigma in response to illness is not new: it has long been associated with mental illness, physical disability, leprosy and TB. • HIV related stigma is particularly severe as it is both a life-threatening illness and also firmly linked in people’s minds to sexual behaviour. • Stigma exists in many forms through our attitudes and behaviour and use of language. Stigma can also be self inflicted. • Fear, ignorance and moral systems are some of the main causes of stigma. • Either deliberately or inadvertently we all stigmatise. 2. Outcomes An understanding of the importance of stigma and discrimination in addressing the spread and impact of HIV. 3. Objectives • To define stigma and discrimination. • To be able to identify stigma at home, in the community and in the church. • To explore some of the causes of stigma. • To be able to ‘map’ stigma and discrimination in your community. • To examine individual experience of stigma and discrimination and their impact. • To analyse the wider impact of stigma and discrimination and how it contributes to the spread of HIV.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 75 4. Deﬁnitions 4.1. Stigma

A ‘mark’ or ‘blemish’ which labels an individual or group in a negative way because of certain attributes that they are perceived to have and that are seen to be ‘shameful’. 4.2. Discrimination

Discrimination is the act of singling out an individual or group for diﬀerent treatment which is often unfair and unjust. In the case of HIV and AIDS such discrimination is a direct consequence of stigma. 4.3. Self stigma

With people who are HIV+, self stigma occurs when they feel ashamed of their situation and fear the judgment of others. 5. Identifying stigma and discrimination Stigmatisation begins soon as we are aware of differences with which we are uneasy, embarrassed and critical and condemn. The individual may, for example, have a mental illness, be of a different sexual orientation, race or gender or have HIV and AIDS. A negative response to this difference becomes discrimination. 6. Activities 6.1. Divide into small groups. Each group should select two of the pictures on Worksheet 1.64

• What do you see in the picture? • How does the picture show stigma? • Record your comments. In plenary session report back your comments and ask a volunteer to make a list of common issues.

6.2. On an individual basis write down your responses to the following65

• Have you ever experienced any form of discrimination e.g. racial or gender based discrimination? If yes, what happened? • What motivated the person(s) to behave that way? • What impact did their behaviour have on you? • If you think about it, how could this situation be dealt with diﬀerently? Discuss your responses with the person sitting next to you. 6.3. As a group, try to relate your experience to the discrimination that HIV+ people may experience.

• What feelings drive people to discriminate against those with HIV? • What impact does this have on the HIV+ person? • How could we deal with these situations diﬀerently?

Page 76 Responding to HIV and AIDS. A toolkit for youth peer educators. 7. Locating stigma and discrimination Stigma expresses itself in many ways including in66 • Communications through words, images, gossip. • Social relations within families. • Self-inﬂicted stigma. • Prejudice, violence, hostility, avoidance. Stigma takes place all around us. It exists in our families, churches; hospitals; schools, markets workplace, at funerals, in the media etc. 8. Activities 8.1. Divide into groups of 4 or 5. Take one of the places or situations listed above and

• analyse how and why stigma occurs, • make a play around that situation on the basis of the results of your analysis, • perform to the whole group. After all the performances try to identify situations and places in which stigma and discrimination are most likely to occur. 9. Causes of stigma The origins of stigma against people living with and aﬀected by HIV and AIDS are many and various and have been analysed in the context of place, people living with HIV and AIDS and society, principally the media67 . These are broadly • Moral attitudes around sex with HIV seen as punishment for what is perceived as immoral behaviour. • Fear borne out of ignorance. • Ignorance and lack of knowledge. • Self interest in reducing potential vulnerability to HIV. • Sensationalism, inaccuracies and poor use of language in the media.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 77 Worksheet 1

Page 78 Responding to HIV and AIDS. A toolkit for youth peer educators. Language and stigma

1. Situation • Language shapes beliefs and can inﬂuence behaviours. • Language has the power to strengthen the response to HIV and AIDS. • Language has the ability both to stigmatise and reinforce stigma and discrimination. • The media, through their inappropriate use of language and images and sensationalist, ill-informed reporting, have reinforced stigma and discrimination thereby contributing to the spread of HIV. 2. Outcomes A greater understanding of and sensitivity towards the use of language around HIV and AIDS, whether in conversation, writing or the media. 3. Objectives • To be familiar with words, metaphors and terminology that are perceived to cause oﬀence or reinforce stigma and discrimination. • To be familiar with current preferred usages of words and phrases. 4. Background Words, metaphors and terms all have the ability to strengthen perceptions and reinforce stigma for they all convey something about HIV and AIDS. Examples include68

Phrase or metaphor Associated stigma AIDS is death Biological and social death AIDS is punishment Immoral and sinful behaviour such as homosexuality or sex work People living with or affected by HIV are ‘criminals’ and guilty of harming their AIDS is a crime ‘innocent’ victims AIDS happens only to others ‘Them’ and not ‘us’ Division of the world among the ‘infected’ ‘The dying’ and ‘the living’ and the ‘not infected’ Fight against AIDS Demonisation of the illness and the attribution of fault to the patient AIDS orphan Suggests the child is HIV+ whereas this may not be the case AIDS victims Images of helplessness and weakness

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 79 Using the correct language is important both in conveying the right message, removing any ambiguity or double meaning that could reinforce stigma and avoiding unnecessary upset or oﬀence. Language, however, is organic and word and meaning change over time. 5. Activities 5.1. As a group, think of words or phrases either in English or your own language that should be avoided when referring to HIV or AIDS.

Prepare a list and indicate whys each should be avoided.

5.2. Get copies of your local newspapers containing stories or articles about HIV and AIDS. Divide into small groups and identify and note:

• inappropriate language • inaccuracies in terms of fact • sensationalist reporting • lack of gender balance In plenary session discuss your reaction to the reporting • How it might contribute to strengthening stigma and discrimination? • What action might be taken to improve levels and quality of reporting? 6. Action ideas 6.1. In collaboration with the editor, review the language used in your church or community magazine around the issue of HIV and AIDS. Oﬀer to run a training programme for the editor and any other contributors should they be interested. 6.2. Monitoring how the news media reports on HIV and AIDS in terms of coverage, content and language would be invaluable in any campaign to improve the quality of media coverage and support the drive to reduce stigma and discrimination. It would also be an opportunity for CWM churches in each country to work together around a speciﬁc national and regional project.

Page 80 Responding to HIV and AIDS. A toolkit for youth peer educators. Impact of stigma and discrimination on the spread of HIV

1. Situation • Stigma can affect every aspect of our lives. It can lead to rejection by family and friends, increased vulnerability to disease, exclusion from work, poverty, lack of self esteem, self harm, denial of human rights etc. • Tackling stigma and discrimination by changing attitudes, thinking and behaviour is fundamental in any effort to reduce the spread of HIV and the impact of AIDS. 2. Outcomes To be conscious of the way that stigma and discrimination can affect the lives of people living with and affected by HIV and AIDS and where appropriate to modify behaviour accordingly. 3. Objectives • To review and understand the effect of stigma and discrimination in different circumstances. • To identify possible personal responses to stigma and discrimination. 4. Stigmatising attitudes towards people living with and affected by HIV and AIDS can be found in many situations and attitudes and their impact is varied. Some examples are given below. 4.1. In the family

• Rejection by and isolation from the rest of the family: no hugging or touching. • Conﬂict within the family: between married partners - sometimes leading to divorce and separation -and diﬀerent generations,

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 81 * Children particularly affected: • sometimes they are treated badly, receive sub standard care and made to work harder than other children in the family. • abandoned by fathers when mother known to be HIV+. * Orphans find it difficult to finder foster or adoptive parents within the family and indeed elsewhere • without support orphans leave school, • unable to play with other children. * Lack of any support network leading to greater poverty and increased vulnerability to AIDS • Absence of emotional and psychological support. • Discredited and made to feel shame. • Losing home and inheritance. 4.2. In the community

• Ostracism: excluded from activities and decision making. • Insults and personal and physical abuse. • Unable to share facilities. • Restrictions on access to basic services and increased vulnerability to disease. • First point of blame when things go wrong. • Diﬃculties in securing and retaining accommodation. • If they own a business, people stop buying. • Women are particularly susceptible to blame, harassment and personal violence. 4.3. In the workplace

• Isolation and unable to work with colleagues. • Constant fear of disclosure. • Inability to secure employment. • Name calling and personal and mental abuse. • Threat of dismissal. • Diminished opportunities for promotion or advancement. 4.4. At hospitals, health centres and clinics

• Public disclosure of HIV status. • Being ignored. • Verbal abuse. • Demeaning and judgmental attitude by health workers. • Poor quality of care and treatment. Page 82 Responding to HIV and AIDS. A toolkit for youth peer educators. 4.5. Self stigma

• High levels of stress. • Self doubt and loss of self esteem. • Withdrawal from society. • Shame and dejection. • Self harm. • Psychological and emotional damage. • Unwillingness to seek treatment and care thus increasing vulnerability to disease. 4.6. Disclosure

• Public censure. • Insecurity of employment. • Exclusion and isolation. 5. Activities 5.1. Divide into small groups and review areas in which the church stigmatises and discriminates against people living with and aﬀected by HIV and AIDS.

• What are the eﬀects on the individual? • How should the church respond? 5.2. Divide participants into four groups with each group discussing one of the following statements.

5.2.1. I am not able to walk freely on the streets. People call me names and whisper to each other as I pass by. They say we are all sick because of my dead sister. 5.2.2. My child was seriously sick. I took her to the clinic but the nurse will not allow me to see the doctor and there was no medicine for me. I was very hurt because I could see medicine right behind her. 5.2.3. I ran to the priest and in my ignorance disclosed my status to him. He preached on Sunday and really condemned me. Even though he did not mention my name, I know he referred to me because he pointed to my direction. 5.2.4. I hit my head against a wall and fell down but no one came to help me rather they passed me by and made bad comments about me. Identify the stigma and discrimination in each scenario and list how you believe • they will feel, • what they will do about their feeling.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 83 5.3. Worksheet 2 lists a number of potential scenes demonstrating the eﬀect of stigma and discrimination. Each scene involves a number of diﬀerent voices.69

• Divide into groups and take one of the scenes. • As a group develop, identify and allocate the voices. • Bring the voices together in a short 5 minute play that illustrates the impact of stigma and discrimination. Use additional language of your own where necessary. In plenary session discuss how the impact of stigma and discrimination contribute to the spread of HIV.

Page 84 Responding to HIV and AIDS. A toolkit for youth peer educators. Worksheet 2

6. Responding to stigma and discrimination

‘You are already dead ‘Who else knows about this?’ ‘You will die anyway’ ‘Don’t come here any more’ ‘Mom said you will be dead soon’ ‘We don’t want AIDS here’ ‘I can’t help you, just go home and die’ ‘You are no longer my daughter’ ‘You don’t exist anymore’ What will our friends say?’ ‘There is no hope for you’ 1 2 ‘You foreigner’ ‘We can’t give you medication’ ‘I thought you loved us’ ‘Your time has come, my son’ ‘Don’t touch my sister’ ‘I’m scared of you’ ‘Don’t touch me’ ‘Don’t waste my time’ ‘You’ve brought shame on our family’ ‘How could you do this to us?’ ‘The wedding is off’ ‘Who will take care of us now?’

‘With your lifestyle, this was bound to happen’ ‘What are you doing here?’ ‘You’re a sinner’ ‘Is it really true what they say?’ ‘It must be God’s will’ ‘What will happen to the choir?’ ‘You’re an unclean woman’ ‘I don’t think that I will send my children to Sunday ‘I don’t want to work with you’ 3 4 school’ ‘We are not allowed to play with you’ ‘What can you expect’ ‘You can’t join us’ ‘I’m going to speak to the church council’ ‘You will have to leave our village’ ‘We need to take a stand against these people’ You’ve brought shame on our country’ ‘I don’t think that I can offer you communion’ ‘Sorry, we can’t grant you a visa’

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 85 Challenging stigma and discrimination either as the initiator, observer or the recipient demands that we change the way we do things, rethink our attitudes and be open to changing our behaviour. There are many ways in which these might be achieved some of these might include: • Hearing testimonies from people living with and affected by HIV and AIDS about their own experience and hurt they have been by the stigma and discrimination suffered. • Having greater knowledge about transmission and prevention thus reducing the element of fear. • Breaking the silence: encouraging people to talk openly about their fears and concerns about HIV. • Persuading by example: being open, warm and embracing to people living with HIV. • Inviting members of ANERELA+ to preach in your churches. • Ensuring that people living with and affected by HIV are encouraged to participate fully in the community and be involved in decision making bodies. 7. Activities 7.1. In small groups identify and list other ways in which you might respond to stigma and discrimination experienced by people living with and affected by HV and AIDS.

• How would they challenge stigma and discrimination? • How would you go about implementing these ideas? Share your ﬁndings in plenary session. 8. Action Ideas 8.1. Develop a code of practice for challenging stigma and discrimination for use in your church or community. 8.2. Using your code of practice as a starting point develop an action plan for encouraging a ‘stigma and discrimination’ free environment in your church or community and among their members. 8.3. Identify and use an appropriate communication tool to promote the code of practice within your church or community.

Page 86 Responding to HIV and AIDS. A toolkit for youth peer educators. Denial of Human Rights 1. Situation • HIV is a human rights issue. Violations of human rights fuel the spread of HIV and worsen its impact. • The ability of people to access their human rights is often constrained by stigma and discrimination. • Stigmatisation of certain groups especially women and girls, disabled people and those living in poverty leads to violations of their basic rights and to higher incidence of HIV. • Freedom from stigma and discrimination is a human right. 2. Outcome To ensure that any response to HIV and AIDS should address issues of human rights. 3. Objectives • To understand the nature of human rights. • To understand the link between human rights, stigma and discrimination and HIV. 4. Background A human rights approach to HIV and AIDS emphasises that all people have a right to a full and satisfying life and are able to develop their potential to the full. These rights have been articulated in a number of international conventions. International guidelines on HIV and AIDS and human rights outlined a range of fundamental freedoms for all which would reduce vulnerability to HIV and AIDS and prevent HIV and AIDS related discrimination and stigma.70 5. Activities 5.1. In small groups prepare a list of AIDS related human rights.

Draw a table of three columns labelled as below and identify the group in the corner. Against each right indicate how it relates to HIV and stigma and discrimination in the respective columns. • After ﬁve minutes, pass the table to the next group to add other ideas. • Repeat the process until every table has been reviewed by all the groups and the table returns to the ﬁrst group. Responding to HIV and AIDS. A toolkit for youth peer educators. Page 87 In plenary session discuss and agree the submissions. Insert any rights etc that were omitted.

Group………..

Human right Relationship to HIV Nature of stigma or discrimination

5.2. Looking at the completed table identify and discuss any shortfalls in the human rights approach that currently exist in your country or community. 5.3. Suggest strategies to overcome the shortfalls.

Page 88 Responding to HIV and AIDS. A toolkit for youth peer educators. The response of the Section VII Churches to HIV and AIDS

The presence of HIV and AIDS in our body, our family and our community calls the church back to what it means to love and pursue justice. If we are the Body of Christ in the world, we must do as Jesus did – live out God’s love toward our sisters and brothers, speak out and advocate for just practices, and create supportive and caring communities of acceptance, safety, refuge and healing.71

1. Situation • Churches are divided in their response to HIV. • The response of churches to HIV is characterised by fear of contagion, ostracism of the infected and affected, silence and denial attitudes that stigmatise those people living with and affected by HIV and AIDS. • Churches are too often silent on related issues of sexuality, sex, condoms, poverty, and gender based violence. • Strong emphasis is placed on sexual morality as the best way to reduce the spread of HIV. • The attitude of churches towards HIV isolates or excludes those most at risk. • The church leadership refuses to accept its own vulnerability to HIV. • The church is both part of the problem as well as being part of the solution. 2. Outcomes An understanding that ending stigma and discrimination around HIV and AIDS and curbing the spread of HIV demands an ‘AIDS competent’ church community and strong, sensitive, truthful and well-informed leadership. 3. Objectives • To identify issues of stigma and discrimination within the church. • To explore ways in which the church can be encouraged to change its attitude towards HIV and AIDS and become welcoming and compassionate to those people living with and affected by HIV and AIDS and to genuinely fulfill its Christian mission. • To understand the importance of engaging with and embracing those people living with and affected by HIV and AIDS.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 89 • To identify practical ways that will support the well being of the whole communities including those people living with and affected by HIV and AIDS. 4. Background Silence and denial, largely bred by ignorance, fear and moral indignation, characterise response to HIV by church leaders. But breaking this silence is not easy, for to do so will strike at the very heart of what they proclaim and believe: in their theology, their language, their liturgy and the way they interpret their scriptures.72 Fear of contagion has dominated the church’s ministry and created practices that exclude people living with HIV from daily church life. These fears are neither rejected nor challenged because sex and sexuality are such taboo subjects. As a result those living with and affected by HIV and AIDS are ostracised and this • leads to a fear of disclosing HIV+ status, • inhibits testing for HIV, • discourages visits to centres for voluntary counselling, testing and treatment (VCTs) and contributes to the spread of HIV. While many church leaders are familiar with the biological and health facts of HIV, far fewer understand the social, economic and cultural dimensions of the disease. This knowledge of the biology of the disease has not brought about behavioural or attitudinal change, for many continue to blame individuals for their HIV+ status and denounce them for moral laxity. Too many church leaders deny that HIV is present among members of their church and that churches are ‘AIDS free zones’. Few have been tested for HIV. Where church leaders have had close personal contact with HIV+ people, there has been a discernable change in their attitude towards the virus and they become more sensitive and understanding of the situations faced by people living with or affected by HIV and AIDS. 5. Activities Before tackling any problem, it is always helpful to understand the nature and extent of the issue. 5.1. Dividing into small groups identify practices in your church or community that isolate and exclude people. • Draw up a list of practices and discuss the impact of each on both the church and the individual or group affected. • List separately those practices that touch people living with or affected by HIV and AIDS. • Share the lists with all the participants.

Page 90 Responding to HIV and AIDS. A toolkit for youth peer educators. 5.2. A WHO regional director is alleged to have said that, “The churches are impossible to work with, because they have so many agendas that are actively hostile to HIV prevention.” • Conduct a formal debate around this claim. • Divide into two groups, one representing the WHO and the other the churches. From each group select two speakers, and two to second the motion. • Appoint a chair for the proceedings. • Working in groups, let each lead speaker make their case. • Questions and comments then to be invited from the floor, with the speakers being invited to respond by the chair where appropriate. • Seconds to sum up, and motion put to the vote. 6. How should the church respond? ‘For the churches, the most Ending stigma demands powerful contribution we can make to combating • a strong, sensitive, truthful and well-informed leadership. HIV transmission is the • that the conspiracy of silence be broken. eradication of stigma and • welcoming and learning from people living with or affected by HIV and discrimination: a key that AIDS and recognising their value in meeting the challenge of the disease. will, we believe, open the • the creation of ‘safe spaces’ in the churches in which people living with or affected by HIV and AIDS can feel welcome, be able to disclose their door for all those who dream HIV+ status and to seek counselling, help and support. of a viable and achievable • a re-evaluation of the morality the church is teaching and the way it is way of living with HIV / preached to the young by making it more in tune with reality. AIDS and preventing the • acceptance that becoming more open about sexuality, will not undermine spread of the virus.73 their commitment to faithful, permanent and trusting relationships. • acceptance of the presence of AIDS within the body of the church. 7. Activities 7.1. In small groups discuss in turn what each of the above requirements for ending stigma means to you. • Allocate the requirements to each of the groups. • Examine how each requirement could be met in your community or church. 7.2. Review your results in a plenary session 7.3. It is argued that on the issue of sex, young people seek moral guidance, but guidance that is rooted in today’s reality. • In plenary session discuss what this means to you. • In what ways is this ‘moral guidance’ not being provided by church leaders? • Where should the emphasis in that guidance lie?

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 91 8. What can churches do? Many churches are already involved in activities both to eradicate stigma and discrimination and provide support to those people living with and affected by HIV and AIDS. These include, for example • Breaking the silence around HIV and AIDS through talking and prayer . • Visiting those who are ill with AIDS related diseases. • The provision of care facilities. • Ending ignorance, particularly among young people, through, for example, encouraging sex education and information on HIV prevention and transmission in schools, at home, in community centres etc. • Providing care for orphans whose parents have died from AIDS related diseases. • Supporting local projects to establish counselling services and telephone hotlines on HIV and AIDS. • Working with other churches, NGOs and government. 9. Activities Paragraph 8 lists a number of the ways in which churches are engaged in challenging stigma and working towards a reduction in the spread of HIV. 9.1. Divide into four groups. Allocate one of the following tasks to each group • Breaking the silence around HIV. • Ending ignorance of HIV and AIDS. • Preventing fear and prejudice associated with HIV and AIDS. • Providing services to those living with or affected by HIV and AIDS. Discuss and list specific activities that could be undertaken by your church to address each of these tasks. In plenary session share your ideas with all the participants. 9.2. The media in its coverage of HIV and AIDS often reinforces stigma and discrimination both in the language used and the way it covers events. Divide into small groups and discuss ways in which you would • encourage more informed and responsible reporting. • implement your ideas. 10. Action ideas It is claimed by people who work with youth around the issue of sex that young people need much more information about how the virus is transmitted, better life and negotiation skills, greater moral guidance and more economic and social empowerment. 10.1. Devise and undertake a survey of young people in your neighbourhood to find out • specific matters or issues related to HIV and AIDS on which they would like more information or guidance.

Page 92 Responding to HIV and AIDS. A toolkit for youth peer educators. • what they feel the churches should be doing to address their speciﬁc needs. In conducting the survey make certain that there is a gender balance among those who are invited to respond and that other marginalised groups or individuals such as people living with or aﬀected by HIV and AIDS or people who are disabled are also appropriately represented. 10.2. With the information from the survey, • identify the issue that gives the greatest concern. • prepare and implement a plan as to how it might be addressed using a particular communication tool. Explain in your plan why you have chosen that particular tool.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 93 Section VIII Response of the Council for World Mission

HIV and AIDS Policy and Strategy Guidelines 1. Situation • In July 2005 at the meeting of the 31 member churches of the Council for World Mission, agreement was reached on an overall HIV and AIDS policy. (See appendix 1) • Along with the policy framework a set of strategic guidelines were established to enable individual regions and churches to develop and establish their own strategies based on local circumstances. • The document entitled HIV and AIDS Policy and Strategy Guidelines was published in November 2005. • The policy framework and strategic guidelines were natural developments from the ﬁve major mission challenges identiﬁed by the CWM Assembly in Ayr, Scotland in 2003. HIV and AIDS was one of those challenges. 2. Outcomes The development of local and regional HIV and AIDS strategies that are consistent with the broad policy framework established in 2005. 3. Objectives • To understand the importance of having an HIV and AIDS policy and a strategy for its implementation. • To understand the background to the development of the policy and strategy guidelines. • To critically examine the current policy and guidelines.

Page 94 Responding to HIV and AIDS. A toolkit for youth peer educators. 4. Background As with any policy aiming to address an issue across different cultural, missiological and societal contexts, the document represents areas in which there was common consensus. The focus given to poverty and basic human rights are at the heart of the policy and the concerns of women and youth are given particular priority. In the policy the CWM member churches affirmed their commitment to inclusivity, their rejection of the notion of HIV as a punishment from God for sins committed, the promotion of responsible sex, and the importance of speaking openly about sexuality. Policy and strategic guidelines provide a common focus and framework for CWM member churches, but they also imply a commitment to readjusting priorities and reallocating resources. Although core policies might be refined or made more explicit they are unlikely to change in the short to medium term. Strategic approaches to implement these policies are, however, more subject to change as they must reflect the changing operational context. 5. Activity 5.1. Identify and discuss the key elements of the policy and strategy guidelines • What are the weaknesses and strengths of the document? • In describing the challenges to CWM, only indirect mention is made of the use of condoms in preventing HIV. Is this an issue within your church? How can it be overcome? • Is it useful in a policy document like this to use language that suggests an approach rather than being specific? Why go for diplomatic language? • Is the emphasis on women and youth right? Why/why not? • How would you prioritise the suggestions for action listed in section 5 ? • Are there any significant omissions? • If you were to prepare a policy document and strategy for your church or region would the balance or emphasis be different and if so in what way?

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 95 Section IX

Being inclusive Creating a compassionate congregation

Communities that are inclusive and caring are…….. a critical factor in the ﬁght against the spread of HIV and AIDS. No human being should be despised or diﬀerentiated by the nurture of stigma or discrimination on any basis. The church is called to be an inclusive community and to promote inclusive community living. The church, after all, is the Body of Christ, and when one member of the body is in pain, the whole body feels that pain. 74

Page 96 Responding to HIV and AIDS. A toolkit for youth peer educators. 1. Situation • Many churches remain distant from the lives, needs and concerns of people living with or affected by HIV and AIDS. • Churches can play – and many do - an important role in talking about stigma and discrimination and in providing support to people living with or affected by HIV and AIDS. • Establishing services and support for people living and affected by HIV and AIDS have often been greeted with great resistance by churches and their congregations. 2. Outcomes To understand the importance of creating a compassionate and supporting environment in fulfilment of Christ’s mission and in enriching the life of the community. 3. Objectives • To define a compassionate congregation. • To recognise existing internal and external barriers to the creation of compassionate congregations and churches. • To identify steps towards creating a compassionate congregation and church. 4. A compassionate congregation A compassionate community is one that listens, engages and serves. It is an AIDS competent community and recognises that showing compassion • fulfills Christ’s message, • demonstrates respect and dignity of human life, • encourages a community based approach towards those living with or affected by HIV and AIDS, • creates momentum for positive messages, • re-enforces prevention and strengthens care and support, • enriches the lives of the individual and community. A community that stigmatises, discriminates or ignores those most in need is itself diminished and in terminal decline. HIV and AIDS is not somebody else’s problem, it is a problem for the church and to fulfil its calling to Christ, demands that the church is a safe place for those people living with and affected by HIV and AIDS.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 97 5. Activities 5.1. As a group, list

• internal barriers i.e. those that directly involve the church. • external barriers i.e. those in the wider community and outside the control of the church, that currently obstruct the development of a more compassionate congregation and church. 5.2. Separating into small groups discuss how you would build bridges with people living with and aﬀected by HIV and AIDS.

• With what actions would you show compassion and understanding as individuals? • What activities would you wish to encourage within your church to become more compassionate? • What resources do you have within the church to support these activities? • Share your results in a plenary session. 6. Action ideas 6.1. Document in ﬁlm, sound, photographs or as a play, the life attitudes and beliefs of a compassionate congregation. In the production

• Highlight to comparison with a non-compassionate community or congregation. • Give voice to people living with and aﬀected by HIV and AIDS. • Show how the lives of all the community have beneﬁted. Use the production to promote the notion of a compassionate congregation in your community.

Page 98 Responding to HIV and AIDS. A toolkit for youth peer educators. Reaching out If we are the Body of Christ in the world, we must do as Jesus did – live out God’s love toward our sisters and brothers, speak out and advocate for just practices, and create supportive and caring communities of acceptance, safety, refuge and healing.75

1. Situation • The churches have often been poor in building relationships with people living with and affected by HIV and AIDS. • Building relationships requires a range of communication skills and behaviours including a willingness to listen, learn, observe and interpret, understand, and be open and loving. 2. Outcomes Open and understanding relationships with people living with and affected by HIV and AIDS. 3. Objectives • To try to have an understanding of the emotions, feelings and responses of a person living with HIV. • To review and practice skills in greeting, establishing rapport, listening and gaining trust and influencing. 4. Building the bridges People living with or affected by HIV and AIDS are encouraged to seek advice and guidance from a good counsellor. Being a counsellor requires training and experience, but in the normal course of events there are likely to be occasions when you will wish to build bridges with members of your church or community who are living with or are affected by HIV and AIDS. In such circumstances it would be sensible to entrust the task of making the first move to someone of the right personality and some basic skills in terms of listening and encouraging dialogue. These might cover • Concern for people. • Apparent honesty and integrity. • Warmth acceptance and genuine. • Ability to gain trust and generate mutual respect. • Easy to talk to. • Ability to listen and understand. • Ability to respond constructively, creatively and clearly.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 99 • An understanding of human nature. • An ability to be objective but “place yourself in their shoes”. • The use of language that is simple and unthreatening. • The ability to understand and respond to non-verbal cues. 5. Activities 5.1. Ask each participant to obtain a piece of paper and pencil76. Tell them to write numbers 1 to 5 on the paper and say that they will be asked to listen to ﬁve statements and respond to those statements on the paper.

Ask the participants to write down against each number in turn • The name of the personal possession that you love the most. (1) • The part of your body you love the most. (2) • The activity you most enjoy doing. (3) • One very secret or conﬁdential thing about yourself that no one else or very few people know. (4) • The name of the person whose love and support means the most in the world. (5) Now go through the list again and whilst this is being done the participants should imagine they are living through each situation • Imagine that something terrible has happened that causes you to lose the one possession you love the most. You will never see it again. Take your pencil and cross out No. 1. • Imagine that something happens that cause you to lose that part of your body that you value the most. This part of your body is gone, you will never have it again. Take your pencil and cross out No. 2. • Imagine that this same happening makes it impossible for you to do your favourite activity ever again. You will never again be able to do the activity listed as No. 3. Take your pencil and cross out No. 3. • Imagine that because of all the above, your secret has been exposed. Everyone knows about it and is talking about what you wrote as No. 4. It has become public knowledge. Circle No. 4 with your pencil now. • Finally, because of all these changes, the person you love most in the world leaves you forever. You will never again see this person that you love and who is the most important source of support. Take your pencil and cross out No. 5. Now ask participants to describe in one word or phrase what they are feeling. Write the list on a ﬂip chart. Keep going until the list is exhausted. Ask the participants to look at the list and imagine in what circumstance you might have these feelings. 5.2. Divide into small groups. In each group ask for three volunteers to take part in a role play. The other members of the group look on and make notes on what they see.

Page 100 Responding to HIV and AIDS. A toolkit for youth peer educators. The role play is as follows. Sam has just moved to a new town and joined a new church where (s)he is invited to join the youth group. After some weeks (s)he realises that there is a group of people, both young and old who always sit in the same pew away from the rest of the congregation. (S)he finds out that they are HIV+. Having last attended a very warm and welcoming church, Sam is very disturbed by this situation. The following Sunday (s)he deliberately sits next to one of the younger members of the group and begins talking to them. An older person from the group, possibly one of the parents joins in the initial discussion. Their initial reaction is one of suspicion. It emerges that the group’s isolation is partly of their own making and partly as a result of comments from the other members of the congregation. The priest has never commented on the situation, but then he has never once spoken about HIV and AIDS since taking over the church some five years earlier. Sam’s task is to • gain the confidence of the group • persuade the young person to join the youth club with him/her. • seek to find out ways in which the church can help with their situation. Allow the role play to go on for about 5 minutes. The other members of the group are asked to comment on whether • the initial approach was effective. How did Sam greet the group? • Sam listened. What was Sam’s body language like? • Sam was convincing in his/her sincerity. • Sam used any inappropriate language. • the ideas Sam put forward were realistic and met the needs of those members of the congregation living with or affected by HIV and AIDS. How did they leave things? How did they say goodbye? After discussion get another three other members of the people to play the roles of Sam, the young person and the parent.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 101 Learning from people living with or aﬀected by HIV and AIDS We encourage the CWM member churches and regions to draw on the special insights and experiences of people living with AIDS within their churches and communities in formulating local strategies and activities in combating the disease.77

1. Situation • In many churches people living with or affected by HIV and AIDS are isolated from policy formulation and implementation. • The experience and wisdom of people living with or affected by HIV and AIDS can significantly contribute to the effort of the church in curbing the spread of the virus. • Involvement of people living with or affected by HIV and AIDS in the work of the church in prevention, care etc affirms and enhances their dignity. 2. Outcomes Increased involvement of people living with HIV and AIDS in the life of the church and community. 3. Objectives • To avoid the ‘them’ and ‘us’ situation. • To recognise the role of people living with and affected by HIV and AIDS in reducing the spread of the virus and in changing behaviour. • To learn about ANERELA+. 4. Background In too many churches there is a divide between those people who are living with or are affected by HIV and AIDS (them) and those who are not (us). It expresses itself both through separation of the two groups and an attitude on the part of ‘us’ that it is ‘their’ problem, but not ‘ours’.

Page 102 Responding to HIV and AIDS. A toolkit for youth peer educators. This response ignores the facts that • HIV does not recognise such boundaries: what affects one part of a community affects us all. • People living with HIV have insights and experience that can contribute to the well being of the whole community. 5. ANERELA+ ANERELA+, the African Network of Religious Leaders Living with or Personally Affected by HIV and AIDS was formed in Uganda in November 2002 as an initiative by Canon Gideon Byamugisha to mark his 10th anniversary of living openly with HIV.

Their membership includes any religious leader, ordained or lay, who is either HIV+ or is personally affected by the disease. ANERELA+ understands personally affected to be someone who is either nursing or has lost a child, spouse or parent to HIV or AIDS. Having all experienced stigma and discrimination first-hand, ANERELA+ members seek to find ways of breaking stigma, silence, indifference and discrimination around HIV and AIDS. They strive to be a network of support without judgment. Their vision is for an Africa in which religious leaders living positively and affected by HIV and AIDS are empowered to live openly as witnesses to hope and be forces for change in their congregations and communities. ANERELA+ is a rapidly growing network throughout Africa and is playing a very important and influential role in fighting HIV and AIDS –related stigma. Its response to HIV and AIDS has been internationally acclaimed and there are requests from other parts of the world, especially India and Jamaica, to start similar networks. 6. Activities 6.1. In small groups address the following questions

• Do you know of any religious leaders – clergy or lay - in your church, community or country who are HIV+? • How are they treated in the community? • How would you react if you heard that your pastor were HIV+? Qualify your answers, e.g. would you leave the church because of that? • Why are religious leaders more harshly stigmatised than other people living with or affected by HIV and AIDS? • Why can religious leaders who are living with or affected by HIV and AIDS be particularly effective in challenging stigma and discrimination? 7. Action Ideas 7.1. Working through the national ANERELA+ network, if one exists, or through organisations that are already working with people living with or affected by HIV and AIDS, seek a number of speakers who

• can talk to young members of your church or community can talk of their own experience of living with HIV,

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 103 • are prepared to assist your eﬀorts in responding to HIV and AIDS in your church, • may welcome your assistance in the establishment or development of an ANERELA+ network in your country/ community. Make certain that there is a gender balance in your speakers. In selecting your speakers, make clear your objectives for the exercise and who will be in the audience. It is also important to ensure that whoever is selected can speak honestly and openly and if there are areas which might be too sensitive or hurtful these should be mentioned in advance.

Page 104 Responding to HIV and AIDS. A toolkit for youth peer educators. Communication Section X approaches

What is communication?

1. Communication is a skill. It is the art of expressing and exchanging ideas, meanings, thoughts, emotions and actions. What is expressed or exchanged is “mediated” through speech, writing, images, music, art, film, photographs, advertisements, movement and signs via a range of “media” such as newspapers, sermons, magazines, books, telephony, radio, television, theatre, film, the Internet, paintings, photographs, hoardings exhibitions or any other “medium”. 2. Sometimes there is confusion between the “medium” and the “message”. In other words, what is being communicated (the “content”) can be confused with the means used to communicate it (the “instrument”). A simple example is conversation in which the mouth is the “medium” sending a “signal” in the form of sound-waves that are received by the ear. The “message” is none of these, but the content and implications of what is being said. Applied to television, the medium is the electronic system called “television”, the signal consists of the images and sounds transmitted, but the message lies in the “content” of the pictures and words communicated. 3. Communication is, therefore, any act by which one person or community gives to or receives from another person or community information or knowledge about their needs, thoughts, ideas, desires, perceptions, or feelings. Communication may be intentional or unintentional, may take linguistic or non-linguistic forms, and may occur through immediate or remote (electronic) modes. 4. Different media can work in any social or cultural environment. However, the infrastructure for mass media such as satellites, television, radio, telephony, and computers can prove expensive. In such circumstances, and especially in rural areas, community media, for example local radio, puppetry etc, may work best. This is especially true where the local culture is more attuned to an interpersonal approach or where social structures at the level of villages and families require ways of mediating that are more subtle and less “aggressive” than the mass media. 5. However, the same “message” can be conveyed by the same kinds of media. For example, national newspapers, radio and television, can conduct generalised health campaigns about the impact of smoking or awareness about HIV and AIDS. But community-based newspapers, community radio might be more effective in addressing local situations where there is greater sensitivity to issues of authority, appropriateness and language.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 105 6. But to use any form of communication requires skill. What is important is to remove the obstacles that prevent messages from reaching their audience or that distort what is being said. Church leaders and religious communities have often been reluctant to use mass or community media even in order to tackle urgent challenges such as HIV and AIDS. Yet there are many examples showing that church and community leaderships need such communication skills and capacities to change opinions and to improve lives. 7. The following section identiﬁes diﬀerent kinds of media and the uses to which they can be put.

Page 106 Responding to HIV and AIDS. A toolkit for youth peer educators. Communication Section XI tools

Theatre 1. Introduction Acting out stories, situations, events or messages in front of an audience using a combination of speech, gesture, music, dance, sound and spectacle is called theatre. There are many diﬀerent forms of theatre, but all, to a greater or lesser extent make use of costume, lighting, sound, scenery, furniture and items or articles, called ‘properties’, (or props) such as books, telephones etc that give greater reality. In all parts of the world, theatre, in addition to entertaining, has long been used to inform, educate promote and challenge. It has often been a catalyst for political and social change. Theatre is increasingly used by the medical profession as a form of therapy to overcome trauma and encourage behaviour change. Churches, in their liturgy, have always used theatre and, in Europe for example, it has been used to get across the Christian message through passion plays, mystery plays and morality plays. Theatrical production can be performed in all types of locations: a formal theatre, a church, in the street, in homes etc. 2. Categories of theatre There are a number of broad categories of theatre. These include • Drama Drama is that form of theatre in which speech – whether from written text called a script or improvised ie made up on the spot - is dominant. • Musical Musical theatre combines music, songs, dance and spoken dialogue. • Physical theatre Physical theatre uses the body (as opposed to the spoken word) as the primary means of communicating with an audience. Text, music, costumes and scenery are used but only very selectively. • Mime In mime, actors do not speak but tell their stories through gesture and movement. Within each category, there are, however, many diﬀerent and distinct forms, styles and traditions. For example, Noh and Kabuki in Japan, Yatra in India, Koteba in Mali and Ozidi in Nigeria.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 107 3. Forms of theatre Theatre can be presented in a number of diﬀerent forms. Those given below are particularly useful in grassroots community based work. 3.1. Street theatre

This is a form of theatrical presentation and performance in outdoor public spaces without a speciﬁc paying audience. These spaces can be anywhere -markets, street corners, football grounds, car parks etc – but generally capable of holding large numbers of people. Street theatre can be done with simple costumes and props and little or no scenery. There is generally no sound ampliﬁcation and therefore the performances tend to rely on dance and mime, are very visible and in order to attract a good crowd are simple to follow. 3.2. Forum Theatre

Forum theatre involves both actors and the audience. An outline of the story, which is normally based on a real life community issue, and details of the characters involved are provided by either a facilitator or one of the actors. The audience provides the characters – played by the actors - with problems and issues they need to deal with and make suggestions as to how this might be done. The audience controls both the action and the direction of the performance. In their roles, the actors are expected to develop their characters and through improvisation suggest an outcome to the recommendations and ideas of the audience. By working together in this way, the audience learns what might happen with diﬀerent solutions to a speciﬁc issue or community concern. This process also shows the impact on people of particular attitudes, behaviours and courses of action. In this, forum theatre is very useful in raising awareness of issues around HIV and AIDS. 3.3. Playback Theatre

Like forum theatre, playback theatre relies on improvisation and again involves collaboration between the actors and a representative of the public who has a particular concern that needs to be addressed. The representative tells the actors a story or describes a real life situation. The characters are defined and are allocated to different actors. A performance is created around the story which is both authentic and spontaneous. Playback theatre enables the voice and story of ordinary people, especially the marginalised such as women or people living with and affected by HIV and AIDS to be heard by individuals or groups who would not normally listen.

Page 108 Responding to HIV and AIDS. A toolkit for youth peer educators. 4. Communicating about HIV and AIDS through theatre Theatre is effective in raising awareness of HIV and AIDS: it can present a message in a clear but non threatening way. Street theatre is popular in reaching out to urban and rural communities and its low cost, flexibility, simple storyline, modest costumes and set make it particularly attractive both for entertainment and delivering messages. While a carefully structured street theatre performance with a prepared script can be very effective in delivering a particular message, it does not necessarily speak to the specific concerns of a community. To achieve this requires collective or participatory theatre that is available through forum and playback theatre. Here the story is owned and developed by the people and is therefore able to be directed at issues of very local concern. Street theatre and forum theatre can reach out to both urban and rural grassroots communities: their low cost and simple costumes, music and storyline are particularly attractive. Literacy and language barriers fall away, while humour and laughter can overcome taboos about discussing serious issues like HIV and AIDS. It is especially useful when followed up by workshops or other information sessions. The advantages of forum and playback theatre are that they • are participatory • are inclusive: there is no gender discrimination for example • involve the whole community • can respond to the local socio-cultural environment • respond to local issues and concerns • appeal to young people • stimulate creativity • give voice to people who would otherwise not be heard • are effective in encouraging sustainable social change

• can lead to behaviour change. The value of playback theatre is that it can be used to tell a diﬀerent audience what they may not want to hear, without having the embarrassment or discomfort of having to address it personally. For example, a group of women concerned about the way they are treated by their husbands, can work with actors to develop a play around the theme which can then be shown to the men in the community, including their husbands. 5. Practical steps in developing a street theatre performance on HIV and AIDS 5.1. Assemble a small team to work with you on the development and production of the play. The team may also include the actors. 5.2. Deﬁne clearly what you want to achieve – your objective – and up to three key messages that you want to get across. Any more than three will dilute the power and impact of the key messages.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 109 Street theatre in a village in India 5.3. Your objective might be, for example, the eradication of stigma suffered by women who are living with or affected by HIV and AIDS. 5.4. Your messages might then include • Faithfulness is no guarantee in preventing HIV if your husband is HIV+. • The burden on women from households living with or affected by HIV and AIDS. • Women should not be deprived of their home or inheritance when they are widowed by AIDS related diseases. 5.5. On the basis of the above, develop a story line. Then produce a script, clearly identifying the characters involved. 5.6. The performance should probably not last too long: 30 - 40 minutes perhaps - it very much depends on your audience and could differ from culture to culture. 5.7. Organise a small team of actors and actresses. 5.8. Discuss the script with the team and allocate roles to your actors and actresses. 5.9. Agree the script and begin rehearsals. 5.10. Prepare music and any sound effects. Use locally produced music or songs as much as possible. 5.11. Prepare simple costumes and props for the show. Eye-catching outfits will attract audience attention. 5.12. Select a location where you will perform the show. If necessary, ask for police permission. Avoid staging the show in front of shops as this will cause a distraction and interrupt business.

Page 110 Responding to HIV and AIDS. A toolkit for youth peer educators. 5.13. Publicise the show through posters, announcements in the churches, public announcements etc. 5.14. Prepare yourself to discuss the issues with the audience after the show as well fielding questions. Seek feedback. 5.15. On with the show and good luck! 6. Practical steps in developing a play on HIV and AIDS using playback theatre 6.1. Assemble a small team to work with you on the development and production of the play. The team will also include the actors. 6.2. Meet the group or individual(s) whose problems or concerns you wish to highlight. These are often about behaviour, attitudes or injustices. 6.3. Discuss and agree with the group or individual the key message that they would like to get across. 6.4. Seek advice and information from the group or individual of particular events or occasions around which the problems occur. In other words find out as much as you can about the context. 6.5. On the basis of the above start putting together a storyline. 6.6. Define the characters and allocate the parts to the actors. Involve the group or individual in this process. 6.7. Using improvisation, work with the group or individual in developing the play. 6.8. Prepare costumes, lights, sound etc as appropriate. 6.9. Organise location and invite audience. You may also wish to publicise the event more widely. 6.10. Before the performance introduce the play and mention that after the play there will be a period of open discussion. 6.11. After the performance stimulate a discussion around the issues with members of the audience. 6.12. Seek to determine whether their understanding or attitude towards the concern has changed. 7. Additional sources of information • UNESCO has developed a manual for theatre troupes entitled Act, Learn and Teach: Theatre. HIV and AIDS a Toolkit for youth in Africa. It is currently available in French, Spanish and Arabic. An English version is anticipated in 2006. http://www.cantieregiovani.org/actlearn&teach_web.pdf • International Playback Theatre Network http://www.playbacknet.org/iptn/index.htm • The site of Mixed Company Theatre has detailed introduction of Forum Theatre and how it could be used for change. http://www.mixedcompanytheatre.com/forum/forum.html

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 111 Music and song

1. Introduction For thousands of years music has been used for cultural and religious ceremonies, healing, education, and social activism. In the mass media age, music has been used to raise awareness about social and political issues, to comment on the way society and governments (mis)behave, and to commemorate symbolic moments in the life of communities and nations. Political music is essentially The militant language of nueva canción (new song) encouraged radical musicians throughout Latin America and Spain to use the power of song to a mode of activist educate and to organise. Pablo Milanés, Silvio Rodríguez, Victor Jara and communication. By injecting Carlos Varela were “revolutionary” in their appeal. Aboriginal musicians in radical consciousness-raising Australia such as Ruby Hunter, Kev Carody and Archie Roach popularised the struggle for land rights and social justice. Fela Kuti from Nigeria, a discourse and subversive leading human rights activist, attacked military dictatorships through song. sound into the public arena, Thomas Mapfuma and his chimurenga music inspired the Zimbabwe it provides the raw materials resistance movement of the 70s and, through his songs, has spoken out about political and social concerns in present day Zimbabwe including and inspiration needed to injustice, domestic violence and HIV and AIDS. And in Thailand Nga effect change and overcome Caravan and Pongsit Kamphee exemplified the protest tradition of “songs for life”. Other musicians have inspired international protest whether they 78 tyranny. be Joan Baez in her attacks on the Vietnam War or James Brown with Say it Loud (I’m Black and Proud)’, ‘We’d rather die on our feet, than be livin’ on our knees.’ Bob Marley from Jamaica gave voice through his reggae music to the struggles of the impoverished and oppressed around the world while spreading messages of hope and unity. The power of music and song is reflected in the many musicians whose works have been attacked or banned by authorities. 2. Musical styles There is an enormous diversity of musical styles across the world, but for convenience we can group them into • Traditional or folk • Popular • Classical 2.1. Traditional or folk music

The origins of traditional music are often lost in time, being passed on from generation to generation through demonstration or word of mouth. In many parts of the world the music relies heavily on percussion instruments of every variety, most commonly drums, and tone-producing instruments such as the mbira or “thumb piano”, the nyanyeru, a one stringed African violin, the manga a lyre like Rwandan string instrument, or the Indian violin, the sarangi. Traditional music is generally associated with celebrations, festivals, and story-telling.

Page 112 Responding to HIV and AIDS. A toolkit for youth peer educators. 2.2. Popular music

Popular world music has its roots in the development of recording technology and the record industry and as such often attracts an international audience. It is influenced by a range of musical forms, particularly from the Americas. Numerous popular styles exist, including, for example, high life, Nigerian juju, and West African makossa, zook from the Caribbean, Indian filmi (film music), mbaqanga music from South Africa and island music from Melanesia. 2.3. Classical music

Classical music, in the context used here, refers to music that has its roots in learned traditions and that is taught through institutions or traditions, often of a religious nature, that are dedicated to a specific kind of music. Apart from western classical music, India’s classical music tradition is particularly strong. 3. Communicating about HIV and AIDS through music Music can be used to stimulate awareness of the causes and consequences of HIV and AIDS,, to tackle ignorance and to lament the loss of life HIV and AIDS brings. A number of musical works in various genres have reacted directly or indirectly to the AIDS crisis. Two successful musicals have highlighted AIDS – William Finn’s Falsettoland (1990) and Jonathan Larson’s Rent (1996) – and major vocalists such as Queen, Elton John and Madonna have released songs. There have also been several rock-style stage works on the theme. In Ethiopia some of the country’s best-known musicians have released a song to fight widespread stigma and discrimination against people living with HIV and AIDS. The song - called Compassion in Modernity – and an accompanying music video - without actually mentioning HIV and AIDS, emphasises the importance of caring for each other. Sung in Amharic, this subtle, but poetic approach, attempts to promote a more caring and compassionate attitude among the public towards those living with or affected by HIV and AIDS. Coming from singers who are widely respected the message has significant impact. 4. Practical steps in communicating HIV and AIDS through music 4.1. As with any communication tool, it is important to define the target group, i.e. the group of people that you would wish to influence and then to determine whether music, and which form of music, has the capacity to engage that particular audience. 4.2. Among older and perhaps more conservative groups, traditional music may have greater appeal whilst a younger, urban audience, may prefer popular music. 4.3. Through your community organisation or church seek out potential performers, backstage crew, writers, directors, choreographers etc 4.4. Work together to build and develop a musical group or band which has a particular and possibly unique sound.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 113 4.5. Agree the message that you wish to get across and decide whether it is best communicated through song or as a musical accompaniment to dance or mime. 4.6. If song is involved, make certain that the words are clear, the message simple and the language appropriate for the audience. Remember that sometimes, as in Ethiopia, messages are best conveyed through less confrontational language. 4.7. Composition of both the words and music may be done by individuals or groups, but by and large it is probably best to entrust to specific individuals during rehearsals. 4.8. Groups that are particularly ambitious may wish to go beyond the single song and develop a full fledged musical. 4.9. Whatever the case, if the words are clear and poetic, and the music ‘catchy’ and melodic, the message will be more memorable and the piece will have greater impact. 4.10. To increase appeal and increase the audience, you may wish to choreograph the performance and record it on video for broadcast on local television. At the very least you could record the performance for broadcast over local or community radio. 5. Activities 5.1. Make a list of music that you know that deals with social issues. Specifically: What kinds of popular songs are there in your country and/or language that deal with HIV and AIDS? 5.2. Write the lyrics of a song tackling the stigma associated with HIV and AIDS. 6. Action ideas 6.1. Get a local musician to set the lyrics from the activity 5.2 to music in an arrangement that can utilize all the musical talent available to you. 6.2. Organise a songwriting competition for local community groups involving the composition of original songs (music and lyrics) that encourage safe sexual practices and respect for persons living with HIV and AIDS. • Secure the services of well known local performers as judges. • If feasible ask competitors to record their songs on tape or disc. These will then be short listed by the judges against a published set of criteria. • The short listed songs will be publicly performed using a local band etc for backing. • Seek sponsorship for the competition from local companies or organizations including, if possible, the local media. • Run the show as part of an evening’s entertainment. • Make certain that you able to offer awards to the participants, particularly the winner.

Page 114 Responding to HIV and AIDS. A toolkit for youth peer educators. Dance 1. Introduction How do you run an education campaign around HIV and AIDS in countries where large numbers of people cannot read or write and most people don’t have television or radio? This is a challenge that can be met through dance. Almost all societies and cultures have a tradition of dance where it is used to communicate, entertain and celebrate. In many churches dance forms part of the worship and scriptural references to dance as a form of celebration and worship are many. Dance is a factor in development and probably more than any other art Let them praise his name form or political or social policy, has the capacity to bring people together, 79 generate understanding, teach the importance of care and support and break with dancing… down barriers. But it is also able to create a mood and a message. Dance thus has the capacity to explore the basic facts around the prevention and transmission of HIV and how fear, gender inequalities, and stigma and discrimination all contribute to the spread of the virus. The Tumbuka Contemporary Dance Company of Zimbabwe, for example, has as one of its objectives the need to inspire and develop an association with “positive youth, healthy lifestyles and responsible sexual behaviour” and has developed a programme for local teacher training colleges which uses dance to explore HIV and AIDS and related issues. Dance can, and does, change attitudes and behaviour. It appeals to the young, one of the key populations at higher risk, and is often the only way of making certain that HIV and AIDS education reaches those among them who are not able to be in school. 2. Practical steps in communicating issues of HIV and AIDS through dance 2.1. Examine the role of dance in your community and church. What form does it take? Is it simply used for entertainment or does it have deep cultural roots linked to ceremony or celebration? Is it also used for education and generating awareness? 2.2. Identify someone with experience in choreography or developing dance routines and seek out a group of dancers and musicians within the church and community to form your troupe. Identify others who may be able to help with the stage setting, lighting costumes etc. 2.3. Invite members of your church or community who are living with or aﬀected by HIV and AIDS to tell their stories to the troupe and sketch out from these stories the messages that you wish to get across. 2.4. As the stories unfold, get the dancers to translate these into movement. Ask the storytellers to comment on the movement and show the dancers the kinds of gestures and movements that they would use. 2.5. Slowly build on the collaboration and turn the stories and messages into a dance piece with relevant accompanying music. 2.6. Use words or song to enhance or strengthen the message if this is appropriate.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 115 2.7. Do not make the performance too long or too complicated. Anything longer than 30 minutes would probably lose an audience. 2.8. After the performance encourage a question and answer session with your audience. Find out what messages they received and how they responded to them.

Page 116 Responding to HIV and AIDS. A toolkit for youth peer educators. Posters 1. Introduction Posters have always been a powerful force in shaping public opinion because visual impressions make a significant and lasting impact. They rely more on design and colours than words to communicate their message. Other media such as radio, television, newspapers or pamphlets can either be turned off or simply discarded. It is difficult however to escape from a poster or hoarding whether on the public highway or places where people gather. Posters, as advertising agencies fully recognise, can influence attitudes, sell products and change behaviour. For HIV and AIDS the poster is a valuable communication tool. Posters have the advantage of being • a relatively inexpensive way to provide information or advocate a cause. • able to remain on display for long periods of time. • able to combine high visual impact with a powerful and instantly transmitted message. These qualities have encouraged HIV and AIDS campaigners and National AIDS Committees to use posters for visually communicating knowledge about disease, identifying health risks, and promoting behaviour change. 2. Practical steps in communicating issues of HIV and AIDS through posters 2.1. Posters are often used in a campaign in combination with other media. In this way the detailed information is left to other media, for example articles and brochures, while the poster is left for high visual impact. The combination of media has a mutually reinforcing effect for the same message. 2.2. A good poster is one that is attention-grabbing, succinct, convincing and memorable. 2.3. In producing an effective poster you must take note of the following 2.3.1. Design and impact

Grab people’s attention with the design. The ﬁrst job of the poster is to attract the attention of the passer-by. Only when this has been done can the message be delivered. 2.3.2. Visibility

Consider how far away the viewers are likely to be. Make the graphics and text of the poster clearly visible from 10 or 15 metres away. 2.3.3. Target audience

Know who the poster is being designed for.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 117 2.3.4. Location

Think carefully about where the poster is likely to be seen by your target audience. 2.3.5. Clarity of message

Distill your message, put as little as possible on the poster. Keep it bold and simple. Leave some space so that your message is not suﬀocated, keep it lean and clean. 2.3.6. Legibility and coherence

Create legible text, and make sure the graphics and text reinforce and support each other. 2.3.7. Evaluating impact and design

Assess your poster design before using it - have someone from your target audience evaluate the design and comment on its impact. 3. Resources 3.1. Ecumenical Advocacy Alliance organised a poster competition on HIV and AIDS entitled “Signs of Hope, Steps for Change”. A collection of poster designs from the competition is available on a CD-ROM. See http://www.e-alliance.ch/ns_cdrom.jsp 3.2. For a history of HIV and AIDS posters from around the world see http://www.avert.org/postershist.htm

Page 118 Responding to HIV and AIDS. A toolkit for youth peer educators. Video and other audiovisual media

1. Introduction Video and other audiovisual media can encourage people to think and talk about HIV and AIDS, to plan actions that they can take to make a difference and to educate and influence peoples’ thinking and actions with respect to HIV and AIDS. • Many people have never listened to someone who is living with or affected by HIV and AIDS talk about their life and their experiences. • Many people who are living with or affected by HIV and AIDS are fearful of rejection or hostile reactions if they speak openly with others about it, even with their own family or church. • Audiovisual media can enable people to speak and to listen to others without being physically present. This may make it easier to speak or to listen. • The story or ideas in a video, tape, CD or DVD can reach many people in small or large gatherings or even one by one. 2. Different audio visual media 2.1. Video

The term video refers to several storage formats for moving pictures: • digital video formats, including DVD, QuickTime, and MPEG-4; • analogue videotapes, including VHS and (where it exists) Betamax Video can be recorded and transmitted in various physical media: • celluloid ﬁlm when recorded by mechanical cameras, • PAL or NTSC electric signals when recorded by video cameras, • MPEG-4 or DV digital media when recorded by digital cameras. 2.2. Audiovisual Media

Audio-visual (also written audiovisual, AV, or A/V) technology combines visual input such as video with sound to convey information. Other examples include ﬁlm, television, CD-ROM and DVD. • CD-ROM (an abbreviation for “Compact Disc Read-only memory“) in its simplest form is a compact disc that contains data only accessible by a computer. All modern CD-ROM drives can also read audio CDs. It is possible to produce composite CDs containing both data and audio with the latter capable of being played on a CD player, whilst data or perhaps video can be viewed on a computer.

CD-ROMs can be used by people and organizations who have little or no access to the internet. They can be viewed on almost any computer.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 119 • DVD, the Digital Video Disc - also known as “Digital Versatile Disc” - is an optical disc storage media format that can be used for data storage, including movies with high video and sound quality. DVDs resemble compact discs as their physical dimensions are the same but they are encoded in a diﬀerent format and at a much higher density.

DVDs can be viewed on many computers as well as on a TV screen attached to a DVD player. Older computers will not be able to play DVDs. 3. Practical steps in communicating issues around HIV and AIDS through video and other audiovisual media Whether video, tape recorder or other audiovisual media, all have two distinct but obviously related features: • The broadcast of existing pre recorded materials from elsewhere. • The creation and recording of programmes designed to meet speciﬁc needs including what is sometimes called “participatory video”. 3.1. Using existing material

CWM’s HIV and AIDS Policy and Strategy Guidelines requires member churches to be safe and welcoming places for those people living with or affected by HIV and AIDS. For this to happen, parish and congregation members and families need to be sympathetic and informed. Peer educators can use video to help their congregation and others in the community learn about HIV and AIDS and think about their attitudes towards HIV and AIDS. Videos on both magnetic tape and digital storage media such as CD-ROMs and DVDs have been made in many languages about different aspects of HIV and AIDS. They can be found from organizations in your country as well as international organizations. They are relatively easy to use. A video particularly suitable for Christian groups is “What Can I Do?” In this film, Canon Gideon Byamugisha an HIV positive ordained minister in Uganda, and the founder of the African Network of Religious Leaders Living with or Affected by HIV and AIDS (ANERELA+) shares the lessons he has learned from his journey with HIV. The film is divided into 14 short programmes on themes such as “Coping with Stigma”, “Why be tested for HIV” and “Challenges for the Church”. You may wish to use this video to generate interest in making your church and community safe and welcoming places for people living with or affected by HIV and AIDS. 3.1.1. Organise a series of meetings in your church or community. Devote each meeting to one or two of the short programmes 3.1.2. As a group discuss the relevance of the programmes to the situation in your church or community. What aspects of the programme ring true? What would you do differently? 3.1.3. Agree a series of actions to be taken based on the lessons learned and prepare an action plan with appropriate deadlines etc.

Page 120 Responding to HIV and AIDS. A toolkit for youth peer educators. A source for videos related to HIV and AIDS is the Johns Hopkins Centre for Communication at: www.jhuccp.org/topics/hivAIDS.shtml Videos specific to Pacific Islands are available from the Public Health Programme of the Secretariat of the Pacific Community at: www.spc.org.nc/AIDS

3.2. Participatory Video

CWM’s Policy and Strategy Guidelines encourage congregations and parishes to draw on the special insights and experiences of people living with AIDS within their churches and communities in formulating local strategies and activities in addressing the disease. Participatory video can be particularly appropriate for doing that. Participatory video can also be an appropriate approach for many other communication purposes related to HIV and AIDS. 3.2.1. Participatory video • involves an individual or a group of people in shaping and creating their ay for people affected by HIV and AIDS to learn how to make a video to tell others what they have to say. • can be a particularly effective way to create information and education materials for young people, if they are made by young people for young people. See the case study on the experience of the St. Lucia project “Breaking the Silence.” • is usually made for a particular audience and for a particular purpose. It does not have to meet broadcast quality standards. • is a good way to create educational materials appropriate for groups in the community who are similar to those who made the video, such as young people who often do not respond well to materials made for them by adults. 3.2.2. If possible obtain and watch an existing participatory video and show to small groups from your church or community to see exactly what it entails and what it achieves. 3.2.3. Put together a checklist of things to consider in using participatory video for HIV and AIDS education in your church and community. Consider • access to production equipment, • training people to use the equipment, • involving people who are living with HIV and AIDS, • when and where the video would be shown, • how to make sure girls and women will be involved, • what resources would you need and how could you get them? 3.2.4. In small groups, • discuss what people in your church and community might benefit from making a participatory video. • who would it be for? • what would be its purpose?

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 121 3.2.5. Reflect on what messages should be in a participatory video to help make your church a safe and welcoming place. • How would you get these messages across in your video? • Would it be a drama or a diary of someone’s life? • Would it be a testimony or reflection from someone living with or affected by HIV and AIDS? • Would you ask members of your church to talk about their attitudes towards HIV and AIDS and ask people with HIV and AIDS to talk about what would make them feel safe and welcome? 3.2.6. Gaining the confidence of people to talk about HIV and AIDS may take a little time. It will necessarily mean that filming may take place over several days or weeks. It may also mean that you will need to consider very carefully a location in which the speakers or participants feel at ease and become unaware that they are being filmed. 3.2.7. After filming it may be necessary to edit some of the programme – to avoid repetition etc, though this should be kept to a minimum to ensure authenticity. 3.2.8. Finally, before showing the production publicly it needs to be seen and approved by the subjects of the video. 3.2.9. A similar approach can be taken for audio recordings. Whilst having less of an impact, audio recordings can be less obtrusive in the making and therefore more authentic and powerful. When using audio recordings it might be useful to use them against a background of photographs of the individual(s) and their environment.

Page 122 Responding to HIV and AIDS. A toolkit for youth peer educators. Mass Media 1. Introduction The term “mass media” is mainly used by academics and media professionals. When the public refer to “the media” they usually mean the news media, which is a section of the mass media. Sometimes mass media (and the news media in particular) are referred to as the “corporate media”, indicating ownership by multinational corporations, or the “mainstream media” to distinguish them from “alternative media” or “indymedia” (independent media) such as community radio stations and local newspapers, cable television and webcasting. The term ‘mass media’ as used in this tool kit includes • broadcasting on radio and television (including by satellite) • publishing daily or weekly newspapers and magazines • films (commercial and documentary) • the Internet • advertising Today, multimedia corporations such as Advance Publications, Disney, General Electric, News Corp., Time Warner and Viacom specialise in acquiring global media outlets and in consolidating media products.80 Star TV in India, for example, is owned by Rupert Murdoch’s News Corp. In many countries the actions of these, largely western dominated international multimedia corporations, are mirrored by local and regional corporations such as O Globo in Brazil, and TATA in India. The mass media play a crucial role in forming and reflecting public opinion. Television and radio are particularly effective in reaching large numbers of young people and have enormous influence. But the mass media can also be manipulated by governments and private interests for political, economic and social ends. For this reason, the issues of media ownership and control, independence, and ethical conduct are often criticised in relation to good governance and social justice. Who controls the flow of information and ideas and access to knowledge is crucial and, for example, can significantly affect the level, nature and quality of coverage of HIV and AIDS. 2. The mass media and HIV and AIDS UNAIDS has been encouraging greater involvement of the mass media in responding to the epidemic. In 2004 it produced the report, highlighting the many ways in which media organizations can make an impact. The report states that: The media have a pivotal role to play in the fight against AIDS. It is often said that education is the vaccine against HIV. Many media organizations are rising to the challenge by promoting awareness of HIV/AIDS and educating listeners and viewers about the facts of the epidemic and how to stop it.81

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 123 The mass media have the potential to: • stimulate and lead open and frank discussion of HIV and AIDS. • provide a platform for those most affected by the epidemic to air their concerns and views. • challenge stigma and discrimination by providing accurate information about HIV and AIDS, and positive images and role models of infected and affected people. • shape or change policy affecting HIV and AIDS and monitor their application. • encourage leaders to take action and hold policy-makers and service providers to account. • foster an enabling environment for the prevention of HIV infection. • create a supportive environment for the care of people living with HIV. It is generally accepted, however, that the mass media have failed to live up to their potential and have not taken a lead in creating a climate of tolerance and understanding in which the spread of HIV can be curbed. It should also be noted that the media is not a neutral voice, does not always reflect reality and that you should think critically about what you read, see and hear. This emphasizes the importance of what is termed ‘media literacy’. It is important to remember that the media can be • the target of your attentions whose representation and coverage you wish to change. • the tool by which your message can be heard by a wider audience. 3. Practical steps in using the media to communicate messages around HIV and AIDS 3.1. Using the media as the target • Identify the range of local, regional and national media with whom you might establish contact. In this, members of your church or local community organisations might be useful in building contacts. • Try to build relationships with journalists, presenters and people who contribute regularly to the media. This is a long term process and not easy to achieve. The WACC publication Who Makes the News provides some guidance as to how links with media may be achieved82. • Create within your church and community a body of people who are critically aware of the media, in all their forms. This is increasingly necessary for the health of society but is also is an essential step in being to use it effectively in tackling issues around HIV and AIDS. • In some schools, media literacy is part of the curriculum. Where this is the case, media literacy teachers might be encouraged to give a brief course to members of your church or community. University departments of communication, local members of the World Association for Christian Communication, or the Communication Department of CWM might also be able to help. • Establish a small group of people to review quality and range of coverage of HIV and AIDS in the media. Prepare a range of questions by which the coverage might be assessed.83 These might include, for example,

Page 124 Responding to HIV and AIDS. A toolkit for youth peer educators. • How are people living with or affected by HIV and AIDS represented? Do they give positive or negative images? • How are women represented? • Is the media supportive of efforts to curb the spread of HIV? • Does the media cover advertisements for condoms? • Does the media use inappropriate language when discussing HIV and AIDS? 3.2. Using the media as a tool • Identify key issues around HIV and AIDS which you feel are either not covered or inadequately covered by the media. • Use the media to highlight the work of your church with respect to HIV and AIDS, especially that which is being undertaken by young people. • Offer stories and testimonies from those living with and are affected by HIV and AIDS. • Get the media to sponsor or cover some of your activities. Always invite them to your events. • Write articles, including letters to the editor, about HIV and AIDS. • Submit some of your recordings through participatory video or audio to local radio and television stations for broadcast. • Develop ideas for programmes that can be used for television and radio and submit them to the broadcasting organisations.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 125 Community Radio

1. Introduction Community media - of which radio is one - • are not-for-profit i.e. they are not commercial enterprises, • are community owned and controlled, • give access to voices in the community, • encourage diversity and creativity, • involve local participation, • have a vital role in reaching out to people and communities at risk of exclusion and disadvantage. Community media provide a vital counterbalance to the increasing globalisation and commercialisation of the mass media. Community-based media projects work by enabling people to work together to • become media producers, • send as well as to receive, • reinforce knowledge, dialogue and cultural expression at neighbourhood and community level.84 Some churches have their own radio stations, many of which operate as community radio. 2. Using community radio Given the generally widespread existence of community radio and the fact that radio exists even in the remotest of villages, this medium is particularly effective for broadcasting messages about HIV and AIDS. Community radio stations exist in all the countries of CWM member churches and details of many of them can be found on the website of the World Association of Community Broadcasters (AMARC)85, a network of community radio stations, associate organizations and individuals that promotes social change through the development of a strong community radio sector. AMARC Africa has a social agenda philosophy with a strong focus on poverty alleviation, conflict resolution, HIV and AIDS, gender empowerment, human rights and democracy. AMARC serves and supports its members by promoting ownership of the means of communication through: • Empowerment, • Access to information and communication tools, • Awareness raising,

Page 126 Responding to HIV and AIDS. A toolkit for youth peer educators. Effectively using community radio requires some basic training in radio production skills and techniques. These would include for example • Preparing scripts, including scripting questions. • Reinforcing key messages. • Interview skills and techniques. • Use of language. • Technical aspects of the use of equipment such as microphones and learning about sound levels and ways to get the best recordings. Such training might be available through your local community radio station. Alternatively CWM might be approached to provide training for member churches in the region. The UNESCO supported primer How to do Community Radio: A Primer for Community Radio Operators, which can be downloaded from the internet is particularly helpful.86 4. Practical steps in using community radio to communicate messages around HIV and AIDS 4.1. Establish a small radio production group from within your church or community including someone who can oversee or direct the programme, script writers, presenters, interviewers, people with some technical experience in using recording equipment etc. 4.2. Establish contact with a local community radio station and agree a fixed amount of air time. 4.3. Seek access to a local recording studio or secure reasonably good recording requirement. 4.4. Agree a programme format depending on what is most suitable for the particular message, the amount of radio time available and the audience you are trying to reach. These formats might be • A short (probably no more than five – ten minutes) daily radio ‘soap’ broadcast over a period of a week, month or longer. • An interview with, for example, a person living with or affected by HIV and AIDS. • A jingle to emphasise, for example, an important aspect of prevention. • A song about an aspect of HIV and AIDS. • A testimony from a person living with or affected by HIV and AIDS. • A competition or quiz between different groups or churches in the community on HIV and AIDS. • Plays or short stories about HIV and AIDS. • A discussion programme. • An ‘agony aunt’ programme in which a specialist on HIV and AIDS answers questions sent in by the public.

4.5. Develop programme and broadcast. 4.6. Evaluate its impact.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 127 Cartoons and comics

1. Introduction Cartoons, whether as a single picture or a strip, as in comics, are a powerful media for highlighting issues and bringing about social change. Cartoons and comics involve visual storytelling and are therefore invaluable in situations of low literacy. They appeal to young people. Cartoons can be used to convey essential information about practical but sensitive issues in a culturally sensitive way which can be assimilated quickly. They can stimulate discussion and deal with complicated issues in a way that ordinary people can understand. Cartoons and comics are relatively low cost. Cartoons in particular can use humour to expose absurdity and contradiction, challenge basic assumptions and question attitudes and beliefs. Cartoons and comics are at their most effective when they are created locally. This ensures that they take account of local perceptions and visual culture. 2. Styles of cartoons The images can be realistic or abstract and can be used to communicate a message or enhance a message conveyed in a written text. Cartoons may take different forms. 2.1. The single cartoon. Perhaps the most common. These can depict daily activities and include ordinary people. 2.2. The narrative cartoon of comic strip. This is generally part of a story line around a particular issue or activity. Each artist has his or her own style and approach which is often immediately recognisable. 2.3. Cartoon character. Either a single cartoon or a narrative cartoon based on the life and times of a particular cartoon character. The cartoon character HIVA in the South African case study is a good example of this. These characters are normally endowed with a personality appropriate to the message. Sometimes, like in Disney, the characters can be ‘brought alive’ in three dimensional form. 2.4. Wall cartoons. Most cartoons are published in newspapers, magazines or comics. In many places, however producing wall posters or painting them on hoardings can also be most effective. For many years Air India used a cartoon character, the Maharaja, on its hoarding in Mumbai to focus on a local political issue whilst at the same time advertising the airline and its services.

Page 128 Responding to HIV and AIDS. A toolkit for youth peer educators. 3. Practical steps in using cartoons and comics to communicate messages around HIV and AIDS 3.1. Identify from within your church or community those who have demonstrated an interest in social activism and others who show some talent for art. Getting artists and activists working together is probably one of the best ways of developing cartoons or comics about HIV and AIDS. 3.2. Collect local examples of cartoons dealing with social or cultural questions and identify styles and approaches that appear to work in your local community. 3.3. Identify issues around HIV and AIDS that you would like to focus on. For example, myths around HIV and AIDS, use of condoms etc. 3.4. With your group develop a cartoon character or style that is attractive, amuses and is able to deliver your message. If you know a local cartoonist or artist, approach them for advice and support. 3.5. Start publishing your cartoon in your church or local magazine. Try to evaluate its impact. 3.6. If the response is good and you wish to be come even more ambitious, see whether your local newspaper would be interested in publishing the cartoon. 3.7. You may also wish to use your cartoon character in speciﬁc campaigns in say schools or other local institutions.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 129 Story-telling 1. Introduction Storytelling is as old as time and even with the invention of the written word it continued to be the means by which messages, ideas, stories, traditions etc were passed on from one generation to another. But of course each storyteller in each generation would inevitably introduce minor changes or different emphases and these stories now form part of our ‘oral tradition’. In many communities, great store is placed on the reliability of oral tradition. Every society and culture has examples of oral stories handed down from generation to generation. They try to make sense of the world and are often used to exchange information and generate understanding. The oral tradition may take the form of narrative proverbs, song-tales, myths, folktales, fairy tales, anecdotes and ballads etc. Like Homer’s The Iliad and The Odyssey, the Indian Sanskrit epic the Maharabharata and the Old English poem Beowulf these stories were eventually written down or, as with the story of the Tortoise and the Birds in Chinua Achebe’s Thing’s Fall Apart, were incorporated into novels. Storytelling can ‘engage, involve and inspire people’87 and using everyday language makes the message both accessible and interesting to listen to. The art of creating, developing and telling stories is a skill in itself, but done well stories can be very effective in addressing issues of social concern. It is also possible to take stories from ‘oral tradition’ and put them in a modern idiom to address present day concerns such as HIV and AIDS. It should be noted that storytelling is becoming a favoured technique in sharing knowledge among an increasing number of management consultants. CWM has promoted storytelling as a method of communication in many of its programmes and looks forward to this as one of the most popular methods in tackling HIV and AIDS. 2. Why use storytelling for HIV and AIDS? 2.1. Stories can be used to convey complex information and ideas about HIV and AIDS in an easily understandable form. 2.2. Stories are normally told with feeling and in simple straightforward language which increases the level of engagement and understanding. 2.3. Storytelling can provide both the context in which HIV and AIDS occurs as well as the HIV and AIDS information or message. 2.4. Stories are not abstract. They are memorable and thus an excellent medium for learning. 2.5. Stories can be used to explain, for example, the importance of behaviour change towards those living with or affected by HIV and AIDS without actually telling people what to do. In this way people are more likely to change. Thus stories can lead to direct action. 2.6. Stories make communicating issues around HIV and AIDS personal and can elicit an emotional response. 2.7. Stories encourage a sense of community and help to build and strengthen relationships.

Page 130 Responding to HIV and AIDS. A toolkit for youth peer educators. 2.8. People enjoy telling and listening to stories. They can inform, entertain and stir the emotions. 3. Practical steps in using story-telling to communicate messages around HIV and AIDS 3.1. We have all told stories at one time or other in our lives, but some of us are better at it than others. However, knowing what kinds of stories work best in different situations and the kind of effects they have, can make us better storytellers. 3.2. Good HIV and AIDS stories – or indeed any other stories - will have a number of common characteristics88. Good stories • Have an ability to last: They are timeless but with an enduring key message. • Are relevant: They relate to their audience and bring out an emotional response. • Rationalise and explain: They are able to explain in simple terms an action, behaviour or how to resolve a problem and offer a solution as to how to respond. • Are credible: They relate well to the listener’s experience and appear to be authentic. • Have a beginning, middle and end: There ought to be no loose ends. • Have a positive ending: To have a real and lasting impact the story needs to have a positive focus. They need to express hope. • Need a ‘hero’ The audience likes to identify an individual to whom they can relate. • Need a plot that grabs the attention of the audience. 3.3. In general a story told orally, as opposed to one that is read, has greater authenticity and impact. 3.4. Identify a number of key issues around HIV and AIDS that might form the core of a number of stories. 3.5. Examine the nature of story-telling in your community or culture and identify why they are effective. 3.6. Collect “successful” stories or stories of hope from different sources and try to adapt them to your own situation to tackle questions related to HIV and AIDS. 3.7. Seek out people living with and affected by HIV and AIDS or others who have suffered as a result of stigma and discrimination who might be prepared to tell their stories to a live audience from your church and community. 3.8. Make such story sessions a regular feature of your church or community programme. 3.9. Publish and/or record your stories.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 131 Sermons

1. Introduction Sermons are at the heart of the Christian liturgy. As has already been noted in the section on Theological Interpretation, religious leaders through their narrow interpretation of the Bible, often reinforce misunderstandings around HIV and AIDS and contribute to stigma and discrimination experienced by those living with or affected by HIV and AIDS. At the same time churches and religious leaders have been at the forefront of efforts to curb the spread of HIV and member churches of the Council for World Mission have fully committed themselves to such endeavours. 2. Using sermons to communicate issues around HIV and AIDS 2.1. Religious leaders need to reflect on HIV and AIDS in their Sunday sermons and at other meetings and services using Biblical injunctions about loving and caring, and of churches as places of refuge where people living with or affected by HIV and AIDS feel secure and not discriminated against or judged. 2.2. Providing local stories and testimonies about HIV and AIDS may encourage pastors or priests to weave them into their sermons. 2.3. There are a number of very useful publications giving outlines of possible sermons available through the

• World Council of Churches – www.wcc-coe.org • the Ecumenical HIV and AIDS Initiative in Africa (EHAIA) - see www. wcc-coe.org/wcc/what/mission/ehaia-e.html • the World YWCA – www.worldywca.org • Ecumenical Advocacy Alliance (EAA) - www.e-alliance.ch and other international ecumenical organisations. 2.4. A particularly helpful publication has been produced by the United Evangelical Mission in Germany (www.uemission.org) called God Breaks the Silence.

Page 132 Responding to HIV and AIDS. A toolkit for youth peer educators. Puppets 1. Introduction Puppetry is one of the oldest art forms in history. The ﬁrst puppet show in China dates back to 10BC, India’s two-faced puppets are more than 1,000 years old and in Turkey puppetry dates back to the 12-13th centuries. It is a traditional art form handed down from one generation to another. Puppet shows are enjoyed by children and adults, are popular in villages, fairs and festivals and are used for both entertainment and education. Plots and stories used in puppet shows are often derived from folklore, fairy tales and religion. Puppet shows are an eﬀective way of providing information and strengthening social values. 2. Types of puppets There are four common types of puppets • hand (or glove) puppets, • string puppets, • rod puppets • shadow puppets. 2.1. Hand (or glove) puppets

These are generally of very simple construction. The head, which has exaggerated features, is usually made of carved wood or papier maché and the body is essentially a Y shaped cloth tube. The puppets ﬁt over the hand or a ﬁnger – hence the term glove puppets. Only the upper part of the puppet is seen and the puppet is controlled from below. 2.2. String puppets

String puppets (or marionettes) have complete bodies and jointed limbs, with carved or moulded heads. To each moving part of the body is attached a string which is ﬁxed to a wooden cross above, by which the operator, or puppeteer, makes the puppet move. 2.3. Rod Puppets

Rod puppets are full length, have a rod running inside to the head with separate rods attached to the arms and legs. They are controlled by the operator or operators from below. 2.4. Shadow Puppets

Shadow puppets are similar to rod puppets but are two dimensional. Performances take place behind a white sheet with a bright light projected behind it. The shadow of the puppet appears a black silhouette on the screen.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 133 3. Using puppets to communicate issues around HIV and AIDS 3.1. Puppets as a communication tool have the ability to present the needs and concerns of ‘real’ people through the actions and words of a third person without oﬀence or embarrassment. This has been described as a sense of “otherness” . 3.2. This is particularly important when discussing issues around HIV and AIDS such as contraception and the prevention of sexually transmitted disease and telling stories about stigma and discrimination. 3.3. Puppet shows provide an eﬀective way of educating and raising public awareness about HIV and AIDS in an informal but entertaining environment for both young and old audiences. 3.4. In deciding to use puppet shows to communicate HIV and AIDS it would be sensible to determine whether there is a tradition for a particular form of puppetry in your community or if not which form might be best both for the message and the audience. 3.5. Developing a puppet show will require you to decide on an issue to be addressed and a clear story line. 3.6. For hand, string and rod puppets, it is important to distinguish the characters using exaggerated features and contrasting colours.

Page 134 Responding to HIV and AIDS. A toolkit for youth peer educators. Fashion 1. Introduction T-shirts and sports caps have long been used to advertise a myriad of messages. They can be easily used to deliver slogans, are popular with young people, costs need not be high, and they can be part of a larger campaign on issues around HIV and AIDS such as stigma and discrimination. The messages can be used to reinforce larger messages or they can be “stand- alone”.

In some countries, the messages can also be used in the making of cloth. Apart from clothes, in recent years fashion accessories such as bracelets, broaches etc have been used with great effect to indicate support and concern for HIV and AIDS. More widely, fashion shows in support of efforts to curb the spread of HIV and AIDS and provide resources for those living with or affected by HIV and AIDS, have proved especially popular. 2. Using fashion to communicate issues around HIV and AIDS 2.1. Developing a slogan that is short, ‘punchy’ and to the point is essential for creating impact. For example AIDS Kills!, Protect Yourself and Me! 2.2. It is important to spend time on the development of the slogan, perhaps enlisting the help of those within your church or community who have experience of advertising. 2.3. Ensure that the messages are locally relevant and acceptable. 2.4. A slogan on, say, a T-shirt, can also be used to identify your group and its efforts to tackle HIV and AIDS. Such branding will both highlight the issue and encourage others to join you in your efforts.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 135 Internet 1. Introduction Despite the fact that many people do not have access to internet, especially in the poorer parts of the world, for a rapidly rising number of people the internet is a part of their working life and leisure time. The internet oﬀers enormous potential in responding to HIV and AIDS. Although English is the dominant language of the internet, other major languages are beginning to chip away at this monopoly. 2. Internet facilities The internet oﬀers various facilities 2.1. Websites

These are accessed via the internet. There are • static websites, with pages of text and images, flash animations or videos for the user to view. • interactive websites with games, forums or chat rooms (this user-to-user interactivity is often moderated by the website hosts). • websites offering services such as advice or counselling. They often have specific target audiences, such as children, adolescents or adults, men or women, straight or gay. And they often have specific subject focus, such as contraception or STDs, or geographical focus such as a particular region or country, or an event such as a conference or festival. Websites can be as small as a few simple pages, like a brochure, or as big as a library, with vast searchable archives of news, articles, reports, manuals, images, audio files or video clips. 2.2. E-mail

E-mail is accessed through the internet and provides a fast way to send and receive written messages • from individual-to-individual, • as part of a group that receives mail from one source (a list), • as a discussion group where each member can mail everyone on the list. Files can be attached to e-mails, such as photographs or documents. 3. Language of the internet The internet has introduced a number of new words and concepts. Apart from website and e-mail there are 3.1. World Wide Web

“WWW” or simply the “Web” is a global, read-write information space where resources such as documents and images are identified by short, unique identifiers called Uniform Resource Identifiers (URLs) so that each can be found, accessed and cross-referenced in the simplest possible way.

Page 136 Responding to HIV and AIDS. A toolkit for youth peer educators. The term is often mistakenly used as a synonym for the Internet itself, but the Web is actually something that is available over the Internet, just like e-mail and many other Internet services. 3.2. Forum

An Internet forum is a facility on the World Wide Web for holding discussions. A sense of virtual community often develops around forums that have regular users. Technology, computer games, and politics are popular areas for forum themes, but there are forums for a huge number of diﬀerent topics. Internet forums are also commonly referred to as web forums, message boards, discussion boards, discussion forums, discussion groups or bulletin boards. 3.3. List serve

An electronic mailing list, that allows for distribution of information by e- mail to many Internet users. It is similar to a traditional mailing list — a list of names and addresses — as might be kept by an organization for sending publications to its members. 3.4. Streaming media

Streaming media is media that is heard and/or viewed while it is being delivered to a computer via the internet. Non-streaming media is ﬁrst downloaded to a computer, and only once it is fully downloaded it is heard or viewed. 3.5. Flash

Flash refers mainly to games and movies prepared using the Flash authoring programme for use on internet browsers. The Flash Player enables users to view this content and is available in most web browsers. 3.6. RSS

RSS is a family of web feed formats, speciﬁed in XML and used for Web syndication. RSS is heavily used, among other things, by news Web sites, weblogs and podcasts. 4. Using the internet The internet can be used in many ways, including the following 4.1. Awareness-raising

For example by placing a forum on HIV and AIDS on a website that is used by adolescents 4.2. Advocacy and campaigning

Such as petitions or building consensus on policy positions within organisations. 4.3. Fund-raising, marketing and raising proﬁle

For groups working on HIV and AIDS ensuring continuation of resources to function is vital - documenting and showcasing their work online can be important. Researching donors and applying for support can be done eﬀectively online. Donations can even be taken through a organisation’s website.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 137 4.4. Networking

Is important for groups working in similar ﬁelds, for sharing experiences, learning from each other, keeping up-to-date with innovations and best practice. 4.5. Disseminating resources

Training manuals or magazines, for example, can be distributed online. 4.6. Facilitating discussions

For example between health professionals and journalists, or between groups across large distances where physical meeting, such as in the Paciﬁc region, is diﬃcult. 4.7. Maintaining contact and community

The internet is obviously invaluable in keeping in contact with other CWM member churches around the world. 4.8. Administration

For example, communicating with donors, members and volunteers, or doing ordering supplies and paying bills. 5. Use of the internet for communicating issues around HIV and AIDS 5.1. The internet has many points in its favour, but there are also many disadvantages, both should be weighed up before using it. 5.1.1. People can use electronic communication anonymously. This is often a great advantage as it allows people to overcome major obstacles of shyness, taboo and stigma as they explore, learn and discuss issues related to HIV and AIDS. At the same time it can take away the human touch of communicating with people, and in some cases, of counselling for example, this can be more important than anything else. 5.1.2. Electronic communication can easily reach thousands, even millions, of people but it doesn’t reach the most disadvantaged, the poorest, and the least educated. There may be a risk of putting poorer people at a disadvantage and creating a two-tier service. 5.1.3. The internet can be relatively inexpensive to run, compared to print for example, but it can also have unexpectedly high costs. After the initial set-up, the ongoing costs of dial-up internet access for example can be prohibitively high in some areas. 5.1.4. The internet can create an unexpectedly high volume of new work, such as responding to ﬂoods of information requests or moderating an online forum. 5.1.5. The internet can bring local community groups into national and international arenas. 5.1.6. The internet can be ﬂexible, for example a website can be added to or corrected, but this can take a lot of work too, and this can often become an ongoing demand of skilled input.

Page 138 Responding to HIV and AIDS. A toolkit for youth peer educators. 5.1.7. Though it can provide many statistics on visits, the internet may provide very little indication of what difference it makes to people’s knowledge and actions. 5.2. When planning to use the internet, bear in mind some of these golden rules: 5.2.1. Keep it simple. Make sure that others can use it, for example by ensuring that it is easy to navigate and does not need the very latest computers or software. 5.2.2. Keep it sustainable. Don’t use a complicated and high-tech design that you don’t understand or won’t be able to maintain. 5.2.3. Keep it strategic. Don’t choose a form of electronic communication just because it is attractive. Instead, think about whether it is what you really need. 5.2.4. Be methodical. For example, identify a staff member to lead the work and make it part of their job description to update your website once a month. 5.2.5. Build internal capacity rather than being dependent on external expertise. 5.3. Before starting to use electronic communication, the advantages and disadvantages of using it should be weighed up and compared to other more traditional communication methods, such as printing, which may be easier or more effective to use. 5.4. Also it is useful to think in terms of time, money and capacity to establish whether you have the resources to sustain what you want to do, such as the skills to maintain a website or the time to respond to requests for information. 5.5. Electronic communication presents many opportunities. But it is important to think strategically and plan carefully – to use it to best effect and to complement other areas of your communications work. 5.6. The World Links Project- details of which are given in the Case Study section of this tool kit – demonstrates how the internet can be used to great effect.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 139 Church magazines

1. Introduction A church magazine is a publication produced at regular intervals by a church for community members, primarily for its parishioners. It is a simple print media that can be produced with the use of a computer with a good Desktop Publishing (DTP) programme, or on a very basic level even a simple word processor will suffice. Typically the content of a church magazine is a mixture of church and community news, such as a message from the pastor, Bible study or reflection, congregational meeting times, church news and events (baptisms, weddings, deaths), a prayer list, inspirational stories, etc. Church magazines are often distributed free or at a nominal fee to the readers. The publication is either made available at the church where it is picked up by the readers, or in some cases the magazines are delivered from house to house. Content in a church magazine is regarded by its readers as real, touching on day-to-day life, and not far-removed. The community members can identify with the magazine because it is produced by a person/people they know, and it talks about people and situations relevant to them, and it is written specifically for them. 2. Using church magazines to communicate messages around HIV and AIDS 2.1. There are a number of distinct advantages in using church magazines for getting across HIV and AIDS messages. 2.1.1. Church magazines are ideal for sharing information with youth about HIV and AIDS as something that is real to their situation and affecting them. 2.1.2. Print medium can be used over a long period of time. The magazine can be read and read. 2.1.3. Church magazines are more easily shared, e.g. a youth may read something of interest and easily share with another person. 2.1.4. The target audience is well known to those producing the magazine - who they are, where they are and their needs 2.1.5. The church magazine can be used to carry other information sources. For example brochures, leaflets can be placed as inserts within the magazine; or for competitions or events relating to HIV and AIDS activities can be advertised in the magazine. 2.1.6. Church magazines can be easily and fairly cheaply produced.

Page 140 Responding to HIV and AIDS. A toolkit for youth peer educators. 2.2. In using a church magazine to communicate HIV and AIDS messages it is important to remember the following points 2.2.1. Presentation of information

Varying the way that information is presented will attract attention and maintain interest. Catchy headlines help as will the use of diﬀerent formats such as quizzes, puzzles, question and answer, a story from a person aﬀected or infected by HIV and AIDS, ten things every teen should know about HIV/AIDS etc. 2.2.2. Language

Avoid jargon and technical and medical terms. If technical or medical terms have to be used, explain what they mean. Use a style and language that are familiar to the age-group. 2.2.3. Brevity

Keep articles short and do not try to overload them with too much information. Everything does not have to be said in one article. Split information into digestible bits and gradually build up knowledge over a series of issues of the magazine.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 141 Testimonies 1. Introduction Experience has shown that people listen to and learn from individuals who are prepared to talk about their experiences. These ‘testimonies’ have the benefit of authenticity and reveal truths which might otherwise be suspect. Within the faith-based community, testimonies have always been an instrument of mission – for what after all are Paul’s letters to the Ephesians? - and their use in addressing issues around HIV and AIDS is therefore very powerful. 2. The use of testimonies in communicating issues around HIV and AIDS 2.1. In the case of HIV and AIDS, testimonies are at their most effective when they originate from people living with or affected by HIV and AIDS. For such people tell it as it is, however uncomfortable the message may be. 2.2. Testimonies can serve a variety of purposes, but the most significant are their role in • encouraging others to know their status. • giving support and encouragement to those who are HIV+ to go public. • highlighting the impact of HIV and AIDS at a very personal and professional level on themselves, their families and their friends. • exhorting churches and communities to take action to curb the spread of HIV. • challenging any tendency to associate HIV and AIDS with ‘sin’. • challenging stigma and discrimination. • giving voice to the concerns and needs of those who are HIV +. • demanding the implementation of policies and practices that can reduce the spread of HIV. • reminding churches and communities that non judgemental love and caring for others is at the heart of Christ’s teaching. • creating a truly Christian community within your church. 2.3. While many examples of ‘testimonies’ have been published on the web, in magazines and book form - those from within your community will probably have the greatest impact since they relate to someone you know or whose circumstances you are acquainted with. 2.4. Seeking testimonies from those members of your community or church living with or affected by HIV and AIDS - husbands, wives, children, orphans, grandparents, friends, young people, pastors, lay preachers – will probably have a greater impact than almost any other communication tool. However, securing those testimonies, through recorded interview, in writing or as a public presentation will require sensitivity and an ability to inspire confidence on your part and great personal courage on the part of the person providing the testimony.

Page 142 Responding to HIV and AIDS. A toolkit for youth peer educators. 2.5. Choosing the right person and the right moment to secure such testimonies is therefore critical. 2.6. Whatever is recorded, transcribed from a recording, written or said, must have the prior approval of the person providing the testimony. The person also needs to be fully aware of the impact it will have on themselves as well as their audience. 2.7. Many examples of testimonies have been published and are available on the internet or in book form. Two such publications are • Future Forsaken: Abuses Against Children Aﬀected by HIV/AIDS in India which is available on the web. • ActionAid’s Strategies of Hope Series called Open Secret: People facing up to HIV and AIDS in Uganda, available through TALC.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 143 Seminars, conferences and workshops 1. Introduction Conferences, seminars and workshops are all ways of exploring issues with a selected audience. Whilst they each operate in diﬀerent ways, all three need to have a clear theme and have well deﬁned objectives and outcomes. 1.1. Conference

A conference is a gathering of individuals invited to discuss and/or present information on a particular topic or a set of topics in related ﬁelds. It normally has a number of keynote presentations or panel discussions, together with group work, concluding with a set of recommendations for follow-up work. Conferences, which are usually for upwards of 30 people, are often promoted as opportunities for networking with people of shared interests. 1.2. Seminar

A seminar is a meeting or series meetings of specialists who have diﬀerent skills but a common interest and come together to learn from each other and to exchange information. The purpose of seminars is to advance knowledge and understanding around a particular issue. Many of the participants will know each other through their work. They are best suited to groups of 30 or less people. 1.3. Workshop

A workshop is similar to a seminar, but it is generally more practical, participative and interactive. Workshops work best when the group is smaller than 20. 2. Using workshops, conferences and seminars to communicate messages around HIV and AIDS 2.1. Workshops, conferences and seminars must respond to a perceived need. Defining this need from the outset is important. 2.2. The need will inevitably define the theme, and will also influence the objectives and outcomes. Preparing a statement on the objectives of the event and longer term outcomes is crucial. 2.3. Successful meetings - especially workshops and seminars – have a number of characteristics which must be taken into account. Apart from clarity over the theme, objectives and outcomes these include:

Page 144 Responding to HIV and AIDS. A toolkit for youth peer educators. • Securing the right speakers, both in terms of what they have to say and their abilities as performers. These may include officials from the National AIDS Commission, academics and others working on HIV and AIDS, theologians from across the denominational and religious divide, people living with and affected by HIV and AIDS, leaders of youth groups and women’s organisations etc. • The involvement of people living with or affected by HIV and AIDS such as representatives of ANERELA+. • Attracting a mix of interesting participants who are guaranteed to provoke and contribute to the discussion. • Good marketing of the event. • Engagement with the media to ensure wider publicity of the activity. • A good location without unnecessary distractions where there are opportunities for interaction both within and outside the sessions. • Good food and warm hospitality. • An efficient organisation with plenty of support staff and facilities – photocopying, on-line access etc. • Entertainment around the theme of the conference, perhaps showing the value of different communication tools. • Visits to places of interest such as ‘healing centres’ or care homes for those with HIV and AIDS. 2.4. By way of example, a conference, seminar or workshop on the common theme of ‘HIV and AIDS and behavioural change’ might have the following distinguishing features89. 2.4.1. Conference • Objective would be to analyse the representation of people suffering from AIDS in the international media. • Comparative studies by leading experts illustrated by clips from television documentaries and news programmes highlighting good or biased reporting. • Monitoring of newspaper coverage with regard to questions of balance, representation and ethics. • Panel discussions on good and bad reporting. • Concluding statement and/or a set of recommendations for action. 2.4.2. Seminar • Objective would be examine local social and cultural obstacles to bringing HIV/AIDS into the open. • Participants to include community leaders, health specialists and representatives of NGOs to discuss how best to tackle the problem and what methods are best suited to the local circumstances. • A clear outcome from the seminar might be an agreement to organise training for church workers and teachers or to make available relevant resources in the local languages. In either case it would be stated how these might be achieved.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 145 2.4.3. Workshop • Objective would be to provide training etc in devising programme formats aimed at increasing awareness about HIV and AIDS. • Participants would be journalists from community radio stations and local newspapers. • Through the workshop participants would gain practical experience in writing articles, producing radio programmes about say, stigma and discrimination, and/or interviewing techniques.

Page 146 Responding to HIV and AIDS. A toolkit for youth peer educators. Competitions

1. Introduction Running competitions is a good way to stimulate activity around a particular theme. People often feel more motivated to participate in an activity if there is something to gain from it. What there is to gain may simply be the honour of being judged to be more knowledgeable or better in some other way than the other participants. Or, there may additionally be an award such as a certiﬁcate, trophy, money or other prize. Competitions may be used eﬀectively in a process that encourages learning, creativity, or industrious productivity of some sort. 2. Using competitions to communicate messages around HIV and AIDS 2.1. Quizzes

In awareness building, education and encouraging behaviour change, competitions such as quizzes are often organised to promote learning in which members of a church group or college are encouraged to learn about HIV and AIDS. A quiz can promote learning and then challenge and test the participants’ understanding. 2.2. Beauty competitions

In several countries there have been Miss HIV-Positive Beauty Competitions. These have been run to challenge the stigma associated with HIV and to show that people living with HIV can remain healthy and productive. For information on such a competition in South Africa see http://tinyurl. com/qasfq, and in Russia see: http://tinyurl.com/9xnrq. 2.3. Media-related competitions

Other experiences in running competitions about HIV and AIDS include the production of some form of communicative media. There are many examples such as • scriptwriting competitions (see http://tinyurl.com/p9m3e for example), • story-writing competitions (see http://tinyurl.com/mse63 for example), • short ﬁlms and music videos (see the MTV staying alive competition for example at http://tinyurl.com/mw2hw), • art competitions (see http://tinyurl.com/nfy3v for example), • poster design competitions to generate thinking and debate about HIV and AIDS have been quite popular and one notable one was run by the Ecumenical Advocacy Alliance, • photographic competitions.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 147 Sport 1. Introduction Sport has always been a very eﬀective medium for promoting messages as is evident from the large number of companies that seek to use it to advertise their products. Its attraction is that sport • is watched by large numbers of people, • often receives wide media coverage, even at a very local level, • has its heroes whose lives are followed by many and whose words are listened to, • brings together people of diﬀerent persuasions and backgrounds, • brings together many people in one space, • provides entertainment, • reaches young people. 2. Using sport to communicate messages around HIV and AIDS Sport can be used to promote HIV and AIDS messages at all levels, local, national, regional and international in a variety of ways. 2.1. Tournaments or competitions

Tournaments and competitions can be developed around an HIV and AIDS issue. Messages can be broadcast during the events, players or athletes can be seen endorsing the message, advisory centres set up, condoms promoted and sold. 2.2. Players and athletes

Engaging prominent players and athletes in support of the HIV and AIDS message will attract widespread interest. They may be asked to speak in support of the issue or, at the very least, their clothes may be branded with the message. Players and athletes who may be HIV+ would provide a very strong voice against stigma and discrimination. 2.3. Promotional materials

Displaying large posters around the perimeter of a sports or athletics venue attracts the attention of those attending and will be picked up by the media covering the event, particularly television. Promotional packs can also be available for distribution to what, in eﬀect, is a captive audience. 2.4. Opening ceremonies etc

Most sport activities, if they are part of a tournament or competition, have an opening ceremony to which leading figures in the community are invited. Their presence and their words in support of the message can have a significant impact. Whatever the form of the sport activity, it is essential that the message be defined from the outset. Sport may be particularly useful in areas such as prevention and breaking the silence. Page 148 Responding to HIV and AIDS. A toolkit for youth peer educators. Photography 1. Introduction To illustrate the power of photography to generate important debate and social change, Augusto Boal reported in ‘The Theatre of the Oppressed’ that during a literacy project in a barrio of Lima, Peru, the Brazilian educator Paulo Freire asked people questions but requested the answers in photographs. When the question “What is exploitation?” was asked, some people took photos of a landlord, grocer, or a policeman. One child took a photo of a nail on a wall. It made no sense to adults, but other children were in strong agreement. The ensuing discussions showed that many young boys of that barrio worked in the shoe-shine business in the city centre, not in the barrio where they lived. As their shoe-shine boxes were too heavy for them to carry, the boys rented a nail on a wall (usually in a shop), where they could hang their boxes for the night. To them, that nail on the wall represented exploitation. The “nail on the wall” photograph fostered enthusiastic discussions there about other forms of institutionalised exploitation and ways to overcome them. Photography is highly inclusive. Anyone can take photographs, it requires no literacy, no particular language and today it doesn’t even require a great deal of resources. The cost of digital photography has reduced so much that it is now within the financial possibilities of many churches and small organisations to run a photography project. Photographs can be used effectively in publications, but are sometimes only for exhibition in a public space such as a Church or school hall. Sometimes they are taken not for the public to see, but for the use of a particular group, such as participants in a workshop, to promote reflection and for group discussions. 2. Using photography to communicate messages around HIV and AIDS Photography can be used in different ways to get across HIV and AIDS messages. Photography may also be used to build useful stories, or photographic story boards, by getting people to pose for each photo and putting them in a sequence to tell a story, with or with use of captions. Given the declining cost of cameras, particularly digital cameras, photography can be a cheap and effective communication tool. It can be used in a variety of ways including the following. 2.1. Documentary photography

In documentary photography, photographers attempt to produce truthful, objective, and usually candid photography of a particular subject, most often pictures of people.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 149 Documentary photography in a particular place or community focuses visually on what is real for the people there. The photographs • are contextualised, in that people seeing them there will recognise their own local scenes, • will tell their stories, • talk about their realities, about their experience and their lives. • This ability of photographs to relate to real people and real lives is particularly useful for focusing a group on issues that are important to them, to promote discussions, analysis, sharing and reﬂection on the realities that a group lives. • Documentary photography of this kind can be very eﬀective in supporting testimonies or bringing to life the real impact of HIV and AIDS. 2.2. Participatory photography • Participatory photography involves putting the camera in the hands of a particular group, of young people for example. They become the photographers. • Participatory photography allows people to take photographs of their own lives, photographs which describe their own experiences, and this can be particularly powerful. • Many projects allow the participants to take cameras away for a day or more to take photographs of their lives and realities outside of a workshop and then to bring back the photographs to work on collectively.

Page 150 Responding to HIV and AIDS. A toolkit for youth peer educators. Section XII Case Studies: Using communication tools. Testimonies, workshops, video, radio, visual aids. Country: Rwanda Organisation: Mbwirandumva Initiative Project: Talk I’m Listening: Campaign against HIV and AIDS Stigma and Discrimination 1. The problem In April 1994, Rwanda suffered one hundred days of violence and genocide, targeted at the Tutsi and moderate Hutu population. Violence against women and girls was widespread. The UN estimates that more than 250,000 women were raped during the genocide, a large number of whom were subsequently executed. Of the survivors, 70% are estimated to have been infected with HIV. These women and their families now face stigma and discrimination, loss of employment, difficulty in asserting property rights, and a denial of civil and political rights. 2. Project outline The Mbwirandumva Initiative is an association of girls and women and their families who are now living with or affected by HIV and AIDS as a result of violence suffered during the genocide. Begun in 1996, its mission is to help these women and girls lead full and positive lives. The organisation offers trauma and AIDS counselling of women and girls, advice and support on gender and human rights issues, family support and micro-credit loans for income-generating activities. The Initiative networks with many civil society organizations especially the Rwandese Association of Trauma Counsellors (RATC). These are very active in AIDS counselling and campaigning. Others include The Association of Widows of the April Genocide (AVEGA) CORDAID (a Dutch NGO) and the Presbyterian Church of Rwanda (EPR). The project consisted of two concurrent community-based campaigns. 2.1. HIV and AIDS communication campaign

This component covered various aspects of HIV and AIDS including • training in advocacy, • awareness raising and information, • dissemination of accurate information to the women members and their families. Its goal was to reduce stigma and discrimination against people living with HIV and AIDS. One-day seminars were held every 3 months in the provinces of Gitarama, Kibungo and Umutara - to sensitize women, youth and civic leaders in all aspects of HIV and AIDS.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 151 Videoed testimonies were provided by women who had suﬀered in the genocide and those who had been infected by HIV as a result of the genocide. 2.2. Safe motherhood and the welfare of families

To complement the HIV and AIDS communication campaign, the Initiative, in collaboration with the Mothers’ Union of Rwanda (MUR) and the Rwanda Human Rights Commission (HRC), embarked on a programme to promote the welfare of families through education around • safe motherhood care including family planning, • primary health care, • social welfare issues particularly around fostering of orphaned children, • human rights for women. The communication tools used throughout the project included: • Demonstrations using visual AIDS including video. These were especially effective in reaching the target groups since about 49% of the Rwandan population is illiterate. • Workshops. • Radio – with its ability to reach all parts of the country in local Kinyarwanda and French – was widely used. • Leaflets and T-shirts carrying anti-stigma and discrimination messages were also produced. The objectives of the project were to: • Reduce stigma and discrimination suffered by those living with or affected by HIV and AIDS. • Generate greater understanding of the causes, prevention and control of HIV and AIDS. • Enable people living with HIV to come to terms with their status and live full and positive lives. • Encourage young girls and youth in general to avoid unprotected sexual practices. 3. Outputs • 12 seminars and workshops in three provinces. • Testimonies. • Counselling sessions for people living with and affected by HIV and AIDS. • Training of women and young girls on HIV and AIDS issues. • Production of radio programmes in both Kinyarwanda and French. • Increased involvement of churches and schools in programmes of HIV prevention and stigma and discrimination. • Production of leaflets and T-shirts with anti stigma and discrimination slogans.

Page 152 Responding to HIV and AIDS. A toolkit for youth peer educators. 4. Outcomes • Greater awareness of HIV and AIDS issues. • Reduction in stigma and discrimination against people living with HIV and AIDS. • Improved care for those living with HIV and AIDS. • Greater collaboration with other groups possible involved in HIV and AIDS. • Reduction in the number of recorded new cases of HIV.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 153 Participatory video Location: St Lucia Organisation: St Lucia Red Cross Society Project: Breaking the silence around HIV and AIDS 1. The problem The Caribbean has one of the highest HIV/AIDS infection rate outside of sub-Saharan Africa. It is estimated that by 2010 from 5 to 6% of St. Lucia’s GDP will be lost as a result of AIDS with devastating social and economic consequences. It is estimated that in St Lucia approximately 92% of the HIV infected youth is female and it appears to be that throughout the region girls are contracting HIV at a rate seven times higher than boys the same age. Although they are the hardest hit demographically, almost two-thirds of sexually active girls aged 15-19 years believe they are not at risk of HIV infection. Moreover, as a UNICEF survey points out, one in three youth respondents claimed to have little or no information about sex education or AIDS, with lower income, rural, people reporting higher levels of feeling uninformed. 2. Project outline The St Lucia Red Cross, which provides an internationally recognised HIV/ AIDS peer education programme for young people, and the Seattle-based 911 Media Arts Centre joined together in a strategic partnership to address issues of gender, reproductive health and HIV/AIDS in St Lucia. 2.1. Objectives • To train a group of 12 young people aged 16-21 from poor backgrounds and who have dropped out of formal education, in hands-on digital video production and media literacy, HIV/AIDS prevention, language and communication skills, self-esteem and values, and peer leadership in a 4- days-a-week 12 weeks module. • To mentor the participants in developing highly transferable vocational skills which might help them to break free of the cycle of poverty and dependency in which most of them live. • To strengthen life skills, especially decision-making and negotiation skills among the girls involved. • To disseminate HIV/AIDS related information to the community. 3. Outputs 3.1. A workshop for twelve young peer educators in HIV prevention, audio visual skills and video production. 3.2. The production of a 15 minute, compelling, provocative and powerful video on HIV and AIDS conceived, shot, and edited by the participants that speaks directly to those most at-risk in contracting HIV. 3.3. A video on HIV and AIDS for use in peer education programmes.

Page 154 Responding to HIV and AIDS. A toolkit for youth peer educators. 4. Outcomes 4.1. A group of young people with highly transferable vocational skills, leadership and teamwork skills, an ethic of civic duty, invaluable relationship skills, self-conﬁdence, skills for self-expression, and a strong sense of community. 4.2. Greater awareness of HIV and AIDS among young people in the community. 4.3. Wider impact of the video in schools and universities, health centres etc across the Caribbean.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 155 Posters Location: Global Organisation: Ecumenical Advocacy Alliance, World Council of Churches Project: HIV and AIDS poster competition 1. The problem Many in the faith-based community have been reluctant to discuss HIV and AIDS openly. Ignorance about the basic facts of HIV and AIDS and the stigmatisation of those living with or aﬀected by HIV and AIDS are common in many churches. 2. Project outline The Ecumenical Advocacy Alliance (EAA), a global network of 86 churches and church-related organizations, based in Geneva, ran a worldwide competition for designing posters to promote discussion of the issues around HIV and AIDS in the churches. Throughout 2003, competition organizers in 32 countries encouraged local groups and congregations to discuss basic facts about HIV and AIDS and attitudes toward the disease within their churches, with an emphasis on the hurt that stigma and discrimination can cause. Participants then drew on these discussions to create posters. English, French, and Spanish toolkits distributed to national poster competition steering committees and local groups helped facilitate informed discussion. The toolkits oﬀered basic information on HIV and AIDS and the stigma and discrimination that surround them, as well as discussion resources tailored to local parishes, churches and church-supported schools, and suggestions for creating poster art. 3. Outputs 3.1. Exhibitions of posters in the participating countries. 3.2. 80 posters selected by national judges were exhibited at the United Nations on World AIDS Day 2003 and at the International AIDS Conference in Bangkok in 2004. 3.3. The production and distribution of a CD-ROM, Signs of Hope Steps for Change, which included the winning posters and multilingual HIV and AIDS-related resources. 3.4. Production of a brochure “Next Steps: For positive change in attitudes that cause HIV and AIDS-related stigma and discrimination” to provide local groups with a starting point to integrate HIV and AIDS-related messages into additional activities, from drama to essay competitions.

Page 156 Responding to HIV and AIDS. A toolkit for youth peer educators. 4. Outcomes 4.1. The poster competition reached thousands of people in developing countries, and many were challenged to examine the role of the Church in allowing stigma to create a discriminatory environment for people living with HIV/AIDS. 4.2. One Indonesian campaign organizer testiﬁed to the project’s unusual impact on local attitudes in his country: “A national church has said they ... will write about HIV/AIDS in their monthly church magazine, in languages that can be understood at the local level. This magazine does get into the local villages, and they hope that gradually through this method, they can help the people to understand the danger of HIV/AIDS.” 4.3. Through the competition, more than 430 churches, schools, and faith- based community groups introduced the subject of HIV and AIDS-related stigma and discrimination to their members. 5. Resources For further information, see the EAA website: http://www.e-alliance.ch/ns_cdrom.jsp

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 157 Participatory photography Location: Democratic Republic of the Congo Organisation: Femmes Foundation Plus Project: Positive Negatives: Picturing Life with HIV/AIDS 1. The Problem Nearly 1.5 million people, more than ﬁve percent of the adult population in this war-torn republic is HIV-positive. Over half of these are women. Many are widows whose positive status has left them ostracised by their extended family, but still responsible for the welfare of up to eight children each. Many will die prematurely and unknown to their children. 2. Project outline A workshop to provide basic training in photography was organised in Kinshasa for ﬁfteen HIV+ women, the members of a local support group Femmes Fondation Plus. Their new found skills provided opportunities to generate income to support themselves and their families as well as building up picture albums to pass on to their children. The photographs taken by the women explore their experiences of HIV, challenge the stigma attached to the disease and help them regain their dignity. This is participatory photography at its most powerful. The words of Celestine, a participant in the workshop are instructive

”I lived happily with my husband until he began to look for another wife. I warned him to stop but he refused to listen to me. He was infected by this second wife. One day, one of our children was ill and I took him to the hospital. He needed a blood transfusion. My husband donated some of his blood: the child fell ill and died. A doctor told us that he had died from AIDS. My husband was deeply aﬀected; he died shortly afterwards. His family rejected me and no longer help me to take care of our seven children. Through my photos I want to show the reality of HIV/AIDS and to encourage people to be careful.” 90

Page 158 Responding to HIV and AIDS. A toolkit for youth peer educators. 3. Outputs 3.1. Fifteen women trained in photographic techniques. 3.2. Photographic albums to be passed on to their children. 3.3. Exhibitions of photographs of life as seen through the eyes of a person living with or aﬀected by HIV and AIDS. 4. Outcomes 4.1. A deeper insight into the life and conditions of HIV-positive women and girls in the Congo. 4.2. Greater understanding of the impact of HIV on women and how it aﬀects their lives. 5. Resources See details at the at the PhotoVoice website http://www.photovoice.org/html/projectgallery/worldmap/africaandmiddleeast/ positivenegatives/

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 159 Street Theatre (1) Location: Guatemala Organisation: Payasos Project : HIV and AIDS Education 1. The problem Guatemala has a large rural and conservative population, with over 60 per cent of the population belonging to the Evangelical Church. Many deny the existence of HIV and AIDS and are unreceptive to HIV and AIDS information. There is widespread resistance amongst teachers and parents to reproductive and sexual health education being offered to young people in schools. Approximately 68,000 people (1.1% of the adult population) are infected with HIV in Guatemala with prevalence rates highest among the 20 to 39 age group. Over 60 per cent of the population are indigenous and speak one of the 21 Mayan languages. 2. Project outline According to UNAIDS, countries with relatively low prevalence rates, such as Guatemala, should target their efforts on high-risk groups to achieve the greatest impact. Based on this thinking, Payasos, an organisation that makes use of clowns to effect social change, worked in eleven regions concentrating on rural communities, port and border towns, and large plantations. The objective of the project was to increase awareness of HIV and AIDS among vulnerable populations in Guatemala including indigenous people, and young people using street theatre Key elements of the project were: 2.1. Street theatre performances by Payasos in public spaces such as parks, football pitches, halls etc. as well as prisons, schools, military barracks, large land-holdings and refugee centres, 2.2. The training of youth educators in the techniques of street theatre and HIV and AIDS. 2.3. Follow up to the street theatre performances by the youth educators through informal workshops in which participants analysed the presentations and identified future courses of action.

Street theatre, using humour and traditional clowns proved very eﬀective in breaking down barriers to discussing HIV and AIDS and issues of sexuality. The performances captured the attention of the audiences and being visual made a lasting impact. In assessing the level of understanding and knowledge of HIV and AIDS, a necessary initial stage in the project, and to avoid the use of written questionnaire which would have been entirely inappropriate in communities in which literacy levels were low, Payasos used participatory character games and strategies.

Page 160 Responding to HIV and AIDS. A toolkit for youth peer educators. 3. Outputs 3.1. Performances of street theatre to diﬀerent types of audiences. 3.2. Workshops for training youth educators. 3.3. Follow up workshops with the audiences. 4. Outcomes 4.1. Increased knowledge and understanding of HIV and AIDS particularly among groups of people with low levels of literacy. 4.2. Straightened capacity of local youth groups to continue working around issues of HIV and AIDS and HIV prevention. 5. Observations on Payasos’s activities “A prevention message transmitted by a clown becomes an object of laughter, and when we can laugh at a problem, it brings us closer to a solution.” “People here have information about the virus but few act upon it. There is a doctor here who says the illness does not exist” Aura, in Reu “Parents here were aware that their teenage kids were having sexual relations before the clowns ever came, but they did nothing about it and treated it as something normal.”

Director of Health Centre, Pochuta

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 161 The Internet Location: Global Organisation: World Links Project: HIV and AIDS online collaborative project 1. The problem HIV and AIDS have had a signiﬁcant impact on children. As of December 2001, 2.7 million children under 15 years of age are living with HIV worldwide. In the same year 800,000 children were newly infected with HIV and 500,000 children died of AIDS related diseases. In 2001 in Zimbabwe alone, over half a million orphaned children struggled to survive in a deteriorating economy. 2. Project outline The World Links is an international NGO established by the World Bank to promote the use of information and communications technologies (ICT) to enhance teaching and learning. The HIV and AIDS online collaborative project was directed towards secondary school students and focused on helping teachers, students, and their surrounding communities explore issues of HIV and AIDS through activities using internet, e-mail and CD-ROMs. Over 30 schools and nearly 300 teachers and students from seven countries, including the United States, participated. The project involved participants working through ﬁve educational goal activities or modules • Cultural Exchange • Basic Facts of HIV and AIDS • The Importance of HIV and AIDS • The Challenge of HIV Prevention • Social Action Teachers and students explored the myths and misunderstandings around HIV and AIDS, conducted research, and discussed how they could prevent HIV in their own lives and communities. The Social Action component was an important project feature encouraging students and teachers to develop an HIV and AIDS action plan through which the students could make an attempt to impact on their community. Some social action plans included working with Parent-Teacher Associations, establishing income-generating projects for youth, and inviting testimonies from people living with HIV and AIDS.

Page 162 Responding to HIV and AIDS. A toolkit for youth peer educators. 3. Outputs 3.1. Regular exchange of ideas and information between students and teachers across the world. 3.2. Development of speciﬁc HIV and AIDS action plans. 3.3. The production and dissemination of a CD-ROM with relevant HIV and AIDS websites drawn from already existing online material (such as UNAIDS, CDC, WHO) for schools with slow or no Internet connections. 3.4. The adaptation of high-quality and locally produced print-based HIV and AIDS educational material for electronic dissemination via CD-ROM and website. 4. Outcomes 4.1. More and improved HIV and AIDS educational materials into schools. 4.2. Improved teaching and support materials for reproductive health. 4.3. Greater awareness of HIV and AIDS among secondary school students in participating schools. 5. Resources: Information about World Links is available on: www.world-links.org/AIDSweb. Information on developments in Zimbabwe can be found on: www.tarsc.org/auntstella

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 163 Sport Location: Africa region Organisation: Confederation of East and Central African Football Associations (CECAFA) Project: Break the Silence: Let’s Talk About AIDS 1. The problem Throughout much of Africa, and indeed elsewhere in the world, people are very reluctant to talk about HIV and AIDS. This only serves to generate misunderstanding about the virus, encourages ignorance and fuels stigma and discrimination. Young people are particularly at risk. 2. Project outline In the late nineties, the Johns Hopkins Center for Communication Programs (JHU/CCP) organised a series of events in the Caring Understanding Partners (CUP) Initiative throughout Africa. The activities were designed to involve more men and youth in reproductive health through sports. Through the Confederation of East and Central African Football Associations, the Association of Sports Journalists for Health/East-Central Africa and national AIDS committees, a regional football tournament was organised as part of the campaign “Break the Silence: Let’s Talk About AIDS”. Teams from Kenya, Ethiopia, Sudan, Uganda, Rwanda, and Eritrea competed and over 140 players under age 20, 20 referees and team managers, and 15 CECAFA board oﬃcials were involved. At the ﬁnal, between Kenya and Uganda in Nairobi, the audience of 120,000 young football fans were encouraged to chant the Swahili word for AIDS, “Ukimwi,”. 120,000 condoms were handed out by trained counsellors, and during the match, as with all previous matches, a one minute silence was observed for all those who had died of AIDS related diseases. In addition messages about HIV and AIDS were widely publicized. 3. Outputs 3.1. A football tournament involving 6 national youth teams in 15 games and attended by large numbers of young fans. 3.2. Distribution of • 45,000 posters on HIV prevention • 125,000 reproductive health calendars • 10,000 soccer tickets with AIDS messages • 170,000 information brochures on HIV and AIDS • 15 giant banners in and around the stadium

Page 164 Responding to HIV and AIDS. A toolkit for youth peer educators. 3.3. Establishment of a telephone hotline in Nairobi manned by local AIDS counselors. 4. Outcomes 4.1. Increased awareness of HIV and AIDS among large numbers of young people. The high volume of calls from pay phones temporarily jammed the lines. 4.2. Greater openness in discussing issues around HIV and AIDS and HIV prevention. 4.3. Local politicians and policy makers made aware of the need for greater openness with respect to HIV and AIDS and the importance of addressing issues of prevention among young people. 4.4. Football associations committed to long term support for HIV and AIDS campaigns.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 165 Street Theatre (2) Location: Tamil Nadu, India Organisation: Imayam Social Welfare Association (ISWA) Project: HIV and AIDS training using street theatre 1. The Problem The most recent survey suggests the incidence of HIV in India - between 3.8 to 4.68 million people living with HIV - is second only to South Africa. Within India, the state of Tamil Nadu has the highest number of reported cases of HIV and one of the highest prevalence rates. Information about HIV and HIV prevention is fairly scant and the stigma and discrimination experienced by those people living with or affected by HIV and AIDS is especially high. The organisation AVERT (www.avert.org) notes that in India the social reactions to people with AIDS have been overwhelmingly negative. For example, in one study 36 % of people felt it would be better if infected people killed themselves, the same percentage believed that infected people deserved their fate. Also, 34% said they would not associate with people with AIDS, and one fifth stated that AIDS was a punishment from God. 2. Project outline The Imayam Social Welfare Association (ISWA) was created in 1992 to improve the living standards of poor under-privileged people. With the high incidence of HIV, particular emphasis has been given to increasing awareness if HIV and AIDS, promoting HIV prevention especially through the use of condoms and the provision of counselling services. Working with women and young people from rural and urban areas of Coimbatore district the project aimed to raise awareness about HIV and AIDS in rural areas through the use of street theatre, a particularly powerful medium in India and one that has a long tradition in promoting social change. The project involved the training of 8 young men and 17 young women in the techniques of street theatre. The trainees were then divided up into small groups and presented over fifty performances throughout the rural areas of Coimbatore district. The primary target group were women. After each performance, fieldworkers from ISWA visited the communities to both evaluate the impact of the performances and identify further areas of concern for necessary follow-up activity. 3. Outputs 3.1. Training of 25 young people in street theatre. 3.2. Around 50 performances of street theatre focusing on different aspects of HIV and AIDS.

Page 166 Responding to HIV and AIDS. A toolkit for youth peer educators. 4. Outcomes 4.1. Greater awareness of HIV prevention and the importance of safe sex. 4.2. Empowerment of women to make their own decisions. 4.3. Reduction in stigma and discrimination associated with HIV and AIDS.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 167 Cartoons

Location: South Africa Organisation: Transformative Human Rights Unit (THRU) Project: HIV and AIDS Education: HIVA Campus Tour

1. The Problem The Republic of South Africa has an estimated population of 40 million of whom 5.3 million were estimated to be living with HIV and AIDS91. Moreover it is asserted that globally 13% of all those people living with HIV and AIDS can be found in South Africa. Statistics from South African universities show that between 15 to 25 per cent of the student population of 400,000 are HIV positive. Despite this, all studies suggest that tertiary students and tertiary educated professionals do not normally accept that HIV poses a genuine threat of transmission. Finding a means to challenge this view is a critically important element in addressing both the pandemic as well as in tackling stigma and discrimination associated with the disease. 2. Project details The objective of the project was to use a cartoon character called HIVA and other forms of popular culture to bring a fresh dimension to HIV/AIDS education of students at tertiary level education and to integrate the cartoon into their daily lives. HIVA was seen as an innovative and vibrant way of conveying an AIDS education message. The cartoon character, HIVA, had a number of flatmates, all of whom were living with or affected by HIV and AIDS. These included a university student called Thembi, a young female lawyer and an unemployed graduate who DJ’d in nightclubs. Various cartoon strips were developed including one featuring the campus tour which Thembi, the student, attended. Another strip was developed featuring the flatmates encountering the person who infected them. HIVA challenged the root causes of stigma and discrimination faced by Positive people and deconstructed the “monstrous” virus. The contextualising of the problem within a group of people’s lives allows for a dramatisation of the problems, the most effective learning methodology for social educational programmes. A pilot project was conducted with peer educators of the University of the Western Cape. It was very successful with the students developing storylines for the cartoon strip which fused their own personal experiences during the Peer Education Training course with HIVA and Thembi, the cartoon characters.

Page 168 Responding to HIV and AIDS. A toolkit for youth peer educators. The HIV and AIDS awareness message concentrated on the human rights dimension of the HIV and AIDS pandemic. Issues of stigma and discrimination were tackled through road shows at university campuses. The road shows included interviews with the campus radio stations, distribution of promotional materials and a short performance by a special guest artist. HIVA then continued to maintain a presence on the campus by means of cartoon strips and informative media columns. THRU, the project holder, worked in conjunction with the HIV/AIDS Co- ordinators in each of South Africa’s 21 universities. Given the importance of religion in South African society, in the next phase` of the project, THRU is proposing to ask faith based organisations and institutions to assist in developing storylines which incorporate the religious beliefs of the cartoon characters. 3. Outputs 3.1. The creation and establishment of HIVA as a recognisable cartoon character within tertiary education institutions. 3.2. Road shows around South Africa’s tertiary level institution involving radio interviews, promotional materials such as posters, calendars and T- shirts and the decoration of local taxis with the HIVA character. 3.3. The publication of the HIV cartoon in university newspapers etc. 3.4. A weekly radio show featuring the characters of HIVA and Thembi. 4. Outcomes 4.1. Reduction in stigma and discrimination experienced by those living with or affected by HIV and AIDS thus enabling them to lead full and normal lives. 4.2. Students living with or affected by HIV and AIDS able to come to terms with their status and to lead a healthy positive life. 4.3. Greater awareness and understanding of HIV and AIDS among the wider campus communities and changes of attitude towards those living with or affected by HIV and AIDS.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 169 References 1. Gender and HIV/AIDS: overview Report, Vicci Tallis, BRIDGE, Institute of Development Studies, University of Sussex, 2002 2. Tools together now!: participatory tools to facilitate mobilizing communities for HIV/AIDS, International AIDS Alliance, December 2005 3. Helpers for healing community: A pastoral Counselling Manual for AIDS, MAP International 1996. 4. AIDS epidemic update, December 2005 UNAIDS 5. Understanding and Challenging HIV Stigma and descriminatiion, Ross Kid and Sue Clay, The Cvhange Project, Academy for Educational Development, September 2003 6. Church Leadership and HIV and AIDS, The New Commitment, Discussion paper 001, Gillian Paterson, Ecumenical Adocacy Alliance 7. Church, AIDS and Stigma, Discussion Paper 002, Gillian Paterson, Ecumenical Advocacy Alliance 8. HIV/AIDS and Gender: UNAIDS inter Agency Task Team on Gender and HIV and AIDS 9. Living on the outside, Health and Development Networks 10. What Religious Leaders can do about HIV/AIDS, UNICEF, 2003 11. AIDS Related Stigma: Thinking Outside the Box, The Theolohgical Challenge, Gilian Paterson, Ecumenical Advocacy Alliance 12. Documenting and communicating HIV/AIDS Work, International HIV/ AIDS Alliance, 2003 13. Towards an AIDS-Free Generation: the Global Initiative on HIV/AIDS and Education, UNAIDS/UNESCO 14. Tools together now!, International HIV/AIDS Alliance, 2005 15. The Rights of Children and Youth Infected and Aﬀected by HIV/AIDS, Save the Children 16. Gender, HIV and Human Rights: A Training Manual, UNAIDS/UNIFEM/ UNFPA 17. Response of the Faith-Based Organisations to HIV/AIDS in Sub Saharan Africa, Dr Sue Parry, Ecumenical HIV/AIDS initiative in Africa (EHAIA) 18. Youth Manual on Anti-Stigma Messages, Edited by Ayoko Togometo Bahun –Wilson 19. Facing AIDS: The Challenge, the Churches’ Response, World Council of Churches 1997,

Page 170 Responding to HIV and AIDS. A toolkit for youth peer educators. HIV and AIDS Appendix 1 Policy and Strategy Guidelines November 2005

Published 2006 by: Council for World Mission Ipalo House 32-34 Great Peter Street London, SW1P 2DB, UK

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Responding to HIV and AIDS. A toolkit for youth peer educators. Page 171 HIV and AIDS Policy and Strategy Guidelines for CWM 1. Introduction

1.1. CWM’s Mission Imperative

The Council for World Mission (CWM) is a community of 31 churches worldwide, which acknowledges the ultimate origin of all that exists in the Triune God. CWM aﬃrms that this God – the creator, redeemer and sustainer – is present and active in history and eternity to redeem creation and to bring all things to consummation in Jesus Christ. CWM and its predecessor, namely the London Missionary Society (LMS), derives its theological basis and its missiological mandate from the central New Testament teaching that in Christ the redeemer and liberator, God has shown unconditional love for all creation. CWM asserts that all human beings created in the image of God are called to faith in Jesus Christ and into eternal fellowship with God. We aﬃrm with the Gospel writer that “God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life…God did not send his Son into the world to condemn the world, but to save the world through him” (John 3.16-17, NIV). CWM exists to spread the knowledge of Christ in word and in deed. From its very inception, CWM has approached its task of proclamation on the basis that God cares for and relates to the whole person, the whole community and the whole world. CWM has therefore directed its mission to promote the spiritual, physical and mental well being of human beings without regard to colour, class, gender, race, or religion; seeking social and economic justice and caring for all God’s creation. Educational and hospital work have been at the heart of CWM’s endeavours in witnessing to God’s unconditional and unfailing love. CWM has therefore accepted the challenge of HIV and AIDS, declaring the pandemic to be one of the most important mission tasks that demand global concern, care and attention.

Page 172 Responding to HIV and AIDS. A toolkit for youth peer educators. CWM was formed also as an act of obedience to Christ’s commands: “Therefore go and make disciples of all nations…” (Matthew 28.19a); “…As the father has sent me so I am sending you” (John 20.21a); and “You will be my witnesses in Jerusalem, and in all Judea and Samaria, and to the ends of the earth” (Acts 1.8b). CWM’s founding document recognised that we become mission partners with God because we are a part of the Body of Christ; are involved with and indebted to the ecumenical movement; and recognise that the “north” is no longer the centre of gravity of the world church. The resources – human and material – which we have belong to all of us, and are to be used under the guidance of the Holy Spirit. Central to CWM’s understanding of its task is that mission has various dimensions: faith and conversion; forgiveness and new life; reconciliation and peace in community; liberation and justice; and sacriﬁcial caring for healing and wholeness. These are all part of our teaching and preaching ministries, whose ends are obedience to Christ’s commands, enjoyment of life- in-God and the growth of the church (D Preman Niles, World Mission Today, 1999, p7).

In 1995, CWM further recognised that it needed to engage in perceiving frontiers, crossing boundaries, reading the signs of the times to see how and where the gospel needed to be proclaimed within the covenantal partnership. The needs of the world are not static, and our mission must be carried out in evolving cultural, economic and political settings. CWM acknowledged that it needed, as a community of churches, to be a sign of hope in a multicultural, multiethnic community of nations amid such growing challenges as economic globalisation, militarisation, gender injustice and abuse of the environment. At its Assembly in Ayr, Scotland in 2003, CWM identiﬁed ﬁve major mission challenges, which guided by the theme Who is my neighbour? were to be addressed over the triennial period 2003-2006. HIV and AIDS is one of those challenges, while the other four are economic justice, environmental degradation, gender justice and interfaith encounter. The subsequent CWM Trustee Body meeting recognised the critical mission challenge to the church posed by the HIV and AIDS pandemic, noting that the disease was one of the “major new mission frontier issues today”.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 173 1.2. Rationale for a Policy on HIV and AIDS

Since 1981, the world has witnessed the horror of the pandemic Acquired Immunodeficiency Syndrome (AIDS) caused by the Human Immunodeficiency Virus (HIV). HIV causes a gradual deterioration of a person’s immune system by killing certain cells in the body and by triggering other events that weaken the body’s immune function. This eventually leads to AIDS, characterised by the onset of opportunistic infections and cancers. Research in recent years has led to the discovery of anti-retroviral therapy (ART) that brings down the viral load and boosts the immune system considerably. These drugs allow HIV and AIDS sufferers to live a longer and healthier life than was previously possible. However, it is important to note that HIV and AIDS at this time in history still remains incurable. There are 38 million people living with HIV and AIDS in our world today facing untold misery, stigma and discrimination. Many of these people living in poorer countries cannot access ART drugs or even the day-to-day care that they and their families often require. The fear of this “unknown disease” and the absence of a cure have lead to the stigmatisation of people infected and affected by HIV and AIDS. In the same way that the world cruelly responded centuries ago to the leprosy patients, so today discrimination and isolation have become the norm in relation to HIV and AIDS. In many places the church has hastily declared HIV and AIDS to be a punishment from God. This discrimination has led to many people living with HIV and AIDS opting to be silent rather than risking condemnation or isolation. This secrecy has contributed to the spread of HIV. HIV and AIDS is different from other diseases in many ways. The stigma and discrimination attached to HIV and AIDS affect those infected as well as their families and especially any dependants. For poverty stricken patients, less or no food and an unhealthy environment expose them to the rapid infection of opportunistic diseases putting them at greater risk of developing AIDS. Cultural taboos in relation to sex prevent young people receiving accurate sexual education, leading to irresponsible sexual behaviour. In many places women are denied the freedom to negotiate safe sex within marriage, silence is preferred at all stages. These issues are compounded by the silence surrounding HIV and AIDS. Silence, stigma and discrimination are at the heart of the unjust relationships which alienate individuals, families and communities associated with HIV and AIDS. Such injustices stand against our faith and call for a radical change in our mindset and action as people who profess a faith in Jesus Christ. It is our conviction therefore that by adopting a policy guideline on HIV and AIDS, we are signalling our seriousness about addressing the many-sided challenges that come with the pandemic, and especially applying ourselves to the tasks that the CWM community is uniquely placed to undertake. We believe that this policy when implemented will break the long silence of our member churches on these issues and encourage the churches to take further actions in minimising future infections as well as embracing with Christ’s love and compassion those who are already infected and affected.

Page 174 Responding to HIV and AIDS. A toolkit for youth peer educators. 2. Missiological Principles Missiological principles that help us to translate our faith into action in relation to addressing the HIV and AIDS issue come directly from the life and teachings of Jesus Christ. The mission agenda that Jesus leaves behind for us to follow includes the following: 2.1. Fullness of Life for all

A wider understanding of the methodology of Christian mission within diﬀerent cultural contexts today is found in Jesus’ saying: “I have come that they might have life, and have it to the full” (John 10.10b). By his life, death and resurrection, Jesus has liberated humankind from the result of sin and inaugurated God’s reign in this world. This has led to the formation of a new global faith community that seeks to follow Christ and to live in obedience to God’s commands. 2.2. Extending God’s Reign

God’s reign that was ushered in by Jesus Christ is to be extended to all parts of the world bringing wholeness in relationships in order to experience the love and freedom that God gives. This can be realised only through acts of peace, justice and reconciliation. This alone will bring about transformation which is the visible sign of our missionary achievements in the varied contexts of diﬀerentiation and discrimination that break up relationships at all levels. In the midst of this broken world, the church is called to be a sign of hope, pointing to the new covenantal relationship with God and the healing which it oﬀers.

The Gospel of Luke captures the practical implication of this in Jesus’ words: “it is not the healthy who need a doctor, but the sick. I have not come to call the righteous, but sinners to repentance” (Luke 5.31). These words of Jesus are spoken within the contexts of the abundant provision of God: sheep grazing in lush pasturage, and disciples – together with the marginalised of their society – enjoying a bountiful feast. Within the good creation in which God’s creatures were placed, special stewardship responsibility was given to humankind. Today, the fundamental realities of sin and disease are still with us. However, we, along with Jesus, categorically deny any direct causal link between the two: “…neither this (blind) man nor his parents sinned” (John 9.3). Therefore, HIV and AIDS is not a punishment from God, rather God as the supreme healer, source of love and compassion, enables us to embrace with human dignity those who are suﬀering. 2.3. Restoring Relationships

The purpose of Jesus’ incarnation was to restore God’s order for creation, the original order that existed at creation, and to enhance life for all. The true order was marked by the inter-relation and the intra-relation between God, humanity and the created world, which was in perfect order or at perfect peace. The biblical understanding of peace in the Old Testament refers to shalom, a state of being or situation which represents the well being of individuals and communities. Shalom is a personal and social reality that focused on the whole common life with its link between the earth and all resources. Therefore, shalom which is fullness of life can be experienced only in fullness of relationships – relationships with God, people and nature or the created world.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 175 In the New Testament the Greek word “eirene” which means putting things in order, not only absorbs the meaning of shalom but also goes beyond it by linking Jesus himself with God’s peace giving life or fullness of life. Ephesians 2.14 refers to Jesus himself as our peace. Peace is God’s gift for the entire creation. Thus Jesus who is our peace was involved in bringing peace or making peace. This process involved the shattering of the existing unjust orders that exhibited false peace. It is in this context that we need to understand the text in Matthew, “Do not suppose that I have come to bring peace to the world. I did not come to bring peace, but a sword” (Matthew 10.34). Jesus sets peace against false peace. He also said that the peace that he leaves behind is not the same as that which the world gives. Thus, peace is not the absence of tension, disputes, wars etc, but the presence of a just social and ecological order, which calls into question and challenges inequality and discrimination based on colour, caste, gender, class, power and position. 2.4. An Act of Justice

Poverty and gender inequalities are major factors in accelerating the spread of the HIV and AIDS epidemic. The process of globalisation and models of development that leave behind the poor, needy and the vulnerable, have a direct bearing on women, children and youth. We will be failing in our Christian response to HIV and AIDS if we fail to hear their cry. Their cry comes through the unjust world order that dominates and exploits families, communities, churches and the world. If, as mentioned above, God’s reign can be extended only through acts of peace, justice and reconciliation to realise fullness of life, it follows that HIV and AIDS is also a justice issue. This calls for reconciliation in all our relationships to promote peace and love. Since HIV and AIDS is spread mainly through sexual intercourse with infected persons, we are called to focus on both sex and sexuality, and to do so in the contexts of family life, schools and churches. Access to information, equal participation in decision making and a just sharing of opportunities and resources will therefore make a huge contribution towards addressing HIV and AIDS. In the ﬁnal analysis ﬁghting HIV and AIDS is not an act of charity but an act of justice, as the task takes us deeper into examining the causes of poverty, power relationships, inequality, discrimination and gender injustice. 2.5. Inclusive Community

Stigma, discrimination and exclusion are hallmarks of HIV and AIDS. Communities that are inclusive and caring are therefore a critical factor in the fight against the spread of HIV and AIDS. No human being should be despised or differentiated by the nurture of stigma or discrimination on any basis. The church is called to be an inclusive community and to promote inclusive community living. The church, after all, is the Body of Christ, and when one member of the body is in pain, the whole body feels that pain. 3. The Challenge to CWM We affirm that the entire CWM family is affected and impacted when people belonging to the different member churches of CWM are infected with HIV and AIDS. We commend the work done by some of our member churches in combating the pandemic. However because the incidence of HIV and AIDS is not high or significantly prevalent in certain countries it is easy for some CWM member churches to remain aloof from this challenge, seeing it as something far away and removed from their concerns.

Page 176 Responding to HIV and AIDS. A toolkit for youth peer educators. CWM does not subscribe to the viewpoint that HIV and AIDS is a punishment from God. We believe that such a notion is flawed both in terms of its theological rationale and its missiological implications. Regarding the latter, for example, the belief that HIV and AIDS is a punishment from God is a major cause of the stigmatisation that has inflicted rejection, abuse and isolation on those individuals, living with HIV and those dying from AIDS. CWM therefore takes the view that instead of condemning those who are living with the virus, we commit ourselves to caring for and accompanying them on their journeys of hardship and suffering. We undertake to care for them and engage them in guiding us, under God, to a meaningful and helpful ministry that, until a cure is found, will help the infected to manage their health, raise their quality of life and prolong their time of living. While we acknowledge that a major percentage of the infections occur primarily due to patterns of sexual behaviour, we also take seriously other causes, such as transmission through needle-sharing by drug-users, mother to child transmission, blood transfusions, accidental infection, etc. Therefore, the range of actions that churches need to take in the face of the pandemic are numerous, and each CWM region or member church should determine and decide on its priorities and the resources which can be applied. In the belief that “prevention is better than cure” we encourage the promotion of responsible sex. This should take into consideration all aspects – physical, mental and spiritual consequences of the two individuals involved in the sexual act. We recognise that the strategy which advocates the use of condoms by those who are not able to maintain either abstinence or faithfulness is controversial. However, instead of avoiding the issue, we encourage open and honest debate on this point. We furthermore believe that the taboos against speaking openly about sexuality, especially in the context of church life, needs to be challenged, especially in view of a silence that promotes the stigmatisation of people living with the virus, discourages many from being tested, and compounds the spread of the disease, for which there is yet no cure. We accept that there are other factors that play a significant role in the spread of HIV and AIDS and we welcome the vast array of emphases, approaches and strategies that are effective in combating this scourge.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 177 HIV and AIDS is not just a global crisis – it is a major challenge to the church in our time, a new “kairos” of mission imperative, a “right moment” of God’s call that challenges us to demonstrate a Christ-like, compassionate response. Jesus, the great and beloved physician and the giver of fullness of life to all, calls us to be good and compassionate neighbours, loyal and faithful friends like those who lowered their sick friend through the roof of the house. Jesus, who embraced the outcast lepers of his day, calls on the church to be a welcoming, safe and affirming place for all. The presence of HIV and AIDS in our body, our family and our community calls the church back to what it means to love and pursue justice. If we are the Body of Christ in the world, we must do as Jesus did – live out God’s love toward our sisters and brothers, speak out and advocate for just practices, and create supportive and caring communities of acceptance, safety, refuge and healing. In this regard the growing involvement of our member churches in HIV and AIDS ministry is welcomed and commended. However, the pandemic is still globally regarded as an “African” or “third-world” problem. Within the CWM family we have identified HIV and AIDS as a major mission priority, committing ourselves therefore to find ways of investing greater material and spiritual resources into our efforts to rise to the challenge. In this regard CWM recognises and appreciates the work of the governments in countries like India, Brazil and South Africa in challenging the work of the drug companies to lower the price of drugs, so as to make it more affordable to economically disadvantaged countries, communities and families. Our CWM member churches have a pronounced tradition of hospitality. Globally, we are a relatively small and close-knit community, but we nevertheless exist in a wide variety of missiological, cultural and societal contexts. We have identified poverty and basic human rights as a challenge and have prioritised the concerns of women and youth. We have a heritage that stresses the importance of preaching and teaching ministries, as well as an involvement in the issues of social justice, health and education. We are committed to working with our global, regional and national ecumenical partners with whom insights, policies and resources are shared. With them we undertake to explore greater measures of collaboration in order to expand mutual HIV and AIDS ministries. We undertake to strategise around sharing our resources, experience and insights in our mutual approach to the missionary opportunity that HIV and AIDS presents. We shall move forward together as the Body of Christ, the infected and the affected, to work towards prevention of further infections and care for all those who are sick. Every Christian is affected when their fellow brothers and sisters are infected irrespective of the fact that they belong to a different denomination, place, race, class, caste, religion or region. So, we shall work together, hand in hand, and experience the love, joy and freedom that God gives us as we unfold ourselves to the mission mandate of Jesus Christ. 4. Policy and Strategy Guidelines 4.1. Awareness and Affirmation

• We recognise that HIV and AIDS is among us in our families, churches, communities, countries and the world.

Page 178 Responding to HIV and AIDS. A toolkit for youth peer educators. • We aﬃrm that HIV and AIDS is not a punishment from God for sins, but rather a new frontier of mission challenge to the Church. • We commit ourselves to engaging in every appropriate way to combating the pandemic, drawing especially on CWM’s unique character, resources and capacity. 4.2. Programmes 4.2.1. Networking and Capacity Building

• We acknowledge our corporate responsibility for ministry to all who are infected and affected. Therefore, we commit ourselves to expanding our capacity building programmes focusing especially on HIV and AIDS ministries that support communities, groups and individuals that are stigmatised and marginalised. • We declare HIV and AIDS ministries to be a priority within CWM’s mission programme and direct executive staff to increase the profile of this component within existing activities and to explore new initiatives in this regard. • We recognise the value of and need for an international consultation, in which CWM constituencies can learn from one another, share with one another and formulate new strategies to prevent and combat HIV and AIDS. We direct CWM executive staff to give attention to the planning and execution of an international consultation. • We undertake to continue and expand our collaboration and cooperation with global ecumenical and mission partners. • We affirm our openness and willingness to work together with “secular” agencies, organisations and groupings in appropriate ways to strengthen initiatives aimed at fighting the disease. • We commit ourselves to engaging more actively in preventing new HIV and AIDS infections within our own families, churches and communities. 4.2.2. Prevention, Treatment and Care

• We recognise the value of and need for periodical international conferences – in the medium term – in which CWM constituencies can learn from one another, share with one another and formulate new strategies to prevent and combat HIV and AIDS. • We shall engage ourselves more actively in preventing new HIV and AIDS infections within our families, churches and communities through various programmes. • We welcome and affirm the research undertaken by medical science to find a cure for the disease. • We express our solidarity and support of agencies that have taken on an advocacy role with drug companies and government structures to press for the affordability of counselling, testing and treatment. • We commend the churches and health-care agencies that work to enhance the quality of support provided, especially in the area of home-based care. • We affirm our belief in the power of prayer to bring about healing and wholeness to those who are infected and affected.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 179 4.2.3. Scholarships and Studies

• We commit ourselves to giving greater consideration to applications for scholarships which have a focus on HIV and AIDS training and education. • We encourage the theological institutions, hospitals, medical colleges and counselling centres within our member churches to create space to include HIV and AIDS as a major subject for study, reﬂection and action to equip all their staﬀ and students for relevant HIV and AIDS ministries. 4.3. Resource Sharing 4.3.1. Global Level

• We undertake to make available additional resources – human, material and ﬁnancial – to maximise the impact of our overall strategies and plans of action in the ﬁght against HIV and AIDS. • We commit ourselves to explore channels of funding beyond ourselves for HIV and AIDS ministries. 4.3.2. CWM Regions

• We encourage the CWM regions to have their own regional policies taking into consideration CWM’s stand to address HIV and AIDS issues according to the intensity of the HIV and AIDS prevalence and problems. • We encourage the CWM regions to also work on an inter-regional basis in sharing their material and human resources in the ﬁght against HIV and AIDS. • We encourage the regions to incorporate resources from the CWM regional resources to strengthen HIV and AIDS initiatives. 4.3.3. CWM Member Churches

• We encourage the member churches to formulate their own HIV and AIDS policy and allocate funds from the CWM Mission Programme Support to address HIV and AIDS more eﬀectively. • We encourage CWM member churches to give serious consideration to adopting policies that are consistent with being an equal opportunities employer. 4.4. Ipalo House Personnel

We aﬃrm that CWM is an equal opportunities employer. 4.5. Evaluation

• We commit ourselves to periodical reporting on the implementation of this HIV and AIDS policy in our areas of responsibility within our churches, regions and at global levels. • We commit ourselves to periodical evaluation of this policy implementation so as to measure the progress made in combating and preventing HIV and AIDS. • We commit ourselves to periodical review of these policy guidelines.

Page 180 Responding to HIV and AIDS. A toolkit for youth peer educators. 5. Suggestions for action by CWM Member Churches and Regions We encourage the CWM member churches and regions to: 5.1. re-examine policies and attitudes on sexuality within the churches in the light of contemporary concerns, contextual implications, biblical teachings, theological teachings and missiological trends; 5.2. address cultural attitudes and transform power relations within the church that currently sustain and promote gender and age discrimination and render these groups vulnerable; 5.3. formulate HIV and AIDS policy statements affirming that the disease is not a punishment from God, and that the pandemic needs to be seen within the greater context of a sinful world and a fallen humanity to which God has sent God’s own Son, not to condemn, but to save the world; 5.4. adopt theological/missiological positions and practical approaches in relation to those infected and affected by HIV and AIDS that are premised on the purpose of God’s redeeming love for all, and on biblically- based principles of inclusion, compassion, justice, accountability and responsiveness; 5.5. use every formal and informal occasion and available opportunity to include references to their policy and practices relating to the pandemic and to incorporate HIV and AIDS education as part of curricula in church training institutions such as schools, theological colleges and teaching hospitals; 5.6. commit and deploy additional funding resources, including funds from the CWM Mission Programme Support and the Regional Empowerment Fund, to undertake projects and programmes with an HIV and AIDS component and to report regularly to CWM regional and global forums in order to facilitate information and resource sharing; 5.7. encourage local churches/parishes/congregations and, in particular, parents to assume responsibility to ensure that adequate and appropriate sex education is given to their young people/children; 5.8. sensitise leaders in denominational/synod administrations, women’s and youth groups and local pastoral structures; 5.9. make every effort to enable local churches/parishes/congregations as well as families to be safe, welcoming places for church and community members who are infected and affected; 5.10. draw on the special insights and experiences of people living with AIDS within their churches and communities in formulating local strategies and activities in combating the disease; 5.11. empower local church/parish/congregational leadership to focus on HIV and AIDS through its preaching, teaching, counselling and prayer ministries and render moral and material support to local churches who have embarked on home-based care to people living with AIDS. 5.12. call on local churches/parishes/congregations to strengthen existing partnerships and establish new ones with local ecumenical and civil society organisations involved in the fight against the disease;

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 181 5.13. encourage local congregations to promote home-based care through special training programmes; 5.14. guide local congregations on ways of integrating HIV and AIDS programme with gender and poverty and help the churches to address youth health issues with special consideration of the rate of infection among young girls; 5.15. incorporate educational programmes at regional, national and local congregational level which strengthen family values and healthier life styles among young people.

Adopted by CWM Trustee Body in Delhi June 2005

Page 182 Responding to HIV and AIDS. A toolkit for youth peer educators. UNESCO Guidelines Appendix 2 on Language and Content in HIV and AIDS-Related Materials January 2006 Foreword HIV and AIDS evoke responses from each one of us – on both individual and institutional levels. Those responses, in order to be articulated and delivered, must be transcribed into textual, verbal and visual contents. They may vary from an oral presentation, to an analytical report on the dynamics of the HIV epidemic in a certain context, to a manual for educators, to technical support to policy-makers in the development of national strategies. The complexity of HIV and AIDS, and the fact that what makes them exceptional is the stigma attached – a real impediment to prevention – makes the way we describe, discuss and portray HIV and AIDS instrumental to our success in eﬀectively responding to the pandemic while fully respecting UNESCO’s mission. This publication provides guidelines for a harmonised use of language and content in HIV and AIDS-related materials that reﬂect an approach to the epidemic which is comprehensive and inclusive, sensitive to the needs and issues of the whole population, but with focused attention on especially vulnerable populations. The guidelines were developed on the basis of many consultations with and the support of UNAIDS and other UN agencies as well as key stakeholders in HIV - and AIDS-related work. As one of the founding members of UNAIDS and one of the ten co-sponsor organizations, UNESCO is committed to reducing the impact of the HIV epidemic. Consequently, it has made the response to HIV and AIDS one of its key priorities – which is why UNESCO is leading the Global Initiative on Education and HIV/AIDS (EDUCAIDS), to which these Guidelines are a contribution. It is my understanding that, considered as a living document, these Guidelines will be updated regularly, building on comments and suggestions from all of you. I urge all of you to use these UNESCO Guidelines.

Koïchiro Matsuura Director-General UNESCO

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 183 Introduction Often, when dealing with documents on HIV and AIDS, one is faced with issues of sensitive content and/or references to vulnerable or marginalized communities. As a standard-setting organization, UNESCO must take special care to avoid the perpetuation of stigma and discrimination often faced by People Living with HIV (PLHIV), sex workers, men having sex with men, and other communities/groups. Moreover, the purpose of many documents is often to sensitize on issues related to HIV and AIDS. Thus, the power of language could not be more strongly emphasized. The following guidelines on the preferred/proper use of language were developed in an effort to respond to UNESCO’s mission and work on HIV- and AIDS-related issues. In general, they are intended to provide guidance towards using uniform, correct, gendersensitive, non-discriminatory and culturally-appropriate language that is respectful to universal human rights. It is important to highlight that these ‘guidelines’ were developed only to assist in the revision, editing and development of HIV - and AIDS-related materials. They are not intended to be used as a fixed and rigid set of rules. This document is targeted to UNESCO staff members and/or other individuals with a previous familiarity with HIV - and AIDS-related issues. The current version of these guidelines was developed following consultations with all UN agencies and is the result of a UNESCO-wide in-house consultation. Moreover, the reader may notice that some of the terms being discussed offer no alternative phrasing and/or explanation as of the moment. This is because the document is to be considered as a ‘living document’ that is continuously developed and evolving. While awaiting the release of UN-wide agreed guidelines currently being developed through a UNAIDS- led consultation with all UN agencies, UNAIDS has approved the current version for distribution. All contributions, comments, feedback, suggestions and information from colleagues at Headquarters, Field Offices and Regional Bureaux, are welcomed and can be addressed to the UNESCO HIV and AIDS coordination unit at ED/PEQ/IQL.

The language we use to conceptualise and talk about HIV/AIDS reflects our personal biases and understanding or lack of understanding. It also helps shape our own and others’ attitudes about HIV/AIDS. Appropriate language is constructive, does not fuel stereotypes and does not cause prejudice. Language has a strong influence on attitudes towards HIV/AIDS and people infected and affected by HIV/AIDS The Power of Language You and AIDS, the HIV/AIDS Portal for Asia Pacific (UNDP)

http://www.youandAIDS.org/HIVAIDS%20Language

Page 184 Responding to HIV and AIDS. A toolkit for youth peer educators. Table of Contents

1. Main language and terminology issues List of useful acronyms Table 1. Commonly used terminology Table 2. Stigmatizing terms and expressions Table 3. Developing a culturally-sensitive language Table 4. Precision and differentiation of certain terms Table 5. Some specific examples Table 6. Cultural issues and practices Table 7. Audio and visual content and HIV- and AIDS related materials 2. The ‘ABC’ of combination HIV prevention 3. Harm reduction and HIV Reference and source materials Annex: Glossary of HIV and AIDS terms

1. 2. Main language and terminology issues when referring to HIV and AIDS related issues

Avoiding negative connotations

Any document on any subject matter, not only HIV- and AIDS-related issues, should be in full respect of human rights, in particular if the document refers to marginalized and/or vulnerable communities. Precision

HIV and AIDS are highly complex issues. Because of their medical and epidemiological complexity and the diﬀerent meanings the can take on in diﬀerent social, economical and cultural contexts, there is a need for precision in order to ensure that the transmitted message is the same for the sender and receiver. Fact versus opinion

The danger of confusing an opinion with a fact is that it can lead to discriminatory statements towards key – often minority – populations. Real or perceived stigma and discrimination leads these populations to keep a low proﬁle and not access services and information. This in turn makes prevention work and promoting care and support services for these populations diﬃcult.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 185 Factual statements – how correct are they?

Some statements are written in a ‘factual’ manner. However, it is important to pay attention to such statements and to ensure that the ‘facts’ are well referenced and backed up by research or credible reports. Obviously, the right source/reference will depend on the subject matter. However, depending on the issue, the appropriate UN agency can be consulted and UNAIDS and the World Health Organization are suggested as primary sources. Gender sensitive language

Gender stereotypes – socially constructed beliefs about men and women’s behaviours and roles - often ﬁnd their way into documents because texts are written by men and women who are themselves products of the culture and society they are brought up in. It is important to pay special attention to the gender sensitivity of a text and to ensure that the statements made are in full respect for equal rights and of non-derogatory language to any sex and to any sex of any age. UNESCO, an organization with a mandate for the promotion and protection of human rights, including gender equality, pays particular attention to this issue. Use of abbreviations and acronyms

The assumption that an abbreviation or acronym is well understood can lead to confusion. Abbreviations and acronyms must therefore be spelled out at least once, usually the ﬁrst time it is used, followed by the abbreviation and acronym between brackets – e.g. National AIDS Plan (NAP). Including a list of abbreviations and acronyms at the beginning of documents is essential. Be aware that some groups may object to being addressed by an abbreviation or acronym. For instance, gay men have objected to being referred to as MSM (men who have sex with men). It is therefore advisable to inquire about the most appropriate and polite term to use. Sensational language

The use of superlatives (e.g. the worst) and strong adjectives (compare infected vs. contaminated) is often – and sometimes unconsciously – an expression of opinion or judgment. The use of superlatives or exclamation marks in some contexts may also provoke stigma, discrimination, fear and anxiety. It is advisable to avoid such language as much as possible. Marginalized and/or key populations

Texts referring to marginalized and/or key populations must be carefully read, bearing in mind that discriminatory language should always be avoided. The best thing to do is to ask a member (or a group of members) of the key population to read the text and check for the appropriateness and accuracy of its terminology. Before requesting this, make sure that you clearly explain what is expected of the person or group and why they are asked to check the text in question. Simplicity

In a large international organization such as UNESCO, English is not the ﬁrst language of many of its staﬀ members. Simplicity in documents will not only ensure that the message is conveyed in a concise and precise manner, but will also avoid confusion.

Page 186 Responding to HIV and AIDS. A toolkit for youth peer educators. Comments and tips Before publishing any UNESCO document with HIV and AIDS content, it is advisable to consult colleagues specializing in HIV and AIDS issues. Please be aware that, when dealing with documents written in French or in any other official UN-working language, these guidelines cannot be translated literally, but require adaptation to the respective language. Furthermore, due to linguistic differences from one English-speaking country to another, the linguistic specificities of the targeted population should be taken into account during the writing stage of the document and before its publication. UNESCO style/format

Please consult the latest UNESCO manual on style (spelling, editing tips, etc.) http://ulis3.hq.int.unesco.org/images/0014/001418/141812e.pdf

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 187 List of useful acronyms AIDS Acquired Immunodeficiency Syndrome (also seen as: Acquired Immune Deficiency Syndrome) ARV Antiretroviral (treatment medication) ART Antiretroviral Therapy CBO Community-based organisation CDC Centers for Disease Control (USA) CSW/MSW/FSW Commercial sex worker/male sex worker/female sex worker DHS Demographic and Health Survey GIPA Greater involvement of people living with or affected by HIV and AIDS HAART Highly active antiretroviral therapy HIV Human Immunodeficiency Virus IAVI International AIDS Vaccine Initiative IDU Injecting drug user IEC Information, education and communication KAP Knowledge, attitudes and practice MAP Multi-country HIV and AIDS Program (for Africa) (World Bank) MSM Men who have sex with men MTCT Mother to child transmission NAC National AIDS Council/Committee NAP National AIDS Plan NGO Non-governmental organization OI Opportunistic infections OVC Orphans and vulnerable children PEP Post exposure prophylaxis PLHIV People/persons living with HIV* PTC Post-test club PTCT Parent to child transmission SRH Sexual and reproductive health STD Sexually transmitted disease STI Sexually transmitted infection UNAIDS Joint United Nations Programme on HIV/AIDS VC(C) T Voluntary (and confidential) counselling and testing

* Although ‘People living with HIV and AIDS’ (PLWHA or PLHA) is widely used, the currently preferred phrase is ‘People living with HIV’ (PLHIV)

Page 188 Responding to HIV and AIDS. A toolkit for youth peer educators. Table 1. Commonly used terminology Medical terms Problematic term Explanation Preferred term

Even though this distinction is made clear in the examples throughout this document, this is one of the most common mistakes seen in reports on HIV AIDS only when referring correctly to AIDS and AIDS issues.

AIDS when the intention is to use HIV AIDS is a range of conditions – a HIV and AIDS syndrome – that occurs when a person’s immune system is seriously weakened by HIV infection. Someone who has HIV HIV infection has antibodies to the virus but may not have developed any of the illnesses that constitute AIDS.

Even though the term HIV/AIDS is widely used and accepted, recent UNAIDS guidelines are promoting the use of HIV where appropriate and AIDS where appropriate. HIV when referring to HIV HIV and AIDS are two different issues and often the term ‘HIV/AIDS’ (meaning HIV/AIDS AIDS when referring to AIDS ‘HIV and/or AIDS’) is unnecessarily used as, often enough, either ‘HIV’ or ‘AIDS’ is relevant (depending on the exact text) and not both. HIV and AIDS when referring to both The terms HIV and AIDS should be used only when both HIV and AIDS are relevant.

According to the definition of ‘epidemic’, HIV is the causative agent; therefore, the term ‘HIV epidemic’ may be more accurate than ‘AIDS epidemic’. However, HIV epidemic it is still correct to speak of an epidemic of disease manifestation. In that respect, AIDS epidemic AIDS epidemic vs. HIV epidemic large numbers of people living with AIDS within a population may also be described as an epidemic. (depending on context and possible Therefore, the use of ‘HIV epidemic’ impact on readers) versus ‘AIDS epidemic’ depends both on the context and on the possible impact on readers.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 189 AIDS virus There is no such thing as the AIDS virus. AIDS is a syndrome not a virus. Only HIV (the human HIV immunodeficiency virus) can cause AIDS. Human Immuno/deficiency Virus The term HIV virus is redundant as HIV stands for The virus that causes AIDS HIV virus Human Immunodeficiency Virus

Human ‘Immunodeficiency’ is one word and need not by Human Immunodeficiency Virus Immuno/deficiency hyphenated Virus AIDS AIDS is not a word. It is an acronym and must be AIDS AIDS fully capitalized. AIDS

An ‘AIDS test’ does not exist. AIDS is diagnosed according to specific medical criteria that AIDS test identify the symptoms of AIDS. The presence of HIV test HIV/AIDS test HIV antibodies in the blood can, however, be determined with a test of blood or – increasingly accurately – saliva.

This term implies that there are varying stages of AIDS, such as half-blown AIDS or full-blown AIDS. Full-blown AIDS People have AIDS only when they present with AIDS an AIDS-defining illness such as an opportunistic infection.

According to UNAIDS, the term STIs (sexually Sexually transmitted infections) should be used rather than STDs (sexually transmitted diseases), unless Sexually transmitted transmitted the latter is part of a title or name. However, infection (STI) disease (STD) unless the phrase is going to be repeated several times in a few lines, it should be spelt out in full.

AIDS is not necessarily a terminal disease. AIDS can and, in many cases, does indeed lead to death, but HIV medication treatment exists. Terminal disease Therefore, it is preferred to use the phrase ‘life Life-threatening illness threatening illness’ instead of ‘terminal disease’, as it encourages the best mental health possible for PLHIV and those around them.

Page 190 Responding to HIV and AIDS. A toolkit for youth peer educators. HIV Transmission and prevention Problematic word choice or Explanation Preferred wording spelling

Strictly speaking, prevention deals with the infection, not the disease. Therefore, ‘HIV prevention’ is usually a more correct HIV/AIDS prevention HIV Prevention wording without necessarily meaning the only phrase/ wording to be used.

Risky sex Unprotected sex

‘Contamination’ and ‘infection’ have two different meanings. A person is infected with HIV, not contaminated. Contamination vs. infection See explanation Equipment (such as a used syringe) may be contaminated with HIV.

Drug injecting equipment, for example, is

Contaminated vs. unclean ‘contaminated’ with HIV, and ‘unclean’ if it is not clean (but See explanation not necessarily contaminated with HIV).

Although this term is widely used, it is NOT necessarily correct. It should be used with care, as some may interpret it ‘Sharing’ (when it is differently. clear what it refers to) According to UNAIDS, sharing in the classical sense does not happen as frequently as is often assumes. In the absence of access to sterile injecting equipment people may use dirty ‘Use of contaminated injecting equipment’ if you Sharing (when discarded equipment (which is anonymous) or bargain away are considering HIV referring to injecting drug for syringes and needles. They do not regard this as transmission equipment) sharing. Neither does ‘sharing’ distinguish between needle borrowing and needle lending; this Is important because (usually) different dynamics are at work: a person aware of their HIV-positive status may try to avoid lending, but ‘Use of non-sterile may continue to borrow. Furthermore, ‘sharing’ has positive injecting equipment’ if you connotations e.g. sharing a meal among injecting drug user are considering risk communities (and wider communities also), which are not of HIV exposure appropriate in writing about HIV.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 191 To catch AIDS AIDS cannot be caught or transmitted. People can become To become infected with HIV To contract AIDS infected with HIV. To contract HIV To catch HIV

To pass on HIV HIV can be transmitted, but not inherited. Transmit HIV

Confusion about the body fluids that can transmit HIV is a common cause of fear and misunderstanding and continues to cause discrimination against PLHIV. Body fluids cover all fluids coming from the body and not just those implicated in HIV transmission. It is advisable to explain at least once in a text (preferably when the term ‘body fluids’ is first used) which body fluids contain HIV Blood, amniotic fluid, semen, Body fluids in sufficient concentration to be implicated in HIV transmission. pre-ejaculate, HIV cannot be transmitted through body fluids such as saliva, vaginal fluids, breast milk. sweat, tears or urine. The concentration of the virus in a body fluid is an important factor in the transmission of HIV. For example, saliva containing traces of blood poses a lower risk than semen from a person who has been infected for a certain period of time when the virus has had the chance to reach a significant concentration.

According to Centers for Disease Control (CDC) ‘mosquito bites do not pose a risk for HIV infection. Studies have shown no evidence of HIV transmission through insects even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes.’ The only known means of transmission are: 1. Unprotected sexual contact with an infected person;

Modes of HIV 2. Using contaminated needles and/or syringes (primarily for transmission: drug injection); • Shaving 3. Transfusions of infected blood or blood clotting factors – this • Mosquitoes is less common now and very rare in countries where blood is • Going to the screened for HIV antibodies; and dentist or hairdresser 4. Babies born to HIV-infected mothers may become infected before or during birth or through breast-feeding. There is a risk for HIV transmission during scarification, tattooing, piercing, circumcision and/or female genital cutting if the same blade/instrument is used without sterilizing between persons.

Some people fear that HIV might be transmitted in other ways; however, no scientific evidence to support any of these fears has been found. (adapted from CDC)

Page 192 Responding to HIV and AIDS. A toolkit for youth peer educators. Terms to describe the epidemic Problematic word choice or Explanation Preferred wording spelling Prevalence is the measure of proportion of people in a HIV/AIDS Prevalence population infected with HIV. AIDS is not relevant in this HIV Prevalence case.

Prevalence in itself refers to a rate (the measure of the Prevalence rates proportion of people in a population infected with a Prevalence particular disease at a given time). AIDS scourge AIDS epidemic AIDS plague These are sensational terms. They can fuel panic, or Killer disease discrimination and fatalism. AIDS pandemic The dreaded HIV/AIDS If a definition of AIDS is required: ‘AIDS, the acquired Similar to the above, this is sensational language and immunodeficiency should be avoided. Also, describing HIV disease and AIDS as syndrome, is a disease caused by a ‘deadly, incurable disease’ creates a lot of fear and only AIDS is a deadly, HIV, the human serves to increase stigma and discrimination. It has also immunodeficiency virus. incurable disease been referred to as a ‘manageable, chronic illness, much like hypertension or diabetes’, but such language may lead Currently, antiretroviral people to believe that it is not as serious as they thought. drugs can slow down replication of the virus, but they do not cure AIDS.’

Fight against Although this phrase is widely used, it is considered militaristic and stigmatizing vocabulary that may lead to HIV/AIDS the thinking that people living with HIV (PLHIV) have to be ‘fought’ or eliminated. Similarly to the words ‘fight’ and Response to HIV and AIDS ‘war’, combatant language, e.g. struggle, battle, campaign, War against should be avoided when referring to a response to HIV and HIV/AIDS AIDS.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 193 Terms to be used with care Problematic word Explanation Preferred wording choice or spelling

Epidemic is a disease that spreads rapidly through a demographic segment of the human population, such as everyone in a given geographic area: a military base or similar population unit; or ‘Epidemic’ or Pandemic’ everyone of a certain age or sex, such as the children or women of according to the relevant Pandemic vs. epidemic a region. Epidemic diseases can be spread from person to person or context in which they are from a contaminated source such as food or water. used Pandemic = A disease prevalent throughout an entire country, continent or the whole world.

There is often confusion between treatment and cure. HIV infection HIV treatment vs. cure HIV treatment can be treated but not cured.

Medication To avoid confusion between medication and widely prohibited Drugs when referring to ARV (Antiretroviral) drugs such as cocaine, heroin and other substances, it is advisable medication Treatment HIV medications to distinguish between these two words. HIV treatment medication

Although the term is widely used, ‘key populations’ is preferred as it does not focus only on the vulnerability. Instead, it looks at key Key populations vulnerable populations as a sub-set of the general population who have the Vulnerable groups to HIV power to raise awareness and play an important and active role Key populations in the response to HIV and AIDS within their own community and communities at large.

These terms should be used with caution as they can increase stigma and discrimination. They may also lull people who do not High risk behaviour identify with such groups into a false sense of security. (unprotected sex, use of contaminated needles, etc.) These terms also may imply that membership of a particular group, rather than engaging in certain behaviours, can be the cause of High(er) risk group becoming HIV positive. This may give a false sense of security to Groups with high risk Highly affected communities people who don’t identify with a high risk group – even when they do engage in behaviours that can put them at risk. For example, a sex worker (member of a population at high risk of Key populations exposure to HIV) who practices safer sex is at a lower risk for HIV infection than a heterosexual male (member of a lower risk group) who practices unprotected sex with a seropositive partner or with a Key populations at higher risk number of different partners of unknown serostatus.

Page 194 Responding to HIV and AIDS. A toolkit for youth peer educators. Terms to be used with care The use of the term general population when referring to a population other than a specific subgroup can be problematic. e.g. for Sri Lanka: Caution is advised in the use of this term. • Sri Lankan population It may imply that people in the populations targeted for HIV • All Sri Lankans General population prevention, education and care are not part of the general • HIV Negative People population. Thus, it could artificially divide the world into those who are infected, or at risk of being infected, and those who are not. It (in case one wishes to falsely implies that identity, or (perceived) membership of a certain address this particular minority group, rather than behaviour, is the critical factor in HIV group) transmission.

As far as HIV infection is concerned, it may be advisable (in some texts) to specify if one intends to say therapeutic or preventive vaccine. Even though this term is now used widely, the correct term is either Therapeutic HIV Vaccine or Preventive HIV Vaccine depending on the Vaccines Therapeutic HIV vaccines vaccine’s intent. AIDS vaccine Preventive HIV vaccines Strictly speaking, there is no such thing as an AIDS vaccine because the vaccine is not intended for the prevention/treatment/cure of AIDS (the syndrome) but rather for the prevention/treatment/cure of HIV infection. Note that no preventive vaccine exists although several trials to develop such a vaccine are underway.

This term is in itself correct but should be used very carefully. A person dying of AIDS is a person in the very last days of his/her life. Dying of AIDS The use of this term for PLHIV in general is not appropriate. e.g. 38 million people Living with HIV (when Living with HIV is also promoted to encourage the best mental health around the world are dying referring to PLHIV) possible for PLHIV and those around them. This is the same principle of AIDS used for cancer or any other life-threatening illness or condition, or for survivors of assault.

Some studies have shown that HIV is more easily transmitted to an uncircumcised man than to a circumcised one (medical explanation is due to some of the body cells on the foreskin on whose receptors the HIV can attach); however, it is very difficult to separate the cultural and medical reasons in why circumcision plays a role in rates of HIV transmission. Some reports extrapolate from the above and refer Male circumcision to circumcision as a means to help prevent HIV transmission. And as a means to prevent HIV although it may be correct to say that the male foreskin facilitates HIV transmission transmission, it is not necessarily correct to extrapolate from that and justify the foreskin’s removal as a means of protection. If high-risk behaviour is not altered, by either circumcised or uncircumcised men, transmission will continue to take place for both circumcised and uncircumcised men. The rate at which HIV is transmitted might be slower in the case of men who are circumcised.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 195 Terms to be used with care

According to UNAIDS, opportunistic infections/diseases in a person with HIV are the products of two things: Malaria as an 1) the person’s lack of immune defences caused by the virus; and opportunistic 2) the presence of microbes and other pathogens in our everyday infection/illness environment. The parasite that causes malaria can invade the body of both HIV-negative and HIV-positive persons. Therefore it does not fall under the category of ‘opportunistic’ diseases – although an HIV- positive person may develop symptoms of malaria more easily.

HIV disease is characterized by a gradual deterioration of immune HIV infection when functions following the initial HIV infection. During the course of referring to the infection. infection, crucial immune cells, called CD4+ T cells, are disabled and HIV illness killed, and their numbers progressively decline. HIV disease HIV disease when Therefore, even though the terms HIV illness and HIV disease are NOT referring to the incorrect, there is a distinction between these two terms and HIV consequences of the infection and ‘HIV disease’ is preferred. HIV infection.

NB: Medical and epidemiological ﬁndings evolve with time. Therefore, any reference to such issues must be veriﬁed and updated regularly. Even though technical issues are probably beyond the scope of these guidelines, latest information on current medical development, antiretroviral treatment medication development, etc. can be found at: Centers for Disease Control, http://www.cdc.gov/.

Page 196 Responding to HIV and AIDS. A toolkit for youth peer educators. Table 2. Stigmatizing Terms and Expressions (especially when referring to people infected and aﬀected by HIV and AIDS, sexual minorities and other key populations)

With regard to the promotion of human rights, action is concentrated in areas where UNESCO has a special mandate: generating and sharing knowledge, protecting human rights, renewing and reinforcing commitment to human rights education and providing advisory services and technical assistance to Member States. In important related areas, such as women and gender, where emphasis is on promoting equality between the sexes and on the social dimension of women’s rights, actions focus on research, networking, advocacy and knowledge sharing of best practices. ‘In the struggle against discrimination, UNESCO tries to identify the obstacles hampering the full exercise of human rights: the impact of nationalism, religious intolerance, discrimination against minorities, and forms of discrimination arising from scientiﬁc progress or from illness such as HIV/AIDS.’ ‘Certain terms used in the context of HIV/AIDS may have negative connotations for those who are HIV positive. The use of inappropriate language may also result in stigma and discrimination, thereby infringing upon individuals’ rights and hindering eﬀective HIV/AIDS prevention and care programmes.’

http://www.unesco.org/human_rights When referring to People Infected and/or Affected by HIV and AIDS Problematic Explanation Preferred wording word choice or spelling

All people living with AIDS also live with HIV, but not all people living with HIV also live with AIDS. Spell out ‘People living with HIV’ PLWHA Even though PLWHA (or PLHA) is still widely used when The acronym of which could referring to ‘people with HIV’, or ‘people with HIV and be PLHIV AIDS’, the use of any acronyms when referring to people PLHA with HIV should be avoided as much as possible a people Spell out ‘People with HIV’ with HIV don’t like to be referred to as an acronym. Some organizations even go as far as not including the word ‘living’.

AIDS victim PLHIV feel these terms imply they are powerless, with no Person with HIV AIDS sufferer control over their lives. Person living with HIV (PLHIV)

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 197 …When referring to People Infected and/or Affected by HIV and AIDS

These terms are not correct and are offensive and stigmatizing to PLHIV. ‘AIDS carrier’ is also incorrect: the infective agent is HIV, not AIDS. This term may also give the impression that people Person with AIDS (attention can protect themselves by choosing a partner based on their should be paid if one is AIDS carrier appearance or by avoiding someone who they know has AIDS. referring to AIDS or HIV) HIV carrier Furthermore, ‘carrier’ is often reserved to describe the presence Person living with HIV (PLHIV) of DNA genes. HIV is neither a dominant or recessive gene. And HIV-positive person by definition AIDS is an acquired syndrome, not an inherited symptom. Therefore, ‘HIV carrier’ should be avoided. Person with HIV Furthermore, a person with AIDS is HIV-positive, but not everyone who is HIV-positive has developed or will develop AIDS.

Victims

NOT victims, as victims can’t do anything about their situation – people living with HIV can! Avoiding words like victim also helps to promote uptake of confidential voluntary counselling and testing (VCT) services providing a more hopeful presentation of living with HIV. Sufferers NOT sufferers, as not all people living with HIV suffer. NOT contaminated – objects are contaminated not people. People living with HIV (PLHIV) Contaminated Also something that is contaminated has connotations of no longer being useful. People living with HIV remain useful and productive members of societies and should not be discarded simply because they have been infected (not contaminated) by a virus.

Sick NOT sick, as often PLHIV live healthy lives.

AIDS is not a disease. It is a syndrome or a group of illnesses Died of an AIDS-related illness. Died of AIDS resulting from a weakening of the immune system. People die To die of an AIDS-related To die of AIDS from opportunistic infections or AIDS-related illnesses, such as tuberculosis (TB) or bronchitis. illnesses.

HIV/AIDS positive HIV-positive person There is no such thing as ‘AIDS positive’ AIDS positive PLHIV

HIV when referring to an HIV- A person is not HIV itself – a person lives with HIV once infected HIV-positive positive person with the virus. PLHIV

Positives The word positives takes the word people out of HIV-positive People living with HIV persons and some PLHIV consider this term, as well as the term HIVers HIVers, derogatory and dehumanizing. HIV-positive people/persons

Page 198 Responding to HIV and AIDS. A toolkit for youth peer educators. When referring to key populations Problematic word Explanation Preferred wording choice or spelling

Prostitute is considered a disparaging term and does not reflect the Sex worker (also seen as Prostitute fact that sex work is a form of employment for a sex worker and not ‘commercial sex worker’ or a way of life. The same applies to the term street walker which does brothelbased sex worker) Street walker not represent the employment aspect of sex work, and is therefore derogatory and misleading.

Injecting drug user Many people who use drugs consider that they are in control of their use of drugs and that they are not abusing them and are not Drug use Drug abuser addicted to them. Calling them abusers or addicts alienates them, Affected by drug use Drug addict which serves no good purpose. It is the act of using contaminated injecting equipment and not the drug use itself that can transmit HIV. Drug users Junkie Furthermore, drug use is only one part of a drug user’s life. Terms such Active drug users as junkie rely on a stereotyped image that is not accurate. Recovering drug users

How drug use is conceptualized, and the language used to do so, will determine the way in which solutions are generated and implemented. Thus, a ‘war against drugs’ can all too easily become a war against drug users or ‘abusers’ as they are more commonly described in much of the documentation. The vilification of drug users may simply reflect a pervasive tendency Fight against drugs to focus upon individuals and their behaviour without sufficient consideration of the socioeconomic context in which drug production, Responding to drug use War against drugs supply and consumption occur. Selecting the level of the individual as the primary focus of the problem obscures the fact that drug use is essentially a social and cultural phenomenon, perhaps the most significant characteristic of which, in most settings, is its illegality. In turn, this gives rise to a vocabulary of ‘policing’, ‘control’ and ‘punishment’ and in so doing risks widening ever further the gap between drug users and potential sources of support.

Promiscuous Promiscuous is judgmental, accusatory and derogatory Having multiple partners

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 199 When referring to sexual minorities Problematic word Explanation Preferred wording choice or spelling

When addressing men having sex with men (MSM), it is advisable to first inquire about the most appropriate term in use in the specific socio-cultural context the text is referring to. Some MSM do not identify themselves as homosexual, especially in regions where same-sex relationships are taboo. In other words, MSM is useful as it includes not only men who self-identify as ‘gay’ or ‘homosexual’ and have sex only with other men, but also bisexual men, and heterosexual men who may, nonetheless at times have sex with other men. When referring to Homosexual (men) MSM’ and ‘homosexual’ refer to different social identities. epidemiological analysis: ‘Men ‘MSM’ refers to the sexual relationships between men. vs. who have sex with men (MSM)’ ‘Homosexuality’, however, refers to more than the sexual Men who have sex with men relationship and may extend to broader relationships with In general: when in doubt, it is (MSM) the same sex, lifestyle, sexuality, etc. advised to use ‘MSM’ in place of ‘homosexual’ Furthermore, in relation to HIV prevention, transmission, and/or from an epidemiological point of view, what is of concern is the sexual activity: thus, MSM is more appropriate. In relation to HIV and AIDS-related social attitudes, stigma and discrimination, etc., what is of consequence is not only the sexual activity: thus, the more appropriate term between ‘MSM’ and ‘homosexual men’ will depend on as the most appropriate term to be used for the local MSM community the document is referring to.

Page 200 Responding to HIV and AIDS. A toolkit for youth peer educators. …When referring to sexual minorities

Although, same-sex sexual relationships are illegal in some countries, UNESCO (and all other UN agencies, including UNAIDS and WHO) supports responses to HIV and AIDS that are inclusive, and sensitive to the needs and issues of the full population, but with particular attention to especially vulnerable populations (in this case MSM). Moreover, there is substantial evidence to support a more inclusive approach to the challenges of HIV and AIDS, and UNAIDS, WHO, UNESCO, bilaterals and civil society organizations have strongly embraced a human rights approach that emphasizes respect for diversity. Therefore, UNESCO promotes the avoidance of terms that are derogatory and discriminatory to sexual minorities vulnerable to HIV. Homosexual relationships Although there is no UN resolution on sexual orientation at this moment, referred to as: during the 59th session of the UN Commission on Human Rights (17 April 2003), resolution E/CN.4/2003/L.92 was drafted by Brazil: reaffirming all declarations Immoral on Human Rights and Conventions against all forms of discrimination; ‘recalling Indecent that recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and Unnatural peace in the world’; ‘affirming that human rights education is a key to changing Homosexuals as a attitudes and behaviour and to promoting respect for diversity in societies’; and social problem calling ‘upon all States to promote and protect the human rights of all persons regardless of their sexual orientation’. Deviant social groups The full text of the declaration can be found at: http://www.ilga.org/news_results.asp?LanguageID=1&FileID=406&ZoneID Perverse social =7&FileCategory=44 groups Decision on the above draft resolution was scheduled to take place during the 60th session of the UN Commission on Human Rights. However, Brazil, in its efforts to achieve a common consensus amongst Member States before presenting the resolution, asked a postponement until 2005. Resolution E/CN.4/2003/L.92 was sponsored by Austria, Belgium, Brazil, Canada, the Czech Republic, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Liechtenstein, Luxembourg, the Netherlands, Norway, Portugal, Spain, Sweden and the United Kingdom of Great Britain and Northern Ireland. Croatia, Cyprus, New Zealand, Poland, Serbia and Montenegro, Slovenia and Switzerland subsequently joined.

Gay and lesbian This term is gender blind. Gay when Furthermore, the expressions ‘gay’ and ‘gay men’ should be used only when Men who have sex designating individuals or groups specifically self-identify as gay. with men (MSM) male and women The broader community of homosexual men and women and transsexuals should when addressing male homosexuals be described as Lesbian, Gay, Bisexual and Transgendered (LGBT). individuals However, UNAIDS general preference is to spell out all terms in full. Same-sex relationships

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 201 Table 3. Developing a culturally sensitive language ‘Developing a ‘culturally sensitive language’ is an invaluable negotiating and programming tool. If the language used is loaded with negative judgements on the community or its values, it creates unnecessary tensions and constructs a wall between the community and the programme. […] Language sensitivity also applies to the choice of project titles and the messages they convey to the community, especially in areas where reproductive health and rights projects have not previously existed.’ UNFPA report ‘Culture Matters’, 2004, p 5-6

Word/Phrase Explanation Alternative language

FGM is still widely used in existing literature. However, it is considered as value-loaded language. This perception may lead to the community’s resistance, at least in the project launching phase, to any advocacy campaigns to terminate the practice (UNPFA report, ‘Culture Matters’, page 6). Female genital cutting: Female genital FGM has been recognized as a form of violence against women This describes the practice in neutral in the UN language that allows discussions of mutilation (FGM) Declaration on the Elimination of Violence against Women and the practice and its negative impact in the UN Beijing Declaration and Platform for action. The 1993 on the health and rights of women UN World Conference on Human Rights in Vienna, resulting in the Vienna Declaration and Programme of Action, called for the elimination of all forms of violence against women to be seen as a human rights obligation.

Although ‘vulnerable groups’ is widely used, it is preferred Key populations to use the phrase ‘key populations’ (or ‘target groups’) as the Key populations at particular risk Vulnerable groups word vulnerable does not allow for the possible role that these to HIV groups can play in the response to HIV and AIDS. (see also Table 2) Key populations vulnerable to HIV The use of the term ‘key populations’ is more constructive, action oriented and inclusive. Target groups

Page 202 Responding to HIV and AIDS. A toolkit for youth peer educators. Table 4. Precision and diﬀerentiation of certain terms

Word/Phrase Explanation Clarifications Youth According to the UN, young people aged 15-24 Young women and men

The UN General Assembly in 1985 defined ‘youth’, on the occasion of the International Youth Year, as those persons falling between the ages of 15 and 24 years inclusive. All UN statistics on youth are based on this definition. The UN also strongly encourages the adoption of this definition in order to allow for comparisons between different demographic reports. Ages below 14: By that definition, therefore, children are those persons under Children the age of 14. It is, however, worth noting that Article 1 of the UN Convention on the Rights of the Child defines ‘children’ Ages 10-19: Adolescents Youth vs. young as persons up to the age of 18. This was intentional, as it was hoped that the Convention would provide protection and rights (according to the people vs. children to as large an age-group as possible and because there was no WHO definition) etc. similar UN Convention on the Rights of Youth. Ages 13-19: Teenagers Adolescents Many countries also draw a line on youth at the age at which a person is given equal treatment under the law – often Ages 15-24: young Teenagers referred to as the ’age of majority’. This age is often 18 in women and many countries, and once a person passes this age, they are men/young people considered to be an adult. However, the operational definition and nuances of the term ‘youth’ often vary from country to Ages 20-24: young country, depending on the specific socio-cultural, institutional, adults economic and political factors. Within the category of ‘youth’, it is also important to distinguish between teenagers (13-19) and young adults (20-24), since the sociological, psychological and health problems they face may differ.

Evidence based Evidence informed

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 203 Table 5. Some speciﬁc examples

Problematic Wording Alternative Wording (Found in UNESCO documents and elsewhere)

To this date there is no adequate treatment for AIDS To this date, there is no cure for the HIV infection

Nor are there any satisfactory immunization methods such as Nor are there any satisfactory immunization methods such as vaccines. preventive vaccines.

HIV and AIDS are amongst the most difficult health challenges AIDS is the most harmful disease faced by humanity today faced by humanity today.

The search for a drug that will cure AIDS The search for a therapeutic treatment of HIV has not yet seems to end in futility… resulted in success…

If married partners, who discover that they have the disease If married partners who discover that they have the disease either one of them is HIV positive, were to have a child it would were to have a child, it would most likely to be infected most likely to be infected there is a possibility that the child would be infected by HIV.

Sexual promiscuity is the primary cause of the spread of HIV/ Unprotected sexual relationships are the primary cause of the AIDS spread of HIV

Page 204 Responding to HIV and AIDS. A toolkit for youth peer educators. Table 6. Cultural issues and practices

Word/Phrase Further Clarification on the subject

It is important to remember that all testing for HIV should be voluntary. If not it is not effective and is a serious violation of the individual’s human rights. It is also essential that Mandatory HIV screening before counselling happens both before and after testing, and for any test result not simply in marriage connection with a positive result. Voluntary, Confidential Counselling and Testing (VCCT) should also include practical skills counselling on partner notification.

Marriage (or polygamy) Marriage (or polygamy) as such does not prevent HIV infection. In fact, it may be a factor of prevents HIV infection vulnerability, especially when one of the partners is monogamous and the other one is not.

‘Widow inheritance is often presented as a risky traditional practice in regards to HIV, but it must be clarified that traditionally widow inheritance would not necessarily presume a sexual relationship between the newly espoused. Widow inheritance is a social mechanism whose main goal is that the widow will not be separated from her children and remains in the family of her deceased husband. For this reason the widow was often ‘inherited’ by a man with whom she could not have a sexual relationship (her son, for example). When Widow inheritance unprotected sexual relationships do take place between the newly espoused following widow inheritance, the risk of exposure to HIV is increased. However, without the widow inheritance system, the widow would likely be thrown out in the street with no resources, often with sex work as the only means of survival and, thus, the risk of transmission is significantly increased for society as a whole. Currently the medical world tends to interpret local and traditional practices as risky a priori.’ Alice Desclaux

Traditional cleansing practices Without taking any position on the practices themselves, the HIV-related risk is linked Coming-of-age Ceremonies either to unprotected sex or to the use of contaminated cutting utensils.

Traditional healers often claim that they can cure HIV or AIDS. Although they may be able to alleviate some of the physical difficulties and/or opportunistic illnesses faced by PLHIV, Traditional healers there has been no proof that they can cure HIV infections or AIDS. The distinction between cure and treatment is critical in this context as any confusion between the two might aid in the perpetuation of false beliefs.

Male circumcision See Table 2

Female genital mutilation (FGM) or See Table 4 excision

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 205 Table 7. Audio and visual content (posters, images, brochures, songs etc.) HIV and AIDS- related materials

Context and Ethical Responsibility

How to ensure Conditions Issues to pay attention to conditions examples

Balance your report by using examples of positive Avoid sensationalism by portraying shocking images and leadership, build your story commentary (e.g. picture of dying people). However powerful around potential national role images (or text) may be, they may propagate the stereotypical models such as supportive images people have of PLHIV and may lead to stigma and school teachers, health Sensitivity to stigma discrimination through evoking fear. workers, political leaders, HIV and discrimination and AIDS activists, PLHIV, etc. Furthermore, although Africa is the region hardest hit by HIV and AIDS in the world, one should not simply use photographs Balance the photographs/ from Africa. AIDS is a global pandemic and its global effect images used in reports/ should thus be represented. posters/brochures to include not only images from Africa but of all geographical regions.

For example, when dealing with traditional healers and HIV and AIDS, during Objective and unbiased Complete your research and understand the (scientific) facts investigative reporting, one investigative reporting before filing a report. may ask questions such as: Can the traditional healer prove he has a cure to HIV? How does he/she diagnose HIV or AIDS?

Sensitive use (gender/cultural Paintings, drawings, music, cultural performance, etc, must human rights issues) of apply proper use of language, semiotics, and metaphors to language in the arts and avoid stigma and discrimination. creative content.

Page 206 Responding to HIV and AIDS. A toolkit for youth peer educators. 2. The ‘ABCs’ of combination HIV prevention

Just as combination treatment attacks HIV at different phases of virus replication, combination prevention includes various safer sex behaviour strategies that informed individuals who are in a position to decide for themselves can choose at different times in their lives to reduce their risk of exposing themselves or others to HIV. These are often referred to as the ABCs of combination prevention. (Global HIV Prevention Working Group, 2003). A is for Abstinence not engaging in sexual intercourse or delaying sexual debut. Whether abstinence occurs by delaying sexual debut or by adopting a period of abstinence at a later stage, access to information and education about alternative safer sexual practices is critical to avoid HIV infection when sexual activity begins or is resumed. B is for Being faithful (sometimes Be safer) by being faithful to one’s partner or reducing the number of sexual partners. The lifetime number of sexual partners is a very important predictor of HIV infection. Thus, having fewer sexual partners reduces the risk of HIV exposure. However, strategies to promote faithfulness among couples only lead to lower incidence of HIV when neither partner has HIV infection and both are consistently faithful. C is for Correct and Consistent Condom use condoms reduce the risk of HIV transmission for sexually active people, couples in which one person is HIV-positive, sex workers and their clients. Research has found that if people do not have access to condoms, other prevention strategies lose much of their potential effectiveness. A, B and C interventions can be adapted and combined in a balanced approach that will vary according to the cultural context, the population being addressed, and the phase of the epidemic. Source: 2004 Report on the global AIDS epidemic, UNAIDS 3. Harm Reduction and HIV At its February 2000 meeting, the Board of Directors of the Canadian AIDS Society (CAS) acknowledged its support of the following definition and basic principles of harm reduction. ‘Harm reduction can be defined as a set of practical strategies with the goal of meeting people ‘where they are at’ to help them to reduce harm associated with engaging in risk taking behaviour’ (Harm Reduction Coalition).

Basic Principles of Harm Reduction and HIV:

• Harm reduction philosophy considers risk taking behaviour as a natural part of our world and suggests that our work should be focused on minimizing the harmful eﬀects of these behaviours rather than focusing on the cessation of the behaviour. • Harm reduction philosophy supports the involvement of individuals in the creation and/or delivery of programmes and services that are designed to serve them. These programmes and services must be oﬀered in a non judgmental and non-coercive manner.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 207 • Harm reduction philosophy recognizes the impact of issues such as poverty, classism, racism, homophobia, social isolation, past trauma, and other social inequities on both people’s vulnerability to and capacity for eﬀectively dealing with risk taking behaviour. Harm Reduction Approaches to Injecting Drug Use

In public health, ‘Harm Reduction’ is used to describe a concept aiming to prevent or reduce negative health consequences associated with certain behaviours. In relation to drug injecting, harm reduction components of comprehensive interventions aim to prevent transmission of HIV and other infections that occur through sharing of non-sterile injection equipment and drug preparations. How it is done

Successful harm reduction is based on a policy, legislative and social environment that minimizes the vulnerability of injecting drug users. Harm reduction for injecting drug users primarily aims to help them avoid the negative health consequences of drug injecting and improve their health and social status. To this end, harm reduction approaches recognize that for many drug users total abstinence from psychoactive substances is not a feasible option in the short term, and aim to help drug users reduce their injection frequency and increase injection safety. The following are components that typically have a signiﬁcant potential to reduce individual risk behaviours associated with drug injection: • Needle-syringe programming (NSP) aims to ensure that those drug users who continue injecting have access to clean injection paraphernalia, including needles and syringes, ﬁlters, cookers, drug containers and mixing water. • Drug substitution treatment involves the medically supervised treatment of individuals with opiate dependency based on the prescription of opiate agonists such as methadone. • HIV related treatment and care primarily aims to help drug users living with HIV and AIDS cope with the infection. • Information, education and communication (IEC) on HIV transmission through injecting drug use provides information which will assist drug users avoid or modify drug injecting behaviours. Embedding harm reduction activities into comprehensive prevention packages for injecting drugusers is indispensable for their success. This applies in particular to complementing safer injection messages by safer sex messages and condom promotion. Comprehensive HIV and AIDS programming should aim to provide opportunities for all IDUs to access the whole range of services described in this document. Recognizing the hidden and often rapidly changing nature of drug injecting, reaching as many individuals as possible who inject on a regular or occasional basis, represents a particular challenge to harm reduction services and necessitates an in-depth understanding of local drug use patterns and contexts. For this reason, harm reduction programming is often informed by situation assessments. Situation assessments can also act as a catalyst for communities to learn about the necessity of evidence-based approaches to HIV prevention among injecting drug users and to reduce controversy about their introduction.

Page 208 Responding to HIV and AIDS. A toolkit for youth peer educators. Reference and source materials Documents

• HIV in the UN workplace, ‘Living in a World with HIV/AIDS’ http://unworkplace.unAIDS.org • What’s in a word, Australian Federation of AIDS Organizations (AFAO) http://www.afao.org.au • School Health Education to Prevent AIDS and STD’, UNESCO, 1994 http://www.unesco.org/education/educprog/pead/GB/AIDSGB/AIDSGBtx/ GuideGB/GuideGB.html • Caring for us, HIV/AIDS in our workplace, UNICEF • Guidelines on Gender-Neutral Language, Paris: UNESCO, 1999 • Gender Sensitivity- A training manual, Paris: UNESCO, 2002 • Addressing Gender Relations in HIV Preventive Education Material; Carol Medel-Anonuevo, UNESCO Institute for Education, 2002 • Operational Guide on Gender and HIV/AIDS: A Rights- Based Approach; UNAIDS Interagency Task Team on Gender & HIV/AIDS • Handbook for Culturally Appropriate Information, Education, Communication for Behaviour Change. A Cultural Approach to HIV/ AIDS Prevention and Care, Paris: UNESCO, 2003 • International Federation of Red Cross and Red Crescent Societies – ‘The truth about AIDS. Pass it on… Terminology’ • UNFPA and UNICEF – ‘Positive Language for Supporting People Living with HIV/AIDS’ • Journalists against AIDS (JAAIDS) Nigeria – Guidelines on Appropriate Use of Language in HIV/AIDS • UNAIDS – http://www.unAIDS.org/en/resources/terminology.asp ‘Glossary of HIV/AIDS-related terms & Terminology Database Web Sites

• UNESCO: http://www.unesco.org/AIDS

• AVERT: http://www.avert.org

• The Body: http://www.thebody.com

• HIV InSite: http://hivinsite.ucsf.edu

• UNIFEM: http://www.unifem.org

• Gender and HIV/AIDS: http://www.genderandAIDS.org • Global Coalition on Women and AIDS: http://womenandAIDS.unAIDS.org

• Women Living with HIV/AIDS: http://www.icw.org

• UNAIDS: www.unAIDS.org • IIEP HIV/AIDS Impact on Education Clearinghouse: http://hivAIDSclearinghouse.unesco.or

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 209 • Centre for Disease Control and Prevention, US: www.cdc.gov (transmission: http://www.cdc.gov/hiv/pubs/facts/transmission.htm )

• World Health Organization: www.who.int

• UNDP: http://www.undp.org/hiv/policies

• World Health Organizations: http://www.who.int/hiv/en

• Canadian AIDS Society: http://www.cdnAIDS.ca • Information on available HIV tests: http://www.hivtest.org/subindex.cfm?FuseAction=FAQ Glossaries

• Glossary of HIV/AIDS Terms SF AIDS Foundation: http://www.sfaf.org/glossary • HIV Glossary AIDS Info: http://www.AIDSinfo.nih.gov/ed_resources/glossary

• HIV Glossary: http://www.aegis.com/ni/topics/glossary • GMHC AIDS Medical Glossary and Drug Chart: http://www.gmhc.org/health/glossary2.html

Page 210 Responding to HIV and AIDS. A toolkit for youth peer educators. Glossary of HIV and AIDS Terms

Term Definition

A large glycoprotein that is found on the surface of T4 cells and is the receptor for HIV. White blood cells killed or disabled during HIV infection. These cells normally orchestrate the immune response, signalling other cells in the immune system to perform their special functions. Also known as T helper cells. HIV’s preferred targets are cells that have a docking molecule called cluster designation 4 (CD4) on their surfaces. Cells with this molecule are known as CD4- CD4+ (helper T cells) positive (or CD4+) cells. Destruction of CD4+ lymphocytes is the major cause of the immunodeficiency observed in AIDS, and decreasing CD4+ lymphocyte levels appear to be the best indicator of morbidity in these patients. Although CD4 counts fall, the total T-cell level remains fairly constant through the course of HIV disease, due to a concomitant increase in the CD8+ cells. The ratio of CD4+ to CD8+ cells is therefore an important measure of disease progression.

A situation or activity that may increase a person’s risk for progressing from asymptomatic HIV infection to symptomatic disease or AIDS. Examples of possible co- Co-factor factors are: other infections, drug and alcohol abuse, homelessness, poor nutrition, genetic disorder, stress etc.

A pouch made of polyurethane inserted into the vagina before intercourse and held in place by a loose inner ring and fixed outer ring. The female condom prevents Condom (female) conception and provides protection from sexually transmitted infections. Unlike the male condom, it does not depend on the man’s erection.

A sheath unrolled over the erect penis. Male condoms made from latex or Condom (male) polyurethane prevent conception and transmission of HIV and other sexually transmitted infections.

ELISA (enzyme-linked A blood test that detects the presence of antibodies to a specific antigen. Relatively cheap HIV antibody test. If a blood test is positive, where possible it should be immunosorbent assay) test confirmed by the more accurate but more expensive Western Blot test.

The branch of medical science that deals with the study of incidence, distribution and Epidemiology control of a disease in a population.

False negative An incorrect test result that indicates that no HIV antibodies are present when in fact infection has occurred.

False positive An incorrect test result that indicates that HIV antibodies are present when in fact infection has NOT occurred.

A term used to describe activities that increase a person’s risk of transmitting or becoming infected with HIV. Examples of high risk behaviours include: unprotected High-risk Behaviour vaginal or anal intercourse (without a condom) or using contaminated injection needles or syringes. These are often also referred to as unsafe activities.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 211 The name given to treatment regimens recommended by leading HIV experts to aggressively suppress viral replication and progress of HIV disease. The usual HAART regimen combines three or more different Highly active antiretroviral drugs such as two nucleoside reverse transcriptase inhibitors and a protease inhibitor, two nucleoside reverse transcriptase inhibitors and therapy (HAART) a nonnucleoside reverse transcriptase inhibitor, or other combinations. These treatment regimens have been shown to reduce the amount of virus so that (with commonly-used tests) it becomes undetectable in a patient’s blood; even so, the virus may still be present in blood and body fluids.

Human Immunodeficiency Virus. The standard name was officially chosen in August 1986 to avoid confusion after different countries gave HIV the virus other names. In old literature one may see the virus referred to as: HTLV-III, LAV or ARV.

HIV-1 The retrovirus that is the principal worldwide cause of AIDS.

A retrovirus closely related to HIV-1 that also causes AIDS in humans, HIV-2 found principally in West Africa.

HIV medications fall under 4 classes: protease inhibitors, nonnucleoside reverse transcriptase inhibitors, nucleoside/nucleotide analogue reverse HIV medications transcriptase inhibitors and (most recently) entry inhibitors (only one medication currently available under this class: Fuzeon).

Showing no evidence of infection with HIV (e.g. absence of antibodies HIV-negative against HIV) in a blood or tissue test. Synonymous with seronegative.

Showing indications of infection with HIV (e.g., presence of antibodies HIV-positive against HIV) on a test of blood or tissue. Synonymous with seropositive. Test may occasionally show false positive results.

As distinct from HIV-positive (which can sometimes be a false positive test result, especially in infants of up to 18 months of age). The term HIV-infected HIV-infected is usually used to indicate the evidence of HIV has been found via a blood or tissue test. Sometimes also referred to as ‘cumulative incidence’, is the proportion of HIV incidence people who have become infected with HIV during a specific period of time.

Usually given as a percentage, HIV prevalence quantifies the proportion HIV prevalence of individuals in a population who have HIV at a specific point in time.

A vaccine designed to prevent an HIV infection becoming established in HIV vaccine, preventive a person.

Also called treatment vaccine. A vaccine designed to boost the immune HIV vaccine, therapeutic response to HIV in persons already infected with the virus.

Page 212 Responding to HIV and AIDS. A toolkit for youth peer educators. Term Definition

All of the mechanisms (e.g. T cells) that act to defend the body against Immune system external agents particularly microbes, viruses, bacteria, fungi and parasites.

The number of new cases occurring in a given population over a certain period of time.

Incidence N.B.The terms prevalence and incidence should not be confused. Incidence only applies to the number of new cases, while the term prevalence applies to all cases old and new.

The time interval between HIV infection and the onset of AIDS defining Incubation period illnesses.

Many people with AIDS experience this cancer of the connective tissues in blood vessels. Pink, broken or purple blotches on the skin may be a KS (Kaposi’s Sarcoma) symptom of KS. KS lesions sometimes occur inside the body in lymph nodes, the intestinal tract and the lungs.

A measure of the proportion of people in a population affected with a particular disease at a given time. Prevalence NOTE: the terms prevalence and incidence should not be confused. Incidence only applies to the number of new cases, while the term prevalence applies to all cases old and new.

A type of virus that is able to insert its genetic material into a host cell’s Retrovirus DNA. Retrovirus infections had not been found in human beings until recently. HIV is a retrovirus.

The process of adopting behaviours that reduce the likelihood that an Risk reduction individual will be exposed to HIV.

Sexual activities that are not likely to transmit HIV. Safer sex involves sexual expressions in which partners make sure that blood, semen, vaginal mucus and menstrual blood from one person do not come into contact Safer sex with the other person’s bloodstream or mucous membranes (vulva, vagina, rectum, mouth and/or nose). This can be prevented by the use of male or female condoms.

The development of antibodies in response to an antigen. With HIV, Seroconversion seroconversion usually occurs 4 to12 weeks after infection is acquired, but in very few cases it has been delayed for 6 months or more.

Serodiscordant couples Couples composed of one HIV negative and one HIV positive partner

Seronegative Testing negative for HIV antibodies

Seropositive Testing positive for HIV antibodies

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 213 Term Definition

The rate of seropositivity in a defined population. Suggests the rate of HIV Seroprevalence infection for that population.

Is defined as the ability of the test to identify correctly those who have the Sensitivity (of the test) disease.

Is defined as the ability of the test to identify correctly those who do not Specificity (of the test) have the disease.

Sexual debut The age at which a person first engages in sexual intercourse.

A contraceptive that works by killing sperm in semen. Some spermicides, Spermicide such as nonoxynol-9 have also been demonstrated to kill HIV in laboratory tests.

The ongoing and systematic collection, analysis, and interpretation of Surveillance data about a disease or health condition. Collecting blood samples for the purpose of surveillance is called serosurveillance.

A group of symptoms as reported by the patient and signs as detected in an Syndrome examination that together are characteristic of a specific condition.

One type of white blood cell. One type of T cell (T-4 Lymphocytes, also called Helper T cells) is especially apt to be infected T Cell by HIV. By injuring and destroying these cells HIV damages the overall ability of the immune system to fight diseases

For HIV transmission to occur two conditions must be satisfied: the presence of the virus and a port of entry into the body. The three most common modes of transmission are: 1. Unprotected sexual contact with an infected partner. The virus can enter the body through the mucosal lining of the vagina, vulva, penis, rectum or, very rarely, the mouth during sex. The likelihood of transmission is Transmission (HIV) increased by factors that may damage these linings, especially other sexually transmitted infections that cause ulcers or inflammation. 2. Direct contact with infected blood, most often by drug injectors using needles or syringes contaminated with minute quantities of blood containing the virus. 3. Mother-to-child transmission either during pregnancy or birth, or postnatal via breastfeeding.

See: antiretroviral therapy and highly active antiretroviral Treatment, HIV therapy (HAART)

Transmission of a pathogen such as HIV from mother to fetus or baby Vertical transmission during pregnancy or birth.

The presence of virus in the blood, which implies active viral Viraemia relication.

Page 214 Responding to HIV and AIDS. A toolkit for youth peer educators. Term Definition

The quantity of the virus in the bloodstream. The viral load of HIV is Viral load measured by sensitive tests, unavailable in many parts of the world. Ability to measure viral load is a key component in effective combination therapy.

Infectious agent responsible for numerous diseases in all living beings. Virus They are extremely small particles, and in contrast with bacteria, can only survive and multiply within a living cell at the expense of that cell.

The HIV wasting syndrome involves involuntary weight loss of 10% of baseline body weight plus either chronic diarrhoea (two loose stools per day for more than 30 days) or chronic weakness and documented fever (for Wasting syndrome 30 days or more, intermittent or constant) in the absence of a concurrent illness or condition other than HIV infection that would explain the findings.

A blood test used to detect antibodies to HIV. This test is often used to Western blot confirm the results of all positive ELISA tests. Their combined accuracy is 99%

Blood cells responsible for the defence of the body against foreign disease White blood cells agents and microbes. HIV targets two groups of white blood cells called CD4+, lymphocytes and monocytes/macrophages

The period between transmission of HIV and the production of antibodies by the immune system. It takes the immune system up to 3 months to Window period produce antibodies to HIV that can be measured in the HIV antibody test. During this window period, an individual tests negative for the virus but is nevertheless capable of transmitting it to others.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 215 Appendix 3 UNAIDS’ Editors’

Notes for authors 92

(May 2006)

UNAIDS’ Editors’ Notes began as a short and simple aide memoire of preferred terminology for use by staff members. Over time the Notes expanded and the range of users grew. Partners as diverse as UNAIDS’ Cosponsors, UN system colleagues, nongovernmental organizations, journalists, students, writers and others asked for guidance and the Notes served them well. Realizing that the Notes have (unexpectedly) become an information resource in wide demand, this latest version has been updated in consultation with UNAIDS’ Cosponsors. In-house, the content has been enriched by inputs from colleagues across the Secretariat under the guidance of UNAIDS’ Chief Scientific Adviser. As language shapes beliefs and may influence behaviours, considered use of appropriate language has the power to strengthen the response to AIDS. UNAIDS is now pleased to make these Notes freely available to all. We want the Notes to be a living, evolving document. Comments and suggestions sent to Alistair Craik ([email protected]) will be gratefully received and will be considered for future updates. Summary of important current preferred usages

Old usage Current preferred usage Sex work or commercial sex, or the sale of sexual Commercial sex work services* Developing countries Low and middle income countries Direct sex workers Brothel-based sex workers or formal sex workers Non-brothel-based sex workers or informal sex Indirect sex workers workers Fight against AIDS Response to AIDS High(er) risk groups Key populations at higher risk* HIV/AIDS HIV unless specifically referring to AIDS HIV/AIDS AIDS diagnosis; HIV-related disease HIV/AIDS epidemic AIDS epidemic or HIV epidemic HIV/AIDS prevalence HIV prevalence HIV/AIDS prevention HIV prevention HIV/AIDS testing HIV testing People living with HIV/AIDS People living with HIV* Prostitute Sex worker

Page 216 Responding to HIV and AIDS. A toolkit for youth peer educators. Old usage Current preferred usage Term to use in respect to juvenile prostitution, Prostitution otherwise use sex work Intravenous drug user Injecting drug user* Most likely to be exposed to HIV Most vulnerable to infection (unless specifically referring to vulnerability) Prevalence rates Prevalence Risky sex Unprotected sex Sharing (needles, syringes, Using contaminated injecting equipment etc.) (if referring to HIV transmission) Sharing (needles, syringes, Using non-sterile injecting equipment etc.) (if refering to risk of exposure to HIV) Vulnerable populations or populations most Vulnerable groups likely to be exposed to HIV or populations at higher risk of exposure

Background for commonly used terms and abbreviations* ABC Prevention strategies: abstain from sexual intercourse (also used to indicate delay of sexual debut); be faithful (have sexual relations with only one partner); condomize (use condoms consistently and correctly). AIDS CARRIER This term often is used to mean any person living with HIV. However, it is stigmatizing and offensive to many people living with the virus. It is also incorrect, since the agent being carried is HIV not AIDS. AIDS or HIV-RELATED ILLNESSES AIDS is what people die of; HIV is what they are infected with. The expression AIDS-related illness can be used if the person has an AIDS diagnosis. AIDS RESPONSE The terms AIDS response, HIV response, response to AIDS and response to HIV are often used interchangeably to mean the response to the epidemic. AIDS VIRUS Since AIDS is a syndrome, it is incorrect to refer to the virus as the ‘AIDS virus’. HIV (the human immunodeficiency virus) is what ultimately causes AIDS (acquired immunodeficiency syndrome). In referring to the virus, write the full expression or use HIV; avoid the term HIV virus. BEHAVIOUR CHANGE There are a number of theories and models of human behaviour that guide health promotion and education efforts to encourage behaviour change, i.e. the adoption and maintenance of healthy behaviours.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 217 CLIENT-INITIATED TESTING Alternative term for voluntary counselling and testing (VCT). All HIV testing must be carried out under conditions of the three Cs: counselling, conﬁdentiality and informed consent. COMMERCIAL SEX WORK Preferred terms are ‘commercial sex’ and ‘the sale of sexual services’. CONTAMINATED and NON-STERILE Drug injecting equipment was ‘contaminated’ if it caused infection, that is, the equipment contained virus; ‘unclean’, ‘dirty’ or non-sterile if it carried the risk of HIV exposure: that is, it may or may not have carried the virus. COSPONSORS The Joint United Nations Programme on HIV/AIDS (UNAIDS) has the following ten Cosponsors, listed in the following order (according to UN rules): the United Nations High Commissioner for Refugees (UNHCR) http://www.unhcr.ch

the United Nations Children’s Fund (UNICEF) (http://www.unicef.org/)

the World Food Programme (WFP) http://www.wfp.org

the United Nations Development Programme (UNDP) (http://www.undp.org/)

the United Nations Population Fund (UNFPA) (http://www.unfpa.org/) the United Nations Oﬃce on Drugs and Crime (UNODC) (http://www.unodc.org/odccp/index.html)

the International Labour Organization (ILO) (http://www.ilo.org/) the United Nations Educational, Scientiﬁc and Cultural Organization (UNESCO) (http://www.unesco.org/)

the World Health Organization (WHO) (http://www.who.int/en/)

the World Bank (http://www.worldbank.org/) CRIS Country Response Information System. Developed by UNAIDS, CRIS provides partners in the global response to HIV with a user-friendly system consisting of an indicator database, a programmatic database, a research inventory database and other important information. The indicator database provides countries with a tool for reporting on national follow-up to the United Nations General Assembly Special Session on HIV/AIDS (June 2001) Declaration of Commitment on HIV/AIDS. The country-level CRIS will be complemented by a Global Response Information Database (GRID), which will support strategic analysis, knowledge-based policy formulation and subsequent programming. At country and global levels a Research Inventory Database (RID) is also being developed. CULTURAL DOMINANCE Familiar terms used in some cultures not be appropriate in other cultural contexts e.g. seasons of the year, avoid ‘fall’ or ‘autumn’ prefer instead last quarter of the year or instead of summer prefer mid-year. Similarly remember that diﬀerent cultures celebrate the New Year at diﬀerent times. Avoid terms which evoke ethnocentricity such as “AIDS has killed more people than the two world wars” (the two most extensive wars in the twentieth century didn’t actually involve the whole world).

Page 218 Responding to HIV and AIDS. A toolkit for youth peer educators. DESCRIBING AIDS AIDS is often referred to as a ‘deadly, incurable disease’, but this creates a lot of fear and only serves to increase stigma and discrimination. It has also been referred to as a ‘manageable, chronic illness, much like hypertension or diabetes’, but this may lead people to believe that it is not as serious as they thought. It is preferable to use the following description: AIDS, the acquired immunodeficiency syndrome, is a fatal disease caused by HIV, the human immunodeficiency virus. HIV destroys the body’s ability to fight off infection and disease, which can ultimately lead to death. Currently, antiretroviral drugs slow down replication of the virus and can greatly enhance quality of life, but they do not eliminate HIV infection. EPIDEMIC In epidemiology, an epidemic is a disease that appears as new cases in a given human population (e.g. everyone in a given geographic area; a university, or similar population unit; or everyone of a certain age or sex, such as the children or women of a region) during a given period, at a rate that greatly exceeds what is ‘expected’ based on recent experience. Defining an epidemic is subjective, depending in part on what is ‘expected’. An epidemic may be restricted to one locale (an outbreak), more general (an epidemic) or global (a pandemic). Common diseases that occur at a constant but relatively high rate in the population are said to be ‘endemic’. Widely-known examples of epidemics include the plague of mediaeval Europe known as the Black Death, the Influenza Pandemic of 1918-1919, and the current HIV epidemic which is increasingly described as pandemic. EPIDEMIOLOGY The branch of medical science that deals with the study of incidence, distribution, determinants of patterns of a disease and its prevention in a population. FAITH-BASED ORGANIZATIONS Faith-based organization is the term preferred instead of e.g. Church, Religious Organization, as it is inclusive (non-judgmental about the validity of any expression of faith) and moves away from historical (and typically European) patterns of thought. FEMINIZATION Referring to the pandemic, feminization is now often used by UNAIDS and others to indicate the increasing impact that the HIV epidemic has on women. It is often linked to the idea that the number of women infected has equalled, or surpassed, the figure for men. To avoid confusion, do not use ‘feminization’ in its primary sense in English, ‘becoming more feminine’. FIGHT Fight and other combatant language, e.g. struggle, battle, campaign, war— avoid using such words, unless in a direct quotation or the context of the text (possibly a poster or very short publication designed to have high impact) makes it appropriate. Alternatives include: response, measures against, initiative, action, efforts, and programme. GAY MEN Write ‘men who have sex with men’ unless individuals or groups specifically self-identify as gay. The broader community of men and women and transsexuals should be described as lesbian, gay, bisexual and transgendered—the abbreviation LGBT is often used of groups, but UNAIDS’ general preference is to spell out all terms in full.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 219 GENDER and SEX The term ‘sex’ refers to biologically determined differences, whereas the term ‘gender’ refers to differences in social roles and relations between men and women. Gender roles are learned through socialization and vary widely within and between cultures. Gender roles are also affected by age, class, race, ethnicity and religion, as well as by geographical, economic and political environments. Since many languages do not have the word gender, translators may have to consider other alternatives to distinguish between these concepts. GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA The Global Fund to Fight AIDS, Tuberculosis and Malaria, established in 2001, is an independent public-private partnership. It is the largest global fund in the health domain, to date (August 2005) it has committed over US$ 3 billion in 128 countries. The purpose of the Global Fund is to attract, manage and disburse additional resources to make a sustainable and significant contribution to mitigate the impact caused by HIV, tuberculosis and malaria in countries in need, while contributing to poverty reduction as part of the Millennium Development Goals (see below). When citing in text spell out title in full at first usage and thereafter refer to the Global Fund in preference to using the abbreviation, GFATM. www.globalfundatm.org GIPA Acronym for ‘the greater involvement of people living with or affected by HIV/AIDS’. In 1994, 42 countries prevailed upon the Paris AIDS Summit to include the Greater Involvement of People Living with HIV/AIDS Principle (GIPA) in its final declaration. http://www.unAIDS.org/publications/documents/persons/index.html GLOSSARIES The internet is a rich source of information about HIV. The following links to glossaries may be useful and are, in our view, usually clear and accurate in the information they provide (but note we cannot verify the accuracy of information on these sites and accept no responsibility for the information provided there).

http://www.sfaf.org/glossary http://www.AIDSinfo.nih.gov/ed_resources/glossary http://www.aegis.com/ni/topics/glossary http://www.gmhc.org/health/glossary2.html HIGH-RISK GROUPS/POPULATIONS WITH HIGHER-RISK OF EXPOSURE TO HIV These terms should be used with caution as they can increase stigma and discrimination. They may also lull people who don’t identify with such groups into a false sense of security. ‘High-risk group’ also implies that the risk is contained within the group whereas, in fact, all social groups are interrelated. It is often more accurate to refer directly to ‘higher risk of HIV exposure’, ‘sex without a condom’, ‘unprotected sex’, or ‘using non-sterile injection equipment’ rather than to generalize by saying ‘high-risk group’. Membership of groups does not place individuals at risk, behaviours may. In the case of married and cohabiting people, particularly women, it may be the risky behaviour of the sexual partner that places them in a ‘situation of risk’. There is a strong link between various kinds of mobility and heightened risk of HIV exposure, depending on the reason for mobility and the extent to which people are removed from their social context and norms.

Page 220 Responding to HIV and AIDS. A toolkit for youth peer educators. Annex

Term Definition

A condition caused by infection with Human Immunodeficiency Virus (HIV). HIV injures cells in the immune system. This impairs the body’s ability to fight disease. AIDS (Acquired People with AIDS are susceptible to a wide range of unusual and potentially life Immunodeficiency Syndrome) threatening diseases and infections. Diseases can often be treated, but there is no successful treatment for the underlying immune deficiency caused by the virus. AIDS is the last and most severe stage of the clinical spectrum of HIV-related disease.

These are proteins that the body makes to attack foreign organisms and toxins. Foreign organisms and toxins are called antigens. They circulate in the blood. Antibodies are usually effective in removing antigens from the body. Following Antibodies infection by some organisms such as HIV, however, the antibodies do not get rid of the antigen. They only mark its presence. When found in the blood, these ‘marker’ antibodies indicate that infection by HIV has occurred.

Any substance – such as bacteria, virus particles or toxins – that stimulates the body Antigen to produce antibodies. HIV is an antigen.

Blood tests that are designed to detect the antigen instead of antibodies produced in Antigen Screens response to the antigen. There are several types of HIV antigen screens.

Antiretroviral medicine (see Medication used to fight infection by retroviruses, such as HIV infection. also HIV Medications)

A treatment that uses antiretroviral medicines to suppress viral replication and improve symptoms. Effective antiretroviral therapy requires the simultaneous use of Antiretroviral therapy three or four antiretroviral medicines, otherwise known as highly active antiretroviral therapy (HAART).

This term refers to the condition of immunosuppression caused by the HIV infection. General symptoms of HIV disease are present, but none of the formal indicators of ARC (AIDS-related complex) AIDS (such as specific opportunistic infections) are present. This term is now being replaced by PGL (Persistent generalized lymphadenopathy).

Having no signs and symptoms of illness. People can have HIV infection and be asymptomatic. Usually used in AIDS literature to describe a person who has a Asymptomatic positive reaction to one of several tests for HIV antibodies, but who shows no clinical symptoms of the disease.

Any fluids made by the body. The only body fluids that may contain significant concentrations of HIV are: blood (including menstrual blood), semen, breast milk, Body Fluids peritoneal fluid, amniotic fluid etc. Other body fluids that may fall under this category are body cavity fluids derived from blood such as cerebrospinal fluid (more important for health professionals).

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 221 HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) The name given to treatment regimens recommended by leading HIV experts to aggressively suppress viral replication and slow the progress of HIV disease. The usual HAART regimen combines three or more different drugs such as two nucleoside reverse transcriptase inhibitors and a protease inhibitor, two NRTIs and a non-nucleoside reverse transcriptase inhibitor or other combinations. More recently, a new drug has been developed to prevent the virus from entering the cell. These treatment regimens have been shown to reduce the amount of virus so that it becomes undetectable in a patient’s blood. (See http://www.AIDSinfo.nih.gov/, a service of the US Department of Health and Human Services). The term ART (antiretroviral treatment or therapy) can be used if it clearly refers to a triple antiretroviral drug combination. HIPC INITIATIVE The Heavily Indebted Poor Countries Initiative is a debt relief tool for increasing the funds that countries have available, and for ensuring that they are channelled to core human development priorities, such as basic health care. The HIPC initiative, created in 1996 by the World Bank and further enhanced in 1999, has already helped some of the poorest nations in the world to free up precious resources for human development that would otherwise have been spent on servicing debt. Fully funded and implemented, the enhanced HIPC initiative has the potential to be an even more powerful tool for helping countries to devote more resources to combating infectious disease. HIV-RELATED DISEASE Symptoms of HIV-infection may occur both at the beginning of HIV infection and after immune compromise sets in, leading to AIDS. During the initial infection with HIV, when the virus comes into contact with the mucosal surface, it finds susceptible target cells and moves to lymphoid tissue where massive production of the virus ensues. This leads to a burst of high-level viraemia (virus in the bloodstream) with wide dissemination of the virus. Some people may have flu-like symptoms at this stage but these are generally referred to as symptoms of primary infection rather than HIV- related disease. The resulting immune response to suppress the virus is only partially successful and some virus escapes and may remain undetectable for months to years. Eventually high viral turnover leads to destruction of the immune system, sometimes referred to as advanced HIV infection. HIV disease is, therefore, characterized by a gradual deterioration of immune function. During the course of infection, crucial immune cells, called CD4+ T cells, are disabled and killed, and their numbers progressively decline. HIV-INFECTED As distinct from HIV-positive (which can sometimes be a false positive test result, especially in infants of up to 18 months of age), the term HIV- infected is usually used to indicate that evidence of HIV has been found via a blood or tissue test. HIV-NEGATIVE Showing no evidence of infection with HIV (e.g. absence of antibodies against HIV) in a blood or tissue test. Synonymous with seronegative. An HIV-negative person can be infected if he or she is in the window period between HIV exposure and detection of antibodies. HIV-POSITIVE Showing indications of infection with HIV (e.g. presence of antibodies against HIV) on a test of blood or tissue. Synonymous with seropositive. Test may occasionally show false positive results.

Page 222 Responding to HIV and AIDS. A toolkit for youth peer educators. HUMAN IMMUNODEFICIENCY VIRUS (HIV) The virus that weakens the immune system, ultimately leading to AIDS. Since HIV means ‘human immunodeficiency virus’, it is redundant to refer to the HIV virus. HUMAN IMMUNODEFICIENCY VIRUS TYPE 1 (HIV-1) The retrovirus isolated and recognized as the etiologic (i.e., causing or contributing to the cause of a disease) agent of AIDS. HIV-1 is classified as a lentivirus in a subgroup of retroviruses. Most viruses and all bacteria, plants, and animals have genetic codes made up of DNA, which uses RNA to build specific proteins. The genetic material of a retrovirus such as HIV is the RNA itself. HIV inserts its own RNA into the host cell’s DNA, preventing the host cell from carrying out its natural functions and turning it into an HIV factory. HUMAN IMMUNODEFICIENCY VIRUS TYPE 2 (HIV-2) A virus closely related to HIV-1 that has also been found to cause AIDS. It was first isolated in West Africa. Although HIV-1 and HIV-2 are similar in their viral structure, modes of transmission, and resulting opportunistic infections, they have differed in their geographical patterns of infection and in their propensity to progress to illness and death. Compared to HIV-1, HIV-2 is found primarily in West Africa and has a slower, less severe clinical course. ILO The International Labour Organization is one of UNAIDS’ ten Cosponsors (see http://www.ilo.org/). INCIDENCE HIV incidence (sometimes referred to as cumulative incidence) is the proportion of people who have become infected with HIV during a specified period of time. UNAIDS normally refers to the number of people (of all ages) or children (0–14) who have become infected during the past year. In contrast HIV prevalence refers to the number of infections at a particular point in time (like a camera snapshot). In specific observational studies and prevention trials, the term incidence rate is used to describe incidence per hundred person years. INJECTING DRUG USERS (IDUs) This term is preferable to drug addicts or drug abusers, which are seen as derogatory and which often result in alienation rather than creating the trust and respect required when dealing with those who inject drugs. UNAIDS does not use the term ‘intravenous drug users’ because subcutaneous and intramuscular routes may be involved. It is preferable to spell out in full and not use the abbreviation. INTERVENTION This term conveys “doing something to someone or something” and as such undermines the concept of participatory responses. Preferred terms include programming, programme, activities, initiatives, etc. MILLENNIUM DEVELOPMENT GOALS (MDGs) Eight goals developed at the Millennium Summit in September 2000. Goal six refers specifically to AIDS but attainment of several goals is being hampered by the HIV epidemic. http://www.un.org/millenniumgoals/ MONITORING AND EVALUATION REFERENCE GROUP Established by UNAIDS, the Monitoring and Evaluation (M&E) Reference Group (MERG) has a broad membership of national, bilateral agency and independent evaluation expertise, enabling it to assist in the harmonization

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 223 of M&E approaches among collaborating organizations and in the development of effective monitoring and evaluation of the response to the epidemic. http://elink.unAIDS.org/menew/Resource/Resource1.asp MSM Abbreviation for ‘men who have sex with men’ or ‘males who have sex with males’. This term is useful as it includes not only men who self identify as ‘gay’ or homosexual and have sex only with other men but also bisexual men, and heterosexual men who may, nonetheless at times have sex with other men. http://www.unAIDS.org/publications/documents/specific/men/mentue2000.pdf MTCT Abbreviation for ‘mother-to-child transmission’ (pMTCT is the abbreviation for ‘prevention of mother-to-child transmission’). Some countries prefer the term ‘parent-to-child transmission’ to avoid stigmatising pregnant women and to encourage male involvement in HIV prevention. Prevention of parent-to-child transmission then becomes pPTCT. http://www.unAIDS.org/ publications/documents/mtct/index.html NAC National AIDS Coordinating Authority (formerly National AIDS Council): the acronym should generally be avoided. http://www.cns.sante.fr/web_sida/uk/htm/home/index2.htm NACP National AIDS Control Programme. NAP National AIDS Programme. NSP National Strategic Plan. Other terms are national AIDS action frameworks and annual AIDS action plans. Recommend avoiding the abbreviation. OPPORTUNISTIC INFECTIONS Illnesses caused by various organisms, some of which usually do not cause disease in persons with healthy immune systems. Persons living with advanced HIV infection may suffer opportunistic infections of the lungs, brain, eyes and other organs. Opportunistic illnesses common in persons diagnosed with AIDS include Pneumocystis carinii pneumonia, cryptosporidiosis, histoplasmosis, other parasitic, viral and fungal infections; and some types of cancers. ORPHANS In the context of AIDS, it is preferable to say ‘children orphaned by AIDS’ or ‘orphans and other children made vulnerable by AIDS’. Referring to these children as ‘AIDS orphans’ not only stigmatizes them, but also labels them as HIV-positive, which they may not necessarily be. Identifying a human being by his/her medical condition alone also shows a lack of respect for the individual. Contrary to traditional usage UNAIDS uses ‘orphan’ to describe a child that has lost either one or both parents. PAF See PROGRAMME ACCELERATION FUNDS.

Page 224 Responding to HIV and AIDS. A toolkit for youth peer educators. PAHO Pan American Health Organization: http://www.paho.org/ PANDEMIC A disease prevalent throughout an entire country, continent, or the whole world. Preferred usage is to write ‘pandemic’ when referring to global disease and to use ‘epidemic’ when referring to country or regional level. For simplicity, UNAIDS often uses ‘epidemic’, see EPIDEMIC. PATHOGEN An agent causing disease. PCB The Programme Coordinating Board of UNAIDS. http://www.unAIDS.org/ about/governance/governance.html PEOPLE LIVING WITH HIV Avoid the expression ‘people living with HIV and AIDS’ and the abbreviation PLWHA. With reference to those living with HIV, it is preferable to avoid certain terms: AIDS patient should only be used in a medical context (most of the time, a person with AIDS is not in the role of patient); the term AIDS victim or AIDS sufferer implies that the individual in question is powerless, with no control over his or her life. It is preferable to use ‘people living with HIV’ (PLHIV), since this reflects the fact that an infected person may continue to live well and productively for many years. Referring to people living with HIV as innocent victims (which is often used to describe HIV-positive children or people who have acquired HIV medically) wrongly implies that people infected in other ways are somehow deserving of punishment. It is preferable to use ‘people living with HIV’, or ‘children with HIV’. http://www.unAIDS.org/publications/documents/persons/index.html PEPFAR The US President’s Emergency Plan for AIDS Relief announced by President George W. Bush in his State of the Union Address 28 January 2003, the plan is ‘a five-year US$ 15 billion initiative aimed at turning the tide in combating the global HIV/AIDS pandemic’. http://www.whitehouse.gov.news/ releases/2003/01/print/20030129-1.html POVERTY REDUCTION STRATEGY PAPERS (PRSPs) Poverty Reduction Strategy Papers are prepared by the member countries through a participatory process involving domestic stakeholders as well as external development partners, including the World Bank and International Monetary Fund”. http://www.imf.org/external/np/prsp/prsp.asp PREVALENCE Usually given as a percentage, HIV prevalence quantifies the proportion of individuals in a population who have HIV at a specific point in time. UNAIDS normally reports HIV prevalence among adults, aged 15–49 years. We do not say prevalence rates because a time period of observation is not involved. ‘Prevalence’ is sufficient, e.g. ‘the Caribbean region, with estimated adult HIV prevalence of 2.3% in 2003, is an area to focus on in the future’.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 225 PROGRAMME ACCELERATION FUNDS (PAF) Programme acceleration funds were designed to assist the UN Theme Group to play a catalytic and facilitating role in advancing the scope, scale and effectiveness of a country’s response to the AIDS epidemic. Activities to be funded must be in line with one or more of the five cross-cutting functions of UNAIDS: to empower leadership for an effective country response; to mobilize and empower public, private and civil society partnerships and civil society engagement; to strengthen strategic information management; to build capacities to plan, track, monitor and evaluate country responses; and to enable access to, and efficient use of, financial and technical resources. In addition funded activities must be in accordance with Global Task team (GTT) recommendations http://www.unAIDS.org/ PROSTITUTION Use this term in respect to juvenile prostitution. Otherwise for older age groups, use ‘commercial sex’ or ‘the sale of sexual services’. PROVIDER-INITIATED TESTING Under certain circumstances, when an individual is seeking medical care, HIV testing may be offered. It may be diagnostic—patient presents with symptoms that may be attributable to HIV or has an illness associated with HIV such as tuberculosis—or it may be a routine offer to an asymptomatic person. For example, HIV testing may be offered as part of the clinical evaluation of patients with sexually transmitted infections and pregnant women. HIV testing may be offered to all patients where HIV is prevalent. Regardless of the type of testing and the location of the offer, all HIV testing should always be carried out under conditions respecting the three Cs—confidentiality, informed consent and counselling. Testing without counselling has little impact on behaviour and is a significant lost opportunity for assisting people to avoid acquiring or transmitting infection. http://www.unAIDS.org/en/Policies/Testing/ PTCT Parent-to-child transmission. A term preferred in some countries (see MTCT). REDPES Red Latinoamericano y del Caribe de Planificación Estratégica (Latin American and Caribbean Network on Strategic Planning and AIDS). http:// ciss.insp.mx/redpes/ REGIONAL SUPPORT TEAM (RST) A team that oversees and coordinates UNAIDS activities in a defined geographical region. RISK Avoid using the expressions ‘groups at risk’ or ‘risk groups’. People with behaviours which may place them at higher risk of exposure to HIV do not necessarily identify themselves with any particular group. Risk refers to risk of exposure to HIV which may be high as a result of specific behaviours or situations. Examples of the latter include risk in discordant couples unaware of their serostatus and recipients of unscreened blood or blood products. Behaviours, not memberships, place individuals in situations in which they may be exposed to HIV. Some populations may be at increased risk of exposure to HIV.

Page 226 Responding to HIV and AIDS. A toolkit for youth peer educators. SAFE SEX Use by preference the term safer sex because safe sex may imply complete safety. Sex is 100% safe from HIV transmission when both partners know their HIV-negative serostatus and neither partner is in the window period between HIV exposure and appearance of HIV antibodies detectable by the HIV test. In other circumstances, reduction in the numbers of sexual partners and correct and consistent use of male or female condoms can reduce the risk of HIV transmission. The term safer sex more accurately reflects the idea that choices can be made and behaviours adopted to reduce or minimise risk. SECOND GENERATION SURVEILLANCE Built upon a country’s existing data collection system, second generation HIV surveillance systems are designed to be adapted and modified to meet the specific needs of differing epidemics. For example, HIV surveillance in a country with a predominantly heterosexual epidemic will differ radically from surveillance in a country where HIV infection is mostly found among men who have sex with men (MSM) or injecting drug users (IDUs). This form of surveillance aims to improve the quality and diversity of information sources by developing and implementing standard and rigorous study protocols, using appropriate methods and tools. SEROPREVALENCE As related to HIV infection, the proportion of persons who have serologic evidence of HIV infection, i.e. antibodies to HIV at any given time. SEROSTATUS A generic term that refers to the presence/absence of antibodies in the blood. Often, the term refers to HIV antibody status. SEXUALLY TRANSMITTED INFECTION (STI) Also called venereal disease (VD) (an older public health term) or sexually transmitted diseases (STDs) a term that does not convey the concept of asymptomatic sexually transmitted infections. Sexually transmitted infections are spread by the transfer of organisms from person to person during sexual contact. In addition to the ‘traditional’ STIs (syphilis and gonorrhoea), the spectrum of STIs now includes HIV, which causes AIDS; Chlamydia trachomatis; human papilloma virus (HPV) which can cause cervical or anal cancer; genital herpes; chancroid; genital mycoplasmas; hepatitis B; trichomoniasis; enteric infections; and ectoparasitic diseases (i.e., diseases caused by organisms that live on the outside of the host’s body). The complexity and scope of sexually transmitted infections have increased dramatically since the 1980s; more than 20 organisms and syndromes are now recognized as belonging in this category. SEX WORK ‘Commercial sex work’ is considered a tautology, which is saying the same thing twice over in different words. Preferred terms are ‘sex work’, ‘commercial sex’, and ‘the sale of sexual services’. SEX WORKER This term has been widely used in preference to ‘prostitute’93. The term ‘sex worker’ is intended to be non-judgmental, focusing on the conditions under which sexual services are sold. Alternate formulations are: ‘women/men/ people who sell sex’. Clients of sex workers may then also be called ‘men/ women/people who buy sex’. The term ‘commercial sex worker’ is no longer used, primarily because it is considered to be saying something twice over in different words (i.e. a tautology).

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 227 SHARING When referring to injecting equipment we do not use the word ‘sharing’ in UNAIDS publications. Instead, write ‘use of contaminated injecting equipment’ if you are considering HIV transmission and ‘use of non-sterile injecting equipment’ if you are considering risk of HIV exposure. This is because injecting drug users uncommonly ‘share’ their needles in the usually understood sense of the word—with the exception of sexual partners who inject together. In the absence of needle exchanges, people may use discarded needles (which are anonymous) or bargain away drugs for a needle or are injected by professional injectors. They do not regard this as sharing. Neither does ‘sharing’ distinguish between needle borrowing and needle lending; this is important because (usually) diﬀerent dynamics are at work. A person aware of his or her HIV-positive status may try to avoid lending, but may continue to borrow or vice versa. Also ‘sharing’ has positive connotations, e.g. sharing a meal in injecting drug use communities (and wider communities also) which are not appropriate in writing about HIV risk. SIDA Swedish International Development Agency: http://www.sida.se/Sida/jsp/ polopoly.jsp?d=107 Sida is also the French language acronym for AIDS which has become an accepted word that is not capitalised. SIDALAC Iniciativa regional sobre SIDA para América Latina y el Caribe: in English ‘The Regional AIDS Initiative for Latin America and the Caribbean’. http:// www.sidalac.org.mx/english/homee.html STIGMA and DISCRIMINATION As the traditional meaning of stigma is a mark or sign of disgrace or discredit, the correct term would be stigmatization and discrimination; however, ‘stigma and discrimination’ has been accepted in everyday speech and writing, and may be treated as plural. SURVEILLANCE The ongoing and systematic collection, analysis, and interpretation of data about a disease or health condition. Collecting blood samples for the purpose of surveillance is called serosurveillance. TARGET This term is acceptable as a noun referring to an objective or goal. Avoid using as a verb for example “targeting men who have sex with men…” as this conveys non-participatory, top-down approaches. Preferred alternative terms include: “programmes for and by men who have sex with men”; “engaging men who have sex with men in programming”; and “programmes involving men who have sex with men in the response to the epidemic”, etc. TESTING HIV testing is pivotal to both prevention and treatment interventions. The ‘3Cs’ continue to be underpinning principles for the conduct of all HIV testing of individuals; testing must be: conﬁdential; accompanied by counselling; only be conducted with informed consent, meaning that it is both informed and voluntary. A full policy statement is available. http://www.unAIDS.org/en/Policies/Testing/default.asp

Page 228 Responding to HIV and AIDS. A toolkit for youth peer educators. TRIPS AGREEMENT Trade-Related Intellectual Property Rights Agreement, supervised by the World Trade Organization, provides certain ﬂexibilities to low and middle income countries with respect to pharmaceutical patent protection. http:// www.wto.org/english/tratop_e/trips_e/t_agm0_e.htm UCC UNAIDS Country Coordinator (formerly called Country Programme Adviser—CPA). UN Reference Group on HIV Prevention and Care among IDU in Developing and Transitional Countries: www.idurefgroup.org UNAIDS Reference Group on HIV and Human Rights: www.unAIDS.org/en/in+focus/hiv_AIDS_human_rights/reference+group.asp

UNAIDS Reference Group on Estimates, Modelling and Projections: www. epidem.org UNAIDS Reference Group on Prevention: www.unAIDS.org UNDP The United Nations Development Programme, one of UNAIDS’ ten Cosponsors (see http://www.undp.org/). UNESCO The United Nations Educational, Scientific and Cultural Organization, one of UNAIDS’ ten Cosponsors (see http://www.unesco.org/). UNFPA The United Nations Population Fund, one of UNAIDS’ ten Cosponsors (see http://www.unfpa.org/). UNHCR The Office of the United Nations High Commissioner for Refugees, one of UNAIDS’ ten cosponsors (see http://www.unhcr.org) UNICEF The United Nations Children’s Fund, one of UNAIDS’ ten Cosponsors (see http://www.unicef.org/). UNODC The United Nations Office on Drugs and Crime, one of UNAIDS’ ten Cosponsors (see http://www.unodc.org/odccp/index.html). UNIVERSAL PRECAUTIONS Standard infection control practices to be used universally in healthcare settings to minimize the risk of exposure to pathogens, e.g. the use of gloves, barrier clothing, masks and goggles (when anticipating splatter) to prevent exposure to tissue, blood and body fluids. URGE The UNAIDS Reference Group on Economics.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 229 VCT Abbreviation for ‘voluntary counselling and testing’. All testing should be conducted in an institutional environment which has adopted the ‘Three Cs’: conﬁdentiality, informed consent, and counselling. http://www.unAIDS.org/publications/documents/health/counselling/index.html VERTICAL TRANSMISSION Sometimes used to indicate transmission of a pathogen such as HIV from mother to foetus or baby during pregnancy or birth but may be used to refer to the genetic transmission of traits. WEF World Economic Forum: http://www.weforum.org/ WFP World Food Programme. http://www.wfp.org/index2.html, one of UNAIDS’ ten cosponsors. WIPO World Intellectual Property Organization. http://www.wipo.org/ WHO The World Health Organization is one of UNAIDS’ ten Cosponsors (see http://www.who.int/en/). WORLD BANK The World Bank is one of UNAIDS’ ten Cosponsors (see http://www.worldbank.org/). WSSD World Summit for Social Development. http://www.visionoﬃce.com/socdev/wssd.htm

Page 230 Responding to HIV and AIDS. A toolkit for youth peer educators. Short summary of terms to avoid when writing and speaking about HIV or AIDS

Do not use this Use this HIV AIDS virus There is no “AIDS virus”. The virus associated with AIDS is called the Human Immunodeficiency Virus, or HIV.

HIV HIV virus The abbreviation “HIV” includes the word virus, so “HIV virus” is redundant.

HIV-positive people or people living with HIV AIDS sufferers Many people living with HIV are healthy and happy. People living with AIDS can have periods of relatively good health. They should not be portrayed as suffering.

Person living with HIV or HIV-infected person

AIDS-infected person People can be infected with HIV, but no one can be infected with AIDS, because it is not a virus or single disease. AIDS is a syndrome of opportunistic infections and diseases that can develop at the end stage of the continuum of HIV disease.

HIV-positive person or HIV-infected person What is the difference in the way these terms are used? Three distinctions can be made between the ways the terms “HIV positive” and “HIV infected” are used. 1. Different tests. An HIV-positive person has tested positive for HIV antibodies. There can be rare “false positive” results on these tests. All infants born to mothers with HIV-infection will HIV-infected person, HIV-positive test positive up to 18 months of age when the mother’s antibodies disappear from the baby’s person blood. A baby that is infected will continue to test HIV-positive after that time. However, a different test for evidence of HIV in blood (antigen test) can confirm whether a baby who has tested HIV-positive has HIV infection or not. 2. Lack of awareness. Only about 10 per cent of people infected with HIV worldwide have been tested and are aware that they have HIV infection. 3. Preference. Some people prefer the word “positive” to the word “infected”, so they use the term “HIV-positive” except when emphasizing points 1 or 2 above.

Patient with HIV-related illness or disease. Use these terms when referring to a hospital setting or to the medical care a person is AIDS patient receiving. Can be used to refer to a person who has been diagnosed with AIDS. Avoid the term ‘full-blown AIDS’.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 231 Do not use this Use this

To have AIDS or live with HIV People with AIDS are not victims. To call someone a victim stigmatizes them by implying AIDS victims or innocent victims powerlessness. The word “innocent” is sometimes used when talking about children who are infected. This is stigmatizing to others living with HIV, because it implies that they are somehow “guilty”.

Person living with HIV

AIDS victim or sufferer The word “victim” is stigmatizing. Use “person with AIDS” or “person living with HIV”. And only use the term AIDS when the person you are referring to actually has an AIDS diagnosis. A person who is HIV-infected does not necessarily have AIDS.

To die of an HIV-related illness. AIDS is not a single disease, but a syndrome of opportunistic infections and diseases. People To die of AIDS do not die of the syndrome. They die from opportunistic infections or diseases, such as pneumonia, that their immune system cannot fight as a result of HIV infection. However, ‘to die of AIDS’ is common usage and can be used. HIV antibody test or HIV test Test for AIDS There is no test for AIDS. AIDS testing Tests can determine whether antibodies to HIV are present or whether there is actual evidence AIDS blood test of the virus in the blood or tissue samples.

Risk of HIV infection

Risk of contracting AIDS Acquiring HIV infection Risk of AIDS infection Transmitting HIV Transmitting AIDS AIDS is not a single disease. It is a syndrome. HIV-positive people are at risk of developing AIDS. No one is at risk of acquiring HIV from social contact. Only HIV, not AIDS, can be transmitted from person to person.

Drug therapy AIDS-related drugs Drugs for AIDS AIDS-related drugs are used to combat specific opportunistic infections, such as tuberculosis or pneumonia. AIDS is not a single disease. Antiretroviral therapy is the standard treatment for AIDS.

Response to HIV Transmission prevention (or simply prevention) Fight against AIDS Avoid using all combatant language (e.g. battle, struggle, campaign, war) whenever possible. Other alternatives include: initiative, programme, action, and efforts.

Page 232 Responding to HIV and AIDS. A toolkit for youth peer educators. UNAIDS editorial house style

Abbreviations: spell out in full whenever possible; always spell out in titles and subheadings. Try to restrict usage to direct quotations or full titles, or when very frequent repetition of the full words would distract rather than aid the reader. Try to avoid creating new abbreviations for common expressions e.g. there is unlikely to be any imperative need to create and use AWP for annual work plan. When an abbreviation is used as an adjective (e.g. UN system, US Government, PMTCT programmes) it should be spelled out on first usage if the meaning may not be clear to all readers. In general, try to avoid the use of abbreviations and acronyms. Advocate (as a verb): write ‘advocate change’ (rather than advocate for change) Ampersand (&): avoid using this symbol unless it is part of an official name or title. Do not use HIV & AIDS. ‘And/or’: try to avoid by rewriting. ART: spell out in full, i.e., antiretroviral therapy or ARV treatment. ARV: spell out in full, i.e., antiretroviral (drug) ‘Assist in implementing’, but ‘help implement’. Behaviour change (rather than behavioural change). Bibliographies and footnotes: authors in bibliographies and footnotes are listed as last name and initial (no periods or commas, as per Harvard style), followed by year of publication in parentheses, title of publication (in italics, unless a paper), place of publication, and publisher. For example: Hardstaff P (2003). Treacherous conditions: how IMF and World Bank policies tied to debt are undermining development. London, World Development Movement. Meda N et al. (1999). Low and stable HIV infection rates in Senegal: natural course of the epidemic or evidence for success of prevention? AIDS, 13(11):1397–1405.

Bullet points should be used to assist readers’ understanding. Documents with many bulleted lists lose impact. If bullet points are required use only a simple point, not any other ‘fancy’ style, to make typesetting easier. Country names and inhabitants: refer to and follow the styles listed by WHO in the Style Guide. On title pages, in signatures and in recording nominations, elections and votes, full names of countries must be used: the United Kingdom of Great Britain and Northern Ireland and the United States of America. Thereafter, short form may be used: the United Kingdom and the United States or the USA. Countries must be listed in the alphabetical order of their official names when featured in a text. To avoid possible confusion, note especially the distinction between the Republic of the Congo (also referred to as Congo—Brazzaville); and the Democratic Republic of the Congo (also referred to as the DRC). Currency: when dollar figures are mentioned, they are normally US dollars (unless otherwise indicated) and should be written thus: US$ 1000. Avoid using ‘m’ to denote million, or ‘b’ to denote billion. Always convert local currencies into US dollar equivalents and cite the approximate US$ figure in brackets e.g. ‘In the United Kingdom it is estimated that it will cost

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 233 £100 000 (approximately US$ 175 000) per year…’. Exchange rates used should be current at time of writing. Dashes: en and em dashes are printers’ terms, named because the smaller is the width of a capital ‘N’ and the larger is the width of a capital ‘M’. Use an en dash between figures to show a range (e.g. 14–16 February, 10–20%). Use an em dash to further explain a clause (e.g. Women account for an increasing share of newly diagnosed HIV infections—33% in 2002, compared to 24% a year earlier). Avoid ‘between 14-20%’ or ‘from 23-24 March’, as opposed to ‘between 14% and 20%’ and ‘from 23 to 24 March’. To use en and em dashes in Word, click on ‘Insert’ on the tool bar, select ‘Symbol’, select the en or em dash and then click the ‘insert’ box. Figures and tables. Figures are illustrative materials of any type (e.g. photograph, diagram) that are not tables; tables present numerical data in cells. Number both separately and sequentially commencing with number one, e.g. Figure 1, Figure 2, Table 1. Remember to provide a reference to the source of all illustrations and tables other than those newly created by the author. Footnote reference numbers in texts should be included inside the punctuation of the relevant sentence, rather than after the period—for example: HIV infection rates rose tenfold in two years2. Geography: eastern, northern, southern, western; capitalize if used to describe countries (geopolitical) so e.g. ‘…the governments of East Africa…’ but lower case if only geographical, e.g. ‘… spread of infection in western Europe…’ Government is only capitalized if used in conjunction with a particular country, as in ‘…the Kenyan Government…’ Hyphens and dashes follow WHO rules in its Style Guide. Do not use a hyphen where a dash is required. To use en and em dashes in Word click on ‘insert’ on the tool bar, select dash and click insert box. -Ise, -ize and -yse spellings: where there is a choice (e.g. organize or organise), ize, derived from the Greek suffix “-izo”, is preferred. Some words such as comprise, surprise and televise must be spelled with -ise. “-yse” must be used for words derived from the Greek lusis, as in analyse, and therefore cannot be spelled -yze. When in doubt, consult the list in the WHO Style Guide. Direct quotations or proper names must use the spelling of the original. Our definitive reference is The Concise Oxford Dictionary. Language option setting in Word: use English (U.K.) option on spell check Latin and other language expressions: try to avoid using them. If you use a foreign expression and it is likely to be familiar to your readers, do not put in italics in text. Like and such as: beware of using ‘like’ in place of ‘such as’. Rather than ‘… in countries like Nigeria and Uganda’ (there are no countries like Nigeria and Uganda), it is more accurate to say ‘in countries such as Nigeria and Uganda …’ or ‘in several countries including…’. Numbers: spell out numbers in full up to and including nine. From 10 upwards use numerals, except at the beginning of a sentence. Rewrite a sentence to avoid beginning it with numerals. Per cent or percent: do not use this form unless the number is written in words. Use the symbol, %, with numerals.

Page 234 Responding to HIV and AIDS. A toolkit for youth peer educators. Punctuating lists: Punctuate lists as if they are sentences, as in this example. In preparing text care should be taken to: • avoid unfamiliar and technical expressions, • ensure that abbreviations are spelled out in full, • present data in a consistent style, and • ensure that the reference list is complete. Punctuation: no punctuation is required for acronyms and abbreviations, including USA and UK, but these should not be used; spell out in full whenever possible. Quotation marks: always use single quotation marks unless you are quoting someone directly. For example, to denote an uncommonly used word, a newly coined term, or a term used out of context, single quotation marks should be used. (e.g. The teenagers considered themselves to be very ‘hip’). Direct quotes are written thus: “Things can only get worse,” said Dr Musanga. If whatever is inside the quotation marks constitutes a complete, free-standing sentence, then the quotation marks close outside the period. If, however, a quotation is contained within a sentence, then the quotation marks close before the period—e.g. The president made a very positive speech on World AIDS Day, saying that he felt “the situation had greatly improved since last year”. ‘Scale up’, when used as verb; ‘scale-up’ or ‘scaling-up’ when used as noun. Same for ‘follow up’ (verb) versus ‘follow-up’ (noun). Simple short words and sentences are always preferred (remember, many who read your documents may not have English as their ﬁrst language). Sexist, stereotyping or belittling language. Avoid it; e.g. do not write ‘male nurse’ which implies that being male and a nurse is unusual. People ‘live with disabilities’ just as people ‘live with HIV’; they should not be referred to as ‘the disabled’ or ‘suﬀering from’ or a ‘victim’. Also avoid use of over- dramatic language, though the expression of emotion and empathy obviously has its place in our work’. Sub-Saharan Africa is written as ‘sub-Saharan Africa’, unless at the beginning of a sentence. “3 by 5” Initiative: always cite in this form, with double quotation marks. “Three Ones” principles: always use in this form, with double quotation marks. Titles of publications. When writing the title of a publication in text, use the ‘upstyle’ form, e.g. • Last year UNAIDS published the 2004 Report on the Global AIDS Epidemic. However, when citing a title in a biography or footnote, use the ‘downstyle’ form referred to in the entry on “Bibliographies and footnotes” above, e.g. • UNAIDS (2004). 2004 Report on the global AIDS epidemic. UNAIDS, Geneva. Units of measure are written with a space between the number and the unit, e.g. 10 km, 16 mg.

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 235 Upstyle versus downstyle. Either can be used for headings and subheadings in UNAIDS layout. In an upstyle title, capitalize every word except for articles, prepositions and conjunctions. In a downstyle title, capitalize the first word and proper nouns, as you would when writing a sentence, e.g.: Upstyle: HIV-Related Stigma, Discrimination and Human Rights Violations Downstyle: HIV-related stigma, discrimination and human rights violations ‘Which’ is often used where ‘that’ is correct. ‘Which’ is normally used with reference to a preceding clause (e.g.: He returned to the office early, which was a good idea…), whereas ‘that’ usually qualifies what precedes it (e.g.: the explosion that killed four people last night was caused by a gas leak). Some preferred spellings • adviser, not advisor • ageing, not aging • among, not amongst • analyse, not analyze • by-law, by-product • capacity building (unless used as an adjective, eg ‘capacity-building activities’) • case-load, case-study • decision-maker • Director-General • et al. (no italics) • HIV-positive (not HIV+; similarly, HIV-negative, not HIV-) • inasmuch as • intercountry (not inter-country) • interagency (not inter-agency) • multisectoral (not multi-sectoral or multi-sectorial) • policy-making • programme (unless referring to a computer software program) • seroprevalence (not sero-prevalence; also serostatus) • socioeconomic (not socio-economic) • time-scale • test-tube • under way, not underway

Page 236 Responding to HIV and AIDS. A toolkit for youth peer educators. (Footnotes)

1 Section 3, HIV and Aids Policy and Strategy \Guidelines, Council for World Mission, November 2005

2 Section 5.7 HIV and Aids Policy and Strategy \Guidelines, Council for World Mission, November 2005

3 The Sexuality Information and Education Council of the United States, SIECUS, quoted in Aids Helpline Counsellor Training Manual, Johns Hopkins University et al August 2000

4 Taken from HIV/Aids Counselling Training Manual for the Church, Presbyterian Church of Ghana HIV/Aids project

5This section draws extensively on the excellent website of AVERT, www.avert.org

6 Strengthening Community Responses to HIV/Aids, UNDP, August 2000

7 A poll in South Africa found that 70% of teenagers wished they had learned about sex from their parents, but only 22% actually did

8 The exercise is produced courtesyc of www.avert.org

9 Section 3, HIV and Aids: Policy and Strategy Guidelines, Council for World Mission, November 2005

10 Opportunistic infections include for example TB, shingles and pneumonia

11 Common STIs include chancroid, herpes, hepatitis B, syphilis, gonorrhoea, chlamydia, genital warts

12 Congolese singer, Franco Luambo Makiadi, who died of Aids

13 We are indebted to AMFAR – an American AIDS Research group – for much of the content of this section.

14 Section 3, HIV and Aids Policy and Strategy Guidelines, Council for World Mission, November 2005

15 This is an example of playback theatre

16 In his message for World AIDS Day 2002, Dr. Peter Piot, UNAIDS Executive Director, said that “In Africa, AIDS has had a catastrophic eﬀect on food security. With millions killed by AIDS, and millions more left ill, whole communities have been left defenceless when drought arrives”.

17 The drive for cheaper drugs is a major focus of attention of UN agencies and Aids activists .

18/19 Section 4.2.1, HIV and Aids Policy and Strategy Guidelines, Council for World Mission, November 2005

20 This section draws extensively on Family Planning Plus: HIV/AIDS Basics for NGOs and Family Planning managers, The Centre for Development and Population Activities, CEDPA Washington DC, USA

21 This belief is widespread in many parts of the world and has led to the deaths of many hundreds of girls and young women. Sadly, this happens most commonly within the family where there is an environment of trust

22 Test on Aid knowledge, Nairobi, Kenya

23 The Guardian: Vatican: condoms don’t stop AIDS

24 SavetheChildren.org Responding to HIV and AIDS. A toolkit for youth peer educators. Page 237 25 Council for World Mission News, November 27, 2002

26 UNAIDS & WHO December 2006 AIDS Epidemic Update

27 UNAIDS/WHO Aids Update, December 2006

28 Where data is missing it is either not available or relatively small

29 Data is not yet available for the Cayman Islands

30 Figures for Hong Kong from 2005 Update. They are not listed separately for 2006

31 No data available for Solomon Island, Nauru, Kiribati, Tuvalu, American Samoa, Papua New Guinea, Samoa

32 Figures from 2005

33 UNAIDS and the World Health Organization (WHO)

34 Towards Universal Access. Scaling up priority HIV/AIDS interventions in the health sector, Progress Report, April 2007, UNAIDS and the World Health Organization (WHO)

35 The WHO distinguishes between the 5 low/middle income regions and one high income region. Comparative statistics for high income countries are not as detailed

36 Estimates from UNAIDS and the World Health Organization (WHO)

37 Comparable ﬁgures for people in need of treatment not available in WHO/UNAIDS report. The UK data, however, indicate that in 2005, 63,500 people were infected with HIV which implies a treatment coverage of 57%

38 Section 3 HIV and AIDS: Policy and Strategy Guidelines, Council for World Mission, November 2005

39 The International Food Policy Research Institute (IFPRI) predicts that globally by 2015, 600 million people will suﬀer from hunger, 900 million people will live in absolute poverty and 128 million pre-school children will be malnourished.

40 Poverty and HIV/AIDS: Impact, Coping and Mitigation Policy, Tony Barnett and Alan Whiteside in AIDS, Public Policy and Child Well-Being, edited by Giovanni Andrea Cornia

41 World Relief, USA February 2003

42 Section 5.2 HIV and Aids Policy and Strategy Guidelines, Council for World Mission, November 2005

43 See Globalization, gender and HIV/AIDS in Ghana, Rose Teteki Abbey Reformed World. Volume 56 (1) March 2006, pg. 37 - 44

44 Section 5.3, HIV and Aids Policy and Strategy Guidelines, Council for World Mission, November 2005

45 The World Council of Churches consultative group on facing AIDS, for example, noted that “by and large the response of the churches to HIV/AIDS has been inadequate, and has, in some cases, even made the problem worse.”

46 Responses of the Faith Based Organisations to HIV/Aids in Dub Saharan Africa, Dr Sue Parry, Southern Africa Regional Coordinator, EHAIA, World Council of Churches

47 Section 5.4, HIV and Aids: Policy and Strategy Guidelines, Council for World Mission, November 2005

48 This section draws heavily on the Windhoek Declaration of December 2003 which was produced by leading academic theologians from ﬁve continents and many church traditions following a UNAIDS sponsored workshop on HIV and Aids related stigma

Page 238 Responding to HIV and AIDS. A toolkit for youth peer educators. 49 See section on stigma and discrimination

50 Section 2, HIV and Aids: Policy and Strategy Guidelines, Council for World Mission, November 2005

51 Section 2, HIV and Aids: Policy and Strategy Guidelines, Council for World Mission, November 2005

52 Guidelines for HIV/AIDS interventions in emergency settings. Inter-Agency Standing Committee Task Force on HIV/AIDS in Emergency Settings. WHO, 2004, p. 13.

53 Guidelines for HIV/Aids interventions in emergency settings, IASC, 2004

54 This form of violence includes speciﬁc acts against women, such as sexual harassment, rape, female and genital mutilation, wife beating, forced marriage, forced prostitution etc. Male rape and mutilation of genitals also constitute gender based violence

55 Para 2.4, HIV and Aids: Policy and Strategy Guidelines, Council for World Mission, November 2005

56 For further deﬁnitions around gender issues see Gender and Development: Concepts and Deﬁnitions, by Hazel Reeves and Sally Baden , Institute of Development Studies, Sussex University, February 2000

57 In this it is diﬀerent from sex which refers to the biological characteristics that categorise someone as either female or male;

58 The causes of vulnerability will vary from society to society

59 It should be noted that any division into categories should not hide the fact that they are inevitably inter-related

60 Taken from the International HIV/Aids Alliance publication, Tools together now! Participatory tools to facilitate mobilizing communities of HIV/Aids, December 2005

61 The Impact of Aids, Department of Economic and Social Aﬀairs, United Nations, 2004

62 UNAIDS/WHO Dec 2006 AIDS epidemic update)

63 In this section on stigma and discrimination we are greatly indebted to the publications of the Health and Development Networks (HDN) and in particular Living on the outside, 2006 together with Understanding and Challenging Stigma: a tool kit for action, Ross Kidd and Sue Clay, The Change project, AED, 2003

64 Section 1.2, HIV and Aids Policy and Strategy Guidelines, Council for World Mission, November 2005

65 Understanding and Challenging HIV Stigma

66 The Rights of Children and Youth Infected and Aﬀected by HIV/Aids, Save the Children (UK)

67 The Role of Stigma and Discrimination in Increasing the Vulnerability of Children and Youth Infected with and Aﬀected by HIV/Aids, a Research Report, Ann Strode, Kitty Barrett Grant, Commissioned by Save the Children (UK), 2001

68 Living on the Outside, Health and Development Networks,2006

69 Quoted in The rights of Children and Youth Infected and Aﬀected by HIV/Aids, Ann Strode and Kitty Barret Grant, Save the Children (UK)

70 Understanding and Challenging Stigma: a tool kit for action, Ross Kidd and Sue Clay, The Change project, AED, 2003

Responding to HIV and AIDS. A toolkit for youth peer educators. Page 239 71 International Guidelines on HIV/AIDS and Human Rights, U.N.C.H.R. res. 1997/33, U.N. Doc. E/CN.4/1997/150 (1997).

72 HIV and Aids: Policy and Strategy Guidelines, Council for World Mission, November 2005

73 Church Aids and Stigma, Discussion Paper 002,Gillian Patterson, Ecumenical Advocacy Alliance

74 Quoted by Gillian Paterson in Church, Aids and Stigma, Discussion paper 002

75 Section 2.5, HIV and Aids Policy and Strategy Guidelines, The Council for World Mission, November 2005

76 Section 3, HIV and Aids Policy and Strategy Guidelines, Council for World Mission, November 2005

77 Adapted from Family Planning Plus: HIV/Aids basics fro NGOs and Family Planning Program Managers, Kathleen Callahan and Laurette Cucuzza, Centre for Development and Population Activities (CEPEDA)

78 Section 5.10, HIV and Aids Policy and Strategy Guidelines, November 2005

79 Politics with soul, Adam Ma’anit. New Internationalist 359, August 2003.

80 Verse 3 Psalm 149, The New Revised Standard Version of the Bible, 1989

81 Columbia Journalism Review “Who Owns What?” at http://www.cjr.org

82 The Media and HIV/AIDS: Making a diﬀerence, UNAIDS, 2004

83 The Advocacy Tool Kit, see Who makes the News? on http://www.whomakesthenews.org

84 See Advocacy Tool Kt, Who makes the News on www.whomakesthenews.org

85 The Windhoek Charter on Broadcasting in Africa (2001) deﬁnes community broadcasting as “broadcasting which is for, by and about the community, and whose ownership and management is representative of the community, which pursues a social development agenda, and which is non-proﬁt.”

86 http://www.amarc.org

87 See http://portal.unesco.org/ci/fr/ﬁle_download.php/ 9f3aef45c6447010890b417095e3a27cCom_radio.pdf

88 See http://www.nelh.nhs.uk/knowledge_management/km2/storytelling_toolkit.asp

89 http://www.nelh.nhs.uk/knowledge_management

90 Adapted from The Media and HIV/AIDS - Making a diﬀerence, UNAIDS, 2004

91 PhotoVoice see web site

92 UNAIDS report 2003

93 Complementary guidance is provided in the World Health Organization Style Guide; general principles of manuscript preparation for UNAIDS are set forth in the ‘Writing and Editorial guidelines for Oﬃcial UNAIDS Document Production’ on the IRC section of UNAIDS intranet.

*For more explanation, see background notes below.

* All web links in this document are up to date. If on clicking the link, the site does not pop up when you are on line to the internet, you can cut and paste the link.

94 Note: if the terms ‘prostitute’ or ‘prostitution’ are found in the oﬃcial name of an organization or the title of a publication, they should not be changed.

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