Women and HIV and AIDS Assignment

Woman to Woman Initiative on HIV and AIDS Cover photo: UNICEF/Insert credits© United Nations Children’s FundUNICEF Somalia Support Centre, 2006For further information and copies, please contact: HIV/AIDS Project Officer UNICEF Somalia Support Centre PO Box 44145 Nairobi 00100 Kenya Email: [email protected] Website : www.unicef.org/somaliaCredits: Technical guidance and supervision: Ulrike Gilbert, HIV/AIDS Project Officer, UNICEF Somalia Support CentreWriter and researcher: Aisha Omar Maulana, Independent consultantLayout: Insert NameTranslation: Insert names Foreword We know that young women are disproportionately vulnerable to HIV infection. It is also well established that women and young girls are often disproportionately affected by the burden of care giving in the epidemic’s wake. Gender inequality and poor respect of human rights of women and girls are key factors which drive the epidemic. The response to HIV and AIDS among Somalis must take account of the gender dimensions of HIV and AIDS and its processes. This resource pack sets out the latest information on HIV and AIDS, why women are more vulnerable, what women need to know and what women can do to protect themselves and their families. It is meant to be a resource pack for facilitators and community volunteers to be used in peer education and outreach efforts to engage Somali women and adolescent girls who do not have access to information on HIV and AIDS. We encourage facilitators to create a “safe space” where women feel comfortable to learn and exchange about HIV and AIDS. The resource pack was developed based on a literature review and builds on international best practices in HIV prevention, treatment, care and support among women. It was put together in close consultation with Somali women who generously gave their time, shared life experiences and helped to decide on priority issues for the resource pack. We are grateful to the numerous Somali women’s development organizations who participated in the pre- testing and revision of the kit. We extend also our appreciation to our international partners and colleagues for their contributions.UNICEF hopes that this resource pack for the ‘Women to Women Initiative on HIV and AIDS’ will be a useful tool to engage women to be able to protect themselves and their families, to care and provide support for Somalis who are infected or affected by HIV and AIDS and to actively participate in the national response.Insert Signature Christian Balslev-Olesen UNICEF Representative Somalia Support Center ContentsAbbreviations 1. Introduction 1.1 Women and HIV and AIDS 1.1.1 What makes women vulnerable to HIV and AIDS?  Biological  Socio-cultural  Economical 1.2 Violence against women (VAW) 1.3 Female genital mutilation /cutting 1.4 HIV/AIDS, women and conflict situations 2. How to use the Resource Pack 3. What you need to know Basic facts of HIV and AIDS Sexually Transmitted Infections Girls, HIV/AIDS and education Women and HIV/AIDS Violence against women Female Genital Mutilation / Cutting Stigma and Discrimination Women rights in Islam Marriage in Islam Reproductive health education in Islam 4. What you can do Communication for change Community Mobilisation House to House Promotion Resource mobilization at community level HIV/AIDS Peer Education Voluntary Counselling and Testing Home Based Care for PLWHA Facilitation Skills Condom use Abbreviations AIDS = Acquired Immune Deficiency Syndrome CEDAW = Convention on the Elimination of Discrimination Against Women FGM/C = Female Genital Mutilation / Cut HBC = Home Based Care HIV = Human Immuno-deficiency Virus IEC = Information, Education, Communication ORS = Oral Rehydration Solutions PLWHA = People Living With HIV and AIDS RIP = Resource Information Pack STI = Sexual Transmitted Infections UNICEF = United Nations Children’s Fund VAW = Violence against Women. WHO = World Health Organisation Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______1. Introduction1.1Women and HIV and AIDSWhile HIV/AIDS is a health and development issue, the epidemic is also a gender issue. In the HIV/AIDS epidemic, gender, defined as the array of societal beliefs, norms, customs and practices that define masculine and feminine attributes and behaviours, plays an integral role in determining an individual’s vulnerability to infection, his or her ability to access care, support or treatment, and the ability to cope when infected or affected. Gender norms, for example, often dictate that women and girls should be ignorant about sex, which greatly constrains their ability to negotiate safer sex or access appropriate services. Similarly, gender norms cast women as being primarily responsible for reproductive activities within the home, in sharp contrast to men who are cast as primary economic actors and producers outside the home. Such gender stereotypes account for women having much less access than men to key productive resources such as education, land, income, credit and employment, which significantly reduces the leverage they have in negotiating protection with their partners and greatly affects their ability to cope with the impact of infection. Statistics show that both the spread and impact of HIV and AIDS is not random. It disproportionately affects women and adolescent girls who are socially, culturally, biologically and economically more vulnerable at the same time. AIDS has become a woman’s issue. Each The current average HIV prevalence among year, as the proportion number of infections Somalis of 0.9 percent is considered to be low due to heterosexual transmission increases, by regional standards. The HIV prevalence proportionally more of those infected are varied between the different parts: Northwest showed average HIV prevalence of 1.4%, women. Looking at the changing ratio of men North East of 1% and Central South of 0.6%. to women with HIV/AIDS in particular However, experience from other Sub-Saharan countries or regions over time can show the countries shows that when the rate exceeds increase in infection among women. one percent, it can quickly double or triple in just two or three years. Women account for nearly half of the 40 million people living with HIV/AIDS worldwide. HIV positive women have a unique and valuable role to play, both in society and in responding to HIV and AIDS. Women hold families and communities together. They are a source of great strength in the face of HIV and AIDS. Sub-Saharan Africa remains hardest-hit, and is home to 25.8 million [23.8–28.9 million] people living with HIV, almost one million more than in 2003. Two thirds of all people living with HIV are in sub- Saharan Africa, as are 77% of all women with HIV1. 1 UNAIDS/WHO.(2005). AIDS epidemic updateIntroduction to the Resource Information Pack Page 1 of 4 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______1.2 What makes women vulnerable to HIV? A variety of factors increase the vulnerability of women and girls to HIV including their limited access to economic and educational opportunities and the multiple household and community roles they are responsible for. Compounding women’s vulnerability are social norms that deny women sexual health knowledge and practices that prevent them from controlling their bodies.There is growing evidence that a large share of new HIV infections is due to gender based violence in homes, schools, the workplace and other social spheres. Women also find themselves discriminated against trying to access treatment, care and support when they are HIV positive. In many countries, men are more likely than women to be admitted to health facilities. Family resources are likely to be devoted to buying medication and arranging care for ill males than females.Physiological Researchers estimate that women’ risk of HIV infection from unprotected sex is at least twice that of men. Semen, which has high concentrations of virus, remains in the vaginal canal a relatively long time. Women are more exposed through the extensive surface areas of mucous membrane in the vagina and on the cervix through which the virus may pass. In men, the equivalent area is smaller. Men and women’s risk of HIV infection escalates if STIs are present. Young women are at even greater risk than mature women. An adolescent girl’s vagina is not as well lined with protective cells as that of an adult women. Her cervix may be more easily eroded, potentially enhancing the risk of HIV infection. She also faces the potential bleeding at first intercourse through tearing of the hymen. In cultures where sex with very young girls is condoned by society, this is likely to cause trauma. In some countries, young girls are married to men three times their age. This is the most risky pattern of sexual partnerships, as a group more likely to have HIV already (older men) transmits the virus to a group with low levels of infection (young girls). In addition, young girls who have unprotected sexual intercourse are at increased risk of cervical cancer or to contract herpes simplex and other sexually transmitted infections.Socio-cultural Gender norms that create an unequal balance of power between women and men are deeply rooted in the socio-cultural context of each society. These norms are enforced by that society’s institutions, such as schools, workplaces, families and health systems. In many societies women are depicted as subordinate, dependent and in a passive position compared to men. Such a cultural female subordination is mainly reflected in the age of marriage, FGM and wife Introduction to the Resource Information Pack Page 2 of 4 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______inheritance practices - all three cultural practices are known to predispose women to the risk of HIV infection.Economical HIV affects all social classes, but not equally. HIV infection will continue to affect higher economic groups, but affects disproportionably lower income groups. Women from poor households are particularly hard hit. Women’s economic and social situation in themselves may increase vulnerability to infection.Lack of education for girls often results in poverty and economic dependence on men. There are fewer opportunities for girls and women to access jobs and career opportunities. Because of their low economic status, some women might be forced into commercial sex work that puts them at risk of getting infected.Women’s economic vulnerability further constrains also their time. Women tend to have more insecure jobs with longer working hours, poorer pay and little or no benefits. Further, smaller incomes make the cost of missing work larger for women. In families where income and resources are pooled from multiple individuals, women are still at a disadvantage in accessing funds for health services. Families typically allocate resources for men and boys first and women and girls later or not at all. As a result, the cost of treating opportunistic infections, STIs and antiretroviral therapy in most developing countries is more likely to constrain women’s access compared to men.1.3Violence against women (VAW) Violence against women is recognised as an important risk factor contributing to women’s vulnerability to HIV infection. According studies conducted around the world, 10-69% of women reported being physically assaulted by an intimate partner. This has been confirmed by other studies. HIV is adding new aspects to the problem of violence against women. It is important to consider both, how violence against women makes women more vulnerable to HIV and how women generally face different forms of violence once they are HIV positive (i.e. violence against women as a cause and consequence of HIV infection). Violence against women takes many forms including physical, sexual and psychological abuse.Sexual violence makes women more vulnerable to HIV infection. Women who are trafficked, who are married as children, or who have been raped cannot negotiate the conditions under which to engage in sexual relations. Women who are raped do not have the possibility of protecting themselves from the diseases of their perpetrator, and thus often must suffer the consequences of HIV infection in addition to the trauma of the sexual violence. In all instances of sexual violence, the tearing of vaginal tissue, that results from the force of the violence makes the transmission of HIV more likely.Introduction to the Resource Information Pack Page 3 of 4 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______1.4Female genital mutilation /cutting Female genital mutilation/cutting (FGM/C) is “the partial or total removal of the female external genitalia or other injury to the female genital organs for cultural or other non-therapeutic reasons.”2 In Somalia, FGM prevalence is about 95 percent and is primarily performed on girls aged 4-11 years. Despite the many internationally recognized laws against FGM, lack of validation in Islam and global advocacy to eradicate the practice, it remains embedded in Somali culture3.Female genital mutilation is a social ritual FGM can increase the likelihood of a girl performed in 28 countries ranging from contracting HIV if unsterilised equipment is Africa to the Middle East and some of the used. Secondly, likely reproductive tract and Islamic Asian countries. It is estimated lower pelvic infections that result from FGM that the most severe form of the practice can increase the risk of HIV infection, by affects 130 million women, most of whom providing a path for HIV to enter the body were circumcised before puberty. The when in contact with the virus. practice itself often takes place in remote rural areas by untrained village midwives who use instruments such as knives, razors or even broken glass. The instruments are often not sterile and the ritual is very often performed in unsanitary conditions. In urban areas, some families use a doctor to perform the operation.The operation involves the total removal of the clitoris, labia minora and severing of the inner side of the labia majora. The sides of the labia majora are then sutured together, leaving a small hole to allow urine and menstrual discharge to pass. The practice often occurs without the use of anaesthesia4.Internationally FGM/C is grouped into four types5: 1. Excision of the prepuce [the fold of skin surrounding the clitoris], with or without excision of part or the entire clitoris. 2. Excision of the clitoris with partial or total excision of the labia minora [the smaller inner folds of the vulva]. 3. Excision of part or all of the external genitalia and stitching or narrowing of the vaginal opening (Infibulations). 4. Unclassified, which includes pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization by burning of the clitoris and surrounding tissue; scraping of tissue surrounding the opening of the vagina (angurya cuts) or cutting of the vagina (gishiri cuts); introduction of corrosive substances or herbs into the vagina to cause 2 WHO, UNICEF and UNFPA, Female Genital Mutilation: A joint WHO/UNICEF/UNFPA statement, World Health Organization, Geneva, 1997, pp. 1–2. 3 UNICEF: Eradication of Female Genital Mutilation in Somalia, Page 3. 4 UNICEF: Eradication of Female Genital Mutilation in Somalia, Page 3 5 WHO, UNICEF and UNFPA, Female Genital Mutilation: A joint WHO/UNICEF/UNFPA statement, World Health Organization, Geneva, 1997, pp. 1–2.Introduction to the Resource Information Pack Page 4 of 4 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______ bleeding or to tighten or narrow the vagina; and any other procedure that can be included in the definition of female genital mutilation noted above.1.5HIV/AIDS, women and conflict situations The power imbalances that make girls and women disproportionately vulnerable to HIV infection become even more pronounced during conflict and displacement. Gender related factors contributing to the spread of HIV infection in these settings include: - Breakdown of family and others social and community structures, - Lack of access to health care, including safe blood supply and social services, - Increased sexual and gender based violence including coerced sex with men infected with HIV, - Sexual interactions between civilians and combatants (who often have much higher STI and HIV prevalence than civilian populations) and the increased presence of sex workers near military installations.Introduction to the Resource Information Pack Page 5 of 4 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______2. How to use the Resource Pack6Who should use the information in the resource pack? The resource pack is designed for use by IMPORTANT volunteers at the community level. However it can Please note that the resource also be used by leaders, coordinators, trainers pack has been provided as and coaches who need to train community SIMPLE and BASIC information volunteers. Also religious leaders and school packs and individuals are teachers can use the resource pack during their encourage to seeking additional normal teaching work. information on areas of interest for their communities and What's in the Resource Pack? adapting them according to The Resource Pack Contains information and their needs and local situation. guidelines that are meant to support community volunteers as facilitators and other local initiatives in response to the HIV epidemic amongst Somalis. It includes basic information on the following subjects:What you need to know What you can do 1. Basic facts of HIV and AIDS 1. Awareness creation a. Definition 2. Community mobilization b. Mode of transmission 3. House to house promotion c. Prevention methods 4. Resource mobilization at 2. Girls, HIV/AIDS and education community level 3. Women and HIV/AIDS a. Setting up merry go rounds 4. Violence against women b. Setting up revolving funds 5. Female genital mutilation / 5. Women HIV/AIDS peer cutting education 6. Stigma and discrimination 6. Voluntary counseling and testing 7. Women rights in Islam 7. Home based care for PLWHA 8. Marriage in Islam 8. Facilitation skills 9. Reproductive health education in IslamWho are the volunteers? 1. Volunteers should reflect the members of the communities in which they serve. 2. Volunteers can be female teachers, religious scholars, grandmothers, health workers, TBAs, mothers, young girls, and retirees, literally any woman community who can learn about a topic and share the information with others. 3. For a coordinated, effective and efficient response in addressing community concerns, volunteers should be part of an established 6 Adapted from the African Red Cross and Red Crescent Societies, 2010 toolkit.Guideline to the use of the Resource Information Pack Page 1 of 3 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______ organization e.g. community based organizations, faith based organization or non-governmental organization. 4. Volunteers should live and work in their own communities and preferably work in and around the households where they live. 5. Volunteers should identify a "back-up" volunteer who can learn what she does. The "back-up" volunteer can carry-on the work when the volunteer is away. 6. "Back-up" volunteers with sufficient experience can eventually become volunteers themselves. How should the volunteers work? 1. Volunteers should agree to work minimum of 1- 3 hours each week. 2. Volunteers working on a house to house promotion should repeatedly visit the same households each week in order to know the population, notice changes (new babies, new pregnancies, and new needs) and to repeat (give) the same messages each visit until desired change is observed. Once desired change is observed volunteer reinforces the change by providing positive feedback in each visit. 3. Volunteers should live near the neighborhoods or households for which they are responsible. 4. Volunteers can work at any time during the week. The important thing is for the volunteer to cover all of her workplan each week. This may take 1 or more hours but should not take more than 3 hours per week. 5. In a house to house promotion initiative all the households in a community should be covered by volunteers. This means that a community with 100 households may need 10-20 volunteers. 6. In a peer education initiative it is important to meet regularly with peers (1 volunteer should form a group of 5 to 10 peers) and share with them information on various issues around HIV and AIDS. Provide opportunities for peers to ask questions and discuss difficult issues. NOTE: It is important for each volunteer to know her target population, e.g. the households for which the volunteer is responsible. Working repeatedly in the same households enables each volunteer to measure her success. Measuring and acknowledging success is important for volunteer retention.Training on the use of Resource PackWhere does the training take place? Training must be done as close to the community as possible. Ideally, community volunteers are trained in their own communities. Volunteers should not need to leave their communities for training. Instead, a trainer can travel to the village to do the training. This will reduce travel and financial costs.Guideline to the use of the Resource Information Pack Page 2 of 3 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______Who does the training? Training can be done by: leaders, coordinators, trainers, and coaches who are located at a regional level closest to the community and who know how to use the toolkits.What does the volunteer training consist of? Training should focus on what the community volunteers will do in their own community. The community members themselves will determine the activity and it will be necessary to decide whether this activity is best done by:  Community mobilization ,  House-to-house promotion,  Peer education,  Awareness creation, or  Advocacy Trainers should carefully explain each information pack or a set of pack that is applicable to a community. Volunteers should then be asked to repeat, explain and demonstrate what she must do as a volunteer. Also it may be useful to have one volunteer explain to another volunteer the activities she is expected to do in the community. Training should be as participatory as possible.NOTE: Initially only 3 - 4 information pack will be needed to train volunteers to start a community activity. Later, as the community volunteers advance, they may wish to address other problems (other relevant issues in the resource pack).How long is the training? Training should be short but sufficient for volunteers to fully understand the information pack needed. This should not require more than 4-5 hours of training. This can be called "pre-service" training."In-service" (training provided during a volunteer's career) is an important motivational factor and can be used to keep volunteers well informed. This can also help in the RETENTION of volunteers and can include topics from the resource pack or others as relevant to the community. Giving a certificate of appreciation after a year of volunteering service can also be motivational and an incentive to volunteers. When embarking on home based care services for PLWHA and other patients with chronic conditions, volunteers would need a much longer training requiring expert trainers for 15 days of training.Is this training expensive? Costs of training should be kept as low as possible. The community volunteers should volunteer their time since they are being trained in their own communities. IEC material incentives such as pens and T-shirts could be made available to encourage the volunteers. Trainers may need to travel from other towns in the region. This will require some costs. Volunteers should be given copies of the pack they need. Guideline to the use of the Resource Information Pack Page 3 of 3 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______Brief Summary 1. You do not need all the information pack to start a volunteer community activity. 2. Use coaches or their equivalent to build community volunteer networks. 3. Keep your costs low by focusing training at the lowest level possible, e.g. the community. 4. Volunteers need a specific purpose (one or two issues in the information pack) and they need a specific target group (e.g. 10-15 households or peer groups) in order for them to be able to measure their effort and impact. Guideline to the use of the Resource Information Pack Page 4 of 3 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______3. What you need to knowBasic facts of HIV and AIDSDefinition HIV - Human Immunodeficiency Virus o The virus that causes AIDS  AIDS -Acquired Immune Deficiency SyndromeHuman A virus (small organism that causes diseases), that infects Immuno deficiency human beings and causes a deficiency/ malfunction of Virus their immune responses or their ability to fight off disease.Acquired: something you get Immune: defense towards disease Deficiency: shortage, lack of Syndrome: group of diseases with a common underlying factor. AIDS is therefore a group of diseases also known as opportunistic infections (e.g. TB, diarrhea) that one gets as a result of having their defense towards disease compromised by HIV.Virus –smallest organism that causes diseases e.g. HIV, Herpes, common coldImmune system –the whole complex of cells that are concerned with fighting disease.Opportunistic infections (OI) –are infections that occur because the immunity is down. These organisms would normally not cause diseases as they are effectively fought off by a healthy immune system.Mode of transmission  The only means of transmission is the exchange of bodily fluids with an HIV positive person: o Sexual: Unprotected sexual intercourse with an infected person whether vaginal, anal or oral o Blood / Blood product: Transfusion of infected blood or blood products including through sharing syringes, injecting and medical equipment which have not been properly cleaned o Mother-to-child transmission: . While the baby is in the wombBasic facts of HIV and AIDS Page 1 of 4 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______. During delivery (because the baby is in contact with the mothers infected blood and body fluids). . While breastfeeding (as the virus can be found in breast milk) HIV can NOT be transmitted by:  Coughing or sneezing  Insect bites/Mosquito bites  Touching or hugging  Water, food or air  Handshakes  Sharing cups, glasses, plates, and other utensils  Sharing of toilet sit.  Any casual contact that does not expose one to high risk infected fluidWhich Body Fluids has HIV? HIV can be found in high  HIV is found in  HIV is not found in infectious quantities in negligible amounts 1. Faeces 1. Blood and blood in 2. Vomit products 1. Saliva 2. Semen and pre 2. Tears ejaculation fluid. 3. Sweat 3. Vaginal and cervical 4. urine secretions 4. Breast milkPrevention methods As there are three ways one can get the HIV infection namely through sexual intercourse, blood and blood products transfusion and thirdly from an HIV positive mother to her unborn child then as a volunteer you need to address prevention activities for all these methods.Prevention of HIV infection through sexual transmission There are three principals in the prevention of sexual HIV transmission from one person to another. These are known as the ABC strategy which means, Abstinence, being faithful to one uninfected partner and using a condom when you do not know the status of your sexual partner.Abstinence: No sex at all Abstinence is the only 100% way to avoid sexual transmission of HIV infection. This option can be easily promoted for young people who have not experienced sex. Practicing abstinence also means you run no risk of pregnancy, STI/HIV.Be faithful: To one uninfected partnerBasic facts of HIV and AIDS Page 2 of 4 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______This is an option particularly agreeable when promoted for married couples. It is also known that some Somali married men and women have extra marital sexual relationships. We also know that often Somali women and girls, particularly from poor or marginalized communities are forced to have sex against their will. So being faithful and the abstinence option might be difficult in practice and not an option for them. Condoms: A third option where one can make a choice is to make sex safer by protecting yourself with a condom. For condoms to protect you against HIV or other sexually transmitted infections you must use it correctly every time you have sexual intercourse.Remember: Male condoms are not wash & wear, they are not reusable. You can not use a male and female condom during the same sexual intercourse. Women’s vulnerabilities to HIV infection7 Women confront a number of gender-based obstacles to prevent becoming infected with HIV, and if positive, to prevent transmission to their offspring:  Women may be unable to negotiate safe sexual practices, including condom use to prevent infection and/or unintended pregnancies.  Women may be unable to access pre-natal health services as their partners often control the household financial or transportation resources, as they cannot take time off work, or because they cannot leave their dependents to travel to a clinic or hospital.  Fear of rejection, stigmatization, violence or abuse may prevent women from utilizing HIV voluntary counseling and testing services, disclosing their HIV status, accessing HIV prevention programs targeting pregnant women, mothers and their children, or engaging in safer infant feeding practices.As a volunteer addressing women vulnerabilities you should therefore take into consideration: 1. Women’s health and access to services 2. Promote the rights of women 3. Increase women’s access to income-generating possibilities 4. Provide treatment, care and support to HIV-positive women, their children, partners and families.Prevention of HIV infection through blood and blood product transmission This is the least common method of HIV transmission. In creating awareness for this mode of transmission the following are key points to address: - Safe blood transfusion through testing of blood and blood products for the HIV antigen prior to transfusion.7 UNFPA, UNAIDS and UNIFEM. Women: Meeting the challenges of HIV/AIDSBasic facts of HIV and AIDS Page 3 of 4 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______ Encourage where possible keeping one own blood in the blood bank when expecting to go for an elective operation such as in the case of elective caesarian section.Prevention of Mother to Child Transmission of HIV infection Overall risk is approximately 40% without Prevention of Mother to Child Transmission (PMTCT):~5-10% during pregnancy ~15-20% during delivery ~10-15% during breastfeedingPrevention of Mother to Child Transmission (PMTCT) of HIV infection involves 5 strategies:1. Primary Prevention –preventing the mother and the young girl from getting infected in the first place. 2. Prevention of unplanned pregnancies (Couple decides not to have children after knowing their positive HIV status). 3. Reducing risks during pregnancy – through attending antenatal clinic and getting quality care including counseling and testing, knowledge on self- care, assessment and treatment for infections such as malaria. This also includes provision of vitamin & mineral supplements. She may also be started on anti retroviral drugs. 4. Reducing risks during delivery. She should plan to deliver in a health facility with qualified staff. The baby may be given Nevirapine, an antiretroviral drug reputed to be effective in Remember reducing transmission of HIV from mother to “In environments where child. replacement feeding is 5. Promotion of best feeding practices after acceptable, feasible, delivery and consider: affordable, sustainable . Use of replacement feeding and safe, avoidance of all . Consider costs, safety and breastfeeding by HIV- acceptability positive women is . If breastfeeding use WHO recommended from birth.” Recommendations: WHO guidelines . EXCLUSIVE breastfeeding for 6 months . The abrupt weaning at 6 months . Optimize breast/nipple care (avoid infections and cracks) Attention: As a volunteer when addressing prevention methods of HIV infection you have to contextualize according to the target population. As your primary objective is to ensure prevention of HIV infection amongst women then your possible target Basic facts of HIV and AIDS Page 4 of 4 Resource Pack for the Woman to Woman Initiative on HIV and AIDS ______groups would be: a) Young girls in School g) Divorced women b) Young girls out of school h) Widows c) Un-married women above 25yrs i) Traditional Birth d) Couples planning to get married attendants e) Married women of all ages j) Traditional healers f) Pregnant women at the ante-natal k) Women health workers clinics l) Commercial sex workersTherefore when advocating for any particular method of prevention bear in mind the target group and put emphasis on the prevention method that is most appropriate for the group. Attention: For detailed instruction for condom use see section on condom use.Basic facts of HIV and AIDS Page 5 of 4 Resource Information pack for the Woman to Woman Initiative for Somali WomenSexually Transmitted InfectionsWHAT ARE STIs?STIs stand for Sexually Transmitted Infections. STIs are contracted when one has unprotected sex with an infected person– that’s sex without a condom. These infections cause discomfort and can damage a person’s reproductive system. Any sexually active person can get an STI from someone who has one of these Infections. It is possible to get more than one STI at a time. If a pregnant woman has an STI, the disease can harm her baby while it is still in her womb. People who have an STI may look and feel healthy, but they can still infect others. In women, STIs can cause: • Sharp pain in the lower abdomen that comes and goes for a long time. • menstrual problems • infertility (not being able to have children) • pregnancy outside the womb, • Abortion, • Premature babies, • Intra uterine deaths • Still births • If a woman has an STI, she can pass the disease to her unborn baby in the womb or during birth.In children, STIs can cause: • physical defects at birth • mental retardation • blindness or deafnessCommon STIs STIs THAT CAUSE PAINFUL URINATION OR UNUSUAL DISCHARGEGonorrhoea, Chlamydia, Trichomoniasis, Vaginosis and CandidiasisSTIs THAT CAUSE SORES OR ULCERSSyphilis, Chancroid and HerpesSTIs THAT CAUSE WARTSGenital wartsSome signs of an STI are: • sores on or around the genitals • itching in and around the genitals • growth or lumps or other skin changes • discharge from male or female genitalsSexually Transmitted Infections Page 1 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women • burning or pain when urinating STIs and HIV • Both are sexually transmitted. • Both imply high-risk behavior • Other STIs increase susceptibility to HIV infection • HIV leads to a weakened immune system and therefore; o A higher chance of contracting an STI. o More severe STI o Greater difficulty in treating the STIRecognizing STI risk Key questions to ask. • Do you have more than one partner? • Does your sexual partner have more/ or other partners? • Changed partners in the last 6 months? • Do you sometimes have sex without a condom?Preventing STIs: . ABSTAINING FROM SEX. This is the only guaranteed protection. . BEING MUTUALLY FAITHFUL. Always have sex with the same person. This person must not have sex with anyone else and must not have an STI. . CONSISTENTLY (EVERY TIME) USE CONDOMS: Condoms are your best protection, because some STIs cannot be cured. Use condoms every time, and use them correctly.If you are treated for an STI, you can make sure that the disease does not return by: . TAKING all your medication according to the directions. Take all of the medication even if your symptoms go away or you feel better. . MAKING SURE all your sexual partners get treated, even if they do not have symptoms. . AVOIDING SEX or using condoms until all treatment is completed and you have returned to the health worker to check that you are cured. . PRACTISING SAFER SEX after you have been cured: keeping with only one partner who is not infected, not having sex or using a condom every time you have sex. Treating STIs STIs are a real danger to one’s health and can cause problems in pregnancy: • STIs make it easier for a person to become infected with HIV. • If STIs are not treated or not treated properly, they can cause infertility, heart disease, madness and even death for both men and women. • STIs can cause pregnant women to lose the pregnancy, have a baby that is born dead, or have a baby born very sick or with defects.Key messages:Sexually Transmitted Infections Page 2 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women If you think you have an STI or know that your partner has an STI, it is important to go to the health clinic for treatment. Treatment can prevent passing it on to others and can prevent permanent damage to your health. a) Most STIs can be cured: • GET TREATMENT RIGHT AWAY from a health worker. Avoid these problems and lower your risk of HIV infection. • VISIT your nearest health centre or health worker for treatment as soon as possible if you notice any of these problems:  a foul smelling or itchy discharge from your private parts;  sores or swelling on private parts or groin;  pain while urinating;  pain in the lower belly (abdomen);  or a skin rash.• VISIT your nearest health centre for treatment as soon as possible if your sexual partner has an STI. You should go even if you have no symptoms yourself. Many people have STIs without any symptoms. • TELL YOUR PARTNER to go for treatment or bring your partner in with you. • PROTECT YOUR BABY. Go for care at the clinic within the first three (3) months of pregnancy. Get a physical exam and a syphilis test. b) If you are treated for an STI, you can make sure that the disease does not return by: • TAKING all your medication according to the directions. Take all of the medication, even if your symptoms get better or you feel better. • MAKING SURE all your sexual partners get treated, even if they do not have symptoms. • AVOIDING SEX OR USING CONDOMS until all treatment is completed and you have returned to the health worker to check that you are cured. • PRACTICING SAFER SEX after you have been cured: keeping with only one partner who is not infected, not having sex, or using a condom.Measuring your success:  Women know more about safer sex practices.  Women talk more openly about the risks of STI transmission.  Women report fewer cases of sexually transmitted illnesses (STIs).  Women report that they use condoms.  Women promote abstinence as key prevention methodKeeping records and reporting on your volunteer work  the number of women you are working with ____  the number of education sessions conducted for women this month ____  the number of days you volunteered during the month ____  indicate other partners you worked with during the month ____ Sexually Transmitted Infections Page 3 of 3 Resource Information pack for the Woman to Woman Initiative for Somali WomenGirls, HIV/AIDS and educationMagnitude of the problem Globally, 115 million children do not attend primary school and 57 % of them are girls  Studies find that 150 million children currently enrolled in school will drop out before completing primary school and at least two thirds will be girls  In sub- Saharan Africa, more than half of girls – 54% do not complete primary school  Children in families affected by AIDS are more likely than others to be taken out of school  In many situations girls education is compromised due to economical reasons.  HIV/AIDS undermines the supply of education through the effect on teacher morbidity and mortality. In parts of Malawi over 30 percent of teachers are estimated to be HIV positive.  Much of the burden of caring for people living with AIDS and orphans falls on women and girls. Girls are often first to leave schools to care for others.  Education and formal classroom learning opportunities are limited and unavailable for a majority of children in Somalia. There have been substantial increases in the number of operational schools and in enrolment rates, but considerable disparities in the quality of and access to primary education are still problematic in parts of the country because of the socio-economic, cultural and political realities.  Most existing schools in Somalia are concentrated in and around urban areas and are mainly financed by fees or other forms of support from parents and communities, with some input from external agencies.  The UNICEF survey of Primary Schools in Somalia for 2003-2004 provides valuable insights. According to the survey report, there are 1,172 operating schools with a total enrolment of over 285,574 children representing a 19.9 per cent gross enrolment ratio (GER). This places Somalia among the lowest enrolment rates in the world.  Gender-related disparities remain an area of major concern. The UNICEF survey results revealed that only slightly over one third, or 37 per cent, of pupils are girls at the lower primary school levels. Since the 2003/4 survey, there has been very little progress toward reducing the gender disparity, which increases rapidly in higher grades. Results of previous school surveys reflect the same pattern. The low enrolment and high drop- out rates of girls in most areas are due to a combination of traditional attitudes, timing of classes and economic considerations.  In Somalia Female teachers are under-represented, making up only about 13 per cent of the total number of all teachers. The sector suffers from Girls, HIV/AIDS and education Page 1 of 2 Resource Information pack for the Woman to Woman Initiative for Somali Women severe managerial, technical and financial resource limitations, and a lack of consistency in standards. Key messages: Multiple benefits of girls’ education Girls education is key to an effective response to HIV/AIDS  Education plays a major role in changing attitudes and behaviour of young men and women, helping them to understand prevention, care and support needs for themselves and for others.  Schools can be a primary source of information about prevention methods in the fight against HIV  Education has an impact on young women’s risk and vulnerability to HIV infection. It can affect HIV rates and change women’s lives by; o Reducing poverty o Improving the health of women and their children o Delaying marriage o Reducing female genital mutilation / cutting o Increasing self confidence and decision making power o Contributing to their economic developmentWhat you can do as a volunteer to increase HIV/AIDS education amongst girls. Advocate for o The infusion of HIV/AIDS as a subject in the school curriculum o Training of peer facilitators for girls clubs that will be based in public schools o All girls to complete at least primary education, and to continue their education through to secondary school o Removal of all financial barriers to primary education and the immediate abolition of school fees. o Training for educators, teachers, educational administrators in gender issues and HIV/AIDS. o Promote access to education for all including marginalized and excluded girls.Measuring your success:  Enrollment of girls to schools has increased in your community.  Girls have a better understanding of HIV/AIDS prevention, treatment, care and support.  Girls have the knowledge and skills needed to prevent HIV transmission  Girls do not stigmatize people with HIV/AIDS. Keeping records and reporting on your volunteer work  the number of schools you are working with ____  the number of girls education sessions conducted this month ____ Girls, HIV/AIDS and education Page 2 of 2 Resource Information pack for the Woman to Woman Initiative for Somali Women the number of days you volunteered during the month ____  Indicate other partners you worked with during the month ____Girls, HIV/AIDS and education Page 3 of 2 Resource Information pack for the Woman to Woman Initiative for Somali WomenWomen and HIV/AIDSBrief situation analysis of Women and HIV/AIDS Globally there are now 17 million women and 18.7 million men between the ages of 15 and 49 living with HIV/AIDS. Since 1985, the percentage of women among adults living with HIV/AIDS has risen from 35 per cent to 48 per cent. Of particular concern are the dramatic increases of HIV infection among young women, who now make up over 60 per cent of 15- to 24-year-olds living with HIV/AIDS. Globally, young women are 1.6 times more likely to be living with HIV/AIDS than young men. In sub-Saharan Africa, 57 per cent of adults with HIV are women. Young women aged 15 to 24 are more than three times as likely to be infected as young men8. Despite this alarming trend, women have less access to HIV/AIDS prevention, treatment, care and support compared to men.In a study on HIV/AIDS STI Knowledge, Attitudes, Behavior and Practices amongst Somalis done by UNICEF in 2003, only 57% of women respondents indicated awareness on HIV versus 67% of their male counterpart. In the same study, condom use as a method of prevention is mentioned by 24 % of men and only by 11 % of the womenDuring the recent consultative meetings held by UNICEF between November 2005 and January 2006 with Somali women, several issues were seen to be common factors across all regions making women vulnerable and at risk of HIV infection. These issues include:- Poverty,  Gender based violence,  Lack of access to education for the girl child and women in general  Harmful traditional / cultural and social practices  Misinterpretation of Islamic teachings by associating cultural practices such as FGM/C and other practices, detrimental to women’s health and basic rights, to a religious practice or duty, justifying their performanceWhat can you do as a volunteer in the community? As a volunteer awareness creation and improving the knowledge base on the issues predisposing women to HIV infection will be one of the key activities. Refer to the awareness creation information pack to identify suitable way of reaching your target group. As a volunteer you might want to consider the following key points when planning to address HIV/AIDS related vulnerabilities and risks affecting women: -1. Prevention8 UNAIDS, UNFPA and UNIFEM. (2004) WOMEN AND HIV/AIDS: CONFRONTING THE CRISISWomen and HIV/AIDS Page 1 of 2 Resource Information pack for the Woman to Woman Initiative for Somali WomenEnsure that adolescent girls and women have the knowledge, skills and services to prevent HIV infection 2. Treatment Ensure equal and universal access to treatment 3. Care giving Recognition and support for home-based caregivers of AIDS patients and orphans4. Education Promote girls’ primary and secondary education and women’s literacy5. Violence against Women Promote zero tolerance of all forms of violence against women and girls6. Women’s rights Promote and protect the human rights of women and girlsVolunteer's checklist  Women have identified the key issue predisposing them to HIV infection in their own community.  You have the information pack to provide the needed information to respond these issues. If not, you have technical experts to assist you e.g. nurses, doctors, lawyers, religious scholars etc…  You know your target group (public, women, youths, leaders, policy makers etc…)  You are aware of the appropriate media to be used (community event, radio production, public performance etc…).  You are coordinating with other community volunteers in planning for campaign.  A "back-up"9 volunteer (junior volunteer) is available to learn from you and to replace you during your absences.  Your coach or volunteer leader is aware of the campaign and is actively involved in the facilitation, coordination and implementationMeasuring your success:  Women talk more openly about the risks of HIV transmission.  Women have a better understanding of HIV/AIDS prevention, treatment, care and support.  Women do not stigmatize people living with HIV/AIDS.  Peers go to get tested and know their HIV status (if you have an HIV voluntary testing and counseling centre)Keeping records and reporting on your volunteer work 9 Note: You cannot always be there. Get yourself a backup-volunteer. Find another person who can offer her services to learn what you do and to replace you during your absences.Women and HIV/AIDS Page 2 of 2 Resource Information pack for the Woman to Woman Initiative for Somali Women the number of women groups you are working with ____  the number of women education sessions conducted this month ____  the number of days you volunteered during the month ____  indicate other partners you worked with during the month ____ Women and HIV/AIDS Page 3 of 2 Resource Information pack for the Woman to Woman Initiative for Somali WomenViolence against womenViolence against women (VAW) and HIV/AIDSViolence against women is a major human rights and public health problem worldwide. It increases female vulnerability to HIV. One of the most common forms of violence is that perpetuated against women by intimate partners or ‘domestic violence’. The true extent of violence against women is unknown, but current research indicates that intimate partner violence ranges anywhere from 10 to 69 per cent, and one in four women may experience sexual violence by an intimate partner in her lifetime10.Domestic violence is one of the leading causes of female injuries in almost every country in the world according to Human Rights Watch. It is associated also with a wide range of general, reproductive and mental health problems.Violence against women is common in practically all societies. It is supported and in turn serves to reinforce discrimination against and subordination of women. As well as domestic violence, recent conflicts have seen an increase in the use of rape and sexual violence as tools of war; in addition trafficking, the sex trade, and other forms of commercial violence also increase female vulnerability to HIV.Key messages  Perpetrators of violence against women are almost exclusively men.  Women and girls are the most frequent victims of violence within the family and between intimate partners. Women are at greatest risk of violence from men they know and who are close to them including a close relative and neighbours or colleagues.  Physical abuse in intimate relationships is almost always accompanied by severe psychological and verbal abuse.  Violence against women and girls is a major health and human rights concern worldwide.  Violence against women has serious consequences for their physical and mental health.  Abused women are more likely to suffer from depression, anxiety and eating problems. Violence and fear of violence makes it difficult for women to negotiate for safe sex.  Research shows that sexual violence against women is associated with increased risk for acquiring sexually transmitted infections (STI) and HIV infections.10 WHO. 2002. World Report on Violence and Health. Geneva; Heise, L., M. Ellsberg and M. Gottemoeller. 1999. Ending Violence Against Women. Population Reports. Series I, No. 11. Baltimore, MD: Johns Hopkins University School of Public Health. p. 1.Violence against women Page 1 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women Women who are exposed to childhood sexual abuse are more likely to engage in HIV- related risk behaviours (e.g. early sex, more partners, use of drugs and alcohol).  Rape can result in vaginal lacerations and trauma, which in turn, increases risk of acquiring an HIV infection.  Fear of violence prevent women from accessing HIV/AIDS information, being tested, disclosing their status, accessing services for the prevention of HIV transmission to infants and receiving treatment, care and support.  Drugs and substance abuse (e.g. use of alcohol, chewing of ‘kat’, etc…) accentuates tendency of men’s violence against women.  Educating girls and women on their rights can reduce domestic violenceWhat can you do as a volunteer in case of a reported case of VAW? As a volunteer and a member of the community you are bound to be approached for assistance when a case of violence and or abuse takes place within your catchment area. This might be done either by the victim herself or people close to her including, relatives, friends or neighbors. To ensure you are prepared to take action you need to prepare yourself to act accordingly. The following are key points to help you respond effectively. a) Key elements you need to know as a volunteer. - What services are available for women who have been raped or are victims of other form of violence? - Where are these services; location, telephone contact, name of focal person and opening hours? - What legal systems are in place to address the issue and deter perpetrators from repeating the offences? b) Key messages to advocate against VAW. - Legal framework to address VAW including Shari’a law. - Establishment or strengthening of existing trauma centre to provide medical and psychological care for women who are victims of violence; - That rape survivors should seek help immediately after the incident without bathing or changing clothes; c) Key steps to take as a volunteer when approached to respond in a case of sexual or physical VAW. - Take the history of the violent action - Prepare the survivor for referral to medical care - Emotional and legal support - Follow-up care of the survivorRemember! A comprehensive response to tackle violence against women and HIV/AIDS at community level must include: - Mobilizing leadership to generate action to ensure that normative change Violence against women Page 2 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women occurs to make violence against women unacceptable - Expanding the evidence base highlighting the prevalence of violence against women, including the economic, social and health costs, and its links to HIV and AIDS. - Promoting community level action that improves the education and legal standing of women and builds on successful efforts and encourages innovation and partnership among groups working on both issues.Measuring your success:  Women know more about their rights.  Women report fewer cases of violence against them Keeping records and reporting on your volunteer work  the number of women you are working with ____  the number of education sessions conducted for women this month ____  the number of days you volunteered during the month ____  indicate other partners you worked with during the month _____Violence against women Page 3 of 3 Resource Information pack for the Woman to Woman Initiative for Somali WomenFemale Genital Mutilation / CuttingDefinition Female genital mutilation (or female genital cutting) comprises all surgical procedures involving partial or total removal of the external genitalia or other injuries to the female genital organs for cultural or non-therapeutic reasons.The facts  Estimates of the total number of women living today who have been subjected to genital mutilation/cutting in Africa range between 100 million and 130 million.  Some 26 million have been subjected to infibulations, the most severe form of female genital mutilation/cutting. o Given current birth rates, this means that some 2 million girls are at risk of some form of genital mutilation/cutting, including infibulations, every year. o These practices have been reported in at least 28 African countries (Somalia is one of the countries), among a number of groups in South and East Asia and among some immigrants in Europe, North America and Australia who come from these countries and regions.  Female genital mutilation/cutting is mainly performed on children and adolescents between 4 and 14 years of age. However, in some countries up to half of female genital mutilation/cutting is performed on infants under one year old, including 44 per cent in Eritrea and 29 per cent in Mali. In Somalia, FGM prevalence is about 95 percent and is primarily performed on girls aged 4-11 years. Despite the many internationally recognized laws against FGM, lack of validation in Islam and global advocacy to eradicate the practice, it remains embedded in Somali culture11.  In Somali society, the practice of FGM is an honored tradition. Those who oppose it do so against the tide of public opinion. However, these groups and individuals are slowly making an impact and, with support, can slowly alter the perception and eventually the practice of FGM in the country12.Health Consequences of FGM / FGC  FGM /FGC have immediate and long term health consequences.  Immediate complications include severe pain, shock, bleeding, urine retention and infection.  Long term complications include abscesses, urine incontinence, painful sexual intercourse and difficulties with child birth.  Genital mutilation may also have psychological effect on the women who has undergone it.11 UNICEF: Eradication of Female Genital Mutilation in Somalia, Page 3. 12 IbidFemale genital mutilation / cut Page 1 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women Other harmful effects include: increased susceptibility to HIV infection, hepatitis and other blood-borne Infections; reproductive tract infection; pelvic inflammatory Infections; infertility; painful menstruation; chronic urinary tract obstruction/ bladder stones, prolonged labour, low sexual sensitivity and cysts.What can you do as a volunteer in the community? Female genital mutilation/cutting (FGM/C) is a traditional practice with severe health consequences for Somali girls and women. As a community volunteer advocating for eradication of this practice you will need to know the underlying causes for the practice within your community. The following two points might be possible reasons why your community is practicing FGM/C: -1. Belief that it is a good custom and tradition beneficial to the woman. 2. Belief that it is a religious obligationOnce you know which of the two or other reasons for its practice in your community, then you need to work with opinion leaders in your community to reach a consensus on the best way to address the issue and promote eradication of the practice. Key messages  Female genital mutilation/cutting does irreparable harm. It can result in death through severe bleeding leading to hemorrhage shock, neurogenic shock as a result of pain and trauma and/or severe and overwhelming infection and septicemia.  WHO compiled three brief scholarly treatises on male and female circumcision as viewed in the body of Islamic law. These treatises, issue an authoritative and conclusive statement about the practice of female circumcision in Islamic countries. o The first treatise proves with sufficient documented evidence that sayings or actions concerning female circumcision ascribed to the Prophet Muhammad have no authenticity. Noting the many risks involved in female circumcision, the scholar concludes that the practice "cannot be legitimate under Islamic law" and further concludes that "female circumcision is neither required nor is it an obligation nor a sunna." o The second treatise, on "Pharaonic circumcision" or infibulation, reviews the harmful effects of this practice and concludes that it is "an odious crime". o The final treatise confirms these views concluding that "since female circumcision is not something required and no evidence from religious sources proves that it is either an obligation or a sunna, what remains is that it is an absolute damage that has no benefit13" 13 http://www.emro.who.int/Publications/Book_Details.asp?ID=58 Female genital mutilation / cut Page 2 of 3 Resource Information pack for the Woman to Woman Initiative for Somali WomenAs a Volunteer in the community As a volunteer in the community you can advocate or lobby for o The development and establishment of a legal framework to eradicate FGM/FGC using Islamic teachings o Alternate means for income generation for FGM/FGC practitioners o Recruit and enroll practitioners of FGM/FGC in the eradication campaign o Include FGM/FGC in the school curriculum to educate both girls and boys on its harmful nature. o Involve religious leaders to disseminate on the Islamic teachings about circumcision and who should be circumcised.Volunteer's checklist  Community has identified the key issue predisposing women to FGM/FGC.  You have technical experts to guide you e.g. nurses, doctors, lawyers, religious scholars etc… in FGM/FGC eradication campaigns  You know your target group (public, women, youths, leaders, policy makers etc…) and are aware of the appropriate media to be used (community event, radio production, public performance etc…).  You are coordinating with other community volunteers in planning for public campaigns.  A "back-up"14 volunteer (junior volunteer) is available to learn from you and to replace you during your absences.  Your coach or volunteer leader is aware of the campaign and is actively involved in the facilitation, coordination and implementationMeasuring your success:  Women know more about their rights.  Women report fewer cases of female genital mutilation or cutting  FGM/C practitioners have alternative means of income Keeping records and reporting on your volunteer work  the number of women you are working with ____  the number of education sessions conducted for women this month ____  the number of days you volunteered during the month ____  Indicate other partners you worked with during the month ____14 Note: You cannot always be there. Get yourself a backup-volunteer. Find another person who can offer her/his services to learn what you do and to replace you during your absences.Female genital mutilation / cut Page 3 of 3 Resource Information pack for the Woman to Woman Initiative for Somali WomenStigma and Discrimination15 HIV/AIDS-related stigma and discrimination are as old as the epidemic itself. In every country and in every social setting since the disease was first identified, individuals who are or who are assumed to be HIV-positive have been subject to a variety of negative reactions, including physical and verbal abuse, loss of homes and employment, rejection by families, spouses and friends, and violations of basic human rights and fundamental freedoms. Even in the health services, where people at risk of infection or living with HIV/AIDS seek and expect care and attention, stigma and discrimination have been common. Discriminatory acts vary from inappropriate comments to breaches of patient confidentiality, from treatment delayed to treatment and basic care and hygiene refused.Understanding Stigma and Discrimination HIV Stigma is rooted in both fear and ignorance. Research has shown that everyone has some information about HIV and AIDS but few have enough information to overcome irrational fears associated with HIV and its transmission. Most people know that HIV can be transmitted through sex, but few are convinced that they are not also at risk through non-sexual “casual contact”. As a result they may fail to distinguish real risks from imagined risks. Their fear of “casual contact” will often lead to isolation and segregation of PLWHAs— isolating them from others, giving them separate plates and cups and a separate room. Attitudes toward PLWHAs are also affected by incorrect and incomplete knowledge. Many believe that a person who tests HIV positive will get sick and die immediately. Many assume that secondary infections (such as TB) cannot be cured in an HIV+ individual. Not knowing that a PLWHA can lead a productive and long life, they stigmatize and de-humanize PLWHAs, calling them “walking corpses” (people who are about to die) and treat them as “useless”, “unproductive” and “burdens on the family.”Stigma and caring in the family are closely linked—some forms of stigma are triggered by family members not knowing what to do or how to care for HIV affected members. This, coupled with poverty and economic stress, creates conditions where frustrations can easily lead to stigma, with PLWHAs being blamed for “being a burden” or neglected because families feel overwhelmed by the duty of care and support. Caring for PLWHAs is something new and many family members have little idea how they can best look after PLWHAsExpressions of stigma: Why PLWHA do not publicly declare Why there is discrimination against their status people living with HIV AND AIDS Feeling of shame Feeling of shame Feeling of isolation Discrimination Feeling of hopelessness of life Victimization 15 Adapted from ICRW. 2003. UNDERSTANDING AND CHALLENGING HIV STIGMA: Toolkit for actionStigma and Discrimination Page 1 of 4 Resource Information pack for the Woman to Woman Initiative for Somali WomenSelf guilt Community guilt Denial BlameCoping with Stigma and Discrimination In any community initiative that aims to combat stigma, it is important to include strategies for supporting people living with HIV and AIDS to cope with the effects of stigma. PLWHAs play a crucial role in helping to identify the many different types of stigma and raising community awareness about the damage and pain that stigma and discrimination bring.Key messages We are all responsible for challenging stigma and discrimination, not just PLWHAs. We can all play a role in educating others and advocating new attitudes and practice.Break the Silence: By talking and disseminating on the real facts about HIV and AIDS you will help to reduce fear and misconception about HIV and AIDS.Be a Role Model. Apply what you have learned in your own lives. Think about the words you use and how you treat PLWHAs and try to change how you think and act.Share what you have learned. After the training tell others what you have learned and get others talking about stigma and how to change it.Challenge stigma when you see it in your homes, workplaces, and communities. Speak out, name the problem and let people know that stigma hurts. Act against stigma as a group. Each group can look at stigma in their own situation and agree on one or two practical things they can do to do to bring about change.Saying “stigma is wrong or bad” is not enough. Help people move to action —agree on what needs to be done, develop a plan and then do it. Think big. Start small. Act now.Things You Can Do Yourselves as Individuals - Watch your own language and avoid stigmatizing words - Provide a caring ear and support to PLWHA family members at home - Visit and support PLWHAs and their families in your neighborhood - Encourage PLWHAs to use the available services: counseling, testing, medical care, ARVs and refer them to others who can help.Things You Can Do to Involve Others - Use informal conversations as opportunities to raise and talk about stigmaStigma and Discrimination Page 2 of 4 Resource Information pack for the Woman to Woman Initiative for Somali Women- Use real stories which put stigma into a practical context: stories of bad treatment of PLWHAs resulting in depression; stories of good treatment - Challenge stigmatizing words when you hear them—but do it in a way that doesn't turn people off—get people to think about how their words can hurt - Encourage people to talk openly about their fears and concerns about HIV and AIDS - Correct myths and misperceptions about AIDS and PLWHAs - Promote the idea of a friendly ear and support to PLWHAs and their families Things to Get the Community Talking about and Acting against Stigma Activities which get people to identify and analyze stigma in community examples: - TESTIMONIES by PLWHAs or their families about experience of living with HIV - LANGUAGE WATCH—school children or youth group make a “listening survey” to identify stigmatizing words used in the community—in media or in popular songs - COMMUNITY MAPPING of stigma—display map at community meeting place - COMMUNITY WALK to identify points of stigma in community - DRAMA by a youth group based on real examples—trigger for discussion - PICTURES drawn by youth or children—focus on starting point for discussionCommunity meetings to discuss what has been learned from the above methods and make decisions about what the community wants to do: agreeing on a code of conduct, specific support to families living with HIV and AIDS and orphans. - Training workshops on stigma for community and peer group leaders - Commitment. Make sure that people who want to make a difference are given an opportunity to state their commitment to challenge stigma publicly. Action starts with commitment and powerful commitment ensures that obstacles are challenged and overcome. The commitment of leaders serves as a role model and encouragement for others. Whenever possible, find examples of how one person’s commitment led to action which made a difference in their communityIslamic teachings on Stigma and Discrimination:Cause of HIV Infection: It cannot be assumed that people affected by AIDS are sinners. This is seen in a number of cases because HIV transmission can happen through many different ways. In marriages where one partner gets infected outside the marriage bond and infects the faithful partner. The faithful partner is innocent and has not committed a sin. Children also are innocent if they get infected through the mother to child transmission route. There are also those who get infected through blood transfusions, or are pricked by contaminated sharp piercing instruments.Stigma and Discrimination Page 3 of 4 Resource Information pack for the Woman to Woman Initiative for Somali WomenWhatever the cause of infection it is not our responsibility to judge any one. Allah is the one who will judge about anyone’s sins as stated in Quran Sura 34 ayat 25 “Say: "Ye shall not be questioned as to our sins nor shall we be questioned as to what ye do."Repentance: repentance in Islam is always possible and accepted if one feels guilty. This applies whether one has an incurable disease such as cancer or AIDS, or one has been sentenced to death or a married man who has committed adultery and been sentenced to stoning, even if the stones have been gathered. His repentance is valid, because Allah accepts the repentance of a person so long as the death rattle has not yet reached his throat. Allah says (interpretation of the meaning):"Allah accepts only the repentance of those who do evil in ignorance and foolishness and repent soon afterwards; it is they to whom Allah will forgive, and Allah is Ever All-Knowing, All-Wise." [al-Nisa 4:17 ]"And all of you beg Allah to forgive you all, O believers, that you may be successful" [ al-Noor 24:31 ]"And verily, I am indeed forgiving to him who repents, believes (in My Oneness, and associates none in worship with Me) and does righteous good deeds, and then remains constant in doing them (till his death)" [ Ta-Ha 20:82] And the Prophet (peace and blessings of Allah be upon him) said: "Allah will accept a person's repentance so long as the death rattle has not reached his throat" i.e., up until the time when the dying person loses consciousness, And Allah is the One Whose help we seek.The meaning of the phrase 'and repent soon afterwards' means that they repent before they die.There are five conditions of repentance: sincerity, regret for what one has done, giving it up immediately, determination not to repeat it in future, and repenting during the time when repentance will be accepted, i.e. before one dies or before the sun rises in the west.Calling derogatory names to anyone: The Quran says in Sura Hujurat: “O ye who believe! let not some men among you laugh at others: it may be that the (latter) are better than the (former): Nor let some women laugh at others: it may be that the (latter) are better than the (former): nor defame nor be sarcastic to each other nor call each other by (offensive) nicknames: Ill-seeming is a name connoting wickedness (to be used of one) after he has believed: And those who do not desist are (Indeed) doing wrong”. (Quran 49:11)Stigma and Discrimination Page 4 of 4 Resource Information pack for the Woman to Woman Initiative for Somali WomenThis clearly shows that there is no place for stigma and discrimination in Islam and people should avoid discriminating anyone as anyone can be faced by misfortunes and illnesses.As a Volunteer in the community As a volunteer in the community you can advocate or lobby for  For the development of a code of conduct and application of professional ethics amongst civil societies and health professionals  Support the application of universal precaution amongst health facilities  Development of a national HIV policy addressing stigma and discrimination of PLWHA  IEC material development. These should break the cycle of using frightening messages about HIV and AIDS as such messages increase fear and therefore leading to stigma and discrimination of PLWHA  Community involvement (Family members as well as neighbors) in reducing stigma and discrimination of PLWHA.Stigma and Discrimination Page 5 of 4 Resource Information pack for the Woman to Woman Initiative for Somali WomenWomen rights in Islam16EQUALITY BEFORE THE LAW “Accord to women equality with men before the law, equal rights to conclude contracts, and to administer property ... and treat them equally in all stages of procedures in courts and tribunals” [article 15] CEDAWAs stated in the Quranic verse below, in Islam both men and women are entitled to equality before the law and courts of law. Both men and women are accountable for their deeds before the law. Like men, women are entitled to seek justice. Islam asserts that both genders are honored and dignified: And they are equal in the sight of Allah, as they have the same religious and moral duties and responsibilities. In addition, both face the same consequences for their actions. “For Muslim men and women and for believing men and women, for devout men and women, for true men and women, for men and women who are patient and constant, for men and women who humble themselves, for men and women who give in charity, for men and women who fast (and deny themselves), for men and women who guard their chastity, and for men and women who engage much in Allah's remembrance for them has Allah prepared Forgiveness and great reward (Quran 33:35”).In the Islamic legal system, only a person conversant with Quran and Sunnah, and with the ability to carry out Ijtihad (according to some scholars) is qualified to be a judge. The majority of Muslim scholars stipulate that only men can be judges. Hanafi, one of the leading Islamic jurists, permits women to become judges on matters not related to capital punishment and contracts. Ibnu jarir Al- tabari and Ibn Hazm were of the opinion that women could be judges in all cases, since there is no clear-cut text which excludes women. Ibn Hazm cited this verse:Behold Allah bids you to deliver all that you have been entrusted with unto those who are entitled thereto, and whenever you judge between people, to judge with justice. Verily most excellent is what Allah exhorts you to do: verily, Allah is all- hearing, all-seeing (Quran 4:58).Ibn Hazm argues that this verse is addressed to both men and women and that there is no reason to prefer men to women (Ibn Hazm, Al-Muhalla bin Athar, vol. 8 Dar Al-Kutub Al-Ilmiya, 1988, p.528).“... take all appropriate measures to eliminate discrimination against women in order to ensure to them equal rights with men in the field of education and training…”[ARTICLE 10] CEDAW16 Adapted from UNICEF Somalia, 2002. WOMEN'S RIGHTS IN ISLAM AND SOMALI CULTUREWomen rights in Islam Page 1 of 2 Resource Information pack for the Woman to Woman Initiative for Somali WomenEDUCATION RIGHTS Education is not only a right but also a duty of all males and females. Prophet Muhammad said: "Seeking knowledge is mandatory for every Muslim. A husband can not prevent his wife from seeking education. Parents are duty bound to educate their girls as they educate their sons. Prophet Muhammad (PBUH) said:" Whosoever has a daughter and does not favor his son over her, Allah will enter him into Paradise." [Ahmad]The first word of the Quran brought down to the Prophet Mohammed (peace be upon him) was 'Read!' Education, reading, acquiring knowledge, travel and exploring and appreciating what the world has to offer is one of the fundamental values in Islam, and its importance is demonstrated by being the first thing that God communicated of the Quran. All Muslims are required to educate themselves regardless of being male or female, in fact the Prophet emphasized that women have a right to education.The Prophet encouraged women to seek knowledge. As an example, the Prophet assigned specific days to instruct women, despite his busy schedule. Islam endorses a woman's right to have access to all types of education and training, and to pursue it to any level they desire. Both males and females can have the same curricula, examination and qualified teachers. Conservative Islamic groups demand separate educational facilities for men and women.PROPERTY RIGHTS “Grant women equal rights with men to acquire, change or retain their nationality” [ARTICLE 9] CEDAWThe nationality of any Muslim is the Islamic Doctrine (Aqida Al-islaamiya). Therefore, it is illegal for a Muslim woman to lose, or to be denied her rights by marrying another Muslim. The Islamic Shari'a recognizes property rights of women before and after marriage. To men is allotted what they earn and to women is allotted what they earn (Quran: 4:32).INHERITANCE RIGHTS OF A WOMAN In Islam inheritance rights are stipulated in great detail in order to avoid arguments and disappointments. Furthermore, it is the first religion to clearly state the inheritance rights of women. This is in order to ensure her financial security. Islam prescribed these rules to protect her over 1400 years ago. As a volunteer in the community: You can advocate for:  Involvement of religious leaders in disseminating women’s rights in mosques and public gatheringsWomen rights in Islam Page 2 of 2 Resource Information pack for the Woman to Woman Initiative for Somali WomenMarriage in IslamThe betrothal system17 “… Ensure on the basis of equality of men and women the right to enter into marriage… the same rights and responsibilities during marriage… the same rights for both spouses in respect of ownership, acquisition, management, administration, enjoyment and disposition of property, whether for free of charge or for valuable consideration….” CEDAW [ARTCILE 16]According to Islam, women have the right to accept or reject marriage proposals. Her consent is a prerequisite for the validity of the marital contract according to the Prophet's teaching."Ibn Abbas reported that a girl came to the Messenger of God, Muhammad, and she reported that her father had forced her to marry without her consent. The Messenger of God gave her the choice ... (between accepting the marriage or invalidating it)." (Ahmad). In another version, the girl said: "Actually, I accept this marriage, but I wanted to let women know that parents have no right to force a husband on them." [Ibn Majah] A woman can stipulate, “not to be married with” in her marriage contract.The rights of a wife In order for a marriage to be valid in Islam, a man must first provide the woman with a wedding gift called the "mahr" which should be cash and could additionally include property, jewellery and clothing. This gift is to ensure that the woman is financially secure regardless of divorce. Even if they divorce the day after they consummate the marriage the gift is for her to keep. Furthermore, a husband is obliged in Islam to financially provide for his wife and cover ALL household and clothing bills for his family. If he does not do so it is considered a sin. In return the wife is obliged to take care of his children and be intimate with him. She is not obliged to cook, clean and stay at home; it is her choice to do so if she wishes. In Islam there are 5 core goals that a husband and wife should strive for in their marriage: 1. Tranquility, 2. Affection, 3. Mercy, 4. To protect and give comfort (the direct translation is to be each other's clothing) and 17 Adapted from UNICEF Somalia, 2002. WOMEN'S RIGHTS IN ISLAM AND SOMALI CULTUREMarriage in Islam Page 1 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women5. To have and raise children. Everything that a husband and wife do in a marriage should have these goals in mind - therefore, physical abuse does not comply with mercy, adultery and arguing does not comply with tranquility, abstaining from sex and ignoring one another does not comply with being affectionate. And of course the most controversial topic of all, polygamy does not comply with 3 of them, in fact, in Islam it is made clear to man that he can have up to four wives under certain conditions and only after he gets permission from his wife. Even if she agrees, he MUST treat them equally in all aspects - emotionally, financially, physically, which for a human is impossible. Islam recognizes this impossibility and says that those men who cannot fulfill those criteria will be punished -therefore discouraging polygamy as opposed to encouraging it. The holy Quran says “If ye fear that ye shall not be able to deal justly with the orphans marry women of your choice two or three or four; but if ye fear that ye shall not be able to deal justly (with them) then only one or (a captive) that your right hands possess. That will be more suitable to prevent you from doing injustice”. 4:3 Sura Nisaa and also the Quran says “Marry those among you who are single or the virtuous ones among your slaves male or female: if they are in poverty Allah will give them means out of His grace: for Allah encompasseth all and He knoweth all things”. 24:32 Sura NurFurthermore, a woman is not obliged to marry anyone she doesn't want to and the Sheikh (religious man) asks for her consent before conducting the wedding ceremony. Divorce and custody Islam stipulates the husband's right to divorce, while recognizing the wife's right to ask for it. The wife can initiate divorce through a process called “khul”-- divestiture. The Somali culture permits the mediation of marital disputes by the relatives. Otherwise, the Shari'a is used to resolve disputes between husbands and wives. The priority for custody of young children (up to the age of about seven) is given to the mother. A child later chooses between his mother and father (for custody purposes). Custody questions are settled in a manner prioritizing the interest and well being of the child. The rights of women in divorce There are clear rules with regards to divorce, conditions in which it is allowed, what the process is and the rights of the woman who is divorced. Most of these rules are there to protect the woman. An example is that a man who wants to divorce his wife has to leave the house and he cannot kick her out, it is her choice if she wishes to remain in the residence. Financial independence Any money that a woman earns in her employment or inheritance is hers and she is not obliged to pay or contribute a cent to her husband or parents, it is her choice if she wants to lighten their financial load. If she financially contributes she is granted blessings from Allah, but if a man requests her to financially contribute Marriage in Islam Page 2 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women he has committed a sin. Mothers in Islam Motherhood is seen as one of the most important roles of humans. Mothers are given great importance and respect. In fact the Prophet says that "paradise is under the feet of mothers". Children are obliged to show the utmost respect for their parents. In fact in Islam it says that first you must show respect and obedience to God, secondly his Prophet, thirdly the mother, fourth the mother, fifth the mother, sixth the father. As a Volunteer in the community As a volunteer in the community you can advocate or lobby for  Application of Islamic marriage contracts  Education of girls on their marital rights prior to marriage Measuring your success:  Women know more about their rights.  Women report use of marriage contract Keeping records and reporting on your volunteer work  the number of women you are working with ____  the number of education sessions conducted for women this month ____  the number of days you volunteered during the month ____  Indicate other partners you worked with during the month ____Marriage in Islam Page 3 of 3 Resource Information pack for the Woman to Woman Initiative for Somali WomenReproductive health education in IslamIslamic Concept of Sexuality Islam recognizes the power of sexual need, and the subject is discussed in Quran and the sayings of Prophet Mohammed (PBUH) in a serious manner, in context with the marital life and family life. Islam does not consider women (or men) an object of sexual pleasure but with a legal framework of relationship fulfilling the will of Allah. While the sex outside marriage is a punishable sin, sex with one's spouse is an act of worship. The Islamic laws regarding sex are fixed and do not change with peer pressure or changing values of society. Who should give reproductive health education? An appropriate and healthy sex education, supplemented with some ethical and moral dimension as well as family love and responsibility is crucial to the fulfillment of a happy marriage. With regards to the questions who should impart sex education, everyone has to play his or her role. The parents as a whole have to assume a more responsible role; especially the father has a duty to be able to answer his son's questions and the mother to her daughter's. Within a family the elder sister has a duty towards the younger one and the elder brother has for the younger one.Proposed Curriculum for Islamic reproductive health education Islamic reproductive health education should be taught at home, starting at an early age. Before giving education about the anatomy and physiology, the belief in the Creator should be well established. The father should teach the son and mother should teach her daughter. In the absence of a willing parent, the next best choice should be a Muslim male teacher for boys and a Muslim female teacher for a girl at the Islamic school. The curriculum should be tailored according to the age of the child and classes where possible be held separately for boys and girls. The Curriculum for Sex Education could include:  Sexual growth and development o Time table for puberty . Mental, emotional & social aspect of puberty . Physical changes during puberty o Need for family life  Physiology of reproductive system o For girls - organ, menstruation, premenstrual syndrome o For boys - the organ, the sex drive  Conception, development of fetus & birth  Islamic Marriage o Marital contract o Marital rights of men and womenReproductive health education in Islam Page 1 of 2 Resource Information pack for the Woman to Woman Initiative for Somali Women Sexuality (emphasize the Islamic aspect). o Sexual transmitted infections and HIV/AIDS . Definitions, . Signs and symptoms . Prevention and treatment o Social, moral and religious ethics o Peer Pressure . Definition . Types and forms of Peer Pressures . How to avoid peer pressure  Female Genital Mutilation / Female Genital Cutting o Definition o Types o ConsequencesAs a Volunteer in the community As a volunteer in the community you can advocate or lobby for  For the development of an Islamic reproductive health education Manual  The inclusion the Islamic reproductive health education manual in the secular and religious curriculumMeasuring your success:  Young girls and boys know more about their reproductive health system.  Young girls have the skills to abstain from sex Keeping records and reporting on your volunteer work  the number of schools you are working with ____  the number of reproductive health education sessions conducted this month ____  the number of days you volunteered during the month ____  Indicate other partners you worked with during the month _____Reproductive health education in Islam Page 2 of 2 Resource Information pack for the Woman to Woman Initiative for Somali Women4. What you can doCommunication for change18 A communication campaign is one of the most effective ways to reach people with information about HIV and AIDS. Communication campaigns are comprehensive activities including public performances, posters, media coverage etc. as part of a strategy to make people more aware about an issue. The most critical step is to get organized by reviewing the goals you hope to achieve with your campaign. Newspapers, radio or television media can do a news story about your activity and help you to get the message out to more people. Whether you are overseeing or planning a series of a communication campaign for a year or you are a woman group planning a single communication campaign the ‘steps to develop a communication campaign’ are the same.Steps to a coordinated communication response1. Set goals & objectives Developing goals and objectives is the first step in developing a communication strategy and follows on from an identification of gaps and problems. Goals and objectives need to be clear, realistic and linked to timeframes. A crucial question to ask is whether the campaign will contribute to an improved human rights situation and gender equality.Example Goal: For men to take more responsibility for parenting, which includes making choices about having children and taking on a caring role with children. Objective: To contribute to a shift in thinking on what responsible fatherhood means.2. Identify the message A prerequisite for identifying a communication message is to have a good understanding of the issue at hand. Does the issue affect women and men differently? Do women and men have different perceptions or expectations with respect to this particular issue? Would addressing this issue change gender relations and contribute to the universal fulfillment of human rights? It is also important to be aware of other campaigns on the issue and whether these have been effective or not.Example18 Adapted from UNAIDS Inter-Agency Task Team on Gender and HIV/AIDS - KIT Publishers, Amsterdam, The Netherlands. (2005). Operational Guide on Gender and HIV/AIDS : A Rights-Based Approach (2005)Communication for change Page 1 of 8 Resource Information pack for the Woman to Woman Initiative for Somali WomenWhat is the dominant notion of manhood and fatherhood in this particular community or society? Is this notion an obstacle to HIV prevention? How does this notion impact on the roles of women and men in dealing with the consequences of HIV/AIDS, and in particular in looking after children who are infected and affected by HIV/AIDS? How do men and women relate to this particular interpretation of manhood and fatherhood? Have there been other initiatives to challenge and change this dominant notion and what can we learn from these initiatives?3. Identify the audience(s) It is important to be clear on who the target audience of the communication is. There may be more than one audience, which is why it is important to carefully analyze who the intended recipients of the message are. In fact, a sophisticated and gender-sensitive communication strategy will distinguish between different audiences rather than assuming that societies, communities, households or certain age groups (e.g. youth) are homogeneous. In particular, it will critically assess whether there are differences in knowledge, attitudes and interests between women and men of different backgrounds and age groups. A simple tool to identify the audience or audiences of communication is presented in the audience targeting table below.The audience targeting table.Source: Save the Children (2003), Toolkits: A Practical Guide to Planning, Monitoring, Evaluation and Impact Assessment, Save the Children, London, p.306.Example Men are the primary audience of a campaign on ‘responsible fatherhood’. More specifically, the campaign has identified young men as the main target audience. Women, and in particular young women, are identified as the secondary audience, because they have internalized certain norms and beliefs that perpetuate a situation whereby men can abscond responsibility for parenting.4. Involve the community and target audience(s) Involvement of the target audience(s) in all stages of the design, delivery and monitoring of the communication strategy is critical. For one, it will help ensure that the communication is relevant and grounded in local experiences, norms and perceptions. At the same time, their involvement is crucial to ensure that those norms and perceptions that perpetuate gender inequality and power imbalances Communication for change Page 2 of 8 Resource Information pack for the Woman to Woman Initiative for Somali Women are challenged and transformed in ways that speak to the intended target audience(s).Example Involving young men and young women in the design of a campaign on ‘responsible fatherhood’ will help to bring out their particular experiences, frustrations and aspirations to transform norms and expectations about men/ fathers and women/mothers. Their involvement will help in identifying the strategic entry points of the communication campaign and how best to address the issue. It will also give credibility to the campaign, as it is not imposed from ‘the outside’, but is based on the norms and aspirations of representatives from the community/ target audience, who are also actively involved in the delivery of the message (as peer educators).5. Build alliances and partnerships Combining the expertise, skills, resources and influence of like-minded organizations and role players is a key to an effective communication campaign. It can help in reaching a greater audience and will give impetus and credibility to the campaign. Critically, alliances and partnerships need to be established with women’s organizations and gender activists and with organizations representing people living with HIV/AIDS.Example Partnerships could be developed with local women’s groups, the national youth council or a national association of young men (where these exist), gender organizations, employers’ organizations and trade unions, leading figures in the target community (role models) and other development agencies (including UN agencies with specific expertise and interest in this area).6. Target the message Because the knowledge, beliefs and interests of target audiences differ, it is important that the content of the message is custom-made and culturally sensitive. Also, the format in which the message is packaged needs to be customized for the specific target audience. It is important to bear in mind that there are likely to be important differences between women/girls and men/boys in terms of access to information and resources, sources of information, time (to read, for example) and so on.Example Men and women are likely to respond to different messages in relation to promoting ‘responsible fatherhood’. For this reason, it might be useful to develop posters that target young men and others that target young women. Whereas community newspapers could be an effective medium to reach young men, to reach young women it might be more effective to use community radio. Also, participatory methods should be considered, bearing in mind where young men and women are most likely to meet. For young men, this could mean linking Communication for change Page 3 of 8 Resource Information pack for the Woman to Woman Initiative for Somali Women group discussions to sports activities. For young women, particularly young mothers, it could mean facilitating peer communication events at schools or madrasahs.7. Develop ‘positive messages’ Given the crisis associated with HIV/AIDS, it can be very tempting to use negative messages in the hope that it will shake people’s false sense of security or propel organizations into action. However, people generally respond better to positive messages than to scare tactics or negative messages, because negative messages tend to result in a sense of disempowerment, fear and apathy. Also, negative messages run the risk of reinforcing stereotypes, unjustifiably apportioning blame and responsibility and enhancing stigma and discrimination. At the same time, communication for change demands that we critically examine the implicit assumptions and norms conveyed in our messages to ensure that these messages do not perpetuate gender stereotypes or other stereotypical portrayals of people that serve to entrench power imbalances. Effective communication messages are positive and affirming, rather than negative and undermining. Communication for change is also empowering, challenging and transforming. A simple tool is to check whether the information or message adheres to the “ACCEPT” principle. ACCEPT stands for Affirming, Correct, Challenging, Empowering, Positive and Transforming. Look up the box on ACCEPT principle below to find an elaboration on what ‘positive messaging’ means.Example Instead of conveying the message that young men are irresponsible and not up to being fathers, try to promote a positive and affirming image of young men who are able to move beyond dominant norms and perceptions to embrace the notion of ‘responsible fatherhood’.The ACCEPT principle Affirm what is ignored and undervalued: Instead of: “There is no need to thank women for looking after those who are infected and affected by HIV/AIDS, because that is a woman’s responsibility.” Consider: “Women are invaluable in the fight against HIV/AIDS and need to be supported and rewarded for fulfilling these tasks.”Correct inaccuracies, ignorance or lies: Instead of: “AIDS can not be cured if you have sex with a virgin.” Consider: “There is no cure for AIDS, but living with HIV/AIDS does not have to be a death sentence. Forced sex with a child is wrong and will leave the child with a permanent psychological scar and physical damage.”Challenge dominant norms, perceptions and stereotypes that are degrading and perpetuate inequality: Instead of: “If a young woman is raped, it is because of the way she dresses or Communication for change Page 4 of 8 Resource Information pack for the Woman to Woman Initiative for Somali Women behaves.” Consider: “Rape is inexcusable and men who rape must be held accountable.”Empower for action: Instead of: “The number of AIDS orphans will increase dramatically and beyond our ability to cope with their needs.” Consider: “Every AIDS orphan deserves a loving home. Does your home qualify?”Present the negative into something positive: Instead of: “Every day, thousands of people are dying of HIV/AIDS. Protect yourself.” Consider: “Every day, people like you choose life. Join the AIDS-free movement and protect yourself.”Transform dominant perceptions and stereotypes: Instead of: “A real man has many sexual conquests and fathers a lot of children.” Consider: “A ‘real’ man communicates with his partner and nurtures his children.”8. Choose the messenger The conveyor of the message needs to be carefully selected. For the target audience(s) to be receptive to the message, the messenger has to be seen as credible. For this reason, it might be most appropriate to use peer communicators to target women and men respectively. Another consideration is whether the messenger has moral or political authority. For example, one could use a public persona who is likely to have some influence on the target audience. It is important to bear in mind that men and women are likely to be susceptible to different public figures.Example At community level, the use of young men and young women as peer communicators and peer facilitators would add credibility to the campaign on ‘responsible fatherhood’. It might also be appropriate to use leading sports figures in mass media to promote a different image of manhood and fatherhood to young men. In some cases, it is advisable to use older peer educators (or educators of all ages) as some people are more receptive to what a different age group says.9. Test material and messages Pre-launch testing of communication material and communication messages can significantly improve the quality and effectiveness of communication. It is therefore important to allocate time and resources for piloting the material and messages. This will help to ensure that the message(s) and the format for presenting the information are culturally specific, appropriate and effective.10. Deliver the message This is the implementation phase of the communication strategy. If the various elements of the communication strategy have been carefully designed, based on Communication for change Page 5 of 8 Resource Information pack for the Woman to Woman Initiative for Somali Women a recognition of the different roles of women and men, of the nature of gender relations and of how gender inequality manifests itself, the delivery of the message or campaign ought to contribute to the desired goals and objectives – i.e. to social change, enhanced gender equality and an improved human rights situation.11. Evaluate the process and results Evaluation of both the process and the results of the communication is an important part of measuring the quality and effectiveness of the communication. It is also essential as a means of ensuring that processes of learning become embedded in the organization. It is important to decide on indicators for measuring results at the outset. Examples of gender indicators to measure progress in reducing vulnerability to HIV infection:  Proportion of women, girls and young people in general involved in design and implementation of the project/program and at what level;  Willingness of boys and men to use condoms with their wives/girlfriends;  Decrease in the number of rapes and other forms of sexual abuse;  Decrease in HIV incidence among young women, pregnant women, women living in slums, etc.  Specific policy changes safeguarding women’s rights to retain their jobs, own land, housing, assets, etc. Examples of gender indicators to measure progress in guaranteeing a dignified and fulfilling life for women and men infected with HIV/AIDS: Proportion of women involved in design and implementation of the project/program and at what level;  Number of women trained as Home Based Care Workers and their ability to fulfill their tasks well;  Number of men and women disclosing their HIV status to their partners;  Perceived wellbeing and sense of belonging, as expressed by women and men living with HIV/AIDS.Examples of gender indicators to measure progress in enhancing coping capabilities of women and men:  Proportion of women involved in design and implementation of the project/program and at what level;  Change in nutritional status of girls and boys in households affected by HIV/AIDS;  Number of advocacy activities effected by women’s organizations and the impact of these activities in qualitative terms;  Specific policy changes safeguarding the rights of widows or child-headed households to land, housing, assets, income, etc.Communication for change Page 6 of 8 Resource Information pack for the Woman to Woman Initiative for Somali WomenWhat you can do as a volunteer in a communication for change response Entertainment: drama, poetry, songs One of the most successful HIV and AIDS communication techniques is the use of entertainment to highlight issues. Drama is incredibly powerful. The strength of Somali drama, poetry and song will no doubt contribute to dynamic and influential awareness among Somali audiences. These means will allow an audience to understand an issue from a less confrontational standpoint that allows for an emotional response to HIV and AIDS issues.Interview and Debate: feature all opinions When a debate covers many different viewpoints the audience is more likely to identify with some points, disagree with others and learn something. Covering different points usually keeps an audience more entertained. It will also ensure that the audience is not alienated by something they disagree with and more receptive to other information.Public Discussions Arranging for a panel of experts to hold public and open discussions on a given subject can be also a strong way to keep audiences interested and attentive. Interactive discussions where audiences are also given the opportunity to ask the panel of expert questions will ensure misconceptions or misunderstandings are clarified. A panel could be made up of a mixture of experts such as a medical doctor, a public health specialist, a lawyer, a religious leader etc… sitting together to discuss an issue of public concern.Women groups Women are more vulnerable to HIV infection than men for various reasons. Yet women are also known to be leaders in creating awareness on topical issues. Identifying and working with women leaders such as women religious leaders, nurses, midwives, can be a great opportunity for a communication campaign on HIV and AIDS issues amongst girls and women.Youth programs Young people are important stakeholders in the development of media and communication packages about HIV and AIDS because 1) They are affected by HIV and AIDS more than any other group, 2) they are more accepted when addressing controversial ideas than adults are, 3) because among Somali stakeholders youth are one of the primary groups involved in communication campaigns, 4) youth increasingly have more media skills and knowledge about HIV and AIDS. Remember: Local groups have experience successfully implementing communication campaigns activities. As a volunteer make use of their experience and activities to create awareness on any given issueCommunication for change Page 7 of 8 Resource Information pack for the Woman to Woman Initiative for Somali WomenReaching Nomadic and Rural women and girls 1. Water Points: Nomadic and rural women as well as girls tend to gather around water points. These water points gathering can offer an opportunity for creating HIV and AIDS awareness 2. Songs, Poetry, story telling and drama. Somalis are known for their love of songs, poetry, story telling and drama. Public performances of songs, poetry, story telling or drama with HIV and AIDS as a theme during festivities could be a powerful way to communicate HIV and AIDS messages. 3. ‘AWS’ and ‘Kabad’ making events is another opportunity for HIV and AIDS communication strategy where women gather to sing and dance 4. Live stock market also offers an opportunity for creating awareness as women gather together to sell their animals and animal products and therefore can be an entry point for a communication campaign.Volunteer's checklist  You know your target group (public, women, youths, leaders, policy makers etc…) and are aware of the appropriate media to be used (community even, radio production, public performance etc…).  You have the information pack for these issues. If not, you have technical experts to guide you e.g. nurses, doctors, lawyers, religious scholars etc…  You are coordinating with other community volunteers in planning for campaign.  A "back-up"19 volunteer (junior volunteer) is available to learn from you and to replace you during your absences.  Your coach or volunteer leader is aware of the campaign and is actively involved in the facilitation, coordination and implementation.Measuring your success:  Target group know more about safer sex practices.  Target group talk more openly about the risks of HIV transmission.  Target group have a better understanding of HIV/AIDS and do not stigmatize People Living with HIV and or AIDS (PLWHA). Keeping records and reporting on your volunteer work  the number of awareness creation activities you conducted or carried out ____  the number of people reached for each awareness creation activity____  the number of days you volunteered during the month ____  indicate other partners you worked with during the month ____ 19 Note: You cannot always be there. Get yourself a backup-volunteer. Find another person who can offer her/his services to learn what you do and to replace you during your absences.Communication for change Page 8 of 8 Resource Information pack for the Woman to Woman Initiative for Somali WomenCommunity MobilisationWhat is community mobilization? Why and when do we need to mobilize communities?Community mobilization is getting together members of a given community to support an issue of public concern (e.g. drug abuse, chewing ‘kat’, HIV and AIDS, stigma and discrimination of PLWHA, violence against women [VAW], Education for the girl child, disease outbreaks, poverty reduction, environmental cleanliness, safe and secure environment for women etc…) identified by a few members as important in order to:-  Create awareness on the existence of the issue of concern  Initiate dialogue and debate on the issue of concern so as to:- a) Identify root causes of the issue of concern. b) Develop possible solutions c) Plan for action to be taken  Raise resources to address an issue of public concern (including human and financial resources)What you need to do if you are a volunteer in the community to respond to HIV and AIDS?  Live and volunteer in your own village  Work with your elders, leaders and local health staff (village health workers, traditional birth attendants etc…).  Know what priority problem(s) that affects women and make them vulnerable to HIV and AIDS the community wants to solve  Know the traditional beliefs about such issues and how they are traditionally solved.  Take note of influential members of the community whose voice is listened and acted upon by the majority such as religious and traditional leaders. Lobby for these people to be on your side.  Identify existing community activities that can be used as opportunities for community mobilization on addressing HIV and AIDS issues such as:-  Community festival  Schools (formal and informal) gatherings  Madrasahs (Quranic schools)  Market places  Weddings  Mosques  ‘Abay Siti’ gatherings  Sports ground  Etc…  Clan meetings  Follow established guidelines and recommendations in addressing any of the issues.  Know what other groups and volunteers are doing in your community about priority problems.Community Mobilization Page 1 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women Measure your success (outcomes of your efforts).  Meet and share information with your volunteer "leader" and your coach Possible activities for a community event In identifying appropriate activity for community mobilization you need to determine your objective and expected outcome and then choose accordingly. For example if your objective is to create awareness on the existence of HIV then you may organize for a lecture, drama or other folklore activity with HIV/ AIDS as a theme in a routine public setting such as in the market place, school or sports ground. Debates are very good in getting sensitive issues on the agenda of policy makers and the involvement of religious, traditional or political leaders can initiate dialogue and large scale community awareness especially when the media is actively involved. Therefore bearing in mind the objective and expected outcome for a community event the following can be possible activities for community mobilization:-  Public performances such as drama, poetry and other folklore activities with specific themes addressing issue of concern.  Public rallies with political, religious and traditional leaders leading the discussions on the HIV and AIDS issue of concern affecting women and girls.  Community meetings chaired by traditional leaders discussing HIV and AIDS issue of concern to women.  Use of mass media to campaign for HIV and AIDS issues of concern (will require strong collaboration with other stakeholders to be successful) Volunteer's checklist when planning for a community event.  You know your target group (general public, women, youths, leaders etc.)  Traditional and administrative leaders have been contacted.  Health authorities, health committee and health workers have been contacted where relevant (especially when addressing a health issue requiring their technical expertise in proposing solution).  The community has identified its priority issue(s) of concern for action.  You have the information pack for these issues. If not, you have technical experts to guide you e.g. nurses, doctors, lawyers, religious scholars etc.  You are coordinating with other community volunteers in planning for the event or trying to implement event on your own.  Your coach or volunteer leader is aware of the planned event and is on hand to support in the facilitation.  A "back-up" volunteer (junior volunteer) is available to learn from you and to replace you during your absences20.  You have a workplan and schedule for each month until you reach your objective. 20 Find another person who can offer her services to learn what you do and to replace you during your absencesCommunity Mobilization Page 2 of 3 Resource Information pack for the Woman to Woman Initiative for Somali WomenMeasuring your success:  Target group know more about safer sex practices.  Target group talk more openly about the risks of HIV transmission.  Target group have a better understand of HIV/AIDS and do not stigmatize People Living with HIV and or AIDS (PLWHA). Keeping records and reporting on your volunteer work  the number of community mobilization activities you conducted or carried out ____  the number of people reached for each educational session conducted____  the number of days you volunteered during the month ____  Indicate other partners you worked with during the month ____Community Mobilization Page 3 of 3 Resource Information pack for the Woman to Woman Initiative for Somali WomenHouse to House PromotionWhat is House to House Promotion? Why and when do we need to do House to House Promotion to respond to HIV and AIDS?As the name shows this is simply going from house to house promoting an idea that will address an issue of public interest. As a community volunteer most of your activities will be done through house to house promotion. House to House promotion is done when an issue of concern requires demonstration on ‘how to’ for its resolution. For example in addressing childhood diarrhea and resulting dehydration at home, the mother or caregiver will need to be shown how to prepare home made oral rehydration solutions (ORS) for the child. Similarly when a patient with AIDS related illnesses or other illnesses confining someone to the bed, as a volunteer in this situation, you may require training the caregiver on home based care of their bedridden patient. In summary, house to house promotion is done with the objective of impacting practical knowledge and skills to individuals in addressing an issue of concern.What you need to do if you are a volunteer in the community?  Live and volunteer in your own village or town.  Be part of an established village, town committee (e.g. village health committee)  Agree with your coach or team leader on the number of houses under your responsibility.  Provide your coach or team leader with a list (name of head of household) and location (address or directions on how to get there) of houses under your responsibility  Know what priority problem(s) the community wants to solve  Know the traditional beliefs about such issues  Know what other groups are doing in your community about priority issues.  Work with your elders, leaders, local health staff (village health workers, traditional birth attendants) and other professionals when resolving an issue of concern.  Follow established guidelines and recommendations in addressing any of the issues. Know the families (infants, children, adults) medical history in the houses21 under your responsibility.21 The number of houses under your responsibility will depend on the population density, distance between houses, and the time you have to serve as a volunteer. Usually this will be approximately 10 households or less. House to House Promotion Page 1 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women Visit each of the houses at least one time per week to provide key messages (IEC) and advice on HIV and AIDS related risks and vulnerabilities.  Measure your success (outcomes of your efforts).  Meet and share information with your volunteer "leader" and your coach.Possible activities for a House to House promotion  Share educational information on HIV and AIDS prevention, treatment, care and support.  Provision of skills and practical knowledge to guardians and caregivers on priority issues. For instance: - o Making home made oral rehydration solutions. o Caring for bedridden patients in the house22. o Managing and caring for a PLWHA at home o Etc…  As part of other programs (e.g. TB program, violence against women program) to follow up and monitor on progress of clients and provide psychosocial support to such clients and their relative.  Rapid house hold surveys to document community needs or other relevant information for possible intervention.Volunteer's checklist  Priority issues to respond to HIV and AIDS are clear.  You know which households you will visit regularly.  You know how often you will work (usually 1 to 3 hours per week)  Traditional and administrative leaders have been contacted and are in agreement with your activities.  You know your target group (Number of infants, children, young people and women in the household under your responsibility).  Health authorities, health committee and health workers have been contacted and are willing to provide technical advice and expertise when needed (especially when addressing a health issue requiring their technical expertise in proposing solution).  You have the information pack for these issues. If not, you have technical experts to guide you e.g. nurses, doctors, lawyers, religious scholars etc…  You are coordinating with other community volunteers in addressing these problems.  You have identified community own resource persons (TBAs, Community Health Workers etc…)and you have recruited them to support you or carry out the house to house promotion activities22 Volunteers need to have taken an established HBC training to be able to provide skills to caregivers of bedridden patients at home.House to House Promotion Page 2 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women A "back-up"23 volunteer (junior volunteer) is available to learn from you and to replace you during your absences.  Your coach or volunteer leader is aware of the planned event and is on hand to support in the facilitation.Measuring your success:  Target group know more about safer sex practices.  Target group talk more openly about the risks of HIV transmission.  Target group have a better understand of HIV/AIDS and do not stigmatize People Living with HIV and or AIDS (PLWHA). Keeping records and reporting on your volunteer work  the number of houses you visited during the month ____  the number of people reached for each visit____  the message you passed to the house during each visit____  the number of days you volunteered during the month ____  Indicate other partners you worked with during the month _____23 Note: You cannot always be there. Get yourself a backup-volunteer. Find another person who can offer her services to learn what you do and to replace you during your absences.House to House Promotion Page 3 of 3 Resource Information pack for the Woman to Woman Initiative for Somali WomenResource mobilization at community levelWhat is resource mobilization at community level? When and how can you mobilize resources at community level?Resource mobilization in general means identification of ways and means to achieve an objective. Resource could be either financial means or technical expertise provided by a professional for achieving the objective. That means resource mobilization could be both the identification of financial and human capacity to achieve an objective.As a volunteer in the community you will come across situations where community concerns requires resource mobilizations for achieving an objective. Such situations could be either requiring financial or human resource support. Example of community situations requiring financial support include but not limited to:- a) Rehabilitation or construction of public buildings (e.g. VCT centre, health centre, school, sports ground, community library etc…). b) Initiating an income generating activity in support of orphans and other vulnerable children. c) Income generating for women living with HIV and AIDS activity as part of a livelihood programIn all community initiatives human resources are needed. Such requirement could be as simple as man power support during an HIV and AIDS awareness creation procession or professional and technical expertise in achieving an objective such as a nurse or doctor to train volunteers in home based care or a lawyer to advice on legal action against perpetrators of violence against women or a religious scholar to advice on religious rulings on FGM/C and so on. In all cases human resource mobilization can be enhanced if you are well prepared and have strong communication skills in seeking support from the public or individuals.Human resource mobilization is close to community mobilization and therefore you need to make use of the ‘Community Mobilization’ info pack to help you with this exercise. As volunteer and as mentioned earlier you will need human resource when addressing an issue of community concern that require labor force (man power such as collecting food donations for PLWA campaign during Ramadhan) or technical expertise (such as in a construction of a VCT centre). Answers to the following key questions will guide you in identifying appropriate persons to meet your needs. What is required to accomplish the assignment i.e. labor force or technical expertise? Or both?Resource mobilization at community level Page 1 of 4 Resource Information pack for the Woman to Woman Initiative for Somali Women Where will you go to get such people? Is it the mosque? Hospital? Primary School? Secondary school? Or the university? Maybe other places such as the market?Possible activities for financial resource mobilization at community levelThere are several activities you can propose and support for financial resource mobilization at the community level. Identifying a suitable activity will be dependant on the objective and amount of financial resources you have to mobilize. The list below shows some of the ways that you can use but it is not exhaustive. There maybe some other ways that are traditional amongst the target community that are more likely to succeed than these. As a community volunteer you should be informed of these. List of ways you can raise financial resources in the community: a) Fundraising event / exercise This is suitable for mobilizing finances for large scale community project requiring a substantial amount of finances and human resources to carry out. Use the community mobilization information pack for additional information in getting community members involved in your planned event or exercise. Event or exercise may include one or more of the following: -  Sell of tickets to a variety show to increase awareness on HIV and AIDS issues (traditional dances, songs, poetry, clothing, etc…)  Food bazaar (community members bring in the food for sell as their contribution)  A walk or run to sponsor a project (in support of orphans, or the establishment of a VCT centre etc…). Individuals taking part in the walk or run will be required to go round getting sponsors to pledge money for the project prior to the exercise.  Public rally with guest of honor (s) invited to solicit for funds directly from the community. Guest of honor (s) should be prominent figures in the community such as business men, politicians or women leaders.  Zakaat collection through mosques in support of AIDS orphans, widows or women living with HIV and AIDS. Religious leaders would need to be involved in supporting such an initiative.  Collection boxes in public places such as mosques and Madrasahs to support the education of AIDS orphans.  Writing a proposal on a community HIV and AIDS project and submitting to potential interested parties including government and non-governmental organizations that are known to fund such initiatives. b) Merry go rounds. This is one of the easiest and common ways to raise financial resources for individual income generating activities as part of a livelihood program. Suitable Resource mobilization at community level Page 2 of 4 Resource Information pack for the Woman to Woman Initiative for Somali Women for a group of 5 to 10 people especially women. The following are the common steps taken for this exercise:-  Each individual in the group gives in an agreed upon sum of money to one of the members on a rotational and regular basis e.g. every week or every month.  A member receives money only once during a cycle of the merry go round.  The group will determine who will receive the money first, second, third and so on either through a consensus or by picking up blindly a number from a piece of paper in a basket.  Once everyone in the group has received money the cycle can start again and continue for as long as members are in agreement.  Members may wish to raise contribution amounts with each subsequent cycle.  New members may be recruited at the end of a cycle.Checklist for utilization of mobilized resources in setting up an Income Generation Activity (IGA) for the community. IGA identified by women groups  Feasibility study on viability of IGA has been done  Women’s ownership of viable IGA  Local resources in implementing IGA have been mobilized  More individual based IGA within the group are considered  Regular consultations with the groups especially the beneficiaries  Revolving fund instead of seed money (outright grants) which makes it easier to instill accountability should be considered  Provision of micro-finance training for beneficiaries (Uli I think we should leave in beneficiaries instead of participants) prior to initiating IGA by an expert trainer.Volunteer's checklist  The group has identified priority issues in responding to HIV and AIDS.  You know who the most likely people to support you technically or otherwise in addressing these concerns. Where to get them and how? (E.g. do you need someone else to get a midwife to give a lecture on HIV prevention to a group of traditional birth attendants?)  Traditional and administrative leaders have been contacted and are in agreement with your activities.  Health authorities, health committee and health workers have been contacted and are willing to provide technical advice and expertise when needed (especially when addressing a health issue requiring their technical expertise in proposing solution).  You have the information pack for these issues. If not, you have technical experts to guide you e.g. nurses, doctors, lawyers, religious scholars etc…Resource mobilization at community level Page 3 of 4 Resource Information pack for the Woman to Woman Initiative for Somali Women You are coordinating with other community volunteers in addressing these problems.  A "back-up"24 volunteer (junior volunteer) is available to learn from you and to replace you during your absences.  Your coach or volunteer leader is aware of the planned event and is on hand to support in the facilitation. Measuring your success:  Target group contribute financial resources to community initiatives.  Target group contribute technical and non technical expertise to community initiatives. Keeping records and reporting on your volunteer work  the number of resource mobilization activities you conducted or carried out ____  the number of community own resource persons recruited to provide technical and non-technical support to community initiatives____  Financial resources raised during the month____  the number and types of community initiatives carried out using the resources mobilized_____  the number of days you volunteered during the month ____  Indicate other partners you worked with during the month ____24 Note: You cannot always be there. Get yourself a backup-volunteer. Find another person who can offer her services to learn what you do and to replace you during your absences.Resource mobilization at community level Page 4 of 4 Resource Information pack for the Woman to Woman Initiative for Somali WomenHIV/AIDS Peer Education In the context of this resource pack, peer education is the process whereby well- trained and motivated women and young people undertake informal or organized educational activities with their peers (those similar to themselves in age, background or interests) over a period of time, aimed at developing their knowledge, attitudes, beliefs and skills and enabling them to be responsible for and protect their own health with regards to HIV and AIDS. Peer education can take place in small groups or through individual contact and in a variety of settings: in schools and universities, clubs, mosques, workplaces, on the street or in a shelter, or wherever women and young people gather. Peer education can be used with many populations and age groups for various goals. Recently, peer education has been used extensively in HIV/AIDS prevention and reproductive health programs around the world25.Examples of peer education activities are:  organized sessions with students in a secondary school, using interactive techniques such as quizzes, role plays or stories on HIV and AIDS;  a theatre play in a women club, followed by group discussions; and  informal conversations with women and young people at home and or sports ground, talking about different types of behavior that could put their health at risk and where they can find more information and practical help.Key messages  HIV is the virus that causes AIDS.  There is no cure for HIV infection  A person who is HIV positive will eventually develop AIDS.  Anyone can get infected with the virus o through unprotected sexual intercourse with someone who has HIV o through blood which contains the virus o from an HIV-infected mother to her new-born child, during pregnancy, during delivery and during breastfeeding  Sex with multiple partners greatly increases the risk of HIV infection  HIV can enter a person's bloodstream through the vagina, penis or anus.  Young girls are increasingly at risk of HIV infection due to their underdeveloped sexual organs.  Abstinence is the safest course  Condoms can provide protection against HIV and other sexual transmitted infections during sexual intercourse when you don’t know your partners HIV or other status.  You can not get HIV infection from casual contact and therefore no need to fear people living with HIV and AIDS.25 Adapted from youth peer education electronic resources (YPEER). Peer Education Training of Trainers Manual. UN Interagency Group on Young Peoples Health Development and Protection in Europe and Central AsiaHIV/AIDS Peer Education Page 1 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women Any instrument used for surgical procedures such as during female genital mutilation or deliveries to be sterilized before and after use to avoid accidental transmission of HIV infection.  Voluntary counseling and testing of HIV infection before marriage help to avoid infection.What you need to know about condoms  For people who are HIV-positive, condoms are a way to reduce passing the virus to others.  It is impossible to tell who has HIV unless one has been tested. So use a condom to ensure safer sex prior to testing.  Condoms are made of latex and are packed in a non-transparent package to protect them from sunlight. Condoms can be stored for up to one year.  Use a female genital model to demonstrate proper use of condomsIf you are volunteering to do peer education you should  Know what people think about HIV/AIDS. What are the barriers or taboos.  Know if there are blood testing and counseling facilities for referring people so they can know whether they have HIV or not.  Find out what other HIV/AIDS activities are already going on in the community.  Find out where condoms are available (free or for sale) and how they cost.  Know the nearest location of voluntary testing and counseling services.  Know what support groups are available to HIV infected persons and orphans. What you should do in your community  Identify groups which need more HIV/AIDS prevention information  Build on existing community activities (schools, nosques, village health workers, other partners), communicate with these partners and find out where there is a need for your help.  Work with the target group(s) to identify key members who can do the information, education and communication (IEC) on HIV/AIDS;  Peer education on HIV/AIDS should always include information on: a) Basic facts on HIV and AIDS b) Condoms and demonstration of condom use c) Health services available, d) Where people can go for voluntary testing and counseling, and, e) Provide a safe space for women and young people to ask questions, explore their attitudes and identify solutions to problems without fear of intimidation or discomfort. NOTE: The language used Peer education can be done by amongst peers in HIV/AIDS  Adult woman to another adult education should be based woman on facts and be sensitive to the religious and cultural belief of target group. HIV/AIDS Peer Education Page 2 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women Young girl to a young girl  Old woman to old womanVolunteer's checklist for peer education  You have contacted the local leaders and health workers to discuss your work.  You have assessed the attitudes and behaviors of the community members about sex and HIV/AIDS.  You are collaborating with existing condom programs for access to condoms and information.  The target group is willing to have a peer education session at least once a week.  You have provided the target group with needed information and materials.  Stimulated your peers to ask questions, even very sensitive ones. If you don’t know all the answers that is OK. But make sure to find out and share with participants in the next session or invite resource persons who can respond to such questions.  You regularly organize for expert led focus group discussions with your peer group on topical issues such as ‘will writing’, memory book, women’s rights, etc.Measuring your success:  Peers know more about safer sex practices.  Peers talk more openly about the risks of HIV/AIDS transmission.  Peers report that they use condoms.  Peers report fewer cases of sexually transmitted illnesses (STIs).  Peers have a better understand of the disease and do not stigmatize people with HIV/AIDS.  Peers go to get tested and know their HIV status (if you have a HIV volunteering testing and counseling centre.  Peers promote abstinence as key prevention methodKeeping records and reporting on your volunteer work  the number of peer groups you are working with ____  the number of peers in each group____  the number of peer education sessions conducted this month ____  the number of days you volunteered during the month ____  indicate other partners you worked with during the month ____ HIV/AIDS Peer Education Page 3 of 3 Resource Information pack for the Woman to Woman Initiative for Somali WomenVoluntary Counselling and TestingVoluntary Counseling and Testing For use only where there are testing and counseling centers Voluntary counseling and testing (VCT) centers in this resource pack refers to places where someone can go for an HIV test on a voluntary basis. At the VCT centre the person will receive counseling prior to testing as well as after testing and knowing their HIV status. Such services should be anonymous and confidentiality maintained at all times. Key messages  There are benefits to knowing your HIV status  If you are HIV negative, you can take measures to remain uninfected.  If you are HIV positive you can protect partners and if a woman, you can protect against mother to child transmission.  If you are HIV positive you can take measures to stay healthy longer.  People living with AIDS can bring first-hand experience to help neighbors and policy makers.  Voluntary testing and counseling results are confidential.  One should consider getting tested before marriage (if a VCT centre is available). If you are volunteering to do Peer Education and VCT referrals you should  Learn what the people know and do not know about HIV/AIDS.  Learn what they think about how HIV is transmitted.  Know where blood testing and counseling facilities are located.  Refer people to these testing and counseling facilities. What you should know about your community  Find out what activities are already going on in the community on HIV/AIDS education.  Learn the attitudes about condoms. What are the obstacles to using condoms? Are they available? What is the cost if any?  Know the nearest location of voluntary testing and counseling services.  Know what support groups are available. What you should do in your community  Go to meet staff at the nearest voluntary testing and counseling centre to familiarize yourself with the centre and workers. Be sure results are always confidential.  Identify with elders and leaders where there is a gap in peer education; identify groups which need more HIV prevention information Voluntary Counselling and Testing Page 1 of 2 Resource Information pack for the Woman to Woman Initiative for Somali Women Build on existing community activities (schools, mosques, village health workers, other partners), communicate with these partners and find out where there is a need and get them to help  Work with the target group(s); identify key members of the target group(s) who can do the information, education and communication (IEC) on HIV/AIDS;  Encourage the formation of post test clubsVolunteer's checklist  Have you contacted the local leaders and health workers to discuss your work?  Have you assessed the attitudes and behaviors of the community or the target group?  Are you collaborating with the condom programs in your area to ensure access to condoms for you and your target groups?  Is the target group willing to have a peer education session at least once a week?  Have you provided the target group with the information and materials they need?  Visit the voluntary testing and counseling centre and know the workers and counselors.Measuring your success:  People talk more openly about the risks of HIV transmission.  People go to get tested and know their HIV status.  People have a better understanding of the disease and do not stigmatize people with HIV/AIDS. Keeping records and reporting on your volunteer work  the number of people referred to a VCT centre ____  the number of peer education sessions conducted this month ____  the number of days you volunteered during the month ____  the number of women / community leaders/ religious leaders/ etc. participate per session____ o session 1:_____ participated o session 2:_____ participated o session 3:_____ participated  indicate other partners you worked with during the month ____Keeping records and reporting by VCT centers As a community volunteer you can encourage staff at existing VCT centers in your community to:  Keep proper records and reports of their activities which should include: o The number of men and women coming in for VCT services____ o The number of tests carried out in a month_____Voluntary Counselling and Testing Page 2 of 2 Resource Information pack for the Woman to Woman Initiative for Somali Women o Test results for men and women_____  Provide anonymous HIV testing services  To maintain confidentiality of clients and not to share any information that will identify clients to their results.Voluntary Counselling and Testing Page 3 of 2 Resource Information pack for the Woman to Woman Initiative for Somali WomenHome Based Care for PLWHAWhat is Home Based Care for PLWHA? Home-based care is an approach to provision of care that combines clinical services, nursing care, counseling, and social support. It represents a continuum of care, from the health facility to the community to the family to the individual infected with HIV/AIDS, and back again26.Home based care takes many forms, but typically it is provided by relatives, friends, or community volunteers working for non-governmental organizations and supported to a greater or lesser extent by health professionals, mainly nurses. If you volunteer for home care training, you should:  Know the families who care for persons living with AIDS  Know what medical, social, religious services that are available and what others are doing about home care in the community  Talk with the families of PLWHAs to identify needs (use the checklist below) What you should do in your community  Visit the houses of the families of PLWHA in your area of responsibility and informally look for new cases.  Teach the family about basic hygiene, nutrition and infection control when caring for PLWHA  Provide information on which groups or agencies (TBAs, village health workers, other partners) are available to give help (blankets, clothing, bed nets, counseling, home care kits, condoms, etc.).  Teach facts about HIV/AIDS and sexually transmitted Infections.  Counsel the ill person and the family  Mobilize and sensitize the community about basic human rights and reduce stigmatization due to negative attitudes about HIV/AIDS. Volunteer's checklist for home visits  Does the family know about HIV/AIDS and how HIV is transmitted?  Have you identified the main problems facing the PLWHA and the family?  Are there children or orphans who need support?  Can the family do the necessary daily tasks to care for the PLWHA?  Does the family know where to go to seek medical help? Important note 26 Adapted from Ministry of Health, Kenya. (2002). National Home Based Care Programme and Guidelines. National AIDS/STD Control program. Ministry of Health.Home Based Care for PLWHA Page 1 of 4 Resource Information pack for the Woman to Woman Initiative for Somali WomenWork with the family, neighbors or other community members who can help the PLWHA. You cannot provide all the needed services but you can give information and support. What the family may need as a minimum to help the PLWHA  Soap and bleach for hygiene and cleaning  Plastic sheeting for the bed  Bucket for washing and cleaning  Heavy rubber globes  Condoms if the family requests them Remember that caregivers of PLWHA:  experience stress and fatigue  have difficulties dealing with death and the dying  fear infection by the HIV virus  need to express their feelings  need relief from the demands of caring for PLWHAWhat you can do to help someone with HIV or AIDS  Accept them for who they are. Do not judge, do not blame, do not discriminate & do not stigmatize. Anyone including you can get the virus.  Listen & share  Inform yourself & teach others  Visit as often as you can.  Help with chores if needed.  Help with exercises  Help to plan for their futureKey messages for living positively with HIV and AIDS1. Try to have a positive outlook on life. . Do not be ashamed and do not blame yourself. . You have a virus that anyone can get. 2. Avoid stress, anxiety and depression . Keep away from those who make you feel bad about yourself and visit your counselor or people who understand you. 3. Eat wholesome and balanced food . Try to eat a balanced diet that includes o proteins (beans, egg, fish, meats, poultry), o Carbohydrates (maize, millet, sorghum, wheat, rice), vitamins and minerals (fruits, o Vegetables), fats (peanuts, cooking oils/ fats) . Take plenty of water and juices. 4. Physical exercise Home Based Care for PLWHA Page 2 of 4 Resource Information pack for the Woman to Woman Initiative for Somali Women. Keeping fit is keeping healthy, both mentally & physically and it relieves stress too. 5. Sleep, Rest and Relax . Don’t tire yourself too much.6. Abstain from sex or have safer sex. . Practice responsible sexual behavior by using a condom to prevent re-infecting yourself with HIV, getting an STI, getting pregnant or passing the infection (HIV) to others. . Remember: there are many other ways to show love and affection.7. Avoid alcohol, tobacco, ‘kat’ & any other form of intoxicants . These are troublemakers and will poison your body.8. Visit your doctor often . For checkups and immunizations or drugs that can prevent you from getting opportunistic infections. . Visit your doctor the soonest possible when you feel sick.9. Avoid people who are sick . So that you do not catch their illnesses. As your immune system is weak it will take longer for you to recover even from a mild flu. Such mild illnesses might also progress to more serious conditions such as pneumonias.10.Practice proper personal hygiene . Bath regularly & brush your teeth & wash your hands when cooking, after the toilet, before meals so that you do not get sick (diarrhoeal illnesses, boils) . Wash your bed linen and clothes and cover your mouth when coughing & spit into something that can be burnt so that you do not pass opportunistic illnesses such as TB to others.11.Work or continue schooling . As long as you can to earn money or get an education, socialize and help you forget your worries.12.Seek to know more about your condition, for your own good & for others.13.When the bad feelings come….. . Do not pretend you are okay if you are not. Acknowledge that these feelings are real. . Talk to a friend, family, counselor or sheikh. It will help you feel better & less alone. . Remember, bottled up emotions can explode.What you can do to help orphans and other vulnerable childrenHome Based Care for PLWHA Page 3 of 4 Resource Information pack for the Woman to Woman Initiative for Somali Women Every child including children affected or infected by HIV have a right to go to school.  Be kind, loving, supporting and friendly to orphaned children.  Inform the teachers –for special care & attention.  Find people in the community who can help with scholarships, grants or feeding programs.  Speak up for the orphans and other vulnerable children when others mistreat them.Measuring your success  Families or caregivers are regularly practicing proper hygiene when caring for the PLWHA.  Families or caregivers are providing proper nutrition, oral rehydration and proper feeding of the PLWHA.  Families or caregivers are using health facilities and other support groups.  Families or caregivers are coping better. Keeping records and reporting on your volunteer work  The number of PLWHA in the households you visit regularly _____  The number of children of PLWHA needing support _____  The total number of visits to these houses this month _____  The number of PLWHA who (died, moved away, or hospitalized) _____  The number of days you volunteered during the month _____  List the most serious problems you saw which you could not resolve _____ Home Based Care for PLWHA Page 4 of 4 Resource Information pack for the Woman to Woman Initiative for Somali WomenFacilitation SkillsFacilitation Skills27High-level facilitation skills can be developed among individuals willing to devote time to practicing, receiving feedback, and reflecting on practice. Several important facilitation skills discussed below include:  Communicating effectively.  Developing and implementing well-structured learning activities.  Encouraging discussion among training participants.  Helping participants revise goals and make decisions throughout the training.  Handling conflict when it arises.Communicating EffectivelyFacilitators communicate effectively by:  Using clear, appropriate, understandable language--breaking down information into succinct and manageable segments, avoiding jargon, and avoiding phrases that might be offensive to participants.  Speaking loud enough to be heard clearly by all participants (this might require the use of a microphone).  Using well-developed visual aids to support verbal messages (Power Point presentations, transparencies, flip charts, handouts, etc.)  Providing concise, step-by-step instructions to guide activities.  Making sure that body language (facial expressions, posture, hand gestures, etc.) matches verbal messages.  Using "I" messages and encouraging others to do the same.Developing and implementing well-structured training activitiesWell-structured training activities typically include an introductory segment, a learning or activity segment, a processing segment, and a summary.The introductory segment should:  Bridge each learning activity to those that preceded it and those that will follow.  Explain the purpose of the learning activity.  Provide a brief overview of the learning activity.  Describe expectations--what will be learned, how long it will take, what the outcomes or products will be.27 Adapted from the National Training Partnership, EDC. Inc, .1998Facilitation Skills Page 1 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women Verbally and visually provide step-by-step instructions for carrying out the activity--including how to divide into small groups, who is responsible for roles such as reporter or recorder, and timing for each aspect of the task.The learning or activity segment should:  Include meaningful/relevant information or activities.  Involve all participants.  Be engaging and interactive.  Call on participants to incorporate their knowledge and experience.The processing segment should:  Include opportunities for participants to describe what happened during the activity.  Include thoughtful questions that facilitate discussion and analysis of what happened during the activity or learning phase.  Include opportunities for participants to apply lessons learnt from the activity to other relevant venues--their lives, their classrooms, their students, their skills.The summary segment should:  Be provided by the facilitator or elicited from the group.  Review what was done, recap what was learned, and highlight implications.Encouraging discussion among training participantsFacilitators encourage discussion by:  Asking thoughtful, open-ended questions that allow for many possible responses. For example, a questions such as "What other alternatives were available to the characters in the scenario?" stimulate thought and discussion, guide the focus of the discussion, and can be answered in many ways. Such questions can't be answered with a simple "yes" or "no" answer--a response that is a certain discussion stopper!  Using listening techniques that are active and reflect information back to the speaker. They may say thing like "uh huh," "I know what you mean," or "I see" to indicate that he or she is engaged and listening. In addition, when facilitators restate (paraphrase) what has been said, they let the speaker know that the original message was communicated and understood, and they provide an opportunity to the speaker to rephrase and clarify what was meant. When facilitators are skillful at paraphrasing, they listen for and convey back to the speaker the total meaning of the message--the content as well as the feelings and underlying attitudes.  Acknowledging every participant's contribution. This doesn't mean the facilitator agrees with the position--it means that he or she has heard, understood, and respected the intent of the message.Facilitation Skills Page 2 of 3 Resource Information pack for the Woman to Woman Initiative for Somali Women Avoiding judgments about or interpretations of opinions expressed by participants. Judgments and interpretation by facilitators may shut down further discussion.  Using body language that engages participants--they make eye contact, they lean in the direction of the speaker, and they circulate around the room to increase contact with all participants.Helping participants revise goals and make decisions throughout the trainingWhen necessary, facilitators help participants make decisions during training events by:  Alerting them when they are "stuck" or at a decision-point and assisting them in revising goals, schedules, activities, and expectations as necessary.  Keeping the discussion and group in positive, problem-solving mode.  Guiding participants through a decision-making process that encourages and respects participation from all group members that assists them in making decisions consistent with essential outcomes and expectations of the event, and moves the group to the next step.Handling conflict when it arisesFacilitators effectively handle conflict when it arises by:  Assisting participants in recognizing barriers to group process and in generating strategies for overcoming them.  Helping the group discuss underlying issues and conflict that participants are avoiding when the issues threaten the ability of the group to continue to engage and move forward.  Reshuffling tasks and activities so that time is available for conflicts to be resolved effectively.  Helping the group develop win-win solutions.  Distinguishing between his or her personal needs and the needs of the group so that solutions emerge from the group and are not the values and opinions of the facilitator.  Continuing to maintain a safe environment by respecting the confidentiality of participants.  Helping to ease tension by being patient, trusting, empathetic, non- judgmental, enthusiastic and, when appropriate, humorous.Facilitation Skills Page 3 of 3 Resource Information pack for the Woman to Woman Initiative for Somali WomenCondom useThe Female Condom Also known as the vaginal pouch, the female condom is a disposable sheath designed to protect a woman from pregnancy and STIs by lining the vagina. The man’s penis must be guided into the sheath. After intercourse, the man may stay in the woman; unlike with traditional condoms, there is no need for immediate withdrawal. You can tell that it is in place when the inner ring is up just past the pubic bone. You can feel your pubic bone by curving your finger towards your front when it is a couple of inches inside your vagina.Then put your finger inside the sheath until you can feel the bottom of the inner ring. Now push the ring up into the vagina.Advantages:  This method allows a woman to protect herself from STDs as well as pregnancy.  Because the vaginal pouch does not require the male to be fully erect, it can be inserted well before penetration is desired.  There is no need for withdrawal immediately following male orgasm. Disadvantages:  This product is fairly new and the information on effective use is somewhat limited.  Some women complain that the sheath moves, or is noisy or uncomfortable. Condom Use Page 1 of 3 Resource Information pack for the Woman to Woman Initiative for Somali WomenMale CondomSteps for the use of male condom When purchasing or collecting the condom: Check the expiry date and ensure package is not damaged.Step1: Remove condom from its package. Hold the top of the condom. Press out the air from the tip and roll the condom. Use both handsStep 2: Roll the condom right to the base of the erect penis. Leave the space at the tip of the condom for the sperm.Step 3: After ejaculation, when you start losing erection, hold the condom at the base and slide it carefully off.Step 4: Remove the condom. Be careful not to let any sperm spill or leak from the condom.Step 5: Make a knot and dispose of the condom in a latrine.Condom Use Page 2 of 3 Resource Information pack for the Woman to Woman Initiative for Somali WomenKey messages when advocating for condom use Part of avoiding doing harm is to tell the truth about condoms: that they are effective but not 100% effective. This includes referring to sex with condoms as ‘safer sex’ rather than ‘safe sex’ and not telling people that they can only get HIV from unprotected sex.  The priority placed on condom promotion should depend on local epidemiology of HIV transmission and the particular group being targeted.  Condom promotion and other strategies must be carefully deployed to work in synergy rather than competition. Much will depend on how well we are able to realize the potential for prevention that condoms clearly offer.  If making use of lubricants during sexual intercourse, only use water based lubricants when using condoms. Below table gives examples of these.Safe with all condoms Unsafe with latex condomsAloe-9® Aldara® cream Aqualube® baby oils Astro Glide® Bag Balm® Cornhuskers® lotion clindamycin 2% vaginal cream deLube® cold cream ForPlay® edible oils glycerin head and body lotions Gynol II® massage oils H-R ® lubricating jelly mineral oil K-Y® lubricating jelly petroleum jelly I-D CreamTM rubbing alcohol I-D GlideTM shortening I-D Juicy LubeTM suntan oil and lotions I-D Millennium® certain vaginal yeast infection I-D PleasureTM medicine PrePair® vegetable or cooking oils Probe® whipped cream silicone lubricant water and saliva Adapted from: Hatcher, RA, et al. Wet® (2003). A Pocket Guide to Managing Contraception. Tiger, GA: Bridging the Gap Foundation.Condom Use Page 3 of 3

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