HIV Prevention Ambassador Training Package for Adolescent Girls and Young Women This training package was developed by the OPTIONS Consortium and Collective Action. The OPTIONS Consortium partners who contributed to the development of the training package include FHI 360, AVAC, LVCT Health in Kenya, Pangaea Zimbabwe AIDS Trust in Zimbabwe, and Wits Reproductive Health and HIV Institute in South Africa. The Optimizing Prevention Technology Introduction On Schedule (OPTIONS) Consortium is a five-year cooperative agreement funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Agency for International Development (USAID). OPTIONS Consortium partners are conducting a range of activities to support the rollout and scale-up of oral pre-exposure prophylaxis (PrEP) for HIV prevention in Kenya, South Africa, Zimbabwe, and globally. A critical component of OPTIONS’ work is ensuring adolescent girls and young women (AGYW) can access and effectively use oral PrEP for HIV prevention. Empowering AGYW with the knowledge, skills and agency to discuss HIV prevention with their peers, partners, families and communities is key to normalizing oral PrEP so that AGYW can successfully use it to protect themselves from HIV. We would love to hear how you’ve used this training package. Please email us at [email protected]. Illustrations and graphic design: Anthia Mirawidya Instructional design and content writing: Alison Barclay, Sarah Williamson, and Melissa Russell, Collective Action Project leadership and technical writing: Morgan Garcia, Michele Lanham, and Giuliana Morales, FHI 360 Technical guidance: Elmari Briedenhann5, Manju Chatani1, Patriciah Jeckonia3, Bridget Jjuuko2, Jordan Kyongo3, Imelda Mahaka4, Maryline Mireku3, Joseph Murungu4, Definate Nhamo4, Diantha Pillay5, Melanie Pleaner5, Ntokozo Zakwe2 1 AVAC 2 AVAC Fellows 3 LVCT Health 4 Pangea Zimbabwe AIDS Trust 5 Wits Reproductive Health and HIV Institute Recommended citation: OPTIONS Consortium. OPTIONS HIV Prevention Ambassador Training Package for Adolescent Girls and Young Women. Durham (NC): FHI 360; 2019. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. This training package was made possible by the generous assistance from the American people through USAID in partnership with PEPFAR. Financial assistance was provided by USAID to FHI 360, Wits Reproductive Health and HIV Institute, and AVAC under the terms of Cooperative Agreement No. AID-OAA-A-15-00035. The contents do not necessarily reflect the views of USAID or the United States Government. HIV PREVENTION AMBASSADOR TRAINING PACKAGE for Adolescent Girls and Young Women Acknowledgements The OPTIONS Consortium and Collective Action would like to acknowledge the leadership, determination and resilience of adolescent girls and young women who are working towards the prevention of HIV in their communities throughout Africa and globally. It is through their leadership that HIV will be eliminated in Africa. We would particularly like to acknowledge the adolescent girls and young women from Kenya, South Africa, Uganda and Zimbabwe who shared their knowledge and experiences to inform the development of this training package. This package is also informed by the collective knowledge and expertise of community-based organisations that work tirelessly for the prevention of HIV throughout Africa. We hope this package supports them in their work. This training package builds on the strong foundation of existing resources in the areas of youth engagement, HIV prevention, gender equality and violence, sexual and reproductive health and human rights including: the YouthPower Action AGYW Mentoring Program Toolkit, the Wits RHI Oral PrEP Adherence Counseling Triangle, the The CHARISMA Toolkit: Empowerment Counseling to Improve Women’s Ability to Use PrEP Safely and Effectively, the International Treatment Preparedness Coalition PrEP Key Population Activist Toolkit and many more. It also draws on World Health Organization guidance on oral PrEP and other OPTIONS resources. Acronyms and Abbreviations AGYW Adolescent Girls and Young Women AIDS Acquired Immunodeficiency Syndrome ART Antiretroviral Therapy ARV Antiretroviral CARE Create a safe space, Actively listen, Reassure and Empower CBOs Community-Based Organisations Convention on the Elimination of all Forms of Discrimination CEDAW Against Women FGC Female Genital Cutting GBV Gender-Based Violence HIV Human Immunodeficiency Virus OPTIONS Optimizing Prevention Technology Introduction On Schedule PEP Post-exposure Prophylaxis PEPFAR U.S. President’s Emergency Plan for AIDS Relief PrEP Pre-exposure Prophylaxis SRHR Sexual and Reproductive Health and Rights STI Sexually Transmitted Infection Acronyms and Abbreviations (continued) SW Sex Worker TB Tuberculosis Trans Transgender U=U Undetectable Equals Untransmissible USAID U.S. Agency for International Development UVL Undetectable Viral Load VMMC Voluntary Medical Male Circumcision WHO World Health Organization Table of Contents About This Training Package 5 Part 1 Facilitator Preparation 7 Identifying HIV Prevention Ambassadors 8 Training Preparation 11 Facilitation Tips 14 Part 2 Training Manual 17 Using This Training Manual 18 Training Introduction 25 Introduction 26 Foundational Knowledge 31 1 Human Rights 32 2 HIV and AIDS - The Basics 41 3 Biological Vulnerability to HIV 50 4 Gender Inequality and Violence 61 5 Responding to Disclosures of Violence 73 Oral PrEP 91 Oral PrEP Essential Knowledge 93 Oral PrEP Sessions 109 1 Combination Prevention and Oral PrEP 110 2 Finding Out About Oral PrEP 116 3 Deciding to Use Oral PrEP 122 4 Getting Oral PrEP 125 5 Taking and Staying on Oral PrEP 128 6 Telling Others 131 7 Awareness Raising 135 8 Advocacy 140 9 Action Planning 144 Ambassador Skills 167 1 Peer Support Skills 168 2 Boundary Setting and Self-Care 181 Closing 191 Ambassador Graduation 192 Next Step 195 Appendices 197 Local Referral Directory Template 198 Key Terms 199 Resources 201 7 About This Package About This Training Training Package Oral PrEP has recently been made available as an additional HIV prevention option for adolescent girls and young women (AGYW) who are vulnerable to HIV. This training package has been developed by the OPTIONS Consortium to support the meaningful engagement of AGYW in the rollout of oral PrEP for HIV prevention. This training package is intended for community-based organisations (CBOs) and other organisations and groups to train AGYW to become HIV Prevention Ambassadors. In this training package, the term adolescent girls and young women refers to girls and women between the ages of 15 and 24. However, this training is still appropriate for girls and women who are slightly younger or older. While we use the term AGYW in this training package, when speaking with participants or Ambassadors, it is important to use the full term (adolescent girls and young women) and not the acronym. This training will support participants to develop the knowledge and skills to: • Educate their peers about human rights, and advocate for their rights – including their right to oral PrEP • Give peers detailed, accurate information about oral PrEP as part of a combination HIV prevention approach and address peers’ questions and concerns • Support their peers to make informed decisions, get access to oral PrEP, use it correctly, continue using it while they are vulnerable to HIV and tell others about their oral PrEP use • Raise awareness and build community support for oral PrEP • Identify barriers to oral PrEP use, and develop and implement advocacy strategies to reduce these barriers • Educate their peers about HIV and AIDS, including how HIV is transmitted and prevented and why AGYW are vulnerable to HIV • Identify how gender norms and inequalities contribute to AGYW’s vulnerability to HIV and violence against women and girls • Support their peers who are experiencing violence by using active listening and by empowering them to access services • Ensure the confidentiality of their peers • Set boundaries and practice self-care OPTIONS HIV Prevention Ambassador Training Package 8 About This Training Package About This Training Why is this training package needed? AGYW in sub-Saharan Africa between the ages of 15 and 24 are two to three times more likely to be living with HIV than their male peers. AGYW face many barriers to HIV prevention, including harmful social and gender norms, unequal access to education and information, limited agency, and systemic rights violations. For these reasons, AGYW are a priority population for the provision of oral PrEP in many countries. Increasing the use of oral PrEP among AGYW is key to ending the HIV epidemic. There are many successful programs that engage and mobilise AGYW for the prevention of HIV. However, because oral PrEP is a new option for HIV prevention, few training materials include it as part of the package of HIV prevention options available to AGYW. This training package has been developed to fill this gap. It will also ensure AGYW have the knowledge and skills to meaningfully inform the development of oral PrEP programs in their communities. It can be incorporated into existing HIV prevention programs or used as a complete training package for a new program. AGYW who complete this training will be called “HIV Prevention Ambassadors” because oral PrEP is only one part of a combination HIV prevention approach. The role of HIV Prevention Ambassadors will vary among organisations and