Transcript EDUCATION IN AIDS PREVENTION - Chulabhorn Research Institute

Ethics group proudly presents:
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Education in preventing AIDS by Ulla Luhtasela
How can we support AIDS patients? by Aung
Zaw Naing Lin
Religion and HIV by Sk. Akhtar Ahmad
Is HIV still a death sentence in Asia? by Matiar
Rahman
Animal Testing and Clinical Trials by Varaporn
Podprasart
A pregnant woman's right to choose to have an
abortion when she has HIV infection by Julaporn
Srinha
The Role of Law in HIV by Gunawan Pratama
Yoga
EDUCATION IN AIDS PREVENTION
by
Ulla Luhtasela
14.7.2000
Content of the presentation
1. Introduction
2 Current situation in some Southeast
Asian countries
-Thailand, Laos, Cambodia, Myanmar,
Malesia
3. Education for different groups
4. Sex and Aids education in the
schools
5. Education for CSW
6. Example of a prevention plan
7. Conclusion
1. Introduction
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Education is necessary component of
HIV prevention
Coupled with promotion of practical
prevention strategies, it can be a
powerful motivator for positive
behavior change
In most countries, an important first
step is making people realize that
they are at risk.
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Biologically thinking, spread of HIV
virus would be comparatively easy to
stop spreading
However, already 30 million people
worldwide has been infected and the
number is growing at the concerning
rate.
WHY?
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knowledge about this disease has not
reached everywhere
to change human behavior and attitude
is extremely difficult
Education is one of the most important
tools for the fight against HIV spread.
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Increasing the awareness of threat
will only be effective when message
is coupled with useful information
In many developing countries
resources are limited and should be
targeted to those individuals and
groups at the greatest risk for
acquiring or transmitting HIV
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The promotion of proper use of
condoms as well as availability of
condoms are key elements in the
prevention of AIDS in high risk groups
Availability of clean needles is a
problem in many countries
School based sex education programs
can be an important part of a
comprehensive country-level HIV
prevention plan
Policies that promote education for
girls and young women
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Particularly sex education should
help dispel sexual myths for young
people and raise awareness about
the relative risks of sexual activity
Existence and level of sex education
varies between the continents and
countries enormously
Country-driven prevention plans are
more effective than donor-driven
2. Current situation
Thailand
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The estimated number of the HIV
positive individuals in the country is
between 800 000 and 1 million
Recently in Bangkok new concerns
about spread of AIDS has been the
infections among the people who do
not consider themselves to be in
the high risk group
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In 1997 the Thai government
ordered local communities to
increase efforts to control AIDS
and to improve assistance offered to
AIDS patients
The same year National Aids
Foundation was set up to look into
how to spent the government’s AIDS
budget in addition to funds donated
by private organizations
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In 1997 Thai government allocated
1600 million Bath to prevent and
control AIDS.
Education of sex and Aids have
been implemented into schools
Mr Mechai Viravaidhya
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Thailand’s condom king has been
active more than 10 years with
introducing the condom to Thailand
He is president of the Population and
Community Development Association
Opened a restaurant in Bangkok called
“Cabbages and Condoms” as means of
raising funds
Revolutionized the NGO world in
Thailand.
CAMBODIA:
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HIV has spread rapidly in Cambodia
since it was first screened in 1991
100 000-150 000 HIV infections in
the country
Cambodia has the highest rate of
increase if HIV
Struggling with highest rates of
poverty, malnutrition and poor
education.
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About 87 % of young man are
having sex with their girlfriends,
prostitutes, or other males, but
nearly half of sexually active men
never used a condom
The disease is spreading faster in
Cambodia than in any Asian nation
except Burma and India
Even the awareness of AIDS is
slowly increasing, the sexual
behavior has not changed
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United Nations Human-rights
representative reported in 1996
that Cambodia is thwarting the
fight against AIDS by closing
brothels, harassing sex workers and
taking down posters promoting
condom use
Such moves drive CSW underground
and make AIDS education more
difficult.
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In 1997 Buddhist monk Pal Hor, who
was operating Cambodia’s
HIV/AIDS treatment center
provides traditional medicine and
Bugghist counseling
Anti-AIDS treatment was
unavailable in Cambodia this was a
last hope for many desperate and
suicidal patients.
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In 1991, Pact, an Independent
international non-profit corporation
started a Community Outreach
Project (CCOP) in Cambodia
Developed culturally sensitive
approaches to community-based
development
Pact was the first donor to provide
assistance
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Provide training, technical support
and direct grant assistance to
Cambodia's first generation of
NGOs
Pact focused on human resource
development, training many local
NGOs in participatory management,
planning communication, program
development, financial management
and community development
LAOS
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Although Laos has so far avoided
the high rates of HIV infections,
epidemic remains a serious threat
The World Health Organization
(WHO) reported 30 cases of AIDS
in Laos in 1997. Although this figure
is low, there are no other officially
reported data available from this
country
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United Nations reported in 1997: “
Increasing urbanization and
population mobility, as well as
increased prostitution and drug use
could facilitate a burst in infection
rates.”
Many work in the sex trade and
when they return home, there is a
real risk of introducing AIDS to
villages, which have no means to
protect themselves
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Condoms are not available for most
of the time they are too expensive
for farmers
Foreign contractors from Thailand,
Vietnam, and other countries with
high HIV rates are hired to work in
infrastructure projects in Laos.
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CARE is a non governmental
organization providing help in Laos
CARE’s Border Areas HIV/AIDS
Prevention Project provides
information on transmission and
prevention of STDs and AIDS to
CSWs and other high-risk groups in
provinces
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They have designed educational
materials specifically tailored for
these groups working along with their
project
partner,
the
National
Committee for the Control of AIDS.
MALESIA
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In Malaysia, 300 new HIV cases are
detected each month, and a total of
448 AIDS cases and 16,349 HIV
cases were reported by June 30
1996.
The estimated figures may not
reflect the actual number of new
cases because many are not reported
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Governmnet is concerned about
situation,and
hopes
that
the
community together with parents,
educators,
and
community
organizations would join the battle
against HIV
The government has approved the
spending of $48 million for AIDS
care between 1993 and 1995, but
says that additional funding is
needed
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The Ministry of Health has
formulated a program to reach out
and educate youths on HIV/AIDS
The Health without Aids for
Malaysian (Prostar) program was
launched in 1996
The aim is to train 20 000 youth
facilitators, who are equipped with
knowledge of the disease and
social values
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The program involves students of
institutes of higher learning as well
as uniformed bodies and factory
workers
This has been a successful program
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Program for Sex Workers has
shown positive results in the
experiment where CSW are reach
out from brothels, back lane,
streets and homes
Peer educators allows for
information dissemination to take
place in a non confrontational
manner
Increasing amount of CSW have
started to use good quality condoms
Myanmar
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According to United Nations
statistics 1998, there was 440,000
HIV-positive individuals in Myanmar;
however, some health workers
estimate the number is higher
Prison conditions are reported to
favor the spread of HIV
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So far, Myanmar has taken few
effective measures to limit the
epidemic
Preferred to deny that promiscuity
and commercial sex thrive in a
Buddhist society
Heroin-takers and prostitutes are
simply put in jail
New quarantine centers to house
people with HIV are being built
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Just recently, the government is
beginning to take steps to counter
the spread of the virus, instituting
anti-HIV and risk-reduction
campaigns
Officials also intend to organize
more HIV-free blood-donation
campaigns and education efforts
3. Education for different
groups
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Type of education depends on the
people to whom it is targeted
Major groups are
-Scientists
-Public
-CSW
-Children
-Youth
Scientists
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People who have higher education and
want to learn more about clinical side of
HIV
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http://www.hopkins-aids.edu/hiv_lifecycle/index_fram.html
Public
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Newspapers, radio, television,
advertisement, campaigns
Information in interesting form, to
make people realize, that this could
happen to anybody, maybe someone
from their own family.
CSW
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Improved health care should include
also information about the risks
Flyers, posters and information
should be translated into major
languages in the region
Condoms should be available
Youth
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Education should be implanted into
the schools
Practical information how to protect
yourself and the one you love
Condom should be introduced
Children
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Children hear and observe
everything what is going around of
them
Colorful children books are
available at least in the western
cultures.
A book from children to children is
effective and help children to
understand
4. Sex and AIDS
education in schools
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Young people are especially vulnerable
to HIV and other sexually
transmitted diseases as well as for
drug use
Many young people can not talk about
sex or Aids either at home or in the
community
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Often young people are
embarrassed to talk about sex to
doctors or nurses, and they might
worry about confidential
Discussions among young people
are conducted in the streets,
information comes from older and
more experienced teenagers,
movies or magazines
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Since most of the young people
attend school at some point, these
topics could and should be
addressed by teachers and
educators
There are number of obstacles
which often stand in the way
Some countries have no policies on
Aids education, and others can
even have policies against AIDS
education
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It is commonly supposed that
talking to young people about sex
will make them do it
Negative effects might be
emphased rather than positive
aspects such as intimacy, sexual
love and pleasure
This kind of unbalanced approach is
often seen through by young people
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In consequence, they may reject
all that adults have to say, seeking
guidance and role models from
peers and from the media
research looking at the effects of
sex education on young people's
sexual behavior offers little
evidence that it hastens the onset
of sexual experience, or increases
sexual risk among those who are
already sexually active
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Indeed, several studies from
different countries show that good
quality sex education can actually
decrease the likelihood that young
people will have sex, and increase
condom use among those who are
already sexually active
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Designing a good curriculum for
Aids education is essential start
for a successful project
Effective programs are those that
have had a positive influence on
behavior as regards sex, drug use
and non-discrimination, and not
simply increased knowledge and
changed the attitudes of students
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Factual information about biology,
sexual development, and sexual and
drug-related risks. Concerns with
personal relationships, feelings and
values should be recognized and
emphasis put on the acquisition of
relevant negotiation skills
Effective programs should
following things:
-Focus on life skills
-Concentrate on personalizing the risk
-Discuss about possible result of
unprotected sex
-Introduce condom and show how to use
it
-Explain where to turn for help and
support
-Stress that skills useful for selfprotection from HIV also help build
self-confidence and avoid unwanted
pregnancy, sexual abuse, and the
abuse of drugs
-Reinforce values, norms and peergroup support for practicing and
sustaining safe behavior and
resisting unsafe behavior
It is important to
 provide sufficient time for
classroom work and interactive
teaching methods such as role play
and group discussions
 Start at the earliest possible age,
certainly before the onset of sexual
activity
5. Education of Commercial Sex
Workers (CSW)
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For most women who enter the life
of prostitution on the streets,
their "choice of prostitution" often
grows out of years of painful
sexual exploitation, sexual
molestation at very early ages,
family violence, and persistent
patterns of substance abuse
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Since prostitutes are in the highrisk group, prevention of HIV
infection is one of the most
important tasks to protect both
them and their clients
The ability to practice safer sex in
prostitution is influenced by a
range of factors, such as demand
by clients for unprotected sex,
urgent need for money, alcohol
abuse, homelessness, ignorance,
lack of resources, younger age etc.
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The knowledge about HIV and
prevention might also be
insufficient, specially when young
illegal girls are recruited from poor
villages and hilltribes.
barriers to health care and health
promotion for prostitutes, the
clients and other sex partners,
should be minimized.
Two main obstacles to get health
care are identified:
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Many prostitutes do not qualify for
health services
The health system is not appropriate
for sex workers
-negative attitude towards
prostitutes and prostitution
-ignorant about prostitution and the
specific problems prostitutes
Implementation of Education for
CSW:
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Pilot phase for new projects
Continuity of funding
Involvement of sex workers
Skills of staff
Attitude of staff
Adequate payment of all staff
Location
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Outreach
Solid infrastructure
Appropriate health education
materials
HIV prevention in a broad
perspective
Extension to remote areas
Attention to all forms of sex work
Attention to all sex workers
6. Example of a prevention plan
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Fogarty Workshop on International
HIV/AIDS Prevention Research
Opportunities on April 1998
Objective: To identify a package of
effective HIV prevention
interventions and develop a list of
priority research goals that combine
biomedical, behavioral and social
interventions for feasible and
relevant for developing countries
with limited resources
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Total of 171 representatives from
37 countries participated on
workshop
6 different plans for developing
countries were developed by the
participants, one of them being a
South East Asian country
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Because of the uncertainty, which
country this is, it will be called
Country A in this example
Country A :
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Small Southeast Asian country with
population of 25 000 000 people
It is one of the poorest countries
in the world
Illiteracy is high, for population
over 15, only 35% can read and
write
Morbidity and mortality rates are
among the highest in the world
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Shortage of medical personnel has
been a major obstacle to the
implementation of an effective
public health program
Most rural areas are served only by
a local infirmary
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First reported AIDS case was
diagnosed in 1993
Currently 200 000 people are
estimated to be infected by HIV
virus
That is 2% of the total population
Epidemic is based on regional
spread rather than importation
from outside the continent
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Condom use has increased
recently, CSW reported to use
condom 80% of sexual acts
However condom use is very rare
with girlfriends and wives which
enables the disease to spread into
families
Small
percent
of
blood
transfusions given in rural areas
are screened
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The National AIDS program (NAP)
has established offices in each
province
The offices provide training,
education, and outreach to CSWs,
schools, the military, and the police
Services are severely restricted by
a lack of human, financial and
technical resources
Prevention plan for Country A:
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Specific groups must be targeted
and provided services necessary for
their group’s specific risks
All the groups should have access to
condoms and other services
Youth must be provided with life
style skills and sex/Aids education
Women must be given skills and
empowerment
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The blood supply must be made
safe through increased screening,
testing and pooling
Improved surveillance is another
priority
Access to HIV testing and
counseling is also needed
Country’s public health
infrastructure must be improved
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Reduce the stigma of testing and
counseling and increase the
confidence of those seeking it
All of these interventions should be
integrated with existing services, if
feasible
7. Conclusion
– Stakeholders
must be brought together to improve
public awareness of the problem
through information and education
campaigns, analyze existing policies,
and assess the health care system
infrastructure.
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To prevent spread of HIV/AIDS
requires input from many different
fields.Medical, educational, legislation
and social sectors need to improve,
work together, and adjust to the
demands of this lethal disease.
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To prevent spread of HIV/AIDS
requires input from many different
fields. Medical, educational,
legislation and social sectors need to
improve, work together, and adjust to
the demands of this lethal disease
Ideally the rate of HIV infections will
decrease as people start realizing that
they are in danger
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Practical help, such as condom
availability and access to health care,
are important tools in prevention
together with education
Information and education work only, if it
is practical to apply into the situation.
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HIV/AIDS is a global problem, and
requires international attention
Developing countries should be helped
not only financially but also with “know
how”
developing countries need to take their
responsibility and contribute to the
prevention plan and maintain projects
In a long run this is beneficial to
everybody and hopefully can
significantly reduce the rate of HIV
infections
THANK YOU FOR YOUR
ATTENTION!!
-Dr. Maria
-Dr. Suvit
-MIT staff
-Our wonderful
class