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Peer Educators
Guide Booklet
Working with children andyoung people affectedby HIV/AIDS
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Peer Educators Guide Booklet
Working With Children And
Young People Affected By
Hiv/aids
Prepared by:
Melina Laukka & Dorcus Asiimwe, social workers
Kawempe Youth Development Association (KYDA)
BOX: 71976 Clock Tower, Kampala
Tel: +256 414 69 11 82 ,+256 752 36 83 32
Email: [email protected]
September 2010
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FOREWORD
HIV / AIDS has infected and affected many
people in Uganda. There have been promising
results from preventing further spread and
supporting HIV/AIDS patients through
community activities. It has been indicatedthat community based volunteers (including
peer educators) are relevant to both
communities and institutions. They have
several functions in the community, such as
providing services that are more relevant to
the needs of the poor and underserved
populations, following up their clients at home
regularly, identifying health and psychosocial
problems early, and making well- timed and
suitable referrals. The use of community based
volunteers is also less expensive and reaches a
bigger area, which ensures that those who are
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vulnerable are reached by services (Government
of Uganda, 2010.)
This guide is supposed to give basic
information about HIV/AIDS while providing
basic knowledge and a framework to peer
educators on how work with people infected
and affected by HIV/AIDS. The main focus is on
children and young people, aged from five to
nineteen, and their families or care givers.
This guide booklet is based on facts from a
workshop organized by Kawempe Youth
Development Association (KYDA) and
literature about HIV/AIDS. The overall
objective of the work shop was for Peer
Educators to gain basic counseling and helpingskills for children living with HIV/AIDS. It was
th thorganized from 6 to 10 August 2010 in
conjunction with trainers from The Aids
Support Organization (TASO) and KawempeHealth Center.
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ACKNOWLEDGEMENT
KYDA wishes to acknowledge the financial
support from the Stephen Lewis Foundation
(SLF) of Canada that enabled the
development of this peer educator's guide.
The Administration highly gives gratitude to
Mr. Otal McBernard the Executive Director
KYDA, Dr. Kasozi Francis In -Charge
Buwambo Health Centre IV, Ms. Nakabugo
Gorret M.A (Sociology) Trainer and Mrs.
Sendaula Sarah Counselor positive living and
Nutrition in children Kawempe Health Centre
for their moral and technical input into this
guide. This guide was also type setted,
compiled and made it a reality by full
commitment and efforts from Melina Laukka
and Asiimwe Dorcus social workers from
KYDA. Their hard work is highly indebted.
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KYDA is further grateful to the community HIV
+ Children Peer Educators for providing
information on various topics, participation insharing of testimonies, materials development
workshop and the actual training were the ideas
for this guide were conceived. We are equally
delighted for their relentless efforts and wisecontributions without which this guide probably
would not have seen the light of the sun.
KYDA handsomely extends its sincere thanks to
all those not mentioned but dully contributed tothe timey completion of this Peer User Guide
Booklet, May God reward them handsomely.
Mr. Otal McBernard
Director of KYDA (Team Leader)
Kawempe
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The technical team which actively
participated in preparation of this Peer
educator's guide booklet comprised of;
1. Mr. Otal McBernard Director KYDA
(Team Leader)
2. Dr.Kasozi Francis In-Charge Buwambo
Health Centre IV.
3. Ms.Nakabugo GorretChild and
Adolescent Counselor
Trainer (TASO). Kanyanya.
4. Ms. Sendaula Sarah Nutrition specialist
for HIV+ Children,
Kawempe. Health centre.
Other KYDA Staff:
5. Ms. Kiwuka Josephine Project officer.
6. Ms. Laukka Melina Repportuers to the
committee.
7. Ms.Asiimwe Dorcus
8. Mr. Kabuye.k. Shaban Counselor for
children KYDA.
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CONTENTS
Forewords 2
Acknowledgment 4
1. Basic facts about HIV/AIDS 8
2. Peer Educator 9
2.1. Peer educators' main tasks and
basic skills in dealing with children
3. HIV/AIDS care and support 14
3.1. Stigma faced by children
and how to handle stigma
3.2. Positive living for children
3.3. Peer to peer counseling
3.4. Nutrition and HIV
4. How to work in practice 26
4.1. Community mobilization
4.2. Home visiting
?4.3. Recording and report writing 30
?4.4. Referral 32
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1. Basic facts about HIV/AIDS
Terms:
HIV = Human Immune-deficiency Virus
AIDS= Acquired Immune DeficiencySyndrome
ART = Anti-retroviral Therapy
Fast facts:
33.4 million people live with HIV/AIDSworldwide.
30 million people live with HIV/AIDS in
low- and middle-income countries
67 percent of all people living with
HIV/AIDS are in sub-Saharan Africa2.1 million children with HIV/AIDS
worldwide at the end of 2008 and 1.8
million of them lived in sub-Saharan
Africa at the end of 2007
Two million people died from HIV/AIDSworldwide in 2008
2.7 million people were newly infected
with HIV worldwide in 2008 and
430 000 of them were children under 15
years.
[Source: WHO 2009]
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Statistics in Uganda:
The current HIV prevalence in Uganda
is estimated at 6.4% among adults and
0.7% among children.HIV prevalence is higher in urban areas
(10% prevalence) than rural areas
(6%)
The number of new infections was
estimated 111,000 in the year 2008The number of annual AIDS deaths was
61,000 in the year 2008
Women are excessively affected,
accounting for 57% of all adults living
with HIV. Ugandan women tend tomarry and become sexually active at a
younger age than their male
counterparts. They often have older
and more sexually experienced
partners. This (plus various biological
and social factors) puts young women
at greater risk of infection [Source:
Government of Uganda 2010]
2. Peer Educator
Peer Educator, also called as a Community
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Educator, is a person who is living in the same
circumstances as others. These kinds of
circumstances are for example age, gender,
culture, subculture, ethnicity and place of
residence. When it comes specifically to
HIV/AIDS, a good peer educator has a wide
knowledge base about the disease and owns
various methods of passing it to the
community. A good peer educator workingwith HIV/AIDS affected and infected children
often holds some, or all, of the following
characteristics:
Be well informed and holds a basic
information about HIV/AIDS
Be able to transfer the information to
others
Have some basics counseling skills and
love working with children.
Committed to working with children.
Should avoid stigmatizing and
judgment
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Be open minded
Good communication- and interpersonal
skills
Good listener and holds confidentiality
Empathetic and emotionally strong
Approachable
Owns self-respect
2.1. Peer educators main tasks and
basic skills in dealing with children
Peer educators working with HIV/AIDS positive
children have the following tasks a head of
them:
Developing activity plans.
Being updated with information
regarding HIV/AIDS among children.
Mobilizing communities for HIV/AIDS
r e l a t e d a c t i v i t i e s .
e.g. counseling and testing.
Working as a link between community
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members and service providers.
Indentifying HIV/AIDS related problems
of children and bringing them to the
awareness of supervisors e.g.
counselors and social workers.
Providing home care to children.
Monitoring positive children and making
proper referrals.
Keeping and maintaining records for
report writing.
To put those tasks in practice it is important to
h a v e g o o d c o m m u n i c a t i o n s k i l l s .
Communication is the process of sending and
receiving messages so that both people
understand the messages as intended.
Everybody has their own way to communicate
with other people but it is good to be aware of
the fact that there exists both verbal and non
verbal communication as shown below on the
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table. You have to observe both.
Before taking an action peer educator should
gather information about the task and set the
goals and plan how to fulfill those tasks
Verbal communication
- Face to face
communication
- Spoken language
Non verbal Communication
- Facial expression- Using hands and eyes- Sitting and standingpostures
13
It also matters how you, as a peer educator,
approach children and young people affected
by HIV/AIDS. You can use active listening
(paying attention), checking understanding,
asking and answering questions as basic skills
of effective communication.
What to be considered in order to
achieve effective listening:
S Sitting Position
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R Relaxed R
Be Open O
L Lean forward towards the person L
E Keep Eye contact with the peer E
S Sit near the peer S
People living with HIV/AIDS have a wide range
of care and support needs. Peer educators
helping skills can be used to provide emotional
support and empowerment to the person inneed. Helping refers to a situation of peer
educator assisting parents/guardians and
children to overcome understand or cope with
a problem in their lives. This can be donethrough encouragement and emotional
support. However, in order to support peers,
peer educators need to first establish trust
from the children and their parents. Trust is
3. HIV/AIDS care and support
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essential for building a relationship
between the peer educators and the
children.
When children and youngsters are diagnosed
with HIV/AIDS, they often face stigma from the
people around them and even from themselves. The disease may be associated with
ways of behavior that are considered socially
unacceptable by many people and therefore
HIV infection is widely stigmatized. In other
words, stigma means negative thoughts aboutthe children based on their HIV status. Many
have been thrown out of homes, rejected by
family and friends, and some have even been
killed. A child or young person may also end up
doing self stigmatizing themselves throughthinking or feeling negatively about him/her
self based on perceived beliefs that other
people threat them negatively. It can lead to
school drop outs, unemployment, low self-
esteem, family breaks ups, depression andeven suicide. It is therefore vital to address HIV
3.1. Stigma faced by children and how to handle stigma
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stigma in order to improve the quality of lives of
children with HIV/AIDS.
Stigma may occur in different areas in life. It
may be caused by the following situations:
Fear of taking responsibility of young
people through blaming them about
their status.
Lack of protective laws to protect people
against being stigmatized.
Lack of treatment and support.
Ignorance about the causes of
HIV/AIDS.
Religious and cultural beliefs that
surrounds HIV/AIDS.
Stigma can be handled in the following
ways:
Counseling for the infected children and
youngsters together with their family or
caretaker.By showing love and care.
Giving Peer support.
Encouraging children and young people
through educating them about stigma.
Positive living involves a life style that fosters3.2. Positive living for children
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physical, mental and spiritual health.
Positive Living is:
When a person develops a positive
outlook towards his/her life.It involves adopting practices and
lifestyles that aims at improving the
quality of life and reducing the
transmission of HIV.
These behaviors are meant to delayprogression from HIV to AIDS by
keeping the childs immunity high.
How to achieve positive living:
Frequently necessary.
Supporting adherence to septrin to
prevent infections.
Provide adequate nutrition.
Immunization.
Promote the regular monitoring ofgrowth and development.
Prevention of infections like malaria.
Facilitate social support, peers, siblings.
Providing all the basic needs.
Emotional support and counseling.
Love and belonging.
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Safe water and hygiene,
hygiene.
Providing education.
Providing ART.
The great majority of people with AIDS in low
and middle-income countries are cared for at
home, since health services are beyond the
reach of large proportions of the population.
Community care and support groups have
sprung up almost everywhere in the world where
the AIDS epidemic has appeared and it has
shown good results through providing comfort
and hope to people living with, or affected by,
HIV. When it comes to children's /young people's
well being, peer to peer networks are significant.
Person can get support through hearing from
other peers, who are in the same situation or
through sharing their experiences. And if there
arises need for counseling, then fellow peers can
environmental
3.3. Peer to peer counseling
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be easier to approach. Below are some of the
principles to follow in peer counseling:
Keep confidentiality of client's
information.
Do not judge clients and be sensitive to
client's feelings.
Respect client's decision.
Be trusted and truthful.
Recognize your l imitat ions in
counseling. Recognize your own
resources and potential; you don't have
to know everything.
Understand the context of the situation
and respond appropriately.
Accept the client as she/he is.
Recognize each adolescent's unique
qualities. Everybody has their own way
to cope in the difficult situations.
Give correct information; too much
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information at once can confuse clients.
Give information, not advice.
Use clear and simple language
.
Good nutrition plays an important role in
maintaining the health of people living with
HIV. Adequate nutrition is essential to
maintain a person's immune system, tosustain healthy levels of physical activity, and
for a quality of life. Adequate nutrition is also
necessary for optimal benefits if receiving
antiretroviral therapy.
When it comes particularly to children with
HIV/AIDS it is good to keep in mind that they
are like other children; their bodies are
especially sensitive to nutrition. All childrenmust eat well to grow properly. On top of the
normal demands of growth, HIV-positive
children must cope with the extra demands that
the virus places on their bodies.
3.4. Nutrition and HIV
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Facing these demands can sometimes be hard
to the family or care givers. As a parent or
guardian of a child with HIV, it is easy to worryabout your child's nutritional needs. Children
living with a HIV can easily have a poor
appetite and have little interest in food and
they can feel full quickly. Therefore, they ofteneat very slowly and tend to be picky eaters.
This can sometimes make meals very difficult.
They are also suffering from the same
problems like adults with HIV, such as,diarrhea, nausea and metabolic problems,
which make it even harder for them to eat.
When children grow into their teenage years,
the challenges continue, when they became
more independent and when they have more
responsibility for their chronic condition.
HIV-positive children should have ongoing
nutritional care at a pediatric centre to make
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sure they stay healthy and grow properly. If
growth is slow, boosting nutrition will be a vital
part
of the treatment plan. The first step will beto change the child's diet to increase calories
and protein. Thus, a lot of things can be done at
home. One of the peer educator's tasks is to
provide accurate information about nutrition tothe families and to young people.
Importance of good nutrition to people with
HIV/AIDS:
It prevents malnutrition and improves
their quality of life.
It strengthens the immune system and
reduces the duration of illness.
It improves the effectiveness of
medication in the treatment of illness.
It provides energy, nutrients and
improves the physical performance of
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the body.
It delays the progression of HIV/AIDS.
How children get malnourished? :
Through eating food of poor quality.
Through eating inadequate variety of
foods.
Through long lasting illnesses.
Through loss of appetite.
Through poor hygiene and sanitation.
Through inadequate care for those
who are most likely to be affected by
malnutrition.
Inability to access the kind of food
and health care that meet their needs
(e.g. result from the poverty or
resources for social and health care)
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How to eat when suffering from HIV/AIDS? :
Have at least three meals and two
snacks in a day.
Increase consumption of foods from all
groups.
Add a little sugar or oil to food or
drinks.
Chew food well.
Rinse mouth regularly with boiled salty
water (to kill bacteria's)
How to deal with loss of appetite? :
Eat meals and snacks frequently at
regular intervals.
Use favorite foods and spices to boost
appetite.
Avoid strong smelling foods if they
affects your appetite.
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Avoid alcohol, smoking, drugs or
medicines that are not prescribed by
your health worker.
Ask your family and friends to prepare
meals for you.
Have meals in the company of friends
or relatives.
Exercise regularly (e.g. walking,
cycling, house hold duties)
Avoid drinks high in sugar.
Drink plenty of boiled or treated
water.
Eat after taking medication (Note:Take the health workers advice)
Deworm at regular intervals.
4. How to work in practice
4.1. Community mobilization
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Community mobilization is a process of
bringing people together for a desired purpose.
Community mobilization is typically plannedand organized for people to participate and
evaluate their activities for self reliance and
sustainability. Peer educators can try to
mobilize the community in various ways suchas drumming, posters, announcements, letter
writing, home visiting and through mass
media.
Community mobilization has the followingadvantages:
Brings people together.
It facilitates work to be done.
People realize the need for collective
effort.
Activities are sustained and therefore
people can build up commitments.
People learn from each other.
Saves time and money.
Results appear in a short time.
Builds a sense of belonging.
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Peer educators can more easily reach people
and mobilize them in the places that they gather
together. Those places may be:
Churches.
Clubs.
Social gatherings.
Funerals.
Community meetings.
4.2. Home visiting
In order to communicate and reach families in
local communities, it is important to also provide
help to homes through home visiting. Even
though peer educators organize meetings,
clients may not get enough information out of
them. They may not open up in a group or they
may even fail to come. Hence, home visiting is
necessary in caring and supporting children and
care givers.
Importance of home visiting:
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It gives clear assessment of the needs
of children and caregivers within their
local environment.
It gives an opportunity to children and
their families within a relaxed and in a
common setting.
It helps to identify children who require
referral for other services.
It reduces fear and eliminates
discrimination and stigmatization
within the family and community.
It promotes behavior change for
children, families and communities.
It fosters acceptability and positive
living among children, families and
communities.
Issues to consider in home visiting:
Transport.
Funds.
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Human resources e.g. people trained to
do the home visiting.
Time.IEC ( In fo rmat i on Educa t i on
Communication) materials.
Steps taken in conducting a home visit:
Announce arrival.Settle down.
Exchange greetings.
Introduce your self ( Your name, where
is your organization located, your role)Introduce purpose of the visit.
Carry out intended activity.
Set goals for the next visit.
Summarize the visit.
Thank people you have visited.
Make appointment for next visit.
Make records if possible.
Say good bye.
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4.3. Recording and report writing
Recording:
In any intervention, record keeping is a critical
step since it provides information for follow up,
provides accountability and keeps track of
activities done by peer educators in the
community.
Methods used in record keeping:
Report writing.
Documentaries.
Filing.
Stores.
Library.Record keeping has the following advantages:
Helps us to monitor and evaluate
progress.
Records act as references.
They help us remember what we havedone.
Record keeping helps in planning and
noticing the best practices.
It increases accountability.
After recording what you have done and
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how you have worked with a client, you
write a report. A Report can be a spoken
or written account of something heard,
seen or done.
Characteristics of a good report:
Concise and precise.
Straight to the point.
Short sentences.
Clear to the reader.
Simple language.
Flow of ideas.
Target the readers' attention.
Write it soon after meeting a client to
memorize.
Remember to update records.
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4.4. Referral
Place to contact/ get more information and
help:
MU-JHU CARE LTD/PEER PSYCHOSOCIALSUPPORT GROUPS (Makerere University Medical
School, P.O. Box 23491, Kampala)
The John Hopkins University (P.O. Box
23491, Kampala)
Reproductive Health Uganda(RHU)Former Family Planning Association of
Uganda(FPAU), Plot 2 Katego Road Off
Kira Road P.O. Box 10746, Kampala
MILDMAY UGANDA, Transforming HIV
care (Entebbe Road P.O. Box 24985)TASO, The AIDS support organization
(Kanyanya, P.O. Box 10443, Kampala)
BAYLOR COLLEGE OF MEDICINE:
CHILDREN'S FOUNDATION UGANDA
(Mulago Hospital P.O. Box 72052, Clock Tower)
KASANGATI HEALTH CENTRE.
BUWAMBO HEALTH CENTRE.
KAWANDA HEALTH CENTRE.
KAWEMPE HEALTH CENTRE.
KAWEMPE YOUTH DEVELOPMENT
ASSOCIATION (KYDA)
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GLOSSARY
Alcohol/drug dependency: The use of non-
sterile injecting drug equipment is one of the
most efficient modes of HIV transmission and
remains one of the critical activities fuelling
HIV epidemics among drug users. Other
dependencies such as alcohol and non-
injecting drugs may also create vulnerabilities
to transmission and infection.
Bereavement Support: Support for people
dealing with grief due to the loss of a loved one.
Care for Orphans and Vulnerable
Children: Support and guidance for children
under the age of 18 who have lost parents
and/or caregivers, and children who are at risk
of abuse, mistreatment, or exploitation.
Child headed house hold: House hold where
everyone who are living there are younger than
18 years old.
Education and Vocational Training:
Learning new skills and/or taking classes.
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Food Security and Nutrition: The
availability of food and one's access to it. A
household is considered food secure when its
occupants do not live in hunger or fear of
starvation.
Gender: Addressing widely held beliefs,
expectations, customs and practices within a
society that define 'masculine' and 'feminine'
attributes, behaviors and roles and
responsibilities.
Grand Mothers/ Guardians: Maternal or
paternal grandparent or guardian, who looks
after, protects or is legally appointed to
manage the affairs of another person, such as
a child.
HIV Prevention and Behavior Change:
Transmission of HIV is mediated directly by
human behavior, therefore changing
behaviors' that enable HIV transmission.
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Health workers/Caregivers: Hospital/clinic
staff, public health, health outreach workers,
family and community caregivers.
HIV Testing and Counseling: HIV tests are
used to detect the presence of the human
immunodeficiency virus in serum, saliva, or
urine. As per UNAIDS/WHO guidelines all
testing, whether client or provider-initiated
should be conducted under the conditions of the
Three Cs: involve informed consent, be
confidential, and include counseling.
HIV and Disability: Addressing the unique
risks of HIV for people with disabilities. This may
include physical barriers to access appropriate
HIV prevention and support services, as well as
vulnerability in the community because of
limited livelihood opportunities and/or stigma
and discrimination.
HIV + children: Children living with HIV/AIDS.
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Home-Based Care Any form of holistic home-
based care given to those in need, and which
strengthens the capacity of and support for
community health workers. Such care includes
physical, psychosocial, palliative, and spiritual
activities.
Medical access, diagnostics, medical care:
Obstacles to medical access include the cost for
ARV treatment, as well as the health
infrastructure required to deliver ARV's and
provide diagnostic services. Access to
treatment depends not only on financial and
human resources but also on people who need
them being aware of their HIV status,
knowledgeable about treatment, and
empowered to seek it.
Orphans and vulnerable children: These are
children who suffer from physical, mental or
environmental stress that is based on a set of
:
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criteria/standards bear substantive risks when
compared to other children.
Opportunistic Infections: Illnesses causedby various organisms, some of which usually do
not cause disease in persons with healthy
immune systems. For example, Tuberculosis is
the leading HIV-associated opportunisticinfection in developing countries.
People living with HIV and AIDS (PLWA):
Those who have been diagnosed with
HIV/AIDS.Persons with Disabilities: Those who have
some disability or infirmity (physical and/or
mental)
Palliative Care: An approach which improves
the quality of life of patients and their families
facing life-threatening illness, through the
prevention, assessment and treatment of pain
and other physical, psychosocial and spiritual
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problems.
Psychosocial Support: Support to address
the ongoing psychological and social problemsof people living with HIV or AIDS, their
partners, families and caregivers.
Positive prevention: Is a strategy that aims
at contributing to the reduction of HIVtransmission by building the capacity of people
having AIDS and the general community to
scale up HIV/ STI prevention.
P o v e r t y A l l e v i a t i o n / E c o n o m i c
Livelihoods/ Income Generation:
Processes that seek to reduce the level of
poverty in a community, or amongst a group of
people or individuals. Programs are aimed at
decreasing economic poverty through
economic development and income generating
activities.
Prevention of vertical transmission
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(PMTCT): Prevention of transmission of HIV
from mother to fetus or baby during pregnancy or
birth.Protection: Efforts to keep PLWHA, their
partners, families and caregivers safe. For
example efforts to provide legal or human rights
protection for PLWHA.
Public outreach: Efforts by individuals in an
organization or group to connect its ideas or
practices to the general public. Activities typically
take on an educational component but may
conceive their outreach strategy as a two-way
street in which outreach is framed as
engagement rather than solely dissemination or
education.
Sexual and Reproductive Health and Family
Planning: Addressing the reproductive
processes, functions and systems at all stages of
life, is aimed at enabling men and women to have
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responsible, satisfying and safe sex lives, as
well as the capacity and freedom to plan if, when
and how often to have children.Shelter and Material support: Provision of
housing or monetary support which may take
the form of government benefits, food, clothing,
furnishings, medical equipment, transportationetc.
Stigma and discrimination: AddressingHIV
infection as widely stigmatized and that people
living with the virus are frequently subject to
discrimination and human rights abuses based
on their positive status.
Street children: Includes children who work in
the streets and markets of cities selling or
begging, and live with their families, as well as
homeless children who work, live and sleep in
the streets, often lacking any contact with their
families.
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Treatment access, readiness, and
adherence: Addressing barriers to accessing
treatment and providing education, support andcounseling to support informed choices about
treatment options and access to and adherence
with prescribed treatments.
Training: Any classes, field training, skillsbuilding workshops and mentoring.
Target groups: This refers to the persons that
the resource
Youth: Persons between the ages of 15 and 24years of age (based on UN definition).
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Acronyms
AIDS= Acquired Immune Deficiency SyndromeART = Anti-retroviral Therapy
ARV = Anti- viral drugs
HIV = Human Immune-deficiency Virus
IEC = Information Education Communication
PLWHA = People living with HIV and AIDS
PMTCT = Prevention of mother to child
transmission
STI = Sexually transmitted infections
UN = United Nations
WHO = World Health Organization
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References
Peer User Pocket Book, Drug Abuse: Peer-to-
Peer Prevention Program, UYDEL (2003).
Peer educators training Manual organized by
KYDA in partnership with trainers from TASO andth thKawempe health centre (6 10 of September
2010). (un published)
Positive Prevention Counseling, A Training
Course for Peer Educators, Participants' notes
(2007).UNGASS COUNTRY PROGRESS REPORT
UGANDA, January 2008-December 2009.
Government of Uganda (2010).
http://www.avert.org/aids-uganda.htm
http://www.catie.ca/ng_e.nsf(A Practical
Guide to Nutrition for People Living with HIV)
http://www.unaids.org
http://www.who.int/en/
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Kawempe Youth Development Association(KYDA)
Located Jinja Kawempe Zone A Near St.benard P/sPO Box: 71976 Clock Tower Kampala