PART ONE: - UNESCO-UNEVOC
LEARNING MATERIALS ON HIV/AIDS LEVELS 1 AND 2 PROGRAMMES FOR VOCATIONAL TRAINING SECTOR IN BOTSWANA.
LEARNERS’ MANUAL.
APRIL 2005
CONTENTS
I. ABBREVIATIONS AND ACRONYMS 4
II. PREFACE 6
III. GLOSSARY 7
IV. ACKNOWLEDGEMENTS 8
V. LIST OF TABLES 10
VI. LIST OF FIGURES 11
1.0 MODULE ONE: BASIC CONCEPTS OF HIV AND AIDS 12
1.1 UNIT ONE: INTRODUCTION 13
1.1.1 The Meanings of HIV and AIDS 14
a. Body Immune System 14
b. Meanings of HIV and AIDS 15
1.1.2 Differences between HIV and AIDS 15
1.1.3 Common Symptoms of HIV infected and AIDS patients 16
1.1.4 The behaviour of HIV Prevalent type in Botswana 19
a. Classification and Epidemiology of HIV Prevalence in BOTSWANA 19
b. Epidemiological Data 20
1.1.5 SUMMARY 21
1.1.6 GLOSSARY 22
1.2 UNIT TWO: COMMON TRANSMISSION MODES. 24
1.2.1 Common Modes of HIV Transmission 25
1.2.2 Process of HIV infection in the human body 26
1.2.3 Facts about HIV Transmission 29
1.2.4 Common misconceptions about HIV transmission 29
a. High risk factors facilitating transmission of HIV 30
1.2.5 SUMMARY 33
1.2.6 GLOSSARY 33
2.0 MODULE TWO: POSITIVE LIVING 34
2.1 UNIT ONE: PREVENTION 35
2.1.1 Precautionary Measures 36
a. Prevention of Sexual Transmission 36
b. Prevention of Transmission by Infected Blood and Blood Products 41
c. Prevention of Mother-to-Child Transmission (PMTCT) 42
d. Prevention of Transmission by Contaminated Needles 43
e. Prevention of Transmission by Post Exposure Prophylaxis 43
f. Other Precautionary Measures for Prevention of HIV Transmission 44
2.1.2 The benefits of voluntary counselling and testing 44
a. Voluntary Counselling and Testing In Botswana 45
b. The Benefits of Voluntary Counselling and Testing 46
c. Post-Diagnostic Reactions to Counselling and Testing 46
d. Factors that compromise HIV prevention 48
2.1.3 SUMMARY 50
2.1.4 GLOSSARY 51
2.2 UNIT TWO: AVAILABLE CARE AND SUPPORT 52
2.2.1 Meaning of Positive Living 53
2.2.2 Dealing with HIV and AIDS infected and affected persons 56
2.2.3 Names and locations of HIV support groups and centres in Botswana 57
2.2.4 Nature of assistance offered by HIV support groups and centres 59
a. Non-Governmental Organisations (e.g. BOCAIP, BONELA, BONEPWA, BONASO) 59
b. Community-Based Organisations 59
c. Faith-Based Organisation 60
2.2.5 National and local sources of information about HIV and AIDS 60
a. National and local Sources of Information 60
b. International Sources of Information and Educational Programmes 63
2.2.6 Educational Programmes on HIV and AIDS in Botswana 64
a. Public Education and Awareness 64
b. Education for Young People 64
c. Condom Distribution and Education 65
d. Prevention of Mother to Child Transmission of HIV (PMTCT) 65
e. Voluntary Counselling and Testing 66
f. Antiretroviral Therapy Programme MASA 68
g. Education and Training of Health Care Workers 69
h. Antiretroviral Support and Education 70
i. Botswana-Harvard Partnership 70
j. Private Sector 71
2.2.7 SUMMARY 71
2.2.8 GLOSSARY 72
3.0 MODULE THREE: EFFECTS OF HIV/AIDS 73
3.1 UNIT ONE: IMPORTANCE OF STATISTICAL FACTS 74
3.1.1 The meaning of Statistics 75
An Understanding of Statistical Concepts 75
3.1.2 Botswana population characteristics 75
a. Survey 75
b. Pregnant Women 76
c. Tobelopelo Voluntary Counselling and Testing 76
d. National Blood Bank 76
e. Mortality and Morbidity Data 77
f. Employment Data and Private Hospitals 77
g. The effects of distorted information and statistics 77
3.1.3 Infection rates 77
3.1 UNIT TWO: IMPACT OF HIV/AIDS 79
3.1.1 Impact of HIV and AIDS on the Botswana Economy 80
a. Psychological Impact 80
b. Socio-cultural Impact 80
c. Socio-economic Impact 81
3.1.2 Comparative Infection Rates of HIV in Botswana with other countries 81
a. Impact on Labour Productivity 82
b. Impact on Death Toll 82
c. Impact of Life Expectancy: 83
3.2 Table 9: Average life expectancy in 11 African Countries 83
3.2.1 Government Action in minimising the impact of HIV and AIDS 84
a. Impact on Health 84
d. Impact on Education: 86
3.2.2 Micro-Economic Impacts 86
a. Impact on the Households 86
b. Impact on Orphans 88
c. Impact on Women 89
3.2.2 SUMMARY 89
3.2.3 GLOSSARY 90
4.0 MODULE FOUR: HIV/AIDS AND THE WORKPLACE 91
4.1 UNIT ONE: TRANSMISSION RISKS 92
4.1.1 HIV and AIDS and the workplace 93
4.1.2 Transmission and possible risks 94
d. Transfers and Labour Mobility 95
4.1.3 Measures against the risks 97
4.1.4 Prevention 97
4.1.5 Health Service Programmes on HIV and AIDS at the Workplace 98
4.1.6 Pre and Post-Test Counselling 98
4.1.7 SUMMARY 100
4.1.8 GLOSSARY 101
4.2 UNIT TWO: OCCUPATIONAL SUPPORT POLICY GUIDELINES 102
4.2.1 Global Workplace Policies and Guidelines 103
a. Code of Practice on HIV/AIDS 103
b. The Southern African Community (SADC) Code on HIV/AIDS 104
c. The Botswana Policy on HIV/AIDS 104
d. Directorate of Public Service Management Code of Ethics 104
4.2.2 Workplace programmes on HIV and AIDS 104
a. Drugs for the HIV Infected 105
b. Informed Consent 105
c. Confidentiality 106
d. Stigmatisation and Discrimination Against HIV Infected Workers 107
4.2.3 Workplace best practices 110
a. Worker’s Compensation Act of 2001 113
b. Confidentiality 114
4.2.3 SUMMARY 117
4.2.4 GLOSSARY 117
5.0 REFERENCES 118
ABBREVIATIONS AND ACRONYMS
|ABC |Abstain, Be faithful, Condomise or use a Condom. |
|ACHAP |African Comprehensive HIV/AIDS Programme |
|AIDS |Acquired Immune Deficiency Syndrome. |
|ARV |Ante Retroviral Therapy. |
|AZT |Zidovudine – Type of HIV/AIDS drug |
|BAIS |Botswana AIDS Impact Survey |
|BOCAIP |Botswana Christian AIDS Intervention Programme |
|BONASO |Botswana Network of AIDS Service Organisation |
|BONELA |Botswana Network of Ethics and Law. |
|BONEPWA |Botswana Network of People Living With AIDS. |
|BCL |Botswana Copper Nickel Mining Co. LTD. |
|BOTA |Botswana Training Authority. |
|CDC |Centre for Disease Control and Prevention |
|CEYOHO |Centre for Youth of Hope |
|COCEPWA |Coping Centre for People With AIDS |
|DEBSWANA |De Beers Botswana Mining Company |
|DMSACs |District Multisectoral AIDS Committees. |
|DPSM |Directorate of Public Service Management. |
|FDA |Food and Drug Administration. |
|GDP |Gross Domestic Product. |
|HBC |Home Based Care |
|HIV |Human Immune Deficiency Syndrome |
|IDCC |Infectious Disease Care Clinic |
|ILO |International Labour Organization. |
|IPT |Isoniazid (TB) Prevention Therapy. |
|KABP |Knowledge, Attitudes, Behaviour and Practices. |
|KITSO |Knowledge, Innovation Training, Shall Overcome AIDS. |
|MTCT |Mother-To-Child Transmission. |
|MFDP |Ministry of Finance and Development Planning. |
|NACA |National AIDS Coordinating Agency. |
|NGO |Non- Governmental Organization. |
|PLWHA |People Living with HIV/AIDS. |
|PMTCT |Prevention of Mother-To-Child Transmission. |
|SADC |Southern African Development Community |
|STDs |Sexually Transmitted Diseases. |
|STI |Sexually Transmitted Infections. |
|UNAIDS |United Nations AIDS Programme |
|UNDP |United Nations Development Programme |
|VCT |Voluntary Counselling and Testing |
|WHO |World Health Organization. |
|YOHO |Youth Health Organization. |
PREFACE
Botswana has one of the fastest growing HIV infection rates in the world. According to the Botswana 2003 second generation HIV/AIDS surveillance, it is estimated that about 34.7% of the total population is HIV/AIDS infected. Mostly HIV/AIDS interventions were not addressed in the vocational training sector although sexually active young people are one of the most vulnerable groups in the country (UNAIDS 2002).
In October 2000, the Botswana Government and the German Government agreed during the governmental consultation to add the HIV/AIDS component to the activities of the Botswana Training Authority (BOTA) for implementing HIV/AIDS activities in the vocational training sector. BOTA is the coordinating body of the vocational training sector, with the mandate to standardise and assure the quality, mandated by the Vocational Training Act No. 22 of 1998.
As a result of, among others, BOTA’s efforts, the vocational training institutions have implemented HIV/AIDS activities in line with the National Strategic Plan 2003-2009. BOTA and the Ministry of Education assist the institutions in implementing HIV/AIDS activities with technical, training and financial support. The private training providers in particular have only received support from BOTA.
One of the key functions of BOTA is to guide the development of programmes, curricula and training/learning materials in vocational training (Vocational Training Act No. 22 of 1998). Guidelines for aligning curricula with unit standards have been made available to training institutions. BOTA also coordinates the development of vocational training curricula and training/learning materials.
BOTA could not identify adequate learning material, which covers the requirements of the HIV/AIDS units standards. The HIV/AIDS Level 1 unit standard is a compulsory generic skill for all Foundation qualifications. BOTA has the responsibility to ensure the implementation of HIV/AIDS unit standards as part of the generic skills through the submission of learning materials.
GLOSSARY
Alcohol and drugs: Alcohol and drugs belong to the same family in HIV transmission as they are habit-forming and can impair people from making reasonable judgments about preventing HIV.
Misconceptions: Refers to common distortions or unfounded fears about what causes AIDS. Because AIDS is caused by HIV which is dangerous to the human race, people can not trust anything about its causes and they develop all kinds of fear-related explanations of other transmission routes that they may think are relevant.
ACKNOWLEDGEMENTS
On behalf of the Educational Development Network (Pty) Limited and the professionals that participated in this consultancy, I wish to extend my appreciation to all those HIV/AIDS institutions and individuals who made various contributions in making this work successful. In particular, my special thanks go to the staff of the Botswana Training Authority (BOTA) in collaboration with the Ministry of Education Curriculum Development Unit, Department of Vocational Education and Training and reference group members from the First National Bank, PMTCT and the United Nations Development Programme (UNDP). In particular, I want to note the institutional support provided by BOTA through the provision of conference rooms, tea breaks and lunch and various times during the duration of this consultancy. I am also sincerely thankful to the members of the consultancy Reference Group comprising of:
▪ Ezekiel Thekiso – BOTA – Chairperson of the Reference Group
▪ Mothebe Madanika – BOTA – Secretary of the Reference Group
▪ Ulla – BOTA
▪ Peter Fleming – BOTA
▪ Josephine Tlale – PMTCT, Ministry of Health.
▪ Kokie Seretse – First National Bank.
The advice and institutional support provided by the members of the reference group was invaluable in bringing this work to completion.
I want to thank the staff of NACA (IEC and resource centre), COCEPWA and PMTCT for providing us with the relevant information without which the consultants could not have proceeded. We thank the heads of these organisations, programme managers, for the understanding and hospitality they showed to the research team at various stages of our data collection process.
Last but not the least the management of Educational Development Network (Pty) Limited acknowledges the effort of Mr Mothebe Madanika for all the logistical support in the development of these learning materials. Thanks also to Mr Ezekiel Thekiso for coordinating and supervising the proceedings of the reference group meetings. We believe it was a very challenging task for him to keep the discussion on track with the terms of reference and the initial consultative documents from the stakeholders’ input into the standards expected from the final products of the modules.
Dr Matthew L. S. Gboku
(Research Team Leader)
LIST OF TABLES
|TABLE | |PAGE |
|1 |Main HIV-1 Subtypes by Region or Country | |
| | | |
|2 |HIV Prevalence Rate in Selected Countries within Southern Africa | |
| | | |
|3 |Body fluids and HIV Transmission | |
| | | |
|4 |Progression of HIV Infection to AIDS | |
| | | |
|5 |Locations of HIV Support Groups and Centres in Botswana | |
| | | |
|6 |Public Health Expenditure in Botswana (1990 – 2000) | |
| | | |
|7 |Core expenditure on HIV and AIDS programmes in Botswana (1999 – 2003) | |
| | | |
|8 |Comparative Impact of HIV/AIDS on agricultural labour force in the most | |
| |affected African countries | |
| | | |
|9 |Average life expectancy in 11 African Countries | |
| | | |
|10 |Programmes on HIV/AIDS at the Workplace | |
LIST OF FIGURES
|FIGURE | |PAGE |
|1 |Picture of a healthy looking but HIV infected person | |
| | | |
|2 |Picture of a Person with AIDS exhibiting many of the | |
| |symptoms mentioned above | |
| | | |
|3 |Progression of HIV infection in the human body | |
| | | |
|4 |A Picture of a Drunk Man and His Sad Family | |
| | | |
|5 |A Picture of an Unfaithful Man Caught by another Man | |
| | | |
|6 |Picture of a Female Condom | |
| | | |
|7 |A picture of a man after HIV/AIDS Counselling Session | |
| | | |
|8 |Friends and Neighbours Turning their Backs on an HIV Infected | |
| | | |
|9 |Benefits of voluntary counselling and HIV Testing | |
| | | |
|10 |A Picture of Healthy Babies whose Parents have used PMTCT | |
| | | |
|11 |A Health Officer Presenting a Workshop Paper on PMTCT | |
MODULE ONE: BASIC CONCEPTS OF HIV AND AIDS
MODULE OVERVIEW
In this module, you will learn about the Basic Concepts of HIV/AIDS. The government of Botswana developed a comprehensive multi-sectoral approach for all levels in the country to fight against the epidemic. One of the key elements in the war against HIV/AIDS in the vocational training sector is to ensure that you understand the basic concepts of HIV/AIDS so that you can use the knowledge to empower yourself in the prevention and transmission of HIV. This is the first of the 3-Module and 4-Module learning designed for HIV/AIDS levels 1 and 2 of the vocational training programmes. The HIV/AIDS programmes are intended to arouse awareness as regards he economic and social impact of HIV/AIDS. They also strive to produce a morally sound and disciplined citizens who are compassionate, responsible, tolerant, healthy and safely conscious.
The HIV/AIDS pandemic has increased the medical expenditure and reduced skilled personnel drastically. The rationale for introducing the HIV/AIDS programmes in vocational training institutions is that it is envisaged the proposed programmes will bring about behavioural changed in the learners that would result in reduced public spending, growth in skilled workforce emanating from reduced death and infection rates, and overall economic growth.
1 UNIT ONE: INTRODUCTION
OVERVIEW
In this unit, you will be introduced to the basic concepts of HIV/AIDS including the meaning and facts about HIV/AIDS. An understanding of the basic concepts of HIV/AIDS will give you the opportunity to develop knowledge, skills and positive attitudes towards behavioural change for prevention of HIV/AIDS.
OBJECTIVES
By the end of the unit, learners will be able to:
1. Explain what the acronym HIV and AIDS stand for
2. Explain the differences between HIV and AIDS
3. Recognize common symptoms in HIV and AIDS infected persons
4. Identify the HIV prevalent type in Botswana and describe its behaviour
TOPICS
1. Meanings of HIV and AIDS
2. The Differences between HIV and AIDS
3. Common Symptoms of HIV and AIDS
4. The Behaviour of HIV Prevalent type in Botswana.
1 The Meanings of HIV and AIDS
1 Body Immune System
Everything we are going to be talking about HIV and AIDS is related to the body immune system. It is therefore important to learn about the body immune system before moving to the meanings of HIV and AIDS. In this way the concept of HIV/AIDS and how it progresses in the human body will be easily understood.
The Body Immune System
Let us take a step further to know more about what HIV does to our body system. The body immune system consists of (a) skin (b) antibodies and (c) white blood cells.
[pic] The skin: Is a physical protective barrier just like the walls of a house protects a person from the wind and the rain, the skin works to protect a person from infection.
[pic] Antibodies: Are like little bombs that fight bad organisms. The body creates specific antibodies to fight off specific diseases. So when a bad organism enters the body the body develops an antibody to fight off that specific organism. So the body might have antibodies to fight against measles, and other antibodies to fight against chicken pox, and other antibodies to fight against the HIV virus.
[pic] The white blood cell: The human body is made up of two types of blood cells, namely, the red blood cells ad the white blood cells. The white blood cells normally protect the human body against diseases. Without the white blood cells, disease can attack and kill us easily. For example, each time you get sick the white blood cells engages into a battle with the disease. You only get well when the white bloods cells win the fight. In most cases, the battle for human survival from diseases is won by the white blood cells. What HIV does is to attack the white blood cells and destroy them once the human body gets infected with it. The HIV being a small but a strong virus will continue to attack the white blood cells and weakens them until the body becomes vulnerable to diseases.
2 Meanings of HIV and AIDS
The acronym HIV stands for Human Immune Deficiency Virus. HIV is a virus and like other viruses, it needs living cells to mutate or make copies of itself. With these new copies, HIV infects other, previously healthy cells. Other important points to note about HIV are:
• The virus can only infect human beings.
• The effect of the virus is to create a deficiency, a failure to work properly within the body’s immune system (i.e. Immune Deficiency).
• The virus does not reproduce by itself but by taking over a human cell.
• Re-infection
The acronym AIDS stands for Acquired Immune Deficiency Syndrome. The relationship between HIV and AIDS is that HIV causes AIDS, a serious condition in which the body’s defences against illnesses are broken down. People with AIDS develop many different kinds of diseases, which the body would usually fight off quite easily. The acronym AIDS as in the case of HIV is derived from certain features which we need to note. These are:
• AIDS is not transmitted through the genes but like other conditions, one must acquire it or get infected with it. You can not inherit it.
• HIV affects the body’s immune system.
• With time, the HIV makes the immune system deficient.
• AIDS creates a conducive environment within the human body for a wide range of different diseases and infections.
2 Differences between HIV and AIDS
|HIV |
|AIDS |
| |
|[pic] |
|[pic] |
| |
|HIV is a virus which is a living thing. |
|HIV is the virus that causes AIDS |
|This virus enters the body and attacks the immune system and makes it weak |
|Your immune system is the body's defence system, which protects it from diseases |
|HIV infection makes the immune system deficient and the infected person becomes sick |
|AIDS is a syndrome which is a group of related problems or symptoms |
|If someone is infected with HIV s/he is said to be HIV POSITIVE |
|AIDS is the final stage of HIV infection |
|At this stage various diseases attack the weakened body |
|These are called opportunistic infections |
|HIV infection is not a death sentence. A person can live a positive and productive life with HIV for a long time. |
| |
3 Common Symptoms of HIV infected and AIDS patients
Before we speak to the issue of symptoms, we need to know that HIV is an unusual virus because you can be infected with it for many years and yet appear to be perfectly healthy. Many people who are infected with HIV do not have any symptoms at all for many years, and other diseases can also cause most of the symptoms normally associated with HIV/AIDS. Some people develop AIDS a few years after becoming HIV positive while other people can carry the infection for longer periods without developing AIDS. The time between HIV infection and progression into AIDS depends on a number of factors such as:
• The type of HIV strain;
• Behaviour of the infected after infection;
• Incidence of opportunistic infections;
• The nature of the person infected. For example some people can easily commit suicide while others can accept and cope with their HIV positive status.
• The availability of support from family, friends, community and the counselling and health providers.
However, most people would not know when they became infected. They will only realize that they are infected when they become sick. The only way of finding out if somebody is infected is by taking the HIV test.
A few weeks after HIV infection a person may have flu-like symptoms or may have serro conversion illnesses. After that, an average of 5 to 7 years will pass without another sign of infection - although that delay can range from a few months to 10 years. However, even when you don't have symptoms, the virus is still multiplying in your body, and you can pass it to other people. Mild symptoms may occur when the immune system first starts to weaken (many of these can be effectively treated or prevented) but they become more severe as the AIDS stage of HIV infection is reached.
Figure 1: Picture of a healthy looking but HIV infected person
[pic]
Bearing all the above factors in mind, however, the following might be indications of infection with HIV:
|Symptoms Associated with HIV may include: |
|[pic] |
|Deep and unexplained fatigue |
| |
|[pic] |
|Rapid weight loss |
| |
|[pic] |
|Frequent fevers and heavy night sweats |
| |
|[pic] |
|Swollen lymph glands in the armpits, groin, or neck |
| |
|[pic] |
|Diarrhoea (running stomach) that lasts for more than a week |
| |
|[pic] |
|Persistent yeast infections |
| |
|[pic] |
|White spots of unusual blemishes on the tongue |
| |
|[pic] |
|Pneumonia |
| |
|[pic] |
|Skin rashes |
| |
|[pic] |
|Red, brown, pink, or purplish spots on or under the skin or inside the mouth, nose, or eyelids |
| |
|[pic] |
|Pelvic inflammatory disease that doesn't respond to treatment |
| |
|[pic] |
|Short term memory loss |
| |
|[pic] |
|Frequent and severe herpes infections causing mouth, genital or anal sores |
| |
|[pic] |
|Painful nerve disease (shingles) |
| |
|[pic] |
|Herpes |
| |
|[pic] |
|Headache |
| |
|[pic] |
|Cryptococal Meningitis |
| |
The most reliable indicator of HIV is a test. Advanced stage of HIV is marked by opportunistic infections, muscle wasting and any other illnesses that may attack the body while the immune system is down.
Figure 2: Picture of a Person with AIDS exhibiting many of the symptoms mentioned above
[pic]
CLASS ACTIVITY
?
• What is the main difference in meaning between HIV and AIDS?
• Which of the symptoms associated with HIV are common in Botswana?
4 The behaviour of HIV Prevalent type in Botswana
1 Classification and Epidemiology of HIV Prevalence in BOTSWANA
By the turn of the 20th Century, about 11 distinct subtypes of HIV-1 and two main types of HIV (HIV-1 and HIV-2) had been discovered. HIV-1 is labelled by letter from A to J, with a separate group O for ‘outliers’, or those that do not fit into the clear groups of A to J. The geographical distribution of HIV subtypes varies widely, an important factor in the development of vaccines.
Table 1: Main HIV-1 Subtypes by Region or Country
|HIV Subtype |Region where subtype is the most common |
|Group M (Major Group) | |
|A |Central and East Africa |
|B |Americas, Europe, Thailand, Japan |
|C |Southern Africa, India |
|D |Central, East and South Africa |
|E |Thailand, Japan, India |
|F |Romania, Brazil, Democratic Republic of Congo |
|G |West Africa |
|H |West Africa, Taiwan |
|I |Cyprus |
|J |Democratic Republic of Congo |
|O |Recently identified subtypes that do not fit into the M Group. |
Source: Ward (1999:357)
Southern African countries are affected by a strain of HIV Subtype 1C. According to the United Nations Programme on HIV/AIDS, the southern African countries of Botswana and Zimbabwe currently have the highest global incidence and prevalence of HIV1 Subtype 1C infection.
The extreme genetic diversity of human immunodeficiency virus type 1 in the global AIDS epidemic coincides with an uneven distribution of HIV-1 strains that have been classified into groups and sub-types on the basis of their phylogenetic relationships. Causing most of HIV-1 infections worldwide, the most representative group of HIV-1 - the M (main) group – is comprised of sub-types A through K. The most severe AIDS epidemic has occurred in sub-Saharan African, where an estimated 25.3 million adults and children lived with HIV-AIDS at the end of 2000. The vast majority of HIV-1 infections in sub-Saharan Africa are caused by sub-types A and C.
Recent studies of HIV1 Subtype 1C infection have suggested that it displays a preferential use of the CCR5 co-receptor, increase virus load compared with other co-circulating subtypes, and an apparent increase in transmission in utero. Many risk factors are likely to influence the outcome of such studies in both the transmission and the epidemic spread of HIV-1 Subtype 1C. HIV-1 Subtype 1C is now responsible for more than half of all HIV-1 infections in the world.
The HIV1 -1C sub-type A epidemic dominates in West, Central and East Africa. In contrast, countries in southern Africa and the horn of Africa have experienced the greatest burden of the AIDS epidemic caused predominantly by HIV-1 subtype C (HIV-1 Subtype 1C).
2 Epidemiological Data
Botswana is one of the countries that have been hardest hit by the worldwide HIV epidemic. In 2004 there were an estimated 260,000 people in Botswana living with HIV, or 350,000 according to a UNAIDS estimate for the end of 2003. This, in a country with a total population of 1.6 million, gives Botswana a prevalence rate of 37.0%, the second highest in the world after Swaziland. Life expectancy is only 39 years, while it would have been 72, if it were not for AIDS. There are around 60,000 registered orphans in the country but it is feared that Botswana will have about 200,000 orphans in 2010 if the current situation is not reversed. In an address to the UN General Assembly in 2001, the President of Botswana, Festus Mogae, said 'we are threatened with extinction. People are dying in chillingly high numbers. It is a crisis of the first magnitude.' The 1997 Sentinel survey data indicated about 207,000 people in Botswana had been infected with HIV, bringing suffering to the affected, family, community and the nation at large.
Table 2: HIV Prevalence Rate in Selected Countries within Southern Africa
|Country |Percent HIV prevalence |
|Botswana |35.8 |
|Swaziland |25.3 |
|Lesotho |23.6 |
|Zimbabwe |25.1 |
|Zambia |20.0 |
|South Africa |19.9 |
|Namibia |19.5 |
|Malawi |16.0 |
|Mozambique |13.2 |
Source: UNAIDS and WHO, 2000
Botswana has become the first African country to aim to provide antiretroviral therapy to its citizens on a national scale. It is believed by many that if any country in Africa is going to succeed in implementing such a comprehensive HIV/AIDS care and treatment programme, then it is Botswana. The country has enjoyed a period of unbroken peace since 1966 and has become relatively prosperous due to its diamond mines. The annual per capita income is US$3,300, amongst the highest in the area.
CLASS ACTIVITY
?
• Why do you think Botswana has one of the highest rates of HIV infection compared to other countries with the least infection rates?
• What can be done to stop HIV from spreading further?
6 SUMMARY
In this unit, you have learnt about the meaning and basic facts of HIV/AIDS. You have learnt of the difference between HIV and AIDS, and how the HIV virus makes a transition from the point of infection to the development of AIDS. You have also discussed common symptoms you may find in HIV and AIDS infected persons. It is hoped that with this knowledge, you will be able to discern HIV and adopt ways of preventing and managing it.
7 GLOSSARY
Antibodies: Any of the numerous protein molecules produced by the body as a primary immune defence to disable unwanted foreign bodies (antigens) such as a virus or bacterium.
Epidemic: Of a disease affecting many persons at the same time, and rapidly spreading from person to person in a locality where the disease is not permanently prevalent.
Epidemiology: Branch of medicine dealing with the incidence and prevalence of disease in large populations and with detection of he source and cause of epidemics of infectious disease.
Immune System: A diffuse, complex network of interacting cells, cell products, and cell-forming tissues that protects the body from pathogens and other foreign substances destroys infected and malignant cells ad removes cellular debris. The system includes the thymus, spleen, lymph nodes and lymph tissue, stem cells, white blood cells, and antibodies.
Opportunist infections:
Infections that take advantage and attack the body when the immune system is low.
Sero-conversion illness:
At the point of infection, the body shows no significant levels of serum antibodies that would indicate previous exposure to HIV infection (sero-negative). As the level of antibodies increases in the body due to HIV infection (sero-positive), the body succumbs to illnesses. Any illness at the point of transition of the body fluid (blood) from sero-negative to sero-positive is regarded as sero-conversion illness.
Strain: A variety, especially of micro-organisms such as viruses and bacteria.
Symptoms: Evidence that arises from and accompanies a particular disease or disorder and serves as an indication of its occurrence.
Syndrome: A group of symptoms that together are characteristic of a specific disorder or disease.
2 UNIT TWO: COMMON TRANSMISSION MODES.
OVERVIEW
In this unit, you will learn about three common ways in which HIV/AIDS is spread. An understanding of common transmission modes of HIV/AIDS will give you an opportunity to avoid the most severe modes of transmission and make informed choices about HIV/AIDS prevention. Remember that prevention is better than cure. Infact there is no cure for HIV/AIDS. It is therefore very important to have enough knowledge and willingness to avoid contracting the HIV.
OBJECTIVES
By the end of this unit, you will be able to:
1. Discuss the four major ways in which HIV can be transmitted
2. Explain the progression of HIV infection in the human body
3. Discuss at least six general misconceptions about transmission modes
TOPICS
1. Common modes of HIV transmission
2. Progression of HIV infection into AIDS
3. General misconceptions about HIV transmission
1 Common Modes of HIV Transmission
HIV is usually found in all body fluids such as blood, semen in men, and vaginal secretions in women. These body fluids serve as important media for the HIV virus to survive. HIV can spread very quickly, if it is not stopped from making copies of itself. Body fluids can be divided into those that contain sufficient quantities of the virus and other body fluids that do not contain sufficient quantities of the virus to be infectious. The table below indicates different body fluids through which HIV can be transmitted.
Table 3: Body fluids and HIV Transmission
|Infectious Body Fluids |Containing Sufficient Quantities of the Virus |
| |Yes |No |
|[pic] semen |[pic] | |
|[pic] Vaginal secretions/fluid |[pic] | |
|[pic] Blood |[pic] | |
|[pic] Breast milk |[pic] | |
|[pic] Saliva | |[pic] |
|[pic] Sweat | |[pic] |
|[pic] Tears | |[pic] |
|[pic] Urine | |[pic] |
For infection with HIV to happen, two things must happen. (i) The virus must find a way to enter the bloodstream, and (ii) the virus must have a host.
There are several ways in several ways in which HIV/AIDS is transmitted. The table below gives a summary of the most common modes of HIV transmission.
|Major Modes of HIV Transmission |
|[pic|Sexual Intercourse: HIV is spread most commonly by unprotected penetrative sexual intercourse with someone already infected with HIV. |
|] |The virus can enter the body through the lining of the vagina, vulva, penis and rectum during sex. Improper of failure in condoms use |
| |can also lead to HIV infection. Condoms can fail because of failure to put them on properly, failure to keep the condom on during the |
| |entire sexual act, and/or a compromise in the condom structure which causes it to break or tear. |
| |Blood and blood products |
| |HIV can be transmitted through blood and blood products in a health facility. Careful screening is done to ensure that blood is safe for|
| |transfusion to those who may need it. However, because of the window period between the point of infection and the time the person |
| |develops symptoms of AIDS, the risk in receiving blood can not be ruled out completely. HIV in some blood may not be detectable at the |
| |time of donation. |
|[pic|Infected Blood: HIV is also spread through contact with infected blood. In this case drug users frequently spread HIV by sharing needles|
|] |or syringes contaminated by the blood of someone infected with the virus. Transmission from patient to health care worker or vice-versa |
| |via accidental sticks or other medical instruments are rare. |
|[pic|Mother-to-Child Transmission (MCT): Pregnant women with HIV can transmit virus to their unborn babies during pregnancy, at birth and |
|] |through breast feeding (mother-to-child transmission). MCT depends on the condition of the mother. If the mother is already having |
| |symptoms of AIDS at the time of conception or delivery, the chance of infecting the child is very high |
2 Process of HIV infection in the human body
Once the Human Immune Virus enters the human body it goes through a process
Step 1: Virus enters the body
Step 2: White blood cells attack the HIV infection
Step 3: The HIV virus attaches to the white blood cell. Then the virus pours its genetic material into the cell. The genetic material contains the codes for making new HIV viruses.
Step 4: The genetic material of the virus gets put together with the genetic material of the cell and the cell starts to create more HIV viruses. The HIV virus basically tales over the white blood cell and begins to replicate or produce more viruses. In some types of white blood cells it can produce thousands of viruses.
Step 5: The HIV core proteins and genetic material are gathered together within the white blood cell as well as a viral envelope. Then the newly made virus forms and is pinched off from the white blood cell. The newly formed HIV virus matures and then infects another white blood cell.
Figure 3: Progression of HIV infection in the human body
EXPLANATION OF THE DIAGRAM
Figure 3 above explains the progression of HIV infection to AIDS up to the point of death. Further explanation of the figure is given in Table 4 below.
Table 4: Progression of HIV Infection to AIDS
|Point of HIV infection |This stage represents the exact moment that a person is infected with HIV |
| |through sex, blood contact or other means. At this time the person does not |
| |have AIDS yet and will not know if he or she has been infected. |
|Window Phase |No signs or symptoms of disease, and no detectable antibodies to HIV. An HIV |
|2–6 weeks, occasionally several months |antibody test may be negative although the virus is present. The person can |
| |still infect others during this time. |
|Seroconversion |The development of antibodies. It may be accompanied by a period of flu-like |
|Brief period that occurs after 2 – 6 weeks up to a |illness, glandular fever-like illness or, occasionally encephalitis. Illness |
|few months |at sero-conversion may be called acute HIV syndrome. About 25% of people |
| |experience no illness at this stage, and many who become ill do not visit |
| |health services. |
|Asymptomatic HIV |Antibody tests are positive but there are no apparent signs or symptoms of |
|Lasts from less than one year to 10 – 15 years or |illness. This is the incubation period. It may be accompanied by persistent |
|more. |generalized lymphadenopathy (PGL) that is glands staying swollen for a long |
| |time, without other disease symptoms. |
|HIV/AIDS-related illness |Signs and symptoms of disease increase because HIV is damaging the immune |
|Lasts months or years |system. They are not usually life threatening initially but become more |
| |serious and long lasting. |
|AIDS |The terminal stage of HIV infection. Life-threatening infections and concerns |
|Usually less than one-two years unless treatment is |occur because the immune system is severely weakened and cannot cope. The |
|available |patient dies when an untreatable life threatening condition develops. Life |
| |expectancy depends on the conditions that develop and the treatment available,|
| |including anti-retrovirals, drugs for opportunistic infections and holistic |
| |care including good nutrition. |
|Source: Helen Jackson (2002:43) – AIDS Africa: Continent in Crisis |
3 Facts about HIV Transmission
Facts about HIV Transmission
• After infection, a person develops antibodies; these are an attempt by the immune system to resist attack by the virus. If a person is tested for HIV, and the presence of HIV antibodies is found, he or she is sometimes called HIV-positive or simply HIV+. The risk of sexual transmission of HIV is increased by the presence of other sexually transmitted infections (STIs).
• A person may live for many years after infection, much of this time without symptoms or sickness, although they can still transmit the infection or re-infect others. Of course, if a person is not aware that they are infected, they may not take precautions and, without knowing, pass on the virus. Periods of illness may be interspersed with periods of remission. If a person is well cared for, can eat properly and rest, they can live for a number of years with a fair quality of life. They will be able to work.
• There is no recorded instance of the virus being transmitted through first aid procedures. Research is currently under way to develop a vaccine, but it is unlikely that one will be available for many years. Research is also being carried out to develop a microbicide (spermicidal) that can be used to prevent infection during intercourse.
• There is no cure. Antiretroviral drugs are available that slow the progression of the disease and delay the onset of AIDS, but they are relatively very expensive. They do have some success in preventing mother to child transmission.
• HIV is a fragile virus, which can only survive in a limited range of conditions. It can only enter the body through naturally moist places and cannot penetrate unbroken skin.
4 Common misconceptions about HIV transmission
HIV is not an immediate death sentence. From the early days of the disease there have been scare stories, misreporting, panic reactions and discriminatory policies. Gradually, the ignorance and prejudice are being dispelled and the right approach has developed. But many myths persist which prevent a rational approach to the illness. Here are some of the mistaken beliefs about how HIV infection is spread.
1. Casual contacts at work, at school, or at home.
2. Shaking hands, hugging, talking, or even kissing.
3. Caring for someone with HIV infection or AIDS, as long as simple precautions are met.
4. Mosquitoes, other insects, or animals.
5. Drinking water, bathing, or swimming.
6. Plates, utensils, or toilet seats.
7. Contact with stool, urine, nasal secretions, saliva, sweat, tears, or vomit. Unless they contain blood.
8. Handling food as long a good personal hygiene and common sense is followed in the preparation and serving of food.
1 High risk factors facilitating transmission of HIV
There are two major factors that can predispose or put people at the risk of HIV infections facilitate the transmission of HIV infections. These are:
Sexually Transmitted Diseases – These are infections of microscopic germs that are
passed from person to person through sexual contact. People who have sexual relations with multiple partners are especially at risk for STDs. Currently the five most common STDs are gonorrhoea, syphilis, Chlamydia, herpes, and trichomoniasis. Some effects of the STDs are itching and burning of infected tissues, sterility (inability to have children), and serious inflammation of the joints, heart, spinal cord, and brain. Medicines are available to cure STDs. Persons with one or more STD increase their risk of HIV infection. STDs cause irritation, swelling, and small breaks in soft tissue linings (skin), which increase the risk of transmitting HI during sexual relations.
Drugs and Alcohol Abuse - A drug is defined as a chemical or natural substance that when used alters the person in some way. It is something that changes the body’s natural processes and affects a person’s normal thought and behaviour processes. Because it alters normal thought and behaviour, alcohol puts people at risk of contracting the HIV infection.
Figure 4: A Picture of a Drunk Man and His Sad Family
[pic]
Resource Materials
The progression from initial HIV infection to death can take many years. Most people do not develop symptoms when they are first infected with HIV, but some people develop flu-like symptoms within a month or two after exposure. These symptoms do not last very long and are often mistaken for those caused by some other virus. The time where a person is “asymptomatic”, meaning they feel fine and are not sick, can vary greatly with some people remaining asymptomatic for 10 to 15 years or more and others only months or a few years. With children onset of more persistent and severe symptoms is usually within two years of when the child was born. However, during this “asymptomatic” time HIV is actively replicating and destroying the immune system. It is only a mater of time before the immune system, namely the CD4+T helper cells are significantly reduced in number and ability. Eventually the person starts to develop more persistent and severe conditions or illnesses. As the immune system deteriorates, a variety of complications begins to surface. In many people one of the first symptoms is enlarged lymph nodes or “swollen glands”. This can continue for up to three months. Other symptoms that may occur before the onset of full blown AIDS are weight loss, fatigue, frequents fevers and sweats, persistent and frequent yeast infections (thrush), persistent skin rashes or flaky skin, pelvic inflammatory disease that does not respond to treatment, or short term memory loss.
The term AIDS applies to the most advanced stages of HIV infection. Official criteria for the definition of AIDS are developed by the Centre for Disease Control in Atlanta, Georgia in the United States of America. The definition of AIDS includes all HIV infected people who have fewer than 200 CD4+T cells (a healthy person will have counts of 1000 or more) in addition; the definition includes 26 clinical conditions that affect people with advance HIV disease. Most AIDS defining diseases are opportunistic in nature, meaning that those diseases rarely cause harm in healthy individuals but for the person who has a compromised immune system due to HIV infection these diseases can be very severe if not fatal. These diseases take the opportunity presented by a compromised immune system (defences are down) to attack the body.
Many of the symptoms or illnesses of AIDS patients are very debilitating that make an infected person to become unable to hold a steady job or to do household chores. Other people with AIDS experience variety of intense life-threatening illness followed by phases of normal living. Unfortunately, once a person develops full blown AIDS they rarely have the ability or the energy to lead a normal life. This is a very painful time for the person with AIDS and for the friends and family. Eventually, the infected person dies due to complications presented by the opportunistic diseases. This is a difficult concept for many people to understand. It would appear that the person died of pneumonia, tuberculosis, or some other disease when in actual fact the person died because HIV had destroyed their immune cells which led to that person being susceptible to opportunistic diseases. Complications due to the disease kill the person but that disease may have never killed that person if HIV had not destroyed the immune cells in the first place. We must come to terms that the person died of AIDS which is a syndrome caused by HIV.
The HIV virus continues to replicate (producing more viruses) and destroy more and more immune cells. The person’s immune system starts to get weak. It may take months or even years for the HIV virus to weaken the immune system enough for that person to develop AIDS. The diagram also shows that over time the white blood cell count becomes less and less. At some point the person starts to develop symptoms or becomes sick. The illnesses could be anything from diarrhoea to swollen glands, or a common cold, tuberculosis, or anything. The illnesses are usually opportunistic in nature, meaning they are illnesses that attack people only when they are weak. A normal healthy person would be able to fight off these illnesses. The person may experience recurrent infections such as oral thrush. Normal treatments take much longer to work or they do not work at all.
Eventually the person dies due to the diseases they have developed because the HIV virus has weakened their immune system.
CLASS ACTIVITY
?
• Which of the common misconceptions of HIV transmission are common in Botswana?
• What can be done to correct misconceptions about the transmission of HIV/AIDS?
• Of the high risk factors in HIV transmission, which ones in your opinion are strongly applicable to Botswana?
• Which ones are the least applicable to Botswana?
5 SUMMARY
In this unit, you have learnt about the meaning and basic facts of HIV/AIDS. You have learnt of the difference between HIV and AIDS, and how the HIV virus makes a transition from the point of infection to the development of AIDS. You have also discussed common symptoms you may find in HIV and AIDS infected persons. It is hoped that with this knowledge, you will be able to discern HIV and adopt ways of preventing and managing it.
6 GLOSSARY
Alcohol and drugs: Alcohol and drugs belong to the same family in HIV transmission as they are habit-forming and can impair people from making reasonable judgments about preventing HIV.
Misconceptions: Refers to common distortions or unfounded fears about what causes AIDS. Because AIDS is caused by HIV which is dangerous to the human race, people can not trust anything about its causes and they develop all kinds of fear-related explanations of other transmission routes that they may think are relevant.
MODULE TWO: POSITIVE LIVING
MODULE OVERVIEW
In this module you will learn about how infected and affected people can live positively with HIV and AIDS. The infected are people who test positive for HIV and the affected are family members, care givers, friendly and entire support network of people who directly or indirectly deal with HIV infected and AIDS persons. This module is divided into two units. The first unit is about prevention of HIV and AIDS while the second unit is addresses the issue of support and its availability for HIV and AIDS infected and affected persons. While the specific objectives of these units are presented, the learners must appreciate the broader aim of the module as intended to help them demonstrate knowledge and understanding of: (i) the different ways of dealing with HIV and AIDS infected and affected persons; (ii) the rights to privacy of people with HIV and AIDS; and (iii) sources of existing counselling groups and centres around the country.
The module is designed for both the HIV/AIDS Foundation and Intermediate programmes, which are intended to arouse awareness as regards the economic and social impact of HIV/AIDS, and to produce a morally sound, disciplined, compassionate, responsible, tolerant, health and safety conscious citizens. The module is therefore suitable for anybody who need to know about (a) HIV and AIDS; (b) personal precautions to reduce the risk and spread of infection; and (c ) how to deal with HIV/AIDS infected and affected people.
1 UNIT ONE: PREVENTION
OVERVIEW
In this unit you will learn about the risk and spread of HIV infection. A risk is a dicey or uncertain situation that people confront in life. In is important to know about the risk and spread of HIV infection because HIV/AIDS has no cure. To contract the HIV virus has serious implications for both the infected and his or her family members.
OBJECTIVES
At the end of this unit, learners will be able to:
1. Evaluate the risks associated with the spread of HIV/AIDS
2. Describe the precautionary measures one can take to avoid the risks of contracting and spread of HIV/AIDS
3. Discuss the various ways the HIV and AIDS infected and affected should positively deal with their condition.
TOPICS
1. Precautionary measures and behaviours
2. The benefits of voluntary testing
1 Precautionary Measures
Precautionary measures include practices that people must adopt to prevent avoid infection and/or manage HIV/AIDS. If you want to use effective methods of preventing HIV/AIDS infection, you must have full knowledge of the common transmission modes, which were discussed in unit two of module one.
CLASS ACTIVITY
?
Without reference to materials in module two, list the common modes of HIV transmission in Botswana
1 Prevention of Sexual Transmission
The main way of preventing sexual transmission of HIV infection is by practicing safer sex. The four common practices of safer sex are:
o Abstinence
o Be faithful to one partner
o Use a Condom
o Do it yourself (masturbation)
These practices are commonly known as ABCD for easy memory recall.
We shall now have a detailed discussion of each of the practices.
i. Abstinence
The simplest way to avoid HIV infection is abstinence. Abstinence means having no sex at all. Many people express their objections or acceptance of abstinence based on religious, moral, and other beliefs. Since sex is the main mode of HIV/AIDS transmission, abstinence is the most important and effective way of preventing HIV/AIDS prevention. However, because the act of sex is a biological need, abstinence requires serious exercise of self control and discipline. Abstinence to many adult men and women is not a feasible practice, and therefore not considered as a serious option for HIV/AIDS prevention.
Advantages of Abstinence
1. Abstinence is free and does not cost any financial cost
2. Abstinence is available to everyone who wants to practice it.
3. It is effective in preventing pregnancy and HIV/AIDS related infections.
4. It has no time, space, gender, or age restrictions.
5. People who abstain may fill the gaps in their lives by building other useful relationship not dependent on sex.
6. It may boost your self esteem and make you feel good about yourself.
7. It may earn you respect and dignity in your community.
ii. Be Faithful
To be faithful means that both partners in a relationship have sex only with each other and that the relationship is long term, as in the case of marriage. Changing partners frequently, even when both are faithful during the relationship, is as risky as having many partners at the same time. Faithfulness as a preventive measure works well as long as:
Figure 5: A Picture of an Unfaithful Man Caught by another Man
• Neither partner has HIV before or during a relationship
• Neither partner is at risk from other sources of HIV infection
• Both partners are faithful to one another all the time
• There is no change in partner
It is recommended that people who use this strategy should both receive voluntary counselling and testing (VCT) and remain mutually faithful to one another after the VCT.
iii. Use a Condom
(Male Condom) A condom is a prevention devise that can be used during sexual intercourse to give both men and women protection against unwanted pregnancies and Sexually Transmitted Diseases (STDs) including HIV/AIDS. The condom serves as a bridge that stops the virus from moving from one person to the other. Before the invention of the pill, the condom was one of the most popular contraceptives. The world-wide HIV/AIDS epidemic prompted a renewed interest in the condom, because it is one of the most inexpensive and successful ways to curb the spread of HIV. By using a condom you decrease your chances of getting HIV.
Both male and female condoms are made of latex or plastic material that is won either by a male or a female before sexual intercourse. The best condoms to use for vaginal and anal intercourse are lubricated latex condoms. Although a lot of people question the effectiveness of condoms, there are several reasons to use condoms when having sex. We encourage the learner to go through these reasons with his or her partner.
Reasons to Use Condoms
You could go through these reasons with your partner and see what she or he thinks.
1. Condoms are the only contraceptive that also helps prevent the spread of sexually transmitted diseases (STDs) including HIV when used properly and consistently.
2. Condoms are one of the most reliable methods of birth control when use properly and consistently.
3. Condoms have none of the medical side-effects of some other birth control methods may have.
4. Condoms are available in various shapes, colours, flavours, textures and sizes- to increase the fun of making love with condoms.
5. Condoms are widely available in pharmacies, supermarkets and convenience stores. You don't need a prescription or have to visit a doctor.
6. Condoms make sex less messy.
7. Condoms are user friendly. With a little practice, they can also add confidence to the enjoyment of sex.
8. Condoms are only needed when you are having sex unlike some other contraceptives which require you to take/ or have them all of the time.
(Female Condom) The female condom is a polyurethane sheath or pouch about 17 cm (6.5 inches) in length. It is worn by a woman during sex. It entirely lines the vagina and it helps to prevent pregnancy and STDs including HIV.
At each end of the condom there is a flexible ring. At the closed end of the sheath, the flexible ring is inserted into the vagina to hold the female condom in place. At the other open end of the sheath, the ring stays outside the vulva at the entrance to the vagina. This ring acts as a guide during penetration and it also stops the sheath bunching up inside the vagina.
There is silicone-based lubricant on the inside of the condom, but additional lubrication can be used. The condom does not contain spermicide. The female condom has been available in Europe since 1992 and it was approved in 1993 by the US Food and Drug Administration (FDA). It is now available in many countries, at least in limited quantities, throughout the world.
Figure 6: Picture of a Female Condom
[pic]
The female condom is great for people who are allergic to latex. It also allows a woman to assume control over sex. Slipping inside the vagina, the female condom provides a lubricated barrier that is stronger than latex. It can be inserted up to eight hours prior to intercourse, providing for the spontaneity that is often lost with latex condoms. Inserting the female condom is not that difficult if the illustrated steps below are followed:
Benefits of Using Female Condoms
• Opportunity for women to share the responsibility for the condoms with their partners
• A woman can use the female condom if her partner refuses to use the male condom
• The polyurethane, the material the female condom is made of, is less likely to cause an allergic reaction than a male latex condom. It’s not clear whether latex or polyurethane condoms are stronger – there are studies suggesting that either is less likely to break. With both types, however, the likelihood of breakage is very small, if used correctly.
• The female condom will protect against most STDs and pregnancy if used correctly
• It can be inserted up to 8 hours before intercourse so it does not interfere with the moment
• The polyurethane is thin and conducts heat well so sensation is preserved
• Female condom can be used with oil-based lubricants
• No special storage requirements are needed because polyurethane is not affected by changes in temperature and dampness. The expiry date for female condoms is 5 years from the date of manufacture.
Disadvantages of Using Female Condoms
• The outer ring is visible outside the vagina, which can make some women feel self-conscious
• The female condom can make noises during intercourse. Adding more lubricant can help this problem.
• Some women find the female condom hard to insert and to remove
• It has a higher failure rate than non-barrier methods such as the pill
• It is relatively expensive and relatively limited in availability in some countries
• It is recommended that the female condom is only used once.
iv. Do it Yourself
Do it yourself is a slang for ‘Solo Masturbation’. Masturbation is the act of manually stimulating the sexual organs in order to provide pleasure.
(i) Male Masturbation – Male masturbation is the act of stimulating the penis to produce pleasure. Ejaculation is usually accompanied by orgasm, a whole body feeling that, for most people, is so powerful and pleasurable it cannot be compared to any other feeling the human body can experience.
(ii) Female Masturbation – For females, masturbation consists of rubbing the area around the vagina and/or stimulating the clitoris, which is a small organ a lot like a tiny penis. Like men, women can experience orgasm as a result of masturbation.
CLASS ACTIVITY
?
1. In small groups of not less than five, discuss the meanings of the concepts of ‘abstinence’, ‘faithfulness’, and ‘masturbation’.
2. How does your community (e.g. village, church, school, country) perceive the use of these modes of HIV prevention?
2 Prevention of Transmission by Infected Blood and Blood Products
HIV as we learned in module one can be transmitted through blood-to-blood contact. However, most countries in the world, including Botswana, now do screening on all blood and blood products for HIV by national blood transfusion services. National blood transfusion services are based on very rigorous standards such that the chances of contracting HIV from blood transfusion are very small.
It is estimated that up to 5% of all HIV infections worldwide have been acquired through transfusion of contaminated blood and blood products. This percentage is now falling due to much wider screening of blood and blood products. In Botswana all blood and blood products are screened for HIV and other transfusion transmissible infections such as syphilis and hepatitis B. Health workers also routinely wear latex gloves to prevent transmission by blood and blood products.
3 Prevention of Mother-to-Child Transmission (PMTCT)
In Botswana, it is estimated that 40% of the babies born to HIV-positive mothers will be HIV infected. Of children infected with HIV in Botswana, 10-20% acquired it in pregnancy, 40-60% acquire it during labour and 2-25% acquire it during breastfeeding.
Figure 7: A Picture of Healthy Babies whose Parents have used PMTCT
[pic]
CLASS ACTIVITY
?
1. What are the dangers of improper blood screening?
2. Why are people uncomfortable about donating blood?
3. What can be done to ensure that blood transfusion is safe?
Figure 8: A Health Officer Presenting a Workshop Paper on PMTCT
[pic]
4 Prevention of Transmission by Contaminated Needles
We know in module one that HIV can be transmitted through the use of needles or skin piercing instruments contaminated with HIV. The risk of HIV transmission can be prevented by never sharing needles or skin piercing instruments such as razor blades and shaving machines.
5 Prevention of Transmission by Post Exposure Prophylaxis
There is available evidence that if Zidovudine (ZDV) is taken within 48 hours after an occupational exposure to HIV, it can reduce the risk of transmission by 50%. This is called pose exposure prophylaxis (PEP). ZDV is now used routinely in many health facilities. In Botswana, ZDV and 3TC are provided to health care workers after exposure (Botswana Guidelines on Anti-retroviral Therapy, 2000) with the option of adding a third drug, a protease inhibitor (PI), at the health worker’s expense. It is a 24-hour service, with counselling and testing available and required.
6 Other Precautionary Measures for Prevention of HIV Transmission
In addition to the prevention methods discussed above, there are other precautionary measures that health providers and caregivers need to consider in providing help to HIV/AIDS infected persons. These measures are known as universal precautions.
Universal Precautions
1. Gloves should be worn for any contact with (i) Body fluids; (ii) Cutaneous or mucosal lesions; (iii) Contaminated, or potentially contaminated material.
2. Wash hands immediately after any contact with potentially infective fluids after every health care procedure.
3. All wounds should be covered
4. Wear protective clothing (masks, goggles & aprons) when there is a risk of blood splashing
5. Care when handling potentially infected sharp objects including: (i) Needles should never be bent back or put back in their original holder; (ii) Needles should not be removed by hand from syringes; (iii) Needles and other sharp objects should be disposed of immediately in a special, puncture proof, sealed container (sharps box)
6. Disinfecting all surfaces and instruments soiled with blood or other bodily fluids immediately with a flesh 1:10 bleach solution or other effective disinfectant.
7. Disposal of contaminated materials in distinctively labelled and sealed packaging and then incinerated.
8. Laboratory settings - The above precautions should take place systematically for all samples. Samples should be transported in sealed tubes or flasks, inside sealed packaging. Mouth pipetting is forbidden.
2 The benefits of voluntary counselling and testing
Voluntary counselling and testing (VCT) is very important as an entry point to HIV care and prevention. As shown in the diagram below, voluntary counselling and HIV testing is very important especially for people who have a positive HIV test. Although initially it is emotionally painful and may be even shocking to learn of HIV positive status, there are practical things people can accomplish once they have tested positive.
1. Firstly, people can plan for their family’s future by writing a will and assigning people to care for their children who may have one or both parents affected.
2. Secondly, access to ARV is only possible for those that have tested.
3. Thirdly, pregnant women can enrol in the PMTCT programme and stop mother-to-child transmission of HIV.
1 Voluntary Counselling and Testing In Botswana
Voluntary HIV counselling and testing (VCT) plays a key part in HIV-related prevention and care. It is particularly important as a starting point for the access of other HIV/AIDS-related services. Since 2000, the government of Botswana and the CDC have supported the Tebelopele network of VCT centres. The Tebelopele centres provide immediate, quality, accessible and confidential VCT services for sexually active Batswana aged 18-49. By October 2003, over 65,000 Batswana had used the Tebelopele centres.
From the beginning of 2004, HIV tests are given as a routine part of checkups in public and private clinics in Botswana. The testing is part of the routine but people who do not want to be tested can opt out. Botswana is the first country in Africa to have a national policy of routinely offering HIV test, on a voluntary basis.
Health Officials believe that routine testing is the best way to rapidly improve the existing treatment programmes and to decrease the burdens on hospitals by treating people with HIV or AIDS at earlier stages and to give them a new prevention tool. There is still a lot of stigma attached to sexually transmitted diseases including HIV/AIDS and people are afraid to get tested for HIV infection. The government officials see routine testing as one way of removing stigma by making testing routine.
2 The Benefits of Voluntary Counselling and Testing
Figure 9: Benefits of voluntary counselling and HIV Testing
Source: UNAIDS (2000) fact sheets on HIV/AIDS for nurses and midwives in Botswana p. 7-9 World Health Organization.
IT IS VERY IMPORTANT TO TEST AS EARLY AS POSSIBLE SO THAT
• Nobody feels forced to test. People must exercise their freedom to test or not to test.
• HIV/AIDS infected can receive treatment while the body immunity is not too low.
• Any sign of opportunistic infections can be controlled.
• To improve length and quality of life.
• To get advise as how to deal positively with HIV.
• It is good to know one’s status and avoid spreading the virus and re-infection.
3 Post-Diagnostic Reactions to Counselling and Testing
As described above, there are many benefits of voluntary testing. However, some people do not want to go for HIV testing until they are very desperate or too sick to resist any form of treatment or suggestion. Such people need to be counselled to accept testing, especially if they have some infections often identified with HIV/AIDS. Despite the
Figure 10: A picture of a man after HIV/AIDS Counselling Session
[pic]
many benefits of VCT, some people may not want to go for voluntary testing for several reasons:
• They fear to know that they have HIV/AIDS which has no cure.
• They are afraid of stigma and discrimination. They may be exposed to discrimination once they have a positive HIV test.
• They are afraid they will eventually get sick and die of HIV opportunistic infections.
• They fear isolation related to cultural, emotional, and religious issues imposed by communities in which they live.
CLASS ACTIVITY
?
• Of all the fears that people may have about voluntary testing, which ones are the most important to (a) you as an individual? (b) family members? (c) your friends? (d) your community?
• List your fears about HIV/AIDS infection.
• Why do you and the people you know fear to go for voluntary counselling and testing?
• What can you recommend to promote voluntary counselling and testing?
• What are the benefits of voluntary counselling and testing?
4 Factors that compromise HIV prevention
i. Social Factors
1. Sexual practices – Multiple partners, sex with old men (Sugar Daddies) and old women (Sugar Mommies), coercive sex.
2. Gender inequalities – The unequal power relationship between men and women in African societies with men having more power to make reproductive health decisions makes the women more vulnerable to contracting HIV infection than men.
3. Mobility – Truck drivers, tourists, transfers, etc.
4. Family set-up – Having same family divided and located in multiple places (e.g. farm lands, cattle post, village, and town).
5. Peer pressure – Pressure from peers could become an important source of influence for engaging in risky sexual behaviours.
6. Breakdown of the traditional family – The disintegration of the traditional extended family which was a source of protection and discipline for all family members has put our society at risk and vulnerable to contracting STDs including HIV/AIDS.
7. Alcohol and substance abuse – Alcohol abuse is recognized as a major problem in Botswana. Research in Botswana has shown that there is an important link between alcohol and HIV/AIDS that contributes to the spread HIV. The use of alcohol and drugs impairs people’s ability to make sound judgment. It also reduces inhibition and increases the chance of engaging in casual sex with partners whose HIV status is unknown.
8. Stigma – Although a lot of anti stigma campaigns are still going on, a lot more still needs to be done to show that HIV infected can live a normal and healthy lifestyle by protecting themselves and their loved ones from infection and re-infection.
9. Discrimination – HIV infected persons were not until recently in Botswana viewed with contempt and as a disgrace to families. They were presumed to be isolated from the rest of society because:
a. They could spread the virus by shaking hands, kissing, hugging and other misconceived means.
b. HIV is an incurable infection and people have to avoid any form of association with it and those already infected.
ii. Cultural and Religious Factors
1. Cultural norms and values – Culture and tradition influence how people interpret, explain and respond to HIV infection and AIDS. The health provider and care giver needs to understand and respect the cultural definitions and roles of different players in relationships.
2. Traditional and religious beliefs – Traditional and religious beliefs may directly or indirectly facilitate HIV transmission.
Commonly held Traditional Beliefs in African Cultures
1. Male supremacy and domination require men to take initiative in sexual practices and do not allow men to be questioned about promiscuity.
2. Cleansing rituals involve men having sex with virgins to cleanse their blood.
3. Traditional beliefs associated with witchcraft prescribe engaging in sexual relations.
4. Belief that uterine illness is healed by conceptions.
5. Expectation to have many children and the belief that if one has only one child, he/she should have more children.
6. Sexual relations as necessary to strengthen the baby’s back during pregnancy.
7. Separation of the couple after the birth of the baby can lead to extramarital affairs.
8. Cleansing of the vagina with herbs and solutions.
9. Stigma/rejection of HIV-positive people by the community.
10. Negative attitudes towards formula feeding.
11. Pregnancy viewed as a sickness and a sensitive time. Belief that a woman should not be told bad news during pregnancy, possible discouraging HIV testing.
Commonly held Religious Beliefs
1. Some churches (ZCC, IPC, Catholic) belief it is against the will of God to prevent pregnancy and thus oppose the use of contraceptives, including condoms.
2. Some churches are against taking any form of medical treatment including antiretroviral drugs. They only believe in spiritual or divine healing.
3. Some Christians believe that if God permitted them to get a disease they will have a way to conquer the disease somehow.
4. Perceptions of some religious groups towards the use of modern medicine, especially during pregnancy, prevent treatment.
5. Some believe elder men are instructed by God in their dreams to have sex with younger girls.
iii. Economic Factors
1. Commercial sex workers – Commercial sex workers deal with multiple sex partners whose HIV status is unknown to them. In Botswana, it has been found that commercial sex workers who charge higher rates consent to sex without a condom. Such behaviours are risky for both the seller and buyer of sex.
2. Poverty – As with most other groups, the poor can be segmented into multiple classifications. Yet as with orphans and women, this group is characterized by multiple vulnerabilities that are influenced or controlled by others. Poor people are more likely to engage in risky sex behaviours such as prostitution as a way of survival. Poor eating habits and the lack of access to adequate medical facilities reduces the period that poor people can live with HIV infection.
3 SUMMARY
In this unit, we have examined the key issues of preventing HIV infection. The prevention methods are based on the transmission modes. Common prevention modes associated with sexual transmission are abstinence, being faithful to one partner, use of a condom, and do it your self (masturbation). These four prevention modes are normally known as ABCD. Each of these transmission modes has its own advantages and disadvantages.
It must be noted that safer sex only reduces the risk of infection, but does not eliminate it. Safer sex is not only a personal issue for one partner. Safer sex should be a mutual agreement by both parties to make sex more enjoyable and interesting. Safer sex also entails deciding when and how sex should take place. Sex should only happen when both parties agree to it. However, implementing a safer sex intervention within a country where you find a predominantly patriarchal society is not easy. The low status of women makes it difficult for them to protect themselves.
Voluntary counselling and testing is a very important entry point to HIV prevention. Although emotionally painful and shocking, people who go for VCT can accomplish a number of practical things. These include planning for their family’s future, access to ARV, enrolling in PMTCT programme in the case of pregnant women, early cure of opportunistic infections, accepting and coping with HIV status, and behaviour change.
Despite the efforts to prevent HIV transmission, the success rate in Botswana has not been encouraging. This is because of a number of social, cultural, and economic factors that compromise prevention methods.
CLASS ACTIVITY
?
• Where is Botswana can you go for voluntary confidential counselling and testing for HIV?
• What are some of the traditional and religious beliefs that influence the prevention and spread of HIV infections in your community?
4 GLOSSARY
Abstinence: Staying away from sex or staying without sexual intercourse.
Counselling: Confidential dialogue between a person and a care provider aimed at enabling the person to cope with stress and make personal decisions related to HIV/AIDS.
2 UNIT TWO: AVAILABLE CARE AND SUPPORT
OVERVIEW
In this unit, you will learn about available care and support systems in place for PLWHAs. Support systems range from global, regional, national, to village and household levels. The government of Botswana, non-governmental organizations and the private sector has joined hands since the beginning of the HIV/AIDS pandemic, to provide support and care by pooling together global, regional and national resources to wage a war against HIV/AIDS. To live a good quality of life with HIV involves a network of support systems for people to find a sense of purpose in life. Without effective support systems, HIV positive people would have very complicated and short lives.
OBJECTIVES
At the end of this unit, you must be able to:
• Explain the concept of positive living of HIV infected and affected persons
• Know how you can deal with the HIV/AIDS affected and infected in your family and community.
• Describe the support systems for PLWHAs.
• Development of a sense of hope that PLWHAs are not alone.
• Evaluate the effectiveness of support systems you or members of your community are familiar with.
TOPICS
1. Meaning of positive living
2. Dealing with HIV/AIDS infected and affected persons
3. Names and locations of HIV support groups and centres in Botswana
4. Nature of assistance offered by HIV support groups and centres
5. National and local sources of information about HIV/AIDS
6. Educational programmes on HIV/AIDS
1 Meaning of Positive Living
Acceptance and hope are important in helping persons live positively with HIV and
AIDS. But first, let us understand what living positively means.
LIVING POSITIVELY MEANS
Positive living means developing mechanisms that enable a person to live a healthy, normal and productive life with HIV infection. People with HIV infection can help themselves live longer by observing the following:
• Treat symptoms and infections as soon as possible to prevent further damage to the system and delay progressing to AIDS.
• Eat a balanced diet, and avoiding too much alcohol and tobacco, and getting enough rest and exercise. All of these things are know to support the body’s immune system.
• Adopt safer sex practices to avoid introducing more HIV into the body (re-infection), as well as other STDs that will damage the immune system even further.
• Adopting a positive attitude towards one’s HIV status and learning to live with HIV/AIDS.
• Reduction of fear, stigma and discrimination of oneself
• Try to avoid stress as much as possible because stress depresses the body immune system. Otherwise stay emotionally and physically healthy
• Making other choices in your life that are good for your health
• Making the best of your life as a person with HIV and AIDS
• Living as normally as possible by participating in community and family events. Continue doing those things like sports and going out with friends that you usually did before the HIV infection.
• To be productive, take medication as prescribed by your medical practitioner
• Looking after your spiritual and mental health
CLASS ACTIVITY
?
• In a small group, identify and discuss some life choices people normally make on every day basis.
• What does living a normal life mean?
• What activities would you recommend for a HIV and AIDS infected person in order for her to make the best of his or her life?
Living positively with HIV and AIDS like normal life is not done in isolation but in community with others. Consequently, the success of positive living is a function of a number of factors including the support from family members, friends, and neighbours.
The Family – The family has roles and responsibilities o play in he health and well being of all family members including those with HIV and AIDS.
IMPORTANCE OF THE FAMILY TO HIV/AIDS INFECTED PERSONS
FAMILY MEMBERS CAN:
• Provide shelter which is a sign of love and acceptance for HIV/AIDS infected persons.
• Help HIV/AIDS infected persons to rest by doing the household chores for them.
• Purchase and cook nutritious foods for HIV/AIDS infected persons.
• Help to dispel their fear by making them feel loved.
• Encourage and counsel HIV/AIDS infected persons.
• Help them dispel the stigma and discrimination associated with HIV/AIDS by looking after them and making them feel they are not alone.
• Encourage them to go for required checkups, and where necessary, take medicines and diet as prescribed so that they can avoid opportunistic infections.
Friends – For people infected and affected by HIV and AIDS, friends:
• Can be source of support and kindness.
• Friends can help infected and affected people cope.
• They can give moral support.
Neighbours – Neighbours can help a family that is affected by AIDS. Clubs, youth and religious groups, as well as local political and social organizations can also help in:
• collecting water
• going shopping
• cooking food
• care for the children
• help in the garden
• clean the compound and
• wash clothes.
As neighbours, we can spend time with the family affected by HIV/AIDS and our concern will help them to feel that they are still part and parcel of the community.
CLASS ACTIVITY
?
1. What specific tasks would you perform for people with HIV/AIDS to live positively?
2. How can you tell that someone is living positively with HIV/AIDS?
3. What words of encouragement would you give to people living with HIV/AIDS
EXAMPLES OF LIVING POSITIVELY
There are several examples of Batswana who are living positively with HIV. According to the director of BONEPWA who is living with HIV (ACHAP, Nd. Pg. 65), “more people are finding that their lives are changing because they are moving away from thinking of death. They are thinking of improving themselves” (Watson pg.65).
The founding member of Thari ya basadi is also living positively with Aids. She said
“I do not live my life thinking I am HIV positive. I just try to think positive to live positively. Everything begins with you, even if you find you are HIV positive, work hard to live positively and have a better life”.
Both the director of BONEPWA and Thari ya Basadi, suffered stigma and discrimination, through family and friends. They have accepted their status and now live a much better life than before. Like other people, the HIV infected need love and support. According to the UB newsletter. Mr. Phil Wilson, a U.S citizen has more than two decades living positively with HIV/AIDS. Addressing UB students on February 16, the now 48 years old Wilson said he contacted the virus when he was only 23 years old. He said he has been with HIV for 25 years. “I managed to survive all those trying times by eating and living responsibly, and even my doctor did not believe that I will live up to this age. I am seeing my doctor every three months so that they can run some tests to count my viral load and tell members” (pg. 5).
As described above positive living is possible for HIV/AIDS sufferers not only in Botswana , but around the world. Positively living with the virus has been facilitated through effective counselling and support groups within Botswana. The natural process of NACA collaborating with ACHAP to support the nations support to the AIDS epidemic adopted a multi choral response and a consensus building process. NACA team visited various parts of the country to listen to DMSACS throughout the country to identify key issues and challenges in the war against HIV/AIDS.
As of January 2004 routine HIV/AIDS testing was introduced in all government health clinics and hospitals. This was another effect to encourage people to live positively with HIV and take advantage of the ARV programme to live positively with AIDS. Let us pause here a think about barriers to positive living.
2 Dealing with HIV and AIDS infected and affected persons
There are different ways of dealing with people infected and affected with HIV/AIDS. Among the most commonly practiced ways are the need to protect the privacy of HIV/AIDS information, positive living, the need to get proper counselling from national and local groups, medical and nutritional support. All of these different ways are equally important and can improve the life of the infected and affected in many ways. We will now learn about different ways in a more detail.
4 Names and locations of HIV support groups and centres in Botswana
Table 5: Locations of HIV Support Groups and Centres in Botswana
|NAME OF SUPPORT GROUP |PHYSICAL LOCATION & CONTACT |
|Botswana Council of Non-Governmental Organisation |Plot 508 Gaborone |
|(BOCONGO) |Private Bag 00418 Gaborone, Botswana |
| |Tel/Fax: (267) 3911319 |
|Botswana Christian AIDS Intervention Programme |Plot 13219, White City |
|(BOCAIP) |P. O. Box 601963 Gaborone, Botswana |
| |Tel: (267) 316454 |
|Botswana National Youth Council (BNYC) |Plot 3178 Extension 12 |
| |Private Bag BO 108 Bontleng, Gaborone, |
| |Botswana. |
| |Tel: (267) 313907; Fax: (267) 580898 |
| |Email: bnyc@info.bw |
|Botswana Family Welfare Association (BOFWA) |Phala Crescent |
| |Private Bag 00100, Gaborone, Botswana |
| |Tel: (267) 301222 |
| |Email: bofwa@info.bw |
|Botswana Network of AIDS Service Organisations |Plot 5281, The Village, Gaborone |
|(BONASO) |Private Bag 3129 Gaborone, Botswana |
| |Tel: (267) 570582; Fax: (267) 302033 |
|Botswana Network of Ethics, Law and Human Rights |C/O Ditshwarelo |
|(BONELA) |Plot 2732, Hospital Way |
| |Private Bag 00416, Gaborone, Botswana |
| |Tel: (267) 306998; Fax: (267) 307778 |
|Botswana Network of People With AIDS (BONEPLA) |Plot 5306, The Village, Gaborone |
| |P. O. Box 1599 Mogoditshane, Botswana |
| |Tel: (267) 3906224 |
|Counselling Centre for People With AIDS (COCEPWA) |P. O. Box 906 Gaborone, Botswana |
| |Tel: (267)584158 |
|Dingaka Medical Association of Botswana |P. O. Box 906 Gaborone, Botswana |
|Gepamere Dingaka Society |P. O. Box 1141 Gaborone, Botswana |
|Nurses Association of Botswana |Plot 2684 Phiri Crescent |
| |P. O. Box 126 Gaborone, Botswana |
| |Tel/Fax: (267) 353840 |
|Population Service International |Private Bag 00465 Gaborone, Botswana |
|(PSI) |Tel: (267) 585029; Fax: (267) 585 029 |
|Society of Men Against AIDS in Botswana (SMAABO) |P. O. Box 403645 Gaborone, Botswana |
| |Tel: (267) 312555; Fax: (267) 352608 |
|Society of Women Against AIDS in Botswana (SWAABO) |Private Bag 00452 Gaborone, Botswana |
| |Tel: (267) 355031 |
|Tebelopele Voluntary Counselling ad Testing Centre |Plot 645 Kutlwano Close Gaborone, Botswana |
|Gaborone |Tel: (267) 314023; Fax: (267) 570487 |
|Tebelopele Voluntary Counselling ad Testing Centre |Tel: (267) 216263; |
|Francistown |Fax: (267) 218200 |
|Tebelopele Voluntary Counselling ad Testing Centre |Tel:/Fax: (267)665043 |
|Maun | |
|Tebelopele Voluntary Counselling ad Testing Centre |Tel/Fax: (267) 810536 |
|Selibe-Phikwe | |
|Tebelopele Voluntary Counselling ad Testing Centre |Tel/Fax: 267) 381281 |
|Jwaneng |Fax: (267) 381293 |
|Tebelopele Voluntary Counselling ad Testing Centre |Tel: (267) 650488 |
|Kasene |Fax: (267) 650532 |
|Young Women’s Christian Association (YWCA) |Plot 1015 Boipelego Close |
| |P. O. Box 359 Gaborone, Botswana |
| |Tel: (267) 353681/357783 |
| |Fax: (267) 374113 |
5 Nature of assistance offered by HIV support groups and centres
Support groups play the following roles and responsibilities in the fight against HIV/AIDS. Support groups function at three levels, namely, Non-Governmental Organisations (NGOs), Community Based Organisations (CBOs) and Faith Based Organisations (FBO).
1 Non-Governmental Organisations (e.g. BOCAIP, BONELA, BONEPWA, BONASO)
• They for a core of implementing expertise at all levels of society.
• Undertake action-oriented HIV/AIDS research.
• Perform a ‘watchdog’ role, ensuring appropriate design and implementation of HIV/AIDS programmes.
• Work closely with other implementing partners and coordinating bodies based on mandate and areas of comparative advantage.
• Undertake advocacy and lobbying activities in support of prevention, care, support, and mitigation initiatives.
• Assist in the design and implementation of workplace interventions.
• Provide counselling, care and support to those infected or affected.
• Assist with scaling up HIV/AIDS interventions and conceptualizing new and innovative strategies.
• Assist with the evaluation of programmes and policies.
2 Community-Based Organisations
• Expand implementation and involvement in the response to the community level.
• Advocate for more volunteerism among communities and community members.
• Assist local communities to mobilize human, financial and material resources to support the fight against HIV/AIDS.
• Provide Implementation expertise at the community level.
• Work closely with District Multi-Sectoral AIDS Committees (DMSACs).
3 Faith-Based Organisation
• Provide community leadership and guidance.
• Mobilise resources for HIV/AIDS interventions.
• Undertake advocacy initiatives.
• Provide counselling, care and support to orphans and PLWHAs.
• Work closely with DMSACs.
• Promote abstinence amongst the youth and delaying sexual debut.
6 National and local sources of information about HIV and AIDS
1 National and local Sources of Information
Dissemination of information is very important for people living with HIV to have a knowledge base that they can use to live positively with the virus and make informed choices. Access to information can be used to know what to do about one’s status, and take all the necessary precautions for a healthy and long living.
NATIONAL AND LOCAL COUNSELLING GROUPS
Names Contact address Type of assistance
National Aids council Gaborone Coordination
NACA Gaborone Training/coordination
BONASO Gaborone Coordination/Collaboration
Tebelopele Gaborone Testing and Counselling
COCEPWA Gaborone Counselling
CEYOHO Gaborone Counselling Youth
Matlo go sa mabap Old Naledi Counselling
Kweneng Network of PLEA Molepolole. Counselling/Fundraising
Scenario
Boipelo is sick with diarrhoea. She tells her friend, Thato that she has had diarrhoea for ten weeks. Thato advises her to go and see her family doctor Ramasasane. Ramasasane recommended that Boipelo must go for an HIV test.
Boipelo is not sure how she will react to an HIV test result. However, she went to Tebelopele for testing. At the beginning she is counselled about HIV/AIDS transmission, prevention and management. Tebelopele happened to be a testing centre closest to Boipelo’s home.
CLASS ACTIVITY
?
1. What do you understand by a pre -test counselling?
2. What is the importance of pre-test counselling?
3. If you were sick and really had to go for HIV counselling and testing, where would you go? Why?
4. Of all five centres you have mentioned above, which ones have you heard about?
RANGE OF COUNSELLING SERVICES
□ HIV prevention
□ STD prevention
□ Clinical care
□ Voluntary counselling and testing
□ Prevention of mother to child transmission
□ Isoniazid TB prevention therapy (IPT)
□ People living with AIDS (PLWAS)
□ Orphans
□ Home based care
□ Reproduction health
□ Alcohol and drug abuse
□ Counselling for victims of abused
Source: UNAIDS facts sheet 7-9 (2000) WHO
Pre-test counselling in various situations can be done as individuals, couples, and mother and child counselling. An important step is to first find out participant’s knowledge about pre-test counselling. Similarly it is important to know about post-test counselling. Botswana has a wide range of counselling services. The list below will help you know a range of counselling services.
Although there are many counselling services the focus here is all counselling that deals with HIV. Any topic that deals directly with HIV is a focus of the range of counselling service listed above. The support and counselling groups are responsible for encouragement and sponsorship The care and support offered is combined with drugs to suppress HIV/AIDS.
• Pre-test counselling is done at the beginning to give people information about HIV/AIDS and prepare them psychologically for the test. Posttest counselling is done after the test before giving the test result.
• Ongoing / supportive counselling is done continuously to give them hope, and support
• Referrals are made for cases that counselling centres can not handle on their own, for instance if a client develops opportunist infections, they can be referred to a medical doctor. If they are depressed and or suicidal they can be referred to a psychiatrist. Counselors make follow ups through home visits to ensure that their clients are stable.
• Counselling, church and groups of PLWAS are responsible for encouragement and can solicit sponsorship for PLWAS. Counselling also combines care and support drugs to support HIV/AIDS. The advertisement “Re Mmogo” meaning we are together, gives a sense of hope that people affected and infected are never alone. There is a network of counsellors, medical personnel, nutritionist and other caregivers. COCEPWA, BONEPWA, CEYOYO and other networks are important for counselling and support for PLWAS.
CLASS ACTIVITY
?
1. What are the barriers to testing?
2. Which ones affect you as an individual?
3. What can be done to remove each of the barriers mentioned above?
4. In addition to the barriers that we have learned about make a comprehensive list of barriers to HIV testing.
As a way of encouraging the public to go for HIV testing, Botswana’s President and the then minister for Health Mrs Joy Phumaphi went for voluntary counselling and testing. The two announced their HIV results to the nation. Fortunately the results were negative.
An important point is that if they had tested positive, they would have opened doors for them to receive care and support from existing programs for HIV. Unless testing is done, people cannot receive any medical support.
2 International Sources of Information and Educational Programmes
|The impact of HIV & AIDS in Africa |aidsimpact.htm |
|Getting HIV & AIDS antiretroviral drugs for Africa |aidsdrugsafrica.htm |
|Who is getting AIDS drugs |aidstarget.htm |
|HIV & AIDS treatment and care in resource poor countries |hivcare.htm |
|HIV related opportunistic infections: prevention, treatment and care in|aidscare.htm |
|resource poor countries | |
|HIV & AIDS in Botswana |aidsbotswana.htm |
|HIV & AIDS in South Africa |aidssouthafrica.htm |
|HIV & AIDS in Uganda |aidsuganda.htm |
|AIDS orphans in Africa |aidsorphans.htm |
|AIDS at the Workplace | |
|HIV & AIDS in North Africa |aidsmiddleeast.htm |
|ILO |public/english/ html …… |
|Sub-Saharan Africa HIV & AIDS statistics |subaadults.htm |
7 Educational Programmes on HIV and AIDS in Botswana
There are a number of different educational programs currently taking place in Botswana. These include:
• Public education & awareness
• Education for young people
• Condom distribution & education
• Prevention of mother to child transmission (MTCT)
• Voluntary Counselling and Testing
• Antiretroviral Therapy Programme (MASA)
• Education and Training Health Workers
• Antiretroviral Support and Education
• Botswana Harvard Partnership
• Private Sector.
1 Public Education and Awareness
Public awareness and education has previously been based on the "ABC" of AIDS (Abstain, Be faithful, use a Condom). Botswana has safe-sex billboards and posters everywhere. Because it is unclear whether anyone pays attention to HIV messages, the aim now is to target the right message to the right people. One recent initiative has been the development of more than 100 episodes of a radio drama, Makgabaneng, dealing with culturally specific HIV/AIDS-related issues and encouraging changes in sexual behaviour. Another initiative has involved workplace peer counselling, including the development, piloting and distribution of a facilitator's manual.
2 Education for Young People
To provide young people with HIV/AIDS prevention and education is crucial. Prevention efforts in Botswana have included supporting the Youth Health Organisation (YOHO). YOHO is a youth-run non-governmental organisation (NGO) that aims to provide other young people with sex education. HIV/AIDS-related education at school plays one of the most important parts in educating young people about HIV and AIDS, and Botswana-specific HIV/AIDS materials have been developed for students with the Ministry of Education.
A teacher-capacity building programme has been developed jointly by the Ministry of Education of Botswana and the United Nations Development Programme (UNDP), in collaboration with the government of Brazil and with support from ACHAP. The programme is trying to improve the teachers' knowledge, demystify and destigmatise HIV/AIDS and break down cultural beliefs about sex and sexuality. It is hoped that this will promote free and informative discussions about HIV prevention, living with HIV/AIDS and caring for adults and children with, or directly affected by HIV/AIDS.
3 Condom Distribution and Education
There has been successful social marketing of condoms in Botswana, and this has included a launch of both male and female condoms and making condoms a commonly available product. One of Botswana's key marketing strategies of condoms has been peer education, with peer education being conducted in a variety of creative settings such as in schools, at fairs and festivals, shopping malls, workplaces and bars.
Targeting of Highly Mobile Populations
USAID, the African Youth Alliance, Botswana National AIDS Service Organisation (BONASO) and NACA, seven ministries, the defence force, the police force, the university of Botswana, the U.S Centre for Disease Control (CDC) and ACHAP are initiating a prevention programme that will be linked to the Corridors of Hope project. The Corridors of Hope is also implemented in other Southern African countries. The programme will target all highly mobile populations countrywide. Intervention activities will concentrate on the treatment of STI's, condom promotion and prevention education. One of the key focuses will be on safe sex practises through peer education and outreach activities.
4 Prevention of Mother to Child Transmission of HIV (PMTCT)
The overall HIV prevalence among pregnant women in Botswana was 35.4% in 2002 as compared to 36.2% in 2001 and 38.5% in 2000. Generally prevalence in rural areas was higher than in urban areas. The CDC has collaborated with the Government of Botswana, in developing educational materials, training counsellors and provided technical assistance and support for the MTCT programmes.
A MTCT programme was the first program to distribute antiretroviral drugs in Botswana, with the drug Zidovudine (AZT) being provided free by the company GlaxoSmithKline. But the enrolment of women in MTCT programmes has been disappointingly low, in the range 11-20%. This low enrolment rate has been blamed on the shortage of staff and on the need for improved infrastructure.
To rectify this many additional PMTCT counsellors are now being trained.
The status of women in relation to men can create further problems. Many women lack the power to control decisions about sexuality and remain under the authority of their husbands, parents and in-laws all their lives. There can also be further difficulties when women return to their communities with formula milk for their baby, as formula feeding can stigmatise and identify the woman as HIV-positive.
It has been reported that the number of women enrolling in PMTCT programmes in 2003 increased. It is hoped that the wider availability of antiretroviral therapy for women and their babies will now increase the numbers of women taking part of the programmes even further.
5 Voluntary Counselling and Testing
Voluntary HIV counselling and testing (VCT) plays a key part in HIV-related prevention and care. It is particularly important as a starting point for the access of other HIV/AIDS-related services.
[pic]
Since 2000, the government of Botswana and the CDC have supported the Tebelopele network of VCT centres. The Tebelopele centres provide immediate, quality, accessible and confidential VCT services for sexually active Batswana aged 18-49. By October 2003, over 65,000 Batswana had used the Tebelopele centres.24
The centres have been supported by the "Know Your Status' campaign. The' Know Your Status' campaign is a part of the VCT marketing strategy developed by the CDC in collaboration with Population Services International (PSI). The campaign has also been marketed through billboards, bus stops, banners, print advertisements and regular radio programs throughout Botswana.
Also, ACHAP in partnership with the Botswana Christian AIDS Intervention Programme (BOCAIP) is establishing additional counselling and testing centres throughout Botswana. The centres have reached over 70,000 attendants in their community mobilization and outreach activities and the centres have trained over 400 counsellors.
From the beginning of 2004, HIV tests are given as a routine part of checkups in public and private clinics in Botswana. The testing is part of the routine but people who do not want to be tested can opt out. Botswana is the first country in Africa to have a national policy of routinely offering HIV test, on a voluntary basis.
Health Officials believe that routine testing is the best way to rapidly improve the existing treatment programmes and to decrease the burdens on hospitals by treating people with HIV or AIDS at earlier stages and to give them a new prevention tool.
There is still a lot of stigma attached to sexually transmitted diseases and people are afraid to get tested for HIV. The government officials see routine testing as one way of removing stigma by making testing routine.
6 Antiretroviral Therapy Programme MASA
In March 2001, President Festus Mogae announced that the Botswana government would provide antiretroviral medication for all those who needed it, before the year end. The government was conducting a "needs assessment", and would pay a "substantial" portion of the program's costs. It was hoped that the program would be operational by the end of the year.
By January 2002 the aim was to provide medication during 2002 for 19,000 of the 110,000 infected people who it was considered could benefit from therapy. As a result of poor resources - laboratory capacity, human resources and poor infrastructure, it was decided to initially target certain population groups. These included people suffering from TB, mothers, babies and their spouses, as well as patients with a CD4 count of less than 200, and/or AIDS defining illnesses.
The National Antiretroviral Therapy Programme was given the name MASA, the Setswana word for 'new dawn', and the first antiretroviral drugs were provided in Gaborone in January 2002. ACHAP is one of the partners in the program providing both financial and technical assistance. By the time of the start of MASA, there were already warnings about the financial sustainability of the program. It was estimated that the program would cost US$24.5 million in 2002 to include 19,000 people, and then an additional 20,000 people would be admitted each year.
By June 2002, an estimated 1,000 people had been enrolled. Although the numbers were disappointingly small, the indications were that few people were having difficulty adhering to the complex antiretroviral regime. It had been a major concern that the poorly educated people would struggle to understand the importance of taking the complex cocktail of drugs on time and the fact that the treatment is for rest of their life. To help to cope with their adherence, NACA has come up with a support system. The 'buddy system' operates in such a way that each patient is encouraged to form a special bond with someone close, who then makes sure that the patient follows their medication schedule. The patients in turn, counsel others who feel they may need help, to come forward.
By September 2002, the numbers had increased to 2,200 enrolled of whom 1,500 were on treatment. It had become clear that enrolling people was a lengthy process. It involved counselling at testing centres, screening blood once a person knew their status, taking a white blood cell count and then eventually enrolling in the programme. The introduction of antiretroviral therapy had required the broadening of the infrastructure including testing centres, storage facilities, equipping existing clinics and hospitals and training medical personnel. But the shortage of trained staff was acute and:
By January 2003 there were about 3,200 people enrolled on MASA and it was becoming clearer not only what had been achieved but also how much more needed to be done. It was estimated in May 2004, that more than 24,000 people had been enrolled on MASA, 14,000 of these people were receiving antiretroviral treatment.41 The Princess Marina Hospital in the capital Gaborone, is currently the largest single provider of ARV therapy in Africa, with over 4,500 patients receiving antiretrovirals. UNAIDS/WHO estimate that between 36,000 and 39,000 people were receiving ARV treatment at the end of 2004, including those using the private sector. This represents 50% of the estimated 75,000 in need.
7 Education and Training of Health Care Workers
As has already been mentioned above, there is an acute shortage of health care workers in Botswana, and this is having a significant affect on programs such as MASA. Many skilled professionals have been hired away from the public health system with offers of better pay and benefits, also some are leaving for other countries.44 The problem is compounded by the fact that over 90% of the doctors are foreign and do not speak Setswana, the local language. Another problem faced when recruiting health care staff from abroad is that it takes time for them to become familiar with the local culture.
There are a number of initiatives taking place to overcome this problem. To ease of the shortage of trained staff, NACA is developing a system of lay counsellors to ease the workload of some of the nurses. It has also been suggested that government should recruit traditional healers as partners in the antiretroviral program, for example, encouraging patients to enter the program and take their drugs properly. The Botswana-Harvard AIDS Institute Partnership has implemented a training program for health professionals in Botswana. And the KITSO AIDS Training Program aims to provide training in HIV and AIDS care including cultural aspects.47
8 Antiretroviral Support and Education
At the beginning of 2003 a series of HIV/AIDS related educational videos were released. The Patient Education videos are a collection of videos designed to educate people about the impact of HIV/AIDS and antiretroviral therapy on their lives. They include people from Botswana telling their story in their own language. The videos focus on the importance of knowing your status, the need to always use a condom when having sex, the hope that ARV therapy offers and the responsibility to adhere to the therapy regimen for the rest of person's life. The videos are being played in patient waiting areas and are also being used in health education talks in up to 120 hospitals and clinics.48 It has been reported that patients in the MASA programme have 90% to 100% drug regimen adherence rates (- as much as 20% higher than in most successful programmes in Western countries.) This success has been attributed to the intense counselling given to patients and the effectiveness of the drugs.49
9 Botswana-Harvard Partnership
On a global scale, the Botswana-Harvard Partnership for HIV research and education stands as a living example of commitment to halt the disease. Components of the partnership include the following:-
• Molecular characterization of HIV-1C. More than 50 viruses have been isolated and decoded. More information is known about the HIV – 1C in Botswana than about any other HIV subtype in any other country.
• HIV Vaccine Initiative. In the quest for a cure to HIV/AIDS, different drug companies have developed and tested several vaccines and Botswana is part of this global initiative. CTL Response and HLA Class 1 Antigens is related to efforts to find a vaccine for HIV/AIDS.
• PMTCT. Prevention of mother to Child Transmission of HIV/AIDs is one way of promoting chances of child survival even if the mother is infected with HIV/AIDS. PMTCT targets prevention of mother to child transmission of HIV/AIDS by administering AZT to HIV infected pregnant women. Generic Analysis of HIV – 1C in infants helps in the prevention of mother to child transmission. The infant health outcome study was the brainchild of the program to explore feeding patterns to ensure that breastfeeding is replaced by artificial methods of feeding to protect the child from contracting HIV from the mother through unsafe breastfeeding.
• KITSO- Knowledge, Innovation and Training Shall Overcome AIDS”. It is an educational program that trains Botswana care givers on HIV/AIDS.
10 Private Sector
According to the Midweek sun, DEBSWANA became the first private sector company to give anti-retroviral therapy to its employees and their spouses through the Infectititious Disease Care Clinic (IDCC) and Pharmacy unit early 2005. Jwaneng clinic enrolled 1,300 people since December 2004, it moved to a new building and is supposed by 4 satellite clinics in Khakhea, Mabutsane, Maokane and jwaneng Town Council serving the whole Jwaneng area.
9 SUMMARY
In this unit, you have learned about available care and support for HIV infected and affected persons. In learning about care and support, you discussed the meaning of positive living and how to deal with HIV infected people. Living positively involves making choices that will enable a person live a healthy, normal and productive life after contracting HIV infection. This involves good health practices and change of behaviour on the part of the infected person. The success of positive living also depends on other factors including support from family members, friends and neighbours in the community. All these people have various contributions to make towards the comfort and continuous living of the HIV infected person There are numerous support groups in Botswana where HIV infected persons can seek assistance. The range off service of these support groups include action research, advocacy on behalf of the infected and affected, design and implementation of interventions counselling, collaboration with partners, coordination of events and activities, evaluation of programes and training and education of staff. There are also many places where one can get information about the support groups and their activities.
10 GLOSSARY
Orphan A child between the ages of 1 and 18 years who has lost both biological parents through death, or less commonly, one parent.
Positive Living: Engaging in a number of appropriate behaviours and practices that enables a person infected with HIV and AIDS to live a healthy, normal and productive life.
MODULE THREE: EFFECTS OF HIV/AIDS
MODULE OVERVIEW
In the first module, you learned basic facts about HIV and AIDS and some misconceptions associated with HIV transmission. In the second module you learned about how infected and affected people can live positively with HIV and AIDS. This the third and last module of the level 1 vocation training programme. In the module, you will learn about the effects of the HIV/AIDS pandemic at different levels of your society, including the sectoral, community, family, and individual levels.
This module is divided into two units. The first unit is about the importance of statistical facts in which you will learn about the geographical distributions of HIV infections in your country and the neighbouring countries. The second unit deals with he impact of HIV/AIDS in which you will learn about the consequences of HIV/AIDS on the Botswana economy, and the action that the Government has taken to redress or mitigate the impacts at various levels of society.
This module like the first two modules is also designed for both the HIV/AIDS Foundation and Intermediate programmes, which are intended to arouse awareness as regards the economic and social impact of HIV/AIDS, and to produce a morally sound, disciplined, compassionate, responsible, tolerant, health and safety conscious citizens. The module is therefore suitable for anybody who need to know about (a) HIV and AIDS; (b) personal precautions to reduce the risk and spread of infection; and (c ) how to deal with HIV/AIDS infected and affected people.
1 UNIT ONE: IMPORTANCE OF STATISTICAL FACTS
OVERVIEW
In this unit you will learn about the importance of statistics and the effects of distorted information. You will also learn about how HIV data is collected and translated into information for use by the public. In the process of learning about the importance of statistics, you will certainly learn about the characteristics of the Botswana population and HIV infection rates based on these characteristics.
OBJECTIVES
By the end of this unit, you will be able to:
1. Explain the importance of statistical data in the presentation of any information
2. Explain the various population characteristics of Botswana
3. Describe the HIV infection rates of Botswana
TOPICS
1. The meaning of Statistics
2. The effects of distorted information and statistics
3. Botswana population characteristics
4. Infection rates
1 The meaning of Statistics
An Understanding of Statistical Concepts
A number of complaints are issued about statistics. To many people, statistics is dry, it is considers the mass and not the individual, it is misleading, and that it is too mathematical for anyone but an expert to understand. A Statistical result is simply a statement about the condition of data. This is bound to be dry unless the person is interested in the problem to which the data relate and understands the significance of those findings for the problem. For example, how many of you will be concerned when you hear about an increase of 1000 HIV infections in Gaborone city next year? If even this figure concerns you, it will not be the same as it will concern the city medical superintendent and the Mayor of Gaborone, because the figure tells them about how many hospital beds, nurses, doctors, new wards and equipment must be ready and how much adjustment will be needed in the budget.
CLASS ACTIVITY
?
1. What Statistical information will be of interest to you as a Student in Vocational Training?
2. Explain why this information is of interest to you.
3 Botswana population characteristics
Have you ever thought of where the get the data reported about HIV/AIDS in Botswana? Let us look at the various sources of HIV/AIDS data and what each source mean.
1 Survey
A survey involves the gathering of information from a representative sample of a population and analyzing the data to characteristics within the population. For example, the 2001 Botswana AIDS Impact Survey (BAIS) used representative samples of households, women, and men to gather information. Surveys may have different aims and objectives. The main objectives of BAIS, for instance, were to:
1. Provide up-to-date information for assessing the HIV/AIDS pandemic at household level in Botswana.
2. Furnish data needed for assessing programmes implemented to improve the knowledge about how HIV is transmitted and strategies for HIV/AIDS prevention and control; and
3. Contribute to the improvement of data and monitoring systems in Botswana and to strengthen technical expertise in the design, implementation, and analysis of such systems.
Surveys can be very reliable source of information if the characteristics of the subjects in samples from which data are obtained are representative of the population characteristics.
2 Pregnant Women
In Botswana, the testing of pregnant women for HIV is mandatory with the consent of the person that is pregnant. This information is added to the data bank and is used for estimating the prevalence rate of HIV infections among adult men and women. This method is not as reliable as the survey method but it provides a reasonable clue of the infection rate.
3 Tobelopelo Voluntary Counselling and Testing
The HIV test results obtained from those who voluntarily go for counselling and testing can also be used to make national projections on HIV prevalence rates. However, caution must be exercised in making projections with VCT data because it may seriously under-represent the true picture of infections in the population. What is normally done is to use it in combination with other sources.
4 National Blood Bank
People who donate blood are also screened to prevent spread of the virus through infected blood. The data obtained from blood screening can also be used as a source of estimate for the prevalence of HIV infection.
5 Mortality and Morbidity Data
In many of the hospitals around the country, facilities exist for HIV testing and post-mortem analysis to determine cause of death. This kind of information is also added to the national data bank for estimating HIV infection prevalence rates.
6 Employment Data and Private Hospitals
Other sources for HIV data include employment data and data records from private hospitals.
7 The effects of distorted information and statistics
In order to reveal the status of HIV/AIDS in any society, the need for HIV/AIDS statistics can not be overemphasised. It is through this kind of data that the disparities between men and women, children and adults, employees and employers in different government sectors can be addressed.
4 Infection rates
1. Zambia’s largest cement company reported that absenteeism for funeral attendance increased by 15 times in the 1992-1995 period.
2. In the mid 1990s Uganda Railways were reporting steep increases in absenteeism and an annual staff turnover rate of 15 per cent, with more than 10 per cent of the workforce dead from AIDS related illness.
3. In Kenya 43 of the 50 employees of the Kenya Revenue Service who died in 1998 died from AIDS. The Kenyan Federation of Employers report that HIV/AIDS is costing companies an average of nearly US$ 50 per employee each year.
4. Some mining companies in South Africa believe that 40 per cent of their workforce may have HIV/AIDS will increase labour turnover by 3 to 6 per cent, and the Goldfields Mining Company estimates that AIDS adds US$ 4-10 to the cost of producing each ounce of gold.
5. According to the Zimbabwe Farmers Union, AIDS has reduced the production of maize by 61 per cent, cotton by 47 per cent, vegetables by 49 per cent and groundnuts by 37 per cent.
6. One major transport company with 11,500 workers in Zimbabwe found that 3,400 of them were HIV positive in 1996. Costs for the company related to HIV/AIDS amounted to more than $ 1million or 20 per cent of company profits.
7. In Chennai (formerly Madras), India, a study of large industries found that absenteeism was expected to double in the next two years, mainly as a result of STDs and AIDS-related illnesses.
8. A Thai government study has calculated that the direct and indirect cost of HIV/AIDS to the nation was US$ 1.2 billion in 2000.
9. A number of firms in the US report annual costs of between US$ 3,500 and US$ 6,000 for each worker with HIV/AIDS.
Source: Centre of International Health, 2001
Cost of HIV/AIDS in Six Companies in Africa (US$)
Company Name Total Costs Cost per employee
Botswana Diamond Valuing 125,941 237
Botswana Meat Commission 379,200 268
Côte d’Ivoire food-processing firm 33,207 120
Côte d’Ivoire packaging firm 10,398 125
Muhoroni Sugar, Kenya 5,830 349
Uganda Sugar Corporation 77,000 300
Source: Centre of International Health, 2001
2 UNIT TWO: IMPACT OF HIV/AIDS
OVERVIEW
In this unit, you will learn about the impact of HIV/AIDS. The PLWIDS, government of Botswana, non-governmental organizations and the private sector have experienced great impacts of HIV ranging from psychological, social, (stigma and discrimination) cultural, and economic in the war against HIV/AIDS.
OBJECTIVES
By the end of this unit, you should be able to:
1. Describe the consequences of HIV on the infected and affected.
2. Describe the impact of HIV/AIDS on the Botswana Economy
3. Compare the infection rates of Botswana with those of neighbouring countries
4. Discuss the contribution of Government, Non-Government Organizations, and private sector to the fight against HIV/AIDS
TOPICS
1. Impact of HIV/AIDS on the Botswana Economy
2. Comparative Infection Rates of HIV in Botswana with other countries
3. Government Action in Minimising the Impact of HIV/AIDS
4. Micro-Economic Impacts
1 Impact of HIV and AIDS on the Botswana Economy
There are different types of impacts that the HIV/AIDS epidemic can inflict on infected and affected populations. In the paragraphs that follow, we have briefly discussed each of the impacts.
1 Psychological Impact
On of the most important psycho-social impacts of HIV/AIDS on the infected is the social stigma. Stigma includes the following:-
• Loss of self image.
• Disfigurement and physical deterioration
• Thoughts about death
• Relationship with others
• Ability to work
• Loss of employment
• Illness procedures and impact on friends and family.
• Fear of contracting the disease, and social stigma from other community members.
2 Socio-cultural Impact
Important factors under this heading include the socially reinforced subordination of women, which underlies many aspects of their vulnerability, especially their relatively weak position in being able to make decisions about sex and their lack of economic empowerment. The social acceptance of sexual networking by men is also fundamental and further underscores the subordination of women in Botswana. Initiatives are ongoing to strengthen the legal and ethical environment to support empowerment of women and youth. The access to and abuse of alcohol, particularly among the youth, has been shown to increase the incidence of casual, unprotected sex, thus having a significant influence on the spread of HIV/AIDS in the country.
3 Socio-economic Impact
Key socio-economic factors are largely represented by a cycle of real or perceived needs and exploitation. On the one hand, people with high levels of disposable income are at risk due to their ability to exploit situations of relative inequality or exert unfair advantage in the pursuit of sex. On the other hand, rising poverty levels indicate that many people are unable to meet their daily needs, often forcing them to adopt high-risk survival strategies. Recent estimates put the proportion of households in Botswana below the poverty line at 22%. In the urban areas it is at 11.7%, while the rural areas it is 27.1%.
2 Comparative Infection Rates of HIV in Botswana with other countries
AIDS weakens agricultural systems and affects nutritional status and food security of rural families.
AIDS leads to poor crop and life stock management, reduced cropping areas leaves households with reduced agricultural inputs, and disrupts the social security system.
Table 8: Comparative Impact of HIV/AIDS on agricultural labour force in the most affected African countries
|Country |2000 |2020 |
|Namibia |3.0 |26.0 |
|Botswana |6.6 |23.2 |
|Zimbabwe |9.6 |22.7 |
|Mozambique |2.3 |20.0 |
|South Africa |3.9 |19.9 |
|Kenya |3.9 |16.8 |
|Malawi |5.8 |13.8 |
|Uganda |12.8 |13.7 |
|Tanzania |5.8 |12.7 |
|Central African Republic |6.3 |12.6 |
|Ivory Coast |5.6 |11.4 |
|Cameroon |2.9 |10.7 |
Source: FAO/SDWP
1 Impact on Labour Productivity
HIV/AIDS deprives families and communities of their young and most productive people. The pandemic is deepening poverty, worsening gender inequalities, eroding the ability of government to maintain essential services. Furthermore, HIV and AIDS reduces labour productivity and supply and put a brake on economic growth.
Elsewhere in the Southern African region, where land is scarce, HIV and AIDS affected households try to cope by renting out or share cropping their fields or shifting production to their home gardens. Widows are often dispossessed of land by their in-laws and rendered homeless.
It is estimated that the economy will be one third smaller by 2021 than without HIV and AIDS, while government expenditure will have to increase by 20% (Landflow, 2003). With the loss of able bodied members, HIV and AIDS affected households are not able to continue ploughing and surviving in rural areas, urban and peri-urban lands are too expensive for them to rent or buy. There are already a growing area of idle and abandoned land (matlotla) and a falling demand for fields for ploughing. By contrast, the demand for residential land and shelter for the poor in urban areas has increased, HIV and AIDS strains the capacity of Botswana’s land administration and management institutions at all levels (Landflow, 203).
2 Impact on Death Toll
The toll of HIV/AIDS on households can be very severe. Although no part of the population is unaffected by HIV, it is often the poorest that are the most vulnerable to HIV/AIDS and on whom the consequences are most severe. In many cases, the presence of AIDS means that the household will dissolve, as parents die and children are sent to relatives for care and upbringing. The majority of households in which the mother had died had dissolved. But much happens to a family before this dissolution happens: HIV/AIDS strips the family of assets and income-earners, further impoverishing the poor.
3 Impact of Life Expectancy:
In many countries of sub-Saharan Africa, AIDS is erasing decades of progress in extending life expectancy. Life expectancy reflects the conditions in a community, but also life expectancy affects conditions in the community. Average life expectancy in sub-Saharan Africa is now 47 years, when it would have been 62 years without AIDS. Life expectancy at birth in Botswana has dropped to a level not seen in Botswana since before 1950. In less than ten years time, many countries in Southern Africa will see life expectancies fall to near 30, levels not seen since the end of the 19th Century.
3 Table 9: Average life expectancy in 11 African Countries
|Country |Before AIDS |2010 |
|Angola |41.3 |35.0 |
|Botswana |74.4 |26.7 |
|Lesotho |67.2 |36.5 |
|Malawi |69.4 |36.9 |
|Mozambique |42.5 |27.1 |
|Namiba |68.8 |33.8 |
|Rwanda |54.7 |38.7 |
|South Africa |68.5 |36.5 |
|Swaziland |74.6 |33.0 |
|Zambia |68.6 |34.4 |
|Zimbabwe |71.4 |34.6 |
By 2010, the populations of five countries - Botswana, Mozambique, Lesotho, Swaziland and South Africa will have started to shrink because of the number of people dying from AIDS. In two more countries, Zimbabwe and Namibia, the population growth rate will have slowed almost to zero.
1 Government Action in minimising the impact of HIV and AIDS
1 Impact on Health
In all Botswana the HIV/AIDS epidemic is bringing additional pressure to bear on the health sector. As the epidemic take its toll on the population, the demand for care for those living with HIV/AIDS rises, as does the toll among health workers. Health-care services face different levels of strain, depending on the number of people who seek services, the nature of their need, and the capacity to deliver that care.
Table 6: Public Health Expenditure in Botswana (1990 – 2000)
|TYPE OF EXPENDITURE |1990 |1995 |2000 |
|Total Health Expenditure as percentage of GDP |3.0 |5.4 |6.0 |
|Public Health Expenditure as percentage of GDP |1.7 |2.8 |3.8 |
|Total Health Expenditure (current per capita income) |89 |168 |191 |
Compared to other countries in the region, there is a high level of government and donor funding of health and HIV/AIDS. Access to the health system is also generally good. For example, the population generally lives within 15 km from a health care facility. However, the human resource capacity constraints may limit the response to HIV/AIDS in spite of the high level of financial resources and widely distributed physical infrastructure.
The available data allows for the functional breakdown of only the government HIV/AIDS expenditures. The main categories of HIV/AIDS expenditures are: information, education and communication programmes (IEC), prevention of mother-to-child transmission (PMTCT), home-based care (HBC), orphan care (OC) and anti-retroviral (ARV) drugs. Since 1999/00, orphan care accounted for the largest, albeit declining, share of HIV/AIDS expenditure – from a high of 67 per cent in 199/00 to 28 per cent in 2002/03. Spending on PMTCT has experienced a significant increase. For example, between 1999/00 and 2000/01 expenditure on PMTCT increased (nominally) by 349 per cent. Most categories show a declining share, but this is most likely due to the introduction of a new category of expenditure in latter years – ARVs. In 2002/03 ARVs are expected to account for nearly ten per cent of (core) HIV/AIDS expenditures.
Table 7: Core expenditure on HIV and AIDS in Botswana (1999 – 2003)
|Agency Name |Agency Type |Main programme |Budget (US$) |Time period |Estimated annual |
| | | | | |budget (US$) |
|Government of Botswana|Government |HIV/AIDS |40,000,000 |1 year |4,000,000 |
|ACHAP |Partnership |HIV/AIDS, TB |100,000,000 |5 years |20,000,000 |
|Melinda & Bell Gates |Private |HIV/AIDS |70,000,000 |5 years |14,000,000 |
|Foundation | | | | | |
|UN Agencies |Multilateral |HIV/AIDS |10,000,000 |5 years |2,000,000 |
|BOTUSA |Government |HIV/AIDS, TB |12,000,000 |1 year |12,000,000 |
|DFID regional projects|Bilateral |HIV/AIDS |12,000,000 |unknown |4,000,000 |
|EU |Multilateral |HIV/AIDS |n/a |n/a |n/a |
|Harvard AIDS Institute|Private |HIV/AIDS |1,000,000 |1 year |1,000,000 |
|Republic of China |Government |HIV/AIDS |900,000 |1 year |900,000 |
|SIDA |Bilateral |HIV/AIDS |1,700,000 |1 year |1,700,000 |
|Turner Foundation |Private |HIV/AIDS |1,000,000 |3 years |333,333 |
|GTZ |Private |HIV/AIDS |400,000 |unknown |133,333 |
|Total | | |249,000,000 | |96,066,667 |
3 Impact on Education:
• Loss of school supply due to death of teachers
• Competition for scarce resources
• Quality of education may suffer as less qualified teachers replace the more qualified who are too weak to teach due to illness
• Discrimination an isolation of teachers suffering from HIV/AIDS may increase.
2 Micro-Economic Impacts
1 Impact on the Households
HIV and AIDS affect the welfare of households through illness and early death of family members.
• Diversion from family savings and investment into care (Cohen, 1993).
• A rise in the number of dependents relying on small numbers of productive family members
• Overcrowded households.
• Child headed households who have a more difficult future than other orphans. These have a greater risk of malnutrition, illness, abuse, sexual exploitation, stigma, discrimination, deprivation of basic social, economic and education services.
• Increase in household expenditure which is a direct outcome of meeting bills and funeral services.
• AIDS will not only reverse efforts to reduce poverty, but will increase the percentage of people living in extreme poverty. In Botswana, household income for the poorest quarter of households is expected to fall by 13%.
• Income earners in these households are also expected to take on an average of four more dependants because of HIV/AIDS.
• Already poor households coping with an AIDS-sick member are reducing spending on basic necessities even further. The most likely expenses to be cut are clothing, electricity and other services. Falling incomes will force households to reduce the amount they spent on food and almost half of households reported having insufficient food at times.
• AIDS has forced rural families to reduce their agricultural work or even abandon their farms.
• Taking care of a person sick with AIDS is not only an emotional strain for household members, but also a major strain on household resources. Loss of income, additional care-related expenses, the reduced ability of caregivers to work, and mounting medical fees and funeral expenses together push affected households deeper into poverty.
• But the financial burden of death can also be considerable, with some families in Botswana spending three times the total household monthly income on a funeral.
2 Impact on Orphans
It is hard to overemphasise the trauma and hardship that children affected by HIV/AIDS are forced to bear worldwide. Not only does HIV/AIDS mean children lose their parents or guardians, but sometimes it means they lose their childhood as well. As parents and family members become ill, children take on more responsibility to earn an income, produce food and care for family members. It is harder for these children to access adequate nutrition, basic health care, housing and clothing. Fewer families have the money to send their children to school.
Orphans are deprived of maternal or paternal love. This puts them at a disadvantage because of the following reasons:
• They lack paternal or maternal love, support and care.
• They may discontinue their education because of lack of money
• They may need to take care of siblings and other relatives
• They may be disadvantaged by growing up as extended family in surrogate homes
• It is costly to raise orphans because of their great numbers (4.7 million in the SADC region as of 1999)
• They lack access to affordable drugs and ARV in inadequately equipped health care facilities
[pic]
A grandmother with her AIDS orphaned children
3 Impact on Women
Women, on the other hand, are vulnerable to the economic impact of HIV and AIDS in several ways including but not limited to the following:
• Generating income from outside the household
• Giving care and maintaining family land
• Vulnerability to sexual harassment and exploitation at and beyond the workplace
• Trading in sexual activities to secure income for household needs
• They may be removed from school to take care of sick family members. This reinforces gender inequality and limits women’s economic opportunities and autonomy.
• Ultimately they may become vulnerable to HIV and AIDS through commercial sex and abusive relationships that may be their only source of sustenance.
• With the growing rates of divorce cases, illegal separations and the influence of in-laws in the institution of marriage, dispossessions with time it will a serious problem in Botswana. There have been several cases of dispossessions of surviving family members, principally women and orphaned children in Botswana. In some cases, there are traditional mechanisms of wife inheritance to ensure women’s access to land in case of widowhood. Such traditions contribute to the spread of HIV infection when the widow marries her husband’s brother to have access to her husband’s property.
3 SUMMARY
In this unit you have learned about the different types of impacts caused by HIV/AIDS. These impacts are psychological, socio-cultural, and socio-economic. You also learned about the two main levels (macro- and micro-economic) at which these impacts can occur. At the macro-economic level, you learned about impacts on health, education, agriculture, labour productivity, death toll, and life expectancy. At the micro-economic level, you learned about impacts of HIV/AIDS on the household, children/orphans, and women. It is our hope that all the knowledge you will acquire from this HIV/AIDS programme will be applied when necessary in resolving the problems at all levels of society.
4 GLOSSARY
Macro Economic Branch of economics dealing with the broad and general aspects of an economy, as the relationship, in this case, between HIV/AIDS and national income and investment of country as a whole.
Micro Economic Dealing with particular aspects of an economy, as in this case, the impacts of HIV/AIDS on specific populations such as children and women.
MODULE FOUR: HIV/AIDS AND THE WORKPLACE
MODULE OVERVIEW OF THE MODULE
In modules 1-3, you learned the basic facts about HIV/AIDS, positive living and how HIV/AIDS infects and affects everyone wherever they may be, including the home, communities and the nation. In this module, you will learn about HIV/AIDS as a workplace issue. In unit one of this module, you will learn about HIV/AIDS transmission risks linked to the workplace and possible measures against the risks. The measures you will learn about are linked to precautions linked to transmission of HIV at the workplace. In the second module of this unit, you will learn about occupational support policy guidelines and existing practices linked to HIV prevention and management at the workplace. Potential loss of a productive labor force means that every workplace must have policies and programmes on HIV/AIDS to improve the lives of employees.
.
1 UNIT ONE: TRANSMISSION RISKS
MODULE OVERVIEW
In this unit, you will learn about transmission risks related to HIV at the workplace. Furthermore, in the last section of the unit you will learn about the measures against risks related to transmission HIV at the workplace. Although risks of HIV transmission exist even outside the workplace, the unit is devoted to occupational risks at the workplace. Some employers have measure in place against occupational risk. Others still have better the conditions of workers who are exposed to occupational risks. It is hoped that an understanding of the risks and measures will help you make informed choices on challenges of reducing HIV at the workplace. In cases where measures do not exist, your knowledge may result in ways of lobbying with employers to set up necessary measures to reduce the impacts related to occupational risks.
OBJECTIVES
By the end of the unit, learners will be able to:
1. Describe HIV/AIDS as a workplace issue and related transmission risks.
2. Describe measures against transmission risks.
TOPICS
1. HIV and AIDS and the workplace
2. Transmission and possible risks
3. Measures against HIV/AIDS transmission risks
4. Prevention
5. Health service Programmes and HIV and AIDS and the workplace
6. Pre and Post-Test Counselling.
1 HIV and AIDS and the workplace
HIV/AIDS is a Workplace Issue. HIV/AIDS should be recognised as a workplace issue, and be treated like any other serious illness/condition in the workplace. This is necessary not only because it affects the workforce, but also because the workplace, being part of the local community, has a role to play in the wider struggles to limit the spread and effects of the epidemic.
Why is HIV/AIDS a workplace issue? The answer to this question can be found in the following facts on how HIV/AIDS hits the world of work in numerous ways:
FACTS ABOUT HIV/AIDS IN THE WORKPLACE
• In badly affected countries, it cuts the supply of labour and reduces income for many workers.
• It threatens the sources of livelihood of employees who are dependent on wage employment. Increased absenteeism raises labour costs for employers. There is low productivity due to increases in absenteeism and early retirement on medical grounds. Reduced productivity leads to a negative impact on economic growth.
• There is loss of social protection, especially in cases of terminal and prolonged illnesses. There is work disruptions, and an increase in labor costs (health insurance, retraining) for employers.
• Undermine efforts of prevention and care. Costs of treatment and funerals are huge.
• Valuable skills and experiences are lost. Often, a mismatch between human resources and labour requirements is the outcome. The nations’ inability to deliver essential goods and services due to loss of skilled workers and managers.
• Along with lower productivity and profitability, tax contributions also decline, while the need for public services increases. National economies are being weakened further in a period when they are struggling to become more competitive in order to meet the challenges of globalization.
• There is a need for replacement of workers and retraining.
• Family pensions, insurance and health costs and legal considerations can put a lot of stress on families of the HIV infected.
• Discrimination at the workplace threatens fundamental human principles and human rights at work. Confidentiality, customer concerns and privacy are other concerns for the HIV infected.
• Employee morale, disability requirements and decision making about promotions, job transfers and relocation are major decisions the HIV infected and their families may have to make.
• Tax revenue, market demands and investments in human resources are a cost to the business. Although drug companies have brought down the price of drugs, a substantial problem remains. The regime of administering the drugs requires a level of health infrastructure, including human resources, which is simply not available in many poor countries. HIV/AIDS leads to a rise in business costs. For this reason the ILO Code of Practice suggests that in some cases the workplace may be a suitable point of delivery. The ILO also encourages employers to pay for treatment where possible – it is well worth treating common opportunistic infections even if antiretroviral therapy is beyond the resources of an enterprise.
• Continuous absenteeism reduces productivity. There is a fall in GDP in Sub-Saharan Africa from 2-4%. Direct and indirect costs of HIV/AIDS for the workplace are very huge.
2 Transmission and possible risks
There are workplace related transmission risks that may include contact with infected blood and blood products. Midwives, medical Doctors, nurses, health facility and home based- care truck and van drivers and other medical personnel are referred to as medical personnel who work in “Special Occupational Settings.” In Botswana, vulnerable groups that need to be specially protected against HIV/AIDS are:-
• Medical Personnel.
• Disabled Persons.
• Uninformed Police/Defence Forces or Disciplinary Forces.
• Mobile/Redeployed Workers.
• Children.
Although the significance of HIV/AIDS transmission linked to such occupations has not been a subject of serious study, HIV/AIDS threatens workers by the extent to which workers are exposed to different modes of HIV transmission. The prevalence rate of infection among these special groups is yet to be established. However, there are transmission modes directly linked to some occupations.
1 Transfers and Labour Mobility
(i) Redeployment of Labour
Workers may have to go and work in HIV infected areas. Although HIV is not contagious, labour mobility through transfers and redeployment may increase employees’ chance of contacting the virus. It is always difficult to cope with new work situations unless people make new friends and where HIV is common, friendships may be a risk factor.
(ii) Poverty
Poverty is one of the psycho-social problems that makes women in particular to compromise in their struggle to earn or obtain a source of livelihood. For example, women that are economically dependent on their male friends at the workplace may stick with them even in case of abusive relationships involving violence and infidelity. Prospects of promotion and empty promises of better working conditions make women vulnerable to abuse and contracting HIV.
Substance Abuse: Alcohol and drug abuse impairs people’s judgment on the need to avoid contracting HIV/AIDS.
KABP: Knowledge, attitudes, beliefs and practice studies. In workplaces where KABP is low and there is a general lack of information, HIV is likely to spread quickly.
(iii) Socio-cultural Beliefs, Behavioural Practices and HIV/AIDS
Women in most of the SADC region are not socialized to initiate or negotiate sexual activity especially where there is unequal power relationship. They remain at the mercy of their male counterparts especially if they hold the future to their progression at the workplace. The task falls in the male’s role and women do not have much control.
Religion and HIV/AIDS: As part of socio-cultural beliefs, some religious workers and organizations do not condone the idea of safe sex on the basis that everyone must be faithful. Such religions condone trust and beliefs in fidelity of partners. In some cases, the church and other leaders may not be exemplary to their follower ship and it becomes problematic if the religious organization is also an employer of the vulnerable person.
(iv) Gender –related Issues
The low status of women put them at risk of HIV especially in the SADC region. Women’s capacity to decide when, with whom and how sexual intercourse takes place can help reduce the transmission of HIV/AIDS at the workplace.
Heterosexual Transmission Risks are also gender- based. Gender issues and sexual harassment at the workplace are factors in transmission of HIV/AIDS. Women are not able to negotiate safer sex especially when dealing with men who have favours to give.
(v) Prostitution/Sex work
This is another very common transmission risks in the Sub-Saharan context of unemployment and poverty. Commercial sex work as the main source of survival puts women at risk of HIV. It is also very sophisticated as it takes various forms. In some case it is within well established relationships where there are some gifts given for sexual favours. In other cases prostitution takes the form of money for each sexual encounter. In other cases sex workers go on the streets and charge each customer depending on the number of thrusts during sexual intercourse and whether it is with or without a condom. A study done by Ntseane (2004) on prostitution in Gaborone indicated that sex workers give clients an option of relatively higher charges for sex with “no condom” and lower charges for sex “with condom”. The more the money charged, the higher the risk of HIV transmission.
Think about any kind of workplace of your choice and do the class activity below:-
Class Activity
| |
|CLASS ACTIVITY |
|? |
|What are the most important transmission risks at the institution you have selected? |
|Why do you think each one of them is an important transmission factor? |
|What strategies would you suggest for controlling HIV/AIDS at the workplace? |
Having learned about HIV/AIDS at the workplace, nowadays there is an even greater call for creating work environments that can protect workers from contacting HIV at the workplaces.
3 Measures against the risks
Measures against the risks are a topical area in prevention of HIV/AIDS related risks. With the global call for protecting workers against the risks of HIV/AIDS at the workplace, many employers have joined the war by making working environments that are in support of universal precautions in prevention and management of HIV/AIDS.
Some workplaces have measures against HIV, while others do not. The ability to implement measures for reducing transmission risks differ in different organizations.
Workplaces take measures ranging from guidelines, policies to best practice in the war against HIV/AIDS. Examples of such measures include the use of protective clothing to minimize work-related injuries that may expose employees to HIV/AIDS. There are also programmes on prevention of HIV/AIDS, road safety, as guided by existing policies and codes of ethics on HIV. Peer and general education by health workers, support and counselling services are provided to affected and infected employees and co-workers. These measures can be adopted at individual and workplace level. At an individual level, workers are expected to be individually and collectively responsible for taking precautionary measures against the risks of HIV transmission. With this understanding, the employers also provide an enabling environment for workers to protect themselves from HIV transmission because it is costly to them and to employers. In the midst of all the important measures are educational programmes and counselling on prevention of HIV/AIDS.
4 Prevention
Prevention is still the main emphasis in HIV/AIDS at the workplace. But why emphasize Prevention?
HIV is a fragile virus, which can only survive in a limited range of conditions. It can only enter the body through naturally moist places and cannot penetrate unbroken skin. Prevention therefore involves ensuring that there is a barrier to the virus – condoms, for example, or protective equipment such as gloves and masks (where appropriate) – and that skin-piercing equipment is not contaminated. The virus is killed by bleach, strong detergents and very hot water. In the event of an accident, and in certain workplaces, it is important to follow the universal blood and body fluid precautions (known as “Universal Precautions” or “Standard Precautions”) which were originally devised by the United States Centre for Disease Control and Prevention (CDC) in 1985. These precautions are explained in Appendix II of the ILO Code of Practice on HIV/AIDS and the world of work.
The HIV/AIDS pandemic has evolved in different ways in different parts of the world, and at varying speeds. In many regions it is still in its early stages. At the end of the year 2001, the total number of people living with HIV/AIDS was estimated to be 40 million with just under half of them being women, and about 8 per cent children. HIV/AIDS caused the deaths of 3 million people during 2001 and, despite widespread prevention measures; 5 million new cases were reported.
5 Health Service Programmes on HIV and AIDS at the Workplace
In addition to global policies on HIV/AIDS at the workplace Botswana has several programmes and strategies to reduce the transmission of HIV at the workplace. There is limited access to health services especially for workers in the informal sector. Several onsite health services are provided for employees and sometimes their dependents. For example, government medical schemes, private sector medical schemes and DEBSWANA (Orapa, Jwaneng and BCL) in some cases give employees an opportunity to include their dependents as beneficiaries of onsite health services. Services range from basic to high benefit depending on the diagnosis and coverage. (UNDP, August 2000).
6 Pre and Post-Test Counselling
Pre and post test counselling must accompany all testing. Pretest is essential for client to know the implications of HIV testing, while post-test counselling prepares the client for the test results. Counselling is very important to give hope and options available for the client. Referral for ongoing supportive counselling services should be offered as part of the post-test service. There are programmes for workers and these are summarized in the table below.
Table 10: Programmes on HIV/AIDS at the Workplace
|Programmes/strategies for HIV/AIDS at the |Specific Programmes and workplace |Application/Target groups at the workplace|
|Workplace |principles | |
|General sensitization programmes on |Dissemination of information |All employees must have access to |
|HIV/AIDS |Peer education, and Counselling and |information, education programmes on |
| |support. |HIV/AIDS/STDs at the workplace, and |
| |Gender sensitive programmes |referral for counselling and medical care. |
|HIV/AIDS Prevention |Affordable or free condoms |All employees. |
| |Behavioural change programmes. | |
|Care and Social Support |Protection Polices |HIV infected must have access to and |
| |Retirement Benefits |receive standard social security and |
| |Terminal Benefits |occupationally-related benefits. the same |
| | |way |
|Anti Stigma |Zero tolerance of stigmatizing by |All Employees, especially employers who |
| |colleagues, employers unions and others. |have the power to recruit and dismiss. |
| |PLWHAS. Healthy HIV infected must be | |
| |treated the same way as any other worker in| |
| |training and promotion. | |
|Anti Discrimination |Zero tolerance of discriminating by |All Employees, especially employers who |
| |colleagues, employers unions and others. |have the power to recruit and dismiss. |
| |Workers with HIV/AIDS related illnesses | |
| |must be treated the same way as any other | |
| |workers. | |
|HIV/AIDS Policy |Zero tolerance of sexual harassment, and |All employees, especially |
|Sexual Harassment Policy |rape leading to transmission of HIV or |employers/managers who have the power to |
| |dismissal. |sexually abuse or dismiss subordinates. |
CLASS ACTIVITY
?
Rethink of the three main levels of protecting companies from the impact of HIV/AIDS at the work place.
• What in your opinion are the economic impacts of HIV/AIDS at the workplace?
• What are the risks involved in HIV/AIDS at the workplace?
• What can companies do to stop the loss of workers to HIV/AIDS?
Botswana government has a policy on HIV/AIDS which echoes sentiments similar to ILO code of ethics. AIDS at work is a Metropolitan’s AIDS risk consulting service covering the following:-
• AIDS Impact Assessment
• AIDS Sustainability Reporting
• AIDS Risk Consulting
• AIDS Impact:
o Demographic
o Financial
o Scenario Modelling
o Impact of HIV/AIDS on industry
• AIDS Sustainability:
o Monitoring
o Reporting HIV/AIDS Risks
• AIDS Risks Consulting:
o Financial Planning
• Scenario Planning
o AIDS is a medical, social and economic issue.
7 SUMMARY
In this Unit, you have learned about transmission risks and measures linked to the risks of HIV/AIDS. There are some occupations that put workers at more risk of HIV than others. Where employers are not sensitive to the needs of workers in reducing the risk of HIV transmission, workers must individually and collectively put pressure on their employers to protect them from contacting HIV. It is important that workers are protected from contacting HIV. In case they are infected because of their occupations, they must get hearing and compensation for exposure to HIV if there is a direct connection between their HIV status and work-related conditions.
8 GLOSSARY
Risks: A risk is an uncertain situation that may expose workers to HIV infection at the workplace. Risks are associated with the extent to which workers are exposed to situations that may increase their susceptibility to HIV. For instance, certain occupations such nursing or giving home based care to AIDS patients, accidents related to driving a community van transporting mainly AIDS patients and other health care provision increase opportunities of contacting HIV.
Discrimination: A psycho-social and cultural process of making an unfavourable distinction of HIV infected and making bad judgments on how they became infected.
Stigma: Looking upon the HIV infected with a burden of shame and associating them with unacceptable socio-cultural practices such as multiple sex partners, casual sex, flirting and prostitution.
2 UNIT TWO: OCCUPATIONAL SUPPORT POLICY GUIDELINES
OVERVIEW
In this Unit, you will learn about occupational support policy guidelines relating to HIV/AIDS. Every workplace must have guidelines on HIV/AIDS at the workplace. Most of the guidelines are based on the ILO and SADC codes of ethics on HIV. In Botswana for instance, the national AIDS policy and the DPSM code on HIV at the workplace serve as general guidelines to dealing with the HIV/ADS affected at the workplace. Some workplaces like the Directorate of public Service management have adapted and modified the National HIV/AIDS Policy to suite their employees and work situations. The parastatsls, private and NGOs have employers’ guidelines. Where these do not exist, it is the duty of employers to provide internal guidelines.
OBJECTIVES
By the end of this unit, you should be able to:
1. Describe occupational support policy guidelines in selected workplaces.
2. Describe successful workplace programs on HIV/AIDS.
3. Describe how workplace practices promote a safe and supportive workplace.
TOPICS
1. Occupational Support Policy Guideline in Botswana
2. Workplace programmes on HIV/AIDS.
3. Workplace best practices.
1 Global Workplace Policies and Guidelines
1 Code of Practice on HIV/AIDS
According to ILO (2001, p. 4.):
HIV/AIDS is a workplace issue, and should be treated like any other serious illness/condition in the workplace. This is necessary not only because it affects the workplace, but also because the workplace, being part of the local community, has a role to play in the wider struggles to limit the spread and effects of the epidemic.
ILO has a code of practice on HIV/AIDS and the word of work. This is based on widespread consultations with governments, employers and workers. The ILO code of ethics provides guidance on principles, polices and programmes to combat the spread of and impact of HIV/AIDS at the workplace. The regime of administering the drugs requires a level of health infrastructure, including human resources, which is simply not available in many poor countries. For this reason the ILO Code of Practice suggests that in some cases the workplace may be a suitable point of delivery. The ILO also encourages employers to pay for treatment where possible – it is well worth treating common opportunistic infections even if antiretroviral therapy is beyond the resources of an enterprise.
ILO Code of Ethics
• Prevention
• Confidentiality, privacy, care, treatment and support of PLWHDS
• Care of orphans and vulnerable children.
• Support to community home- based care.
• HIV/AIDS must be integrated into Poverty Reduction Strategies developed by MFDP.
• Protection against stigma/Discrimination and misuse of child labor.
• Legal, ethical and legislative environment.
• Protection of social security coverage for all employees regardless of HIV status.
2 The Southern African Community (SADC) Code on HIV/AIDS
The SADC code is sensitive to the high prevalence rates of HIV in Sub-Saharan Africa. The code has guidelines to governments, employers and employees on best practices for prevention of HIV/AIDS in the workplace. The ultimate goal is to strike a balance between goals, rights and responsibilities of all stakeholders in handling workers with HIV/AIDS.
3 The Botswana Policy on HIV/AIDS
Botswana National Policy on HIV/AIDS Policy outlines strategic approach to the management of HIV/AIDS by setting up the institutional framework in the form of National AIDS Council, NACA and HIV/AIDS Coordinators at individual ministerial and district levels. HIV testing is available to all Botswana on a non- discriminatory basis.
4 Directorate of Public Service Management Code of Ethics
The Directorate of Public Service Management (DPSM) has a code of ethics adopted from ILO for occupational Support Guidelines. The Ministry Management is responsible for IEC programs in the workplace and creating a conducive environment that is non- discriminatory to HIV infected officers. Furthermore, the DPSM code of Ethics of July 2001 emphasizes the following:-
• Protection against victimization,
• Sick leave to all regardless of HIV status,
• Undiscriminatory occupational benefits.
• Informed Consent in HIV testing and training.
• Recognition that the needs of individuals with life threatening illnesses shall be met.
• Sustainable and non- discriminatory benefits including those with HIV infection.
2 Workplace programmes on HIV and AIDS
Related to guidelines are best practices in caring and supporting the HIV infected and affected co-workers. Although workplaces differ in ways of operation, there are certain educational, counselling and services for the workplace against HIV. Certain behaviours are promoted as good practice in the war against HIV/AIDS.
Drugs for the HIV Infected
Governments and other workplace guidelines must ensure that people benefit equally from social protection regardless of their HIV status. Anglo-American, a large mining group which is the biggest employer in southern Africa, has decided to make the drugs available to its workforce free of charge. It estimates that this may cost between 2.5 and 5 million US dollars. Around 23 per cent of its 134,000 workforce are infected with HIV/AIDS (Financial Times, London, 2002).
Another global initiative is to make drugs affordable for workers infected with HIV/AIDS. Anglo-American, a large mining group which is the biggest employer in southern Africa, decided to make the drugs available to its workforce free of charge. It estimates that this may cost between 2.5 and 5 million US dollars. Around 23 per cent of its 134,000 workforce are infected with HIV/AIDS (Financial Times, London, 2002). While this is a welcome development, it is clouded with a lot of politics as not every country can afford the cost of HIV/AIDS drugs.
Similarly, Botswana was the first country to offer ARVs to its citizens including workers. It was found that the HIV infected need education, care, counselling and support just like patients with other chronic illnesses. Other support services include anti stigma and anti discrimination of people living with AIDS. To discriminate is a violation of human rights of the HIV infected. Where there no workplace counselling services, workers have to use Tebelopele testing centres wherever they exist.
In giving occupational support and services, care must be given to ensure that employers operate within the ethics and laws dealing with HIV at the workplace. BONELA (2003), as a watchdog of law and ethics in HIV/AIDS designed a code of ethics on HIV testing. There are certain legal/ethical issues that must be considered in HIV testing at the workplace.
Informed Consent
HIV testing should not be done without the knowledge and consent of the subject. When Botswana’s Ministry of Health and the president introduced the idea of routine HIV testing beginning January 2004, he echoed the same sentiments that where necessary, subjects would be informed of the need for HIV testing. Employees themselves can volunteer information on their HIV status.
Confidentiality
Because of the sensitivity of HIV/AIDS, counselling should be confidential. In this case, the point is that there must be shared confidentiality. The identity of the subject must be protected both verbally and in print form. Except on cases of rapists, HIV testing is not carried against the will of individuals. Rape is a civil offence that puts victims in a vulnerable position of contracting HIV. The HIV infected at times loses hope and may be driven to rape depending on their state of mind. It is important to detect the HIV and psychological status of the rapist so that informed judgment can be made for each case.
Below is an example of a role play on confidentiality and privacy of information on HIV/AIDS during counselling sessions. The counsellor can discuss any of the questions with groups or individuals to ensure that confidentiality is not violated either to family members or the workplace.
| |
|Counsellor: Awetse, does your mother know that you have come to discuss your health with me? |
|Have you informed any of your family members that you are living with HIV? |
|What does your family say about your illness? |
|What does confidentiality mean to you? |
|What is important to you as a sign of confidentiality of your HIV status regarding your workplace? |
|Has anyone violated your confidentiality? |
|What does privacy mean to you? |
|What is important to you as a sign (s) of privacy of information about your HIV status? |
|Has anyone violated your privacy? |
|Would you like your doctors/counsellors to disclose information about your HIV status to your next of kin? |
|If you would like the doctors or counsellors to disclose your HIV status top your next of kin, what would you like them to say? |
|Do you have any concerns about issues of confidentiality of information about HIV/AIDS relating to your workplace? |
Counselors can ask people to share and discuss in role plays and process the feedback. Counselors must also share with the HIV infected on how the social environment in
which they live should handle them to ensure that they have some dignity and respect like other people.
Stigmatisation and Discrimination Against HIV Infected Workers
HIV has been described as a medical, economic and social disease. An important factor associated with HIV at the workplace is stigma and discrimination against PLWHAS.(WHO/UNAIDS, 2000). People with HIV/AIDS are subjected to stigma and discrimination at the workplace and theses may hinder their promotions and retention at work.. It is important that workers are educated and counselled not to discriminate against the AIDS infected and affected. Women are particularly vulnerable to severe stigmatization than men (Achamat, 2001). For example, in Botswana, when people talk about prostitutes or sex work, they usually associate it with women. One of the biggest problems with denial, stigma and discrimination is that they cause the HIV infected to go underground and not get the necessary care and support from the Government or AIDS service organizations. Once they do not turn up for clinical and other forms of available support, the body immune system may not sustain them enough to be fit for the workplace without drugs. The damage done by HIV progresses faster than in people where the process is closely monitored. The table below some signs of discrimination that workplaces are supposed to counsel their workers to guard against. The list is however not exhaustive.
Figure 7: Friends and Neighbours Turning their Backs on an HIV Infected
[pic]
|Some Signs of Discrimination Against PLWHA |
| |
|Early messages and development of IEC were that HIV/AIDS was: |
|A killer disease |
|A lethal weapon |
|Contagious /Transmitted Disease |
|Death sentence |
|Stigmatized, shun and isolation by some health workers |
|Spread through corpses (covered with plastic to prevent infection by the virus). |
| |
|People and employers therefore reacted to these messages by: |
|Dismissing HIV infected for their HIV status |
|Insisting on an HIV test for a hidden purpose of dismissal of the HIV positive |
|Not wanting top shake hands with someone who has HIV |
|HIV infected person may not get the job even if they are quality |
|Avoiding all those families whose member (s) has HIV |
|HIV infected may be dismissed form their jobs even if they can still work |
|Feeling uncomfortable sitting next to someone who has HIV/AIDS |
|HIV infected may not be allowed to go to school for fear that she/he might infect others |
|Not hugging anyone with HIV/AIDS |
|Associating HIV with multiple partners and casual sex. |
| |
|CLASS ACTIVITY |
|? |
|Which of the above are you familiar or conversant with at workplaces you know about? ? Explain. |
|Are there any other signs of discrimination at the workplace which are not listed above? Explain. |
|How can workplaces ensure that there are free of discrimination against PLWADS? |
Since the 1990s, the governments of Botswana and AIDS service organizations have worked together through educational and counselling programmes to reduce stigma and discrimination associated with HIV/AIDS. Stigma and discrimination violate human rights of PLWHADS.
According to BONELA, about 33% of workers’ deaths in Botswana are related to HIV. (BONELA, 2004, p. 5).
Though opportunistic infections are a life threat, there is hope of prolonged life if they are controlled and treated. Different organizations continue to advocate that there is no need to discriminate against PLWHAS because nobody deserves to be infected with HIV and the people may just be unfortunate. Some people meet just one infected partner and that is all it takes to get infection and reinfection. HIV infected, like everyone, need love and understanding. They feel a lot of stress if they are discriminated against. Stress in turn affects feelings, thinking, behaviour and the whole body. People need to be supported, educated and counselled against discrimination to avoid stressing up the HIV infected.
The table below summarizes multiple feelings associate with stress:
| |
|FEELINGS: |
|Depressed |
|Frustrated |
|Short tempered |
|Anxious |
|Irritable |
| |
|THINKING: |
|Mental block |
|Confusion |
|Inability to think straight |
|Day-Dreaming |
|Inhibited Creativity |
| |
|BEHAVIOURS: |
|Shouting and yelling |
|Excessive use of alcohol |
|Confrontation |
|Attention Seeking |
|More sex |
|Less sex |
|Wanting to walk about |
| |
|BODY: |
|Tired |
|Headache |
|Palpitations |
|Skin rashes |
|Spasms |
| |
|CLASS ACTIVITY |
|? |
| |
|Having studied how stress affects the bodies, of PLWHAS, which of the experiences are consistent with what you know? |
|What does stress mean to you as an individual? What would you do if stressed up? |
3 Workplace best practices
Workplace codes promote retention of employees to get the best out of their productivity as long as they are able to perform standard tasks. One of the key impacts of HIV/AIDS is the lowering of productivity and health and safety issues at the workplace. The Botswana National Productivity was established to encourage productivity by training and retraining in work ethics even before the impacts of HIV/AIDS become too conspicuous. Since the HIV pandemic, safety at work is particularly emphasized regarding truck driving and the risk of contacting the AIDS virus at work. The risk of road traffic accidents is also a notable concern to the productivity movement. HIV/AIDS has medical costs, absenteeism, sickness benefits, employee death benefits, and funeral cost benefit and productivity losses.
| |
|CLASS ACTIVITY |
|? |
|Why is HIV/AIDS a workplace Issue in Botswana? |
|What can be done to protect workers from HIV/AIDS? |
|List some of the practical things that can be done to make drugs available for the workforce in Botswana. |
In Botswana, BONELA has responded to the dire need of educating the public about HIV/AIDS. Its focus had been the spreading of the vital role of law and ethics in dealing with AIDS related issues. BONELA has furthermore revisited the question of human rights and protection of workers given the scourge of HIV. Instructional materials have been developed towards that end.
BONELA has embarked on development of materials for teaching about HIV/AIDS. HIV/AIDS is a big and fatal social problem since 1985 when the first case was discovered in Botswana, everyone in the country is either affected or infected. It is Botswana’s most challenging epidemic that has taken many lives since 1985 when the first case was discovered.
Everyone needs to be aware and understand the implications of HIV/AIDS to effectively do something about it. Existing channels of raising awareness include the mass media campaigns, curriculum and materials development for teaching, peer counselling and experiential learning form the wealth of interventions and experiences from people living with HIV/AIDS.
Some of the interventions include the HIV/AIDS Policy, the Sexual harassment policy, the Tebelopele service provided at the University of Botswana Wellness Centre, the rules that govern the ARV programme and ongoing research by colleagues in our university who are concerned about the socio-cultural interventions in the prevention and management of HIV/AIDS.
BONELA has embarked on development of materials for teaching about HIV/AIDS. HIV/AIDS is a big and fatal social problem since 1985 when the first case was discovered in Botswana. Everyone in the country is either affected or infected. It is Botswana’s most challenging epidemic that has taken many lives since 1985 when the first case was discovered. As part of BONELA’s effort to protect ethics, law and human rights of people with HIV, BONELA has assisted an employee who had been dismissed from employment because of his HIV status. Read a summarized version of the case below and the questions subsequently after the presentation of the case.
| |
|INDUSTRIAL COURTS NO. 35 OF 2003 |
| |
|On the 22nd November 2004, the Industrial court of Botswana judgment on a workplace issue in which an employee with HIV was dismissed from |
|work because of his HIV status. The employee had been employed by Northern Air company since 1998. Between 1999 and 2004, his health |
|deteriorated and he even had to seek unpaid leave and exhausted his leave entitlement. The employee disclosed his HIV positive status on the |
|29th January 2004. He was dismissed without any fair hearing and concluded that disclosing his HIV status had triggered dismissal. His |
|employers had tolerated about 191 days of absenteeism yet immediately after disclosing his HIV status he got dismissed. |
|The court had to determine if dismissal was fair and protect the applicants’ entitlement and whether it was legal to have pre-employment HIV |
|testing. |
|“The court underscored that to exclude an HIV/AIDS positive employee from employment through dismissal solely because he is HIV positive and |
|without having established that he is incapacitated, lacks a rational foundation and is unfair.” |
|The court ruled in favour of the dismissed employee. |
|(p. 1, BONELA Guardian, 2005 ) |
|In your opinion, where did the employer go wrong in dismissing the employee? |
|If you were the employer, what appropriate action would you take before dismissal? |
|If you were an employee with HIV, would you disclose your status to your employer? Explain. |
|What are your fears about HIV in regard to job security? |
According to BONELA (2004):
“Stigmatization continues to be a large feature of HIV litigation…Eliminating stigma is the key to solving the HIV scourge…In one case, the complainant was being victimized by her employer for having gotten pregnant despite her being HIV positive, and was dismissed.”(BONELA, p. 1).
There are also examples of neighbours and workmates causing others to boycott members of society. They have done so by spreading rumours about the HIV status of the person causing ostracism, loss of business and reputation.
There are two other cases related to the one above.
|INDUSTRIAL COURTS CASE NO. 50 OF 2003 |
|In this case, an employee’s employment status was dependent on a negative HIV status. She resumed work Feb 2002 and had not made up her mind |
|to go for HIV testing. She was asked to go for HIV testing. In October 2002, she dismissed the instruction and disclosed her decision not to |
|go for HIV testing. |
|“As far as I know HIV status, it’s a personal right, not for public or employment requirement.” Her employment was terminated 19th October |
|without reason. She challenged the decision in the Industrial Court. Similar to case 35 of 2003, the Industrial court had to decide if the |
|dismissal was fair and if there was a violation of her constitutional rights. |
|The court ruled in her favour on the grounds that her privacy and liberty had been violated. Furthermore, the court ruled that the dismissal |
|was discriminatory against her as a person living with HIV. The court ruled in her favour and that there was a need to protect all workers |
|regardless of HIV status. She had to be compensated for the time she had lost her employment. |
The two cases above indicate the plight of HIV infected and efforts made to protect them against work- related stigma and discrimination.
1 Worker’s Compensation Act of 2001
This act obliges all employees to ensure that they have safe and secure working conditions for all workers exposed to hazardous diseases at work.
Employers obliges own expense to have the employee examines by a medical officer and provide treatment where possible.
Employer is obliged to pay compensation for any such injuries or death resulting from workplace injuries.
Similarly, the Employment Act focuses on the welfare of workers with the following as key features:-
• Safety at work.
• Confidentiality of HIV related information.
• Privacy
• Acceptable Performance Standards
• Termination of Employment
• Human Rights
• Non- Discrimination.
The author of the act, Tabengwa (2001) recommended that it must be reviewed to accommodate new trends including HIV.
BONELA also published the HIV and the World of Work booklet emphasizing the National Industrial Relations Code of Practice. Base don ILO’s Code of practice on HIV/AIDS. The key features of the National Industrial Relations Code of Practice include:-
• Non- discrimination
• Confidentiality
• Privacy
• Prevention, care and Support.
2 Confidentiality
Information on HIV status of workers must be trusted confidentially. If there is a need to divulge information, it is important that the information must be done with the consent of the individual.
Shared confidentiality is applied for those who need to know for health and social welfare care to be provided.
The employee is not obliged top inform the employer of his/her HIV status.
PLWHA must not transmit the virus to others. It is their responsibility not to do so. Having learned about HIV as a workplace issue, do a brainstorming exercise below:
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|CLASS ACTIVITY |
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|What in your opinion is the significance of HIV of policies in relation to HIV/AIDS at the workplace? |
|What policies are in place are you familiar with on HIV/AIDS? |
|What are common examples of work-related stigma that HIV/AIDS infected suffer from at the workplace? |
|What are the common examples of work-related discrimination that HIV/AIDS infected suffer from? |
S HIV/AIDS a
POEM: THE HIV/AIDS SCOURGE
Never in human history has Botswana known a scourge
That has swept the country and the workplace since 1985 to date!
A scourge that knows no profession,
No geographical limits, no ethnic identity, no marital status, no creed, and no colour.
A virus that permeates every workplace—both old and new, high, prestigious and low buildings!
A scourge that does not discriminate against the good and bad, intelligent and unintelligent, average and below, rich and poor, peasants and middleclass, black and white, old and young, boys and girls, men and women, beautiful and ugly, working and non-working, employed and unemployed, Short and tall, Educated and uneducated, !!
Beware the scourge, Beware HIV, a ruthless virus that knows no limits!
The scourge has many names!
Some call it 8s (AIDS), others say it is “Incurable, (Bolwetsi jo bo senang kalafi) Bolwetsi jwa Radio, (A disease often talked about in the radio), Laela mmago, (Bid your mother farewell) Phamokate, (Grab and bury) Four letters (Ditlhaka tse NNE)”. It has a thousand names! Whatever name you give it, it means the same thing—HIV/AIDS.
A virus without cure—HIV/AIDS.
Several vaccines are being tried but so far no cure.
All the most intelligent doctors have cracked their heads to find a curative vaccine.
A virus that devastates the economy and does not respect the world‘s richest man, Bill Gates, Who has joined the global war against it. The virus is ever ruthless and viscious!1 It attacked=s the entire world, Leaving a billion orphaned, houses and cities empty with no life!
To all the world we say, Let us protect ourselves from the deadly virus By using all preventive measures We can afford: it is a coat of many colours: Abstinence, Faithfulness, Safe blood Transfusion and if all else fails CONDOMISE Every time and if not sure of your Partner’s HIV status! Together we stand Together we can fight the virus Together we can stop the denial, the scourge, stigma, discrimination before the virus wipes out the human race. Where there is a will, there is a way to stop the scourge!
The struggle continues! Long live Batswana, Long live the Human Race and Down with the Scourge of HIV!
4 SUMMARY
In this unit, you have learned about occupational support and policy guidelines and best practices related to HIV/AIDS at the workplace. You have learnt about selected guidelines and codes of good practice in dealing with the HIV infected and affected. Occupational guidelines are very important to know as they provide HIV infected workers with information on how they must be treated. Access to information is power in effectively dealing with stigma and discrimination at the workplace. Codes of ethics and good practice are important to create a conducive working environment for all workers regardless of their HIV status.
5 GLOSSARY
Code of practice: System of laws relating or standards of good practice or morally good behaviours and treatment of workers especially the HIV infected.
Code of Ethics: System of laws relating to moral principles of what is the right human conduct towards workers and especially the HIV infected.
Occupation: Routine or standardized ways of earning or obtaining a source of livelihood.
Confidentiality: A process of sharing information based on trust that the information relates to a private sensitive issue that must be kept in secret by the parties concerned. This is common in HIV counselling, testing and other personal information.
REFERENCES
Abt Associates South Africa Inc. /UNDP/MFDP (August 2000). The Impact of HIV on the Health Sector in Botswana- Socio-Economic Impact of HIV/AIDS in Botswana. UNDP.
Court Rules in Favour of HIV Positive Employee who came to BONELA for ASSISTANCE. BONELA Guardian Vol. 2 (1). February 2005.
UNAIDS (June 2003). Action against AIDS in the Workplace. Joint United Nations Programme on HIV/AIDS.
ILO. (2001). Code of Ethics on HIV/AIDS and the World of Work.
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White Blood Cells
Can a person be HIV positive but not have AIDS?
Remember, an HIV positive person may feel healthy for a long time. Hence the infected person starts to have symptoms and develop diseases that normal medicines cannot cure. The other way to tell if a person has AIDS is to look at their White Blood cell Count. If it drops below a certain number then the doctor will say that the person has AIDS.
YES!
Planning for family’s future
- Will
- Orphans
Accepting and coping with HIV status
Use of Botswana PMTCT programme
Facilitate behaviour change for HIV prevention
Normalizes HIV/AIDS in the community and home
Facilitates referral to social and poor support
Access to ARV therapy, IPT, etc
Early care of opportunistic infectious STDs, TB, etc
Voluntary counselling and HIV testing
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