1. Supporting Children Impacted by HIV Through SBHCs Malia Woessner, MS, CCLS Vanessa La Torre, BA Kids’ Connection Cascade AIDS Project Portland, Oregon

2. Participants Will: Understand basic HIV transmission Gain a sense of how HIV impacts the family system and child’s functioning Learn how a child’s understanding of HIV develops Feel more confident talking to children about HIV Know how to refer families to Kids’ Connection

3. Picture Game Get in pairs Spread out to three picture stations Sort the pictures into YES—the activity poses a risk for HIV transmission NO—the activity does not pose a risk for HIV transmission, or MAYBE—the activity could put the individual at risk of HIV transmission

4. 5+5+N 5 body fluids that carry enough HIV to transmit the virus to others: 1. Blood 2. Semen 3. Pre-cum 4. Vaginal Fluid 5. Breast Milk 5 mucous membranes where HIV can enter the body: 1. Vagina 2. Urethra 3. Rectum 4. Mouth 5. Eyelids +N: Needles

5. Macro-Affects What challenges or barriers exist in our larger society that could be affecting families living with HIV?

6. Micro-Affects What HIV-specific challenges affect the family system?

7. 2-5 year olds What you can expect Can really only think about themselves Use magical thinking Understand the external body, but don’t really understand the internal body Need information about the here-and-now Think that death is an altered state of life where many normal daily functions still happen, like sleeping and breathing, but that the person can’t move anymore The adult’s role Use short messages that you repeat often: “I love you.” “You are safe.” “Don’t touch blood.” “Medicine keeps us healthy.” “Germs can make us sick.” Allow them to “play” out what they’re thinking and feeling act out being sick, being the doctor or parent, and dying

8. 6-10 year olds What you can expect Have a very concrete understanding the world Can understand how one thing can cause another thing to happen Can understand basic health concepts about internal body functioning Beginning to want personal privacy The adult’s role Children in this age range will want to know and can understand very concrete facts: “HIV is a virus that lives in the blood.” “The body has white blood cells that keep us healthy. HIV attacks white blood cells. Without them, the body gets sick.” Talk to children in this age range about basic HIV prevention messages: “Don’t touch other people’s blood.” Reinforce all of the ways that someone cannot get HIV: “It’s safe to hug, kiss, play with and share food with someone who is living with HIV.” Teach them what confidential means—give them a “High 5” list of five people with whom they can talk about HIV If a child tells someone about the HIV in your family they are not doing it on purpose. Use that opportunity to reward them for honesty and then move forward helping others understand your family’s situation

9. 11-13 year olds What you can expect May begin puberty Can understand subtlety and ambiguity (the gray areas), not so concrete in their thinking Able to understand the internal processes of how the body functions Aware of how serious illness can be The adult’s role Begin introducing more mature HIV education and transmission messages: “HIV lives in 5 body fluids: blood, breast milk, semen, vaginal fluid, and pre-ejaculation fluid (or… the fluids that pass when a baby gets made).” “HIV can transmit (or pass) through 5 mucous membranes, or thin parts of our skin, like the mouth, eyes, urethra, vagina, and anus (or penis, vagina, and bottom).” “HIV is transmitted (or passed) when infected body fluid passes through someone else’s mucous membrane (or thin skin), like breast milk through a baby’s mouth.” “Sometimes HIV makes someone’s body so weak that what they have is called AIDS.” Begin introducing more mature HIV prevention messages: “Always have a barrier between you and someone else’s body fluids.” “ Since pre-teens are beginning to understand more complex concepts, introduce the idea of HIV/AIDS related stigma and discrimination Stigma keeps people from talking about HIV/AIDS. It also keeps people from getting tested for it. That’s why new people keep getting HIV

10. 14-18 year olds What you can expect A lot of mental and emotional focus is put on how they compare to their peers, including the health of their family members Very self-conscious about being different—their own or a family member’s chronic illness can increase this The strongest influence over decision-making and behavior comes from peers Commonly feel indestructible or immortal—deny that they can be hurt or may die The adult’s role Adults need to be the ones bringing up topics like healthy sexuality, safer sex, and HIV prevention: “HIV is transmitted (or passed) when infected body fluid passes through someone else’s mucous membrane, like semen through the vagina or when people share injection drug needles.” Continue reinforcing and having discussions about HIV prevention: “Always have a barrier between you and someone else’s body fluids.” “Use condoms.” “Abstain from sex.” “Don’t share needles.” “Don’t do drugs. They limit your decision making skills.” “Get tested for HIV.” “You CAN develop healthy, intimate relationships with others without the risk of HIV.” Continue having conversations with your teen about stigma and discrimination related to HIV Encourage your teen to get tested or take a friend to get tested

11. What To Say When: Preschool: Don’t touch blood, Germs make you sick School Age: HIV science facts, It’s passed through blood, How it’s not passed, Confidentiality Middle School: 5+5+N, More mature prevention messages, Stigma High School: 5+5+N, All prevention messages, Stigma, Get tested

12. Starting the Conversations Children and youth living in families impacted by HIV know to not talk about it Don’t ask them to disclose—chances are they’ve been told to explicitly NOT tell anyone Instead, bring HIV up whenever you can with the children and youth in your care Your comfort with the topic will help them know you’re a safe adult

13. Kids’ Connection Teaching children about HIV Support for children living with HIV HIV disclosure in the family Promoting healthy sexuality development Family-to-family social connections Guardianship planning School disclosure support Training for local service providers

14. Cascade AIDS Project Kids’ Connection 620 SW 5 th Ave, Suite 300 Portland, OR 97204 503-223-5907 Malia Woessner, Family HIV Services Coordinator mwoessner@cascadeaids.org Vanessa La Torre, Family HIV Services Specialist vlatorre@cascadeaids.org