1. POSITIVE PREVENTION Key to stemming HIV transmission Ms. Lovette Byfield Prevention Coordinator National HIV/STI Control Program

2. HIV situation in Jamaica There are approximately 25,000 persons living with HIV in Jamaica Approximately 15,000 unaware of status 4000 persons need treatment Increase in cases in all age group

3. HIV Prevention Prevention is one component of the national HIV/STI control program. The main objective is to identify and address existing high risk sexual behaviours ( i.e.thoughts feelings and actions) which contribute directly or indirectly to the spread of the HIV epidemic.

4. Prevention Goals Prevent sexual HIV transmission Reduce unprotected discordant sexual act Reduce the probability of transmission in discordant sexual acts.

5. Critical risk behaviours for Prevention The high risk sexual behaviours include: –Early initiation of sex –Unprotected sex –Multiple partners –HIV positive persons involved in unprotected sex without disclosing status –HIV positive person sexually active unaware of status

6. Prevention Prevention activities is targeted at different audiences: Persons who are not infected but who are practicing certain risk behaviours Persons who are already infected who are practicing certain risk behaviours

7. Positive Prevention Positive prevention addresses individuals who are infected with HIV and are currently practicing risk behaviours that expose both themselves and their sex partners and in the case of females both themselves and their offsprings to HIV infection.

8. Positive Prevention Positive prevention is premised on the fact that increased HIV transmission may occur when an HIV positive person has unprotected sex with an individual who is not infected with HIV. Increased may transmission occur with each new sex partner Increased transmission may also occur with repeated sexual intercourse with the same uninfected partner Need to break the chain of infection

9. Positive Prevention Targets persons who are living with HIV Places the responsibility to reduce transmission on both persons that is, the uninfected and infected Looks into the social, cultural, economic context of the PLWHA and how these impact risk behaviours

10. A closer look at the PLWHA Face a high level of stigma and discrimination: few able to disclose status Experience economic challenges: employment opportunities, daily needs Some have accessed ARVs Influenced by societal norms relating to gender roles and sexual behaviours

11. Access to ARVs PLWHA on ARVs look and feel better –Improved self esteem and desirability –Increased attention from potential sex partners –Tell by looking myth in selecting sex partners

12. Some Societal Sexual Norms More than one sexual partner evident more among males than females Very little or no condom use with main partner (regular partner) 1 in 3 man and woman engage in unprotected sex (heterosexual) Transactional sex; this practice has benefits for: females need support for children or lifestyle –Males convenience etc

13. Sexual norms (cont’d) PLWHA are not separate from society hence some of these persons are likely to be practicing the same behaviours that are reflective of societal sexual norms. For Example KAPB 2004 indicated that no shift in condom use since 2000: –77% of males condom use with non regular partner –67% of females condom use with non regular partner –Use with main partner 45% among females, 57% males

14. Challenges of positive prevention Need to be scaled up and integrated into all interventions that bring the PLWHA into contact with service provider Need to include; Risk reduction Negotiation for safer sex – condom use, contextual abstinence Build self efficacy Create supportive environment

15. Susceptibility and Risk In order to for individuals, communities or populations to change they must first recognize that they are at risk of being infected and of infecting others. Risk perception is key to motivating behaviour change

16. Perception of Risk Persons in our audiences have to be assisted to have an accurate perception of risk. Persons in our audiences have to be equip with the skills to reduce their risk

17. Risk Reduction Framework All sexually active are at risk. However there are those who are at higher risk based on their behaviour: multiple partners inconsistent condom use transactional sex early sexual initiation unprotected sex between HIV positive and negative unprotected sex between HIV positive and positive

18. Risk Reduction Interventions Changing behaviours at the individual level requires: understanding basic facts, Appropriately assessing risk adopting key attitudes, learning a set of skills having access to appropriate products and services

19. Positive Prevention Interventions –Individual level Adopting key attitudes –What ar the existing negative attitudes What are the risk behaviours –Have the behaviours been acknowledged –What are the barriers to change Learning a set of skills –Condom use skills –Condom negotiation skills –Self efficacy skills

20. What is Self Efficacy? People are afraid to try things that may make them look awkward, inept, incompetent or that may lead to outright failure. (discrimination)

21. What is Self Efficacy? Self confidence Perceived competence Belief in one’s ability Self regulation of behaviour

22. What is Self Efficacy? One’s judgment of personal capability to perform a behaviour Confidence in overcoming barriers to adopting a behaviour

23. Positive prevention Interventions Group Level Positive peer influence to challenge and change group norms, promotes and supports individual responsible behaviours – disclosure and condom use Environmental level supportive environment that reduces stigma and discrimination e.g. access to product and services, documentation of cases of stigma and discrimination

24. Positive prevention conclusion The greatest challenge occurs at the individual level. Therefore service providers at all levels who interact with these individuals have to be aware that opportunities exist to: –Introduce the new behaviour –Reinforce the new behaviour –Make referral for further assitance to address the behaviour

25. Conclusion It is important that positive prevention be seen as an one of the most important approaches in stemming the HIV epidemic However also necessary to suspend bias in reaching this and other vulnerable populations.

26. Group work guidelines for communication intervention Positive Prevention Interventions at the individual level involves: Adopting key attitudes –What are the key attitudes What are the risk behaviours –Have the behaviours been acknowledged –What are the barriers to change Learning a set of skills. What is involved in learning these skills –Condom use skills –Condom negotiation skills –Self efficacy skills

27. Group work Scenarios Using the information on the previous slide as a guide to explore the issues intervene with the individuals in the following cases in your group. At the end of the interaction the individual should have developed a plan to address the behaviours

28. Scenario A 34 years old mother of two children who has been positive for six years, uses condoms with her main partner sometimes. She was recently confirmed that her partner has another sex partner. 20 year old male who has been living with HIV for three years, he is aware of his status and has been on ARVs for approximately two years. He has a regular partner who he informs you is pregnant. He admits that the pregnancy is unplanned

29. Scenario 43 year old male who is positive has a 27 year old sex partner who is also positive. He refuses to use the condom. Positive female started relationship with partner 6 months ago. The partner is beginning to doubt her HIV status and he wants to stop using the condom.

30. Scenarios Bisexual positive male who does not use condom with regular male partners. 18 year old positive female who is not in a stable relationship has many partners does not feel she can inform them about her status as this will make her unattractive and undesirable.