Ethics group proudly presents: Education in preventing AIDS by Ulla Luhtasela How can we support AIDS patients? by Aung Zaw Naing Lin Religion and HIV by Sk. Akhtar Ahmad Is HIV still a death sentence in Asia? by Matiar Rahman Animal Testing and Clinical Trials by Varaporn Podprasart A pregnant woman's right to choose to have an abortion when she has HIV infection by Julaporn Srinha The Role of Law in HIV by Gunawan Pratama Yoga

EDUCATION IN AIDS PREVENTION by Ulla Luhtasela 14.7.2000

Content of the presentation 1. Introduction 2 Current situation in some Southeast Asian countries -Thailand, Laos, Cambodia, Myanmar, Malesia 3. Education for different groups

4. Sex and Aids education in the schools 5. Education for CSW 6. Example of a prevention plan 7. Conclusion

1. Introduction

Education is necessary component of HIV prevention Coupled with promotion of practical prevention strategies, it can be a powerful motivator for positive behavior change In most countries, an important first step is making people realize that they are at risk.

Biologically thinking, spread of HIV virus would be comparatively easy to stop spreading However, already 30 million people worldwide has been infected and the number is growing at the concerning rate.

WHY? knowledge about this disease has not reached everywhere to change human behavior and attitude is extremely difficult Education is one of the most important tools for the fight against HIV spread.

Increasing the awareness of threat will only be effective when message is coupled with useful information In many developing countries resources are limited and should be targeted to those individuals and groups at the greatest risk for acquiring or transmitting HIV

The promotion of proper use of condoms as well as availability of condoms are key elements in the prevention of AIDS in high risk groups Availability of clean needles is a problem in many countries School based sex education programs can be an important part of a comprehensive country-level HIV prevention plan Policies that promote education for girls and young women

Particularly sex education should help dispel sexual myths for young people and raise awareness about the relative risks of sexual activity Existence and level of sex education varies between the continents and countries enormously Country-driven prevention plans are more effective than donor-driven

2. Current situation

Thailand The estimated number of the HIV positive individuals in the country is between 800 000 and 1 million Recently in Bangkok new concerns about spread of AIDS has been the infections among the people who do not consider themselves to be in the high risk group

In 1997 the Thai government ordered local communities to increase efforts to control AIDS and to improve assistance offered to AIDS patients The same year National Aids Foundation was set up to look into how to spent the government’s AIDS budget in addition to funds donated by private organizations

In 1997 Thai government allocated 1600 million Bath to prevent and control AIDS. Education of sex and Aids have been implemented into schools

Mr Mechai Viravaidhya Thailand’s condom king has been active more than 10 years with introducing the condom to Thailand He is president of the Population and Community Development Association Opened a restaurant in Bangkok called “Cabbages and Condoms” as means of raising funds Revolutionized the NGO world in Thailand.

CAMBODIA: HIV has spread rapidly in Cambodia since it was first screened in 1991 100 000-150 000 HIV infections in the country Cambodia has the highest rate of increase if HIV Struggling with highest rates of poverty, malnutrition and poor education.

About 87 % of young man are having sex with their girlfriends, prostitutes, or other males, but nearly half of sexually active men never used a condom The disease is spreading faster in Cambodia than in any Asian nation except Burma and India Even the awareness of AIDS is slowly increasing, the sexual behavior has not changed

United Nations Human-rights representative reported in 1996 that Cambodia is thwarting the fight against AIDS by closing brothels, harassing sex workers and taking down posters promoting condom use Such moves drive CSW underground and make AIDS education more difficult.

In 1997 Buddhist monk Pal Hor, who was operating Cambodia’s HIV/AIDS treatment center provides traditional medicine and Bugghist counseling Anti-AIDS treatment was unavailable in Cambodia this was a last hope for many desperate and suicidal patients.

In 1991, Pact, an Independent international non-profit corporation started a Community Outreach Project (CCOP) in Cambodia Developed culturally sensitive approaches to community-based development Pact was the first donor to provide assistance

Provide training, technical support and direct grant assistance to Cambodia's first generation of NGOs Pact focused on human resource development, training many local NGOs in participatory management, planning communication, program development, financial management and community development

LAOS Although Laos has so far avoided the high rates of HIV infections, epidemic remains a serious threat The World Health Organization (WHO) reported 30 cases of AIDS in Laos in 1997. Although this figure is low, there are no other officially reported data available from this country

United Nations reported in 1997: “ Increasing urbanization and population mobility, as well as increased prostitution and drug use could facilitate a burst in infection rates.” Many work in the sex trade and when they return home, there is a real risk of introducing AIDS to villages, which have no means to protect themselves

Condoms are not available for most of the time they are too expensive for farmers Foreign contractors from Thailand, Vietnam, and other countries with high HIV rates are hired to work in infrastructure projects in Laos.

CARE is a non governmental organization providing help in Laos CARE’s Border Areas HIV/AIDS Prevention Project provides information on transmission and prevention of STDs and AIDS to CSWs and other high-risk groups in provinces

They have designed educational materials specifically tailored for these groups working along with their project partner, the National Committee for the Control of AIDS.

MALESIA In Malaysia, 300 new HIV cases are detected each month, and a total of 448 AIDS cases and 16,349 HIV cases were reported by June 30 1996. The estimated figures may not reflect the actual number of new cases because many are not reported

Governmnet is concerned about situation,and hopes that the community together with parents, educators, and community organizations would join the battle against HIV The government has approved the spending of $48 million for AIDS care between 1993 and 1995, but says that additional funding is needed

The Ministry of Health has formulated a program to reach out and educate youths on HIV/AIDS The Health without Aids for Malaysian (Prostar) program was launched in 1996 The aim is to train 20 000 youth facilitators, who are equipped with knowledge of the disease and social values

The program involves students of institutes of higher learning as well as uniformed bodies and factory workers This has been a successful program

Program for Sex Workers has shown positive results in the experiment where CSW are reach out from brothels, back lane, streets and homes Peer educators allows for information dissemination to take place in a non confrontational manner Increasing amount of CSW have started to use good quality condoms

Myanmar According to United Nations statistics 1998, there was 440,000 HIV-positive individuals in Myanmar; however, some health workers estimate the number is higher Prison conditions are reported to favor the spread of HIV

So far, Myanmar has taken few effective measures to limit the epidemic Preferred to deny that promiscuity and commercial sex thrive in a Buddhist society Heroin-takers and prostitutes are simply put in jail New quarantine centers to house people with HIV are being built

Just recently, the government is beginning to take steps to counter the spread of the virus, instituting anti-HIV and risk-reduction campaigns Officials also intend to organize more HIV-free blood-donation campaigns and education efforts

3. Education for different groups Type of education depends on the people to whom it is targeted Major groups are -Scientists -Public -CSW -Children -Youth

Scientists People who have higher education and want to learn more about clinical side of HIV http://www.hopkins-aids.edu/hiv_lifecycle/index_fram.html

Public Newspapers, radio, television, advertisement, campaigns Information in interesting form, to make people realize, that this could happen to anybody, maybe someone from their own family.

CSW Improved health care should include also information about the risks Flyers, posters and information should be translated into major languages in the region Condoms should be available

Youth Education should be implanted into the schools Practical information how to protect yourself and the one you love Condom should be introduced

Children Children hear and observe everything what is going around of them Colorful children books are available at least in the western cultures. A book from children to children is effective and help children to understand

4. Sex and AIDS education in schools Young people are especially vulnerable to HIV and other sexually transmitted diseases as well as for drug use Many young people can not talk about sex or Aids either at home or in the community

Often young people are embarrassed to talk about sex to doctors or nurses, and they might worry about confidential Discussions among young people are conducted in the streets, information comes from older and more experienced teenagers, movies or magazines

Since most of the young people attend school at some point, these topics could and should be addressed by teachers and educators There are number of obstacles which often stand in the way Some countries have no policies on Aids education, and others can even have policies against AIDS education

It is commonly supposed that talking to young people about sex will make them do it Negative effects might be emphased rather than positive aspects such as intimacy, sexual love and pleasure This kind of unbalanced approach is often seen through by young people

In consequence, they may reject all that adults have to say, seeking guidance and role models from peers and from the media research looking at the effects of sex education on young people's sexual behavior offers little evidence that it hastens the onset of sexual experience, or increases sexual risk among those who are already sexually active

Indeed, several studies from different countries show that good quality sex education can actually decrease the likelihood that young people will have sex, and increase condom use among those who are already sexually active

Designing a good curriculum for Aids education is essential start for a successful project Effective programs are those that have had a positive influence on behavior as regards sex, drug use and non-discrimination, and not simply increased knowledge and changed the attitudes of students

Factual information about biology, sexual development, and sexual and drug-related risks. Concerns with personal relationships, feelings and values should be recognized and emphasis put on the acquisition of relevant negotiation skills

Effective programs should following things: -Focus on life skills -Concentrate on personalizing the risk -Discuss about possible result of unprotected sex -Introduce condom and show how to use it -Explain where to turn for help and support

-Stress that skills useful for self-protection from HIV also help build self-confidence and avoid unwanted pregnancy, sexual abuse, and the abuse of drugs -Reinforce values, norms and peer-group support for practicing and sustaining safe behavior and resisting unsafe behavior

It is important to provide sufficient time for classroom work and interactive teaching methods such as role play and group discussions Start at the earliest possible age, certainly before the onset of sexual activity

5. Education of Commercial Sex Workers (CSW) For most women who enter the life of prostitution on the streets, their "choice of prostitution" often grows out of years of painful sexual exploitation, sexual molestation at very early ages, family violence, and persistent patterns of substance abuse

Since prostitutes are in the high-risk group, prevention of HIV infection is one of the most important tasks to protect both them and their clients The ability to practice safer sex in prostitution is influenced by a range of factors, such as demand by clients for unprotected sex, urgent need for money, alcohol abuse, homelessness, ignorance, lack of resources, younger age etc.

The knowledge about HIV and prevention might also be insufficient, specially when young illegal girls are recruited from poor villages and hilltribes. barriers to health care and health promotion for prostitutes, the clients and other sex partners, should be minimized.

Two main obstacles to get health care are identified: Many prostitutes do not qualify for health services The health system is not appropriate for sex workers -negative attitude towards prostitutes and prostitution -ignorant about prostitution and the specific problems prostitutes

Implementation of Education for CSW: Pilot phase for new projects Continuity of funding Involvement of sex workers Skills of staff Attitude of staff Adequate payment of all staff Location

Outreach Solid infrastructure Appropriate health education materials HIV prevention in a broad perspective Extension to remote areas Attention to all forms of sex work Attention to all sex workers

6. Example of a prevention plan Fogarty Workshop on International HIV/AIDS Prevention Research Opportunities on April 1998 Objective: To identify a package of effective HIV prevention interventions and develop a list of priority research goals that combine biomedical, behavioral and social interventions for feasible and relevant for developing countries with limited resources

Total of 171 representatives from 37 countries participated on workshop 6 different plans for developing countries were developed by the participants, one of them being a South East Asian country

Because of the uncertainty, which country this is, it will be called Country A in this example

Country A : Small Southeast Asian country with population of 25 000 000 people It is one of the poorest countries in the world Illiteracy is high, for population over 15, only 35% can read and write Morbidity and mortality rates are among the highest in the world

Shortage of medical personnel has been a major obstacle to the implementation of an effective public health program Most rural areas are served only by a local infirmary

First reported AIDS case was diagnosed in 1993 Currently 200 000 people are estimated to be infected by HIV virus That is 2% of the total population Epidemic is based on regional spread rather than importation from outside the continent

Condom use has increased recently, CSW reported to use condom 80% of sexual acts However condom use is very rare with girlfriends and wives which enables the disease to spread into families Small percent of blood transfusions given in rural areas are screened

The National AIDS program (NAP) has established offices in each province The offices provide training, education, and outreach to CSWs, schools, the military, and the police Services are severely restricted by a lack of human, financial and technical resources

Prevention plan for Country A: Specific groups must be targeted and provided services necessary for their group’s specific risks All the groups should have access to condoms and other services Youth must be provided with life style skills and sex/Aids education Women must be given skills and empowerment

The blood supply must be made safe through increased screening, testing and pooling Improved surveillance is another priority Access to HIV testing and counseling is also needed Country’s public health infrastructure must be improved

Reduce the stigma of testing and counseling and increase the confidence of those seeking it All of these interventions should be integrated with existing services, if feasible

7. Conclusion

Stakeholders must be brought together to improve public awareness of the problem through information and education campaigns, analyze existing policies, and assess the health care system infrastructure.

To prevent spread of HIV/AIDS requires input from many different fields.Medical, educational, legislation and social sectors need to improve, work together, and adjust to the demands of this lethal disease.

To prevent spread of HIV/AIDS requires input from many different fields. Medical, educational, legislation and social sectors need to improve, work together, and adjust to the demands of this lethal disease Ideally the rate of HIV infections will decrease as people start realizing that they are in danger

Practical help, such as condom availability and access to health care, are important tools in prevention together with education Information and education work only, if it is practical to apply into the situation.

HIV/AIDS is a global problem, and requires international attention Developing countries should be helped not only financially but also with “know how” developing countries need to take their responsibility and contribute to the prevention plan and maintain projects In a long run this is beneficial to everybody and hopefully can significantly reduce the rate of HIV infections

THANK YOU FOR YOUR ATTENTION!! -Dr. Maria -Dr. Suvit -MIT staff -Our wonderful class