HIV AIDS Workplace Training

“XXXXXX recognizes that HIV/AIDS is a global problem impacting on our employees, dependents and their communities, our service providers, customers and the infrastructure we operate. We have a responsibility to manage the potential impact of HIV/AIDS on our business” HIV/AIDS Policy & Strategy 2003”

Introduction Part 1 HIV AIDS RESPONSE Charter Policy Flowchart Part 2 STI, HIV and AIDS An Introduction Part 3 “VCT” and Prevention Part 4 STIGMA & DISCRIMINATION SUMMARY We have allowed a lot of time for interaction. A doctor will join us towards the end of the session – barring emergencies. Tea Break 15 minutes after Part Two Complete the Pre test questionnaire now please

Part 1 XXXXXXX HIV / AIDS work place policy Introduced in 2003. Main purpose protect employees Issues for managers So lets look briefly at the HIV AIDS workplace policy. There’s a Copy in your hand out Introduced in 2003 – It’s main purpose is to protect the employee. By firstly seeking to prevent infection – by committing the company to provide HIV education and awareness raising. Secondly, to protect against discrimination. We’ll talk more about discrimination later, but the policy protects the workers rights to continued employment as long as they can do the job. You don’t get fired for being HIV positive. And finally, the policy outlines the provisions for health care to provide access to testing, the conditions under which testing can occur, and the care available if an employee is HIV positive. As managers of people, you may have an employee who is HIV positive, and if you haven’t already done so, you should familiarise yourself with this policy in detail.

Test “VCT” STI What is HIV? Mode of Transmission HIV NEGATIVE “for now” Prevention Abstinence Be Faithful to one partner Condom High risk behaviour Other HIV Positive “positive forever” STI Clinicians Prophylaxis Management ARV Monitoring Human rights NEW START Positive Living Condoms Treatment Love Food Health Living For many years This slide is an overview of what we will talk about today – We will mostly focus on the top line - what is HIV? How do we get it? How do we test for it? How do we prevent it? PLWHA Choice Care and Support Emotional support Spiritual support Physical Needs Counselling Negative Living Alcohol abuse No Treatment No support Develop AIDS Illness then DEATH ADVOCACY

STI, HIV and AIDS An Introduction Part 2 STI, HIV and AIDS An Introduction

Terminology T = Transmitted I = Infection S = Sexually T = Transmitted I = Infection STI’s are infections passed from person to person during sexual activity. HIV is one of the sexually transmitted infections We’ll go into more detail later

Terminology I = Immune deficiency V = Virus A = Acquired I = Immune H = Human I = Immune deficiency V = Virus HIV is the name of the virus, and it affects the body for many years and eventually causes AIDS. A = Acquired I = Immune D = Deficiency S = Syndrome AIDS is not a disease, but a syndrome- a collection of symptoms and signs. When a person has AIDS, their body has no more strength to fight infection and many severe infections can attack them.

Immune system What is the immune system? Immune system contains special defense cells in the blood stream and lymph nodes, which can recognize germs entering the body, kill them and remember them if they enter the body again. Defense cells are White blood cells. “CD4” cell is the white blood cell attacked by HIV.

This is a CD4 cell. An HIV virus enters the cell, makes its home in the cell and multiplies. Soon the amount of HIV virus inside the CD4 cell increases until the CD4 cell wall breaks open. The HIV viruses then get out in the blood stream and find new CD4 cells to invade and eventually kill. When this happens the number of CD4 cells - defense cells- goes downl, so the body can no longer protect itself from infections. Germs that would normally be killed quickly by CD4 cells, can now start to attack the body.

From HIV to AIDS

How is HIV spread?

HIV Transmission Unprotected sex with an infected person Any form of penetrative sexual intercourse without a condom, this includes: vaginal sex anal sex oral sex Anal and vaginal sex are the most dangerous for transmission HIV virus is found in the blood, male semen, female vaginal fluids and breast milk. Factors influencing risk of transmission if exposed…… Quantity of virus passed on Quality of virus - Route of entry:- next slide looks at route of entry

HIV Transmission Risk of transmission: Anal receptive sex - 1 in 30 chance Vaginal receptive sex - 1 in 500 chance Anal insertive sex - 1 in 1000 chance Vaginal insertive sex - 1 in 1110 chance Oral sex - too low a risk to measure But these risks are considerably increased if there is an STI or any trauma Source: Madang Short course on HIV medicine 2004 If a person has unprotected sex with someone who is positive HIV, depending on how they have sex, the risk is different

HIV Transmission Parent Mother to Child Transmission During pregnancy During child birth During breast feeding In HIV positive women , 3 or 4 babies out of every 10 will become HIV positive, if there is no intervention. Second most common cause of HIV in PNG Risk of transmission without any intervention = 30 -35% one third. If we follow a prevention protocol we can hope to reduce it to 5-8%. About 1 in 20

Estimated risk and timing of MTCT of HIV Timing of transmission of HIV from mother to child Population with no breastfeeding Breastfeeding through to 6 months Breastfeeding 18-24 months During pregnancy 5 to 10% During labour 10 to 20% Through breastfeeding Early (first 2 months) 2 to 10% Late (after 2 months) 1 to 5% Overall risk of MTCT of HIV 15 to 30% 25 to 35% 30 to 45% Intervention to reduce the transmission includes: ARV treatment for woman during pregnancy ARV for baby at birth. Controlled labour conditions – minimal trauma approach Controlled breastfeeding De Cock et al: PMTCT in resource poor countries – Jama 2000; 283:1175-1183

HIV Transmission Blood or blood products handling blood without gloves blood transfusion (rare due to testing) sharing used sharp instruments e.g tattooing, skin cutting, needles This has implications here for industrial accidents, traffic accidents, fights in the bar, and any other time that a person unexpectedly comes into contact with someone else’s blood. Health care workers around the world are at risk of exposure to blood and body fluids and we practice “Universal Precautions” That means – we treat EVERY person the same - as if they’re infected and we protect ourselves at all times. It is dangerous to make value judgements about who may be infected and who isn’t ….because you can’t tell. So if you are in a position of having to touch someone’s blood, protect yourself first. Put a barrier between you and the blood. Gloves are best .

HIV Transmission Accidental workplace exposure -Personal Protective equipment -Reporting to OH & S

The link with STI’s? A person with a….. Sexually Transmitted Infection has a greater chance of getting HIV. HIV is a Sexually transmitted infection – Preventing STI’s will prevent HIV. IMR research results People with STI’s have an increased risk of getting HIV. They must be practicing unsafe sex to get an STI in the first place – so they are exposing themselves to possible infection. But also, STI’s cause inflamed and broken skin around the area they are infecting and CD4 cells hang around the infected area trying to fight the infection- so an HIV virus can get in easily and doesn’t have far to go. And there are some other more complicated medical reasons that we wont go into today… If we can prevent STI’s we can prevent HIV. One of the dangers is people think STI’s are “curable” so it doesn’t matter if they get one….but they are exposing themselves to HIV – which is NOT curable…. Institute of Medical Research PNG has done a series of studies in 2005 on STI prevalence. Porgera was found to have 32%, Daru 34%, Lae 45%, and Tabubil a staggering 50.4% But we are not the worst….Kikoro and Moro are even higher. They studied 238 volunteers from around the area and, most alarming, the highest rate was amongst married women. Warn people about the next slide…

Discharges IMR STI study in Tabubil, 2005 Gonorrhoea 10% Trichomonas 15.7% Chlamydia 17% The infections that IMR found area here include gonorrhoea – 10% of people studied Trichomonas – 15.7% , chlamydia 17%

Ulcers Syphilis 9.2% Warts not studied Herpes not studied Donovanosis not studied And syphillis 9.2% Warts, herpes and donovanosis are also common but they weren’t studied so we don’t have any data available.

Why are we STILL talking about STI’s? STI’s are a serious link to HIV STI’s are a serious problem in our community

You cannot get an STI or HIV by… Talking on the phone Sharing a meal or a drink Shaking hands or holding hands

HIV is NOT spread by… Kissing, cuddling, dancing, using the same toilet, mosquitoes, coughing….. HIV can’t jump! It doesn’t survive outside the body…it is very fragile The point to make here is: Day to day contact with someone who is HIV positive will not put you at risk of getting HIV You don’t have to be scared to be near someone who has HIV.

BUSINESS IMPACT “ companies are already suffering the consequences of the HIV/AIDS epidemic, with 40% of the manufacturers and transport companies and 60% of the mines reporting that HIV/AIDS has led to a loss of experience and vital skills in their organizations” Source: South African Business Coalition for HIV AIDS, November 2005.

Go through the flow chart Source: The Business Response to HIV AIDS, UN AIDS 2000

Source: AusAID Economic report, 2002. Impact on households – illness or death of breadwinner> Loss of income> Re-allocation of household tasks >Children taken out of school > can no longer afford it and need kids to work If this happens in one household it is a pity, but….. When this happens in many households it has serious long term effects. Increasing cost of doing business > less profit > Less government revenue Government > more sick people > more money into health system > less money into other services> squeezed from both sides> less revenue but more demand for money to meet the needs Population > taking kids out of school > Cant afford to feed them, or they become orphans > long term consequences > unskilled, illiterate, unhealthy with disrupted social supports > families and communities dissolved Source: AusAID Economic report, 2002.

HIV statistics World wide

Global estimates for adults and children, 2006 People living with HIV 39.5 million [34.1 – 47.1 million] It is thought that more than 60 million people have been infected with HIV since we first started taking notice. Many have died. Source: UN Aids

More than 5 people died every minute from AIDs in 2006

In PNG

HIV AIDS in PNG, 1987 – 2006 (March). Since 1987 when it was first recognised in PNG, there is exponential growth. A few comments about this chart…. The number of cases is not accurate. These are the numbers REPORTED. We don’t know how bad it really is- because there is very limited access to testing in most of the country and reporting systems are inadequate. Fewer cases were reported in 2005 than 2004. Is this a response to an active prevention campaign? Or something else? Source: NACS Report,: March 2006

Age & Sex distribution of people with HIV / AIDS 200 400 600 800 1000 1200 1400 Cases 0 - 4 5 - 9. 10 -14. 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 > 60 yrs Age groups Male Female Should we be worried about it? This slide gives us a look at who is getting HIV There are several ways to get HIV but in PNG it is mostly through heterosexual sex. Sex between a man and a woman. And if you look at this graph we can see that young women are most affected and older men are affected. This is a double edge sword – young women are child bearing women…and they are passing it on to their babies during pregnancy and birth. The second most common way to get HIV in PNG is to be born with it. So HIV is not confined to one generation, or even two, we now have HIV across three generations. And with common sexual practices, high rates of sexually transmitted infections, people using sex as a commodity to get money or goods to survive, polygamy, adultery, violent crime…the list goes on… the situation in some parts of PNG is out of control. And there are terrible social consequences to this in the longer term. So, yes….we should be worried. Source: NACS Report, March 2006

In North Fly

HIV/AIDS in North Fly, 1999 - 2006. Overall spread of HIV in our community over the past seven years in those tested. Source: Public health data, Tabubil hospital

HIV/AIDS in North Fly, 1999 - 2006. Here we see the trend in the community. The increase in community members is alarming. Source: Public health data, Tabubil hospital

Factors contributing to the spread of HIV What are the factors that contribute to HIV spreading in the community? What are the strengths found in your community that can be used to address the issue of HIV? Group Exercise:

Factors contributing…..1 Big picture: Poverty Rural to urban drift (seeking opportunity) Lack of education , illiteracy, ignorance Cultural behaviour – polygamy Churches (discouraging protected sex) Lack of health infrastructure Churches are also a potential strength – not targeting churches but when people are told NOT to use condoms, they are being put at risk. Encouraging family values and faithful relationships are positive contributions…

Factors contributing…..2 Generally: “mobile men with money” “mobile men with many ...polygamy” FIFO – single status Unfaithful partners No access to condoms Lack of personal accountability Troubled relationships Violence / rape Alcohol Ignorance

Strengths to draw on…. History Radio Fly / OTV / Media Leadership XXXXXXX resources Advocacy PLWHA Cooperative approach Schools Sporting groups Churches Radio Fly / OTV / Media Local government Open discussion Educated people advocating- YOU! Sharing skills and knowledge

TEA BREAK

Part 3 HOW CAN I KNOW IF I HAVE HIV?

“VCT” Voluntary Counselling and testing Process is mandated by law Steps involve pre test information Blood Test Post test counselling Voluntary Counseling and Testing is a term used to describe the process of receiving counseling before and after having a blood test to find out if you have HIV. At the same time, the clinician can check for STI’s. Why is VCT important? So the person understands “what is HIV” , what does it mean if he is positive, how does he need to change his lifestyle to protect himself and others And because of stigma and discrimination, counselling after the result helps people come to accept it. No person should be tested for HIV without receiving both pre and post test counseling

Where can I get a test? Access in PNG generally can be difficult XXXXXXis accredited by National Aids Council Secretariat (NACS) to conduct HIV rapid testing. Contact Public Health department

More about the test…. Blood sample is tested TWICE First test is “indicative” only. Result is available quickly Sensitivity 99.9% Second test is confirmation of the first If result is positive, it is sent to a reference laboratory. It can take up to two weeks for final result. But……

What is the Window Period?” “Window period” is: the period of time between when a person becomes infected with HIV virus and when the virus is detectable in their blood. Example June 3/6 July 3/7 Aug 3/8 Sept 3/9 If a person is infected with HIV virus on the 3rd June, likely detection of HIV antibodies will be on September 3rd. We may advise clients to return after 3 months to have their blood test repeated.

Prevention strategies

HIV Prevention Strategies A Abstinence B Be Faithful C Condom Use D Delay sex Condom demonstration

HIV Prevention Strategies To talk about HIV openly and publicly Create community understanding “don’t underestimate the power of a strong community” Listen to the people affected-share their stories (PLWHA = People Living With HIV AIDS) The answer is here. In PNG. In this society. PNG nationals are the best ones to know how to control HIV in PNG. The talking has begun….You are now part of the HIV prevention strategy. Talk with your colleagues, your friends, your families and wantoks, your communities. If PNG is going to stop the HIV epidemic, (and it IS possible) people need to be talking about it , thinking about it and deciding to change their behavior. Community understanding and acceptance of PLWHA will help. People wont have to “hide” their status…people can seek treatment… We are very lucky to have a guest speaker with us today…. I would like to welcome xxxxxxxxxxx to come and share his experience with the group. MAKE A POINT OF SHAKING HANDS (or hug him if men do that here!)

Part 4 Stigma Discrimination

Exercise Take a minute and think about the visitor we had earlier , then answer these questions: Would you know he was HIV positive by looking at him? Write one or two words to describe what you were thinking or feeling? For example -were you scared, fascinated, disgusted, angry, sad, curious, indifferent, worried, supportive, etc etc. Collect the cards and while one person presents the other collates them into groups.

Stigma and Discrimination When the characteristics of a person or people is seen to be different and undesirable (pasin bilong daunim na bagarapim arapela) Discrimination Is when a comparison is made against a person that results in their being treated unfairly and unjustly Some examples of acts of discrimination that are against the law. Refusing to employ a person because he/she is HIV positive Refusing to grant superannuation pay out, sickness benefits or early retirement to an employee because he is sick with an AIDS related condition Breaking a contract or business partnership with a person because he is caring for a sick relative with HIV or AIDS. Evicting a family from an accommodation compound because a member is suspected of being HIV positive Refusing to serve an HIV positive person in a shop or kai bar. Rejecting a friend or family member because they are positive.

Human Rights People living with HIV/AIDS have the same rights as any other human and should be treated equally. Everyone despite their race, tribe, place of origin, political opinion, color or sex, has fundamental rights and freedom according to PNG Constitution, Sept 1975.

The HAMP Act It is against the law to treat a person affected by HIV/AIDS differently from other people in a way that disadvantages or harms them. (HAMP ACT 2003)

STIGMA Group exercise Let’s take a look at the results of our cards. Group discussion to explore what people thought about the visit?

Question time

SUMMARY Test “VCT” What is HIV? Mode of Transmission HIV NEGATIVE “for now” Prevention Abstinence Be Faithful to one partner Condom High risk behaviour Other HIV Positive “positive forever” SUMMARY Clinicians Prophylaxis Management ARV Monitoring Human rights NEW START Positive Living Condoms Treatment Love Food Health Living For many years This slide is an overview of what we have talked about today – PLWHA Choice Care and Support Emotional support Spiritual support Physical Needs Counselling Negative Living Alcohol abuse No Treatment No support Develop AIDS Illness then DEATH ADVOCACY

Review pre test answers using the tool box tool. Next steps Review pre test answers using the tool box tool.

What now? Talk about HIV in a safety toolbox meeting Using the tool provided Complete the toolbox attendance form and return it to Training department Certificate of Completion

Course Evaluation form Thank You