Adolescent Education Program

Adolescent Education Program
Training of Nodal Teachers

RESOURCE PERSONS

Some Indicative Ground Rules are Listed below
Maintain confidentiality at all times. What is shared by the group remains strictly within it. Punctuality and time management. Mutual support in maintaining timings for the training.

Compulsory attendance on all days.
Ground Rules(contd.) Compulsory attendance on all days. Openness. It is important not to disclose others’ personal or private lives. It is acceptable to discuss general situations without using names.

Ask questions one at a time and also give others a chance to talk.
Ground Rules(contd.) No interruptions. It is better to raise hands so that the Resource Person can invite the individual’s comment. Ask questions one at a time and also give others a chance to talk.

Non-judgemental approach. Do not laugh at any person.
Ground Rules(contd.) Questions can also be asked by writing them down and putting them in the Question Box in the room. Non-judgemental approach. Do not laugh at any person. Respect each other’s feelings, opinions and experiences.

Objective of the Training Programme
This three-day training programme has been designed to: Provide the rationale and framework for the Adolescence Education Programme (AEP). Build the knowledge base of Nodal Teachers (NTs) with accurate information on Growing Up, Adolescence, HIV/AIDS, Substance-Abuse, as well as the myths and misconceptions surrounding these issues.

Empower Nodal Teachers in dealing with issues of Growing-Up.
Train Nodal Teachers to transact training sessions by reinforcing skills essential for preventing HIV infections and Substance-Abuse. Empower Nodal Teachers in dealing with issues of Growing-Up. Ensure that Nodal Teachers are equipped with adequate skills to conduct an in-school, skills-based Adolescence Education Programme (AEP) in the course of the academic year.

Methods Group games Role play VIPP Group Situation guided analysis
discussion Methods Presentation Case studies Brainstorming

Setting the Context

Who are Adolescents? Growth phases: Adolescents: 10-19 years
Youth: years Young people: years Growth phases: Early adolescence: years Mid adolescence : years Late adolescence: years

Why focus on Adolescents?
Large human resource (22% population) Caring, supportive environment will promote optimum development – physical, emotional, mental.

Why focus on Adolescents?
Their behaviour has impact on national health indicators. Adolescents are vulnerable to STIs, HIV/AIDS and various other forms of abuse Health of girls has inter-generational effect.

Age structure of India’s population-2005

Comparative age structure of population-2005 Nigeria and USA

India’s demographic bonus
‘Window of Opportunity’. How can we make this a reality?

Adolescent concerns Growing Up concerns Developing an identity.
Managing Emotions. Body image concerns Building Relationships. Resisting Peer-Pressure.

What are the issues related to Adolescent Health?

Issue: Education Enrollment figures have improved but dropout rates are high – 68% from class 1 to X. (Source: NSSO, 55th round, 2001). Gender disparities persist - girls enrollment less than 50 % at all stages Young people not at school join the workforce at an early age – nearly one out of three adolescents in yrs is working. (Source: Census 2001).

Issue: Education(contd.)
Quality of education is poor-students are not equipped with skills to face life challenges Please reflect on How can we make education useful in handling day-to-day issues?

Issue: Marriage Despite laws prohibiting marriage before 18 years, more than 50% of the females were married before this age. (Source: Census 2001). Nearly 20% of the 1.5 million girls who were married under the age of 15 years are already mothers. (Source: Census 2001). Choices are limited as to: whether, when and whom to marry; when and how many children to have.

Issue: Marriage(contd.)
Please reflect on How can you contribute to prevent early marriages? What can we do to equip young people to have children by choice, not chance?

Issue: Health Adverse sex ratio years: 882/1000, 0-6 years: 927/1000. (Source: Census 2001). Malnutrition and anaemia - boys and girls below 18 years consume less than the recommended number of calories and intake of proteins and iron. Higher female mortality in the age group of years.

Issue: Health Please reflect on
For rape victims in the age group of years, a majority of the offenders are known to victims. More than 70% girls suffer from severe or moderate anaemia (Source: District Level Health Survey – Reproductive and Child Health, 2004). Please reflect on How can we improve the nutritional status of Adolescents?

Issue: HIV/ AIDS There are 2 – 3.1 million (2.47 million) people living with HIV/AIDS at the end of 2006. Number of AIDS cases in India is 1,24,995 as found in 2006 (Since inception i.e to 2006). (Source: naco.india.org) 0.97 million (39.3%) are women and 0.09 million (3.8%) are children

Issue: HIV/ AIDS(contd.)
India – 2nd largest population of HIV positive persons infected. Over 35% of all reported HIV cases are in the age group of years (NACO). India has the second largest population of AIDS patients. Over 35% of all reported AIDS cases occurs among year olds. {Source: NACO and UNICEF, Knowledge, attitudes and practices for young adults (15-24 years; NACO India Resolves to Defeat HIV/AIDS)}.

Issue: HIV/ AIDS(contd.)
Lack of abstinence is a contributory cause. Persons living with HIV/AIDS face stigma and discrimination. The estimated adult prevalence in the country is 0.36% (0.27% %).

Issue: Substance Abuse
Estimated number of drug abusers in India is around 3 million and that of drug dependents is million. (Source: UNODC and Ministry of Social Justice and Empowerment, 2004) Problem is more severe in the North-Eastern States of the Country.

Issue: Substance Abuse(contd.)
Most drug users are in the age group years. Drug abuse rate is low in early Adolescence and high during late Adolescence. Among current users in the age group of years, 21% were using alcohol, 3% cannabis and 0.1% opiates (NHS-UNODC 2004).

Issue: Substance Abuse(contd.)
A Household Survey on Drug Abuse indicated that 24% of 40,000 male drug users were in the age group of years. (Source: UNODC and Ministry of Social Justice and Empowerment, 2004) Please reflect on How can we reduce the vulnerability of young people to Substance - Abuse?

Salient Findings on Study on CHILD-ABUSE
Two Out of every three children were Physically-Abused. Out of 69% children Physically-Abused in 13 sample states, 54.86% were boys. Over 50% children in all the 13 sample states were being subjected to one or the other form of Physical-Abuse.

Salient Findings on Study on CHILD-ABUSE(contd.)
Out of those children Physically-Abused in family situations, 88.6% were Physically-Abused by parents. 53.22% children reported having faced one or more forms of Sexual -Abuse. Andhra Pradesh, Assam, Bihar and Delhi reported the highest percentage of Sexual-Abuse among both boys and girls.

Salient Findings on Study on CHILD-ABUSE(contd.)
21.90% child respondents reported facing severe forms of Sexual-Abuse and 50.76% other forms of Sexual-Abuse. Out of the child respondents, 5.69% reported being sexually assaulted. In matters of Sexual-Abuse, 50% abusers are persons known to the child or in a position of trust and responsibility. Most children did not report the matter to anyone.

Vision for Healthy and Empowered Adolescents
Through information, education and services adolescents are empowered to: Make informed choices in their personal and public life promoting their creative and responsible behaviour.

Empowering adolescents
Provide opportunities for making informed choices in real life situations. Improve adolescent-friendly health services and link with existing programmes. Provide education and build life skills. Create a safe and supportive environment.

Adolescence Education Programme (AEP)
Upscaled to Adolescence Education as a component of National Population Education Programme(NPEP)

Objectives of AEP To develop essential value enhanced Life-Skills for coping and managing concerns of adolescence through co-curricular activities (CCA). To provide accurate knowledge to students about process of growing up, HIV/AIDS and Substance-Abuse.

Objectives of AEP To develop healthy attitudes and responsible behaviour towards process of growing up, HIV/AIDS and Substance-Abuse. To promote respect for the opposite sex and deal with gender stereotypes.

Process of Growing Up Nutritional needs of Adolescents in general and Adolescent girls in particular. Physical growth and development.

Process of Growing Up Psychological development.
Adolescent Health Issues (AHI) Gender sensitisation.

HIV / AIDS HIV/AIDS: Causes and consequences. Preventive measures.
Treatment: Anti-Retroviral Therapy (ART).

HIV / AIDS Individual and social responsibilities towards people living with HIV/ AIDS (PLWHA). Services available for prevention of the spread of HIV, and of HIV infected persons and also of drug abusers.

Substance Abuse Situations in which Adolescents are driven to Substance-Abuse. Commonly abused Substances. Consequences of Substance-Abuse.

Substance Abuse Preventive measures. Treatment.
Rehabilitation of drug addicts. Individual and Social-Responsibilities.

APPROACHES CURRICULAR CO-CURRICULAR Students Teachers

Co-Curricular Approaches
STRATEGIES Interactive Activities Teacher Counseling Peer Education

Interventions for Co-curricular Activities
Advocacy Capacity building of Teachers/Peer Educators Student activities Health services – Counselling and referrals to Adolescent-Friendly Health Services

School-level Activities
Time: Minimum of 16 hours per academic year (more than 16 hours, wherever feasible). Training: At least two Nodal Teachers and two Peer-Educators per school are trained along with a plan of action for schools to conduct activities by teachers. Advocacy activities at the school and community levels. Conducting sessions by organising interactive activities.

School-level Activities(contd.)
Using Question-Box activities and responding to questions raised by students. Training Peer-Educators and students to reach out to children who have dropped out or were never enrolled in school. Strengthening linkages with Adolescent/Youth-Friendly Health Services.

Effective implementation of the programme is the key to its success

Perspective Building on Life Skills Development

Life- Skills: Definition
Life-skills are abilities for adaptive and positive behaviour that enable individuals to deal effectively with the demands and challenges of everyday life. Life-Skills are abilities that Facilitate the Physical, Mental and Emotional well-being of an individual. (WHO)

Interpersonal relationships Effective communication
LIFE SKILLS Self-awareness Empathy Critical thinking Creative thinking Decision making Problem solving Interpersonal relationships Effective communication Coping with emotions Coping with stress

Cont… In particular, life skills are psychosocial competencies and interpersonal skills that help people make informed decisions, solve problems, think critically and creatively, communicate effectively, build healthy relationships, empathise with others and cope with managing their lives in a healthy and productive manner. Life skills may be directed towards personal actions or actions toward others or may be applied to actions that alter the surrounding environment to make it conducive to health.

Self-Awareness Self-awareness includes our recognition of ‘self’, of our character, of our Strengths and Weaknesses, Desires and Dislikes. Developing Self-Awareness can help us to recognise when we are stressed or feel under pressure. It is also often a prerequisite to Effective-Communication and Interpersonal - Relations, as well as developing empathy for others.

Critical- Thinking Critical -Thinking is the ability to analyse information and experiences in an objective manner. Critical-Thinking can contribute to health by helping us to recognise and assess the factors that influence attitudes and behaviour, such as values, Peer-Pressure, and the media.

Problem- Solving Problem solving enables us to deal constructively with problems in our lives. Significant problems that are left unresolved can cause mental stress and give rise to accompanying physical strain.

Creative Thinking Creative-Thinking contributes to both Decision-Making and Problem-Solving by enabling us to explore available alternatives and the various consequences of our actions or non-action. It helps us to look beyond our direct experience, and even if no problem is identified, or no decision is to be made, Creative -Thinking can help us to respond adaptively and with flexibility to the situations of our daily lives.

Decision Making Decision-Making helps us to deal constructively with decisions about our lives. This can have positive consequences for the health of young people when they actively make decisions about their own health practices by assessing different options and the effects of different decisions.

Other Life Skills Interpersonal-Relationship Skills help us to relate to the people we interact with in positive ways. This means being able to make and sustain friendly relationships, which can be of great importance to our mental and social well-being. It means keeping good relations with family members, who are an important source of social support. It may also mean being able to end relationships constructively. Effective-Communication means that we are able to express ourselves, both verbally and non-verbally, in ways that are appropriate to our cultures and situations. This means not just being able to express opinions and desires, as well as needs and fears. And it may mean being able to ask for advice and help in time of need.

Empathy is the ability to imagine what life is like for another person, even in a situation that we may not be familiar with. Empathy can help us to understand and accept others, who may be very different from ourselves. This can improve social interactions, for example, in situations of ethnic or cultural diversity. Dealing with Emotions includes skills for increasing the internal locus of control for managing emotions, anger etc. Coping with Stress means that we take action to reduce the sources of stress, for example, by making changes to our physical environment or lifestyle. It also means learning how to relax, so that tensions created by unavoidable stress do not give rise to health problems.

Framework of Life Skills for AEP
Thinking Skills Self awareness Problem solving/decision making Critical thinking/creative thinking Planning and goal setting Social Skills Interpersonal relationships Effective Communication Cooperation & teamwork Empathy building Negotiation Skills Managing feelings / emotions Resisting peer / family pressure Consensus building Advocacy skills

EFFECTIVE COMMUNICATION
Critical Thinking Empathy Creative Thinking

Interpersonal Relationship
Self Awareness Effective Communication Empathy

Key Messages The various Life-Skills work best in conjunction.
Many Life-Skills are required to manage a particular situation effectively. One particular skill may be effectively utilised in diverse situations. The appropriate combination of Life-Skills at a given moment is an art.

Cont…. Adolescents learn their Life-Skills from Parents/Teachers/Significant others who act as role models. Stories from PANCHATANTRA and JATAKA TALES are based largely on effective utilization of Life-Skills, e.g., “The Thirsty Crow”, “The Clever Rabbit”, etc. Participants would need to recognize and enhance their own Life-Skills to become effective Facilitators.

Healthy Growing up – Understanding Adolescence

Adolescence Adolescence is the period between childhood and adulthood.
Boys and girls between 10 and 19 years are called “adolescents”. Persons in the age group 15 – 24 years are called “youth”.

Adolescence Persons in the age group 10 – 24 years are called “young people”. “Puberty” is the name given to the changes that occur in girls and boys as they grow up.

Health Health is the state of complete physical, mental and social well-being and not merely an absence of disease or infirmity. (WHO)

Health Physical well-being refers to the normal functions of the body and body organs within the limitation of gender, age and occupation.

Health Mental well-being refers not only to the absence of mental illness but also to the awareness of one’s talents, abilities, emotions, strengths and weaknesses.

Health Social well-being refers to one’s ability to interact with, and adjust to other members of society. It also means being responsible towards oneself, one’s family, community and country.

Health The spiritual component of health is now considered an important integral part of well being.

Physical Changes in Girls
Growth spurt occurs. Skin becomes oily. Ovulation occurs (may or may not). Menstruation begins. Waistline narrows

Physical Changes in Boys
Growth spurt occurs. Muscles develop. Skin becomes oily. Shoulders broaden.

Physical Changes in Boys(contd.)
Voice deepens. Underarm and chest hair appear. Facial hair appears. Sperm production begins.

Emotional and Social Changes
Preoccupation with body image. Fantasy and idealism. Mood changes. Attention-seeking behaviour.

Emotional and Social Changes(contd.)
Need to establish own identity. Inquisitiveness. Increased energy levels. Changes in dress code.

Concrete-Thinking, but confused at times. Future-Oriented. Increased self exploration and evaluation. Conflicts with family over control.

Need for attachment to a peer group. Peer group defines behavioural code. Formation of new relationships. Need for independence, self assertion and urge for expression

Key Messages The quest for information about changes and its impact starts as early as class 3 or age 8. Questions across generations are similar. Children are receiving information directly or indirectly. It is important to ensure that they receive right information, at the right time and from the right source.

Key Messages(contd.) In the current context, lack of authentic and complete information will only make young people more vulnerable to high-risk behaviours such as exposure to HIV/AIDS and Substance-Abuse.

Analysis of Advertisements for developing good nutrition practices
Key Message Adolescents need to understand that there are certain food items which can be labeled as “good” and some as “bad” for their help.

Self Esteem – Case studies
Case A Ritu is a schoolgirl who, since childhood, has always felt ashamed of her dark complexion. Her mother makes her apply curd, milk and turmeric to lighten her skin, but nothing seems to have any effect. Her friends and her sister are fairer than her and she feels uneasy going out with them. Is it her fault that she is dark?

Self Esteem – Case studies
Case B Rahul is a 16-year-old boy and a student of standard X. His problem is that he is shy and not comfortable in making friends. All his friends call him a bookworm, and he feels that his only image amongst people is of a bookworm. This embarrasses him a lot; he loses Self-Confidence and can’t concentrate fully on his studies. He feels the lack of friend and has lost interest in everything. Such thoughts of inadequacy remain uppermost in his mind. He often wonders why this is happening to him.

Children learn what they live
If children live with criticism, they learn to condemn. If children live with hostility, they learn to fight. If children live with ridicule, they learn to be shy. If children live with praise, they learn to appreciate. If children live with fairness, they learn justice. If children live with security, they learn to have faith.

Children learn what they live
If children live with shame, they learn to feel guilty. If children live with tolerance, they learn to be patient. If children live with encouragement, they learn confidence. If children live with approval, they learn to like themselves. If children live with acceptance and friendship, they learn to find love in the world.

Key Messages No matter what the disability, what the situation or personal issues are, each person is precious, has specific personal attributes, is valued, has equal rights and dignity and is as worthy of respect as any other person. It is essential for all young people/adults to have a sense of appreciation and respect for self.

Key Messages(contd.) Only when we respect ourselves, others will respect us. Life is the first gift we receive. It is the most basic and fundamental gift. We have to live our life to the best of our ability, develop it to its full potential, protect it from physical and moral danger, and from any physical abuse. Our body is like a temple and no body has right to violate it.

Sunita Case Study 16-year-old Sunita studies in class XI. Of late, she gets angry and irritable over every small issue, tends to avoid family members and does not meet her friends. Unable to bear the stress any longer, she breaks down and tells her best friend that her neighbour has recently physically abused her. She fears that abuse may recur. She is hurt, depressed, anxious and fears that she may be put into a very embarrasing situation including pregnancy.

Consequences of Sunita's situation
Family problems. Social and community problems. Education problems. Psychological problems. Health problems. Depression. Problems for the baby. Associated RTI/STI and HIV/AIDS, if any. Effect on future pregnancies. Complications of unwanted pregnancy.

My Value System - Key Messages
Boys and girls are socialised into different roles and often have different social beliefs. Each person needs to be able to sort out and make clear what his or her personal values, beliefs and feelings are. Our values are what “we think” is right and wrong. It is important for a Facilitator to respect the beliefs and opinions of the participants and be non-judgemental. Peer-Pressure and social pressure may compel us into certain actions which are contrary to our belief system.

Giving Positive strokes
Giving Positive strokes elevates the level of happiness in an Individual. It Gives a feeling of well being which has positive manifestition for the individual for the family and the society.

Key Messages Positive Strokes make one feel good about one self.
It also makes you feel good when you say nice things to others. Feeling good makes you behave in a more positive manner in every day situations.

Johari Window – Key Messages
As physical changes occur in Adolescents, they also experience changes in their feelings. The best relationships result from both people contributing to the positive qualities. A good relationship requires mutual trust, commitment, give and take, maturity and adjustment. Adolescents need to learn to regulate their feelings in a friendship. It is important to communicate to adolescents that they are responsible for the decisions and actions they take. A good friend should be trustworthy, reliable, empathetic, caring.

Understanding gender Gender refers to the socially determined personal & psychological characteristics associated with being male or female: masculinity & femininity Gender stereotype is any biased generalization according to which people are wrongly assigned traits they do not possess & also extends it to all spheres of activity. Gender exploitation: When the sex of the individual is reiterated & used to promote products/ideas in a gender-irrelevant situation

Key Messages Many myths and misconceptions about roles and responsibilities in the area of social interaction, gender etc. exists. These are usually gender biased and result in unfair disadvantages to girls and women.

Key Messages They are outdated and have to be corrected.
Gender related discrimination against girls and women are deep rooted in our culture and society. We can and should all do our best to promote the idea of equity and equality.

Sexual Abuse Raghav, a student of Class IX, constantly bunked his class and was always found in the primary block of the school. The disturbing part was his association with boys of classes VI or V, who were always scared of him and reported the same to the principal.

The school watchman frequently touches and pets girls, sometimes brushes their chest and does other such things that make them uncomfortable and angry.

Discussion Questions Should any action be taken and if so what?
Suppose the abuser is a teacher, parent or the boss at work or senior school mate or a close relative : what action if any, can be taken?

Key Messages Several instances of Sexual-Abuse and Sexual-Harassment take place around us everyday. This is one of the problems in our communities that have to be tackled by us.

Reproductive Tract Infections (RTIs), Sexually Transmitted Infections (STIs) & HIV/AIDS

RTIs STIs STIs are RTIs transmitted during sexual activity.
These are infections of the reproductive tract in both males and females. All RTIs are not sexually transmitted. Some may occur due to imbalance of the normal bacteria in the reproductive tract. Agents of infection are bacteria, viruses or protozoa STIs are RTIs transmitted during sexual activity. Some of them have no cure.

Common STIs Chlamydia. Chancroid. Genital warts. Gonorrhoea.
Hepatitis B and C. Herpes simplex. Syphilis HIV which leads to AIDS. The germs or virus that causes these diseases are all very small and cannot be seen with the naked eye. They can be diagnosed through medical examination and various laboratory procedures.

Consequences of Untreated STIs
Infected persons can transmit STI to their partners. The reproductive organs of the infected person could get damaged, resulting in infertility or sterility. A pregnant woman can transmit it to her baby, resulting in the infant suffering from congenital defects/malformations, deafness or blindness.

Consequences of Untreated STIs
There is increased vulnerability to HIV. There are increased chances of cervical cancer. Repeated abortions or even foetal death could take place.

Prevention & Treatment of STIs
Improving knowledge of RTIs/STIs via adolescent health education. Maintaining proper genital hygiene; girls should also maintain good menstrual hygiene. Practising abstinence

Prevention & Treatment of STIs
Not neglecting any unusual discharge. Seeking medical help immediately. Avoiding quacks.

Key Messages Both girls and boys should practise proper pubic hygiene to prevent RTIs. Girls should follow proper menstrual hygiene to prevent RTIs. It is important to remember that the symptoms of RTIs/STIs may go away after some time even without treatment, but the disease remains in the body and causes damage to the reproductive tract. Hence all RTIs/ must be treated adequately and early.

Key Messages STIs increase vulnerability to infections such as HIV.
Qualified doctors are the only ones who can give a guarantee of care. Self-medication and quacks do more harm than good and therefore should be avoided. STIs increase vulnerability to infections such as HIV. Abstinence is the best form of protection from STIs/HIV.

Let’s discuss – HIV / AIDS
HIV is: Human Immunodeficiency Virus Hence, HIV is present only in humans.

Immune System In healthy individuals, infections are kept at a distance through an array of defenders which constitute the immune system in the body.

Immune System White blood cells are an important part of this defence, which fight and destroy the infection-causing bacteria and viruses. HIV directly attacks, enters and stays inside these white blood cells. Slowly, the number of white blood cells in the body is reduced and the immune system is paralysed.

Modes of HIV Transmission
Infected blood – blood transfusions with untested blood. Infected equipment – needles / instruments / syringes.

Modes of HIV Transmission (contd.)
From an infected mother to her unborn child. Unprotected sexual activity when one of the partners is infected with HIV. Hence, it is a STI.

HIV and Young People Six young people are infected every minute with the HIV virus. Half of all new HIV infections worldwide are among young people aged years. Those affected are likely to die of AIDS before they turn 35.

HIV and Young People (contd.)
In some of the hardest-hit countries, adolescent girls are five to six times more likely to be HIV positive than their male counterparts due to various factors.

Factors that put young people at risk
Curiosity about sex. Limited information on growing up and sexuality issue. Early marriages. Experimentation with alcohol and drugs.

How one can tell if a person is HIV Positive?
A person living with HIV may NOT show any external signs of the infection, he/she may continue to be healthy but can infect others.

How one can tell if a person is HIV Positive?(contd.)
The only way to find out if one has HIV is to have an HIV test. This is done at a hospital or clinic and should involve being counselled about HIV infection. The test requires a person to give a sample of blood which is tested for the antibodies produced by the body to fight HIV.

Different types of tests used for HIV Detection
Rapid Test / Spot Test ELISA [Enzyme Linked Immunosorbent Assay] Western Blot PCR-DNA (Polymerase Chain Reaction - Deoxyribonucleic Acid) The Elisa/Rapid/Spot Tests are screening tests that need to be confirmed by Western Blot Test. They detect antibodies of HIV. PCR-DNA detects the presence of the virus.

Integrated Counselling and Testing Centres (ICTCs)
A person can get tested for HIV at a general hospital or Integrated Counselling and Testing Centres (ICTC) or any medical centre that provides these facilities.

Integrated Counselling and Testing Centres (contd.)
ICTCs provide pre- and post-HIV test counselling to understand the need for testing as well as the test results. Counsellors are bound by confidentiality – that means that whatever is disclosed should not be shared or discussed with others.

Progress of HIV in the body.
Entry of virus in the body through any of the four routes. 6 Weeks – 6 months. [appearance of antibodies] No symptoms 5–10 yrs. Uncontrolled diarrhea and fever, Unexplained weight loss, general weakness, enlarged lymph nodes, skin infections & opportunistic infections HIV Infection Window period Silent Infection AIDS

AIDS results from HIV infection
Acquired: Not genetically inherited but contracted from somebody. Immune Deficiency: Inadequacy of the body’s main defense mechanism to fight external disease producing organisms. Syndrome: Not just one disease or symptom, a group of diseases or symptoms present in the body.

Difference between HIV & AIDS
HIV+ means that the person has been infected with HIV. Being HIV+ does not mean that a person has AIDS. AIDS is the advanced stage of HIV infection.

Difference between HIV & AIDS (contd.)
A person is said to have AIDS when the immune system is completely destroyed & potentially opportunistic infections invade the body. An HIV+ person can appear healthy and carry out most day-to-day activities.

Signs & Symptoms of AIDS
As the person’s immune system starts getting weak, signs and symptoms of AIDS develop. These can be: Weight loss greater than 10% of previous body weight. Fever longer than one month. Diarrhoea longer than one month. Persistent severe fatigue. Repeated infections.

Signs & Symptoms of AIDS (contd.)
These symptoms can also occur in people who do not have HIV infection. However, when several of these occur at the same time in the same person and are persistent, they may indicate the development of AIDS and need to be investigated.

Prevention There is a lot that young people/adults can do to protect themselves from HIV infection: Practice abstinence. Learn the facts about growing up and HIV/AIDS. Clarify doubts and fears.

Prevention(contd.) Resist peer pressure to engage in sexual activities. Avoid substances such as alcohol and drugs, which cloud one’s judgement and make one prone to risky behaviour.

Prevention(contd.) Sterilise any instruments that pierce the skin, such as needles and syringes. Test all blood being used before transfusion; it should be certified HIV free.

Prevention(contd.) Pregnant women should get themselves tested; treatment that will prevent mother to child transmission is now available in all government medical hospitals; if necessary, seek treatment. As adolescents: abstinence till marriage. As adults: faithfulness to one’s partner.

Key Messages Everyone is vulnerable – especially young people. Global data shows that 50% of all new infections occur in the 15–24 year age group and 35% of all reported new infections in India are in the 15–29 year age group. Young people are at the centre of the epidemic.

Key Messages(contd.) Learn to protect yourself, and dispel myths about HIV. Remember, HIV is preventable. A person living with HIV may not show any external signs of the infection, he/she may continue to be healthy but can infect others.

Key Messages(contd.) The only way to find out if a person has HIV is to have an HIV test. This is done at a hospital or clinic and should involve being counselled about HIV infection. The test requires the person to give a sample of blood, which is tested for the antibodies produced by the body to fight HIV.

Key Messages(contd.) For every person with AIDS, there are many more who are infected with HIV but have no visible symptoms. There is an important distinction between infection with HIV and AIDS (the late stage of the infection).Being HIV+ does not mean that the person has AIDS.

Key Messages(contd.) Even if the HIV tests are negative, the person should take preventive measures in the future. It has been difficult to develop a cure or vaccine, because the HIV virus hides inside the very cells that are supposed to attack such viruses.

Assessing the Risk of HIV Transmission Key Messages
How HIV is not transmitted The virus can live only inside a living human body and survives for just a few minutes outside it.. Therefore, it is not an air-borne disease. HIV cannot be transmitted through saliva, tears, vomit, faeces and urine, although very small amounts of the virus have been found in these fluids. HIV has not been found in sweat

How HIV is not transmitted(contd.)
HIV cannot pass through unbroken skin and is not spread through casual contact such as touching someone with HIV, or something they have used; sharing food or drink, using the same utensils; or using the same toilet seats or washing water.

How HIV is not transmitted(contd.)
Nursing or caring for someone with HIV is not risky if sensible precautions are followed, such as the safe disposal of sharp needles and keeping cuts covered. HIV is not transmitted by mosquitoes or other blood-sucking insects because the virus cannot survive in their bodies.

Attitudes – AIDS: Creating Empathy
Individuals living with HIV/AIDS need just as much of our support and understanding as those with any other life threatening illness. Persons living with HIV/AIDS need to be respected and treated with dignity. It is possible for them to lead a reasonably normal and healthy life.

Attitudes – AIDS: Creating Empathy
They have a right to education, accurate information, friendly health services, along with support and understanding from the community. They need the following: Love & support from family & friends. Prompt treatment of opportunistic infections. Healthy life style. A nutritious diet, sufficient rest & exercise.

Preventing Substance Abuse Know The Facts

Drugs A drug is a chemical substance that changes the way our body works. When a pharmaceutical preparation or naturally occurring substance is used primarily to bring about a change in some existing process or state, it can be called a ‘drug’.

Substance Abuse Substance abuse is “The use of illicit drugs or the abuse of prescription or over-the-counter drugs for purposes other than those for which they are indicated or in a manner or in quantities other than directed.”

Substance Dependence Substance dependence is defined as “compulsively seeking to use a substance, regardless of the potentially negative social, psychological and physical consequences.” Substance abuse leads to substance dependence with the development of tolerance and withdrawal.

Substance Dependence(contd.)
Tolerance is defined as a need for increased amount of substance to achieve intoxication or the desired effect. Withdrawal symptoms occur when the user who is dependent on a substance stops using it. They range from mild tremors to convulsions, severe agitation and sometimes death. Withdrawal symptoms vary depending upon the substance abused, the duration of the use of substance and the quantity abused.

Signs & symptoms Feeling that one needs the substance on a regular basis to have fun, relax or deal with one’s problems. Giving up familiar activities such as sports, homework or hobbies. Sudden changes in work or school attendance & quality of work or marks.

Signs & symptoms(contd.)
Doing things that a person normally wouldn’t do to obtain the substance, such as frequent borrowing of money or stealing items from employer, home or school. Taking uncharacteristic risks, such as driving under the influence Anger outbursts, acting irresponsibly and overall attitude change.

Deterioration of physical appearance and grooming. No longer spending time with friends who don’t use substances and/or associating with known users. Engaging in secretive or suspicious behaviours such as frequent trips to the toilet, keeping room and things locked, always going out of the house at particular hours, excessive resistance in giving an account of movements, etc.

Feel the need to use greater amounts of the substance of choice to achieve the same effects. Talking about the substance all the time and pressuring others to use. Feeling exhausted, depressed, hopeless, or suicidal.

Substances of Abuse Cannabinoids (e.g., hashish, charas and marijuana). Stimulants (e.g., amphetamines and cocaine, nicotine, tobacco). Depressants (e.g., alcohol, barbiturates, methaquolone etc.)

Substances of Abuse(contd.)
Narcotics (opioids and morphine derivatives, e.g., heroin, opium). Hallucinogens (e.g., LSD and mescaline). Other compounds (e.g., steroids and inhalants).

Gateway Drugs The commonly abused substances among adolescents are tobacco and alcohol, which act as gateway to the use of other drugs.

Harmful effects of smoking cigarettes
Diminished or extinguished sense of smell and taste. Smoker’s cough. Gastric ulcers. Chronic bronchitis. Increase in heart rate and blood pressure. Premature and more abundant face wrinkles. Heart disease. Stroke. Cancer of the mouth, larynx, pharynx, oesophagus, lungs, pancreas, cervix, uterus, and bladder.

Harmful effects of smoking cigarettes
Cigarette smoking is perhaps the most devastating preventable cause of disease and premature death. Smoking is particularly dangerous for teens because their bodies are still developing and changing and the 4,000 chemicals (including 200 known poisons) in cigarette smoke can adversely affect this process.

Harmful Effects of Alcohol Abuse
Long-term effects Loss of appetite. Vitamin deficiencies. Stomach ailments. Skin problems. Liver damage. Heart and central nervous system damage Memory loss. Short-term effects Distorted vision, hearing, and coordination. Altered perceptions and emotions. Impaired judgement. Bad breath. Hangovers.

Harmful Effects of Other Substances of Abuse
Cannabinoids Frequent respiratory infection, impaired memory and learning, increased heart rate etc. Stimulants Rapid or irregular heart beat, reduced appetite, weight loss, panic, paranoia, aggressiveness, damage to respiratory areas etc. Depressants Fatigue, confusion, impaired coordination, respiratory depression and arrest, death etc.

Harmful Effects of Other Substances of Abuse(contd.)
Narcotics Nausea, unconsciousness, coma, death, etc. Hallucinogens Persisting perception disorder, sleeplessness, etc. Inhalants Unconsciousness, cramps, weight loss, memory impairment, damage to cardiovascular and nervous system etc.

Psycho-social Complications of Substance Dependence
Financial Spending money on substance instead of essential needs; exhausting savings; borrowing money, etc Occupational Inefficiency due to decreased performance; unpunctuality; fights, quarrels, thefts; absenteeism; accidents at work place; suspension, etc. Familial Arguments over substance use; neglect of family obligations; quarrels and physical violence; divorce; ostracism by family, etc.

Psycho-social Complications of Substance Dependence(contd.)
Peer alienation; arguments, fights; decreased social reputation, etc. Legal Violation of rules; thefts and petty crimes; arrests and court cases.

Why are Adolescents Vulnerable?
Personal Factors False beliefs and perceptions about the benefits of Substance-Abuse. Lack of knowledge of consequences. Feeling of enhanced Self-Efficacy. Personality factors, e.g., depression, low Self-Esteem. False sense of psychological well-being.

Behavioural factors Adolescents: Tend to be heavier and more frequent users of Substances than adults. Often use more than one Substance. With poorer academic achievement are statistically at higher risk for Substance Abuse.

Behavioural factors(contd.) Adolescents: Tend to engage in more high-risk behaviours than adults. Often lack well-developed self-control and may behave more impulsively than adults. Experiment out of curiosity.

Environmental factors Attitudes and values of parents and peers in support of Substance -Abuse. Parental, sibling and peer use of Substances. Advertising and media glamorisation of Substances. Easy accessibility of Substances.

Environmental factors(contd.) Social and cultural norms accepting Substance-Abuse. Factors such as low socio-economic status are statistically related to the tendency to use Substances. Physiological factors Developing brains and bodies are more sensitive to drugs.

Protective Factors Individual Family Peer Group
High Self-Esteem; high intelligence; optimistic about future; coping skills; belief in self, expectations, norms and values. Family Strong parent and youth attachment; consistent discipline and supervision; no family history of Substance-Abuse. Peer Group Non-Substance Abusers; have conventional values and shared interests.

Protective Factors(contd.)
School Connectedness; quality school with opportunity to succeed. Community & Society Health, support and recreational facilities; safe neighbourhood; connectedness to culture, religion, etc.

Treatment and Rehabilitation
Interventions are multimodal and planned. Treatment goals Achieve and maintain abstinence from the drug. Relieve him/her of adverse health and psycho-social consequences of substance use. Prevent relapse into the habit. Adequate support and participation of family members is a must to help recovery and maintain a drug free lifestyle.

Common Myths about Drug Intake
FACTS There is no harm in trying drugs just once. Almost all drug addicts start by trying just once. Drugs alter the metabolism of our brain and body. Once the drug is taken, the user is always at risk to increase the drug intake, which becomes a part of his/her habit. Alcohol promotes good sleep. People dependent on alcohol cannot sleep well without it. Those who do not use alcohol regularly may have disturbed sleep after alcohol consumption.

FACTS Will - power alone can help a drug addict stop taking drugs. A person dependent on Substances is suffering from a disease, not just from a failure of will-power. He or she requires medical and psychiatric treatment. Alcohol helps people to forget their problems. This has become a ‘truth’ because regular and heavy alcohol users often use this excuse for their drinking. Very often the opposite is found to be true – people bring up forgotten problems only when they are intoxicated. Alcohol only adds on other problems.

FACTS Most addicts get their first dose of drugs from a peddler or a pusher Most of the addicts get their first dose of drugs from a friend or close associate.

FACTS Beer is not ‘hard liquor’ and can be consumed safely. Beer is an alcoholic beverage, although it contains less alcohol than hard liquor like whisky or rum. Beer contains 4% to 8% alcohol. One 285 ml bottle of beer is equal to a peg of whisky; thus, drinking six such bottles of beer in an evening, is equivalent to consuming six pegs of whisky.

Influence of advertising media on drinking & smoking
What attracts you in these ads.? What message seems to run through all the advertising? What influence will such ads. for alcohol & cigarettes have on you & other people? Do these ads. fail to tell us the negative aspects? If so what are they? How do you feel about the ads? Is it right to have such ads?

Key Messages Commonly Abused Substances among Adolescents are tobacco and alcohol, which act as gateways to the use of other drugs. Substance dependence involves tolerance, withdrawal and disruption of psychological, occupational and social functioning. There are severe financial, occupational, familial, social and legal consequences of Substance dependence.

Key Messages(contd.) Factors which make Adolescents vulnerable to serious Substance-Abuse are poor Self-Esteem, family history of Substance-Abuse, low achievement at school, family instability, history of abuse and aggressive / impulsive personality. No one starts taking Substances with the aim of getting addicted. However, these Substances have such brain-altering properties that, after a point of time, a person loses control and becomes addicted to them.

Let’s know-Peer Pressure Key Messages
Peer pressure is a part of life. Peer pressure can be negative or positive. Acting under the influence of negative peer pressure can often have detrimental consequences for one’s life. Peer pressure may compel us into certain actions which are contrary to our personal values. Therefore it is important to choose friends or peers who share our values and beliefs. Positive peer pressure can be used for bringing about desirable change.

It is important for adolescents to communicate in an assertive manner.
This can help them to stand firm and resist external attempts to mould thoughts and behaviours. Assertive communication leads to greater selfconfidence and control and evokes respect from other. Passive behaviour leads to feelings of helplessness, anxiety, disappointment and a violation of your rights. An aggressive style can lead to feelings of anger, frustration; you win at the expense of others.

Ways to say “No” Polite refusal. Give reason. Broken record.
Peer pressure (situations young people may encounter) Strategies that can be adopted Possible answers “Would you like to come to the cinema?” Polite refusal. “No, thanks, “How about a drink?” Give reason. “I don’t like alcohol – it tastes horrible.” “Here, smoke this cigarette with me.” “Come on!... We always do fun - things together.” “Just try it.” Broken record. “No thanks.”... “No thanks”….

Peer pressure (situations young people may encounter)
Strategies that can be adopted Possible answers “Hey, do you want to try some alcohol – it will give you a high – it really makes you feel good.” Walk away. Say “No” and walk away while you are saying it. “Do you want to watch some adult movies tonight?” Cold shoulder. (NB: Not the best strategy to use with close friends). Keep going as if you did not hear the person. “Will you come with me for a night-show movie? Aren't we grown up?” Give an alternative. “I’d rather stay home – why don’t you come join my family with me for dinner. We can watch the movie on T.V. – it is a really nice movie”

“Come on, just spend some time alone with me.”
Reverse the pressure (change the topic). “What did I just tell you? Weren’t you listening?” “There is nothing harmful in this, do it for my sake. I do so much for you, won’t you do this one thing just for me?” Owning your feeling. “I am not comfortable doing this, it makes me unhappy. Would you like me to do something that made me unhappy?” Explicit high-risk situations such as smoking, drinking etc. Avoid the situation. If you know of people or situations where you’re likely to be pressurized into doing things you don’t want to, stay away from them, such as parties where you know these things will definitely happen. Strength in numbers. Associate with people who support your decision not to drink, not to use drugs, or watch adult movies, etc.

Coping with stress Key Messages
Everyone experiences stressful situations in life. There are healthy and harmful ways to deal with stress. Sharing feelings with a trusted person is healthy. If feelings are not expressed or shared, then pressure builds up inside the person and the effects can be harmful.

Coping with stress Key Messages(contd.)
It is essential to Analyse how stress affects our lives. Find ways to control levels of stress. Learn to relax. Not indulge in self pity. Learn to accept failures and find alternatives. Focus on strengths – the positive components of life and self.

Anger Reducing Technique- Get RID of Anger
R – Recognise your anger signals and accept that you are angry. I - Identify a positive way to analyse the situation D - Do something constructive to calm down. Count to 10. Take a deep breath. Ask for time to calm down. Leave the scene.

Cont… Talk about your feelings with someone not involved.
Listen to music. Exercise or do some physical activity. Write –and then destroy –a letter to the person. Explain how angry you are. Help someone else. Watch a funny movie. Spend time on your favorite hobby. Do something creative.

Tips on Facilitation

Facilitation vs Teaching
Paradoxes are appreciated There is no place for paradoxes The experiences of the participants are valued. The experiences of learners are most valued for introduction of the topic Empathy is the key. No scope for Empathy. The Facilitator is one with the participants. The Teacher is a superior being. More teaching is achieved by teaching less. To teach more, the quantum of teaching has to increase

The child as participant is respected and encouraged. No scope for such a thing Learning takes place in circles and straight lines. Learning is unidirectional The Facilitator discovers himself/ herself as much as the participants. Participants’ persona is not important Contents undergo adjustment and even change with the spontaneity of the moment. Contents are rigid and cannot be changed.

Learning is behaviour centered. Learning brings in behavioural changes. Less work accomplishes more. To accomplish more, more input is needed. The Facilitator states his/her assumptions and lets the participants The course of action is fixed.

Do’s and Don’ts of Good Facilitation
Position yourself to face the entire group. Smile at individuals. Listen carefully while they talk. Maintain eye contact. Nod affirmatively, be positive. Talk with all the group members. Don’ts Turn your back to the group. Frown or look judgemental. Shuffle papers or look at your watch while group members are talking. Stare at individuals. Remain impassive. Talk to only a few people.

Cont.. Don’ts Do’s Scan too rapidly.
Impose your beliefs as the only correct ones. Stare at individuals. Force people to speak. Get personal or argumentative. Walk around unnecessarily, as it distracts the participants Do’s Continually scan the group with your eyes. Encourage shy, withdrawn, participants to participate. Keep your body open i.e., unfold your arms, uncross your legs.

Essentials for Conducting Student Sessions
The primary purpose of the programme is to address the real concerns and issues young people have. Therefore: Have a good rapport with students during the training and deal with them tactfully. Gain the trust and confidence of students. Be a resource for accurate information. Be non-judgmental.

Essentials for Conducting Student Sessions(contd.)
Respect confidentiality at all times. Personal issues discussed within the classroom must remain within the classroom. Never embarrass a student by telling him or her that a question is silly. Never question motives when a student asks a question.

Future Action Plan, Monitoring and Evaluation, Responsibility of Participants

Process Evaluation Answers the following questions:
How is the programme being conducted? Is it being implemented as planned? Dimensions of process evaluation Coverage – extent to which the programme actually reaches the intended audience. Quality – adequacy of training, and satisfaction of stakeholders with training and delivery of the programme.

Outcome Evaluation Assesses the results and impact of the interventions. Answers the following questions To what degree have objectives been accomplished? To what extent have knowledge, attitudes, skills and behaviour of students and staff been influenced? Which specific interventions or components of the programme work best? • Which elements did not work?

LEVELS OF ASSESSMENT National Level State Level
District and School Level

Key Performance Indicators in the AEP
Reach and coverage of the AEP. Effectiveness of training programme. Effectiveness of advocacy sessions.

Key Performance Indicators in the AEP(contd.)
Changes measured by pre- and post-measurement tools for knowledge, attitude and life skills application. Integration - Policy level changes (curriculum, pre-service and in-service teacher training)

Monitoring of AEP – School Level
Expected Outcomes Supportive family environment Supportive institutional environment AEP Interventions Advocacy on AEP with school Principals, parents, community leaders

Monitoring of AEP – School Level (Cont.)
Expected Outcomes Teachers/peer Educators knowledge base on AE increased. Teachers/Peer Educators attitude towards adolescent issues, HIV/AIDS, gender concerns improved. Teachers/Peer Educators skills to use interactive methodology enhanced. AEP Interventions Capacity building of teachers/peer educators

Monitoring of AEP – School Level (Cont.)
Expected Outcomes Knowledge and understanding related to ARSH, gender issues enhanced Attitude towards adolescent issues, HIV/AIDS, gender concerns improved Life skills (thinking, social, negotiation skills) improved Reduced risk behaviour Utilization of services AEP Interventions Interactive student activities Health services including Counseling for adolescents

Monitoring of AEP – School Level Indicators for Advocacy
Expected Outcomes Supportive family environment Suggested Indicators Number and type of issues related to health and gender concerns dialogued between adolescents and parents/family members.

Monitoring of AEP – School Level Indicators for Advocacy (Cont,)
Suggested Indicators % of teachers participating in AE activities Number of hours devoted to AE activities % of students (class 9-12) available as Peer educators % of students using resources (books, magazines etc) if available through the Resource center % of students (class 9-12) actively involved in planning and conducting activities Expected Outcomes Supportive institutional environment

School Level Indicators for Capacity Building
Expected Outcomes Teachers/peer Educators knowledge base on AE increased. Teachers/Peer Educators attitude towards adolescent issues, HIV/AIDS, gender concerns improved Teachers/Peer Educators skills to use interactive methodology enhanced. Suggested Indicators % of teachers/PEs giving correct information on process of growing up, ARSH, HIV/AIDS, substance abuse, gender issues Number & type of activities undertaken around gender issues (gender roles, discrimination, sexual abuse, vulnerability, rights ) % of teachers have positive attitude towards adolescent health and gender issues % of trained teachers reporting confidence and satisfaction in using interactive methodology % of students reporting satisfaction in teachers using interactive activities in AEP

Monitoring of AEP – School Level Indicators for Health Services
Expected Outcomes Utilization of services Suggested Indicators % of students aware of health services available Number of students seeking counseling services in the school from teachers or counselors (if available) Number of adolescents referred to professional health workers/clinics by the teachers

Monitoring of AEP – School level Indicators for Interactive Activities
Expected Outcome Suggested indicators Enhancement of knowledge and understanding related to AHI and gender issues Percentage of students participating in AEP able to give correct information on process of growing up, adolescent health issues, HIV/AIDS, substance abuse, gender issues Improvement of attitudes towards adolescent issues, HIV/ AIDS, gender concerns Percentage of students participating in AEP with a positive attitude towards adolescent health and gender issues

Expected Outcome Suggested indicators Improvement of life skills Percentage of students participating in AEP reporting improved ability to: Identify personal strengths, weaknesses, opportunities and concerns (self-awareness). Identify alternatives to solve problems in the context of AHI (problem solving skills, creative thinking). Express views clearly and effectively (communication skills).

Expected Outcome Suggested indicators Improvement of life skills (contd.) Empathise with others especially people living with HIV/AIDS, underprivileged (empathy). Resist negative peer pressure in the context of AHI (drugs, smoking, alcohol) (self-awareness, critical thinking, effective communication and coping with stress). Cope with emotions and stress (managing emotions/ stress). Reduction of risk behaviour Percentage of students reporting decreased consumption of alcohol, tobacco, drugs

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