1. Knowing about HIV/AIDS and Role of Anganwadi Workers
HIV Testing and Treatment
Facilitators notes
The session is scheduled for one hour based on the ppt slides

2. Session objectives To learn the protocols of HIV testing.
To learn about the treatment procedures for PLHIVs
To explore the role of Anganwadi workers towards HIV testing , counseling and treatment services

3. ? HIV Testing How does a person know if he/she is HIV positive
The only way to know if one has HIV or not is through a blood test.
Facilitators Note:
Probe further from participants to understand their knowledge on HIV basics, testing centre and protocols, counseling process. And then proceed to further slides
Emphasize on the key message

4. You can help women and men in the village with information about
HIV Testing
It is simple to get HIV testing done
Blood tests for HIV are done free of cost at the Integrated Counseling and Testing Centres (ICTC)
ICTCs are located at Community Health Centre (CHC) or District Hospital
Counselor provides
pre-test counseling and
post-test counseling
to all persons being tested
for HIV
Identities of the person getting tested are kept confidential
Facilitators:
Ask if anyone from participants have known of ICTCs, if so what had been their experience and for what purpose?
Share the list of ICTCs in their locality as a handout
Discuss in detail on the contents of pre and post test counseling
Discuss in detail on the need for keeping the test result confidential
You can help women and men in the village with information about
ICTC centres.

5. What is an HIV Test?
ELISA or Rapid are the two commonly done tests to detect HIV in our body
These tests detects for antibodies in the blood, produced as a result of HIV infection
During window period, HIV tests give negative results
In suspected high risk cases, the test need to be repeated after three months
There are three strategies followed for testing , done based on the contexts , common being three different tests with a single blood sample to diagnose HIV
Facilitators Note:
Discuss the objectives of HIV testing.
Discuss in detail on the debates on unlinked anonymous, voluntary and mandatory testing
Point 1: Different types of HIV testing for detecting antigens and antibodies in human body. How is ELISA different from Rapid test. Specifics on different generation ELISA tests
Point 3: Explain why HIV test give negative results during WINDOW period and need of repeating the test after three months for suspected High risk groups

6. Counseling during HIV testing
The Counselor helps the person to understand:
the importance of taking blood test
to know his/her HIV status
the importance of taking treatment if HIV positive
Planning for children and
the use of condoms to protect the partner from virus
Help women/spouses and other family members to get tested for HIV
Facilitators Note:
Point 1: Discuss principles of counseling relevant for HIV related pre and post test counseling.
Point 2: Discuss the attitude and skills required in pre and post test counseling
Point 3: Discuss the tools and contents in pre and post test counseling
Point 4: Discuss the importance of partner counseling and testing

7. If the test results are negative ?
If one or both partners have a high-risk behaviour in the past three months and test negative for HIV, they should be advised to repeat the test after three months.
Counsel them to avoid any high-risk behaviour during the window period even if the test is negative.
Counsel about using condoms consistently and correctly
Facilitators Note:
Point 1: Help them to recollect the steps in using condoms (male and female)

8. If the test results are positive?
Advise the HIV positive person to register at an ART center and take the CD4 count test.
Ensure the information is kept confidential
Develop their social support though family, friends and peer group.
Ensure they follow-up regularly at the ART Center
In case of pregnant women, ensure they deliver at the hospital, and receive Nevirapine (NVP).
Discuss issues related to diet, nutrition, exercise and risk reduction.
Facilitators:
Discuss the need for ART centre registration and monitoring for CD4 testing
Discuss the issues related to diet, nutrition, exercise and risk reduction
Avoiding unwanted pregnancies, coercive sexual behaviour of the partner
Sharing and caring for each other
Delivery and breastfeeding practices
Using condoms

9. WHO clinical Staging of infection based on CD4 count
Stage
Symptoms (OI)
800 – 1200
Normal
Nil
> 500
Stage I
Minor fever
Stage II
Common cold, Respiratory Tract Infections,skin infections , Fungal infections
Stage III
TB, Oral candidiasis, wt. loss > 10%, Diarrhoea > 1 month, Fever > 1month
<200
Stage IV
Extra pulmonary TB, Meningitis, severe wasting
CD 4 count decreases
Viral load increases
HIV stage
Explain the participants the importance of CD4 test in identification of the stages and initiation of ART drugs.
All HIV positives should be registered in ART and undergo CD4 count.
Care increases the life span by delaying the progression of disease to further stages
Symptoms have to be treated at ART centre with the help of OI drugs distributed free of cost at ART centres
ART
AIDS stage

10. Provide information about:
Avoiding unwanted pregnancies ( through safe sex and family planning – condoms and sterilization options), coercive sexual behaviour of the partner
Sharing and caring for each other
Delivery and breastfeeding practices
Using condoms for prevention of HIV transmission
Staying healthy
AWW can play an important role by disseminating HIV prevention messages to the community in general and women in particular; services available through ICTC and ART Centres and services for HIV positive pregnant mothers and how they can prevent HIV transmission to their baby

11. PLHIV should remember:
Must not donate blood, semen or organs
Must inform the sexual partner and always use condoms
Must consult the doctor at the nearest medical centre
Must plan pregnancy carefully, and seek advice of the doctor at the ICTC
Must seek early treatment at PHC or CHC if suffering from any other infections

12. HIV treatment
ART is the combination of 3 drugs Given to a HIV positive person having CD4 count below 250 cells
ART medicines are given free of cost at ART Centers
ART medicines are to be taken 2 times a day, regularly for the rest of the positive person’s life
Discontinuation/irregular intake of medicines makes treatment ineffective after sometime
HIV/AIDS has no cure but with proper treatment, the PLHIV can live a long productive life.
Facilitators Note:
Focus on the point that ART does not cure HIV/AIDS.
Inform the ART medications provided under the NACO program, common side effects
Inform about the first line and second line therapies

13. Helping PLHIVs
Ensure that the woman and her spouse and children go for HIV testing.
Help them in getting their HIV test results
Encourage all those diagnosed as HIV positive to get themselves registered at Antiretroviral Treatment (ART) centres
Advise them to get the CD4 test done at the earliest
Ensure that PLHA are regularly taking ART medicines as advised by the doctor.
Ensure they visit the ART centre regularly and earlier if they experience any symptoms
Ensure that PLHA are taking the diet as advised by the counselor
Facilitators Note:
Though, all the above points are important for an Anganwadi worker to serve PLHIV in the community, discuss heir willingness and how they could do this?
Along with medicines, a positive attitude helps the person and the family to overcome the trauma of having this infection. You can be as source of support and guidance for HIV infected couples and women and making informed decisions about treatment and care.

14. Helping PLHIVs Eating healthy and nutritious food Exercising regularly
Stopping alcohol and tobacco use
Getting regular health check-ups
Taking medicine as prescribed by the doctor for opportunistic infection (OI)
Provide moral and psycho-social support to PLHA and keep them motivated with positive attitude. Don’t let anyone stigmatise and discriminate against them.

15. Preparing patients for initiating ART
Key messages
It is not curative, but prolongs life
Treatment is life long, expensive
High level of adherence is critical
May have short or long term side effects
Safer sex still essential
Do not share with friends, family members
ART must be started only when the person living with HIV is ready
Facilitators Note:
Inform the participants on the need of providing support to PLHIVs on treatment preparedness. The reasons in prolonging treatment initiation or lost to ART follow ups.
Discuss on the importance and benefits of adherance

16. Opportunistic Infections - OI
Common OI s are
Diarrhea ,TB Herpes zoster, Candidiasis and Pneumonias
Most important treatment /drugs need to know are
Cotrimoxazole treatment and prophylaxis,
Fluconazole and
Acyclovir
Facilitators Note:
Categorise diseases under major causative organisms, its symptoms and when to consult doctor

17. HIV and Tuberculosis
Tuberculosis (TB) is one of the most common opportunistic infections among PLHIVs
More than half of the PLHIVs develop TB as their body’s immunity weakens
Common signs and symptoms are:
Constant cough for three months
Low grade fever lasting for more than a month
More than 10% weight loss within one year
Any enlarged/swollen lymph node in the body
Refer to the nearest DOTS centre/DMC available in all hospitals
DOTS treatment lasts for six months
Facilitators Note:
Discuss the types and symptoms of various type of Tuberculosis

18. How do you think this information will be useful in your working situations? (Open for discussion)
Facilitators Note:
List out the points from participants. These would be registered and take home messages from this session.

19. THANK YOU
Content Courtesy: Shaping Our Lives- Learning to Live Safe and Healthy; A Booklet on Women and HIV/AIDS for ANM, ASHA, AWW and SHGs; NACO, 2007 Adaptations : SAATHII (Solidarity and Action Against The HIV Infection in India) Technical Assistance Partner to Jagruti (APSACS-WD&CW Dept) Project Gandhi Nagar, Hyderabad , Andhra Pradesh Telephone: ; Telefax: (India's comprehensive HIV resource centre)