REPORT OF HIV/AIDS AWARENESS AND SKILLS WORKSHOP FOR CENSUDI STAFF, BOARD AND COMMUNITY PARTNERS Friday 12 th to 13 th June, 2009 INTRODUCTION In Ghana, there is a growing concern of the number of people being infected and affected by the deadly HIV/AIDS disease. This pandemic has an impact on the lives of all sectors of the Ghanaians environment, both public and private sector and there is therefore the need to work together to prevent the spread of the disease and develop compassionate ways of assisting those already infected. The Centre for Sustainable Development Initiatives (CENSUDI) as a private organization is conscious of this need to manage the social and economic consequences of HIV/AIDS on the organization and to reduce the risk among its direct and indirect partners. It is for this reason that, CENSUDI set out a formal HIV/AIDS policy for its staff. The fear exists and genuinely so, that if HIV/AIDS education is not internally mainstreamed into the CENSUDI, staff with little knowledge about this disease might be at risk. It is therefore in this direction that, a two- day HIV/AIDS training workshop was organized for staff, board members and the Community Facilitation Team (CFT) members held from Friday 12 th to 13 th June, 2009. OBJECTIVES The objective of this training session was to further enhance the knowledge of the Board members, management, staff and CFTs on the HIV/AIDS pandemic. With the knowledge that HIV/AIDS is a pandemic that has far-reaching effects and intertwined with complex social issues, the training session seeks to enlighten participants on: • Personal Risk Reduction • Voluntary Counselling and Testing vs. Provider- Initiated HIV Testing and Counselling • HIV Workplace Policy • Basic HIV counselling guides and key principles METHODOLOGY The facilitation methods employed in achieving the objectives of the workshop included questions and answers, brainstorming, discussions, power point presentation, group work and plenary sessions. At a stage deemed necessary, stratified group discussion was employed where men and women were interviewed separately. Each method was strategically employed to achieve specific information on the various topics outlined. PowerPoint presentation and questions and answers were predominantly used to engender the spirit of participation by all. 2 PROFILE OF PARTICIPANTS Participants at the workshop comprised of the Board members of CENSUDI, management, staff, Community Facilitation Team CFT) members and the press. The CFTs came from CENSUDI’s partner communities. OPENING CEREMONY Workshop activities were preceded by a Christian prayer and this was followed by a self-introduction by participants. EXPECTATIONS Participants indicated their expectations during the self-introduction which were subsequently summarized on flip charts as follows; To learn more about HIV/AIDS Broaden the knowledge level on the HIV/AIDS pandemic and share with colleague participants Gain new insights on the HIV/AIDS pandemic Know that AIDS is real, want to discuss how one is at risk Learn more about the available medications for HIV Learn about VCT TOPICS COVERED 1. Personal Risk Reduction 2. During this session, participants were taken through sexual transmission, Prevention of sexual transmission (SAVE method), sexual violence, rape and HIV, occupational exposure and prevention, preventing of mother-to-child transmission (PMTCT) of HIV and Circumcision. Dr. Rachel Bagaaley, the facilitator introduced participants to the most common ways that people become infected with HIV that included; having unprotected sexual intercourse (vaginal or anal) with an infected person; as a baby of an infected mother (during pregnancy, labour or delivery, or through breastfeeding) and injecting drugs, using a needle or syringe which has been used by someone who is infected. Dr. Rachel indicated that, in Ghana the most common means by which people become infected is through unprotected sexual intercourse with an infected (about 80- 85%). This according to her allows the HIV virus present in an infected person’s sexual fluids to pass directly into the body of the unprotected partner. She indicated that this can occur during vaginal, anal and oral sex though oral sex carries a lower risk since one need a bucket full of saliva to be able to get infected. 3 Dr. Rachel however indicated that, it was possible for one to prevent or lower his/her risk of getting infected with HIV through abstinence, reduction of the number of sexual partners, faithfulness to one sexual partner, treat other sexually transmitted infections and by being circumcised. It was noted that in Ghana, women are more affected by HIV than men as they (women) are approximately 2 times more likely to be infected than men. Participants were taken through the reasons why women were vulnerable to HIV. Among the reasons identified is the case of sexual violence. Sexual violence as Dr. Rachel indicated entails forced sex and is usually committed by people known to the women (victims) such as intimate partners, family members and people in Authority. The facilitator indicated that sexual violence increases the risk of HIV transmission because of the lack of condom use and the forced nature of rape that usually result in bleeding. Measures identified during this session as key to the prevention of sexual violence and rape included; raising public awareness, availability of health services and economic empowerment of women. Participants were also taken through the occupational exposure and prevention of HIV. According to Dr. Rachel’s presentation, health workers for instance can be infected with HIV due to exposure to HIV-infected blood through percutaneous injury. However, she indicated this could be prevented through the provision of workers with the necessary materials and protective equipment, training health care workers in universal precautions, education of staff about the risk of acquiring HIV, provision of first aid and continuous counselling, treatment and follow-up and care. Dr. Rachel indicated that, post-exposure prophylaxis which involved a short-term antiretroviral treatment can be used to decrease the chances of HIV infection following potential exposure to HIV and victims of rape could potentially harness this treatment option. She also indicated that, with the post-exposure prophylaxis involved risk assessment and counselling as well as HIV testing based on informed consent and provision of short-term antiretroviral drugs with follow-up and support. As the mother-to-child transmission (MTCT) is another means by which HIV is transmitted, Dr. Rachel indicated that an HIV positive woman passes the virus to her baby during pregnancy, labour, delivery and breastfeeding. Without treatment, Dr. Rachel indicated that, about 5-30% of babies born to HIV positive women will become infected with HIV during pregnancy and delivery and an additional 5-20% will become infected through breastfeeding. However, preventing mother to child transmission can be achieved through the prevention of HIV infection among prospective parents, avoidance of unwanted pregnancies among HIV positive women and preventing the transmission of HIV from HIV positive mothers to their infants during pregnancy, labour, delivery and breastfeeding. 4 3. Voluntary Counselling and Testing vs. Provider Initiated HIV Testing and Counselling Participants were introduced to the main method of HIV testing and counselling. Dr. Rachel through a PowerPoint presentation indicated that, with the introduction of voluntary counselling and testing (VCT), people actively seek HIV test at health or community-based facilities because the VCT approach is client-initiated. VCT as Dr. Rachel indicated is VCT is voluntary and based on informed consent, confidentiality and counselling. The challenges of the VCT were indicated as follows: • Its uptake is limited by low coverage of services, fear of stigma and discrimination and the perception by many people-even in high prevalence settings-that they are not at risk. • It misses many opportunities to diagnose HIV in clinical settings, even in places with serious HIV epidemics. • So even though VCT is still needed, other strategies are also needed if coverage of HIV testing and counselling is to increase and eventually access to HIV prevention, treatment, care and support is to be achieved. Unlike the VCT, Dr. Rachel indicated that the provider-initiated HIV testing and counselling involved situations where health care providers recommend HIV test to patients attending health facilities who may or may not be showing signs, symptoms or medical conditions that could indicate an HIV infection. Once specific pre-test information has been provided, the HIV test is performed unless the patient specifically declines (i.e., opt-out) testing. Evidence according to her suggests that PITC can increase uptake of HIV testing, improve access to health services for PLWH and create new prospects for HIV prevention. But there are concerns about the potential coercion of patients and compulsory testing, as well as the unauthorised disclosure of HIV status and the potentially negative outcome of knowing one’s HIV status (e.g., discriminatory attitude of health care providers, financial burden linked to testing and or unauthorised testing resulting in discrimination or violence). For this reason, the WHO recommend that the three Cs be adhered to, to ensure positive outcome of HIV testing and counselling. 4. HIV Workplace Policy As CENSUDI recognizes that HIV/AIDS is a workplace issue, and should be treated like any other serious illness/condition at the organization’s places of business, Dr. Rachel took participants through HIV Workplace Policy. She commended CENSUDI for developing one of the best HIV workplace policies that she has come across. She gave a PowerPoint presentation of the features of an HIV staff manual based on Christian Aid’s staff HIV policy. Key features included the following: • A Policy statement which should illustrate organisation’s commitment to equality in employment, non-discrimination of HIV infected employees, prevention of transmission, carrying out assessment of HIV risk posed to employees and 5 sternly dealing with staff showing prejudice and discrimination towards HIV infected employees. • Employment issues, that should entail HIV testing for employees as well as guidelines for the counselling and testing of staff with information on the type of services and support available for staff. • Confidentiality, illustrating the organization’s stance on employees’ rights when it comes to disclosing their HIV status, and the organization’s commitment to treating any information on HIV status with confidentiality and stating organisation’s way of dealing with breaches in confidentiality • Organization’s way of helping and supporting HIV positive prospective employees • Organization’s way of helping and supporting HIV positive employees (during contract) • Organization’s insurance policy for its contracted staff • Information on the available treatments for HIV positive staff. • Forms of available support is there for field employees • Training/raising awareness in employees, indicating the programmes available for basic HIV training and raising HIV awareness • Provision of condoms at the Workplace 5. Basic HIV counselling guides and key principles Dr. Rachel took participants through basic HIV counselling guides and key principles. Her presentation indicated two main stages of HIV counselling, the pre-test and post- test stages. She introduced participants to Kenya National guidelines for voluntary counselling and test. The pre-test and post-test stages involved the following as tabulated below: Pre - test Post - test Prepare for test Implication of status Personalised risk assessment Correct myths and misconception Prepare for result Give the result Coping with results Risk prevention strategies Dr. Rachel indicated that, the pre-counselling serves as an opportunity for the health care provider to provide adequate information on the disease and the process that will go into testing. This process as she indicated include enough and appropriate information so that the patient can give informed consent for the test. The counsellor Dr. Rachel added that, the counsellor’s duty to be able to gain the confidence of the patient and to ensure the confidentiality of the interview and the test results. She emphasized that, in the post post-test counselling, the result of the test will guide the interview. For instance, she indicated that, for a negative test the patient will be informed of the risk factors associated with HIV, the limitations of the test result and what precautions he should take to avoid risk factors. For a positive test, the counsellor must help the patient accept the results. The patient must be informed of the disease process and plans to manage them. Patients who have recreationally acquired HIV may be referred 6 to an HIV specialist and for anti-retroviral therapy. Dr. Rachel said it should be advised that sexual partners are tested and counselled while all lifestyle changes will also need to be explained and emphasized. She however indicated that, after the risk prevention and strategies of the post-test stage, other issues such as window periods, partner notification, family planning counselling and education, condom education and distribution, referrals and so on should be addressed. Participants gain insights into the stage of pre-test and post-test counselling. The understanding that the whole process includes empathy and confidentiality, most participants with the knowledge that VCT is helpful in HIV prevention and management indicated their interest to go in for it. OUTPUTS At the end of the two-days training session, feedback from participants indicated that the understanding of the following: That the Human Immunodeficiency Virus (HIV) is a virus that weakens the body’s immune system, ultimately causing the Acquired Immune Deficiency Syndrome (AIDS). AIDS is a cluster of medical conditions. To date, there is no cure for AIDS and HIV inevitably leads to the development of AIDS, and is almost always fatal HIV weakens the human body’s immune system, making it difficult to fight infection. Without proper drug therapies, infected persons may live for ten years or more after HIV infection, much of this time without symptoms or sickness, although they can still transmit the infection to others. Early symptoms of AIDS include; chronic fatigue, diarrhea, fever, mental changes such as memory loss, weight loss, persistent cough, sever recurrent skin rashes, herpes and mouth infections, and swelling of the lymph nodes. Opportunistic diseases such as meningitis, TB and malaria may also take advantage of the body’s immune systems weakened by HIV and are the main causes of death due to AIDS. The transmission of HIV requires the exchange of bodily fluids containing the virus. HIV infection is transmitted through blood and blood products via infected transfusion and organ or tissue transplants, or the sharing and use of contaminated injection (needle) or other skin-piercing instruments (razor blades, knives, needles) contaminated with HIV. Also, an infected mother can transmit the virus to her child in the womb or at birth, whilst nursing with an infected mother’s breast milk can also transmit the virus to the child. HIV is not transmitted by everyday casual physical contact with people at work, home, school or anywhere else, or by shaking hands. It is not transmitted by coughing, sneezing, tears or kissing, not by sharing toilet and washing facilities or clothes, nor by using eating utensils or consuming food and beverages handled by someone who has HIV. It is not spread by mosquitoes or other insect bites Prevention of HIV transmission can only be done by adopting specific behaviours. To reduce the risk of sexual transmission, one should; get tested for HIV with his/her 7 partner, abstain from sexual intercourse when not with one’s regular partner and reduce the number of sexual partners Health workers should eliminate contact with blood by using protective materials. Needle, surgical knives and other skin-piercing instrument should be used only once, for only one person and then discarded. Pregnant mothers should be encouraged to get tested for HIV infection and if they are HIV+, be assisted in receiving appropriate drug therapies before and after birth, and abstaining from breastfeeding their new born babies Currently there is no cure for AIDS, and treating the symptoms of AIDS is a complicated and multi-phased operation. HIV+ individuals should be given the opportunity to be evaluated for appropriate prophylaxis for opportunistic infections and once they occur, opportunistic infections should be aggressively treated. The development of life-prolonging HIV/AIDS drugs (anti-retroviral therapies) can help an HIV+ individual live longer and more productive life. ISSUES AND CONCERNS • The training session was given at a short notice and thus, much preparation could not be made towards its start off. The experience in the delay of getting a working projector for the PowerPoint presentation is a case in point. • The workshop training session was technical. However, with the availability of the materials of the topics covered, participants will be enabled to actually grasp the topics more comprehensively. LESSONS LEARNT The lessons learned from this workshop experience can be summarized as follows: 1. CENSUDI’s workplace and programs addressing HIV/AIDS are consistent with the organization’s social response and represent responsible responses to the threat of HIV/AIDS and the application of best practice to addressing the epidemic. 2. The participation of some board members, management, staff and CFT members in the workshop indicates that, CENSUDI as an organization recognizes that successful implementation of the HIV/AIDS policy. 3. With enhanced knowledge in the HIV/AIDS participants will take active roles within the organization in mainstreaming HIV/AIDS within CENSUDI. 4. We are concerned that approaches to HIV/AIDS mainstreaming are better collaborated and Dr. Rachel’s training with us, reinforced more collaboration with our donors, Implementation partners and communities. CENSUDI believe that more effective collaboration will add value to our mainstreaming process. WAY FORWARD Educational programmes within the workplace informing employees of the facts of AIDS will assist and encourage appropriate work attitudes. In this light, regular HIV/AIDS training 8 session for staff should be paramount in the HIV/AIDS mainstreaming process within CENSUDI. Timing of such training should be strategic so as cover a wider section of staff. Materials on the presentation by Dr. Rachel should be made available to participants. This will enhance a more comprehensive understanding of the topic covered.