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Peer Educators Guide Booklet

Working with children and young people affected by HIV/AIDS

Peer Educators Guide Booklet

Working With Children And Young People Affected By Hiv/aids

Prepared by: Melina Laukka & Dorcus Asiimwe, social workers Kawempe Youth Development Association (KYDA) BOX: 71976 Clock Tower, Kampala Tel: +256 414 69 11 82 ,+256 752 36 83 32 Email: otal_kawempeyouth2006@yahoo.com September 2010

FOREWORD HIV / AIDS has infected and affected many people in Uganda. There have been promising results from preventing further spread and supporting HIV/AIDS patients through

community activities. It has been indicated that community based volunteers (including peer educators) and are relevant to both have

communities

institutions.

They

several functions in the community, such as providing services that are more relevant to the needs of the poor and underserved populations, following up their clients at home regularly, identifying health and psychosocial problems early, and making well- timed and suitable referrals. The use of community based volunteers is also less expensive and reaches a bigger area, which ensures that those who are
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vulnerable are reached by services


of Uganda, 2010.)

(Government

This

guide

is

supposed

to

give

basic

information about HIV/AIDS while providing basic knowledge and a framework to peer educators on how work with people infected and affected by HIV/AIDS. The main focus is on children and young people, aged from five to nineteen, and their families or care givers. This guide booklet is based on facts from a workshop organized by Kawempe (KYDA) The Youth and

Development literature

Association HIV/AIDS.

about

overall

objective of the work shop was for Peer Educators to gain basic counseling and helping skills for children living with HIV/AIDS. It was organized from 6th to 10th August 2010 in conjunction with trainers from The Aids Support Organization (TASO) and Kawempe Health Center.
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ACKNOWLEDGEMENT KYDA wishes to acknowledge the financial support from the Stephen Lewis Foundation (SLF) of Canada that enabled the

development of this peer educator's guide. The Administration highly gives gratitude to Mr. Otal McBernard the Executive Director KYDA, Dr. Kasozi Francis In -Charge

Buwambo Health Centre IV, Ms. Nakabugo Gorret M.A (Sociology) Trainer and Mrs. Sendaula Sarah Counselor positive living and Nutrition in children Kawempe Health Centre for their moral and technical input into this guide. This guide was also type setted, compiled and made it a reality by full commitment and efforts from Melina Laukka and Asiimwe Dorcus social workers from KYDA. Their hard work is highly indebted.

KYDA is further grateful to the community HIV + Children Peer Educators for providing

information on various topics, participation in sharing of testimonies, materials development workshop and the actual training were the ideas for this guide were conceived. We are equally delighted for their relentless efforts and wise contributions without which this guide probably would not have seen the light of the sun. KYDA handsomely extends its sincere thanks to all those not mentioned but dully contributed to the timey completion of this Peer User Guide Booklet, May God reward them handsomely.

Mr. Otal McBernard Director of KYDA (Team Leader) Kawempe

The technical team which actively participated in preparation of this Peer educator's guide booklet comprised of; 1. Mr. Otal McBernard 2. Dr.Kasozi Francis 3. Ms.Nakabugo Gorret
Director KYDA (Team Leader) In-Charge Buwambo Health Centre IV. Child and Adolescent Counselor Trainer (TASO). Kanyanya.

4. Ms. Sendaula Sarah

Nutrition specialist for HIV+ Children,

Kawempe. Health centre.

Other KYDA Staff: 5. Ms. Kiwuka Josephine 6. Ms. Laukka Melina 7. Ms.Asiimwe Dorcus 8. Mr. Kabuye.k. Shaban

Project officer. Repportuers to the committee.

Counselor for children KYDA.

CONTENTS Forewords Acknowledgment 1. 2. Basic facts about HIV/AIDS Peer Educator 2.1. Peer educators' main tasks and basic skills in dealing with children 3. HIV/AIDS care and support 3.1. Stigma faced by children and how to handle stigma 3.2. 3.3. 3.4. 4. Positive living for children Peer to peer counseling Nutrition and HIV 26 14 2 4 8 9

How to work in practice 4.1. 4.2. Community mobilization Home visiting

? 4.3. Recording and report writing ? 4.4. Referral

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1.

Basic facts about HIV/AIDS Terms: HIV = Human Immune-deficiency Virus AIDS= Acquired Immune Deficiency Syndrome ART = Anti-retroviral Therapy Fast facts: 33.4 million people live with HIV/AIDS worldwide. 30 million people live with HIV/AIDS in low- and middle-income countries 67 percent of all people living with HIV/AIDS are in sub-Saharan Africa 2.1 million children with HIV/AIDS worldwide at the end of 2008 and 1.8 million of them lived in sub-Saharan Africa at the end of 2007 Two million people died from HIV/AIDS worldwide in 2008 2.7 million people were newly infected with HIV worldwide in 2008 and 430 000 of them were children under 15 years. [Source: WHO 2009]
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Statistics in Uganda: The current HIV prevalence in Uganda is estimated at 6.4% among adults and 0.7% among children. HIV prevalence is higher in urban areas (10% prevalence) than rural areas (6%) The number of new infections was estimated 111,000 in the year 2008 The number of annual AIDS deaths was 61,000 in the year 2008 are excessively affected, Women accounting for 57% of all adults living with HIV. Ugandan women tend to marry and become sexually active at a yo u n g e r a g e t h a n t h e i r m a l e counterparts. They often have older and more sexually experienced partners. This (plus various biological and social factors) puts young women at greater risk of infection [Source: Government of Uganda 2010] 2. Peer Educator Peer Educator, also called as a Community
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Educator, is a person who is living in the same circumstances as others. These kinds of circumstances are for example age, gender, culture, subculture, ethnicity and place of residence. When it comes specifically to HIV/AIDS, a good peer educator has a wide knowledge base about the disease and owns various methods of passing it to the community. A good peer educator working with HIV/AIDS affected and infected children often holds some, or all, of the following characteristics: informed and holds a basic Be well information about HIV/AIDS to transfer the information to Be able others Have some basics counseling skills and love working with children. Committed to working with children. Should judgment avoid stigmatizing and

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minded Be open Good communication- and interpersonal skills Good listener and holds confidentiality Empathetic and emotionally strong Approachable Owns self-respect 2.1. Peer educators main tasks and basic skills in dealing with children Peer educators working with HIV/AIDS positive children have the following tasks a head of them: Developing activity plans. updated Being with information

regarding HIV/AIDS among children. Mobilizing communities for HIV/AIDS r e l a t e d a c t i v i t i e s .

e.g. counseling and testing. as a link between community Working


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members and service providers. Indentifying HIV/AIDS related problems of children and bringing them to the a wa r e n e s s of supervisors e.g.

counselors and social workers. home care to children. Providing Monitoring positive children and making proper referrals. and maintaining records for Keeping report writing. To put those tasks in practice it is important to have good communication skills.

Communication is the process of sending and receiving messages the so that both as people

understand

messages

intended.

Everybody has their own way to communicate with other people but it is good to be aware of the fact that there exists both verbal and non verbal communication as shown below on the
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table. You have to observe both.


Before taking an action peer educator should gather information about the task and set the goals and plan how to fulfill those tasks Verbal communication Non verbal Communication

- Face to face communication - Spoken language

- Facial expression - Using hands and eyes - Sitting and standing postures

It also matters how you, as a peer educator, approach children and young people affected by HIV/AIDS. You can use active listening (paying attention), checking understanding, asking and answering questions as basic skills of effective communication. What to be considered in order to achieve effective listening: Position S Sitting
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R Relaxed Be Open

R O

L Lean forward towards the person L E Keep Eye contact with the peer E

the peer S Sit near


3.
HIV/AIDS care and support

People living with HIV/AIDS have a wide range of care and support needs. Peer educators helping skills can be used to provide emotional support and empowerment to the person in need. Helping refers to a situation of peer educator assisting parents/guardians and children to overcome understand or cope with a problem in their lives. This can be done through encouragement and emotional

support. However, in order to support peers, peer educators need to first establish trust from the children and their parents. Trust is
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essential

for

building

relationship

between the peer educators and the children. 3.1. Stigma faced by children and how to handle stigma When children and youngsters are diagnosed with HIV/AIDS, they often face stigma from the people around them and even from them selves. The disease may be associated with ways of behavior that are considered socially unacceptable by many people and therefore HIV infection is widely stigmatized. In other words, stigma means negative thoughts about the children based on their HIV status. Many have been thrown out of homes, rejected by family and friends, and some have even been killed. A child or young person may also end up doing self stigmatizing themselves through thinking or feeling negatively about him/her self based on perceived beliefs that other people threat them negatively. It can lead to school drop outs, unemployment, low selfesteem, family breaks ups, depression and even suicide. It is therefore vital to address HIV
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stigma in order to improve the quality of lives of children with HIV/AIDS. Stigma may occur in different areas in life. It may be caused by the following situations: taking responsibility of young Fear of people through blaming them about their status. protective laws to protect people Lack of against being stigmatized. treatment and support. Lack of Ignorance about the causes of HIV/AIDS. Religious and cultural beliefs that surrounds HIV/AIDS. Stigma can be handled in the following ways: Counseling for the infected children and youngsters together with their family or caretaker. By showing love and care. Peer support. Giving Encouraging children and young people through educating them about stigma. 3.2. Positive living for children Positive living involves a life style that fosters
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physical, mental and spiritual health. Positive Living is: a person develops a positive When outlook towards his/her life. It involves adopting practices and lifestyles that aims at improving the quality of life and reducing the transmission of HIV. behaviors are meant to delay These progression from HIV to AIDS by keeping the childs immunity high. How to achieve positive living: Frequently necessary. Supporting adherence to septrin to prevent infections. adequate nutrition. Provide Immunization. Promote the regular monitoring of growth and development. Prevention of infections like malaria. Facilitate social support, peers, siblings. Providing all the basic needs. Emotional support and counseling. Love and belonging.
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Safe water and hygiene, environmental hygiene. Providing education. Providing ART. 3.3. Peer to peer counseling The great majority of people with AIDS in low and middle-income countries are cared for at home, since health services are beyond the reach of large proportions of the population. Community care and support groups have sprung up almost everywhere in the world where the AIDS epidemic has appeared and it has shown good results through providing comfort and hope to people living with, or affected by, HIV. When it comes to children's /young people's well being, peer to peer networks are significant. Person can get support through hearing from other peers, who are in the same situation or through sharing their experiences. And if there arises need for counseling, then fellow peers can
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be easier to approach. Below are some of the principles to follow in peer counseling: confidentiality Keep information. judge clients and be sensitive to Do not client's feelings. client's decision. Respect Be trusted and truthful. n i z e Re c o g counseling. your limitations your in own of client's

Recognize

resources and potential; you don't have to know everything. Understand the context of the situation and respond appropriately. the client as she/he is. Accept Recognize each adolescent's unique qualities. Everybody has their own way to cope in the difficult situations. Give correct information; too much
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information at once can confuse clients. Give information, not advice. and simple language. Use clear 3.4. Nutrition and HIV Good nutrition plays an important role in maintaining the health of people living with HIV. Adequate nutrition is essential to maintain a person's immune system, to sustain healthy levels of physical activity, and for a quality of life. Adequate nutrition is also necessary for optimal benefits if receiving antiretroviral therapy. When it comes particularly to children with HIV/AIDS it is good to keep in mind that they are like other children; their bodies are especially sensitive to nutrition. All children must eat well to grow properly. On top of the normal demands of growth, HIV-positive

children must cope with the extra demands that the virus places on their bodies.
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Facing these demands can sometimes be hard to the family or care givers. As a parent or guardian of a child with HIV, it is easy to worry about your child's nutritional needs. Children living with a HIV can easily have a poor appetite and have little interest in food and they can feel full quickly. Therefore, they often eat very slowly and tend to be picky eaters. This can sometimes make meals very difficult. They are also suffering from the same problems like adults with HIV, such as, diarrhea, nausea and metabolic problems, which make it even harder for them to eat. When children grow into their teenage years, the challenges continue, when they became more independent and when they have more responsibility for their chronic condition. HIV-positive children should have ongoing nutritional care at a pediatric centre to make
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sure they stay healthy and grow properly. If growth is slow, boosting nutrition will be a vital part of the treatment plan. The first step will be to change the child's diet to increase calories and protein. Thus, a lot of things can be done at home. One of the peer educator's tasks is to provide accurate information about nutrition to the families and to young people. Importance of good nutrition to people with HIV/AIDS: It prevents malnutrition and improves their quality of life. It strengthens the immune system and reduces the duration of illness. It improves the effectiveness of

medication in the treatment of illness. It provides energy, nutrients and

improves the physical performance of


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the body. the progression of HIV/AIDS. It delays How children get malnourished? : eating food of poor quality. Through eating inadequate variety of Through foods. long lasting illnesses. Through loss of appetite. Through poor hygiene and sanitation. Through inadequate care for those Through who are most likely to be affected by malnutrition. to access the kind of food Inability and health care that meet their needs (e.g. result from the poverty or resources for social and health care)

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How to eat when suffering from HIV/AIDS? : least three meals and two Have at snacks in a day. consumption of foods from all Increase groups. Add a little sugar or oil to food or drinks. Chew food well. Rinse mouth regularly with boiled salty water (to kill bacteria's) How to deal with loss of appetite? : Eat meals and snacks frequently at regular intervals. Use favorite foods and spices to boost appetite. Avoid strong smelling foods if they affects your appetite.
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Avoid alcohol, smoking, drugs or medicines that are not prescribed by your health worker. family and friends to prepare Ask your meals for you. Have meals in the company of friends or relatives. regularly (e.g. walking, Exercise cycling, house hold duties) Avoid drinks high in sugar. Drink plenty of boiled or treated

water. taking medication (Note: Eat after Take the health workers advice) at regular intervals. Deworm
4. How to work in practice 4.1. Community mobilization
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Community

mobilization

is

process

of

bringing people together for a desired purpose. Community mobilization is typically planned and organized for people to participate and evaluate their activities for self reliance and sustainability. Peer educators can try to

mobilize the community in various ways such as drumming, posters, announcements, letter writing, home visiting and through mass media. Community mobilization has the following advantages: people together. Brings It facilitates work to be done. realize the need for collective People effort. are sustained and therefore Activities people can build up commitments. learn from each other. People Saves time and money. appear in a short time. Results a sense of belonging. Builds
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Peer educators can more easily reach people and mobilize them in the places that they gather together. Those places may be: Churches. Clubs. Social gatherings. Funerals. Community meetings. 4.2. Home visiting In order to communicate and reach families in local communities, it is important to also provide help to homes through home visiting. Even though peer educators organize meetings, clients may not get enough information out of them. They may not open up in a group or they may even fail to come. Hence, home visiting is necessary in caring and supporting children and care givers. Importance of home visiting:
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clear assessment of the needs It gives of children and caregivers within their local environment. an opportunity to children and It gives their families within a relaxed and in a common setting. to identify children who require It helps referral for other services. It reduces fear and eliminates

discrimination

and

stigmatization

within the family and community. It promotes behavior change for

children, families and communities. It fosters acceptability and positive living among children, families and communities. Issues to consider in home visiting: Transport. Funds.
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resources e.g. people trained to Human do the home visiting. Time. (Information IEC Communication) materials. Steps taken in conducting a home visit: Announce arrival. Settle down. greetings. Exchange Introduce your self ( Your name, where is your organization located, your role) Introduce purpose of the visit. intended activity. Carry out for the next visit. Set goals Summarize the visit. Thank people you have visited. Make appointment for next visit. Make records if possible. bye. Say good
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Education

4.3. Recording and report writing Recording: In any intervention, record keeping is a critical step since it provides information for follow up, provides accountability and keeps track of activities done by peer educators in the community. Methods used in record keeping: writing. Report Documentaries. Filing. Stores. Library. Record keeping has the following advantages: us to monitor and evaluate Helps progress. act as references. Records They help us remember what we have done. keeping helps in planning and Record noticing the best practices. It increases accountability. After recording what you have done and
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how you have worked with a client, you write a report. A Report can be a spoken or written account of something heard, seen or done. Characteristics of a good report: and precise. Concise to the point. Straight Short sentences. the reader. Clear to language. Simple ideas. Flow of the readers' attention. Target soon after meeting a client to Write it memorize. Remember to update records.

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4.4. Referral Place to contact/ get more information and help:


MU-JHU CARE LTD/PEER PSYCHOSOCIAL SUPPORT GROUPS (Makerere University Medical School, P.O. Box 23491, Kampala) The John Hopkins University (P.O. Box 23491, Kampala) Reproductive Health Uganda(RHU) Former Family Planning Association of Uganda(FPAU), Plot 2 Katego Road Off Kira Road P.O. Box 10746, Kampala MILDMAY UGANDA, Transforming HIV care (Entebbe Road P.O. Box 24985) The AIDS support organization TASO, (Kanyanya, P.O. Box 10443, Kampala) BAYLOR COLLEGE OF MEDICINE: CHILDREN'S FOUNDATION UGANDA
(Mulago Hospital P.O. Box 72052, Clock Tower)

KASANGATI HEALTH CENTRE. BUWAMBO HEALTH CENTRE. KAWANDA HEALTH CENTRE. KAWEMPE HEALTH CENTRE. M P E Y O U T H D E V E L O P M E N T K AW E ASSOCIATION (KYDA)
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GLOSSARY Alcohol/drug dependency: The use of nonsterile injecting drug equipment is one of the most efficient modes of HIV transmission and remains one of the critical activities fuelling HIV epidemics among drug users. Other dependencies such as alcohol and noninjecting drugs may also create vulnerabilities to transmission and infection. Bereavement Support: Support for people dealing with grief due to the loss of a loved one. Care for Orphans and Vulnerable

Children: Support and guidance for children under the age of 18 who have lost parents and/or caregivers, and children who are at risk of abuse, mistreatment, or exploitation. Child headed house hold: House hold where everyone who are living there are younger than 18 years old. Education and Vocational Training:

Learning new skills and/or taking classes.


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Food

Security

and

Nutrition:

The

availability of food and one's access to it. A household is considered food secure when its occupants do not live in hunger or fear of starvation. Gender: Addressing widely held beliefs,

expectations, customs and practices within a society that define 'masculine' and 'feminine' attributes, behaviors and roles and

responsibilities. Grand Mothers/ Guardians: Maternal or paternal grandparent or guardian, who looks after, protects or is legally appointed to manage the affairs of another person, such as a child. HIV Prevention and Behavior Change: Transmission of HIV is mediated directly by human behavior, therefore changing

behaviors' that enable HIV transmission.


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Health workers/Caregivers: Hospital/clinic staff, public health, health outreach workers, family and community caregivers. HIV Testing and Counseling: HIV tests are used to detect the presence of the human immunodeficiency virus in serum, saliva, or urine. As per UNAIDS/WHO guidelines all testing, whether client or provider-initiated should be conducted under the conditions of the Three Cs: involve informed consent, be confidential, and include counseling. HIV and Disability: Addressing the unique risks of HIV for people with disabilities. This may include physical barriers to access appropriate HIV prevention and support services, as well as vulnerability in the community because of limited livelihood opportunities and/or stigma and discrimination. HIV + children: Children living with HIV/AIDS.
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Home-Based Care: Any form of holistic homebased care given to those in need, and which strengthens the capacity of and support for community health workers. Such care includes physical, psychosocial, palliative, and spiritual activities. Medical access, diagnostics, medical care: Obstacles to medical access include the cost for ARV treatment, as well as the health

infrastructure required to deliver ARV's and provide diagnostic services. Access to

treatment depends not only on financial and human resources but also on people who need them being aware of their HIV status, and

knowledgeable

about

treatment,

empowered to seek it. Orphans and vulnerable children: These are children who suffer from physical, mental or environmental stress that is based on a set of
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criteria/standards bear substantive risks when compared to other children. Opportunistic Infections: Illnesses caused by various organisms, some of which usually do not cause disease in persons with healthy immune systems. For example, Tuberculosis is the leading HIV-associated opportunistic

infection in developing countries. People living with HIV and AIDS (PLWA): Those who have been diagnosed with

HIV/AIDS. Persons with Disabilities: Those who have some disability or infirmity (physical and/or mental) Palliative Care: An approach which improves the quality of life of patients and their families facing life-threatening illness, through the prevention, assessment and treatment of pain and other physical, psychosocial and spiritual
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problems. Psychosocial Support: Support to address the ongoing psychological and social problems of people living with HIV or AIDS, their partners, families and caregivers. Positive prevention: Is a strategy that aims at contributing to the reduction of HIV

transmission by building the capacity of people having AIDS and the general community to scale up HIV/ STI prevention. Poverty Alleviation/ Income Economic Generation:

Livelihoods/

Processes that seek to reduce the level of poverty in a community, or amongst a group of people or individuals. Programs are aimed at decreasing economic poverty through

economic development and income generating activities. Prevention of vertical


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transmission

(PMTCT): Prevention of transmission of HIV from mother to fetus or baby during pregnancy or birth. Protection: Efforts to keep PLWHA, their partners, families and caregivers safe. For example efforts to provide legal or human rights protection for PLWHA. Public outreach: Efforts by individuals in an organization or group to connect its ideas or practices to the general public. Activities typically take on an educational component but may conceive their outreach strategy as a two-way street in which outreach is framed as

engagement rather than solely dissemination or education. Sexual and Reproductive Health and Family Planning: Addressing the reproductive

processes, functions and systems at all stages of life, is aimed at enabling men and women to have
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responsible, satisfying and safe sex lives, as well as the capacity and freedom to plan if, when and how often to have children. Shelter and Material support: Provision of housing or monetary support which may take the form of government benefits, food, clothing, furnishings, medical equipment, transportation etc. Stigma and discrimination: Addressing HIV infection as widely stigmatized and that people living with the virus are frequently subject to discrimination and human rights abuses based on their positive status. Street children: Includes children who work in the streets and markets of cities selling or begging, and live with their families, as well as homeless children who work, live and sleep in the streets, often lacking any contact with their families.
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Treatment

access,

readiness,

and

adherence: Addressing barriers to accessing treatment and providing education, support and counseling to support informed choices about treatment options and access to and adherence with prescribed treatments. Training: Any classes, field training, skills building workshops and mentoring. Target groups: This refers to the persons that the resource Youth: Persons between the ages of 15 and 24 years of age (based on UN definition).

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Acronyms AIDS= Acquired Immune Deficiency Syndrome ART = Anti-retroviral Therapy ARV = Anti- viral drugs HIV = Human Immune-deficiency Virus IEC = Information Education Communication PLWHA = People living with HIV and AIDS PMTCT = Prevention of mother to child transmission STI = Sexually transmitted infections UN = United Nations WHO = World Health Organization

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References http://www.avert.org/aids-uganda.htm http://www.catie.ca/ng_e.nsf (A Practical Guide to Nutrition for People Living with HIV) http://www.unaids.org http://www.who.int/en/ Peer User Pocket Book, Drug Abuse: Peer-toPeer Prevention Program, UYDEL (2003). Peer educators training Manual organized by KYDA in partnership with trainers from TASO and Kawempe health centre (6th 10th of September 2010). (un published) Positive Prevention Counseling, A Training Course for Peer Educators, Participants' notes (2007). UNGASS COUNTRY PROGRESS REPORT UGANDA, January 2008-December 2009. Government of Uganda (2010).

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Kawempe Youth Development Association (KYDA) Located Jinja Kawempe Zone A Near St.benard P/s P.O.Box: 71976 Clock Tower Kampala Tel:0414 691182 ; 0752368332 Email: otal_kawempeyouth2006@yahoo.com

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