«ILO/USDOL HIV/AIDS Workplace Education Programme for Trinidad and Tobago ILO Subregional Office for the Caribbean Copyright © International Labour ...»
• Reinforce need for a return visit (if rapid testing is not used) 47 Post-Test Counselling: Goals for Negative result
• Provide test results and explain meaning
• Reinforce safe behaviour
• Discuss need to re-test in three to six months (window period)
• Answer questions
• Refer client to support services Post-Test Counselling: Goals for Positive result
• Provide test result and explain meaning
• Clarify the difference between HIV and AIDS
• Discuss medical follow-up
• Discuss partner notification
• Reinforce safe behaviour
• Emphasize that HIV is not a death sentence
• Refer client to support services
Mandatory HIV testing
Mandatory HIV testing is testing that is forced on someone with or without his/her consent (and sometimes even without his/her knowledge). It arouses very strong feelings and provokes opposition because it disregards fundamental rights and may lead to discrimination.
The ILO Code of Practice on HIV/AIDS and the world of work has a detailed section on testing. HIV screening should not be required of job applicants or persons in employment. However, workers who, of their own initiative, wish to be tested should be encouraged to do so. Voluntary testing should normally be carried out by trained health care workers either at the workplace or at public/private health facilities with adherence to strict confidentiality and disclosure requirements. Pre- and post-test counselling which facilitates an understanding of the nature and purpose of the HIV test should form an essential part of any testing procedure.
In many countries, and for a variety of reasons, HIV counselling and testing services are underused. This exercise is designed to get participants to think about why they would or would not go for a test and consider what influences their decision.
Step 1: Write down the following questions on pieces of paper (one question per paper):
Group 1: “Why should people undergo HIV counselling and testing? What are the advantages of doing so?”
Step 2: Divide the participants into small groups and assign questions for discussion to each group.
Step 3: Have each group report back to the main group regarding their discussion points.
Step 4: Summarize the points with the groups. Some examples of
possible points to develop:
Under the close supervision of their doctor, some HIV positive women may choose to become pregnant and give birth. Only a doctor with extensive HIV knowledge can advise a woman on this process.
How can an HIV-positive woman give birth to an HIV-negative baby?
During pregnancy, the mother and baby do not normally share blood. Although the child receives nutrients, vitamins and other important substances from the mother, blood does not pass through the placenta into the baby’s body. The placenta is a natural barrier that (unless damaged) prevents the virus from passing from the mother to the child.
However, HIV can be transmitted from a pregnant mother to
her child during:
• Pregnancy (damage to placenta)
• Childbirth (baby’s eyes, mouth or nose can come in contact with mother’s blood)
• Breastfeeding (HIV transmission via breast milk)
The following factors increase the risk of mother-to-child transmission:
• High viral load in the mother
• Advanced HIV disease (AIDS)
• Giving birth shortly after becoming infected with HIV
• Presence of other infections
• Genital infections from STIs
• Difficult childbirth (lots of blood)
• Prolonged duration of childbirth
• Bleeding wounds in the birth canal of the mother or on the baby’s body
• Breastfeeding, especially of newborns receiving breast milk together with other foods
• Breastfeeding with dry or cracked nipples
Since mothers do not always pass HIV to their unborn babies, there are ways to greatly reduce the risk of babies becoming infected.
Step 1: Explain to participants that in Trinidad and Tobago, every pregnant woman who attends a pre-natal clinic would be strongly advised to take an HIV test. Therefore, many women find out about their HIV status after they are already pregnant. Ask participants to list the things they think HIV-positive mothers can do to reduce the chances that they would transfer the virus to their babies.
• Take antiretrovirals. As prescribed by your doctor ARVs can greatly reduce the risk of mother-to-childtransmission, reducing the risk of transmission by 50 per cent. The mother is given ARVs in the early stages of labour and then one dose of ARV syrup is given to the baby within 72 hours of its birth. ARVs reduce the amount of HIV in the mother’s body, thereby decreasing the risk of HIV transmission to the baby during childbirth.
• Use infant formula. The breast milk of infected women contains a small amount of HIV. An HIVpositive mother should not breastfeed, but should give her baby milk formula made with boiled water.
• Seek spiritual and other counselling.
II.1 Living Positively with HIV Living positively means doing everything possible—mentally, emotionally and physically—to stay healthy, active and well for as long as possible. In the case of HIV, it also means helping the immune system to stay strong so that it can cope with the virus.
People living with HIV (PLHIV) who take care of themselves and have a positive outlook on life, can live much longer than other people who have the virus, even without medication or other treatments.
Tips for living positively:
• Make plans for life. PLHIV should not stop doing the things they enjoy doing or give up on their dreams and aspirations.
They should keep working for as long as possible. Keep old friends and make new ones; continue to live a fruitful and enjoyable life.
• Find people to talk to for emotional support. PLHIV need the love and support of those around them. Keeping their infection a secret can weaken the immune system and diminish their quality of life.
• Avoid tobacco, drugs, alcohol and other harmful substances.
These can weaken the immune system and hamper the absorption of essential nutrients.
• Devise a healthy eating plan. Eat a variety of food from the four main food groups every day. Eat at least three meals a day and have wholesome snacks in-between. It is also important to drink plenty of clean water and other liquids— at least eight glasses a day.
• Keep up daily hygiene. Maintaining good daily hygiene helps prevent infections and makes people feel good about themselves.
• Exercise regularly. It is important for people to remain active
• Get enough rest. Getting a good night’s sleep is critical.
Naps or rest periods during the day can help if someone is feeling tired or weak.
• Avoid other infections. PLHIV have weakened immune systems and should stay away from contact with anyone who has a cold, upset stomach, cough or flu. The living space should be clean and kept well ventilated.
• Monitor general health. PLHIV should visit a doctor regularly for check-ups, early treatment of possible co-infections, and any other health problems.
Activity 16: Making the right choices
To get participants to examine the ethical choices they make, related to care and support, and to examine the consequences of those choices
Living positively means doing everything possible mentally, emotionally and physically to stay healthy, active and well for as long as possible.
Step 1: Explain that you will read a list of statements and ask participants to decide if the action recommended in the statement would be a good or bad thing to do, and why.
(Good. At times, people living with HIV who are sick are too weak to look after themselves and really appreciate someone giving them a helping hand. Knowing that someone is trying to help them makes them feel much better.)
(Bad. Looking out a window at passers-by and children playing is a healthy distraction for people living with HIV and AIDS who are ill. The fresh air from an open window can also be refreshing.)
(Bad. Often, seeing children can cheer someone up. There is no risk of children getting infected through casual contact such as hugging or touching. Children have no fear of people living with AIDS unless they have been told by their parents or others that they should be afraid.)
(Bad. It is very important to seek medical care at a hospital or clinic and follow the advice of the doctor and nurse.)
• Clear liquids with salt added, such as chicken broth, coconut water, rice water or oral rehydration solutions should be given to people living with HIV and AIDS, who often have diarrhoea.
(Good. Some people mistakenly think that withholding liquids stops diarrhoea, but it actually makes the situation much worse and can even cause death. Everyone with diarrhoea needs lots of clear liquids).
Step 3: Provide information on care and support services available for people living with HIV and AIDS. (See end of Appendix for list of services provided) 57 II.2 Opportunistic Infections and Antiretroviral Therapy Opportunistic infections are infections that only cause disease in persons with weak immune systems. With the passage of time and in the absence of treatment, the immune system gets weaker and weaker, and people living with HIV or AIDS become more and more vulnerable to opportunistic infections and AIDS-related illnesses.
Some examples of opportunistic infections include tuberculosis, thrush in the mouth and throat, skin rashes, pneumonia, skin cancer, dementia (mental illness/forgetfulness), fever and night sweats, weight loss and herpes zoster.
The immediate treatment of opportunistic infections helps support the immune system and minimize the viral load.
The body is protected by the immune system, which consists of white blood cells. There are different types of white blood cells, including CD4 cells. HIV attacks and destroys CD4 cells, and when the CD4 count is very low (around or below 200), a person will begin to suffer from opportunistic infections because the immune system is no longer strong enough to fight off disease.
Antiretroviral drugs (ARVs) are not a cure for HIV. ARV therapy attacks HIV directly and decreases the viral load (amount of virus in the body). A medical doctor will advise on when ARV therapy should start.
Once ARV therapy has been started, the medication must be taken every day at the same time. If the ARVs are not taken every day, at the same time, the person may develop a resistant strain of the virus that is difficult to treat. ARVs cause side effects such as nausea, anaemia, rashes and headaches, especially at the beginning of the treatment.
ARVs are used to reduce the likelihood of mother-to-child HIV transmission if taken by pregnant HIV-infected women before, during and/or after birth, and by the baby after birth. When a pregnant woman in Trinidad and Tobago attends a pre-natal clinic, she will
Activity 17: Taking Antiretroviral (ARV) drugs.
To better understand how to keep taking antiretroviral drugs and why people may decide to stop taking them
Taking antiretroviral (ARV) drugs regularly for the rest of their lives is a big challenge for people living with HIV and AIDS, especially if they suffer side effects. There are different approaches to assisting individuals in taking their ARVs regularly.
Step1: Explain to participants that not all people living with HIV have to take medications, but once the body’s immune system becomes very compromised (CD4 count below 200), they will have to take ARVs every day, at the same time. It is VERY important that they do not miss any doses of the medication as the body can become resistant to the medication.
Step 2: Ask participants to make a list of reasons why people living with HIV might have difficulty taking ARVs every day at the right times.
• It is difficult to coordinate taking medicine with or without food (some ARVs have strict food requirements)
• Individuals get tired of the side effects of ARVs
• Individuals get tired of always having to take ARVs
• People may start to feel better and stronger and think they no longer need the medication
• Getting to the clinic to pick up the ARVs may be difficult (money, time-off, travel-time etc.)
• People who are travelling away from home may forget to take their ARVs with them
• Some people sell their ARVs
Challenges for men and women In Trinidad and Tobago, as in other parts of the world, women are more likely to become infected and are more often adversely affected by the HIV and AIDS epidemic than men, due to biological, socio-cultural and economic factors. The greater the gender discrimination in societies and the lower the socio-economic position of women, the more negatively women are affected by HIV.