Training of

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Adolescent Education Program
Training of
Nodal Teachers
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RESOURCE PERSONS
www.schoolofeducators.com
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DAY 1
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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.

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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.

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Ground Rules(contd.)

• No interruptions. It is better to raise hands so
  that the Resource Person can invite the
  individuals comment.
• Ask questions one at a time and also give others
  a chance to talk.

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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 others feelings, opinions and
  experiences.

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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.

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• 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.

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Group games
Role play
VIPP
Situation analysis
Group guided discussion
Methods
Presentation
Case studies
Brainstorming
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Setting the Context
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• Who are Adolescents?
• Adolescents 10-19 years
• Youth 15-24 years
• Young people 10-24 years
• Growth phases
• Early adolescence 10-13 years
• Mid adolescence 14-16 years
• Late adolescence 17-19 years

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Why focus on Adolescents?

• Large human resource (22 population)
• Caring, supportive environment will promote
  optimum development physical, emotional, mental.

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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.

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Age structure of Indias population-2005
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Comparative age structure of population-2005
Nigeria and USA
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Indias demographic bonus

• Window of Opportunity.
• How can we make this a reality?

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Adolescent concerns

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

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What are the issues related to Adolescent Health?
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• 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 10-19 yrs is working. (Source
  Census 2001).

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• 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?

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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.

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Please reflect on
Issue Marriage(contd.)

• How can you contribute to prevent early
  marriages?
• What can we do to equip young people to have
  children by choice, not chance?

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Issue Health

• Adverse sex ratio 10-19 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 15-24
  years.

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Issue Health

• For rape victims in the age group of 14-18 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?

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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. 1986 to
  2006). (Source naco.india.org)
• 0.97 million (39.3) are women and 0.09 million
  (3.8) are children

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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 15-24 years (NACO).
• India has the second largest population of AIDS
  patients. Over 35 of all reported AIDS cases
  occurs among 15-24 year olds. Source NACO and
  UNICEF, 2001. Knowledge, attitudes and practices
  for young adults (15-24 years NACO. 2005. India
  Resolves to Defeat HIV/AIDS).

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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 - 0.47).

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Issue Substance Abuse

• Estimated number of drug abusers in India is
  around 3 million and that of drug dependents is
  0.5 - 0.6 million. (Source UNODC and Ministry of
  Social Justice and Empowerment, 2004)
• Problem is more severe in the North-Eastern
  States of the Country.

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Issue Substance Abuse(contd.)

• Most drug users are in the age group 16-35 years.
• Drug abuse rate is low in early Adolescence and
  high during late Adolescence.
• Among current users in the age group of 12-18
  years, 21 were using alcohol, 3 cannabis and
  0.1 opiates (NHS-UNODC 2004).

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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 12-18 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?

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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.

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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.

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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.

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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.

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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.

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

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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.

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Process of Growing Up

• Nutritional needs of Adolescents in general and
  Adolescent girls in particular.
• Physical growth and development.

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Process of Growing Up

• Psychological development.
• Adolescent Health Issues (AHI)
• Gender sensitisation.

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HIV / AIDS

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

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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.

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Substance Abuse

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

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Substance Abuse

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

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APPROACHES
CO-CURRICULAR
CURRICULAR
Students
Teachers
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Co-Curricular Approaches
STRATEGIES
Interactive Activities
Teacher Counseling
Peer Education
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Interventions for Co-curricular Activities

• Advocacy
• Capacity building of Teachers/Peer Educators
• Student activities
• Health services Counselling and referrals to
  Adolescent-Friendly Health Services

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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.

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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-Frien
  dly Health Services.

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Effective implementation of the programme is the
key to its success
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Perspective Building on Life Skills Development
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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)

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

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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.

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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.

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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.

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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.

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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.

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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.

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• 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.

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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
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EFFECTIVE COMMUNICATION
Critical Thinking
Creative Thinking
Empathy
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Interpersonal Relationship
Self Awareness
Empathy
Effective Communication
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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.

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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.

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Healthy Growing up Understanding Adolescence
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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.

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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.

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Health

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

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Health

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

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Health

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

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Health

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

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Health

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

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Physical Changes in Girls

• Growth spurt occurs.
• Skin becomes oily.
• Ovulation occurs (may or may not).
• Menstruation begins.
• Waistline narrows

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Physical Changes in Boys

• Growth spurt occurs.
• Muscles develop.
• Skin becomes oily.
• Shoulders broaden.

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Physical Changes in Boys(contd.)

• Voice deepens.
• Underarm and chest hair appear.
• Facial hair appears.
• Sperm production begins.

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Emotional and Social Changes

• Preoccupation with body image.
• Fantasy and idealism.
• Mood changes.
• Attention-seeking behaviour.

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Emotional and Social Changes(contd.)

• Need to establish own identity.
• Inquisitiveness.
• Increased energy levels.
• Changes in dress code.

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Emotional and Social Changes(contd.)

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

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Emotional and Social Changes(contd.)

• 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

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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.

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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.

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Key Message
Analysis of Advertisements for developing good
nutrition practices

• Adolescents need to understand that there are
  certain food items which can be labeled as good
  and some as bad for their help.

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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?

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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 cant 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.

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Children learn what they live
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.
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.
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Children learn what they live
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.
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.
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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.

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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.

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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.

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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.

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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.

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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.

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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.

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DAY 2
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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.

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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

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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.

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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.

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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.

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

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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?

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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.

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Reproductive Tract Infections (RTIs), Sexually
Transmitted Infections (STIs) HIV/AIDS
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(No Transcript)
108
RTIs STIs

• 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.

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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.

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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.

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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.

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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

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Prevention Treatment of STIs

• Not neglecting any unusual discharge.
• Seeking medical help immediately.
• Avoiding quacks.

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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.

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Key Messages

• 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.

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Lets discuss HIV / AIDS

• HIV is
• Human Immunodeficiency VirusHence,
  HIV is present only in humans.

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Immune System

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

118
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.

119
Modes of HIV Transmission

• Infected blood blood transfusions with untested
  blood.
• Infected equipment needles / instruments /
  syringes.

120
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.

121
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 15-24
  years. Those affected are likely to die of AIDS
  before they turn 35.

122
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.

123
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.

124
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.

125
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.

126
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.

127
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.

128
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.

129
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 510 yrs.
• Uncontrolled diarrhea and fever, Unexplained
  weight loss, general weakness, enlarged lymph
  nodes, skin infections opportunistic infections

HIV Infection
Window period
Silent Infection
AIDS
130
AIDS results from HIV infection

• Acquired Not genetically inherited but
  contracted from somebody.
• Immune Deficiency Inadequacy of the bodys
  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.

131
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.

132
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.

133
Signs Symptoms of AIDS

• As the persons 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.

134
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.

135
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.

136
Prevention(contd.)

• Resist peer pressure to engage in sexual
  activities.
• Avoid substances such as alcohol and drugs, which
  cloud ones judgement and make one prone to risky
  behaviour.

137
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.

138
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 ones partner.

139
Key Messages

• Everyone is vulnerable especially young people.
  Global data shows that 50 of all new infections
  occur in the 1524 year age group and 35 of all
  reported new infections in India are in the 1529
  year age group.
• Young people are at the centre of the epidemic.

140
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.

141
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.

142
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.

143
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.

144
Assessing the Risk of HIV TransmissionKey
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

145

• 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.

146

• 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.

147
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.

148
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.

149
Preventing Substance AbuseKnow The Facts
150
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.

151
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.

152
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.

153
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.

154
Signs symptoms

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

155
Signs symptoms(contd.)

• Doing things that a person normally wouldnt 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.

156
Signs symptoms(contd.)

• Deterioration of physical appearance and
  grooming.
• No longer spending time with friends who dont
  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.

157
Signs symptoms(contd.)

• 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.

158
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.)

159
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).

160
Gateway Drugs

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

161
Harmful effects of smoking cigarettes

• Diminished or extinguished sense of smell and
  taste.
• Smokers 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.

162
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.
163
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.

164
Harmful Effects of Other Substancesof 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.
165
Harmful Effects of Other Substancesof
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.
166
Psycho-social Complications ofSubstance
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.
167
Psycho-social Complications ofSubstance
Dependence(contd.)
Social Peer alienation arguments, fights decreased social reputation, etc.
Legal Violation of rules thefts and petty crimes arrests and court cases.
168
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.

169
Why are Adolescents Vulnerable?

• 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.

170
Why are Adolescents Vulnerable?

• 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.

171
Why are Adolescents Vulnerable?

• 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.

172
Why are Adolescents Vulnerable?

• 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.

173
Protective Factors
Individual 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.
174
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.
175
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.

176
Common Myths about Drug Intake
MYTHS 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.
177
Common Myths about Drug Intake
MYTHS 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.
178
Common Myths about Drug Intake
MYTHS 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.
179
Common Myths about Drug Intake
MYTHS 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.
180
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?

181
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.

182
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.

183
Lets 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 ones
  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.

184

• 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.

185
DAY 3
186
Ways to say No
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 dont 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.... No thanks.
187
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. Id rather stay home why dont you come join my family with me for dinner. We can watch the movie on T.V. it is a really nice movie
188
Come on, just spend some time alone with me. Reverse the pressure (change the topic). What did I just tell you? Werent you listening?
There is nothing harmful in this, do it for my sake. I do so much for you, wont 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 youre likely to be pressurized into doing things you dont want to, stay away from them, such as parties where you know these things will definitely happen.
Explicit high-risk situations such as smoking, drinking etc. Strength in numbers. Associate with people who support your decision not to drink, not to use drugs, or watch adult movies, etc.
189
Coping with stressKey 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.

190
Coping with stressKey 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.

191
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.

192
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.

193
Tips on Facilitation
194
Facilitation vs Teaching
Facilitation 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
195
Facilitation vs Teaching
Facilitation Teaching
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.
196
Facilitation vs Teaching
Facilitation Teaching
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.
197
Dos and Donts of Good Facilitation

• Dos
• Position yourself to face the entire group.
• Smile at indivi