Tobias Troll Sven Voigtländer AIDS Education in Akatsi, Ghana Documentation of the Methods ASA Program Germany & National Youth Council Ghana 2002 In the second half of 2002 the following project, within the framework of the German ASA-Program of InWEnt, was carried out in cooperation with the National Youth Council, Ghana, in the Akatsi District of Ghana: HIV/AIDS awareness campaign for young people in rural areas Within this document, which also serves as a final report to the ASA-Program, the three ASA-participants: Tobias Troll, Sven Voigtländer and Irma Welinsky, want to present parts of the Awareness Campaign. This package consists of a brochure and an accompanying video. Table of contents 1 INTRODUCTION 2 THE MODULES 2.1 Introduction 2.2 Mouse game 2.3 AIDS-graph 2.4 Our body game 2.5 Traffic light game 2.6 Boats of hope 2.7 Condom demonstration 2.8 Sexually transmitted infections (STI's) 2.9 Leticia's story 2.10 ABC song 2.11 Questions, discussion and viewpoints 3 FURTHER MODULES 4 REFERENCES 1 Introduction The aim of this brochure is to reflect on our experiences, present key modules of the awareness campaign in detail and, especially, to make them accessible and shareable with others. Thus, we want to support other people who are working in this or comparable fields of study, in their work as well as in their realization of similar projects. At the same time we are aware of the limits and imperfections of our representations, which are due to a stay of only some months. In this sense we regard the brochure more as stimulation than perfect knowledge, with the aim of making a contribution to further intercultural cooperation. In Ghana the concrete cooperation partner was the Akatsi District Youth Office of the National Youth Council, Ghana. This Youth Office also initiated the forming of an Akatsi Youth Committee. Additionally, there were contacts to representatives from the Social Welfare and Education Office. All mentioned institutions participated in the planning of the HIV/AIDS Awareness Campaign. This enabled us to get a first-hand insight into local points of view and attitudes. However, the willingness of those partners to contribute to the program's conception in terms of content was very low. Thus, initially we unconsciously worked out a very "European" conception. This conception was very knowledge-based, was grounded on too much material, and was rarely aiming at aspects of stigmatisation and attitudinal change. After some timely progress we tried to make the campaign more simple, more understandable and visual. For example, we left out an ambiguous poster explaining the use of a condom, and substituted some illustrative charts of the "Traffic light game" with real and genuine things. In contrast to this rather pedagogical program, Sven prolonged his stay and offered group counselling on HIV/AIDS issues. The related way of proceeding was more gentle and integrated. Through the use of a forum for debate, the emphasis was laid on the crystallized categories of the awareness campaign: stigmatisation, fears, conflicting information and gender issues, which were seen as more useful. One part of the group counselling sessions was the separation of people according to sex and age to booster a broad discussion. Not least, more attention was paid to coordination: appointments were made in close contact with the concerned villages (their churches as well as schools), and a reliable way of transport was assured to all in advance. Towards the end the group counselling was carried out mainly by our Ghanaian counterparts. In our view the continuous adaptation to the local context was very important. According to our experiences, the related influencing factors and conditions to be noted were: literacy and the general level of education, the division into official and local languages, religiosity, the material infrastructure, e.g. means of transport and video recorder facilities, and macro-economical data like the average annual income per capita. Our project resulted in a continuous company of interpreters, the differentiation of the program regarding the level of education, the target group (12 up to 49 year-old people in schools or communities) and their religiosity. In our opinion a further key point in the planning and carrying out the HIV/AIDS awareness campaign was continuous conceptual work and reflection, without which you reach nobody and nothing is achieved if the worst comes to the worst. Apart from the already mentioned improvements, we were discussing teenage pregnancy in the form of a frontal teaching unit. This was not very successful, particularly because the concentration of the audience was decreasing towards the end of the program. We substituted a short story for the frontal teaching unit so we were able to capture the audience's attention better. Finally, we want to mention some points that are fundamental to awareness campaigns. Besides context adaptation and a positive attitude, participation and integration between the team as well as with the audience is very important. This also includes the provision of bilingual material. Furthermore, a general connection is more important than the provision of many details, thus, concise simplifications are often appropriate. Last, and especially important, the arguments given should be orientated at the everyday life of the audience. Argumentations concerning stigmatisation and their reasons have to be attached to the everyday life of the recipients in order to enable a change of attitudes. 2 The modules The modules represented are listed below. The modules, which are also documented on video, are marked with (VIDEO). Introduction Mouse game (VIDEO) AIDS graph (VIDEO) Our body game (VIDEO) Traffic lights game (VIDEO) Boats of hope (VIDEO) Condom demonstration Lecture to sexually transmitted infections (STI's) Leticia's story ABC song Questions, discussion and viewpoints 2.1 Introduction The introduction helps everyone to get acquainted with one another. Furthermore, an overview of the forthcoming course can be given by stating expectations, objectives and the central modules. In a short way this can also be done at the beginning of each module. Before the introduction all preparations, for example, the provision of required materials, should be finished to ensure a smooth and flowing program. 2.2 Mouse game Objectives: The Mouse game should help break the ice between the audience and the speakers, so as to create a relaxed and interactive atmosphere. Additionally, the speakers should get an impression of the knowledge and the existing audience's prejudices related to HIV/AIDS. Materials: * throwable object * poster or something similar as stimulation [In our case a cloth mouse and a poster with the title "What have you heard about AIDS?", on which you could see two Ghanaian children with questions about HIV/AIDS.] Description: Interactive game to get to know each other. Realization: The speaker sets off with the question: "What have you heard about AIDS?" and throws the mouse into the audience. The one who catches the mouse is supposed to tell the audience what he has already heard about AIDS. Afterwards he throws the mouse back to the speaker. At the same time the speaker makes it clear that people can answer in their local language if they prefer, that he is not carrying out a knowledge test with right or wrong answers, and widens the question to "What have your parents, friends or media told you about HIV/AIDS?" The first catcher is a member of the presenting team and tells the audience what he has been told. He can deliberately give wrong answers to stimulate and challenge the audience. The appreciation of each answer with clapping seems important to us in order to push the game forward and to reduce fears. Duration: 5 Minutes. [This is the average duration, which we needed for this module. The duration of this module depends on the context, and in individual cases it may be 2 or even 10 minutes long. This fact is also valid for the following modules.] Problems: * After announcing the game, or, after the first couple of throws, people are running away from the mouse. Some individuals, especially women, do not dare to answer the question. > Above all throwing to individuals who are showing less fear (young men according to our experience) or, if necessary, breaking off the game. Alternatives: * People do not throw the cloth mouse back to the speaker but throw it further on themselves. 2.3 AIDS-graph Objectives: The audience gets an idea of what HIV and AIDS are, and how they are connected. This unit should explain the causal connection between the pathogen HIV and the syndrome AIDS. Materials: * two illustrative charts with the written-out meaning of the acronyms HIV and AIDS * a blackboard image Description: Construction and explanation of a blackboard image. Realization: The two illustrative charts are explained and stuck to the blackboard. While doing this it is important that the speaker breaks down the expressions HIV and AIDS and makes them understandable. In our case there were no corresponding words for "immunodeficiency," "immune deficiency," "virus" and "syndrome" in the local language. Next, the speaker draws an arrow from HIV to AIDS, which explains the causal connection: an HIV infection will certainly result in AIDS. Another arrow as the y-axis represents the strength of the immune system. The drawing in of a falling curve illustrates that the immune system of the body, which is still intact at the beginning of the HIV infection, is decreasing. It is only a matter of time until the immune system is increasingly unable to repel pathogens and/or to push the recovery process. At the end of this process the person living with HIV is in the full stage of AIDS, which is characterized by several symptoms and ends with death. Finally, we stressed the individual differences of this inevitable process, and its duration from the HIV infection up to the first signs of AIDS. We exemplary mentioned 2, 5 or 10 years, particularly because the individual resistances are already weakened due to poor living standards. We compared the individual differences of the duration up to the breakout of AIDS with individual differences in stature, body weight, height as well as the reached age. Duration: 10 Minutes. Problems: * Illustration with the help of a coordinate system may be too abstract. Due to low literacy levels and low commands of the English language, the explanation of HIV and AIDS makes little sense. > Flexible use of this module and, if necessary, reduce it or leave it out completely Alternatives: * The module "AIDS graph" is left out completely, and the contained information (HIV and AIDS, chronological process, causal connection and duration) is covered in the "Our body game." 2.4 Our body game Objectives: Following the slightly dull lecture, "AIDS graph," the connection between infection and syndrome will be presented in a more accessible, fun and interactive way. Materials: * cape or sign to mark a volunteer as "Our body" * 4 caps of the "White blood cells" * 4 disease masks, e.g. cough, fever, malaria and HIV * illustrative chart with the word "AIDS" on it Description: Interactive game with audience participation. Realization: At the start of this game the speaker has the task of briefing the volunteers about their roles, and to explain what the playful presentation represents. The explanation links the game to the prior module: "AIDS graph." One volunteer is representing "Our body" and positions himself in front of the audience. Additionally, "Our body" has an immune system which is characterized by 4 volunteers wearing the "White blood cells" caps. One after another other volunteers are acting as more or less severe diseases by putting on the disease masks. The audience then can see how cough, fever, malaria, or other diseases, one after another try to attack "Our body." It results in small fights and scraps; however, "Our body" is well protected by the surrounding "White blood cells." Ultimately, the game shows how his immune system can repel these threats. Instead of attacking "Our body," the HIV attacks the "White blood cells" and pulls them away from "Our body." Now "Our body" is defenceless; instead of the "White blood cells," the HIV is standing besides him. At last the diseases have an easy job and can, unhindered, attack "Our body." There is no immune system anymore that could fight off the diseases, and "Our body" becomes increasingly weaker. This weak and defenceless state of "Our body" ["Our body" surrounded by "HIV", "cough", "fever" and "malaria"] is called AIDS by the speaker. The illustrative chart "AIDS" is held up high. At the end of the game it seems important to us to point out the exemplary character of the diseases cough, fever and malaria in order to prevent the development of stereotypes and stigmatisation. AIDS is a general immune deficiency, which makes the body defenceless to all manner of diverse diseases. [Pathogens (bacteria, viruses, funguses and so on) are not diseases, or rather, their connected symptoms are attacking the body. If the repel reaction is inadequate or the offence takes place on such a large scale, a disease develops. HIV is not a disease but a pathogen. We are aware of those simplifications, which are leading to a better understanding of this module.] Duration: 15 Minutes. Problems: * This illustration is clearly a simplification, which can also lead to confusion. Symptoms, pathogens and diseases, and their cause and effect connection, are in a muddle. > More or less differentiation (e.g. pathogens on the masks) in relation to the educational level of the audience Questions: [Within this part we are showing examples, and presenting some questions and the answers we were giving or rather the strategies we were using.] * Where does HIV/AIDS originate from? Answer: This is a very interesting question, but we unfortunately do not know for certain. There are different assumptions (Europe, Africa, Asia, America) about it, but none is for certain up to now. Do you know where Malaria and Polio originated from? Is it important at all? HIV, Malaria and Polio exist, and they are a threat to all of us. Therefore, we have to focus on going into action against all of them, and to protect us as well as possible. In front of students or pupils of secondary level we were also talking about the different types and sub-types of HIV, which are all widespread in Africa, whereas in other continents only one type is dominating. With a high probability the origin of HIV lies in Africa. [However, the last paragraph is very delicate and can offend people. In case of doubt we recommend to leave it out.] * What are the symptoms of a typical HIV infection? How can one identify a person living with HIV? > Answer: An HIV test is the only possibility to be sure whether somebody is infected or not. AIDS is an immune deficiency syndrome that can basically be accompanied by all kinds of symptoms. Frequent symptoms are chronic diarrhoea, high loss of weight, long and continuous fever, tiredness and nightly sweating. These symptoms, however, have another cause, e.g. tuberculosis, which is not related to an HIV infection. Thus, these symptoms are not always the result of an HIV infection. [Eventually make stigmatisation the subject of discussion.] 2.5 Traffic light game Objectives: This module should clarify what are the possible ways of transmitting HIV, and which situations are risky, or risk-free, of contracting HIV. Ultimately, for participants to develop a risk understanding. Materials: * a red and green circle - the traffic light * illustrative charts labelled with blood, breast milk, semen, vaginal fluid * Objects or charts which are representing possible and impossible ways of transmission, e.g. a razor blade, a syringe set, a sponge, a ball, a plate, a comb and images showing a breastfeeding mother, a mosquito, a kiss and sexual intercourse Description: Interactive game with audience participation. Realization: In the beginning the different body fluids - sweat, spit, urine, blood and so on - are listed. Only some of them can transmit HIV. Blood, breast milk and sexual fluids are those body fluids that can potentially transmit HIV. The concerning charts are stuck to the wall or blackboard. The speaker gives an example of transmission for each of them. Following, the red circle is put on the side of the risky body fluids, and on the other still empty side, the green circle is put. The understanding of this information is then checked with the help of objects and charts. The audience is requested to assign the following objects and charts either to the red and risky side or the green and safe side. The assignment is done by gestures and calls. Objects and charts, which are arousing disagreement, are discussed in detail. According to our experiences these are kiss and mosquito. Duration: 20 Minutes. Questions: * Why is a kiss safe? What if one has a bleeding wound? > Answer: Would you kiss somebody who has a bleeding wound? In case of a deep kiss there is a very low risk of infection. * Why don't mosquitoes transmit HIV? > Answer: The mosquitoes are digesting the poured blood. With this the HIV is destroyed. * If a man is HIV positive and he is fathering a child is the child going to be positive as well? > Answer: He can be but does not have to be. The semen contains HIV, but not the sperms of which meet with the egg. * What if somebody wants to take revenge and mixes his blood with drinking water or food? > Answer: There is no risk of an HIV infection. Both food as well as drinking water is digested. With this the HIV is destroyed. Furthermore, the HIV can only survive for a certain period of time outside the body. This time span is extremely reduced by heat. However, an exact and reliable statement is not possible. [Eventually make stigmatisation the subject of discussion.] Alternatives: * Depending on the educational level of the audience, more differentiating and scientific answers can be given. For example, that each body fluid contains HIV but only within blood, breast milk and the sexual fluids the concentration is high enough to enable a transmission. 2.6 Boats of hope The boats of hope are a widely used strategy in Africa, and in particular the basis of the Ghanaian HIV/AIDS prevention program. Key points are the different ways of protection: abstinence, being faithful and use of a condom. With this the boats of hope offer the opportunity to integrate Christian and Muslim clergymen and conservatives who are, categorically speaking, against condom use. Ultimately, this integration approach is very important in strongly religious societies and countries like Ghana. Objectives: The audience knows how to effectively protect themselves from contracting HIV. The main emphasis lies upon the sexual transmission of HIV. Materials: * objects of the traffic light game * large blue cloth with three boats sewn on it * different characters and crocodiles on small paper strips [The necessary materials are available from the John Hopkins University, USA.] Description: Visualizing unit with audience participation. Realization: One after another the three body fluids - blood, breast milk and sexual fluids - are made the subject of discussion. The speaker takes the syringe and the razor blade out of the prior game. Here it seems important to us to refer to the use of one-way syringes which are thrown away after use and which are, according to our knowledge, applied in all hospitals. In other cases the risk of transmission can be prevented by sterilization, e.g. ten minutes in boiling water. The joint use of razor blades that are available for a small amount of money should be avoided. Concerning hairdressers we referred to those who were using sterilization machines. Regarding breast milk, the speakers have to clarify in advance which recommendations they want to provide. This is because a hygienic preparation of alternative products is often difficult, and can highly disturb personal resistance and growth. In case of a pregnant woman with HIV we recommend this relegating sequence: a) the use of alternative products under the condition of a hygienic preparation, b) a woman without HIV takes over the breastfeeding, and last c) breastfeeding through the infected mother. However, according to our current knowledge sexual intercourse is the most common way of HIV transmission in Africa, and that is why we were focusing on this. The speaker, therefore, uses a large blue cloth with three boats sewn on it, as well as several characters on paper strips. The boats are representing the ways of protection ABC - "Abstinence," "Being faithful" and "Condom use." The blue background is supposed to illustrate a flood of HIV which people are drowning in, meaning people contract HIV if they do not protect themselves. In the beginning some of the characters on paper strips who do not protect themselves are sacrificed by being drowned with their feet up high, or, being put into the pockets of the cloth. However, nobody is forced to drown in the flood, and so the following characters are personalized, and on the basis of short and credible stories put into the boats "Abstinence," "Being faithful" and "Condom use." While doing so the boats are explained. The characters/persons can change the boats if their opinion or life situation changes. Above all it is important that they stay in one of the three boats to be protected. Furthermore, the speakers appeal to those who are already in one the boats to help other friends and acquaintances to climb into the boats. Finally, one can stress on the safety of each boat. The safest one is the boat of abstinence. Condoms can burst or tear in some cases, and faithfulness includes the partner's monogamy as well, thus it is not completely controllable. Duration: 20 Minutes. Problems: * One should consider that ABC as an acronym only functions in English, but not in the local language and others. Alternatives: * After a detailed explanation of the concept of ABC, the characters on paper strips are handed out among the audience. The characters are now assigned by individuals from the audience by stepping in front of the audience. The individuals tell, either in the local or official language, a story related to their character and then put them in the boats or the flood. The speaker should try to bear some names and stories in mind to resume to this later on. This alternative worked better compared to the above-mentioned format, however, it is not video documented. * In case there is no cloth at one's disposal, the boats and characters can be drawn and laminated. To illustrate the opportunity to change the boats, they can be connected with bridges made out of paper strips. 2.7 Condom demonstration Objectives: The audience knows about the purpose and the right use of condoms. Rumours and contradicting information are dispelled. Materials: * new male and female condoms * wooden penis Description: Practical exercise with audience participation. Realization: The speaker should stress the importance of condoms. HIV/AIDS are widespread, and pre-marital sex is not a rarity. The person who acknowledges this has to point out the opportunity of using condoms. Otherwise the person withholds an effective way of protection. Male condom: The speaker demonstrates its proper use. Before he opens the condom with his hands on the marked place, he pays attention that the condom is undamaged and has not exceeded its expiring date. Afterwards he explains the purpose of the reservoir, and holds this tightly while unrolling the condom. After the ejaculation the condom is held tightly at the shaft of the penis, and pulled out of the vagina. Then the condom is tied with a knot and disposed: burn, bury or dustbin. Further information on the singularity of use, price and where to buy condoms follow the demonstration. After the demonstration the speaker asks somebody from the audience to come in front to demonstrate a condom's proper use a second time. The volunteer should be given enough time and advice. Arising problems are pointed out and discussed. Female condom: To our mind it is best if a woman demonstrates the use of a female condom, because she is seen as more credible. In the beginning there follow the same steps as for the male condom: singularity of use, expiring date and opening with hands. The female condom differs from the male condom in two ways: it contains more lubricant and has an inner and outer ring. Both of the rings serve to hold the condom inside. The inner ring serves, moreover, to increase the ease of inserting the condom. For demonstration purposes, one can use a hand to symbolize the vagina. Operating instructions can be found on the back of the condom's package. The frequency of use is a controversial case. We recommend the single use of a female condom and the following disposal. However, the condom can be inserted several hours in advance of sexual intercourse. Further information on the price and where to buy condoms follow the demonstration. After the demonstration the speaker points out that male and female condoms should not be used at the same time, and that male condoms should not be doubled. In the opinion that this provides better protection one is wrong. In fact the level of protection reduces, because the rubbing of condoms between each other can cause cracks. Furthermore, the speaker again explains the order of precedence for the several ways of protection, and stresses that abstinence is the safest way. Duration: 15 Minutes. Problems: * The awareness program takes place in a religious context, a church, a mosque or at a religious youth meeting. > The recommendation of condom use is always a balancing act between the security needs of the youth and the religious and conservative attitudes of local clergymen. Here it is recommended to clarify the standpoints of the people in charge before the awareness program takes place. In case the people in charge are not open-minded towards condoms, the module should be dropped fully, and short attention on condoms should be paid within the boats of hope module According to our experience, questions on condoms will also arise in religious contexts, meaning that the speakers can deepen the issues without the module "condom demonstration." Questions: * I have heard that condoms easily burst or that the pores of the condom are bigger than the HIV - is this true? Answer: With proper use, the chances that a condom will burst are very small - approximately two of one hundred. Thus, they are not 100 per cent safe. One can blow up a condom to demonstrate its elasticity. Condoms are made out of latex and have no pores at all. * Which brand can you recommend? Do condoms fit to variously large penises? Answer: It was hard for us to recommend a certain brand. We referred to quality measures and tests within the production process that have to be fulfilled by all brands of condoms. In Europe different condom sizes are offered. This was not the case in Akatsi, Ghana, and so we pointed out the elasticity of the condom (see above). * I have heard a story that in East Africa many condoms were distributed, and at the same time HIV infections were rising? Answer: We do not know the truth, context and source of this information. It is recommended to again talk about the proper use of condoms, because only proper use offers extensive protection. If a condom is applied in the wrong way, there is no difference to this and unprotected sexual intercourse. [It was important to us to not slide down into complex and abstract attempts of explanation. We wanted to avoid being unintelligible.] * Can the female condom get lost in the women and kill her? Answer: No, there is nothing dangerous about the female condom. The cervix prevents the condom to find its way into the womb. One can also stress on the two rings again, which keep the condom in the correct position. Alternatives: * Should there be enough concentration left on the side of the audience, the module "STI's in general" is better placed, regarding the subject matter, after the module "boats of hope" and before the module "condom demonstration". 2.8 Sexually transmitted infections (STI's) Objectives: The audience knows that staying in boats also protects oneself from contracting other STI's, which AIDS is one of. Furthermore, it knows about the increased risk of contracting HIV if STI's remain untreated. Above all the audience receives general information on symptoms, courses of disease and treatment options. Materials: * not necessary, eventually brochures about STI's Description: Frontal teaching unit. Realization: The speaker refers to the further use of the "Boats of hope." They offer reliable protection from other STI's such as syphilis, gonorrhoea and hepatitis. If possible the speaker should use the corresponding expressions in the local language. STI's in general are not to be underestimated, because untreated they can lead to infertility, death and other such dire consequences. Next the speaker should describe the symptoms and refer to treatment options. On the basis of symptoms it can be vividly explained why STI's, under the condition that the partner is infected with HIV, increase the probability of contracting HIV. Concerning treatment options, it is particularly important that the concerned person seeks treatment together with his sexual partners. Otherwise there can be a repeated infection, and thus the treatment success does not last long. Duration: 10 Minutes. Problems: * This module, due to its frontal teaching format, is not very suitable at keeping the audience's attention for more than one hour. Improvements regarding ways of presentation should be striven for. Owing to this we inserted the "condom demonstration" between the "Boats of hope" module and the "STI's in general" module as you can see above. Questions: * Is it true that if I get syphilis I will get AIDS later on? Answer: No, both syphilis and AIDS are STI'S. HIV causes AIDS. If one is infected by an STI [here syphilis] there is an increased probability of contracting HIV when having unprotected sex with an HIV positive partner. Alternatives: * We applied the module "STI's in general" in communities. In schools with a much lower average age we applied "Leticia's story," instead of "STI's in general." The story illustrates the meaning of teenage pregnancy, as well as showing the possible consequences of teenage pregnancy. Its aim is to inform people to deal more responsibly when making decisions over sexual relations. 2.9 Leticia's story Objectives: The audience becomes aware about the meaning and the possible consequences of teenage sex. This module aims to make the participants think and to reflect about their own behaviour and to change attitudes. Materials: * exaggerated story, if possible in the local language Description: Telling a story. Realization: The story is aimed at 10 up to 17-year-old pupils and teens who are soon to make their first sexual experiences, are doing so at the moment, or who have already had some sexual experiences. The story is presented with distributed roles: storyteller, Leticia, Grando, Leticia's father and mother, Leticia's husband. The used names and the described situations should be adapted to the local context. Because our story was not written in the local language it was afterwards translated. Through the use of simple and concise English words, many pupil and teens could follow the course of the story. Leticia´s Story [the story written and applied by us] One day Grando would take over his father's Photocopy Shop. However, at the moment he was only interested in Leticia, a 15-year-old girl from the neighbourhood. For two weeks they were secretly going out in the evenings with each other. Leticia had already a womanly appearance; one could clearly see that her body and her platted hair were very beautiful. "No Grando, we are too young and we still have plenty of time," she answered every time when Grando wanted to have sex with her. Grando did not give up: "Why do you torment me so, it is the most common thing in the world. I love you and when we are old enough we will marry anyway." She was torn apart, on the one hand she loved Grando, on the other hand she had a bad feeling about having sex with him. Finally she gave in. The first time was painful; however, the following times it did not hurt anymore, but did not feel good. She did it, but only for Grando. "Grando, for two months I have had no menstruation. I think I am pregnant," said Leticia. Grando was not glad about this and their relationship was not like it was in the beginning. Some evenings he did not come and meet Leticia, and when he came they had sex but barely spoke. After Grando heard about Leticia´s pregnancy he came no more. "My feelings for you are not the same like in the beginning. I do not love you anymore" were his last words. At least she could rely on her parents Leticia thought. However, her parents were very angry when they found out about her pregnancy: "We always wanted the best for you and what are you doing? You misuse our trust. You are a disgrace for your whole family. In future you will not visit Grando again. From tomorrow you are staying at home." Her girlfriends she only saw seldom. At the moment of her child's birth almost everybody, including her former school friends, avoided her. Nobody wanted to have anything to do with her. The child she had to raise up on her own, without the support of her parents. Her mother only told her: "Be glad that you can still live in our house, in regard to the disgrace you brought to the family." The required money for the child and herself she had to earn by selling sugar cane at her former school. This brought not much in. She seriously thought about killing herself but her relatives talked her out of it. Finally, they found a husband for her - a man who was too poor to pay a proper dowry and who was considered by most of the village girls to be quite a foolish, irresponsible and a lazy person. At this point she could not say no. She felt she was such a burden to her parents that she could not refuse, and so she married a man she did not even like. Leticia was now in a very sad position. Her new husband was abusive towards her: "I don't have any respect for such a discounted bride." The people in the village felt Leticia was lucky to get a husband at all considering how foolish she was in her youth. Duration: 10 Minutes for telling the story and another 10 minutes for the following explanation in the local language. Problems: * The command of the English and French language may be very low in several cases. > Here it is recommendable to leave out the telling of the story and start right with the explanation in the local language Alternatives: * So far as time resources allow, this module can be released from the program and be used separately as a stimulus for a program aimed towards youth, gender issues and sexuality. Following discussions and teamwork are imaginable. 2.10 ABC song Objectives: At the end of the session the speakers and the audience are singing a song together. This song will hopefully spread among the target group and contributes to the break of HIV/AIDS-related taboos. Materials: * song text * copies for distribution to the audience Description: Song. Realization: A song worked out by the speakers, or better, in cooperation with local youth clubs, is sung. The verses are sung alternately by the speakers and the audience joins in with the chorus. An accompaniment with a rhythmical instrument like a drum or bongo can improve the presentation. The presented song is based on the "Boats of hopes" and the concept of ABC. The melody corresponds to the song "Oh, Susanna" ("I come from Alabama with my banjo on my knee..."). ABC song Chorus: A, B, C and AIDS won't attack me / Abstinence or Faithfulness or Condoms protect me 1. Victoria is a smart girl and she doesn't waste her life, / She abstains from sex because she knows; it's the best way to survive (Chorus) 2. Being faithful is the way of choice for Kofi and Mary-Ann, / They are standing side by side from the day their love began (Chorus) 3. Kwame loves the girls and he also loves his life, / So he uses condoms till the day he gets a wife (Chorus) 4. Also if I don't want to become young daddy or young mum/ I use A or C and the baby will not come (Chorus) 5. So if I want to avoid disease and STD, / I follow those simple rules of A or B or C! (Chorus) Duration: 5 Minutes. Alternatives: An English-language song is sung excluding those who have a low command of the English language. Due to a lucky coincidence, an American volunteer of the Peace Corps was teaching us a song on HIV/AIDS in the local language Ewe. With this song we could reach the whole audience. Below we present the song and its translation: Ewe song 1.wobenuka ya [what are they saying?] migble mase ye [tell me and I will listen] maibe aids ye [they are saying: It is AIDS!] 2. wobenuka ya [what are they saying?] maibe dikanaku [they are saying: It is AIDS!] 3. midschaye [be careful] dekakpio midschaye [young man, be careful] midschaye [be careful] detugbio midschaye [young woman, be careful] 4.aids donye dobada [AIDS is a dreadful disease] ame wum lak beme [it will kill you] aids donye dobada [AIDS is a dreadful disease] ame wum lak beme [it will kill you] 2.11 Questions, discussion and viewpoints After the modules the speakers offer to all the audience the opportunity to ask questions, criticise, present own viewpoints and thus, contribute to the discussion. This last part is also of great importance to the speakers. This is because the feedback provides an understanding of the whole situation, as well as indicating changes needed for the program's content and strategies. In particular, an understanding of attitudes and viewpoints, which one is confronted within an HIV/AIDS awareness campaign, is important. Without regarding those attitudes and viewpoints the campaign can remain totally ineffective. As is above-mentioned, we have put forward stigmatisation, isolation and their causes as key areas to cover. This is in contrast with the initial knowledge-dominated orientation. Thus, this module offers the opportunity also to discuss views on and, treatment of, people living with HIV/AIDS again, and to destigmatize it. We orientated ourselves towards the integration of people living with HIV/AIDS instead of isolation, on learning from people living with HIV/AIDS in order to fight the worldwide HIV epidemic, and on the viewpoint that nobody is guilty of contracting HIV. Who would come to the idea to say that somebody is guilty of his low educational level? 3 Further modules Within this document the presented modules do not claim to be the entirety, with there being many other methods and ideas one can think of. Within this section we want to present some further methods that we partly did apply. On the one hand there are two action games. The first game is based on the "Our body game," and consists in trying to make tin cans fall down with a limited amount of throws. The tins are decorated as "Our body" and "White blood cells." The "White blood cell"-tins are positioned around the "Our body"-tin. There are two balls to throw with: one "HIV"-ball to throw at the "White blood cells" and an "AIDS"-ball to throw at the "Our body." As soon as one has thrown away the "White blood cell"-tins, one is allowed to throw with the "AIDS"-ball at the "Our body"-tin. The second game is based on the "Boats of hope" module. The boats are arranged similarly to an obstacle walk. One can only move on the marked bridges and on the marked boats. In case one is stepping outside of the marked objects the game is lost. The arrangement is very free, e.g. one can precede hand over hand from one boat to the other, or balance over a small plank. On the other hand there is theatre and video. For a (puppet) theatre there are many possible linkages to several modules. For example, "Leticia's story" can be widened and filled with more dialogues so that one produces a screenplay. The speakers can rehearse and present the play themselves, or in cooperation with a local youth club. Cooperation has the advantage of everyone getting to know each other, and of being in a situation to raise several subjects like HIV/AIDS, sexuality, gender issues, violence and different perspectives. Another opportunity consists in the use of a video. Video films proved very popular in Akatsi. One evening we screened a Zimbabwean video film called "Yellow Card" on teenage pregnancy in the market place. Within a short period one thousand people were watching the television. We assume that not everybody understood the English-speaking video film, but watched because of the novelty of moving pictures. Regarding the combination of different methods and contents the imagination has no limits. Additionally one can find lots of suggestions in written publications and on the internet (see also references). 4 References www.afronets.org African networks for health research and development www.aids-kampagne.de/materialien/index.html Action alliance of several NGOs in the fight against AIDS www.aidsmap.com/organisations a worldwide list of AIDS/HIV NGOs www.asa-programm.de Program offering work and study trips to Africa, Latin America, Asia and Southeast Europe > Network for developmental political learning www.bzga.de German federal agency for health promotion > Information concerning health education and promotion www.difaem.de German Institute for Medical Mission > Library and materials concerning AIDS campaigning in Africa www.hcpartnership.org Health Communication Partnership > The M/MC Health Communication Materials Database permits searching for educational materials (sorted by country, region, content or kind of media) www.inwent.org Organisation for international human resource development, further education and dialogue > Responsible body of the ASA-Program www.jhuccp.org John Hopkins University Center for Communication Programs > Documentation of worldwide health care programs www.steppingstonesfeedback.org Stepping Stones > Training package including a video for prevention work in communities concerning gender issues, HIV/AIDS, communication and social competencies; excellent range of games and team activities http://www.der-ueberblick.de/archiv/200003/content.html Der Überblick (Magazine: The Overview) > Main topic March 2002: AIDS - Africa's new plague www.unaids.org Joint United Nations Program on HIV/AIDS > Library and epidemiological fact sheets www.who.int World Health Organization www.yellow-card.org “Yellow Card" > Zimbabwean movie about HIV/AIDS and teenage pregnancy produced by Media for Development (http://site.mweb.co.zw/mfd/) Contact: Tobias Troll 96 rue des Maraîchers 75020 Paris France phon: +33-1-55797586 cell:+33-6-17663046 tobias.troll@gmx.de Sven Voigtländer Auerbachstrasse 52 07549 Gera Germany cell1: +49-179-9028530 cell2: +372-55552686 s-voigtlaender@web.de Irma Welinsky Oberdorfstrasse 24A 78465 Konstanz Germany phon: +49-07533-4858 welinsky@gmx.de 2 33 32 33 60 59