Knowing about HIV/AIDS and Role of Anganwadi Workers HIV Testing and Treatment Facilitators notes The session is scheduled for one hour based on the ppt slides

Session objectives To learn the protocols of HIV testing. To learn about the treatment procedures for PLHIVs To explore the role of Anganwadi workers towards HIV testing , counseling and treatment services

? HIV Testing How does a person know if he/she is HIV positive The only way to know if one has HIV or not is through a blood test. Facilitators Note: Probe further from participants to understand their knowledge on HIV basics, testing centre and protocols, counseling process. And then proceed to further slides Emphasize on the key message

You can help women and men in the village with information about HIV Testing It is simple to get HIV testing done Blood tests for HIV are done free of cost at the Integrated Counseling and Testing Centres (ICTC) ICTCs are located at Community Health Centre (CHC) or District Hospital Counselor provides pre-test counseling and post-test counseling to all persons being tested for HIV Identities of the person getting tested are kept confidential Facilitators: Ask if anyone from participants have known of ICTCs, if so what had been their experience and for what purpose? Share the list of ICTCs in their locality as a handout Discuss in detail on the contents of pre and post test counseling Discuss in detail on the need for keeping the test result confidential You can help women and men in the village with information about ICTC centres.

What is an HIV Test? ELISA or Rapid are the two commonly done tests to detect HIV in our body These tests detects for antibodies in the blood, produced as a result of HIV infection During window period, HIV tests give negative results In suspected high risk cases, the test need to be repeated after three months There are three strategies followed for testing , done based on the contexts , common being three different tests with a single blood sample to diagnose HIV Facilitators Note: Discuss the objectives of HIV testing. Discuss in detail on the debates on unlinked anonymous, voluntary and mandatory testing Point 1: Different types of HIV testing for detecting antigens and antibodies in human body. How is ELISA different from Rapid test. Specifics on different generation ELISA tests Point 3: Explain why HIV test give negative results during WINDOW period and need of repeating the test after three months for suspected High risk groups

Counseling during HIV testing The Counselor helps the person to understand: the importance of taking blood test to know his/her HIV status the importance of taking treatment if HIV positive Planning for children and the use of condoms to protect the partner from virus Help women/spouses and other family members to get tested for HIV Facilitators Note: Point 1: Discuss principles of counseling relevant for HIV related pre and post test counseling. Point 2: Discuss the attitude and skills required in pre and post test counseling Point 3: Discuss the tools and contents in pre and post test counseling Point 4: Discuss the importance of partner counseling and testing

If the test results are negative ? If one or both partners have a high-risk behaviour in the past three months and test negative for HIV, they should be advised to repeat the test after three months. Counsel them to avoid any high-risk behaviour during the window period even if the test is negative. Counsel about using condoms consistently and correctly Facilitators Note: Point 1: Help them to recollect the steps in using condoms (male and female)

If the test results are positive? Advise the HIV positive person to register at an ART center and take the CD4 count test. Ensure the information is kept confidential Develop their social support though family, friends and peer group. Ensure they follow-up regularly at the ART Center In case of pregnant women, ensure they deliver at the hospital, and receive Nevirapine (NVP). Discuss issues related to diet, nutrition, exercise and risk reduction. Facilitators: Discuss the need for ART centre registration and monitoring for CD4 testing Discuss the issues related to diet, nutrition, exercise and risk reduction Avoiding unwanted pregnancies, coercive sexual behaviour of the partner Sharing and caring for each other Delivery and breastfeeding practices Using condoms

WHO clinical Staging of infection based on CD4 count Stage Symptoms (OI) 800 – 1200 Normal Nil > 500 Stage I Minor fever 350-500 Stage II Common cold, Respiratory Tract Infections,skin infections , Fungal infections 200-350 Stage III TB, Oral candidiasis, wt. loss > 10%, Diarrhoea > 1 month, Fever > 1month <200 Stage IV Extra pulmonary TB, Meningitis, severe wasting CD 4 count decreases Viral load increases HIV stage Explain the participants the importance of CD4 test in identification of the stages and initiation of ART drugs. All HIV positives should be registered in ART and undergo CD4 count. Care increases the life span by delaying the progression of disease to further stages Symptoms have to be treated at ART centre with the help of OI drugs distributed free of cost at ART centres ART AIDS stage

Provide information about: Avoiding unwanted pregnancies ( through safe sex and family planning – condoms and sterilization options), coercive sexual behaviour of the partner Sharing and caring for each other Delivery and breastfeeding practices Using condoms for prevention of HIV transmission Staying healthy AWW can play an important role by disseminating HIV prevention messages to the community in general and women in particular; services available through ICTC and ART Centres and services for HIV positive pregnant mothers and how they can prevent HIV transmission to their baby

PLHIV should remember: Must not donate blood, semen or organs Must inform the sexual partner and always use condoms Must consult the doctor at the nearest medical centre Must plan pregnancy carefully, and seek advice of the doctor at the ICTC Must seek early treatment at PHC or CHC if suffering from any other infections

HIV treatment ART is the combination of 3 drugs Given to a HIV positive person having CD4 count below 250 cells ART medicines are given free of cost at ART Centers ART medicines are to be taken 2 times a day, regularly for the rest of the positive person’s life Discontinuation/irregular intake of medicines makes treatment ineffective after sometime HIV/AIDS has no cure but with proper treatment, the PLHIV can live a long productive life. Facilitators Note: Focus on the point that ART does not cure HIV/AIDS. Inform the ART medications provided under the NACO program, common side effects Inform about the first line and second line therapies

Helping PLHIVs Ensure that the woman and her spouse and children go for HIV testing. Help them in getting their HIV test results Encourage all those diagnosed as HIV positive to get themselves registered at Antiretroviral Treatment (ART) centres Advise them to get the CD4 test done at the earliest Ensure that PLHA are regularly taking ART medicines as advised by the doctor. Ensure they visit the ART centre regularly and earlier if they experience any symptoms Ensure that PLHA are taking the diet as advised by the counselor Facilitators Note: Though, all the above points are important for an Anganwadi worker to serve PLHIV in the community, discuss heir willingness and how they could do this? Along with medicines, a positive attitude helps the person and the family to overcome the trauma of having this infection. You can be as source of support and guidance for HIV infected couples and women and making informed decisions about treatment and care.

Helping PLHIVs Eating healthy and nutritious food Exercising regularly Stopping alcohol and tobacco use Getting regular health check-ups Taking medicine as prescribed by the doctor for opportunistic infection (OI) Provide moral and psycho-social support to PLHA and keep them motivated with positive attitude. Don’t let anyone stigmatise and discriminate against them.

Preparing patients for initiating ART Key messages It is not curative, but prolongs life Treatment is life long, expensive High level of adherence is critical May have short or long term side effects Safer sex still essential Do not share with friends, family members ART must be started only when the person living with HIV is ready Facilitators Note: Inform the participants on the need of providing support to PLHIVs on treatment preparedness. The reasons in prolonging treatment initiation or lost to ART follow ups. Discuss on the importance and benefits of adherance

Opportunistic Infections - OI Common OI s are Diarrhea ,TB Herpes zoster, Candidiasis and Pneumonias Most important treatment /drugs need to know are Cotrimoxazole treatment and prophylaxis, Fluconazole and Acyclovir Facilitators Note: Categorise diseases under major causative organisms, its symptoms and when to consult doctor

HIV and Tuberculosis Tuberculosis (TB) is one of the most common opportunistic infections among PLHIVs More than half of the PLHIVs develop TB as their body’s immunity weakens Common signs and symptoms are: Constant cough for three months Low grade fever lasting for more than a month More than 10% weight loss within one year Any enlarged/swollen lymph node in the body Refer to the nearest DOTS centre/DMC available in all hospitals DOTS treatment lasts for six months Facilitators Note: Discuss the types and symptoms of various type of Tuberculosis

How do you think this information will be useful in your working situations? (Open for discussion) Facilitators Note: List out the points from participants. These would be registered and take home messages from this session.

THANK YOU Content Courtesy: Shaping Our Lives- Learning to Live Safe and Healthy; A Booklet on Women and HIV/AIDS for ANM, ASHA, AWW and SHGs; NACO, 2007 Adaptations : SAATHII (Solidarity and Action Against The HIV Infection in India) Technical Assistance Partner to Jagruti (APSACS-WD&CW Dept) Project Gandhi Nagar, Hyderabad- 500080, Andhra Pradesh Telephone: 040 27674757; Telefax: 040 27654688 http://www.saathii.org/orc (India's comprehensive HIV resource centre)