BARRIERS TO HIV and AIDS

1. BARRIERS TO HIV and AIDS

2. Behavior change models and HIV The risk elimination model: “Abstinence is Best” The risk reduction model: “Use a Condom” Harm reduction model

3. The risk elimination model: “Abstinence is Best” The risk of infection is eliminated because the behavior is eliminated. “Just say no” and eliminate the problem.

4. The risk reduction model: “Use a Condom” The risk reduction model advises individuals to engage in “safer” sexual acts by using condoms whenever they have sex, or by not sharing their needles if they are going to inject substances

5. Harm reduction model Harm reduction challenges the “all or nothing” approach to behavior change, characterized by the previous models. This model Acknowledges that risk is a part of everyone’s life and ranks an individual’s risk/s for HIV infection among other life issues such as illness, unemployment, and drug use.

6. different behavior change stages according to the Centers for Disease Control HIV Prevention and Counseling Guidelines of 1993 are: 1. Knowledge/awareness 2. Significance to self 3. Cost/benefit analysis 4. Capacity building 5. Provisional try 6. Behavior change

7. Directions CASE ANALYSIS Identify helpful and /or harmful factors to effective AIDS response in the following cases, and recommend possible solutions

8. CASE 1 Roberto is a pastor in a neighboring community. He is an admired spiritual leader in his village and is respected by his congregation. Nearly everyone feels welcome in his church where sermons are delivered with energy and conviction; however, upon learning that one woman in his congregation was recently diagnosed as HIV-positive, Roberto let the woman’s family know that she was no longer allowed to attend church activities. Roberto told them, “I don’t want that sick woman to infect anyone else in my church!” The next Sunday he dispenses a sermon in which he characterizes people with HIV as “prostitutes and tainted by the devil.” Soon, many in the community refuse to talk with the family of the woman with HIV, including the woman’s husband, who leaves her and takes her children away. Few people stop by their courtyard and some avoid working in the fields with the said woman and her family. Soon after these events, Roberto leaves town to attend a regional gathering of religious leaders.

9. Analysis Case 1 • AIDS-related stigma and discrimination particularly religious denunciation • Ignorance of the basic facts and issues surrounding HIV and AIDS

10. CASE 2 At 36 years old, Christine is a widow with four daughters from two fathers. She lives in one of the districts in Quezon City. In 1989, when she was still a schoolgirl, she fell victim to a rapist and gave birth to a baby boy who later passed away from a "mysterious" illness after only ten months. In 1990 she was forced to marry the same man and had three daughters by him. During her ten years of marriage, her husband used to fall sick very often. She tried many medicines with little improvement to his condition. At the time she did not know her husband had HIV/AIDS. He did not disclose it to her. He later died in 1999 after suffering long under her care. On the death of her husband, relatives took away all the family property and left Christine with three helpless children. After two years as a widow, she re-married in 2001 and tragedy struck again - her second husband passed away in 2003. Christine is worried because two of her children is having consistent fever and diarrhea. She herself has been taking TB drugs but no improvement for the past 3 months. She is afraid to die and leave her children.

11. Analysis Case2 • Lack of HIV and AIDS education • Lack of appropriate medical intervention for Christine and the children. • The need for Christine to undergo counselling

12. CASE 3 Fely is a 35 year old woman from Iloilo with four children. She sells tomatoes and other vegetables in the market but does not have enough money to send her children to school. They have recently moved to Bangued, Abra to stay with her husband’s family because he had rarely found work in the places they had been before. Fely’s husband is a heavy drinker. From Abra, he went to Vigan to work as a construction worker in a hotel to be built there. Although her husband is not around much, Fely is faithful to him, though she wonders if he has other sexual partners. Fely is worried because her youngest daughter has been having diarrhea for the past several days. She has gone to their town’s health clinic for treatment of the baby, but could not find an Ilonggo-speaking counselor. She has been feeling tired lately and she’s worried about her baby. Her mother in law told her, “ I do not want you in my house.” Fely thinks she might have AIDS and thinks her mother in law might have cursed her with it.

13. Analysis Case 3 • Socio-cultural barriers Language barrier • Lack of AIDS education • Relational problems between husband and wife, wife and mother in law

14. CASE 4 Richard is a 28 year old math teacher. He has been teaching in a vocational school in a small town in Palawan for about two years now. Richard occasionally has sex with his female students. As compensation, the female students get improved marks and free tutorial sessions. The College Dean is aware that Richard has been having relationships with his students, yet he has remained silent. Recently, Richard discovered some rashes in his genital area. He has gone to a traditional healer but the treatment does not seem to work. He is afraid that one of his students had given him a sexually transmitted infection (STI). He confided to his friend, Rafael, the school’s science teacher, who told him to go to the health center to be tested for HIV. Richard is scared because he knows that he has not been using preventive measures in his sexual encounters with his students. He had always assumed that he was their only sexual partner. He thinks that maybe, if he waited long enough, the rashes would eventually disappear. He is also afraid that the test results would not be confidential, should he volunteer to have himself tested.

15. Analysis Case 4 Refrain from judging the behaviour of Richard, but focus in his need for counselling