Melissa: Peer2Peer training

A few weeks ago, Joshua and I were selected to become peer educators in the Stellenbosch University HIV awareness program. The program- Peer2Peer- focuses on prevention methods, including voluntary counseling and testing, awareness sessions and condom distribution. Their vision is: “By 2012 there are no new infections on campus. University management, institutional units, staff and students are working together to enable leadership, health seeking behaviour and quality education needed to effectively respond to the challenges of HIV and AIDS in South Africa, and the African continent.” As Peer2Peer educators within this program, Josh and I will receive training before participating in clinic outreaches, mentoring sessions and individual or group interventions. The biggest outreach hosted by the organization, the Grow Up and Get Tested campaign, is held annually in March so unfortunately we will not be able to participate in that. However, there are many other ways to get involved.

We had our first training weekend two weeks ago. We began on Friday with activities meant to break the ice between peer educators. For instance, a sticker was placed on each of our foreheads and we had to ask questions to discover who our new persona was. Josh successfully figured out he was Marge Simpson, while I didn’t manage to figure out Christiano Ronaldo (shame on me, I know). After a few other exercises and a pre-training questionnaire, we discussed our role at Stellenbosch. Peer educators are educators, activists, referral resources (able to provide names of locations, as well as directions and a name of a contact) and role models.

We next explored personal attitudes regarding values and gender. Much of being a peer educator is recognizing personal viewpoints and learning to express these clearly, while at the same time understanding how to put personal beliefs aside when dealing with people who have different belief systems. As an exercise, the group of around 40 trainees was asked to stand in the middle of the room. One wall became “agree” while another was “disagree.” We were then asked to bodily respond to a series of statements--Virgins can be sexually active. Men and women cannot have an equal say in decision-making. Heterosexuality is a choice. If a man is diagnosed with an STD he should be forced to test for HIV. After the group split into “agree” and “disagree,” individuals were asked to explain why they chose that particular wall. The answers were extremely interesting and varied as a result of the wide range of cultures represented in the room. Everyone was able to listen respectfully and some people were even persuaded to cross the room and change their response.

On Saturday morning we began by trying out a webCT course on HIV that will be compulsory for all first-year students to complete, beginning next year. The course consists of a pretest, informative module, and a posttest. While the module itself was interesting and informative, Josh and I suggested many improvements, most of which involved grammar or punctuation. We both felt that if the course was going to be affiliated with Stellenbosch University, it should look and sound professional!

Next was a session on HIV/AIDS. To share a few of the scary facts we learned:
-There were an estimated 33.2 million people living with HIV in 2007 with 2.5 million from new infections during that year.
-Of these 33.2 million, 22.5 million are in Sub-Saharan Africa.
-In South Africa, the Western Cape (where we are) has the lowest prevalence. It is 1.9%, while in other regions it is as high as 16.5%.
-Africans have a prevalence of 3.4% while other race groups are below 1%.
-In the 15-24 age group, females have 8X higher incidence (6.5% compared to .8% for males). This is likely due to multiple partners (one infected male infects multiple women) and women sleeping with older men in return for gifts.
-The age of sexual debut is 11. This refers to penetrative sex not due to rape or molestation. (This was particularly shocking to Josh and me. Eleven?!)
-More than half (57%) of sexually active females 15-24 have never used contraception.
-66% of people believe they are not at risk for HIV.
-51% of HIV positive respondents thought they would probably not or definitely not get infected with HIV.

After a quick lunch tea break we returned for another session, this time on how HIV/AIDS works.
-HIV= Human Immunodeficiency Virus
-AIDS=Acquired Immunodeficiency syndrome.
-HIV/AIDS can be spread through semen, vaginal fluids, blood and breast milk. Saliva and tears contain negligible amounts of the virus. You cannot get AIDS from mosquitoes or an animal bite.
-In the body’s immune response, phagocytes patrol and look for intruders. When an intruder is recognized, it sends for macrophages, which then confiscate an antigen. CD4 cells recognize antigen and attack the HIV. Next, antibodies are produced, slowing down HIV and making it an easier target for phagocytes to find.
-During the first 12 weeks after infection, the viral load increases as the HI virus replicates itself, killing CD4 cells in the process. This is the window period. Antibodies have not been produced, so if you are tested in this time it will be a false negative. Also, you are most contagious in this time.
-After 12 weeks, antibodies are produced and CD4 count goes up. There is then an asymptomatic period that can last 8-10 years, but CD4 cells continue to die slowly. Eventually, there is a tipping point, where there are not enough CD4 cells to manage your immune system. At this time opportunistic infections, especially TB and Meningitis, begin to appear due to a weakened immune system.
-South Africans qualify for government provided ARVs when their CD4 count drops below 200. They continue to take ARVs for the rest of their lives.
-AntiRetroviral (ARV) treatment suppresses or prevents the replication of HIV in cells. This allows CD4 counts to increase and the immune system to rebuild itself.

For lunch, the Peer2Peer program provided everyone with food from the Neelsie Student Center. We ate outside with new South African friends from the program. The lunch discussion revolved around the issue of race and how it is acceptable conversation in South Africa while almost taboo in the United States.

On our return to training we were placed into same-gendered groups and asked to discuss what sexuality meant to us. To do this, each group traced a body on large pieces of paper. We then drew what could be seen with clothes on in detail. My group’s body (Phobe- a homage to Friends) was given extremely good nails and facial features, as well as numerous pieces of jewelry. Next we were asked to draw everything that could be seen with clothes off. People were a little hesitant to draw at this point, but we soon got over it. Next came labeling parts of the body that everyone was self-conscious about. This was easy. Our labels included: fat legs, skinny legs, love handles, weird hands, ugly feet, crooked teeth, big calves, arm flab, scars, birthmarks, strange toes, acne, big breasts, small breasts, too short, too fat, too thin, too black, and so on. Less easy was labeling of areas of the body that give pleasure. Girls were again reluctant to begin, but eventually proposed labels that ranged from forehead kissing to ear licking to foot massages to the general area of breasts, etc. Upon finishing the posters, each group was then asked to explain their poster to their group. I was amazed at how explicit and open everyone was willing to be. There was laughter and teasing at some of the labels (especially the boys’ groups for some reason!) but it was a very safe environment.

On Sunday the training focused on living positively with HIV. We were first informed that yesterday everyone was infected with a rare strain of a disease. To counteract this, we must take medicine (a piece of sugar coated candy) every 6 minutes. My table set an alarm every 6 minutes and everyone would remind everyone else to take it. While at first we were so aware of the time we did not need the alarm, it came in handy as we began to be distracted by other things. The trainees were shown several videos about people living with HIV/AIDS. One was a televised support group comprised of doctors and also people living with the disease. One member of the group was a hemophiliac man from Stellenbosch who contracted HIV during a blood transfusion at age 6. His parents did not tell him until he was 15 and he came out at age 19. Now 23 and married, he was subject to discrimination in Stellenbosch due to his status. That just goes to show how great the stigma around HIV is. A white, straight man is HIV positive, but didn’t contact it through sexual means and he is still blamed by the conservative community. Other videos included a video of a white HIV+ Afrikaans woman who gave birth to an HIV+ son, a documentary-style video about a reporter trying to trace who gave a woman HIV, and interviews with positive black HIV+ role models. By the end of the day, we had a better idea of the different responses to living with HIV, as well as an idea about how difficult it is to remember to take medicine at a certain time. How terrible it is that those on ARVs have to take pills for the rest of their lives!

The weekend was long, but extremely interesting and informative. The second training session is this coming weekend and I am excited to learn more and become better prepared to discuss the topic with others. We'll keep you informed. Also, if you have questions, just ask!