1

Choose Life 3.0

with Adaptations and Skills for Healthy Relationships

by Food for the Hungry

Guide for Peer Educators and Youth Leaders

for youth 15 years of age and older

September 2008

A

A

World Relief 1.0 Acknowledgements Choose Life (version 1.0) youth leader’s guide was designed and developed through a collaborative process with World Relief staff and partners from Mozambique, Kenya, Haiti, Rwanda, Sierra Leone and the United States.

Design Team Advisors and reviewers Haiti Mozambique Deborah Dortzbach, MSN, MPH Marckenzy Deterriére Sybil Baloyi Dr. W. Meredith Long, PH Daniel Éliassaint Hubert Morquette, MD Oméga Pierre-Louis Rwanda Rev. Joaquina Nhanala Socra Saint Joy Edith Nyirabaera Nia Olupana, MPH Kenya Nerea Thigo Rev. Patrick Makewa Sierra Leone James Vilus, MD Anne Musya Nicole Behnam Lilian Wambua, MD John Mwangi Esther Ng'ang'a United States Joy Njeremani Rebecca Heidkamp Lucy Njoroge Laura van Vuuren Kepha Nyandega Choose Life (version 1.0) builds upon the work and experience of World Relief Rwanda and World Relief Kenya who developed the first Choose Life youth series. It also draws from the Ngili a Mué Clubs curriculum for World Relief Sierra Leone’s Child Development Program. Many thanks to the staff and youth of Scripture Union Kenya, Kenya Students Christian Fellowship, and Life Skills Promoters for their review of many of the activities included in the curriculum.

Food for the Hungry Acknowledgements Food for the Hungry has completed two revisions of World Relief’s Choose Life curricula. This revision includes the addition of the Skills for Healthy Relationships and incorporates the additional sessions and adaptations from Choose Life 2.0. Many thanks to World Relief US for their cooperation and willingness to work with us in making these adaptations possible. In addition, Food for the Hungry would like to thank staff member, Kimberly Buttonow, for her guidance and input in the final stages of editing. Extracts from this guide may be freely reproduced for non-profit purposes with acknowledgement to the authors and their funding agencies. For inquiries about the expanded version, please contact Mitzi Hanold at fhdc@fh.org This curriculum was made possible through support provided by the Office of HIV/AIDS, Bureau of Global Health, and U.S. Agency for International Development, under the terms of Award No. GPO-A-00-05-00008-00. The opinions expressed herein are those of the authors and do not necessarily reflect the view of the U.S. Agency for International Development.

B

Suggested Citation: Hanold, Mitzi J. and Davis Jr., Thomas P., in collaboration with World Relief (2008) Choose Life 3.0 with Adaptations and Skills for Healthy Relationships by Food for the Hungry: For Youth Ages 15 and older. Washington DC. Food for the Hungry (FH), made possible through support from USAID under Award No. GPO-A-00-05-00008-00.

C

Table of contents Session 1 ● Being Yourself, Being Content .............................................................. 1

Session 2 ● Good Communication............................................................................. 7

Session 3 ● Communicating a message with confidence [Skill 1] ....................... 13

Session 4 ● Choosing a Good Mentor ..................................................................... 19

Session 5 ● Making Good Choices [Skill 2] ............................................................ 29

Session 6 ● Mentor and Me Meeting ........................................................................ 39

Session 7 ● Understanding Sexuality...................................................................... 45

Session 8 ● Communicating your Relationship Boundaries [Skill 3] .................. 53

Session 9 ● Overcoming Obstacles to Abstinence [Skill 4] .................................. 59

Session 10 ● I Am Able! ........................................................................................... 67

Session 11 ● Right to Say “No” to Sexual Advances ............................................ 75

Session 12 ● Saying no with your voice, body and actions [Skill 5].................... 85

Session 13 ● Making a Commitment........................................................................ 91

Session 14 ● Risk Reduction Options - For Youth Who Did Not Make a Commitment to Abstinence ...................................................................................... 99

Condom Discussion (optional) ........................................................................ 111

Session 15 ● Gender Roles and [Skill 6] ............................................................... 115

Maintenance of Y2Y and LY Groups ...................................................................... 123 Does Abstinence Work? ................................................................................. 125 Consequences of Misused Sexuality .............................................................. 133 Sexually Transmitted Infections (STIs) ........................................................... 139 Strategies for Maintaining Abstinence ............................................................ 145 Maintaining My Commitments ........................................................................ 153 Additional Activities and Discussions: ............................................................. 159

Participant Handouts ............................................................................................... 167 Discussion Guide for Choose Life Sessions ................................................... 169 Talking to Youth Guide.................................................................................... 173

Resources ................................................................................................................. 175 Resource A: Additional Information about HIV and AIDS............................... 177 Resource B: Three-Part Role-play for HIV Prevention ................................... 183 Resource C: Good Listening Skills.................................................................. 191 Resource D: Supplemental Stories ................................................................. 195

Pre and Posttest Answers....................................................................................... 197

Credits ....................................................................................................................... 201

D

Choose Life Adaptations and Skills for Healthy Relationships by FH

Food for the Hungry (FH), in partnership with World Relief, has adapted the Choose Life curriculum for use in the “Healthy Choices Leading to Life,” HIV prevention program.1 By integrating principles of Motivational Interviewing2, Barrier Analysis3, the Skills for Healthy Relationships, and the ABC approach to HIV prevention4, we have adapted the World Relief curriculum to meet the philosophy, goals, and methods of FH’s current HIV prevention project. Further information about this approach can be found below. Barrier Analysis is a rapid assessment tool that was developed by FH to identify behavioral determinants and barriers associated with behavior change (mostly from the Health Belief Model). By identifying the main determinants and barriers for sexual abstinence in youth in each of our four countries of implementation, we are able to adapt the curriculum messages to target these determinants of abstinence. The five priority determinants identified in our targeted regions are perceived susceptibility, perceived action efficacy, perceived self efficacy, perceived social acceptability and perceived divine will. We have added one additional session for self efficacy, as well as augmented the text and discussion questions to address the other determinants. Through the process of comparing personal values with behavior and promoting “change talk,” Motivational Interviewing (MI) enables informal counselors to guide others towards healthy behaviors. It is especially effective when working with those who are ambivalent about a particular change. A brief overview of good listening skills using the OARS5 of MI is included in the Resource section. Choose Life facilitators can use this guidance to talk with youth who are unsure about choosing abstinence. Discussion questions have also been added that encourage youth to contemplate the level of importance that they assign to a change (e.g., delaying sex) and to assess their confidence in their ability to make a change for healthier sexual behavior. Skills for Healthy Relationships Making changes in behavior requires more than just new knowledge and new attitudes; new skills are required. Six skills have been identified to help youth make the transition towards healthy behavior change. After every few sessions, a new skill is introduced. Youth are given time to discuss, practice the skill, and make commitments to keep them. As youth demonstrate success with each skill, their confidence grows (as well as their self-efficacy). This encouragement helps to move them towards a long-term commitment for a healthy relationship choice.

1 USAID Cooperative Agreement # GPO-A-00—05-00008-00 2 See http://mi.fhi.net for more information. 3 See http://barrieranalysis.fhi.net/ for more information. 4 ABC stands for Abstinence, Be Faithful or use Condoms. It is the approach adopted in 2003 by the President’s Emergency Plan for AIDS Relief (PEPFAR). See http://www.pepfar.gov/ for more information. 5 OARS is an acronym for open-ended questions, affirmations, reflective listening and summarizing.

E

How to use this guide The Choose Life Guide for Peer Educators and Youth Leaders provides detailed lesson plans for interactive learning sessions. It uses an easy-to-follow format with many helpful reminders and notes. The activities are designed to make learning fun and active. They include stories, learning games and activities. WHO IS THE TARGET AUDIENCE? This guide focuses on youth, male and female, aged 15 and older. In any group, youth will have a variety of life experiences. Some have never experienced sex; others will have been sexually active by choice or by force. Some may even be HIV-positive or have a sexually transmitted infection. For some, abstinence will be a new consideration. Others may already have chosen abstinence. Some may be considering abstinence but are not ready to make a commitment. Regardless of where youth are personally, this guide tries to promote positive communication and move youth towards practicing behaviors that will reduce the risk of HIV infection. PLANNING YOUR TRAINING Creating a good learning environment • Meetings and learning sessions should always be held in a place where youth feel

physically safe and free to say what they think and feel. • Remember that you are a “facilitator” who is helping youth discover things for

themselves. You are not a lecturer telling them what to do. • Even when they say they wrong answers or have trouble understanding or

applying what they are learning, do not make them feel as though they have failed. Always encourage youth toward a positive and truthful way.

Location and room arrangement • No matter where the sessions take place (such as a classroom, church, or open

space), do NOT set up the room to feel like a school classroom if possible. • Move chairs so that the youth are sitting in a circle or semi-circle and the entire

group can see each other. You should also sit or stand in the circle, not up front. • The meeting space should be healthy with good ventilation and protection from

harsh weather like hot sun, wind, rain (even insects). • Youth should face away from things that may distract their attention from the

learning session, like a busy street or playing field. • You might want to try changing the set up of the room or even the location from

session to session to keep the youth interested and see what works best. Being prepared • Before you present it to the group, read the entire lesson and practice it until you

are comfortable. • Arrive at least 30 minutes before the session begins to prepare the room or space • Have all supplies ready to pass out before you begin the session.

GUIDELINES FOR LEADING THE SESSIONS Your role as a facilitator is to:

F

• Remember that you are there for the youth and the issues that concern them. Do not give orders or force your opinion. Be flexible if it seems like more time and attention needs to be given to certain topics.

• Listen first. Ask questions before you tell answers. • Create an atmosphere of openness, trust and excitement, where youth will not be

made to feel small or ignorant. • Clearly explain what you want the group to do and let them know how long they

have to do it (suggested times listed for activities will help you plan). Things to remember: 1. Reflect on your own life and seek to be a positive example for the youth. 2. Be prepared. Give yourself enough time to prepare. Be familiar with the lesson for

that day. Follow the curriculum provided but be natural (do not read it word for word).

3. Do not lecture or dictate to youth. Teenagers get bored easily and need to be actively involved.

4. Let youth discover important lessons for themselves rather than giving them all the answers. You can help them do this by asking good questions and challenging them to try new things.

5. Keep the energy up. The flow between activities should be quick and without delay. Leaders should always be prepared with the next activity beforehand.

6. Encourage participation by youth whenever possible and involve as many different youth as possible. The youth should talk and DO more than the leader.

7. Teach from your heart. Youth will know if you are being sincere. 8. Encourage and praise youth for their efforts, even when they are not perfect. 9. Be humble. Let the youth know that you are learning with them. 10. Show respect by listening and valuing their ideas and contributions. 11. Be consistent and fair to all. Show equal love to all, especially those who might

be difficult to love. 12. Make learning fun. Have a sense of humor and make the sessions fun and

exciting so that the youth do not want to miss anything and want to return. GUIDELINES FOR USING THE SKILLS FOR HEALTHY RELATIONSHIPS At the end of this section is a picture representing the Skills for Healthy Relationships. Leader Youth and Promoters should use this picture (or one of their own design) to display the six skills at youth meetings. After youth complete each skill session, they have an opportunity to make a commitment to use the skill in their life. When youth make a commitment, write their name on one of the lines near the stepping stone of the skill they have learned. This will help youth to chart their progress as they learn new skills. Guidelines for reinforcing skills and commitments: • Praise each person who makes a verbal commitment at the end of a session.

Encourage them as they take small steps towards a commitment for healthy relationships.

• Do not show disapproval towards youth who do not make a particular commitment. Youth need to decide for themselves what commitments they will make and should not be forced to commit. It may take some youth more time to commit than others.

• After each skill, give youth another chance to make new commitments to any of the previous skills.

G

• Review the youths’ progress with the skills they have already learned. Give youth an opportunity to talk about how they have put their commitments into action. Use praise and “change talk questions6” to encourage them.

• Discuss any barriers that youth have in carrying out particular commitments. Use group discussion to discover solutions. The youth leader does not need to have all the right answers. Use the other youths’ ideas, as well.

STRUCTURE OF THE LEARNING SESSIONS The learning sessions offer simple and clear ways of saying things. You should make these words your own as you become more comfortable with the sessions.

The words you say to the youth appear in normal typeface. Discussion questions appear in bold. Italics are used in the learning sessions to indicate instructions to you, the facilitator. You should not read these instructions directly to the youth. More helpful reminders are included in the boxed text on each page.

Each new session opens with a section called “Notes to the Facilitator” with information to help you prepare for the session. The objectives tell you what the participants should achieve by the end of the session. The “materials needed” list will remind you of what materials should be prepared before the session begins. At the beginning of each skill session, two different time formats are listed: a 60-minute format and a 90-minute format. Promoters and Leader Youth should choose the format that best fits the length of time they have with youth. If you are following the 60-minute format, boxes with information on the 90-minute format should be skipped. Each session offers a combination of the following elements:

Review Most sessions begin and end with a time for review. Starting the session with a review allows you to find out what youth remember from the previous sessions. It also benefits those who may have missed a session. At the end of the session, there is a review of the current material and the opportunity to challenge youth to apply what they are learning. These sections include a variety of activities:

Opening and closing prayer (if appropriate) - Whenever prayer is used as part of a US government funded program, it is important to make it clear that prayer is optional. Youth are not required to pray, nor is the facilitator of the group required to include prayer in each session. If the facilitator decides to include prayer, they should inform the youth that they have the option of joining after the beginning prayer, or leaving without embarrassment if they choose not to participate in the closing prayer.

Take Action - At the end of most sessions, there is a take home assignment or activity for each youth to do on their own. These assignments will challenge the youth to think about and apply what they are learning. At the beginning of the next meeting, there will be a time to share what they have done or learned through these experiences. 6 Change talk is a term used in Motivational Interviewing (MI). Change Talk questions include: asking about the advantages of change, the disadvantages of staying the same, and youth’s concerns about their current behavior. For more information, see http://mi.fhi.net.

H

Meeting with your Mentor – In Session 4, Choosing a Good Mentor, youth are encouraged to identify a mentor whom they can meet with after all of the remaining sessions. You will see a reminder about these meetings in the review section. These meetings will reinforce what they have learned, provide support and encouragement to the youth in their commitments, and inform adults in the community about HIV prevention methods.

Stories In our communities, stories are shared to pass information and teach important lessons. People can relate to stories in a very personal way. Some of the same characters occur repeatedly and the story builds over several sessions.

Story and Discussion (optional) - In church or other settings where it is appropriate to use Bible references, Bible stories that relate to the learning session are included along with discussion questions. You can read these as summarized in the session or directly from the Bible.

Games Learning games and activities help youth learn by doing rather than just listening. As youth laugh and have fun, they feel more free to express their thoughts and feelings.

Warm up game - These quick games help the youth get to know one another, feel more comfortable and possibly introduce a new idea or topic.

Learning game - Learning games are designed to communicate a particular point or idea through the activity. It is very important to follow the games with discussion to be sure the youth understand the message.

Life Skills Activities These are interactive group activities that allow youth to practice or apply new skills and knowledge.

Simulations Simulations are designed to help youth practice the Skills for Healthy Relationships. It is very important that the facilitator monitor and guide these practice sessions so that youth feel comfortable using the skills, and discover new ways to integrate the skill into their life.

Making commitments After learning each new skill, there is an opportunity for youth to make a commitment to continue using the skill. Making commitments in front of their peers will help youth to remember the skills, and encourage them to integrate the skill into their life.

HIV Facts Many sessions include discussion questions and a short presentation about HIV. This reinforces correct information about the risks, consequences, and transmission of HIV.

Presentation and Discussion These are times when you, as the facilitator, share some important information and lead the youth in a discussion about the topic presented in the session.

Reflection Verse (optional)

I

A verse from the Bible reinforces the messages in the session. You can also encourage youth to memorize these verses as appropriate. FACILITATION HELPS Participatory learning is an effective tool to help youth change their behavior. The Choose Life learning sessions are designed to help you facilitate in a participatory way.

There will be times when the facilitator must explain certain concepts or directions. It is important to know how to present information clearly and in a way that keeps the youth interested. Here are some things to remember when explaining something new: • Be familiar with important points so you do not have to read them word for word. • Keep the presentation within the recommended time. • Do not speak too quickly, because the participants will not hear what you say. Do

not speak too slowly, because they might get bored. • Look at the participants as you give the information. Even if you read the

information, look up occasionally so that people do not feel ignored. • After an important point, pause for a moment to let the audience think about it. • Watch people for signs of confusion. If you see signs of confusion, stop and ask

what questions they have. One of the leader’s most important roles is to facilitate discussion among the youth about the topics and activities presented in the learning sessions. The sessions include questions marked by the ? symbol to help you direct the discussion. Here are some important things to remember when facilitating a discussion: • Pause after asking a question to allow participants time to think of their answers. • Look around the group expectantly as you wait for someone to answer. If no one

responds, ask the same question using different words and pause again, waiting for them to answer.

• Once someone volunteers a response, do not be too quick to go on to the next question. Rather, ask if someone else has a response.

• Listen to the responses for important points and commend the speaker. • When someone gives an answer that is clearly wrong, just continue by asking if

someone else has a different answer. Do not say directly that it was wrong. When the correct answer is given, repeat it so the correct information is emphasized.

• Sometimes, the learning sessions will include “possible answers” in italics after the question. Do NOT read the answers to the group but use them to help you guide the conversation if youth are having trouble developing their own answers.

• Avoid interrupting people while they are talking. If you must interrupt someone who is talking too long, do so, but apologize.

• Try to have as many people as possible participate in the discussion. Encourage this by saying, “I’d like to hear from someone who has not spoken yet.”

• Remember that for youth, speaking up in a group takes courage. Listen carefully to increase speaker’s sense of confidence and safety. When people feel safe, they speak more freely, give honest answers, ask questions and, in the end, learn more.

• If a person gives a very short answer, you may want to encourage them to say more. You could say, “Tell us more about that.”

J

• Sometimes it can be a challenge to manage the time of the sessions. You want people to feel free to talk about their thoughts and feelings but still respect time limits.

Stories are most effective when they are told in a way that captures the audience’s attention and helps them relate to what is being shared. When telling a story: • Know the story well and practice telling it before starting the session. • Before telling the story, review it carefully for actions or events that may be

offensive or misleading to the audience. Make changes as needed. • Use a different tone of voice for each person in the story. • Show different feelings on your face and in your gestures, such as worry,

excitement and fear that follow the story line. • To be sure youth have understood the lesson that the story teaches, you may

want to ask a volunteer to repeat the story after you read or tell it. • Be sure to follow a story with the questions presented in the session. Most

learning happens after the story during the discussion.

K

Pre- and Posttest Questions Choose Life Promoters7 should take a pretest prior to beginning their training for the Choose Life manual. This will allow their supervisors to monitor the Promoter’s progress throughout the year. Posttests, using the same questions, should be given to the Promoters at the end of each training. In FH’s ABY program, youth participating in Choose Life are only required to take posttests. Posttests should be given after every three sessions. See the end of the manual for the answers. Sessions 1-3

1. How does HIV hurt the body? Why does it make someone sick? 2. What are the benefits of accepting yourself? 3. In what three ways do we communicate a message - our voices/words, our

body language, and our __?___. 4. Name the three most common ways HIV is transmitted. (They must name all

three.) 5. Which of these three ways is the most common? 6. How can you use your body to show confidence?

Session 4-6

1. Name two characteristics (or qualities) of a good mentor. 2. True of False: It is important that my mentor is practicing healthy sexual

behaviors. 3. What are the seven steps that should be followed to make a good choice? 4. After you have listed the positives and negatives of each choice, what should

do next? How does the list help you to make a decision? 5. True or False: One person’s actions (or poor choices) can negatively affect

many others. 6. How does the number of sexual partners someone has affect their risk of HIV

infection?

Session 7-9 1. What is sexual abstinence? 2. Our bodies are made up of four different aspects. Name two of them. 3. Where should you set a relationship boundary? 4. What is one technique you learned to help you tell someone a difficult thing? 5. What does drug or alcohol abuse have to do with HIV infection? 6. Name three things that Zimba did in the story, that will make it difficult for him to remain abstinent.

Session 10-12

1. Name three things that help you to be confident that you can reach your goals. 2. How does the way we THINK affect whether or not we will reach our goals?

7 In the “Healthy Choices Leading to Life” program, Promoters are paid staff members who train and guide the Leader Youth (peer educators) who teach Choose Life sessions to their peers.

L

3. Define “consent.” 4. True or False: Everyone has the right to say “no” to any kind of physical or

sexual contact that makes them feel uncomfortable. 5. True or False: If you smile and touch the person when you are saying “no,” it

will strengthen your message. 6. Name two things you can do if you feel you are in real danger. If boys practiced asking for consent during Session 12, ask the following questions: 7. Optional question for boys: True or False: If a girl smiles and says nothing, you

know she is giving consent. 8. Optional question for boys: What is one way you can ask for consent?

Session 13-15 (A total of 4 questions) 1. What are two things that should be shared between people for a good healthy

relationship? 2. True or False: Sometimes the things that our culture tells us to do to “act like a

man” or “act like a woman” may increase our risk of HIV infection.

There are no questions for session 13. For youth who practiced simulations during Session 14, add two more questions relating to the skill that they used.

If youth participated in the Risk Reduction session, ask the following questions: 3. Which one of the following practices has the HIGHEST risk of HIV infection:

hugging, kissing, oral sex, or anal sex? Choose one answer. 4. Name one thing that makes HIV spread more quickly in a community.

M

Skills for Healthy Relationships

N

1

Session 1 ● Being Yourself, Being Content Notes to the Facilitator

Youth often suffer from a poor self image (what a person thinks about themselves) and need to know that they are acceptable and lovable as they are. Many are not happy with who they are or their situation. They constantly compare themselves to their peers. They want to have more money, look like movie stars, live in a different house, be more popular, be older, etc. They are vulnerable to pressures from their peers. In order to feel better about themselves or to feel accepted and admired by others, they try things even if they know it could bring them harm. The purpose of this lesson is to help youth build self confidence, to see that it is all right to be different, and to accept and feel good about themselves. Improving self image can decrease a young person’s vulnerability to poor life choices that could put them at risk for HIV. During this learning session youth will: 1. Describe the benefits of being content. 2. Identify some of their good qualities and their capacities. 3. Define HIV and AIDS. 4. Be able to describe the link between self respect/confidence and the ability to

protect oneself from HIV. 5. Describe how HIV affects the immune system. Values, Attitudes and Beliefs strengthened through this session: 6. Youth discover that they are unique and valued. Materials needed: • basket or other container for “Guess Who” game • (optional) an umbrella and crumpled piece of paper or cardboard for the HIV

demonstration Activities: 60-minute format 90-minute format Warm up Game: 20 minutes 20 minutes Story and Discussion: 30 minutes 45 minutes HIV Facts: 10 minutes 15 minutes Reflection Verse (optional): (2 minutes) (2 minutes) Review and Reinforcement: -------------- 10 minutes If you choose to add the Reflection Verse (optional), decrease the time for one of the other activities by 2 minutes. Sixty minute sessions may not have time for the Review and Reinforcement. End the meeting with the HIV Facts (or optional Reflection Verse).

2

Warm Up Game: 20 minutes Opening prayer (optional) The Guess Who Game: Ask participants to write on a piece of paper something that they can do well (a unique skill or talent). Ask them to fold these papers and put them in a container (i.e. basket, hat). Then have each participant choose one from the container. If they pick their own, they should put it back and take a new one. The youth should stand in a circle. Ask one youth to read aloud what is on the paper and try to guess who it describes. If they are not able to guess after two tries, the others in the group can try to guess. Continue giving each youth a turn to identify the person described on their paper, until all the youth are identified. Option 2: If the group does not know one another well, ask each youth to choose a partner. Give them two minutes to find out 1) their partner’s name and 2) one thing that their partner does well (a talent or skill). Then each person should quickly introduce their partner to the rest of the group and sharing their talent or skill. For example – “This is John. He is very good at fixing motorbikes.” Each of us has different talents and skills. Sometimes when we are feeling sad, we need to remind ourselves of these talents and the things that we can do well. This group will be a place where we help each other and focus on the positive; a place where we all feel accepted. Today and in the coming months, we will explore life issues that young people are facing. We will discuss your dreams for the future, choices you have to make, and changes you are going through. We will also be talking about some of the challenges that we are facing today, including sex and HIV/AIDS. This will not be like your school classes. You do not need to take notes unless you want to. I am not here just to teach you, I am also coming to learn from you. The important thing is that we discuss together. You must feel free to speak what is on your mind and in your heart. Whatever you want to ask, whatever you want to know, I will try to answer. We will have 15 meetings. It is important that we come to every meeting! We will be learning new skills to help us make healthy relationship choices. If you miss some of the sessions, you miss out on skills that will help you in your daily life.

Serial Story and Discussion: 30 (or 45 minutes) Let’s start our session with a story. Change names of the story’s characters to fit your context. Know the story well and practice telling it before the session begins. You may also ask one of the participants to read the story to increase participation. Story: Rebecca is 17 years old and in secondary school. She does very well in her classes and hopes to get a spot at the university to study law. She will be the first woman from her family to attend university, and sometimes she feels burdened by the expectations her family members have for her.

3

Lately though, concentrating during math class has not been so easy for Rebecca. Two weeks ago, when the teacher decided to reassign the seating positions, a boy Rebecca had been interested in all year was assigned the seat in front of her. Rebecca really has to try to listen to the lecture. Otherwise, she could spend the entire class period imagining what it would be like to be his girlfriend. As you read the story, be expressive and look up occasionally. Rebecca is pretty but does not try to draw attention to her looks. When she was younger, boys paid a lot of attention to her, but once they realized that she was more interested in studying then flirting with them, they stopped. Now she feels almost invisible to boys, especially the boy from her math class. She is afraid to speak in front of him in case she says something foolish. She does not raise her hand to answer questions because she does not want him to think she is smarter than him. When she sees him talking and laughing with other girls, she finds herself comparing the way she looks to them. She wishes her skin and hair were as pretty as the other girls. Sometimes it feels like she would give anything, even her place at university, just to feel like she was attractive to this one boy who she has never even spoken to! Say: Now let’s hear about Peter. Peter also struggles, just like Rebecca. Peter is 15 years old and a student at the same school as Rebecca. His older brother David is in Rebecca’s class. Peter has always looked up to his older brother and tried to be seen with him and his friends as much as possible. They tease him sometimes and he is always comparing himself to them. Now Peter finds himself wishing he was not just always doing what his older brother does. He wants to join the choir at church and to participate in the community drama group, but he can only imagine what David and his friends would say if he tells them he will not be playing football after school anymore because he wants to sing and act instead. He would never hear the end of it! Encourage participation but do not pressure individuals to answer.

? How does Rebecca view herself? Encourage discussion. Responses could include: she is unsure of herself, she is shy in front of boys, she does not like the way she looks

? How does Peter view himself? Responses could include: he feels inferior to his brother; he wants to do something different

? What are some of the good things (qualities or talents) that Rebecca and Peter have? Responses could include: Rebecca does well in school. She does well in math class. Peter likes drama and singing. He is not scared of performing in front of others (in a play or at church).

4

? How do you think the way they feel about themselves will affect the choices that they make? Responses could include: They may not use their skills and talents. They may make poor choices, because they are not happy with the way they are. For 90-minute sessions only – Ask youth to choose a partner and discuss:

? What are some things you do not like about yourself that others might see as positive? For example – Rebecca didn’t like the fact that she was smart, but many others might see this as something positive. After the pairs have time to discuss, ask the groups if they would like to share. Listen to several responses. Each one of us is special. God made us the way we are for a special purpose. But often we are not happy with ourselves and want to be like someone else. Sometimes, we do things not because we want to, but just to get others to accept us.

? What are the benefits of being content with yourself, just as you are? Encourage discussion. Add any of the following points that are not mentioned:

• If you are content, you will feel happier about yourself. People will like being around you. (When we are unhappy, and always comparing ourselves to others, our friends may find it difficult to talk with us).

• If you are content, you can use the gifts and skills that you have, instead of trying to be like everyone else.

• If you are content, you can focus on your work or school, and have hope for the future. (When we feel unhappy, it is hard to focus on our everyday activities, and do things well.)

• If you are content, you can make wise decisions and not worry about what others think.

Another benefit of being content is that you are less likely to be pressured or coerced by others into sexual activities. Sexual activities put us at risk for HIV infection. With the right knowledge combined with self-respect, you can make wise choices and stick to them – no matter what others say. We want to make sure that we not only learn new life skills (like how to be content), but that we also learn how to protect ourselves from HIV infection. We also understand that there are certain situations where confidence and self respect are not enough. Some youth are sexually abused and unable to enforce their own sexual choices. We will talk about these situations later in our meetings. Today, we are focusing on the situation when you are given a choice, and being content is one tool that will help you make healthy choices.

HIV Facts: 10 Minutes (or 15 minutes) We hear a lot about HIV in the community around us. In fact, many of us may think that we already have all the facts straight. Let’s review what we know so far. 1. What is HIV (Human Immunodeficiency Virus)?

5

Response: HIV is the name of the virus or germ that causes infection. After a person carries HIV in their body for several years, they become very sick with many different illnesses. 2. What is the difference between HIV and AIDS (Acquired Immune Deficiency Syndrome)? Response: AIDS is the name of the illness that is caused by HIV. When HIV becomes strong in the person’s body, the person become sick with many illnesses; they are said to have AIDS. 3. What does HIV do to the body? Why is it so harmful? Response: Once HIV enters a person’s body, it starts to attack the person’s immune system (or germ-fighting system). The immune system fights off diseases and keeps the body healthy by attacking and destroying germs that enter the body and cause illness. HIV slowly “puts holes” in the immune system and destroys it until it cannot protect the body from illness any longer. The average life expectancy for a person with untreated AIDS from the time that they start having symptoms is one to five years. There is no cure for AIDS. There is no medicine that will kill the HIV virus once it enters your body. ARVs (antiretroviral) drugs help to slow down HIV so that it stops attacking the immune system. These drugs help to prolong the life of a person with HIV. However, they will always have the virus in their body and will need to take ARV drugs for the rest of their life. For 90-minute sessions only - Optional demonstration: Explain that the immune system works like an umbrella that protects you from sun and rain. Show everyone an umbrella. Ask someone to pour a cup of water on the umbrella to show how it protects you from the rain. Then say, if my umbrella was attacked by a wild dog, it would not be very effective. Explain that the dog may have put holes in the umbrella and damaged the strength of the fabric. Now hold up a crumpled piece of cardboard or paper. Explain that after the dog attacked your umbrella, it is now no stronger than a small piece of cardboard or paper. Ask if there are any volunteers who would like to test your “paper umbrella,” to see how it holds up in the rain. Explain that the immune system is like the umbrella. It protects the organs inside your body from germs. If your immune system is attacked by HIV, it loses its strength and can no longer protect you from the germs that cause illness. This is why people become ill with many different illnesses from HIV.

? Does anyone have questions? Answer questions as necessary. If you don’t know the answer, tell the youth you will try to find out by the next meeting. We will talk more about HIV at each meeting, and learn new ways to protect ourselves from infection.

6

Reflection Verse (optional): 2 minutes Psalm 139:14 “I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well.” For 90-minute sessions only ⎯ Review and Reinforcement:

10 minutes

? What did you learn today that could help you accept yourself the way you are? Encourage participation, especially among those who have not yet actively participated. Take Action: This week, do one thing to encourage someone and help them feel better about themselves. Next time we meet, we will hear your stories. Closing prayer (optional) Whenever prayer is used as part of a US government funded program, it is important to make it clear that the prayer is optional. Anyone can leave prior to the prayer if they are not comfortable with prayer in general, or with prayer in this group. Close the session and give the participants a short time to leave without embarrassment if they choose not to participate in the prayer.

7

Session 2 ● Good Communication Notes to the Facilitator

Good communication is essential for our happiness as well as our survival. Being able to appropriately communicate thoughts, feelings, needs and desires is a skill that can help youth build self confidence, solve problems, resolve conflict and protect themselves from unwanted sexual advances. Many youth are afraid to ask questions about their own sexual development or feelings and then get false information from other youth or from television, music, movies, etc. Others who have been sexually abused never tell anyone about their experience because they are frightened that they have done something wrong and will be punished. Healthy relationships and good communication involves having confidence, good verbal and non-verbal communication skills, and listening skills. The purpose of this session is to help youth develop these skills and to encourage healthy communication between their friends, families and others in their community. During this learning session, youth will: 1. Define good communication. 2. Discuss how we communicate with others. 3. Identify techniques for good communication. 4. Define the three main routes of HIV transmission. Values, Attitudes and Beliefs strengthened through this session: 5. Whether you are male, female, young, or old, your opinions and desires are

valuable. Materials needed: none Activities: 60-minute format 90-minute format Review: -------------- 10 minutes Learning Game: -------------- 15 minutes Serial Story and Discussion: 35 minutes 35 minutes HIV Facts: 20 minutes 20 minutes Story and Discussion (optional): -------------- (15 minutes) Refection Verse (optional) (2 minutes) (2 minutes) Review and Reinforcement 5 minutes 10 minutes Sixty minute sessions will not have time for the Review, Learning Game or Optional Story and Discussion. Skip the sections marked “-------------“ above. Begin the session with the Story and Discussion. If you choose to add the Reflection Verse (optional), decrease the time for one of the other activities by 2 minutes. For 90-minute sessions, if you choose to add the Story and Discussion (optional) and the Reflection Verse (optional), decrease the time for some of the other activities by 17 minutes.

8

For 90-minute sessions only ⎯ Review: 10 minutes Opening prayer (optional)

? What did you do to encourage someone since our last session? Listen to three or four responses for each question. Encourage participation and affirm positive responses For 90-minute sessions only ⎯ Learning Game: 15 minutes

Let’s being today’s session with a game. Telephone Game: Choose a volunteer in the circle of youth. Ask the volunteer to think of one new thing they learned from the last session. Then, ask the volunteer to whisper this new thing to their neighbor (the message should only be one sentence long). Then, ask that neighbor to whisper the message to person sitting next to them. The youth should continue whispering the message from one youth to the next, until the message reaches the last youth (the person who is next to the first volunteer). The last person should share out loud the message which he/she heard. Compare this message with the original message sent by the volunteer. Usually the message that is heard after it has been whispered to many people, will be very different that the original message. Ask for a new volunteer and repeat the game.

? What can we learn from this game? Encourage discussion. Possible responses include:

• When a message passes through many people, the content may change. • If we speak into someone’s ear, they may not understand what we mean. • It is important for us to ask for clarification if we don’t understand something.

Sometimes we need to hear it more than once. Now that we have practiced poor communication let’s see how we can improve!

Serial Story and Discussion: 35 minutes

? Today we are going to talk about good communication. What is communication? Response: Communication is sharing a message, feeling, thought, or idea to someone else.

? In what ways do we communicate with one another? Response: words, body language (smiling, frowning) and actions.

9

Use the same local names that you used for Session 1. Remember Peter and Rebecca from our first session? Today we will hear more of their story. Story: The teacher tells everyone in class that they should work with a partner on the math problem. Peter is paired with Rebecca. “Hi Rebecca,” Peter says. ‘I am not very good with math. Do you understand what we are supposed to do?” Rebecca is embarrassed. She really likes Peter, but now that he is talking to her she doesn’t know what to do. She is smiling, but doesn’t want Peter to see it. What if he guesses that she likes him? She turns her head away, saying nothing. “Rebecca, are you ok? Is something wrong?” Rebecca quickly glances in Peter’s direction. He is still looking at her. Rebecca mumbles that nothing is wrong, but Peter doesn’t understand what she is saying. “What?” he asks. “What did you say?” Rebecca continues to look down, until Peter says, “If you don’t want to work with me then I will ask someone else.” Rebecca doesn’t answer. Peter turns to the boy on the other side of him and they work on the problem without her. Ask a volunteer to repeat the main points of the story. Then ask the following questions:

? What was Rebecca communicating to Peter? Response: She was communicating that she did not want to work with Peter (by not looking at him). She was communicating that she didn’t want to talk with him (by not answering him). She was communicating that she didn’t know what she wanted to say (by not using her words or speaking clearly). Even though she WAS HAPPY to be working with Peter (she really liked him), her words, body language and actions sent a different message to Peter. Peter thought she did NOT want to work with him.

? What was Peter communicating to Rebecca? Response: He was communicating that he was interested in her (he was looking her in the eye). He was communicating that he wanted to work with her (he said this with his voice). He was communicating that he was concerned about her (he used his words to ask if something was wrong).

? Where both Peter and Rebecca communicating? Response: YES! They both were communicating a message. Peter was communicating clearly. Rebecca was thinking one thing (I really like Peter), but communicating something else (I don’t want to talk to him). Only Peter was using good communication skills. He was effectively communicating his thoughts and feelings.

10

? What are some good communication skills that we can learn from Peter? Encourage discussion. Add any of the following points that are not mentioned.

1. He used his voice! a. He spoke clearly to Rebecca. b. He had a clear message. He thought about his words before he said

them. He made it very clear to Rebecca that he wanted to hear from her.

c. He repeated his message, when she didn’t respond. 2. He used his body language!

a. He was looking at her. b. He didn’t turn away.

3. Use your actions! a. He began working with someone else when it was clear that Rebecca

wasn’t going to work with him. He did what he said he was going to do.

At our next session, we will spend more time practicing good communication. So don’t forget what you have learned from Peter! In the meantime, let’s return to the discussion we started at the last session about HIV.

HIV Facts: 20 minutes Good communication can improve your relationships with others and allow them to understand what you want and need. It can also save lives! If you know the facts about HIV and AIDS and can effectively communicate these facts to others, you can help others avoid HIV infection. Last week we talked about the definitions of HIV and AIDS and how it affects the body. This week we will discuss transmission. I will read several phrases to you and you must decide whether HIV can be transmitted in this way. If you agree that HIV can be transmitted in this way, you should stand up. If you disagree and think HIV cannot be transmitted in this way you should stay seated. Do not be overly influenced by others. If no one else is standing, but you believe the statement is true, stand up! You may be the only one who gets it right. Review the following actions: Yes = Stand, No= Stay seated. Make sure that everyone understands what they should do. Read each statements below, pausing after each statement to allow youth to respond (by standing or staying seated). After everyone has picked their response (yes or no), tell them the correct answer. 1. HIV can be transmitted through sex with an infected person. (Yes) 2. HIV can sometimes be transmitted through the breast milk of an infected mother to

her baby. (Yes) 3. HIV can be transmitted if you receive a blood transfusion of infected blood. (Yes) 4. HIV can be transmitted if someone has sex with an infected prostitute. (Yes) 5. HIV can be transmitted if you share unsterilized instruments used for piercing with

an infected person (when fresh blood is present). (Yes)

11

6. HIV can be transmitted if unsterilized circumcision instruments are shared with an infected person (when fresh blood is present). (Yes)

7. HIV can be transmitted from a mother to her baby while she is pregnant. (Yes) Next, explain to the group that all the statements are true. Ask for a volunteer to name as many ways that HIV is transmitted as they can remember from the list. Say “Yes” after each one that is correct, and keep a count of how many they mention. Stop the person if they mention any that are not correct and ask them to sit down. Ask for a new volunteer. Continue until someone correctly names six of the ways that HIV is transmitted. Reward the participant who mentions the most correct ways with applause.

? Which of these is the MOST COMMON way that HIV is transmitted8? Response: The main way that HIV is transmitted is through sex with an infected person.

? In summary, what are the three main ways that HIV is transmitted? Allow the group to respond and then reinforce the following:

1. Sex: the most common way that someone gets AIDS is through sex with an infected person.

2. Blood-to-blood: when fresh HIV-infected blood from one person comes in contact with the bloodstream of another person. HIV can be passed through blood when:

a. Infected blood is given to someone through a transfusion b. Unsterilized needles and syringes (with fresh blood) are shared between

people who inject medicines or drugs c. Unsterilized cutting instruments (with fresh blood) are shared between

an infected person and someone else (for example those used for circumcision).

3. Mother-to-child: sometimes, but not always, mothers pass HIV to their babies during pregnancy, at birth, or while breastfeeding.

In our meetings, we hope to strengthen your understanding of HIV and empower you to have healthy relationships. We will learn new skills and make commitments to using them in our lives. After twelve lessons, we will give you an opportunity to make a public decision about healthy relationships, and how you will protect yourself from HIV. You may make a decision before that time, but we are reserving one session when all of us can make commitments together. We will talk more about this in the coming weeks.

8 In the regions where this curriculum is being used, the highest prevalence of HIV is in the general population. If you are using this curricula in a region where the epidemic is concentrated to high risk groups, then the responses to these questions needs to be changed.

12

For 90-minute sessions only ⎯ Story and Discussion (optional) – 15 minutes

Story is from Numbers 27:1-7. You can read the story from the Bible or tell it as it is here. Tell a Story: Listen to this story about the daughters of a man named Zelophehad who lived long ago. Zelophehad had no sons but he had five daughters. When their father died, they received nothing. So they went to seek help from their leader Moses. They said to Moses, “Our father died in the desert and left no sons. Why should our father’s name disappear from his clan because he had no son? Give us property among our father’s relatives.” So Moses brought their case before God, and the Lord said to him, “What Zelophehad’s daughters are saying is right. You must certainly give them property as an inheritance among their father’s relatives and give their father’s inheritance over to them.” Ask a volunteer to repeat the main points of the story then ask the following questions:

? What examples of good communication did you see in this story? Responses include: they stated their situation clearly and spoke the truth. They didn’t remain quiet, but took their request before the leader.

? How did good communication help to solve the daughters’ problem? Because they clearly communicated their needs, and Moses took their request before God, they were treated justly and received what they asked for. Sometimes the first step of good communication is being brave enough to share your needs, thoughts and desires with someone else.

Reflection Verse (optional): 2 minutes Romans 12:18 “If it is possible, as far as it depend on you, live at peace with everyone.”

Review and Reinforcement 5 (or 10 minutes)

? What skills did you learn for good communication? Encourage discussion. Add any of the skills the youth forget to mention. (See the Story and Discussion section.) Take Action: This week practice using good communication skills with your friends and family. We will spend more time practicing at our next session. Closing prayer (optional)

13

Session 3 ● Communicating a message with confidence [Skill 1] Notes to the Facilitator

Making changes in behavior requires more than just new knowledge and new attitudes. Often, new skills are required. For example, if you want to improve your diet there are many things you can learn. You can learn about healthier foods, you can learn the benefits of a healthier diet and you can change your attitude about making a change. However, you will also need to learn new skills: how to prepare new foods (or encourage changes with the person who cooks for you); how to choose healthy restaurants (and avoid others); and how to talk to friends who offer you unhealthy foods. In the same way, youth learning healthy relationship choices need to rehearse (practice) new skills to help them make a change in their behavior. The Skills for Healthy Relationships are designed to help youth to make that change in small, easy steps. This session is devoted to practicing Skill 1 using a simulation. In a simulation two or more people interact in a situation. Simulations are NOT the same as role plays. In a role play, two people act together adopting a certain role and script that applies to the character that they are given. In a simulation the trainee (the person practicing) needs to ACT as themselves, and respond using their own ideas, skills and experiences. Simulations give trainees time to rehearse new skills in a safe environment before using them in real life. They also give trainees a chance to take new information and put it into their own words. Finally, as trainees voice certain facts about themselves, (e.g., “I want to wait until I am older to have sex”), they are more likely to believe them, and incorporate them in to their lives. During this learning session, youth will: 1. Practice using good communication skills. 2. Discuss (and discover) new ways to communicate a message with confidence. 3. Have an opportunity to make a commitment to Skill 1: I will continue to

communicate with confidence. Values, Attitudes and Beliefs strengthened through this session: 4. Good communication is something I can learn. If I practice, I will get better. Materials needed: • Posttest for each youth. • Skills for Healthy Relationships picture from the front of the manual (or one of your

own design). Activities: 60-minute format 90-minute format Review: 15 minutes 20 minutes Simulations: 40 minutes 60 minutes Making Commitments: 5 minutes 10 minutes

14

Introduction: 15 (or 20 minutes) Note to the Facilitator: Reminder – if you are following the 60-minute format, you have 15 minutes to complete the Introduction. If you are following the 90-minute format you have 20 minutes to complete this section. Hold up the Healthy Relationships picture from the front of the manual. This picture represents the skills that will help us to have healthy relationships. Each one of these skills will help us to have healthy relationships. The more skills you learn and practice, the easier it will be to maintain healthy relationships. These skills will help you with your “intimate” friendships, but also with your friends and family. Read through each of the six skills as written on the picture. We will chart your progress on the Skills for Healthy Relationships picture. Once you have practiced and gained confidence in each skill, you will have the opportunity to make a commitment to use the skill in your own life. After each commitment, we will mark your name on the picture. We will use this to encourage one another as we move towards the goal of healthy relationships. Today we will practice the first skill using a simulation. In a simulation, two or more people interact in a situation. The skill we are learning is: communicating a message with confidence. Ask the youth to repeat today’s skill (in bold above) several times.

? What are the skills for good communication that we learned last week? Add any of the points below that the youth do not mention.

• Use your voice! a. Speak clearly. Don’t mumble or talk too quietly. a. Have a clear message. Think before you speak. Make sure you

message is easy to understand. Don’t use ten sentences if you can communicate the same message with four sentences. (When you take too long to communicate a message, it may sound as if you are unsure about what you want to say.)

b. If the listener does not understand your message, say it again using different (or easier) words.

• Use your body language! a. Be confident (use proper eye contact, sit up (or stand up) straight and

tall). b. Show that you are listening to the other person as they respond (nod,

look at them, say “yes” or other words to affirm them as they speak). • Use your actions.

a. If you say you are going to do something; then do it. Here are some other steps for good communication.

• Don’t use ten sentences if you can communicate the same message with four sentences. (When you take too long to communicate a message, it may sound as if you are unsure about what you want to say.)

15

• Try to avoid phrases like “I think” or “maybe” – use words that show confidence such as “I know” or “I believe.”

Know that we KNOW the skills, let’s spend some time practicing.

Simulations: 40 (or 60 minutes) Ask for a volunteer (trainee).

1. Explain to the trainee: You will be practicing communicating a message with confidence. We will call you the “trainee,” the one practicing the new skill.

2. Explain the situation to the trainee: Your best friend comes to you for advice. He/she heard a rumor about HIV and comes to you asking if it is true.

3. Remind the trainee: During the simulation, be yourself. Don’t think about the observers; respond as if the situation was real. You may want to use some of the following ideas and techniques. • Explain why the “rumor” is not true. • Use the information that we covered in our last two meetings about HIV.

Explain the three ways HIV is transmitted. • Use the communicating with confidence techniques we discussed. • Use your own ideas to communicate clearly about HIV.

4. Ask the trainee to explain his/her role to you. Clarify misunderstandings.

Next, ask for another volunteer (performer). Speak to them in private (so the others can not hear).

1. Ask the volunteer (performer): What is an incorrect belief about HIV in our community – something that many people believe but is NOT true?

Note to the facilitator: Make sure the rumor is something that is commonly heard (e.g., that mosquitoes transmit HIV). If the suggestion is not common, ask for a different example. The performer will use this rumor in the simulation below.

2. Explain to the performer: You will be a performer – the one acting a role with the trainee.

3. Explain the situation to the performer: Start the conversation by talking about the rumor. You think the rumor is true. Try to persuade the trainee to believe the rumor and give reasons why you think the rumor is true. Continue until the trainee explains clearly why the rumor is false and has used at least three of the good communication techniques we discussed.

4. Then, agree with the trainee that the rumor must be false. Do not show anger or negative emotions towards the trainee after you have agreed.

5. Begin talking about something else (20 seconds) and end the simulation. 6. Explain to the performer: Do not overreact; make the simulation as REAL AS

POSSIBLE. Do not do things that are very strange or unlikely to happen in this community. This is not an opportunity to make people laugh. We want the trainee to learn how to use this skill in a life-like situation.

7. Ask the performer to explain his/her role. Clarify any misunderstandings. Now bring everyone back together.

16

Explain to the rest of the youth: You are the observers. Your role is to watch SILENTLY. Do not laugh or make noise. We will talk after the simulation is over. Begin the simulation. They have 5 -10 minutes to complete the simulation. Directions for the Facilitator: Observe the simulation. Do not stop the simulation unless there is a problem. 1. If the trainee is ACTING (not being themselves): Pause the simulation. Remind

the trainee to use their own ideas and skills for practice. The trainee should not try to entertain the observers.

2. If the trainee does not know what to say (for a long time): Pause the simulation. Ask the observers, “What could the trainee say now?” Ask the trainee to continue the simulation using these suggestions.

3. If the performer over-reacts or acts like a clown: Pause the simulation and remind the performer of his/her role.

4. If they simulation is too long: Stop the simulation at 10 minutes. Move to the discussion questions.

It is best if the performer agrees with the trainee and they both feel “good” at the end of the simulation. If the simulation ends after five minutes of arguing, the trainee will feel as if he/she failed. If necessary, coach the performers so that the conversation comes to an agreement and then briefly moves on to a different topic (20 seconds). After the simulation (5 minutes)

? Ask the observers: • What good skills (or techniques) did the trainee use during the simulation? • What other skills (or techniques) could they have used? • Add if needed:

o Did the trainee speak clearly? o Did the trainee use proper eye contact? o Did the trainee show that he/she was listening to the friend? o Did the trainee repeat the message using different words if the other

person (performer) did not understand? o Did the trainee avoid using phrases such as “I think” or “maybe.”

? Ask the trainee: • What other skills (or techniques) did you try (that were not mentioned)?

During the last 20 minutes, work in pairs: Explain the roles of the performer and trainee to the large group. Ask youth who have not been a trainee, to do the simulation with a partner. Observe the pairs; coach those who are having difficulties. After 10 minutes, ask the pairs to switch roles. For 90-minute sessions: Choose new volunteers. Repeat the simulation and discussion questions several times in a large group. During the last 20 minutes, work in pairs until everyone has a chance to be a trainee.

17

Making Commitments: 5 (or 10 minutes)

? What new things did you learn about communicating a message with confidence? How can you use these skills in your life? Encourage discussion. Now, you have a chance to make a commitment to USE this skill. Making a commitment doesn’t mean that you have mastered all of the skills of good communication. It means that you understand some of them, realize the importance of the skill, and are committed to using the skill in your life. Some of you might not be ready to make that commitment today. That’s ok. We will give you a chance to make new commitments at our next session. However, I encourage all of you to make a commitment if you are ready. Making a commitment here with your friends will also keep you accountable. We can help each other. Ask those ready to make a commitment to stand. Today’s commitment statement is: I will continue to communicate with confidence. Ask those standing to repeat the commitment after you. Do this several times. Congratulate those standing for taking the first step towards healthy relationships. Ask for a round of applause! Ask those who have made a commitment to write their names on the Skills for Healthy Relationships’ picture near the first stepping stone. Encourage everyone to use this skill in their life. Reminder! Give a posttest to the youth to ensure that they have learned all of the material. Use the questions listed at the end of this manual for Sessions 1-3.

19

Session 4 ● Choosing a Good Mentor Notes to the Facilitator

The goal of this session is to start a mentoring relationship between an adult mentor and each youth. This relationship will allow the lessons of Choose Life to reach the adults who influence the choices and decisions of youth. It is important to reach these adults since studies (including our project baseline survey) have shown that these adults are not always supportive of prevention methods that can help youth avoid HIV (e.g., abstinence, condoms). In addition, they sometimes hold mistaken beliefs about HIV and HIV transmission. By encouraging youth to set up regular meetings with an adult, we hope to accomplish three goals. First, to reinforce the correct HIV information that is heard by adults in the community. Second, to influence these adults (changing their knowledge and attitudes) so that they are supportive of youth’s decisions regarding HIV prevention. Third, to motivate these influencers to provide encouragement and support to the youth in their commitment to change. We begin this session with The Ruler Exercise. This exercise helps Leader Youth to assess youth’s true feelings about the importance of abstinence, their confidence in being abstinent (self-efficacy), and their perceived risk of infection (susceptibility). It also helps to identify youth who are resistant to change. Leader Youth and Promoters are encouraged to meet with youth who have low scores in importance and (or) susceptibility in one-one-one interviews. Using the Relationship Checkup9, these interviews will help to break down the barriers to behavior change. Leader Youth and Promoters may also decide to wait until Session 13 and use the Relationship Checkup with those who decide not to be abstinent. Talk with your promoter to find out more about this tool and its use in your program. Optional Discussion Guide for each participant: The guide can be copied and distributed to all of the youth in the group to help them in their discussions with their mentor. Starting with the completion of this lesson, youth are expected to meet with their mentor after each session to share and discuss what they have been learning. During this learning session youth will: 1. Rate their confidence in their ability to be abstinence (self-efficacy). 2. Rate the importance of abstinence to them. 3. Rate how vulnerable they feel to HIV infection (perceived susceptibility). 4. Define the characteristics of a good mentor. 5. Choose a mentor to meet with after each session. 6. Define what it means to be sexually responsible. Values, Attitudes and Beliefs strengthened through this session: 7. We should seek wisdom and guidance from our elders. Materials needed:

9 The Relationship Checkup is a Motivational Interviewing tool that was designed to help leaders encourage youth who are resistant (or ambivalent) to change using a short one-on-one- interview.

20

• Paper to identify the numbers or “High and Low” for the Ruler Exercise. Chalk, string or masking tape to draw the line on the floor or chalkboard.

• (Optional) Copies of the Discussion Guide for each youth (see the Participant Handouts’ section).

Activities: 60-minute format 90-minute format Review: -------------- 10 minutes The Ruler Exercise: 15 minutes 15 minutes Story and Discussion: 20 minutes 30 minutes HIV Facts: 20 minutes 30 minutes Reflection Verses (optional): (2 minutes) (2 minutes) Review and Reinforcement: 5 minutes 5 minutes Sixty minute sessions will not have time for the Review. Begin the session with the Ruler Exercise. If you choose to add the Reflection Verse (optional), decrease the time for one of the other activities by 2 minutes. As you introduce the ideas of sexual abstinence, delay of sexual debut, partner reduction and faithfulness, there may be some youth who are resistant to change, or uncertain about the benefits of these behaviors. Make yourself available to these youth. Be prepared to listen and guide them as they choose the best option for healthy sexual behavior. Be sure to read Resource C for guidelines on good listening skills. For those with internet access, a complete online training in counseling for HIV prevention can be found (in English) at http://mi.fhi.net.

For 90-minute sessions only ⎯ Review: 10 minutes Opening prayer (optional)

? Many of you made a commitment at our last meeting to continue communicating with confidence. How many of you have used this skill in your life? How did the simulations help you to respond? Allow a few participants to share their experiences communicating with confidence.

? What struggles have you faced keeping your commitment? How have you overcome these struggles? Encourage those who had difficulty.

The Ruler Exercise: 15 minutes If you have a mixed group (boys and girls), or the youth are less wiling to share, ask youth to write their numbers on a piece of paper for the Leader Youth to see. After the Leader Youth looks at everyone’s numbers, the LY can give a summary such as, “Most of you think abstinence is very important; I saw many 4’s and 5’s. However, many of you feel that you do not have the skills to be abstinent even if you wanted to; I saw mostly 1’s and 2’s. However, all of you feel vulnerable to HIV; I saw many 5’s.” Then, continue with the paragraph at the end of the exercise.

21

Make a line on the floor or on the chalkboard. At one end of the line, write “High.” At the other end of the line, write “Low.” You can also use the numbers 1 to 5.

We have talked about HIV infection and the ways it is transmitted. One way that we can stop sexually transmitted infection is by being abstinent. Being abstinent means that a person decides to abstain, or stop having sex until a certain time. The person might decide to abstain until marriage or until they finish school or some other goal. Before we start talking about abstinence as a prevention method, I need to know what you think you about it. I don’t want to know what your friends think, or what you think you should say; I want to know what YOU REALLY FEEL about abstinence. • Some of you may feel that abstinence is very important to you. If you were to

place yourself on the importance line, you would be here at number 5. Using the line on the floor or chalkboard, point to the end of the line at number 5 (or stand in front of the High mark on the floor).

• Some of you may feel that abstinence is somewhat important, but you have other concerns. If you were to place yourself on the importance line, you would be here between numbers 3 and 4. Using the line on the floor or chalkboard, point to a space between 3 and 4.

• Some of you may feel that abstinence is not important. If you were to place yourself on the importance line, you would be here, between numbers 1 and 2. Using the line on the floor or chalkboard, point a space between 1 and 2.

? How important is abstinence (until marriage) for you? Remember I want to know what you really think. Ask the youth to stand on the line (or to write their name on the blackboard where the line is drawn) to show their level of importance.

? (Choose one person with a number greater than 1) and say: You think that abstinence is [a little, somewhat or very] important to you. Why do you think this way? Why is abstinence more important than the numbers behind you? (Mention the numbers lower than the place where they are standing.) Be sure the person responds to your question - not why they don’t think it is not very important, but why they feel it is more important than the numbers behind them (1 or 2. etc). The goal of this exercise is to encourage even those with “a little importance” and help them to verbalize positive reasons. Do not make youth who rate themselves at a low levels feel bad. Do not try to convince people at low numbers that abstinence is important. This is not a time to teach or lecture. We want to know how youth really feel about abstinence. You will have another opportunity to measure their responses in a later session. By that time, we hope the teachings will have encouraged them to

Low High 1 2 3 4 5

22

move to higher numbers. Ask two more youth (with numbers greater than 1) the reasons why abstinence is more important than the numbers behind them (1, 2, etc). Summarize the things that the youth have said.

? Next we will measure confidence. How confident are you in your ability to be abstinent (until marriage)? That is, if you decided to be abstinent, would you be able to do it? Ask the youth to stand on the line (or to write their name on the blackboard where the line is drawn) to show their level of confidence in being abstinent.

? (Choose one person with a number greater than 1) and say: You have [a little, some, a lot of] confidence that you could be abstinent if you wanted to. Why is it that you have this confidence? Why is it that you are higher than the numbers behind you? (Mention the numbers lower than the place where they are standing.) Be sure the person responds to your question - not why they do not have confidence, but why they have [a little, some, or a lot of] confidence. Ask two more youth (with numbers greater than 1) why they feel they have more confidence than the numbers behind them (1, 2, etc). Summarize the things the youth have said.

? Finally, we will measure vulnerability. Do you think that it’s possible that you could get HIV if you had sex without using a condom? Number 5 means that it is very possible. Number 1 means that you don’t think it is possible. Remember it doesn’t matter if you are having sex or not. We are only asking IF you were to have sex, if you think it is possible that you could get HIV. Ask the youth to stand on the line (or to write their name on the blackboard where the line is drawn) to show the level of possibility (high or low) that they feel.

? (Choose one person with a number greater than 1) and say: You feel that there is a [low, medium or high] possibility of getting HIV if you were to have sex without a condom. Why do you feel this way? Why do you feel that the possibility of infection is greater than the numbers behind you? (Mention the numbers lower than the place where they are standing.) Ask two more youth (with numbers greater than 1) why they feel that there is a [low, medium or high] possibility of getting HIV. Summarize the things that the youth have said. In the next few weeks we are going to be talk about risk, importance and skills for healthy relationships. We hope that by talking and sharing together, we can learn

23

more about these three things. In today’s session we are going to talk about mentors and how we can find good ones who will help us as we consider these things. We will begin with a short story.

Serial Story and Discussion: 20 (or 30 minutes) Read the story below using the character’s name which you used in Session 2. If you are teaching in a religious setting, you may read the historical account of Rehoboam instead. See the Story and Discussion (Option 2) below. Choose the story that is best for your youth. Remember, if you are following the 60-minute format, you have 20 minutes to complete the Story and Discussion. If you are following the 90-minute format you have 30 minutes to complete this section. Know the story well and practice telling it before the session begins. You may also ask one of the participants to read the story to increase participation. Story: Deborah wandered down the dusty street. A few houses down, she spotted her friend Rachel, sitting outside sorting beans. “Oh Rachel,” she sighed. “I wish I understood this ‘sex’ thing. It seems like everybody my age has a boyfriend or girlfriend. I hear all sorts of stories about it. Yet, my parents get so upset when the subject comes up and do not want to talk about it. If they only knew what my classmates tell me and encourage me to do, they probably would never let me go back to school.” Deborah continued, “Rachel, do you understand all about sex? Have you tried it?” Rachel laughed. “No, Deborah, I have never slept with a boy. Several years ago, some of the women in my church planned a special seminar for the teenage girls. We spent several days together at the church talking about what sex is and when God intends for us to enjoy it. They talked about the kinds of things that grandmothers used to teach our aunts and mothers about before life changed so much in our country. They also gave us time to ask the questions we had.” “I have so many questions!” said Deborah. Rachel spent time sharing the things she had learned. Deborah was thankful for Rachel’s help, but she still had some unanswered questions. She decided that she needed to find someone older to talk with about sex and how it was supposed to be. Ask a volunteer to repeat the main points of the story then ask the following questions:

? Why do you think Deborah found it difficult to talk to her parents about sex? Responses may include: When she asked them questions, they got upset and didn’t want to talk about it. She felt ashamed and did not think they would understand.

24

? What about you? Do you find it difficult to talk to your parents or caregivers? Encourage group discussion.

? Let’s say Deborah decides to find another adult to talk with about sex and relationships. What things should she look for when choosing an adult mentor? Allow youth to share their responses and then add any of the following responses that are not mentioned. A mentor should be someone who is:

1. the same gender 2. easy to talk to 3. available - you can see or meet with them when you need to 4. respected by others in the community 5. knowledgeable or willing to find out the answers to your questions 6. trustworthy – can keep information confidential 7. practicing healthy sexual behaviors in their own relationships 8. (optional) religious – a strong believer in your faith tradition if you are a religious

person Continue with the HIV Facts below.

Story and Discussion (Option 2): 20 (or 30 minutes) Story is from 1 Kings 12:1-15. You may read it from the Bible or tell it as it is here. Rehoboam was the son of King Solomon. Rehoboam's name means "he who enlarges the people.” However, as you will hear in the story, Rehoboam’s choice of mentors did not enlarge his territory; it brought great division. Story: After his father King Solomon died, Rehoboam became king. King Solomon required a lot of money in taxes from the people in the last few years of his reign. The people also felt burdened by the hard labor they had endured under King Solomon. They hoped that Rehoboam would make things easier for them. At King Rehoboam’s inauguration, the people gathered to him and said, "Your father made life hard for us, but now lighten the harsh labor and we will willingly serve you." “Give me three days to think it over then come back," Rehoboam said to them. Then King Rehoboam talked it over with the elders who had advised his father. "How would you advise me to answer these people?" he asked. They replied, "If you will be a servant to this people, be considerate of their needs and respond with compassion, work things out with them, then they will do anything for you." Rehoboam rejected the advice the elders gave him and consulted the young men who had grown up with him. He asked them, "What is your advice? How should we answer these people who say to me, 'Lighten the harsh labor your father put on us'?"

25

The young men replied, "These people who complain, 'Your father was too hard,’ tell them, 'My little finger is thicker than my father's waist. If you think life under my father was hard, you have not seen the half of it. My father thrashed you with whips; I'll beat you bloody with chains!'" Three days later the people showed up, just as Rehoboam had directed. The king's answer was harsh and rude. He rejected the counsel of the elders and went with the advice of the younger men, "If you think life under my father was hard, you haven't seen the half of it. My father thrashed you with whips; I'll beat you bloody with chains!" Rehoboam ignored the pleas of the people, and the country became divided. The northern tribes rebelled and appointed their own leader, ignoring the leadership of Rehoboam. Ask a volunteer to repeat the main points of the story then ask the following questions:

? Why did you think King Rehoboam decided to ask someone else for their opinion? Why didn’t he just do what the elders told him to do? Responses may include: Maybe he did not want to do what they asked him to do, he was looking for someone who would advise him to do what he wanted to do anyway, he wanted to find out what others wanted, or he was lazy and looking for a better/easier option.

? What can we learn from this story? Responses may include: It is important that we consider the experience and the wisdom of the people whom give us advice. Not all advice is good advice. It is important to choose your mentors carefully.

? What are the qualities of a good mentor (or advisor) in our time? Allow youth to share their responses and then add any of the following responses that are not mentioned. A mentor should be someone who is:

1. the same gender 2. easy to talk to 3. available - you can see or meet with them when you need to 4. respected by others in the community 5. knowledgeable or willing to find out the answers to your questions 6. trustworthy – can keep information confidential 7. practicing healthy sexual behaviors in their own relationships 8. (optional) religious – a strong believer in your faith tradition if you are a religious

person Continue with the HIV Facts below.

HIV Facts: 10-25 Minutes

? One of the mentor’s criteria is practicing healthy sexual behaviors. In light of HIV and AIDS, what are healthy sexual behaviors?

26

Response: Healthy behaviors are behaviors that eliminate or greatly reduce the risk of HIV infection. Healthy sexual behaviors strengthen the relationship between the committed partners. You cannot KNOW the details about someone’s personal life, and it is not something you can easily ask. However, you can watch them, and consider their behavior. Here are some questions to think about. • If the adult is married, are they faithful to their spouse? Being faithful is a healthy

sexual behavior. • If the adult is not married, are they practicing abstinence? If not, are they using

condoms? Are they behaving in a way that shows that they are making wise decisions about HIV prevention?

• Does this adult encourage you to be sexually responsible? Or do they encourage you to experiment and take risks with HIV transmission?

? Do you agree? Is there anything else we should add, or change? Discuss changes, or additions. Make sure that the additions and changes are healthy behaviors! If someone suggests a change that is not sexually responsible, then ask the others if they agree or have a different opinion. That way the other youth can correct unhealthy behavior. If there is still disagreement, clarify why the suggestion in not appropriate. Not only do we think that Deborah needs to find a healthy mentor. We also think that it is important for each one of us to find an adult whom we can go to for advice about our relationships. We should choose someone who would support us as we consider abstinence and other healthy sexual behaviors. Optional Discussion to reinforce Perceived Social Acceptability10 (15 minutes)

? What groups of adults do you think would support a decision for abstinence? Why do you think they would support this decision? Possible responses: teachers, community leaders, and health volunteers. Ask youth to list the different reasons for each group. Responses may include: • Teachers – because they know that abstinent youth are more likely to stay in

school and concentrate on their studies. • Religious leaders – because abstinence is line with their faith teachings. Ask each individual to write down the names of the people in each category whom they know - adults whom they think would support and encourage them in a commitment to abstinence.

10 Perceived Social Acceptability is one of the important barriers to abstinence identified in FH’s Barrier Analysis studies. If youth are under the impression that the majority of people in their community would criticize them or disapprove of a decision for abstinence, they may be unwilling to adopt this behavior. However, if the youth believe that people whom they admire would be happy if they chose abstinence, this helps them to think more positively about abstinence.

27

? How do you know that they would support a decision for abstinence? Is it by something they have said to you? Or the actions that you see in their lives?

? If we are already discussing relationships in our meetings here, why do we need to get advice from anyone else? Allow youth to respond and then add: We can learn a lot from the experience of adults. Although we may have a lot of energy and new ideas, those who are older than us have gained more life experience. Listening to their stories can help us to make wise choices. Emphasize the importance of choosing a mentor who is the same sex as the youth. A same-sex adult will be able to give better advice and support than someone of the opposite sex, especially when talking about sexual behavior. There is a possibility that talking with someone of the opposite sex may put the youth at risk of coercion or abuse. Although the youth may have opposite-sex influencers who can give them good advice, we are requiring same-sex mentors for this program so that they can speak openly (without fear) about sex and HIV. Ask the youth to share with the others whom they would choose as their mentor. Listen to several responses and then add: Not only will your mentor be able to share from their own experience to guide you, but you will also be able to share the things you are learning. Read both options below. Choose the option that pertains to your group. Option 1: If you are able to give each youth a discussion guide, say:

• We have a question guide to help you talk about the sessions with your mentor. There are questions for you to answer, and questions to ask your mentor. You do not need to take notes or write down your answers. The Discussion Guide is only a tool to help you have a good discussion.

• Give one Discussion Guide to each youth. Read the introduction and the questions for Sessions 1-3. Make sure that everyone understands that they should 1) Choose a mentor. 2) Talk with them about committing to meet with them after each session and 3) Talk with their mentor using the questions listed for the first three session.

Option 2: If you are not able to give each youth a discussion guide, say:

• Here are some things you can discuss with your mentor. o You can tell them the skills that you have learned. o You can tell them the stories from each session and discuss what you

learned from these stories. o You can share with them the things you have learned about HIV. o You can ask them questions about their “youth” and how things were

different for them when they were young. o Ask them what skills they have learned that can help you in your life.

28

• Encourage each youth to choose a mentor. They should then talk with the mentor (communicating confidently!) asking them if they will meet with the youth after each session to discuss what they have learned. If appropriate, encourage youth to write down the “discussion ideas” above, or review them after each meeting to remind youth.

Explain Session 6, the “Mentor and Me Meeting.” Begin planning for this event, assigning responsibilities, and sending out invitations if desired. See Session 6 “Notes to the Facilitator” for more information.

Reflection Verses (optional): 2 minutes Proverbs 11:14 “For lack of guidance a nation falls, but many advisers make victory sure.” Proverbs 15:22 “Plans fail for lack of counsel, but with many advisers they succeed.”

Review and Reinforcement: 5 minutes

? What did you learn today that can help you in your daily life? Encourage participation, especially among those who have not yet actively participated. Take Action: Tell the youth that they should approach their mentor and ask them if they are willing to meet regularly with them to share about what they have been learning. After they have received a commitment from the mentor, they should set up a time to meet after each session. Closing prayer (optional) If you have been trained to use the Relationship Checkup, ask those who had very low numbers on the Ruler Exercise to stay after. Ask them if they would be willing to go through a one-on-one interview with you. Meet with one of the youth now. Schedule an interview with the next youth after the next session. Continue scheduling a one-on-one interview with each of these youth until they have all been interviewed.

29

Session 5 ● Making Good Choices [Skill 2] Notes to the Facilitator

The choices and decisions a young person makes today can change their lives completely. They need to understand that in every situation they do have choices and that their actions have consequences. Too often young people only consider short-term consequences, whether they be negative or positive. They do not consider the fact that a decision they make today could have a very negative impact in the future. The purpose of this session is to equip youth to make good choices that will protect their own life, health and integrity as well as the life and heath of others in their communities. This session offers a process to follow for making decisions. It encourages youth to make wise choices for their current health and happiness and in order to realize their dreams for the future. Young people need to know that it is an exciting time to be alive and that there are options open to them that could never be considered in past generations. There are also challenges that previous generations did not have to face – the spread of HIV/AIDS, the breakdown of families and villages, the influence of media. They need to learn ways to overcome these negative influences and to avoid risky behavior that could lead to being infected with HIV. During this session, youth are also given the chance to practice making good choices, the second skill for healthy relationships. Practicing this skill and making a commitment to use this skill will build confidence and self-efficacy for youth as they consider making a long-term commitment for a healthy relationship choice. During this learning session youth will: 1. Discuss the short and long term consequences for a specific behavior. 2. Practice a method for decision making. 3. Have an opportunity to make a commitment to Skill 2: I will continue to use the

steps for good decision making. 4. Have an opportunity to make new commitments to Skill 1. Values, Attitudes and Beliefs strengthened through this session: 5. Wisdom is found in considering and weighing your options. Materials needed: • chalk to draw on the floor or tape to mark the floor • one blindfold

Activities: 60-minute format 90-minute format Review: 10 minutes 10 minutes Story and Discussion: 25 minutes 25 minutes Life Skills Activity: 20 minutes 20 minutes Reflection Verse (optional): (2 minutes) (2 minutes) Simulations: -------------- 25 minutes Making Commitments: 5 minutes 10 minutes

30

If you choose to add the Reflection Verse (optional), decrease the time for one of the other activities by 2 minutes.

Review: 10 minutes Before the session begins, draw the question mark shape for the Steps to Making a Good Decision on the floor or a blackboard with chalk. Or you can trace it in the dirt outside, or use a long piece of string and pieces of paper to make the outline. If you trace it on the floor, make sure it is big enough that seven youth can stand inside the outline. Opening prayer (optional)

? The last time we met, you were asked to select an adult whom you could share with about our meetings. Whom did you choose? How did they respond? Encourage participation. Encourage youth who haven’t met with a mentor, to choose one today, and meet with them before the next session.

Serial Story and Discussion: 25 minutes

Read the story below using the character’s name which used in Session 1 for Peter’s older brother, David. If you are teaching in a religious setting, you may read the historical account of Joseph instead. See the Story and Discussion (Option 2) below. Choose the story that is best for your youth. Know the story well. Practice telling it before the session. Try using a different tone of voice for each character in the story. We will begin our lesson with a story about David. Story: David and Mark go to the same school, but they don’t do many things together. When Mark asked David to help him carry a heavy load across town, he agreed to go. He thought he could get to know Mark better if he helped him out. When David arrived to help Mark, he discovered that the load was “stolen goods.” Mark explained, “Look, I won’t tell anyone you helped me out here. But if you help me this time, I will owe you a big favor. You know that girl you want to meet, Esther?” I will introduce you to her. (Now David had been interested in Esther for a long time. She was the most beautiful girl David had ever seen.) David knew it was not right, but he didn’t say anything more. He moved the stolen goods back to Mark’s house. They did not get caught. A few weeks later, Mark asked David to go to a party. David however, already had plans to help his mother. “Come on David,” said Mark, “Don’t be a loser, it will be great. One of the guy's parents are away and we are planning to get together at his house. So we can do what we want. Esther will be there and you can check her out and see if she is really as good in bed as they say.” David looked away at Mark’s last comment.

31

“You have done it with a girl, haven't you David? You are not a real man until you do. Besides, everyone is doing it! So, are you coming or not?” Ask a volunteer to repeat the main points of the story and then ask the following questions:

? What kind of friend do you think Mark is? Why? Response: He doesn’t seem interested in what Mark is doing. He is mainly concerned with having fun and getting the things that he wants.

? What different choices did David face? Encourage discussion. Add any of the following points that are not mentioned.

• He had a choice at the start, whether to help Mark with the heavy load or not. • Once he found out the load was stolen, he had a choice to continue helping

Mark or stop helping him. • He had a choice whether he was going to tell someone about Mark’s stolen

goods and confess that he was part of it, or not tell at all. • He had to decide whether or not he was going to help his mother. • He had to decide whether or not he was going to go with Mark to the party. • And if he went to the party, he had to decide if he really was going to spend

time with Esther or not. For those of us reading David’s story, it may seem like the “best” choice about the party is easy. But it can be difficult to make a good decision when friends try to pressure us. Maybe David really does want to spend time with Esther. Maybe he is worried that if he says no to Mark, Mark might get him in trouble by telling others that David helped him with the stolen goods. Decisions are not always as simple as we would like them to be. Sometimes it seems there are too many choices. Sometimes there are no good choices at all. Today we are going to learn a new skill – the skill of making good choices. And we will use David’s situation as an example.

Story and Discussion (Option 2): 25 minutes Story is from Genesis 39: 1-23. You can read the story from the Bible or tell it as it is here. We will begin our lesson with a story about a man named Joseph. Joseph lived long ago. He had to persevere through many difficulties. First of all, Joseph’s brothers were jealous of him and sold him as a slave to a rich and powerful master (the master’s name was Potiphar). However, the master watched Joseph and saw that he was a very good man. He made Joseph his personal assistant, putting him in charge of his house and all of his property. Our story begins with Joseph working at his master’s house. Story: Joseph was very handsome, and the master’s wife was impressed. She asked him to make love to her, but he refused and said, "My master isn't worried

32

about anything in his house. He has placed me in charge of everything he owns. The only thing he hasn't given me is you, and that's because you are his wife. I won't sin against God by doing such a terrible thing." But she kept begging Joseph day after day. Still, he refused to have sex with her, or even to go near her. One day, when all of the other servants were gone, the master’s wife grabbed hold of his coat and said, "Make love to me!" Joseph ran out of the house, leaving her hanging onto his coat. She called in her servants and said, "Look! This slave tried to rape me, but I screamed for help. And when he heard me scream, he ran out of the house, leaving his coat with me." The master believed his wife’s lie and put Joseph into prison. Ask a volunteer to repeat the main points of the story then ask the following questions:

? What difficult choice did Joseph face? Encourage discussion. Responses may include:

• The biggest choice was whether he was going to sleep with the master’s wife. • He may also had other choices such as whether he should tell the master

about his wife’s requests; whether to go back for his coat. Whether to try to reason with the master.

? Why do you think Joseph made the decision not to sleep with the master’s wife? Responses may include: He knew that it would displease God. He wanted to honor his master.

? What were the short -term consequences of Joseph’s decision? Response: Joseph was thrown into prison. However, this wasn’t the result of his good behavior; it was the result of the lies told by the master’s wife. Sometimes the short term consequences of doing what is best are difficult or don’t turn out as we would hope. We know that Joseph didn’t want to go to prison. However, because of his good character (he continued to make good choices over a long period of time); he was able to overcome the difficulties and live a successful life. If you know the story of Joseph you will remember that he later became the most important man in the land next to the king. When Joseph’s family was suffering from a famine in his homeland, he was able to save the lives of his father and his brothers as well as their families and livestock. Because he was a good man, and God honored him, he was able to overcome the difficult circumstances and achieve great things. Today we are going to learn seven steps for making a good decision.

Life Skills Activity: 20 minutes Use the picture at the end of this session, or the drawing that you have made. Point to each step as you discuss it. Here are seven steps to follow the next time you are faced with a difficult decision.

33

1. Identify the problem. Take time to name and explain the difficult situation you are facing. This will help you see the whole picture more clearly.

2. List your options. Even though it might not always seem so, you DO have choices in every situation. Think about (or write down) all the options you have.

3. Consider the outcomes/consequences of each option. Make a list of the possible outcomes, both positive and negative. Write them down and compare them. Look at short term outcomes (those that happen immediately after the decision) as well as long term consequences (outcomes that might affect your future). Compare the positive outcomes with the negative ones. Are there some that might really help your future? Are there some that might really hurt your future? Which of these outcomes/consequences are most important to consider when making a final decision?

4. Consider your faith teachings. By seeking wisdom from your faith, you can find guidance for many situations. Before making a decision, take time to search for wisdom or guiding principles that can guide you in making a good decision.

5. Seek wise counsel from people you respect. Take the time to talk through your different options with someone who knows you well, like your mentor, or a good friend. Let them ask you questions about the decision. They may suggest new options you have not considered.

6. Pray (optional). Ask God to help you to choose the best choice. Remember, no decision is too small to bring before God in prayer. Do not worry if you do not hear the answers you think you should or that others do. Your questions may be answered in ways that you do not expect – such as changes in circumstances, or changes in the way you think about the situation, or changes with others who are part of this decision.

7. Decide and act - When you have thought through each step – make a final decision and move forward.

Now let’s consider the choices of the characters in our story using these steps for good decisions. Choose six (or seven) volunteers. Ask each volunteer to stand in a line (or inside the drawing or outline on the floor) to represent each of the six (or seven) steps for making a good decision. Read the first step. Then ask the first volunteer to respond how this step applies to David’s decision about the party (or Joseph’s decision about sleeping with his master’s wife). Add any of the points below that the volunteer does not mention. Then move to the next step. Ask the next volunteer to respond. For Joseph’s story, go to the box on the next page. 1. Identify the problem. Response: David, he had to decide whether to go to the

party or not with Mark. 2. List your options. Response: David could go with Mark. He could decide to visit

the party after he helps his mother. He could decide not to go to the party at all. He could decide to go to the party but with someone else who would help him to stay out of trouble. There are many different options for David.

34

3. Consider the outcomes. Possible responses: Positive (short term) outcomes of going to the party: meeting Esther and making new friends. Negative (short term) outcomes of going to the party: He might be pressured into having sex with Esther. Positive (long term) outcomes of avoiding the party: earning respect from his parents, and reaching his goals because he is able to avoid the things that might distract him. Negative (long term) outcomes of going to the party: losing his good reputation, getting involved with Esther and contracting an STI that causes him long term problems.

4. Consider your faith teachings. Response: David might consider the following

faith teachings: there is wisdom in avoiding temptations; we should live an honorable life so that others might see our faith and actions and be encouraged. It is wise not to get involved with someone who is dishonest (or deceitful). It is best to honor your parents (and therefore not ignore the plans he already made with his mother).

5. Seek wise counsel from people you respect. Response: David could talk with

his mother about the options. He could also talk with his mentor or friends from school before he makes a decision.

6. Pray. One possible response: David asks God to help him to make a good

decision that pleases God. David also asks God to make him brave enough to make the best decision even if it means his friends will tease him.

7. Decide and act. Ask the last volunteer what decision is best for David.

? Ask the group – Is this a good decision? Hopefully the group will agree on a good decision. However, it there is disagreement, don’t spend time arguing about the best decision. Remind everyone that we have to use our own minds to make a decision – and not everyone will always agree with what we choose. Once you are certain that everyone understands the steps, move to the next section. Option 2: Joseph’s decision 1. Identify the problem. Response: The master’s wife continued to beg Joseph to

sleep with him. 2. List your options. Response: Joseph could decide to tell his master. He could

decide to sleep with her. He could decide to ask his master to send him someplace else. There are many possible options.

3. Consider the outcomes/consequences. Positive outcomes: of sleeping with his

master’s wife include temporary enjoyment. Negative outcomes include getting caught by his master, dishonoring God, and breaking up the marriage of his master, as well as the possibility of pregnancy.

4. Consider your faith teachings. Possible responses include: Joseph’s faith

reminded him that it is wise to avoid temptations. It is wise to live an honorable life

35

so that others might not say bad things about you because of your actions. God tells us to be faithful and not commit adultery. We should honor those in authority over us (like his master’s wishes).

5. Seek wise counsel from people you respect. Response: Joseph could ask for

advice from his friends, religious leaders, or others who work for the master. 6. Pray. One possible response: Joseph asks God to help him make the best

decision. 7. Decide and act. Ask the last volunteer what decision is the best for Joseph.

? Ask the group – Is this a good decision? Based on the responses above, the best decision is choosing not to sleep with the master’s wife. However, if youth in the group begin arguing, end the discussion by mentioning that Joseph made the best choice as we can see from history. Answer questions about the seven steps. Then move to the next section.

Reflection Verse (optional): 2 minutes Jeremiah 6:16 “This is what the Lord says: Stand at the crossroads and look; ask for the ancient paths, ask where the good way is, and walk in it, and you will find rest for your souls.”

For 90-minute sessions only ⎯ Simulations: 25 minutes Reminder: If you are following the 60-minute format, skip the simulations (below) and close Choose Life Session 4 with Making Commitments. If you are following the 90-minute format, you have 25 minutes to practice simulations. Now let’s practice in pairs. You will work with a partner using the steps for good decision making. After 10 minutes, switch roles with your partner so that you both have a turn being a trainee and working through a decision. Explain the performer and trainee rules to the group. Observe the pairs; coach those who are having difficulties. After 5-10 minutes ask the pairs to switch. 1. Trainee’s situation: You are in a relationship with someone you really care about.

Recently, they have been treating you poorly and saying bad things about you. There are rumors that this person is involved with someone else. Talk with a friend about the situation and work through as many of the steps for making a good decision as you can. Remind the trainee: During the simulation, be yourself. Respond as if the situation was real.

2. Performer’s role: Your friend is struggling with a relationship. Help them to think through each step for making a good decision.

After all youth have completed the second simulation, move to the reflection questions (5 minutes).

36

? Did you remember all of the steps for making good choices? • (If they reached a decision) Did the trainees agree upon a good decision? • What good ideas/skills did the trainees use during the simulation? • What new things did you learn about the steps for making good decisions? • How can you use this skill in your life? Encourage discussion.

Making Commitments: 5 (or 10 minutes)

For 90-minute sessions: On our last simulation day, we practiced communicating a message with confidence.

? How many of you have used Skill 2 since our last meeting? How did the simulation help you to respond to this situation? Encourage discussion. Now you have a chance to make a commitment to USE Skill 2. Remember, making a commitment doesn’t mean you have mastered all of the steps for good decision making. It means that you realize the importance of the skill, and are committed to using the skill in your life. Some of you might not be ready to make that commitment. We will give you another chance on the next simulation day. Explain to the youth that you will read the first and second commitments in order, pausing after each one. Those who have already made a commitment - or want to make a new commitment – should stand when that commitment is read and repeat the statement after you in unison. Those who are not ready to make a specific commitment should sit quietly while that statement is read. Commitments: I will continue to communicate with confidence. I will continue to use the steps for good decision making. Congratulate those who have committed to the first two Skills for Healthy Relationships. Ask for a round of applause! Ask those who have made a commitment to write their names on the Skills for Healthy Relationships’ picture near the stone that represents their commitment. Encourage everyone to use these skills in their life. Make any last minute preparations with the youth for the Mentor and Me Meeting. Continue assigning responsibilities as needed. Closing prayer (optional)

37

Steps for Decision Making

38

39

Session 6 ● Mentor and Me Meeting Notes to the Facilitator

This session is designed to inform youth mentors, caregivers or other influencers of youth about HIV prevention methods. It requires youth to think through HIV prevention methods and develop skits and other activities to inform others. Finally, it enables open discussion between adult influencers, mentors and youth regarding sexuality and HIV. This public meeting will strengthen the commitments made by youth and their mentors to meet regularly as described in Session 4. It will also inform the community, youth mentors and other influencers of youth about the purpose and function of the youth groups. Preparing for the Meeting: This session requires advance preparation by the youth in the group. It can be integrated into a normally scheduled group meeting, or can be rolled out as a special event done at a different time. Because there will be many adults who might come to this event, extra planning may be required for the large number of participants. The youth may wish to invite their mentors directly or send out invitations. Choose the approach that works best in your region. In some cultures, it may not be acceptable for youth to facilitate a meeting, or teach adults. This session was designed so that youth can openly share with adults the things they have learned while indirectly sharing facts and information about HIV prevention. It may be more culturally acceptable to have an older or influential adult lead the majority of the teaching segments. It may also be necessary to sensitize mentors to the objectives, aims and importance of such a meeting (through radio messages for instance) prior to this event. Make adaptations as necessary. During this learning session mentors will: 1. Review the basic facts about HIV transmission. 2. Learn the purpose and format of the group meetings for youth. 3. Hear from youth about the things that they have been learning. 4. Learn how to discuss HIV facts with youth.

During this learning session youth will: 5. Review the basic facts about HIV transmission. 6. Learn to present HIV facts and information to an audience. Values, Attitudes and Beliefs strengthened through this session: 7. As adults, we have a responsibility to guide youth towards making wise decisions

about relationships and their sexuality. Materials needed:

• (Optional) Copies of the Talking to Youth Guide for each adult (See the Participant Handout section)

Activities: 60-minute format 90-minute format Introduction: 10 minutes 10 minutes Warm Up Game / HIV Facts: 25 minutes 25 minutes Presentation and Discussion: 20 minutes 45 minutes

40

Reflection Verses (optional): (4 minutes) (4 minutes) Review and Reinforcement: 5 minutes 5 - 10 minutes If you choose to add the Reflection Verses (optional), decrease the time for one of the other activities by 4 minutes.

41

Introduction: 10 minutes Preparing for the Game: Before the meeting begins, select the people who will carry the disease (HIV) for the warm up game. Approximately 15% of the total number of guests should be selected to carry the disease. (If you have 15 guests, choose two people to carry the disease. If you have 25 guests, choose three people to have the disease.) Explain to them that you are pretending in this game that they have HIV. Tell them not to let others know before or during the game that they have HIV. Opening prayer (optional) Introduce yourself to the group and thank everyone for coming to the meeting. Create a positive environment for all of your guests. Be sure to make everyone feel welcome. Explain the purpose of the groups: The youth come together on a regular basis to talk about life issues. We discuss the goals and dreams of youth, responsible choices that help keep youth safe, and changes that are part of becoming an adult. Our main goal is to discuss the challenges of sex and HIV. We encourage responsible behaviors especially abstinence for youth. We will talk more about this later today. Explain the purpose of this meeting: We have asked you to come and be a part of our meeting because you are an important part of the lives of the youth here today. We hope to share with you the things we have learned over the past few months, and ask that you help us (youth) to continue taking responsible actions to prevent HIV and AIDS. We know that it is important to learn and talk about life with our parents/caregivers and mentors. We also know that sometimes this is hard to do. We hope that this meeting will help you as a parent or youth mentor to have better communication about relationships, sex and HIV with youth. We will begin with a short learning activity.

Warm Up Game / HIV Facts: 25 minutes Instruct everyone (adults and youth) to greet and shake hands with five people. When they are finished greeting five people, they should sit down. Make sure that everyone understands what they should do. Then, begin the game. After everyone is seated, ask those with the “disease” to stand. In this exercise, which is only for pretend, we selected a few people to represent those who have been infected with HIV. Explain that everyone who was in a relationship (had sex) with these people (symbolized by shaking hands) has also been infected with HIV. This is only a game. You cannot get HIV from shaking hands or greeting your neighbors. However, let us think about what this illustration means.

• Say to those who are still seated: If the first person that you greeted is standing, then you should stand also; you have been infected with HIV.

42

• Then, say to those who are still seated: If the second person that you greeted is standing, then you should stand also; you have been infected with HIV.

• Then, say to those who are still seated: If the third person that you greeted is standing, then you should stand also; you have been infected with HIV.

• Continue asking the seated participants to stand until you have finished all five greetings.

? How many people were infected at the start of the game? Response: Mention the number of people whom you selected at the start of the game.

? How many people are infected now? Response: Count the number of infected. Emphasize that the actions of those who were infected affected many others.

? What if the infected person(s) had interacted with only one other person? How many would be infected now? Response: The number of infected people would be much smaller. The spread of the disease would have been much slower.

? What if the infected person had interacted with no one else? Response: It would have stopped the spread of the disease from spreading.

? What are the ways that we could have protected ourselves from being infected in this exercise? Listen to responses and then reinforce the following points:

1. Choose not to “shake hands” where shaking hands is a symbol for having sex (be abstinent).

2. Choose to shake fewer people’s hands (reduce the number of chances that we might come in contact with someone with HIV).

3. Find out who has HIV before you shake hands (find out the HIV status of someone before you have sex with them).

? What other messages can we learn from this exercise? Listen to responses and then reinforce the following points:

• You cannot always tell a person is infected with HIV. They often appear normal and healthy.

• The more sexual partners that we have, the higher our risk of getting the disease, the more quickly HIV will spread, and the more people it will affect in our communities.

• One person’s actions can negatively affect many other people. • How we act affects others. By remaining sexually faithful in our marriages, or

encouraging abstinence for youth, or partner reduction for those who are already sexually active, we have the capability to slow the spread of HIV.

43

Reinforce the important facts about HIV if these things are not brought up by the participants during the discussion. The main methods of HIV/AIDS transmission 1. The most common way that people get AIDS is through sexual intercourse (anal,

vaginal, or oral sex) with another person who has the disease. (Oral sex caries a very low risk of HIV infection, but still allows transmission especially if there are cuts or sores on the mouth or genitals).

2. Blood to blood. Someone can be infected with HIV if fresh blood that contains the HIV virus enters their blood stream. This can happen if an infected syringe needle is reused rather than being destroyed, or if HIV-infected blood enters the blood stream through an open cut or sore. It can also happen if a person receives HIV-positive blood in a transfusion.

3. Mother to child. A baby can be infected from the mother if the mother is HIV-positive. Most babies born to HIV-positive mothers are not infected. But some may be infected during pregnancy, at the time of labor and delivery, or while the baby is breastfeeding (especially if the mother gives both breast milk and other foods or liquids before the child is six months old).

This game illustrates many of the things we have been teaching youth. Youth are learning about HIV prevention specifically abstinence, and also learning skills for healthy relationships. To tell you more about what the youth have learned, we will have a short presentation.

Presentation and Discussion: 20 (or 40 minutes) Choose one or more of the following suggestions to present the information they have learned from the first five sessions.

1. Organize the youth to develop a role play, or series of skits to demonstrate some of the things which they have learned about communication, being yourself, and making good choices – and how this relates to abstinence and HIV.

2. Ask the youth to role play one or two of the stories that they have read and follow this by a brief presentation of what they learned in that session.

3. Have the youth explain the Skills for Healthy Relationships and what the skills that they have learned so far. Ask youth to give short testimonies as to how these skills have helped them in their life.

Thank the youth for their presentations. Today, with the situation of HIV/AIDS in our nation, we (youth and adults) each have an important role to play in HIV prevention. Adults need to help support the young people in their decisions to remain abstinent. Not only do parents/caregivers need to talk to their children about healthy behaviors, but also teachers, pastors, aunts, uncles and youth mentors. We all have a responsibility to talk to youth about making wise decisions. We (adults) need to help youth remain accountable to their decisions and be a support and guide to them. Talking about this also helps those of us who are married to remember the commitment we made when we married. We need to be good role models in our words and actions so that youth can learn from us.

44

Reflection Verses (optional): 4 minutes Deuteronomy 4:9 “Only be careful, and watch yourselves closely so that you do not forget the things your eyes have seen or let them slip from your heart as long as you live. Teach them to your children and to their children after them.” 1 Timothy 4:12 “Don’t let anyone look down on you because you are young, but set an example for the believers in speech, in life, in love, in faith and in purity.”

Review and Reinforcement: 5 (or 10 minutes) Some of you have agreed to be mentors – to meet regularly with the youth to discuss the things they have been learning. Please continue to talk with youth. Ask them about what they have been learning and how it has helped them to prevent HIV infection. If each youth was given a Discussion Guide, say: We have given each youth a Discussion Guide. (Hold up a Discussion Guide so that everyone can see). This guide has questions for the youth to answer and questions for the mentor to answer. The Discussion Guide will help your conversations go smoothly. If you are meeting with a youth, be sure to remind them to bring it with them. If you are able to give each adult the Talking to Youth Guide, say: We also have a handout for you today. It discusses the facts of HIV and AIDS and gives guidance about how to talk with youth. You can use this guide to help you talk with youth in your community about HIV and the importance of abstinence and other healthy behaviors. Hand out the Talking to Youth Guide to all adults. Thank the adults and youth for coming. Closing Prayer (optional)

45

Session 7 ● Understanding Sexuality Notes to the Facilitator

Sexual temptation and social pressure are very real forces that affect all of us. How can youth abstain from sex until marriage and remain sexually pure in the face of such challenges? Young people need to understand that sex is a special gift created by God to intensify the bond between a man and a woman in a way that nothing else can. They need to see that their sexuality is more than simply the physical act of sex, but that it also involves mental, emotional and spiritual expressions of what it means to be male and female. The purpose of this session is to encourage youth to value sexual purity and to hold out for the ultimate expression of physical sex with their life partner. You may want to separate boys and girls for this session if you think it will improve openness. During this learning session youth will: 1. Define abstinence and secondary abstinence. 2. Discuss the consequences of having sex before you are ready. 3. Examine the different aspects of their sexual nature. 4. Identify reasons that married and non-married people choose to have sex. 5. Explain why youth are a high-risk group for HIV infection. Values, Attitudes and Beliefs strengthened through this session: 6. Sex is a wonderful gift when it is part of a loving, committed (marriage)

relationship. Materials needed: • Posttest for each youth

Activities: 60-minute format 90-minute format Review: 10 minutes 10 minutes Presentation and Discussion: 20 minutes 20 minutes Serial Story and Discussion: 30 minutes 40 minutes HIV Facts: -------------- 15 minutes Reflection verse (optional): (2 minutes) (2 minutes) Review and Reinforcement: -------------- 5 minutes If you choose to add the Reflection Verse (optional), decrease the time for one of the other activities by 2 minutes.

46

Review: 10 minutes Reminder! Give a posttest to the youth to ensure that they have learned all of the material. Use the questions listed at the beginning of this manual for Sessions 3-6. Opening prayer (optional)

? At our last meeting, we presented HIV information to the adults in the community. How did you feel about talking so openly about HIV and sex with these adults? Encourage discussion. Listen to several responses.

? How have these meetings helped you in your daily life?

Presentation and Discussion: 20 minutes You may want to separate boys and girls for these discussions. Today we are going to talk together about sex. Even if you have not already faced decisions about sex, this is a subject that concerns us all.

? What is sex? This question may be hard for youth to answer. If so, try asking, “What have you heard people say about sex?” Listen to several responses as time allows Responses may include what sex is or the reasons for having sex. Let youth share whatever thoughts they have. For boys: some say you should have sex to prove you are a man; some say you will go mad if you do not have sex. For girls: some may say that older boys and men say they want to show us what it’s all about; some say it’s good to practice before you get married. Depending on their responses and the age of the group, you may want to give this description of sex: Sex is a physical act when a man’s penis enters a woman’s vagina. As a man and woman begin touching and kissing, their bodies begin to respond in preparation for sex. The man’s penis becomes hard and long, while the woman’s vagina begins to secrete mucous to help the penis enter. When a man is fully aroused, he will expel a substance called semen that contains sperm combined with other fluid that you cannot see. If the timing is right in a woman’s menstrual cycle, the sperm may unite with the woman’s egg. If this occurs, the woman becomes pregnant, and a child begins to develop within her uterus.

? What are the reasons married people have sex?

47

Responses may include: having children, satisfying your body, strengthening relationships between two people, etc.

? Why do some unmarried young people have sex? Responses may include to satisfy desire, for experience, for pleasure, getting free gifts, being accepted by peers, feeling loved, fun, prove manhood or womanhood, stress reliever, seduction/flirtation, curiosity, lust, etc.

? Why do some young, unmarried people choose to wait to have sex until they are married? Responses may include: fear of getting diseases, pregnancy, want to save sex for marriage, etc. Many youth agree that vaginal sex (as we talked about before) should be reserved for marriage, but some of them are involved in other sexual activities that they do not define as sex. For instance, some youth may be involved in oral sex, or anal sex, but still think they are being abstinent. Explain so that everyone understands. Oral sex means that someone is using their mouth or tongue to stimulate a man or woman’s genital organs (clitoris or penis). Anal sex means that a man’s penis enters the anus of someone else – man or woman.

? What do you think? Should abstinence (waiting for sex) include oral and anal sex? Allow youth to respond and then add: During our discussions, we are defining sex as including all three of these activities: vaginal sex, anal sex and oral sex. When we discuss abstaining from sex – we mean abstaining from all three: vaginal, anal and oral sex. Answer questions as needed. We will continue with a story about Rachel. We will hear about the choices she made and how those choices affected her future.

Serial Story and Discussion: 30 (or 40 minutes) Remember, if you are following the 60-minute format, you have 30 minutes to complete the Serial Story and Discussion. If you are following the 90-minute format you have 40 minutes to complete this section. Story: After many heartbreaks, Rachel finally found the man she had been waiting for all her life. And he loved her too! But then fear filled Rachel’s heart. What if he found out about her past? Would he still love her? Would he still want to marry her? How could she tell him the truth? When Rachel was a teenager, she fell in love with an older boy. At least she thought it was love. When she went to the market, he was there, and he always found a way for them to get away from the crowd and talk together. When they were together, he would tell her how much he needed her and that someday they would marry. Finally, he told her that if she really loved him, she would not hurt him any longer but she

48

would share herself with him. She had resisted his pleas for a long time, but finally she had felt such a desire within herself that she could not hold back any longer. Once he was with her on the bed, it was as if he changed and become another person. She did not know what to do, and she was scared. But that was not all that changed. The next day, he acted like he did not know her and before long Rachel saw him with another girl. Rachel’s heart was broken. She tried to get his attention by wearing sexy clothes and flirting with other boys. But he did not seem to notice. Look at participants as you tell the story. Even if you are reading, look up occasionally. Rachel had been number three in her class but now it seemed that she could not think straight. Her grades began to drop and she was at risk of failing in some subjects. That was when her teacher called her into his office after class. At first, she thought he wanted to give her some special help, but she soon realized that he wanted something else. He told her that he had noticed her new style and if she would have sex with him, he would be sure to give her a passing grade. Rachel had always thought she would wait until marriage for sex. She regretted having sex the first time, but now it seemed as if she had already failed. She needed to pass her subjects, so she let her teacher do what he wanted with her. Rachel continued to dress in sexy clothes and tried to find a boyfriend who would love her for who she was. Her flirtations to find love usually resulted in having sex with men she thought loved her, but they would leave her soon after or not be faithful to her. Even though she still attended church, Rachel felt something had changed. She felt ashamed to be there sometimes and found it difficult to pray. Over the years, Rachel contracted several different sexually transmitted infections, but she was ashamed to go to the clinic for help. All Rachel wanted was to live her dream of being married to a man who truly loved her. Now that she had finally met this man of her dreams, she was afraid that he too would leave her if she told him the truth about herself. Ask a volunteer to repeat the main points of the story.

? Rachel was affected in many ways by her sexual choices. What are some of the outcomes/consequences of these choices? Encourage discussion. Add any of the points below that youth do not mention.

• Regret about her first sexual experience • She felt she had to try harder to be loved by others • She changed the way she dressed to look sexy • She lost hope and continued to have sex with others (like her teacher) • She did poorly in school • She was ashamed and found it difficult to pray. • She was afraid to tell her new love the truth about her past.

Draw a circle on the ground or blackboard for youth to see. Divide it in four parts.

49

We have a physical side, but we also have emotions, and a spiritual and mental side. These four aspects are part of what makes us human. All four parts come together to make us whole and complete. You can write each aspect (physical, emotional, mental and spiritual) in the sections of the circle or create a symbol for each section.

Sex is more than a physical act. It also involves the mental, emotional and spiritual expression of what it means to be male and female. When a man and woman are committed to each other in marriage, these physical, emotional, mental and spiritual responses enable a husband and wife to express their desires in a close and intimate way. Sex is meant to be more than skin on skin; it is emotional and spiritual glue designed to bind a man and woman together for life, and to keep them in a solid, trusting relationship.

Some youth have sex with many partners just for fun, only thinking about the physical pleasure. What they don’t realize is that sex affects more than just the physical aspects of their life. Let us look again at Rachel’s story and how she was affected by her choices.

? How did having sex without a commitment (i.e. marriage) affect Rachel emotionally? Responses could include: she felt unloved, she lost confidence in herself, she tried too hard to get boyfriends, and she was heartbroken many times. She lost interest in sex.

? How did having sex without a commitment (i.e. marriage) affect Rachel mentally? Responses could include: her grades suffered, she could not concentrate, and she continued to make poor choices.

? How did having sex without a commitment (i.e. marriage) affect Rachel spiritually? Responses could include: she felt separated from God and she was ashamed to go to church. For 90-minute sessions:

? We have talked a lot about the bad things that affected Rachel from having sex before she was married. Abstaining from sex could have helped her to avoid these negative consequences. But what are some of the good things about waiting to have sex until you are married? What are some of the positive outcomes that come from waiting to have sex until marriage? Responses may include: you can spend more time with your family and friends, you can build better friendships with people of the opposite sex, or you can focus your energy on other things like school, your faith, or work.

50

? (Optional question to reinforce Divine Will11) What do your faith teachings tell you about the right time to have sex? Think for a moment about your own life. Maybe some of you have already had experience with sex, some of you may have committed to wait until marriage to have sex, some of you may just be thinking through these things now. Maybe our conversations are making you feel uncomfortable about your past or your current relationships. Remember, we all have second chances. Rachel felt like she had failed, and this affected all of her relationships. We don’t have to feel that way. We are able to make changes, and new commitments which will keep us from repeating those mistakes. We can start over with secondary abstinence.

? What is secondary abstinence? Response: Secondary abstinence means that someone can make a new commitment to abstain from sex from this point until they are in committed (married or long-term) relationship.

For 90-minute sessions only ⎯ HIV Facts: 15 minutes We spend a lot of time talking about the importance of refraining from sex for youth. But what is the big deal?

? Isn’t HIV a problem for everyone? Why is everyone always targeting the youth? Encourage discussion. Add any of the following points that are not mentioned: • More than half of all NEW HIV infections each year happen to youth under the age

of 25. About 6,000 infections occur each day in this age group - that means worldwide, one 15-24 year-old is infected every 15 seconds. 1

• The percentage of infected youth is highest in sub-Saharan Africa, followed by the Caribbean. These two regions have the highest percentage of infected youth.

• The number of sexually transmitted infections (STIs) among sexually active youth is high – STIs make youth MORE vulnerable to sexually-transmitted HIV.

• Youth, especially young girls, are more vulnerable to HIV infection because their sexual organs may not be fully developed – their vaginal canal is more likely to tear or bleed during vaginal sex – increasing the risk of HIV infection.

• Girls often have sexual partners who are much older than they are. This increases the chance that their partner has had previous sexual relationships and increases the chances that he is a carrier of HIV or other STIs.

• Many youth do not know or understand how to protect themselves from HIV. • Some youth feel they are not at risk and do nothing to protect themselves or their

partners. • Youth are more likely to exchange sex for things they desire.

11 Divine Will is one of the barriers to abstinence identified in FH’s Barrier Analysis studies. If youth believe that it is not God’s will that they avoid a disease or problem, they many not do anything to prevent the disease. On the other hand, if youth believe that abstinence or other healthy sexual behaviors are in line with their faith teachings, they are more likely to adopt these new behaviors.

51

• Children and youth are more likely to be coerced or forced into sexual activity against their will, which increases their risk of HIV infection.

That sounds like a lot of bad news. What is the good news? The good news is that studies have shown that when youth are given the correct information and the tools to protect themselves, they are the ones who respond and make a difference in their communities! So even though it may seem like you are in a lot of “danger,” there is hope that with the right information and the support of your friends, you can make a difference.

Reflection Verse (optional): 2 minutes Jeremiah 29:11 “I have plans for you, plans to prosper and not to harm you, plans to give you hope and a future.” For 90-minute sessions only ⎯ Review and Reinforcement:

5 minutes

? What did you learn today that will help you in the coming week? Take Action: Make a list of the qualities that you would like your future marriage partner to have. For example, kindness, patience, strength, etc. Share these ideas with your mentor this week. Closing prayer (optional) Reminder! Give a posttest to the youth to ensure that they have learned all of the material. Use the questions listed at the end of this manual for Sessions 4-6.

52

53

Session 8 ● Communicating your Relationship Boundaries [Skill 3] Notes to the Facilitator

During this session, youth will practice the third skill for healthy relationships, communicating relationship boundaries. During this simulation it is important to help youth to consider the importance of boundaries and the boundaries that are appropriate for their life. By practicing with an opposite sex partner, youth will be able to practice this skill in a safe environment. Trainees will also be able to understand how they can express boundaries to those that they car about. Finally, as trainees voice certain facts about themselves, (e.g., “I want to wait until I am older to have sex”), they are more likely to believe these things and incorporate these beliefs in their life. By talking about boundaries, they are more likely to set and keep them later. Practicing this skill and making a commitment to use this skill will build confidence and self-efficacy for youth as they consider making a long-term commitment for a healthy relationship choice. During this learning session, youth will: 1. Practice communicating relationship boundaries. 2. Discuss (and discover) new ways to communicate relationship boundaries. 3. Have an opportunity to make a commitment to Skill 3: I will continue to

communicate my relationship boundaries. 4. Have an opportunity to make new commitments to Skills 1 and 2. Values, Attitudes and Beliefs strengthened through this session: 5. Communicating relationship boundaries is something I can learn. If I practice, I will

get better and be able to use this skill with my partner. Materials needed: none Activities: 60-minute format 90-minute format Review: -------------- 10 minutes Presentation and Discussion 20 minutes 20 minutes Simulations: 35 minutes 50 minutes Making Commitments: 5 minutes 10 minutes

54

For 90-minute sessions only ⎯ Review: 10 minutes At the end of our last meeting, you were encouraged to make a list of some of the advantages and disadvantages of abstinence. Ask a few volunteers to share some of the items on their list. Encourage discussion. Allow youth to share freely, even the disadvantages of abstinence.

? How many of you shared these things with your mentor? What was their response?

Introduction: 20 minutes Today we are going to practice the third skill for healthy relationships. This skill is about communicating relationship boundaries.

? What is a boundary? Encourage discussion. A boundary is a border or limit. Some people put a boundary fence around their house or land. These fences protect the people and things inside the fence. Like a fence, healthy relationship boundaries protect us from harm. If we do not set healthy boundaries, or do not keep our boundaries, we are more likely to break our commitments, to get hurt (emotionally or physically), or do something that we will regret later. Each of us needs to choose our own boundaries. Once we set a boundary, we need to keep it, and warn someone if they are getting too close to the boundary. Set the boundary at the point where temptation is most difficult for you (or the person whom you are with) - the place where you both need a warning to stop. For example, let’s say you want to be abstinent (or delay sex until you are older). Maybe too much touching (or specific types of touching) makes sex too difficult to avoid. You could set a limit on what type of touching, or how much touching you will do in a relationship. Maybe spending time alone with someone makes sex too difficult to avoid. You could set a boundary that you will not meet with your partner when no one else is at home. Maybe certain clothing makes sex too difficult to avoid, you could ask your partner not to wear this clothing when you are together.

? These are some examples, what are some of your ideas for healthy relationship boundaries? Encourage youth to think about physical boundaries for sexual activity (boundaries for touching, kissing and other intimate activities), as well as boundaries for being alone with someone. Be sure that youth discuss HEALTHY boundaries. If someone suggests an inappropriate boundary, ask the rest of the group if they agree, or if anyone has a different idea. This way other youth can correct inappropriate boundaries. If there is still disagreement, clarify why these boundaries are “not appropriate” for healthy relationships.

55

Today, you will practice communicating your relationship boundaries with people of the opposite sex. Even if you have not decided what your (personal) relationship boundaries will be, you can practice communicating to a partner. Ask the youth to repeat today’s skill (in bold above) until they can repeat it by memory. Sometimes it can be difficult to talk with a boyfriend or girlfriend when they do something that you don’t like, or when it is clear that they are about to do something that you do not like. Here is something you can try. Surround the “difficult thing” with two positive things. First, say something positive about the person. Then, clearly state the difficult thing. Then add a positive suggestion, something that communicates what you prefer to do instead. For example: I really like you and enjoy spending time with you. But I am not comfortable when you touch me like that. Let’s hold hands instead. Another example: I really like studying with you. But I should not be spending time with you alone. Let’s invite other friends to study with us from now on. If someone does not respect your boundary, even after you ask nicely, then you need to let them know that there are consequences. (For example, “I asked you earlier not to touch me that way again. If you continue to do that, I will stop seeing you and tell my father... and things will not go well for you.”) If we set boundaries, we must be prepared to keep them and respond appropriately if someone continues to ignore those boundaries. These are two techniques (using consequences, and surrounding the difficult thing with positive statements) that you can practice today.

Simulations: 35 (or 50 minutes) This exercise may be uncomfortable for some youth. If you have a mixed group (boys and girls) and they are not comfortable practicing with an opposite sex partner, split them into same sex groups. Coach the groups simultaneously, helping those who have difficulties. Ask for a volunteer trainee.

1. Explain the situation to the trainee: You and your boyfriend/girlfriend really care about each other, but things are moving very fast. He/she just crossed one of your physical boundaries and touched you where you did not want to be touched. Remind the trainee: During the simulation, be yourself. Don’t think about the observers; respond as if the situation was real. You may want to use some of the following ideas and techniques. • Make it clear that you are communicating something important by saying

something like, “We need to talk about something,” or “I need to tell you something.”

• Avoid giving mixed signals - by smiling or touching - when communicating your boundaries.

56

• Explain why you are not comfortable. • Surround the “difficult thing” with positive statements. • Describe the reasons why boundaries are important to you • Explain the benefits of healthy boundaries for your relationship. • If the person persists or argues with you, talk to them about the

consequences of crossing your boundaries. • Use your own skills to persuade your boyfriend/girlfriend to choose healthy

boundaries. 2. Ask the trainee to explain the situation and what he/she should do. Clarify

misunderstandings. Ask for an opposite sex volunteer (performer). Speak to them in private (so the others can not hear).

1. Explain the situation to the performer: During the simulation you should NOT inappropriately touch the trainee. Begin the simulation with your hand on the trainee’s knee, talking affectionately. You have never heard about relationship boundaries. Try to persuade the trainee that you don’t need boundaries. Continue until the trainee makes their boundaries very clear to you. Then, stop being resistant. Work together to set a new relationship boundary. Stop the simulation when you are able to agree.

2. Remind the performer: Do not overreact; make the simulation as REAL AS POSSIBLE. Do not do things that are very strange or unlikely to happen in a relationship. This is not an opportunity to make people laugh. We want the trainee to learn how to use this skill in a life-like situation. Ask the performer to explain his/her role to you. Clarify misunderstandings.

Explain to the rest of the youth: You are the observers. Your role is to watch SILENTLY! Do not laugh or make noise. We will talk after the simulation is over. Directions for the Facilitator: Observe the simulation. Do not stop the simulation unless there is a problem. 1. If the trainee is ACTING (not being themselves): Pause the simulation. Remind

the trainee to use their own ideas and skills for practice. The trainee should not try to entertain the observers.

2. If the trainee does not know what to say (for a long time): Pause the simulation. Ask the observers, “What could the trainee say now?” Ask the trainee to continue the simulation using these suggestions.

3. If the performer over-reacts or acts like a clown: Pause the simulation and remind the performer of his/her role.

4. If the simulation is too long: Stop the simulation at 10 minutes. Move to the discussion questions.

After the simulation (5 minutes)

? Ask the observers: • What good ideas (or techniques) did the trainee use during the

simulation? • What other ideas (or techniques) could they have used?

57

? Ask the trainee: • What other ideas (or techniques) did you try (that were not mentioned)?

Next, work in pairs. Explain the performer and trainee rules to the group. Ask youth who have not been a trainee, to do the simulation with a partner. Observe the pairs; coach those who are having difficulties. After 5 - 10 minutes, ask the pairs to switch roles until everyone has had a chance to be a trainee. For 90-minute sessions: Do as many group simulations as possible; spend the last 20 minutes working in pairs until everyone has been a trainee.

Making Commitments: 5 (or 10 minutes)

? What new things did you learn about communicating your relationship boundaries? Encourage discussion. Review the techniques that they discovered during the simulation to help them communicate relationship boundaries. For 90-minute sessions:

? When is the best time to choose your boundaries? Response: Choose your relationship boundaries before you begin a relationship. If you are already in a relationship, choose boundaries and talk about them with your partner. Encourage youth if they have not decided on their (personal) relationship boundaries, to think about them today and commit to communicating them. Now we have a chance to make the third commitment for healthy relationships. Remember, making a commitment doesn’t mean you have mastered all of the skills in communicating your relationship boundaries. It means that you realize the importance of the skill, and are committed to using the skill in your life. Some of you might not be ready to make this commitment today. You can decide to make this commitment at our next session if that would make you more comfortable. Explain to the youth that you will read through each commitment in order (Commitment 1, Commitment 2, and Commitment 3), pausing after each one. Those who have already made a commitment - or want to make a new commitment – should stand when that commitment is read and repeat the statement after you in unison. Those who are not ready to make a specific commitment should sit quietly while that statement is read.

Commitments: I will continue to communicate with confidence. I will continue to use the steps for good decision making. I will continue to communicate my relationship boundaries. Congratulate those who have committed to the first three skills for healthy relationships. Ask for a round of applause! Ask those who have made a new commitment to write their names on the Skills for Healthy Relationships’ picture near the stone that represents this commitment. Encourage everyone to use these skills in their life.

58

59

Session 9 ● Overcoming Obstacles to Abstinence [Skill 4]

Notes to the Facilitator "No man knows how bad he is until he has tried very hard to be good… A silly idea is current that good people do not know what temptation means. This is an obvious lie. Only those who try to resist temptation know how strong it is. After all, you find out the strength of an army by fighting against it, not by giving in. You find out the strength of a wind by trying to walk against it, not by lying down… We never find out the strength of the evil impulse inside us until we try to fight it.” – C.S. Lewis 2 The goal of this session is to openly discuss the things that make maintaining a commitment to abstinence difficult. The decisions and choices that we make every hour of every day can either help us to keep our commitment or make it more difficult. We are also impacted by the decisions and choices of those around us. By discussing these challenges and obstacles, this session will give youth the tools to make better choices and be more alert to the temptations around them. Like the quote says above, making commitments may be an easy task - maintaining those commitments becomes harder with time. This session will also encourage persistence in keeping up the fight! During this learning session youth will: 1. Identify obstacles that make it difficult to remain abstinent. 2. Identify ways to overcome or avoid these obstacles. 3. Discuss ways in which drug and alcohol abuse increases the risk for HIV infection. 4. Discuss (and discover) new ways to communicate a decision to others. 5. Have an opportunity to make a commitment to Skill 4: I will continue to avoid the

people, places and things that make healthy relationships difficult. 6. Have an opportunity to make new commitments to Skills 1, 2 and 3. Values, Attitudes and Beliefs strengthened through this session: 7. Strength is found in overcoming obstacles, not allowing them to overpower you. Materials needed: • Three blindfolds (or scarves) and any other items that you will need for the Warm

Up Game • Posttest for each youth

Activities: 60-minute format 90-minute format Review: -------------- 10 minutes Warm Up Game: 10 minutes -------------- Story and Discussion: 35 minutes 35 minutes HIV Facts: -------------- 10 minutes Reflection Verse (optional): (2 minutes) (2 minutes) Simulations: -------------- 20 minutes Making Commitments: 15 minutes 15 minutes

60

If you choose to add the Reflection Verse (optional), decrease the time for one of the other activities by 2 minutes.

For 90-minute sessions only ⎯ Review: 10 minutes Opening Prayer (optional) We have already practiced four of the Skills for Healthy Relationships. At our last session, we practiced communicating relationship boundaries.

? How many of you have used this skill since our last meeting? How did the simulation help you to respond? Encourage discussion.

? What struggles have you faced keeping your commitments? How have you overcome these struggles?

Warm Up Game: 10 minutes For the 90-minute format, skip the warm Up Game so you can spend more time doing simulations. Jumbling the Senses3: Ask for three volunteers. Blindfold the volunteers one at a time and assign each one a task. For example, pick up a set of keys from a table, draw a picture on the blackboard, or hop across the room on one leg. Before the volunteers start their task, turn them around several times in a circle. Then, tell them to begin. Be careful about safety. Turning participants in circles will make them dizzy and unsteady. Make sure that they do not hurt themselves.

? After they have finished, ask the group: Was the task itself difficult? Response: No, picking up keys or drawing a picture is not difficult. However, being blindfolded and turning in a circle made the task hard to complete.

? How did the “turning in a circle” affect the volunteers’ ability to complete the task? Response: It affected their balance, making it difficult to walk and complete the task. In today’s session we will focus on overcoming the things that make it difficult to keep our commitments. We will begin with a story. Listen and identify the things in this boy’s life that are going to make it difficult for him to keep a commitment to abstinence.

Story Telling and Discussion: 35 minutes Change the boy’s name to a common name in the local language. Be sure to use the same name in the pre and posttest questions for this session.

61

Story: Zimba stayed after school to play soccer with his schoolmates, as he does on most school days. When it began to get dark, he said goodbye to his friends and started walking. As he walked, he thought about the day… Some of the boys on the soccer team had found some cigarettes. Zimba never smoked a cigarette. Sometimes he heard his older brother talking about smoking and how it made him feel like a man. Zimba imagined himself smoking with his friends. Maybe that pretty girl from school would walk by. In his mind, Zimba imagined the pretty girl admiring him. Zimba imagined her thinking how much older and wiser he looked with a cigarette in his hand. Maybe my brother is right, Zimba thought to himself. Maybe the girls would treat me more like a man if I smoked. But Zimba didn’t have time today to try smoking. He had to go home. Zimba turned the corner and chose the path towards the restaurant. He could hear the sweet sound of the woman’s voice, who often stood on the corner. She did not seem to be wearing enough clothing. It made Zimba nervous and excited. He liked to look at her. She always smiled and made comments about his body. Sometimes she invited him into her room. Zimba imagined sleeping with her. It made him feel good inside. But he quickly stopped his thoughts. Zimba knew that she slept with many men. He knew that HIV was transmitted by sex workers, so he reminded himself to look away. He continued walking and tried to think of other things… He passed a group of older youth that he knew from school. It was getting dark and he could not see exactly what they were doing. However, he could hear them clearly. They must be drinking, Zimba thought. They were saying things out loud that people do not usually say in public. He also heard girls giggling and laughing. He stopped walking and tried to identify their faces in the dark. One of the boys saw Zimba and called him over. They were drinking local alcohol. Zimba tried some. It did not taste too good, but he smiled anyway. He liked being with these older boys. It made him feel important. He decided to stay for a while. Soon his mind began to grow unclear and he began leaning against the girl sitting near him. She smelled good. He liked sitting next to her. He touched her arm and she did not pull away. Zimba started laughing. Everything seemed funny now. He was not thinking about walking home anymore. He was just doing what everyone else was doing and progressively getting closer to the nice smelling girl sitting next to him. Ask a volunteer to summarize the story. Explain: Every day we make small decisions about what we look at, what we think about, what we say, and what we do. Each one of these decisions can make it easier or more difficult for us to make and keep our commitments. We are also affected by decisions that are made by the people around us. Sometimes the decisions of our parents, friends or extended family make it easier or more difficult for us to keep our commitments. Let us consider Zimba’s walk home.

? What are the some of the things in this story that might make it difficult for Zimba to keep a commitment to abstinence?

62

Allow youth to respond. Add any of the following points that are not mentioned. • He is easily influenced by his friends (peer pressure). • He has a long walk home every night; this makes him more vulnerable to

getting into trouble with others. • He has a brother who is not giving him good advice. • He allows himself to imagine intimacy with the street worker. • He makes poor choices – he chose to walk by the street worker knowing that

she is a temptation. • When he saw the group of youth drinking alcohol, he STOPPED to watch them

instead of moving on. • He has started drinking alcohol. He is thinking about smoking too. • He is worried about “being a man” and what that means in relationship with

girls. • It doesn’t appear that he has set any healthy relationship boundaries.

? If you were Zimba’s friend and wanted to give him WISE advice, what would you tell him to do to help him overcome these difficult things? How would you suggest he change so that it is easier for him to keep a commitment to abstinence? Possible Responses:

• He should respect himself and do what he wants to do – not allowing his friends to influence his decisions.

• He should find a friend to walk home with – someone who has also made a commitment to abstinence – so that they can help each other make good choices.

• He should find a mentor in his community who will give him good advice, instead of listening to the bad advice of his older brother.

• He should not let his mind dwell on thoughts of sexual intimacy. The more he thinks about being involved with someone in his mind (the sex worker), the easier it will be for him to act out those desires.

• He should not take the path by the street worker since he knows this is a temptation.

• When he sees youth drinking alcohol and not acting properly, he should move away (run if necessary) from the situation, and not stop to watch.

• He should avoid alcohol and drugs because these things keep him from making wise decisions – they cloud the mind.

• He should change the way he THINKS. Being a man is not about smoking or having sex, it is about being wise and making wise choices. He should be proud of his ability and strength to choose wisely and not be swayed by temptation.

• He should set healthy boundaries and keep them. • (optional) He should ask God to help him keep his commitment instead of

relying on his own strength.

? What are some of the obstacles that we face that make it difficult to avoid having sex? Responses may include: peer pressure, alcohol, drugs, temptation, lust, and desire.

63

? How would you suggest that we overcome these obstacles? Encourage discussion. Some responses may include: having a friend to help us avoid difficult things, and learning to avoid people, things, and places that make healthy choices difficult.

For 90-minute sessions only ⎯ HIV Facts: 10 minutes It is very possible that youth will experiment with drugs and alcohol. One drink or one experimental moment of drug use is not the same as abuse. Substance (drug and alcohol) abuse means that the youth takes drugs or alcohol regularly, and it has already begun to affect their life and actions. Some youth may not understand the connection between substance abuse and HIV. Use the discussion questions below to raise awareness of the consequences of substance abuse.

? Youth who regularly abuse drugs and alcohol4 are at a higher risk for HIV infection. What are some of the reasons for this? Allow youth to respond. Add any of the following points that are not mentioned: • Youth who abuse drugs start having sex at a younger age than others. • Because they are having sex earlier, they also have more partners than if they

started sex at a later age. More partners means a higher risk of being exposed to sexually transmitted infections including HIV. STIs increase the risk of HIV infection.

• Youth who abuse alcohol and drugs are more likely to have risky sex since the drugs and alcohol keep them from thinking clearly. (Risky sex includes sex without a condom, sex with a prostitute, and anal sex. Risky sex has a high risk of transmission if your partner is infected.)

• People using drugs and alcohol are more likely to be forced or coerced into sexual activities.

• Drugs and alcohol become addictive with time; some youth use transactional sex to obtain the money that they need for drugs and alcohol. Transactional sex is a high risk behavior.

Youth who regularly abuse alcohol and drugs are more likely to have poor school performance, miss more days of school and even drop out of school. In order to have healthy relationships, we need to avoid the things that put us at risk. If we avoid these things, it will make it easier for us to keep our commitments and have healthy relationships.

Reflection Verse (optional): 2 minutes 1 Corinthians 10:13 “No temptation has seized you except what is common to man. And God is faithful; he will not let you be tempted beyond what you can bear. But when you are tempted, he will also provide a way out so that you can stand up under it.”

64

For 90-minute sessions only ⎯ Simulations: 20 minutes Here is an exercise to help you practice avoiding the people, places and things that make healthy relationships difficult. This is skill number four of the Skills for Healthy Relationships. Work with a partner to practice avoiding the difficult things. In the first round one of you will be the trainee. After 5 minutes, switch roles with your partner. Explain the performer and trainee rules to the group. Observe the pairs; coach those who are having difficulties.

1. Explain the situation to the trainee: You are walking with your friends. They decide to go to [a place] that you have decided you will avoid. Instruct the trainee to identify a place and tell it to their partner.

2. Remind the trainee: During the simulation, be yourself. Respond as if the situation was real. You may want to use some of the following ideas and techniques: • Try to persuade your friends to go somewhere else or do something

different. • Tell them firmly that you will not go. • If necessary, explain the reasons for not wanting to go to this place.

However, you are not required to explain the reasons behind every choice that you make. Sometimes the easiest thing to do is to state your opinion and move away from the situation.

• (If culturally appropriate) Make up an excuse about having something else to do. It’s always better to tell the truth, but it’s better to make up an excuse than to do something you will regret later.

• Use these or any other ideas to avoid going with your friends.

1. Explain the situation to the performers: Begin the simulation by talking about the place. Try to persuade the trainee to join you. Continue arguing with the trainee until they make their decision very clear and it is obvious they will not come with you. Then, talk about something else. Do not show anger or negative emotions toward the person after they have made their decision clear. End the simulation.

2. Remind the performers: Do not overreact; make the simulation as REAL AS POSSIBLE. Do not do things that are very strange or unlikely to happen in this community. We want the trainee to learn how to use this skill in a life-like situation.

After the simulations are finished (5 minutes),

? Ask the group • What good ideas (or techniques) did the trainees use during the simulation? • What new things have you learned about avoiding people, places and things

that make healthy relationships difficult? • How can you use this skill in your life?

65

Making Commitments: 15 minutes Not only do we need to avoid certain things, but we also need to fill our free time with good and useful activities. Plan activities with your friends that are good for you (sports, helping people in the community, learning a new trade). Keep your hands busy! Be active. Set goals. Learn! The more you fill your life with useful and good activities, the easier it will be to avoid the things that make healthy choices difficult.

? What are some “healthy” activities that you like to do? Encourage discussion. Now we have a chance to make the fourth commitment for healthy relationships. Remember, making a commitment doesn’t mean you are able to avoid everything. It means that you realize the importance of the skill, have chosen a few things (people, places or things) that you want to avoid, and are committed to avoiding those things. As you continue practicing, it will become easier. Some of you might not be ready to make a commitment today. You can decide to make this commitment at the next session if you need more time to think about it. Explain to the youth that you will read through each commitment in order (Commitment 1, Commitment 2, and Commitment 3... etc.), pausing after each one. Those who have already made a commitment - or want to make a new commitment – should stand when that statement is read and repeat the commitment after you in unison. Those who are not ready to make a specific commitment should sit quietly while that statement is read. Commitments: I will continue to communicate with confidence. I will continue to use the steps for good decision making. I will continue to communicate my relationship boundaries. I will continue to avoid the people, places and things that make healthy relationships difficult. Congratulate those who have committed to the first four skills for healthy relationships. Ask for a round of applause! Ask those who have made a new commitment to write their names on the Skills for Healthy Relationships’ picture near the stone that represents this commitment. Encourage everyone to use these skills in their life. Reminder! Give a posttest to the youth to ensure that they have learned all of the material. Use the questions listed at the end of this manual for Sessions 7-9.

67

Session 10 ● I Am Able! Notes to the Facilitator

One of the eight behavioral determinants identified in Barrier Analysis12 is perceived self-efficacy. Perceived self-efficacy is whether or not you believe that you are capable of performing a certain behavior. Self-efficacy is the belief (whether or not accurate) that you have the power to do it. The goal of this session is to build up youth’s confidence that they can accomplish the healthy behavioral goals that they plan to make in the next session. This confidence is echoed in the phrase, “I am able!” During this learning session youth will: 1. Review the HIV Facts from previous sessions. 2. Identify goals that they have already achieved. 3. Rate their confidence in their ability to be abstinence (self-efficacy). 4. Identify reasons why they are confident they can achieve their goals. 5. Rate the importance of abstinence to them. 6. Rate how vulnerable they feel to HIV infection (perceived susceptibility). Values, Attitudes and Beliefs strengthened through this session: 5. I am capable of achieving the things that I set my mind to do. 6. My gifts, self control, and discipline will help me to overcome the challenges I face. Materials needed: none Activities: 60-minute format 90-minute format Review: -------------- 10 minutes Warm Up Game: -------------- 15 minutes Story and Discussion: 40 minutes 40 minutes The Ruler Exercise 15 minutes 15 minutes Reflection Verse (optional): (2 minutes) (2 minutes) Review and Reinforcement: 5 minutes 10 minutes If you choose to add the Reflection Verse (optional), decrease the time for one of the other activities by 2 minutes.

12 See http://barrieranalysis.fhi.net/ for more information.

68

For 90-minute sessions only ⎯ Review: 10 minutes Opening Prayer (optional) We have practiced four of the Skills for Healthy Relationships. During the last session, we discussed overcoming obstacles to abstinence.

? How many of you have identified difficult things that you need to avoid? How many of you were successful at avoiding at least one of the things on your list? Encourage discussion. Praise youth who have been successful at avoiding difficult things.

? What are some of the benefits that you have received from meeting regularly with your mentor? Reinforce the positive responses that you hear from youth. For 90-minute sessions only ⎯ Warm Up Game: 15 minutes This game is a quick review of many of the topics from Choose Life. Preparation: Write the following names on small pieces of paper - one name on each piece of paper. Make sure that you have enough names so that each person in your group will receive one piece of paper. You may also add a first name (using a familiar local name) to make the couples sound more realistic. Names: Mr. Abstinence, Mrs. Abstinence, Mr. Faithfulness, Mrs. Faithfulness, Mr. Condom, Mrs. Condom, Mr. Self Respect, Mrs. Self Respect, Mr. Good Communication, Mrs. Good Communication, Mr. STI, Mrs. STI, Mr. Youth, Mrs. Youth, Mr. VCT, Mrs. VCT, Mr. Alcohol, Mrs. Alcohol, etc. Add others names as needed. Directions for Mr. and Mrs.: Give each youth a piece of paper with one name on it. They must find their match (each Mr. is looking for the Mrs. with the same last name). Once they find their match, they must say two things about their names that relate to HIV prevention. Tell them to consider the HIV facts they have learned from the previous sessions. Read the following example: Mr. and Mrs. Choose Life 1) Choose Life helps youth to know how to protect themselves from HIV infection. 2) Choose Life helps youth to teach others about HIV. Give them a few minutes to find their match and discuss with their partner. Then ask them to present their answers to the rest of the group. Allow the group to reward the Mr. and Mrs. pair with cheering if they respond with good answers. Ask the group to give alternative answers if they feel the given answers are not strong enough. Responses may include: Mr. and Mrs. Abstinence

1. Abstinence is 100% effective in preventing sexually-transmitted HIV. 2. Abstinence protects against STIs that promote the spread of HIV.

69

Mr. and Mrs. Faithfulness 1. Mutual faithfulness is the best way for a married couple to prevent sexually

transmitted HIV. 2. Sticking to one partner and not having multiple partners decreases the risks of

HIV for youth. Mr. and Mrs. Condom

1. Condoms are 80-95% effective in preventing HIV. 2. Condoms should be used correctly and consistently every time you have sex

for HIV prevention. Mr. and Mrs. Self Respect

1. Self respect gives youth the ability to make their own decisions about when they will have sex.

2. Youth with self respect are less likely to be coerced or persuaded by others to have sex against their will.

Mr. and Mrs. Communication 1. Good communication allows youth to share HIV prevention methods with

others. It saves lives. 2. Good communication strengthens relationships so that you can talk with your

marriage partner or others about your concerns or desires to protect yourself from STI and HIV infections.

Mr. and Mrs. STI 1. STIs increase the risk of getting an HIV infection from others. 2. STIs increase the risk of transmitting HIV to others.

Mr. and Mrs. Youth 1. Children and youth are more likely to be coerced or forced into sexual activity

against their will, which increases their risk of HIV infection. 2. More than half of all new HIV infections happen to youth under the age of 25.

Mr. and Mrs. VCT 1. A VCT clinic provides testing so that someone can know their HIV status. 2. A VCT clinic also provides counseling so that you will know how to deal with

the results of your test and protect yourself – whatever the result. Mr. and Mrs. Alcohol

1. Alcohol increases the chances that someone might become involved in a high-risk sexual activity, which increases the risk of HIV transmission.

2. Addiction to alcohol may cause some youth to start having sex earlier, which increases the chances that they will be exposed to HIV before marriage.

Story and Discussion: 40 minutes

Today we are talking about the ability to set and achieve the goals that you choose for yourself. Some of us are very good at setting goals and achieving them. Others of us have difficulty believing in ourselves, and may not reach our goals because of self-doubt. Let us think about some of the goals that you have already reached. It can be as simple as making it to school on time, or remembering to buy something at the store for your mother, or it could be a serious goal, like helping your family save enough money to purchase medicine for a relative. Each person should share two goals that you have set and achieved in the last year.

70

Allow everyone to share. Give positive reinforcements to the youth as they share their success stories. Sometimes we set goals that are “against all odds” - a goal that others perceive as impossible or too difficult to achieve. People may think we are crazy, but because of our perseverance and belief in ourselves, we are able to achieve the impossible.

? Who can share a story of a goal that you achieved “against all odds”? Allow youth to share stories. Give positive encouragement and reinforce the reasons the youth mention that enabled them to achieve these goals. Today we are discussing our perception (or belief) in our ability to achieve our goals. Why is this important? As we consider making a commitment to abstinence, or any other healthy sexual behavior, the way that we THINK (our perception of whether we will reach these goals) has an impact on whether we will get there. The following is a story about a famous American woman who had no reason to believe that she would succeed, but did! Curriculum committees may substitute a local or national success story for greater impact. Begin by reading the following quotations by Oprah Winfrey:

"All my life I have always known I was born to greatness." 5

“You become what you believe. You are where you are today in your life based on everything you have believed.” 6

Story: Oprah Winfrey was born in 1954, to a poor, unmarried black couple in the USA. Her mother meant to name her after the Biblical character of Orpah but misspelled the name on her birth certificate, and soon everyone was calling her Oprah.7 Her parents stopped living together when she was very young and she spent the first years of her life with her grandmother living on a farm. At the age of six, she was sent to live with her mother. In her mother’s home, she was sexually abused by her family members for several years. This abuse traumatized Oprah and she tried to run away from home at the age of 13.8 She was found, and sent to live with her father. She gave birth to a baby boy at age 14. The baby died two weeks later. Winfrey confessed to her father that she had been experimenting with drugs and sex and asked for his advice. He insisted that hard work and discipline were the only routes to success. Oprah refocused her life and won a scholarship to go to college. She worked as radio announcer during her studies, and later became a TV reporter and then TV news anchor. This was just the beginning of her rise to fame. Today, Oprah Winfrey is the most successful woman in television history. She has her own weekly TV show, watched by 48 million people in the US each week.9 She produces her own magazine, has acted in plays and film, and has received numerous business and performance awards. Her influence in the US is unmatched. In fact, a

71

US magazine has named her one of the 100 Most Influential People of the 20th Century. In 2003, Forbes magazine published its list of America's billionaires for the year. Oprah Winfrey was listed as the first female, African-American billionaire. Ask a volunteer to repeat the main points in the story and then ask the following questions:

? What enabled Oprah to succeed in life? Response: She believed in herself, and was confident that she could accomplish her goals. Her father insisted that she develop the skills of hard work and persistence. She was also given support (emotional and social support) by her father and a “scholarship” which gave her the finances she needed to attend college.

? How did Oprah’s self-perception enable her to succeed? Response: It gave her confidence (she believed she could make it). It enabled her to be persistent, even when her life was difficult. Some may think that making a commitment to abstinence, or any other healthy sexual behavior, is an “against all odds” commitment. Often it is difficult to make a commitment about sexual behaviors. There are external factors that may influence our sexual behavior (poverty, lack of family support, or our culture), but there are also internal factors that influence our choices. One of these factors is our belief in our ability to achieve our goals. We learned in Session 1 about respecting yourself and identifying your values and strengths. Not only do we need to believe in WHO we are, but we also need to believe in WHAT WE CAN ACCOMPLISH! Remember the Ruler Exercise which we used many weeks ago to measure how we felt about abstinence? We are going to measure our feelings about abstinence again today, and see if our discussions have changed the way you feel.

The Ruler Exercise: 15 minutes If you have a mixed group (boys and girls), or the youth are less wiling to share, ask youth to write their numbers on a piece of paper for the Leader Youth to see. After the Leader Youth looks at everyone’s numbers, the LY can give a summary such as, “Your confidence has increased; I saw many 5s and 6s.” Then continue with the paragraph at the end of the exercise. Make a line on the floor or on the chalkboard. At one end of the line, write “High.” At the other end of the line, write “Low.” You can also use the numbers 1 to 5.

? How confident are you in your ability to be abstinent (until marriage)? That is, if you decided to be abstinent, would you be able to do it? Remember, I want to know what you really feel about your confidence level. There are no “wrong” answers in this exercise.

Low High 1 2 3 4 5

72

You may substitute “abstinent” in the question above with “temporary abstinent” or “delay sex until you finish school,” or “use condoms correctly and consistently” depending upon the commitments that you perceive the group will choose in the coming weeks. The goal of this exercise is to encourage even those with “a little confidence” and help them to verbalize positive reasons. Do not make youth who have low confidence feel bad. This is not a time to teach or lecture; just listen. We want to know how youth really feel about abstinence. Ask the youth to stand on the line (or to write their name on the blackboard where the line is drawn) to show their level of confidence in being abstinent.

? (Choose one person with a number greater than 1) and say: You have [a little, some, a lot of] confidence that you could be abstinent if you wanted to. Why is it that you have this confidence? Why is it that you are higher than the numbers behind you? (Mention the numbers lower than the place where they are standing.) Be sure the person responds to your question - not why they do not have confidence, but why they have [a little, some, or a lot of] confidence. Ask two more youth (with numbers greater than 1) why they feel they have more confidence than the numbers behind them (1, 2, etc). Summarize the things the youth have said. Here are some others reasons why you can feel confident that you can reach your goals. Add any of the following responses that were not mentioned.

• I do not let others (or my circumstances) discourage me. • I am able, because I respect myself. • I have friends who support me. • I have already learned many skills which will help me to keep my relationship

commitment. • I spend time with people who believe in me. • I am persistent and work hard to keep the goals that I have set. • I remember my past success. I have written them down and read them when I

am feeling discouraged. • (optional) I trust in God and know that He will empower me to reach my goals. • (optional) I pray for strength to keep my commitment.

Let’s review our other two measures.

? How important is abstinence (until marriage) for you? Remember I want to know what you really think. Ask the youth to stand on the line (or to write their name on the blackboard where the line is drawn) to show their level of importance.

73

? (Choose one person with a number greater than 1) and say: You think that abstinence is [a little, somewhat or very] important to you. Why do you think this way? Why is abstinence more important than the numbers behind you? (Mention the numbers lower than the place where they are standing.) Ask two more youth (with numbers greater than 1) the reasons why abstinence is more important than the numbers behind them (1, 2, etc). Summarize the things that the youth have said.

? Finally, we will measure vulnerability. Do you think that it’s possible that you could get HIV if you had sex without using a condom? Number 5 means that it is very possible. Number 1 means that you don’t think it is possible. Remember it doesn’t matter if you are having sex or not. We are only asking IF you were to have sex, if you think it is possible that you could get HIV. Ask the youth to stand on the line (or to write their name on the blackboard where the line is drawn) to show the level of possibility (high or low) that they feel.

? (Choose one person with a number greater than 1) and say: You feel that there is a [low, medium or high] possibility of getting HIV if you were to have sex without a condom. Why do you feel this way? Why do you feel that the possibility of infection is greater than the numbers behind you? (Mention the numbers lower than the place where they are standing.) Ask two more youth (with numbers greater than 1) why they feel that there is a [low, medium or high] possibility of getting HIV. Summarize the things that the youth have said.

? How have your responses changed since the last time that we measured confidence? Encourage discussion. Reinforce the improvements that youth have seen in their confidence. Remind everyone that learning new skills and committing to using them, can make abstinence easier for us.

Reflection Verse (optional): 2 minutes Philippians 4:13 “I can do everything through him who gives me strength. “

Review and Reinforcement: 5 (or 10 minutes) For 90-minute sessions:

? What did you learn today that will help you in the coming week? Encourage discussion. Reinforce the positive things that the youth mention.

74

Take Action: Ask each youth to develop a short story about their life ten years into the future. Have them assume that they were abstinent before they were married, and tell how their lives have turned out because of that decision. Encourage the youth to be creative in how they tell the story. One idea is that they could write a letter (assuming they are 10 years older than they are today) to one of their children about their decision and how it affected their life. Another idea is for youth to tell a story (assuming they are 10 years older than they are today) comparing themselves to a neighbor who was not abstinent. Tell the students that they should be prepared to read, or verbally share their story at the next session. Remind the group to continue meeting with their mentors. Closing Prayer (optional)

75

Session 11 ● Right to Say “No” to Sexual Advances

Notes to the Facilitator Many youth are made more vulnerable to HIV by the power differences and gender relationships that affect their sexuality. Many assume that youth who have had sex, choose it on their own. However, studies show that much of the sex that is happening is not consensual or wanted. From a recent study in Kenya, it was noted that girls who were coerced reported that they had been “deceived or tricked into having sex.” Many reported their partner’s insistence or “not taking no” for an answer.”10 In this session,11 youth will gain an understanding of how their actions might cause someone else to feel vulnerable or uncomfortable. Youth will also learn skills to be more assertive and respond appropriately to avoid unwanted advances. During this learning session youth will: 1. Define and discuss what it means to give consent to physical touch. 2. Gain understanding that they have the right to turn down physical or sexual

advances that make them feel uncomfortable. 3. Define inappropriate and appropriate behavior in specific stories. Values, Attitudes and Beliefs strengthened through this session: 4. I will respect the desires and needs of others. 5. I value my body and will not let others take advantage of it. Materials needed: none Activities: 60-minute format 90-minute format Review: 10 minutes 15 minutes Presentation and Discussion: 20 minutes 20 minutes Stories and Discussion: 25 minutes 25 minutes Life Skills Activity: -------------- 20 minutes Reflection Verse (optional): (2 minutes) (2 minutes) Review and Reinforcement: 5 minutes 10 minutes If you choose to add the Reflection Verse (optional), decrease the time for one of the other activities by 2 minutes.

76

Review: 10 (or 15 minutes) Opening Prayer (optional) Take Action: Ask two or three youth to share the stories that they wrote. Reinforce the positive things that youth mention that happened because of their commitments. If most of the youth want to share their stories, ask the youth to share their story with a partner. After everyone has shared and listened to someone else’s story, ask the group to mention some of the good things that happened as a result of abstinence. Summarize what the youth share and move to the next section.

Presentation and Discussion: 20 minutes

? We are going to start by talking about the word “consent.” Who can tell me what this word (consent) means? Responses might include: agreement to do something or saying ‘yes’ When you are in a relationship often you have expectations as to how your partner will act and what you will do together. Sometimes, your expectations are not the same as your partner. In fact, your partner may do things that make you feel uncomfortable. For example, each partner has the right to be touched only in ways that he or she chooses. If a person wants to be touched in a certain way, he or she can give his or her consent. If the person does not want to be touched, he or she has the right to say, “no.” This applies to people in a relationship. The same “right” applies to people in our families and people that we in the community. Physical contact between any two people must be mutually acceptable. A person has a right to say “no” to any form of physical or sexual contact that makes them feel uncomfortable. Note to promoter – if there are specific laws that support these rights in your country, be sure to talk to the Youth Leaders about this and have them explain this right to the youth in their groups.

? How do you know if someone is giving consent? Response: Only if someone says yes with words. If you use body language or make a guess, you do not KNOW for certain. Body language is not enough. Sometimes a person might respond for reasons other than pleasure or desire. The person might feel that this is what he or she is supposed to do, even though it does not feel good. A person might feel too afraid, shy, or embarrassed to say “no,” so they say nothing. If you assume that someone is giving consent because they don’t say anything, you may be wrong. Here are some important things to remember about consent:

• Both partners must want and freely choose the touching (or kissing). Ask your partner by saying “Is this okay?” or “Are you okay?” Asking your partner can also increase trust. However, if you ask the question, you must be willing to

77

accept “no” for an answer. • Tell your partner if you are not comfortable with the touching that is going on

and walk away if you need to. • A person cannot give true consent when he or she has had too much to drink

or has passed out. It is never right to touch someone sexually who is unable to respond appropriately.

• Even if you and your partner have decided to be abstinent, this does not mean that all other activities are acceptable and desired by your partner. We need to be sensitive to each other’s needs and not pressure others to do things that make them uncomfortable.

Stories and Discussion: 25 minutes

If you are teaching in a religious setting, you may read the historical account of Tamar instead. See the Story and Discussion (Option 2) below. Choose the story (or stories) that are best for your youth. I am going to read you two stories about youth in different situations. Listen to the stories. We will decide together whether we think the characters have given consent, or are being pressured to do something. Choose two of the following stories for discussion. Choose the stories which are most relevant to youth in your area. Remember: do not read the responses to the youth. Encourage discussion. Add any of the remaining responses that they do not mention. Story 1 - Tadesse and the neighbor Story: Tadesse returned home from school one day to find that his parents had gone out for the evening. The neighbor was staying over to watch Tadesse and his little sister while his parents were away. Tadesse was washing himself when the woman from next door took off her clothes and approached Tadesse. Tadesse did not know what to do. He stood there paralyzed. She said to him, "What are you standing there for? Be a real man and make love to me.” Tadesse had sex with her. Afterwards, he felt strange, and did not know if he should tell anyone.

? Did Tadesse give consent? Response: No. He felt pressured by the situation to do what the neighbor asked. Add other culturally appropriate responses.

? Why do you think he had sex with her if he did not really want to? Response: Perhaps he was shamed into having sex with her. She made him feel like this is what a real man would do. Add other culturally appropriate responses. Story 2 - James and Mary Story: Mary went to a party and wore her favorite dress. She had made a vow to remain abstinent and was doing her best to keep her commitment. She ran into James at the party and they began talking on the couch. Pretty soon, James had his

78

hand on Mary’s leg. He told Mary that he was proud of her for choosing to be abstinent, and for that reason he was not going to try to push her to do something she did not want to do. However, as he spoke, his hand kept moving further up Mary’s leg. When she tried to get up, he pulled her back onto the couch and told her he did not understand why she was getting upset since he was not doing anything wrong.

? What was James doing that upset Mary? Response: He was touching her leg and she did not feel comfortable with this.

? What should Mary have done to change the situation? Response: She should have told James that she felt uncomfortable with what he was doing. She should have grabbed his hand and pushed it away. Add other culturally appropriate responses.

? What do you think James should have done differently? Response: When he saw that Mary was feeling uncomfortable, he should have immediately pulled his hand away and asked her what was wrong. He should not have assumed that he could touch Mary in this way. Add other culturally appropriate responses. Story 3 - Abebe and Meseret Story: Abebe and Meseret are boyfriend and girlfriend. They have been friends for a long time. They have decided to be abstinent. However, one afternoon Abebe suggests to Meseret that they lie in bed together. Meseret laughs nervously and says no. Meseret thinks that this would be a temptation to have sex with Abebe and she does not want to do it, but she does not say this out loud. Abebe tells her that if she really cares for him, she will do it. Meseret laughs again and says no several times, but it is hard to hear her response because of her nervous laughing. She turns to walk away, but Abebe proceeds to pull her into the bedroom. “It will be OK.” Abebe says, “It will be OK.”

? Did Abebe have a right to take Meseret into the bedroom? Response: No. Even though they were good friends, Abebe does not have the right to make Meseret do what he wants her to do. Meseret told him “no” several times. She also tried to walk away from him, but he pressured her into doing what he wanted.

? Why would Meseret go if she really did not want to? Response: Maybe she really cares about Abebe and did not want to make him unhappy. Maybe she did not know how to say “no” in a way that Abebe would understand. Add other culturally relevant responses.

? What was wrong with the way the Meseret responded to Abebe?

79

Response: She was saying “no,” but her laughter did not make it clear to Abebe that she really meant “no.” Meseret should have said “no” in a strong voice and stopped laughing so that Abebe knew that she was serious. Story 4 – Elizabeth at the market Story: Elizabeth walked quickly down the path. Her mother had sent her to the market to get some ingredients for the evening meal. She was in a hurry as she knew there was not much time to prepare. At the market stall she tells the clerk all of the items that she needs. One by one, he puts them onto the counter. When everything is ready, Elizabeth slides her hand into her pocket, and finds two bills and the frayed edge of a hole where her coins have slipped out. She looks frantically around her to see if the coins have fallen near the stall, but there are no coins in sight. “What is wrong?” The clerk asks. She does not answer but begins to calculate which of the items she will have to go without. She also begins to worry about her return home. She knows that her mother will not be happy about the lost coins, nor the items that she will have to go without, and there will be punishment for that. The clerk can see her unease. He stares at her for a long time. ‘I will do you a favor,” he says reaching over the counter and stroking her arm. “I will let you have all of the ingredients that you need.” She looks up at him eager to take his offer, but knows from the hand on her arm that he has something else in mind.

? What do you think the clerk at the market wants from Elizabeth? Responses may vary. The text does not say specifically what he wants. Encourage discussion.

? Does the clerk at market have the right to touch the customers? Response: No.

? What should Elizabeth do? Responses may vary: She could pull her arm away and tell him assertively that she is not interested in his favors. She could buy her food at a different place. She should walk away quickly. Add other socially appropriate responses. Story 5 – Paying Rent Story: John was talking in the courtyard with his friends when the landlord’s wife signaled for him. He did not like the landlord nor his wife very much. John’s parents had asked for an extension on this month’s rent, and the landlord was threatening to throw them out if they did not pay on time. Yet, the landlord’s wife had been really nice to John lately. She had been asking him for small favors. John hoped that by doing these favors, the landlord would give his family the rent extension they needed.

80

“We really don’t want to give your apartment to someone else,” she said just as John stepped inside her door. "But we have bills to pay too. I'm sorry, but this will be the last week for your family in the apartment.” She paused and watched the fear sweep across John's face. The landlord's wife closed the door behind him. “Unless of course you could do me one last favor.” She approached John now and stood within inches of his face. He could smell the alcohol on her breath. He began to step back, but she moved closer again. He was trapped against the door. "My husband is out of town tonight,” she said. “Perhaps, you can keep me company while he is away and I will let your family stay.” John knew that the landlord’s wife was trying to trick him into sleeping with her, but he was also concerned about the rent. Where would his family go if they lost the apartment?

? What was the wife of the landlord suggesting? Response: She was suggesting that if John stayed the night with her, she would allow his family to have the rent extension and not send them out of the apartment.

? Does the wife of the landlord have the right to act this way towards John? Response: No

? How can John respond to the landlord so that she knows he does not consent to her closeness to him, nor the offer that she is suggesting? Responses may vary. Encourage discussion of culturally sensitive ways to be assertive and non-violent and yet respond in a way so that the woman knows that John is not interested. He should use his tone of voice, his body language and his words to say no.

Story and Discussion (Option 2): 25 minutes Story is from II Samuel 13: 1–29. You can read the story from the Bible or tell it as it is here. Story: Amnon and Tamar were brother and sister. They had the same father, King David, but different mothers. Amnon fell in love with Tamar, even though she was his half sister. He was so much in love with her that he became sick because it seemed impossible to have her. Amnon’s cousin said to him, "You are the king's son, yet day after day I see you looking sad. What's the matter?" "I'm in love with Tamar." Amnon answered. "I have an idea," his cousin said. Pretend that you are sick and go to bed. When your father comes to see you, say to him, 'Please ask my sister Tamar to come and feed me. I want her to fix the food here in my room and then serve it to me herself.”

81

This seemed like a good idea, so Amnon pretended that he was sick and went to bed. When his father came to see him, Amnon said, "Please let Tamar come and make a few cakes here where I can see her, and then serve them to me herself." So his father asked Tamar to go to Amnon's house and fix him some food. She went there and found him in bed. She made some cakes there where he could see her. Then she baked the cakes and emptied them out of the pan for him to eat, but he would not eat the cakes. Amnon sent everyone else away. Then Amnon said to Tamar, "Bring the cakes here to my bed and serve them to me yourself." She took the cakes and went over to him. As she offered them to him, he grabbed her and said, "Come to bed with me!" "No," she said. "Don't force me to do such a degrading thing! How could I ever hold up my head in public again?” But he would not listen to her, and since he was stronger than she was, he overpowered her and raped her. Then Amnon was filled with a deep hatred for her. He hated her now even more than he had loved her before. He said to her, "Get out!" "No," she answered. "To send me away like this is a greater crime than what you just did!" But Amnon would not listen. He yelled, "Get this woman out of my sight! Throw her out and lock the door!" Tamar sprinkled ashes on her head, tore the sleeves of her royal robe, and went away crying with her face buried in her hands. Ask a volunteer to repeat the main points of the story then ask the following questions:

? Did Amnon ask for consent? Response: No, he did not.

? Did Amnon have the right to force his half sister to have sex with him? Response: No. No one has the right to force someone else to have sex with them. Optional discussion questions to reinforce Divine Will

? Do you think that God was pleased with the way that Amnon behaved? Why or why not?

? Was it Tamar’s fault that she didn’t escape from Amnon? Response: No. Rape is never the victim’s (the person who was forced) fault. Sometimes it is too difficult to escape, if the person is stronger and more powerful. Tamar tried to persuade Amnon, but she could not escape. There may be times when someone we know has been raped or forced to do something that they didn’t want to do. We should never blame them, or tell them that they should have tried harder. We can learn new skills to help us, but there still may

82

be times when we are not able to escape. When this happens we need to support the victim, and help them to recover.

For 90-minute sessions only ⎯ Life Skills Activity: 20 minutes

If your group is all boys, focus on the specific responses for boy’s behavior. If your group is all girls, focus on the specific responses for the girl’s behavior.

? Who can think of some situations when saying “no!” would be a useful skill for girls AND boys your age to learn? Boys responses may include: being approached by a prostitute, at school if you are approached by a teacher or student. If an older girl or relative pressures you to do something that you do not want to do. Add other responses as appropriate. Girl responses may include: If you are alone at night and someone grabs you from behind. If your partner does not listen to you when you try to talk to them and they are doing something to hurt you. Add other culturally relevant responses.

? When a girl says “no,” how does a boy know whether she means “no” or whether she might mean “yes”? Youth may give many different answers. However, it is important to emphasize that boys should NOT try to interpret the girl’s behavior. He should listen to what she is saying. If she says no, then stop. No means no. Girls as well should not send mixed signals. Girls should say no, if they really mean yes!

? What could the girl and boy do to change their behavior to each other, so that the boy can understand when a girl says “no,” she means “no”? Encourage the participants to give specific examples of how boys and girls can behave differently. Examples might include:

• Boys need to ask for consent and wait until they get it before they move forward.

• If the boy is getting mixed signals, he should ask the girl what she wants not assume that he knows what she wants.

• Boys and girls need to communicate clearly. If they mean no, then say no. If they mean yes, then say yes.

• Boys and girls could talk about boundaries before they get too serious. • Girls should speak with confidence when saying no and not send mixed

signals (such as saying no and smiling at the same time). • Add other culturally relevant responses.

It is important to emphasize that boys and girls must take responsibility for their own actions. We should not try to blame others, but should behave as responsibly as we can. This means that the boys should not blame the girls for not being clear. Challenge the boys to think about how THEY can behave more responsibly when they interact with a girl instead of blaming the girls for the problem.

83

? Has anyone successfully turned down an unwanted advance from another person? If yes, can you describe what you did? Encourage discussion.

Other ideas the youth can use to turn down an unwanted advance: • Use the communicating with confidence techniques from Skill 1 (speaking

clearly; repeating the message if it is misunderstood, having a clear message). • Use your body to show confidence (proper eye contact, standing tall). Do not

smile or touch the person when you are speaking. • If possible, stand further away from the person (than normal) as you speak. • Use your words to say no. Be firm.

The following question is specific for girls groups. If all of the youth in your group are boys, skip to the next section. We have discussed saying “no” to people we know when we are feeling uncomfortable. There are also times when we are attacked or are in danger. In these situations, saying no is not enough.

? How can you defend yourself in situations where you feel you are in real danger? Encourage discussion. Add any of the remaining points not mentioned. • Try to escape, run towards lighted houses, crowds or busy streets. • If you can’t get away, SCREAM as loud as you can until help arrives. • Act crazy, drool, do anything you can think of to discourage them (vomit, urinate,

tell them you are menstruating). • If you think you are capable of resisting, act quickly attacking the person’s eyes or

groin with anything you can find as a weapon (fist, a stick, keys) then run as fast as you can.

In most societies, women are taught to obey men. Therefore, it is often very difficult for a girl to resist a boy even when they are in danger. But with the use of your voice, your body language, and your actions you CAN make it very clear when you need to say “no!”

Reflection Verse (optional): 2 minutes James 5:12b “Let your yes be yes and your no be no.”

Review and Reinforcement: 5 (or 10 minutes) For 90-minute sessions:

? What did you learn today that will help you in the coming week? Encourage discussion. Reinforce the positive skills and lessons that the youth mention. Take Action: Watch the people around you this week. Look for examples of people who are using their words and body language to effectively communicate saying, “no.” Closing prayer (optional)

84

85

Session 12 ● Saying no with your voice, body and actions [Skill 5] Notes to the Facilitator

During this session, youth will practice the fifth skill for healthy relationships, saying no with your voice, body and actions. By practicing with a partner, youth will gain confidence in using this skill, so that they can apply it to real life situations. By practicing, they are more likely to learn the skill, and incorporate it into their life. For male youth, “saying no” might not be as useful, as “asking for consent.” If your group is mostly male, consider focusing on asking for consent during this session. You may also talk with the youth and ask them which skill would be more helpful to them in their lives. Alter the commitment statement to reflect the new skill. More suggestions are given on the following pages. Youth have almost completed the Skills for Healthy Relationships! Encourage them as they approach the last skill. These skills will give them confidence and build self-efficacy (belief that they can be abstinent if they wanted to) so that they are more prepared for making a commitment about abstinence in Session 13. During this learning session, youth will: 1. Practice saying no with their voice, body and action (or boys may practice asking

for consent when trying something new.) 2. Discuss (and discover) new ways to say no (or ask for consent). 3. Have an opportunity to make a commitment to Skill 5: I will say no (when I need to)

with my voice, body and actions (or I will continue to ask for consent when I try something new).

4. Have an opportunity to make new commitments to Skills 1, 2, 3 and 4. Values, Attitudes and Beliefs strengthened through this session: 5. Saying no is something I can learn. If I practice I can learn to protect myself (or

asking for consent is a skill I can learn. If I practice, I will be able to use it in my life).

Materials needed: • Posttest for each youth Activities: 60-minute format 90-minute format Review: 5 minutes 10 minutes Simulations: 45 minutes 70 minutes Making Commitments: 10 minutes 10 minutes

86

Review: 5 (or 10 minutes)

? What are some of the important things we learned at our last session for about asking for consent? Encourage discussion. Mention any of the following points not mentioned.

• Both partners must want and freely choose the touching (or kissing). Ask your partner by saying “Is this okay?” or “Are you okay?” Asking your partner can also increase trust. However, if you ask the question, you must be willing to accept “no” for an answer.

• Tell your partner if you are not comfortable with the touching that is going on and walk away if you need to.

• A person cannot give true consent when he or she has had too much to drink or has passed out. It is never right to touch someone sexually who is unable to respond appropriately.

• Even if you and your partner have decided to be abstinent, this does not mean that all other activities are acceptable and desired by your partner. We need to be sensitive to each other’s needs and not pressure others to do things that make them uncomfortable.

Simulations: 45 (or 70 minutes)

Practicing the simulations below with opposite sex partners is the best way for youth to learn in a “real life” situation. However, if you have a same sex group, this is not possible. The performers will have to play the part of an opposite sex partner. If you have a mixed group (boys and girls), and only 60 minutes, you will need to decide which skill you will practice (saying no or asking for consent) and spend the whole session on that skill. For 90-minute sessions with a mixed group, you may consider doing one simulation of each and then have youth practice is pairs the skill that applies to them (boys practicing consent, girls practicing say no). (Optional) Asking for consent: Today we are going to practice the fifth skill for healthy relationships. At our last meeting (Choose Life Session 11) we talked about consent. We listened to stories and decided whether we thought consent was given. Today, we will practice asking for consent with a partner. Remember we are not talking about asking our partner to have sex; we are talking about anything new that we think might make our partner uncomfortable. Asking for consent is a way of showing respect to our partner’s needs and desires. Ask for a volunteer trainee. 1. Explain the situation to the trainee: You want to get closer (more intimate) with

your girlfriend. You are sitting next to her on a bench. 2. Remind the trainee: During the simulation, be yourself. Don’t think about the

observers; respond as if the situation was real. You may want to use some of the following ideas and techniques.

• Find an appropriate way to ask the girl what she wants. • Remember not to move ahead, without getting a verbal response. • Communicate with confidence (Skill 1).

87

• Make it clear to the performer that you need an answer. Don’t except mixed signals.

Ask for a volunteer performer. Speak to them in private (so the others can not hear). 3. Explain the situation to the performer: You are the trainee’s girlfriend. He has

been getting increasingly physical with you and you are not very comfortable with this new behavior. When the trainee talks to you about your relationship, don’t give him an answer. At first, be resistant, not responding to the trainee, or saying “I don’t know.” Try to change the subject and talk about something else. Continue until the trainee makes it clear he is waiting for an answer. Then respond with an appropriate response (depending on what he is asking) and end the simulation. If your response is no, give a reason and suggest an alternative activity.

4. Remind the performer: Do not overreact; make the simulation as REAL AS POSSIBLE. Do not do things that are very strange or unlikely to happen in this community. This is not an opportunity to make people laugh. We want the trainee to learn how to use this skill in a life-like situation.

Use the discussion questions after each simulation as written below. Saying “no” with voice body and actions: Today we are going to practice the fifth skill for healthy relationships. This skill is saying “no,” with your voice, body and actions. At our last meeting (Choose Life Session 11) we talked about consent. We listened to stories and decided whether we thought consent was given. Today, we will practice getting out of situations where there is no consent. We will practice saying no in a simulation where we are approached by an acquaintance or stranger. Ask for a volunteer trainee. Remind everyone that this exercise is to help them prepare! It may be uncomfortable to practice saying no with the opposite sex at first, but we can learn to overcome these feelings as we practice. If the youth are still uncomfortable, then allow them to work with same sex partners.

1. Explain the situation to the trainee: A family friend comes to your house. When he/she discovers that you are alone, he/she begins to touch you in a way that makes you feel uncomfortable.

2. Remind the trainee: During the simulation, be yourself. Don’t think about the observers; respond as if the situation was real. You may want to use some of the following ideas and techniques. • Use the communicating with confidence techniques from Skill 1 (speaking

clearly; repeating the message if it is misunderstood, having a clear message).

• Use your body to show confidence (proper eye contact, standing tall). Do not smile or touch the person when you are speaking.

• If possible, stand further away from the person (than normal) as you speak. • Use your words to say no. Be firm. • Discuss the consequences that will follow if they continue. • Find a way to leave the situation if you think you are in danger. If you can’t

get away, and the person is pursuing you, use your voice to scream as loud as you can until help arrives.

• Use your own ideas to get out of this situation.

88

3. Ask the trainee to explain the situation and what he/she should do. Clarify misunderstandings.

Ask for a volunteer performer. Speak to them in private (so the others can not hear).

5. Explain the situation to the performer: Greet the trainee and talk for a few minutes. While you are talking, roughly grab the trainees arm. Defend your actions. Show some anger (but not too much). Continue holding the trainee’s arm, but give them time to respond and room to escape.

6. When the trainee has done a good job using their voice, actions, and words to say no, leave the “house.”

7. Remind the performer: Do not overreact; make the simulation as REAL AS POSSIBLE. Do not do things that are very strange or unlikely to happen in this community. This is not an opportunity to make people laugh. We want the trainee to learn how to use this skill in a life-like situation.

8. Ask the performer to explain his/her role. Clarify misunderstandings.

Remind the observers to watch silently. Directions for the Facilitator: *Pay close attention to male trainees. They should not respond in an angry or violent manner. They need to react firmly, but should not do anything to harm or threaten the performer. *Give the trainee lots of positive, encouraging feedback when they communicate with confidence and show assertiveness. Observe the simulation. Do not stop the simulation unless there is a problem. 1. If the trainee is ACTING (not being themselves): Pause the simulation. Remind

the trainee to use their own ideas and skills for practice. The trainee should not try to entertain the observers.

2. If the trainee does not know what to say (for a long time): Pause the simulation. Ask the observers, “What could the trainee say now?” Ask the trainee to continue the simulation using these suggestions.

3. If the performer over-reacts or acts like a clown: Pause the simulation and remind the performer of his/her role.

4. If they simulation is too long: Stop the simulation at 10 minutes. Move to the discussion questions.

After the simulation (5 minutes)

? Ask the observers: • What good ideas (or techniques) did the trainee use during the

simulation? • What other ideas (or techniques) could they have used?

? Ask the trainee: What other ideas (or techniques) did you try (that were not mentioned)? During the last 20 minutes, work in pairs: Explain the roles of the performer and trainee to the large group. Ask youth who have not been a trainee, to do the

89

simulation with a partner. Observe the pairs; coach those who are having difficulties. After 5 - 10 minutes, ask the pairs to switch roles. For 90-minute sessions: Repeat the simulation and discussion questions several times in a large group. During the last 20 minutes, work in pairs until everyone has a chance to be a trainee. Optional: Change the role of the performer. After several simulations, instruct the performers to be more gentle or more forceful (as appropriate). This will give youth the ability to react to different types of situations. However, the performer needs to act within limits: shoving, pushing, or hurting the trainee in any way is not appropriate.

Making Commitments: 10 minutes

? What new things did you learn about saying no with your voice, body and actions (or asking for consent)? How can you use these skills in your life? Review the good ideas and skills that they discovered during the simulation. Now we have a chance to make the fifth commitment for healthy relationships. Remember, making a commitment doesn’t mean you have mastered the skill. It means that you realize the importance of the skill, and are committed to using the skill in your life. You are committed to saying no (when you need to) with your voice, body, and actions (or asking for consent when you try something new). As you continue practicing, it will become easier. Some of you might not be ready to make a commitment today. You can make a commitment at our next session if you need more time to think about it. Explain to the youth that you will read through each commitment statement in order, pausing after each one. Those who have already made a commitment - or want to make a new commitment – should stand when that commitment is read and repeat the statement after you in unison. Those who are not ready to make a specific commitment should sit quietly while that statement is read. Commitments: I will continue to communicate with confidence. I will continue to use the steps for good decision making. I will continue to communicate my relationship boundaries. I will continue to avoid the people, places, and things that make healthy relationships difficult. I will say no (when I need to) with my voice, body and actions (or I will continue to ask for consent when I try something new.)

Congratulate those who have committed to the first five skills for healthy relationships. Ask for a round of applause! Ask those who have made a new commitment to write their names on the Skills for Healthy Relationships’ picture near the stone that represents this commitment. Encourage everyone to use these skills in their life. Remind the youth: At the next meeting, they will be making a choice about abstinence and other healthy relationship choices. Review the different options that will be listed on the pledge card. Encourage them to think about the choice that is best for them.

90

Reminder! Give a posttest to the youth to ensure that they have learned all of the material. Use the questions listed at the end of this manual for Sessions 10-12.

91

Session 13 ● Making a Commitment Notes to the Facilitator

During this session youth will be asked to make a private or public decision about abstinence and other healthy relationship choices. Some may have already made their choice long before this day and may want to renew that commitment, others may be committing for the first time and may want to make this commitment privately or have public recognition. Some may not be ready to commit to abstinence until marriage, but are able to make a small step towards reducing their risk of HIV infection (for example, temporary abstinence, delaying sexual debut, or reducing the number of sexual partners). Care must be taken so those who are not ready to commit to abstinence are not ridiculed or judged. This is a time to build confidence and unity. Youth should also feel good about making a decision that is combating AIDS in their own life as well as in their country. For those who want to make a commitment, you may consider having a ceremony either during this session or at a later date when parents, family, community, religious leaders or school members can attend and support the youth. This session also offers an opportunity for youth to see that they can have a positive influence on the lives of others. Rather than feature a story, youth are given the opportunity to share their own stories about their commitment. During this learning session youth will: 1. Review information about AIDS, sex and abstinence. 2. Make a decision about committing to abstinence 3. Consider their part in the fight against AIDS. Values, Attitudes and Beliefs strengthened through this session: 4. A person of integrity only makes vows or commitments that he intends to keep. Materials needed: • ball, beanbag or something soft to pass • pledge cards, or handouts for youth to make the commitments. A blackboard or

large piece of paper to display the commitments if pledge cards are not available.

Activities: 60-minute format 90-minute format Review: 10 minutes 15 minutes Story and Discussion: 25 minutes 35 minutes Story and Discussion (optional): -------------- (20 minutes) Time of commitment: 20 minutes 20 minutes Learning Game -------------- 15 minutes Reflections verse (optional): (2 minutes) (2 minutes) Review and Reinforcement 5 minutes 5 minutes If you choose to add the Reflection Verse (optional), decrease the time for one of the other activities by 2 minutes. For 90-minute sessions, if you choose to add the Story and Discussion (optional) and the Reflection Verse (optional), decrease the time for one or more of the other activities by 22 minutes.

92

Following this session, youth will be split into two groups based on their commitment. A. Youth who commit to abstinence will practice another simulation at the next

meeting. See the guidance at the end of this session for more information. B. Youth who choose not to make a decision for abstinence will meet to discuss

Session 14, “Risk Reduction Options.” It is important that that you teach this session. Those who have not committed to abstinence must be given the information about reducing their risk of infection. Inform youth who made a private decision not to be abstinent, in appropriate way. After session 14, all youth will again meet together as one group for the final session, “Gender Roles.”

Review: 10 (or 15 minutes) Opening prayer (optional) The “Quick Review” Game: Ask participants to sit in a circle. Select one of the following review topics (or make up your own category describing something they have learned through Choose Life): • Ways that HIV can be transmitted • Techniques for one of the Skills. For example, how do you communicate with

confidence (Skill 1)? • Reasons youth are vulnerable to HIV • Reasons to delay sex until marriage • Reasons why youth are confident they can maintain their commitment. • Name all the commitments in order for Healthy Relationships Choose one participant to begin and give them a ball. As quickly as possible, the first person should begin to list four answers that fit the selected topic. As soon as the person begins speaking, he must pass the ball to the person on his left. The ball should continue to be passed quickly around the circle. The starting person must finish listing all four items before the ball comes back to him or her. Try it again with other participants. If the game is too easy, increase the number of responses to seven, eight or more.

Story and Discussion: 25 (or 35 minutes) Encourage youth their personal stories about choosing abstinence or other healthy sexual behaviors. You need to create an atmosphere where people feel free to share without embarrassment. Allow as many stories as time allows. If appropriate, begin by giving your own testimony and commitment to encourage others to share.

93

For 90-minute sessions only ⎯ Story and Discussion (optional): 20 minutes

Story is from 1 Samuel 17: 1-50. You can read the story from the Bible or tell it as it is here. Story: David was the youngest of eight brothers. He lived long ago and tended his father’s sheep in a city called Bethlehem. A neighboring group of people wanted to take over David’s country so they gathered their forces for war and assembled them on a hill inside David’s country. Their champion was named Goliath who was fierce and about 3 meters tall. He wore a bronze helmet on his head and a coat of steel that weighed nearly 60 kgs (130 pounds). He also had armor on his legs and had a huge spear with a bronze tip that weighed 7 kgs (15 pounds). He even had a man who walked in front of him to carry a huge shield for extra protection. Goliath stood at the edge of the camp and shouted to the army of David’s country, “Choose a man and have him come down to me. If he is able to fight and kill me, we will become your servants, but if I overcome him and kill him, you will become our servants.” On hearing this, all the soldiers were terrified and lost hope. “Give me a man and let us fight each other!” shouted Goliath again. For 40 days, Goliath came forward every morning and evening and shouted this challenge. But no man from David’s nation was brave enough to fight him. During this time, David was sent to bring food to his older brothers who were soldiers in the army. When he heard about Goliath he was surprised that no one had tried to defeat him. Even though he was just a boy, David was very brave. Once he had defended his flock of sheep against a lion and a bear with just his two hands and his slingshot. David was full of confidence because he trusted in God for his strength. He knew that God would be with him if his heart was right. He told them, “I will go and fight Goliath, and I will kill this intruder!” Everyone laughed at David’s boast, but he was certain that he could succeed. He persuaded the king of his country to let him go and fight Goliath. When Goliath saw David coming, he laughed. “Am I a dog that you come at me with sticks? Come here boy, and I will give your flesh to the birds of the air and the beasts of the field!” But David did not back away. He said to Goliath, “You come against me with sword and spear and javelin, but I come against you in the name of God, whom you have defiled.” As Goliath moved closer to attack him, David ran quickly towards the battle line to meet him. Reaching into his bag and taking out a stone, he slung it and struck Goliath on the forehead. The stone sank into his forehead, and he fell face down on the ground. David ran and stood over Goliath. He took Goliath’s sword and cut off his head.

94

Ask a volunteer to repeat the main points of the story. Then ask these questions:

? How is the giant Goliath like HIV in our land? Responses may include: Like Goliath, many people are fearful of HIV. Some people are so frightened, that they lose hope and don’t know what to do. HIV is threatening our nation.

? What can you do to stop new HIV infection like David stopped Goliath? Response: By practicing healthy sexual behaviors (such as abstinence, delay of sexual debut, and faithfulness) we stop the spread of HIV. Like David, it may appear that the Goliath AIDS is bigger and stronger than we are. However, by practicing healthy sexual behaviors, we can slow and even stop the spread of HIV in our communities.

Time of Commitment: 20 minutes Below are different commitment options. Make changes or additions as appropriate. Youth may also decide to write their own pledge. Write the different options on a pledge card, or the blackboard so that youth can review them together.

Sample pledge card Write your name on the line next to the statement which represents your commitment.

Because we are all vulnerable to infection, I commit to choose sexual abstinence. No one is forcing me. This is what I want for my life. It will not be easy. I know that there will be many temptations. However, by practicing the skills for healthy relationships (such as _________ _________allow youth to write in skills they can use_____________________________), and seeking support from others, I can, and will work to maintain this commitment. It is my contribution (both physical and moral) to the fight against the spread of HIV. _________________ I have read the pledge above, and commit today to be abstinent until

marriage. _________________ I have read the pledge above, and commit today to be abstinent for the

next six months. _________________ I have read the pledge above, and commit today to be abstinent for the

next twelve months. _________________ I have read the pledge above, and commit today to be abstinent until I

finish school (or ____________________________). _________________ I understand the benefits of being abstinent, but am not ready to commit

to abstinence today. Hand out the pledge cards (or write the commitment on the blackboard). Review each option with the youth. Making a pledge is a commitment to action. It means that we will do everything that we can to keep that commitment. By sharing this commitment with others, we are asking them to encourage and help us to keep that commitment too. If you are not

95

ready to commit to abstinence, then you should not feel pressured. Sign your name next to the last option – saying that you are not ready. Maybe you are willing to make a commitment to delay sex until you reach a certain age or goal. Maybe you want to try being abstinent for six months, before you make a longer term commitment. Choose the option that is best for you. We need to be truthful and only make commitments that we plan to keep. Answer any questions the youth have about the pledges. Remind them that they should choose ONE commitment and sign their name next to that commitment. Give youth 5 minutes to review the cards and sign their pledge card. If youth do not have a pledge card, they should tell the Leader Youth one by one their commitment, or write their commitment on a piece of paper which they turn into the Leader Youth. For 90-minute sessions only ⎯ Learning Game: 15 minutes

Leaning Circle Game: Ask all the participants to stand in a circle. If there is an odd number of people you should join the circle, if not stand to the side and supervise. Tell everyone to hold hands. Starting with one participant in the circle, have them count off by twos (one, two, one, two, etc…) all they way around the circle until everyone has a number, either a one or a two. The numbers should alternate so that no two people with the same number are standing immediately next to each other. Tell them to remember their number. At the count of three, with everyone still holding hands, the “ones” should lean forward and all the “twos” lean backwards with all their weight. After 5 seconds, the leader yells “switch” and all the players lean the opposite way, with all the “twos” leaning forwards and the “ones” leaning backwards. Do this few times until the players get it right and are really leaning with all their weight without stumbling.

? How can we “lean on each other” when we are having difficulties keeping our commitments? Encourage discussion. One possible response: If we see our friend is having trouble, or needing help to keep their commitments, we can support them and help pull them back. We can do this by giving them advice, encouragement, and helping them overcome obstacles. Listen to their responses and add: If we work together, we can achieve our goals!

Reflection Verses (optional): 2 minutes Numbers 30: 2 “When a man makes a vow to the Lord or takes an oath to obligate himself by a pledge, he must not break his word but must do everything he said.” Ephesians 4:25 “Therefore, each of you must put off falsehood and speak truthfully to his neighbor, for we are all members of one body.”

96

Review and Reinforcement: 5 minutes Take Action: Talk with your mentor about your decision. Ask him or her to keep you accountable to your goal. Creative Assignment: Choose an object that you can use to remind you of your commitment. Examples might include a ring, or a ribbon, a rock, a flyer from an Anti-AIDS club, a drawing, a letter, etc. Find something that you can put in your room, or carry around with you to remind you of your commitment. The object can also be used to declare to others your intentions. Be prepared to share with the group at the next meeting about the item you chose, and how this will remind you to keep your commitment. Remind the group to continue meeting each week with their mentor. Closing prayer (optional) Inform the youth about the next session. A. Youth who made a commitment to abstinence will practice more simulations for

the skills for healthy relationships (while the LY is leading Session 14). Ask the Co-Promoter or another youth to lead the simulations. Help them to choose one of the extra simulations in the Additional Activities section at the back of this manual. Choose the skill which is the most difficult for youth. The person facilitating should follow the same pattern as the other simulations.

B. Youth who did NOT make a commitment to abstinence (they signed the last commitment) will meet for Session 14. Speak privately to the youth who did not make a decision for abstinence, so that you do not embarrass them or make them feel stigmatized by this decision.

97

The Following Two Sessions are Designed for Youth Who Did Not Commit to

Abstinence.

Risk Reduction Strategies

by Food for the Hungry

Session 14 ● Risk Reduction Options Optional Session: Condom Discussion

98

99

Session 14 ● Risk Reduction Options - For Youth Who Did Not Make a Commitment to

Abstinence Notes to the Facilitator

After going through the first half of Choose Life, some youth will choose not to make an abstinence commitment or to marry their sex partner. This session is only for youth who did not make a commitment to abstinence in the last session. The goal of this session is to help youth who are not yet ready to commit to sexual abstinence — or who have rejected abstinence — to understand what their options are for reducing their risk of getting HIV, and the risks associated with these behaviors. Again, this session is not for the entire group, but only for those who did not make a commitment to abstinence. This module explicitly discusses different sexual practices and the risks involved in these practices. Lower risk sexual practices are encouraged for those who refuse abstinence including the use of condoms. Because of the sensitivity of these issues, some Promoters and Leader Youth13 may not feel comfortable leading this session. Consult a local health worker or a community leader with health background who is willing to lead it. This session could also be held off-site at a local clinic or someone’s home. Make sure to approach the youth for this meeting privately and schedule the session at a time when the others will not be present. During this learning session youth will: 1. Visualize and understand how HIV can spread rapidly in a community through

sexual partners. 2. Compare sexual abstinence to other HIV risk-reduction methods. 3. Rate different behaviors as no risk, low, or high risk for HIV transmission. 4. Look at examples of youth who are not ready to make abstinence commitments

and discuss what they can do to reduce their risk of becoming infected. Values, Attitudes and Beliefs strengthened through this session: 5. It is not only important to protect myself, but also my sexual partner from infection. Materials needed: • Cards (or pieces of paper) for the Warm-Up Game with various marks written on

them (see below) o One card to distribute to each youth o Mark the cards as follows: Mark one card with an “X,” one third of the

remaining cards with a “C,” and one third of the cards with an “N”. Leave one third of the cards blank. (For groups of 15 youth, mark one card with an “X,” mark 5 cards with “C” and 5 cards with “N”.)

• Newsprint and markers if the group is literate

13 Leader Youth are trained peer educators who facilitate the Choose Life sessions.

100

• Cards for the Risk Rating Exercise. The Promoter should distribute these cards to all Leader Youth. The Leader Youth should label each card as described in the Risk Rating exercise prior to beginning this session. You will need one set of cards for each same sex group of 5-6 youth.

Activities: 60-minute format 90-minute format Review: 5 minutes 5 minutes Warm Up Game: --------------- 30 minutes Risk-rating Exercise / HIV Facts: 20 minutes 20 minutes Stories and Discussion: 25 minutes 25 minutes Review and Reinforcement: 10 minutes 10 minutes If you choose to add the Story and Discussion (optional) in a 90-minute session, decrease the time for one or more of the other activities by 15 minutes. There is not enough time to use the Story and Discussion (optional) during for a 60 minute session.

Review: 5 minutes Opening Prayer (optional)

? Did you share with your mentor the decision that you made during the commitment ceremony? Did they support your decision? What was their response? Do not make the youth feel bad or judged for not making a choice of abstinence. Some youth may not be ready to make a commitment to abstinence. Others may feel too much pressure to make the choice at this time. We may not agree with their choice, but we must respect them for being honest. You may have friends or family who are disappointed that you did not make a choice for abstinence. It can be difficult to make a choice that is different from the others. However, we are glad that you were honest about your decision. It is better to be truthful about what you plan to do, than to lie about something you are not ready to do, or do not plan to do at all. Whatever the reason for your choice, we are glad that you are here today. If you are sexually active, you need to know how to reduce your risk of HIV infection. The skills you learn today will help reduce the risk for you and your sexual partner. For 90-minute sessions only ⎯ Warm Up Game: 30 minutes This game helps youth to understand HIV transmission and how it can spread through a community through sexual partners. It will help youth to recognize ways to eliminate or reduce their risk of becoming infected with HIV.

101

Option 2: Give objects to the youth instead of marked papers. You can use rocks, sticks, pencils, or any other objects that you can find. Designate one object to be the “N”. Designate another object to be the “X”. Choose another object to be the “C”. Give out these objects as directed in the “Notes to the Facilitator” section. Instead of writing down the names of those whom they meet, ask the participants to remember the name of each of the three people they greet. Continue with the discussion questions below, making changes as necessary. Direction for the HIV Handshake12 Shuffle the deck of marked cards (as indicated in the section, “Notes to the Facilitator”). Give a card to each youth in the room. Ask the youth to sign their name in the top right-hand corner of the card. Your name identifies your card. You should keep track of your card throughout this activity. Ask the youth to go around the room, and greet three other youth. After greeting each person, they should sign each other’s card. Once each youth has greeted three people, he or she should have three signatures on his or her card. Ask someone to explain the rules back to you, to verify that they understand. After they have greeted everyone, ask the youth to return to their seats. This exercise demonstrates how quickly HIV can spread within a community. Remember HIV cannot spread between two people unless one person is infected. For this exercise, we needed one youth to represent a person infected with HIV. The person selected does not really have HIV; it is only for the purpose of the game. Ask the youth to look at their cards and see if there is an “X” on their card. Ask the one person with the “X” to stand up. Option 2: Ask the youth holding the object which represents the “X” to stand. For this exercise, we are going to say that the person standing up is infected with HIV. You cannot tell if someone has HIV by looking at them. Most people who are infected with HIV do not show any visible signs or symptoms. In fact, many individuals with HIV do not even know that they are infected.

? What are the ways that HIV is spread? Response: Make sure that the group agrees that HIV can be transmitted the following ways:

1. During sexual intercourse (anal, and vaginal) with or without a condom. A condom is not 100% effective. A condom – when used consistently and correctly – is 80-95% effective in preventing the transmission of the HIV virus. When they break, come off during intercourse, or are removed improperly (allowing liquid to leak out), they are not effective. Sex with a condom is always safer than without a condom. However, it does not provide complete protection.

2. By HIV-infected blood transfusions or injecting equipment or cutting

102

instruments where fresh blood is exchanged. 3. From an HIV-infected woman to the baby during pregnancy, delivery, or breast-

feeding. For this game, we are pretending that greeting someone represents being in close relationship with another person. Sometimes these relationships are sexual relationships, sometimes they are not. Ask the youth with the “X” card to state the names of people on his or her card. Option 2: Ask the person with the object representing the “X” to name all three people whom they greeted. Ask those who hear their names to stand up when called. (Say to all of those standing) You were all in a relationship with someone who was HIV infected. Those of you who were sexually active might have contracted the HIV virus and passed it on to your friends. Ask those standing to share the names of their cards. Those who hear their names should also stand when called. Continue to do this activity until all of the youth who were in relationship with an HIV infected person are standing. In a world of sex – especially sex without a condom – HIV can spread very quickly through the social networks of a community. A single sexual contact does not mean that every time a person has one act of unprotected sex with an infected person, the virus is passed, but there is a chance of transmission. HIV can be transmitted if you only have sex one time with an infected person. Your chances of getting the virus are increased when you have sex multiple times and with multiple partners. HIV infection can be prevented in a number of ways; some ways are more reliable than others. Ask the youth to see if they have an “N” on their card. Option 2: Ask the youth holding the object which represents the “N” to sit down. Every person with an “N” on his or her card said “no” to sex (abstinence) and therefore, is not infected with HIV. Those with an “N” may sit down. Ask the youth if they have a “C” on their card. Every person with a “C” on their card had sex, but used a condom consistently and correctly every time they had sex. Most, but not all of you were protected from HIV. Select one of the youth who has a C on his/her card to remain standing. Ask the rest of those with a “C” to sit down. Option 2: Select one youth who is holding the object with represents the “C” to remain

103

standing. Ask the rest of the youth holding the objects which represent the “C” to sit down. Those of you who are still standing did not say “No” to sex, did not use a condom correctly and consistently, or used a condom that broke. You are now infected with HIV.

? How many youth are infected now? Response: Count the number of infected youth. Emphasize that one person’s actions affected many others. Remind the group that this is just a game, and allow everyone to sit down. Continue with the discussion questions below.

? How many youth were infected when we started the game? Response: One. Remind the group again that the person who had the “X” card is not really infected with HIV.

? How does this exercise help explain how HIV can spread so quickly in a community? Response: The more sexual partners that we have, the more people will be infected with HIV and pass the infection on to others.

? In real life, do you think that HIV is passed from one person to another without anyone realizing that they are infected? Response: Because of the following three reasons, it is very common for someone to be HIV infected and pass it on to others without anyone knowing: 1. You cannot usually tell if someone is infected by looking at them. 2. It can take several years before a person develops any symptoms of HIV. 3. On average, it takes between 20-90 days after infection for HIV antibodies

(infection fighting cells) to be found in your blood. Therefore, someone can infect several others before HIV even shows up in their blood.

Risk Rating Exercise / HIV Facts: 30 minutes

Preparing for the Exercise: Make a stack of cards for each same sex group of 5-6 youth. For each stack of cards, write each of the practices below on a separate card, plus three additional cards that say High Risk, Low Risk, and No Risk. Do not indicate on the card whether the practice is No Risk, Low Risk, or High Risk for HIV transmission. The youth will first work in small groups to try to discover the meaning and risk level of each activity. This will be followed by a group discussion and explanation of the correct responses. No Risk Practices: • Holding hands • Cuddling / Hugging • Kissing (regular or deep kissing)

104

• Touching or mutual stimulation (using one’s hands on the other person’s genitals, or breasts with or without lubricants to stimulate them)

• Massaging (e.g., rubbing the person’s back) • Masturbating • Abstinence • Non-penetrative sex (where the penis does not enter the rectum, vagina, or mouth

and no bodily fluids are exchanged) Low Risk Practices: • Vaginal sex with a condom • Oral Sex (with or without a dental dam or condom) High Risk Practices: • Withdrawing before the man ejaculates (if the male is HIV infected) • Anal sex • Sex with a partner who has a sexually-transmitted infection • Dry sex [use this card only if culturally relevant] • Using a condom with an oil-based lubricant • Forced sex (rape)

? We are going to start a new activity in which we will categorize low and high risk sexual behaviors. What is risk? Response: Risk is the possible harm that may come from an activity. A risky activity means that you are exposing yourself to danger if you do the activity. A low risk activity means that there is not much danger of being harmed. A high risk activity means that there is a large chance that the activity could be dangerous to your health. There are times to speak plainly about HIV, and this is one of them. Knowing this can mean the difference between life and death. We want youth to Choose Life! Divide the youth into same-sex groups of about 5-6 people and give each group a stack of cards. I am going to give each of you a set of cards that have sexual practices and other actions listed on them. These practices have different levels of risk associated with them when one partner is HIV positive. Please remember that we are not talking about whether these practices are moral or allowable, we are just talking about the level of risk of transmission of HIV. For questions about whether these things are right or moral, you should talk to your parents or your religious leader. There are two steps in this activity: Your job is to (1) respectfully and quietly discuss the words and define each practice so that everyone understands and (2) categorize each practice as being High Risk, Low Risk or No Risk in regards to HIV transmission. You have 15 minutes to talk about the items and to categorize them into the three categories. After the peer group has finished, ask each person in the peer group to talk about one

105

card, what it means, and which category it belongs in. Correct any misunderstandings as they discuss the activities. No Risk: • Cuddling / hugging • Kissing (Kissing can involve some exchange of saliva, but scientists have never

found a case where someone contracted HIV through kissing.) • Massaging (rubbing one another) • Masturbation (touching one’s genitals to please one’s self) • Touching or mutual stimulation (using one’s hands on the other person’s

genitals or breasts with or without lubricants to stimulate them) • Abstinence and/or non-penetrative sex (a general term for any of the above

activities or others that do not include vaginal, oral, or anal penetration or the exchange of bodily fluids)

All of these practices are No Risk in terms of transmitting HIV since they do not involve exchange of bodily fluids. Remember: We are not talking about whether these practices are moral or good for youth. We are talking about the level of risk of transmission of HIV.

Correct any misunderstandings as they discuss the activities.

Low Risk: • Vaginal intercourse with consistent and correct condom use. This has a

lower risk of HIV transmission than no condom, or when condoms are used improperly. A condom – when used consistently and correctly – is generally 80-95% effective in preventing the transmission of the HIV virus. When they break, come off during intercourse, or are removed improperly (allowing liquid to leak out), they are not effective. Sex with a condom is always safer than without a condom. However, when a person only uses condoms some of the time, it offers little protection.

• Oral sex (the stimulation of the genitals with the mouth or tongue). Oral sex without a dental dam or condom caries a very low risk of HIV infection. If there are cuts or sores on the mouth or genitals, it is a higher risk practice, and the chance of getting an STI increases. Using a dental dam (on the woman’s genitals) or condom (on the man’s genitals) reduces the risk of getting an STI during oral sex. A dental dam is a non-lubricated condom that is cut in half horizontally and placed over the woman’s genitals.

Correct any misunderstandings as they discuss the activities. High Risk: • Withdrawing before ejaculating (if the male is HIV infected). This does not lower

the risk of HIV transmission since the virus is present in pre-ejaculation fluids. A condom used correctly and consistently is the best way to protect each other from HIV during sex.

• Anal sex (the insertion of the penis into the anal cavity). This has a very high risk

106

of HIV transmission (much higher than vaginal sex) as it often causes tears in the anal canal. Using latex condoms and lots of water-based lubricant helps reduce these tears, but does not eliminate the risk of transmission.

• STIs. When one of the partners has a sexually transmitted infection (STI) and a condom is not used, there is an increased risk of infection because of the sores and open wounds on the genitals.

• (Only mention if culturally appropriate) Dry sex is practiced in some societies where a woman dries out her vagina with herbs or local products. This increases the chances of vaginal tears and suppresses the natural bacteria that live in the vagina (the germ fighting agents) which increases the chances of HIV infection.

• Using a condom with an oil-based lubricant. Oil-based lubricants damage condoms. Using an oil-based lubricant with a condom is more risky than having sex with a condom and no lubricant, or using a water-based lubricant with a condom.

• Forced sex (rape) denies a woman the right to say “no.” It increases the chances of HIV transmission as the woman’s vaginal canal may tear. The chance of transmission is higher both for a man who is raping a woman, and for a woman who is being raped.

There are some other things that make HIV spread more quickly in a community:

• Having multiple concurrent sex partners. Having sex with several people during the same time period (e.g., during a month) makes HIV spread more quickly than having one sex partner at a time.

• Being uncircumcised. Men who are circumcised are about 60% less likely to become infected with HIV.

• Having sex with prostitutes. People who have sex for money or gifts often have a great number of sex partners, and are therefore at higher risk.

• Having sex with someone much older than you. When a girl has sex with a man who is much older than her, her chances of becoming infected with HIV are greater. Why? Men who engage in relationships with younger women are more likely to be infected with STIs or HIV compared with the boys in the girl’s own age group. A woman is also more vulnerable to HIV infection because of the anatomy of the vaginal canal. Semen can remain in the vagina for days, which raises the risk of contracting the virus.

When a person makes a change in their behavior, they often do not make the change all at once, but make it in steps. For example, let us say there is a youth who wants to quit smoking. Here are some of the steps he may take before he makes a final decision. 1. He may hear someone talk about quitting. 2. He may talk to people he knows and trusts about quitting. 3. He may present questions and doubts he has about stopping. 4. He may decide to cut back on the number of cigarettes he smokes. 5. Then he might delay when he has the first cigarette of the day. 6. He may try to stop several times and fail. 7. Until finally, he is able to stop smoking completely and maintain this behavior. In fact, most smokers try to quit three to five times before they succeed! In the same

107

way, any change in behavior can take time, and not everyone will want to make a commitment to abstinence, or return to abstinence, immediately. In the meantime, if they are having sex, they are putting themselves at risk.

? Aside from avoiding Low and High Risk practices (the best option), what are the things that youth can do to work towards an abstinence commitment or to return to abstinence? Response: They can do any of the following… • Begin talking to their partner and other people about abstinence. • Stop doing things that put them at the most risk of getting HIV. • Take steps towards secondary abstinence: For example, a youth may want to

make an abstinence commitment of only 1-3 months. • Reduce or eliminate any habits that make it difficult for him or her to practice

abstinence (e.g., avoiding pornography, alcohol, drugs or nightclubs, and substitute those with healthier behaviors).

• Talk to a counselor who can help you examine your options regarding your sexual behavior and relationships (e.g., using Motivational Interviewing).

Don’t think of every mistake as a failure. Instead, you should try again, and change your behavior one step at a time, moving towards abstinence.

Story and Discussion: 25 minutes We are now going to hear two short stories about youth who have refused to (or are not yet ready to) make a commitment to abstinence, and are engaged in risky sex. Keep in mind that these are stories about youth who have learned about abstinence and given an opportunity to make an abstinence commitment, but have decided not to commit. We will discuss what they can do now to reduce their risk of HIV infection. After hearing each story, you will be asked to suggest ways that the youth can decrease his or her risk of being infected with HIV. Choose two of the following three stories that are most appropriate for the youth in your group who have not chosen to make an abstinence commitment. Story #1

Story: Benjamin and Evelyn are 16 years old. They have been seeing each other for four months. Evelyn had sex with one boy before, but Benjamin has never had sex. They both love each other, and have a lot of opportunities to be alone. When they are alone, they kiss, hug, and touch each other, but are not having sex. Benjamin really wants to sleep with Evelyn, and Evelyn feels the same way, but they think that they should be abstinent. They did not make an abstinence pledge, because they did not feel ready. However, it is getting harder to resist having sex, and every time they are alone, they take things a little bit further.

? What is the thing (or things) that they are doing that put them at the most

108

risk? Response: They are not engaging in any high or low risk activities.

? What are the low or no risk things for HIV transmission that they are doing? Response: The main problem seems to be that they are already sexually stimulating each other and spending a lot of time alone. For this couple, it would be good to work towards spending more time in groups, and to try to limit what they are doing to kissing/hugging so that they will not be tempted to go further.

Story #2 This story speaks about anal and oral sex. If this is not practiced in your region, skip to the next story. Story: Felipe and Maria are 18. When they started seeing each other, they just kissed and hugged. Eventually, Felipe wanted to do more. Maria was afraid of getting pregnant, so Felipe convinced her to let him have anal sex and oral sex with her (without a condom). They went to talks on abstinence, but Felipe was not convinced that he could be abstinent even if he wanted to. Maria would like to try. Felipe and Maria do not have other partners now, but Felipe had sex with a few girls before he met Maria.

? What is the thing (or things) that they are doing that put them at the most risk? Response: This couple is at high risk because they are having anal sex and not using condoms.

? What are the low or no risk things that they are doing? Response: kissing and hugging are no risk activities. Oral sex is a low risk sexual activity for HIV transmission.

? What are the things that the youth in this story could do to lower his risk of getting HIV, even if they are not yet ready to become abstinent? Response: Felipe should begin using a condom and try to stop having anal sex with Maria, which greatly increases their risk. They should also use a dental dam or condom when having oral sex. It is good that neither is having sex with other partners right now. Maria should get Felipe to talk to a counselor to help work through some of the resistance he has to abstinence.

Story #3

Story: Ely and Silvie are 16 and have been seeing each other for one year. In the first month when they met, they started kissing, touching and having vaginal sex. Ely has sex with two other girls that Silvie does not know. Sylvie went to some AIDS prevention sessions that focused on condom promotion and she got Ely to start using condoms each and every time they have sex. (He uses them with one of the two other girls, too, because she demands it.) They have no plans at this point of being abstinent.

? What is the thing (or things) that they are doing that put them at the most

109

risk? Response: Ely is having sex with several girls. He does not always use a condom with one of these other girls. This puts Ely and Silvie at high risk of HIV infection.

? What are the low or no risk things that they are doing? Response: Kissing and touching are no risk activities.

? What are the things that the youth in this story could do to lower the risk of getting HIV, even if they are not yet ready to become abstinent? Response: It is good that they are always using condoms since they are having sex – but if Ely is having sex without a condom with another girl, he is still putting himself and all of his sexual partners at high risk. Ely should begin using condoms with all of his partners each and every time he has sex to lower his risk. Ely could also reduce the risk of HIV infection by reducing the number of his sexual partners. NOTE: For youth who are sexually active, you may choose to set up an additional meeting to discuss the next session on the proper use of condoms.

Review and Reinforcement: 10 minutes

? What did you learn today that will help you to talk to people who have not yet made a commitment to abstinence? Be sure to review all the main points discussed about ways in which youth can reduce their risk of HIV infection. Take Action: This week, talk to youth who have not yet made abstinence commitments and see if you can help them discover ways of reducing their risk of getting HIV, and to continue exploring abstinence. Remind the group to continue meeting each week with their mentor. Closing Prayer (optional) At the next meeting all youth, including those who committed to abstinence, will meet together to discuss “Gender Roles.”

110

111

For Youth Who Did Not Make A Commitment to Abstinence Condom Discussion (optional)13

Notes to the Facilitator This session is optional. Leader Youth are not required to teach it during the first 15 sessions. However, if many youth choose not to be abstinent, you may consider adding this session so that youth will not continue to put themselves (and their partners) at high risk. This optional discussion explicitly discusses the advantages and use of condoms14 as an HIV prevention method. Because of the sensitivity of these issues, some Promoters and Leader Youth may not feel comfortable leading this session. Consult a local health worker or a community leader with health background who is willing to lead this session. This session could also be held off-site at a local clinic or someone’s home if that would be more appropriate. Again, this session is only appropriate for youth who have chosen not to commit to abstinence and are sexually active. This session is designed to help them to reduce the risk of HIV transmission by using condoms. This whole exercise needs to be conducted in such a way that every question encourages a good discussion. Encourage your participants to do as much of the asking and answering as possible - remember you are there just to prompt and guide - not to lead! Below is a long list of questions. You may not want to ask them all at one setting. Alternatively, you may find that many of them are asked by participants. The questions and appropriate information are just listed below for your information. Note that this exercise may be just a beginning in people's knowledge of condoms and may need to be repeated. (Optional) As you encourage discussion of each question, produce some condoms in their sealed wrappings and hand one to each participant, so that everyone has a chance to grow used to them. Encourage people to draw diagrams to share with one another, if they think this will help to describe or understand things better. This may be quite a difficult session for some people. Humor helps! Try to keep it light, but make sure that everyone understands and gets their questions answered. During this learning session youth will: 1. Openly discuss the use and disposal of condoms. 2. Handle condoms to understand how to use them properly. Materials: • If appropriate, bring a condom for each participant. • If you bring a condom for demonstration, you will also need a glass of water. • If appropriate, bring a tube of K-Y jelly, or other locally available, water-based

lubricant. • Newsprint and markers to draw pictures if necessary

14 This exercise explains the proper use of male condoms. Female condoms may also be available in

your area. If so, be sure to include them in your discussion.

112

Time: 60 minutes (depending upon the amount of questions and discussion) Throughout this whole exercise, encourage participants as much as possible to tell one another the answers to your and their own questions. Ask those who know something about condoms already to join in and share their knowledge with the others. Only provide the answer to a question yourself if they do not know it, or if you think it is not accurate enough. This means that most of the talking in this exercise should, as much as possible, be amongst your participants and not from you. Directions: Sit in a circle with the participants and explain that we are now going to show one another how to use a condom.

? What are condoms? Response: They are made of rubber and are very strong. They are tested in the factory by being stretched and filled with water to check that they are completely watertight. A condom is worn on a man's penis. A condom will stop sperm or other fluids coming into contact with a woman's vaginal fluids so she will not be able to get pregnant and, if either the man or the woman has a sexually transmitted disease (such as HIV); it cannot be passed between them. However, condoms sometimes break or slip off, so they are not 100% effective. (Optional: Fill a condom carefully with water, to show its watertight qualities to everyone.)

? What is the most important thing about a condom? Response: Be sure you have one before you need it! (Optional: Hand out condoms to each participant.)

? How do you know if a condom packet is good? Response: If you have a choice, choose pre-lubricated condoms that come in sealed wrappers and are packaged so that light does not reach them. (Optional: Help everyone to feel how the condom feels lubricated inside the still-sealed wrapper.)

? How do you open the wrapper? Response: You must open the wrapper carefully so that you do not tear the condom. (Optional: Show everyone how to do this.)

? What do you look for or feel for to know that a condom is good? Response: Check that it is not discolored, or sticky or brittle or damaged. (Optional: Encourage everyone to inspect their condom gently.)

? What can damage condoms? Response: Oil-based lubricants, such as Vaseline, damage condoms. Only use water-based ones, such as K-Y jelly, or glycerin. Lubricants may need to be used if the condoms have no lubricant themselves. However, if both partners make sure that the woman is properly aroused at the start, then her vagina will be moist enough and no extra lubrication will be needed. You may need to add here an explanation about the

113

importance of foreplay in enabling a woman to feel properly aroused. However, it is important to stress that during foreplay, the penis should not come into contact with the vagina. (Optional: Show a tube of KY jelly or other water-based lubricant if locally used or available.)

? How many times can you use a condom? Response: Only once. Each time you have sex, you must use a new, unused condom on the penis before it enters the vagina or rectum.

? When do you put the condom on? Response: Only when the penis is erect (hard).

? What do you do if the penis is uncircumcised? Response: Pull the foreskin of the penis back before putting on the condom.

? How do you put the condom on? Response: Pinch the top, closed end of the condom first. This leaves a small empty space to hold the semen. Then, unroll the condom down the length of the penis all the way to the base.

? What happens if the condom tears during sex? Response: This is less likely to happen if the condom is good quality and if you have put it on properly. However, it does occasionally happen. The best thing to do is to withdraw the penis immediately and put on a new condom.

? What do you do after ejaculation? Response: After ejaculation, before the penis goes soft, hold on to the bottom of the condom as you pull the penis out, so that the condom does not slip off, then take off the condom carefully without spilling semen.

? How do you dispose of the condom? Response: Wrap the condom in paper (such as newspaper) or in a piece of cloth or leaf until you can dispose of it in a toilet, or a pit latrine or by burying or burning it. Then, if you wipe yourselves after sex, remember to use separate cloths. Condoms should be disposed of away from where children or animals can find them and play with them.

? Where is the best place to store condoms? Response: If possible, condoms should be stored in a cool, dark, dry place. Heat, light and humidity can damage condoms.

114

? What else can a condom protect against (besides HIV)? Response: Latex condoms when used correctly and consistently every time you have sex can reduce the risk of transmission of STIs including gonorrhea, chlamydia, and trichomoniasis. Latex condoms when used consistently and correctly every time you have sex can also reduce the risk of genital herpes, syphilis, and HPV, but only if the infected area is covered or protected by the condom. Condoms also protect against unwanted pregnancy

? Do you have any other questions? Response: If you do not know the answers to some of the questions from the group, say you do not know and promise to find out for them. It is much better to be honest than to give false information!

115

Session 15 ● Gender Roles and [Skill 6] Meeting (regularly) with others who keep you

accountable

Notes to the Facilitator The goal of this session is to challenge unhealthy gender roles and expectations that exist in our world. Many of these role expectations are fueling the spread of HIV/AIDS in youth today, especially among women. Almost half of all HIV-positive people in the world are women. In Africa, among the 10-24 year old age group, 76% of those infected are women and girls14. Young women are three times more likely to be HIV-positive than young men15. This is not the fault of women or girls; there are many cultural, biological and economic reasons, which make females more vulnerable to infection. This session targets gender norms and behaviors which put females at risk. By discussing positive and negative behaviors in relationships and challenging youth to rethink what is acceptable and unacceptable behavior, we hope to begin to make changes that can bring about greater equality among men and women. During this learning session youth will: 1. Generate a list of current male and female behavior expectations in relationships. 2. Generate a list of good behaviors that are needed for healthy relationships

between men and women. 3. Discuss how gender roles can put girls at higher risk for HIV infection. 4. Have an opportunity to make a commitment to Skill 5: I will continue to meet with

others who keep me accountable. 5. Have an opportunity to make new commitments to Skills 1, 2, 3, 4 and 5.

Values, Attitudes and Beliefs strengthened through this session: 6. Women and girls deserve equal respect and value as men and boys.

Materials needed: • Posttest for each youth Activities: 60-minute format 90-minute format Review: 5 minutes 10 minutes Warm Up Game: -------------- 10 minutes Story and Discussion: 45 minutes 45 minutes HIV Facts: -------------- 10 minutes Reflection Verse (optional): (2 minutes) (2 minutes) Making Commitments: 10 minutes 15 minutes If you choose to add the Reflection Verse (optional), decrease the time for one of the other activities by 2 minutes.

116

Review: 5 (or 10 minutes) Opening Prayer (optional)

? What skills have you used in the last few weeks that have helped you to keep healthy relationships? Encourage discussion. For 90-minute sessions:

? What challenges or struggles have you faced trying to keep these commitments (or use these new skills)? Listen to several responses. Using suggestions and group discussion, try to provide solutions and advice for those who are having difficulty. For 90-minute sessions only ⎯ Warm Up Game: 10 minutes Hello Hello: Ask two boys and two girls to go stand away from the rest of the group. Make sure that they cannot hear what you are saying to the others. Tell the rest of the group that the two boys are very good friends who have not seen each other in a long time. Ask the group to predict how the two will greet one another. What type of voices will they use? What actions will they use to greet one another? Next ask the group how two girls, who are very good friends, would greet each other if they had not seen each other for a long time. Once the group has given you a few ideas, tell the boys that they should enter the room (from different sides) and greet one another as if they are very good friends and have not seen each other in a long time. Have the group compare what the boys did with their expectations. Then send the boys back outside. Next ask the girls to enter the room and greet one another as if they are very good friends who have not seen each other in a long time. Have the group compare what the girls did with their expectations.

? Were your expectations right? Or did the boys and girls respond differently than you expected? Sometimes it can be easy to predict the way people behave, at other times our expectations are completely wrong. Today, we are going to compare the behavior expectations of boys and girls.

Story and Discussion: 45 minutes We will begin with a story about two youth… (Replace the names with local names) Story: Girum (boy) and Yeshi (girl) are both 18 years old. They have been boyfriend and girlfriend for almost a year. They both love each other very much. They have not been sexually active, but it is becoming increasingly difficult for Girum. He cannot get thoughts of sleeping with Yeshi out of his mind. One afternoon he begins talking to her about having sex to see if she is feeling the same way.

117

“How could you ask me such a question when you know that we have both committed to abstinence until marriage?” Yeshi responds. Girum looks down. “I know that we made that commitment to honor God and protect each other, but it is so hard to be abstinent. All I can think about is you, and I don’t know what to do about it.” They talk for a little while longer and decide together that maybe they should spend less time together in private. They could meet in public places, and invite other friends to join them; this they hoped would help them to keep healthy boundaries and not act out their thoughts of sleeping together. “And our friends can help us remain accountable!” Yeshi adds. Girum agrees. “Yes, our friends should be there to remind us of our commitment to one another.” Later that week, Girum meets his friend Gashaw (boy) at a restaurant. He begins telling him about the discussion he had with Yeshi. “What?” Gashaw asks raising his eyebrows. “I don’t think you should have a discussion about sex with her. You are a man. If you take the lead, she will follow. That is how strong men act. Yeshi will do as you ask if she really loves you.” Gashaw’s girlfriend slipped in beside him on the bench. Girum really did not want to continue talking about his relationship with Yeshi in front of Gashaw’s girlfriend, but he needed to say what was on his mind. “I don’t believe in that kind of relationship, Gashaw. If I really love her, I will do what is best for the two of us and also respect her opinion. Yeshi is not just a girlfriend I want to use and throw away. I really love Yeshi and I want to marry her when we finish school.” He paused. “Look, I came to you because I wanted to ask for you for support – to help me and Yeshi be accountable. But I can see that you don’t want to be that kind of friend to me.” Gashaw shook his head, “I am not going to help you to shy away from your role as a man.” Girum was very disappointed. He thought he had a friend who would support him. “I’m sorry that you feel that way,” Girum said. “I think women deserve better treatment than that.” Gashaw scoffed at Girum and put his arm around his girlfriend. She pulled away from him and stood to her feet. “I think I’ve just realized what has been wrong with our relationship,” his girlfriend blurted out. “You are the one who doesn’t understand what it means to be a real man.” Gashaw reached up to grab her, but she slipped from his grasp and darted out of the restaurant. Ask a volunteer to repeat the main points of the story and then continue with the discussion questions.

? What was the main problem that Girum and Yeshi had in the story? Response: They were having a hard time remaining abstinent.

? How did they decide to resolve this problem? Response: They decided to talk to their friends about helping them be accountable. They also decided to spend less time together in private.

118

? Gashaw said to Girum, “I am not going to help you to shy away from your role as a man.” What was Girum doing that made Gashaw say this? Response: Girum was talking to Yeshi about his desire to sleep with her. He asked for her opinion. Girum decided that Yeshi was right and they talked together about how they should resolve the problem. Girum was expected to act “like a man.” His girlfriend was also supposed to respond “like a woman.” Neither of them behaved in the way that their friends expected them to behave. I want you to think a minute about the expectations that we have for men and women in relationships. What do we mean when we say, “Act like a man” or “Act like a woman”? What are the emotions, actions, and behaviors that we define as feminine or masculine? If you have both boys and girls in the group, ask the boys to define what it means to “act like a man.” Ask the girls to define what it means to “act like a woman.” If you have only one gender, everyone can share ideas for both genders. Possible responses might include: • Act like a man: Expected to be in charge. To have relationships with many girls.

Allowed to be harsh with their girlfriends/spouse/younger siblings. Should be the leader. Should be the money provider. Should not cry or act weak.

• Act like a woman: Be passive and quiet. Be the caretaker. Listen and do what your boyfriend/spouse says to you. Take care of the home and children. Be faithful.

? Are all of these expectations healthy for a good relationship? For example, if Girum had done as Gashaw had suggested and forced Yeshi to sleep with him, how would this have affected his relationship with his girlfriend? If Gashaw’s girlfriend had decided to “act like a woman” and stay with Gashaw even though he did not respect her, how would this have affected her relationship with Gashaw? Response: Participants may have very different answers to this question. We want to emphasize that healthy relationships require that you listen and respond to the needs of the other person. When this does not happen, the individual can be hurt emotionally and physically.

? What are the things that must be equally shared between a boy and a girl to have a healthy and good relationship? Response: Give participants a few minutes to brainstorm ideas and then add any of the points below that the group does not mention.

• Love • Respect • Honesty • Good Communication

? How did Girum and Yeshi show these qualities towards one another? Encourage discussion. Add any of the following points that are not mentioned.

119

• Girum showed love by considering Yeshi’s opinion. Yeshi showed love by listening and working with Girum to find a solution. Girum showed love by saying good things about Yeshi even when she wasn’t with him.

• Girum showed respect by listening to Yeshi’s opinions. He didn’t force her to do what he wanted. Yeshi showed respect by not laughing at his struggles. She listened and they worked together to find a solution.

• Girum showed honesty by not hiding his struggles from Yeshi. Yeshi told Girum she would not give up her commitment; she didn’t hide her true feelings.

• Both Girum and Yeshi clearly communicated to one another their desires, needs and struggles.

Love, respect, honesty and good communication can help strengthen any relationship. By practicing these principles in our friendships and relationships, we will have happier and more fulfilling relationships.

For 90-minute sessions only ⎯ HIV Facts: 10 minutes In sub-Saharan Africa, of all of the youth infected with HIV, 75% of them are females. This means that if this room was filled with 100 infected youth, 75 of them would be girls. One reason that girls have a higher rate of infection is because of the design of the female genital organs. The soft tissues of their genitals are more vulnerable to tearing and abrasions during sex which increases the chances of becoming infected.

? How might gender norms make girls more vulnerable to HIV infection? Allow youth to respond. Add any of the following reasons that are not mentioned: • In some cultures, men do not allow women to make decisions about sex. This

means it is more difficult for a girl to refuse sex or insist on using a condom to protect herself.

• Many cultures encourage boys to have multiple sexual partners. One infected man can therefore infect many girls.

• Girls are more likely to be the victims of sexual abuse, and sexual assault, or dry sex (only mention dry sex, if practiced in your region). Forced sex and dry sex have a higher chance of transmitting the virus to girls because of rips or tears that may occur in the vaginal canal.

• Girls are more likely to be coerced into having older sexual partners. An older man is more likely to have had previous partners, increasing the chances that he is infected and can infect others.

• Girls are more likely to have less (money and goods) and have a lower education than boys. This makes them more likely to engage in transactional sex or other high-risk sexual activities to get the things that they need for survival.

As we consider the expectations that society has for men and women, we need to be aware of how these expectations put women and girls at a much higher risk of infection.

Reflection Verse (optional): 2 minutes Galatians 3:28 “There is no longer Jew or Greek, there is no longer slave or free, there is no longer male and female; for all of you are one in …Jesus.”

120

Making Commitments: 10 (or 15 minutes) Meeting (regularly) with others who keep you accountable

Now we have a chance to make a commitment to the LAST skill for healthy relationships. The last commitment is probably the most important! It is a commitment to accountability. This means that you commit to meeting regularly with others who keep you accountable to your commitments. It is a time to talk about struggles you have had with your commitments, success you have had overcoming these struggles, and new skills that you have learned for healthy relationships. Although we have finished the main sessions in Choose Life, there are still more sessions to review. Making a commitment doesn’t mean you have to meet every week or every month. It just means that you are committed to finding someone to talk with (a relative, a mentor, or a group of friends like this one) and will set a time to regularly meet with them (e.g., once a month). It means you are committed to the skills for healthy relationships and want others to help you to continue learning and growing. Explain to the youth that you will read through each commitment statement in order, pausing after each one. Those who have already made a commitment - or want to make a new commitment – should stand when that statement is read and repeat the statement after you in unison. Those who are not ready to make a specific commitment should sit quietly while that statement is read. Commitments: I will continue to communicate with confidence. I will continue to use the steps for good decision making. I will continue to communicate my relationship boundaries. I will continue to avoid the people, places, and things that make healthy relationships difficult. I will say no (when I need to) with my voice, body and actions. I will continue to meet with others who keep me accountable. Congratulate those who have committed to all six of the skills for healthy relationships! Ask for a round of applause! Ask those who have made a new commitment to write their names on the Skills for Healthy Relationships’ picture near the stone that represents this commitment. Celebrate success for those who completed all six skills. Encourage everyone to use these skills in their life. Note to the Facilitator: If you have a formal pledge ceremony for those who commit to healthy relationship choices (Choose Life Session 13: Making a Commitment), consider adding a certificate (or public recognition) for those who have committed to all six of the skills for healthy relationships.

? How many or you would like to continue meeting in this group? • If very few people are committed to coming, encourage them to follow through on

their commitments – finding another group of friends to meet with for accountability. End of Choose Life meetings.

121

• If youth are committed to continue meeting: Explain the meeting times and format of the upcoming meetings (which will be planned by the Co- promoter and Leader Youth).

Ask for a volunteer who is willing to share their testimony (10 minutes) at the next session. Give them the following guidance and ask them to practice before the next meeting.

1. Describe the healthy relationship commitment that you made and why you chose this commitment.

2. Explain the challenges that they have faced keeping this commitment. 3. Explain how you overcame these challenges. What skills have you used to

maintain your commitment? (If they did something they regret, or made a mistake, they should be honest with the others and share what they learned from this event and what they plan to do to avoid this situation in the future).

Reminder! Give a posttest to the youth to ensure that they have learned all of the material. Use the questions listed at the end of this manual for Sessions 13-15.

122

123

Maintenance of Y2Y and LY Groups After the completion of the Choose Life manual, it is imperative to continue meeting regularly with youth. They need peer support as well as guidance in their commitments to abstinence and other sexually responsible behaviors. Do not lose the momentum that you have created! Schedule regular follow-up meetings so that the youth will retain the information they have learned and help support each other. We are asking that the Co-Promoters15 schedule regular meetings with the Leader Youth to develop games and activities for future meetings. Below is an outline to help Co-promoters design these sessions. Leader Youth should continue to meet with youth at the regularly scheduled meeting time – preferably the same frequency (once a month or every other month) as before. The main goal of these follow-up meetings: • Accountability and support for youth in their commitments. • Discussion of the importance of maintenance of the commitments youth have

made. • Discussion and reporting back from the youth about the challenges and

successes they have had since the last meeting. • More practice (simulations) for skills that youth find difficult.

Here are some ideas you can use for your meetings. • Begin each session with a testimony from one of the youth in your group (10-20

minutes). • Use the following sessions to introduce new topics. Consider alternating a

simulation day with a teaching session. After all of these sessions are finished, plan new sessions using the following ideas.

• Discussion of struggles or problems that who have been facing. Use the Review questions from Session 15. (10 - 20 minutes).

• Learning game or activity (30 minutes) • Testimony from a PLWHA or influential adult (15 minutes) • Games (e.g., ice breakers and energizers) (5-15 minutes) • New reflections verses and inspiring faith teachings (30 minutes) • Brainstorming new skills for healthy relationships (45 minutes). Setting up

simulations for practicing these new skills. • Hearing feedback from the youth on successful interactions and strategies they

have used to remain abstinent. (20 minutes) • Repeat selected Choose Life sessions as new youth join the group and as a

reminder to the others. 15 In the "Healthy Choices Leading to Life" program, Co-Promoters are teachers, pastors, and other community leaders who volunteer to assist the Promoter (paid staff) in training and guiding the Choose Life facilitators (Leader Youth). After 15 sessions, the Co-Promoters take over the work of the Promoter in supervising the Leader Youth. The Co-Promoters then work to maintain the existing peer groups, and start new groups as youth graduate into the program or move into the area.

Additional Sessions and Activities

124

Additional Sessions and Activities

125

Does Abstinence Work?

Notes to the Facilitator One of the eight behavioral determinants identified in Barrier Analysis16 is perceived action efficacy. Perceived action efficacy is whether or not someone believes that the new behavior will work to prevent a given problem or disease. If I do not believe that the new behavior is going to be effective in preventing the disease or problem, then I will probably not change my behavior. In some regions, action efficacy is an obstacle that prevents youth from considering abstinence and faithfulness. They are not convinced that these actions – even if they are practiced in a disciplined way – really work to prevent HIV. These youth sometimes think that other things will give them HIV (e.g., mosquitoes, shaking hands) even if they are abstinent or faithful. This session is designed to show the effectiveness of abstinence and faithfulness as prevention methods for sexually transmitted HIV. Since youth in the accountability groups have already made a commitment to abstinence, use this session to teach the youth how to explain why abstinence works to their “non-believing” friends. During this session youth will: 1. Review the three main ways that HIV is transmitted. 2. Identify the strategies to prevent HIV transmission. 3. Rank the strategies that are most effective compared to those which are least

effective. 4. Review secondary abstinence. Values, Attitudes and Beliefs strengthened through this session: 5. Abstinence and faithfulness really work in reducing one’s risk of getting HIV. Materials needed: • Glasses of water (optional)

Activities (core activities are in bold): 1. Testimony: 20 minutes 2. Presentation and Discussion / HIV Facts: 40 minutes 3. Presentation and Discussion (optional): 20 minutes 4. Life Skills Activity: 20 minutes 5. Reflection Verses (optional): 4 minutes 6. Review and Reinforcement: 5 minutes

16 See http://barrieranalysis.fhi.net/ for more information.

Additional Sessions and Activities

126

Testimony: 20 minutes Opening Prayer (optional) Begin the meeting with a prepared testimony from one of the youth (10 minutes) After the testimony ask those listening:

? Have any of you had similar struggles or challenges? How did you overcome these struggles? Encourage discussion. If new skills or techniques are mentioned, encourage others to try using these skills in their life.

? Will you hold (insert name of youth who gave the testimony) accountable to his/her commitment? (This means they will support him/her in their commitment and help them to maintain it). Encourage youth to respond in unison, “Yes we will!” Thank the person sharing and ask another youth to prepare to share at the next meeting. Ask the new volunteer to meet with you when today’s session is finished.

Presentation and Discussion / HIV Facts: 40 minutes Today we are going to discuss the different ways people try to protect themselves from HIV. Some ways work. Some ways are less effective, while others do not protect someone from HIV at all. We want to make sure that when we talk about HIV prevention, we all understand which behaviors are the most effective for the job and that we can explain these reasons to others. Here are some examples of things that youth can do to protect themselves from sexually transmitted HIV.

1. Abstinence from all sexual contact (anal, vaginal, and oral). 2. Being faithful to one partner 3. Using condoms consistently and correctly every time you have sex. 4. Temporary abstinence or delaying sexual debut. Waiting to have sex, or

refraining from sex temporarily (for example, for three months, until I finish school, etc).

5. Reducing the number of sexual partners you have. 6. Going to a VCT clinic.

Ask youth if there are other things that people do to try to prevent HIV. Add these things to the list. Now, go back through the list and ask the youth to choose the ones that are most effective. Cross out any of the responses which are not effective in preventing HIV. See Resource A for more information about HIV and AIDS.

Additional Sessions and Activities

127

If youth mention a prevention method, and you are not sure if it is an effective HIV prevention method, tell them that you will find out. Talk with your Co-Promoter or local health clinic to get more information. Tell the youth that you will have the answer for them at the next meeting.

Add any of the following points that the youth do not mention. Reinforce the effectiveness of each one of these practices 1. Abstinence. Refraining from all sexual contact (anal, vaginal, and oral) gives

100% protection from sexually transmitted HIV. This is the MOST effective prevention practice for youth.

2. Being faithful to one partner. If your partner is not infected and is also sexually faithful to you (and they tell you the truth), then you have no risk of sexually transmitted HIV. This is the most effective prevention practice for married youth or youth in a long-term, committed relationship.

3. Using condoms consistently and correctly every time you have sex has 80-95% chance of protecting you from HIV if you have sex with an infected person. This is one way of lowering your risk of exposure, but it is not as effective as abstinence.

4. Temporary abstinence or delaying sexual debut. Waiting to have sex, or refraining from sex temporarily (for example, for three months, until I finish school, etc), reduces the number of sexual relationships that a youth will have before marriage. Reducing the number of partners is good. However, there is still risk of HIV exposure once the youth begins having sex.

5. Partner reduction. Reducing the number of sexual partners you have, reduces your risk of exposure to HIV. This reduces your risk, but is not the most effective way of avoiding HIV. Remember, having sex only once with an infected person may give you HIV.

6. Going to a VCT clinic helps you to know your HIV status, but it does nothing to protect you from HIV infection. Only by following the prevention advice that the counselor gives you, can you prevent HIV transmission.

? Would you rather be 100% sure that a behavior would work or would you settle for something that is 50% effective? Response: Most people would rather be certain that something works. However, many find abstaining difficult, and therefore settle for something less effective. Let’s watch a demonstration so that we can get a better understanding of the effectiveness of some of these behaviors. Bring in three glasses of water. Tell the youth that one glass is filled with water from a well in a village where there is a cholera outbreak. The other two glasses contain water that is free of cholera. Be sure to mention that within 1 to 5 days of drinking water with cholera you will develop very serious diarrhea. Many people die from this type of diarrhea. Let us say you are very thirsty. It is a warm day and you would like a drink. However, you are worried about cholera. You know that it is a very serious illness.

Additional Sessions and Activities

128

You want to avoid getting sick. However, you do not know which glass contains the cholera bacteria, because you cannot tell by looking at the water. What would be the wise choice to make? Read the following three choices aloud. A – Refrain from drinking until you go home and can get water from your own well, a source that you know is clean. B – Refrain from drinking for a few hours, but then choose a glass of water to drink. C – Drink a little bit from each glass. You are very thirsty.

? Which choice is the best choice? Allow discussion. Reinforce the following points: Only choice A (abstinence) will give you 100% confidence that you will not get cholera. Choice B (temporary abstinence) and Choice C (having many partners) both have a risk of infection.

? If someone has been sexually active in the past, is it possible for them to choose abstinence now? Response: Yes. Youth may decide to have secondary abstinence. This means that they will start over and choose to be abstinent from this point until they are in committed (married or long-term) relationship. If they have been tested and are HIV negative then they too can be 100% sure that abstinence from this point forward will protect them from sexually-transmitted HIV infection. However, some youth decide to be sexually active even though they KNOW that they are taking a risk.

? What are some reasons why youth might not choose to believe that abstinence works? Response: they don’t want to do it, so they don’t want to believe that it works; they may believe HIV is caused by witchcraft or mosquitoes or something else (besides sex); they may have been sexually abused and therefore don’t consider abstinence to work; or they might like sex too much and choose to believe something that they know may be false in order to not look foolish.

? If people choose NOT to believe, does this mean that abstinence does not work? Response: No. Allow youth to respond. Then add: No, many people believe things that are wrong, or not true. The majority of people in the world used to believe that the world was flat. Now we know that the world is a round globe, like a ball, because we have seen it from space and proved it. Many people used to think that AIDS was caused by witchcraft, but we now know that it is a virus in the blood that makes people ill. We may talk to people who disagree with us about abstinence or other choices that we make. However if we know and understand the facts about HIV, we do not need

Additional Sessions and Activities

129

to worry about what others think. We can be confident of making a choice that is 100% effective, and help others to understand the truth too.

Presentation and Discussion (optional): 20 minutes This story is based on Genesis 2:5-6; 6:3, 5-22; and 7:24. Story: As the number of people began to multiply on the earth, so did the bad things that were in the hearts of the people. All of their thoughts were evil and the wickedness on the earth was everywhere. This upset God and He decided to destroy all of humankind. One man, however, loved and obeyed God. His name was Noah. God told Noah He was going to send a flood to destroy the earth because it was filled with violence. He also told Noah to make a very large boat and described in detail how Noah, his family and some of every kind of animal and bird could go into the boat to be saved from the flood. This ark was to be made of wood. It was to be painted inside and outside with tar to prevent it from leaking. There were to be rooms inside, three decks, one window, and a door. God gave the exact measurements that Noah needed for the boat. It took many years for Noah to complete the ark. He did not do all the work himself. He hired people to help him. During this time, three sons were born to Noah and his wife. At last the ark was finished. God told Noah that it was time for him and his family to come into the ark with the animals as He had commanded. The door of the ark closed. For seven days Noah and his family waited in the ark. Then finally, water began to fall from the sky. It rained for forty days and forty nights. The water covered all the earth. Even the highest mountains were covered. All of the living things on the face of the earth died – except for those who were safe inside of the boat. Ask a volunteer to summarize the story and then ask the following questions: We are told in Genesis that rain had never fallen on the earth before the days of Noah. A mist used to rise from the ground to water the plants and animals. We are also told that the people in Noah’s day were evil and filled with violence.

? Knowing this, how do you think they treated Noah while he worked on the boat for many years?

? Do you think Noah had doubts about whether the boat would actually work?

Additional Sessions and Activities

130

Optional discussion: Contrast the story of Noah with an example of a remarkable event that occurred in your nation. Explain that although few people believed the event at first, soon the story was verified and proven to be true.

? How does this story relate to the lessons that we have learned today?

Life Skills Activity: 20 minutes Ask the youth to break into groups of three to work together. Tell them to develop a very short (1 minute) TV commercial promoting abstinence. They should try to “sell” abstinence using their creativity as well as the information that they have learned in the past few weeks. Give them 10 minutes to plan their commercial and practice. Have each group perform their commercial for the rest of the participants. Option 2: If the youth in your group are not familiar with TV commercials, ask them to role-play a discussion with a friend. Assign each group one of the following topics. • Talking to a peer who does not believe that abstinence is the best choice. Explain

to them why abstinence is effective. • Talking to a peer about why being abstinent is the popular thing to do. Explain to

them why all the popular youth are being abstinent. • Talking to a peer about how being abstinent will make you a better spouse in the

future. • Talking to a peer about why being abstinent will give you better relationships with

your opposite-sex peers. • (Optional role-play to emphasize Divine Will) Talking to a peer about how

abstinence is in line with their faith teachings and will help them to have a healthy spiritual life.

Reflection Verse (optional): 4 minutes

Proverbs 4:20-27 “My son, pay attention to what I say; listen closely to my words. Do not let them out of your sight, keep them within your heart; for they are life to those who find them and health to a man's whole body. Above all else, guard your heart, for it is the wellspring of life. Put away perversity from your mouth; keep corrupt talk far from your lips. Let your eyes look straight ahead, fix your gaze directly before you. Make level paths for your feet and take only ways that are firm. Do not swerve to the right or the left; keep your foot from evil.”

Review and Reinforcement: 5 minutes

? What did you learn today that will help you to talk with friends who those who don’t believe that abstinence works?

Additional Sessions and Activities

131

Take Action: Encourage youth to practice the water demonstration at home and use it to talk with their friends and neighbors. Closing prayer (optional) Talk with the new volunteer who will share his /her testimony at the next meeting. Give them guidance on the things that should be included in their testimony. See the guidance at the end Session 15 Gender Roles.

Additional Sessions and Activities

133

Consequences of Misused Sexuality

Notes to the Facilitator This session focuses on what happens when sex is abused and misused. When boundaries for sex and sexuality are not considered, there are certain risks and negative consequences. The purpose of this session is to make youth aware of the risks associated with pre-marital sex and to reinforce reasons for saving sex for mar-riage. They are also given the opportunity to explore the issues of sexual abuse, abortion and gender differences in the light of responding to unmarried pregnancy. If there are local organizations or special services for young pregnant girls or single mothers in your area, you should also provide information about these and bring them into the discussion at the appropriate time. During this learning session youth will: 1. Analyze the risks and consequences of pre-marital sex. 2. Define sexual abuse and its impact on the victims of abuse. 3. Reflect on how the consequences of misused sex are different for boys and girls. 4. Analyze how misused sex can affect them physically, emotionally, mentally and

spiritually. 5. Review the benefits of saving sex until marriage. 6. Identify ways to prevent sexual abuse. Values, Attitudes and Beliefs strengthened through this session: 7. Sex can be hurtful when the boundaries for sex are not followed. Materials needed: • 6 long pieces of fabric to tie legs, arms and use as blindfold

Activities (core activities are in bold): 1. Testimony: 20 minutes 2. Story and discussion: 20 minutes 3. Learning Game: 20 minutes 4. Reflection verse (optional): 2 minutes 5. Review and reinforcement: 5 minutes

Additional Sessions and Activities

134

Testimony: 20 minutes Opening Prayer (optional) Begin the meeting with a prepared testimony from one of the youth (10 minutes) After the testimony ask those listening:

? Have any of you had similar struggles or challenges? How did you overcome these struggles? Encourage discussion. If new skills or techniques are mentioned, encourage others to try using these skills in their life.

? Will you hold (insert name of youth who gave the testimony) accountable to his/her commitment? (This means they will support him/her in their commitment and help them to maintain it). Encourage youth to respond in unison, “Yes we will!” Thank the person sharing and ask another youth to prepare to share at the next meeting. Ask the new volunteer to meet with you when today’s session is finished.

Serial Story and Discussion: 20 minutes

? How many of you were able to share the water demonstration with family or friends? How did they respond? Encourage discussion. We will begin today’s lesson with a story. Story: Sarah sits with tears streaming down her face in her darkened hut. Usually she goes the market with her mother on Saturdays, but today Sarah did not feel well at all. In fact, she felt sick and tired most of the time. Sarah was pregnant and she did not know what to do. When she told her boyfriend James that she was pregnant, he would not even accept that she was carrying his child. He said, “How can I trust you? You have probably been seeing other boys, and you are just saying it is my child to trap me.” Sarah was stunned when he said that to her. She thought he really loved her. He was always telling her he did, and that he wanted to be with her forever. Sarah had always wanted to be a mother, but now she was pregnant long before her heart or her body was ready to be. When she pleaded with James not to leave her, he told her she must go for an abortion. He said he knew a woman who performs abortions in secret and she should go there. But this thought frightened Sarah. She did not want to harm herself or her baby. This was not the first time Sarah had been hurt deeply because of sex. When Sarah was a small girl, her uncle forced her to have sex with him when they were alone together.

Additional Sessions and Activities

135

It was very devastating to her, and she never spoke to anyone about it. After that, she always felt bad about herself. Her parents never encouraged her very much anyway. She felt very insecure around people, especially boys. When she met James, she quickly gave in when he insisted that they have sex. She did not know how else to make him love her. And now, what would her parents say? She knew she would be bringing shame to her family. Worse yet, would she ever be able to find a good husband? All the boys seemed to want to play around with the girls, but none of them wanted to marry somebody who had a child. Ask a volunteer to repeat the main points of the story and then ask the following questions:

? Sarah and James had sex together, but James treated Sarah differently when she became pregnant. Why?

? What does your faith say about abortion?

? What is meant by the term “sexual abuse”?

? The story said that Sarah’s uncle forced her to have sex with him when she was a child, how do you think this affected her emotionally later in life?

? Whom could Sarah talk to about her problem? What would you do if you were in Sarah’s situation? You may want to mention groups in your area that help young pregnant girls and single mothers and groups that address issues of sexual abuse and violence.

Learning Game: 20 minutes The “Handicap” Game: Explain that we all have physical (our bodies), mental (our minds), emotional (our feelings), and spiritual (our faith) parts that together make us who we are as human beings. When we take a particular action or get involved in a relationship, all the different parts are involved and affected. To be healthy, we must care for all four parts of who we are. Ask for four volunteers. Tell the group that each of the four volunteers represents a different part (assign each volunteer a different part). Together they represent one complete person. We are going to consider how misused sex can affect each of the parts. We will show the negative effects by limiting each person’s ability to use a part of their body.

Additional Sessions and Activities

136

Say to the volunteers, All of you together represent one young person who, like Sarah in the story, who had sex with their boyfriend or girlfriend. Stand next to each volunteer as you read the following scenarios to the group. Physical: You are now at risk of infection from many different STIs and also early pregnancy. We will represent this by you not being able to use one of your legs. Tie this person’s leg up with one of the cloths. Emotional: You are now carrying the burden of all of the emotional consequences of the misuse of sex. You are anxious about pregnancy and STIs, you are worried about whether or not your partner will really stay with you; you wonder what your parents will say if they find out and what others will think of you. So you are completely paralyzed. Tie this person’s legs so they cannot move them and put them in a chair. Mental: You are worried and distracted at school because you keep thinking about what happened and what the consequences might be. It is affecting your performance at school. So, you will be blindfolded. Blindfold this person. Spiritual: Engaging in sex outside of marriage has affected your faith. You now often feel guilty, afraid and distant from God. You have forgotten that he still loves you in spite of your behavior. We will represent this by completely restricting your use of your arms. Tie the arms of this person behind them. Now assign the group a task (sweep the floor, move a chair from one end of room to other, etc). Tell them that all four must do the task by working together, even though their movement is limited. You may want to leave the paralyzed person in a chair and have the others push him or her. They must all work together and be involved in carrying out the task. After the task is complete, remove all the handicaps and let the four perform the task again. Ask those involved in the activity after they do the task the second time:

? How did it feel to perform this task with all the handicaps?

? How did it feel to do the task without the handicaps?

? How can having sexual relations before you are married handicap you and prevent you from living your dreams for the future?

Additional Sessions and Activities

137

Reflection Version (optional): 2 minutes 1 Corinthians 6:18 “Flee from sexual immorality. All other sins a man commits are outside of his body, but he who sins sexually sins against his own body.”

Review: 5 minutes

? What did you learn today that will help you in the coming week? Closing prayer (optional) Talk with the new volunteer who will share his /her testimony at the next meeting. Give them guidance on the things that should be included in their testimony. See the guidance at the end Session 15 Gender Roles.

Additional Sessions and Activities

139

Sexually Transmitted Infections (STIs)

Notes to the Facilitator Sexually transmitted infections (also called STIs or STDs) are easily spread when youth are sexually active and have multiple sexual partners. The purpose of this session is to inform youth about sexually transmitted infections and the effects that STIs can have on their physical and emotional health. Often brochures about STIs are available free from government health offices or other organizations. You may want to check to see if these are available and hand them out to the youth. During this learning session youth will: 1. Identify the risks of STIs. 2. Analyze how STIs are spread by having multiple sexual partners. 3. Identify the best way of preventing STIs. Values, Attitudes and Beliefs strengthened through this session: 4. Honesty about your sexual past may protect you and your partner from STIs and

HIV. 5. Lack of discipline and self-control can lead to disease and death. Materials needed: • a bed spread, sheet, blanket or large piece of cloth to represent a bed • hand-outs on STIs from local clinics

Time: 65-85 minutes Activities (core activities are in bold): 1. Testimony: 20 minutes 2. Learning game: 15 minutes 3. Presentation and Discussion / HIV Facts: 30 minutes 4. Story and discussion (optional): 20 minutes 5. Reflection verse (optional): 2 minutes 6. Review: 5 minutes

Additional Sessions and Activities

140

Testimony: 20 minutes Opening Prayer (optional) Begin the meeting with a prepared testimony from one of the youth (10 minutes) After the testimony ask those listening:

? Have any of you had similar struggles or challenges? How did you overcome these struggles? Encourage discussion. If new skills or techniques are mentioned, encourage others to try using these skills in their life.

? Will you hold (insert name of youth who gave the testimony) accountable to his/her commitment? (This means they will support him/her in their commitment and help them to maintain it). Encourage youth to respond in unison, “Yes we will!” Thank the person sharing and ask another youth to prepare to share at the next meeting. Ask the new volunteer to meet with you when today’s session is finished.

Learning Game: 15 minutes Remember to have cloth or blanket ready. Directions for “The Crowded Bed” Game 16 1. Ask for one male and one female volunteer to step forward and stand in the center

facing the audience. It is best to choose people who are least likely to be embarrassed and most likely to add humor to the activity. Ask the group to pretend that the two are named John and Lydia. He is 18 years old and she is 16.

2. Tell the group that John and Lydia met a few months ago when they were taking

the same class at secondary school. They are hopelessly in love and think that they are ready to make the decision to begin sexual relations with each other.

3. Pull out the sheet and ask John and Lydia to help you make the bed. Together

spread the cloth on the floor. Invite them to come and sit on the front of the cloth. 4. Explain the following scenario using volunteers from the group: During their conversations, John told Lydia that he had one previous sexual partner, his former girlfriend. Select another volunteer to represent John’s ex-girlfriend and ask her, “Please come over here and sit on John’s side of the bed.” John does not know this, but on a school trip, his ex-girlfriend had a brief sexual relationship with another student. Choose a male volunteer to represent this person and ask him to sit on John’s side of the bed.

Additional Sessions and Activities

141

What John’s ex-girlfriend did not know is that the student with whom she had a brief affair had already had sexual relations with two women before her. Choose two volunteers to represent these people and ask them to sit on John’s side of the bed. Actually, John had his first sexual experience at a very young age with another girl. Get a volunteer and ask her to sit on the bed on John’s side. We have some news for John as well. Lydia told John that she had been involved with only one sexual partner, a former boyfriend. Choose another volunteer to be this person and ask him to sit on Lydia’s side of the bed. Lydia has led John to believe that she is sexually inexperienced because she had only one boyfriend. But even though she was not in love, she had sexual relations with two other men. Ask for two more male volunteers and have them sit on her side of the bed. If you run out of volunteers – just continue reading the story – place rocks or other objects on the cloth to represent the other partners. What Lydia does not know is that the second of these men had sex with this woman (choose another female volunteer), and that he was an injecting drug user who shared needles with two other men, one of whom was HIV positive. Get three more male volunteers and have them sit on her side of the bed. Oh, and one more thing. John was not completely honest about his sexual past. While he was away in a different village visiting his uncle, he had too much to drink one night and had sex with a local prostitute. Choose another volunteer and ask her to sit on John’s side of the bed. And the prostitute slept with… Discuss: Now let us think about this situation between John and Lydia. The bed is very full.

? Ask John and Lydia, Now that you see how many partners you have actually been exposed to, do you still think it would be wise to have sex together?

? What are some of the dangers that John and Lydia face if they have unprotected (no condom) sex with one another? Response: unplanned pregnancy, infection with STIs including HIV John and Lydia could not tell the number of partners each was exposed to just by looking at each other. Even when they talked about their sexual pasts, they did not tell each other the truth.

? What are the dangers that you face if you do not tell the truth about your sexual past?

Additional Sessions and Activities

142

Presentation and Discussion / HIV Facts: 30 minutes We have been talking a lot about HIV as a physical consequence of sex. However, HIV is only one type of infection that is transmitted through sexual activities. There are many other infections that are common for sexually active youth. These are called STIs, sexually transmitted infections, or STDs, sexually transmitted diseases. HIV is ONE type of sexually transmitted infection, but there are many more.

? What have you heard about sexually transmitted infections? Response: STIs are infections that are transmitted by sexual activity with an infected partner. Some STIs can also be transmitted through intimate skin-to-skin (genital) contact with an infected person. The most common sexually transmitted infections include trichomoniasis, gonorrhea, syphilis, and herpes. Symptoms of STIs may include: • genital sores • pain when urinating • inflammation around the genitals • unusual and foul-smelling discharge

At first the symptoms of these STIs may seem minor, but if they are left untreated, some may cause permanent damage to the body. Untreated STIs are a major cause of illness, infertility, mental illnesses, and in some cases, death. The symptoms and consequences of STIs are more severe for women, and the newborn babies of infected mothers. Some STIs, like HPV, make it more likely that a woman will get cancer. STIs also increase the risk of HIV infection, because of the sores or inflammation of the genitals. Individuals with STIs are two to five times more likely than uninfected individuals to get HIV if they are exposed to the virus through sex. In fact, if someone has HIV and another STI, they are more likely to transmit HIV through sexual contact than someone who only has HIV.17 STIs could have easily been passed between any of the people we saw on the “Crowded Bed.” This means that Lydia’s chances of getting HIV from the injecting drug user in the story increases greatly if he had an STI, or if she had an STI from her first partner. Many STIs are treatable and will clear up with medicine. Others, however, require long-term treatment to reduce the symptoms. HIV is one type of STI that does not have a cure. In some cases, proper nutrition and drugs can prolong life and improve the quality of life, but there is no cure. If handouts on STIs are available, pass them out to participants now. To review, ask the following questions:

? Who is at risk for STIs?

Additional Sessions and Activities

143

Response: Anyone who is sexually active is at risk. The more sexual partners you have, the greater the chance that you have a STI. However, even if you have sex with only one person, if they have had previous partners, you are at risk. Sexually active YOUTH are especially at risk. The highest rates of STIs are found in unmarried people who are between the ages of 15-35.18

? Why is it important for youth who are committed to abstinence to know the facts about STIs? Allow youth to respond and then add any of the points below that are not mentioned: • They may be able to speak to others about the consequences of sexual activity. • It may encourage them - they do not have to worry about STIs. • It may increase their understanding of the consequences of sexual activity and

help them keep their commitments.

? Why is it important for youth who are sexually active to know the facts about STIs? Allow the youth to respond and then add: • So they might consider the advantages of abstinence and delay when they start to

have sex. • So they can slow the spread of HIV by treating all STI infections immediately. • So they can take precautions (use condoms) to help prevent STIs. (Condoms

help to lower the risk of STIs but are not 100% effective. Keep in mind that even when using condoms, one can get genital herpes, syphilis and HPV.)

Story and Discussion (optional): 20 minutes

In Session 3, Choosing a Good Mentor, we learned the story of King Solomon’s son King Rehoboam. In this passage, we hear the words of his father, King Solomon, as he writes in the book of Proverbs. Story is adapted from Proverbs 5. You can read the story from the Bible or tell it as it is here. Story: My son, pay attention to my wisdom, listen carefully to my wise counsel. Then, you will learn to be discreet and store up knowledge. The lips of an immoral woman are as sweet as honey, and her speech is smoother than oil. But in the end she is as bitter as poison, sharp as a double-edged sword. Her feet go down to death; her steps lead straight to the grave. She gives no thought to the way of life. She staggers down a crooked path, and does not even realize where it leads. Now then, my son, listen to me. Do not stray from what I am about to say. Keep to a path far from her! Do not go near the door of her house. If you do, you will lose your honor and hand everything you have achieved in life to merciless people. Strangers will obtain your wealth and someone else will enjoy the fruit of your labor. At the end of your life you will groan, when your flesh and body are spent. You will say, "How I hated discipline! How my heart spurned correction! I would not obey my teachers or listen to my instructors. I have come to the brink of utter ruin and now I must face public disgrace."

Additional Sessions and Activities

144

Drink water from your own cistern, running water from your own well. Should your springs overflow in the streets, your streams of water in the public squares? Let them be yours alone, never to be shared with strangers. Let you wife be a fountain of blessing for you. Rejoice in the wife of your youth. She is a loving doe, a graceful deer. Let her breasts satisfy you always. May you always be captivated by her love. Why be captivated, my son, by an immoral woman or adulteress? Why embrace the bosom of another man's wife? For the Lord sees clearly what a man does, examining every path he takes. An evil man is held captive by his own sins. They are ropes that catch and hold him. He will die for lack of discipline, led astray by his own great folly. Ask a volunteer to summarize the advice given by King Solomon and then ask the following questions:

? According to this passage, from whom should young men (or women) find sexual pleasure? Response: From their spouse.

? According to this passage, what are the consequences if young men (or young women) share their sexuality with strangers? Responses may include: You will enrich another man’s house, your flesh and body will be spent, you will be in pain (emotional and physical consequences).

Reflection Verse (optional) – 2 minutes Hosea 4:6 “My people are destroyed from lack of knowledge.”

Review: 5 minutes

? What did you learn today that will help you in the coming week? Closing prayer (optional) Talk with the new volunteer who will share his /her testimony at the next meeting. Give them guidance on the things that should be included in their testimony. See the guidance at the end Session 15 Gender Roles.

Additional Sessions and Activities

145

Strategies for Maintaining Abstinence

Notes to the Facilitator This session reinforces the reasons for choosing abstinence and addressing barriers that would prevent youth from maintaining their commitment. The story features David, a main character, who has thought through his situation and has decided, in spite of having already had experience with sex, to commit to delaying sex until marriage. Using drama in the “Quick Skits” activity, youth have the opportunity to practice strategies for setting sexual boundaries and responding with confidence in situations where previously they felt powerless. They also consider the influence of the media on their life choices and discuss the importance of testing for HIV. During this learning session, youth will: 1. Create strategies for dealing with temptation and peer pressure. 2. Consider the influence of the media on behavior and choices. 3. Discuss the importance of testing to know one’s HIV status Values, Attitudes and Beliefs strengthened through this session: 4. Real strength is being in control of your desires, not allowing your desires to

control you. Time: 75 - 90 minutes Materials needed: none Activities (core activities are in bold): 1. Testimony: 20 minutes 2. Serial Story and Discussion: 30 minutes 3. HIV Facts: 20 minutes 4. Life Skills Activity: 30 minutes 5. Story and Discussion (optional): 20 minutes 6. Reflection Verse: 2 minutes 7. Review: 5 minutes

Additional Sessions and Activities

146

Testimony: 20 minutes Opening Prayer (optional) Begin the meeting with a prepared testimony from one of the youth (10 minutes) After the testimony ask those listening:

? Have any of you had similar struggles or challenges? How did you overcome these struggles? Encourage discussion. If new skills or techniques are mentioned, encourage others to try using these skills in their life.

? Will you hold (insert name of youth who gave the testimony) accountable to his/her commitment? (This means they will support him/her in their commitment and help them to maintain it). Encourage youth to respond in unison, “Yes we will!” Thank the person sharing and ask another youth to prepare to share at the next meeting. Ask the new volunteer to meet with you when today’s session is finished.

Serial Story and Discussion: 30 minutes In the story below we catch up with David from Session 5. However much has happened since he was contemplating going to the party. Review Resource D. Give a summary of David’s story before reading the text below. Story: David is walking home from school a few days after his talk with his mentor, Paul. He thinks about what Paul said; that it is not too late for him to change his life. Could he really start over? There are so many temptations around him, could he do it? Could he wait until he is married to have sex again? When he went to the clinic to be treated for the STI, he decided to be tested for HIV as well. When he got the results and his test was negative, David was so relieved and thankful. It gave him new determination that it was the time for him to make a fresh start. David considers what it will take. He thinks of the magazines that the guys pass around. He knows they are always going to be there along with the movies and billboards showing beautiful women. There would always be plenty of girls like Esther who were willing to have sex with him. There would be constant reminders of the pleasures of sex. It would not be easy. But as he thinks through his options and considers the consequences, it finally makes sense to David. He is more and more convinced that if he wants to be truly free, and realize his dreams for the future, he will have to be strong now. “It’s not like I will never have sex again,” he thought to himself. “It just means holding out and waiting for the right time.”

Additional Sessions and Activities

147

David remembered the leaflet Paul had given to him. It was something some guys who had committed to abstinence had written. They called it, “Tough Love19” and it said:

Some people think a guy has to have sex to prove he is a man. We do not think so. The truth is, it takes a lot more strength to keep your passions under control than to give in to them. We have chosen to save sex for marriage and waiting is not easy (for guys or girls). But waiting is worth it. We have chosen to wait because we know sex is supposed to unite a man and a woman in a way nothing else can. It is supposed to be fun and much, much more. That is why we are passing up on cheap sex now. And why we are holding out for the ultimate sex with the one we will vow to love forever.

Ask a volunteer to repeat the main points in the story and then ask:

? Do you think David will succeed in his commitment to being abstinent from now on?

? What do you think will help David stay committed to this choice?

? Why do you think it is important to be tested for HIV if you have had sex before marriage?

HIV Facts: 20 minutes

? What happens at a HIV testing center? Ask the youth if they know anyone who has gone to a VCT clinic and can explain to the others what happens there. Allow youth to respond. Read the following story to enhance your discussion. See Resource A for more information on HIV and AIDS. In the story today, you heard that David went to a clinic to be treated for his STI. Here is the way it happened… Story: The clinic referred him to a VCT, a Voluntary Counseling and Testing Center. There he met with a counselor who spoke to him about his worries about HIV. The counselor told him that it would be good to get a HIV test, since STIs increase the chance of HIV transmission. She explained about the different types of tests and told him that after the test he would receive counseling and HIV prevention guidance – no matter what the results were. She was very kind and helped ease David’s fears. He decided to follow through and have an antibody test. They took a small sample of David’s blood; it was not too painful. The nurse said that the test would measure the antibodies in his blood. Antibodies are produced by the immune system to fight the

Additional Sessions and Activities

148

virus. If the test finds HIV antibodies, then they know that the virus is present in the body. The hardest part was that David had to wait for two weeks before he could get the results. At the end of those two weeks, he went back to the VCT clinic. The counselor took him into a quiet room to talk to David. She told him that his test was negative. He was so relieved! However, the counselor was not finished. She told David that even though his test had come back negative, he should come back in a few months to confirm the results. She explained about the “window period.” She said, “It can take up to three months after a person is infected with HIV for their body to produce enough antibodies to be detected with an antibody test. This is called the ‘window period,’ the time between the infection and the immune system’s response to the virus. If a person has an HIV antibody test during the window period, the test will be negative, even though they may have HIV and are able to infect others.” This was not good news, but David was confident that he could remain abstinent until the second test, after the window period of his time with Esther had passed. The nurse explained to him how to prevent future infections. She answered his questions, and told him that their conversation and his test results were confidential. David thanked her and returned home. Answer any questions from the youth.

Life Skills Activity: 30 minutes Controlling yourself and maintaining your commitments takes strength. It is difficult to overcome peer pressure, sexual desires and curiosity. How can you remain sexually pure in the face of such challenges? Here are some ways to help guide you: Know what you believe - Review your faith statements about sex and morality. Know your personal goals and work towards them - Think about your goals and dreams for the future. One wrong choice can have a big impact on your chances of living your dreams. Focus on building strong friendships - True friends are there when times are tough. Romantic relationships can seem strong at the time, but often do not last. Even when you have fallen in love and marry, you will still need the support of friends and family. So invest in lasting friendships now. Set boundaries in relationships - It is not wrong to find a particular person attractive and want to focus some of your time and attention on him or her. It is necessary, however, to set some boundaries in those relationships to keep them from leading you into sex and emotional and physical pain. Talk to your friends, boyfriend or girlfriend about your boundaries and your commitment to abstinence.

• Anticipate difficult situations before they happen.

Additional Sessions and Activities

149

• Be aware of your body language. Think about what sort of messages the clothes you wear and the way you interact with others send to the other person.

• Avoid tempting or risky situations. Do not put yourself in a situation where you are alone with the person for a long period of time, especially at night or in the dark.

• Stay in control. Avoid drinking alcohol and using drugs because they will lower your self control.

Seek the help of others - Seek the support of others who understand your commitment to delay sex. Be ready to run - Sometimes, in spite of all you may do to avoid having sex, you might find yourself in a difficult situation. Be prepared to firmly say “No.” If necessary, run away and if it is not possible to run away and someone is forcing sex on you, scream as loud as you can and try to get attention from others.

Quick Skits Activity: Choose eight volunteers to form four groups of players with two people in each group (preferably one boy and one girl for most scenarios). The remainder of the group can help encourage the players. Explain that you will be giving them a situation and they have to make a skit about it. Encourage them to apply what they have just heard about resisting pressure to the situation they are given. Remind participants: Speak clearly and loud enough for all to hear. Do not turn their back to the audience when speaking or gesturing. Each group should pick a number from one to four. Assign them the corresponding situation. Give them a few minutes (no more than five) to create a 3-minute skit that deals with the assigned situation. Suggested situations (or provide your own):

1. Economic pressures/ sugar daddies - Girl cannot pay school fees and also wants new clothes and nice things. One older man offers to pay for them if she will sleep with him.

2. Peer pressure - Boy being teased because he is a virgin. His friend (another boy) wants to take him to a prostitute.

3. Partner pressure - Girl loves movies and believes if she had a nice dress and hairstyle she could be like the glamorous women in them. Her boyfriend says he will buy her these things if she sleeps with him.

4. Temptation and media pressure - Boy has committed to abstinence after already being sexually active but continues to watch sexually explicit movies. There is a flirtatious girl who has made it obvious that she would sleep with him.

? What did the players do to resist pressure? If one of the skits deals with media ask the group to respond to this question:

? How does the media (radio, TV, movies) influence your decisions about sex?

Additional Sessions and Activities

150

Story and Discussion (optional): 20 minutes Story is from John 8:2-11. You can read the story from the Bible or tell it as it is here. Story: Early one morning, Jesus went to the Temple in Jerusalem. While he was there, all the people gathered around him. He sat down and began to teach them. The teachers of the Law and the Pharisees brought in a woman who had been caught committing adultery, and they made her stand before them all. “Teacher," they said to Jesus, "this woman was caught in the very act of committing adultery. In our Law Moses commanded that such a woman must be stoned to death. Now, what do you say?" They said this to trap Jesus, so that they could accuse him. But he bent over and wrote on the ground with his finger. As they stood there asking him questions, he straightened up and said to them, "Whichever one of you has committed no sin may throw the first stone at her." Then he bent over again and wrote on the ground. When they heard this, they all left, one by one, the older ones first. Jesus was left alone, with the woman still standing there. He straightened up and said to her, "Where are they? Is there no one left to condemn you?" "No one, sir," she answered. "Well, then," Jesus said, "I do not condemn you either. Go, but do not sin again." Ask a volunteer to repeat the main points of the story and then discuss the following questions: In Jesus’ time, the law said that if a man and woman who are not married to each other have sex together, they should both be punished. In this case, they only brought the woman to be punished.

? Do you think that is fair? Why or why not? If they do not respond right away, be patient and encourage participants to think about these questions. Jesus showed the woman that he would not condemn her for her past mistakes but that she should change her ways from now on. In the same way, when we fail to keep our commitments, or do something that we regret, we can start over. We can reach our goals, if we are persistent. Don’t let small set-backs discourage you.

Reflection Verse (optional) – 2 minutes Philippians 4:8 “In conclusion my friends, fill your minds with those things that are good and that deserve praise: things that are true, noble, right, pure, lovely, and honorable.”

Additional Sessions and Activities

151

Review: 5 minutes

? What did you learn today that will help you in the coming week? Closing prayer (optional) Talk with the new volunteer who will share his /her testimony at the next meeting. Give them guidance on the things that should be included in their testimony. See the guidance at the end Session 15 Gender Roles.

Additional Sessions and Activities

152

Additional Sessions and Activities

153

Maintaining My Commitments

Notes to the Facilitator Maintaining a commitment to abstinence is not easy. Temptation and ongoing life pressures cause youth to question their decisions. The purpose of this session is to continue strengthen their commitments and to encourage youth to support each. During this learning session youth will: 1. Identify the barriers to maintaining abstinence. 2. List ways to support each other to maintain abstinence. 3. Analyze the power of positive peer pressure. Values, Attitudes and Beliefs strengthened through this session: 4. We should lift up and encourage others. Time: 40-95 minutes Materials needed: none Activities (core activities are in bold): 1. Testimony: 20 minutes 2. Serial Story and discussion: 25 minutes 3. Learning game: 20 minutes 4. Story and discussion (optional): 25 minutes 5. Reflection verse (optional): 2 minutes 6. Review: 5 minutes

Testimony: 20 minutes Opening Prayer (optional) Begin the meeting with a prepared testimony from one of the youth (10 minutes) After the testimony ask those listening:

? Have any of you had similar struggles or challenges? How did you overcome these struggles? Encourage discussion. If new skills or techniques are mentioned, encourage others to try using these skills in their life.

? Will you hold (insert name of youth who gave the testimony) accountable to his/her commitment? (This means they will support him/her in their commitment and help them to maintain it). Encourage youth to respond in unison, “Yes we will!” Thank the person sharing and ask another youth to prepare to share at the next meeting. Ask the new volunteer to meet with you when today’s session is finished.

Additional Sessions and Activities

154

Serial Story and Discussion: 25 minutes The last time we met, we heard your stories, this week we will have one last visit with David and his friends. Story: David is standing next to a stall in the market buying shoes for his younger brother Peter. They have just finished bargaining for a pair of black school shoes that Peter can wear as he starts junior secondary school. Peter is excited about the new purchase and runs off to show his sister Sarah who is buying a blanket for her baby at a stall not far away. As David turns to go he nearly runs into Mark, the friend who introduced him to Esther. Use different voices for each character “David, how are you?” asks Mark. “We haven’t seen you for awhile. You have missed a lot of fun nights on the town with some fun girls.” “Hi Mark.” David responds, quickly looking down, embarrassed that he has been confronted about his changing lifestyle. But then, David feels a new strength and confidence. “It’s good to see you Mark. I have been busy with school and other things lately.” “Esther has been asking about you. I guess she misses your company, huh?” Mark laughs and slaps his friend on the back. “You must be some kind of man for her to be missing you so much. I know you guys had a good time together. She is going with James now, but her younger sister is a lovely thing. I am sure you could have an even better time with her. Why don’t you come along to hang out tonight? Everyone is going to be there, and I know they would be glad to see you.” “Thanks Mark, but I am too busy with school to get distracted by those things. I am sure Esther’s sister is a nice girl, but I do not have time to mess around like that anymore. Tell everyone I say hello and wish them well.” Mark’s face gets serious. He lowers his voice a bit and says, “David, look, you’re a young man and you have to show you are strong while you are young. Come along and have some good times with us so you can remember what real living is like.” “Mark, I do remember the ‘good times’ you are talking about. And you know, it did start out great, and I felt cool and accepted. But now I know that kind of fun was not worth the price. A strong man thinks about the future. I do not mean I am better than you guys. I just am making different decisions now. Time will tell who made the best ones. But listen Mark, I am going to a youth meeting tonight at my church. There are some really cool people there who think differently about what it takes to have a good time. Why don’t you come with me?” Mark blinks a few times, not sure how to respond. David was usually so easy to persuade, and generally much quieter than this. What has changed him? Mark stares at David for a moment and almost agrees to go to the meeting, but then he remembers his other friends who will be waiting for him tonight and he knows what they would say.

Additional Sessions and Activities

155

He focuses again on David and says, "Thanks man, but maybe another time. I will think of you when I am with Esther’s sister tonight. Hope you don’t regret it.” “Don’t worry about me. I’m just fine,” says David as he waves to Mark. Sarah and Peter emerge from a row of stalls just behind them, and Sarah silently looks at her older brother with a new light in her eyes. She was walking ahead of Peter and overheard David’s conversation with Mark. (Sarah has a baby of her own, and no husband, but David has given her new hope. A whole new world with new possibilities has opened in front of her.) She decides to ask Peter to watch the baby while she goes with David to the meeting. She wants the kind of freedom that she sees David has. She knows she will find a way to return to school. She smiles to herself, and feels a small spark of hope for the first time in a very long time. Maybe life is worth living after all. Ask a volunteer to repeat the main points of the story. Then ask:

? What was David’s response to Mark’s invitation? What do you think helped him be strong and able to stand up to this temptation?

? We have talked in the past about negative peer pressure. How can peer pressure be positive?

? How did David’s response to Mark affect Sarah? How can our decision to abstinence affect others around us?

? Did David act as though he was better than Mark? How should we talk to people who have chosen differently from us if we want them to respond positively to what we have to say?

? Paul was a positive influence on David and helped him make a decision to be strong. How can you be a positive presence in the life of someone else? Emphasize encouragement and not to be judgmental but forgiving and understanding like Paul was for David, and like he was with Mark and his sister Sarah.

? How can we support each other and help each other to stay committed to our commitments?

Learning Game: 20 minutes Those who have committed to stand for abstinence need to help each other stay faithful to their commitment. Trust is a very important part of counseling a friend. We have to trust each other enough to be open and honest, and we have to be worthy ourselves of the trust others place in us - to keep their secrets, to be non-judgmental but honest. All of these elements are important if we are going to support each other.

Additional Sessions and Activities

156

Now we are going to do an activity that demonstrates trust - how difficult it can be and how important it is that we can be trusted. Trust Fall Game: The facilitator should pick eleven volunteers. One of them will be the “faller,” the person who has to trust the others and ten are the “catchers,” who must be trusted. The facilitator tells the faller to stand on top of a table or some other object. It is best if it is at least a meter high, higher than a chair. Be sure the table is stable and have people support it if necessary. The other ten should stand facing each other, shoulder to shoulder, five on one side and five on the other. DO NOT USE LESS THAN TEN PEOPLE TO SUPPORT THE “FALLER”. Then, each person should reach across and grab the wrists of the person across from them, so that they form a kind of bridge with their arms. While they are standing, do not allow anyone to kneel or sit. They become the “catchers.” The faller then stands on the table with his or her back to them. He or she then has to fall back onto the grasped arms of the group. The facilitator should demonstrate this first with the ten other volunteers. Keep your legs straight rather than trying to sit down into the catchers’ arms. The catchers should then rotate and also become fallers so that all people in the group get a chance to participate.

? How did we show that we trusted each other in this activity?

? Why is trust important between people? Why is it important between those of us who committed to abstinence?

Story and Discussion (optional): 25 minutes This story can be found in the book of Nehemiah chapters 1-13 Story: Many years before this story takes place, the Israelites had been forced to leave their land and live in Babylon as exiles. Nehemiah is one of these exiles in Babylon, and he works for the king in a very important position. One day, Nehemiah hears that the wall back in Jerusalem is still broken down, and his people there are in disgrace. Nehemiah is broken-hearted and prays to God. He confesses his and his peoples’ sins, fasts for days and asks for God’s help. Then God gives him the answer. Nehemiah decides to go before the King and ask if he can return home. He will be risking his life, because it was against the King’s wishes to ever show a sad or worried face in his presence. When Nehemiah goes before the King and asks permission to return home, God shows that he in control. The King honors his request and agrees to let him go. He even gives him some supplies for the journey. So, Nehemiah returns home to Jerusalem and begins to organize those left there to rebuild the wall. He and his fellow Israelites immediately meet with resistance. Sanballat the Horonite, Tobiah the Ammonite, and Geshem the Arab mock and make

Additional Sessions and Activities

157

fun of the Israelites for even thinking they can do such a difficult thing as rebuild the city’s walls. Nehemiah assigns each group of Israelites a special section of the wall to rebuild. They begin working and soon they see that the wall is really getting built. Meanwhile, the enemies of the Israelites are mocking and planning to attack them and destroy all their hard work. But Nehemiah reminds his people that God is protecting them and that they should stand strong. He speaks out against the oppression of the leaders against his own people. Their enemies try to discredit and intimidate Nehemiah by spreading lies and rumors but he does not listen. The Israelites stand together strong. Their enemies are reduced to nothing because the people refuse to be dissuaded from their purpose. Despite all of the obstacles, the people remain faithful to their goal and finally the wall is finished. All of the people rejoice, and the society in Jerusalem begins to rebuild itself. Ask a volunteer to repeat the main points of the story.

? What does this story tell us about standing strong together? Encourage group participation. Listen to several responses.

? What are some obstacles our own enemies can put in our way to try to get us to fail in our goal of remaining abstinent?

? What are some the ways we can act toward each other that will help us to stand strong and feel encouraged?

Reflection Verse (optional): 2 minutes Hebrews 10:24 “Let us be concerned for one another, to help one another to show love and to do good.”

Review: 5 minutes

? What did you learn today that will help you in the coming week? Closing prayer (optional) Talk with the new volunteer who will share his /her testimony at the next meeting. Give them guidance on the things that should be included in their testimony. See the guidance at the end Session 15 Gender Roles. Make a plan for what you will discuss at the next meeting. There are a few additional activities in the next few pages. Refer to the section, Maintenance of Y2Y and LY groups, after session 15 for ideas.

Additional Sessions and Activities

158

Additional Sessions and Activities

159

Additional Activities and Discussions:

Additional simulations for selected skills Follow the guidance from Session 3 for setting up the simulation. For 60 minute sessions, begin with two or three large group demonstrations, then move to working in pairs until everyone has practiced being a trainee. For 90-minute sessions, give everyone a chance to be a trainee in front of the large group. If you are running out of time, move to working in pairs. Skill 1: Communicating a message with confidence. Trainee: Your friend (or sibling) tells you secretly that he/she has been sleeping with two different partners. Performer: Begin the conversation by talking about you new partner. You believe that “only those who sleep with prostitutes get HIV.” You don’t feel you are at risk. Ask a lot of questions about HIV. Continue until the trainee has clearly explained the way in which HIV is sexually transmitted, and has used at least three good communication techniques. Stop the simulation. Skill 3: Communicating your relationship boundaries. Trainee: Your boyfriend/girlfriend continues to talk about activities (that you decided together you would not do). Performer: Talk lovingly to the trainee. Try to persuade the trainee to change their boundaries. Tell the trainee that you will find another partner to satisfy your desires. Continue until the trainee makes it clear they will not change their boundaries. End the simulation. Skill 4: Avoiding the things that make healthy relationships difficult. Trainee: You are talking with your friends when one of them hands you a sexy magazine [or other object which you have decided to avoid]. Soon everyone is gathered around you looking at the magazine. Performers: Show your interest and excitement about the magazine. Continue trying to persuade the trainee until he gives three good reasons why he doesn’t want to see the magazine OR moves away from the situation. Then close the magazine, change the subject and end the simulation. Skill 5: Saying no with your voice, body and actions. Trainee: Your friends leave you alone with someone whom you don’t know. While they are away the person starts making advances towards you. Performer: Stand in front of the person taking small steps closer with each word. Grab the trainees arm and tell them that you have been watching them for a long time. Keep them firmly in your grip. Be persistent. Continue until the trainee has done a good job using their voice, actions, and words to say no OR runs away from the situation.

Additional Sessions and Activities

160

HIV Discussion: 20 minutes

Use this discussion to reinforce the importance of faithfulness. We’ve talked a lot about how sex before marriage can stop us from reaching our goals. However, when we do get married, does this mean we won’t have to worry about HIV infection any more?

? Can married youth get HIV? Listen to their responses and then add any of the following points that are not mentioned: • YES! Even if you are married, there is still a risk of HIV infection! Married people

must take precautions too! • If both husband and wife have been sexually abstinent and (have had no prior risk

of HIV transmission through blood) then they are not at risk. However, they must both remain sexually faithful to one another (no sex with others) throughout the entire marriage.

• If one or both of the married persons were sexually active before they were married – they should be tested for HIV. If both persons receive a negative HIV test (at least three months after the time of possible infection), and they both remain sexually faithful to one another throughout the entire marriage, they have no risk of sexually-transmitted HIV.

• (if applicable) For youth involved in polygamous marriages, all partners must be free of HIV and remain faithful. If one person in the marriage is unfaithful and becomes infected, everyone else is also at risk.

? So if our friends are getting married, what advice should we give them? Listen to the responses and then add any of the following points that are not mentioned: • Talk to your future spouse before you get married about the importance of

faithfulness in marriage. Make a commitment to be faithful to your spouse and make sure that they commit to being faithful to you too!

• If you are unsure about your status, or the status of your future spouse, get tested so that you can be sure.

• If you find out that your spouse is not faithful (or you suspect that they are unfaithful) or you do not feel that you can be faithful, talk to a health provider about male or female condoms to protect yourself from HIV exposure.

Additional Sessions and Activities

161

HIV Learning Game: 50 minutes This game reviews the ways that HIV is transmitted. It also addresses peer pressure.

Think about the pressures you feel in your life and what is influencing you. We feel as though every step we take, every decision we make, can be dangerous and affect our future. Plus, there are so many voices trying to tell us what to do – our parents, teachers, friends, boyfriends and girlfriends, brothers and sisters. Some of them give us good advice, and some of them try to lead us to do things that are bad for us. Let us play a game that reflects this. Let us pretend this grid is a river. Each stone represents a crocodile. The crocodiles symbolize an activity that puts us at risk of HIV infection. We want to make it across the river, without meeting any crocodiles – that is cross the river without doing things that put us at risk for HIV infection. We will begin by naming each of these stones/crocodiles with an activity that puts someone at risk of HIV exposure.

? What are some activities that might put someone at risk of HIV transmission? As they name a correct response, place a rock in the grid. Continue until all the rocks are placed in the grid, or you have run out of ideas. Correct any misunderstandings. Use the information in Resource A if you need more information. Responses may include:

Activities with a RISK of HIV transmission • Having sex with a commercial sex worker • Having sex without a condom • Receiving an untested blood transfusion • Using unsterilized instruments (that have fresh blood on them). • Using unsterilized needles or other injectors (that have fresh blood on them).

Start

Finish

X X X

X X X X

X X

X X X

X

X X

X X

Preparation: Draw a large version of the grid shown to the left on the ground, in the sand, or on the floor with chalk or masking tape. Make it large enough for a person to stand in each square. Collect stones or other objects to represent the Xs. Use the concept of crossing a river with sinkholes and crocodiles (or create a different scenario of your choosing which represents everyday dangers as they travel from one place to another).

Additional Sessions and Activities

162

• Having a baby (if the mother is HIV infected and not taking antiretroviral drugs) – the baby may become infected during birth

• Having a baby (if the mother is HIV infected and not taking antiretroviral drugs) – the baby may become infected while inside the mother

• Breast-feeding a baby, especially if the mother gives both breast milk and other foods or liquids before the child is six months old (if the mother is HIV infected and not taking antiretroviral drugs)

If youth mention any of the following, be sure to correct them. HIV is NOT spread in any of the following ways. Do not mention these unless one of the youth brings it up first. HIV is not spread by:

• by touching someone with HIV • by mosquitoes or other insects • by kissing someone with HIV • by sharing eating utensils – spoons, forks, or bowls with someone with HIV • by swimming or bathing with someone with HIV • by living in the same house or working with someone with HIV • by using the same toilet as someone with HIV • by witchcraft

Grid Game: Next, choose a volunteer and blindfold them. Move the objects on the grid so they do not know where they have been placed on the grid. Have the other players stand around the square. These players represent the people in this blindfolded person’s life such as mentors, parents, brothers, sisters, friends, boyfriends, girlfriends, and schoolmates. These people should begin yelling instructions at the blindfolded person on how to get through the grid without stepping on a crocodile (X). Some people should yell the right things, and some the wrong. The blindfolded person must try to make their way through the grid safely using their instructions. Very often the youth will get excited and yell their instructions all at once so that the blindfolded person cannot hear anything. If this happens, suggest that the “crowd” gives their instructions one at a time Let 2-3 people try it blindfolded, and encourage the surrounding “friends and family members” to yell both correct and incorrect directions.

? Ask those who were blindfolded: • How did it feel playing the game? Possible responses: If was hard to

know who to listen to. It was discouraging. • Did you feel bad when you made a mistake? Possible response: I felt

like I disappointed my friends.

? Ask the others: How did it feel to be the person on the side yelling instructions? Listen to several responses. Possible response: It was fun trying to guide them. I didn’t like it when others gave them the opposite advice.

Additional Sessions and Activities

163

? Ask the group: Why is it important for us to pick people to give us advice who are knowledgeable and trustworthy? Response: If we listen to bad advice, it may get us into trouble. If the person is not trustworthy, they may be giving your poor advice to make you do something wrong. Here are some tips for avoiding peer pressure from those yelling the wrong instructions!

• Choose friends that share your values. For example, if you spend all of your time with sexually active friends, you are more likely to give into pressure and act like them. There are many people who are not having sex. Making friends with them will help you to say no, too.

• Be prepared to say no. Regardless of who you or your friends are, you are going to feel pressured to go along with what others are doing. You need to be prepared and practice different ways to say “no” to peer pressure. Practice communicating with confidence and saying no!

• Communicate your decisions clearly. If someone pressures you to do something you do not want to do, speak with confidence. You may need to repeat yourself over and over as people try to find different ways to convince you. Be brave enough to walk away from a bad situation.

• Be yourself. Remember that sometimes people talk big just to gain recognition. If they pressure you to try something because “everyone is doing it,” they may not have done “it” themselves.

Additional Sessions and Activities

164

The Human Knot Game – 15 minutes This game encourages youth to work with others to solve problems.

1. Ask the youth to stand in a circle, with shoulders touching. 2. Each youth should grab the hand of another youth. They can grab anyone’s

hand EXCEPT the hand of someone standing next to them. 3. They must use both hands, but CANNOT hold two hands of the SAME person.

Each youth should be holding hands with two different people. They should not be holding the hand of the person next to them on either side.

Now that you are all tangled in a knot, it looks as though it could never be untied, but try it! Don’t let go of your hands, but try to untangle yourselves! You can move in any direction, as long as no one lets go of the others’ hands. You may need to lift arms over shoulders several times and step over each other’s clasped hands. If you all work together, and listen to each other’s suggestions about your movements, you should end up in a single joined circle (some youth may be facing out, rather than in). After the knot is untangled, ask the following questions:

? What do you think this game is teaching us? Encourage discussion. Add any of the following points that are not mentioned:

• Even things that look impossible can be accomplished if we work together. • If we don’t listen to others around us, we may not succeed solving our own

problems. • Our lives are woven together and as a group we can bring success if we

communicate and work together. • Others may see our problems from a different angle, and have a better

solution. Many times things that seem impossible can be accomplished with the help and support of our friends. If we work together, the “knots” in our lives can often be untangled.

Story and Discussion (optional): 20 minutes This story discusses gender expectations. The story is adapted from John 4:7-27. In the time of Jesus, women had very few freedoms. They were restricted by laws of the Jewish people and the expectations of their society. They had very little authority. They were mostly restricted to staying at their father's or husband’s home. They were considered to be inferior and under the authority of men. Jesus, however, treated women differently. In the society in which he lived, it was uncommon to talk to a woman other than your wife. It was also against Jewish tradition at that time to teach women. Listen to the following story to find out what Jesus did.

Additional Sessions and Activities

165

Story: Jesus was traveling and came to a foreign city called Sychar. Jesus, worn out by the trip, sat down at the well. It was noon. A local woman came to draw water from the well. Jesus said, "Would you give me a drink of water?" (His disciples had gone to the village to buy food for lunch.) The Samaritan woman, taken aback, asked, "How come you, a Jew, are asking me, a Samaritan woman, for a drink?" (Jews in those days did not associate with Samaritans.) Jesus answered, "If you knew the generosity of God and who I am, you would be asking me for a drink, and I would give you fresh, living water." The woman said, "Sir, you don't even have a bucket to draw with, and this well is deep. So how are you going to get this 'living water'? “ Jesus continued to talk to her about “the living water,” and she begged him to tell her more about this water. He asked her to bring her husband so that they could all talk together. She said that she had no husband. Jesus, knowing her situation told her that he knew that she had married five times and was currently living with someone that she was not married to. She knew in her heart that he was a prophet. Otherwise, how would he know such things about her? So she continued to ask him questions about spiritual things. Just then his disciples came back. They were shocked. They could not believe he was talking with a woman, especially a Samaritan woman. No one said what they were all thinking, but their faces showed it.

? What was so unusual about Jesus talking to the woman at the well? Response: It was uncommon for a man to talk to a woman he did not know. She was also from a different people group that was despised by the Jewish people, and in those days, these groups did not talk together.

? Why do you think Jesus treated this woman differently? Responses may vary. One reason may be that he truly valued and respected this woman. He was revolutionary in the way he spoke with her, and in this way set a new standard for talking with women and even those of different people groups.

? When is it OK to challenge the behaviors and expectations that society has for us, especially concerning how men and women should act towards one another?

Additional Sessions and Activities

166

Learning Game: 10 minutes Use this game to discuss peer pressure. I love you Baby, why won’t you smile? Game: Have the entire group stand in a circle but choose one person to be in the middle and act as the “persuader.” Everyone standing in the circle must keep a serious face and not smile. The person in the middle then goes around the circle, from person to person saying “I love you baby, why don’t you smile?” The person says back to the persuader, “I love you too, but I just can’t smile.” The person in the middle tries to make at least one person smile as they ask the question. The persuader can make funny faces, jump up and down, do whatever they think they need to in order to make someone smile. When someone in the circle finally breaks down and smiles, he or she becomes the new person in the middle and the game begins over again. Sometimes people in our lives try to persuade us to do things we do not want to do. In this case it was smile, but sometimes it can be more serious and the things they want us to do can have bad consequences. Abstinence is not always easy. Sexual temptation and peer pressure are very real forces that affect us all.

? What are some situations where others are trying to make you to do things you do not want to do? Responses may include: being pressured to have sex, drinking, doing drugs, watching dirty movies, cheating, stealing, etc.

? What are some things we can do to “keep from smiling” (that is, resist peer pressure from others)?

Participant Handouts

167

Participant Handouts

Participant Handouts

169

Discussion Guide for Choose Life Sessions Choose an adult mentor (parent, caregiver, adult relative or adult friend) whom you can meet with after each meeting. Ask the mentor to make a commitment to meet with you. Arrange a time and place for these meetings. Keep this question guide in a safe place so that you can use it to guide and direct your conversations with your mentor.

Being Yourself, Good Communication, and Choosing a Good Mentor (Sessions 1-4)

Questions for the youth to answer: • What are the benefits of being yourself, and being content? • What skills do you learn for speaking a message with confidence? • How do you think having a mentor will help you in your daily life?

Question for the mentor to answer: • Share about a time when being yourself (being content, or confident) helped you

to get through a difficult situation or decision. • Share about a time when you found it difficult to talk with an adult about

something – but you persisted and were able to get the advice that you needed.

Making Good Choices (Session 5)

Questions for the youth to answer: • What are the seven steps you learned for making a decision? • Were you able to use these steps in a decision this week? How? • In light of the HIV/AIDS epidemic, how does Making Good Choices affect your

behavior towards the opposite sex? Questions for the mentor to answer: • What are some of the wise decisions/choices that you have already observed in

the life of this youth? • Share about a time as a youth when you were struggling with an important

decision. What did you decide to do? How was the situation resolved? • (optional) What do our faith teachings say about making wise decisions?

Mentor and Me Meeting (Session 6) Questions for the youth to answer: • How do you think being involved in a youth group will help you in your life? • What are the three ways that HIV is transmitted? • How has having a mentor encouraged you in the last few weeks?

Questions for the mentor to answer: • How do you think being involved in the youth group will help this youth? • Whom did you go to for advice when you were young? Whom do you go to for

advice now? • (optional) What do our faith teachings say about getting advice from elders?

Understanding Sexuality (Session 7) Questions for the youth to answer:

Participant Handouts

170

• What are some of the disadvantages of choosing to have sex before you are married?

• What are some of the advantages of choosing to wait until marriage to have sex? • In light of the HIV/AIDS epidemic, what did you learn from Rachel’s story that

affects the way you behave with the opposite sex? Questions for the mentor to answer: • When you were young, did your family talk to you about sexuality? Or did you

learn from your friends about sexuality? • How has the problem of HIV changed the way parents advise their children today? • (optional) What do our faith teachings say about the purpose of sexuality?

Communicating your Relationship Boundaries (Session 8) Questions for the youth to answer: • What are relationship boundaries? • What are some techniques that you learned to communicate your relationship

boundaries. • In light of the HIV/AIDS epidemic, how will boundaries help you to have healthy

relationships? Questions for the mentor to answer: • How could boundaries help this youth to make wise choices? • What skills have you learned to help you communicate difficult things to others? • (optional) What do our faith teachings say about the setting boundaries?

Overcoming Obstacles to Abstinence (Session 9) Questions for the youth to answer: • What commitments have you made for healthy relationships? What challenges

and successes have you faced keeping these commitments? • What are some of the obstacles to abstinence that you discussed in your group? • In light of the HIV/AIDS epidemic, how will this session change the way you

behave towards the opposite sex? Questions for the mentor to answer: • What obstacles to abstinence did you face when you were growing up? • What strategies did you use to keep away from drugs and alcohol (or other

obstacles)? • (optional) What do our faith teachings say about overcoming (or avoiding)

obstacles?

I Am Able (Session 10)

Questions for the youth to answer: • As you consider the abstinence, what is your intention? Are you ready to commit to

abstinence? If not, what are you willing to do to lower your risk of HIV infection? • What gives you confidence that you can reach this goal? • In light of the HIV/AIDS epidemic, how will this session change the way you behave

towards the opposite sex? Questions for the mentor to answer: • What are some of the ways that you have seen this youth succeed in the past? • How confident are you that this youth can succeed in reaching their goals?

Participant Handouts

171

• How do you feel about the choice that this youth plans to make? Do you think that this decision is the best choice in protecting this youth from STIs and sexually transmitted HIV?

Right to say “No” to Sexual Advances (Session 11) Questions for the youth to answer: • What does consent mean? • Why is consent important in a relationship? • In light of the HIV/AIDS epidemic, how does this session affect the way that you

behave towards the opposite sex? Questions for the mentor to answer: • Have you ever successfully turned down an unwanted advance from another

person? What are some good techniques that you learned? • How do you think this session will help youth protect themselves from HIV?

Saying No to Sexual Advances (Session 12) Questions for the youth to answer: • What techniques did you learn for saying no (or asking for consent)? • How will this skill help you to have healthy relationships? • In light of the HIV/AIDS epidemic, how does this session affect the way that you

behave towards the opposite sex? Questions for the mentor to answer: • What techniques have you learned that might help this youth to say no (or ask for

consent)? • How do you think this session will help youth protect themselves from HIV?

Making a Commitment (Session 13) Questions for the youth to answer: • How do you feel about the commitment that you made? • How confident are you that you can maintain this commitment? • What can your mentor do to help support you in this commitment?

Questions for the mentor to answer: • How do you feel about the commitment that this youth made today? • What advice would you give this youth about how they can maintain this

commitment? • What will you do to help support this youth in keeping their commitment?

Risk Reduction Options for youth who did not commit to abstinence (Session 14)

Questions for the youth to answer: • What is risk? Why is it important to lower HIV transmission risk? • Name some practices that are no risk, low risk and high risk for HIV

transmission. • In light of the HIV/AIDS epidemic, how would you counsel one of your sexually

active friends to reduce their risk of HIV transmission? Question for the mentor to answer:

Participant Handouts

172

• What are some things that married couples can do to lower their risk of HIV infection?

Simulation Day for youth who made a commitment to abstinence (Session 14)

Questions for the youth to answer: • What commitments have you made for healthy relationships? What challenges

have you faced keeping these commitments? • Which of the Skills for Healthy Relationships is the most useful to you? • In light of the HIV/AIDS epidemic, how will these skills help you to avoid HIV

infection? Questions for the mentor to answer: • What other skills do you think are important for this youth to learn? • How can they learn the skills that you have mentioned? • What skills or advice helped you when you were growing up?

Gender Roles (Session 15) Questions for the youth to answer: • What did you learn about healthy relationships from the story in this session? • When do you think it is OK to challenge the expectations that people have for

youth – concerning the way that boys and girls should act towards one another? • In light of the HIV/AIDS epidemic, how will this session change the way you

behave towards the opposite sex? Questions for the mentor to answer: • What married relationships do you admire in the community around you? What is

so special about their relationship? • What do you appreciate about the opposite sex now that you did not appreciate

when you were younger?

Participant Handouts

173

Talking to Youth Guide HOW TO TALK WITH YOUTH ABOUT HEALTHY BEHAVIORS FOR HIV PREVENTION20:

• Find a private and comfortable place (such as in the house after dinner at night) to talk one-to-one with youth. Youth may find it difficult to reveal their feelings if there are other family members around. Be understanding and patient with them.

• Ask the youth about the things they have learned about HIV in the youth groups. Ask

them about behaviors that they can adopt to prevent them from getting the virus. If that is difficult, show them this guide and read through it together.

• Ask them questions to make sure they understand. Allow them to ask you questions too. • Ask them about specific skills they are learning and the commitments they have made.

Are they keeping them? What are the struggles that they are having with these commitments? Work together to find good solutions to the problems they face.

• Always tell them how much you love and care for them. Tell her or him that you want to

help protect them from this killer disease and would like to talk to them regularly about healthy behaviors to prevent HIV.

• Finally, be a good role model. Demonstrate healthy behaviors in your own life. And in

turn, show youth that you value, respect and trust them to adopt the same behaviors in their life.

QUESTIONS TO ASK & ANSWER WITH YOUTH: What is HIV/AIDS?

There is a disease killing our communities. This disease is called AIDS. It starts with an HIV infection. HIV gets into a person’s body and destroys their immune system (their ability to fight off illness). Eventually, it becomes AIDS. You can have HIV for many years without knowing it. When the virus develops into AIDS, you become very sick. This is because the immune system can no longer fight off disease-causing organisms such as bacteria and viruses. There are treatments for these bacteria and viruses. These medicines can help treat these problems and prolong your life and make your body stronger. Medicines can treat the early illnesses that develop because of the virus, but there is no cure for AIDS. How can the virus that causes AIDS infect a person? The virus is found in body fluids such as semen and blood of an infected person. There are many ways the virus can be transmitted to another person. The most common way is through sexual intercourse without a condom. The virus can also be passed through sharing of needles or razors (with fresh blood) with an infected person (such as through blood transfusions, injections, or circumcision), although this is far less common than transmitting HIV through sexual intercourse. Finally, mothers can pass HIV to their unborn children during pregnancy or birth. Babies can also become infected while breastfeeding if the mother gives both breast milk and other foods or liquids before the child is six months old. The virus can NOT be passed through sharing utensils, sharing clothes, touching, shaking

Handout 2: Photocopy the next two pages and give it to the adults attending the Mentor and Me Meeting.

Participant Handouts

174

hands, sitting together with, hugging or kissing an infected person. Mosquitoes can NOT pass the virus. What are the signs of AIDS? When a person has the virus (HIV positive), they do not show any signs of illness. In fact, infected people may look healthy. An infected person can only know if they have the virus through a blood test at a hospital or health clinic. A person with the virus can easily pass the disease to others before they know they are infected. When the virus develops into AIDS, a person gets very sick. S/he can suffer from different diseases such as diarrhea, pneumonia, tuberculosis and body sores (shingles). The person often loses a lot of weight. How can an unmarried person avoid AIDS? Abstain from sex until marriage The best way to avoid AIDS is to abstain from sex until marriage. Abstinence means avoiding sexual intercourse (vaginal sex and anal sex are two types of sex that put a person at greatest risk). If you choose not to abstain until marriage you should delay having sex for as long as possible (e.g. until you are 18 years of age). If a person cannot abstain, they must use a condom each and every time to avoid pregnancy and HIV. Talking about condoms makes youth realize that sex is not play and must be taken seriously. Avoid risky situations To abstain, youth must avoid dangerous situations. Youth, especially girls, should travel in groups when going out at night. Youth should also be encouraged to avoid events, locations, and friendships that encourage drug or alcohol use which impairs judgment. Practice safe use of sharps Do not share needles or razor blades with other people. During any cultural practices where cutting is done that draws blood, be sure that all instruments have been sterilized. How can a married person avoid AIDS? Remain faithful to your spouse If a person remains sexually faithful to their spouse, and neither of them has been exposed to HIV, they form a “fence of protection” around their home. If one of them has sex outside of the home, they can bring HIV back to the home and infect their spouse. By remaining sexually faithful, couples greatly reduce the chance of spreading the virus to others in their family and community. If a person is not able to remain faithful, they should use a condom consistently and correctly every time they have sex with their spouse and other partners. This will help protect the person from receiving HIV from new partners, or passing the virus to their spouse if they are already infected. Reducing the number of sexual partners will also help to reduce someone’s chances of becoming infected. If someone does not know their HIV status, they should go to a clinic to get an HIV test. Then they will know for sure. It is always best for both partners to go together, so they can support one another.

Resources

175

Resources

Resources

177

Resource A: Additional Information about HIV and AIDS What are HIV and AIDS? 21 HIV stands for Human Immunodeficiency Virus. HIV is too small to see, but can be passed between people through genital fluids, blood, and breast milk. HIV weakens the immune system (the body’s disease fighting system), making the body susceptible to, and less able to recover from infections. At first, a person with HIV may look and feel well. Over time, without treatment, a person infected with HIV will become sick with many illnesses that do not go away. At this point, when the body is unable to fight infection, the person is said to have AIDS. AIDS stands for Acquired Immune Deficiency Syndrome. There is no cure for AIDS. Medication can help to reduce these illnesses, but the damage to the immune system is permanent. If medication is taken properly, and a physician provides adequate care, those infected can live a long time. Eventually however, everyone with AIDS will die of the disease or related causes. How is HIV passed from one person to another? HIV is passed between people in three ways: 1. Sex. The most common way of transmitting HIV is through genital fluids

exchanged during sexual intercourse with an infected person. 2. Blood to blood. A person becomes infected with HIV if fresh blood that contains

the virus enters into their bloodstream. This could happen in the following ways: a. Sharing contaminated needles or syringes b. Receiving a transfusion of infected blood c. Sharing contaminated instruments used for piercing, cutting, or tattooing

skin. 3. Mother to child. HIV-infected mothers may pass the virus to their baby during

pregnancy, delivery, or breast-feeding. HIV is not spread by:

• by touching someone with HIV • by mosquitoes or other insects • by kissing someone with HIV • by sharing eating utensils – spoons, forks, or bowls with someone with HIV • by swimming or bathing with someone with HIV • by living in the same house or working with someone with HIV • by using the same toilet as someone with HIV • by witchcraft

How can someone avoid sexually transmitted HIV? 1. Abstaining from sex before marriage is the best way to avoid all sexually

transmitted infections including HIV. 2. Once someone enters a marriage relationship, they should be sexually faithful (no

sex with others) to protect their spouse and family. If HIV status is unknown, they should be tested to confirm they are free of infection.

3. If someone is unable to be abstinent, faithful, or not sure if their spouse is infected, they should follow the guidelines below to lower the risk of infection. • Use condoms consistently and correctly every time they have sex. • Avoid high risk sexual practices (see Session 14 for more details).

Resources

178

• Treat all sexually transmitted infections immediately. How do sexually transmitted infections increase the risk of HIV infection? When one sexual partner has a sexually transmitted infection (STI) and a condom is not used, this increases the risk of HIV infection because of the sores and open wounds on the genitals. Using condoms consistently and correctly every time you have sex helps to lower the risk of STI infection. However, some STIs such as genital warts (also called Human Papillomavirus or HPV) can easily be transmitted by skin-to-skin contact and are not prevented by condom use. For this reason, someone who is at risk of STI infection should use condoms consistently and correctly every time they have sex, and also treat STIs immediately to prevent the risk of HIV transmission. Does male circumcision protect against HIV transmission? Recent studies show that circumcision is associated with 50-60% reduction in risk of HIV transmission (from female to male) during sexual intercourse.22 Circumcised men can still become infected and, if HIV-positive, infect their sexual partners. However, combined with other prevention methods (correct and consistent use of male or female condoms, reduction in the number of sexual partners, and delayed sexual debut), circumcision greatly reduces the risk of HIV transmission. To prevent infection during the procedure, clean and sterilized equipment must be used. Circumcised males must also wait until they are completely healed before having sexual intercourse. How does someone use a male condom correctly and consistently? Male and female condoms reduce the risk of HIV transmission if used correctly and consistently every time someone has sex with any partner - whether or not they know they are infected. Below are guidelines for correct male condom usage.17

• The package should be sealed and used on or before the date on package; do not use the condom if the date has passed.

• After opening the package, the condom should be moist. If it is dry, throw the condom away.

• Only use water-based lubricants with latex condoms. Never use petroleum jelly or Vaseline (oil-based lubricant) on a latex condom.

• Do not unroll the condom before putting it on. Put the condom on only when the penis is erect (stiff). Pinch the top of the condom to leave a small empty space to hold the semen and use the other hand to slowly unroll it down the erect penis.

• If the condom tears or has a hole in it, remove it and replace it with a new one. • Hold the base of the condom when the man withdraws so the condom does not

slip off and the semen does not spill. • After removing the condom, dispose of it properly. Tie the end in a knot and

throw it in a pit latrine or bury it. • Never wash a condom or try to reuse it.

How can someone avoid HIV transmission through blood?

• Avoid direct contact with fresh blood and bodily fluids of an infected person.

17 Female condoms are also available in some locations. Contact a healthcare provider for more information on availability and use.

Resources

179

• Do not share instruments with others that cut, pierce or tattoo the skin. If an instrument must be shared, sterilize the instrument after contact with blood or bodily fluids.

• Avoid blood transfusions. If a transfusion is necessary, be sure the blood has been tested for HIV.

How can an HIV- infected mother avoid transmission to her baby? Without interventions, it is estimated that 15-30% of infants born to HIV-infected mothers will be infected before or during delivery. Another 10-20% will be infected through breastfeeding.23 Specific anti-retroviral drugs can be taken to prevent transmission during pregnancy and birth. Contact a healthcare provider for more information. For HIV-infected and non HIV-infected mothers, immediate and exclusive breastfeeding for the first six months of the child's life greatly improves the chances of survival. If the mother is HIV-infected and a breast milk substitute is (AFASS) available, feasible/culturally acceptable, affordable, safe and sustainable for the duration of the infant’s life, the mother should talk with her healthcare provider about this option. However, in all other settings, the HIV-infected mother should exclusively breastfeed her baby until six months of age. After six months, the mother should reassess the situation. If replacement feeding is still not AFASS, continuation of breastfeeding with additional weaning foods is recommended.24 Although there is a risk of HIV transmission with prolonged breastfeeding, without an AFASS substitute, it is best to strengthen the health and nutrition of the child with breast milk during the first year of growth. Who is a carrier? Anybody who has HIV is a carrier and can infect others. Often, an infected person does not know they are a carrier, because they look and feel healthy. The carrier may not have symptoms, and the person who infected them may not have any symptoms either. A person can be a carrier unknowingly for many years before they become ill. During this time, they can transmit the virus to others. What is acute HIV infection? The amount of HIV in the blood rises dramatically within a few days or weeks after HIV infection. This first stage of infection is called acute HIV infection. Some people may not feel well during this time, others do not notice any unusual symptoms. The most common symptoms are fever, tiredness and a rash. Other symptoms may include headaches, swollen lymph glands, sore throat, muscle aches, vomiting, diarrhea, nausea and night sweats. When is a person with HIV most infectious to others? The number of HIV particles a person’s body is much higher during the acute phase of HIV infection (the first two to four weeks) than during the months or years before the onset of AIDS. Exposure to the blood, genital fluids, or breast milk of someone in the acute phase of infection is more likely to result in infection than exposure to someone who has been a carrier for many years and shows no symptoms. Once the immune system (the body’s disease fighting system) becomes overwhelmed by the virus, the person will show symptoms of AIDS. At this point they are highly infectious to others because of the increase in HIV particles in the body.

Resources

180

What is the time period between the acute infection and the onset of AIDS? After the early symptoms of HIV disappear, the HIV infected person usually does not develop any further symptoms for two to ten years. Some people develop AIDS symptoms within months of the infection. During this time, HIV continues to multiply in the body reducing the number of germ fighting cells. Children born to HIV-infected mothers develop AIDS symptoms faster than others. HIV positive children usually develop symptoms of AIDS within two years. What are the symptoms of AIDS? People with AIDS will develop some or all of the following symptoms:

• Excessive weight loss • Diarrhea for more than one month • A persistent fever • A cough that does not stop • Respiratory illnesses (especially tuberculosis and pneumonia) • Sores on the body and lips • White coating in the mouth and on the tongue (thrush) • Swollen glands in the neck and arm-pit • Itchy skin rash

Not everyone with these symptoms has HIV or AIDS. The only way to know if a person has HIV is to be tested at a health clinic or testing center. What is VCT? VCT stands for Voluntary Counseling and Testing for HIV. Special sites for VCT have been established in urban and rural communities. At these sites, HIV counseling and testing are provided for a small fee, or free of charge. Counseling helps people to cope with the results of their test and can educate them about lowering their risk of HIV infection and transmission. What is an antibody test? The most common type of HIV test is the antibody test. When a virus enters the body, the immune system (the body’s disease fighting system) begins to produce antibodies, to neutralize the virus. By taking a sample of blood or saliva, a health care provider can look for these antibodies. If HIV antibodies are present, the person is infected with HIV. It can take up to three months after a person is infected with HIV for their body to produce enough antibodies to be detected with an antibody test. This is called the “window period,” the time between the HIV infection and the immune system’s response to the virus. If a person has an HIV antibody test during the window period, the test will be negative, even though they may have HIV and are able to infect others. What drugs are available for people living with HIV or AIDS? There are many drugs available to treat people living with HIV or AIDS. Some drugs treat the symptoms and illnesses that affect people with AIDS. These include fever reducers, pain medications and antibiotics.

Resources

181

Other drugs work on the virus itself. These are called antiretroviral (ARV) medications. There are many different types of ARVs and a doctor must decide which combination of drugs is best for each patient. ARVs help to reduce the speed at which HIV multiplies inside the body. This helps the person stay healthy longer. ARVs do not cure AIDS. A person taking ARVs can still pass the virus to others. However, ARVs greatly improve a person’s health, life expectancy, and lowers the risk of HIV transmission to others. New international laws are lowering the price and increasing availability of HIV drugs. Contact a healthcare provider for more information about the availability and cost of ARVs in the region. Not all of the illnesses related to AIDS require drugs from the clinic. You can make some simple and effective treatments at home, such as Oral Rehydration Solution for diarrhea. Talk with a healthcare provider to get advice about treating the symptoms of AIDS with low-cost treatments. How should I advise people who might have HIV or AIDS? If you think a person might have HIV or AIDS, encourage them to go to a health facility to be tested. Talk with them about sexual practices which lower the risk of HIV transmission. Make sure that they understand how HIV is transmitted so they can protect themselves and others from new infections. Should I avoid a person with HIV or AIDS? There is no reason why you should be afraid to be around an HIV infected person. Like others who are ill, they need compassion and support. Since AIDS is an illness that causes a lot of fear, a person with AIDS needs your support and friendship even more.

Resources

183

Resource B: Three-Part Role-play for HIV Prevention

A Frank Talk between Adamu & His Uncle This is an example of the type of role-play that you can use to get across the most important facts about AIDS, Abstinence and Being Faithful. You can modify this role-play for your use, or create your own new way of getting the information out to people. If you decide to use this role-play, please change the names of the two men in this role-play to reflect names used in your country. (Try to change Solomon to a name that means “wisdom” in your country.) In addition to translating this role-play script, you should also change the interactions to make them more believable and to better reflect how people speak in your country. Please preserve the factual information about HIV/AIDS. You should add in some humor, but do not use so much humor that the content gets lost. Adamu is a 15-year-old youth who comes to see his uncle, Solomon, who is a wise counselor. Adamu visits him to ask him questions about a disease that is killing people and how he can prevent it. In the first act, Adamu is a young man, 15 years old. The second act is one week later. In the third act, Adamu has returned to talk to Solomon ten years later after he has gotten married.

Act I

[Adamu knocks on the door of Solomon’s house and is invited in by Solomon.] Adamu: Uncle Solomon, you know that I have always come to you when I had questions

that I could not answer on my own. There are things that are happening in our community that worry me. Did you know that Kato died?

Solomon: Yes, I did, Adamu. There are quite a few young men who have fallen ill and

cannot work, and some have died. What did you see happen to Kato? Adamu: Well, he lost a lot of weight, he had diarrhea for many months before he died, and

an itchy skin rash. Solomon: What do you caused that? Adamu: Maybe he was eating bad food … or he was cursed. Solomon: But he was sick a long time, right? And everyone was friends with Kato. Who

would want him to be so sick he would die. I think it was something else. Adamu: Really? What do you think it was? Solomon: He may have had AIDS.

Resources

184

Adamu: What is AIDS? Solomon: A-I-D-S stands for Acquired Immunodeficiency Syndrome. It is a serious

disease that hurts a person’s ability to fight infection. It kills millions of people each year.

Adamu: What does the disease do to a person? Solomon: It kills the soldiers in a person’s body – Some cells of our body work as

soldiers and defend us from invading germs. Without them we would be ill all the time. The AIDS virus, called HIV, is a little germ that you cannot see. It kills or immobilizes these soldiers (T - helper cells) which leave the body practically defenseless. When a person has AIDS, other germs, fungi, viruses and bacteria are able to attack the body and the infected person becomes ill and eventually dies. People who have AIDS often lose a lot of weight, have diarrhea for more than one month and have an itchy skin rash. They may also have a fever, cough, or sores on their body that keep coming back. They can have a white coating in their mouth and tongue and swollen glands in their neck or armpit. They eventually die – there is no cure. Once the virus enters your body, it stays forever and the damage is permanent.

Adamu: So how do people get AIDS? Solomon: The most common way that people gets AIDS is by having sex with another

person who has the disease. If a healthy woman has sex with an infected man then she can catch the virus from him. A healthy man can catch the virus from an infected woman during sex, too.

Adamu: Well, Kato did have sex with a lot of women. So people can get it from another

while they are kissing during sex? Solomon: No. Kissing is not dangerous if neither person has sores in or on the mouth.

There are not many viruses in the spit of an infected person. BUT, you can get AIDS from other bodily fluids when semen or fluids from the vagina of an infected person touch the mucous membranes (like anus, vagina or mouth) of a healthy person. That is, when a man’s penis goes inside of a woman’s body, and one of the two people has AIDS, the other person can get the disease.

Adamu: But only prostitutes have sexually transmitted diseases like that, right? Solomon: Anybody who has the AIDS virus can infect others. Very often an infected person

does not know that he or she has AIDS because they look and feel healthy for a long time before they die. He or she does not notice anything different – no diarrhea, no skin problems, nothing – and the person that they have infected may not have any symptoms either. But even though they do not know they are infected, they can still spread the virus to others, and if they do, those people will eventually become sick and die.

Adamu: But eventually, a person with AIDS will know they have the disease, right? Solomon: Yes, they will eventually know they are sick. But that may not be for years after

they have been infected. And during that time, they may have infected many other people. If a person thinks – if you think – that you may have gotten the disease, then you need to be tested for AIDS.

Resources

185

Adamu: Is having sex the only way that a person can get AIDS? Solomon: No, but it is the main way. But a person can also get AIDS from using injectable

drugs, or if a person (doctor, nurse) were to use instruments (like needles) that were not sterile. Also knives, razors, and other skin piercing and cutting instruments like those that some people use for scarification, circumcision and ear piercing can transmit AIDS if they are not sterilized (that is, boiled for 20 minutes or soaking in bleach) first. And even if a person decides not to have sex, they can be raped. … Also, a mother with AIDS can pass AIDS on to her baby while she is pregnant, during delivery, or when she breastfeeds her baby. That does not always happen, but sometimes it does.

Adamu: So I guess people with AIDS should not have babies…. Solomon: Well, doctors usually recommend that parents who know or think that one of them

may be infected with the AIDS virus should avoid having children. A woman can have a blood test at an antenatal clinic to find out if she has the virus or not before she decides to get pregnant.

Adamu: Wow, so I could get AIDS from having sex, using injectable drugs, or if a person

were to cut my skin with a knife, razor or other instrument that was not sterilized. What about if I shake hands with someone with AIDS, or touching something that they have touched?

Solomon: No, there’s no problem with shaking hands or touching something that they have

touched – assuming it doesn’t have blood or some other bodily fluid on it, and even then the virus does not live long when it is exposed to air. You could eat with the same plate as a person with AIDS and you would not get the disease. The virus is not spread by glasses, cups, plates, eating utensils, toilets, or showers.

Adamu: How about breathing the same air that they breathe? Solomon: No, there is no problem with that either. It is not passed through sneezing or

coughing. Adamu: That is good to know. What about mosquitoes? Could I get AIDS from a

mosquito bite? Solomon: No, that is not possible. If you could, everyone would have AIDS by now! Adamu: It sounds easy to avoid some of those ways that people get AIDS. I can make

sure that any razor or knife used on me is sterilized. I can only get shots from doctors that I trust who sterilize their needles and syringes. But NOT HAVE SEX? How can I avoid having sex?

Solomon: You do not need to avoid sex forever. You just need to follow what the Bible says

about having sex. Before you are married, you abstain from sex. You use your time to make plans for your life, get an education, and do things with groups of other youth. Then after you get married, you can have all the sex you want with your wife (and only with your wife). My pastor says that sex is God’s gift to us … we just need to use it wisely. Remember that the Bible says that your body is a temple.

Adamu: But Uncle Solomon, that will be very difficult for me. I do not know that I can do

Resources

186

that. Solomon: Remember that the Bible says too: "With man this is impossible, but with God all

things are possible." [Add cultural proverb here.] We will talk more the next time you are here about that.

Act II

Narrator: For the next week, Adamu reflected on what his uncle had taught him and shared what he had learned with his friends. Solomon reflected on his nephew’s situation. Then one day…

[Adamu knocks on the door of Solomon’s house again and is invited in.] Adamu: Uncle! Solomon: Nephew, it is so good to see you. Adamu: I have shared what you taught me last week with my friends and they are very

grateful. Solomon: Good – these are things that everyone in the community should come to know. Adamu: You promised me that we would talk more this week about how to prevent AIDS.

But is that really something that people my age have to worry about? Solomon: Yes, Adamu. HIV/AIDS is not just a problem for adults. Last year, there were

[Insert your country’s AIDS statistics for youth under 15 and 15-24 here] youth who became HIV+ in our country.

Adamu: Wow, that is a lot. What about condoms? When I talked to my friends, some of

them said that condoms prevent AIDS. Is that true? Solomon: Often people who use condoms only use them some of the time or use them

improperly, and you can get AIDS from having unprotected sex only once. When a couple uses a condom consistently – every single time – and correctly (exactly as instructed), it reduces the risk of getting HIV/AIDS by 80-95%. But the only way to be 100% sure that you will not get AIDS during sex is to abstain from sex before marriage, and only have one faithful partner when you get married. How do you feel about abstinence?

Adamu: Can we talk freely? Solomon: Yes, Adamu. Whatever you tell me, I will hold in confidence. You are becoming

a man. Abstinence is a decision that you have to make yourself – no one can make it for you. I can help you make decisions, but it is your decision.

Adamu: Thanks, uncle. Then I can tell you, I have mixed feelings about this abstinence,

not having sex until I am married. Solomon: That is quite normal, Adamu. So there are some things about it you like and

some things about it that you do not like. What do you think would be good about it?

Adamu: Well, I would definitely not get AIDS or any other diseases passed during sex.

Resources

187

Solomon: That is true. That would be a very positive thing. Adamu: But I am afraid that the girls and my friends would think less of me. Solomon: I can understand that. Whenever someone makes a big decision, there are often

people who support the idea and those who do not agree. So you think that everyone would think less of you? Are there some people who would support your decision to be abstinent?

Adamu: Yes, there are definitely some people who would. I know my parents would, my

pastor would, you would, and some of my friends – both boys and girls – would. But some people might make fun of me.

Solomon: Are there any other benefits you can think of if you were to be abstinent until

marriage? Adamu: [Pausing] Yes. I would have peace of mind and not worry so much about getting

AIDS. I would be able to put more attention on my studies so that I could do what I want to do in life. I would also be sure that I would not bring the disease into my family where it could kill my wife or children. And being abstinent would also help my girlfriend – if I had one – to protect her reputation. And we learned that the Bible says that we are to honor God with our body, that abstinence is God’s plan for people before they are married, and that God shows love to a thousand generations of those who keep God’s commandments. But it would be very difficult at times. I am not sure I could commit to it.

Solomon: Those are excellent reasons. I believe that sex is a gift from God, but that we

need to use it the way God says or we will not be able to enjoy it as God intended. And yes, it would be very difficult at times. So why not do what many other people do and just decide when you have a girlfriend? What would be the problem with not making a commitment to be abstinent?

Adamu: If I do not make a commitment, promising to myself and to others, then I would

imagine that it would be difficult to decide to do it later when I am around girls. Also, I would not prepare for it.

Solomon: I agree, Adamu. When you make big commitments, you need to prepare for

them. [Add proverb here, if available, on how you need to plan when you set out to do something big.]

Adamu: I am still not sure. What can I do? Solomon: Well, I heard that there is something called a Youth-to-Youth group starting up in

our community. They will talk in that group about girls and boys, sexuality, and the big choices you have to make in life. Each of the youth in that group will be responsible for telling other youth about what they have learned. I suggest that you sign up for that group and if you are chosen to be a Youth Leader, you can learn more about those things. Even if you are not chosen, you can learn from one of the Youth Leaders in the group and eventually make some of those big decisions.

Adamu: Thanks, uncle Solomon. I will do that.

Resources

188

Act III

Narrator: Adamu joined the Youth-to-Youth group, and learned many things. He made a commitment in front of his community to be abstinent until marriage, and with the help of others in his community and the things he learned in the group, he was able to keep it. He married an intelligent, beautiful woman who he loved very much. After his first year of marriage, he went to visit his uncle again.

Adamu: Uncle! Solomon: Hello, Adamu! Congratulations on your recent marriage! Adamu: Thanks, uncle. I am so happy that I can finally … be with a woman! Solomon: Was it worth the wait? Adamu: Definitely! We are both very much in love, and my wife is so beautiful and

talented. Also, since I was abstinent before we married, she is not jealous like many of my friends’ wives. She knows that I love only her. And we do not have to worry about coming down with AIDS or passing AIDS to our children.

Solomon: It was a difficult path, but I am glad that you decided to take that road. Things

have definitely changed a lot since 2006 when you and I first started talking about AIDS. Now there are so few cases of AIDS. I am glad that people started paying attention to what was happening and decided to change their lifestyles so that they could avoid AIDS.

Adamu: Yes, uncle. If they had not done that, there would very few people left in this town

and all the children would be orphans. Solomon: That’s right. Now there are other skills that you need now that you are married to

keep from getting AIDS. Adamu: What do you mean? Solomon: There will still be sexual temptations while you are married. You need to know

how to protect your marriage from those temptations. You need to build a fence around your marriage to keep out those temptations.

Adamu: But I care about my wife. Why do I need to do I need this fence that you are

talking about. Solomon: Because many men care about their wives then they start having feelings for

other women because they are not protecting their relationship. Then they start sleeping with other women and they lose the trust of their wives, create jealousy, destroy their marriages… and they can get AIDS. Did you know that [Insert your country’s AIDS statistics for married men here (e.g., number of sexual partners in last year).]

Adamu: That’s not good. How does a person protect their marriage? Solomon: One thing that is important is for both people – you and your wife – to remind

each other that you love each other, and only each other. You need to let her know that she can trust you and she should let you know that you can trust her. You also need to let each other know what you expect of one another – that you

Resources

189

expect her to stay faithful to you only and that you will stay faithful to her only. You need to talk about these things. You also need to identify places and times where you are more likely to be tempted, and learn how to avoid those places and times or do things differently so you are not at risk. You also need to meet with other men who are accountable to one another and who are also working on protecting their marriages. I have heard that there will be a training in this community on how to protect your marriage. Why don’t you talk to the pastor who is organizing it, and see if you can participate. Adamu, how would you feel if your wife slept with another man?

Adamu: Uncle! That would never happen! I think I would want to hurt her! Maybe a

husband would consider sleeping with another woman, but women should never sleep with another man! I don’t think that happens to women.

Solomon: The same outrage that you would have if your wife slept with another man is the

same way that she would feel if you were to sleep with another woman. It is important for both of you to work on making sure the other one is cared for, loved, and protected from all the things that destroy your marriage. And if something ever does happen, you should make sure to be tested for AIDS … but FIRST you should ask your wife’s forgiveness, work to repair the damage you have done, and make sure never EVER to do it again. Being faithful to each other is not only the best way to keep you free from HIV/AIDS, but it is also the healthiest for your marriage! Respectable couples honor and protect each, even when it is difficult.

Adamu: I will do that uncle. And I will attend the training that you mentioned. I want to

protect my marriage and be respected by others.

Resources

191

Resource C: Good Listening Skills

Below are some guidelines to help Choose Life facilitators counsel and guide youth in their decisions for healthy sexual behaviors.

When counseling others, the first thing we must do is LISTEN. There will be time to discuss options later. First, we need to hear from the youth about the problem or decision that they are facing. A good way to remember listening techniques is to use the word OARS. Each letter in the word, OARS, reminds us of a different technique for good listening.18

O Open Ended Question A Affirmations R Reflections S Summary Statements

The first letter is “O,” which reminds us to use open-ended questions. An open-ended question is a question that does not have a simple yes or no answer. Open-ended questions invite a long response. On the other hand, a question with a yes or no answer (or only one or two choices) is a closed question. When counseling youth, you want the youth to tell you the whole story. Open-ended questions encourage long answers. We will try a few questions to practice. Read the questions below and choose whether they are open-ended questions or closed questions based on the definition above. Circle open or closed for each question. (You will find the answers at the bottom of this page.)19 1. Have you ever been tested for HIV? Open or Closed 2. How would being abstinent before marriage be good for you? Open or Closed 3. Do you want to stay in this relationship? Open or Closed 4. What consequences of HIV concern you most? Open or Closed 5. Who decides whether you will use a condom, you or your partner? Open or Closed 6. Have you ever thought about being abstinent? Open or Closed 7. What do you like about being abstinent? Open or Closed 8. Where do you go for information about HIV? Open or Closed 9. What are the reasons that you would want to continue having sex with your

boyfriend? Open or Closed 10. Does your girlfriend ever ask you if you have other partners? Open or Closed

18 The OARS is a reflective listening technique developed by Dr. William Miller and Dr. Stephen Rollnick outlined in their Motivational Interviewing literature. See http://mi.fhi.net/ for more information on this technique and how FH has adapted it for HIV Prevention.

19 Answers to the exercise above. 1) Have you ever been tested for HIV? Closed 2) How would being abstinent before marriage be good for you? Open 3) Do you want to stay in this relationship? Closed 4) What consequences of HIV concern you most? Open 5) Who decides whether you will use a condom, you or your partner? Closed 6) Have you ever thought about being abstinent? Closed 7) What do you like about being abstinent? Open 8) Where do you go for information about HIV? Open 9) What are the reasons that you would want to continue having sex with your boyfriend? Open 10) Does your girlfriend ever ask you if you have other partners? Closed

Resources

192

Using open-ended questions when counseling youth encourages them to do talk more than you. That way you have to listen. They will also provide you with much more information than if you asked them only closed questions. The second letter in OARS is “A,” which reminds us to use affirmations. An affirmation is a compliment. It praises positive behavior and supports the person as they talk about difficult things. As you listen to youth sharing with you the struggles that they have, use praise to reinforce and encourage them. Some examples include: • You seem to be a very caring person. You are always helping your friends. • That situation must have been very painful for you, but you managed to get

through it. • I really admire how you have handled this situation. It is obvious that you are

serious about your standards. The third letter in OARS is “R,” which reminds us to use reflections. A reflection is a statement that repeats or mirrors what the person has already said using different words. When using reflections, you are simply paraphrasing what they have said in your own words. Reflections can start with the phrases, “In other words…” or “What I hear you saying is…” Using reflections when counseling confirms what the youth has said, and encourages them to continue telling the story. Some examples include: • You had a difficult time confronting your boyfriend about his behavior, and now

you do not know if you should stay in the relationship. • What I hear you saying, is that your mother is really concerned that you will get

pregnant before you finish school. • In other words, you see both the positive and negative sides of making a decision

for abstinence and do not know what is best for you to do.

Reflections encourage youth to tell you more about the situation. Try it and you will see! The last letter in OARS is “S,” which reminds us to use summary statements. What is the difference between a summary statement and a reflection? A summary statement restates everything that was said. It is used at the end of a discussion or story. A reflection is used more frequently, after every few sentences. It is helpful to use a summary statement when you feel the youth has finished sharing the full story. It helps to summarize the feelings of the youth and move them towards making a decision about what to do. Some examples include: • You are feeling a lot of pressure to have sex with this man. He offers you money

for nice clothes, to pay your school fees, and for other things that you want. Your parents will not object. You do not want to do it, but you feel trapped.

• This has been a really difficult year for you. You had to drop out of school, you are worried about the health of your baby, and now your boyfriend has decided to take a job in another town.

Using summary statements confirms what the youth has shared with you. It also encourages the youth to think about next steps.

Resources

193

Good listening and counseling skills require a lot of practice. It may seem strange at first, but it will become easier as you practice. Try using the OARS with your family and friends so that you will become more comfortable with these techniques during your group sessions and with individual youth as they come to you.

Resources

195

Resource D: Supplemental Stories Use the text below to supplement David’s story in Strategies for Maintaining Abstinence. Tell a Story: One day after school David sits down on a bench to wait for his younger brother Peter. David has a lot on his mind, and it shows on his face. He has been having sex with a new girlfriend, Esther, who is more experienced than he is. Now he has a painful STI and is also worried that he might have HIV. He is getting very down and depressed and does not know who to talk to about it. Not only is he worried about himself physically, but he just failed a math test. He had always been at the top of his class in math. When David sees Rebecca coming toward him, at first he is surprised. They used to be better friends but have not spoken for some time because he has been spending so much time with Esther and her friends. But when Rebecca sits down next to him the first thing she says is, “David, something is wrong. I can see it in your face, and if you want to talk about it, I would like to listen.” David hesitates at first, not sure he should tell her what he is thinking. But he has always respected Rebecca, and besides, she is beautiful. All the guys would like to be seen with her. Maybe it would be interesting to hear a girl’s point of view. So, with a few hesitations, David tells Rebecca about his relationship with Esther. ”Even though I thought it would make me happier to be with Esther, I am actually suffering. I cannot eat. I am not sleeping well. My school work is suffering, and I just feel empty. I don’t know what to do.” Rebecca pauses to think before she speaks, and then decides the best thing is to be honest with David. “You know David, a few months ago I was going through a difficult time myself and I was fortunate enough to get some good advice. I spoke to a young couple from my church. Do you have a mentor yet? I am sure Paul would be cool with talking to you about some of your struggles. They are young enough to understand us but really wise. I can show you where they live after school tomorrow.” The next day, David finds himself sitting in Paul and Mary’s front room talking with Paul. At first he was not sure he wanted to tell a stranger what was going on, but Paul seemed like someone David would choose to be friends with, and he found himself telling him about things with Esther. Paul listened carefully to David and did not seem shocked or upset about anything he was saying. Instead, he told David about his own struggles he had faced with sexual temptations when he and Mary were dating and engaged. “It wasn’t easy,” said Paul, “especially because we had to be really careful about being alone together too much and to remind each other about our boundaries all the time. It was not as if any of the desires went away because we wanted to save sex for marriage. But we made it, and I am thankful almost every day for the friendship and trust we built while we were dating. We have a lot of fun together. I consider Mary to be my best friend and now that we are married, we get to really enjoy sex. We don’t compare ourselves to past

Resources

196

partners or have to deal with any STIs, but most of all, we just really love each other and sex is an expression of that love rather than of lust.” David thinks a minute, then looks at Paul and says, “It all sounds so easy when you talk about it like that, but what about Esther? We are not really friends. And anyway, it is too late for me. I have already had sex and I don’t know if I can go back.” “Look David, I am not trying to tell you it’s easy, but what good thing ever comes easily? Don’t you have to study hard when you have a big exam? But look at the result. Abstinence is a daily battle. We all have temptations and it is hard to say no all the time. But it gives us the freedom to live a life without fear. It allows us to give our energy and attention to the things that will help us succeed in life. David, you were created for something better. You can make the decision to stop having sex at any time. It does not matter how many partners you had in the past. You can start over today.” (Continue with David’s story in Strategies for Maintaining Abstinence)

197

Pre and Posttest Answers After every three sessions, youth should take a posttest to make sure they have learned the main objectives for each session. You may give them a written test or ask each youth to answer the questions orally. Each posttest will have six questions, two from each of the last three sessions you have taught. The last posttest (Session 13-15) will only have four questions, because there were no questions for session 13. For youth who practiced simulations during Session 14, add two more questions relating to the skill that they used. If 70% of the youth in your group answer 5 out of 6 questions correct (83%), then you should celebrate and move on to the next session! If less than 70% of the group answer 5 out of 6 questions correct, then review the questions that the group missed. Spend the next session reviewing the material that they did not understand. For the last posttest, youth need to answer 3 out of 4 questions correctly. 6/6 = 100% 5/6 = 83% 4/6 = 67% 3/6 = 50% 2/6 = 33% 1/6 = 17%

Sessions 1-3 1. If you are not happy with yourself, how could this affect the choices that you make?

• If you aren’t happy with yourself, it is easier to be negatively influenced by others. You may make poor choices because you are not thinking about your own needs, gifts and talents.

2. What are the benefits of accepting yourself? (Any of the following responses are correct.)

• You will feel happier about yourself. • You can use the gifts and skills that you have. • You can focus on your work or school, and have hope for the future. • You can make wise decisions and not worry about what others think. • You have the ability to resist pressures to do things that you know are wrong or

are not good for your health. 3. In what three ways do we communicate a message - our voices/words, our body language, and our __?___.

• Actions (the things we do) 4. Name the three most common ways HIV is transmitted. (They must name all three.) • Sexual intercourse with an infected person. • Blood to blood. Someone can be infected with HIV if fresh blood that contains the

virus enters their blood stream. • Mother to child. A baby can be infected from an HIV-positive mother during

pregnancy, at the time of labor and delivery, or while the baby is breastfeeding. 5. Which of these three ways is the most common?

• Sex with an infected person. 6. How can you use your body to show confidence?

• Use proper eye contact, sit up (or stand up) straight and tall. Session 4-6 1. Name two characteristics (or qualities) of a good mentor. (Any two of the following responses are correct.)

• the same gender as you

198

• easy to talk to • available - you can see or meet with them when you need to • respected by others in the community • knowledgeable or willing to find out the answers to your questions • trustworthy – can keep information confidential • displays healthy sexual behavior • (optional) religious – a strong believer in your faith tradition if you are a religious

person 2. True or False. It is important that my mentor is practicing healthy sexual behaviors.

• True 3. What are the seven steps that should be followed to make a good choice? (They must mention at least six of the seven steps.)

• Identify the problem • List your options • Consider the outcomes • Reflect on your faith • Seek wise counsel • Pray • Discuss and Act

4. After you have listed the positives and negatives of each choice, what should do next? How does the list help you to make a decision? (Either of the following answers is correct.)

• Compare the positive and negative outcomes. Which of these outcomes is the most damaging? Which of these outcomes is the best for your future?

• Look at short term outcomes (those that happen immediately after the decision) as well as long term consequences (outcomes that might affect your future). Considering the outcomes will help you to choose the option that is best for your future.

5. True or False: One person’s actions (or poor choices) can negatively affect many others.

• True 6. How does the number of sexual partners someone has affect their risk of HIV infection?

• The more sexual partners someone has, the higher their risk of getting HIV and spreading it to others.

Session 7-9 1. What is sexual abstinence? • Refraining from sex (vaginal, anal and oral) until you are married. Some people

may decide to be abstinent for a period of time – until they reach their goals, or graduate from school, etc.

2. Our bodies are made up of four different aspects. Name two of them. (They must mention two of the following.)

• Mental, spiritual, physical and emotional. 3. Where should you set a relationship boundary?

• Set the boundary at the point where temptation is most difficult for you (or the person whom you are with) - the place where you both need a warning to stop.

4. What is one technique you learned to help you tell someone a difficult thing? • Surround the “difficult thing” with two positive things. First, say something

positive about the person. Then, clearly state the difficult thing. Then add a

199

positive suggestion, something that communicates what you prefer to do instead.

5. What does drug and alcohol abuse have to do with HIV infection? (Any of the following answers are correct.)

• Youth who abuse drugs start having sex at a younger age than others. • Because they are having sex earlier, they also have more partners than if they

started sex at a later age. More partners mean a higher risk of STI infections, increasing the risk of HIV infection.

• Youth who abuse alcohol and drugs are more likely to engage in risky sexual behaviors – things they would not do if they could think clearly.

• People using drugs and alcohol are more likely to be forced or coerced into sexual activities.

• Drugs and alcohol become addictive with time. Youth may resort to transactional sex so they can continue to buy drugs and alcohol.

6. Name three things that Zimba did in the story, that will make it difficult for him to remain abstinent. (Any three of the following responses are correct.)

• He was easily influenced by his friends (peer pressure) • He has a long walk home every night; this makes him more vulnerable to

getting into trouble with others. • He listens to his brother who is not wise. • He thinks about having sex with the street worker. • He does not avoid temptation. • He has started drinking alcohol and is thinking about smoking. • He is worried about “being a man” and what that means in his relationship with

girls.

Session 10-12 1. Name three things that help you to be confident that you can reach your goals. (Allow youth to list their own reasons; below are some which may be mentioned.)

• Self confidence • Friends who encourage and believe in you • Remember your past successes • I am able because I respect myself • (optional) Trust in God

2. How does the way we THINK affect whether or not we will reach our goals? • Being confident (having positive thoughts) gives you the ability to persist and

reach your goals even when you have obstacles in the way, or life becomes difficult.

3. Define consent. • It is an agreement to do something, saying yes, or asking if something is OK.

In a relationship both people must give consent to any sexual activities. 4. True or False: Everyone has the right to say “no” to any kind of physical or sexual contact that makes them feel uncomfortable.

• True 5. True or False: If you smile and touch the person when you are saying “no,” it will strengthen your message.

• False 6. Name two things you can do if you feel you are in real danger. (Any two of the following responses are correct.)

• Try to escape, run towards lighted houses, crowds or busy streets.

200

• If you can’t get away, SCREAM as loud as you can until help arrives. • Act crazy, drool, do anything you can think of to discourage them (vomit,

urinate, tell them you are menstruating). • If you think you are capable of resisting, act quickly attacking the person’s eyes

or groin with anything you can find as a weapon (fist, a stick, keys) then run as fast as you can.

If boys practiced asking for consent during Session 12, ask the following questions: 7. Optional question for boys: True or False: If a girl smiles and says nothing, you know she is giving consent. • False. You only know if she uses her words. 7. Optional question for boys: What is one way you can ask for consent? (Either

answer is correct.) • “Is this okay?” or “Are you okay?”

Session 13-15 (A total of 4 questions) 1. What are two things that should be shared between people for a good healthy relationship? (Any two of the following answers are correct. You can also include ideas that were mentioned by the youth during the session.)

• Love, honesty, good communication and respect 2. True or False: Sometimes the things that our culture tells us to do to “act like a man” or “act like a woman” may increase our risk of HIV infection.

• True There are no questions for session 13. For youth who practiced simulations during Session 14, add two more questions relating to the skill that they used.

If youth participated in the Risk Reduction session, ask the following questions: 3. Which one of the following practices has the HIGHEST risk of HIV infection: hugging, kissing, oral sex, or anal sex? Choose one answer. • Anal sex 4. Name one thing that makes HIV spread more quickly in a community. (Any of the following answers are correct.) • Having sex with several people during the same time period (e.g., during a

month). • Being uncircumcised. • Having sex with prostitutes. • Having sex with someone much older than you.

201

Credits 1 Report on the Global AIDS Epidemic. UNAIDS 2004. July 2004. 2 Temptation. When Bad Things Happen Series. Bible Studies Acts 17:11 Available:

http://www.acts17-11.com/tempt.html. Visited May 2007. 3 Game adapted from Schueller, Jane. Christian Family Life Education: Teaching Youth about

Reproductive Health and HIV/AIDS. Family Life Education/YouthNet. Pages 124-125. 4 Tuko Pamoja: Adolescent Reproductive Health and Life Skills. PATH, Family Health

International, USAID and PEPFAR. March 2006. (pages 90-91) Available: www.path.org/files/CP_kenya_KARHP_curric_3-06.pdf

5 IGN Entertainment. Actress of the Week. Oprah Winfrey. Available: http://www.askmen.com/women/actress_150/187c_oprah_winfrey.html. Visited June 2007.

6 Evan Carmichael. Motivation and Strategies for Entrepreneurs. Oprah Winfrey Quotes. Available: http://www.evancarmichael.com/Famous-Entrepreneurs/514/Oprah-Winfrey-Quotes.html. Visited June 2007.

7 NNDB: Tracking the Entire World. Oprah Winfrey. 2007 Soylent Communications. Available: http://www.nndb.com/people/466/000022400. Visited June 2007.

8 Academy of Achievement. America’s Beloved Best Friend. May 2006. http://www.achievement.org/autodoc/page/win0bio-1. Visited June 2007.

9 About Oprah. Oprah Winfrey’s Biography. Jan 2007. Available: http://www2.oprah.com/about/press/about_press_bio.jhtml Visited June 2007.

10 The Experience of Sexual Coercion Among Young People in Kenya. International Family Planning Perspectives. Volume 30, No. 45, December 2004.

11 Parts of this session have been adapted from the following resources: 1) Men as Partners: A program for Supplementing the Training of Life Skills Educators, 2nd Edition (EngenderHealth). Available: http://www.engenderhealth.org/pubs/indpubs/ppasamanual.pdf 2) Welbourn, A. & Williams, G. A. (2002). Stepping Stones. A Training Package on HIV/AIDS, Communication and Relationship Skills. London, UK: ACTIONAID.

12 Adapted from Men as Partners: A program for Supplementing the Training of Life Skills Educators, 2nd Edition. Engender Health. Available: http://www.engenderhealth.org/pubs/indpubs/ppasamanual.pdf

13 This session is adapted from Stepping Stones. A Training Package on HIV/AIDS, Communication and Relationship Skills. London, UK: ACTIONAID. Available through TALC.

14 Preventing HIV/AIDS in Young People: A Systematic Review of the Evidence from Developing countries, WHO 2006. Available: http://www.who.int/child-adolescent-health/publications/ADH/ISBN_92_4_120938_0.htm

15 HIV/AIDS – A Gender Equality and Human Rights Issue, UNIFEM 2006. Available: http://www.unifem.org/gender_issues/hiv_aids/at_a_glance.php

16 Ball, M. and Cerullo, J. It Takes Courage. Kerus Global Publishing, 2004. 17 The Role of STD Detection and Treatment in HIV Prevention – CDC Fact Sheet. US

Centers for Disease Control and Prevention. Available: http://www.cdc.gov/std/default.htm. Visited June 2007.

18 Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections. World Health Organization. 2001. Available: http://www.who.int/hiv/pub/sti/pub7/en/index.html Visited June 2007.

19 Tough Love. True Love Waits. Save Sex: Holding Out for the Ultimate. Available: www.lifeway.com/tlw

20 Adapted from the School Health and Nutrition Program of Save the Children Malawi.

202

Available: http://www.comminit.com/materials/ma2003/materials-183.html

21 Adapted from Choose Life Guide for Peer Educators and Youth Leaders: For Youth Ages 10-14, copyright ©2006 World Relief, used by permission. Resources referenced from their guide include the following: 1) LINKAGES FAQ Sheet 1: Breastfeeding and HIV/AIDS Frequently Asked Questions. Academy for Educational Development. Updated April 2004. www.linkagesproject.org 2) www.youthandhiv.org 3) The Effectiveness of Condoms in Preventing HIV Transmission, Amfar Issue Brief No. 1. American Foundation for AIDS research. January 2005. www.amfar.org 4) KwaZulu Natal Dept of Health www.kznhealth.gov.za/testing.htm and 5) AIDS Info A Service of the U.S. Department of Health and Human Services, November 2004; Introduction of ARV Drugs - Family Health International, Handbook on access to HIV/AIDS related treatment – UNAIDS/WHO/International AIDS Alliance.

22 WHO and UNAIDS Secretariat. Welcome Corroborating Findings of Trials Assessing Impact of Male Circumcision on HIV Risk. World Health Organization. Available: http://www.who.int/mediacentre/news/statements/2007/s04/en/index.html. Visited February 2007.

23 The Linkages Project. Breastfeeding and HIV/AIDS FAQ Sheet 1. June 2006. Available: http://www.linkagesproject.org/media/publications/FAQ_HIV_Eng_Update_10-06.pdf

24 WHO HIV and Infant Feeding Technical Consultation Held on behalf of the Inter-agency Task Team. Geneva. World Health Organization. October 2006. Available: http://www.who.int/hiv/mediacentre/Infantfeedingconsensusstatement.pf.pdf