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SEXUALITY AND DECISION MAKING: PROMOTING POSITIVE LIFESTYLES AND HEALTHY CHOICES A HUMAN SEXUALITY PROGRAM FOR STUDENTS IN SENIOR 1 REVISED - 2002 ACKNOWLEDGEMENTS The Board of Trustees and the Superintendent’s Department wish to acknowledge the following people for their contributions toward establishing this program in Assiniboine South School Division No. 3. Joyce MacMartin, Manitoba Representative, Advisory Committee, Skills for Healthy Relationships (Queen’s University, Council of Ministers of Education, Canada, and Health and Welfare Canada). Dr. Wendy K. Warren, Director, Social Action Program Group, Queen’s University at Kingston, Ontario. Al Robertson and Nicola Wright of Queen's University, Ray Petrachek of University of Regina and Sergei Sherman for the 1992 in-service component. Dr. J.P. Krecsy, Assistant Superintendent, Program, and David Collins, Supervisor Of Extended Programming, Assiniboine South School Division, for overseeing the program. Sergei Sherman, former Family Life/Personal Safety Program Coordinator, Secondary, for steering the program through two years of development. The grade nine teachers who taught the pilot program, and those who developed the Family Life Program, 1993 version: Blair Morden, Ken Wensel, Ron Hutsal, David Rankin, Ron Cassels, Doug Jordan, Doug DeGraeve, Martin Wagner, Cheryl Boguski, Michèle Manaigre-Sims. The Family Life Review Committee, composed of parents and representatives of the administrative community which reviewed the program during the 1994-1995 school year and which made a number of recommendations respecting revisions and additions to the program. The Family Life Program Revision Committee, comprised of Cheryl Boguski, Tag Haney, Ron Hutsal, Ken Wensel and Wayne Thompson who worked with the recommendations of the Review Committee to update the program. Dr. Richard S. Boroditsky, MD, FRCSC, FACOG, FSOGC, who provided the Revision Committee with a critique of the factual information related to STD’s/STI’s which enabled the committee to provide more current and accurate information. The Human Sexuality Review Committee 2002, comprised of Linda Dier, David Collins, Ken Atnikov, Tag Haney, Nick Dyck, and parent representatives Leslie Malcomson, Cheryl Langer, Catherine MacKinnon and Richard Wiebe for their insights and recommendations. 2 Sexuality and Decision-Making: Promoting Positive Lifestyles and Healthy Choices TABLE OF CONTENTS Page Unit One Activity 1 Activity 2 Activity 3 Activity 4 Unit Two Activity 5 Activity 6 Activity 7 Activity 8 Unit Three Activity 9 Activity 10 Activity 11 Activity 12 Activity 13 Unit Four Values and Sexuality – Getting Started ................................................................................................................... 5 – Working Together - Classroom Climate ............................................................................. 6 – Defining Personal Values ................................................................................................... 8 – Values Voting ..................................................................................................................... 12 Healthy Relationships – Affection is In ...................................................................................................................... 17 – Abstinence / A Healthy Choice .......................................................................................... 21 – You Decide ......................................................................................................................... 30 – How Do I Communicate My Decisions ............................................................................... 33 * Safer Sex – Safer Sex ........................................................................................................................... 36 – Condom Practice ................................................................................................................ 40 – The Line Up ........................................................................................................................ 43 – Attitudes About Condoms ................................................................................................... 45 – Condom Knowledge ........................................................................................................... 52 * Birth Control and Teen Pregnancy Activity 14 – Birth Control ....................................................................................................................... 56 Activity 15 – Teen Pregnancy ................................................................................................................ 65 Unit Five Activity 16 Activity 17 Activity 18 Activity 19 Unit Six * Sexually Transmitted Diseases / Infections – STD’s/STI’s ........................................................................................................................ 74 – HIV/AIDS – Program Video and Test ................................................................................. 82 – Estimating the Risk ............................................................................................................. 87 – Evaluating Responsibility.................................................................................................... 93 Respecting Self and Others Activity 20 – Equality for All ..................................................................................................................... 97 Activity 21 – Compassion / Empathy ...................................................................................................... 104 Activity 22 – Supports for Responsible Behaviours ................................................................................ 110 Glossary ................................................................................................................................................... 115 Community Resources ........................................................................................................................... 121 * Topics from Units Three, Four, and Five may be facilitated by Teen Talk (Klinic), Women’s Health Clinic or a Public Health Nurse. Nine Circles Health Centre (formerly Village Clinic) 940-6000, can provide speakers on STD / STI’s. 3 To the Student, Teacher, and Parent(s): One might ask the question - WHY STUDY ABOUT HUMAN SEXUALITY AND DECISION-MAKING AND THE MANY FACTORS THAT IMPACT THESE DECISIONS? Making the choice to become sexually active too early has life-changing and long lasting implications – socially, emotionally, and physically. Many adults, who have experienced the consequences of making uninformed sexual decisions too early have stated that if they had appropriate information and skills they would have made decisions with a more life-enhancing outcome. Teens and adults who are HIV positive or have been diagnosed with AIDS, state categorically that they wished they had known more about how to prevent getting the virus. Many pregnant teens say that they didn’t use contraceptives because they didn’t know enough about how to get or use them. It would seem that having reliable and detailed knowledge is the first step in the process of reversing some of the negative physical and emotional consequences associated with sexual decision-making. But knowledge alone is not necessarily going to solve these problems. People must develop new skills in order to change their behaviours. Learning and applying the information and skills presented in this curriculum better enables students to make personal decisions based on their own values and beliefs. Changes in knowledge, attitude, and beliefs usually precede changes in behaviour. After a person makes the resolve to change his/her behaviour, he/she needs motivational supports to keep on track. This curriculum will try to address all of these aspects - knowledge, skills, attitudes and motivational supports. You may wish to keep a personal journal as you work through this curriculum. In it you might want to make a note of some of the things you have learned in each activity, things you would like to find out more about, and thoughts that have occurred to you as you progressed through the curriculum. 4 Unit 1: Values and Sexuality Activity 1 Getting Started READY This activity will help to set the stage for the program. Students will explore the reasons for including human sexuality education in the program of studies. SET 1. Read the letter addressed TO STUDENTS, TEACHERS, AND PARENT(S) as a group. 2. Divide the class into mixed gender groups. 3. Provide each group with markers and chart paper and have each group respond to the following question. Why do you think it is important to learn about human sexuality and decision-making? a) On a second sheet of chart paper have the students list the possible physical, emotional and social consequences of becoming sexually active too early. b) Have each group share their responses with the rest of the class. 5 Unit 1: Values and Sexuality Activity 2 Working Together READY As many of the activities in this curriculum require small group and whole class discussions related to sensitive topics, it is important that individuals treat each other with care and respect. SET 1. With your students review the suggestions for CREATING A CLASSROOM CLIMATE. 2. Generate with the students a list of behaviours that describe how the class will work together in a respectful and caring manner. * These behaviours may need to be reviewed several times throughout the course. Other behaviours may be added at any time. 6 ACTIVITY 2 CLASSROOM CLIMATE Ground Rules Many of the topics and issues you will be discussing in this program are of a sensitive nature. Every student will have a different comfort level with the content and ensuing discussions which are based on personal, family and religious values. It is important to foster respect for others’ values, concerns, feelings and opinions. It is important for all group participants to: 1. Respect the confidentiality of classmates. 2. Respect a person’s privacy - this can be done by saying “I know someone who...” instead of using the person’s name. 3. Respect others’ opinions and values. 4. Keep communication open -- listen and consider others’ ideas. 5. Avoid “put downs”. Try to reinforce others. Guidelines for Working in Small Groups You will carry out a large part of this program in small groups. It is important to reinforce the notion of respectful communication, cooperation, participation and support for others. The following are suggested guidelines for working in groups: 1. Be inclusive and respectful of all group members. 2. Listen attentively to what every member has to say. 3. Communicate with all group members, not just one or two. 4. Do not monopolize the discussion. Too much talking by one person may prevent effective communication. 5. Be yourself. Express your true feelings and be honest. 6. Respect and support a group member who expresses his/her feelings. 7. Encourage all group members to participate, but avoid forcing anyone to speak if he/she does not wish to. (Students have the right to pass.) 8. Avoid personal criticisms. 9. Don’t be afraid of silence. 10. Help others understand things if they need help. 11. Rotate leadership in the group. 7 Unit 1: VALUES AND SEXUALITY Activity 3 Defining Personal Values READY These activities will help students to identify, clarify, and evaluate their values related to sexuality. Activity 3 will examine values in a general manner. Activity 4 applies values to situations involving relationships and sexuality. Several homework activities that encourage participants to discuss values with an adult they trust (e.g. parent, guardian, aunt, uncle, member of the clergy, etc.) are also included. Because the moral aspects of human sexuality are often controversial, teaching about these issues requires a balanced approach that respects diversity and promotes basic democratic principles. While students should be encouraged to articulate and discuss their value positions on sexuality issues, the teacher can mediate these discussions by drawing students’ attention to fundamental principles such as honesty, fairness, respect for self and others, justice, etc. Students and teachers should also recognize that parents and religious institutions often have strong value positions related to sexuality issues. Facilitating classroom discussions in which different perspectives toward sexuality issues are considered is an important step in helping students to develop more mature ways of thinking about human sexuality. Key Terms Values are the qualities that a person thinks are important. For example, one person may value intelligence as a quality while another may value loyalty. Moral values are the concepts or principles that a person may use to make moral judgements. For example, a person may use the criteria of honesty, equality, and responsibility to arrive at a decision or judgement about a situation or dilemma. Teaching Tips Things to do: Refer to your group’s ground rules for discussion. Students should be asked to show a basic respect for points of view different from their own. Directly challenge discriminatory remarks by making reference to basic democratic principles such as equality, justice, and respect for persons. For example, if a student insists that a woman is “asking for it” if she is dressed a certain way, ask the student how this assumption supports values such as equality and respect for others. Encourage students to support their points of view in terms of their values and moral beliefs. Attempt to ensure that a range of views is expressed. Support the right of students with unpopular points of view to express themselves. Things to avoid: Try to avoid steering classroom activities to a moral consensus that reflects your own values. While healthy debate in the classroom should be encouraged, do not allow students to make fun of or denigrate each other’s opinions. 8 Activity 3 Defining Personal Values SET 1. Write a definition of personal values (e.g. things or qualities that a person thinks are important) on the blackboard/flipchart. 2. Ask participants to give some examples of personal values (e.g. loyalty, intelligence, dedication, attractiveness, fairness, equality, justice, respect for others). 3. Ask participants to discuss where they learn their personal values (e.g. family, media, religion, friends). 4. Point out that, since each of us learns our values from different sources, different people will have different values. In a democratic society like Canada, people respect each person’s right to have his/her own values. However, to live together in a free and fair society, we use basic values like equality, justice, responsibility, and respect for others as guidelines for how our society is organized and how people treat each other. 5. Ask participants to give examples of how values such as honesty, equality, respect, and responsibility apply to sexuality and interpersonal relationships. The following are some examples: Being honest about your feelings (e.g. not deceiving a person about your feelings in order to get something from them). Having an equal relationship (e.g. giving each person in a relationship an equal say in decisions about the relationship including sexual behaviour). Respecting the rights of others (e.g. treating everybody with equal fairness whether they are male, female, gay, lesbian, heterosexual, bisexual etc.; respecting the right of a partner to say no to sex). Taking responsibility for myself and others (e.g. always using condoms if I have sex to protect myself and my partner). 6. Conclude the discussion by suggesting that participants can keep these ideas about personal and democratic values in mind as the group moves on to explore choices, relationships, and behaviour related to sexuality and sexual health. 7. Homework Assignment: What Do I Value? – Have the students read and complete the homework assignment for discussion during the next class. 9 Activity 3 Defining Personal Values What Do I Value? Procedure 1. Explain that it is easier to deal with pressures if we know what’s important to us—or what we value. 2. Ask participants to take home and complete the participant section of the “What Do I Value?” handout. 3. Once each person has individually completed the worksheet, instruct participants to ask an older person they trust (e.g. parent, guardian, aunt, uncle, member of the clergy, neighbour, etc.) to also fill it out. 4. In order to maintain the privacy of participants, ask participants to submit the Declaration of Completion slip once the assignment is done. 5. In follow-up, ask the following discussion questions: What was it like doing this activity? Was it easy or difficult? What did you learn about yourself; your adult support person? 6. Conclude the activity by pointing out how useful it can be to consult with people we trust and care about when clarifying our values and making decisions. Note: Some young people may be unable to complete this assignment with their parent(s) or guardian(s). Allow them the opportunity to complete the assignment with another trusted adult such as an aunt, uncle, sports coach, or member of the clergy. 10 Activity 3 Defining Personal Values What Do I Value? Participant: Draw a circle around the number that shows how important each value is to you. Adult Support Person: Draw a square around the number that shows how important it is to you that the participant values each item on this list. Very A little Not Important Important Important 1. Being honest 1 2 3 2. Feeling good about myself 1 2 3 3. Being happy 1 2 3 4. Caring for others 1 2 3 5. Doing what my parents think is right 1 2 3 6. Having fun 1 2 3 7. Being popular 1 2 3 8. Looking good 1 2 3 9. Having the “right” clothes 1 2 3 10. Being good in sports 1 2 3 11. Having a boyfriend or girlfriend 1 2 3 12. Having a good education 1 2 3 13. Taking responsibility for my actions 1 2 3 14. Getting along with my parents 1 2 3 15. Standing up for a friend who is picked on 1 2 3 (Detach and hand in this slip only) We completed the What Do I Value? homework assignment. Participant Adult Support Person 11 Unit 1: VALUES AND SEXUALITY Activity 4 Values Voting READY In this activity the students will explore their values regarding relationships and sexuality. SET Procedure: 1. Explain that this exercise is designed to explore personal values, and give the following directions: On your own, read the statements. Most of the statements are about relationships, dating, and sexual behaviour. Think about the statement, and decide whether you: AGREE, are UNSURE, or DISAGREE. Also, think about the reason(s) for your position. 2. Divide the class into three groups. Give each group a piece of chart paper, and have them cut and paste or write the statements onto the paper. Ask everyone in each group to state their position on each of the eight statements. Tabulate each groups results, and have a representative from each group present the findings. Ask volunteers to explain the differences of opinions for selected statements. 3. Tabulate the results for the class. 4. Ask the class to arrive at a consensus on any two statements for further discussion or discuss the statements where there is the greatest class discrepancy. Some follow-up questions may be: How easy was it to decide on whether to agree or disagree with the statements? Which statements were the hardest for you? Why? How many of you have ever talked to your parents about any of these issues? What happens when your values are different from your friends’ values? (Encourage them to discuss some of these value statements with their parents.) What is one thing you learned about your own values from this activity? About the values in this group? 5. Conclude by pointing out how understanding and standing by our values and what’s important to us, even when they differ from the majority, is an integral part of decisionmaking and fostering safe and healthy behaviours. Note: If participants are all voting for one statement, explore the position that is not expressed. If necessary, give some of the beliefs from that point of view. Tell participants that they can benefit from 12 being exposed to all points of view and will be better prepared to respond when someone challenges their values. Activity 4 Values Voting Values Statements 1. Seventh and eighth graders should be allowed to have parties at home without adult supervision. 2. Most thirteen year olds are too young to “go out” with someone alone (no group and no adults). 3. When a girl is out with a guy, it’s really up to her to make sure that things don’t go too far sexually. 4. People should only use condoms when they’re having sex with someone who has had many sexual partners. 5. Talking someone into having sex before they are ready is taking unfair advantage of them. 6. Having sex with someone who you don’t really care about is wrong. 7. Choosing not to have sex is the best choice for teenagers. 8. Teenagers are too young to be good parents. 13 Activity 4 Homework - What I Think Procedure 1. Distribute the “What I Think” handouts. Explain that the homework involves values. It should involve an adult that the participant trusts (e.g. parent, guardian, aunt, uncle, member of the clergy, neighbour) and the participant. There are separate sheets to complete. Participants should discuss the activity with the adult after they each have completed their own sheet. 2. In order to maintain the privacy of participants, ask participants to submit the Declaration of Completion slip once the assignment is done. 3. Conclude the activity with a discussion based on the following questions: How difficult/easy was it to do this activity? How similar/different were your answers from your adult support person? What did you learn from the activity? Would your or your adult support person’s answers be different if the teen referred to was 13 years of age? 19 years of age? Will the activity influence your choices? How? Note: Some young people may be unable to complete this assignment with their parent(s) or guardian(s). Allow them the opportunity to complete the assignment with another trusted adult such as an aunt, uncle, sports coach, or member of the clergy. 14 ACTIVITY 4 Handout What I Think My Opinion Directions: Please fill in the blanks with your own ideas. Then discuss your answers with an adult you trust. 1. What do you think about teenagers seeing restricted movies or reading pornographic magazines? 2. What do you think about teenagers wearing revealing clothes? 3. What do you think about teenagers’ use of swearing and slang? 4. What do you think about sexual activity for teenagers? 5. Is there some other question about how some teenagers dress, talk, or act that you’dlike to ask an adult? (Detach and hand in this slip only.) We completed the What I Think? homework assignment. Participant Adult Support Person 15 ACTIVITY 4 Handout Adult Opinion What I Think Directions: Please fill in the blanks with your opinions about the following topics. Please feel free to discuss this with the participant. 1. What do you think about teenagers seeing restricted movies or reading pornographic magazines? 2. What do you think about teenagers wearing revealing clothes? 3. What do you think about teenagers’ use of swearing and slang? 4. What do you think about sexual activity for teenagers? 5. Is there some other question about how some teenagers dress, talk, or act that you’d like to ask a teenager? 16 UNIT 2: HEALTHY RELATIONSHIPS ACTIVITY 5 AFFECTION IS IN READY Physical affection is an important part of human relationships. Humans, from infancy, need the comfort of human touch; it feels good to be touched by someone we care about. Showing physical affection for someone close to us tells that person that he or she is cared for by us. There is a wide range of ways to show physical affection. * For the purpose of this curriculum “sex” refers to vaginal and anal intercourse, and oral sex. In this activity you will: • • list ways of showing physical affection; discuss the importance of a physical affection continuum. SET We all have many relationships in our lives. The ways of showing affection and caring may differ depending upon the relationship. 1. In groups have the students list ways of showing affection for a friend, a family member, a boy or girl friend. Discuss why certain behaviours appear on one or more lists and not on others. 2. Have students add any behaviours from the Showing Affection without having Sex sheet that are missing from the student generated lists. 3. Complete the Follow-up as directed by the teacher. 17 ACTIVITY 5 GO Showing Affection without Having Sex 1. Tell the other person that you love them 2. Give or get a hug 3. Kiss 4. Hold hands 5. Talk on the telephone 6. Talk openly about your feelings 7. Snuggle up together 8. Do homework together 9. Write each other letters 10. Give or receive a promise ring 11. Send flowers 12. Whisper something nice into the other's ear 13. Dedicate a song on the radio 14. Send a funny card 15. Play “footsie” 16. Go for a walk 17. Giving or getting a “high-five” 18. Give each other sexy looks 19. Body-to-body rubbing while wearing clothes 20. Deep (wet) kissing 21. Dry kissing 22. Touching breasts or genitals through a person’s clothes 18 ACTIVITY 5 FOLLOW-UP 1. Physical affection can be very sexually arousing. The more sexually arousing the activity, the more likely it will eventually lead to sexual intercourse. In order to maintain a decision to delay sexual intercourse you and your partner should know your limits. When should you stop before it leads to sex? Decide where on the Physical Affection Funnel you would place each of the following behaviours. A. B. C. D. hugging body rubbing with no clothes deep (wet) kissing body rubbing with clothes E. F. G. H. touching breasts and/or genitals with no clothes holding hands touching breasts and/or genitals through a person's clothes dry kissing Physical Affection Funnel Least Physical 1. 2. 3. 4. 5. 6. 7. 8. 9. Sexual Intercourse Most Physical 2. Why is it difficult to stop as you get further down the funnel? 19 3. Would it be easy to go back up the funnel to a safer activity? Why or why not? 4. a) Who should decide where “the limit” is? b) When should the limit be decided? 5. Discussing ways to express affection without having sexual intercourse may be difficult. Suggest ways of making this type of discussion easier. 20 UNIT 2: HEALTHY RELATIONSHIPS ACTIVITY 6 ABSTINENCE – A Healthy Choice READY Abstaining from sex is not always easy. Decisions about sex are often made in a hurry - at a party, in a car, under the influence of alcohol, or at home when parents are about to return. Decisions about sex should be well thought out and discussed by a couple when both are able to think clearly. An informed decision made when each person is calm and not feeling pressured is more likely to result in behaviours that will avoid a possible physical, emotional or social difficulty. In this activity you will: list and evaluate reasons a young person might give for saying “Yes” to sex; rank order reasons why a young person, in your opinion, is likely to abstain from sex; rank order reasons why you would abstain from sex. select guidelines that would help a person remain abstinent. Positive Reasons for Abstinence as a Lifestyle: Positive self-esteem where the individual feels in control of his/her own choices and actions. The chance to attain short and long term goals without the need to interrupt or reject these goals as unattainable because of sexual activity. Freedom from worry or anxiety about: being exploited sexually, pregnancy, and STD’s/STI’s. Developing the sensitivity to allow a dating partner his/her own right to body privacy. Friendships with the opposite sex are allowed to grow and mature without the hindrance of a sexual attachment. Time to be an adolescent and all that this entails without the concern of a rushed transition to adult responsibility. Allowing time for the development in a relationship of trust, caring and commitment that are major elements in a committed relationship. 21 SET Part 1 1. On your own, read Ashley and Jason Considering Abstinence. 2. In a small group, brainstorm possible reasons that: 3. Ashley might say “Yes” to having sex with Jason; Jason might say “No” to having sex with Ashley. In a small group, consider each reason in terms of responsibility for reducing the spread of HIV/AIDS and rate each reason using the scale provided. Write the group's consensus in the box provided. FOLLOW-UP 1. On your own, read Usual Reasons for Abstaining from Sex. In the A boxes rank order three reasons you think young people usually have for abstaining from sex. In the B boxes rank order three reasons that would be most important to you for abstaining from sex. 2. Following your teacher's instructions move to the card representing your first choice for Usual Reasons for Abstaining from Sex and with a partner compare and discuss your rankings. 22 Activity 6 GO Part 1 Ashley and Jason Considering Abstinence Ashley and Jason have been going together for several months. They are very attracted to each other and are very much “in love.” Lately it seems that Ashley and Jason's friends are always talking about having sex. Jason and Ashley have not discussed having sex, although they have been getting closer and closer. It is Friday night, and Ashley is over at Jason's home while his parents are out for the evening. They have gone pretty far and they both realize that some decisions have to be made about having sex. POSSIBLE REASONS FOR ASHLEY TO SAY “YES” After brainstorming the possible reasons for Ashley to say “Yes” write each reason on the chart. Possible Reasons for Ashley to Say “Yes” Group's Rating 1. 2. 3. 4. 5. In a small group, consider each reason for saying “Yes” in terms of responsibility for reducing the spread of HIV/AIDS and evaluate each reason on the scale. 0 1 2 3 = = = = terrible reason poor reason fair reason good reason 23 Write the group's consensus on the rating in the box beside the reason. POSSIBLE REASONS FOR JASON TO SAY “NO” After brainstorming the possible reasons for Jason to say “No” write each reason on the chart. Possible Reasons for Jason to Say “No” Group's Rating 1. 2. 3. 4. 5. In a small group, consider each reason for saying “No” in terms of responsibility for reducing the spread of HIV/AIDS and evaluate each reason on the scale. 0 1 2 3 = = = = terrible reason poor reason fair reason good reason Write the group's consensus on the rating in the box beside the reason. 24 ACTIVITY 6 FOLLOW-UP Usual Reasons for Abstaining from Sex 1. In the A boxes rank order from 1 (most important) to 3 (least important) the reasons you think young people usually have for abstaining from sex. 2. In the B boxes rank order from 1 (most important) to 3 (least important) the three reasons that would be most important to you for abstaining from sex. A B 1. Fear of pregnancy Abstinence is the only method of birth control that is 100 percent safe and effective. 2. Fear of STD/STI Abstinence effectively eliminates the risk of sexually transmissible infections. 3. Family expectations A person's family expects him/her to abstain from sex. 4. Fear of cancer Abstinence reduces the risk of cancer of the cervix. 5. Fear of HIV/AIDS Abstinence eliminates the risk of the sexual transmission of HIV. 6. Other forms of affection Abstinence allows a couple to develop a friendship and show affection in a variety of ways that do not include sex. 7. Religious values Abstinence may be among a person's religious values. 8. Not ready Abstinence is the appropriate choice for individuals who are not ready to have sex. 9. Not with the right person Abstinence is the appropriate choice for individuals who are not sure they have met the right person. 10. Wait until marriage Delaying sex until marriage is one way of avoiding pregnancy before marriage and being free of HIV and STD’s/STI’s at the time of marriage. 25 ACTIVITY 6 SET Part II 1. Read Behaviours That May Support Abstinence on your own. Add other ideas, if you wish, in the spaces provided. 2. Read the Action Scenarios to yourself. From Behaviours That May Support Abstinence select three actions/decisions that you think would help Nancy, in the first scenario, and Gary, in the second, to remain abstinent. Write your selections in the spaces below the scenarios. FOLLOW-UP 1. Complete the Follow-up: Part II as directed. 26 ACTIVITY 6 GO Part II Behaviours That May Support Abstinence a) Go with a group of friends to parties and other events. b) Attend only supervised parties. c) Avoid secluded places where you are put in a vulnerable position. d) Avoid going out with people who have a reputation for drinking and/or using drugs. e) Decide your alcohol/drug limits before being in a sexual pressure situation. f) Decide your sexual limits before being in a sexual pressure situation. g) Avoid falling for romantic lines. h) Be honest, from the beginning, by saying you do not want to have sex. i) Be clear about your intentions to avoid giving mixed messages. j) Avoid “hanging out” with young people who pressure you to be sexually active. k) Pay attention to your feelings; when a situation becomes uncomfortable, leave. l) Get involved in activities (e.g. sports, clubs, and hobbies). Other: m) n) o) 27 ACTIVITY 6 Action Scenarios 1. Nancy and Ted have been seeing each other for some time now. Nancy feels very attracted to Ted, and lately they both have found it difficult to control their sexual feelings for each other. Nancy has promised herself not to have sex until she is older, and, so far, Ted has respected her decision. One of Nancy and Ted's classmates has announced that her parents/guardians are out of town for the weekend and she is having a party on Friday night. Everyone is making plans. Ted told Nancy he will bring along some beer and a few of Nancy's friends have been thinking this has possibilities of becoming an “all-nighter.” Nancy thinks about her promise to herself, but also thinks it would be a great chance to have fun with friends and spend some time alone with Ted. Actions/Decisions for Nancy: i) ii) iii) 2. Gary and Paula are both very serious about their relationship. Lately, whenever they are alone their sexual feelings have led to activities that are close to having sex. Paula has invited Gary over to her house for the afternoon. Gary knows that Paula's parents/guardians will not get home from work until the evening, and that this could be an opportunity to have sex for the first time. However, Gary has been learning about the risks of HIV/AIDS and other STD’s/STI’s. Now he is not sure he wants to have sex. Nevertheless, he feels Paula is ready for sex and she will probably be hurt if he turns down her invitation to come over to her house. Actions/Decisions for Gary: i) ii) iii) 28 ACTIVITY 6 FOLLOW-UP Part II 1. If you were in a relationship and were not ready to be sexually active list three behaviours that you think would help you abstain from sex. i) ii) iii) 2. What problems could be created if a person wished to be abstinent or delay sex and his/her partner did not? 29 UNIT 2: HEALTHY RELATIONSHIPS ACTIVITY 7 YOU DECIDE READY A decision about abstinence can be influenced by what males and females have learned from society about conforming to expected sex roles. For example, some males may have learned that it is “cool” to get as far as they can on a date. On the other hand, some females may have learned it is up to them to keep their date from going too far. Males and females may also have different ideas about what is expected from a date particularly if one person has paid for the date. For example, a male who has paid for a movie and a pizza may expect sex in return. These ideas are out-of-date and need to be changed. Understanding these differences is important in maintaining decisions about delaying sexual intercourse and reducing or eliminating old ideas. In this activity you will: • • • identify some male and female roles related to sexual behaviour; write new statements to replace some male and female roles related to sexual behaviour; discuss ways to reduce or eliminate some stereotypes. SET 1. On your own, read Statements to Consider. 2. On your own, evaluate each statement with respect to your own beliefs. Circle “R” if you think it is right to think this way. Circle “W” if you think it is wrong to think this way. 3. Finally, for each statement circled “W”, write a new statement that you think would be better for both males and females. 4. Complete the follow-up statement as directed by your teacher. 30 ACTIVITY 7 GO Statements to Consider 1. The success of a date can be judged by how sexual it was. R W R W R W R W R W R W R W R W The success of a date should be judged on 2. Saying “no” to sex is a real put-down. Saying “no” to sex should be 3. If a lot of money is spent on a date, sex should be given in return. If money is needed for a “date” it should be 4. “No” to sex really means “maybe” and “maybe” means “yes”. “No” to sex really means 5. You are thought of as “cool” if you have had sex. You are “cool” if 6. Dressing sexy means you want to sex. The way a person dresses 7. If a boy/girlfriend agrees to go to your house you can expect to have sex. If a boy/girlfriend decides to go to your house it might mean 8. It is the female’s responsibility to decide how sexual a relationship becomes. It is responsibility to set sexual limits. 31 ACTIVITY 7 FOLLOW-UP 1. Why do people sometimes have different ideas about their roles related to sexual behaviour? 2. How do these differences influence decisions to delay sex? 3. Are there other ideas that people believe about sex that you think are wrong and that you would like to change? What are they and how would you change them? 32 UNIT 2: HEALTHY RELATIONSHIPS ACTIVITY 8 HOW DO I COMMUNICATE MY DECISION? There are many ways to communicate your decisions. You are assertive when you stand up for your personal rights without putting down the rights of others. If you are assertive you are capable of: 1. Saying “NO” without feeling guilty. 2. Disagreeing with someone without becoming angry. 3. Asking for help when you need it. Assertive people: 1. 2. 3. 4. 5. Stand up for their rights without putting down the rights of others. Listen to the other person's viewpoint. Express their true feelings, negative and positive. Are confident, but not “pushy”. Are respectful of others and themselves. When assertive people speak to others you might see that their head and eyes are up, their shoulders and body are firm but relaxed, and often there is a smile on their face. Assertiveness enables you to be more honest and open in your communications and relationships with other people. Assertiveness is a human relations tool or technique. Passive people: 1. 2. 3. 4. 5. Do not stand up for their rights. Put others first, at their own expense. Give in to what others want. Remain silent, even though something bothers them. Apologize for their behaviours or lack of them. Passive people may hold their head and eyes down as they speak. Their shoulders may be slumped and they sometimes look sad or emotionless. Aggressive people: 1. Stand up for their rights without regard for the rights of others. 2. Put themselves first at the expense of others. 3. Overpower others - physically, intellectually or verbally. Aggressive people may hold their head up, and point their eyes up and over the eyes of the person to whom they are speaking. Often they will hold their hands on their hips and keep their feet apart slightly in a “fighting” pose. 33 ACTIVITY 8 HOW TO DELIVER AN ASSERTIVE MESSAGE Steps Words You Might Say 1. State how you feel and explain the problem. I feel ... when ... I don't like it when ... I wish you would ... It bothers me when you ... 2. Make a request. I would like it if ... Please don't ... I would like you to ... Could you please ... 3. Ask how he/she feels about what you have just said. Is that OK with you? What do you think about this? How do you feel about that? The Other Person's Response 4. Accept with thanks if he/she agrees. He/she may agree, disagree or try to dissuade you. Thanks! I appreciate that! Great! RESPONDING TO PERSUASION Ways that someone can get you off your assertive message or not accept it. 1. Put you down. “You're just a chicken.” 2. Argue. “Why not?” “So what?” “Everyone else is doing it.” 34 ACTIVITY 8 WHEN PEOPLE DON'T AGREE WITH YOU TRY ONE OF THESE ALTERNATIVES: BARGAIN, DELAY OR REFUSE BARGAIN: Try to negotiate something which both of you will like. “Let's do ... instead.” “What if we try ... instead.” “I won't do that, but maybe we could do ...” “What would make us both happy?” DELAY: Put off making a decision so that you can think about it more. This also gives the other person a chance to reconsider his/her position. “Not now.” “I'm not ready yet.” “Let's see how we feel tomorrow.” “I'd like to talk to my friend first.” REFUSE: Say “NO” clearly, and if necessary, leave and/or call for help. “No, thanks.” “I said NO and I mean it.” “I'm not arguing with you. I said NO. I'm leaving.” GO With a partner, prepare an assertive message which you will perform in front of the class. Use one of the Action Scenarios. Action Scenarios 1. With a very close friend of the same gender, you are discussing opinions about relationships and the pros and cons of having sex. Your friend tells you that having sex is “the greatest” and that you should try it. You decide to tell your friend that you have made up your mind that you are not ready and you do not want to discuss the topic further. 2. While your parent(s)/guardian(s) are at work, you invite your friend over to your house for something to eat. After eating, your friend gets quite physical, holding you close and wrestling with you. You feel things have gone far enough and fear the next thing may be having sex. You want to continue your friendship, but decide to tell him/her to stop being so physical. 3. Your friend thinks that it is time to have sex. You love him/her but your parents have taught you that sex before you are ready is wrong and you feel the same way. Your friend says, “You are just oldfashioned, and if you loved me you would agree.” Although you are afraid you will end the relationship, you decide to tell your friend you are not ready to have sex now. 4. Every time you go out with your friend, he/she becomes very serious and possessive of you. He/she is jealous of your other friends and wants to be with you all the time. You want to spend less time with him/her, and more time having fun with a number of other friends. You like this friend, but you decide to tell him/her that you want more time to yourself. Note: This is a good time to show the video “When Sex Means Trouble”. 35 UNIT 3: SAFER SEX ACTIVITY 9 CONSIDERING “SAFER” SEX READY Deciding for abstinence is the only way to avoid sexual transmission of STD’s/STI’s, HIV and unplanned pregnancy. A minority of teens may decide against abstinence and become sexually active. It is therefore important that all teens become knowledgeable about safer sex practices. Those that do not abstain and who use safer sex practices are not completely protected against STD’s/STI’s or unplanned pregnancy. When used in combination, these safer sex practices, considerably reduce the risk of STD’s/STI’s, HIV and unplanned pregnancy. In this activity you will: • • • identify safer sex practices and their benefits; identify potential risks of safer sex; discuss ways to make situations safer with respect to HIV or STD’s/STI’s. SET 1. Assessing prior knowledge of safer sex practices. 2. With a partner, read Decisions about Safer Sex. Decide which safer sex practice each of the five couples is thinking of adopting, what problems the couples may have if they rely on the particular practice(s) they have chosen. 3. Complete the Follow-up as directed by your teacher. 36 ACTIVITY 9 Decisions about Safer Sex In each scenario described below, a couple has decided to have sex and to rely on a safer sex practice to reduce the risk of infection by HIV or other STD/STI causing organisms. For each scenario state: • • • the safer sex practice(s) adopted by the couple; the problem(s) they may have; ways they might make the situation safer with respect to HIV or STD/STI infection and unplanned pregnancy. 1. May and Jim plan to have sex and use a condom, although they do not know very much about condoms. Neither has had sex before or injected drugs. Safer sex practice(s): Possible problems: 2. Carol and Bob plan to have sex without using a condom. Carol has been taking the birth control pill for several months for menstrual cramps. This will be her first experience having sex, and Bob has recently been tested for HIV and received a negative test result. Safer sex practice(s): Possible problems: 3. Barb and Peter plan to have sex without using a condom. Barb thinks she does not have any sexually transmitted diseases. Peter has told Barb about his previous sexual partners and assured her that all of them told him they were disease free. Safer sex practice(s): Possible problems: 37 ACTIVITY 9 4. Steve and Sara plan to have sex without using a condom. Steve has assured Sara that they are safe because Sara is taking the birth control pill and he has reduced his number of sexual partners since he found out about AIDS. Safer sex practice(s): Possible problems: 5. Jessica and Mike plan to have sex without using a condom. Both of them have had vaginal intercourse before but neither of them has engaged in anal sex. Jessica is seeing only Mike, and Mike has told Jessica he is also monogamous. Mike has never used injection drugs, and Jessica has told Mike that she gave up doing injection drugs two years ago and has felt healthy every since. Safer sex practice(s): Possible problems: 38 ACTIVITY 9 FOLLOW-UP 1. What problems are common to most, if not all, of these Decisions About Safer Sex scenarios? 2. Why do some people in a relationship not tell the truth about their sexual history? 3. How can you be certain about your partner’s sexual health? 4. If you are or will be sexually active, which of the safer sex practices would you use? On a scale of 1 (low) to 3 (high), what do you think your risk of contracting HIV or an STD/STI will be if you use these safer sex practices? 39 UNIT 3: SAFER SEX ACTIVITY 10 CONDOM PRACTICE READY In this voluntary activity you can practice putting a condom on a demonstration model of a penis. It may be difficult for you to do this task, and you may decide to observe rather than volunteer. Whatever your decision, consider that this activity will prepare your for a time in the future when you will want to make healthy decisions in a sexual relationship. In this activity you will: • • observe how to put a condom on a demonstration model of a penis; practice putting a condom on a demonstration model (voluntary). SET 1. With your teacher, read the Condom Practice Task Card. 2. Observe a demonstration of how to put a condom on the model of a penis. Using the Condom Practice Task Card, read each step as it is completed. Ask your teacher to explain any of the instructions that are not clear to you. 3. In a small group, observe a student demonstrating how to put a condom on the model. Assist the student doing the demonstration by taking your turn reading the instructions for each step on the Condom Practice Task Card. 4. You will be given an individually packaged condom. Observe the type of packaging and the information on the outside of the condom wrapper. Do not open the condom wrapper yet. 5. If you are comfortable with the activity, volunteer to practice putting a condom on the model. Other group members will assist you by either reading the instructions on the Condom Practice Task Card as you perform each step or by giving feedback on your performance after you have completed the whole task (you should indicate your choice to them before you start the task). Continue this process until all volunteers have had a chance to practice the task. When it is your turn to practice putting a condom on the model, open the condom wrapper and note the ease of opening it, the colour, shape and texture of the condom, then continue with the task. 6. Complete the Follow-up as directed by your teacher. 40 ACTIVITY 10 CONDOM PRACTICE TASK CARD Diagram Step Instructions 1 When ready to use condom, check the expiry date, open the package very carefully. Do not twist or bite the package. Do not damage the condom with your nails or rings. 2 Do not unroll the condom before using it. Do not test the condom. Make sure the condom will unroll in the correct direction. 3 4 Pinch the air out of the reservoir tip with thumb and forefinger. Leave 1 to 2 cm at the tip if there is no reservoir tip. Roll the condom on to the glans of the erect penis (model). (Hold the pubic hair away from the penis.) Continue to roll condom downward to the base of the penis model, smoothing out any air bubbles as you proceed. (Apply a water-based lubricant, if desired.) INTERCOURSE AND EJACULATION 5 6 7 Withdraw penis immediately after ejaculation, holding the rim to prevent the condom from slipping off the penis. Point penis downward to prevent spillage of semen. Keep the condom away from your partner's body. Roll the condom partially off the penis and slide it off. If semen spills, immediately wash the body parts with warm water and soap. Twist the condom at the opening and dispose of it in a garbage container. Urinate, and then wash the penis with warm water and soap. Never reuse a condom. 41 ACTIVITY 10 FOLLOW-UP 1. a) What procedures would be important to prevent semen from spilling? b) What procedures would be important in preventing the condom from breaking? c) What procedures would be important to ensure that the condom is withdrawn from the vagina without spilling any semen? 2. Discuss difficulties that you think might occur if you were to use a condom with a partner in a real life situation (e.g. darkness, being unable to see). 42 UNIT 3: SAFER SEX ACTIVITY 11 THE LINE-UP READY You may not have seen, handled or even thought about condoms as being in any way relevant to you. The aim of the next series of activities is to prepare you for the future. Trying to do something for the first time is often embarrassing. It is usually less embarrassing for those who have a clear idea how to proceed. By knowing the proper way to use a condom you are less likely to be embarrassed and more likely to consider using them should it become necessary sometime in the future. In this activity you will: • learn the steps to follow to use a condom correctly. SET 1. Read the Steps for Condom Use listed beside the Condom-Use Staircase. 2. In your groups decide on the correct sequence of steps for condom use and complete the Condom Use Staircase. 43 ACTIVITY 11 GO CONDOM-USE STAIRCASE Directions: Write the letter corresponding to each step for condom use on the appropriate step of the Condom-Use Staircase. STEPS FOR CONDOM USE a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. withdraw penis open package intercourse hold rim of condom unroll condom on penis buy condom (lubricated latex) squeeze air from condom dispose of condom ejaculation slide condom off hold back pubic hair loss of erection arousal and erection discuss condom use check expiry date h. 14 dispose of condom 13 12 11 10 9 8 7 6 5 4 3 2 n. 1 discuss condom use 44 UNIT 3: SAFER SEX ACTIVITY 12 ATTITUDES ABOUT CONDOMS READY For those who have decided to have sex, proper use of a condom every time they have sex is the best protection against HIV infection and other STD/STI. However, many young people are uncertain how they feel about using condoms. They may have heard negative comments about condom use. They may also be embarrassed to discuss, buy and use condoms. If you have negative attitudes towards using condoms you may be less likely to use condoms. Often we may be quite positive about condoms and their use, but our partner(s) may object to the use of condoms. It may be important for you to try and convince your partner that condom use is a safer and more positive alternative than not using one at all. If you are unable to convince your partner to use a condom it is important to abstain from having sex with that person. In this activity you will: • • • become aware of some of the negative attitudes towards condom use; discuss embarrassing situations related to condoms; deal with partner objections to the use of condoms. SET Part I 1. On your own, read and complete Unfinished Sentences About Condoms. 2. In a small group, read your finished sentences using the Summary of Condom Comments chart. Record the positive and negative comments made by group members. Did the group have more negative or more positive comments about condoms? Discuss reasons for this result. 3. In a small group select 3 of the negative comments about condoms and discuss possible reasons for these negative comments. Then substitute a positive statement and reason for each of the selected statements. For example, “Condoms are really messy.” Positive substitution: “Actually using condoms can be less messy because semen is contained in the condom.” 45 ACTIVITY 12 GO Part I UNFINISHED SENTENCES ABOUT CONDOMS Write an ending you think would best complete each sentence. 1. When it comes to condoms, males believe ... 2. When it comes to condoms, females believe ... 3. Buying condoms can be ... 4. Asking a partner to use a condom would be ... 5. Using a condom is ... 6. Personally, I think condoms are ... 46 ACTIVITY 12 Summary of Condom Comments Positive Comments Negative Comments Positive Statement and Reason Condoms are really messy. Actually using condoms can be less messy because semen is contained in the condom. 47 ACTIVITY 12 Temperature Check Activity SET Part II 1. Read Embarrassing Moments. As a group, rank the embarrassing moments from most to least embarrassing. Give a reason why you ranked each of the two most embarrassing moments as you did. Give a reason why you ranked each of the two least embarrassing moments as you did. Embarrassing Moments 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. buying a condom from a sales clerk of the same sex buying a condom from a sales clerk of the opposite sex standing at the condom section in a store deciding which package to buy knowing someone in the line or behind the counter as you wait to pay for the condoms obtaining a condom from a vending machine in the washroom having a parent/guardian find a condom in your pocket, wallet or purse talking to your partner about using a condom having your partner talk to you about using a condom putting a condom on before sexual intercourse taking off and disposing of a condom after use obtaining a free condom from a clinic (e.g. Village Clinic) No. Reason for Ranking MOST Embarrassing LEAST Embarrassing 48 ACTIVITY 12 Part II In a small group, discuss ways of making these situations less embarrassing. One member of your group will report your answers to the class. Part III 1. Complete Part III as directed by your teacher. 2. On your own, read Partner Objections to Condoms and Possible Response(s) to Partner Objections to Condoms. Select the response you think is most appropriate for each objection and write the letter of the response in the space provided. Some objections may have more than one response. If you have time, think of other responses to the objections. 3. Join with another student and compare one or two of your responses to Partner Objections to Condoms. 49 ACTIVITY 12 GO Part III Partner Objections to Condoms Possible Response(s) 1. Don't worry, I'm taking the pill so you don't really need to use a condom. 2. I'm clean. I don't run around. I don't have an infection. 3. Condoms don't feel good. It won't be natural. 4. By the time you put a condom on, you have lost the mood. 5. I feel like an idiot buying condoms and then trying to hide them from my parents. 6. I'd be embarrassed to use one. 7. Condoms are gross. They're messy - I hate them. 8. Just this once. We hardly ever have sex. 9. I don't have a condom with me. 10. They cost too much. Possible Response(s) to Partner Objections a. Maybe I can help by keeping the condoms for you. b. Once is all it takes. c. I'd like to use a condom anyway. It protects us both from infections we may not realize we have. d. I always carry a condom with me, because I care about myself and about us. e. Let's put sex on hold, until we have a chance to work out our differences. f. This isn't a joke. It's important to protect ourselves. g. Condoms may be a little awkward the first time, but it will get better. h. I'll get the condom. It'll only take a few minutes. i. I think we could get used to condoms after a while. It might even be fun. j. It's not true. Anyone can get AIDS. k. Millions of people are infected without knowing it. Isn't it better to be safe? l. Maybe we're not ready for sex if we can't talk about condom use. m. Embarrassment never killed anyone. 50 ACTIVITY 12 FOLLOW-UP Part III 1. Why do some young people risk their health, even their life, by deciding to have sexual intercourse and refusing to use a condom? 2. What can be done to change negative attitudes about condoms and condom use? 51 UNIT 3: SAFER SEX ACTIVITY 13 CONDOM KNOWLEDGE READY Not having sex is the only sexual choice that is 100% risk-free. Everyone not abstaining from sex needs to take precautions to reduce his/her risk of getting HIV/AIDS and other STD’s/STI’s. Taking these precautions is called practicing “safer sex.” Even if you are not sexually active, learning about “safer sex” practices will improve your knowledge for a time in the future when you may need protection against HIV/AIDS and other STD’s/STI’s. Using a latex condom during sexual intercourse is a safer sex behaviour and the safest method to protect oneself and one's partner against HIV infection and STD’s/STI’s if one is sexually active. Condoms also provide some protection against unplanned pregnancy. Correct information about condoms will help you consider the advantages and disadvantages of using condoms. In this activity you will: • • demonstrate your present level of knowledge about condoms; have the opportunity to increase your knowledge about condoms. SET 1. Follow your teacher's instructions and respond to the statements in A Test About Condoms. 2. Discuss the correct answers with your teacher. 3. Determine your Condom Knowledge score. 4. Discuss any questions you have with your teacher. 52 ACTIVITY 13 The CONDOM Success Rate: 98% What is it ? A condom is made of latex (rubber), or sheep’s gut (intestines). Because HIV may pass through a condom made of sheep’s gut, a latex condom is recommended. Some condoms are made of more durable latex for use in anal sex. Condoms are sold at pharmacies, supermarkets, convenience stores and vending machines in public washrooms. It is best to buy condoms in a store that sells a lot of condoms so that the stock is fresh. Condoms deteriorate from exposure to direct light, heat, rough treatment and with the passage of time. Do not store condoms in your wallet, in the car’s glove compartment, or any other place where heat and cold will affect them. A condom, stored correctly, should be good for about two to three years. Most condoms have an expiry date printed on the package. Condoms are packaged for sale in several ways. i) individually wrapped in see-through plastic or foil pouches. ii) in boxes of twelve, six or three condoms which have individual wrappers. How does it work ? A condom works by containing the sperm and preventing it from entering the vagina. Some condoms are coated with a substance that melts when the condom is placed on the penis. This lubricant makes it easier for the penis to be inserted into the vagina. Some men prefer to place additional lubrication (K-Y Jelly) directly onto the head of the penis prior to rolling down the condom. This reduces friction as the condom is rolled over sensitive skin of the glans or head of the penis. The only acceptable lubricants are the sterile water based lubricants. DO NOT use any petroleum or oil based lubricants such as Vaseline, baby oil, vegetable oil, or Crisco. These will cause the condom to deteriorate immediately and may cause it to leak. Condoms may fail as a contraceptive measure because they can be torn when the package is being opened or when the condom is being rolled onto the penis if the user is not careful about sharp rings or fingernails. Condoms must be rolled down the entire length of the penis to prevent spillage of sperm into the vagina. Space should be left at the tip for the sperm to collect after ejaculation occurs. Most condoms are now designed with a special reservoir tip. A female condom has been developed (called an intra-vaginal pouch) which is inserted inside the female vagina. It may be slightly less effective than those for men and as a result is less popular. Some brands of condoms are coated with Nonoxynol-9, which is a spermicide. If the condom breaks during intercourse and sperm is deposited into the vagina, this spermicide is supposed to kill the sperm. Nonoxynol-9 is also believed to provide some protection against the transmission of HIV. Yet it must be noted that in some individuals a side effect like genital irritation, rash, or itchiness to Nonoxynol-9 may occur leaving them more susceptible to a STD/STI. Because condoms may fail to provide sufficient protection against pregnancy, it is recommended that an additional contraceptive be used by the woman. It is very important to use condoms at all times with other birth control methods to prevent the spread of STD’s/STI’s. REMEMBER: ABSTINENCE IS THE ONLY 100% WAY TO PROTECT YOU FROM PREGNANCY AND TRANSMISSION OF STD’s/STI’s. 53 ACTIVITY 13 GO A Test About Condoms In your notebook, answer true or false, to the following statements: True False 1. Over 80 percent of sexually active youth now use condoms. T F 2. A condom, if used properly, gives 100 percent protection against HIV infection, STD’s/STI’s and pregnancy. T F 3. As a result of effective education the rate of HIV infection among gay males has decreased. T F 4. Condom packages have an expiry date. T F 5. Females now buy more than 40 percent of the condoms sold. T F 6. Condoms can be damaged depending on where they are stored. T F 7. A thicker condom means a stronger condom. T F 8. Lubricating a latex condom with Vaseline is an effective way to prevent breaking or tearing during use. T F Natural condoms (made from lamb intestine) are more effective against HIV than latex condoms. T F 10. Condoms with the spermicidal lubricant Nonoxynol provide additional protection against HIV. T F 11. Condoms with reservoir (receptacle) tips are less apt to break than those with rounded ends. T F 12. A person can damage a condom while opening the package. T F 13. You have to be at least 16 years old to buy condoms. T F 14. All lubricated condoms include Nonoxynol. T F 15. Condoms reduce sexual sensations for a male. T F 16. Condoms enable many males to “last longer” before they ejaculate during intercourse. T F 17. Coloured condoms are less effective against HIV transmission than uncoloured condoms. T F 18. A condom can be safely reused. T F 19. All brands of condoms are equally effective in terms of protection against pregnancy and STD’s/STI’s. T F 20. A condom has now been developed for female use. T F 9. Total number of correct answers 54 ACTIVITY 13 Determine your Condom Knowledge Score using the scoring key below. Number of Correct Answers CONDOM KNOWLEDGE SCORE 16 - 29 Very good You have great “condom knowledge” to share with your group. 11- 15 Good The activities to follow should correct any misinformation you have. 6 - 10 Fair Hope this test and the activities to follow will help you learn more. 1-5 Poor Find out more! You may need this information in future. 55 UNIT 4: BIRTH CONTROL AND TEEN PREGNANCY ACTIVITY 14 BIRTH CONTROL Birth Control is defined as the use of various methods to prevent a woman who has vaginal intercourse from becoming pregnant. Several birth control methods have been available since early history, but it was only in the twentieth century that a variety of scientifically researched and tested methods became widely available. As science and technology make it possible for people to live longer lives and for the death rate to drop dramatically, the need to control conception has become an issue in many countries. In some countries, limiting family size is encouraged by government through the distribution of free birth control devices, establishment of family planning clinics, and even providing free abortion services. On the other hand, in places such as Ireland, information on birth control, and the devices themselves, are not available because of government opposition to birth control. In Canada, some birth control clinics are run by private organizations such as Planned Parenthood, but each provincial health department offers free birth control information and counselling services to the public. Doctors prescribe birth control methods to women and pharmacies sell them the products. Recently, because of the HIV/AIDS epidemic, many other retail outlets such as convenience stores have begun to sell condoms. Modern day couples may choose to practice birth control. They do so for a variety of reasons. They may want to limit the size of their family so as to have a higher standard of living. They may want to space their children's births so that they can give each child a generous amount of attention and care. Financial commitments such as mortgages and loans sometimes may make it necessary for both the husband and the wife to work. Working couples may delay having children until they are better off financially. Some married women wish to pursue a career and do not wish to have any children. Single people who wish to engage in sexual intercourse may use birth control to prevent pregnancy. The use of birth control, especially the artificial methods such as the pill, condom, diaphragm, etc., is a controversial issue in some religions. Teens and Birth Control Each year in Canada more than 35,000 unmarried teenage girls become pregnant. Teens should be given information and counselling about birth control. Will this knowledge about reliable techniques of birth control and how to protect oneself against sexually transmitted diseases/infections (STD’s/STI’s) encourage a greater number of teens to have sexual intercourse? Some communities are strongly divided about the issue of birth control. A few high schools have set up clinics where birth control devices and counselling are provided free to students, however there are many school districts that do not offer human sexuality education (Family Life) programs because parents are opposed to sex education being taught in schools. 56 ACTIVITY 14 Effectiveness of Birth Control Methods The SR or Success Rate means the number of women out of 100 who consistently and correctly used the method for one year and did not become pregnant. 1. ABSTINENCE SR: 100% Only abstinence from vaginal intercourse is a 100% effective method of birth control, as well as a help in the prevention of the spread of STD’s/STI’s. All other methods have lower rates of effectiveness. Positive Reasons for Abstinence as a Lifestyle: • Positive self-esteem where the individual feels in control of his/her own choices and actions. • The chance to attain short and long term goals without the need to interrupt or reject these goals as unattainable because of sexual activity. • Freedom from worry or anxiety about: being exploited sexually, pregnancy, and STD’s/STI’s. • Developing the sensitivity to allow a dating partner his/her own right to body privacy. • Friendships with the opposite sex are allowed to grow and mature without the hindrance of a sexual attachment. • Time to be an adolescent and all that this entails without the concern of a rushed transition to adult responsibility. • Allowing time for the development in a relationship of trust, caring and commitment which are major elements in a committed relationship. 57 ACTIVITY 14 2. FAMILY PLANNING OR FERTILITY AWARENESS SR: 80-90% What is it ? Many women use the Biological Birth Control methods (knowing when she is likely to get pregnant and when she is not). These methods are suitable for married couples who have decided not to use artificial birth control methods such as the condom or the pill. The couple usually attends a course offered by a national organization called Serena. They are instructed on how to observe various changes in the woman’s body which help them to plan when not to have intercourse so as to avoid pregnancy. There are four ways to calculate the Fertile Period. i) Calendar Method ii) Temperature Method iii) Cervical Mucus Method iv) Combined Method (Sympto-Thermatic) How does it work ? Calculation of the fertile time (unsafe) is based on normal events of the menstrual cycle and on sperm survival. i) Egg survives for 24 hours after ovulation. ii) Sperm survives for 4872 hours after ejaculation. iii) Time from start of menstrual bleeding until ovulation varies from 6 20 days. iv) Ovulation occurs about 14 days before her next period. v) Progesterone released by the ovary after ovulation causes rise in body temperature until her next period. vi) Mucus from the cervix appears scant, thick, and milky when a woman is infertile and appears thin and clear when she is fertile. vii) Precision in predicting exact ovulation time is difficult, therefore 2 to 3 days must be added to the start and the end of the “fertile time”. During the “safe” days a condom is advised to increase effectiveness as well as prevent any transmission of any STD’s/STI’s. * IMPORTANT TO STRESS: Some women, particularly teenage girls, have irregular menstrual cycles. Normally, ovulation occurs mid-way through a woman’s cycle. However, in some women it may occur very close to the time of menstruation or during menstruation. If intercourse occurs during that time, pregnancy may occur. Couples who want to have a child can take advantage of the knowledge of when the woman is in the most fertile phase of the menstrual cycle and increase the frequency of intercourse to achieve pregnancy. REMEMBER: ABSTINENCE IS THE ONLY 100% WAY TO PROTECT YOU FROM PREGNANCY AND TRANSMISSION OF STD’s/STI’s. 58 ACTIVITY 14 3. CONDOMS SR: 98% What is it ? Condoms are made of latex (rubber), or sheep’s gut (intestines). Because HIV may pass through condoms made of sheep’s gut, latex condoms are recommended. Some condoms are made of more durable latex for use in anal sex. Condoms are sold at pharmacies, supermarkets, convenience stores and vending machines in public washrooms. It is best to buy condoms in a store that sells a lot of condoms so that the stock is fresh. Condoms deteriorate from exposure to direct light, heat, rough treatment and with the passage of time. Do not store condoms in your wallet, in the car’s glove compartment, or any other place where heat and cold will affect them. A condom, stored correctly, should be good for about two to three years. Most condoms have an expiry date printed on the package. Condoms are packaged for sale in several ways. i) individually wrapped in see-through plastic or foil pouches. ii) in boxes of twelve, six or three condoms which have individual wrappers. How does it work ? Condoms work by containing the sperm and preventing it from entering the vagina. Some condoms are coated with a substance which melts when the condom is placed on the penis. This lubricant makes it easier for the penis to be inserted into the vagina. Some men prefer to place additional lubrication (K-Y Jelly) directly onto the head of the penis prior to rolling down the condom. This reduces friction as the condom is rolled over sensitive skin of the glans or head of the penis. The only acceptable lubricants are the sterile water based lubricants. DO NOT use any petroleum or oil based lubricants such as Vaseline, baby oil, vegetable oil, or Crisco. These will cause the condom to deteriorate immediately and may cause it to leak. Condoms may fail as a contraceptive measure because they can be torn when the package is being opened or when the condom is being rolled onto the penis if the user is not careful about sharp rings or fingernails. Condoms must be rolled down the entire length of the penis to prevent spillage of sperm into the vagina. Space should be left at the tip for the sperm to collect after ejaculation occurs. Most condoms are now designed with a special reservoir tip for that purpose. A female condom has been developed (called an intra-vaginal pouch) which is inserted inside the female vagina. It may be slightly less effective than those for men and as a result is less popular. Some brands of condoms are coated with Nonoxynol - 9, which is a spermicide. If the condom breaks during intercourse and sperm is deposited into the vagina, this spermicide is supposed to kill the sperm. Nonoxynol-9 is also believed to provide some protection against the transmission of HIV. Yet it must be noted that in some individuals a side effect like genital irritation, rash, or itchiness to Nonoxynol-9 may occur leaving them more susceptible to a STD/STI. Because condoms may fail to provide sufficient protection against pregnancy, it is recommended that an additional contraceptive be used by the woman. It is very important to use condoms at all times with other birth control methods to prevent the spread of STD’s/STI’s. REMEMBER: ABSTINENCE IS THE ONLY 100% WAY TO PROTECT YOU FROM PREGNANCY AND TRANSMISSION OF STD’s/STI’s. 59 ACTIVITY 14 4. SPERMICIDES: VAGINAL FOAMS, CREAMS, JELLIES, SUPPOSITORIES SR: 97% What is it ? These products contain chemicals which kill sperm on contact or stops them from moving. One of the most widely used chemicals is Nonoxynol-9. Another substance called a base is mixed with the spermicide to keep it from spilling out of the vagina. It also coats the vagina and makes it difficult for the sperm to enter the cervix by blocking the entrance to the cervix. These products are sold in drug stores without a prescription and come with specific directions which must be followed carefully by the woman to ensure maximum effectiveness. The man should also use a condom to decrease the risk of pregnancy and the transmission of STD’s/STI’s. How does it work ? Spermicidal foam is the most popular of these contraceptives. The foam comes in a pressurized container. The woman inserts the foam into the upper region of her vagina, near the cervix or opening to the uterus, using a plastic applicator. The foam should be inserted no sooner than 30 minutes before having intercourse, as it loses its effectiveness if put in too early. After intercourse, the woman must not bathe, swim, or douche her vagina for 6 to 8 hours. This time is needed for all the sperm to be killed by the chemical in the foam. A woman should have available two containers of foam. It is difficult to tell when one will become empty and it is important to place the right amount into the vagina for maximum protection. If the woman wants to have intercourse a second time during the 6 to 8 hour period, she must introduce another application of foam into her vagina. Creams and jellies are applied in a similar fashion. Suppositories are inserted into the vagina using the fingers. These products cannot be felt during intercourse, although they tend to provide additional lubrication to the vagina. REMEMBER: ABSTINENCE IS THE ONLY 100% WAY TO PROTECT YOU FROM PREGNANCY AND TRANSMISSION OF STD’s/STI’s. 60 ACTIVITY 14 5. THE DIAPHRAGM SR: 94-98% What is it? A diaphragm is a dome-shaped rubber cup set on a flexible metal rim. It is placed at the back of the vagina to prevent sperm from reaching the egg and is used with spermicide jelly or cream, which immobilizes and kills the sperm. A doctor determines the correct size of diaphragm for the woman and prescribes the correct type. She purchases the kit (diaphragm, plastic inserter, and spermicidal jelly) at a pharmacy. The diaphragm may be inserted and removed with the fingers as well as the plastic inserter. Any changes in the woman’s vagina due to childbirth, abortion, or miscarriage, abdominal surgery, and large weight changes will necessitate a refitting of the diaphragm by the doctor. How does it work? A diaphragm acts as a physical barrier to sperm. The most important contraceptive aspect of this method however, is its holding the spermicide cream or jelly in place at the cervix (opening to the uterus). The diaphragm must be inserted prior to intercourse (up to 2 hours) and must remain in the woman’s vagina without bathing, swimming, or douching for at least 8 hours. If the woman wishes to have additional intercourse in that 8 hour period more spermicidal jelly must be inserted into the vagina with an applicator. After removal, the diaphragm must be washed with mild soap and water, dried, sprinkled with cornstarch to keep it soft, and stored in its case away from direct heat and light. The average life of a diaphragm is two years. A smaller version of the diaphragm is available. It is called a cervical cap. REMEMBER: ABSTINENCE IS THE ONLY 100% WAY TO PROTECT YOU FROM PREGNANCY AND TRANSMISSION OF STD’s/STI’s. 61 ACTIVITY 14 6. ORAL CONTRACEPTIVE PILLS SR: 99% What is it ? Oral contraceptives (the Pill) is one of the most effective and popular methods of birth control in North America. The Pill contains artificial hormones that control a woman’s fertility cycle. It is taken daily by mouth and can only be obtained by a doctor’s prescription. How does it work ? The Pill works by preventing the ovaries from releasing an egg, which normally would occur each month. The Pill does this by changing the hormone levels that control ovulation (the release of an egg). Consequently, no eggs are present in the fallopian tubes for sperm to fertilize and pregnancy cannot occur. In the first month of use the woman should use other contraceptive methods until the hormones take effect because pregnancy can still occur at this time. There are almost 20 brands of oral contraceptives on the market today. Some contain 28 pills per package and are taken one per day. Others contain 21 pills and are taken one per day with seven days off between packages. Most pills contain estrogen and progestin and are called combined oral contraceptives. Some brands contain progestin only and are called Mini-Pills. If a pill is forgotten, take it as soon as you remember, even if it means taking two pills in one day. If you forget three or more pills in a row, throw out the package and start a new one. Use a second method of birth control for the first week. REMEMBER: ABSTINENCE IS THE ONLY 100% WAY TO PROTECT YOU FROM PREGNANCY AND TRANSMISSION OF STD’s/STI’s. 7. INTRAUTERINE DEVICE or IUD SR: 98.5% What is it ? An intrauterine device (IUD) is a small plastic object inserted through the vagina into the uterus by a doctor. They are often called “coils” or “loops.” Some are covered with thin copper wire, others contain a slow-release hormone, and still others are plastic only. An IUD remains in the uterus until removed by a doctor (every one to five years). How does it work ? There are many theories about how IUD ‘s work. They change the lining of the uterus and increase the speed with which the egg travels down the fallopian tube. They may immobilize sperm and dislodge a fertilized egg implanted in the uterine wall. Copper seems to enhance the effectiveness of the IUD. REMEMBER: ABSTINENCE IS THE ONLY 100% WAY TO PROTECT YOU FROM PREGNANCY AND TRANSMISSION OF STD’s/STI’s. 62 ACTIVITY 14 8. VASECTOMY AND TUBAL LIGATION What is it ? Couples who have decided that they do not want any children, who wish to permanently limit the size of their family, or who may be having difficulties with conventional birth control methods may choose to have a vasectomy or tubal ligation procedure performed by a doctor. These methods are, in most cases, permanent methods of birth control. The procedure for women is called a tubal ligation, and for men is a vasectomy. Both operations involve closing off tubes in the reproductive system so that the egg and sperm cannot meet. The vasectomy operation is less serious, expensive, and time-consuming than the tubal ligation operation. Neither operation affects the ability of the man or woman to have and enjoy sex afterwards. How Does it work ? In a tubal ligation, the doctor makes a small cut in the lower abdomen through which the fallopian tubes can be reached. The tubes are either tied with surgical thread or cut and blocked so that eggs released from the ovaries won’t be able to meet with sperm and are absorbed by the woman’s body. The woman menstruates as usual. There are many kinds of tubal ligations, but most operations last only 30 minutes and require only a day-long or overnight stay in a hospital. In a vasectomy, the doctor makes a small cut on each side of the scrotum to reach the vas deferens. The tubes are cut and tied so that sperm produced in the testicles won’t become part of the semen ejaculated into a woman during intercourse. The body absorbs the sperm that is produced by the testicles. This operation lasts less than one hour and is performed in a doctor’s office or hospital. The man’s semen has to be tested for the presence of sperm after the vasectomy. These operations have no negative effect on a man’s masculinity or a woman’s femininity, as they do not affect the production of hormones. REMEMBER: ABSTINENCE IS THE ONLY 100% WAY TO PROTECT YOU FROM PREGNANCY AND TRANSMISSION OF STD’s/STI’s. 63 ACTIVITY 14 9. LONG ACTING HORMONES: INJECTIONS; IMPLANTS What is it ? This method is administered by a doctor who surgically implants small rods filled with hormones (progesterone) under the skin in the arm just above the elbow. These rods release hormones very slowly for up to 5 years. This method is available in the United States and is generally unavailable in Canada. How does it work ? This method relies on the release of progesterone into the blood. The mucus of the cervix and lining of the uterus are changed, making pregnancy unlikely. Often ovulation is blocked. The most common implant in North America is “Norplant”. Some women suffer many side effects such as irregular periods, heavy menstrual flow, weight gain and depression. Such implants must be removed surgically when a woman wants to get pregnant. REMEMBER: ABSTINENCE IS THE ONLY 100% WAY TO PROTECT YOU FROM PREGNANCY AND TRANSMISSION OF STD’s/STI’s. 10. LESS EFFECTIVE METHODS WHICH SHOULD NOT BE USED i) Withdrawal This method depends on the male pulling his penis out of the vagina just before ejaculation and ejaculating outside of the vagina. This takes a lot of self-control on both partners’ part. Males can release a small amount of sperm-carrying fluid prior to the main ejaculation, enough to make a woman pregnant. ii) Douching Douching is flushing out the vagina with a liquid. It is not an effective birth control technique because the liquid will not reach the sperm which has already entered the uterus. Furthermore, it may help carry the sperm toward the egg. REMEMBER: ABSTINENCE IS THE ONLY 100% WAY TO PROTECT YOU FROM PREGNANCY AND TRANSMISSION OF STD’s/STI’s. 64 UNIT 4: BIRTH CONTROL AND TEEN PREGNANCY ACTIVITY 15 TEEN PREGNANCY The rate of pregnancy among teenage Canadian girls is high. The reasons for this vary but health care workers state that the main reasons are that many teens are having intercourse at an early age. There is a lack of reliable information about contraception. Some teens still believe in the myths about when a girl is “safe” and contraception is not necessary to prevent pregnancy. Some teens think that using contraception is unromantic and implies that they are promiscuous or prepared to have sex with anyone. A few teenage girls actually want to have a baby because they want someone to love and to love them in return. They may be using having a baby as a way to escape a difficult home life or as a way to rebel against parental authority. Whatever the reasons, the high number of pregnancies among teens creates a substantial strain on individuals, families, and the health and social services of our country. Teenage girls who are pregnant are more at risk than older women. Premature birth and low birth weight are two of the many health complications that they experience. The use of tobacco, alcohol and other drugs, along with poor dietary practices contribute to problems with their baby’s health. Some teens don’t go for prenatal care until very late in their pregnancy, thus increasing the risk to themselves and their babies. Emotional stress during pregnancy is usually very high for both the mother and the father. The choice of keeping the baby, adoption or abortion, are difficult decisions to make. The decision to keep a baby changes lifestyles dramatically. Teens who marry because of pregnancy often experience divorce. Young women who have a child in their teens frequently face raising the child on their own and being dependent on others for financial assistance. Decisions of Pregnancy A pregnant teen under the age of eighteen is still her parents’ legal responsibility and is not eligible for some social assistance programs such as welfare. She often has to live in her parent’s home and is dependent on them for food, shelter and spending money. She is entitled to Federal Child Tax Credits, Day Care Subsidy, and child support from the child’s father. Teenage girls who choose to parent their baby often find it difficult to continue their education while having to look after a child. Without a high school diploma it is extremely difficult to find a job which would pay more than minimum wage. Many girls who are 18 and are not living at home have to rely on welfare assistance. As a result, they are trapped in a lifestyle of dependency on the system. The responsibilities and financial stresses on teens raising children make it difficult for them to continue their education. 65 ACTIVITY 15 Understanding Risks and Stresses or Demands of Keeping the Baby Part 1 Living with Others In order to keep a baby and live with others, there are several areas that need to be considered. As you answer these questions keep in mind that they are designed to familiarize you with the responsibilities, stresses and relationships you would have as a teen parent. Remember that the baby could be in the care of the mother or father. 1. Would you have your own room? _________________________________________________ 2. Where would the baby sleep? ____________________________________________________ 3. Describe how a baby would change or affect relationships within the household. _____________________________________________________________________________ 4. Would you be working? __________________________________________________________ 5. What would your monthly expenses be? (e.g. shelter, food, toiletries, transportation, entertainment for you and the baby)? _____________________________________________________________________________ 6. If you are not working, who would support you and your baby? ___________________________ 7. Would you be attending school? ___________________________________________________ 8. a) Would you need a babysitter/day care? _________________________________________ b) Who would be available? _____________________________________________________ c) What would be the cost? _____________________________________________________ 9. How much responsibility would each person in the household have toward your baby (think about discipline, feeding, changing, laundry, babysitting). List each person and what you would like them to do. Then record what they would realistically be willing/able to do. Person What I Would Like What Would They Do _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 10. What concerns would you have about raising your baby with other people? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 66 ACTIVITY 15 11. Which of the following describes your living situation now (in terms of dating, curfew and your personal freedom in general)? Complete freedom Some freedom Very little freedom 12. How would the arrival of a baby affect your personal freedom? _____________________________________________________________________________ _____________________________________________________________________________ Part 2 Living Independently In order to keep a baby and live independently there are several important areas to consider. These questions are tools to help you think about the responsibilities of teen parenthood. Remember that the baby could be in the care of the mother or the father. 1. a) How would you financially support yourself and your baby? __________________________________________________________________________ __________________________________________________________________________ b) List the people who would be supportive to you and your baby. Beside each name write down the ways you hope they would help and then consider if this would be possible given their other commitments and responsibilities. Person What I Hope What is Possible _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 2. How do you think parenthood would affect your social life? _____________________________________________________________________________ _____________________________________________________________________________ 3. How would being a parent affect your ability to work or go to school? What plans would you have to make to reach your goal? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 4. Describe the relationship you would like to have with the baby’s other parent. _____________________________________________________________________________ _____________________________________________________________________________ 67 ACTIVITY 15 5. Describe the relationship you would like the other parent to have with the baby. _____________________________________________________________________________ _____________________________________________________________________________ 6. What kind of relationships would you have with the grandparents? _____________________________________________________________________________ _____________________________________________________________________________ 7. In one column list all the things you would look forward to in raising your baby. In the other column list all the things you would not be looking forward to or which would cause you concern. Looking forward to Not look forward to 68 ACTIVITY 15 Adoption Some parents decide to give their babies up for adoption. This is a very difficult decision and is usually made because the parents feel it would be in the best interest of the child. This can have a long-lasting impact because the parents often feel a deep sense of loss and grief. Counselling is recommended to help them deal with these feelings. There are two methods of arranging for an adoption in Manitoba. The most common one is using the services of Child and Family Services Agency (C.F.S.). The other one is through a lawyer who specializes in adoption services. This is called a Private Adoption. a) Child and Family Services Agency Couples who wish to adopt a child apply to C.F.S. They are then investigated as to their suitability of becoming adoptive parents. A social worker will inform the prospective parents of the availability of a child at the first possible opportunity. A pregnant teen who thinks she wants to have her baby adopted and who has been counselled by a social worker from C.F.S. will enter the hospital and deliver her baby. The mother does not sign the document called Voluntary Surrender of Guardianship giving up her rights to the child until nine days after the birth of the child. Two court working days later C.F.S. can place the baby in the adoptive parents’ care and the birth mother may not change her mind about giving up her child. Girls who are under 18 years of age do not need their parents’ consent or the consent of the father of the baby. It is important that the father cooperate with C.F.S. in providing as much health information as possible. This ensures that the adoptive parents will have a good medical history in case the child becomes ill. Only non-identifying information about the birth mother and father is given to the adoptive parents and vice versa. This protects the privacy of both parties and of the adoptive child. In Manitoba, there is a post adoption registry where parents and children may voluntarily leave their names so that they may be reunited when the children become adults. Both parties (parents and child) have to register in order for a reunion to take place. b) Private Adoption This option is only available for adult women (18 years of age and over). Usually a doctor will inform the pregnant patient of parents that would like to adopt a child. A lawyer then handles the legal papers and the court procedures to finalize the adoption. In this system, the birth mother gets to know the adoptive parents and often can make an agreement to continue to see them and the child in future years. C.F.S. reviews the suitability of the adoptive parents and submits a report to the Court prior to the hearing on the adoption. Considering Adoption One of the most important decisions a pregnant teen will ever make is whether or not to release the baby for adoption. This decision can affect many lives. The following questions may help in understanding the factors involved in making this decision. 69 ACTIVITY 15 1. a) At what point in your life would be the ideal time for you to have a baby (age, financial situation, health, emotional and mental state)? ______________________________________________ ___________________________________________________________________________ b) What would the other parent of the baby be like? ___________________________________________________________________________ ___________________________________________________________________________ 2. What would the differences be between your ideal situation and if you were to have a child now? _____________________________________________________________________________ _____________________________________________________________________________ 3. Compare all the positive and negative factors in raising your baby and those involved in having your baby adopted. Adoption _____________________________________________________________________________ Positive Negative Raising Your Baby _____________________________________________________________________________ Positive Negative 70 ACTIVITY 15 Extended Family Placement Manitoba law allows the Court to place a child in the home of a relative such as an uncle, brother, or grandparent. C.F.S. or a lawyer is not needed in this process. A lawyer acting for the birth mother and relative can do it through the legal system. Marriage Statistics show that teens who marry primarily because of pregnancy end up divorced at a rate twice to three times greater than those who marry without the complication of premarital pregnancy. If either party is under the age of 16, the law states that they must seek Court permission for marriage. Parental consent is needed for those between 16 and 18 years of age. Abortion Prior to 1989 abortion was legal under specific conditions which were described in a section of the Criminal Code of Canada. The Supreme Court of Canada ruled that the abortion section of the Code was unconstitutional. Since then Parliament has not been able to pass a bill to replace the old section on abortion, therefore Canada doesn’t have specific laws governing abortion. This means that a woman can have an abortion if she finds a doctor who is willing to perform the abortion in a hospital or clinic. For health reasons, abortions should be performed shortly after the pregnancy is confirmed. The risks to the mother increase as the pregnancy progresses, since more radical procedures must be used to achieve a successful abortion. Women considering abortion should seek counselling from their doctor or clinic before and after the abortion. Women having abortions often experience a sense of loss or grief that may have a lasting effect upon the rest of their lives. Responsibilities and Role of the Father Ideally, a teen father should be supportive of his pregnant girlfriend as she faces the difficult decisions concerning her pregnancy. He should, if she wants him to, accompany her to the doctor, to the counsellor(s) and to tell her parents of the pregnancy. He should help her to make the decisions about adoption, abortion or parenting the child herself. However, he should know that the Supreme Court of Canada has recently ruled that the father has no rights in terms of the woman’s decision to abort. If his girlfriend chooses to give up their baby for adoption, he should cooperate with C.F.S. in providing the adoptive parents with personal and medical information of a non-identifying kind. If the mother decides to keep the baby the father should provide child support. In many cases girls must proceed through the courts to get child support from the father. Pre-Natal Classes Manitoba Health and Child and Family Services offer pre-natal classes to address the concerns of single pregnant women. Social workers, public health nurses and home economists teach these classes. For students of Pembina Trails, these classes are offered by the Manitoba Health Unit, 233 Provencher Avenue. Phone 945-8966, for the times and location of the classes. 71 ACTIVITY 15 Some other resources to assist teens who may be pregnant are: Pregnancy Counselling and Testing: Teen Klinic Women’s Health Clinic Children’s Hospital Clinic 784-4078 947-1517 787-2401 If continuing pregnancy: Child and Family Services 944-4200 72 ACTIVITY 15 Optional Activities 1. What’s it like to have the responsibility of having a child? Go to the store. Buy a ten pound bag of flour. Take it home and wrap it in a baby blanket. For two weeks treat it just like you would your baby. Set your alarm for two A.M. and get up and ‘feed’ your baby. Then get up at six and ‘feed’ your baby again. Never leave your baby unattended. Either take your baby with you or find a babysitter for it. Keep a journal on your feelings and responsibilities as a parent. 2. What are the financial responsibilities of having a child? In preparing to be a parent there are many items you will need. The following list will give you the idea of the expenses of living independently and caring for a child: Items Resources Furniture for apartment Bed Dresser Sofa Chairs Tables Lamps Other $ $ $ $ $ $ $ ___________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ Price new and used furniture (Check store catalogue, classified ads in paper, used furniture stores.) Write in estimated cost. Will you have a furnished or unfurnished apartment? Household items Dishes Pots and pans Utensils Towels Sheets $ $ $ $ $ ____________________ ____________________ ____________________ ____________________ ____________________ Price these items in catalogues and stores. Write in estimated costs. Baby furniture Bassinet Crib Bathtub Dresser Change table Baby seat Car seat Playpen $ $ $ $ $ $ $ $ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ Price in catalogue and store. Look in classified ads. Call Salvation Army, Goodwill, and other volunteer organizations to see if they have any of these items. Layette Diapers Undershirts Sleepers Nightgowns Baby sacs Outfits Booties/socks Towels/cloths Other $ $ $ $ $ $ $ $ $ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ Call someone you know who has a baby and ask how many of each item you will need. How many diapers per week? How many outfits? How much formula per week? What other expenses? Total $ ____________________ 73 UNIT 5: SEXUALLY TRANSMITTED DISEASES/INFECTIONS (STD’s/STI’s) ACTIVITY 16 STD’s/STI’s, TRANSMISSION, SYMPTOMS, AND TREATMENT What Are Sexually Transmitted Diseases (STD’s/STI’s)? Sexually Transmitted Diseases are infections which are passed from one person to another when they engage in risky sexual behaviour (e.g. anal, oral or vaginal sex). Each disease is different, each needs a different type of test to detect it and each needs a different medicine to treat it. Some STD’s/STI’s are curable and others are not. AIDS is not. People who contract AIDS die. About 85% of STD’s/STI’s occur in persons between the ages of 15 and 30. However, anyone can become infected with a STD/STI regardless of their age, sex, race or social class. Even babies can be infected. Why are STD’s/STI’s such a big health problem? 1. Some people are involved in very high-risk sexual activity. Anyone having vaginal intercourse, anal intercourse, or oral sex without a condom is at varying degrees of risk of contracting a sexually transmitted disease. 2. Some adolescents practice serial monogamy. Even though they may start using condoms the first times they have intercourse, once they have established their sexual life and move to future partners, they start to use the oral contraceptive and fail to use condoms, putting themselves at high risk of contracting a STD/STI. This explains the very high incidence of sexually transmitted diseases in the adolescent and young adult population. 3. Many infected persons do not know they have a STD/STI because they are asymptomatic. They have the disease but do not have any symptoms. If they continue to have sex with other people they can spread the disease. 4. Some people are ashamed or afraid to go to a doctor for treatment when they suspect they may have a STD/STI and continue to spread the disease. They often don’t tell their partner about the infection and the partner can spread the disease to others. 5. Some teens are sexually active and some young adults remain single longer than in previous generations. This trend may increase the risk of infection due to the potential increase in the number of sexual partners. 6. Condoms used properly provide protection against the spread of most STD’s/STI’s. Choosing not to use a condom puts you and your partner at a higher risk of infection. 7. Some STD’s/STI’s are becoming resistant to treatment by the usual drugs, making it more difficult to cure the disease. 8. A person can be reinfected with the same STD/STI. 9. With the exception of Hepatitis B, there are no vaccines to protect someone from contracting a STD/STI. 74 ACTIVITY 16 GENITAL WARTS What is it? Genital warts are flesh-coloured growths that appear on or around the genital or anal areas of the body. Genital warts are caused by the Human Papilloma Virus (HPV). This is probably the most common sexually transmitted disease (STD). It is estimated that 10-30% of the adult population is infected with the virus. This is a life-long infection that can never be cured but can be controlled. Genital warts vary in shape, size and number based on their location. How is it spread? The Human Papilloma Virus is passed from one person to another when they engage in sexual activity such as anal or vaginal intercourse. A condom may not cover an affected area thereby leaving the partners at risk. What are the symptoms? Genital warts look much like other warts but they vary in shape, colour, size, and number depending on their location. On dry skin surfaces they look like warts on a person’s hand--small, pointed and firm. In moist areas they are usually pink, soft, and in clusters. In men, they usually appear on the head and shaft of the penis, but may also be found on the scrotum or around the anus. In women, they appear on the vulva and anal area, but are also found inside the vagina and on the cervix. It is important to note that many people who carry the Human Papilloma Virus are asymptomatic (no symptoms) and may have no visible warts. However, they can transmit the virus to a partner during vaginal or anal sex. The partner may also remain asymptomatic or develop genital warts. How is it treated? This is a life-long infection that can never be cured but can be controlled. Genital warts are treated surgically or with a cream that is applied to the warts. What are the possible complications? The Human Papilloma Virus has been linked with cancer, in particular cancer of the cervix. Consequently, since the majority of women who carry the virus do not have visible warts, and some of them may only have the virus present in the vagina and cervix, which can only be detected with special instruments and a PAP smear, it is important that all women be screened with PAP smears on an annual basis. It should also be noted that many men carry the Human Papilloma Virus on the penis and/or scrotum and that these lesions are very often not visible. GENITAL HERPES What is it? A virus called Herpes Simplex, Type II causes the majority of genital herpes infections. It is also possible to be infected in the genital region by Herpes Simplex, Type I that is usually associated with common cold sores that appear on the lips and around the mouth. Both types of herpes are capable of causing an infection in either area. 75 How is it spread? The herpes virus is transmitted through sexual contact such as anal, oral, or vaginal sex. The herpes virus can also be transmitted from a pregnant woman to her child, usually during the birth process. This is referred to as neonatal herpes and can lead to significant problems for the baby and even be fatal. Once infected a person must avoid touching the herpes sores as the virus may be spread to other parts of the body. Once a person is infected, genital herpes may recur in the same area of the body without the person having further sexual exposure. This is because the virus remains dormant within an infected person’s body. The person is not usually infectious as long as the virus remains dormant. While the blisters are present, the person is highly infectious and should refrain from any sexual contact with another person. A condom may not cover an affected area thereby leaving the partners at risk. What are the symptoms? Symptoms for herpes may include itching, burning and pain in the genital area; small, painful blisters in the genital area or rectal area, which break and form crusty sores. The sores heal on their own in two to four weeks but the person carries the virus for life and may have recurring attacks. In men, sores may develop on the penis, scrotum, buttocks, anus or thighs, and possibly in the urethra, where they remain invisible but may cause a discharge and painful urination. Women develop sores on the outer genital area, buttocks or thighs or in the vagina or cervix. The sores may cause vaginal discharge, pain during urination, inflammation of the vulva, and aching or pain in the entire genital region. The first attack is generally from two to twenty days after exposure to the virus, is generally the most severe, and is usually accompanied by flu-like symptoms such as fever, headache, fatigue, and swollen lymph nodes in the groin. Approximately two-thirds of the people infected with genital herpes will have recurring attacks. How is it treated? Since no treatment exists to cure herpes, treatment is aimed at relieving discomfort and preventing bacterial infection. The sores must be kept clean and dry. Anti-viral drugs may help the sores to heal faster. What are the possible complications? Herpes sores can become infected with bacteria causing further pain, a longer time to heal, and can result in scarring. HEPATITIS B What is it? Hepatitis B is an infection of the liver caused by a virus. There are presently more people dying from Hepatitis B in the world than from AIDS. How is it spread? The virus that causes Hepatitis B is found in the body fluids of an infected person. The virus is transmitted to another person by sexual contact and sharing needles. It can also be transmitted to the newborn following delivery, and especially during breast-feeding. What are the symptoms? Symptoms may occur abruptly, gradually, or not at all. In its early stages the infected person may feel fatigue, muscle and joint pain, abdominal pain, fever, nausea, or sore throat. As the liver becomes involved, the person may experience jaundice (yellowing of the skin and whites of the eyes), tea-coloured urine, and light coloured stools. 76 How is it treated? Hepatitis is treated with rest and a proper diet. It should be noted that there is now a vaccine to prevent the spread of Hepatitis B. This, in fact, is the only vaccine available today for a STD/STI. What are the possible complications? Hepatitis B causes damage to the liver. This damage is often permanent and can lead to death from liver failure. CHLAMYDIA What is it? Chlamydia is a bacterial infection caused by a bacteria called Chlamydia trachomatis. How is it spread? Since the bacteria does not survive away from the body, the exchange of infected secretions during anal or vaginal sex is the most common manner of transmission. Chlamydia can also be transmitted from the mother to her baby during delivery, resulting in eye infection and possibly pneumonia later on. What are the symptoms? In men, there may be a watery or cloudy discharge from the penis and urination can be painful. In women, urination may be more frequent and painful, there may be increased discharge and light bleeding between periods. Anal infection may cause discomfort with or without discharge. However, up to 50% of men and 50% of women can be asymptomatic, meaning they have the disease and can infect others, but have no symptoms themselves. How is it treated? Chlamydia is treated with antibiotics. What are the possible complications? In men, untreated chlamydia can cause infection of the epididymis, the coiled up sperm tube on the back of the testicle, which may lead to infertility. Untreated, chlamydia in women can lead to infection of the fallopian tubes and ovaries (Pelvic Inflammatory Disease, PID), which can cause permanent damage leading to complete obstruction and sterility (one of the leading causes of sterility among women), or partial obstruction, which can result in a tubal (ectopic) pregnancy. Pelvic Inflammatory Disease in adolescents causes more damage than in older women. Having PID more than once increases the risk of damage. GONORRHEA What is it? Gonorrhea, also called “a dose” or “the clap”, is an infection caused by the Gonococcus bacterium. How is it spread? Gonorrhea can be transmitted by any sexual penetration. The gonococcus bacteria thrives in warm and moist parts of the body such as the mucous membranes which line the body openings. A person with gonorrhea may infect another area of his or her body by transferring the bacteria contained in body secretions from one mucous membrane to another. Gonorrhea can also be transferred to a newborn during the birth process, and can cause serious eye infections. 77 What are the symptoms? In men, there may be a discharge from the penis and/or a burning sensation when urinating. In women, there may be an increased discharge from the vagina and/or painful urination, and possibly some irritation of the vulva. An oral infection may result in a sore throat. Anal infections usually have no symptoms but there may be some anal discomfort, itching, or a discharge of pus or blood. Many men and women are asymptomatic, meaning they have the disease and can spread it to others, even though they have no symptoms themselves. How is it treated? Gonorrhea is treated with antibiotics. Some strains of gonorrhea have developed resistance to some of the more common antibiotics like penicillin and tetracycline. Newer antibiotics are also used. What are the possible complications? In men, untreated gonorrhea can lead to infection of the epididymis which can cause sterility. In women, if gonorrhea is left untreated, it can lead to infection of the fallopian tubes and ovaries (Pelvic Inflammatory Disease, PID), which can result in scarring which may result in tubal (ectopic) pregnancy or infertility. In both men and women who are not treated, gonococci can spread to the bloodstream causing a rash, joint pains, or damage to the heart and liver. SYPHILIS What is it? Syphilis is a STD/STI caused by a corkscrew-shaped bacterium called Treponema pallidium. How is it spread? Syphilis is transmitted from one person to another when they engage in sexual activity such as anal, oral, or vaginal intercourse. The bacteria penetrate the mucous membranes or enter small cracks in the skin. Syphilis can be transmitted from a pregnant woman to her baby through the placenta, and the child can be born dead, deformed, or with congenital syphilis which leads to complications. What are the symptoms? Syphilis is described by stages. In Stage 1, a painless sore called a chancre appears where the bacteria entered the body, usually from 10 to 90 days. The sore disappears but the disease remains. In men, the sore may appear on the head or shaft of the penis or on the scrotum. In women, it may appear on the vulva or cervix. When anal sex is practiced, it may be on the anus or in the rectum. When oral sex is practiced, it may appear in the mouth or throat. In Stage 2, the person may develop a rash, swollen joints, and flu-like symptoms. The symptoms disappear, but the disease remains and may be latent for years. In Stage 3, the disease attacks the nervous system and may lead to paralysis, brain damage, blindness, or insanity. It also attacks the circulatory system causing disease in the blood vessels and heart that can be fatal. How is it treated? Syphilis is treated with antibiotics. It is best treated early. What are the possible complications? When syphilis goes untreated it can result in paralysis, insanity, or death. Babies born with syphilis may experience early death, teeth and bone deformities, and eye problems. 78 TRICHOMONAISIS What is it? This is an infection of the vagina and/or urethra in women and the urethra in men. It is caused by a onecelled protozoan that thrives in warm, moist areas. How is it spread? Trichomonaisis is passed from one person to another when they have vaginal intercourse. Non-sexual transmission is possible with the exchange of mucous secretions. What are the symptoms? Symptoms appear from 4 to 28 days after exposure. In women, these may include vaginal discharge and odour, burning, painful urination, itching, inflammation of the vulva, and lower abdominal pain. Symptoms in men are absent or far less noticeable, often little more than discomfort in the pelvis. How is it treated? Trichomonaisis is treated with an antifungal medication. What are the possible complications? Although this disease does not carry dire consequences, it needs to be treated to prevent its spread to other partners. PREVENTING SEXUALLY TRANSMITTED DISEASES/INFECTIONS The only 100% effective method of avoiding contracting a STD/STI is abstinence. If you intend to be sexually active there are other forms of safer sexual activity which will not only decrease the risk of contracting a STD/STI, but also the risk of pregnancy. If you do have sex, it is imperative that you use a condom as well as spermicide. If you choose to be sexually active, remember it is very difficult to be certain your partner is disease free. And remember, the more partners you have, the greater the risk of contracting a STD/STI. Finally, don’t forget that you can choose to stop being sexually active. eliminates the risk of contracting a STD/STI, unless you already have one. Eliminating sexual activity TREATMENT FOR SEXUALLY TRANSMITTED DISEASES/INFECTIONS Only a doctor can properly test for and treat a sexually transmitted disease/infection. If you have any of the symptoms of a STD/STI, go to your doctor, get checked, and get any necessary treatment. It is your responsibility to inform your sex partner(s) about your infection so they can be tested as well, even if they have no symptoms. They may be asymptomatic. Your doctor will inform you as to when you can resume having sex. If you do not have any symptoms, but have been engaging in high risk activity and are worried you might have a STD/STI, see your doctor and get tested. If you are not comfortable with going to a doctor contact a STD/STI clinic. There you can see a doctor who specializes in STD’s/STI’s. In addition to testing and treatment, a nurse or worker who will ask you to give the names of your sex partners will interview you. These partners are then notified that they have been in contact with a person who has a STD/STI. The partners are asked to report to the clinic to be tested and treated. This process is called contact tracing and is vital in stopping the spread of the STD/STI. It is also a confidential process and the Public Health Nurse does not give your name out. 79 When you report to a doctor or a community health clinic requesting tests for STD’s/STI’s, the test for HIV/AIDS is not routinely done. You must specifically ask for it and sign a consent form. Be responsible to yourself, to all your future partners, and to any future children you may bear. 80 ACTIVITY 16 In your notebook, draw a chart similar to this one. Using point form entries, write in the information under each heading for chlamydia, gonorrhea, genital herpes and genital warts. COMMON SEXUALLY TRANSMITTED DISEASES Name of STD Symptoms In Males Symptoms In Females Possible Complications Method of Treatment 1. Chlamydia 2. Gonorrhea 3. Genital Herpes 4. Genital Warts 81 UNIT 5: SEXUALY TRANSMITTED DISEASES / INFECTIONS ACTIVITY 17 HIV / AIDS PROGRAM VIDEO AND QUESTIONS READY In order to make wise decisions about your behaviour, it is necessary to have accurate, up-to-date information about HIV/AIDS and other STD’s/STI’s. In this activity, you will receive the information you need to do the activities in this program and to make healthy decisions about relationships now and in the future. Specifically, in this activity you will have the opportunity to increase your knowledge on HIV/AIDS and other STD’s/STI’s by: • • • watching a video about HIV/AIDS and other STD’s/STI’s; being presented with additional information on HIV/AIDS and other STD’s/STI’s by your teacher; demonstrating your level of knowledge about HIV/AIDS and other STD’s/STI’s by completing an AIDS & STD’s/STI’s Knowledge Test. SET 1. Watch the Program Video on HIV/AIDS and other STD’s/STI’s. 2. Your teacher will present additional information on HIV/AIDS and other STD’s/STI’s. 3. Answer the questions that are presented in the video (AIDS and STD’s/STI’s Knowledge Test) in the GO section of this activity. 4. Your teacher will provide answers to the questions presented in the video. 5. Tabulate your score on the questions for each subsection and determine your overall AIDS and STD’s/STI’s Knowledge Test Score. 6. Discuss any questions you have with your teacher. 82 AIDS What is it? AIDS stands for Acquired Immunodeficiency Syndrome. It is caused by the Human Immunodeficiency Virus (HIV), which attacks and weakens the body’s immune system, making the victim more susceptible to other diseases. As symptoms related to the infection by the virus begin to appear, the term AIDS-Related Complex (ARC) is used. When the immune system nears total collapse or specific infections like pneumonia or cancers develop, a patient is said to have AIDS. How is it spread? Human Immunodeficiency Virus (HIV) is found in the body fluids, particularly in blood, semen and vaginal secretions. Sexual transmission is the most common way in which it is spread. People who engage in anal, oral, or vaginal sex risk contracting the virus. Drug users who share needles are at risk. Until recently, people receiving blood transfusions were at risk. The virus can also be passed from a pregnant mother to her child. The virus may also be spread when infected body fluids come in contact with open cuts or wounds. What are the symptoms? A person infected with HIV does not develop AIDS immediately and can carry the virus for years with no symptoms but still be able to pass the virus on to others. As the disease progresses and the immune system weakens, symptoms include swollen glands, unexplained weight loss, bleeding from body openings, extreme fatigue, sweating, diarrhea, persistent fever or cough, and white coating on the tongue or throat. Life-threatening diseases like pneumonia or cancer follow. How is it treated? There is no known cure for AIDS. There are some drugs available, like AZT that help slow the progress of the disease, but it is not a cure. What are the possible complications? As the immune system weakens, the person succumbs to diseases such as cancer or pneumonia, and dies. 83 ACTIVITY 17 GO AIDS and STD’s/STI’s KNOWLEDGE TEST Please circle the correct answer -- T (true) or F (false). HISTORY OF AIDS 1. HIV is caused by AIDS. T F 2. AIDS damages the body's immune system. T F 3. People with AIDS suffer from fatal infections and cancers. T F 4. There is a cure for AIDS. T F 5. Teenagers infected with HIV when they are 14 may not have any AIDS symptoms until their mid-twenties. T F 6. There are many more Canadians with HIV infection than with AIDS. T F 7. The incidence of AIDS among women is increasing in Canada. T F 8. Worldwide, the most common way that HIV is transmitted is through vaginal intercourse. T F 9. Sharing needles for injecting drugs can pass infected blood from one person to another. T F 10. HIV can be spread by casual contact such as hugging, kissing or holding hands. T F 11. In Canada, it is very unlikely that someone will become infected with HIV by having a blood transfusion. T F 12. You can get HIV from giving blood in Canada. T F 13. A mother with HIV can pass it to her unborn child during pregnancy. T F 14. HIV can be transmitted through insect and animal bites. T F 15. Latex condom use is the most effective way to avoid HIV. T F 16. The more sexual partners a person has, the greater the chances that a partner will be infected with HIV. T F INCIDENCE TRANSMISSION PREVENTION 84 17. Methods for avoiding HIV usually do not help one to avoid other STD’s/STI’s. T F 18. Latex condoms, when properly used, give you 100 percent protection against HIV infection. T F 19. Sharing needles for ear-piercing or tattooing is safe. T F 20. Everyone infected with HIV whether they have symptoms or not can transmit the infection to others. T F 21. You can tell if a person has a STD/STI by his or her looks. T F 22. A positive HIV test result means that a person has AIDS. T F 23. It can take over 6 weeks for antibodies to appear in the blood to turn the test result positive. T F 24. An HIV-infected person can receive a negative test result if tested immediately after exposure to HIV. T F 25. Persons having sex with different partners should have regular STD/STI check-ups even if they do not have STD/STI symptoms. T F 26. Your local Health department will provide confidential information. T F 27. Only people who have engaged in high-risk behaviour need to get the HIV antibody test. T F 28. A person who suspects he or she has a STD/STI should stop having sex and go to a doctor quickly for a STD/STI check-up. T F 29. People who discriminate against people living with AIDS are often HIV/AIDS-phobic or homophobic. T F 30. Bentley's advice to young people is to get the correct information, think about it and use it. T F SYMPTOMS TESTING and HIV/AIDS HELP SOURCES DISCRIMINATION and COMPASSION Total correct answers /30 85 Number of Correct Answers KNOWLEDGE TEST SCORE 30 Excellent! You know the answers to these questions. 25-30 Very Good Even so, what you do not know may be critical. 20-25 Good But, you still have critical information to learn. 1-19 Poor Find out more! The information is very important to your health. 86 UNIT 5: TRANSMISSION OF HIV ACTIVITY 18 ESTIMATING RISK READY There is no cure for AIDS and no vaccine against HIV, but HIV is preventable. To protect yourself from HIV infection, you must know how the virus is transmitted. This information will help you know the behaviours that place you at risk, and those behaviours that are not risky. Myths about HIV transmission may prevent people from taking effective precautions to protect themselves, may make them unnecessarily afraid of contracting HIV, and may contribute to discrimination against people living with HIV/AIDS. In this activity you will: • • • categorize behaviours from no risk to high risk of possible HIV transmission; identify the risk of contracting HIV when a person engages in a number of risk behaviours; estimate whether your own behaviour puts you at risk of HIV infection. SET Part 1 1. Divide the class into mixed groups. 2. Read and discuss the Information Guide for Risk Categories and the Criteria for Risk Categories. 3. Give each group a copy of the 30 behaviours and chart paper with the risk categories on the top. Have each group cut and paste the behaviours under the appropriate risk category. N EL L H = = = = no risk extremely low risk low risk high risk 4. Facilitate a group sharing and class discussion. 87 ACTIVITY 18 GO Part 1 INFORMATION GUIDE FOR RISK CATEGORIES HIV can be transmitted by: High levels of HIV are found in: Lower levels of HIV are found in: Unprotected sexual intercourse (vaginal and anal) and possibly oral sex, Shared needles/syringes (e.g. injection drug use, steroid use), Other shared implements(e.g. razors), Infected mother to fetus, Blood and blood products* An infected person's: Blood Semen Vaginal fluids An infected person's: Tears Urine Feces Spinal fluid Saliva Breast milk *Highly unlikely to happen in Canada. CRITERIA FOR RISK CATEGORIES It is useful to categorize actions into four risk categories: very high risk, low risk, extremely low risk, and no risk. HIGH RISK - high possibility of HIV transmission high levels of HIV in body fluids unquestionable evidence of transmission LOW RISK - low possibility of HIV transmission low risk (low levels of HIV in body fluids) slight evidence of transmission EXTREMELY LOW RISK - extremely low possibility of HIV transmission risk in theory (low levels of HIV in body fluids) no evidence of transmission NO RISK - no possibility of HIV transmission no evidence of transmission NO AGREEMENT - group cannot agree on risk category Participation in a number of risk behaviours may increase the chances of HIV infection. The risk of male to female transmission is much higher than female to male transmission. In countries where there is a relatively high incidence of HIV/AIDS risk is likely to be higher. For the extremely low and low risk categories, current information about transmission may change as researchers publish findings from their studies. It is important to be aware of developments in HIV/AIDS research. 88 ACTIVITY 18 1. body-to-body rubbing without clothes 2. sharing a razor for shaving legs or face 3. having sex with a condom 4. having sex without a condom 5. using toilets in public washrooms 6. genital petting 7. wet kissing 8. cleaning spilled HIV infected blood while not wearing rubber gloves 9. receiving a blood transfusion in Canada after 1985 10. abstaining from sexual intercourse 11. sharing unsterilized needles for ear piercing 12. shaking hands with an HIV-infected person 13. touching or comforting someone living with AIDS 14. swimming with an HIV-infected person 15. being born to an HIV-infected mother 16. going to school with an HIV-infected person 17. eating food prepared by an HIV-infected person 18. having sex with a number of partners without using a condom 19. sharing a towel with an HIV-infected person 20. using public drinking fountains 21. giving mouth-to-mouth resuscitation without a mask 22. being close to an HIV-infected person who coughs or sneezes 23. having sex with a double condom and lubricant 24. sharing a needle cleaned with water to inject a drug 25. sharing unsterilized needles for tattooing 26. being bitten by an HIV-infected person 27. being bitten by a mosquito 28. donating blood 29. having sex using a condom properly 30. having sex using the same condom more than once 89 ACTIVITY 18 SET Part II 1. On your own, read Risky Behaviours, a description of the behaviours of five individuals. 2. In a small group, for each person identify the level of risk for each person and give reasons for your decision. Assign a risk level to each person using the key below. N EL L VH 3. Complete the Follow-Up: = = = = no risk extremely low risk low risk very high risk Part II in your small group. 90 ACTIVITY 18 RISKY BEHAVIOURS A. Sam: is involved in a serious relationship which involves wet kissing, genital petting and massage. He has decided that he is not ready to have sex. Rate the Risk: B. Zowie: has only had sexual intercourse with her steady boyfriend whom she believes had never had sexual intercourse. Zowie's boyfriend has not told her that he has had sexual intercourse with a number of different people without using a condom and has shared unsterilized injection needles in the past. Rate the Risk: C. Esther: has had sexual intercourse with a number of different partners. With each sexual partner, she made sure a condom was always used during sexual intercourse but never used a condom during oral sex. Rate the Risk: D. Ralph: has sex with a number of different partners. He did not use condoms when the person he was with was on the birth control pill. He shares unsterilized needles to inject steroids. Rate the Risk: E. Manuel: has had sex with his girlfriend. The couple decided not to use condoms because Manual had never had sex. His girlfriend had a negative HIV test a few days after her last unprotected sexual experience. Manual's girlfriend has shared unsterilized needles for earpiercing. Rate the Risk: 91 ACTIVITY 18 FOLLOW-UP Part II 1. a) What would the person you ranked with the least safe behaviours have to do to make his/her behaviours safer? b) What are the risks of reducing some, but not all, behaviours that put a person at risk of HIV infection? 2. Why is a female at greater risk of contracting HIV during vaginal intercourse than a male? 92 UNIT 5: TRANSMISSION OF HIV ACTIVITY 19 EVALUATING RESPONSIBILITY READY People in close relationships who are considering sexual intercourse need to assume responsible behaviours to protect themselves and others from HIV infection and other STD’s/STI’s. Parents and teachers should be informed about all STD’s/STI’s and be willing to discuss topics related to them with young people. In this activity you will: • identify responsible behaviours that reduce the spread of HIV/AIDS and other STD’s/STI’s; • decide how responsible you think five people are in reducing the spread of HIV/AIDS and other STD’s/STI’s. SET 1. Read A Summer Holiday to yourself. 2. On your own, identify for each character in A Summer Holiday the responsibility he or she upheld for reducing the spread of HIV/AIDS and other STD’s/STI’s. Also identify the responsibility each character did not uphold. Write your answer in the spaces provided. 3. On your own, rank order the characters in A Summer Holiday from most responsible to least responsible in reducing the spread of HIV/AIDS and other STD’s/STI’s. Write the names of the character and the reason for each ranking in the spaces provided. 4. In a small group, rank order the five characters. Write the names of the characters and the reason for each ranking in the spaces provided. 5. Complete the Follow-up as directed by your teacher. 93 ACTIVITY 19 GO A Summer Holiday Jill: Jill is in love with Rex. Neither has had sex. On Rex's urging they have decided to wait and have fun in their relationship before having sex. Jill got a job at a summer camp some distance away from her home. Jerry: At the camp Jill started seeing Jerry, a good-looking senior counsellor. Their relationship became physical very quickly. When they decided to have sex Jill wanted to use condoms and get Jerry to have an STD checkup. Even though she said “no” at the beginning, after awhile Jill agreed to have sex with Jerry without using a condom and getting a check-up. Jill and Jerry split up at the end of the summer. A little while later Jerry developed symptoms that he knew were linked to a STD/STI. At an STD/STI clinic he was told he had gonorrhea and was advised to contact any sexual partners he might have infected. Jerry called Jill to tell her that he had gonorrhea and she should get a checkup. Rex: Jill and Rex resumed their relationship. Jill realized she really had strong feelings for Rex and wanted to have sex with him. After hearing from Jerry, Jill waited a week for STD/STI symptoms to appear. When none appeared, she decided she was probably HIV/ STD/STI free. Jill began to pressure Rex to have sex, but insisted that Rex use a condom. Rex did not want to use a condom, so they decided to continue their relationship without having sex. After watching a television show about AIDS, Jill started to worry that she might have a STD/STI. Jill decided to talk to her friend Susan about her worries. Susan: She advised Jill to avoid any further behaviours that would put her at risk of HIV or STD/STI infection. Susan told Jill not to worry because Jill had no signs or symptoms of HIV/ STD/STI. Just to be sure, she recommended that Jill take the HIV antibody test immediately. Jill was still worried, so Susan told Jill that Ms. Jones, their homeroom teacher, had been helpful to her about a problem and suggested Jill talk to her. Ms. Jones: Ms. Jones had helped students with their concerns about drug use, but she was not very comfortable talking about sex. In fact, she thought that talking about sex really gave permission to kids to go ahead and do it. She advised Jill to talk with her parents. When Jill told Ms. Jones that she did not communicate very well with her family, Ms. Jones said, “I'm not sure who else you can talk to.” Finally, Jill decided she had nothing to worry about and had sex with Rex without using a condom. 94 ACTIVITY 19 1. a) Identify the responsibility for reducing the spread of HIV/AIDS and other STD’s/STI’s each character upheld. Also identify the responsibility each character did not uphold? Write your answers in the spaces provided. PERSON RESPONSIBLE ACTIONS IRRESPONSIBLE ACTIONS Jill Rex Jerry Susan Ms. Jones (OPTIONAL) b) Order the characters in A Summer Holiday from most responsible to least responsible in reducing the spread of HIV/AIDS and other STD’s/STI’s. Write the names of the characters and your reason for each ranking in the spaces provided. Most Responsible NAME REASON FOR RANKING Least Responsible 95 ACTIVITY 19 FOLLOW-UP 1. Do you think that Jill made a responsible decision? Why or why not? 96 UNIT 6: RESPECTING SELF & OTHERS ACTIVITY 20 EQUALITY FOR ALL READY When we treat others as less than our equals (intolerance) we deny them a basic human right. Intolerance usually begins as prejudice which often leads to discrimination. Discrimination is failing to treat others as equals. In this activity you will: • • • SET decide if each of a series of statements presents prejudice or discrimination; read and discuss a story about a person who experienced prejudice and discrimination; identify examples of prejudice and discrimination and identify statements that you do and do not agree with. Part I 1. With your teacher, read Prejudice and Discrimination. 2. On your own, read the List of Statements and decide whether each statement represents prejudice or discrimination. 3. Complete the Follow-up: Part I as directed by your teacher. 97 ACTIVITY 20 GO Part I Prejudice and Discrimination To be prejudiced is to “prejudge,” to hold a negative opinion of someone without a basis for that opinion. A common form of prejudice is judging a person's abilities or intentions by his/her appearance. For example: • • She really looks dumb. He seems weird. Also common is basing a negative opinion of a person's behaviour on the behaviour of others with similar characteristics. For example: • • Males are thoughtless. The grade 9's are the reason we don't have school spirit. When prejudice is translated into actions it is discrimination. When we, without learning the facts about an individual, do not treat him/her with the same respect and grant him/her the same privileges as anyone else in our society, we are discriminating against him/her. Discrimination, like prejudice, is often based on assumptions about the appearance of others or on their membership in a group, for example: • • A person is denied a job because he/she is overweight. Women are not paid as much as men for equal work. 98 ACTIVITY 20 List of Statements Decide whether each statement represents prejudice or discrimination and place a check mark (√) in the appropriate column. STATEMENT PREJUDICE DISCRIMINATION 1. Taxi drivers are reckless drivers. 2. Females are not allowed to play on male teams. 3. Jocks cause all the trouble in school. 4. People on welfare are lazy. 5. Only gay people get AIDS. 6. A doctor/dentist refuses to treat a person who is HIV-positive or has AIDS. 7. Only a gay guy would wear an earring. 8. A person who is HIV-positive is not considered for a job in which he/she will handle food. 9. People living with AIDS get what they deserve. 10. An HIV-positive student is barred from attending school. 99 ACTIVITY 20 FOLLOW-UP Part I 1. Why is it in your own best interest not to be prejudiced or to discriminate against others? 2. How can we begin to change attitudes and stop actions that result in individuals not being treated as equals? SET Part II 1. In a small group, read HIV-Positive Teen Barred from Pool and identify examples of: a) b) prejudice discrimination 2. Read A Letter to the Editor and write statements you agree and disagree with. 3. Complete the Follow-up: Part II as directed by your teacher. 100 ACTIVITY 20 GO Part II HIV-POSITIVE TEEN BARRED FROM POOL The Council was meeting and the town hall was filled. In the middle of the circle of chairs were three people: Dr. Little from the Public Health Department; Jerry, an 18-year-old gay male, known to be HIVpositive; and the Mayor of the town, who had announced the meeting. The special meeting had been called in response to the community's outcry to prevent Jerry from swimming in the public pool. The first speaker was a woman who had three young children taking swimming lessons at the pool. She insisted that Jerry be quarantined because she didn't want her children near anyone who is gay and particularly someone who has AIDS. The doctor tried to assure her that AIDS could not be transmitted by swimming in a pool, but was interrupted by an angry young man who stood up and said, “I am repulsed by this man's lifestyle. I am repulsed by his disease and I am repulsed by him. This is a disease of nature. Nature will take care of something that is wrong; it will get rid of it. AIDS will kill them off. These people are getting what they deserve. They should all be quarantined.” Several people in the crown supported his comments by applauding and a number of others stood up to speak, urging the Council to exclude Jerry from the public swimming pool. When a vote was taken, it was unanimously decided that Jerry should not be allowed in the pool. As well, two restaurant owners said, publicly, that he wouldn't be allowed to eat at their tables. When Jerry was given the chance to respond he said, “I'm trying to fight a very serious illness. I've been fired from my job and I have trouble getting medical care. Even some of my friends and my family members have rejected me. How do you think I feel when my own community turns against me?” Examples of Prejudice and Discrimination 1. Prejudice (A) (B) (C) 2. Discrimination (A) (B) (C) 101 ACTIVITY 20 Letter to the Editor Although there was such strong support to bar him from the pool by those attending the public meeting, Jerry felt he had to speak out against the false statements that had been made. His comments were printed in a letter to the editor of the local newspaper several days later. “When you're HIV-positive,” Jerry wrote, “there are usually no signs or symptoms to indicate that you have the virus that leads to AIDS. That means there are probably others in the pool who don't even know they are infected. As well, it is now well documented that HIV is not transmitted by saliva and certainly the chlorine in the pool would kill any possible viruses.” “Casual contact such as swimming in a public swimming pool, touching, sharing eating utensils, or even dry kissing is not risky behaviour.” “The intolerance and discrimination of this situation is of more concern to me. Homophobia (a fear of gay men and lesbians and a fear of homosexual feelings and actions in oneself) damages all of us, not just those who are gay. Homophobia prevents some males from forming close relationships with other males because they fear they will be labeled gay. Certain activities which are usually considered feminine are off limits to males - as valuable as they may be.” “Studies have concluded that people with the most prejudice toward homosexuals tend to be strongly authoritarian, support double standards for men and women, and generally discriminate against other minority groups.” 1. Statements by Jerry with which you agree: 2. Statements by Jerry with which you disagree: 102 ACTIVITY 20 FOLLOW-UP Part II 1. Why did the man in the audience express anger toward gay people? 2. If you were in the audience, would you rise to speak? What would you say? 3. If you chose not to rise to speak, explain your reasons for remaining silent. 103 UNIT 6: RESPECTING SELF & OTHERS ACTIVITY 21 COMPASSION/EMPATHY READY You have compassion for those in physical or emotional pain if you understand their pain in such a way that you feel you share it and want to do whatever you can to help. In this activity you will: • • identify reasons for showing compassion towards people living with HIV/AIDS; identify compassionate actions you would feel comfortable doing to help two people whose problems are described to you. SET Part I 1. On your own, read Reasons for Showing Compassion Towards People Living with HIV/AIDS. Add any additional reasons you think of in the spaces provided. 2. Rate each reason, on a scale from 0 (not a good reason) to 3 (an excellent reason) for showing compassion. Write your rating in the spaces provided. 3. Complete the Follow-up: Part I in a small group. 104 ACTIVITY 21 GO Part I Reasons for Showing Compassion Toward People Living with HIV/AIDS Consider each reason for showing compassion. Identify three of the more important reasons to show compassion toward people living with HIV/AIDS and evaluate each reason on the scale. Rank the reasons from 1 to 3 with 1 being the most important reason. You may add your own reasons at the bottom. People living with HIV/AIDS should be treated with compassion because: 1. everyone deserves to be treated with understanding 2. they are scapegoats for people who blame them for society's problems 3. they are infected with a painful disease which has no cure 4. they are often rejected by possible caregivers 5. you will be contributing to a caring society 6. it is good to think of someone other than yourself 7. it will help you overcome your own fears about HIV/AIDS 8. they are too young to be dying 9. it will make you feel good 10. they are often rejected by family and friends 11. they are often subjected to discrimination (loss of job, wages and/or housing) 12. 13. 14. 105 ACTIVITY 21 FOLLOW-UP Part 1 1. The list of reasons to show compassion includes both benefits to the person living with HIV/AIDS and benefits to yourself and society. Discuss your top two ratings with regard to benefits to yourself, society and people living with HIV/AIDS. Which of the benefits is more important to you? Why? 2. Compassion and pity are often confused. In your small group discuss the difference and how each effects the giver and the receiver. SET Part II 1. Read the story Local School Shows Support. 2. Read Possible Ways to Show Compassion. Notice that the possible ways to show compassion have been listed in three groups. For this story, select from each grouping, one way you might show compassion for Nick. Your selections should represent actions you think could help Nick and which you believe you would be able to do. Write the letter of your selections and a reason for each selection in the spaces provided. 3. Complete the Follow-up: Part II on your own. 106 ACTIVITY 21 Local School Shows Support Last night Nick Cornelius spoke to over 400 parents and fellow classmates telling them what it was like when his school found out he had AIDS. When Nick finished his story and stepped back from the microphone he received a standing ovation. “All I want is to be one of the kids, because that's what counts in high school,” said Nick as he began his speech. Nick found out that he had AIDS a year ago - he was 17 years old. “ I never felt so utterly alone in the world. Had it not been for my parents and my dog, I don't know what would have happened to me in the first six months.” Nick described the initial reaction in his hometown as mostly rejection. People who had been his friends at school believed he could give them AIDS if he sneezed on them. Lots of times kids flattened themselves against the wall when he walked by. His parents received more than one “hate” letter and his two younger brothers were teased and avoided at their school. “Mom never gave up, she kept telling me to never feel sorry for myself. She was honest to me about my disease and was always there to listen even when I wanted to talk about death.” Nick's talk at his high school was the kick-off for a charity dinner to raise funds for a local service for people living with HIV/AIDS. He was asked to speak because he had struggled through months of meetings with school board officials to defend his right to attend school with the same rights and privileges as other students. Nick says that life is better now. But there are still classmates who avoid him or make jokes. He has no guarantee against future illnesses. In the meantime, he would like to help by speaking out against misinformation about AIDS and about the people who are living with HIV/AIDS. Nick closed by saying, “People living with AIDS need someone to help them. Friends can be very valuable. Remember you cannot get AIDS by being near to someone who has AIDS.” 107 ACTIVITY 21 Possible Ways to Show Compassion Select from each group two ways you might show compassion for Nick if you were his friend. Write the letters of your six selections and a reason for each in the spaces provided after the list. GROUP 1 A. Ask the person if he or she would like to talk about the problem. Listen actively. B. Be futuristic. Talk about tomorrow, next week, next year, without denying the problem. Discuss current events, mutual friends and common interests. C. Talk about your feelings of concern about changes in his or her appearance (weight loss, etc.) and physical ability (fatigue and strength). D. Accept that the person may be angry and encourage him/her to express anger. E. Don't lecture or become angry. Be positive and non-judgemental. Don't allow the person to blame him/herself. F. Share emotions - laugh and cry. Encourage the person to express feelings. GROUP 2 G. Offer to help with chores the person cannot do - buying food or providing transportation, for example. H. Encourage the person to continue to make decisions for themselves. Volunteer to do chores they cannot manage. I. Accept that occasionally the person may not want to see you. Be willing to call again. J. Help celebrate holidays and other special occasions. K. Be creative. Decorate the room. Play music, bring books and magazines. Celebrate life. GROUP 3 L. Touch or hold his hand; give him or her a hug or a kiss if it is appropriate. M. Enjoy quiet times just sitting with the person, perhaps watching TV. Silence is okay. N. Offer to relieve the family members who are caring for the person. Invite them out. Listen to them. Stay with the person while they go out. O. Find additional support groups among friends and in the community. Don't let the person become isolated. P. Take care of your health. Share your emotions with friends and loved ones. You can be more help when you are well. 108 ACTIVITY 21 In your groups discuss possible ways to show compassion to Nick. FOLLOW-UP Part II 1. Why might it be difficult for some people to have or to show compassion? 109 UNIT 6: RESPECTING SELF & OTHERS ACTIVITY 22 SUPPORTS FOR RESPONSIBLE BEHAVIOURS READY Youth is often a time of experimentation which may involve risk taking. Research has shown that many young people support risks that can be dangerous to their health and safety. For example, young people frequently support peers who take risks sexually. However, in the era of HIV/AIDS this can be dangerous. The norms surrounding drinking and driving have been changed by friends supporting friends who don't drink and drive. Similarly friends can support friends who value abstinence, have made the decision to use safer sex practices (e.g. condoms) or who have decided to show tolerance and compassion toward people living with HIV/AIDS. In this activity you will: • • indicate ways to support a decision to adopt responsible, healthy behaviours; indicate ways to support tolerance and non-discrimination and compassion towards people living with HIV/AIDS. SET 1. With your teacher, read the Action Scenarios. 2. The main character in each Action Scenario adopts responsible behaviours that avoid discrimination and the risk of sexually transmitted infections. With your teacher, discuss the behaviours of the main character in each Action Scenario and decide if it represents the typical response of a young person. Discuss how friends might respond to the main character in each of the scenarios. 3. Complete the Follow-Up. 110 ACTIVITY 22 GO Action Scenarios 1. You are at a party and talking to a person to whom you are very attracted. You have noticed this person at school, but have never had the chance to meet him/her. You know that he/she is quite “experienced.” Both your parents and his/her parents are out of town for the weekend and he/she suggests you spend the night together. You refuse and avoid the person for the rest of the evening. It is the next morning and your friends ask you what happened the night before as everything seemed to be going so well. You tell them you didn't feel comfortable leaving with someone who is that sexually experienced. What could friends say to support your decision not to have sex? 2. Someone you have been seeing for awhile and really “love”, is trying to persuade you to have sex. You use all of your assertive skills, but the situation gets worse. He/she will not agree with you and becomes impossible to reason with. Finally you phone your brother/sister who comes to give you a ride home. One the way home you tell your brother/sister what happened. What could your brother/sister say to support your decision not to have sex? 3. You have been going with the same person for quite some time now. Your respect and love each other very much. You have talked about sex and agreed you must use a condom if you have sex. You have experienced sex together a few times already. Everything is right to have sex again. However, for some reason neither of you has a condom. Your boyfriend/girlfriend suggests that you not “break the mood” by going to get one, but after some convincing he/she agrees that you should not have sex without using a condom. Instead, you continue to show your affection for each other with more talking and lots of hugging, kissing and caressing. You feel you made the right decision to not have sex because you didn't have a condom. But you are very concerned that this might affect your relationship, and that your boyfriend/girlfriend will lose interest in you. You really want to discuss this with someone and see what they think so you go talk to a friend about it. What could your friend say to support your decision not to have unprotected sex? 111 ACTIVITY 22 4. It is Monday morning in a school hallway. You are talking with your friends about things that happened over the weekend. One of your friends is bragging about his/her weekend experiences. There had been a party at which people did drugs, got drunk and had sex. A couple of people in the group are impressed by your friend and make statements that support the behaviours he/she was involved in. At this point in the conversation, your friend turns to you. You, however, are not impressed. What could you say to your friends to support responsible and respectful sexual behaviours that avoid transmission of HIV/AIDS and other STD’s/STI’s? 5. After the basketball game, you and four of your friends want to go for pizza. The decision has been made to go to a nearby pizza place when somebody in the group says, “I don't want to go there.” Someone else asks, “Why not?” The response is,”I heard that the pizza maker there has AIDS. I'm not going to risk getting AIDS!” Another person in the group says, “You can't believe everything you hear.” The fourth member of the group adds, “I don't know - I heard something like that, too, but I wasn't going to say anything about it.” Everyone in the group turns to you. You are in favour of going to the pizza place. What could you say to your friends to support responsible and respectful sexual behaviours that avoid transmission of HIV/AIDS and other STD’s/STI’s? 112 ACTIVITY 22 6. You are sitting around at a house party with some of your friends. The conversation is about a new display at a downtown mall. The display features the AIDS quilt and a photo collection. No one in the group has been to see the display. One person says that he/she saw some television coverage of the display. Each quilt panel has the name of a person who died of AIDS. There are more than a thousand panels in the quilt. Someone else says that the photo collection tells the story of discrimination, rejection and suffering experienced by many people living with AIDS. Someone else says that he/she heard that many of the photos are of homosexual males or drug users. One of your friends suggests you go down to the mall together tomorrow afternoon to support the idea behind the display. Another of your close friends says, “I wouldn't be caught around a display like that because someone might think that I'm gay.” Another person in the group offers, ”I know what you mean. My brother went to see the display and someone said that he must be gay or a drug user.” You know that your friends now expect you to say something. You would like to visit the display at the mall. What could you say to your friends to support responsible and respectful sexual behaviours that avoid transmission of HIV/AIDS and other STD’s/STI’s? 113 ACTIVITY 22 FOLLOW-UP 1. Some people feel that it is not cool to support healthy decisions like those in the scenarios in this activity. Why do you think this might be true? 2. What difficulties might you encounter in supporting healthy behaviours and how might you overcome these difficulties? 3. In a small group, state how talking about values and beliefs with friends can influence a person's behaviour. 114 GLOSSARY OF TERMS Abortion The termination of a pregnancy either spontaneously or medically induced. After the third month a spontaneous abortion is also referred to as a miscarriage. Abstinence Refraining from participating in vaginal, oral or anal sex. Acquired Immunodeficiency Syndrome (AIDS) A fatal immune-system disease caused by a virus, in which the resistance of the body to certain infections and cancers is lowered. The virus is spread through blood, semen and other body fluids. Aggressiveness Attempting to control a situation for one’s own good; attacking or starting a quarrel without cause. Anal Sex A sexual act in which the penis is inserted into the partner’s anus. Antibody A natural or synthetic substance that protects the body against infection or poisoning by a foreign substance. Some antibodies are naturally produced by the body in response to such infections, while others must be introduced by inoculation. Anus The exterior opening of the lower digestive tract. Assertiveness The willingness to stand up for one’s rights and consider the feeling of others; direct and honest communication. Asymptomatic Not showing any symptoms of a disease, even if the disease is present. Bacteria One celled microorganisms which are capable of causing infection and disease. Breasts The two milk producing glands on the chest of the human female (mammary glands). Cervix The lower 1/3 of the uterus which extends downward into the upper portion of the vagina. Communication The act of sharing or exchanging ideas. Compassion The feeling for another’s sorrow or hardship that leads to help; pity, sympathy. Condom A sheath commonly of latex rubber worn over the penis during intercourse intended to prevent conception or the transmission of a STD/STI. Consequence The result of a course of action. 115 Contact Tracing The process of finding previous sex partners of someone who has a STD/STI. Contraception The use of any method, drug, or device to prevent conception or pregnancy. Date An appointment or a social engagement for a fixed time. Decision-making The process of identifying and choosing among alternative courses of action. Discrimination The act of singling out for unfavourable treatment or making of distinctions (often unfair) in meeting out treatment, service, etc. Ectopic Pregnancy A pregnancy in which a fertilized ovum implants itself elsewhere than in the uterus, such as the fallopian tube or in the peritoneal cavity. Ejaculation The discharge of seminal fluid through the male urethra. Erection The enlargement of the penis or clitoris, usually as a result of sexual excitement. The enlargement is caused by the filling of cavities within the organs with blood. Estrogen A female sex hormone which stimulates the development of secondary sexual characteristics. The actions of estrogen and progesterone stimulate the menstrual process. Fallopian Tube Either of the pair of tubes conducting the ovum from the region of the ovary to the uterus. Feces The waste matter discharged from the intestines through the anus. Feces is also called excrement. Fertile Capable of reproduction. Fertile Period That period of time in the menstrual cycle when pregnancy is most likely to occur after sexual intercourse. Fertilization The union of an egg cell and a sperm cell which results in conception. Fetus An unborn human embryo after about two months of development when features become recognizable. Genitals The external sex organs. HIV Positive The term which indicates that a person’s blood contains antibodies to the HIV virus, indicating that he or she has been infected. A person can test positive for HIV and have no symptoms for years, but can transmit the virus to others during that time. 116 HIV Test A blood test to determine the presence of antibodies to the HIV virus to determine whether a person has been exposed to the virus. Homophobia The fear or dread of homosexuals. Homosexuality Sexual attraction to persons of the same sex. Hormone A substance produced by an endocrine gland that is secreted into the blood stream or body fluids. Human Immunodeficiency Virus (HIV) A virus that attacks and kills off the concentration of white blood cells called T-cells. This weakened state of the immune system allows otherwise controllable infections to result in disease and death. Infertile Incapable of reproduction. Intolerance The act of not tolerating beliefs, etc., that differ from one’s own or being unfriendly or hostile towards persons who have different beliefs or practices. Lubricant A substance placed between two surfaces to make it easier for one surface to move over the other. Lubrication The act of adding a lubricant between two surfaces. Masturbation Self-stimulation of the genitals. Menstruation The discharge of blood and tissue from the non-pregnant uterus through the vagina. This normally recurs at approximately 28 day intervals from menarche to menopause and lasts from 3 to 5 days. Moral Values The concepts or principles that a person may use to make moral judgements. For example, a person may use the criteria of honesty, equality, and responsibility to arrive at a decision or judgement about a situation or dilemma. Mucous Membranes Membranes which line the body cavities and tubes. Moist areas of the body where there are mucous membranes include the mouth, vagina, anus, and penis. Myth Information that may be believed to be true but which has no basis in fact. Oral Sex Stimulation of the male or female genitals by the mouth of the partner. Ovary The female reproductive organ that produces ova and female sex hormones. Ovulation The release of an egg from an ovary. 117 Ovum The female sex cell produced by the ovary. Pap Smear Test A test in which cells from the vagina and cervix of the uterus are examined to detect shed cells characteristic of early cancer. Passive Allowing persons or situations to control one’s behaviour or decisions, often in an attempt to please people. Peers People of similar age, interests and ideas. Penis The external reproductive organ of the male through which the urethra passes. Phobia A morbid and often irrational fear or dread of some specific thing. P.I.D. Pelvic Inflammatory Disease, a severe interior infection of the lower abdomen. Prejudice A preconceived opinion, usually unfavourable, or an unjustified and unreasonable bias. Premature Birth Giving birth to a baby before it has developed to full term. Prenatal Care The care required by both the expectant mother and the baby prior to birth. Progesterone The female hormone that is secreted by the ovaries in a non-pregnant female and by the placenta during pregnancy. Protected Sex A sex act during which a condom is used. Pubic Having to do with the pubis, the lower part of the abdomen. Quarantined Kept away from others for a time to prevent the spread of a contagious disease. Responsible Able to assume and carry out an obligation. Resuscitation The act of restoring to life or consciousness. Scrotum The pouch suspended from the groin that contains the male testes. Secondary Sexual Characteristics Physical characteristics which appear during puberty other than maturation of the external sex organs, such as pubic hair, breast and penis development. 118 Self-Concept The mental image we have of ourselves including all aspects; physical, emotional, intellectual, spiritual and social. Self-control Having control over one’s feelings and actions. Self-esteem To have regard and respect for oneself. Seminal Fluid The secretion of the male reproductive organs that is ejaculated from the penis during orgasm and which contains sperm cells suspended in fluid (semen). Sex As defined by this curriculum is the insertion of the penis into the vagina, anus, or mouth. Sexual Fidelity Remaining faithful to one sex partner. Sperm Male reproductive cells. Spermicide A chemical capable of killing sperm. (e.g. nonoxynol-9) Sterility The incapability of fertilization or reproduction. Sterilized (1) Made free from living germs or microorganisms as by heating or otherwise; (2) Made incapable of producing offspring by removing the organs of reproduction or by the inhibition of their function. Testicle A primary reproductive organ of the male which produces sperm and testosterone. Testosterone The male sex hormone secreted by the testes which induces and maintains the male secondary sex characteristics. Transmission The transmitting or passing of a disease from one person to another. Tubal Ligation A surgical procedure in which the fallopian tubes of a female are cut and blocked or tied, rendering the female incapable of reproducing. Unprotected Sex A sex act in which a condom is not used. Unsterilized (contaminated) Not free from living germs or microorganisms. Urethra The duct through which urine passes from the bladder to the outside of the body. In the male, the urethra also passes semen to the outside of the body. 119 Urine The fluid that is excreted by the kidneys as a waste product of the body. Human urine goes through the ureters into the bladder and is then discharged from the body through the urethra. Uterus The hollow pear-shaped organ located in the female pelvis which contains and nourishes the fetus during development prior to birth. Vagina A tubular female organ extending from the vulva to the cervix which receives the penis during intercourse and through which the baby passes at birth. Vaginal Fluid The moisture that is normally found within the vagina. Vaginal Sex The sexual union of a male and female in which the penis is inserted into the vagina (sexual intercourse, coitus). Values Qualities or things a person considers important or desirable. Vas Deferens The tube in the male leading from the epididymis to the urethra in the reproductive tract. Vasectomy A surgical procedure in which the vas deferens in a male are cut and tied thereby rendering the male incapable of reproducing. Virus A substance composed of protein and nucleic acid that can cause infectious diseases. Vulva The external sex organs of the female, including the labia majora, labia minora, the clitoris, and vestibule. 120 COMMUNITY RESOURCES Klinic Community Health Centre Medical Services (Teen Klinic) .......................................... 784-4078 24 Hour Crisis Intervention ................................................. 786-8686 Sexual Assault Counselling ............................................... 786-8631 Teen Talk (speakers) ......................................................... 784-4010 AIDS/STD InfoLine .................................................................... 945-2437 ........................................................................... 1-800-782-AIDS Nine Circles Health Centre ........................................................... 940-6000 Child and Family Services Agency ............................................... 944-4200 Families Affected by Sexual Abuse ............................................... 786-7051 Facts of Life Line ........................................................................... 947-9222 ........................................................................... 1-800-432-1957 Kids Help Phone ............................................................... 1-800-668-6868 Teen Touch Line .......................................................................... 783-1116 ........................................................................... 1-800-563-8336 Women’s Health Clinic ................................................................. 947-1517 Public Health Nurse / Community Health Office ........................... 940-2005 121