Download “Playing with a Ladder” Game: Objective of the activity: This is a

“Playing with a Ladder” Game:
Objective of the activity:
This is a supportive tool for interpersonal communication of IDU peer education sessions
to increase attraction, and compelling to the clients
- help IDUs identify their risk level and how to reduce their risk
- discuss with clients about their risk and help them develop own plan for risk reduction
in the future.
Materials needed to conduct this activity:
1 plastic shelf designed as a ladder with 6 step cards
With how many people can this activity be conducted:
One by one
or small group <5 people
When should this activity be conducted:
IPCs can use this game at the hotspots, tea shops or at IDU’s home
Tool description: This tool is designed as a ladder, and it should be able to stand on a
flat ground or table. The ladder consists of six levels numbered from one (lower end) to
six (higher end), and the first level labeled as “No Risk” while the sixth level labeled as
“High Risk”
Each Ladder Step has 2 sides: Front Side has a short statement and the Back Side has
longer sentences to help IPC explain to IDUs about each front statement.
Sentences to be written on ladder steps:
On Step 1:
- Front Side: I don’t use drug
- Back Side: Using drug is very dangerous, so it’s good that you stopped using it
On Step 2:
- Front Side: I only use drug by inhale
- Back Side: Injecting drug is very dangerous, and if you could not stop using it, try
to just inhale (it’s much safer)
On Step 3:
- Front Side: I always inject drug with a new N/S
-
Back Side: Using used N/S is high risk of getting HIV, so try to always use a new
N/S whenever you inject
On Step 4:
- Front Side: I keep my own N/S and clean it for re-use
- Back Side: Sharing N/S with others is very dangerous, so if you can not have new
N/S each time of injection, try to use your own one (and make sure you know
how to clean it correctly each time)
On Step 5:
- Front Side: I only share N/S with people I know well
- Back Side: You may know well everything about someone, but you can’t know
whether that person has HIV or not. Don’t share N/S with him
On Step 6:
- Front Side: I share N/S with many people
- Back Side: It’s most dangerous to share N/S with many people as it’s likely that
some of them already HIV positive and you put yourself at high risk of getting
HIV. Even if you are PWA, you are at risk of getting other types of infections,
such as hepatitis B, hepatitis C…
Procedure for conducting this activity:
1. IPCs introduce the game to clients: there are different sentences written in the
ladder steps describing different injecting behaviors among IDUs. Some are
dangerous and the others are less dangerous or no harm. Make sure clients
understand all sentences
2. Ask clients put the steps on the ladder frame in an order that they think most
appropriate, from “no risk” to “high risk” (Step 6 is the highest risk).
3. Ask clients to explain why they put them in that order, that is, why one level is
less risky than the next level (for example, why sharing N/S with people you
know well is more risky than keeping your own N/S and re-using it after
cleaning?) Client explain risk level of each step, and ask clients to re-arrange
steps if needed.
4. Ask clients where they are on the ladder in terms of their common injecting
behaviors, and then discuss with them about the plan to reduce their risk (to the
lower step) and explain that it’s difficult to jump from the top of the ladder to the
ground, but it’s more feasible and easier to take one step at a time. Do easy things
first so you will avoid the failure make you become discouraged.
5. Ask clients which steps are safe, which are unsafe? After discussion, IPC tell
client that only three blue steps are safe behaviour; three red and yellow steps are
high risk related to sharing needle and syringe. Thus, make sure you always use
your own needle if you inject.
There are some example questions for discussion:
- Why do you decide to stop using drug? Why do you just inhale drug? Why do you
decide always inject with a new N/S? Why keep your own N/S? Why sharing with
people you know well? Why sharing with many people?
- What are the risks associated with each behavior? And why?
- In the future, what should you do to reduce your risk and how?
- How can I help you reduce your risk?
6. Sum up the activity by making the following points:
 It’s the best if you stop using drug, but it maybe very difficult. You can,
however, take small steps to reduce your risk associated with your
injecting behaviors.

Sharing N/S with people you know well is not safe at all. In fact, it is the
second most dangerous injecting behavior that may lead to HIV and other
infections, such as hepatitis B, C…

Never share N/S with others, even with people you know well as you may
know well everything about someone, but you can’t know whether that
person has HIV or not.

Message of this game is that “more high you climb, more pain if you fall
down”. That mean if you inject less safe, you are more risk contracting to
HIV. Therefore, make your own plan for risk reduction!