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Quick Reference Guide
to the
HIV Basic Care Package
for Community Health Workers
and Peer Educators’
1
References
1. HIV & AIDS Training Guide for Workplace and
Community Outreach, PSI/Kenya
2. National Manual for the Management of
HIV—Related Opportunistic Infections and
Conditions, Ministry of Health
Produced by Population Services International (PSI-Kenya) for
APHIA II Health Communication & Marketing Program, with
support from USAID
Technical Advisers PSI-Kenya, Ministry of Public Health &
Sanitation, NASCOP
Content Director Dr. Anne Musuva
For enquiries:
National AIDS/STI Control Program
Ministry of Health
P.O. Box 19361
KNH, Nairobi 00202
Tel: 254-20-272-9502/9549
Fax: 254-20-271-0518
www.aidskenya.org
Population Services International/Kenya (PSI-Kenya)
P.O. box 22591- 00400
Tel: 254-20-714-354/5
Fax: 254-20-714-342
www.psi.org Email: [email protected]
Publication Development & Design
Jacaranda Designs Ltd
PO Box 1202–00606, Nairobi, Kenya
Email: [email protected]
Creative Director Susan Scull-Carvalho
Graphic Design Mbula Makaa-Kinuthia
Illustrations Nkrumah Ondiek
Printed in Nairobi, Kenya
ISBN 9966-956-66-2
Copyright © Population Services International (PSI-Kenya), 2010
All rights reserved. While every attempt has been made to
verify all facts, instructions and procedures, the publisher claims
indemnity against results of any nature whatsoever arising from
the application/s thereof.
Quick Reference Guide
to the
HIV Basic Care Package
for Community Health Workers
and Peer Educators’
Abbreviations and Acronyms
ii
AIDS
Acquired Immune Deficiency Syndrome
APHIA
AIDS Population and Health Integrated
Assistance
ART
Anti Retroviral Therapy
ARV
Anti Retroviral
BCC
Behavior Change Communication
BCP
Basic Care Package
CDC
Centers for Disease Control
CHW
Community Health Worker
FBO
Faith Based Organization
HCBC
Home based care
HCM
Health Communications and Marketing
HIV
Human Immunodeficiency Virus
IEC
Information, Education and Communication
KAIS
Kenya Aids Indicator Survey
LLIN
Long Lasting Insecticide treated Net
NASCOP
National Aids and STI Control Council
NGO
Non Governmental Organization
MOH
Ministry of Health
OIs
Opportunistic Infections
PLHIV
People Living with HIV/AIDS
PMTCT
Prevention of Mother to Child infection
PSI
Population Services International
STI
Sexually Transmitted Infections
SWS
Safe Water Systems
VCT
Voluntary Counseling and Testing
WHO
World Health Organization
USAID
United States Agency for International
Development
iii
Acknowledgements
This HIV Basic Care Package quick reference guide for peer
educators and Community health workers was developed
through the tireless efforts of members of the HIV Basic Care
Package Technical Working Group. We wish to express our
gratitude to all stakeholders who made valuable contribution
in the development of this reference guide.
We would like to thank Dr. Nicholas Muraguri (Head,
NASCOP), Pauline Mwololo (NASCOP), Lenet Bundi (NASCOP),
Josephine Kioli (NASCOP), Lucy Maikweki (PSI/APHIA HCM)
and Dr. Anne Musuva (PSI/APHIA HCM) for spearheading
the process.
The following are members of the BCP Technical Working
group:
Lenet Bundi
-
NASCOP
Dorcus Kameta
-
NASCOP
Josephine Kioli
-
NASCOP
Dr. Nicholas Muraguri
-
NASCOP
Pauline Mwololo
-
NASCOP
Dr. Maurice Maina
-
USAID
Emma Mwamburi
-
USAID
Ruth Tiampati
-
USAID
Dr. Marta Ackers
-
CDC
Dr. James Odek
-
CDC
Mabel Wendo
-
Mildmay
Daun Fest
-
PSI/APHIA ll HCM
Lucy Maikweki
-
PSI/APHIA ll HCM
Dr. Anne Musuva
-
PSI/APHIA ll HCM
We would like to acknowledge and thank the United States
Agency for International Development for their financial
support towards the development of this reference guide.
iv
Contents
Foreword..................................................................................... vi
How to Use this HIV BCP Quick Reference Guide...... viii
Introduction to the HIV Basic Care Package................... ix
Basic Facts on HIV and AIDS................................................. 1
Prevention with Positives- Disclosure,
Partner Testing, Safer Sex, PMTCT...................................... 6
STIs and HIV.............................................................................. 12
Diarrhea Prevention.............................................................. 14
Malaria Prevention................................................................. 20
TB and HIV................................................................................ 23
Medicine to help Prevent Sickness.................................. 25
Nutrition and HIV................................................................... 29
Positive Living......................................................................... 31
v
Foreword
The Kenya Aids Indicator Survey (KAIS) 2007 results estimate
that 1.4 million Kenyans are currently living with HIV/AIDS.
Without appropriate care and treatment, most People living
with HIV will suffer from debilitating opportunistic infections
leading to hospitalization, lost income, disruptions to their
family life and eventually death. Today, HIV/AIDS no longer
has to be an acute, debilitating disease. It is possible to
delay or prevent disease and improve the quality of life for
persons with HIV through a comprehensive approach to
health care that emphasizes on preventive care, extending
beyond just antiretroviral therapy. People living with HIV
need simple, practicable solutions for improving their health
and extending their lives.
A number of low-cost and practical interventions have been
shown to reduce HIV-related morbidity and mortality and
prevent HIV transmission. long-lasting insecticide treated
nets, safe water systems and Cotrimoxazole preventive
therapy are inexpensive and clearly benefit people living
with HIV/AIDS (PLHIV) in sub-Saharan Africa by reducing
the incidence of opportunistic infections e.g., malaria and
diarrhea (WHO, 2007; Mermin, Lule et al, 2004; Kamya,
Gasasira et al., 2007). Correct and consistent condom use
has also been shown to reduce HIV transmission among
sexual partners.
PLHIV need access to an array of preventive services to prevent
opportunistic infections. In particular, the GOK recommends
safe drinking water, condom use, mosquito bednets and daily
multivitamins for all HIV-infected persons and calls these
the Basic Care Package. At the time of KAIS, 45.5% of HIVinfected adults in Kenya lived in a household that treated its
main source of drinking water; the most common treatment
practice was boiling. Among all HIV-infected adults, 45.3%
slept under a mosquito net the night before the survey and
20.2% slept under an insecticide-treated net. Only 36.4%
vi
PLHIV were taking daily multivitamins. Condom use at last
sex was low among marital/cohabiting partnerships (4.2%
among partnerships reported by women and 5.9% among
partnerships reported by men)
These results indicate that efforts towards availing these
services to PLHIV need to be intensified. At the same
time, PLHIV need instruction on proper use of the Basic
Care Package and education on other aspects of HIV care
including prevention of opportunistic infections and positive
living. This instruction is provided by peer educators and
community health workers who are supervised by the health
care providers in the health facilities. These peer educators
and community health workers require support in the form
of a quick reference guide with information on HIV and
Prevention of Opportunistic infections that they can consult
while carrying out health education sessions.
It is our hope that this quick reference guide will offer the
necessary support for peer educators and community
health workers as they facilitate health education sessions
in the health facilities, communities and elsewhere as may
be required.
Dr. Nicholas Muraguri
Head, NASCOP
vii
How to Use this Reference Guide
This guide is a tool designed to support peer educators,
community health workers(CHWs) and other volunteers
carrying out health education sessions on the HIV Basic
Care Package. This guide helps them update and refresh
their knowledge on key issues related to HIV and prevention
of opportunistic infections amongst people living with HIV.
It will guide them as they facilitate health education
sessions and group discussions on HIV related issues at the
health facility, community, support groups and even within
homesteads.
The topics covered in this guide include:
• Current situation and Basic Facts on HIV
• Prevention with Positives- disclosure, partner testing,
safer sex, PMTCT
• STIs and HIV
• Diarrhea prevention
• Malaria prevention
• TB and HIV
• Medicine to help prevent sickness
• Nutrition and HIV
• Positive Living
Getting started
Before giving a health education session or facilitating a
group discussion, one should read and review this Quick
reference guide to be familiar and comfortable with the
topics to be presented in the health education sessions.
Being prepared with facts and knowledge will enable the
CHW and peer educators to guide discussions and answer
questions that arise.
The information provided in this quick reference guide is
aligned with the goals of the BCP program which is to prevent
HIV transmission and prevent opportunistic infections
among PLHIV, therefore improving their health.
There are 9 topics in this reference guide. For each topic,
a brief introduction is given together with key facts and
information. This guides provides useful information at a
quick glance.
viii
Introduction to the HIV Basic Care Package
The Basic Care Package
The Basic Care Package contains items that are used by
PLHIV and their families to reduce HIV transmission and
reduce opportunistic and other infections such as diarrhea,
malaria and STIs amongst PLHIV. By using the items in the
package every day, PLHIV and their families live a longer
and healthier life.
The Basic Care Package contains the following items:
• 2 mosquito bed nets (long lasting insecticide treated net)
• 100 male condoms
• A 20l water vessel
• Water filter cloth
• 4 bottles of Waterguard® 150ml
• Informational material
• Resupply: 4 bottles of Waterguard® are resupplied to
every person who received the BCP.
Who can receive the BCP?
All PLHIV who are registered at a Comprehensive Care Center
(CCC) or a health facility that offers care and support for PLHIV
can receive the BCP.
Before receiving the BCP, PLHIV should receive a health
education session on the BCP and also a demonstration on
how the contents are used e.g. Waterguard ®, mosquito nets,
condoms etc
ix
x
Basic Facts on
HIV and AIDS
Facts about HIV and AIDS:
• HIV is the Human Immunodefiency Virus. This is the virus
or germ that causes AIDS.
• AIDS stands for Acquired Immunodeficienc y
Syndrome.
• Acquired means the infection is external and is not
inherited.
• Immunodeficiency means that the body’s defense
mechanism is weak and therefore the body is unable
to fight infections and illnesses.
• Syndrome refers to the symptoms and diseases brought
about by HIV infection.
• In 2007, it was estimated that there were almost 1.4
million PLHIV (KAIS 2007)
How is HIV transmitted?
1. Through sex
Unprotected sexual intercourse (vaginal, oral, anal) with an
infected person. In Kenya this is the most common mode of
transmission.
2. Contact with infected blood or other body fluids
through
• Blood transfusion from a HIV infected donor/person,
• Use of contaminated instruments e.g. needles, knives,
instruments used in circumcision, skin piercing,
traditional healing etc.
• Organ transplant from an infected donor
3. From an infected mother to a child in the womb,
during labour and birth or through breast feeding.
4. Although deep kissing can be risky, it is not the
saliva itself that may cause infection, but the bleeding
gums or open sores in the mouth, which are common in
a HIV infected person
1
HIV is not transmitted through
• casual contact such as holding hands, hugging,
• sharing food or drink.
• Dancing, swimming
• Living together
• Coughing
• Sharing a toilet or latrine
There are many factors that put one at risk
of HIV infection
What puts one at risk of contracting HIV?
• Unprotected sex –
• Sexually Transmitted infections (STIs) especially those
that form genital wounds/ulcers.
• Multiple sexual partners increase the chances of
contracting HIV infection. It could also lead to reinfection, if someone is already infected.
• Separation of spouses- is another risk factor e.g. when
a husband leaves his wife in the rural area to seek
employment in urban centres. Often these separations
are long and lonely and one may engage in sex with
other partners.
• Alcohol and drugs -an individual under the influence
may take sexual risks.
• Intravenous drug use, when drug users share needles
without sterilizing them.
• Unresolved conflicts at home may also be a risk factor
as the aggrieved partner may seek sexual solace outside
the home.
• Rape
2
Once someone becomes infected with HIV,
they go through the following stages of
HIV infection
STAGE 1: Primary HIV Infection (Window period)
This stage of infection lasts for a few weeks. During this stage
there is a large amount of HIV in the blood and the immune
system begins to respond to the virus by producing HIV
antibodies to fight the virus.
If an HIV antibody test is done at this stage it may not be
positive. At this stage chances of transmitting HIV are very
high.
STAGE 2: Clinically Asymptomatic Stage (No
symptoms)
This stage lasts for an average of ten years and is free from
major symptoms. The level of HIV in the blood drops to very
low levels but people remain infectious.(can transmit HIV to
another person)
HIV antibodies are detectable in the blood, so antibody tests
will show a positive result.
Nowadays, with use of ARVs PLHIV can remain in this stage
for even 20 years or more.
STAGE 3: Symptomatic HIV Infection (Symptoms
begin to show)
Over time the immune system becomes severely damaged
by HIV.
As the immune system fails, so symptoms develop. Initially
many of the symptoms are mild, but as the immune system
becomes weaker, the symptoms worsen.
STAGE 4: Progression from HIV to AIDS (Severe
symptoms)
As the immune system becomes more and more damaged,
the illnesses that occur become more and more severe
leading eventually to AIDS. A healthy person usually has
3
a CD4, (white blood cells that fight HIV) count of between
600 and 1,200. In this stage, the CD4 count is usually less
than 200.
HIV Prevention
One can protect oneself from HIV infection through the
following ways:
• ABC- Sexual abstinence, being faithful to one uninfected
partner, or correct and consistent condom use.
• Do NOT share unsterilized cutting and injecting
instruments such as needles, circumcision knives,etc.
• Mothers should also go for antenatal clinics and deliver
under a skilled health worker in a hospital to protect
their unborn children from infection.
• Post exposure prophylaxis (PEP) is a course of anti HIV
drugs, which may prevent transmission of HIV after a
risky exposure e.g rape
• Avoid risky isolated places that can lead to prevent cases
of rape.
• The youth should learn life skills to keep them busy in
order to avoid casual sex.
• Knowing your HIV status is important in HIV prevention
because it helps one to avoid spreading it to others.
N.B PLHIV need to remember that even though they are
HIV infected, continued exposure to HIV may increase the
amount of virus in the system and risk re-infection with
different types of virus.
Counselling and Testing for HIV
Counselling and testing provides an opportunity to help
clients understand HIV and AIDS and provide information
on HIV transmission and prevention.
HIV testing and counseling is the main entry point to
prevention, care and treatment of HIV. Those who test
negative learn how to stay HIV negative and those who test
positive can access care, treatment, support and counseling.
They also learn how to prevent transmission of HIV to others
and avoid re-infection.
4
There are 3 main steps in counselling and testing:
1. Pre test counselling to explain about HIV/AIDS and the
procedure of the test.
2. The HIV test, usually done by a finger prick to collect a
few drops of blood.
3. Post test counseling where the results of the tests are
explained and one is advised how to disclose the results
to partners and family. For those who are HIV infected,
counseling should also be given on how to protect their
partners from becoming infected.
Many of the HIV tests usually take about 15 minutes to give
results. However the whole process from pretest counseling,
the test and post test counseling take about 45 minutes.
One can access HIV Counselling and testing from
• VCT centres
• nearest health facilities
• Ante natal clinic
• Mobile HIV testing center
• During HIV Counselling and Testing campaigns.
5
Prevention with PositivesDisclosure, Partner Testing,
Safer Sex, PMTCT
Prevention with Positives (PWP)
PWP is one of the interventions of the Basic Care Package.
PLHIV are the most important people for HIV prevention
messages, because at least one positive person is involved
in each case of HIV transmission.
Today, many PLHIV are living longer and healthier lives, due
to access to good care and medication.
PLHIV may engage in risky behaviors that affect their own
health and of others, and therefore PWP helps PLHIV in
protecting those around them from HIV.
For HIV prevention two things are important
1. HIV negative people have to take responsibility to
remain negative
2. PLHIV should avoid transmitting the virus to their sexual
partners and unborn children.
PLHIV are important members of the community and key
to the solution to the HIV problem and not part of the
problem.
PWP involves the following
• Partner testing (sexual partners testing)
• Disclosure of HIV status to sexual partner(s)
• Safer sex (including using condoms)
• Prevention of mother to child transmission of HIV
(PMTCT) and Family planning
• Screening and management of sexually transmitted
infections
Stigma and discrimination are big challenges to PWP. PLHIV
may be unable to disclose their HIV status to their partners
6
due to stigma. The community should be educated on HIV
related matters to help reduce stigma and discrimination
that may prevent PWP interventions.
1. Disclosure
Disclosure in HIV occurs when someone living with HIV
shares their HIV status with another person. HIV disclosure
can be particularly difficult when sharing with family and
sexual partners.
Disclosure can be done in the following ways
• By the PLHIV on his/her own. The client is counselled by
the counsellor at the health facility on how to go about
it.
• Disclosure can also be done with support from the
counsellor or a friend. (supported disclosure)
Importance of disclosure
• Encourages safer sex practices including sexual partner
reduction and condom use.
• It reduces stress and pressure a PLHIV may be having.
Disclosure reduces self stigma by enabling someone with
HIV to seek support without fear of discrimination.
• Disclosure helps prevent infection to others or
reinfection with other types of HIV.
• Disclosure can strengthen relationships
7
2. Partners testing
Partners of PLHIV should know their HIV status. This is
important because:
• Persons with HIV may engage in risky behavior that
affects their own health and their partners health. E.g.
sex without a condom. Counseling can help those
who are discordant to change their behavior and avoid
spreading HIV to the negative partner.
• Helps to make informed decisions about relationships,
pregnancy, career and other long-term plans.
• They can be advised on changes in lifestyle that improve
their health and prevent opportunistic infections.
Discordance
Discordance in HIV occurs when two sexual partners have
different HIV sero-status. This is where one is HIV negative
and the other is HIV positive.
Couple reactions to discordance may be shock, disbelief,
confusion, blame, anger, or relief.
Many couples are usually already discordant when they
enter into a relationship due to sexual relationships one
had in the past.
Couples can remain discordant for many years.
Negative partners in discordant couples are at higher risk
of getting HIV.
Discordant couples are more common than many people
may think. A survey done in Kenya in 2007 showed that 45%
of PLHIV are in discordant relationships.
Why does discordance happen?
• HIV is not transmitted at every exposure during sexual
intercourse.
• There are many different factors that affect HIV
transmission.
Factors affecting HIV transmission
8
• Abstinence completely eliminates the risk of
transmission.
• Condoms greatly reduce the risk of transmission when
used correctly and consistently.
• Presence of STls increases the chances of HIV transmission
especially the STIs with sores/ulcers/wounds
• Viral load: people with higher viral load are more likely
to transmit HIV to negative partners.
• Circumcision also reduces the risk of transmission. The
foreskin is highly concentrated with cells that attract the
virus.
Counselling is an excellent opportunity to support discordant
couples. At counseling they are taught how to practice safer
sex and positive living. Effective counseling can save lives
and reduce risk of HIV transmission.
3. Safer sex and condom use
Safer sex involves using a condom.
Using a condom when having sex protects one’s partner
from HIV infection and also prevents PLHIV from getting reinfected with other HIV types and even sexually transmitted
illnesses.
Male or female condoms should be used every time during
sex and for the whole duration of sex.
Before using a condom talk about condom use with your
partner.
Condoms should be stored in a cool,
dry place.
Before using the condom
one should ensure the
condom is well sealed and
check the expiry date to
ensure it is not expired.
9
Steps in using a condom
2
1
Decide to use the condom
together with your partner.
Open the foil carefully. Your
fingernails can tear the
condom. Ensure that the part
to be unrolled is on the outside.
3
4
Hold the tip of condom. Pinch the
air out, place it on the hard penis,
and unroll the condom all the way
to the base.
5
After ejaculation, hold the condom at the
base of the penis so it does not slip off,
and pull out of our partner before the
penis becomes soft.
You and your partner
are protected.
6
Wrap in toilet
paper and throw
away in latrine or
somewhere out of
reach of children.
4. Prevention of Mother-To-Child
Transmission of HIV (PMTCT)
What is Mother-to-Child Transmission (MTCT)?
• This is where a HIV positive mother passes on the HIV
infection to her newborn baby.
MTCT can occur during pregnancy (across the placenta),
during child birth or through breast feeding.
10
What is prevention of mother-to-child
transmission?
• This is what is done to reduce the risk that a HIV positive
mother will pass on the HIV infection to her newborn
baby.
Interventions of PMTCT
• Family planning to prevent unintended pregnancy.
• Voluntary HIV counseling and testing for all pregnant
women and their partners to establish their HIV sero
status
• Early, regular attendance of antenatal care clinic.
• Antiretroviral therapy (ART) for the mother and child
• Prevent breast milk transmission. One should go to the
health facility to discuss the best feeding option with
the health care provider.
• Avoid breast feeding when the breast is infected or
nipples are cracked.
• Delivery by Caeserian section or vaginal delivery by
skilled birth attendant at a hospital
• Early and proper treatment of all sexually transmitted
infections.
11
STIs and HIV
Sexually Transmitted Infections (STIs)
These are infections that are passed from one person to
another through unprotected sex with an infected person.
They can be spread through vaginal, oral and anal (through
the anus) sex. Most STIs are spread through sex, others are
spread by blood transfusions, body contact and even by a
pregnant mother to her unborn baby.
• HIV is a STI.
• STIs play a big role in spreading HIV because a person
with a wound on the genitals due to STIs has a higher
chance of acquiring HIV and also spreading HIV through
the wound. For PLHIV, STIs may be more severe and may
take longer to heal due to the weakened immunity.
Common symptoms of STIs
• Sores, lumps or wounds in the genitals (private parts)
• Unusual discharge from the genitals (vagina in women
or penis in men)
• Itching
• Pain when passing urine
• Soreness and pain in the genitals
• Pain in the lower abdomen
12
Common STIs in Kenya
The common types of STIs can be grouped into two:
a) STIs with ulcers (wounds, sores)
Someone suffering from this STI has an ulcer in the genital
area. These include:
• Syphillis
• Herpes
• Chancroid
b) STIs with discharge
• Gonnorrhea
• Candidiasis (Thrush)
Someone suffering from any of these symptoms should visit
their nearest health facility for testing and treatment.
Prevention of STIs
1. Always use a condom when having sex. All PLHIV should
be trained to be able to use condoms correctly.
2. Abstain from sex
3. Limit the number of sex partners one has.
4. Know your sex partner. One should tell his/her sex
partner if they have an STI and ask the partner if he or
she has one. One should then be tested for STIs with
his/her partner.
5. Look for signs of an STI in your sex partner. For example,
look for sores around the penis or vagina, or for any
of the symptoms listed. But remember that STIs don’t
always have symptoms.
6. All sexually active PLHIV should be tested for STIs e.g.
Syphillis every year.
7. Adhere to the treatment.
13
Diarrhea Prevention
Diarrhoea prevention
Diarrhoea is a common opportunistic infection and common
cause of illness for People living with HIV.
Even when they get diarrhea, people living with HIV have
more severe and frequent episodes of diarrhea because of
their low immunity.
What are the common sources of germs that cause
diarrhea?
• Unclean drinking water
• Poor hygiene - not washing hands with soap and
water
• Eating contaminated food especially fruits and
vegetables
How is water made safe for drinking?
1. Treatment of water with the following chemicals
a) Water treatment tablets e.g. Aquatab®
These tablets are introduced into the water to kill germs.
One tablet is put into 20l of water. Shake well and leave for
30 minutes before drinking.
b) PUR powder
The powder pulls together the dirty particles while it also
kills germs. PUR is used for treating turbid (dirty) water.
One satchet of the powder is put into 10 liters of water. Stir
the water for 5-10 minutes then leave to stand for another
14
5–10 minutes until all the dirt collects at the bottom and
the water is clear. Before drinking the water, filter the water
using a clean cotton cloth into a clean container. Leave for
20 minutes before drinking.
c) Waterguard®
WaterGuard is a liquid chlorine solution that is used to treat
water and make it safe for drinking without boiling.
How to use WaterGuard?
• Filter unboiled water using a clean cotton cloth into a
20 liter water vessel.
• Pour one capful of WaterGuard liquid into the water
vessel full of unboiled water.
• Cover the water vessel and shake thoroughly for 1
minute until Waterguard is completely mixed with water.
Wait 30 minutes.
• Your water is now safe to drink.
Waterguard should be used together with a 20l water vessel
and a filter cloth. These 3 items are referred to as the safe
water system. Water treated with Waterguard® remains safe
to drink as long as it is not re-contaminated. (Germs entering
again). The water vessel should have an inlet and a tap to
prevent recontamination.
The bottle of Waterguard should be stored, in a cool dry place,
away from direct sunlight and out of the reach of children.
Where can I find WaterGuard®?
• The Basic Care Package contains Waterguard, the 20 liter
water vessel and a water filter cloth. These 3 items are
distributed free to PLHIV within the BCP.
• WaterGuard® is also sold in kiosks, supermarkets, select
clinics, pharmacies and other retail outlets.
15
What are other purposes of Water Guard treated water
besides using it for drinking?
WaterGuard treated water should also be used for hand
washing, washing fruits and vegetables and cooking.
Other methods of making water safe for drinking include
2. Boiling
Heat water until it starts boiling and allow to boil for 15
minutes. Store the water in a clean container which has a
tap in order to prevent recontamination.
This is effective though it is expensive.
3. Filtration
Water is passed through a cloth or a porous material to collect
large particles of dirt.
• This is a simple method. However, it does not remove
all germs from the water.
4. Solar disinfection of water
Sunlight is used to kill germs present in water. Fill transparent
plastic containers with water and expose them to full sunlight
for about five hours (or two consecutive days under very
cloudy sky).
Solar disinfection requires clear water to be effective.
5. Settling/ the 3 pot system
Water is allowed to sit for a period of time to allow the
particles/sediment to sink to the bottom of the bucket. A
system called the 3 pot system is used where water is stored
for at least 2 days before drinking. 3 pots are used. Pot 1, 2
and 3.
Water to drink is taken from pot 3. This water has been stored
for at least two days, and the quality has improved.
Periodically this pot will be washed out and may be sterilized
by scalding with boiling water.
Each day when new water is brought to the house:
(a) Slowly pour water stored in Pot 2 into Pot 3, wash out
Pot 2.
16
(b) Slowly pour water stored in Pot 1 into Pot 2, wash out
Pot 1.
(c) Pour water collected from the source into Pot 1. You
may strain/filter it through a clean cloth.
• This is a simple to use method. However, it does not
remove all germs from the water and water may still
need to be boiled or treated with chlorine.
Handwashing
• Washing hands with soap and running water is very
important in preventing infections.
• Hand washing benefits the PLHIV and the entire
household by decreasing germs that cause diarrhea.
• Unwashed (or poorly washed) hands can transfer
harmful germs to other people.
• Discourage many people using the same basin and
water to wash hands inside.
When should people wash their hands?
• Before preparing or eating food
• After going to the toilet/latrine
• After cleaning up a child
• After handling uncooked foods, particularly raw meat,
chicken, or fish
• After blowing your nose, coughing, or sneezing
• After handling an animal or animal waste
• After handling garbage
• When treating a cut or wound
17
Proper Hand Washing Steps
1. Place your hands together under water (warm water if
possible)
2. Use soap
3. Rub your hands together for at least 10-15 seconds.
Wash all surfaces thoroughly, including wrists, palms,
backs of hands, fingers, and under the fingernails.
4. Clean the dirt from under your fingernails
5. Scrub forearm well above the wrists
6. Rinse forearms and hands using running water.
7. Dry your hands completely with a clean towel if possible.
If no clean towel is available, air-dry your hands
Wet hands with
water
Apply soap to
hands
Rub hands
together
Cover all surfaces
of the hands and
fingers
Clean knuckles,
back of hands and
fingers
Clean the space
between the
thumb and the
index finger
Rinse well under
running water
Dry with a clean
towel
Clean the fingernails by
working the fingertips
into the palms
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Together, drinking safe water and hand washing can greatly
reduce the risk of diarrheal diseases.
As a CHW or peer educator, promote safe water by
• Practicing use of safe water systems and hand washing
in your own life style. Be confident using it.
• Encourage behavior change amongst PLHIV and the
community by repeating the benefits of Treating water,
safe storage and hand washing.
• Continue teaching about Safe Water and be supportive
to your groups until they finally get to practice proper
hand washing and drinking safe water.
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Malaria Prevention
Malaria prevention
What causes malaria?
Malaria is a disease caused by parasites called Plasmodium
carried by mosquitoes.
One gets Malaria if they are bitten by a Mosquito infected
with the malaria parasite (Plasmodium)
• The mosquitoes that carry malaria parasites usually bite
at night, between 10pm and 5 am.
• Those at high risk of getting Malaria are children under
five years, pregnant women and people living with
HIV.
What are the symptoms of malaria?
Someone with malaria may have fever, headache, loss of
appetite, general weakness and joint pains.
If the malaria is not treated or is improperly treated one can
get more severe symptoms such as
• Fits/ convulsions,
• Very high temperature
• Difficult breathing
• Jaundice( yellow eyes)
• Anaemia
• Loss of consciousness
Advice someone with these symptoms to go to the nearest
health facility to be tested for Malaria and treated.
HIV and malaria
PLHIV have an increased risk of contracting malaria due to
the weakened immunity
PLHIV may also suffer from more severe Malaria.
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Malaria prevention
Prevention of malaria is the best way to control malaria. Ways
to prevent and control malaria include:
1. Sleep under a mosquito net. A long lasting insecticide
treated net is the best.
2. When you suspect someone has Malaria, refer them to
the nearest health facility for treatment.
3. Clearing the stagnant waters and bushes where
mosquitoes usually breed.
4. Spraying indoors with Insecticide.
5. Use of mosquito repellant creams and wearing long
clothes like trousers in the evenings to reduce body
exposure to mosquito bites.
The Long lasting insecticide treated net (LLITN)
• This is a net that has already been treated with the
insecticide/ chemical from the factory. This chemical is
harmful to mosquitoes.
• Long lasting insecticide treated nets (LLITN) are
best because they do not need to be retreated with
insecticide to maintain their effectiveness.
• LLITN act as a physical barriers against mosquito bites.
They also repel and kill mosquitoes coming to bite
humans sleeping under the net.
• They are safe to use for humans, even babies. But they
are deadly for mosquitoes and even other insects in the
house.
21
Use of the LLITN
• The LLITN is tied with the strings provided above the
bed or sleeping mat.
• One can also use poles to support the net at the corners
of the bed or sleeping mat.
• It should hang loosely and should cover the whole bed
or sleeping mat.
• Tuck the net under the mattress or sleeping mat to
ensure there are no holes inside.
• When you wash your net, hang it out to dry in the shade.
Do not hang it out under direct sunlight.
• LLITN should be washed with simple bar soap and not
left to soak. JIK and other bleaches should not be used
on the net.
LLITN can retain the insecticide for at least 3 years or up to
twenty washes.
Ways of hanging a mosquito net
Extend net with cloth.
Tuck net under mat.
22
Use two nets, and tie separately.
Fix posts into cemented tins.
Fix posts to bed corners.
Modify hanging points to join two nets.
TB and HIV
Tuberculosis and HIV/AIDS
Tuberculosis (TB) is the most important and common
opportunistic infection in PLHIV, and one of the defining
infections of AIDS. A person with HIV is ten times at risk of
developing active TB (symptoms of TB).
An estimated 50-60% of TB patients in Kenya are infected with
HIV. TB is caused by bacteria known as Tubercle bacillus.
There are two types of TB
• TB in the lung - This affects the lung and is the most
common
• TB outside the lung- this affects all other parts of the
body except the hair and nails. It is difficult to diagnose.
It mainly affects those with more advanced HIV and a
weaker immune system.
TB transmission
TB is transmitted from an infected person to a healthy person
through cough and sneezing. In most cases, this infection is
controlled by the immune system and one can remain for
many years, even for life without symptoms. Active TB with
symptoms occurs when the immune system fails to keep the
bacteria under control. At this point, one begins showing
signs and symptoms of TB.
Signs and Symptoms of active TB
• Cough for more than 2 weeks
• Fever
• Night sweats
• Weight loss
• Chest pain
• Blood in the sputum (after coughing)
The following factors place one at risk of
contracting active TB
• HIV infection- due to lowered immunity
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• If one is very young or very old
• Living in overcrowded areas e.g. the slums
• Poor nutrition (feeding)
• Chronic infections like diabetes
How is TB diagnosed?
If one suspects that they may have TB, they need to go to
hospital, where one will be required to give sputum for a
test.
Chest X-rays could also be done to help in diagnosing TB.
TB Treatment and Prevention
Once diagnosed with TB one is started on TB treatment
which takes 6-8 months. The TB medicine should be taken
as directed by the health care provider. Failure to take the
TB medicine correctly is a serious problem that leads to drug
resistance. Some of the reasons why people stop taking the
TB drugs are:
• They start to feel better and therefore think that TB is
cured,
• Long treatment duration 6-8 months
• Stigma associated with TB.
The family is very important in
providing support to ensure adherence to the TB medicine.
When one has TB symptoms he/she should seek
diagnosis and treatment immediately
to avoid spreading the infection.
Children should
also be vaccinated against
TB. People with TB,
should cover the mouth when
coughing or sneezing.
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Medicine to help prevent
sickness
Medicine to help prevent sickness:
Cotrimoxazole prophylaxis
Cotrimoxazole is a medicine commonly known as Septrin.
• It is taken by PLHIV to prevent Opportunistic
infections.
• Prophylaxis means the medicine is taken everyday to
help prevent opportunistic infections.
• It prevents many infections including pneumonia,
malaria, diarrhea and some brain infections.
• All PLHIV , including children should take Cotrimoxazole
unless there are reasons why they should not. E.g.
allergies. It should be taken by PLHIV whether they are
taking ARVs or not.
• Children born to mothers who are HIV infected should
also be given Cotrimoxazole until a HIV test is done
which shows that the baby is HIV negative.
• The medicine is taken daily as either as a tablet or
syrup.
• Cotrimoxazole can only be dispensed by pharmacies or
from the health facility.
• Cotrimoxazole used for prophylaxis is the same as the
cotrimoxazole that is used for treatment, but the doses
are different.
25
Who should not take cotrimoxazole prophylaxis?
• Anyone with a proven severe allergy to Cotrimoxazole,
or other medicines that contain sulpha e.g. Fansida® and
Metakelphin®
Side effects
• Side effects are rare. Some side effects are rash, nausea,
loss of appetite and severe rash.
• Refer anyone who suffers from side effects e.g. severe
rash to the health facility
• All those who react to Cotrimoxazole can be assisted by
the health care provider.
Adherence
Adherence means that a patient takes medicine as instructed
by the health care provider.
Adherence is important so that the client takes the medicine
in the correct quantity and at the right time. One must not
miss any doses. This will ensure prevention of opportunistic
infections.
• A plan of adherence is important to identify when one
will be taking the drugs and what to do if they travel
(carry the drug). One can use a calendar or book to
ensure they take the medicine every day. They can also
ask a family member or friend to remind them of taking
the medicine everyday.
A Support Person is also important to help the client adhere
to cotrimoxazole prophylaxis.
• Having to take medicine everyday for the rest of your
life, can be difficult and stressful, a patient may at times
get discouraged.
• The support person supports and encourages the client
to take the medicine.
• This could be a family member, other PLHIV, friend,
neighbor or any other person.
Multivitamins
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Multivitamins are tablets taken everyday by PLHIV to
promote good health. These tablets contain important
vitamins for the body such as Vitamin B, C and E and have
the following effects:
• They promote good health and therefore delay the time
before one is put on ARVs.
• PLHIV taking multivitamins have higher levels of the
immune cells fighting HIV in the body and less amount
of HIV virus in the body.
• Reduce painful mouth ulcers/wounds and reduce
painful swallowing of food.
• They also reduce rashes, diarrhea and give more
energy.
• Multivitamins also help other medicines such as ARVs
to work better
• All PLHIV should take multivitamins as prescribed by
their health care provider everyday.
Anti Retroviral Drugs (ARVs)
Anti – HIV drugs are called anti-retroviral drugs or ARVs. These
medicines help to extend the lives of PLHIV. Anti Retroviral
therapy (ART) includes the whole range of drugs, medical
attention, nutritional care and support provided to PLHIV.
ARVs are usually taken in combination in order to achieve
maximum effect.
ARVs inhibit the multiplication of the HIV virus, delay the
destruction of the immune system and therefore improve the
quality of life. They reduce HIV related sickness and death.
In the past, ARVs were expensive and therefore, many people
could not afford them. Today ARVs are much cheaper and are
provided free in government hospitals in Kenya.
Not all PLHIV are put on ARVs. When starting a PLHIV on ARVs,
the doctor considers the following factors:
1. The patient’s clinical state. Does the patient have
symptoms or not?
2. CD4 count or Viral load (Amount of virus in the blood).
Those with a low CD4count or high Viral load are started
on ARVs even if they have no symptoms.
3. Whether the patient accepts the treatment.
4. Whether the patient will be adherent to the treatment
i.e. will take it as instructed
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Side effects of ARVs
Most drugs usually have side effects. Most of the side
effects of ARVs are mild and disappear within a few weeks
of beginning the treatment. People react differently to ARVS
and not all people may get side effects. The side effects are
the main reasons why people stop taking drugs. In case of
severe side effects, the doctor may stop and change the
drug.
ARVs may also interact with other medication that one may
be taking e.g. TB medicine and therefore the doctor should
be aware of all other medication one may be taking.
Some side effects include: Nausea, Vomiting, loss of appetite,
headaches, skin rashes, diarrhea, abdominal pain, lack of
sleep.
PLHIVs should monitor for any side effects to ARVs and report
these to the doctor.
Drug Adherence
This is a life long commitment made by a PLHIV to take the
drugs as prescribed. Adherence is very important for the
drugs to be effective. It requires one to have self discipline
and also to endure the initial side effects of the ARTs. It is
important to identify a support person who will support one
to adhere to the treatment plan.
One should take the drugs when they are due. If more than
one or two hours pass from the time the drug was to be taken,
the virus becomes active and starts multiplying.
Adherence to ARVs also requires a change in the lifestyle
including keeping away from alcohol and cigarettes.
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Nutrition and HIV
Nutrition involves eating the right foods in the right quantities
to ensure good health. A balanced diet helps boost the body’s
immune system and helps a PLHIV keep AIDS away. HIV/AIDS
affects one’s nutritional status in the following ways:
• The body requires increased energy and nutrients
• Poor food absorption
• Frequent diarrhea
• Infections such as thrush (in the mouth) lead to difficulty
in feeding
• Poor appetite
A balanced diet/good nutrition prevents malnutrition and
wasting, helps the body fight opportunistic infections and
delays disease progression.
Balanced diet
A balanced diet consists of proteins, carbohydrates, vitamins,
minerals, fibre and water.
Proteins are for growth and repair of the body. E.g. milk, eggs,
beans, soya, njahi, fish, poultry, beef
Carbohydrates provide energy. Eg. Ugali, maize, sugar, fat,
Vitamins keep the body healthy. They are found in fruits,
vegetables and food.
Fibre- they promote proper functioning of the intestines.
They are found in fruits, vegetables and whole grain foods.
Minerals- they keep bones and muscles healthy. They are
found in many foods, fruits and vegetables.
Water
Following are some common conditions found among
PLHIV, which require dietary management:
• Thrush- eat mashed foods, avoid hot foods, avoid spices
and sugar
• Constipation-eat high fibre foods and drink plenty of
fluids
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• Diarrhea- drink a lot of fluids and eat high energy and
high nutrient foods e.g. maize, potatoes
• Nausea- eat small but frequent meals
• Anaemia- eat iron rich foods such as green leafy
vegetables and take iron supplements
Safe Food Handling
To ensure PLHIV do not develop diseases from the food they
eat, they should Wash hands before handling or eating food
and wash fruit and vegetables before eating or cooking them.
Food should also be prepared in a hygienic manner.
30
Positive Living
Positive Living is adopting behaviours and attitudes that
enhance the quality of someones life. It involves getting
tested in order to know your HIV status and accepting your
HIV status.
Positive living also means avoiding risky behavior that could
lead to HIV infection or re-infection.
Living positively with HIV involves growth in 5 areas of life:
1. General Well being
This involves
• Eating a well balanced diet
• Exercise- it helps relieve stress, boosts immunity and
improves blood circulation
• Rest and relaxation
2. Psychological Well being
This involves keeping your mind healthy. This includes
counseling, bulidng your self esteem, keeping a positive
attitude, reducing stress and interacting well with others.
3. Social Well Being
It is important to interact with other people in society. This
can be done through support groups, seeking support from
the family, spouse and peers, continue with work to earn a
living, volunteer as a peer educator.
4. Physical Well Being
This helps one maintain a healthy lifestyle. This is achieved
by treating opportunistic infections promptly, taking ARVs
as recommended by your doctor and also taking drugs that
boost the immunity as recommended by your health care
provider.
5. Spiritual well being
This involves believing in a supernatural power- God, praying,
praising and worshipping God.
But do NOT throw away your ARVs at the instructions of a
faith-based healer!
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Notes
Notes
Notes
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