What is HIV and AIDS?

VSO China
HIV and AIDS Mainstreaming Toolkit
(November 2009)

A big thank you must go to all the VSO China volunteers and staff who helped
me to develop this document. Thank you to Leandra Lok and Susan Heshui for
sharing examples of their mainstreaming work in China. I would especially like
to thank the following people for helping to provide suggestions and ensure
that everything is as it should be: Joel Balaquit, John Edwards, Julia Fahrmann,
Dolores Ladouceur, Eilidh Macpherson, Yin Meng, Cailean Watt, Wang
Lumeng and Zhang Cao.
Thank you to VSO Ethiopia, Tanzania, Rwanda and Vietnam for sharing their
HIV mainstreaming resources, as well as the previous VSO China HIV and
AIDS Pack. They were invaluable.
Thank you to all agencies whose resources we have been able to use as part
of this document. Please see the detailed list of references for more
information.
A big thank you to all the National Volunteers who are helping to translate this
pack into Chinese. Thank you so much!
I hope you find this toolkit helpful.
Kruti Buch
HIV and AIDS Mainstreaming Adviser
VSO China volunteer
November 2009
Acknowledgments

Contents
Acknowledgements
Contents
Introduction 1
Before you begin 4
Ground Rules 7
Language 8
Section 1: What is HIV and AIDS? 13
1.1: HIV Quiz 19
1.2: Risk Continuum 20
1.3: What is HIV and AIDS? 23
1.4: Immune System Game 24
1.5: True or False 27
1.6: The Infection Game 30
Section 2: HIV and AIDS in China 32
Timeline of China’s HIV epidemic 37
Section 3: Why is HIV a development issue? 38
3.1: What is Development I 42
3.2: What is Development II 44
3.3: Problem Tree 46
Section 4: HIV and STDs 48
4.1: HIV and STDs 49
Section 5: Stigma and Discrimination 52
5.1: Occupations 54
5.2: Stereotype Pictionary 55
5.3: Discrimination Circle 56
5.4: Discrimination Pairs 57
5.5: Different People 59
5.6: Power and Diversity 61
5.7: Facing Fears 64
5.8: We are all in the same boat 65
5.9: Judging Characters 66
5.10: The BIG Question 68
5.11: Who am I? 71
Section 6: HIV and Gender 72
6.1: Sex, Sexuality and Gender 76
6.2:Balance of Power 79
Section 7: What is mainstreaming? 81
7.1: What is mainstreaming? 84
7.2: Case studies 90

Section 8: Different approaches to HIV
93
mainstreaming within VSO China
Section 9: HIV workplace Policies 94
9.1: Why do we need a policy? 95
9.2: What is a HIV workplace policy? 98
9.3: Negotiation 100
9.4: What would we do? 104
Section 10: Monitoring and & Evaluation
Annex
1: VSO HIV testing procedure for International
Volunteers
2a: HIV and AIDS Quiz
2b: HIV and AIDS quiz answers
3: Useful HIV and AIDS websites
4: Risk Continuum PPT
5: What is HIV and AIDS PPT
6-10: Photos for What is Development
11: Problem Tree Diagram
12: Most common STDs
13a: Assessment Tool I (English)
13b: Assessment Tool I (Chinese)
14: Assessment Tool II (English)
15: HIV workplace policy PPT
16: Guidelines for deciding on negotiation
strategies
17: HIV Glossary (English)
18: HIV Terms (Chinese)
19: KABP Example survey
20: Example evaluation form
106
Reference Page

Introduction: Why is HIV mainstreaming important?
HIV and AIDS does not discriminate. Age, gender, ethnicity, occupation, urban, rural,
developed or developing – HIV and AIDS can impact anyone at anytime.
VSO’s goal is to promote volunteering to fight poverty and disadvantage globally. In
order to do this, VSO recognises the need for HIV to be part of all its work regardless
of whether it is an education, livelihood or governance project. But why is it important?
Read about Xiao Gang.
Xiao Gang is 12 years old. He lives in a rural village in Shanxi province. He has
three younger brothers and sisters. His parents are both peasants and have a
small plot of land where the family grows vegetables to sell in a nearby market.
Xiao Gang’s family only earns 800 yuan a month. They can sometimes earn a bit
or less depending on what they can grow.
At age 12, he no longer goes to school. Although the school he attended was free,
his parents could no longer afford the school books and uniform. Also, his parents
need him to help on the land.
The future for Xiao Gang is bleak. At age 17 he finds it difficult to get a job. His
parents are getting older and the land does not provide enough for them all. There
are no job opportunities available to him in his village. He decides to move with his
best friend to the provincial capital, Taiyuan to find a job. Finding a job here is hard.
There are lots of people from all over the province looking for the same things as
him. Without his high school qualifications, he can only find as a security guard at a
shopping mall. He works longs hours for very little money. He lives in a cramped
basement apartment with 10 other people just like him, all hoping for the same – a
better life.
So, if only Xiao Gang had opportunities to attend school, if the school could find
money to pay for the books of these students, if Xiao Gang’s parents could find other
means to help support their income then Xiao Gang’s future may change. However,
now think about how this situation might change if Xiao Gang’s parents were living
with HIV.
1

Although Xiao Gang liked school and enjoyed learning, he was relieved to leave
school when his parents could no longer pay for his school books. It all began a few
months ago. He overheard his teachers talking about some “strange disease” that
was affecting people in nearby villages. People were getting sick but no-one seemed
to know why. Some of the teachers debated on whether they had been involved in
“bad behaviour”. Xiao Gang walked away curious but thought nothing of it.
As the months went on, he watched as his parents became ill. At first, his parents
began to lack energy and suffered from more colds and flus. Over time, the family
realised that something was not right. Xiao Gang’s parents were not getting better.
They were worried. They visited their doctor who tested their blood. The results
showed that Xiao Gang’s parents were HIV positive. They did not tell anyone about
this.
Life continued for Xiao Gang. His parents were still sick and he helped at home and
on the farm as much as he could. Villagers were beginning to notice how ill his
parents were. He could hear them whispering about his family as he walked past. He
saw how his family’s close friends who lived next door became distant. Before they
had helped look after his siblings and helped his parents when they could. Now, they
no longer come into his house. They no longer cook food to share with his family.
They have told his parents that because they too are getting older, they cannot help
to look after the children.
The children at school have not been friendly to Xiao Gang. They have called him
names and have told him that they no longer want to sit next to him or play with him
because he is “dirty and diseased”. His best friend, Xiao Hu, is also afraid to be near
him. Before they used to share everything, food, toys, books, but now Xiao Hu will
not share anything. He will not touch Xiao Gang. He will not look at Xiao Gang. Xiao
Gang is sad. He doesn’t understand why people are acting like this. He doesn’t
understand why people are being so mean.
When Xiao Gang finally leaves school, he is relieved. His parents used to travel to
the provincial capital to get the medicines they needed but they can no longer afford
to do this and are getting sicker by the day. His days are hard. Xiao Gang tries his
best to look after his parents and his siblings. He works on the land to sell what little
they grow at the market but people have been talking and do not want to buy the
vegetables that come from the “diseased family”. They have very little money for
anything. Most nights, Xiao Gang is afraid and sad. He does not know what will
happen to him and his family. Who will help them? Who will look after them? He is all
alone.
2

Q) What can YOU do to help?
Answer: Support VSO’s work on HIV mainstreaming
But what does mainstreaming mean? It means making it a part of everything that you
do. That HIV is not a separate topic that you talk about once a year but is linked the
work that you do everyday. This does not mean that you have awareness-raising
sessions everyday but that you look more broadly at the topic and recognise ways to
raise awareness and combat stigma and discrimination that is appropriate for your
environment.
HIV mainstreaming is a journey. It deals with sensitive areas about individual’s needs,
values, attitudes and behaviours. To think that you can change this in a day is
unrealistic. But over time, it is possible. It may be easy to be disheartened by the little
progress seen but what should be more important is that change is happening – REAL
change.
This guide is to help give you some ideas about what you could do. Feel free to adapt
and amend according to your environment. The guide will provide basic facts and
information as well as detailed activity plans and examples. There is also an index for
all the terminology used.
If you have any other ideas or would like to add to this toolkit, please contact
Yin Meng, HIV and AIDS Programme Support Officer – Yin.Meng@vsoint.org.
3

Before you begin mainstreaming
Before embarking on HIV and AIDS mainstreaming activities in your placement, it is
important to first understand the local context. This does not have to involve a formal
assessment, but it is important to spend time understanding what the gaps are, how
much support is available for HIV mainstreaming work, attitudes towards HIV and any
support/resources both financial and technical that are available locally that you can
draw upon. This can be done informally in the first few months, as you begin to
familiarise yourself with the local environment and your role.
1) Key Questions to Assess Yourself
Questions Issues and Activities
Do you feel comfortable talking It is ok not to feel comfortable conducting the training and
openly with men/boys and activities yourself. Consider using colleagues or people from
women/girls about sexual and health other organisations. You can facilitate external trainers and
matters?
speakers and make materials available.
How well do you speak Chinese or Discussion of sensitive or sexual issues is better conducted
the local language?
in people’s first language. If you work with a national
volunteer, you can facilitate sessions together or alternatively
ask colleagues to support the discussion. In some cases,
people may feel more comfortable speaking with a foreigner
about these issues and can be more open. You can decide
the best approach to use once you have assessed the
environment.
Do you have enough knowledge You can use this manual as a starting point as well as the list
about HIV & AIDS and related of websites for more information. You can also use the VSO
sexual health issues, or at least Moodle site and contact the HIV and AIDS team at the
have access to such information? Programme Office for technical support. There may be local
organisations, that can support you and government
agencies like the Centre for Disease Control (CDC) and local
health bureaus. There is a lot of information out there. Don’t
feel pressured to be an expert, do what you feel you are
comfortable with and ask for external support if needed.
How much time can you allocate to Decide on how much time you can realistically dedicate to
HIV and AIDS mainstreaming? HIV mainstreaming work. Can you support the organisation
in holding a World AIDS Day event? Or a longer term
commitment such as developing and delivering training with
your colleagues?
Who is your target group? Do you Work with people that you will have an on-going relationship
have contact with a particular group
of people e.g. students, women,
farmers, nurses, teachers etc?
with and experience of working with.
4

How might your religious / cultural /
ethnic background influence your
ideas on HIV, AIDS and related
issues?
Do you have support from the
leaders/management?
Self-awareness is important in ensuring activities are
conducted in a non-judgmental manner.
Without support from leaders and management,
mainstreaming HIV will be very difficult. It may even cause
tension in your relationships with colleagues if they feel this
is not your role. That is why it is so important to understand
the local environment. Encourage discussions with leaders
and management before embarking on activities. Talk
through any concerns they may have and ensure that if
activities are being planned, they are consulted and
included.
(Source: Adapted from the VSO Tanzania HIV and AIDS Mainstreaming Manual, 2006)
2) Points to agree with management
So, once you have the commitment and support from management, it is time to begin.
It is good to ensure that HIV mainstreaming activities are not just VSO volunteer-led
activities. If possible, it is best to work with a colleague that has shown interest to the
work and wants to help co-facilitate. Before you begin, the following points must be
agreed upon with management:
What the activity is expected to achieve.
What topics will be covered.
The number of days and the number of hours a day people will attend.
Who the participants will be.
Where the course will be held and what facilities will be available to you.
3) Things to consider when deciding on activities
Questions Issues and Activities
Who will help you co-facilitate the session? It is best to have a local counterpart to
co-facilitate activities with. It helps to overcome
the language barrier. Also, ensures there is
ownership of the mainstreaming work by the
organisation. They can also give valuable insight
into the local culture.
What do people already know and what are the
gaps?
One of your first activities could be supporting the
development of a knowledge, attitudes and
behaviour survey. Confidentiality is a paramount
here as people will be disclosing their personal
opinions. The survey could also include questions
on what type of work they would like to be
involved in and what information they want to
5

How might religious or cultural practices or
ethnic diversity affect actions / perceptions in
respect to HIV & AIDS? (e.g. how are
condoms perceived as opposed to abstinence
and being faithful as methods of prevention?)
What methods would be appropriate in
conveying messages?
know. Everyone in the organisation should
complete a survey.
Consider the diversity of the population while
addressing inaccurate or incomplete knowledge.
Working with a local counterpart will also provide
valuable insight into the local community. You
may need to tailor activities as appropriate, taking
a softer approach. It is important to build the trust
of the participants to then enable deeper issues to
be discussed.
Using participatory methods such as those
included in this guide or those from other sources
is a good way to engage participants in
discussion. These methods may be new to the
participants and they may seem wary, so being
prepared and confident is important.
4) Preparations before each session
Location of the room is important. Ensure that it is large enough for all participants
and has enough space to move around in. Use a room that is private because you
will be discussing issues that can be very personal and sensitive. This is especially
important in trying to create a safe and open environment for participants.
Setting of the room - Try to set the room up so that you can
see all the participants involved. A horse-shoe shape () is
one way. This also allows room for the participants to see
one another and room to move around. For different
activities, change the layout of the room accordingly.
Materials – Make sure that you have all the materials you need
before the session begins. Flip-charts, maker pens, post-it notes, any props,
handouts, booklets and information leaflets etc.
Translation – to make things easier for participants it would be best to translate all
handouts. Whilst preparing for the session, ensure that you and your co-facilitator
are clear on the context of the work. Sometimes, things do get lost in translation but
it is important to communicate the same messages, particularly when dealing with
very sensitive and personal topics.
Warm-ups and energizers – these are good to get people talking to one another
and get people involved.
Monitoring and Evaluation – prepare tools to gain feedback on the activity/session.
This can help you to determine what worked well, what needs improvement and
suggestions for future activities. See Monitoring and Evaluation section for more
details.
6

Ground rules are basic rules about how the session should run and can help a team
work effectively. They are particular important in sessions discussing very personal
and sensitive information. Ground rules need to be owned by the group and can be
revised at any time. They can be used as a reminder to the group if people start to
break them.
Session Outline
Objective: At the end of the session, the participants will be able to understand the
importance of ground rules and agree on a set of rules for future use.
Time Activity
20
minutes
Duration/Timing: 20 Minutes
Ground Rules
Materials/Resources: flip chart paper or white board, white board marker,
pens.
1) Explain to the group what are ground rules and why they are important.
2) Ask group to think of any ground rules.
3) As a group, decide on 5 ground rules that everyone will adhere to for all sessions.
Ensure that everyone understands the rules.
(As a group you can decide on whether there are any punishments for those who
break the rules e.g. not coming back from breaks on time – sing a song, be
responsible for the next ice-breaker etc).
Refer to the rules if people start breaking them.
Possible Ground Rules
No interrupting Being on time Confidentiality
Listen when people are talking
No name-calling or offensive comments about other people in the group
Switching off mobile phones Respect other people’s opinion No smoking
7

Discussing HIV and AIDS can sometimes be a minefield! It can easily becoming
confusing with so many different acronyms and new terminology. When discussing
HIV and AIDS, it is very important to be aware of the language we use. If we do not
take care, it can change people’s perceptions of HIV or reinforce negative
stereotypes.
Session Outline
Objective: At the end of the session, the participants will be able to understand the
importance of using appropriate terminologies related to HIV and AIDS.
Duration/Timing: 45-60 Minutes
Language
Materials/Resources: flip chart paper or white board, post-it notes, or small
pieces of paper, white board marker, pens, hand outs of terminology
Time Activity
5-10 minutes Ice-breaker – encourages participants to relax and be interactive. The
following icebreaker can be used.
Ask participants to stand up. Pick a name (doesn’t have to be a participantscan
use your own) and tell them they have to say the word in the different
manner that you read out (e.g. surprised, angry, shy, happy, excited, nervous,
seductive).
5 minutes Introduce yourself to the group. Explain why we are all here and what the
objective of the session is. Explain that language is very important in our daily
lives, it’s a way to communicate feelings, thoughts, actions. Ask them to think
back to the icebreaker.
\30 minutes 1) Hand out a few post-its/ pieces of paper to each participant along with
pens.
2) Ask participants to think about any words or acronyms that are related to
HIV. Ask them to note down any local terms they know of too.
3) Ask the group to stick their terms on the board or flipchart paper and give
them a few minutes to look at all the other responses.
4) Ask them to group them together.
5) Ask the group if there are any terms they don’t know, ask participants to
explain. Ask participants to explain any local terms. (If you are unsure of
any of the words, explain that you don’t know and will find out).
6) Explain to the group any words or language that is used incorrectly by
people. Using the handout, explain why it is best to avoid this terminology.
8

7) Give each participant a handout.
8) Ask them to think of any other language or terminology that reinforces
negative attitudes and behaviours and corresponding suggestions.
9) To end the session, agree as a group, the language and terminology that
you will use for all future sessions, including any local terminology. Explain
that for prevention work to be successful, using appropriate words and
terminology is critical. Words should be inclusive and not carry value
judgments.
10 minutes Monitoring of the session
(Sources: Ice-breaker “Oh Emanuel!” – PHARE [Prevention of HIV and AIDS in Rwanda
through Education], VSO;
Activity adapted from – Language Policy; HIV and AIDS peer education and life skills training
workshop; Joel Balaquit; VSO China (2007)
9

The following are some of the words/phrases that reinforce negative attitudes and
proposal for a more neutral, positive and empowering expressions.
Summary of terms to avoid when writing and speaking about HIV or AIDS
AVOID USE THIS REASON
1. AIDS sufferers People living Many people living with HIV are healthy and
with HIV or happy. People living with AIDS can have
AIDS
periods of relatively good health. They should
2. AIDS Victim (PLWH/A)
not be portrayed as suffering.
3. HIV/AIDS
Carrier
4. Innocent Victims
5. AIDS Infected
Person
6. AIDS patient
7. Full-blown AIDS
8. AIDS Virus
9. HIV Virus
HIV-positive
people (in
reference to
serostatus)
Patient with
HIV-related
illness or
disease.
The word victim makes people powerless. They
are not victims.
HIV is not like a cough that one can get through
sneezing. One Person Living with HIV was
quoted as saying “HIV carrier makes me feel
as if I’ve got something that could explode
out of my body at anytime as if I carry
something that I could readily hand-over to
someone else. It’s offensive.”
The word “innocent” is sometimes used when
talking about children who are infected. This is
stigmatizing to people living with HIV, because it
implies that they are somehow “guilty”.
Only use the term AIDS when the person you
are referring to actually has an AIDS diagnosis.
A person who is HIV infected does not
necessarily have AIDS. People can be infected
with HIV, but no one can be infected with AIDS,
because it is not a virus or single disease.
Use these terms when referring to a hospital
setting or to the medical care a person is
receiving. Can be used to refer to a person who
has been diagnosed with AIDS. AIDS is a
syndrome of opportunistic infections and
diseases that can develop at the end stage of
the continuum of HIV disease.
HIV There is no “AIDS virus”. The virus causes AIDS
is the Human Immunodeficiency Virus or HIV
The abbreviation “HIV” includes the virus, so
“HIV Virus” is redundant.
10

10. Test for AIDS
11. AIDS testing
12. AIDS blood test
13. Risk of
Contracting
AIDS
14. Risk of AIDS
infection
15. Transmitting
AIDS
16. Risk Groups or
High Risk
Groups
17. Drug Addicts
18. Drug Abusers
HIV antibody
test or HIV test
Risk of HIV
infection
Acquiring HIV
infection
Transmitting
HIV
Risk
behaviors
High Risk
Behaviors
Higher Risk of
HIV Exposure
Injecting Drug
Users or IDUs
19. Prostitute Women in
Prostitution
Sex Worker
Women who
sell sex
Men who sell
sex
People who
sell sex
20. Lesbians Women who
have sex with
women
There is no test for AIDS. Tests can determine
whether antibodies to HIV are present or
whether there is actual evidence of the virus in
the blood or tissue samples.
AIDS is not a single disease. It is a syndrome.
HIV-positive people are at risk of developing
AIDS. No one is at risk of acquiring HIV from
social contact. Only HIV, not AIDS, can be
transmitted from person to person.
In the context of HIV epidemic, it is the
behavior that places one at risk of HIV
infection rather than their affiliation or
membership within a group.
The terms to be avoided can increase stigma
and discrimination. They may also lull people
who don’t identify with groups into a false sense
of security.
High risk group also implies that the risk is
contained within the group, whereas in fact, all
social groups are interrelated.
The term drug addicts and drug abusers are
seen as derogatory and which often result in
alienation rather than creating the trust and
respect required when dealing with those who
inject drugs.
The word prostitute is very degrading for most
women especially those in the developing
countries. It should be noted that there are
“pushing” factors why women are forced into
prostitution. Though it is true that others do
have options but most of them don’t. It is a
problem caused by gender power imbalance
and old-age societal structure.
The term sex worker is intended to be
non-judgmental focusing on the conditions
under which sexual services are sold
Many women who have sex with women do not
identify themselves as lesbians. It is also
inappropriate to label people by virtue of their
11

21. Homosexual
22. Gay Men
23. Plague
24. Scourge
25. Dreaded
26. Monster
27. Enemy
28. Pity
29. Charity
Men who have
sex with Men
(MSM)
sexual orientation.
Appropriate prevention intervention targeted to
this group my not be effective as many men
who have sex with men do not identify
themselves as gay or homosexual.
Epidemic These words contribute to a climate of fear
which has been shown to perpetuate stigma.
This makes it harder to speak openly about the
disease and is a barrier to addressing the
epidemic.
The word plague or scourge is something
helpless while epidemic can be controlled. With
plague people became ill and died rapidly, with
AIDS the body’s immune system can fight the
virus for a long time.
Serious
disease
Solidarity
Respect for
Human Rights
Monster, enemy reinforces negative attitude
while serious disease reinforces positive
attitude like solidarity in fighting the disease.
Empowering words that allow people to live
positively. A Person Living with HIV does not
need pity but respect for their rights as human
being.
(Source: UNESCO Guidelines on language and content in HIV and AIDS related
material, 2006)
12

What does HIV mean?
Human Immunodeficiency Virus
H - Found only in humans.
I - Weakens the immune system.
V - Caused by a virus.
Section 1: What is HIV and AIDS?
What does AIDS mean?
Acquired Immune Deficiency Syndrome
A - Not “caught” like a cold.
I and D - Weakens the immune system.
S – A combination of certain symptoms at the
same time.
HIV is the virus that leads to AIDS. It works by attacking our body’s natural defense,
the immune system, against disease. HIV weakens our immune system making it
harder for us to fight disease and means that we get sick more often and take longer
to recover from illness. Without taking antiretroviral drugs (ARVs), it is likely that we
will get sicker and suffer from more serious illnesses and be diagnosed with AIDS. If
we can access ARVs and treatment well adhered to, we can live a long and healthy
life.
If we are diagnosed with AIDS, it means that our immune system is very weak and we
are sick with an “opportunistic infection” such as tuberculosis or pneumonia. They are
called this because they take advantage of your body being weak and unable to fight
off illness. It is these illnesses that result in death.
What puts us at risk of HIV?
We know how HIV can be transmitted (see basic facts below for more information)
and prevented but information is not enough. When we engage in risky behaviour we
put ourselves at risk. How many of us have crossed the road when the green man is
not flashing? How many of us have not worn a seat belt in a car because we only want
to go around the corner? How many of us smoke? How many of us drink coffee? How
many of us drink alcohol? Or eat junk food?
Even if all these activities put us at risk of illness and sometimes death, we all at one
time or another will take that risk. We know that we should wear a seatbelt in car but
we think to ourselves, “Oh it’s just this one time, I’m not traveling far.” When we make
a similar decision related to our sexual health, it puts us at risk of HIV. This is one of
the reasons why it can be difficult to prevent the spread of HIV, especially in
communities where to talk about sexual health and/or drug use is taboo. In
mainstreaming HIV, we hope to encourage discussion about these issues but also
about why we make the decisions we do. VSO believes that being equipped with the
right knowledge, attitude and skills can make a difference in preventing the spread of
HIV
13

Basic Facts - FAQs
How can HIV be transmitted?
HIV can only be transmitted through the exchange of vaginal secretions, semen,
blood and blood products from a person living with HIV to a non-infected person. One
partner must already be living with HIV for the virus to be transmitted. This person
may not necessarily be aware of their status.
The main modes of transmission:
Having unprotected vaginal or anal sex with
a person living with HIV.
To a child through pregnancy, birth or through
breast milk to a child when the mother is
living with HIV.
Sharing needles or syringes with a person living
with HIV.
Receiving a blood transfusion from a person
living with HIV.
14

How HIV cannot be transmitted?
How can I protect myself from HIV?
Hugging
Shaking
Hands
Sharing
chopsticks
Kissing
From a
toilet seat
Mosquito
bite
The main ways to protect yourself are to reduce your risk to HIV transmission. It
means looking carefully at your lifestyle and eliminating or reducing any risky
behaviour that can make you vulnerable to HIV. It also means having an HIV test to
determine your status. Here are some of the ways:
Safer sex This includes:
a) Using condoms correctly and consistently.
b) Reducing the number of sexual partners. Fewer partners = less exposure to
transmission.
c) Changing the type of sex you engage in = non-penetrative sex.
d) Abstaining from sex.
e) Being tested and treated for sexually transmitted diseases (STDs).
Harm Reduction:
a) Not sharing needles.
b) Being aware of how to dispose of needles correctly and obtain clean needles.
Being aware of the basic facts of HIV.
15

What does a HIV test involve?
Different countries use different test procedures, depending on the safety of the blood
collection system, laboratory facilities of, including human technical expertise and
logistical capacity i.e. equipment, transport, climate etc
1) Standard test - A sample of your blood is taken and sent to the lab to test for
antibodies. The results can take up to a week. You are normally asked to come in
again after three months for a repeat test for confirmation due to the
“window-period” if your test is negative (see below).
2) Rapid test
Also tests for antibodies. This is commonly used in countries where there are limited
laboratory facilities or highly trained staff. The results take approximately 30 minutes.
A positive result usually needs confirmation by more complex blood test usually
Western Blot.
3) Oral testing – used in countries where it may be unsafe to draw blood. A sample of
oral fluid is taken. Saliva in the mouth does dilute the antibodies that are present so
the tests must be able to detect weaker concentrations. The tests are found to be
accurate and anyone who tests positive must return for a confirmatory test.
For more information about different testing procedures, visit www.avert.org.uk
For VSO International Volunteers, see Annex 1 for the testing procedure or refer to
the VSO China HIV and AIDS Workplace policy you received during In-Country
Training.
What is the “window period”?
Once you feel that you have possibly been exposed to HIV and take a test, you are
normally asked to re-test after three months. This is because if you test negative it
does not necessarily mean that you have not been infected with HIV. It can take up to
three months for your body to start producing the antibodies that the test detects.
Therefore the period between the initial test and confirmation test is called the window
period.
Why is pre and post test counseling needed?
Pre and post test counseling is essential to the testing process to explain the
procedure, its results and the effects the results on our lives.
Pre-test counseling involves explaining the test, how it is done, its reliability, what the
different results may mean, and what further steps may be required following the
16

esults.
Post-test counseling is to provide necessary support according to the result. If positive,
the counselor will explain what the next step should be, the treatment available, and
existence of support groups, what this may mean for the person. If negative, there will
be a discussion on safer behaviour practices and about returning after the window
period for re-test.
What is Anti-Retroviral Therapy?
Anti-retroviral medication (ARVs) is a combination of drugs used to reduce the volume
of the virus in the body (the viral load) to the lowest possible level as quickly as
possible and for as long as possible. There are lots of different types of anti-retroviral
drugs in order to minimise the possibility of opportunistic infections and the
development of AIDS. There are several types of anti-retroviral drugs which all act
differently. Some work to stop the virus from attaching to a host cell, others to prevent
it from replicating itself. This is why most HIV patients receive a “cocktail” of drugs;
this is called combination therapy.
What is drug resistance?
HIV is a virus that replicates quickly once in the body but it doesn’t always reproduce
perfect copies of itself – this is called mutation. This is what makes it difficult to find a
vaccine for HIV. This mutation also causes drug resistance. The drugs cannot stop the
mutant strains from replicating so while it stops others, the mutant strain continues to
reproduce and becomes the dominant form.
What are first and second line therapy?
The first combination of drugs the patient receives is called first line therapy. If HIV
becomes resistant to this line of drugs or the side effects are very bad then the patient
will receive a new combination of drugs; this is called second line therapy.
China’s 4 free 1 care policy (see HIV in China section for more information) only
covers first line drugs. In areas where treatment has started early up to 40% of
patients are showing drug resistance, thereby needing second line therapy. However,
the Chinese Government is working to provide more second line therapy drugs as
part of its 4 free 1 care policy.
What is PEP?
Post-Exposure Prophylaxis (PEP) is a combination of ARVs given to reduce the risk of
HIV infection after exposure. It is only given after an initial risk assessment which
decides that you had significant exposure. It is ideal to take PEP within the first 24
hours after exposure. After 72 hours, the drugs are no longer effective. The course of
17

drugs lasts a month. Some people do not complete the course.
What is “positive living”?
Think about what we need as people to live healthy, happy lives. The same is vital for
a person living with HIV. Nutrition, rest, shelter, people to support you, people who will
help care for you when you are ill, no stress, financial support. You can lead long,
productive and health life if you have these things. Adherence to therapy is just as
important. You cannot stop and start treatment; it must be consistent for the ARVs to
work and to prevent resistance.
18

.
Time Activity
Activity 1.1: HIV and AIDS Quiz
Section 1: What is HIV and AIDS?
Activity Outline
Objective: At the end of the activity, the participants will know basic facts about HIV and
AIDS.
Duration/Timing: 45 minutes
Materials/Resources: copies of the quiz and answers (Annex 2a and 2b),
pens copies of the red bilingual HIV and AIDS Q&A booklet, list of websites
(Annex 3).
35-40 minutes 1. Explain the aim of the activity.
2. Hand–out copies of the quiz to each participant.
3. Go through any terms of words that they are not familiar with. Ask other
participants to explain the meanings.
4. Ask participants to complete the quiz. They may work in pairs.
5. Go through the answers using the answer sheet. Be sure that the group
is clear on methods of transmission.
5 minutes Hand out copies of the red bilingual HIV and AIDS Q&A booklet. This has
more information for people to read in their own time. Also distribute the list of
websites for people to acquire more information.
19

.
Time Activity
Activity 1.2: Risk Continuum
Section 1: What is HIV and AIDS?
Activity Outline
Objective: At the end of the activity, the participants know modes of HIV transmission.
Duration/Timing: 35 minutes
Materials/Resources: Annex 4 PowerPoint presentation or pictures depicting
activities, 3 signs with high-risk, low-risk and no-risk. (You can also use the
information below to make your own PPT).
5 minutes Split the group into 3 smaller groups and give each group a sign (high risk,
low risk, no risk).
30 minutes 1. Introduce activity. When you show each picture, give groups a minute to
decide whether the activity is high risk, low risk or no risk of transmission.
2. Call time. Ask groups to shout out the answer. If there are two answers
being given, ask participants to explain. Correct any myths or incorrect
information.
3. Explain to the group that behaviour change is very complex. It is not just
about eliminating risk but reducing risk too. For example, reducing the
number of sexual partners you have. If you have multiple concurrent
partners, you are at greater risk of contracting a sexually transmitted
disease, which puts you at risk of HIV infection.
20

Sexual Activities and HIV risk
No risk of HIV Low risk of HIV High risk of HIV
Description:
These are sexual
activities with no risk of
HIV transmission
because the activities do
not involve semen,
vaginal fluid and blood
in any way.
Examples include:
Massage
Hugging
Masturbating yourself
Body-to-body rubbing
(not involving the
genitals)
Talking sexy
Sexy dancing
Sharing sexual
fantasies
Body kissing
Washing together
Using sex toys without
sharing them
Description:
These are sexual
activities which involve
semen, vaginal fluids or
blood but people take
care to prevent any of
these fluids from getting
onto the thin, wet or
broken skin of another
person.
These activities not
100% risk free because
condoms can break,
there may be breaks in
the skin and people may
not manage to
completely avoid getting
fluid onto the genitals.
Examples include:
Masturbating each
other (cover cuts on
hands and wash after
playing before you
touch your own
genitals).
Open mouth kissing
(do not do this if either
of you have bleeding
gums and or sores in
the mouth).
Vaginal intercourse
with a condom.
Anal intercourse with
a condom and
water-based lubricant.
Oral sex is kissing or
licking each other’s
genitals. The risk is
greater for the person
doing this; especially if
Description:
These are sexual
activities where semen,
vaginal fluids or blood
from one person go onto
the thin, wet skin in the
vagina, penis, anus or
broken skin of another
person.
Examples include:
Any contact between
blood, semen or
vaginal fluid and the
thin wet skin of the
genitals or anus or
breaks in the skin on
the body or mouth.
Vaginal intercourse
without using a
condom.
21

they have mouth sores
or either has untreated
STIs. These are also
easily transmitted
through oral sex. Using a
condom or piece of
plastic over the vulva,
and avoiding ejaculation
of semen into the mouth
reduces the risk of HIV.
(Source: “Feel! Think! Act! A guide to interactive drama for sexual and reproductive
health”, International HIV/AIDS Alliance, 2008)
22

.
Time Activity
Section 1: What is HIV and AIDS?
Activity 1.3: What is HIV and AIDS?
Activity Outline
Objective: At the end of the activity, the participants will have a basic knowledge of HIV and
AIDS.
.
Duration/Timing: 45 minutes
Materials/Resources: Annex 5 PowerPoint presentation, flip-chart paper,
pens, list of websites (Annex 3), and local CDC information.
5 minutes Introduce the topic. Let the group know that this is an introductory session.
10 minutes 1. Form smaller groups of the participants.
10 minutes
2. Ask the smaller groups to discuss what they know about HIV and AIDS.
Ask them to write it down on the flip-chart paper. They can use diagrams,
pictures and illustrations.
3. Ask the groups to put their papers in the middle of the floor, forming a
circle. Ask participants to form an outer circle. Give them 10 minutes to
look at all the papers.
10 minutes 4. Discuss the papers with participants. Ask what they found interesting,
something they didn’t understand. Correct any inaccurate information. Go
through PPT, explaining terminology and give information about HIV and
AIDS in China.
10 minutes 5. Ask them to then look at the PPT of different people. Ask them which
person they think has HIV or AIDS? Give them time to explain why they
think someone does or does not have HIV or AIDS. Explain that you
cannot see HIV or AIDS from the outside. Only a blood test can tell if you
have HIV.
5 minutes 6. Conclude the activity by stating that everyone is at risk of HIV. We must
all be informed and be aware of our behaviour. Show the last PPT or pass
around list of websites or local CDC details where they can get more
information.
(Source: Leandra Lok, Education Adviser, VSO China Volunteer, 2008)
23

.
Time Activity
10 minutes Warm-up activity.
Section 1: What is HIV and AIDS?
Activity 1.4: Immune System Game
Activity Outline
Objective: At the end of the activity, the participants understand the basic biology terms of
HIV and the immune system.
Duration/Timing: 40 minutes
Materials/Resources: Labels with the names:
HIV, ANTIBODIES, ARVs, PNEUMONIA, MALARIA, TUBERCULOSIS.
Note: Ensure that people don’t hurt themselves in this game. People can
sometimes get a bit too excited!
30 minutes 1. Stand all the participants in a circle, holding hands or linking arms. Say
that this circle represents the body.
2. Ask for a volunteer to stand in the middle. This person is given the label
ANTIBODIES. Ask them to look as strong and lively as possible.
Describe how the antibodies are the soldiers of the body’s defense
system (the immune system). If an illness attacks, it is the antibodies that
fight them away. The body creates new ones to attack different illnesses.
3. Ask for three more volunteers to stand outside the circle. Give each of
them a label, PNEUMONIA, MALARIA, and TUBERCULOSIS. In turn
ask them to break past the linked arms or hands around the circle to get
into the body. At this point state that the body now has
malaria/pneumonia etc. Then ask ANTIBODIES to remove them from the
body by pushing them back through the circle. Say that the defense
system has worked hard to get rid of the attacking forces.
4. Then ask for another volunteer to leave the circle. Give them the label
HIV. Ask HIV to break through the circle and into the body. Ask
ANTIBODIES to try to push HIV out of the system, but tell HIV to stand
strong and not let him be pushed out.
5. State that the body now has HIV but that a test would show negative for
up to three months. This is because the test does not look for the virus
24

ut it looks for signs that the body is fighting HIV. The body creates new
antibodies between 2 and 12 weeks after being infected to try to fight off
HIV and these are the signs that the body creates.
6. Explain that even though the test could be negative, this person is HIV
positive and is capable of passing on the virus. These three months are
called the ‘window period’. If a result is negative, people are advised to
avoid risky behaviour and to take another test after another three months
to see if the result changes.
7. Say that it is impossible for ANTIBODIES to get rid of HIV once it is in the
system. HIV remains in bodily fluid, which are the liquids found in the
body. These are blood, semen, saliva, breast milk and vaginal fluid.
8. Ask for one of the illnesses to re-enter the body. ANTIBODIES must try to
push it back out of the circle. This is more difficult but it is still possible.
Allow another illness to come into the circle and be pushed back out. Say
that ANTIBODIES is very tired now...
9. Say that the body can remain healthy for more than 12 years but the body
is still more likely to get illnesses. Ask MALARIA to re-enter the system.
Ask ANTIBODIES to try to fight him off. ANTIBODIES is tired and
MALARIA does not leave the system. Then ask TUBERCULOSIS to
re-enter the circle too. ANTIBODIES cannot fight both off. Ask
PNEUMONIA to re-enter the system too.
10. State that now the body has AIDS. AIDS is a syndrome or a collection of
illnesses which the body cannot break down. They can be different in
each person. These illnesses are called ‘opportunistic infections’ because
they enter the body when the immune system has been weakened by
HIV.
11. Ask if anyone knows what the body could do to become stronger.
12. Explain that the body can eat good food (fruit, vegetables) to strengthen
the immune system. Say that the body needs to do exercise (ask the
circle to walk around once to re-energize) and also needs to take lots of
rest. Say that the body needs to have lots of friends around (ask each
person in the body to say hi to the people on either side of them).
13. Say that there is no cure for HIV but that drugs called ARVs can help
strengthen the immune system. Ask for another volunteer to leave the
circle. Give them the label ARVs.
14. Ask ARVs to enter the body and give Antibodies a high five to re-energize
him...
15. Say that ARVs work by lowering the amount of HIV in the body and
increasing the number of antibodies. Say also that if you start to take
ARVs you must take them for the rest of your life. If you stop taking ARVs
it is extremely bad for the body. Ask ARVs to leave the body.
16. Explain that HIV is even more powerful now and will cause a lot of
damage to the body.
17. Ask what they think would happen if the body was re-exposed to HIV
25

again.
18. Say that a virus changes inside the body of every individual. This means
that if you re-infect yourself you have different mutations of the virus
which is very harmful for the body.
19. Ask PNEUMONIA, MALARIA, and TUBERCULOSIS to enter. Explain
that the ANTIBODIES are tired. HIV is still in the circle but with no ARVs
to help, it cannot fight anymore. Ask the outer circle, the immune system,
to sit down. This means that the immune system has broken down.
Explain that the ANTIBODIES can only fight with help, that HIV is more
powerful. When it cannot fight disease any more, opportunities infections
– like TUBERCULOSIS, MALARIA and PNEUMONIA, take over the
disease. This results in AIDS and causes death.
20. De-role and ask participants if they have understood. Ensure they
understand the difference between HIV and AIDS.
[Source: PHARE -Prevention of HIV and AIDS in Rwanda through Education; VSO Rwanda]
26

.
Time Activity
Activity 1.5: True or False?
Section 1: What is HIV and AIDS?
Activity Outline
Objective: At the end of the activity, the participants understand the true facts about HIV
and have dispelled any myths.
Duration/Timing: 40 minutes
Materials/Resources: True and False labels, cello tape (scotch tape),
statements.
Before the session begins, tape the two labels (True, False) on opposite ends
of the room. Ensure there is plenty of room for people to move around and
there are no obstacles in the middle.
40 minutes 1. Introduce the activity. Explain to participants this is an opinion continuum.
You will read out a statement and they have to move according to whether
they think it is true or false. If they are not sure, they can remain in the
middle. If they are 80% sure it is true, they can move closer to the true
sign but not under it.
2. After each statement, ask a few participants to explain why they moved to
where they are.
3. After participants have given their view, give them the correct information.
4. At the end of the statements, ask if there are any other questions the
group has. Explain that there are lots of myths around HIV. This is due to
stigma and discrimination and inaccurate information. Emphasise it is all
our responsibility to be informed about the true facts about HIV to better
protect ourselves.
27

True Statements
1. There are over 700,000 people living in China with HIV.
2. There is no cure for AIDS.
3. Everyone is at risk of HIV, at any time of their lives.
4. The only way to know if you are HIV positive is to have a blood test.
5. You can live for a long time with HIV if you take ARVs.
False Statements
1. AIDS is not an issue in China.
2. AIDS only affects foreigners.
3. You only get HIV/AIDS if you are living in Africa
4. HIV can be passed through sneezing or coughing.
5. You can look at a person and know that he/she has HIV.
Background for True Statements
1. This statistic comes from the UNAIDS China website (www.unaids.org.cn). Check
recent statistics when you are doing the session.
2. Although there is a lot of research and development into finding a vaccine, there is
currently no cure for AIDS. ARVs work to reduce the volume of HIV in the body,
but do not kill the virus.
3. HIV does not discriminate. Age does not prevent its transmission. The most at risk
populations are ages 15-49. Engaging in risky behaviour at any stage of your life
puts you at risk of HIV.
4. There is no way you can look at someone and know they have HIV. People can
live with HIV without any symptoms for up to 10 years. The only way to know you
have HIV is to get a blood test.
5. If people adhere to treatment, they can live long healthy lives. With ARVs, a
nutritious diet and support from family and friends, people can live “normal” lives.
However, there is always the risk of the drugs no longer working (drug resistance).
Background for False Statements.
1. Although the prevalence rate in China is low (less than 1%), if prevention, care
and treatment is not in place, HIV and AIDS can become more of an issue. A few
years ago, UNAIDS estimated that by 2010 up to 10 million people would be
affected by HIV in China. There are programmes for prevention and treatment in
place but there are also gaps. The potential for a larger scale epidemic is always
there. AIDS is an issue in China. Every province is affected and it is the
responsibility of every individual to informed and aware of HIV.
2. This is a common myth in China. When the first cases of HIV were diagnosed, it
was mostly among foreigners and overseas Chinese. This image of HIV has
stayed. Stigma and discrimination also have a role to play here. People who are
not informed about HIV often think that HIV is something that affects other people.
3. Sub-Saharan Africa has been the hardest hit region in the world. It is a common
misconception that HIV and AIDS only affects Africa, especially with media
28

portrayals. However, HIV and AIDS affects every country, in its own unique way.
HIV is an issue in China too.
4. HIV is not an air-borne disease. It cannot survive very long outside the body. HIV
can only be transmitted through bodily fluids, semen, vaginal secretions and
blood.
5. There is no way of looking at a person and knowing they have HIV. Only a blood
test can determine who is HIV positive and who is not.
29

.
Time Activity
Section 1: What is HIV and AIDS?
Activity 1.6: The Infection Game
Activity Outline
Objective: At the end of the activity, the participants will understand how quickly HIV can
spread.
Duration/Timing: 60 minutes
Materials/Resources: post-it notes, pens, flipchart paper.
Before the session, prepare enough cards to make sure that every student
can have one, and makes a mark “” on the back of one card and “Ω” on the
backs of the other four cards.
60 minutes 1. Distribute the cards to the participants, trying not to let them notice the
marks.
2. Ask each participant to find two other people to sign their names on
his/her card. They must also sign their name for two other participants.
3. Bring the group back together. Then ask the one with mark ““ to stand
up. Explain that this means that s/he has been infected with HIV, but is
not aware of it.
4. Ask the person to point out the two who signed their names for him/her
and the two s/he signed his name for, and ask the four participants to
stand up. Explain that suppose the four have been infected with HIV
through unsafe behavior and stress that the infection of HIV is hidden,
both parties are infected without knowing.
5. Then ask those who had a relationship (either signed their names, or had
them their cards signed by those standing). This means that they too
have been infected.
6. Repeat the last step again until all participants have stood up, which
means that everyone has had a chance of being infected with HIV, given
that they were ignorant during the process of signing their names. Explain
that signing names represents unsafe behavior, such as unprotected sex,
sharing a needle for drugs or illegal blood transfusion.
7. Ask everyone to sit down
30

8. Ask participants with mark “Ω“ to stand up. Explain that this means that
the four had taken protection measures (such as using condom), so they
haven’t been infected with HIV. Although they have had contact with
those infected with HIV, their preventive measures protected them.
9. Ask those who have had contact with the four students to stand up,
explain they are infected because they didn’t take any preventive
measure.
10. Ask participants how they felt being during the stages of the game.
Summary – explain that HIV can spread quickly when people are unaware of
their status and do not take precautions. This is why having accurate
knowledge of HIV is important, so all people can protect themselves.
(Source: International Labour Organisation China, 2008)
31

Section 2: HIV in China
“China’s seemingly low national prevalence data also gives no hint of the
dynamic character and geographic reach of its epidemic, which has spread to
all 31 provinces and is still gaining momentum. New infections have increased
75% in two years and the 840,000 people now estimated to be living with HIV or
AIDS is one-third higher than in 2001. If the epidemic increases at a rate of 20%
to 30% a year and no measures are taken, we estimate that by 2010 there will be
ten million HIV infections.”
Wang Longde, China’s Vice Minister of Health in charge of HIV/AIDS.
“Act Now – AsiaPacific leaders respond to HIV” UNAIDS (2005)
The Quick Facts:
There are approximately 700,000 people known to be living with HIV in China
(UNAIDS, 2007).
Sexual transmission is the main mode.
Women account for 30% of all new infections.
History of the HIV epidemic in China
The timeline on page 18 shows how in just over 10 years, the spread of HIV in China
has been rapid and extensive. To better understand the causes of the spread of HIV
and AIDS, it is useful to look at the geographic spread of HIV infections. See the map
below.
(Source: China AIDS info, 2009)
32

The map above shows two provinces that have the most number of infections.
Henan Province – in the 1990s, many impoverished farmers sold their blood to illegal
blood stations in order to supplement their incomes. In order for the donors to recover
quickly from the blood loss, plasma that had been pooled together was re-injected into
the donor. This plasma was not tested for HIV. This has resulted in more than 10,000
cases of HIV and AIDS in 2003 (UNICEF, 2005).
The Government responded by shutting down all the illegal blood stations as well as
providing support to those affected including:
- waiving school fees for children affected by HIV and AIDS
- free screening test and confirmation test for anyone who wants to be tested for
HIV
- all clinics, hospitals and health workers are required to use disposable needles
and syringes for all injections
- road construction in villages affected by HIV and AIDS to help stimulate local
economy
- provision of water to every household to maintain good sanitary conditions, and
make agricultural work easier for HIV and AIDS affected families
- free flour and low-cost supplies for families in especially difficult economic
circumstances
- and exemption from a variety of local taxes for people living with HIV and AIDS
and their family members
(Source: UNICEF, 2005)
Yunnan Province – this south-western province borders Vietnam, Laos and Burma. It
is part of what is known as the “Golden Drug Triangle” with links to nearby Thailand.
Because of its location, drug smuggling within the region is widespread. This has led
to an increase in injecting drug use. With increasing unsafe drug use through sharing
of needles the number of HIV infections has also grown.
Other most-at-risk populations (MARPs) include commercial sex workers and migrant
workers. The rate of infections amongst commercial sex workers has also risen due to
lack of access to information and services. According to a Beijing municipal report in
November 2008, only 4.5% of female sex workers used condoms with their clients
(TIME, 2009).
A rising and highly mobile population of rural migrant workers are also increasingly
vulnerable to HIV. Being away from home and lacking the normal social support
structure needed, migrant workers are vulnerable to risky behaviour including drug
use and unsafe sex. With an estimated 135 million internal migrant workers
(Shi, 2008), many of whom are illiterate, speak only local dialects and have no
knowledge of SRH makes it very difficult for healthcare workers to monitor and treat
33

those who are HIV positive (Gill et al, 2002). Therefore, many are unaware of their
status and transmit infections to their partners back at home resulting in the spread of
HIV into the general population.
The graph below shows how the modes of transmission have changed over the years.
(Source☺)
(Source☺ - WL – PPT for HIV ICT)
(Source: UNGASS Country Progress Report, 2007)
Like many countries, China’s HIV epidemic has evolved. The most-at-risk populations
(commercial sex workers, injecting drug users) are still at increasing risk but as
heterosexual transmission has increased, it shows that the epidemic has moved in the
general population.
Risky behaviour
So what is driving the epidemic?
Lack of care and treatment,
especially in rural areas
Can you think of anymore factors?
FACTORS
DRIVING THE
HIV EPIDEMIC IN
CHINA
Stigma and
Discrimination
Lack of information
and awareness
34

Government Response
“HIV/AIDS is a major issue pertinent to the overall quality of the
Chinese people and the country’s prosperity. Starting with
education and focusing on prevention, we must contain the
proliferation of HIV/AIDS.”
Chinese President Hu Jintao
The Chinese government has increased its support over the last few years, notable
seen through its commitment to support families affected by HIV through the “4 Frees
1 Care policy”
In badly affected provinces such as Yunnan, local policies and procedures have been
set up to tackle the epidemic.
China 4 Frees 1 Care Policy
1. Free anti-HIV drugs to AIDS patients who are rural
residents or people with financial difficulties living in
urban areas.
2. Free voluntary counselling and testing.
3. Free drugs to HIV infected pregnant women to
prevent mother-to-child transmission and HIV testing of
newborn babies.
4. Free schooling for children orphaned by AIDS; and
Care and economic assistance to the households of
people living with HIV and AIDS.
35

Other initiatives have included:
Increasing the number of voluntary counselling and testing sites (VCT).
Harm Reduction for injecting drug users
Developing safer practices of blood donation.
Awareness and prevention campaigns.
However, there are still challenges.
1. Prevention – awareness about HIV is still very low.
2. Stigma and discrimination against people living with HIV is widespread. In
a recent knowledge, attitudes, behaviour and practices survey undertaken in
6 Chinese cities. 65% of respondents would be unwilling to live with a People
Living With HIV and AIDS (PLWHA) and 48% would not eat with a PLWHA.
(CHAMP and Partners, 2008)
3. Quality voluntary counselling and testing (VCT) – lack of qualified people
for people pre and post test counselling, especially in rural areas.
4. Confidentiality – this cannot yet be guaranteed. Without confidentiality,
people are hesitant to come forward for testing. Anonymous testing where
people provide false names is common but it is hard to follow-up especially
with people who have tested positive.
5. Access to ARV drugs and treatment – in rural areas, people have to travel
to the provincial or prefecture capital to access treatment. This can be costly
and time-consuming.
6. Lack of co-ordination of prevention and treatment work, such as with
harm reduction. It is reported that only 7% of people who inject drugs have
access to needle and syringe programme services in areas where they exist.’
(International Harm Reduction Association, 2008)
7. Lack of wider involvement from society.
36

INITIAL PHASE
(1985-1988)
Only a small number of cases
found in coastal cities amongst
overseas Chinese and foreigners.
THE SECOND PHASE
(1989-1994)
148 people diagnosed with HIV
amongst in SW Yunnan. Mostly
among Injecting Drug Users (IDUs),
sex workers and people with
sexually transmitted diseases
(Source: VSO China HIV and AIDS Workplace Policy, 2008)
Timeline of China’s HIV epidemic
THE STAGE OF INCREASE
(1994 – late 1995)
Increased number of HIV infections
amongst IDUs, commercial plasma
donors, people with STDs and migrant
workers.
THE STAGE OF RAPID
INCREASE
(1996-2003)
HIV is found in all 31 provinces.
2007 (last reported data)
New infections: estimated
40,000-60,000.
People dying of AIDS:
estimated between
15,00-25,000.
Move from most-at-risk
populations to the general
population.
37

‘The real wealth of a nation is its people. And the purpose of development
is to create an enabling environment for people to enjoy long, healthy and
creative lives. This simple but powerful truth is too often forgotten in the
pursuit of material and financial wealth.’
(quoted in UNDP, Human Development Report in 1999)
Human Development Index
In 1990, the introduction of the Human Development Index (HDI) showed that the
international community had begun to understand that poverty is more than just financial
deprivation. HDI looks at a broader definition of well-being and is measured by three
things:
1. Living a long and healthy life (measured by life expectancy.
2. Being educated (measured by adult literacy and enrolment at the primary, secondary
and tertiary level).
3. Having a decent standard of living (measured by purchasing power parity, PPP,
income).
Although HDI does not reflect other inequalities such as gender, it is a useful measure for
governments and organisations to use because it takes into account the complex
relationship between income and well-being.
Millennium Development Goals
In September 2000, 189 nations signed up to the United Nations Millennium Declaration.
As part of this Declaration, countries decided on 8 Millennium Development Goals (MDGs)
to be achieved by 2015 that respond to the world's main development challenges.
The 8 goals are:
Section 3: Why is HIV a development issue?
38

The MDGs are significant because they bring together all the commitments made by
countries over the last few years in one single, concise agreement. Most importantly,
“they recognise the interdependence of poverty, growth and sustainable development”
(UNDP, 2009).
China has made great progress towards achieving its MDGs. For example, the number of
people living in absolute poverty has decreased from 85 million in 1990 to 25.1 million by
the end of 2004 (UNDP, 2009). In terms of Goal No 6, although the epidemic is expanding,
the rate is slowing. The Chinese Government have over the last few years worked hard to
raise public awareness of HIV and AIDS. There is great commitment by the Government
to achieve these goals. For more information visit MDGs in China :: United Nations
Development Programme :: China
Possible effects of HIV and AIDS on international development targets
Development goal Effect of HIV and AIDS Global and national impact
Reduction by one-half of AIDS increases poverty especially Will slow global progress, some
proportion of people living in at the household level, and has national impact but main impact
extreme poverty by 2015 serious impact on human capital at community/ household level.
Goal hard to achieve
Universal primary education in Impact on supply of education Worst affected countries will see
all countries by 2015
through teacher deaths and declining enrolment especially
resources, on demand side among most vulnerable groups.
through uptake especially of Goal harder to achieve in some
female volunteers
countries
Demonstrated progress towards Girl children most likely to be kept Disparity will not be reduced
gender equality, women’s out of school to provide care or without targeted intervention.
empowerment by eliminating
disparity in primary and
secondary education by 2005
when resources are limited Goal harder to achieve
Reduction by two-thirds in the Infant and child mortality will The target will not be met and in
mortality rates for infants and continue to increase for the next some countries there will be
children under age five by 2015 decade and possibly longer deterioration over the period
Reduction by three-quarters in
maternal mortality
Access through the primary
health care system to
reproductive health services for
all individuals of appropriate
ages and no later than 2015
Little impact recorded to date No impact recorded
Demand from HIV and AIDS
patients will put pressure on the
public health care system,
additional human and financial
resources required
Will require more resources than
previously envisaged. Goal may
be more difficult to achieve
Implement national strategies Little impact recorded to date, but Not yet known
for sustainable development in may be some – and surprising,
all countries by 2005 to reverse e.g. loss of skills, increased
the loss of environmental demand for wood for cremation or
resources by 2015
land for burial
(Source: HIV & AIDS and Development, Learning from Development: An opening learning pack for
VSO volunteers, A. Butler, 2003)
The impacts of HIV can be felt at different levels ranging from individual level to a national
39

level. In countries with a high prevalence of HIV, the impacts can be felt in a shorter
amount of time. Sub-Saharan Africa is a region that reflects this. The effects of HIV and
AIDS are widespread and devastating. Let us look at Botswana to better understand the
effects.
HDI 1996-2000. Fell 26 places from 71 to 122.
Life-expectancy Projected life-expectancy in 2010 before AIDS – 66 years old.
Projected life-expectancy in 2010 with AIDS – 36 years old.
Household impact Coming decade 50% of households will have at least one
member living with HIV.
1/4 of all households will lose at least one income earner.
2% of all households will lose all breadwinners causing the
number of households living in poverty to rapidly increase.
National Productivity Direct and indirect costs (e.g. medical costs, lost productivity) to
account for 4.9% of the country’s wage bill between 1996-2004.
Within 25 years the country’s economy will be 31% smaller
than it would have been in the absence of AIDS.
It is projected that over the next decade HIV/AIDS will result in
a cumulative budget deficit of 2% annually; reduce
government revenue by 7%; and cause expenditures to rise
Gross Domestic
Product (GDP)
by 15%.
Reduce by 1.5%
Health Sector Health expenditures will increase dramatically. Total recurrent
health spending is projected to rise by 5 to 19%.
In 2000 approximately 60% of hospital beds were occupied by
people with HIV/AIDS.
Between 1989 and 1996, the TB [tuberculosis] case rate
increased by 120%, primarily because of HIV/AIDS.
Higher rates of infant mortality due to AIDS.
Education Sector Demand for schooling affected as fewer children attend
because they are needed for labour and caring duties at home.
Death of teachers further reduces supply of schooling. Each
year Botswana loses 2-5% of its teachers to AIDS.
(Source: The Body, 2001)
The above list is just an example of some of the effects that HIV and AIDS can have on a
country. HIV is not just a health issue but one of the biggest social issues to affect the
world today. Experiences from the worst-affected areas in Africa and Asia have prompted
many governments worldwide, including the Chinese Government, to take action now.
40

Scenario
A country is rapidly developing. Its focus is on ensuring that its citizens become
wealthy. Everyone in the country believes that money will equal a better life. The
country invests a lot of money into schooling, infrastructure and technology. There
are job opportunities for everyone in the country. Over the last few years, people
have been leading better lives, they no longer go hungry, they can buy new clothes,
a car, and travel. Life is looking good!
However, the country has not invested in its health system. It is still very expensive
and people have to wait a long time for treatment. In some rural areas, there is no
health care in place at all. As people have got more money, they appear to be
leading healthier lives, but, there is a new disease that seems to be spreading. At
first it was only affecting certain sections of society, people who were involved in
“risky behaviour”. It wasn’t thought about as much then. Doctors and nurses thought
it was the lifestyle of these people that was causing the illness and so wouldn’t be a
problem for the rest of society. Slowly, young people, educated people, people of all
sections of society began to exhibit the same symptoms. Over time, people were
dying. Whole sections of a community were disappearing. Women, men, children –
no-one was safe. Teachers, engineers, construction workers, university students –
all dying.
Now the country is not developing as quickly as it once was. The economy has
slowed down. People are sick. They can no longer work. They sell their car. They
use their savings to pay for rent and healthcare. They are hungry. They are sick.
They are dying.
Development is not only about material wealth, it is about social and mental wellbeing too.
For a country to develop, it needs to invest in all things, most importantly good affordable
and accessible healthcare, including sexual and reproductive healthcare.
No-one is immune to HIV, but living in poverty increases your vulnerability to infection.
Livelihoods, culture, access to information, health services, age, gender all contribute to
your level of vulnerability. For example, a woman living in a rural area who has limited
access to healthcare and sexual and reproductive information is far more vulnerable to
infection than say a professional man living in the city.
HIV disproportionately affects poorer households as well. If one person becomes sick
with HIV, the whole family is affected. This could be through decreased income and
increased medical costs, as well as facing stigma and discrimination.
HIV is not the only cause of poverty but it does exacerbate it. A more holistic approach to
development is needed. You may not be working on a HIV project but your work will
impact the spread of HIV. It is time for all sectors to work together to combat the spread of
HIV.
41

.
Time Activity
Section 3: HIV and Development
Activity 3.1: What is Development I
Activity Outline
Objective: At the end of this activity, participants should be able to understand that
development is a process that encompasses social, economic, political,
environmental, cultural aspects.
Duration/Timing: 90 minutes
Materials/Resources: Annex 6-10 (photos), flipchart paper, pens, cello tape.
You can use photos that you have taken in China or other countries as well as
photos in the appendices in the first part of this activity.
Before this session, the facilitator should be familiar with the basic Millennium
Development Goals (MDGs). See appendix for more information. The
facilitator should put the photos on the wall ready for the session.
5-10 minutes 1. Introduce the session by explaining to participants that we talk about
development all the time but what does this word mean? This session will
explore what we mean by “development”.
10 minutes 2. Divide the group into smaller groups. Ask all participants to spend 10
minutes looking at the images on the walls and choose one image which
best sums up for them what development is. All the photos show aspects
of development – there is no right or wrong answer.
20 minutes 3. After deciding on an image, go back to into your small groups and discuss
your choices. Ask each group to decide on one image they feel defines
development. Ask each group to feedback explaining why.
4. Comment that different groups have chosen different images showing that
development means different things to different people.
15 minutes 5. Ask them to go back into their smaller groups and come up with a
definition of development. Begin with “Development is…”
6. Ask each group to feedback on their definition of development. Comment
on similarities and differences amongst the definitions. Explore the
following ideas:
Development is a process and often a complicated one at that. It involves
42

economic, political, social, environmental and cultural aspects. All
development should be about improvement of human lives and it is
essential to such development that people have the chance to lead long,
healthy lives, have access to knowledge and learning; and both contribute
to, and share in, increases in prosperity. Prosperity is not just increased
GNP or wealth but also about a fair distribution of incomes and about the
actual purchasing power of these incomes. It also means fair access to all
opportunities (health, knowledge, resources) to all groups in society,
women as well as men, and it means a serious effort to eradicate poverty
Development is about change, which is a key element in life at all levels. It
may be positive or negative. Positive change for one group of people can
either have a positive or negative effect for others
Some people associate development to progress but in fact it is a process
from which people lose as well as win. The winners are often people with
access to power and resources
Sustainability, which takes into account the holistic impact of development
activities, their environmental consequences, their capacity to continue in
the longer term, is an important consideration in genuine development.
25 minutes 7. Ask participants if they know of the Millennium Development Goals. Briefly
explain each one. Explain that as discussed today, development
encompasses a range of things, material wealth, physical wellbeing,
spiritual and cultural aspects. The MDGs are all interlinked. You cannot
just concentrate on one aspect. For example, only supporting the goal of
primary education when not considering whether people can eat. The
same is for HIV. Without providing maternal health, food, and education
only then can the MDG to prevent HIV, malaria and other diseases be
achieved.
5 minutes 8. Conclude with VSO’s definition of development: “development as a
complex and continuous process that empowers people and communities
to fight disadvantage, take control of their future and fulfill their potential”.
(Source: The Wider Role of the Volunteer Training Course, VSO)
43

.
Time Activity
Section 3: HIV and Development
Activity 3.2: What is Development II
Activity Outline
Objective: At the end of this activity, participants should be able to understand development
issues globally, nationally and locally.\
Duration/Timing: 40 minutes
Materials/Resources: Whiteboard/flipchart paper, pens, VSO HIV and AIDS
Q&A booklets.
Before the session, create an information table where people can access
information about local issues. It might be worth visiting local NGOs for
leaflets and the CDC for health related information. Include VSO’s HIV and
AIDS Q&A booklet. Make sure the area is in a convenient location which
people can access.
30 minutes 1. Ask the group to discuss what development means to them.
2. Ask the group to discuss what issues they feel prevents or slows
development globally. Note these down on the board or flipchart paper.
3. Now ask the group what issues prevent or slows development nationally.
Again write these on the board. Discuss whether there are any similarities
or differences or why this might be.
4. Finally ask about what issues prevent or slow development locally. Try
and ask them to be as specific as possible. For example if people
mention health or disease ask them what kinds of diseases.
5. Comment on the differences in opinion about different issues. If HIV has
not been mentioned, raise the topic. This can be in conjunction with other
local epidemics e.g. swine flu, T.B. Discuss with the group whether they
think these have an impact on their local community and why.
10 minutes 6. Summary – ask the group to look back at the issues at different levels,
looking at the similarities and differences. Explain that development
issues impact on different levels. Sometimes a local issue spreads and
becomes a national problem quickly. Sometimes even globally. Look at
the recent swine flu epidemic. It becomes a global issue in a very short
space of time because of modern living through migration and
44

international travel. Emphasise that this session is to be aware of the
local issues we face but also to realise that what happens in other
provinces can and already does have an impact on our local
environment.
(Source: Susan Oldham, Education Adviser, VSO China, 2008)
45

.
Time Activity
Activity 3.3: Problem Tree
Section 3: HIV and Development
Activity Outline
Objective: At the end of this activity, participants should be able to understand causes and
consequences of poverty in China.
Duration/Timing: 60-120 minutes
Materials/Resources: flipchart paper, pens, post-it notes, Annex 11 problem
tree diagram.
45-minutes
Note to facilitator: The topic chosen is broad so that it can generate wider
discussion as an introduction to development issues. Use the problem tree
diagram as template.
1. Divide into two smaller groups. Give each group some pens, a flipchart
paper and post-it notes.
2. Assign one group to be the “causes” group and one to be the
“consequences” group.
3. Ask each group to write down as many causes or consequences
(depending on their group) to the problem on a separate post-it note.
4. State the problem - Poverty in China.
5. As you go round the groups, ask them to be as specific as possible and
connect problems using arrows. For example, a cause of poverty in
China could be lack of education. This is a broad cause but it could be
more specific to the local context. For example, not enough schools in
the local area.
40 -50 minutes 6. Bring the group back together and put the two parts together. The
causes are the roots of the tree, the consequences the branches.
7. Ask each group to give feedback on their flipchart, explaining why they
thought certain things were interlinked. After each group, finishes, ask if
there are any points to add that are not yet written down.
8. Ask the group now to look at the local causes and consequences. Is
there anything that they can do?
20 minutes 9. Summary – explain that development issues are interlinked. One effects
another. It can be easy to fall into the “poverty trap”, e.g. without
46

education = limited job opportunities = crime, drug use, further poverty,
social exclusion. Explain that the wider causes and consequences have
an impact locally and that is where we can be most effective. Emphasise
some of the ideas that the group have already come up with that they
can do in their local environment.
47

Section 4: HIV and STDs
Sexual and reproductive health (SRH) is an important part of our overall health. It is
often neglected. With increasing levels of sexually transmitted diseases (STDs), the
need for sexual and reproductive health is paramount. In some countries, due to
cultural gender roles, women are at a huge disadvantage. With the perception that
women should be “innocent” and have little knowledge of sex, they are increasingly at
more risk of STDs and HIV. With little or no SRH education, people are vulnerable to
numerous STDs and also to HIV. The table below shows a list of the most common
STDs. In many countries, rising levels of STDs can be seen as an indicator for
increasing HIV infections. See Appendix 8 for the most common STDs
In most societies, sex and sexuality are rarely discussed openly. They are considered
taboo areas and avoided at all costs. We keep this area of our lives private. However,
for lowering STD and HIV rates, we need to start discussing these matters openly. We
need to create safe environments where people can access information about SRH
freely and confidentially, where people can speak openly about sex and sexuality and
receive the support they need. SRH education needs to begin before people are
sexually active, so that people are can make informed decisions about their sexual
health.
In many countries, including China, schools are the environments in which young
people formally learn about sex and sexual health. In China, the curriculum includes
health education is split between biology and politics lessons, covering topics such as
puberty, sex, peer pressure, drugs, communication and how to develop good morals.
However, there is much embarrassment on the part of teachers and students
discussing sex. The internet, books and friends are a way that many youth learn about
SRH, though it is not always accurate. HIV mainstreaming can support existing health
education initiatives. It should be put into the context of sexual reproductive health
education. It should be part of a wider engagement with youth to discuss health
matters. For other target groups, HIV mainstreaming can again be part of a wider
health initiative offered by companies and organisations.
48

.
Time Activity
Activity 4.1: HIV and STDs
Section 4: HIV and STDs
Activity Outline
Objective: At the end of the activity, the participants are able:
(i) Identify symptoms of 4 major STDs.
(ii) Understand how an STD can increase risk of HIV transmission.
(iii) Understand why it is important to get tested and treated quickly and
know where to go.
Duration/Timing: 2 hours
Materials/Resources: Annex 12 STD information, STD cards with symptoms
and names of the diseases, flipchart, blu tack/cello tape (scotch tape).
Important Notes to Facilitator:
a) Participants should know about different STDs before the session
and are familiar with some of the names. You can distribute copies of
appendix 8 before the session for people to read.
b) As the facilitator, you should be comfortable delivering this session. If
you are unsure of the biology, ask for support from a biology teacher,
doctor or local health professional. It may be easier to conduct some
of this session in Chinese for participants to fully understand the
content.
c) This can be an embarrassing topic for many people. Ensure that you
are aware of this and encourage participants to ask questions if they
have not understood. Creating a safe and open environment is very
important for this activity to be successful.
Before the session prepare the STD name and symptom cards on individual
cards using appendix 8. Photocopy appendix 8 as a handout for participants.
15 minutes Introduce activity. Explain that having an Sexually Transmitted Disease (STD)
can greatly increase your risk to HIV transmission. A genital sore or ulcer as
in Syphilis, Chancroid, or herpes expands the portal of entry. Having a
discharge, as in Gonorrhea or Chlamydia, means that more white blood cells
49

are present. Since white blood cells are hosts for HIV, it means that more
virus can be transmitted or received when the discharge is present. Quick and
proper treatment of STDs and immediate referral of partners can be important
strategies for HIV prevention. Often women do not have apparent symptoms
of sexually transmitted diseases, so check-ups and partner referrals are very
important. But men, too, may occasionally not have symptoms, even of
Gonorrhea; so, it is important that the man seek treatment also if his partner is
infected and avoid blaming partners for infection.
30 minutes STD Game:
1. Tape the names of STDs along the top of the board or in a line on the
floor.
2. Write the common/popular names for the diseases at the bottom of the
cards.
3. Split the group into smaller groups and assign them the name of one
disease.
4. Lay the symptom cards out randomly on the floor.
5. Ask each group to find the symptoms associated with their disease and
line them up in a column underneath the wall/other part of the floor.
6. Once the groups have finished, discuss the cards and correct any
misplaced cards.
30 minutes Lead a discussion on the following questions:
a) Where do people in our community go to get treated for STDs?
b) Which of these places is the best place to get treated? Why?
c) Are people afraid to seek treatment for STDs? Why?
d) Why is it important to get treated early for an STD?
e) Why is it important that your partners get treated?
f) How can we tell someone that they have been exposed to an STD
without blaming them or getting hurt ourselves?
30 minutes Role-play. Split the group into pairs. Give each group one of the two situations
and ask them to role-play.
Situation 1) a male partner informs his female partner that she needs to get
treated for gonorrhea because he is having symptoms of that disease.
Situation 2) a female partner tell her male partner that he needs to get treated
for syphilis because she just learned in her prenatal exam that she has that
disease.
Bring the group back together. Evaluate how the situations went. Were they
realistic? Did they achieve the desired outcome, willingness of the partner to
get tested? Did partners feel blamed? Are there other ways to reveal this
news that would have been more effective at getting the desired outcome?
10-15 minutes Summary – explain that STD’s greatly increase your risk of HIV transmission.
50

Detecting and treating STDs reduces your risk to HIV greatly. Informing
partners is essential to protect them. There are clinics available where you
can have these tests (give information on local testing sites) and get more
information.
(Source: Life Skills Manual, Peace Corps, 2001)
51

“Prejudice springs from ignorance”
Chinese Proverb
(Source: The Pocket Oxford Dictionary and Wikipedia)
We grow up with different prejudices. These prejudices may have been
influenced by family, friends, what we have read, what we have heard and what
we have seen. Everyday, whether consciously or unconsciously we judge people
based on these prejudices.
There is much stigma and discrimination surrounding HIV
and AIDS.
Reasons for stigma include:
Fear of death and disease.
Ignorance – lack of knowledge of HIV and AIDS.
Belief in myths and inaccurate knowledge.
Moral judgments on sex and drug use.
Don’t believe the facts. Information is received but not
internalised.
Section 5: Stigma and Discrimination
Definitions
Prejudice – preconceived opinion or bias can be against or in favour of.
Stigma - a stigma is an attribute, behavior, or reputation which is socially discrediting in a
particular way: it causes an individual to be mentally classified by others in an undesirable,
rejected stereotype rather than in an accepted, normal one.
Discrimination - unfair treatment of a person or group on the basis of prejudice.
Because of the modes of HIV transmission, moral judgments
of people living with HIV are common. The activities
associated with HIV transmission, sex and drug use in
particular are considered taboo and are difficult to discuss,
leading to stereotypes of people living with HIV, e.g. “they are
all prostitutes and drug users.” HIV is then frequently
regarded as “punishment” for engaging in these types of
activities. That is why the language we use when discussing
HIV and AIDS is so important. Language can perpetuate
What’s the difference
between stigma and
discrimination?
Stigma is to do with
attitudes and thoughts.
E.g. “Your skin is so
beautiful and white, not
like your sister’s, hers is
dark and rough”.
Discrimination are the
actions that manifest
because of stigma, e.g.
refusing a person medical
treatment because they
are HIV positive.
52

stigma and incorrect moral judgments. Stigma can be exhibited in a number of
ways such as name-calling and gossip leading to exclusion of not only HIV
positive people, by family and friends of those affected.
In China, there many initiatives to educate people on HIV and AIDS but stigma
and discrimination remains widespread. In a recent knowledge, attitudes and
behaviour survey conducted in 6 cities across China, 31.7% respondents thought
that “people with HIV or AIDS deserved their disease because of their behaviour”
(CHAMP, 2008). In the same survey nearly half of all respondents (48%) would be
“strongly unwilling or unwilling to eat with a person living with HIV and AIDS”.
People living with HIV who reveal their status or whose status has been revealed
frequently experience social exclusion, as do their families. There have been
cases where people have been denied treatment or refused medical care for
illnesses because they are HIV positive; this is often caused by fear.
More efforts are needed to educate people about HIV., to make them see it can
affect us all, not just “other people”. HIV mainstreaming has proven effective in
educating the masses. Taking a multi-sectoral approach to HIV and AIDS
education is needed, so that HIV is no longer just a health issue. All ministries
must be united in preventing the spread of HIV and AIDS. Targeted campaigns are
already in place such as the work of the International Labour Organisation (ILO) in
Beijing, working in conjunction with Ministries of Labour and Social Security to
reach migrant workers (see www.workonaids.org for more information).
Government policy such as the recent 2008 Employment Promotion Law which
states that anyone with an infectious disease has the right to work, helps to reduce
levels of stigma and discrimination.
53

.
Time Activity
Activity 5.1: Occupations
Activity Outline
Objective: To encourage participants to think about different perceptions.
Duration/Timing: 30 minutes
Section 5: Stigma and Discrimination
Materials/Resources: Large open space for participants to walk around.
30 mins 1. Ask participants to walk around the room quietly and calmly.
2. Explain that when you speak they have to pose.
3. Shout “Freeze as a …“followed by an occupation. Participants should
quickly freeze in a pose.
4. Ask participants to stay as they are and have a look around at each
other’s pose. Once they have had a look, ask them to unfreeze if
uncomfortable and explore the reasons for different poses in the room,
talking about different perceptions. Gender may arise as a topic for
discussion. Are certain roles associated with men or women? Why?
5. Repeat steps 1-4 again with different occupations.
(Source: “Feel! Think! Act! A guide to interactive drama for sexual and reproductive health”,
International HIV/AIDS Alliance, 2008)
Possible Occupations
Bus Driver
Police
Farmer
Politician
Teacher
Pop singer
Shop keeper
Use occupations related to your
specific context.
54

.
Time Activity
Section 5: Stigma and Discrimination
Activity 5.2: Stereotype Pictionary
Activity Outline
Objective: To encourage participants to understand stereotypes and how they arise.
Duration/Timing: 30 minutes
Materials/Resources: Flipchart paper and pens. Pieces of paper with different
words. Alternatively you could ask people to act out the words. A small prize for
the winning team.
Before the session, write words on small pieces of paper to give to groups.
Words could include different occupations, nationalities, and countries -
anything that could conjure up stereotypes. Include a person living with HIV
and AIDS.
30 minutes 1. Divide the group into smaller groups.
2. Give each group 1 flipchart paper.
3. Ask one person from each team to collect a piece of paper. They are not
allowed to share this with the rest of their group.
4. They then have one minute to draw or act out this word for their group to
guess. The group can guess as many times as they want in one minute.
5. Call time after one minute. Give the groups who answered correctly, one
point.
6. Ask another person from each group to come up and repeat the process.
7. Tally all the scores and award the prize to the group with the most points.
8. If using flip-charts, bring them together and ask group to look and discuss
any similarities or differences. The group should explore why they drew
or acted out certain things, why we perceive people and places in a
particular way.
9. Conclude that stereotypes are common but they can lead to problems.
Link back to HIV and AIDS and problems of stigma and discrimination
overall.
(Source: VSO P2V (Preparing to Volunteer) training course)
55

.
Time Activity
Section 5: Stigma and Discrimination
Activity 5.3: Discrimination Circle
Activity Outline
Objective: This activity should:
(i) Allow participants to feel what it is to be stigmatised and to stigmatise
others.
(ii) Remind participants that we have all been stigmatised at some point in our
lives and that it is important to support each other.
Duration/Timing: 30 minutes
Materials/Resources: Large open space for people to move around freely.
1. Stand in a circle.
2. Ask people to stand in the middle of the circle if they have ever been
discriminated against because….(e.g. you are short, you are young, you
are from another province, you are a woman etc). The facilitator can also
take part in the game. Tell people they do not have to go in the middle if
they feel uncomfortable, they can just keep quiet.
3. Those in the middle who have felt they have been discriminated against
look around at each other and then shake hands or hug. Remember you
are not alone.
4. Ask people to think individually if they have ever discriminated against
someone for this reason and why. Do not have to share their thoughts
with the rest of the group.
5. Repeat, calling out different ways in which someone might be
discriminated against. Ask participants for their input too. Reassure
people they do not have to go into the middle if they do not want to.
6. Discuss with the group how it feels to be discriminated against. Ask
people how they felt in the game.
7. Ask: “what did people learn from the game?”
(Source: “Feel! Think! Act! A guide to interactive drama for sexual and reproductive health”,
International HIV/AIDS Alliance, 2008)
56

.
Time Activity
10 minutes 1. Ask participants to get into pairs.
2. Ask each person to describe to the other:
a) a time I felt I was discriminated against
b) I how felt when it happened
3. Encourage people to listen to each other carefully.
Section 5: Stigma and Discrimination
Activity 5.4: Discrimination Pairs
Activity Outline
Objective: This activity should:
(i) Allow participants to feel what it is to be stigmatised and to stigmatise
others.
(ii) Remind participants that we have all been stigmatised at some point in our
lives and that it is important to support each other.
Duration/Timing: 60 minutes
Materials/Resources: Whiteboard/Flipchart paper, pens.
10 minutes 4. Bring the group back together and ask people to feedback on their
feelings. Some people may feel uncomfortable sharing, that is ok, they
can listen to others. Ask a member of the group to write these feelings on
the whiteboard/flipchart paper.
5. Talk about how these feelings may affect our behaviour and
decision-making, e.g. sexual activity, drug use.
10 minutes 6. Ask the group to get back into their pairs but this time discuss:
10 minutes
a) a time when I discriminated against another person
b) the reasons why I discriminated against them
7. Bring the group back together and this time discuss the reasons for
discriminating against people. Ask someone to write this on the
whiteboard/flipchart.
8. Discuss how discrimination affects sexual reproductive health and HIV.
Explore reasons why there is discrimination against people living and
affected by HIV.
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10 minutes 9. Ask the group to come up with different ways to reduce stigma and
discrimination. Write these on the board/flipchart paper.
10 minutes 10. Conclude by reminding the group we have all discriminated against
people and been discriminated against. Think about how we felt at that
time and the reasons why. Ask the group to try and implement some of
their ideas for reducing stigma and discrimination to prevent other people
feeling the same way.
(Source: Adapted from the “Feel! Think! Act! A guide to interactive drama for sexual and
reproductive health”, International HIV/AIDS Alliance, 2008)
58

.
Time Activity
Activity 5.5: Different People
Section 5: Stigma and Discrimination
Activity Outline
Objective: At the end of this activity, participants should be able to understand how stigma
affects different people.
Duration/Timing: 70 minutes
Materials/Resources: Flipchart paper, pens.
Before the session, prepare flipchart papers with target groups written at the
top of each one. Target groups can include: people living with HIV and AIDS,
community workers, children, commercial sex workers, intravenous drug
users, women, and men. Lay these flipcharts on the floor or tape on the wall.
20 minutes 1. Spilt into smaller groups. Assign each group a target group.
2. Ask the groups to brainstorm “How does stigma affect your target group?”
and write down thoughts on flipchart. Ask participants to think of
immediate effects such as isolation and depression and secondary and
long-term effects such as loss of job, suicide.
15 minutes
3. After a few minutes, shout “Change!” and ask groups to move onto the
next target group and add any points. Continue until groups have
contributed to all flipcharts.
4. Ask groups to stand by their original flipchart and feedback on main
points. Explore the comments with the wider group, asking for clarification
and commenting on anything unusual.
20 minutes 5. Ask the group: “How does stigma and discrimination affect people
accessing HIV and AIDS services and prevention? Can work in smaller
groups or as a big group to discuss.
15 minutes 6. Summary – stigma and discrimination has many effects that are both
immediate and long-term. In terms of HIV and AIDS, stigma can :
Prevent people learning their HIV status through testing because of
fear.
Discourage people from telling their partners their status which could
59

lead to infecting non-positive partners or re-infecting partners.
Prevent people from accessing services and treatment.
Can link to another exercise on how to reduce stigma. Or close with the
message that we all have a role to play in reducing stigma.
(Source: Understanding and Challenging HIV Stigma: Toolkit for Action, Kidd & Clay,
2003)
60

.
Time Activity
Section 5: Stigma and Discrimination
Activity 5.6: Power and Diversity
Activity Outline
Objective: At the end of this activity, participants should be able to understand the different
members that make up a community and the differences in power and skills
within a community.
Duration/Timing: 30-45 minutes
Materials/Resources: Sticky labels with names of different members of a
community (character labels).
Before the session, write on sticky labels the names of different members of a
community. Can include: a teacher, a doctor, a politician or government
official, a VSO volunteer, a mother, a student, a vegetable seller, a truck
driver, a commercial sex worker, a farmer, a construction worker, etc.
Include context-specific members. Assign one member of the community to
be HIV positive. Don’t stereotype and make it the sex worker or construction
worker.
15 minutes Round One
1. Assign everyone in the group a character.
2. Ask them to stand in a line at the end of the room.
3. Ask them to get into role and think about their character for a few minutes
and the life they lead.
4. Explain that you will read out different statements related to power,
access to resources and opportunities. If they feel their character would
typically be able to carry out the activity or would rise to that particular
responsibility/ opportunity then they should step forward by one (small)
pace. Participants should make intelligent guesses if they don’t know
the answer, remembering the region/country context.
5. Read out 4 or 5 of the power/opportunities statements (see below for
some examples). Include statements that are relative to your context.
Ensure that you include the asterisked ones to draw attention to gender
issues.
6. After each statement, if appropriate query any participant’s decisions
61

asking them to state why they did or did not move forward. E.g. a student
being the first to speak in a meeting.
7. At the end, ensure volunteers remain in their places in the line but get
those at the front to look back at those left behind. Ask them how they
feel about those ‘left behind’; ask the people at the back, how it felt to see
others ‘striding ahead’.
8. Discuss briefly who is most powerful/has most access to resources and
who has least access/power. Who are the people being ‘left behind’ –
are there a disproportionate number of women in that group? If so, why
might this be?
NB if one participant played the role of the volunteer, it may be useful to
analyse their position within the line-up and what that may say about the
power relations they would have and how they might be perceived by
other people.
15 minutes Round 2
1. Explain that you will now call out some other skills and characteristics.
Some examples are listed below. Ensure you include at least 1 from each
column. Again participants will need to make intelligent guesses as to
whether the characters they are ‘playing’ have these skills.
2. At the end, ensure volunteers remain in their places in the line but get
those at the front to look back at those left behind.
3. Discuss how much more those people with less power and access over
resources and opportunities moved in the second part of the activity
compared to the first. Ask participants if this surprised them. Ask them
what they think the key differences between the two lists are i.e. 1 st list
depends on access to education/resources etc, status and power; 2 nd list
are non-formal skills & qualities, either inherent or learnt from family or
through experience.
4. Summarise that all people contribute to a community but unequal power,
resources and access to resources makes it harder for certain members
of a community. Relate how gender, HIV, disability, ethnicity can create
disadvantages because of stigma and discrimination.
10-15 minutes 5. Summarise that all people contribute to a community but unequal power,
resources and access to resources makes it harder for certain members
of a community. Relate how gender, HIV, disability, ethnicity can create
disadvantages because of stigma and discrimination.
[Source: Skills for Working in Development (SKWID) Training Course, VSO]
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Power, Resources, Opportunities Statements
First to speak in a meeting
Are literate
Have received formal education
Free to travel
Control the money you earn*
Have free time*
Own land*
Able to speak your mind
Have access to health services.
Skills and Characteristics
Basic planning
Cooking
Listening
Persuasive power
Negotiation
Informal networking
Writing
Caring for sick relatives
Simple arithmetic
Childcare
Agricultural skills
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.
Time Activity
Activity 5.7: Facing Fears
Section 5: Stigma and Discrimination
Activity Outline
Objective: At the end of this activity, participants should be able to speak openly about their
fears and think of ways to overcome them.
Duration/Timing: 50 minutes
Materials/Resources: Post-it Notes/pieces of paper, pens, bowl to put bits of
paper in, flipchart or white board.
5 minutes 1. Distribute a few post-it notes or small pieces of paper to each participant.
2. Ask them to think 2-3 of their greatest fears about HIV and write them
down.
10 minutes 3. Collect all the pieces of paper and put into a bowl.
4. Divide the group into pairs/small groups.
5. Go round to each person and ask them to pick two pieces of paper each.
6. They should then discuss these fears with the other person/s and think of
ways how this may impact people’s behaviour and attitudes towards
people living with HIV.
10 minutes 7. Come back together in a big group and ask people to feedback on their
discussions to the rest of the group
15 minutes 8. Cluster the main fears and write on the whiteboard or flipchart paper.
10 minutes
9. Ask the group to come up with ways to overcome this fear. Ask them to
write them down on the flipchart or whiteboard.
10. Summary – Reassure participants that we all have fears in our lives,
especially around health and disease. This is natural. But these fears
create stigma and lead to isolation and discrimination of people living with
and affected by HIV and AIDS. Fear can lead to believing incorrect
information and stop us from accessing information and services that we
need. But we can face our fears. Emphasise that today they have thought
of numerous ways to do this and should try and take opportunities to do
this.
(Source: Adapted from “Assessing Fear about HIV and AIDS”, Understanding and
Challenging HIV Stigma: Toolkit for Action, Kidd & Clay, 2003)
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.
Time Activity
Section 5: Stigma and Discrimination
Activity 5.8: We are all in the same boat
Activity Outline
Objective: At the end of this activity, participants recognize that we are all at risk of HIV
infection.
Duration/Timing: 20 minutes
Materials/Resources: Open Space for people to move around freely.
20 minutes 1. Ask participants to stand in a line all facing the same direction.
2. Explain that where they are standing is the bank. When you call out “in
the river” they should take a step forward. But when you call out “on the
river” they should not move. If you say “on the bank” they should take one
step back on the bank. But if you say “in the bank” no-one should move. If
someone makes a mistake then they are eliminated from the game.
3. Start the game. Give commands quickly and ask anyone who has made a
mistake to leave the game. Continue for a few more minutes. Then
debrief.
4. Debrief: Note that everyone laughed when the first person made a
mistake. Ask the person who made the mistake—“How did that make you
feel?” (Embarrassed, angry, stigmatized, the laughter made me feel
bad!). Then explain that this game shows us that “We are all in the same
boat.” There is no separation between “us and them.” We are all facing
and living with this epidemic together. We are all affected—we have all
taken risks at one time in our lives and many of us still do. Lots of people
like to laugh at, blame and judge others, but one day they may also “fall
into the river”— and others will laugh at them. Remember: HIV affects
everyone. All of us are at risk of getting HIV so there is no point in
stigmatizing or blaming those who are already affected. We could join
them any day!
[Source: “We are all in the same boat”, Understanding and Challenging HIV Stigma:
Toolkit for Action, Kidd & Clay, (2003)]
65

.
Time Activity
Section 5: Stigma and Discrimination
Activity 5.9: Judging Characters
Activity Outline
Objective: At the end of this activity, participants can identify the effects of stigma on
different people and institutions.
Duration/Timing: 60 minutes
Materials/Resources: Sticky labels or cards with different characters
(character cards), 3 signs (High risk, low risk, no risk).
Before the session, write or draw characters in the community on pieces of
card or paper. Characters include farmer, nurse, teacher, housewife,
businessman and other members of the local community.
10 minutes Divide groups into pairs. Give each of them a character card. Ask them to
discuss their characters. Ask them to discuss:
a) What they do for a living?
b) Your perceived HIV risk status of this person and why
While the group is discussing lay the 3 signs on the floor.
15 minutes Bring the group back together and ask people to feedback on their character.
Ask them to put their character card under one of the signs.
Ask the rest of the group to make any changes and explain why.
20 minutes 1. Discuss with the group what they learnt from this exercise. Key questions
to ask:
How does the community perceive or judge high-risk people?
What words do they use? What are the attitudes behind the words?
What assumptions do we make about people?
How do we judge/misjudge people? How do we resist judging people?
5-10 minutes 2. Ask participants to spend 5-10 minutes alone and reflect about:
What have you done in your life that is culturally unacceptable?
What judgments could be made against you by others?
How would they make you feel?
5-10 minutes 3. Summary - We are all capable of misjudging people based on their
occupation, dress, age or gender. We make assumptions about
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people—and this is a source of stigma. Example: a women who works in
a bar is assumed to be sexually active because she works in a bar but
this assumption may be wrong. We have all done things in our lives which
others would “judge badly.” We are all at risk of HIV so we should stop
judging others. HIV does not discriminate. It is not limited to particular
groups or communities, it is in every community.
(Source: “Judging Characters”, Understanding and Challenging HIV Stigma: Toolkit for
Action, Kidd & Clay, 2003)
67

.
Time Activity
Section 5: Stigma and Discrimination
Activity 5.10: The BIG Question
Activity Outline
Objective: At the end of this activity, participants should understand why asking this
question can be judgmental or stigmatizing and how to respond differently.
Duration/Timing: 30 minutes
Materials/Resources: Flipchart paper/Whiteboard, pens, sticky labels or
pieces of card (character labels/cards), a ball or small object that can be
Before the session:
1. Make up a song or a chant with words “WHERE DID YOU GET IT?”
You can make it in Chinese. Ask participants for help.
2. Write names of different characters that make up a local community.
Alternatively you can draw these characters. Characters can include:
mother, businessman, teacher, student, farmer, wife, hairdresser, local
government official. Think of characters that you would find in your local
context.
15 minutes 1. Introduce the session and get everyone to start singing the song. Begin
by singing the song and walking around in a circle.
2. Stop after a minute and explain the rest of the activity.
3. Ask the group to think about their character.
4. Ask them to nominate a leader.
5. Explain that they start by singing the song and passing the ball around
the group.
6. When the leader claps their hands, the person holding the ball must walk
into the centre of the circle.
7. The group then points their fingers at the person and chants 3 times
“Where did you get it?”
8. The person must then respond – i.e. “I got it from my husband”. Remind
them they must answer as their character.
9. Note their response on the board/flipchart paper and continue with the
game until most/all have had an opportunity to respond to the question.
15 minutes 10. De-brief asking the group the following questions:
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How they felt when they were asked this question with everyone
pointing their fingers.
Why do we ask this question?
Does the answer we receive make a difference to how we respond to
this person?
11. Help the group to see that this question is judging and makes people feel
bad. We are casting blame on people and judging whether they are
“innocent” or “guilty”. The response may affect they way we respond,
reassuring us or creating fear.
12. Ask group to discuss how they could counter this response. What would
they do if they heard this or experienced this?
13. Summary – Moral judgments can be made by the language we use and
the questions we ask. We need to be aware that we can be perpetuating
stigma and discrimination. But we can combat stigma and discrimination
through the ideas that have already been discussed. Emphasise we can
all do something.
(Source: “Where did you get it?” Understanding and Challenging HIV Stigma: Toolkit
for Action, Kidd & Clay, 2003)
69

.
Time Activity
Activity 5.11: Who am I?
Section 5: Stigma and Discrimination
Activity Outline
Objective: At the end of this activity, participants should understand the prejudices that exist
within a community/society.
Duration/Timing: 30 minutes
Materials/Resources: Paper, cello tape, and pens.
10 minutes 1. Divide the participants into small groups and give each person a piece of
paper. Ask half the groups to draw a picture of someone respected in
society. Ask the other groups to draw someone that is not respected in
society, as well as writing their profession. Tell each member of the group
that they cannot draw the same person as anyone else in the group.
2. When all the pictures are finished, ask the groups to explain who they
have drawn and why.
10 minutes 3. Collect the pictures and shuffle them.
4. Ask the group to stand up and move chairs and tables away from the
middle so there is plenty of room for people to move around.
5. Stick a picture on the backs of each person.
6. Ask the group to walk around and to greet each other in the way they
would greet and talk to the person drawn on the persons back. They
should not greet them by name to give away each other’s identities. Tell
them that at the end the participants will be asked to guess their own
identity. Give examples such as “If you met Hu Jintao how would you
act?” “If a beggar stopped you in the street, how would you act?” Once
they have got the idea, ask them to start the activity. Carry on for 10
minutes.
7. Ask the group to return to their seats, but do not let them take the pictures
off their back. Ask the group the following questions:
• How were you treated?
• How did this make you feel?
• Who do you think is drawn on your picture?
8. Ask the questions:
70

• If you ‘label’ someone what are you doing?
• Why do you think people discriminate against AIDS patients and
people living with HIV?
• Why do you think attitudes are so difficult to change?
• What are possible causes of prejudice? E.g. People are frightened
they might get HIV & AIDS themselves. Some societies refuse to
acknowledge that there are some people living with HIV in their
communities. People do not know enough about HIV & AIDS and lack
of knowledge causes fear. People believe it’s ones own fault to get
HIV & AIDS.
• Ask the group - What can we do to limit prejudice?
9. Summary – we all grow up with prejudices for the reasons we have
discussed. Summarise some of the impacts that were discussed. Explain
that we can limit prejudice by first changing our own attitudes. We can
use some of the ways we have discussed to limit our own prejudices and
encourage our family and friends to do the same.
(Source: HIV and AIDS Pack, VSO China, 2005)
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Section 6: HIV and Gender
For Every Woman
For every woman who is tired of acting weak
when she knows she is strong,
There is a man who is tired of appearing strong
when he feels vulnerable.
For every woman who is tired of acting dumb
There is a man burdened with the constant expectation
of “knowing everything.”
For every woman who is tired of being called
“an emotional female”
There is a man who is denied the right to weep and be gentle.
For every woman who feels “tied down” by her children
There is a man who is denied the full pleasure of parenthood.
For every woman who is denied meaningful employment
and equal pay,
There is a man who must bear full financial responsibility for
another human being.
For every woman who was not taught the intricacies
of an automobile,
There is a man who was not taught the satisfaction of cooking.
For every woman who takes a step toward her own liberation,
There is a man who finds that the way to freedom
has been made a little easier.
(Source: N. Smith, DAWN)
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Definitions
Sex - Refers to the biological differences between men and women. These differences are
generally universal and unchanging.
Sexuality - Refers to the total expression of who we are as men and women. It is about our
maleness and femaleness not simply body parts, reproduction or the physical act of coitus.
Gender - The socially constructed roles and responsibilities assigned to women and men in
a given culture or location and the societal structures that support them. These roles are
influenced by perceptions and expectations arising from cultural, political, environmental,
economic, social, and religious factors, as well as from custom, law, class, ethnicity, and
individual or institutional biases. Gender attitudes and behaviours are learned and can be
changed overtime.
(Source: HIV and AIDS peer education and life skills training workshop; Joel Balaquit HIV
Technical Adviser, VSO China Volunteer, 2007)
HIV and AIDS disproportionately affects girls, women and vulnerable men. The
reason for this are the socially constructed gender beliefs that are deeply entrenched
in societies across the world. In many countries, girls and women have less power
than men, particularly in relation to sexual health, making them increasingly
vulnerable to HIV infection. However, gender inequality does not only affect girls and
women but also vulnerable men. Men having sex with men and male sex workers are
increasingly at risk of HIV infection.
Why are HIV and Gender linked?
HIV transmission is based on social behaviours. These behaviours are determined by
the social, economic, political and cultural contexts in which gender roles are defined.
These roles can determine the level of knowledge, access to services and
decision-making power people have in their relationships with one another. For
example, in many societies a woman is unable to ask her husband or boyfriend to
wear a condom for fear of violence. So how do these gender roles affect men and
women?
For Women – Vulnerability to infection and risk-taking is increased by cultural
attitudes that makes it inappropriate for women to be knowledgeable about sex or to
suggest condom use; by the common link between substance abuse and the
exchange of sex for drugs or money; and by the economic need experienced by some
migrant and refugee women that forces them to resort to sex work.
For Men – Vulnerability to infection and risk-taking is heightened by cultural attitudes
that make it hard for men to admit to gaps in their knowledge about sex; by the link
73

etween socializing and alcohol use; by the frequency of drug abuse, including
injection; and by the number of predominantly male occupations that entail migration
and thus disrupt family life (Balaquit, 2007).
Gender in China
“Women hold up half the sky”
Mao Zedong
The World Bank stated in its 2002 Country Review of China that “the developmental
gap between men and women is widening. In fact, the various gaps separating men
and women’s status, income, and power keep shifting in response to constantly
changing social, economic, cultural and political realities in China”. This is very true of
China today. In many cities across this vast country, women enjoy the same equal
status in society as men. Looking at major cities such as Beijing and Shanghai, it is
easy to believe that gender is not an issue in China. To some extent, the gender
issues present in China are not as prominent as those in other countries; there is very
little research or data available regarding this issue. However, in those reports that
are available, gender inequalities are still very much present in rural China today.
The World Bank describes the increasing “feminisation of poverty”. In its work with
Chinese scholars and researchers, they identified barriers to gender equality.
These include:
1. Inequality in the labour market in terms of income gaps, discrimination in hiring
and firing and also discrimination in top-level positions. Women are generally
employed in lower status and lower-wage jobs, and are often neglected in
promotions to management level, coming up against the “glass-ceiling” (Asian
Development Bank, 2006).
2. Uneven impacts of education and health reforms. Women tend to be heavier
users of health services due to their reproductive role. Their ability to access
these services depends on their income levels, which are lower in comparison to
men resulting in unequal access. There is also evidence showing high levels of
illiteracy particularly amongst girls and women in rural counties, with three out of
four illiterate people being women.
3. The one-child family planning policy that has reinforced the traditional cultural
preference for boys over girls. This has been reflected in the birth ratio of 117
males to 100 females in 1999. Fewer female partners for men has resulted in an
increase in trafficking of women and girls particularly from border regions.
An increasing concern for China is the unusually high female suicide rate. The
worldwide is 1.6% whereas China’s is 4.5% (World Bank, 2002). The reasons for this
are complex. They include women’s increasing workload as men move to urban areas
to find work, women are left with both the agricultural and domestic duties (Asian
Development Bank, 2006). Forced marriages and domestic abuse are other causes.
As mentioned above, gender is also an issue for vulnerable men, particular males
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who have sex with males and male sex workers. In China, there is still a great taboo
associated with homosexuality. Although there is more tolerance particular in big
cities, it is not openly practiced. This makes it harder for vulnerable men to reach HIV
prevention services.
HIV and Gender in China
The rates of HIV amongst women is increasing in China. Women account for 30% of
all HIV infections (IAVI, 2008). One reason for this is that the majority of female sex
workers are female. Vulnerable men are also still at great risk. As Chinese society
evolves and develops, a need for a more gender sensitive approach is needed in HIV
prevention work (IAVI, 2008). Without tackling the issue of gender, the epidemic will
spread rapidly through the general population, including an increase in
mother-to-child transmission.
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.
Time Activity
Section 6: HIV and Gender
Activity 6.1: Sex. Sexuality and Gender
Activity Outline
Objective: At the end of this activity, participants should be able to:
(i) Differentiate sex, sexuality and gender;
(ii) Clarify perception on sex, gender, gender stereotypes and gender
discrimination.
Duration/Timing: 60 minutes
Materials/Resources: flipchart paper, pens, post-it notes, 3 cards labeled
sex, sexuality and gender.
Before the session on three separate pieces of card write the words - Sex,
sexuality and gender. Post these on the board of put on the floor.
10 minutes 1. Introduce the session’s objective. Emphasise that STIs and HIV and
AIDS are not only health issues. Point out that since STIs and HIV and
AIDS are commonly spread through exchange of bodily fluids during sex,
issues about sex and sexuality would likely to arise in the discussions.
Thus it is important that to gain knowledge and understanding of sexuality
issues. Furthermore, since STI and HIV/AIDS affect both men and
women, gender issues will be discussed as well.
5-10 minutes 2. Ask each participant to write down as many ideas as possible on
individual post-it notes regarding their understanding of the 3 terms: sex,
sexuality and gender. Ask them to put them under each heading.
15 minutes 3. Discuss results and try to formulate a working definition of the 3 terms for
use in future discussions
10 minutes 4. Ask the group to now consider in what situations do they see gender
differences. Can use the headings below to generate ideas.
10 minutes 5. Summary - The questions on sexuality bring messages, which form part
of how we perceive ourselves and our gender roles; this in turn influences
how we perceive others. We receive various messages on sex, sexuality
and gender from different sources. The questions on sexuality bring
messages, which form part of how we perceive ourselves and our gender
roles; this in turn influences how we perceive others. Emphasise that the
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last activity will deepen understanding of sex, sexuality and gender
sensitivity.
(Source: HIV and AIDS peer education and life skills training workshop; Joel Balaquit HIV
Technical Adviser, VSO China Volunteer, 2007)
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Areas where we see gender differences
Social
Different perceptions of men’s and
women’s social roles: the man is seen as
head of the household and chief
breadwinner, while the woman is seen as
nurturer and caregiver.
Educational
Differences in the educational
opportunities and expectations of girls
and boys: family resources are directed
to boys’ rather than girls’ education, and
girls are streamed into less-challenging
academic tracks.
Political
Differences in the ways in which women
and men assume and share power and
authority: men are more involved in
national and higher-level politics, while
women are more involved at the local
level in activities linked to their domestic
roles.
Economic
Differences in women’s and men’s
access to lucrative careers and control
over financial and other productive
resources, such as credit, loans, and
land ownership.
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Time Activity
Activity 6.2: Balance of Power
Section 6: HIV and Gender
Activity Outline
Objective: At the end of this activity, participants should be able to:
(i) Understand what gives men and women power and what takes power
away from them.
(ii) Look at how imbalances of power affect all our lives.
. (iii) Find ways to make power between men and women more equal.
Duration/Timing: 70 minutes
Materials/Resources: post-it notes, pens, sticks or 2 long pieces of string.
10 minutes 1. Ask everyone to think of a time when they felt powerful because of their
gender and share this with their neighbour. Ask for three or four
examples.
5 minutes 2. Ask everyone to complete the sentence “To me power means…”
20 minutes 3. Divide the group in two smaller mixed groups. Explain that we are going
to look at the things that make men and women feel powerful and
powerless in their sexual and reproductive lives.
4. Give each group a stick/piece of string to make a line like a see-saw and
some pieces of paper.
5. On one end of the see-saw put a drawing of a woman and on the other a
man.
6. Ask the women to work at the women’s end of the see-saw and the men
at the men’s end.
7. Ask the women to write all the ways that women gain power in their lives
including their sexual and reproductive life on pieces of paper and all the
ways that they lose power.
8. Place the ways women gain power under the stick and all the ways that
women lose power pushing them down. Ask men to do the same at their
end.
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25 minutes 9. Bring the group back together and discuss: what are the similarities and
differences between the things that increase power for men and women
and the things that reduce it?
10 minutes
10. Move the pieces of paper with things which are true for both men and
women to the middle of the seesaw.
11. Where does the balance of power lie for men and women like them?
What effect does this balance have on sexual and reproductive
well-being? How can men and women work together to increase their
collective power and to make the balance more equal? What can men
and women do individually to increase their power and to make the
balance more equal?
12. Summary – that sexual reproductive health cannot be seen in isolation.
The power and relationships in all aspects of our life impact our sexual
health and the decisions we make. However, power imbalances can be
changed. It is up to us to change the way we think about gender roles and
change our behaviour accordingly.
(Source: Preparing to teach sexuality and life skills, International HIV/AIDS Alliance , 2008)
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“HIV mainstreaming is a process of reshaping and redesigning the core sectors
of a programme to reduce people’s vulnerabilities towards HIV and help people
living with HIV to be better able to cope.”
‘Mainstreaming HIV into Tearfund’s operational
relief programmes’ (2008)
Over the years there has been much discussion and debate about HIV mainstreaming.
The definitions that numerous agencies have developed are often vague as to what
mainstreaming actually is. It is easier to describe it when you think of it in stages or as
a journey. See the diagram below:
Stage 1: HIV is a separate issue
Stage 2: Integration of HIV activities
Stage 3: Mainstreaming HIV
Section 7: What is the mainstreaming journey?
The organisation’s focus is not HIV and AIDS. HIV and
AIDS is seen as a separate issue. The organisation thinks
it is only a health issue and therefore has no impact on
their work.
The organisation is beginning to understand that HIV may
have an impact on their work in the future. They begin to
conduct one-off activities such as distributing basic HIV
and AIDS information to all staff on World AIDS Day.
However, the organisation still feels HIV is far away and
affects other people. There are no long-term changes in
the way the organisation works.
The organisation’s focus of work has not changed but HIV
and AIDS is no longer seen as a separate issue. The
organisation aims to ensure that the appropriate
knowledge, attitudes and behaviours are exhibited by
staff. Issues such as HIV and AIDS and gender are
considered throughout all its work from project design to
evaluation. The changes are long-term.
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VSO has produced a mainstreaming guide which details their commitment to
mainstreaming and the different stages of mainstreaming.
The VSO model illustrates the idea that HIV mainstreaming happens at different
levels of an organisation, starting from the Programme Office reaching out to the
volunteers and partners. Activities can also happen at different levels at the same time,
for example on World AIDS Day. The model also shows the strong link between
gender and HIV which should be part of all HIV mainstreaming work, as well as the
GIPA principle. The model should be used to develop context-specific activities that
lead to small, significant and sustainable changes.
The Two Dimensions of Mainstreaming
“Internal Mainstreaming” is a term referred to an organisation’s response to the
impact of HIV on itself as an organisation and on its work force. Workplace
programmes and workplace policies are an example of internal mainstreaming.
“External mainstreaming” is the term which refers to an organisation’s response to
HIV in its programmes and project work.
(Source: VSO Tanzania – HIV and AIDS Mainstreaming Manual, 2006)
Sensitisation is the first step and it is the most important. It is encouraging people to
discuss HIV openly and creating safe environments for them to do so. It is also the
stage where people begin to recognize that HIV affects them as an individual. Without
this, HIV will still be thought of as an issue that is far away. As a volunteer, you can
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support the sensitisation process in ways that you feel are comfortable and
appropriate to your placement. Here are some examples of different activities you
could do:
HIV mainstreaming is a process. It will take time, energy and commitment for
sustainable changes. It does not happen overnight and although it can be frustrating
at times, persevere; the smallest changes do really make a big difference.
Possible stages of sensitisation
Stage 1 - Observe your work environment. This is important to gauge
what further mainstreaming work you can do. Learn about the
organisation’s work. Listen for any talk about HIV and AIDS. Observe
people’s attitudes to people living and affected by HIV.
Stage 2 -- Start to engage people in conversations about HIV. What do
they think? Can they easily access information about HIV? Do they feel
it is a problem for their area?
Share VSO’s HIV and AIDS Q&A booklet with the organisation you work
for. Maybe leave it in a place where all staff can access it.
Share any news articles or information about HIV with your colleagues.
Stage 3 – Speak to your organisation about holding an activity for
World AIDS Day. Ask the leaders and management to be involved and
gain their support.
Stage 4 – Where possible, support your organisation’s and VSO’s
strategy for HIV mainstreaming.
Other tools that are available to you are the two mainstreaming assessment tools (see
Annex 13a, 13b and 14) that can help you and your organisation to look at your
current stage of HIV mainstreaming and decide on how to further your work in this
area. Assessment Tool I is for a basic analysis of your organisation. Assessment Tool
II gives a detailed plan on how to reach each stage of the mainstreaming journey.
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.
Time Activity
Section 7: What is mainstreaming?
Activity 7.1: What is mainstreaming?
Activity Outline
Objective: At the end of this activity, participants should be able to understand the concept
of mainstreaming.
Duration/Timing: 60 minutes
Materials/Resources: Pieces of paper with different statements, whiteboard
or large area of the floor, 3 signs (mainstreaming, integration and HIV-focused
work).
10 minutes 1. Explain to participants the definitions of HIV-focused work, integration
and mainstreaming. Explain that HIV focused work involves prevention,
treatment and care, for example a VCT centre. Integration involves
including elements of HIV work such as awareness activities for World
AIDS Day but these activities are one-off. HIV Mainstreaming is a
concept whereby an organisation looks at its structures and projects from
a different perspective and makes any necessary changes in light of the
HIV and AIDS epidemic.
15 minutes 2. Divide into smaller groups. Give each group a set of statements and ask
them to decide whether the statements relate to HIV-focused work,
integration or HIV mainstreaming. Give the group 15 minutes to discuss
depending on number of statements given to each group.
20 minutes 3. Bring the group back together and ask each group in turn to put their
statements under the correct heading.
4. Ask the rest of the group if they agree or disagree and why. Ask the
original group to explain their decision. Make any necessary corrections,
explaining why in the process. Continue until all statements are on the
board/floor.
15 minutes 5. Summary – explain the concept of mainstreaming can be confusing. It is
important to know the difference and understand that the organisation’s
core work does not change. Instead it begins to look at things from
another perspective. HIV mainstreaming begins with individuals. We
must first examine our own attitudes and behaviours in relation to HIV
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efore embarking on organisational changes. Explain that it is a staged
process and that help can be found through VSO and other local
networks.
(Source: Adapted from Development and disasters in a time of AIDS – An HIV
mainstreaming toolkit, CAFOD, 2008)
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Possible Statements
Statement HIV work, integration
or HIV mainstreaming
We train teachers and students to
become professional HIV and
AIDS experts.
I include one session about HIV
and AIDS in my English class.
We develop a confidential
counselling system for staff,
students and volunteers.
I make links with the local CDC to
find out more about HIV and AIDS
in my local area.
I decide to learn more about HIV
and AIDS so I attend an HIV
awareness-raising event.
Explanation
HIV work Being an expert means that you
are changing the focus of your
work. Mainstreaming requires
you to gain more knowledge
about basic facts of HIV and its
impact but it is also about
internal processing – thinking
about your own attitudes and
behaviours.
Integration This is a one-off activity. There
is limited or no follow-up to this
activity. Other subjects are not
contributing to this either.
Integration This is an integrated activity.
The organisations have started
to offer services to its staff and
volunteers in light of the HIV
epidemic. For this to be
mainstreamed, it must be part
of a wider programme of
prevention and VCT.
HIV Mainstreaming Building networks and
relationships is an essential
part of mainstreaming. Meeting
with local organisations can
help to provide valuable
HIV Mainstreaming
information regarding the local
context and also support in any
technical assistance you may
need.
Mainstreaming begins with the
individual. In deciding to learn
more and attend an event, a
change of attitude or mind-set
has taken place which is
essential for mainstreaming
work. Only when we begin to
consider HIV in relation to our
own lives can we then make
changes.
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We get support from professional
HIV organizations to help brief
and or train our staff and
volunteers.
We link staff, volunteers and
beneficiaries with local Centres
for Diseases Control and/or HIV
organizations for information and
support.
We need to invest in developing a
lot of HIV resources for the info of
staff, volunteers and
stakeholders.
We need to train volunteers to
become professional HIV and
AIDS workers.
We involve people living with HIV
and AIDS in planning, monitoring
and evaluation of projects.
We include HIV briefing info into
volunteer orientation/training.
HIV Mainstreaming Networking and relationship
building is very important.
Mainstreaming does not require
people to become HIV experts.
Looking for external support to
provide technical assistance
Integration
and resources is necessary.
Providing local referral services
is very important. Providing
information is the first step – a
starting point. Making it part of a
workplace policy and having
continuous engagement with
the local CDC and HIV
organisations
mainstreaming.
would be
HIV Focused Work This would be the role of a HIV
focused organisation. There is
no need for organisations to
develop their own resources;
they can use what other
organisations have produced.
However, they may wish to
tailor the messages to their own
context.
HIV Focused work Becoming HIV and AIDS
HIV Mainstreaming
experts is not the aim of
mainstreaming. Being equipped
with knowledge and skills to
protect yourself is important as
well as understanding the wider
impacts of HIV.
The GIPA principle (Greater
Involvement of People living
with HIV and AIDS). It reduces
stigma and discrimination as
well as recognizing the valuable
contribution PLWHAs have.
HIV Mainstreaming Including HIV as part of a
health, safety and security
session is useful for volunteers
to learn about the risks and
impacts of HIV and how this
might affect them in their
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We include HIV briefing info into
staff induction.
We develop HIV&AIDS policy to
protect and support our staff and
volunteers.
We need to train some of our staff
to become professional
HIV&AIDS workers.
We need to initiate HIV&AIDS
prevention and care projects.
We need to develop into a
professional HIV&AIDS
organization in order to
mainstream HIV.
We make HIV information
available to our beneficiaries.
We make HIV information
available to our volunteers.
HIV Mainstreaming
placements/roles.
Providing information to new
staff is a part of a prevention
strategy to protect staff. This
prevention work could be an
element of the organisation’s
HIV workplace policy.
HIV Mainstreaming Having a workplace policy
represents the organisation’s
commitment to HIV prevention,
care and support. Each
organisation must develop its
own policy in relation to its own
context. See workplace policy
section for more information.
HIV Focused work Becoming HIV and AIDS
HIV Focused work
experts is not the aim of
mainstreaming. Being equipped
with knowledge and skills to
protect yourself is important as
well as understanding the wider
impacts of HIV.
Developing HIV projects is not
mainstreaming. The aim of
HIV Focused Work
mainstreaming is not to change
the focus of work but to look at
the wider impacts of your work
from a different perspective.
The aim of the organisation
does not change in
mainstreaming. There is no
need to develop into a new
organisation with a new focus
but to make changes to reduce
your organisation’s
vulnerabilities to HIV.
Integration Providing accessible and
accurate information is an
important first step. This can
increase basic knowledge and
dispel any myths about HIV.
HIV Mainstreaming Providing accessible and
accurate information is an
important first step. This can
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We make HIV information
available to staff.
We apply for funding for
mainstreaming work.
We hold an activity on World
AIDS Day.
We attend a training session on
HIV Mainstreaming. When we
return to our jobs we do not share
what we have learnt.
increase basic knowledge and
dispel any myths about HIV.
HIV Mainstreaming Providing accessible and
accurate information is an
HIV Mainstreaming
important first step. This can
increase basic knowledge and
dispel any myths about HIV.
Some organisations may need
initial seed funding for
mainstreaming work. For
example, paper, pens,
photocopying of information.
Integration
Also when holding activities,
funding may be required for
equipment hire or refreshments
etc.
An on-off yearly awareness
raising event.
Integration Attending the session is a good
way to learn more about
mainstreaming. Sharing what
was discussed with the whole
team will help to develop the
organisation’s mainstreaming
plan and keep everyone
informed of what is going on.
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.
Time Activity
Activity 7.2: Case Studies
Section 7: What is mainstreaming?
Activity Outline
Objective: At the end of this activity, participants should be able to understand the concept
of mainstreaming.
Duration/Timing: 60 minutes
Materials/Resources: Case studies.
20 minutes 1. Divide the group into smaller groups and give each one a case-study.
2. Ask them to read the case-study and discuss what they think
mainstreaming is and what does this involve.
25 minutes 3. Bring the group back together and ask them to share their thoughts.
4. Ask the group, what elements of the case-studies would be relevant for
their organisation. For example, we would be able to provide information
sessions to all our staff and volunteers but we would not be able to fund
ARV treatment.
15 minutes 5. Summary – explain that mainstreaming may sound like very complicated
but involves simple steps that all organisations can do. From the
case-studies and discussions, highlight a few things. Emphasise the point
that mainstreaming should be contextual. What is happening in Africa
may not seem related to China BUT similar impacts of HIV can happen if
it is not considered an issue. Mainstreaming work can help to prevent the
effects of HIV and AIDS on a large scale. Small steps can result in
significant changes
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Case Studies
Rwanda: As a result of the training of schools headmasters, it is becoming a good practice for
schools to develop HIV & AIDS sensitive workplace policies at school. The VSO PHARE
project and partners are in the process of developing a school policy on HIV&AIDS that sets a
replicable model for other schools. 10 guidelines have so far been drawn up.
Kenya: All VSO partners now receive initial sensitisation and basic training in workplace
programming, through the Partnership Orientation Workshop, which follows ILO and Kenya
Federation of Employers codes of conduct. A baseline tool has been developed by VSO for
all partners to measure their current level of HIV & AIDS awareness and activities. In
addition:
• Two partners accessed small grants from VSO to support staff training and
workplace policy development.
• VSO Kenya, together with Jitolee, carried out staff training in HIV & AIDS, and
partnered with an AIDS service organisation to provide quality prevention,
treatment and care services for staff.
• 20 Disability partners received training through VSO in HIV & AIDS mainstreaming
• 8 Secure Livelihoods partners received training in HIV & AIDS mainstreaming.
Malawi: Through the facilitation of a volunteer development worker placed with the key
partner at the Chitipa District AIDS Coordinating Committee (DACC), an HIV & AIDS
Workplace Policy was developed. This policy was developed to be a guide, which could be
adopted by CBOs under Chitipa DACC, and all government departments in Chitipa
District. The policy was documented, reviewed and agreed by staff and heads of
departments. As a result of the development of the workplace policy, notable changes
have been observed such as the establishment of a Workplace Committee from different
government and non governmental departments, responsible for HIV & AIDS programme
activities at the workplace, condom distribution in toilets, provision of information,
communication, education (IEC) materials at the workplace, reminding staff and partners
about risky behaviours, and encouraging members of staff to go for HIV & AIDS
counselling and testing. Heads of Departments have also renewed their commitment to
ensure that 2% of any funds allocated to them will be used to run HIV & AIDS activities at
the workplace for staff, where previously no HIV & AIDS activities were undertaken.
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Ethiopia: VSO Ethiopia is also continuing to promote HIV and AIDS mainstreaming
internally to staff, volunteers and partner organisations. A HIV & AIDS staff committee
has been established with the main objective of bringing forward the need of staff in
relation to training, information and possible support around HIV & AIDS issues. The
committee is also expected to be involved in collecting and assessing staff suggestions
about HIV & AIDS mainstreaming activities. 2 sensitisation sessions were organised last
year for the guards and cleaners. There has also been staff training on stigma and
discrimination that helped staff to reflect on their own prejudices and pre-assumptions. A
learning visit for staff to African Services Committee VCT Centre in Addis Ababa has
been held and involved 13 staff members. The purpose of the visit was to understand
the advantages of VCT and practical aspects of VCT. VSO Ethiopia now holds
mainstreaming workshops for all new volunteer arrivals and their partner organisations
to build their capacity to mainstream HIV & AIDS into their workplaces and to give them
tools and ideas to do so. In November 2006 3 workshops were conducted in 3 regions. A
total of 90 individuals attended the 3 workshops (48 volunteers and 42 representatives
form partner organisations). The background of participants varies widely – drawn from
all 3 VSO Ethiopia programmes in education, participation and governance and HIV &
AIDS and representing both government and NGOs. At the end of the one-day
workshop partners and volunteers developed an action plan to introduce mainstreaming
activities into their workplace and local communities.
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Section 8: Different approaches to HIV mainstreaming within VSO China
Basic Education: The programme’s objective is to improve the quality of basic
education programmes in primary and middle schools. The programme’s work
focuses on introducing new teaching methodologies to schools with the aim of
creating a more student-centered approach to learning. Looking at education broadly,
schools not only provide an environment to develop academic knowledge but also the
place to acquire essential life skills. These include decision-making, confidence,
self-esteem, assertiveness, ability to communicate as well as many others. The
middle schools already provide moral and health education classes to students,
covering health and disease topics including HIV and AIDS, and discuss moral issues
such as honesty, resistance to drugs and communication. However, there can be
ways to strengthen this. The life-skills education approach is a method that has been
used in countries across the world to support HIV mainstreaming. It has been
developed because, information is not always enough. We need the skills to be able
to use information, in this case how to protect ourselves from HIV.
National Volunteering: The programme’s aim is to promote volunteering as an
effective way of reducing poverty and disadvantage in China. It focuses on building
the capacity of volunteer involving organisations. The NGOs that VSO China work
with focus on addressing a range of development issues through the use of
volunteers, therefore to mainstream HIV into these organisations, it is best to
approach it using HIV as another development issue to consider. This can be part of
training that the organisations conduct with other NGOs and volunteers.
HIV and AIDS: Because the focus of work is on HIV and AIDS projects, much of the
mainstreaming work that is carried out in the other programmes is not applicable here.
However, because of the expertise within the programme, volunteers could share
technical knowledge and training support to volunteers in the other programmes. The
development of workplace policies if they do not already exist could be another focus
of mainstreaming work within the HIV and AIDS programme.
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Section 9: HIV Workplace Policy
As part of VSO’s commitment to inclusion and HIV mainstreaming, VSO has both an
international and local country HIV workplace policy. A policy is important for many
reasons, including:
To be a responsible employer.
A commitment to action.
A guide for employers in how to deal with HIV and AIDS issues in the workplace.
A guide for employees in matters related to HIV and AIDS.
Ensures that all everyone in the organisation, at all levels, knows what is expected
of them. This is very important in terms of stigma and discrimination.
A HIV and AIDS workplace policy can take many forms and must be specific to the
local context. Looking at what support an organisation can realistically offer is
important to ensure that the policy developed is relevant and applicable. It is not just a
piece of paper. It is a set of values and actions that should be part of the everyday
work of the organisation.
Prevention is a large element of a workplace policy. HIV mainstreaming activities in
staff induction, staff training, health and safety can all be part of an organisation’s
commitment to providing support to employees.
For some organisations, developing equal opportunities and health and safety policies
might also be part of this process. For others, these basic policies may already be in
place.
There is no standard policy. Examples of policies are included in this section but
remember it must be relevant for your organisation in order for it to be implemented
successfully. Draw on other examples for ideas but ultimately, it is your own policy.
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.
Time Activity
Section 9: HIV and AIDS Workplace Policy
Activity 9.1: Why do we need a policy?
Activity Outline
Objective: At the end of this activity, participants should be able to understand the importance in having a HIV
workplace policy.
Duration/Timing: 45 minutes
Materials/Resources: Role-play briefing notes (Scenario 1 and 2), small prize.
5 minutes 1. Ask the group to divide into pairs.
2. Explain that each pair will be given a scenario. They have to read through
their characters briefing notes and then have 10 minutes to enact the
conversation that will take place. Explain that body language and physical
use of the space is as important as the language being used.
3. Hand out character briefing notes to each pair. Ask them to think about
their character and to get into role.
10 minutes 4. Give the group 10 minutes to act out the role-play. Some people may find
role-play embarrassing or are unsure what to do. Support them through
asking questions about their character and encourage them to answer as
their character. Ask them to think about the wider picture, paying attention
to the small details in the briefing notes, e.g. how do you feel working in a
new organisation? Are you still trying to fit-in? How does this new
situation make you feel now?
10 minutes 5. Bring the group back together and ask for volunteers to show the rest of
the group their role-play. Show each scenario. You can use a small prize
as an incentive. If people are too embarrassed, then continue with
debriefing.
10 minutes 6. Ask the Xiao Hongs from each scenario to explain how they felt in the
role-play. Continue with the debriefing for each character.
7. Ask the group to comment of the different responses. Explore how having
a policy can make a difference.
10 minutes 8. Summary – explain that a policy is not just a piece of paper but a
commitment of action. A workplace policy influences how staff behave in
a workplace. That body language and physical movements can convey a
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lot more than verbal communication and can have a huge impact on a
person living with HIV. Use the role-play as an example of the difference
a policy can make to an organisation. Emphasise that a policy is a written
document but for it to have an impact, it must be implemented. Only then
will change take place.
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Character Briefing Notes
Scenario 1
Xiao Hong: She is dating a divorced Chinese man. She does not know him very well, but
likes him a lot. She recently had unprotected sex with him and is now very concerned.
She comes from a very traditional Chinese family. Her parents would get very angry with
her if they knew that her boyfriend was divorced let alone that she might be infected with
HIV because of her relationship with him. What’s more, her mother has a heart condition
and is too fragile to face any difficulty. On the other hand, she is afraid that she would be
fired by the organisation she has newly joined if she was infected with HIV. She really
likes the job which she has got with a great deal of effort. She does not want to lose the
job.
The Colleague: S/he has little knowledge about HIV and AIDS. In her/his mind, the
disease is the most deadly and can be transmitted very easily among people through
everyday contact. After s/he knows Xiao Hong’s concern, she cannot help taking two
steps back. She is not sure whether Xiao Hong will be fired because of this or not. She
regrets being close to her in the office.
Scenario 2
Xiao Hong: She is dating a divorced Chinese man. She does not know him very well, but
likes him a lot. She recently had unprotected sex with him and is now very concerned. She
comes from a very traditional Chinese family. Her parents would get very angry with her if
they knew that her boyfriend was divorced let alone that she might be affected with HIV and
AIDS because of her relationship with him. What’s more, her mother has a heart condition
and is too fragile to face any difficulty. On the other hand, she is afraid that she would be
fired by the organisation she has newly joined if she was affected with HIV and AIDS. She
really likes the job which she has got with a great deal of effort. She does not want to lose
the job. Without the job, she would not have enough money to get proper treatment.
Although she would not be fired she is still worried that colleagues will be scared off and do
not want to work with her.
The HR Manager: She is a very empathetic person. She greets Xiao Hong with a smile and
asks her how she can support her. After she listens to her concern, she first calms down
her. Then she patiently advises Xiao Hong on how to deal with the situation. (You can refer
to VSO’s HIV&AIDS Workplace Policy)
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.
Time Activity
Section 9: HIV and AIDS Workplace Policy
Activity 9.2: What is a HIV workplace policy?
Activity Outline
Objective: At the end of this activity, participants should be able to understand what a HIV workplace policy is
and how to develop one.
Duration/Timing: 1 hour and 30 minutes
Materials/Resources: Appendix 14 PPT presentation, paper, pens.
45 minutes
Before this session, the facilitator should review the PPT and make any
changes as necessary. If there are any questions regarding the content of the
presentation, you can contact the VSO China HIV and AIDS team.
1. Go through PPT presentation.
2. Important points to emphasise:
There is no standard policy. Each organisation must develop a policy
that is relevant to the local context, needs and resources of the
organisation.
Developing a policy is a process. Draft Implement Monitor
Review Amend Implement
Management support is vital in ensuring the success of the policy.
Case-studies – organisation’s offer different things. Some may offer
VCT, ARVs, others focus on prevention and referral support.
3. Summary – developing a policy is an important part of mainstreaming. It
represents an organisation’s commitment to action. Some people may be
wary of having a policy when others are not in place e.g. equal
opportunity, confidentiality but it is the content of the policy that is the most
important. Management support for implementation is essential.
45 minutes
Remember only include what you can offer and what support is available.
You can always amend later when your situation changes. Keep it simple
and possible.
In pairs or individually, ask participants to begin to draft their own workplace
policy. Ask participants to think about their organisation and what they could
realistically include in their policy. Explain this is just an exercise to go through
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the process and get an understanding of how a policy could be developed.
They can use the ILO guidelines and case-studies as examples.
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.
Time Activity
Activity 9.3: Negotiation
Section 9: HIV and AIDS Workplace Policy
Activity Outline
Objective: At the end of this activity, participants understand the process of negotiation for
an HIV workplace policy.
Duration/Timing: 60 minutes
Materials/Resources: Character briefing notes and Appendix 15.
15 minutes 1. Divide the group into 2 smaller groups.
2. Give each group a briefing note and a copy of VSO’s ‘Guidelines for
Negotiation Strategies’. Explain that they will be playing that character.
3. Explain that once each team has read their briefing note (they are not to
show the other team), each team has 15 minutes to decide on a
negotiation strategy to use in the role-play.
15 minutes 4. You must select one person from your team to start the role-play as that
character. They can use a prop to identify themselves in character.
5. The role-play begins and proceeds until the person in role, or a member of
their team, calls ‘time out’ to consult on what to do next. When a ‘time-out’
is called, all the characters return to their respective teams to reflect and
consult on strategy. When the play re-starts a different member of one or
both teams should take the appropriate role (using the prop if used). Allow
15 minutes for the role-play but be flexible, if it is going well then allow
more time.
20 minutes 6. Ask participants to de-role.
7. Debrief with the whole group. Ask the following questions:
How did each team feel in the negotiation?
What went well?
When was it hard?
Did you think you achieved your aims? Why/Why not?
What could you do differently next time?
10 minutes 8. Summary – Explain that management support is essential for
mainstreaming work. Negotiating for a policy or to start this work requires
both sides understanding the other’s needs and concerns. Body language
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and non-verbal communication is very important. Compromise is
essential. People should not be forced into mainstreaming work. Ask
participants to think of strategies they could use in future negotiations.
Being prepared is important, knowing facts, figures and impacts will all
help to gain support from management and leaders.
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Character Briefing Notes
Briefing Notes for Xiao Gang
You have started working at an NGO. It is a small organisation with only 6 people.
The work of the NGO focuses on income-generation projects for ethnic minority
groups in rural areas. Over the last two years, it has also begun working on small
education projects with local schools. You have to travel for one day to visit the
beneficiaries and the projects. A key member of the staff used to be the community
development officer. She was based at the projects, liking and working with the
ethnic minority groups but she has recently left. The organisation is having
financial problems and could not afford to replace her. Instead have hired two
short-term project officers who are based in the head office. The management and
board of the organisation never visit the community projects.
You enjoy the work and the team you are working in. However, you begin to notice
that all decisions are made by the management and the board. The staff are not
always happy with the decisions that are made but cannot object.
You also notice that HIV and AIDS is an issue in the communities you work with
but it is not being tackled by the organisation. One of the new project staff
members has come up with some great ideas to support HIV and AIDS education
as part of their work but the rest of the team do not think it is their work. They feel it
is a health issue that should be addressed by the local health bureau. You have
also heard some negative comments being made by some members of the
organisation regarding people living with HIV.
You would like to discuss with the management about mainstreaming HIV into the
projects. However, you know that it would be very difficult. So, you decide you
would like to approach them to get their support in developing a HIV workplace
policy. You are nervous about approaching the management even though you do
have a good relationship with them. But you are still new and you don’t want this to
ruin your relationship with them or jeopardise your work. But this matter is
important to you.
You have managed to arrange a 15 minute meeting with the Managing
Director.
At the meeting you need to negotiate with the Managing Director the
importance of addressing the issue of HIV and developing a workplace
policy.
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Briefing Notes for the Managing Director
You have been working as the Managing Director of the organisation for 5
years now. You are well respected by others, used as a role model for what
organisations could achieve with good management. You know that your staff
are hard-working but sometimes they don’t see the bigger picture. You have
to answer to the board and that means making tough decisions at times. You
know that your staff don’t always agree with it. Sometimes you hear them
criticize your decisions, saying that you don’t understand how it works
because you have never been to see the communities or learn about the
projects. You feel that visiting the projects is not your ole. Your role is to
ensure that projects are funded, that deadlines are met and that objectives
are achieved.
Recently, you have been under a lot more pressure. You have lost key
member of staff and have found it hard to replace her. The organisation has
also lost a key funder, meaning that you have to cut your costs. This has
meant employing people on a short-term contract and to get rid of the job
post based in the community. You are under pressure from the board too.
They want to know why the funding was lost and you feel that they blame
you. You have recently employed Xiao Gang who shows a lot of promise. He
has a lot of experience and seems to be doing well.
Xiao Gang has requested a meeting with you to discuss the issue of HIV
and AIDS. You don’t know why he wants to discuss this as the
organisation does not work with health issues. You have tried to tell him
you are busy but he has been persistent. So you have given him 15
minutes to discuss this topic with you.
Tips :As the MD, you must be clear that you are a busy person and that you
only have a short amount of time. Initially you must express your reservations
and doubts about this but if you feel that his argument is persuasive, try to
come to some sort of compromise. Don’t make too hard or easy for Xiao
Gang. When playing the MD also think of the cultural context, what kind of
protocol would you expect from your staff. How should they address you?
What kind of respect should they show you? What happens if they don’t show
you respect etc?
103

.
Time Activity
20 minutes 1. Divide the group into 2 smaller groups.
2. Give each group the case studies below.
3. Ask one group to work out what they would do next if they were
managing that organisation.
4. Ask the other group to decide what they would do if they were staff at the
organisation but had no managerial responsibilities.
20 minutes 5. Bring the group back together and ask each group to feedback.
6. Explore the differences in actions with each group.
Does having responsibility make a difference?
What steps are similar?
Section 9: HIV and AIDS Workplace Policy
Activity 9.4: What would we do?
Activity Outline
Objective: At the end of this activity, participants should be able to understand that
mainstreaming is a process.
Duration/Timing: 50 minutes
Materials/Resources: Case studies.
Does your position in the organisation make a difference to how you
would proceed? E.g. you are responsible for finance so mainstreaming
may be seen as an added expenditure.
10 minutes 7. Summary – management support and buy-in is essential to HIV
mainstreaming. Without it, very little work can be done. Explain that some
organisations will only focus on external mainstreaming – how HIV affects
its projects – but rarely look internally – how does this affect our staff. A
combination of both internal and external mainstreaming is necessary for
changes to happen. There is no point advocating prevention to
beneficiaries and volunteers if staff are unaware of their own risks. Briefly
repeat some of the suggestions put forward and explain mainstreaming is
a process. There are a number of things organisations can do and it will
take time and continued commitment.
(Source: HIV and AIDS Mainstreaming Toolkit, VSO Vietnam, 2008)
104

Case Studies
All the organisations are committed to HIV and AIDS Mainstreaming
1. Guang Nan Education Bureau has decided that it wants to mainstream HIV and
AIDS. It has decided that to do this it will provide awareness training for its entire staff
and feels that it does not need to do anything else.
2. No. 4 Middle School has changed its curriculum and now provides an extensive
sex education and HIV and AIDS awareness classes to students. Local parents are
complaining that the materials are too explicit and are starting to suggest that they
will stop their children from going to school
3. Xian Ri Qui a small local NGO has started to undertake mainstreaming. It has
assessed all its strategies, structures and procedures but is unclear what else it
should do.
4. Rainbow a large international NGO which has an office in China. It has been
undertaking mainstreaming work for a long time. It requires that all its staff are
trained in HIV and AIDS awareness, all its policies, strategies and procedures
undergo an impact assessment and are changed accordingly. But it wants to do
more.
105

Monitoring and evaluation (M&E) is essential in mainstreaming work. M&E must look
at whether change has happened asking the following questions:
Have changes occurred?
What has changed?
How has it changed?
Why has it changed?
Who was involved?
When did it happen?
These are basic starting points.
Section 10: Monitoring and Evaluation
M&E of mainstreaming work can be difficult to capture because you are looking at
changes in attitudes and behaviours as well. Be aware of your context when
designing monitoring and evaluation tools, making sure they are culturally
appropriate.
You may decide that before embarking on any activities to do a knowledge, attitude,
behaviour and practice (KABP) survey. This can serve as baseline data. You can then
measure after one year and two years what changes have taken place since then by
repeating the survey. People may find it uncomfortable to write down let alone talk
about personal practices and behaviour. You may wish to start off with some
questions regarding knowledge and attitudes first and then move onto behaviour. See
Annex 19 for an example.
For every activity that you do, you must incorporate some kind of monitoring. This is
important for two reasons; firstly to determine what people have learnt as a result of
the activity and the second is what has worked well and any suggestions for
improvements for next time. See Annex 20 for an example.
It does not always have be formal written questionnaires but some way to capture
what has happened. Be creative. Use the VSO guide “Participatory Approaches: A
facilitator’s Guide” to help you design your monitoring activity. Remember, informal
conversations and observations are just as important as quantitative data. For
example, is there more discussion regarding HIV and AIDS amongst people? Are
people using the free condoms available in the workplace? How have peoples
relationships changed? Are men and women working together?
For volunteers – as part of monitoring of your placements such as the quarterly or 6
month review, questions regarding HIV mainstreaming are included to help VSO
China capture changes that are happening at placement level.
106

For organisations – including a review of mainstreaming work as part of the
organisation review is important to learn from previous work and make a plan for the
future.
Monitoring and evaluation is important but can also be fun. Use different methods to
stimulate discussion and always feedback to the rest of the group the findings of the
M&E. It lets people know what is changing and how they are making a difference.
107

If RBMA agrees take the test
locally at provincial CDC
(Source: VSO China HIV and AIDS Workplace Policy, 2009)
Annex 1: HIV Testing Procedure for International Volunteers
Volunteer wishes to take an HIV and AIDS test
Travel to Beijing to take the
test at B&J (doctor available
to provide support)
Contact your Recruitment Base Medical
Adviser (RBMA)
The decision may be taken for the volunteer to take the
test outside of China (this option must be agreed with
your RBMA)
RBMA informs VSO China office of volunteers’ travel,
but does not need to disclose the reason.

1. What is HIV?
a) a virus
b) a fungus
c) a bacterium
2. Can insects transmit HIV?
a) Yes
b) No
c) Only mosquitoes
Annex 2a: HIV Quiz
3. How many people in China are HIV positive?
a) 2 million
b) 700,000
c) 200,000
4. Which protects you most against HIV?
a) Condoms
b) Contraceptive pills
c) Spermicidal jelly
5. How can you tell if someone has HIV?
a) Because of the way they act
b) They look tired and ill
c) There is no easy way to tell
6. Which practice puts you most at risk of HIV infection?
a) Kissing
b) Using the same toilet as an infected person
c) Unprotected vaginal sex
d) Anal sex with a condom
7. What does the standard HIV test identify?
a) The number of red blood cells
b) Antibodies
c) The virus
8. What percentage of HIV infections in China are women?
a) 5%
b) 80%
c) 30%

9. Without treatment, and with a good diet, what is the average time it will
take for HIV to progress to AIDS?
a) 10 years
b) 5 years
c) 6 months
10. When doing a rapid HIV test how long must a patient wait for their results?
a) 1 minute
b) 30 minutes
c) 24 hours
11. HIV can be transmitted through a mother to her child in which way?
a) In the womb
b) During childbirth
c) Through breast milk

1. What is HIV?
a) a virus
2. Can insects transmit HIV?
b) No – there is no evidence that the virus cannot survive in an insect. When
mosquitoes bite they do not inject blood from previous person.
3. How many people in China are HIV positive?
b) 700,000 – This is the estimated figure from 2007. There is no data for 2008 as yet.
There are probably more unreported cases but due to stigma and discrimination or
lack of knowledge of HIV, people have not been tested and do not know their status,
so the actual figure could be much higher.
4. Which protects you most against HIV?
a) Condoms
Annex 2b: HIV Quiz Answers
5. How can you tell if someone has HIV?
c) There is no easy way to tell - -people with HIV can lead normal healthy lives for
many years, particularly if they are on treatment.
6. Which practice puts you most at risk of HIV infection?
Unprotected vaginal sex
7. What does the standard HIV test identify?
b) Antibodies – the test does not identify the virus but the antibodies that are produced
by our body to fight the virus. Antibodies are special bodies the body produces in
reaction to an unknown infection in the body. These can take anything up to 6 weeks
to 3 months to be produced. This is called the “window-period”. That is why when you
have a standard HIV test you will be asked to come in again after 3 months for a
repeat test. Different countries have different practices. China follows the same model
as most other countries. (?)
8. What percentage of HIV infections in China are women?
c) 30% - in most countries women are biologically and socially more vulnerable to
HIV.
9. Without treatment, and with a good diet, what is the average time it will take for
HIV to progress to AIDS?
a) 10 years

10. When doing a rapid HIV test how long must a patient wait for their results?
b) 30 minutes
11. HIV can be transmitted through a mother to her child in which way?
a) In the womb
b) During childbirth
c) Through breast milk
All ways

http://iiep.tomoye.com/ev.php
(IIEP-UNESCO HIV/AIDS Impact on Education Clearinghouse)
The Clearinghouse is an online collection of downloadable documents exploring the
relationship between HIV/AIDS and education.
www.unaids.org
Joint United Nations Programme on HIV and AIDS. Source of information on global
statistics and UN action.
www.aidsalliance.org
Supporting and enabling community action on HIV and AIDS in conjunction with
partners in developing countries at both local and regional levels. Internationally, works
on policy, development, best practice, and sharing lessons learnt. Programmes in
Africa, Asia and Latin America.
www.aidsconsortium.org.uk
The UK Consortium on AIDS and international development (formerly the UK NGO
AIDS Consortium) is a group of more than 60 UK-based organisations who work
together to understand and develop effective approaches to the problems created by
the HIV epidemic in developing countries. It enables each agency to bring its own
experience to be shared and used to help all the members improve their responses to
the epidemic, through information exchange, networking, advocacy and campaigning.
www.stopaidscampaign.org.uk
The UK Consortium on AIDS and international development (formerly the UK NGO
AIDS Consortium) is a group of more than 60 UK-based organisations who work
together to understand and develop effective approaches to the problems created by
the HIV epidemic in developing countries. It enables each agency to bring its own
experience to be shared and used to help all the members improve their responses to
the epidemic, through information exchange, networking, advocacy and campaigning.
www.tht.org.uk
Leading UK HIV and AIDS organisation - advice, information and counselling.
www.avert.org
Online HIV information, international HIV & AIDS charity with the aim of averting HIV &
AIDS worldwide.
www.aidsmap.org
HIV & AIDS organisations worldwide online and news, books, services. NAM is a
community-based information provider based in the UK whose sole aim is to combat
the AIDS epidemic through accurate, accessible and up-to-date information.
www.aidsfonds.nl
All documentation published by Aidsfonds.
www.iaen.org
Annex 3: Useful HIV and AIDS websites

The International AIDS Economic Network (IAEN) provides data, tools and analysis on
the economics of HIV and AIDS prevention and treatment in developing countries, to
help developing countries devise cost-effective responses to the global epidemic.
www.aegis.org
AIDS Information Global Education System. Through our keyword-searchable
knowledgebase, AEGiS offers cutting-edge information via HIV & AIDS specific
publications and news sources from around the world. In addition, an array of
reference materials are offered. As new aspects of HIV & AIDS arise, AEGiS will
continue to extend its efforts towards the dissemination of potentially life-saving
information.
www.eldis.org
The gateway to information on development issues.
www.globalfundatm.org
The official Global Fund website.
www.safaids.org.zw
Southern Africa Information Dissemination Service.
www.hdnet.org
Health and Development Networks. Parent organisation to the af-aids & sea-aids listserves.
Acts as an information channel for AIDS and other health and developmentrelated
issues.
www.aidschannel.org
AIDS channel is a multimedia web portal on issues relating to HIV & AIDS.
www.sarpn.org.za
Southern African Regional Poverty Network (SARPN). To provide a facility for raising
the level and quality of public debate on poverty across the Southern African
Development Community - SADC.
www.genderandaids.org
United Nations Development Fund for Women web portal on Gender and AIDS.
www.satregional.org
Southern African AIDS Training Programme, supporting community responses to HIV
& AIDS in Africa.
www.und.ac.za/und/heard
Health Economics and HIV & AIDS Research Division, Unniversity of Natal, Durban,
South Africa.
www.nat.org.uk
This website is a useful resource from the National AIDS Trust, particularly helpful for
planning World AIDS Day events.
www.actionaid.org/ourpriorities/hiv/hbw.shtml

Action Aids website has lots of useful HIV & AIDS information and regularly updated
campaign actions.
www.behaf.org.uk
The British Ethnic Health Awareness Foundation aims to set up a HIV & AIDS
awareness campaign amongst the UK's minority ethnic communities.
www.accessmed-msf.org
Médecins Sans Frontières Campaign for Access to Essential Medicines.
http://hivinsite.ucsf.edu/InSite
Comprehensive up-to-date information on HIV and AIDS treatment, prevention and
policy from the University of California San Francisco.
www.tac.org.za
Treatment Action Campaign based in South Africa has been a leading voice for
making treatment for HIV & AIDS more available in South and sub-Saharan Africa.
www.icw.org
International Community of Women Living with HIV & AIDS.
Other links:
http://www.china-aids.org/english/
http://china.hivaidsinfo.net/
http://www.chain.net.cn/aidsenglish/
http://www.unaids.org/EN/Geographical+Area/by+country/china.asp
http://www.futuresgroup.com/Publications.cfm?Browse=Project
http://www.fhi.org/en/HIVAIDS/country/China/index.htm
http://www.mercycorps.org/items/318/

Annex 4: Risk Continuum PPT
How can HIV be
transmitted?

Kissing

Sharing Needles

Shaking Hands

Having sex

From a toilet seat

In the womb

Insect Bite

Breast Milk

WORLD AIDS DAY
2008-12-01
Annex 5: What is HIV and AIDS PPT

Welcome to our English corner about
HIV/AIDS

Sharing cutlery

What do you already know about
AIDS?

Which of these people have
HIV/AIDS?

The difference between HIV/AIDS
H : Human
I: Immunodeficiency
V: Virus
It’s the virus in humans which creates a
failure in the body’s immunesystem

AIDS
A: Acquired
I: Immune
D: Deficiency
S: Syndrome
AIDS is caused by HIV. If a person has
HIV, he doesn’t have AIDS yet. This can
take between 8-11 years

HIV/AIDS in China
In 1985-1989 the first cases of HIVinfected
people were found in coastal
cities
Since then the epidemic has spread to
all provinces.
China has an estimated 700000
HIV/AIDs case (85000 with AIDS)

The Awareness of HIV/AIDS is more
and more in China

Famous Chinese people also help the
AIDS-campaign

The government started in 2004 with a
State Council AIDS working committee

Do you need to be afraid?
NO!

It’s important to know how you can
protect yourself
You can get HIV/AIDS by
1. Having unsafe sex (without a condom)
2. Blood exchange
- needles in the hospital (most of the time, this is
safe now)
- by using the same needles if someone is using
drugs
3. Breastfeeding

Do you want to know more?
Gansu CDC, Lanzhou 0931-8413459
www.cnukaids.org
www.chain.net.cn
www.unchina.org/unaids
The hospital
Li An

Photo: Yin Meng
Annex 6: What is Development I

Photo: Yin Meng
Annex 7: What is Development I

Photo: Yin Meng
Annex 8: What is Development I

Photo: Yin Meng
Annex 9: What is Development I

Photo: Yin Meng
Annex 10: What is Development I

Annex 11: Problem Tree
LOCAL CONSEQUENCES
WIDER
CONSEQUENCES
ROOT CAUSES
LOCAL CAUSE
LOCAL CONSEQUENCES
WIDER
CONSEQUENCES
PROBLEM: WHY IS THERE POVERTY IN CHINA?
ROOT CAUSES
LOCAL CAUSE
LOCAL CONSEQUENCES
ROOT CAUSES
WIDER
CONSEQUENCES
LOCAL CAUSE

Chlamydia A bacterial
infection of
the genital
area.
Trichomoniasis A parasitic
infection of
the genital
area.
What is it? How is it spread? Symptoms Possible
consequences
Through
unprotected
vaginal, oral or anal
intercourse.
Through
unprotected vaginal
intercourse or
vulva-to-vulva
contact.
Annex 12: Most Common STDs
There are no
symptoms in most
women and men.
Some may experience
abnormal vaginal
bleeding, unusual
discharge or pain
during urination within
one to three weeks of
having sex with an
infected partner.
Often there are no
symptoms, especially
in men. Some women
notice a frothy, smelly,
yellowish-green vaginal
discharge and/or
genital area discomfort,
usually within 5 to 28
days after exposure to
the parasite. Men may
notice
Infertility and increased
risk of HIV infection. In
women, Chlamydia can
lead to pelvic
inflammatory disease
(PID) and tubal
(ectopic) pregnancy.
Increased risk for
infection of other STDs,
including HIV. In
women, trich can cause
complications during
pregnancy. Also, it’s
common for this
infection to happen
again and again.
Treatment
Oral antibiotics cure the infection. Both
partners must be treated at the same
time to prevent passing the infection
back and forth, and both partners
need to abstain
from intercourse until the infection
is gone.
Antibiotics can cure the infection. Both
partners have to be treated at the
same time to prevent passing the
infection back and forth and need to
abstain from intercourse until the
infection is gone.

Gonorrhea A bacterial
infection of
the genital
area.
Human
Papilloma Virus
(HPV)
A viral
infection
with more
than 100
different
Through
unprotected
vaginal, oral, or
anal sex.
Through
unprotected
vaginal, oral, or
anal intercourse, or
by touching an
a discharge from the
penis or
a slight burning after
urination
or ejaculation.
Most people infected
have no symptoms. For
those who do,
it can cause a burning
sensation while
urinating, green or
yellowish vaginal or
penile discharge, anal
discharge or
discomfort, and for
women, abnormal
vaginal bleeding and/or
pelvic pain. Symptoms
can appear within 2 to
30 days
after infection.
Soft, itchy warts in and
around the genitals
(vagina, penis,
testicles, and anus)
may appear weeks or
Increased risk of
infection of other STDs,
including HIV, and
increased risk of
infertility. In women, the
infection can spread
into the uterus and
fallopian tubes, causing
PID, which can lead to
infertility and tubal
(ectopic) pregnancy.
Increased risk for
infection of other STDs,
including HIV. In
women, the persistent
infection with certain
Oral antibiotics. Both partners must be
treated at the same time to prevent
passing the infection back and forth,
and both partners need to abstain
from intercourse until the infection is
gone.
There is no cure, but warts can be
treated by medication or can be
removed through other methods. Even
with such treatments, the virus stays in
the body and can cause future

types, 30 of
which are
sexually
transmitted
and can
infect the
genital area,
both inside
and out.
Genital Herpes A viral
infection of
the genital
or rectal
area that
also can
occur
around the
mouth.
infected area
(infected areas may
not always be
noticeable).
By touching an
infected area
(infected areas may
not always be
noticeable), or
having unprotected
vaginal, oral, or
anal intercourse.
Warning: Some
people may be
contagious even
when they don’t
have symptoms.
months after exposure.
Many people, however,
have no symptoms but
are still contagious.
Most people have no
symptoms. Herpes 1
causes cold sores and
fever blisters on the
mouth but can be
spread to the genitals;
Herpes 2 is usually on
the genitals, but can be
spread to the mouth.
Outbreaks are often
recurrent and can
cause red bumps that
turn into painful blisters
or sores on genitals
and elsewhere. During
the first attack, flu-like
HPV types is the most
important risk factor for
cervical cancer;
however, the majority
of infected women do
not develop cervical
cancer.
Increased risk for
infection
of other STDs,
including HIV.
Recurring sores—the
virus
lives in the nerve roots
and
keeps coming back.
Passing
herpes from mother to
newborn
is rare; however, an
infant who
gets herpes can
become very
outbreaks.
There is no cure, but medications can
help reduce the pain, itching and
frequency of recurrent
outbreaks as well as reduce
transmission to partners.

Syphilis A bacterial
infection
that can
spread
throughout
the body.
Through
unprotected
vaginal, oral, or
anal sex—and also
through kissing if
there is a lesion on
the mouth.
symptoms—fever,
headaches, and
swollen glands—may
occur. Symptoms
usually appear within 2
weeks of infection and
can take 2 to 4 weeks
to heal.
In the first phase, a
single sore (chancre)
may appear on the
genitals or mouth 10 to
90 days after exposure
and may last for three
to six weeks. Often,
however, there are no
noticeable symptoms.
In the second stage, up
to several weeks after
the first sore has
disappeared, a variety
of symptoms can
appear, including a
rash (often on the
palms of the hands,
soles of the feet, or
ill, so precautions are
advisable.
Increased risk for
infection of other STDs,
including HIV.
Untreated, the
symptoms will
disappear, but the
infection stays in the
body and can progress
into the third stage,
damaging the brain,
heart, and nervous
system, and possibly
causing death. Syphilis
in women can seriously
harm a developing
fetus during pregnancy.
Antibiotic treatment can cure the
disease if it’s caught early, but
medication can’t undo damage
already done. Both partners must be
treated at the same time and must
abstain from intercourse until the
sores are completely healed.

Hepatitis B Virus A viral
infection
affecting the
liver.
Through
unprotected
vaginal, oral, and
anal sex, but also
through sharing
contaminated
needles or any
behavior in which a
person’s mucus
membranes are
exposed to an
infected person’s
blood, semen,
vaginal secretions,
or saliva. The
chance of getting it
through kissing
is low.
genital area). Though
symptoms may
disappear, the disease
is still present.
Many people don’t
have any symptoms.
Others may
experience tiredness,
aches,
nausea and vomiting,
loss of appetite,
darkening of urine,
or tenderness in the
stomach,
usually within one to six
months of exposure.
Yellowing of the
skin and the whites of
the eyes (called
jaundice) can occur
later.
Increased risk for
infection of
other STDs, including
HIV, and
also Hepatitis C.
Chronic, persistent
inflammation of the
liver and later cirrhosis
or cancer of the liver. If
you are infected and
pregnant, your baby
must be immunized at
birth.
Most cases clear up within one
to two months without treatment,
during which time you should not drink
alcohol until liver function returns to
normal. Some people are contagious
for the rest of their lives. A three-dose
vaccine is
now available.
(Source: “It’s your [sex] life – your guide to safe and responsible sex”, The Henry J Kaiser Family Foundation and MTV Think, 2005)

Scale/Mainstreaming Stage
Indicator 0 1 2 3
Does the organisation plan any HIV
and AIDS mainstreaming activities?
What is the organisation's commitment
to HIV and AIDS mainstreaming?
Are the organisation's
beneficiaries/stakeholders involved in
HIV and AIDS mainstreaming
activities?
Does the organisation have
partnerships with any HIV and AIDS
organisations?
Has the organisation implemented
activities to build the staff capacity to
address HIV and AIDS?
Annex 13a: HIV Mainstreaming Assessment Tool I (English version)
This tool is to help determine which stage of HIV mainstreaming all partners are at. By using this, each team can determine which partners
they will work with on focused mainstreaming work for the next year.
No activities are planned.
Employees and
managers are generally
not involved. Work is led
by VSO volunteers only.
Beneficiaries are not
involved.
They do not work with
other HIV and AIDS
organisations.
No such activities have
been implemented
Has planned some
activities, mostly around
World AIDS Day.
Employees and
managers are sometimes
involved. It is usually led
by a few committed
individuals.
Beneficiaries are
sometimes involved.
They sometimes work
with HIV and AIDS
organisations.
General HIV awareness
trainings.
Has 1 year HIV and AIDS
mainstreaming workplan.
Employees and
management at all levels
are involved and believe it
is important to their work.
Beneficiaries are often
involved.
They have partnerships
with HIV and AIDS
organisations.
Some specialised HIV
awareness trainings.
HIV and AIDS
mainstreaming is part
of long-term and
strategic planning.
Everyone is involved -
employees,
managers,VSO
volunteers,beneficiarie
s.
Beneficiaries are
regularly involved.
They have long term
and planned
partnerships with HIV
and AIDS
organisations.
HIV is part of the
regular organisation
training programmes.
Scale

Does the organisation have focal
points who work on HIV?
Does the organisation have finances
for HIV and AIDS activities?
Does the organisation have a HIV and
AIDS workplace policy?
Has the organisation adjusted its
strategies in the context of HIV and
AIDS?
Does the organisation have a
monitoring and evaluation strategy for
HIV and AIDS?
No HIV and AIDS focal
points exist.
No finances exist for HIV
and AIDS activites.
No workplace policy
exists.
No adjustment has taken
place.
No monitoring or
evaluation strategy is in
place.
Focal points exist but are
not well organised and
many lack training and
resources.
Have minimal finances for
HIV and AIDS activities.
A workplace policy is
being developed to
address HIV.
Have allocated employee
hours for workplace
activities and a workplace
policy is being developed.
Some HIV and AIDS
activity inputs are
recorded but mainly for
financial purposes.
Focal points are well
Focal points have some trained, well organised
training and are somewhat and well equipped with
organised to work on HIV resources to implement
and AIDS training. HIV and AIDS
activities.
Have regular funding from
internal and external
sources for HIV and AIDS
actions.
There is a workplace
policy addressing HIV but
no implementation or
sharing to workforce has
taken place.
Some guidelines, job
descriptions & work
strategies have been
revised or introduced to
support HIV and AIDS
activities.
HIV and AIDS is
monitored separately from
other organisations
activities.
Have budgeted for HIV
and AIDS activities
throughout the year.
HIV and AIDS
workplace policy is
implemented and all
staff are aware.
Adjustments are made
based on experience
and research findings.
HIV and AIDS activities
are monitored along
with the organisation's
other programmes and
projects.

等级/主流化阶段
指标 0 1 2 3
该组织计划开展任何HIV/AIDS主流化
活动吗?
该组织在HIV与AIDS主流化方面的承诺
是什么?
该组织的受益人/利害关系人参与HIV
/AIDS主流化活动吗?
该组织与任何HIV 与 AIDS组织具有合
作伙伴关系吗?
该组织实施过增强工作人员应对
HIV/AIDS的能力的活动吗?
不计划开展任何活动。
员工和管理层通常不参
与,此项工作仅由志愿者
进行。
已经计划了一些活动,大
多围绕世界艾滋病日
员工和管理层有时参与。
此项工作通常由少数热衷
于此项工作的个人进行。
具有一年期HIV/AIDS主
流化工作计划。
各级员工和管理人员都参
与,并相信这对于他们的
工作很重要。
HIV/AIDS主流化是
长期及战略规划的一
部分。
每个人都参与,员工
、经理、受益人。
受益人不参与。 受益人有时参与。 受益人不经常参与。 受益人定期参与。
他们不与其他HIV 与
AIDS组织合作。
Annex 13b: HIV 与 AIDS 主流化评估工具
本工具旨在帮助确定各合作伙伴的HIV主流化进程处于哪个阶段。通过使用此工具,每个小组均可确定下一年与哪个合作伙伴合作
进行重点主流化工作。
他们有时与HIV 与 AIDS
组织合作
他们与HIV 与 AIDS组织具
有合作伙伴关系。
他们与HIV 与 AIDS
组织具有长期和有计
划的合作伙伴关系。
未实施过任何此类活动。 一般HIV知晓培训。 一些专业的HIV知晓培训。 HIV是定期组织培训
计划的组成部分。
等级

该组织具有HIV工作重点(focal
points)吗?
没有任何HIV/AIDS 重
点存在。
有重点存在,但组织不
利,且许多缺乏培训和资
源。
有一些培训,且在开展HIV
/AIDS培训方面,略有组
织。
重点有着良好的培训
、良好的组织,且配
备有良好的资源来实
施HIV/AIDS活动。
该组织有HIV/AIDS活动资金?
没有HIV/AIDS活动资金
存在。
具有最小限度的HIV/
AIDS活动资金存在。
具有内外部资源提供的定
期资金提供,供HIV/
AIDS活动使用。
常年具有HIV/AIDS
活动预算。
该组织具有HIV/AIDS工作场所政策
吗?
没有工作场所政策存在
正在制定针对HIV的工作
场所政策。
有针对HIV的工作场所政
策,但未实施且未共享劳
动力。
已实施HIV/AIDS工
作场所政策,且所有
工作人员都知晓。
该组织调整过HIV/AIDS方面的策略
吗?
未发生过任何调整。
已为工作场所活动分配员
工工时,同时正在制定工
作场所政策。
为支持HIV/AIDS活动,
修订或引进了一些指导方
针、工作描述及工作策略
。
依据经验和调研结果
进行调整。
该组织具有HIV/AIDS监测与评估策略
吗?
没有任何监测或评估政策
实施到位。
有一些HIV/AIDS活动输
入记录,但主要是为了经
济目的。
HIV/AIDS与该组织的其
他活动分开监测。
HIV/AIDS活动与该
组织的的其他计划和
项目一同监测。

Milestones/Indicators
1) What is the
organisation’s
commitment to HIV
mainstreaming?
Annex 14: HIV Mainstreaming Assessment Tool II
Stage (year)
0 1 Activities 2 Activities
HIV mainstreaming is HIV mainstreaming Meet with VSO to HIV
Implement HIV
generally led by the is considered of understand the HIV mainstreaming is a workplace policy
volunteers.
some importance to mainstreaming concept and considered
(see workplace
Management and the organisations why it is important to their fundamental part policy indicator).
staff are not involved. work by some work.
of the organisation The job
management and Focal person/organisation work, both recruitment
staff. Volunteers and attends training to internally and process
few staff take the understand HIV as an externally. All includes HIV
lead in important development levels of the mainstreaming
mainstreaming work. issue.
organisation are
VSO shares case-studies of involved, including HIV
HIV mainstreaming work. management/lead mainstreaming
Training sessions for ers, staff, objectives are
internal staff on HIV basic volunteers and set for each staff
awareness.
beneficiaries.
member as part
Develop a statement of
of their
commitment. Could include:
professional
“we take a non-judgmental
development
and non-discriminatory
and are
approach regardless of
reviewed during
gender or HIV status” (can
appraisals and
include other things
performance
批注 [B1]: 1)JD includes HIV
mainstreaming objective
2) Application – question about
development issues in China
including HIV.
3) Question about stigma and
discrimination
4)Interview- emphasis of
organisation’s commitment to
preventing the spread of HIV.

2) What is the
awareness level of HIV
and
staff?
AIDS amongst
Staff have no or very
limited knowledge of
HIV and AIDS
Staff have basic
knowledge of HIV,
including ways of
transmission and
means of protection.
depending on context).
Allocate time for all staff to
participate in HIV
mainstreaming work as part
of their personal and
professional development.
Budget is set aside for
mainstreaming work.
Carry out a confidential
internal survey on people’s
knowledge and attitudes to
HIV. This will be your
baseline data.
Training sessions are
designed and delivered
according to needs
identified in the baseline
survey. Training could
cover: HIV transmission
modes, means to prevent
All staff are
confident in their
awareness of HIV.
reviews.
Annual budgets
include costs for
mainstreaming
work. It is no
longer a
separate budget
for this. External
funding may be
sought for some
activities or
research or
resource
development.
Develop a basic
health session
or HIV session
for all new staff
as part of their
induction.
Develop a range
of activities for
HIV
mainstreaming
with partners
including WAD
批注 [B3]: Include information
on: basic knowledge and means of
protection, workplace policy,
information on VCT. Maybe a
handout with this information for
staff to take away and read?

3) Is there a HIV
workplace policy?
4) What HIV and AIDS
Information/Resource
are available?
No workplace policy
in place.
No information or
resources about HIV
available for staff.
The organisation
begin to develop a
workplace policy that
is relevant to their
own context.
An information area
is created for staff.
This area contains
information on basic
HIV information,
HIV, what are HIV and
AIDS, positive living, stigma
and discrimination.
Develop activity/activities
for staff, volunteers and
beneficiaries for World
AIDS Day (WAD).
VSO shares examples of
HIV workplace policies.
Arrange a meeting with all
staff to decide on what
elements should be
included in their own
workplace policy.
Work with partners and
networks to provide
technical support for this
policy.
Select a focal person (or
team depending on size of
organisation) to initially take
the lead on HIV
mainstreaming work. This
The organisation
implement its HIV
workplace policy
(pilot phase).
The HIV
information area is
used and
maintained by all
staff. It may evolve
for everyone to
participate in.
Information
available to all
staff on HIV.
Arrange a
meeting to
inform all staff of
the workplace
policy and what
is available.
Review policy in
6 months from
implementation
and evaluate
after 1 year.
Make any
necessary
changes.
The area is
updated by all
staff with
current news
about HIV and
批注 [B2]: VSO and other
networks can provide technical
support, resources, VSO
volunteers could help with
co-facilitation.
批注 [B4]: 1)Regular awareness
raising sessions.
2) Local confidential VCT
referral services.
3) Any financial contribution?
Tests, treatment, allowances
4)Flexible working
5)Free condoms
6)Guaranteed confidentiality and
support
if status is disclosed –
supportive environment.
批注 [B5]: Is the policy being
used? Are people attending
sessions? Are they using the free
condoms? Have people’s attitudes
changed? Is it a more supportive
environment?

contact details for
VCT, a copy of the
workplace policy,
news articles, dates
of training.
person will be supported by
the whole organisation.
Select an accessible area in
the office to be the HIV
information area.
Focal person collects
resources for this area
including information about
local referral system.
VSO supports organisation
through sharing resources,
e.g. the HIV Q&A book.
Update the area as needed
to ensure all information is
relevant.
Provide free condoms for
staff to be placed in the
bathrooms. All staff are
aware that these are
available.
The focal person monitors
the uptake of condoms and
replenishes as needed.
The focal person monitors
through observations,
informal discussions and
into a general
notice area about
development
issues overall or
be a health notice
board for staff. It is
tidy and has
current
information. The
whole organisation
takes
responsibility
the area.
for
other
development
issues.
New resources
are found and
shared.
Designated
members of staff
replenish
condoms
stocks.

5) What links does the
organisation have with
local and national
agencies to support
their HIV
mainstreaming work?
The organisation has
no links with external
agencies apart from
VSO. It does not have
any contact with local
CDC, HIV and AIDS
NGOs.
The organisation
has begun to make
links with local
agencies that can
support their HIV
mainstreaming work.
other means, the interest
people take in the corner,
how many leaflets are
taken, any suggestions
made by staff.
Identify local agencies that
work in HIV and AIDS
through desk research and
networks.
exercise).
(Mapping
Organise a meeting with
CDC to discuss local
context of HIV to inform all
other mainstreaming work.
How many people are
affected? What support is
available? What work is
being done? What are the
challenges? Any resources
they can share?
Set up meetings with local
HIV and AIDS organisations
to find out about their work
and possibilities of support
for organisation's
mainstreaming work.
The organisation
has good
relationships with
a number of
partners both local
and national that
support their HIV
mainstreaming
work.
Keep in regular
with
partners,
your
updating them
on your work not
just on HIV but
overall. Keep
updated with
what work they
are doing too.
Invite partners to
provide
feedback to HIV
mainstreaming
ideas. Ask them
to be involved in
facilitating
designing
and
trainings
needed.
if
Organise joint

6) How are people
living with HIV (GIPA
Principle) involved in
the project cycle?
Important Note: If the
GIPA principle is not
undertaken with
sensitivity, it can lead
to exploitation of
PLWHA and cause
bad feeling and
resentment amongst
PLWHA groups.
Wider beneficiaries
are only involved at
the needs analysis
stage of projects. The
needs of people living
and affected by HIV
are seen as no
different/not
considered. Projects
are not aware if
PLWHA are part of
the wider
beneficiaries.
Wider beneficiaries
are more involved in
the project cycle.
The needs of people
affected by HIV are
considered.
Identify a few key partners
that can support your HIV
mainstreaming work after
initial mapping.
Work with these partners to
design and deliver your
internal HIV mainstreaming
work. Partners will provide
technical support, guidance
and possibly facilitation of
trainings.
When conducting needs
analysis staff goes to the
beneficiaries to understand
their needs before
designing project. Any initial
ideas for projects are
discussed at this stage to
ensure relevance,
buy-in/support and it helps
to alleviate poverty.
Understand the local HIV
epidemic and how it
impacts your beneficiaries
and projects.
Where possible, meet with
There is greater
involvement of all
beneficiaries
including GIPA.
events and
support each
others
activities.
WAD
Involve
beneficiaries at
every stage of
project cycle.
Build genuine
relationships
with
beneficiaries to
gain their
support
trust.
and
Work with
beneficiaries to
amend any
projects to make
批注 [B6]: Ensure regular contact
via email, telephones, meetings
and attending any events. Invite
them to any events you have so
you both gain a better
understanding of each others
work.
批注 [B8]: We use wider
beneficiaries because
mainstreaming does not involve
separating PLWHA from other
beneficiaries but taken account
their needs. Some projects may
not target PLWHA or have no
PLWHA as part of their wider
beneficiaries.
批注 [B7]: Greater Involvement
of People Living with HIV and
AIDS.

7) How are
vulnerabilities to HIV
considered at all levels
of programme and
projects?
There is little or no
knowledge of the
direct or indirect
vulnerabilities of HIV
on programmes and
projects.
Programme staff
begin to understand
some of the direct
and indirect
vulnerabilities of HIV
on their work and for
their beneficiaries.
people living and affected
by HIV to better understand
their needs.
Monitor the projects with
involvement of all
stakeholders. What are the
impacts so far, has it helped
or hindered? Increasing or
reducing vulnerability?
Organise training on HIV as
a development issue for all
staff. how does it increase
poverty? What makes
people vulnerable? What
impact does it have on a
community? Impact on a
town, country?
Use one project as a
case-study, analyse the
vulnerabilities to HIV.
Develop an action plan to
reduce the vulnerabilities.
Monitor the changes, are
there any? If so what?
Programme staff
are aware of the
vulnerabilities of
HIV and are
implementing
changes to their
work.
them more
relevant to their
lives.
Process
designing
projects
of
changed to
include
analysing
:
vulnerability to
HIV and making
action plan to
reduce
vulnerability.
Ask HIV and
AIDS partners to
look over any
project
proposals
assess
to
批注 [B9]: This is a sensitive area.
It can be easy to make people
living with HIV feel that they are
being exploited. Involvement
must be genuine and without
judgment.
Confidentiality must be assured.

8) What is the current
monitoring and
evaluation (M&E)
system?
The organisation has
M&E systems in
place for projects but
nothing related to HIV
mainstreaming.
Current M&E systems
may be weak.
The organisation
begins to develop
more
comprehensive M&E
systems. HIV is
beginning to be
incorporated in its
M&E systems.
The organisation reviews its
M&E systems. 1) What is
the current system? 2) Who
does it involve? 3) Does it
capture impact?
VSO shares its own M&E
system that includes HIV
mainstreaming and
supports organisation to
strengthen theirs.
The organisation looks at
other organisation's M&E
frameworks.
New tools are developed
that are participatory.
Tools are piloted.
Feedback collected from all
stakeholders on the new
tools.
The organisation
implements a
revised M&E
system that
includes HIV
mainstreaming.
vulnerabilities to
HIV.
Monitor levels of
stigma and
discrimination,
new infections,
knowledge.
The revised
system is
shared amongst
all teams.
The M&E is
implemented.
Information
HIV
on
mainstreaming
is shared
amongst
teams.
all
The M&E tools
are reviewed
and amended
as needed.

Amendments are made to
new tools.

Annex 15: HIV Workplace Policy PPT
HIV Workplace
Policies
September 2009

What is a policy?
• A set of guidelines instituted by an
organisation. It sets out clear boundaries,
protecting both employees and employers.
Workplace policies can range from
anything from dress code to discrimination,
sexual harassment and abuse in the
workplace.

Why do we need a policy?
“We cannot continue to tell communities to take
HIV/AIDS seriously if we fail to take action to protect
and support staff in our own organisation”
ACORD staff member Mozambique
• To be a responsible employer.
• It is a commitment to action.
• To guide managers on how to deal with HIV and AIDS
issues among their staff.
• It helps employees to know what support is available to
them.
• Ensures all employees at ALL levels know what is
expected of them (stigma and discrimination).
Any other reasons?

What does a HIV policy look like?
No standard HIV policy. Organisations need to
develop a policy that is suitable to their own
environment.
Things to consider:
• Prevalence rate – high or low?
• Is there support from management?
• What can the organisation realistically offer the
organisation? E.g. Are there funds to cover testing,
treatment?

What can a policy include?
ILO guidelines –
• General statement – sets out how the
policy relates to the local context and other
company policies.
• General principles – for example, the
organisation will not tolerate discrimination,
the organisation understands that HIV can
affect anyone at anytime, no-one is
immune.

• What support the organisation can offer –
a) financial support through testing and
treatment b) prevention through education,
information and training
• Implementation and Monitoring – how the
policy will be implemented across the
organisation asking for all employees to
pledge their support. How the policy will be
monitored to determine if it is successful
and reviewed.

Steps to developing a policy
1. Start with a knowledge, attitude and behaviour (KAB)
survey to assess staff’s awareness of HIV.
2. Discussions begin with need for a workplace policy
using results from KAB survey.
3. Develop draft policy. Focal person or people may lead
on drafting policy but this should then be shared with
all members of the organisation and discussed and
reviewed.
4. Policy implementation. Supported with prevention work.
5. Policy monitored and reviewed through surveys and
feedback from staff.
6. Amend and update all staff on new policy.

CASE STUDIES

1. Christian Aid
2002 - mainstreaming HIV became an organisational priority;
began developing policy.
Set up a HIV unit to co-ordinate activities across the
organisation.
Developed a HIV awareness booklet for all staff.
Consultation with all staff about the development of a policy.
Field offices gathered data about the HIV context in their area,
issues HIV positive staff were facing, how could the
organisation better support them.
Data presented to the Directorate who realized the need for a
workplace policy. Having their buy-in helped to move things
along much quicker.
A key element of the policy was providing education and
training to all staff to prevent the spread of HIV. Local offices
are responsible for developing their own education programme
relevant to the local context.
Time frame – 9 months.

2. NGOs and Small Medium Enterprises in
Uganda
More external support needed because of the size of NGOs and
SMEs.
Their HIV project included comprised of 3 elements:
1. Information and Education activities – an annual program, 1
IEC session per month for 1 hour during work hours. Used
participatory methods. Example of topics; basic knowledge
about HIV; STDs and HIV and AIDS; VCT; positive living;
ARVs; stigma and discrimination.
2. Peer Education – each company nominates 2-3 people to be
trained as peer educators who will ensure sustainability of the
HIV and AIDS workplace program.
3. HIV workplace policy - developed through meetings with
senior management, peer educators and the project team.
Each company developed a policy tailored to their needs.

3. NGOs in Uganda – Stop AIDS Now!
project
• Sensitisation workshop – senior managers and directors of
the organisation attended. Realised the vulnerability of their
staff/organisation to HIV. Some organisation’s recognized that
long travel periods to the field and workshops increased risk
especially those of younger age range (20-30).
• However, because of no follow-up to the training, did not start
developing the policy because they were unsure about how to
proceed.
• When the sessions were reinitiated – participants fed back to
other staff at regular meetings or directly to management.
• Began with a KAB survey.
• Real-life stories - powerful motivation to begin work
• Focal person or committee developed draft and shared with
organisation for comments.

Content of Policy
• Link to free health services for NGOs that can’t afford ARVs.
• One organisation committed to PMCT support through food.
• Disciplinary action - if discrimination is found (suspension –
dismissal)
• Allocated area for education and counseling including a
suggestion box.
• Part of induction pack for all new staff.
• Family days - where all the family can learn about HIV.
• Liaise with other organisations.
• Sharing of good practice – organisations began to network
with each other and were proactive and asked for information.
• Tackle gender issues - Support men to also care for sick,
reducing burden of care for women.
• Condoms available to staff in toilets and in the AIDS corner.
• Signed up to receive email updates from the AIDS information
centre

4. Heineken in Africa
• Has lots of employees that are on short-term or monthly
contracts e.g. truck drivers, so there is not a steady
relationship between employer and employees.
Therefore the emphasis of their programme is
PREVENTION.
• E.g. on family day they give information on HIV and
promote VCT.
• Successful because; a) focus on small target population
b) commitment from all levels of the company c) serious
investment in training and knowledge transfer d) active
search for partnerships with NGOs and transparent to
government.

5. Celtel mobile phone
company in Africa
• Management communicated their commitment through
signed letter from the MD which is displayed in every
Celtel office.
• Clear information is given to each employee about what
the programme means, how it works, which VCT centres
are contracted and how confidentiality is guaranteed.
• HR dept are allocated to be responsible for the
implementation of the programme.
• M&E of policy included focus group discussions, KAPB
survey, HIV prevalence survey (anonymous).
• Success – because of management support, guaranteed
confidentiality, and realization that it is a long-term
process – it takes time to see the effect.

Learnings from these case studies
1. Management buy-in is essential.
2. Use of real-life case studies.
3. Need to create an open and safe
environment.
4. Need to ensure sustainability – focal
person or team.
5. Need to involve PLWHA.

Challenges
1. Lack of support from management.
2. Stigma.
3. Lack of time.
4. Lack of skills of staff.
5. Funding.

Summary
In China, it may be that most organisation
don’t have an HIV workplace policy
because they don’t think it is relevant to
them.
Key things to remember:
1. Management support is needed.
2. Have to make it relevant to their own
organisation.

Context
• What is their power base and support base? What is yours?
• Are there background issues which might impact on the negotiation? Do you have an
ability to influence sources of leverage?
Planning and preparation
• Who is involved? How will you handle the people problem? What roles will your team
members each take?
• What are your interests? Which are most important? Do you know what you are prepared
to concede?
.
• What are their interests?
• What are some realistic objectives?
• Which objective criteria/principles are relevant? Do these show you what you will not
concede e.g. impartiality?
Establishing the climate
• What are their customs, norms of behaviour (pace, formality, directness of communication,
oral or written agreements)
• What is conveyed by location, non- verbal communication?
Exploring needs and options
• Explore their interests. If given a position in reply - ask the question 'Why?'
• Show your understanding of their interests
• Explain your interests. Be specific.
Working towards solutions
• Be prepared for conflict at this stage. Be neither hostile nor submissive.
• Take a strong stance on attacking the problem, but not the people.
• Look as widely and creatively as possible for options for mutual gain.
• Insist on using objective criteria. Invite them to state their reasoning. 'How did you arrive at
that figure?'
When things are tough
• Ask questions rather than making statements e.g.'Correct me if I'm wrong, but is........?'
• Use silence to lead them into answering a question or as a response to personal attacks
Closing
Annex 16: Guidelines on deciding negotiation strategies
• If you are not completely ready to sign off take a break and suggest when to meet again.
• Make a clear concise statement of the agreement as you understand it, confirming details.
• Thank everyone for their time and co-operation

Annex 17
Term
AIDS (Acquired
Immunodeficiency Syndrome)
Annex
Glossary Of HIV and AIDS Terms
Definition
A condition caused by infection with Human Immunodeficiency
Virus (HIV). HIV injures cells in the immune system. This
impairs the body’s ability to fight disease. People with AIDS are
susceptible to a wide range of unusual and potentially lifethreatening
diseases and infections. Diseases can often be
treated, but there is no successful treatment for the underlying
immune deficiency caused by the virus. AIDS is the last and
most severe stage of the clinical spectrum of HIV-related
disease.
Antibodies These are proteins that the body makes to attack foreign
organisms and toxins. Foreign organisms and toxins are called
antigens. They circulate in the blood. Antibodies are usually
effective in removing antigens from the body. Following infection
by some organisms such as HIV, however, the antibodies do
not get rid of the antigen. They only mark its presence. When
found in the blood, these ‘marker’ antibodies indicate that
infection by HIV has occurred.
Antigen Any substance – such as bacteria, virus particles or toxins – that
stimulates the body to produce antibodies. HIV is an antigen.
Antigen Screens Blood tests that are designed to detect the antigen instead of
antibodies produced in response to the antigen. There are
several types of HIV antigen screens.
Antiretroviral medicine (see Medication used to fight infection by retroviruses, such as HIV
also HIV Medications)
infection.
Antiretroviral therapy A treatment that uses antiretroviral medicines to suppress viral
replication and improve symptoms. Effective antiretroviral
therapy requires the simultaneous use of three or four
antiretroviral medicines, otherwise known as highly active
antiretroviral therapy (HAART).
ARC (AIDS-related complex) This term refers to the condition of immunosuppression caused
by the HIV infection. General symptoms of HIV disease are
present, but none of the formal indicators of AIDS (such as
specific opportunistic infections) are present. This term is now
being replaced by PGL (Persistent generalized
Asymptomatic
lymphadenopathy).
Having no signs and symptoms of illness. People can have HIV
infection and be asymptomatic. Usually used in AIDS literature
to describe a person who has a positive reaction to one of
several tests for HIV antibodies, but who shows no clinical
symptoms of the disease.
Body Fluids Any fluids made by the body. The only body fluids that may
contain significant concentrations of HIV are: blood (including
menstrual blood), semen, breast milk, peritoneal fluid, amniotic
fluid etc. Other body fluids that may fall under this category are
body cavity fluids derived from blood such as cerebrospinal fluid
(more important for health professionals).
CD4+ (helper T cells) A large glycoprotein that is found on the surface of T4 cells and
is the receptor for HIV. White blood cells killed or disabled
during HIV infection. These cells normally orchestrate the
27

immune response, signalling other cells in the immune system
to perform their special functions. Also known as T helper cells.
HIV’s preferred targets are cells that have a docking molecule
called cluster designation 4 (CD4) on their surfaces. Cells with
this molecule are known as CD4-positive (or CD4+) cells.
Destruction of CD4+ lymphocytes is the major cause of the
immunodeficiency observed in AIDS, and decreasing CD4+
lymphocyte levels appear to be the best indicator of morbidity in
these patients. Although CD4 counts fall, the total T-cell level
remains fairly constant through the course of HIV disease, due
to a concomitant increase in the CD8+ cells. The ratio of CD4+
to CD8+ cells is therefore an important measure of disease
progression.
Co-factor A situation or activity that may increase a person’s risk for
progressing from asymptomatic HIV infection to symptomatic
disease or AIDS. Examples of possible co-factors are: other
infections, drug and alcohol abuse, homelessness, poor
nutrition, genetic disorder, stress etc.
Condom (female) A pouch made of polyurethane inserted into the vagina before
intercourse and held in place by a loose inner ring and fixed
outer ring. The female condom prevents conception and
provides protection from sexually transmitted infections. Unlike
the male condom, it does not depend on the man’s erection.
Condom (male) A sheath unrolled over the erect penis. Male condoms made
from latex or polyurethane prevent conception and transmission
ELISA (enzyme-linked
immunosorbent assay) test
of HIV and other sexually transmitted infections.
A blood test that detects the presence of antibodies to a specific
antigen. Relatively cheap HIV antibody test. If a blood test is
positive, where possible it should be confirmed by the more
accurate but more expensive Western Blot test.
Epidemiology The branch of medical science that deals with the study of
incidence, distribution and control of a disease in a population.
False negative
An incorrect test result that indicates that no HIV antibodies are
present when in fact infection has occurred.
False positive
An incorrect test result that indicates that HIV antibodies are
present when in fact infection has NOT occurred.
High-risk Behaviour A term used to describe activities that increase a person’s risk
of transmitting or becoming infected with HIV. Examples of high
risk behaviours include: unprotected vaginal or anal intercourse
(without a condom) or using contaminated injection needles or
syringes. These are often also referred to as unsafe activities.
Highly active antiretroviral The name given to treatment regimens recommended by
therapy (HAART)
leading HIV experts to aggressively suppress viral replication
and progress of HIV disease. The usual HAART regimen
combines three or more different drugs such as two nucleoside
reverse transcriptase inhibitors and a protease inhibitor, two
nucleoside reverse transcriptase inhibitors and a nonnucleoside
reverse transcriptase inhibitor, or other
HIV
combinations. These treatment regimens have been shown to
reduce the amount of virus so that (with commonly-used tests) it
becomes undetectable in a patient’s blood; even so, the virus
may still be present in blood and body fluids.
Human Immunodeficiency Virus. The standard name was
officially chosen in August 1986 to avoid confusion after
different countries gave the virus other names. In old literature
28

one may see the virus referred to as: HTLV-III, LAV or ARV.
HIV-1 The retrovirus that is the principal worldwide cause of AIDS.
HIV-2 A retrovirus closely related to HIV-1 that also causes AIDS in
humans, found principally in West Africa
HIV-infected As distinct from HIV-positive (which can sometimes be a false
positive test result, especially in infants of up to 18 months of
age). The term HIV-infected is usually used to indicate the
evidence of HIV has been found via a blood or tissue test.
HIV incidence Sometimes also referred to as ‘cumulative incidence’, is the
proportion of people who have become infected with HIV during
a specific period of time.
HIV medications HIV medications fall under 4 classes: protease inhibitors, nonnucleoside
reverse transcriptase inhibitors, nucleoside/
nucleotide analogue reverse transcriptase inhibitors and (most
recently) entry inhibitors (only one medication currently available
under this class: Fuzeon)
HIV-negative Showing no evidence of infection with HIV (e.g. absence of
antibodies against HIV) in a blood or tissue test. Synonymous
with seronegative.
HIV-positive Showing indications of infection with HIV (e.g., presence of
antibodies against HIV) on a test of blood or tissue.
Synonymous with seropositive. Test may occasionally show
false positive results.
HIV prevalence Usually given as a percentage, HIV prevalence quantifies the
proportion of individuals in a population who have HIV at a
specific point in time.
HIV vaccine, preventive A vaccine designed to prevent an HIV infection becoming
established in a person.
HIV vaccine, therapeutic Also called treatment vaccine. A vaccine designed to boost the
immune response to HIV in persons already infected with the
virus.
Immune system All of the mechanisms (e.g. T cells) that act to defend the body
against external agents particularly microbes, viruses, bacteria,
fungi and parasites.
Incidence The number of new cases occurring in a given population over a
certain period of time.
N.B. The terms prevalence and incidence should not be
confused. Incidence only applies to the number of new cases,
while the term prevalence applies to all cases old and new.
Incubation period The time interval between HIV infection and the onset of AIDSdefining
illnesses.
KS (Kaposi’s Sarcoma) Many people with AIDS experience this cancer of the
connective tissues in blood vessels. Pink, broken or purple
blotches on the skin may be a symptom of KS. KS lesions
sometimes occur inside the body in lymph nodes, the intestinal
tract and the lungs.
Life skills Life skills are cognitive, personal and interpersonal abilities that
help people make informed decisions, solve problems, think
critically and creatively, communicate effectively, build healthy
relationships, empathize with others, and cope with and manage
their lives in a healthy and productive manner.
There is no definitive list of life skills! The listing below only
includes the interlinked psychosocial and interpersonal abilities
generally considered important.
29

Learning to know – cognitive skills
• Decision making/problem solving skills
• Critical thinking skills
Learning to be – personal skills
• Skills for increasing internal locus of control
• Skills for managing feelings
• Skills for managing stress
Learning to live together – communication and interpersonal
skills
• Interpersonal communication skills
• Negotiation/refusal skills
• Empathy
• Cooperation and teamwork
• Advocacy skills
Morbidity rates The percentage of those who are ill during a particular span of
time
Mortality rates The percentage who die during a particular span of time
Opportunistic infections Infections caused by organisms that do not normally cause
disease in people whose immune systems are intact. Some of
the most common opportunistic infections indicating that
someone has AIDS are: PCP (pneumocystic carinii pneumonia),
oesophageal candidiasis, toxoplasmosis etc.
Pandemic A disease prevalent throughout an entire country, continent or
Post-exposure prophylaxis
(PEP)
the whole world
Post-exposure prophylaxis (PEP) is an emergency medical
response that can be used to protect individuals exposed to
HIV. PEP consists of HIV antiretroviral medication,
laboratory tests and counselling. Ideally PEP should be
initiated within 2 to 24 hours (and no later than 48 to 72
hours) of possible exposure to HIV, and must continue for
approximately four weeks.
Although PEP has not been conclusively proven to prevent
the transmission of HIV infection, research studies suggest
that if medication is initiated quickly after the possible
exposure (ideally within 2 to 24 hours and no later than 48
to 72 hours) it may be beneficial. The efficacy of PEP is
probably higher if treatment is started within the first few
hours of exposure and is probably progressively reduced if
started later. After 48 to 72 hours, the benefits are probably
minimal (or non-existent) and the risk of intolerance and
side-effects associated with antiretroviral treatments will
outweigh any potential preventive benefit.
Prevalence A measure of the proportion of people in a population affected
with a particular disease at a given time.
NOTE: the terms prevalence and incidence should not be
confused. Incidence only applies to the number of new cases,
while the term prevalence applies to all cases old and new.
Retrovirus A type of virus that is able to insert its genetic material into a
host cell’s DNA. Retrovirus infections had not been found in
human beings until recently. HIV is a retrovirus.
30

Risk reduction The process of adopting behaviours that reduce the likelihood
that an individual will be exposed to HIV.
Safer sex Sexual activities that are not likely to transmit HIV. Safer sex
involves sexual expressions in which partners make sure that
blood, semen, vaginal mucus and menstrual blood from one
person do not come into contact with the other person’s
bloodstream or mucous membranes (vulva, vagina, rectum,
mouth and/or nose). This can be prevented by the use of male
or female condoms.
Seroconversion The development of antibodies in response to an antigen. With
HIV, seroconversion usually occurs 4 to12 weeks after infection
is acquired, but in very few cases it has been delayed for 6
months or more.
Serodiscordant couples Couples composed of one HIV negative and one HIV positive
partner.
Seronegative Testing negative for HIV antibodies.
Seropositive Testing positive for HIV antibodies.
Seroprevalence
The rate of seropositivity in a defined population. Suggests the
rate of HIV infection for that population.
Sensitivity (of the test) Is defined as the ability of the test to identify correctly those who
have the disease
Specificity (of the test) Is defined as the ability of the test to identify correctly those who
do not have the disease
Sexual debut The age at which a person first engages in sexual intercourse.
Spermicide A contraceptive that works by killing sperm in semen. Some
spermicides, such as nonoxynol-9 have also been
demonstrated to kill HIV in laboratory tests.
Surveillance The ongoing and systematic collection, analysis, and
Syndrome
interpretation of data about a disease or health condition.
Collecting blood samples for the purpose of surveillance is
called serosurveillance.
A group of symptoms as reported by the patient and signs as
detected in an examination that together are characteristic of a
specific condition.
T Cell One type of white blood cell. One type of T cell (T-4
Lymphocytes, also called Helper T cells) is especially apt to be
infected by HIV. By injuring and destroying these cells HIV
damages the overall ability of the immune system to fight
diseases.
Transmission (HIV) For HIV transmission to occur two conditions must be satisfied:
the presence of the virus and a port of entry into the body.
The three most common modes of transmission are:
1. Unprotected sexual contact with an infected partner. The
virus can enter the body through the mucosal lining of
the vagina, vulva, penis, rectum or, very rarely, the
mouth during sex. The likelihood of transmission is
increased by factors that may damage these linings,
especially other sexually transmitted infections that
cause ulcers or inflammation.
2. Direct contact with infected blood, most often by drug
injectors using needles or syringes contaminated with
minute quantities of blood containing the virus.
3. Mother-to-child transmission either during pregnancy or
birth, or postnatal via breastfeeding.
31

Treatment, HIV See: antiretroviral therapy and highly active antiretroviral
therapy (HAART)
Vertical transmission Transmission of a pathogen such as HIV from mother to fetus or
baby during pregnancy or birth.
Viraemia The presence of virus in the blood, which implies active viral
replication.
Viral load The quantity of the virus in the bloodstream. The viral load of
HIV is measured by sensitive tests, unavailable in many parts of
the world. Ability to measure viral load is a key component in
effective combination therapy.
Virus Infectious agent responsible for numerous diseases in all living
beings. They are extremely small particles, and in contrast with
bacteria, can only survive and multiply within a living cell at the
expense of that cell.
Wasting syndrome The HIV wasting syndrome involves involuntary weight loss of
10% of baseline body weight plus either chronic diarrhoea (two
loose stools per day for more than 30 days) or chronic
weakness and documented fever (for 30 days or more,
intermittent or constant) in the absence of a concurrent illness or
condition other than HIV infection that would explain the
findings.
Western blot A blood test used to detect antibodies to HIV. This test is often
used to confirm the results of all positive ELISA tests. Their
combined accuracy is 99%
White blood cells Blood cells responsible for the defence of the body against
foreign disease agents and microbes. HIV targets two groups of
white blood cells called CD4+, lymphocytes and
monocytes/macrophages
Window period The period between transmission of HIV and the production of
antibodies by the immune system. It takes the immune system
up to 3 months to produce antibodies to HIV that can be
measured in the HIV antibody test. During this window period,
an individual tests negative for the virus but is nevertheless
capable of transmitting it to others.
32

艾滋病及其他医疗词汇 政府机构、政策法规
节欲 abstinence (副)局长
(deputy) director of ***
Bureau
获得性免疫缺陷综合症
Acquired Immune Deficiency
Syndrome
(副)县长 (vice) County Mayor
艾滋孤儿 AIDS orphans 县乡村三级防治网络
“County-Township-Village”3
level response
健忘 amnesia 责任制 accountability system
安非他命 amphetamines 补助 allowance
直肠的,肛门的,肛门附近
的
anal 自治区 autonomous region
肛交 anal intercourse 人均寿命 average life expectancy
贫血 anemia 受益者 beneficiary
肛门 anus 分局 branch bureau
抗病毒治疗 ARV/ART antiretroviral therapy 能力建设 capacity building
无症状的 asymptomatic 关怀救助 care and support
HIV携带期 (无症状期) asymptomatic HIV CDC防艾科 CDC AIDS and STD section
宣传教育 awareness raising and education 疾控中心
CDC Center of Disease
Control
基线调查 baseline survey 中央政府 central government
行为改变 behavior change 主任 chairman
行为干预 behavior intervention
Annex 18: HIV Terms (Chinese)
昌宁县艾滋病防治工作委员会
办公室
Changning HIV and AIDS
prevention and control
commission office

水泡 blister 检察长 Chief Prosecutor
输血 blood transfusion 民政局 Civil Affairs Bureau
体液 body fluids 结束语 closure
CD4检测 CD4 testing 党委 Communist Party Commission
产道分泌物 cervical secretion 建设局 Construction Bureau
子宫颈 cervix 促进因素 contributing factors
门诊 clinic 法庭、法院 court
临床表现 clinical manifestation 精神文明建设 cultural and ethical progress
可卡因 cocaine 文化渗透 culture penetration
并发症 complication 文体局
Cuture and Sports Bureau(参
考)
强制戒毒 compulsory drug rehabilitation 办公室主任 director of general office
安全套 condom 教育局 Education Bureau
安全套谈判 condom negociation 出入境检验检疫
EntryExit Inspection and
Quarantine
确诊检测 confirmatory testing 计划委 Family Planning Commission
结膜炎 conjunctivitis 计生站 Family Planning Station
牙科 dentistry 农民工 farmer-labours
骨科 department of orthopaedics 扫黄打非
Fight pornography, illegal
publications and piracy
腹泻 diarrhea 财政局 Finance Bureau
难产 difficult labour 外事办公室 Foreign Affairs Office
阴茎模具 dildo 林业局 Forestry Bureau
歧视与污辱 discrimination and stigma 四免一关怀 Four Free One Care
药物相互作用 drug interaction 筹资 fund raising
戒毒 drug rehabilitation 第四轮全球基金 Global Fund Round 4
药物耐药性 drug resistence 责任目标书
goal responsibility contract
(参考)
功能异常 dysfunction 卫生局 Health Bureau
宫外孕 ectopic pregnancy 卫生监督所 Health Inspection Institution

射精 ejaculation 阻碍因素 hindering factors
流行病、流行的、传染的 epidemic 工商局 Industry&Commence Bureau
传染科 epidemic department 检查 inspection
流行病学调查 epidemological survey 招商局 Investment Promotion Bureau
勃起 erection 司法部 Judiciary
安乐死 euthanasia 国土资源局 Land and Resources Bureau
艾滋家庭 family living with HIV and AIDS 监督与评估
M&E monitoring and
evaluation
胎儿 foetus 流动人口 migrant workers
督导 follow-up 最低生活保障 minimun standard of living
胃液 gastric juice 监督 monitoring/surveillance
淋病 gonorrhea 直辖市 municipality
National HIV and AIDS
肝炎(甲肝、乙肝……) hepatitis (A, B, C^^^) 全国艾滋病防治综合示范区
Prevention and Control
Comprehensive
Demonstration Area
海洛因 heroin 新型农村合作医疗
New Rural Cooperation
Health Care(参考)
疱疹 herpes 纪律检查委员会
Party Discipline Inspection
Commission
异性恋 heterosexual 组织部
Party Organization
Department
高流行区 high-prevalence area 宣传部 Party Propaganda Department
高危行为 high-risk behavior 党委书记 Party Secretary
同性恋 homosexual 防治艾滋病人民战争
People's Fight of HIV and
AIDS (参考)
拘留所、看守所 house of detention 人民医院 People's Hospital
尖锐湿疣 HPV 检察院 People's Procuratorate

人类免疫缺陷病毒 Human Immuno-deficiency Virus 一把手负责制
Personal Responsibility
System(参考)
盐酸 hydrochloric acid 人事局 Personnel Bureau
热身游戏 icebreaker 派出所 Police Station
Policy of developing border
免疫学 immunology 兴边富民
areas and making people well
off(参考)
潜伏期 incubation period 法院院长 President
个人随访档案 individual home-visit profile 主任科员 principal staff member
传染性 infectivity 公共卫生科 Public Health Section
不孕 infertility 公安局 Public Security Bureau
炎症 inflammation 以人为本 put people first
知情同意书 informed consent contract(参考) 干部年轻化 rejuvenation of cadres
住院部 inpatient department 居留许可 resident permit
精神错乱 insanity 科学发展观 scientific development outlook
失眠 insomnia 秘书长 secretary-general
痒 itchness 科长 section director
少管所 juvenile prison 小额基金 small grant
肾脏 kidney 社会主义市场经济体制 socialist market economy
Standing Committee of
麻风 lepra 人民代表大会常务委员会 National People's Congress
(NPC)
外伤 lesion
国家外国专家局 State Bureau of Foreign
Experts Affairs
肝脏 liver 国务院 State Council
肝功异常 liver disorder 战略性计划 strategy plan
The Chinese People's Political
润滑剂 lubricant 政协
Consultative Conference
(CPPCC)

疟疾 malaria 田园镇人民政府
Tianyuan Township People's
Government
内科 medical department 旅游局 Tourism Bureau
月经 menstruation 乡镇卫生所 township hospitals
美沙酮 methadone 交通局 Transport Bureau
流产 miscarriage 一票否决制 Unanimous Based
美沙酮维持治疗
MMT methadone maintainence
treatment
村卫生室 village clinic
国家参比实验室 National Referential Lab 村医 village doctor
恶心 nausea 村民委员会 villagers' committee
针头 needle 水利局 Water Resource Bureau
娱乐场所
night clubs(entertainment places,
salon)
妇幼保健院 Women&Children hospital
乳头破损 nipple crack 妇联 Women's Federation
职业暴露 occupation exposure 研讨会 workshop
手术 operation 团委 Youth League
Yunnan Provincial HIV and
高潮 orgasm 云南艾滋病防治局
AIDS Prevention and Control
Bureau
外展 out-reach
胰腺炎 pancreatitis
寄生虫 parasite
参与式活动 participatory activities
同伴教育 peer education
盆腔炎 pelvic inflammatory disease
插入性无保护性行为 penetrative unprotected sex
药房、药店 pharmacy
咽炎 pharyngitis
胎盘 placenta

艾滋病病毒感染者和艾滋病
病人
PLWHIV and AIDS
肺炎 pneumonia
暴露后防护 Post-exposure Prophylaxis
孕产妇 pregnant and parturient women
早产 premature delivery
传播性、普及度
prevalence eg. Low-prevalence
area
妓女 prostitute
卖淫 prostitution
直肠 rectum
红灯区 red light district
红丝带 red ribbons
劳教所 reeducation-through-labor centers
劳教戒毒
reeducation-through-labor
rehabilitation
转诊 refer v. referral n.
储精囊 reservior
风湿症 rheumatism
初筛检查 screening test
自慰、手淫 self masturbation
精液 seminal fluid/semen
血清 sero
血清转化期 seroconversion stage
性工作者 sex worker
性工作者管理员 sex worker manager
性刺激 sexual arousal
皮疹 skin rash
酸 soreness
性病 STD sexually transmitted diseases

不育 sterility
感染者支持小组 support group
外科 surgical department
梅毒 syphilis
注射器 syringe
目标人群 target group
肺结核 TB tuberculosis
T细胞计数 T-cell quantity
检测试剂 testing apparatus
治疗依从性 treatment adherence
溃疡 ulcers
超声波 ultresonic
尿道 urethra
泌尿系统 urinary tract
尿 urination
疫苗 vaccine
阴道或阴茎磨损 vaginal or penile abrasion
阴道分泌物 vaginal secretions
自愿咨询监测点 VCT clinic
自愿咨询检测
VCT voluntary counselling and
testing
病毒載量 viral load
自愿戒毒 voluntary drug rehabilitation
记号笔 marker pens
(Source: Zhang Cao, 2009)

Important Note: This is a strictly confidential survey. Please complete the
survey, fold in half and put in the collection box.
1. Sex:
□ male
□ female
2. Age:
□ 15-19 years
□ 20-24 years
□ 25-29 years
□ 30-34 years
□ 35-39 years
□ 40-44 years
□ 45-49 years
□ 50-54 years
□ 55-59 years
□ 60+
Annex 19: KABP Example Survey
3. How can HIV be transmitted? (Tick as many boxes as you like)
□ Sex without a condom
□ Sleeping in the same bed
□ Kissing □ Mosquito bite
□ Shaking hands
□ Blood transfusions
□ In the womb mother-to-child
□ Breast feeding
□ Sharing a needle (drug use)
□ Using public toilets
□ Sharing a drink
4. In general do you think that people who have sexually transmitted infections have
been promiscuous?
□ Definitely
□ Very Likely
□ Likely
□ Perhaps
□ Not Likely

5. Do you think a person who has AIDS deserves it because of something they did
wrong?
□ Yes
□ No
□ t’s hard to say
6. If you knew one of your colleagues was infected with HIV, would you feel happy to
continue working with him or her?
□ Definitely
□ Very Likely
□ Likely
□ Perhaps
□ Not Likely
7. If you knew you had HIV but were in good health would you tell someone at your
workplace in confidence?
□ Definitely
□ Very Likely
□ Likely
□ Perhaps
□ Not Likely
8. In general, do you think that the male staff members in your workplace are vulnerable
to sexually transmitted infections and HIV?
□ Definitely
□ Very Likely
□ Likely
□ Perhaps
□ Not Likely
9. In general, do you think that the female staff members in your workplace are
vulnerable to sexually transmitted infections and HIV?
□ Definitely
□ Very Likely
□ Likely
□ Perhaps
□ Not Likely
10. Do you think you are vulnerable to HIV?
□ Definitely
□ Very Likely
□ Likely
□ Perhaps
□ Not Likely

11. How many sexual partners have you had in the last year?
□ 0
□ 1-3
□ 4-6
□ 6-8
□ 8-10
□ 10+
12. How often do you use condoms when having sexual intercourse?
□ Not applicable (never engaged in sexual intercourse)
□ Never
□ Sometimes
□ Always
13. Do you or have you ever engaged in intravenous drug use?
□ Yes
□ Used to
□ No, never.
14. If yes, do you have your own clean needle supply?
□ Yes
□ No
15. Are you aware of needle sterilisation practices?
□ Yes
□ No
16. Do you feel that HIV has relevance to your work? (Please expand on your answer)
□ Yes
□ No
17. What would you like to know more about in terms of HIV/AIDS?
18. What does the term “mainstreaming” mean to you?

19. Describe the mainstreaming activities you have been involved in. Have they been
useful? If so in what way?
20. What do you feel are the challenges in engaging with mainstreaming work?
21. How would you improve the current mainstreaming work? What kind of activities
would you like to be engaged in?
Anything else you would like to add?
Thank you for your time.
(Source: Adapted from “AIDS on the Agenda”, Holden, 2003)

HIV&AIDS Mainstreaming Training
Help us improve our HIV&AIDS mainstreaming training by evaluating the effectiveness of the
training in terms of the objectives, process, and facilitation. Please check the appropriate box to
indicate how well the objectives are met, and provide feedback on the process and facilitators.
Activities Not Met Partly Met Fully Met
Activity 1 : HIV and AIDS quiz
Activity 2: Risk Factors
Activity 3: Scenarios
Activity 4: Testing, Treatment and Care
Please comment on the process used.
Please provide feedback on the facilitators.
What could be done differently to help with the learning?
Please list 1 thing you have learnt today:
In terms of HIV&AIDS related topics, what other topics would you like us to discuss in the future?
Any other comments
Annex 20: Example Evaluation Form
Thank you very much!

Asian Development Bank (2006) Gender Country Assessment Report – People’s
Republic of China, Asian Development Bank
Balaquit, J. (2007) HIV and AIDS peer education and life skills training workshop,
VSO China
Bates, G. Chang, J. and Palmer, S (2002). China’s HIV Crisis Foreign Affairs,
March/April
Butler, A (2003) HIV&AIDS and Development, Learning from Development, An open
learning pack for VSO volunteers, VSO
Holden, S. (2003) AIDS on the Agenda: Adapting Development and Humanitarian
Programmes to meet the challenges of HIV/AIDS, UK: Oxfam
International HIV/AIDS Alliance, (2008) Feel! Think! Act! A guide to interactive drama
for sexual and reproductive health, International HIV/AIDS Alliance.
International HIV/AIDS Alliance (2008) Preparing to teach sexuality and life skills,
International HIV/AIDS Alliance
International AIDS Vaccine Initiative (IAVI) and Tsinghua University (2008) Workshop
on Gender and New prevention technologies in China, IAVI.
Kidd, R. & Clay, S (2003) Understanding and Challenging HIV Stigma: Toolkit
for Action, The Change Project.
Lok, L (2008) VSO China
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