MODULE 6 PREVENTION IN HIV AND AIDS

STRATEGIES PUT IN PLACE TO ALLIENATE HIV/AIDS

OVERVIEW
HIV prevention is the cornerstone of the control of the epidemic. With reduced infection
rates lives will be saved, and the burden of the disease on the individual, family,
community, society, government and the business sector will be reduced. This module is
about prevention of HIV from different perspectives. I addresses components of
prevention, namely primary prevention, secondary prevention and tertiary prevention of
HIV infection. It also covers partnerships in the prevention of HIV including international
organizations, non-governmental and local community based organizations and
programes.
OBJECTIVES
At the end of this module, you should be able to:
1. Define prevention in he context of HIV and AIDS.
2. Describe the different approaches to HIV prevention
3. Discuss the stratgies for HIV prevention
4. Expalin the different organizations and programmes involved in HIV/AIDS prevention
in Botswana.
MODULE UNITS
Unit 1
Unit 2
Unit 3
Unit 4

Definition and to strategies HIV prevention

The different approaches for HIV prevention
Partners in the prevention of HIV and AIDS in Botswana
The role of individuals and families in HIV prevention

UNIT 1: DEFINITION AND STRATEGIES TO PREVENTION OF HIV

Definition of Prevention
The Medical dictionary defines prevention as follows:
Prevention (in nursing care) actions directed to preventing illness and promoting health
to reduce the need for secondary or tertiary health care. Prevention includes such
nursing actions as assessment, including disease risk; application of prescribed
measures, such as immunization; health teaching; early diagnosis and treatment; and
recognition of disability limitations and rehabilitation potential. In acute care nursing
many interventions are simultaneously therapeutic and preventive.
Prevention also involves providing comprehensive HIV/AIDs education to individuals,
families and communities so that they can understand how the infection is spread, their

individual contribution to its transmission and how they can prevent it or assist/support
other to do so.
"Comprehensive sexual health education" means education regarding human
development and sexuality, including education on pregnancy, family planning, and
sexually transmitted diseases (EC 51931).
HIV/AIDS prevention education" means instruction on the nature of HIV/AIDS, methods
of transmission, strategies to reduce the risk of human immunodeficiency virus (HIV)
infection, and social and public health issues related to HIV/AIDS (EC 51931
In this module prevention education includes both comprehensive sexual health
education and HIV/AIDS prevention education.
Strategies for HIV prevention
The most common approaches to preventing HIV infection include:
a) Information, education and communication (IEC) campaignes, which involve
teaching people about HIV and AIDS, what it is what causes it, how it transmitted,
who is most affected, what factors contribute to its spread and how can it be
prevented.
The government of Botswana has initiated public awareness and education based
on ABC (abstain, be faithful and condomise) and to reduce the discrimination faced
by the infected. This initiative is accelerated through billboards, school curriculums
and also the government has built institutions like youth health organization (YOHO)
that offers counselling and guidance on sex and HIV/AIDS issues. The number of
people with major misconceptions on HIV/AIDS has since decreased by 36% in
2008 especially in the youth who are mostly preyed by the pandemic.
b) ABC, and other safer sex strategies, focus on sexual abstinance, being faithful in a
monogamous (one sexual partner at a time in sustained relationship) and correct
and consistent use of the condom (male and female). In addition the Botswana
government has initiated free distribution of both male and female condom in rural
and urban societies. This improvement has been noted to encourage safe sex
thereby reducing the new infection rate. According to
http://www.avert.org(International HIV and AIDS Charity) the Botswana government
managed to circulate 200million condoms in 2009 after installing 10500 condoms
dispensers in both rural and urban settlements.
c) Behavior change communication (BICC) focuses on educating and supporting
people in changing behaviors that can put them and others at risk of HIV infection.
Each behavior is anlyzed critically in terms of how it contributes to HIV infection, and
what people can do to prevent it or reduce its impact. A unit was established by the
Ministry of Health in 1989 to create awareness, change attitudes and motivate
people to adopt positive health behavior.

At first it was known as the Information Education and Communication Unit (IEC). It
also stimulates dialogue and communication amongst the community by educating
on the negative and positive social norms, cultural values and risk factors on
HIV/AIDS.Currently IEC activities such as the Antiretroviral therapy, PMTCT, and STI
diagnosis and treatment, Community Home Based Care and workplace and
wellness have been incorporated into the BCIC. It seeks to increase self-esteem and
confidence of People living with HIV through public education and awareness
conducted through multimedia approaches like radio, television, advertisements and
newspapers. Programs such as Makgabaneng, Talk Back and Morwalela have been
used to reach out to the general public on HIV/AIDS issues, like how to avoid new
sexually transmitted infections, delay HIV/AIDS disease progression , avoid reinfection, prevent disease transmission and adopt a wellness lifestyle aimed at
Prolonging life. At the moment the BCIC interventions efforts have resulted in the
high levels of awareness and knowledge on HIV/AIDS and condom use.
The BCIC is faced with challenges regarding its interventions in that there exists a
gap between knowledge and practice in the public thus posing as a problem to
attaining the desired behavior for HIV/AIDS prevention. Another challenge faced by
the BCIC is lack of resources such as manpower, finances which lead to inadequate
support to address public health needs and problems.
d) Voluntary Counselling and Testing (VCT) and routine (opt-out) testing addresses the
importance of seeking counselling services as the first step to HIV prevention.
Knowing your status gives power to prevent being infected if you are negative, or
avoiding infecting others if you are HIV infected. It also involves avoiding getting a
secondary infection of a different strain of the virus, or other infections so that you
can deal with the one infection.
The HIV testing and counseling programme was established in 1989 as a
component of the National Aids Control Programme. The programme aims to meet
the emotional, psychological, social and spiritual needs of both HIV affected and
infected individuals and families. The goal of the counseling and testing programme
is to increase access to HIV testing and counseling to maximize prevention,
treatment care and support services. It is particularly important for the sexually
active population(15-49) to know their HIV status. The government has endevoured
to build capacity for the provision of HIV testing and counseling services, to develop
HTC policy standards and programmes, and also to ensure quality HTC service
delivery.
In 2000 the government of Botswana and the United States of America government
established the Tebelopele VCT programme, which was scaled to HIV up to 16
centers nationwide, in order to increase access to HIV testing & counseling and
maximize prevention and treatment opportunities. These centers give free testing
and guidance and at the end of 2005 they managed to train 447 counselors and

offer their services to 70000 people. In 2004 Botswana also introduced routine HIV
testing (RHT) in government clinical settings. Botswana Christian Aids Intervention
Programme (BOCAIP) is a based organization providing HIV counseling and
services implemented as its 11 centers established country wide and training lay
counselors for its own centers and other partners, couple counseling, provide
support to mothers on PMTCT programme, provision of care and support to orphans
and vulnerable children and formation and facilitation of support groups for people
testing HIV positive and negative.
Botswana Family Welfare Association provides information and services on Sexual
and Reproductive Health (SRH). This approach appears necessary based on the
current statistics of teenage pregnancy, HIV infection & AIDS cases in Botswana.
The approach targets young people who are vulnerable to HIV infection due to
unprotected sex which also leads to unplanned pregnancy which comes with
psychological, social and physical consequences.
e) Pre and post-exposure prophylaxis (PEP), here prevention of exposure before the
infection occurs, or prevention of proliferation of the virus after exposure. Exposure
occurs in many invouluntary situations such as rape, ocupational exposure (such as
for health care prividers and industrial workers who handle harzardous and
potentially infected materials). The us of universal,precautions to avoid exposure are
very critical at this stage. Also, reporting and seeking preventive therapy and
adhering to protocol for exposures is also very critical. The wellness programmes do
fall in this category.
f) Prevention of Mother-to-Child Transmission of HIV (PMTCT) and Prevbention of
parent-tochild transmission of HIV (PPCT): mothers and fathers who are infected
can be assisted to reduce the risk of infecting their own babies. Therapy is available
in Botswana to prevent this type of exposure for babies. Women are encouraged to
enrol for the programme, which is available at every health facility countrywide. A
prevention of mother-to-child transmission (PMTCT) programme was the first
programme to distribute antiretroviral drugs in Botswana, with the drug zidovudine
(AZT) being provided free by the company GlaxoSmithKline. When early enrollment
of women in PMTCT programmes was disappointingly low,the Government
responded with training and recruitment programmes for PMTCT counsellors, and
later with routine HIV testing of all pregnant women. HIV positive mothers who
choose to avoid breastfeeding are given a year's free supply of infant formula.
The PMTCT program was established in July 1999 at Francistown and Gaborone
respectively. By July 2000 and November 2001 all health facilities in Botswana
offered the PMTCT programme. The overall goal is to improve child development
and survival through the reduction of HIV related morbidity and mortality. Its main
objective is to increase PMTCT uptake both prophylaxis and treatment to 95% by
March 31st 2015.

PMTCT programme was the first programme to distribute ARV drugs in Botswana,
with the drug Zidovudine (AZT) being provided free by the company Glazco Smith
Kline. It strives to provide free milk to women who have tested positive for HIV/AIDS.
Once a pregnant woman has been diagnosed to be with the virus they are placed on
the program to prevent the transmission of the virus to the foetus.The program
reaches out to people through various ways such as advocating awareness to the
general public through media and Kgotla meetings. Communitys mobilization
encourages the programme. The programme is promoted through various multimedia approaches such as television and radio. Its achievements include routine
testing of all babies exposed to HIV from 6 weeks of age. It provide counseling and
psycho-social support services to pregnant women, their partners, their families.
Some short-comings include low male involvement and therefore repeat
pregnancies among HIV positive women. Furthermore there is inconsistent supply of
infant formula for HIV/AIDS patients and poor monitoring.
g) Safe male circumcision (SMC) has been introduced following a research revelation
that it can reduce the risk of partner transmission by about 60%. However it does not
replace other methods of prevention and actually works better combined with them
(eg, condom use)
h) Use of microbicides are available in the market to prevent sexual trans,ission of HIV.
These are chemical agents the protect the vaginal and penile tissues during
penetration. Their use has not been reported in Botswana, and research is ongoing
to determine their practical efficacy and safety.
i) Isoniazid Prevention Therapy (IPT). This prevention therapy has been institued
because tuberculosis is a common co-infection with HIV, especially in Botswana.
Therefore the aim is to prevent TB infection among people who are HIV infected.
This is not treatment for TB, therefore tests for TB must be run to ensure that the
person who gets the therapy is not TB infected, and is receiving it to prevent TB. If a
person is already TB infected, they are nor eligible for IPT, but get the TB treatmnent
according to presribed protocol for Botswana. IPT is imprtant especially with the
development of multidrug resistant TB, and it would be very beneficial if we could
prevent TB in the first place so that one does not have to deal with issues of
resistance to TB medication.
j) HIV vaccine . Research is ongoing to develop a vaccine for HIV, and no good news
has come forward yet in that regard. As of now we know that there is no cure nor
vaccine for HIV.
k) Life skills development for HIV prevention entails prevention education focusing on
life skills that people can use to avoid the infection. This particularly important of
young people who need to thionk criticallly and make decisions to protect
tehmselves. Therefore critical thinking and decision making are key life skills for the
prevention of HIV infection. Others include self-esteem, self-efficacy, assertiveness,
negotaition, problem solving, compassion, Botho etc.

l) Diagonosis and treatment of sexually transmitted infections

m) Safe blood transmission services ensure that there is a wide campaigne for blood
donations, after which strict testing of the blood is done to ensure that it is safe for
treatment of people who need it. Todate safety of blood is almost 100% guaranteed.
The4 major challenge is the inadequacy of eligible donors.
n) Masa ARV Programme: Masa is a government initiative them more time to nurture
their families and to help build a better future for Botswana, which was launched in
2002. It was the first national antiretroviral (ARV) program. Masa is a Setswana word
meaning new dawn. The name was given to signify the hope that the ARVs offer
people living with HIV/AIDS the opportunity to live longer and healthier lives by
giving them more time to nurture their families and to help build a better future for
Botswana.
The overall goal of the Masa ARV Programme is to enhance prevention efforts and
the impact of HIV/AIDS on the people of Botswana through the introduction and
effective utilization of ARV therapy. MASA ARV programme has amongst other
things aimed at providing ARV therapy to eligible individuals, guide or coordinate all
efforts in the country geared towards implementation of the ARV program, monitor
and evaluate the program to ensure continuous improvement of quality and
effectiveness.
The program has been fully rolled-out to 32 planned ARV sites across Botswana.
The successes include reduced morbidity associated with HIV/AIDS, increased
survival rate, stabilization of the orphan population, training of partners to ensure
effective and efficient implementation and improved access to ARV services. The
major partner in this program is ACHAP, with provision of financial and technical
assistance.
Challenges faced by MASA includes shortage of skilled manpower, lack of
infrastructure, stigmatization and discrimation which discourages people from
coming forward to be tested, insufficient resources.
UNIT 2-APPROACHES TO HIV PREVENTION
1. Primary prevention refers to prevention of a disease or condition before it occurs.
The strategies involved are those that are geared towards making sure that the infection
does not occur in the first place; including strategies above and;
Primary prevention strategies include some listed above: IEC ABC, vaccination (once
available), behavior change education, VCT, PEP, SMC, use of microbicides, and life
skils development as well as the diagonosis and treatment of sexually transmitted
infections
2. Secondary prevention addresses prevention programs for the positive,

It means that a person is already infected and efforts are being made to prevent
secondary infection with another strain of the virus, or aonther infection of a different
kind. This could complicate the management of the infection b incresing mutations,
resistance, as the different infections compete for the same immune response, and
treatment failure.
Secondary prevention strategies include some of the ones listed above and other
programs fo the infected, such as positive living and healthy lifestyles; disclosure
issues, violence prevention, suicide prevention, IPT, Nutrition education, adherence
counselling and support, exploring support systems, and joining support groups
3. Tertiary prevention involves taking care of those who are not just infected, but had the
full blown disease AIDS. These people will need full recovery, rehabilitation and or
palliative care (in hospice care or home-based care) to reduce the burden of symptoms.
UNIT 3: PARTNERSHIPS FOR HIV PREVENTION AND CONTROL
The government of Botswana has managed to attract many governmental, international
and non-governmental organizations in the fight against HIV and AIDS and to reduce
the impact.
Think about the list of partners who work towards reducing the impact of HIV and
AIDS inBotswana. Do you recognize any names listed below?
World Health Organization
World bank
UNAIDS
UNICEF
UNDP
African Comprehensive HIV/AIDS Partnerships (ACHAP)
Bill and Melinda Gates Foundations
BOTUSA
Berhiger
Meck Foundation
Baylor Colege of Medicine
University of Penyslvania
JHPIEGO
Global Health Program and Global Fund
World Bank
DFID
These are a few of the International organizations involved in the fight against
HIV/AIDS, taking dirfferent aspects of the fight (prevention, treatment and care and
research). Some of them are involved in specific projects while others provide funding
and oversight.

The government also partners with local community based organizations and faithbased voluntary organizations in the fight against HIV.
Think about some of the the main NGOs such as BONELA, BOCCAIP, BONASO,
BONEPWA and other community and faith based organizations you know locally, you
should be familiar with the ones in your own local community. Some of these provide
support for people living with HIV, care for formpwersons with AIDS and related
diseases, care for orphans etc.
GOVENRMENT UNITS INVOLVED IN HIV PREVENTION AND CONTROL
1. NATIONAL AIDS COORDINATING AGENCY [NACA]
Formed in 1999 with the vision to effectively lead and coordinate the efforts of all
stakeholders in the comprehensive national response to ensure effective management
and control of the HIV/AIDS PANDEMIC. Its mission is to lead and coordinate a
multisectoral response to the HIV/AIDS pandemic.
Its objective is to develop, support partnerships, harmonize coordinate and facilitate
implementation of the national response to HIV/AIDS. These include formulation and
facilitation of national strategies, policies and laws that pertain to HIV/AIDS. The
process of mainstreaming HIV/AIDS into ministries, institutions and civil society
organizations requires facilitation by NACA and it ensures that HIV/AIDS is
mainstreamed in the day to day mandate of sectors. NACA was involved in the
development of the national HIV/AIDS policy unit the strategy for BCIC. It is also
responsible for establishment and development programmes of consistent resource
mobilization and capacity building for managing and implementation the National
response. Its objective is to be leading the communication and advocacy for the fight
against HIV/AIDS.
NACA has been involved in formation and setting of programme as follows: PMTCT,
ANTIRETROVIRAL treatment, HTC (HIV Testing and counseling), OVC (Orphans and
vulnerable Children), community home based care programmes, safe blood transfusion,
and management of sexual transmitted infection, workplace wellness, and condoms
distribution. In its latest developments it is gearing up for the launch of second National
strategic framework of HIV/AIDS, which serves as a roadmap for the National response
over the next seven years.
In the past it has continued to partner with Non-governmental organizations and a major
contributor to AIDS day commemoration. Naca is set to launch the National HIV
Prevention Brand, TSAYA TSHWETSO, with objective to promote testing for HIV,
staying faithful, enroll for PMTCT, and to adhere to treatment. In 2009 it launched the
National HIV AIDS STI and Other Related Infectious Diseases Research Conference
(NHASORC 11).
NACA is faced with challenges such as difficulties with behavior change and the low
response to HIV testing and continued multiple sexual partners which they consider to
be the key driver of the virus.

2. KITSO TRAINING COORDINATING UNIT (KTCU)

The government of Botswana introduced yet another initiative called Kitso
Training Coordinating Unit which is aimed at preparing the workforce for the provision of
ARVS. From the beginning of the epidemic, Botswana was faced with challenge of
shortage of skilled manpower that is people with knowledge about HIV/AIDS. In 2000
the Government of Botswana, laid a foundation to create a training programme for
health care and non-health care professionals to support the provision of HIV/AIDS
prevention, care and treatment services to strengthen human capacity. Later on the
year the Ministry of Health did a needs assessment on the training and communication
requirement and the results were used to develop a five year in service training plan. All
this led to the establishment of KITSO AIDS training programme in 2001 for HIV/AIDS
care and treatment. When ARV program was introduced in 2002, it was KITSOS main
focus to prepare the workforce for the provision of ARVs. KTCUs vision is to have an
excellently integrated HIV/AIDS training programme contributing to improved HIV/AIDS
prevention and care services by 2016. Its objectives are to build the capacity of the
KTCU to coordinate in service training, develop and maintain high standards of training
in the country and also to strengthen information sharing among stakeholders.
Ever since KTCU was established high quality trainings are still ongoing. Appropriate
trained expertise is available in the country; there is training information to help manage
training programmes. However it has been faced with some challenges like inadequate
teamwork in assessing training needs and developing training curriculum, lack of clear
guidelines for the monitoring and evaluation of training programmes, training needs are
not systematically defined.
There are many departments in the Ministry of Health and other Ministries involved in
HIV prebention and care, and you will need to identify and learn about those, especially
the ones that relate to the work of your ministry.
UNIT4 THE ROLE OF INDIVIDUALS, FAMILIES AND COMMUNITIES IN HIV
PREVENTION AND CARE
Read the items below and think about how you as an individual can participate
As an individual you can play any of the role below
1. Provider of care: including self care and care to other individuals around you. The
care may include direct physical care during an acute or chronic AIDS related illness, or
psychological care during distress related to getting results, living with HIV, dealing with
the burden of disease for self or loved one. Everyone needs others in these times of
distress.
2. Counsellor, you may find yourself playing the role of councellor for others in need, to
help them effectively deal withthe emotional distress associated with being infected or
affected by HIV.
3. Educator. Now that you havev learnt about HIV and AIDs, you are empowere to teach
others about the disease so that they can also benefit by prevention it.

4. Leader. With your knowledge you can lead and participate in HIV/AIDsrelated
programmes.
5. Activist. There are many programmes that you can be involved in to actively advocate
for people infected or affected by HIV. In Botswana almost everyone is affected because
of the high rates of infection, and everyone is likely to have family, friends or neighbor
infected. So we all need to be activists in one way or other.
6. Community participant. There are many organizations and programmes in the
community in which one can make time and colunteer to participate in.You have a
chance to contribute, an all you need is to find out about these.
7. You can influence others to change their behaviors and live healthy life styles by
being a role model.
As family or community members people can play any of the above roles in many
different ways.
Think about the ways in which you can play your part in HIV prevention and care. List
some of the actions you can take to be involved. Then make a list of the steps you want
to take and how and when you want excecute your plan. The sooner the better. Ntwa e
bolotse.

Here is one example of how people get involved.

Care and Support for People Living with HIV/AIDS
The Family of Love in Beijing Youan Hospital (refer to colored page 3).
Since 1990, this organization has treated more than one hundred AIDS patients, giving
direct consultation, medical exams, life guidance and family services to more than 600
inquirers.
The goals of the organization is to:

Provide an all-around medical service

Provide help and psychological support.

Persuade social forces to participate in the fight against AIDS.

Promote healthy ways of living.

Reduce discrimination in society.

The Family of the Red Ribbons (ref. colored page 3)

January 1, 1999, the Family of the Red Ribbons was founded in the STD treatment
center of Beijing Ditan hospital. The institute was established to care for AIDS patients.
It has provided a hotline service to more than 8000 patients and face-to-face
consultation and clinical service to more than 20,000 STD and AIDS patients in the past
year.

The teaching of medical knowledge (from the 9th to the 15th day of each month).

Family visiting.

Support and contact related organizations.

Pass along information on AIDS

SELF-ASSESSMENT ACTIVITY

1. Define Prevention
2- Identify the different strategies to prevention
3. Explain the approaches to prevention under the following headings
a) Primary prevention
b) Secondary prevention
c) Tertiary prevention
4. List at least 5 international organizations involved in HIV prevention and care
5. Think about and discuss at least three some government units that are responsible
for HIV Prevention not already discussed in this module
5. Select one community based organization that provides services to persons living
with HIV/AIDS. In view of what you have learnt in this unit, briefly discuss whether you
think they assist in reducing the effects of HIV/AIDS.
6. When caring for a person infected with HIV at home, which strategy would be most
useful for you to prevent being infected by this person.

FURTHER READING

Kirton, C. (Ed.). (2003). ANACs Core Curriculum for HIV/AIDS Nursing. Sage
Publications: Thousand Oaks.
California Department of Education Comprehensive Sexual Health & HIV/AIDS
Instruction retreaved on 19/07/2011 from http://www.cde.ca.gov/ls/he/se/
International HIV and AIDS Charity obtainable at http://www.avert.org