Sexual Health

Female (left) and male (right) reproductive systems (Medscape)

There are many ways to have safer sex. This always requires both partners to participate. Look at your Pathfinder International

SAFER SEX

Abstinence

No sex at all. This includes: no anal, no oral, no touching genitals to each other.

Long-term, faithful relationship

Neither person has ANY sexual touching outside the relationship. Both parties should make sure they do not have any diseases BEFORE doing this.

Latex Condoms

Latex-Condoms are the best way to prevent disease and pregnancy. To prevent disease they should be used before genital touching and until both people are done. Non-intercourse sex Awareness Mouth Condoms Masturbating, touching (fingers), or rubbing (fingers or with clothing on).

CAUTION: It is still possible to pass a STD if you touch genitals to each other (even without intercourse) or mouth to genital. Some diseases can be seen or have obvious signs. Do not have sex if you think you or the other person has a STD. Mouth to penis sex: a condom on the penis. Mouth to vagina sex: a condom between the woman's vagina and her partner's mouth.

SEXUALLY TRANSMITTED DISEASES: HERPES, CHLAMYDIA, GONORRHEA, SYPHILIS

Often called STDs, these are diseases that are passed through different kinds of sex. This can include: vaginal, anal, oral, and genital touching. These diseases do not only impact our reproductive and sexual health - they can make us very ill and even kill us. We will follow the same key steps to understanding these disease as explained above: What, Causes, Symptoms, Treatment, and Prevention. In some cases, explaining these steps for STDs can be a bit simpler, as you will see.

What Causes Herpes is a virus that causes painful open sores and illness Vaginal or anal sex Oral sex with a person with open sores around or in their mouth Genitals touching each other Symptoms Treatment Prevention Open sores/ulcers on genitals, anus, mouth Temperature and general illness Pain when peeing There is no cure, but some things help: No sex while there are open sores Carefully washing hands before and after touching genitalia A sitz bath or a bath in lightly salted water Safer Sex Practices: Condoms, abstinence, non- intercourse/contact sex A person may have herpes from a prior relationship, so if in a long-term, faithful relationship, they should be aware of a recurrence and NOT have sex when there are open sores What Causes Chlamydia is a bacteria that if untreated can cause infertility in women Vaginal, oral, or anal sex Genitals touching each other It can also be passed during child birth Symptoms Treatment Prevention Women Men Antibacterial tablets specific to treating chlamydia. You should always get a test before taking medication. Safer Sex: Condoms, abstinence, non- intercourse/contact sex, long-term, faithful relationships Avoid sex while being treated and make sure sex partners are treated before having sex again Pain when peeing Vaginal discharge Pain during sex or bleeding after sex Pain when Peeing White/cloudy/watery discharge from penis Pain in testicles What Causes Gonorrhea is a bacteria that can infect your genitals, anus, or throat; if untreated it can cause infertility and long-term abdominal pain Vaginal, anal, and oral sex Genitals touching each other It can also be passed during child birth Symptoms Treatment Prevention Women Men Antibacterial tablets specific to treating gonorrhea. You should always get a test before taking medication. Safer Sex: Condoms, abstinence, non- intercourse/contact sex, long-term, faithful relationships Avoid sex while being treated and make sure sex partners are treated before having sex again Pain when peeing Vaginal discharge Bleeding between periods Pain when peeing White or Yellow discharge from penis Pain in testicles What Causes Syphilis is a bacteria that can cause sores, skin rashes, lesions, and if very serious, can eventual damage internal organs, eye sight, and the brain. Vaginal, anal, and oral sex when there is a syphilis sore Genitals touching each other when there is a syphilis sore It can also be passed during child birth Symptoms Treatment Prevention Stage 1: Firm, round, usually painless sore(s) Stage 2: Skin rashes, lesions on genitals and mouth, spots on the palm of your hand Fever, sore throat, weight loss, fatigue Stage 3: Headaches, paralysis, dementia, blindness, organ failure Antibacterial tablets specific to treating syphilis. You should always get a test before taking medication. Safer Sex: Condoms, abstinence, non- intercourse/contact sex, long-term, faithful relationships Avoid sex while being treated and make sure sex partners are treated before having sex again

PRACTICE: Many of these STDs seem very similar. Separate into different groups and together talk about ways to simplify teaching STDs. Do you need to teach each STD separately, or can you teach them as a group? Are there common issues to teach. Each group should make a teaching sheet using questions, songs, or even images. Present back to the group - what was helpful? What was not? HIV/AIDS What Causes The Human Immunodeficiency Virus (HIV) is a virus that can only infect humans that makes it very hard for the body to fight disease. If a person does not treat their HIV, it may eventually turn into Acquired Immune Deficiency Syndrome (AIDS). AIDS is an advanced form of this virus that makes it even easier for us to get very, very dangerous illnesses like cancer, skin disease, and TB. HIV only lives in blood, sexual fluids, birth fluids, and breast milk. It does not live in sweat, or puss, or spit, or hair, etc. You also cannot get it by eating or drinking someone with HIV in it UNLESS you have a cut in your mouth. HIV is not very strong - it cannot survive heat or live outside of a human for very long - you cannot get HIV from touching dead blood or sitting on a toilet seat. You can get it from: Contaminated blood or sexual fluids shared through vaginal, anal, or oral sex. When sex is rough or causes bleeding, it is more likely that HIV can be shared. Blood to contaminated blood contact, such as a blood transfusion. Shared needles or used needles for injecting drugs Freshly used, not cleaned, and shared sharps - razor blades for scarification, tattoo needles, knife used in circumcision, manicure blades **Mother to child** Symptoms Treatment Prevention Early Stage: In good health, may not notice, no symptoms First Symptom Stages: Sores, weight loss, weakness, tired, forgetful, fevers. May get sick and then get better a lot. AIDS Stage: The person gets serious illnesses like tuberculosis, pneumonia, cancer, skin infections like shingles, rashes and sores, confusion and memory loss. There is no cure for HIV. ARTs are pills a person can take. These pills can help a person to live a long, healthy, normal life. The medication can feel worse before it feels better. It can also have long-term side effects. A person should always get a test and counseling from a doctor. In Nigeria, ARTs SHOULD BE available for free or at a low cost at designated public hospitals. If a person is turned away, they should go to a JEI paralegal to talk about options. Safer Sex: Condoms, abstinence, non- intercourse/contact sex, long-term, faithful relationships. There is no vaccine for HIV If a person has HIV, they can have sex if they are very careful and always use a condom. There are different kinds of HIV, so a person who has HIV should always use a condom, even when with someone else who has HIV. There are a lot of myths about HIV. See if you can answer these correctly. True or False: HIV can spread by mosquitos. True or False: Only people who have lots of sex with unknown people get HIV. True or False: A person with HIV must take the medication every day for the rest of their life. True or False: HIV cannot be spread through touch or cough. True or False: HIV can be spread when needles are reused. True or False: With the proper medication, as person with HIV can live a long, normal life. True or False: If a mother has HIV, her baby will always get HIV. True or False: A person can be cured of HIV. True or False: You can get HIV from food prepared by someone with HIV.

DISCUSSION: Are there other ways that people believe HIV is passed? What are those? Why might they not be true? Look at page 29 of the Pathfinder International Handbook. Why might these groups be more vulnerable to getting HIV?

GAME: Divide into groups. Each group has to make up a song or a rhyme to explain how HIV is passed, prevented, and treated. Come back together and perform - which one was the best? Getting Tested: There are two kinds of tests. Rapid Test - Using a small pin, a drop of blood is collected and analyzed - an answer is given within one hour. The test is sometimes wrong, so if a person has HIV-like symptoms or if they get a positive result, they should always get a second test using a blood sample. Blood sample - Blood is collected from the vein and sent to a laboratory where they can do tests. Results can take between 2 days to 2 weeks. SKITS: 2 volunteers come up for each of the following and do the following skits: 1) You hear a story about a young girl who is a virgin who got AIDS from a piece of fruit. The mother has accused the street vendor, who has sores on his hands and who people believe has HIV. Explain to the mother why this is not possible. 2) The class you are teaching tells you that kissing a person with HIV means you will get HIV. How do you respond? What about sharing a hair pick? 3) You know your community has been treating someone with HIV very badly - no one will eat with them, their family has kicked them out, and people act very afraid when they come near. What should you tell your savings group about HIV to help them be less afraid?

FAMILY PLANNING

Why do people use family planning?

Look at your handout: Family Planning. Please read pages 1-4 at home. As a group, read each of the steps a person should consider when choosing their family planning method on page 5. At the bottom there is a picture of a woman caught between a priest and a doctor. Discuss: What are some of the ways in which religion pressures women and men around family planning? What are some of the ways doctors and nurses pressure women and men around family planning? What is your role as a CHE when discussing family planning?

FAMILY PLANNING METHODS Review page 6. Divide into separate groups and answer the following questions:

1) Which methods prevent STDs? ________________________________________________________________________________

2) Which methods require both partners to participate? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3) Which methods rely only on the woman? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4) Which methods rely only on the man? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5) Which are most common in Nigeria? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6) Are there any that you never see in Nigeria? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

7) Look at page 7. What are the advantages and disadvantages of these different approaches?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

. For homework, go home and learn 1 approach very well, and using the Teaching Sheet approach, come back and teach this one way to the class.

DISCUSSION: At the start of class we discussed different rules for CHEs. One of those rules was confidentiality. This could include abortion. Abortion is one of the most common reasons a pregnant woman dies in Nigeria. What should you do if a girl comes to you who is bleeding heavily and you suspect that she has had an abortion?

GAME: Have the room split into two teams. The teacher will read out a series of statements or questions. The group who gets the most points wins.

CONDOMS Condoms or Rubbers are the most common way to prevent STIs and pregnancy. They should be used the right way every time a person has sex - even if married. * Always use latex rubbers to protect against HIV. * Use a new rubber every time - otherwise it can spread diseases or break. * Only use one rubber at a time. * Use lubricants like spit, KY jelly, or water when possible. Never use oil or Vaseline, as they tear the rubber. * Buying rubbers: o Do not use an old rubber - look at the packet to see the date on it. o Never use a rubber from a ripped packet, or a packet that is not sealed. o Do not buy a rubber that has been sitting in the sun. * Do not keep a rubber in your back pocket. * Do not open the rubber packet with your teeth. *

PRACTICE: Separate into groups of 2. Go back to your Pathfinder International Handout and open to page 32. Read the directions carefully. Using the rubbers and bottles that were handed out, together practice demonstrating how to put a rubber on and take it off. Remember to keep it simple. 2 teams volunteer to demonstrate. PRACTICE: Read pages 34-35. Plan a simple way to demonstrate how to use the female condom - and why some people might prefer it. Keep it simple. 2 teams volunteer to demonstrate.

PREGNANCY THE ANATOMY OF A PREGNANCY

A woman's body goes through many changes when she is pregnant. All of her organs move to make room for the growing fetus and women have special joints in their hips that allows them to grow wider to help hold the fetus. After a baby is born, it can take some time for the body to rearrange itself. Breast-feeding tells the body that the baby is born and can help the body return back to how it was.

FERTILITY A woman has the possibility to get pregnant from when she starts having a regular period to when it completely stops. Pregnancy happens when a woman ovulates (releases an egg) and sperm from a man fertilizes the egg. This does not guarantee pregnancy. Once an egg is fertilized, it has to implant (attach to the uterus). Sperm can live in the woman's body for 5 days, so even if she has not ovulated at the time of sex, it can happen after. Infertility: Some people cannot have children of their body. The most common causes are: Sterility Both men and women can be born or become sterile - meaning they cannot become or make someone pregnant. This is usually permanent and cannot be changed with traditional or other medicines. Some types of sicknesses can make a person sterile, like polio. Sterility is no one's 'fault'. Weakness / lack of nutrition Poor nutrition (not enough healthy food), lack of iron (usually from red meat), or lack of iodine (often found in diary) can make it hard to become or keep a pregnancy. Chronic Infection Infection from STIs or unclean living situations can cause a woman to become sterile. Low chances Sometime a man or woman may not be sterile, but rather have a very low sperm count or release very few eggs. Sometimes going to a doctor can help. *

DISCUSS: Who is usually blamed when a baby does not come? How often do people go to see fertility specialists? How can you help as a CHE?

THE STAGES OF PREGNANCY AND PRENATAL CARE

Once a woman is pregnant, she will need regular check-ups, tests, and medication. She will also need to eat healthy foods and vitamins. This will help prevent illnesses and other problems that lead to still birth and death during or after birth. At each trimester, a woman should expect: At each visit, the woman should expect: A woman should immediately get help:

1 s t T r i m e s t e r ( M o n t h s 1 - 3 ) Decide on a trusted TBA or medical provider. Get tested for STDs or other disease, which if untreated could hurt the fetus. If the mother has HIV/AIDS, the right medications (given by a doctor) can prevent it from passing to the baby. Overall Health Checkup - - Weight: A TBA or Health Worker might recommend health foods for a woman to eat as well. - Blood pressure: If a woman's blood pressure is too high, she might be in danger. Other warning signs can be swollen ankles, regular headaches, and dizziness. - Vitamins: Pregnant women are often recommended to take iron supplements and other vitamins. Preventative tests and medications - Malaria can be very dangerous for a pregnant woman. This is why they are suggested to sleep under a net even if no one else does. They should also get tested regularly and take anti-malarial medication if needed. - Typhoid and other common illnesses - Many of these medications are free General information - These visits are a chance for the woman to ask questions and prepare for the birth. - At each visit she will be advised on the things she needs to be collecting, such as clean cloths, cottons, new razor blades, misoprostol. If she is bleeding: This could mean a number of things - from miscarriage to a blocked birth opening. The woman could bleed to death. She should lay as still as possible and be taken to a hospital as quickly as possible. Very weak, tired, very pale/transparent skin: This could mean that she does not have enough iron in her blood - and could cause her to bleed to death during childbirth. Headaches, blurred vision, dizziness, swelling in the face, hands, and feet, and/or pain high in the belly: Any or all of the above could mean pre- eclampsia or toxemia. This can cause seizures or bleeding that can kill both the mother and child. Baby decreases/stops moving: About halfway through the pregnancy, the baby should start moving. Once movement starts, it should happen at least three times a day. If they stop, this could mean that the baby is dying - she must go to the hospital right away.

2 n d T r i m e s t e r ( M o n t h s 4 - 6 ) Some vaccinations should be given while the mother is pregnant, such as tetanus. This helps to prevent the transmission of a disease during child birth.

3 r d T r i m e s t e r ( M o n t h s 7 - 9 ) Later in the pregnancy, it is important for a doctor to check the position of the fetus and make sure the baby is healthy and positioned for birth. This is very important - if the baby is not positioned correctly, the woman and the baby could die during the birth. Birth Contractions: Some women have fake contractions before they finally go into labor. One way to tell if they are real are if they get closer together. After the birth, the placenta should be fully out, if any remains, a woman may bleed to death. Delivery should not last longer than 2 days - if longer, the baby and mother may die. A delayed delivery could also cause fistula - a hole in the bladder. Surgery is required to fix a fistula. After Birth A woman should still get checkups. Many women die after childbirth from minor problems. General health and help: This can range from help with breastfeeding to ensuring she is eating healthy.