Module 7. Pilina A o: Understanding Sexually Transmitted Infections Overview Duration: 60 minutes Goal: To gain knowledge about different STIs and how STIs can be transmitted. Learner Outcomes Students will: 1. Identify the types of STIs and how STIs are transmitted. 2. Be able to identify the bodily fluids that transmit HIV and some other STIs. 3. Understand that there are many myths about STIs and HIV. Standards and Benchmarks HE.6-8.1.7, HE.6-8.1.8, HE.6-8.1.9, HE.6-8.2.1, HE.6-8.3.2, HE.6-8.4.1 Materials Needed 1. Pono Choices Poster 2. Group Agreements Poster 3. Module 7 Presentation a. The Voyage of the Wa a Kaulua b. Understanding STIs Presentation c. Video: You Cannot Get HIV Ladatt! 4. Student Workbooks a. Reflection Squares b. Myth or Fact Worksheet Activity Overview A. Introduction (2 minutes) B. Review Ohana Activity: Hāpai Pono (5 minutes) C. Hawaiian Cultural Value: Pilina A o (3 minutes) D. The Voyage of the Wa a Kaulua (10 minutes) E. Understanding STIs (15 minutes) F. You Cannot Get HIV Ladatt! (15 minutes) G. Myth or Fact Activity (5 minutes) H. Conclusion (5 minutes) Pono Choices Facilitator Curriculum Implementation Guide Page 130
Module 7 Activity A: Introduction 2 Minutes Review the previous lesson. All students should have their Student Workbook. Welcome back to Pono Choices. The last time we met, we learned how to prevent an unintended pregnancy. We also discussed the Hawaiian Cultural Value Hāpai Pono. Turn to your neighbor to review the definition of Hāpai Pono. Who remembers what Hāpai Pono means? Target response(s): A pregnancy that is right with the person, physically, emotionally, spiritually, and financially Hāpai Pono means a pregnancy that is right with the person, physically, emotionally, spiritually, and financially. Give an overview of what the students will be learning in this lesson of Pono Choices. After this lesson, you will be able to: Identify the types of STIs and how STIs are transmitted Identify the bodily fluids that transmit HIV and some other STIs, and Understand that there are many myths about STIs and HIV. End Pono Choices Facilitator Curriculum Implementation Guide Page 131
Module 7 Activity B: Review Ohana Activity Hāpai Pono Review the Ohana Activity from Module 6. 5 Minutes Take out your Ohana Activity Worksheet. You asked your ohana to share information about some of the costs related to having and raising a child, and what they think some of the major responsibilities are. Display Module 6 Presentation Slide 24. Debrief the Ohana Activity: Topics to Discuss. Let s hear some of your responses. Who would like to share? Target response(s): They said it costs a lot of money to have a baby, they said the total cost for raising a child until age 18 was more than some people make in a year, they said that some of the responsibilities involved are providing health care, food, clothing, day care, education, sports and activities, and a lot of time Great job! As we can see, there are many different ways your ohana has experienced the costs and the responsibilities of having and raising a child. Because pregnancy involves physical, emotional, spiritual, and financial demands, we can see that it is a big responsibility. End Pono Choices Facilitator Curriculum Implementation Guide Page 132
Module 7 Activity C: Hawaiian Cultural Value Pilina A o 3 Minutes Introduce today s Hawaiian Cultural Value: Pilina A o. To Be Done: Have Module 7 Presentation Slide 2, Pilina A o, displayed. Today s Hawaiian Cultural Value is Pilina A o. (pee-lee-nah ah-oh) Repeat after me, Pilina A o. Pilina A o. To Be Done: Read the definition of Pilina A o on Module 7 Presentation Slide 2, Pilina A o. Pilina A o means linking your knowledge to understanding. The root word of pilina is pili, and pili means to adhere to, join, and connect with something or someone. Students will write the Hawaiian Cultural Value and its definition on a Reflection Square in their Student Workbook. To Be Done: Students write the term and definition for today on a Reflection Square. In the back of your workbook, write today s Hawaiian Cultural Value, Pilina A o, and its definition on a Reflection Square. I want you to connect the knowledge of what STIs are to the understanding of how STIs are transmitted. End Pono Choices Facilitator Curriculum Implementation Guide Page 133
Module 7 Activity D: The Voyage of the Wa a Kaulua Introduce The Voyage of the Wa a Kaulua. 10 Minutes To Be Done: Prepare Module 7 Presentation Slide 2, Pilina A o, and Slide 3, The Voyage of the Wa a Kaulua. Have Slide 2 displayed, and click the link on Slide 3 to load the audio story in your browser. We are now going to listen to The Voyage of the Wa a Kaulua. To Be Done: Review the story from the previous lesson. Last time, we heard that Ka iwi and Pailolo were observing the differences between a pregnancy that was Hāpai Pono and one that was not. They noticed that Holopuni and Me e worked hard and accomplished many of their goals and dreams. Together, they planned their pregnancy. Their friend Kalohi s pregnancy was not planned. She was young, confused, and immature. She was unsure about her relationship with her partner, George, and acknowledged that her pregnancy was not pono. To Be Done: Before starting the story, read what s on the slide: Pilina A o: linking your knowledge to understanding. When a wa a is on a voyage, it may encounter rough seas. In order to successfully navigate and reach your goals and dreams, you must connect your knowledge with your skills to meet the challenges you may encounter. Have students turn to page 24 in their workbooks. Students can take notes or make drawings that help them remember what today s story is about. To Be Done: Direct students attention to the story by having them listen for certain details. Turn to page 24 in your Student Workbook for the Review Questions and a place to take notes or make drawings. Pono Choices Facilitator Curriculum Implementation Guide Page 134
To Be Done: Start The Voyage of the Wa a Kaulua audio, Play, and then End audio. Why were STIs spreading rapidly in the story? Target response(s): No one knew how STIs were spread or how to prevent them What were some of the ways that Ka iwi and Pailolo s community learned about how STIs were transmitted? Target response(s): Unprotected sex, tattooing As we just heard in The Voyage of the Wa a Kaulua, part of Pilina A o is to gain knowledge about how STIs are spread and understand how to prevent them. This lesson is about knowing how STIs are transmitted so you know how to protect yourself. End Pono Choices Facilitator Curriculum Implementation Guide Page 135
Module 7 Activity E: Understanding STIs Presentation 15 Minutes Go through a brief presentation to provide students with information about what STIs are and how they are spread. To Be Done: Have Module 7 Presentation Slide 4, Understanding Sexually Transmitted Infections (STIs), ready. We are going to be learning about STIs, including HIV. You will learn the 2 main types of STIs, the 3 main ways many STIs are transmitted, and the 4 main bodily fluids that can transmit HIV and some other STIs. Slide 4 To Be Done: Begin the Understanding STIs presentation. Slide 5 An STI is an infection or disease that passes from one infected person to another person. STIs, or sexually transmitted infections, and STDs, sexually transmitted diseases, refer to the same thing and are often used interchangeably. The current trend is to use the term STI. It s the more accurate term since not all infections become diseases. STIs can be transmitted during: Unprotected vaginal, anal, or oral sex Intimate sexual contact, including skin-to-skin contact, or Non-sexual contact with infected bodily fluids, like blood. Pono Choices Facilitator Curriculum Implementation Guide Page 136
Slide 6 When we talk about STI transmission, it s important for everyone to remember our definition of sex: Vaginal sex is when the penis enters the vagina. Anal sex is when the penis enters the anus. Oral sex is when one person s mouth is on another person s genital area. And, remember that the genital area includes the penis, scrotum, vagina, vulva, labia, clitoris, and anus. For STI transmission, sex can also include intimate sexual contact, such as skin-to-skin or genital-to-genital contact. Slide 7 Slide 8 Facilitator Note: Skin-to-skin transmission often refers to contact with a sore, wart, or other infected skin. When we talk about unprotected sex, we mean not using a barrier, such as a condom, dental dam, or other type of barrier, when having vaginal, anal, or oral sex. Facilitator Note: Condom failure is more often the result of inconsistent and incorrect use than the result of breakage. Condom breakage rate is very low in the United States, and each latex condom is electronically tested for holes before packaging. Here are some different types of barriers. We have already talked about male and female condoms when we discussed birth control methods, as they can help prevent pregnancy as well as STIs. Using condoms plus a hormonal method can reduce your risk of an unintended pregnancy even further. A male condom is a thin sheath that covers the penis to prevent semen from entering the vagina, anus, or mouth. Condoms that protect against STIs and pregnancy are made from latex, polyisoprene, or polyurethane. Pono Choices Facilitator Curriculum Implementation Guide Page 137
A female condom is a thin, loose-fitting pouch. The closed end has a flexible ring, which is inserted into the vagina. The open end remains outside, partially covering the labia. A dental dam is a flat piece of latex or polyurethane and is used to prevent bodily fluids from entering the mouth during oral sex. Slide 9 A latex glove can be used to protect a person s hand during contact with another person s genital area. which leads us to how STIs are spread. Generally, an STI can pass from an infected person to an uninfected person in 3 main ways: The first way is through unprotected vaginal, anal, or oral sex. The second way is through sharing needles. A person is at risk if they share needles with an infected person to shoot up drugs, get a tattoo or body piercing, or inject steroids or hormones. Sharing needles could allow infected blood to pass from one person to another. The third way is from mother to baby. This can happen during pregnancy, during delivery, or from breastfeeding. Slide 10 Some STIs can be spread from one person to another by skin-toskin contact, usually through contact with sores, warts, or infected skin. Now let s talk about bodily fluids. We just learned the 3 main ways that STIs can be transmitted. Think about the bodily fluids that could be involved during transmission. Who can tell me what the 4 main bodily fluids are that can transmit HIV and some other STIs? Answer: [After students respond, advance to the next slide showing the 4 main bodily fluids.] Pono Choices Facilitator Curriculum Implementation Guide Page 138
Slide 11 Slide 12 The 4 main bodily fluids that can transmit HIV and some other STIs are: blood semen vaginal fluids, and breast milk. There are 2 main types of STIs: bacterial and viral. Bacterial STIs include chlamydia, gonorrhea, and syphilis. Viral STIs include HIV, HPV, hepatitis, and herpes. Slide 13 STIs that are caused by bacteria include chlamydia, gonorrhea, and syphilis. Bacterial STIs are curable. A person can take medicine and be rid of a bacterial STI. But just because a bacterial STI can be cured does not mean it cannot cause harm. A bacterial STI may cause irreversible damage if left untreated or undiagnosed. For example, if left untreated, chlamydia and gonorrhea can result in infertility. What does infertility mean? Answer: It means a person cannot get pregnant or get someone else pregnant. That might not mean much to you now, but it may have a big impact on you later in your life. If a person cured their bacterial STI, and has unprotected sex, can they get it again? Answer: Yes! Pono Choices Facilitator Curriculum Implementation Guide Page 139
Slide 14 STIs caused by a virus include HIV, HPV, hepatitis, and herpes. Viral STIs cannot be cured. Once a person gets a viral STI, they may have it for the rest of their life. Viral STIs are treatable. The sooner it is diagnosed and treatment begins, the more effective the treatment will be. But, a viral STI can cause severe damage if left undiagnosed or untreated. Some can even cause death. HPV and herpes are STIs that can be transmitted via skin-to-skin contact. Facilitator Note: A person can take medications to treat the symptoms of a viral infection, but the medication does not make the virus go away. Slide 15 Slide 16 Here are some common signs and symptoms of having an STI. The #1, most common symptom has been left blank, and we will talk about it in a moment. Other signs include: Burning when urinating, urinating more frequently, and/or blood in the urine Sores or blisters on or near the genital area Itching of the genital area, and Unusual discharge from the penis, vagina, or anus. What is the #1, most common symptom when a person has an STI? [Wait until students guess No Symptoms, then go to the next slide.] Pono Choices Facilitator Curriculum Implementation Guide Page 140
Slide 17 Answer: No Symptoms. Many people who have an STI will not have any symptoms! If a person does not have any symptoms, what is the only way to find out if they have an STI? Answer: Get tested. Slide 18 We will talk more about testing when we talk about preventing STIs. You cannot tell if someone has an STI by looking at them, and they may not even know they have one themselves! Let s review what we learned: What are the 2 main types of STIs that we identified? Answer: Bacterial and viral What are the 3 main ways a person can get an STI? Answer: Unprotected vaginal, anal, or oral sex; sharing needles; and mother to baby. What are the 4 main bodily fluids that can transmit HIV and some other STIs? Answer: Blood, semen, vaginal fluids, and breast milk Who can get an STI? Answer: Anyone! It s not who you are or what you look like, it s what you do that makes the difference! End Pono Choices Facilitator Curriculum Implementation Guide Page 141
Show a video about how HIV is transmitted. Module 7 Activity F: You Cannot Get HIV Ladatt! 15 Minutes Facilitator Note: For current statistical information about HIV in Hawai i, please visit the following website: http://health.hawaii.gov/harmreduction/hiv-aids/data-and-statistics/ To Be Done: Have the You Cannot Get HIV Ladatt! video ready. Click the link on Slide 19 of the Module 7 Presentation to load the video. Next, we are going to watch a video that will talk more about HIV. Is HIV a viral or bacterial STI? Target response(s): Viral, or from a virus This video is called, You Cannot Get HIV Ladatt! It is a locally made video on how a person can and cannot get HIV. While watching the video, I want you to listen to the ways that HIV is spread, and some of the myths that people believe about HIV. To Be Done: Play the You Cannot Get HIV Ladatt! video. Facilitator Note: The video uses the term safe sex, but it is now considered more accurate to use the term safer sex since using condoms can reduce, but not eliminate, a person s risk for HIV transmission. From the video, how can a person get HIV? Target response(s): Unprotected vaginal sex, anal sex, or oral sex; sharing needles; getting a tattoo or piercing with unsterilized equipment What is the message about condoms in the video? Target response(s): A person can get condoms easily at grocery stores, drug stores, and places like Planned Parenthood of Hawai i and the Life Foundation. Pono Choices Facilitator Curriculum Implementation Guide Page 142
Great! In the video, they use the term safe sex, but it is more correct to say safer sex. Condoms can reduce, but not eliminate, a person s risk for HIV transmission, and as we saw from Mokie s Condom Wagon, there are many different types of condoms so that everyone can find one that works for them. Facilitator Note: For disease prevention, male condoms should be made of latex, polyurethane, or polyisoprene, and female condoms should be made of nitrile. How can a person tell if someone has HIV? Target response(s): A person cannot look at another person and tell if they have HIV, they must ask if the person has been tested for HIV How can a person get HIV from tattooing? Target response(s): From blood transmission on unsterilized needles or blood transmission from contaminated ink; it is important to use a brand-new needle and new ink every time a person gets a tattoo If choosing to undergo piercing or tattooing, look for a reputable shop. Ask questions beforehand about how the equipment is cleaned. Make sure the employees use sterile needles. If the staff won t answer questions, look for another shop. Any questions? Great job! You are demonstrating good Pilina A o by taking your knowledge of STIs and applying it to your understanding of how you can get an STI like HIV. End Pono Choices Facilitator Curriculum Implementation Guide Page 143
Module 7 Activity G: Myth or Fact Activity 5 Minutes The purpose of this activity is to highlight some common myths and reinforce the importance of having correct information. The video we just watched talked about many myths regarding HIV. Next, we are going to look at more myths and facts. Turn to page 25 in your workbook, to the worksheet titled Myth or Fact? What is a myth? Target response(s): Something that is not true What is a fact? Target response(s): Something that can be proven to be true Great! For the next few minutes, you are to read each statement and determine if it is a myth or a fact, based on what we have learned about STIs and HIV. Circle which answer you think is correct. Then, we will review as a class to answer any questions that you have. To Be Done: Give students time to read each Myth or Fact statement and circle their choice on the worksheet, found on page 25 of student workbook. Now, we will review each statement. Check your answers and make corrections as we go along. Going around the room, have students read the statement and say whether they thought it was a myth or a fact. Pono Choices Facilitator Curriculum Implementation Guide Page 144
1. Syphilis, chlamydia, and gonorrhea are examples of bacterial STIs. Target response(s): Fact 2. All STIs are curable. Target response(s): Myth 3. If a person cures their STI, it is possible to get re-infected or get it again. Target response(s): Fact 4. Abstinence can be practiced by anyone at any time. Target response(s): Fact 5. A person may be at risk for an STI from getting a tattoo. Target response(s): Fact 6. The only way to know if you are infected with an STI is to get yourself tested. Target response(s): Fact 7. STIs can only be spread through sexual contact. Target response(s): Myth 8. A person can die from an STI. Target response(s): Fact Pono Choices Facilitator Curriculum Implementation Guide Page 145
9. HIV can be transmitted through vaginal fluids, semen, breast milk, and blood. Target response(s): Fact 10. You can tell by looking at someone if they have an STI. Target response(s): Myth Conclude the activity by reinforcing the importance of having accurate information. So, by knowing what is fact and what is myth, you are able to protect yourself better, because you are not relying on false information. End Pono Choices Facilitator Curriculum Implementation Guide Page 146
Module 7 Activity H: Conclusion 5 Minutes Conclude this lesson and recap what the students have learned. We ve learned a lot of information about STIs. In this lesson, you learned: 2 main types of STIs 3 main ways many STIs are transmitted 4 main bodily fluids that transmit HIV and some other STIs, and Some myths and facts about HIV and STIs. It s important to have accurate information about STIs so you can know how to protect yourself. In our next lesson, we will learn how to prevent transmission of STIs. End Pono Choices Facilitator Curriculum Implementation Guide Page 147