CBO MODULE: Institutional Capacity Building of Community Based Organizations on

Peer Education for Behavioural

Change Communication
A Trainer’s Workshop Guide

September 2013
The ISEAN-Hivos Program

In 2010, the Insular Southeast Asian Network (ISEAN) on Males having Sex
with Males (MSM), Transgender (TG) and Human Immunodeficiancy Virus (HIV)
and the Humanist Institute for Co-operation with Developing Countries (Hivos)
jointly submitted a regional proposal to the Global Fund for AIDS, Malaria, and
Tuberculosis (GFATM) Round 10. The programme, entitled ‘Strengthening
Community Systems to Reduce Vulnerability to and Impact of HIV infection on
MSM and TG in Insular Southeast Asia’, was approved by GFATM and contract
for the grant was signed on 6 October 2011. This grant has the main goal of
reducing (a) the vulnerability and risks of MSM and TG to HIV infection and (b)
the impact of HIV on their lives in Insular Southeast Asia. It intends to address
critical gaps in supporting and scaling up activities that reduce HIV/AIDS among
MSMs and TGs.

Being a community systems strengthening program targeting HIV-AIDS initiative

amongst a very specific target population required the localization of various
standard tools being used for Peer Education for Behavioral Change
Communication. This module intends to address such a need for the Philippine
MSM and TG populations specific for CBOs conducting peer education on HIV-
AIDS.

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Table of Contents

Introduction………………………………………………………………………………………………………………………….. 5
Introductory Session…………………………………………………………………………………………………………….. 7
Knowing your epidemic………………………………………………………………………………………………………… 9
Venues and Risk……………………………………………………………………………………………………………………. 11
Sex, gender, sexual orientation, and gender identity…………………………………………………………… 14
Sub-session: Perception map………………………………………………………………………………….. 15
Sub-session: Defining sexuality………………………………………………………………………………. 17
Sub-session: Case studies……………………………………………………………………………………….. 18
Sub-session: SOGI-related stigma and discrimination…………………………………………… 19
HIV, SOGI, and the legal environment…………………………………………………………………………………… 22
STI and HIV and AIDS……………………………………………………………………………………………………………. 26
Sub-session: Safer sex self-rating 1………………………………………………………………………... 27
Sub-session: STI matching exercise…………………………………………………………………………. 28
Sub-session: HIV Carousel and HIV and AIDS 101…………………………………………………… 34
Sub-session: Risk continuum…………………………………………………………………………………… 37
Sub-session: Safer sex self-rating 2……………………………………………………………..…………. 39
Behavior Change Communication………………………………………………………………………………………… 40
Peer Education……………………………………………………………………………………………………………………… 44
Wildfire………………………………………………………………………………………………………………………………… 48
Safer sex skills building………………………………………………………………………………………………………. 54
Sub-session: Condom line-up…………………………………………………………………………………. 54
Sub-session: Condom demonstration……………………………………………………………………… 55
Sub-session: Safer sex negotiations………………………………………………………………………… 57
Peer Education and BCC activities………………………………………………………………………………………… 59
Sub-session: What to Anticipate in Peer Education and Steps to Peer Education…. 59
Sub-session: Developing Referral system……………………………………………………………….. 61
Sub-session: Developing standard messages…………………………………………………………. 62
Action planning and monitoring and evaluation………………………………………………………………… 64
Sub-session: Outreach planning…………………………………………………………………………….. 64
Sub-session: Developing M & E tools………………………………………………………………………. 65

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Introduction

PEER EDUCATION MANUAL FOR MSM & TG CBOs

A Trainer’s Guide

Introduction

This manual is intended to be an instructional aid to capacitate peer educators and outreach workers for
men having sex with men and transgenders (MSM and TGs).
It provides instructions, guides, situational analysis, and structured experiential learning on various
issues concerning the sexual health and human rights of MSM and TGs. It is designed to assist facilitators
in delivering content, insights, and lessons on a host of sexual health concerns and issues around sexual
orientation and gender identity (SOGI).
This manual is composed of 12 modules.
The content of this manual is based on up-to-date evidence on sexually transmitted infections, including
HIV. It should be clear, however, that due to the pace of the scientific development on HIV and AIDS, it is
incumbent upon the facilitators to update the medical and scientific facts that are included in this
manual. Furthermore, standards for HIV prevention, treatment, care and support are rapidly evolving,
and thus the content of the module pertaining to these should be regularly checked.

Methodologies
Different methodologies for adult structured learning experiences are used in this manual. Inputs and
lectures are recommended for concepts and to share the latest scientific evidence on the HIV epidemic.
Collaborative and participatory structures are embedded in the modules to facilitate common
understanding of issues related to stigma and discrimination.
Simulation exercises and role plays are also employed to sensitize the participants and evoke the values,
conduct, and attitudes that peer educators should carry. Cliniquing and peer-led feedbacks shall be used
to sharpen messages and situational approaches for some of the sessions.
Pre-test and post-test are recommended for the key sessions for monitoring and evaluation purposes.
However, it is left to the user of the module to determine which content shall be used for the pre-test
and post-test.

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Introduction

Training Outline

Module Content Time Alloted

Introductory Session Introduction, Expectations Check, House Rules 1.5 hours

Knowing your epidemic Latest evidence on HIV and AIDS; behavioral 1 hour
studies for MSM and TGs
Venues and Risk Mapping of venues for sex and sexual network- 1 hour
ing and potential risks
Sex, gender, sexual orienta- Sub-session: Perception map 45 mins
tion, and gender identity

Sub-session: Defining sexuality 30 mins

Sub-session: Case studies 45 mins
Sub-session: SOGI-related stigma and discrimi- 30 mins
nation
HIV, SOGI, and the legal envi- Discussion on the legal environment facing 1 hour
ronment MSM and TGs
STI and HIV and AIDS Sub-session: Safer sex self-rating 1 15 mins

Sub-session: STI matching exercise 45 mins

Sub-session: HIV Carousel and HIV and AIDS 1 hour
101
Sub-session: Risk continuum: 45 mins
Sub-session: Safer sex self-rating 2 15 mins
Behavior Change Communica- Concepts on BCC 1 hour
tion
Peer Education Basic peer education concepts 1 hour
Wildfire Simulation activity 3 hours
Safer sex skills building Sub-session: Condom line-up 30 mins

Sub-session: Condom demonstration 1 hour

Sub-session: Safer sex negotiations 1 hour
Peer Education and BCC activi- Sub-session: What to Anticipate in Peer Educa- 1 hour
ties tion and Steps to Peer Education
Sub-session: Developing Referral system 1 hour
Sub-session: Developing standard messages 1 hour

Action planning and monitor- Sub-session: Outreach planning 1 hour

ing and evaluation
Sub-session: Developing M & E tools 1 hour

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Module 1

Module 1: Introductory Session

Introduction
HIV and AIDS and sexual orientation and gender identity are subjects surrounded with stigma and
misconceptions. In this training, the participants will find themselves in exercises and discussions where
their own awareness and perceptions of these issues are juxtaposed to evidence, new concepts, and
values that they may not initially share. It is crucial that in the introductory activities, an atmosphere of
openness, sharing, collaboration, and eagerness to learn is established.

Time: 1.5 hours

Learning Objectives
At the end of the session, the participants will be able to:
1. Become acquainted with each other and with the staff involved in the training;
2. Gain insights and understanding on the scope and content of the training;
3. Clarify the objectives of the training and his or her own expectations from it; and
4. Determine and provide consent to collective agreed upon training rules.

Materials
- metacards and pens

Process

1. Ask the participants, co-facilitators and trainings staff to sit on chairs arranged in semi-circle.
Introduce yourself as the lead facilitator, and welcome everyone to the training. Thank the
participants for their decision to join the training. Explain briefly the objectives of the training, and
how the participants were engaged. Introduce the implementing agency of the training as well.
2. After the initial introduction, instruct them to pick one partner from the group, someone that they
have not met yet.
3. Once they found a partner, the participant is instructed to interview him or her using the following
questions:
a. Name, pre-occupation, organization, and where he or she is from
b. What part of his or her partner’s body is his or her favorite
c. What does he or she like do with that part.

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Module 1

4. After the partner answered, they should switch roles and the interviewee is instructed to ask the
same questions to the interviewer.
5. Give all the pairs 4 minutes to finish the interview. Once done, ask the participants and staff to
introduce their partner to the plenary.
6. Once all the participants and staff have introduced themselves, thank them and encourage them to
continue acquainting themselves with each other for the entire training.
Expectations Check

1. Give four metacards to each participant. Instruct them to write down their expectations for the
training according to the following categories:
a. Training content
b. Facilitators and Staff
c. Co-participants
d. Logistics and accommodation: food, venue, facilities, etc.
2. Ask the participants to post their metacards on the board according to the categories once they
finish.
3. Once everyone has written their expectations, go through each cluster and discuss the points raise.
Clarify any expectations that cannot be covered by the training content, and emphasize points where
consensus among the participants is clear.
4. Proceed to a presentation of the training design and clarify if the expectations on the content are met.
5 To synthesize the expectations, present the guidelines that will be adopted for the whole training:
a. Use “I” statement - opinions are personal and should not be presumed to be shared by
everyone
b. Confidentiality - the sensitive issues to be shared by co-participants should remain in the
group
c. No killer phrases - avoid conversation enders or hostile remarks
d. Be considerate - ensure that the proper learning atmosphere is maintained, no Facebook or
Twitter during sessions, give time for others
e. Freedom - Openness is highly encouraged
f. Let’s have fun - Keep the sessions fun
g. Let’s build a team - Ensure that the spirit of collaboration is present and maintained.

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Module 2

Module 2: Knowing Your Epidemic

Introduction
In this session, the importance of evidence should be introduced and emphasized fully. Understanding
evidence is crucial in determining the strategies and approaches that should be taken to halt or reverse
the epidemic. As an epidemic affected by stigma, the importance of understanding the facts around the
epidemic becomes all the more important.
The idea of “knowing your epidemic” also highlights the need for peer educators to appreciate their own
roles in the HIV response – as agents within their own communities who can use evidence to shape their
own methods in bringing their own communities to the crucial HIV services.
The evidence presented in this session is important in guiding the peer educators in identifying their
priorities and in ensuring that their approaches would help generate the desired impact for the HIV
response.
As of the writing of this module, the HIV prevalence among MSM and TGs in the Philippines has already
reached epidemic level. As of May 2013, 13 new HIV cases are reported everyday, of which 11 are due to
unprotected sex among MSM and TGs.

Time
1 hour

Learning objectives
At the end of the session, the participants will be able to:
1. Understand the growing HIV epidemic in the Philippines, and how it affects the men having sex
with men and transgenders;
2. Appraise up-to-date evidence on the HIV epidemic and the MSM and TG-specific response to
the epidemic

Materials
· Slide presentation on the latest epidemiological data (Source: latest results of the Integrated
HIV Behavioral and Serological Survey and the latest HIV and AIDS Registry from the
Department of Health)
· Papers and pen

Process
1. Ask the participants to rank the state of the HIV epidemic in the Philippines from 1 to 5, with
one being the least alarming and ten being the most alarming.
2. Ask them to briefly explain the basis of the rank they have provided.

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Module 2

3. Present the latest epidemiological data on the HIV situation in the country.
4. Open the discussion on why it is important for peer educators to know the facts about the
epidemic. Underscore that in any response to the HIV epidemic, “knowing your epidemic” is
always important.

Facilitator’s Note
· HIV is a constantly changing epidemic. Ensure that the presentation provides the latest data
from health authorities.
· Highlight data on the behaviors of MSM and TGs that make them vulnerable to HIV.
· The latest data from the HIV Registry can be downloaded from the website of the Philippine
National AIDS Council: www.pnac.org.ph
· Data on the HIV and AIDS incidence or prevalence would be insufficient if evidence on
behavioral risks are not provided. Behavioral risks data would provide the context for the data
on the HIV incidence and prevalence.

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Module 3

Module 3. Venues and risks

In Philippine context, venues for socialization among MSM and TGs present various levels of
opportunities for sex. These venues can range from physical spaces where actual sexual activities could
take place or areas or occasions where one could find potential sexual partners.
With the growing access to internet in many urban centers in the Philippines, opportunities for sexual
encounters have significantly diversified. While traditional venues for male-to-male sexual encounters
still endure, smartphone apps and MSM and TG-targeted social networking sites such as Grinder and
Planetromeo have made possibilities for sex more available.
An understanding of where and how MSM and TGs access sex is crucial in identifying the various risks
that an MSM or TG might encounter, and how they can respond to such risks. Knowing the dynamics in
these venues contextualizes the situation of the MSM and TG community - the role that stigma and
discrimination plays in their sexual and social behavior, how they appreciate and calculate the risks they
encounter, whether this involves unwanted disclosure of their sexuality to other people, the chance of
hostile or abusive encounter with law enforcers, or the likelihood of exposure to sexually transmitted
infections, including HIV.
In responding to the HIV epidemic among MSM and TGs, a vital factor that should be considered is how
sexual networking occurs. This provides peer educators and outreach workers an awareness of how
MSM and TGs could be exposed to HIV or other STIs, and how such risks could be reduced or eliminated.
This session hopes to list possible venues for sex and sexual networking among MSM and TGs, their
dynamics, and the various risks that MSM and TGs may encounter in those venues.

Learning objectives
At the end of the exercise, the participants will be able to:
1. Map out specific venues for sex and sexual networking for MSM and TGs (i.e. parks, movie houses,
Grinder, etc.)
2. Understand the dynamics in those venues
3. Identify and categorize the possible risks that MSM and TGs may encounter in these venues

Materials
• Manila paper
• Pentel pens
• White board

Time
1 hour

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Process
1. Begin by explaining to the participants that the purpose of the exercise is to map out venues for
sexual networking and the dynamics and risks that MSM and TGs in these venues.
2. Define the following terms:
a. Venues - places, locations, or situations where MSM and TGs are known to find sexual partners,
or can have sex;
b. Features or dynamics - description of the sexual networking that happens in each venue, such as
the characteristics of the venues themselves, the way sex could be obtained in those places, or
the age, sexual or gender identification of those who go these venues, or even the sexual acts
that could happen in those venues (anal sex, oral, etc.).
c. Risks - the different dangers or threats that MSM and TGs might encounter for every venue.
3. To illustrate, provide an example:
a. Venue: Parks
b. Features: Normally, cruising begins in the afternoon up until late at night; those who cruise are
usually old men; sexual activities are known to happen in some parts of the park.
c. Risks: You could be cruising a person who is hostile, or could harm you.
4. Divide the participants into groups. Instruct each group should be able to list at least 5 venues. Ask
them to report using the matrix below:

Venues Features / Dynamics Risks

5. After the group discussion, ask each group to choose a reported to present their outputs. Regularly
check with the participants if similar venues have been identified. Consolidate similar venues.
6. After the reporting, process the information from the groups. Identify similar venues, dynamics and
risks, and highlight comparable contexts.
7. Categorize the risks according to the following: Risk to Property (hold up, etc.); Risk to Person
(Violence, health risks); Risk from Authorities (arrest and detention, police harassment); and Social
Risks (forced disclosure of one’s sexuality or sexual behavior; media entrapment).
8. Identify which among the risks can be controlled or mitigated. Ask the participants what preparations
are needed to reduce the risks that one might encounter in such venues.
9. Identify which among the risks are beyond the control of an individual (i.e., uncontrollable risks) .
Encourage the participants to share how such risks can be addressed.
10. In closing the exercise, highlight the following points:
a. In any venue where MSM and TGs socialize, the possibilities for sex could be present;

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b. These venues pose varying levels of risks. There are some risks that can be controlled by an
individual, thus mitigating or eliminating the possibility of these risks occurring.
c. There are risks that are beyond the control of an individual. To address these risks, it is important
for the community to act collectively.

Facilitators Note
This exercise serves as an introduction to the context why MSM and TGs are vulnerable to HIV. It
presents the sexual behaviors that provide an entry point for sexually transmitted infections, including
HIV.
It also contextualizes how these risks are shaped by stigma and discrimination on the basis of sexual
orientation and gender identity (SOGI). The lack of awareness on STIs and HIV, for instance, is a result of
stigma on male-to-male sexual behavior or biases against transgenders, which bars the MSM and TG
community from accessing crucial sexual health services and information. In the course of the training,
the relationship between SOGI-based factors and risky sexual behavior should be constantly
emphasized.

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Module 4

Module 4. Sex, Gender, and sexual orientation and gender identity (SOGI)
Prevailing attitudes and cultural norms on sex have made any open discussion on sexual behavior and
sexual health a taboo in Philippine society. A controversial topic excluded in schools and in other
mainstream educational settings, sexuality is understood based on misconceptions and prejudiced
notions.
This is all the more amplified in the case of the public’s understanding of the sexuality of MSM and TGs.
The persistence of derogatory labels and negative notions associated to homosexuality, from ‘third sex’
to ‘AIDS carriers’, reflects how stigma determines a person’s grasp of sexuality, including his own’s. Even
for many MSM and TGs, sexuality as a complex concept needs to teased out.
This session hopes to deepen the understanding of the participants on the different issues that revolve
around human sexuality. In a culture where different elements of human sexuality are simplified and
lumped into binary categories (male or female), it is unsurprising to discover that even among MSM and
TGs, sexuality-related prejudices are common. This session is intended to help the participants be
conscious of and sensitive to the nuances of sexuality-related issues.
The session has four sub-sessions:
1. Perception map
2. Understanding sexuality
3. Case studies
4. SOGI-related stigma and discrimination
The “Perception Map” explores popular and common notions on sexuality-related labels applied on
individuals, while the second sub-session, “Understanding sexuality”, involves defining the different
sexuality-related concepts, including sexual orientation and gender identity. The sub-session on case
studies is an exercise on process how the concepts would be used, and the final one is a discussion on
SOGI-related stigma and discrimination.

Learning objectives
At the end of the sessions, the participants will be able to:
1. Identify different notions and ideas associated with sexual labels and understand how such notions
are arbitrarily constructed and applied;
2. Define different concepts related to sexuality and distinguish their differences;
3. Have an understanding how to sexuality-related concepts can be applied in their own community
work; and
4. Understand stigma and discrimination, and how they are linked to sexual orientation and gender
identity.

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Time
Perception Map: 45 minutes
Defining sexuality: 30 minutes
Case studies: 45 minutes
SOGI-related stigma and discrimination: 30 minutes
Total: 2.5 hours

Sub-session: Perception Map

Materials
• Manila paper
• Meta cards
• Pentel pens
• White board

Process
1. Start by explaining that the session aims to level off the understanding of the participants of the
complex issue of human sexuality. Based on the earlier session on venues and risks, discuss briefly
how the risks encountered by MSM and TGs are linked to perceptions and notions around their
sexuality.
2. Discuss with the participants how perceptions and notions on sexuality can oftentimes be gleaned
from the labels or terms used for MSM and TGs. As a short introduction for the activity, solicit from
the participants some examples of the terms used for MSM and TGs, or the labels they use for
themselves (eg, “gay”, “bisexuals”). Ask them how they feel about it.
3. Proceed to the activity. Explain to the participants that the objective of the activity is to map out the
different perceptions, ideas, and notions associated with certain labels or terms.
4. Tell the participants that you will flash several ‘trigger words’ that reflect certain sex or gender-
related labels or terms, and instruct them to write on a piece of metacard the first word or idea that
comes to their mind when the read the trigger word. Give each participant four metacards.
5. Flash the trigger words (see Facilitator’s Notes) one by one. Make sure that the participants have
ample time to write on the metacards. Gather the metacards for each trigger word and post them
in separate areas in the session room. Make sure that the trigger word is visible for each cluster.
6. Go to one cluster. Ask for a volunteer to read aloud the words or ideas written on the metacards.
Encourage the group to identify which of the words or ideas are deemed positive (or socially
acceptable) and which ones are seen as negative (or socially unacceptable), and urge them to explain
why. Discuss with the group any agreements or disagreements on how to categorize the words or
ideas.

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7. Go through each cluster following the same process.

8. At this point of the exercise, emphasize these points:
a. Labels that we use to identify individuals according to their sex or gender often carry with them
positive and negative biases and prejudices.
b. The distribution of these biases among the terms displays inequality among sexual or gender
identities and lopsided acceptance of certain communities: notions associated with male
heterosexuality are viewed to be positive by most, followed by ideas linked to female
heterosexuality.
c. Homosexuality is deemed to be least positive, but underscore that even among among the so-
called homosexuals, there are varying degrees of acceptability: for male homosexuals, whether
one is deemed effeminate, or when one is seen as overly flirtatious (‘malandi’) or ‘indecent’; for
lesbians, negative biases are often linked to their perceived violence, although as women, they
are also exposed to the same unfairness that heterosexual women experience.
d. So-called positive notions can actually be negative since they may entail unreasonable
expectations. A heterosexual man expected to be emotionally strong is stifled from expressing
his emotions. On the other hand, the belief that a bakla is someone funny and entertaining
restricts possibilities of social acceptance or limits his career choices.
9. After the discussion, remove the trigger words from their respective clusters and try to match them
with other sets of words and ideas (i.e., put the bakla in a different cluster). Ask the participants if the
same notions would still apply, and if the ‘positive’ or ‘negative’ classification of the attributes would
remain given the new configuration.
10.During the discussion, highlight the following points:

a. The attributes associated with sex or gender-related labels are based on perceptions that have
been reinforced by years of gender-based stereotyping and stigma.

b. The invisibility and disempowerment of sexual minorities have made it difficult to correct these
stereotypes and encourage a more diverse and a less stigmatized depiction of the community.
11. To end the session, explain that a peer educator should always expect to encounter different views
on sexuality, some of which could be stigmatizing and alienating. It is therefore important to
understand the complexity of human sexuality.

Facilitators Note
These are the suggested trigger words: GIRL, BOY, BAKLA, TOMBOY. Other sex or gender-related labels
or terms may be used depending on the background of the participants. For emphasis, pictures may be
used along with the trigger words.
Note that for many Filipinos, sexuality is an alien topic, and therefore various contentious issues could
be raised. In the interest of time, prioritize which of them can or should be immediately processed
during the session, and which ones can be flagged and addressed later.

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Sub-session: Defining Sexuality

Materials
• Manila paper
• Meta cards
• Pentel pens
• White board
• Slides on “Understanding Sexuality” (see Facilitator’s Note)

Process
1. Divide the participants into sub-groups.
2. Instruct each group to define the following terms: sex, gender, sexual orientation, and gender
identity. Tell them to write their answers on a manila paper.
3. Review the answers quickly. Inform the participants that you will discuss the results later on.
4. Present the slide on “Understanding Sexuality”.
5. Elicit comments and questions from the participants as you discuss the different sexuality-related
concepts.
6. Go through the group outputs again to emphasize certain points and definitions.

Facilitator’s Note
The presentation on sexuality should cover the following points:
• Human sexuality is best seen as a constellation of different elements, which includes sex,
gender, SOGI, and a person’s sexual behavior.
• At its core is sex, the biological differentiation, including genetic, anatomical and
biochemical differences, that defines humans at birth as males or females.
• Meanwhile, gender refers to the differences between males and females that are
constructed by the society and are changeable over time. It relates to a set of learned
behavior and expectations to fulfill certain masculine or feminine roles.
• SOGI is the acronym for sexual orientation and gender identity.
• Sexual orientation refers to the direction of one’s sexual or emotional attraction. An
individual may be attracted towards persons from the opposite sex (heterosexuality), of
the same-sex (homosexuality), or both sexes (bisexuality).
• Gender identity, meanwhile, refers to an individual’s deeply felt internal and individual
experience of gender, which may or may not to correspond with the sex at birth. This may
include one’s personal sense of the body, which may involve, if freely chosen, the personal
sense of the body (which may involve, if chosen freely, modification of bodily appearances

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or function through medical, surgical or other means) and other expressions of gender,
such as speech, dress, mannerisms, and preferred name.
• LGBT, or Lesbian, Gay, Bisexual, and Transgender, is a term used to refer to different
SOGIs. Transgender refers to individuals whose gender identity doesn’t match their sex at
birth. A transgender may be male-to-female or female-to-male.
• Sexual behavior refers to a person’s sexual practices or sexual conduct, which may not
always reflect one’s SOGI. It describes or illustrates sexual behavior and should not be
confused with SOGI. The term MSM is a behavioral label for men who have sex with men.
• There are several factors that shape sexuality, as a person is immersed in different
contexts and situations: 1. At the individual level, sex, gender roles, economic status, age,
and social conditions influence how a person’s understand his or her sexualityl; 2. there
are interpersonal factors, including relationship with the family, community, or a partner,
which affect one’s views and behaviors on sexuality and gender; 3. subcultural influences,
such as social class and ethnicity, also dictate sexual and gender norms; and 4. at the
macro level, institutions like the State (public health agencies, police, etc) and religion
regulate human sexuality.

Sub-session: Case Studies

Materials
• White board and pens
• Slides on the case studies (see Facilitator’s Note)

Process
1. Review the different elements of sexuality that were discussed in the previous session: sex, gender,
sexual orientation, gender identity, and sexual behavior.
2. Present to the group different case studies that illustrate different elements of human sexuality (see
Facilitator’s Note).
3. In a plenary discussion, asks the participants to the following questions:
a. What is the sex of the character?
b. What is his or her gender (masculine, feminine, etc.)?
c. What is his or her sexual orientation and/or gender identity?
d. What sexual behaviors could be gleaned from the narrative?

4. Using the answers from the participants, clarify the definition of the different elements of human
sexuality.
5. In processing the answers, introduce the concept of human sexuality as a continuum. A person’s
understanding of his or her sexuality is a continuing process of negotiation with different factors, as

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discussed in the previous session. It is important, therefore, to be sensitive in using labels and
stereotypes because they may be reinforcing incorrect or biased ideas about sexuality.
6. Explain the roles that labels often play in our understanding of sexuality. Explain how the meanings of
sexual labels change depending on certain contexts. Highlight that existing labels are oftentimes
limiting and fail to capture the complexity of human sexuality.
7. Conclude the session with a short note on how labels and perceptions on sexuality are shaped and
reproduced by biases based on different elements of sexuality.

Facilitator’s Note

Below are several case studies that could be used for the exercise:
• Destiny is a 25-year old beautician who works for a parlor in her community. Her partner is
a married man who currently lives with her but he goes home to the province regularly to
see his wife. Destiny engages in anal sex with Manny as a receiver, but when Manny is
away, Destiny hooks up with other guys, saying that she does it to do things that she
normally can’t do with Manny - which is to top another guy. Destiny has a child from a
woman with whom Destiny lived with for a few years.
• Emman is a nurse who is decided to work for a BPO while waiting for his visa. He plans to
go to Canada to join his wife, also a nurse. Emman recently discovered a smartphone app
where he can meet up with other persons anonymously for sex. In his latest sexual
encounter, he met a good-looking guy who was keen to have a long-term relationship with
him. He rejected the man, and told him that he is loyal to his wife.
• Born male, Razelle has always considered herself as female and dreamed to meet her ideal
man. With all her earnings as an entertainer abroad, she began her transition into
womanhood and started to undergo a series of sex reassignment surgeries. She now uses
her preferred name. In one party, Razelle met Cathy, a lesbian working for an NGO. Their
friendship grew, and Cathy one day admitted to Razelle that she has fallen in love with her.
The admission made Razelle happy, and she realized that she is also attracted to and in
love with Cathy.

Sub-session: SOGI-related stigma and discrimination

Materials
• White board and pens
• Projector
• Slides on “SOGI-related Stigma and Discrimination” (see Facilitator’s Note)

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Process
1. Explain to the participants that the session aims to explore the link between SOGI and stigma and
discrimination.
2. Ask the participants to share their insights on the following statement: “Homosexuality is accepted in
the Philippines.” Probe the responses by asking for the possible basis of the statement, and if this
reflects the experiences that the participants or their peers have encountered in the group.
3. Stress that for many Filipinos, the high visibility of gay entertainers is oftentimes cited to indicate that
LGBTs are accepted in the country, but documented cases show a different picture.
4. Present the slides of SOGI-related stigma and discrimination (see Facilitator’s Note).
5. After the presentation, encourage the participants the participants to share other incidents that
illustrate SOGI-related stigma and discrimination.
6. In closing the session, raise the following points:
a. Stigma and discrimination are inter-related. A climate of stigma creates an environment where
discriminatory practices and policies against MSM and TGs.
b. Stigma fuels the HIV epidemic because it pushes the community underground, thus creating a
barrier in accessing or delivering vital HIV or HIV-related services.

Facilitator’s Note
Below are some inputs for the presentation:
• Preface the presentation with incidents that demonstrate stigma on the basis of SOGI, e.g.
anti-LGBT pronouncements of public officials or religious leaders, specific events that
stirred anti-LGBT sentiments, etc.
• Share documented cases of SOGI-related discrimination in the Philippines. The civil society
submission to the Review of the commitment of the Philippines to the implementation of
the International Covenant on Civil and Political Rights contain examples of these cases.
You may obtain the submission here: http://www.ccprcentre.org/country/philippines/
• Explain stigma and discrimination using standard definitions from international human
rights instruments:
➡ Stigma refers to the dynamic process of devaluation or dehumanization that
discredits an individual in the eyes of others. This process may be based on
culturally assigned meanings or constructs attached to certain attributes: race,
ethnicity, class, sex, gender, SOGI, etc.
➡ Discrimination means any distinction, exclusion, or restriction based on any ground
such as race, color, sex, SOGI, religion, political or other opinion, national or social
origin, birth or other status, whether actual or perceived, that has the purpose or
effect of nullifying or impairing the recognition, enjoyment, or exercise by all
persons, natural or juridical, of equal footing of all rights and freedoms.
• Elaborate that while stigma refers to how a particular group or category is viewed and
valued, discrimination stands for the acts triggered by stigma.

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Module 4

• Note that due to the stigma experienced by the larger LGBT community, it is difficult to
document actual cases of discrimination.

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Module 5

Module 5. SOGI, HIV, and the legal environment

The Philippines doesn’t outlaw same-sex sexual behavior. However, the wrongful application of some
laws has the punitive effect of regulating or criminalizing certain sexual behaviors, including sex between
men or the gender expressions of transgenders.
Laws influence the risks that the MSM and TG community encounters. Instead of serving as a recourse
against discrimination, laws become the instrument of persecution. They also affect how MSM and TGs
access HIV and other public health services. Legal barriers hinder the HIV response by making it harder
for various HIV interventions to reach their target MSM and TG clients.
This session aims to explore elements of laws that currently affect SOGI and the HIV epidemic in the
Philippines. A basic understanding of these laws provides a knowledge of rights that protect peer
educators and their clients, as well as an appreciation of how laws and policies can harm the HIV
response or the MSM and TG community.
In this session, participants can develop ways on how to utilize protective laws and mitigate or eliminate
the potential effects of laws that unjustly penalize or regulate the MSM and TG community.

Time
1 hour

Learning Objectives
At the end of the session, the participants will be able to:
1. Identify and understand laws that affect the HIV response and the MSM and TG community
2. Improve their awareness of RA 8504, or the HIV and AIDS law, and understand how it is relevant in
their peer education work.
3. Identify laws and policies that are being applied to regulate or penalize same-sex sexual behavior.

Materials
• Whiteboard and pens
• Projector
• Slides on the salient points of RA 8504 and other relevant laws and policies

Process
1. Begin by explaining that in this session, the participants will be acquainted with different laws and
policies that affect the HIV response and the MSM and TG community.
2. Ask the participants to cite any laws or policies that they know of or have heard about that are
related to the HIV epidemic or affects the MSM and TG community.

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Module 5

3. List the laws that have been mentioned. Discuss with the participants which of these laws are
deemed favorable to the MSM and TG community and which ones are not.
4. During the discussion, stress that despite a law’s intent, the wrong or inadequate implementation of
the law could lead to a different outcome. For example, a law may not be intended to penalize same-
sex behavior, but in the hands of abusive law enforcers, it can be used against the community.
5. Start discussing the laws that affect the MSM and TG community and the HIV response. Start with
laws that have an impact of the rights and freedoms of LGBTs, and then present the salient features
of RA 8504 (see Facilitator’s Notes).
6. Relate the intent and content of the laws to how they are being implemented. Ask the participants
how can maximize laws and policies that promote and protect the rights and welfare of the MSM and
TG community, and how the negative impact of laws that indirectly penalize same-sex sexual
behavior could be mitigated and eliminated.
7. Highlight how the law penalizes involuntary or non-consensual disclosure of HIV status and
mandatory HIV testing. Get the insights of the participants on these two controversial issues, and
underscore how mandatory testing and non-consensual disclosure can further HIV-related stigma.
8. Discuss the different layers of issues involving disclosure of HIV status to one’s sexual partner/s.
Stress that the law makes it an obligation but doesn’t penalize non-disclosure. Tease out issues and
biases of the participants on non-disclosure, and ask how disclosure to sexual partner/s can be made
possible.
9. Highlight the following points to close the session:
a. Laws have the effect of enabling or hindering the HIV response. Laws that protect the human
rights and welfare of communities vulnerable to HIV help reduce stigma that limits or weakens
HIV interventions.
b. While no laws in the Philippines directly criminalize or prohibit same-sex sexual behaviors, the
enforcement of some laws has the effect of penalizing such behaviors and regulating the
sexuality of MSM and TGs.
c. The HIV and AIDS law is deemed to be model legislation on HIV when it was enacted. It
established various mechanisms that safeguard and protect the human rights of Filipinos
vulnerable to affected by the HIV epidemic. However, with the changing nature of the HIV
epidemic, some provisions of the law are no longer relevant or effective.
d. HIV testing should be conducted voluntarily and should be done with the necessary pre-test and
post-test counselling.
e. Mandatory HIV testing and disclosure to sexual partner/s can further stigma, which diminishes
the effectiveness of HIV interventions. To encourage HIV testing and disclosure, the approach
should be stigma-free.

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Module 5

Facilitator’s Notes
In the slide presentation on the features of the laws and policies relevant to the HIV response and the
MSM and TG community, share the following points on the application of punitive laws against the MSM
and TG community:
• Unlike its Southeast Asian neighbors, the Philippines has no laws criminalizing gay sex. It
has no anti-sodomy laws.
• However, there are certain laws that are wrongfully or illegally applied which have the
effect of criminalizing, prohibiting, or regulating same-sex sexual behavior.
• In the past, the anti-vagrancy, anti-public scandal, and anti-prostitution laws had been
used by law enforcers to detain gays, bisexuals, and transgenders who are alleged to be
found having sex in parks, cinemas, and similar public spaces.
• Vagrancy was an act prohibited under the Revised Penal Code (Article 202). It referred to
persons who have no apparent means of subsistence, who loiter in inhabited or
uninhabited places, and who “habitually” associate with prostitutes. Vagrancy was already
repealed under RA10158.
• Under Article 202 of the Revised Penal Code, prostitution was limited to women who, for
money or profit, engages in sexual intercourse or other lascivious acts. This limitation did
not prevent law enforcers from using this provision to arrest and file charges against gay
men during raids in gay establishments. This provision was also interpreted to mean that
people in prostitution are
• This provision was entirely repealed by RA10364, or the Expanded Anti-Trafficking Act,
which, as interpreted by some, changed the categorization of so-called prostitutes from
offenders to victims of trafficking, a crime that by legal definition includes prostitution.
• The anti-trafficking law is deemed as a graver offense. Before the repeal of Article 202, it
was wrongfully applied by law enforcers to implement raids in gay establishments. Since
trafficking is non-bailable, it has proven to be an effective tool for extortion: in all instances
of raids conducted by law enforcers, there are reports that policemen demanded for bribe
money to prevent the filing of charges.
• While it is true that the wrong application of these laws are motivated by extortion on the
part of law enforcers, the premise behind the belief that same-sex sexual behavior is
tantamount to prostitution should also be examined to understand its prejudicial
underpinnings. It reflects the heterosexist assumption that male-to-male sex is only
possible in the context of paid or transactional sex.
• To prove that sexual intercourse, and hence transactional sex, is happening, law enforcers
wrongly claim that the presence of condoms is a prima facie evidence for prostitution. In
several instances, condoms, an important HIV prevention commodity, have been the basis
of anti-prostitution charges against MSM and TGs and establishment owners.

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Module 5

Explain the background and salient points of RA 8504, the law that governs the HIV response:
• Enacted in 1998, the law was seen by many countries as a model legislation.
• The law affirms the human rights of persons living with HIV and was aligned with existing
international human rights standards for PLHIVs. It was also aligned with the existing
evidence on HIV at that time.
• It provides for HIV education and information, defined to be part of health services, in
schools and workplaces, including for Filipinos working abroad and for tourists and
transients in the country.
• It penalizes misinformation on HIV, especially false claims on a cure for HIV, as well as
unsafe practices that deliberately or unwittingly lead to HIV infection.
• It lays down the policy framework for HIV testing. It imposes medical confidentiality on HIV
testing and its results and allows for anonymous testing. Disclosure of test results is only
allowed for the surveillance program of the Department of Health, provided that
confidentiality is maintained and the information doesn’t go outside the program. It also
prohibits compulsory testing and requires that testing is conducted with pre-test and post-
test counselling. Compulsory testing is only allowed when the HIV status of a person is
relevant in certain criminal cases or in organ donations.
• The current law also penalizes discrimination on the basis of perceived, actual, or
suspected HIV status of an individual in employment, education, and healthcare.
Restrictions to travel, exclusion from credit and insurance, and denial of burial services
due to one’s perceived or actual HIV status are also prohibited.
• The law also establishes the national program on HIV and STI prevention, as well as the
mandate for HIV testing facilities for the country.
• Under the law, the governance for the HIV response is spearheaded by the Philippine
National AIDS Council (PNAC), a multisectoral body comprised of key government agencies
and community organizations. Headed by the Secretary of Health, the council is main
policy-making body for HIV and AIDS. It is attached to the the Department of Health. At
the local level, it provides for the establishment of local AIDS councils (LAC), or LGUs may
designate other local structures tasked to localize the HIV response.
• Gaps in the current legal framework have become more evident with the growing HIV
epidemic. For one, the interventions identified are designed for a general population
epidemic, since at the time of its enactment, the drivers of the epidemic were mainly
female overseas workers. There is also confusion on its governance structure - PNAC is a
multisectoral body attached to DOH, and yet the programs identified in the law are limited
to the health sector response. Furthermore, the appropriations provision in the law is only
for the PNAC secretariat, and so the source of funding for HIV programs is unclear.

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Module 6

Module 6. STI and HIV and AIDS

A precise understanding of HIV is the core of any effective strategy against the spread of the AIDS
epidemic. The failure to adhere to the best evidence in existence on HIV impairs any approach to contain
the epidemic. The most important principle is always to “know your epidemic.”
Three decades into the HIV epidemic, the virus itself is ironically still surrounded by myths and
misconceptions. Advances in HIV treatment has already transformed HIV infection from a death
sentence into a chronic, manageable condition, and yet these developments have been stunted by the
prevalence of stigma and fear.
In this session, the most recent evidence on HIV will be discussed, from transmission to treatment, and it
will be assessed vis-a-vis perceptions of risks and vulnerability to HIV infection. This would underline
how science and evidence are often trumped by stigma and fear, the main architects of misconceptions.
It must be noted, however, that while this module contains the most up-to-date evidence on the virus,
accelerating headways in the evidence on HIV and its treatment may easily render current knowledge
obsolete. It is therefore important to remain updated with the latest medical and scientific
developments on HIV.
The session has four sections. The main topic, the basics HIV and AIDS, is preceded by a discussion on
sexually transmitted infections and will be followed by an exploration of risks of exposure to HIV and
various STIs. These are bookended by safer sex self-ratings of the participants to sensitize them on how
risks are perceived in relation to evidence.

Time
Safer sex self-rating: 15 minutes
STI matching exercise: 45 minutes
HIV Carousel and HIV and AIDS 101: 1 hour
Risk continuum: 45 minutes
Safer sex self-rating: 15 minutes
Total: 3 hours

Learning Objectives
At the end of the session, the participants will be able to:
1. Assess their own risks relative to STIs and HIV based on their pre-existing knowledge of and the latest
evidence on STIs and HIV;
2. Distinguish different symptoms and signs of sexually transmitted infections, including HIV, based on
the following: their causes, modes of transmission, means of prevention, and known treatment;
3. Differentiate and identify the levels of risks to sexually transmitted infections or HIV infection of
various activities.

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Module 6

Sub-session: Safer sex self-rating

Materials
• Pens
• Metacards

Process
1. At the start of the sub-session, explain to the participants that the exercise is an introduction to the
subsequent discussions on STIs, including HIV. The aim of the exercise is for the participants to assess
the level of safety of their own sexual activities in relation to STIs;
2. Distribute one metacard and a pen to each of the participants. Ask participants to rate between one
to five how safe their sexual activities in the past month were, with one being the “least safe” and
five being the “safest”.
3. Instruct the participants to write on the metacard their self-rating and think why they gave
themselves that rating.
4. Once they finish answering, ask for volunteers to share their ratings and explanations.
5. Identify commonalities and divergences, especially instances where same sexual activities are rated
differently. Probe conflicting explanations.
6. Conclude the sub-session by underlining the following:
a. Assessing one’s sexual behavior is stems from personal perceptions of safety and risk, which
sometimes are not based on evidence or facts;
b. Sexual behaviors are located in certain contexts, and although they may appear similar, these
situations can affect how one’s appreciates risks and safety.
7. Explain that the succeeding sub-sessions present evidence on STIs, including HIV, that should inform
one’s assessment of risks and safety. Tell the participants to keep their self-rating cards because they
will need it again.

Facilitator’s Notes
Risk assessment is an important tool that peer educators can use in conducting their outreach or peer
education intervention. It aids peer educators in understanding the risk factors that their clients
encounter, thus giving them a chance to tailor their messages or design their own referral mechanisms.

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Module 6

Sub-session: STI matching exercise

Materials:
• Metacards containing syndromes, causes, modes of transmission, signs and symptoms, and treatment
of various STIs (see Facilitator’s Notes)
• Pictures depicting the symptoms of the STIs

Process:
1. Start by asking the participants to define “STI” and to provide examples of STIs. After the discussion,
ensure that everyone has a common understanding of the definition of STIs: “sexually transmitted
infections” refer to infections that are spread through the transfer of organisms (such as bacteria,
virus, or protozoa) from person to person by means of sexual contact. Mention that older terms such
as ‘venereal diseases’ (VD) and ‘sexually transmitted diseases” (STDs) are no longer used because
they fail to caption the idea that some STIs are asymptomatic.
2. Explain that for this exercise, the participants will be asked to match STIs according to their common
syndromes. Divide the participants into five groups, with each group assigned with one syndrome -
genital discharge; genital ulcers; genital warts; parasitic infestations; and asymptomatic STIs (see
Facilitator’s Notes).
3. Review the syndromes one by one. Ask each group to explain what for them is the meaning of the
particular STI symptom or sign assigned to them.
4. Based on the symptoms assigned to them, ask each group to go through a mix of metacards that
show other signs or symptoms of STIs, their possible causes, modes of transmission, and treatment,
as well as pictures that illustrate some of the aforementioned syndromes (see Facilitator’s Notes).
5. Ask them to collect the metacards and pictures that they think correspond with the syndrome
assigned to them. Instruct them to post their metacards on the wall or the white board according to
the arrangement below. Give the participants 10 minutes to finish the task.

Common syndromes E.g. Genital Discharge

Possible cause/s Name of the STI
Pictures Pictures that depict the syndromes
Modes of transmission How the STI is transmitted
Signs and symptoms Manifestations of infection
Prevention How infection can be prevented
Treatment How it is treated or cured

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Module 6

6. Once everyone is done, encourage all the participants to take a look at the resulting matrix. Ask if
there are metacards or pictures that they think are misplaced and should be transferred to a different
syndrome or cluster.
7. Discuss the basic evidence on the STI syndromes (see the matrices in the Facilitator’s Notes). Move
the metacards and the pictures if necessary to reflect the correct information.
8. Discuss the Eight Core STI Messages to close the discussion:
a. Every sexual activity is an opportunity for a variety of infections
b. Co-infection and multiple infections are common
c. Some infections may present signs and symptoms, others may not
d. If you have STI and are sexually active, you have exposed your partners
e. Even if you don’t have signs and symptoms, you are still infectious
f. Diagnosis and treatment of all partners is imperative to avoid re-infection
g. Avoid self-medication. Always seek appropriate diagnosis and treatment from physicians.
h. Complete the treatment. Non-compliance may result to a more complicated and expensive
treatment.

Facilitator’s Notes:
According to UNAIDS, the spectrum of STIs now includes more than 20 disease-causing organisms and
syndromes. This exercise focuses only on five common syndromes of STIs:
1. Genital discharge (“Scrotal swelling” and “lower abdominal pain” may be included, as they are the
result of complications of STIs under this syndrome)
2. Genital ulcers
3. Genital warts
4. Parasitic infestations
5. “Asymptomatic” STIs

For the mix of metacards, use the bullets below:

For genital discharge -
• Gonorrhea
• Chlamydia
• Sexual intercourse or contact with discharge
• Yellowish discharge in urethra, vagina, or anus
• Whitish discharge in urethra, vagina, or anus
• Scrotal swelling

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Module 6

• Lower abdominal pain

• Diagnosis: anal, vaginal or cervical swab
• Treatment: Antibiotics

For genital ulcers -

• Syphilis
• Herpes
• Transmission: Sexual intercourse, direct contact with the sore; Mother to child; prolonged
kissing, if sore is in the mouth
• Symptoms - Cold sore, rashes, swelling
• Symptoms - small, painful blisters
• Prevention - condom use to reduce risks, abstinence, mutual monogamy
• Diagnosis - Blood test
• Diagnosis - inspection of the blisters
• Treatment - Antibiotics can cure the infection
• Treatment - Cannot be cured, but symptoms may be treated

For genital warts

• HPV
• Transmission - oral, vaginal, or anal sex; genital-to-genital contact
• Symptoms - mass or warts in genital or anal areas
• Prevention - condom use can reduce risks
• Diagnosis - inspection of warts; There is no screening available
• Treatment - cauterization

For itchiness or scaling

• Crabs or lice
• Scabies
• Transmission: sexual intercourse, skin-to-skin contact, or sharing of infected towels
• Symptoms: Itchiness in pubic areas, scaling
• Prevention: mutual monogamy or abstinence; non-sharing of underwear
• Treatment: medicated shampoo or ointment

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Module 6

For asymptomatic STIs

• Hepa B
• Transmission: oral, vaginal or anal sex; intense kissing; sharing of needles
• Symptoms: Asymptomatic, but some persons may display flu-like symptoms during early stage
of infection
• Diagnosis: blood tests
• Treatment: treatment available to delay progress of infection

Common Genital Discharge (including scrotal swelling and lower

syndromes abdominal pain)

Pictures Use pictures that depict the syndromes

Possible cause/s Gonorrhea - caused by the gonoccocus bacteria. It can- Chlamydia - caused by
not survive outside the body, and has an incubation peri- the bacteria chlamydia
od of 3-7 days. trachomatis. It has an
incubation period of 7-21
days.
Modes of transmis- Sexual intercourse (anal, vaginal, or oral) or contact with
sion the discharge.

Signs and symp- • Discharge in the penile urethra, vagina, or anus: thick,
toms yellowish green for gonorrhea, and whitish for Chla-
mydia. Note that for chlamydia among women, symp-
toms are not easily evident.
• Painful urination
• Pain in the penis, anus, or throat
• Scrotal swelling for men
• Lower abdominal pain

Prevention Consistent and correct use of condoms reduces risks, but

the most certain way is sexual abstinence or mutual mo-
nogamy with an uninfected partner.

Diagnosis & Treat- • Diagnosis: swab for anus, urethra, or cervix

ment • Treatment: Doctors prescribe antibiotics for treatment.
Since co-infection between Gonorrhea and Chlamydia
is common, the treatment regimen usually covers
both infections.

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Module 6
Common Genital Ulcers
syndromes
Pictures Use pictures that depict the syndromes
Possible Syphillis - A highly contagious bacterial infec- Herpes - A viral infection caused by
cause/s tion caused by Treponema pallidum.
Modes of Syphillis:
transmission • Direct contact with syphillis sores during
sex (oral, vaginal, or anal).
• Occassionally through prolonged kissing -
if the sores are located in the mouth
• Mother-to-child
Signs and Syphillis -
symptoms 1st stage: one or more cold sores called
chancres, which are round, hard, and pain-
less, located in the genital or mouth. They
appear 10 to 90 days after the infection, and
will disappear without scar even after treat-
ment.
2nd stage: Rashes that are rough, red or
reddish brown develop on the palms of the
hands or the soles of the feet. Other rashes
may appear in other parts of the body that
may be taken as symptoms of other diseas-
es. In some cases, lesions may develop in
warm and moist areas of the body. This stage
may begin while the symptoms of first stage
syphilis is healing or weeks into the infection.
These symptoms will also heal even without
treatment.
3rd stage: Soft swellings (also called gumma)
appear, including lesions in many tissues and
organs. This happens after 2-3 decades into
the infection (after an asymptomatic, latent
period) & is considered to be deadly.
Prevention Consistent and correct use of condoms re-
duces risks, but the most certain way is sexu-
al abstinence or mutual monogamy with an
uninfected partner.
Diagnosis & • Diagnosis is through a blood test
Treatment • Syphilis is curable through antibiotics pre-
scribed by doctors. Treatment prevents
further damages, but it can’t repair dam-
age caused by syphilis.
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herpes simplex viruses type 1 (HSV-1)
or type 2 (HSV-2)
Sexual intercourse (anal, vaginal, or
oral) where contact with the sores
caused by the virus occurs. However,
infection can still happen through con-
tact with the skin that appears to have
no sores.
Herpes -
• One or more blisters around the
genitals, anus, or mouth that eventu-
ally break and become painful
sores. It takes two to four weeks for
the blisters to heal. Outbreaks of
blisters occur frequently in the be-
ginning of the infection but it tends
to decrease over time.
• Infected persons may experience
fever, body aches, and swollen
glands during the first outbreak.
Consistent and correct use of condoms
reduces risks, but the most certain way
is sexual abstinence or mutual monoga-
my with an uninfected partner.
• Diagnosis is done through inspec-
tion of the area with the outbreak
• Herpes is not curable, but antiviral
medications can be used to reduce
or prevent outbreaks
Module 6

Common Genital warts

syndromes
Pictures Pictures of genital warts
Possible Human Papilloma Virus (HPV), a virus that can cause genital warts and/or cervical
cause/s cancer for women, among others
Modes of HPV is transmitted through vaginal or anal sex. It can also be passed through oral sex
transmission or genital-to-genital contact.
Signs and • Warts on the genital or anal areas, which can come in the form of a bump or a
symptoms group of bumps in the genital areas. The symptoms manifest weeks or months after
infection, even if the partner doesn’t display symptoms of infection.

Prevention HPV vaccines are recommended for girls and boys aged 11 or 12 years old. Condoms
reduce risk, but cannot fully protect a person from HPV because infected areas cannot
always be covered by condoms.

Diagnosis & • Diagnosis: screening for cervical cancer caused by HPV is available, but there is no
Treatment screening that can detect one’s HPV status.
• Treatment: There is no treatment to cure HPV, but cauterization and surgery can
remove genital warts. Cervical cancer or other HPV-related cancers are treatable if
diagnosed early.

Common Itchiness
syndromes

Pictures Use pictures that depict the syndromes

Possible pthiriasis, or parasitic lice infestation Scabies
cause/s

Modes of Sexual intercourse (anal, vaginal, or oral) or skin to skin con-

transmission tact; sharing of underwear, beddings

Signs and • Itchiness in pubic areas • Itchiness on skin

symptoms • Spots on underwear • Scratch marks
between fingers
and toes
Prevention Mutual monogamy or abstinence

Diagnosis & • Diagnosis: inspection of the infected areas

Treatment • Treatment: special medicated shampoo or ointment.

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Module 6

Common Asymptomatic
syndromes
Pictures No pictures to be used
Possible Hepatitis B HIV
cause/s
Modes of (to be discussed in the next
transmission • Unprotected sex session)
• Sharing of needles
• Mother-to-child

Signs and No symptoms, but some persons may develop

symptoms flu-like symptoms during acute stage (first six
months of infection). If and when it reaches
chronic stage, it will remain asymptomatic until
symptoms of liver damage is detected.

Prevention Hepa B vaccine; condom use to reduce risks

Diagnosis & • Diagnosis is through a blood test

Treatment • Treatment is available to delay or reverse
effects of liver disease

Sub-session: HIV Carousel and HIV and AIDS 101

Materials
Metacards for the HIV Carousel
Slides for HIV and AIDS 101 (Please see Facilitator’s Notes)
Whiteboard and pens

Methodology
- Group Activity (HIV Carousel)
- Inputs (Lecture-Plenary discussion)

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Module 6

Process
1. Begin the session by referring back to the responses related to HIV as an asymptomatic STI in the
previous exercise. Ask the participants to define “HIV and AIDS” to assess the knowledge level of the
participants on HIV and AIDS.
2. Probe the responses by asking which of them could be based on misconceptions and which ones are
based on existing evidence.
3. Proceed to the group activity, the “HIV Carousel”. Divide the participants into three sub-groups. Point
to the participants the three “stations” in room. Posted in each “station” are three questions: “How
is HIV transmitted?”; “What are the body fluids that contain HIV?” and “How is HIV infection
prevented”.
4. Distribute metacards to the sub-groups and instruct them to go around the stations. Ask them to
provide at least 2 answers per question.
5. Once all of the sub-groups have finished providing their answers in all three stations, present inputs
on HIV and AIDS 101.
6. During the discussion on the inputs, refer to their definition of HIV and AIDS and their answers in the
HIV Carousel to correct misconceptions. Highlight that the body of medical and scientific evidence on
HIV and AIDS is rapidly developing, and it is crucial to continuously update information on HIV and
AIDS.

Facilitator’s Notes
For the HIV and AIDS 101 input, present the “Six Things to Know About HIV and AIDS”:
ONE: “One” type of infection - HIV infection is a type of asymptomatic retroviral infection. The infection
itself is known to have NO symptoms. It gradually attacks the immune system and makes a person
vulnerable to opportunistic infections that can cause death. HIV infection is determined through an HIV
anti-body test.
TWO: It involves “Two Concepts” that are distinct from each other: “HIV” and “AIDS”. HIV stands for
“Human Immunodeficiency Virus”, which causes “Acquired Immunodeficiency Syndrome” or AIDS, a
condition where the body is susceptible to various opportunistic infections. The virus is transferred from
human to human and therefore cannot be transmitted by animals. HIV is a volatile virus, and it is not
known to survive outside the body. AIDS refers to different symptoms of various infections and diseases
acquired by a person living with HIV once the immune system is diminished. There is still no cure to or
vaccine for HIV, but the current treatment regimen is successful in suppressing the replication of HIV,
thus averting progress to AIDS. When opportunistic infections associated with AIDS are addressed, the
immune system of a person living with HIV may recover during HIV treatment.
THREE: There are “Three known modes of transmission”: unprotected sex (oral, vaginal, or anal sex);
blood and blood products (blood transfusion, organ transplant, or sharing of syringes); and mother-to-
child (during pregnancy, childbirth, or while breastfeeding). The most efficient transmission is thru blood
-to-blood because it provides direct exposure to the virus. Thus, the risk to HIV infection when sharing
syringes is high.

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Sexual transmission is the most common but not the most efficient, and the risk of exposure varies
according to sexual acts. Unprotected anal or vaginal sex may lead to lacerations or small wounds that
could provide an entry point for the virus.

FOUR: There are four requisites for a successful transmission:

1. First, there should be a portal of entry to the blood stream. Remember that HIV is a volatile virus and
it has to be inside the human body in order to survive and replicate.
2. Second, at least one known mode of transmission (blood-to-blood, sexual, or mother-to-child) should
occur.
3. Third, there should be a medium of transmission, which can be blood, semen, vaginal fluid, or
breastmilk. These are the body fluids that have high concentration of HIV. While HIV can be detected
in other body fluids (tears, saliva, sweat, etc.), the amount of HIV in these fluids is not sufficient for a
successful transmission.
4. Fourth, the viral load should be enough to carry out the transmission. Persons living with HIV who are
not under treatment have high viral load and may pass the virus to other individuals, while the viral
load of those under HIV treatment may become low and undetectable over time, thus lowering the
risk of transmission.
The presence of all of these requisites determines the levels of risks of HIV transmission. Assessing risks
to HIV infection entails knowing the presence of these four variables, and the absence of just one factor
means that a transmission is not viable: for example, if there is no portal of entry to the body or the
blood stream, or if any of the body fluids above is not involved, then HIV infection is unlikely. These four
requisites are a good tool in risk assessment.

FIVE: There are five ways to prevent infection (Also known as the ABCDEs of HIV prevention).
1. A for Abstinence - sexual abstinence prevents the sexual transmission of HIV. However, this is only
effective if it is practiced consistently (100% sexual abstinence)
2. B for Be Faithful or Monogamous - Sexual monogamy is an effective approach to prevent the sexual
transmission of the virus IF both partners are aware of their status and are practicing it consistently
(100% monogamy).
3. C for Condom Use - the use of condoms is the most effective way to prevent the sexual transmission
of HIV if practiced correctly and consistently (100% condom use). The correct use of condoms
involves using water-based lubricant since using lubricants with oil (soap, shampoo, or baby oil) can
damage or tear the condom.
4. D for Don’t Do Drugs or Don’t Share Needles - sharing needles among injecting drug users is a high
risk activity among drug users. Drug use, meanwhile, increases risk-taking behavior and may impair
one’s health-seeking practices.
5. E for Education, Early Detection, and Early Treatment - Knowledge and awareness of HIV and AIDS
helps men who have sex with men and transgenders understand how infection can be prevented.
Early detection of HIV infection through HIV testing and counseling is an important HIV prevention
intervention. Knowing one’s status provides opportunities to access HIV services, including life-saving
HIV treatment services, if one is diagnosed positive.

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SIX: There are six steps to consider in getting an HIV test to determine HIV status:
1. “Window Period” - there is a period after infection where a person won’t test positive for HIV. The
length of the window period depends on the type of HIV test that is used. An antigen test (also called
RNA test) detects the presence of the virus itself, and after one to three weeks since transmission,
there would be enough viral material to detect HIV. Antigen tests are not commonly used, however.
The more common type of HIV tests are anti-body tests (or rapid tests), which detects antibodies to
HIV. The window period for rapid tests can last from three to six months. It is important to wait for
the window period before getting an HIV anti-body test since during the window period, a person can
test negative even though he or she is already infected by the virus. HIV can be transmitted from
people who are in the window period.
2. “Pre-test counseling” - prior to getting tested, a person is provided with pre-test counseling which
includes risk assessment and basic information on HIV and AIDS. Guidance is also provided on the
kind of HIV services that are available for HIV negative and HIV positive individuals. Clients are also
informed of safeguards under the law, which include the provision of written consent and the
confidential nature of HIV testing. Under RA 8504, the Philippine law on HIV and AIDS, failure to
provide pre-test counseling is prohibited. It also penalizes disclosure of HIV test results without the
consent of the individual.
3. “Screening” - HIV rapid tests are the most commonly used test, and it detects the presence of HIV
antibodies in the blood sample.
4. “Confirmatory test” - A confirmatory test is conducted for blood samples that were screened reactive
for HIV anti-bodies to confirm the result. Only those that tests reactive require confirmatory tests.
5. “Results” - Since HIV information is considered to be confidential information, the results of HIV anti-
body tests cannot be disclosed by the clinical staff or the counselors to anyone other than the client.
A ‘reactive’ result means that HIV antibodies have been detected, while a non-reactive result means
the absence of HIV anti-bodies.
6. “Post-test counseling” - counseling after the test regardless of the results is required by law. During
post-test counseling, HIV prevention is discussed to the client regardless of the result, and if the
client tested positive, he or she is given information on available HIV services on treatment, care, and
support and they are referred to service providers for PLHIV.

Sub-session: STI and HIV Risk Continuum

Materials
- Metacards: title cards to be posted on the board and the cards containing sexual activities.
 Pens

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Methodology
- Group activity
- Inputs

Process
1. Explain to the participants that the next topic is on various sexual activities and the sexual health risks
that they may pose. Quickly review the four requisites for HIV infection.
2. On the board, post the title cards that show the RISK CONTINUUM for STIs, including HIV. NO RISK,
LOWER RISK, HIGHER RISK. Explain that NO RISK refers to activities that pose no risk to STIs; LOWER
RISK pertains to activities with lower risk to STIs; and HIGHER RISK is for sexual activities that have
high risks to STIs.
3. Distribute the cards containing the different sexual activities and contexts to the participants
randomly. Instruct them to place the cards according to their risk category. (See Facilitators Notes).
4. Once the participants have finished posting the cards, discuss the sexual activities and the categories
under which they are placed. Move along the continuum and compare the activities according to
their risks. If necessary, review the requisites for a successful HIV infection, as well as the modes of
transmissions for other STIs. Engage the participants in determining risk levels of certain activities
compared to other activities, and how these levels could change depending on the situation.
5. Emphasize the following points:
a. Oral, vaginal, and anal have differing risk levels. Unprotected anal sex is the riskiest, followed by
vaginal sex, and then oral sex. Lubrication plays a role in the levels of risk, as it determines the
possibilities of tears and wounds that could provide the virus entry to the body. These risk levels
could also be affected by the presence of other STIs or wounds (ie, oral sex is a low risk activity
but oral ulcers could provide entry points for HIV, thus increasing its risk).
b. Condom use lessens risks, but only if they’re used correctly and consistently.
c. Being a receiver or an inserter in penetrative sex also have differing levels of risks.
6. During the process, some cards may need to be parked as points of discussion. These cards may refer
to certain contexts, stereotypes, or behavior that influence one’s appreciation of risks. For instance,
some gender-based notions (“having sex with transgenders”) do not have direct effects on risk levels
but are presumed to be so because of misconceptions and stigma.
7. In the course of the discussion, ask the participants if the risk levels vary according to STIs. Emphasize
the differences in risks depending on the STI.
8. To close the session, highlight that risks to STI or HIV infection depends on behavior and not on the
identity of the person.

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Facilitator’s Notes
Use the following terms for the metacards on sexual activities based on the categories below:
a. Penetrative sexual activities: unprotected anal sex (top), unprotected anal sex (bottom), unprotected
anal sex (versa), unprotected oral sex (receiver), unprotected oral sex (inserter), unprotected vaginal
sex (inserter), unprotected vaginal sex (receiver)
b. Other sexual activities: rimming, fisting, fingering, frottage (espadahan), mutual masturbation, pissing
or golden shower.
c. Other eroticized activities: kissing, hugging, massage, online sex, showering together
d. Sexual partnerships: having multiple sexual partners, orgies, sex with call boys, sex with
transgenders, sex with “bisexuals”, sex with masculine gay men, sex with drug users, sex with young
men, sex with boyfriend.
e. Other activities or conditions: sex while intoxicated with alcohol, sex while high on drugs, abstinence,
sharing of needles.

Sub-session 5: Safer Sex self-rating

Materials
• Pens
• Metacards

Process
1. Ask the participants to rate themselves again between one to five on how safe their sexual activities
in the past month were, with one being the “least safe” and five being the “safest”.
2. Process their answers based on their key lessons from the previous sessions on STI and HIV.
3. In closing, encourage the participants to be conscious on how to assess risks based on evidence, and
how such assessments should guide one’s behavior to prevent STI or HIV infection.

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Module 7. Behavior Change Communication

Introduction
This session aims to provide a deeper understanding on how behavior can be influenced through
communication and information to yield positive or desirable results. In the context of HIV prevention,
behavior change communication (BCC) is a strategy to mitigate or change risky behaviors and in the
process reduce the vulnerabilities of particular groups.
This session hopes to equip peer educators with the different theories on behavior change. to help them
develop their peer education and outreach messages.

Time:
1 hour

Learning Objectives:
At the end of the session, the participants will be able to:
1. Understand the meaning of behavior change communication, including the determinants of behavior
and the different stages of behavior change
2. Know the different elements of effective communication
3. Identify different pathways where BCC activities can be conducted.

Materials
- Slide presentation (See Facilitator’s Notes)

Methodology
- Inputs from facilitator

Process
1. Start the session by eliciting from the participants their understanding of what “Behavior Change
Communication” or BCC means.
2. Establish the contexts in relation to the HIV epidemic among men who have sex with men where BCC
is important.
3. Present the slides on behavior change communication

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Facilitator’s Notes
Use the following inputs for the slide presentation:
What is behavior - behavior or actions are determined by many factors, among them external variables,
which influence an individual’s attitudes, social influences, and self-efficacy. These shape one’s intention
which leads to certain actions or behavior depending on barriers that an individual may encounter or his
or her abilities. (See diagram below)
What is behavior change - There are many models that explain the different stages of behavior change,
which is best viewed as a continuum and not a linear process:
Based on these stages, behavior change communication strategies should be developed to ensure that
behavior change is sustained.
For example, a person may have reached the ‘concerned’ stage already but due to external factors could
also experience barriers that demotivate him or her to change. Among MSM and TGs, stigma and
discrimination could prevent behavior change despite their awareness of risky behaviors and how they
increase their vulnerabilities.
Peer educators should be conscious of where their clients are located in relative to the continuum so
that they can assess which strategies to develop and employ to sustain behavior change.
Elements of communication - In developing communication strategies, the following elements should be
considered:
• The source, which refers to the origin of the communication
• The message, or the content of the communication
• Channel refers to the medium used to communicate the message
• The receiver is the recipient of the message
• Once the message reaches the receiver, it generates an effect or a feedback that goes back to the
source.
• Noise, such as unneeded information, may affect or distort the flow of the message from the source to
the receiver and from the receiver to the source.

Follows the 7 C’s of effective communication:

1. Command attention - to establish connection with the client, a peer educator should be able to get
immediately the attention of the client and establish connection.
2. Cater to the heart and the head - the goal is to generate empathy from the client to make the
message resonate.
3. Clarify the message - noise permeates the pathways of communication, and competing messages and
information can be overwhelming. To make the message stick, it should be clear.
4. Communicate a benefit - the message should be able to relay the gains that the client would get from
the information and ultimately, from behavior change.

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5. Create trust - BCC for HIV involves sharing sensitive information and enticing clients to talk about
practices and behaviors that are stigmatized. Trust is an important ingredient to prevent barriers to
communication.
6. Call to action - be clear on what actions you are proposing, what steps you are recommending
7. Consistency - messages need to gain traction before they can catalyze certain actions. It is important
that consistency is maintained to make the message to latch.

BCC Framework
The BCC Framework lays down what enables behavior change through communication. It underscores
the enabling environment that allows for successful behavior change strategies (effective
communication, legal rights, and access to crucial HIV services), and the channels that can be used to
relay the message (mass media, community networks, interpersonal channels, etc.)

Planning BCC activities

Planning BCC activities requires mapping out pathways where interventions to deliver messages for
behavior change could be initiated. Below is an illustration based on the Philippine MSM and TG Plan of
on-the-ground and online venues where MSM and TG clients could be reached (Text clans, social
networks, residential communities at the barangay level, non residential communities, open spaces such
as parks, and MSM-frequented registered establishments such as clubs and bars). The map also provides
the existing HIV services for the MSM and TG communities (Mobile HIV testing, treatment hub

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extensions, community clinics, etc), and what BCC events and activities
could be implemented to increase uptake of HIV services by MSM and
TGs.
The goal for this model is to encourage MSM and TG clients to get HIV
information and access HIV services, especially HIV testing. Using the
map, peer eds can establish pathways to the services through the
suggested BCC activities. Depending on the target communities (MSM
and TGs in social networks, text clans, etc.), the BCC planning process
should consider what kind of messages are apt for the sub-population,
where messages should be delivered, and how they should be delivered.
For instance, online outreach activities should consider what messages
should be crafted online, and how they’re linked to BCC messages once
the clients proceed to offline or face-to-face interventions in facilities or
during actual BCC events.

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Module 8. Peer Education

Introduction
In a stigmatized environment, HIV peer education is an essential approach to reach communities that
need to access life-saving HIV information and services. By mobilizing communities to promote health-
seeking behavior, peer education provides a gateway to populations that are vulnerable to HIV infection.

In the context of MSM and TGs, peer education is critical in catalyzing behavior change. Armed with the

correct skills and the right messages, peer educators can organize their communities for health
promotion, demand generation for HIV services, and for other interventions that can enable better or
MSM and TG-friendly HIV services.

In this session, the participants will be introduced to the concept of peer education to familiarize them
of the principles behind peer education and its role in the HIV response.

Time: 1 hour

Learning Objectives

At the end of the session, the participants will be able to:

1. Understand the meaning of peer education and its role in addressing HIV among MSM and TGs

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2. Learn the roles and functions of peer educators

Materials
 Slide presentation

Methodology
- Inputs from the facilitator
- Small group workshop

Process
1. Ask the participants to define peer education or who peer educators are.
2. After a brief discussion on the responses, present the slides. (See Facilitator’s Notes)
3. Emphasize that the efficacy of peer education as an approach rests on the connection between the
peer educators and the populations they wish to reach. When this common ground is lost, peer
educators lose their intrinsic access to the communities they are supposed to be working with.
4. To discuss the characteristics of a peer educator, divide the participants into four sub-groups. Assign
for each sub-group a role of the peer educator (Use P-E-E-R). Ask each group to identify at least three
characteristics for each of the role, and then afterwards to present their outputs to everyone.
5. After the presentation, summarize exercise by emphasizing that a peer educator must satisfy basic
human needs in communication:

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a. To be heard and be understood

b. To be respected and valued
c. To trust and be trusted
d. To be involved
6. Remind the participants of the 7 Cs of effective communication.

6. Close the session by highlighting that the whole training is designed to develop peer educators.
However, capacity and skills building for peer educators is a continuing process especially with the
ever-changing nature of the HIV epidemic.

Facilitator’s Notes

Use the following inputs for the slide presentation.

Peer education is a health promotion intervention that aims to deliver behavior change messages to
communities and populations that are otherwise difficult to reach.

Functions of peer education in the HIV response:

1. Provide insights on the risks that the target population may have relative to the HIV epidemic
2. Bridge communities to HIV services, or vice versa
3. Facilitate or initiate the behavior change process
4. Identify communities and sub-groups for HIV prevention
5. Provide stigma-free and enabling environment for the HIV response.

Advantages of peer education:

1. Peer education builds the community and enables community organizing

2. It strengthens the links between communities and health facilities and other services
3. It is based on the context of the communities and therefore can easily resonation
4. It complements other forms of education, but it is more targeted

Who is a peer educator?

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A peer educator shares key characteristics with the target population. A peer educator may be a
member of the same community, come from the same socio-economic background, have the same HIV
status or risky behavior, or have had the same salient experience (history of drug use, sex work, etc.)

Roles of a peer educator

P - Positive Educator: he or she encourages and enables the client

E - Encourager of health behavior adoption: he or she facilitates health-seeking attitudes
E - Emphatic source of social and emotional support: a peer educator is there for the client
R - Role Model: A peer educator follows or practices what he or she teaches

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Module 9. Wildfire

Introduction

The Wildfire is a simulation exercise that aims to aid the participants walk through the different
challenges that the HIV epidemic poses to the community. It follows the flow of the HIV infection - from
getting exposed to the virus to getting tested and finally to the scenarios that one has to confront once
you know your HIV status.

As an exercise, the Wildfire is both complex and sensitive, as it navigates the participants through
different situations that are surrounded by misconceptions, stigma, and prejudice. It can be an
emotional process for many, as they would need to confront their own personal appreciations of the
issues that we previously discussed.

It therefore requires thorough preparation on the part of the facilitator. It is important to read and
review these instructions thoroughly, and to imagine the range of responses that each step could
generate. It is also crucial to scope prior to the activity the profile of the participants: their age and
educational background; level of awareness on HIV and AIDS, and their attitudes on the issue based on
the previous discussions; their sexual orientation and gender identity; the variety of sexual experiences
and their own risky behaviors; and their willingness to be open and to share even their personal biases.

The process is an important sensitization exercise for peer educators. It aids them to understand the
situation of their target populations, including their own personal feelings, thoughts, and opinions on
HIV and AIDS and their own vulnerabilities. It is also an important opportunity for the facilitator to
review the facts about the epidemic and inculcate evidence-based attitudes on HIV.

Finally, it is important to establish, prior to the workshop, the spirit of confidentiality and mutual trust
among the participants so that they can all fully share thoughts and apprehensions on the epidemic that
can facilitate or hinder behavior change communication.

Time: 3 hours
Learning Objectives:
At the end of the exercise, the participants will be able to:
- Demonstrate increased awareness on the issue of stigma and discrimination, and how they relate to
the spread of HIV
- Identify different challenges facing the MSM and TG community in addressing the epidemic
- Show improved knowledge on the HIV epidemic

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Materials
For a group of 10 to 15 participants:
- Pieces of paper to be used as HIV test results. 9 should contain “NON-REACTIVE”, while 6 should
contain “REACTIVE”. They should all be placed in unmarked envelopes.
The number of reactive and non-reactive results should be adjusted according to the number of
participants.

Guide for facilitators:

1. Here are some standard questions to remember for each important step of the process: How do you
feel? Would you share this to anyone? What will you do? Always synthesize responses, and use them
as an opportunity to review facts and correct misconceptions.
2. Milestones for the flow of the exercise:
a. Introduction
b. Sexual networking (handshake)
c. Exposure to HIV
d. Deciding on getting tested
e. Taking the test
f. Waiting and dealing with the result
g. Living with HIV, co-existing with persons living with HIV
h. Debriefing

Process
1. Explain the objectives of the exercise, and highlight that it aims to help the participants understand
the experiences associated to HIV infection.
2. Remind the participants of the House Rules: the information to be shared shall be treated with
confidentiality; there should be mutual respect among all; mutual trust should be encouraged.

Sexual networking: symbolic handshake

3. Ask all of the participants to stand up and to form a circle facing each other. Explain to them that you
will begin with an exercise on sexual networking, which is to be demonstrated through a symbolic
handshake. Go to a participant and shake his or her hand. While holding the hand, explain to
everyone that a hand shake symbolizes having unprotected sex.
4. While still holding the participant’s hand, remind the participants that unprotected sex presents a
potential exposure to HIV. For this exercise, a scratch on the palm indicates an exposure to HIV.
Shake the hand of the participant and demonstrate scratching his or her palm. A scratch indicates
having unprotected sex with an HIV positive person.

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5. Emphasize that a potential exposure to HIV is not equivalent to infection. The virus is not transmitted
in every act of unprotected sex. Review quickly the requisites of infection.
6. After the initial demonstration, ask all the participants to shake the hands of their co-participants.
Remind everyone that this is just a demonstration, and no one from the group has been exposed to
HIV. Remind them of the nature of HIV: that it is aymptomatic, and you can’t tell based on the
characteristics of a person.

Exposure to HIV
1. Ask all the participants to go back to their previous position in the circle. Tell them of the next step:
you will walk outside the circle, and you will tap a participant on the shoulder. This symbolizes
exposure to HIV. Remind them again that exposure is not equivalent to HIV infection.
2. You will proceed to selecting a participant to be exposed. Tell everyone to close their eyes. Go
outside the circle and go around the group. Remind them that the person who’s shoulder has been
tapped is considered to be exposed to HIV. Consequently, when that person shakes the hand of
another participant, he should scratch his or her palm discreetly.
3. Tell everyone of the rule that if their palm had been scratched, they must also scratch the palm of
the next persons that they shake hands with. Remind everyone to scratch discreetly.
4. While going around, review the process quickly to ensure that there is no confusion. Tap one
participant on the shoulder.
5. Remind the participants to keep their eyes closed. Tell them you have tapped someone of the
shoulder already, and tell that person not to disclose himself to other.
6. Tell the participants to open their eyes. Ask them if they can identify the person who had been
exposed to HIV. Emphasize that HIV is an asymptomatic infection.
7. Ask the group how they felt while you were going around. Tell them that one stigmatising attitude
towards HIV is the refusal of others to touch someone who’s infected because of fears that they
might get the disease. Remind them HIV cannot be transmitted though touching of hands, and the
exercise symbolizes unprotected sex and exposure to HIV. Tell them that at this point, a person had
been been exposed to HIV, and when they shake hands with the person, he or she will scratch their
palm.
8. Tell the group that the sexual networking exercise is about to start. Each participant will have a
maximum number of handshakes. For a group of 10-15, the recommended maximum is 3 per person.
For a group of 14-25, the recommended maximum is 4 per person.
9. A participant CAN shake the hand of a person only once. Repeat hand shakes are not allowed.
10. Step out of the circle and ask the participants to start the handshaking exercise. Remind everyone of
the maximum number of hand shakes per person.
11. Once the handshaking exercise is over, ask the participants go back to the circle. Go to the center of
the group. Check with everyone if their decision on who to shake hands with is purposive, and what
affected their decisions.
12. Ask the participants whose palms have been scratched to step forward and form an inner circle. Ask
those whose palms have not been scratched to sit down, still facing the inner group.

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13. Ask everyone how they feel. (See standard questions). Probe how they feel about the others - those
who are inside the inner circle, or those outside. Ask the person whose shoulder you’ve tapped to
identify himself or herself. Ask the participants how do they feel about him or her.
14. Remind everyone that at this point people are exposed to the virus. It is not sure yet if the infection
is successful. Emphasize, too, that in the exercise the participants were following instructions to
engage in “unprotected sex”. In the real world, people have choices - they can practice safer sex or
abstain from sex. Ask them if they considered NOT shaking hands with anyone.
15. Remind them as well that at this point, it is only exposure to HIV that the group is looking into. Any
sexual activity presents potential exposure to other STIs.
16. Regularly use the standard questions to probe feelings and path of actions from the participants.
Check with them if at this point they are considering changing behavior, and why.
17. It is expected that many would decide based on fear. Underscore that fear itself is not an effective
catalyst for behavior change: that it leads to paralysis (refusal to act) or evasion (denial that there is a
problem).

Deciding to get tested

1. Present HIV testing as the only tool to determine the HIV status of the participants. Recall that HIV
testing is voluntary and confidential. Explain the procedures for HIV testing: the window period, the
pre-test counseling, screening and getting the results, the confirmatory test, post-test counseling.
2. Offer HIV testing to the participants, and check who’s willing to get tested, and who is not. Instruct
those who wish to get tested to move to the inner circle (regardless of exposure), and those who do
not want to get tested to go to the outer circle.
3. Emphasize that testing requires the consent of the individual, and one cannot be forced to get
tested.
4. Probe the decisions of the participants: why have they decided to get tested, or why not? What
could change their minds? What can we tell to those who do not wish to get tested to change their
minds? Would they inform anyone of their situation and decision? What kind of support do they
need.
5. Delve into the window period. Inform the participants that they have to wait 3 to 6 months. Ask
them what they would intend to do while waiting: Would they continue the same practices? Would
they seek more information about HIV?

Taking the test

1. Inform the participants that the window period is over, and they can now finally undergo HIV
testing. Ask the participants again who are willing to get tested. If anyone has changed his or her
mind, discuss why they made the decision, and what made them change their mind.
2. Clarify the process of getting screened. Explain that blood sample will be taken from those who gave
their consent to undergo HIV testing. With the current testing technology, HIV screening only lasts
for one to two hours.
3. Solicit for questions on HIV screening process to clarify possible confusion.

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Waiting and Dealing with the result

1. 32. The results of the screening are out. Distribute the envelopes containing the result to those
who are in the inner circle. The envelope should be a mix of reactive and non-reactive results. Tell
the participants in the inner circle not to open the envelopes yet.
2. Distribute the envelopes to those who are in the outer circle, or those who didn’t wish to get
tested. Explain to them that without their knowledge, they were screened for HIV.
3. Explain that while the law prohibits mandatory HIV testing or testing without consent, there are
instances where the law is violated. Ask the participants if they have heard or encountered any of
these incidents.
4. Ask those who were forced to get tested how they feel. With the violation of their rights, are they
going to complain or file charges?
5. Ask everyone to open their results. Inquire if they are willing to share their results to the entire
group. Probe their feelings (using the standard questions) and check if they are going to change
their behavior because of the result. Do they regret knowing their status?
6. Some of those who have been scratched may have received non-reactive results, while others who
have not been scratched may receive reactive results. Clarify that everyone engaged in unprotected
sex, and that exposure is not tantamount to HIV infection. The only way to know one’s status is thru
an HIV test.
7. Explain further that what was just conducted was an HIV anti-body test. Those who test positive for
HIV antibodies will need to wait for the result of the confirmatory test. Tell them that the current
testing technology is extremely accurate, but the confirmatory test is necessary under existing
Philippine standards for access to treatment services. Without the results of the confirmatory tests,
one cannot get into treatment.
8. Inform the participants that there are many instances where a person who tested positive in the
screening would disappear and would not get the result of the confirmatory test anymore. Get their
insights on what could be the reasons why people disappear, and how it can be addressed.
9. Once everyone has shared their results, ask the REACTIVE group to go to the inner circle and the
NON-REACTIVE group to go to the outer circle. Tell the REACTIVE group that the results of the
confirmatory test are out, and they really are positive for HIV infection.

Living with HIV, co-existing with persons living with HIV

1. Engage both reactive and non-reactive participants in a conversation on how they feel about living
with HIV, or co-existing with friends, lovers, or family members who are HIV positive. Use the
standard questions the surface feelings and sentiments that may not be evidence-based and needs
to be corrected, or could potentially limit their peer education work.
2. Ask them what was their reaction when they first got the result, how they feel about their own HIV
status and the other participants’ HIV status? For those who tested negative, are they going to get
tested again?
3. Expand the discussion to topics about sexual behavior: would they consider continuing the same
practices? Would they consider having sex with anyone who’s tested positive?

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4. Ask the participants what kind of support they need at this point, and whether they are willing to
disclose their status.
5. Point out the role that stigma and discrimination play in the epidemic. Ask them how do they expect
people living with HIV are going to be treated, and how misconceptions or stigmatizing attitudes
could be addressed.
6. Go back to the procedures involved in HIV testing. Remind everyone that after getting the test
result, post-test counseling should be provided. This should contain information on how to prevent
the spread of the virus. It should also reinforce health seeking behavior, and offer referrals to
services that the clients will need.
7. For people living with HIV, after the confirmatory tests (in some instances, even before the
confirmatory test), additional tests are conducted to determine whether they should get into
testing. They are referred to other service providers for treatment, care and support. They are also
informed that the current HIV treatment regimen has been successful in preventing the virus from
replicating, thus extending significantly the lives of people living with HIV. It has transformed HIV
from a dreaded disease to a chronic condition that, like diabetes, can now be managed through
lifetime treatment.

Debriefing
1. Formally close the exercise. To initiate debriefing, tell the participants that the Wildfire is just a
simulation, a role-play. Encourage them to tear the results or give them back to the facilitator to
signify that the simulation is over.
2. Invite the participants to share how they feel about the whole exercise. Have each of them share
reflections on their experiences, and how the exercise can change even their own personal
behavior.
3. End the session with a symbolic gesture of solidarity.

Facilitator’s Notes
The Wildfire can be an emotionally exhausting process. Confronted with sensitive HIV-related situations,
the participants may disclose their own fears and apprehensions, even their own secrets. The facilitator
should be able to keep the communication line open and the tone of the process non-stigmatising and
non-judgmental.
In any peer education training, the possibility of having HIV positive participants is constantly there. In
simulated scenarios where traumatic or deeply emotional experiences could surface, leading to
discussions anchored on real-life episodes. It is always important to clarify that the exercise is a
simulation. If the discussion is colored by prejudicial language or other manifestations of stigma,
immediately correct stigmatized and stigmatizing views are crucial and direct the participants towards
an evidence-based understanding of the epidemic.

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Module 10. Safer Sex Skills Building

Introduction
Preventing HIV infection is still the most cost-effective approach to address and halt the epidemic. These
activities in this session are intended to provide peer educators with the necessary skills in promoting
condom use and in negotiating for safer sex practices.
This section has three sub-sessions:
1. Condom line-up
2. Condom demonstration
3. Safer sex negotiations

Time:
Condom line-up 30 mins.
Condom demonstration 1 hour
Safer sex negotiations 1 hour.
Total 2 hrs and 30 mins

Learning Objectives
At the end of the session, the participants will be able to:
1. Outline correct use of condoms and lubricant
2. Identify commonly held norms that weaken safer sex practices and the techniques that can be used
to counter them.

Sub-session One: Condom Line Up

Materials
- 2 sets of metacards with the procedures on using condoms (see Facilitator’s Notes)

Methodology
- Group activity

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Process
1. Create two sub-groups. Shuffle each set of metacards to ensure that they are not in order, then give
each sub-group a set.
2. Instruct them to discuss the correct procedure in using condoms and arrange the metacards in the
right order.
3. Once finished, ask the sub-groups to discuss their work. Check for corrections or modifications.
4. Ask the participants to share what they learned. Gather insights on how this procedure can be
negotiated with sexual partners.

Facilitator’s Notes
Here are the step-by-step procedures in using condoms and lubricant correctly:
1. Talk about using condoms and lubricant with your partner
2. Check the date of expiry
3. Open the packet carefully
4. Find the correct unrolling side
5. For increased sensation, add a little lube on the penis before putting the condom on
6. Pinch the tip of the condom gently to remove air
7. Roll down condom to the base of the penis
8. Add water-based lube
9. Penetrative sex
10. Check regularly if condom is still in place
11. After ejaculation, withdraw penis while still erect
12. Remove condom carefully and dispose properly

Sub-session Two: Condom Demonstration

Materials
- 2 Dildos
- Water-based lubricant
- Condoms
- Baby oil, shampoo or other commonly used oil-based lube

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Methodology
- Group activity
- Demonstration

Process
1. Distribute several condoms and lubricants to each participant
2. Ask the participants to check the packet and its content. Encourage them to describe the condom -
how it smells, how it feels, and how it tastes.
3. Using the step-by-step procedure above, demonstrate the process using the dildo.
4. Remove the condom from the dildo once down, and then tie-up the condom to show how it should
be properly disposed.
5. Discuss some alternative ways of putting on the condom. Demonstrate, if possible, how to put it
using one’s mouth.
6. Talk about lubricants. Ask what kind of lubricants that they commonly use and distingush the water-
based lube from oil-based lube.
7. To demonstrate the possible effect of oil-based lubricant, make a condom balloon. Ask for a
volunteer to put a small amount of baby oil on the condom balloon and then rub it using his or her
finger. Once it bursts, explain to the participants that friction and oil can damage the condom.
8. Discuss access to condoms and lubricants and ask them where condoms and lube can be bought.
Encourage them to share their preferred types of condom and lube, and why.
9. Ask them to identify reasons why MSM and TGs refuse to use condom, and how they can respond to
these claims.
10. Close the session with a summary of these arguments against condoms and possible counter-
arguments.

Facilitator’s Notes
Highlight the following points:
• Mention information that condoms should be properly stored to avoid tears, and that condom
beyond its expiry date should not be used.
• Share with the participants that condoms should be rolled down the penis only when the penis is
erect.
• Warn against opening condoms using their teeth, as it may accidentally break the condom. Use the
perforated side instead. Before tearing the packet, push the condom to the opposite side to make
sure that the condom won’t rip. Once open, gently push out the condom from the packet.
• Always use water-based lubricant. Explain that oil-based lubricants such as baby oil, shampoos, and
lotion will cause the condom to break.

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Sub-session Three: Safer Sex Negotiations

Materials
- Written stories of sexual activities in different situations (sex between couples inside a motel, sexual
tryst in the cinema, cruising in the park, online hook-up involving drug use, sex with a famous actor,
etc.). One story should involve more than two people.

Methodology
- Role playing

Process
1. Explain to the participants that in the next activity, they will explore how safer sex could be
negotiated between and among sexual partners.
2. Divide the group in such a way that one sub-group is composed of three or four members and the
rest in pairs.
3. Assign a story or a narrative per sub-group. Instruct them to discuss the situation thoroughly.
4. Ask the sub-group to assign or identify roles: one should be a “Convincer”, whose role is to convince
his or her partner to practice safer sex (protected sex, or less risky sexual acts), while the other is the
“Refuser”, whose role is to refuse the attempts of the convincer. Instruct each group to take note of
the arguments and counter-arguments used by the Convincer and the Refuser.
5. Remind the Convincer to use the lessons on safer sex from the previous sessions. Inform them that
the over-all goal of the exercise is to convince the Refuser to practice safer sex.
6. For this round of negotiations, give the groups 10 minutes. After 10 minutes, reverse the roles.
7. When the time is up, ask the sub-groups to go back to the large group. Ask for volunteers to
demonstrate their assigned situations or stories, and how the negotiations went.
8. After the presentations, ask the group how they felt about the whole exercise. Highlight the issues
that were identified by the refusers, and how they were addressed by the convincers.
9. Ask the group which issues they found difficult to address. Solicit from the participants possible
responses to these issues.
10. Explore situations where negotiating for safer sex is difficult or almost impossible. Identify certain
values that could hinder or facilitate successful safer sex negotiations (“more sex means you’re
beautiful”, “hooking up with young guys is safe”, “using condoms is a sign of mistrust”) Ask the
participants for ideas on what can be done under such situations or to respond to these values.
11. Close the activity by highlighting that in every situation, there are a variety of ways and techniques to
guarantee successful safer sex negotiations.

Facilitator’s Notes

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It is crucial to understand the context of sexual behaviors and how these contexts lead to resistance or
refusal to address risks to HIV infection. In the discussion for this activity, review existing evidence on
the sexual behavior of MSM and TGs - the rate of condom use, cited reasons for refusing condom use,
etc. - and encourage the group to collectively address these behaviors.
Engage the participants in a conversation on values and self-esteem. In some cases, refusal to practice
safer sex is linked to certain values that indicate the need for community and psychosocial support that
may be provided by peers or by service providers.
Finally, tackle issues that are related to stigma. In the context of MSM and TGs, condom use could be
influenced by how individuals and the society in general view same-sex sexual behavior. These hindering
factors need to be considered in developing strategies to encourage safer sex among MSM and TGs.

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Module 11

Module 11. Peer Education and BCC Activities

Introduction
At this point of the training, the sessions are designed to help the participants on how to conduct their
BCC activities as peer educators. The previous sessions impart knowledge and skills on the HIV epidemic
and HIV prevention. The succeeding sessions center on how peer educators can organize effective BCC
activities.

This module has three sub-sessions:

1. What to Anticipate in Peer Education and Steps to Peer Education
2. Developing Referral system
3. Developing standard messages

Time
What to Anticipate in Peer Education
and Steps to Peer Education 1 hour
Developing Referral system 1 hour
Developing standard messages 1 hour
Total 3 hours

Learning Objectives
At the end of the session, the participants shall be able to:
1. Demonstrate understanding of what to anticipate while undertaking peer education
2. Identify the steps to peer education
3. Map out the potential needs of their clients and which providers they may be referred to
4. Plot messages that they can use for peer education

Sub-session: What to Anticipate in Peer Education and Steps in Peer Education activities

Materials
- Slide presentation (See Facilitator’s Notes)

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Methodology
- Role plays
- Inputs from the facilitator

Process
1. Begin by explaining that the next sessions aim to explore what the peer educators may encounter
during their BCC activities and to provide them with the necessary steps in conducting peer education
and outreach activities.
2. Divide the participants into four sub-groups. For each sub-group, assign one of the following
situations:
a. The peer educator discovers his or her own partner in a cruising area
b. The peer educator was invited to an orgy
c. The peer educator encounters someone who is extremely knowledgeable about HIV and
AIDS
d. In an outreach activity, the peer educator encounters a former sex buddy with whom he or
she had unprotected sex in the past
3. Ask each group to talk about the story assigned to them and discuss how the peer educator should
react to the situation.
4. Tell the groups to designate roles for the members and to present their situation to all participants
after 15 minutes.
5. After the presentation, ask the participants how peer educators should react in those situations.
Explain that peer educators should be ready to face a host of situations and issues as they conduct
their BCC activities, and should be aware of how to react to these situations.
6. Present the slides.
7. To close the session, emphasize that peer educators also need to conduct themselves according to
the objectives of their own work. Highlight that the strength of peer educators is their access or
proximity to the communities they wish to reach, but they must also learn to maintain balance and
distance to be able to fulfill their functions effectively.

Facilitator’s Notes
Present the inputs below.

What to anticipate in outreach sites:

1. Many venues share some things in common - take advantage of these commonalities and be aware
of the dynamics of these sites
2. Many unique things to consider for every venue -

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3. Varying situations to consider for every venue

4. Health and other risks exist in varying degrees in different venues
5. Norms are observed and values are shared in every venue
6. Sub-culture in venues support risk-taking behavior and enhancement of the likelihood of risk

What to anticipate from target clients:

1. They share some things in common but are generally diverse
2. They feel around the venues they cruise or hang out
3. They have a sense of self-preservation
4. They may display hesitation or resistance to outreach but has potential for engagement
5. Being unaware doesn’t mean being ignorant
6. Always expect that among individuals, despite commonalities, there will always be exceptions and
exceptions to exceptions

SISTERS: Steps in Peer Education

1. Scan and select - scan the site and determine whom to approach and where to approach
2. Introduce and inform - Introduce yourself and inform the client why you are there
3. Socialize - Make the client more comfortable to tell him or her that you mean no harm
4. Tell / Teach - Deliver your key messages
5. Explore / explain / encourage - encourage questions and elaborate
6. Referral and resources - in an outreach site, opportunities to communicate are not consistent. Refer
clients to services and resources that they can access if they wish to know more
7. Sustain - continue links with the clients

Sub-Session: Referral system

Materials
- Manila paper
- Pens

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Methodology
- Group work

Process
1. Explain to the participants that the session is intended to map out existing services for MSM and TGs
in their areas and to develop a referral mechanism for their BCC activities.
2. Divide the participants into several groups according to their community organizations.
3. Ask each group to list the possible needs of their MSM and TG clients. Provide sample categories for
these needs: HIV paraphernalia (condom, lube, etc.), HIV testing, STI testing, counseling, care and
support, treatment, etc.
4. Encourage the groups to consider needs that are not limited to specific HIV services such as
psychosocial support, legal assistance, etc.
5. Instruct the groups to identify which agencies or organizations that can deliver or provide those
services. Match each need with existing or potential providers.
6. Identify gaps that require interventions from the peer educators or their organizations, whether
through advocacy for program establishment or referral to outside groups or services.
7. Once the community groups finish their mapping activities, regroup the participants according to
geographic areas (city level or regional level). Ask the new groupings to compare the mapping done
by the organizations and identify convergence. Ask each geographic group to present once they finish
their discussions.
8. In closing, emphasize that the mapping exercise is important to determine the services that are
needed, who provides them, and how the peer educators can bridge the clients to the services. Tell
the participants that the data should feed into the core messages of the peer educators.

Sub-Session: Developing standard messages

Materials
- Manila paper
- Pens

Methodology
- Group work
- Role play

Process

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1. Explain to the participants that for this session, they will be tasked to come up with effective core
messages for their outreach activities.
2. Divide the participants into four groups. Ask each group to develop at most 10 messages for MSM
and TG clients, with each message not exceeding more than 140 characters.
3. The messages should tackle the following themes: HIV Prevention (HIV Counseling and Testing or
condom use); Referral to services; and SOGI-related stigma and discrimination.
4. Tell the groups to prioritize their messages. Ask the groups that if there is time only for three
messages, which of the ten messages will it be? If there is time for five messages, what would it be?
5. Once the groups have finished their core messages, ask them to create stories where the messages
could be applied. Instruct them to consider the following:
a. Venue (where outreach is happening): Online, face-to-face, group activities or events
b. Topic: HCT, condom use, referral to services, SOGI-related stigma and discrimination
c. Context (scenario details): Negotiating for sex online, coffee shop, etc.
6. In the story that they are developing, inform the participants that they should identify the
background (venue, topic, and scenario details), and the core messages that will be used in the
scenario. Each group needs to present their stories to the plenary.
7. After all the groups have presented, ask the plenary for feedback on the messages that were
developed. Use the 7 Cs of Effective Communication to synthesize the session.

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Module 12

Module 12: Action Planning and Monitoring and Evaluation

Introduction
These set of sessions comprise the final part of the training. This section aims to help the participants to
develop effective plans for the BCC activities by applying what they have learned from the previous
sessions.

This module has two sub-sessions:

1. Action Planning
2. Monitoring and evaluation tools

Time
Action Planning 1 hour
Monitoring and Evaluation 1 hour

Learning Objectives
At the end of the session, the participants shall be able to map out details of their BCC activities,
including their targets, specific activities, resource requirements, and budget, among others.

Sub-session: Outreach Planning

Materials
- Planning matrix (see Facilitator’s Notes)

Methodology
- Small group discussion
Process
1. Ask the participants to group themselves according to their organization (or areas)
2. Present the planning matrix.
3. Ask each group to fill up the matrix with the details of their planned BCC activities.
4. Emphasize the following points in the planning activity:
a. Clarify with the organization how reach is defined.

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b. When identifying persons in charge, it is crucial that the specific roles of the each person is
clear within the organization.
c. In identifying resources, clarify the sources of the items that are needed.
d. For the budget, provide the budget breakdown according to the budget items.
5. Once all the groups have finished working on their matrix, ask for volunteers to present their plans to
the plenary. Solicit for feedback and suggestion from the large group.

Facilitator’s Notes
Present the sample Planning matrix below to the participants:

BCC Activity & Target Person in Timeline Venue Resources Total

description Number of charge Needed Budget
Clients
Reached

BCC Event and 250 Jdela Cruz Nov: pre- TBA IEC Materials, IEC:
mobile VCT paratory Condoms, P15,000
(A clan party activities Lubricant
where peer edu- Dec: Party, PE allow-
cators will pro- reporting ance:
vide IEC materi- P4,0000
als and encour-
age testing. A
mobile VCT will
be arranged in a
location adja-
cent to the party
venue)

Sub-session: Monitoring and Evaluation tools

Materials:
- Slide presentation

Methodology
- Inputs from the facilitator

Process:
1. Explain to the participants the role that monitoring and evaluation play in conducting activities.

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2. Ask the participants to share tools that they use to monitor and evaluate their activities. Emphasize
that M & E tools are important to measure the success of an outreach activity.
3. Present the slides on M & E tools.

Facilitator’s Notes
Present the following inputs:

Monitoring and evaluation aid HIV programs in measuring the levels of success of an HIV intervention. It
provides evidence on the effectiveness of the activities, as well as key gaps and challenges of the
activities.

M & E Considerations
Indicators - What indicators should the organization use to measure the outputs and outcome of the
activities. For ex.: “Number of MSM reached; Number of MSM that accessed testing; Number of MSM
provided with basic HIV information.”
Number of targets - One factor in setting the number of target clients is the country’s estimates of key
populations and the targets of universal coverage. Here are some questions to be considered: What is
the estimated population size of MSM and TGs in the area? How many of them should be reached?
Target population - The monitoring tools should also be able to document which target population is
being reached. While it is relatively easy to define MSM, the challenge lies in reaching transgenders,
especially since in the Philippine context, the concepts of MSM and TGs are still conflated. Self-
identification offers no solution since not all transgenders self-identify as such.

Below is the working definition of TG from the national program:

- Would self-identify as a TG woman, but may also identify/label themselves using various terms/labels
more common in their locality

(1) Whose birth assigned sex is male (AND)

(2a) Whose gender identity is more female (AND)
(2b) Whose gender expression (appearance, behavior, attitude) is more feminine
OR more masculine
- May or may not have injected/taken female hormones
- May or may have not undergone any body modifications (for breasts and/or hips,
surgical or non-surgical)
- May have varying sexual orientations (hetero, homo, bi, poly, etc.)
Definition of Reach - How do you define reach? What are the existing standards on BCC interventions
that you could use in defining reach? How many instances of contact are needed to qualify that a client
has already been reached? What BCC information or IEC materials should be imparted to qualify as
reach?

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Documentation - what are the tools used by the peer educators to document their activities and their
outputs. For purposes of effective program and financial management, organizational forms should be
developed to help peer educators to ensure proper documentation.
Avoiding double counting- Monitoring tools should be able to ensure that the same clients are not being
reached repeatedly by the peer educators. For the ISEAN-Hivos Program, a Unique Identifier Code (UIC)
was developed to avoid duplication and at same time meet the documentary requirements of the
program. The client’s information (see below) were used to create unique codes.

1. First two letters of mother’s first name

2. First two letters of father’s first name
3. Gender (single letter M/F) or number (1=MSM, 2=TG, 3=F, 4=M)
4. Year of birth (last two digits)

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