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Module 5: Comprehensive sexuality education

Welcome to Module 5!

Exit level outcome 11

Execute and communicate prevention measures for communicable diseases and sexually
transmitted infections

Exit level outcome 12

Communicate the basics of sexual health, maternal health, contraception and reproductive health
rights in a peer education setting.

By the end of this Module you will be able to:

 Apply and communicate prevention measures for communicable diseases, including sexually
transmitted infections.
 Communicate the basics of sexual health, maternal health and contraception and reproductive
health rights in a peer education setting.

Topic 1 HIV awareness: new perspectives

What is the HI virus and how does it infect your body?

HIV is a virus that attacks the human immune system. Once infected, there is no cure, so you will have
the virus in your body for the rest of your life, or until a cure is found.

The virus targets the white blood cells in the immune system, specifically the CD4 cells. These cells
play a very important role in protecting the body against disease and infection. If you don’t know you
have the virus, it stays in your body, silently destroying your CD4 cells all the time. This is while you
believe you are healthy and well because there are no symptoms for four to six years when you first
contract HIV.

To do
Watch the video and then answer the questions:
 [Link] South Africa: young women at greater risk
of HIV (5 min)
1. What core messages do you get from this video?
2. How can you use the information as a peer educator?
3. Has this video changed anything you may have believed about HIV? If so, what?

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RISK ASSESSMENT HIV

Zone Check: HIV Yes No

1. Are you having unprotected sex?
2. Did you have unprotected sex in the
last 24 hours?
3. Do you have only one sexual partner?
4. Do you have difficulty convincing your
partner to use a condom?
5. Do you believe that you don’t need
to use a condom because you (or
your partner) are using
contraception?
6. Do you know your HIV status?
7. Do you know your partner’s HIV
status?
8. Do you think it is possible that you
may have been exposed to HIV?
If any of your answers place you on a red square, you
are in the RED ZONE. This means that you are at risk
for HIV. Ask your HIGHER HEALTH Campus
Coordinator for help with HIV Testing Services and
support as soon as possible. It is important to know
your HIV status so that you can protect yourself
whether you are positive or negative

Know your HIV status

It is important to know your HIV status so that you can protect your own health and the health of
your sexual partner(s).
• HIV is preventable, through avoiding contact with other people’s body fluids such as blood and
sexual fluids.
• If a person is infected with HIV, there is a four- to 12-week period where they may not know that
they have the virus (the window period), but the virus is very active and can easily pass on to other
people at this time.
• HIV and AIDS can be managed and treated so that people with HIV can live happy, healthy and
productive lives.

Get tested for HIV and other STIs.

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To do
Watch the video and then answer the questions:
 [Link] Gilead HIV: What HIV does inside the body
(3 min)
1. Why is HIV called an immune-deficiency virus?
2. Why is it important to start HIV treatment as soon as possible?

Basic questions you need to be able to answer as a peer educator:

What is HIV?
Human Immunodeficiency Virus (HIV) is a virus that targets CD4 cells
in the human immune system.
Without treatment, it would lead to severe immune deficiency, which
is called Acquired Immunodeficiency Syndrome (AIDS), high viral
loads, and eventual death.

What is AIDS?
Acquired Immunodeficiency Syndrome (AIDS) is a condition resulting
from HIV infection (Acquired). Your immune system is depleted of
CD4 cells to the point of becoming deficient (Immunodeficiency).
Hence it is unable to protect your body from infection and invasion by
a myriad of infections at the same time (Syndrome).

What is the difference between exposure and infection in relation

to HIV?
Exposure is where you have come into contact with the virus but have
not been confirmed as being infected. At this point, infection can also
be prevented using Post-Exposure Prophylaxis (PEP).

Infection is where the virus has entered your body and replicated to the
point where prevention is no longer possible.

How is HIV transmitted?

There are body fluids in which the virus can live and make copies of
itself. These fluids must come into contact with an uninfected person’s
body fluids through sexual contact, an entry point in the skin, infected
needles, or from mother to child.

Three fluid types that can transmit HIV are:

Sexual fluids (semen and vaginal fluids), blood, and breast milk.

What is an opportunistic infection (OI)?

An OI is an infection that is able to invade the body because it is
immune-compromised (low CD4 cell count) and thus unable to
protect itself. OIs take the opportunity to enter your body when its
defences are low.

When should you start with HIV treatment?

All people living with HIV can start antiretroviral therapy immediately
when they are diagnosed. This is regardless of age, CD4 cell count,
and clinical stage.
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How HIV is not transmitted

HIV testing services

HIV counselling and testing is referred to as HIV testing services (HTS) to embrace the full range of
services that should be provided together with HIV testing.

Coordination
Linkage to Clinical and with
Counselling
Care Support Laboratory
Services Services

HIV testing is the crucial entry point for all HIV services, including both prevention and treatment.
When you test and learn that you are HIV positive, there is an opportunity to get access to life-
saving treatment, take care of your health and well-being and that of your loved ones.

For those who test HIV negative, there is an opportunity to stop and think about your level of risk
and make important life decisions about which HIV prevention options are the best fit for you.

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There is a movement across the world to accelerate universal access to HIV prevention,
treatment, care and support services for people living with HIV and AIDS. The main entry point for
HIV treatment, care and support is through HTS, which is available on your campus.
South Africa has adopted the UNAIDS’ 90–90–90 strategy, which calls for 90% of all people living
with HIV to be diagnosed; 90% of eligible people with diagnosed HIV to have access to ART; and
90% of those on ART to have a suppressed viral load, with the aim of ending the AIDS epidemic by
2030.

What you need to know about HIV testing services (HTS)

Anyone can get HIV, but you can take steps to protect yourself from HIV infection.
The only way to know whether you have the virus is to test regularly for HIV.

The 5Cs of effective HTS

CONSENT
People who receive testing must consent to be tested and counselled. Students must be informed of the
process for HTS and of their right to decline testing.

CONFIDENTIALITY
Discussions between the HTS provider and the student should not be disclosed to anyone without the
consent of the student being tested. Shared confidentiality with a partner or family members or trusted
others must be encouraged.

COUNSELLING
Pre-test information can be shared in a group setting, but a private setting must be provided for individuals
who have questions that they do not wish to share with others. HIV testing must be followed by
appropriate high-quality post-test counselling.

CORRECT RESULTS
Quality assurance (QA) mechanisms are essential to ensure that people receive the correct diagnosis.

CONNECTION
Linkage to prevention, treatment and care services and effective and appropriate follow-up should be
provided.
(Source: National HIV Testing Services Policy, DoH)
To read more about HTS, download this policy:
[Link]

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Case study This is my story
My name is Nathi and I am a 2nd year student studying engineering. I love being a student and am
enjoying the course. I had a partner before coming to study and we did have sex, sometimes with
and sometimes without using a condom.

Since coming to study I have met somebody else

and we occasionally have sex, also sometimes
using condoms but at other times not.

I never thought of HIV or other STIs as I am a fit

and healthy young guy. It never even crossed my
mind when we were having sex, to be honest. I was
just enjoying myself.
Then one day a peer educator told me there is an
HIV testing drive on campus and I should go for a
test.

No way, I said. I can’t have HIV! And anyway, if I did, I would rather not know about it!

The peer educator explained that the HIV test is painless, quick, comes with counselling before and
after the result, it is confidential and that I should really consider it if I am sexually active. The peer
educator told me that it is better to know your HIV status because you can immediately start taking
medication. This will lower your viral load and stop you from passing HIV on to others. Also, you will
realise you always have to use a condom; whether you have HIV or not.

I thought about it, and told myself perhaps I should do as advised.

I went to the campus clinic for a test. They were really friendly and helpful. It was quick and the
counselling was so good.

I was very nervous about the result. I am so thankful the result

showed that I don’t have HIV. But they advised me to test again
because I may be in the window period. They also told me to use
a condom every time.

I think about the day the peer educator persuaded me to go for

an HIV test, and I am thankful I did. It was the right thing to do.

To Do
Read the case study and then answer these
questions:
1. What can you say in response to a peer who
tells you this:
“I am NOT going for an HIV test. Others will see me there and say
I have HIV.”
2. How will you respond to a peer who says:
“I don’t want to know my HIV status. I will NOT test.”
3. What will you say to this peer who says:

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“I will not go for an HIV test because the nurse at the clinic knows my mother. She will tell my
mother and then I will be accused of having sex.”
4. How will you respond to a student who tells you:
“I am too scared to go for the HIV test”.
5. What will you say to a student who says:
“I don’t need an HIV test. I only have sex with people that I trust.”
6. How will you respond to this peer:
“There is a cure for HIV, so I don’t need to worry or go for a test.”
Share your answer in pairs.

Prevention of mother-to-child HIV transmission

(PMTCT)
Pregnant and breastfeeding HIV-infected women must
take HIV medicines lifelong to reduce the risk of passing
HIV to their babies and to maintain their health. Their
new-born babies also receive HIV medicine for six weeks
after birth.

The HIV medicine reduces the risk of infection from any

HIV that may have entered a baby’s body during
childbirth. PMTCT programmes provide ART to HIV-
positive pregnant women to stop their infants from
acquiring the virus. Without treatment, the likelihood of
HIV passing from mother-to-child is 15% to 45%.
However, ART and other effective PMTCT interventions
can reduce this risk to below 5%.

HIV medication
ARVs are Antiretrovirals. These are medicines you need to take if you are HIV positive. The medicines
are called antiretrovirals (ARVs) because HIV is a type of virus called a retrovirus. HIV treatment
must be taken every day for the rest of your life. Your healthcare provider will advise you which
ARVs to take.

ART is Antiretroviral treatment or antiretroviral

combination therapy, the medicines (ARVs) that treat
HIV. Many people living with HIV are taking treatment
and so are staying healthy. There is not yet a cure for
HIV. However, ART can keep HIV under control so that it
does not develop into AIDS. ART works by keeping the
level of HIV in your body, your viral load, low. This helps
your immune system to get better and stronger.

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To Do
Watch the video and then answer the questions
 [Link] HIV: 5 Reasons to stick with treatment
(4 min)
1. Why should you keep up with your HIV treatment?
2. Explain how you would advise a peer who is HIV-positive, to continue taking ARVs.

HIV stigma
Your role as a peer educator is vital in terms of opposing stigma against people living with HIV.

(Poster source: [Link]

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Reflection
1. What could you to help to stop the spread of HIV, and support students living with HIV, as a
peer educator?

Useful resources
Websites
 [Link]
 [Link]
 [Link]
 [Link]
 [Link]
Videos
 [Link] Gilead HIV: the goal of undetectable (3
min)
 [Link] What is HIV? (3 min)

 [Link] South Africa: young women at greater risk

of HIV (5 min)
 [Link] HIV treatment, PreP, PEP, (5 min)
 [Link] World Aids Day: Physician on latest treatment
and prevention tools (4 min)
 [Link] SA to pilot new HIV prevention drug (6 min)
 [Link] Prof Salim Abdool Karim speaks about context
of “cures” for HIV (10 min)

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Topic 2 TB prevention and cure
Tuberculosis (TB) is caused by the bacterium
Mycobacterium Tuberculosis. The bacterium
can cause disease in any part of the body, but it
normally enters the body through the lungs and
stays there.

TB is a disease caused by germs that are spread

from person to person through the air. The
bacteria escape into the air when a person with
TB of the lungs or throat coughs, sneezes, spits,
speaks, or sings. People nearby may breathe in
these bacteria and become infected.

TB
usually
affects
the
lungs, but it can also affect other parts of the body, such as
the brain, the kidneys, or the spine.

Symptoms of TB depend on the parts of the body affected.

With TB of the lungs, symptoms can include coughing, chest
pain, and coughing up blood. TB of the spine may give you
back pain, and TB in your kidneys might cause blood in your
urine A person with TB can die if they do not get treatment.

To Do
Watch this video and then answer the question.
 [Link] TB photovoices - people, affected by TB,
express and communicate their experiences through photos (2 min)
1. What did you learn from this video about how people experience TB?

What is the relationship between TB and HIV?

There is a close relationship between TB and HIV. People living with HIV are more likely to develop
active TB disease than people without HIV. Infection with HIV suppresses your immune system,
making it difficult for your body to fight TB bacteria. As a result, people with HIV are many times more
likely to get TB and to progress from latent to active disease than people who aren’t HIV positive.

HIV and TB are a powerful bacteria and virus team, each helping speed the other’s progress.
Someone who is living with HIV and TB is much more likely to become sick with active TB.

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Antiretroviral drugs (ARVs) do not cure TB, and TB drugs don’t cure HIV. This is why it is very important
that people know their HIV status and get tested for HIV and screened for TB regularly.

(Image source:
[Link]
deaths-people-living-with-hiv)

To Do
Watch the video and then answer the questions
 [Link] How the body reacts to TB (3
min)
1. What is latent TB?
2. What happens if your immune system is overwhelmed?
3. How will you know if you have TB?

RISK ASSESSMENT TB

Zone Check: TB Yes No

1. Have you had a persistent cough
for two weeks or more?
2. Are you HIV positive and have been
coughing for any duration?
3. Have you experienced high
temperatures/fever for more than two
weeks?

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4. Have you experienced night
sweats that leave you dripping wet?
5. Have you noticed that you’ve been
losing weight without trying to (more than
1.5 kg in a month)?
6. Do you feel tired all the time?
7. Do you know/live with someone
who is experiencing these symptoms or
been diagnosed with TB?
If any of your answers place you on a red square, you
are in the RED ZONE. This means that you are at risk
for TB. Ask your HIGHER HEALTH Campus
Coordinator for help with TB screening, testing,
treatment and support as soon as possible.

Can TB be cured? How?

TB can be cured, even in people living with HIV. It is important that people who have TB are identified
as early as possible so that they can receive treatment, their contacts (people exposed to them while
they were infectious) can be traced so that they too can be tested for TB, and measures can be taken
to minimise the risk to others.

TB treatment uses a variety of powerful antibiotics in different ways to attack bacteria and make sure
that they are destroyed.

How important is treatment?

If people with active TB disease do not take their medication, they can become seriously ill, they can
develop germs that are resistant to the TB medications which is passed onto other people, and they
may even die. But people with active TB disease can be cured if they have proper medical treatment
and take their medication exactly as prescribed.

Drug-resistant TB strains are expensive and difficult to treat, and pose a greater risk of infection to
people in close contact with the infected person. These strains more often can lead to treatment
failure and death.

What is drug resistant TB?

If you have active TB and the TB drugs that the health worker or clinic gives you do not work, it means
the germs are resistant to the medication. They have found ways to fight the drugs.

The main cause of drug resistance is not taking the medication properly (missing doses). This means
that you are not adhering to treatment. If you miss doses, it can make your TB bacteria stronger and
more powerful so that it becomes resistant to one or more of the antibiotics used to treat TB. This
form of TB is called drug-resistant TB.

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It is becoming more common that people who get TB for the
first time are getting infected with the drug-resistant strain of
TB. This is very scary because drug-resistant TB (DRTB) is
much harder to treat.
A new recommendation from the World Health Organization
is the use of shorter-treatment regimens for people with
drug-resistant tuberculosis.

WHO recommends countries to forgo the non-injectable

regimens, adopt all oral MDRTB treatment, shorter regimens
and look at innovative approaches which include adherence enablers to support patients. (Source:
[Link]

To Do
Watch the video and then answer the questions
 [Link] TB was the leading cause of death for
teenagers between 2008 and 2018 in South Africa. Find out why and what we can do to make
treatment more accessible to them in this short video. (2 min)
1. Why are teenagers more prone to contracting TB?
2. What makes it difficult for teenagers to keep taking their medication?
3. What can help teenagers to take their medication?

What can you do as a peer educator?

Be a buddy to a student who has TB

Adherence means taking your pills exactly as prescribed without missing doses. Directly Observed
Treatment Short Course (DOTS) is the internationally recommended strategy for TB control. This
means that the person with TB should have a buddy (friend or family member or peer educator) that
observes them taking the medication. This is done to provide support and help them remember to
take the treatment.

Encourage students to get tested for TB

All students can get TB. Anybody can get TB. However, it is especially vital that these students are tested
for TB:
 A student who has symptoms of active TB disease.
 A student who has been exposed to someone such as a family member, friend, or co-worker, other
students, lecturers, admin and support staff who have active TB disease.
 A student who has HIV or medical illnesses such as diabetes or chronic kidney failure.
 A student who is taking steroids or other immune - suppressing drugs for chronic medical
conditions.
 A student who has been in a homeless shelter, prison, hospital, nursing home, residence, hostel or
another similar group setting.

To Do
Discuss in a small group:
Why can opening windows help to prevent contracting TB?

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1. What can you do as peer educators to promote the opening of windows in classrooms, cafeterias,
residences and offices on campus?

2. L
(Image source: [Link] [Note I have downloaded
the hi-res version but it’s a pdf so can’t insert in this doc but the layout people can]

Opposing TB stigma
Sadly, some people are still stigmatising those with TB. In addition, the close relationship between TB
and HIV leads to further stigma,
The best way to oppose stigma is to educate, speak out and actively oppose stigma.
Stigma is harmful because people fear to go for TB testing, collection of medication and don’t want to
share that they have TB.
People who have contracted TB need support, understanding, motivation to take their medicine and
to be free from stigma.

To Do
Watch this video and then answer the question.
 [Link] Miss South Africa has made TB
the focus (6 min)
1. What can you, as a peer educator, do to oppose TB stigma?

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World TB Day
24 March is World TB Day every year.
World TB Day aims to build public
awareness that TB is an epidemic in
much of the world, causing the deaths
of several million people each year. TB
remains one of the world’s deadliest
infectious killers.

The date marks the day in 1882 when Dr

Robert Koch announced that he had
discovered the bacterium that causes
TB. This led the way towards diagnosing
and curing this disease.
People with active TB disease are most
likely to spread it to people they spend
time with every day.

(Poster source:
[Link]

To do
Work in a small group.
1. Watch this video. Then comment on how you think the TB screening App can be
used:
 [Link] World TB Day TB health check App for
screening (8 min)
2. Organise an event on campus or assist HIGHER HEALTH with an event that may be organised
for your campus, to help make students aware of TB and go for TB screening.

Reflection
1. How do you feel about TB?
2. What can you do as a peer educator to help prevent the spread of TB?

Useful resources
Websites
 [Link]
 [Link]
locked-up-in-the-mysterious-minds-of-teens/
 [Link]
 [Link]
 [Link]
 [Link]

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 [Link] (Ethics guidance for the implementation of the end
TB strategy)
 [Link]
myths-facts

Videos
 [Link] What makes tuberculosis (TB)
the world's most infectious killer? (TED) (5 min)
 [Link] Mayo Clinic Minute: Understanding
tuberculosis (1 min)
 [Link] What is TB? (5 min)
 [Link] 5 Things to know about TB (1 min)
 [Link] Vital Signs - TB is still a major problem in South
Africa: 26 March 2022 (60 min)
 [Link] World TB day 2021 -South African Medical
Research Council (3 min)
 [Link] Tamara Green TB Campaign Launch (6 min)

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Topic 3 STI awareness and prevention
This topic is included, not because we want to put you off having sex or scare you into abstinence, but
because we want you to be informed. That will help you to make the decisions you need to stay safe
and well. Consensual sex between partners who care for each other is beautiful. Keep it that way by
knowing how to prevent STIs.

A Sexually Transmitted Infection, or STI, is an infection passed from one person to another person
mainly through unprotected sexual contact. Remember that HIV is also an STI.

If you have an STI and it is not treated, it can make you very sick. The worrying thing is that STIs
sometimes don’t have symptoms, which means you or your partner may have an STI and not know
it.

STIs can be caused by a virus, bacteria or parasite. Having an STI can cause the body to lose some
of the immune cells that keep the body strong and protect it from other dangerous infections. As a
result, your immune system could become weak and allow other infections to enter the body at the
same time.

If an STI is not treated, it can result in serious long-term health problems, such as infertility, cancer,
long-term pain, and even death. It can also be passed from a pregnant mother to her baby.

If you are sexually active, go for regular screen tests to check if you have any STIs.

Vulnerability, economic dependence, and lack of

power in sexual relationships make it difficult for
women to negotiate safer sex or have control over
sexual decision-making. In such situations, women
are at high risk for STIs, including HIV.

STIs can affect anyone, regardless of your sexual

orientation or hygiene habits. Some STIs can also
spread through nonpenetrative sexual activity.

Who can contract an STI?

 Any sexually active person
 People who change sexual partners
frequently
 People who do not use condoms or do not
use condoms correctly
 If you have a previously successful treatment
for an STD, you may still catch the infection again.
 Reinfection can happen even after
successful treatment.
 Make sure your partner(s) also get treated to
prevent reinfection.

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To Do
As a peer educator, how will you respond to the following statements by
students? Share your answers in a small group.
1. I don’t think STIs are a problem; they just use it to scare us from having
sex.
2. I won’t test for STIs because I only had sex once.
3. Keep out of my business; I don’t want to test for STIs, yuk.
4. STIs bore me we heard about them in school all the time, now again at PSET it’s again taught –
it is not relevant to me, I won’t contract an STI!

RISK ASSESSMENT STIs

Zone Check: SEXUALLY TRANSMITTED INFECTIONS Yes No

1. Are you using a condom correctly and consistently every time you have sex?
2. Do you have an unusual bad smell or coloured liquid coming from your vagina
or penis?
3. Do you have any rash, bumps, sores or blisters around your genitals with or
without pain?
4. Do you have genital warts?
5. Do you have an itchy penis, vagina or anus?
6. Do you experience a burning sensation when urinating?
7. Do you experience pain during sexual intercourse?
8. Do/es your partner/s (past or current) have/ had an STI?
If any of your answers place you on a red square, you are in the RED ZONE. This means that you
are at risk for having a STI. Ask your HIGHER HEALTH Campus Coordinator for help with STI
screening, testing, treatment and support as soon as possible.

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To Do
Watch the video and then answer the questions.
 [Link] The most common STI in
the world (TED) (4 min)
1. What is HPV?
2. How can you protect yourself from HPV?

General STI signs and symptoms

Some of these STIs and their symptoms can be permanent. They can cause chronic pain, emotional
distress, infertility, and even DEATH. Some STIs can show no symptoms.

These are common symptoms: redness or soreness of the genitals; pain when urinating; strong-
smelling or cloudy urine; unusual discharge from the penis or vagina; swelling, sores or blisters on or
around the genitals, mouth, or anus; itching or irritation in and around the vagina, penis or anus; pain
and/ or bleeding during sexual intercourse; a sexual partner with such symptoms.

To Do
Not every discomfort is an STI.
Watch this short video for more information.
 [Link] What causes a red bump down there?
(1 min)

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To Do
Watch the video and then answer the questions
 [Link] How can I tell if I have an STI? (4 min)
1. Can you be infected with an STI but have no symptoms? Explain.
2. Do STIs go away by themselves?

STI Testing and Prevention

Testing: If you have symptoms, you should go to your healthcare provider for a check-up.
Testing for STIs includes taking a urine sample, taking a swab of the vagina or penis for secretions,
examining sores or bumps on the genitals, or doing a blood test.

Managing an STI includes the following steps:

 Counselling for the individual, so they understand the STI and its spread and treatment.
 Condom use for any future sexual encounters, to prevent the spread of the STI.
 Compliance with treatment that is given to the patient at the clinic; and
 Contacting previous sexual partners to advise them to get tested – it is their right to know as
they have the responsibility to treat it and not spread it.

How to prevent STIs

Abstaining from vaginal, oral, or anal sex is the best way to prevent an STI.
However, if you are sexually active, you can protect yourself and lower your risk of getting an STI with
the following steps:
If sexually active, lower your STI risk by:
 Use condoms
 Get vaccinated HPV and Hepatitis B
 Get tested
 Be faithful
 Limit your number of sex partners.
 Do not douche. Douching is washing the inside of the vagina with water or other mixtures of
fluids
 Do not abuse alcohol or drugs
 Explore other forms of sexual pleasure
 Delay sexual activity.

Women who have sex with men can use a female condom or the male can use a male condom
during sex.

Men who have sex with men can use condoms to protect themselves and their partners from most
STIs.

Women who have sex with women can use barriers, such as squares of latex called dental dams,
latex condoms which have been cut open, or plastic wrap to cover the vulva and form a barrier so
body fluids cannot be exchanged.

What to do if you think that you have been infected with an STI
 Get medical testing and treatment right away
 Inform your sexual partner(s)

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 Abstain from sexual contact at least until there is no evidence of infection and under the
guidance of a healthcare worker.

To Do
Watch the video and then answer the questions.
 [Link] STI MythBusters (4 min)
1. Will a sexually transmitted infection heal by itself?
2. How do you know if you have an STI?
3. How often should you get tested if you are sexually active?

Protect yourself and the people you love by getting tested for STIs.

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Table: Sexual Health STI Chart
Disease How you get it Symptoms Treatment Partner
Treatment

Diseases that are transmitted sexually

Chlamydia By having vaginal Women often have Antibiotics. Recent sexual

Bacterial infection of or anal sex no symptoms or may partners need
genitals can lead to without a condom have pain with treatment.
inflammatory with someone sexual intercourse, Don't have sex
disease (PID) in who has the lower abdominal until 7 days
women and infertility infection; from pain, changes in after starting
in men and women. mother-to-baby bleeding pattern. treatment and
(eye and chest Men may have no until sexual
infection) symptoms or may contacts have
have watery or thick been treated.
discharge from
penis, pain or
urinating.

Gonorrhoea By having vaginal, Women usually have Antibiotics. Sexual partners

Bacterial infection of anal or oral sex no symptoms, but must be tested
genitals, throat, or without a condom may have pain with and treated if
anus, can lead to with someone sex, vaginal positive. Avoid
infertility particularly who has the discharge, lower sex until 7 days
in women. infection; from abdominal pain. after treatment
mother-to-baby Men may have no is completed.
(eye infections). symptoms or Condoms
discharge from provide some
penis, discharge protection, but
from anus, pain in not total.
testicles, pain on
urinating.

Syphilis By having vaginal, Painless ulcer Antibiotics with Sexual partners

Bacterial infection anal or oral sex (chancre) usually on follow-up blood must be tested
entering the body without a condom genitals; later tests. and treated if
through breaks in with someone swollen glands, positive.
skin or linings of the who has the rash, hair loss. Current health
genital area; over infection; from regulations
time, goes on to mother-to-baby advise no sex
damage internal across placenta until you are
organs (heart, brain, during pregnancy cleared.
spinal cord) (congenital
syphilis).

Genital warts HPV transmitted Fleshy or flat lumps Visible warts can Condoms
Human by direct skin-to- on or around be treated, but the provide some
papillomavirus (HPV) skin contact, genitals, anus, groin infection cannot be protection, but
causes fleshy or flat usually during or thigh. cured. not total.
lumps – may be sex; from mother- HPV immunisation
present even if not to-baby. prevents.
visible Sometimes no
identifiable
source of
transmission.

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Disease How you get it Symptoms Treatment Partner
Treatment

Genital herpes Close skin Painful, red blisters, Anti-herpes drugs Partners may or
Herpes simplex virus contact with little sores or ulcers, and pain relief can may not catch
causes skin infection someone with the flu-like symptoms, be given to treat herpes. Do not
usually on mouth virus; from and sometimes a symptoms, but the have sex when
and lips (cold sores) mother-to-baby. discharge. infection cannot be open sores are
or on genitals. cured. Some may present.
need medication to Condoms
prevent further provide some,
outbreaks. but not
complete,
protection.

Non-specific Can be caused by Women usually have Antibiotics. Partners need

urethritis (NSU) chlamydia or by no symptoms. Men to be examined
Infections that cause bacteria, viruses have discharge from and treated.
inflammation of the or other the penis, pain on
urethra. organisms. urinating, but
sometimes there are
no symptoms.

Trichomoniasis During sexual Women may have no Antibiotic tablets Treat with
Trichomonas intercourse with symptoms, but there and/or vaginal antibiotics to
vaginalis, a small an infected may be a yellowy- pessaries. avoid re-
parasitic organism, person. green frothy vaginal infection. Don't
causes irritation in discharge. Men have sex until 7
the vagina in women usually have no days after
and can cause an symptoms. starting
irritation inside the treatment and
penis in men. until sexual
contacts have
been treated.

Diseases that can be transmitted sexually or may be transmitted in other ways

Hepatitis A Mainly through Often no symptoms, Immunisation for Immunisation

Viral infection which contaminated or may have mild flu- prevention. Good for prevention
affects the liver food or water or like illness, or hygiene and hand- and avoid anal
not hand-washing vomiting, abdominal washing. Avoid sexual
after toilet, before pain, dark urine and alcohol and drugs. practices until
food etc. Can be yellowing of the skin Eat a well- recovered.
through anal sex and whites of the balanced low-fat
and oral-to-anal eyes. diet.
contact
(rimming).

Hepatitis B By having vaginal, May have no Rest, exercise and Always use a
Viral infection which anal or oral sex symptoms or mild avoid alcohol, condom if
affects the liver. without a condom flu-like illness or drugs and smoking. partner is not
with someone vomiting, abdominal Eat a well- immunised.
who has the pain, dark urine and balanced low-fat Protection is
infection; form yellowing of the skin diet. Check any offered to
mother-to-baby. and whites of the prescribed or over- babies on the
By sharing eyes. the-counter immunisation

© HIGHER HEALTH
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Disease How you get it Symptoms Treatment Partner
Treatment

needles, syringes, medicines are safe schedule and to

toothbrushes, to take. children under
razors and 16 years. Free
unsterilized immunisation is
instruments that available for
pierce the skin. household and
Blood transfusion sexual
in countries that contacts.
do not pre-test
blood for
transfusion.

Hepatitis C After contact with Often no symptoms Rest, exercise and Sexual and
Viral infection which infected blood or or may have mild, avoid alcohol, needle-sharing
affects the liver. by sharing flu-like illness or drugs and smoking. partners can
needles or vomiting, abdominal Eat a well- have a blood
syringes or pain, dark urine and balanced low-fat test to check for
possibly through yellowing of the skin diet. Hep C
sexual contact. and whites of the antibodies.
Blood transfusion eyes.
in countries that
doe no pre-test
blood for
transfusion.

HIV HIV is transmitted Usually no obvious No immunisation Practice safer

Human through blood, symptoms for many or cure available sex to prevent
Immunodeficiency semen and years. although some transmission.
Virus attacks the vaginal fluids, secondary Partners should
white blood cells sharing needles infections can be ask for an HIV
and causes damage and from mother- treated or test.
to the immune to-baby. Blood prevented. Keeping
system so that it can transfusion in well for longer is
be difficult to fight countries that do possible with good
off infections. not pre-test blood care. Women with
for transfusion. HIV/AIDS need a
cervical smear
yearly.

Pelvic Usually by having Pain during sex, sore Antibiotics and Need to check
inflammatory vaginal sex abdomen or back, rest. for STIs and be
disease (PID) without a condom heavy, irregular or treated to avoid
An infection of the with someone painful periods, reinfection. No
womb and fallopian who has spotting, high sex until
tubes that can cause gonorrhoea or temperature, feeling treatment is
infertility. chlamydia. sick; sometimes no completed and
symptoms. until sexual
contacts have
been treated.

Pubic lice – crabs By close body Intense itching in the Special shampoo, Treat partners
Small lice that live in contact, usually pubic area, small cream or spray of the last 3
during sex with an applied to pubic months in the

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Disease How you get it Symptoms Treatment Partner
Treatment

the pubic hair and infected person. nits (eggs) on pubic area. Wash all same way at
cause irritation. Can be spread via hair. clothing and bed the same time.
infected bedding linen.
and clothing.

Scabies By close body Itching, worse at Special lotion, Treat partners

Small mites that contact, night, and a rash on cream or ointment. of the last 3
burrow into the skin sometimes during the body. Wash all clothing months in the
cause irritation. sex. Can be and bed linen. same way at
spread by sharing the same time.
clothes or
bedding.

Infections that are not sexually transmitted but can affect the genital area

Thrush or Yeast overgrowth Women have vaginal Creams and Need treatment
candidiasis may occur when or vulval itching and pessaries for local if showing
Irritation of mucous antibiotics are a thick, whitish treatment. Anti- symptoms.
membranes from a used, during vaginal discharge. fungal tablets may
yeast organism. It pregnancy, with Men have itching be given in severe
can occur in or diabetes, or when and may have a red cases. Salt water
around the vagina, immunity is rash on the head of baths for men are
and on the tip of the lowered. It can the penis or a usually effective.
penis. occur after sex, discharge under the
but also without foreskin.
sex.

Cystitis Bacteria from Burning sensation Antibiotics after

Bacteria cause around the anus when urinating, urine test if
inflammation of the getting into the needing to urinate symptoms last
bladder lining; can urethra and urgently and more longer than a day,
spread to kidneys bladder, not often than usual, drink plenty of
and cause damage emptying the cloudy, water, use pain
to kidney function. bladder properly. bloodstained or relief and using
Much more smelly urine, aching alkalisers.
common in in lower abdomen or
women than men. back.

Bacterial vaginosis It may be brought Greyish white, Oral tablets and/or

If the control of the on by anything smelly vaginal vaginal pessaries.
normal bacteria in a that changes the discharge.
healthy vagina fails, balance in the
an overgrowth of vagina, e.g., new
certain bacteria can sexual partners,
occur. The increased sexual
acid/alkaline activity.
balance is upset and
irritation results.

(Source: [Link]

© HIGHER HEALTH
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To Do
Watch the video and then answer the questions
 [Link] What causes yeast infections? (TED) (5
min)
1. What contributes to yeast infections?
2. How can yeast infections be treated?

Talk about STIs

The best way to oppose stigma about STIs, is to talk about it. Share information, be open and educate
your peers by giving the facts. The more people know, the less they will stigmatise.

To Do
Watch this video and discuss the answers to the questions in a small group.
 [Link] STI stigma (2 min)
1. Brainstorm creative, student-friendly messages about STIs, how to test for and
prevent contracting STIs.
2. Create a youth-friendly, informative message about STIs and post this on social media.

© HIGHER HEALTH
 27

Reflection
1. How do you feel about STIs?
2. How will you protect yourself from STIs?
3. What can you do to help peers to protect themselves and others from STIs?

Useful resources
Websites
 [Link]
 [Link]
 [Link]
 [Link]

Videos
 [Link] STIs: What you need to know. (2
min)
 [Link] Lowering your risk for STIs (4 min)
 [Link] The most common STI in the world (TED) (4
min)
 [Link] What causes yeast infections? (TED) (5 min)
 [Link] What causes a red bump down there? (1 min)
 [Link] STI MythBusters (4 min)
 [Link] How can I reduce my risk of getting a STI? (7
min)
 [Link] How talking about sex could end STIs (TED) (13
min)

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Topic 4: Sexual Health
Sexual Health
The World Health Organization explains that sexual health is a state of physical, emotional, mental
and social well-being in relation to sexuality. It is not merely the absence of disease, dysfunction or
infirmity. It is not just about avoiding HIV and other STIs and unplanned pregnancy.

To be sexually healthy means you need to have a positive and respectful approach to sexuality and
sexual relationships. You should respect yourself and others, always make sure sex is consensual
and that you partake in safer sex practices. You should have the required information about sex and
sexuality, as well as be personally aware, and accept and value yourself.

Sexual health includes the

possibility of having pleasurable
and safe sexual experiences, free
of coercion, force, discrimination,
exploitation and violence.

For sexual health to be a reality,

the sexual rights of all people must
be respected, protected and
fulfilled. This includes the right to
sexual orientation, the right to set
boundaries, the right to
contraception, the right to a safe
abortion, the right to say no to sex
at any stage, the right to medical
care, testing and access to condoms.

Sexual health includes an ability to be intimate with or very close to a partner. It also means to be able
to communicate clearly about your sexual desires.

Being sexually functional is part of sexual health. This means to have desire, become aroused, and
obtain sexual fulfilment. This should always take place in the context of being responsible, practicing
safer sex and avoiding sexual risks.

To summarise: Sexual health is as valuable as any other kind of health. It means you are not sexually
dysfunctional, have no STIs and are not forced to have sex or are assaulted. Sexual health affirms
sexuality as something natural, positive and enjoyable that you can engage in with confidence in
yourself and respect for your sexual partner.

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Sexual health is not only about being aware of the risks of sex; it is also about having fun and enjoying
yourself.

To do
1. When you heard the topic is about sexual health, did you think it will be just
about avoiding pregnancy and STIs? Explain your answer.
2. What is your understanding of the meaning of sexual health?
3. What does sexual health as ‘a state of physical, emotional, mental and social well-being in
relation to sexuality’ mean for you?
4. Look at this poster. Add two items to the list of what it takes to be sexually healthy.

(Image source: [Link]

To do
Watch the video and then answer the questions.
 [Link] Let’s talk about sexual health (5
min)

© HIGHER HEALTH
 30
1. Why is it important to talk about sexual health with your partner as well as medical provider?
2. What may make it difficult for you to talk about sexual health?
3. Why is it vital to have easy access to sexual health care?
4. What facilities do you have for sexual health care on your campus?

Many influences on sexual health

How you see sexual health and sexuality may differ. This is because sexual health is affected by a
range of personal and social factors. You may have received mixed messages about sex. For
example, your parents may have told you nothing about sex, your teachers may have encouraged you
to abstain and not have sex when you were at school, your pastor may have preached that sex before
marriage is evil and your grandparents may have asked you when they can expect a grandchild, and
your peers may have encouraged you to have sex.

Possible influences on how you experience sexual health include:

 Your body image and level of confidence
 Your values and beliefs
 How you were brought up and taught about sex, family attitudes and beliefs about sex
 Culture
 Religion
 Coming of age rituals
 Difficulty or ease of negotiating for safer sex
 Understanding of consent
 Spirituality
 Your peers
 Your personal experiences of good or bad sex
 Community expectations as to what you are
supposed to do
 Media such as movies and TV shows
 Social media
 Exposure to porn
 Social acceptance or rejection for your sexual orientation
 Access to sexual health care and services

Sexual health

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Sexual behaviour and sexual health
Your sexual health has a clear relationship with your sexual behaviour. If you take risks related to your
sexual behaviour, these risks have consequences

Health Effects of Sexual Behaviour

Risky sexual behaviours can lead to many negative health-related consequences, especially STIs,
including HIV, and unplanned pregnancies. Poor sexual health can have many effects on you and your
relationships, as well as your studies.

RISK ASSESSMENT SEXUAL HEALTH

Zone Check: SEXUAL HEALTH Ye No

s
1. You are uncomfortable talking about sexuality
2. You feel shy of your body
3. You do not understand your genital and reproductive body
parts
4. You think sex is just something you must do because it is
expected from you
5. You are unable to set boundaries in sexual relationships
6. You are so scared of sex you avoid it
7. When you are having sex all you worry about is getting a
disease; you don’t enjoy sex
8. You say there are no risks involved in having sexual
relationships with many people
9. Sexual health is not something you think about
10. You say intimacy and love is not for you; you just want to
have sex
11. You feel ashamed, embarrassed, and confused about sex
12. You say you cannot have a satisfying sex life because you
hate having sex.
If any of your answers place you on a red square, you are in the RED ZONE.
This means that you are at risk not having optimal sexual health. Ask your
HIGHER HEALTH Campus Coordinator for help and support and work
through all the modules in this course.

Consent
You dealt with the meaning of consent in Module 2. It is vital to give and get consent before engaging
in sexual activity. You cannot be sexually healthy if you have sex without giving or getting consent.

Unplanned and unintended pregnancies

Unplanned and unintended pregnancies can result in young mothers needing to sacrifice their
education. This can create dependence on others to provide for the family economically. In such
situations, women become vulnerable and have no power in their relationships. This can place them

© HIGHER HEALTH
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at great risk of being abused and exploited which, in turn, places them at risk in terms of their sexual
health.

To do
Discuss in a small group:
1. Why may some students be ashamed of their sexuality and the topic of sex?
2. Why is accurate information about sex and sexuality important for sexual health?
3. Why is it essential to know the risks of unsafe sex e.g., sex without correct use of
a condom?

Reflection
1. How does the topic of sexual health make you feel?
2. Do you think you are sexually healthy? Why or why not?
3. In what way did your upbringing influence your sexual health?
4. Why is sexual health important to you?
5. What can you do to improve or maintain good sexual health?

Useful Resources
Websites
 [Link]
 [Link]
important#:~:text=Being%20in%20control%20of%20your,infections%20(STIs)%20including%
20HIV.
 [Link]
 [Link]
 [Link]
 [Link]

Videos
 [Link] What is sexual health? (3 min)
 [Link] What is sexual health? Adopting a
sexual health paradigm (4 min)
 [Link] What is sexual health? A Comprehensive and
Holistic Explanation of Sex and Sexual Health (11 min)
 [Link] Women's sexual and reproductive health (3
min)

© HIGHER HEALTH
 33
Topic 5 Facts and Myths about Sexual Health
There are many myths or lies about sexual health matters. This is because sex is often shrouded in
ignorance, silence and secrecy, which makes it easy for myths to be created and to spread. Myths
change and vary from region to region and campus to campus.

Many students feel shy to talk about sexual health and some are even too shy to ask questions at the
clinic.

To Do
You may work alone or in pairs.
1 Watch this video and comment on any new information you may have learnt.
 [Link] Sexologists Debunk 17 Sex Myths - Debunked
(19 min)

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 34
To Do
1 Read the myths and their corresponding facts in the Table that follows. Choose 10 myths to look
at in detail.
2 Comment in the column on the right as to whether you had believed this myth, still believe it, or
have never believed it.
3 Add any other facts you may know, to help show these myths up for what they are: lies.
4 What other myths, apart from the myths in the Table, have you heard?

Myths and Facts

Myths, lies, Facts; truths Comments
misinformation, wrong
statements, false
1. If you don’t have sex Even if you only have one sexual partner, you
with a lot of people, still need to have a regular sexual health check.
you don’t need a Some STIs don’t show any symptoms, so it
sexual health check wouldn’t be possible for you or your partner to
know if either of you have an STI unless you
both have been tested. If you are sexually
active, you should have a sexual health check
regularly, at least once a year or more often if
you’ve had unprotected sex, and each time you
change sexual partner.

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2. Infertility is always the Infertility doesn’t just affect women. Both men
women’s problem and women can equally contribute to infertility.
Causes of infertility in males may include
abnormal sperm production, low sperm count
and difficulties with the delivery of sperm.
3. When you take a Oral contraception cannot protect against
contraceptive pill, then contracting an STI. It only protects against
you cannot be infected pregnancy
with an STI as you are
safe
4. The withdrawal Men discharge bodily fluids before they
method is a sure way ejaculate, and women produce vaginal fluids
to prevent pregnancy during arousal. This exchange of bodily fluids
and STIs could cause pregnancy and STIs even if the
male pulls out before he ejaculates, as sperm
may be in his pre-cum.
5. Sperm can only live for After ejaculation, a man’s sperm can live in the
a short time after it’s female reproductive tract for about 5 days, even
released if you wash yourself after sex. So, if a man has
sex with a woman a few days before she
ovulates or before she’s in her fertility window,
there's still a chance she could get pregnant.
6. Douching is necessary Avoid douching. Douching can change the
to keep the vagina necessary balance of natural vaginal bacteria
clean that live in the vagina and natural acidity in a
healthy vagina. A healthy vagina maintains both
good and harmful bacteria. This balance of
bacteria creates an acidic environment within
the vagina that helps protect it from infections
and irritations.
The best way to clean your vagina is to rinse it
gently in the shower with warm water and mild
or unscented soap.
7. You can’t get an STI You can get an STI from any kind of sex vaginal,
from oral or anal sex oral, or anal or by close intimate contact with a
partner.
8. Using two condoms This is riskier because the likelihood of the
doubles the protection condom breaking, slipping and tearing is higher
due to the amount of friction. A single condom
is the best option.
9. Men can’t get HPV HPV is common among both men and women.

10. You can only transmit A lot of people pass on STIs to others without
an STI if you have even knowing. STIs can be spread with
symptoms symptoms or without. The majority of STIs have
no symptoms or only mild symptoms that may
not be recognized as an STI.
11. To prevent pregnancy Taking a shower or douching after sex does not
and STIs you should prevent pregnancy, not does it prevent STIs.
shower or douche after
having sex.

© HIGHER HEALTH
 36
12. If you stand and lie in You can get pregnant no matter what position
certain positions, you you and your partner are in.
can’t get pregnant.
13. You can’t get HIV from Though less common, it is possible to contract
getting a tattoo HIV from getting a tattoo or body piercing if the
instrument – the needle is not sterile and has
someone else’s blood on it.
14. You can contract STIs STIs are spread through unprotected vaginal,
from a toilet seat anal, or oral sex, and by genital contact and
sharing sex toys. They are not spread by toilet
seats.
The viruses and bacteria that cause STIs cannot
survive for long outside the human body, they
die quickly on surfaces like toilet seats.
15. You can’t get pregnant While conception is most likely when
while you are having intercourse occurs a few days before ovulation,
your period it is still possible to get pregnant during your
period. Sperm can live in the female body for up
to five days after sexual intercourse. Sperm can
fertilize an egg a few days after it has been
released in ovulation.
16. Condoms are only for Condoms are made for women as well as men
men and both types are equally effective and safe.
While condoms may look different for men and
women, they work the same way: providing a
protective barrier to block semen from entering
the vagina. Both types of condoms can be used
to lower the risk of STIs during sexual
intercourse and unplanned pregnancy.
17. Masturbation is bad or Masturbation is normal and common for
your health and is anyone to do at any age. Masturbation has
abnormal many health benefits including stress relief.
Masturbation is the safest kind of sex. There is
nothing wrong with masturbating; almost
everybody masturbates.
18. There are no There are treatments for all STIs. However,
treatments for STIs some cannot be cured like hepatitis B, herpes
simplex virus (HSV), HIV, and human
papillomavirus (HPV).
19. Abortion is unsafe and If an unintended pregnancy occurs, abortion is
bad. a safe option to end the pregnancy. It is a safe
medical procedure if done by a qualified
professional health worker. There are no long-
term health risks from having an abortion. It will
not affect your ability to become pregnant in the
future. Most people who have had an abortion
feel relieved and have no harmful mental health
effects from the procedure.
20. Pap smears test for A Pap test only checks for cell changes that may
STIs lead to cervical cancers. It does not test for
STIs.

© HIGHER HEALTH
 37
21. Women are less sexual Being a woman does not make you less sexual
than men and have than men. This myth has the effect of shaming
lower sex drives women who have sexual desires and active sex
lives.
22. You don’t need to Many STIs do not have any symptoms
worry about STIs until
you have symptoms.
23. If you have sex in water Having sex in the pool does not prevent
e.g. a pool, you can pregnancy.
prevent pregnancy
24. Grinding and dry Grinding and dry humping -sex motions with
humping can lead to your clothes on – cannot result in pregnancy.
pregnancy
25. You can learn about What is shown in porn videos does not reflect
sex from watching porn the reality of sex or human relationships. The
aim of porn is to make money, not to educate
you about sex.
26. Oral sex is safe sex Oral sex is safer, but STIs can still be
transmitted by oral sex due to the exchanging of
bodily fluids.
27. You cannot get You can get pregnant every time you engage in
pregnant if you have vaginal sex, even if it is your first time.
sex for the first time
28. You can tell if someone The only way one might know that they have a
has a sexually sexually transmitted infection is by getting
transmitted infection. tested.
29. Once a man is sexually It is not harmful for a man to have an erection
aroused and has an and not ejaculate. Nothing will happen to him. A
erection, he must man’s testicles will not burst if he does not have
ejaculate to avoid an orgasm. His penis won’t fall off. Men
produce sperm all the time, and if they don’t
harmful physical
ejaculate, the sperm is just re-absorbed
effects.
30. Most women do not Most women and men masturbate.
masturbate.
31. You can re-use a Never reuse a condom; throw it away after one
condom if you wash it use. It loses its effectiveness.
out
32. There are no risks The anus lacks the cells that create the natural
associated with anal lubricant the vagina has. It also does not have
sex the saliva of the mouth. The rectum’s lining is
also thinner than that of the vagina. Lack of
lubrication and thinner tissues increase the risk
of friction-related tears in the anus and rectum.
Some of these tears may be very small, but they
still expose the skin. This can lead to infections,
including STIs.
33. It is ok to have sex with No, it is not OK. If someone is asleep, or drunk
someone who is asleep or drugged they cannot consent to any sexual
or drunk or drugged. activity.

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 38
34. You can get pregnant You cannot get pregnant from having oral sex,
from having oral sex if even if you swallow sperm. However, you can
you swallow sperm catch STIs such as herpes and chlamydia. Use a
condom on the penis, and a dental dam over
the vagina to protect against transmission of
STIs through oral sex.
35. Contraception leads to It doesn’t. Birth control prevents pregnancy
infertility while you are actively using it. Fertility resumes
as soon as birth control stops and ovulation
resumes. This is why women can become
pregnant after missing only one dose of the pill.
36. Some penises are too This is untrue and only used as an excuse for
big for condoms not wanting to use a condom. Condoms can
easily expand to the size of a big balloon, so
they can fit any size penis.
37. A virgin cannot have a You cannot tell if a woman is a virgin based on
broken hymen the state of her hymen. A hymen can change
due to any activity. And sex does not
necessarily result in changes to the hymen.
Both the hymen and tightness of the vagina
have nothing to do with being a virgin or not.
That is why virginity testing is unfair. It is sexist
and a violation of women’s rights.
38. Sex is just about Foreplay is also part of sex and there are other
penetration and having things apart from physical touching that are
an orgasm important. Intimacy, closeness, trust, affection
or love, enjoyment are all part of sex.
39. It is not an orgasm if Many women need clitoral stimulation, instead
sex is not vaginal of just vaginal penetration, to have an orgasm.
For some women penetration does not lead to
an orgasm but clitoral stimulation alone is their
preference.
40. Sexual anorexia does Sexual anorexia indeed is real. This is when
not exist people feel they must deprive themselves from
sexual pleasure and have obsessive thoughts
about avoiding sex. This is like food anorexia
where you refuse food, but here you refuse sex
or intimacy.

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To Do
Brainstorm your ideas in a small group.
 What can you do as a peer educator to help dispel the myths about sexual health
that are spread among peers? What can you do to help to spread and give the facts?

Reflection
1 How do you feel about the myths about sexual health?
2 Did any of the facts surprise you? Which facts and why?
3 As a peer educator, what can you do to ensure you spread facts, not myths, about sexual
health?

Useful Resources
Websites
 [Link]
 [Link]
important#:~:text=Being%20in%20control%20of%20your,infections%20(STIs)%20including%
20HIV.
 [Link]
 [Link]
 [Link]
 [Link]
 [Link]
 [Link]
 [Link]
 [Link]
 [Link]

Videos
 [Link] Sexologists Debunk 17 Sex Myths -
Debunked (19 min)
 [Link] Sexual health myths decoded (3 min)

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 [Link] 4 Popular lies we've been told about sex (7 min)
 [Link] Contraception- Myths and Facts - Dr Anjali
Kumar - Maitri (8 min)
 [Link] Myths About Sex Debunked (2 min)
 [Link] sexual health myth (11 sec)
 [Link] A series of
short (30 sec) videos on facts and myths of sexual health

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Topic 6 Safer Sex
What does safer sex mean?
Safer sex means protecting yourself and your sexual partner from the transmission of STIs, including
HIV and unplanned pregnancy. Safer sex helps you to be healthy and more relaxed when having sex,
so you enjoy it more.

Safer sex means having one partner that you have sex with, not multiple partners. The more sexual
partners you have, the greater your risk is, and the more unsafe sex may become. Each time you
change sexual partners, you increase the chance that you might be having sex with someone who has
an STI. The fewer partners you have, the less likely you are to get an STI or pass it on to several others.

Safer sex means to use condoms and water-based

lubricant correctly during all anal and vaginal intercourse.

Safer sex means that if you are sexually active, you go for
regular sexual health check-ups.

Safer sex means talking about it, avoid myths and lies,
telling the truth, understanding the facts about sex and sharing your feelings openly with your sexual
partner.
It means having open, honest conversations about safer sex. It also means sharing information about
any STIs you may have, to better protect your partner.

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Safer sex is being able to tell the difference between a myth and a fact. The more informed you are,
the more able you will be to have safer sex.

Safer sex means you need to do research to find information. Use the informative videos given as
useful resources, in this course to become better informed about safer sex.

RISK ASSESSMENT SAFER SEX

Zone Check: SAFER SEX

I CANNOT talk to my partner about using condoms/I am not practising Yes No
safer sex with my partner because:
1. He/she will think I am cheating and will not trust me anymore
2. My partner will not enjoy sexual intercourse with me anymore
3. He/she will leave me to have sex with someone else
4. My partner makes those decisions and has control over when and how we have
sex

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5. My partner may beat me if I suggest such a thing
6. I am scared and/or embarrassed to bring up the topic of protection
7. I have only one partner so I’m not at risk in any way
8. I trust my partner
9. We can stop in time so there’s no risk or need for protection
10. My partner refuses to use condoms
If any of your answers place you on a red square, you are in the RED ZONE. This means
you are at risk for HIV and STIs. Ask your HIGHER HEALTH Campus Coordinator for help
with counselling, contraception and safer sex options and further support as soon as
possible.

Sexual behaviour and sexual health

Our sexual health has a clear relationship with our sexual behaviour. If we take risks related to our
sexual behaviour, for example, these risks have consequences. Examples of high-risk behaviours
are shown in the diagram below.

Inconsistent Having sex

Becoming Having and/ or whilst Sexual Having Having
sexually many incorrect under the violence unprotected unprotected
active under sexual condom use influence of sex sex with a
the age of 18 partners alcohol or stranger
drugs

Safer sex means:

Get tested and talk to your partner about HIV

Discuss HIV If you’re sexually active, practice

testing before low-risk sexual behaviour
you have sex
Avoid
injectable
Get tested drugs. But if
Use a and treated you do, use
Oral sex is for STIs and
condom only sterile
much less risky request that
correctly every equipment and
than anal or time you have your partner(s) water, and
vaginal sex vaginal, anal, get tested and never share
or oral sex treated too your drug
injecting
equipment with
anyone

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Talking about safer sex options

Preventing the sexual transmission of HIV and other STIs needs you to use condoms correctly each and
every time you have sex. Talking about safer sex with a partner is not always easy, as it often raises
questions about trust, and may raise suspicion between a couple.

It is important to introduce the topic at a relaxed time, not during a fight and also not when the couple is
aroused and already ready to have sex. A good idea is to have some strategies or pre-planned phrases to
start the conversation.

Talk about it!

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It’s useful to start a conversation about safer sex early on in the relationship. Some ideas on
negotiating for safer sex are discussed in the Table.

Technique Why Suggestion

Express your feelings A “YOU” message, for example, “You need to use Instead, you could say: “I want to use a condom
using “I” statements a condom because I don’t want you giving me because I believe protecting our health and
some life-threatening disease…” comes across as safety is a priority...”, or “I feel strongly about
accusing and blaming. This is likely to trigger anger taking responsibility for my actions…”, and “My
or resistance. reasons are...”
“I messages” are about what you feel and think, and
you avoid demanding, blaming, or finger pointing.
Focus on interests, not By exploring your partner’s interests, you will Instead, say: “I would be really happy to talk
positions discover the real issue at hand. Avoid saying “So more about why you don’t want to…”
you’re refusing to use a condom…?” (Taking a A person may not want to use condoms because
position). he/she is concerned that their enjoyment
That tone or style of question will start an argument (interest) will be affected. You can then address
that is not likely to end well. this concern with appropriate suggestions.
Listen to and In this way you let them know their needs are Instead, say: “So you’re worried that it will
acknowledge your important to you too. spoil the moment and disrupt everything…? I
partner’s concerns Avoid saying: “So you don’t care about my feelings”, understand what you’re saying, and I want us
or “This relationship is all about you and your to enjoy our time together. Could we try... so we
needs.” could avoid that situation, still have pleasure and
be safe.”
Give your partner time Pushing or rushing creates pressures and leads to Instead, talk about it early on, just as the
to think about what you resistance. Avoid stopping in the middle of a moment relationship starts to get physical, so that you
are saying; don’t rush of passion and insisting on looking for a condom. It are both clear about the terms of your sexual
will result in anger and frustration. relationship.
Have the discussion before you find yourself in
the middle of the sexual act!
You don’t need to Safer sex is a big topic and a critical aspect of any Take your time, and if you need, decide together
make a final decision relationship. when you will continue the conversation.
during your first
discussion

Sometimes less direct approaches are as effective in promoting the use of safer sex practices as
more direct, verbal suggestions. Non-verbal strategies include:
• Strategically placing a condom on a pillow.
• Placing a safer sex pamphlet in view to start discussion or to “drop a hint”.
• Seduction (i.e., putting the condom on your partner).
• Use flattery (“Ooo, we’ll need to use an extra-large condom!”).

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Reasons some students find it difficult to negotiate for safer sex
• They may not have the right communication skills to talk about protection with
their partners.
• Young women may not have control over when and how they have sex because
their male partners may make those decisions.
• Young people may believe that if they suggest having safer sex, their partners
will think they do not trust them.
• Young people may be scared or embarrassed to bring up the topic of protection.
• Young people may want to get pregnant. Young women might believe that it is a
way to stay in a relationship. For young men, getting a girlfriend pregnant may be
a way to prove their manhood.
• Sometimes, young women who feel a lack of love in their lives think that having
a baby assures them of unconditional love.

To Do
Watch this video and then answer the questions
 [Link] Condom negotiation (3 min)
1. What is the first step in negotiating for condom use?
2. What can you do if your partner refuses to use condoms?

To Do
Work in a small group to role play negotiating for safer sex in these scenarios.
Choose THREE scenarios to work with.
1. A blesser tells a student that as he “owns” her, she has no right to ask him to use a
condom.
2. A student refuses to use a condom because he says he has no diseases.
3. The couple don’t have a condom with them but want to have sex.
4. “You don’t trust me” the student complains when the partner requests condom use.
5. “You are spoiling the romantic moment by talking about a condom now” the partner mumbles.
6. “Condoms are too small for me” the student boasts.
7. “I am allergic to latex” the student complains.
8. “If you really love me, you will allow sex without a condom.”
9. “We don’t need to use condoms as we are in a monogamous relationship”
10. “We don’t have to use condoms because we are the same age”.

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Can medication be used to prevent HIV infection?

Yes, HIV medicines are also used for pre- and post-exposure prophylaxis (PrEP and PEP,
respectively) and to prevent mother- to-child transmission (MTCT) of HIV.

What is Pre-Exposure Prophylaxis (PrEP)?

PrEP is Pre-Exposure Prophylaxis. Pre (meaning before), Exposure (meaning contact with the
virus), and Prophylaxis (meaning prevention). It involves the use of ARVs to keep HIV- negative
people negative. PrEP has been shown to be safe and effective at preventing HIV infection.

The current guidelines recommend that PrEP be considered for HIV-negative adults who are at high
risk for HIV infection, such as men who have sex with men, Sero-discordant couples (where one
partner is HIV-negative and the other is HIV-positive), adolescent girls and young women and sex
workers. Research suggests that PrEP is highly effective in preventing the sexual transmission of HIV,
as long as PrEP is taken exactly as directed. However, PrEP does not prevent other STIs or pregnancy.
It is recommended that PrEP be used together with other methods of preventing HIV and STI
transmission and pregnancy.

What is Post-exposure prophylaxis (PEP)?

PEP is Post Exposure Prophylaxis. Post (meaning after), Exposure (meaning having had contact
with the virus), and Prophylaxis (meaning prevention). PEP is given to help prevent the
transmission of HIV in an HIV-negative person who may have been recently exposed to the virus
through contact with HIV-infected blood or sexual contact with an HIV-positive person. It must be
administered within 72 hours (three days) after a potential exposure to HIV. It may prevent the virus
from replicating sufficiently to infect the person. The PEP regimen consists of a combination of anti-
retroviral (ARV) medications that are taken over a period of four weeks.

To Do
Watch this video and answer the question.
 [Link] PrEP and PEP (2 min)
1. What is the difference between PEP and PrEP?

What is dual protection?

 Dual protection means preventing STIs, HIV and unwanted pregnancy at the same time. Dual
protection includes:
 Using male or female condoms with another contraceptive method such as the oral contraceptive
pill.
 Using male or female condoms alone.
 Abstinence (not having sex at all).

Always use condoms

• Couples should use a new condom correctly and consistently each time they have intercourse.
• Condoms should be inserted before the penis touches the vagina.
• Internal condoms can be inserted up to eight hours ahead of time.
• When finished, the woman must move away from her partner and take care not to spill semen on
the vaginal opening.
• The condom should be thrown away properly, in a bin or trash can as appropriate immediately
after sexual intercourse.

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• If your partner won't use a condom, then engage in sexual acts other than intercourse.

To Do
Watch the video and then answer the question.

 [Link] How do I use a male and female condom? (3 min)

1. Briefly describe how to use a female and male condom.
Always use a condom correctly

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To Do
Discuss in a group how you can best distribute condoms, so they are accessed where and when
needed, on campus.

Reflection
1. How do you feel about having safer sex?
2. What could make it difficult for you to have safer sex, if you are sexually active?
3. How could you use what you learnt in this session, as a peer educator?

Useful resources
Websites
 [Link]
negotiation-and-common-excuses
 [Link]
 [Link]
 [Link]
 [Link]
 [Link]
 [Link]

Videos
 [Link] Our protection broke. Explaining PEP
by Nozibele (14 min)
 [Link] How to talk about having safer sex (4
min)
 [Link] What you need to know about condoms (3
min)
 [Link] Tips for Safer Sex and Pregnancy Prevention (4
min)
 [Link] Safe sex tips and how to use a condom (5 min)
 [Link] What is a female condom- internal condom? (1
min)
 [Link] Sex and masturbation (1 min)
 [Link] Condoms, lubricants and safer sex (2 min)
 [Link] What you need to know about condoms
(3 min)
 [Link] HIV: How to protect yourself and others
(2 min)
 [Link] What should you do if you had
unprotected sex? (3 min)
 [Link] How does PrEP prevent HIV? (2 min)
 [Link] PEP: preventing HIV after exposure (3 min)

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Topic 7: Maternal health and contraception

Sexual and Reproductive health is crucial to our overall health and well-being. Understanding sexual
health as well as rights (see the next topic for more on rights) is essential before you become sexually
active.
 Your readiness for sex is important to understand.
 Regular screening is important to prevent various cancers of the reproductive health system.

To Do
Watch the video and then answer the questions.
• [Link] Are you ready to have sex? (3 min)
1. What kind of questions do you need to ask yourself to find out if you are ready to have sex?
2. What do people who want to have sex have to discuss and agree on?
Reproductive health includes family planning. This includes looking after maternal health and
contraception. Family planning is planning in terms of:
 How many children to have
 When to have your children
 Who to have children with
 How to provide and look after your children
 Prevention of pregnancy (contraception)
 Planning for pregnancy (conception)

Benefits of Family Planning

 Allows women to make decisions about when to have children, who to have them with, and how to
provide adequately for children when they are born
 Family planning allows couples to have planned families so that every child that they have is a
wanted pregnancy
 It allows spacing between children so that the woman can recover from one pregnancy before
having another child.

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 Family planning can prevent unplanned and
unwanted pregnancies.
 Family planning allows for partners to engage in
sexual activity without conceiving a baby

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RISK ASSESSMENT UNPLANNED PREGNANCY

Zone Check: Unplanned Pregnancy

You or your sexual partner are NOT ON Yes No
CONTRACEPTION because you
1. Are having unprotected sex but do not think you are
at risk of pregnancy
2. Don’t have sex often enough to get pregnant
3. Want to have a baby so that your
boyfriend/girlfriend will marry you
4. Are embarrassed to ask for information about
contraception
5. You and your partner are ready/planning to have a
baby
6. Don’t have access to contraception
7. Feel pressure from your partner or family to get
pregnant
8. Are scared your partner will reject you if you talk
about family planning
9. Are scared of side effects of contraception (e.g.
weight gain)
10. Fear that sex will feel different or less pleasurable

If any of your answers place you on a red square, you are in the RED
ZONE. This means you are at risk for unplanned pregnancy. Ask your
HIGHER HEALTH Campus Coordinator for help with pregnancy
testing, counselling, contraception and support as soon as possible.

Contraception
“Contra” means “against” and “ception” means “to conceive”. So contraception involves the use of
different devices, medicines, sexual practices, or surgical procedures to prevent pregnancy. There are
many different contraceptive methods that are freely available at clinics around the country. Some
methods are more effective than others.

Any person can use contraception, including those who are HIV positive. It is best to consult a
healthcare provider to discuss the best contraceptive method.

Some factors to consider include age, plans to have children, and other conditions that a person may
have as some medicines and contraceptive methods may not work well together. The healthcare
provider can then guid ethe person to make the most appropriate choice of contraceptive method.

To Do
Watch this video and then answer the questions
 [Link] Birth control: the final frontier (5 min)
1. What should you be aware of before having sex?
2. How can you protect yourself and your partner from STIs and unplanned pregnancy?

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Contraception summary
The FIVE main types or categories of contraception

1. Barrier methods prevent sperm from getting inside the woman. These include male and female
condoms and diaphragms.

2. Hormonal methods are those that prevent eggs from being released inside the woman’s uterus by
altering hormone levels. These include pills, injectables, emergency contraception, and implants.

3. Long-term methods must be provided at a health clinic by a trained nurse or doctor. These include
intrauterine devices (IUDs) and implants.

4. Permanent methods like male and female sterilization require surgery.

5. Natural methods do not require any materials (i.e., the withdrawal method, and the “rhythm method”
which is when the woman learns to recognize when she is fertile and avoids having sex during that
time). However, these natural methods are not as reliable as other methods and pregnancy can still
occur.

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Oral contraception
Oral contraceptive pills may be a challenge for
young women. Stopping and starting pill taking
results in suboptimal contraceptive cover and an
increase in side-effects. Women should be
advised to use them without interruptions even if
they go through phases when they are not
sexually active.

 [Link] Birth control: what is it? (4 min)

 [Link] Does pulling out (withdrawal)

prevent pregnancy? (3 min)

What is emergency contraception?

Emergency contraception is a safe way to prevent pregnancy after unprotected sex. There are two ways
to prevent pregnancy after you have unprotected sex:

Emergency contraception is an important method in terms of prevention of unintended pregnancy. It

must be taken as prescribed and, while it is safe to use, it is not recommended multiple times
between monthly periods. It is relatively effective if used within 120 hours (5 days) after unprotected
sex, but the sooner the more effective.

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The emergency contraceptive pill (also known as the morning-after pill) can be taken within 120
hours (five days) after having unprotected sex.

The morning-after pill

• Ella is a type of “morning-after” pill that you
can only get with a prescription.
• There are also Plan B, One Step, Take Action,
My Way, AfterPill, and others.
• You can buy these morning-after pills over
the counter without a prescription in most
pharmacies.
• These types of morning-after pills work best
when you take them within 72 hours (three
days) after unprotected sex, but you can
take them up to five days afterwards.
• The sooner you take them, the better they
work.

To Do
Watch this video
 [Link] What Is Emergency Contraception? (The Morning
After Pill) (2 min)

Adolescent girls and young women are

particularly vulnerable to HIV and
STIs. So counselling for all
methods needs to focus on
prevention options, e.g. condoms
(male and female), and PrEP.

Unplanned Pregnancies can have serious consequences

 Can have negative effects on the health of a woman or girl
 Cause pregnant teenagers to be at high risk of:
 Premature labour and delivery,
 Anaemia,
 Pre-eclampsia, and

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 Having a baby with a low birth weight.
 Too many pregnancies or pregnancies that are closely spaced can cause major health problems for
women, including:
o A shortage of essential nutrients such as iron and folate (Vitamin B),
o Stress, and
o Complications with the uterus.
 There are also risks for the baby, including:
 Low birth weight,
 Premature birth, and
 Developmental problems.
 Cause financial stress including not being able to afford the cost of having a child.
 Cause existing or new children in the family to suffer from hunger, neglect or abandonment.

The risks of falling pregnant at a young age

 Young mothers are at a higher risk of complications during pregnancy because they are not fully
developed, and their bodies may not be ready to handle pregnancy or to give birth.
 Young mothers may face problems such as obstructed labour, long labour, anaemia, pre-
eclampsia (a condition that pregnant women develop marked by high blood pressure which they
never experienced before), a high level of protein in their urine, and often swelling in the feet,
legs, and hands. This may cause impaired kidney and liver function, blood clotting problems,
pulmonary oedema (fluid on the lungs), seizures and, in severe forms or if untreated, maternal
and infant death.
 Young mothers may also suffer the consequences of unsafe abortion, spontaneous abortion,
stillbirth, premature birth and low birth weight babies.
 Adolescents younger than 17 often have not reached physical maturity, and their pelvises may
be too narrow to accommodate a baby’s head.
 Pregnancy often means the end of formal education for girls, as they may have to drop out of
school when they become pregnant.
 Pregnancy changes a girl’s career options and her future opportunities.
 Unmarried mothers sometimes
have to take low-paid and risky jobs,
or become sex workers to support
their children.
 Sometimes the partner refuses to
take responsibility for the
pregnancy, which makes things
much harder for the young mother
and child.
 Young parents are often not ready to
raise a child which, in some cases,
can lead to problems like child
abuse or neglect.
 Early marriages that happen
because of an unplanned pregnancy are often unhappy and unstable.

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To do
 [Link] What are the stages of pregnancy? (4
min)

What options are there for unplanned pregnancies, and what are the implications of each of
these?
 Termination of pregnancy (TOP): psychological issues f o r s o m e e . g . , stress, anxiety, guilt,
depression, and medical issues if not carried out by a medical professional.
 Having the baby:
o Adoption: psychological issues of stress, anxiety, guilt, depression, and medical
issues.
o Foster care: psychological issues of stress, anxiety, guilt, depression, and medical
issues.
o Keeping the baby: financial, practical, education, support, and lifestyle change
issues.

To do
Watch these videos about pregnancy to learn more.
 [Link] So, you think you are pregnant? (3 min)

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 [Link] The surprising effects of pregnancy (6

min)

To Do
Read this list of reasons and add other reasons you may know about.

Reasons why young people may not use contraception

• They do not think they are at risk of pregnancy, STIs or
HIV. They think: “It can’t happen to me” or “I don’t have
sex often enough to get pregnant or contract an STI or
HIV”.
• They do not have access to youth-friendly reproductive
health services, or are embarrassed to ask for
information or required services.
• They do not have access to accurate information at
home, on campus, in the community, or from media
sources (television, radio, etc.).
• Contraceptive methods are not easily available or are
too expensive.
• Denial: “My partner would never expose me to any risk”.
• They feel pressure from their boyfriend or family to get
pregnant.
• They are scared their partner will reject them.
• They are scared of side effects (e.g., fear of hormonal
side effects associated with ‘the pill’, or fear that sex
will feel different with a condom).
• They feel embarrassed.
• A doctor or nurse at the clinic has a judgemental
attitude.
• They do not know how to negotiate condom use with
their partner.
• They have inaccurate information, for example,
thinking that a girl cannot get pregnant if she is
menstruating, or that a girl cannot get pregnant when
she has sex for the
first time.

To Do
Explain what you will do as a peer educator to advise the students making these
statements. Choose THREE statements to work with. Share in pairs.

1. Because I am a male, contraception is not my responsibility; it is not my problem.

2. I don’t think I need contraception; I only have sex about once every three months.
3. I am too scared to check whether I am pregnant or not. I would rather not know.
4. I think it’s better to have a baby while you are still very young as then you are stronger.

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5. My boyfriend wants me to have his baby, but I don’t want to get pregnant. Can I use contraceptives
without him knowing?
6. My sexual partner assured me that I won’t get pregnant. I trust him because he is older and more
experienced in sex than me.

Reproductive Cancers

Breast Cancer

To Do
Looking at the following risk factors for breast cancer (not exhaustive, there are other
risks too). Is there any risk that may be applicable to you or someone you know?

Breast cancer Explanation of the risk Is it a risk for

risk myself
Sex Being a female. More women develop
breast cancer than men, and it may be
related to the oestrogen and
progesterone hormones.
Age As one grows older, the risk for breast
cancer increases, e.g., about 75% of
breast cancers occur after 50 years of
age.
Family history If a family member has had breast
cancer, a women’s breast cancer risk
is doubled. The closer the relationship
(mother, sister), the higher the risk.
About 5% to 10% cases of breast
cancer cases are hereditary
Breast density Dense breasts (having fewer fatty
tissues and more glandular and
fibrous tissues) have an increased
risk of breast cancer.
Benign breast Any medical illness related to the
conditions breast: conditions such as cysts and
infection of the breast, have an
increased risk, due to related cell
abnormalities

Breast self-examination
One of the screening activities for breast cancer is breast self- examination and can be done by
women themselves in the comfort of their homes. This can be done standing in front of a mirror first.
The picture below shows the steps to follow when doing a breast self-examination:

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Warning signs for breast cancer

When doing breast self-examination, the woman needs to know the abnormalities to check for. This
will provide opportunity for early consultation with a health care provider who will continue with the
required care.

If you notice any of these symptoms depicted in the following pictures, you should consult a health
care provider for further assessment

(Source: [Link]

Cervical Cancer
In South Africa, cervical cancer (cancer of the cervix) affects about 2% of women. Worldwide, it was
documented that cervical cancer was the 4th most common cancer and the 4th most common cause
of cancer death in women.

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Considering that cervical cancer may progress to invasive cancer over a period of 10 to 20 years,
having regular screening allows detection of abnormalities early enough to be able to prevent the
cervical cancer from spreading. The screening is called a Pap smear and should be done at least
every three years for all women who are 25 years and older.

Cervical cancer is caused by the Human Papilloma Virus (HPV) and can be prevented through HPV
vaccination for primary prevention for girls aged 9 years and can be given to women up to the age of
45 years.

HPV is sexually transmitted and can be passed even when the infected person does not display any of
the signs and symptoms.

Warning signs for gynaecologic cancer

Gynaecologic cancer is any cancer that starts in
a woman's reproductive organs.
• Abdominal vaginal discharge or bleeding
• Pelvic pain or pressure
• Abdominal and back pain
• Passing urine frequently
• Itching and burning of vulva
• Changes in vulva colour or skin such as a rash,
sores or warts

Testicular and prostate cancer

Males have to check for testicular and prostate cancer as these types of cancers occur only in men.

Testicular cancer forms when malignant (cancer) cells develop in the tissues of one or both testicles.
Your testicles are sex glands that produce sperm and the hormone testosterone.

Prostate cancer is a common type of cancer in males. It is treatable in the early stages. The cancer
starts in the prostate gland, which is between the penis and the bladder. The prostrate produces the
fluid that nourishes and transports sperm.

TO DO
Watch the videos on how to check for breast cancer and testicular
[Link]://[Link]/watch?v=lvOp16CbWwg How to check for breast cancer -Dr Claudia
(2 min)
 [Link] How to check for testicular cancer (2 min)

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Crossword Puzzle

To Do

Read each clue and fill in the correct answer. Your answer must fit into the correct number of
boxes. Where a vertical answer crosses with a horizontal answer, they will share a box with the
same letter.

Across
1. The place where a baby develops.
7. Forceful release of semen from the penis.
8. Time in life when a woman’s menstruation ends.
9. Ducts connecting the ovaries to the uterus where fertilisation takes place (two words).

Down
1. Passing of semen during sleep (two words).
2. Release of an egg from an ovary.
3. Place where sperm is produced.
4. A thick fluid that is discharged from the penis during ejaculation.
6. The process by which a child’s body develops toward becoming an adult body and being able to
reproduce.
7. Hardening of the penis.

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Reflection
1. How do you feel about family planning?
2. Why is it important to take care of your reproductive health?
3. How can you share what you learnt with your peers?

Useful resources
Videos
 [Link] Contraceptives Got Talent: The Pill, The
Shot and IUD (4 min)
 [Link] Birth Control Basics: Condoms, The Pill & Patch (2
min)
 [Link] What Is Emergency Contraception? (The Morning
After Pill) (2 min)
 [Link] Know Your Birth Control Options (2 min)
 [Link] How to do a breast cancer self-examination - BBC
News (2 min)
 [Link] 10 Warning Signs of Prostate Cancer (5 min)
 [Link] What you need to know about the contraceptive
pill (3 min)

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Topic 8 Sexual and Reproductive health rights
In South Africa, Sexual and Reproductive Health Rights are protected in section 27 of our
Constitution. This says that “everyone has the right to have access to health care services, including
reproductive health care”.

Everyone in South Africa has a right of access to reproductive health services. Everyone has the
freedom to make free and responsible decisions and choices about their own bodies.

This policy is a demonstration of the Department of

Health’s commitment to provide comprehensive
sexual and reproductive health services with a
rights-based approach, to achieve health for all.
Embedded in the principles of equity and equality,
this policy emphasises the autonomy and agency of
clients seeking sexual reproductive health and
rights (SRHR) services.

This policy responds to women’s needs on agency

and choice in a rights-based approach.

(Source:

[Link]
03/National%20Integrated%20SRHR%20Policy_Final_2021.pdf)

Rights to reproductive and sexual health include the right to life, liberty and the security of the person;
the right to health care and information; and the right to non-discrimination in the allocation of
resources to health services and in their availability and accessibility.

Of importance are the rights to autonomy and privacy in making sexual and reproductive decisions,
as well as the rights to informed consent and confidentiality in relation to health services.

You will recall the meaning of good sexual and reproductive health. It is a state of complete physical,
mental and social well-being in all matters relating to the reproductive system. It implies that people
are able to have a satisfying and safe sex life, the capability to reproduce and the freedom to decide if,
when, and how often to do so.

To maintain their sexual and reproductive health, people need access to accurate information and
the safe, effective, affordable and acceptable contraception method of their choice. They must be

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informed and empowered to protect themselves from sexually transmitted infections. And when they
decide to have children, women must have access to skilled health care providers and services that
can help them have a fit pregnancy, safe birth and healthy baby. Every individual has the right to make
their own choices about their sexual and reproductive health. (Source:
[Link]

To Do
1. See:
 [Link]
[Link]
2. Look at page 7 and read the information about sexual and reproductive rights.
3. Explore this useful website: [Link]

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Be informed about Sexual and Reproductive Health Rights

Right to privacy and confidentiality

All personal information concerning a client, their health status,
treatment, or stay in a health establishment must be kept
confidential, unless ordered by a court of law or done so for the
advancement of the client’s care and treatment after following
the necessary procedure.

Right to refuse HIV testing

Clients have the right to refuse HIV testing, without
compromising their access to standard healthcare. There shall
be no mandatory HIV testing, and all testing shall remain
voluntary with informed consent, even when the services are
initiated by the service provider.

Informed consent
Informed consent refers to a person being given relevant and
appropriate information about an HIV test, and based on that
information, given an opportunity to either accept or refuse to
do the HIV test. Informed consent should always be in written
form and signed by the client and the healthcare provider only
to avoid unintended disclosure of results.

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Sexual and Reproductive Health Rights include:

• Right to define one’s sexuality
• Right to choose one’s partner
• Right to receive confidential, respectful and high-quality services
• Right to equality and non-discrimination
• Right to life, liberty and security
• Right to be free from torture and cruel, inhuman or degrading treatment or punishment
• Right to be free from all forms of violence and coercion
• Right to privacy
• Right to the highest attainable standard of health, with the possibility of pleasurable, satisfying
and safe sexual experiences
• Right to enjoy the benefits of scientific progress and its application
• Right to information
• Right to education including comprehensive sexuality education
• Right to enter, form and dissolve marriage and similar types of relationships based on equality
and full consent
• Right to decide whether to have children, the number
and spacing of children, and to have the information
and means to do so
• Right to participate in public and political life
• Right to access to justice, remedies and redress
(Source: [Link]
content/uploads/2019/07/S27-adolescentSRHR-
[Link])

To Do
1. Work in a small group. Watch this video and then
discuss the meaning of what you saw.
 [Link] It
begins with One: Sexual & Reproductive Health & Rights
(2 min).
2. What can you do as a peer educator to make sure your
peers are aware of their sexual and reproductive health
rights?
3. Discuss this statement in your group:
 Being sexually active involves bothy sexual rights and responsibilities
4. Identify sexual rights and responsibilities.
5. Which rights are not always provided for or easy to access?
6. Which responsibilities are more difficult to fulfil?

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Remember Consent, respect and Non-violence

• Consent is an important sexual and reproductive right.

• Respect is a core sexual and reproductive right.
• Non-violence is an essential sexual and reproductive right.

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Hurting somebody you say you love, is not love.

To do
I hurt you because I love you
1. Discuss the above statement in a small group.
2. What would you say to the person who says this?
3. Why do some people say this?
4. Why do some people believe this?

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Discrimination

There are different forms of discrimination,

including:
• Being rejected or isolated from family of a
community
• Verbal discrimination: gossiping, taunting, scolding.
• Physical discrimination: insisting that a person uses
separate eating utensils or sleeps in a separate living
space.

Stigma

Reminder of the meaning of stigma:

“When we have a negative attitude toward people who we think are different, or not ‘normal’ or
‘right’. For example, stigma can mean not valuing people living with HIV or people associated with
them, or people we think are homosexual” (source: [Link]

What does it mean to stigmatise someone? Labelling a person and seeing them as inferior (less
than or below others) because of something about them, or something you assume about them (e.g.,
because of their job, because they are poor, because they have a disease, etc.). Often people
stigmatise others because they do not have accurate information and knowledge, and this leads to
fear.

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What is self-stigma? When a person begins to see themselves in a negative way because of the
way others see them, or because of the way they perceive others to think. Self-stigma can lead
people to isolate themselves from their families and communities (e.g., someone is HIV-positive and
is afraid of “giving the disease” to their family, so they keep to themselves, eat meals alone, and use
separate cups and plates.

What is secondary stigma? When people are stigmatised by their association with someone
else, for example, the family member of an HIV-positive individual may also be stigmatised by the
community. Secondary stigma may affect doctors and nurses at HIV clinics, family members or
caregivers of people living with HIV, and even SRHR champions

STIs and stigma

Despite rising rates, there is still significant stigma attached to STIs. For some, this might mean
individuals are less willing to speak about sexual health concerns or raise questions with a doctor.
This unwillingness to speak openly about sexual health can breed misinformation. The internet is
useful when someone has a question they would like to ask anonymously. However, not all
information that appears on the web can be trusted and much of it may be inaccurate.

Impact of Stigma and Discrimination on the Health

of the LGBTQI+ Population
LGBTQI+ persons report fear of unfair and
discriminatory treatment at the hands of society
including health service providers with limited
understanding of sexual orientation, gender identity,
and transgender issues.
• This leads to prejudice, mistrust, discriminatory
treatment, denial of healthcare, and even abuse.
• They express fears relating to disclosure of
information regarding their HIV status, sexual
orientation, or gender identity.
• Denial of healthcare, verbal abuse, harassment and
violations of confidentiality of men who have sex
with men, gay men, transgender men, and intersex
persons may occur. As a result, LGBTQI+ persons
may not seek out health services that they need.

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To Do
Watch this video in a small group and then discuss the answers to the
questions.
 [Link] STI stigma (2 min)
1. How can STI stigma harm?
1. What can you do as a peer educator to ensure that your campus is free from stigma, discrimination
and sexual violence?
2. How would you explain consent to students on your campus?
3. How would you promote sexual and reproductive health rights on your campus?

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Reflection
1. How do you feel about your sexual and reproductive health rights?
2. Do you experience all these rights? Explain.
3. What can you do as a peer educator to promote an understanding and application of sexual and
reproductive health rights?

Useful Resources
Websites
[Link]
[Link]
03/National%20Integrated%20SRHR%20Policy_Final_2021.pdf
 [Link]
 [Link]
 [Link]
 [Link]

Videos
 [Link] What is Sexual and Reproductive
Health and Rights? (3 min)
 [Link] Sexual
Reproductive Health Rights (TED) (19 min)
 [Link] The psychological trauma of living with HIV in
South Africa (2 min)
 [Link] When someone isn’t quite sure if they want to
have sex – consent (4 min)

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