Lesson #4: No Call for Alcohol

I. Objective: Students will identify effects of alcohol on body organs and body systems. They will discuss peer pressure, and demonstrate and practice using refusal strategies.

1. Flipcharts: “Effects of Alcohol” and “Say No to Alcohol and Other Drugs”

-You can get addicted to alcohol (meaning that you can’t stop drinking, even if you want to.)

· The answers are all “true.” You should point this out and discuss any misconceptions that might have influenced students’ answers.

Show the flipchart “Effects of Alcohol” and discuss main concepts: Alcohol is a depressant drug; it affects thinking, judgment, and reasoning abilities; and its use affects many parts of the body. (You might want to leave the flipchart mostly blank and have students fill it in as you go along to check for comprehension).

· Brain/Central Nervous System: Alcohol is a depressant that also acts as an anesthetic in the central nervous system. Although a depressant, alcohol has a unique action that initially creates a feeling of mild and pleasant stimulation. Alcohol affects the thinking, judgment and reasoning abilities first. More alcohol intake means that breathing and reflexes will also be impaired. Heavy social drinking may also cause brain atrophy. Over time, the brain and nervous system become less sensitive to alcohol's effects.

· Stomach: Some of the alcohol consumed is absorbed quickly from the stomach into the bloodstream. The amount of food in the stomach helps determine the effect alcohol has on a person. Alcohol stimulates the stomach to secrete more stomach acid. Prolonged heavy drinking is related to ulcers and even cancer of the stomach, mouth, tongue and esophagus.

· Lungs: Some alcohol is exhaled through the breathing process, which is why alcohol can be smelled on the breath of a person who has been drinking. Extremely high alcohol levels result in unconsciousness, coma and even death through the suppression of the brain's breathing center, the cerebellum.

· Liver: Almost all the alcohol consumed is metabolized or oxidized in the liver at the rate of ¼ to ½ ounce of pure alcohol per hour. Since each typical drink of beer, wine, wine cooler or distilled spirit contains about ½ ounce of pure alcohol, it takes about two hours for the body to fully oxidize one typical alcoholic drink. Prolonged heavy drinking can cause fat to accumulate in the liver, which will eventually become non-functional scar tissue or cirrhosis, the sixth leading cause of adult deaths in the United States.

· Kidneys: Alcohol is a diuretic, so it increases the production of urine from the kidneys. Drinking alcohol on a hot day greatly increases the risk of dehydration.

· Small Intestine: Almost all alcohol consumed is absorbed from the small intestines into the bloodstream.

· Cardiovascular System/Circulatory System: Alcohol is a vasodilator, which means it opens up blood vessels, especially those near the surface of the skin. This gives drinkers a feeling of warmth, even though their body temperature may actually go down. This phenomenon is often observed at football games played in very cold weather. Some fans will drink so much alcohol they will take their jackets off to “cool off.” Unfortunately, they often find themselves in bed days later with upper respiratory infections.

· Reproductive System: Alcohol decreases production of the male sex hormone testosterone. Women who drink during pregnancy risk giving birth to an infant with Fetal Alcohol Syndrome (FAS), a disorder that causes heart malformation, joint problems, growth deficiencies and mental retardation. Less obvious but more common is Fetal Alcohol Effect, which includes all of the conditions of FAS, but to a lesser degree.

· Draw a long line on the board, or put up different pieces of paper around the room. Write “10: Strongly Agree” at one end of the line, “5” in the middle and “1: Strongly Disagree” at the other end. Ask for a volunteer to take a stand on a controversial issue, such as wearing clothing with explicit language in school, allowing female soldiers in combat, or making cigarettes illegal. Ask the volunteer to stand under the point of the line on the board that indicates her or his stand on the issue. Ask the class to try to convince the volunteer to change her or his mind and move to a different part of the line.

· Discussion points: For the volunteer: how did it feel to be pressured? For the class: what kinds of arguments seemed to work the best for changing the volunteer’s mind?

· Brainstorm refusal strategies with students. Then show the flipchart “Say No to Alcohol and Other Drugs” with the following information on it:

· 1. Act confident: Be direct and look the other person in the eye. Say "No," "No Thanks," "Yeah-right," etc. Don't feel you need to argue.

· 2. Have a friend along: Make sure a friend who you know will back up your decision is around. Stick together and make positive peer pressure work for you.

· 3. Use humor: Say something witty that turns down the suggestion. Example: “Who do I look like, Spud McKenzie?”

· 4. Give an excuse: Use a believable excuse. Practice beforehand. Examples: “I'm taking a prescription medicine right now.” “I just found out I'm allergic to alcohol.”

· 5. Plan your exit: Think of ways to avoid or leave the situation. Plan this beforehand. Examples: “My girlfriend's looking for me.” “Is there any food around here?”

· 6. Suggest an alternative: To help preserve the friendship, suggest an alternate activity or doing something together later on. However, be sure that this friendship is worth preserving. Example: “I don't drink. But hey, let's check out Austin Powers tomorrow, okay?”

· 7. Delay your decision: Postpone or hold off on making your decision. Examples: “Maybe I'll drink something later—right now my stomach hurts.” “Not tonight, I have to get up early in the morning for a game.”

· Students practice refusal strategies: Divide class into small groups. Distribute a role-play situation to each group. Ask students to discuss within their group how they would refuse the offer of alcohol in their situation. Ask each group to role-play their scenario.

· Reflect, summarize, and discuss: As groups present their role-plays, discuss the effectiveness of the refusal strategies they used. Discussion points: Why did group members choose a particular refusal strategy for the situation? What other strategies might have been effective in the situation?

1. Oksana stops over at her friend Dima's house Saturday morning to play on the computer. Dima says he has to clean up the apartment from a party his parents had last night before he can play. Oksana volunteers to help. Leftover food and half-filled bottles of beer, wine, and vodka are spread around the living room and kitchen. As Oksana and Dima start cleaning up the living room, Dima starts drinking some of the partially consumed beer. He then offers Oksana one that hasn't been opened yet. What could Oksana say and do?

2. Tamara and her cousin Anya are at the beach with Anya's older sister Yulia and Vlad, her boyfriend from university. When Tamara and Anya come in from the water, food has been laid out on a picnic table, and there are some bottles of beer also. Yulia and Vlad offer Tamara and Anya some beer to go with the food. Anya looks at Tamara expectantly. What could Tamara say and do?

3. Roma is having a big party to celebrate graduation from the eleventh form. At least thirty kids from your school are there. Roma’s parents have gone to a neighbor's house to stay out of the way. A few of the students have brought beer or vodka in their school bags and are passing them around in the living room. You want to get some food from the living room, but don’t want to drink. What could you do or say if you were offered alcohol?

Some material adapted from the Lviv Youth Employment Center’s Youth Leadership Program training manual and from Sound Mind, Sound Body, Peace Corps 2001

I. Objectives: Students will know about the various STIs and their means of transmission. They will understand the risk factors for sexually transmitted infections, and what they can do to decrease their risk. (If you need a more in-depth coverage of HIV/AIDS, follow this lesson with lesson #6; otherwise, this lesson can be used on its own as an introduction to STIs and sexual health).

3. One condom for each student, and a banana or cucumber for each team (see activity 9)

· Susceptible: an immune system is in a weakened condition due to any number of factors.

· Environment: an area of the living organism (you?) where an agent may enter the body and be able to live and thrive in darkness, moisture, warm temperature, nourishment, etc.

· Pathogen: a disease-causing agent (fluid, cells, parasite, bacteria, virus, protozoan, fungus, etc.)

1. Establishing rules: Tell students that we will be discussing a very personal matter today, so we should establish some rules for this lesson:

· You must respect the ideas and views of others. In this session, we cannot say things are “right” or “wrong” but will try to say behavior is “healthy” or “not healthy.”

2. Warm up/Discussion: ask students to define “sexual health” on a piece of paper individually. Then ask people who are comfortable to share their definitions with the group, and write them all down on a flipchart.

· Brainstorm with students all the STIs they know. Possible answers: Chlamydia, gonorrhea, syphilis, genital herpes, genital warts, HIV/AIDS, hepatitis (virus), trichomoniasis (protozoan), candidiasis (fungus ‑ includes vaginitis, and thrush), general urinary tract infection (UTI), Pubic Lice (“crabs,” parasite), pelvic inflammatory disease (PID, may be caused by multiple STI infections of woman's reproductive tract), conjunctivitis (eye infection, possible blindness, may be caused by chlamydia), etc.

· There are more than 20 different types of sexually transmitted infections (STIs). Each has a separate test for diagnosis: most often ‑blood, urine, and/or visual. The early symptoms of any STI are usually not serious ‑ a mild discomfort, an annoying itch, or a fluid discharge. If left untreated, some infections can cause sterility (no ability to have children), blindness, central nervous system destruction, disfigurement, or even death. Mothers carrying the pathogens of an STI at the time of delivery are at risk of giving it to their newborn baby. STIs affect males and females, from all social and income levels, all ages, all ethnic groups, and all countries of the world. Remember, it’s not who you are, it’s WHAT YOU DO. The more sexual partners a person has while practicing unprotected sexual activities, the greater the risk for contracting an STI. Note: Bacterial pathogen infections are curable through using an appropriately prescribed antibiotic. Viral pathogens are often controllable, yet not curable.

4. Lecture/Discuss: Ask class WHY sexually transmitted infection rates are high. Possible answers include:

· Many infected persons are uncomfortable discussing sexual issues and may be less likely to ask their partner to use protection (a condom) as a means of protection from pregnancy or STIs.

· There is a casual attitude about sex. The media (television, movies, songs, etc.) glamorize it and many people are sexually active ‑ without using protection or considering the consequences.

· Many people are pressured into having sex and either do not use protection, or are too inebriated to think about using it.

· Most STI pathogens are spread through some form of intimate sexual contact with an infected person: Broken skin, mucous membranes, urethra, etc. Some may be spread through infected fabric, utensils, toilet seats, etc.

· Infection can occur through unprotected sexual intercourse ‑ vaginal, oral, or anal ‑ hand, mouth, or genital contacts with an infected person.

· Infection may be spread through sharing drug injection needles with an infected person.

· All pathogens prefer dark, moist, warm mucous membranes, especially those covering the linings of reproductive organs.

· Some pathogens are susceptible to light, excess heat, cold, dryness, and may die quickly when exposed to air.

· Chlamydia: Bacterial infection of uro‑genital tract. This is the most common STI in USA. More women than men have this disease. It is called the "Silent Epidemic" because it often has NO SYMPTOMS. Over 70% of infected women do not realize they have it until secondary damage occurs, such as blocked reproductive tubes.

Symptoms. MEN: Painful and difficult urination, frequent urination, and a watery pus‑like discharge from penis. WOMEN: There may be yellowish discharge from vagina, spotting between menstrual periods, and occasional spotting after intercourse. However, often there are no observable symptoms in women.

Effects on the body:. MEN: Damage to prostate, seminal vesicles, possibly blood vessels and heart. WOMEN: Damage to cervix, fallopian tubes, sterility, and/or pelvic inflammatory disease. INFECTED MOTHERS: Conjunctivitis or blindness to newborn infants during delivery.

· Gonorrhea: Bacterial infection. It infects the lining of the pharynx, urethra, genital tract, and rectum. May spread to the eyes and other areas of body due to infected fluids via the hands or sexual activity. Sexually active women between 15‑20 years of age, practicing unprotected sexual intercourse, are at high risk for infection.

Symptoms. MEN: 80% of infected men experience symptoms. Symptoms include painful and burning urination 2‑9 days after contact with an infected partner. WOMEN: Only 20% of infected women experience symptoms. Bacteria may stay in vagina, cervix, uterus, and fallopian tubes for a long time and show no symptoms.

Effects on the body. MEN: Damage to prostate, seminal vesicles, possibly blood vessels and heart. Damage and/or scar tissue in reproductive tubes, causing sterility. WOMEN: Damage to reproductive organs, and sterility.

· Syphilis: Bacterial infection. It is delicate and dies on exposure to air, dryness, or cold. It is transferred from infected person through direct sexual contact. This disease is unique because it affects males and females in a similar way. There are four stages of syphilis

Symptoms. Primary syphilis is marked by a painless oozing sore at the infection site.

Effects on the body. Late syphilis occurs years after infection and if left untreated, can cause heart damage, central nervous system damage, blindness, deafness, paralysis, premature senility, and ultimate insanity.

· Genital Warts: Viral infection ‑ NO CURE. Condyloma‑Human Papilloma Virus (HPV) enters the genitals or anus through unprotected sexual contact with an infected partner. It is relatively easy to catch. There is a 6‑8 week incubation period (time the virus grows and spreads throughout the body) after contact with an infected person.

Symptoms. Many people have no apparent symptoms. Others have small to large, hard, itchy, white/yellow or gray colored, cauliflower‑like growths on genitals, in vagina, or in urinary tract.

Effects on the body. Scar tissue can stop reproductive capability in men and women. HPV could lead to dysplasia, a pre‑cancerous condition.

· Herpes: Viral infection ‑ NO CURE. Herpes Simplex Virus I gives people cold sores and oral fever blisters. Herpes Simplex Virus II gives people small burning blisters on genitals. It is one of the most widespread STIs in the world.

Symptoms. Burning and redness at site of the infection. Small blisters form and they are filled with clear, viral fluid.

Effects on the body. Viral fluid on hands can make infection spread to other parts of the body including the eyes, possibly causing blindness.

· HIV/AIDS: Viral infection ‑ NO CURE. HIV (Human Immunodeficiency Virus) is an extremely virulent STI that eventually makes the body’s immune system unable to function at all (this is AIDS, Acquired Immune Deficiency Syndrome). Every continent has been affected by the HIV/AIDS pandemic. The HIV virus has affected all ages, races, ethnic origins, social and income levels, and sexual orientations of people all over the world. A person is considered HIV+ if he or she has been tested with a blood test and HIV antibodies have been found in the blood, though one may not have any symptoms or feel “sick.” There is NO ONE GROUP receiving or spreading the disease. It is an “Equal Opportunity Pathogen.” ANYONE WHO ENGAGES IN HIGH RISK SEXUAL BEHAVIORS IS SUSCEPTIBLE TO THIS DISEASE.

· Question your partner(s) about his or her sexual history BEFORE sexual activity occurs.

· Both partners should stay in a monogamous, committed relationship with each other and not use illegal injected drugs.

· If you have sexual relations with someone whose history you don’t know or aren’t sure of, USE A CONDOM! (see activity 9 for how to correctly put on a condom)

· Don’t put yourself into situations that might compromise your sexual health (getting really drunk at a party, for example).

· Always feel free to say no to sex, without an explanation—you don’t owe anyone anything!

· Being sexually active with many partners, and/or not using protection are high-risk behaviors for contracting HIV/AIIDS and other sexually transmitted infections.

· Sharing drugs, needles, and syringes with anyone, who may or may not be infected, is a high-risk behavior for possibly contracting HIV/AIDS and other highly infectious diseases (Ex. Hepatitis, Tuberculosis).

Some material adapted from the Lviv Youth Employment Center’s Youth Leadership Program training manual and from Sound Mind, Sound Body, Peace Corps 2001

I. Objectives: Students will have a basic understanding of the current HIV/AIIDS pandemic in Ukraine, and will be able to explain the transmission, symptoms, treatment, and prevention of HIV/AIDS.

· Ask students to respond, individually and in writing, to the following five statements.

Review with students. The answers are all “false” (the last question is a trick question: the infection you get from someone is HIV; the disease is AIDS and it is the result of the virus; therefore you can’t get AIDS from someone). You should discuss any misconceptions that might have influenced students’ answers.

· Because there is a high incidence of young people using intravenous drugs in Ukraine, they are increasingly at risk for HIV. One-fifth of the adolescents aged 15-18 have used drugs.

· About 70 per cent of reported HIV cases in Ukraine are intravenous drug users; most of them involve young people. A big reason for this is that people share needles or buy drugs in pre-filled syringes that have already been used many times.

· Non drug users are also at risk for contracting HIV—particularly young people. Teenagers are especially at risk for HIV and other STIs (sexually transmitted infections) because they tend to engage in irresponsible sexual behaviors.

· Ukraine has the fastest recorded growth of new HIV/AIDS infections in Eastern Europe and Central Asia. Many cases of HIV remain unregistered, and the overall number of cases might be as high asapproximately 2% of the Ukrainian population.

· To contract HIV, you must be in direct contact with one of the four body fluids that can transmit HIV (the virus that causes AIDS). These fluids are blood, semen, vaginal fluid and breast milk. These fluids must find an entry route into your body. Entry can occur through a cut, sore, or through soft tissue or membranes located in the vagina, tip of the penis, the anus, the mouth, the eyes or the nose.

· HIV is spread through unsafe or high-risk behaviors. These include: sharing needles and syringes with an HIV/AIDS infected person, and unprotected vaginal, oral, anal intercourse with an HIV/AIDS infected person. To see what your personal risk is for contracting HIV, take the quiz “Are you at risk for becoming infected?”

· You are at a very low risk for contracting HIV if you do the following: practice abstinence (no sexual contact ever), practice celibacy (you were sexually active at one time but are not now); or if you and your sexual partner are in a monogamous and committed relationship with each other, have both tested negative for HIV and DO NOT have sexual contacts with anyone else, AND neither uses illegal injected drugs.

· REMEMBER: You cannot diagnose yourself. The only way to diagnose HIV/AIDS is to have your blood tested at a hospital or clinic. Also, in order to know something is unusual for yourself, you must know your own body.

3. More information about HIV/AIDS (for lower level classes or younger students, you might choose to skip this portion):

· How does HIV infect immune system? The HIV viruses enter the body, find white blood cells, and invade them. Each small virus multiplies within the cell and finally breaks the cell open, destroying it. Then the HIV viruses enter new WBC and continue doing the same thing again and again. Over time, this is the cause of the reduced count of Master Immunity cells that control the immune system. HIV antibodies are detected in the blood within 6 weeks to 3 months of original, infected contact. Detection time depends upon strength of the HIV/AIDS viruses.

· Common Symptoms: Excessive amounts of colds, sore throats, fever, severe fatigue/tiredness, nausea, night sweats, swollen lymph glands (throat, armpits, groin), PCP, KS, and of course, the many positive laboratory tests.

· Treatment: Nucleoside Analogues ‑ AZT, ddl, ddC, d4T, 3TC are drug "cocktails" that inhibit the “enzyme reverse transcriptase” of the virus before it enters a new WBC cell. “Protease inhibitor” also act to prevent the production of the virus in new cells. There are many uncomfortable side effects and therefore, it is critical to have the correct dose of these drugs. This is why a hospital stay is often necessary to make sure the correct dosage is being used and tolerated. Note: In Ukraine, as in many areas of the world, one must register in order to receive treatment. Of course, registration also may bring discrimination by employers, friends, and families along with the HIV/AIDS treatment. This may be why there is suspicion there are many more HIV/AIDS cases than actually diagnosed in Ukraine.

· Ask for 3 volunteers. Hand them each a script and tape the corresponding status (HIV+ or HIV-) on their back without letting them read it. Explain to the audience that one of the three students has HIV, but even they do not know whom. They are to introduce themselves by reading the first line of the script only. Let the audience vote on who they think has HIV. Have the participants read their scripts. See if the voting changes. Then have the volunteers turn around for the others to read their status. The object of the game is to have students consider which questions to ask of potential partners and not to rely on stereotypes.

· Discuss with students after the activity: Did you make any assumptions about who has HIV? What does this say about our ability to determine whether a person has HIV by educational status, position or age?

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