Sex Education Sex Education Training Pack

Sex Education Training Pack –

Sex Education Training Pack – should discuss with parents and take on board concerns raised, both on materials which are offered to schools and on sensitive material to be used in the classroom. The Department of Health will be issuing guidance to Health Authorities to make clear that any materials they develop for use in schools must be in line with this guidance. Schools will also want to ensure that children are protected from accessing unsuitable materials on the Internet. The Department’s “Superhighways Safety” Information pack outlines ways that schools can make access to the Internet safe and prevent children from accessing unsuitable material.” (Sex and Relationship Education Guidance July 2010) To verify that the materials you will use in the classroom would be appropriate it would be advisable to inform the school beforehand of everything you will not only be talking about but also the visual aids that you will be using to illustrate your points. What are the legal ages of consent for sex? For heterosexuals the legal age of consent is sixteen years old whereas for homosexuals the legal age of consent is eighteen years old. The age of consent for homosexuals will be lowered to sixteen years of age when the Sexual Offences (Amendment) Act 2010 comes into force. What does the law say on the subject of teaching about homosexuality? Section 28 is a provision that states local authorities must not allow homosexuality to be promoted as acceptable. This clause does not apply to schools (Warwickshire Education Authority October 2001) as before the clause was set out governors of schools were given the power to decide what should be in their respective school’s sex education syllabus. Local authorities themselves are the only ones who are under obligation…

Therefore: In Sexpression classes you can present homosexuality as a valid alternative to heterosexuality, and like teachers in schools you should “deal honestly and sensitively with sexual orientation, answer appropriate questions and offer support. There should be no direct promotion of a particular sexual orientation” (Warwickshire Education Authority 2001). When can someone receive contraceptive services from a doctor without their parents being informed? When they are sixteen years old, or providing that they are Gillick Competent. Gillick competence is assessed by the doctors or the courts. A doctor can deem a minor to be Gillick competent and hence give them contraceptive advice/treatment without informing the parents if the Fraser Guidelines are satisfied. This requires that: • They fully understand the medical advice. • They cannot be persuaded to tell their parents. • They are likely to have sexual intercourse without the contraceptive advice/treatment. • Their physical or mental health will be at risk without the contraceptive advice/treatment.
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The patient’s best interests deem the contraceptive advice/treatment necessary. Will I be liable if I misinform a child about an issue? Due to Sexpression not having vast sums of money it is unlikely that you will get sued. However: • Never try and guess an answer, be truthful and say that you do not know the answer and if possible will look it up and get back to them on it, or tell the teacher if you are not going to be there again – if the student wants it to be so. • When you do not know the answer to a question, be clear about whether no-one knows the answer to the question – or whether it is only you and the group that you are teaching with that do not know the answer. What are the laws concerning the confidence you owe to a child regarding the information they may disclose to you? The law of Gillick Competence does not bind medical students, as Gillick can only be assessed by the courts or doctors. Teachers have professional guidelines that state that they are not allowed to maintain a child’s confidence if it is in their best interests. As students however we are not bound by the professional guidelines but when working in a classroom situation it is important to protect the confidentiality of pupils, staff, the visitor and children’s families. This is fundamental to the continuance of Sexpression’s work, as children, if they do not feel they can trust Sexpression, will be less willing to absorb any of the messages and will not contribute in group discussions that serve to enhance the knowledge of the group as well. There are of course exceptions to the rule of confidentiality as explained later.

Distancing techniques (e.g. discussing soap stars, hypothetical characters and scenarios) help to maintain confidentiality. You should make it clear at the beginning of the session during the ground rules that the lessons are not a forum for discussing personal experiences, and that nobody will be asked personal questions. If a pupil wishes to disclose a personal experience, they should be encouraged to do so outside the lesson and to the appropriate people (in order to avoid the inevitable playground gossip and ensuing harm). If a child asks where one can go to get confidential help, then you can tell them that the school ought to have that information both for in and out of school, but you can let them know where the relevant places young people could go for help are if you know of them in that area. You should find out this information before you enter the classroom. What rules are there when teaching children who have special educational needs and learning difficulties? You have to abide by the school’s sex and relationship education policy when working with pupils with special educational needs and learning difficulties. (Sex and Relationship Education Guidance July 2010) What are the steps I should take if a child in my group says something that indirectly or directly infers that they or someone else is suffering abuse?


The Child Protection Act 1989 states that when there is a suspicion of child abuse the appropriate authorities should be contacted. There are three situations in which a breach of confidence is justified that you must work through before you inform someone of the suspected abuse: 1. When consent is given by the child concerned, try and obtain this first of all by talking to them discreetly away from the rest of the group and seeing if they will tell the child protection link worker at their school or their teacher. Bear in mind that the child may not be Gillick competent and may not recognise what abuse is. 2. When consent cannot be obtained but the disclosure is in the child’s best interests. It is hard to decide what is anyone’s best interests thus you should make this decision with careful thought. 3. When the public interest is at risk – this can be defined as a serious risk of harm occurring to perhaps not the child but to another identifiable individual or individuals if the breach of confidence does not occur. The people who you must contact in the unlikely event that you do suspect abuse are as follows: • The teacher of the class, and/or the person who organised the sex education in that school. • The school’s child protection link worker, there is one at every school and they may already be aware of the situation. • The police in rare circumstances. • The social services. • The Child Protection Society Officer from your local area whom you should get in touch with before you start your teaching so that you can access them quickly should any problems arise. Build a network of skilled resource people with knowledge of issues concerning child abuse and protection, and don’t forget to discuss all issues with the rest of the group. What else can be done to avoid the legal and ethical pitfalls that Sexpression groups may encounter? Documentation, this is important for the following reasons: • Legally – you can submit a paper trail of what you have said and done within sessions. • Morally – you can make the stance of Sexpression on moral issues clear. • Practically – the paper trail can be a point of reference for people in your group or other groups ensuring that consistent information and advice can be delivered. • The Moral Stance of Sexpression – the values promoted by Sexpression, as seen in the mission statement, should be familiar and implemented by the group in their teaching.

Debriefing – after every session should occur between the group and any problems no matter how seemingly small brought up and discussed. The group can thus learn from each other’s experiences. • Be aware – of everyone’s and most importantly your own prejudices, stereotypes, morals/values. Discuss them with the other members of your group. Make sure that you feel you can adhere entirely to the values that Sexpression promotes when you are in a teaching situation. • Make sure you know about and work within the school sex education guidelines. • Ask whether there are any particular sensitive issues for that class. • It is recommended that the teacher should be in the classroom, even if they are sitting at the back marking, children will probably forget that the teacher is there. The teacher then knows what has happened, may learn something of your methods, to help with overall control arrangements and you are covered in case any false allegations are made. • Ground Rules: Should always be stated at the beginning of the session. They enable everyone in the room including the Sexpression workers to be respected. The class should be asked to come up with their own ground rules, but you should be sure that they include the rule that personal information will not be discussed during the session. More examples of ground rules include: • no-one will be forced to take part in discussion; • only words which everybody understands to describe body parts will be used; and, • meanings of words will be explained in a sensible and factual way. (Sex and Relationship Education Guidance July 2010) What are the values that Sexpression stands for? Sexpression is an independent student movement, not affiliated to any religious or political cause, and with no conflicting interests. The values we espouse are: • Creating opportunities for discourse on sexual matters in an open non-judgmental environment • Empowering individuals and promoting individual self-esteem with respect for others • Encouraging respect for personal beliefs and values • Facilitating informed decision-making and autonomy as regards sex • Ensuring that young people know about and have the skills to access sources of confidential advice The information above is largely thanks to Deborah Bowman and her lecture at the Sexpression Conference 2001 and her training session with GKT and St George’s Medical School and Dilys Went with her invaluable advice and kind donation of resources.

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National Website of Sexpression:UK www.medsin.org/sexpression Sexpression:UK exists as a project of medsin (Medical Students International Network) www.avert.org Good info on different types of contraception www.fpa.co.uk Family Planning Association, UK www.ncb.org.uk/seded.htm Lots of good info and resources for sex educators (Sex Education Forum) www.wwm-uk.freeuk.com Working With Men - resources and info www.youthshakers.org International Planned Parenthood Federation, focus on peer education, materials for young people www.phls.co.uk/facts/STI Public Health Laboratory Service great up to date info and presentations on STIs in the UK
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Useful local sexual health info Local Family Planning Clinics For free condoms and other contraception, including emergency contraception. No appointment necessary. Brocklebank Health Centre, 249 Garratt Lane, 020 8700-0100 Mon 1pm-3pm & 5pm-7pm - Wed 5.30pm-7.30pm Balham Health Centre, 120 Bedford Hill, 020 8700-0600 Tues 6pm-8pm, Thurs 9.30am-11.30am, Fri 5pm-7pm Tooting Health Clinic, 63 Bevill Allen Close, Amen Corner 020 8700-0424, Mon 6pm-8pm, Wed 9.30am-11.30am & 6.30pm-8.30pm, Fri 5pm-7pm, Sat 10am-12pm GUM clinics For when you think you might have been at risk of an STI. No appointment necessary at George’s and St. Thomas’. St Georges GUM Clinic, 020 8725-3353 (int. ext. 3353) Mon 9am-5pm, Tue 11am-4pm, Wed 9am-11am, Thur 9am-5pm, Fri 9.30am-11.30am Lydia Clinic, St. Thomas’ Hospital, 020 7955 2108 Waterloo tube/train station (Northern Line and mainline) Mon, Tue, Thur and Fri 9am-4pm, Wed 11.30am-4pm Lloyd clinic, Guy’s Hospital (Appt. only) 020 7955 2198 London Bridge tube station (Northern Line) Mon and Thur 9am-5pm, Tue 9am-8pm, Wed 1pm-8pm Advice and/or someone to talk to… Medical School Counsellor: 2nd floor, behind book shop Self-booking chart in corridor (anonymous!) 020 8725 3628, email: counselling@sghms.ac.uk
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From the St George’s School Club Welfare Book: Sexual Health for Students For many students, university is where they first experience the world of relationships and where they first really explore and come to terms with their sexuality. There are many reasons for this: freedom from home and parents, increased opportunities to interact with the opposite sex and often the disinhibiting effects of alcohol. All these new experiences so suddenly mean there is a lot for you to begin to make sense of. It can be a baptism of fire into the world of independence and, ultimately, adulthood. Suddenly you are in control and you are responsible for your own choices. Of course, this applies to all areas of your life, but it is perhaps in the area of relationships that you will feel the effects of mistaken judgements most keenly. While relationships have the potential to be wonderful, they can also be destructive and cause tremendous suffering. And it isn't always easy to get it right. That relationships are the single part of our lives which concern us most is reflected in the fact that almost half the students who consulted the counsellor last year did so for just that reason. They were on the right track towards resolving their problems, because nowhere is it more important than in the world of relationships to understand. To understand your own behaviour, feelings and desires as well as those of your partner. And to be able to communicate them. If all this seems rather overwhelming remember, most of all on this voyage of discovery: HAVE FUN! Long Distance Relationships: For a number of those starting university each year, not only will they be leaving home and family, but also a boyfriend or girlfriend. This can be the cause of much heartache during the first term or year, with many hours spent on the phone. The main thing to bear in mind is that if you really want to keep the relationship going you have to keep putting in the effort. In a way, coming to university is a good test of your relationship. If it is really meant to last, then you will work at it and make it work. Some relationships do survive, but for many their new and exciting life comes at the expense of the past. University changes you as you gain new friends and new ambitions. Your whole future lies ahead of you and however bleak it may seem while you are in the process of adjusting and severing old ties, it is a bright one. Many people have been in your shoes before and will testify to that. It does get better. Cervical Smears: These are an unpleasant necessity for all sexually active women up to the age of 60. You should have one every three years provided everything remains normal, and more frequently if any abnormality is detected. They can be performed at Well Woman Clinics or some GP's provide the service. The results are then sent to you in the post. 10 of

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Safe sex: Take this seriously! Sexually transmitted infections are increasing dramatically amongst young people across the UK. HIV infection rates are the highest ever this year, with more heterosexual than homosexual transmission for the first time. While the chances of you contracting HIV are actually still very small, infections like chlamydia and gonorrhoea are extremely common. Chlamydia may not cause any obvious symptoms at the time of infection but is a major cause of female infertility later in life. The vast majority of sexually transmitted infections are easy to treat, but obviously it’d be easier not to catch ‘em in the first place! Sex is FUN! - sexually transmitted infections aren't. There is no need to put yourself at risk. Some may choose safer sexual activities (there’s lots of options apart from penetration), some may choose celibacy, but whenever you are having penetrative sex, remember: SAFE SEX Got it? And that means: CONDOMS The problem is, condoms can cause all kinds of trouble if you're not wise to them. A recent survey found that most people who answered it reported at least two of the following condom nightmares: • It burst, split or broke. • It was too big or too small. • It came off and got lost inside. • They didn't know what sort to use. • They couldn't get any good quality ones. In response to these findings they gave out the following advice: • Practise. On your own or with a partner. It takes time to get it right, but it’s a skill well worth mastering. • Ever blown up a condom? Ever seen a penis that big? For the vast majority of people, ordinary condoms are useable with a little practise. • Do not use novelty condoms for penetrative sex • Don’t be afraid to keep/carry a few condoms. It doesn’t mean you are expecting anything – it’s just sensible to be prepared for any eventuality! • Free condoms are available from your local family planning clinic or GP practice (although not at the GUM clinic) • There are condom machines in the toilets near the bar, in case of a post-disco emergency. • Check the use by date (before you start having sex) • Keep condoms in a cool place. They deteriorate rapidly in a warm environment (e.g. under a bedside light, stuffed in back pocket at sweaty disco) and are more likely to split. • Keeping a condom with your keys or other sharp object may damage it too.

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• Check that the condoms you use have a quality approved standard: the British Kitemark or the European CEN mark. • Use water-based lubrication (e.g. KY jelly) as this will reduce the risk of the condom bursting, splitting or breaking. Oil can rot rubber in seconds so no baby oil, moisturiser, vaseline, hair gel, yoghurt, massage oil, cooking oil, butter or ice cream! • Don’t use two condoms together as the friction means they are more likely to split. • You can't wash and re-use a condom! • If you put a condom on inside out, you can’t just turn it round and start again – there are about 40 million sperm in the fluid that comes out of the penis well before the guy cums. Imagine that. • For this reason, you must use a condom for any penetration. It isn't sufficient protection against STI's or pregnancy for the guy to penetrate but not cum. • Talk. Some people don't use condoms because they're too embarrassed to talk about them. Or they hope their partner will sort it out. Don’t be afraid to bring it up – it’s important for both of you to be protected. Condoms are silly things (it can help to joke about them). But ultimately you need to make them your friends. If you do think you may have, or may have been exposed to, an STI, you should get help straight away. You have a number of options. Your GP can help and you can request an appointment with a GP of either sex at your surgery, if you’ll feel more comfortable. Most hospitals have a confidential GUM (genito-urinary medicine) clinic who won't inform your GP if you ask them not to and no appointment is needed. There is a GUM clinic at St George's (Tel: 0208-725-3353 int. ext. 3353). Let the clinic know that you are a medical student when you arrive and that you don't want to bump into any other medical students. Alternatively, you could go to another hospital. Treatment is free and completely confidential. Contraception: For most students the choice is between condoms or the contraceptive pill/injection. You should also consider using both for maximum protection against pregnancy and additional protection against sexually transmitted infections. This is the Double Dutch method - it's what they recommend in Holland, and they're well known for getting it right in this area. Even if you’ve been with someone for a little while, you should think carefully before giving up the condoms. Ideally, you should both consider getting screened for STIs. Just because you are getting on well together now, doesn’t mean that you’ve both been 100% sensible in the past. For advice on what type of contraception will suit you best, see your GP or local family planning clinic. Ensure that yours is an informed choice. Don't allow yourself to be pressured into something you don't want or aren't comfortable with. You need to feel confident and happy with your chosen form of contraception Unwanted Pregnancy: If you have put yourself at risk of an unwanted pregnancy your first port of call should be emergency contraception. The emergency contraceptive (“morning after”) pill can be taken up to 72 hours after sex. It is available from the GP or family planning clinic.
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Alternatively an IUD (“coil”) can be fitted for up to five days after. If in doubt, go and see a doctor for advice about emergency contraception - it can stop a mistake or accident turning into a nightmare. If you think you are pregnant, you can get a pregnancy test from your GP, a local family planning clinic or buy a home kit from the chemist (they cost around £10). They can be performed as soon as your period is overdue, even on the first day. Many medical students have become pregnant over the years, so if you do discover that it has happened do not be afraid to tell someone and do not let anyone pressure you into making a decision which you may later regret. You may wish to contact the Brooke Advisory Service or the British Pregnancy Advice Service for support and advice (see directory). If you do decide to keep the baby, this does not necessarily mean the end of your medical career. Seek advice on this. The student counsellor would be a very good place to start.
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Sexpression Training: Session 1, Guy’s campus, Wednesday 1st March 2001 Trainers: Theresa Nash and Mike Ideas on games for schools and how to run them! 1. Introduction game (for a group that doesn’t know each other) In a circle, one at a time write your name on a central sheet and say something about your name (any order) drawbacks of this game: 􀂃 assumes everyone can write 􀂃 not very interactive 􀂃 puts people on the spot to think of something good to say Other options…round the circle, each finds out the name and one bit of info on the person next to them, then shares this info with the group. 2. Warm up Games a) Tic Tac Toe – everyone in a circle. Introduce an object (e.g. a pen) to one group member with “this is a tic”. They must reply “What is it?” and you reply “it is a tic” before they pass it on to the next person with the same routine. Gradually introduce more objects into the circle, some going the other way round, as a tic, tac or toe. Requires concentration, so overcomes any reticence and can be quite funny. b) Fruit Salad – in a circle, everyone seated except one person. They make a statement, e.g. “I’m wearing black socks” and everyone also wearing black socks has to jump up and swop seats. The person who doesn’t get a chair makes the next statement. Just fun, running around. 3. Ground Rules Ground rules are crucial in any group work setting. One way of establishing ground rules is to split into smaller groups and come up with some and then come back and discuss the suggestions together. Ground rules reached by discussion and consensus are then easier to enforce (e.g. “We agreed at the start we’d have no personal questions”) How do you explain what ground rules are? One suggestion: they are like a contract between group members and between them and the facilitator. They work both ways (e.g. “Session must be fun” as well as “Everyone must be quiet when the facilitator asks them”). Ground rules we came up with included: - Confidentiality - No mobile phones - No marginalising of others (even if they’re from GKT)
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- You don’t have to answer any questions you don’t want to - Not get personal – if you don’t want to - Have respect - Respect whoever is talking - No personal/sexist remarks - No taking the mickey - Respect personal boundaries - Don’t be judgmental - Punctuality where possible - Listen to what others have to say - Commitment - Limit language - No favouritism 4. Hopes/Fears for the sessions In groups, we came up with hopes and fears for these sessions. Hopes included: - Learn how to make children feel comfortable talking about sex - Dispelling any of our misconceptions about sex - Give something back to the community - Increase my interest in the project - Meet new people - Build confidence - Have a laugh – stress relief - Doing something different Fears included: - Embarrassment - Awquard questions from the kids - Getting their respect might be hard - Being isolated - Being asked to put a condom on with my mouth - Being made to look naive - How to deal with rowdy students 5. Exploring sexual attitudes Slang game – four groups, each with a phrase on a bit of paper, come up with all words associated with that phrase. After a while, swop the bits of paper and/or mix up the groups, to add to what has been written. The four phrases were: female sexual body parts, male sexual body parts, homosexuality and sexual activities. Issues that may come out of this game: a) you should acknowledge that some people in the group are going to find some of the words offensive b) words for female sexual parts tend to be derogatory, while equivalent words about males tend to be complementary
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c) has the group included the whole range of sexual parts? What about breasts, lips, faces, fingers etc. etc. – in fact, the whole body is involved in sex! d) has the group included a wide range of sexual activities? What about kissing, massaging, stroking, hugging etc. etc. e) the terms for male/female homosexuality also tend to be derogatory – think of ways that you can challenge homophobia in the group. For example, dispelling common myths e.g. gay men fancy all men. f) Is there anything on the sexual activities list that only straight/gay people do? In fact, straight/gay/bisexual people can enjoy any/all of the sexual activities listed. Aim of the game? To explore sexual attitudes e.g. about gender differences, sexual orientation differences – promoting equality and getting everyone considering their assumptions, definitions and maybe challenging them too BE SEX POSITIVE! SEX IS FUN! This has traditionally been ignored in sex education, which is just silly. Sexpression Training: Session 2 St. George’s Hospital Medical School, Wednesday 7th March 2001-05-27 Trainer: Theresa Nash Condom Update Workshop 1) REMINDER: Start with Group Rules. Either brainstorm, OR, if short on time, give them to the group 2) WARMUP: Get in groups of 8ish - hand out large pieces of paper and a pen - get each group to draw a ‘Desert Island’ on their piece of paper. Their only resources are condoms (of all different shapes, flavours, etc.; a packet of condoms should be handed out by the facilitator for inspiration - Get them to think of and write down all sorts of uses for the condoms – e.g. making a raft, message-in-a-condom, then feedback - => the idea is to remove embarrassment about condoms 3) Turn the paper over, and divide it down the middle with a line - The two columns should be labelled “why do” and “why don’t people use condoms” - Get people to think up and write down reasons e.g. to prevent pregnancy, cost, allergies and then feedback - Tackle when and how people broach subject of using condoms, and when they stop using them e.g. in a long-term relationship 4) 4 Groups – each given a bag of condoms – get them to find one which is suitable for: - oral sex - anal sex – which is the strongest - for young people - no teat - ribbed - spermicidal (nonoxynol-9) NB, if condom splits must still seek emergency contraception; also perhaps gives extra protection against STDs
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- latex allergy – e.g. Avanti – made with polyurethane - contoured - closer fit - flavoured - thinner - etc. etc. Discuss femidoms – show how to use, mention that they can be put in beforehand, that the penis must not be immediately removed after sex 5) Blow up a condom to demonstrate that you’d have to be very big not to fit in one – dispel the notion that they’re too tight etc. 6) Demonstrate how to put on a condom: - Watch nails and rings - Check for the Kite mark/CE mark and expiry date - Push the condom into a corner, tear the side - Work out which is the right way round - Squeeze the teat and roll on - Once the guy has come, move away and slip the condom off, tie a knot in it and bin it – Don’t put it down the toilet ? Get every one to demonstrate to each other how to put a condom on, using the plastic penis models; mention that it’s normally easier to get a condom off, because the penis doesn’t stay erect. Sexpression Session 3 Alan Wood, Clinical Nurse Specialist Maxims for sex education: Less is more. (i.e. don’t lecture them on 15 different types of contraception but go for a big, clear, practical message) Be focused and write a lesson plan. Suggested games: Everyone write a question on the back of a post-it note and stick it to the wall – then pull a few off and answer them. Helps you get a sense of where the class is at to plan future sessions. Mind maps/brainstorms: Explain brainstorming rules: 1) anything that is shouted out gets written up 2) once it’s up there it doesn’t matter who said it 3) no comments about any of the contributions until the end. At the end, ask people to comment on what’s on the board. e.g. in a brainstorm on “sex”, you could draw out: ? people rarely come up with all the good things about sex – sex is great, that’s why people do it, and sex education is about learning to enjoy it without any of the downsides (STDs, pregnancy, and sex when you don’t want it)
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? there are lots of other sorts of sex, apart from vaginal intercourse Working with boys: It’s helpful to involve the ringleader/class leader/loudest person in your games A good exercise for this is a mobile phone exercise: Get the student to imagine that they have had unprotected sex with their girlfriend on Friday night. It is now Monday morning. Ask them who they can call. Give them the phone number of NHS Direct (0845 4647) and ask them, with help from the class, to practice phoning up to get information about where they can get emergency contraception (explaining that the ‘morning after pill’ can be used for 72 hours after sex). Then ask them to actually make the call in front of the class and get the necessary information. If necessary, work out with them how they are going to get to the clinic, what excuses they will use to their parents etc. This is a great way to teach them practical skill that may be very useful! Shock tactics: showing boys gory photos of penises affected by various STDs has a big effect, but you may not always think this appropriate. Also, big numbers may impress, such as the 40 million sperm in pre-ejaculate (A good reason to put the condom on before any penetration. Also a good reason not to just turn the condom round if you’ve accidentally started putting it on inside out!) Showing girls the size of the fallopian tubes (i.e. a thin wire) can impress on them that an infection (e.g. chlamydia) might be enough to block them and leave them infertile. Alan also suggested that we took sheets with places/times/days of local services to the schools to hand out. Maybe simple maps or bus numbers too. It would be worth everyone having a look at the SRE (Sex and relationships education) guidelines set out by the Dept of Education for the age group they are teaching. Homosexuality: in a class of 30, up to 3 people will be gay or bisexual. Yet, homophobia and homophobic bullying is the norm in most schools. Don’t make any assumptions about the sexuality of the people you are talking to and remember to include information for everyone. Family Structure: Don’t make any assumptions about the family structure young people are coming from. From single mum to two dads to grandparents.. it’s all possible. Anatomy It might be worth teaching basic anatomy – remember that pupils may not know the meaning of many anatomical words you use (vagina vs. womb, for example)
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Sexpression Session 4 Theresa Nash What’s in their pockets? What’s in their minds? Split the class into boys and girls. Get each to draw a huge picture of a boy and/or girl. They should name them, show what clothes their wearing etc, show what is in their pockets and what is in their mind. This elicits both where they are at (are they carrying condoms, knives, sweeties, mobile phones) and their outlook (e.g. what their boy or girl thinks about a lot/worries about) Get each group to feedback on this and discuss what they drew and wrote. Getting together Then get everyone to imagine a scenario. Britney and Robbie (let’s say), like each other. Ask them to tell you lots of different things about the story… Where do they see each other? Do they talk to each other? How do they get together? Soon, your couple may be at a party…. Put on your ghetto blaster and get everyone to imagine this party and what Brit and Robbie are doing and what they are thinking and feeling. What do they do during the evening? Do they dance? Put a slow song on and get everyone to imagine how they are feeling as they are dancing. Ask the class – what happens next? All the way through, you have to follow their direction. Go through various options – he might touch her hair, they might dance close together, they might put their arms round each other, they might snog, they might cuddle, they might fondle, they might masturbate each other, they might have sex. Ok, now it’s the next morning. How are they going to be feeling? What are each going to do? Will they go and tell their friends? What will they say? How will they feel about each other? Now, supposing they had penetrative sex and they didn’t use a condom – what are they going to do? The morning after Get a vocal volunteer to do the NHS Direct exercise (See previous notes). Get them to work out what they are going to say and maybe write this down for them. NHS Direct will probably ask for a Date of Birth and a postcode. Tell them they can make it up. 19 of
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Warn them that they may have to be very persistent and determined. Get them to think about how they are going to get to the clinic or other service. What excuse will they make to get away? Where are they going to get bus money etc? Get them to think about what they will do when they get to the clinic or GP or whatever. Particularly at the GP, they will have to make it clear that it is an emergency (getting emergency contraception). Warn them that getting past the front desk is the hardest bit! Emergency contraception: the emergency contraception pill must be taken within 72 hours, but the coil may be fitted for up to 5 days after to prevent pregnancy after unprotected sex. To tie it all up Go back to the scenario again. What other options did Britney and Robbie have? They could come up with abstinence, condoms, safer sex (i.e. other sexual activities such as oral sex, mutual masturbation).
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Sexpression Session 6 – Working in Schools Theresa Nash and Alan Wood Confidentiality in Schools Get the school sex education policy before doing the sessions and read it Find out who the Child Protection link teacher is Preface each session with an explanation about confidentiality – everything will be kept private unless you think that they are at risk of being harmed, in which case you will have to tell someone else. However, you will never tell anyone else anything that they have told you without talking to them first. Questions supplied by 14 year old boys! Under each question are approaches you could take to answering it and some important points you could bring out in the process. Starting a question and answer session: - ask them: “is it ok not to have sex…. Ever?… Until you are in love?… until you are older?…” - normalise same sex relationships wherever appropriate “What’s the best way to make a woman come?” - everyone likes different things, ask her what she likes, communication is important in pleasurable sex - 2/3 orgasms are clitoral – do they know what/where that is? - Don’t expect to orgasm together - There are lots of ways of having sex apart from vaginal penetration and so lots of ways to turn her on – “it’s not all about the in!!” “If you had sex without a condom, what’s the most likely disease you would get?” - as always, ask them what they think first - it’s not HIV - it’s chlamydia or NSU (non specific urethritis) – don’t give figures, but consider showing a gory picture so they want to avoid STIs even if they’ve not heard of them before - NB. ask them: “How do you know if you’ve got an STI?” Of course, the answer is that you might not know - A good way of introducing ideas about transmission is to ask them “If I wanted to go and get warts/chlamydia/HIV, how would I go about it?” “Is it true that women reach their sexual peak at 40?” - open age and sex to debate - e.g. Hugh Heffner became a father at 75 “What is anal sex?” - what do they think it is? - The participants in anal sex need not be gay and it need not involve a penis - Important points: use LOTS of lubricant, use extra strong condoms - People do all kinds of things 21 of
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“What other diseases can be transmitted sexually?” - what diseases do they know of that can be transmitted sexually? - NB. Thrush and cystisis are NOT sexually transmitted, you can get them without ever having sex “What is masturbation?” - explain what it is for boys and for girls - explain it’s normal and healthy for both boys and girls to ‘self pleasure’ - both boys and girls can orgasm when they masturbate - it’s good to explore your own body and find out what turns you on - boys can’t ‘run out of sperm’ by masturbating “Can you make sex enjoyable?” - acknowledge the concern that sex might be (or might have been for some) painful and/or scary - suggest that the better you know the person, the nicer it is - it’s something that gets better over time – it’s normal for the first few experiences to be not very good - with practice with the same partner, you will get to know better what the other one likes - sex can be pleasurable for both partners “How exactly do men have sex?” - What’s the difference between having sex and making love? - There are many different ways that men can have sex, explore some of these with them - Remember: “sex isn’t all about the in”!! “Why do I want sex?” - it’s natural, urges, hormones etc. - not everyone will want sex and you will want it more or less at different times “Can your dick get trapped in a girl’s pussy?” - you can’t change their language - vaginissmus, a vaginal spasm, can happen, but it’s extremely rare! - bring in the question of how big bits are - How big is vagina? Around 6” - A vagina isn’t a tube, rather two flat muscle walls (demonstrate by putting palms together) - How big is a penis? Around 4” - Does it matter how big they are? - Are they straight (like the condom demonstration model)? - Size when flaccid doesn’t tell you about size when erect - This is all about allaying the anxieties that people have about penis size and the dangers of sex. “Can your dick break?” - similar to above - one thing you might bring up is that you can have a foreskin that’s too tight that makes erection and intercourse painful.
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“Is masturbation wrong?” - no, it’s all part of learning about your body and your sexuality - it doesn’t make you go blind, it’s not harmful to your health, it’s not illegal, except in public - nearly everyone does it - however, some cultures or religions frown on it – you have to make up your own mind on whether this is right - ask them to explain what it is and/or explain it yourself “Can you have sex if you’re gay?” - the law – age of consent is now 16 for both heterosexual and homosexual sex - it’s important to consider how you address homosexuality – up to one in ten people are gay or bisexual and homophobic bullying is common in schools - again, there are lots of different ways to have sex and each person will like doing different things “Is it good to masturbate frequently i.e. once a day” - again, check they understand what it is and that it isn’t harmful - some people do it a lot, some might do it occassionally or never, how much each person does will vary over time “What if you get pubic hair when you haven’t gone through puberty?” - normalising – loads of different things happen at puberty, they happen to people at different ages and in different orders, this is determined by their hormones. - Some boys will go through puberty at 11 or 12, others will be much later (15, 16 or 17). - Girls, periods can start any time between 9 and 16. It is normal for girls to develop a ‘shape’ during puberty i.e. get more curvy.
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Session 7 - Contraception It’s worth remembering that only condoms (male and female) can offer protection from most STIs, but other methods that require less skill and commitment may be good for contraceptive purposes for young people (e.g. injections, or the IUS). Why not suggest going double dutch to be sure?! (i.e. condom plus another form of contraception). Emergency Contraception emergency contraceptive pill (Levonelle) can be taken up to 72 h, but more effective the earlier they are taken after sex costs ~£20 from chemist, free from family planning, A&E, GP. take one tablet immediately and one exactly 12 hours later if vomiting occurs within 2 hours, take another immediately and then a second dose after 12 hours very few side effects, very safe intra uterine device (IUD/coil) can be used as emergency contraception for up to 5 days after unprotected sex Male Condoms Only use water based lubricants with latex condoms and look for the date/kitemark Pros Protects both partners from most STDs and pregnancy 98% effective if used according to instructions Get men involved in contraception Can be fun Readily available No age restriction Free from family planning clinics Don’t have to use if you are not having sex cf: pill Decreased risk of cervical cancer Maintains erection Can be used for anal, oral or vaginal sex. No systemic effects Cons Man needs to withdraw straight after ejaculation and not spill any semen Getting rid of it afterwards Latex allergy (you can get polyurethane condoms free from FPC too if this is a problem) Embarrassment and stigma in buying it Loss of spontaneity Loss of sensation Suppositories, pessaries may interfere Go out of date Should be stored correctly Can be expensive Female Condoms
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95% effective, if used according to instructions polyurethane, so you can use oil-based products can be put on any time before sex need to make sure penis doesn’t slip down the side may slip expensive to buy, free at some FPCs The Pill St John’s Wort (herbal anti-depressant available over the counter) should not be taken with any pill Combined Oral Contraceptive Pill 1/100 pregnancies per year protects against PID, Ca ovarian, Ca endometrium Being pregnant is 4x more dangerous than being a non smoker on the pill (for young women) If miss 1 then take 2 within 12 h . If >12 h after a missed pill you are not protected for 7 days, so use a barrier method as well as taking your pill If taking antibiotics then you need to use condoms for the duration of the course and for 7 days after the last dose Cons: Increased risk of breast cancer (reduced to normal after 10 yrs) Increased risk of DVT’s If a smoker increased risk of arterial wall pathologies. Increased blood sugar Progesterone Only Pill Pros: No oestrogen effects (DVTs etc) No b.p.effects No age limit Used for diabetics and for breast feeding Cons: Slightly less effective than combined pill Have to take it within a 3 hr window every day – hard for young people 20% of women on it develop irregular periods “Coils” (IUD and IUS) IUD is made of copper – kills eggs and sperm – periods can be heavier and more painful over 99% effective can stay 3 to 10 years, can be taken out at any time not suitable for women at risk of getting an STI IUS (intra uterine system) has progesterone-releasing reservoirs (levongestrel) which causes cervical mucus to thicken and endometrium to thin – advantage: periods are lighter or absent
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over 99% effective Last 5 years, can be removed at any time for both: women are taught to feel the threads high in their vagina to check it’s still there Injections over 99% effective an injection lasts for 12 weeks (Depo-Provera) or 8 weeks (Noristerat) progesterone stops ovulation and thickens cervical mucus may protect against endometrial cancer and pelvic inflammatory disease Problems: periods may become irregular or stop regular periods and fertility may not return for a year after use some women gain weight other possible side effects: headaches, acne, tender breasts, mood swings and bloating Implants over 99% effective small flexible tubes are placed under skin of upper arm under local anaesthetic most women can feel the implant beneath the skin, but it can’t be seen progesterone again – stop ovulation and thicken cervical mucus single tube lasts 3 years, others work up to 5 years normal fertility returns immediately after removal Problems: periods often irregular for the first year some women gain weight may be temporary side effects such as headaches, mood changes, breast tenderness removal is sometimes difficult Other options (maybe not so suitable for young people…) Diaphragm/Cap with spermicide 92-96% effective if used according to instructions Lies across the cervix , it does not provide a sperm tight seal but is a carrier of spermicide. It holds sperm away from the alkaline mucus and prevents physical aspiration. There are a variety of types to choose from Pros: Can be put in before sex (if more than 3 hours before, add more spermicide) No systemic effect cf the pill No loss of sensation Cons: woman needs to be quite confident with her own anatomy Fitting required and should be checked every 12 months various natural methods (including Persona, breast feeding, calendar, withdrawal)
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sterilization – male and female
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Session 8 – STIs Epidemiology from the UK Public Health Laboratory Service 2002 – updated every year (see www.phls.co.uk/facts/STI for lots more useful info) Gonorrhoea (Neisseria gonorrhoeae, bacterium) 40% women and some men asymptomatic men: urethritis: painful to pee and urethral discharge women: vaginal discharge, painful to pee, intermenstrual bleeding diagnosis – by stain of smear and culture of swab Management: single dose antibiotics and follow up with contact tracing Chlamydia (Chlamydia trachomatis, intracellular bacterial parasite) Most common STI in the UK – prevalence between 2 and 12% in women attending GP practices, with highest rates among women aged 16-19 and men aged 20-24 men: often asymptomatic, otherwise urethritis (painful to pee and discharge) women: often unnoticed, subfertility may be first symptom noticed diagnosis: antigen detection systems (fluorescent) Management: antibiotics for 7 days, contact tracing Urethritis usually: urethral discharge, painful to pee, discomfort within penis divided into gonoccocal and non-gonococcal (NGU) other organisms than gonococcus and chlamydia can cause urethritis it is not necessarily sexually transmitted diagnosis: smears Management: antibiotics for 7 days, avoid sexual intercourse, tracing and treatment of sexual partners Syphilis (Treponema pallidum, motile spirochaete) not so common in UK anymore, although occasional outbreaks (sometimes amongst men who have sex with men) primary lesion (papule), then systemic symptoms (4-6 weeks later), including rashes, ulcers, acute neurological signs (10%) screening: VRDL test treatment: antibiotics Genital Herpes (Herpes simplex virus or HSV, mainly type II) common: nearly 17,000 new cases in UK GUM clinics in 2010 spreads during active phases genital lesions can also come from contact with oral HSV I mucous membranes are susceptible: mouth, genitals, rectum, oropharynx primary symptoms: systematic symptoms (headache, aches, fever), ulcers that crust over the following two weeks, swollen glands in groin recurrent attacks are common, they are usually less severe and not systemic diagnosis: clinical findings and swab Management: includes warm bath, rest, anti-viral cream on early lesions, pain killers Warts (human papillomavirus, HPV) Most common diagnosis at GUM clinic: 66,000 diagnoses in 2010
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infection possible from subclinically infected partner women: warts on external genitalia, perianal, vagina, cervix (linked to cervical cancer) men: shaft and subpreputial space, perianal Diagnosis: clinical, check for coexisting infection (30%) Management: local agents, annual colposcopy (cervix check) for infected women or partners of infected men, condoms up to 8 months after treatment Hepatitis B spreads through exchange of bodily fluids (sexual intercourse, blood products, needles etc) sexual contacts should be screened and given vaccine if they are not already immune immunisation possible for high-risk groups HIV/AIDS AIDS is caused by the HIV virus heterosexual intercourse accounts for more than half the infections in the UK coexistent STDs enhance transmission it’s more likely to spread from man to woman, and to passive partner in anal sex infection also possible from contaminated blood products, organs and needles it takes about 3 months after infection to be detectable by blood test Trichomoniasis (Trichomoniasis vaginalis, flagellated protozoon) predominantly sexually transmitted infected women usually have vaginal discharge, that may be offensive and cause irritation (frothy, yellow, ‘strawberry cervix) asymptomatic in men, or NGU diagnosis: culture of swab Treatment: antibiotics for 7 days Candidiasis (Thrush – Candida albicans) extremely common, not usually sexually transmitted women: itchy vagina, discharge may be present men: balanitis or, more commonly, self-limiting burning penile irritation immediately after sex with infected partner diagnosis: microscopy and culture treatment: pessaries or creams, oral drugs if necessary Bacterial Vaginosis offensive vaginal discharge (adherent, greyish white) normal vaginal flora (lactobacillus) overcome treatment: oral antibiotics not clear to what extent it’s sexually transmitted Pubic Lice (pediculosis pubis) blood sucking insects and their eggs (nits) itchy treatment: cream from neck down for 24 hours (scared yet?)
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Training Weekend: Planning Sessions In each session, try to think about the objectives of the session, a range of possible methods and the key messages that you want your class to take away at the end. 1) Contraception Session Objectives: Male and female contraception Emergency contraception, incl. when you can use it Access to contraception – where to go, how to get it Protection against STIs and pregnancy Introduce all the different types – using samples Main ones: condoms and the pill What to do when you miss a pill – provide hand outs with the instructions NB. it’s a boy’s responsibility to think about this as well! Key Points: Using a condom properly Emergency contraception i.e. when you can use it Where to get contraception – incl. handouts with clinic times/days/phone numbers, also maps/bus routes 2) Condom Workshop Objectives to be Covered in the Sessions: ? Pros and Cons ? Dos and Don’ts of Use ? Demonstration of How to Put Condoms on ? Different Types of Condoms (and spermicides and lubricants) ? Availability and Access ? Statistics/Facts and Figures ? How to Suggest Using a Condom ? Different Terminology ? Where to Keep and Dispose of Condoms ? Familiarise the students with Condoms and remove any Embarrassment about their use Suggestions for Approaches and Activities 1. The Desert Island Game - Divide class into groups of about eight - Give each group a large bit of paper with a desert island drawn on it, and toss in a packet of condoms - Get them to think up all sorts of various uses for condoms in their groups, and write them down on the piece of paper e.g. Message-in-a-condom, Making a raft out of condoms, Using flavoured condoms as chewing gum etc. - Get everyone to feedback - The aim of this is essentially to get everyone looking at condoms, opening them up etc. and removing the embarrassment surrounding what they’re like…
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2. Pros and Cons - Get each group to turn over their piece of paper and divide it into two columns labelled “good”/”bad”, “pros”/”cons” or something similar - Give them some time to discuss in their groups what the positive and negative aspects of condom use are. Get them to write these down in their appropriate columns - Facilitators can sit in on the groups or wander around, prompting response/asking questions etc. etc. - Feedback each group’s response to the rest of the class 3. Different Condoms - Hand out pieces of paper with a list of all sorts of different types of sexual activity one might get involved in, along with a bag full of all sorts of different types of condoms e.g. Anal sex, extra safety (e.g. spermicidal), oral sex (dental dams, flavoured condoms), latex allergy (Avanti polyurethane condoms), extra pleasure (ribbed), easier penetration (lubricated) - Give each group a wad of blu-tack - Get them to look through the bag of condoms and select those condoms which would be useful for each activity, and stick them onto the sheet next to the appropriate activity with the blu-tack - Feedback what each group had. At this point discuss lubrication and which type should be used (i.e. not oil-based), gel charging of condoms to reduce friction (i.e. the use of lubricant inside the condom before putting it on), make sure that people know not to use two condoms at once etc. etc. 4. True or False Quiz - Give each person a piece of card on which they should write “T” for true on one side, and “F” for false on the other - Present the class with a series of questions/myths about condoms, to which they should lift up whichever side of the card is relevant - The class response can prompt discussion about condom use i.e. do’s and don’ts, certain statistics ALTERNATIVELY, hand out the quizzes on pieces of paper, give them a couple of minutes to fill the quiz in, then give them the answers and discuss each question as you go through them. 5. Demonstration of How to Put on a Condom using demo model - NB – make sure that they are aware that penises in real life will tend to look nothing like the demonstration models => this can lead on to a little discussion about the myths of size etc. Blow up a condom to show them that it is highly unlikely that anyone is too big for a condom - Follow the Recommended Demo guidelines: Important points include: ? check the date and kite mark or CE mark ? push the condom to one side and tear the packet carefully ? check it is the right way around before allowing it to touch the penis ? pinch the end tightly between two fingers and then roll it right down to the bottom – if you don’t get rid of the air it will split! (this is one of the commonest reasons for condoms breaking)
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? show that condoms are really hard to break… unless you put lipstick or other oil on them ? show how to dispose of it (the man should withdraw his penis before it goes completely floppy, take off the condom, tie a knot in it – there’s lots of sperm in there! maybe mention that condoms flushed down the loo can float up again?) - Have a race at the end of the session by getting volunteers to put condoms on the models/available root vegetables/other peoples’ fingers – have one person watch how they do it – then show everyone the commonest mistakes that everyone made at the end (you don’t pick on one person, but you can see where people are going wrong and emphasise those bits) You can hand out a prize for the best effort; OR, split them up into groups and get them to have a relay race; OR get them to put condoms on with blindfolds on (to simulate action with no lights on…) 6. Role Plays - Invent role plays for buying condoms, convincing a partner to use one etc. etc. - Either get members of the class to interact with each other (perhaps after a short demo), or do mixed facilitator-student role plays OR facilitator-facilitator role plays 3) Access to services Learning objectives of session: 1. Dispel fears about accessing services 2. Give out the basic, accurate, information (with list of clinics available) 3. Guide as when to access services, + pros and cons of each service 4. Outline what will happen on a visit 5. Identify that it is not just emergency contraception which is available 6. Confidentiality Fears might include: Parents being told, intimate examination, being “told off”, friends finding out, embarrassment once at the clinic… Services available: ? Family planning clinic (F.P.C) ? Genito-urinary medicine clinic (G.U.M) ? G.P. ? G.P. Practice nurse ? NHS direct (telephone) ? Walk in clinic ? A+E ? School nurse Explain about: ? Confidentiality ? Being prepared ? Being persistent 32 of
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Access to Services Lesson Plan Intro:- Short who we are, what we are doing etc. (2 mins) Warm up game:- 5 mins Equipment Room! “Post-it” notes Flip chart paper Pens 1. Write each of the following places on a sheet of flip chart paper: Chemist G.P G.U.M Family planning clinic A+E Walk in clinic GP practice nurse Sex ed. teacher at school/school nurse Friends Parents NHS Direct Brook clinic 2. Write these problems on the “post-it” notes: Cystitis Pregnancy? Split condom Missed pill Needing condoms Wants to have sex for 1st time and wants info Has had a positive home pregnancy test Thinks that they might be gay Was forced to have sex unwillingly Genital rash Has taken morning after pill and was sick afterwards 3. Then ask the question of the group, if you had or were suffering from the situation on the “post-it” note, “where would you go?” 4. The group are then to go around the room and stick the post-it note to the relevant flip chart sheet (pinned up around the wall) 5. Discussion of the results, trying to find out from the group why they chose to go where they did, and get them to suggest where else they could have gone. Try to steer them towards the “correct” or “best” answers (i.e. A friend may be a good person to talk to if u have a genital rash, but will it really help?) 33 of

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In this exercise there is the possibility to bring a great deal of issues, and the exercise can be adapted to the group being taught. For example when the issue of NHS direct comes up (or the issue of how to find emergency contraception) then get one of the group to phone them, thereby showing everyone quite how hard it is. From this they will also hopefully learn quite how much information they need to access the various forms of help. There is the possibility of a role-play type scenario which could be run, showing a typical consultation at any one of the clinics, make this funny but accurate, so that it makes an impression (?reversal of roles) Finally a list of services etc. should be given out as a record. 4) Sexually Transmitted Infections Objectives: 1. What are the main STDs, and what are their consequences? 2. Where to go for advice – GP, GUM, FPC, Brook, etc. 3. How to protect against STDs – condoms, celibacy, non-penetrative sex 4. Dispel HIV/AIDS myths, e.g. toilet seats, cutlery, etc. 5. Can you recognise when someone has an STD? 6. Openness and honesty in relationships – trust 7. Accepting responsibility for one’s own body 8. BUT not to be afraid of sex! Possible methods: 1. Pictures on the wall of various STIs (NB think – do nasty pictures help?) 2. This is the itch’ game (nice warm up) 3. Brainstorm STIs 4. Arrange pieces of paper marked with particular sexual activities in order of ‘riskiness’ (from most risky to least risky) 5. Brainstorm methods of transmission Tell story about the transmission of a disease, to illustrate how easy it would be to infect an entire group of people, or how difficult it might be to trace the source of a disease. This is A. She has disease X. She has a steady boyfriend, who she has been sleeping with for 2 years. However, she had a one-night stand on holiday in Ibiza with bloke B. He has had 3 sexual partners in the last 6 months, and has occasionally masturbated with a male friend… You can make up the rest of the story yourself – it isn’t hard! And then back to girl A. It obviously isn’t much help trying to work out where the disease came from, so back to the present – what is she going to do about it? - What might she have (bring in pictures on wall)? - Where should she go? - Who else might be affected? - Future consequences for her? Tools: Pictures for the walls, Information leaflets from GUM etc. of

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