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Cover picture: Benoit is “Mr Condom Man” at the 8th International Peer Education Training (IPET) in Bangkok, Thailand Right: The SCORAddicts at the IFMSA August Meeting 2010 in Montreal, Canada

A Few words from the Director of the Standing Committee on Reproductive Health Incl. AIDS Dear friends all over the world, I’m very glad to welcome you in our Standing Committee on Reproductive Health including Aids (SCORA), one of the six committees in the International Federation of Medical Students’ Associations. Since 1992, SCORA is developing, promoting and encouraging local, national and international medical students’ activities aimed at improving sexual and reproductive health and rights; protection against HIV and STIs; support to PLWHA; women’s health and the social status of women – for the students themselves and their communities. This is done through training, awareness campaigns, local, national and international projects, assessment and improvement of medical education. Here are some examples of our activities: • • • • • • • • •

World AIDS Day December 1st International Women’s Day March 8th Zero tolerance to Female Genital Mutilation IlluminAIDS – stigma & discrimination towards PLWHA National Peer Education Programs SCORA Exchange Programs Gender Equality Mainstreaming of SCORA/IFMSA Activities Sexpression Mr & Ms Breastestis – reproductive neoplasms prevention

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project SCORA Twinning SCORA Manual Peer Education Database National HIV/AIDS prevention programmes

I hope this booklet will give you some ideas on what kind of activities you could engage in locally in your country. Hopefully, you will also get some useful information on how to start SCORA in your own country! I hope that you will join our SCORA family and serve our cause. If you have any other questions or new ideas for SCORA please feel free to contact me on Let’s work together for a healthier world! Joško Miše, interim IFMSA SCORA DIRECTOR 2010/2011

History of SCORA In 1992 the newest working group in IFMSA was formed, namely SCOAS, ‘the Standing Committee on AIDS and Sexually Transmitted Diseases. The committee was formed as the result of the concern of IFMSA on the growing number of people living with AIDS and the strong will of medical students to participate in programs for prevention of HIV and STIs. The activities in SCOAS later developed from HIV/STI advocacy and awareness campaigns to encompass a wider range of reproductive health and related issues. This leaded to a change of focus for the committee in 1998, resulting in a new name: ‘The Standing Committee on Reproductive Health including AIDS’, SCORA in short. From the beginning, SCORA has believed that one of the important methods of fighting AIDS is through prevention; and

the only way of prevention is through education. Therefore, the main focus of this committee is on activities that emphasize already existing solutions and create new educational programs for medical students, as well as for the general population, emphasizing teenagers as a risk group. Other activities have been directed towards promotion of healthy sexual and reproductive behavior, prevention of HIV and STI, prevention of abortion and appropriate use of contraceptives, reproductive rights, women’s rights (gender equality), fight against domestic violence, Female Genital Mutilation, and maternal health. A number of international workshops have been organized by SCORA through the years, which mirror the development of this committee.

Definition of Reproductive Health Reproductive health is defined by WHO as a state of physical, mental, and social well-being in all matters relating to the reproductive system at all stages of life. Reproductive health implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. Implicit in this are the right of women and men to be informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care services that enable women to safely go through pregnancy and childbirth. Reproductive health concludes diseases of the human coitus itself as well as all the sanitary/health problems arising around the subjects of sexuality, puberty, love, relation and family. While the discussion about sexually transmitted infections (STIs), the illnesses with mental, social and religious causes (sexual abuse, domestic violence, female genital mutilation (FGM), abortion etc.) should receive the same heed. Reproductive health care is defined as the constellation of methods, techniques, and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems. It also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counseling and care related to reproduction and sexually transmitted infections. In support of this aim, WHO’s reproductive health programme has developed four broad programmatic goals: • Experience healthy sexual development and maturation and have the capacity for equitable and responsible relationships and sexual fulfilment. • Achieve their desired number of children safely and healthily, when and if they decide to have them; • Avoid illness, disease, and disability related to sexuality and reproduction and receive appropriate care when needed; • Be free from violence and other harmful practices related to sexuality and reproduction.

How to start SCORA in your own country Think globally and act locally!

One of the strengths of IFMSA/SCORA is that we work together locally, world wide. Through campaigning, workshops and peer education we intend to increase the awareness among medical students, as well as in the general population, of safe sexual behaviour and HIV prevention, of gender equality and women’s health. Knowing that these are global issues, yet complex and multifaceted, we encourage medical students to voluntarily take active part in local campaigning for better health as a crucial aspect of our work.

Step-by-step Starting up SCORA • • •

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Find out about your National Member Organisation of IFMSA. Get in contact with the President and find out about the structure of the organisation. Find a few students interested in Reproductive health and HIV/AIDS. Learn about the situation in your own country and about the local/national organisations involved in reproductive health: what has been done so far concerning reproductive health and HIV/AIDS? Are there peer education projects on sexual health? Get in contact with an active SCORA from another country that can share its experience, the problems faced and the success achieved (The Buddy system). Contact the International SCORA director (scorad@ifmsa.

org) who can provide you with up-to-date information about current SCORA activities and subscribe you to the international SCORA mailing list for exchange of ideas with other NORAs (National Officer on Reproductive Health including AIDS). Now that you have a team, local connections with other organisations, a SCORA network internationally, you are ready to act locally.

What to do?

With a dedicated team, take part in on-going activities in you universities or other universities, and organisations. • Look in your university for the programs concerning reproductive health and try to organise an event: lecture about sexual education, sexually transmitted diseases. • Sell ribbons on World AIDS Day (Dec 1st) • Arrange a discussion about women’s empowerment on the International Women’s Day (March 8th) • Start a mailing list between students in your university to exchange ideas and enthusiasm. • Suggest a talk show. Now that you have an idea about “how to start SCORA in your own country”, all you need is a couple of students, enthusiasm, and dedication!

Introduction to some reproductive health related topics HIV/AIDS

SCORA does its best to raise awareness among medical students as well as the general public.on all aspects of HIV/AIDS with the help of a variety of actions, such as lectures, exhibitions, distribution of condoms and pamphlets, charity concerts or parties. Recently, we started emphasizing the importance of human rights approach when it comes to tackling HIV/AIDS issues. Medical students all over the world have witnessed how human rights of PLWHA are being neglected and violated by means of care refusal, suboptimal care, excessive precautions and humiliation too often. Therefore, providing the training on all aspects of HIV for health care students and professionals is crucial in achieving universal access to treatment, care and support of PLWHA. Stigma and discrimination towards PLWHA among general population still, after over 25 years since the beginning of the epidemic, remains high in all the regions of the world. This still represents a major obstacle in decreasing the number of people affected by HIV. How important is to deal with the problem of stigma surrounding HIV/AIDS, says new UNAIDS vision statement: “zero new HIV-infections, zero new AIDS-related deaths, zero discrimination.“ IlluminAIDS is a recently started SCORA project that wants to

address the problem of stigma and discrimination People Living With HIV/AIDS face in their life.


What is the difference between sex and gender? Sex includes the biological and physiological characteristics of men and women while gender is socially constructed roles and behaviours. The UN has approved, as one of the Millennium Development Goals, to promote gender equality and empower women. Why is gender important? Women make up 70% of the worlds poor and only hold 6 % of seats in National Cabinets. This gives them less power to protect their rights. Women have less access to education which is proved to be an important factor for good health. Gender issues concerns both men and women. The culture could expect men to be more risk taking and there is an expectation of men to be more violent. This leads to harm for both men and women. HIV/ AIDS increases more among women today but they have less access to treatment.

Gender is an aspect of life that follows us in everything we do. (WHO) What can we do then? 1. Educate ourselves 2. Educate other medical students about gender issues related to health like: • Rape • Contraception • Right to your own sexuality • Domestic violence • Circumcision 3. Make statements and increase the consciousness in society Gender values are not the same in different times or places. Therefore actions on this issue have to be suited for each countries needs.

two types of human papilloma virus (HPV), which is transmitted sexually, is strongly associated with cervical and vulvar cancer and is the primary risk factor. Regular screening with a Pap smear effectively lowers the risk for developing invasive cervical cancer by detecting precancerous changes in cervical cells. Women who do not receive regular Pap smears have a higher risk for the condition.

But remember-it is possible to make a change! • (gender department of the World Health Organization) • (United Nations Division for the Advancement of Women) • (UNESCO priority women, gender equality)

Maternal and child health

International Women’s Day – March 8th

International Women’s Day is a traditional international day that focuses on raising awareness about problems related to girls and women all across the globe. In this part of the Manual, you will have the possibility to explore the history and specific themes related to this event, as well as to get few pointers on International Women’s Day in the IFMSA. International Women’s Day (March 8th) aims at honoring the achievements of women and promoting women’s rights. Recognized as a national holiday in numerous countries, it has been sponsored by the United Nations (UN) since 1975 under the name of United Nations’ Day for Women’s Rights and International Peace. One of the major focuses of the Standing Committee on Reproductive Health including AIDS (SCORA) is the empowerment of youth and woman to take initiative when it comes to reproductive health and rights. The Standing Committee on Human Rights and Peace (SCORP) also focuses on the empowerment and education of the youth in human rights and peace related issues, with focus on women and their rights. It is of great importance to give women’s rights the momentum that is required due to the delicate existence of human nature. An attempt to truly address issues that have roots in social gender inequality and inequity, as well as special physical and pathological processes that affect girls and women should be addressed by a pallet of activities through joined efforts of medical students worldwide

Cervical cancer

Cervical cancer develops in the lining of the cervix, the lower part of the uterus (womb) that enters the vagina (birth canal). This condition usually develops over time. Normal cervical cells may gradually undergo changes to become precancerous and then cancerous. Most (80-90%) invasive cervical cancer develops in flat, scaly surface cells that line the cervix (called squamous cell carcinomas). Approximately 10-15% of cases develop in glandular surface cells (called adenocarcinomas). Cancer of the cervix is the second most common cancer in women worldwide and is a leading cause of cancer-related death in women in underdeveloped countries. Worldwide, approximately 500,000 cases of cervical cancer are diagnosed each year. Infection with

Mr & Ms Breastestis is a SCORA transnational project which is working on promotion of reproductive neoplasms prevention. A couple of useful Internet links: • • •

The prevalence of maternal and child deaths is high. Most of them occur in developing countries. Every year, about half a million women worldwide die from complications of pregnancy and childbirth, mainly from severe bleeding, infections, unsafe abortions, hypertension, and obstructed labour. Most of these deaths could be prevented at a low cost. Awareness by both women and family members of the risks of pregnancy, labour, and delivery, and accessible and quality health care and services can prevent and diminish the consequences of the pregnancy related complications when they occur. 12 million children die every year before the age of five. Most of them are killed either by one or a combination of the following five conditions: malnutrition, pneumonia, diarrhoea, measles and malaria. Poverty, malnutrition, a decline in breast-feeding, inadequacy or lack of sanitation and of health care facilities, unwanted births, child neglect and abuse, and vertical transmission of HIV infection before or during childbirth and breastfeeding, all contribute to the increasing child mortality and morbidity. To reduce mortality and morbidity, we should think about women’s and children’s rights too. Yet that child, like any adult, was born endowed with fundamental human rights – right to life, to good health, to protection, to education, to an adequate standard of living and more.

Female Genital Mutilation

Definition FGM involves extensive cutting or removal of parts of the female genitalia for social rather than medical reasons. It is usually performed with unsterilized and crude instruments and without anesthesia. WHO Classification: Type I- Clitoridectomy = excision of the clitoral hood with or without removal of the clitoris Type II- Excision = Removal of the clitoris together with part or all of the labia minora Type III- Infibulation = Removal of part or all of the external genitalia and stitching/narrowing of the vaginal opening, leaving a small hole for urine and menstrual flow Type IV- Unclassified = All other operations on the female genitalia. Epidemiology FGM is performed on infants, children, adolescents, single, married, pregnant and post-partum women. It is practiced by many communities around the world- most commonly in Africa and Asia. The highest prevalence occurs in 28 African countries, where it ranges from 43% in Cote d’Ivoire to 97% in Egypt. Why is FGM performed? The practice is used for a variety of reasons which include but are not limited to the following:

• • • • • • • •

preserving a girl’s virginity by diminishing sexual desire creation of the appearance of virginity cleanliness initiation rite for pre-pubescent girls an act of love to daughters pre-requisite for marriage (FGM will attract a favorable dowry) giving pleasure to the husband achieving good social status

Consequences FGM is often performed with unsterilized and crude instruments, and without anesthesia. Short-term consequences: Pain, injury to adjacent tissue of the urethra, hemorrhage, shock, tetanus, septicemia, acute urine retention, infection and failure to heal. Long-term consequences: recurrent urinary tract infections, pelvic infections, infertility, keloid scars, dyspareunia, fistulae, problems during child birth. Current trends- good and bad Medicalization of FGM • response by the medical community to avoid adverse consequences of unsafe conditions including increased HIV transmission • WHO has strongly advised that FGM in any of its forms should not be practiced by any health professional in any setting Approaches to abandon FGM WHO and PATH (Program for Appropriate Technology in Health) framework includes 6 elements • Strong and capable institutions implementing abandonment programs at the national, regional and local levels • A committed government that supports FGC abandonment with strong policies, laws and resources • Institutionalization of FGC issues into national reproductive health and development programs • Trained health providers who can recognize and treat the complications of FGC • Coordination among governmental and nongovernmental organizations • Advocacy efforts that foster a positive policy and legal environment, increased support for programs, and public education Internet links: • • F1479259802569A5007186EC?Open&Highlight=2,FGM •

Peer education

Peer education describes education programmes that make use of trainers and educators who share similar background characteristics with those being taught. In the case of SCORA programmes the trainers are of a similar age to those being trained, and will often have come from a similar background, helping the young people relate to them. This has been shown to be especially effective when teaching sensitive topics such as sexual health education, which is why it is used so extensively throughout SCORA projects. The use of peers also means that the language and messages used are more relevant to the young people, and therefore more useful to them. Another advantage of peer education is that it is cheap, as the trainers are non-professional, and so are not paid for their work. They are, though, specially trained by others to be able to teach effectively. Peer education projects usually work in small groups and make use of interactive techniques and games, producing a comfortable and non-judgmental environment. The educators also gain from being involved in peer education – they learn new skills, personal development and leadership skills. SCORA projects also provide the educators the chance to work with young people, to learn about sexual health issues and hopefully have fun! Peer education has been implemented and studied all over the world, and has been shown to be very effective. Studies have shown that: • Many young people prefer to receive reproductive health information from peers rather than from adults. • The involvement of peer promoters significantly increases referrals for contraceptive services at a fixed site. • Interactive training improves project outcomes. • Turnover is a common problem in peer programs but it can be partially addressed by careful selection, the use of contractual agreements, and by good support, reinforcement, compensation, or other rewards. Overall, peer education is a valuable tool and has proved to be an effective and interesting way of teaching and learning. The emphasis is largely on making the teaching fun for the young people ensuring the lessons learnt are not forgotten. SCORA already has many successful projects running all over the world, showing that peer education can work in any environment. On this March Meeting 2011, we are proud to have 10th International Peer Education training, as a pre-GA workshop. One of the projects that aims to teach and learn young people reproductive and sexual health issues is Sexpression.

Cooperating Organizations IFMSA co-operates with several United Nations agencies and other health organizations. IFMSA has appointed Liaison Officers to several of these organizations or to standing committees. A liaison officer takes care of the contacts between the organization and IFMSA members. Any contacts made with these agencies should always go via the Liaison Officer. UNAIDS - Joint United Nations Programme on HIV/AIDS (UNAIDS) UNFPA - United Nations Populations Fund Contacts: (Liaison Officer for SCORA)

Y-PEER – Youth Peer Education Network UNESCO – United Nations Educational, Scientific and Cultural Organization UNICEF – United Nations Children’s Fund WHO – World Health Organization Global Health Council

Algeria (Le Souk) Argentina (IFMSA-Argentina) Armenia (AMSP) Australia (AMSA) Austria (AMSA) Azerbaijan (AzerMDS) Bahrain (IFMSA-BH) Bangladesh (BMSS) Bolivia (IFMSA Bolivia) Bosnia and Herzegovina (BoHeMSA) Bosnia and Herzegovina - Rep. of Srpska (SaMSIC) Brazil (DENEM) Brazil (IFMSA Brazil) Bulgaria (AMSB) Burkina Faso (AEM) Burundi (ABEM) Canada (CFMS) Canada-Quebec (IFMSA-Quebec) Catalonia - Spain (AECS) Chile (IFMSA-Chile) China (IFMSA-China) Colombia (ACOME) Colombia (ASCEMCOL) Costa Rica (ACEM) Croatia (CroMSIC) Czech Republic (IFMSA CZ) Denmark (IMCC) Ecuador (IFMSA-Ecuador) Egypt (IFMSA-Egypt) El Salvador (IFMSA El Salvador) Estonia (EstMSA) Ethiopia (EMSA) Finland (FiMSIC) France (ANEMF) Georgia (GYMU) Germany (BVMD) Ghana (FGMSA) Greece (HelMSIC) Grenada (IFMSA-Grenada) Hong Kong (AMSAHK) Hungary (HuMSIRC) Iceland (IMSIC) Indonesia (CIMSA-ISMKI) Iran (IFMSA-Iran) Israel (FIMS) Italy (SISM) Jamaica (JAMSA) Japan (IFMSA-Japan) Jordan (IFMSA-Jo) Kenya (MSAKE) Korea (KMSA)

Kurdistan - Iraq (IFMSA-Iraq/Kurdistan) Kuwait (KuMSA) Kyrgyzstan (MSPA Kyrgyzstan) Latvia (LaMSA Latvia) Lebanon (LeMSIC) Libya (LMSA) Lithuania (LiMSA) Luxembourg (ALEM) Malta (MMSA) Mexico (IFMSA-Mexico) Mongolia (MMLA) Montenegro (MoMSIC Montenegro) Mozambique (IFMSA-Mozambique) Nepal (NMSS) New Zealand (NZMSA) Nigeria (NiMSA) Norway (NMSA) Oman (SQU-MSG) Pakistan (IFMSA-Pakistan) Palestine (IFMSA-Palestine) Panama (IFMSA-Panama) Peru (APEMH) Peru (IFMSA Peru) Philippines (AMSA-Philippines) Poland (IFMSA-Poland) Portugal (PorMSIC) Romania (FASMR) Russian Federation (HCCM) Rwanda (MEDSAR) Saudi Arabia (IFMSA-Saudi Arabia) Serbia (IFMSA-Serbia) Sierra Leone (MSA) Slovakia (SloMSA) Slovenia (SloMSIC) South Africa (SAMSA) Spain (IFMSA-Spain) Sudan (MedSIN-Sudan) Sweden (IFMSA-Sweden) Switzerland (SwiMSA) Taiwan (IFMSA-Taiwan) Tatarstan-Russia (TaMSA-Tatarstan) Thailand (IFMSA-Thailand) The former Yugoslav Republic of Macedonia (MMSA-Macedonia) The Netherlands (IFMSA-The Netherlands) Tunisia (ASSOCIA-MED) Turkey (TurkMSIC) Uganda (FUMSA) United Arab Emirates (EMSS) United Kingdom of Great Britain and Northern Ireland (Medsin-UK) United States of America (AMSA-USA) Venezuela (FEVESOCEM) medical students worldwide

SCORA for Newcomers