**Goal: To increase participants' understanding of how treating STDs is
an important HIV prevention intervention.**

**Objectives:** To increase participants':

1.  Understanding of how HIV infection is transmitted through sexual
    behaviors

2.  Knowledge of how the presence of a STD increases a person's chances
    of getting HIV and transmitting HIV to a sexual partner (HIV
    susceptibility and communicability - the Double Edged Sword)

3.  Awareness that STD screening & treatment is an important HIV
    prevention intervention

**Time:** 30 minutes - 1 hour

**Materials:**

-   Poster board -- in 6 colors

-   Hole puncher

-   Elastic cord or clothespins

-   Magic marker

**Directions to prepare for exercise**

**1. Prepare the cards** indicated below prior to the exercise. The
cards are used to assign each participate a 'role' in the educational
theatre exercise. Cut each poster board into 8 x 11 size pieces.
Hole-punch two holes into the top two corners of each piece and insert
elastic cord so the card can be worn around a person's neck
(alternative; attach one or two clothespins, so that the card can be
clipped to a person's shirt). Magic markers or masking tape should be
used to write the name of the part being portrayed in large print. The
cards indicate either a type of white blood cell or a type of organism
(germ). Suggested number of players and color for each type of card (23
total):

8.  Pink -- mucous membrane lining cells "pink parts" -- write [Vagina,
    Rectum, Mouth, Urethra]{.underline} on front

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4.  Dark Green -- Scout Immune Cells (including macrophage & dendritic
    cells) - Write [Scout Immune Cells]{.underline} on front

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3.  Orange -- T 4 white blood cells -- write [WBC T4]{.underline} on
    front

4.  Blue -- STD germs -- write [STD]{.underline} on front

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4.  Light green -- HIV germs -- write [HIV]{.underline} on front

**2. Adjusting the Exercise to smaller or larger numbers of
participants**: Using the numbers above would result in a total of 23
participants. This exercise can be done with smaller or larger numbers
of participants by adding or subtracting the number of persons assigned
to be cells or germs. The entire group should be assigned a role and
participate.

**3. Setting up the Exercise:**

1)  Clear a space in the middle of the room.

2)  Give each participant a card and ask them to wear it.

3)  Instruct the "Pink parts" to form an inverted U shape in the middle
    of the space.

4)  Place the "Scout cells" around the outside of the U.

5)  Place the T4 cells around the outside of the U, further out.

6)  Ask the STD and HIV germs to stand by the facilitator at the open
    part of the U.

7)  Hand each HIV germ a small yellow card with "HIV" written on it.

**Scout cell**

**T4 cell**

**T4 cell**

**Scout cell Scout cell**

**T4 cell**

**Scout cell**

> **Facilitator**

**STD germs HIV germs**

**"Sex in the City -- An Inside View\" Script**

**Facilitator:** Welcome to the educational theatre exercise: "Sex in
the City; An Inside View." You will be a participant in this exercise
and you will experience what really happens during sex; how HIV is
transmitted and how STDs make it easier. My name is
\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- and I will be your narrator.
I'll be walking you through each scene. I have the only speaking part.
The PINK PARTS are non-moving, but the rest are moving parts. From time
to time during the movements, I will issue a FREEZE command. At that
time, all players should stop instantly.

Before we begin, let me introduce you to the players. First, we have a
BODY CAVITY formed by the pink parts into the shape of a U. A body
cavity is lined with PINK PARTS, which are really -- squamous and
columnar epithelial cells. This could be a vagina, rectum, urethra, or
mouth. It doesn't matter because the lining is the same in all sites.
These cells overlap and form a barrier. All PINK PARTS now join hands.
Choose the body cavity you would like to portray.

Next, meet the SUBMUCOSA. This is the layer just underneath the lining
of the body cavity. Here you will find some WHITE BLOOD CELLS (WBC) who
are soldiers in the 'battle' that takes place when germs enter any body
cavity.

#1 is the Scout Immune Cell affectionately known as the SCOUT CELL.
Scout

immune cells include macrophage cells and dendritic cells. The Scout
cell's job is to

rush to the pink parts if any germs or irritants get into the body
cavity. The

Scout cell then tries to destroy the germ.

#2 are the T4 LYMPHOCYTE CELLS. The T4's job is to signal the
bloodstream

when the germ gets into the body cavity to get it to start making
antibodies to fight

off the infection.

A strange coincidence is that both Scout cells and T4s have a specific
receptor on the outside called a CD4 RECEPTOR. These players please
raise one arm and open your hand. Keep your arm raised.

Now, meet the HIV GERM. HIV is a scary germ, but really it\'s sort of
wimpy in that it can't live on its own. It has to get inside a cell and
live there. If HIV doesn't infect a cell and get inside it after 24
hours (often only 6 -- 8 hours), it will die. The HIV germ has a protein
on the outside called an ATTACHMENT PROTEIN. These players raise one arm
and make a fist. In order for HIV to infect a cell, the attachment
protein has to find a cell with a specific receptor. It just so happens
that the one and only receptor that fits HIV, is the CD4 receptor (see
the raised open hands). These of course, are on the Scout cells and the
T4 cells. If this connection is not made, then infection can't happen.

Lastly, meet the STD GERMS. These can be bacterial ones like gonorrhea
and chlamydia, or viral ones like herpes. They all have the same effect
in connection with HIV. Unlike HIV,

STD GERMS directly infect PINK PARTS. These players should do a doggie
paddle motion with your hands and paddle against the joined hands of the
PINK PARTS. PINK PARTS drop your arms to indicate that you have been
infected and the layer of protection is disrupted.

Now, let the action begin.

**SCENE 1:**

Here is a healthy body cavity. See how the cells are joined and form a
barrier (hands held). The Scout cells and T4 cells are under the
surface, but not on the lining of the pink parts. Sex happens. It could
be oral sex, vaginal sex or rectal sex, it doesn't matter. The body
fluid (either semen or cervical/vaginal secretions) gets into the body
cavity. The body fluid has HIV germs in it. *HIV germs please go into
the BODY CAVITY with your arms raised with fists*. The HIV germs are
desperately looking for a CD4 receptor -- in order to live. But, they
can't find one. The pink parts don't have CD4 receptors and HIV can't
infect them. They also can't reach the Scout cells or the T4 cells
because the lining is intact. *Scout cells please wave your raised arms
with open hands.* The HIV germs are
dying........dying..........dying.............dead. *HIV germs please
run out of the body cavity.* The HIV germs are now just part of the wet
spot on the sheet. CUT!

Any questions, any answers? Process responses.

**SCENE 2:**

Here is the same healthy body cavity. See how the cells are joined and
form a barrier (hands held). The Scout cells and T4 cells are under the
surface, but not on the lining of the pink parts. Sex happens. This
time, STD germs are in the semen or cervical/vaginal secretions. Unlike
HIV, STD germs do attack the pink parts and infect those cells. *STD
germs please go into the BODY CAVITY and start paddling the joined hands
of the pink parts. Pink parts should drop their hands after being
struck.* This wakes up the Scout cells that rush into the cavity to
fight off the STD germs. Now, let's say the person who owns this body
cavity actually goes for care and gets treatment for the STD infection.
The STD germs die. *STD germs please run out of the body cavity.* The
Scout cells still hang out in the body cavity, because they're not
really sure what is happening. Maybe, the STD germs are coming back?
CUT!

Explain that STDs aren't the only things that cause Scout cells to come
out into the body cavity. Things that cause inflammation, like douches,
products, ectopy, etc. can have the same effect.

Any questions, any answers? Process responses.

**SCENE 3:**

Sex happens again. This time there are HIV germs in the semen/cervical
vaginal secretions. *HIV germs please enter the body cavity with your
raised fists.* This time, the HIV germs find their lifeline, the CD4
receptors on the Scout cells. *Scout cells - please grab the fist of the
HIV germ with your raised open hand.* The Scout cells are now infected.
They go back to the submucosa and they take the HIV germs with them.
*Attached Scout cells and HIV germs please move to the submucosa.*
There, they find the T4 cells and give some HIV to them. *HIV germs give
the T4 cells your small yellow card with HIV written on them*. The T4
cells run to the bloodstream to alert other immune cells to begin making
antibodies -- but HIV finds more CD4 cells to attach to in the
bloodstream and this is how the bloodstream becomes infected*. T4 cells
take the HIV card and run to the bloodstream.* Meanwhile, infected Scout
cells remain in the submucosa. CUT!

Any questions, any answers? Process any responses.

**SCENE 4:**

Now, this is the body cavity of a person who is living with HIV/AIDS.
The HIV is in the bloodstream in the T4 cells and also still in the
Scout cells under the surface of the pink parts. The pink parts are
healthy, with just a little HIV being shed. *Pink parts please join
hands again and one HIV germ should stay in the cavity. The rest of the
HIV germs please stay joined to the Scout cells in the submucosa.* Sex
happens AGAIN. This time, a STD is in the semen or cervical/vaginal
fluids. *STD germs please run into the body cavity.* The STD germs again
attack the pink parts and destroy some of the lining. *Pink parts;
please drop your joined hands. The Scout cells again come out to fight
off the STD infection, but they bring the HIV germs with them.* So, more
HIV is being shed out making it more likely to be passed to other sex
partners -- more communicable. Now, let's say that this person living
with HIV/AIDS actually got STD testing and treatment. The STD germs will
die. *STD germs please run out of the body cavity.* The Scout cells
eventually go back to the submucosa and the amount of HIV germs in the
body cavity goes down again. *Scout cells please take the HIV germs and
go back to the submucosa. One HIV germ should stay in the body cavity.*
So, by getting STD treatment, the person living with HIV/AIDS can reduce
their chances of passing HIV to a sexual partner. CUT!

Any questions, any answers? Process responses.

**FINAL SCENE:**

Ask participants to come out of role now and to explain how the STD/HIV
inter-relationships are like a double-edged sword. Ask participants what
this information means for them. Ask how they could apply what they
learned to their work with their clients.