Think you understand HIV? Really know your stuff? So did I. Then I started training.
When I first started my job at Terrence Higgins Trust Scotland, I had been out of the field for two years. I was worried that some of the information I held was out of date, or not relevant to a UK context. This was true to some degree. I’ve had to update and geographically re-position my information. All of this has been acquired learning for me. However, this has paled in comparison to the amount of new knowledge I have gained by doing one, simple (or not-so-simple) thing: training.
Why ‘I don’t know’ isn’t good enough
They say that to teach is to learn twice. For me, as I develop and deliver courses on HIV, sexual health, and related topics, this is most decidedly true.
One reason for this learning is because, when I plan a course on any topic, I need to be prepared to answer the question why. I don’t feel it’s simply good enough to explain concepts or deliver information without being able to answer this question. While “I don’t know” is, of course, an acceptable answer sometimes, and no trainer can know everything, I far prefer to see the lightbulb moment of understanding among trainees when they fully understand why or how something works. That moment of being able to say “because…” in a comprehensive way that fully satisfies their curiosity and assuages their confusion, is deeply satisfying.
As Training Manager, a great deal of my work entails non-training related activities - marketing, administration, emails, paperwork and so on. These moments of being able to deepen understanding are among the true highlights of the job.
A deeper level of understanding
People learn in different ways; they conceptualise things in different ways, and being able to hear answers to questions can facilitate the understanding of all people in the room. It also goes a long way in building your credibility as a trainer.
But to do this means that I can’t just be content with understanding something myself. I have to be able to explain it to an audience. In lay language. To participants with little to no previous understanding of the virus. In simple, digestible, terms, and using multiple methods or approaches. Sometimes I realise I have not understood something as well as I thought. This forces a different level of understanding.
Ask the ‘why’ questions!
Of course, even if you answer all the ‘why’ questions, you can never fully anticipate all questions, and I do occasionally get stumped! But this is great too. Being asked difficult questions that I can’t answer has enabled me to research and look up the answers to questions I wouldn’t have even thought to ask. This benefits both the trainee and the trainer.
Discovering my own knowledge gaps
Asking the why question has enabled me to learn so much about a topic that I’m truly passionate about. While it’s the social and equity issues that drew me to this field in the first place, the nature of the virus itself and its role in the immune system is truly fascinating. But asking why has also helped me to fill in some knowledge gaps that I never really knew existed. For example, I was quite surprised to learn that I could not articulate how HIV treatment actually works in the body. I realised that I while I could easily explain, say, the window period for testing, I wouldn't be able to explain the difference between an antibody and an antigen. How could I have worked in HIV for 5 years without being able to define an antibody?
The why questions have also led me to solve some mysteries that puzzled me as I learned more and more. Often answers lead to new questions. For example, once I understand why antibodies cannot fight off the virus as they would other pathogens, I had a better understanding of HIV vaccine research.
Being a trainer and putting myself in the shoes of my participants has allowed me to deepen my knowledge of HIV in a way I never did before. It’s exciting to discover your own knowledge gaps, especially when you are able to fill them, and even better when you can facilitate the lightbulb moment for somebody else.
Here is just a sample of some of the things I have learned while working as Training Manager for the last 6 months. I pose it to you as a quiz:
How many of these questions can you answer (in your own words, and to a lay audience with little or no knowledge of HIV or immunology). Post in the comments how many you can answer and which, if any, have stumped you!
- What is the difference between RNA and DNA?
Why can breastmilk transmit HIV in a baby’s gut, even if the mother has an undetectable viral load?
What is an antibody?
What is an antigen?
Why can’t antibodies control HIV?
Why is it so difficult to create an HIV vaccine?
How does anti-retroviral therapy actually work in the body?
If HIV treatment stops the virus from replicating, what happens to the CD4 cells that have already been infected?
How many types of strains and sub-strains of HIV are there?
What is the clinical name for a viral load test?
Does a viral load test measure cell-associated virus or free virus or both?
If my viral load is undetectable, how do the doctors know that the virus is still in my body?
What are the main areas of HIV cure and vaccine research?
Do recreational drugs interfere with HIV medications and why?
Why can’t the cure that was used in the Timothy Brown case be replicated to other people (besides the fact that it’s dangerous)?
And, here is one I still haven’t been able to answer sufficiently - bonus points for someone who can leave this answer in the comments:
16. How do they provide estimates of numbers of people who are infected but unaware of their status? How, specifically, are these estimates made?