Counselling in HIV Infection

Introduction

Counselling is face to face communication by which you can help the person make decisions and act on them. It aims at preventing transmission of HIV infection and providing psychological support to those already affected.

Counselling is a helping process aimed at problem-solving. It helps people to understand themselves better in terms of their own needs, strength limitations, and the resources they can avail of. It brings about change through a supportive relationship, aiming to make the client independent through the interpersonal contact along with opportunity to ask questions and to meet frequently and help greatly.

Tips for Good Counselling

1. Greet your client.
2. Make him/her comfortable
3. Create the confidence of the client in you and assure confidentiality.
4. Listen carefully to his/her problems.
5. Do not interrupt while he/she is talking.
6. Try to elicit more information regarding his/her problem.
7. Counsel over a number of sessions and be empathetic towards the client.
8. Provide information on the issue for which your client has come.
9. Help him/her to reach a decision.
10. Time to time reassurance and follow up regarding health condition.
11. Encourage client to decide regarding communication of his problem to the family members/spouse. It should be done in the presence of the counsellor.

The medical officers undergoing training should be able to improve through a series of role plays the following qualities viz.

Willingness to listen, empathy and understanding of client’s good communication skills, non-judgemental attitude i.e. should not bring his/her own values and impose on the client and maintain confidentiality, about their life, boost their self-confidence, improve family/community relationships, and support the families of infected people by providing encouragement and care for those with HIV infection.

Functions of Counselling

Prevention

Counselling is concerned with preventing infection with HIV and its transmission to other people and living with HIV/AIDS. The main steps of preventive counselling are:<

1. determine whether individual/group has high risk behaviour patterns.
2. help people to understand and acknowledge their high risk behaviour patterns.
3. define with them how their life style and self image are linked to their behaviour.
4. help individual define their potential for changing behaviour.
5. work with individuals to introduce and sustain the modified behaviour.

Health Promotion

This involves counselling those individuals having high risk behaviour patterns but not aware of the magnitude and the nature of risk involved to their life. It aims at creating this change focusing on behaviours that present a risk of HIV infection and reviewing ways of managing individual change.

Specific Protection

Those infected with HIV should be given instructions as to ways by which they can prevent the spread of infection to others. An attitude of understanding should be adopted as the fact that he has tested positive is traumatic enough to accept. Since behaviour change is going to be difficult he should be asked to take certain precautions:

1. do not donate blood
2. use condom while have sexual intercourse

Personal history and assessment of risk

1. 1. Sexual behaviour – multipartner, prostitutes, unprotected sex, homosexuality, bisexuality.
   2. drug users.
   3. blood transfusion
   4. organ transplant

do not share needles and syringes.

Psychological Support

People diagnosed with HIV infection and HIV related illness and those close to them are confronted by a multitude of problems and often need emotional support and/or practical support. People have anxieties regarding hospitalization, and depression because of stigma attached to their condition. Counselling should help those infected by HIV to live full and productive lives by enabling them to `take charge’ of their lives and help in decision making, thus enabling people to remain active in their work and in their education. Families and friends can help to reduce their dependence on health and social services and reduce their psycho-social problems.

Requirements of Counselling

Approaches to counselling will differ from individuals and groups depending upon the characteristics of the people being counselled and their social and family networks. Certain points which remain constant irrespective of the situation are:

The client cannot be rushed by the news that he is HIV positive. Sufficient time should be taken to establish rapport with the client so as to understand his mental framework and basic level from where the counselling should be carried forward. This basic level will determine the number of sessions required by the person to make decision about his life style.

Acceptance

The people infected by HIV should not be shunned on basis of the behavioural patterns adopted by them. They should be treated with respect whatsoever their background or behaviour.

Accessibility

People found to be HIV positive are bound to develop anxieties and fear which will be always raising some doubts in their minds. Therefore, counselling services should be available easily where the individual can approach at any time and get clarifications.

Consistency and Accuracy

Any information provided through counselling should be consistent, therefore, the counsellor must equip himself with all the latest knowledge and management of HIV infection and disease so as to be able to clarify doubts/uncertainties arising in the minds of the client. He should not pretend to know or acknowledge a thing when in doubt but try to clarify it.

Confidentiality

Being diagnosed HIV positive creates uncertainties in the mind of the clients. The counsellor should be able to gain the trust of the client and convince him that all information provided by him will be kept confidential.

As HIV infection is progressive, it is necessary that counselling should be undertaken regularly to understand what the client is going through due to the various changes occurring within him and those around him. The counsellor should also provide to the client necessary information regarding where he will be able to get medical support, community resources and what changes he can make in his life styles to cope with emerging needs.

Counselling Before HIV Testing

Counselling before the test should provide the individuals being tested with information on technical aspects of screening and possible personal, medical, social, psychological and legal implications of being tested +ve or -ve. The information should be simple and up-to date. Testing should be organised in a way that minimizes the possibility of disclosure.

Issues in Pre-Test Counselling

Pre-test counselling consists of two parts:

1. Personal history and assessment of risk

1. 1. Sexual behaviour – multipartner, prostitutes, unprotected sex, homosexuality, bisexuality.
   2. drug users.
   3. blood transfusion
   4. organ transplant

2. Assessment of factors and knowledge

1. 1. Why test is being requested
   2. What behaviours/symptoms are of concern to the client/
   3. What the client knows about test and its uses
   4. What will the client do if test +ve or -ve?
   5. Beliefs regarding HIV transmission.
   6. What role will family play?

Post-Test

If results are negative: The client may feel relief, however, should be exercised as following exposure to HIV there is a `widow period’ during which negative result cannot be considered reliable. Further, a negative test should not give a false sense of security to a person indulging in unsafe sex. Three months must have elapsed from possible exposure before a negative test can be considered to mean that there is no infection. A negative test result carries greatest certainty if six months have lapsed after last exposure. HIV infection can be prevented by avoiding high risk behaviour, safer sex, avoiding sharing needles. In general, development of safer sex behaviour has to be to advocated to the client.

If result are positive: People diagnosed as having HIV infection should be told about their results privately and in confidence. Single test giving positive result does not necessarily mean HIV infection. To establish HIV infection, three tests for Antibodies based on different Antigens/methods are to test positive. Discussion should be allowed with the clients to absorb the news. After a period of preliminary adjustment the client should be given clear and factual explanation of what the news means. This does not mean speculating about prognosis of estimate about the time left to live but for providing support; and encouraging hope for achievable solutions to personal and practical problems that may result. The client must be informed where resources are available and possible treatment for some symptoms to HIV infection and efficacy of anti-viral treatment.

Psychological issues

The uncertainty involved when the individual comes to know he has tested positive are varied. Clarifications are to be given regarding the fears which arise related to illness, death, job, length of life, etc. Besides these the individual feels at a loss due to stigma attached by society and the speculation in the minds of people regarding the behaviour of those infected with the virus.

There is generalised anxiety regarding all aspects of life, anger, depression and denial of the fact that he has tested positive can even lead to suicidal thinking in the individual.

These numerous feelings can only be changed through counselling and giving correct information about the infection and disease and building the self esteem and the positive thinking ability of the individual.

Besides the individual who has tested positive those dealing with them. i.e., the health workers and family face the share of fears and uncertainties regarding their getting the infection. All those involved with those who have tested positive need to be given proper and full information so that they can provide the support which the individual requires to be able to face their problem.

Some Special Issues

Pregnancy: Those females of child-bearing age found to be HIV +ve should be told to avoid pregnancy and the risk of vertical transmission from mother to child.

If pregnant: There is a one-in-three chance of having an infected child. Counselling depends on the personal, religious, cultural factors regarding termination of pregnancy.

Both the partners need to be counselled.

Infants: should be kept under medical observation and treated with care and affection. Parents and siblings need to be counselled. Though the risk of acquiring infection from infants’ body fluids is minimal, nevertheless the people with cuts should avoid contact with fluids. Hygienic practices would be emphasized upon.

Breast feeding

This may result in transmission of HIV from mother to child. In developing countries, withholding breast feeding may deprive the newborn of the protective immunity transferred from mother to newborn. Therefore, a counselling is required to have a balance between the two, the possibility of acquiring HIV infection and the lack of antibodies in the newborn if not breast fed

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