COUNSELING IN HIV/AIDS

Dr Arun Kr SharmaDepartment of Community Medicine

University College of Medical Sciences

Delhi 110 095 India

E mail: tingu98@hotmail.com

Counseling skills properly used are tools to help individuals seek and find their own solutions to the dilemmas they face.

Definition

Why Is Counseling Necessary?

Because infection with HIV is life long To cope with HIV positive status and live a

meaningful life To adjust and to learn about change in

one’s life style in order to reduce risk of contracting HIV infection

Objectives

To provide psycho-social support To prevent transmission of HIV infection To improve quality of life of HIV infected

people To provide risk assessment for people who

are potentially at risk of contracting HIV infection

Whom to counsel?

Self motivated counseling seekers Persons seeking HIV tests HIV positive persons High Risk Behavior Groups Family Members Employers Health professionals People unaware of risks

Characteristics of a Counselor

Committed Open minded Non judgmental Sense of responsibility Patient listener Tolerant Attentive Informed Positive body language

Skills Required in Counseling

Excellent communication skills Ability to judge state of mind of a person Quick empathetic response Focused Reflection of feeling Questioning Paraphrasing

Skills Required in Counseling

Respectful Structuring and prioritization Help to formulate strategies Help develop coping mechanisms

Stages of Counseling

1. Risk assessment counseling

2. Pre test counseling

3. Post test counseling

4. Follow up counseling

Principles of Counseling

Unconditional positive regard for the client Trust and confidentiality Empathy Time

Steps in Counseling

Rapport building Gaining trust Explaining limits Problem identification Discuss options Take action Follow up

Role of Counselor

Advocacy role

Health education

Referral

Clinical and therapeutic role

Contents of Counseling

Contents of counseling will depend on the ability of the client to grasp. It’s a dynamic process. The counselor must be able to assess the clients need and state of mind quickly.

However, following components should be incorporated in all counseling scenarios:

Contents of Counseling

The need to prevent infection and re infection Basic information about HIV infection and

associated diseases Review of possible sources of client’s infection Methods of safe sex including condom use Exploration of obstacles to change of behavior

Contents of Counseling

Information about what HIV testing can and cannot do.

Coping with HIV test results. Need to tell the HIV status of the client to

the key persons in his/her life. Handling hostility, fear, violence,

depression, suicidal tendencies etc.

Working Goals of HIV Counseling

Forming a helping relationshipClarifying and addressing problemsEstablishing personal goalsProviding information on alternative resourcesSelection of realistic alternativesStimulation of motivation and decision makingHelping client to develop competenceRecognizing and diagnosing signs of psychological distress and providing support

Possible Reactions to a Positive Test Result

Fear Sense of loss Grief Guilt Denial Depression

Anger Anxiety Stress Shock Loss of self esteem Suicide

Special Situations in HIV Counseling

A. Pregnant women

B. Childless couples

C. Breast feeding positive mothers

D. Spouse and family members of HIV infected persons

Some Common Counseling Errors

a. Directing and leading

b. Being judgmental and evaluating

c. Moralizing, preaching and patronizing

d. Unwarranted reassurance

e. Not accepting the client’s feeling

f. Interrogating

g. Encouraging dependencies