COUNSELING IN HIV/AIDS
Dr Arun Kr SharmaDepartment of Community Medicine
University College of Medical Sciences
Delhi 110 095 India
E mail: [email protected]
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