COUNSELLING IN HIV/AIDS

Qurrot Ulain TaherP.G Diploma in Nutrition & Dietetics

Dietetic Techniques & Patient Counseling

HIV/AIDS

HIV stands for Human Immunodeficiency Virus. AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a result of the development of the HIV virus into a more serious condition. AIDS was first recognised by the U.S. Centers for Disease Control and Prevention in 1981 and its cause, HIV, identified in the early 1980s.

Understanding HIV

• HIV is a contagious infection which attacks the immune system, reducing its effectiveness and leaving the body susceptible to infections. The HIV infection damages the cells the body needs to fight illnesses. AIDS can be diagnosed when the number of immune system cells (CD4 cells) in the blood of a person with HIV drops below a certain level.

• There is no cure for HIV or AIDS, but there are treatments that can slow down the disease, and help prevent the onset of AIDS. It takes around ten years for someone with HIV to develop AIDS, but it can be prevented with early detection and treatment of the HIV

PREVENTION OF Mother to child transmission

• An HIV-positive mother can pass HIV on to her baby any time during pregnancy, labor, delivery and breastfeeding, so the transmission of the virus must be blocked at each stage.

• Current World Health Organization guidelines recommend that HIV-positive pregnant mothers should go on a regimen of three antiretroviral drugs (ARVs) as soon as possible and stay on these drugs until their infants are born and breastfeeding has concluded. Ideally, the mothers themselves will also remain on treatment once breastfeeding has concluded, for their own health.

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• As soon as the infant is born, the baby should be given nevirapine — a very inexpensive drug — daily for six weeks.

• The infant should be formula-fed rather than breastfed if possible, but it’s recognized that formula feeding is both expensive and difficult to do safely in resource-limited settings.

• As such, if the mother cannot formula-feed her child, it is recommended that the mother should breastfeed her child exclusively for six months while continuing to take her ARVs.

• this regimen can reduce transmission of HIV to their babies by an amazing 95 percent or more.

Treatment for HIV and AIDS

HAART There is treatment available for HIV which will slow

down the progression of the virus, allowing people to lead a normal live. This treatment is called highly active antiretroviral therapy (HAART), and is a combination of medicines administered in two or three pills to be taken once or twice daily.

They will also need to have regular blood tests to monitor the HIV.

Counseling skills properly used are tools to help individuals seek

and find their own solutions to the dilemmas they face.

Definition

TYPES OF HIV TESTSAntibody Tests: The most common HIV tests look for HIV antibodies in your body, rather than looking

for HIV itself:• Enzyme immunoassay (EIA) tests use blood, oral fluid, or urine to detect HIV antibodies. Results

for these tests can take up to two weeks.• Rapid HIV antibody tests also use blood, oral fluid, or urine to detect HIV antibodies. Results for

these tests can take 10–20 minutes.• If you get a positive result from either of these tests, you will need to take another test, called

a Western blot test, to confirm that result. It can take up to two weeks to confirm a positive result.Antigen Tests

These tests are not as common as antibody tests, but they can be used to diagnose HIV infection earlier—from 1-3 weeks after you are first infected with HIV. Antigen tests require a blood sample.

• PCR Test (Polymerase chain reaction test)This test detects the genetic material of HIV itself, and can identify HIV in the blood within 2-3 weeks of infection.Babies born to HIV-positive mothers are tested with a special PCR test, because their blood contains their mother's HIV antibodies for several months. This means they would test HIV-positive on a standard antibody test—but a PCR test can determine whether the babies have HIV themselves.Blood supplies in most developed countries are screened for HIV using PCR tests. PCR tests are also used to measure viral loads for people who are HIV-positive.

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 counseling2. Pre test counseling3. Post test counseling4. Follow up counseling

1. Risk assessment

INTERNATIONAL LAW:Consent to HIV testing and confidentiality of HIV status

are key components of the right to privacy (UniversalDeclaration of Human Rights, Article 12, InternationalCovenant of Civil and Political Rights, Article 17(1)).

As the International Guidelines on HIV/AIDS andHuman Rights clarify, “The right to privacy encompasses

obligations to respect physical privacy, including theobligation to seek informed consent to HIV testing andprivacy of information, including the need to respect

confidentiality of all information relating to a person’sHIV status” (para. 119). Thus, under Guideline 3, “HIVtesting of individuals should only be performed with the

specific informed consent of that individual” (para. 20(b)).

2. Pre test counseling Counselling before the test should provide the individuals being tested with information on:

• Technical aspects of screening & possible personal, •Medical, • Social, •Psychological, &• Least implications of being tested positive or negative.

The information should be simple & up to date.Testing should be organized in a way that minimizes the possibility of disclosure.

Issues in pre Test counseling

A. Personal history & assessment of riskB. Assessment of factors & Knowledge

• Sexual Behaviour• Drug users

•Blood Transfusion•Organ Transplant

i. Why the test is being requested?

ii. What behavior? Symptoms are of concern to the client?

iii. What the client knows about the test & its uses?

iv. What will the client do if test is positive or negative?

v. Beliefs regarding HIV transmission

vi. What roles will family play?

3. Post test counselling A. WHAT YOUR TEST RESULTS

MEAN - NEGATIVE TEST RESULTB. WHAT YOUR TEST RESULTS

MEAN - POSITIVE TEST RESULT

Negative result• a negative result may not always be

accurate. It depends on when client might have been exposed to HIV and when they took the test.

• It takes time for seroconversion to occur. This is when body begins to produce the antibodies an HIV test is looking for—anywhere from 2 weeks to 6 months after infection. So if client had an HIV test with a negative result within 3 months of thier last possible exposure to HIV, the CDC recommends that you be retested 3 months after that first screening test.

• A negative result is only accurate if they have had any risks for HIV infection in the last 6 months—and a negative result is only good for past exposure. If they get a negative test result, but continue to engage in high-risk behaviors, they are still at risk for HIV infection.

Positive Result• If the initial HIV test comes back

positive, they will automatically be offered a confirmatory test. If the confirmatory test is also positive, the client will be diagnosed as “HIV-positive.”

• At this point, Discuss• what having HIV means for patient and

their health. • informed about how the virus can

affect .• how to protect others from becoming

infected. • informed about resources and

treatments available • Finally referred to a medical

professional for follow-up treatment.

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 roleHealth educationReferralClinical 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 womenB. Childless couplesC. Breast feeding positive mothersD. Spouse and family members of HIV infected

persons

Some Common Counseling Errors

a. Directing and leadingb. Being judgmental and evaluatingc. Moralizing, preaching and patronizingd. Unwarranted reassurancee. Not accepting the client’s feelingf. Interrogatingg. Encouraging dependencies

Aids awareness

These are just some of the days that promote HIV/AIDS awarenessNational Black HIV/AIDS awareness day every February 7th.· National Women’s and Girls HIV/AIDS awareness day every March 10th.· National Native American HIV/AIDS awareness day every May 20th.· HIV vaccine awareness day every May 18th.· National Asian and Pacific Islanders HIV/AIDS awareness day every May 19th.· National Caribbean HIV/AIDS awareness day every June 8th.· National HIV testing day every June 27th.· National Latino HIV/AIDS awareness day every October 15th.· World AIDS day every December 1st.· December is AIDS awareness month.