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HIV/AIDS is a lifelong disease which to date has no exact cure or vaccine. In addition, lack of a healthy non-judgemental and non-discriminatory environment has resulted in isolation, victimisation and breach of fundamental rights of the infected and affected people living with the virus in respect of denial of equal rights and dignity, property inheritance, right to education, treatment and other basic things among others including denial of basic medical services to people with HIV infection, instances of which are often being witnessed in the country.
HIV/AIDS counselling can help people in accessing correct information and scientific knowledge about HIV/AIDS and policies, assessing risks, making appropriate behavioural changes, leading to protection of self and others. This will help in developing coping mechanism in people with HIV infection. Counselling can lead to empowerment and raise individual consciousness and can make individual take responsibility for their own behaviour.
Counselling is a process where one person, explicitly and purposefully, gives his/her time, attention and skills to assist a client to explore their situation, identity and act upon solutions within the limitations of their given environment. In simple terms, counselling is a process in which two people meet and have a dialogue to resolve a crises, solve a problem or make decisions involving highly personal and intimate matters and behaviours.
WHO (World Health Organisation) defines HIV/AIDS counselling as a dialogue between a client and a care provider aimed at enabling the client to cope with stress and to take personal decisions relating to HIV/AIDS. The counselling process includes the evaluation of personal risk of HIV transmission and the facilitation of preventive behaviour.
HIV/AIDS counselling is mandatory for providing voluntary HIV testing services. This is so because diagnosis of HIV in an otherwise healthy individual induces a series of psychological reactions like denial, anger, anxiety, depression, to finally acceptance.
So far, there is no successful cure or appropriate vaccine available for HIV infection. In order that the individual to be able to accept the infective status, carry on with life, plan future, prevent transmission and continue to function as a useful member of community, counselling is a must.
Counselling induces a positive attitude and high life force in the individual helping him to carry on as before in spite of the HIV infection. HIV/AIDS counselling is mandatory (pre and post-test) as laid down by WHO/UNAIDS. Government of India is also actively emphasising the necessity of HIV counselling.
The objectives of HIV/AIDS counselling include:
- Prevention of HIV infection by changing life styles and behaviours (primary prevention)
- Providing psychological support to those already infected and
- Motivating for chan-ge in high-risk behaviour (Secondary Prevention)
HIV/AIDS counselling is recommended for the following groups of people.
- Persons already identified as having AIDS or being infected with HIV and their families.
- Those being tested for HIV (Pre and Post test)
- Those seeking help because of past or current risk behaviour and planning their future and
- Those not seeking help but practising high-risk behaviour.
HIV/AIDS counselling can be provided in any setting including hospital wards, STD clinics, ANC clinics, family planning clinics, VCCTC & PPTCT centres in Govt hospitals/district hospitals, health facility centres, blood donation centres, TB Dots centres, drug de-addiction centres, prisons, primary/secondary health centres and community based programmes.
HIV/AIDS counselling can be provided by any one who has a sympathe-tic ear, can give time to listen, has knowledge of accurate scientific facts abo-ut HIV/AIDS and undergoes systematic and periodic training in counselling.
In addition to docto-rs, nurses, psychologists, psychotherapist and soci-al workers, even teachers, community and peer leaders, youth and self help groups and even selected individuals can undertake preventive and supportive counselling.
Types of counselling include:
- Pre test,
- Post test-positive, negative and indeterminate results,
- Follow up,
- General and
- Family.
Some of the main contents of preventive HIV counselling include:
- Determine whether the behaviour of an individual or group of individuals involve a high-risk behaviour which can lead to HIV infection.
- Work with individuals to make them understand the risks and acknowledge the risks associated with their behaviour.
- Define and discuss with them how their life, attitude/values and self-image is linked to these behaviour.
- Help individuals to define their potential for attitude shifts, behaviour modification and change and
- Work with individuals to introduce and sustain the modified behaviour.
Counselling is more focused, specific and goal targeted and involve personal problem solving in the individual client which is useful not only for giving information but also for changing attitudes and motivating behaviour change. It differs from health education which is much more generalized in nature and is used mostly for information sharing only.
Counselling evokes strong emotions in both counsellor and client but health education sessions are emotionally neutral in nature.
Pre-requisites of counselling include:
- Time and availability of counsellor
- Acceptance of the activity by counsellor
- Easy accessibility to counselling
- Aptitude for maintenance of confidentiality
- Correct knowledge and information about HIV /AIDS and policies etc and
- Consistency in counselling.
While providing counselling services to patients with HIV infection, the following messages are to be emphasised:
- Drugs do not cure HIV disease, but convert it into a manageable chronic ailment.
- Drug treatment has to be taken life long.
- Drug treatment improves the longevity and quality of life.
- Patients remain infective and must practice safe sex even while on ARV treatment.
- Drug treatment should be taken only from certified practitioners.
- Drug should be taken according to prescription only.
- Drugs should not be shared with relatives/friends.
- If there are adverse effects with drugs, then consult the doctor and
- If NACO/SACS supplied drugs are available in the market, it should be reported.
The counsellor should be trained in HIV/AIDS counselling before placement and they should fulfil the qualification criteria as per the guidelines of NACO.
The counsellors will be specially trained in counselling issues on the following specific areas:
- Disclosure
- Discrimination and stigma.
- Dealing with the impact of emotional reactions including shock, denial, depression, anger, fear, guilt, anxiety and suicidal thoughts.
- Disease progression,
- Changes in physical appearance
- Deterioration in health
- Death and dying
- Loss and grief
- Dealing with relationship - partners, family, friends.
- Financial difficulties and employment.
- Treatment issues particularly to adherence and side effects.
- Interventions for psychological issues to develop support, network and self help skills.
- Developing support groups and linking with community networks and other referral agencies.
- Emotional and spiritual support
- Palliative and home based care and
- Community outreach.
Voluntary Counselling and Testing (VCT) is a key entry joint for a wide range of interventions in HIV prevention and care. VCT is an non-coercive, confidential, cost-effective and inclusive approach that aspires to provide information, education and communication and to motivate behaviour charge in HIV positive individuals.
A voluntary and confidential counselling and testing centre (VCTs), NACO beli-eves, should be nerve centre and a gateway, a one step stop, for a host of related services. The vision is clear and determined:
- Atleast one VCCTC in every district of India.
- Trained and informed gender sensitive counsellors
- Counsellors pre-disposed to supporting people living with HIV, and those directly affected.
- High quality laboratory services and
- Confidentially is non-negotiable.
VCTCs will promote moving away from high-risk behaviour towards sustained behaviour change. VCTCs will have strong referral services: early access to medical supervision, treatment and care for opportunistic infection, and STIs, linkages to blood banks and sites for prevention of parent to child transmission, and access to condoms and harm reduction programmes.
VCTCs will provide psycho-social support and crisis counselling to people living with, and directly affected by HIV. A network of support institutions will access VCTCs, like community care centres and drop in centres. In turn, the VCTCs will develop linkages with the public sector three tier primary health care system.
The vision has to work through the barriers of stigma associated with HIV.
The vision has to lead people towards the conviction that testing for HIV increases the chance of living longer and better, for those who test HIV positive.
— to be continued...
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* Elam Saratchandra Singh wrote this article for The Sangai Express .
This article was webcasted on 16th July 2007.
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