COUNSELING IN HIV/AIDS
Dr Arun Kr Sharma
Department of
Community Medicine
University College of
Medical Sciences
Delhi 110 095 India
E mail:
[email protected]
Definition
Counseling skills properly used
are tools to help individuals seek
and find their own solutions to the
dilemmas they face.
Why Is Counseling Necessary?
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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
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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?
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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
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Committed
Open minded
Non judgmental
Sense of responsibility
Patient listener
Tolerant
Attentive
Informed
Positive body language
Skills Required in Counseling
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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
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Respectful
Structuring and prioritization
Help to formulate strategies
Help develop coping mechanisms
Stages of Counseling
1.
2.
3.
4.
Risk assessment counseling
Pre test counseling
Post test counseling
Follow up counseling
Principles of Counseling
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Unconditional positive regard for the client
Trust and confidentiality
Empathy
Time
Steps in Counseling
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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
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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
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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 relationship
Clarifying and addressing problems
Establishing personal goals
Providing information on alternative resources
Selection of realistic alternatives
Stimulation of motivation and decision making
Helping client to develop competence
Recognizing and diagnosing signs of
psychological distress and providing support
Possible Reactions to a Positive
Test Result
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Fear
Sense of loss
Grief
Guilt
Denial
Depression
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Anger
Anxiety
Stress
Shock
Loss of self esteem
Suicide
Special Situations in HIV
Counseling
A.
B.
C.
D.
Pregnant women
Childless couples
Breast feeding positive mothers
Spouse and family members of HIV
infected persons
Some Common Counseling
Errors
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b.
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e.
f.
g.
Directing and leading
Being judgmental and evaluating
Moralizing, preaching and patronizing
Unwarranted reassurance
Not accepting the client’s feeling
Interrogating
Encouraging dependencies