THIKA SCHOOL OF MEDICAL AND HEALTH SCIENCES

HIV/AIDS AND OTHER

PANDEMICS
STUDY MODULE

This documents is a study module that is aimed at providing competent knowledge regarding
HIV/AIDS & Other pandemics and how these concerns can be managed after/before they have
manifested themselves in the society
 TOPIC 1
MEANING OF HIV/AIDS

Human immunodeficiency virus infection / acquired immunodeficiency syndrome

(HIV/AIDS) is a disease of the human immune system caused by infection with human
immunodeficiency virus (HIV). The term HIV/AIDS represents the entire range of disease
caused by the human immunodeficiency virus from early infection to late stage symptoms.
During the initial infection, a person may experience a brief period of influenza-like illness.
This is typically followed by a prolonged period without symptoms. As the illness
progresses, it interferes more and more with the immune system, making the person much
more likely to get infections, including opportunistic infections and tumors that do not
usually affect people who have working immune systems.

FACTS/MISCONCEPTIONS AND MYTHS

FACTS MISCONCEPTION

HIV has got no cure  HIV can be cured by ARVs

HIV/AIDS does not have a cure ARVs
only prolong one’s life
The HIV particle cannot pass through
a the barrier provided by a condom
 Sex with a virgin does cure one of HIV
 The antibody method of testing is the
most effect method of testing
 
ARV cure HIV/AIDS
 The HIV particle can pass thorough a condom
and therefore it’s important to use two
condoms
 SEX with a virgin will cure one of HIV/AIDS
 The antigen method is the best method of
testing of HIV/aids

HIV and AIDS are interlinked. HIV is the HIV and AIDS are not associated and are
virus that leads to the development of independent.
AIDS
 Impacts of HIV and AIDS in various sectors

1. The Education sector

HIV has created a lot of instability in the education sectors in many countries. Many
schools lost competent staff members to the scourge leading to many classes being
left untaught. This resulted to many children leaving schools without capturing the
content being taught.

When the scourge became a pandemic, many governments channeled vast amounts
of resources in to HIV management programmes. This left many important sectors
and project bare since the money that the government has was being channeled to
the prevention of the condition.

2. The health sector

The health sector has equally suffered from the emergence of HIV/AIDS. When the
condition became an issue in the globe, many health facilities did not have the
capacity to cater to the needs of people who ad full blown aids. Many hospitals were
forced to make people suffering from AIDS related complications too share ward
with other people with less serious conditions. This is not advised because of the
nature of suffering these patients went through. The health sector could not cope
with the emergence of the many complications that infected people went through

In some countries that did not have strict safety measures, many health workers got
infected because the either lacked protective gear or knowledge of how the
condition is transmitted.

Due to the lack of capacity to cope with the condition, many health facilities were
made ineffective to cateer tp the needs pf other patients being treated.

3. The business sector

The productivity of any business deoend largely on the productivity of its staff
members. In the late 80’s, countries like Kenya lost many people who were in the
productive age bracket due to AIDS related complications. This meant that business
were losing many people that could have been used in the production process.

Many businesses also ended up spending a lot of money on insurance policies that
their worker had with them. This basically affected the profits being witnessed in
these companies.

How did HIV/AIDS affected the job market in Kenya in the early 90s

List one misconceptions regarding that has lead to sexual abuse in Kenya

How many strains of HIV have been documented by researchers?

 Topic 2
EFFECTS OF HIV/AIDS ON THE IMMUNIE SYSTEM

Meaning of body immunity

This is the natural protection the body has against infection from antigens. This ability
results from the existence of a system (including the thymus and bone marrow and
lymphoid tissues) that protects the body from foreign substances and pathogenic
organisms by producing the immune response.

Pathogens can rapidly evolve and adapt, and thereby avoid detection and neutralization by
the immune system; however, multiple defense mechanisms have also evolved to recognize
and neutralize pathogens. Even simple unicellular organisms such as bacteria possess a
rudimentary immune system, in the form of enzymes that protect against bacteriophage
infections. Other basic immune mechanisms evolved in ancient eukaryotes and remain in
their modern descendants, such as plants and insects. These mechanisms include
phagocytosis, antimicrobial peptides called defensins, and the complement system. Jawed
vertebrates, including humans, have even more sophisticated defense mechanisms, [1]
including the ability to adapt over time to recognize specific pathogens more efficiently.
Adaptive (or acquired) immunity creates immunological memory after an initial response
to a specific pathogen, leading to an enhanced response to subsequent encounters with that
same pathogen. This process of acquired immunity is the basis of vaccination.

Effects of HIV /AIDS on the body’s immune system

HIV damages the body's immune system and makes it susceptible to infections and certain
types of cancers. A single HIV viral particle is called virion. The viron is surrounded by the
viral envelope which contains the proteins gp120 and gp41. The matrix lies below the viral
envelope. The capsid is the viral core and houses HIVs genetic material (RNA) and the
enzymes required for viral replication. HIV is a retrovirus, therefore it is capable of copying
RNA into DNA. The enzymes required for HIV viral replication are reverse transcriptase,
integrase and protease.

HIV Infects and Destroys T Helper Cells

The major steps in the HIV infection and replication cycle are attachment, entry, reverse
transcription, integration, protein processing and maturation. Gp 120 is a protein present
on the viral envelope. This protein binds to the CD4 receptor that is present on T-helper
cells. Once the virus enters the T-helper cell, it is uncoated and the viral RNA undergoes
reverse transcription to become proviral DNA. This DNA is transported into the T cell
nucleus. The HIV integrase enzyme then incorporates the proviral DNA into the T-helper
cell genome. When the provirus is activated, HIV viral polyproteins are expressed using the
T-helper cell machinery. Polyproteins are cleared by the HIV protease enzyme and the
virion buds from the host cell. The budding process destroys the T cell. The T cell can also
be destroyed when the virus overwhelms the host T cell machinery. Mature viral particles
go on to infect more cells..

HIV Affects B Cells and CD8 T Cells

T helper cells are involved in helping B cells make antibodies. The CD8 T cells, also called
cytotoxic T cells, are involved in killing virally infected or damaged cells. As HIV replicates
it continues to destroy CD4 T-helper cells. Over time, HIV infection leads to a significant
reduction in the number of CD4 T helper cells. Since CD4 T helper cells are needed to
activate B cells and cytotoxic T cells elicit an immune response, the destruction of these
cells weakens the immune system.

HIV Affects Macrophages

Macrophages are large immune cells that engulf and digest invading microorganisms and
also scavenge damaged cells, dead cells and cellular debris. Macrophages play a crucial role
in HIV infection and are the first cells infected by HIV. They also serve as the source of HIV
production when CD4 T cells are depleted.
Exercise

Discuss how T-helper cells are affected by HIV

What organs make up the immune system?

Which family of viruses is HIV?

 TOPIC 3
SOCIO ECONOMIC EFFECTS OF HIV/AIDS

Hiv/aids like many other diseases has dealt a huge blow in the socio-economic status of
many countries and communities. HIV threatens to whipe out some communities that have
not been successful in the management of HIV/AIDS

The impact on the Macro-Economy

The impact of HIV/AIDS on the macroeconomic environment takes two dimensions,

namely the direct and indirect costs (Balyamujura et al, 2000: 14). The former refers to the
cost of treatment associated with HIV related illness, which has serious implications for
health care budgets around the region. Those segments of the population that are poverty-
stricken stand to lose the most as pressures on the health budgets increases resulting in
higher medical costs. Indirect costs are more difficult to measure as the refer to loss of
value of production, the loss of current wages, the loss of the present value of future
earnings, training cost of new staff, high staff turn-over, cost of absenteeism, higher
recruitment costs, the drainage of savings, amongst others.

In the South African context, at least two macroeconomic modelling exercises have been
conducted seeking to illustrate the potential impact of HIV/AIDS on the South African
economy (Aliber, 2001). In the one, ING Barings identified seven “key impact channels” that
link the demographic effects of AIDS to the South African economy (2000):

1. A lower labour force;

2. Lower labour productivity through absenteeism and illness;
3. Cost pressures for companies through benefit payments and replacement costs;
4. Lower labour income, as employees bear some of the AIDS-related costs;
5. Lower population translating into lower expenditure;
6. Increased private sector demand for health services;
7. Higher government expenditure on health services.
The economic consequences of HIV suggests that that the sector that will be hardest hit will
be mining, followed closely by transportation and storage, and that about 27 percent of
current mine workers and 22 percent of all transport and storage workers will die of AIDS
by 2005 (ING, 2000). Economic growth will be hit badly as the diversion of funds away
from savings to pay for the costs of the illness decreases the country’s investment potential
(SAMP, 2002: 9). Arndt and Lewis’ simulation study examines similar “channels” and
arrives at similar conclusions. All of these “impacts” may result in changes in the broader
economies in Southern and Eastern Africa as a direct result of the high prevalence rates in
these countries.

Thus it is clear that HIV/AIDS will have a major adverse impact on Gross Domestic Product
(GDP) of various countries. It is estimated that by 2010, the South African economy will be
22 percent smaller than it would have been without HIV/AIDS, amounting to a total of
about US$17 billion (De Waal, 2001). This will have an important knock-on implication for
the region as a whole as South Africa is the largest and most dynamic economy in the
continent. It should be emphasised that the impact on human and social development will
be much more profound than reflected in limited indicators such as GDP or per capita GDP.
These impacts would be felt throughout the economy, from the macro-level to the
household, particularly as wage opportunities become scarcer.

The impact of HIV/AIDS at the household level also negatively impacts on the macro-
economic context. The repercussions of HIV/AIDS is felt most acutely at the household
level, with the burden weighing most heavily on the poorest households, those with the
fewest resources with which to cushion the economic impact. One study estimated that
households experience a decline in income of between 48 percent and 78 percent when a
household member dies from HIV/AIDS, excluding the costs of funerals. This burden
readily translates into an overall cost on national development and the macro economies of
individual countries, a situation aggravated by the fact that the portion of the population
most affected by HIV/AIDS is the most economically active.

Ownership or access to rural land is a key part of many African families’ well-being and
livelihood. It is, however, only a small part in some contexts: small-scale agriculture in
South - and southern - Africa has been shown over the past decade to have become
impossible without inputs from labour migrant remittances. However, with the decline of
the mining and manufacturing industries in a number of southern and east African
countries, particularly South Africa and Zimbabwe, significant changes in the rate and
extent of labour migration have occurred and hence in the degree of success of such
strategies. This indicates that rural livelihoods are complex and aimed at managing risk,
reducing vulnerability and enhancing security and are therefore based upon environmental
stability. It is therefore important to have a sense of both the role of land and the broader
labour market and macro-economic environment, which often underpin the incomes
within the rural economy and the diverse livelihood strategies. These all come under
increasing pressure with the broad impact of HIV/AIDS.

5.2 The Impact on the Rural Economy

It is widely acknowledged within general development literature that the urban and rural
economies are usually intrinsically interlinked and that incomes within the rural
environment depend upon wages earned within the urban economic environment. Thus it
is clear that the impact of HIV/AIDS on the formal, largely urban-based economies of
Southern and Eastern Africa will increasingly have an impact in reducing the options and
the cash flows between the two sectors.

Within Southern and Eastern African countries, HIV/AIDS has been acutely experienced in
rural areas. A recent Fact Sheet prepared by the FAO (2000) clearly describes the threat to
rural Africa:

 More than two-thirds of the population of the 25 most-affected African countries

live in rural areas.
 Information and health services are less available in rural areas than in cities. Rural
people are therefore less likely to know how to protect themselves from HIV and, if
they fall ill, less likely to get care.
  Costs of HIV/AIDS are largely borne by rural communities as HIV-infected urban
dwellers of rural origin often return to their communities when they fall ill.

 HIV/AIDS disproportionately affects the economic sectors such as agriculture,

transportation and mining that have large numbers of mobile or migratory workers.

As discussed above, the extensive labour migration between and within countries,
associated with annual or more frequent visits home, has facilitated the spread of
HIV/AIDS to the most remote rural areas. The prevalence of HIV/AIDS in rural areas is not
adequately documented due to poor health infrastructure, restricted access to health
facilities and inadequate surveillance. This emphasizes the fact that rural communities
have fewer resources to prevent infection and to nurse ill people. Access to treatment and
other services, as well as education, are often limited in such contexts.

According to Sehgal, the effects of HIV/AIDS within a rural economy may include (1999):

 Redistribution of scarce resources with an increasing demand for expenditure on

health and social services;
 A collapse of the educational system due to high morbidity and mortality rates
amongst educator and learners;

 Younger and less experienced workers replacing older AIDS related casualties,
causing reduction in productivity;

 Employers becoming more likely to face increased labour costs because of low
productivity, absenteeism, sick leave and other benefits (attending funerals), early
retirement and additional training costs.

Agricultural production is often central to the rural economy. This form of production is
usefully differentiated into the commercial farming sector, where the organization and
running of a farm often approximates a business, and the subsistence sector, which is
characterized by a close relationship between the general activities of a household
(including child care and rearing, support relations between adult members, home
maintenance and food processing) and the production of crops and care of animals. These
sectors will be further elaborated below.

5.3 The Impact on Agricultural Production

Agriculture is one of the most important sectors in many developing countries, providing a
living or survival mechanism for up to 80 percent of a country’s population. However, while
agriculture is extremely important to many African countries, not least of all for household
survival, there are marked differences among countries in terms of current economic
conditions and agricultural and economic potential. Agriculture faces major challenges
including unfavorable international terms of trade, mounting population pressure on land,
and environmental degradation. The additional impact of HIV/AIDS is also severe in many
countries. The major impact on agriculture includes serious depletion of human resources,
diversions of capital from agriculture, loss of farm and non-farm income and other psycho-
social impacts that affect productivity (Mutangadura, Jackson and Mukurazita, 1999).

The adverse effects of HIV/AIDS on the agricultural sector can, however, be largely
invisible as what distinguishes the impact from that on other sectors is that it can be subtle
enough so as to be undetectable. In the words of Rugalema, “even if [rural] families are
selling cows to pay hospital bills, [one] will hardly see tens of thousands of cows being
auctioned at the market...Unlike famine situations, buying and selling of assets in the case
of AIDS is very subtle, done within villages or even among relatives, and the volume is
small”. Furthermore, the impact of HIV/AIDS on agriculture, both commercial and
subsistence, are often difficult to distinguish from factors such as drought, civil war, and
other shocks and crises (Topouzis, 2000). For these reasons, the developmental effect of
HIV/AIDS on agriculture continues to be absent from the policy and programme agendas of
many African countries. Many studies on HIV/AIDS that have focused on specific sectors of
the economy such as agriculture have been limited to showing the wide variety of impacts
and their intensity on issues such as cropping patterns, yields, nutrition, or on specific
populations. They have not adequately touched on questions such as the effects of changes
in prices of commodities, such as tea or cocoa, land tenure and the rights of women and
children.

5.3.1 Impact on the Commercial Sector

Commercial agriculture is particularly susceptible to the epidemic and is facing a severe

social and economic crisis in some locations due to its impact. Morbidity and mortality due
to HIV/AIDS significantly raise the industry’s direct costs (medical and funeral expenses)
as well as indirectly through the loss of valuable skills and experience. The epidemic thus
adversely affects companies’ efficiency and productivity. Thus HIV/AIDS is leading to
falling labour quality and supply, more frequent and longer periods of absenteeism, losses
in skills and experience, resulting in shifts towards a younger, less experienced workforce
and subsequent production losses. These impacts intensify existing skills shortages and
increase costs of training and benefits.

At the recent FAO Conference on HIV/AIDS and agriculture, an example was given of the
costs to this particular sector. It was argued that in Sub-Saharan Africa’s 25 worst affected
countries, seven million agricultural workers have died from the epidemic since 1985 and
sixteen million more may die by 2020. Table three clearly depicts the grim picture of the
agricultural labour force decreases in the ten most heavily affected countries in Africa.
Balyamujura et al, have argued that intensive agriculture will be severely impacted through
the loss of this specialised labour. Areas of production such as harvesting and processing
that require a high level of skill will be most severely affected.
 Impact of HIV/AIDS on agricultural labour in selected African countries (projected
losses in percentages)

Country 2000 2020

Namibia 3.0 26.0
Botswana 6.6 23.2
Zimbabwe 9.6 22.7
Mozambique 2.3 20.0
South Africa 3.9 19.9
Kenya 3.9 16.8
Malawi 5.8 13.8
Uganda 12.8 13.7
Tanzania 5.8 12.7
Central African Republic 6.3 12.6
Ivory Coast 5.6 11.4
Cameroon 2.9 10.7

Source: FAO, 2001, cited in Fourie and Schonteich, 2001: 32

It should also be emphasised that the impact on commercial agriculture is only one side of
the story. In much of southern Africa, agriculture is not the dominant economic sector, even
while access to land and its resources is important for the diverse multiple livelihood
strategies of many rural denizens.

5.3.2 Impact on the Small-Scale and Subsistence Sectors

Many studies conducted on the impact of HIV/AIDS in Africa have focused on the farm-
household level where agricultural production at the subsistence or small-scale level is
often embedded within multiple-livelihood strategies and systems. Over the past two
decades there have been profound transformations in these livelihood systems in Africa,
set in motion by Structural Adjustment Programmes, the removal of agricultural subsidies
and the dismantling of parastatal marketing boards. As a result of these and other issues,
many African households have shifted to non-agricultural income sources and diversified
their livelihood strategies.

However, despite the evident diversification out of agriculture, rural production remains
an important component of many rural livelihoods throughout Sub-Saharan Africa. ‘African
rural dwellers ...deeply value the pursuit of farming...food self-provisioning is gaining in
importance against a backdrop of food inflation and proliferating cash needs’. Participation
in “small-plot agriculture” is highly gendered, with women taking major responsibility for it
as one aspect of a multiple livelihood strategy. Access to land-based natural resources
remains a vital component of rural livelihoods particularly as a safety net. In this context,
land tenure becomes increasingly important for the diverse livelihood strategies pursued
by different households.

Diversification out of agriculture may be compounded by the affect of HIV/AIDS in a

number of ways. These include its impact on labour, the disruption of the dynamics of
traditional social security mechanisms and the forced disposal of productive assets to pay
for such things as medical care and funerals. In turn, local farming skills are drained and
biodiversity in crop variety diminished. Indigenous knowledge systems and technology
adapted by farmers to suit the particular conditions of specific areas often die with the
farmers. A large number of Sub-Saharan African countries have already experienced a shift
in the allocation of labour especially by subsistence households

A study in Zimbabwe conducted by the Zimbabwe Farmers Union showed that the death of
a breadwinner due to AIDS will lead to a reduction in maize production in the small-scale
farming sector and communal areas of 61 percent. The loss of agricultural labour is likely to
cause farmers to move to production of less labour intensive crops in a bid to ensure their
survival. This often means a shift from cash to food crops or high value to low value crops.
Haslwimmer has further developed this argument emphasizing that the impact of
HIV/AIDS on crop production relates to a reduction in land use, a decline in crop yields and
a decline in the range of crops grown, mainly with reference to subsistence agriculture.
Reduction in land use occurs as a result of fewer family members being available to work in
cultivated areas and due to poverty resulting in malnutrition leading to the inability of
family members to perform agricultural work. This, in turn, leads to less cash income for
inputs such as seeds and fertilizer. In Ethiopia, for example, labour losses reduced time
spent on agriculture from 33.6 hours per week for non AIDS-affected households to
between 11.6 to 16.4 hours for those affected by AIDS.

At a recent workshop on HIV/AIDS and land, the FAO director in South Africa stated that
the food shortages facing several Southern African countries, including Lesotho and
Zimbabwe, were ‘a stark demonstration of the collective failure to recognize and act upon
the deep-rooted linkages between food security and HIV/AIDS. This reiterates the
argument that the continuous interruption of labour may also impact on the type of crops
grown, and hence substitution between crops may take place. This is especially true for
labour intensive crops, which would likely result in the substitution for less labour
intensive production and a possible decrease in the area being cultivated. Food security
therefore becomes an important issue in the context of HIV/AIDS. Food security implies
that every individual in a society has a sustainable food supply of adequate quality and
quantity to ensure nutritional needs are satisfied and a healthy active life be maintained. At
a household level, food security refers to the ability of households to meet target levels of
dietary needs of their members from their own production or through purchases

According to Louwenson and Whiteside, the impact of HIV/AIDS on agriculture directly

affects food security, as it reduces:

 Food availability (through falling production, loss of family labour, land and other
resources, loss of livestock assets and implements).
 Food access (through declining income for food purchases).

 The stability and quality of food supplies (through shifts to less labour intensive
production).

HIV/AIDS can therefore be a cause of food insecurity and a consequence thereof. For
example, during times of food insecurity, such as during drought, individuals or families
can be forced to engage in survival strategies that increase their vulnerability to
contracting HIV.

Natural resource management has also been directly impacted on by HIV/AIDS, which has
important implications for non-agriculturally based multiple livelihood systems.
Conservation and resource management are also dependent on human factors such as
labour, skills, expertise and finances that have been affected by the epidemic. Therefore the
reduction in the number and capacity of ‘willing, qualified, capable and productive people’
who have managed natural resources has negatively impacted on sustainable utilization of
these resources. In addition, the epidemic can impact natural resource conservation and
management by accelerating the rate of extraction of natural resources to meet increased
and new HIV/AIDS demands.

Exercise

State three ways in which developing economies have suffered HIV?

How have house hold been affected by HIV/AIDS?

How has food security been affected by HIV?

 TOPIC 4
PREVENTION AND CONTROL OF HIV/AIDS

Ways in preventing and controlling HIV /AIDS

 Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal
sex. Anal sex is the highest-risk sexual activity for HIV transmission. If you are HIV-
negative, insertive anal sex (topping) is less risky for getting HIV than receptive anal
sex (bottoming). Sexual activities that do not involve the potential exchange of
bodily fluids carry no risk for getting HIV (e.g., touching).
 Use condoms consistently and correctly.

 Reduce the number of people you have sex with. The number of sex partners you
have affects your HIV risk. The more partners you have, the more likely you are to
have a partner with HIV whose viral load is not suppressed or to have a sex partner
with a sexually transmitted disease. Both of these factors can increase the risk of
HIV transmission.

 Talk to your doctor about pre-exposure prophylaxis (PrEP), taking HIV medicine
daily to prevent HIV infection, if you are at substantial risk for HIV. PrEP should be
considered if you are HIV-negative and in an ongoing sexual relationship with an
HIV-positive partner. PrEP also should be considered if you are not in an exclusive
relationship with a recently tested, HIV-negative partner and are a:

o gay or bisexual man who has had anal sex without a condom or been
diagnosed with an STD in the past 6 months; or

o heterosexual man or woman who does not regularly use condoms during sex
with partners of unknown HIV status who are at substantial risk of HIV
infection (e.g., people who inject drugs or have bisexual male partners).

 Talk to your doctor right away (within 3 days) about post-exposure prophylaxis
(PEP) if you have a possible exposure to HIV. An example of a possible exposure is if
 you have anal or vaginal sex without a condom with someone who is or may be HIV-
positive, and you are HIV-negative and not taking PrEP. Your chance of exposure to
HIV is lower if your HIV-positive partner is taking antiretroviral therapy (ART)
consistently and correctly, especially if his/her viral load is undetectable (see Can I
transmit HIV if I have an undetectable viral load?). Starting PEP immediately and
taking it daily for 4 weeks reduces your chance of getting HIV.

 Get tested and treated for other STDs and encourage your partners to do the same. If
you are sexually active, get tested at least once a year. STDs can have long-term
health consequences. They can also increase your chance of getting HIV or
transmitting it to others. Find an STD testing site.

 If your partner is HIV-positive, encourage your partner to get and stay on treatment.
ART reduces the amount of HIV virus (viral load) in blood and body fluids. ART can
keep people with HIV healthy for many years, and greatly reduce the chance of
transmitting HIV to sex partners if taken consistently and correctly.

Skills used in the management of HIV/AIDS

Life skills: Life skills have been defined by the World Health Organization (WHO) as
“abilities for adaptive and positive behavior that enable individuals to deal effectively with
the demands and challenges of everyday life”.

They represent the psycho-social skills that determine valued behaviour and include
reflective skills such as problem-solving and critical thinking, to personal skills such as self-
awareness, and to interpersonal skills. Practicing life skills leads to qualities such as self-
esteem, sociability and tolerance, to action competencies to take action and generate
change, and to capabilities to have the freedom to decide what to do and who to be. Life
skills are thus distinctly different from physical or perceptual motor skills, such as practical
or health skills, as well as from livelihood skills, such as crafts, money management and
entrepreneurial skills . Health and livelihood education however, can be designed to be
complementary to life skills education, and vice versa.

IN today’s world, many people are face by challenges that put their well being at risk. It has
been noted that people that are well versed with the ways if dealing with these stresses are
less likely to make decisions that may put them at risk of being affected. This skill is vital in
the case where someone is trying to live positively with the condition

Communication skill: These are the skills that are used to transfer information from one
person to another. Since counselling is a conversation or dialogue between the counsellor
and client, the counsellor needs certain communication skills in order to facilitate change.
Some of the skiils involved in communication invole

 Attending

 Listening

 Empathy

 Summarizing

Negotiation kills: Negotiation simply means discussing something with an aim of reaching
an agreement. People in sexual relationships can prevent doing riskt activiries by simply
being able to negotiate with their partners on the items that they are not comfortable with.
This skill will prevent someone from doing something just because they have neeb coerced
into doing it.

Negotiations skills: Negotiation simply means the act of discuss something with the aim
or reaching an amicable conclusion. This skill is very vital I the case where by a person
want to talk about the terms and conditions of them getting involved in sexual matters.
Many women in society do not have the power to suggest the regulations in the sexual
relationships they get involved in. This os mostly due to cultural beliefs that is usually
patriarchal in nature. This skill enables both parties in any sexual relationship to openly
talk about what they are and are not comfortable with regarding sex. This gives them the
ability to present views that will lower the chances of them being negatively affected after
indulging in sexual relations.

Activities aimed at preventing and controlling the spread of HIV AND AIDS

HIV/AIDS epidemic is a multi-faceted issue, which requires multi-dimensional responses;

and accordingly the broad goals of SANKALP’S action plans include;

a) ensuring mass mobilization of the communities, groups, families, individuals and

governmental and non-governmental organisations;
b) raising public awareness towards behaviour change;

c) building community-based prevention and care programmes;

d) supplementing and supporting new creativity linked to HIV/AIDS prevention and

control; and

e) Giving special attention to the endangered groups.

The target groups covered by organisation’s that perform these activities normally target
specific groups in the society due to their high levels of vulnerability. Such groups include.

a) commercial sex workers;

b) People in mobile professions e.g long distant truck drivers.

c) segregated groups e;g the disabled

d) Homosexuals.

Exercises

Why do homosexuals stand a higher chance of being infected by HIV?

Explain four skills that are used in communication skills?

How can behavior change be promoted in the society?

 TOPIC 5
ARV THERAPY
This is the management of HIV/AIDS normally includes the use of multiple antiretroviral
drugs in an attempt to control HIV infection. There are several classes of antiretroviral
agents that act on different stages of the HIV life-cycle

Usually, the CD4 test is used to determine when a person should start HIV treatment.

HIV attacks a type of immune system cell called the T-helper cell. The T-helper cell plays an
essential part in the immune system by helping to co-ordinate all the other cells to fight
illnesses. HIV damages and destroys T-helper cells. A major reduction in the number of T-
helper cells can have a serious effect on the immune system.

A CD4 test measures the number of T-helper cells (in a cubic millimetre of blood) which is
known as a CD4 count. Someone who is not infected with HIV normally has between 500
and 1200 cells/mm3. In a person infected with HIV, the CD4 count often declines over a
number of years.

HIV treatment is now recommended when the CD4 test shows fewer than 500 cells/mm 3,
as stated in the World Health Organization (WHO) 2013 guidelines. This will vastly
increase the number of people eligible for treatment by 9.2 million, forming a challenge for
resource-limited countries. As of 2011, most but not all resource-limited countries had
been administering ART to patients with a CD4 count of 350 cells/mm 3 or less. However
some are only able to start treatment at less than 200 cells/mm 3, which was what the
WHO's 2006 guidelines recommended.

Classes of HIV/AIDS Antiretroviral Drugs

There are six major types of drugs used to treat HIV/AIDS. Called antiretrovirals because
they act against the retrovirus HIV, these drugs are grouped by how they interfere with
steps in HIV replication

A. Entry Inhibitors interfere with the virus' ability to bind to receptors on the outer
surface of the cell it tries to enter. When receptor binding fails, HIV cannot infect the
cell. Examples of this drugs are enfuvirtide and maraviroc
B. Fusion Inhibitors interfere with the virus’s ability to fuse with a cellular
membrane, preventing HIV from entering a cell. Examples of such drugs are
emtricitabine (FTC), lamivudine (3TC)

C. Reverse Transcriptase Inhibitors prevent the HIV enzyme reverse transcriptase

(RT) from converting single-stranded HIV RNA into double-stranded HIV DNA―a
process called reverse transcription. There are two types of RT inhibitors:

 Nucleoside/nucleotide RT inhibitors (NRTIs) are faulty DNA building blocks.

When one of these faulty building blocks is added to a growing HIV DNA chain,
no further correct DNA building blocks can be added on, halting HIV DNA
synthesis.

 Non-nucleoside RT inhibitors (NNRTIs) bind to RT, interfering with its ability to

convert HIV RNA into HIV DNA

Examples of such drugs are abacavir, lamivudine (3TC)

D. Integrase Inhibitors block the HIV enzyme integrase, which the virus uses to
integrate its genetic material into the DNA of the cell it has infected.
E. Protease Inhibitors interfere with the HIV enzyme called protease, which normally
cuts long chains of HIV proteins into smaller individual proteins. When protease
does not work properly, new virus particles cannot be assembled.

F. Multi-class Combination Products combine HIV drugs from two or more classes,
or types, into a single product.
To prevent strains of HIV from becoming resistant to a type of antiretroviral drug,
healthcare providers recommend that people infected with HIV take a combination of
antiretroviral drugs in an approach called highly active antiretroviral therapy (HAART).
Developed by NIAID-supported researchers, HAART combines drugs from at least two
different classes.

Drug adherence
This is the extent to which patients take medications as prescribed by their health care
providers.

People infected with HIV who take antiretroviral treatments sometimes find it difficult to
adhere to their drug regimens. This may be because it can be hard to take several
medicines each day and at different times or because of the unpleasant side effects caused
by some medicines, such as nausea and vomiting.

Non-adherence is a problem that has many determinants and the responsibility for
adherence must be shared by health professionals, the health care system, the community
and the patients. Many studies have identified factors affecting adherence, and these have
been grouped into the five dimensions.

a) socioeconomic-related factors
b) health care team/health system-related factors;

c) condition-related factors;

d) treatment-related factors, and

e) Patient-related factors.

HIV Drug Resistance

When you are first diagnosed with HIV infection, your blood is full of copies of the HIV
virus, all looking for CD4 cells that they can attach themselves to. This virus is called “wild
type,” because it has never been challenged by the HIV medications that can control it.
Once you start treatment, the goal is to keep HIV from reproducing. When HIV isn't fully
controlled by HIV drugs, the virus makes copies of itself at a very rapid rate. Because this
replication is occurring so fast, HIV often makes mistakes in the copies. If these “mistaken
copies” are able to reproduce themselves, they are called mutations—which creates new
forms of the virus.

Mutations may not respond to existing HIV drugs—a characteristic known as resistance.
This means that the drugs are less effective and do not stop the virus from multiplying. If
your healthcare provider suspects that you have a drug-resistant virus, he or she can do
drug resistance testing (called genotyping or phenotyping) to find out if you have drug-
resistant HIV and which of your meds may have stopped working.

Resistance can be reduced using the following ways

You can help reduce the chances that you will develop drug-resistant forms of HIV by
taking a few simple steps:

 Work with your healthcare provider to find a drug combination that is effective and
that you can tolerate.
 Take every dose of every medication every day, missing as few as possible.

 Keep your appointments with your HIV clinician and have your CD4 count and viral
load checked every 3-4 months. Those tests will help detect resistance so that, if
necessary, you can make changes to your treatment plan and keep your HIV under
control.

 Keep a record of which combinations of HIV medications you've taken.

Side Effects

All medicines have side effects. Some are unpleasant and some are unnoticeable. Mild side
effects are common and mean that the medicine has started to work.

The goal of HIV treatment is to find the right combination of medicines at the right dosage
that will be powerful enough to fight the HIV in your body, but won’t cause too many side
effects. You should talk to your healthcare provider about all treatment options and the
potential side effects with each one.

Short-Term Side Effects

Almost all medicines have side effects, including HIV medicines. While your HIV meds are
controlling the virus in your body, they may also cause:

 Anemia (abnormality in red blood cells)

 Diarrhea

 Dizziness

 Fatigue

 Headaches

 Nausea and vomiting

 Pain and nerve problems

 Rash

Long-Term Side Effects

HIV medications can have some significant, long-term side effects. While many of these side
effects are treatable, some can be long-term. You need to tell your healthcare provider
about any side effects, so that he or she can decide the best course of treatment for both
your HIV disease and the side effects. Always let your healthcare provider know if your side
effects are severe, especially if you are finding it difficult to stay on your treatment plan.

Some of the most common long-term side effects of HIV treatment include:
  Lipodystrophy–A problem in the way your body produces, uses, and stores fat.
(Also called “fat redistribution”). These changes can include losing fat in the face and
extremities, and gaining fat in the abdomen and back of the neck.
 Insulin Resistance–A condition that can lead to abnormalities in your blood sugar
levels and, possibly, diabetes. Lab tests which look at your sugar levels are usually
the best indicators that you have insulin resistance.

 Lipid abnormalities–Increases in cholesterol or triglycerides. Like with insulin

resistance, lab tests (cholesterol and triglycerides) are the best indicators of lipid
abnormalities.

 Decrease in bone density–Can be a significant issue, especially for older adults

with HIV. This can lead to an increase risk of injury and fractures.

 Lactic acidosis–A buildup of lactate, a cellular waste product, in the body. This can
cause problems ranging from muscle aches to liver failure. Alert your health care
provider immediately.

First Steps to Treatment

You may feel a little overwhelmed when you first begin treatment for your HIV disease.
During your first appointment, your healthcare provider should ask you questions about
your medical history, conduct a physical exam, and order various medical tests. This is also
a good time to ask all of the questions you may have about living with HIV and various
treatment options available to you.

The initial medical tests your provider may order will give a better understanding of how
the HIV virus is affecting your immune system. Two of the most important tests will be a
CD4 count and a viral load test. You may also take a drug resistance test to determine the
best medication options for you. The results of all of these tests will provide a baseline
measurement for future tests.

 Your provider may also order some other tests:

 Complete blood count

  Blood chemistry profile (including liver and kidney function tests)

 Urinalysis

 Tests for other sexually transmitted diseases (STDs)

 Tests for other infections, such as hepatitis, tuberculosis, or toxoplasmosis

 An HLA-B*5701 test: Checks to see if you are sensitive to a specific HIV medication
(abacavir) and should avoid taking it.

 Coreceptor tropism assay: Checks to see if a specific type of HIV medication is

appropriate for you. This test is usually used only if your body has shown resistance
to other medications.

Other Needs and Services

When you are beginning treatment for HIV, you may need other services and/or support.
During your initial few visits your healthcare provider or case manager may ask you if you
need access to the following:

 Housing

 Supportive care and in-home health care

 Mental health care

 Food assistance

 Support groups

 Activity groups

 Pharmacy-assisted medication management programs

It’s possible that you will have to complete additional forms or show that you meet
eligibility requirements to get access to these programs. Talk with your provider to
determine which programs may be right for you.
 Complementary and Alternative Therapies

Massage
The term “massage therapy” covers a group of practices and techniques. There are over 80
types of massage therapy. In all of them, therapists press, rub, and otherwise manipulate
the muscles and other soft tissues of the body, often varying pressure and movement.
There appear to be few risks to massage therapy if it is used appropriately and provided by
a trained massage professional.

Dietary Supplements
Dietary supplements are products that are taken in addition to foods and liquids that are
part of a regular diet. These products contain one or more dietary ingredients (including
vitamins, minerals, herbs or other botanicals, and amino acids). Dietary supplements are
those intended to be taken by mouth, in the form of a tablet, capsule, powder, softgel,
gelcap, or liquid.

 Supplements can be made from plant products (herbs), minerals (zinc), vitamins
(Vitamin C), or other substances (omega-3 fatty acids).
 Some supplements are important to maintain health or prevent disease. For
example, women who are planning to become pregnant, and those who are already
expecting a baby, are advised to take folic acid to prevent major birth defects to
their babies’ brains and spines.

 Laws regulating dietary supplements are different from those that regulate
prescription medications. Manufacturers of dietary supplements do not have to
prove that their supplements are safe or effective before they sell them to the public.

 It is important to alert your healthcare provider if you are considering taking

supplements. Speak to them BEFORE taking these supplements to ensure they are
beneficial and do not have ingredients that could interact in a negative way with
your current medications..
Meditation
Meditation refers to a variety of techniques or practices intended to focus attention or
control the mind. These techniques have been used by many different cultures (often as
part of religious practice) for thousands of years. Today, many people use meditation
outside of its traditional religious or cultural settings as a form of mind-body medicine. In
2007, nearly 10% of adults in the U.S. reported using meditation as a form of CAM.

Acupuncture
Acupuncture is among the oldest forms of healing practice in the world. Its goal is to
restore and maintain health through the stimulation of specific points on the body. The
acupuncture technique that has been most often studied scientifically involves penetrating
the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical
stimulation.

Exercise

Describe the reason why a CD4 count is takes after one is found to be HIV
positive

State the major classes of ARVs

Explain the common long term effects of ARV therapy

How does mediation help a PLWA as a form of therapy

 TOPIC 6
HOME BASED CARE
This is defined as provision of comprehensive services, including health and social services
by formal and informal caregivers in the home.

HBC Components

Clincal Care

Within the MACODEP context, is the continuation of medical care in the home. The goal is
to ensure the continuity of the care and treatment the PLWHA was receiving from the
health facility.

Nursing Care

Nursing care is the art of assisting individuals ,sick or well to do those things they would do
if they had the strength ,knowledge or will, or to a peaceful death

Counselling

Counselling is a professional helping relationship that assists people to understand and

deal with their problems .This includes psycho-spiritual support, anxiety reduction,
promotion of positive living, and help with making informed decisions about HIV testing,
life, and living positively.

Social Support

Social support, for HIV infected people, is the creation of an enabling environment for the
PLWHA by all involved in providing care .It incorporates information dissemination and
the referral to support groups and welfare, economic, and legal services.

Challenges of Home based care

Most of the HIV and AIDS home care is carried out by family members who have no contact
with professional help and suffer through lack of support. This means that infected people
may be inadequately looked after despite the best efforts of their careers and families.
Studies have shown that the most effective home-based care programmes involve ongoing
support for their workers, support from local communities and integration within existing
health systems. However, many home-based care programmes lack these elements.

Inadequate help from home-based care organisations

While home-based care organisations are valued by their patients there are weaknesses in
how some home-based care programmes are delivered. Carers’ workloads may be very
heavy and they are often unable to make frequent home visits or stay with individual
patients or households for very long. Any failures of home-based care often stem from the
shortage of investment in the individuals and organisations that carry out the work. It
should also be remembered that home-based care organisations cannot attend to patients
around the clock, so there are limitations on what they should be expected to do. While
they should be able to help with daily tasks such as changing bandages, assistance with
more frequent occurrences such as going to the toilet will mostly be done by family
members.

In one survey, some primary caregivers felt that home-based carers did not give them
adequate attention and were only interested in the sick person. Insufficient material
assistance such as food was also mentioned. Furthermore, lack of communication between
the families and home-based care groups meant visits were irregular and occasionally
stopped without notice.
Limited resources

The necessary supplies that should be provided in home-based care kits are very often
inadequate. In a survey of home-based care organisations in South Africa, less than a fifth
were able to provide the complete health department list of recommended contents. Less
than a quarter of home-based care kits in the survey contained mild painkillers, and
vitamins and iron supplements were largely unavailable. Most of the home-based care
organisations share individual kits among at least six careers who in turn have multiple
patients. This inevitably creates problems over how and when to allocate the home-based
care kits.

With the ‘lay’ kits costing as much as US$130 and professional kits costing $US160, the
biggest obstacle to providing them was lack of funding and being unable to pay staff to
procure them. There was also no standardized system for tracking their distribution or
utilization. Limited stock and not knowing where to find the home-based care kits were
other reasons for not using them, as was the non-replenishment of supplies after their
initial provision by the health department. Organizations that did not use such kits
provided basic items on an ad hoc basis.

For home-based care organizations lacking in resources, greater coordination between

them could facilitate sharing and bulk purchasing of supplies leading to lower costs.
Monitoring and evaluation of home-based care kits would also ensure they are being
tailored to the precise needs of the individual.

Some researchers were able to make contact with only half of the nearly 900 home-based
care organizations throughout South Africa that they tried to reach, suggesting that
hundreds were no longer operating or were so poorly funded that they could not afford a
telephone. Understaffing and high turnover of volunteers as well as low accountability
were put forward as other difficulties facing home-based care groups.
Risks faced by careers

Caring for someone whose mobility and bodily functions have deteriorated can place great
demands on the health of caregivers. Carers may risk their physical health when assisting
someone, perhaps heavier than themselves, with tasks such as getting out of bed or moving
around the home. One study of both primary and voluntary carers found most suffered
physically as a result of caring, with the most common problems being headaches, body
aches, back aches and exhaustion. Sudden and recurring headaches also affected some
carers. Some elderly women physically affected by their care work had existing ailments
including arthritis, diabetes and hypertension, with one 75-year-old woman cited in a
study having headaches, body pain and weakness of the heart through looking after her
daughter who was in her end of life stage.

Women primary caregivers were found to take on the most physically demanding tasks
including bathing patients, helping them go to the toilet, changing soiled nappies, clothing
and sheets, and obtaining water, sometimes a long distance away. A lack of support from
other family members was found to be a significant factor in the overburdening of primary
careers.

For the voluntary home-based care workers in the study, walking long distances in the hot
sun to reach their patients, as well as the sheer number of people that they had to attend to,
contributed to work overload and burnout.

Close contact with patients’ faeces, vomit, and other bodily fluids creates health risks for
the carer. This risk is made worse in areas where there is poor sanitation and where the
carer does not take precautionary measures such as wearing rubber gloves, either through
lack of appropriate knowledge or resources. Although there are anecdotal reports of carers
becoming infected with HIV there is little documented evidence of this.

Fear of sexual abuse and rape was also found among voluntary caregivers, especially
among women caregivers visiting men who lived alone.
The risks of injury and infection associated with caring for a sick individual point to the
need for such care to be supported through visits by home-based care groups. These could
alleviate some of the burden, encourage wider community participation, and provide
education and resources that could reduce the risk of infection and physical harm.

The burdens placed upon careers of sick people living with HIV highlight the scale of the
activities they undertake to enhance the quality of life of their dependents, yet also reveal
the importance that home-based care programmes have in relieving mental and physical
suffering for both patient and carer.

Economic burden on the family

When a family member falls sick as a result of HIV, not only does that individual’s inability
to work lessen family income, so too does the fact that carers will spend less time making
money. In a survey of over 700 South African households where someone was either sick
or had recently died from AIDS, more than a fifth had diverted time from work or informal
income-generating activities to provide care in the home.

Furthermore, at the time the earning potential of a household is diminished, the cost of
treatment, medicines and other healthcare provisions constitute an added financial burden
on carers. One study in Botswana found that families do not have the resources to cover the
cost of caring for sick relatives and often have to use their own wages for things such as
food, washing soap and transport to hospital. This meant that, on average, the caregivers
were spending their entire monthly earnings on caring for sick relatives and had to rely on
a small government allowance and support from community members to make ends meet.

While the assistance of a well-resourced home-based care programme does not eliminate
the need for families and friends to divert some attention from work to care for their sick
relatives, it can nevertheless make more time available for caring activities.

Exercise
Explain three challenges of HBC

State the SOCIO effects of HBC in the community

Explain themeaning of counseling as a components in HBC?

 TOPIC 6
HIV AND AIDS COUNSELLING

Counselling in HIV and AIDS has become a core element in a holistic model of health care,
in which psychological issues are recognised as integral to patient management. HIV and
AIDS counselling has two general aims:

 The prevention of HIV transmission and

 The support of those affected directly and indirectly by HIV.

It is vital that HIV counselling should have these dual aims because the spread of HIV can
be prevented by changes in behaviour. One to one prevention counselling has a particular
contribution in that it enables frank discussion of sensitive aspects of a patient's life—such
discussion may be hampered in other settings by the patient's concern for confidentiality
or anxiety about a judgmental response.

Also, when patients know that they have HIV infection or disease, they may suffer great
psychosocial and psychological stresses through a fear of rejection, social stigma, disease
progression, and the uncertainties associated with future management of HIV. Good clinical
management requires that such issues be managed with consistency and professionalism,
and counselling can both minimise morbidity and reduce its occurrence. All counsellors in
this field should have formal counselling training and receive regular clinical supervision as
part of adherence to good standards of clinical practice.

The counseling process is a vital initiative that can help manage the HIV scourge in
societies. However to practice professional counseling one needs to have the following
qualities

 Empathy

Empathic understanding is the ability to see things from the client’s perspective. Without
this quality a counsellor will be unable to comprehend the problems, experiences, thoughts
and feelings of another person, and will not be able to offer clients the level of supportive
understanding that they will require.

The counsellor’s full attention and empathy encourages a client to relax and trust and
encourages self-disclosure.

 Congruence and warmth

A counsellor should be agreeable and act appropriately to provide the client with a
comfortable foundation for the counselling relationship. Only by creating a friendly
atmosphere can the counsellor encourage interaction and disclosure.

 Maintain warmth and genuine understanding.

 Use appropriate body language such as a non-threatening posture, while maintaining eye
contact and respecting the client’s personal space.

 Maintain a reassuring and comforting way of speech – the tone of voice, speed of speech and
style of delivery.
  Respect

Counsellors must at all times show respect for clients and their welfare. They must also
remain impartial and non-judgmental.

A client must feel comfortable, safe and confident that confidentiality will be maintained at
all times and also that the counsellor is committed to helping, encouraging and supporting.

Whilst maintaining a professional focus a counsellor must be able to show a genuine

openness.

 Positive regard

It is of vital importance in the counselling relationship that the counsellor demonstrates a

positive acceptance of the client and that the client is valued and respected.

A positive, unconditional regard for the wellbeing of a client is the basis from which clients
can explore their thoughts, feelings and experiences, and develop an understanding and
acceptance of their emotions.

A counsellor must not judge in any way. This may be difficult in some situations, but is the
basis of a counselling relationship built on trust.

Accepting a client shows the individual that you are there to support them through the
counselling process, regardless of their weaknesses, negativity or unfavourable qualities.

Important values: At all times counsellors must show a commitment to values such as
the following:
I. Human dignity
II. Alleviating personal distress

III. Appreciating the differences in culture

IV. Remaining non-judgmental

 V. Ensuring the integrity of the client/counsellor relationship

VI. Maintaining client confidentiality and ethical principles.

 Personal skills

Each counsellor will bring their own unique abilities, qualities and skills into a counselling
relationship to help ensure that their client feels safe and supported. These may include:

I. Active listening skills

II. Good interpersonal skills

III. The ability to question, reflect and challenge attitudes and beliefs

IV. A genuine interest in providing support.

Other important skills include good planning and motivational skills, problem solving,
organizational ability and re-orientation skills.

 Personal knowledge

In addition to counselling qualifications, a counsellor should be armed with sufficient

personal knowledge and understanding of what counselling is all about.

He/she must also be clear about the role of the counsellor and the problems, issues and
expectations every client will present.

Counsellors must be self-aware, and must be in control of their feelings, thoughts and
emotions whilst working with clients.

 Personal development

Through his/her own development a counsellor will also pick up additional understanding
and knowledge, which can be used effectively to support a client during the counselling
process.
Counselling skills are constantly improved if the counsellor has an interest in self-
awareness and self-development. This continual process can include a growth in the
following:

I. Self-awareness
II. Self-counselling

III. Work/life balance

IV. Career and personal focus

V. Goal setting.

Post and pre test counseling

Counselling after a negative HIV test result

 For both the client and the counsellor, a negative HIV result is a tremendous relief.
 A negative test result could however give someone, who is frequently involved in
high-risk behaviour, a false sense of security. It is therefore extremely important for
the counsellor to counsel HIV-negative clients in order to reduce the chances of
future infection. Advice about risk reduction and safer sex must therefore be
emphasised.

 If you practise high risk sex behaviour and test negative, it does not mean that you
are “immune” to HIV and that precautions are therefore unnecessary. Nobody is
immune to HIV and everyone risks being infected if they do not change their
behaviour.

 The possibility that the client is in the “window period” or that the negative test
result may be a false negative should also be pointed out. If there is concern about
the HIV status of the person, he or she should return for a repeat test after about
three months and ensure that appropriate precautions are taken in the meanwhile.
Note to councellors: Don’t underestimate the extreme importance of counselling a client
who tested HIV negative. This may be your only chance to talk to this person about his or
her sexual practices, potential drug abuse and other risk behaviours, and to educate him or
her about safer sex practices. Free condoms can be given out at this session together with
advice on how to use them and where to get more when needed. Use this counselling
session to prevent a future situation where somebody else has to give the client a positive
HIV test result!

Counselling after a positive HIV test result

To communicate a positive test result to a client is a huge responsibility. The way people
react to test results depends to a large extent on how thoroughly the counsellor has
educated and prepared them both before and after the test.

When a test is positive, the following guidelines for counselling may prove useful for
counsellors:

1. Sharing the news with the client

 Positive (as well as negative) test results should be given to the client personally.
 Feedback should take place in a quiet, private environment and enough time should
be allowed for discussion.

 The news of a positive result ought to be communicated openly, honestly and

without fuss. Simple and straightforward language should be used. Do not give the
individual false hopes and (alternatively) do not paint a hopeless scenario.

 Choose neutral words when conveying a positive HIV test result. Don’t attach value
to the news by saying “I have bad news for you” - because such an attitude reflects a
hopelessness in the mind of the counsellor. Rather say: “Mr Peterson, the results of
your HIV test came back, and you are HIV positive”.

 A positive result is NOT a death sentence and the counsellor's task is to convey
optimism and hope.
  There are a few Don’ts that we need to observe when sharing a positive HIV test
result with a client.

o Don't lie or dodge the issue.

o Don’t beat about the bush or use delaying tactics. Come to the point.

o Don't break the news in a corridor or any other public place.

o Don't give the impression of being rushed, distracted or distant.

o Don't interrupt or argue.

o Don't say that “nothing can be done” because something can always be done
to ease suffering.

o Don't react to anger with anger.

o Don't say “I know how you feel” because you don't.

o Don't be afraid to admit ignorance if you don't know something.

2. Client reaction to a positive HIV test result

 Clients’ responses to the news usually vary from one person to another, and may
include shock, crying, agitation, stress, guilt, withdrawal, anger and outrage - some
clients may even respond with relief.
 The counsellor should allow clients to deal with the news in their own way and give
them the opportunity to express their feelings.

 The counsellor should show empathy, warmth and caring.

 Maintain neutrality and respond professionally to outbursts. Don’t show surprise or

make value-laden comments such as “There is no need to be upset with me!”
Because the loss of health is a bereavement, it manifests with all the components of
 denial, anger, bargaining, depression and acceptance. The counsellor must respect
the personal nature of an individual's feelings.

3. Responding to client needs

 People's needs, when they receive an HIV positive test result, vary, and the
counsellor has to determine what those needs are and deal with them accordingly.
 Fear of pain and death are often the most serious and immediate problems and
these can be dealt with in various ways. Talking to clients about their fears for the
future is one of the most important therapeutic interventions that the counsellor
can make.

 Often it is enough for the counsellor just to be “there” for the client and to listen to
him or her.

 One of the major concerns for HIV positive people is whom to tell about their
condition and how to break the news. It is often helpful to use role-play situations in
which the client can practise communicating the news to others.

 In responding to a client's needs, an attitude of non-judgmental empathic

attentiveness is more important than doing or saying specific things. Listening is
more important than talking; being with more important than doing.

4. Crisis intervention

 Crisis intervention is often necessary after an HIV positive test result is given
 Make sure that the person has support after he or she leaves your office. A person in
crisis should never be left alone: he or she should have somebody with whom to
share the burden.

 Ask the client where he or she is going after leaving your office. Let the person think
about and verbalise his or her plans for the next few hours. Although it is better for
the client not to be alone, personal needs should be taken into consideration: Some
people prefer to be alone and work through a crisis all by themselves.
  Be sensitive to the possibility of suicide. If the client shows any suicidal tendencies,
emergency hospitalisation should be arranged if a friend or family member cannot
be with the client.

 Make sure that your client does not leave your office without support to help him or
her through the first few days.

 Don’t ever give an HIV-positive result on a Friday, because there are often no
support systems available over weekends.

5. Follow-up visits

 When people hear that they are HIV positive, they usually experience so much stress
that they absorb very little information.
 Follow-up visits are therefore necessary to give clients the opportunity to ask
questions, talk about their fears and the various problems they encounter.

 Significant others, such as a lover, spouse or other members of the family, may be
included in the session. During follow-up visits, clients should be offered a choice
concerning their treatment.

 If health care professionals are not in a position to do follow-up counselling,

information about relevant health services should be given. If there is a concern that
the person might not return for follow-up counselling, information about available
medical treatments such as anti-retroviral therapy, treatment of opportunistic
infections, and social services for financial and ongoing emotional support should be
given.

 Give the client a handout with whatever relevant information that he or she may
need (such as the telephone numbers and addresses of Aids centres and other social
services).

6. Support systems

 Find out what support systems are available to clients.

  Refer clients to support systems where people meet on a regular basis to talk about
their difficulties or simply to relax and enjoy each other’s company.

 Information about support systems such as the buddy system is usually available at
the nearest Aids centre or from the offices of NGOs (non-governmental
organisations) who work in the community.

7. Advice about health and sexuality

 Convey information about safer sex, infection control, health care in general and
measures to strengthen the immune system.

8. Medical check-ups

 Encourage clients to go for regular medical check-ups to their family doctor or

health clinic. Infections and opportunistic diseases can be prevented if treated in
time.

Exercise

Explain three qualities of an effective counselor

State the general aims of HIV/AIDS counseling

Differentiate beween empathetic and sympathetic?

 TOPIC 7
Role of stake holders in fighting HIV/AIDS

HIV is not just a health problem but also has social, political, legal and economic
implications. Consequently, it is important to involve, coordinate and mobilize a range of
stakeholders in order to confront the epidemic, both because they are affected and because
they can play various roles.

This means making serious efforts to build and maintain both formal and informal
relationships within and between governments, communities, business and civil society.

Stakeholders include:

 People with HIV; The infected segment of the society needs to be involved in the
prevention and management process by providing the society with case studies of
how ona can live positively with the disease in the society. Many prople still believe
in misconceptions that make the condition very mysterious to many people in the
community. If these misconceptions are disapproved for people to have a better
understanding of how the condition manifests itself in the community.
 local community and traditional leaders;

 Health-care workers; these professional have the skills that are needed in the
preventing the prevalence rate of the diseases from sky rocketing. These skills can
be offered to all that are concerned especially in cases where home based care is
trying to be used in the management and prevention process.

 Governments; The institution needs to make the required medication readily

available so the infected people can live productive lives in the community even
though the nave already contracted the disease Kenyan has made generic ARVs
available. This has managed tame the scourge in the country leading to a more
PLWAS who are involved in nation building. The government can also pass and
implement laws prevent discrimination of PLWAS, especially in the job market
  Nongovernmental organizations (NGOs);The government of any country has got
many concerns to settle. Due to this it may not be able to alleviate certain emerging
problems like HIV/AIDS. NGOs can fill in the gaps left by the government in the
management and prevention process of HIV/AIDS and other pandemics.

 community-based organizations (CBOs);

 faith-based organizations (FBOs);

 medical associations;

 drug regulatory authorities;

 the private sector, i.e. employers, unions;

 donors / cooperating partners;

 Academic institutions.

Involving and mobilizing stakeholders should happen at both the central level and the
implementation level and should be coordinated. Each stakeholder has her or his reasons
for entering into partnership or collaboration on testing and counselling services. It is
important to keep differing interests balanced and focused on the primary purposes,
namely those of supporting people with HIV and promoting public health. Moreover, for
the public policy environment it is important to facilitate partnership between different
stakeholders.