COUNSELLING

IN HIV/AIDS

Qurrot Ulain Taher

P.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.
 PMtct
• 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.
DeFInItIOn

cOUnSelIng SkIllS
PrOPerly USeD Are tOOlS
tO HelP InDIVIDUAlS Seek
AnD FInD tHeIr Own
SOlUtIOnS tO tHe
DIleMMAS tHey FAce.
 TYPES OF HIV TESTS
Antibody 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 counseling

2. Pre test counseling
3. Post test counseling
4. Follow up counseling
 INTERNATIONAL LAW:
Consent to HIV testing and confidentiality of HIV status
are key components of the right to privacy (Universal
Declaration of Human Rights, Article 12, International
Covenant of Civil and Political Rights, Article 17(1)).
As the International Guidelines on HIV/AIDS and
Human Rights clarify, “The right to privacy encompasses
obligations to respect physical privacy, including the
obligation to seek informed consent to HIV testing and
privacy of information, including the need to respect
confidentiality of all information relating to a person’s
HIV status” (para. 119). Thus, under Guideline 3, “HIV
testing of individuals should only be performed with the
specific informed1.consent
rISk aSSESSmEnT
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 risk

B. Assessment of factors & Knowledge

i. Why the test is being

requested?
ii. What behavior? Symptoms are
of concern to the client?
• Sexual Behaviour iii. What the client knows about
• Drug users the test & its uses?
•Blood Transfusion iv. What will the client do if test is
•Organ Transplant 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 RESULT
B. 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 role
Health education
Referral
Clinical and therapeutic role
 contents of
counseling

Contents of counseling will depend on the ability

of the client to grasp. It’s a dynamic process.
The counselor must be able to assess the
clients need and state of mind quickly.

However, following components should be

incorporated in all counseling scenarios:
 contents of
counseling
• The need to prevent infection and re
infection
• Basic information about HIV infection and
associated diseases
• Review of possible sources of client’s
infection
• Methods of safe sex including condom use
• Exploration of obstacles to change of
behavior
 Contents of
Counseling

• Information about what HIV testing can and

cannot do.
• Coping with HIV test results.
• Need to tell the HIV status of the client to
the key persons in his/her life.
• Handling hostility, fear, violence,
depression, suicidal tendencies etc.
Working goals of HiV
Counseling
Forming a helping 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
• Fear • Anger
• Sense of loss • Anxiety
• Grief • Stress
• Guilt • Shock
• Denial • Loss of self esteem
• Depression • Suicide
 sPeCial situations in
HiV Counseling

A. Pregnant women
B. Childless couples
C. Breast feeding positive mothers
D. Spouse and family members of HIV infected
persons
 some Common
Counseling errors
a. Directing and leading
b. Being judgmental and evaluating
c. Moralizing, preaching and patronizing
d. Unwarranted reassurance
e. Not accepting the client’s feeling
f. Interrogating
g. Encouraging dependencies
aids aWareness
These are just some of the days that promote HIV/AIDS
awareness
National 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.