PICT Trainers E-Manual

II TRAINER’S E-MANUAL
Tuberculosis (TB) is still a major public health problem

in the country. In 2018, the Philippines ranked as the
fourth country in the world with the highest number
of TB cases, next to India, Indonesia, and China. Every
year, there are about 26,000 people who die from TB
while approximately 35 percent of Filipino families
face catastrophic costs due to this disease. Hence,
the Philippines aims to diagnose, notify, and treat 2.5
million people with active TB by 2022.
For the past 20 years, Philippine Business for Social

Progress has served as one of the key players in TB
control management in the Philippines, having
cemented its solid experience and expertise in
managing projects as subcontractor and later as
principal recipient through funding from major
donors like the United States Agency for International
Development, United Way Worldwide and The Global
Fund.
Under PBSP’s portfolio, more than 37,000 multidrug-

resistant patients underwent treatment, more than
43,000 healthcare providers were trained, hundreds of
treatment centers across the country were built, over
200 companies established Workplace TB policies
and programs, and thousands of patients were cured.
These numbers increase each year as PBSP continues
to partner with the Department of Health National TB
Control Program in its goal to end TB in the country.
TRAINER’S E-MANUAL III

RATIONALE FOR THE ONLINE PICT TRAINERS’ MANUAL
The Philippines has the fastest growing HIV epidemic in the Asia and Pacific region with the annual
increase of 203% from between 2010 and 2018. Currently, 64% of total cumulative HIV cases are diagnosed
only in the last five (5) years. Two-thirds of the cases were young people between 15 to 24 years old.
Integrated HIV Behavioral and Serological Surveillance (IHBSS) conducted in 2018 key findings on HIV
prevalence for MSM & TGW who ever had anal sex across the 13 sites at 5.9%, syphilis prevalence at 4.0%,
Hepatitis B prevalence at 4.9% and Hepatitis C prevalence at 1.6% in Cebu City. Likewise, the Philippines
is the 9th worldwide which has a high burden of TB according to the World Health Organization (WHO)
and reported as the 6th leading cause of death with 73 Filipinos dying of TB per day by the Department
of Health (DOH). Before the COVID 19 pandemic, it was already recognized that the Philippines had an
increasing HIV and TB incidences.
On the other hand, the blueprint for the national response which is Philippine HIV Policy Act of 2018,
Article IV – Screening, Testing and Counseling under Section 31 – Mechanisms and Standards on
Routine Provider-initiated and Client-initiated Counseling and Testing mandates that “pre and post-test
counseling shall be done by the HIV and AIDS counselor, licensed social worker, licensed health service
provider, or a DOH-accredited health service provider; Provided, that for the government HIV testing
facilities, pre-test and post-test counseling shall be provided for free.” Likewise, the DOH shall “set the
standards for HIV counseling and shall work closely with HIV and AIDS CSOs that train HIV and AIDS
Counselors and Peer Educators in coordination and participation of the NGOs, government organizations
(GOs), and Civil Society Organizations of PLHIV (CSO-PLHIV)” In this light, the HIV Counseling and Testing
(HCT) Training and other related training must be supervised by the Department of Health even at least
at the regional-level and also following the standard set by the department. In 2017, the Administrative
Order 2017-0019 declares the Policies and Guidelines in the Conduct of Human Immunodeficiency Virus
(HIV) Testing Services (HTS) in Health Facilities. This policy directs the DOH Regional Offices to facilitate
capability-building activities regarding HTS, to ensure testing sites’ compliance to certification, licensing
and accreditation and monitor and supervise the implementation of HTS. Hence, coordination must
be initiated accordingly. The Administrative Order 2014-0005 “Revised Policies and Guidelines for the
Collaborative Approach of TB and HIV Prevention and Control” mandates to intensify case finding by
screening and management of HIV among confirmed TB cases and among those HIV infected individuals.
The stringent measures to respond to the COVID-19 pandemic have significantly affected the access and
supply of HIV and TB services. In the Online Survey conducted by the Epidemiological Bureau (EB) of the
Department of Health (DOH), while the HIV testing dropped to more than 74%, there was an increased
proportion of MSM and TG who engages in anal sex based on the Global Fund HIV Project. Data also
showed that while there was an increase in the number of PLHIV who were not diagnosed, there were
more PLHIV who are not on treatment. Clearly the pandemic has affected the access to services, Hence,
the HIV service delivery points need to be ensured and expanded. The demand for more HIV service
providers must not stop from expanding during the pandemic as more new HIV infection cases need
to be diagnosed and linked to care. The HIV counseling and testing (HCT) training must continue and
maximize the existing technologies while adhering to the requirements set by the government response
to the pandemic.
IV TRAINER’S E-MANUAL
ACKNOWLEDGEMENT
As an interim response to the challenges posed by the COVID 19 Pandemic and the community restrictions
imposed by the government, this Training Resource Package aims to bridge the continuation of trainings
for Health Service Providers (HSPs) of TB-DOTS and PMDT Facilities on HIV Counseling and Testing. The
development of this manual was commissioned by Philippine Business for Social Progress (PBSP) -
ACCESS TB Project and the Department of Health (DOH) under the technical directions of Dr. Jose Gerard
Belimac and Dr. Anna Marie Celine Garfin. A core Group was formed to lead the development of this
Training Resource package for Online Training on PICT for TB-DOTS and PMDT Facilities. The members
of the core group are: Michael Cagaoan, Celestino Ramirez, Ryan Pinili, Devine David and Jhaye Encabo.
PBSP-ACCESS TB and the core group would like to acknowledge the following for their valuable time and
effort in the development of this Trainer’s Resource Package:
MASTER HIV COUNSELOR TRAINERS’
� Rosario Jessica Tactacan-Abrenica, MD � Bro. Lolito P. Cruz � Mary Ann Joy Aguadera, MD
� Jason “Jhaye” Encabo � Honnielyn Fernando, MD � Celestino “KT” Ramirez
DOH-CERTIFIED HIV COUNSELING & TESTING TRAINERS’
BATCH 2014
� Maria Cecila Anonuevo, RSW � Ryan Pinili, PTRP
BATCH 2015
� Renz Robinson Alvaro � Ma. Grace Guevarra, RMT � Anjela Platon, RN
BATCH 2019
� Nicolle Lourdes Dela Cruz, MD � John Dave Mare “Devine” David
SPECIAL MENITON TO:
� Jojie Maglaqui, RPsy � Mary Joy Morin, RN � Jesus “Jess” Ramirez
IN MEMORIAM:
� Gerardo Alcantara, MD � Aureo de Castro
TRAINER’S E-MANUAL V
RATIONALE FOR THE ONLINE PICT TRAINERS’ MANUAL
Introduction to the Trainer’s Resource Package:
The training resource package for the “Training on Provider-Initiated Counseling and Testing (PICT)
for Health Services Providers of TB Facilities” was developed during a series of consultations, locked-in
planning and designing sessions starting September 13 to November 30, 2020 with the core Group and
other experts mentioned above.
Overall Objectives of the Training:
1. To improve the technical capacity of counselors to provide HIV testing and counseling specific to
contact with enrolled TB-patients;
2. To train counselors in evidenced-based counseling strategies that may include pre-test and post-
test counseling across the HIV disease continuum;
3. To provide counselors with skills to support adherence to HIV treatment and care; and,
4. To reduce the psychological morbidity associated with HIV diseases and improve the quality of life
of people living with HIV.
This 7-day training package consists of the following:
1. Trainer’s Manual on PICT for TB Facilities - the manual consists of 15 session plans, reporting and
recording forms, policies and counseling tools.
2. Philippine Handbook for HIV Counseling and Testing (Three Sections)
3. Synchronous HCT Training Videos (6 videos)
4. Online Quizzes and Forms
5. Fact Sheets on the Policies
6. NTP Recording and Reporting Tools
Before starting any training programme, you may wish to refer to this trainer’s manual for preparation
and taking note of the program flow.
REMEMBER: The session plans, activity forms and tools in the trainer’s manual should be used in
conjunction with the Philippine Handbook on HIV Counseling and Testing.
VI TRAINER’S E-MANUAL
Please make sure that the Online Training Kit containing all electronic copies of the materials and videos
be sent to the participants at least two (2) weeks before the actual training date. The Kit shall contain the
following:
Reference Materials:
15. Positive Thinking Meditation
1. HIV Counseling Handbook for the Asia-Pacific
16. Virtual Meeting Etiquettes: Dos and Don’ts
2. Tools for HIV Counseling for the Asia-Pacific
Reference Reading Materials:
3. Philippine Handbook HIV Counseling and
Testing (Sections 1 to 3) 1. IRR RA 11166
4. Trainer’s Manual Philippine National AIDS 2. AO 2014-0005 TB-HIV

Council (Modules 1 to 7) 3. AO 2017-0019 HTS
4. DC 2016-0171 Enhancing Linkage to Care
Video Materials:
5. AO 2009-0016 PMTCT
1. And the Band Played On
6. AO 2018-0024 ART
2. HIV 101 AVP Crowd
7. AO 2019-0001 rHIVda
3. HIV Replication
8. DM 2020-0276 CBS
4. HIV What’s Going on Inside Your Body?
9. Philhealth Circular
5. HIV Stopping the Virus
10. UNAIDS Terminology
6. HIV The Goal of Undetectable
7. PrEP Other Materials for Participants:
8. Putting a Condom 1. UIC Template
9. Comprehensive Sexuality Education 2. Gender bread Person Version 4
10. The Girl Effect 3. Brief Suicide Preventive Intervention
11. Talking About Mental Health: Tagalog 4. Mental Health and HIV
12. Talking About Mental Health: Cebuano 5. HIV and Mental Health
13. Conducting State of the Art Suicide Assessment 6. Training Ground Rules
14. Something More
TRAINER’S E-MANUAL VII

TABLE OF CONTENTS
Rationale of the Trainers’ Manual IV

Acknowledgment V
Introduction and Use of this Manual VI
PICT Preliminarie
Session Plan 1
Slide Presentation 2
UIC template 4
Daily Reflection 5
Workshop Ground Rules 6
PICT M1: What Counselors Should Know on STI, HIV-TB

Session Plan 7
Section 1 Chapter 1 What Counselors Should Know on STI, HIV-TB 12
Section 3 Chapter 17 Counseling TB Patients 15
Tools 19
PICT M2: Understanding Sex, Gender, Sexuality and SOGIE

Session Plan 21
Section 3 Chapter 13 Counseling MSM/ Transgender/ Intersex Clients 25
When the Tears Dry Up 32
PICT M3: RA 11166 and Other Policies & Guidelines

Session Plan 33
Factsheets 38
PICT M4: The Responsibilities of TB Healthcare workers as Trained HIV Counselors

Session Plan 85
Fact Sheets 88
PICT M5: Key Elements of Ethical of Effective HIV Counseling Practice

Session Plan 97
Section 1 Chapter 2,3 Counseling: An Overview 101
PICT M6: HIV Testing Process and HTS Forms

Session Plan 107
HIV Test Results 110
VIII TRAINER’S E-MANUAL

PICT M7: Conducting the Group Pre-test Information
Session Plan 113
PICT M8: Conducting the Individual HIV Pre-test Counseling among TB Patients
Session Plan 117
Pre-Test Counseling 123
Tools 125
PICT M9: Conducting the Individual HIV Post-test Counseling among TB Patients
Session Plan 129
Slide presentation 133
Post-Test Counseling 135
Tools 137
PICT M10: Ensuring a Successful Referral

Session Plan 141
PICT M11: Recording and Reporting for TB Patients Provided with PICT
Session Plan 145
PICT M12: Mental Health & HIV and the Importance of Suicide Risk Assessment
in HIV Counseling; Facilitating HIV Disclosure
Session Plan 153
Factsheets 157
Tools 170
PICT M13: Counselor Self-Care

Session Plan 171
Infographics 174
PICT Closing Activities

Session Plan 175
Code of Ethics 176
Training Evaluation 177
Infographics 178
TRAINER’S E-MANUAL IX
SESSION PLAN
PRELIMINARY ACTIVITIES
Title of the Session Preliminaries
Duration 50 minutes
Session Know the expectation of the participants as to the training, their co-
Objective/s: participants and the trainers
At the end of the Remind the participants about the rules to observe during the entire
course and the online etiquettes in participating in the online platform
training session,
the trainers will be Gauge the level of knowledge of the participants regarding HIV prior to
able to: the training
Identify which topic or information needs to be strengthened
Content: Expectations regarding the training, co-participants and trainers

gathered through google form at the start of the training.
Set of house rules provided to the participants ahead of time and online
etiquette while attending the online training
Pre-test evaluation examination through google form
Materials needed Power point Presentation on the summary of the expectations

Power point Presentation of the house rules to be reminded to the
participants and the online etiquette to be observed
Online pre-test examination
Email Address of each participant
Important Slide 1: Summary of Training Expectation Result

Information to Slide 2: House Rules to remind
appear in the ppt
presentation
Instructions to the 1. Preparations:

Trainer Prepare the link for the training expectation form. You may ask the
participants to access the link and answer them as they come so
trainers have time to collate the participants’ responses and include
them in the presentation.
Prepare the House rules and online training etiquette
Prepare the online exam link
Prepare the UIC template; Have it flashed while participants
are taking the examinations so they may be reminded of it and
disturbances are minimized while they are taking the test.
2. End session.
Reminders to Mute microphone all throughout the session.

participants They can ask questions anytime using the chat box
1 TRAINER’S E-MANUAL
SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE
TRAINER’S E-MANUAL 2
SLIDE PRESENTATION
7TH SLIDE 8TH SLIDE
9TH SLIDE
UIC TEMPLATE
DAILY REFLECTION
UIC: DAY REFLECTION DATE:
Today I learned…
Tomorrow, I hope…
UIC: DAY REFLECTION DATE:
Today I learned…
Tomorrow, I hope…
ORGANIZER’S COPY
Workshop Ground Rules
1. All participants are encouraged to contribute to the workshop to the extent they are able to.
2. Participants and facilitators have an equal part in creating a safe environment wherein all feel free to
speak and contribute to the discussion.
3. All participants (including facilitators) listen with an open mind and encourage input.
4. Everyone’s opinion will be valued and respected – disagreements are welcome but must be non-
judgmental in tone.
5. Everyone has the right to pass up any valid question.
6. “I-statements” – it is preferable to share your feelings or values using “I-statements.”
7. All honest questions are valid and participants should respect each other’s informational needs. If
participants wish, workshop facilitators will maintain a confidential question box for anonymous
questions, and all questions will be addressed in time .
8. It is acceptable to feel uncomfortable with the topics under discussion – one purpose of the workshop
is to help reduce the feeling.
9. Disruptions (e.g., cell phones, pagers, and non-emergency phone calls) are discouraged.
10. Participants and facilitators commit to being on time and participating in all sessions.
Signature over Printed name: Date:
PARTICIPANT’S COPY
Workshop Ground Rules
1. All participants are encouraged to contribute to the workshop to the extent they are able to.
2. Participants and facilitators have an equal part in creating a safe environment wherein all feel free to
speak and contribute to the discussion.
3. All participants (including facilitators) listen with an open mind and encourage input.
4. Everyone’s opinion will be valued and respected – disagreements are welcome but must be non-
judgmental in tone.
5. Everyone has the right to pass up any valid question.
6. “I-statements” – it is preferable to share your feelings or values using “I-statements.”
7. All honest questions are valid and participants should respect each other’s informational needs. If
participants wish, workshop facilitators will maintain a confidential question box for anonymous
questions, and all questions will be addressed in time .
8. It is acceptable to feel uncomfortable with the topics under discussion – one purpose of the workshop
is to help reduce the feeling.
9. Disruptions (e.g., cell phones, pagers, and non-emergency phone calls) are discouraged.
10. Participants and facilitators commit to being on time and participating in all sessions.
SESSION PLAN
PICT M1
Title of the Session What a Counselor Should Know on STI, HIV-TB
Duration 1 hour and 15 minutes
Reference Guide Chapter 1 pages 2- 12

Section 3 Chapter 17 pages 192- 196
Chapter 18 pages 197- 208
Chapter 19 pages 209- 214
Annex B page 217
Session How is HIV transmitted?

Objective/s: How is HIV diagnosed?
At the end of the How HIV disease progresses?
training session, How does HIV treatment work?
the trainers will be How are STIs transmitted?
able to: What are types of STI?
How STI is related to HIV?
How HIV and TB are related?
How important it is for TB patients to be tested with HIV?
Content: The difference between HIV and AIDS

The Immune System
HIV Transmission and Prevention Messages
Link of HIV to STI, TB and Pregnancy
How HIV is diagnosed and Treated
Types of HIV Testing, Results and Window Period
HIV Disease Progression (including clinical staging)
HIV Clinical Management (focused only on monitoring immune system,
importance of HIV ARV drugs, co-infection with TB, STI co- infection, Viral
hepatitis co-infection)
Updates on National HIV and STI Response
Tools needed Video Presentation (HIV 101)

PowerPoint Presentation
Handbooks and Handouts
Online Learning Gadget: Laptop, Tablet, Mobile, Headphone, preferably
with Microphone (make sure it’s near your mouth when you speak)
Important Slide 3- Objectives

Information to Slide 4 - “Keep messages (it) Simple, Short and Specific”
appear in the ppt Slide 5 - Basic Information Template “1-2-3-4-5”
presentation Slide 6 - HIV Disease Progression (for artwork) “Keep Immune System
Healthy”
Slide 7 - Link of HIV to TB coinfection, STI, Pregnancy “Opportunistic
Infections takes advantage of a weak immune system”
Slide 8 - National HIV and STI Response (Free ARVs and Treatment Hubs
and Primary Care Clinics, Blood and Organ
Safety, PMTCT, PEM, PreP, Harm Reduction for PWID, HTS, rHIVda, CBS
and U=U)
Slide 8 - Closing slide THANK YOU!
SESSION PLAN
Speakers Note’s Refer to Table 1.3 WHO Clinical Staging from Handbook Section 1:
on Additional Introduction
Information Discussion on Link of STI to HIV, transmission and the 6 common STI
syndromes
Instructions to 1. Preparations:
the Trainer � Prepare the video material and check on the connectivity and audio.
� Prepare the PowerPoint presentation on the laptop and check if
PowerPoint is readable and audio is operational. Q&A
� Prepare Zoom Poll o
2. On the exact session, show slide 1 and introduce the session by discussing
the objectives and flow of the session.
3. Allow trainees to watch the video on “Basic HIV Information for Service
Providers”.
4. Begin processing by asking the trainees on their learning and insights from
the video.
5. Show Slide - 2 and explain the importance of clearly and concisely
communicating the information to the client.
6. Ask the trainees to provide examples of information that is difficult to
communicate to clients.
7. Process by asking on the reason “why?” is it difficult to communicate.
8. Show Slide - 3, ask the participants if they could relate these numbers to the
messages they watched in the video.
9. Process by emphasizing on “1-2-3-4-5” as the template for providing and
explaining basic HIV information to clients.
10. Show Slide - 4 and explain on HIV disease progression and emphasize on
maintaining a healthy immune system.
11. Ask the trainees on the possible practices that will ensure a healthy immune
system.
12. Show Slide 5 and explain the link of HIV to TB, STI, Pregnancy and weak
immune system. Emphasize on the inset of opportunistic infection if a
person is living with HIV, and how it takes advantage of a weak immune
system.
13. Show Slide 6 and explain the importance of early HIV diagnosis and
Treatment. Discuss the Types of HIV testing and its effectiveness and explain
the window period.
Reminders to 1. Always refer to DOH, WHO and UNAIDS for evidenced- based facts when
participants sharing or giving information
2. Level off with your client’s level of comprehension, avoid using medical
and scientific jargons.
3. You are taking the role of a DOH-Trained HIV Counselors, resource person
and speaker. Be careful on maintaining ethics and proper decorum.
4. When sharing slides and downloading pictures on the internet. It also has
copyright issues. Better use words or do your own artwork.
SESSION PLAN
Zoom Polls for Slide 3 Poll: Nakakahawa ang AIDS. (Tama, Mali, Hindi Alam)
Interaction (after
Slide 3 Poll: Mamamatay ka sa HIV. (Tama, Mali, Hindi Alam)
slide presentation)
Slide 3 Poll: Maisasalin ang HIV sa kagat ng Lamok. (Tama, Mali, Hindi
Alam)
Slide 5 Poll: Kapag may TB madaling mahawaan ng HIV. (Tama, Mali,

Hindi Alam)
Slide 5 Poll: Kapag may Tulo (Gonorrhea) ka magiging HIV positive ka.
(Tama, Mali, Hindi Alam)
Slide 5 Poll: Lahat ng sanggol na isinilang mula sa Isang inang HIV positive
ay magkakaroon reactive sa HIV antibody Test. (Tama, Mali, Hindi Alam)
Toolkit to be used Source: Tools for HIV Counseling for the Asia Pacific
1.1 HIV Transmission
1.2 HIV Replication
1.3 Explaining HIV in the body
1.4 Sexually Transmissible Infection Syndromes
4.2 Window Period
4.3 Correct Condom Use
4.4 Safe Injecting
Additional Tool:
Communicating information to your clients (laymanized
explanation)
Things to remember in HIV
SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE
SLIDE PRESENTATION
7TH SLIDE 8TH SLIDE
Section 1 Chapter 1 What Counselors Should Know on STI, HIV-TB
2 3
Chapter 1 The Immune System
What HIV counselors need to know about HIV, STI, and TB: The Basics
The immune system is a collection of cells and substances that defend the body against for-
Your work as an HIV counselor will require you to understand and communicate to clients eign substances, also known as antigens. An antigen is a substance (such as HIV) that, when
a number of facts about HIV: how it is transmitted, how it is diagnosed, how the disease introduced into the body, stimulates the production of an antibody (the word antigen is short
progresses, and how HIV treatments work. It is also important that HIV counselors understand for ”antibody generating”; antibodies fight antigens). Antibodies form in a person’s blood
how sexually transmitted infections (STIs) are transmitted, treated, and relate to HIV. As HIV when HIV or other antigens enter the body. Usually antibodies defend against disease agents.
fuels the tuberculosis (TB) epidemic, it is important that counselors understand the relation- The replication of HIV in the body over time, and especially without pharmacological inter-
ship between HIV and TB, and the role counseling plays in addressing TB-HIV co-infection. vention, breaks down the immune system to the point where it can no longer fight disease.
This guide assumes that counselors have the opportunity to consult with or make referrals to The immune system can be compared to an army guarding the borders of a state and pro-
a doctor or medical officer for clinical problems. tecting it from foreign invasion. As long as the army is strong, the state has little to fear. But if
the army is weakened or encounters a stronger enemy, the state becomes vulnerable and can
no longer defend itself against attacks, even from smaller neighbors.
The immune system functions in a similar way. It is composed of cells (called T-lymphocytes
and B-lymphocytes) that perform the role of defending army. Among the T-lymphocytes are
What is HIV? How is it different from AIDS? cells that carry what are known as CD4 receptors. These cells are called T4 lymphocytes (or
T-cells or CD4 cells).
HIV stands for Human Immunodeficiency Virus, a type of retrovirus that attacks the immune
system of a person. Researchers have identified two types of HIV: HIV-1 and HIV-2. HIV-1 and HIV infects a person’s CD4 and T-cells and uses them to make copies of itself–a process
HIV-2 are transmitted in the same way and are associated with similar opportunistic infections, known as replication. In a person infected with HIV, CD4 cells are progressively destroyed. As
though they differ in the efficiency of transmission and rates of disease progression. HIV-1 these cells are destroyed, an infected person’s immune system is weakened and the person is
accounts for the majority of infections in the world; there are more than 10 genetic subtypes. more likely to develop opportunistic infections (OIs) and certain cancers. Any other infection
HIV-2, found primarily in West Africa, appears to be less easily transmitted and progresses that stimulates the immune system is likely to accelerate this destruction, making the person
more slowly to AIDS than HIV-1. A person can be infected with both types of HIV simultane- more vulnerable.
ously. It causes AIDS in humans.
AIDS is an acronym for ”Acquired Immune Deficiency Syndrome”. Acquired means “trans-
mitted from person to person”; immune is the body’s system of defense; deficiency means
a ”lack of” or not working to the appropriate degree; and a syndrome is a group of signs Principles of HIV Transmission
and symptoms. AIDS is a condition of advanced stage of HIV infection, wherein the immune
system is severely compromised. This makes the individual prone to various opportunistic There are four body fluids that carry high concentration of HIV: blood, semen, vaginal fluids,
infections manifesting with different signs and symptoms. Not all persons living with HIV will and breast milk. It can be transmitted in any of four ways:
have AIDS.
• through sexual contact with an infected person;
• from infected mother to baby before or during birth or through breast-feeding after
birth;
• through infected blood and blood products (transferred via blood transfusions and
organ transplants); or
• through the sharing of needles, syringes, and other injecting equipment (including
tattooing equipment).
4 5
For HIV to be successfully transmitted, it should meet the four principles: Transmission through infected blood
Field Test version only Field Test version only
• Exit - the virus must exit the body of an infected person HIV infections resulting from the transfer of infected blood account for about 5% of all HIV
• Survive –the virus must be in conditions in which it can survive infections in the Philippines. Transmission can occur through transfusion with contaminated
o (TAMA) – temperature, atmosphere, moisture, acidity blood or blood products, the exchange or sharing of needles or contaminated syringes, and
• Sufficient – sufficient quantities of the virus must be present to cause infection needle stick injuries.
• Enter – the virus must enter the blood stream of another person
Table 1.1 HIV Exposure Risk
The chance that a person will become infected with HIV varies greatly depending on the type
of exposure he or she has had. For example, the risk of becoming infected with HIV through Risk of
Type of Exposure
a blood transfusion with infected blood is very high compared with the risk of becoming in- Transmission
fected from an accidental needle prick in the health-care setting. Similarly, there is less risk of
acquiring HIV from unprotected oral sex than from unprotected anal or vaginal sex. Blood Products 90 %
Mother to Child Transmission 13 - 48 %
Needle Sharing; IV drug use 0.67 %
Unprotected anal intercourse 0.56 %
Needle Stick 0.3 %
Unprotected vaginal intercourse

0.1 %
M --> F
Unprotected vaginal intercourse

0.05 %
F --> M
It is important that your clients understand that HIV may be present in and transmitted by MMWR Jan 21, 2005/ 54(RR02); 1-20 adapted
semen, vaginal fluids, breast milk, and blood. In order for your clients to reduce risk they will
need to understand that different behaviours carry different levels of risk. HIV counselors
must assess each client’s understanding and impart relevant information depending on his or Transmission during pregnancy, delivery and breastfeeding
her needs and level of knowledge. Clients and patients must be encouraged by counselors
to make informed decisions about testing and behaviour change. Such informed decisions A mother can transmit HIV to her child during pregnancy or delivery, or through breast-
require a clear understanding of the modes of transmission, the risk involved, and the im- feeding. The risk of transmission is affected by factors related to the virus, the mother, the
plications of an HIV test result, as well as the correction of clients’ misconceptions. About delivery process, the baby, and infant-feeding practices. During pregnancy and delivery, the
70%-80% of global HIV transmission occurs through unprotected sexual intercourse between mother’s health, disruption of the placental barrier, preterm delivery, and hemorrhage are
infected persons and their partners. The sexual contact may be heterosexual or homosexual. significant predictors of the child’s infection. Viral, bacterial, or parasitic placental infections
are other factors that increase the opportunity for transmission during this period. Most infants
In the Philippines, from 1984 – 2009 the predominant mode of transmission was male -fe- who acquire HIV during delivery have been exposed to maternal blood or cervical secretions
male sex. Beginning 2010, the trend shifted to male-male sex as the predominant mode of that contain the virus. Prolonged membrane rupture and invasive delivery techniques have
transmission and has continually increased since then.1 While the probability of transmitting also been associated with higher risks of mother-to-child transmission (MTCT) during labor
HIV in a single sexual act is quite low, even a lower-risk activity can get people infected if it and delivery. The risk of MTCT increases if a woman has a higher viral load, which occurs
is done often enough. Furthermore, the risk of infection can increase dramatically because of if she becomes infected or reinfected with HIV during pregnancy or if she becomes ill with
several factors, including the presence of a prior STI (sometimes manifested in genital sores AIDS. HIV counselors should emphasize early initiation of anti-retroviral therapy (ART) upon
or discharge) and unprotected intercourse with sexual partners. diagnosis or at least 4 weeks before delivery. Condom use must also be emphasized during
pregnancy to prevent reinfection of HIV and other STI.
After delivery, breastfeeding is the most significant risk factor without ART. WHO recommends
that HIV positive mothers (and whose infants are HIV uninfected or unknown HIV status) should
1
Epidemiology Bureau. Feb 2017
exclusively breastfeed their infants for the first six months of life, introducing appropriate
Section 1 Chapter 1 What Counselors Should Know on STI, HIV-TB (CONTINUED)
6 7
complementary foods thereafter and continue breastfeeding for at least 12 months for up to HIV Disease Progression
24 months or longer. Breastfeeding should then only stop once a nutritionally adequate and
safe diet without breast milk can be provided. Mothers should be fully supported for ARV HIV infection is the successful entry of HIV in the body. HIV induces the body’s immune system
adherence. to produce antibodies. At the time of infection, 30%-50% of people have a recognizable acute
illness characterized by fever, lymphadenopathy (enlarged lymph nodes), night sweats, skin
rash, headache, and cough or commonly described as flu-like symptoms.
HIV-positive individuals may remain asymptomatic for up to 10 or more years. In this phase
they are potentially a critical factor for HIV transmission, as they are infectious but can be
identified only through HIV test. At this point, it is crucial for the person to know his/her HIV
status.
After a period that varies from person to person, an individual’s viral load (number of virus
present in the body) increases as HIV continues to multiply, and along with it, the immune
system is weakened by the destruction of CD4 cells, resulting in a condition called AIDS
Table 1.2: Timing of transmission of HIV from mother to child or Acquired Immunodeficiency Syndrome. Progression depends on a number of factors:
w/ ART + the type of HIV infection, the person’s age, other infections, possibly genetic (hereditary)
mother factors, lifestyle, and other risky behaviors. Infections, diseases, and malignancies occur
MTCT Risk without ARV infant
on ART
prophylaxis among HIV-infected individuals and are related to the degree of immune suppression.
During pregnancy 35% 2%* ---
Overall without breastfeeding 20 - 25% 0%* 0%*
Overall with breastfeeding up to 6mos 25 - 30% 1.08%** 1.08%**
Overall with breastfeeding up to 12mos 30 - 35% 11%* 2%*
Overall with breastfeeding up to

30 - 35% 22%* ---
18 - 24 mos
Source: de Cock K. et al. Prevention of mother-to-child HIV transmission in resource-poor countries: Translating research
into policy and practice. JAMA 2000, 283: 1175-1182.
* UNAIDS. Ending new HIV Infections among children. 2012
** Chikhungu Lana, Stephanie Bispo and Marie-Louise Newell. Postnatal HIV Transmission rates at age six and 12 months
in infants of HIV-infected women on ART initiating breastfeeding: a systematic review of the literature. WHO. 2016
The window period

WHO clinical staging
For an HIV-infected individual, the window period is a common term used for the time between
the initial HIV infection and the detection of HIV antigens and antibodies. If a person is non - For people who present with clinical symptoms, diagnosis is usually based on the WHO
reactive to HIV antibody tests, the HIV counselor should explain that the person may either clinical stage (see table 1.3 below). Though counselors are not expected to make diagnoses, they
be non-infected or may have been infected from the most recent exposure but the body must be aware of clinical staging to facilitate referral to medical providers for clinical management.
has not produced sufficient level of antibodies that can be detected by the HIV test kit.
However, HIV is replicating in the body and the person can already transmit the virus to
another person.
HIV Counselors should encourage retesting for HIV after six (6) weeks from the last HIV test
8 result for individuals who received non-reactive result but with significant risk for HIV. 9
Table 1.3 WHO Clinical Staging Adults and Adolescents a Children
Clinical Stage 4c
HIV wasting syndrome Unexplained severe wasting, stunting or
Adults and Adolescents a Children severe malnutritiond not responding to
Pneumocystis (jirovecii) pneumonia standard therapy
Clinical Stage 1
Recurrent severe bacterial pneumonia Pneumocystis (jirovecii) pneumonia
Asymptomatic Asymptomatic
Chronic herpes simplex infection Recurrent severe bacterial infections
Persistent generalized lymphadenopathy Persistent generalized lymphadenopathy (orolabial, genital or anorectal of more than (such as empyema, pyomyositis, bone or
one month in duration or visceral at any joint infection, meningitis, but excluding
Clinical Stage 2 site) pneumonia)
Moderate unexplained weight loss Unexplained persistent hepatosplenomegaly Esophageal candidiasis Chronic herpes simplex infection
(<10% of presumed or measured body (or candidiasis of trachea, bronchi or lungs) (orolabial or cutaneous of more than 1
weight) Recurrent or chronic upper respiratory tract month’s duration or visceral at any site)
infections (otitis media, otorrhoea, sinusitis, Extrapulmonary tuberculosis
Recurrent respiratory tract infections tonsillitis) Esophageal candidiasis
(sinusitis, tonsillitis, otitis media, pharyngitis) Kaposi sarcoma (or candidiasis of trachea, bronchi or lungs)
Herpes zoster
Herpes zoster Cytomegalovirus infection Extrapulmonary tuberculosis
Lineal gingival erythema (retinitis or infection of other organs)
Angular cheilitis Kaposi sarcoma
Recurrent oral ulceration Central nervous system toxoplasmosis
Recurrent oral ulceration Cytomegalovirus infection
Papular pruritic eruption HIV encephalopathy (retinitis or infection of other organs with
Papular pruritic eruption
Fungal nail infections onset at age older than one month)
Fungal nail infections Extrapulmonary cryptococcosis,
Extensive wart virus infection including meningitis Central nervous system toxoplasmosis
Seborrhoeic dermatitis (after the neonatal period)
Extensive molluscum contagiosum Disseminated nontuberculous mycobacterial
infection HIV encephalopathy
Unexplained persistent parotid enlargement
Progressive multifocal leukoencephalopathy Extrapulmonary cryptococcosis,
Clinical Stage 3 including meningitis
Chronic cryptosporidiosis
Unexplained severe weight loss Unexplained moderate malnutritionb not Disseminated nontuberculous mycobacterial
(>10% of presumed or measured body adequately responding to standard therapy Chronic isosporiasis infection
weight)
Unexplained persistent diarrhoea Disseminated mycosis (extrapulmonary histo Progressive multifocal leukoencephalopathy
Unexplained chronic diarrhoea for longer than (14 days or more) plasmosis, coccidioidomycosis)
1 month Chronic cryptosporidiosis (with diarrhoea)
Unexplained persistent fever Lymphoma (cerebral or B-cell non-Hodgkin)
Unexplained persistent fever (intermittent or (above 37.5°C, intermittent or constant, for Chronic isosporiasis
constant for longer than 1 month) longer than one 1 month) Symptomatic HIV-associated nephropathy or
cardiomyopathy Disseminated endemic mycosis
Persistent oral candidiasis Persistent oral candidiasis (extrapulmonary histoplasmosis,
(after first six weeks of life) Recurrent septicaemia coccidioidomycosis, penicilliosis)
Oral hairy leukoplakia (including nontyphoidal Salmonella)
Oral hairy leukoplakia Cerebral or B-cell non-Hodgkin lymphoma
Pulmonary tuberculosis Invasive cervical carcinoma
Lymph node tuberculosis; HIV-associated nephropathy or
Severe bacterial infections (such as pneumonia, pulmonary tuberculosis Atypical disseminated leishmaniasis cardiomyopathy
empyema, pyomyositis, bone or joint infec-
tion, meningitis, bacteraemia) Severe recurrent bacterial pneumonia
a In the development of this table, adolescents were defined as 15 years or older. For those younger than 15
Acute necrotizing ulcerative stomatitis, gingivi- Acute necrotizing ulcerative gingivitis or years, the clinical staging for children should be used.
tis or periodontitis periodontitis b For children younger than 5 years, moderate malnutrition is defined as weight-for-height < –2 z-score or
Unexplained anaemia (<8 g/dl), Unexplained anaemia (<8 g/dL), mid-upper arm circumference ≥115 mm to <125 mm.
Neutropaenia (<0.5 × 109/L) or c Some additional specific conditions can be included in regional classifications, such as penicilliosis in Asia,
Neutropaenia (<0.5 × 109/L) and/or Chronic thrombocytopaenia (<50 × 109/L) HIV-associated rectovaginal fistula in southern Africa and reactivation of trypanosomiasis in Latin America.
Chronic thrombocytopaenia (<50 × 109/L) d For children younger than five years of age, severe wasting is defined as weight-for-height < –3 z-score;
Symptomatic lymphoid interstitial pneumonitis
stunting is defined as length-for-age/height-for-age < –2 z-score; and severe acute malnutrition is either
Chronic HIV-associated lung disease, including weight for height < –3 z-score or mid-upper arm circumference <115 mm or the presence of oedema.
bronchiectasis
Source: Adapted from: WHO case definitions of HIV for surveillance and revised clinical staging and immuno-
logical classification of HIV-related disease in adults and children. Geneva, World Health Organization, 2007
(www.who.int/hiv/pub/guidelines/HIVstaging150307.pdf).
Section 1 Chapter 1 What Counselors Should Know on STI, HIV-TB (CONTINUED)
10 11
Table 1.4 Type of sexually transmitted infections according to etiology

What does clinical management involve?
Individuals who are reactive to HIV test or confirmed HIV positive should be immediately
linked to care at the DOH-designated treatment hub or primary HIV care facilities of choice
by the individual for clinical assessment and management, including ART initiation, immune
system monitoring, adherence counseling, follow up care, and appropriate referrals.
Antiretrovial therapy
Antiretroviral Therapy (ART) refers to the use of a combination of three or more ARV drugs
to achieve viral suppression. This generally refers to lifelong treatment aimed at prolonging
and improving the quality of life of a person living with HIV (PLHIV).
Opportunistic infections
Other Opportunistic In counseling clients with STI, the following must be considered:
An individual with a low CD4 count is susceptible to Infections in the Philippines
opportunistic infections (OI). The prevention and treatment • It is difficult to change sexual behaviour. Knowledge does not automatically lead
Oral Candidiasis
of OI decreases the mortality risk of HIV infection. Individuals to behaviour change. STI control is difficult because sexual practices are rooted in
Syphilis
with low CD4 counts are prescribed preventive medications everyday life and culture. Counselors should let their clients know that they can help
called OI prophylaxis. If CD4 count is below 200, Co-tri- Retinitis
them make these changes.
moxazole, Azithromycin and Isoniazid are given to prevent Warts
pneumonia, and TB infections. Pneumocytis Pneumonia
• People find it embarrassing to discuss sex. Sometimes people are shy about asking
Other types of Pneumonia for the information they need, slow in seeking treatment, or reluctant to discuss
The clinical management of OIs may also involve nutrition Cryptococcal Meningitis the issue with their partners. People can feel uncomfortable talking about sex, and
counseling and treatment of HIV wasting and severe weight Cytomegalovirus retinitis the subject is sometimes taboo. Counselors should carefully explain to the client or
loss, chronic or intermittent fever, and chronic or intermittent patient why discussing these sensitive issues is so critical.
Herpes zoster
diarrhea
• Many people with STI exhibit no symptoms. People with STIs can spread infection
Hepatitis B and C co-infection even without knowing they are infected. Counselors should refer all clients presenting
Hepatitis B (HBV) and hepatitis C (HCV) co-infection are common among people who inject with transmission risks for STI screening.
drugs (PWID). HBV transmission is similar to HIV transmission. HCV, on the other hand, is
transmitted by infected blood products through sharing of injecting equipment. Both HBV • Treatment is not always available, easy, or effective. Counselors can support clients
and HCV cause liver inflammation, which may complicate the patient’s ARV treatment. Coun- in initiating and maintaining treatment adherence.
selors should therefore urge their clients to be tested for the presence of these infections.
Patients with HBV or HCV should be counselled to avoid or limit their alcohol intake to prevent
liver damage.
Other Sexually Transmitted Infections
Sexually transmitted infections (STI) are infections transmitted through unprotected sexual
intercourse through oral, vaginal or anal. STI are caused by bacteria, viruses, fungi, protozoa,
and parasites (see Table 1.4).
If left untreated, STIs can lead to serious consequences. A person with STI has an increased
risk for HIV. Thus, to reduce the risk of HIV infection, one must avoid contracting other STIs.
If other STIs do occur, they must be treated promptly and effectively to minimize the risk of
acquiring or transmitting HIV.
2
12 13
STI Core Messages
- Every sexual activity is an opportunity to acquire STI including HIV. Condom do not
cover everything
HIV Counseling:
An Overview
- Co-infection and multiple infections are common
- Some STI may have signs and symptoms, others may not. If you do not have sign and
symptoms you can still transmit the infections and they can continue to damage your
health
- If you are sexually active and having STI expose your partner/s, and if your partner/s is/
are not treated you will get STI back again
- Do not self-treat or medicate, you need the right drug for your infection, don’t risk with
fake drugs, don’t use your friend’s drugs.
- Complete the treatment even if you feel better and the symptoms disappear, untreated
or incomplete treatment of STI can lead to complications
- Having an STI can become serious when you have HIV- it can complicate your treatment
- STI can be passed from mother to child and can cause serious illness or birth defects to
the child
- Get checked if you have Hep-B. Get vaccinated so you are protected. You will need to
complete the whole course of injections and go for a post vaccination check-up to
ensure, you are protected.
STI and its link to HIV

- Same Modes of Transmission
- Same Preventive Measures
- STI services is the entry point for HIV services
- Persons with STI have higher risk of acquiring and transmitting HIV
- Persons with STI should be treated and offered HIV testing

Section 3 Chapter 17 Counseling TB Patients
Section 3 Chapter 17 Counseling TB Patients (CONTINUED)
TOOLS
Explaining HIV, AIDS and the Results to your clients
HIV Human Immuno Deficiency Virus; Isang uri ng Mikrobyo o Virus nasa tao lang
may kakayananang mabuhay at may kakahayang umatake at maka panira ng
natural na depensa ng taong magtataglay nito.
AIDS Acquired Immuno Deficiency Syndrome; Ito ay ang kondisyon na resulta ng

tuluyang pagkasira ng natural na depensa ng katawan dahil sa HIV. Sa panahong
ito, mas madalinang dapuan ng iba’t-ibang oportunistang impeksiyon ang isang
taong may HIV.
HIV Infection Ito ang matagumpay na pagpasok ng mikrobyo ng HIV sa katawan ng tao
Window Period ito ay ang panahon mula sa huling exposure (pakikipagtalik/ pagtanggap
ng dugo) hanggang tatlong (3) buwan kung saan ang katawan ay lumilikha
ng panglaban (antibody) sa HIV na sapat upang matukoy (detectable) sa
pagsususuring gagawin.
Confidentiality Ang makakaalam lamang sa lahat ng paguusapan natin ay ikaw bilang pasyente,
ako bilang counselor mo at kung kinakailangan, lahat ng tao na maaaring
magbigay ng pangangalaga sa iyo sa darating na panahon.
Paanomakukumbinsi Ang TB ay senyales ng mahinang natural na depensa, may iba-ibang dahilan ng

ang TB patient paghina ng immune system isa na rito ang pagkakaroon ng mga sakit gaya ng
magpa HIV test HIV infection. Nandito kami para ialok ito nang libre upang mas maging maayos
ang gamutan natin sa iyong TB.
Non-Reactive Result Sa ngayon, wala pang reaksiyon na natukoy sa pagsusuri maaaring ikaw ay wala
ngang HIV o di kaya ay nasa window period pa, ngunit ikaw ay ineengganyo na
magpa-ulit ng pagsusuri makalipas ang anim na lingo sa kahit saang HIV testing
facility.
Reactive Result Nagkaroon ng reaksiyon sa Antibody Testing na ginawa sa iyo, hindi

nangangahulugan na positibo ka na. Ngunit upang tayo ay makasigurado,
ang sample ng iyong dugo ay ipapadala natin sa SACCL upang ipadaan
sa confirmatory test na makalipasang 3 linggo hanggang isang buwan ay
magbibigay ng resulta na maaring positibo,negatibo o indeterminate na resulta.
Reactive Result Nagpositibo ka sa HIV antibody test at ikaw ay irerefer na natin pabalik sa
Treatment hub kung saan kita inirefer nung una para simulan ang iyong gamutan
o para ipagpapatuloy ang iyong gamutan kung nasimulan na ito.
Negative Result Sa ngayon, nagnegatibo sa HIV antibody testing ang iyong dugo. ikaw ay
ineengganyo magpaulit ng pagsusuri makalipas ng 6 na lingo sa pinakamalapit
na Social Hygiene Clinic, RHU o saan mang HIV testing center
Indeterminate Result Sa ngayon, nag-indeterminate ang iyong resulta, ibig sabihin, hindi pa matukoy
kung positibo o negatibo ka sa HIV antibody, maaring ikaw ay nasa window
period pa o hindi pa sapat ang panglaban ng katawan mo sa HIV, kaya ikaw ay
ineengganyo na magbalik ditto makalipas ang 6 nalinggo para makuhanan ka
ulit ng dugo at ipapadalaulit naming sa SACCL para sa confirmatory test.
TOOLS
THINGS TO REMEMBER IN HIV:

LINK Between TB & HIV
z TB is a sign of a compromised immune system.
z A person with HIV has a greater chance of developing OIs
z In the Philippines, TB is the most common Opportunistic Infection of PLHIV
LINK Between STI & HIV

z They have the same mode of transmission
z They have the same preventive measures
z A person with STI is more vulnerable in acquiring HIV
z This is our clinical point of entry for HIV education and VCT
LINK Between Pregnancy & HIV

z Pregnancy is a result of an unprotected sex
z HIV can be transmitted from the HIV+ mother to her child
2 Phases of HIV
z HIV Infection (Asymptomatic Stage)
z AIDS Condition (Symptomatic Stage)
3 Modes of HIV Transmission

z Unprotected Penetrative Sexual Intercourse (Anal, Vaginal, Oral)
z Receiving contaminated blood or blood products (Blood transfusion, organ transplantation, sharing
needles)
z From an infected mother-to-child transmission (during pregnancy, delivery or breastfeeding)
4 Principles for a Successful HIV Transmission

z Exit of the contaminated fluid from a PLHIV
z Survival of the virus
z Sufficiency of the virus
z Entry to the bloodstream of a new host
4 Body Fluids with High concentration of HIV

z Blood
z Seminal Fluid
z Vaginal Fluid
z Breast Milk
4 Conditions needed for the survival of HIV

z No sudden or extreme changes in Temperature
z Acidity or PH of the environment should be neutral or close to neutral
z Environment should be Moist
z There should be no exposure to Air
5 Conditions needed for the survival of HIV

z Abstinence
z Be mutually faithful
z Consistent and correct use of condoms
z Do not us drugs or alcohol
z Education and early prevention, detection & treArly detection and treatment of STI
SESSION PLAN
PICT M2
Title of the Session Understanding Sex, Gender, Sexuality and SOGIE
Duration 40 minutes
PNAC Module 3 GSS
Reference Guide Philippine Handbook HIV Counseling and Testing
Section 3 Chapter 13 pages 139- 154
Session Learn and understand the definition of sex, gender and sexuality.
Objective/s: Understand the impact of socio-cultural environment to sex, gender and
At the end of the sexuality.
training session, Learn and understand relevant terminologies related to SOGIE.
the trainees will be Understand the different facets of Sexual Orientation, Gender Identity
able to: and Expression.
Effectively communicate with their clients utilizing appropriate and
gender sensitive concepts and messages.
Content: Definition of Terms- Sex, Gender, Sexuality.

The impact of Socio-cultural environment to Sex, Gender and Sexuality.
Definition of relevant terminologies related to SOGIE.
Different facets of SOGIE.
The DOs and DON’Ts in dealing with your clients.
Materials needed SGS/ SOGIE Video Presentation

Gender bread V4
Important Slide 1: Title

Information to Slide 2: Session Objectives (copy session objectives)
appear in the ppt
Slide 3: Moving Brain
presentation
Slide 4: Remember
Slide 5: SOGIE (gender bread)
Slide 6: Gender bread Activity
Slide 5: DOs and DON’Ts
Slide 6: Never Assume slide
Slide 7: Thank You!
Speakers Note’s Slide 2; SEX- discuss Determinants of Sex

on Additional Slide 2; GENDER- emphasize ACT, THINK, FEEL, BEHAVE
Information
Slide 4; give example for deeper understanding for each terminology.
SESSION PLAN

Trainer
Prepare the video material and check on the connectivity and
audio.
Prepare the power point presentation in the laptop and check if

power point is readable and audio is operational.
2. On the exact session, watch the video.
3. Show slide 2 and introduce the session by discussing the objectives and
talk about the flow of the session.
4. Show Slide 4 and elicit responses from participants’ interpretation of the

slide.
5. Show Slide 5 validate their understanding of the message and briefly

discuss the statement in the slide.
6. Show Slide 6 and discuss each term and give at least three examples.
Encourage interaction from participants.
7. Show Slide 7 ask participants their understanding of the slide
8. Show Slide 8 briefly explain the statement and reiterate the importance of
RESPECT
9. End Session.

participants They can ask questions in the chat box
Interactive Identify gender sensitive terms associated with the slide presentation.
discussion (Gender Bread)
Toolkit to be used Source: www.genderbread.org Genderbread Person v4
SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE
SLIDE PRESENTATION
7TH SLIDE 8TH SLIDE
9TH SLIDE
Section 3 Chapter 13 Counseling MSM/ Transgender/ Intersex Clients
Section 3 Chapter 13 Counseling MSM/ Transgender/ Intersex Clients (CONTINUED)
The Genderbread Person v4
Identity
Attraction
Expression
Sex
means a lack of what’s on the right side
Identity Expression Sex

Gender Sexual Orientation
and/or (a/o)
Genderbread Person Version 4 created and uncopyrighted 2017 by Sam Killermann For a bigger bite, read more at www.genderbread.org
WHEN THE TEARS DRY UP
A person living with HIV who lost the ability to cry shares his story
of rejection and how he bounced back
I want to show them that HIV is not a death sentence,

that there is still life after all these things and I am
grateful to God for giving me this opportunity.”
Ayuha said, “There could be nothing more painful for

an HIV positive than to be rejected by your family. From
that day, I continue to contact them but they would not
answer. There is a saying that goes, ‘Walang magulang
ang makakatiis sa anak,’ (No parent can resist his child)
but there is, my mother.”
TAKING COURAGE
Beset with all these misfortunes, Ayuha couldn’t even
Crying is undeniably one of the most human things bring himself to cry to somehow ease what he was
to do. Just like smiling, shedding tears is universally feeling. The tears won’t fall as much as he wanted to. But
understood throughout the world and breaks any instead of succumbing to sorrow and playing the victim,
cultural barrier: it is a language of emotion that speaks he took courage and fought the diseases.
to other people without words.
After being cured of tuberculosis, he was able to take
So imagine how devastating it would be for someone anti-retroviral drugs (ARVs) to keep the HIV in check and
to lose this precious ability? It may sound impossible little by little regained his strength.
but that’s what exactly happened to Moses Ayuha who
suffers from a damaged tear duct as a complication of “I was eager to get better because I want to live. If not,
him having HIV (human immunodeficiency virus). I would simply give up. I really encouraged myself and
by the grace of God, I continue to enjoy this second life
After being diagnosed with tuberculosis (TB) and HIV now,” he said.
co-infection, his instinct was to call his family abroad
for support, but the reaction he got was not what he Ayuha is now an active advocate, helping other people
expected. who are in the situation. Through the Positive Action
Foundation Philippines, Inc. organized by PBSP.
He shared, “When I called them to tell my status, my
family disowned me because they could not accept (PAFPI), he is now an empowered person living with
it and told me that I was a disgrace to the family. My HIV and speaks in forums like those. Although telling
mother even told me that they would be proud of me if his story time and again brings back painful memories,
I’ll just die.” he is happy that he has become an instrument of
empowerment to others.
As a result of late diagnosis, the virus already weakened
his body. Because he was living alone, Ayuha had to go to “I have the courage to speak up without hiding my face
the hospital all by himself at a time when he could barely and giving voice to people living with HIV because I
walk. It was the most terrible thing that ever happened know that the issue on HIV needs people who can testify
in his life. without hiding their faces. I want to show that people
living with HIV do not live in darkness. I want to show
“I want to show that people living with HIV do not live in them that HIV is not a death sentence, that there is still
darkness. I am humbled by this responsibility of being life after all these things and I am grateful to God for
an advocate reaching out to those who are bedridden, giving me this opportunity,” he said.
even feeding them.
SESSION PLAN
PICT M3
Title of the Session RA 11166 and Other Policies & Guidelines
Duration 45 minutes
Reference Guide IRR of RA 11166 Included in the Training Kit
Session Objective/s: Understand the significance of the law in the campaign to halt the
spread of HIV.
At the end of the
training session, the Gain a better grasp of the key features of R.A 11166
trainees will be able to:
Understand the penalties imposed for violating the provisions.
Know and Understand the existing HIV- related Policies and

Guidelines
Content: Guiding Principles
State Policies
History and Development
Comparison of significant differences RA 8504 vs RA 11166
Key Features of RA 11166
Case Study and Penalties for violations
Existing Policies and Guidelines
Materials needed Power point Presentation
IRR of RA 11166 ecopy
Online Learning Gadget: Laptop, Tablet, Mobile,
Headphone, preferably with Microphone (make sure it’s near your

mouth when you speak)
Important Slide 1: Title

Information to
Slide 2: Session Objectives (copy session objectives)
appear in the ppt
presentation Slide 3: Declaration of Policies
Slide 4: State Policies
Slide 5: History and Development
Slide 6: Key Features of RA 11166
Slide 7: Key Features of RA 11166
Slide 8: Case Studies and Penalties
Slide 9: Existing Policies and Guidelines
Slide 10: Thank You!
SESSION PLAN
Speakers Note’s Slide 3 & 4; Read and emphasize the importance of having a law to
on Additional guide the implementation of an effective HIV program.
Information
Slide 5; Quickly run through the slide
Slide 6; Focus on the Key Points
Slide 8; Discuss key points on these policies and guidelines that were
assigned to them ahead of time
AO 2017 – 0019
DC 2016 - 0171
AO 2014 - 0005
AO 2009 - 0016
AO 2018 – 0024
DM 2018 – 0400
AO 2019 – 0001
DC 2020 – 0276

Trainer
Prepare the power point presentation in the laptop and check
if power point is readable and operational.
Prepare Zoom Meeting connectivity and share the link to

trainees.
2. On the exact session, show slide 1 & 2 and introduce the session by
discussing the objectives and flow of the session.
3. Show Slide 3 and briefly explain the Guiding Principles.
4. Show Slide 4 and briefly explain the State Policies.
5. Show Slide 5 and briefly discuss the importance of the years 1984, 1992,
1998, 1999, 2018 and 2019
6. Show Slide 6 and discuss 3 bullets and 8 sub- bullets with emphasis
on Minors getting tested, strengthen provision of HIV & AIDS care and
treatment, boost HIV response in the Philippines
7. Show Slide 7, reveal cases one by one. Give poll - Law Abiding or Law
Breaking, ask participants to identify specific violation committed and
briefly discuss corresponding penalties.
8. Show Slide 8, reveal guidelines one by one. Give brief explanation for
each guideline.
9. End Session.
SESSION PLAN

participants
They can ask questions in the chat box
Remind participants to do additional reading on the whole Law.
Interactive discussion Refer to slide 7
Factsheet to be used IRR of RA 11166 AO 2018 – 0024
AO 2017 – 0019 DM 2018 – 0400
DC 2016 - 0171 AO 2019 – 0001
AO 2014 - 0005 DC 2020 - 0276
AO 2009 - 0016
SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE
SLIDE PRESENTATION
7TH SLIDE 8TH SLIDE
9TH SLIDE 10TH SLIDE
11TH SLIDE
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
SESSION PLAN
PICT M4
RESPONSIBILITIES OF TB HEALTHCARE WORKERS AS TRAINED HIV
Title of the Session
COUNSELORS
Duration 15 minutes
Reference Guide AO 2014 0005
Session Objective/s: Understand the roles of TB Healthcare Workers as trained HIV

Counselors
At the end of the
training session, the Effectively offer PICT to existing TB patients
Recognize available resources (e.g. people, tools, services) that can
support identified clients
Apply CEA (Catharsis, Education and Action) method to bring out the
psychological concerns that result from wrong perception of reality
and hinder appropriate behavior
Appreciate the benefit of integrating PICT in the provision of universal

healthcare
Content: Specific roles of TB healthcare workers as HIV counselors
Link of TB & HIV
Available resources (e.g. people, tools, services) that support PICT
CEA (Catharsis, Education and Action) method
Benefit of integrating PICT in the provision of universal healthcare
Materials needed PowerPoint presentation
Online Learning Gadget: Laptop, Tablet, Mobile, Headphone,

preferably with Microphone (make sure its near your mouth when
you speak)
Important Slide 2- Session Objectives

Information to
Slide 3 – Roles of TB HCW & additional tasks as HIV Counselors
appear in the ppt
presentation Slide 4 - Link between TB & HIV
Slide 5 – Target populations and Available resources
Slide 6 – CEA method
Slide 7 – Integration of PICT in the provision of Universal healthcare
SESSION PLAN

Trainer
Prepare the PowerPoint presentation on the laptop and check
if PowerPoint is readable
2. Show slide 2: introduce the session by discussing the objectives and

flow of the session
3. Show slide 3: Roles of TB HCW & additional tasks as HIV Counselors.
4. Show Slide 4: Review the Link Between TB & HIV.
5. Show slide 5: Available resources for doing PICT
6. Show slide 6: CEA Method
7. Show slide 7: Integration of PICT in the provision of Universal healthcare
Reminders to z Always refer to DOH, WHO and UNAIDS for evidence-based facts
participants when sharing or giving information
z Level off with your client’s level of comprehension, avoid using

medical and scientific jargons.
z You are taking the role of a DOH-Trained HIV Counselors, resource

person and speaker. Be careful on maintaining ethics and proper
decorum.
z When sharing slides and downloading pictures on the internet. It

also has copyright issues. Better use words or do your own artwork.
Toolkit to be used AO 2014 0005
SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
FACTSHEETS
SESSION PLAN
PICT M5
Title of the Session Key Elements of Ethical and Effective HIV Counseling Practice
Duration 1 hour and 45 minutes
z Chapter 2: HIV Counseling: An Overview pages 13-19
Reference Guide z Chapter 3: Key Elements of Ethical and Effective HIV Counseling Practice
pages 21- 34
Session Objective/s: Describe the different approaches to HIV counseling

Discuss an Ethical and Effective Counseling
At the end of the
training session, the Demonstrate effective HIV counseling communication skills
trainees will be able Convince TB patient to consider HIV Testing and Treatment
to: Understand the Code of Ethics
Content: Definition of Counseling and HIV Counseling

Aims of HIV Counseling
Approaches to HIV Counseling (CICT versus PICT)
Key elements of HIV Counseling
Interpersonal and Communication Skills
Communication Micro skills
Motivational Skills for Counselors
(HIV Testing and Treatment for TB patient)
LOVERS Technique
Materials needed PowerPoint Presentation

Zoom Poll Questions
Online Learning Gadget: Laptop, Tablet, Mobile, Headphone, preferably with
Microphone (make sure it’s near your mouth when you speak)
Important Slide 2 - At the end of the training session, the trainees will be able to do the
Information to following: Describe the different approaches to HIV counseling, discuss Ethical
and Effective Counseling, demonstrate effective HIV counseling communication
appear in the ppt
skills,
presentation
Slide 3 - Counseling - a helping process that implores communication techniques
to gauge clients to resolve personal conflicts and emotional problems
HIV Counseling - a confidential interactive communication process between a
person and trained HIV counselor enabling clients to make informed choices
about being tested for HIV and assist the client to understand and cope with HIV
test result, and be able to identify future plans.
Slide 4 – Aims of HIV Counseling

Slide 5- CICT versus PICT
Slide 6 - Elements of Ethical and Effective HIV Counseling 4As and 4Cs
Slide 7 - Communication Micro skills
Slide 8 - Motivational Skills
SESSION PLAN
Speakers Note’s Ask trainees on practical experiences to motivate patients on TB treatment as an

on Additional example for Motivational Skills.
Information

Trainer z Prepare the PowerPoint presentation in laptop and check if PowerPoint is
readable and audio is operational.
z Prepare the Zoom Electronic Polls for interactive discussions (refer in the
section on Zoom polls)
2. On the exact session, show slide 2 and introduce the session by discussing the
objectives and flow of the session.
3. Show Slide 3. Explain the general meaning of counseling and emphasize on the
difference of HIV counseling (site on confidentiality, and the three (3) approaches:
Client-centered, Issue-Focused, Goal-oriented). Ask the trainees on their take with
three approaches.
4. Show Slide 4 - Discuss the AIMS of HIV counseling. Ask the trainees “Techniques or
Strategies that could not be applied to achieve those HIV counseling aims”
5. Show Slide 5 - CICT versus PICT. Use Zoom Polls on Specific Cases related to CICT or
PICT. Ask the participants to identify.
6. Show Slide 6 - 4 As and 4Cs. Every image represents each key element, ask the
participants to write their answers in the Chat Room. Then Trainer will explain the
answer.
7. For Interpersonal and Communication Skills, ask the trainees, “what interpersonal
skills they regularly implore when talking to their patients?” Process their answers
written in the Chat Room.
8. Show Slide - 8, explain the items in the slides. Explain the Communication Skills.
Explain the LOVERS Technique as part of processing for communication.
9. Address their needs.
Reminders to Tap instead of touching. A tap in the shoulder is enough to reassure support to
participants client.
Maintain a professional relationship with clients. Do not engage into intimate or
romantic relationship with them.
For Accessibility, do not share your personal phone number. Set time limitations
during work hours and days.
Ensure your safety as a counselor. Wear protective gears and maintain physical
distancing.
Zoom Electronic Poll 1: Case Study: Isang Doctor ng comatose na TB patient nag-order ng HIV
Polls Testing. (Is it PICT, CICT, Hindi Alam)
Poll 2: Case Study: TB patient nag-offer ng HIV testing sa wife niya. Gustong
magpatest ng Wife niya sa isang Health Center. (PICT, CICT, Hindi Alam
Poll 3: Identify what type of question: Palaging kang gumagamit ng condom, ‘di
ba? (Open-ended, Close-ended, Leading)
Poll 4: Ano ang iyong nalalaman tungkol sa HIV? (Open-ended, Close-ended,

Leading)
Poll 5: May pagkakataon na ba na ikaw ay nasalinan ng dugo? (Open-ended,

Close-ended, Leading)
SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE
SLIDE PRESENTATION
7TH SLIDE 8TH SLIDE
9TH SLIDE

Section 1 Chapter 2,3 Counseling: An Overview

Section 1 Chapter 2,3 Counseling: An Overview (CONTINUED)





SESSION PLAN
PICT M6
Title of the Session HIV Testing Process and HTS Forms
Duration 60 minutes
Reference Guide Annex AO- HTS
Session Learn and understand the current HIV testing algorithm.

Objective/s: Understand the process involved in each phase of the testing process
At the end of Learn and understand the different results
the training Explain the results to their clients in the simplest way possible
session, the
Explain the next steps after receiving a result
trainees will
be able to: Familiarize themselves with the existing forms to be used in counseling.
Learn the skills of ensuring proper filling up of forms
Content: Current HIV testing algorithm

What are the procedures that a person undergoes when having an HIV test.
Interpretation of different results
What are the next steps to discuss with the clients after receiving their result.
Introducing and familiarizing with the different forms used in counseling
Instructions on how to properly fill up a counseling form and when to use them.
Materials Power point Presentation

needed Online Learning Gadget: Laptop, Tablet, Mobile, Headphone, preferably with Microphone
(make sure it’s near your mouth when you speak)
Important Slide 2: Session Objectives (copy session objectives)

Information Slide 3: HIV Testing algorithm with moving arrows and possible results
to appear Slide 4: Explaining a non-reactive, negative & indeterminate results and reminders
in the ppt
Slide 5: Explaining a reactive or positive result and reminders
presentation
Slide 6: Briefly present HTS forms 2, 3 & 4
Speakers Slide 3: Remind that Form A should only be accomplished after signing the consent form
Note’s on Slide 4; emphasize on the importance of considering the window period and the need
Additional for retesting
Information
Instructions 1. Preparations:
to the Prepare the power point presentation in the laptop and check if power point is
Trainer readable and audio is operational.
Prepare Zoom Meeting connectivity and share the link to trainees.
2. While slide 3 us being discussed, remember to talk about HTS form 1 and EB form A
3. Slide 5: Inform the participants that a thorough discussion regarding this topic will be
covered in Day 7 (Module on Doing a Successful Referral)
4. End Session.
Reminders Mute microphone all throughout the session.

to They can ask questions in the chat box
participants Do advance reading on conducting individual pre-test & post-test counseling and how to
do a successful referral to prepare them for the role-play
Toolkit to be Handouts of possible results

used HTS forms 1, 2, 3 & 4 and EB form A

SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE

SLIDE PRESENTATION
7TH SLIDE 8TH SLIDE
9TH SLIDE

FACTSHEETS
January 3, 2016/ 8:55 AM

SACCL2016-01-1855
XXX 098191
Whole Blood
January 16, 2016

FACTSHEETS
January 3, 2016/ 8:55 AM

SACCL2016-01-1855
XXX 098191
Whole Blood
January 16, 2016

FACTSHEETS
January 3, 2016/ 8:55 AM

SACCL2016-01-1855
XXX 098191
Whole Blood
January 16, 2016

SESSION PLAN
PICT M7
Title of the Session Conducting the Group Pre-Test Information
Duration 45 minutes
Reference Guide Section 2- Chapter 7 pages 77- 78
Session Objective/s: Conduct a group pre-test information session

At the end of the Manage discussing sensitive issues and concerns of the participants
training session, the
Content: Overview on the Video – Providing Group Pre-test Information

Synchronous video watching: 15-Minute video showing
Process learning and insights from the video
Things to Prepare Before the Group Pre-test Information
Things to Cover in the Group Pre-test Information
Handling Difficult Participants
Materials needed PowerPoint Presentation

Important Slide 2 - At the end of the training session, the trainees will be able to do
Information to the following: Conduct a group pre-test information, address specific
appear in the ppt issues of clients in a while in a group information session
presentation Slide 3 – Elements of a pre-test counseling
Discuss the content of each
SLIDE 4 - Things to Prepare Before Group Information
Flipchart or LCD Presentation
IEC Materials and commodities
HTS Form 1, EB Form A and A-MC
Slide 4 - Things to Cover in Group Pre-test Information
Introduce self, designation, as DOH-Trained TB-HIV Counselor
Rationale of HCT Services
Benefits of HIV Testing
Process of Testing
Waiting time for HIV Test Result
Possible Test Results
Provide opportunities for clients to ask question
Speakers Note’s If Trainees have no available Flipchart. They could ask for this material
on Additional from the Provincial TB Coordinators. Flipcharts have already been
Information dispensed or distributed from Regional, Provincial level and down to
LGU and TB Facilities.

SESSION PLAN

Trainer Prepare the PowerPoint presentation in laptop and check if
PowerPoint is readable and audio is operational.
Prepare Zoom Meeting connectivity and share the link to trainees.
3. Explain the purpose of the video. Call the participants attention to the
video. Play the video shared in Zoom.
4. Ask the participants on what they have learned and realized from
watching the video.
5. Show Slide – 3 explain the things to prepare and the reason why these
needs to be prepared
6. Show Slide 4 - explain to the trainees the things that must be covered
within the group pre-test information.
7. Open the floor for trainees to raise question and concerns with regards
to the conduct of Group information in their facilities.
8. Provide technical support to address their concerns.
Reminders to Do not make risk assessment during the Group Pre-test Information
participants
Be careful in the manner of calling the clients for HIV individual pre-
test counseling.
Ensure your safety as a counselor. Wear protective gears and maintain

physical distancing. Remind everybody to wear protective gears
properly and maintain physical distancing.

SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE

SESSION PLAN
PICT M8
Title of the Session Conducting the Individual HIV Pre-Test Counseling among TB Patients
Duration 4 hours per day
Section 2 Chapter 7 page 80
Reference Guide
Section 3 Annex C pages 218- 227
Session Objective/s: Conduct individual HIV pre-test counseling process.

Motivate client to pursue HIV Testing and claim their test result.
At the end of the
training session, the Address sensitive issues during HIV pre-test counseling
trainees will be able to: Prepare client to receive the HIV test result.
Content: Overview on the Video – Conducting Individual Pre-test HIV Counseling

Synchronous video watching: 15-minute video showing
Process learning and insights from the Video
Things to prepare before the individual Pre-test HIV Counseling
Things to cover in the conduct of individual Pre-test HIV Counseling
Briefing on the Role Play
Providing feedback and mentoring after the role play
Materials needed Video Presentation: Conducting Individual Pretest HIV Counseling

Counseling Forms: EB Form A/ A-MC; HTS Form 1
Decking Sheet from Day 1 (refer to page 20 of the Trainers’ Guide)
Case Study
Online Observation Checklist and Client’s Satisfaction Rating
Information to following: Conduct individual pre-test counselling, Understand the basic
requirements for the provision of HIV test, Address sensitive issues and assess
appear in the ppt individual coping strategies and psychosocial support system during HIV pre-
presentation test Counselling’ Understand the importance of proper referral for clients (HIV
-, HIV +) should the need arise’ Make the client understand the importance of
re-testing
Slide 3 - Things to Prepare Before the individual HIV Pre-test Counseling
Hard copies of the forms (DOH EB Form A, DOH EB Form A-MC,
DOH NASPCP HTS Form 1) IEC Materials and commodities, Condom
Demonstration Materials.
Slide 4 -Things to Cover in the individual HIV Pre-test Counseling
Consent, Confidentiality, Counseling, Correct Diagnosis, Connection
to Care
Prepare client to receive the possible result
Ask client regarding support network

SESSION PLAN
Note: If ever the client did not undergo group pre-test information need to cover
Rationale of HCT Services, Benefits of HIV Testing, Process of Testing, Waiting
time for HIV Test Result, Possible Test Results, Provide opportunities for clients
to ask question
Slide 5 - Guide for Role Play per batch
Assignment of Facilitators/Observers
Timing: 5 minutes setting up,
15 minutes role play (Round 1)
5 minutes debriefing
15 minutes role play (round 2)
10 mins Feedback (per pair as scheduled)
Reminder to the Refer to Trainers’ Guide for the instructions on dividing the group, giving general
Trainers instruction for the role play, providing specific role play instruction, timing and
schedule of a role play session

Trainer
Prepare the PowerPoint presentation in laptop and check if
CF3 Prepare Zoom Meeting Breakaway Rooms and share the link to
trainees. Have a dry-run before actual conduct.
3. Explain the purpose of the video. Call the trainees attention to the video. Play
the video and shared via Zoom.
4. Ask the trainees on what they have learned and realized from watching the
video.
5. Show Slide 3 and explain the things to prepare and the reason why these
things need to be prepared
6. Show Slide 4 and explain to the trainees the things that must be covered
within the individual HIV pre-test Counseling.
7. Open the floor for trainees to raise question and concerns with regards to
the conduct of individual HIV pre-test information in their facilities. Provide
technical support to address their concerns.
8. Give Instructions on the Role Play
General orientation will be given by the CF2 for 30 minutes. It will

focus on the process of the role play including time allotment for each
counselor. Here, the Mentor/Trainer may give tips and techniques in
ensuring that counselors extract the needed information from the
clients. Here, CF1 will also mention that another orientation which is
specific to their roles will be provided to them after this session.

SESSION PLAN
Specific Role Orientation for another 30 minutes follows. The LF and

CF1 will handle the briefing before the pre-test role play in preparation
for their respective roles for each round. From the decking sheet,
All Odd numbers will be the Round 1 counselors and they will be
oriented by the LF. All Even numbers will be Round 1 clients and they
will be oriented by the CF1.
On Days 3, only participants 1,2,3 and 4 from each Mentor/Trainer will

be doing the role play. After the orientation, only the 4 participants
will remain in the main room wherein they will wait for their turns
to be distributed by the CF3 to their respective breakaway rooms.
They will also be instructed here to leave after they finish the session
and come back the following day for the preliminaries/ quizzes only
where they may leave the main meeting room after the preliminaries
or taking their quizzes.
On Days 4 only the participants 5-12 from each Mentor/Trainer will

be doing the role play. After the orientation, only they will remain in
the main room wherein they will wait for their turns to be distributed
by the CF3 to their respective breakaway rooms. They will also be
instructed here to leave after they finish the session and come back
the following day
1. Specific Role Orientation

The Role Orientation will be divided into 2 parts with a total of 30
minutes. The first part will be orienting the participants for their
Round 1 roles.
LF- orients the R1 counselors of preparing their clients for the

process of the test and the results to expect. LF should inform
the R1 counselors their clients are TB patients who are products
of the group pre-test information. LF also talks about the pointers
he/she will be observing during the entire 15 minutes including
preparing the needed counseling forms and or/results and how
they will be graded in this round.
CF1- orients the R1 clients of their case. Highlight the specific
risks and possible last exposure to HIV. This will, in a way test
whether counselors will be able to determine and recommend
the possible re-testing date. Clients are also reminded that they
are not to give the details freely to their counselors instead, have
them supply the information to the counselor only when asked.
Clients are also asked of their client satisfaction rating at the end
of their role play round to be sent via a private message to their
Mentor/Trainer.

SESSION PLAN
After the 15 minutes participants will be oriented on their R2 roles

in the same breakaway room. (R1 counselors will be R2 clients
and R1 clients will be R2 counselors)
Clients of each Round to will also rate their respective counselors

by sending a private message to their Mentor/Trainer for recording
Client’s Satisfaction Ratings may be:
3 = Satisfied
2 = Average
1 = Needs Improvement
Timing for each pair
ROLE PLAY EXERCISE (55 minutes per pair)
5 Minutes preparation while waiting
5 minutes debriefing (before shifting roles)
15 minutes feedback (per pair as scheduled)
Reminders to Be time-conscious and attentive on your schedule for Role Play

participants Do not entertain other tasks during your schedules for Role Play, be on
stand-by in the waiting area in the main room for your turn to do role play
Find the best location with a more stable connection.

SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE

SLIDE PRESENTATION
7TH SLIDE 8TH SLIDE

Pre-Test Counseling

TOOLS

TOOLS

TOOLS

TOOLS

TOOLS
Name of Participant:
Trainer
Rating
Skills & Specific Strategies, Statements & Additional
Needs Very
Techniques Behaviors Average Comment
Improvement Good
(2)
(1) (3)
Greets patient
Establishing Assure confidentiality of the conversation

rapport with
the client Maintains eye contact
Shows interest in the client’s issues
Looks at the patient
Shows appropriate body language.
Maintains a comfortable distance with the
client.
Listening Skills Uses facial expressions that indicate concern

and interest for the client.
Occasionally summarizes the client’s
statements.
Uses minimal encouragers such as “Yes,”
“Okay,” etc.
Gives comment on client’s challenges while
indicating patient’s strengths.
Empathy
Repeats the statements to the client to
ensure understanding.
Uses close-ended questions to get basic
information such as age, civil status.
Avoids overuse of close-ended questions.
Questioning Uses open-ended questions to get more in
Skills depth information.
Uses style of questioning that reflects
interest, care and concern for the client.
Asks relevant questions.
Validates his/her understanding of what the

patient is saying.
Clarifying
Uses phrases such as “Are you saying that…”
or “Correct me if I am wrong…”
Explain the procedure for testing/ after

receiving result
Providing
additional Procedure of testing and possible results
information
Prevention of Transmission and Risk
reduction strategies
Prepare the client for the test/ result
Prepare needed forms
Key Assist client in accomplishing forms properly
Considerations
Validate information/ check, double check
result before providing to the client
Secure Client’s consent for Testing
Overall Trainer's Impression (1 to 3) 0
Client’s Rating (1 to 3) 1
Total Rating 1 1

SESSION PLAN
PICT M9
Title of the Session Conducting the Individual Post-Test HIV Counseling among TB Patients
Duration 4 hours per day
Reference Guide Section 2 Chapter 8 pages 81- 90
Session Conduct individual post-test (HIV -, HIV +) counseling process.

Objective/s: Understand the basic requirements for the provision of HIV test result
At the end of the Address sensitive issues and assess individual coping strategies and
training session, psychosocial support system during HIV post-test Counseling
the trainees will Understand the importance of proper referral for clients
be able to: (HIV -, HIV +)
Content: Overview on the Video – Conducting Individual Post-test HIV Counseling

Synchronous video watching: 15-minute video showing
Process learning and insights from the Video
Things to prepare before the individual Post-test HIV Counseling
Things to cover in the conduct of individual Post-test HIV Counseling
Briefing on the Role Play
Providing feedback and mentoring after the role play
Materials Video Presentation: Conducting Individual Post-test HIV Counseling

needed PowerPoint Presentation
Counseling Forms: HTS Form 1, 2, 3, 4
Result forms: Negative, Positive, Indeterminate
Case Study
Information following: Conduct individual Post-test counseling, Understand the basic
to appear requirements for the provision of HIV test result, Address sensitive issues and
assess individual coping strategies and psychosocial support system during
in the ppt
HIV Post-test Counseling’ Understand the importance of proper referral for
presentation clients (HIV -, HIV +) should the need arise’ Make the client understand the
importance of referral to the treatment hubs if HIV +
Slide 3 - Things to Prepare Before the individual HIV Post-test Counseling
Hard copies of the forms (HTS Form 1, 2, 3, 4) IEC Materials and
commodities, Condom Demonstration Materials.

SESSION PLAN
Slide 4 -Things to Cover in the individual HIV Post-test Counseling

Consent, Confidentiality, Counseling, Correct Diagnosis, Connection to
Care

Note: If ever the client did not undergo group Post-test information need to
cover Rationale of HCT Services, Benefits of HIV Testing, Process of Testing,
Waiting time for HIV Test Result, Possible Test Results, Provide opportunities for
clients to ask question
1. Slide 5 - Guide for Role Play per batch
(1) Assignment of Facilitators/Observers
(2) Timing: 5 minutes setting up,
5 minutes debriefing
10 mins Feedback (per pair as scheduled)
Reminder to Refer to Trainers’ Guide for the instructions on dividing the group, giving general
the Trainers instruction for the role play, providing specific role play instruction, timing and
schedule of a role play session
Instructions to Video Presentation: Conducting Individual Post-test HIV Counseling

the Trainer PowerPoint Presentation
Counseling Forms: EB Form A/ A-MC; HTS Form 1
Case Study
Reminders to Slide 2 - At the end of the training session, the trainees will be able to do
participants the following: Conduct individual Post-test counseling, Understand the
basic requirements for the provision of HIV test, Address sensitive issues and
assess individual coping strategies and psychosocial support system during
HIV Post-test Counseling’ Understand the importance of proper referral for
clients (HIV -, HIV +) should the need arise’ Make the client understand the
importance of re-testing
Slide 3 - Things to Prepare Before the individual HIV Post-test Counseling
Hard copies of the forms (DOH EB Form A, DOH EB Form A-MC,
DOH NASPCP HTS Form 1) IEC Materials and commodities, Condom
Demonstration Materials.

SESSION PLAN
Slide 4 -Things to Cover in the individual HIV Post-test Counseling

Consent, Confidentiality, Counseling, Correct Diagnosis, Connection to Care
Give Instructions on the Role Play

General orientation will be given by the CF2 for 30 minutes. It will focus on
the process of the role play including time allotment for each counselor.
Here, the Mentor/Trainer may give tips and techniques in ensuring that
counselors extract the needed information from the clients. Here, CF1 will
also mention that another orientation which is specific to their roles will be
provided to them after this session.
Specific Role Orientation for another 30 minutes follows. The LF and CF1
will handle the briefing before the pre-test role play in preparation for their
respective roles for each round. From the decking sheet, All Odd numbers
will be the Round 1 counselors and they will be oriented by the LF. All Even
numbers will be Round 1 clients and they will be oriented by the CF1.
On Days 3, only participants 1,2,3 and 4 from each Mentor/Trainer will be

doing the role play. After the orientation, only the 4 participants will remain
in the main room wherein they will wait for their turns to be distributed by
the CF3 to their respective breakaway rooms. They will also be instructed
here to leave after they finish the session and come back the following day
for the preliminaries/ quizzes only where they may leave the main meeting
room after the preliminaries or taking their quizzes.
On Days 4 only the participants 5-12 from each Mentor/Trainer will be doing
the role play. After the orientation, only they will remain in the main room
wherein they will wait for their turns to be distributed by the CF3 to their
respective breakaway rooms. They will also be instructed here to leave after
they finish the session and come back the following day
Specific Role Orientation

The Role Orientation will be divided into 2 parts with a total of 30 minutes.
The first part will be orienting the participants for their Round 1 roles.
LF- orients the R1 counselors of preparing their clients for the process of
the test and the results to expect. LF should inform the R1 counselors their
clients are TB patients who are products of the group pre-test information.
LF also talks about the pointers he/she will be observing during the entire 15
minutes including preparing the needed counseling forms and or/results
and how they will be graded in this round.
CF1- orients the R1 clients of their case. Highlight the specific risks and
possible last exposure to HIV. This will, in a way test whether counselors
will be able to determine and recommend the possible re-testing date.
Clients are also reminded that they are not to give the details freely to their
counselors instead, have them supply the information to the counselor
only when asked. Clients are also asked of their client satisfaction rating
at the end of their role play round to be sent via a private message to their
Mentor/Trainer.
SESSION PLAN
After the 15 minutes participants will be oriented on their R2 roles in the

same breakaway room. (R1 counselors will be R2 clients and R1 clients will
be R2 counselors)
Clients of each Round to will also rate their respective counselors by sending
a private message to their Mentor/Trainer for recording
Client’s Satisfaction Ratings may be:
3 = Satisfied
2 = Average
1 = Needs Improvement
Timing for each pair
ROLE PLAY EXERCISE (55 minutes per pair)
5 Minutes preparation while waiting
5 minutes debriefing (before shifting roles)
� 15 minutes role play (round 2)
15 minutes feedback (per pair as scheduled)

SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE

SLIDE PRESENTATION
7TH SLIDE 8TH SLIDE

Post-Test Counseling

Post-Test Counseling

TOOLS

TOOLS

TOOLS

TOOLS
Name of Participant:
Trainer
Rating
Skills & Specific Strategies, Statements & Additional
Needs Very
Techniques Behaviors Average Comment
Improvement Good
(2)
(1) (3)
Greets patient
Establishing Assure confidentiality of the conversation

rapport with
the client Maintains eye contact
Shows interest in the client’s issues
Looks at the patient
Shows appropriate body language.
Maintains a comfortable distance with the
client.
Listening Skills Uses facial expressions that indicate concern

and interest for the client.
Occasionally summarizes the client’s
statements.
Uses minimal encouragers such as “Yes,”
“Okay,” etc.
Gives comment on client’s challenges while
indicating patient’s strengths.
Empathy
Repeats the statements to the client to
ensure understanding.
Uses close-ended questions to get basic
information such as age, civil status.
Avoids overuse of close-ended questions.
Questioning Uses open-ended questions to get more in
Skills depth information.
Uses style of questioning that reflects
interest, care and concern for the client.
Asks relevant questions.
Validates his/her understanding of what the

patient is saying.
Clarifying
Uses phrases such as “Are you saying that…”
or “Correct me if I am wrong…”
Explain the procedure for testing/ after

receiving result
Providing
additional Procedure of testing and possible results
information
Prevention of Transmission and Risk
reduction strategies
Prepare the client for the test/ result
Prepare needed forms
Key Assist client in accomplishing forms properly
Considerations
Validate information/ check, double check
result before providing to the client
Secure Client’s consent for Testing
Overall Trainer's Impression (1 to 3) 0
Client’s Rating (1 to 3) 1
Total Rating 1 1

SESSION PLAN
PICT M10
Title of the Session Ensuring a Successful Referral
Duration 30 minutes
Philippine HIV Counseling & Testing Handbook Chapter 10
Reference Guide AO 2016-0171
AO 2018-0024
Session Strengthen the need for referring your clients

Objective/s:
Learn and identify all the documents needed in referring their clients
At the end of the
Understand the importance of facilitating an appropriate referral
training session,
the trainees will Assess client’s referral needs
be able to:
Identify the reasons for immediate referral upon diagnosis
Identify and address common referral issues
Understand the things to remember in making a referral successful
Content: How to start the conversation on referring your clients.
HTS forms needed for referral
Possible challenges that a patient might encounter during the referral process
Addressing issues in referring your clients
What happens after referring your clients
Materials Doing a successful referral video presentation

needed
Power point Presentation
HTS forms 3 & 4
online learning gadget: Laptop, tablet, mobile headphone preferably with

microphone (make sure it’s near your mouth when you speak)
Important Slide 2: Session Objectives

Information
Slide 3: Algorithm with “Reactive”
to appear
in the ppt Slide 4: Forms to be used
presentation
Slide 5: Facilitating appropriate referrals
Slide 6: Assessing client’s referral needs
Slide 7: Reasons for referral upon diagnosis
Slide 8: Common referral issues and addressing the issues
Slide 9: Making a successful referral
Slide 10: Final Reminders

SESSION PLAN
Speaker’s Slide 3: Reiterate the importance of DC 2016-0171

notes on
Slide 3: The importance of getting their confirmatory results
additional
information Slide 4: The important details needed to be filled up in HTS form 2
Slide 6: remind the importance of HTS form 3
Slide 9: The importance of communicating with the receiving facility and

bringing back the return slip
Instructions to 1. Preparations:
the Trainer
Prepare the video material (Doing a Successful Referral) check on the
connectivity and audio.
Prepare the PowerPoint presentation on the laptop and check if

2. Show slide 2 and introduce the session by discussing the objectives and flow
of the session.
3. Play the video “Doing a Successful Referral”
4. Show Slide 3: Process the reaction and learning from the video. Discuss the
start of referral from a reactive result.
5. Show slide 4: Discuss HTS forms 2 &3
6. Show Slide 8: and briefly discuss each possible issue and how to address them.
7. Show Slide 10: Read the reminders and give some helpful tips
8. Show Slide 10: Briefly explain the need to go back to the referring facility for
continuous TB treatment
9. End session

participants
Tools to be HTS forms 2, 3, 4

used

SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE

SLIDE PRESENTATION
7TH SLIDE 8TH SLIDE
11TH SLIDE

SESSION PLAN
PICT M11
Title of the Session Recording and Reporting for TB Patients Provided with PICT
Duration 1 hour
National TB Prevention Program Manual of Procedures 6th edition
Reference Guide
AO 2014-0005
Session Objective/s: Describe the process of HIV PICT for TB patients
At the end of the Identify the different tasks in every process in HIV PICT
training session, the Recognize the forms used in every process in HIV PICT
Content: Guidelines for Providing PICT

Logical framework of conducting PICT
TB HIV programmatic indicators
Accomplishments
PICT process in TB Facilities
Updating the TB Registry
Forms that will be used in PICT
TB HIV cohort reporting
Recording exercises
Materials needed Power point Presentation

online learning gadget: Laptop, tablet, mobile headphone preferably
with microphone (make sure it’s near your mouth when you speak)
Important Have a copy of the power point presentation for Recording and
Information to Reporting from PBSP.
appear in the ppt DO NOT ADD or DELETE slides from the presentation without
presentation permission from the PBSP
Instructions to the Since most of the content of the slides are already discussed in the
Trainer previous sessions, please DO NOT lengthen the explanations; instead,
ask the participants if they remember the key points in the slides
presented.
DO NOT ADD unnecessary information so participants may focus on
the presentation only
Keep track of your time

participants They can ask questions in the chat box
Tools to be used Recording and Reporting Exercise form

SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE
7TH SLIDE 8TH SLIDE

SLIDE PRESENTATION

SLIDE PRESENTATION

SLIDE PRESENTATION

SLIDE PRESENTATION

SLIDE PRESENTATION

SLIDE PRESENTATION
51TH SLIDE

SESSION PLAN
PICT M12
Mental Health & HIV and the Importance of Suicide Risk Assessment in HIV
Title of the Session
Counseling; Facilitating HIV Disclosure
Duration 30 minutes
HIV Counseling Handbook for the Asia Pacific chapters 5 & 6
Philippine Handbook HIV Counseling & Testing Section 3 Chapter 11 pages
Reference Guide
Philippine Handbook HIV Counseling & Testing Section 2 Chapter 9 pages
91-97
Session Objective/s: Understand the importance of talking about their client’s mental health
At the end of the Understand why PLHIVs have higher risk to some mental health conditions
training session, the Understand the important role of the counselor in improving the mental
trainees will be able to: health of their clients
Identify reasons why clients may be contemplating suicide
Learn to do conduct a suicide risk assessment using the tool
Help the client understand the importance of HIV disclosure
Help the client facilitate HIV disclosure to partner/s
Content: What is mental health? What is the importance of talking about it?
Why are PLHIVs at higher risk of developing mental health conditions?
How can an HIV counselor be of help to the client?
What are the factors that contribute to a client contemplating of
committing suicide?
Using the Suicide Risk Assessment Tools
The importance of HIV Disclosure
How to facilitate HIV Disclosure
Materials needed Power point Presentation on Mental Health, Suicide & Disclosure
Video assignment on Suicide Assessment
( https://ed.ted.com/on/Qe7z7iav )
Factsheets on Mental Health & HIV
( https://www.hiv.gov/hiv-basics/staying-in-hiv-care/other-related-
health-issues/mental-health)
( https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-
mental-health )
Philippine Handbook HIV Counseling & Testing Section 3 Chapter 11
pages 121-125
Tools 5.1 & 5.2
pages 91-97

SESSION PLAN
Important Slide 3 to 6: focus on the key points

Information to Slide 7: Do not be afraid to raise the issue of suicidal thinking
appear in the ppt Slide 8: Briefly run through the use of the tool
presentation
Slide 9 to 10: focus on the key points

Trainer
Ask the participants to watch the video material ahead (give it as
an assignment).

flow of the session.
3. Begin processing by asking their learning from the video assignment.
4. Show slide 3. Discuss mental health, the importance of talking about it
and its relation to HIV.
5. Show slide 4. Discuss the higher risk of PLHIVs to develop mental health
conditions as compared to non-PLHIV
6. Show slide 5. Discuss the roles of an HIV counselor to the mental health
of their clients
7. Show slide 6. Raising the issue of suicidal thinking to your client
8. Show slide 7. Introduce Tools 5.1 & 5.2
9. Show slide 8. Discuss the importance of V disclosure
10. Show slide 9. Discuss how to facilitate HIV disclosure
11. Show slide 10. End presentation
Reminders to 1. Mute microphone all throughout the session.

participants
2. They can ask questions in the chat box

SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE

SLIDE PRESENTATION
7TH SLIDE 8TH SLIDE
9TH SLIDE

FACTSHEETS
ORIGINAL | http://dx.doi.org/10.4172/Psychiatry.1000112 J Psychiatry 2014;17:543-547
Brief suicide preventive intervention in newly diagnosed HIV-positive

persons
Govender RD1, Schlebusch L2, Esterhuizen T3
1
Department of Family Medicine, University of KwaZulu-Natal, Durban, South Africa
2
Emeritus Professor of Behavioural Medicine, University of KwaZulu-Natal, Durban, South Africa
3
Programme of BioResearch Ethics and Law, Department of Public Health Medicine, College of Health Sciences, University of
KwaZulu-Natal, Durban, South Africa
Abstract
South African studies have found that country wide suicide rates are high and that people diagnosed with HIV/AIDS can
have increased suicidal ideation and resultant suicide risk. In this study, we evaluated the effect of a brief psychosocial
intervention on preventing suicide ideation after a positive HIV test result. Suicidal ideation was assessed by both groups of
patients having to complete a suicide risk screening scale (Annexure 1). The study was conducted at a university-affiliated
hospital in Durban, KwaZulu-Natal, South Africa. Consenting adult patients (age 18 years and older) recently diagnosed as
being HIV-positive following voluntary HIV counselling and testing were enrolled in the study. Participants (N=126) were
assigned to standard post-test counselling (SPTC). Thereafter, every alternate patient (N= 64) was counselled using a brief
suicide preventive intervention (BSPI). Patients were assessed at baseline, 72 hours later and 6 weeks after a positive HIV test
result. The balance of 62 participants who received SPTC only were the control group, and compared with the BSPI group.
Although both groups benefited from post-test counselling, results from the BSPI group demonstrated a clinically significant
decrease in suicidal ideation over the time period studied. The results provide preliminary evidence on the efficacy of a
BSPI for recently diagnosed vulnerable HIV-positive persons and the importance of educating such patients on suicide-
prevention strategies.
Keywords: Brief suicide risk screening; HIV

Received date: 2-12-2013
Accepted date: 30-01-2014
doi: http://dx.doi.org/10.4172/Psychiatry.1000112
Background lies ahead. In a previous study, the most commonly endorsed

Worldwide, suicide rates have increased by 60% in the last statement by recently diagnosed HIV-positive persons was,
few decades, with a projected global suicide mortality rate “I can’t imagine what my life would be like in 10 years”.6
of about 1.5 million people per annum by 2020.1 Similarly, It is known that in many cases a positive HIV diagnosis
suicide has been recognised as a significant public health can be linked to hopelessness and depression with the
concern in South Africa (SA) where the national suicide potential risk for suicidal ideation6,12-14, and that one of the
mortality rate has steadily increased over the past few most vulnerable periods for suicide risk is in the immediate
decades from about 1% in the 1980’s to approximately 11% post HIV-diagnosis period.9-10,14 Depression and anxiety are
or more currently of all unnatural deaths.2-4 Aside from the common in people living with HIV/AIDS.6,12,13 Not only have
numerous complexities associated with suicide, the country studies shown that HIV infection is associated with a greater
faces the added burden of the HIV/AIDS pandemic with risk for such disorders,13 but untreated depression increases
one of the largest seropositive populations globally and the risk of suicidal behaviour and or suicidal ideation.6,13
KwaZulu-Natal province (where the present study was done) Suicide prevention is defined as any self-injury
bearing one of the highest proportions of this load.5 prevention or health-promotion strategy that is generally
Suicidal ideation is defined as having the intent to or specifically aimed at reducing the incidence and
commit suicide, wanting to take one’s own life or thinking prevalence of suicidal behaviour.15 Amongst others, suicide
about committing suicide with or without actually making intervention includes: early recognition and assessment of
plans to do so.6 Although there is a paucity of suicide and risk; immediate response to suicide risk; resource referrals;
HIV/AIDS research in Africa7, the studies done, have shown and follow-up management and treatment of at-risk
a high suicide risk in this population.6-10 As early as 1995, individuals.16 Although various intervention approaches
AIDS phobia was cited as a trigger in 17% of parasuicide have been described to prevent suicidal behaviour,16 a
cases among youth in SA.11 HIV-positive people are at risk complete and comprehensive preventive model is the
for suicide2,6 and when first diagnosed with HIV, many universal/selective/indicated (USI) model, which targets the
individuals react with disbelief, anxiety and fear for what general population, vulnerable populations and persons at
high risk for suicide. Universal preventive interventions are
directed at entire populations; selective interventions are
Correspondence directed at individuals who are at greater risk for suicidal
Professor L Schlebusch, behaviour; and indicated preventions target individuals who
Postnet Suite 208, Private Bag X10, Musgrave Road, have already begun to display self-destructive behaviour.16
Durban, 4062, South Africa,
In addition, a systematic review of suicide-prevention
Email: schlebuschl@ukzn.ac.za
Journal of Psychiatry • March 2014 543

FACTSHEETS
strategies has suggested five key areas for intervention, back-translated to accommodate isiZulu speaking patients
viz.:(i) education and awareness; (ii) screening for at- (one of the largest language groups served by the clinic)
risk persons; (iii) treatment of psychiatric disorders; (iv) so as to avoid possible language bias. The translation was
restricting access to lethal means; and (v) media reporting performed by a professional linguist and had been through
of suicide.17 rigorous review by the ethics committee.
There is growing evidence that suicide is increasing in In the model used for the SPTC group the main principles
the context of HIV/AIDS with HIV-positive persons having a 3 included:
times higher prevalence than the general population despite
1. Addressing the impact of disclosure of the HIV test
the introduction of Antiretroviral therapy (ART).18 Extensive
result, allowing the participant to digest this information,
research19 as part of the World Health Organization’s
and giving the participant time to explore his/her feelings
worldwide initiative for the prevention of suicide across
and fears.
five continents, found that brief intervention can be an
important component of suicide prevention programmes 2. Considering that the participant may be emotionally
and confirmed that indicated suicide prevention strategies ‘shocked’, and giving reassurance that he/she would not
should complement universal and selective suicide be abandoned by the team of healthcare professionals
prevention strategies. Given this, the aim of the present who have much to provide in terms of different treatment
study was to assess the effect of a brief suicide preventive modalities.
intervention on suicidal ideation in HIV-positive persons
3. Explaining to each participant that coming to terms
immediately post-test, within 72 hours and 6 weeks later.
with the result may take some time and that he/she can
Patients and Methods remain healthy by taking care of him-/herself, which
includes following the recommended treatment plan and an
The study was conducted at a university-affiliated hospital
appropriate diet, and seeing a doctor when necessary.
in Durban, South Africa. The study site was at a district
level health facility in the KwaZulu-Natal province which 4. Addressing the need to understand the different modes
has one of the highest local provincial HIV prevalence of HIV transmission and how the virus can be transmitted
rates.5 Patients attending the hospital clinic for voluntary to others, emphasising safe-sex practices and condom use,
counselling and testing (VCT) for the HIV were informed and explaining the natural history of the progression of the
about the study. Those meeting the inclusion criteria (age 18 disease.
years and older and testing seropositive, i.e. HIV Stage 1 and
2) were approached for voluntary participation (N=126). 5. Explaining the intervention or treatment programmes
Participants received standard post-test counselling (SPTC) available and changes in lifestyle, and emphasising that
administered by the resident hospital VCT nurse counselor hospital social workers would be a part of the programme
and conducted individually. Thereafter, every alternate and would assist with social and support resources.
patient was counselled utilizing a brief suicide preventive The BSPI included an extra one-hour individual therapy
intervention (BSPI) administered by a trained BSPI counsellor. session that addressed additional psychosocial issues
Both the SPTC and the BSPI were done in patients’ preferred related to HIV-positivity at the time of presentation, and
language of either English or isiZulu (the predominant entailed identifying and helping to resolve interpersonal
languages spoken). The counsellor was certified-trained difficulties which may cause or exacerbate psychological
in HIV pre-post test counselling. Additionlly demographic distress. To render the BSPI effective and relevant to the
data was collected (age, gender, educational status, target population, it was conducted according to a protocol
marital status, ethnicity and religion). The BSPI participants that encompassed:
constituted the intervention group (N=64) and were then
compared with the balance of patients ( =62) who received 1. Feedback on research-based epidemiology and the
SPTC only (the control group). Because some patients were risk for suicidal behaviour as indicative of psychological
lost on follow-up and not all patients provided relevant data, and/or social distress following VCT and a seropositive
patient samples varied as depicted in the tables. result.
After counselling, participants in both groups were asked 2. Exploring potential suicide risk and protective factors
to complete a self-administered suicide risk screening and how patients should deal with such risk factors.
scale (SRSS)20 (Annexure 1) at baseline, after 72 hours and 3. Expressing empathy and discussing the situation
6 weeks later. The 14-item SRSS was developed previously in light of the participant’s personal circumstances, while
from a shortened version of the Beck Hopelessness Scale maintaining objectivity and being non-judgemental.
(BHS) and the Beck Depression Inventory (BDI).20 The scale
was tested for validity, internal consistency and a receiver 4. Providing simple advice on how to live positively and
operating characteristic (ROC) analysis was performed for encouraging personal responsibility to change behaviour,
sensitivity and specificity for suicidal ideation (positive at and encouraging self-efficacy and the participant’s belief in
a score of ≥ 4). The area under the ROC curve (AUC) was his/her ability to make meaningful changes.
regarded as the probability of correct prediction. The 5. Highlighting sociodemographic protective factors.
AUC was 0.730 (p<0.001; 95% confidence interval (CI)
0.64 - 0.81) at baseline and 0.776 (p<0.001; 95% CI 0.68 - 6. Discouraging personalisation of psychosocial factors
0.87) 3 weeks thereafter. Accordingly, the SRSS score was such as stigmatisation, fear of disclosure and discriminatory
considered to be a good predictor of suicidal ideation in the gender issues.
population studied.20 Hopelessness was also assessed using 7. Openly discussing HIV/AIDS, including prevention
a pre-determined score of ≥5 (items V1-V11; Annexure 1) and treatment, to help to de-stigmatise the disease, and
and direct suicidal risk using a score of ≥ 1 (itemsV12-V14; discussing alternative coping mechanisms in case of
TAnnexure
R A I N E R 1).
’S EThe
-MASRSS
NUA was
L translated into isiZulu and suicidal ideation. 158

FACTSHEETS
8. To prevent participants from playing a passive role, the Table 2: Crude incidence rate ratio for suicidal ideation following
counsellor focussed on re-enforcing a positive participant BSPI
mindset, discussing referral options where more intensive BSPI Controla Total
psychological/psychiatric treatment was required,
Cases (n) 42 50 92
encouraging the possibility of family therapy if the patient
was agreeable increasing the patient’s sense of personal Patient time 2 646 2 526 5 172
value, advising the patient to seek help when difficulties Incident rate 0.015873 0.0197941 0.0177881
arise, encouraging openness to exploring potential suicide
risk factors, garnering support from social networking Point estimateb 95% CI
and relevant people, and developing a renewed sense of -0.0112113 -
purpose in life. Incident rate difference -0.0039211
0.0033691
Ethics considerations Incident rate ratio (exact) 0.8019048 0.5191035 - 1.233345
The research protocol was approved by the University of Previous fraction explained -0.2333446 -
0.1980952
KwaZulu-Natal Biomedical Research Ethics Committee. All (exact) 0.4808965
enrolled patients provided written informed consent for Previous fraction for population 0.1013457
participation. All patients considered to be at high risk for a
SPTC only.
suicidal ideation were referred for appropriate psychiatric/ b
(midp) Pr(k<=42) = 0.1466 (exact)
psychological treatment. (midp) 2*Pr(k<=42) = 0.2932 (exact)
Statistical analyses
Strata software (version 12) was used for statistical analysis. Table 3: Chi-square tests
Generalised linear modelling was used to categorise Number of valid
Group Exact Sig. (2-sided)a
participants with suicidal ideation. Pearson’s chi-square cases (n)
test was used to determine the statistical significance of Controlb 62 0.000
differences between the control and intervention groups. BSPI 64 0.000
McNemar’s chi-square test was used for paired binary Total 126 0.000
proportions. a
McNemar’s chi-square test; Binomial distribution used.
Results
b
SPTC only.
Table 1 depicts the assessment of suicidal ideation among

participants following SPTC and BSPI at the 3 time-points that the maximum change from positive to negative took
(baseline,72 hours and 6 weeks after a positive HIV test result). place in the first 72 hours after the BSPI. Table 3 depicts the
Although Pearson’s chi-square tests showed no statistically corresponding statistical significance (using McNemar’s
significant outcome between the SPTC and BSPI at all 3 time- chi-square test) of the effectiveness of the BSPI, from having
points, the trend analysis for suicidal ideation from baseline, suicidal ideation (positive) at baseline to having no thoughts
to 6 weeks (Table 2) showed a suicidal ideation incidence of of suicide (negative) 6 weeks later.
019.79/1000 person days (95% CI 14.31 - 25.28) in the SPTC
The first 11 items of the SRSS (Annexure I) measures
group and 015.87/1 000 person days (95% CI 11.07 - 20.67)
features of hopelessness. Consistent with previous findings,6
in the BSPI group. In comparison with the control group, the
descriptive statistics for each of the SRSS statements
crude incidence rate ratio for suicidal ideation among the
revealed that the statement, “I can’t imagine what my life
intervention group was 0.80 (95% CI 0.52 - 1.23). Therefore,
would be like in ten years” (Annexure 1) had the highest
although both groups benefitted from post-test counselling,
affirmative score in both the control and intervention groups
the BSPI proved more protective against the possibility of
at all 3 time-points, although in the BSPI group there was a
suicidal ideation in the patients studied. In addition, there
significant abnormal reduction in this view over the time
was a significant change from positive (suicidal ideation)
period studied (Table 4).
to negative (no suicidal ideation) from baseline to 72 hours
and from baseline to 6 weeks. The change from 72 hours Discussion
to 6 weeks was not statistically significant. This suggests
HIV/AIDS has been shown to be associated with a higher
Table 1: Suicidal ideation following SPTC and BSPI at 3 time- risk for suicide in certain patients.2,6-10 Brief interventions
points after a positive HIV test result have consistently been found to be effective in different
Outcome (suicidal ideation ≥4) patient populations.19-21 In this study, the implementation
Time-point p-valuea of a brief suicide preventive intervention along with the
Negative n (%) Positive n (%)
standard post-test counselling decreased suicidal ideation
Baseline 0.275 in seropositive patients particularly within the first 72 hours.
Controlb 25 (40.3) 37 (59.7) We can consider these first 72 hours as the ‘golden hours
BSPI 32 (50.0) 32 (50.0) of suicide prevention’ in HIV-positive persons. The added
72 hours 0.610 advantage is that during this early period those patients that
Controlb 44 (71.0) 18 (29.0) are lost to follow up over a longer time frame would still have
BSPI 48 (75.0) 16 (25.0)
the benefit of suicide intervention treatment. Within the
South African context, this is an absolute advantage, given
6 weeks 0.189
that so many HIV-positive persons are lost to follow up.
Controlb 42 (67.7) 20 (32.3) More importantly, in South Africa, suicide risk assessment
BSPI 50 (78.1) 14 (21.9) and interventions are limited by the shortages of adequately
a
Pearson’s chi-square test. trained health care professionals, suicide risk screening and
b
SPTC only. suicide preventive intervention guidelines. HIV counsellors
FACTSHEETS
Table 4: Descriptive results for the SRSSa

Baseline 72 hours 6 weeks
SRSS item
Controlb (%) BSPI (%) Control (%) BSPI (%) Control (%) BSPI (%)
V1 51.6 43.8 43.5 42.2 38.3 39.7
V2 83.9 78.1 62.9 56.3 63.3 55.6
V3 32.3 25.0 17.7 18.8 21.7 17.5
V4 35.5 32.8 21.3 20.3 13.3 11.1
V5 47.5 42.2 24.2 23.4 21.7 20.6
V6 50.0 40.6 19.4 14.1 18.3 19.0
V7 50.8 45.3 17.7 15.6 31.7 22.2
V8 36.1 31.3 17.7 12.5 18.3 14.3
V9 50.0 40.6 23.0 20.3 23.3 14.3
V10 38.7 37.5 16.1 14.1 23.3 12.7
V11 37.1 31.3 6.5 3.1 15.0 4.8
V12 3.3 3.1 4.8 3.1 5.0 1.6
V13 0.0 0.0 0.0 0.0 0.0 0.0
V14 11.5 10.9 1.6 1.6 0.0 0.0
a
Refer to Annexure 1.
b
SPTC only.
and primary care physicians who are responsible for pre- should be considered when interpreting the research
and post-test HIV counselling and psychosocial education findings. Firstly, the study's overall generalisability needs to
can easily be task-shifted to screen and provide suicide be considered. The sample sizes were not large and the study
interventions resulting in effective reduction of suicidal was confined to the post-HIV-test period, with the biggest
ideation at a reasonable cost and minimal training. part of the study population being urban-based. Thus, the
results should be interpreted with caution. Secondly, the
Although the BSPI was intended as an intervention to
participants should be followed up for a longer period
reduce suicidal ideation in recently diagnosed seropositive
than 6 weeks to determine the prolonged effectiveness
patients, its value to potentially prevent eventual suicidal
of the intervention. This together with the relatively small
behaviour at a later stage cannot be underestimated
sample size might have contributed to a lower statistical
because of the various suicide risk phases HIV/AIDS
significance in this study, as suggested in a meta-analysis
patients may go through.2,6 Importantly, a multi-site research
of studies on psychosocial interventions.28 Further research
study using standardised methodology 22 has shown that
is required to gain greater clarity regarding the presence
suicidal ideation can be construed as a sign of distress
of suicidal ideation at the different stages of HIV infection
and that there is a strong cultural underpinning underlying
and the effectiveness of suicide preventive intervention at
suicidal behaviour.22 Our findings suggest that witin this
these different stages within the context exposure to anti-
context the BSPI assisted in decreasing hopelessness and
retroviral treatment.
psychosocial stress, thereby helping the patients to cope
better and attenuate suicidal ideation. This is supported Conclusion
by other studies,23-26 which showed that people living with
In the present study, suicidal ideation was reduced in
HIV/AIDS can develop enhanced coping skills if they have
access to medical treatment and a strong and supportive both the SPTC and BSPI groups, but to a greater degree
social network. in the latter, suggesting that although general counselling
can have a positive psychological outcome, the BSPI was
Resilience in individuals facing adversity is considered more effective in reducing suicidal ideation. We showed
to be attributed to a combination of personal and contextual a decrease in the levels of suicidal ideation in newly
resources that enable effective adjustment to challenges diagnosed HIV-positive persons following appropriate
and life situations.23 This implies that with appropriate help, counselling and BSPI. Thus the findings of our study support
HIV-seropositive individuals can overcome the perception of
the value of such an approach in recently diagnosed HIV-
adversity brought on by the infection, and in some patients
positive persons in the primary care setting and especially
it may be this resilience that serves as a protective factor
for those presenting with either overt or covert signs of
or coping mechanism27 which can also be postulated to be
one of the effects of the BSPI. Furthermore, studies have hopelessness, depression and suicidal ideation. All health
shown that the duration of psychosocial intervention can care workers at HIV/AIDS clinics, but especially in poorly
be relevant to its effectiveness.28,29 In the present study the resourced countries, should be trained to increase their
maximum change in reducing suicidal ideation occurred knowledge regarding suicide prevention and reduce
within the first 72 hours following a positive HIV diagnosis, suicidal ideation in vulnerable HIV-positive patients.
which confirms the value of early intervention to prevent
suicidality in these patients. Declaration
The authors declare that this is original work and has not
Study limitations previously been published.
Although the results of the present study provide valuable
information on how to reduce suicidal ideation in newly Conflict of Interest
diagnosed HIV-positive individuals, important limitations
TRAINER’S E-MANUAL None. 160

FACTSHEETS
Acknowledgements in the spectrum of intervention: Definitions of critical

The authors wish to thank the fieldworkers for their excellent terms and constructs. Suicide Life Threat Behav 1995; 25:
work ethic and the collection of data for this research. 70-81.
We express sincere gratitude to Ms P Pillay for research 16. Nordentoft M. Crucial elements in suicide prevention
assistance. strategies. Prog Neuropsychopharmacol Biol Psychiat
Financial acknowledgements: RDG was supported by 2011; 35: 848-853.
a Doctoral Research Grant Award (2010) funded by the 17. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, et al.
University of KwaZulu-Natal. Suicide prevention strategies: A systematic review. JAMA
2005; 294: 2064-2074.
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5. Actuarial Society of South Africa (ASSA). ASSA 2008 21. Bien TH, Miller WR, Tonigan JS. Brief interventions for
AIDS and Demographic Model (lite version 110207). alcohol problems: A review. Addiction 1993; 88:315-36.
Pretoria: ASSA, 2011. http://aids.actuarialsociety.org.za/ PMID:8461850 doi:10.1111/j.1360-0443.1993.tb00820
ASSA2008-Model-3480.htm (accessed 16 July 2013).
22. Fleischmann A, de Leo D,Wasserman D. Suicidal thoughts,
6. Govender RD, Schlebusch L. Hopelessness, depression suicide plans and attempts in the general population on
and suicidal ideation in HIV-positive persons. S Afr J Pysch different continents. In: D. Wasserman, C. Wasserman, eds,
2012; 18:16-21. Oxford Textbook of Suicidology and Suicide Prevention. A
7. Kinyanda E, Hoskins S, Nakku J, Nawaz S, Patel V. The Global Perspective. Oxford: Oxford University Press, 2009;
prevalence and characteristics of suicidality in HIV/ 99-104.
AIDS as seen in an African population in Entebbe district, 23. Carvalho FT, Morais NA, Koller SH, Piccinini CA. Protective
Uganda. BMC Psychiat 2012; 12: 63. factors and resilience in people living with HIV/AIDS. Cad
8. Skinner D, Mfecane S. Stigma, discrimination and the Saude Publica 2007; 23: 2023-33.
implications for people living with HIV/AIDS in SA. J Soc 24. Zhang Y, Zhang X, Aleong TH, et al. Impact of HIV/AIDS
Aspects of HIV/AIDS 2004; 1: 157-164. on Social Relationships in Rural China. The Open AIDS
9. Govender RD, Schlebusch L. Suicidal ideation in Journal 2011; 5: 67-73.
seropositive patients seen at a South African HIV voluntary 25. Ncama BP, McInerney PA, Bhengu BR, Corless IB,Wantland
counselling and testing clinic. Afr J Psychiat 2012; 15:94- DJ, Nicholas PK, et al. Social support and medication
98. adherence in HIV disease in KwaZulu-Natal, South Africa.
10. Schlebusch L, Govender RD. Age, gender and suicidal Int J Nurs Stud 2008; 45(12):1757-1563.
ideation following voluntary HIV counselling and testing. 26. Waddell EN, Messeri PA. Social support, disclosure, and
Int J Environ Res Public Health 2012; 9: 521-530. use of antiretroviral therapy. AIDS Behav 2006; 10: 263-272.
11. Mhlongo T, Peltzer K. Parasuicide among youth in a 27. Seery MD, Leo RJ, Lupien SP, Kondrak CL, Almonte JL.
general hospital in South Africa. Curationis 1999; 22: 72-6.
An Upside to adversity? Moderate cumulative lifetime
12. Ciesla GR, Roberts JE. Meta-analysis of the relationship adversity is associated with resilient responses in the face
between HIV infection and risk for depressive disorders. of controlled stressors. Psychological Science. 2013.
Am J Psychiat 2001; 158: 725-730.
28. Crawford MJ,Thomas O, Khan N. Psychosocial interventions
13. Olley BO, Seedat S, Nei DG, Stein DJ. Predictors of major following self-harm. Systematic review of their efficacy in
depression in recently diagnosed patients with HIV/AIDS preventing suicide. Br J Psych 2007; 190: 11-17.
in South Africa. AIDS Patient Care STDs 2004; 18: 481-487.
29. Rehse B, Pukrop R. Effects of psychosocial interventions on
14. Thom R. Common mental disorders in people living with quality of life in adult cancer patients: meta analysis of 37
HIV/AIDS. S Afr J HIV Med 2009; 10: 8-13. published controlled outcome studies. Patient Education
15. Silverman MM, Felner RD. The place of suicide prevention and Counseling 50: 2003; 179-186.

FACTSHEETS
Mental Health and HIV

Almost every person faces mental health challenges at some point. Major
stresses—like the death of a loved one, divorce, loss of a job, or
moving—can have a major impact on mental health. Having a serious
illness, like HIV, can be another source of major stress. You may find that
a diagnosis of HIV challenges your sense of well-being or complicates
existing mental health conditions. HIV and some opportunistic
infections can also affect your nervous system and can lead to changes in
your behavior.
Good mental health will help you live your life to the fullest and is
essential to successfully treating HIV. To help manage your mental
health, it is important to know when, how, and where to get help. Many
mental health conditions are treatable and many people with mental
health conditions recover completely.
One of the most common mental health conditions that people living with
HIV face is depression. Depression can range from mild to severe, and
the symptoms of depression can affect your day-to-day life. Both HIV-
related medical conditions and HIV medications can contribute to
depression.
Symptoms can include:
 Feeling sad or anxious often or all the time

 Not wanting to do activities that used to be fun
 Feeling irritable‚ easily frustrated‚ or restless
 Having trouble falling asleep or staying asleep
 Waking up too early or sleeping too much
 Eating more or less than usual or having no appetite
Content Source: HIV.gov Date last updated: March 19, 2020

FACTSHEETS
 Experiencing aches, pains, headaches, or stomach problems that do

not improve with treatment
 Having trouble concentrating, remembering details, or making
decisions
 Feeling tired‚ even after sleeping well
 Feeling guilty, worthless, or helpless
 Thinking about suicide or hurting yourself
Other mental health conditions include anxiety disorders, mood

disorders, and personality disorders. For a good description of specific
mental health conditions and their symptoms, visit mentalhealth.gov.
Getting help in a crisis. At times, the problems of life can take a toll on
people. Some might feel trapped, hopeless, or might wonder what they
have to live for. If you are having thoughts like these or are thinking
about hurting or killing yourself, know that you are not alone and that
things can change. SAMHSA's Suicide Prevention Lifeline provides 24/7,
free and confidential support for people in distress. Get information
online or call:(800) 273-TALK (8255). You can also:
 Call your HIV health care provider.

 Get help from another health care provider.
 Reach out to a close friend or loved one.
 Contact a minister, spiritual leader, or someone else in your faith
community.
Talk to Your HIV Health Care Provider

Talk to your HIV health care provider if you are experiencing any of the
symptoms above. Your provider may ask you some questions to assess
how you are feeling and may prescribe medications to help with
depression or anxiety or refer you to a mental health specialist.

FACTSHEETS
If you are taking antiretroviral therapy (ART) or plan to take ART, consider
the following:
 Sometimes ART can relieve your anxiety because knowing you are
taking care of yourself can give you a sense of securing.
 However, some antiretroviral medications may cause symptoms of
depression, anxiety, and sleep disturbance, and may make some
mental health issues worse. Talk to your health care provider to
better understand how your HIV treatment might affect your mental
health and if anything can be done to address the side effects.
 Also, some medicines for mental health conditions or mood
disorders can interact with ART.
Communicate openly and honestly with your health care provider about
your mental health so that he or she can help you find the support you
need. Discuss any changes in the way you are thinking, or how you are
feeling about yourself and life in general.
Mental Health Providers and Programs

Because mental health conditions are common, many outlets can help
you maintain good mental health. If you are having symptoms of
depression or another mental health condition, talk to your health care
provider, social worker, or case manager. These people can refer you to a
mental health provider who can give you the care you need.
Types of mental health providers include:
 Psychiatrists: Medically trained physicians who treat mental health

problems with various therapies, like talk therapy, and by
prescribing medicine.
 Psychologists: Trained professionals who help people cope with life
challenges and mental health problems with therapies, like talk
therapy, but usually cannot prescribe medicines.

FACTSHEETS
 Therapists: Mental health or marriage and family counselors who

help people cope with life issues and mental health problems.
You may also choose to join a support group. Support groups include:
 Mental health support groups: An organized group of peers who

meet in a safe and supportive environment to provide mental health
support to members of the group.
 HIV support groups: An organized group of peers living with HIV
who meet in a safe and supportive environment to provide support
to other people living with HIV.
Work with a trained mental health professional to learn about treatment

options such as therapy and/or medicine. You and your provider can
develop a plan that will help you regain and maintain good mental health.
Other ways to help improve mental health and well-being include:
 Exercise: Regular exercise may help improve symptoms of

depression and decrease stress. When you exercise, your brain
releases chemicals called endorphins. These chemicals help
improve your mood.
 Meditation: Recent studies suggest that mindfulness meditation can
help ease depression, anxiety, and stress.
You may find it helpful to create an action plan for your mental well-
being. SAMHSA offers a free self-help guide you can use to create and
maintain a wellness plan for yourself.
Find Mental Health Services

Many organizations have websites and telephone hotlines that can help
you find treatment for mental health conditions.

FACTSHEETS
 Substance Abuse & Mental Health Services Administration

(SAMHSA)’s Find Help website provides a list of organizations and
contact numbers that can help you find mental health treatment
and support in your local area.

FACTSHEETS
HIV and Mental Health

Last Reviewed: September 24, 2020
Key Points
 Mental health refers to a person's overall emotional, psychological, and social well-
being. Good mental health helps people make healthy choices, reach personal goals,
develop healthy relationships, and cope with stress.
 If you have HIV, it's important to take care of both your physical health and your
mental health.
 People with HIV have a higher risk for some mental health conditions than people
who do not have HIV.
 Mental health conditions are treatable, and people with mental health problems can
recover.
What is mental health?
Mental health refers to a person's overall emotional, psychological, and social well-
being. Mental health affects how people think, feel, and act. Good mental health helps
people make healthy choices, reach personal goals, develop healthy relationships, and
cope with stress.
Poor mental health is not the same as mental illness. Mental illnesses include many
different conditions, such as post-traumatic stress disorder (PTSD), bipolar disorder,
and schizophrenia. A person can have poor mental health and not have a diagnosed
mental illness. Likewise, a person with a mental illness can still enjoy mental well-being.
If you are living with HIV, it's important to take care of both your physical health and
your mental health.
Are people with HIV at risk for mental health conditions?
Anyone can have mental health problems. Mental health conditions are common in the
United States. According to MentalHealth.gov, in 2014, about one in five American
adults experienced a mental health issue.
However, people with HIV have a higher risk for some mental health conditions than
people who do not have HIV. For example, people living with HIV are twice as likely to
have depression as people who do not have HIV.

FACTSHEETS
It's important to remember that mental health conditions are treatable and that people
who have mental health problems can recover.
What can cause mental health problems?
The following factors can increase the risk of mental health problems:
 Major life changes, such as the death of a loved one or the loss of a job
 Negative life experiences, such as abuse or trauma
 Biological factors, such as genes or brain chemistry
 A family history of mental health problems
The stress of having a serious medical illness or condition, like HIV, may also negatively
affect a person's mental health. HIV infection and related opportunistic infections can
affect the brain and the rest of the nervous system. This may lead to changes in how a
person thinks and behaves. In addition, some medicines used to treat HIV may have
side effects that affect a person's mental health.
What are the warning signs of a mental health problem?
Changes in how a person feels or acts can be a warning sign of a mental health
problem. For example, potential signs of depression include:
 Losing interest in activities that are usually enjoyable

 Experiencing persistent sadness or feeling empty
 Feeling anxious or stressed
 Having suicidal thoughts
If you have any signs of a mental health problem, it's important to get help.
What should I do if I need help for a mental health problem?
Talk to your health care provider about how you are feeling. Tell them if you are having
any problems with drugs or alcohol.
Your health care provider will consider whether any of your HIV medicines may be
affecting your mental health. They can also help you find a mental health care provider,
such as a psychiatrist or therapist.
Here are additional ways to improve your mental health:

FACTSHEETS
 Join a support group.

 Try meditation, yoga, or deep breathing to relax.
 Get enough sleep, eat healthy meals, and stay physically active.
To find mental health treatment services, use these resources from the National
Institute of Mental Health (NIMH) and the Substance Abuse and Mental Health Services
Administration.
This fact sheet is based on information from the following sources:
From the Centers for Disease Control and Prevention:
 Learn About Mental Health

 Mental Health
From MentalHealth.gov:
 Mental Health Myths and Facts

 What Is Mental Health?
From NIMH:
 HIV/AIDS and Mental Health
From the U.S. Department of Veterans Affairs:
 Mental Health and HIV

TOOLS

SESSION PLAN
PICT M13
Title of the Session Counselor Self Care
Duration 30 minutes
Session Objective/s: Understand mental health the importance of maintaining good mental
health as counselors or health care providers
At the end of the training session,
Understanding stress and its effect to our body
the trainees will be able to:
Identifying the causes of our stress/es
Learning how people cope up with their stress/es?
Understanding burnout
Identifying signs of burnout and how to effective address it
Content: What is mental health? What is the importance of talking about it as HIV
Counselors and Healthcare Providers?
What is stress and ho its effect to our body?
What are the common causes of stress?
What are common coping mechanisms of people in response to stress?
What is burnout?
How to identify burnout and how to prevent it
Materials needed Power point Presentation on Counselor self-care

Meditation video (Feeling Good www. audiomeditation.co.uk )
pages 66-73
Important Information Slide 3 to 9: focus on key points

to appear in the ppt
presentation
Instructions to the Trainer 1. Preparations:

Prepare the video material (positive meditation) check on the
connectivity and audio.
Prepare Zoom Meeting connectivity and share the link to
trainees.
flow of the session.
3. Slide 3: Emphasize that our own mental health is equally important as
our clients’.
4. Slide 4: Mention tht stress is experienced in different levels by everyone;
how each responds and copes with stress is unique and personal
5. Slide 7: Point out that every person may experience burnout
6. Slide 8: Briefly Discuss effective stress management & prevention
strategies
7. Before ending: lead the group to a meditation
Reminders to participants Mute microphone all throughout the session.


SLIDE PRESENTATION
1ST SLIDE 2ND SLIDE
3RD SLIDE 4TH SLIDE
5TH SLIDE 6TH SLIDE

SLIDE PRESENTATION
7TH SLIDE 8TH SLIDE
9TH SLIDE

Ang TB ay pangkaraniwang sakit ng mga taong may HIV.
Mas mahirapgamutin ang TB sa isang pasyente na may HIV.
TANDA AN
Mas mahirap gamutin ang pasyenteng may

TB kung ito ay may HIV co-infection.
Pag ang pasyenteng may TB ay

nagkaroon ng HIV, agad ipaalam para
mabigyan ng tamang gamot at tuloy-
tuloy ang pangangalaga sa kanya.
Ang TB ay pangkaraniwang
opurtunistang impeksyon ng
taong may HIV.
TRAINER’S E-MANUAL 1 74
SESSION PLAN
PICT CLOSING ACTIVITIES

Title of the Session Closing Activities
Duration 20 minutes
Session Objective/s: Assess the participants learning

Know if the expectations were met
At the end of the training session,
the trainees will be able to: Assess the participants learning
Know if the expectations were met
Content: Post-test evaluation examination

Training Evaluation
Materials needed Online Post-test examination

Online Training Evaluation
Instructions to the Trainer 1. Preparations:

Prepare the consolidated training expectations
Prepare the online exam
Prepare the online training evaluation form.
2. End Session
Reminders to participants Online certificate of participation will be provided at the end of the
training session
Certificate of completion will be provided after completing five
counseling sessions (with pre-test and post-test)

CODE OF ETHICS for DOH-CERTIFIED HIV COUNSELORS
As an HIV Counselor, I agree to follow the rules and policies which govern the HIV Program. I understand
the following and accept them as my personal “code of ethics” as long as I continue to work as an HIV
Counselor.
1. I will respect the individuality of every person, I am helping, regardless of sexual orientation, gender
identity and expression, cultural and religious background , including choices they make that may not
be my own;
2. I will respect the rules of confidentiality with regard to helping relationships, counseling sessions, and
in every interaction with fellow counselors;
3. I understand that it is my responsibility to immediately seek supervision in situations regarding

potential suicide, abuse, threatened violence or homicide;
4. I will continue to learn , as much as possible, the issues that affect my clients;
5. I will offer only information that I am qualified to share, with utmost accuracy;
6. I will not take advantage of my client and that I vow to prevent romantic involvement with them;
7. I will be role model, maintain integrity as a person, make healthy choices, be true to myself, and follow
through on my words and promises to my clients towards healing and positive change;
8. I agree to be a team leader, be supervised, and to follow the guidance that is offered in supervision,
and will accept support from others;
9. I will not use my position for my own gain or profit;
10. I will refer clients in situations upon which I am not able to be effective HIV counselor due to training
limitations, emotional connection, or personal discomfort;
11. I will not allow my duties to put my emotional or physical well-being at risk;
12. I will respect my own energy and value my own limitation.
I agree to follow this “Code of Ethics” to the best of my ability.
I understand that I may be removed from the roster of DOH Certified HIV Counselor in violation of this
“Code of Ethics.”
I value and know who I am. I am an individual, a caring helper and an HIV educator.
I am an HIV Counselor.
_________________________________________ ___________________________________________
Name and Signature of HIV Counselor Address
Contact No. _______________________________ Date: ______________________________________

TRAINING EVALUATION
ONLINE TRAINING ON HIV COUNSELING & TESTING

Department of Health
Philippine Business for Social Progress
Date of Activity:
Annex 5 Training Evaluation Form
TRAINERS
A. ABOUT THE WORKSHOP/TRAINING Strongly Agree Agree Disagree Strongly Disagree
1. The activity met my expectations.
2. The objectives for each topic were covered
3. The content was organized and easy to follow
4. The training taught me knowledge and skills to do
counseling in our facility
B. LOGISTICAL ARRANGEMENT Strongly Agree Agree Disagree Strongly Disagree
B.1 Secretariat
1. Sent all needed materials ahead of time
2. Ensure all online forms needed are collected on time
3. Address/es possible issue/s prior to the scheduled
training
B.2 Online Platform/ Internet Connection Strongly Agree Agree Disagree Strongly Disagree
1. Registration process is clear & easy to follow
2. Ease of logging in
3. Seminar link is working properly
4. Internet connection is stable
5. Presentations are clear and concise
6. Online materials are easily accessible
7. Sound is clear
B.3 Trainer/s Strongly Agree Agree Disagree Strongly Disagree
1. Mastery of the topic
2. Encourages participation and interaction
3. Substantially answers participants' questions
B.4 Information, Education & Communication
Materials Used
1. Presentations were brief and concise
2. Presentations were easily understood
3. Video materials used were relevant and relatable
4. Video materials were clear
5. Online Handouts were clear
6. Online examinations and quizzes were not confusing
C. OVERALL ASSESSMENT Excellent Very Good Average Poor
In general, how do you rate the workshop/training?
D. SUGGESTIONS & RECOMMENDATIONS
1. What aspects of the workshop/training can be

improved?
2. Other comments/suggestions/recommendations:

What are the benefits of knowing
your HIV status as a TB patient?
If your test result is HIV(-), you will need to learn how to maintain your HIV free status
to protect yourself, your child, your partner, and other loved ones from getting HIV
if your test result is HIV(+), you will be able to:
Get prompt and proper Protect your child and loved

treatment for HIV to strengthem ones from HIV
your immune system
Learn how to keep from Start practicing a healthy

contracting other diseases lifestyle

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II TRAINER’S E-MANUAL

Tuberculosis (TB) is still a major public health problem

For the past 20 years, Philippine Business for Social

Under PBSP’s portfolio, more than 37,000 multidrug-

TRAINER’S E-MANUAL III

MASTER HIV COUNSELOR TRAINERS’

� Jason “Jhaye” Encabo � Honnielyn Fernando, MD � Celestino “KT” Ramirez

DOH-CERTIFIED HIV COUNSELING & TESTING TRAINERS’

� Maria Cecila Anonuevo, RSW � Ryan Pinili, PTRP

� Renz Robinson Alvaro � Ma. Grace Guevarra, RMT � Anjela Platon, RN

� Nicolle Lourdes Dela Cruz, MD � John Dave Mare “Devine” David

SPECIAL MENITON TO:

� Jojie Maglaqui, RPsy � Mary Joy Morin, RN � Jesus “Jess” Ramirez

� Gerardo Alcantara, MD � Aureo de Castro

Overall Objectives of the Training:

This 7-day training package consists of the following:

2. Philippine Handbook for HIV Counseling and Testing (Three Sections)

3. Synchronous HCT Training Videos (6 videos)

4. Online Quizzes and Forms

5. Fact Sheets on the Policies

6. NTP Recording and Reporting Tools

4. Trainer’s Manual Philippine National AIDS 2. AO 2014-0005 TB-HIV

TRAINER’S E-MANUAL VII

Rationale of the Trainers’ Manual IV

PICT M1: What Counselors Should Know on STI, HIV-TB

PICT M2: Understanding Sex, Gender, Sexuality and SOGIE

PICT M3: RA 11166 and Other Policies & Guidelines

PICT M4: The Responsibilities of TB Healthcare workers as Trained HIV Counselors

PICT M5: Key Elements of Ethical of Effective HIV Counseling Practice

PICT M6: HIV Testing Process and HTS Forms

VIII TRAINER’S E-MANUAL

PICT M10: Ensuring a Successful Referral

PICT M13: Counselor Self-Care

PICT Closing Activities

Content:  Expectations regarding the training, co-participants and trainers

Materials needed  Power point Presentation on the summary of the expectations

Important  Slide 1: Summary of Training Expectation Result

Instructions to the 1. Preparations:

Reminders to  Mute microphone all throughout the session.

1ST SLIDE 2ND SLIDE

3RD SLIDE 4TH SLIDE

5TH SLIDE 6TH SLIDE

7TH SLIDE 8TH SLIDE

UIC: DAY REFLECTION DATE:

UIC: DAY REFLECTION DATE:

Signature over Printed name: Date:

5. Everyone has the right to pass up any valid question.

6. “I-statements” – it is preferable to share your feelings or values using “I-statements.”

Reference Guide  Chapter 1 pages 2- 12

Session  How is HIV transmitted?

Content:  The difference between HIV and AIDS

Tools needed  Video Presentation (HIV 101)

Important  Slide 3- Objectives

 Slide 5 Poll: Kapag may TB madaling mahawaan ng HIV. (Tama, Mali,

 Things to remember in HIV

1ST SLIDE 2ND SLIDE

3RD SLIDE 4TH SLIDE

5TH SLIDE 6TH SLIDE

7TH SLIDE 8TH SLIDE

Chapter 1 The Immune System

Needle Stick 0.3 %

Unprotected vaginal intercourse

Unprotected vaginal intercourse

Field Test version only Field Test version only

Content: Expectations regarding the training, co-participants and trainers

Materials needed Power point Presentation on the summary of the expectations

Important Slide 1: Summary of Training Expectation Result

Reminders to Mute microphone all throughout the session.

Reference Guide Chapter 1 pages 2- 12

Session How is HIV transmitted?

Content: The difference between HIV and AIDS

Tools needed Video Presentation (HIV 101)

Important Slide 3- Objectives

Slide 5 Poll: Kapag may TB madaling mahawaan ng HIV. (Tama, Mali,

Things to remember in HIV

Overall with breastfeeding up to 6mos 25 - 30% 1.08% 1.08%

Content: Definition of Terms- Sex, Gender, Sexuality.

Materials needed SGS/ SOGIE Video Presentation

Important Slide 1: Title

Speakers Note’s Slide 2; SEX- discuss Determinants of Sex

Prepare the power point presentation in the laptop and check if

Reminders to Mute microphone all throughout the session.

Know and Understand the existing HIV- related Policies and

Content: Guiding Principles

History and Development

Comparison of significant differences RA 8504 vs RA 11166

Key Features of RA 11166

Case Study and Penalties for violations

Existing Policies and Guidelines

Materials needed Power point Presentation

IRR of RA 11166 ecopy

Online Learning Gadget: Laptop, Tablet, Mobile,

Headphone, preferably with Microphone (make sure it’s near your

Important Slide 1: Title

Slide 4: State Policies

Slide 5: History and Development

Slide 6: Key Features of RA 11166

Slide 7: Key Features of RA 11166

Slide 8: Case Studies and Penalties

Slide 9: Existing Policies and Guidelines

Slide 10: Thank You!

Slide 6; Focus on the Key Points

Prepare Zoom Meeting connectivity and share the link to

Reminders to Mute microphone all throughout the session.

Remind participants to do additional reading on the whole Law.