Key Elements for Ethical and

Effective HIV Counseling

Practices
What is Counseling?
 Differences from Education?
 GAME KA NA BA?
 Game ka na ba?
 Which of the following best describes counseling?
a. One on one advise
b. Pair by pair
c. Three in one
d. Face to face
 Game ka na ba?
 Which of the following best describes counseling?
a. One on one advise
b. Pair by pair
c. Three in one
d. Face to face
Counseling

a face-to-face communication between a

client and the health worker during
which the latter helps the client cope
with problems related to her/his disease,
make decisions associated with her/his
health, and avoid risks.

Enhanced Comprehensive STI Case Management, 2006 DOH-NASPCP

This is done with neutral emotion.
This is done with neutral emotion.

Answer: Education
This is to motivate the recipient for behavior change.
This is to motivate the recipient for behavior change.

Answer: Education
It is described as issue oriented.
It is described as issue oriented.

Answer: Counseling
This is based on client’s needs.
This is based on client’s needs.

Answer: Counseling
It has a goal that is focused and specific to the target recipient/s.
It has a goal that is focused and specific to the target recipient/s.

Answer: Counseling
This evokes a strong emotion in both parties.
This evokes a strong emotion in both parties.

Answer: Counseling
This is content oriented.
This is content oriented.

Answer: Education
The goal is generalized.
The goal is generalized.

Answer: Education
Counseling IS NOT…
 Telling or directing

 Giving advice
 A conversation
 An interrogation
 A confession
 Praying
Enhanced Comprehensive STI Case Management, 2006 DOH-NASPCP
 Difference
Counseling Health education

Closely linked, may take place at same time

process that enables part of a process of

people to change, to make enabling someone to
choices and decisions. In understand the
order to change, the nature of the infection or
patient must want to disease
change

Enhanced Comprehensive STI Case Management, 2006 DOH-NASPCP

 Difference
Counseling Health education
Confidential Not usually confidential
Usually a “one- to- one” Small or large groups of
process or small group people
Evokes strong emotions in Emotionally neutral in
both counselor nature and client
Focused, specific and goal- Generalized
targeted
Information used to change Information used to
attitudes increase knowledge and
educate and motivate
behavior change
Issue-oriented
Content-oriented
Based on needs of the client
Based on public health
needs
Enhanced Comprehensive STI Case Management, 2006 DOH-NASPCP
 Counseling Review
 Counseling is a PROCESS of HELPING a person/people
LEARN how to SOLVE certain emotional, interpersonal and
decisional problems.

 Counseling is based on a set of techniques and skills that the

counsellor brings to the interaction to help the client to
explore and better understand a problem, deal with related
feelings and concerns, evaluate alternatives, make choices
and take action.
 AIMS of HIV Counseling
 To prevent HIV transmission by providing information
about the transmission risk (eg.unsafe sex and needle
sharing);
 To assist people in developing the personal skills needed to
negotiate safer practices;
 To provide psychological support to people who are
infected with and affected by HIV in improving their
emotional, psychological, social, and spiritual well-being;
and,
 To support clients in treatment adherence.
 Different Types of HIV
Counseling
 HIV Prevention Counseling
 Pre-HIV test counseling
 Post- HIV test counseling
 Ongoing counseling for people affected by HIV
 Treatment Adherence counseling
 Pediatric counseling
 5 Cs in HIV Counseling to
Testing
 CONSENT
 CONFIDENTIALITY
 COUNSELLING
 CORRECT RESULTS
 CONNECTION/ REFERRAL
 CICT versus PICT
HCT Approach Client-initiated C&T
Clients/Patients - Comes specifically for HIV test
- Expect HIV test/result
- Likely asymptomatic
Providers - Usually trained not necessarily
HCW
Primary Purpose Focus on preventing HIV
transmission thru risk assessment,
risk reduction & testing
Protocols - Client-focused
- Usually one-on-one
- Important for prevention
Follow-up - Referred to medical and support
services (CB)
Provider-initiated C&T
- Come specifically for TB
services
- Not necessarily expecting HIV
test
- HCW trained for Counseling
Diagnosing HIV appropriate
TB&HIV management,
particularly referred
- Provider recommends test as
routine
- Limited discussion on the need
- emphasis on medical care &
prevention
- Referred to medical and support
services (CB)
 Ethical Concerns in
Counseling
Counseling is a non-exploitative activity

Counselor’s Responsibility to Client:

1. Client Safety
2. Client autonomy
 Engaging in sexual activity with client is unethical

3. Contracting – terms including confidentiality

4. Counselor competence – monitor limitations of own
competence
 Key Elements (3A and 4C)
 Ample Time
 Acceptance
 Accessibility
 Consent
 Consistency and Accuracy
 Confidentiality
 Cultural and Social Considerations
 Counseling Communication
 ROLE PLAY
“LOVERS” in COUNSELING
L – EAN FORWARD

O – PEN POSITION

V – OICE PROJECTION

E – YE CONTACT

R - ELAXED

S – IT PROPERLY
 MICROSKILLS IN
COUNSELING
1. LISTENING - ?
2. QUESTIONING
3. SILENCE
4. NON-VERBAL BEHAVIOR
 Gestures, Facial expressions, Posture, Body orientation, Body
proximity / distance, Eye contact, Mirroring, and Removal of
 

barriers (e.g., desks).

 Empathy and listening skills
● Explain that empathy can be demonstrated in the two following
ways:

1.  Paraphrasing involves restating, in your own words, the

essence of what the client has said.

Example: The Client says, “I feel so helpless. I can’t get the

housework done, get the children to school on time, or even cook
a meal. I can’t do the things my wife used to do.”

Then the Counsellor says, “You are feeling overwhelmed by

having to do things you did not have to do in the past when your
wife was alive.”
 Empathy and listening skills
2. Reflecting emotions is similar to paraphrasing except that the
focus is on the emotions expressed by the client. Example: The
Client says, “I don’t know what to do. Before he died I
promised my husband that I would take care of his mother for the
rest of her life. But I no longer have the energy. I cannot seem to
get myself sorted out to do anything. He knew that his mother
and I did not get along and that the situation would be miserable.
Why did he die and leave me in this mess?”

The Counselor reflects, “You seem to be feeling very low and

helpless right now, but at the same time you seem to be feeling
guilty and angry about your promise to your husband.”
 Tips for Counseling with Active
Listening
Use eye contact – shows interest in what client is saying
Use open-ended questions- allow clients to express
themselves
Check your understanding – summarizing/ paraphrase
Nod & use encouraging words but avoid unnecessarily
interrupting client
Use tone of voice that shows interest
Listen for feelings as well as facts
 Tips for Counseling with Active
Listening
 Do not
 Interrupt client unnecessarily
 Finish off clients sentences
 Let your mind wander & spend time formulating responses or
thinking about lunch
Open-ended questions
 ROLE PLAY
Interpersonal Skills and Techniques
 Establishing Rapport
 Ensuring privacy and confidentiality
 Showing Respect and Empathy
 Acknowledging Difficult Feelings
 not the counsellor’s job to ”remove” or ”fix” feelings
 Offering Acceptance
 Communication Skills and
Techniques
 Attending Skills
 Listening Skills
 Showing Immediacy
 Appropriate Language Level and Impersonal Statements
 Appropriate Use of Silence
 Questioning
SKILLS ARE LEFT FORGOTTEN IF
NOT PRACTICED.
Oath of Commitment