1. COUNSELING IN HIV/AIDS Dr Arun Kr Sharma Department of Community Medicine University College of Medical Sciences Delhi 110 095 India E mail: tingu98@hotmail.com

2. Counseling skills properly used are tools to help individuals seek and find their own solutions to the dilemmas they face. Definition

3. Why Is Counseling Necessary? Because infection with HIV is life long To cope with HIV positive status and live a meaningful life To adjust and to learn about change in one’s life style in order to reduce risk of contracting HIV infection

4. Objectives To provide psycho-social support To prevent transmission of HIV infection To improve quality of life of HIV infected people To provide risk assessment for people who are potentially at risk of contracting HIV infection

5. Whom to counsel? Self motivated counseling seekers Persons seeking HIV tests HIV positive persons High Risk Behavior Groups Family Members Employers Health professionals People unaware of risks

6. Characteristics of a Counselor Committed Open minded Non judgmental Sense of responsibility Patient listener Tolerant Attentive Informed Positive body language

7. Skills Required in Counseling Excellent communication skills Ability to judge state of mind of a person Quick empathetic response Focused Reflection of feeling Questioning Paraphrasing

8. Skills Required in Counseling Respectful Structuring and prioritization Help to formulate strategies Help develop coping mechanisms

9. Stages of Counseling 1. Risk assessment counseling 2. Pre test counseling 3. Post test counseling 4. Follow up counseling

10. Principles of Counseling Unconditional positive regard for the client Trust and confidentiality Empathy Time

11. Steps in Counseling Rapport building Gaining trust Explaining limits Problem identification Discuss options Take action Follow up

12. Role of Counselor Advocacy role Health education Referral Clinical and therapeutic role

13. Contents of Counseling Contents of counseling will depend on the ability of the client to grasp. It’s a dynamic process. The counselor must be able to assess the clients need and state of mind quickly. However, following components should be incorporated in all counseling scenarios:

14. Contents of Counseling The need to prevent infection and re infection Basic information about HIV infection and associated diseases Review of possible sources of client’s infection Methods of safe sex including condom use Exploration of obstacles to change of behavior

15. Contents of Counseling Information about what HIV testing can and cannot do. Coping with HIV test results. Need to tell the HIV status of the client to the key persons in his/her life. Handling hostility, fear, violence, depression, suicidal tendencies etc.

16. Working Goals of HIV Counseling Forming a helping relationship Clarifying and addressing problems Establishing personal goals Providing information on alternative resources Selection of realistic alternatives Stimulation of motivation and decision making Helping client to develop competence Recognizing and diagnosing signs of psychological distress and providing support

17. Possible Reactions to a Positive Test Result Fear Sense of loss Grief Guilt Denial Depression Anger Anxiety Stress Shock Loss of self esteem Suicide

18. Special Situations in HIV Counseling A. Pregnant women B. Childless couples C. Breast feeding positive mothers D. Spouse and family members of HIV infected persons

19. Some Common Counseling Errors a. Directing and leading b. Being judgmental and evaluating c. Moralizing, preaching and patronizing d. Unwarranted reassurance e. Not accepting the client’s feeling f. Interrogating g. Encouraging dependencies