How to Counsel HIV Positive Patients

It is a known fact that HIV infection or AIDS is an incurable condition. There is no effective treatment or a reliable vaccine for the same.Besides the symptoms of the disease, AIDS is complicated by the misery of oppurtunistic infections.This is further aggravated by the psychological impact on the person with AIDS, the concerned family and the community.

The stigma or the discrimination is yet another problem. Counselling is therefore necessary to improve the quality of life of the individual and their near and dears. Counselling plays a crucial role in the prevention, transmission and management of HIV infection or AIDS and allows the individual to make informed decisions that can improve his lifestyle. AIDS counselling is an active process of communication and dialogue between a trained counsellor and the person who presents with problems related to HIV or AIDS in a view to deal with these problems appropriately.

Objectives of Counselling:

Promotion of a healthy lifestyle, behaviour, moral and spiritual values to prevent infection and transmission. Provision of psychosocial support to those infected to improve the quality of life. To complement health education and correct myth about AIDS. Understand the importance of medication for his well being, patient compliance, understand strategies to deal with medication, side effects and drug interaction.

Who Needs Counselling?

Individuals with multiple sexual parteners, drug abusers who share needles, prostitutes, those who practise risky behaviour. Individuals presenting with medical or neuropsychiatric symptoms suggestive of AIDS. Individuals suffering from psychological or psychosocial problems related to AIDS like depression, rejection etc. Caregivers involved in the management of infected person.

The Challenges of HIV Counselling:

Individuals find it difficult to accept the possibility of a shortened life span. Coping with the reaction of others to a stigmatizing illness. Developing and adopting strategies for maintaining physical or emotional health. Initiating changes in behaviour to prevent HIV transmission to others.

Counselling:

The main function of HIV or AIDS counsellor is to be supportive of the person, listen to their problems, empower them to solve their problems and better their lives. The counselling must be done in a private setting and confidentiality must be maintained. The counselling should depend on the chronicity of the illness, physical disability and psychiatric complications.

Importance must be placed to support a person just undergoing the HIV test. Educate them how to interpret the test results and on the reliability of the test as well. For a person who has just been tested positive enough support must be given to accept the fact and disclose it to others. For those with false negative results the long waiting period before the confirmatory results be available would be stressful.

Support:

The counsellor must be able to empathise with the individual. The counsellor must be honest in providing all information while giving support. Avoid giving false informations to the individual while on the other hand give them hope. It would be better to be non judgemental. Do not interrupt while the patient is talking.

Compile a list of problems.  Assist the patient to find a possible solution to their problems. It would be desirable if the patient could come up with their own solutions according to their capabilities. Empower them to make their own decisions. Help them to develop new coping skills. Empower them to take control of their lives whenever possible. Understand and  help them to solve the relationship problems with their family, friends and loved ones. Acceptance and support from the family and friends is highly desirable.

Education:

It is necessary to educate the person regarding the disease, the mode of transmission, the signs and symptoms, the possibilty of oppurtunistic infections, its complications. Help them understand how important it is to modify their risky behaviour. Advise them about the necessity of safer sex.

The use of condoms can prevent the transmission to an extent. Drug abusers need to stop the habit for sustaining good health, sharing of needles is definitely unadvisable.  There are many myths associated with the disease and the mode of transmission. Lay beliefs and misconceptions have to be corrected. For eg: virus can be transmitted through toilet seats,sharing of common utensils etc. Transmission does not occur through casual contact such as hand shake.

Treatment and Drug Therapy:

It is important to give them knowledge about the treatment for HIV, ART. They should also be informed about the availability of alternative therapies for the treatment of AIDS. Educate them about the possible side effects, how to cope with them,and things that may hamper their action. Ensure adherence to the therapy. The objective of any treatment is to lessen the misery of the patient and prolong a healthy lifespan.

Psychological support:

Psychological support must be aimed at reducing stress and avoiding conflicts. Help them in dealing with feelings of loneliness, depression, powerlessness and suicide. Help them to deal with social issues like marriage, divorce, employment and financial problems. Direct the victims anger towards non self destructive behaviour.

Social Isolation:

To deal with social isolation establish networks of support or connect with existing systems in a community. Self help groups can be formed. This would provide a setting to share problems, coping skills, how to cope with medical and psychiatric complications, how to disclose the diagnosis to near and dear ones. Adherence to the drug therapy can also be achieved through these groups. Contacts with institutions and organizations that provide services for HIV must be maintained.

Caregivers:

Helping the caregivers involved in the management of the infected person to handle the daily pressures of caring for the sick is of outmost importance. They too should know what to expect, how to deal with it and how to handle any crisis. They must know where to turn for help when required.

HIV in itself is incurable, without any fool proof treatment. Every effort must be made to enhance the mental and physical welfare of the person with HIV. There is an urgent need to develop strategies and skills to deal with the disease, its complications, nutrition, psychosocial issues, the treatment and ensure a better life.