In order to make an informed or educated decision about having an HIV test it is important to understand what is involved, why you should have a test, or why not. This is one of the reasons for HIV/AIDS counselling. There are emotional issues to deal with.
Information will need to be provided about the HIV test and about the possible outcome of the test. There are emotional questions such as, what if the test result is positive?
Counselling is always confidential. Any discussion that takes place and the reason for such discussion must remain confidential, between the councillor and the person being counselled. The person being counselled must feel the issues discussed will be kept secret. Confidentiality refers to the right of a person to privacy as set out in the Bill of Rights. Everyone has the right to decide which parts of their personal lives to keep private, and which parts can be made public. Any issues discussed with a counsellor may only be spoken about when the person being helped gives permission.
The counsellor should listen to and show respect for the person who is in need of counselling or guidance. The purpose of counselling is to explore a specific problem and at the same time to find ways of satisfactorily dealing with a problem. HIV/AIDS is such a problem but there are many others that counsellor's deal with each day - marriage guidance counselling and career guidance and counselling.
A counsellor assists a person in need of help by offering advice or by proposing solutions for dealing with problems. The person who is counselled needs time and understanding from the counsellor. It is the role of the counsellor to assist with solving problems by advising how to deal with them but not doing it for them. Counselling requires the sharing of information so that informed decisions can be made and solutions can be decided on.
Who can counsel?
Any person can be a "counsellor". There are however professional counsellors available that should be contacted when counselling might be complicated.
An employer, manager or colleague may be required to listen to an employee about concerns to do with HIV in a work situation.
Teachers may assist pupils with personal problems. Most schools provide a counselling service and have professional counsellors employed specifically for this reason.
A doctor will sometimes counsel patients particularly if the patient is seriously ill.
A minister, church leader, or Rabbi may offer counselling on topics relating to religion and other spiritual needs.
Parents are counsellors when their children have problems they wish to discuss.
In all of these situations the counsellor, or person giving advice, may be asked whether or not it would be right to have an HIV test, or whether to disclose the results of a test to an employers or others. A person who has tested positive may simply need someone to turn to, someone who can be impartial and listen.
Family or friends may also need help. Counselling is important for families at times of serious illness, bereavement or loss. When a family has been through a crisis such as a hijacking or a particularly violent attack or robbery counselling is advisable.
In the case of HIV/AIDS it is good for families to seek counselling as this will assist them in dealing with the problem. The counsellor will be able to offer advice on how best to help the infected family member and to deal with issues such as prejudice.
Counselling for medical issues
Basic HIV knowledge, how the infection is transmitted and how to prevent it are areas for discussion as well as discussion on sexually transmitted infections, the symptoms and treatment. Pregnancy may also need to be discussed.
Counselling for personal issues
Personal issues that may need to be discussed include issues around the feelings of isolation, rejection, anxiety, stress, religion, beliefs, body image and possibly thoughts of suicide.
Sexual relations, family relationships, friends, employers and relationships with colleagues may require discussion.
The most important skill of any counsellor is listening. There is an important difference between hearing and listening. How often have you heard someone say 'you are not listening'? You reply 'I am, I hear you'. You may hear but are you really listening?
You are not listening when you don't care. You have an answer for a problem before your friend has finished telling you what the problem is. You cut a person off in mid sentence or before the have finished speaking. How often do you finish a sentence for the person you are speaking with because you are dying to talk about something else?
When your friend is telling you a story and you interrupt to tell them about your experience making theirs seem unimportant, are you listening?
When you refuse thanks by saying you have really done nothing to deserve it, you are not listening. You were given two ears and one mouth for a reason, why?
You are listening when you really try to understand even if the person with whom you are communicating is not making much sense. You grasp their point of view, even when it is against your own convictions. When you realise the hour you spent listening to another person left you tired and drained, you know you have really listened. When you allow your friends the dignity of making their own decisions, even though you think they are wrong you are listening. Don't take over a problem from someone else let them deal with it their own way. Give them space to discover for themselves what is really going on.
How else can you be a good listener?
Limit your own talking - you cannot talk and listen
Look for feelings as well as fact so you get the whole picture
Do not jump to conclusions. Avoid making assumptions or trying to complete sentences for another person. Let them finish speaking.
Ask for clarification if you do not understand or feel you may have missed a point. Ask relevant clarification questions and dont interrogate
Dont interrupt when a person pauses. This may indicate they are looking for the right words are coming to an embarrassing part of the story or trying to summon up the courage to continue.
Concentrate on the person and what is being said. If possible, go to a quite area. Show empathy and not sympathy.
Empathy is different to feeling sorry for another person. Empathy means imagining how you might feel in a similar situation. It means putting yourself in their shoes so that you can gain understanding of the problem.
In dealing with terminal illness, we have to cope with feelings of hopelessness because we are required to sit at the bedside and watch life draining away. We forget that by just being there and listening creates an environment where the dying person can die with dignity and honour.
Counselling and HIV/AIDS
Counselling is an important part of dealing with HIV and Aids. Counselling is normally provided before an HIV test, this is known as pre-test counselling or after an HIV test known as post-test counselling.
Pre test counselling
The counsellor should discuss with the individual all the advantages and disadvantages of knowing his/her status. In addition the counsellor should offer advice on how to deal with a negative result as well as understanding the implications of a positive result.
The individual should be told the result in person and only by a skilled counsellor where possible. In cases where the test result is positive, they must have access to on-going counselling.
Confidentiality is required. The test results can only be revealed if the person has given consent. The issue of confidentiality should be discussed with the person concerned as well as the advantages or disadvantages of disclosing their HIV status to employers, colleagues, family and friends. It is important to point out that they are not legally obliged to disclose their HIV status to anyone.
The format of any pre-test counselling session is flexible, but the following main points should be addressed if possible
1. Greet the person and introduce yourself if you do not already know each other. Explain the reasons for the pre-test counselling session. Explain that informed consent is needed before taking the test and that the implications of having an HIV test will be explored. Discuss confidentiality and re-affirm the secrecy and privacy of the session and of the results.
2. Discuss why the person has decided to take the HIV test.
3. Establish general understanding and knowledge of HIV and AIDS.
4. Discuss with the person the perceived risk they may have been exposed to.
5. Explain the advantages and disadvantages of having an HIV test. (see notes below)
6. Educate briefly on the basics of HIV and transmission. Discuss safer sex and the use of condoms and any related emotional issues. This is an opportunity to encourage behaviour change, especially if the person is HIV negative. This discussion may save that person's life in the future.
7. Discuss the HIV tests and how it works. Discuss what the possible results mean. Explain the "window period" where a person may just have been infected, but still gets a negative test result.
8. Discuss how, when, and where, the results will be obtained. Make sure that the person wants to give informed consent to have the test.
Advantages of having an HIV test
Getting a negative test result may relieve worry, anxiety and stress.
Having a test may motivate a person to change their sexual behaviour and cause them to realise the dangers involved. It might stop high risk activities
An HIV test result may allow a woman to make a decision about whether to fall pregnant, continue or terminate a pregnancy
A positive test result can prevent unknowingly transmitting the disease to others
If positive, previous sexual partners can be informed and given the opportunity to have an HIV test and prevent spreading HIV
If positive, treatment can be started and the person would be able to start protecting his/her health
If the employer were informed of the result, he would have to try to accommodate the employee's illness. The employer if not informed might have grounds to dismiss the employee if excessive sick leave and absence cannot be explained. An employer may not discriminate against an employee who is HIV positive.
Possible disadvantages of having an HIV test
The result might be positive
Coping with the knowledge that it will develop to full blown AIDS
Could lead to depression and even suicidal tendencies
Prejudice of others and the stigma associated with the disease
Possible difficulties with family, friends and loved ones
Concerns about who else might be infected
The format of any post-test counselling session is flexible, but the following main points should be addressed
1. Give the person a brief overview of your intentions for the session
2. Give the person the test result. Be brief and to the point
3. If the result is positive allow the person to respond when they are ready.
Give them time to think. When they are ready allow them to talk about whatever they choose
4. Discuss where they can go for support, the importance of support and any concerns they might have in this respect
5. Discuss their understanding of a positive result
6. If the person is responsive and willing to talk discuss the long-term implications
7. Agree on a date and time to meet again
People who are HIV positive will have to learn about many things that cannot be covered during this kind of session. Giving adequate time for people to express their feelings is important. A person may forget everything said in the session except for the fact they are HIV positive. Hopefully they will also remember that you were there for them when they needed help.
Encourage further sessions so that the person can be educated about HIV and AIDS, and learn how to live a healthy life for as long as possible. These sessions will also allow the person to deal with the emotions that they will certainly experience. These should take place within 24 to 48 hours. During the sessions that follow you will need to discuss the need of a person living with HIV and the various stages of the disease as it progresses to full blown AIDS.
Written by: W D Squire
Contact Des on 011 884 5456 or [email protected]