Showing posts with label social intervention. Show all posts
Showing posts with label social intervention. Show all posts

Monday, January 25, 2016

Is there such thing as Indian Childhood?

The worldview towards childhood was captured by the CRC adopted by the United Nation in 1989, and was implemented all over the world, including in India in 1992.  The CRC stance of childhood was directly influenced by the North (western developed countries) and as such, it is individualistic, ungendered, and to a great extend nostalgic in nature. Such construct of childhood has been criticized by activists in the south from the very beginning and rightly so. The CRC view of childhood was criticized for many valid reason, two key criticism includes 

  • Not giving a role or importance to the kin, family groups, community which are critical in the south as part of the socialization process of the child (Nieuwenhuys, 1998). 
  • And, ignoring the multiplicity of childhood in the south.  

Considering the plurality of childhood in the south, it seems like an individualistic approach in policy paper seems logical, but the childhood in the south is too complicated to be addressed as such in policy papers. So how complicated is the childhood in the south, and looking at India specifically, can there be such thing as an Indian childhood?  

According to Raman (2000), in classical Hindu literature, there’s only one type of childhood i.e. ‘boychild’ as its point of reference, whereas in some tribes in India, the practice varies. She also mentioned that in India, the individuality of the child is acknowledged while deeply embedded in the larger social matrix of community, caste/tribe, kin group and family.  Some key / common feature of childhood that can be observed across India might includes: 

Plurality of Childhood: Childhood in India is marked by its plurality as captured by Raman (2000). For instance, the experience of childhood in India varies horizontally and vertically. Horizontally, there are almost 5000 communities in India which translate to 5000 diverse experience, while vertically, we have the caste, class and gender (Raman, 2000).

Distinct Development task: Also, the distinction of Indian childhood from that of the western concept can be seen in the developmental task of Indian children (Bisht, 2008), for instance;  the  girl child gradually take over the household chores from mothers and in preparation of a marriage life, while the boys get indulgence in their earlier life gradually moving towards an inflexible standards of absolute obedience and conformity to familial and societal standards.

This implies that Indian childhood can be marked by:
  • Plurality of childhood: Since childhood is socially construct, then the extreme diversity in India will definitely have an impact on how we construct childhood across the country.  
  • Continuity between childhood and adulthood. There's no rigid gap between childhood and adulthood like in the west especially for the girl child, she's expected to perform adult gender role from a very early age.  
  • Childhood as a time for preparation for adulthood, especially for girls who are constantly groomed for marriage.
  • Unique developmental task (girls priority is household works and preparation for marriage which are not a priority among parents in the west, while boys are indulged at first then move towards familial and social conformity). 
What more can we add to this list...any suggestion?



Friday, March 01, 2013

ROLE OF SOCIAL WORK IN CANCER PREVENTION AND CANCER CARE

 
Cancer is, to a large extent, avoidable. Many types of cancers are preventable. Others can be detected early in their development, treated and cured. Even with late stage cancer, the pain can be reduced, the progression of the cancer slowed, and patients and their families helped to cope.

The profession of social work has great strength in tools and techniques especially in the areas of community mobilization and in providing psychosocial support that the medical profession doesn’t have. Some other example of the strength of social work will include social action and mass mobilization; understanding of community’s dynamics and eliciting community participation; social welfare linkage and management; counselling, group work and community work for educational purpose and psycho-social support, etc. The tools of social action especially mass motivation, mobilization and participation of the community will be very effective at the preventive level of cancer.

In the Curative level, social work can provide supportive roles to the doctors and patients by providing psychosocial and emotional support which is today, widely accepted as a critical component of medical treatment. It can provide motivational, educational and therapeutic counselling to the cancer patients; it can links patients with necessary resources like funding and treatment aids from the governmental sector as well as non-governmental sectors, etc.

At the rehabilitation level, there is even a greater role for social work by taking care of the palliative unit. At the palliative level, taking care of the psycho-emotional needs is critical not just for the cancer patients but also for their families for any eventualities.

The Government of India under its National Cancer Control Programmes (NCCP) followed four principal approaches in controlling cancer in India. This paper will also follow that approach in exploring the possible roles of the profession of Social Work in Cancer Care and Prevention, with one more heading added, i.e. Policy level.  
  1. Prevention
  2. Early Detection
  3. Diagnosis and Treatment
  4. Palliative Care
  5. Policy Level


1. PREVENTIVE LEVEL
Prevention should be the key element in any disease control programme. Prevention means eliminating or minimizing exposure to the causes of cancer, and includes reducing individual susceptibility to the effect of such causes. This approach offers the greatest public health potential and the most cost effective long-term method of cancer control.

Cancer prevention at the individual and community level, social worker can take a leading role by ensuring community participation in taking preventive actions, awareness generation at all level from school, neighbourhood, to community.
  • The most useful prevention strategy is reduction in tobacco consumption (all forms). Currently about 50% of cancers in men and 20% of cancers in women are related to tobacco use. Social workers can take a leading role in spreading the health implication of tobacco, helping people deal with tobacco addiction, and rehabilitation of tobacco farmers and those whose livelihoods depended on tobacco in one form or the other by helping and generating alternative source of livelihood;
  • The social workers can ensure in involving all levels of the population in the educational process regarding cancer. The contents of cancer education should focus on, tobacco control, physical activity and avoidance of obesity, healthy dietary practices, reducing occupational and environmental occupational exposures, reducing alcohol use, immunization against hepatitis B virus, safe sexual practices to avoid human papilloma virus infection.
  • Campaigning for a healthy lifestyle, which includes eating plenty of fruits and vegetables, avoidance of alcohol and adequate physical activity, is protective for many of the non-communicable diseases including cardiovascular disease and diabetes, and can be considered as part of the overall health promotion programmes.
  • Cancers related to infectious agents such as human papillomavirus and hepatitis B virus can be prevented through vaccination strategies, and social workers can take a leading role in mobilizing the communities.
For the above mentioned prevention measures at the community level, a variety of methods can be employed to educated the community:
  • Among School and University student: Conducting drawing and essay competitions, debates, discussions, seminars and street play competitions, etc.
  • Among Community organization, Municipal, District and State Health Administration: Organizing Participatory workshops and training sessions.
  • In the Mass Media: Participatory programmes on radio and television, descriptive articles in newspapers and magazines,
  • Among the General population: Conducting exhibitions and public lectures, conducting street level awareness drive, focus group discussion with community members, health camp, etc.


2. EARLY DETECTION OF CANCER
Early detection of cancer is critical in combating cancer mortality rate. In India, almost 60 – 70 % of cancer patients are detected at advanced stage which reduced the chances of recovery and raise the cancer mortality rate. 

Cancer Screening is the application of a relatively simple and inexpensive test to asymptomatic subjects to classify them as being likely or unlikely to have cancer. A screening test in itself will not prevent cancer; it needs to be followed up through a systematic medical approach. Still, this is a relative simple measure for early detection of cancer that can be undertaken even by those who have no advance training in medicine but are familiar with medical processes like medical and health social workers with minimal training about the screening process.
  • Opportunistic screening or case finding can be done by the Medical Social Welfare Unit in selected pockets of community based on the populations’ likelihood of getting cancer (this can be determined by many criteria like life-style, community living in industrial areas, or in a waste disposal or waste treatment areas, community whose livelihood are related to radiation or tobacco industry, etc.). This will help not only in early detection but also in increasing the awareness level of the community.
  • Clinical breast examination can be made feasible for women above the age of 40 years, which can be carried out by general practitioners besides community mobilizers like Social Workers. Also there are some simple breast self-examination techniques for women which social workers can teach to groups of women in the communities.
  • Cancers in accessible parts of the body like the oral cavity may be detected at an early stage or even in a precancerous stage through simple inspection and examination; medically familiar personnel like medical social workers can be trained for this purpose.
  • Self-examination of the oral cavity (MSE) and breast (BSE) can be useful methods and each can be propagated widely as a strategy through simple IEC (Informational, Educational Communication) materials, community meeting, focus group discussion, etc. for the early detection of cancer.

3. DIAGNOSIS AND TREATMENT LEVEL
In the Curative level, social work can provide supportive roles to the doctors by providing psychosocial and emotional support to the patients and their families which is considered as a critical component of medical treatment. It can provide motivational, educational and therapeutic counselling to the cancer patients; it can links patients with necessary resources like funding and treatment aids from the governmental sector as well as non-governmental sectors, etc.

At the diagnosis and treatment level, the roles and functions that a social worker can play in cancer care are:
  • Motivation counselling to patients to seek medical help and enabling resources for the treatment and providing proper referral services
  • Educational counselling to the cancer patients about their medical status, preparing them for future course of treatment and treatment process and the possible outcomes of the treatments.
  • Therapeutic counselling to deal with the psychological stress and trauma that can have severe implication on their already weak physical body;
  • If the patients and/or the family are in crisis because of the treatment, crisis intervention has to be undertaken
  • Emotional support to the family of the cancer patients, and eliciting the involvement of the family in the treatment process
  • Providing the cancer patients with various social welfare resources that will enable and enhance their access to better health care and treatment
  • Linkage of cancer patients with governmental and non-governmental welfare resources
  • Organizing therapeutic and/or peer support group for cancer patients
  • Since cancer patients are under extensive emotional and psychological anxiety and stress, organizing recreational and entertainment for them is important
  • A diagnosis of cancer and subsequent treatment can have a significant impact on self-concept, the way in which people perceive or react to themselves. Living with cancer may affect personal self-concept (facts about the self or a person’s self-opinion); social self-concept (perceptions of how one is regarded by others); and self-ideals (perceptions of oneself with respect to how one would like to be). Social worker can provide support and counselling for such patients.

4. PALLIATIVE CARE
Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment, and treatment of pain and other problems – physical, psychosocial and spiritual. Palliative care is particularly important in less developed countries where a high proportion of cancer patients are diagnosed in advanced stages when treatment is no longer effective. These patients can be relieved from suffering with relatively low-cost interventions.

The various issues that crop up in palliative care especially in the terminal stages are:
  • Physical issues towards the end of life incudes loss of function and curtailment of activity and physical effects to perform activities of daily living, including self-care activities, mobility, physical activities and role activities.
  • Psychological issues towards the end of life include fear, distress, anxiety, anger, frustration, disappointment, depression, etc.
  • Social issues towards the end of life include disruption social relationships as a result of impaired ability to pursue normal activities and maintenance of social contacts.
  • Existential and spiritual issues towards the end of life include confrontation with mortality, the meaning of life, isolation and worth as a person. As patients reached terminal stages, spiritual issues gain importance as determinants of quality of life. Spiritual considerations may also assist the individual to endure present discomforts and, if need be, to face death with courage and dignity.
  • Impact of towards-the-end-of-life issues on the family includes general depression, concern about old parents or young children, unclear role and power structures in the family, unclear source of income and means of livelihoods, etc.
The role of the social worker is to help the family and patient deal with the personal and social problems of illness and disability, as well as to provide support during the progression of the disease and the bereavement process if the patient is at the end of life.
  • The social worker’s assessment helps define the patient’s and family’s needs from a psychosocial perspective, and helps anticipate problems within the family that may result from dysfunction and financial difficulties, particularly as the family begin planning for the future.
  • Social work offer such interventions as referral to needed community services, emotional support (including individual counselling of patients and family members) and bereavement counselling.
  • At this stage, social worker can help in finding help and assistance for the patients if there is no one to take care of them, find a nursing home or palliative care unit that can take-care of their personal needs, and helping the family of the patients on how to deal with this physical issues.
  • The social worker can help the patients in coping and dealing with the issues of their medical condition, including the possibility of death, ensuring that their personal concern and worries are taken care of as much as possible, and if the need arises, finding spiritual guide and person to interact with the patients.
  • The social worker can help the patients in staying in contact with family and friends and other loved ones, explain to the family how he is unable to maintain or reciprocate the relationships, etc.
  • Conducting support group for the family, along with therapeutic counselling to cope with the situation.

5. POLICY LEVEL OF CANCER CARE
There are many ways that a social worker can get involved at the Macro level of cancer prevention and cancer care:
  • Many types of cancers can be prevented to a large extent through a comprehensive tobacco control programme including education, legislation, and tobacco cessation services.
  • Ensuring leadership that create clarity and unity of purpose, and to encourage team building, broad participation, ownership of the process, continuous learning and mutual recognition of efforts made in cancer care.
  • Ensuring involvement of stakeholders of all cancer related sectors, and at all levels of the decision-making process, to enable active participation and commitment of key players for the benefit of cancer control programme.
  • Creation of partnerships to enhance effectiveness through mutually beneficial relationships, and build upon trust and complementary capacities of partners from different disciplines and sectors.
  • Responding to the needs of people at risk of developing cancer or already presenting with the disease, in order to meet their physical, psychosocial and spiritual needs across the full continuum of care.
  • Ensuring decision-making based on evidence, social values and efficient and cost effective use of resources that benefit the target population in a sustainable and equitable way.
  • Ensuring the application of a systemic approach by implementing a comprehensive programme for cancer with inter-related key components sharing the same goals and integrated with other related programmes and to the health system.
  • Seeking continuous improvement, innovation and creativity to maximize performance and to address social and cultural diversity, as well as the needs and challenges presented by a changing environment.
Looking at the prevalent trends in the spread and magnitude of cancer and its non-discriminate penetration of every sections of the society, cancer is already a health concern that needs urgent attention from all sections including policy-makers across the world. According to the World Health Organization, death from cancer and other life-style diseases in the developing world including India is expected to increase 104% worldwide by the year 2020. In India, the total cancer cases alone are likely to go up from 979,786 cases in the year 2010 to 1,148,757 cases in the year 2020.

The profession of Social work, especially medical and health social work must take this opportunity in order to survive and thrive in this fluctuating and complex environment in which it is reduced to a supporting role. Social workers must either accept this challenge to change and re-evaluate the services provided and expand their horizon of works or lose the opportunity to be players in the field of cancer prevention and cancer care.


[This is an extract from my Research Paper titled: Exploring the Role of Social Work in Cancer Care and Cancer Prevention submitted to the Dept. of Social Work, Jamia Millia Islamia (New Delhi) and conducted in BRAIRCH of All India Institute of Medical Science (New Delhi) between September 2011 – March 2012 ]


Saturday, May 19, 2012

EMPLOYING A MINOR AS DOMESTIC HELP

 

It is becoming pretty common to see young couple within our community here in Delhi and other major cities around India raising their children without the help of the traditional pattern of child-rearing –the grandparents. But in most instances, the young couples are bound to employ domestic help, especially the help of young girls.

It’s good to see our younger generation seeing household chores as worth a full-time job, but in doing so, there are certain rules and laws, as well as human rights involved that one must be fully aware of, so that we don’t destroy someone's life in the process.

It is rare to see cases of young children being sexually abused within our community, but financial exploitation like underpaying could be rampant thought it is conveniently swept under the carpet. In order to raise awareness, here are few points to note especially child labour and child abuse.

CHILD LABOUR

What is Child Labour?
Child Labour, in simple term, refers to work performed by children that HARMS them or EXPLOITS them in one or more ways (physically, mentally, morally, or by blocking access to basic rights like freedom, education, etc.).

Not all labour of children constitute child labour, and there is no universally accepted definition of ‘child labour’, however, if the work done by the child is considered to be harmful or exploitative, or that the child feels that he/she is being harmed or exploited, it is considered as child labour.

Who is a child?
Any child yet to attain the age of 14 years [Child Labour (Prevention & Regulation) Act].

However, depending on the kind of work being done by the child, the employer can also be prosecuted for harbouring child labour by employing anyone yet to attain the age of 18.

Punishment for Employing Child Labourer:
Penalty for violators: 3 months – 1 year of imprisonment and/or fine of Rs. 10,000 - Rs.20,000, Penalty for repeat violators: 6 months to 2 years of imprisonment.

A child working as a domestic help is also considered as child labour if the work done by the child in any ways comes to disrupts, hamper or block the child’s basic human rights. The child’s basic rights include the right to survival (food, nutrition, shelter); to develop to the fullest (cognitively, physically and developmentally); to be protected from harmful influences, abuse and exploitation; and to participate fully in family, cultural and social life.

Majority of child labourer are in need of care and protection, as such, the Juvenile Justice Act, which define a child as anyone yet to attain the age of 18 years, will be applied. Which means, if the domestic help you employed is younger than 18 years of age and the Child Welfare board think he/she is in need of care and protection, the Juvenile Justice Act will be applied. The Juvenile Justice Court is not a civil court, as such it is pro-child, trials are swifter and punishment are much harsher than under the Child Labour Act.

CHILD ABUSE

What is child abuse?
Child abuse is the INTENTIONAL injury or maltreatment of a child by any significant people in the child’s life which lead to temporary or permanent impairment of the child’s physical, mental or psycho-social development, or disability or death.

‘Significant people’ includes anyone of any age, any sex, related or unrelated to the child, including parents, legal and non-legal guardians, employers, etc.

Who is a child?
Anyone yet to attain the age of 18 years of age [Juvenile Justice (Child in Need of Care & Protection) Act].

What constitute child Abuse?
Abuses are of three major types – physical, emotional & sexual. But financial exploitation is also considered as a form of abuse nowadays.

  1. Physical Abuse includes – any act of physical aggression including beating, trashing, slapping, punching, pinching, pulling by hair or clothes, pushing, throwing, biting, burning with hot object, branding, aggressive handling, arm twisting, etc.
  2. Emotional Abuse includes – verbal and non-verbal; cursing, humiliating, degrading, frightening, threatening, belittling, name-calling, habitual blaming, constant hostility toward them, etc.
  3. Sexual Abuse includes – touching and non-touching behaviours including kissing, fondling, touching private part, rubbing genitals on the child, forcing them to touch your private parts or forcing them to any kind of sexual activities, and inserting body parts and/or objects in into the private part, anus and mouth of the child or attempting to do that. The non-touching behaviour includes undressing, voyeurism, exposing them to pornography or exhibition of private parts to them.
  4. Financial Exploitation includes – paying less, not paying or not paying in time, withholding payment for reason or no reason, etc.

Employing anyone below the age of 14, no matter what are the conditions and terms you agreed on, is a crime. In such case, if any other person like the parents of the child agreed to let the child be employed, the parents too could be prosecuted for human trafficking.

Abusing anyone, no matter what type of abuse it is, is a crime, and the crime become graver if the abused person is yet to attain the age of 18. The JJ Act also includes the parents/guardian as possible perpetrators, so it is applicable for the family as well i.e. if you abuse your own children, your children can charge you for abuse.

Concluding Remarks: We the north-eastern are often labelled as westernized, it is true to some extent. However, we still have this traditional tribal mind-set when it comes to laws and legal matter by solving it through traditional channel, or making traditional arrangement to help with domestic chores by providing basic education to the child while helping with the domestic chores, or taking children under guardianship.

It is good that if we are providing education to the less fortunate children of our relatives, and it is good if we could maintain consensus and avoid ugly legal wars by solving serious matter including murder using our traditional channel. But in many instance, societal sanction against certain behaviours is just not enough to deal with the magnitude of the crime and the crimes of the perpetrators. In cases like child sexual abuse, the abusers usually are serial abuser. And there is no denying that there certainly must be some such cases among us.

PS: In cases that come under the Juvenile Justice Act, the child can be made to undergo medical test to determine his/her age even if a proper birth certificate is provided.

Child Helpline : 1098

Thursday, April 19, 2012

HEALTH CARE AS HUMAN RIGHTS


THE HUMAN RIGHTS BASED APPROACH TO HEALTH CARE
Health is a fundamental human right indispensable for the exercise of other human rights. Every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity.[1] - (International Covenant on Economic, Social and Cultural Rights, 2000)

The human right to health means that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services without any kind of discrimination. It means that hospitals, clinics, medicines, and doctors’ services must be accessible, available, acceptable, and of good and equal quality for everyone, on an equitable basis, where and when needed.

The design of a health care system must be guided by the following key human rights standards and principles:
  • Universal Access: Access to health care must be universal, guaranteed for all on an equitable basis. Health care must be affordable and comprehensive for everyone, and physically accessible where and when needed.
  • Availability: Adequate health care infrastructure (e.g. hospitals, community health facilities, trained health care professionals), goods (e.g. drugs, equipment), and services (e.g. primary care, mental health) must be available in all geographical areas and to all communities.
  • Acceptability and Dignity: Health care institutions and providers must respect dignity, provide culturally appropriate care, be responsive to needs based on gender, age, culture, language, and different ways of life and abilities. They must respect medical ethics and protect confidentiality.
  • Quality: All health care must be medically appropriate and of good quality, guided by quality standards and control mechanisms, and provided in a timely, safe, and patient-centred manner.

The human right to health also entails the following procedural principles, which apply to all human rights:
  • Non-Discrimination: Health care must be accessible and provided without discrimination (in intent or effect) based on health status, race, ethnicity, age, sex, sexuality, disability, language, religion, national origin, income, or social status.
  • Transparency: Health information must be easily accessible for everyone, enabling people to protect their health and claim quality health services. Institutions that organize, finance or deliver health care must operate in a transparent way.
  • Participation: Individuals and communities must be able to take an active role in decisions that affect their health, including in the organization and implementation of health care services.
  • Accountability: Private companies and public agencies must be held accountable for protecting the right to health care through enforceable standards, regulations, and independent compliance monitoring.

 The Human Right to Health is protected by international laws and Indian laws as in:
  • Article 25.1 of the Universal Declaration of Human Rights affirms: ‘Everyone has the right to a standard of living adequate for the health of himself and of his family, including food, clothing, housing and medical care and necessary social services’.
  • Article 12 of the International Covenant on Economic, Social and Cultural Rights that affirm: Health is a fundamental human right indispensable for the exercise of other human rights. Every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity.
  • Article 24 of the Convention on the Rights of the Child;
  • Article 5 of the Convention on the Elimination of All Forms of Racial Discrimination;
  • Articles 12 & 14 of the Convention on the Elimination of All Forms of Discrimination Against Women;
  • Article 25 of the Convention on the Rights of Persons with Disabilities;
  • Article 21 of the Indian Constitution that prescribe right to life and personal liberty -the Supreme Court has brought Article 21 to prescribes for the right to health, along with numerous other civil, political and economic rights, etc.
  • Various articles under the Directive Principle of State Policy and Health: Article 38 imposes liability on State to secure a social order for the promotion of welfare of the people, Article 39(e) related with workers to protect their health, Article 41 imposed duty on State to public assistance basically for those who are sick and disable and Article 42 makes provision to protect the health of infant and mother by maternity benefit. Besides, Article 47 considers it the primary duty of the state to improve public health, securing of justice, human condition of works, extension of sickness, old age, disablement and maternity benefits and also contemplated.




[1] General Comment No. 14 (2000) (1), Article 12 of the International Covenant on Economic, Social and Cultural Rights








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Tuesday, February 07, 2012

HIV/AIDS Counselling: Disclosure Counselling

This post is part of a larger write-up on HIV/AIDS Counselling & Support - A Social Works Perspective. You may download it in one single pdf: HERE


DISCLOSURE COUNSELLING
This type of counselling assists clients to understand the need to share their HIV status with trusted loved ones for the purpose of support and care. In addition, it assists clients understand the importance of disclosure to reduce risks of re-infection by partner(s).

PLWHA may need support to disclose their status to loved ones and their loved ones may need support to cope with their feelings about the information. This is what makes Disclosure counselling a complicated process because the counsellor has to give support to the primary client but also to the significant others of the client and in some instances it is the counsellor that may have to disclose the HIV status of client to loved one.

Motivations for disclosure vary greatly, and debates about “degrees of disclosure” have been evoked. The “degrees of disclosure” refer to level of disclosure a client seeks, some want to disclose to loved ones while others may want to go public with their disclosure to help in reducing stigma in the community and to work as HIV/AIDS activists.

The Benefits of Disclosure Counselling
  • Helps the client ensure that an HIV negative partner does not become infected
  • Help ensure that positive partner can also access early care, treatment and support
  • It can also reduce the risk of an unborn baby contracting HIV from its mother.
Guidelines for disclosure counselling
  • Counsellor must respect a client’s decision not to disclose to partner when adamant and not put any pressure on client to disclose status out of coercion.
  • Counsellor must never disclose client’s status without consent.
  • The Counsellor must support client through the decision-making process with on-going counselling sessions.
  • If the client refuses or is taking time to disclose status then Counsellor must work and encourage the client to identify at least actions that would be adopted to reduce risk of infecting partner during this period.
  • The Counsellor must be ready to have series of counselling sessions with client before arriving at a final decision.
PARTNER NOTIFICATION IN DISCLOSURE
There are three ways in which partner notification can be carried out. They are:
  • Client Referral: This is a situation where the PLWHA chooses to inform the partner himself or herself. The advantage of this sort of disclosure is that Client is familiar with the partner and knows the best way to approach difficult issues with the partner and also knows what to do to calm or appease partner during such emotional crisis. The disadvantage is that the client lacks the counselling skills and experience which may help to alleviate the situation.
  • Counsellor referral: This is a situation whereby the Counsellor provides disclosure of client’s status to client’s partner with client’s consent.
  • Dual referral: In this situation the partner is informed by both client and counsellor after rehearsal has been done to see how best the disclosure can be carried out. The advantage of this sort of partner notification is that both client and counsellor can promptly react to any situation that arises from partner, the counsellor handling the situation with a professional touch while the client gives it a personal colouring.
Disclosure counselling, especially partner notification, is a controversial subject still highly debated in many countries and society, so it is wise to consider every aspect including the legal provision of the country.


REFERENCES

  1. World Health Organization (1994); Source Book for HIV/AIDS Counselling Training,
  2. Thomas, Prof. Gracious (2010), HIV/AIDS: Stigma, Discrimination and Prevention, IGNOU, New Delhi
  3. World Health Organization (2004): Voluntary HIV Counselling and Testing, Manual for Training of Trainers, New Delhi, India
  4. NACO (2011): Annual Report 2010 – 2011, National AIDS Control Organisation, Ministry of Health & Family Welfare, GOI
  5. UNAIDS (2007); Counselling and HIV/AIDS, UNAIDS Technical Update, Best practice Collection

Monday, February 06, 2012

HIV/AIDS Counselling: Bereavement & Crisis Counselling

Download the entire Article of HIV/AIDS Counselling & Support - A Social Works Perspective in one single pdf: HERE


BEREAVEMENT/GRIEF COUNSELLING
Bereavement is a term that can be used to describe any event that includes loss, so this could mean losing a job or the death of someone you know. Bereavement can also be termed as grief.

Bereavement in relation to HIV/AIDS could be grief over the loss of a dear one or grief upon learning one or a partner or a friend is HIV positive. Grief is multidimensional it can be experienced on all levels of the person, in the heart (feelings and emotions), the mind (thoughts), the spirit (meaning of life), the body (physical manifestations). It is a time of transition, beginning with period of diagnosis to death, shock of an anticipated loss, of trying to prepare for the inevitable.

When death follows a terminal illness (like AIDS) even though the family and friends know that the death is inevitable and have watched the person slip away during the illness, they are still left with a sense of loss. People grieve not only for the deceased, but also for the unfulfilled dreams and plans for the future that they hoped to share with them.

There is no right way of coping with a death; people respond to a loss in their own individual way. The way a person responds is partly dependent on their relationship with the deceased, but it also depends on their own personality and upbringing.

Goals of Bereavement Counselling
The main goal of bereavement counselling is to increase the reality of the loss to the mourners and help provide psychosocial and emotional support to them. Bereavement counselling also helps:
  • To help the person deal with spoken and unspoken feelings which he/she is experiencing about the loss of loved one or the HIV diagnosis
  • To help the person overcome difficulties of readjustment to everyday life after the loss or diagnosis
  • To encourage the person to say an appropriate goodbye and to feel comfortable reinvesting in life after the loss of the loved one without feelings of guilt
  • To help the person to be able to adjust to life after an HIV diagnosis.
CRISIS COUNSELLING
Crisis counselling is a short term intervention which focuses on dealing with the immediate situation. It involves helping clients to understand the crisis situation, express their feelings about it, and outlines an action plan and getting referrals. Crisis counselling in relation to HIV/AIDS is defined as a confidential dialogue between a PLWHA and a counsellor aimed at enabling the client to cope with the crisis which is being experienced. The crisis could be:
  • · Diagnosis of HIV infection
  • · Unexpected death in family
  • · Breakup of a relationship
  • · Death of another PLWHA
  • · Emergence of new symptom
  • · Treatment failure or anything that an individual perceives as a severe life event
The role of the counsellor in crisis counselling
One of the counsellors’ major roles during crisis counselling is to help the client define the problem and help restore a sense of control. Sometimes the crisis is so overwhelming for the client that he/she is unable to identify what the major problem of the crisis is, is it the HIV diagnosis itself or is it the need to disclose HIV status to a spouse that is causing the crisis and if both are regarded as a problem, which is the more serious of the two to the client. The counsellor must “Begin where the client is” and be reassuring and supportive as the client discusses the crisis. The counsellor must listen carefully and patiently because the client may sound incoherent initially but with adequate support will calm down and start communicating in a more coherent manner.

Counsellors should never offer false assurances to clients such as statements like “all will be well” because the counsellor really does not know if all will be well and cannot guarantee the client that his HIV diagnosis status will decline rapidly to AIDS or that if client was raped that the rapist is probably not HIV positive. This sort of false reassurance may temporarily help in calming the patient but on the long term I f the client does test HIV positive or declines rapidly from HIV to AIDS, the client will lose trust in the counsellor and feel that the counsellor lied to him/her.

The counsellor should help break the problem into smaller parts and help client prioritize different aspects of the problem. The counsellor should repeat certain information repeatedly to ensure that the client understands the situation and is not in denial. But the counsellor should not overstate the issue and annoy the client who is already emotionally overwrought. The counsellor should also help client set realistic goals for problems and identify which ones he can do something about and which one the client will just have to accept as a part of life.

Sunday, February 05, 2012

HIV/AIDS Counselling: Preventing Mother-to-Child Transmission

 
PREVENTING MOTHER-TO-CHILD TRANSMISSION (PMTCT)
This is another form of pre-test counselling. This is because for the pregnant woman who is getting tested she will be given pre-test counselling but because she is pregnant she will also be informed about the different options available for pregnant women who are HIV positive to avoid infecting their child with HIV.

Counsellor in antenatal clinics should provide information on Mother to Child Transmission (MTCT) to pregnant women. Counsellors must explain that HIV can be transmitted from mother to child during pregnancy, delivery, or breastfeeding. The benefits of early testing during pregnancy so as to enable better care for mother and child should also be emphasized.
Most HIV-positive children get the virus from their mothers. This type of transmission is called “vertical transmission”. There are three major ways for a pregnant positive woman to pass the virus to her child they are
  • During pregnancy: About 25 % of infections occur during this stage. During pregnancy, the virus can be passed to the child through the placenta, especially if it is damaged in any way.
  • During childbirth: About 60% of infections occur during this stage. During childbirth, the virus can be passed to the child through contact with the mother’s vaginal secretions and blood.
  • Through breastfeeding: About 15% of infections occur during this stage because of the presence of the virus in breast milk. The chances of a mother passing HIV to her baby are higher if she becomes pregnant at a time when there is a high level of HIV virus in her blood. This happens when she is in the window period or she is ill with AIDS.
Advantages of Testing during pregnancy
  • Knowledge of HIV status facilitates early referral for care.
  • Knowledge of HIV status allows appropriate treatment and follow-up of the child.
  • Knowledge of HIV status provides an opportunity to implement strategies to prevent transmission to the child.
  • Knowledge of HIV status enables women to take precautions to help prevent transmission to sexual partners.
  • For HIV-negative women, knowledge of HIV status can lead to appropriate HIV prevention measures and risk-reduction behaviour.

Saturday, February 04, 2012

HIV/AIDS Counselling: Preventive Counselling

This post is part of a larger write-up on HIV/AIDS Counselling & Support - A Social Works Perspective. You may download it in one single pdf: HERE

 
 
PREVENTION COUNSELLING
Prevention counselling is similar to pre-test counselling as it provides an opportunity for the counsellor/client to negotiate and reinforce a plan to reduce or eliminate the risk of HIV transmission. Prevention counselling can also be given to relatives and significant others of an infected person so as to protect them from contacting the infection in the process of caring for the PLWHA. As seen above prevention counselling can be categorized into two:
  • Primary Preventive Counselling: This is the counselling given to an individual to avoid contracting an infection.
  • Secondary Preventive Counselling: This is the counselling given to an individual who is positive to help reduce the risk of re-infection. It is also given to the family, significant others and care givers of any infected person to enable them to be able to give proper care to the PLWHA as well as to protect themselves. It covers such issues as Universal Basic Precaution as well as Home Based Care.
Goals of Prevention Counselling
Preventive counselling facilitates an accurate perception of HIV risk for those who are unaware, uninformed or in denial. It should also:
  • Translate the client’s risk perception into a risk reduction plan that may be enhanced by knowledge of HIV infection status.
  • Helps clients initiate and sustain behaviour changes that reduce their risk of acquiring or transmitting HIV
  • Assess the clients readiness to adopt safer behaviours by identifying behaviour changes the client has already implemented and negotiate a realistic and incremental plan for reducing risk
  • Determine the client’s understanding of HIV transmission and the meaning of HIV antibody test results
  • Safe sex options can be discussed. A condom demonstration can be carried if client is willing to use condoms and is interested in knowing how to make proper and consistent use of a condom

Friday, February 03, 2012

HIV/AIDS Counselling: Post-Test Counselling

This post is part of a larger write-up on HIV/AIDS Counselling & Support - A Social Works Perspective. You may download it in one single pdf: HERE

 
POST TEST COUNSELLING
Post-test counselling helps the client understand and cope with the HIV test result. Here, the counsellor prepares the client for the result, gives the result and then provides the client with any further information required, if necessary referring the person to other services. The two usually discuss ways to reduce the risk of infection or transmission. HIV test results should always be given with counselling. The form of post-test counselling will depend on what the test result is.

The main goal is to help the client to understand and come to terms with his/her test results and to initiate adaptation to their sero-positive or sero-negative status. Post-test counselling helps the client to understand and cope with the HIV test result. Counselling for people who have recently received their results is similar to pre-test counselling, because both of them involve HIV risk assessment and the promotion of safer behaviours. The main difference is that in post-test counselling clients need to deal with the reality of their situation and not imagining it in the future. Clients also need to have a clear understanding of what their results mean and what options are available to them.

Giving results (positive) can be difficult and uncomfortable for the counsellor. Sometimes the counsellor fears they may not know what to say or do to an emotional client and fear that clients may harm themselves or others. Because of this counsellors may be tempted to make inaccurate suggestions and give inappropriate assurance so as to make the client feel better but this would be doing the client a disservice because the counsellor would be lying to the client and it is also unethical and unprofessional.

IMPORTANCE OF POST TEST COUNSELLING
Counselling after an HIV test is important for the following reasons:
For Positive test results: Post test counselling is given to convince the client about the reality and seriousness of the situation – it is often difficult for people to accept and believe that they are HIV positive based only on the results of a blood test, especially if they are feeling healthy and strong:
  • To ensure understanding of the test result.
  • To help client cope with the positive result, especially in the days and weeks to follow.
  • To make a plan for ongoing medical care and necessary referrals
  • To provide information about the dangers infecting others and getting re-infected with different strain of the virus.
  • To understand the need for careful planning and importance of medical attention for client who want to have children
  • To help the client with the issue of disclosure.
For negative test results
  • First, because of the “window period”, a negative result may not mean absence of infection, and the client might wish to consider returning for a repeat test after 3-6 months.
  • Second, counsellors need to discuss HIV prevention, providing support to help the client adopt and sustain any new safer practices.
For indeterminate test results
  • To explain the need for re-testing and the reasons that the result could have been indeterminate
  • To help the client develop a plan for protecting him/herself from HIV
Clients may experience a range of emotions upon learning their test results. Many of these emotions will be very strong and should be acknowledged by the counsellor. A client who is very emotional, either in a positive or negative way may be too distracted to hear information that is given to them. Therefore, it is important to help the client to explore his/her emotions and “vent” them. Once a client has released his/her feelings, s/he will be more receptive to receiving other information regarding prevention, treatment and referrals.

Reactions to results from clients can vary from happiness (negative result) to anger despair, depression, grief, anxiety, suicidal ideations, shock and denial (positive or indeterminate result). What determines people’s reactions to their result varies. One of the most important is how well-prepared the person was for the news during the pre test counselling at which the counsellor should have properly prepared the client for the result and also have studied the client and be able to determine the pre-test psychological condition of the client which would help in anticipating how the client would react to the result.

IMPORTANT POINTS FOR POST TEST COUNSELLING
Post test counselling must begin the session by asking how the client has been feeling since having the test and what has been going through his/her mind since taking the test. They should also give the test result in a neutral tone of voice which shows no emotions to reflect what the result is. State the result clearly and simply.
  • It is important to begin the post-test session by asking how the client has been feeling since having the test and what has been going through his/her mind since taking the test.
  • Ask the client if they have any questions but by this time most clients are anxious to receive their result and might not be ready to ask any questions.
  • Give the test result in a neutral tone of voice which shows no emotions to reflect what the result is. State the result clearly and simply.
  • Make sure that the client has understood the test result and that the client is emotionally and psychologically ready for more information to be provided
  • Assess the clients understanding of the test result. Ask the client to explain what the test result means to him/her and check for any misperceptions or misinformation.
  • Assess emotional understanding by asking the client how he or she is feeling at that moment, and allow the client to express the emotions
Once the client is emotionally able to cope start to help the client to plan what the next steps will be. This is called behavioural integration. Behavioural integration requires that the client make an immediate plan (ask ‘what are you planning to do when you leave here today?’) as well as plans for partner notification (disclosing HIV status to partner), modifying the risk-reduction plan or other behavioural changes depending on their test result and the clients Situation.

Thursday, February 02, 2012

HIV/AIDS Counselling: Pre-Test Counselling

This post is part of a larger write-up on HIV/AIDS Counselling & Support - A Social Works Perspective. You may download it in one single pdf: HERE

 
1. PRE-TEST COUNSELLING
HIV counselling is often given in connection with a voluntary HIV test. Such counselling helps to prepare the client for the HIV test, explains the implications of knowing that one is or is not infected with HIV, and facilitates discussion about ways to cope with knowing one’s HIV status. It also involves a discussion of sexuality, relationships, possible sex- and drug-related risk behaviours, and how to prevent infection. It helps correct myths and misinformation around the subject of AIDS. Whenever resources permit, pre-test counselling should be made available to those who desire it.

People who do not want or do not have access to pre-test counselling should not be prevented from taking a voluntary HIV test, however. In contrast, informed consent is always required before an HIV test where the individual’s name will be linked to the result. To allay anxieties while awaiting the test result, some individuals may seek support not only from their own families or a knowledgeable community worker.

Pre-test counselling simply refers to counselling given to an individual prior to taking an HIV test. It is given to prepare the person for the HIV test and the implications of taking the test. Pre test counselling has certain core objectives which are:
  • To explain the test and clarify its meaning;
  • To also explain the limitations of test results and to caution the client about potential misuse of results.
  • To help the client to think about possible reactions to the test result and who should be told. If the test result is positive, who could be informed and who could provide emotional support
  • To help the client understand why the test is required and to make a decision about the test.
  • To review the client’s risk of infection which is also called risk assessment. HIV/AIDS risk assessment requires discussion of personal sexual lifestyle of the client, with far-reaching implications.
  • Correct myths and misinformation about HIV
  • Review the test procedure, including issues related to false positive and false negative and also “window period”
  • Explain and obtain informed consent Discuss potential implications (personal, medical, social, psychological and legal) of a negative or positive result; discuss and demonstrate condom use

1.1 IMPORTANT POINTS FOR PRE TEST COUNSELLING
Pre-test Counselling is usually the first point of contact of the client with counsellor/health facility that is providing the testing service so it is important to establish a good rapport. If you prepare your client well during the pre-test session, you may encounter fewer difficulties during the post test.
  • Identify yourself and clarify your role as a counsellor.
  • Emphasize confidentiality of everything that will be discussed.
  • Ask if relevant why he/her opted to come for counselling and/or testing or clarify why he was referred for counselling.
  • Obtain relevant medical history (past and present) e.g. serious illness in the past, blood transfusion; cough and diarrhoea, STD's etc;
  • Ask about personal habits such as smoking, drinking, drugs etc. This helps with assessing risk behaviour
  • Ask about sexual history. Does the individual have a steady partner, wife/husband, boy/girlfriend, other partners outside relationship, etc;
  • Assess client's knowledge on HIV/AIDS. This enables the counsellor the opportunity to correct misconceptions /misunderstandings; Also to cover such issues as modes of transmission, prevention etc.
  • Assess the client’s understanding of getting tested for HIV and what the test entails
  • Explain what the result will mean if positive or negative including the window period and explore the personal implications of having the test, and what a positive or negative result will mean to him/her and their family and/or significant others;
  • Educate the individual on safer sex practices and healthy lifestyle practices.
  • Discuss with the client what will be required in the area of behaviour change to reduce the risk of contracting HIV irrespective of whether the result will be positive or negative;
  • Help identify how the client will protect their sexual partner/s
  • Explore clients support mechanisms. Who they will tell or talk to about their results? Where they will get support? Explore areas of strength e.g. faith and/or other support systems (supportive husband/wife, relatives, or work-mates);
  • Explain the procedure for the HIV test and what it entails
  • Provide an opportunity for the client to ask questions
  • If the client decides to test, obtain informed consent. Explain the informed consent form and allow the client time to read a leaflet on HIV testing where feasible
1.2 RISK ASSESSMENT
Risk assessment refers to conducting a review of clients’ risk of HIV infection. It is important to remember that this is a very sensitive subject and the client is expected to share information that he/she may never have shared with any other person. To assess the client’s personal risk, the counsellor should continue to explore with him/her the following areas:
  • Current and past client’s sexual behaviour
  • Current and past sexual behaviour of the client’s sexual partner(s)
  • Current and past drug usage pattern of both the client and clients partner
  • Has client’s ever had a blood transfusion done?
  • Client’s exposure to non-sterile invasive procedures
Based on the information gathered from the risk assessment, the counsellor can help the client identify any behaviour that leaves the client open to risk of acquiring or transmitting HIV. The essence of exploring risk with the client is not only to show the client that he/she is open to risk of infection but also to help the person examine ways in which he/she can reduce the chances of getting infected. This means helping the client to develop a risk reduction plan.


1.3 EXPLAINING HIV TESTING AND THE MEANING OF TEST RESULTS
Clients considering testing for HIV must be provided with appropriate information they need to make an informed decision and this should include the method for testing used in the organization. This is very important because some people have a fear of needles and need a lot of psychological preparation before taking an injection so the counsellor may have to prepare the individual as well answer questions the client will have about the testing procedure.

It is important that the counsellors be sufficiently knowledgeable about HIV testing procedures as clients will often have concerns about the accuracy of the test and have specific questions about the laboratory procedures used and the counsellor has to be able to show familiarity with the testing procedure so as to convince the client. The client should also be assured of the confidentiality of the whole testing procedure.

The counsellor should also take time and ensure that the client understands the meaning of a negative or positive HIV result. The counsellor should never assume that the client understands the meaning of the negative/positive test result because the meaning of negative/positive in the English language may confuse some clients.

1.4 CONSENT FOR HIV TESTING
Counsellors should always ensure that a client’s consent is given and depending on the organization maybe in written format. It is the client’s right to have or refuses to have an HIV test carried out and they should not be coerced.

It is the counsellors duty is to ensure that client understands the meaning and possible implications of HIV testing and to ensure that the client does not feel pressured to make a decision but rather that the client makes the decision to test at their own pace.

Finally it is important to reassure the client that the test result will be held in the confidence, to reinforce reasons why the client may benefit from knowing his/her HIV sero-status, and provide an appointment to return for test results.

Wednesday, February 01, 2012

HIV/AIDS Counselling: Definition, Goals & Types

Download the entire Article of HIV/AIDS Counselling & Support - A Social Works Perspective in one single pdf: HERE

 
HIV/AIDS COUNSELLING: DEFINITIONS
Counselling has been defined as a process of helping a person/people learn how to solve certain interpersonal, emotional and decisional problems. Counselling, in relation to HIV and AIDS is a confidential dialogue between a person and a care provider aimed at enabling the person cope with stress and make informed personal decisions relating to HIV and AIDS (World Health Organisation-WHO 1994).

Counselling poses an essential part of HIV antibody testing. HIV/AIDS Counselling is universally performed in two distinct phases - before (pre-test) and after testing (post-test) - regardless of the client’s HIV status. Counselling prior to the test, known as Pre-test Counselling, will help the client understand the test results and its implications. Post-test Counselling is undertaken irrespective of the test result to help the client to integrate and understand the meaning of the test result at all levels - rationally, emotionally, behaviourally, and medically (Jose & Jyothiram, 2008).


MAJOR GOALS OF HIV/AIDS COUNSELLING
The major goals of HIV/AIDS counselling are as follow:
a) Preventive: Providing counselling service and information to help prevent and mitigate the continued spread of HIV by providing information about risk behaviours that leave people vulnerable to contracting HIV infection as well as helping individuals to develop the required skills for behaviour change.
b) Supportive: Providing counselling services to help support people that are infected or affected by HIV. The support includes emotional, social and psychological help given to people who are infected by HIV and those that are affected by the virus.
c) Rehabilitative: Ensuring that clients have access to all the health services available by providing adequate referrals for treatment, care and support services.


TYPES OF HIV COUNSELLING
There are several types of counselling in relation to HIV Counselling. The essence of the different types is to provide for the different stages of the HIV infection that the infected person and the relations will go through. The types include:
a) Pre-test counselling
b) Post-test counselling
c) Prevention counselling
d) Bereavement counselling
e) Crisis counselling
f) Disclosure Counselling
 
The Various type of HIV/AIDS Counselling are explained in the next posts….

Saturday, October 01, 2011

HIV/AIDS: STIGMA

Download the entire Article of HIV/AIDS Counselling & Support - A Social Works Perspective in one single pdf: HERE


1.                 MAJOR CHALLENGES: STIGMA AND HIV/AIDS

“Stigma in terms of HIV/AIDS is any form of behaviour towards a person living with HIV/AIDS that leaves the individual feeling unwanted or dejected. It can occur in different settings – healthcare setting, home, office, church or community. HIV/AIDS-related stigma is a real or perceived negative response to a person or persons by individuals, communities or society. It is characterized by rejection, denial, discrediting, disregarding, underrating and social distance. It frequently leads to discrimination and violation of human rights.” [1]

The Joint United Nations Programme on HIV/AIDS has defined HIV/AIDS-related discrimination as follows “Any measure entailing any arbitrary distinction among persons depending on their confirmed or suspected HIV serostatus or state of health”.

HIV/AIDS is not the only disease that is affected by stigma other conditions like epilepsy, cancer, tuberculosis, syphilis and psychiatric illnesses are stigmatizing diseases, what differentiates HIV from them is that people living with HIV are stigmatized for a multi-dimensional number of reasons which go beyond the physical illness itself. Some of the reasons are:
  • HIV is associated with a number of behaviours that are regarded as deviant by society, i.e. homosexuality, drug use, promiscuity etc.
  • People are afraid of getting infected with the virus
  • HIV has no cure and finally
  • Religious or moral beliefs lead some people to conclude that having HIV/AIDS is the result of a moral fault that deserves punishment and that God is punishing people that is why some people are HIV positive.


Causes of Stigma in HIV/AIDS
The cause of stigma and discrimination can be reduced to the following points:
  • Fear: Fear is a powerful feeling. When people are afraid of something they run away from it and as they run away from it the less correct and accurate information they will get about the object of their fear. This leads to the fear increasing and a vicious cycle is continued.
  • Ignorance: Ignorance is the harbinger of fear, and the source of misinformation.
  • Intolerance: This occurs when people are unwilling to cooperate and compromise. Intolerance is breed by people’s inability to accept diversity and difference
  • Denial: Is a phenomenon whereby instead of people facing the reality of a situation they would rather avoid the situation.
  • Misinformation: This one of the biggest causes of stigma. When people are ignorant of certain information they will make up stories or embellish the stories to suit their own thoughts and values about the situation.


Forms of Stigma
There are 2 major forms of stigma.
  1. Felt Stigma: Self Stigma -This refers to the stigma that a PLWHA develops towards him/herself as a result of all the negative misconception that the individual has about a positive HIV result. Self Stigma can be manifested in the following ways: loss of interest, withdrawal, dejection, loss of self-esteem, guilt, isolation, etc.
  2. Enacted Stigma: This refers to the stigma that a PLWHA faced from his environment because of his status as HIV positive. The various form of enacted stigma are:

  • Family Stigma: This refers to stigma within the family and friends. Manifestations of stigma in family include: rejection of infected person by family members and friends, family refuse to share food, room or talk with infected person, etc.
  • Community Stigma: This refers to stigma within the community and community member refuses to interact with PLWHAs
  • Religious Stigma: This refers to stigma within religious Organizations, such as churches and mosques. Religious stigma are manifested in the same way as does mentioned in the area of community stigma but it is unique because the PLWHA will be labelled a sinner and is can be regarded as deserving the HIV punishment for his/her sins.
  • Media related Stigma: This refers to stigma that is perpetrated by the mass media. This includes referring to PLWHAs as “victims” or “promiscuous people”, or disclosing the status of a PLWHA without consent.
  • Office/Work Place Stigma: This refers to stigma that occurs within an Office or work place.


Consequences of Stigma and Discrimination
Stigma and discrimination affects the individual but it also affects the society at large when it continues and is not remedied. Below are some of the consequences of Stigma and discrimination:
  • It Limits peoples access to healthcare because people fear stigmatization that may occur if they go to HIV clinics and others people get to find out.
  • It increases HIV prevalence and incidence in the country because people are afraid to disclose their HIV status for fear of stigma caused by lack of disclosure.
  • When PLWHA are discriminated against economically (unjustly sacked) the loss is that of the whole family which is affected by the loss in income
  • Because of the fear of disclosing their HIV status, PLWHA are not able to access the social support available to them in the society
  • There is increase in psychological and emotional disturbances amongst PLWHA which takes a toll on the society as a whole
  • The PLWHA may Loss self esteem and confidence and this may leave the person unable to face challenges ahead of him/her.


Strategies to Address Stigma and Discrimination
The issue of stigma and discrimination can only be resolved with a concerted effort from all levels. As shown stigma and discrimination can occur anywhere and can be perpetrated by anybody even loved ones. All stakeholders in the fight against HIV have to be involved in addressing the issue of stigma and discrimination and how to combat it. Some strategies which have worked in other countries and can be adopted appropriately can be found below:
  • Planning and formulating of comprehensive HIV prevention and care activities that will involve all necessary stakeholders.
  • Advocacy/sensitization of communities about HIV/AIDS to demystify it
  • Inclusion of HIV/AIDS into various curricula across the country to ensure that all young people are aware and knowledgeable about HIV/AIDS.
  • The Government should ensure that policies aimed at reducing stigma and protecting the rights of PLWHA are adopted and implemented.
  • HIV Counselling and Testing should be promoted and encouraged with emphasis on the benefits of knowing ones status.
  • Improving access to HIV treatment, care and support by increasing the number of HIV treatment centres across the country
  • Giving the virus a human face through PLWHA activist who will speak out about living with the virus
  • Promoting the establishment of autonomous self-help groups/support groups that will act as support system and advocates for PLWHA in the country



[1] Definition of HIV-AIDS related stigma produced from Stigma-AIDS 2001, discussions and Regional Consultation on Stigma and HIV/AIDS in East and Southern Africa, 2001

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Friday, March 04, 2011

Psychosocial Impact of Disaster and Social Work Intervention With Survivors


(This is part of my assignment on types of disaster and psycho-social impact of disaster, references are given at the end)

Content:

  1. Psychosocial Impact of Disaster on Vulnerable Group
  • Children
  • Women
  • Elderly
  • Differently Able
  1. Social Work Intervention with Survivors of Disaster
  2. Conclusion
  3. References 


1.            PSYCHOSOCIAL IMPACT OF DISASTER ON VULNERABLE GROUPS
Disasters do not affect everyone in the same way. At an individual level, some may experience a disaster with few or no psychological consequences, while others will go through the same disaster and be emotionally devastated. Beyond individual variation, certain categories of people are especially vulnerable or vulnerable in specific ways.
1.1         CHILDREN
Two myths are potential barriers to recognizing children’s responses to disaster and must be rejected: (1) that children are innately resilient and will recover rapidly, even from severe trauma; and (2) that children, especially young children, are not affected by disaster unless they are disturbed by their parents’ responses. Both of these beliefs are false. A wealth of evidence indicates that children experience the effects of disaster doubly.
Most children respond sensibly and appropriately to disaster, especially if they experience the protection, support, and stability of their parents and other trusted adults. However, like adults, they may respond to disaster with a wide range of symptoms. Their responses are generally similar to those of adults, although they may appear in more direct, less disguised form.
Among younger children, anxiety symptoms may appear in generalized form as fears (separation, strangers, animals, or sleep disturbances. They may withdraw socially or may lose previously acquired developmental skills (e.g., toilet training). Among the older ones, anxiety symptoms may appear in sleep disturbances, irritability, or aggressive behavior and angry outbursts may appear. Other changes in behaviour includes mood swing, obvious anxiety and fearfulness, withdrawal, loss of interest in activities, etc.
As children approach adolescence, their responses become increasingly like adult responses. Greater levels of aggressive behaviors, defiance of parents, delinquency, substance abuse, and risk-taking behaviors may be evident. School performance may decline. Wishes for revenge may be expressed. Adolescents are especially unlikely to seek out counselling.
1.2         WOMEN
Women’s roles and experiences create special vulnerability in the face of disaster. In poorer countries, women are more likely to die in disasters than men are. In richer countries, as well, women often show higher rates of post disaster psychological distress – depression, PTSD, and anxiety (Enrenreich, 2001). Several aspects of women’s experience of disaster may contribute to these results:
·         Women are often assigned the role of family caregivers. As such, they must stay with and assist other family members. This may affect their willingness to leave their homes when a disaster (such as a storm) threatens.
·         Women may be more isolated and home-bound due to their traditional roles. As a result, they may have less access to information (both before a disaster and after).
·         In the aftermath of disaster, women may face another threat: violence. This threat may take several forms like physical or emotional abuse from their spouse and sexual exploitation by other.
·         Women may also be exposed to rape and other forms of violence in shelters or refugee camps. In war situations, women and girls are extremely vulnerable.
·         Health care facilities in shelters and refugee camps often do not attend to women’s needs with regard to reproductive health, and providing for relief of other sources of strain on women, such as responsibilities for childcare, often get a low priority.
·         In the aftermath of disaster, women who have been widowed by the disaster may find it harder to remarry than men. Lacking skills that are saleable in the paid job market, they may be left destitute.
The experience of women in disaster, it should be emphasized, can create opportunities for women, as well. Women may have better social networks and hence, more social support than men. They may emerge as the leaders of grass-roots level organizations. They may be able to use disaster aid to develop skills and acquire tools and take on non-traditional roles.
1.3         THE ELDERLY
Reports on the responses of the elderly to disaster are inconsistent. In some disasters, they seem no more vulnerable than younger people. In others, they appear more vulnerable. Despite the inconsistency in formal research studies, there are reasons to believe that that the elderly are at increased risk for adverse emotional effects in the wake of disaster. They may live alone and lack help and other resources. Depression and other forms of distress among the elderly are readily overlooked, in part because they may not take on exactly the same symptom pattern as among younger people. For instance, disorientation, memory loss, and distractibility may be signs of depression in the elderly.
The elderly are also more vulnerable to being victimized. In the context of increased stress on the family and community, meeting their special needs may take on a lowered priority. One particular issue that may appear is feelings that they have lost their entire life (loss of children, homes, memorabilia) and that, due to their age, there is not enough time left in their life to rebuild and recreate.
1.4         THE DIFFERENTLY ABLED
Although people who are physically challenged and mentally ill or challenged have distinct needs from one another, all three groups are at especially high risk in disasters. For those in each group, the normal patterns of care or assistance that they receive and their own normal adaptations to produce acceptable levels of functioning are disrupted by disasters. For instance, supplies of medication, assistive devices such as wheelchairs, familiar caretakers, and previously effective programs of treatment may become unavailable. This has both direct effects and increases anxiety and stress. Stress, in turn, may exacerbate pre-existing mental illness. There may also be special needs with regard to housing or food.
Those who were mentally ill or developmentally delayed may also have fewer or less adaptable coping resources available and less ability to mobilize help for themselves. The ongoing problems of the disabled may seem to the other victims of the disaster to be of only minor importance in comparison to their own acute and unaccustomed suffering. Their disabilities may even seem like an obstacle to dealing with the disaster itself. The disabled are especially vulnerable to marginalization, isolation, and to “secondary victimization.” They are at greater risk of post-disaster malnutrition, infectious disease (e.g., in a shelter situation), and of the effects of lack of adequate health care.

2.            SOCIAL WORK INTERVENTION
Social Work practice can adopt various approaches in intervention with survivors of disaster. At the micro level, we can undertake psycho-social support of victims and do curative work, at the mezzo level, we can undertake preventive measures like community mobilization and capacity building, and at the macro level, we can intervene in better disaster mitigation and management programmes.
At the micro level, psycho-social support in the context of disasters refers to comprehensive interventions aimed to address a wide range of psychosocial problems arising in the aftermath of a disaster. These interventions help individuals, families and groups to restore social cohesion and infrastructure along with maintaining their independence and dignity. Psychosocial support helps in reducing the level of actual and perceived stress that may prevent adverse psychological and social consequences among disaster affected people
The role of a social worker in providing psycho-social support to survivors varies from one disaster phase to another. It is thus important to understand their phase specific roles in the aftermath of a disaster.
A. Immediate phase: At the aftermath of the disaster, the first major role is to reduce the distress of the people by helping them overcome their trauma and come to terms with their losses (material or life).  The second major role is to increase relief and the third major role is to establish linkages with resources.
B. Later phase: After the immediate phase of disaster is over, the next major role is the assessment of needs to ensure a holistic intervention. Interventions at this stage should focus on making people own the process and become equal partners in the entire rebuilding process right from planning to implementation. They should help survivors to ensure that the options are viable, sustainable and owned by the people. Regular monitoring should form an integral part of the needs assessment because it could bring out new issues that need to be addressed and lead to innovative intervention packages for better recovery and rebuilding. And, the final role is in referring a person to a specialist if the worker is not able to help the survivors to deal with their problems.

In order to make a holistic and beneficial intervention, the Social worker must adhere to some basic principles, values and understanding including;

  • -          No one who experiences or witnesses the event is untouched by it
  • -          Safety and material security underlie emotional stability
  • -          Disaster stress and grief reactions are normal responses to an abnormal situation.
  • -          Disaster results in two types of trauma i.e. individual and collective
  • -          Interventions must be appropriate to the phase of disaster
  • -          Interactions should be matched to the disaster phase
  • -          Interventions must take people’s culture into account
  • -          Direct interventions have an underlying logic
  • -          Family and Social Support systems are crucial for recovery
  • -          Recognize that there is a specially vulnerable group in the society

The basic techniques adopted by social worker in providing psycho-social care to survivors of disaster are (Sanapathy, 2009):
a) Ventilation: ventilation is a process to help the disaster survivors in expressing their thoughts, feelings and emotions related to the disaster and the resulting living conditions. Beside survivors of disaster who are undergoing traumatic-stress disorder and PTSDs have urgent need to ventilate, so they should be allowed to do so as it is shown to be therapeutic to them.
b) Empathy: Looking at the event from the other person’s perspective and trying to realise the trauma of the other person by keeping himself/herself in that situation
c). Active Listening: Active listening is an important skill to facilitate ventilation and develop empathy, which in turn facilitate the whole process of providing emotional support.
d). Social support: In a disaster situation all the support systems get disrupted, hence the need to rebuild and restore. The rate at which the survivors will get over with the trauma of the events will highly depends on the kind of social support he or she gets, and also social support in any form is known to be therapeutic.
e). Externalization of Interests: Engaging survivors in small but productive activity/work would help them in imbibing a positive thinking and feelings. This technique is very crucial from the participatory community disaster management approach. This also helps the survivors in providing a channel to ventilate/express some of their repressed emotions and feelings. In addition this technique has a positive impact on their self-esteem and self-concept. Once they are engaged, their minds will be meaningfully occupied and the physical movement will also add to the increased level of feeling better and energized.
f). The Value of Relaxation: Introducing relaxation activities for children (for instance some games, songs, dancing, painting, colouring and other things) and adults involving physical movement has proved to be very beneficial in helping survivors recover from their trauma and pain. These activities will help to channelise their energy and control some stress producing hormone.
g). Turning towards Religion and Spirituality: Religious belief or belief in a higher power greater than man is an integral part of human beings’ existence and this gives great relief and support during critical periods of their lives. Similarly, spiritualism can also help in rebuilding shattered life gradually. Therefore, it is important to reinforce the religious practices and spirituality in the person we are working with because it has tremendous power to heal the pain and suffering.
Psychosocial and emotional care services deal with human emotions, thoughts and behaviours in situations when people are highly distressed due to their exposure to disaster consequences. It is important to understand that, providing this type of care services is not a charity or pity rather it is an essential aspect of the human rights of the survivors to live with dignity in disaster situations.

3.            CONCLUSION
India is a theatre of Disasters. Natural disasters are quite frequent in different parts of the country, be it earthquake, Tsunami, cyclone, flood, drought or land-slides. Further the human made disasters like industrial, chemical, fire, nuclear, riots, refugees, internally displaced persons and prolonged conflicts and other complex situations retard country’s overall development. These disasters are quite devastating and life threatening for the affected people.
Disasters have impacts on individuals, families and communities. These are not distinct, separable effects. The devastating effects of disaster on the individuals making up a family or a community play a major role in creating the family and community effects. Even more important, social support systems play an extremely important role in protecting individuals from the impact of the disaster and from the impact of stress in general. Social disruption both reduces and interferes with the healing effects of the family and the community and is itself an enormous source of stress on the individuals who make up the family or community. Disruption of the family or community may be more psychologically devastating, both in the short run and especially in the long run, than the disaster itself.
However, disaster tends to dehumanize the majority population, evident in the manner of their treatment of survivors.  This is most evident amongst the marginalized section of the society. For example, in every disaster in India, the medium of meeting the emotional needs of women usually is to arrange for their marriage.  Secondly, community participation in post-disaster rebuilding seems a goal unattained. The government always took over a parental role of doling out compensation and the community are pre-occupied with chasing after the compensation.  Thirdly, India does not have a framework for rehabilitation with a long-term perspective.  In most disasters, there is a massive upsurge of goodwill and material support at the acute phase, but once the acute phase is over, they are totally ignored.
India is a vast country and undeniably disaster prone, however, it must challenge why each and every disaster is allowed to cause the same amount/level of damages with every new disaster, again and again.
The most basic issue in psychosocial intervention following disasters is to transform those affected from being victims to survivors. What differentiates a victim from a survivor is that the former feels himself  subject to a situation over which he has no control over his environment or himself, whereas a survivor has regained a sense of control and is able to meet the demands of whatever difficulty confronts him. A victim is passive and dependent upon others; a survivor is not – he is able to take an active role in efforts to help his community and himself recover from the disaster (Ladrido-Ignacio & Perlas, 1995).





4.            REFERENCES

1.             British Psychological Society (1990): Psychological Aspects of Disaster; British Psychological Society, Leicester
2.             Cedar Rapids Counselling & Psychotherapy Group (2008): Phases of Disaster; Back to Business: Health Recovery – Stress Management, Cedar Rapid (AI)
3.             Centre for Research on the Epidemiology of Disasters (CRED): Technical Reference, Chapter 4. Disaster: Types and Impact, "Safer Homes, Stronger Communities: A Handbook for Reconstructing after Natural Disasters" published by the World Bank in January 2010.
4.             Ehrenreich, John H, (2001): Coping with Disaster: A Guidebook to Psychosocial Intervention (Revised Edition), Centre for Psychology and Society, State University of New York 
5.             Ladrido-Ignacio, L, & Perlas, AP, (1995): From victims to survivors: Psychosocial intervention in disaster management in the Philippines. International Journal of Mental Health, 24, pp. 3-51.
6.             Roa, MVS Srinivasa (2006): Chapter 5: Psycho-Social Consequences of Disaster in Disaster Management, Oxford Press, New Delhi
7.             Satapathy, Sujata (2009): Psychosocial Care in Disaster Management: A Training of Trainers Module; National Institute of Disaster Management, Ministry of Home Affair, GOI, New Delhi
8.             WHO (1992): Psychosocial Consequences of Disabilities: Prevention and Management”. WHO/MNH, PSF/91.3, Rev. 1

INTERNET
1.      David Baldwin’s Trauma Pages, http://www.trauma-pages.com
2.      Disaster Management, http://www.en.wikepedia/disastermanagement
3.      Disaster Mental Health Institute, http://www.ncptsd.org
4.      International Society for Traumatic Stress Studies (ISTSS). http://www.istss.org
5.      National Centre for PTSD, http://www.dartmouth.ed/dms/ptsd