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.

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….

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

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[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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Strategies for Women's Empowerment

I wrote this as an assignment, and consulted various books. I posted this with the hope that it will help students and other who are looking for quick answer.  So the basic content is broken down into 3 different posts, as a series, and the references are kept with the last post. keep on scrolling :)

1. Introduction: What is women's empowerment?
2. Approaches to/for Women's Empowerment
-A. South Asian Approaches (Batliwala)
-B.  Women Empowerment in Development (WED) or Developmental Approach
-C.  Women in Development (WID)
-D. Women and Development (WAD)
-E. Gender and Development (GAD)
-F. The Welfare Approach
-G. The Equity Approach
-H. The Efficency Approach
-I. Anti-Proverty Approach
-J. The empowered Approach
3. Strategies for Women's Empowerment (include references)
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STRATEGIES FOR WOMEN EMPOWERMENT

There are various methods and means for women empowerment although a fool proof strategy is not possible.  Some of popular methods of women empowerment include education, entrepreneurial training, programmes, formation of SHGs, social action, legislation, mass communication and propaganda, etc.  These are individual as well as institutionalized methods for the empowerment of women.

(1)   Gender Sensitization and Awareness Generation:  Planning for women’s empowerment cannot succeed unless supported by an awareness generation programme covering all sections of the population including women.  Women’s empowerment is a strenuous task of rooting out gender bias and implanting positive attitudes in the hearts and minds of men, women, and children so that the family and the society would endorse and participate in the planning process for women’s advancement.  For this purpose, mass media, political parties, development agencies, educational institutions, etc can be employed. 

Women must not merely recognize that they are disempowered, but must also be aware of what they can do legally, peacefully and constructive to overcome their oppression.  Generating awareness includes dissemination information about law, entitlements, accountability and government projects for health, nutrition and sanitation, etc.

(2)     Participatory Learning & Processes: Strategies for empowering women must focus beyond economic restructuring, to include restructuring of social relations, which constraint the freedom of women.  It is powerlessness and not poverty which is the real inhibiting factors even among the poor women.  Empowerment of women must result in specific, workable and sustainable measures that would help create a social order based on gender justice.  Non-conventional model for development are the best strategy for empowerment.  Once the women acquire the ability to think of themselves as rightful claimants to better life motivation to overcome the culture of submission will follow.

(3)   Mass Movement: It is one of the accepted modes of agitation for securing justice and human rights.  An organised mass movement among women would challenge and transforms all existing social evils against women and the violations of their rights.  Such movements are targeted to changes in laws, civil codes, systems of property rights, and the social and legal institutions that underwrite male control and privileges.  These changes in the prevailing social, economic and political systems are essential for the achievement of women’s equality.

(4)   Women Organisation:  These organisations are oriented to developing new structures and culture that reflect women’s needs, interests and behavioural preferences.  Organising women means to bring women together to think through their common problems, to agree on their common issues, to decide on common action and to forge common ideologies.

(5)   Welfare and development approach:   It is all those target oriented and well monitored programmes that can help women overcome the socio-cultural constraints of empowerment.  Conception and delivery of a development programme taking special attention to deal with the gender bias, and directly involving women in the planning and implementation of projects will help in empowering women.

(6)   Intervention at ideological structure: intervening at the society level is required to break the barrier of women empowerment.  For development of positive attitudes it is imperative to infuse family, social, human and spiritual values among the masses through ideologies.   This can be done through value education in the formal and informal education stream.

(7)   Mass Media: The role of civil society in the process of women empowerment is reflected in mass media and literature.  The image of women depicted in literature and media reflects the average expectation of the population.  Communication media as well as visual are the most popular and effective means of reaching out to the masses so they are an very critical to the shaping of the image of women and in their empowerment.

(8)   Education: Education and access to education are the primary requirement for women empowerment.  Education is an important tool which enables the children to develop the necessary confidence, self-esteem, capacity for reasoning and social skills to protect their rights and dignity.  It also empowers them to become productive and fully participating adult members of the society.  When designed and carried out purposefully, education can create and build the commitment of society as a whole to respect the rights and dignity of its children. 

(9)   Religion: Religion is not only a social institution but also a strong voluntary mass movement to shape views, beliefs, outlooks, and ideology.  The role and status of women in the family and in the society are well defined in religious texts, so the sensitive and correct interpretation of religion plays a vital role in maintaining social status quo, the roles of the genders, and the position of women.

(10)           Legal Empowerment: Legal provision alone do not ensure any substantial change in the status of women, however social legislation are the beginning of a desirable social change which are advocated and supported by the social forces.  Thus it’s important that social legislation or legal provision promote social welfare, social security, social justice and gender justice, etc, which also includes the rights of women as equal citizens.

(11)           Social Empowerment: Social empowerment deals with empowerment at the level of family, community and at personal level which includes psychological and physical health of women.  It also includes religion, literature, arts, media, history, legislation, social movements and human rights.

(12)            Economic Empowerment: Financial security and independence is an important indicator of measuring the empowerment of any marginalized groups including women.  It not only improves and individual or group standard of living but also enhances self-image.  Economic empowerment can be brought about by addressing the structural causes of deprivation through changes in economic structures, ensuring equal access (participation) for all women, including those in rural areas, as vital development agents, to productive resources, opportunities and public services.  Some of the simple steps used are promoting self-employment, through credit & training, providing micro-credit, lean season wage and employment, encouraging saving habit among them.

(13)           Political Empowerment: For the realization and full implementation of the hum rights o women and of the girl child as an inalienable, integral and indivisible part of all human rights and fundamental freedoms, political empowerment and participation are required. Political participation can be at two level, one is in giving opportunities for equal participation to women in the political process so that woman can have an equal say in the daily running of the government and two, in legislating women right oriented laws and programmes.

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Bibliography/References:

1. Kumar, Hajira; “Women’s Empowerment : Issues, Challenges and Strategies”: Daya Publications at New Delhi; 2004
2. Bisnath, Savitri and Elson, Diane, “Women’s Empowerment Revisited” UNIFEM – Progress of the World’s Women Biennial Report, New York, 2001
3. Batliwala, Srilatha; “Women’s Empowerment in 21^st Century India – Changing Meanings, Contexts and Strategies”, in Shiva Kumar and Rajani Ved (Eds), “The Wellbeing of India’s Population”
4. OECD; "DAC Sourcebook on Concepts and Approaches linked to Gender Equality", Paris, 1998
5. Malhotra, Anju; "Conceptualizing and measuring women's Empowerment as a Variable in International Development"; Paper presented at the World Bank, Washington DC, Feb. 2003
6. Oxaal, Zoe with Sally Baden; Gender and empowerment: definitions, approaches and implications for policy, October 1997 (revised)
7. Batliwala, Srilatha. 1994. “The Meaning of Women’s Empowerment: New Concepts from Action”, in Gita Sen, Adrienne Germain and Lincoln C. Chen eds. Population Policies Reconsidered: Health, Empowerment and Rights. Cambridge: Harvard University Press.
8. Beneria, Lourdes with Savitri Bisnath eds. 2001. Gender and Development: Theoretical, Empirical and Practical Approaches Vols. I & II. International Library of Critical Writings in Economics series, Mark Blaug editor. Cheltenham: Edward Elgar Publishers.
9. Moser, Caroline. 1989. “Gender Planning in the Third World: Meeting Practical and Strategic Gender Needs”, in World Development, 1989
10. Rowlands, J, 1995, ‘Empowerment examined’, Development in Practice 5 (2), Oxfam, Oxford,
11. 'Male or Female Ethics for Corporations?' People in Corporations: Ethical Responsibilities and Corporate Effectiveness, ed. Enderle, Almond and Argandona, Holland, Kluwer, 1990. 
12. Robbins, Susan P, Edward R Canda, Pratap Chatterjee; Contemporary Human Behavior Theory: A Critical Perspective for Social Work, Allyn & Bacon, London, 1998