Counselling needs of persons exposed to HIV

[Guest guest]

Counselling needs of persons exposed to human immunodeficiency virus.

Indian J Med Res 126, August 2007, pp 158-160

Sir,

The HIV epidemic in India is at once complex and challenging, with

nearly 40 per cent monogamous women among the new cases1-3. There is

a need to change behaviour of the affected persons as well as to

improve their access4. The Counseling Training Manual of National

AIDS Control Organization (NACO) spells out the guidelines but in

reality, counselling remains perfunctory5. Not much efforts seem to

be directed towards promoting effective counselling services.

ASHA Foundation, in Bangalore, a registered Charitable Trust working

in the field of HIV/AIDS,carried out an in depth study to identify

the major counselling needs of all subjects coming for voluntary pre-

test counselling during January to October, 2004, and their

relationship to basic socio-economic and sexual background.

The study also determined the methodology and skills needed to

counsel effectively. A total of 133 men and 71 women were studied

(ages 17-65 yr, with a majority (55%) in the age group 25-34 yr. The

purpose of the study was explained to these individuals, and informed

consent obtained.

An interview guide was developed with open and closed type of

questions to record the subjects knowledge of HIV/AIDS and of the

laboratory tests, past and present risk activity, and basic details

of the counselee and his/her family to determine existing support

systems. The counselling sessions were held in a quiet, confidential

atmosphere by two well trained and experienced women counsellors on a

one-to- one basis, each session lasting about an hour. Depending on

the subject's emotional and cognitive status, the questions were

asked and appropriate counselling given. They were encouraged to come

back for post-test counseling and follow up sessions. The reliability

and validity of the responses were confirmed by including repeat

questions and having both counsellors in some of the sessions and

comparing their independent assessments.

Chi-square and z-test were used to test statistical significances of

differences observed in terms of gender, age and marital status of

the subjects.

Fifty three (74.6%) women and 76 (58.6%) men were currently married.

Only two of 71 (2.8%) women as compared to 51 of 133 (38.3%) men were

unmarried.

In terms of educational background 78.3 per cent of men and 54.7 per

cent of women had high school education or more. Single persons were

generally more educated than the married. More women (31%) as

compared to men (16.6%) were illiterate or studied only up to primary

school. Most women (62%) were housewives. Nearly 50 per cent of men

were in professional or managerial jobs and 15 per cent of men were

in unskilled labour.

Of the 133 men, 47 (35.3%) had multiple partners and the average

number of sexual encounters with spouse was 2-3 times a week. The

sexual partners of women were mainly their husbands, though 15.5 per

cent of women gave history of sex with other male partners. Age at

first sexual contact for men was between 26-30 yr and for the women,

it was 15-18 yr; 83.4 per cent of the men and 90.2 per cent of women

gave a history of sexual encounter between 3 months to one

year earlier. Risk factors other than sexual involvement mentioned

were alcohol, substance abuse in the men (22.6%) and a HIV positive

spouse in the female (67.6%).

A total of 96 (72.3%) males and 63 (88.7%) females had very little

knowledge about HIV/AIDS, the difference was statistically

significant (P<0.01). Among the men 60.9 per cent and among the

females 88.7 per cent had never used a condom (P<0.01). Only 22.6 per

cent of men said they always used a condom, mostly with commercial

sex workers and very rarely with their wives.

The counseling needs in order of priority were: (i) knowledge on

HIV/AIDS in terms of transmission, testing and progression of

disease; (ii) coping with feelings of guilt and shame, maintaining

self-esteem; (iii) retaining/strengthening family ties, social

circles; (iv) handling issues of medical complications, longevity;

(v) decisions on marriage and children; and (vi) handling depression

and suicidal ideation.

Invariably, all clients were anxious about the results of the test,

and were apprehensive in case the test was confirmed positive. Their

fears were largely about their own future health and that of the

family and their longevity. The unmarried males were concerned about

marriage and family life, and inability to cope with the disease,

loneliness and discrimination. The married men felt very guilty and

were concerned about revealing the truth to spouse and family thereby

jeopardizing trust and dignity, as well as transmission of infection

to wife and security of children. They were also worried about job

security and premature death.

The concerns of women were somewhat similar, but they generally felt

cheated, shocked, and expressed their inability to cope with future.

For the single woman, obstacles to marriage and companionship, and

for the married, the questions on well-being of their husbands and

children, were major issues.

Thus, the counselling needs varied according to the characteristics

of the subjects, and classified by age, sex, marital and educational

status as well as by their understanding of HIV/AIDS.

Suicidal ideation was expressed specifically by 7, 4 women and 3 men,

all of them in the age group of 25- 34 yr. Analyses of these cases

showed that most of them had prior HIV testing done without

counselling and were informed as positive

The major skills required for effective counselling were: (i)

adequate knowledge on HIV/AIDS and of its testing; (ii) ability to

listen and infuse confidence in counsellee; (iii) ability to identify

and understand critical personal issues to counsel; (iv) plan

necessary interventions to strengthen family ties; and (v) build

motivation to continue counselling.

Thus, in addition to being knowledgeable on HIV and on the testing

process, the counsellor must have the ability to infuse confidence in

the person and provide necessary options to cope with individual

situation and motivate them to continue required counselling.

A vast majority of HIV/AIDS patients were women, the silent victims

of transmission through their husbands3. Educating and empowering

these women will be a great challenge to be faced urgently and

expediously. One powerful method and approach will be through expert

counselling of the women, their husbands and immediate family.

Counselling has been tried with fair amount of success in many health

situations6,7, and not very

effective in others8. We suggest the counselling sessions be

intensive and custom-made to suit the personal and social profiles of

people concerned.

The study identified several categories of subjects who required

varied and appropriate coping strategies. Married women with living

children, and those without, will need different counselling, as

compared to young unmarried counselees. Counselling is a profession

requiring specific skills with ability to listen and ascertain

foremost needs of the person and to adopt participative approaches to

provide the best possible solutions. HIV test is different from all

other tests and has tremendous emotional, practical and social

implications for the individual, regardless of the results of the

test9. Counsellors must therefore be sensitized and trained in

adequate skills to perform their job effectively10. Counsellors

should develop skills to make the clients express their felt needs,

counsel accordingly, and establish long-term relationships to

continue counselling.

All the best available evidence must be siphoned back to the

counsellors, so that they practice evidence based counselling11.

Acknowledgment: Authors thank all the subjects who participated in

this study.

G. , B.J. Sunitha, L.K. Chitra & P.S.S. Rao*

ASHA Foundation

No. 58, 3rd Main, SBM Colony

Anand Nagar

Bangalore 560024, India

* For correspondence:

88, 4th Cross, Kuvempu Layout

Gubbi Cross, Kothanur

Bangalore 560077, India

References

1. Kumar S. HIV cases rising sharply in India. BMJ 2003; 327 :

2. Prasada Rao JVR, Ganguly NK, Sanjay MM, Bollinger C.

India's response to the HIV epidemic. Lancet 2004; 364 : 1296-7.

3 Gangakhedkar RR, Bentley ME, Divekar AD, Gadkari D, Mehendale SM,

Shepherd ME, et al. Spread of HIV infection. ALEXANDER et al:

COUNSELLING NEEDS OF PERSONS EXPOSED TO HUMAN IMMUNODEFICIENCY VIRUS

in married monogamous women in India. JAMA 1997; 278 : 2090-2.

4. Houser R, Wilczenski FL, Ham MD. Culturally relevant ethical

decision making in counselling. New Delhi: Sage Publications; 2006.

5. National AIDS Control Organizations (NACO), Ministry of Health &

Family Welfare, Government of India. HIV/AIDS/ STD counselling

training manual. Section 3 C. Pre-test counseling. New Delhi: NACO;

1994 p. 92-8.

6. Winkleby MA, Cubbin C. Changing patterns in health behaviours and

risk factors related to chronic disease, 1990-

2000. Am J Health Promot 2004; 19 : 19-27.

7. DW, Bercedis P, Colleen M, Isaac L, Eliszabeth C Current

health behaviours and readiness to pursue lifestyle changes among men

and women diagnosed with early stage prostate and breast carcinomas.

Cancer 2000; 88 : 674-84.

8 Rena RW, FS, GG, Delia SW, JA, WJ, et

al. Behavioral science research in diabetes. Diabetes Care 2001; 24 :

117-23.

9. Green J. Counselling for HIV infections and AIDS: the past and the

future. AIDS Care 1989; 1 : 5-10.

10 AV, ph JV. Psychology of people seeking HIV/AIDS

counseling in Kenya: an approach for improving

counselor training. AIDS 1999; 13 : 1557-67.

11. World Health Organization. World Report on Knowledge for Better

Health-Strengthening Health Systems. Geneva: WHO; 2004. 160 INDIAN J

MED RES, AUGUST 2007

http://www.icmr.nic.in/ijmr/2007/august/0814.pdf

Dr. Glory

Director

ASHA Foundation,

No. 58, 3rd Main, S B M Colony,

Anand Nagar, Bangalore

INDIA - 560 024

Telephone: (+91- 80) 2354 5050

Telephone & Fax: (+91- 80) 2333 2921

Email: ashafblr@...