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Ferry Febrian

on 16 October 2014

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Counseling skills properly used are tools to help individuals seek and find their own solutions to the dilemmas they face.
To provide psycho-social support
To prevent transmission of HIV infection
To improve quality of life of HIV infected people
To provide risk assessment for people who are potentially at risk of contracting HIV infection
Whom to counsel?
Self motivated counseling seekers
Persons seeking HIV tests
HIV positive persons
High Risk Behavior Groups
Family Members
Health professionals
People unaware of risks
It is important to counsel persons seeking HIV test because usually they are not aware of the fact that there is no cure for the disease and once positive life will be different. Counseling helps them to face the results in a pragmatic manner.
Family members and employers usually take a harsh view of HIV positive status of a person. He is usually thrown out of the job and rejected by family members. They need to be counseled to accept the person in a empathetic manner.
I have seen medical students, doctors and nursing staff becoming paranoid about having spilled blood of a person (whose HIV status is not known) on their body, and then assuming that they have become positive themselves. Such fears turn into serious psychological problems. Such health professionals need skilful counseling. Counseling also helps them to practice universal precautions.
Skills Required in Counseling
Excellent communication skills
Ability to judge state of mind of a person
Quick empathetic response
Reflection of feeling
Structuring and prioritization
Help to formulate strategies
Help develop coping mechanisms
Why Is Counseling Necessary?
Because infection with HIV is life long
To cope with HIV positive status and live a meaningful life
To adjust and to learn about change in one’s life style in order to reduce risk of contracting HIV infection
Dr Arun Kr Sharma
Department of Community Medicine
University College of Medical Sciences
Delhi 110 095 India
E mail: tingu98@hotmail.com
Alternative definitions are:

It is a special form of interpersonal communication in which feelings, thoughts and attitudes are expressed, explored and clarified.
In relation to HIV/AIDS prevention, counseling is the only practical means for promoting changes and adoption of long term low risk behaviors.
Counseling becomes necessary because people are at a loss and unable to decide what to do with their lives, once they are found to be HIV positive. Those who have practiced high risk behavior are unable to take a decision whether to go for HIV test or not. Another important issue is breaking the news to the family members and sex partners. In such circumstances, counseling helps a person to come to term with the realities of HIV/AIDS and act in a balanced way.
Counseling is a dynamic process. The counselor has to quickly understand the clients state of mind, his/her concerns, worries, level of confidence and ability to cope with crisis. And the counselor has to proceed accordingly. The counselor may have to change his/her approach as per the client’s response. The counselor should appear to be actively participating in understanding the client’s dilemma by reflection of feeling, questioning and paraphrasing.
Stages of Counseling
Risk assessment counseling
Pre test counseling
Post test counseling
Follow up counseling
Principles of Counseling
Unconditional positive regard for the client
Trust and confidentiality

Steps in Counseling
Rapport building
Gaining trust
Explaining limits
Problem identification
Discuss options
Take action
Follow up
Role of Counselor
Advocacy role
Health education
Clinical and therapeutic role
Contents of Counseling
Contents of counseling will depend on the ability of the client to grasp. It’s a dynamic process. The counselor must be able to assess the clients need and state of mind quickly.

However, following components should be incorporated in all counseling scenarios:
For example, when talking to a college student, the counselor should be free and make the student feel free and comfortable. It should not be a class room like scenario.
In case of uneducated persons and people with low level of confidence, the counselor may have to take the upper hand and provide advice and guidance as well.
Some times, the counselor has to behave more like a friend and treat the client at par with him to gain his confidence.
Contents of Counseling
The need to prevent infection and re infection
Basic information about HIV infection and associated diseases
Review of possible sources of client’s infection
Methods of safe sex including condom use
Exploration of obstacles to change of behavior
Information about what HIV testing can and cannot do.
Coping with HIV test results.
Need to tell the HIV status of the client to the key persons in his/her life.
Handling hostility, fear, violence, depression, suicidal tendencies etc.
Working Goals of HIV Counseling
Forming a helping relationship
Clarifying and addressing problems
Establishing personal goals
Providing information on alternative resources
Selection of realistic alternatives
Stimulation of motivation and decision making
Helping client to develop competence
Recognizing and diagnosing signs of psychological distress and providing support
Possible Reactions to a
Positive Test Result
Sense of loss
Loss of self esteem
Special Situations in HIV Counseling
Pregnant women
Childless couples
Breast feeding positive mothers
Spouse and family members of HIV infected persons
Some Common Counseling Errors
Directing and leading
Being judgmental and evaluating
Moralizing, preaching and patronizing
Unwarranted reassurance
Not accepting the client’s feeling
Encouraging dependencies
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