The ppt is prepared to serve the need of curriculum for post graduate students interested in learning about the counselling for terminal disease esp. HIV/AIDS.

1. Counselling for Terminal Disease:
HIV/AIDS
Dr. Garima Gupta
Assistant Professor
Department of Psychology
Arya Mahila PG College, Varanasi
This ppt is developed to meet out the curriculum need of the counseling psychology. I sincerely acknowledge google image and other content that helped to develop the matter.

2. HIV/AIDS
● HIV stands for human immunodeficiency virus that damages one’s immune system and
makes it harder to fight off infection and disease.
● AIDS stands for acquired immune deficiency syndrome and represents variety of
dangerous (and potentially life threatening) illnesses that happen when our immune
system has been weakened by HIV.
● Currently there is no cure for HIV, however drug usage may make people to live long, and
healthy lives. An early diagnosis and effective treatment allows most people with HIV to
avoid any AIDS-related illnesses
Although, many people understand both term alike, but they are different.
• HIV is a permanent virus and people who receive a positive diagnosis for HIV do not have
AIDS.
• AIDS is a set of serious illnesses. People with the HIV virus ultimately get if they don’t
receive treatment. The HIV virus can be transmitted whereas, AIDS cannot.
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3. How is HIV transmitted?

4.  Unprotected Sexual activities.
 People with HIV can easily transmit the virus when they aren’t
experiencing symptoms. Even it can be passed on more easily in the
first few weeks following infection. However, start of HIV treatment
may significantly reduces the risk of passing on the virus.
 Apart from sexual contact, other ways of transmitting HIV includes:
- Sharing needles and syringes, sharing sex toys, from mother to baby
before birth, during birth or after birth (through breastfeeding),
through blood transfusion (this is now very rare in the UK)
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5. Who should be
counselled?

6.  Everyone needs counselling from diverse perspectives for example, people involved in care and in
controlling the spread of HIV.
 Individual counselling can be offer to each sexually active person (who have major probability of
risks of contracting HIV).
 Counselling for both gender irrespective of sexual orientation (heterosexual, homosexual or
bisexual).
 People with multiple sexual partners practising unprotected penetrative sex, sexual partners
of these people, drug users who share injecting equipment, and recipients of unscreened
blood products and donated organs.
 Additionally, many other people like who are exposed to infection through previous invasive
medical and surgical procedures.
 Other people, such as pregnant women who are HIV-positive, sexually abused, assaulted or
raped, sexually active teenagers (high risk group) and commercial sex workers.
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7. Counselling for HIV/AIDS

8.  WHO (1995) explains AIDS counselling as a confidential dialogue between a patient and the counsellor or care
provider that aimed at enabling the patient to cope with the stress and to take personal decisions relating to
HIV infection and AIDS morbidity and mortality.
 NACO, 2004 defines counseling as “Essentially a confidential dialogue between an individual/couple and a
counselor, aimed at enabling the individual to make personal decisions in the context of HIV/AIDS”.
 Counselling for HIV and AIDS, however, is little intricate since HIV-positive people face difficulties arising from the
nature of the disease, the way it progressively affects and the difficulties/ stigma that arising.
 Counselling in HIV/AIDS denotes giving information, facilitating risk reduction behaviour, and providing
unconditional emotional support to the people affected.
 Counselling in HIV/AIDS care is an interaction of information exchange, skill acquisition and emotional support.
This exchange is done between the counsellor, the infected person and others significant (family members,
friends, health practitioners, employers and people who give spiritual support).
 The interaction is directed at meeting the physical, psychological and socio-economic needs of the client to
enable him or her to attain optimal physical, mental and social health and to offer incessant support so that
transmission can be prevented.
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9. Why Specialized
Counselling?

10. HIV/AIDS counselling is different from other forms of care.
 The disease is not only at physical level but more at psychological (emotional
reactions) too.
Such reactions include fear, denial, loss, grief, anxiety, anger, rejection by family
members/friends/groups, isolation, annoyance, blame apportioning, pity, self-
condemnation, depression and suicidal thoughts (Moynihan 1991; WHO 1995b).
Apart from this, it may also brings problems concerning work and finance.
There may also be problems meeting basic life needs, changes in body image
and anxiety about dying and death.
It is not only the clients who go through the grieving process but every person
in their social network.
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11. Psychological
Issues in
HIV/AIDS
counselling

12. Shock
• diagnosis
• mortality
• loss of hope for future
Fear and anxiety
•Uncertain prognosis
•Effects of medication and
treatment/treatment failure of
isolation and abandonment and social
•rejection
Depression
•adjustment to living with a chronic
viral condition
•No cure
•in case of treatment failure, social,
occupational, and sexual rejection
Anger and frustration
•becoming infected
•new and involuntary health/lifestyle
restrictions
•incorporating demanding drug regimens,
Guilt
•HIV as a punishment
•Cheating on the partner

13. Aims of HIV /AIDS
counselling

14. (A) To enable patient to cope with the information related to the disease and the test regarding
• To make them understand of what the test results mean
• Importance of Informed consent before the test
• In case of test results being positive, various life coping skills are made to learn
• In case of test results being negative, understanding about HIV/AIDS is improved and they are
being motivated to change in behavior that reduces risk of getting infected
(B) To bring prevention
• To decide whether the lifestyle of an individual places him/ her at risk
• Ascertaining the meaning of high risk behaviour
• Enabling them to understand the true potential for behaviour change
• Working with these individual to attain and sustain behaviour change
(C) To provide Support
• Individual, relationship, and family
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15. Counselling to Modify Behavior
• To understand reason for seeking counselling.
• Ascertain the problem.
• What behavior/attitude caused to the problem.
• To make them aware about the consequences of their behavior/attitude.
• To provide patient with different options and also to evaluate the effectiveness of the chosen option.
Counselling to modify risky sexual beahviour
• Overview of the reproductive organs in the human body and Sexually Transmitted Diseases (STD) is
briefed.
• To make them aware with consequences of risky behavior -- Sexually Transmitted Diseases and
HIV/AIDS.
• Explanation regarding the OPTIONS for risk reduction: (i) Self-denial from sex, (ii) sticking to one partner
sex, (iii) Learning to have orgasms without penetration (iv) correct use of condom every time of sex
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16. Types of Counselling for
HIV/AIDS

17. Client Initiated Counseling
It is a counseling service chosen by the client himself and also known as voluntary counseling. This
counseling is more dependent on client’s perception of risk of getting HIV and need for test. Clients
visiting Voluntary Counselling and Testing (VCT) centers is an example of client initiated counseling.
This counseling is recommended by client’s health care provider (HCP) as a part of the treatment
given to him/her. This type of counseling and testing helps the doctor or HCP in treating the client in
a healthier manner. Recommending HIV test under antenatal care or under Revised National
Tuberculosis Control Programme (RNTCP) are few examples of provider initiated counseling
Provider Initiated Counseling
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18. Pre-testing Counselling
 It is given to before going for HIV testing.
 It is usually done to know that one is/is not infected with HIV.
 The pre-testing counselling facilitates discussion about ways to cope with knowing one’s HIV status
and the discussion is around the sexuality, relationships, possible sex- and drug-related risk
behaviors, and preventing infection further.
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Post testing Counselling
 Post-test counselling helps the client understand and cope with the HIV test result. Counsellor prepares the client for
the result, gives the result and then provides the client.
 Where it is positive, the counsellor needs to tell the client clearly, and as gently and humanly as possible, providing
emotional support and discussing with the client on how best to cope, including information on relevant referral
services.
 Ongoing counselling will help clients accept their HIV status, and take a positive attitude to their lives.
 Through ongoing counselling the infected person may choose to invite a trusted family member to share
confidentiality

19. Crisis Counseling
 Crisis is not a traumatic event or experience in itself. Its more an individual’s reaction or response to the
situation.
 This helps to minimizes the severity of the traumatic situation.
 Assessment of the situation, educating and helping the client to understand the situation, offering them support,
encouragement to get support from near and dear ones to overcome the crisis, helping to establish dialogue between
different people affected by the crisis and finally developing coping strategies for the situation are major aspects of crisis
counseling (Coats, 1990).
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 It is a human response to a stable loss of someone near and dear.
 While counselling HIV patients they come across many circumstances, where they have to counsel the children or
spouses of the HIV infected individual after his/her death.
 The prime objective is to assist a person accepting the death and minimizing the feeling of insecurity and loneliness.
However, it includes assessing the perception of death, providing emotional support, working on Stigma and
discrimination and bringing the client back to normal life
Grief Counseling

20. Adherence Counseling
 Well, HIV is no longer a fatal/incurable disease. Adherence is defined
as ‘the act or quality of sticking to something—to adhere to
something’. In the context of ‘Anti Retroviral Therapy’, adherence means
a more collaborative process between the patient and provider.
 It has become manageable illness with the advent of Anti Retroviral
Therapy (ART).
 Adherence to ART is then more vigorous in this treatment. Any
irregularity may cause to resistance to HIV drugs, causing weaker or
reversing its effect.
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21. Couples Counseling
 Couple counseling plays very important role in sustaining couple relationship, family and social
life.
 The major focus is not only to build harmonious, careful, supportive and healthy couple relationship
but also to maintain their relationship trustworthy, sensitive and based on the mutual understanding,
 The function of counselor is crucial in giving equal respect to each couple, to listen to both and remains
neutral during discussion.
 The partner might also get a feeling of great loss to his/her life. They may be worried about children’s
future, getting conceived, financial crunch, and the health status of the infected partner.
 Simultaneously, HIV infected partner might have a sense of guilt of affecting the marital relationship,
s/he might have fear of separation, agony of losing their position, love and respect in the family.
 Counselor also supports to empower them to deal with the emotional crisis situations.
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22. CounsellingSkills
For counsellor
Empathy
Active
Listening
Patience
Acceptance
Proper Use of
Silence
Proper
Questioning
with
Necessary
Probes

23. Speak openly what’s bothering him/her
Recognize the reasons for their concerns
Predict barriers for overcoming their problems
Discover their strengths and weaknesses
With effective counseling the clients becomes empowered and able to …

24. Learns skills to overcome the weaknesses
Design strategies to overcome their worries/ problems
Practice the strategies
Not to get discouraged with the same problem in future