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Counselling in HIV Infection

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If results are negative: The client may feel relief, however, should be exercised as following exposure to HIV there is a `widow period’ during which negative result cannot be considered reliable. Further, a negative test should not give a false sense of security to a person indulging in unsafe sex. Three months must have elapsed from possible exposure before a negative test can be considered to mean that there is no infection. A negative test result carries greatest certainty if six months have lapsed after last exposure. HIV infection can be prevented by avoiding high risk behaviour, safer sex, avoiding sharing needles. In general, development of safer sex behaviour has to be to advocated to the client.

If result are positive: People diagnosed as having HIV infection should be told about their results privately and in confidence. Single test giving positive result does not necessarily mean HIV infection. To establish HIV infection, three tests for Antibodies based on different Antigens/methods are to test positive. Discussion should be allowed with the clients to absorb the news. After a period of preliminary adjustment the client should be given clear and factual explanation of what the news means. This does not mean speculating about prognosis of estimate about the time left to live but for providing support; and encouraging hope for achievable solutions to personal and practical problems that may result. The client must be informed where resources are available and possible treatment for some symptoms to HIV infection and efficacy of anti-viral treatment.

Psychological issues

The uncertainty involved when the individual comes to know he has tested positive are varied. Clarifications are to be given regarding the fears which arise related to illness, death, job, length of life, etc. Besides these the individual feels at a loss due to stigma attached by society and the speculation in the minds of people regarding the behaviour of those infected with the virus.

There is generalised anxiety regarding all aspects of life, anger, depression and denial of the fact that he has tested positive can even lead to suicidal thinking in the individual.

These numerous feelings can only be changed through counselling and giving correct information about the infection and disease and building the self esteem and the positive thinking ability of the individual.

Besides the individual who has tested positive those dealing with them. i.e., the health workers and family face the share of fears and uncertainties regarding their getting the infection. All those involved with those who have tested positive need to be given proper and full information so that they can provide the support which the individual requires to be able to face their problem.

Some Special Issues

Pregnancy: Those females of child-bearing age found to be HIV +ve should be told to avoid pregnancy and the risk of vertical transmission from mother to child.
If pregnant: There is a one-in-three chance of having an infected child. Counselling depends on the personal, religious, cultural factors regarding termination of pregnancy.

Both the partners need to be counselled.

Infants: should be kept under medical observation and treated with care and affection. Parents and siblings need to be counselled. Though the risk of acquiring infection from infants’ body fluids is minimal, nevertheless the people with cuts should avoid contact with fluids. Hygienic practices would be emphasized upon.

Breast feeding

This may result in transmission of HIV from mother to child. In developing countries, withholding breast feeding may deprive the newborn of the protective immunity transferred from mother to newborn. Therefore, a counselling is required to have a balance between the two, the possibility of acquiring HIV infection and the lack of antibodies in the newborn if not breast fed.

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