Department of Educational Psychology,
College of Education Katsina Ala
HIV and AIDS are the greatest public health crises facing the world, the African continent and indeed Nigeria, today. They affect all and every segment of society, especially children, women and youth. This paper examines pertinent issues that must be considered when counselling people who are affected. The paper posits that people who are affected by HIV/AIDS need professional counselling to help them overcome their predicaments. It has proffered counselling modes, skills and techniques to be used by the counselor. Some of these include individual and group counselling, cognitive restructuring and personal-social counselling. Problems associated with HIV/AIDS counselling in Nigeria are highlighted and some suggested recommendations made.
Keywords: Counselling, Human Immuno-deficiency Virus (HIV), Acquired Immune deficiency syndrome (AIDS), People.
Counselling is one of the several services that are involved in guidance programme counselling as defined by Okobiah and Okorodudu (2004), is a helping process whereby a trained professional in the helping relationship assists a troubled person through services of interactions to understanding vividly his problem (developing better insights) and his world, so that he can resolve his problems. It is also explained as a process of aiding normal people to achieve higher levels of adjustment, skills which manifest themselves as increased maturity, so as to be meaningfully integrated into the society and become more responsible citizens. Counselling is an interpersonal relationship through which a professionally trained counsellor assists a troubled person to develop skills, attitudes and behavior which enable him to overcome obstacles to his personal growth and development. The practice of counselling is imperative wherever there are people who have problems and who wish to be helped out of such problems.
The origin of counselling is traced to the Socratic dialectic methods of inquiry (Oko, 2008). It was Socrates who directed the focus of philosophical inquiry to the nature of human beings and advocated the person- centred world view. Socrates is credited with such dicta as ‘‘know thyself’’ ‘‘the unexamined life is not worth living’’ and so on. He encouraged his disciples to take care of their souls by looking at the good in them, and examining and analyzing themselves. These postulations constitute the core of counselling which centers on positive adjustment to the environment (Malikiosi-Loizos, 2007).It therefore helps the counselee discover himself in the course of counselling and is able to adjust appropriately.
It must be noted that though Guidance and Counselling services are closely related, counselling is not synonymous with guidance, neither is it the same as psychotherapy. On the one hand, while guidance is concerned with advice giving, making judgment, persuading and recommending; counselling is concerned with enabling clients to achieve self-direction and clients’ right to choose, based on their understanding of self and environment. On the other hand, psychotherapy aims to help someone who is already having some emotional disorder to treat. Counselling addresses personal problems not classified as mental illness. Its focus is on ‘‘normal’’ persons who have challenges of adjustments and decision making that could lead them to emotional disorder, if allowed to persist.
Imperative for counselling people living with HIV/AIDS
One of the principles of guidance and conselling is that guidance and counselling services are for all people (Akume, Igbo and Tor-Anyiin, 2008). This means that counselling services are not limited to schools only. It is along this line of reasoning that the Counselling Association of Nigeria (CASSON) has recently embarked on a mission to bring about a paradigm shift in counselling practice in Nigeria. This paradigm shift means that the focus of counselling is no longer solely on providing guidance to students, particularly in secondary schools, but broadened to carter for the needs of other people outside the school setting. Denga (1986) had earlier taken a cursory look at societies around the world and concluded that, the entire world has fast become a psychological society. He contended then, that the counselor has the professional responsibility to immunize or innoculate individuals and societies against psychological devastations.
Ortese (2015) provided further justifications for the provision of counselling to different groups outside the school settings. According to him, ‘‘there exist an avalanche of psycho-social challenges confronting individuals, groups, institutions and societies. The trauma arising from conflicts, wars, bombings, economic depression, economic deprivations, spread of incurable diseases, genetic abnormalities and childhood critical incidences among others call for psychotherapeutic solutions’’. Counselling, for people living with HIV/AIDS involves individuals and group. In counselling people living with HIV/AIDS, both individual and group counselling are used depending on the issues observed by the counselor, counselor’s assessment of the clients’ personality, or the demand of the persons involved.
Individual counselling is a highly personalized relationship involving the counselor and one client. According to Anagbogu (1991), individual counselling is characterized by the following:
- It requires that the counselor must be honest, sincere, genuine and intelligent to be able to cope with complexities of human behavior.
- It requires the use of tests to enable the counselor obtain accurate, correct, useful and reliable information about the client’s attitudes, aptitude, interests and personalities, among other attributes.
- Verbal interactions and technical words are utilized for effective counselling session.
Group counselling on the other hand, refers to the process whereby a counselor assists a number of individuals to discuss their common interpersonal problems with a view of finding solutions to them (Denga, 1986; Okobia, 1991)
Conditions best suited for group counselling include the following:
- When the anti-social or maladaptive behaviours are general to the group
- When an encounter with a counselor may look threatening to a client
- When individuals desire a spirit of belonging
When there is the need to develop skills in interpersonal interactions and foster group cohesiveness
- When some members of the group have a faulty self appraisal.
Counselling people living with HIV/AIDS
The human immune-deficiency Virus (HIV) is the virus that gradually kills the human immune system thus exposing the individual to any opportunistic disease that may attack them. The immune system is a collection of cells and substances that defend the body against foreign substances known as antigens. The multiplication of HIV in the body over time, breaks down the immune system to the point where it can no longer fight disease. When the immune system is sufficiently broken down and the body cannot fight disease any longer, any opportunistic disease to which the person is exposed can successfully attack such a person. The person is then said to have acquired AIDS (Acquired Immune Deficiency Syndrome). At this point, the person becomes vulnerable to attack by any disease. HIV is found in blood, semen, vaginal fluids and breast milk (Casey 2009). HIV can be transmitted through the following ways:
- Sexual contact with an infected person.
- From infected mother to child before or during birth and through breast feeding.
- Through blood transfusion and organ transplant
- Sharing of sharp objects e. g syringes, needles.
The chance that a person will become infected with HIV depends on the type of exposure he has had. About 70-80% of global HIV infections occur through unprotected sex.
The Window period
For the HIV-infected individual, the window period refers to the interval between the time of infection and the development of a measurable immunologic response to the infection. Casey (2009) states that during this period, the person infected with HIV could still have a negative HIV test result. The window period varies from one person to another and ranges between two weeks to three months.
HIV/AIDS patients, like other terminally ill persons need counselling, to help them cope with their emotional stress, overcome their shock and panic, depression, loneliness, sense of guilt and low esteem, among others (Tor-Anyiin, 2005).
Counselling strategies for HIV/AIDS patients.
Casey (2009) opined the following as counselling strategies for HIV/AIDS patients;
- Group and individual counselling at scheduled times with clients
- Religious/spiritual counselling to help clients draw nearer to God. (The existential counselling theory suffices here).
- Cognitive restructuring to help patients think logically and rationally, so that they may not drift to despair and possible suicidal ideation.
- Counselling family members to equip them with necessary skills and attitudes, to communicate empathy and care for their unfortunate members
- Counselling in life-style. HIV/AIDS patients need to be helped to develop healthy lifestyles. This has to do with healthy dieting, exercise and self-control. They need to be assured that life goes on even with the infection, if they adopt the correct lifestyles.
Benefits of Counselling People Affected with HIV/AIDS
Casey (2009) highlights the following as benefits that persons affected with HIV/AIDS enjoy when counseled. These include:
- It helps the patient to define the problems that accompany the disease.
- It helps the persons concerned to make realistic decisions on how to reduce the impact of the disease in the patient.
- It helps people affected, to acquire knowledge, skills and attitudes as well as confidence to make necessary lifestyle changes that facilitate preventive and therapeutic behaviour.
- It is useful in resolving anxiety about relationships, intimacy and sexuality.
- It helps the clients to accept the uncertainty of their future and objectively, analyze such feared issues as illness and treatment pain and separation from loved ones by death.
- By counselling, clients are helped to understand beliefs, religion and views about self as well as legal, ethical and human rights issues.
The appreciation of HIV/AIDS as a chronic disease that has social implications and the demands it makes on everyone related to the person affected/living with the disease, it therefore means that everyone needs counselling, and from different perspectives, everyone has a role to play in care and in controlling the spread of HIV. Moreover, every sexually active person stands the risk of contracting HIV and needs individual counselling, that is focused on the behaviour that puts a person at risk. Fundamentally counselling should be for men and women, irrespective of sexual orientation, whether heterosexual, homosexual or bisexual.
Time and Types of counselling to be done
Guideline for counselling are derived from the needs for primary, secondary and tertiary prevention of the spread of HIV and the need for care which will enhance the quality of life of people already affected (FMH, 2008). These guidelines indicate when and how people affected by HIV or AIDS should be counseled. Tarkighir, H (2012) highlights three main times people affected with HIV/AIDS should be counseled namely:
- Before testing or screening (pre test)
- Post-screening period
- When the client has been confirmed as having the infection.
Pre-Test Counselling must take place before the client is screened. It prepares the client to:
- Explore – sharing information
- Assess their own risk
- Understand the benefits of HIV testing
- consider options.
- Be aware of the range of options and services available to them, including post-test support and on-going psychological support.
- Make an informed decision about having the test.
- Cope with a positive and negative HIV test result.
- Develop a risk – reduction plan.
In carrying out this, the following major components are involved:
- Basic facts on HIV and AIDS
- Discussion of benefits and potential difficulties
- Explanation of HIV rapid test process and meaning of HIV test results.
- Obtaining informed consent for HIV testing
- Exploration of personal HIV risk behaviour, and options for reducing risk including dual protection.
- Assessment of client readiness for HIV testing.
- Exploration of support systems and disclosure mechanism.
- Provision of follow-up counselling to both HIV negative and positive clients.
Post-test Counselling prepares the client to:
- Cope with HIV test result
- Review their risk reduction plan
- Review available psycho social support systems
- Discuss disclosure of test results and partner referral.
In doing this, three major components of the post-test counselling must be provided:
- Provision of HIV test results highlighting window period for HIV negative clients.
- Review of risk reduction plan including condom-use skills building.
- Of course follow-up counselling must be provided to both HIV negative and positive clients.
The post-test face-to-face counselling session is not only to give the result but to advise on the implications to the client and significant others. The client must be helped to understand the difference between being HIV positive and having AIDS. Again, post-test counselling period is a real challenge and is often emotionally demanding, even for the counselor when the clients result is positive.
- Adherence counselling – Is the degree to which the client follows a treatment regimen, which has been designed through consultative partnership between the clients and the counselor. It encourages the engagement and accurate participation of a client in the plan of care and provides opportunity for discussion about the various factors in the client’s life, that will influence the ability to exactly follow the treatment.
Problems of HIV/AIDS counselling in Nigeria
Omolola, I. (1999) enumerates several factors that may limit what the counselor can do. These include ethical, legal, psychological and social issues that are challenging, and at times frustrating to the counselor involved in HIV/AIDS counselling. Furthermore, there are fundamental problems in ensuring privacy and confidentiality. Nigerian culture accepts that everyone in the neighbourhood takes an interest in what is happening in the lives of their neighbors. As positive as this may be at other times, it has been a hindrance in counselling patients with HIV/AIDS. The problem is that the counsellor may be inhibited in visiting clients at home to avoid bringing upon them suspicion and the associated stigma, possible ridicule and even possible homicide by non-supportive family members who may see the client as a disgrace.
- The inadequacy of the telephone system in Nigeria contributes in no small measure to making life uneasy, even for people who ordinarily would have been willing to talk to the counsellors anonymously. While the few people working in this area may still be able to help through anonymous counselling, they lack facilities and resources to do this most of the time. In a situation such as this, the members of the family should be sensitized not to see the patient as a disgrace to them but rather cooperate with the counsellor to give maximum service to the patient with HIV/AIDS even in their homes.
- It is uncertain whether appropriate and adequate counselling is provided through screening facilities provided by the government. Some people go without counselling before and after screening, except for the general health information that health practitioners give. Counselling should be done before and after the screening of the patient.
- The general pretense that anyone can do counselling and the poor attention given to the need to train people for this job may prove to be expensive for the country in the long run.
There is an acute problem of non-availability of trained counselors to handle most of the sensitive issues that often arise, to help the untrained persons who are forced to take responsibility and to give the time required to meet the needs of the people affected. Making use of any untrained available person to do HIV/AIDS counselling may be doing more harm than good. There is therefore the need for government and corporate bodies to encourage and give assistance in training counsellors to handle these sensitive issues that may arise.
Furthermore, Tor-Anyiin, S A (2015) in his work identifies other problems in counselling patients with HIV/AIDS namely:
- That the consent of the client must be taken by service providers. That means clients consent is primary and must be sought.
- Training sexual partners of clients with HIV infection is contingent upon their giving information and consenting to the search.
- Notification of partners is not a thing that the counsellor would want to do without the cooperation of the client.
- There is stigmatization of people involved in caring for people affected by HIV/AIDS and derogatory comments even from colleagues often have to be endured. These acts by the colleagues or other persons must be discouraged.
- Most of the people involved in HIV/AIDS counselling in Nigeria today are engaged in other full-time jobs and usually have not enough time to meet the needs of the clients. These people should be disengaged from doing other assignments and should focus only on the issue of offering HIV/AIDS counselling services.
HIV/AIDS counselling is the skill of helping people to take important decisions about life, relationships, dying and death. When the skill is well learnt, it is adaptable to managing all health-related problems. The health and illness patterns of the world’s population are changing, especially with the emergence of aging populations and increasing life expectancy. There are changes in the patterns and forms of existing diseases as well as the emergence of new ones. The orientation to health and illness has gone beyond thinking of cure as the only major motive of caring. Life involves accepting limitations and living positively within them. Counselling is caring that goes beyond curing. The issues brought to light by the needs of people living with HIV and AIDS, and the people affected by their relationship to those affected, go beyond the disease itself. We are all affected otherwise the whole world would not be talking about it.
- More HIV/AIDS counsellors should be trained to handle the ever increasing number of patients living with HIV/AIDS.
- Those involved in HIV/AIDS counselling services should not be engaged in several other jobs so that they can have more time doing this service.
- Family members of those living with HIV/AIDS should be sensitized to cooperate with counselors visiting the patients even at home.
- Government should ensure appropriate and adequate facilities for both screening and treatment of HIV/AIDS cases.
- Counselling for people living with the condition should be a right in health care, irrespective of the nature of the disease.
- The level of poverty of a majority of Nigerians continues to destroy the social network and directly contributes to the problems of HIV and AIDS. There is a need to look into the changing patterns of familial structures and interactions in Nigeria, and how functional and supportive the extended family can be.
- Counselling is a time-consuming process that requires planning and devotion. Therefore, it should not be fitted into care regimes in which it is not highly regarded.
- There is a need for anonymous counselling facilities.
Akume, G. T., Igbo, H. I, & Tor-Anyiin, S. A. (2008). Elements of guidance, counselling and psychopathology. Makurdi: Lord Sharks communications
Casey, K. (2009). HIV Counselling handbook for the Asia-Pacific. UNICEF East Asia and Pacific Regional office. Thailand: Keen media Co. Ltd.
Denga, D. I. (1986) Guidance and counselling in school and non-school settings. Calabar: Centeur Press.
Federal Ministry of Health. (2008) Nigeria: National guidelines for HIV counselling and testing.
George, I. N. (2004). Ethics and professional counselling. The researcher: Journal of Nigeria Education Research Reporter Association.
Hatch T. A. (2008). Professional challenges in counselling. Journal of Counselling 6(22).
Hopson, B. (1981). Counselling and helping. In Psychology and Medicine, ed. D. Griffiths. London: Macmillan Press.
Low, P. K. (2009). Considering the challenges of counselling practice international. Journal of Advanced Counselling.
Malikiosis-Liozos, M. (2007). Counselling psychology in Greece. International Association of Applied Psychology, 1(3).
Oko, A. K. (2008) Theory and practice of indigenous counselling. Aba: Life cycle counselling and educational services
Okobia, O. C. & Okorodudu, R. I. (2004) Issues, concepts, theories and techniques of guidance and counselling. Benin City: Ethiopia Publishing Company.
Omolola, I. (1999). The continuing African HIV and AIDS. Ile-Ife: University Press.
Ortese, P. T. (2015). A foreword in G. T. Akume; Theories of counselling and psychotherapy for Nigerian practitioners. Makurdi: Eagle Prints
Tarkighir, H (2012). Issues in HIV/AIDS counselling. Unpublished manuscripts.
Tor-Anyiin, S. A (2015). Imperatives of counselling in non-school settings. Unpublished Manuscript.