If the test report is positive the counseling becomes very important. A negative report may also require counseling as there are three possible outcome of HIV testing:
- Positive result.
- Negative result.
- Equivocal result.
Counseling after Negative Result.
Discussing a negative test result is equally important and it should be done carefully. The client might get a relief from the negative test result but the counselor must emphasize on following points:
- To wait for the window period to elapse before actually feel reliable about the test result. In fact at least three months must have elapsed from the exposure time before a negative test can be considered that there is no infection. The most certain negative test would be if six months have elapsed since the last possible exposure.
- The exposure comes from high risk behaviour and it can be avoided by changing this high risk behaviour. the counselor must explain the importance of safe sex and avoiding sharing of syringes which is understood by the client.
- The counselor must share other related information on how to control and avoid HIV infections and developing positive health behaviour, these kind of explanations will require repetition and the counselor must practice together Methods of negotiating with others so that the client gets introduced to new behaviors.
Counseling after a Positive Result.
A positive result should be conveyed to the client as soon as possible. The client’s first discussion must be in confidentiality and in private. This is a big news and the client must be given time to absorb it. After the client is adjusted to the preliminary period the counselor must explain the factual explanation of the result, what it means? This time is not for prediction of how much time is left to live, but the counselor must provide support to adjust to the shocking diagnosis.
The counselor must try to instill hope in the client for achievable solutions that can be found for the practical problems. With whatever resources available possible treatment can be tried and is justifiable to discuss this with the client and also talk about the symptoms of HIV infection and the antiviral drug that can prove to be helpful. The counselor must provide important practical information to the client. With the positive test result the client and the counselor enter into a new phase of their relationship. Problem-solving counseling and counseling in times of crisis will always be necessary. Pre test assessment will also prove to be the best way to explain the client about the test result.
How will the person accept it will be dependent on the psychological circumstances, previous knowledge about HIV/AIDS and the client’s personality. The counselor will also explain to get in touch when in extreme stress situations. The counselor must also discuss how others will react when they come to know about the infection such as the employer or colleagues. The discussion about safe sex. prevention of transmission and maintaining health will have to be repeated. On routine basis there must held follow-up visits, Its the counselor’s duty to repeat and tress the client’s responsibility so that he can bring change in behaviour, avoid infection and transmission. The counselor must explain the fact that this infection never goes and stays with the patient along with the risk of infecting others.
What does the news of HIV infection is received by the client depends upon:
Physical health of the person at that time as the physically wreak may not be able to react to it.
What was the preparation of the person to accept the news. There are different reactions from those who are prepared and from those who are not. Even if the person is well prepared it might become difficult for the person to accept it.
The community and friend’s support for the person will also make a difference. There are many other factors such as family life, unity, job satisfaction and opportunities for recreation and sexual contact will also make a difference in his response. Those who are socially isolated may be badly hurt to the news of a positive result. Poor people, poor work prospects and little family support are some more situations where the person finds it difficult to react to the result.
he pre-testing psychological condition and his personality may be considered by the counselor. When there is psychological distress before the report is known the reaction of the client may . differ it can be less or more complicated which need different management strategies than other cases. The psychological state and the client’s psychiatric history must be taken into account because the stress of living with AlDS may bring back earlier disturbances.The positive test result may sometime old unresolved fears and problems, which will need acceptance and adjustment be handled carefully and at the earliest.
The communities where there is a belief in life after death or a accepting attitude towards life they may receive the personal knowledge of HIV in a much more calmer way than others. In many other communities AIDS is considered to be antisocial or offensive behaviour the feeling of guilt and rejection is associated with it.
When a person is tested positive to HIV/AIDS there is a tremendous need of counseling and support. Some may have intense reactions which is normal for a life threatening news which, one can anticipate. Some common shock reaction to diagnosis of are as follows:
- Numbness/silence and disbelief.
- Confusion/uncertainty of present and future circumstances.
- Denial — don’t want to accept it.
- Aggression towards family, health staff due to circumstances.
- Fear of death, pain and disability. Loss of bodily and mental functioning/ loss of confidentiality/ privacy.
- Guilt of association of sexual activity which brought the illness, or towards drugs.
- Severe and acute anxiety.
- Emotional instability (one moment laughing the other moment in tears).
- Sad and gloomy as concerned about the future for work, family/spouse and health.
- Doubtful about the behavior of staff/colleagues /helpers.
- Relief knowing the cause of illness.
With respect of the report there are some shocking behavioural reactions:
- Crying—unpredictable most of the times.
- Anger and irritability—over small issues and usually sparked off.
- Withdrawal—distancing self from present issues and circumstances.
- Self-denigration—describing self as deserving this plague, worthless.
- Keep checking the body for symptoms or physical deterioration.
- Questioning—reassurance and further information.
The following points need to be emphasized on regular basis:
- HIV infection and AIDS are two different kinds. Both have different projections but it is advised for the infected person to live a normal social and economic life unless the symptoms appear and cause problems. Counseling for the family and friends is required as the normal social life is not possible without their support.
- An HIV positive person should always be careful about his health. The presence of infections like STDs can ruin immune system and speed up development of AIDS. It is advisable to stay away from exposure to illness and common infections for prolonged life. The counselor can advise on the measure to avoid infections and keep general hygiene and prevent other sexually transmitted diseases.
- The client’s spouse and partner will need support and counseling as disclosure of the HIV may shock them. A counselor may ask the client to bring the souse along for counseling so that they can be explained about how to prevent, it further and referring them for frequent testing.
- The most important aspect is to save the partner and souse against infection. Some cultures and religions do not accept the use of condoms. The counselor must explain the consequences of not using it.
- An HIV infected person should not share his skin piercing instruments with others.
- The infected person should not donate blood, plasma, body organs.
- An infected woman should avoid pregnancy. As a pregnant woman can transmit infection to unborn child and many other health complications may arise due to this. As there is no adequate treatment available today.
- The breastfeeding again needs discussion and the counselor must keep themselves abreast with latest news and information.
The post-test counseling must include the following:
- The positive test is something that needs to be understood by the person in right sense.
- Discuss their feeling after knowing about their infection.
- Support the person to deal with it.
- Discuss immediate future plans.
- Establishing a relationship a base for future counseling.
- Schedule for medical evaluation appointments and follow up counseling must be fixed.
- If there is any partner counseling for them as well.
- Refer local community service to the person.
Counseling after an Equivocal Test Result.
There are many reasons for which a test can prove to be ambiguous, due to lack of time for sero-conversion to take place from the time of possible exposure to HIV infection or window period. In these circumstances the counselor may consider two issues:
The test used to determine whether the person is infected with HIV:
the first test is ELISA with 100% with the positive test result the sensitivity and specificity of 99.5% so the negative result can be regarded as the person is not infected with the exception of window period. On the other hand a positive result indicates possible HIV infection for which the test needs to be repeated again for 100% ELIS specificity. This test result can be positive which strongly means HIV infection is 100% and if the result is negative that means there is no infection. In case of second positive test result a third ELISA test with 100% specificity on sero-positive with first two. ELISA is carried. out. If the result is positive it strongly indicated the infection but in case third test is negative it is indefinite. There may be following reasons for the same:
- There are non-clinical signs of HIV infection in the person which have developed more quickly than expected.
- A relative HIV virus is present.
- There is a cross reaction with non-viral protein and reaction is simulating associated with HIV core protein.
Then there are some more points to consider: Use alternative method with objective of a reliable result, may be by using combination of techniques to rule out false positive result. Where the test result is indeterminate and further testing is not possible we cannot say with any degree of that the person is HIV infected. The counselor may call him after three months for repeat testing. This is important to know that with areas of low level of HIV infection the risk of finding false positive result is more than where there are rate of HIV infection is higher.
Prevention and support while waiting for an unequivocal result:
The period when the person is waiting after an indeterminate test result is three months from last instance of potentially high risk exposure. The counseling is more important where more emphasize is on the prevention activity regarding sex, drugs, body fluid, tissue donation and breast feeding. The person will have to take preventive measures as that of an HIV positive person until proved otherwise. There are many uncertainties associated with this period which brings severe psychological difficulties for which the counselor must be prepared to assess and mange the client and if require make necessary referrals. The counseling for sero positive and terminal persons:
- Keeping a tab on the development of client’s all spheres of life.
- Acknowledge earlier information shared.
- Handle the sudden disruption in life.
- Supporting the client where he is feeling loss of control in life.
- The client may feel hesitated to disclose his HIV positive status counselor. may have to support the client in such situations in case visiting a dentist.
- The counselor must help the client to overcome the hostility, indifference and prejudice of others.
- Re-establish coping skills and realizing self-worth.
- Teaching of taking care of self and protecting others.
- Regular touch with the client either at home and keep discussions confidential.
- Counselor must have a good relationship with the client’s family.
- Always talk about positive living and hope and Stress on improvising of quality of life.
- The perception of HIV infection need to be explained to the client by differentiating between terminal illness and chronic disease which last for longer years.
- Tech the client meditation techniques for relaxing.
- Encouraging the client to support in preventive and social activities with others and inculcate individual hobbies and support anticipatory grief.
- Encourage the client to get involved in planning for the future and participation in self-help.
- Help in accepting death.
- Help the client in concentrating on past achievements not the failures.
- Encourage spiritual approach for coping.