Counselling and testing for HIV and AIDS in pregnant women
In principle, HIV / AIDS counselling is a separate consultation. However, private pre-test counselling can be partially integrated with education and communication for each subgroup
Form and place of consultation
The counseling place should be discreet but easy to access. Because the counselor may have stigma or stigma, although the counseling office must have a clear name variable, it should not write or show any signs that it is related to HIV / AIDS. In case the facility lacks room, it is possible to arrange together with the prenatal counseling room (for pregnant women) or family planning counseling, provided that the room must allow individual counseling separately and confidentially.
In principle, HIV / AIDS counseling is a separate consultation. However, private pre-test counseling can be partially integrated with education and communication for small groups of people in need of information (also known as group counseling). It is possible to organize each education and communication session on HIV / AIDS in groups (10-20 people each) with supporters presenting or using media (such as video tapes). During these sessions, general information on HIV / AIDS, transmission routes, and prevention can be discussed together with focus group discussions. It is then possible to conduct a separate consultation for each person in need to discuss their own personal matters. This is a way that can help save time and manpower, provide sufficient information while ensuring confidentiality when needed.
Consult before the test
Builds trust of the audience with the counselor.
Investigate, evaluate psychology, understanding, education level, circumstances of the counselor.
Provide consulted persons with essential information on HIV / AIDS.
Explain the routes of HIV transmission and how to limit risky behaviors.
Identify needs, help subjects overcome initial fears.
Help the counselor assess his / her risk of infection and possible consequences, thereby deciding on his own HIV testing needs. This is very important, especially for pregnant women because of the risk of mother-to-child transmission.
Provides information on HIV testing and the significance of test results. Emphasize the confidentiality of test results.
The content of consultation steps
Step 1 :
Hello, get acquainted. This is a very important step to help the counselor get the object's goodwill. The object's trust will help counselors learn information about individuals and their family's economic, medical and social circumstances in a specific way. Through it, the counselors can initially identify the needs of the subjects as well as their motivations to come to themselves to support them in the next steps.
Step 2 :
Discuss in detail to assess the subject's situation, knowledge about HIV / AIDS and risk level.
Depending on the results of knowledge assessment, provide the consulted with necessary and appropriate information.
Provide the consulted with general information about HIV / AIDS, the duration and course of the disease.
Work with the subjects to determine their level of risk. In assessing risky behavior, it is important to discuss many delicate issues such as sex, sexual behavior, and drug use in order to give appropriate advice.
For unsafe sexual behavior, it is important to understand the circumstances in which the behavior occurs. There can be a wide variety of circumstances ranging from having multiple sex partners regularly to euphoria (due to alcohol, drugs, etc.), being manipulated by friends while not having a condom, or having condom but punctured, broken. It is important to emphasize fidelity, monogamy and condom use, even with your partner, even if they think they are not infected. Unsafe sex does not only happen in sex work, but also through relationships with sexual partners and lovers. The risk of HIV transmission is not only limited to heterosexual sex but also increases through same-sex sex. especially for sex workers or those who appear to be prone to outgoing sexual behavior, infrequently, easily influenced by excitement. It is in such "high-energy, explosive" times that the subject easily forgets, ignores the use of condoms most.
For injecting drug addicts, detoxification is ideal.
However, detoxification is a difficult and long-term task. Therefore, the counselor should emphasize the risks of sharing needles and syringes. Risk is minimized by rinsing / disinfecting syringes and needles, preferably using disposable syringes and needles which is immediate beneficial action to reduce harm and can be more easily achieved. It is important to advise these people how to properly clean / disinfect the syringe and try to use the disposable one and throw it away.
For health workers who have occupational risks or accidents while caring for a loved one with HIV or suspected infection related to blood or body fluids (through injections, cuts during surgery , spraying fluid into the eyes, nose, mouth or skin wounds), they must all be consulted about infection and tested for HIV as well as preventive treatment according to regulations of the Ministry of Health.
For a person suspected of having been exposed, whether high or low risk, the counselor should comfort the counselor's fears and provide immediate (before test results). they have the necessary information to avoid infecting others such as temporarily avoiding donating blood, sperm, tissue, or milk; Practicing safe sex to protect your partner from infection.
Especially for women, counselors should emphasize a woman's susceptibility to HIV transmission as well as the possibility of mother-to-child transmission if the woman herself is infected and pregnant so they can think. and depending on each stage that you should decide whether you should become pregnant or not (for a woman who is not pregnant) or how to manage if you are pregnant or term. It is important to emphasize the importance of HIV testing, especially for pregnant women, to be able to intervene early and reduce the risks and consequences.
Step 3 :
Discuss HIV transmission and non-transmission routes, how and when antibodies are formed if infected, the type of test (antigen test) and the advantages and limitations of testing, Meaning of the window stage ...
Step 4 :
Discuss with the subject the practical meaning of the first test results. Right from the consultation before the test, the counselor should also emphasize the meaning of the first test result:
HIV negative does not mean that you are not infected with HIV. The person being consulted may still be in the window stage. Therefore, it is still necessary to do the test again after about 2-3 months to confirm again.
Being HIV positive for the first time does not mean that you are definitely infected with HIV, but it only means to be suspicious. need to be retested with two other tests (in accordance with method 3) in competent and competent health facilities to confirm for sure.
The counselor should also immediately explain to the subjects during this time the possibilities of either false positive (HI V is positive but not infected) or false negative (HIV negative but still infected) because it depends on the technique. these abilities are rare (or very rare) but still can occur.
Step 5 :
Discuss the possible impact of the tests on the counselor and those involved. But the real effects of test results can include lifestyle changes in the family, sexual intercourse, medical care for infected people in the family, health insurance, work in the family. in the future ... The main goal of this step is to alert the audience in advance of possible medical, psychological, family and social consequences, not to create anxiety. Europe is not required. Right from this step, the counselor also needs to note that the pre-test counseling not only prepares the test process but also has the ability to help the subject change his or her behavior to prevent infection. for yourself (if the result is then negative).
Step 6 :
Evaluate the subject's anxiety level before the test. The purpose of the step
This is to find out how the counselor feels about HIV / AIDS, their ability to react to the test results, especially if it is HIV (+) so that they can prepare themselves for the end. fruit. need to comfort the target audience and emphasize that HIV (+) status, even when confirmed, does not mean AIDS. People infected with HIV are also capable of living for quite a long time. Not only do they have to find ways to avoid transmitting transmission to those around them, but also be able to live a quality and productive life during that time.
Step 7 :
Describe the steps of the test, including the blood drawn, how long it took to wait, when the results were received, how to report the results to them. At the same time, reassure subjects that test results will be delivered in person (unless they otherwise wish) and kept confidential.
For testing, the technician needs to take a small amount of blood from a subject's vein (in the arm) and test for antibodies (in the vast majority of cases) or antigens (rarely because very valuable, but very expensive).
Step 8 :
Discuss a healthy lifestyle and ways to reduce the risk of infection (for yourself and yourself). Evaluate the target's knowledge level about HIV / AIDS and prevention methods. Thereby additional counseling to improve their level of understanding, discussing (a preliminary way) in advance of ways they can deal with test results and management first. Emphasize letting the subject know they can get some social support when needed.
Step 9 :
Appointment of the next consultation day. The timing of post-test counseling should be set together with the date of receipt (immediately after receiving) the test results so that they can discuss with them how to deal with specific results. Do not let the time from the time of receiving the results to the time of post-test counseling to prolong, avoid the situation where the counselor may experience mental crisis.
It should be noted that no matter how carefully the pre-test counseling is conducted, everyone has an anxious attitude, which can lead to negative while waiting for the test result. Therefore, they need to be supported while waiting for test results. They should be encouraged to return to the inquiry room (or call, if the facility has telephones) for outstanding questions and assistance when needed.
Counseling after the test
The staff returning test results must have the professional responsibility so that they can advise or refer the subject immediately to the counselor, especially in the case of HIV positive results. Test results must be delivered directly to the subject, not in the hands of others unless it is the subject's intention, Do not notify the test results via mail, by phone ...
in terms of timing, as noted above, the timing of post-test counseling should be scheduled on the same day or as soon as possible after the test results are received so that the counselor can be given prompt encouragement. necessary.
To avoid repeating (or omitting) something, the best post-test counselor should be arranged at the same time as the pre-test counsel. The counselor should also have a card or notebook recording what has been discussed / discussed since the last time. However, this is a difficult thing to do in many facilities.
In any case, the counselor should reassess the subject, see what information they have been provided with and remember what information from the previous consultation to have information and discussion in this time. At the same time, recall the most important information.
Notification as well as consultation and discussion of test results should be conducted directly with the subject, ensuring the principle of confidentiality and confidentiality. Subject's relatives can only be present during counseling sessions if the subject directly requests them.
Counseling for people who test HIV negative
A negative HIV test result will make the subject feel secure and cleared. However, this is still a good opportunity to encourage the counselor to change high-risk behavior (if any), to avoid infecting themselves in the future. It is necessary to reiterate basic information about HIV / AIDS, identify high-risk behaviors, make it difficult and conducive to behavior change as well as encourage and make subjects confidently change their behavior.
The counselor also needs to reiterate the importance of the window period as well as the possibility of false negatives (rare) and encourage subjects to voluntarily re-test after about 3 months to be able to confirm with more certainty.
Counseling for people with an HIV positive result has been confirmed
Subject may have been prepared to receive the test results from the consultation
carefully before. However, in the post-test counseling time, if the HIV result is positive, the counselor still needs to carefully consider and choose an appropriate time to notify the results to the subjects.
No matter how well prepared a couple may be during a prior consultation, getting an HIV positive result will also have a serious psychological impact on them. Counselors must understand their psychological developments as well as possible reactions to take appropriate action.
Reactive capacities of new HIV-positive recipients and supportive management in counseling
Subject appears confused, panicked, dizzy, or may even pass out or faint. Although it may have been mentally prepared, in this situation, if the consultation continues immediately, the subject will not understand what he is being told about at all. In these cases, the subject needs to be near someone close, intimate, and trustworthy in order to be cared for and comforted. If you do not have a loved one by your side, the counselor needs to try to create a close relationship to calm them mentally, helping them through this stage.
Subject expresses disbelief in the results, claims that he cannot be infected, and remains healthy. This is a strong reaction, occurring unconsciously out of fear and very common in practice. This form of reaction begins as soon as a subject hears the test results and can be as long or short as depending on the person's feelings. The counselor needs to patiently explain, not being annoyed by the subject, in order to make them understand that they have been infected.
Subject may express anger towards himself (self-deprecation, guilt), towards others (hatred of the person who transmitted the disease, revenge ...) or general (hatred of life. The counselor should patiently listen, let the subject say all the angry things in his heart to feel more comfortable, at the same time find a way to soothe the subject.
After going through the initial crisis period, or immediately upon hearing the announcement, a person with an HIV-positive result may become afraid of all the consequences they can think of: fear of pain, loss of job, fear of people. others know, friends and colleagues abandon, drive away, break family happiness, fear of death ... To make them more reassuring, counselors need to let them express all their worries, on that basis explain their rights (the right to confidentiality, the Health Protection Law, the Labor Law, the occupations they can continue to do ...), as well as guide them to inform them. family or counsel their family appropriately (infected people can still live at home without infecting others).
Feeling of being abandoned, alienated by people around, or wanting to withdraw, avoid external social interaction. This is usually a late response. In this case, the consultant needs to determine the cause to resolve the problem. If they are truly shunned by their family and relatives, it is necessary to advise their whole family that HIV is not transmitted through casual contact, and at the same time advise them to practice safe behaviors to avoid. infection. If this is just the feeling of the subject itself, the counselor needs to persuade family members to join in to comfort the subject. It is important that they know that there are many people in the same situation, there are groups of "You Help You", necessary social support.
It feels like everyone is paying attention to me, talking about their HIV positive result, feeling guilty, not worthy of everyone around. Counseling firmly that they can still lead a productive life, for society and encouraging them to change their behavior in that direction.
Subject feels hopeless, feels helpless. Without timely counseling, they may have negative reactions such as not eating, leading to physical exhaustion or more dangerously than committing suicide. In this case, the counselor should encourage them to interact with society, people in the same situation, and encourage them to think about their responsibilities towards themselves and their families. In particular, encourage their relatives to participate in the counseling process to achieve good results.
This can be seen as a positive attitude and is often a late response. However, well-counselled pre-test subjects, especially those with knowledge/knowledge, may have this attitude as soon as they are notified of their HIV positive results. After a while, when subjects have overcome initial crises, they begin to accept HIV status, willing to cooperate, change their behavior and find the best solution for their life (living with quality and useful).
This is a very convenient time for the person to advise the object to discuss and plan for the future life (work, family, society) as well as how to take care of the subject's own health.
Subjects may have a positive attitude that hopes for a future life: being able to continue living with HIV positive status for a long time, still able to live a useful life, taking care of their family My children, I hope that my family members can still be healthy and have a future. need to continue to encourage them to keep that hope, while still advising them on how to prevent infecting those around them.