Helping the infected person and affected significant others

The main function of the HIV/Aids counsellor is to be supportive of his of her infected and affected clients, to listen to their problems and to empower them to solve their problems and better their lives.

1. Support and empowerment

• Compile, with each client, a list of their problems, and let them reflect on what they want.
• Assist the client to identify possible solutions to these problems. Encourage clients to come up with their own solutions because clients will be more likely to implement solutions that they find feasible and practical.
• Ask the client to make a list of his or her good qualities and possible limitations. He or she should, for instance, list his or her coping skills, describe the level of his or her self-esteem, analyse his or her personality style, communication style, sense of humour - and any other strengths and weaknesses that may be important.
• Examine and discuss possible solutions to whatever problems the client may have identified. Assess each solution in terms of the client's actual capabilities and capacity. Refrain from giving advice and suggesting solutions.
• Ask the client to write down the answers to the following question: “Why must I go on living?” Once this has been done, encourage him or her to work toward those goals and to make new and longer-term goals along the way. Clients should set goals that will give them a sense of purpose and pride (goals such as “I want to see my children growing up”).
• Identify the ways in which clients have dealt successfully with their problems in the past and help them (if necessary) to develop new coping skills.
• Empower clients to make their own decisions and to take control over their lives wherever and whenever possible.
• Make a note of any relationship problems between the client and his or her loved ones, friends and family, as well as between the client and other health providers.
• Encourage the client to call on peer support (buddy systems) or self-help groups. The counsellor may also be able to put clients in touch with each other on an individual basis (with the consent of the individuals involved).

2. Peer support (buddy system)

Clients should be encouraged to become involved in support groups or to form their own groups if none exist in their communities. The following issues are usually dealt with in peer support groups:
• Learning to live with HIV infection. Many of the people involved in the peer support group, may have already gone through the process of living with HIV. They can describe the medical and psychological problems they have experienced and the interventions they found most useful.
• Helping caregivers and loved ones handle the daily pressure of caring for sick people.
• Reducing stress and avoiding conflict. Buddies can exchange practical advice on how to overcome anxiety, depression and other psychological problems that can lead to stress and conflict.
• Deciding how best to talk about HIV/Aids to loved ones, friend and colleagues. Disclosing a diagnosis of HIV can be particularly stressful, and buddies can share ideas on what to say, to whom, when and how.
• Dealing with feelings of loneliness, depression, powerlessness and suicide. The peer support group can provide help and mutual support. Advice from people who have actually experienced those feelings personally and who have coped with them successfully is more valuable than theoretical information.
• Advice about sexual relations and the implications of safer sex behaviour. Peer support groups can discuss all aspects of these problems and opportunities and give each other good advice about safer sex practices. Peer commitment to safer sex also helps to make these practices socially acceptable, attractive and sustainable.