The significant others in an HIV positive person's life often need help themselves to come to terms with (1) their own fears and prejudices and (2) the implications and consequences of their loved one's sickness and ultimate death.

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The counsellor can play a tremendous role in counselling the lovers, friends and family of the HIV-positive person in the practicalities of physical and emotional care. Affected significant others experience more or less the same psycho-social feelings as do their HIV-positive loved ones – the same feelings of depression, loneliness, fear, uncertainty, anxiety, anger, emotional numbness and, at times, hope.

The impact of HIV infection on affected others can be summarised as follows:

• Affected others often experience fear and anxiety about their own risk of infection.
• They are often angry with the infected person for “bringing this onto them”.
• They anticipate the loss of the HIV-positive person and issues of loss, bereavement and uncertainty are introduced into the relationship.
• They often feel unable to cope with the new demands that the infection place on them. They feel incompetent, unqualified and powerless in their interaction with the HIV-positive significant other.
• Responses to disclosure can range from involvement, caring and support on the one hand, to abandonment, indifference, and antagonism on the other.
• Affected others suffer in many ways as a result of untimely deaths. People who die of Aids are usually young (between 20 and 35 years old), and this leads to the “unnatural” situation where parents outlive their children. Grandparents who are preparing themselves for a quiet and contented old age now often find themselves forced to nurse and care for sick and dying children as well as grandchildren.
• Children suffer tremendously when their parents are infected, and the needs of children with infected parents are often neglected. There is no tradition of talking to children as equals and on an intimate basis in many African societies, and caregivers often report seeing “the suffering of children, who are too often hovering in the shadows of a sick room, seeing and hearing everything but never addressed directly”.
• Significant others often have to fulfil a role for which they are not trained, namely that of caregiver. They have to look after serious ill loved ones.
• Neurological complications and deterioration in mental functioning in the client can be extremely disturbing to significant others. They may feel that they are already losing their loved ones and this can precipitate an early grieving process.

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