BIBLIOGRAPHY 91 APPENDICES 99
6.5 The Namibian method of counselling
i) Why should counselling services be offered to the women of Walvis Bay?
Counselling is important, because a diagnosis of HIV infection can create enormous psychological pressures and anxieties, that can worsen illnesses and even evoke fear or misunderstandings. In the absence of a cure, information about prevention and transmission is a crucial part of counselling.
Counselling services should be offered to:
•correct misinformation and mis-education.
•reduce the risk of HlV-transmission to un-infected community members,
•provide psychological and emotional support to those infected and affected,
•promote social support.
ii) What is HIV counselling?
HIV Counselling is a new concept in Namibia, which came into being with the HTV/AIDS pandemic.
Some people mix up counselling with health education. Counselling does not replace health education. According to the definition of the World Health Organisation, HIV/AIDS counselling is defined as a confidential dialogue between a client and a counsellor, with the aim of helping the client to cope with the problem and take personal decisions related to the problem (1995:3).
Hi) Who should provide HIV/AIDS counselling?
In Walvis Bay, in addition to doctors, nurses, psychologists, psychotherapists, social workers, teachers, and religious workers, counselling can be provided by anyone who has been specially trained in HIV/AIDS counselling.
iv) Where do they counsel?
They can counsel anywhere but the place must be:
•Quiet, where interruptions can be avoided.
•Comfortable, such as the beach.
•Private, where no one else can overhear.
v) When should counselling services be offered to Walvis Bay women?
•When women come to clinics for testing, diagnosis or ongoing treatment.
•When women come requesting support and help.
•When a woman with HIV is in hospital.
•When women seek information about HIV testing.
•When women are considering finding out about their HIV test results.
6.6 Different types of HIV/AIDS Counselling i) Preventive counselling
Counselling is directed towards prevention of HIV-infection. Preventive counselling might mean to anticipate or to act in order to discourage that which one does not want to happen. There are many steps involved in preventive counselling, such as assisting the women to understand the risks associated with their behaviour or discussion of relationships between women's lifestyles and their self image. Preventive counselling aims at helping women to understand and change risky behaviour before they are infected and at supporting those who are infected or affected by the HTV/AIDS virus.
It should be accessible to everybody, regardless of social background, religion and culture. There
is primary or secondary preventive counselling (HIV/AIDS Home Based Care Handbook 2000:5).
a) Primary preventive counselling
Primary preventive counselling relates to counselling of those at risk of HIV infection who are, at the time of counselling, unaware of their HIV status. Primary preventive counselling is, therefore, directed at everyone. It can be offered to any individual at risk: it should not be limited to commercial sex workers, truck drivers, etc.(HTV/AIDS Home Based Care Handbook 2000:5).
b) Secondary preventive counselling
This is counselling of a person who is known to be HIV- infected. Information on transmission, safer sex, and use of condoms is of important in secondary preventive counselling. Before secondary preventive counselling is given, pre- and post test counselling is conducted (HIV/AIDS Home Base Care Handbook 2000:6).
ii) Pre-test counselling
Pre-test counselling can be defined as the counselling offered to a person before they have an HTV antibody test. In the context of testing for HTV infection, everyone including those who are tested voluntarily, needs to be counselled first. Such counselling sessions are mostly be given by health professionals. Bayley puts considerable emphasis on the provision of counselling and the need for those providing it to possess the necessary counselling skills (1996:48-50). Compassionate care begins when persons seek HTV testing, either voluntarily, because they believe they are at risk, or at the request of a medical professional, because AIDS is suspected as the cause of illness (A
Pastoral Documentation prepared by The Catholic Health Association (CHA) of the United States and The Conference of Major Religious Superiors (CMRS) of Men's Institutes of the United States, Inc. 1988:20).
Appropriate pre-test counselling should include a discussion about HIV/AIDS, its transmission, signs, symptoms, prevention, as well as the meaning of a positive HIV test or a negative HTV test.
During the discussion, women need to be encouraged positively whatever the result may be.
Confidentiality is a very important aspect but not easy to maintain. Therefore, it should enjoy first priority. Pre-test counselling can be repeated many times, until the client decides to have the blood test being done. Women often find it difficult to have an HIV/AIDS test (interview no.3 - /Namtago).
The counsellor must alleviate their fears by positive affirmation. Counselling does not end with pre- test counselling but it goes a step further with post-test counselling (Bor, Miller and Goldman 1992:64). However, it is essential to give the pre-test counselling process sufficient time so that women feel comfortable to proceed for testing. Effective counselling help women make informed decisions, weighing up the benefits and disadvantages for them of the test and not deciding for them.
Counsellors are not allowed to make decisions for HIV/AIDS clients.
Hi) Post-test counselling
Post-test counselling should be available to assist the individual in coping with the result and in formulating a support plan (Tjibeba 1997:52). HIV testing is an extremely serious issue, with important and far reaching implications. The type of counselling given will depend on the test result of the individual - positive, negative or indeterminate (when the test is not clearly either positive or
negative). An HIV - positive result can change the life of a woman in its totality. According to the documentation prepared by The CHA of the United States and the CMRS of Men's Institutes of the United States, women who are tested HIV positive should also be counselled and encouraged to inform their physicians, and sexual partners, as well as others who may be treating them (1988:20).
This must be seen as a respectful and trustworthy action. If the test is positive, counselling will start with informing the individual of the result and may gradually progress into ongoing counselling until the individual has accepted and made plans to meet the challenges of living with HTV/AIDS.
iv) Supportive counselling
Supportive counselling is a continuous process of psycho-social support to a person infected with HIV or a person with AIDS or their families and close contacts. It deals with inner feelings, the need to avoid re-infection, discussion about pregnancy and its implications and management options for female clients. The aim of this counselling is to empower women with HIV and to maintain control over their lives and to develop healthy coping skills.
v) Ongoing counselling
Ongoing counselling support can provide an opportunity for women to plan how to cope with future problems that might arise. Women might be coping on a day to day basis. However, they might have several issues that may become problems in the future. An example of this might be planning for the future of their children. Often, making such plans can help the mothers feel more in control of their lives. It aims at helping women to accept their status and to develop and maintain a positive attitude.
vi) Terminal and bereavement counselling
Bereavement counselling is the counselling offered to HTV/AIDS clients in the last days of their HTV-infection. This kind of counselling is offered to address the grief clients go through in the course of being HIV- infected and also to empower them to prepare for death with a positive mind or attitude. It is also offered to the immediate family members of the infected person because at this time they are also going through a similar loss reaction or grief.