HIV counselling--a luxury or necessity?

WHO and UNAIDS have consistently promoted HIV counselling as a routine part of HIV testing in developing countries. Nevertheless, in many countries counselling is not considered a crucial accompaniment of testing services, and patients are tested without access to counselling during and after testing. Thus, information on the need for and results of counselling is needed to convince policy-makers and service managers to give greater priority to the development of counselling services. This qualitative study describes informational, social and emotional needs and problems of newly diagnosed seropositive patients attending public health services in Zimbabwe. Their basic factual information on HIV/AIDS was reasonable, but many patients equalled HIV to AIDS and conceptualized their infection as 'social and physical death'. This seriously impeded their capacity to use knowledge of their test results in a constructive way, and stimulated coping by denial and/or secrecy about their HIV status. These avoidant coping strategies discouraged clients from using condoms, seeking social support and taking measures to protect their vulnerable health. The complex and changing nature of clients' needs indicates that common short-cuts in counselling (e.g. giving brief information before and after the HIV test) are seriously flawed as a strategy to prepare clients for effective coping. Comprehensive pre- and post-test counselling are an essential preparation for coping effectively during and immediately after testing. Availability of supportive counselling beyond this first phase is essential to assist clients with needs and problems which will appear over time. Development of counselling interventions should be guided by research into their effectiveness and by national policy guidelines. Replacing fear-inducing HIV campaigns with interactive, constructive information about HIV prevention and care will increase the preparedness of the community as a whole for effective living with HIV.

Child sexual abuse in Matabeleland, Zimbabwe.

The extent, nature, causes and consequences of child sexual abuse in Matabeleland. Zimbabwe, are explored by an intersectoral working group consisting of health, legal and AIDS prevention workers who were struck in the course of their work by the regularity with which they saw sexually abused children infected with HIV and STDs. Methods used in this study are record review, focus group discussions, structured and in-depth interviews. Child sexual abuse cases form between 40-60% of the rape cases brought to the attention of hospitals, police and court and many more are believed to remain unreported. Half of the sexual abuse in children is detected through STDs and some have HIV. The majority of offenders are mature men known to the child. Factors influencing child sexual abuse are male dominance in society, men's professed inability to control sexual desire, and magic beliefs. Victims are traumatized by the abuse itself as well as by subsequent problems in family, health and in court. Since child sexual abuse may endanger the life and well-being of the child, it is a serious problem that requires urgent action.

What leads to good counselling?

PIP: Human immunodeficiency virus (HIV) counseling involves advising those who are facing an incurable, stigmatizing disease. The counselor needs to be emotionally stable and have respect for the patient's rights and dignity. The abilities to listen, communicate, keep confidentiality, and maintain a nonjudgemental attitude are all necessary. Institutions need to provide privacy and time for such counseling. Practical items (condoms, soap, bleach, plastic sheets, home care visits, and travel expenses) should also be provided. Training in counseling is useful for anyone involved in the care and support of HIV patients. Skills include the ability to 1) explain HIV testing, prevention of sexually transmitted disease (STD), and family planning methods clearly, simply, and appropriately; 2) speak openly and frankly, encouraging the same in the patient, about sex; 3) listen and to allow time for the patient to talk; 4) ask nonleading questions that encourage patients to express feelings and to think about their life and personal relationships; 5) empathize; 6) give psychological support; 7) assist someone in making realistic decisions and in adjusting to change by drawing upon their resources; and 8) establish trust and to keep confidentiality. A training course should be limited to 20 participants who attend several workshops conducted over a few months. Group exercises, demonstrations, role plays, short talks, and videos should be mixed to allow participants to learn and practice skills. This should include an exercise allowing them to discover their own values, fears, and prejudices. Supervision by an experienced counselor is necessary during and after training. This includes dealing with the counselor's emotional reactions to counseling. A follow up workshop should be held a few months later, where difficult situations could be role played. Regular meetings with colleagues, supervision, and further training should be continued. Training courses should be evaluated through discussion, supervision, and questionnaires.^ieng

Use of alcohol among high school students in Lesotho.

Data on alcohol consumption, attitudes to and knowledge of alcohol were collected by means of questionnaires from 1133 high school students aged 11-22 years in Lesotho. Additional data were obtained by means of classroom discussion and 13 in depth interviews. About half of the students (54% of the boys and 42% of the girls) had drunk alcohol at some point in their lives. Drinking was found to be related to age, sex, drinking of friends, family income, and drinking in the family. No indication of widespread alcohol abuse was found, but about half of the students (drinkers and non-drinkers) believed that moderate drinking is impossible and that the fun of drinking is to get drunk, indicating the possibility of alcohol abuse in the future. The results have implications for future research and for preventive work among youth and adults in Lesotho.

Use of flow-charts by nurses dealing with mental patients: an evaluation in Lesotho.

General nurses without previous training in psychiatry were instructed, over a period of thirteen hours, in the use of eight flow-charts for the identification and management of mental health conditions. They then prepared management plans, with the aid of the flowcharts, for 105 patients with suspected mental health problems who were seen in three outpatient clinics. The same patients were also seen by trained mental health workers who made a diagnosis and wrote up a management plan, which subsequently was compared with the management plans devised by the nurses.Seventy-eight of the 105 patients (74%) were identified and treated correctly by the nurses. A total of 32 mistakes were made, 17 of which were due to the nurses and 15 to defects in the flow-charts. On the basis of these findings, suggestions are made for improvements in the flow-charts and in the way the nurses are instructed in their use.

Use of flow-charts by nurses dealing with mental patients: An evaluation in Lesotho

General nurses whithout training in psychiatry were instructed, over a period of thirteen hours, in the use of eight flow-charts for the identification and management of mental health conditions. They then prepared management plans, with the aid of the flow-charts, for 105 patients with suspected metal health problems who were seen in three outpatient clinics. The same patients were also seen by trained mental health workers who made a diagnosis and wrote up a management plan, which subsequently was compared with the management plans devised by the nurses. Seventy-eight of the 105 patients (74 percent) were identified and treated correctly by the nurses. A total of 32 mistakes were made, 17 of which were due to the nurses and 15 to defects in the flow-charts. On the basis of these finding, suggestions are made for improvements in the flow-charts in the way the nurses are instructed in their use

Coping with HIV lives of HIV-positive people in Bulawayo; Zimbabwe

After one year follow-up of 72 recently diagnosed symptomatic HIV positive patients; an inventory was made of qualitative and quantitative results found up to date. RESULTS: - At present a more or less stable contact has been made with 72 clients; recruited between May 1991 and May 1992. - The most common reasons for refusal and not keeping contact were: denial of being HIV positive of the patient and/or the partner; fear of being detected by others as HIV positive; and practical problems in keeping contact; for example after having moved to distant rural areas. Informing the sexual partner and other relevant family or community members is an important step in coping with HIV. However; 17/39 patients with a steady partner did not inform their sexual partner. Among the patients who dropped out of the research; patients who did not want to inform anyone of their HIV status predominated. - Research clients had a high level of HIV-related problems and needs such as: need for more information; material needs; need for appropriate health care; need for conflict intervention and securing social support; need for help in legal and work-related issues; and need for emotional support. Many patients; however; felt that looking for help to secure these needs meant risking stigmatisation and rejection. Patients tended to hide their problems; or to look for help without revealing their HIV status even to medical sources and close family members. As a result some sources of help available to people with HIV were actually underutilised

Child sexual abuse in Matabeleland

Health and legal workers in Bulawayo; alarmed by the number of child sexual abuse cases they saw in the course of their duties; decided to do an explanatory; descriptive research on the causes and circumstances of child sexual abuse in the area. They analysed the data from 54 abused children and their parents; referred to them for counselling and support. They held focus group discussions with various community groups to determine attitudes towards sex and people's familiarity with child sexual abuse; and asked legal and health workers about their experiences and recommendations on care of victims and problemsin the legal process. Also; court and hospital records were studied to determineattitudes towards sex and people's familiarity with child sexual abuse; and asked legal and health workers about their experiences and recommendations on care of victims and problems in the legal process. Also; court and hospital records were studied to determine the frequency of such abuse

Child sexual abuse in Matabeleland

Health and legal workers in Bulawayo; alarmed by the number of child sexual abuse cases they saw in the course of their duties; decided to do an explanatory; descriptive research on the causes and circumstances of child sexual abuse in the area. They analysed the data from 54 abused children and their parents; referred to them for counselling and support. They held focus group discussions with various community groups to determine attitudes towards sex and people's familiarity with child sexual abuse; and asked legal and health workers about their experiences and recommendations on care of victims and problems in the legal process. Also; court and hospital records were studied to determine attitudes towards sex and people's familiarity with child sexual abuse; and asked legal and health workers about their experiences and recommendations on care of victims and problems in the legal process. Also; court and hospital records were studied to determine the frequency of such abuse