Counselling / Elizabeth Ngugi

Counselling by Elizabeth Ngugi Department of Community Health, University of Nairobi There is a story about the "after famine" behaviour of a child who cried himself to sleep every night even though the mother was now feeding him with enough food. In desperation and recognising the need for a helpful relationship, the mother gently asked why he cried so much. Feel- ing safer and therefore gaining con- fidence , he said, " I cry because I'm afraid I might not get food tomor- row, just as happened last month. " The mother explained the past and present situations and reassured her child : "The famine has ended and there is plenty of food for the future. " From then on, she let the boy go to sleep holding a piece of sweet potato so that , if he were hungry in the night , he could simply eat it . The boy never had another sleepless night , since he felt the situation was under control and he was part and parcel of the entire process. Counselling brings about an un- derstanding as to why a person is being tested for HIV antibodies. The counsellor, having established credentials and identified himself or herself in relationship to the per- son, also taking into account the latter's social and cultural beliefs , establishes a level of "objective acceptability. " And counselling can be tough, even harrowing. The predicament of those who learn they are infected with the AIDS virus or have the disease , is appalling for the father of a young family , for the mother of a breastfeeding child , for a son on whose future earnings three gener- ations may be relying. For each and every individual in this situation, the future looks grim; the counsel- lor's job is to try, against the odds, to lift that grimness by whatever degree is possible. The ability to listen coupled with skilful communication, enables the counsellor to confront the issue purposefully in a non-judgmental 14 and non-threatening climate. Once trust and confidentiality are estab- lished , this increases the client's motivation to learn more about HIV, and his (or her) self-determi- nation to change his behaviour whether or not he is AIDS virus infected or "sero-positive." With this approach, the client begins to Counsellors such as this young doctor in Singapore need to blend the art of communication with the ability to listen. Photo W HOfT. Farkas deal with the situation even before the result of the test is known. When this result has to be commu- nicated to him, the counsellor uses his creativity and identifies the op- portune moment and appropriate approach to take with each per- son -since the " clients " are usually at different levels of understanding and acceptance. Should the person be "sero-negative," then the coun- selling consists of building up the knowledge of modes of transmis- sion, so as to avoid behaviour that can risk exposure to AIDS virus infection. Recommended behaviour will include: - having a faithful monogamous marriage (or relationship) ; - reducing the number of sex partners; - using condoms to reduce the risk; - avoiding having mJections with unsterilised needles ; - avoiding skin-piercing pro- cedures with unsterilised instruments ; - avoiding unnecessary transfu- sions of unscreened blood and blood products. One question that increasingly arises regarding persons who are in- . fected with the AIDS virus but have no symptoms is : should they be told they are infected? Guided by the principles of health educa- tion for the control and prevention of HIV transmission, the answer is yes, they should be told. Other- wise , as a main focus of infection , it would be impossible to control the spread without their full participa- tion. One beneficiary of counselling is the client who, through support, is able to live a fully functioning life and to avoid transmitting HIV to others. But it is also rewarding for the counsellor who has managed to recruit one more agent for change-a true partner in the fight against AIDS virus spread. The AIDS patient has a lot to handle ; firstly a disease which car- ries a stigma, secondly the suffering and pain, and thirdly the fear of death. The counsellor has in turn an enormous responsibility for establishing and sustaining the patient's coping mechanism to the point where he can really think of preventing the spread of the disease to others . Family members and close friends also need to be counselled so that they understand that only sex partners will be exposed to the risk of infection with the AIDS vi- rus. It is they who will be able to give the person much-needed sup- port in his own environment. The "extended family kinship system" is crucial here as a tool in the stra- tegy to prevent and control AIDS . Women of child-bearing age need special attention as regards fertility control, since it has been estab- lished that 30 to 50 per cent of babies born to AIDS virus infected mothers will also be infected. Counselling will include persuading and convincing them that they should avoid becoming pregnant. To sum up , counselling is vital for bringing about behavioural changes that will help to control and prevent AIDS . Just like the famine-saved child, once he has been reassured, the afflicted person can become a role model and an informal educa- tor, living a fully functioning life and able to deal with the situation of being ill because he understands and accepts. • W ORLD HEALTH, March 1988