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COUNSELING FOR           NEWLY DIAGNOSED HIV PATIENTS                   IN MALAYSIA                                    CHA...
WHO ARE PLHIV?Brother                        Sister               Husband Doctor                       Employer           ...
WE AREPeople who come from all walks of life-   the mother sending her children to school-   the hawker selling chicken at...
WE AREWe come from all sectors of society-     from fishermen to grand fathers-     from drug users to transgenders-     f...
WE AREPeople who work, pay taxes & contribute to the economy.WE ARE YOU!                                                 m...
CHALLENGES OF PLHIVDiagnosisPost diagnosisFollow-upSelf-limitationPre HAARTStarting treatmentResponding to treatmentRebuil...
POST DIAGNOSISDENIAL / ANGER / LONELINESS / DEPRESSIONWhat it means to be HIV+Understanding the virusRealising that it’s n...
FOLLOW UPImportance of follow-up monitoringNutritionExerciseUnderstanding blood testsManaging financesReorganising workloa...
SELF LIMITATIONWhat can I do? What can’t I do?Should I quit my job?Can I still get promoted?Can I look for a new job?Need ...
PRE HAARTPreparing to start treatmentFear of starting treatmentTreatment literacyTreatment comprehensionDiscussing with th...
STARTING TREATMENTUnderstanding AdherenceUnderstanding ComplianceWhat are the medicines doing in my body?Trusting the DrAs...
RESPONDING TO TREATMENTUnderstanding the side effects-   Lipodystrophy-   Lipoatrophy-   Increased cholesterol level-   Li...
REBUILDING SELF IMAGEMoving forwardI am alive!Seeing the medicines effect on CD4 and VLSelf-confidence                    ...
THE FUTUREMarried and their spouse / Unmarried and their partnersDo I still have the right to be loved?Looking for a life ...
CONTINUUM OF CAREPREVENTION             TESTING                       TREATMENT                                   CARE AND...
THE ESSENTIAL COMPONENTAddressing individual / psychological barriers:  -   Community agencies:      Address barriers such...
COUNSELINGWhy do we need it?                                  myplus.org.my@gmail.com
WHATProvide accurate informationClarify factsDispel mythsEncourage acceptanceSource of emotional strengthAssist in psychol...
WHENCounseling must be provided soonest possible after the patientis informed of the HIV positive diagnosisCounseling must...
WHEREHIV screening venue:--    VCT centres-    ALL Private labs-    Clinics-    HospitalsAs long as we accept the responsi...
WHYThe patient must be provided with:--    Sufficient counseling-    Referral to treatment centre-    Helpline contact num...
WHOPLHIV-   Stable emotionally and medically-   Well trained with skills and knowledge-   Community-focused-   Understands...
KNOWLEDGE                               SKILLS• basics of HIV                                                    • buildin...
CHALLENGESIdentifying potential peersProviding trainingSelecting a location that is convenientEnsure privacy and confident...
HOSPITAL PEER SUPPORT                PROGRAMMEHPSP is currently being provided by many Partner Organisationsof the Malaysi...
WHY DOES IT WORK?Close collaboration between doctors, nurses, counselors andvolunteersAcceptance by the hospital authoriti...
P2P GROWTH & HEALING              PROGRAMMEKLASS pilot tested a different approach in Peer-to-PeerSupport in July & August...
P2P DISCUSSION TOPICSGroup grows and heals together by facilitated discussions on:-  Diagnosis  Changes experiences  Effec...
P2P CREATEDOpportunities for  Learning  Understanding  Sharing  Growth  Healing  Strengthening  Empowerment  LeadingThese ...
CONSIDERATIONSUnderstand your patients-    which communities do they represent-    what are their unique needsEnsure commu...
IF YOU DO IT WELLBenefits for HCPs  Spend less time on counseling  Focus more on management of OIs  Focus more on treatmen...
IF YOU DO IT WELLBenefits for PLHIV  Current timely information  Stronger long term support  More stable psychologically  ...
IF YOU DO IT WELLBenefits for counselor  Clients will appreciate the support  Some may volunteer to help others  Trained t...
TERIMA KASIH   XIE XIE RUMBE NANDRETHANK YOU KHAP KUN KHAP     KOP JAI SHUKRANJAZAKALLAH KHOIRAN KATHIRO   MARAMING SALAMA...
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Counselling for newly diagnosed HIV patients in Malaysia challenges & best practices by Andrew Tan

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Counselling for newly diagnosed HIV patients in Malaysia challenges & best practices by Andrew Tan

  1. 1. COUNSELING FOR NEWLY DIAGNOSED HIV PATIENTS IN MALAYSIA CHALLENGES AND BEST PRACTICES Presented by Andrew Tan International Seminar on Socio-Economic and Mental Health Burdens of HIV/AIDS in Developing Countries 21 – 22 November 2011myplus.org.my@gmail.com Palace of the Golden Horses Hotel, Kuala Lumpur, Malaysia
  2. 2. WHO ARE PLHIV?Brother Sister Husband Doctor Employer Son Lover Boyfriend ColleagueGirlfriend Partner Daughter Staff Nurse Wife Mother Father myplus.org.my@gmail.com
  3. 3. WE AREPeople who come from all walks of life- the mother sending her children to school- the hawker selling chicken at the pasar tani- the quiet computer programmer at your office- the smartly-dressed executive in the next car- the grandmother sitting beside you on the bus- the much loved teacher at school- the government department staffs serving you myplus.org.my@gmail.com
  4. 4. WE AREWe come from all sectors of society- from fishermen to grand fathers- from drug users to transgenders- from straight men to men who have sex with menWe come from different levels of education- from the illiterate to the PhD holderWe live in the small kampungs in remote rural areas and alsoin the largest cities in the countryWe are people who have a chance to live due to the freetreatment provided by the government myplus.org.my@gmail.com
  5. 5. WE AREPeople who work, pay taxes & contribute to the economy.WE ARE YOU! myplus.org.my@gmail.com
  6. 6. CHALLENGES OF PLHIVDiagnosisPost diagnosisFollow-upSelf-limitationPre HAARTStarting treatmentResponding to treatmentRebuilding self-imageThe future myplus.org.my@gmail.com
  7. 7. POST DIAGNOSISDENIAL / ANGER / LONELINESS / DEPRESSIONWhat it means to be HIV+Understanding the virusRealising that it’s not the endACCEPTANCE of the diagnosisDisclosure Do I tell my wife/partner? How do I tell?Questions, questions, questions When will I die? How long do I have? Why me? Who did I get it from? myplus.org.my@gmail.com
  8. 8. FOLLOW UPImportance of follow-up monitoringNutritionExerciseUnderstanding blood testsManaging financesReorganising workloadWhat is CD4? What is Viral Load? myplus.org.my@gmail.com
  9. 9. SELF LIMITATIONWhat can I do? What can’t I do?Should I quit my job?Can I still get promoted?Can I look for a new job?Need to reorganise workloadMind → Physical → EconomicManaging stressManaging OIs myplus.org.my@gmail.com
  10. 10. PRE HAARTPreparing to start treatmentFear of starting treatmentTreatment literacyTreatment comprehensionDiscussing with the DrAsking more questions More knowledge = More understanding = Less fear = Less stress myplus.org.my@gmail.com
  11. 11. STARTING TREATMENTUnderstanding AdherenceUnderstanding ComplianceWhat are the medicines doing in my body?Trusting the DrAsking more questions myplus.org.my@gmail.com
  12. 12. RESPONDING TO TREATMENTUnderstanding the side effects- Lipodystrophy- Lipoatrophy- Increased cholesterol level- Liver functions- Skin problems (eczema psoriasis)Managing the side effectsDetermination to continue medsFeedback and discussion with Dr myplus.org.my@gmail.com
  13. 13. REBUILDING SELF IMAGEMoving forwardI am alive!Seeing the medicines effect on CD4 and VLSelf-confidence myplus.org.my@gmail.com
  14. 14. THE FUTUREMarried and their spouse / Unmarried and their partnersDo I still have the right to be loved?Looking for a life partnerPositive Health, Dignity & PreventionDo I have to use a condom every time?How do I negotiate to use a condom?How do I reveal my statusWhen do I reveal my status When we first meet? Before? During? After?Will they still be interested? myplus.org.my@gmail.com
  15. 15. CONTINUUM OF CAREPREVENTION TESTING TREATMENT CARE AND SUPPORT myplus.org.my@gmail.com
  16. 16. THE ESSENTIAL COMPONENTAddressing individual / psychological barriers: - Community agencies: Address barriers such as self-stigma, lack of self-esteem, alcohol / drug use Through drop-in centres, peer counseling and self-help support groups - Government: Advocate for providing client-centered counseling (in every government treatment centre) and addressing individual/psychological level barriers faced by PLHIV including all marginalised groups (IDU / MSM / TG) myplus.org.my@gmail.com
  17. 17. COUNSELINGWhy do we need it? myplus.org.my@gmail.com
  18. 18. WHATProvide accurate informationClarify factsDispel mythsEncourage acceptanceSource of emotional strengthAssist in psychological stabilityEnsure moral supportReinforce adherence and compliance myplus.org.my@gmail.com
  19. 19. WHENCounseling must be provided soonest possible after the patientis informed of the HIV positive diagnosisCounseling must be provided BEFORE the patient leaves thetesting centreThe initial counseling session must be tailored to the needs ofthe individual myplus.org.my@gmail.com
  20. 20. WHEREHIV screening venue:-- VCT centres- ALL Private labs- Clinics- HospitalsAs long as we accept the responsibility to provide testingservices, we MUST be prepared to follow it up with counselingservices myplus.org.my@gmail.com
  21. 21. WHYThe patient must be provided with:-- Sufficient counseling- Referral to treatment centre- Helpline contact number- Information on available support servicesWe must ensure that patients are aware of:-- availability of treatment- NGO support groupsFailure to provide counseling IS NOT an option! myplus.org.my@gmail.com
  22. 22. WHOPLHIV- Stable emotionally and medically- Well trained with skills and knowledge- Community-focused- Understands their own limitations myplus.org.my@gmail.com
  23. 23. KNOWLEDGE SKILLS• basics of HIV • building trust• technical knowledge • empathy• up-to-date information • listening on treatment • clarity of thinking• psychological • moving at client’s issues pace IDEAL• human rights • communication issues TREATMENT • counseling• referral PROVIDER • sharing services information ATTITUDES • positive • focus on • sensitive empowerment • patient • emotionally strong • non-judgemental • confident • supportive • compassionate • respectful myplus.org.my@gmail.com Reference: Adapted from a workshop on access to HIV-related treatment, India HIV/AIDS Alliance and the International HIV/AIDS Alliance, India, February 2001.
  24. 24. CHALLENGESIdentifying potential peersProviding trainingSelecting a location that is convenientEnsure privacy and confidentialityPresenting a strong case to the key stakeholders to encourageacceptanceSecuring funding to ensure sustainability myplus.org.my@gmail.com
  25. 25. HOSPITAL PEER SUPPORT PROGRAMMEHPSP is currently being provided by many Partner Organisationsof the Malaysian AIDS Council. CAKNA, Terengganu CASP, Penang FHDA, Penang ILZ, Johor KASIH, Sabah KLASS, KL MTAAG, KL PT Foundation, KL myplus.org.my@gmail.com
  26. 26. WHY DOES IT WORK?Close collaboration between doctors, nurses, counselors andvolunteersAcceptance by the hospital authoritiesAvailability on clinic daysLinkages with NGOs with PLHIV Support GroupsReferrals to:-- shelters / homes- palliative care services myplus.org.my@gmail.com
  27. 27. P2P GROWTH & HEALING PROGRAMMEKLASS pilot tested a different approach in Peer-to-PeerSupport in July & August 2011.- Small group of 8 – 10 persons- Similar background- Created a facilitated 8 week journey which was experienced together- More manageable compared with a larger support group- Develop friendship- Flexible & Portable myplus.org.my@gmail.com
  28. 28. P2P DISCUSSION TOPICSGroup grows and heals together by facilitated discussions on:- Diagnosis Changes experiences Effects Impacts Disclosure Side effects Forgiveness Stress myplus.org.my@gmail.com
  29. 29. P2P CREATEDOpportunities for Learning Understanding Sharing Growth Healing Strengthening Empowerment LeadingThese are the people who can change the future. myplus.org.my@gmail.com
  30. 30. CONSIDERATIONSUnderstand your patients- which communities do they represent- what are their unique needsEnsure community-specific services are available- addressing needs of marginalised peoples- providing appropriate informationProviding the right information at the right time- awareness of the patient’s health status- just diagnosed? / OIs? / starting treatment? / managing side effects? myplus.org.my@gmail.com
  31. 31. IF YOU DO IT WELLBenefits for HCPs Spend less time on counseling Focus more on management of OIs Focus more on treatment Patients are more prepared to start HAART Lessens the amount of questions from patients Patients more well adjusted Shortens individual treatment time Increases turn around time in the clinic myplus.org.my@gmail.com
  32. 32. IF YOU DO IT WELLBenefits for PLHIV Current timely information Stronger long term support More stable psychologically Easier to be adherent & compliant Back to a sense of normalcy Back to life BACK TO LIVING (with HIV) myplus.org.my@gmail.com
  33. 33. IF YOU DO IT WELLBenefits for counselor Clients will appreciate the support Some may volunteer to help others Trained to run their own groups Formed into teams based on:- - Language - Background - Gender - Geography myplus.org.my@gmail.com
  34. 34. TERIMA KASIH XIE XIE RUMBE NANDRETHANK YOU KHAP KUN KHAP KOP JAI SHUKRANJAZAKALLAH KHOIRAN KATHIRO MARAMING SALAMAT POKYAE ZUU TIN BA DE ORKHUN KHOP CHAY LAY LAY VINAKA VAKA LEVU myplus.org.my@gmail.com

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