Stefan and Boban tested positive for HIV antibodies during post-test counseling. When the counselor informed them of the results, Stefan took Boban's hand in an affectionate gesture, but Boban pulled away, seemingly uncomfortable. The counselor realized they needed privacy and briefly left the room. Upon returning, she saw Stefan holding Boban's hand with both of his, looking at him affectionately. Boban still seemed uncomfortable. The counselor proceeded to gently explain the next steps to the newly diagnosed couple.

1. "CASE STUDY“ - MINI MODEL
FOR VCT SUPERVISION
“STUDIJA SLUČAJA“ – MINI MODEL ZA DPST SUPERVIZIJU
Mr sci med prim dr MILA PAUNIĆ
Center for HIV and STIs Prevention
Institute for Students Health of Belgrade University
SERBIA

2. Supervision = caring for counsellors
Supervizija = briga za savetnike
It is difficult to follow our own behaviour, notice
our own mistakes and prevent ourselves from
burnout
Teško je pratiti sopstveni rad/ponašanje, uvideti
sopstvene greške i prevenirati sopstveno izgaranje

3. Supervision = SELF CARE
Supervizija = briga za sebe
EXCHANGE of ideas and experiences with “own
equals” – a precious treasure = inducing potential
for personal changes, learning and building upon
Razmena ideja i iskustva sa “jednakima”=neprocenjivo blago
– indukuje promene, učenje i izgradnju
The most important instrument in learning is
constructive BENEVOLENT “criticism” of colleagues
Najvažniji instrument učenja je konstruktivna
DOBROMAMERNA “kritika” kolega

4. Supervisor’s advice – inducing our own
possibilities for personal change
indukovanje mogućnosti za sopstvene promene
Learning and correction through work
Učenje i korigovanje kroz rad
Careful listening to others’ experiences
Pažljivo osluškivanje iskustva drugih
Observing other colleagues’ work
Posmatranje rada drugih kolega

5. Prikaz „studije slučaja“ Case study
Savetnica Mila Paunić Counsellor Mila Paunić
U ovom materijalu se nalaze This material contains
poverljive informacije i tekst se confidential information and
može koristiti samo u svrhu this text can only be used for
supervizije the purpose of supervision

6. 17. marta ….. u Centru smo radile On the 17th of March .... Mara
Mara i ja. and I worked in the Centre.
Somehow, there were lots of
Nekako se desilo da je od ranog jutra
clients since the early morning so
bilo dosta klijenata; pa smo obe
both of us did counselling at the
radile savetovanja istovremeno
same time (usually, if there were
(obično, ako nema veće gužve jedna
no much crowd one counsellor
sedi u prijemnoj sobi a druga radi u
would sit in the reception room
sobi za savetovanje).
and the other in the counselling
room).
Upravo sam ispraćala klijenta i nisam I was just seeing off my client
ni videla kada je Mara obavila trijažu and I did not see when Mara did
dva klijenta koja su sedela u greeted the two clients who were
prijemnoj sobi zajedno, tako što je sitting in the reception room
jednog (Stefana) uputila kod mene, a together and referred one of
drugog (Bobana) u drugu sobu, tamo them (Stefan) to me, and the
gde je Mara radila. other one (Boban) in another
room where Mara worked

7. Stefan je visok i markantan mladić, Stefan is a tall and striking young
ima naglašene obrve i »neurednu« man; he has prominent eyebrows
kratku bradicu. Svojom iskrenošću i and short »messy« beard. By his
neusiljenom konverzacijom brzo sincerity and ease in conversation he
„osvaja“ simpatije kod svojih quickly wins inclination of the people
sagovornika. Držao je u rukama he talks with. He held in his hands
dnevne novine „Blic“ i vrlo daily newspaper „Blic“ and very
simpatično, bez mnogo wittily, without much „emotional
„emocionalnog uplitanja“, duhovito involvement“, commented the front
komentarisao naslovnu stranu. page.
Stefan ima 27 godina, završio je pre Stefan is 27, several months ago he
nekoliko meseci arhitekturu, radi u finished his studies at the Faculty of
jednoj poznatoj firmi, u svojoj architecture, he works in a well
struci; iako je veoma mlad ima known company. Although he is very
mogućnosti da iskaže svoju young he has possibilities to express
kreativnost, kolege ga uvažavaju i his creativity, his colleagues respect
cene, sam je sebi „natovario tempo him, he “imposed the work pace
rada „od ujutru do uveče“, ali uziva from morning till late evening” on
u poslu, ima odlična primanja i himself but he enjoys his work, has
izuzetno je zadovoljan. excellent salary and he is very
satisfied.

8. Na savetovanje i testiranje je He came to the counselling and
došao nakon dugih razgovora sa testing after long conversations
svojim partnerom, koji je insistirao with his male partner who
da dodju i urade test obojica. insisted that they both should
Stefan smatra da nije imao „tako come and do the test.
puno“ rizika a to je objasnio: „ Stefan believes that he did not have
imao sam samo nekoliko partnera „so many“ risks, and he explained
– 4 odnosno pet. Ja se u this by saying: „I had only a few
potpunosti vezujem za svoje partners – 4 or actually 5. I get
partnere, kad nekoga volim onda completely attached to my
sam s njim dugo i tesko se partners, when I love somebody I
rastajem. Zato i mislim da nemam am with him for a long time and
razloga mnogo da brinem, Vi znate it is difficult for me to break up.
i sami da za gej populaciju važi da That is why I think I shouldn`t
promeni puno partnera, cak i za worry too much. You yourself
jedno vece a kamoli za 6 ili 7 know that it is common for gay
godina.“ population to change lots of
partners, even for one evening
and let alone for 6 or 7 years.“

9.  When I asked him about the type
Kada sam pitala o vrsti odnosa
of intercourse he had with his
koje je imao sa svojim partnerima
partner and whether they used
i da li su bili sa ili bez kondoma,
condom or not, he replied
neodredjeno je odgovorio – Pa,
vaguely – Well, mostly anal, but
uglavnom analne, ali i oralne, a
also oral, and the condom
kondom - I tako – i tako. Više ih je
sometimes yes, sometimes no.
bilo sa kondomom. Zatim je
More frequently we used the
insistirao na tome da nije imao
condom. Then he insisted that he
samo analne odnose sa
did not have only anal
muškarcima, da je imao i jednu
intercourses with men, that he
devojku pre 5 godina, sa kojom je
had a girlfriend 5 years ago, with
bio dosta dugo; ali su imali samo
whom he was for a rather long
dva odnosa i nisu koristili kondom,
time, but they had only 2
(zapravo ona nije želela da koriste
intercourses and they did not use
kondom).
a condom. (she did not want to
use a condom).

10.  When I asked him about the type
Kada sam pitala o vrsti odnosa
of intercourse he had with his
koje je imao sa svojim partnerima
partner and whether they used
i da li su bili sa ili bez kondoma,
condom or not, he replied
neodredjeno je odgovorio – Pa,
vaguely – Well, mostly anal, but
uglavnom analne, ali i oralne, a
also oral, and the condom
kondom - I tako – i tako. Više ih je
sometimes yes, sometimes no.
bilo sa kondomom. Zatim je
More frequently we used the
insistirao na tome da nije imao
condom. Then he insisted that he
samo analne odnose sa
did not have only anal
muškarcima, da je imao i jednu
intercourses with men, that he
devojku pre 5 godina, sa kojom je
had a girlfriend 5 years ago, with
bio dosta dugo; ali su imali samo
whom he was for a rather long
dva odnosa i nisu koristili kondom,
time, but they had only 2
(zapravo ona nije želela da koriste
intercourses and they did not use
kondom).
a condom. (she did not want to
use a condom).

11. Stefan je ubedjen da je sve to Stefan believes that it was all
samo premor – i Boban jako because Boban is too tired –
mnogo radi, ali „pristao“ je da Boban also works a lot. However,
obojica urade i test na HIV jer su i he “agreed” that they both do the
o tome dosta pričali, a Bobanu je HIV test because they talked a lot
ta kuma ionako „napunila glavu“ about it too, and Boban`s friend
da treba i to da uradi. “preached” a lot they Boban
should do this test as well.
Pitala sam o drugim rizicima; I asked about other risks; he
negirao je bilo koji drugi rizik, ali negated any other risk, but he
je uporno na neki način persistently minimised risks with
minimizirao rizike sa svojim his partners because those were
partnerima jer su to bile „duge i „long and safe relationships“.
sigurne veze“.
Stefan and Boban finished the
Stefan i Boban su skoro counselling sessions almost at the
istovremeno završili savetovanja i same time and went together to
zajedno otišli u laboratoriju. the lab.

12. Rezultati HIV testova su HIV test results were
bili gotovi istog dana ready on the same day
popodne i kod obojice in the afternoon and
su bili pozitivni. they were positive for
both of them.

13. Since the work process in our Centre
Kako se proces rada u našem Centru
changed and since there are
promenio i kako je trenutno mnogo
considerably less counsellors that the
manje savetnika od „objektivnih
objective needs, Mara`s working
potreba“, Mari je bilo završeno radno
time finished at 15h (although she
vreme u 15h (mada je Mara ostala
stayed almost until 16h hoping that
skoro do 16h u nadi da će njen klijent
her client would come); and I worked
doći); a ja sam radila do 17h.
until 17h.
Boban and Stefan came to the post-test
Boban i Stefan su na post test counselling together at 16.20h.
savetovanje došli zajedno u 16,20h.
I asked them to sit down and a told
them that I would issue the results
Zamolila sam ih da sednu, a da ću separately in the counselling room.
rezultate da im dam pojedinačno u They both remained standing and
sobi za savetovanje. Obojica su ostala asked me to do the post test
da stoje i zamolila me da zajedno udju counselling together, because Boban
na post test savetovanje, jer, Boban je said „I am scared that one of use
izgovorio, „plašim se da je jedan od might be positive, and we will tell
nas dvojice pozitivan, a mi ćemo to this to each other for sure“. Stefan
sigurno jedan drugom reći“. Stefan je repeated the same and asked me to
ponovio isto i zamolio da zajedno čuju hear the results together.
rezultate.

14. Kada je izgovorio „Molim vas  When he said „Please don`t
nemojte nas razdvajati, želimo da separate us, we want to be
budemo zajedno; nisam više together, I did not hesitate any
oklevala, uzela sam sve papire longer, I took all the papers (the
(razultate) (bila su uradjena po 3 results) (3 test of different
testa različitih proizvodjaca za producers were done for each
obojicu) i svo troje smo konačno blood sample) and the three of
seli. Jednostavnim rečima sam us finally sat down. In simple
rekla da su i kod jednog i kod words I told them that in both of
drugog nadjena antitela na HIV, their blood samples antibodies for
što znači da su, najverovatnije, HIV were found, which meant
HIV pozitivni. that, most probably they are HIV
positive.

15.  Stefan took Boban`s hand and Boban
Stefan je uhvatio Bobana za ruku,
suddenly moved away. I was
a Boban je naglo pomerio,
convinced that he was uncomfortable
izmakao. Bila sam ubedjena da mu
because of me, that they did not
je neprijatno zbog mene i da nije
want them to hold hands before me.
zapravo želeo da se drže za ruke
We slowly explained the meaning of
predamnom. Polako smo razjasnili
the results and the following steps.
značenje rezultata, sledeće
Once again Stefan took Boban`s
korake; još jednom je Stefan
hand and he moved it away again
uhvatio Bobana za ruku, a on je
after a few seconds. I realised that it
posle par sekundi opet izmakao.
would be good if I went out at least
Shvatila sam da je dobro da makar
for a few minutes and give them time
na kratko izadjem i da im dam
for some tenderness, because in
vremena za neku nežnost, jer je u
these moments they need to be alone
ovakvim trenucima potrebno da
for a short time. I said that I was
ostanu malo sami. Rekla sam da
going to the toilet. After a few
idem do toaleta. Posle par minuta
minutes I entered the room again.
sam ponovo ušla, Stefan je držao
Stefan held Boban`s hand with both
Bobanovu ruku sa obe ruke i
of his and looked at him. Boban
gledao u njega. Boban je gledao u
stared at the wall in front of him.
zid ispred sebe.

16.  We talked for a long time. They were
Dugo smo pričali. Obojica su bila
both involved, I would say equally.
uključena, rekla bih podjednako.
We talked mostly about the tests,
Pričali smo o uglavnom o samim
about the following steps, therapy,
testovima, o predstojećim
what to do next and how to behave
koracima, terapiji, šta dalje, kako
at work… What would further
na poslu, .... Kako će teći
diagnostics looks like. To whom they
dijagnostika dalje. Kome i da li
should tell, and whether they should
ikome reći.... Zakazali smo pregled
tell anybody. We scheduled a check
na Infektivnoj klinici. Dogovorili
up at the Clinic for Infectious
smo se da ostanemo na vezi, da
diseases. We agreed to stay in touch
se odmah sutradan cujemo; dala
and to speak on the phone the
sam im telefon Centra i moj i
following day. I gave them the phone
Marin raspored rada; oni su mi
number of the Centre and the
dali brojeve svojih mobilnih
working times of Mara and me. They
telefona.
gave me their mobile phone
numbers.

17. I had an impression that, in general,
Imala sam utisak da je generalno,
everything went quite right, that the
sve prošlo dosta dobro, da su
patients were completely reasonable,
pacijenti potpuno razumni, zreli,
mature, responsible. However, I also
odgovorni. Medjutim, imala sam i
felt some apprehension that there
neku «zebnju»; nesto što ipak tu
was something that is not totally OK
nije sasvim «ok» a nisam znala šta
and I did not know what it was.
je «to».
The following day Stefan called me and
Sutradan me je Stefan zvao i
said that they went to dr Jevtović and
rekao da su bili kod dr Jevtovića i
gave blood samples for analyses for
da su dali krv na Western Blot.
Western Blot. Further diagnostics
Dalju dijagnostiku će morati da
would have to be done in VMA
urade na VMA (PCR i CD4) jer
hospital (PCR and CD4) because the
Infektivna klinika nema trenutno
Clinic for Infectious diseases did not
reagenasa za ove nalize. To malo
have reagents for these analyses. It
komplikuje jer moraju da idu u
made things a bit complicated
svoj dom zdravlja po upute za
because they had to go to their
VMA.
primary health care centre to get the
referral for VMA.

18. Ponovo smo se čuli u sredu oko We spoke again on the phone around noon
podneva (opet je Stefan zvao) da on Wednesday (Stefan called again) to
se požali da ništa nisu uradili na complain that they did not do anything
VMA jer oni rade samo rano in VMA because they do these analysis
ujutru sredom te analize, a oni su only on Wednesday morning at 7h and
bili oko 11h. Tek mogu da ih they arrived there only at 11h. They
urade sledece srede. Rezultat WB could do the test next Wednesday. The
jos nije gotov, trebalo bi da bude result of the WB was not ready yet, it
u cetvrtak. should be ready on Thursday.
Posle par sati (oko 14,30h) me je After a few hours (around 14.30h) Stefan
ponovo nazvao Stefan i rekao da again called me and told me that they
su sreli dr Jevtovića i da im je met dr Jevtović and that he told them
rekao da je WB stigao i da je (literally in the street) that the WB
pozitivan. Pitala sam Stefana da li arrived and that it was positive. I asked
žele da dodju u Centar, da ćemo Stefan whether they wanted to come to
ih Mara i ja čekati; da slobodno the Centre, and told them that Mara
dodju ako imaju potrebu da and I would wait for them. I said that
pričaju s nekim. Stefan je rekao they should not hesitate to come if they
da su se upravo on i Boban feel the need to talk to someone. Stefan
razdvojili i da je svako krenuo said that he and Boban just parted and
svojoj kući. they were both going to their homes.

19. Opet sam mu rekla kada smo Mara i I again told him when Mara and I would
ja u Centru i da imamo za dva dana be in the Centre and that in two days –
- u petak uvece- noćno testiranje i on Friday evening - we would have night
savetovanje i da slobodno i u to testing and counselling and that they
vreme mogu obojica da dodju. could both come then.

20. Stefan se nije javljao dva dana. Stefan did not call for two days.
U petak uveče, oko 22,30h je On Friday evening around 22.30h he came
došao sam. Delovao je umorno. alone. He looked tired. I asked whether
Pitala sam da li će i Boban doći, a Boban would come too, and he covered
on je pokrio lice rukama i počeo his face with his hands and started to
da plače. Rekao je da Boban ne cry. He said that Boban did not know
zna da je on kod mene. Počeo je that he came to see me. He started
da priča kroz suze – Boban se od talking through tears – “Boban has
onog dana promenio. U stvari changed since that day. Actually, maybe
možda i ne samo od onog dana... not just since that day... He has friends,
On ima prijatelje, kumove, parents... He told everybody that he
roditelje... Svima je rekao da je was HIV positive; his friend (girl
HIV pozitivan; kuma mu je rekla working in the lab) told him that he got
da je to sigurno od mene dobio... it from me for sure... He did not start
On me još ne optužuje, ali accusing me yet, but the people around
njegova okolina je protiv mene. him are against me. I feel terrible. I did
Ja se osećam užasno. Nikome not tell anything to anyone, it`s hard,
nisam rekao ništa, teško mi je, a and Boban does not want us to see
Boban ne želi da se vidjamo, želi each other, he wants to somehow to
da se sredi nekako i da se put his thoughts together.
«presabere».

21. Ne znam; možda je sve baš I don`t know; maybe everything is
tako... možda sam ga ja i zarazio. true...maybe I infected him. I had a
Imao sam letos krajem avgusta i kind of flu in the end of August,
ja nešto kao grip, možda tada... A maybe then... And Boban and I had a
imali smo i Boban i ja jedan break-up that lasted for about a
prekid... od oko mesec dana – u month – in November. I had a few
novembru. Tada sam imao neke intercourses then, but he did as well!
susrete i par odnosa, ali imao je i
on!
I cannot be sure that he maybe got
Ne mogu da budem siguran da je
infected then and then infected me.
možda tada on dobio HIV pa
Who can tell, anyway?
mene zarazio. Ko to može uopšte
da zna?
Zatim smo pričali o potrebi da, na Then we talked about the need for two
dalje, imaju odnose sa kondomom of them to have protected sex from
(i objašnjenja koja slede...) that time on (and accompanying
explanation...)

22. Zvoni telefon... Stefan: «Izvinite The telephone rang... Stefan: «I
moram da se javim». apologise, I need to answer».
Čujem razgovor (bez obzira što I heard the conversation (although I was
me ne zanima, Stefan je u not interested, but Stefan was in the
ordinaciji i prosto htela ne htela room and I could hear him regardless
čujem šta govori): «...Ma ne, of my will): «...No, I have just went
malo sam samo izašao da se out to walk around the
prošetam po kraju, uskoro neighbourhood, I’ll be home soon...
dolazim kući... Svrati. Ma nije Drop by. It is not too late, just come.
kasno, slobodno svrati. Čekam I`ll be waiting for you.»
te.»
I was sure that it was Boban, so I asked:
Bila sam sigurna da je Boban, pa «Was that Boban»?
sam i pitala: «je l to Boban»?
Stefan: «No, a friend.»
Stefan: «Ma nije; neki prijatelj.»

23. Boban ne zna da sam ja ovde kod Boban doesn`t even know that I am
vas. Dogovorili smo se da ćemo here. We agreed that we will come to
sledeće nedelje doći kod vas see you together next week. Don`t
zajedno. Nemojte da mu kažete tell him that I was here today.
da sam ja bio ovde danas.
Then he continued in crying voice: “What
Zatim nastavlja opet plačnim can I tell you, I am really desperate, I
glasom – I šta da vam kažem - ja feel I’m having guilty conscience. I
sam stvarno očajan, osećam grižu can`t tell anyone – neither my mother
savesti. Ne mogu da kažem or my father, I thought maybe to tell
nikome – ni majci ni ocu, mislio my sister, but she’s still so young, she
sam možda sestri, ali ona je još is in high school – second grade (16
klinka, ona je u srednjoj školi - years old). She is the only one who
drugi razred gimnazije. U mojoj knows that I am gay.
okolini jedino ona zna da sam gej.

24. Više i ne živim s njima, živim sa I don`t live with them, I live with a
jednim cimerom koji zna da sam roommate who knows that I`m gay,
gej ali mi nismo u «šemi». Eto, but we are not in a relationship. Here,
(opet počinje da plače) Plašim se (he again started to cry), I`m afraid
da će me Boban ostaviti. On ima that Boban will leave me. He has
prijatelje koji ga «huškaju» protiv friends who turn him against me, and
mene, a on nije dovoljno jak da he is not strong enough to make
sam odlučuje... Brine me što me decisions himself... I’m worried
Boban totalno izbegava ovih because Boban is totally avoiding me
dana... these days...”
Opet zvoni telefon. Stefan: His phone rang again. Stefan: «I
«Izvinite moram opet da se apologise, but I need to answer
javim». again».
Sličan razgovor malopreĎašnjem The conversation resembled the first one
– i neverovatna transformacija – and incredible transformation
(Stefan veselim glasom ugovara (Stefan in joyful voice arranges to
da se vidi sa još jednim meet another friend after midnight).
prijateljem iza ponoći).

25. Ja sam potpuno zbunjena. Stefan I am totally confused. Stefan goes from
iz jednog raspoloženja upada u one mood straight into another.... I
drugo... Vidim da se trudi da could see he was trying to act that he
dobro odglumi veselo was in very good mood…. He
raspoloženje... Posebno drugi put succeeded especially that second
mu to polazi za rukom . time.
Sve mi deluje kao proba za neki, Everything seemed to me as a rehearsal
ne preterano dobar film. for a not very good movie.
Oko 23,15 Stefan odlazi. Around 23h Stefan left.
Ja sam ostala sa gomilom I stayed with a bunch of dilemmas.
nedoumica.

26. Drago mi je da je Stefan ostao sa I am glad that Stefan has stayed in
mnom u kontaktu i što možemo contact with me and that we can talk
da pričamo otvoreno o svemu. S openly about everything. On the other
druge strane šta je to «da side what does it mean “to talk openly
pričamo otvoreno o svemu»? i about everything»? and how sincere
koliko je iskrena ta komunikacija. that communication is.
Poštovala sam želju klijenata da I respected the wish of the clients to
saznaju rezultate zajedno, hear the results together, I estimated
procenila da su podrška jedan that they are support for each other, I
drugom, bila sasvim sigurna da su was completely sure that hey were
veoma iskreni - i jedan prema sincere – both towards each other and
drugom i prema meni, takodje. Ali to me, too. But now I have a
sada sam u nedoumici, da li sam dilemma, was I deceived? And by
obmanuta? I od koga? Ko je ovde whom? Who is sincere here, and who
iskren, a ko ne? Stefan? Boban? is not? Stefan? Boban?

27. Bobana u stvari niko od nas (iz None of us in the Centre either saw of
Centra) nije ni čuo ni video od heard from Boban since the day he
dana kada je dobio rezultat. received the result.
Žao mi je što se Boban nijednom I am sorry that Boban hasn’t called not
nije javio (ni Mari ni meni). even once (Mara or me).
Žao mi je što je prema Stefanu I am sorry that he treats Stefan in this
takav. way.
Ali, istovremeno, umesto da se However, at the same time, instead
učvrsi, moja empatija prema
being reinforced, my empathy for
Stefanu je počela da bledi.
Stefan started to pale.
Ne shatam u potpunosti – zašto?
I don’t completely understand why.