HIV Testing and Counselling Presentation

1. HIV
Counselling
&Testing

2. Global summary of the AIDS epidemic 2018
Number of people Total 37.9 million [32.7 million–44.0 million]
living with HIV Adults 36.2 million [31.3 million–42.0 million]
Children (< 15 years) 1.7 million [1.3 million–2.2 million]
-----------------------------------------------------------------------------------------------------
People newly infected Total 1.8 million [1.4 million–2.4 million]
with HIV in 2017 Adults 1.7 million [1.4 million–1.9 million]
Children (< 15 years) 160000 [100000–220000]
_________________________________________________________________________________________________
AIDS death in 2017 Total 940000 [670000 –1.3 million]
Adults 890000 [740000–1.1 million]
New HIV infections have reduced by 47% since the peak in 1996.
• In 2017, around 1.8 million [1.4 million–2.4 million] were newly infected with
HIV compared to 3.4 million [2.6 million–4.4 million] in 1996.
• Yet, there are 5000 new infections per day (2017)

3. HIV / AIDS in INDIA

4. How much do you remember????
⬗ HIV / AIDS – Acronym
⬗ Difference between HIV & AIDS
⬗ First evidence of HIV in India when? And where?
⬗ Who discovered India's first HIV cases ?
⬗ What is Red Ribbon Club?
⬗ CD4 for ART initiation

5. What is HIV/AIDS?
HIV (Human immunodeficiency virus)
AIDS (Acquired immune deficiency syndrome)
• HIV attacks the immune system's protective CD4 cells. When the
immune system loses too many CD4 cells, a person is less able to
fight off infection and can develop serious opportunistic infections
(OIs)
• A person is diagnosed with AIDS when there are less than 200 CD4
cells and/or has one of 21 AIDS-defining OIs

6. First Evidence of HIV
Infection in India
1986
Dr. Suniti Solomon & Dr. Sellappan Nirmala

7. People Living with HIV
New Cases
HIV Estimations India 2017

8. Risk Groups
General Population
HIV is no longer confined
to high risk groups but
now affects the general
population

9. Modes of HIV Transmission

10. Burden in India
“HIV free Country”

11. Unsafe Sex and Low Condom Use Men Who Have Sex with Men (MSM)
Injecting Drug Use (IDU) Migration and Mobility
Low Status of Women
Widespread Stigma

12. ABC Method
Avoid pre-marital sex
Be mutually faithful to each other
Condom – if “variety is the spice of your life”

13. HIV Counselling

14. Counselling
⬗ “Confidential dialogue between a person
and a care provider aimed at enabling the
person to cope with stress and make
personal decisions related to HIV/AIDS.”
⬗ “The counselling process includes an
evaluation of personal risk of HIV
transmission and facilitation of preventive
behaviour.”

15. Who requires
counselling
 Pre/post test clients
 Persons already identified as being HIV positive.
 Those seeking help because of current/ previous risk behaviour.
 Those not seeking help but who practice risk behaviour
 The families/ close friends of those who are HIV positives

16. HIV Counselling is……
 Passing on accurate information
 Provide Support at times of crisis
 Encouraging change when is needed for the prevention or
control of infection
 Helping clients identify for themselves their immediate and ling
term needs.
 Assisting clients to accept and act on information non health
and well being.
 Helping clients to be well informed and appreciate the
technical, social, ethical and legal implication of HIV testing.

17. Key Elements of
Counselling
 Effective Communication
 Confidentiality, Short- simple – need based, Non – judgemental , Non-
verbal communication, Open ended questions.
 Supportive Communication
 Time, Privacy, patient

18. Types of Counselling
⬗ Voluntary Counselling and Testing (VCT)
● Pre-test counselling
● Post test counselling
⬗ Individual, Couple and Family Counselling
⬗ Marital Counselling
⬗ Support Counselling
⬗ Adherence Counselling
⬗ Fertility and Antenatal Counselling
⬗ Terminal Counselling
⬗ Grief Counselling

19. Pre-test &
Post Test
Counselling

20. The HIV Test
⬗ If the client decides to test
⬗ Inform client about the procedure for
test
⬗ Length of time for results – immediate/
delayed
⬗ Amount of and manner in which blood
will be taken
⬗ Remember to show client blood tube/
slide collection form & labels which
have their code

21. Pre-test Counselling: Goals
⬗ Reaffirm need for testing and prepare the person for the result.
⬗ Positive Result
⬗ Negative Result
⬗ Indeterminate result
⬗ Identify support systems for the person
⬗ Clarify the test and how results are interpreted
⬗ Obtain informed consent
⬗ Reassure confidentiality

22. Post- test Counselling:
Goals
⬗ Deliver results in a supportive environment
⬗ Provide psychological support for immediate emotions
⬗ Prevent the spread of HIV
⬗ Facilitate follow-up for treatment and care

23. Post test for HIV Negative
Results
⬗ Announce the HIV test results
⬗ Interpret result and explain its
meaning in a simple manner
⬗ Ask about the last episode of
risky behaviour
⬗ Remind the participant about
window period
⬗ Check if the participant
understands all the information
⬗ Negotiate risk reduction plan
⬗ Use, reduce number of partners,
cleaning needles and injection,
equipment, review strategies of
behavioural risk reduction
⬗ Safe sexual behaviour – give him
options.

24. Post test for HIV Positive
Results
⬗ Announce HIV test result
⬗ Interpret result and explain its
meaning in a simple manner
⬗ Explaining the difference
between HIV positive and
AIDS.
⬗ Check if the participants
understand all the information.
⬗ Discuses what the result means
for the participant
⬗ Discuses the impact of the
results on the participants life
⬗ Discuses whether the participants will
disclose the result to parents or friends
⬗ Encourage participants to disclose to
sexual partners.
⬗ Develop strategies of maintain health
and reducing risk of transmission
⬗ Reduce and / or safety drug use.
⬗ Safe sexual behaviour
⬗ Encourage responsible behaviour

25. Key consideration for post HIV
test counselling
⬗ Cross check all results with client file and blood samples
⬗ Provide results only “face-to-face” with client
⬗ Be conscious of the manner in which you invite clients from the waiting area

26. Reactions to diagnosis
⬗ Shock
⬗ Anger
⬗ Denial and disbelief
⬗ Gilt or shame
⬗ Blaming

27. Managing Emotional
Responses
⬗ Crying: Let the client cry, this allows them to vent their feelings
⬗ Anger: Stay calm, let the client express their feelings, acknowledge
that these feelings are normal
⬗ No response: Due to shock, denial or helplessness
⬗ For all response encourage the client to talk about their feelings.
Encourage the client to ask questions. Remind the client of support
persons available as discussed during the pre-test counselling session

28. Possible Crisis Points
PLHA and Family
⬗ First hospitalization, first OI or new symptoms
⬗ Recurrences or relapses
⬗ Terminal stage of illness

29. Adherence Counselling
⬗ Important of ART drugs and other medicines
⬗ Why ART drugs has to be taken regularly
⬗ How ART drugs work on them
⬗ Stress the importance of regular follow-ups
⬗ In case of side effects to contact physician at once

30. Issues in Counselling
⬗ To understand the need for different types of HIV counselling
⬗ To identify avenues for accessing other types of HIV counselling
⬗ To dispel personal myths and misconceptions associated with HIV and sexuality.

31. Antiretroviral-based prevention
31
Post-exposure prophylaxis (PEP)
Pre-exposure prophylaxis (PrEP)

32. Antiretroviral-based prevention
• Post-exposure
prophylaxis (PEP)
• Pre-exposure
prophylaxis (PrEP)

33. Post-Exposure Prophylaxis (PEP)
•Emergency 28-day course of antiretroviral drugs
(ARVs) that should be started immediately after
possible exposure—no later than 72 hours
•In use for “occupational” exposure (oPEP) since
1988.
•CDC guidance for “non-occupational” exposure
(nPEP) didn’t come out until 2005.
•New nPEP guidelines were released in April 2016
•PEP is vastly underused

34. Pre- Exposure Prophylaxis
⬗ The ongoing use of one or two antiretroviral by HIV-negative
individuals starting before an exposure and continuing
afterwards
⬗ A potential option to prevent infection from ongoing exposures
to HIV during periods of risk

35. THANK
YOU