Counselling and HIV/AIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) is preparing materials on subjects of relevance to HIV infection and AIDS, the causes and consequences of the epidemic, and best practices in AIDS prevention, care and support. A Best Practice Collection on any one subject typically includes a short publication for journalists and community leaders (Point of View); a technical summary of the issues, challenges and solutions (Technical Update); case studies from around the world (Best Practice Case Studies); a set of presentation graphics; and a listing of key materials (reports, articles, books, audiovisuals, etc.) on the subject. These documents are updated as necessary. Various studies have proved that good counselling has: assisted people to make informed decisions—such as whether to have an HIV test; helped many other people living with HIV or AIDS to cope better with their condition and lead more positive lives; and helped prevent HIV transmission. However, many decision-makers and service managers—such as policy-makers in government ministries, directors of hospitals or heads of nongovernmental organizations (NGOs)—are doubtful about the effectiveness of counselling. Their scepticism is a major obstacle to the development and provision of good counselling services. The resulting inadequacies include: • lack of policy approval for establishing counselling services; • insufficient space or resources provided for counsellors; • unreasonable demands on the time of counsellors; • difficult access to the service for clients; • intimidating or inappropriate atmosphere within counselling clinics; • a lack of privacy and confidentiality; • no follow-up support for those infected with HIV and their families, spouses and partners. Disseminating the results of studies on the beneficial impact of counselling can help overcome the scepticism and strengthen the support given to counselling. For an effective counselling service, a number of things are needed, including: • careful selection of trainees who will be able to provide counselling services; • training that includes supervised placement after initial training, and follow-up training after a period of work experience; • retention of trained counsellors, by providing them with sufficient space and reasonable working hours; sufficient administrative support, professional support and support from their colleagues; • the creation of appropriate settings for counselling, avoiding an environment which prevents clients from freely expressing personal concerns; confidentiality for clients; and ensuring that informed consent is always given and counselling offered before an HIV test; • referral systems that link counselling services with medical clinics and with a range of …