Chapter 4

ROLE AND FUNCTIONS OF INTEGRATED COUNSELLING AND TESTING

CENTRES

This chapter deals with the role and functions of the ICTCs in the controlling and
awareness of HIV/AIDS. The National AIDS Control Organization (NACO)’s Guideline
has a pivotal role in the procedures of ICTCs. The NACO has prescribed guidelines on
informed consent, confidentiality and testing. It states: “HIV testing is more than a
biological test, for it involves ethical, human, and legal dimensions.” However, in
practice NACO does not have the structure to ensure such guidelines. There is a need for
proper monitoring and providing legal framework to address the breakdown of laws and
codes. Until and unless such mechanisms are created through which one can put checks
on inappropriate behaviour of Non-Governmental Organizations and health
professionals, putting this philosophy to practice would remain a difficult proposition.
The confidentiality in the case of HIV/AIDS is crucial for the HIV patients have to face
the intensity of stigmatisation of the society (Sharma, 2010).

In India Counselling and testing services were started in 1997. The challenge before us is
to make the entire society aware of the risks of the HIV/AIDS, which is possible only
through micro-level interventions that take the citizens into confidence. Only through
such local initiatives where greater public participation is ensured, that the medical
fraternity can gain public trust and institutional credibility. That’s why counselling and
testing services turns to be of extreme importance in the prevention and control of
HIV/AIDS.

The ICTCS provide free counselling and testing to all citizens. The main functions of
ICTC as per the NACO guidelines are (A) Early detection of HIV, (B) Information
transmission and provocation HIV /AIDS for promoting behavioural change and
reducing vulnerability, (C) Its links people with the other HIV preventing care and
treatment services available at various places. ICTCs are for all people with facilities that
serve specific categories such as pregnant women and young people. ICTCs are located
in the medical college or district hospital or a maternity home where obstetrics and
gynaecology department situated. Such centres provide prophylaxis to prevent

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transmission of HIV/AIDS from pregnant women to their infants. There are more
chances for HIV infection to the people more engage with sex works like MSN
transgender IDU truckers migrant labourers, workers and spouses and children prone to
risky behaviour. ICTCs need more to focus on these sub-populations than general
population. The ICTCs must be located in all government departments and organization
as well as private sectors. An ICTC should have coordination with other department of
medicine and institution link with health of people. All people should have easy access to
check himself or herself such a test so that they can come to know whether they are
infected with HIV/AIDS or not.

There are Two types of ICTCs; a) Fixed facility for urban and semi urban area, b) Mobile
facility which for rural area with team member include medical officer, counsellor and
lab technician. The HIV/AIDS counselling and education should be a confidential
correspondence between a client and counsellor. Its provide information as well as share
information about risk of HIV/AIDS so that behaviour changes can be brought in the
client.

There are three stages in the HIV/AIDS counselling: (a) HIV pre-test counselling and
information stages its provide basic information on HIV and other risk assessment, (b)
second stage HIV post test counselling where client is helped to understand regarding
HIV test outcomes, (c) follow–up counselling where reemphasis on adoption of safe
behaviours to prevent transmission of HIV infection to others with nutrition, home based
care and all legal support provided by ICTC team (NACO, 2007).

The NACO/SACS always recommends the multiple use of rapid HIV test at ICTC. They
provide test’s result of client within 30minutes. The rapid test kits detect less than 99.5
per cent of HIV/AIDS infected individuals and give some negative result in less than 2
per cent of who tested at ICTC. If a client who has a negative result knows within in one
test to be HIV– Negative. If Client test result comes with positive then they re
examination test required up to three times after that its declare as HIV positive result.
HIV antibodies can be detected within 6 to 12 weeks in blood so HIV testing require
further testing after 12 weeks from window period completed. All hospitals provide
guideline for women with an unknown HIV status and basic information on HIV/AIDS.
After that single HIV test offered to pregnant women for prevent transformation mother
to child. There are also repeat sample required from same tested person for ICTC to

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confirm the HIV status. Sometimes some patient’s sample required to collect from
different department and different hospitals.

4.1 AIDS and the Constitutional Provisions

Thomas Gracious et al. (1997) have discussed about AIDS and national law. They
discussed that “Under the Indian Constitution, public health and sanitation and hospitals
and dispensaries fall in the State List. Family planning and population control, medical
education, adulteration of food stuffs and other goods, drugs and poisons, medical
profession vital statistics including registration of births and deaths, mental deficiency
are in the concurrent list. The Union Ministers of Health and family Welfare is bound to
play a vital role in the national efforts to help citizens lead a healthy and happy life. The
ministry is responsible for implementing programs of national importance like prevention
and control of disease, primary health care services, etc. Our national commitment is to
achieve health for all by 2000 AD in accordance with the Alma-Ata Declaration of
September 1978.

The HIV is different from other infectious diseases in that the primary intervention
strategy is changing individual behaviour. With appropriate behavioural change, people
can protect themselves from the risk of HIV infection, but appropriate social support is
needed to facilitate this behaviour change. The various recognized human rights that are
relevant in the context of the HIV. These include the rights to life, the right to privacy,
the right to education, the right to health and the right to human dignity. Because, many
groups of society have been identified as having inadequate access to HIV prevention
information (e.g. children, women, poor people), it is also relevant to consider access to
available medical treatment.

4.2 HIV Counselling and Testing

Counselling is an integral part of the HIV antibody testing programs. The primary goals
of counselling and testing are to help uninfected persons initiate and sustain behaviour
changes that reduce their risk of becoming infected and help infected persons avoid
infecting others. Pre-test counselling and post-test counselling are available from
specially trained health care workers in tuberculosis control programs or from facilities
that provide these services, e.g. HIV counselling and testing centre, sexually transmitted
infection (STI) clinics and some primary care clinics. Tobacco existence tuberculosis

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increases the possibilities of HIV infection thus to know HIV status of the individuals is
essential for sake of early treatment and therapy. HIV test is not a test for AIDS but a
blood test which detects antibody made by the body as response to infection to HIV.

Today counselling is developed as a profession and is being practical across the globe.
But yet what is counselling and what can be achieved through counselling? What are its
aims? These are difficult questions to answer. Great change has occurred in the present
century regarding traditional concept of counselling. Advice has taken formally and in
organised form today. Nowadays advice is given by professionally trained persons and
by those who have knowledge of psychology. Counselling Psychology is a developing
branch of psychology. it helps people in their puzzling problems. After the Second World
War the profession of counselling developed very fast as speciality. The main objective
of counselling is to create attitude and skills of solving problems. Through this skill
people solve their problems and become efficient enough to solve new problems when
they occur. HIV/AIDS is a major problem of today. Its solution is much difficult. No
medicine is invented that can remove HIV/AIDS completely so far. Information,
awareness, counselling and guidance are the only remedy for this disease. Awareness of
this disease, and the causes and result of it only can save a person from the disease.
Considering the seriousness of the disease National AIDS Control Organization
organizes various programmes to control and prevent this disease. Various programmes
are conducted by each states State AIDS Control Society (SACS) to control and prevent
HIV/AIDS in Gujarat state Community Health Centres (CHC) are established and along
with it ICTCs have been established.

The profession of counselling is old enough but now it has emerged as a new one and its
impact is quite deep on the developing society. Today many people turn to counsellor to
solve the problem of their life. Problems such as choice of profession, unemployment,
indecisiveness, frustration, lack of self-confidence, family problems, sexual problems,
self-conflict, loneliness, marriage etc are perceived in our day to day life. Many
counselling centres exist to help people in their puzzled problems. Such counselling
services are generally found in schools, colleges, hospitals, rehabilitation centres, social
health centres, business centres, social institutions etc. As per the guidelines of National
AIDS Control Organization the counsellors performing duty in ICTCs are trained. At the
time from appointment to six months the counsellors have to undergo 12 days induction
training provide by ICTC which gives basic information about HIV/AIDS testing

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information and testing practice session. They have also to complete a five days
refresher training every year. With their academic knowledge on this complicated issue
of HIV/AIDS they bring awareness in people regarding the causes and effects of
HIV/AIDS. They also provide counselling to HIV positive people how to live a normal
life. They try to remove frustration from HIV positive people. With their counselling they
make people aware how to save oneself from transmitted disease.

It is not the mandate of an ICTC to counsel and test everyone in the general population.
There are subpopulations that are more vulnerable or practise high-risk behaviour. These
subpopulations include sex workers and their clients, men who have sex with men
(MSM), trans-genders, injecting drug users (IDUs), truckers, migrant workers, spouses
and children of men who are prone to risky behaviour.

4.3 What is Counselling?

The term ‘Counselling’ is well known since long but the meaning of counselling is
complex in the fast developing field of professional counselling. The emergence of the
very term ‘Counselling’ indicates so many ideas in a single stroke. Counselling is a
speciality or a profession. It is a set of various activities or methods. Shertzer and Stone
(1974, p.80) have said that the term counselling is used for various activities such as
giving information, encouraging giving advice, interpretation, psycho analysis etc.

Belkin (1980) says that counselling is a continuous changing and developing concept.
According to developed concept “counselling is a helpful process for the people who
crave for development and his/her problems to get solved by trained professional
persons.” Various authors have their viewpoints and concepts have attempted to define
‘Counselling’. All these definitions are helpful to understand counselling. Some of them
are as given below;

- Counselling is a series of individual’s direct contact with view to help in changing

his/her behaviour and psychological attitude (Rogers Carl, 1942, p. 4).
- Counselling is a voluntary professional relation established between an individual
who needs psychological help and trained person who can help (Patterson, 1962,
p. 112).

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 - Counselling is a process of linking mutual interaction between the client who
desires counselling and the trained counsellor who can impart counselling (Perez
J.F., 1965, p. 15).
- Counselling is a private and direct relation between two individuals in which the
counsellor through the capacity of his/her special skill, relations and ability
creates. Such education system which helps the client who is a layman to realize
his/her present probable future situation and his/her own self. So that he/she can
utilize his/her capacity and attributes in such manner as he/she derives satisfaction
which is beneficial to society and he/she can learn to satisfy his/her future needs
and solve the methods of future problems (Tolbert, 1972, p. 9).
- Counselling is a relation between professionally trained expert counsellor and a
person desiring individual help (Pietrofesa, Hoffman and Splete, 1984, p. 3).

Certain common elements are observed in majority definitions of counselling. According

to Lewis (1970) there is diversity in the definitions of counselling. Yet three certain
common elements have been observed: (a) perplexed client. (b) counsellor- whose
function is to help the client. (c) interaction between the counsellor and the client which
brings some change in the behaviour of the client. With the changing pattern of time
much change has occurred in the concept of counselling. In context with our study we
can say that attempts have been made to solve sexual problems of people through trained
counsellors of ICTCs. People are getting proper guidance regarding HIV/AIDS and other
sexual transmitted disease.

Counselling is imparted individually or in group. Individual counselling is effective. In

the recent years group counselling also has been much effective. It has become integral
part of individual perplexed problems and its positive solution. Methods and principles of
individual counselling are used in group counselling. In counselling two or more persons
come in direct contact. Interaction occurs among them and relations are established. This
relation becomes unique, meaningful and full of emotions. When pregnant women come
at Community Health Centre for check-up, doctor refers her to counsellor for counselling
and several test of blood. Here counsellor counsels her. In pre-counselling, the counsellor
organizes group counselling of pregnant women. However the post counselling is done
exclusively by the counsellor at the individual level. Because problems of persons vary,
individual counselling is necessary during post counselling. Most psycho-social models
of health behaviour are individualistic in focus in that they seek to predict and explain the

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health behaviour of individuals by reference to their personal characteristics. These
models emphasis the health beliefs (Rosenstock, 1974), self- efficacy (Bandura, 1977)
and motivations and skills (Rosenstock et al., 1988) of individuals to behave in certain
ways, tend to assume that individuals decision making on health choices in based on the
perceived costs and benefits of action. Models of behaviour change that stem from these
theories aim to enable individuals to have the knowledge and means to make healthy
choices about their lifestyles and behaviour.

Trained counsellor of ICTC provides their humble services regarding HIV/AIDS. Here
the sample of blood is taken from the patients, pregnant women, people who came for
guidance and testing of HIV. Individual counselling is provided to the HIV positive
patients. Counselling performed through counsellor at ICTC is according to the
guidelines of National AIDS Control Organization. The dialogue between the client and
the counsellor is confidential. HIV positive patient suffers from social stigma. He/she
feels loss of social status in society and faces discrimination. Also he/she may not treat
equally. Considering these points National AIDS Control Organization has formed code
of conduct to keep the relations between the client and the counsellor about information
and identity of HIV positive people. It is essential to observe this very strictly.

The person who desires solution of his/her problems is called a ‘Client’ in counselling.
Normally the problems are psychological. The person who is trained and has acquired
skill to solve psychological problems is known as ‘Counsellor’. Counsellor is a qualified
person. A counsellor is an expert person in counselling. He/she has acquired the skill to
deal with psychological problems of the client. A person who joins ICTC as a counsellor
initially receives induction training and every year he/she obtains refresher training.
Through these trainings they become expert in their work regarding prevention and
control of HIV/AIDS in society. Mostly the staffs functioning as a counsellor in ICTC is
an expert in that field with particular insight into sociology and psychology.

It is much essential to know what a thing is, to define the thing certain things must be
known by those who desire to study counselling. Patterson (1973) has described certain
things which are not included in the characteristics of counselling. Considering in that
context: (a) Counselling is not merely giving information; information can be imparted in
counselling. (b) Counselling is not preaching, advice or a matter of recommendation. (c)
Counselling is not a matter of influencing client’s psychological attitudes, beliefs,
behaviour through persuasion, guidance, surety which may be whatever indirect or
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painless may be. (d) Counselling is not a matter of influencing client’s behaviour through
caution, persuade, threat or compulsion. Counselling is not a means of imposing
discipline. (e) Counselling is not mere a matter of paying visit. Visit is included in
counselling but it is not the substitute of counselling. (f) Counselling is not a bundle of
magical techniques, yet various techniques are used in counselling.

Counselling differs from health education in many ways and they are: (a) counselling is
usually a ‘one is to one’ process whereas; health education addresses a group of people.
(b) Counselling is useful for not only giving information but also for changing attitudes
and motivating behavioural change. Health education is mostly used for information
sharing. (c) Counselling sessions involve personal problem solving. In health education,
general issues are discussed. (d) Counselling is more focussed, specific and goal targeted,
whereas health education is much more generalized. (e) Counselling evokes strong
emotions in both counsellor and client whereas health education sessions are emotionally
neutral in nature (Guidelines on HIV Testing, NACO, 2007).

4.4 Legal and Ethical issues of HIV/AIDS

According to the Guidelines on HIV Testing (NACO, 2007), “HIV/AIDS epidemic has
posed an array of legal and ethical challenges. These challenges includes limits and
significance of confidentially; obligatory informed consent before testing and initiating
treatment; counselling of women to make reproductive decision; burden on infected
individuals to protect their sexual partners; obligation of the state to prevent spread of
disease; obligation of physician to care for HIV infected; issues related to insurance,
men, women and children, etc.

There are ethical responsibilities of the concern authority to treat possible victims of HIV
with respect and cherish the human dignity. if such authority fail to respect the social and
cultural norms such individuals it’s a ethically wrong. It also state responsibility to
protect and offer all kinds of help and supports which creates ambitious for such people
life they deserve and wish to live.

Sex education is also of great help for empowerment of women and their control or
sexual intercourse. Women empowerment can change and challenge the social norms and
women subjugated and sub ordinate position. To control AIDS it’s extremely needed to

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arrive at common conciseness by spreading awareness of possible hazards of AIDS
through mass education and counselling.

Modern codes of ethics recognize this principle: The patient has the right to
confidentiality. The physician should not reveal confidential communications or
information, without the consent of the patient, unless provided for by law or the need to
protect the welfare of the individual or public interest. Civil and criminal penalties may
ensue for unlawful disclosure of HIV positive status.

Some state statutes make exception to confidentiality with regard to the spouse and
sexual partners of the patient, other state statutes make no such exceptions. The United
States presidential commission addressed this issue in 1988. The decision about whether
to breach the confidentiality was to remain with the physician and was not to be imposed
as a matter of law. However, confidentiality is central to the control program.
Maintaining confidentiality encourages more and more people at risk to access the testing
services and helps to instil faith about the public health system in the community.

As such HIV/ AIDS involves issues of privacy, communal health, social and economic
discrimination, coercion and liberty. HIV testing outside the context of blood banking
evoked a great deal of controversy and debate about issues such as should the individuals
at high risk be required to be tested? How and who will counsel those who were to be
tested regarding implications of positive test for themselves and others? What about
confidentiality? What about the consequence of testing right to work, to go to school, to
get married, to bear children and to obtain insurance? There emerged a broad consensus
for voluntarism. Except

HIV screening/ testing can be undertaken as voluntary testing after counselling for
behaviour change; for clinical purposes; for seroprevalence studies; for ensuring safety
and for research. Lets discuss about some guidelines on ethical aspect of HIV/AIDS from
General medical Council of UK which includes doctor and patient relationship is base on
mutual trust and respect to each other, AIDS patient would get high standard medical
treatment and support compare to other patient, patient found to be infected have prior
medical supervision, explicit informed consent is must for HIV/AIDS testing, and last
confidentiality of result must be maintained.

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4.5 Characteristics of Counselling

It is necessary to know the characteristics of counselling to understand the meaning and

process of counselling.

4.5.1 Counselling is a process

Counselling is a process which can be described and explained. The description of

counselling and its analysis becomes easy if it is understood as a process. Counselling is
not an event or a happening accidently. It is an activity that includes many sub-functions
leading towards aim. Counselling process is neither mechanical nor inanimate. It is live
and dynamic. Counselling process covers long term requirements of the client.
Counselling is not a onetime event. The counsellors of ICTC discuss many times with
clients during counselling session. They create confidence by repeated counselling.
Counselling process covers long term hygienic requirements of HIV positive persons.
Counsellors establish cordial and reliable relations with clients. Counselling is not an
event or an incident. Client’s follow up is strictly observed. So that he does not leave
treatment incomplete. Sometimes some person do not co-operates in treatment of
HIV/AIDS. If person detect HIV positive, counsellor register him/her for Anti Retroviral
Therapy which provided at ART centre located at district hospital. After counselling
counsellor send those at ART centre. But sometimes some people do not go for treatment
at ART centre. The counsellor inquiries at ART centre about status of that person. If
he/she not reach at ART, why he/she not go for ART? Get information about reasons for
not taking treatment and follow up counselling for take treatment. (2) Counselling is a
direct relation:

Counselling is a relation between the counsellor and the client. Counselling may
individual or in group interaction and direct contact are found in it. Counselling is
successful only when two or more people meet face to face and good personal relations
are established among them, and interactions arise. Here in ICTC face to face relations
between client and counsellor is established and strengthened through direct contact.
Counsellor discusses with the client the causes of HIV/AIDS. He/she discusses its
outcome also with the client and explains what HIV/AIDS is. This process is called pre
counselling. Blood sample of the client is collected for HIV test. He/she is given next
appointment and when he/she visits again he/she is told his HIV status. If he/she is found
HIV negative he/she is made aware for protection of HIV infection. He/she is informed
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about the safety measures. If the client has high risk behaviour then it is possible that
HIV is not detected in blood. He/she is advised for once again HIV test after three month.
If a person has come in contact with HIV it takes three month to ten years to be positive
and it is known as window period. The counsellor advises risky behaviour person to
undergo HIV blood test every three month or three times in a year. If person is HIV
positive detected then his post-counselling is carried out. The counsellor has to show his
counselling skill in this situation, because when the client comes to know about his/her
HIV positive status he/she gets frightened and nervous. This situation has got to be
tackled very delicately. It is essential to perform counselling without giving the client any
shock. The counsellor has been trained to handle the situation very tenderly with the HIV
positive people. Trained counsellors performed their duty according to the guidelines of
National AIDS Control Organization. Along with it to bring the clients out of frustration
and depression they create some examples by themselves. They educate them regarding
HIV/AIDS. They sit face to face and talk without any freight.

4.5.2 Counsellor-client relations are important in counselling process

A number of scholars look at the relation between counsellor and client. Established
relations between counsellor and the client are important and basic. Brammer and
Shostrom (1982) say that relation between the counsellor and the client is the base of
remedy. Boy and Pine (1982) also gives important to this relation. It is useful and helpful
for effective counselling. Effect of counselling depends on the relations between
counsellor and client. Counselling cannot be successful in casual circumstances.
Counselling process continues due to relation. It ceases due to counsellor also. Rogers
(1951) has emphasized on relations. His contribution in developing counselling and
relationship is remarkable. The HIV positive people are socially discriminated and ill-
treated. They believe that such person must have approached sex worker or have illicit
relation with others, that why he/she is infected by HIV. Thus, HIV/AIDS is a stigma for
a person. Therefore the client demands secrecy in this regard. Such persons have no trust
in the counsellor initially or trust him little less. Gradually the counsellor creates
confidence in his/her own-self and shows sympathy for him/her. Aim is achieved only
after trust is created. Thus, awareness of HIV/AIDS, its prevention and control is
possible through strong relationship between counsellor and client. Society can be saved
from this deadly disease through this mutual knowledge-relationship between the
counsellor and the client.

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4.5.3 Counselling is a changing relationship between counsellor and client

When there is interaction between counsellor and client there is impact on needs,
perception and attributes. According to Tolbert (1972) this relationship is unique and
matchless. It is ever changing and moves towards specific direction. It keeps more
distance also. If the interaction is not proper then the distance between the counsellor and
the client increases and as a result awareness of HIV/AIDS, its control and prevention
objectives cannot be achieved. If the interaction is proper and adequate and relation is
established then only through relationship objectives of minimal threat of infection can
be achieved.

Relation with client’s expression of feelings is changing. Client trust on counsellor more
than earlier time. He/she feels that he/she has been persuaded well. Relation changes
every movement during counselling session. This type of relation is not observed in the
second or there after meeting. Every person is a changed person due to relationship. In
the first meeting the counsellor talks with the client about general and casual things.
Through light talk he tries to create cordial environment and closeness. Then they come
closer and gradually the feeling of co-operation between the counsellors and the client
occurs and good and strong relations are established.

4.5.4 Counselling relationship is personal and formal

Counselling relationship is personal, confidential and informal. Counselling relation is

not beyond professional relation. This relationship is established and continued with on
interest or request of the client. Special time is allotted in counselling. Relationship is for
limited time period. It is limited for sitting in a week for the client. Yet this relationship is
more intense than any social relationship. It is deep and full of warmth. It reduces threat
of the client. It enables them to reveal themselves, express themselves and to search
themselves. Relationship is established with the consent of HIV/AIDS client’s
willingness and need. This relationship does not last long if the client is not
understanding or sincere. Counsellor’s relation with HIV positive clients is always
humble, warm, objective and deep, therefore clients reveal themselves with the
counsellor. They express their feelings. The counsellor motivates them.

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4.5.5 Counselling is related to the problem

Counselling is related to individual’s problems of behaviour. People have many problems

and misunderstanding regarding HIV/AIDS and other sexual disease. The problems
related to life, should be solved wisely. They crave for help in the solution of their
problems. Indian society is traditionally orthodox and conservative. People feel shy and
they do not discuss sex problems in public. Many changes have occurred in society but
people have not become open minded in this matter. Sometimes they create danger for
themselves and for others due to their conservative attitude. If they do not have sufficient
and proper information regarding HIV/AIDS they knowingly or unknowingly spread
infection to others, which is dangerous for society. Due to counselling one can become
aware of one’s problems as well as the problems of others. The counsellor shows the
right way and help to removes problems.

4.5.6 Counselling is a professional service and it is imparted by expert counsellor

Counselling shows professional relationship in which the counsellor takes the

responsibility of being positively helpful to the client. Pietrofen, Hoffman and Splete
(1984) say that counselling is not a casual event pre-organized to set the client right, but
the skilful utilization of technique, obtained through education for effective result. The
counsellors associated with HIV/AIDS sectors are the master degree holders with social
sciences and skilled persons. They are appointed as counsellor they have to undergo the
training according to National AIDS Control Organization guidelines. They have
obtained twelve days induction training at the time of joining to six month. Then every
year they have to attend refresher training course. Thus, Working in the sector of
HIV/AIDS are trained, degree holders and knowledgeable in the field. On the basis of
training received and their skill together with their experience and their art of counselling
they use their ability to their maximum capacity. They utilize their capacity the most
effectively. Boyd (1978) says that successful counsellor grows individually and
professionally. With continuous practice of counselling and experience they become
experts. Counsellor’s special knowledge is an important element of counselling. This
attribute is not observed in other relationship. Counsellors associated with HIV/AIDS
sector with their special skill and knowledge performs their duty total with devotion and
dedication.

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4.5.7 Counselling is a humane experience

Day by day many changes have occurred. People are surrounded by various problems to
cope up with fast developing world. People are becoming more and more inhumane.
Counselling is a humane experience in this technical world. HIV positive patients
consider counsellor an important person. Counselling has occupied important place in
their life. Counsellor is the only person before whom they reveal their problems, puzzles,
difficulties, feelings etc. They consider their counsellor their God because they have the
fear of existence, fear of loss of social status and feelings of being discriminated by their
family members and others. Their mental state is not proper.

This shows the role and status of counsellor in the life of patients. Counsellor to an extent
is the only person who realizes their feelings. Counsellors know their feelings and
thoughts. Fully well patients get strength and motivation to live life from counsellor only.
They realize patient’s problems. Counsellors are helpful to them at every stage of their
life.

Here close relationship between counsellor and client is observed. Engelkes and
Vandergoot (1982) say that in the era of various ideologies and technology. Counselling
profession is helpful in maintaining the importance of humanity. Counselling is carried
out for the benefit of people. For them it is an opportunity to share Client’s aspirations,
frustration and fear. The most important thing is humanity that occurs in it.

This matter reveals self-less relations between counsellor and client. Counsellors perform
their duty with complete dedication, honesty and efficiency. They work for fixed salary
yet they do not show any temptation or greed. They are not got sufficient salary yet they
serve with dedication. Their appointment is on contractual basis yet they perform their
duty well.

4.5.8 Counselling is more preventive than remedy to the problem

Counselling is more related to prevention than remedy to problems most of the clients
approach with major or minor problems of behaviour. If timely treatment is not given,
then they have to face acute problems. The function of counselling is to prevent extreme
behaviour. Sometimes regarding HIV/AIDS person feels insecurity due to their visit to
sex worker and having kept physical relation with sex workers they visit ICTC and
consult counsellor to remove false belief or suspicion by getting HIV test performed.
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Here the main function of counsellor is to save the people showing high risk behaviour.
They have to bring then out of such problems. They have to educate those regarding
HIV/AIDS by proper guidance and to motivate them not to take risk regarding sexual
problem to save themselves, their family and society. Men who have Sex with Men
(MSM), Female Sex Workers (FSWs), Injected Drug Users (IDU), Truckers, Migrants
etc are involve in high risk behaviour group. People who are covered in High Risk
Groups (HRGs) visit Integrating Counselling and Testing Centre for counselling, testing
and treatment of HIV/AIDS. They carry out client’s pre-counselling and post-
counselling. Psycho therapy can improve their acute behaviour. Clients many times go
for remedy also. HIV infected person refer to Anti Retroviral Therapy (ART) centre for
registration and treatment. But sometimes HIV infected persons are not treated regularly
in this centre. The function of counselling is to control and prevent undesirable high risk
behaviour. It is therapeutic in less degree. The counsellor of Integrating Counselling and
Testing Centre refer HIV infected person to ART centre for treatment.

4.5.9 Counselling is educational

Counselling is an education. People are made aware of HIV/AIDS and other sexual
transmitted disease through counselling. So that can save himself/herself and his/her sex
partner and make future generation safe. The function of counselling is to make the
person understand his/her characteristics and its relation with environment. When skill is
developed for applied understanding then education situation is created. The counsellors
in Integrating Counselling and Testing Centre explains the client how to save
him/herself, how to behave, what is the effect of HIV/AIDS etc. They educate the client
regarding this matter. Here the counsellor does make compulsion regarding behaviour.
Counsellor never asserts “dos and don’ts”. He/she explains the situation of client’s
behaviour. What will happen if the client behaves in particular manner. Counsellor
attempts to bring changes in the mental attitude and feelings of the client. Process
becomes dynamic only if the client utilizes counselling as education situation. Client
learns regarding his/her role behaviour and environment through counselling.

According to Patterson (1973) the purpose of counselling is to create the situation which
makes changes easy. Situation means individual’s right to choose, freedom and self-
sufficiency. Individual’s awareness about HIV/AIDS and other related disease is created
through counselling. Attempts are made to make them self-sufficient like other relations
in the process of counselling limitation is drawn on the client, limitations like not to have
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extra marital relations, to be loyal to one and the only life partner etc. clients are called
after specific time duration and frequent counselling is carried on. Many times the client
joins the counsellor in discussion. Many questions arise in his/her mind and attempts are
made to solve his/her problems. The counsellor knows his/her client and others also
know client in their own views. But there is a difference in their understanding regarding
the client. A counsellor is supposed to know the client thoroughly. This is crucial for the
prevention and control of HIV/AIDS.

For achievement of objectives the counselling process is carried out in private at

Integrating Counselling and Testing Centre. Many types of wrong notions prevail in
society regarding HIV/AIDS. Moreover people are ashamed of discussing this matter in
public. People look with doubt towards HIV positive patients. People hate him/her.
He/she is discriminated by people of society. As a result National AIDS Control
Organization has formulated code of conduct for the counsellors. The identity of HIV
positive person is not revealed. It is kept secret. Dialogues between the counsellor and
the client are kept confidential. Generally the patients of HIV have psychological
problems regarding sexual transmitted disease and the counsellors have skill to solve
their problems.

4.6 Main Objectives of Counselling

Compared to any other type of infections and diseases, the problems and issues related to
HIV/AIDS are far more complicated. HIV infection is lifelong and fatal. No medicines
are invented to cure HIV/AIDS and to render HIV infected person non infectious. HIV is
spread mostly through sexual relations. Persons known to be infected by HIV are often
faced stigma and discrimination by people of society. Such a situation results from the
lake of proper knowledge or understanding regarding the HIV/AIDS. The HIV testing is
recommended by the World Health Organization only for selected purpose (WHO Global
Programme on AIDS, 1992). These include (a) screening of blood including blood
products, and organs and tissues for transplantation; (b) epidemiological surveillance,
particularly HIV sentinel surveillance using unlinked anonymous HIV testing
methodology where all personal details of the person being tested are removed from
blood samples so that the results of HIV testing cannot be linked with the identity of the
person- the specific purposes of testing in these situations are to ensure blood safety or to
conduct epidemiological surveillance respectively; (c) diagnosis of symptomatic
infection among those clinically suspected of having AIDS; and (d) early diagnosis of
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HIV infection among asymptomatic persons who would like to know their HIV status. In
the latter two situations testing of HIV is carried out with informed consent and with
strict maintenance of confidentiality. No situation other than the four listed above warrant
testing of HIV, and there is no place in national AIDS control and prevention programs
for testing without informed consent.

The HIV testing has plays an important role in national AIDS control programs. It should
be carried out in a rational manner and without resort to coercive approaches. Testing
without informed consent and mandatory testing are not only counter-productive but also
wasteful of scarce resources. The spread of HIV/AIDS cannot be controlled by
mandatory testing of high risk groups in the population and hospital [Link] testing
should be carried out only those purposes which are specific objectives of National AIDS
Control Programs (NACP). George and Cristiani (1981) have showed five objectives of
counselling: (a) to facilitate behavioural change. (b) to established relations and to
improve ability of client in maintaining relations. (c) to increase effectiveness in client.
(d) to encourage the process of decision making. (e) to motivate client’s hidden abilities
and development.

It is more useful to discuss the accepted objectives of counselling.

4.6.1 Change in behaviour

The main objective of counselling is to change the client’s behaviour so that he/she can
become more constructive to live. Majority of the counsellors consider vast objective of
counselling as change in the client. Here change means the change occurring in
behaviour, mental attitude, values, beliefs and feelings. Due to change in his/her
behaviour the client finds him/herself fit to live in society. He/she feels satisfaction due
to constructive life in society. Counsellors of ICTC bring changes in client’s behaviour
and create the environment which is conducive to client. So the client is able to live
his/her life. The new public health movement of the 1980s promised to move beyond a
biomedical understanding of individual health behaviour towards a new understanding
which encompassed the social and environmental influences on individuals’ health
choices, perceptions and actions (Ashton and Seymour, 1990). The HIV epidemic has
brought new dimension of risk. It has also brought about many changes. These changes
have occurred in the everyday lives of the individuals and communities affected by HIV
disease. They have also occurred in the ways health interventions aim to encourage risk
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reduction and behaviour change. The aim of community change interventions are to bring
about changes in the community practices and norms which impede individual attempts
at risk reduction and reinforcement in the community practices and norms which endorse
safer behaviour (Rhodes, 1993). These interventions encourage not only individual
change but community change which is oriented towards communities, groups or
networks of individuals (Bracht, 1990).

According Rogers (1961) due to counselling process required change can be brought in
the client. Sometimes people have unsafe sexual relations. Injected Drug Users (IDU) use
the same siring of injection for drug intoxication. The health conscious drug user was
considered to be responsive to public health and educational information, able to engage
in health planning and to balance long term threats against short terms pleasures
(Stimson, 1989). Proponents of syringe exchange programs have argued that they are an
important means to engage drug users in the public health system, provide education and
make referrals to much needed health and social services where available (Hartgers et al.,
1989; Van den Hoek et al., 1989; Purchase et l., 1989). Some person becomes sex
workers as their compulsion or hobby. All these are risky behaviour. The aim of
counsellor is to make the client realize the risk factors and save him/herself from
HIV/AIDS by changing behaviour. According to Dustin and George (1977) counsellors
should develop special objectives to realize desired special behaviour precisely.

4.6.2 Improvement in relations

The HIV infected persons face social stigma and discrimination and this in effect
corrupts their relations. HIV infected people are insulted and hated. Through counselling
an individual can maintain better relations with whom he/she had established them. The
counsellor with the permission of the client visits his/her house if he/she is HIV positive
to understand how they are treated within the family and neighbourhood. The counsellor
guides and gives information to them regarding the causes of HIV/AIDS and its result.
How it can be stopped for further spread is also told by the counsellor. He/she persuades
them not to discriminate HIV positive patients. He/she tries his/her best to establish once
again healthy social relations. The counsellor functions for relation improvement.

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4.6.3 Improvement in individual effectiveness

The aim of the counsellor is to increase individual effectiveness in client. This aim is
considered to develop hidden qualities of an individual. The aim of counselling is
maximum welfare and development of an individual. Client is given opportunities to
learn and uses his/her positive attitude in life. So, that he/she can grow and develop
his/her own self. He/she is motivated for growth and development. According to Blocher
(1966) individual is attempting to enjoy maximum freedom within him/herself and
his/her environment. Counselling teaches him/her to control their environment and it
helps him/her to increase its effectiveness. Counsellor educates client regarding
HIV/AIDS and other related sexual disease. It helps individual to gain effectiveness
knowledge of reality more effectively.

4.6.4 To motivate the process of decision making

The objective of counsellor is to help the client to take his/her own important decision.
Counsellor does not decide which option the client should prefer. Client should know
why and how the decisions are taken. He/she him/herself has to decide what is best for
him/her. Client with his/her decision learns many things such as sacrifice, of time, money
and things, economic expenditure, risk etc. HIV positive person with counselling takes
his/her own decision. For example, an HIV positive unmarried person can take the
decision to remain unmarried and save the life of other, or can marry another HIV
affected person. A married HIV positive person can take the decision to be loyal to one
partner and keep relations with that person only. He/she can avoid unsafe sexual relation.
He/she can decide to use condom. Counselling helps to control emotional situation, to
identify and separate individual characteristics. Counsellor helps the client to take such
vital decision. Final responsibility of decision is not of the counsellor but of the client
only.

4.6.5 Removal of the problem

The objective of counselling is to solve the problem of people. The problem related to
HIV/AIDS have got to be solved is the aim of counselling. Most of the people do not
have the skill to solve such problems. They do not know who they should approach.
Counsellor helps their clients to solve their problems. They feel relief through
counselling. Counselling may not be helpful to change their behaviour and examine the

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causes behind their problems. It is more practical to make an individual competent to
solve his/her problems than to help in solving his/her problem.

4.6.6 Maintenance of mental health

The objective of counselling is maintenance and gaining of mental health. Counselling

helps people to live happier and healthier life. According to Thorne (1950) and Shertzer
and Stone (1974) this is the main objective of counselling. It helps people to adjust to
environment and to hold positive view point in their response.

4.7 Skill and Abilities of HIV Counsellor

Thomas et al. (1997) have discussed skills and ability of HIV counsellor. According to
them, “Counselling and guidance in HIV can be provided by a counsellor who is
interested and has adequate knowledge, aptitude and capacities on the subject. However,
HIV counsellor should have certain basic skills and abilities which are essential for
dealing with delicate problems and issues of HIV/AIDS. For HIV counselling a client
may approach the counsellor, when one feels unable to cope effectively with one’s
problems and is very panic by about HIV infection. In such a situation, the confident
counsellor strengthened by his/her professional education and experience lends out
his/her helping hands of acceptance. Thus the counsellor meets the client, accepting
him/her as a person who is in trouble.” Therefore the technical and social skills of the
counsellor and his/her ability to interact with the client are central to his/her success as a
counsellor. He/she should be having great sociological and psychological rigour to
analyse the socio-economic and cultural backgrounds and the behavioural characteristics
of the client. The counsellor must be able to converse in the language known to the client
as well.

4.8 Conclusion

ICTCs has are established at the Community Health Centres. Every day clients visit the
centre for getting adequate information, diagnosis and treatment. The doctors of the
Community Health Centre refer patients to the ICTC for counselling and blood testing if
required. Here the counsellor explains patients the causes of HIV/AIDS and educates
them how to save oneself from the risks of HIV/AIDS. This is known as pre-counselling.
Then after taking consent in writing with the client’s signature send them to laboratory
technician for blood collection. There blood is examined and HIV testing is performed.
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Client is called again to collect report and at that time post-counselling starts. If the
report is HIV negative he/she explained the cautions to save him/her self from
HIV/AIDS. If the client’s conduct is of high risk he/she is convinced to get his/her blood
examined minimum three times in a year. It is possible that he/she is affected by HIV but
it is not detected in blood. This period is known as window period. If the client’s report is
HIV positive he/she compulsory registered and refers to ART. Here is treated with
medicines to maintain immunity and care is taken. So that the level of HIV does not
increase in his/her body and he/she can live normal life. Many times it so happens that
person cannot reach up to ART. It is the duty of the counsellor to make him take
treatment. He persuades him/her for treatment. If the counsellor fails then he/she informs
the case to the district supervisor who persuades the client. At Community Health Centre
pregnant women, patients and many other people also came. As per the guidelines of
National AIDS Control Organization pregnant women’s HIV counselling and testing are
compulsory. As per guidelines since a pregnant women’s diagnosis of HIV positive till
the child reaches 18 months follow up is required. As soon as a pregnant woman is found
HIV positive she is registered and referred to ART. If the pregnant women is found HIV
positive during initial three months of pregnancy then her new born baby is given
Nevirapine syrup for six weeks according to its weight. If at the time of birth baby’s
weight is less than 2 kilograms 0.2 millilitres, 2 kilograms to 2.5 kilograms then 1
millilitres and more than 2.5 kilograms 1.5 millilitres Nevirapine syrup is given. If the
pregnant woman is found HIV positive during four to six months of pregnancy, then the
child is given Nevirapine syrup till twelve weeks. If she is found HIV positive seven to
nine months of pregnancy then the child is given Nevarapine syrup till eighteen week. So
child can become HIV negative. To know HIV positive pregnant woman’s neo-natal
child, whether it is HIV infected or not, first test is carried out during one and a half
month to six month. Second test is carried out seven to twelve months and the third test is
carried out thirteen to eighteen months.
Along with the client the counsellor has to counsel the client’s spouse also. The HIV
testing and counselling of spouse is also essential and compulsory. If the spouse is HIV
affected, with timely proper treatment his/her life can be saved and avoid the situation of
others to be affected by HIV. If the client is male, his present address, permanent (native)
address are noted by the counsellor. If the client is female, along with her present
address, the address of her father and in-laws also is taken. So that the follow up of the
client can be easy. The counsellor should be sincere about his/her duty. The counsellor

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should not accept anything from the client. They must perform their duty honestly. It is
necessary to mention that the counsellor is a postgraduate in social sciences, according to
the NACO guidelines. They are appointed on contractual basis with fixed salary which is
actually salary is low. Yet they are devoted and dedicated to their duty. The ICTCs play
key role in the control, prevention and awareness of HIV/AIDS. The next chapter is
about interaction between the counsellor and client, during duty are described and
discussed detail in this chapter.

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