HIV/AIDS MANAGEMENT STRATEGIES

Voluntary Counselling and Testing Services (VCT)

- Counseling is a process that involves listening to people talk about their problems,
and helping them to work out what to do about the problems.

- Counselor guides the counselee in making alternative choices to either cope or

overcome the problem.

- Counselors are people who are trained to help others to understand their
problems, identify and develop solutions, and make their own decisions about
what to do.

- Counseling requires that counselors spend time with the counsellees, listening to
them talk about their problems and fears, helping them to increase their own
self-esteem, and when necessary giving correct and useful information based
on what they need to know at that point in time.

- It is a powerful weapon in the fight against HIV/AIDS since it is associated with

behaviour change that reduces HIV transmission and serves as a point of entry
into care for those testing HIV positive (MOH and NACC, 2001 a., UNAIDS,
2000., Van de Pierre, 2000.,

- Keya national VCT programme uses four models of service delivery:

1. Integrated sites: A VCT centre is usually located within the grounds of health
facilities such as hospitals, health centres or dispensaries. Their main
advantages include easier referral to medical care services and low start-up
costs that allow for rapid scale-up.

2. Stand-alone sites: These are not associated with any existing medical institution
and usually have staff fully devoted to VCT. Their main advantages are that the
staff can work full time on VCT services, and they may have donor funds that
facilitate their work.

3. Community-based sites: VCT is either integrated into other social services or

implemented as the sole activity of a local community-based organization
(CBO) or a faith-based organization (FBO). There is widespread scale-up of VCT
at the grassroots, given the widespread distribution of CBOs and FBOs in many
countries

4. Mobile sites. VCT is provided as an outreach to remote or hard-to-reach

communities where other models of VCT are either not feasible or unavailable.
Most mobile VCT services are offered by standalone or community-based VCT
programmes.
Reasons for testing

 Medical reasons: Pregnancy, STDs, or Legal reasons

 Voluntary testing

HIV TESTING
i. Pretest counseling

HIV counseling is an effective public health intervention because it promotes the

health of HIV infected persons and plays a role in reducing HIV transmission.

Aims of pretest counseling

- Help to identify risk factors and symptoms that may indicate that the client is HIV
infected.

- Help the client to identify one with whom he/she will share the results with.

- To ensure the client has a full understanding of the implications of the test and is able
to make an informed decision whether to take the test or not

- Ensure informed consent to carry out the test is obtained from the client

- Give the client the opportunity to discuss modes of HIV transmission

- Discuss the implications and support needs that may follow either a positive or
negative test result.

- Consider ways to reduce transmission or contraction of HIV in future.

- Encourage the client to consider and evaluate the impact the result may have on
him/her, emotionally, physically and in relation to his/her lifestyle.

- Reduce the internalized stigma by providing information about HIV in a neutral

environment.

Advantages of testing

i. Ability to seek early medical intervention which prevents complications of AIDS

ii. Prevention of transmission to others,

iii. Making healthy life style changes; (e.g. eating a balanced diet and regular exercising).
 iv. Understanding the cause of various symptoms.

Disadvantages of a positive test include:

i. Increased fear of illness and death

ii. Fears related to family relations/parenting

iii. Guilt of past relationships and sexual behaviour

iv. Stigma associated with HIV/AIDS

If results are negative benefits include: Increased self confidence by knowing that one is not
HIV positive. However, this self confidence if not well handled may lead to risky behaviour.

N.B:

- Positive test mean the person is HIV infected except for infants who may carry the
mother’s antibodies and may test positive even when they don’t carry the HIV.

- There is a period of 3-6 months during which antibodies may not show up in the blood
and test will reveal the person to be negative.

- This is the ‘window period’. Western blot is used to confirm the positive results.

- Because of the window period, tests giving negative results should be repeated again
after 3 and 6 months respectively.

2. Post-test counseling

If the person tests positive, the counselor should explain to him/her that there is a chance
of not developing full blown AIDS through medical intervention by ARVs, antibiotics and
antifungal drugs, good nutrition and reducing stress, and change of lifestyle through
positive living.

If results are negative, then,

- Clarify that the test did not yield positive results but this does not means that the
person does not have the HIV since one may be in the window period.

- Let the person know that there is need to repeat the test after 3 months. However
don’t forget to congratulate the person.

- Discuss methods of reducing the risk of transmission and avoid risky behaviour.
 - Discuss the current risk situations of the patient and help to develop strategies to
increase prevention of transmission.

Role of VCT centers:

i. Enlightening and guiding people on issues relating to HIV/AIDS.

ii. Contributed immensely in the control of HIV/AIDS by offering counseling services and
even treatment.

iii. Offer testing and avail the results to people within short period.

iv. The clients are prepared for both positive and negative results before and after testing
then allowed to know their HIV status.

v. Through counseling, infected people, majority of who have lost hope are with offered
an opportunity for positive living

vi. They reduce the revenge attitude for those innocently infected and may opt to die with
many or commit suicide

[Link] enable the public who include the relatives of the infected to stop him/
stigmatizating those infected to be able to live normal lives knowing that someone
cares for them

viii. They also help the government to keep statistics on the prevalence of the disease
hence policy development or strategic planning.

ix. They enhance peer counselling - which is a more effective tool as it applies peer
pressure.

General reactions to testing HIV positive

 Shock

 Denial

 Anger

 Bargaining

 Fear

 Loneliness
  Self-consciousness

 Depression

 Acceptance

Living positively with HIV/AIDS

The following steps may be taken to cope with the situation:

i) Breath

When one gets overwhelmed, he/she should take three deep breaths. Body ventilation
improves everything from chronic health problems, stress related disorders to sporting
performance. Whether one wants to boost one’s workout, ease stress or improve one’s health,
learning to breathe properly can enhance one’s quality of life.

ii. Refuse to be a victim by:

- Focusing on positive thoughts like living with HIV and not dying

- Living one day at a time,

- Seeking support not pity.

iii. Educate one’s self about HIV by attending HIV/AIDS seminars, workshops or any
education forum

iv. Physical exercise — exercise regularly to keep muscle tone and reduce stress

v. Keep busy and avoid self pity by concentrating on development but one must be careful
not to overwork

vi. Express one’s self and ask for support by;

- Talking to friends

- Sharing feelings with a partner, friends and family

- Consulting a professional counselor, therapist and clergy

vii. Embrace one’s own spirituality - Faith based organizations have ministers who
support HIV positive people these should be consulted for spiritual support.

viii. Think and act positively in all things.

 ix. Seek out people who are honest, trustworthy and supportive.

x. Cry when one needs to let it out, as it creates room for positive feelings

xi. Accept responsibility: Pledge that HIV stops with me. Do not deliberately seek to infect
others. Use condoms to protect others and to avoid re-infection.

xii. Join HIV/AIDS support groups that over group therapy as infected people share
experiences.

xiii. Eat a well-balanced diet with lots of proteins and vitamins. Avoid alcohol, drug and
substance abuse

xiv. Attend to opportunistic infections immediately

xv. Have hope about many things. For example that;

- One will live for long

- Their baby will be healthy

- Each sickness will be treated as it comes

- They are loved and accepted for who they are

- Scientists will find a cure

- There is life after death.

Home based HIV/AIDS care

• People living with HIV/AIDS have basic, physical, economic and psychological
needs.

• The needs can be met at familiar home environment and may lead to an
improvement of the quality of life for PLWA’s.

• Home based care establishes an important link between health professionals and
the care givers at home.

• Family, friends and the community must fill the “care gap” at home.

• Home based care simply means the care given to HIV/AIDS patients at home.
 • It means that the things people might do to take care of themselves or the care
given to them by the family and community.

Components of home based care:

 Clinical management; which includes early diagnosis, rational treatment and

planning for follow up care of HIV related illness

 Nursing care; which includes care to promote and maintain good health, hygiene
and nutrition

 Counseling and psycho social care; which includes reducing stress and anxiety,
promoting positive living, and helping individuals to make informed decisions on
HIV testing, plan for the future and behavior change

 Social support; which includes information and referral to support groups, /

welfare services and legal advice for individuals and families and where possible
provision of material assistance

Advantages of organized home based care

i. It affects the socio economic, psychosocial and medical well-being of the patient, the
family, the community and the health care system

ii. It provides comfort of a familiar environment to the PLWA

iii. It is less expensive for families

iv. It helps counteract the myths and mistaken beliefs about HIV/AIDS

v. It encourages people to take steps to prevent infection

vi. It encourages community participation in the care of PLWA’s and thus maintains
community cohesiveness in responding to community members’ needs.

vii. It eases the demand on the national health system by reducing crowding in hospitals,
thus better care is given to those who really need to be in hospital.

Nutritional needs of people living with HI V/AIDS

 • Nutrition implies the process of absorbing nutrients from food and processing
them in the body in order to keep healthy or to grow.

• Adequate food security in the household is requisite for optimum nutrition,

health and survival (FAQ, 2002).

• However, HIV/AIDS reduces the household’s ability to produce and buy food by taking
away the adult labour that would otherwise be engaged in agricultural production or in
earning an income.

• At the same time, HIV/AIDS increases health expenditure.

• The capacity of an affected household to obtain an adequate amount and variety

of food, and to adopt appropriate health and nutritional responses to
HIV/AIDS, especially for the already vulnerable ones, is grossly reduced.

• On the other hand both HIV/AIDS and malnutrition compromise the immune
system, resulting in increased susceptibility to severe illnesses, which reduce
the quality of life and shorten life expectancy.

• Malnutrition due to HIV/AIDS is linked to inadequate food intake, poor uptake

of food into the body, and poor use and storage of nutrients.

• Each of these factors must be considered in providing the most appropriate

nutritional care for the HIV-positive person.

Reduced food intake

Reduced food intake in persons with HIV may be due to painful sores in the mouth and
throat, loss of appetite, or fatigue. The main causes of loss of appetite are infections and
depression. Other causes include side effects of medication such as nausea and vomiting, and
inadequate access to and availability of appealing foods.

Poor nutrient absorption

Poor absorption of nutrients results when HIV damages the small intestine and alters the
healthy bacteria of the digestive system, causing malabsorption of fats and carbohydrates and
frequent episodes of diarrhea. Intestinal infections also cause diarrhoea, with loss and waste
of nutrients.

Increased metabolism
Infections, including HIV itself, lead to increased requirements for energy and protein,
inefficient use of nutrients, and loss of nutrients. Energy requirements are likely to increase
by 10% to maintain body weight and physical activity in adults and growth in symptomatic
children.

HIV/AIDS patient require the following nutrients in a well-adjusted diet:

- Vitamins: A good multivitamin should be considered

- Proteins: Sources of protein are red meat, fish, poultry, eggs, nuts, beans, peas and other
pulses.

- Carbohydrates: are required for energy and for the purpose of PLWAs, they may be
categorized into insoluble and soluble dietry fibres.

- Fats: Fats are high in calories (energy). They are needed for many membranes in the
body. Fish, beef, and vegetables all supply fats.

- Vitamins and minerals: Vitamins and minerals are also needed by the immune system.
While our foods contain vitamins and minerals, it is important to recognize that
available data indicate food alone does not supply enough in the presence of HIV, and
that supplementation is very important.

- Water is also very important.

Advantages of good nutrition to PLWA

Good nutrition entails eating a well-balanced diet that contains all the nutrients the body
needs for growth and proper functioning

Balanced nutrition helps the body to:

• Increase resistance to infection and disease and improve the energy supply

• Boost the immune system and therefore reduce the frequency of episode of morbidity.

• Lessen severity of infection, improve the response to treatment for opportunistic

infections such as TB, and speed the rate of recovery.

• Replace lost micronutrient and provide the body with all essential nutrient required
for good health.

• Preserve muscle mass, slow or stop the loss of lean tissue, prevent weight loss, and
improve body strength and energy.

• Delay the rate of progression of HIV to AIDS and the further advance of AIDS itself.
• Keep PLWAs alive and able to lead an active life; this in turn reduces their
dependence, thus allowing them to take care of themselves and to delay early orphan
hood of their children.
N.B:

 Studies show that nutrition interventions can positively affect nutrition status
(FAQ, 2002), the immune system and even personal esteem, by maintaining body
weight, improving effectiveness of medication and prolonging life.

 Supplementing micronutrients has been shown to increase life expectancy of

subjects with fewer than 200 CD4 cells per milliliter.

 A number of micronutrient supplements including vitamin A, zinc and iron have

been found to boost the immune system in a person with HIV infection.
Multivitamins can reduce the risk of death and improve immune function (FAQ,
2002)

 Good nutrition can therefore play an important role in the comprehensive

management of HIV/AIDS, as it improves the immune system, boosts energy,
and helps recovery from opportunistic infections

The following basic principles are being advocated for all programmes of HIV/AIDS
patient management, counselling or education;

- Nutritional education and counselling

- Water and food safety intervention to prevent diarrhoea

- Income-generating activities to enhance food security

- Nutritional supplementation

- Meal designing and planning using locally available foodstuffs