Counseling, Bereavement, and Emotional Impact: HIV/AIDS Overview & Insights

1. Good Morning!

2. Counseling, Bereavementand the Emotional Impact on those living with and affected by HIV and AIDS

3. Overview Part I Counseling and Disease Continuum Part II Some Insights on Bereavement Assistance for people living with HIV/AIDS and Part III Emotional Impact on the Infected and the Affected; Caring for the Dying/Grieving Part IV Theology: HIV and AIDS

4. Counselling Issues Across the HIV Disease Continuum

5. Session Objectives Identify common psychosocial issues of clients living with HIV Identify the link between VCT and treatment and care Describe the continuum of care Identify the interrelationship between disclosure, stigma and discrimination Counselling Issues Across the HIV Disease Continuum

6. Psychosocial Issues Consideration of psychosocial issues is fundamental to HIV/AIDS counselling & care Counsellors need to view the client in a holistic manner within the context of their social environment A range of issues can be experienced by clients Different clients experience different issues – no two people are the same Issues can change across time & with disease progression Counselling Issues Across the HIV Disease Continuum

7. Common Key Issues Confidentiality Difficulty accepting diagnosis Disclosure Discrimination and stigma Emotional reactions – shock, denial, depression, anger, fear, guilt, depression, anxiety, suicidal thoughts Counselling Issues Across the HIV Disease Continuum

8. Common Key Issues Disease progression Changes in physical appearance Illness/deterioration in health Loss of control Death and dying Loss and grief Counselling Issues Across the HIV Disease Continuum

9. Common Key Issues Relationships – partner, family, friends, child(ren) Financial difficulties Welfare – income/employment/housing Sexual difficulties Employment difficulties/loss of job Treatment issues – access, adherence, side-effects Counselling Issues Across the HIV Disease Continuum

10. Interventions for Psychosocial Issues Psychosocial care encompasses a range of interventions that address the social & psychological issues & needs of PLWHA & their significant others Interventions can assist clients to: - Develop a support network - Experience autonomy - Gain a sense of control Counsellors play an integral role in facilitating interventions & care across the HIV disease continuum Counselling Issues Across the HIV Disease Continuum

11. Possible Interventions Counselling – individual, couple, family, pastoral, group, community Support groups & peer support networks Emotional & spiritual support Economic support/welfare interventions Counselling Issues Across the HIV Disease Continuum

12. Possible Interventions Medical interventions/symptom management Pharmaceutical management Regular health checks Nutritional care Palliative care Counselling Issues Across the HIV Disease Continuum

13. Possible Interventions Home-based care STI care Family planning services Community activities Assistance to orphans & other vulnerable children Counselling Issues Across the HIV Disease Continuum

14. VCT is an entry point for HIV prevention, treatment & care Counselling Issues Across the HIV Disease Continuum

15. The HIV/AIDS Continuum of Care VCT is the entry point Proposes a range of interventions Incorporates a range of different people, resources and services Includes hospital care, community and home care over the course of the illness Provides comprehensive and holistic care for PLWHA and their significant others Counselling Issues Across the HIV Disease Continuum

16. Peer support Primary Health Care Prevention Care Continuum Service Continuum Health posts Dispensaries Traditional Orphan care Secondary Health Care District Hospitals HIV Clinics Social/legal Support Hospice Community Care NGOs Churches Youth Groups Volunteers Voluntary Counselling Testing Counselling Issues Across the HIV Disease Continuum Specialists and Specialised Care facilities Palliative emotional and spiritual support self care PLWHA The entry point Tertiary Health Care Home care

17. AN ACTIVITY

18. The person I love most

19. My greatest value as a person

20. My greatest dream in life

21. Some Insights On Bereavement Assistance on PLWHA

22. Questions on our mind…

23. How do you actually feel about dying?

24. Are you afraid of dying? Or are you afraid of the unkown?

25. Do you think seriously about your own death, that it might happen tomorrow, or even today? Or do you deny it?

26. What do you think you ought to do in preparation for your death? Have you thought positively about life after death? Can you look forward to it?

27. Are you willing to entrust your body, mind and spirit to your God? Do you trust God on this?

28. Take a deep breath…

29. Definition of Bereavement

30. Bereavement • The objective state of having lost someone or something precious; the objective situation of individuals who have experienced a loss. • Refers to the particular grief that accompanies and is evoked by the death of a loved one.

31. Grief • Refers to the psychological process of adjustment to any substantive loss or change • Grieving is about the natural response of people to all types of life crises—death, divorce, unemployment or retrenchment, loss of health, limbs or physical disappearance, loss of purpose and self-esteem; loss of anyone or anything we value.

32. Mourning • Represents the culturally defined acts that are usually performed after a death • Sorrow or regret expressed through customs and conventions

33. Bereavement Assistance

34. Bereavement Assistance HIV-AIDS Bereavement in contrast to Cancer Bereavement Levels of Grief Traumatic stress Grief-related depression symptoms Anxiety, depression, somatic symptoms Social Dysfunction Lower level of social support More likely to hide the cause of death Greater level of rejection Refuge from “support groups” than family

35. Purpose of Bereavement Assistance • Infected • Acceptance of one’s situation / Integrate in the daily undertakings • Management of Infection • Eliminate adverse psychological burdens • Make plans on how to live with the virus • Enhancing Quality of life

36. Purpose of Bereavement Assistance • Affected • Recognition and acceptance of the reality of loss • Management of painful memories • Eliminate adverse psychological burdens • Coping with situational lifestyle changes resulting from loss • Adapting to the loss, and reconfiguring their own life

37. Phases of Reaction to HIV/AIDS

38. A GeneralSense of Loss • physical ability • cognitive ability (thinking) • home, work • social status and support • sense of the future • faith, hope, and a sense of God’s care Caitlin Ryan, Recommendations for a Support and Management Plan for People with AIDS and HIV Infection in the Republic of Korea (February 1990)

39. Reactions to HIV/AIDSInitial Response • Shock • Range of Emotions: confusion, despondency • Difficulty in comprehending diagnosis • Beginning to mobilize resources Caitlin Ryan, Recommendations for a Support and Management Plan for People with AIDS and HIV Infection in the Republic of Korea (February 1990)

40. Reactions to HIV/AIDSAdaptation Stage • Range of emotions: fear, sadness, guilt, anger, depression, etc. • Possible displacement of anger by acting out (placing others at risk for infection) • Beginning to cope with health status • Dealing with stigma and need to manage information about HIV status • Increased dependency Caitlin Ryan, Recommendations for a Support and Management Plan for People with AIDS and HIV Infection in the Republic of Korea (February 1990)

41. Reactions to HIV/AIDSIntegration Stage • Learning to live with chronic illness • Feeling a broad range of emotions which may not be understood by family and friends • Grieving cumulative losses • Coping with increasing health crises • Continuing risk reduction and management of stress • Exploring spiritual concerns • Re-negotiating relationships Caitlin Ryan, Recommendations for a Support and Management Plan for People with AIDS and HIV Infection in the Republic of Korea (February 1990)

42. Reactions to HIV/AIDSStage of Advanced HIV-disease • Need to cope with continued and worsening health crises • Loss of body control, disfigurement, possible dementia • Facing death and dying Caitlin Ryan, Recommendations for a Support and Management Plan for People with AIDS and HIV Infection in the Republic of Korea (February 1990)

43. Understanding the Stages of Bereavement

44. Bereavement Stages STAGE 1: Acclimation and Adjustment • Adjusting to changes brought by the loss • Functioning appropriately in daily life • Keeping emotions and behaviours check • Accepting support Phil Rich Ed. D., MSW, The Healing Journey Through Grief (January 1999)

45. Stages of Bereavement STAGE 2: Emotional Immersion and Deconstruction • Contending with reality • Development of insight • Reconstructing personal values and beliefs • Acceptance and letting go Phil Rich Ed. D., MSW, The Healing Journey Through Grief (January 1999)

46. Stages of Bereavement STAGE 3: Reclamation and Reconciliation • Development of social relations • Decisions about changes in lifestyle • Renewal of self-awareness • Acceptance of responsibility • Phil Rich Ed. D., MSW, The Healing Journey Through Grief (January 1999)

47. HIV/AIDS and Suicide Persons living with HIV/AIDS may experience thoughts about suicide, especially when they are first informed about HIV infection or when first admitted to hospital for AIDS-defining illness. Possible signs of that suicide is being considered: • Previous attempts, • Verbal or written threats • Gathering of potentially dangerous items, • Giving away valuables • Extreme sadness, • Withdrawal from family & friends, sudden mood elevation Source: Communities of Care Team Manual (Third Edition), AIDS Pastoral Care Network, Chicago, Illinois

48. HIV/AIDS and Suicide Ways to offer help … • Take talk of suicide very seriously - get help fast! • Listen … Loved ones may be afraid to talk with person about these things. • Don’t be afraid to ask questions - keep talking until person calms down - that gives you time to get help • Encourage the person to get professional help. Source: Communities of Care Team Manual (Third Edition), AIDS Pastoral Care Network, Chicago, Illinois

49. Caring for the Dying

50. What are your reactions to the following statements: agree or disagree?