Counselling

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4th HIV AIDS Symposium

• Counselling Service Provision
• for
• Newcomers with HIV / AIDS
• By
• Believe Dhliwayo
• Black CAP

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Why is it important to talk about HIV /AIDS in
Settlement work ?
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Why it is important to talk about HIV /AIDS
Settlement ?

• Immigrants make up a large of Ontario/Torontos
  populations
• Canada 18 (or 5.4 million) of the population
  are immigrants/newcomers.
• Ontario 26.8 (3 million) of the population are
  immigrants/newcomers
• Metro Toronto
• About 50 of Torontos population are
  foreign-born.
• Receives 77 of Ontarios immigrants though made
  up only 41 of Ontarios population.
• (Census 2001)

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Why it is important to talk about HIV
Settlement ?

• Immigrants made up a disproportionate of new
  HIV cases in Canada.
• In 2006, there were 2558 new cases of HIV in
  Canada, amongst them 382 are from new
  immigrant/refugee applicants (14.9 of total) In
  2005 it was 15.7
• The 382 cases represented only the applicants
  tested in land, an additional 215 new HIV cases
  were identified from applicants outside Canada.
• According to CIC, over 80 of them were
  eventually accepted, therefore, total percentage
  of newcomer cases is over 20 of total.
• Among cases in 2006, 417 (69.7) were born in
  Africa and the Middle East, 131 (21.9) in the
  Americas, 29 (5) in Asia and 20 (3.4) in
  Europe.

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So are refugees immigrants bringing HIV to
Canada ?
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NO !
Every 2 hours someone gets infected with HIV
(Canada Public Health Agency)
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Estimated number of prevalent HIV infections in
Canada, including range of uncertainty, by year.
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Why HIV/AIDS Counseling in Settlement Work

• Majority of PHA newcomers are accepted as refugee
  claimants, a small as sponsored spouses and
  less than 5 on Humanitarian compassionate
  grounds.
• DMPs are currently offering limited or No Pre
  Post HIV Counseling.
• Effective HIV/AIDS Counseling is an entry point
  to care and support.
• There is a difference between settlement
  HIV/AIDS Counseling.

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To Help Clients With Coping
Shock
Moving on
Anger /fear
Planning
Depression
Accepting
Bargaining
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What Is HIV/AIDS Counselling?
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What Is HIV/AIDS Counselling?

• Counselling is a process which involves a private
  and confidential conversation between a
  counsellor and a client, during which the
  counsellor helps the client to explore her
  problems, feelings and emotions and to find ways
  to improve her situation.
• 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.

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Types Of HIV/AIDS Counselling

• Preventative counseling .
• Pre-Test Counselling.
• Post-Test Counselling.
• Supportive Counselling.
• Crisis counseling.

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What Are The Aims Of HIV AIDS Counselling?

• Prevention of HIV AIDS,
• Information about HIV AIDS,
• Emotional support,
• Reference to medical and psycho-social support
  services needed by the client.

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Important Features of HIV AIDS Counselling,

• Respect and friendliness.
• Client-centred.
• Acceptance and Understanding.
• Encouragement and emotional support.
• No advice, provide Appropriate and accurate
  factual information to help the client understand
  his/her situation and make appropriate decisions
  .

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Important Features Of Effective Counselling Cont

• Focus on immediate and important needs of the
  client.
• If appropriate, refer to other service
  providers, who can provide further assistance to
  the client.
• At the end of the counselling session, review the
  results of the discussions and the decisions that
  have been made together.
• Each counselling sessions should not be too long.

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Counselling Techniques

• Establishing a relationship.(Proffessional )
• Active listening.
• Building on your client strength.
• Reflection of feeling.
• Taking one down.
• Questioning. (Open ended questions)
• Summarizing.
• Empathy.
• Using an empty chair technique.
• Widening the system through the use of genograms.

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The HIV AIDS Counselling stages /process

• Establish a good relationship through casual
  conversation.
• Discuss and agree upon the objectives and nature
  of the counselling, with the (you) counsellor
  giving reassurance about confidentiality.
• Exploration and discussion of the clients
  problems, feelings, emotions.
• Exploration and discussion of the clients
  options for improving his/her situation, and
  decision-making by the client.
• Referral to other services (if appropriate).
• Summary of the results of the session.
• Further appointments (if appropriate).
• Conclusion of the session.

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What are the Challenges that Newcomer PHAs Face
?
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Challenges Faced by New comer PHAs

• Stigma internalized and external.
• Inability to move through the coping cycle.
• Access to culturally sensitive counseling .
• Being misunderstood (language barriers).
• Forgetting due to a couple of factors ( meds,
  too many pots which need urgent attention.
• Limited /lack of positive living principles.
• Red tape (too many too long protocols, process
  to follow through.)

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Challenges related to migration settlement

• Pre-migration trauma.
• Migration journey.
• Adaptation challenges.
• Multiple losses.
• Legal barriers.
• Navigating the immigration system.
• Systemic policy gaps.

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Barriers to Social Determinants of Health

• Economic status/Poverty
• Struggles with basic settlement issues e.g.
  obtaining gainful employment, affordable housing,
  food, etc.
• High unemployment/underemployment rates.
• Special challenges for women in multiple roles in
  care giving and income earner.
• Struggles to alleviate poverty take first
  priority
• e.g. work long hours at several low paying jobs
• health needs often left unattended until crisis.
• Before coming to Canada, I worked as a teacher
  and in for a secondary school . Since I have
  been here in Canada, I have been working in very
  low-end jobs ..as a labourer and I have also
  been working in coffee shops. (Newcomer PHA from
  Kenya)

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Impact of stigma and discrimination

• Silence and secrecy about ones HIV status
• ( hidden epidemic).
• Delay in diagnosis treatment, higher
  resistance, poorer outcomes .
• Fears about confidentiality when accessing
  services - (poorer services).
• Inability to disclose even to sexual partners
  (Increased risk).

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Challenges related to service access barriers

• Language barriers.
• Stigma and discrimination preventing access.
• Service access barriers due to status.
• Lack of culturally competent services.

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Health challenges Outcomes

• Increase incidence of co-infections (TB/Hep B
  C)
• Increase incidence of depression.
• Delayed diagnosis and start of treatment.

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What has been done ?

• Committee for Accessible AIDS Treatment
• Ethno-racial Treatment Support Network
• Ethno-racial MSM working group
• African Caribbean Council on HIV/AIDS in
  Ontario

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CAAT

• Action Research Project to improve mental health
  of IRN-PHAs (OHTN/ AIDS Bureau)
• Develop best practice framework
• Community Engagement and capacity building
  project on knowledge transfer exchange.
• Community Mobilization Project to engage
  ethno-racial leaders in faith-based, media,
  settlement and social justice sectors to reduce
  HIV stigma and discrimination.
• Settlement frontline workers training on HIV/AIDS
  Counseling.

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Making good referrals for newcomer PHAs,

• Make sure the referral line is appropriate for
  the client provide as many options dont advice.
• Give instruction on how to locate services.
• Make sure the reason for referral is clear.
• Provide name of the service provider to the
  client, notify service provider to expect client.
• Explore potential obstacles e.g. distance
  ,confidentiality, availability of service
  provider etc.
• Ensure you always get a feed back from the Client
  or the service provider.

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Making good referrals for newcomer PHAs,
ISAP Manning Referral Desk ascertain the needs
of a Client.
Physical Support. Medical Doctors
Psychological Support. Counselors
Social Support. Support Group.
Spiritual Support. Mental Health
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Dos and donts when dealing with PHA newcomers.

• Judging the client through words or non-verbal
  communication, showing that the counsellor
  disapproves of the clients lifestyle, behaviour
  or decisions.
• Telling the client how she should behave .
• Asking questions which sound like accusations
• Preventing the client from fully expressing her
  feelings and emotions.

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Counselling Errors Which Should Be Avoided Cont

• Not accepting the clients feelings.
• Telling or advising the client how to manage her
  problems.
• Giving unrealistic reassurance or optimism to the
  client
• Asking irrelevant questions to satisfy the
  counsellor's curiosity.
• Giving too much information or information which
  is not directly relevant to helping the client
  deal with her problem.

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Questions ,Answers comments
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Thank You !