ADJUSTMENT PROBLEMS AND NEED FOR COUNSELLING FOR HIV POSITIVE PATIENTS

ADJUSTMENT PROBLEMS AND NEED FOR COUNSELLING

FOR HIV POSITIVE PATIENTS

*Chandrakant Jamadar **Prof. S.P.Melkeri

                Counselling has been defined as a helping process whereby one person (the counselor) helps another (the client ) to make positive changes In the latter’s life in a way that empowers him / her counseling is not all about advice though advice may be given (about diet, exercise, treatment options, etc). It is also about hearing and more importantly, listening. It is special form of interpersonal communication where feelings, thoughts, experiences and attitudes are explored, expressed and clarified.

                A counselor has to be highly skilled and must maintain an emotional detachment, trying to see the client’s problems through his / her eyes at the same time. To maintain this delicate balance is sometimes difficult. Counsellores have to work on their own fears and prejudices before beginning to work with clients, as they will not be able to work effectively if they are judgmental or unwilling to help the person living with HIV / AIDS. Attitudes about  sex and sexuality, as well as feelings towards vulnerable groups such as men who have sex with men, injecting drug users and sex workers, have to be specially examined.

* Asst. Professor, P.G. Studies in Psychology Maharani Arts and Commerce college for women, P.G. Department of Psychology, Mysore.

**Professor & Chairman ,Dept of Psychology Gulbarga university Gulbarga.

            The main aims of counselor is to help his / her client to make proper adjustment in different life situations, over the individual is aware that he is HIV infected he leads a stressful life; which creates many problems in his adjustment.  Adjustment refers to conformity of oneself to the norms  of the society. The society as such do not accept any unsocial behavior which make may result in the transmission of particular disease. Therefore, HIV infected people are socially not accepted which creates many adjustment problems to the patient.

            The concept of adjustment is used to denote the personality of individual. It is also used to refer to one’s behavior psychological  condition (normal or abnormal) sociability etc . This epithet is also used to describe the quality and success of life.

            Adjustment is an important psychological variable, which an a index of integration between needs and satisfaction related to the achievement of social acceptance, age, sex, economic security and normal standards. As Abrahm (1985) puts “Adjustment generally, means an effective adaptation to the environment both external and internal including conformity to group norms, mores, ideals, values and so on. “ He stresses upon the conformity to group norms and values. But blind conformity to group norms and adapting oneself to the group without expression of his own thoughts and desires is not adjustment. Mouly (1966) defines, adjustment as the process by means of which individual seems to maintain physiological and psychological equilibrium and progress him to self towards self-enhancement.

            Adjustment  is one of the most popular psychological terms, it indicates the art of living of an individual. Similarly self-disclosure in on index of our personality. As self –disclosure is a cyclical aspect of HIV positive patients in the same way adjustment problems are also of a great importance for them.

            Adjustment is important for a happy living in a society. It help the individual to keep his basic impulses at tolerable levels. Thus adjustment help for a self- initiated growth and development along intellectual emotional, social, physical and vocational dimensions.

            Adjustment is the process of establishing a satisfactory psychological relationship as well as constant interaction between the individual and his environment. During the course of interaction people modify their behavior so as to get along with other people. When an individual fails to modify his behavior necessary for the personal and social demand, his deviant behavior goes beyond the permissible limits of the society.

            HIV / AIDS counseling is aimed at providing psycho-social support and preventing HIV infection. Psycho-social support is necessary because a diagnosis HIV infection. confronts people with a host of emotional and practical problems. Counselling is of vital importance in overcoming resistance to making the change in behavior that are necessary if, risks is to avoided and transmission prevented. Counselling in context of primary prevention is intended to prevent the infected persons from spreading of this disease. The infected people can be made aware of risk through which these disease can be contracted. The secondary prevention focus on the ways and means to prevent transmission of this disease. Counselling implies education directed towards the specific needs raising from HIV infection. It also involves communicating the information which is specific and focused to serve a purpose.

The importance area of adjustment:

• Home adjustment:

  AIDS patient home adjustment involves the individuals satisfaction or dissatisfaction with the home life and relationship with the family members. The adjustment of basic needs or partial satisfaction of needs, lack of warmth and satisfactory relationship with in the family lead to adjustment problems.

• Health adjustment:

     Health adjustment relates to the illness, diseases and health  status of the individual. Health of individual depends upon the nourishment and medical care provided to him. Early malnutrition and illness cause everlasting effect on the health of an individual, economic insufficiency surroundings and lack of awareness about health and nutrition lead to health problems.

             

• Social adjustment:

     Social adjustment includes the individuals participation in social activities, seeking and enjoying company of others desirable and favourable  attitudes and establishment of spontaneous and harmonious interpersonal relationship. Due to poverty, social and cultural problems, the HIV positive patient have their own limits in social participation. Hence he avoids meeting  people, feels uneasy awakened embarrassed, remains in the background and does not take initiative to meet other people. Patient’s emotions have direct impact  on the social adjustment.

• Emotional adjustment:

    Emotional adjustment is concerned with emotional instability of the individual. Nervousness, depression, excitement, shyness are the characteristics of maladjustment which frustrates the individual unsatisfaction of needs leads to emotional disturbances. Socio-cultural, rejection leads to feeling of inferiority, in security, inadequacy and lack of self – respect.

• Facing discrimination and stigma:

     Rejection of people who have HIV or who are perceived to have HIV, occurs within couples, extended families, communities, workplaces, health care setting and at international borders. Experiencing such discrimination can be emotionally, socially and physically devastating. Psychosocial support is essential to enable victims of discrimination and rejection to continue functioning  in settings that were once safe but are now hostile. HIV / AIDS programs around the world have had to provide advocacy services to respond to discrimination, emergency housing for people who have lost their homes and protection for people who have been victims of violence. However, programs also provide assistance in rebuilding and maintaining a positive self image in social setting that erode people’s.. Psychosocial support is an important aspect of programs that assist people whose human rights have been violated (Danziger 1994.)

    Stigma is also a universal aspect of HIV/AIDS. People in all countries hide their HIV status because they fear being discriminated against or abandon by their families and communities. Some what paradoxically, interacting with people living with HIV/AIDS is the most effective means of countering discrimination and refection and promoting acceptance of than. The emotional strength that peer support programs scan provide to people living with HIV AIDS(PLWHAS) often empowers them to disclose their HIV status to families and others in the community.

Counseling in relation to HIV / AIDS:

            Counseling is a therapeutic (healing) process based on scientific principles, which aims at helping a person to learn and to seek realistic solutions. It enables a person to solve his / her own problems through a special therapeutic relationship with a counselor.

            Counseling is usually a helping process and differs from casual conversation in being focused, specific and purposeful. It helps the person to understand the needs, strengths, limitations, resources and through this awareness brings about change in ways of  coping.

Importance of counseling for HIV / AIDS:

            Although HIV is transmitted through a virus, it is people’s behavior that is responsible for the spread of the virus. Prevention requires changes and modification in behaviors, particularly sexual behaviours. Social and economic climate conducive to the adoption of “safer” behaviours needs to be created Living with HIV also entails adopting a healthy life style, seeking timely treatment for opportunistic infections, taking complex and sensitive decisions regarding sexual behaviours, as well as coping with emotions, feelings and a high degree of stress. For these reasons, counseling is the key for preventions and care activities. Moreover, people with HIV / AIDS face discrimition sigma and prejudice because of two main reasons. HIV is mainly transmitted through the sexual route and because there is no ‘cure’ for HIV. Mostly people in india do not differentiate between HIV infection and AIDS. They think any one who is HIV positive has AIDS; and that any one who has AIDS will die. To some extent, negative messages commonly used in the media, are responsible for these beliefs and attitudes. Due to pervasive discrimination and prejudice, people with HIV face problems in their family and working life. They have difficulty in accessing medical services and all forms of care.            Counselling can help people living with HIV / AIDS find solutions to some of these problems or to cope with them.

            In Katmandu, Nepal, people with HIV recently spoke out against prejudice and discrimination. As one spokesperson with HIV explained, “our aim is to spread the message -  don’t fight people with AIDS, fight the disease instead”. The city’s first support group now has nearly 50 members, who receive counseling, medical care and advocacy (AIDSLINK 1998).

Main aims of counseling for HIV / AIDS:

• To prevent HIV infection in uninfected individuals, re-infections in positive clients and transmission of infection from the client to others.                       
• To handle disclosure of the person’s HIV status in a sensitive manner.
• To help an infected person cope with life.

Principles of counseling in relation to HIV / AIDS:

• Individualise counseling to the specific needs, background and problems of client.
• Accept the client for what he / she is and be sensitive to lifestyle  issues (for instance, sex workers, injection drug users (IDUS).
• Facilitate client’s active participation in the counseling process.
• Maintain confidentiality.
• Discuss sensitive issues, such as sexual behavior.

Counselling needs:

            An important step in preventing HIV transmission is the recognition of behaviour that put a person at risk soke people, especially the young, are likely to take more risks. Some people also have ‘risk taking’ personalities, they enjoy the thrill of speed, the height of winning at gambling etc. A large number of people adopt behaviour that are risky because they do not have the knowledge and awareness and under social and economic compulsion for instance they need money for for maintaining their family, to behave in a manner that puts them at risk.

            Steps in risk reduction include an assessment of risk, when where, now and in what circumstances the “at risk” behaviours occurs. This assessment is done with the active participation of the client. The counselor then helps clients to analyse the situation and jointly develop develop an intervention strategy that is likely to work for them.

Steps in risk reduction:

1. Find out reasons for risk behaviours
2. Are there emotional or interpersonal factors associated with this beahviour? Or, is it for pleasure seeking?
3. Circumstances under which this behavior occurs.
4. Does it occur when along, while travelling or in company?
5. Association with other risk taking behaviours.
6. Is there a combination  of risk taking behavior such as gambling, drug and intoxicant use, sexual risk.
7. Do those occur together?
8. Association of intoxicant use and risk taking.
9. Any other associations

a)     Economic for material gain

b)     Family factors

c)      Sexual problems

d)     Marital

e)     Occupational, etc.

·         CONCLUSION

After analyzing the situation which as lead to risky behavior. Which is the cause of this infection, it is the duty of the counselor to provide important information which is helpful in leading a well-adjusted life. Different problems faced by the patient has one at only important reason that he is HIV infected by his misbehavior knowingly or unknowingly. Counselling helps him to understand the situation in the right perspective and adjust himself accordingly. People/HIV without such help may not be aware of how to make positive adjustments with their changing trends in life process.

References:-

1. John T.J, “ The importance of counseling in the care of persons with HIV infections or AIDS”
2. Julian Gold et al – “The AIDS manual”, 1994, Mackman & Petty London –III edition, pg.26-27.
3. Kenneth Citron – “HIV and Psychiatry”, 2005, Cambridge Publication, Second edition, Pg. 16-18.
4. Lakshmi, K.s.-“Encyclopaedia of Guidance and Counselling’ – 2000. Mittal Publications, New Delhi – 2004, Pg. 79-80.
5. Neill McKee, June T. “Strategic communications in the HIV/Aids epidemic”, SAGE Publications, New Delhi – 2004,             Pg. 24-26.
6. Prabhu S.Chandra and Jayashree Ramakrishna – “HIV / AIDS counseling manual –AIDS Forum Karnataka’, 2000 – Pg 6-8.
7. Rshid Merchand Kaizad – ‘HIV infection in woman and children” 1999. A1Printers, IEdition, Pg.48-53.
8. Stephen Broker – “Opening circles, HIV / AIDS care o support manual’, 2001, BFC Publication, Bangalore, First Editions, Pg. 16 – 17.