FACE TO FACE
WITH
GEORGE LIPANDE
CLINICIAN/COUNSELOR – MACRO [LILONGWE BRANCH]
Fellow: What is VCT all about?
Clinician/counselor: The VCT process is composed of three stages –pre-test counseling, results dissemination and post-test counseling. Pre-test counseling seeks to establish rapport with the client as well as to decipher the clinical history of the client. The counselor delineates the client’s weaknesses in terms of factors that might predispose him/her to contracting HIV/AIDS. These may be cultural variables such as cultural practices like ‘kuchotsa fumbi’, or economic variables like poverty. Other risk-factors like alcoholism, marital breakdown and partner infidelity may be highlighted by the client during the pre-testing session and these have a bearing on the post-testing session.
After the pre-testing session results are disseminated. Before disseminating the results however, the counselor needs to observe and probe whether the client is ready or prepared to accept the test results.
Fellow: Sorry for interrupting you but in my previous FGD study and from personal experience people allude to the fact that sometimes the way they are queried at this stage, with the counselor emphatically asking ‘Are you really ready to receive the results?’, sometimes several times really becomes scurry to the client. How do you perceive those sentiments.
Clinician/counselor: You know, l have had experience working in a hospital environment where you need to be objective and frank with patients. You have to face the brutal facts and be realistic…..l don’t know but I see no problem with the plea for readiness unless otherwise. Nevertheless you need to wait for the client to accept and concede whether he/she wants to hear the test results/outcome or not following which provided the client has not opted-out you disseminate the result. Either way, whether the serostatus is negative or positive you however need to monitor the client’s reaction to the outcome.
Fellow: What about the post-test session?
Clinician/counselor: The nature of this session depends on the client’s test outcome. If for instance the test is negative the counselor focuses on prevention of contraction of HIV by the client in future. This is basically done through strengthening of the client’s weaknesses as may have been noted during the pre-testing session. Motivators for VCT if proven a weakness for instance indulgence in a risky sexual debut are dissuaded against in future.
In case the test turns out positive then the counselor needs to be diplomatic not judgmental in his approach to respect the rapport already established with the client even when predisposing factors as highlighted by the client are clearly evident of reckless risky behaviours.
The session also serves a referral purpose in both sero-negative and sero-positive clients. In the former case, a client might have presented with an STI or even any other clinical condition like EPTB or pneumonia which may have prompted uptake. He/she is referred to the clinic or hospital for treatment of that condition. In case of a sero-positive outcome, if the client is diagnostically categorized to be in Stage 2 of the disease but with a CD4+ count between 250-500, he/she is given Cotrimoxazole [bactream] for staging. On the other hand, If diagnostically categorized as in stage 2, 3, or 4 but incidentally with a CD4+ count below 250, then the patient is automatically put on ART.
Fellow: Are there extraordinary or unique cases you have encountered in your experiences with clients?
Clinician/counselor: Certainly yes, for those who turn out to be positive acceptance tends to be a problem in most circumstances. There was for instance a case where a lady was not ready to accept her test results. Coincidentally she came with her husband who happened to be a pastor. When both were tested positive the lady could not believe it let alone accept bearing in mind that they were a prayerful couple and believed God could protect them from adversity. She could not anticipate that HIV/AIDS could happen to them and she was so traumatized.
The other case concerned another couple as well. The mother and father were sero-negative but their 7 year old son turned out to be positive. It was really a clinical dilemma begging the question of genesis. However it took time for me to establish that previously the child had been transfused, not only that, the parents also alluded to the fact that they had been patronizing a herbalist. It remained however a dilemma to trace back the infection to blood transfusion or negligence by the herbalist.
Fellow: Any personal lessons drawn from your experiences as a counselor with respect to your life and HIV/AIDS.
Clinician/counselor: Basically there are three major life changing experiences. First, I for one tend to empathize with the client especially in case of a positive outcome. I tend to ask myself what l would feel like if I was in his or her shoes…….sometimes it’s traumatic. Second, I feel we are lacking genuine information about HIV/AIDS but are still relying on information that has outlived its reliability and validity and needs to be revisited. Third, I do believe we are in a scenario where we could conclude that people no longer care, there is some sort of AIDS fatigue and coupled with the availability of life prolonging ARVs people have become complacent. You hear for instance some clients reiterating that ‘AIDS came for people hence no need to be worried or concerned about it’. However for some people ART is not a cause for complacency but a glimmer of hope for a life that was on the blink of being lost. For these few who may have suffered chronically from diverse clinical conditions but are abruptly revived through ART……the regimen is a life saver.
Fellow: Thank you very much - the interview has been an eye-opener on real life experiences concerning VCT …….it’s been a pleasure chatting with you.
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