HIV / AIDS
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- Title
- HIV / AIDS
- extracted text
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RF_DIS_2_U_SUDHA
Qtiotl
JAMA
The Journal of the
American Medical Association
April 11, 19S6
Vol 255, No 14
' T? I S "■ T—.
Stability and Inactivation of HTLV-III/LAV Under
Clinical and Laboratory Environments
lionet Resnick, MD; Keith Veren; S. Zaki Salahuddin, MS; Sue Tondreau; Phillip D. Markham, PhD
'he »t#blllty of human T-cell lymphotroplc virus type lll/lymphadenopatecleted vlru» (HTLV-III/LAV) under environmental conditions encounIfl 8 Clinical or laboratory sotting and Its inactivation by commonly used
_r comfortable]
pie, chronic,«
constipation.;.^
j| hulk forming
tJtllnfectnnl-. were investigated. Under our experimental conditions
ig 8 highly concentrated viral preparation, virus with an initial
CUi tiler of approximately 7 log,, tissue culture Infectious dose (TCID50)
jltltlter can bo recovered for more than a week from an aqueous
flfnent hold at room temperature (23 to 27 °C) or at 36 to 37 °C. Virus
ify Is reduced at a rate of approximately 1 iog,oTCID„ per 20 minutes
hold (I 64 to 66 *C. Dried and hold at room temperature, HTLV-III/LAV
i infectivity for more than three days with a reduction of approximately
^TCIDW per nine hours. Viral Infectivity Is undetectable and reduced
Ulin 7 log,,TCID„ within one minute with 0.5% sodium hypochlorite,
OlCOhOl, Or 0.5% nonldet-P40, and within ten minutes with 0.08%
WOry ammonium chloride or with a 1:1 mixture of acetone-alcohol.
> fSIUlto help provide a rational basis to prevent the accidental spread
.V'lll/LAV In the laboratory or clinical setting.
4M 1080;255:1887-1801)
jble The Perdiej
iN T-cell lymphotropic virus
l/lymphadmopathy-associated
JtTlA-HI.'l.A V), the etiologic
of the required immunodefiwndromo (AIDS) and AIDSI complex," infects helper/
f (0KT4+/Leu 3a+) T lympho-
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cytes and possibly other cell types
with a direct cytopathic effect and/or
with indirect effects on cells involved
in cellular and humoral immunity, as
noted in the literature"1 and our
personal observations. The HTLVIII/LAV is transmitted primarily by
sexual contact and through blood or
blood products in vivo, and will infect
frosh human helper/inducer T lym
phocytes, as well as established T- and
B-lymphoid and monocytoid cell lines
in vitro1’""1 (unpublished data, S.Z.S.
and P.D.M., 1985). In view of the
serious consequence of HTLV-III/
LAV infection, its stability under
clinical and laboratory conditions and
its inactivation by commonly utilized
inactivating agents and disinfectants
are of tremendous importance to
health care workers and laboratory
personnel.
Here, the results of testing the
stability of HTLV-III/LAV under
various experimental conditions are
reported. The test system utilized
different HTLV-III/LAV isolates to
infect fresh human peripheral blood
mononuclear cells and, in some
instances, an established T-cell line,
H9.1 Cell cultures were propagated for
more than a month to facilitate the
detection of low quantities of virus.
These and similar studies should
lead to a more complete understand
ing of the stability of HTLV-III/LAV
and to the development of rational
procedures to limit its accidental
spread in the laboratory or clinical
setting.
METHODS
HTLV-lll Viruses
Isolate HTLV-III (TM) was obtained
from the culture supernatant of normal
peripheral blood mononuclear cells in
fected with virus isolated from a patient
with AIDS." The virus stock contained
approximately 10’ total virus particles per
milliliter by electron microscopy count.
The HTLV-III (H9) was obtained from the
culture supernatant of H9 cells infected by
multiple isolates of virus' and was concen-
T-Cell Lymphotropic Virus Type III—Resnick et al
1887
trated X 1,000 by banding in sucrose. The
H9 virus stock had a total virus particle
count of 10“ to lO’VmL. Using the Reed
and Muench method11 for calculation of the
tissue culture infectious dose (TCIDw) of
virus, virus stock HTLV-III (TM) con
tained an infectious titer of approximately
7 log.oTCID^/mL and the XI,000 concen
trated HTLV-III (H9) approximately 10
log.oTCIDjo/mL. Filtered (cell-free) TM
and H9 stocks were stored at —100 °C until
used.
Preparation of Peripheral Blood
Mononuclear Cells and H9 Cells
Peripheral blood mononuclear cells
(PBMCs) were obtained by leukopheresis
of healthy adults and banding by FicollHypaque gradient centrifugation. These
mononuclear cells were incubated in
growth medium (RPMI 1640, with 20%
heat-inactivated fetal calf serum and 0.25
mg/mL of glutamine) containing 5 mg/L
of phytohemagglutinin for 48 hours at
37 °C in a 5% carbon dioxide atmosphere.
They were then washed with phosphatebuffered saline (PBS) and refed with
growth medium containing 10% purified
interleukin-2,“ as .previously described.M
The established T-cell line H92 was main
tained in growth medium until used.
Infectivity Assays
Virus-containing supernatant fluids
were thawed and diluted with 50% human
plasma before use for experimental proce
dures. After the indicated treatment,
sequential dilutions of the treated virus or
untreated control virus were prepared in
PBS and 1.0 mL of each dilution was used
to infect fresh PBMCs or the T-cell line
H9.;
For infection, target cells were seeded at
a concentration of 106/mL and exposed to
diethylaminoethyl dextran (25 mg/L) for
20 minutes at 37 °C. Cells were then rinsed
twice with PBS, pelleted, and 5 to 6 X10‘
cells exposed to 1 mL of treated or
untreated HTLV-III for 90 minutes at
37 °C. After infection, cells were resus
pended in fresh growth medium supple
mented with 10% interleukin-2 and ear
ned in triplicate cultures maintained at
0.5 to 1 X106 cells per milliliter at 37 °C in
humidified air containing 5% carbon diox
ide. Viral TCIDjo was determined as
described previously.11 With some reagents
or conditions, HTLV-III-infected H9 cells
were exposed for the indicated times,
rinsed, and 5X10' cells cocultivated with
5X10' uninfected H9 cells.
Monitoring Infectivity
Media changes were performed at threeto four-day intervals, and the viable cell
concentration was adjusted to 0.5 to 1 X10‘
cells per millimeter. To determine infected
1888
cell cultures, cells were monitored for
characteristic cytopathic effect by light
microscopy of Wright-Giemsa-stained
cells and supernatant fluids were assayed
for particle-associated reverse transcrip
tase activity, as previously described,
using Mg** as divalent cation, oligo
dT«poly(rA) or oligo dG-poly(rC) as prim
er-template representing viral polymerase
activity, and oligo dT«poly(dA) as primer
template representing cellular polymerase
activity.1’1 Results are expressed as counts
per minute of methyl-tritiated-deoxythymidine triphosphate (16 to 18 Ci/mmole)
incorporated per 10X of culture fluid con
centrated 17-fold. Cell cultures were moni
tored for a minimum of a month.
Temperature Conditions
One milliliter of each dilution of HTLVIII (TM) was exposed to the following
temperatures and time periods: room tem
perature (23 to 27 °C) for 2, 3, 4, 6,11, and
15 days; 36 to 37 °C for 2, 3, 4, 6,11, and 15
days; and 54 to 56 °C for 30 minutes and 1,
3, and 5 hours. Virus suspended in 50%
human plasma was placed in closed tubes
and incubated in a regulated water bath.
After incubation at the specified tempera
tures and time, periods, infectivity assays
were performed to detect infectious virus
and to determine the TCIDM. Samples
were also tested directly for residual
reverse transcriptase activity.
Drying Conditions
One-milliliter aliquots of each dilution
of HTLV-III (TM) were spread in 30X50mm culture plates and allowed to dry
completely at 23 to 27 °C (approximately
45 minutes). When fully dried, samples
were covered and incubated at room tem
perature for 3, 6, 24, 72, and 168 hours.
After the specified incubation period, sam
ples were reconstituted in 1 mL of serumfree media and tested for residual reverse
transcriptase activity and infectious vi
rus.
Chemical Disinfectants/lnactivators
Chemicals were obtained from commer
cial sources: a combination of quaternary
ammonium chlorides, ostyle-decyl-dimethyl ammonium chloride (1.536%), dioctyl
dimethyl ammonium chloride (0.768%),
N-docyl-dimethyl ammonium chloride
(0.768%), and alkyl-dimethyl benzyl am
monium chloride (12.288%), totaling 15%
quaternary ammonium chlorides; alcohol;
sodium hypochlorite; nonionic detergent
P40 (Nonidet-P40); and alcohol and ace
tone. These were used at recommended
concentrations to treat HTLV-III (H9)
supplemented with 50% human plasma or
HTLV-III-infected H9 cells for various
times at room temperature (23 to 27 °C).
Infectivity assays were performed begin-
JAMA. April 11, 1986—Vol 255, No. 14
ning with a dilution of treat
containing a nontoxic concenti
chemical, ie, one that did not'
with cell growth and viability a
replication. The concentrations
cal used to treat HTLV-III (H9)jL?
follows: quaternary ammonium 'X-diluted 3 g/3.8 L of water (a final*.
tration of 0.08%); sodium hyrriL
diluted 1:10 in water (0.5% finalT
tration); nonidet-P40 diluted to (k.
isotonic buffer; alcohol diluted toX-"
water; and methyl alcohol and ad
mixed in equal proportions (1:1). *
RESULTS
dr
serial dilutions of virus stocks
tested in an infectivity assay ton.
titate the amount of infectiougLL.
present. A delay in the appear®
detectable reverse transcript*^ 7.
tivity and, in some instances^ “
duction in the level of recover
activity correlated with the
ing concentrations of virus usfii—
infection (Fig 1, top).
”
HTLV-III (TM) was calculated}
approximately 7 log^TCID^/nl.
similar pattern was obtained wit
XI,000 concentrate of HTLV-inV
and the titer was determined!
approximately 10 logwTCIDj/injLr
shown). The relative sensitivity of r
reverse transcriptase assay and
infectivity assay for HTLV-IH/r
are reflected in Fig 1, top.-rjundiluted supernatant fluids'^
tained detectable reverse transrtase activity (at time 0), infed
virus was detected at higher dikp(10” through 10“). This emphai.
the need to continue cell cul'----an adequate time period to ensmji
detection of low levels of viruST
for infection.
To test the effect of son^freqt
ly encountered clinical ar^pborlt
conditions on the infectivitjlJ^L
HTLV-III (TM), virus diluted media supplemented with 50%p_
man plasma was dried (Figs
and 2, top) and incubated at’8*7
27 °C, or incubated in an aq®*“
state at one of several different}^
peratures: room temperature (23~
27 °C) (Table 1), 36 to 37 °C (Ta»£
and 54 to 56 °C (Fig 1, bottoms,
various periods of time. In a
state, complete inactivation of
(approximately 7 logloTCIDj j r>
quired between three and seven
with an inactivation rate of ap&
mately nine hours per log reded
T-Cell Lymphotropic Virus Type III—Resnick)
■ition of treated! I .
-pjg 2, bottom). A low level of
toxic concentrate! |Uter. Reverse transcriptase activithat did not
Id be detected in the dried
d viability and/jl IOrations only through the 24ntentrations of 4]
L incubation period at room temHTLV-III (H9)
Lure (F’S
center)- Infectious,
y ammonium chid ^associated virus in a dried state
•' water (a finaljj
. sodium hypojg L detected in a dried preparation of
er (0.5% finalTjj Confected cells (5X10’ cells) after 24
10 diluted to QjJ
but not after three days (Table
>hol diluted to 7w
• i alcohol and aJ fExposing virus to different temperoortions (1:1). J L’r^ resulted in a reduction of
Ifectious virus corresponding to in
Lasing times of incubation and
of virus stocks^ Creasing temperatures. Complete
•ivity assay to nJ Ltfivation of 7 logl0TCIDw or more
. of infectious
[(infectious virus was seen between
n the appearanS [j and 15 days of exposure at 36 to
- transcriptasjj K’C (Table 1). Infectious virus was
•me instances,:'^ kill detected after 15 days at room
vel of recovers temperature (23 to 27 °C) (Table 1).
• with the deS Beating virus in 1 mb of medium
virus used! fcntaining 50% human plasma at 54
Th® titer] L 56 °C resulted in a reduction of
■ s calculated tsj tirus titer at a rate of approximately
ogioTCIDa/nra j log reduction in TCID„ per 20
> obtained with# Linutes (Figs 1, bottom, and 2, bot
of HTLV-III (JI tom). The infectious virus titer was
determined tol reduced approximately 3 log,0TCIDw
^gioTCIDjo/ntLld liter one hour, 6 logloTCIDM or more
"e sensitivitydfa Srithin three hours, and after five
.se assay and n lours no infectious virus (>7
or HTLV-III/Lfl k„TCID„ reduction) was detectable.
ig 1, top..;TO hi> contrast, no residual reverse transiant fluids'"®! piptase activity was detected in virus
■everse transcS preparations after exposure to 30
me 0), infedis minutes at 54 to 56 °C (time 0 points
it higher dilntid In Fig 1, bottom).
This empHasS F Several commonly used chemical
e cell cultures^] [disinfectants were also tested for
riod to ensures Ithtir ability to inactivate HTLV-III
els of virus'lSS :.(H9) at room temperature (23 to
[27 ’C). Sodium hypochlorite at a 0.5%
if^ne freqoSj concentration (common household
a^Vd laboniM bleach in 10% concentration in water)
a infectivity q >nd alcohol at a 70% concentration
virus diluted^ Inactivated infectious virus below
1 with 50% M iWlcctable levels within one minute (a
■:d (Figs 1, eeid4 'Muction of >7 log„TCID„). Quaterabated at*23l ;Mry ammonium chlorides at a conin an aqoefl tentration of 0.08% reduced virus
. al differential
below detectable levels in
Lu/"311 ten minutes. Since nonionic
nperature
„ 37 °C (Ta®J I
rRCn!3 are routinely used for the
; 1, botton>)S ' -baration of viral proteins, the
Days in Culture
SULTS
I
nonidet-P40 on viral infectivme. In a
ivation of*?! [IITiv3? a'so tested. Exposure of
iOg,0TCID»E*| [•“Ited”' ■
0’5% nonidet-P40 reand seven gM ; Hon f” 'nact'vation of virus (reduc-ate of app^| ;»ithin 'nfectivity s8 log..TCID„)
One minute. A combination of
r log redn^TI E
Ill—Resi**^B I-.
a
•
-April
1986—Vol 255, No. 14
Fig 1.—Effect of sequential dilutions of untreated human T-cell lymphotropic virus type III
(HTlV-III) (TM) (top) and exposure of undiluted HTLV-III (TM) to dried state (center) or 54 to
56 °C (bottom) on infectivity of normal human mononuclear leukocytes. Mononuclear cells from
normal donors were prepared and infected with sequential dilutions of untreated or treated
HTLV-III as described in ‘‘Methods” section. Top, Solid circles indicate undiluted; open circles.
1O-7 dilution; solid squares, 1O'4 dilution; and open squares, 10“6 dilution Dilution of 1O'e
yielded no detectable virus through 42 days in cell culture (not shown). Center, So'id circles
indicate control; open circles, three hours; solid squares, six hours; open squares. 24 hours,
solid triangles, 72 hours; and open triangles, 168 hours. Bottom, Solid circles indicate control;
open circles, 0.5 hour; solid squares, one hour; open squares, three hours; and solid triangles,
five hours.
Table 1 —Stability of Human T-Cell Lymphotropic Virus Type III (HTLV-III) After
Exposure to Environmental Conditions*
Cell Free
23-27 °C (Room Temperature)
Cell Associated! (Drying [30 =C1)
•After exposure of HTLV-III (TM) (titer of approximately 7 logi0 tissue culture infectious o^se) to an
indicated condition for the specified time period, infectivity assays were performed as deserted in the
"Methods” section. Plus sign indicates that infectious virus was detected; minus sign, no infectious virus
detected.
TOne milliliter containing 5 X t0$ HTLV-lll-infected H9 cells was dried; after the specified time period, cells
were reconstituted in 1 mL of serumless media, cocultivated with 5X105 normal peripheral blood
mononuclear cells, and monitored lor infectious virus as described in the “Methods” section.
T-Cell Lymphotropic Virus Type III—Resnick et al
1889
alcohol and acetone at concc
routinely used to fix cells be
ing for viral proteins also re.
number of cells liberating j
virus to below detectable ]t
virus was detected in H'1
infected H9 cells treated for
utes with a 1:1 mixture of
acetone (Table 2). In contra
tious virus can be recover
fewer than 100 infected h
using the same cocultivatior. :
dure (data not shown).
COMMENT
Fig 2.—Effect of storing of human T-cell lymphotropic virus type III (HTLV-III) (TM) in dried state
at room temperature (24 to 27 °C) (top) and in aqueous solution at 54 to 56 °C (bottom) on
titer of infectious virus. Mononuclear cells from normal donors were prepared and infected with
sequential dilutions of HTLV-III (TM) preparations that were exposed to dried state and at 54 to
56 °C for variable periods of time as described in "Methods" section. Log,0 tissue culture
infectious dose (TCID,c) was calculated using Reed Muench method. Standard deviation was
calculated to be ±0.513 log,oTCIDM.
Table 2.—Stability of Human T-Cell Lymphotropic Virus Type III (HTLV-III) (H9)
After Exposure to Chemical Disinfectants
Chemical*
Final
Concentrationf
Exposure
Time, mint
Infectivity After
Exposure, LogI0
TCIDS0§
0.5%
1. 5. 10. 15
- <2.5
Untreated virus (control)
NP-404
+
10.5
Sodium hypochlorite
0.5%
1. 5
- <3.5
Alcohol
70%
1. 5
-. <3.5
Quaternary
Ammonium chloride
0.08%
t
+ >4.5
10
- <3.5
-------- 411
Alcohol-acetone
1:1
20
•Chemicals and viruses are described in '•Methods" section.
fVirus preparations were mixed with the indicated final concentration of chemical and mcutaicd for the
specified times at room temperature (23 to 27 °C)
iTime of exposure of the virus to the chemical.
§ Infectivity assays were performed at a final dilution that avoided toxic effects on the ceils, as described in
the “Methods" section infectivity is expressed as log(o tissue culture infectious dose (TCIDS0) per milliliter of
virus treated with the chemical disinfectants. Plus sign indicates virus detected; minus sign, no virus
detected
■ Five X1O5 HTLV-lll-infected H9 cells were fixed and air dried after the specified time period. Cells werereconstituted in 1 mL of serumless media, cocultivated with 5X1O5 normal peripheral blood mononuclear
cells, and monitored for infectious virus as described in the "Methods" section.
1890
JAMA. April 11. 1986—Vol 255, No. 14
Human T-cell lymphotropi.
type III/lymphadenopathy-aj
virus, in the presence of hum;- ma, was exposed to several ■
mental conditions encountered ural, clinical, or laboratory <- '
It should be emphasized L
concentration of virus used f.,
experimental studies (7 to 10
viral activity) was m:4^oi
magnitude above those co
encountered from patient
specimens. However, it is in
not to ignore any' potential i
tions regarding possible trans
of virus by contaminated need.
syringes or in clinical situ
involving contact with patient
or body fluids.
Infectious cell-free virus c<recovered from dried inateri.
up to three days at room tempeand in an aqueous environment
tious virus survived longer ir days at room temperature: .
27 °C) and 11 days at 36 to
Even under the more rigorous h.
conditions commonly used to '
vate complement (54 to 56 °C).
tious virus was detected after
hours of exposure. Tln^^ipro:
rate of HTLV-III inactivatin' '
served, about 1 logioTCIDs/20 n— much slower than previous!. 1
ported, ie, inactivation of HTLLAV after 30 minutes” or with'
minutes'6 '’ at 54 to 56 °C.
i
It is not known why an >
tenfold difference in the ap?'
rate of inactivation at 54 to 56’C
found. It appears that the n
inactivation determined herein
closely approximates that rep
for 50 °C in a previous report-”^ data emphasize the necessity 4
ing into account initial viruSp
and the effect of different expel?
T-Cell Lymphotropic Virus Type III — Ref
■ e at concenttU 11 nditioi'S (eg. volumes used, supx cells before! Ei^nts added, and the types of
as also redu£3 |
used) before reaching a concluerating infe(d
F53'
t0 the effectiveness of an
■ ec'table leveM L "fixation procedure. The stability
d in HTLVj h’ljTLV-ni at 54 to 56 °C suggests
■•eated for 2trj ■
the inactivation of virus in blood
:xture of aS L^ducts (eg, antihemophilia factors)
'n contrast,®;
fcld require more extensive treatrecovered^ Unt, as has been suggested. ’
nfected H9:a
[An important conclusion from
acultivation‘;ffi L c investigations is that monitor
-n).
residual viral reverse transcript. activity is not a reasonable alterO.-MENT
'<
1 ’tjvc to tests for infectious virus."
mphotropic «y in fresh preparations of high titer of
.opathy-assocW rirus, the level of viral enzyme activi
ce of humanS
ty roughly parallels the quantity of
> several enm!
infectious virus. However, the ability
".countered is{3 to detect viral reverse transcriptase
moratory settS ictivity is rapidly lost on dilution
lasized that! [Fig 1. top) or treatment of virus. For
is used for tu trample, at 54 to 56 °C, the level of
s (7 to 10 M riral reverse transcriptase activity
kiy orders']
se comirvd
patient-derid I J. Gallo RC, Salahuddin SZ, Popovic M, et al:
it is impord b'rrquent detection and isolation of cytopathic
otential imply hrtroviruses (HTLV-III) from patients with
[AIDS and at risk for AIDS. Science 1984;
ble transmisa £•500-503.
ated neediest I 2. Popovic M, Sarngadharan MG, Read E, et
Detection, isolation, and continuous produc
• nical situatia
tion of cytopathic retroviruses (HTLV-III) from
h patient tissw tp*lients with AIDS and pre-AIDS. Science 1984;
«
[221497-500.
virus could! f 1 Salahuddin SZ, Markham PD, Popovic M, et
Fib Isolation of infectious HTLV-III from AIDS
' material aid [and ARC patients and healthy carriers: A study
risk factors and tissue sources. Proc Natl
.am tempera® ;'cf
LtadScj USA 1985;82:5530-5534.
ironment, ira I 4. Sarngadharan MG, Popovic M, Bruch.L, et
. longer thail iak Antibodies reactive with human T-lymphoterature (23 a jtropie retroviruses (HTLV-III) in the serum of
with AIDS. Science 1984;224:506-508.
at 36 to 31'1 [patients
i 5. Broder S, Gallo RC: A pathogenic retrovi
rigorous heat® rus (HTLV-III) linked to AIDS. N Enyl J Med
|l*4;311:1292-1297.
used to inatti 6. Safai B, Sarngadharan MG, Groopman JE,
to 56 °C), it*! rtil: Seroepidemiological studies of HTLV-III in
■ted after thii
hj^^proxiffll
■ nacti vation'dj
.. .'CID^/20 min]
previously fl
■n of HTLV-M
;l! or withiBW
°c.
AIDS. Lancet 1984;1:1438-1440.
, 7. Biggar RJ, Bouvet E, Effesen P, et al: AIDS
Europe, status quo 1983: Recommendations:
•wporl of a meeting co-sponsored by the Danish
rapidly decreased to below detectable
levels within 30 minutes, whereas
infectivity assays detected virus for a
much longer period of time.
It is clear from these and other1617
studies that infectious HTLV-III/
LAV can be present after exposure to
a number of environmental condi
tions encountered in a laboratory
and/or clinical setting. Fortunately,
HTLV-III/LAV behaves similarly to
other enveloped retroviruses in its
sensitivity to chemical disinfectants
and detergents?61819 We found 0.5%
sodium hypochlorite (10% solution of
household bleach), 70% alcohol, or
0.5% nonidet-P40 to completely inac
tivate HTLV-III within one minute of
exposure.16 Also, a combination of
quarternary ammonium chlorides
(0.08%) completely inactivated 7
logl0TCIDy) or more of infectious virus
within ten minutes. Fixation of
infected cells with alcohol and ace-
tone also abolished the ability to
recover virus within 20 minutes of
exposure.
Laboratory personnel who come
into contact with HTLV-III/LAVcontaminated materials, especially
concentrated preparations, should be
aware that infectious virus can per
sist in a liquid or dried state for
prolonged periods of time, possibly
even at elevated temperatures. A
thorough cleansing of contaminated
surfaces, utensils, and equipment
with commonly used disinfectants,
however, is sufficient to inactivate
the virus. As more is learned regard
ing the stability of HTLV-III/LAV, a
rational basis for prevention of its
accidental spread can be formulated.
This investigation was supported in part by a
grant from the Key Pharmaceuticals Medical
Research Foundation, Inc, Miami, Fla
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Dalgleish AG, Beverly PCL, Clapham PR,
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Popovic M, Reed-Connole E, Gallo RC: T4
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Spire B, Barre-Sinoussi F, Dormont D, et
al- Inactivation of lymphadenopathy-associated
virus by heat, gamma rays, and ultraviolet light
Lance/1985;l:188-189.
16.
Martin LS, McDougal JS, Loskoski SL:
Disinfection and inactivation of the human
T-lymphotrophic virus type III/lymphadenopathy-associated virus. J Infect Dis 1985; 152:400403
17.
McDougal JS, Marlin LS. Cart SP, et al:
Thermal inactivation of the acquired immunode
ficiency syndrome virus human T-lymphotrophic
virus III/antihemophilic factor. J Clin Invest1985;76:875-877.
18.
Spire B, Montagnier L, Barre-Sinoussi F,
et al: Inactivation of lymphadenopathy-associ
ated virus by chemical disinfectants. Lancet
1984^899-901.
19.
Klein M, Deforest A: Principles of viral
inactivation, in Block SS (ed): Disinfection, Ster
ilization and Preservation, ed 3. Philadelphia,
Lea & Febiger, 1983, pp 422-134
3
• hy an all®]
■ the app®*]
54 to 56 °C’]
at the rati J
d herein Ofl
that reporfj
. report"
■cessity of4*l
al virus ti^l
•nt expert®™
I—Resnick M LJAMA- April iit 1986—Vol 255, No. 14
T-Cell Lymphotropic Virus Type III—Resnick et al
1891
P 1 S ' 2-v .
Page1 of 2
Cofnrrtunity Health Cell
’ I tX 32" <rextniriyiwo(a;norrnaii.com>
<hiv@Dhmovement.orq>
Thursday, May 20. 2004 10:03 AM
Trsstiny IIIV snd AIDS usiny the Dr. I larold D. Foster Concept
rrom:
To:
Sent:
Subject:
Hello
I got an email sent to me asking me to share information about the work. of
Dr. IlaTvld D. Foster on the treatment oflllV and AIDS. I think you may be
very interested in it.
Dr. Harold Foster has Apparently developed a safe, simple to administer and
low cost approach to help people with HIV and AIDS. Dr. Foster's approach
addresses the extreme iiutiitiuual dcuCieiivies found hi people with AIDS by
applying the concept of "total deficiency targeting". Dr. Fosters approach
apparently helps people with Hit7 and AIDS overcome competition from the HIV
vims for specific essential minerals and amino acids in their bodies
Di. rostei's appioauii is consistent with tieaunenl icgnnes piuuiuted by Di.
1 shabaiaia-Msimang, South Africa’s Minister of Health, a physician and
obstetrician, and with the general principles of the VTTAGRANT program
tmenited bv the Clinical Directors Network Inc, in New York. Details on the
s\r-r\n*"rsP +Ur>+
ivwuivu uuut.
v41- I'Ve V.-\
noeOAnf Ann kvrv yznirmrl «+
>-> x_zx . a. voivi o uvuaiuvjw
v vixxx
Iv'ixxxli tie
www.ioukioiheip.com.
Dr. Foster has been committed to helping people with HTV and AIDS recover
and resume productive lives. He has been responsible for providing advice on
tec tbriuUiation ot products presently uiidcigomg clinical trials m Africa.
preliminary reports from Botswana, Kenya and South Africa apparently
indicate a recovery rate exceeding 90%.
I believe Dr. Foster has been prrending products at his own expense to
people with 111V or AIDS in Kenya and South Africa. Dr. Fosters approach
appears to work quickiy without the unfortunate and unpleasant side-effects
of many antiretroviral drugs. Dr. Foster has apparently developed products
suitable for children, both those with HTV and those who are most
susceptible to contracting ft
Dr. Foster is a very accomplished academic and researcher, with over 235
books and articles published.
T\r
x^x . x-
nr*4r»ljar i»sz'1rrfJr-nrr HVVlvrr Tll\7 I Pi nr- TVffircnrJ Cfx
ojvuiulu LukivivJj
!1 xxj
aajx »
x xxuxx tyu-kuevu mv ITAUV.I
Muic Rapidly iii Sub-Sahaian ATiiua Thun in Nuith Amciiuu", Medical
Hypotheses, vol. ou(4), pp. 011-014,2UQ3, and "Howhiv-i causes aids:
implications for prevention and treatment”. Medical Hypotheses, Vol. 62(4),
pp. 549-53,2004, are available al (he National Library ofMedicine
MEDLLNE'PubMcd W’cbatcs, ww.nlm.nih.gov or www.pubmcd.com. If you scorch
PubMcd fur ”Fu»lcr HD" yuu will see ixita£ the absu avis fur the Mcdiuul
Hypotheses HIV/AIDS papers are available online.
The Tftnnftry/Fphnisiry 2004 and March/Anril 2004 issues ofNexus
also contain recent articles wi'ittcii by Dr. fostet about tlic ticatmcnt ot
AIDS. These articles are available at
www. nexusmagazine, com/articles/aids. selenium, html and
www.nexusmagazme.com/articles/aids. selenium2. html.
5/2i/04
Page 2 of2
If One is iiitvi OStvd, COpieS uf Di'. Foster's bOOK, "What ready CaUSeS
AIDS’’, published by Trafford Press, are available free at
www. hdfoster. comAVhatReallvCausesAIDS .pdf.
A complete list of his publications is available at www.hdfoster.com.
Interest in Dr. foster's work has been growing. On March 23,2004, Dr.
Foster was a special guest for over one hour on Radio786 in Cape Town, South
Africa. On April I, 2004, he was a special guest on Paltalk Radio in New
York, v,lien two hours were dcdmated to caller ^ues lions on his research and
iieaimeui approach for HTV and AIDS. Earlier iliis month, Dr. Foster was
apparently presented with its "Doctor ot the Year" award by the
International Society for Orthomolecular Medicine at its 33rd Annual
International Conference in Vancouver, Canada.
If you are interested. Dr. Foster can be reached by telephone at the
University of Victoria, in Canada, at (area code 250) 721 -7331, or by email
at fosterhd@fosterlabs.com.
Sincerely,
Tex Tardy
Leant to simplify your finances and your life hi Streamline Your Life from
MSN Money. hnp.7/speciai. msn.com/money/0405streamiine.armx
5/21/04
Page I of 2
3>l 5’— 7_V.
Community Heaiih Ceii
r-rom:
To:
1 Kichara Stem" <rastem(gjracsa.co.cr>
<sochara@vsnl.com>; "Brad McIntyre" <bradmcin@telus.net>; "Renate Koch"
<rkoch@accsi.org.ve>; "yolanda simon" <cm@carib-link.net>: "william smith"
<sm!thw@c2rib2nk.org>; "tilly sselers" <tsGl!ers@2!ds2Hi2nce.org>; "simon harris"
■*o» ioi i
i
i iuivo.wi 1i* ,
”O«z^++ Ci r>->
vwuuvuiu.
!n l-t r•*m r4tn rtlrtrize*’
'vwn.o»oi u.\jyi nio.Uiy’, iumyivlid
<iyiuiia@suuiaisecuiiiy.uig.bz>, "luy iieau” <iuy.heud@bbu.uu.uk>, "RBM"
<canerxe@paho.org>; ‘ Patricio Marquez" <pmarquez@woridbank.org>; “Pamela Teicnman"
<pteichman@usaid.gov>; "npersaud" <npersaud@sdnp.orq.gy>; "mary Mulusa"
<mmu!usa@worldbank.org>: "Maria Noguerol" <maria.noguerol@aeci.es >: "manual
Msnchcno" <mm2ncheno@integr2.com. sv>j "Leslie Rsmssmmy"
<rn;n;3tGrofhGaith@hotnia;l,com>; "Icasti'lo <ICQStinO^^LJSSic».gov>; jchanna
».
'-juiianna.Kiiuess@ylz.de>, "Jaya Chirnnani" <juiiiiiniuiii@s-3.uum>, 'janiue Riuhuids”
<Richardsj@moh.gov.jm>; “guide bakker" <guido.bakker@thegiobaifund.org>; “Francisco
Paniagua" <paniagua@ops-oms.org>; "f.cox" <fascox@yahoo.com>;
<emmanuel@caricom.org>: "egaillard" <egaillard@msn.com>: "Dominic"
<Dom!n’c.s2m@undp.org>; "DFID Caribbean" <w-om2m11Ii@dfid.gov. uk^; "DFID" <mrnwMroGx^dnd.50v.uk*’j dannis jonas" <drnjonGS@bt!.r.8t>; Corina Gardner
^uuiifia.yaiunei@iifi&.yuv>, "ukiilon@Gaiiuurn.oiy" <ukiiiuoii@uaiiuuni.oiy>, "BSD"
Sent:
Subject:
<emestm@iadb.org>; "Barbara" <odez@s-3.com>; ::Annette Ghee"
<ghee@u.washington.edu>; "Anneqret" <juventud.sida@intemet.net.do>; "almiron, Maria"
<almiron@paho.org>: "Alexandre Grangeiro" <grangeiro@aids.gov.br>
Bunds'* Msv 23 2004 11:41 PM
700 PLWA in Pariarria Face 'Dcatn by Bureaucracy'
IT you wish to be removed from this list send an e-mail to raslemffiracsa.co.cr.
Completesilence from UNAIDS, PAHO:
700 PLWA in Panama Face "Dggih by Bureauorggy*
<r-\0
Mtld Gvaised »»»O
Y,
Agua Buena Human Hights Association"
Unbelievable es it seems 700 People I iving with HIV/AIDS (PI WA) in Panama have been without their anti-retroviral
treatment for ny«r two months du? to bureaucratic ''errors.”
J
L
.
/ •.
Most of these 700 people receive ARVs through the Panamanian Ministry of I Icaith at one major Inner city hospital
come from the country's working classes, and informal labor force, and are therefore among the nation's most
impoverished people.
Shu
1100 employed middle and upper class PLWA who receive treatment through the government run but semiautonomous "Social Health Institute," continue to receive their treatment. Like many Latin American countries Panama
has a divided health care system, with the poorest people generally receiving little or no health care through the Health
Ministries.
This past Anri!, two Panamanian NGO's. Genesis and PRORIDSIDA sent letters to Health Minister Fernando Garcia
demamfing the end to interruptions of ARV therapy, which succeeded in immediately ending a brief treatment interruption
for those who receive medications from the -Social Health Institute, but has had no impact on the care and treatment of
those who must rely on the Health Ministry.
in total, 1,823 PLWA ioCciVc ARV uiorupy iu PafiaiTiu, u'liuUyh both ScyiTioFitS of th© divided HOaith Cai~6 systei'n.
Dr. Gladis Guerrero, National AIDS program director acknowledged that because of "human error," the Health
Ministry program failed to carry out purchases to insure continued treatment access for those who receive their ARVs
5/24/04
Page 2 <.if2
through if? program?. Ths result has been a complete halt to treatment for these 700 people. Ague Buena spoke with Dr.
Guerrero on May 21st.
Dr Guerrero would not say when the problem wss expected to be resolved, only that she hoped that it would be "as soon
as possible."
Just six months ago. dunng the third Central American AIDS Conference held among Panama City's five star hotels and
skyscrapers, the country was praised by officials from UNAIDS, PAHO, and WHO for its efforts to combat the epidemic.
But now that the limefight has shifted elsewhere, the Panamanian government seems to have found a way to save some
money at the expense of the country’s poorest people who have little impact on government policies and face
overwhelming social and economic obstacles. Meanwhile not a word of protest or concern has come from these
same International Agencies of Cooperation who are busy espousing new programs at Innumerable press conferences.
Although both government end intemetione! officials ere ewere of the danger of resistant strains of AIDS, not to mention
the Inevitable deterioration 2nd eventus! death of those affected there has been virtual!'' no nubile outer'* other than
the •s-ttitlcee Acehiree hv
Donerwoniom NfiO’®
50 uuicr rattan laniai is with advanced AIDS who aisu icceive uieti iieaiui oaie iium lhe Hcuii.ii Millisby have completed
the onerous bureaucratic procedures in order io qualify io begin anti-retroviral therapy but many of them have already
died while waiting for medications that have never arrived.
Dr. Peter Plot. Director General of UNAIDS, and Dra. Mirta Roses Periago. Director of PAHO ” should step forward
and condemn this blatant human rights abuse that violates all of the best practices developed by the various UN Agencies
with respect to the epidemic, and also singles out as its victims the most defenseless members of Panamanian society.
Although feilure to nlsco individuals on enti-retrovira! there*"* should bo condomnod, in our opinion it is even more
horrible to sisrt PLWA on treotment 2nd then intem!nt this treotment for 2 neriod of months which will inevitob!'* lend to
death
e«ma
and
a earinne rtyhlir* haalfh nrehlrsm fnr ell rAnramar]
If I IMAIPlQ end DAt-IO rAnfimra M
"ns'-jtmiity" nround such blstwfit ebusss they lose their more! credibility end become eccomn!lces in this very
r.vxrvinl,-.
r>k>r>r»n
irvijk vAUriii^ vi uvuw
lr* z4rWz-.rr\»n4
i4J-»7Avi45jR.r>
1 vs 4 n
rtf 4«4«lh r rrnrirrttr'fl| J“v^.d 5<*dit Hdr
iiiMiii^iynit uuuiviiuvo u^umoiu vruoo vi Ivwiiy >i iui yn iv»iti_vv iiimiiimuuIu.
“PAHO is the pan American Heaiih Organization, responsible for implementation of the WHO "3 x 5" program in Latin
Amenca.
’Agua Buena Human Rights Association
San Jose, Costa Rica
Richard Stem, Director
Tel/Fax: 506-234-2411
rastem@racsa.co.cr
Guillermo Murillo
Assistant Director
Tel/Fax: 506-433-8522
memonvs@racsa co nr
www wnijwtwiRniR nrn
(Aqls
wtehss Io rscosntzs Jsv?€r Pczstts cf Fur-dsdor? Csnssfe for Ms support !n cornnSry’ this Infonnstlon'
3/24/04
\^i
S •*” *2— o,
12/14/2004
Page 1 of2
From:
To:
Sent:
Subject:
'AIDS Health News" <aids_health_news@yahoo.coif)>
<hiv@phmovement.org>
Tuesday. December 14, 2004 12:53 AM
Article: Disease theory more innovative, says MD
Disease theory more innovative, says MD
Grama Lilwin
Times Colonist
i-ridav, December 10, 2004
An American specialist who has treated AIDS patients for two decades
believes the controversial theory advanced by UVic professor Dr. Harold
^Foster has ment,
■
"I tiihik the combination of nutrients he has come up with addresses the
Achilles hoc! of the immune system, when it is infected with HIV," says Dr.
Brad Parks, a medical doctor and neurologist who treats AIDS patients in
the Seattle area and specialized in immunity disorders.
"I used to get 40 or 50 active AIDS patients coming to see me each year,
but I haven't for the last couple of years." Parks says he's not getting
the calls because he directs patients to Foster's web site, where they can
print out his book for free and use the information in it to buy their own
supplements or nutrient-rich foods.
"I say, call me if you have any questions, but they don't. Clinically,
these people get well," Parks said.
Parks adds the theory about these supplements is not complex or
controversial. "it's just innovative," and word of it is spreading through
"No one else is promoting it because there is no patent substance here, no
exorbitant mark-up. no navoff in millions. Harrv has put cvcn/thing out
there, without any hook, because he is tremendously generous."
Victoria respirologist Dr. Jim Sparling, who has been to Africa a dozen
times and is well aware of the AIDS pandemic, is also investigating
Poster's theorv.
The director of. Victoria's IB Clinic at the Jubilee Hospital, is involved
in a small trial at a hospital in Kampala, Uganda, where three UBC students
are tracking 40 patients taking the supplements.
"So far tire information is anecdotal, but patients do feel better and some
i/winiM
ilciVC gaiuCu VVCiguL.
u ui&insu vu-ifi CiGcioi. wn&t Goes lie uiiniv oi tlie theory /
"Either I larry Foster is totally off-the-wall crazy, or brilliant, 1 do know
he is verv interesting, enthusiastic and passionate."
Sparling acids the tact tnat ATDt> patients in Airtca and everywhere have
increasingly low levels of selenium is important and has never been
properly studies, "though it has been known for 55 years."
"Hepatitis B is also associated with a selenium dependent enzyme system,
and 350 million people are infected with it in Asia.
"These are opportunistic infections, and I am very concerned both as a
doctor and a human."
There have been 11.510 reported cases of HIV in B.C. during the past 20
years and 3,730 cases of AIDS., according to the B.C. Centre for Disease
Control.
Copyright Times Colonist (Victoria)
12/14/2004
Page 1 of 4
From:
To:
Sent:
Subject:
if you
"Richard Stern" <rastern@racsa.co.cr>
'Brad McIntyre" <bradmcin@telus.net>: <scchara@vsnl.com>; "Alexandre Grangeiro"
<grangeiro@aids.gov.br>: "almiron, Maria" <almiron@paho.org>. "Annegret"
<juveniud.sida@internet.net.do>: "Annette Ghee" <ghee@.u.$sshington.edu>; "Barbara"
<bdez@s-3.com>; "BID" <ernestm@iadb.org>; "ckirton@caricom.org" <ckirtcon@caricom.org>:
"Corina Gardner" <corina.gardner@hhs.gov>: "dennisjones" <dmjones@btl.net>: "DFID" <mmunroe@.dfid.gov.uk>: "DFID Caribbean" <w-o,■•namuli@dfid.gov.uk>: "Dominic"
<Dcminic.sam@undp.org>: "egaillard" <egaillard@msn.com>-; <emmanuel@caricom.org>; "f.cox"
<fascox@.yahoo.com>; "Francisco Paniagua" <paniagua@ops-oms.org>; "guide bakker"
<guidc.bakker@theg!obalfund.org>; "janice Richards" <Richardsj@moh.gov.jm>; "Java Chimnani"
<jchimnani@.s-3.com>: "johanna" <johanna.Knoess@gtz.de>; "Icastillo" <lcastillo@usaid.gov>:
"Leslie Ramsammy” <ministerofhea!th@hotmail.com>; "ma.nuel Mancheno"
<mmancheno@integra.com.sv>: "Maria Noguerol" <maria.noguerol@aeci.es>: "mary Mulusa"
<mmuiusa@v7orldbank.org>; "npersaud" <npersaud@sdnp.org.gy>: "Pamela Teichman"
<pteichman@usaid.gov>; "Patricio Marquez" <pmarquez@worldbank.org>; "RBM"
<carterke@.paho.org>; "roy head" <roy.head@bbc.co.uk>; "ruth gloria"
<rgioria@socialsecurity.org.bz>; "Scott Evertz" <Scott.evertz@hhs.org>; "simon harris"
<sharris@cwjamaica.com>; "tilly seelers" <tsellers@aidsalliance org>; "william smith"
<smithw@caribank.org>; "yclanda simon" <crn@carib-link.net>
Wednesday, September 15, 2004 6:15 AM
Deadly Bureacracy: Dominican Republic Retreats from "3 x 5” commitments. Lowers ARV Access
to a? removed from this list, send an e-mail to rastern@racsa.co cr
13 September. 2004
(t iV 15 tircr? u £ lei €V i
■LfVlIUfijK <llt X\A
‘-I iS-i ~r »»
J.
4
241V.!:?.?
.EjWr“.
Eugene Schiff-"
Santo Domingo,
The two of us held tightly to die moto-tard driver and handrail as the rusty old bike sputtered along the dirt road leading to a
middle class neighborhood on die outskirts of Higuey, an agricultural town in the easternmost comer of die Dominican
Republic. We paid 4G pesos, about a dollar, and the mote zipped away.
Irene Ramirez”, an HIV- mother, leader and activist from the nearby city of La Romana and I were soon met by Alejandra
Sanchez. Adejandra sreeted us. and welcomed us into her home. She prepared plastic chairs, and beeged us to please sit
down.
Tdejandra” is die founder of a support group consisting of forty individuals, mostly of women living with HIV or .'.IDS in
Higuey. She related that of these forty, only she and another woman were currently receiving antiretroviral ("ARV) therapy.
Both were paying for the therapy and their own tests and doctors fees out of pocket, without any assistance. Alejandra
confessed she was periodically obligated to buy her medicines on the black market from another person living with
04
who offered their own treatment to her at reduced prices.
Still, even tile minimal package of generic ARVs, vitamin supplements, expensive lab tests needed to monitor viral load and
CD4- cc unts, and transport to the clinic is too costly for the vast majority of people living with .'JDS in the Dominican
Republic .; pay fo r dremselve.. Economic security for people living with AIDS is further challenged by the tact that
employers m die area, including resort hotel owners and factories in special Free Trade Zones, regularly break the law
nominally protecting people living with /'JDS here. They routinely fire workers found to be HIV- and require an HIV test
before rering new employees Most of tire HIV men and women I have met here are poor and unemployed, which they
£vui:
^ricu-dy. .u-iiz.lv. suu.ised diat die personally knew 15 to 20 of the others, many highly sensitized and longtime
mc;nb_m e .'foe group. who already showed signs of AIDS defining illnesses, such as wasting and weight-loss, and seme had
.... i. ia i.... a.?<■. . ■.,.', a iis, is i <—c tier is. I? rgenll, needing but itliout access ti w iR\ ti eatmen,,, t,anv o f them might
no, live ;m ;s tiiw; si?; months to a year without these medicines.
Nationally, tliere are an estimated SS.000 people living with HIV.'AIDS in the Dominican Republic, according to the 2004
UX.UDS report ?»t least ten thousand people living with /JDS currently need antiretroviral treatment. Yet barely 600 (6%'j
receive medicines in publicly funded treatment centers. Of the .9,400- others who need treatment now, and SO.OOCH- others
mav need it mine luiure, most have incomplete or no access to antiretroviral treatment, medicines for opportunistic
miecuons. er la— icsis oliVsicians use to place patients on ?1R\ s at ill— appropriate time and momtoi progress
Many blame die lack of significant political will and the previous administration’s notorious ineffectiveness for the current
si tuauon. fixpectutieris tor scaiiiig up tieatm—nt access her— hu< e been lev, cred i epeatedly. u om the goal of 20CO people on
/JRVs by the end of 2003 to 1500 in 2004 and now to 1000. There are some doubts if there will even be 1000 people
enrolled in the National Program by the end of 2004. These expectations run counter to the WHO’s well publicized “3 x 5”
ciun desitmed to drumuticaliv increase numbers of PLA, A w ho hav — AR\ access by 2005.
However, there are also numerous other institutions with tremendous resources, capacity, and influence-all of which must do
much more, as they have committed to working for scaling up treatment here. For example, the Clinton Foundation secured
and provides die cheapest available medicines from generic manufactures, which are new distributed in at least 12 sites
throughout die country. Columbia University has provided technical assistance in areas like establishing national guidelines,
L umma he—. tn » ■. ci kem, and lookrns’ at adv er >?— effects for patients on ARV s. In press i eleasec. websites, anu bulletins both
Columbia and the Clinton Foundation regularly promote their respective institution's programs and commitments.
Unfortunately neither publicly disseminates candid, accurate and up to date information about the real needs and lack of
progress to date as widely in similar media channels.
USAID, which is one of the main donors for HIV,AIDS programs here, sponsors a diverse range of projects-upgrading
CjiTiies, u aiiui iz . ouths and counselor s foi prev ention and education campaigns, and col labor a ting w i th religious groups.
among other efforts while providing S35 million dollars for HIV,'AIDS over 5 years. USAID also finances an NGO called
Conecta, winch coordinates and provides technical and financial support to NGOs and government health programs.
—on——ia tics assumed temporary miancial re&ponsibilitv ror certain lab procedures like CD4• and viral load tests for a limited
number of people living witli AIDS registered in the National Program. However, the agency pays well above the market
rates, appreacliing nearly S100 per CD 4+ test and even more for the viral load. In contrast, CD4 tests cost from $5 to S30 in
most countries in the region. Witli excuses of “limited funds," and need for greater control, the tedious bureaucracy
associated », ith obtaining these tests has also created severe bottlenecks and waiting lists that reduce timely access to the tests
throiiahom me country.
Often unable to pay out of pocket for the same test, which would ensure them speedier results, many people living with AIDS
find themselves returning numerous times to centers in order to be placed on a waiting list and again to find out when they'
will be allowed to can take the —-D4— test and then to again to obtain the results.
Many lose patience as result, some never return, while others switch sites and enroll elsewhere to take the test again. Worse
still, many people living with AIDS are hospitalized and near death (if even then) before they can be authorized to take this
test and obtain results indicating they must start ARV treatment. Guidelines provided by tile World Health Organization
for “resource poor countries” suggest beginning ARV treatment in symptomatic HIV+ individuals, without waiting for CD-I
test results. Still, government programs, international donors, lab facilities, and companies supplying reagents and equipment
for such tests must reinforce their commitments to people living witli ?JDS and assure that these tests are widely available to
those who need them, not simply a luxury' purchased by those who can afford it.
The pharmaceutical companies also exercise great influence. Indian companies like CIPL/.. entered into special agreements
with the Clinton Foundation providing their cheapest prices for their generic medicines, which most of 600 people enrolled in
die national program currently receive. Tliis same price should also be unequivocally offered to the National AIDS
Commission t'COPRESIDA) for ARV purchases with money from the Global Fund. Also, serious concerns about bio
equivalence and recent WHO disqualifications of certain CIPLA and other generics need to be addressed in order to prevent
confusion and assure patients and physicians (who often have little choice in the matter) of file safety and quality of generic
antiretroviral medicines in the future. The Brazilian Government has also offered to donate stocks its own generic medicines
and provide complete ARV tlierapy fere for 100 pregnant women who are HIV-.
Gertam manuAciums ufyatented medicines, like Merck, have committed to reduce die price for ARVmedicines, like its
Stocrin tEfavirenz) a drug commonly used in first line ARV cocktails, and are providing the lowest available prices they
ocrur
r.a _ ,i,. n J otinuat!
. wirenz is par of one of the prefe . ’
;u tu u- j i.ill. riere >n Lbs Domm.-iui Republic. Still, uoctoi'.'r-poil thtn
t line treatment combinations but tliat it hasn't always been vvideh available
— '2 c.. x < V
. Cax-Gx «
> .. ...
uv-K, ixitil i'vvvilw i uxilxCx x'vfU2.>C tO lIIUiulCLj ulliJ DOIIllIUCtill RcpllOllC ill IiiJUClul UvCi,’ ’ '
c.i w--- -‘ v ; < • i ;v_.x; -..2. —, ;;i ^ ..•<•«' •
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' > i v -: •.’!uu> x-.vll J .OJIxi lux IxlvdlU UlC 3 ci 11U lijb pfCdUCtb u! i blit OU* •-'! f iuCx i j' ■« i T»cl ilSiGH
i. <■< ;*< -.lOu-kUi cucgc .-. »■'. ju i\?z Lie 2c4iii.iv di’, liiuiicd nuinbcu of pundits who niiglit uocd such u’cutiiidrits.
x ‘.'x
ui -ivui
nun.' Lui.i ...dlx.tUv- i.ilv v..<i~-U jNU'AiiUvx. U vrvll KllOVrix 01 pl Li.'.! iu 12 C iiu.'i prOVldcC* AR v II IcdlCli ?J. ’ tijill Uij'-A
icr AAJwu h;~ug wilh A’DS iu Sardo Domingo, offered documentation to Agua Buena that prices in Dominican Pesos of
. ki.30ii s XiiiviJa. Cs cii «vim a speeiui Gi^cuuiu orfbicd Ly a local cii??tnbiitoi. have doubled over the past v ear. flic
govemmrii
unit i'UCAD lias incorporated 11 new children at the Casa Ro sad a into the national program and
pioviucv. am
gdiiCixC . n •< <■ > Uijdjdjnes. but has stated that it cannot assume the cost of the remaining 22 children who
i-ixxxidvx
i.uLxc*c:xi il-.ciapcuuc regime;?., p'Timuiil'. due to tlic lugii costs of brand-name drugs, including Raletra.
. xij xiiiid.' al ale -—idSi-i RoiiLiLL a religious chanty, sav.? that private donations have decreased recentlv, and the entire program
is in jeopardy as they can barely afford the escalating cost of ARV therapy for the 22 children initially covered, winch has
risen w over So 6,0 00 dollars per \oar just for the medicines for these children alone. Despite die national economic crisis
uj..x ireutnicnt need^ uKe aiose al die ousa Rosada and elsewhere, Abbott refuses to include the Dominican Republic in its
Access to HIV Care Program. which would free up new resources for scaling up treatment access by providing lower prices
’ .-r k -.’.a+ri
.--Tic-T * T? * p'orl- ,->i
*<'• imivIlU UJ .K-l VUIwl . Ilk V l.lvLU Vlllv J.
/mother higlily profitable pharmaceutical company. Gilead, has performed clinical trials that have helped in evaluating and
approt trig its popular new drug V tread here m Santo Domingo for the past font years. Still, despite promoting its
to compart’, s plulanthropic global access progiams, Ciilead won t include tlie Dominican Republic in the list of
countries eligible for its access program for Viread Ctenofovir'), and reportedly doesn't even market this drug in the country.
Additionally agencies like UNAIDS, UNICEF. UNFP?., UNDP, GTZ, PAHO'WHO, the Spanish Cooperation, resource®
xrom the Catholic Church and private sector, a S25 million dollar loan from the World Bank for HIV,'AIDS several years ago,
arid the Dominican government’s own public health sector budget have established several important programs, but
cnsusu o,,circles hu’> e bceii unable to coordinate better access to treatment. k-r .IDS .aid P.\HO have specie 1
mandates to support tlie WHO 3 x 5 program, but their impact in the Dominican Republic lias been negligible.
The Global Fund proposal, which would provide over S-IO million during a five year period, was approved here in January
— suc.
_tive oi ,|UiCld. mcieasins ,e..-curses a.uilable tor tlie purchase oi AR . treatment. 1 et in ^eptemoer
Dro-J, over 20 months later, none of this money has been received for treatment and no .\PvVs have been purchased.
Bureaucratic procedures and internal conflicts between the Global Fund, different agencies and COPRESIDA, the Principal
Recipient, have resulted in delays and the deaths of thousands.
Trie combined result of all of these agencies and resources is dismal and insufficient-a national program that has not been
cole to provide more than 600 people with ARV treatment to date. Extraordinary measures must be taken in order for these
instiruiicns to move forward witli the appropriate dynamism and ambition needed to empower local actors and overcome
current crisis. For rite sake of thousands more people living witli AIDS here and their families and children-medicines, lab
tests, counseling, and appropriate social services must be made swiftly available. A month or year or two from now will be
cities mentioned above)
Eugene Schiit
vanobeun coordinator
. rgua Buena rmmun Rights jYssociation
lecsS'Cii.c aol.com
Tel: S09-S5S-1332
Ricnarfi Stem. Director
Tel/Fax: 506-234-2411
I iijlcllilui' iciC5il.C0.CI
'v
ex C LI 2 0 U S fl S. Q TQ
9/15. OJ.
Page 4 of4
Murillo
FeLFax. .‘•v..-430-M' c
iCli ivi.'I S ci 1 <-•- AL. w
1:
~pi S "
Counselling Guidelines
on Survival Skills for
People Living with HIV
Caiudisn International
Development Agency
Agcnce carudicnne
de devcloppcmcnt international
Counselling Guidelines on
Survival Skills for People Living with HIV
© SAT Programme
First Edition July 2001
Produced by the
Southern African AIDS Training (SAT) Programme
With funding from the Canadian International Development
Agency (CIDA)
Extracts from this publication may be freely reproduced
with acknowledgement of the source, provided
the parts reproduced are not distributed for profit.
Copies of this publication may be obtained from the
Southern African AIDS Training Programme
3 Luck Street
PO Box 390 Kopje
Harare, Zimbabwe
Tel: 263 4 781-123
Fax: 263 4 752-609
E-mail: info@sat.org.zw
ISBN: 0-7974-2303-6
Foreword
This is the fifth publication in a series of guidelines for counselling
people who are infected with HIV, who are concerned about being
infected with HIV, or who are living with or caring for people with AIDS.
Each booklet offers practical guidance on specific counselling issues.
The publications are designed for use by volunteer counsellors, non
professional counsellors, and professional counsellors who do not
have extensive experience of counselling in the context of HIV.
The guidelines are the result of workshops organised under the SAT
Programme’s “School Without Walls” bringing together professional
counsellors, people living with HIV, staff of AIDS Service Organisations,
and people working in the field addressed by the publication.
Production of this booklet on survival skills for people living with HIV
was facilitated by The Centre, a self-help group of people living with
HIV in Harare, Zimbabwe. Editorial, and design assistance was
provided by the Southern Africa AIDS Information Dissemination
Service (SAfAIDS), a regional organisation based in Harare
specialising in AIDS information management and dissemination. The
booklet reflects the unique experience of the group of counsellors
and activists that met in the workshop facilitated by The Centre.
To date, the SAT Programme has published counselling guidelines in
English and Portuguese on the following subjects:
Number 1: Disclosure of HIV Status
Number 2: Child Sexual Abuse
Number 3: Palliative Care and Bereavement
Number 4: Domestic Violence
The SAT Programme is a project of the Canadian international
Development Agency delivered by the Canadian Public Health
Association. It has been at the forefront in supporting the community
response to AIDS in Southern Africa since 1991. “The School Without
Walls” is an initiative of the SAT Programme to validate, promote, and
diffuse the unique Southern African experience and expertise in
responding to HIV. The SAT Programme is profoundly grateful to the
volunteers and professionals who have made this publication possible
and who are supporting SAT in the preparation of further publications.
> J
M'
' \
SAT Programme
Counselling guidelines on
survival skills for people
living with HIV
Creating these guidelines
These guidelines are based on the experiences and advice of people
from across Southern Africa who have extensive experience in
counselling people living with HIV or AIDS. The guidelines were
produced by the SAT Programme in collaboration with The Centre
and with editorial support from the Southern Africa AIDS Information
Dissemination Service (SAfAIDS). The Canadian International
Development Agency funded the publication. Cartoons were drawn
by Joel Chikware.
iii
Contents
Definition of terms
........ ............ ................................... 1
Introduction ............................................................................................. 2
Preparing for a counselling session.................................................... 3
Pre-test counselling................................................................................ 4
Testimony 1.............................................................................................. 5
Post-test counselling.............................................................................. 6
Testimony 2......................................................................................... .
7
Stress management............................................................................... 8
Disclosure of HIV status.......................................................................10
Treatment and medicines.................................................................... 11
Nutrition................................................................................................. 14
Testimony 3........................................................................................... 18
Reproductive and sexual health..........................................................19
Self-awareness..................................................................................... 22
Supportive counselling.........................................................................23
Testimony 4........................................................................................... 25
Peer counselling................................................................................... 26
Supporting the counsellor................................................................... 28
v
Definition of terms
Survival skills are skills that empower
persons living with HIV to cope with the
difficulties and challenges they might face, and
to live a long, fulfilling life. Some people refer to
such skills as positive living skills.
Client is used to refer to the person
who is being counselled.
PLWHA is an abbreviation for
"person living with HIV or AIDS”.
The abbreviation is used with different
meanings in different publications. In this
booklet, it refers to a client who is HIV positive.
Support groups are groups of people who are facing similar
challenges and who decided to meet regularly to share experiences
and to help each other. Sometimes such groups are referred to as
self-help groups.
Opportunistic infections are infections that are particularly common
or particularly severe in people whose immune system has been
weakened by AIDS. The most common opportunistic infection is
tuberculosis.
Disclosure means telling others that you are HIV positive. Disclosure
can also be involuntary when this information is revealed by someone
else without your approval or knowledge.
Anti-retroviral drugs or ARVs are a group of medicines that are
capable of slowing down the progression of HIV infection to AIDS.
These medicines do not cure AIDS, but if taken daily for the rest of
your life, they may prevent the progression from HIV infection to AIDS.
1
Introduction
Talking about survival skills is a vital part of HIV counselling. It helps
people understand that their life is not over because a laboratory test
has found that they are infected with HIV. They can still live fulfilling
lives, and they are still in control of their own quality of life. Survival
skills should be discussed in all counselling sessions, including in
sessions with clients who are unaware of their HIV status and are
considering being tested. Knowing about survival skills helps people
accept a positive HIV test result because it reinforces the message
that this result does not mean the end of their life. Everybody needs to
understand that being HIV positive is not an immediate death sentence.
Following the positive living practices described in this booklet helps
people living with HIV to stay healthy and to live a longer life.
2
Preparing for a counselling session
Counsellors need to prepare for counselling sessions. Each
counselling session differs depending on the needs of clients and on
the issues and concerns they bring to the session. There are, however,
several things you can do to prepare yourself:
X Find out as much information as possible about HIV, AIDS, and
related subjects. This information should be accurate (from a reliable
and recognised source) and up-to-date.
X Make yourself familiar with the skills needed to prolong life and the
behaviours that speed up the progression of AIDS.
X Inform yourself about other counsellors, groups, and organisations
you can refer your client to for further help and support, especially
on issues where you feel that you laek expertise and experience.
X If you know other people dealing with similar problems for your
client, explore your client's interest in meeting these people to help
in the formation of support or self-help groups.
X Decide on the length of the counselling session beforehand and
advise your client.
X Have a positive attitude; your personal gloom will not help anybody.
Hope
Is
Vital
3
Pre-test counselling
Begin to discuss survival skills with your clients as early as possible,
preferably during pre-test counselling. Most people going for an HIV
test are already thinking about how a positive test result may affect
their life. Knowing beforehand that there are survival strategies can
ease the tension. If the test does turn out to be positive, the knowledge
that there is something one can do to stay healthy will help your client
cope with receiving the result.
Some issues you should be aware of when you are counselling a
person who intends to have an HIV test:
X Determine the reasons why the client has decided to have an HIV
test. Sometimes people are pressured or coerced into having a
test by another person such as a doctor, counsellor, or partner. It is
important that the client, and nobody else, decides to have a test.
Taking an HIV test is a big step and the client needs to be aware of
the advantages and disadvantages. The test should not be done
without the client’s full and genuine consent.
X Give the client accurate and up-to-date information about HIV and
AIDS, and correct any misconceptions the client might have. Give
your client time to express any worries or fears, and address them
before the test is taken.
X Stress the confidentiality of counselling and testing. It is important
that the client understands that both the discussion and the results
of the test will be confidential, and that nobody else will be told
about them without the client’s permission.
X If your client thinks that he or she might be HIV positive, you should
explore the reasons. Help your client assess the risks and the effects
of HIV in preparation for the results.
X Whenever possible, help your client identify a support person - a
relative or a friend - to provide company when going for the test
results and for post-test counselling.
X Tell your client about support groups and explore the possibility
that he or she may join such a group if the HIV test is positive. This
4
is particularly important if you sense during the interview that the
client does not have a strong social support network.
X If the client has a stable sexual partner, you should explain the
advantages of getting tested and getting results with the partner.
Explore the difficulties and possible consequences of disclosing
the test result to the partner. Try to encourage the client to bring his
or her partner to a pre-test counselling session.
g Prepare your client for both a positive and a negative HIV test result.
In preparation for a negative result explore with your client how to
reduce his or her personal risk for HIV infection. In preparation for
a positive result introduce the subjects of survival skills and positive
living that will be covered in much greater detail during post-test
counselling.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
x
x
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
x
Testimony 1: pre-test counselling
Very few people come for pre-testing of
"We stress
their own free will. Doctors or relatives
usually send them. Others get tested to the importance
of having a
join a pension or health care insurance
positive
mind."
plan, or a training programme such as
entry to the police force. At their first
visit, clients are usually very anxious. As counsellors, we give
them as much information as possible. We discuss what HIV is,
what it does, how it can be controlled and how one can manage
it. We stress the importance of having a positive mind. After
talking to us people usually want to go ahead with the test.
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
*xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
5
Post-test counselling
Survival skills are a very important subject of post-test counselling.
When people find out that they are HIV positive they often feel as if
their world has fallen apart and that there is no point in living any
longer. Post-test counselling should help people develop coping
mechanisms for dealing with their HIV status, and to realise that life is
not over just because of the result of a laboratory test.
Some issues you should be aware of when you are counselling
persons who have returned for their HIV test result:
X Assure yourself that the client is ready to receive the result. You
can assume that most people who have returned to the testing
centre want to know their test result, but you should still ask. If you
sense some hesitation, talk about the reasons. Your client may not
be here out of his or her own free will. Discuss the advantages and
disadvantages of knowing one’s HIV status. Do not give the results
until you are sure your client is ready to receive them.
X Assure your client again that the result of the HIV test and the
discussions of the counselling session are confidential and will not
be disclosed to anyone without his or her explicit permission.
X If and when the client is ready, give the test result.
If you have just given a positive HIV test result to a client:
X Observe and assess your client’s erfiotional state. People react in
different ways to a positive result. Some people show little emotion,
others react with emotional outbursts. The counsellor’s role is to
assist clients to deal with their emotions as they are expressed.
X Address your client’s needs and concerns. This discussion must
be driven by the client and not by the counsellor. This means that
you should respond to the issues and topics brought up by your
client, but not tell your client how he or she is feeling or what
emotions he or she might be going through.
X Find out if the client has had a pre-test counselling session and
what was discussed. Sometimes people are tested for HIV without
6
pre-test counselling. In this case, you should try and cover the most
important pre-test issues in your post-test counselling session.
X Discuss survival skills and strategies for positive living. These
include risk reduction, nutrition, and stress management. They are
explored in greater detail in this booklet.
X Disclosure of HIV status is a very important issue at the time of
post-test counselling. Explore to what extent this has been
discussed during pre-test counselling. Has the client thought about
whom to tell about the result? Who are the people that the client
can rely on for support? Do not rush your client into making
decisions about disclosure. This is a big step that has to be
considered carefully.
X Remember that your main task when counselling a person who
has just received a positive HIV test result is to provide emotional
support and information. If you do not have the information, refer
your client to another counsellor or to another source of information
or support.
X After receiving a positive HIV test result, many people find it hard to
concentrate on specific issues. Your client’s mind is racing - many
points covered in the counselling session will be quickly forgotten.
Encourage your client to return for further sessions of supportive
counselling where issues can be dealt with as they become
important and relevant. Make a follow-up appointment.
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
X
*
.
X
Testimony 2: reactions to the results
X
*
X
x People react differently when we give
"Some people
x
* them their HIV test results. Women
Wnv nnnru " x
x
i|
.
r
,|
9el very angry.
x
x usually cry — sometimes tor more than ---------------------------- t
* half an hour. Some people get very angry. Women get very *
x angry with their husbands. Men are often defensive. They ask, x
x “where did Iget it from?” Some people insist on another test. *
x Othersjust reel helpless. As counsellors, we wait and observe J
x our clients’ reactions until they are ready to talk.
x
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
7
Stress management
Dealing with stress is an important survival skill.
A person who is stressed may show the following signs and symptoms:
X social withdrawal, loss of interest in surroundings;
X moodiness, irritability, or intolerance;
X difficulty falling asleep, or early morning wakening;
X constant fatigue, difficulty in getting out of bed;
X upset stomach, loss of appetite, over-eating;
X headaches or pain in the neck and shoulders;
X loss of sexual desires or urges;
X loss of ability to concentrate;
X loss of interest in activities, apathy;
X poor performance at work or in school;
X pacing or restlessness;
X increased use of alcohol, tobacco, dr other drugs.
8
Possible causes of stress that are related to HIV infection may be:
X receiving the result of a positive HIV test;
X involuntary disclosure of a positive HIV test;
X break-up of family or of a relationship;
X death of a spouse or child;
X financial difficulties;
X loss of employment;
X inability to talk about one’s problems;
X isolation due to expected or actual.stigma;
X belief that death is imminent;
X fear of dying.
As a counsellor, you should help your clients manage their stress:
X Encourage your clients to talk about the issues troubling them.
X Discuss potential sources of support. Who can your clients turn to
for help? With whom can they share their worries and concerns?
Sources of support can be found amongst family, relatives, friends,
church groups, support groups, or counselling organisations.
X Encourage your clients to rest, relax, and get enough sleep. Some
people find it relaxing to pray, meditate, or to talk to themselves in
private. Physical exercise is very effective for stress management.
Encourage your clients to take up yoga, go jogging, join an aerobics
class, or go dancing.
X Encourage your clients to spend time with other people and help
them identify people they feel secure with.
X Try to identify the problem. It is easier to deal with stress once you
know what is causing it.
X Death or sickness in the family is a corhmon cause of stress. Another
booklet in this series provides counselling guidelines for palliative
care and bereavement.
People are affected differently by stress. After a stressful event some
people "shut down” and adopt a life style of mere survival without joy
or expectations. Others react by becoming over-active and pushing
themselves harder. It is important that you help your clients in either
extreme to recognise this behaviour as a reaction to stress. Encourage
9
them to adopt techniques like affirmation
(I am..., 1 can..., I will...) and relaxation
(meditation, exercise) to help them return
to a pace and a style of life that is
comfortable for them.
Affirmation
Look in the mirror
and tell yourself:
"I AM strong
Remember that some stress can be
I CAN stay healthy
positive. Knowing that they are HIV positive
I WILL beat HIV."
has motivated many people to plan their
lives more carefully and deliberately. They
are achieving much more because they have developed a positive
attitude to life.
Disclosure of HIV status
Another booklet in this series provides counselling guidelines on
disclosure of HIV status. Whom, when, and how to tell about your HIV
status are very important decisions for a person living with HIV. You
should be aware of the following disclosure issues when counselling
for survival skills:
X People who plan to disclose their HIV status need a lot of support
and emotional preparation.
X The respondents, whom your clients want to disclose their HIV
status to, should have correct information about HIV and AIDS,
and should have an open and non-stigmatising attitude towards
people living with HIV. You may need to help some clients prepare
their respondents.
X Some clients may ask for your presence when disclosing their HIV
status. The presence of a counsellor can support both your client
and the confidante. Remember that finding out that a loved one is
infected with HIV can be very stressful.
X Encourage your clients to be selective about disclosure. There are
advantages and disadvantages to disclosure in each situation.
X People should never be forced or pressured to disclose their HIV
status; they must only do so when they feel ready to deal with the
10
consequences. The client and not the counsellor has to decide
whom to tell and when. This may be difficult for the counsellor who
may know the client’s family or sexual partner.
X Talking to somebody who is HIV positive may be very helpful to a
person who is considering disclosure. Some support groups of
people living with HIV have trained volunteer counsellors. They
have personal experience of sharing information about their HIV
status and can give guidance to your client. Joining a support group
and talking to other people living with HIV is always a good idea,
and it is particularly helpful for reaching a decision on disclosure.
Treatment and medicines
There are at least 15 different types of medicines known as anti
retroviral drugs (ARVs). None of these drugs can cure AIDS or eliminate
HIV, but if taken in the right combination, they can slow down the
progression from HIV infection to AIDS.
Until recently, the drugs have been very expensive. However, an
intensive international lobby has resulted in the reduction of price in
some countries, and the movement is gaining ground all over Africa.
ARVs are already available in specialised clinics and big hospitals in
all major cities, however still at a price that places them out of reach of
most of the population.
The currently available ARVs have to be taken for life. An effective
treatment requires that at least three different drugs are taken at the
same time. The drugs have major, and sometimes life-threatening side
effects. In countries where these drugs have been available for a long
time, about one in three persons stops taking them because of side
effects or inability to follow the very strict drug regimen.
There are a number of other medicines that are known to be beneficial
to people living with HIV through their action of preventing common
opportunistic infections. These are generally much more affordable
and more widely available than ARVs.
11
As a counsellor, you should be aware of the types of medical treatment
available to people living with. HIV in your community, and how to
access these treatments. However, it is not wise to discuss medical
therapies with your client unless you have expertise in this area.
There are, however, alternate therapies being explored by PLWHA
groups all over the world, whether they have access to ARV treatment
or not. Many of these therapies have proven beneficial. You should
explore among local support groups what types of natural or alternative
medicines are available. The main guidelines in recommending
alternative therapies are that you should not believe any claims of a
“cure” of AIDS; the treatment should not do any harm to the patient;
and it should not waste the patient's money without providing any
benefit.
Taking vitamin supplements, improved nutrition, prevention and early
treatment of minor infections and avoiding stress can help prolong
your client's life. Prompt attention to minor aches, pains, skin rashes,
or injuries is essential for health and survival.
Here are some alternative therapies that PLWHAs have found useful.
Remember that therapies such as aromatherapy, herbal remedies,
reflexology, and hypnotherapy require a qualified practitioner:
X meditation - the process of relaxing
daily in a quiet setting to focus deeply
on body energy and breathing
techniques;
X relaxation - taking a short break away
from work or chores to rest and control
your breathing and body’s response to
increased tension;
X massage - kneading or rubbing parts
of the body to promote circulation,
suppleness, pain relief or relaxation;
X aromatherapy - the application of
fragrant essential oils to relieve tension
and certain minor ailments;
12
REMEMBER!
Everyone gets sick at
times. Colds, flu,
allergies, food
poisoning, upset
stomach and fatigue
are not necessarily
HIV related. Anyone
can suffer these
ailments. But if you
are HIV positive, you
need to give your
body additional help
to fight diseases.
X herbal remedies - the treatment of ailments with plants. There are
many effective and widely known herbal remedies for common
ailments such as diarrhoea. Some herbal remedies, for instance
the African potato, are believed to boost the immune system and
help fight off infections;
X reflexology - a form of therapy where pressure is applied to specific
areas on the feet and hands, which stimulate the blood supply
and nerves to create a relaxing and healing effect on other body
parts;
X art therapy - drawing, painting or other forms of art as a way of
relaxing or expressing emotions;
X hypnotherapy - inducing a state of deep relaxation and
concentration in which deeper parts of the mind are accessible for
the treatment of emotional problems.
Remind your client to “listen to your body”. If eating in a certain way
or receiving a certain type of treatment makes your client feel better, it
will almost certainly be beneficial.
13
Nutrition
Good nutrition is the only form of therapy that is available to most
people. It is generally affordable because unrefined and unprocessed
foods tend to be cheaper, though healthier.
Nutrition as a therapy can improve the quality of life for people living
with HIV because it can help them feel in charge. It allows them to do
something practical to help themselves.
People living with HIV need to protect their immune system because
it is weakened by the HIV infection. They can do this by paying attention
to two rules:
1. Do not give your immune system other things to fight. You are
most vulnerable to the effects of HIV when your body is trying
to fight off other types of
infections or when it is
The Golden Rules of
weakened by stress or
exhaustion.
Healthy Eating
2. Strengthen your immune
system by providing your
body with the necessary
nutrients to remain strong.
This means eating a healthy
and balanced diet.
Eat WHOLE (unrefined)
foods.
Eat NATURAL (unprocessed)
foods.
Eat INDIGENOUS (not
imported) foods and foods
that are IN-SEASON (fresh
foods that have not been
stored for a long time).
As a counsellor, you should
become familiar with the rules for
healthy eating in order to advise
your clients.
Drink CLEAN water (boiled
for ten minutes or filtered).
When foods are “refined” it means
that all the goodness has been
removed. You are paying more for
less value. When foods have been
“processed" it means things like
colourings and preservatives which can be harmful to your'
health - have been added.
Eat LITTLE and OFTEN - 5
times daily (every 3 hours).
This applies especially to
people with appetite loss or
weight loss.
14
A healthy plate should look like this
Whole Grain (50%) - Grains should be whole, even if ground for
thick porridge. For example, sorghum, millet, whole ground maize,
whole wheat bread made from whole wheat flour, brown (unpolished)
rice, barley, oat porridge, brekweet, or maltabella.
Vegetables (30%) - Combine yellow (pumpkin, butternut, carrots,
and sweet potato) with white (onions, leeks, cabbage, cauliflower)
and green vegetables (spinach, rape, broccoli, okra, pumpkin leaves).
Eat lots of vegetables every day.
Pulses (15%) - Pulses should make up the majority of protein in the
diet: lentils, peas, nuts, dry beans, peanut butter, chick peas, beans,
and soya (soya mince or TVP). Soya and round nuts are “perfect
proteins”. Just like meat all the others must be combined with whole
grains to make 100% protein.
Side Dish (5%) - This group should make up no more than 5% of the
total amount eaten. It includes:
X fruits: eat when fresh and when in season. Avocados, tomatoes
and peppers are also in this group.
X meat: little or no meat is recommended. Fish and chicken are best.
If meat is desired, eat liver, kidney or heart as they are high in iron.
X dairy: milk, cheese and milk products should be eaten very
sparingly. Don’t eat any dairy at all when you have diarrhoea, except
yoghurt and lacto, which are good at all times. Eggs are good
occasionally.
15
More samples of healthy foods
Foods to avoid
X Sugar and all foods containing
sugar: this includes cool drinks,
cakes, sweets and cookies.
X Tinned, processed and refined
foods.
X Strong tea and coffee: rooibos
tea, herb tea, fruit tea, bush tea
and decaffeinated coffee can be
good substitutes.
REMEMBER!
It is important to keep
emphasising the role of
nutrition in disease
prevention, and the
relationship between
nutrition and the
immune system.
X Alcohol and tobacco.
X Red meat and pork: liver and kidney are best if you crave red meat.
X Cooking oil: except olive oil or cold pressed oils. Heating oil to
cook with it destroys any goodness. Use it for salads only. Fats
(dairy products) should be used sparingly and not at all when you
have diarrhoea.
16
The table of health
Nutrition
Spiritual
Physical
Mental
Social
Health to achieve long-term survival with HIV can be compared to a
table with four legs representing mental, physical, spiritual, and social
health. The top of the table is nutrition.
Mental - Encourage your clients to learn to co-exist with the virus. By
giving your clients accurate and positive information about HIV and
the immune system, you can help them adapt their lifestyle to
overcome the immediate threats of HIV infection and to adopt a mental
state in which they are not always feeling fragile and in danger.
Spiritual - Encourage your clients to seek spiritual support, whatever
their religious and cultural background. Prayer or meditation can
induce deep mental and spiritual relaxation and renewal.
Physical - Encourage your clients to learn the practical steps they
can take to improve and maintain health e.g. exercising.
Social - Encourage your clients to join asupport group and to become
active in the community. Social isolation because of fear of being
rejected or because of past experiences of rejection is bad for your
clients’ health and survival.
Paying attention to all of these aspects of health ensures a better and
longer life.
17
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Testimony 3: changing my diet
I didn’t find it hard to change my diet. 1 was determined. I was
sick and I wanted to get better, if you are not sick, it is harder
to change because there is no incentive. My family found it
very funny when they saw me boiling sorghum or wheat. They
didn’t see the sense in not having Fried food or meat. But in
the end they adopted this diet too because they saw that it
saved a lot of money.
Sometimes it is difficult for people to change their diet when
they have not disclosed their HIV status to their family, or
when they are the only people in the family who want to change
— especially if they are not earning the money, if you cannot
do everything, the most important thing is to identify the
foods that make you sick and to avoid these foods. I know
that if I eat sugar, cookingoil, or coffee I get sick, so I NEVER.
take these foods.
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
*xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Vitamins and minerals
Vitamins and minerals are natural substances contained in food which
are needed by your body in very small quantities for many different
functions, including boosting your immune system. They are called
micro-nutrients. If you follow the guidelines for a healthy diet, you are
eating all the micro-nutrients you need.
Many people living with HIV take additional micro-nutrients in the form
of tablets. But remember, vitamin tablets are no replacement for a
healthy diet. If your client is poor, do not recommend spending money
on vitamin preparations. The priority should be a balanced nutrition
for the family. If there is money left over, then your client may consider
vitamin supplements.
18
One combination recommended by PLWHA groups consists of zinc,
vitamins A, C, and E and selenium (ZACES). ZACES is an infection
fighting combination of vitamins and minerals. It increases the body’s
natural resistance and protects against the side effects of medications.
Zinc
1 x 10mg tablet, twice daily
Vitamin A
1 x 25,000 I.U. tablet, once daily
Vitamin C
2 x 500mg tablet
twice daily
(or 4 x 250mg
twice daily)
Selenium
1 x 10Omcg tablet
daily (or 2 x 50mg
twice daily)
Medox 12x12
1 tablet daily
Garlic
Up to 5 cloves a day
Garlic is nature's
an+ibioticl
Take up to 5 cloves of
garlic per day - to keep
the doctor away! If you
don't like the taste of
fresh garlic swallow a
whole peeled clove
like a tablet.
You can double the number of times you take ZACES if you are taking
antibiotics, or suffering from a cold, flu, an infection, or stress.
Reproductive and sexual health
After receiving the result of a positive HIV test, some people feel “off”
sex, some feel dirty or “contaminated”, and some believe that they
can no longer have normal sexual relations. Yet a person living with
HIV has the same sexual feelings and needs as anyone else, and
there is no reason why these should be denied. Counsellors can help
people understand this. At the same time they must make their clients
aware of the risks so they can make informed and responsible choices
about their sexual and reproductive lives.
19
You should be able to talk to your clients freely and objectively about
sex. This means that you have to build a relationship of trust. Condom
use is a key issue to be discussed. You have to impress on your
clients that consistent use of a male or female condom in every act
of sexual intercourse is important for their own health and the health
of their partners. If the partner is not infected, then he or she risks
becoming infected with HIV. If the partner is already HIV positive,
then both partners risk re-infecting each other, and thereby increasing
the number of virus particles in their system. This may result in a
faster progression of the HIV infection to AIDS. Therefore, strict
condom use or practising non-penetrative sex will protect both
partners, whatever their status.
Other important counselling issues related to reproductive and sexual
health include:
X family planning;
X abstinence;
X partner notification;
X sexually transmitted diseases;
X changes in the menstrual cycle;
X transmission of HIV from mother to child.
Your role as a counsellor is to:
X provide accurate and relevant information so that your client can
make informed choices;
X give and explore options;
X recognise and respect the uniqueness of your client;
X be aware of your own beliefs and values;
X know when to refer your client to another counsellor or agency for
more appropriate and accurate information.
20
Your clients may be concerned about whether or not they can have
children. You need to advise them on the risks of HIV transmission to
the child. Most of the transmission occurs during labour or through
breastfeeding. However, most children born to HIV-positive mothers
are not infected with HIV, and there are interventions that can reduce
the risk of HIV transmission to the infant.
HIV-positive women who wish to conceive should seek out good ante
natal and obstetric care. After delivery,
they should avoid breastfeeding or
Rememberl
practise “safer breastfeeding”. The four
Not all HIV-positive
components of safer breastfeeding are:
mothers will pass the
X exclusive breastfeeding for up to six
months;
X condom use during the lactation
period;
X proper positioning and attachment
of the baby during every feed; and
X immediate medical attention for
minor infections of the breast or
lesions in the baby’s mouth.
21
infection to their
babies. On average, one
in three babies born to
HIV-positive mothers
will be infected. This
means that most babies
born to HIV-positive
mothers are not
infected with HIV.
Self-awareness
As a counsellor, you should be aware that your own attitudes, beliefs,
and life experiences will affect the way you react to the client and may
influence the outcome of the counselling session.
Your understanding and interaction with the client may be influenced
by your:
X religious beliefs
X fears
X social status
X unfinished business
X marital status
X prejudices
X gender
X race
X age or stage in life cycle
X own ability to deal with stress
X HIV status
X culture (traditions and values).
If you feel that your work is being influenced by negative feelings or
prejudices towards the client, you must seek counselling to deal with
the issues yourself, and refer the client to somebody else for
counselling. An important goal in counselling is to make clients aware
of their strengths and positive characteristics. If you project a
judgmental and disapproving attitude towards the client, you are
undermining what you are trying to achieve.
You should also be aware of the language you use when talking to
your client. If you use words like "AIDS victim” or “AIDS sufferer" you
are undermining your objective to build the client’s inner strength and
self-confidence. If your body language signals distance and it appears
tike you are trying to shield yourself from your client, then you may
reinforce your client’s feelings of shame, guilt, and isolation that you
want to overcome through counselling.
22
Supportive counselling
After the initial post-test counselling, a person living with HIV will often
require further supportive counselling sessions. These sessions can
cover a wide range of issues depending on the client's needs.
Supportive counselling should instil hope in the client and strengthen
the client’s will to live on.
Supportive counselling may be centre-based - the client coming to
see the counsellor when they need advice and support. Or it may be
home-based. The advantage of home-based supportive counselling
is that clients may be seen in their own environment. It may not be
very expensive if it is well planned, because several clients can often
be seen in one visit. It is an opportunity to get to know clients better,
to know their social and material situation, and to get to know their
families and support networks.
23
Examples of supportive counselling activities include:
X setting up tasks or goals (remember to check or follow upon goals
on next visit or session);
X providing a “sounding board” (being a listener) for clients to express
their concerns or talk about particular issues;
X working with the family, e.g. to improve the client’s social support,
or to help create more openness within the family;
X helping clients to improve their communication skills, especially if
they are preparing to disclose their HIV status;
There are limitations to remember:
X Supportive home-based counselling requires a lot of resources. It
is time consuming and it often requires transport.
X A long-lasting supportive counselling relationship may create
material and emotional dependency on the counsellor.
X Some clients may feel that their privacy is being invaded by the
counsellor.
. ■
X As a counsellor, you may become too involved with a small number
of clients, which will reduce your overall effectiveness in your job.
Supportive counselling often involves repetition of things that have
been discussed before. Clients who are stressed or upset will not
absorb information the first time they hear it because of their emotional
state. Be patient and be prepared to repeat discussions and to restate
important messages several times.
24
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
x
Testimony 4: how counselling helped me XX
I had my first counselling session fiveyears after I found out 1
was HIV positive. I was down.'I had lost weight. I had lost hair.
I had even lost hope. I got my first counselling from my bed.
when I was told that I was HIV positive,
"Because she was
the doctor gave me four years to live.
also someone with
At this time lhad a three-year-old son.
HIV I knew I
It was after four years that my health
could trust her."
started to deteriorate. I had been
waiting for this time and expecting that I would die because
that is what the doctor had told me.
The counsellor asked me "Areyou prepared to leave your son
behind?” I knew that I was not. She told me about stress
management, visualisation, affirmation, and nutrition. She
gave me the support I wanted. Because she was also living
with HIV I knew I could trust her.
After two months of seeing her I was up and about again. I
changed my way of living and my relatives saw the positive
change in me. I disclosed my HIV status to my relatives and
they were not shocked. They knew that I could handle it.
Because I now had something to live for, I needed to work. I
started knitting and set up my own business. I worked in
business until I received money to train to be a counsellor. I
now work as a counsellor at The Centre in Harare. My son is
l£. I have to see him through High School. I am lookingrorward
to greater things.
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
*xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
25
Peer counselling
Peer counselling overcomes barriers caused by class, age, gender,
sexual orientation, or HIV status. Peer counsellors have similar
characteristics and experiences as their clients.
The advantages of peer counselling are that:
X it is easier for the client to feel at ease with a counsellor and the
discussion will therefore be more open and free;
X most barriers and boundaries between counsellor and client are
removed, e.g. language, age, gender, etc.;
X the sessions are informal and tend to be more spontaneous;
X the counsellor and the client frequent the same social circles and
often live or work in proximity. This makes the counselling sessions
more accessible and often more affordable for the client;
X the peer counsellor may provide a role model for the client that is
easy to emulate;
X counselling may be linked to group support if several peers meet
together.
The disadvantages of peer counselling are that:
X knowledge may be limited within the peer group so there may be
misinformation and misconceptions;
X confidentiality may be compromised by the informal nature of the
interactions;
X dependency on the counsellor may develop because of the easy
access and the frequent social contact;
X there may be tendencies to compete within peer groups;
X problems of some clients may be trivialised as everybody in the
peer group may face similar hardships.
26
In peer counselling it is important to remember the following:
DO:
DO NOT:
X establish ground rules
X
judge or penalise
X respect individuality
X
take over the burden
X acknowledge the limitations
of counsellors
X
argue
X refer when stuck
X
ignore
X listen
X
instruct
27
Supporting the counsellor
Counsellors spend most of their time listening to others and giving
other people support, but to do their job well, they too need support.
The types of support that counsellors need include:
X back-up support and personal protection when facing angry clients
or potentially violent spouses and relatives;
X an incentive for motivation, such as acknowledgement for hard and
reliable work;
X psychological and emotional support (debriefing and counselling
sessions);
X retreat (time away) to allow collecting new energy;
X adequate logistic support, e.g. a counselling room with privacy,
transport, communications facilities;
X professional development and training to keep up to date on issues
of importance;
X networking, exchange visits, and counsellor support groups, to keep
in touch with their peers.
28
Counselling guidelines
on disclosure of HIV status
© SAT Programme
First Edition June 2000
Produced by the
Southern African AIDS Training (SAT) Programme
With funding from the Canadian International Development Agency
(CIDA)
Extracts from this publication may be freely reproduced
with acknowledgement of the source, provided
the parts reproduced are not distributed for profit.
Copies of this publication may be obtained from the
Southern African AIDS Training Programme
3 Luck Street
PO Box 390 Kopje
Harare, Zimbabwe
Tel: 263 4 781-123
Fax: 263 4 752-609
E-mail: info@sat.org.zw
ISBN: 0-7974-2145-9
Foreword
This publication is a first in a series of guidelines on counselling people who
are infected with HIV, who are concerned about being infected with HIV, or
who are living with or caring for people with AIDS. Each booklet in the
series is designed to offer practical guidance on specific counselling issues.
The publications are designed for use by volunteer counsellors, non
professional counsellors, and professional counsellors who do not have
extensive experience in counselling in the context of HIV.
Each booklet is the result of a workshop organised under the SAT Programme
“School Without Walls” initiative that brought together professional
counsellors, people living with HIV, and staff of AIDS Service Organisations
from Southern Africa. The booklets reflect their unique experience and take
account of their specific expertise. Further publications on different
counselling issues are in production, eventually making up a complete
counselling kit to be used as reference material.
The SAT Programme is a project of the Canadian International Development
Agency implemented by the Canadian Public Health Association. It has been
on the forefront of supporting the community response to AIDS in Southern
Africa since 1991. The School Without Walls is an initiative of the SAT
Programme to validate, promote, and diffuse the unique Southern African
experience and expertise in responding to HIV. The SAT Programme is
profoundly grateful to the volunteers and professionals who have made this
publication possible and who are supporting SAT in the preparation of further
publications in this series.
\. J
Southern African AIDS Training Programme
Programme d’Afriquc australe de formaqtion sur le sida
Counselling guidelines
on disclosure of
HIV status
Creating these guidelines
These guidelines are based on the experiences and advice of people from
across southern Africa who are either living with HIV or who have extensive
experience of counselling people living with HIV. The guidelines were
produced by the Southern African AIDS Training Programme (SAT) with
funding from the Canadian International Development Agency. They were
written and designed by Southern Africa AIDS Information Dissemination
Service (SAfAIDS), on contract to the SAT Programme. Cartoons were
drawn by Joel Chikware.
Contents
Important terms................ -................... -......................... 1
Decisions, decisions...... -........................... -................... 2
Reasons to consider disclosure.................. .................. 2
Testimony 1 ...................................................... —............. 3
What is counselling.........................................-............... 4
The need for effective counselling ............................... 4
General guidelines on effective counselling —........... 4
Testimony 2 -..................... —........................................ — 5
Steps towards disclosure.......... -...... -.......................... 6
Testimony 3.................. -.............................-................. — 7
Counselling process of disclosure-............................... 8
Possible consequences of disclosure---.................. . 8
Possible consequences of non-disclosure —.......... 9
Coping mechanisms....... -............................................. 10
Disclosure of HIV status for gay people —-.............. 10
Testimony 4 —.................. -................................. -........ 10
The media and disclosure................. -.......................... 11
Safeguards when disclosing HIV
or AIDS to the media ................................................... 11
The media and payment for stories....... ----...............12
Non-disclosure form.............. ................. ...... ...............14
Important terms
HIV status: in these guidelines we use the term ‘HIV status' to refer to
HIV positive status.
Voluntary disclosure refers to when the client shares information about
their HIV status with other people. This may be partial or full disclosure
(see below). A counsellor should help the client to identify possible impacts
on their decision.
Full disclosure is when the client publicly reveals their HIV status to a
person or organisation, for example, a family member, friend, support group
or to the media. Before a client discloses their HIV status, a counsellor can
assist them to explore who to tell, how and when to tell. In this way, the
client remains in control of what to say and how to say it.
Partial disclosure means that the client will only tell certain people about
their HIV status, for example, a spouse, a relative, a counsellor or a friend.
Counsellors need to assist their clients to think carefully and prepare them
for the range of possible outcomes before disclosing their status. The client
may not be able to control what happens, once they have disclosed. Most
cases of involuntary disclosure arise from situations where a client decides
to partially disclose their status and without their knowledge the information
is made public by an individual or organisation.
Non-disclosure means that the client does not reveal their HIV status to
anyone.
Involuntary disclosure happens when someone reveals someone's HIV
status without their approval or even without their knowledge.
Shared confidentiality. Disclosure is usually on the understanding that
people will not tell others, unless they have been given permission.
“I disclosed my HIV status to prove to my community that
there is a need to do something about HIV and AIDS"
1
Decisions, decisions—
who, what, when and how
When someone discovers they are infected with HIV, they face a difficult
decision about whether to tell anyone.
If they opt for disclosure, they may need your support. They will need to
decide who to tell, how and when to tell them. Disclosure is to be encouraged,
but it is important that people take time to think through the issues carefully.
Their choices can have major implications.
These guidelines - developed from the direct experience of people living
with HIV and AIDS - are to help those who may be called upon to counsel or
advise people who are either thinking about disclosure or who are trying to
cope with the consequences of involuntary disclosure.
By raising key issues and sharing practical hints, the guidelines are designed
to promote informed choices about disclosing HIV status and improved
coping strategies following disclosure.
Reasons to consider
disclosure
People thinking about revealing their
HIV status need to be clear about
whether to choose partial or full
disclosure. If they are able to disclose
their HIV status, it can have the
following benefits.
X Disclosure can help a person accept
their status and reduce the stress of coping on their own. “A problem
shared can be a problem halved”.
X Disclosure can help a person access the medical services, care and
support that they need.
X Disclosure can help people protect themselves and others. In particular,
openness about HIV status may help women negotiate for protected
sex.
X Disclosure means that people may be better equipped to influence others
to avoid infection.
2
X As more people disclose their HIV status, it will help to reduce the stigma,
discrimination and denial that still surrounds HIV and AIDS.
X People may suspect the person's HIV status, particularly if they show
symptoms of AIDS. Openness about their HIV status can stop rumours
and suspicion. It can also reduce the stress caused by “keeping a secret”.
X Disclosure promotes responsibility - it can help the person's loved
ones plan for the future.
"I would make my
disclosure to the closest
persons to me, and only
when I am prepared"
Testimony 1:
fear, love and support
“I tested HIV positive in July 1^0. what made me disclose? I believe
it was fear. Hear of illness. Pear of the unknown. I felt so alone and
needed to talk to someone. Ijust could not handle it on my own.
Love and support from everyone
around me made it easier. Their
acceptance gave me strength and
courage to keep telling more people.
I wouldn’t have told so many if the
first people had rejected me.
“What made me disclose?
I believe it was fear.
Fear of illness ... of the
unknown. I felt so alone
and needed to talk to
someone"
if I had to do it again, I wouldn’t do it
differently. My friends have always given me support, so I guess I’d
still tell them first”.
3
What is counselling?
Counselling is a structured conversation between two or more people that
assists one of the participants to work through particular problems he or
she faces, for example, disclosure of HIV status. Counsellors encourage
people to recognise and develop their own coping capacity, so they can
deal more effectively with problems.
The need for effective counselling
Despite their need for support, many people feel unable to tell relatives or
friends about their HIV status for fear of stigma and rejection. Even if they
do reveal their HIV status they may not receive the emotional support and
information they require. They may be overwhelmed by thoughts and fears
about the future, the possible consequences to them and others, feelings
of guilt, anger, shock and despair. People may need support to tell family
members about their HIV status, and the family may need support to cope
with their feelings about the information. Although disclosure of HIV status
is usually advocated as a way to reduce stigma and to protect uninfected
partners, this is a complex situation and there are many factors to consider
before disclosure takes place. This is why counselling is essential.
General guidelines on effective counselling
These are some basic, practical guidelines for those without formal counselling
training who find themselves in a situation where counselling is required.
X Listen attentively to the client; give them time to say what they need
and be patient. Help them express their feelings and emotions and show
warmth and caring for the person.
X Treat clients and their families with respect and be reliable and consistent.
Accept people as they are and avoid moralistic judgements.
X Try to avoid giving advice; rather let clients work through issues and
make their own decisions with your help.
X Help the person focus on issues where they can achieve some positive
change, rather than being overwhelmed by the problems of HIV and AIDS.
Help them identify others they can rely on and receive help from.
X Do not pretend to have skills, knowledge or resources you do not have know when (and where) to refer clients for more specialised help.
4
Testimony 2:
disclosure <& a new lease of life
“I was tested unknowingly in \J&8 and the result was disclosed in the
ward where everybody heard. I was shocked and felt humiliated.
when 1 got home, I only told my husband. I hoped he would support
me but ne accused me and after a
short while he abandoned me.
"The miraculous change
I suffered alone forthe nextfiveyears came when I got my first
without telling anybody. I wasted counselling ... It was like
away because there was nobody to I started living again. I
advise me on what to do. I did not tell
stopped mourning"
my parents and sisters about my HIV
status because they were very negative on the issue of HIV.
The miraculous change came in l<?j?5 when I got my first counselling
at The Centre in Harare. It was like I startea living again. I stopped
mourning for myself and started getting confident. I now knew the
right foods to eat and how to avoid stress. I becamea happy person
and started gaining back my weight.
This big change was noticed by many people. I started talking much
more about HIV issues, but not referringto myself, when I saw that
they were now understanding I revealed my status to them. They
were not shocked.
I was introduced to other people living with HIV and AIDS and
started feeling comfortable talking about the illness. I started
participatingin a radio programme. At home my sisters made sure
that whenever I went for the programme they would change the radio
station so that my son would not hear my voice.
Unfortunately, one day he heard me and identified my voice. I had
to give him a lot of counselling because he was so depressed. I am
happy to know from his response that he would never shun me and
up to now he is very supportive.
As for myself I talk freely about it at work, at home, or at conferences
and workshops”.
5
Steps towards disclosure
Disclosure is a process and not an event. It is a major decision that can
have consequences for the person living with HIV and those around him or
her. It is important that people do not rush into disclosure, but think it through
carefully and plan ahead. Planning allows for possible prediction and control
of the process of disclosure.
The ideas and advice below can be shared with a client.
X Help the client to take time to think things through. Make sure it is what
. they want to do and assist them to plan how they are going to go about
it.
X . Identify sources of support, such as groups for people living with HIV
■ and AIDS, church members and counselling organisations.
X Role plays and “empty chair" enactment techniques could be used to
help the client prepare for disclosure.
X Provide support and reassurance to the client and help them to accept
themselves positively.
X Discuss about sexual partners who need protection from infection.
X Prepare the client for a shocked and even hostile reaction. This often
happens, but you can reassure the client that with time people close to
them should learn to accept their HIV status.
X Help the client to realise that once a decision to disclose has been reached,
it may be easier to start with those nearest to them: relatives, family,
friends, or someone they are very close to and trust.
6
X When a client has decided to disclose their HIV status to someone, assist
them to think about the likely response. They will need to assess how
much the person they plan to disclose to knows and understands about
HIV and AIDS. This will help the client decide what they need to tell the
person and how to tell them so it is less traumatic for both of them.
X It is important for a client to be strong enough to allow others to express
their feelings and concerns after their disclosure. A counsellor can assist
the client to work on these issues over time.
X Provide the client with information and support to “live positively".
"You have to decide for yourself if it is the right thing to
disclose your status. It is helpful when you can be open, but.
you shouldn't judge others who may not be ready to divulge
their status"
Testimony 3:
life needs courage
“I decided to come out publicly because a lot of Swazis are dying
and they think HIV is a problem in other countries but not ours.
I have had problems with my wife’s
family. They accuse me of being
unfeeling ano insensitive - to them it
was humiliating that everyone knows
my status. But my wife stood by me
and we are still together.
"In the long run I have
always felt good about
the choice I made by
disclosing my status"
In the long run I have always felt good about the choice I made by
disclosing my status. It feels good not to have kept it to myself.
Just talking about my situation has helped a lot of HIV positive
people andtheir relatives. My advice is to remember that life needs
courage”
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Counselling process of disclosure
X Allow the person to develop trust in you and feel at ease.
X Get to know them, in particular about what HIV and AIDS means to
them.
X Assess the person's ability to cope and establish their sources of support.
X Discuss the implications of disclosure fully, to help the person consider
in advance the reactions of family, friends, work colleagues and others.
X Help the person develop a plan on disclosure. This should cover any
preparations they need to make before disclosure, who they will inform
first, how and where they will disclose and the level of disclosure.
X The counsellor needs to work with the client on the implications of
disclosing to inappropriate persons or groups.
X Arrange to see the person again - at a date and time agreed by both of
you - to review this process.
X Counsellors have to protect their clients against undue pressure to
disclose.
Possible consequences of disclosure
The stigma attached to HIV and AIDS means that disclosure can sometimes
lead to negative consequences, especially in the short term. Possible
consequences include:
8
X Problems in relationships, whether with sexual partners, family and
friends, community members, employer or work colleagues.
X The experience of rejection. People who have disclosed their HIV status
may feel that people are constantly judging them. They need to be
prepared for this and be ready to make full use of the support that is
available.
X Disclosure can result in pressure being placed on people living with HIV
or AIDS to assist in AIDS work and become role models.
Possible consequences of non-disclosure
Sometimes it seems that there is too much to lose by disclosing HIV status.
But non-disclosure can also have major consequences. It is useful to discuss
with the client the following potential consequences of non-disclosure.
X Lack of support - family and friends may not give the support the client
needs and they will have to deal with everything on their own.
X Risk-placing others at risk of infection, particularly sexual partners and
increasing the risk of re-infection for the client.
X Lack of care - the client may be unable to access appropriate medical
care, counselling or support groups if they are not open about their status.
X Suspicion - people may become suspicious of the client’s actions because
they do not understand their HIV status.
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Coping mechanisms
Whether they opt for disclosure or non-disclosure, or experience involuntary
disclosure, it is important for clients to try to adopt positive ways of coping
with stress and anger. There are many options, for example, song, prayer,
long walks, spending time with family and friends, or joining 3 support group.
A counsellor can help the client to explore what works best for them.
Disclosure of HIV status for gay people
Disclosure can be particularly difficult for gay people. Gay people may find
it hard to discuss their sexuality with a support group of non-gays. In such
settings they may have to counter discrimination and stigma attached to
their sexuality.
Gay people should be advised to seek help and counselling from the gay
community and to join support groups that are sensitive to their needs and
to protect uninfected partners. This is a complex situation and there are
many factors to consider before disclosure takes place. This is why
counselling is needed.
Testimony. 4:
'coming out twice'
"Being gay and HIV positive in Zimbabwe bas devastating stigmas
attached. Disclosure of sexual orientation and HIV status for
homosexual people often leads to discrimination at the work place,
in the community and within the femili
This makes it very difficult for gau
people to find help and often leads
to them living isolated lives and
suffering the complications of HIV
and AIDS alone.
"Being gay and HIV
positive has devastating
stigmas attached"
It is difficult and often impossible for a gay person tojoin a support
group and disclose his or her sexual preference, because of
homophobia and negative attitudes. That is why it was necessary
for us to start the Gays and Lesbians Association of Zimbabwe
(GALZ) HIV & AIDS Support Group in
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The media and disclosure
People living with HIV and AIDS have the same rights
as anyone else to privacy, confidentiality and respect in
their dealings with the media. They may choose to go
public about their status. However, they are not always in
control of the situation. Since most people are still reluctant
to reveal their HIV status, a disclosure story is a scoop in
many countries and communities. The journalist may decide
what questions to ask and what to emphasise, and they do not always feel
obliged to check back for accuracy. This can lead to misrepresentation of
facts.
If you are called upon to counsel or advise someone who is thinking about
disclosure in the media, what guidelines should you follow? These are some
practical guidelines that a counsellor can offer to people thinking of talking
to the media:
X Assist the client to establish their motive for disclosing to the media.
Advise them never to be pressurised to give an interview when they are
not ready.
X Assist the client to carefully select the journalist that they want to work
with and help them prepare for the interview. They should have clear
objectives for the meeting. It may help for them to write down everything
they want to say in advance. This helps them to control the focus of the
story.
X The client should ask for the meeting to be recorded and insist on reading
the story before it is printed. Sometimes this is not possible, but the
client can request a discussion to clarify issues before the story is printed
or broadcast.
X Inform the client that if they do not like the way an interview develops,
then they are at liberty to terminate it and explain why they have done so.
X Advise the client to think carefully about having their picture taken. If in
doubt, they are entitled to decline to be photographed.
Safeguards when disclosing HIV or >4IDS to
the media
People living with HIV/AIDS strongly feel that safeguards are needed to
protect them from exploitation from the media—newspapers, magazines,
the radio or TV. Many journalists still fail to see anything positive to report
11
about HIV/AIDS - to them it is still a “gloom and doom” story and the issue
of morality often is pushed to the forefront.
Counsellors can help clients thinking of disclosing their HIV status to the
media to consider the following issues:
X The client needs to be sure that they are prepared for the general public
to know about their HIV status.
X The client needs to try and ensure that yvhat they have disclosed to the
media is going to be reported correctly.
X If the client seeks partial disclosure, it is advisable for them to use a non
disclosure form, such as the one provided in these guidelines. This sort
of agreement can be binding in a court of law.
X Counsellors and their clients can help improve reporting on HIV/AIDS
by cultivating a good relationship with the media. Establishing such a
relationship can help the media to be more sensitive and avoid use of
words and phrases that are negative.
"I am now full-time public about my status and I will
continue until behavioural change is established among people,
especially youths in Zambia"
The media and payment for stories
Some people living with HIV or AIDS feel that since the
media is making money out of their stories, they should be
paid for giving interviews. However, this can create ethical
problems for journalists. It is important to realise that when
a person living with HIV/AIDS and a journalist agree to do a
story, each is trying to achieve something different although
sometimes their objectives can merge.
Payment can complicate the motive for telling the story and can lead to
allegations of selfishness and money-making on the part of the person living
with HIV or AIDS. Establish if payment is involved at the outset.
"My view is that going public is an important way to reduce
stigma. The more we reveal our HIV status, the more
difficult it is for society to stick to its attitudes towards
people living with HIV or AIDS "
12
Non-disclosure form
The form overleaf can be used as a safeguard against exploitation
from the media and media personnel. Please photocopy the form if
you wish to use it.
13
Non-disclosure form
i................ ................................ .............. ................... .........................................
do hereby state that I:
X Am a Person Living with HIV or AIDS (delete as appropriate).
X Have agreed to speak to or be interviewed by
of
with regard to my HIV status.
X Have been offered remuneration for my story in the sum of
, or that I have not been offered remuneration for
my story (delete as appropriate).
X Participate in the interview on the following grounds:
X That I shall not be identified either by name or by any description that
is likely to identify me.
x
x
x
or his/her employer
or his/her friends, relatives or associates shall
not be permitted to sell, cede or in a’ny other manner give or assign
the rights to my story to any other person or organisation without my
specific written consent.
That any story written about me and concerning my status as a Person
Living with HIV or AIDS shall not be published until I have had sight of
the draft and agreed to the same.
That the said
That any departure or deviation from the above conditions shall entitle
me to full redress including but not restricted to damages for loss of
privacy and dignity and any consequential damages arising therefrom.
Signed by:
Date:
PERSON LIVING WITH HIV or AIDS
UNDERTAKING BY INTERVIEWER
I do hereby state that I have read and understood the above declaration
and hereby state that I agree to the conditions attaching thereto.
Signed by:
•
INTERVIEWER
14
Date:
- Media
RF_DIS_2_U_SUDHA.pdf
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