心理社会问题

Aims目的DefinetheaimsofHIVcounselling

咨询的目的TypesofcounsellinginHIVandAIDSHIVandAIDS咨询的类型Understandwhyitisimportant

明确为何咨询很重要Learncounsellingskills

掌握咨询的技巧Whatiscounselling?

咨询的定义?“HIV/AIDScounselingisaconfidentialdialoguebetweenapersonandacareprovideraimedatenablingtheclienttocopewiththestressandtakepersonaldecisionsrelatingtoHIVandAIDS” (WorldHealthOrganization)“HIV/AIDS咨询是求询者和咨询员之间的在保密情况下的谈话，目的是是使求询者能应付HIV感染带来的紧张压力，做出自己的决定。” (世界卫生组织)VCTismorethan

abloodtest!

VCT不只是抽血化验!Promotesplanningforfuturecare;e.g.orphans,wills促进将来咨询的计划;例如孤儿NormalisesHIV/AIDS+reducesstigma正常化处理HIV阳性所产生的歧视Enablesreferraltosocial+peersupport加强Enablespreventivetherapy+contraceptiveadvice加强预防治疗和避孕建议PromotesearlyOI/STItreatment+accesstoART促进早期OI/STI治疗和开始ARTReducesmother-to-child-transmission(MTCT减少母婴传播Facilitatesbehaviourchange促进行为改变IncreasesacceptanceofHIVresultandcoping提高HIV检测结果的接受和处理自愿咨询检测(VCT)Whyiscounsellingin

HIVimportant?

为什么HIV咨询很重要?HIVdiagnosishasmanyeffects–physical,psychological,social,andspiritualHIV

确诊有很多影响–身体,心理,社会和精神HIVislife-threateningandlifelong

HIV是伴随终生、致命性的疾病Preventioncounsellingcanpreventtransmission预防性咨询可以预防HIV传播HIVcontinuestobehighlystigmatisedHIV感染者仍然受到很大的歧视Stigmaanddiscrimination

丑化和歧视Howdoyoudefinestigma?

怎样定义丑化?Howdoyoudefinediscrimination?

怎样定义歧视?WhatarethecausesofstigmainHIV?

导致HIV丑化的原因是什么?NameasmanywaysasyoucanthatstigmacanaffectPLWHA

尽可能的定义丑化影响PLWHA的情况Stigmaquestions歧视问题

Agree同意

Disagree不同意WomenwithHIVshouldnothavechildren感染HIV的妇女不应该生小孩通常AIDSismostlyaproblemforpeoplewhoarebadAIDS发生在道德败坏的人身上IwouldshareacupwithsomeonewhoisHIV我愿意和HIV感染者公用一个水杯PeoplewithHIVshouldbeisolatedinhospitalHIV感染者应在医院进行隔离AlldrugusersshouldbeforcedtotestforHIV所有吸毒的人应该强制进行HIV检测PLWHAshouldgetfreeARVs艾滋病感染者应该得到免费的ARVsItistheirownfaultthatwomenwhosellsexgetHIV卖淫感染HIV的妇女是自己的错IwouldletaPLWHAholdmybaby我可以让PLWHA抱我的小孩MSMarenotnormal;theyhaveanillness男同性恋不正常,他们有病IfadoctorhasHIV,heshouldberemovedfromhisjob如果医生感染HIV，他应该调离工作ThereisnoHIV-relatedstigmainmytownship在我们镇上没有HIV相关的歧视Ifpeopledonotusecondoms,itistheirownfaultiftheygetHIV不使用安全套而感染HIV则是自己的错StigmacanpreventpeoplefromgettingHIVcare歧视将阻碍人们获得HIV关怀如果感染HIVPeopleshouldalwaystelltheirfamilyiftheyareHIV应该告诉家人他的HIV身份Whatothertypesof

HIVcounselingarethere?

HIV其他类型的咨询都包括哪些?Pre-andpost-HIVtest(VCT)HIV检查前、后咨询PreventionofMothertoChildTransmission(PMTCT)预防母婴阻断Supportivecounseling支持咨询Crisiscounseling危机咨询Prevention/behaviourchangecounseling行为干预咨询Griefandbereavementcounseling悲痛、丧亲咨询Canbeofferedtoindividuals,couples,families,groups,andcommunities(andhealthcarestaff)

可以提供给个人、夫妻、家庭、团体和社会（包括医务工作者)Whataresomecommoncounsellingissue

forPLHIV

通常还有哪些常见的咨询问题?

WhatissuesarethereforPLHIVinyourcommunity

你们社区有什么样的问题?Relationshipsandsex关系和性Facingstigmaanddiscrimination面对歧视和丑化Copingwithfear,anxiety,guilt,shame,andisolation应付恐惧、焦虑、罪恶和耻辱Livingwithuncertainty处理生活充满变数Copingwithmanylosses处理很多损失Copingwithillness处理疾病PregnancyandPMTCT怀孕和母婴阻断HIVcareoptionsincludingART,nutrition,etc.关怀：包括药物和营养KnowledgeandacceptanceofHIVstatusHIV身份和知识的接受PLHIV

Bio-psychosocialmodelofHIV

生理心理社会模式

与心理问题相关的因素:

疾病相关的因素(最初诊断\并发合并症及其类型\疾病的进程),

与个人相关的因素(以前心理状态\处理类型和控制力\察觉疾病的能力),

人际社会因素(社会支持\社会态度\社会调整)

PsychologicalimpactofHIV/AIDS

心理影响Adjustmentreactions:shock,terror,anger,guilt,denial

调整反应，震惊、恐惧、愤怒、愧疚、否认Decisionmakingdilemmas:toknowornottoknow,treatment,whototell,pregnancy,work,relationships

决策困难：知道或不知道、治疗、告诉谁、怀孕、工作、关系FearandAnxiety:uncertainty,rejection,coping,pain,death,infectingothers,beingalone,telling,changinglifestyle

恐惧和焦虑：不确定、拒绝、处理疼痛、死亡、感染，被孤立、改变生活方式Depression:uncertainty,multiplelosses,multipleillnesses,hopelessness抑郁：不确定、失去很多、多重疾病，孤独Suicidalthoughts/behaviour自杀的想法和举动Bereavement-oftenmultiple失去亲人－通常多重Psychologicalimpactcont.

心理影响包括Decreasedself-esteem/self-image降低自尊、形象Socialisolation社会孤立Lossofpersonalcontrol自我控制降低Obsessionalstates:e.g.bodychecking妄想强迫状态Aversiontomedicalprocedures厌烦医疗程序Relationshipconflicts关系危机Sexualdifficulties:maintaining‘safersex’,aversion,sexualdysfunction

性难题：维持有保护措施的性行为，厌恶、性困难Alcoholanddrugmisuse嗜酒、吸毒Neuropsychologicaldifficulties:memoryloss,confusion,concentrationdifficulties,motorimpairment,headache,personalitychanges神经精神困难：记忆丧失、神志模糊、精神不集中、头痛、性格改变Personalandsocialfactorsaffect

reactiontoHIV

个人和神会因素影响Priorexperience既往经验KnowledgeofHIVandAIDS相关知识Howtoldresult/feelingsaboutbehaviourwhichledtoinfection如何被告知可以引起感染的行为Stageandseverityofillness疾病的阶段和严重Perceivedsocialsupport感觉到社会支持Personal,socialandfinancialsituation

个人、社会和经济情况SocialandcommunityreactiontoHIV

社会、社区的反应Psychiatrichistory精神病的经历Copingstyle 处理类型Decisionmakingdilemmas

下决定的难题HIVtesting检测Disclosure(tellingothers)不告诉别人Relationships关系Work工作Economicsituation经济情况Medications治疗Pregnancy(abortionordecisiontotryforachild)…

怀孕（流产或要小孩）等等WhatotherthingsdoPLHIVhavetomakedecisionsabout?还有哪些影响做决定HIVdiseasecontinuum

HIV疾病连续带

Casestudy1:BeforeHIVtesting案例分析1：检测前

YandZareplanningtogetmarriedandareveryhappy.TheyaretoldtheymustgetanHIVtestbeforemarriage.YhasnottoldZbutseveralyearsbeforehehadvisitedCSWs.HeisworriedthatthismightcomeoutduringtheVCTandZwillthenrefusetomarryhim.HeargueswithZthathewouldprefera‘truthmarriage’atthistime.

Y和Z正在非常高兴地打算结婚。他们被告知需要在婚前进行HIV检测。Y没有告诉女友几年前他曾经有与性工作者有过接触。他担忧这会在VCT中被查出，Z会拒绝和他结婚。他和Z争论说，他更倾向于“事实婚姻”

Casestudy2:AfterHIVdiagnosis

案例分析2：确诊感染HIV之后

YhasbeenHIV+forabouttwomonths.HewentforanHIVtestwithhisgirlfriendZastheywereplanningtogetmarried.ZtestednegativeforHIVandafterhetoldherhistestwasHIV+shelefthim.Yisworriedthathewillneverhaveawifeandchildnow.Hehasnottoldanyoneabouthisdiagnosisandhasnotletthedoctorvisithimafterthefirsttime.Hisfamilyareaskinghimwhyheisnotgettingmarriednow.Heisverydepressedandfrightenedaboutwhatwillhappen.Hethinkshewilldiesoon.

Y确诊HIV感染2个月，因为打算结婚，与女友一起去做的检测。Z结果是阴性，当Y告诉Z说他是阳性时，女友离开了他。Y担心他会找不到老婆，不会有小孩了。他没有告诉任何人，也不让医生去看他。他的家里人问他为什么现在还不结婚。他很压抑，害怕将来会发生的事情。他认为他快要死了。Casestudy3:

Decisionmakingdilemmas

案例分析3：做决定的难题 YandJmetatasupportgroupforPLWHA.JisalsoHIV+foroneyearandistakingARTbutiswell.SheisawidowafterherhusbanddiedofAIDSandIDU.HerprevioushusbandrefusedtohaveanHIVtestandblamedJforHIVwhenshewentforatest.YandJlikeeachotherverymuchandwouldliketogetmarried.Jwouldliketobecomepregnantasshehasnochild.YisnotsureabouthavingachildashethinksthebabywillbebornHIV+.

Y和J相识于PLWHA互助小组。J确诊阳性1年，现在口服ART治疗，现在很好。她是个寡妇，丈夫死于AIDS，静脉吸毒。她的前夫拒绝HIV检测，当她去做检测时责备她。Y和J彼此相爱，可能结婚。因为自己没有小孩，她想怀孕。J不能确定是否要小孩，因为他觉得孩子也会感染艾滋病。Casestudy4:

WhengettingAIDS

案例分析4：AIDS发病时 Yhasbeenlosingweightandhashadpneumonia.Hehasdifficultypayingthedoctorforhistreatment.HislastCD4waslessthan100.HewastoldtostartARTbythedoctorbutwhenhetookthepillshesoonhadnausea,vomitingandconstantdiarrhoea.Hestoppedthepillsandhasdecidedthatithisfatetodie.Hehasbeentooilltoworkandstaysinhishomeinadarkroom.

Y最近得了肺炎，越来越瘦。他支付治疗费用有困难。最后一次CD4小于100。医生告诉他要开始ART治疗，但是当他开始口服药物的时候，很快出现恶心、呕吐和持续的腹泻。他停止用药，觉得自己注定会很快死掉。他病情太重已经不能工作，只能呆在自己家的一个黑屋子里Casestudy5:

Deathanddying

案例分析5：死亡 Ydiedthismorn