Counselling And Partner Management

Counselling & Partner Management

What is Counselling? Importance of Counselling Effective Counselling Helps People to... Barriers of Effective Counselling Skills and Attitudes Counselling Process Harm Reduction Breaching Confidentiality Partner Management Partner Notification Partner Notification Prerequisites Types of Partner Notification

What is Counselling?

Counselling is a collaborative confidential process of professional assistance and guidance which helps clients in resolving personal or psychological problems.

Importance

Counselling is an effective tool to help people learn about their sexuality and STIs. Many people feel embarrassed or ashamed to talk about such topics. So, they usually seek a friend or a relative who may not give them the right information or the emotional support they need. A good counsellor will diminish their fears, guilt, and anger and give them the necessary information.

Effective Counselling Helps People to:

1. Clearly understand their situation and all its aspects 2. Cope better with the situation 3. Choose the best option that suits their needs, feelings, and values 4. Make decisions and take full responsibility for them 5. Develop new skills to deal with life and sexuality in particular

Barriers of Effective Counselling

Barriers related to the client Social stigma Fear of treatment Fear of emotions Anticipated Utility and Risk

Barriers Related to the Counsellor

10 Rules for Skills and Attitudes

Controlling instead of encouraging Judging Moralizing and preaching Labelling and making assumptions Unwarranted reassurance Not accepting the client’s feelings

The counsellor’s attitude is extremely important especially in matters related to sexuality and STIs. This is because of the sensitivity and stigma related to these topics. A counsellor should be able to create a safe space for the clients to talk openly about their feelings and issues. This could be achieved by:

1.Showing respect to the clients’ feelings, values, and problems 2.Understanding their resources, knowledge and strength to deal with their problems. 3.Not judging, being warm and easy to talk to, and using words of empathy, not sympathy. 4.Being open and modest to learn from them. 5.Being sensitive to inequality between both genders and how this may affect their sexual health. 6. Being trustworthy and confidential about clients’ information. 7. Taking informed consent before any procedure 8. Knowing your limits i.e knowing when to refer a client. 9. Listening actively to them and taking notice of the change in their body language. 10. Taking permission before taking notes and not doing it while they’re talking.

Counselling Process

Building rapport Defining roles and boundaries Ongoing support Closure or ending

STIs Harm Reduction:

Harm reduction is a strategy directed toward individuals or groups that aims to reduce the harms associated with certain behaviours, it was developed initially for adults with substance abuse problems for whom abstinence was not feasible. In recent years, harm reduction has been successfully applied to sexual health education in an attempt to reduce both teen pregnancies and sexually transmitted diseases, including HIV. There are several possible approaches to risky behaviours:

Discourage the behaviour (ie, stopping the behaviour completely);

Encourage individuals to reduce the behaviour

Provide them with information aimed at reducing the harmful consequences of the behaviour when it occurs

Breaching Confidentiality:

Medical ethics principles stress respect, beneficence, and justice; however, STIs cases stretch our concept of these principles. Although confidentiality is an essential part of the physicianpatient relationship, there are situations that may justify breaching confidentiality: 1. There is abuse of a vulnerable person, such as a child or older person 2. There is public health risk, such as with communicable disease 3. The patient is a substantial danger to himself/herself or to others.

Partner Management

Partner Notification for STIs has been recommended as an important step to help interrupt transmission of infections, prevent potential re-infection, and prevent complications. However, there are obstacles. Patients may not inform their sex partners out of fear, embarrassment, or unawareness of the importance of doing so. In resource-poor settings, it is usually impractical for notification to be done by the health sector.

Partner Notification

Partner notification should be considered whenever an STI is diagnosed to enable earlier diagnosis for partners, motivate behavior change in patients and partners, and reduce the burden of disease in communities. Partner notification also offers an important opportunity for identifying asymptomatic persons, particularly women, at an early stage and prior to the development of complications.

Partner notification ensures success in limiting STIs transmission by:

Treating all sexual partners (at least within the previous three months) of the patient.

Treating the partners for the same STI (and any additional ones found) as in the index patient.

It must observe the principles of confidentiality and non compulsion. Particular care should be taken to observe human rights and respect the dignity of the individual. It should be voluntary and non-coercive. The necessary support and counselling needs should be provided.

Partner Notification Prerequisites:

The aftermath of partner notification may require other services to be available to provide support and counselling. This can be done through collaborative institutions offering such services or by training existing health workers to meet this need .

Types of Partner Notification

There are 3 main types of partner notification; the suitability of partner notification types will depend on the choice and circumstances of the index patient:

1. Patient referral:

The index patient takes responsibility for informing their sexual partner(s) of their possible exposure to an STI and for referring them to services. Patients may personally inform their partner(s) of the risk of infection, accompany partner(s) to a healthcare facility, or simply hand over a contact card from the service where they are diagnosed.

2. Provider referral:

The provider (service) takes responsibility for informing sexual partner(s) of the index patient of their possible exposure to an STI. This requires healthcare professionals to obtain from the index patient the names of sexual partners along with other identifying information. It is usually not successful if it is perceived to threaten patient confidentiality.

3. Contract referral:

The provider (service) makes a contract with the index patient that the index patient will contact their sexual partners within a certain time period. Provider referral is carried out if the index patient fails to do this. Activities

Activity 1: Roleplay

Goals Giving participants the creative freedom and letting them think of the best way to act and what to say to get their point across to others all while having fun Materials Markers, paper Methodology The trainers will come up with some scenarios for acting out like (two partners discussing STIs and counseling, or a counselor and a patent, or a counselor and a patient's partner, two random people with one supports counseling and the other is against it) and the participants will be selected randomly and given the main point/theme to memorize and act for the rest of the group with the freedom to change and improvise 15-20 minutes

Expected time

Activity 2: Cases stimulation

Goals the stimulation aims at testing what they have learned in the session and how will they use it to apply to the case if they were in their shoes and will also give them a sense of Materials markers papers Methodology the trainers will come up with some controversial cases about partner management and how to handle difficult situation and uncooperative patients and the participants will be divided into groups with he number of cases and each will be given a case to discuss and say what would they do if they were in their position and if they think the person in the case behaved correctly or faulty

Expected time 10-15 minutes

Activity 3: What is counselling: Counselling in one word Goals At the end of this activity, participants will be able to 1. define counselling 2. Understand how people have different opinions about counselling based on their personal experience and beliefs. Materials Flip chart, markers, sticky notes Methodology Give each participant a sticky note Ask the participants to describe counselling in one word, write it down on the sticky note, and stick it on the flipchart. Read all sticky notes and discuss the definition with the participants. Expected time 30 mins

Activity 4: Counselling skills: Active listening skills

Goals

At the end of this activity, participants will be able to listen actively and communicate non judgmentally. Materials -

Methodology Divide the participants into pairs, one speaker and one responder. For 2 mins, Ask each pair to make a conversation; in which one conversate and the other responds with “yes, but… ” Repeat the same but the response will be “yes, and… ” Ask the participants to compare their feelings at both times.

Expected time 20 mins

Suggested questions to ask

which approach you felt more comfortable with as a listener/speaker? In counselling, what do you think is the best approach?

Activity 5: Counselling: Partner involvement Goals At the end of this activity, participants will be able to understand the importance of partner management and how to do it. Materials laptop, Showscreen Methodology Watch the videos then reflect on them. Expected time 30 mins

Resources Including partner in counselling: https://www.youtube.com/watch? v=P66JrB4VV5A How to tell your partner you have an STD? https://www.youtube.com/watch? v=xxV7CiE2Bwc

Frequently Asked Questions (FAQs)

Q1. Why should I risk my reputation and get tested?

No one is far from getting infected by an STI, and reputation has nothing to do with getting infected or being ill. Consequently, getting tested can help find an infection early or when you have no symptoms. This is important so that:

You can get treatment and avoid long-term problems and spreading the infection to others. You can tell your sex partner(s) so they can be treated and can avoid spreading the infection. If you're pregnant, an STI test can find an infection so you don't spread the infection to your newborn.

Q2. How is premarital and prenatal testing and counseling helpful?

Premarital & prenatal testing help detect STIs which can help prevent the transmission to the partner or the babies. Moreover, premarital STIs counselling and testing is a necessity because these infections may remain dormant and asymptomatic for months or even years in carriers without showing any symptoms, and getting married without knowing that will expose the partner and babies to the risk of acquiring infection.

Q3. What should I do if I suspect that my partner is unfaithful?

The two partners should get tested for sexually transmitted diseases at the earliest opportunity.

It's best to be direct and honest.

Allow the conversation to proceed naturally.

Don't push your partner to make decisions about sex or your relationship right away.

Encourage your partner to ask questions.

Keep in mind that some STDs don’t always show up right away.

It’s possible that you or your partner got the STD in a previous relationship without even knowing it.

Talk about the STARS: STIs status, Turn-ons, Avoids,

Relationship intentions, and Safer sex etiquitte.

References

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8. https://www.ippf.org/sites/default/files/counsellingforstihivprev entioninsrhsettings.pdf http://helid.digicollection.org/en/d/Js2660e/6.4.html http://naco.gov.in/sites/default/files/STI%20Counsellor%20Refr esher%20Training%20Trainee%20Handout.pdf https://iris.wpro.who.int/bitstream/handle/10665.1/11368/929 0610557 _ eng.pdf https://thefarmrehab.com/common-barriers-to-counseling/ https://data.unaids.org/publications/irc-pub04/una97-6 _ en.pdf https://www.unaids.org/sites/default/files/media _ asset/stdcont roltu _ en _ 0.pdf https://ssha.info/wp-content/uploads/ssha-guidance-onpartner-notification-aug-2015.pdf