HIV counselling in prisons

HIV presents particular problems in penal establishments: the nature of the population; conditions in prison; media attention and misinformation; the possibility of transmission within and beyond the prison population; the extra issues that apply to female prisoners. These are discussed in the context of prison policy regarding HIV and the broad strategic approach which is being adopted to manage the problem of HIV within penal institutions. Counselling has a key role is the overall strategy. Pre- and post-test counselling with prisoners is described and the particular problems presented by inmates are discussed and illustrated by reference to case histories. Developments in counselling provision for inmates are outlined.     

Psychological trauma associated with AIDS and HIV infection in women

The growing numbers of women faced with HIV infection and AIDS has specific counselling implications. This paper analyses the psychological needs of all women patients seen by the psychology department (n = 33) over the past 12 months. The mean age was 32.3 years. Psychological crisis was high. Four women reported rapes (three accounting for their HIV infection). Two women had suicide attempts (one on two occasions), Death experiences were notable, including multiple bereavement. Conjidentiality was problematic for many of the women. Problems were reported around pre- and post-test counselling which was absent for three women, and often surrounded the diagnosis of a loved one (child, husband or partner). Most women were first seen as in-patients (when disease progression was extensive) or when their partners or children were in-patients. Despite offers of out-patients follow-up, only four HIV + ve women attended, three of which were irregular. A group of ten women were only seen indirectly when provision of care wasgiven to their children. A consistent group were seen with worries about HIV (either due to sexual contact with a known HZV+ ve or at risk individual) or to unfounded concerns often reflecting underlying psychological problems. This paper explores the counselling challenges of AIDS and HIV for women.     

The Challenges of HIV/AIDS Counselling in Nigerian Secondary Schools: A Case Study of Kwara State

The study investigated the challenges of HIV/AIDS counselling in Nigerian secondary schools as expressed by school counsellors in Kwara state, Nigeria. The respondents comprised 132 purposively selected counsellors in Kwara state public secondary schools (Male=85; Female=47). Data were collected with the use of a survey instrument and the data were quantitatively analyzed. The study identified the challenges hindering effective implementation of HIV/AIDS counselling in Nigerian secondary schools as ignorance, non-existence of governmental policy on HIV/AIDS counselling in schools and negative attitudes of school administrators, students and teachers to HIV/AIDS. Geographical location and job status had significant influence on the respondents' views of the challenges facing HIV/AIDS counselling in Nigerian secondary schools. The Counselling Association of Nigeria (CASSON) should enlighten Nigerians on the importance of HIV/AIDS counselling in schools.     

Changes in health status after one year for persons at-risk for and with HIV infection

Abstract

Health status is an important component of the evaluation of patient outcome in HIV infection where disease is chronic, progressive, and debilitating. This paper compares patient self-report for 9 dimensions of health status for patients followed in ATHOS (AIDS Time-Oriented Health Outcome Study). We compared changes in functioning after 12 months for 1, 524 patients with varying HIV disease severity: 238 asymptomatic, 447 symptomatic, 441 AIDS, and 398 HIV-negative individuals who are at-risk for infection.

Declines in health status were observed for all HIV-infected persons, including also asymptomatic patients. Individuals with symptomatic disease or AIDS had significant declines (p < 0.001) in physical functioning, energy, global health, pain, and increased disease symptoms, but no significant declines in health distress, cognition, or mental health. Persons with AIDS had greater declines than those with symptomatic disease. All HIV-infected individuals reported significantly fewer hours at work and more disability days than HIV-negative patients from similar risk pools. The adverse impact that HIV infection has on the health status of HIV-positive asymptomatic individuals is striking; HIV-negative individuals are more similar to HIV-positive individuals than to the general population.     

Depression and HIV infection: impact on immune function and disease progression

Can psychological factors, such as depression, affect human immunodeficiency virus progression? HIV infection is viewed as a chronic illness in which those infected often confront a number of emotional challenges and physical health and disease-related issues. Over the past 20 years, there has been increasing evidence that depression and other mood-related disturbances are commonly observed among HIV-positive individuals. There is also mounting data showing that depressive symptoms might further impact upon specific elements of immune system functioning and influence quality of life and health status. This paper will highlight studies examining the prevalence of depression during HIV infection and review some of the evidence examining the impact of depressive symptoms on immune function and HIV disease progression.     

Perinatally acquired HIV infection: Long-term neuropsychological consequences and challenges ahead

Over the past three decades, perinatal HIV infection in the United States has evolved from a fatal disease to a manageable chronic illness. As the majority of youth with perinatal HIV infection age into adolescence and adulthood, management of this stigmatizing, transmittable disease in the backdrop of a cadre of environmental stressors presents challenges beyond those of other chronic illnesses. The neurologic and neuropsychological consequences of this neurotropic virus have important implications for the successful navigation of responsibilities related to increasingly independent living of this aging population. This article will review the neurologic and neuropsychological consequences of perinatal HIV infection and concomitant factors in the era of highly active antiretroviral therapy and will provide an overview of the neuropathology, pathogenesis, neuroimaging findings, and treatment of perinatal HIV infection, as well as recommendations for service provision and future research.     

Homeless youths and HIV infection.

Risk of human immunodeficiency virus (HIV) infection exacerbates the already difficult lives of 1.5 million homeless adolescents in the United States. Homeless youths engage in sexual and substance-abuse behaviors that place them at increased risk of contracting HIV, and they demonstrate other problem behaviors that reduce their coping responses. Model HIV prevention programs and interventions for HIV-positive youths, implemented for homeless adolescents, need to be disseminated on a national level. Social policies must recognize adolescents' rights to satisfaction of basic survival needs; comprehensively address the needs of dysfunctional, disenfranchised, and single-parent families; and provide continuity of care for adolescents to facilitate independent living. Special provisions must be made when designing programs for gay, sexually abused, and substance-abusing youths.     

Research Report: Antenatal HIV testing from the perspective of pregnant women and health clinic staff in South Africa—implications for pre- and post-test counselling

HIV testing is not routinely available at present in health clinics in Umtata, South Africa. However current statistics indicate that up to 25% of the population may be infected. Such findings imply that HIV testing and counselling should be introduced in health clinics as a means of promoting HIV prevention and reducing the risk of vertical transmission. However this would only be beneficial if staff are prepared to implement it and patients are willing to test. The issues are couched in a background of political activity surrounding HIV that may question approaches to HIV testing and a lack of availability of interventions to prevent mother to infant transmission. Furthermore the infrastructures of counselling training and provision may not be universally available, especially in pressured rural clinics. Therefore, a group of clinic staff and pregnant women, in rural and urban health centres in Umtata, were asked to participate in focus group discussions to elicit attitudes to HIV testing and counselling. In principal the majority of women, particularly in the rural clinic, were willing to have an HIV test, and strongly articulated the desire to test with their partners. Women who were reluctant to test emphasized their fear of receiving the result. The rural women appeared to be far more willing to disclose their HIV status to clinic staff, than urban women. Nevertheless, the discussions illustrated the impact of the stigma surrounding HIV, with clinic staff reporting cases where patients who were suspected to be positive were avoided by health workers. However staff in both clinics were willing to make the effort to implement HIV tests if they were to be made available. Despite the non-availability of rapid testing and interventions to reduce mother to child transmission most women saw advantages to HIV test provision. Pessimism and fear were underlying emotions associated with HIV for both staff and women. The implications for pre- and post-test counselling are discussed.     

Knowledge and causal attributions for mental disorders in HIV-positive children and adolescents: results from rural and urban Uganda

Increasing availability of antiretroviral treatment (ART) has led HIV to be considered a chronic disease, shifting attention to focus on quality of life including mental wellbeing. We investigated knowledge and causal attributions for mental disorders in HIV-positive children and adolescents in rural and urban Uganda. This qualitative study was nested in an epidemiological mental health study among HIV-positive children and adolescents aged 5–17 years in rural and urban Uganda. In-depth interviews were conducted with caregivers of HIV-positive children (5–11 years) and adolescents (12–17 years) in HIV care. Interviews were audio recorded with permission from participants and written consent and assent sought before study procedures. Thirty eight participants (19 caregivers, 19 children/adolescents) were interviewed. Age range of caregivers was 28–69 years; majority were female (17). Caregivers had little knowledge on mental disorders ;only 3 related the vignette to a mental problem and attributed it to: improper upbringing, violence, poverty and bereavement. Five adolescents identified vignettes as portraying mental disorders caused by: ill-health of parents, bereavement, child abuse, discrimination, HIV and poverty. Caregivers are not knowledgeable about behavioural and emotional challenges in HIV-positive children/adolescents. Mental health literacy programmes at HIV care clinics are essential to enhance treatment-seeking for mental health.     

Assessment of HIV counselling and social care services in a London hospital

The use of, and satisfaction with, counselling and social care services was investigated among HIV-infected clients attending HIV specialist climes at Guy's Hospital and Southwark Social Services, London. A survey of 71 clients with HIV infection was carried out using a self-administered questionnaire. The greatest demand was for advice about income support, housing, counselling for the HIV test, counselling for depression or anxiety, psychological support for coping with HIV, help with sleeping problems, mobility allowance, and help with furniture/household appliances. Overall, 57% thought the service was good or excellent; 66% of respondents thought they would use the services in the future. Over nine in ten clients had used the psychosocial support services at some stage since their HIV diagnosis, although only two-thirds anticipated that they would have need of these services in the future. The psychosocial support service will need to remain responsive to the shift in demand for this service, as well as the changing needs of clients who use it.     

Creating mother and baby therapy groups in prison: emotional valuation

Mothers in prison are at high risk of depression and other mental health issues and yet access to therapeutic services is limited. This paper describes the development by the author of two prison therapy groups: one for pregnant women, the other for mothers and their babies. Called the ‘Born Inside’ project, both groups are currently held in Bronzefield Prison, Surrey. The theory and principles behind the project are discussed, as well as the processes and practicalities involved in providing the therapy and specialised support to the women and their vulnerable infants. In addition, principles of forensic psychotherapy in relation to this specific prison population are described, and the situational and emotional challenges faced are illustrated through narratives of group members.     

Self-efficacy and disclosure of HIV-positive serostatus to sex partners.

HIV-positive persons face significant challenges to disclosing their HIV serostatus, and failure to disclose can place their sex partners at risk. The current study examined HIV serostatus disclosure in 266 sexually active HIV-positive persons recruited from the community. Results showed that 41% had not disclosed their HIV serostatus to sex partners. Men who had not disclosed to partners indicated lower rates of condom use during anal intercourse and scored significantly lower on a measure of self-efficacy for condom use compared to individuals who had disclosed. Emotional distress was also greatest among persons who had not recently disclosed. Having not disclosed to sex partners was closely associated with lower self-efficacy for disclosing, with women who had not disclosed reporting the lowest disclosure self-efficacy. As people living with HIV-AIDS are encouraged to disclose their HIV status, interventions are needed to facilitate disclosure decision making.     

The Role of the Black Church in HIV Prevention: Exploring Barriers and Best Practices

Black people have the highest rate of HIV/AIDS infection in the USA, and they are less likely to access quality physical and mental healthcare. To address these disparities as outlined in the National HIV/AIDS Strategy, there is a need for culturally congruent, innovative approaches to HIV/AIDS prevention. The first multi‐denominational national study of Black faith leaders was conducted utilizing focus groups that were held in 11 US cities. The 265 participants were faith leaders who reported involvement in such prevention practices as sponsoring HIV/AIDS workshops, integrating HIV/AIDS messaging in the worship service, hosting HIV/AIDS screenings, distributing written materials about HIV/AIDS through the bulletin or flyers, pastoral counselling, advocating for policies that provide quality healthcare to the community and disseminating HIV/AIDS prevention messages through new media such as the Church website. These findings, including attention to barriers to engagement, provide insight into innovative practices that can be integrated into faith‐based HIV/AIDS prevention programming. Copyright © 2016 John Wiley & Sons, Ltd.     

A short-term group treatment model for gay male survivors of childhood sexual abuse living with HIV/AIDS

HIV-positive gay male survivors of childhood sexual abuse (CSA) face three layers of trauma: childhood abuse, homophobic oppression, and HIV/AIDS. Additionally, CSA has been shown to increase HIV risk behavior among gay men, and the trauma of HIV infection often parallels the experience of CSA. Effective coping strategies are particularly important for people living with HIV/AIDS in order to adapt to physical, psychological, and social implications of infection. However, coping strategies once adaptive in the context of CSA may become maladaptive in adulthood. Interventions are needed that enhance coping and address CSA for survivors living with HIV/AIDS to protect their own health and to prevent new transmissions. This article presents a group model found to be efficacious for treating gay male survivors of CSA living with HIV/AIDS.     

HIV counselling in the 1990s and beyond

It is 15 years since AIDS was first described in the medical literature. Reports of immune system disorders among gay men in large cities in the USA in 1981 signalled the start of what has now become a pandemic affecting millions of people. The psychological impact of HIV infection has been well-documented and it is widely reported that psychological treatment is mosdy provided for the treatment of adjustment reactions. Counselling for HIV prevention and HIV antibody testing has also been at the forefront of psychological support services. More recenuy, there has been a determined effort among counsellors to develop a range of psychotherapeutic approaches to help people to cope with and adjust to living with terminal illness. Most research published in the 1980s on the psychological impact of HIV addressed the infected individual. This symposium introduces a growing interest in the field for counselling those who are affected by HIV, including families, health-care workers and communities. This trend is becoming the focus of many counselling programmes worldwide and is likely to continue throughout the 1990s and beyond.     

Kenyan students' expectations upon beginning a master's course in counselling studies

A sample of 23 students - 12 women, 11 men - enrolled on a two-year part-time master's course in counselling studies in Nairobi, Kenya, took part in a focus group discussion about their expectations of the course. The key themes that emerged were: adding to their skills and status and challenges to the counsellors. The findings are discussed within the context of counselling and culture.     

Experiences of transgender prisoners and their knowledge,attitudes, and practices regarding sexual behaviors and HIV/STIs: A systematic review

Background: Despite transgender people being more visible in prison systems, research suggests they are at higher risk of experiencing sexual violence compared to other prisoners. Research also suggests that transgender prisoners experience harassment, and physical and sexual assault by fellow prisoners, and prison officers who lack transgender-specific health knowledge. There exist no systematic reviews on the experiences of transgender people in prisons. This review aims to fill this research gap. The following question developed in consultation with transgender, sexual health/HIV and corrective services stakeholders has guided the systematic review: What are transgender and gender-diverse prisoners’ experiences in various prison settings and what are their knowledge, attitudes and practices regarding sexual behaviors and HIV/STIs?

Methods: The review followed the PRISMA guidelines and searches were conducted in four databases for the period of January 2007 to August 2017. Studies were assessed against predetermined inclusion and exclusion criteria. Included studies were peer-reviewed, written in English with online full-text availability and reported data on transgender and gender-diverse prisoner experiences relevant to the research question.

Results: Eleven studies (nine qualitative, one quantitative, one mixed-methods; nine in USA, two in Australia) met the criteria for review. Four studies were of high quality, six were of good/acceptable quality, and one study was of modest quality. Transgender and gender-diverse prisoners reported a range of challenges which included sexual assault, discrimination, stigma, harassment, and mistreatment. Information on their sexual health and HIV/STIs knowledge, attitudes, practices is in short supply. Also, their lack of access to gender-affirming, sexual health/STIs and mental health services is commonplace.

Conclusions: The experiences of transgender prisoners as reported in this review are almost uniformly more difficult than other prisoners. Their “otherness” is used as a weapon against them by fellow prisoners through intimidation and violence (including sexual) and by prison officers through neglect and ignorance.     

Counselling implications of anxiety and depression in AIDS and HIV infection: A pilot study

Anxiety and depression are two major psychological reactions to HIV infection. The recognition and treatment of these are of fundamental importance as they may alleviate the suffering for those with a potentially terminal illness, may increase coping and may improve the quality of their life. Furthermore, many of the physical symptoms associated with anxiety mirror AIDS symptoms. For prompt care it is important that those with HIV/AIDS, and those caring for them, recognize the role of anxiety to minimize unnecessary symptoms and recognize those which could respond to medical intervention. In this study a group of front line AIDS/HIV workers were given an in-depth training course on anxiety and depression. Evaluation of the course revealed a high number of patients suffering from anxiety (80.1%) and depression (31%). The evaluation revealed gains in counselling proficiency, knowledge and symptom recognition. Some of the entrenched myths, particularly surrounding suicide, were not resolved. These findings are discussed in the light of the difficulties of training non-mental health workers in the use of counselling skills.     

Randomized Controlled Pilot Study of Cognitive-Behavioral Therapy in a Sample of Incarcerated Women With Substance Use Disorder and PTSD

This randomized controlled pilot study compared a cognitive-behavioral therapy (Seeking Safety; SS) plus treatment-as-usual (TAU) to TAU-alone in 49 incarcerated women with substance use disorder (SUD) and posttraumatic stress disorder (PTSD; full or subthreshold). Seeking Safety consisted of a voluntary group treatment during incarceration and individual treatment after prison release. TAU was required in the prison and comprised 180 to 240 hours of individual and group treatment over 6 to 8 weeks. Assessments occurred at intake, 12 weeks after intake, and 3 and 6 months after release from prison. There were no significant differences between conditions on all key domains (PTSD, SUD, psychopathology, and legal problems); but both conditions showed significant improvements from intake to later time points on all of these outcomes across time. Secondary analyses at follow-up found trends for SS participants improving on clinician-rated PTSD symptoms and TAU participants worsening on self-reported PTSD symptoms. Also, SS demonstrated continued improvement on psychopathology at 3 and 6 months, whereas TAU did not. However, alcohol use improved more for TAU during follow-up. Satisfaction with SS was high, and a greater number of SS sessions was associated with greater improvement on PTSD and drug use. Six months after release from prison, 53% of the women in both conditions reported a remission in PTSD. Study limitations include lack of assessment of SS outcomes at end of group treatment; lack of blind assessment; omission of the SS case management component; and possible contamination between the two conditions. The complex needs of this population are discussed.