Counseling and psychotherapy in HIV infection

HIV infection has brought about a change in the way we approach this threatening illness and the patients suffering from it, in terms of protection of public health via information. Perhaps it is the first time an illness has been seen holistically and the interrelatedness of its organic, social and psychological parameters been acknowledged. This has led to new forms of communication within the health care community and has stirred issues concerning sexuality and diversity. Rapid and facile access to information cannot replace the importance of personal communication which allows space for fears, concerns and hesitations to unfold, concerning one’s most private area: sexuality. Counseling and psychotherapy – the very opposite of “massive information” – is there to individualize, to de-dramatize, motivate and support the individual in finding his/her own answers to the needs and conflicts that overwhelm and sentence him/her to idle, repetitious discharges and inhibitions.

 

The Aids Helpline (AH) and Counseling Center (CC) was founded as a unified Service in 1992 by the Psychology Department of the Psychiatric Clinic of Athens University. In 1995 it was incorporated in KEELPNO (former KEEL) and since 2006, has been an Office of the Department of Community Interventions.

From its inception, it was hosted at the “A. Syngros” Hospital, which, as an STD Clinic as well as an HIV Reference Center, has served the Service’s goals excellently, facilitating public attendance, and, at the same time, promoting cooperation between mental health professionals and medical staff.

The AH and CC is the first governmental psychosocial agency for HIV in Greece. It employs professionals in the psychosocial field (psychologists, social worker, psychiatrist and nurse) as well as a secretary. The scientific staff has received specific training in AIDS-related issues as well as in telephone counseling and psychosocial support, psychological evaluation, individual and group psychotherapy and adult education.

The main goal of the service is timely and successful prevention as well as dealing with and processing the various psychological and social matters that come with the infection. This is accomplished through specialized psychological, psychotherapeutic and social interventions in AIDS and STD cases. Additionally, relevant issues such as interpersonal relations, sexuality, sexual orientation, health education, psychosocial crisis, loss, and bereavement burnout are addressed and interventions are offered when necessary. The service’s educational and research ventures are a joint activity.

The needs and characteristics of the community are regularly recorded. This activity systematizes the public’s clinical picture and advances the examination and promotion of more effective ways of addressing public needs. As a unified service, it operates under a shared scientific approach, based on the acknowledgement of the role and the handling of psychosocial factors associated with the importance of preventing and managing organic illness. The Service’s activities are complementary, their basic objective being preservation of individual mental health along with the promotion of public health.

 

To date, the AH has received more than 78,500 calls providing information, counseling and referrals. The CC has served 3400 individuals in 17,000 sessions of pre- and post-test counseling, individual and group psychotherapy, social work and psychiatric evaluation and follow up. The Office’s staff has delivered numerous educational lectures and workshops to the youth population as well as to other professionals and community groups. The staff participates in research programs, is actively involved in the information campaigns and community interventions organized by KEELPNO, and engages in planning and actualizing educational programs. More specifically, the Office offers training to medical students and other health care professionals; practice to psychology senior students and young professionals, in cooperation with their supervisors; supervision and support to colleagues in the psychosocial and healthcare area.

Our clinical and educational experience indicates that acceptance or adaptation to the HIV reality, whether it concerns adoption of safer sex practices or the experience of seropositivity, depends on the ability of individuals to process those mental mechanisms that secure mental and physical integrity, at the same time broadening free will and self-determination. In this sense, information, prevention and psychological support are interrelated.

Encountering HIV (whether contracting it, or not) is, for many, a milestone or a trigger to pursue, within a trustful relationship with the clinician, the support that will give the individual the ability to deal with the vital dilemmas they encounter. Counseling and psychotherapy are individualized interventions that focus on the history, experience and psychic capability of each individual.

Additionally, psychotherapy provides more consistent processing which takes into account the infection’s imagined background and thus respects the slow rhythm of both mental rearrangements and the developments in social consciousness.

Data collected by the CC and AH concerning the population that has communicated with the Office as well as the clinical experience acquired, have served as valuable material that has inspired the editing of one book, two research projects, seven annual reports, 60 publications in magazines or conferences and numerous announcements at scientific events.

Nevertheless, this material is important also because it reflects the course and developments in the area of needs, beliefs about and attitudes towards a “public health issue” which requires the alignment of public and private interest. Additionally, because of the difficulties in the management of sexuality, it underlines the complexity of prevention, the accomplishment of which remains a priority. The deceptive disinhibition due to the recent medical developments is fragile if we consider the new casualties recorded every year and listen to the pain of those living with the virus. Together with the psychosocial implications of the economic crisis, these facts create a new reality to be studied and managed by psychologists and social scientists through our clinical work and the thorough and long-term planning of appropriate intervention strategies.

 

References
  1. Bor R, Miller R, and Goldman E. 1993. Theory and Practice of HIV Counseling. A systemic approach. London: Cassell.
  2. Breton C. 2005. La transmission sexuelle du VIH, Figure de la transgression? Interview at CELERIER M.C. L’Esprit du temps, Champ psychosomatique, 2, 38: 93-107.
  3. Ioannidi-Kapolou E. and Agrafiotis, D., 2005. Sexuality(ies) in the years of uncertainty and AIDS. The new intimate relationship of Greeks and Europeans. Comparative approach. Athens: Polytropon.
  4. Ruffiot A, et al. 1989. Psychologie du Sida: approches psychanalytiques psychosomatiques et socio-éthiques. Liege: Ed. Pierre Mardega.
  5. AIDS Helpline and Counseling Center, Yearly Reports 1992-1999

 
E. Nicolopoulou, M. Gounaropoulou
AIDS Helpline and Counseling Center