Couples HIV Counseling and Testing

Module Seven: Support and Prevention Services

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**Module Perspective:**

This module will begin with an opportunity for participants to clarify
any materials they may have questions about before moving on to discuss
support services for couples.

One issue that has been mentioned throughout the training is the need
for ongoing services for couples after they have received CHCT. In this
module, small groups will list support services couples might need.
Counselors should be allowed to think broadly and not limit themselves
to services currently available; rather, they should make an ideal list
of services either offered by a CHCT site or by the greater community.

**Objectives for Module Seven:**

-   Identify support services that can be offered to couples after CHCT.

-   Describe Prevention with Positives approach to preventing HIV
    transmission.

-   Identify steps counselors can take to link clients to support
    services.

-   Discuss how to mobilize a community.

**Advance Preparation**

## 

## ***Prepare Overheads*** 7-1 through 7-6

> 7-1: Prevention with Positives
>
> 7-2: Strategies for Bringing Prevention and Support Services into HIV
> Treatment and Care
>
> Settings
>
> 7-3: Strategies for Bringing Prevention and Support Services into HIV
> Treatment and Care
>
> Settings (Continued)
>
> 7-4: Fundamentals of Referrals and Linkages
>
> 7-5: Fundamentals of Referrals and Linkages (Continued)
>
> 7-6: Community Mobilizing Basics

-   ***Prepare Newsprint***

> Support Services (see page 4)

**[Day Five]{.underline}**

**Module 7: Topics/Activities Schedule**

+-----------------------------------------------------------------------+
| ***Start time: 8:30am***                                              |
|                                                                       |
| **Activity Time**                                                     |
|                                                                       |
| Morning Review 20 Minutes                                             |
|                                                                       |
| Support Services 70 Minutes                                           |
|                                                                       |
| Morning Break 20 Minutes                                              |
|                                                                       |
| ***End time: 10:20am***                                               |
+-----------------------------------------------------------------------+

> ***Begin by welcoming the participants to the final day of the
> training. Conduct a culturally appropriate morning energizer to get
> started. Clarify any material participants have questions about before
> you move on to discuss this morning's topics: support, prevention
> services, outreach, and recruitment.***

Welcome to the final day of the CHCT intervention training. We have
finished going through the entire CHCT intervention. This morning we are
going to discuss support and prevention services and outreach and
recruitment. Before we begin with new material, do you have any
questions about anything we have covered so far?

One of the issues we have touched on several times this week has been
the need for ongoing services for couples after they receive couples HIV
counseling and testing.

> What types of couples do you think will have the most need for
> follow-up services or support?
>
> ***Acknowledge responses**.*
>
> ***Listen for:***

-   ***Concordant positive couples***

    -   ***Discordant couples***

    -   ***Couples with relationship problems***

How many of your sites currently make return visits possible for
concordant positive and discordant couples?

> ***Acknowledge responses.***
>
> Do clients often come back for follow-up services?

**Acknowledge responses and facilitate a brief discussion.**

Many facilities do not have the ability to provide ongoing services to
individuals and couples affected by HIV. However, it is beneficial to
allow couples to come back for another counseling session to deal with
any remaining issues. This will help ensure that the couple accesses
continued care and support.

> ***Display newsprint.***

On this newsprint I listed three areas of support services: care and
treatment, psychosocial support, and community services.

I am going to break you into three small groups and give each group one
of these areas to discuss. In your discussion, I would like for you to
identify support services for couples that fit into your specific
category. On a sheet of newsprint, make a list of the services you come
up with. Please do not only focus on what you currently have in your
community. Rather, make an ideal list of services. These could be
services offered by a CHCT site or by the greater community. Think
broadly.

For example, for community services you might begin your list with
economic support and support for children of HIV-positive parents.

> ***Ask participants to count off by threes (for example, 1,2,3, 1,2,3,
> 1,2,3, etc.). Ask all the ones to form a group, all the twos to form a
> group, and all the threes to form a group in different parts of the
> room. Give each group one or two sheets of newsprint for their lists.
> Assign the groups the following areas:***
>
> ***Group 1: Care and treatment***

###### Group 2: Psychosocial support

> ***Group 3: Community services (e.g., economic support, support for
> children of HIV positive parents, etc.)***

***Give the groups 20 minutes for this exercise. Each group should then
assign a spokesperson, who will have 5 minutes to present the small
group's ideas.***

You will have 20 minutes to work in your small groups to create your
list of needed or useful services. After 20 minutes, a spokesperson from
each group will have 5 minutes to present your ideas.

Are there any questions?

Please begin.

> ***Be sure to help the groups keep track of time throughout the
> exercise by letting them know when they have 5 minutes remaining.***
>
> ***After 20 minutes are up, have a spokesperson from each group
> present their group's ideas.***
>
> ***After each group has presented, acknowledge any comments or
> questions, and thank the groups for their work. Post the group's
> newsprint in a visible place in the room.***
>
> ***Then ask the participants to turn to their manuals to review the
> list of support services and resources for couples. Be sure to
> highlight similarities of the services listed in the Participant's
> Manuals and those listed by the groups.***

Thank you for your presentations. Please turn to page \_\_ in your
manuals to the list of support services and resources for couples. Take
a moment to review these.

You will notice many similarities between the services listed here and
the services you came up with. It's important to remember that the
services listed here and the services you came up with in your small
groups are not necessarily complete lists. As we continue to work in HIV
prevention, we may find a need for additional services that we did not
mention. Every community is different, and each will have different
needs and resources.

Are there any questions?

Which of these support services and resources can be offered by a CHCT
site?

> ***Acknowledge responses.***
>
> ***Listen and probe for:***

-   ***Ongoing counseling for couples, individuals, groups, and
    families***

-   ***HIV counseling and testing for children***

-   ***Post-test clubs and support groups***

> ***Facilitate a brief discussion of services currently offered at
> counseling and testing sites or by the community.***

Are some of the services we have discussed currently offered at your
sites?

**Acknowledge responses.**

What happens when counselors see people coming through the door who need
support services that are not available?

**Acknowledge responses.**

> ***Responses may include:***

-   ***Counselors may discourage testing.***

-   **Counselors and clients may become stressed or overwhelmed because
    of a lack of needed resources.**

Without meaning to, counselors can convey anxieties to concordant
positive and discordant clients about a lack of support services. This
anxiety can influence couples and individuals not to get HIV-tested.

> What thoughts do you have about this issue?
>
> ***Acknowledge participants' comments and facilitate a short
> discussion. Be sure to emphasize the need to support couple counseling
> services.***
>
> ***Listen for:***

-   ***CHCT is an important intervention. Its many advantages outweigh
    any existing gaps in support services.***

-   ***Support services will improve as demand increases.***

    -   ***Counselor self-awareness can minimize how a counselor's
        emotions may influence a couple.***

As counselors, we need to continue to talk about these issues. We need
to emphasize to our fellow counselors the importance of couple HIV
counseling and testing despite any existing gaps in support services.

How many of you have heard of Prevention with Positives?

**Acknowledge responses**.

HIV counseling and testing is the beginning step in Prevention with
Positives. Learning that one has HIV and needs to prevent transmission
to others is a very important step. Some HIV-positive persons need
reminders and ongoing counseling to keep from transmitting HIV.

> ***Prevention with Positives is an ongoing intervention designed
> to:***

-   ***Prevent HIV transmission to others***

-   ***Protect the health of HIV-positive persons***

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-   **Provide infected individuals with information, skills, and
    support**

**Display and read Overhead 7-1.**

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This overhead describes the basic premise of Prevention with Positives.

Most HIV prevention strategies target preventing uninfected individuals
from becoming infected with HIV. However, since there is one
HIV-positive person involved in every case of HIV transmission,
Prevention with Positives may be a very efficient and effective
intervention. Prevention with Positives is designed both to prevent HIV
transmission to others and also to protect the health of infected
individuals by providing them with information, skills, and support.

> *Go through Overheads 7-2 and 7-3.*
>
> ![](media/image1.wmf)
>
> Perhaps the most effective model for implementing Prevention with
> Positives is to bring prevention and support services into HIV
> treatment and care settings. Strategies for doing this include:

-   Have providers deliver HIV prevention messages when positive
    individuals visit clinics or other treatment facilities.

-   Facilitate the disclosure of HIV status to sex partners.

-   Develop sensitive and culturally appropriate health promotion
    materials that support disclosure of HIV status and safer sexual
    behavior among people living with HIV/AIDS.

    -   Facilitate partner referral for counseling and testing services.

-   Provide enhanced, ongoing HIV counseling sessions for HIV-positive
    individuals and couples.

-   Provide small group counseling sessions to enhance and reinforce
    risk reduction.

> This information can be found on page \_\_in your manuals.
>
> Are there any comments about the Prevention with Positives approach?
>
> ***Acknowledge responses.***
>
> The final area of care and support that I would like to discuss is
> services for HIV-affected children.
>
> Children with one or both parents infected with HIV have ongoing
> health care, psychosocial, and support needs. Research has shown that
> early outreach to HIV-affected children and their families can help
> them more effectively cope with HIV and plan for the future.
>
> How many of you have dealt with care and support services for
> HIV-affected children?
>
> ***Acknowledge responses.***
>
> HIV counseling and testing programs should explore what options and
> programs exist in their communities. It's important to make
> appropriate referrals to help HIV-positive parents with their
> children's ongoing care and support needs.
>
> Referring couples to appropriate care and treatment services and for
> other support is very important. What steps can you take to establish
> referral networks for your CHCT site?
>
> ***Acknowledge responses.***
>
> ***Listen for:***

-   ***Identify gaps in available support services---both on-site and in
    the referral network.***

-   ***Create an integrated referral network.***

-   ***Create procedures for processing referrals.***

-   ***Create and regularly maintain a resource directory.***

> ***Display Overhead 7-4.***

Let's look in detail at how you can establish a referral network.

First, you should identify gaps in services both at your site and in the
referral network. Assess the gaps and identify the range of services
available.

Create an integrated referral network. To do this, assess what resources
are available. Meet with staff at possible referral sites. Facilitate
the coordination of service providers. Analyze how accessible and
acceptable these resources and services are to clients.

**Display Overhead 7-5.**

Create protocols and procedures for processing referrals. This includes
when to make a referral, how to follow up on a referral, and how to
problem-solve obstacles such as transportation, confidentiality, and
childcare.

Create and regularly maintain a resource directory, including the name
of the referral, location, and directions to the organization, the hours
of operation, and eligibility criteria.

This information can be found in your manuals on page \_\_. Please take
a moment to review them.

**Give participants a moment to review this material.**

Are there any questions?

Some of you may not yet have all the services you need in your
communities. However, there are steps you can take to generate attention
to this issue and engage the community.

Can someone explain the term "community mobilization"?

**Acknowledge responses.**

> ***Listen for:***

-   **Making people aware of services and getting them involved and
    invested in the issues.**

**Display Overhead 7-6.**

Let's review some basic steps to mobilizing a community.

-   Meet with local leaders and community policy-makers.

-   Meet with various groups in the community, such as churches and
    community centers.

-   Convene interested and invested parties for discussions.

-   Initiate sensitization and awareness campaigns.

-   Establish advocacy groups.

-   Generate media attention. Media attention can be generated through
    newspapers, billboards, and radio.

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-   Be aware of the role of public and private sectors.

For example, donor organizations, existing partnerships, community-based
organizations, and faith-based organizations all have the potential for
collaboration or the potential to give funding to your organization.
Counseling and testing sites should build partnerships within their
communities and ensure that their activities compliment existing
services.

Are there any questions about this?

As we have discussed, couples that have undergone CHCT may need many
support services. As ambassadors for CHCT in your communities, you must
seek to establish a continuity of care and support and you must help
mobilize communities that do not yet have access to a range of services.

Let's take a 20-minute break. When we return, we will move on to the
last module, Module Eight, which covers outreach and recruitment. Please
be back by (state time).

**Overheads**

**Module Seven: Support and Prevention Services**

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