Session 3: Fundamentals of HIV Testing Services
Counselling for Key Populations
In this section, we will discuss provision of counselling to key populations. We will also review some of the most at-risk and vulnerable populations that may need HTS. There are many considerations around counselling key populations and we will highlight just a few of them. Please refer to the Zimbabwe National Guidelines for more information about and how to counsel key populations.
Learning Objectives
By the end of this session, you will be able to:
- Define key populations.
- Define terminology used when discussing sexual identity.
- Discuss the correlation of substance abuse and risk behaviour.
Learning Activities
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Key Populations (5 min)
Key populations are people who are at higher risk of being infected or affected by HIV. They play a key role in the spread of HIV and their involvement is vital for an effective and sustainable response to HIV. They include both most-at-risk populations and vulnerable populations.
Most-at-risk populations are those who are most likely to be exposed to HIV and most likely to be infected. Some of their behaviours create, increase, and perpetuate risk (e.g., unprotected sex, multiple sexual partners, and injecting drug use with contaminated needles). They include sex workers, injecting drug users (IDU), transgender people (TG), and men who have sex with men (MSM).
Vulnerable populations are at risk due to such factors as age, social mobility, gender and the environment in which they live (e.g., poverty, gender discrimination, lack of health services, and lesser legal, social, or policy protection resulting in limited ability to access HIV prevention services). They include adolescents (especially girls); orphans; street children; people in closed settings (e.g., prisoners); people with disabilities (PWD); mobile workers, such as long-distance truck drivers (LDTD); and migrant populations, including refugees, fishermen, and small-scale miners.
Counselling for key populations
When we provide counselling for key populations we need to consider some of the common behaviours within these groups:
- Unprotected sex
- Multiple sex partners
- Injection drug use
These are all high-risk behaviours and we need to be sensitive yet address the risk factors with the client. We need to remember our principles and techniques of counselling and be sure to apply them.
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Terminology for Discussing Sexual Identity (4 min)
When working with key populations, it is important for us to remember what we learned earlier about self-awareness. We can come across clients who are behaving in ways that we would never have imagined, it is not for us to judge, but to provide care and treatment without discrimination. There are some terms that are used to discuss sexual identity and we should be able to incorporate these into our vocabulary.
Sexual identity is a person’s understanding of who she/he is sexually, including the sense of being male or being female. Sexual identity consists of three “interlocking pieces” that, together, affect how a person sees himself/herself.
Tap on each three aspects of sexual identity to read more about them.
Gender identity
Knowing whether one is male or female. Most young children determine their own gender identity by age two. Sometimes, a person’s biological gender is not the same as his/her gender identity – this is called being transgender.
Gender roles
Socially constructed duties and behaviors which say what men and women should/can do. There are many rules on what men and women can/should do that have nothing to do with the way their bodies are built or function.
Sexual orientation
This refers to a preference for sharing sexual expressions with members of the opposite sex, members of the same sex or both. Preferences maybe socially or biologically determined or both.
Sexual Patterns
There are a number of terms that are used for describing people’s sexual behaviours, or patterns with regards to sexual orientation. The patterns are defined as follows:
Heterosexual: Preferring emotional/sexual partners of the opposite sex.
Homosexual: Preferring emotional/sexual partners of the same sex.
Bisexual: Enjoying emotional/sexual partners of both sexes.
Asexual: Having little or no sex drive. No desire for sex.
Celibacy: The deliberate abstention from sexual activity, a choice people make for a variety of reasons.
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Addressing Substance Abuse (5 min)
Alcohol and cannabis/marijuana (mbanje) are the major substances abused in Zimbabwe. It is important to counsel clients on the reasons why these substances are not good for their health and puts them at particular risk.
The intoxicating effects of many drugs can alter judgment and inhibition, and lead people to engage in impulsive and unsafe behaviours. It is a key determinant of secondary HIV transmission risk and poor treatment adherence.
Substance use adversely affects immune function by decreasing infection-fighting white blood cell counts and antibody production. It increases the risk of exposure to stressful and traumatic events, including physical and sexual assault, which are likely to lead to the development of post-traumatic stress disorder, which complicates existing health outcomes.
Substance use further compounds elevated distress associated with HIV-related burdens, which are common among HIV-positive individuals and have high association with suicide ideation.
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Substance Abuse Counselling (5 min)
Social support has been demonstrated to provide a buffer against substance use. The provision of integrated HIV and AIDS services and HIV group intervention formats is important as an effective strategy for substance use prevention and treatment among people with HIV.
Examples of strategies include:
- Adequate case management and links to care providers.
- Links and access to available social support resources, such as self-help groups and community and/or religious organisations.
- Adaptive coping skills and stress management training. For example, HIV-positive youth and adolescents with maternal histories of substance abuse have demonstrated the need for family support to help decrease their risk of substance abuse.
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Key Points (5 min)
- Vulnerable and key populations can be counselled using the guiding principles of HTS.
- Self-awareness contributes to high quality counselling services.
- Substance abuse can increase risk for HIV.