Week 1: Children and Adolescents & HIV
Notes: Content in this week covers modules 3-4 in the HTS for Children and Adolescents manual. Keep in mind that everyone has their own style of counselling. Some of the questions will ask you to write down your thoughts about different topics in your workbook and then “compare answer”. We have provided sample responses from experts. You may find that you have written something that is not listed. This does not necessarily mean your response is wrong.
Learning Objectives
- Demonstrate self-awareness in the provision of quality HTS for children and adolescents
- Assess your own personal values and beliefs that influence the provision of HTS
- Demonstrate an understanding of legal and ethical issues encountered in HTS for children and adolescents
- Describe the different needs of children and adolescents
- Reflect on the role of the PC in child and adolescent HTS
Practice
This week pay attention to how you are counselling children and adolescents related to legal and ethical issues. You will share a challenging situation you handled with your WhatsApp partner. Use your Action Plan to document your challenges and plans related to this week’s topic.
Learning Activities
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Video: Sarah (15 min)
Instructions
View the following short video of an 11-year-old girl living with HIV. In your workbook, write down your answers to the questions below.
Credit: United Nations Development Programme (UNDP)Questions
- What attitude does the girl have about living with HIV?
- Why does she have this attitude?
- In your work, what have you observed about the attitudes of children and adolescents living with HIV?
- In your work, how can you support adolescents living with HIV to have a positive attitude, like the girl in this story?
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Video: Importance of Getting HIV Tested (15 min)
Instructions
View the following video of 3 children talking about the importance of getting tested early for HIV. In your workbook, write down your answers to the questions below.
Credit: Africaid Zvandiri, ZimbabweQuestions
- What reason do each of the children give for getting tested for HIV early?
- How has getting tested for HIV benefited their lives?
- What do you do in your work as a PC to encourage children and caregivers to get tested for HIV?
- What are some challenges you’ve encountered when encouraging testing and how have you overcome these?
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Self-Assessment on Attitudes, Values, and Beliefs (20 min)
Instructions
Explore your self-awareness, attitudes, and beliefs about children and adolescents. Complete the assessment in your workbook. When you are done, answer the follow-up questions, then tap the button to see feedback.
- Is there anything that surprised you about your responses?
- Do you see any patterns in your responses?
- Judging from your responses, do you see any behaviours that you need to change to become a more child friendly counsellor?
- What behaviour do you plan to change after completing this exercise?
It is important for you as a PC to recognize that a child needs to be treated like a person and that the counselling session is for the child. They should be treated respectfully and as the main focus from the moment they walk in (for example, the child should be greeted first, before the parent or care giver).
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Case Study: Impact of HIV on Children and Adolescents - Rufaro (20 min)
Instructions
Complete the case to learn more about the impact of HIV on children and adolescents. Refer to the HTS for Adolescents and Children Manual module 3 (pages 22-45) if you need to refresh your memory.
Background
Rufaro, a mature orphan, is 15 years old. She is HIV-positive and lives with 2 siblings: one is negative and the other is positive and on treatment. They attend school and live in the same hut together, which has one room for sleeping, cooking and eating. The roof is leaking. The clinic and school are 12 km away. They do not have electricity or water; they get their water from a borehole 2 km away. Firewood is scarce, so they use cow dung for fuel, which they collect on the way to and from school. Whenever possible the siblings attend church. Rufaro cares for her younger siblings. The one who is on ART has many health issues. Consequently, Rufaro misses a lot of school.
Answer the questions below about Rufaro and her family and the impact of HIV.
3.What are the physical, psychological, social, and spiritual needs for Rufaro and her family? Consider how you would work with Rufaro to address these four areas. Write your responses in your workbook then tap the compare answer button.
- Physical needs The roof needs to be repaired for shelter to be sound. Contact Kraal head or see if a local NGO who deals with children can help. Alternatively, see if faith-based organizations are available to provide assistance. Further assess food and clothing needs.
- Psychological needs Ask if the children have a support system and if they do not, provide linkages to support.
- Social needs Find out who is paying for school fees and uniforms and, if needed, connect them to local services.
- Spiritual needs Encourage them to attend church more often. If possible, help them share their situation with the church leadership, who may be able to mobilize support for the children from the church membership.
5.Give examples of how you might use the following 5 counselling techniques with Rufaro. Write your responses in your workbook then tap the compare answer button.
- Building a relationship Be inviting, thank her for coming in, discuss the weather, ask how they traveled to the clinic.
- Widening the system Ask if there are any relatives on either the maternal or paternal side who can assist when things get tough.
- Empowering/Empathy Tell her that she is strong and very determined in single-handedly taking care of her younger siblings / let her know that you can imagine what she is going through.
- Storytelling Ask Rufaro to tell you a story of her life and pay attention to the tone and non-verbal cues that will allow you to discover the important, interesting, and challenging aspects of her life.
- Play Use the Soldier Game or role play life experiences.
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Podcast: The Right to Have Children (20 min)
Instructions
Listen to this podcast from the book Red Ribbons and Roses, created by a group of HIV positive youth. In your workbook, write down your answers to the questions below.
Credit: Africaid Zvandiri, ZimbabweQuestions
- What did the people in the stories say about their right to have a baby?
- How did they care for themselves and their baby?
- What was the result?
- How can you support HIV positive people who want to have babies?
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Check Your Knowledge: Understanding Children and Adolescents (15 min)
Instructions
Complete these quiz questions to check your knowledge on children and adolescent development.
3.Describe how the characteristics of adolescents listed below can have a positive or a negative effect on their prevention, care, support, and treatment of HIV. Write your responses in your workbook then tap the compare answer button.
- Inquisitive Can be positive if the adolescent is interested in information about HIV and new experiences (including sex) or negative if the adolescent is inquisitive and engages in high-risk behaviours.
- Desire for independence Can make an adolescent more active in self-care or they may not want to listen to the PC.
- Influenced by peers Can be a positive in a support group but can be negative if an adolescent is coerced into unprotected sex.
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Video: Role of PCs in Child and Adolescent HTS (10 min)
Instructions
View this video of counsellors discussing their role in caring for children living with HIV. In your workbook, write down your answers to the questions below.
Credit: United Nations Development Programme (UNDP)Questions
- What struck you about the video?
- What motivates you in your role as a PC supporting HIV positive children and adolescents?
- Who supports you professionally when working with children and adolescents? How does this support affect you?
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Check Your Knowledge: Myth or Fact? (20 min)
Instructions
Answer true or false to the following statements about children. Some are common myths and some are facts. You decide.
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Case Study: Legal and Ethical Issues - Child (20 min)
Instructions
Complete the case to learn more about legal and ethical issues related to counselling children.
Note: You can refresh your knowledge of the legal and ethical guidelines on pages 51-59 of the HTS for Children and Adolescents manual.
Background
Chengetai is 5 years old. He has been unwell for the past year with recurrent ear infections, diarrhoea, and herpes zoster. His mother, Joyce, was advised by her local clinic that she should bring Chengetai to you for HIV testing. During the pre-test information session, Chengetai’s mother informs you that she has changed her mind and does not want him to be tested.
You spend some time in discussion with Joyce and you ask her questions about her family life and her access to the clinic. She responds that she was not booked because she is the fourth wife of a 60-year-old polygamist, who is the leader of an apostolic sect and does not believe in conventional medicine. She delivered in a clinic by default because she was visiting her sister when she went into labour. She was offered an HIV test, which she refused, but allowed them to do whatever they deemed necessary for the baby, including BCG vaccine. She told you that they gave her information on breastfeeding and check-ups.
2.You can see that Joyce loves her child and is concerned about his health because she has brought him to clinic. She expresses several concerns. In your workbook write what you would say to address these concerns below. When you are done, tap the compare answer button.
- “When you test me you will introduce your own blood, which is infected, and then you tell me that I have HIV.” Explain how the test is conducted and how used syringes are disposed of.
- “HIV is due to witchcraft and my husband is the leader of the Apostolic so I am immune to HIV.” HIV knows no religious boundaries. Explain how HIV is transmitted. Use of the Soldier Game could be useful here.
- “I’m not HIV positive because I’ve heard that women who are HIV positive cannot have children.” Provide her with correct information on menstruation, conception, rights of sexual and reproductive health (SRH).
- “When I test positive then that will mean that I am considered dead.” Explain that ARVs allow infected people to live longer, normal, healthier lives. Reassure her that she has a family to look forward to.
- “I’m afraid my husband will divorce me because I came to the clinic. He will think that I disobeyed him. He doesn’t want me to visit clinics because it goes against his religious beliefs.” Explain and reassure her of the confidentiality principle.
4.What would you say to Joyce to encourage her to get Chengetai tested? In your workbook, write down 3-4 statements you would say, then tap the compare answer button.
- Using the guiding principle of “best interest of the child” you should counsel the mother on reasons why it is important to test.
- Provide ongoing support and counselling to her and encourage her to ask questions. Address any concerns and misconceptions that she may be having.
- Explain that if the child is positive and does not know it, he is at an increased risk of getting sick and not developing well.
- Stress the positive facts about “living with HIV,” such as the medications and care available if he is positive.
Read about the best interests of the child below and then answer a few questions.
Best Interests of the Child
A guiding legal and ethical principle for counselling children and adolescents is that the best interests of the child shall be a primary consideration. The principle applies when:- A child and adolescent is ill and diagnosis will facilitate appropriate care and treatment
- A child and adolescent is a survivor of sexual abuse
- A child and adolescent has been exposed to HIV through vertical or sexual transmission
- A child and adolescent expresses concern that given an HIV positive result, he or she will be denied access to care and treatment by the parent/caregiver
- A child and adolescent is concerned about MTCT
This principle may be used under these circumstances in order for the provider to ensure that the child and adolescent is provided with adequate care and support, sometimes in conflict with the parent/caregiver. When counsellors face legal and ethical dilemmas, this principle guides the counsellor in how to manage the situation. If the counsellor acts in the best interests of the child and adolescent at all times, the child and adolescent will be protected and legal and ethical principles will be upheld.
Chengetai’s mother has agreed to get him tested. You recognize that since she has agreed to testing her child, it may be a good opportunity for her to get tested as well. Now you would like to provide counselling to encourage her to get tested.
10.What could you say to Chengetai’s mother to encourage her to get tested? Write answers in your workbook, then tap the compare answer button.
- Explain that even if Chengetai tests negative, it does not necessarily mean that she is also negative.
- Provide ongoing support and counselling to her and encourage her to ask questions. Address any concerns and misconceptions that she may be having.
- Explain that if she is positive and does not know it, she is at an increased risk of getting sick and not being able to look after her family.
- If your clinic has access to mentor mothers, you could ask whether she would be willing to meet with a mentor mother for more information.
- Stress facts about living positively with HIV and the support services available instead of the idea that “everyone dies from HIV”.
Joyce agrees to take the test.
You conduct pre-test counselling with Joyce before giving her the HIV test. The next section presents statements you would say to her during your session.
13.You decide to conduct a risk assessment. What questions do you ask Joyce? Write answers in your workbook, then tap the compare answer button.
There are many questions you can ask to assess risk, including:
- Do you have other children and if so, have they been tested?
- Are your children from the same marriage?
- Is this your only marriage?
- Have you or husband been treated for STIs?
- Is he the only man you have had sexual intimacy with?
- Have you had sex without your consent? (sexual abuse)
- Do you and your husband use a condom during sex?
- Do you use vaginal herbs?
During a risk assessment, you should explore many issues, including abuse and family life. Although a client like Joyce may be coming in for a specific reason, it is often the case that other issues will arise around the health and safety of not just the child but also the entire family. Though you should always address the presenting issue, you should also be ready to also address any additional concerns.
Note: Tap here to see a Risk Assessment questionnaire.
Risk Assessment PDF Risk_Assessment.pdf
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Case Study: Legal and Ethical Issues - Adolescent (10 min)
Instructions
Complete the case to learn more about legal and ethical issues related to counselling adolescents.
Background
Sibongile is 15 years old. She has attended your facility alone, requesting an HIV test. During pre-test counselling, she shares with you that she has a 17-year-old boyfriend, Peter.
Sibongile reports that she and her boyfriend are sexually active. She is a double orphan (both parents have passed away) and has a young brother and sister she takes care of. You discover that she is having sex with her boyfriend so that he helps her with upkeep.
5.You learn that Sibongile is having unprotected sex with Peter. What do you counsel her about this? Write your answers in your workbook, then tap the compare answer button.
- Discuss the implications of unprotected sex: STI, HIV, unwanted pregnancy
- Educate her about STIs and relationship of STI and HIV: Both are sexually acquired. There is a high risk of acquiring HIV because STI distorts the natural history of HIV—STIs accelerates the progression of HIV.
- Conduct a condom demonstration of both male and female condoms (Stress the importance of correct and consistent use of condoms. Dispel the myth that being in a relationship for some time does not mean that you can trust your partner to stop using condoms.)
- Talk about the implications of getting pregnant at this age (such as dropping out of school, pregnancy complications, abortions which are illegal, but still happen, preterm deliveries, delivery complications)
- Mention the importance of monogamy (having just one partner): Importance of having sex not based on material things but of the heart. Dealing with things which matter to empower the self.
- Discuss sexual reproductive health issues such as hygiene and the menstrual cycle. (Week 4 discusses SRH.)
- Conduct regular pre-test counselling with a risk assessment.
- Educate her about the basics of HIV.
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Video: Stigma (10 min)
Instructions
Watch the video, “Loyce,” which was produced by Africaid, Zvandiri in Harare, Zimbabwe. In your workbook, write down your answers to the questions below.
Credit: Africaid Zvandiri, ZimbabweQuestions
- What was the video about?
- What are some of the effects of HIV stigma on children and adolescents?
- Have you ever seen or witnessed stigma?
- What will you do personally to reduce stigma in your work?
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Action Plan (30 min)
Instructions
In your workbook, fill in the Action Plan for this week. There are three parts to fill in.
Part 1: Describe a challenging case. The worksheet will help you to develop the details.
Part 2: Create a strategy. From the ideas generated above to address the challenge, choose one and create a strategy to apply in your workplace.
Part 3: Putting your learning into action. Using the worksheet, you will list out what you learned this week and how you will apply it to your job. -
Partner Discussion (30 min)
Instructions
Using WhatsApp, send your response to the following discussion topic to your partner before midnight on Thursday. By midnight on Saturday, please post thoughtful responses to your partner’s posts. To get credit, forward the discussion to the administrator before midnight on Sunday.
Discussion Topic: Think back to a challenging situation that you documented in your Action Plan about Legal and Ethical Issus of Testing and Counselling for Children or Adolescents. With your partner, share one challenge you faced and 2-3 ideas for taking action to resolve it. Give you partner feedback to his or her post, which can include suggestions for other actions to take or things he or she might have overlooked in his or her action plan.