Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) Focusing Clients are often overwhelmed by emotional or personal problems related to their particular sexual and reproductive health problems. They may want to address all the issues at once. If clients start to talk about problems or situations that will be discussed later in the session, the counsellor may want to bring the topic of discussion back to the current issue. Example: At the beginning of the first counselling session, the client begins talking about the most recent situation when he may have been exposed to HIV. He asks about where and how he can get condoms. The counsellor does not want to interrupt the flow of the discussion, so says: “Using condoms is an excellent way to reduce your risk of getting an STI or HIV infection. We can talk about that in a few minutes. Right now, let’s continue talking about your HIV situation.” If the client wants to talk about other emotional or personal issues, such as problems at home or a partner’s drug use problem, the counsellor should help the client find appropriate support. Affirming Affirming is congratulating or complimenting clients on the positive actions that they have taken. It is important to encourage success. Complimenting clients helps them feel respected and valued and encourages them to try to make other changes to reduce their risk of HIV infection. It may also make them more willing to share information about other actions they have taken. Example: Client: “I’ve recently started using condoms each time I have sex”. Counsellor: “That’s a really positive step in protecting yourself against HIV and sexually transmitted infections. Well done!” Clarifying Counsellors clarify in order to make sure that they understand a client’s statements or questions. Clarifying also helps the client understand his own situation or feelings better and identify uncertainty or conflict between his thoughts and behaviour. Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-8
Male circumcision under local anaesthesia Version 3.1 (Dec09) Example: Client: “My partner gave me gonorrhoea. I’m afraid of getting HIV. But I’m also afraid that, if I use condoms when I have sex with her, she’ll think I am not faithful.” Counsellor: “Help me understand this. You are afraid you might get HIV from your partner, but you do not want to use condoms with her.” Pointing out a conflict may help the client identify which of two issues is more important to him. It is better than the counsellor telling the client to do something that he is not ready to accept. Clarifying also helps clients make their own choices and draw their own conclusions. Saying “help me understand this” is a good way to begin this type of discussion. Correcting false information It is important to provide correct information to clients and to correct any myths and false information. There are many incorrect rumours about HIV, AIDS, sexually transmitted infections, male circumcision and vasectomy. These should be corrected. However, this needs to be done in a sensitive way, without making the client feel stupid or defensive. Counsellors should acknowledge false information and then correct it quickly. It is not necessary to give detailed explanations. Example: Counsellor: “You mentioned that it is possible to cure HIV by having sex with a child or virgin. Many people believe this, but it is untrue. Firstly sex with a child is wrong and is a crime. Second, it has no benefit to you – at present, there is no cure for HIV or AIDS. Third, and most important, you are likely to transmit the virus to the child” Counsellor: “You mentioned that you want to have a circumcision in order to prevent you from getting HIV from your multiple sexual partners. I think you need to know that male circumcision does not fully protect a man against HIV infection. Circumcised men who do not use protection or who engage in risky sexual behaviour are more likely to contract HIV infection than circumcised men who practise safer sex. Having sex with multiple sexual partners certainly is risky behaviour. You can reduce your risk of HIV infection by cutting down on the number of your sexual partners, avoiding full sexual intercourse (penetrative sex) and using condoms correctly every time you have sex.” Summarizing Counsellors summarize in order to present the main points of the conversation to the client. Summarizing can be useful when moving to another topic or ending the session, and to make sure that counsellor and client have understood each other correctly. Summarizing also Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-9
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Manual for Male Circumcision under Local Anaesthesia

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