Guidelines for Counselling around HIV and Pregnancy - Southern ...

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Discordant couplesA discordant couple is a couple where one partner is HIV positive andthe other partner is HIV negative.If a discordant couple wants to have a baby together, they will need tohave sex without a condom. There is a chance that the HIV-positivepartner will infect the HIV-negative partner. However, this need nothappen. Discordant couples can choose artificial insemination or .sperm washing.Some hospitals, clinics and private doctors offer a service called artificialinsemination to help couples have babies. When the woman is HIVpositive and her partner is HIV negative, artificial insemination meansthat the doctor takes the man’s sperm and puts it inside the woman,without the couple having unprotected sex. The man is thereforeprotected from HIV infection from his partner.If the woman is HIV negative and the man is HIV positive, some privatehospitals offer sperm washing followed by artificial insemination. Washingthe sperm removes all the HIV found in the fluid around the sperm.Therefore only sperm, and not HIV-infected cells, are used in artificialinsemination.Discordant couples can .maintain a happy and .healthy relationship.As a counsellor, you could keep a list of clinics and hospitals in yourarea that offer artificial insemination and sperm-washing services.Termination of pregnancySome HIV-positive women or couples have unplanned pregnancies, andthey might feel it would be better for them not to have the baby. Theymight not want to take the chance of the baby being infected with HIV, andworry that they will not be able to take care of a sick child because of theirown HIV infection. They may also be worried that they will be too sick tolook after a child, or that they may die.Termination of pregnancy (also known as a TOP or an abortion) islegal in many countries in southern Africa. Many government clinicsoffer termination of pregnancy for free. The least risky time to terminate apregnancy is in the first three months (12 weeks) of pregnancy.As a counsellor, is it important to do the following things.Help your client understand why she does not want to continue with herpregnancy. Some of her fears about HIV and pregnancy might be becauseof a lack of information.Give the couple accurate information about:– the risks of parent-to-child transmission of HIV;– ways of trying to prevent parent-to-child transmission of HIV;– positive living, so that she and her partner can stay healthy for along time.Know your country’s laws about termination of pregnancy.Have a list of clinics and health workers who will be able tohelp your client, if she and her partner decide to terminate thepregnancy.Help the couple make an informed decision about continuing(carrying on) or discontinuing (not carrying on) the pregnancy.Do not judge them for their decision.Remember that in many cultures, women are expected to havechildren. There is a stigma to being childless, or terminatinga pregnancy. Many women may wish to keep their decision toterminate a secret. This might be because they fear violence fromtheir partner, or anger from their community. Remind your clientthat you will keep her story confidential.Inform your client about other choices, like adoption and foster care.24 25
Prevention of MTCTPMTCT during pregnancyIf a mother, who is not already taking ARVs, wants a natural birth she needsto take ARVs at some point before or during her labour. Exactly when shehas to take them depends on the kind of drugs available at the health clinic.Some are taken four weeks before labour, others are only taken duringlabour. Read more about ARVs during pregnancy on page 22.PMTCT during childbirthPMTCT programmes help to prevent a baby from being infected with HIVduring the birth process. MTCT can be reduced if:an HIV-positive mother gives birth by planned operation, such as a .C-section or Caesarean. This means that the baby will not come intoas much contact with the mother’s body fluids during birth. .The chance of infection is then reduced;a mother who wants a natural birth takes ARVs before or duringlabour, depending on the ARVs available;the baby is given a short course of ARVs once it is born.For more information on ARV treatment, read SAT’s HIV CounsellingSeries No. 12: Guidelines for Counselling on ARV Treatment.PMTCT during infant feedingBreastfeeding gives a newborn baby the best possible nutrition. It alsoboosts the infant’s immune system, and reduces the risk of the baby gettingdiarrhoea. Diarrhoea is a cause of many deaths among infants in southernAfrica. However, there is a risk that an HIV-positive mother might transmitHIV to her baby through breastfeeding.Health workers have different thoughts about whether or not an HIV-positivemother should breastfeed. This is what the World Health Organizationrecommends:It is essential that mothers decide on ONE WAY ONLY of feeding their baby:either breastfeeding ONLY; or milk formula ONLY. Mixed feeding, which is acombination of breastmilk, formula and food, gives the baby the biggest chanceof getting HIV from the mother.As a counsellor, it is important to do the following things.Provide accurate, helpful information. This will help your client makeinformed decisions about PMTCT. Make a list of the hospitals, clinics orNGOs in your area that offer PMTCT programmes.Remind your clients that even with a good PMTCT programme, thereis still a chance that the baby will be born HIV positive. Help the couplethink about the possibility of having a baby with HIV.Understand that your client may not wish to disclose her HIV status toher health workers. She will then not be able to participate in the PMTCTprogramme. Do not judge your client, but help her to think carefullyabout her choices.Prepare your client for the possibility that she might have to start takinglong-term ART after she has given birth. She might be worried aboutARTs, because she may think they are dangerous. Find out as muchas you can about the ART medicines and programme at the clinics inyour area, so that you are able to provide accurate information. Thismeans taking the right drugs at the right time, every day.Exclusive breastfeeding means giving the baby breastmilk only, untilthe baby is six months old. This means no water, cow’s milk, infantformula or other food. The baby must only be given breastmilk, andmedicine given by a doctor or nurse. Anything else will upset thebaby’s stomach, and make it easier for HIV to get into his or her body.Exclusive breastfeeding is recommended for women:who cannot afford to buy formula. In some countries, formulais sometimes provided free for six months – find out what yourcountry provides;who do not have access to clean tap water;who are afraid of the stigma if they feed using formula.26 27
Page 1 and 2: SATSouthern AfricanAIDS TrustSuppor
Page 3 and 4: ForewordTh. is.is.the.thirteenth.pu
Page 5 and 6: IntroductionThis book has been writ
Page 7 and 8: What is counselling?Counselling IS:
Page 9 and 10: Asking questionsWhen you ask questi
Page 11 and 12: Conducting a counselling sessionBef
Page 13 and 14: As a counsellor, it is important to
Page 15: Why test for HIV before conception?
Page 19 and 20: As a counsellor it is important to
Page 21 and 22: The fear of domestic violence is on
Page 23: SAT’s HIV Counselling SeriesThis

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