The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic is in its third decade and has reached to alarming proportions worldwide. According to the Centers for Disease Control and Prevention, more than one million people are living with HIV with an estimated 56,300 infections happening each year in the United States. Diagnosis of HIV/AIDS via early testing along with pretest and post-test counseling is important for psychosocial stabilization and destigmatization. Risk reduction counseling as a preventive counseling method is equally important in high-risk individuals such as adolescents, substance abusers and in gay and bisexual population. The purpose of this review is to address a number of counseling strategies used for education and counseling of individuals at risk of getting HIV/AIDS and also among those who are HIV-infected
1.1 Background of the study
HIV/AIDS has become a threat to public health in Nigeria as a result of its devastating consequences, which are manifested in forms of prolonged sickness, deaths and increase in number of orphans and widows/widowers. Nigeria has an estimated population of about 150 million of which about 3.5 million are infected by HIV/AIDS (FMINO, 2007). HIV/AIDS was first identified in Nigeria in 1985 and reported at an International Conference in 1986 (Adeyi et al, 2006). The HIV/AIDS pandemic led to the death of 170,000 Nigerians in 2007 (UNAIDS, 2008). According to Edewor (2010), Nigeria has already surpassed the 5 percent explosive prevalence phase and the disease has killed more than 1.3 million people and orphaned more than 1 million children (FMINO, 2007). The infection rates of HIV/AIDS vary across the six geopolitical zones of Nigeria. According to Edewor (2010), the mode of HIV transmission in Nigeria is mainly through unprotected sex, and other factors which contribute to the spread of the virus include poverty, Sexually Transmitted Infection (STI), social and religious norms and political and social changes (National AIDS/STD Control Programme, 1999). Parke and Aggleton (2007) noted that negative social attitudes toward marginalised populations, policies mandating the testing of high risk groups and limited legal protections based on HIV status may exacerbate stigma. They stressed further that increase vulnerability to discrimination complicates the social and psychological adjustment of Persons Living With HIV/AIDS (PLWHA). The victims require necessary assistance to be able to live happily and contribute meaningfully to the development of the society. Thus, they need psychosocial supports to be able to cope with their challenges. Psychosocial needs can be described as social, mental and spiritual requirements of PLWHA in order to live quality life and contribute to development of the society. The needs can be viewed from a psychological theory propounded by Abraham Maslow in 1943. According to Maslow (1954), the hierarchy of needs is often portrayed in the shape of a pyramid, with the largest and most fundamental levels of needs at the bottom, and the need for selfactualization at the top. The most fundamental and basic four layers of the pyramid contain what Maslow called “deficiency needs” or “d-needs”, esteem, friendship and love, security, and physical needs. With the exception of the most fundamental (physiological) needs, if these “deficiency needs” are not met, an individual’s body gives no physical indication but the individual feels anxious and tense. Maslow’s theory suggests that the most basic level of needs must be met before an individual strongly desires (or focuses motivation upon) the secondary or higher level needs. Maslow also coined the term “Meta-motivation” to describe the motivation of people who go beyond the scope of the basic needs and strive for constant betterment. “Meta-motivated” people are driven by B-needs (Being Needs), instead of deficiency needs (D-Needs)(Wikipedia, 2011). For the purpose of this study, the psychosocial needs adopted comprise physiological needs, safety needs, belongingness needs, esteem needs, aesthetic needs and self-actualization as propounded by Maslow. Physiological needs include food, air and water; safety needs involve housing and security; belongingness implies social interaction and group affiliation; esteem needs involve high regard for self and others; aesthetic needs deal with love of beauty while self-actualization involves becoming what one desires to be in life. Since the discovery of HIV/AIDs in the 1980s, more than 20 million people have died from the disease. The disease killed three million people in 2003 and is now the leading cause of death and lost years of productive life for people aged ranging from 15 to 59 worldwide (WHO Report, 2004). HIV/AIDS epidemic has become a worrisome phenomenon and individual carrier of the infection suffers from several mental health consequences. The infection is associated with enormous trauma of which stigma and discrimination against people living with HIV/AIDS remain the major psychological stresses. It is perhaps no news that HIV/AIDS patients suffer from psychosocial and neuropsychiatric problems even their health care workers sometimes develop burn-out syndrome that is characterized by emotional distress, lowered job productivity and spread of work problems to family and conjugal relationships. The potential impact of stigma and discrimination has been of ongoing concern to counselors and agencies involved in addressing the HIV/AIDS epidemic. Discrimination at individual, community and national levels have major implications for the epidemic, as divides or separation is created between those who are vulnerable to infection and those who are not. Stigmatization in any magnitude has multiple effects on the lives of people living with HIV/AIDS and more broadly on members of society, creating disruptions in social functioning, and increasing people’s vulnerability to infection and reducing the overall caring capacity of communities. Stigma is perhaps a pervasive problem that affects health globally, threatening an individual’s psychological and physical well-being. HIV/AIDS epidemic has significant effect on the economic and sociological wellbeing of victims. The psychological aftermaths of HIV test mostly if positive prevent majority of the people in Nigeria and Yakurr Local Government area in particular to be tested. As such, counseling of people living with HIV and how to deal with the psychological as well as the social effects of the infection in the area remains a challenge to counselors and corporate bodies alike. However, the problem of how best to counsel infected people is perturbing especially with the rate at which HIV and AIDS are spreading in the state.