A Crisis Workers guide to HIV/AIDS related crises

This reference guide is designed to help clients in a crisis related to HIV/AIDS. Below you will
find steps to take, what to emphasize, what not to say, and general guidelines based on several
crisis intervention models and expert analysis.

It is very important to note that the ever-changing course of HIV/AIDS represents a

continuous series of unexpected stressors.

Repeated crisis intervention is common and appropriate for people who are HIV/AIDS
infected.

Its also important to remember that every crisis and client is different, but all crises
require immediate intervention to interrupt and reduce crisis reactions and restore
affected persons to pre-crisis functioning.

Rid yourself of any stigmas, extreme views, or prejudice against those infected with
HIV/AIDS.

Your goal is to provide clients with emotional first-aid targeted to the particular
circumstances related to HIV/AIDS.
What are HIV and AIDS?

AIDS is an acronym that stands for acquired immunodeficiency syndrome and may
occur when someone becomes infected with HIV (human immunodeficiency virus).

AIDS is third stage of an HIV infection. It occurs when your immune system is badly
damaged and you become vulnerable to infections and infection-related cancers
called opportunistic infections.

Since the discovery of HIV in the late 1970s, there have been many advances in
diagnosis and medical treatment options. These advances have extended the life
expectancy of people who are HIV positive to upwards of 20 years.

HIV is not a death sentence; someone who is infected with HIV can live for many years
as long as they take their medications and continue to live a healthy lifestyle.
AIDS Statistics and Facts

The CDC estimates that 1,201,100 persons aged 13 years and older are living with HIV
infection, including 168,300 who are unaware of their infection.

Approximately 50,000 new HIV infections occur in the United States each year.

HIV is spread mainly by having sex with someone who has HIV or by sharing
needles, syringes, rinse water, or other equipment (works) used to prepare injection
drugs with someone who has HIV.

HIV can also be spread by;

Being born to an infected mother. HIV can be passed from mother to child during
pregnancy, birth, or by breastfeeding.
Being stuck with an HIV-contaminated needle or sharp object. This risk is mainly
for health care workers.
Receiving blood transfusions, blood products, or organ/tissue transplants that are
contaminated with HIV. This risk is very small because of the rigorous testing of
the US blood supply.
Eating food that has been pre-chewed by and HIV-infected person.
Oral Sex.
Deep open mouth kissing if the person with HIV has sores or bleeding gums and
blood is exchanged. HIV is not spread through saliva.

Step 1: Conduct an Assessment of your client

Your assessment should cover the client's environmental supports and stressors, medical
needs and medications, current use of drugs and alcohol, and internal and external coping
methods and resources.
Rather than interrogating your client for information, be sensitive and patient.
Direct the assessment in a way that allows pertinent information to surface as your
client's story unfolds.
If you have a solid understanding of your client's situation, the client will feel as though
he/she has been heard and understood.
Making an accurate assessment is the most critical aspect of a crisis response because it
guides the intervention. A wrong decision in response to a crisis can be potentially lethal.
Although situations with clients may be similar, each person is unique; therefore,
care must be exercised to avoid overgeneralizing.

There are four types of clients you might encounter during your assessment:

One group of clients that you might see is also the largest: the worried well.
- Many of these individuals experience sexual guilt caused by fear of AIDS.
- They are often anxious about their own mortality and their childrens future.
- They are generally hesitant about being tested for HIV.
- They often experience fear arising from their past sexual encounters.
- Issues of suicide for this type MUST be taken seriously.

Another group you might encounter is those who ponder whether to be tested for the
virus.

Issues such as denial and a sense of it can never happen to me may be

present.
Some of these may suspect that they will surely die if they find out.
This group may cope by using a form of denial in which they just assume they
are positive and restrict their sexual behaviors. If they dont get help, they are
putting themselves and others at risk.
Explain the importance that a test detects the virus and knowing can prevent
exposing others to the virus.
You might need to reframe several times to get across to this group.
You can also point out that that even though the test is positive, the client can use
the knowledge to prolong life through medications, nutrition, and physical
wellness.

A third group of clients that you might see is made up of clients who are dealing with a
positive test result.
- Many issues of denial and thoughts of a life ending death sentence.
- The clients energies will be best spent in optimistic support groups, complying
with medications, and learning to engage in healthy behaviors.
- They will often believe that they have lost a world of free sexual activity and any
opportunity for childbearing.

Lastly, the forth group that you might encounter is made up of those who start to develop
symptoms of precursor illnesses.
- These clients will feel dirty or contaminated.
- Fears of physical deterioration. Thoughts of just wanting to die before it gets
worse.
- Will often not let themselves get close to others because of fear of imminent
and painful death.

Step 2: Establish rapport with your client

Establishing rapport is done by active listening, showing empathy, and displaying

excellent non-verbal communication.
Your client may feel judged, embarrassed, depressed, and in some cases punished by
God or family.
Convey respect and acceptance, you will develop a solid therapeutic relationship with the
client.
Displaying a nonjudgmental attitude and neutrality are important in talking with clients
with HIV/AIDS.
Reassure you client that you are there to listen to their worries and concerns. Reaffirm
that you are here to help and support them through this time.
Having good eye contact, having a positive mental attitude, reinforcing small gains and
building up your clients confidence instills trust and respect from your client.

Step 3: Identify the clients major problems

Crisis intervention focuses on the client's current problems, which are often the ones that
precipitated the crisis. Many of the crisis issues related to HIV/AIDS are;
o Afraid of dying/death sentence
o Fear of disclosure
To lovers, family, work, friends, etc.
o Fear of lifestyle changes
Coming clean, treatment, healthy living
o Medical Cooperation and Medical Care
Denial, depression, anxiety, etc.
o Suicide as a means to an end
Feeling as there is no way out, depression, etc.
o Financial issues
o Disability issues
o Caretaker issues
Prioritize your clients issues and problems in terms of which to work on first.
Once a person is infected, they may believe that they have lost a world of free sexual
activity and any opportunity for childbearing.

Step 4: Feelings and Emotions

You should strive to allow the client to express feelings, to vent and heal, and to explain
her or his story about the current crisis situation.
o To do this, you need to rely on the familiar active listening skills such as
paraphrasing, reflecting feelings, and probing.
o Very cautiously, you must eventually work challenging responses into the
dialogue. These can include giving information, reframing, and interpretations. If
these are appropriately applied, they help to loosen the clients beliefs and
consider other options.

If your client is in denial or pondering on whether to be tested for the virus, encourage
your client to get tested. This will help the client prolong life through nutrition,
medication, and physical wellness. Encourage them to talk to others who have been
tested, and they will gain support and encouragement for completing this step.

If your client is recovering from discovering positive test results for HIV/AIDS, this may
require making some meaning out of the crisis event. Receiving a positive diagnosis,
even if you were anticipating the result, is often very unsettling.
Some questions that will be wondered by the client may be;
o Why did it happen? What does it mean? Who gave me the virus? When will I
die? What do I do now? What is my family going to think of me?
o Working through the meaning of the event is important for gaining mastery
over the situation and for being able to cope in the future.

Everyones experience will be different, but being diagnosed with HIV can create a raft of
emotions including anger, denial, depression, anxiety, shock, and the fear of death.
Remind your client that people have a right to feel the way they do, that emotions
are neither right nor wrong, that they will come and go, and also that people can
choose how they deal with them.
Step 5: Generate and Explore Alternatives
This stage can often be the most difficult to accomplish in crisis intervention.
o Clients in crisis, by definition, lack the composure to see the big picture and tend
to relentlessly cling to familiar ways of coping even when they are backfiring.
Help your client consider the pros and cons of various medical programs for treating
HIV/AIDS. (Alternative medicines, mental health support, etc.)
Inquire about what the client has found that works for them so far.
It is important to keep in mind that these alternatives are better when they are generated
collaboratively and when the alternatives selected is thought of and owned by the client.
Step 6: Implement an Action Plan
Encourage your client to establish a support system such as;
o Discussing feelings with others
o Taking part in relaxing activities
o Family therapy
o Reading and further education about HIV/AIDS
o Maintaining health through exercise and good eating
o Joining an optimistic support group run by peers
Doing so will help your client see that they are able to live with the virus and realize that they are
not alone in what they have gone through. These peers will be able to offer the best advice.
Many strategies that have been proven successful to help those infected by HIV/AIDS are;
Working with your client to restore a sense of hope and purpose.
Help your client see how harmful it is to suppress emotions and self-medicate through
alcohol and substance abuse.
Give your client references to help with their doubts, their emotions, and their fears.
Step 7: Follow-Up

You should plan for a follow-up contact with the client after the initial intervention to
ensure that the crisis is on its way to being resolved and to evaluate the post-crisis status
of the client. This post-crisis evaluation of the client can include:
o Physical condition of the client (e.g., sleeping, nutrition, hygiene);

o Does the client have a better understanding of what happened and why it
happened?
o An assessment of overall functioning including, social, spiritual, employment, and
academic
o Satisfaction and progress with ongoing treatment (e.g., financial counseling)
o Any current stressors and how those are being handled
o Need for possible referrals (e.g., legal, housing, medical)

References for your client:

Southwest Center for HIV/AIDS
1101 N Central Avenue, Suite 200
Phoenix, AZ 85004
(602) 307-5330
www.swhiv.org
The Southwest Center for HIV/AIDS is a non-profit organization that aims to lead the fight
against HIV and AIDS. It helps hundreds of thousands of people around the world who are
taking HIV and AIDS fighting drugs with approval from the FDA in part to the Centers clinical
trials and biomedical research program.
Shanti Group
2345 W Glendale Avenue
Phoenix, AZ, 85021
(602) 279-0008
www.shantiaz.org
The Shanti Group provides housing, education, and direct client services to individuals, families,
and loved ones infected and affected by HIV/AIDS.
AIDS Hotline
(602) 402-9396
24-hour hotline for AIDS support, information, and resources. Phones are manned by licensed
professional counselors who can answer your questions and offer free educational materials.