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HIV: Therapeutic Strategies for Guilt, Uncertainty, and Taking Control
On the last track we discussed emotions. Three emotions regarding positive diagnoses of HIV are fear, guilt, and uncertainty.
On this track we will discuss disclosure strategies. Three aspects of disclosure regarding a client’s HIV positive status that we will discuss are who to tell, feelings about disclosure, and dual disclosure.
Remember Thomas from the last track? After dealing with his fears regarding HIV, Thomas had questions about disclosure. Thomas wasn’t sure who he should or shouldn’t tell. Thomas also didn’t know how to disclose his infection. If you are treating a client who is learning to live with HIV, perhaps the information and strategies on this track can be applied to your next session.
#1 Who to Tell
You may find that your HIV positive client is concerned over the possible reactions of coworkers. Could the knowledge that your client doesn’t have to disclose his or her HIV status help alleviate concern over who to tell?
I continued to discuss who to tell with Thomas. Thomas mentioned that he felt as though it would be easier to tell his best friend, Karen, than to hide his HIV status from her. I stated, "If telling someone will make things easier, then the benefits might outweigh the consequences. However, here are some things you should consider before telling someone about your HIV status.
Think of your HIV positive client. Could Thomas’ considerations regarding disclosure help your client disclose his or her HIV status?
#2 Feelings About Disclosure
Thomas stated, "If there’s a one in five chance I’m going to regret it, and almost half of the people with HIV are undecided about disclosure, why should I bother telling anyone at all?" I gave Thomas five reasons that I have heard for wanting to disclose HIV status. As you listen to these five reasons, consider your client. Do any of these reasons characterize your client’s desire to disclose? Here is reason number one:
#3 Dual Disclosure
Billy stated, "The first question that comes to people’s mind when you tell them is ‘How did you get it?’ Well, when I told mom and dad, I just decided to answer that first." Billy had called his parents in advance to tell them he was coming over and had something important to tell them. Billy had sat with his parents in the living room for a few minutes before rising and stating that he needed to tell them something. Billy stated, "First, I said ‘Mom. Dad. The good news is: I’m gay.’"
Before Billy’s parents could respond, Billy added that he was also HIV positive. Billy stated, "My mother cried and my dad looked like he was petrified. I gave them some brochures about HIV and left. I’m sure they’ll come around." Whether Billy’s approach was appropriate clearly depends on the direction his relationship with his parents went following Billy’s dual disclosure.
Does your client have two disclosures to make instead of one? If your client feels as though he or she needs to disclose the reason for HIV infection as well as the diagnosis, you might consider discussing how the client can approach the subject with those he or she plans to tell. Perhaps playing this track for your client or in a group session might be beneficial. Would you agree?
On this track we discussed disclosure strategies. Three aspects of disclosure regarding a client’s HIV positive status that we discussed are who to tell, feelings about disclosure, and dual disclosure.
On the next track we will discuss dating and sex. Topics will include additional disclosure tactics, sex, and the dangers of sex.
Reducing HIV-Related Stigma: Lessons Learned from Horizons
- Pulerwitz, J., Michaelis, A., Weiss, E., Brown, L., and Mahendra, V. (2010). Reducing HIV-Related Stigma: Lessons Learned from Horizons Research and Programs. Public Health Reports, 125. p. 272-281.
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