I had walked to Broadhurst Clinic for an HIV test, and as I sat in the caravan set aside for HIV testing, I wondered what future would be dealt by my test results and for the baby who had been growing in me for two months. An indifferent counsellor sat opposite me, asking in monotone: “Why are you testing?”
She scribbled on a piece of paper and, without making eye contact, shot the next question. “Are you aware of the PMTCT program?”
Monei Motswetla, who is an independent counsellor, offered an explanation for the counsellors’ apathy.
“One of the challenges faced by counsellors is fatigue caused by taking more clients than they can cope with.”
Monei, who was formerly based at BOCAIP, a Christian organisation against HIV and AIDS in Botswana, also says another reason for bland counselling sessions is that counsellors are dealing with educational aspects of HIV and AIDS, rather than identifying how their clients feel.
“People come in for HIV tests with varied feelings, others feel shame, some are angry and some could be frustrated; these emotions influence how they accept their status,” says Monei.
Clients should be allowed to work through their emotions, so do counsellors, who must have daily debriefing sessions to prevent them from burnout.
Pontsho Tidimalo, (not his real name) is a former HIV and AIDS counsellor who resigned from his post due to burnout.
“I quit in 2001, before the rollout of Antiretroviral (ARV) therapy,” he told me. “Back then, there was no assurance of life with an HIV positive status. All you could do was reassure you client as best as you could until their health started to fail,” Pontsho recalled. “I felt as if I was party to the situation they found themselves in on their last days,” Pontsho said looking away.
“The most difficult thing for me was providing services to economically disadvantaged clients who could not afford to buy the necessary dietary requirements to keep healthy,” said Pontsho, adding that one of the few tools a counsellor had to work with before ARVs was a firm understanding of nutrition.
“Being a counsellor, I couldn’t give financial assistance to clients so providing nutritional information but not the funds to purchase the required foods felt sadistic,” said Pontsho, who now only counsels couples.
Pontsho started HIV and AIDS counselling after completing a course at the Institute Development Management (IDM) in 1999.
“I was attached at a public clinic, and clients were referred to me by nurses on observing symptoms.
“I would explain facts about HIV and AIDS, because you simply can’t counsel without the client knowing what exactly might happen to them,” he said.
Pontsho said he saw an average of 20 people a day. A number of those clients, who found themselves HIV positive, coped differently. While some accepted their status some would actually turn violent, directing so much aggression towards him.
“With the limited life assurance it was harder for people to accept their statuses. Some committed suicide.” Pontsho said.