CAMPUS:

COURSE: DIPLOMA IN COUNSELLING PSYCHOLOGY

TOPIC: HIV AND AIDS COUNSELLING

MODULE: ADC403-A TAKE AWAY

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TABLE OF CONTENT.
Cover Page…………………………………………………………………………………………………………………….1

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Table of Content…………………………………………………………………………………………………………….2

Is HIV Infection a Universally Fatal Diagnosis?...................................................................3

When Should Antiretroviral Therapy Be Given?.................................................................5

What Approaches Should Be Encouraged for HIV Cure?....................................................7

Counseling Intervention for an HIV-Positive Client Toward Self-Actualization…………………9

Conclusion………………………………………………………………………………………………………………………12

References……………………………………………………………………………………………………………………..14

1.Is HIV infection a universally fatal diagnosis? Discuss (20marks).

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For many years, the diagnosis of Human Immunodeficiency Virus (HIV) infection was

synonymous with a grim and almost certain death sentence. The widespread fear and

stigma surrounding the virus stemmed from a lack of effective treatments, leading to the

inexorable progression to Acquired Immunodeficiency Syndrome (AIDS) and subsequent

opportunistic infections. However, advancements in medical research, treatment, and

public health have significantly transformed the landscape of HIV care. Today, HIV infection

is no longer considered a universally fatal diagnosis. With early detection, consistent

treatment, and proper management, individuals living with HIV can lead long, healthy, and

productive lives.

One of the most transformative developments in HIV care has been the introduction and

widespread availability of antiretroviral therapy (ART). ART works by suppressing the

replication of the virus in the body, thereby preventing the progression from HIV to

Acquired Immunodeficiency Syndrome (AIDS), which is the most advanced stage of the

infection. According to the World Health Organization (WHO, 2023), ART has reduced HIV-

related deaths by more than 60% since its peak in 2004. When taken consistently and

correctly, ART can reduce the viral load in an individual’s blood to undetectable levels. This

not only improves the individual's immune function but also prevents transmission to

sexual partners—a concept widely promoted through the message "Undetectable=

Untransmittable" (U=U) (UNAIDS, 2023).

Moreover, the perception of HIV as a fatal illness fails to account for the role of early testing

and counseling. Early diagnosis enables timely initiation of treatment, which significantly

improves outcomes. In many parts of the world, public health campaigns and HIV testing

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services have made it easier for individuals to know their status. Studies show that

individuals who are diagnosed and start ART early can now expect a life expectancy close

to that of the general population (Marcus et al., 2016). This shift in life expectancy further

challenges the outdated notion of HIV as a universally fatal condition.

Despite these advances, disparities in access to healthcare still affect outcomes in some

regions, particularly in sub-Saharan Africa and parts of Asia. Social stigma, poverty,

inadequate healthcare infrastructure, and lack of education can hinder timely diagnosis

and access to treatment (AVERT, 2022). In such settings, individuals may still experience

HIV as a life-threatening illness due to late presentation and lack of consistent care.

Therefore, while HIV is no longer inherently fatal, socio-economic and structural barriers

continue to influence outcomes in certain populations.

Another key factor in survival and quality of life is adherence to treatment. Individuals who

fail to adhere to ART regimens may develop drug resistance, leading to treatment failure

and progression to AIDS. Opportunistic infections such as tuberculosis and certain cancers

remain significant causes of death among people with HIV, particularly in those who are

not receiving or adhering to treatment (CDC, 2023). Therefore, although HIV can be

managed as a chronic condition, it still requires lifelong commitment to care.

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2. When should antiretroviral therapy be given? Describe (10 Marks).

Antiretroviral therapy (ART) is the cornerstone of HIV treatment and prevention. It

involves the use of a combination of medications that suppress the replication of the

Human Immunodeficiency Virus (HIV) within the body. Over the years, research and public

health guidelines have evolved regarding the optimal time to initiate ART. Today, global

consensus strongly supports that ART should be initiated immediately after an HIV

diagnosis, regardless of CD4 cell count or clinical stage.

According to the World Health Organization (WHO, 2023), ART should be started as soon

as possible after diagnosis, including on the same day, when feasible. This recommendation

is grounded in evidence showing that early initiation of ART leads to better health

outcomes, including a stronger immune system, reduced risk of opportunistic infections,

and significantly lower chances of HIV transmission. Early treatment not only prolongs life

but also improves quality of life for individuals living with HIV.

Historically, ART was only started once a person’s CD4 cell count dropped below a certain

threshold or when clinical symptoms of immune suppression appeared. However, pivotal

studies such as the START trial (Strategic Timing of Antiretroviral Treatment)

demonstrated that initiating ART early—before the immune system is weakened—leads to

lower rates of AIDS-related events, non-AIDS illnesses, and death (INSIGHT START Study

Group, 2015). This has led to a universal "test and treat" approach endorsed by major

health organizations globally.

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In addition to individuals diagnosed with HIV, ART is also recommended immediately for

specific situations. For instance, post-exposure prophylaxis (PEP) involves starting ART

within 72 hours of a potential HIV exposure to prevent infection (CDC, 2023). Similarly,

pre-exposure prophylaxis (PrEP), although not treatment but a preventive strategy, uses

antiretrovirals in HIV-negative individuals at high risk of infection to prevent HIV

acquisition. Pregnant women living with HIV are also initiated on ART immediately to

prevent mother-to-child transmission during pregnancy, delivery, or breastfeeding.

Initiating ART early also contributes to public health goals by reducing the community viral

load and decreasing new infections. When a person achieves viral suppression—defined as

having an undetectable viral load—they cannot sexually transmit HIV to others. This

understanding, summarized in the U=U (Undetectable = Untransmittable) campaign, has

revolutionized HIV prevention (UNAIDS, 2023).

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3. What Approaches Should Be Encouraged for HIV Cure?

Despite decades of medical advancement in the treatment of HIV, a complete cure remains

elusive. Current antiretroviral therapy (ART) effectively suppresses the virus but does not

eliminate it from the body. As such, scientific efforts have shifted toward investigating and

developing potential strategies for a definitive cure. Two major approaches have emerged:

the sterilizing cure—which aims to completely eliminate the virus from the body—and the

functional cure, which seeks to control HIV without the need for lifelong treatment. Various

strategies are being explored, each with different levels of promise and complexity.

One key approach under investigation is shock and kill, which involves reactivating latent

HIV reservoirs in the body—dormant cells where the virus hides from the immune system

—and then targeting those cells for destruction. The major challenge of HIV eradication lies

in these hidden reservoirs, which are not affected by ART (Margolis et al., 2016). Scientists

use latency-reversing agents (LRAs) to "shock" the virus out of hiding, followed by

immune-based therapies or drugs to “kill” the exposed infected cells. While promising, this

approach is still under clinical evaluation, with concerns about effectiveness and safety.

Another promising strategy is the block and lock approach. Unlike shock and kill, this

method seeks to permanently silence HIV by locking the virus into a deep latent state,

rendering it incapable of reactivation. This would effectively prevent the virus from causing

disease even without ART (Darcis et al., 2017). Although still in the experimental phase,

block and lock is considered safer than shock and kill, as it avoids activating the virus.

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Gene editing has also become a highly discussed area of HIV cure research. Technologies

such as CRISPR-Cas9 are being investigated for their potential to remove or disable HIV

genes within human cells. Additionally, genetic modification of immune cells—especially

CCR5 receptor editing, inspired by the case of the "Berlin Patient" who was cured through a

bone marrow transplant from a donor with a CCR5 mutation—has provided proof that a

cure is biologically possible (Hütter et al., 2009). However, gene-editing approaches are

complex, expensive, and not yet scalable for global use.

Therapeutic vaccines represent another strategy, aiming to boost the immune system’s

ability to control or eliminate HIV without the need for daily medication. Unlike preventive

vaccines, these are given to people already living with HIV. Researchers hope to create

long-lasting immune responses that can keep the virus at bay, even in the absence of ART

(Barouch et al., 2020).

In addition to biomedical approaches, combination strategies are increasingly favored.

Since HIV is a complex virus with sophisticated survival mechanisms, using a combination

of latency reversal, immune modulation, and gene therapy may enhance the chances of a

durable cure. Collaboration across global institutions and continuous funding for HIV cure

research are also essential to accelerate progress.

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4. Counseling Intervention for an HIV-Positive Client Toward Self-Actualization.

A 35-year-old HIV-positive man presenting with prolonged fever, chronic diarrhea, and a

history of AIDS-defining illnesses such as Pneumocystis carinii pneumonia requires not

only medical intervention but also intensive psychosocial and emotional support. Having

lived with HIV for four years and experienced several opportunistic infections, this client is

likely facing psychological distress, identity challenges, stigma, and existential concerns.

Counseling interventions should be strategically structured to empower the client, restore

his sense of purpose, and support his journey toward self-actualization.

Self-actualization, as proposed by Maslow’s hierarchy of needs, is the highest level of

psychological development where an individual achieves fulfillment of personal potential

and purpose (Maslow, 1943). To help this client reach self-actualization, the counselor

must address his basic physiological, safety, social, esteem, and self-fulfillment needs

through an integrated and empathetic counseling approach.

The initial counseling sessions should prioritize crisis intervention and stabilization,

addressing the client’s immediate concerns related to health, nutrition, and treatment

adherence. The presence of chronic diarrhea and intermittent fever suggests ongoing

health deterioration, possibly due to poor ART adherence or immune suppression.

Encouraging adherence to antiretroviral therapy (ART), providing information on

managing side effects, and involving a multidisciplinary medical team can help the client

regain a sense of physical stability and control (World Health Organization [WHO], 2023).

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The next phase should focus on psychosocial support. The client's experience with multiple

opportunistic infections likely contributes to feelings of helplessness, depression, or

anxiety. Using person-centered therapy, the counselor can create a non-judgmental,

empathetic space for the client to express his fears, frustrations, and emotional pain. Active

listening and unconditional positive regard help rebuild the client’s self-worth, which is

essential for progress toward higher psychological needs (Rogers, 1951).

Cognitive-behavioral therapy (CBT) can be applied to challenge and reframe negative

thoughts related to the client's HIV status, perceived social rejection, or hopelessness. Many

people living with HIV internalize stigma, believing they are unworthy of love, success, or

happiness. Addressing these distorted beliefs helps restore self-esteem and cultivates a

more positive self-concept (Beck, 2011).

Another important intervention is supportive counseling to combat stigma and social

isolation. People living with HIV often experience exclusion from family, friends, or the

community. Facilitating family therapy or support group involvement can foster a sense of

belonging and connection. Community-based organizations or peer support groups provide

the client with relatable experiences and reduce feelings of loneliness (UNAIDS, 2023).

Once the client's emotional and social needs are being met, counseling can focus on goal-

setting, identity reconstruction, and purpose finding. Narrative therapy techniques may

allow the client to rewrite his life story—not as a victim of HIV, but as a resilient individual

with strengths and a future. Helping the client identify passions, skills, and goals supports

movement toward self-actualization. Vocational guidance or volunteer work can restore

purpose and motivation.

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Spiritual counseling or existential therapy may also be valuable for clients facing life-

threatening illnesses. Encouraging the client to explore meaning in suffering, faith, or

legacy can deepen his sense of identity and fulfillment (Frankl, 2006). This step is crucial in

helping clients move from mere survival to personal growth.

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Conclusion.

In conclusion, HIV infection is no longer a universally fatal diagnosis. Modern medicine has

transformed HIV from a terminal illness into a manageable chronic condition. The key to

survival lies in early detection, access to and adherence to antiretroviral therapy, and

comprehensive healthcare support. However, continued efforts are needed to address the

disparities that prevent equitable access to care. With the right interventions, HIV-positive

individuals can live full, healthy lives—dispelling the fatalistic view that once surrounded

the diagnosis.

Antiretroviral therapy should be given as soon as an individual is diagnosed with HIV,

regardless of symptoms or immune status. Early initiation improves individual health

outcomes and plays a critical role in ending the HIV epidemic by preventing transmission.

Comprehensive counseling and support services are essential to help patients begin and

adhere to treatment, ensuring the success of ART at both personal and public health levels.

Multiple approaches should be encouraged in the pursuit of an HIV cure. These include

shock and kill, block and lock, gene editing, therapeutic vaccines, and combination

therapies. While challenges remain in safety, affordability, and scalability, the ongoing

research brings hope for a future where HIV can be cured. Until then, treatment,

prevention, and stigma reduction must remain integral to the HIV response.

Guiding a chronically ill HIV-positive client toward self-actualization requires a holistic,

client-centered counseling approach. The process begins with ensuring physical and

emotional stability and progresses through empowerment, identity reconstruction, and

purpose-driven goal-setting. With consistent counseling, compassionate care, and

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community support, clients with advanced HIV can still reach meaningful self-fulfillment

and lead dignified lives.

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References.

AVERT. (2022). Global information and education on HIV and AIDS.

Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.

Barouch, D. H., Whitney, J. B., Moldt, B., Klein, F., Oliveira, T. Y., Liu, J., ... & Nussenzweig, M. C.

(2020). Therapeutic efficacy of potent neutralizing HIV-1-specific monoclonal antibodies in

SHIV-infected rhesus monkeys. Nature, 503(7475), 224–228.

Centers for Disease Control and Prevention. (2023). HIV basics.

Centers for Disease Control and Prevention. (2023). HIV treatment.

Darcis, G., Kula, A., Bouchat, S., Fujinaga, K., Corazza, F., Ait-Ammar, A., ... & Van Lint, C.

(2017). An in-depth comparison of latency-reversing agent combinations in various in vitro

and ex vivo HIV-1 latency models identified bryostatin-1+JQ1 and ingenol-B+JQ1 to

potently reactivate viral gene expression. PLOS Pathogens, 11(7), e1005063.

Frankl, V. E. (2006). Man’s search for meaning. Beacon Press.

Hütter, G., Nowak, D., Mossner, M., Ganepola, S., Müßig, A., Allers, K., ... & Thiel, E. (2009).

Long-term control of HIV by CCR5 Delta32/Delta32 stem-cell transplantation. New England

Journal of Medicine, 360(7), 692–698.

INSIGHT START Study Group. (2015). Initiation of antiretroviral therapy in early

asymptomatic HIV infection. The New England Journal of Medicine, 373(9), 795–807.

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Marcus, J. L., Chao, C. R., Leyden, W. A., Xu, L., Quesenberry, C. P., Klein, D. B., ... & Silverberg,

M. J. (2016). Narrowing the gap in life expectancy between HIV-infected and HIV-

uninfected individuals with access to care. Journal of Acquired Immune Deficiency

Syndromes, 73(1), 39–46.

Margolis, D. M., Archin, N. M., Cohen, M. S., Eron, J. J., & Honda, M. (2016). Latency reversal

and viral clearance to cure HIV–1. Science, 353(6297), aaf6517.

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396.

Rogers, C. R. (1951). Client-centered therapy: Its current practice, implications, and theory.

Houghton Mifflin.

UNAIDS. (2023). Understanding U=U.

World Health Organization. (2023). Consolidated guidelines on HIV prevention, testing,

treatment, service delivery and monitoring: Recommendations for a public health approach.

World Health Organization. (2023). HIV/AIDS.

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