# HIV & AIDS counselling

HIV is now a manageable chronic condition: a person on treatment lives a near-normal lifespan, and effective treatment with a sustained undetectable viral load makes the virus sexually untransmittable (U=U). The counselor's battle is therefore mostly with stigma, disclosure, and adherence, not the virus.

## Facts, VCT, and the psychosocial load

**Transmission: only four routes:**

- Unprotected sex with an infected person
- Infected blood (transfusion, shared needles)
- Mother-to-child (pregnancy, birth, breastfeeding: largely preventable with treatment)
- Contaminated sharp instruments
**Not transmitted** by touch, sharing food or utensils, mosquitoes, toilets, or living together: the facts that dissolve most household stigma. HIV (the virus) is not AIDS (the late, untreated stage); with antiretroviral therapy most people never reach AIDS.

**VCT: voluntary counselling and testing** is the curriculum's named service.

- *Pre-test counselling:* informed consent, what the test can and cannot say (window period), risk review, preparing for either result
- *Post-test:* a negative result is a prevention conversation; a positive result is delivered simply and humanely, sitting with the shock, assessing suicide risk, planning who to tell and how, and linking to ART the same week
- *The 5 C's:* consent, confidentiality, counselling, correct results, connection to care
Nepal

Concentrated epidemic: key populations include people who inject drugs, sex workers and their clients, men who have sex with men, and returned migrant workers and their wives: the last group is why HIV counselling belongs in every district, not just cities. ART is free at government centres. Stigma ("HIV = immorality") still blocks testing; your confidentiality practice is the counterweight. Ethical note from the ACA code: disclosure to an identifiable at-risk partner is a last resort, only after working with the client toward voluntary disclosure: take such cases to supervision.

The VCT flow. The two highlighted boxes are where the counselor lives: before the test (consent, what a result would mean) and after it (the result, plainly, with the next step in hand). Everything else is the health system's job.

Key points

1. HIV is a manageable chronic condition; treatment gives a near-normal lifespan, and a sustained undetectable viral load means no sexual transmission (U=U).
2. Only four routes transmit it; touch, food, mosquitoes and living together do not. These facts dissolve most stigma.
3. The counselor's work is testing with consent (VCT), disclosure, adherence and stigma, not the virus itself.
Learn more

Pick one, not all.

Article**WHO HIV/AIDS fact sheet (who.int)**: current global picture, U=U, treatment basics.

Film**Philadelphia (1993)**: stigma's anatomy, still accurate about the social disease.

Free book[Where There Is No Psychiatrist: HIV counselling section](https://www.cambridge.org/core/books/where-there-is-no-psychiatrist/47578A845CAFC7E23A181749A4190B54): scripts for pre- and post-test sessions.


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*Source: https://manoatlas.com/hiv · Licence: CC BY-NC-SA 4.0. Mano Atlas is an educational resource, not a diagnostic tool.*