心理社会问题精品文稿.ppt

心理社会问题第1页，本讲稿共20页 Aims目的Define the aims of HIV counselling咨询的目的Types of counselling in HIV and AIDS HIV and AIDS咨询的类型Understand why it is important明确为何咨询很重要Learn counselling skills掌握咨询的技巧第2页，本讲稿共20页What is counselling?咨询的定义?“HIV/AIDS counseling is a confidential dialogue between a person and a care provider aimed at enabling the client to cope with the stress and take personal decisions relating to HIV and AIDS”(World Health Organization)“HIV/AIDS 咨询是求询者和咨询员之间的在保密情况下的谈话，目的是是使求询者能应付HIV感染带来的紧张压力，做出自己的决定。”(世界卫生组织)第3页，本讲稿共20页VCT is more than a blood test!VCT不只是抽血化验!Promotes planning for future care;e.g.orphans,wills促进将来咨询的计划;例如孤儿Normalises HIV/AIDS+reduces stigma正常化处理HIV阳性所产生的歧视Enables referral to social+peer support加强Enables preventive therapy+contraceptive advice加强预防治疗和避孕建议Promotes early OI/STI treatment+access to ART促进早期OI/STI 治疗和 开始 ARTReduces mother-to-child-transmission(MTCT减少母婴传播Facilitates behaviour change促进行为改变Increases acceptance of HIV result and coping提高HIV检测结果的接受和处理自愿咨询自愿咨询检测检测(VCT)第4页，本讲稿共20页Why is counselling in HIV important?为什么HIV咨询很重要?HIV diagnosis has many effects physical,psychological,social,and spiritualHIV 确诊有很多影响 身体,心理,社会和精神HIV is life-threatening and lifelongHIV是伴随终生、致命性的疾病Prevention counselling can prevent transmission预防性咨询可以预防HIV传播HIV continues to be highly stigmatised HIV感染者仍然受到很大的歧视第5页，本讲稿共20页Stigma and discrimination丑化和歧视How do you define stigma?怎样定义丑化?How do you define discrimination?怎样定义歧视?What are the causes of stigma in HIV?导致 HIV丑化的原因是什么?Name as many ways as you can that stigma can affect PLWHA尽可能的定义丑化影响 PLWHA的情况第6页，本讲稿共20页Stigma questions歧视问题歧视问题 Agree同意 Disagree不同意Women with HIV should not have children感染HIV 的妇女不应该生小孩通常AIDS is mostly a problem for people who are bad AIDS发生在道德败坏的人身上I would share a cup with someone who is HIV我愿意和HIV感染者公用一个水杯People with HIV should be isolated in hospital HIV感染者应在医院进行隔离All drug users should be forced to test for HIV所有吸毒的人应该强制进行HIV检测PLWHA should get free ARVs艾滋病感染者应该得到免费的ARVsIt is their own fault that women who sell sex get HIV卖淫感染HIV的妇女是自己的错I would let a PLWHA hold my baby我可以让PLWHA抱我的小孩MSM are not normal;they have an illness男同性恋不正常,他们有病If a doctor has HIV,he should be removed from his job如果医生感染HIV，他应该调离工作There is no HIV-related stigma in my township在我们镇上没有HIV相关的歧视If people do not use condoms,it is their own fault if they get HIV不使用安全套而感染HIV则是自己的错Stigma can prevent people from getting HIV care歧视将阻碍人们获得HIV关怀如果感染HIVPeople should always tell their family if they are HIV应该告诉家人他的HIV身份第7页，本讲稿共20页What other types of HIV counseling are there?HIV其他类型的咨询都包括哪些?Pre-and post-HIV test(VCT)HIV 检查前、后咨询 Prevention of Mother to Child Transmission(PMTCT)预防母婴阻断 Supportive counseling支持咨询Crisis counseling危机咨询Prevention/behaviour change counseling行为干预咨询Grief and bereavement counseling悲痛、丧亲咨询Can be offered to individuals,couples,families,groups,and communities(and health care staff)可以提供给个人、夫妻、家庭、团体和社会（包括医务工作者)第8页，本讲稿共20页What are some common counselling issue for PLHIV通常还有哪些常见的咨询问题?What issues are there for PLHIV in your community你们社区有什么样的问题?Relationships and sex关系和性Facing stigma and discrimination面对歧视和丑化Coping with fear,anxiety,guilt,shame,and isolation应付恐惧、焦虑、罪恶和耻辱Living with uncertainty处理生活充满变数Coping with many losses 处理很多损失Coping with illness处理疾病Pregnancy and PMTCT怀孕和母婴阻断HIV care options including ART,nutrition,etc.关怀：包括药物和营养Knowledge and acceptance of HIV statusHIV身份和知识的接受PLHIV第9页，本讲稿共20页Bio-psychosocial model of HIVBio-psychosocial model of HIV生理心理社会模式生理心理社会模式与心理问题相关的因素:疾病相关的因素(最初诊断并发合并症及其类型疾病的进程),与个人相关的因素(以前心理状态处理类型和控制力察觉疾病的能力),人际社会因素(社会支持社会态度社会调整)第10页，本讲稿共20页Psychological impact of HIV/AIDS心理影响Adjustment reactions:shock,terror,anger,guilt,denial调整反应，震惊、恐惧、愤怒、愧疚、否认Decision making dilemmas:to know or not to know,treatment,who to tell,pregnancy,work,relationships 决策困难：知道或不知道、治疗、告诉谁、怀孕、工作、关系Fear and Anxiety:uncertainty,rejection,coping,pain,death,infecting others,being alone,telling,changing lifestyle恐惧和焦虑：不确定、拒绝、处理疼痛、死亡、感染，被孤立、改变生活方式Depression:uncertainty,multiple losses,multiple illnesses,hopelessness抑郁：不确定、失去很多、多重疾病，孤独Suicidal thoughts/behaviour 自杀的想法和举动Bereavement-often multiple 失去亲人通常多重第11页，本讲稿共20页Psychological impact cont.心理影响包括Decreased self-esteem/self-image降低自尊、形象Social isolation社会孤立Loss of personal control自我控制降低Obsessional states:e.g.body checking妄想强迫状态Aversion to medical procedures厌烦医疗程序Relationship conflicts 关系危机Sexual difficulties:maintaining safer sex,aversion,sexual dysfunction 性难题：维持有保护措施的性行为，厌恶、性困难Alcohol and drug misuse嗜酒、吸毒Neuropsychological difficulties:memory loss,confusion,concentration difficulties,motor impairment,headache,personality changes神经精神困难：记忆丧失、神志模糊、精神不集中、头痛、性格改变第12页，本讲稿共20页Personal and social factors affect reaction to HIV个人和神会因素影响Prior experience 既往经验Knowledge of HIV and AIDS相关知识How told result/feelings about behaviour which led to infection如何被告知可以引起感染的行为Stage and severity of illness 疾病的阶段和严重Perceived social support感觉到社会支持Personal,social and financial situation个人、社会和经济情况Social and community reaction to HIV社会、社区的反应Psychiatric history 精神病的经历Coping style 处理类型第13页，本讲稿共20页Decision making dilemmasDecision making dilemmas下决定的难题下决定的难题HIV testing检测Disclosure(telling others)不告诉别人Relationships 关系Work 工作Economic situation 经济情况Medications 治疗Pregnancy(abortion or decision to try for a child)怀孕（流产或要小孩）等等What other things do PLHIV have to make decisions about?还有哪些影响做决定第14页，本讲稿共20页HIV disease continuumHIV疾病连续带 Case study 1:Before HIV testingCase study 1:Before HIV testing案例分析案例分析1 1：检测前：检测前Y and Z are planning to get married and are very happy.They are told they must get an HIV test before marriage.Y has not told Z but several years before he had visited CSWs.He is worried that this might come out during the VCT and Z will then refuse to marry him.He argues with Z that he would prefer a truth marriage at this time.Y 和Z正在非常高兴地打算结婚。他们被告知需要在婚前进行HIV检测。Y没有告诉女友几年前他曾经有与性工作者有过接触。他担忧这会在VCT中被查出，Z会拒绝和他结婚。他和Z争论说，他更倾向于“事实婚姻”第15页，本讲稿共20页Case study 2:After HIV diagnosisCase study 2:After HIV diagnosis案例分析案例分析2 2：确诊感染：确诊感染HIVHIV之后之后Y has been HIV+for about two months.He went for an HIV test with his girlfriend Z as they were planning to get married.Z tested negative for HIV and after he told her his test was HIV+she left him.Y is worried that he will never have a wife and child now.He has not told anyone about his diagnosis and has not let the doctor visit him after the first time.His family are asking him why he is not getting married now.He is very depressed and frightened about what will happen.He thinks he will die soon.Y确诊HIV感染2个月，因为打算结婚，与女友一起去做的检测。Z结果是阴性，当Y告诉Z说他是阳性时，女友离开了他。Y担心他会找不到老婆，不会有小孩了。他没有告诉任何人，也不让医生去看他。他的家里人问他为什么现在还不结婚。他很压抑，害怕将来会发生的事情。他认为他快要死了。第16页，本讲稿共20页Case study 3:Case study 3:Decision making dilemmasDecision making dilemmas案例分析案例分析3 3：做决定的难题：做决定的难题Y and J met at a support group for PLWHA.J is also HIV+for one year and is taking ART but is well.She is a widow after her husband died of AIDS and IDU.Her previous husband refused to have an HIV test and blamed J for HIV when she went for a test.Y and J like each other very much and would like to get married.J would like to become pregnant as she has no child.Y is not sure about having a child as he thinks the baby will be born HIV+.Y和J相识于PLWHA互助小组。J确诊阳性1年，现在口服ART治疗，现在很好。她是个寡妇，丈夫死于AIDS，静脉吸毒。她的前夫拒绝HIV检测，当她去做检测时责备她。Y和J彼此相爱，可能结婚。因为自己没有小孩，她想怀孕。J不能确定是否要小孩，因为他觉得孩子也会感染艾滋病。第17页，本讲稿共20页Case study 4:Case study 4:When getting AIDSWhen getting AIDS案例分析案例分析4 4：AIDSAIDS发病时发病时Y has been losing weight and has had pneumonia.He has difficulty paying the doctor for his treatment.His last CD4 was less than100.He was told to start ART by the doctor but when he took the pills he soon had nausea,vomiting and constant diarrhoea.He stopped the pills and has decided that it his fate to die.He has been too ill to work and stays in his home in a dark room.Y最近得了肺炎，越来越瘦。他支付治疗费用有困难。最后一次CD4小于100。医生告诉他要开始ART治疗，但是当他开始口服药物的时候，很快出现恶心、呕吐和持续的腹泻。他停止用药，觉得自己注定会很快死掉。他病情太重已经不能工作，只能呆在自己家的一个黑屋子里第18页，本讲稿共20页Case study 5:Case study 5:Death and dyingDeath and dying案例分析案例分析5 5：死亡：死亡Y died this morning from AIDS.He was very ill at the end but refused to go to hospital and his wife J looked after him at home with support from the rural doctor.J had been rejected by Ys family as they blamed her for infecting him with HIV.She has a healthy baby from her marriage with Y who is now 3 years old.J is very tired and sad and has started to worry that she is also becoming ill.She is also worried about how she can look after her child now.今天早上Y死于AIDS。他最后病情很重，但是拒绝去医院，由他的妻子J在乡村医生的帮助下在家里照顾他。因为丈夫家人责怪她传染给丈夫HIV，J已经被家人所抛弃。她和J结婚后有个3岁健康的孩子。J很累很伤心，她开始担忧她也会生病，她同样担忧他怎样能照顾她的孩子。第19页，本讲稿共20页Practice counselling咨询实践Work in pairs 成组工作Think of an example of someone whom you counselled recently put yourself in their shoes you are going to see a counsellor for a brief first interview 10 minutes回想你最近咨询过的患者，换位思考你要去见咨询师10分钟Then switch 换组Group demonstration and feedback小组展示和反馈第20页，本讲稿共20页