**6. Forms of defence and adaptation mechanisms**

In stressful situations, each person reacts differently. Each has his own defence mechanisms which help to reduce tension and anxiety. These mechanisms function on the subconscious level and they deny or distort the reality. The most common defence mechanisms occurring in different types of situations, which are stressful for the child, such as HIV / AIDS thus frustrating in situations, include the following: (Bratska, 2001)


Defence mechanisms are often used by adults, but almost by all children. An acceptable level of use is considered normal. Only when it becomes the predominant way of response, when the child uses this mechanism electively, it signalizes a bad adaptation. The reason for that is because: they prevent the child in dealing with the world in a realistic way. They waste energy that could be used more efficiently. When they fail, the resulting anxiety can present for the child serious difficulties.

Coping with difficult life situations, describes various coping strategies. Unlike defence mechanisms, which falsify the reality, coping strategies – respect the reality. We can define "coping" as behavioural, cognitive or social response of an individual whose aim is to control internal or external pressures stemming from the individual interactions with the environment. We can distinguish two basic coping strategies:

Psychosocial Aspects of People Living with HIV/AIDS 195

• to assist clients manage their problems more effectively and develop unused

Counselling should be about constructive change and about making a substantive difference in the life of the client. However only the client can make that difference, the counsellor is

The counselling before and after testing HIV/AIDS has phenomenal emotional, practical, psychological and social implications for each client. This type of counselling has some

• Pre-test counselling that is done in a proper and comprehensive way prepares the client

• Clients are often too relieved or shocked to take much information in during post-test counselling. The counsellor should make use of the educational opportunities offered

• Counsellors are trained to do pre- and post-test counselling in a professional way and to keep all information confidential. It is also a right of client to sty anonymous. • Nobody may be tested for HIV without informed consent and without proper pre-HIV

The counselling before the examination is focused on providing information regarding the technical side of screening, but also the possible personal, medical, social, psychological and legal implications of diagnosis, whether it is positive or negative. Information should be given in an appropriate form and must be based on actual information. The process of child counselling has specific differences. It is necessary to explain to them every act of procedure

• Consideration of whether the client understands the HIV / AIDS issue, as well as his

The initial interview should include discussion and assessment of the client's attitude,

People who have been confirmed as being infected with HIV must be informed about it as soon as possible. The first interview should be confidential and the client should get some time to deal with this report. After that, he should be very clearly and factually informed about the importance of the diagnosis. At this time, devoid of different speculations about the forecast or consideration of how much time remains the affected person has to live. It is a time period, when a person has to deal with the new reality and overcome the *shock*. It's also time to provide security support and assistance. It is a time of hope for resolving personal and practical problems that may arise. If there are real possibilities of such support, it is appropriate to talk about possible ways of therapy in case of some HIV / AIDS

Whether the client will or will not accept the diagnosis is usually determined by the

• Current state of health. Persons, who are already sick, may have a prolonged reaction

time. Their actual response occurs, only when they are physically stronger.

• to empower clients to become more effective self-helpers in the future

• HIV testing never is done without thorough pre-test counselling.

and counsellor for more effective post-test counselling.

Interview before the inquiry should focus on two main areas:

previous experience in crisis management.

symptoms, as well as the effectiveness of treatment.

• Personal history of the client and risks that they were or are exposed to,

appraisal of psycho-social factors and knowledge about HIV/AIDS issues.

opportunities to cope more fully,

specifications:

by pre-test counselling.

test counselling.

that will reduce the initial fear.

following factors: (Bar, 2000)

merely an instrument to facilitate that process of change.

**7.1 Counselling before and after testing HIV/AIDS** 


Choice of coping strategy depends on the previous experience and subjective evaluations of the event. Optimal coping strategies include an estimation of the significance of the critical events and consideration of the risks of the subsequent acts or, conversely, the risk of interruption of activity. In some emergency situations it is necessary to respond immediately, while in others it is better to stop the activity. It is a very difficult period for children and it is necessary for them to get help, whether from close relatives, friends, acquaintances or institutions in the form of emotional support, practical help, advice and information. Social support has a direct impact on reducing stress; or rather it acts as a buffer or blocking in dampening the impact of a crisis. It is also an important determinant of mental health and subjective well-being. When a system of social support is lacking, it leads to a reduction in the child's mental endurance and the possibility to deal with the crisis.
