HIV/AIDS Education and Counseling
Caleb J Migombo, MDiv, MSW. MFT Cert.

There are many individuals, interest groups and professionals  who are actively engaged in Education and Counseling Services to HIV/AIDS victims, their families and the public around the world. However, there are at least two major disciplines of trained professionals whose training and ethical standards require them to adhere to their highest professional conducts and set a good example of how counseling /therapy to HIV/AIDS should be conducted. The first group consist of Licensed Clinical Social workers, Licensed Professional Counsels, Or Marriage and Family Therapist. The second group consist mainly the Clergy who have both the Theological and Psychological training to provide counseling to their parishioners.
It is the clergy and faith-based counselors that I would like to address today. Pastors, Reverends, Priests, Rabbis, Imams and all spiritual leaders in every denomination have the voice, the platform and public respect to do good to their fellow citizen and members if they use their God given talents well.  As someone with both a theological and Psychological training in pastoral counseling as well as psychotherapy, I am deeply concerned about how we go about caring for the infected and affected in our churches and community. There are dangers and fears associated with our ministries which we must address and overcome. If we do not use our theology the right way and are not careful with our approach and methodology, we may cause more harm in the name of God to the already suffering group. It is with such concern that I want to share what other concerned clergy have written about Pastoral care to those who are living with HIV/AIDS.
It is my intentions to use this page to contribute to the body of knowledge needed by both Licensed Therapist and Pastoral counselors whose practice mainly focus on working with HIV/AIDS population.

Today we begin by looking at the "Guidelines for the Giving of Pastoral Care to Those Infected/Affected by HIV/AIDS"  as discussed by Don Nations. Don provides the theological and psychological framework out of which appropriate emotional/spiritual support needs to take place.

My own experience supports the notion that such a framework most adequately addresses the emotional/spiritual needs of persons infected with or affected by HIV/AIDS.

1. The First Question to Ask is Not, "How did You Get Infected?"
We do not ask someone who has cancer, lupus, or suffered a heart attack how they got sick; so why should we ask that of someone with HIV? When someone tells us their HIV status, they are usually dealing with the present and future more than the past. There may be lifestyle issues that need to be discussed at a future time, but our initial reaction needs to be compassion-- not questioning.

2. Avoid the "Blame Game."
Spending time blaming people who are HIV positive for their illness distracts from the most important issues. The truth is that we have all done things in our life that involved risk. For the most part, we have been spared the consequences of those acts. We are hypocritical when we blame others if they suffer the consequences of their acts. The "blame game" prevents us from giving beneficial pastoral care to those who need it.

3. Compassion is the Key.
Compassion is being a channel of God's grace and coming to the side of one who is hurting. We suspend judgmentalism and focus on the needs of others. Compassion is shown in gentleness, kindness, acceptance, and love. Pastoral care that lacks compassion is not helpful. Compassion is the way of Jesus.

4. Confront Your Own Fears.
Fear leads some pastors and churches to reject people infected/affected by HIV/AIDS. They may refuse to visit or care for them. We must confront our fears with facts, put judgmentalism and prejudice behind us, and get on with the privilege and obligation of ministry.

5. Focus on Life, Not Death.
A person infected with HIV will eventually die. So will a person who is not infected by HIV. We all will die; none of us knows when death will arrive. Therefore, our focus needs to be on how we will live the rest of our life. Focusing only on death gives the impression that we have given up hope and are just waiting for the person to die. Focusing on life declares that the person has a lot of living yet to do.
6. Let the Individual Set the Agenda.
Many of us like to be in control of everything, including the direction of our conversations. This approach can sabotage our best efforts. The earlier you are in your relationship with the person you are counseling the more they need to control the issues that are discussed. If you begin a relationship by making demands of the HIV positive person such as his/her immediate repentance, notification of family/partner(s), and acceptance of death, you are being, at best, unfair and unhelpful. At worst, you are being destructive.

7. Confidentiality is a Must.
We must keep the trust people place in us. Disclosing one's HIV status is often a difficult decision. It means becoming vulnerable and trusting another with a secret. Pastoral visitors are not free to tell others secrets entrusted to us. We do not tell spouses, church committees, pastors, or friends. If we break confidentiality, we may hurt the one who trusted us so much that he/she never reaches out for help again.

8. Act Like There is Hope.
HIV is not a situation completely devoid of hope. New medications are extending the lives of persons infected with HIV. A cure may be found. There is the power of prayer. Most importantly, we all have much living left to do. The gospel of Jesus Christ is a call to hope that this life is meaningful because God is working in our life and eternity will be spent in the presence of God.

9. Affirm the Worth of the Person.
All people are created in the image of God. All people inherently have great dignity and eternal worth. God's grace has gone out to all people and God, calling all people to a life filled with power, love, joy, and service to others. "God so loved the world" (John 3:16) means that there are no second class people. We must embody the message of love or we fail to offer the Gospel.

10. Feel Free to Show Emotion.
HIV/AIDS surfaces concerns about death, prolonged illness, lack of control of our lives, financial stability, transmission of the disease, prejudice, and more. The giving of good pastoral care requires that we confront these issues and get in touch with our own emotions about them. We must be careful, however, to respond to the needs of the person and not our own anxiety, fear, and pity. Our role is to be a pastor to them, not the reverse. Be emotionally present. Feel free to appropriately cry, laugh, or express other emotions when visiting with a person who has HIV.

10. Feel Free to Show Emotion.
HIV/AIDS surfaces concerns about death, prolonged illness, lack of control of our lives, financial stability, transmission of the disease, prejudice, and more. The giving of good pastoral care requires that we confront these issues and get in touch with our own emotions about them. We must be careful, however, to respond to the needs of the person and not our own anxiety, fear, and pity. Our role is to be a pastor to them, not the reverse. Be emotionally present. Feel free to appropriately cry, laugh, or express other emotions when visiting with a person who has HIV.

11. Remember to Touch.
One of the tragedies of HIV is that many people are reluctant to touch someone who is HIV positive. Some of this hesitation is due to irrational fears about contracting HIV through casual contact. Others hesitate because they do not accept the HIV positive person or the lifestyle they are believed to have. Whatever the reason, refusing to touch someone who wants to be touched sends the message that we are not emotionally present for the person or that we do not accept the person. (We must also be sensitive to times when a person does not want to be touched for any reason or cannot be touched because of a physical condition.) Our willingness to touch shows our willingness to care.

12. Look for the Stages of Grief.
People who are infected/affected by HIV wrestle with the stages of grief. They deal with shock, denial, anger,bargaining, depression, and acceptance. People go through these stages in differing periods of time and may bounce back and forth between stages. People will grieve over their HIV status, an AIDS diagnosis, the loss of a job, becoming symptomatic, the loss of their future, the death of their friends, and the anticipation of their own death. Our job is not necessarily to move people through these stages but to help them deal with their present stage. We are called to offer support to our brothers and sisters during these difficult times.
13. Be Aware of the Psychosocial Issues Surrounding HIV/AIDS.
Those infected/affected with HIV deal with a variety of issues such as social isolation, rejection by friends and family, prolonged periods of illness, fear of what tomorrow will bring, the sometimes negative reactions of the religious community, reproductive decisions, guilt, and grieving. As givers of pastoral care, we need to recognize these issues and help people as they work their way through them. We also need to educate our community about HIV/AIDS so that it may respond supportively.

14. Expressions of Spirituality and the Experience of Spiritual Life Varies from Person to Person. No one experiences God in the same way. Some people express their faith emotionally; others are quiet and contemplative. Some people enjoy singing; others prefer to listen. Some belong to a particular religious group; others do not. Some are very sure about their spiritual direction; others are searching and have a lot of questions. Such differences are not bad. They demonstrate the unique way God reaches out to all of us. Since religious expressions differ, we must not require everyone to experience God the way that we do. We can not assume that we know another person's spirituality just because we know they are infected/affected by HIV. We must be present as pastoral guides who help people to find their own way on their spiritual journey.

15. Avoid Saying, "I Know How You Feel."
Even if we had similar situations, we cannot completely understand how anyone else is experiencing a particular situation. More helpful responses include, "I hear your pain"; "I am sorry"; "I am here for you"; "I understand this is a difficult time for you"; "What can I do to help?"; and "How do you feel?" Sometimes a quiet hug is appropriate and needed.

16. Get Educated.
To give helpful, consistent pastoral care, educate yourself about HIV. Learn the basic facts about modes of transmission, progression of the infection, common illnesses and medications, and the psychosocial issues that surround HIV/AIDS. Becoming educated about HIV communicates to people with HIV that you care about them. You can find out about HIV in many ways: books, tapes, seminars, volunteer opportunities, HIV/AIDS hotlines, American Red Cross programs, denominational resources, hospitals, and more. However you choose to become educated, do it today.

17.Pastoral Care with a Person infected/Affectedby HIV/AIDS is Usually a Long Process.
We cannot heal every wound and solve every problem in one hour. Pastoral care with someone whose life has been touched by HIV requires time, patience, and the development of a relationship. Our role is to come along side of people and support them, to be present with them. It is not to answer every question and give the solution to every problem. We must be patient as people work through the stages of grief and the myriad of issues that surround HIV.

18. Know Your Limits.
HIV brings us into contact with issues such as counseling, bio-ethics, living wills, medical treatment, grief, guilt, stresses reduction, and nutrition. None of us can adequately deal with all of these issues. We must realize when we have reached our limits and be willing to refer the client to another person.

19. Every Pastoral Care Situation Can Be Used by God to Make Us into the People God Wants Us to Be.
God meets us in the people we encounter. People living with HIV, through the issues they raise, help us confront fear, death, frustration, impatience, prejudice, and spirituality. Walking through these issues with them can be mutually beneficial. We must always be open to growth and personal change.

20. Doctrine, Dogma, Denominationalism, and Guidelines are Not Adequate Substitutes for Caring, Sharing, and Love.
We all operate within the structure of a religious organization. That does not mean, however, that all we have to offer is that structure. We must add to that framework caring, personal sharing, and love. Unless we become personally involved, we will fail to show God's love to others and fail to follow the example of Jesus.

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