COMMUNICATION AND CONTROL

SKILLS FOR BEHAVIOUR CHANGE

Introduction
In the work of pastoral care giving, we may encounter situations where encouraging
behaviour change will be necessary. As such, we need to be able to teach the principles of
behaviour change.

In this regard, the curriculum aims to express clearly the need for behaviour change and
explain the steps a client undergoes when changing behaviour. We shall learn how to
identity and understand the six core qualities that enhance any helping relationship.

1. Identify and define verbal counselling skills and non-verbal types of

communication between the HIV/AIDS counsellor and clients, and how they
affect the HIV/AIDS counselling relationship.
2. Identify personal values and discuss how they may affect the helping relationship.
3. Recognise and demonstrate an understanding of verbal counselling skills and non-
verbal types of communication seen in HI V/AIDS counselling situations.
4. Understand that a client goes through many steps when changing behaviour By a
client, we mean yourself, or a HIV positive person who has taken a choice to live
positively with [-DV or any other person you may encounter in your work that
may express need or desire for behaviour change.

Behaviour Change
The principal mode for HIV transmission is heterosexual intercourse. Stopping this form
of transmission requires large-scale fundamental changes in community norms, sexual
values and practices. Bringing this about calls for wide-ranging programmes at national,
local and community levels, that seek to develop an enhanced sense of sexual
responsibility. In particular there is need for such programmes to reduce the occurrence
within society of multiple concurrent sexual partnerships (on the part of both men and
women);8 the incidence of intergenerational sex (sex between partners of very unequal
age, and usually with the female partner being several years younger than the male);
widespread physical, psychological and financial coercion to have sexual intercourse;
extensive gender-based violence; the vulnerability of married women; and alcohol abuse.
For the greater part, developing responsible behaviour in each one of these areas
necessitates some change in existing behaviour norms and practices. This is what the
behaviour change approach to preventing HIV transmission seeks to achieve. Ethically
speaking, this is a worthy objective that should be pursued with vigour throughout
society. Seeking to bring about behaviour change in each of the areas that have been
mentioned is morally principled. The policy of behaviour change in each of them accords
well with Christian values and the teachings of moral theology.

Thus, there is universal agreement and no moral problem in acknowledging that getting
ahead of HI V/AIDS requires substantial changes in sexual norms and practices. There is
less agreement, however about the nature of the desired changes, the messages being
communicated and the values embodied in these messages. The steadfast Catholic
position is that the changes should enhance the practice of marital fidelity and pre-marital
abstinence, whereas many agencies that promote behaviour change include condom use
as an essential element, sometimes even as the most important element, of their anti-HIV
strategy. Some behaviour change strategies also embody rather limited understandings of
sexuality that often lead to its trivialisation. Concerns may also be expressed about the
teaching of sexual and reproductive health, and HIV prevention, in schools. Finally, at
the meta-ethical level, there is concern that the urgent need for behaviour change may
deflect attention from circumstances that make such change very difficult, if not
impossible, and that must themselves be changed if genuine behaviour change is to occur
and be sustained.

How to Stop the Spread of HIV

At present, there is no vaccine to protect people from HIV. There are ways, however, to
prevent the spread of HIV. Look again how HIV is spread and what actions put people at
risk. What can be done in each of these situations to prevent a person from being infected
with the virus?
• Abstain from sex before marriage. There is a great temptation for friends to get
involved in sex before marriage. Friends must overcome this temptation and wait
until marriage to be sexually active.
• Be faithful in marriage. In marriage, one must be faithful to his/her spouse. When
a partner is infected, abstain from sexual intercourse.
• Check all blood donations for HIV before transfusion. Blood transfusions should
only be given if the blood is HIV negative. It is better to reduce the number of
blood transfusions by giving oral iron whenever possible to prevent anaemia
occurring from accidents and haemorrhage in childbirth. If HIV testing is not
available, try to select a person at low risk of HIV to donate blood.
• If one of the partners is infected, pregnancy must be avoided. There is the
possibility of the baby becoming infected. Even if the child does not have HIV, it
may soon be orphaned.
• Health workers in all health care settings should practice consistent infection
control: Infection control includes sterilising needles and instruments after each
use, careful hand washing, using gloves when touching body fluids such as blood,
vaginal secretions, amniotic fluid, etc.

This is also important for traditional birth attendants Distribution of disposable gloves to
traditional birth attendants should he considered.
Instruments that result in bleeding should be sterilised after use on each person. These
include instruments used for circumcision, tattooing scarification and treatments

HIV Prevention Education in Schools

Within the context of the provision of a general education of good quality, schools can
contribute significantly to HIV prevention by what they leach in the areas of HIV/AIDS,
reproductive health, sex education, life skills and skills- based health education. The
future of children and young people is in the hands of schools and educators who, in a
most generous spirit, apply themselves industriously to ensuring that their charges learn
and understand a wide range of subjects. The AIDS pandemic requires that they extend
these subjects to include the many dimensions needed for a response to the disease.
Failing this, they will have the distress and trauma of seeing much of their hard work
going to waste, as learners whom they could have equipped with protective knowledge,
skills and attitudes that would have resulted in sexually responsible behaviour become
HIV-infected and eventually succumb to AIDS.
Ideally, the content of what is taught in schools should extend to the following areas:
• sexuality and relationships, leading to a good understanding of what sexuality
means, its role in relationships and the norms for a healthy sexuality;

• manifesting respect and regard for others in a spirit of equality and power sharing
between girls and boys that extends to all areas of life:
• knowledge and understanding of HI V/AIDS. the modes of transmission, what the
infection does inside the human body and how it progresses, and popular myths
and errors relating to the disease;
• a core set of psycho-social life skills for the promotion of the earners’ health and
well-being, including decision-making, interpersonal relationships, self-
awareness, stress and anxiety management, coping with pressures, negotiating
contentious situations, assertiveness and attitudes of self-esteem and self-
confidence;
• knowledge and an understanding of how to protect and manage one’s
reproductive health;
• the role and value of abstinence, the development of positive attitudes towards
abstinence, and the skills that enable one to abstain from sexual activity;
• the meaning of protected sex, the role it plays in preventing FIIV infection, the
skills that are implied, and how to obtain and use condoms and other supplies;
• the desirability of voluntary counselling and testing and the importance of early
presentation of potential STDs to the appropriate health services; and
• the meaning of a healthy lifestyle, its role in making an individual less susceptible
to HIV infection, and its role in promoting the quality of life and extending the
survival years of an individual who is HI V-infected.
The ultimate objective of this comprehensive programme is behaviour that will not put an
individual or any partner at risk of HlV infection. For many young people, this will
involve helping them maintain behaviour patterns that are already appropriate, whether
these involve abstinence or some other method of self-protection. For others, it will
involve motivating them to change to behaviour that does not put them at risk of infection
and providing them with the attitudes, information and skills that will support them in
making this change.
Second, it is necessary to begin at the beginning, that is, with an understanding of
sexuality and relationships. Educators should not hesitate to affirm that sexuality is a
beautiful, good and extremely powerful energy, experienced in every cell of our being as
a mighty urge to overcome our incompleteness and to find fulfillment in a strong and
abiding relationship with another. I-laying sex, or genitality, is a very important aspect of
this larger reality of sexuality, but it is no more than an aspect. It does not exhaust the full
notion of sexuality, which can work powerfully and constructively even in the absence of
the particularised, physical, short-lived bodily encounter with another that constitutes
“having sex.” In practical terms, this means that it would be a mistake to focus on
protection messages, whether these relate to abstinence, condom use, delaying the onset
of sexual activity or whatever, prior to establishing a good understanding of the meaning
of sexuality and relationships.

Third, learners should be introduced to this comprehensive package while they are still
very young, some would say from the day they commence school. While it may be
necessary to begin at a later age for those who are already in the school system, education
about KIV and AIDS should start as early as possible with younger children, and
certainly well before they enter the period of puberty. But whatever is presented to
children must be appropriate to their age and grade. It would be foolhardy and
counterproductive to expose young children to matters beyond their comprehension and
experience.

A further issue is the need to remain sensitive to traditional, cultural and religious values.
Parents’ concerns should also be taken into account. As stated already, the overwhelming
weight of evidence is that this form of education does not lead to increased sexual
activity; on the contrary, it can lead to later and less sex. But parents, and many educators
themselves, need to be convinced of this.

Finally, the importance of emphasising a healthy lifestyle should be noted.

Conditions of poverty facilitate HIV transmission partly because the body’s de- I fence
mechanisms are already run down through malnutrition, the legacy of other
illnesses, a heavy burden of parasites (especially from malaria), and vitamin and trace
element deficiency. When HIV succeeds in gaining admission to such an impoverished
body, its task is greatly facilitated because the defence system is already low. The
individual can become infected in circumstances where a better-nourished and healthier
individual would bc able to ward off the infection. Maintaining a healthy lifestyle is in
itself a substantial step towards preventing HIV infection. It is also a significant step
towards slowing down the progression of HIV to clinical AIDS. All else being equal,
infected persons who maintain a healthy lifestyle are likely to enjoy more years of life
than infected persons who do not take balanced nourishing meals, who smoke, drink
alcohol or use drugs, and who do not take adequate exercise and rest. This is an important
message that educators can always communicate, without fear of giving any offence to
parents. It can also be a life-prolonging message, since it will probably help an infected
person to keep healthy and live longer.