Counselling challenges in haemophilia and HIV infection/AIDS

Summary. The advent of AIDS has had such a deep‐reaching effect on the international haemophilia community that one can make a reasonable distinction between a pre‐AIDS and a post‐AIDS era in haemophilia management. In the context of counselling, however, talking about a ‘before’ and an ‘after’ in haemophilia does not (and, in our opinion, should not) necessarily imply a separation of the past from the present. Dealing with the psycho‐social implications of haemophilia and HIV infection does not mean focusing exclusively on HIV‐generated problems at the expense of haemophilia‐related issues. Since the HIV crisis, counselling has posed the multiple challenge of: (a) assessing and alleviating the more immediate emotional effects of HIV infection; (b) paying due attention to the underlying influence of haemophilia on reaction, defence and coping; (c) formulating a flexible approach that is based on close cooperation with the medical staff and effective interpersonal communication with the counsellees. * In practice, the flexibility and effectiveness of the counselling model are promoted by means of: (a) ongoing counselling, (b) multiple counselling sites (i.e. the Haemophilia Centre and other appropriate locations), (c) interdisciplinary team‐work, (d) respect for individual/ ethnic values, (e) maintenance of exo‐empathy (i.e. neutrality), and (f) transfer of coping skills. The above framework can help maximize the effectiveness of counselling sessions through a personalized rapport of mutual trust and confidence between the counselling team and the counsellees.