Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) information private and allow clients to decide when and with whom to discuss their sexual and reproductive health problems. Clients will feel more comfortable about sharing personal information with counsellors and being tested for STIs or HIV if they know that this information will remain secret. This also applies when the client’s main interest is male circumcision. An atmosphere of trust will encourage clients to discuss other sexual and reproductive health needs. Another reason why confidentiality is so important is that many people have negative feelings about STIs, HIV/AIDS and sexual health concerns. There is strong social pressure to conform, and considerable social stigma is associated with behaviours or conditions perceived as unusual. Sometimes, health care workers at a clinic need to know a client’s HIV status. This happens, for example, when a client is sick and the best treatment depends on knowing whether the person is HIV-positive or HIV-negative. The counsellor should tell the client about this possibility during counselling. An HIV test is recommended for all clients requesting circumcision, but is not required for the operation to go ahead. Male circumcision can be safely performed in men whose HIV status is unknown and in those with HIV infection, provided that they are clinically healthy. However, except in some rare cases where circumcision is necessary to correct a health problem of the glans or foreskin in a man with HIV infection, there are no medical or public health reasons to perform circumcision in men with HIV infection. HIV testing of clients before circumcision is not necessary to protect the clinic or surgical staff during the operation. It is important that the clinic applies high infection-control standards, including proper implementation of universal precautions to minimize the risk of transmission of HIV and other infections to health care workers or other patients. Universal precautions are discussed in full in Chapter 8. Counselling skills All counsellors need certain basic counselling skills in order to talk with clients in a helpful way. Some of these skills are explained below. Empathizing Empathy is the ability to see the world through another person’s eyes and understand how that person feels. Counsellors should listen to clients carefully and show them that they understand without judging. Empathy is not sympathy; it is not feeling sorry for the client. Empathy is understanding the client’s feelings. Example: An adolescent says to the counsellor: “My girlfriend keeps asking me to go for circumcision. I feel embarrassed and angry.” Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-6
Male circumcision under local anaesthesia Version 3.1 (Dec09) Counsellor’s empathic response: “So you often feel irritated, uncomfortable, and pressured by your girlfriend. That must be difficult for you.” Active listening Active listening involves paying attention to what a client says and does, in a way that shows respect, interest and empathy. Active listening is more than just hearing what clients say. It is paying attention to the content of the message, as well as the client’s feelings and worries that show through his movements, tone of voice, facial expressions, and posture. Example: The client looks very nervous and is biting his nails, but tells the counsellor he is fine. Counsellor: “Sometimes when we think we are relaxed, we can still feel quite anxious inside. I see you are biting your nails. Perhaps something is bothering you that you do not know how to express. Do you have any idea what that might be” Open questioning Open questions are questions that require more than a one-word answer. They usually begin with words such as “how”, “what” or “why”. Open questions encourage clients to express their feelings and share information about their situation. Examples: “Why have you decided to come for male circumcision” “How do you think circumcision can reduce your risk of STI or HIV infection” “What do you do that may make it possible for you to get infected with an STI or HIV” “What are you currently doing to protect yourself against STIs and HIV How is this working” Probing Probing is using questions to help clients express themselves more clearly. Probing is necessary when the counsellor needs more information about the client’s feelings or situation. Asking a probing question is a good way to follow up on a question that has been answered by “yes” or “no.” Examples: “Can you tell me more about that” “How do you feel about that” Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-7
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Manual for Male Circumcision under Local Anaesthesia

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