As i have already Discussed in my previous post the Word Association Exercise which are used while doing counselling like:-FSW, MSM, MOBILE POPULATION, PRISONERS, IDUs. These are all behaviours of an individual so counselling strategies will be also different, So we will Discus this in this post.

Counselling for Different Behaviour’s of Individuals

COUNSELLING OF FSW (Female Sex Workers)

FSW:-FEMALE SEX WORKER

An individual who sells sex for money or for pleasure and she may not consider her self as sex worker for them they had relations with different partners for them this relationship have different values or meaning

TYPOLOGIES OF SEX WORKERS

Mainly there are six types of FSW

STREET BASES:- We have seen in areas particularly where we see females standing and inviting clients for sex in cheap rates like red light areas etc they charges money for an hour or night stand these are called Street based sex workers.

BROTHEL BASES:-These types of sex workers lives in a house or brothels and clients visits them.

LODGE BASED:-They lives in lodges or managers call them for clients or pimps contacts clients.

DHABA BASED:- Road sides DHABA are mainly their area where truckers or others go there for sexual pleasure.

HOME BASED OR SECRET:- These types of sex workers have reputation in a society and they are hidden and operate from homes , contacting on phone or word of mouths.

HIGHWAY BASED:-They solicits the client on highway by standing roadsides or small wooden or house are builds near Highway.

Note:-TYPOLOGIES are often overlapping and fluid.

While doing counselling of FSW A counsellor should always keep in mind that Female sex worker may not identify themselves as an sex worker.

COUNSELLING ISSUES:-
Safer Sex Practices
Condom use
Condom negotiation with clients
Regular check up/visits
Complete treatment
Essential Services rendered to FSW

Treatment for Symptomatic STI
Treatment for Asymptomatic STI
Syphilis Testing Every 6 month
Regular Medical check up (Internal examination) once every 3 month

Consider Points and Issues While Counselling

Females Sex workers may not identify themselves as sex workers:-
So better not to label anyone unless the client herself uses the label and it is not a label of vulnerability but it is a behaviour,

FSWs are more likely to consider using condoms with a one-time client, less with a regular client and even less with a regular partner:-

It is very Important to help FSW to find ways for present availability of condoms for safe sex to regular clients and as well as partners as a way of showing love cares for each other.

Some times it is very difficult to negotiate for safer sex when FSW is in need of money and When client pays more charges for unprotected sex:-

So they need to be counselled on assertiveness and negotiation skills or those clients who pay more for unprotected sex.

Risk of Violence from police/goons/clients and regular partners:-

Provide skills in sensing for violent clients and avoiding them or assist FSWs to find ways to refuse unsafe clients.

Some FSWs refuses for speculum examination while regular medical check-up:-

while doing counselling always explain why internal examination is important and show a speculum and allow her to handle it.

Some FSWs uses alcohol or Drugs to Feel Good or reduce negative feelings:-

When counselling FSWs on safer sex, explore their use of drugs and its risk and provide skills and ways to reduce risk by practicing safer sex.

Poor compliance to STI treatment and schedule visits (RMC)regular medical check-up and periodic Syphilis Screening:-

Plan and Make schedule for STI treatment and provide follow up schedule time table for each STI Syndrome.

Reoccurring STI:-

Find the reason for getting recurrent STI and Explore barriers to prevention, risk reduction planning, Link the complication of STI.

Difficulty in partners notification:-

Focus on partner notification with regular partners

Note:-

A counsellor always have a information and knowledge of STI Clinics, ICTC centres and ART centres, TB Clinics, so that the FSWs gets proper treatment , support and cares.

COUNSELLING OF MSM(Men having Sex with Men)

A specific behaviour not as an identity for any specific population group, Many men who are Heterosexuals may have sex with men for a variety of reasons and some man not even consider MSM behaviour as a sexual act. Before going to understand Typologies of MSM we have to understand SEXUAL BEHAVIOUR The range of sexual acts, expressions and partners that an individual has, and (LGBT) TERMINOLOGY{LESBIAN GAY BISEXUAL TRANSGENDER}

TRANSGENDER:-A person anatomically of one sex but feels comfortable with a different gender and seeks to express this by attire, sex-reassignment surgery etc it includes Transsexuals, Transvestites, Inter-sex, Hermaphrodites and Cross-dressers.

TRANSSEXUAL:-An Individual anatomically born of one sex but is convinced that she/he is of a different gender.

TRANSVESTITE:-Person Anatomically born of one sex but prefer to wear clothes of the other gender.

HERMAPHRODITES:-A person whose external genitilia is indeterminate.

INTER-SEX:- A person whose biological sex cannot be classified as Male or Female.

LESBIAN:- A Woman emotionally, sexually, romantically attracted to other women.

GAY:- A man emotionally, sexually, romantically attracted to other men.

BISEXUAL:-A person attracted emotionally, sexually, romantically attracted to both man and woman but in act of sex case might not be there.

TYPOLOGIES OF MSN

Mainly are of four types:–

HIJRAS
KOTHIS
DOUBLE DECKERS
PANTHIS

HIJRAS:-Third Gender, inter sexed persons(HERMAPHRODITES) Emasculated Men(castrated, nirvana),Non-Emasculated Men(Non Castrated, Akva/Akka).

KOTHIS:-A men who plays female role on the sexual relationship with other male partner.

DOUBLE DECKERS:-A men who both insert and receive during penetrative sexual encounter(a men plays both role as a female and male on the sexual relationship)

PANTHIS:- Male masculine partner of KOTHIS

ISSUES AND POINTS TO KEEP IN MIND WHILE COUNSELLING OF MSM

1.MANY MEN WHO HAVE SEX WITH MEN DO NOT THINK THEMSELVES

HOMOSEXUAL:-

Never make any assumptions about MSM;

COUNSELLOR need to keep in mind that many of this male will also have sexual relationship with women due to their sexual identity or preference, and many of them will marry in order to keep their secret and if will use the label “homosexual” or asking about “homosexual” the counsellor wouldn’t be able get the desire information which is very essential for a Good counselling.

2.SECRECY OF MSM:- It will lead to unprotected sexual encounter which will lead to high risk of getting HIV;

COUNSELLOR

should explore the barriers and help the client to find out practical solution and capable and confident to negotiate to use safer sex techniques or knowledge and skills of using condoms where they likely to have sex.

3.GUILT FEELING ABOUT HOMOSEXUAL BEHAVIOR:–Fear of rejection after being discovered by family, friend and community;

COUNSELLOR should assure confidentiality and always keep non-judgmental attitude and show acceptance.

COUNSELLING OF IDUs(Injecting Drug user)

This type of behavioural individual’s are at High risk of getting infected of HIV and STI, and individual’s who are of this types are very aggressive in nature coz they are not in their conscious mind i.e. what & How to respond? or react with normal peoples. So counselling of such behavioural individuals is at very risk for counsellor, they may become violent and harm to anyone who comes close to them after used drugs.

Injecting Drug Users:-

Those who use any drugs through injecting routes are called IDUs, sometimes they share drug injecting equipment’s with each other i.e. needle, syringe etc, IDUs may also be prone to STI and HIV as she/he engage in unsafe sex(after being high on drugs), sometimes they even sell sex for money to buy drugs.

ISSUES AND POINTS TO KEEP IN MIND WHILE COUNSELLING OF IDUs

Drug use may lead to unsafe sex because people are high on drugs and find it more difficult to think about safer sex and use of condom:-While doing Counselling the Counsellor should explore whether the client uses drugs or not and explain the risk of using drugs, Discuss how to use Condoms and also keeping a condoms all the times.

IDUs are at High risk of HIV because of sharing of needles/syringes and have a very high risk of Hepatitis B and C:-Talk to clients about preventing infection through injections, help the client understand the need of use of fresh needle/syringe every time she/he takes drugs..

Male and Female IDUs may have multiple sex partners. Females some times sell sex to support their own and their partner’s drug habits. Males may have regular and commercial sex partners:-Counsel for safer sex and promote for condom uses, if a drug habit is a reason for selling sex and unsafe sex, Discuss referral to Drug Rehabilitation services.

Counselling of mobile populations(Truckers, Construction Workers)

Mobile populations are often exposed to unique pressures and situations, coz they are away from Home, Family a week and even for months for income sources like construction workers and Truckers, due to this they are removed from their normal socio-cultural safety nets and their they indulge in unprotected sex with sex workers is a common high risk behaviour, The socio-economic vulnerability of female mobile population may force them into transactional sex(sex for money or favour)

ISSUES AND POINTS TO KEEP IN MIND WHILE COUNSELLING

Mobile population clients are removed from their families for extended periods of time which leads to unsafe sexual behaviours:-Counsellors must never assume that a mobile clients only have sex with the opposite sex and must give opportunity to talk about their sexual activities and ask whether their sexual partner are male, female, transgender, or all of them.

Mobile population may face language, socio-economic, cultural problems which creates barriers for unable to get preventive information and services:-Counsellor must clarify common misconceptions relating to STI/HIV preventions.

Mobile clients are very difficult follow up with:- So provide appropriate health education in available contact time.

Fear(e.g. Of Police harassment) and secrecy may lead to hurried and unprotected sexual encounter increasing the risk of HIV transmission:-Counsellor must accept their clients fear and limitations explore clients barriers to safer sex behaviour and practical solutions to HIV and STI risk reductions.

COUNSELLING OF PRISONERS

Why prisoners need counselling and why they are at high risk?:-Prisoners may have unprotected sex in the prison coz their partner may be male or female, and share infected injecting equipment’s often found to have various psychiatric and mental disorder, and they may already practicing high risk behaviours prior to being imprisoned. As a result, there may be an increased risk of transmission of HIV and other blood-borne viruses.
Risk Assessment of Prisoners:-Explore sexual behaviours and possible non-sexual exposure such as sharing of needle and syringes, provide the client with appropriate IEC materials like Flipchart, Booklets etc so that they will easily understand the route of transmission of STI/RTI and HIV and prevention techniques.