SRINAGAR: A pioneering study has revealed that female HIV counsellors in Kashmir suffer from profound psychological distress, acute emotional exhaustion, and severe social stigma. The research highlights that these frontline workers face intense pressure when delivering life-altering diagnoses in a conservative society. Furthermore, they struggle with a critical shortage of specialised skills needed to counsel people who inject drugs (PWID) safely.
The paper, Psychological and Emotional Challenges Faced by Female HIV Counsellors in Kashmir – A Phenomenological Study, was co-authored by Dr Khalid Bashir, Dr Inaamul Haq, Dr Mariya Amin Qurieshi, and Dr S. Muhammad Salim Khan. All four researchers belong to the Department of Community Medicine at Government Medical College (GMC) Srinagar.
The study was published in 2025 by SAGE in the Journal of the International Association of Providers of AIDS Care.
The study notes that adult HIV prevalence in India stands at an estimated 0.22%. This marks a significant 33.3% decline from the 0.54% recorded in 2000-01. Despite falling national figures, early testing and post-test counselling remain vital for prevention. However, providing this support creates severe psychological tolls within the specific socio-cultural dynamics of Kashmir. Traditional gender roles heavily restrict local conversations around sexual health.
The researchers interviewed 12 female counsellors across Kashmir and Leh between December 2022 and January 2023. These women face harsh discrimination at work, at home, and in public. Stigma often starts with their own peers. One counsellor revealed, “Healthcare workers within the hospital have given us the label ‘HIV-positive person’ disparagingly”. Another recalled the deep pain of public humiliation: “A boy shouted ‘AIDS, AIDS’ as I passed by on the road… I lowered my gaze and walked through shrunken hearts”.
Even family support is limited. A participant shared that her husband told her “not to talk about my experiences at home” and viewed the illness as a sign of “immorality”. Another counsellor’s husband forced her to alter her office nameplate to hide her specific job profile.
The emotional burden of the job often lingers long after working hours. Counsellors regularly suffer from severe heart palpitations when delivering positive test results. A counsellor likened the duty to “giving them a death certificate,” admitting that she frequently cries at home. Certain cases leave profound, permanent emotional scars. One counsellor shared a heartbreaking case from a local village: “Once, I felt very bad when a couple from Uranhama came out positive, and their 3 kids came out positive as well… That day, I cried and became very emotional. What was their fault?”
The socio-cultural silence around sexual health leaves female counsellors vulnerable to predatory behaviour. Male clients frequently sexualize counselling sessions through lewd gestures and vulgar language. One counsellor recalled an incident where a male client “sat unnecessarily close to me and made some lewd gestures”. She noted that she was completely “numbed due to fear”. During community health camps, male students deliberately sought sessions to make “dirty hand gestures” and ask vulgar questions.
A rising substance abuse crisis in Kashmir has added severe complications to the job. Over half of the counsellors (54%) feel their training is insufficient to handle substance use. Clients who are high on drugs frequently become volatile and physically aggressive. The threat of physical injury remains constant. A participant noted, “I have seen a PWID patient that was kicking people. What if a female gets injured?”
The sheer scale of the danger was highlighted by another shocking account: “Once a PWID was brought to us, about 25 men were not able to control him… How is it possible for a single female counsellor to handle such patients?” To protect themselves, counsellors now refuse to work alone, keeping male laboratory technicians in the room for security.
The study stresses that immediate systemic interventions are vital to protect these workers. The authors call for multi-day annual training sessions and cross-state exchange programmes. Counsellors hope to learn advanced techniques from high-prevalence areas. As one participant suggested, “We can learn from Manipur, which ranks first in drug addiction”. The researchers conclude that providing structured emotional debriefing, introducing mental health professionals into teams, and launching anti-stigma campaigns are crucial steps to safeguard counsellors and improve regional healthcare.
