Abstract #208  -  The complexity of advice in voluntary counselling and testing: a distinctly moral activity
Authors:   Presenting Author:   Dr Heidi van Rooyen - HSRC
Additional Authors:
Aim: Voluntary counselling and testing (VCT) comprises three interactional activities: information, advice and support. Interactionally, advice-giving is demanding and complicated for both participants in the encounter – it involves addressing sensitive topics, it taps into normative views on client behaviour, and how to give advice in counselling is unclear. The aim of the study was to examine how clients and counsellors manage the giving and receiving of advice in this context.
Method / Issue: Informed by social constructionism and adopting a discursive approach, a sample of twenty-seven videotaped simulated VCT sessions in South Africa were analysed. The goal of the analysis was not to examine practitioners’ competencies, but to explore participants unfolding actions in the situation and to consider the interactional functions these actions might serve
Results / Comments: Counsellors drew on a range of discursive strategies to help clients consider their behaviour. These were employed with varying levels of success – those that placed the onus of responsibility on the client to those that constructed the counsellor as the primary actor capable of influencing change through the power of his/her authority and professional position. Often in response to low client uptake of advice or client resistance to advice, counsellors tended to upgrade their advice in moral terms. Framing advice with strong moral overtones regarding client risk behaviour, as well as their responsibilities to themselves and to others, seemed to be a fallback position that most counsellors retreated to in the context of VCT.
Discussion: This study points to some of the difficulties inherent in influencing change in others’ sexual behaviour. The data also shows the limitations of approaches that rely on instructing, explaining and exhorting people to change their behaviour. In contrast, the more directive strategies that placed responsibility for change firmly in the hands of clients resulted in greater degrees of client engagement and participation in the interaction. This kind of engagement regarding risk behaviour is what the epidemic requires. While these activities can and should take place within the context of prevention counselling, this is not enough. Collectively we need to develop a culture of responsibility that defines a set of normative messages regarding our responsibilities to ourselves and our sexual partners living in a time of AIDS. These conversations need to move beyond the counselling room and into the more intimate spaces that drive HIV risk and influence our behaviour – that of our relationships, our peer groups, our social networks, our families and communities.
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