CHAPTER SEVEN DISCUSSION
7.1 THE ROLE OF INFORMATION-GIVING IN VOLUNTARY COUNSELLING AND TESTING
Previous studies, locally and elsewhere, which explored HIV counsellor perceptions of their role, showed that counsellors use primarily a prescriptive, didactic and disease- centred approach in their work, with strong applications of information-giving (and advice) aimed at patient compliance and behaviour change (Buskens & Jaffe, 2008;
Delaney, 2002; Fawcett, 2001; Richter et al., 1999, Stein et al., 1997). These findings reflect the normative health promotion view on the role of information and advice – i.e. that these activities are used in the interests of client compliance and behaviour change in the context of HIV/AIDS counselling.
Previous studies that have focused on counsellors’ perceptions of their role have indicated that counsellors identify strongly with their information-giving role and feel most proficient when giving advice and making clients see things (Fawcett, 2001; Nulty
& Edwards, 2005). Similarly, Silverman (1997), using a more discursive approach to analyse HIV/AIDS counselling, confirms that interactively, information-giving acts as a
“home base” around which much of the activity in the session revolves. In keeping with these studies, this study confirmed the centrality of information-giving relative to the other interactional tasks of VCT such as advice-giving and support.
By adopting a more discursive analytical approach and by analysing VCT in its natural environment through simulated client, videotaped counselling sessions, this study was able to move beyond reports of the importance of information-giving in the context of VCT to describe in detail how these informational contexts are created in practice.
Significantly, this study was able to provide additional and useful insights regarding the functions of information-giving within the context of HIV/AIDS counselling, and to show in detail the impact that these functions have on emerging constructions of each other, and on the unfolding interaction.
The data on the role of information-giving in the context of HIV/AIDS added new perspectives on the role of information-giving in the context of counselling people at risk for HIV or those who have AIDS. The long-held view is that information alone does not contribute to behaviour change (Rollnick & Nick, 1992). In the contexts explored, information-giving was constructed not so much as a tool to fashion patient compliance in the service of behaviour change, but it acted as a powerful mechanism through which a range of interpersonal tasks could be achieved.
This study showed that the giving and receiving of information was constructed by both participants as a critical component of VCT and was intimately connected to both client and counsellor identities. Like several other CA studies (Peräkylä, 1995; Peräkylä and Silverman 1991a; Silverman, 1990; Silverman, 1994a; Silverman, 1997) these South African transcripts revealed a similar uniformity and structure to information formats –
i.e. participants oriented to certain norms that govern information-giving: the counsellor provides authoritative information about HIV/AIDS through the delivery of statements, with the client assuming a more passive role in the interaction.
The centrality of the information-giving role for VCT was also evidenced in the way that participants created informational contexts under a range of conditions: it was the immediate and most natural response to a client’s request for help; it was provided when clients did not ask for it or appear to want it; it was repeated when there appeared to be no need for it; and it was offered in an attempt to ease client troubles. Given the variety and diverse range of informational contexts that were constructed in these client-counsellor exchanges, it appeared that information-giving was important and valued in and of itself, for itself, irrespective of the immediate conditions that surround it and that may justify its meaning and importance in the interaction.
7.1.1 Functions of information-giving
The answer to understanding the centrality of information-giving in VCT can be found in the broader contexts that shape HIV test counselling. In the face of an overwhelming, devastating and compelling disease such as HIV/AIDS, where a cure and effective technologies to prevent the virus continue to elude us, where treatment is increasingly available in these contexts but not easily accessed, information-giving enables counsellors to do something. The role of information-giving as a pivotal tool in the prevention response to HIV/AIDS is best captured in the words of the counsellor in Extract 5.6 who explains that she does not “have help that I can give you (.) but I will just give you the information that I have”. The informational strategies used by counsellors suggest that they believe that the specialised, technical information they
impart to clients may be an important tool at their disposal in their response to the epidemic, and working in the contexts that they do. Counsellors, although trained to do what they do, show in these extracts that they are people too. As suggested by ethnomethodology, counsellors have a range of resources at their disposal that help them manage the clients and the interactions that they encounter. This data suggests that both in their professional roles and as ordinary members of society, counsellors draw on information-giving as an interactional resource in the context of a disease that threatens to overwhelm us.
In the broader context of the disease, information-giving assumes an additional interactional function for both participants. The data showed that beyond a possible (but limited role) in trying to use information to educate and inform people about HIV and risk (and hopefully change their behaviour) information-giving was constructed as a powerful tool through which hope could be dispensed by counsellors and received by clients.
Typically, information exchanges and advice-giving tend to be linked to behavioural and medical interventions, and are not normally considered a part of counselling activities or encounters (Rollnick & Nick, 1992). Considering some of the hope-giving functions of information, it is ironic that an activity – such as information – normatively defined as “bad counselling” (Burnard, 1992) is used by counsellors to construct hope and to alleviate client distress. Attempting to provide hope to clients through normalizing the client’s situation appeared to be a common feature of AIDS counselling talk in this study (and appears in both advice and support talk too). As in other contexts where people work with chronic conditions, (Hunt, 1989 in Li & Arber, 2006), and in the context of an overwhelming and devastating disease such as AIDS,
the production of ordinariness and normality may help to create control in a context that feels overwhelming and out of control. The analysis suggests that information, advice and support are all constructed as ways of creating hope and normality for clients.
Linked to the “doing something” function of information-giving, the findings suggest that the way that information is dispensed, (in a rote fashion, with the counsellor in an expert position, dispensing technical, authoritative and medical information) acts as a resource for both participants in the interaction. In sum, the information-delivery mode serves to help counsellors keep things certain and controllable when dealing with client uncertainty and emotional distress in the context of HIV/AIDS. For the client, the passive role afforded them in this format keeps them safe from the interpersonal difficulties of HIV/AIDS and risk. In this sense, information-giving is as much a counsellor mode of coping with HIV as an attempt to empower clients – it offers both participants a respite from the emotionally demanding tasks associated with HIV/AIDS counselling.
While these two functions operate in the interests of client issues and concerns, information-giving plays an important role in helping counsellors too. Previous South African studies (Fawcett, 2001; Nulty & Edwards, 2005) have described that counsellors felt a greater sense of control when they were in the factual or information- delivery mode and generally found it more difficult when dealing with client emotions.
This study confirmed these observations and showed the interactional difficulties counsellors faced when dealing with client distress and emotionally charged talk.
Further, information-giving formats afford counsellors a knowledgeable and expert identity, and for these reasons counsellors may place a greater premium on it, than the
advice and support aspects of their role. The fact that counsellors turn to information- giving as a first response to client needs and requests, may also say something about the levels of competency they feel doing this as compared to the sense of their competencies in their advice and support roles. Clients appear to pick up on this and do what they can to keep information formats going – and counsellors comfortable in their knowledgeable and expert identities.