In their analysis of audio recordings derived from 49 HIV-test counseling sessions conducted in northern California, Lee and Sheon (2008) found that when
counsellors attempt to use the reason for testing discussion as a lead-in to a discussion of risk behaviour, clients often describe their testing as part of a routine, not in response to a specific risk. Clients use three practices to present themselves as reasonable and responsible people who are in control of their HIV status. First, clients present the normal and routine nature of testing, thereby portraying their reasonableness in seeking an HIV test. Secondly, clients deny or downgrade their risk when counsellors seek to identify a specific risk. Thirdly, when introducing a particular risk, clients package it within mitigating contexts that emphasise their knowledge about and control over the risk. These practices can make it difficult for counsellors to focus the counselling session on a specific risk incident. (p. 167)
A remedy to this challenge was observed in the transcripts of
[s]essions by one counsellor ... [participating in this study that offer] an alternative route to a discussion of concerns over risk behaviour. In a departure from the rest, this counsellor designed an open-ended question such as 'What does routine testing do for you?' when clients presented routine testing. This kind of question opens up the range of topics clients can talk about, rather than focusing the discussion on risk behaviour. ...
This kind of discussion on the role of routine testing in the client's [approach to] risk reduction seems beneficial for the counselling interaction. It not only pays attention to the client's presentation and validates routine testing as a legitimate part of HIV healthcare, but can also help illuminate the ways that routine testing functions as part of an overall risk-reduction strategy. Previous research shows that over time, many routine testers tend to view their repeated negative test results as proof that their current risk-reduction strategies are effective or that they are somehow immune to HIV infection ... . A discussion of the client's current testing patterns can help them see how routine testing can contribute to a 'certificate of health effect' that provides a warrant for risk behaviours ... . In addition, such a discussion can provide a more client-centered footing on which to launch future risk-reduction steps relevant to the client's current view of ... [his] situation. This different route to a risk discussion can help make counselling more effective by paying more attention to the context of how clients present their own HIV healthcare during the session. (pp. 178-179)
How do men and women who test seropositive make sense out of that information? Valle and Levy (2008) looked into "the cognitive interpretations African American injection drug users [(IDUs)] make of an HIV-positive test result and the attitudinal and behavioural patterns that accompany those interpretations" (p. 130) among 80 IDUs who tested seropositive within a larger sample of 839 street-recruited study participants. "Individuals who interpreted testing HIV-positive as a 'wake[-]up call' displayed the attitudinal and behavioural patterns of 'being blessed', 'living clean' and 'advocacy'. Those that interpreted the test result as a 'death knell' displayed 'self-destructive', 'pleasure-seeking' and 'vengeance' [behavior]. Those that interpreted the positive test result as 'just one more problem' displayed 'resignation' and 'minimization'" (p. 130).
As Valle and Levy see it, the "period following the diagnosis of HIV provides an opportunity for intervention. A positive HIV status can produce lifestyle changes that either facilitate or militate against a person's health and quality of life. HIV-prevention efforts can be improved by helping individuals living with the virus to interpret and act on their diagnosis in positive ways" (p. 130). More specifically, in the view of these investigators, "HIV-prevention interventions that target African American injectors living with HIV would benefit from structuring their services to consider the interpretation the injector makes of his or her status. Medical and social service providers could help HIV-positive individuals to refrain from high-risk behaviours by reframing their diagnosis in more positive ways [i.e., as a 'wake-up call' rather than a 'death knell' or 'just one more problem']. Such a re-conceptualisation may well influence the success of HIV prevention efforts" (p. 136).
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Summer 2008 Newsletter / Volume 9, Issue 4
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