'It is just the way it was in the past before I went to test': a qualitative study to explore responses to HIV prevention counselling in rural Tanzania

• Published in: BMC public health Vol. 16; no. 1; p. 489
• Main Authors: Cawley, Caoimhe, Wringe, Alison, Wamoyi, Joyce, Lees, Shelley, Urassa, Mark
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.06.2016; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Attitude of Health Personnel; Attitude to Health; Behavior; Clients; Cohort Studies; Communication; Communities; Community; Confidentiality; Consent; Constraints; Counseling; Cultural factors; Culture; Data collection; Design; Disease prevention; Disease transmission; Ethics; Female; Focus groups; Gender; Health care; Health counseling; Health Personnel; Health risks; Health surveillance; HIV; HIV infection; HIV Infections - prevention & control; HIV prevention; HIV prevention counselling; HIV testing and counselling; Human immunodeficiency virus; Humans; Hygiene; Identity theft; Male; Medical personnel; Medical research; Medical tests; Medicine, Preventive; Mens health; Messages; Methods; Middle Aged; Nurses; Personal information; Phospholipase A; Power, Psychological; Prevention; Preventive health services; Public health; Qualitative Research; Quantitative research; Risk management; Risk reduction; Risk Reduction Behavior; Risk-Taking; Rural areas; Rural Population; Sexual Behavior; sexual behaviour; Sexual risk reduction; Sexually transmitted diseases; Social aspects; Stability; STD; Studies; Surveillance; Tanzania; Training; Women; Workers; Young Adult; Tanzania; Sexual risk reduction; HIV prevention; HIV testing and counselling; HIV prevention counselling; Tanzania; sexual behaviour
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-016-3109-7

Voluntary counselling and testing (VCT) for HIV first evolved in Western settings, with one aim being to promote behaviours which lower the risk of onward transmission or acquisition of HIV. However, although quantitative studies have shown that the impact of VCT on sexual behaviour change has been limited in African settings, there is a lack of qualitative research exploring perceptions of HIV prevention counselling messages, particularly among clients testing HIV-negative. We conducted a qualitative study to explore healthcare worker, community and both HIV-negative and HIV-positive clients' perceptions of HIV prevention counselling messages in rural Tanzania. This study was carried out within the context of an ongoing community HIV cohort study in Kisesa, northwest Tanzania. Nine group sessions incorporating participatory learning and action (PLA) activities were conducted in order to gain general community perspectives of HIV testing and counselling (HTC) services. Thirty in-depth interviews (IDIs) with HIV-negative and HIV-positive service users explored individual perceptions of HIV prevention counselling messages, while five IDIs were carried out with nurses or counsellors offering HTC in order to explore provider perspectives. Two key themes revolving around socio-cultural and contextual factors emerged in understanding responses to HIV prevention counselling messages. The first included constraints to client-counsellor interactions, which were impeded as a result of difficulties discussing private sexual behaviours during counselling sessions, a hierarchical relationship between healthcare providers and clients, insufficient levels of training and support for counsellors, and client concerns about confidentiality. The second theme related to imbalanced gender-power dynamics, which constrained the extent to which women felt able to control their HIV-related risk. Within the broader social context of a rural African setting, HIV prevention counselling based on a Western model of individual-level agency seems unlikely to make a significant contribution to sexual behaviour change until there is greater recognition by counsellors of the ways in which power dynamics within many relationships influence behaviour change. More culturally relevant counselling strategies and messages and infrastructural improvements such as additional training for counsellors and counselling rooms which ensure privacy and confidentiality, may lead to better outcomes in terms of sexual risk reduction.