Advice dilemmas: managing advice against the competing public health and counselling imperatives that shape VCT in South Africa

Abstract

The public health and counselling imperatives that shape VCT create advice dilemmas for counsellors. Public health proponents view the dispensing of advice as important, whilst most contemporary counselling dictates that advice should not be given under any circumstances. Using a qualitative, discursive approach transcripts of twenty-seven videotaped simulated VCT sessions in South Africa were analysed with a view to understanding how counsellors implemented advice in their daily practice and the discursive strategies they used to do so. The results show that counsellors generally struggled to adhere to the dictates of both public health and counselling. In managing their advice-dilemmas, counsellors either tagged an open-ended question to the end of a directive advice statement, or told clients what to do but softened these with client-centred skills. As a dual-identified encounter, the role of advice in VCT needs to be clarified. Key to resolving this issue is an acknowledgement that, whether as counsellor or health adviser, persuasion and influence are central features of the VCT interaction. Clear practice guidelines and tools are required to assist counsellors to distinguish between advice, suggestion or mere confirmation of an intended client action, and the circumstances under which these would be recommended or not.