Counsellors perceptions of applying cognitive behavioural counselling approaches to intervention for HIV sexual risk reduction.

Abstract

There are two dominant approaches to counselling for sexual risk reduction In South Africa. The TASO model which is based on client centred principles, informs much of vCT counsellors' training. More recently, the (ARRM) AIDS Risk Reduction Model which includes a cognitive behavioural component to counselling for sexual risk reduction has been introduced. A sample of vCT counsellors who have been trained using the ARRM were interviewed to develop an understanding of their experiences of using this approach. These participants provide a vCT service to clients in the midlands of the province of KwaZulu-Natal. A central finding was that although counsellors experienced the cognitive behavioural approach as having good potential for effecting sexual behaviour change, numerous barriers were identified to applying the approach within the South African context. Counsellors were also critical of the TASO model as a model for counsell ing for sexual risk reduction. Elements of the cognitive behavioural approach they experienced as useful included its potential for changing cognitions (misconceptions and myths in communities), the collaborative nature of the approach, negotiating strategies for risk reduction, use of a problem solving approach, follow-up and monitoring of behaviour. Barriers identified included contextual constraints such as poverty, gender power differentials and cultural practices. Also identified as a barrier was the dominance of the biomedical approach within the health care system. Despite identifying barriers to the application of this approach, counsellors remained optimistic that cognitive behavioural approaches could be adapted to the life context of their clients and that this could be facilitated through further training and mentoring.