The meaning and experience of receiving HIV post-test psychological counselling by African childbearing migrant women from a culturally appropriate counselling model in comparison to classical western models: an interpretative phenomenological analysis

The worldwide Human Immuno-deficiency Virus (HIV) pandemic has now lasted more than three decades. Highly Active Antiretroviral Therapy (HAART) has revolutionised its impact (Anderson et al., 2000). HIV infection now produces a chronic, manageable illness. Nonetheless, a majority of people living with HIV (PLWHIV) suffer the psychological impact both of being infected and of accepting the diagnosis. In the United Kingdom (UK), HIV is highly prevalent in African women. Although Africans are the second largest group of PLWHIV after gay men in the UK (Prost Elford, Imrie, Petticrew & Hart, 2008), they are reported as reluctant in accessing available psychotherapy/counselling services (Malanda, Meadows & Catalan, 2001). Apart from the perception that such services are threatening, little is known about this reluctance. This is worrying, as Africans continue to be the most underrepresented HIV service users. One’s cultural background and language has an impact on service use. There is a profound existential impact of migration; and migration has an impact on illness and self-concept.
Whilst there is a plethora of literature advocating culturally sensitive counselling services, there is a paucity of research relating to HIV-counselling. A notable exception is the Terrence Higgins Trust (THT). A 2001 service-user feedback survey conducted by this trust revealed some reasons why Africans LWHIV might not engage with available counselling provisions. These findings prompted the British Association of Counsellors and Psychotherapists (BACP) to establish the award-winning African Emotional Support culturally appropriate counselling model (AESC). Nevertheless, very little is known about how this initiative works, how it compares to the classical or conventional Western Counselling (CWC) model and how it relates to any gaps in cross-cultural counselling practice.
The objectives of this study are to obtain an in-depth understanding through exploration of the lived experiences of 15 HIV sero-positive African childbearing migrant women living in London-UK; and to investigate and evaluate differences in efficacy between the AESC and the CWC models in terms of how the former works, and its strengths and limitations in practice. The research design had two arms: participants with CWC and later AESC (Arm 1); and those with AESC only (Arm 2). The 15 participants were purposively sampled and underwent in-depth qualitative semi-structured tape-recorded interviews. Subscribing to the constuctionist/ interpretivism paradigm, Interpretative Phenomenological Analysis (IPA) as a phenomenological, interpretative and analytic research methodology was considered appropriate for the study population and research question. After verbatim transcription, in-depth thematic mapping was used to examine the interviews and intellectual analysis using IPA.
The findings were considered in the context of the existing literature, which was predominantly British. Participants emphasised the significant positive impact of situation-specific counselling by a counsellor from a similar cultural background compared to counselling by a therapist of a different cultural background. They explored their experiences and barriers to effective helping, comparing the CWC and AESC models. Tensions, links and paradoxes of the African philosophical sense of interdependent self-emerged in contrast to anxiety and isolation in the context of the stigma and discrimination associated with HIV diagnosis. Long-term was far preferable to time-limited counselling. Participants emphasised their sense of African heritage and identity, which instils distinct values. These are important aspects of counselling. Further emphasised was raising awareness in training about the impact of cross-cultural counselling, the impact of the patient's first language in counselling, and the power dynamics inherent in counselling. Othering, self-othering and social identity theories are proposed as possible tools for psychotherapeutic practice interventions. The findings might inform policy, existing NICE guidelines and BHIVA-BPS (2012) standards, and the development of existential psychotherapy/counselling psychology practice and training. Further research output includes research-informed teaching and local HIV services development.