The impact of client-counselor similarity on acceptance of counseling services for women living with HIV

ABSTRACT

This study investigates the effect of similarity of health status between counselors and clients on the acceptance of counseling services among women living with HIV (WLWH). We hypothesized that WLWH should be more willing to seek counseling from an HIV-positive counselor as opposed to one living free of HIV or with another stigmatized disease like Hepatitis C, because a counselor with HIV should be perceived as more empathetic and credible. Moreover, the positive effect of similarity on acceptance should be particularly pronounced among WLWH who perceive high levels of HIV-related stigmatization and low levels of social support. Participants were 89 WLWH in Germany. In an online scenario experiment, we varied the similarity of health status between participants and a fictitious female counselor by presenting participants with one of three counselor profiles: The profile either stated that she was living with HIV but not Hepatitis C, with Hepatitis C but not HIV, or with neither HIV nor Hepatitis C. We then measured participants’ perceptions of the counselor’s similarity, empathy, and credibility, and their willingness to accept counseling with her. Results from an ANOVA with planned contrasts supported our assumption that participants presented with an HIV-positive counselor perceived her to be more similar to themselves and were more willing to accept the counseling than participants exposed to a HIV-negative counselor (either with or without Hepatitis C), for all relevant contrasts, η²s ≥ .08. Regression analyses corroborated that this effect was mediated by the counselor’s perceived empathy and credibility, total indirect effect = .36, 95%CI [0.22, 0.53]. Moreover, moderated regression analyses revealed that the similarity effect on acceptance was particularly strong when participants experienced high levels of stigmatization and low levels of social support, for both interaction terms, ΔR²s≥ .04, F(1, 85)s ≥ 5.03, ps ≤ .028.

KEYWORDS:

• Counseling
• HIV
• peer support
• similarity
• stigma
• women

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Data on the number of participants recruited through each of these means (flyers, HIV-specific webpages, and e-mail invitations) is not available to us.

2 See supplemental material for more detailed information on measures.

3 One of the 89 participants reported being intersex. The exclusion of this participant from our sample did not alter the results. Please note that from an initial sample of 114 WLWH participating in our study the data of 25 women were excluded from our analyses due to a technical error (n = 1) or because participants did not fully complete the study (n = 24).

4 We also conducted a Welch test on the willingness measure because the variances between conditions were not homogenous, Levene’s F(2, 86) = 4.80, p = .011. This analysis yielded a similar effect.

5 Separate ANOVAs to check for potential effects of the similarity of health status manipulation on perceived HIV stigma and perceived social support yielded no significant effects, all F(1, 86)s ≤ 1.42, ps ≥ .247.

6 Results from regression analyses with the experimental manipulation instead of perceived similarity as the predictor replicated these findings (for a detailed description, see supplemental material).

7 Results from regression analyses with the experimental manipulation instead of perceived similarity as the predictor replicated these findings (for a detailed description, see supplemental material).