Claudia Mora

Convenciones sociales y sus modulaciones

http://dx.doi.org/10.1590/1984-6487.sess .2018.29.01.e Copyright

Convenções sociais e suas modulações

http://dx.doi.org/10.1590/1984-6487.sess .2018.29.01.e Copyright

Social conventions and its modulations

http://dx.doi.org/10.1590/1984-6487.sess .2018.29.01.e Copyright

Institutional context and VCT practitioner narratives: possibilities and limitations for HIV prevention in Rio de Janeiro, Brazil

BackgroundVoluntary Counseling and Testing (VCT) is an HIV prevention strategy that promotes the principles of confidentiality and informed consent. International research has highlighted VCT counselors’ isolation from service planning and the contradictions they negotiate between local values and global testing recommendations. In Brazil, studies have identified many limitations, including counselors’ difficulties to implement a vulnerability approach to HIV prevention as recommended in the country’s national guidelines. These studies, however, have not considered the particularities of the institutional contexts where counselors work. This research addresses these gaps in the VCT literature by exploring how VCT services are organized and how counselors perceive and perform their practices in the state of Rio de Janeiro, Brazil.MethodsThis is a case study of VCT services in the state of Rio de Janeiro. The research design included individual structured interviews with seven VCT service coordinators and twenty individual semi-structured interviews with VCT counselors. Participants were sampled according to gender, undergraduate degree and work trajectory to capture a diverse range counselor narratives.ResultsThe VCT services were relatively homogenous in terms of functioning and had a similar restricted roll of activities including individual counseling and occasional external prevention activities with groups vulnerable to HIV. All VCT services reported reductions in staff size. Some counselors used dialogical practices to build trust, guarantee confidentiality and adjust their practices in accordance with their clients’ values and practices. Others emphasized imperative messages or focused on risk and individual responsibility. Connections between how counselors perceive their practices and the organization of their work environment were observed.ConclusionsDue to the importance of counseling as a prevention strategy we recommend rethinking the relationship between counselors’ practices and the organization of VCT services. The challenges brought about by the expansion of “test and treat” programs globally and other social and symbolic aspects of the HIV epidemic, such as gender inequalities, must also be taken into account. Further reflection is also needed on the relationship between counseling guidelines and practices within the vulnerability approach to HIV prevention.

Formação, práticas e trajetórias de aconselhadores de centros de testagem anti-HIV do Rio de Janeiro, Brasil

Perante a importância do aconselhamento na testagem anti-HIV, analisamos as diretrizes institucionais, as competências privilegiadas no treinamento profissional e os saberes/práticas de aconselhadores. Trata-se de estudo qualitativo centrado na análise documental, observação e entrevista com aconselhadores de Centros de Testagem e Aconselhamento (CTA) do estado do Rio de Janeiro. A análise foi orientada pela teoria de Pierre Bourdieu. Foi evidenciado que o habitus profissional dos aconselhadores resulta da articulação dos treinamentos, da graduação e de experiências e interesses pessoais. A operacionalização de competências, como a escuta ativa, é limitada pela rotina dos serviços e escassez de espaços de reflexão. Para incrementar a prática do aconselhamento, é importante desenvolver competências no treinamento, manter a educação continuada e fazer adequações na rotina do serviço. Tais ajustes podem fortalecer a passagem das diretrizes à ação e o aprimoramento da organização e gestão dos CTA.Given the importance of counseling in HIV testing, we analyzed the institutional guidelines, the competencies encouraged during counselors’ professional training and these counselors’ knowledge and practices. This was a qualitative study based on document analysis, observation and interviews with counselors at HIV testing and counseling centers in the state of Rio de Janeiro. Bourdieu’s theory was the foundation for the analysis. It was shown that counselors’ professional habitus is produced by the connections between trainings, undergraduate experiences and personal interests and experiences. Putting competencies such as active listening into operation is limited by the routine within the services and lack of opportunities for reflection. In order to improve counseling practices, it is important to develop competencies within training, maintain the inservice education and make adjustments to healthcare service routine. These arrangements may strengthen the transition from guidelines to action and enhance the management and organization of the testing and counseling centers.

Formación, prácticas y trayectorias de consejeros de centros de test anti-VIH de Río de Janeiro, Brasil.

Perante a importância do aconselhamento na testagem anti-HIV, analisamos as diretrizes institucionais, as competências privilegiadas no treinamento profissional e os saberes/práticas de aconselhadores. Trata-se de estudo qualitativo centrado na análise documental, observação e entrevista com aconselhadores de Centros de Testagem e Aconselhamento (CTA) do estado do Rio de Janeiro. A análise foi orientada pela teoria de Pierre Bourdieu. Foi evidenciado que o habitus profissional dos aconselhadores resulta da articulação dos treinamentos, da graduação e de experiências e interesses pessoais. A operacionalização de competências, como a escuta ativa, é limitada pela rotina dos serviços e escassez de espaços de reflexão. Para incrementar a prática do aconselhamento, é importante desenvolver competências no treinamento, manter a educação continuada e fazer adequações na rotina do serviço. Tais ajustes podem fortalecer a passagem das diretrizes à ação e o aprimoramento da organização e gestão dos CTA.Given the importance of counseling in HIV testing, we analyzed the institutional guidelines, the competencies encouraged during counselors’ professional training and these counselors’ knowledge and practices. This was a qualitative study based on document analysis, observation and interviews with counselors at HIV testing and counseling centers in the state of Rio de Janeiro. Bourdieu’s theory was the foundation for the analysis. It was shown that counselors’ professional habitus is produced by the connections between trainings, undergraduate experiences and personal interests and experiences. Putting competencies such as active listening into operation is limited by the routine within the services and lack of opportunities for reflection. In order to improve counseling practices, it is important to develop competencies within training, maintain the inservice education and make adjustments to healthcare service routine. These arrangements may strengthen the transition from guidelines to action and enhance the management and organization of the testing and counseling centers.

Training, practices and paths of counselors at HIV testing centers in Rio de Janeiro, Brazil.

Perante a importância do aconselhamento na testagem anti-HIV, analisamos as diretrizes institucionais, as competências privilegiadas no treinamento profissional e os saberes/práticas de aconselhadores. Trata-se de estudo qualitativo centrado na análise documental, observação e entrevista com aconselhadores de Centros de Testagem e Aconselhamento (CTA) do estado do Rio de Janeiro. A análise foi orientada pela teoria de Pierre Bourdieu. Foi evidenciado que o habitus profissional dos aconselhadores resulta da articulação dos treinamentos, da graduação e de experiências e interesses pessoais. A operacionalização de competências, como a escuta ativa, é limitada pela rotina dos serviços e escassez de espaços de reflexão. Para incrementar a prática do aconselhamento, é importante desenvolver competências no treinamento, manter a educação continuada e fazer adequações na rotina do serviço. Tais ajustes podem fortalecer a passagem das diretrizes à ação e o aprimoramento da organização e gestão dos CTA.Given the importance of counseling in HIV testing, we analyzed the institutional guidelines, the competencies encouraged during counselors’ professional training and these counselors’ knowledge and practices. This was a qualitative study based on document analysis, observation and interviews with counselors at HIV testing and counseling centers in the state of Rio de Janeiro. Bourdieu’s theory was the foundation for the analysis. It was shown that counselors’ professional habitus is produced by the connections between trainings, undergraduate experiences and personal interests and experiences. Putting competencies such as active listening into operation is limited by the routine within the services and lack of opportunities for reflection. In order to improve counseling practices, it is important to develop competencies within training, maintain the inservice education and make adjustments to healthcare service routine. These arrangements may strengthen the transition from guidelines to action and enhance the management and organization of the testing and counseling centers.