Giving advice in HIV counselling in Malaysia

Abstract In HIV counselling, giving advice is the core activity to help people living with HIV (PLHIV) make positive behaviour change. Malay nurse counsellors, however, face considerable challenges in eliciting information on patients’ sexuality and sexual behaviour, due to the socio-cultural context in which well-defined attitudes about sexuality and precise ideas of accepted sexual practices prevail. Against this backdrop and drawing primarily from Conversation Analysis, this paper examines how Malay nurse counsellors and PLHIVs manage advice-giving sequences on the delicate issues of safe sex. The analysis highlights the intricacies of advice-giving in Malay and strategies used by nurse counsellors to ensure advice uptake while managing institutional constraints and cultural sensitivities. It shows how strategically sequenced questions are used to introduce delicate topics, while possible threats are managed using hypothetical and implicit advice and the use of the inclusive ‘we’ in Malay.