AIDS Care Psychological and Socio-medical Aspects of AIDS/HIV
ISSN: 0954-0121 (Print) 1360-0451 (Online) Journal homepage: http://www.tandfonline.com/loi/caic20
The impact of client-counselor similarity on acceptance of counseling services for women living with HIV Linn Mehnert, Birte Siem, Stefan Stürmer & Anette Rohmann To cite this article: Linn Mehnert, Birte Siem, Stefan Stürmer & Anette Rohmann (2017): The impact of client-counselor similarity on acceptance of counseling services for women living with HIV, AIDS Care, DOI: 10.1080/09540121.2017.1381329 To link to this article: http://dx.doi.org/10.1080/09540121.2017.1381329
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Date: 02 October 2017, At: 19:59
AIDS CARE, 2017 https://doi.org/10.1080/09540121.2017.1381329
The impact of client-counselor similarity on acceptance of counseling services for women living with HIV Linn Mehnert*, Birte Siem*, Stefan Stürmer and Anette Rohmann
Downloaded by [Australian Catholic University] at 19:59 02 October 2017
Department of Psychology, FernUniversität in Hagen, Hagen, Germany
ABSTRACT
ARTICLE HISTORY
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 HIVnegative 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, ΔR 2s ≥ .04, F(1, 85)s ≥ 5.03, ps ≤ .028.
Received 20 February 2017 Accepted 13 September 2017
Introduction Perceived client-counselor-similarity is crucial for the acceptance of a counseling offer (e.g., Cabral & Smith, 2011). Although there are good reasons to assume that perceived similarity might play a crucial role in the client-helper relationship, especially in the context of HIV/AIDS service organizations (e.g., Stürmer, Snyder, & Omoto, 2005), this issue has received only limited attention thus far. The present study addresses this gap by investigating whether (and why) similarity of HIV status (i.e., whether or not the counselor also has HIV) increases acceptance of counseling offers. Our research focuses on a group that has been underrepresented in the HIV/AIDS literature: women living with HIV (WLWH) in a Western country. WLWH are more reluctant to seek help and more affected by disclosure concerns than men living with HIV (e.g., Peterson, 2010). The present study investigates whether WLWH
KEYWORDS
Counseling; HIV; peer support; similarity; stigma; women
are more willing to accept counseling offers from an HIV-positive counselor than from an HIV-negative one. Interview studies with HIV-positive counselees suggest that the counselor’s perceived empathy and credibility could be important mediators of this preference (e.g., Peterson, Rintamaki, Brashers, Goldsmith, & Neidig, 2012). The present study seeks to consolidate this qualitative data by exploring in a quantitative scenario study whether the effect of a counselor’s similar health status on WLWH’s counseling acceptance is brought about by perceptions of the counselor’s heightened empathy and credibility. Level of HIV-related stigmatization could moderate the similarity-acceptance link. Fear of stigmatization prevents WLWH from disclosing their positive HIV status (e.g., Peterson, 2010). Knowing that the person to whom one is turning for help carries the same “burden” can diminish this fear (Rice, Comulada, Green, Arnold,
CONTACT Birte Siem [email protected] Department of Psychology, FernUniversität in Hagen, Universitätsstraße 33, 58084 Hagen, Germany *The first and the second author contributed equally to this work. Supplemental data for this article can be accessed https://doi.org/10.1080/09540121.2017.1381329. © 2017 Informa UK Limited, trading as Taylor & Francis Group
2
L. MEHNERT ET AL.
& Rotheram-Borus, 2009). The positive effect of the counselor’s similar health status on WLWH’s acceptance of a counseling offer should thus be stronger among WLWH who perceive high levels of HIV-related stigmatization. From a different perspective, one could also argue that the positive effect of the counselor’s similar health status should be stronger among WLWH who perceive relatively low levels of social support. Because PLWH often lack social support, connecting with others with similar stigma experiences is especially important to them (Frable, Platt, & Hoey, 1998).
Method Downloaded by [Australian Catholic University] at 19:59 02 October 2017
Design and participant recruitment Predictions were tested in an online experiment varying the similarity between a client’s and a fictitious counselor’s HIV status as a between-subjects factor. Specifically, we contrasted a condition in which the counselor was said to be HIV-positive with a condition in which the counselor was said to be HIV-negative. To explore whether the proposed effect of similarity of health status is unique to the counselor’s HIV-positive status or extends to other stigmatizing infections, we included a third condition in which the counselor was said to be HIV-negative but Hepatitis C-positive. Participants were recruited in Germany through flyers, HIV-specific webpages, and e-mail invitations in 2014.1 Criteria for participation were being a woman and having been diagnosed with HIV. Participants were randomly assigned to one of the three conditions. Procedure After working through socio-demographic and healthrelated questions, participants were asked to imagine searching the Internet for a counseling service regarding an HIV-specific problem and coming across a counselor profile. Similarity manipulation Participants were then randomly presented with one of three profiles for a fictional female counselor that varied with regard to the information provided about the counselor’s health status (see supplemental material for the full profiles). In the “counselor with HIV/without HCV” condition (n = 27), the profile stated that the counselor was living with HIV but not HCV; in the “counselor with HCV/without HIV” condition (n = 33), it stated that she was living with HCV but not HIV; in the control “counselor without HIV/HCV” condition (n = 29), it stated that she was living with neither HIV nor HCV.
Subsequently, participants completed a questionnaire and were debriefed. Measures To check the effectiveness of the health status similarity manipulation, we assessed perceived similarity by asking participants to indicate on three items how similar they perceived the fictitious counselor to be to themselves. To measure the counselor’s perceived empathy, we translated and adapted eleven items of the empathy subscale of the Relationship Inventory (Barrett-Lennard, 1986). Building on the Counselor Effectiveness Rating Scale (Atkinson & Wampold, 1982), we created an HIVspecific twelve-item scale to measure the counselor’s perceived credibility. Willingness to accept the counseling service with the fictitious counselor was assessed through five items. To measure perceived HIV stigma, we used the revised German adaptation of the 21-item HIV Stigma Scale (Dinkel et al., 2014). Perceived social support from people in participants’ environment was measured with the eight-item perceived social support subscale of the Berliner Social Support Scales (Schulz & Schwarzer, 2003). Composite scores were computed for all measures by averaging across corresponding items (Cronbach’s α ≥ .78 and ≤ .95).2
Results The sample consisted of 89 women,3 all living in Germany (M = 47.22 years, SD = 11.74). 47.2% had been living with their HIV diagnosis for 14 years or longer (see Table 1 for a detailed sample description). Means and standard deviations for all theoretically relevant variables for each of the three experimental conditions are presented in Table 2. Perceived similarity and willingness to accept the counseling service Two separate 1 × 3 (similarity: counselor with HIV/without HCV, counselor with HCV/without HIV, counselor without HIV/HCV) ANOVAs on perceived similarity and on willingness to accept the counseling service yielded significant effects, both F(2, 86)s ≥ 5.34, ps ≤ .007, η2s ≥ .11 (95%CIs for effect sizes [≥ 0.01, ≥ 0.23]).4 Planned contrasts provided evidence that compared to participants hypothetically exposed to a counselor without HIV/HCV, those exposed to a counselor with HIV/without HCV perceived her to be more similar to themselves and were more willing to accept counseling, both t(86)s ≥ 2.74, ps ≤ .007, η2s ≥ .08 (95%CIs for effect sizes [≥ 0.01, ≥ 0.20]). Moreover, they perceived her as
AIDS CARE
Downloaded by [Australian Catholic University] at 19:59 02 October 2017
Table 1. Sociodemographic and health characteristics of participants. Civil status Single Married Separated/divorced Widowed Relationship status Long-term partnership Migration background Education Vocational training University degree Employment Full-time Part-time Retired Disclosure of HIV statusa To intimate partnersb To most or all family membersc To most or all friendsd To most or all colleaguese Currently on ART Undetectable viral load CD4-count > 500 µl HIV/HCV co-infection Note: ART = Antiretroviral therapy. a Only to people available. b Data from 50 participants. c Data from 89 participants. d Data from 85 participants. e Data from 65 participants.
n
%
30 18 32 9
33.7 20.2 36.0 10.1
45 12
50.6 13.5
49 29
55.0 32.6
21 18 22
23.6 20.2 24.7
48 65 49 13 82 74 52 20
96.0 73.0 57.7 20.0 92.1 83.2 58.4 22.5
more similar and were more willing to accept the offer than participants in the counselor with HCV/without HIV condition, both t(86)s ≥ 2.87, ps ≤ .005, η2s ≥ .09 (95%CIs for effect sizes [≥ 0.01, ≥ 0.21]). The two conditions in which the counselor was depicted as HIVnegative did not significantly differ with regard to similarity or willingness to accept the service, both ps ≥ .497.5 Mediators: perceived empathy and credibility Results from a mediation analysis (linear regression) with perceived similarity as predictor, perceived empathy and credibility as mediators, and participants’ willingness to accept the counseling offer as the criterion supported the mediating roles of the counselor’s perceived empathy and credibility (Figure 1).6
Perceived credibility of counselor
b = 0.32***
b = 0.36***
b = 0.55**
b = 0.62*** b’ = 0.26*
Willingness to accept counseling
Perceived empathy of counselor
b = 0.52**
Perceived similarity
3
Figure 1. Mediation model for the effects of perceived similarity on willingness to accept counseling through the perceived credibility of counselor and perceived empathy of counselor. Indirect effect via credibility: PE = .18, SE = 0.08, 95%CI [0.04, 0.36]; indirect effect via empathy: PE = .18, SE = 0.09, 95%CI [0.03, 0.37]; total indirect effect: PE = .36, SE = 0.08, 95%CI [0.22, 0.53]. * p < .05. ** p < .01. *** p < .001.
Moderators: perceived HIV stigma and perceived social support In a moderated linear regression analysis with HIV stigma as moderator, perceived similarity as predictor, and willingness to accept the counseling offer as criterion, the Similarity × Stigma interaction term received a significant regression weight (Table 3, upper half), indicating that, as expected, the positive relationship between perceived similarity and willingness to accept the counseling offer was more pronounced among WLWH who perceived high levels of HIV stigma than among WLWH who perceived low levels of HIV stigma (Figure 2, upper half). An analogous analysis with social support as moderator yielded a significant Similarity × Support interaction (Table 3, lower half), indicating that the positive relationship between the counselor’s perceived similarity and participants’ willingness to accept the counseling offer was more pronounced among WLWH who experienced relatively little social support than among WLWH who experienced relatively high levels of social support (Figure 2, lower half).7
Discussion As predicted, WLWH were more willing to accept a fictitious counseling offer when the counselor was depicted as HIV-positive rather than HIV-negative because the
Table 2. Means and standard deviations for all theoretically relevant variables for the three experimental conditions.
Variable Perceived similarity of counselor Perceived empathy of counselor Perceived credibility of counselor Willingness to accept counseling Perceived HIV stigma Perceived social support
Counselor without HIV/HCV n = 29 M (SD)
Counselor with HCV/without HIV n = 33 M (SD)
Counselor with HIV/without HCV n = 27 M (SD)
3.06 (1.33) 4.33 (0.78) 5.37 (0.81) 4.72 (1.75) 1.86 (0.49) 3.50 (0.57)
3.30 (1.51) 4.55 (1.01) 5.06 (1.04) 4.66 (1.76) 2.06 (0.60) 3.36 (0.73)
4.36 (1.39) 5.07 (1.02) 5.82 (0.83) 5.88 (1.11) 2.04 (0.59) 3.36 (0.50)
4
L. MEHNERT ET AL.
Table 3. Results from moderated regression analyses with willingness to accept counseling as the criterion and (a) perceived HIV stigma or (b) perceived social support as moderator. (a)
Predictors Step 1
Perceived similarity (A) HIV stigma (B) R 2 = .32, F(2, 86) = 20.36, p < .001 Step 2 (A) × (B) ΔR 2 = .08, F(1, 85) = 10.53, p = .002 Overall R 2 = .40, F(3, 85) = 18.59, p < .001 (b)
SE
t
p
0.10 0.27
6.07 −0.95
ISSN: 0954-0121 (Print) 1360-0451 (Online) Journal homepage: http://www.tandfonline.com/loi/caic20
The impact of client-counselor similarity on acceptance of counseling services for women living with HIV Linn Mehnert, Birte Siem, Stefan Stürmer & Anette Rohmann To cite this article: Linn Mehnert, Birte Siem, Stefan Stürmer & Anette Rohmann (2017): The impact of client-counselor similarity on acceptance of counseling services for women living with HIV, AIDS Care, DOI: 10.1080/09540121.2017.1381329 To link to this article: http://dx.doi.org/10.1080/09540121.2017.1381329
View supplementary material
Published online: 29 Sep 2017.
Submit your article to this journal
Article views: 7
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=caic20 Download by: [Australian Catholic University]
Date: 02 October 2017, At: 19:59
AIDS CARE, 2017 https://doi.org/10.1080/09540121.2017.1381329
The impact of client-counselor similarity on acceptance of counseling services for women living with HIV Linn Mehnert*, Birte Siem*, Stefan Stürmer and Anette Rohmann
Downloaded by [Australian Catholic University] at 19:59 02 October 2017
Department of Psychology, FernUniversität in Hagen, Hagen, Germany
ABSTRACT
ARTICLE HISTORY
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 HIVnegative 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, ΔR 2s ≥ .04, F(1, 85)s ≥ 5.03, ps ≤ .028.
Received 20 February 2017 Accepted 13 September 2017
Introduction Perceived client-counselor-similarity is crucial for the acceptance of a counseling offer (e.g., Cabral & Smith, 2011). Although there are good reasons to assume that perceived similarity might play a crucial role in the client-helper relationship, especially in the context of HIV/AIDS service organizations (e.g., Stürmer, Snyder, & Omoto, 2005), this issue has received only limited attention thus far. The present study addresses this gap by investigating whether (and why) similarity of HIV status (i.e., whether or not the counselor also has HIV) increases acceptance of counseling offers. Our research focuses on a group that has been underrepresented in the HIV/AIDS literature: women living with HIV (WLWH) in a Western country. WLWH are more reluctant to seek help and more affected by disclosure concerns than men living with HIV (e.g., Peterson, 2010). The present study investigates whether WLWH
KEYWORDS
Counseling; HIV; peer support; similarity; stigma; women
are more willing to accept counseling offers from an HIV-positive counselor than from an HIV-negative one. Interview studies with HIV-positive counselees suggest that the counselor’s perceived empathy and credibility could be important mediators of this preference (e.g., Peterson, Rintamaki, Brashers, Goldsmith, & Neidig, 2012). The present study seeks to consolidate this qualitative data by exploring in a quantitative scenario study whether the effect of a counselor’s similar health status on WLWH’s counseling acceptance is brought about by perceptions of the counselor’s heightened empathy and credibility. Level of HIV-related stigmatization could moderate the similarity-acceptance link. Fear of stigmatization prevents WLWH from disclosing their positive HIV status (e.g., Peterson, 2010). Knowing that the person to whom one is turning for help carries the same “burden” can diminish this fear (Rice, Comulada, Green, Arnold,
CONTACT Birte Siem [email protected] Department of Psychology, FernUniversität in Hagen, Universitätsstraße 33, 58084 Hagen, Germany *The first and the second author contributed equally to this work. Supplemental data for this article can be accessed https://doi.org/10.1080/09540121.2017.1381329. © 2017 Informa UK Limited, trading as Taylor & Francis Group
2
L. MEHNERT ET AL.
& Rotheram-Borus, 2009). The positive effect of the counselor’s similar health status on WLWH’s acceptance of a counseling offer should thus be stronger among WLWH who perceive high levels of HIV-related stigmatization. From a different perspective, one could also argue that the positive effect of the counselor’s similar health status should be stronger among WLWH who perceive relatively low levels of social support. Because PLWH often lack social support, connecting with others with similar stigma experiences is especially important to them (Frable, Platt, & Hoey, 1998).
Method Downloaded by [Australian Catholic University] at 19:59 02 October 2017
Design and participant recruitment Predictions were tested in an online experiment varying the similarity between a client’s and a fictitious counselor’s HIV status as a between-subjects factor. Specifically, we contrasted a condition in which the counselor was said to be HIV-positive with a condition in which the counselor was said to be HIV-negative. To explore whether the proposed effect of similarity of health status is unique to the counselor’s HIV-positive status or extends to other stigmatizing infections, we included a third condition in which the counselor was said to be HIV-negative but Hepatitis C-positive. Participants were recruited in Germany through flyers, HIV-specific webpages, and e-mail invitations in 2014.1 Criteria for participation were being a woman and having been diagnosed with HIV. Participants were randomly assigned to one of the three conditions. Procedure After working through socio-demographic and healthrelated questions, participants were asked to imagine searching the Internet for a counseling service regarding an HIV-specific problem and coming across a counselor profile. Similarity manipulation Participants were then randomly presented with one of three profiles for a fictional female counselor that varied with regard to the information provided about the counselor’s health status (see supplemental material for the full profiles). In the “counselor with HIV/without HCV” condition (n = 27), the profile stated that the counselor was living with HIV but not HCV; in the “counselor with HCV/without HIV” condition (n = 33), it stated that she was living with HCV but not HIV; in the control “counselor without HIV/HCV” condition (n = 29), it stated that she was living with neither HIV nor HCV.
Subsequently, participants completed a questionnaire and were debriefed. Measures To check the effectiveness of the health status similarity manipulation, we assessed perceived similarity by asking participants to indicate on three items how similar they perceived the fictitious counselor to be to themselves. To measure the counselor’s perceived empathy, we translated and adapted eleven items of the empathy subscale of the Relationship Inventory (Barrett-Lennard, 1986). Building on the Counselor Effectiveness Rating Scale (Atkinson & Wampold, 1982), we created an HIVspecific twelve-item scale to measure the counselor’s perceived credibility. Willingness to accept the counseling service with the fictitious counselor was assessed through five items. To measure perceived HIV stigma, we used the revised German adaptation of the 21-item HIV Stigma Scale (Dinkel et al., 2014). Perceived social support from people in participants’ environment was measured with the eight-item perceived social support subscale of the Berliner Social Support Scales (Schulz & Schwarzer, 2003). Composite scores were computed for all measures by averaging across corresponding items (Cronbach’s α ≥ .78 and ≤ .95).2
Results The sample consisted of 89 women,3 all living in Germany (M = 47.22 years, SD = 11.74). 47.2% had been living with their HIV diagnosis for 14 years or longer (see Table 1 for a detailed sample description). Means and standard deviations for all theoretically relevant variables for each of the three experimental conditions are presented in Table 2. Perceived similarity and willingness to accept the counseling service Two separate 1 × 3 (similarity: counselor with HIV/without HCV, counselor with HCV/without HIV, counselor without HIV/HCV) ANOVAs on perceived similarity and on willingness to accept the counseling service yielded significant effects, both F(2, 86)s ≥ 5.34, ps ≤ .007, η2s ≥ .11 (95%CIs for effect sizes [≥ 0.01, ≥ 0.23]).4 Planned contrasts provided evidence that compared to participants hypothetically exposed to a counselor without HIV/HCV, those exposed to a counselor with HIV/without HCV perceived her to be more similar to themselves and were more willing to accept counseling, both t(86)s ≥ 2.74, ps ≤ .007, η2s ≥ .08 (95%CIs for effect sizes [≥ 0.01, ≥ 0.20]). Moreover, they perceived her as
AIDS CARE
Downloaded by [Australian Catholic University] at 19:59 02 October 2017
Table 1. Sociodemographic and health characteristics of participants. Civil status Single Married Separated/divorced Widowed Relationship status Long-term partnership Migration background Education Vocational training University degree Employment Full-time Part-time Retired Disclosure of HIV statusa To intimate partnersb To most or all family membersc To most or all friendsd To most or all colleaguese Currently on ART Undetectable viral load CD4-count > 500 µl HIV/HCV co-infection Note: ART = Antiretroviral therapy. a Only to people available. b Data from 50 participants. c Data from 89 participants. d Data from 85 participants. e Data from 65 participants.
n
%
30 18 32 9
33.7 20.2 36.0 10.1
45 12
50.6 13.5
49 29
55.0 32.6
21 18 22
23.6 20.2 24.7
48 65 49 13 82 74 52 20
96.0 73.0 57.7 20.0 92.1 83.2 58.4 22.5
more similar and were more willing to accept the offer than participants in the counselor with HCV/without HIV condition, both t(86)s ≥ 2.87, ps ≤ .005, η2s ≥ .09 (95%CIs for effect sizes [≥ 0.01, ≥ 0.21]). The two conditions in which the counselor was depicted as HIVnegative did not significantly differ with regard to similarity or willingness to accept the service, both ps ≥ .497.5 Mediators: perceived empathy and credibility Results from a mediation analysis (linear regression) with perceived similarity as predictor, perceived empathy and credibility as mediators, and participants’ willingness to accept the counseling offer as the criterion supported the mediating roles of the counselor’s perceived empathy and credibility (Figure 1).6
Perceived credibility of counselor
b = 0.32***
b = 0.36***
b = 0.55**
b = 0.62*** b’ = 0.26*
Willingness to accept counseling
Perceived empathy of counselor
b = 0.52**
Perceived similarity
3
Figure 1. Mediation model for the effects of perceived similarity on willingness to accept counseling through the perceived credibility of counselor and perceived empathy of counselor. Indirect effect via credibility: PE = .18, SE = 0.08, 95%CI [0.04, 0.36]; indirect effect via empathy: PE = .18, SE = 0.09, 95%CI [0.03, 0.37]; total indirect effect: PE = .36, SE = 0.08, 95%CI [0.22, 0.53]. * p < .05. ** p < .01. *** p < .001.
Moderators: perceived HIV stigma and perceived social support In a moderated linear regression analysis with HIV stigma as moderator, perceived similarity as predictor, and willingness to accept the counseling offer as criterion, the Similarity × Stigma interaction term received a significant regression weight (Table 3, upper half), indicating that, as expected, the positive relationship between perceived similarity and willingness to accept the counseling offer was more pronounced among WLWH who perceived high levels of HIV stigma than among WLWH who perceived low levels of HIV stigma (Figure 2, upper half). An analogous analysis with social support as moderator yielded a significant Similarity × Support interaction (Table 3, lower half), indicating that the positive relationship between the counselor’s perceived similarity and participants’ willingness to accept the counseling offer was more pronounced among WLWH who experienced relatively little social support than among WLWH who experienced relatively high levels of social support (Figure 2, lower half).7
Discussion As predicted, WLWH were more willing to accept a fictitious counseling offer when the counselor was depicted as HIV-positive rather than HIV-negative because the
Table 2. Means and standard deviations for all theoretically relevant variables for the three experimental conditions.
Variable Perceived similarity of counselor Perceived empathy of counselor Perceived credibility of counselor Willingness to accept counseling Perceived HIV stigma Perceived social support
Counselor without HIV/HCV n = 29 M (SD)
Counselor with HCV/without HIV n = 33 M (SD)
Counselor with HIV/without HCV n = 27 M (SD)
3.06 (1.33) 4.33 (0.78) 5.37 (0.81) 4.72 (1.75) 1.86 (0.49) 3.50 (0.57)
3.30 (1.51) 4.55 (1.01) 5.06 (1.04) 4.66 (1.76) 2.06 (0.60) 3.36 (0.73)
4.36 (1.39) 5.07 (1.02) 5.82 (0.83) 5.88 (1.11) 2.04 (0.59) 3.36 (0.50)
4
L. MEHNERT ET AL.
Table 3. Results from moderated regression analyses with willingness to accept counseling as the criterion and (a) perceived HIV stigma or (b) perceived social support as moderator. (a)
Predictors Step 1
Perceived similarity (A) HIV stigma (B) R 2 = .32, F(2, 86) = 20.36, p < .001 Step 2 (A) × (B) ΔR 2 = .08, F(1, 85) = 10.53, p = .002 Overall R 2 = .40, F(3, 85) = 18.59, p < .001 (b)
SE
t
p
0.10 0.27
6.07 −0.95
