1-to-1 information and advice

The key to this intervention Providers of one-to-one information and advice engage individuals in brief discussions, listen to their needs, and then do what they can to meet those needs with information, advice and onward referral. The intervention forms the cornerstone of what is often described as outreach or detached work.

What is the activity?

Information and advice interventions typically offer individuals the opportunity to discuss sexual health concerns, such as safer sex, negotiating relationships or sexual dysfunction. However, HIV prevention need reaches beyond access to adequate sexual health information, and includes needs related to security, safety, productivity and freedom from discrimination. The provision of information and advice on welfare benefits, immigration, housing, employment and training are also interventions that help to reduce HIV prevention need among African people in England.

Engaging individuals in discussion, listening to their experiences and feelings, and offering information and advice is at the centre of many activities undertaken by agencies delivering HIV prevention interventions. Although the contexts through which individual service users come into contact with such services vary widely, many core principles of information and advice provision remain the same, regardless of the setting in which it is offered.

One-to-one advice is typically client-led and should be easily accessed. Many agencies tend to focus on their detached or outreach work as the main way of giving information and advice, but we also include centre-based services (offered on a drop-in or appointment basis) and helpline (offered by telephone) and chat-room interventions (on the internet), although the latter two intervention types do not occur face-to-face.

Listening in an open, non-judgmental way helps those providing this intervention to get a better sense of how to tailor the information and advice that they give.

Strengths and limitations

The highly personalised delivery of one-to-one talking interventions means they can be responsive to service users’ needs, in ways that are not possible in written interventions.

One of the most significant challenges in the provision of one-to-one advice and information (particularly through outreach or detached work), is the recruitment, training and retention of people willing to work unsociable hours who also have excellent communication skills and sufficient sexual health expertise to deliver the intervention.

Outreach and detached work is notoriously difficult to monitor and evaluate, and there can be resistance among some workers to using monitoring tools in the field. Similarly, service-users’ interactions in settings outside of the agency may be fleeting, making monitoring and evaluation challenging.

Where does it happen?

During detached work or outreach interventions, advice sessions can occur in public, private and commercial spaces where African people socialise, including markets, pubs, clubs, places of worship, schools, colleges, universities, businesses and community centres. Access is therefore immediate, and interactions tend to be short (typically 5-15 minutes).

Workers generally operate in pairs in settings other than their agency, in order to ensure their own safety, and also to protect themselves against accusations of misconduct. Advice is usually information-based, and the session can be used as a means of referring individuals to other services, and distributing HIV prevention resources (such as leaflets and condoms) where appropriate.

Wherever possible, centre-based drop-in should take place in an area away from other service users and staff, offering people privacy while discussing personal issues. There should be a secure area for keeping confidential records, and private rooms may be equipped with a panic button system to be used if there is a physical danger.

Telephone helplines and web-based personal support interventions provide users with direct, one-to-one information and advice, at times and in settings that are most comfortable for them. Once again, they often demand self-referral, although accessibility is increased compared to centre-based interventions, and is in the control of the user. Such interactions do not require an appointment, and can be of varying durations and intensities. In such interventions, the technology affords relative anonymity to the user, while the provider can tailor the information and advice offered to the needs of individuals accessing the service.

Frequently delivered alongside ...

Issues to consider

Providers of one-to-one information and advice should be knowledgeable about a range of sexual health issues such as the transmission, prevention and treatment of sexually transmitted infections (including HIV). Beyond this, they also require familiarity with related issues, in order to identify acute needs (relating say to domestic violence, homelessness, or non-consensual sex) and to be familiar with an array of services to which they can make appropriate referrals. Positions demanding this type of expertise and experience are ideally paid as it is difficult to ensure adequate quality of provision by volunteers. Workers providing information and advice should have proven listening and communication skills.

It is essential that workers display a professional, non-judgmental, knowledgeable and reliable persona while communicating with service users.

Agencies will need to have procedural and boundary guidelines for one-to-one workers, and will need to ensure that these are built into staff inductions, and are regularly revisited. These should aim to maximise the physical safety and comfort of workers while also ensuring a standardised and reliable service. The providers’ credibility is paramount to the success of these interventions, therefore workers will need training about personal, professional and social boundaries during work (and about contact with clients outside of work).

Outreach workers will generally need to be equipped with:

  • identification cards
  • relevant written resources and other materials such as condoms / femidoms
  • contact details for other services
  • monitoring instruments
  • mobile phone
  • a letter on agency-headed paper explaining their presence

Agencies in larger cities could consider pooling their sessional outreach staff in order to ensure high quality provision, as well as ensuring that there is enough work to keep individuals in post.

Making arrangements to gain access to community and commercial venues can be time-consuming, but careful preparation and community consultation will help agencies to successfully identify appropriate venues.

Outcomes

The outcomes from this intervention are primarily information based, and the list below offers some examples of outcomes, but is not exhaustive. Outcomes among African people receiving one-to-one information and advice can include:

  • Knowing HIV exists and understanding the harm it can cause (see associated needs).
  • Having a clearer understanding about how and why different sexual acts carry differing risks of HIV transmission (see associated needs).
  • Knowing more about reducing harm when unprotected sex does happen - such as withdrawal and ensuring sero-concordance - while also understanding that there are more effective means of avoiding HIV transmission (see associated needs here and here).
  • Knowing how to correctly use male and female condoms, and feel more confident introducing condoms with sexual partners (see associated needs).
  • Understanding the benefits of knowing their own HIV status (see associated needs here and here).
  • Increasing the extent to which they consider that the sex they have could risk HIV transmission (see associated needs here, here and here).
  • Knowing about the HIV prevention options for conception in couples where a partner has diagnosed HIV (see associated needs).
  • Knowing more about other services that they can access to better help them meet a range of needs, including HIV prevention need (see associated needs).
  • Increased confidence and motivation to openly  discuss sex and sexuality, as modeled by the provider of a face-to-face intervention (see associated needs here, here and here).
  • Increased requests for (and uptake of) PEP following sexual exposure to HIV (see associated needs).
  • Increased requests for (and uptake of) STI screening (see associated needs).

Monitoring and evaluation

It is most common for one-to-one information and advice to be delivered alongside interactive distribution of resources, and is generally subject to monitoring as well as access evaluation which collates information about service users’ basic demographics (age, ethnicity, gender etc.) in order to assess if the intervention is reaching the desired targets.

It is possible that innovative and lower-cost evaluation models such as mystery-shopping or the use of peer evaluation would contribute to the monitoring and evaluation of this HIV prevention activity.

Page last updated: 17 July 2013

Case study

Love Safely

Youth Projects International and Embrace UK

The Love Safely intervention begins with a face-to-face, structured needs assessment, to determine what individuals already know about HIV prevention, and what further interventions may be of benefit. This is followed by a detailed discussion on areas where information is lacking. An information sheet is left behind for participants to consider in greater detail, and appropriate referrals are made (in particular, referrals for HIV testing). Those providing the service find that the intensive approach brings great rewards for individuals. Participants are also encouraged to help recruit others who might benefit from taking part.

Case study

Community Outreach

Pan Afrique

Pan Afrique employs outreach staff supplemented by volunteers who provide information and advice in a range of community settings. Their training in health promotion is provided externally, including courses provided by Naz Project London. Examples of settings where outreach is undertaken include: local football matches, drama and other cultural events and parties. As well as ensuring the distribution of sexual health resources such as condoms and small media, outreach workers directly engage African people in discussions about sexual health and HIV (often using written media as ice-breakers).

Case study

HarbourSafe

The Harbour Trust

The Harbour Trust runs HarbourSafe, an HIV prevention intervention ingLondon aimed at supporting MSM members of the BME community to take responsibility for practising safer sex. Volunteers from the same community are trained to mentor others who are either placing themselves at risk of HIV infection or are at risk of doing so. Together, mentor and mentee work through a series of 9 modules that explore the broader, contextual reasons why people place themselves at risk. Subjects like, self-esteem and gobal uilding are discussed. Progress is measured and relationships are closely monitored to ensure consistent support and improvement.