This document provides details about a proposed PhD research project that will examine the counseling practices and perspectives of counselors working with targeted HIV intervention programs in Gujarat, India. The research aims to understand counselors' personal experiences providing HIV counseling services, their views on current practices and capacity building needs, and ultimately develop an indigenous and culturally appropriate model for HIV counseling. The proposed methodology is a grounded theory approach involving interviews with approximately 17 counselors and observation of counseling sessions. Expected outcomes include informing culturally appropriate HIV counseling training and practices to support India's National AIDS Control Program.
1. HIV Counseling Practices:
Experiences and Perspectives of Counselors Working
with Targeted Interventions in Gujarat
PhD Research Proposal
Apurva Pandya, MA Shagufa Kapadia,PhD
Researcher Research
Guide
Department of Human Development and Family Studies
Faculty of Family and Community Sciences,
M S University of Baroda, Vadodara
21 October 2010 1
2. A GLOBAL VIEW OF HIV INFECTION
Number of people living with HIV
33.2 Million
Young people aged 15–24 living with
HIV 5.4 million
Children below 15 years living with
HIV 2.5 Million
2
3. GLOBAL SCENARIO
Everyday 6800 people get HIV infection.
96% are belong to poor and middle income countries.
5600 are adult,1200 are children and out of which
50% are women and 40% are young (15-24 years of
age).
Negative impact on life ( life expectancy, orphans,
economic crisis, stigma and discrimination).
3
4. TYPES OF HIV/AIDS EPIDEMIC
NASCENT EPIDEMIC
An HIV epidemic in a country in which less than 5% of individuals in
high-risk groups are infected.
CONCENTRATED EPIDEMIC
An HIV epidemic in a country in which 5% or more of individuals in
high-risk groups, but less than 5% of women attending urban ante-natal
clinics are infected.
GENERALISED EPIDEMIC
An HIV epidemic in a country where more than 5% of individuals in
high-risk groups as well as women attending urban ante-natal clinics are
infected.
(World Bank, 1997, 87)
It is easier to control a nascent epidemic than a generalised one.
4
5. HIV/AIDS: INDIAN SCENARIO
120000
104087
100000
80000
Number of AIDS cases
56615
60000
40000
12193
20000 8890
0
0-14 years 15-29 years 30-49 years >49 years
Age Group
Total 1,81,785 people
are living with HIV
(June,2007).
Out of them, 31.2 are
women.
5
6. HIV PREVALANCE IN DIFFERENT GROUPS
8.00
IDU, 6.95
7.00 MSM, 6.48
6.00
FSW, 4.9
5.00
4.00 STD, 3.74
3.00
o
n
P
e
y
v
c
s
r
t
i
2.00
1.00 ANC, 0.6
0.00
6
9. GLOBAL EFFORTS IN PREVENTION AND
CONTROL OF HIV/AIDS
Phase-1 Phase 2: Phase3:
Up to mid 1990s Mid 1990s to 2000 2000 to date
Characterised by Health Characterised by Period of paradigm
Belief Model [a medical Primary Behaviour ‘shift’, recognition that
problem] Change (informed by social, community and
Health Belief Model and structural factors are
Medically and various behaviour important, but
epidemiologically driven. change theories and biomedical and
Education and knowledge
are regarded as ‘the key to
models) [a behavioural behavioural approaches
effective prevention’ problem] still dominant [a
(UNESCO, 2005, 6) development issue].
9
11. But infections continued to rise…
questions asked…
Appropriateness for sexual behaviour
A Western approach
Onus on the individual
No understanding of the risk taking
environment
11
12. GLOBAL EFFORTS IN PREVENTION AND
CONTROL OF HIV/AIDS
Phase-1 Phase 2: Phase3:
Up to mid 1990s Mid 1990s to 2000 2000 to date
Characterised by Health Characterised by Period of paradigm
Belief Model [a medical Primary Behaviour ‘shift’, recognition that
problem] Change (informed by social, community and
Health Belief Model and structural factors are
Medically and various behaviour important, but
epidemiologically driven. change theories and biomedical and
Education and knowledge
are regarded as ‘the key to
models) [a behavioural behavioural approaches
effective prevention’ problem] still dominant [a
(UNESCO, 2005, 6) UN agencies development issue].
combined forces
Multi-sectoral
approach (SIPPA,
2005, 11) ABC 12
12
15. But infections continued to rise…
questions asked…
Why are people still continuing to take risks?
Research showing that individual agency is
constrained by social, economic and structural
factors, such as poverty, mobility and migration
patterns and gender inequality (Parker, 2000).
15
16. GLOBAL EFFORTS IN PREVENTION AND
CONTROL OF HIV/AIDS
Phase-1 Phase 2: Phase3:
Up to mid 1990s Mid 1990s to 2000 2000 to date
Characterised by Health Characterised by Period of paradigm
Belief Model [a medical Primary Behaviour ‘shift’, recognition that
problem] Change (informed by social, community and
Health Belief Model and structural factors are
Medically and various behaviour important, but
epidemiologically driven. change theories and biomedical and
Education and knowledge
are regarded as ‘the key to
models) [a behavioural behavioural approaches
effective prevention’ problem] still dominant [a
(UNESCO, 2005, 6) UN agencies development issue].
combined forces Tackling HIV/AIDS
Multi-sectoral becomes a
approach (SIPPA, Millennium
2005, 11) ABC Development Goal 16 16
17. THE WIDER PICTURE OF THE FACTORS THAT
FACILITATE HIV TRANSMISSION
17
18. SOME ISSUES
Less number people who need ARV, receiving ARV.
Patient compliance -especially in deprived
communities.
Fears of drug resistance and strains of development of
viral load.
Focus diverted to care and treatment - Prevention
need is ignored.
Infection and death from HIV and AIDS continue to
rise.
Despite knowledge risky sexual behaviour
18
19. PARADIGM SHIFT
AIDS is a ‘behavioural problem with
behavioural solutions.’ (Green, 2003).
Questioned by Farmer.
‘AIDS is also surely, a social problem with social
solutions.’ (Farmer, 2003).
19
20. “AIDS is rooted in problems of poverty, food and livelihood
insecurity, socio-cultural inequalities and poor support services
and infrastructure.” ( Hemrich & Topouzis, 2000).
‘...there is a need to focus on the psycho-social and community level
determinants of sexuality. We need to pay attention to the social change
that needs to take place to support the likelihood of healthier sexual
behaviour. Sexual behaviour, and the possibility of sexual behavioural
change, are determined by an interlocking series of multi-level processes,
ranging from the intra-psychological to the macro-social.’ (Campbell , 2003.
p. 183) 20
21. CHALLENGES IN HIV PREVENTION
The HIV/AIDS epidemic is hidden, often concentrated among already
marginalized groups.
[female sex workers (FSW), Injecting Drug Users (IDUs) and spouses of
Men who have Sex with Men (MSM)].
Number of people are testing for HIV.
HIV/AIDS related stigma.
Programmes that exist are based on clinical services reaching out to a
limited number of those in need.
The programmes pay little attention to the psycho-social needs of the
most-at-risk populations (MARPs).
21
22. Behaviour change is the key !
Hence counseling remains significant aspect of HIV
prevention, care, support and treatment.
AIDS responses have grown and improved
considerably over the past decade. But they still do not
match the scale or the pace of a steadily worsening
epidemic.’ (UNAIDS, 2005,5)
‘…the AIDS epidemic continues to
outstrip global efforts to contain it.’
(UNAIDS, 2005,6
‘…responses to the epidemic came too late and were not
commensurate to the magnitude and urgency of the
challenge.’ (UNESCO, 2005, 5) 22
23. CURRENT NEED
People need knowledge to enable them to be
able to make choices about their life styles.
But this alone cannot guarantee behavioural
change.
There are many intervening factors that
prevent individuals adopting safer behaviour.
23
24. BEHAVIOUR CHANGE THEORIES AND MODELS
1. INDIVIDUAL FOCUSED
THEORIES 2. SOCIAL THEORIES AND
MODELS
Health belief model
Social learning theory Diffusion of innovation theory
Theory of reasoned action
Stages of change model Social influence or social inoculation model
AIDS risk reduction model
3. STRUCTURAL AND Social Network theory
ENVIRONMENTAL
Theory of gender and power
THEORIES AND MODELS
4. CONSTRUCTS ALONE AND
TRANSTHEORETICAL
Theory for individual and social change or MODELS
empowerment model
Perception of risk control
Social ecological model for health promotion
Socio economic factors Sexual communication 24
25. RATIONALE OF THE STUDY
HIV is the virus which can be prevented from transmission
through change in behavior.
Change in knowledge about STI/HIV and risky sexual behavior
is the way to prevent HIV transmission among most-at-risk
populations (MARPs).
The programmes pay little attention to the psycho-social needs
of the MARPs.
Many theories of behaviour change exist but none is depicting
counselors’ experiences and explore counselors’ perspectives.
Indigenous counseling practices are not known in Indian
context.
25
26. OBJECTIVES OF THE STUDY
Main Objective
The intent of this research is to examine personal experiences of
counselors’, and juxtapose them with their preferred counseling
theories to evolve a culturally appropriate theory or model of HIV
counseling.
Specific Objectives
Examine counselors’ personal and professional experiences of
providing HIV counseling services.
Understand their perspectives on current practices and capacity
building.
Evolve indigenous practices and a culturally appropriate working
model for HIV counseling. 26
27. RESEARCH QUESTIONS
How do counselors practice HIV counseling services
within targeted intervention?
How do counselors use or develop counseling skills
and techniques?
How do counselors deal with challenges in everyday
counseling practice?
What are counselors’ perspectives on current HIV
counseling practice and their capacity building?
Does the experience of HIV counseling enable
development of a personal counseling approach?
How? 27
28. Research Design
Research Methodology: Grounded Theory (GT).
It helps in discovery of new information (Glaser and Strauss 1967).
Develop theoretical formulations (Byrne 2001) , and
Establish framework for future exploration (Strauss & Corbin, 1990).
Universe:
Counselors working with Targeted Interventions in the state of Gujarat and
their clients
Sample Size:
Sample size will be determined on the basis of saturation of themes.
Approximately Seventeen Counselors will be interviewed and five counseling
sessions will be observed
Sampling Technique:
Theoretical Sampling
Data Collection Tools:
In-depth interview protocol and naturalistic observation protocol 28
9
29. DATA COLLECTION THROUGH VARIOUS
METHODS
To Gain Demographic
Information, Understand
Knowledge and Beliefs of
Counselors─HIV/AIDS, Targeted To Understand Counseling
Types of Research Data
Interventions, Risk populations, Effectiveness, Clients’
and Counseling, Feedback and Perceptions of
Existing HIV counseling practices Counseling
Text Visual
Narrative
To Understand
Process of
In-depth Interview Brief Interview of Counseling
Counseling documents of Counselors Clients
For example, daily diary,
registers Observational Field Photographs Participants
Observation of
Notes Counseling sessions
To Understand Recording To Understand Counseling Context and
and documentation of
counseling process Organizational Environment
29
30. ETHICAL CONSIDERATIONS
Informed consent in written- counselors and clients (in case of
naturalistic observation)
Voluntary participation.
Any form of moral, physical or emotional harm .
Adequate training on ethics in social science research and research
methodology from-
Tata Institute of Social Sciences, Mumbai;
Mailman School of Public Health, Columbia University, New
York
Prior approval from Gujarat State AIDS Control Society,
Department of Health and Family Welfare, Government of Gujarat
has been taken.
30
31. PLAN OF ANALYSIS
ANALYSIS OBJECTIVES
Qualitative analysis using Maxqda® Explore emerging themes around following concepts and
or ATLAS- Ti or NVIVO 9 new themes.
•Indigenous counseling skills, techniques and strategies
•Ways counselor relate psychological concepts
•Reflections on everyday counseling practice
Evolve culture specific counseling theory or model
A grounded theory based analytic approach will be used. The conceptual framework proposed in
this study will provide an initial list of themes, while allowing for new themes to emerge from
the data.
31
32. ANALYTICAL ISSUES AND THEIR RESOLUTION
Sr. Analytical Issues Management
No.
1 Threat to Theoretical Validity Researcher will remain :
open and receptive to respondents
responses
open to contradictory evidence
2 Threat to Interpretive Validity Researcher will remain aware about
Researchers’ bias to interpret data perspectives and beliefs the research
brings to the research project.
Recoding of the data by external person
External Audit of the result and
discussion will be carried out
3 Threat to Descriptive Validity Audio -taping interviews and detailed,
concrete, and chronological field notes
during the interview process will be taken
Member Check will be applied to ensure
description validity.
Technical literature review will be done
once coding is completed 32
33. EXPECTED OUTCOME
Inform culturally appropriate HIV counseling theory or model to
National AIDS Control Programme Phase III of National AIDS
Control Organization (NACO).
Facilitate policy development on HIV counseling to support decision-
making to improve the quality of HIV counselors’ training and
counseling practices.
Contribute to the development of counselors’ training modules,
counseling tool kit and counseling best practices specific to Targeted
Intervention programme of the Gujarat state.
Facilitate development of culturally appropriate counseling theory or
model for the country to guide Targeted Intervention programme.
33
34. PLAN OF ACTION
Activities Oct- Jan- May- Dec Jan Feb Mar-1 Apr- May- Jun- Jul-1 Aug-12
Dec Apr Nov -11 -12 -12 2 12 12 12 2
10 11 11
Review of Literature
Development of
Data Collection
Protocol
Data Collection
Interim Analysis
Preliminary Analysis
PoA Seminar
Writing Results and
ROL
Writing Discussion
R&D Seminar
Synopsis
Thesis Submission
34
35. REFERENCES
Bogdan, R. & Biklen, R.C. (1992). Qualitative research for education: An introduction
to theory and methods. Boston: Allyn-Bacon.
Byrne, M. (2001). Grounded theory as a qualitative research methodology. AORN
Journal, 73 (6), 1155-1156.
Centers for Disease Control and Prevention. (1997). Perspectives in disease prevention
and health promotion: Public Health Service guidelines for counseling and antibody
testing to prevent HIV infection and AIDS. Morb Mortal Wkly Rep 1987; 36:509–15.
[Medline]
Denzin, N.K. & Lincoln, Y.S. (1994). Handbook of qualitative research. Thousand Oaks,
CA: Sage.
Lincoln, Y. & Guba, E. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.
Maxwell, J.A. (1996). Qualitative research design: An interactive approach. Thousand Oaks,
CA: Sage.
National AIDS Control Organization (2009). 2009-10 Annual Report. Department of
AIDS Control, Ministry of Health and Family Welfare, Government of India, New
Delhi.
Strauss, A. and Corbin, J. (1990). Basics of qualitative research: Grounded theory
procedures and techniques. Newbury Park, CA: Sage Publications.
35
36. THANK YOU VERY MUCH!!
DOORS ARE OPEN FOR YOUR COMMENTS
AND FEEDBACK!
36
Hinweis der Redaktion
Move the conceptual framework slide before the objectives (that is, after the rationale).
The first two seem similar. Check and clarify. Is this or the next slide to be considered?