HIV Counseling Practices:   Experiences and Perspectives of Counselors Working        with Targeted Interventions in Gujar...
A GLOBAL VIEW OF HIV INFECTION                Number of people living with HIV                33.2 Million                ...
GLOBAL SCENARIO   Everyday 6800 people get HIV infection.   96% are belong to poor and middle income countries.   5600 ...
TYPES OF HIV/AIDS EPIDEMICNASCENT EPIDEMIC    An HIV epidemic in a country in which less than 5% of individuals in    high...
HIV/AIDS: INDIAN SCENARIO                                       120000                                                    ...
HIV PREVALANCE IN DIFFERENT GROUPS    8.00                                  IDU, 6.95    7.00                             ...
HIV PREVALANCE IN GUJARAT AND INDIA                                  7
Mode of Transmission of HIV In India                                       8
GLOBAL EFFORTS IN PREVENTION AND           CONTROL OF HIV/AIDSPhase-1                   Phase 2:                    Phase3...
Biomedical and Health Belief Response to HIV/AIDS                    epidemics                                            ...
But infections continued to rise…            questions asked…   Appropriateness for sexual behaviour   A Western approac...
GLOBAL EFFORTS IN PREVENTION AND           CONTROL OF HIV/AIDSPhase-1                   Phase 2:                    Phase3...
Sexual Behaviour and Biomedical Determinants and             Responses to HIV/AIDS                                        ...
Health Belief Model and Primary Behaviour Change              Responses to HIV/AIDS                                       ...
But infections continued to rise…              questions asked…   Why are people still continuing to take risks?   Resea...
GLOBAL EFFORTS IN PREVENTION AND           CONTROL OF HIV/AIDSPhase-1                   Phase 2:                    Phase3...
THE WIDER PICTURE OF THE FACTORS THAT     FACILITATE HIV TRANSMISSION                                    17
SOME ISSUES   Less number people who need ARV, receiving ARV.   Patient compliance -especially in deprived    communitie...
PARADIGM SHIFT   AIDS is a ‘behavioural problem with    behavioural solutions.’ (Green, 2003).Questioned by Farmer.   ‘A...
“AIDS is rooted in problems of poverty, food and livelihood       insecurity, socio-cultural inequalities and poor support...
CHALLENGES IN HIV PREVENTION   The HIV/AIDS epidemic is hidden, often concentrated among already    marginalized groups. ...
Behaviour change is the key !Hence counseling remains significant aspect of HIVprevention, care, support and treatment.   ...
CURRENT NEED   People need knowledge to enable them to be    able to make choices about their life styles.   But this al...
BEHAVIOUR CHANGE THEORIES AND MODELS1. INDIVIDUAL FOCUSED   THEORIES           2. SOCIAL THEORIES AND                     ...
RATIONALE OF THE STUDY   HIV is the virus which can be prevented from transmission    through change in behavior.   Chan...
OBJECTIVES OF THE STUDY   Main Objective    The intent of this research is to examine personal experiences of    counselo...
RESEARCH QUESTIONSHow do counselors practice HIV counseling services within targeted intervention?How do counselors use or...
Research DesignResearch Methodology: Grounded Theory (GT).It helps in discovery of new information (Glaser and Strauss 196...
DATA COLLECTION THROUGH VARIOUSMETHODSTo Gain DemographicInformation, UnderstandKnowledge and Beliefs ofCounselors─HIV/AID...
ETHICAL CONSIDERATIONS   Informed consent in written- counselors and clients (in case of    naturalistic observation)   ...
PLAN OF ANALYSISANALYSIS                             OBJECTIVESQualitative analysis using Maxqda® Explore emerging themes ...
ANALYTICAL ISSUES AND THEIR RESOLUTIONSr.   Analytical Issues                     ManagementNo.1     Threat to Theoretical...
EXPECTED OUTCOME   Inform culturally appropriate HIV counseling theory or model to    National AIDS Control Programme Pha...
PLAN OF ACTIONActivities             Oct-   Jan-   May-   Dec   Jan   Feb   Mar-1   Apr-   May-   Jun-   Jul-1   Aug-12   ...
REFERENCES   Bogdan, R. & Biklen, R.C. (1992). Qualitative research for education: An introduction    to theory and metho...
THANK YOU VERY MUCH!!DOORS ARE OPEN FOR YOUR COMMENTS          AND FEEDBACK!                              36
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PhD Proposal Seminar_Revised__Apurva 21oct2010

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  • PhD Proposal Seminar_Revised__Apurva 21oct2010

    1. 1. HIV Counseling Practices: Experiences and Perspectives of Counselors Working with Targeted Interventions in Gujarat PhD Research ProposalApurva Pandya, MA Shagufa Kapadia,PhD Researcher ResearchGuide Department of Human Development and Family Studies Faculty of Family and Community Sciences, M S University of Baroda, Vadodara 21 October 2010 1
    2. 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. 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. 4. TYPES OF HIV/AIDS EPIDEMICNASCENT 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. 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. 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 3.00onPeyvcsrti 2.00 1.00 ANC, 0.6 0.00 6
    7. 7. HIV PREVALANCE IN GUJARAT AND INDIA 7
    8. 8. Mode of Transmission of HIV In India 8
    9. 9. GLOBAL EFFORTS IN PREVENTION AND CONTROL OF HIV/AIDSPhase-1 Phase 2: Phase3:Up to mid 1990s Mid 1990s to 2000 2000 to dateCharacterised by Health Characterised by Period of paradigmBelief Model [a medical Primary Behaviour ‘shift’, recognition thatproblem] Change (informed by social, community and Health Belief Model and structural factors areMedically and various behaviour important, butepidemiologically driven. change theories and biomedical andEducation and knowledgeare regarded as ‘the key to models) [a behavioural behavioural approacheseffective prevention’ problem] still dominant [a(UNESCO, 2005, 6) development issue]. 9
    10. 10. Biomedical and Health Belief Response to HIV/AIDS epidemics 10
    11. 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. 12. GLOBAL EFFORTS IN PREVENTION AND CONTROL OF HIV/AIDSPhase-1 Phase 2: Phase3:Up to mid 1990s Mid 1990s to 2000 2000 to dateCharacterised by Health Characterised by Period of paradigmBelief Model [a medical Primary Behaviour ‘shift’, recognition thatproblem] Change (informed by social, community and Health Belief Model and structural factors areMedically and various behaviour important, butepidemiologically driven. change theories and biomedical andEducation and knowledgeare regarded as ‘the key to models) [a behavioural behavioural approacheseffective prevention’ problem] still dominant [a(UNESCO, 2005, 6) UN agencies development issue]. combined forces Multi-sectoral approach (SIPPA, 2005, 11) ABC 12 12
    13. 13. Sexual Behaviour and Biomedical Determinants and Responses to HIV/AIDS 13
    14. 14. Health Belief Model and Primary Behaviour Change Responses to HIV/AIDS 14
    15. 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. 16. GLOBAL EFFORTS IN PREVENTION AND CONTROL OF HIV/AIDSPhase-1 Phase 2: Phase3:Up to mid 1990s Mid 1990s to 2000 2000 to dateCharacterised by Health Characterised by Period of paradigmBelief Model [a medical Primary Behaviour ‘shift’, recognition thatproblem] Change (informed by social, community and Health Belief Model and structural factors areMedically and various behaviour important, butepidemiologically driven. change theories and biomedical andEducation and knowledgeare regarded as ‘the key to models) [a behavioural behavioural approacheseffective 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. 17. THE WIDER PICTURE OF THE FACTORS THAT FACILITATE HIV TRANSMISSION 17
    18. 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. 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. 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 leveldeterminants of sexuality. We need to pay attention to the social changethat needs to take place to support the likelihood of healthier sexualbehaviour. Sexual behaviour, and the possibility of sexual behaviouralchange, 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. 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. 22. Behaviour change is the key !Hence counseling remains significant aspect of HIVprevention, 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. 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. 24. BEHAVIOUR CHANGE THEORIES AND MODELS1. INDIVIDUAL FOCUSED THEORIES 2. SOCIAL THEORIES AND MODELSHealth belief modelSocial learning theory Diffusion of innovation theoryTheory of reasoned actionStages of change model  Social influence or social inoculation modelAIDS risk reduction model3. STRUCTURAL AND Social Network theoryENVIRONMENTAL Theory of gender and powerTHEORIES AND MODELS 4. CONSTRUCTS ALONE AND TRANSTHEORETICALTheory for individual and social change or MODELSempowerment model Perception of risk controlSocial ecological model for health promotionSocio economic factors Sexual communication 24
    25. 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. 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. 27. RESEARCH QUESTIONSHow 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. 28. Research DesignResearch Methodology: Grounded Theory (GT).It helps in discovery of new information (Glaser and Strauss 1967).Develop theoretical formulations (Byrne 2001) , andEstablish framework for future exploration (Strauss & Corbin, 1990).Universe:Counselors working with Targeted Interventions in the state of Gujarat andtheir clientsSample Size:Sample size will be determined on the basis of saturation of themes.Approximately Seventeen Counselors will be interviewed and five counselingsessions will be observedSampling Technique:Theoretical SamplingData Collection Tools:In-depth interview protocol and naturalistic observation protocol 28 9
    29. 29. DATA COLLECTION THROUGH VARIOUSMETHODSTo Gain DemographicInformation, UnderstandKnowledge and Beliefs ofCounselors─HIV/AIDS, Targeted To Understand Counseling Types of Research DataInterventions, Risk populations, Effectiveness, Clients’and Counseling, Feedback and Perceptions ofExisting 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 sessionsTo Understand Recording To Understand Counseling Context andand documentation ofcounseling process Organizational Environment 29
    30. 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. 31. PLAN OF ANALYSISANALYSIS OBJECTIVESQualitative analysis using Maxqda® Explore emerging themes around following concepts andor 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 modelA grounded theory based analytic approach will be used. The conceptual framework proposed inthis study will provide an initial list of themes, while allowing for new themes to emerge fromthe data. 31
    32. 32. ANALYTICAL ISSUES AND THEIR RESOLUTIONSr. Analytical Issues ManagementNo.1 Threat to Theoretical Validity Researcher will remain : open and receptive to respondents responses open to contradictory evidence2 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 out3 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. 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. 34. PLAN OF ACTIONActivities 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 11Review of LiteratureDevelopment ofData CollectionProtocolData CollectionInterim AnalysisPreliminary AnalysisPoA SeminarWriting Results andROLWriting DiscussionR&D SeminarSynopsisThesis Submission 34
    35. 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. 36. THANK YOU VERY MUCH!!DOORS ARE OPEN FOR YOUR COMMENTS AND FEEDBACK! 36
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