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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
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
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
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
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
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
HIV PREVALANCE IN GUJARAT AND INDIA




                                  7
Mode of Transmission of HIV In India




                                       8
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
Biomedical and Health Belief Response to HIV/AIDS
                    epidemics




                                                    10
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
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
Sexual Behaviour and Biomedical Determinants and
             Responses to HIV/AIDS




                                                   13
Health Belief Model and Primary Behaviour Change
              Responses to HIV/AIDS




                                                   14
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
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
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
    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
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
“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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
THANK YOU VERY MUCH!!




DOORS ARE OPEN FOR YOUR COMMENTS
          AND FEEDBACK!
                              36

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PhD Proposal Seminar_Revised__Apurva 21oct2010

  • 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
  • 7. HIV PREVALANCE IN GUJARAT AND INDIA 7
  • 8. Mode of Transmission of HIV In India 8
  • 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
  • 10. Biomedical and Health Belief Response to HIV/AIDS epidemics 10
  • 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
  • 13. Sexual Behaviour and Biomedical Determinants and Responses to HIV/AIDS 13
  • 14. Health Belief Model and Primary Behaviour Change Responses to HIV/AIDS 14
  • 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

Notes de l'éditeur

  1. Move the conceptual framework slide before the objectives (that is, after the rationale).
  2. The first two seem similar. Check and clarify. Is this or the next slide to be considered?