PhD Proposal Seminar in the Department of Human Development and Family Studies, M S University of Baroda. I presented PhD Seminar in front of PhD Committee, post graduate student, and research scholars. However, after interaction with various experts in USA, I have changed my methodology of my PhD research. To see revised PhD proposal check another presentation: PhD_Proposal Seminar_Revised_

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 August 2010 1

2. A GLOBAL VIEW OF HIV INFECTION
33 million people [30–36 million] living with HIV, 2007
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 high risk groups (HRGs).
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
Health belief model
Social learning theory 2. SOCIAL THEORIES AND MODELS
Theory of reasoned action Diffusion of innovation theory
Stages of change model Social influence or social inoculation model
AIDS risk reduction model Social Network theory
Theory of gender and power
3. STRUCTURAL AND
ENVIRONMENTAL
THEORIES AND MODELS
4. CONSTRUCTS ALONE AND
Theory for individual and social change TRANSTHEORETICAL
or empowerment model
Social ecological model for health
MODELS
promotion Perception of risk control
Socio economic factors Sexual communication
24

25. RATIONALE OF THE STUDY
 HIV is the virus which can be prevented from
transmission through change in behaviour.
 Change in knowledge about STI/HIV and risky
sexual behavior is the way to prevent HIV
transmission among High Risk Groups (HRGs).
 The programmes pay little attention to the
psycho-social needs of the high risk groups
(HRGs).
 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
n Study existing counselling practices of counselors' working with Targeted
Intervention projects supported by National AIDS Control Organization (NACO),
Ministry of Health and Family Welfare, Government of India.
n Examine counselors’ ways of relating psychological concepts and theories to
everyday counseling practice.
n Explore counselor’s perspectives on HIV current counseling practice.
n Explore challenges faced by counselors in everyday counseling practice.
n Explore innovative HIV counseling skills and techniques being used by the
counselors.
n Explore counselors’ reflective journey of counseling practice and their personal
counseling approaches. 26

27. RESEARCH QUESTIONS
Total 16 questions
9 questions address quantitative aspects and
7 questions deal with qualitative aspects
NOTE: Questions are given in the handout.
27

28. Existing major behaviour
change models/theories for
Orientation training on Targeted Intervention HIV prevention
project and Counselling provided by State
Training Resource Centre (STRC)
Knowledge of counselling
approaches, theories skills
and techniques Knowledge of High Risk
Groups and sensitivity
Knowledge of toward their issues
Knowledge of Targeted
Counselling and
Intervention project and
behaviour change theories
HIV issues
Process of counselling
Counselors’ cultural reference
Reflections of knowledge in actual
counselling practice Innovative use of
Personalized counselling knowledge of targeted
style and practicing Intervention and HIV
indigenous counseling Innovative use of
approaches/ strategies counseling skills
Challenges faced in and techniques
application of counselling Working model/theory of HIV
principles and theories Counselling
CONCEPTUAL MODELOF THE STUDY 28

29. RESARCH DESIGN
A Mixed Method Model III (Smith, 1997) with sequential
exploratory design (Creswell,2003) is ideal for this proposed
research.
QUANTI QUALI
The study will use the grounded theory-GT (Strauss &
Corbin, 1990) approach, which has emerged as one of the
most popular and rigorous methods of deriving theories
from qualitative data.
29

30. OVERVIEW OF RESEARCH DESIGN AND METHODS
Research
Phase Objectives Tools Sample Groups
Questions
1 RQ-1 - RQ-9 Assess knowledge in three Structured Survey Instrument All counselors working
Quantitative domains, relationship with with Targeted
knowledge, cultural Intervention projects in
Gujarat (approx. 87)
sensitivity and counseling
practice. Assess gender
differences in knowledge ,
cultural sensitivity and
counseling practice.
Obj.-1 Overview
2 RQ-10 - RQ 16 Application of knowledge, Telephone In-depth Interviews 30 counselors working
Qualitative skills and techniques in with Targeted
practice, challenges, Intervention projects in
Gujarat.
indigenous practices.
[Objectives-1, 2, 4,5,6 ]
3 RQ-16 Counselors’ perspectives Focus Group Interviews 22 counselors
Qualitative on current HIV counseling through Satellite (11 men counselors + 11
practice and context Communication Technology, women counselors)
BISAG, Department of
Information Communication
and Technology, Govt. of
[Objective-3] Gujarat, Gandhinagar.
4 RQ-14 - RQ 15 Counselor client- Naturalist observation of 5 counselors (one
Qualitative interaction, clients’ counselling sessions counselor from each TI
response to counseling project typology i.e.
MSM, FSW, IDU,

31. UNIVERSE
Counselors working with Targeted Interventions in the Gujarat state
DATA COLLECTION TOOLS
In this study, survey instrument, in-depth interview, Focus Group Interview and
naturalistic observation will be used to gather data.
STUDY SITE
Gujarat
SAMPLE SIZE
All counsellors (87) working with NGOs implementing Targeted Intervention
projects willing to participate in the study will be selected for the survey.
Sample size determination for the in-depth interview will be dependent on
saturation of themes. Approximately 30 participants will be selected for the in-
depth interview.
Up to 11 men and women counsellors will be requested to participate in satellite
based Focus Group Interview (FGI). Determination of no. of FGI will be based
on saturation of themes.
31

32. 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 Harvard University, Boston and
Centre for Disease Control
(CDC), Atlanta.
 Prior approval from Gujarat State AIDS Control Society,
Department of Health and Family Welfare, Government32

33. PLAN OF ANALYSIS
ANALYSIS OBJECTIVES
Quantitative analysis using SPSS Find correlation between knowledge, cultural sensitivity, and
Correlation test; counseling skills
T test Gender difference in knowledge and counselling skills and
techniques
Qualitative analysis using Maxqda® Explore emerging themes around following concepts and
or ATLAS- Ti 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.
33

34. ANALYTICAL ISSUES AND THEIR RESOLUTION
 No tested and validated scale to measure counselors’ knowledge and counseling
practice in Indian context for HIV counselling investigator intends to
develop survey instrument.
 Self-reported and explanatory survey responses incomplete information will
be sought from the participant.
 Non-generalizability of the results focuses on personal experiences and
existing counseling, not generalizations.
 Mixed method study with prime focus on qualitative approach thus reliability and
validity of the study will be challenging
 Multiple methods: methodological triangulation and theory triangulation, Denzin,
1984 will be used.
 Thick description (Denzin & Lincoln, 1994)
 External audit (Emerson & Pollner, 2002; Miles & Huberman, 1994, pp.275-77) by
experts from India and USA will be done.
 Member checks (Emerson & Pollner, 2002; Miles & Huberman, 1994, pp.275-77).
34

35. 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.
35

36. 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.
 Emerson, R. M. & Pollner, M. (1988). On the use of member’s responses to research account.
Human Organization, 47, 189-198
 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.
 Miles, M.B. & Huberman, A.M. (1994). Qualitative data analysis (2nd ed.). 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.
36

37. THANK YOU VERY MUCH!!
37