 |
|
|
COMPLETED PROJECT
A.Understanding sexuality in context of HIV/AIDS among college youth of Pune, India (Prevention)
PI: Dr. N. Mawar
This study was conducted by the team of 2, one was facilitator and the other one was note taker. a tool guideline was followed to generate data from the FGD
It is imperative that for success of HIV/AIDS prevention programs a baseline data on sexuality issues from the emic perspective among youth be available for initiating interventions. The study aimed to understand the perception of risk in context of HIV/AIDS among college youth.. The study covered boys and girls from six co-educational colleges of Pune University in rural,semi-rural and urban areas . Qualitative (FGDs:69, Indepth interviews:152) and quantitative (survey using self administered semi-structured questionnaire:1826)methods were employed. Anonymity was assured and maintained.
Results:
Most boys and girls were aware of AIDS/HIV,modes of transmission, prevention through condoms- an information obtained from TV, magazines, AIDS awareness program in colleges Details on condom usage was lacking , especially in girls. Misconceptions persist in boys & girls eg Having sex with multiple partners within a small group is considered as "safe". Safe sex is perceived as using family planning methods (FPMs) or following "safe period". Concern for both boys & girls is to prevent pregnancy rather than HIV/AIDS. Safe sex in context of HIV/AIDS was better understood by urban students due to their access to more information. Masturbation was not perceived as safe sex by many boys. During adolescence, boys try new experiences without considering the repercussions eg smoking, alcohol consumption, reading pornographic literature etc under peer pressure, while social pressures inhibit girls to do so. Pre-marital sex is reported more often by boys than girls. Boys reported visiting CSWs where condom is not always used. Knowledge of STDs is limited to only a few. Both girls and boys expressed a need for more reliable information on sexual issues, reproductive health matters in their own colleges.
Conclusions:
Merely increasing AIDS knowledge is not enough. It needs to be integrated with reproductive health, sexuality, etc. This needs to be done through training programs for youth enabling responsible decisions making for themselves and their partners.
B. Preventing mother to child transmission (Prevention)
PI: Dr. N. Mawar
This study was conducted by the team of 2, one was facilitator and the other one was note taker. a tool guideline was followed to generate data from the FGD
This study was carried out at the behest of NACO to observe the women participating in their feasibility study on AZT intervention. The study describes the experiences and concerns of women participating in a short-term AZT intervention feasibility study to prevent mother-to-child HIV transmission at three sites in India. The study used qualitative methods to examine the experiences of 31 women during late pregnancy, delivery and at post-natal visits. It also elicited the perspectives of 19 healthcare providers. Frequent visits required during late-pregnancy and the post-natal period presented concerns for the women in the study. Women’s understanding of the long-term implications of participating in the intervention study was poor, and living with uncertainty about the HIV status of the newborn was a major concern. The provision of psychosocial support is essential in future intervention studies and should be incorporated on an ongoing basis. Networking with women-centred support groups may be helpful in enabling women to gain the long-term benefits of this type of intervention.
A. National Counselling Training Program: (Care and support :capacity building)
PI: Dr. N. Mawar
NARI was identified by NACO as a Regional Centre for national counseling training program for states of Jammu and Kashmir, Uttar Pradesh and Rajasthan during NACP I. As part of the program a two week Masters level Training was conducted at NARI for training the trainers. Subsequently, one week Training of Trainers program was conducted in the three selected states at Srinagar, Lucknow and Jaipur to cover GOs and NGOs in each state so that they can conduct further training in their regions. A total of 80 participants in three starts were covered. Grass root level training were planned through the these TOTs in their state. NARI helped the TOTs to conduct four grass-root level training in Benaras, Kanpur and two in Lucknow covering more than 100 participants. This is an ongoing activity of NARI
B. Stigma and discrimination in health care setting : Care and support
PI: Dr N Mawar (India) with PI Dr Peter Salovey (USA)
A significant aspect of HIV epidemic is the social impact often referred as the third epidemic that affects social ly, culturally and psychologically through stigma and discrimination. Preventive efforts need to be directed towards reduction in stigma at varied levels including health care settings. A collaborative study with Yale University was conducted in three government health settings to understand the perspectives and concerns of Health Care Providers in providing care and treatment to HIV/AIDS patients vis a vis the concerns of the HIV/AIDS Infected People and quantify the implicit and explicit biases of Health Care Providers towards HIV/AIDS.
The study used qualitative methods like focus group discussions, indeth interviews with doctors, nurses, ward boys and indoor and outdoor patients. It also used quantitative methods like explicit questionnaire and an Implicit Association Test to measure stigma. The IAT test for HIV/AIDS was developed especially for this study .Both these tools are self administered and was given to doctors and nurses. Findings from both approaches are presented.
Stigma Related Issues:
- Perception of Risk: The health care staff perceive high amount of risk in providing treatment and care to HIV/AIDS patients and expressed fear of infection through body fluids and blood.
- The hospital practices like isolation of the HIV patient (separate place, “separate operation theatre and labour room-“septic ward”, specific fumigation followed with HIV patients, labeling as biohazard/ICS/positive with a mark, wrapping of dead body in plastic sheath, maintaining distance).
- Denial of services like Dialysis, Ventilation in one of the hospitals
- Blaming attitudes of the health care providers
- Discriminatory actions: The actions of health care staff are seen as discriminatory by HIV patients (making faces, inserting needle with force, anger, hatred, etc).
- Limited resources: Inadequacy of staff, duty to provide services, perception of risk are some of the factors which make the health care staff to encourage a family care provider to be with the HIV patient for all the time, who provides all the nursing & other care to the patient.
- The counselor has a supportive role however there are situations where she/he has to work as per the instructions of the doctors.
- These examples indicate the existence of the forms of stigma in health care setting.
Explicit Attitudes of HCPs:
Doctors and Nurses explicitly showed negative feelings for patients of AIDS as compared to leukemia, cholera, positive feelings for AIDS as compared to syphilis.
Other Explicit Attitudes:
As compared to the doctors, Nurses significantly (p=0.010), hold AIDS patients responsible for getting HIV infection, people deserve AIDS, who got it through sex and drugs; AIDS patients should not be refused medical treatment, health services should be similar as other patients and not to force to ware identity cards.
Implicit Attitudes of HCPs:
Doctors and Nurses implicitly associated AIDS as bad compared to Leukemia and AIDS as good compared to cholera. As compared to the doctors, nurses (p=0.046) significantly associate AIDS as bad than syphilis.
Implicit and explicit Attitudes of HCPs:
Stigma exists both at implicit and explicit level as HIV/AIDS is Fatal and Sexually transmitted. Structural constraints like:limited resources, lack of adequate policies related to Universal safety precautions, Post-exposure prophylaxis, lack of adequate training related to HIV/AIDS, blaming attitudes of HCPs are the major contributory factors. These issues could be addressed through information, knowledge, education viz. Comprehensive training on HIV/AIDS facts, patient care issues like confidentiality, disclosure, gender, Patient sensitivity, Universal Safety Precautions, PEP and enhanced resources to provide quality care.
3. Prevention Intervention/ and Operational Research:
A. Women and AIDS: understanding reproductive heath concerns of women in context of HIV Prevention Intervention/ and Operational research
PI: Dr. N. Mawar
Project Aim and Objectives :
To carry out pilot study to understand the women’s reproductive health concerns in context of STDs/HIV/AIDS and the potentials for change.
Specific Objectives:
To carry out pilot study to understand the women’s reproductive health concerns in context of STDs/HIV/AIDS and the potentials for change.
- To study the reproductive health concerns in three groups of women the adolescent girls from slums, their mothers and the working women in the hostel.
- To enable women’s empowerment through need based HIV/AIDS interventions.
- Denial of services like Dialysis, Ventilation in one of the hospitals
- Demonstrate behaviour change in adolescent girls, their mothers from slums and workingwomen in hostels through prevention intervention program.
The study was carried out in collaboration with University Women’s Association (UWA) which is a NGO working in the city involved in educating school drop-outs from slums and giving opportunity to continue higher school education and income generating activities. The study was carried out in three phases: Phase I:Base line study Phase II the intervention and phase III the post intervention study.
B. Varied tools both qualitative and quantitative tools were used for different phases.
Phase I:
This included a census to identify households through the UWA list in the five slum clusters with the adolescent girls and their mothers and identified young girls (208) their mother (140). Seventy households belonged to girls attending UWA program and the rest girls were the control
A need based analysis used In depth interviews and focused group discussions were conducted among adolescents, their mothers and the working women covering two of each in-depth interviews two Focused Group Discussions one with working women , another with the mothers. This helped to develop a self administered 54 item questionnaire on knowledge, attitude and practices focusing on women issues of status, equality, rights, reproductive health, sexual health, and sexuality, HIV/AIDS, STDs and TB etc. In case of illiterates respondents the research team member conducted a face-to-face Interview (FTFI). This was administered before and after the intervention as Pre Intervention (133 girls,69 mothers and 109 hostelites) and post intervention survey (117 girls,69 mothers and 103 hostel women.
Phase II:
Interventions This included health check-ups, training workshops for the NGO participants, the adolescents, potential peer-educators and mothers from the community and the working women in the hostels. The intervention focussed reproductive health, sex and sexuality, women’s rights and women’s issues, HIV/AIDS and its Scenario, Impact of HIV on Women, RTIs/STDs ,health and family planning. The interventions were made participatory through exercises, group work, interactive discussions etc. The process indicators like participation, regularity were used for monitoring the operations of interventions.
Phase III Post Intervention Phase:
The gap between pre and post intervention was about 10-12 weeks. During the post intervention phase KAP Questionnaires were administered and collected from the adolescent girls and their mothers and also from the hostel women.
LESSONS LEARNT:
As a pilot study has enabled in operational issues in HIV prevention: Major behaviour changes cannot be envisaged in a short period, however could demonstrate, changes in knowledge of HIV, RH including safe-sex in the three groups of women. Community workshops are useful, but boys and men also need to be involved
Collaboration : An equal partnership of GOs and NGOs benefits both for networking and outreach in the community. The involvement of the community, the internal stakeholders is important and would go a long way for mobilizing community efforts for change through HIV prevention interventions.
The study based on women, need to involve the men.
The following are study related findings.
- Women need accurate knowledge of reproductive and sexual health as the knowledge varies in all the three groups of women.
- The study has demonstrated that interventions using participatory approach for women help in increasing their knowledge that is seen among the three groups of women.
- To bring long term changes in the attitudes that will influence behavior and on going training is essential for women through community support and peers.
RECOMMENDATIONS:
- Preventive interventions need to be addressed to both mothers and their adolescent daughters as they expressed problems in communication due to their existing myths and misconceptions.
- Integrated programs aimed at behaviour change regarding reproductive health, need to be provided at the community level targeting the young to prepare for a safer future motherhood
- Women and men need to be given correct information on Reproductive and Sexual Health, Sexuality within the context of HIV/AIDS at an early age.
- Training workshops using participatory approach would enable women’s empowerment and men need to be involved.
4. Adolescent Reproductive and Sexual Health Education [ARSHE]
Sponsors: ICMR, INDIA
Study Period: March 2003 – August 2006
Study Title: Adolescent Reproductive and Sexual Health Education An Intervention Study
An ICMR Task force study Site Principal Investigator (Pune, Maharashtra): Dr. Seema Sahay, NARI
Site Co-Investigators: Dr. S. M. Mehendale, NARI; Ms. Suvarna Sane, NARI
Report:
Experiences of adolescence vary by age, sex, class, region and cultural context. With the increasing emergence of HIV/AIDS epidemic and the early sexually active adolescence are leading health concerns in India. In the social and cultural context, India disregards pre and extra marital sexual relationships, which leave the impression that premarital sexual relationship, are unlikely among adolescents. As a group, adolescents have sexual and reproductive health needs that differ from those of adults in important ways. ICMR task force conducted a multicentric study in six states of India to set a benchmark for intervention and develop adolescent reproductive health and sexual health modules for school going adolescents in rural and urban India. NARI conducted this study in six rural and urban schools/ junior college in Pune, Maharashtra.
The study was conducted among the 9th and 11th standard students in rural and urban schools. Six schools/ junior colleges participated in this study. The intervention package for adolescents consists of following modules:
1. Life Skills 2. Growing up concerns 3. Body Image 4. Reproductive and Sexual health Education 5. Interpersonal and gender relationships 6. RTI/STI & HIV/AIDS
A total of 910 students participated at baseline and 634 participated in impact evaluation. In addition, 564 parents/ teachers/ guardians were participated in study. We received total 1080 frequently asked questions (FAQ’s) from students the questions were then categorized in to themes. There was significant increase in the knowledge level of the adolescents after one year. Girls reported significant changes in their worries regarding body changes after intervention. There was change in attitude towards body changes after the education intervention. The number of students reporting positive reactions like ‘sensed maturity and ‘thought it natural’ increased at the end line while most of the negative emotions reduced. It was heartening to observe low level of misconceptions regarding HIV prevention, however, correct knowledge has not even reached 50%. Girls and boys showed lesser knowledge about technologies available especially contraceptive options. Students indicated curiosity about reproductive and sexual health by asking maximum number of questions on this issue. Students from Co-Ed schools asked more questions probably due to enabling environment for good communication. A significant change in the seeking information on HIV/AIDS was observed after the intervention (P< 0.01). Students showed some decrease in reading about body changes although the results were not significant.
ARSHE Module for schools in India:
Under this task force study, ARSHE guideline and modules targeted towards young school going adolescents in India have been developed. This module was tested by Pandit G. B. Pant Institute of Studies in Rural Development, Lucknow,( Uttar Pradesh); Department of Psychology, Calcutta University, Kolkata, (West Bengal); Child Development Centre, Medical College Campus, Trivandrum,( Kerela); Indian Institute of Health Management & Research, Jaipur,( Rajasthan); and National AIDS Research Institute, Pune, (Maharashtra). The education intervention was designed and developed with the help of investigators from all six sites to give it a cultural context.
It is a ready reckoner for the instructor who would utilize it to impart reproductive and sexual health education to the school going adolescents. The slides are readymade and a brief introduction to the slides has been given. This way it becomes a simple and handy module for the instructors. The guidelines have frequently asked questions as appendices. Modules are to be finalized by ICMR. The module and the guidelines have been planned to be posted at ICMR website.
Site specific data is being analyzed and manuscripts are being developed.
5 .Psychosocial stressors study [Completed]
Sponsors:
National AIDS Control Organization [NACO], India
Study Title:
Psychosocial stressors Among HIV infected individuals with reference to partner support issues
Principal Investigator:
Dr. Seema Sahay, NARI
Co-Investigators:
Dr. S. M. Mehendale, NARI; Dr. A. R. Risbud, NARI
Consultant:
Dr. V. Paralikar, Psychiatrist, Pune
Brief description:
This is a care and support study involving HIV infected individual. The study was initiated in the year 2005. The study is divided into two parts:
1) Mental health needs assessment of HIV infected individual:
The goal is to develop mental health needs assessment tool through classical study design in a series of steps of formative research, survey and item reduction using principal component analysis. This part of the study is cross-sectional study involving 680 PLHAs. This tool is expected to be utilized by health care providers in any HIV care setting to arrive at mental health needs of a patient at individual level and provide focused intervention. At the population level, the tool can be used to provide mental health needs of PLHAs in India and inform the program.
2) Impact of involvement of significant other to provide informal help to HIV infected individual:
This part involves administration of structured intervention modules that aims to train the significant other to provide help to the HIV infected individual. This is an experimental study involving 180 participants randomized into experimental and control arm receiving novel intervention involving significant other and standard HIV counseling respectively. The study is expected to provide intervention for home based care and reduce burden on health services by empowering significant other to provide informal help to the PLHA.
The study is expected to be completed by the March 2009.
A Joint collaborative study between NARI and Maharashtra State AIDS Control Society (MSACS), Mumbai
PI: Dr. Seema Sahay, NARI
Sponsors: NARI [Intramural]
Brief description:
In consultations with Maharashtra State AIDS Control Society (MSACS), Mumbai
In India, thirty three percent of the total (National AIDS Control Program – III (NACP-III) budget has been allocated to the ART services. National AIDS Control Organisatinon (NACO) is focusing on iincreased access to ART, including resistance monitoring and pediatric. It has established 350 community care centers and 127 Anti-Retroviral Treatment (ART) centers. Currently, 85,000 patients are receiving free ART in public sector and estimated 35,000 in private sector. In the year 2006, National Pediatric ART Initiative was launched to enhance coverage of children living with HIV/AIDS. Pediatric drugs are provided at 86 ART centers where 6000 children are currently receiving free ART. NACO targets at 300,000 adults & 40,000 children on ART by the year 2012.
The study proposes to explore the emic perspective and attitude of ART recipients towards adherence and compliance and develop a model for ART delivery for different populations of PLHAs in three different settings in high prevalence state of Maharashtra in India
This is a qualitative study being conducted at Vidharbha, Marathwad and rural regions of Maharashtra.
7. ABOUT TO BE INITIATED STUDIES
1. Short Title: Qualitative Adherence study (NARI-MSACS Study)
Sponsors: NARI (Intramural study)
Study Title: To explore the correlates of ART adherence and compliance strategies among the stakeholders at three different categories of cities / town in high prevalence state of Maharashtra.
Principal Investigator:Dr. Seema Sahay, NARI
Consultant: Mrs. Neelam Joglekar, NARI
Brief description:
This is a qualitative study to understand correlates of non adherence to ART . In consultations with the Maharashtra State AIDS Control Society (MSACS) at Mumbai, India, this study is has been planned to be conducted at ART centres of Yewatmaal, Nagpur and Ambejogai in Maharashtra.
PhD Scholar: Dipak Wani
A. Community Participation in AIDS Healthcare Delivery Study of Conflicts and Cooperation with Regard to AIDS Healthcare Delivery in Pune Division of Maharashtra.
Brief description:
Based on the government of India Health policy, GOI AIDS Policy and literature review addresses need for community participation. For achieving this, harmonious relationship between different elements of healthcare delivery care system is necessary. This study proposes to understand the present healthcare system regarding HIV/AIDS. It aims at understanding relationship between different elements of healthcare system & assessment of community participation in healthcare programmes.
National AIDS Research Institute, Pune All rights reserved.