HIV Counseling Practices

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A review of HIV/AIDS Counseling Practices: Experiences and Perspectives of Counselors, by Apurvakumar Pandya.

Apurvakumar Pandya’s dissertation explores the process of HIV/AIDS counseling in the context of the Target Intervention (TI) project of the National AIDS Control Organization (NACO) in Gujarat, India. He looks at the project modalities and implementation from both a theoretical as well as practical perspective. The dissertation has six chapters; each chapter covers a different selection of important issues related to HIV counseling in an Indian context.

Chapter 1 presents an introduction to HIV, the TI project, and the use of counseling services as a preventive strategy meant to produce behavioral changes in clients. The author conducts a rigorous literature review and presents critical reflections on existing research on HIV counseling in India. The issue of sexual orientation and its discussion is very relevant in the Indian context, and Pandya connects the issue of counseling focused on the “Most at Risk Population” (MARP) to the sexual activities in which members of this population engage. He discusses the religious and spiritual notions which regulate the clients’ sexual behaviors, as well as Indian cultural aspects related to sexuality, marriage, and gender roles.

Chapter 2 focuses on methodology and the application of counseling theories in an Indian context. The study employs a constructivist grounded theory methodology. Pandya’s philosophical and theoretical stand on current research is both “integrative” and “interpretive.” He argues that western counseling theories need to be modified to meet the needs of people according to their cultural beliefs and perspectives. The constructivist grounded theory of HIV counseling practice that emerges from his study represents a culturally-grounded counseling practice. The author uses different research methods—both quantitative and qualitative—for data collection, resulting in a good attempt to gather and analyze subjective information provided by the respondents and to set the tone for grounded theory adaptation. He also takes into consideration the evolution and development of grounded theory. He reviews a number of grounded theory-based research projects, leaning in particular on the work of Charmaz, who has applied a constructivist approach to grounded theory since the mid-1990s (see Kathy Charmaz, Constructing Grounded Theory. 2nd ed. London: Sage, 2014).  Pandya uses a purposeful sampling strategy with maximum variation. To achieve maximum variation, participants for in-depth interviews were selected based on work experience, education, geographical location, type of counselor, and typology of targeted interventions.

In Chapter 3, Pandya presents the results of his data analysis and outlines the four key theoretical frameworks: the counselors’ professional experiences; HIV counseling practices; the HIV counseling process; and behavioral change processes of clients. The integration of these theoretical frameworks generated a constructivist grounded theory of HIV counseling in TI, which Pandya explains in a results section. The data gathered covers various subjects, such as significant characteristics of the research participants (counselors), including their socio-demographic profile as determined by gender, age, education, training, typology of TI, and their geographical region. Counselors’ routine activities clearly reflected participants’ priorities and allocation of time to counseling and non-counseling activities.

Pandya’s data presents a very clear and real picture of HIV counseling, making visible the pressure on counselors to provide services in very strict and inflexible mode under the TI project. The data reveals the routines followed by counselors on the job, from the maintenance of daily diaries, documentation, making field visits, and other similar activities, to the actual counseling of clients, the other important issue affecting time management in the counseling practice. The complexities of documentation and counseling presented a clear picture of the involvement of counselors in non-counseling activities. All these factors, in one way or another, contribute to the number of challenges in counseling services. Pandya articulates very well these challenges from the view point of participants, showcasing issues of work efficiency and the ultimate capacity of counselors through his discussion of their programmatic, professional, and personal challenges.

Chapter 4 provides a discussion of results by integrating research findings with the relevant literature. The chapter first presents an evaluation of constructivist grounded theory that has emerged from the research. Pandya uses two models for evaluating this body of theory, first with an evaluation based on Charmaz, and second with one based on Glaser (Kathy Charmaz, “Grounded Theory in the 21st Century: A Qualitative Method for Advancing Social Justice Research.” In N. Denzin & Y. Lincoln (Eds.), Handbook of Qualitative Research. 3rd ed. Thousand Oaks, CA: Sage, 2005; B. G. Glaser, Basics of Grounded Theory Analysis. Mill Valley, CA: The Sociology Press, 1992). After a discussion of grounded theory, Pandya applies it to his analysis of specific cultural features of HIV counseling in the TI context. His study reveals that HIV counseling represents a combination of client-centered and solution-focused orientations; these orientations encompass a variety of culturally-grounded practices that inform the counseling process and yield behavioral changes in clients. This discussion of the meeting of theory and practice is very important in terms of learning from ground practices. Pandya links key features of established theoretical models to behavioral change, to individual counselors’ experiences with established theories, and to counselors’ personal/professional perspectives on their work.

Chapter 5 concludes the discussion. Pandya provides information about the Indian culture and belief systems, and tries to place the counselors’ professional ethics and roles in HIV counseling within these systems. Doing this, he highlights the possible dilemmas of delivering the services in the Indian context. He explains that counselors’ experiences are constructed through various influences such as training, peers, the nature of the TI program, and the organization’s environment. Overall, the counseling process reveals values and practices reflective of Indian culture, while at the same time raising the issue of “good” versus “best” practices. He places emphasis on the creation of a framework that is not only sensitive to cultural sensibilities, but also ensures that the process does not violate ethical principles. The constructivist grounded theory of HIV counseling practice that emerges from the study represents such culturally-grounded counseling practices. In this context, Pandya suggests that, with experience, counselors may develop a culturally-informed theory and use methods or techniques which are culturally relevant in the counseling process.

Pandya’s research is significant in different ways. Practical suggestions provided by the results will be useful to counselors in general, and the presented theoretical models of counseling techniques and behavioral change processes could be used by counselors to enhance their counseling practices. Based on his research, Pandya has proposed a modification to the existing counseling training module developed by the Department of AIDS Control, Government of India. The research contrasts very real and fact-based counseling practices in an Indian context with the counseling programming in the TI context. The present study has brought out the thin line between best versus good practice. From Pandya’s work emerges the need for a balance between culturally sensitive practices and ethically appropriate practices, rather than the reliance on a mere amalgamation of skills that are essentially based on Western perspectives. The author insists there is a need for the generation of appropriate criteria for the assessment and evaluation of counseling skills and processes. He also emphasizes the necessity of sharing successful case studies between Indian states in order to improve the services in each region and to motivate the service providers engaged in counseling of HIV/AIDS in the TI project. He also (perhaps bravely) questions the expertise of counselors and their qualifications just by dealing with such a sensitive issue. He points out that in many areas, peer educators are engaged in counseling. The local people have faith in them, more than the any other service provider of the TI project.

Pandya also provides recommendations for future research. He points out that theoretical frameworks that have emerged from the study need to be empirically tested, and more work needs to be done on the efficacy of religious- or spirituality-based strategies in bringing about desired behavioral changes among clients. Also important is the development of a professional identity by counselors through the removal of barriers to counselor development. In this regard, the author emphasizes enhancing the resources owned by national agencies and providing the training and supervision needed to achieve the target of quality services. He makes several recommendations related to the updating of our knowledge regarding the program and HIV/AIDS, including developing culturally-specific strategies and counseling techniques, empanelling counselors as resource persons, providing supportive supervision and mentoring, creating a continuing education program, and developing a professional identity among clients. All of these are important and in the TI project implemented by NACO.

Shashi Rani
Department of Social Work
University of Delhi, India
shashi.socialwork@gmail.com

Primary Sources

Field interviews of 14 counselors working with targeted interventions from 6 districts (Vadodara, Surat, Kheda, Mehsana, Bhavnagar, and Rajkot).
Participant observation of counseling sessions conducted in five districts (Vadodara, Surat, Mehsana, Bhavnagar and Rajkot). A total of 23 counseling sessions (including 3-4 follow-up counseling sessions) by 5 counselors were observed.

Dissertation Information

Maharaja Sayajirao University of Baroda, Vadodara. 2014. 253pp. Primary Advisor: Shagufa Kapadia.

Image: Photograph by author.

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