2nd Draft of Project Proposal

Robyn Richardson
March 25, 2011

Women and HIV Perception in Coimbatore, India
A Field Study Proposal

Statement of Intent

Public health in India is a major concern, especially among women.  Furthermore, India has the third highest HIV infection rate in the entire world (WHO) and in order to decrease that number it is important to have an effective prevention program that is taught to the women in order to teach them about the dangers of HIV and how it can be prevented. I believe that the prevention methods being taught are not effective due to the high rate of infected individuals; however I believe that this ineffectiveness is due to the cultural viewing of HIV. There are issues that come with prevention methods. For example, due to the culture of India and the high number of sex workers, women who are following the prevention plans are being infected with HIV from their husbands who are disloyal.  I intend to work through an organization called Shanti Ashram and interview women who are being taught HIV prevention to see what their beliefs are on HIV, how it is spread.
 In addition, I plan on researching what methods Shanti Ashram is using in order to teach these women about HIV prevention in a culturally sensitive manner. On a personal aspect, I plan on learning from a culture that is entirely different from mine. Being able to learn about the different ways of life and what is important to the people in southern India will help me gain a greater knowledge of the world, and how I can better my life and the environment in which I am living.  In addition, the challenges and successes that are associated with cross-cultural prevention programs will assist me in learning what aspects are included in a productive program. Regardless of where a prevention program is being issued, cultural barriers are always crossed.  In public health it is expected to be able to teach the masses how to change their lifestyle habits while being culturally sensitive. This generally is the biggest problem when trying to help someone change their behavior; therefore, gaining experience in this area will be beneficial to my future career.  
I hope to gain a new understanding of a non-western way of life. I have traveled primarily traveled throughout Latin American countries and Europe. However, I have never been to this part of the world and I am interested to learn from their way of life and culture. Each culture has a positive aspect to their lives that can be taken and adapted to enrich the life of the foreigner. I am hoping to learn from the Indian culture to help me open my eyes a little bit more to a different way of life.
The Human Immunodeficiency Virus (HIV) is a virus that attacks and destroys the human immune system. The only medication that is available is antiretroviral therapy, which is a series of expensive medications that must be taken for the rest of the infected person’s life.  As a result, the most effective method for improving HIV is preventing it. Thus, prevention method programs are vital to the success of improving lives throughout the world. HIV is one of the most devastating diseases today, it affects millions of lives. In India it is estimated that that 5.2 million people are infected with HIV or one in eight of worldwide cases (Chandrasekaran, 2006, p. 508). In southern India there are high levels of HIV infection rate, in fact the first case of HIV was in southern India in the region of Tamil Nadu (Chandrasekaran, 2006, p. 509). In addition, women are now responsible for over half of all HIV infections worldwide and are therefore becoming the focal point for prevention programs (Chatterjee, 2006, p. 81).
As previously stated, the complication with HIV prevention is that research is showing that those that are at-risk are women that are in a monogamous relationship. In a recent study done in southern India, of the women that were infected with HIV, 81% were housewives (Chatterjee, 2006, p. 81). According to this study, married women have a risk perception that is low (they do not feel that they are at high-risk); however, in reality their risk is linked to the behavior of their husbands, which may increase their actual risk. In India, many religious beliefs, customs, and traditions have put women in exploitable positions. Due to low rates of education and economic independence women are generally dependent on the men in their lives (Sharma, 2005, p. 375). This dependence crosses over into what they do with their bodies in addition to their sexual practices. It has been suggested that married women have little ability to discuss using protection with their partners because of the patriarchal society in which they live (Gangakhedkar, 1997, p. 2091). This causes problems when trying to teach prevention methods to women because they are not in charge of their sexual practices. Indian women are doing everything in their power to have a safe lifestyle; however, they still become infected through their husbands who are not in a faithful relationship. So the question remains of how to help women understand the dangers of HIV transmission and how to protect themselves. Although prevention programs are important, they also must be adapted to the culture of those who are in need of the prevention. HIV is a common problem throughout the world and although the methods of prevention are generally the same, the methods of teaching those prevention techniques vary with each region.
In Coimbatore there is an organization known as Shanti Ashram that focuses on HIV prevention in the city as well as the areas surrounding. This organization is based off the understanding that religion plays an important role in the lives of the individual; as a result, part of the HIV prevention program involves working with local religious leaders to increase the awareness of HIV transmission. In addition to working with this organization I plan on finding other organizations and clinics to observe so that I will be able to view the different ways of teaching HIV prevention.
A common difficulty when addressing HIV is the stigma that is attached to this disease that makes it difficult to discuss. Most people do not think that it is appropriate to talk about HIV infection and believe false infection ideas. It is apparent that developing an effective prevention program is difficult under such circumstances and as a result I am interested in researching what prevention methods are being taught and how effective they are.

Location-Specific Information
BYU Field Study has a long history with sending students to Coimbatore, India. In addition, many students have volunteered at Shanti Ashram, the organization that I plan on volunteering at. Since India has such a high prevalence of HIV, and Shanti Ashram specifically works with women who have HIV, this is the perfect opportunity for me to student this subject matter in India.
The participants will be chosen by their association with local prevention organizations and will be participants in the programs provided by the organizations. Interviews will be conducted with a translator and notes will be taken by hand. Interviews will be organized and discussed in my final research paper. Topics discussed in the interview will include the woman’s history: what type of education she has had, is she married or single, what are her daily activities. This will help me get a better understanding of the background of the subject and her lifestyle (e.g. if she has had the opportunity to have a formal education or not). Any participant will be able to withdraw at any time during the interview if they feel uneasy or feel the need to stop.
After an idea of the lifestyle of the subject has been gained questions will then be asked about the subject’s basic knowledge of health. What health is, how to stay healthy, if they view health as an important subject, etc. etc. Then the subject will be asked questions regarding HIV: what is HIV, how is it contracted, how does the subject view HIV. Questions will also be asked regarding HIV transmission between mother and child: how is HIV transmitted, can it be prevented, etc. Finally, questions will also be asked regarding how the subject got her information and how long ago this information was obtained.
In addition, I will observe the program provided by the organizations and view the prevention methods they teach, how they teach it, and their reasoning behind choosing this prevention program. This will be done throughout the research process in India.
Ethics and Approval
Since I will be working with sensitive information of the informants, I will explain the importance of confidentiality to my translator and have them sign a document saying that they will keep the information that is learned about the informants confidential. In addition, I plan on keeping all written notes under lock and key and all electronic notes under a password-protected file. I plan on asking permission from the informants to interview them and explain that all their information will be kept private and not shared. While writing my final paper I plan on changing names in order to maintain the privacy of those I am working with.
Faculty Mentor and Coursework
My mentor, Dr. Eugene Cole is a full-time professor at Brigham Young University who received his MSPH and PhD at UNC with an emphasis in Global Health Promotion. He currently teaches infectious disease and refugee health in the Health Science Department. He has had research opportunities in South Africa and Southeast Asia working on health promotion.
My coursework will include Health 451, IAS 220, IAS 399R, and IAS 380R (see attached course contracts).