Research Proposal

Rachel Kelley
Research Proposal
Blog #3
October 7, 2009

In discussions of HIV prevention and treatment, cultural practices are often considered “barriers” or “obstacles” to effective health interventions. While it is true that some cultural traditions - initiation ceremonies and the practice of widow inheritance in the Luo culture of Kenya, for example – are undeniable contributors to the spread of disease, the complexity of cultures and social relations suggests that they need not be considered solely a stumbling block. In order to be successful, HIV prevention and treatment programs must not only reach the population, but the people must be able to process the information in the framework of their daily lives. Clearly there are many models of successful HIV/AIDS programs throughout the world. I am curious to know how (or if) such programs are able to address cultural barriers to intervention. Are they able to turn “obstacles” into opportunities?

I will attempt to answer this question by doing case studies of organizations/initiatives that are partnered with or funded by UNAIDS or The Global Fund. Obviously, this includes more organizations than it would be possible to analyze in the short time and reporting space available, so I will select one country from each region (determined by the Global Fund) that has a significant population ascribing to a health-related beliefs distinct from “modern” medicine. After selecting five to six countries to further investigate, I will begin research on their HIV/AIDS prevention and treatment programs by collecting data from the online grant portfolio of The Global Fund. To supplement this information, I plan to research NGOs from the selected countries involved with UNAIDS. When available, I will research organizations/initiatives by visiting their respective websites. In order to evaluate these organizations and initiatives, I plan to use three criteria: efficacy (has the organization increased access to treatment or decreased rates of transmission?), community integration/engagement (who is involved?), and sustainability (will the community sustain behavioral change if the program were to end?). To aid evaluation of the selected programs, I plan to do background research on behavioral change and stigma, as well as the actual cultural practices currently hindering HIV/AIDS interventions in the selected countries.

I realize that this proposal may be a bit too much for a 5 page paper. If that is the case, I will focus on a single country. Bolivia interests me because I spent time there this summer and because the WHO prevalence map indicates that all of its neighbors (save Chile) have a higher prevalence that it does, with two of its neighbors, Peru and Paraguay moving up a level in prevalence since the last report. I would be curious to investigate the effectiveness of the prevention measures Bolivia has in place (if any), since it seems that the epidemic is spreading in the area. With a population that is between 60% and 70% indigenous, traditional beliefs about health and medicine are still very much a part of the culture, so my research question (How can HIV/AIDS interventions make cultural practices an opportunity rather than an obstacle?) would apply.