Conclusion

The findings of the study should be interpreted in the context of the study limitations. First, the study focused on Indian adolescents and their families living in a rural hamlet of Aghai. We did not interview urban families, and the community from which we sampled families was relatively poor. India is a diverse country and our sample may not be representative of other geographical communities. Our study was qualitative in nature; consequently, no causal inferences can be made.

Although demand characteristics (such as taboos against open discussions of sex, HIV/AIDS-related stigma, gender norms for females, and the psychology of group processes) could have influenced participant responses, these potential biases were addressed in several ways.

First, we selected a homogenous sample from a small number of hamlets and separated the groups by gender and generation. Familiarity can impede openness, but it can also promote trust and self-disclosure, as well as enhance participants’ comfort in challenging one another. Second, informed consent was obtained from all participants, and the focus groups were conducted in ways to protect participant comfort and confidentiality. Third, focus group moderators were carefully selected and trained. All facilitators received extensive training on how to moderate focus groups, manage group dynamics, and facilitate discussions about sensitive topics like sexual behaviour and HIV/AIDS.

Because of the focus group setting, we did not ask in-depth questions about parent-adolescent communication about sex. As a result, we cannot make definitive statements about the nature of family communication. Future research should explore this topic in both individual in-depth interviews and in survey research with adolescents, mothers and fathers. Here, multiple perspectives will be especially important as they can be used to explore congruency in family reports of parent-adolescent communication about HIV/AIDS and to identify behavioural targets at both the parent and adolescent levels.

Despite these limitations, a strength of this research was the integration of perspectives from adolescent females, adolescent males, mothers and fathers. HIV/AIDS is a disease that affects all members of the family, and research focused on helping Indian adolescents avoid HIV needs to reflect the perspectives of all members of the family system.

In addition, the scope and impact of HIV/AIDS in India necessitates international collaborations that can address the diversity of the epidemic. This study was a collaboration between social scientists in India that was funded by the Indo-US bilateral agreement. It is the first of several formative studies focused on developing an empirical body of literature on how to develop efficacious family-based HIV-prevention programmes for rural Indian youth, and the findings have important implications for researchers interested in developing family-based HIV prevention interventions for Indian adolescents.

Competing interests
The authors declare that they have no competing interests.

Authors’ contributions
Drs Soletti and Guilamo-Ramos, as principal investigators, had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The study was designed by Drs Guilamo-Ramos, Soletti, Burnette and Bouris. Drs Soletti, Guilamo-Ramos and Burnette and Ms Sharma were responsible for acquiring the data. All authors are responsible for data analysis, interpretation of data, writing of the manuscript, and for the decision to submit the manuscript for publication.

References

• Joint United Nations Programme on HIV/AIDS (UNAIDS):
  Report on the global AIDS epidemic 2008. Geneva. 2008.
• National AIDS Control Organisation (NACO): HIV sentinel surveillance and HIV estimation, 2007.
• National AIDS Control Organisation (NACO): HIV/AIDS epidemiological Surveillance and Estimation report for the year 2005.
• Kronstadt KA: CRS report for Congress: U.S.-India bilateral agreements in 2005.
• United States Department of Health and Human Services and Republic ..... full References ... »

Asha Banu Soletti, Vincent Guilamo-Ramos, Denise Burnette, Shilpi Sharma and Alida Bouris

1 School of Social Work, Tata Institute of Social Sciences, Mumbai, India
2 Columbia University School of Social Work, New York, NY, USA
3 School of Social Service Administration, University of Chicago, USA

Journal of the International AIDS Society 2009, 12:35doi:10.1186/1758-2652-12-35