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Migrant workers are understood to be vulnerable to HIV. However, little is known about the experience of migration-based households following HIV infection. This qualitative study examined the migration-HIV relationship beyond the point of infection, looking at how it affects livelihood choices, household relationships and the economic viability of migrant families. We conducted semi-structured interviews with 33 HIV-positive migrant men and women recruited from an anti-retroviral therapy (ART) centre in north India. Following infection among the migrant men, contact with free, public-sector HIV services was often made late, after the development of debilitating symptoms, abandonment of migrant work and return to native villages. After enrolment at the ART centre participants' health eventually stabilised but they now faced serious economic debt, an inflexible treatment regimen and reduced physical strength. Insecure migrant job markets, monthly drug collection and discriminatory employment policies impeded future migration plans. HIV-positive wives of migrants occupied an insecure position in the rural marital household that depended on their husbands' health and presence of children. The migration-HIV relationship continued to shape the life course of migrant families beyond the point of infection, often exposing them again to the economic insecurity that migration had helped to overcome, threatening their long-term survival.

Migrant workers are designated a bridge population in the spread of HIV and therefore if infected, should be diagnosed and treated early. This study examined pathways to HIV diagnosis and access to care for rural-to-urban circular migrant workers and partners of migrants in northern India, identifying structural, social and individual level factors that shaped their journeys into care. We conducted a qualitative study using in-depth interviews with HIV-positive men (n = 20) and women (n = 13) with a history of circular migration, recruited from an antiretroviral therapy centre in one district of Uttar Pradesh, north India. Migrants and partners of migrants faced a complex series of obstacles to accessing HIV testing and care. Employment insecurity, lack of entitlement to sick pay or subsidised healthcare at destination and the household's economic reliance on their migration-based livelihood led many men to continue working until they became incapacitated by HIV-related morbidity. During periods of deteriorating health they often exhausted their savings on private treatments focused on symptom management, and sought HIV testing and treatment at a public hospital only following a medical or financial emergency. Wives of migrants had generally been diagnosed following their husbands' diagnosis or death, with access to testing and treatment mediated via family members. For some, a delay in disclosure of husband's HIV status led to delays in their own testing. Diagnosing and treating HIV infection early is important in slowing down the spread of the epidemic and targeting those at greatest risk should be a priority. However, despite targeted campaigns, circumstances associated with migration may prevent migrant workers and their partners from accessing testing and treatment until they become sick. The insecurity of migrant work, the dominance of private healthcare and gender differences in health-seeking behaviour delay early diagnosis and treatment initiation.

In HIV prevention and care programmes, disclosure of status by HIV-positive individuals is generally encouraged to contain the infection and provide adequate support to the person concerned. Lack of disclosure is generally framed as a barrier to preventive behaviours and accessing support. The assumption that disclosure is beneficial is also reflected in studies that aim to identify determinants of disclosure and recommend individual-level measures to promote disclosure. However, in contexts where HIV infection is stigmatised and there is fear of rejection and discrimination among those living with HIV, concealment of status becomes a way to try and regain as much as possible the life that was disrupted by the discovery of HIV infection. In this study of HIV-positive women and children in India, concealment was considered essential by individuals and families of those living with HIV to re-establish and maintain their normal lives in an environment where stigma and discrimination were prevalent. This paper describes why women and care givers of children felt the need to conceal HIV status, the various ways in which people tried to do so and the implications for treatment of people living with HIV. We found that while women were generally willing to disclose their status to their husband or partner, they were very keen to conceal their status from all others, including family members. Parents and carers with an HIV-positive child were not willing to disclose this status to the child or to others. Understanding the different rationales for concealment would help policy makers and programme managers to develop more appropriate care management strategies and train care providers to assist clients in accessing care and support without disrupting their lives.

Background: The emerging human immunodeficiency virus (HIV) epidemics in rural areas of India are hypothesized to be linked to circular migrants who are introducing HIV from destination areas were the prevalence of HIV infection is higher. We explore the heterogeneity in potential roles of circular migrants in driving an HIV epidemic in a rural area in north India and examine the characteristics of the "sustaining bridge population", which comprises individuals at risk of HIV acquisition at destination and of HIV transmission into networks at origin capable of sustaining an epidemic., Methods: Results of a behavioral survey of 639 male migrants from Azamgarh district, India, were analyzed using χ(2) tests and logistic regression., Results: We estimated the size of various subgroups defined by specific sexual behaviors across different locations and over time. Only 20% fit our definition of a sustaining bridge population, with the majority making no apparent contribution to geographical connectedness between high- and low-prevalence areas. However, we found evidence of sexual contacts at origin that could potentially sustain an epidemic once HIV is introduced. Variables associated with sustaining bridge population membership were self-perceived HIV risk, current migrant status, and age., Conclusions: Circular migrants represent a heterogeneous population in terms of their role as a bridge group. Self-perception of heightened risk could be exploited in designing prevention programs., (© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.)

Global policy on HIV prevention among marginalised populations recommends a community-based approach with participation and mobilisation as central features. The overall aim is to empower individuals and groups to reduce their vulnerability to HIV. Community empowerment initiatives have had mixed results, however, in spite of utilising very similar peer-education based intervention strategies. This is particularly true of community-based interventions in sex work settings. Drawing upon an ethnographic study conducted in the early years of a well-known sex worker initiative-the Sonagachi STD/HIV Intervention Project (SHIP) in Kolkata, India-this paper argues that ethnographic research can illuminate the complex and inter-dependent dynamics of context, practice, agency and power that are specific to a project and shape the course of intervention implementation in ways that may be 'hidden' in conventional techniques of project reporting. Two detailed excerpts of what we refer to as 'private contexts of practice' are presented-focusing upon the complex processes underlying community mobilisation and peer education. We show that the gathering of ethnographic forms of evidence in conjunction with more conventional evaluation measures has two distinct benefits. First, an ethnographic approach is able to capture the play of power through observation of real-time events that involve multiple actors with widely different perspectives, as compared with retrospective accounts from carefully selected project representatives (the usual practice in project evaluations). Second, observation of actual intervention practices can reveal insights that may be hard for project staff to articulate or difficult to pinpoint, and can highlight important points of divergence and convergence from intervention theory or planning documents.

This paper uses ethnographic data from a sex workers' HIV project in India to consider the appropriateness of individual, social/group and structural theories of health behaviour when applied to HIV-prevention initiatives. Existing theories are critiqued for their modernist representation of behaviour as determined by individual rational decision-making processes or by external structural forces, with inadequate recognition being given to the roles that human agency, subjective meaning and local context play in everyday actions. Analysis of sex workers' accounts of their sexual practices suggests that existing theories of health behaviour can only partially account for sexual behaviour change retrospectively and that they have limited predictive value with respect to the outcomes of individual sexual encounters. Our data show that these outcomes were, in fact, highly context dependent, while possibilities for action were ultimately strongly constrained by structural forces. Findings suggest that interventions need to adopt an integrated, structurally-oriented approach for promoting safer sexual practices in sex work settings. Recognising that no one model of health behaviour is likely to be adequate in explaining or predicting behaviour change encourages responsiveness to local people's agency, recognises the different (health- and non-health-related) registers of risk with which people operate and encourages flexibility according to local contingencies and contexts.

This paper provides a comparative analysis of modes of dialogue, non-verbal communication and embodied action relating to sex and health in two contrasting countries-India and South Africa-which have the world's two most heavily HIV-affected populations (in terms of numbers of people living with HIV). Drawing on material derived from multiple studies, including ethnographic and other forms of qualitative and multi-disciplinary research, the paper identifies commonalities as well as differences in communication relating to sex and sexual health in these diverse settings. The paper considers: first, how and by whom sex is and is not talked about, in public discourse and private conversation; second, how sexual intention and desire are communicated through indirect, non-verbal means in everyday life; and third, how references to sexuality and the sexual body re-enter within a more explicit set of indigenous discourses about health (rather than 'sexual health' per se), such as semen loss in India and womb 'dirtiness' in South Africa. The concluding section reflects on the implications of a comparative analysis such as this for current policy emphases on the importance of promoting verbal communication skills as part of 'life skills' for HIV prevention.

In this ethnographic article, we explore the character of local discourse about AIDS in an affected township community in South Africa, describing the “indirection” that characterized communication about suspected cases of AIDS. Through a case study of one affected family, the article first explores the diverse ways in which people came to “know” that specific cases of illness were AIDS related, and how this “knowledge” was communicated. We consider why communication was indirect and coded, arguing that this reflected not a “denial” of its presence in this community but, rather, a complex group of overlapping concerns far from unique to AIDS: first, a normative injunction on naming potentially fatal conditions; second, an interest in pursuing different therapeutic options and the need to maintain hope of recovery; and third, a wish to avoid the “disrespect” entailed in referring directly to the nature of the problem in a context where, discursively, stigma was still present. The coded and indirect character of HIV/AIDS-related talk underlines the importance of ethnographic inquiry in understanding community responses to this epidemic, demonstrating that the subtleties entailed by verbal silence and elision should not be interpreted naively as collective “denial” but rather be grounded within existing patterns of responses to dangerous sickness. [ABSTRACT FROM AUTHOR]