Localocentricity, mental health and medical poverty in communication about sex work, HIV and AIDS among trans women engaged in sex work.

Trans women engaged in sex work live at the intersections of discrimination against sex workers, women and transgender people. Dominant public health approaches have constructed trans women in sex work as a group at high risk of HIV infection. This study employed localocentricity, situated within a cultured-centred approach, as a theoretical framework to document health narratives among 29 trans women who had knowledge of or experience in sex work. This theoretical framing draws attention to the articulations between health and illness expressed by trans women in sex work in USA. Research participants emphasised how their health was affected by extreme socio-political-cultural marginalisation as well as medical poverty and mental health issues.

A Qualitative Exploration of "Mother First" Identity and Antiretroviral Adherence among African American Women Living with HIV in the Mid-South Region of the United States.

The majority of African American women living with HIV are of child-bearing age and large numbers of these women express a desire to have children. Extant research suggests that motherhood provides HIV-positive women with a sense of hope and normalcy and, in some cases, is associated with positive HIV-related health behaviors. Guided by the tenets of the culture-centered approach (CCA), this qualitative study sought to understand the relationship between motherhood identity and ART adherence among a sample of 50 African American women living with HIV in the Mid-South region of the United States. Our theoretically-informed thematic analysis of in-depth interviews with all 50 women produced three primary themes: (1) experiencing HIV through the lens of motherhood, (2) the physical and social realities of the "mother first" orientation while living with HIV, and (3) the impact of the "mother first" orientation on ART adherence and self-care. These findings identify how participants' "mother first" identity orientation interacts with their sociocultural environment to enable and constrain their attempts at ART adherence. The findings also provide empirical evidence to support the CCA's theorizing regarding the ways in which the materiality of structures interact with symbolic cultural meanings to (re)produce health inequalities.

Reba and Her Insurgent Prose: Sex Work, HIV/AIDS, and Subaltern Narratives.

Narratives of cultural stakeholders in marginalized sex worker spaces often do not find the traction to influence mainstream health discourse. Furthermore, such narratives are framed against the grain of the dominant cultural narrative; they are resistive texts, and they depict enactments of resistance to the normal order. This article, based on 12 weeks of field study in a sex worker community in India, foregrounds how sex workers communicatively frame and enact resistance, and hence formulate insurgent texts, along a continuum-from overt violence to covert negotiation on issues such as condom and alcohol use. Making note of these insurgent texts is crucial to understanding how meanings of health are locally made in a sex worker community as it is often that members of such marginalized communities take recourse to covert and ritualistic forms of resistance to work, to survive, and to stay free of HIV infection.

Toward Eliminating Hospice Enrollment Disparities among African Americans: A Qualitative Study.

Over the past decade, scholars and practitioners have called for efforts to reduce disparities in the cost and quality of end-of-life care; a key contributor to these disparities is the underuse of hospice care by African American patients. While previous studies have often relied on interviewing minority individuals who may or may not have been terminally ill, among them only few who were using hospice care services, this essay reports the findings of a grounded theory analysis of interviews with 26 African American hospice patients (n = 10) and lay caregivers (n = 16). Participants identified several barriers to hospice enrollment and reported how they were able to overcome these barriers by reframing/prioritizing cultural values and practices, creating alternative goals for hospice care, and relying on information obtained outside the formal health system. Finally, participants offered suggestions for eliminating barriers and providing salient information about hospice care to other African Americans.

Understanding Culture and Its Influence on HIV/AIDS-Related Communication Among Minority Men Who Have Sex With Men.

Scholarly research and government surveillance reports demonstrate that African American and Latino men who have sex with men (MSM) bear an inequitable burden of new HIV infections. Among the estimated 31,896 HIV infections attributed to male-to-male sexual contact in 2011, approximately 62% occurred in African American (38.2%) and Latino (23.5) MSM. Simultaneously, recent scholarship on minority MSM and HIV/AIDS reports a dearth of qualitative communication research that address this health issue. This manuscript reports a research study that seeks to fill this gap in health communication theory and praxis. Through in-depth interviews with 17 MSM of color, this article draws upon the culture-centered approach to demonstrate how cultural and contextual nuances, (in)access to structural resources, and participants' agentive capacity to act upon available knowledge/resources influences the ways they manage (the threat of) HIV/AIDS.

African Americans and Hospice Care: A Culture-Centered Exploration of Enrollment Disparities.

Over the past decade, scholars and practitioners have called for efforts to reduce disparities in the cost and quality of end-of-life care; a key contributor to these disparities is the underuse of hospice care by African American patients. While previous studies have often relied on interviewing minority individuals who may or may not have been terminally ill and of whom few were using hospice care services, this essay draws upon the culture-centered approach to report the findings of a grounded theory analysis of 39 interviews with 26 African American hospice patients (n = 10) and lay caregivers (n = 16). Participants identified several barriers to hospice enrollment and reported how they were able to overcome these barriers by reframing/prioritizing cultural values and practices, creating alternative goals for hospice care, and relying on information obtained outside the formal health system. These findings have implications for understanding hospice experiences, promoting hospice access, and improving end-of-life care.

HIV/AIDS and minority men who have sex with men: a meta-ethnographic synthesis of qualitative research.

The World Health Organization (2009) estimates that there are as many as 33 million people currently living with HIV/AIDS throughout the world. Studies also reveal that racial disparities significantly influence HIV/AIDS diagnoses within the U.S. men who have sex with men population (MSM). In recent years, the burden of HIV/AIDS has shifted from White MSM to younger men of color, particularly African Americans and Latinos. The disproportionate effect of the HIV/AIDS epidemic in African American and Latino MSM populations requires that scholars and practitioners work diligently to address cultural and structural factors that uniquely influence such populations. The goal of this article is to synthesize qualitative findings that address cultural and structural factors that influence HIV/AIDS risk in African American and Latino MSM populations using a qualitative meta-synthesis procedure. Ultimately, our analysis suggests that "structure-centered" approaches (Dutta & Basu, 2011) are needed to address this health disparity in meaningful ways.

'We are mothers first': localocentric articulation of sex worker identity as a key in HIV/AIDS communication.

The connection between identity and health communication has been amply documented in communication research. How an individual frames oneself with respect to and in conjunction with one's interpersonal relationships and material and communicative structures shapes one's identity. This in turn shapes how one enacts the self, given the relationships and available contexts one is embedded in, all of which have a significant influence on how one communicates about and negotiates health and illness. This study reports the results of an ethnographic field study conducted during two periods-June and August 2007 and July and August 2009, which examined, chiefly through interviews of 46 participants, how members of a community of sex workers in Kalighat, in the city of Kolkata in India, communicatively constructed their selves with respect to their prevalent cultural indices and available structures, and how enunciations and enactments of sex worker selves as "mothers first" influenced localized patterns of HIV/AIDS communication and related work practices. Sex worker narratives suggested that mainstream assumptions and identity labels that depict sex workers as incapable mothers and the concurrent HIV/AIDS practices sex workers are asked to adopt need to be questioned and transformed to effect positive changes in health and HIV/AIDS negotiation practices among members of this marginalized community.

The message development tool: a case for effective operationalization of messaging in social marketing practice.

That messages are essential, if not the most critical component of any communicative process, seems like an obvious claim. More so when the communication is about health--one of the most vital and elemental of human experiences (Babrow & Mattson, 2003). Any communication campaign that aims to change a target audience's health behaviors needs to centralize messages. Even though messaging strategies are an essential component of social marketing and are a widely used campaign model, health campaigns based on this framework have not always been able to effectively operationalize this key component, leading to cases where initiating and sustaining prescribed health behavior has been difficult (MacStravic, 2000). Based on an examination of the VERB campaign and an Australian breastfeeding promotion campaign, we propose a message development tool within the ambit of the social marketing framework that aims to extend the framework and ensure that the messaging component of the model is contextualized at the core of planning, implementation, and evaluation efforts.

Center for Disease Control's Diethylstilbestrol Update: a case for effective operationalization of messaging in social marketing practice.

The Center for Disease Control's (CDC) Diethylstilbestrol (DES) Update, a campaign to educate people who may have been exposed to the drug DES, is framed on the premises of the social marketing model, namely formative research, audience segmentation, product, price, placement, promotion, and campaign evaluation. More than that, the campaign takes a critical step in extending the social marketing paradigm by highlighting the need to situate the messaging process at the heart of any health communication campaign. This article uses CDC's DES Update as a case study to illustrate an application of a message development tool within social marketing. This tool promotes the operationalization of messaging within health campaigns. Ultimately, the goal of this project is to extend the social marketing model and provide useful theoretical guidance to health campaign practitioners on how to accomplish stellar communication within a social marketing campaign.

Meanings of health: interrogating structure and culture.

Based on the argument that context ought to be centralized in discourses of health communication, this article applies the culture-centered approach to engage in dialogue about issues of health with 18 men in rural West Bengal. The culture-centered approach is based on dialogue between the researcher and the community members, with the goals of listening to the voices of cultural members in suggesting culture-based health solutions. In this project, our discursive engagement with the participants suggests that health is primarily constructed as an absence, framed in the realm of minimal access to healthcare resources. In a situation where the resources are limited, the participants discussed the importance of trust in their relationship with the local provider. Health was also seen as a collective resource that was both an asset of the collective and a responsibility of the collective. Finally, the participants also pointed out the ways in which corruption in the structure introduced a paradox in policy discourse and the material conditions of the participants.

The relationship between health information seeking and community participation: the roles of health information orientation and efficacy.

Health communication scholarship has built on the health-promoting role of the community in exploring participatory communication techniques in community-based health promotion efforts. Community participation inculcates responsibility, strengthens community bonds, and provides a platform for diffusing health interventions. This power of a community to embody responsible action and promote participation in preventive behavior is examined in recent research on social capital. Exploring the link between community participation and health, this article demonstrates, through 2 survey studies, that health information orientation and health information efficacy are positively correlated with community participation. Furthermore, community participation is linked with prevention orientation, health beliefs, and health behaviors. Based on the findings, theoretical and pragmatic suggestions are presented.

Participatory change in a campaign led by sex workers: connecting resistance to action-oriented agency.

Studies predict that the number of HIV infections among commercial sex workers (CSWers) in India may rise to 3.93 million. Efforts have been made to stem the tide. But most campaigns have been designed to ensure condom compliance among CSWers by spreading awareness and increasing availability. Absent from the discursive space of such campaigns are the agency of CSWers and their ability to resist dominant social structures. The authors respond to this lacuna in health communication by foregrounding voices of CSWers participating in two HIV/AIDS interventions in India. Based on the culture-centered approach to health communication and subaltern studies theory, it examines data from two sites to analyze how communicative narratives of agency and resistance are enacted in the marginalized lives of sex workers.

Centralizing context and culture in the co-construction of health: localizing and vocalizing health meanings in rural India.

A growing number of communication scholars have articulated the need for understanding context as a key component of health meanings. In this project, the authors seek to explore the role of context in the domain of health meanings in tribal India. The tribal population in India comprises people who have been consistently isolated and exploited, and stripped of their rights and resources. Interest in their health is propelled by this marginalization and their existence in the twilight of tradition and modernization. This article, through the use of participant narratives and a grounded theory of analysis, aims to lay out how meanings of health are contextually constructed by tribals in India. The results demonstrate the constant pain and hardship that envelop their lives, their pining for structural capabilities, and a dialectical tension between tradition and modernization in the coexistence of multiple treatment options.

Health among men in rural Bengal: Exploring meanings through a culture-centered approach.

Researchers in health communication usually adopt a linear approach to the study of health. Under this linear model, the emphasis is on the transmission of beliefs, information, and knowledge from key points at the core (the traditional senders) to the peripheral receivers of messages. A growing body of scholarship foregrounds the importance of understanding health communication from a culture-centered perspective that privileges the dialogue with community members. Drawing on a culture-centered approach, the authors examine the meanings of health among men in rural Bengal. Their dialogue with these men suggests that communication in the realm of health exists in the context of responsibility as care providers, work life, structural barriers, and solutions through participatory processes. The findings elucidate the connection between structure and the communication practices of marginalization. The authors' discursive engagement with the participants points toward spaces of entry for theorizing health communication and developing culture-centered praxis.