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The incipient HIV/AIDS epidemic in Chile poses challenges for responsiveness of the Chilean national health care system, Fondo Nacional de Salud (FONASA) (National Health Funds), especially given the sociocultural forces for inertia in FONASA. Thus, the issue is what is the nature of the forces for change. A grounded theory approach was applied to interview data from two qualitative studies, one with HIV/AIDS advocates and activists as interviewees and the other with Chilean low-income women. The stories of their experiences with and perceptions of FONASA revealed major issues facing FONASA, including quality of care and ethics. Ways in which these issues are being addressed by the activists result in constructed environmental dynamism. A conceptual model of the forces for change was developed including actors, strategies, and targets of change that constitutes organizational environmental dynamism. The construct of environmental dynamism has international applicability, particularly to governmental health systems, which are influenced by strong sociocultural forces.

This chapter is an exploratory piece to comprehend how national policies react to regional policy solutions designed to cope with the HIV/AIDS epidemic. It uses data from the national strategic plans for HIV/AIDS from 13 of 15 Caribbean Community (CARICOM) members to illustrate how they interpret the regional response to the pandemic. In drawing upon the existing literature on transfer, it focuses on what I term cooperative policy transfer – explore how policy concepts flow back and forth between the national and regional levels through cohesive harmonization – to understand how new policy trends emerge. A cross-sectional analysis based on a content analysis reveals the emergence of three new policy trends distinct to the region that guide HIV/AIDS education: (i) creating a multisectoral approach; (ii) setting international targets; and (iii) establishing regional benchmarks. These new trends are identified as what I call the rise of new mutualism in education. The chapter concludes that the national and regional policy responses to HIV/AIDS in CARICOM countries, centered on new mutualism, became a rallying cry based on the belief that the Caribbean Single Market and Economy (CSME) can only function if CARICOM countries combine their resources to reverse the effect of HIV/AIDS on national educational systems.

Purpose: Fear of deportation and its relationship to healthcare access has been less studied among immigrant Latinx men who have sex with men (MSM), a population at risk for HIV and characterized by their multiple minority statuses. The first step is to accurately measure their fear of deportation.

Approach: We used an exploratory sequential mixed methods design. Eligibility criteria were that research participants be ages 18–34 years; Latinx; cisgender male; having had sex with another male; residing in the District of Columbia metro area; and not a US citizen or legal permanent resident. In Study 1, we used in-depth interviews and thematic analysis. Using participants' interview responses, we inductively generated 15 items for a fear of deportation scale. In Study 2, we used survey data to assess the scale's psychometric properties. We conducted independent samples t-test on the associations between scale scores and barriers to healthcare access.

Findings: For the 20 participants in Study 1, fear of deportation resulted in chronic anxiety. Participants managed their fear through vigilance, and behaviors restricting their movement and social network engagement. In Study 2, we used data from 86 mostly undocumented participants. The scale was internally consistent (α = 0.89) and had a single factor. Those with higher fear of deportation scores were significantly more likely to report avoiding healthcare because they were worried about their immigration status (p = 0.007).

Originality: We described how fear of deportation limits healthcare access for immigrant Latinx MSM.

Research implications: Future research should examine fear of deportation and HIV risk among immigrant Latinx MSM.

U.S. health policy promotes HIV testing and linkage to care (test-and-treat) with an emphasis on high risk groups such as convicted offenders. We sought to identify whether or not laws for mandatory HIV disclosure to sexual partners are a barrier to HIV testing among offenders under community supervision.

A total of 197 probationers and parolees were surveyed in a closed/item-open-ended item methodology on two reporting days in Alabama. Three main questions were asked: (1) What do offenders know about HIV? (2) What do they know about the law? (3) Do they support mandatory disclosure and HIV testing? Data for the quantitative items were analyzed with SPSS and matched with open-ended responses for explanatory purposes.

Testing and criminalization of non-disclosure were fully supported as key elements of HIV prevention. This support was framed by conceptions of HIV as a killer disease, of people with HIV as potential murderers, and by low self-awareness of HIV risk.

While the study involved only a single group of convicted offenders in a southern state, the results suggest that disclosure laws legitimize HIV stigma and undermine test-and-treat strategies among communities at risk.

The research is the first of its kind to investigate possible links between HIV criminalization and barriers to HIV prevention and care among convicted offenders.

This chapter seeks to explore the nature of and motivations for cross-generational relationships, and to examine how these relationships structure, limit and enable access to schooling for youth in Ndola (Zambia). Amidst increasing HIV infection rates and decreasing economic opportunity, youth experiences in and outside of school provide information about the impact of macro-level influences, particularly global economic trends and the HIV/AIDS pandemic, on the lives of these young women. Utilizing qualitative methods that seek to explore the lived realities of Zambian youth, this study examines perceptions of the phenomenon of “sugar daddies” and how they are seen to effect educational access and opportunity for young women. Although the study finds that young women are finding ways to cope with being enmeshed in a context characterized by severe economic decline and an extensive HIV/AIDS crisis, the strategy of securing a “sugar daddy” is one that may result in deadly infection and social isolation. Furthermore, policymakers in Zambia can and should take the opportunity to rethink austerity measures and hostility to social spending as well as the content of public health education.

Local adaptations to economic blight and overreliance on the tourism industry demonstrate significant aspects of resilience and risk among Caribbean populations. Those individuals who choose sex tourism as a way to benefit from its increasing revenue demonstrate resilience through their adaptations to shifts in the local and national economies, including national debt, expansion of the all-inclusive hotel industry, and seasonal variations in tourist arrivals. Based on ethnographic research conducted in Negril, Jamaica, I argue that the very activities of “hustling” and sex work that illustrate local men’s resilience are the same practices that put their sexual health at risk.

This research contextualizes the practice of female sex tourism using the anthropology of tourism, gender and sexuality studies, and the anthropology of HIV/AIDS with a focus on the Caribbean region. This work is based on a project that entailed nine months of fieldwork in 2010–2011 in Negril where I conducted ethnographic observations, life history interviews with three men who sell sex, and 54 semi-structured interviews.

Men who sell sex to women tourists demonstrate resilience in the face of economic shifts and changing cultural norms. These men are also, however, exposed to risk through their sexual activities and health seeking behaviors.

In order for the issues of STI/HIV risk to be adequately addressed among this population, effective public health efforts must prioritize health over tourism revenue and utilize anthropological approaches to explore the health costs of the tourist dollar.