SUMMARY Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide. Despite decades of research and programme activity, the epidemiology of HIV and the role that structural determinants have in mitigating or potentiating HIV epidemics and access to care for FSWs is poorly understood. We reviewed available published data for HIV prevalence and incidence, condom use, and structural determinants among this group. Only 87 (43%) of 204 unique studies reviewed explicitly examined structural determinants of HIV. Most studies were from Asia, with few from areas with a heavy burden of HIV such as sub-Saharan Africa, Russia, and eastern Europe. To further explore the potential effect of structural determinants on the course of epidemics, we used a deterministic transmission model to simulate potential HIV infections averted through structural changes in regions with concentrated and generalised epidemics, and high HIV prevalence among FSWs. This modelling suggested that elimination of sexual violence alone could avert 17% of HIV infections in Kenya (95% uncertainty interval [UI] 1–31) and 20% in Canada (95% UI 3–39) through its immediate and sustained effect on non-condom use) among FSWs and their clients in the next decade. In Kenya, scaling up of access to antiretroviral therapy among FSWs and their clients to meet WHO eligibility of a CD4 cell count of less than 500 cells per μL could avert 34% (95% UI 25–42) of infections and even modest coverage of sex worker-led outreach could avert 20% (95% UI 8–36) of infections in the next decade. Decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33–46% of HIV infections in the next decade. Multipronged structural and community-led interventions are crucial to increase access to prevention and treatment and to promote human rights for FSWs worldwide.

We conducted a systematic review in June 2012 (updated September 2013) to examine the prevalence and factors shaping sexual or physical violence against sex workers globally. We identified 1536 (update = 340) unique articles. We included 28 studies, with 14 more contributing to violence prevalence estimates. Lifetime prevalence of any or combined workplace violence ranged from 45% to 75% and over the past year, 32% to 55%. Growing research links contextual factors with violence against sex workers, alongside known interpersonal and individual risks. This high burden of violence against sex workers globally and large gaps in epidemiological data support the need for research and structural interventions to better document and respond to the contextual factors shaping this violence. Measurement and methodological innovation, in partnership with sex work communities, are critical.

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BackgroundThe aim of this study was to describe barriers to accessing and accepting highly active antiretroviral therapy (HAART) by HIV-positive mothers in the Ugandan Kabarole District's Programme for the Prevention of Mother to Child Transmission-Plus (PMTCT-Plus).MethodsOur study was a qualitative descriptive exploratory study using thematic analysis. Individual in-depth interviews (n = 45) were conducted with randomly selected HIV-positive mothers who attended this programme, and who: (a) never enrolled in HAART (n = 17); (b) enrolled but did not come back to receive HAART (n = 2); (c) defaulted/interrupted HAART (n = 14); and (d) are currently adhering to HAART (n = 12). A focus group was also conducted to verify the results from the interviews.ResultsResults indicated that economic concerns, particularly transport costs from residences to the clinics, represented the greatest barrier to accessing treatment. In addition, HIV-related stigma and non-disclosure of HIV status to clients' sexual partners, long waiting times at the clinic and suboptimal provider-patient interactions at the hospital emerged as significant barriers.ConclusionsThese barriers to antiretroviral treatment of pregnant and post-natal women need to be addressed in order to improve HAART uptake and adherence for this group of the population. This would improve their survival and, at the same time, drastically reduce HIV transmission from mother to child.

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This article explores the complex interrelationships between language and culture, between teachers' sociocultural identities and teaching practices, and between their explicit discussions of culture and implicit modes of cultural transmission in their classes. A 6‐month ethnographic study examined how teachers deal with institutional and curricular expectations regarding their teaching of (North American) culture in their EFL classrooms in a postsecondary institution in Japan. The study also explored the teachers' changing understandings of what constitutes culture and of how they viewed themselves in terms of their various social and cultural roles. Common themes included (a) the complexities and paradoxes associated with teachers' professional, social, political, and cultural identities and their (re)presentation of these in class; (b) their quest for interpersonal and intercultural connection in that EFL context; (c) their desire for educational (and personal) control in the face of contested cultural practices; and (d) disjunctures between teachers' implicit and explicit messages in relation to their cultural understandings and practices. We discuss these themes and make recommendations for teacher education purposes. We argue that the cultural underpinnings of language curricula and teaching must be examined further, particularly so in intercultural situations in which participants are negotiating their sociocultural identities as well as the curriculum.

Although much has been written about academic discourse from diverse theoretical perspectives over the past two decades, and especially about English academic discourse, research on socialization into academic discourse or literacies in one's first or subsequently learned languages or into new discourse communities has received far less attention. Academic discourse socialization is a dynamic, socially situated process that in contemporary contexts is often multimodal, multilingual, and highly intertextual as well. The process is characterized by variable amounts of modeling, feedback, and uptake; different levels of investment and agency on the part of learners; by the negotiation of power and identities; and, often, important personal transformations for at least some participants. However, the consequences and outcomes of academic discourse socialization are also quite unpredictable, both in the shorter term and longer term. In this review I provide a brief historical overview of research on language socialization into academic communities and describe, in turn, developments in research on socialization into oral, written, and online discourse and the social practices associated with each mode. I highlight issues of conformity or reproduction to local norms and practices versus resistance and contestation of these. Next, studies of socialization into academic publication and into particular textual identities are reviewed. I conclude with a short discussion of race, culture, gender, and academic discourse socialization, pointing out how social positioning by oneself and others can affect participants’ engagement and performance in their various learning communities.

TESOL Quarterly publishes brief commentaries on aspects of qualitative and quantitative research. For this issue, we asked two researchers to discuss narrative research in TESOL.