Displacement and HIV: Factors Influencing Antiretroviral Therapy Use by Ethnic Shan Migrants in Northern Thailand

Abstract

Migrant populations face increased HIV vulnerabilities, including limited access to antiretroviral therapy (ART). Civil conflict in Myanmar has displaced thousands of people from the minority Shan ethnic group into northern Thailand, where they bear a disproportionate HIV burden. To identify barriers and facilitators of ART use in this population, we conducted a rapid ethnographic assessment and case study with a clinical sample of Shan migrants receiving treatment for HIV in a district hospital in Chiang Mai, Thailand, Thai nurses providing their care, and health care administrators (n = 23). Barriers included fears of arrest and deportation, communication difficulties, perceived social marginalization, limited HIV knowledge, and lack of finances. Facilitating factors included hospital-based migrant registration services and community outreach efforts involving support group mobilization, referral practices, and radio broadcasts. These findings provided a contextualized account to inform policies, community interventions, and nursing practice to increase treatment access for minority migrant groups.

Quick and dirty? A systematic review of the use of rapid ethnographies in healthcare organisation and delivery

“…Murray et al 42 used their rapid ethnography to inform local policies, and Agyepong and Manderson31 used the study findings to develop a field manual for the rapid assessment of the cultural aspects of malaria. Findings were shared mainly through reports and academic publications, but some of the authors also reported sharing the results of studies through meetings and workshops with relevant stakeholders 35 38…”

“…Exceptions were the articles by Murray et al 42 and Harte et al ,44 which presented detailed descriptions of coding processes. In most articles, it was not clear if analysis was carried out using ‘traditional’ techniques or if rapid approaches were also used to analyse and interpret the data 2 49–51.…”

Migrant Workers and Their Occupational Health and Safety

“…The geopolitical context of the host country creates barriers to the testing and treatment of sexually transmitted infections and HIV across the globe (1,62,64). Laws and policies have historically limited migration of HIV-positive individuals into various countries, not for purposes of health promotion but to prevent the spread of the virus.…”

"When I first saw a condom, I was frightened": A qualitative study of sexual behavior, love and life of young cross-border migrants in urban Chiang Mai, Thailand

“…In our quantitative study [ 21 ], which included 442 participants aged 15–24 years, more than half (57%) of participants were sexually active, but the majority had never used condom, and a significantly low proportion of young MWs reported using condoms consistently. The majority of our participants were from the Shan ethnic group, [ 21 ] a group primarily from Shan State in Myanmar and constitutes one of the largest groups of cross-border MWs in Chiang Mai province [ 1 , 22 , 23 ]. The Shan in Thailand include two major groups.…”

“…The second group includes both documented and undocumented Shan MWs who have migrated in search of economic opportunities in Thailand. Many Shan work in low-paid jobs including domestic work, construction, agricultural labor, and sex work [ 1 , 22 , 23 ]. Changes in social and traditional norms of the Shan living in Thailand have been reported anecdotally.…”