A cultural practice following traditional male circumcision (TMC) in the Atoni Meto tribe, Indonesia, involves unprotected sex with unrelated women, such as widows or female sex workers (FSWs), known as sifon. This practice carries a high risk of transmission of HIV among men and sifon women. This study draws on in-depth interviews with 34 men from the tribe who had undergone TMC, and 12 healthcare professionals who engaged with young men from the tribe. Men who had engaged in sifon tended to have limited knowledge of HIV and its risks or of HIV testing. HIV testing was assumed to be necessary only on a doctor's recommendation or for individuals with multiple unprotected sexual encounters with FSWs, though not for sifon purposes. Such lay understandings and lay epidemiology led participants to view themselves as non-candidates for HIV and thus not requiring HIV testing. Reliance upon and a valuing of tradition contributed to a gap between knowledge and practice on the HIV risks of sifon and HIV testing, even among Atoni Meto health professionals. Some were aware of the HIV risks associated with sifon but engaged in 'strategic ignorance' in understating the risk of transmission and avoiding stigma. Health professionals continued to face challenges in discussing the risks associated with sifon and promoting HIV testing due to their fears of community resistance. Understanding these community-shaped barriers to accessing HIV testing after sifon is critical for developing tailored interventions in order to increase awareness of the risks of HIV transmission through sifon practice.
The commercial determinants of health (CDoH) represent corporate practices that systematically influence population health through the promotion of harmful commodities like tobacco, alcohol and ultra-processed foods. This article examines how perceptions of health risks from these commodities form distinct bundles that shape individual risk judgements. Drawing on practice theory and data from a representative survey of N = 2,000 Polish adults, the study identifies four distinct patterns of risk perception across tobacco, alcohol, ultra-processed foods, sugar-sweetened beverages, and air pollution. The analysis reveals how harmful commodities become embedded in social practices, creating systematic variations in risk perception. Women and older and high SES individuals showed higher risk awareness, while younger people and those in lower occupational classes demonstrated lower risk perception. Notably, alcohol-related risks emerged as a distinct category, often perceived independently from other health risks, reflecting their unique social and cultural embeddedness in Polish culture. The findings suggest that public health interventions should target integrated bundles of risk perceptions and practices rather than individual behaviours. This approach offers new insights into how commercial determinants of health systematically shape risk understandings across social strata, with important implications for addressing health inequalities and risk communication strategies.
France is on track to meet the World Health Organisation's goal of eliminating hepatitis C by 2030, thanks to effective harm reduction policies and broad access to antiviral treatments. However, new hepatitis C virus (HCV) infections and reinfections continue to occur. This study explored the practices associated with the risk of exposure to HCV. To do this, we adopted an interactionist approach grounded in social practice theory to examine the cultural, material, and relational dimensions of risk, and to shed light on the practices in which HCV continues to circulate. Drawing on discourses from semi-structured interviews (n = 15) with men living with HIV who experienced HCV reinfection, we analysed how HCV risk arose from everyday practices in sexual, chemsex, and shared drug injection contexts. Our findings highlight how risk was shaped not only by individual choices, but also by shared social norms (in particular regarding condom use and drug consumption in sexualised settings), an interpretative framing of individual responsibility and an affective distancing from others. Furthermore, our results emphasise how situational disruptions and practical constraints could contribute to the relational and material dynamics through which risk was produced. The study questions the suitability of individualised approaches to HCV prevention by showing how risk materialises through socially and culturally embedded collective practices.
This article explores how young Swedish mothers aged between 13-25 years of age understand and position their maternal identity in relation to discourses of risk, life course, and good motherhood. Drawing on 17 in-depth qualitative interviews, the analysis reveals how perceptions of risk and life trajectory intersected to shape the degree of a mother's perceived risk, which in turn was described as influencing the conditions under which maternal identity work was performed. A mother's alignment with, or deviation from, expected life-course trajectories shaped her positioning as low risk, high risk, or too risky for mothering, thereby affecting her access to dominant maternal discourses. Mothers who perceived themselves as low risk were able to engage with all maternal discourses and access a relatively untroubled position within a framework of relaxed, 'good-enough' motherhood. In contrast, those who understood themselves as categorised as high risk faced considerable challenges accessing dominant motherhood discourses, resulting in more stressful identity work as they sought to affirm themselves as adequate mothers while resisting the stigmatised identity of the 'bad mother'. The youngest participants (aged 13-16), deemed too risky for motherhood, were largely excluded from dominant maternal discourses and struggled to claim the maternal role. Nevertheless, these mothers articulated a more autonomous and rebellious maternal identity that both challenged normative expectations and asserted their legitimacy as mothers.
In this article we report on a small-scale qualitative study of COVID-19 vaccination in a Romanian village with exceptionally low uptake, inhabited predominantly by people of both Roma ethnicity and Pentecostal faith. In explaining vaccine refusal, public health studies conventionally assume this to be an individual decision based on weighing perceived risk of disease against that of vaccination. Explanations of traditionally low levels of vaccination in (for example) tight-knit religious communities often assume that these levels result from the aggregate of multiple individual decisions. Here we suggest that vaccine refusal in this community was presented and sustained as a collective community position, yet still shaped in heterogeneous ways by villagers' religious beliefs and Roma ethnicity. Our qualitative data indicate that Pentecostal beliefs provided a religious justification for refusing vaccination, while Roma communities' historical marginalisation shaped scepticism towards political and public health authorities and their messages. In this case study, vaccine refusal is interpreted as safeguarding a community and its culture, with this taking precedence over risks to individual health.
