Culture, but more than culture: an exploratory study of the HIV vulnerability of Indian immigrants in Canada

Explanations of immigrant health that ascribe to culture a fundamental causal role neglect the broader structural and contextual factors with which culture intersects. Based on a qualitative study of Indian immigrants' vulnerability to HIV in Canada, this paper presents a contextualised understanding of these individuals' understanding of, perceptions about, and responses to the HIV risk in their post-immigration lives. The study reveals that although culture - both traditional values and the norms of the diaspora community - appears to have constrained Indian immigrants' capacities to respond to the risk, this effect can be properly understood only by situating such constraint in the context of the settlement process that has shaped participants' living conditions, including their relationship with the diasporic community in Canada. We argue that HIV vulnerability should be conceptualised as a health inequality associated with broader systems of power relations (eg socio-economic marginalisation, gender inequality, discrimination, and racism). This more holistic conceptualisation of the intersection of culture, integration, and HIV vulnerability will facilitate exploration of HIV prevention strategies, through which interconnected inequalities of gender, race, and access to knowledge and resources can be challenged.