The technological imperative in tuberculosis care and prevention in Vietnam.

A monocausal bacteriological understanding of infectious disease orients tuberculosis control efforts towards antimicrobial interventions. A bias towards technological solutions can leave multistranded public health and social interventions largely neglected. In the context of globalising biomedical approaches to infectious disease control, this ethnography-inspired review article reflects upon the implementation of rapid diagnostic technology in low- and middle-income countries. Fieldwork observations in Vietnam provided a stimulus for a critical review of the global rollout of tuberculosis diagnostic technology. To address local needs in tuberculosis control, health managers in resource-poor settings are readily cooperating with international donors to deploy novel diagnostic technologies throughout national tuberculosis programme facilities. Increasing investment in new diagnostic technologies is predicated on the supposition that these interventions will ameliorate disease outcomes. However, suboptimal treatment control persists even when accurate diagnostic technologies are available, suggesting that promotion of singular technological solutions can distract from addressing systemic change, without which disease susceptibility, propagation of infection, detection gaps, diagnostic delays, and treatment shortfalls persist.

Borderline well-being: Mental health in a development zone.

Mental illness contributes hugely to global disease burden. Inadequate resources, limited access to services and pervasive stigma jointly foster its increasing severity, especially in resource-poor countries. Despite recognition that social determinants such as poverty, inequality and marginalization aggravate mental distress, minimal scrutiny has focused on the negative impact of targeted development schemes creating social and economic change that exacerbates mental health risks for poor people. This article examines the rise of mental disorders as an unwanted consequence of a new special economic zone being built in a border district in Northwest Thailand. Ethnographic data from villages surrounding the intended industrial hub was collected during six-months fieldwork in 2017 and 2018. Informants included public health staff in the community and district hospitals, villagers who had lost farming land, health volunteers and spirit healers. Using local narratives and hospital data to show an emergent vulnerability to anxiety, depression and suicide, I argue that global public health approaches seeking to decentralise mental health services and donor-driven mitigation guidelines fail to alleviate stressors for locals caught up in development's slipstream. In turn, distressed by land reclamation, debt, gambling and substance abuse, villagers turn to reinvigorated forms of spirit-healing for assistance in regaining a sense of well-being. In this context, I demonstrate that development schemes potential to affect the epidemiology of behavioral pathologies remains significantly under-addressed within rubrics of 'border-health'.

Vigilance and Sentinels in Global Health Security.

Global health security is increasingly reliant on vigilance to provide early warning of transnational health threats. In theory, this approach requires that sentinels, based in communities most affected by new or reemerging infectious diseases, deliver timely alerts of incipient risk. Medicalizing global safety also implies there are particular forms of insecurity that must be remedied to preempt disease spread. I examine vigilance in the context of spreading drug-resistant malaria in Southeast Asian border zones and argue that to act as sentinels, marginal groups vulnerable to infection must be able to articulate what social and behavioral factors prompt proliferating disease risks.

Deviance and resistance: Malaria elimination in the greater Mekong subregion.

Malaria elimination rather than control is increasingly globally endorsed, requiring new approaches wherein success is not measured by timely treatment of presenting cases but eradicating all presence of infection. This shift has gained urgency as resistance to artemisinin-combination therapies spreads in the Greater Mekong Sub-region (GMS) posing a threat to global health security. In the GMS, endemic malaria persists in forested border areas and elimination will require calibrated approaches to remove remaining pockets of residual infection. A new public health strategy called 'positive deviance' is being used to improve health promotion and community outreach in some of these zones. However, outbreaks sparked by alternative understandings of appropriate behaviour expose the unpredictable nature of 'border malaria' and difficulties eradication faces. Using a recent spike in infections allegedly linked to luxury timber trade in Thai borderlands, this article suggests that opportunities for market engagement can cause people to see 'deviance' as a means to material advancement in ways that increase disease vulnerability. A malaria outbreak in Ubon Ratchathani was investigated during two-week field-visit in November 2014 as part of longer project researching border malaria in Thai provinces. Qualitative data were collected in four villages in Ubon's three most-affected districts. Discussions with villagers focused primarily on changing livelihoods, experience with malaria, and rosewood cutting. Informants included ten men and two women who had recently overnighted in the nearby forest. Data from health officials and villagers are used to frame Ubon's rise in malaria transmission within moral and behavioural responses to expanding commodity supply-chains. The article argues that elimination strategies in the GMS must contend with volatile outbreaks among border populations wherein 'infectiousness' and 'resistance' are not simply pathogen characteristics but also behavioural dimensions born of insistent market aspirations.

Linked spaces of vulnerability: HIV risk amongst migrant Dai women and their left-behind husbands in Southwest China.

In one county of Southwest China bordering Myanmar, large numbers of minority Dai women leave to work in southern Thailand. Many are married and they leave behind husbands and children, sending remittances and returning home intermittently. These women commonly establish relations with Chinese/Malaysian men in their worksites--massage parlours in the tourist sites near the Malaysian border. These men become second husbands just as the Dai women become second wives. This paper examines the complicated set of HIV risks and assumptions that emerge from the circular Dai exodus to Thailand and the manner in which transnational employment networks impact on domestic and sexual relationships for women and their non-migrant husbands back home.

Trade circles: aspirations and ethnicity in commercial sex in Laos.

The contours of commercial sex in Lao PDR are significantly shaped by forces facilitating the entry of women from one ethnic group, the Khmu, into this service industry niche. Agricultural transitions, development policies, changing gender roles, ethnic hierarchies, snowballing recruitment networks and growing capitalist sensibilities collectively prompt poor Khmu women to aspire to material gain via selling beer and sex. Their predominance in lower echelons of the sex industry demonstrates how forces of neoliberal expansion build on both opportunity and enduring marginalisation and that material economies are closely intertwined with intimate economies as trajectories of modernisation evolve in contemporary Laos.

Fleeing the fire: transformation and gendered belonging in Thai HIV/AIDS support groups.

By the turn of the millennium, HIV had infected nearly one million people in Thailand. A large number of support groups now exist throughout the country. These groups have emerged as the primary forum through which having HIV is negotiated and normalized in Thai society. This is done by allowing members to publicly refashion their sense of self and its appropriate place in the world. However, the moral and social space created by support groups is not without its own structuring principles. The discursive strategies that shape support groups are embedded within local moral economies and frameworks of meaning. Gender and social identity are significant factors that influence the benefits to be gained from belonging. To date, women markedly outnumber men in most groups, and many members regard masculinity as a constraining factor on male participation. Within support groups, unwillingness to join is considered one reason for the perception that men with HIV seem to die sooner than do women with HIV. Clinically true or not, this belief has major ramifications.

Harm reduction and alternative development in the Golden Triangle.

The authors of this Digest are anthropologists from Macquarie University, Sydney Australia. At the invitation of the German aid agency GTZ, they have been monitoring opium use and the impact of drug rehabilitation in Muang Sing Laos over the past 3 years. Their role is to provide analyses of how development projects alter the social make-up of their target communities and contribute to ways in which substance use/abuse is understood, practiced and controlled or reconfigured. In their consideration of development projects they take the perspective that harm reduction can and should include pre-emptive concern with factors that promote damaging drug use in the first place and furthermore, that these factors are at times the products of the distinct drug reduction strategies themselves.

Sister cities and easy passage: HIV, mobility and economies of desire in a Thai/Lao border zone.

It is recognised that people movement can increase potential risk of HIV transmission. In recent years, mobile populations moving across national borders have become a focus for HIV/AIDS prevention campaigns. These programs generally target border "hot zones" that produce high levels of HIV vulnerability due to the degree of mobility and the risk behaviours fostered by these marginal environments. However, high degrees of movement and social exploitation need not be the only criteria for borders to exacerbate HIV vulnerability. The types of social interactions promoted by mobility take many forms. In this paper we consider a border zone between Thailand and Laos to show that the links between movement and HIV vulnerability are not confined to stereotypical instances of coercion and exploitation. Rather we demonstrate that HIV risk in this area is a product of both a sense of community and a sense of difference that together foster a range of interactions based on mobility back and forth across the border. As HIV/AIDS prevention programs increasingly control forms of sexual interaction, the border provides a practical and symbolic opportunity to establish new forms of sexual relationship falling outside these constraints. This tendency to move outside bounds is not limited to border areas but has implications for prevention programs everywhere.