Negotiating risk and resilience: HIV prevention practices among hill tribe communities in northern Thailand

Abstract

This article explores how hill tribe communities in Chiang Rai, Northern Thailand, engage with HIV prevention in the context of cultural complexity and marginalisation. Drawing on qualitative data from 29 semi-structured interviews and two participatory workshops, and informed by a modified social ecological framework, the research examines how individuals navigate risk and protection through informal knowledge networks, relational dynamics and constrained access to health services. Rather than depicting community members as passive or uninformed, the findings suggest active, contextually grounded strategies for managing HIV risk, often shaped by trust, silence and the negotiation of moral and emotional boundaries within families and partnerships. Prevention knowledge was largely circulated through peers, village health volunteers and social networks, while formal services were frequently viewed as inaccessible, untrustworthy or culturally misaligned. Structural factors, including geographic isolation and stigma, further exacerbated uncertainty and limited engagement with public health systems. The article argues for a reframing of HIV prevention as a relational and situated practice and calls for interventions that are co-designed with communities, inclusive of informal care systems and grounded in cultural safety and structural inclusion. Collectively, these insights offer suggestions for more effective, equitable and context-sensitive HIV prevention policy and practice in these marginalised populations.