Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences


Mary-Margaret Weigel



The prevention of HIV/AIDS is a major global public health goal. The Joint United Nations Programme on HIV and AIDS (UNAIDS) estimates that 33 million individuals are infected with HIV worldwide and over two million of these cases are from India. The main mode of transmission of HIV in India is heterosexual contact.

In the past decades there has been a steady increase in immigration rates from India to the U.S. Education and marriage are the main reasons for immigration from India to the U.S. In general, the frequently risky sexual and substance use behaviors of college students in India and U.S. place them at risk for infection with HIV. India currently accounts for the highest number of foreign students attending U.S. Universities and at least 300 Indian students are enrolled per semester in the Paso del Norte border region universities in West Texas and Southern New Mexico.

Prevention of HIV/AIDS is a major health concern in the U.S.-Mexico border and the factors affecting HIV vulnerability and risk must be understood with relevance to all sub-groups in the region in order to implement effective HIV prevention strategies. The large number of Indian college students in the region comprises one of these subgroups and, unique factors related to immigration may be affecting their HIV vulnerability, risk and resilience.

Research shows that migration can affect perceptions about sexuality and sexual relations to reconstructs norms that can affect HIV risk behaviors. Acculturation and acculturative stress may also influence HIV risk in immigrant populations by modifying their HIV risk behaviors. Indian women in particular are seen to be at high risk for HIV due to traditional social norms and gender expectations. These norms may interact with factors in their receiving environment (U.S.) to affect their HIV vulnerability, risk and resilience and, may also cause certain individuals to exhibit positive deviance with respect to reducing their HIV risk. However, there is a dearth of studies comparing the factors in the sending and receiving environments affecting the HIV risk of immigrant populations, at the same point in time. The concomitant comparison of both environments is essential to the understanding of how migration can affect HIV risk through reconstructions of norms since both these environments are dynamic and evolving. Helping to close this research gap is the main goal of the present qualitative exploratory study which derives its multi-level theoretical framework from constructs the Health Belief Model, Social Learning Theory, Culture Theory, Theory of Social Proximity of HIV and AIDS, and John Berry's Acculturation Model.

The specific aims of this qualitative research are (1) to investigate the specific knowledge and attitudes regarding HIV/AIDS among female Indian University students in South India, and female Indian students as immigrants in the U.S.-Mexico border region; (2) to explore perceived individual and community risk of HIV infection among female Indian university students in relation to their initial acculturation process; and (3) to investigate the interaction between the sending and receiving environments, and the female Indian university students, and compare factors which affect their vulnerability, risk and resilience for HIV infection as students, immigrants, and women.

The data collection in the U.S. involved individual in-depth interviews with 15 female Indian university students, two focus group interviews with 6 female and 5 male Indian university students, respectively, and in-depth interviews with 6 local border area key informants. In India, the data collection included individual in-depth interviews with 21 female university students, two focus group interviews consisting of 10 female and 10 male university

students each, and 9 individual in-depth interviews with local key informants from a South Indian city.

The study results indicated that personal HIV risk perception may not be related to having adequate knowledge of HIV/AIDS and awareness about HIV risk behaviors within immediate social networks. HIV risk behaviors prevalent in the social networks of the participants may be shaped by factors in both their sending and receiving environments such as structural and social norms. Structural inequalities may co-factor with socio-cultural and gender norms to magnify female Indian college students' risk for HIV through heterosexual contact. Study findings also indicate the evidence of positive deviance with respect to HIV risk reduction in the study population. The current study findings shed light on the multiple migration-related contexts which may intersect to shape the vulnerability, risk and resilience of the South Indian female college students in the U.S. to HIV, and their implications for HIV/AIDS prevention research.




Received from ProQuest

File Size

246 pages

File Format


Rights Holder

Thenral D. Mangadu