This study compared evidence from two low caste labouring communities in India: a relatively modernized urban group and a rural group in a backward region. It explored their levels of ill health, their capacities to respond to adult illness and the support they received. In each region, a baseline survey of approximately 1,000 households provided background quantitative evidence with qualitative evidence was collected from about 55 families. HIV infection and AIDS deaths were found to occur in the 'less poor' segments of the study group in both regions. In keeping with the official data, they formed a small proportion of the overall mortality and morbidity in this group. Stigma and discrimination were found to be low but fear of stigma was high, generated by the medical response to AIDS and used opportunistically for personal gains. The study provides insights into the structural determinants of health and coping mechanisms in these communities. The best conditions for a healthy life were found in the group that had a rooted community setting, collective political power, migrant economic support and improved working conditions - the less poor rural group. While improved economic status was associated with better health status, this relationship was stronger when combined with the presence of improved working conditions, with social cohesion at family and community levels and with political power as indicated by levels of organized collective representation and identity formation in workplace, local- and state-level politics. However, the traditional forms of social cohesion are under stress and new forms, moderated by commercial relations, are proving inadequate to meet major household shocks, like adult mortality. © 2007 United Nations Research Institute for Social Development (UNRISD).

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urban area rural area HIV Infections Human immunodeficiency virus infection India lowest income group health survey community care poverty Stereotyping sex ratio human middle aged health service priority journal morbidity Adaptation, Psychological rural health Urban Health religion Cross-Sectional Studies HIV Long-Term Survivors social status Humans Adolescent Infant, Newborn male female Socioeconomic Factors Infant Child, Preschool newborn socioeconomics Article adult Prejudice health care system social class social discrimination acquired immune deficiency syndrome mortality public health Child