Stigma, Abuse, and Resistance: Unveiling Community Fear of COVID-19 Through Voices of India's Frontline Community Health Workers.

During the COVID-19 pandemic, community health workers (CHWs) worldwide faced violence and abuse. In India, CHWs, known as Accredited Social Health Activists (ASHAs), encountered community resistance and violence in their frontline roles. However, positioned precariously within a neoliberal public health system, their voices remained absent in policymaking, reinforcing structural invisibility. This study, guided by the culture-centered approach (CCA), draws on semi-structured interviews (n = 30) with ASHAs in Odisha, India, to examine their negotiations with community resistance. Findings reveal that resistance and abuse stemmed from structurally induced fears-misinformation spread via social media, loss of wages, restricted access to resources due to quarantine measures, and community ostracization. However, rather than being passive recipients of violence, ASHAs exercised agency through self-created strategies such as peer learning, leveraging social ties, persistent counseling, and voicing their concerns to senior officials-despite their hierarchical marginalization. This study highlights how India's neoliberal public health system-relying on ASHAs as underpaid, unprotected workers-intensified their vulnerabilities. The individualization of health responsibility manifested at multiple levels: ASHAs were held responsible for pandemic control without adequate resources, while community resistance to top-down health measures was criminalized rather than viewed as a response to structural violence. This framing absolved the state of responsibility, displacing blame onto ASHAs and marginalized communities. The study calls for bottom-up decision-making spaces that include CHWs and their communities as stakeholders, ensuring pandemic policies address systemic inequities rather than penalizing vulnerable populations.