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| ISBN-13: | 9780226016047 |
|---|---|
| Publisher: | University of Chicago Press |
| Publication date: | 04/01/2010 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 192 |
| File size: | 311 KB |
About the Author
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Global Sex
By Dennis Altman
University of Chicago Press
Copyright © 2003
University of Chicago
All right reserved.
ISBN: 0-226-01605-6
Chapter One
AIDS, Sex, and Globalization
(from Chapter Five, Imagining AIDS: And the New Surveillance)
By overwhelming [Africa's] health and social services, by creating
millions of orphans, and by decimating health workers and teachers, AIDS
is causing social and economic crises which in turn threaten political
stability.... This cocktail of disasters is a sure recipe for more
conflict. And conflict, in turn, provides fertile ground for further
infections.
-Kofi Annan, 2000
By the beginning of this century the number of people infected with HIV
was approaching 35 million, with infections increasing rapidly in much of
Africa, south Asia, and the Caribbean. Responsible UN officials have
compared AIDS to the great plagues of history, with some countries close
to an adult infection rate of 25%, and the UN Population Division
estimates that life expectancy is falling in twenty-nine African countries
due to AIDS. By the turn of the century AIDS had become the number one
cause of death in Africa, imposing a particularly heavy burden because it
is most heavily concentrated among the most productive sectors ofthe
population. In some ways the epidemic had become a metaphor for the
potential struggle between life and death within sexuality at the
beginning of the new millennium.
The politics of AIDS encompass its regulation through state and
international organizations, the development of a vast range of community
responses, the political economy of health, and widespread cultural
manifestations. As Richard Parker wrote: "In little more than a decade the
rapid spread of the international AIDS pandemic has profoundly changed the
ways in which we live and understand the world. Never has a common, global
problem so clearly drawn attention to the important differences that shape
the experience of diverse cultures and societies. And nowhere is this more
true than in relation to our understanding of human sexuality." AIDS has
entered the global imaginary, using this term in Appadurai's sense of "a
constructed landscape of collective aspirations ... the imagination as a
social practice."
The urgency of HIV/AIDS and the mobilization, interventions, and research
generated by the epidemic introduced a new dimension to debates about
sexuality. For moral conservatives AIDS seemed almost tailor-made as a
rebuke to those who argued that it was possible to regard sex as
recreation, and in many parts of the world-in Africa and the Caribbean as
much as within the Catholic Church and the U.S. Senate-it was argued that
the only meaningful response to AIDS was abstinence, celibacy, or at best
mutual monogamy. In KwaZulu-Natal (South Africa), King Goodwill Zwelithini
has sought to restore a commitment to celibacy before marriage to help
curb the spread of HIV, using the traditional "reed dance" to reemphasize
the tradition. Even in Australia, generally agreed to have had one of the
most progressive official responses to the epidemic anywhere, the first
chair of the National Advisory Committee on AIDS, Ita Buttrose, gained
considerable notoriety when she spoke of her own "radical celibacy."
Buttrose was a strong supporter of widespread condom use and empowering
gay community education, but she also typified a dominant attitude when
she wrote: "Woodstock could never happen again after the arrival of AIDS.
'Free love' was now a dirty word [sic] because everyone knew it was not
necessarily love or free. Indeed, it could come at a great cost. Free love
had meant sex with anyone you chose, with no complications and no strings
attached. The problem was, free love could not take account of someone's
sexual past-his or her history."
As we shall see, some gay men in particular opposed this view of the
implications of the epidemic, but certainly the explosion of HIV from the
early 1980s has changed both the discourses and practices of sexuality. As
Mark Merlis, one of the most original contemporary gay writers, put it:
"No one will ever go that way again, not even if the cure is found. Partly
because we will never own our bodies again, as they did. We are vectors
now, or vessels, sources of transmission; our bodies belong to the
unseen."
AIDS fits the common understanding of "globalization" in a number of ways,
including its epidemiology, the mobilization against its spread, and the
dominance of certain discourses in the understandings of the epidemic.
Note that I follow the accepted usage which increasingly conflates HIV
(the virus which weakens the immune system) and AIDS (the medical
condition which results from such weakening) despite the fact that there
are significant differences in practice between the two. As Anthony Smith
has pointed out: "While arguably they are simply cause and effect
separated by a significant although variable period of time, they are in
fact produced in two, largely distinct, cultural fields, the treatment of
AIDS being mainly-almost exclusively-within the purview of clinical
biomedicine and the prevention of HIV infection being within the province
of the social and behavioral sciences, although the ownership of HIV by
these disciplines has been under sustained attack from biomedicine."
Reports of a new infectious and potentially fatal disease date from 1981,
when young men were diagnosed as suffering from severe immune deficiency
on both coasts of the United States. It is almost certain that some
version of HIV/AIDS had long existed in Africa; unfortunately this claim
has sometimes been read as racist, though it is no more than an attempt to
understand the etiology of the disease. It is possible that HIV mutated in
the recent past, so as to become far more harmful to humans, and its rapid
spread in the past two decades is closely related to the forces of
"development," and to global population movements. It is even possible
that the spread of the virus resulted from experiments with a potential
polio vaccine in the 1950s. It is probable that the virus was spread
beyond its original home through urbanization and population shifts, and
that its rapid dispersion across the world is closely related to the
nature of a global economy. HIV followed the huge population movements of
the contemporary world, whether these are truckers moving across Zaire and
India, women taking up sex work as a means of survival as old communities
and social order crumbled, men seeking work on the minefields of South
Africa and Zimbabwe, or tourists (for example Americans in Haiti),
refugees (Haitians fleeing to the United States), and soldiers (Cubans
serving in Angola; UN troops in Cambodia or the former Yugoslavia) moving
across national boundaries. To take one example almost at random, the
early spread of HIV in Honduras, which has the highest AIDS figures in
Central America, has been attributed to the interaction of prostitutes and
American soldiers at the U.S. base at Comayagua. The involvement of armies
from seven African countries in the civil strife at the end of the 1990s
in the Congo seemed tailor-made for a rapid spread of HIV.
AIDS is both a product and a cause of globalization, linking the least
developed and the most developed regions of the world. Despite attempts to
close borders to its spread, as in the restrictions on entry of
HIV-positive people applied by many countries, the spread of the virus
made a mockery of national sovereignty. Speaking of the greater Mekong
region-which straddles China, Burma, Thailand, and Laos-Doug Porter has
written: "The nexus of HIV transmission across this territory is a
metaphor for the globalisation of investment, trade and cultural identity.
Although the dominant realist tradition in international relations studies
conceives national territorial spaces as homogenous and exclusive, what is
referred to as the 'new global cultural economy' has to be seen as a
complex, overlapping, disjunctive order, which cannot be adequately
understood in terms of centre-periphery, inner-outer, state border models
of the past."
The growing internationalization of trade in both sex and drugs has played
a major role in the diffusion of HIV, and its rapid spread into almost
every corner of the world. It has been argued that "patterns of use of
illicit drugs are becoming globalized and 'standardized,'" leading to the
rapid spread of HIV in countries in both Southeast Asia and South America
where the U.S.-led "war on drugs" has meant injecting practices have
partly replaced traditional opium smoking. The United Nations Drug Control
Program estimates that the international trade in illegal drugs amounts to
some $400 billion a year, and touches virtually every part of the world.
We are used to hearing of the drug trade from Colombia and Burma, but
other parts of the world-Nigeria, ex-Soviet Central Asia-are also major
exporters. In the same way injecting drugs, with the concomitant risks
from shared needles, is a practice found in increasing numbers of
countries and populations.
While it is often said that HIV is "spread through prostitution" (a
formulation which repeats the usual demonization of the sex worker while
ignoring the client), it is also true that fear of AIDS itself changes the
nature of the international sex trade. It is well established that AIDS
has played a role in increasing demand for younger, presumably uninfected,
prostitutes, often from rural areas, which has meant an increased demand
for young Burmese women in Thailand and Nepali girls in India, and so on.
(There are estimates that nearly half the prostitutes in India are less
than eighteen years old, and 20% less than fifteen.) Of course the demand
for young girls-above all virgins-is an old tradition, and one which has
long fueled a great deal of the trade in prostitution.
In some ways the very policies urged by international bodies and economic
theorists to promote faster development have added to the conditions which
make people vulnerable to HIV infection. There is now some literature
which discusses the vexed relationship between HIV infection and
development; one example I like to cite is the Thai-Lao Friendship Bridge
across the Mekong, which was opened with some fanfare in 1994. By
increasing traffic across the river the bridge has also increased the
vulnerability of Laotians, particularly in the border city of Nong Khai,
to infection. Similar connections have been established between
globalization and the spread of cholera in the past twenty years. Lee and
Dodgson speak of the adverse impacts of globalization on health systems in
Latin America, including "increased national debt, rapid urbanisation,
environmental degradation, inequitable access to health services, and
reduced public expenditure on public health infrastructure. Cholera then
arrived in 1991, spreading rapidly across the continent in an epidemic of
1.4 million cases and more than ten thousand deaths in nineteen
countries." This account goes on to point to similar outbreaks in the
former Soviet Union, linked to related conditions. Although the means of
transmission are different, similar conditions of social dislocation,
poverty, and the absence of health services mean HIV will spread much
faster (other untreated sexually transmissible diseases increase
susceptibility to infection). As Gita Sen points out: "Globalization
itself, in the sense of unregulated privatization, [means] open season for
pharmaceutical companies, health sector cutbacks, and a weakening of
concern for health equity poses enormous barriers to the fledgling
reproductive and sexual rights agenda"-to which one might add the
prevention of HIV and other sexually transmissible diseases.
There is an irony in the World Bank's putting increasing sums of money
into AIDS work in countries such as Brazil and India where the Bank's own
policies had helped weaken the health structures which might have helped
prevent the spread of HIV. (One of the most telling examples of how
structural adjustment affected the spread of AIDS is data from Kenya,
which showed a steep drop in attendance at STI clinics after the World
Bank enforced charges for such visits.) Moreover part of the impact of an
epidemic linked to social and economic upheavals has been to effectively
increase the vulnerability of women, who are more likely to be unable to
protect themselves against infection, to carry a greater share of the
burden of care for those who are sick, and to have less access themselves
to treatments. Violence and rape (usually, but not exclusively, directed
at women) are a major cause of HIV transmission which increases
dramatically in situations of social and political dislocation. Yet in
some countries women who ask their rapists to use condoms are deemed to
have given consent.
The development of various international responses to HIV/AIDS forms part
of the globalization of human welfare, one of the six "vectors" identified
by Hopkins and Wallerstein in their discussion of the developing world
system. The formation of the World Health Organization in 1948 could be
seen as the beginnings of a so far very slow movement toward recognizing
the need to establish certain basic standards of "health for all," a
program of global preventive and primary care endorsed by the World Health
Organization and UNICEF in 1978. Equally the international response has
implications for the globalization of certain biomedical and
sociobehavioral paradigms, which are often ignored in discussions of
globalization. Global mobilization around the demands of a biomedical
emergency has inevitably meant the further entrenchment of western
concepts of disease, treatments, and the body. I happen to believe that
the western rationalist view of AIDS as essentially caused through
infection by a retrovirus is correct, but to recognize this as the basis
for global programs is also to recognize that this further undermines
other and different ways of viewing medicine and the body. In some
societies there has been resistance to western conceptions of AIDS, often
linked to the interests of traditional healers, but such resistance has
been comparatively weak in the face of the homogenizing impact of global
biomedical science. The frequent calls to involve traditional healers in
HIV programs too often overlook the problem of integrating very different
epistemological frameworks and understandings of illness.
The first significant international response to the new epidemic came in
1986 when the World Health Organization established the Global Program on
AIDS (GPA), based in its Geneva headquarters. GPA can be seen as having
had three clear achievements: the establishment of an international
discourse about HIV/AIDS which stressed the language of empowerment and
participation; technical support for a number of developing countries in a
range of policy and program areas; and mobilization of donor countries to
support a multilateral response to the epidemic.
Continues...
Excerpted from Global Sex
by Dennis Altman
Copyright © 2003
by University of Chicago.
Excerpted by permission.
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Table of Contents
Preface: Sex and Politics1. Introduction: Thinking about Sex and Politics
2. The Many Faces of Globalization
3. Sex and Political Economy
4. The (Re)Discovery of Sex
5. Imagining AIDS: And the New Surveillance
6. The Globalization of Sexual Identities
7. The New Commercialization of Sex:
From Forced Prostitution to Cybersex
8. Sexual Politics and International Relations
9. Squaring the Circle:
The Battle for "Traditional" Morality
10. Conclusion: A Global Sexual Politics?
Acknowledgments
Notes
Index