Of desire,the Farang,and textual excursions: Assembling ‘Asian AIDS’

ABSTRACT

This article documents and discusses the neo-orientalist tendencies in the First World's sporadic coverage of ‘Asian AIDS’, with a particular focus on the localized context of Thailand. It takes the problem of ‘Asian AIDS’ as a critical point of articulation between a health crisis and the specific geopolitical movements of capital, tourism, and desire within the processes of globalization. In order to highlight the episodic nature of the First World's narrative about HIV/AIDS in Thailand and to witness the necessarily fragmentary quality of representation in the global sphere involving competing and constantly moving voices, I attempt to enact an imaginary dialogue in the form of what Trinh T. Minh-ha has termed ‘textual excursion’. The purpose of this imaginary dialogue is to elaborate on the various strands of narratives and different levels of discourse (for example, the documentary, the theoretical, the imaginary, the political) that comprise the field of jumbled voices. As the HIV/AIDS pandemic in Pacific and Southeast Asia is taking shape around the configurations of globalist imperatives, it illuminates a dual process: the revitalization of orientalist fantasies in the global sphere and the self-orientalizing tendencies within the Asian world captured by global development. It also illuminates the necessity of addressing the problem of ‘Asian AIDS’ as a migrating vector.     

Eastern Europe and Community of Independent States

This article reviews the literature on migration, HIV/AIDS, and sexually transmitted diseases in Eastern Europe and the Community of Independent States (CIS): Bulgaria, Czechoslovakia, Hungary, Poland, Romania, and the former Yugoslavian countries; and Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Russian Federation, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan. There is little in-depth research on the prevalence of HIV/AIDS. After the collapse of the USSR, the opening up of borders presented greater options for the spread of HIV. During 1991-1996, HIV-infected persons increased from 0.3/100,000 to 7.8/100,000. Syphilis and gonorrhea also spread in the 1990s. The increased prevalence is attributed to changes in sexual behavior due to increased travel and migration, disruption among families, and changes in sexual mores; and changes in the structure, availability, and effectiveness of health services. Many migrants in the CIS are young people. Mobile populations in the CIS include labor migrants, refugees, persons displaced by armed conflicts, repatriates, forced migrants, resettlement of formerly deported persons, and ecological migrants. It is general knowledge that migrants are poorly informed about HIV/AIDS. Condoms are not readily available in the CIS. Eastern Europe has high rates of HIV among migrant sex workers.     

Temporary Migration and The Spread of STDs/HIV in China: Is There A Link?1

Using data from the literature and a specially designed community‐level survey, this article examines the link between temporary migration and the spread of HIV/STDs in China. The results suggest that temporary migrants not only are overrepresented among people with STD/HIV risk‐taking behaviors, but also account for disproportionately more STD patients and persons infected with HIV. It is imperative that STD and AIDS prevention intervention and education programs in China target temporary migrants. More research is needed that focuses on the underlying mechanisms by which the process of temporary migration renders migrants vulnerable to STD/HIV risk‐taking behaviors.     

Eastern and Southern Africa

This article reviews the literature on migration and the spread of HIV/AIDS in Eastern and Southern Africa. It includes Angola, Botswana, Burundi, Djibouti, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Somalia, South Africa, Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. The literature focuses separately on AIDS or migration. HIV/AIDS is widespread and prevalent in these regions. The major concern is that migrants are at risk due to their migration and HIV infection is spread after a return to their home countries. Populations at risk include rural-to-urban migrants, displaced persons in the Sudan and in the Horn of Africa, refugees crossing borders, and pastoralists moving within rural areas. In 1997, there were an estimated 1.3 million refugees in east African countries and 5 million internally displaced due to conflicts in Angola, Mozambique, and South Africa. Risk factors among migrant groups include high rates of partner change, unprotected sexual intercourse, nonuse of condoms, prior sexually transmitted diseases, IV drug use, and residence in a high HIV-prevalence community. Confounding factors may be age, gender, occupation, and mobility. Health services for migrants vary between countries. There are successful models for prevention of HIV. 13 targeted interventions are identified.     

Battling for Survival, Battling for Moral Clarity: "Illegality" and Illness in the Everyday Struggles of Undocumented HIV+ Women Migrant Workers in Tel Aviv

Undocumented migrant workers living with HIV/AIDS in Israel, like their counterparts elsewhere, are doubly abject due to their lack of legal status on one hand and their ill health on the other. Unlike Israeli citizens living with HIV/AIDS, who can access an array of state funded treatments and support services, undocumented migrant workers living with HIV/AIDS are marginalized both by the state's exclusive immigration regime and by its efforts to shake off responsibility for their health needs. At the same time, HIV treatment and care are generally unavailable in migrants' countries of origin. Despite the state's exclusionary orientation and in contradiction of official policies, certain forms of HIV treatment are available to undocumented migrants through the day‐to‐day efforts of a small array of activist Israeli NGOs, (state‐employed) doctors, and state officials. The tension between these simultaneous, oppositional processes of exclusion and inclusion generate a “gray area”— a zone of competing values, claims and interests‐ in which undocumented migrants living with HIV/AIDS and these other stakeholders search for new options and possibilities while continually taking pains to protect their own varied, and often competing, interests. Actors thus constantly bargain with laws, health policies, and one another in a collective battle not only over migrants' chances of survival, but also over the rationality and the morality underlying the state's “and their own” decisions and choices. Anchored within this complex, indeterminate zone, the present article draws upon ethnographic field research conducted among undocumented HIV+ migrant women in Tel Aviv to explore some of the stakes, mechanisms, and outcomes of these complicated, high stakes negotiation processes.     

West and Central Africa

This article reviews scientific and other literature during the 1990s that links migration and mobility with the spread of sexually transmitted diseases (STDs), including HIV/AIDS. The focus is on key population groups linked to the spread of HIV and STDs in West and Central Africa: migrant laborers, truck drivers, itinerant traders, commercial sex workers (CSWs), and refugees. Countries with high emigration and immigration tend to have high levels of HIV infection, with the exception of Senegal. The main destination of immigrants are Senegal, Nigeria, and Cote d'Ivoire in West Africa and Cameroon, Congo, Gabon, and Congo in Central Africa. The risk of infection and the spread of HIV is variable among migrants. There is little in the literature that substantiates hypotheses about the strong association between migration and HIV-positive status. Information is needed on the duration, frequency of return visits, living conditions, sexual activities with multiple partners, and information before departure, along the routes, at final destination, and at the time of returns. Action-based research in five West African countries (Burkina Faso, Cote d'Ivoire, Mali, Niger, and Senegal) should produce results in late 1998. Comparable studies in Central Africa are unknown. Regional studies should be complemented by local studies. Prevention would benefit from studies on the relative size of these five population groups by geographic location.     

The impact of overseas labour migration on rural Thailand: regional,community and individual dimensions

"This paper provides a case study of the impact at origin of recent labour migration from rural Thailand to East Asian destinations. It does so through survey information on 63 villages and detailed biographic interviews with recently returned workers. It is concluded that work abroad is regarded by migrants as a strategy of life support; it is sometimes life-enhancing, but only rarely life-changing."     

Prostitution and the Politics of HIV Prevention in Cambodia: A Historical Case Study

Cambodia received international attention in the early 1990s when it emerged from civil war with the highest HIV rate in Asia, in which up to 60% of sex workers were infected. A massive influx of financial, human, and material resources ensued, and debates over “best practices” for HIV prevention were played out. Over time, the politics of AIDS shifted, mirroring changes in the politics of the largest player in global health, the United States. This sparked acrimonious polarization within international health policy, with direct implications for the lives of sex workers. This article traces those debates over sex work and HIV, highlighting the example of one brothel district in Cambodia where Medecins Sans Frontieres provided services to over 300 migrant Vietnamese sex workers. Using literature and program documentation from the time, this article highlights how countries such as Cambodia can become vulnerable to manipulation and used to serve wider political agendas.     

Privileged migrants and their sense of belonging: Insider or outsider?

Asia is gaining prominence as a destination for millions of migrants, totaling to about one-third of total international migrants. The privileged migrants (highly skilled and affluent) make up a large part of this group. They remain a fertile ground for scholarly examination owing to the fact that extremely scarce research attention has been paid to this group. Within this context, this paper focuses on the sense of belonging of this migrant group in the host countries. We argue that professional hierarchy; socioeconomic and sociocultural factors contribute to the privileged migrants’ positionality as an insider or outsider in the host country. In this research, four Southeast Asian countries (Singapore, Malaysia, Brunei, and Thailand) are selected. Via multiplex communication (WhatsApp, email, and phone calls), a total of 27 interviews were conducted. Findings suggest that most of the privileged migrants position themselves as an outsider for multifaceted factors.     

Aids prevention,Stigma and migrant status

This article discusses how stigma has been applied to disease and also to foreigners, especially during epidemics. Foreigners, or migrants, fit particularly well into AIDS stigma, being both objects and originators of the generalised reaction: ‘it's somebody else's problem’. Material is presented from a European Community Concerted Action assessing AIDS/HIV prevention which surveyed programmes for short‐ and long‐term guest populations and ethnic minorities in twelve European countries. It is shown how the potential for stigmatisation seriously hindered the establishment of AIDS prevention efforts directed towards migrants. Basic shifts of programme focus which help overcome stigmatisation problems concerning migrants are defined, including: 1) making fine differentiations amongst migrant groups rather than considering ‘migrants’ as a generalised ‘other’, 2) basing programmes on a universal right to know rather than on the notion of risk group, and 3) working in real and effective collaboration with minority communities rather than imposing top down programmes.     

HIV/AIDS Projects with and for Gay Men in Northern Thailand

Abstract

In this paper I look at three HIV/AIDS projects which were run by and for gay men, transsexuals and men who have sex with men (MSM) in northern Thailand in the early 1990s. These three projects were very different in format and in context, ranging from a rural village AIDS association to an urban drag beauty contest. The projects were located in settings as different as gay bars and cruising areas, shopping malls and rural villages. Aspects of the three Thai projects have important implications for those working in HIV/AIDS prevention and in the care and support of people living with HIV/AIDS (PLWHAs) across cultures, particularly in relation to education, outreach and counselling programs.     

Do transnational brokers always win? A multilevel analysis of social support

Migrants often maintain relationships with significant others located in their countries of origin, which results in having transnational interpersonal ties in addition to local ones. The majority of previous studies indicate that financial and social remittances flow from countries of immigration to the countries of emigration through migrants and their networks. However, less is known about who is involved in those exchanges, what kind of supportive resources flow within and across nation-state borders, and what level of individual cross-border engagement of migrants is related to those flows. We ask whether and how transnationality as an individual attribute, together with other personal, dyadic, and supradyadic characteristics, explain received social support. Drawing on data from 100 ego-centric networks collected from Turkish migrants in Germany, the results indicate that not only the dyadic level but also network structure, the position occupied by individuals in the network and their level of transnationality explain supportive resource flows within and across borders.     

Mexico and Central America

This article reviews the literature on migration and HIV/AIDS in Mexico and Central America, including Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama. Most migrants travel to the US through Mexico. US-Mexico trade agreements created opportunities for increased risk of HIV transmission. The research literature focuses on Mexico. Most countries, with the exception of Belize and Costa Rica, are sending countries. Human rights of migrants are violated in transit and at destination. Migration policies determine migration processes. The Mexican-born population in the US is about 3% of US population and 8% of Mexico's population. About 22% arrived during 1992-97, and about 500,000 are naturalized US citizens. An additional 11 million have a Mexican ethnic background. Mexican migrants are usually economically active men who had jobs before leaving and were urban people who settled in California, Texas, Illinois, and Arizona. Most Mexican migrants enter illegally. Many return to Mexico. The main paths of HIV transmission are homosexual, heterosexual, and IV-drug-injecting persons. Latino migrants frequently use prostitutes, adopt new sexual practices including anal penetration among men, greater diversity of sexual partners, and use of injectable drugs.     

Thailand's responses to transnational migration during economic growth and economic downturn

This paper gives an historical overview of immigration to Thailand since the 1970s and emigration since the 1960s. It describes migration policies since the 1930s. Final discussion focuses on the impact of economic contraction on migration. Immigration to Thailand dates back to the 1760s when a huge wave of Chinese emigrated to Thailand. The flow continued until about 1850 and resumed during 1905-17. The next big waves of immigrants were after 1975, when refugees fled Indochina, and in the 1990s, when migrants flocked from neighboring countries drawn to the booming economy. Thai professionals left in the 1960s for the USA. During the 1980s, many left for work in the Middle East. During the 1990s, Thai migrants moved within the East and Southeastern Asian countries and the USA or Europe, and they included many women and illegal migrants. Emigrants leave as arranged by the government, by employers, by recruitment agencies, and as trainees. The first official act was in 1950 and revised in 1979. Many work permits were approved in the 1990s, especially for unskilled labor. There are supports for Thai migrants abroad, but little is offered to foreigners at home. By 1997, the country's recession led to nonrenewal of many work permits. The 1998 economic crisis led to a new labor policy that deported illegal and unskilled migrant workers in order to create jobs for Thais. Policy encouraged Thais to seek work overseas.     

When Battlefields become Marketplaces: Migrant Workers and the Role of Civil Society and NGO Activism in Thailand

The vast majority of migrant workers in Thailand are employed predominantly in low‐paying occupations commonly described as “3‐D jobs” (dangerous, dirty, and difficult). Currently, there are nearly two million documented and undocumented migrant workers, mostly from neighbouring Burma, Lao People’s Democratic Republic, and Cambodia, employed in various industries, including domestic service, throughout the country. While over half a million migrants are officially registered to work in the country, both documented and undocumented migrant workers remain unprotected primarily due to the lack of concrete measures to monitor, implement and enforce laws regarding working and living conditions. Regardless of where they are employed, migrant workers face common problems: low wages; harmful working conditions, poor living conditions; discrimination and harassment, the threat of arrest and deportation; and lack of access to basic resources such as medical care and legal assistance. Based on preliminary research conducted in the summer of 2005, this article looks at the situation of migrant factory and domestic workers in Thailand and explores the ways in which local activists, NGOs, community‐based organisations, and international bodies have been looking to assist and protect migrant workers. Successful migrant workers’ struggles and ongoing efforts of mobilization have been made possible with the help of these support groups, and raise the possibility that union and NGO activity have the potential to improve the situation of migrants in Thailand. This also raises the question of whether advocacy groups should be acting in lieu of the state rather than alongside the state, especially when it appears that they are fulfilling their civic duty as enforcer and monitor of migrant workers’ problems.     

ECONOMIC AND OTHER SOCIETAL DETERMINANTS OF THE PREVALENCE OF HIV: A Test of Competing Hypotheses

The spread of human immunodeficiency virus (HIV) is believed to result from HIV-infected individuals who are unaware of their infection and, thus, the possible consequences of their sexual behavior for others. However, differential rates of HIV infection between countries may reflect a different set of circumstances. We obtained data from the World Bank and several other sources to test eight alternative explanations for the global differences in prevalence of HIV infection: (1) economic underdevelopment, (2) inadequate public health care, (3) insufficient media, (4) political instability, (5) overurbanization, (6) social inequity, (7) religion, and (8) region. Our regression findings showed that income inequality and political instability had statistically significant positive effects on HIV/AIDS prevalence and that gender equality had a negative effect on HIV/AIDS prevalence. Religion and region were also important predictors, as countries that were predominately Muslim and Christian Orthodox generally had lower prevalence of HIV/AIDS, whereas West Africa, Central Africa, and Southern Africa had a higher prevalence of HIV/AIDS. None of the public health and media indicators were statistically relevant.     

HIV/AIDS Orphans' Education in Uganda

Abstract

The HIV/AIDS epidemic in most sub-Saharan African countries has created a crisis in the African family structure. In Uganda, older people's roles have been reversed from being provided for to providers. Older people, who are already poor, face the loss of economic support from their adult children and unexpected social, psychological and economic burden due to the care-giving role they assume. In this study, we used cross-sectional data from Kayunga district in Central Uganda to examine the impact of HIV/AIDS on the role of older persons. We found that there were HIV/AIDS related deaths in 82.3% of the surveyed households. In almost 34% of the households, the care-givers of HIV/AIDS orphans were older people over 50 years old. Almost all households headed by older people (97.8%) had on average three school-going orphaned children living in the household.     

Indigeneity in Asia: an emerging but contested concept

This introduction presents background information about some of the ways that the concept of indigenous peoples is emerging but is also being contested in Asia. Indeed, many governments in Asia accept that there are indigenous peoples in the world, but claim that the concept does not apply to them due to a relative lack of European settler colonization in the continent. This is why many governments of Asia signed onto the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) in 2007, but with the understanding that UNDRIP does not apply to them. This has become known as ‘the salt-water theory’ or the ‘Asian controversy’. This special issue includes five articles that variously consider the ways that the concept of indigeneity is being deployed in various parts of Asia, including Cambodia, Myanmar, and Nepal, and also transnationally between Thailand, Myanmar, China and Laos; and between Cambodia, Vietnam and the United States.     

Contextualizing Migrants' Strategies of Seeking Medical Care in Russia*

Russia is an important destination for labour migrants from the former Soviet Union republics especially Central Asian low‐income countries: Kyrgyzstan, Tajikistan, and Uzbekistan. The life of migrants from Central Asia is characterized in Russia by scarce resources and social exclusion. Limited access to healthcare is aggravated by the negative attitudes and discrimination that migrants face when visiting state hospitals and clinics. In our study, we aim to describe the medical infrastructure available to migrants in Moscow. We investigate how migrants use formal and informal strategies to overcome the barriers to their receiving medical care in the urban environment. The study is based on the analysis of qualitative interviews with 60 labour migrants from Central Asian countries and 23 caregivers working in Moscow‐based medical facilities such as state hospitals, outpatient clinics, ambulance stations, and private medical centres including the so‐called Kyrgyz clinics.     

Migration and AIDS

This article presents the perspectives of UNAIDS and the International Organization for Migration (IOM) on migration and HIV/AIDS. It identifies research and action priorities and policy issues, and describes the current situation in major regions of the world. Migration is a process. Movement is enhanced by air transport, rising international trade, deregulation of trade practices, and opening of borders. Movements are restricted by laws and statutes. Denial to freely circulate and obtain asylum is associated with vulnerability to HIV infections. A UNAIDS policy paper in 1997 and IOM policy guidelines in 1988 affirm that refugees and asylum seekers should not be targeted for special measures due to HIV/AIDS. There is an urgent need to provide primary health services for migrants, voluntary counseling and testing, and more favorable conditions. Research is needed on the role of migration in the spread of HIV, the extent of migration, availability of health services, and options for HIV prevention. Research must be action-oriented and focused on vulnerability to HIV and risk taking behavior. There is substantial mobility in West and Central Africa, economic migration in South Africa, and nonvoluntary migration in Angola. Sex workers in southeast Asia contribute to the spread. The breakup of the USSR led to population shifts. Migrants in Central America and Mexico move north to the US where HIV prevalence is higher.