BOOK REVIEWS

Marie-Eve Blanc, Laurence Husson and Evelyne Micollier eds., Sociétés asiatiques face au Sida

Edited by Marie-Eve Blanc, Laurence Husson and Evelyne Micollier, this work presents a remarkable compendium of works dedicated to the prevention of Aids and the fight against this scourge in Asia, with the final chapter offering a comparison between the strategies conducted on this continent and in Africa.

We know that only Uganda and Thailand have succeeded in reducing the prevalence of Aids in the general population. Although the book contains no article per se on Thailand, the situation in this country serves as a reference throughout the work. Thailand seems to be one of the rare countries that has spared itself the stage of denial that has been observed, in one form or another, by the majority of countries affected. In China, Vietnam, Malaysia, Indonesia and India, what is most striking is the systematic and persistent refusal even to acknowledge the existence of the problem. In the name of a purity that is socialist (China, Vietnam), ethno-social and religious (India) or ethno-religious (Malaysia, Indonesia), the Aids epidemic has been dangerously denied, the national context prevailing over an international approach that seems to have been relatively more easily imposed in Africa on supposedly weaker states who, to a large extent, did not have the means necessary to staunch the epidemic.

Two lines of thought run through this work. The first is political and analyses the institutional strategies that have been developed, in particular by the individual states. The second is more anthropological and serves as support for the ethno-epidemiological articles, or those concerning the representations of the disease, which offer a rich tableau of the contribution made by the social sciences to Aids. There is little homogeneity in the Asian cultural context, but “sexual cultures” can be identified. The reader will be likely to spend some time on the most important texts, such as that by Franck Dikötter on the discussions on and representations of sexuality and sexually transmitted diseases (STDs) in China. It is noted that, despite the official denials, STDs reappeared in 1986. And in 1990, a law was introduced obliging foreign residents to undergo an Aids test, bringing to light both the “traditional” and the socialist certitudes of the former Middle Kingdom. It thus becomes possible to envisage this disease (Aids) as the harbinger of the collapse of Western capitalist societies.

The apologia of sexual morality does not stand up against the facts that have compelled recognition in the very last years of the twentieth century. It is only very recently that the prevention of Aids has been tackled in a realistic manner that is no longer ideological. From now on, growing individualism will tend to transfer responsibility for the management of sexuality from the state to the individual. In the transitional situation in which China finds itself today, there is every reason to fear the development of Aids there. The article by Evelyne Micollier on prevention in Taiwan places us in another Chinese society, where access to tritherapy is taken care of in its entirety by the Ministry of Health. The campaigns that are conducted take their inspiration from Western models and the approach to the disease is very similar to the one that has been developed in Japan.

The weight of social ideologies is thus established in the assumption of responsibility for a collective risk such as Aids. The case of Vietnam (Marie-Eve Blanc) confirms this, in its stringent analysis of the state campaigns and how they have evolved. For a long time, the family has been presented as the sanctuary of social and sanitary harmony against the “social plagues” such as prostitution and drugs, which have been strongly stigmatised despite their prevalence since the economy was opened up. The failure of the normative revolutionary rhetoric has opened the field to the very active foreign NGOs, and the emergence of the first association for HIV-positive patients has recently been seen in Ho Chi Minh.

In China, as in Vietnam, the most important evolution has consisted in the admission that the concept of prevention has to reach beyond simply deviants—prostitutes, homosexuals and drug addicts. Aids is no longer a disease of society (a healthy socialist society) but a disease within society, which implies fewer slogans and more information, education and prevention.

For an epidemic against which frontiers are particularly impotent, a look at the situation among one’s neighbours becomes apposite. With the opening of all the states of the Asian continent to the flows of capitalist markets, it would be something of an anachronism to shut the country up in a national approach. The accession of China to the WTO will be rapidly accompanied by a sudden global awareness of the battle against Aids, as separating the flow of goods and the way that diseases travel does not seem a very clear-headed approach. Health is also a global market. In this regard, the countries of market socialism have a lot to learn, but they do possess a major trump card: they are states that are “still strong”.

This is not the case with Cambodia, which offers the image of a dependent and aided country when it comes to Aids, similar to large parts of Africa. The NGOs are implementing “cultural” strategies here with fairly mediocre results, for lack of a political will that in Thailand was explicit and well timed.

For a long time India, a little like China, believed that Aids was a disease of degenerate foreigners. F. Bourdier reveals the previous aberrations in this regard and rightly underlines that Indian culturalist purism sometimes infects the social sciences when they refuse to put their finger on the major phenomena represented by the various social marginal groups in order to manage a lower-risk sexual practice. The ways that Aids is transmitted does not conform to the social norms and it is thus necessary to gain a better understanding of the pattern of risks, the logic behind them and how they are determined. The case of Nepal tackled by David Seddon fits into a similar context of strict segregation.

As in other Muslim states (Malaysia), Indonesia offers an example of a country where, despite a phenomenon of prostitution linked to poverty, the moralist religious discourse allows the necessity for a differentiated national policy to be hidden. The role of the foreign NGOs is thus important without ever being decisive, as it becomes a substitute for national responsibilities that have been poorly assumed. In Asia, as in Africa, the NGOs only treat the tip of the iceberg.

The case of Malaysia is emblematic of the political obscurantism where Aids is concerned. S. Vignato describes how Aids is invisible within this country. Despite a remarkably accessible health care system, the results of a liberalism that is combined with nationalism and “Islam” are crushing when it comes to prevention. The condom is presented as a threat to the ideological foundations of the nation, although Malaysia is one of the world’s principal producers of this contraceptive.

It is regrettable that in certain contributions that have not been mentioned there is an occasionally summary culturalism, but this is compensated for by the political maturity of the other articles. In fact, overcoming Aids is first of all a political process that is conducted through the action of the state, prevention, non-segregation and access to treatment. The cultural devices that are useful in some strategies are only adjuvants. The comparisons with Africa are illuminating and useful. Beyond the models of propagation that are specific and local, other factors such as underdevelopment, the vulnerability of women, inadequate detection and prevention by exclusion have been observed for a long time in Africa. Uganda, like Thailand, has faced up to the reality rather than denying it. In comparing the policies implemented in Burkina Faso and in Thailand, A. Desclaux reveals that the capacity of the state is crucial for organising society. If two epidemiological situations and two contexts of prevention can be observed in Africa and Asia, it remains true that the knowledge acquired about the modes of transmission, the representations of sexuality, the practices of drug addicts must circulate from Africa to Asia and from Asia to Africa. Because several Asian states possess a formidable power in this field, the responsibility is incumbent upon them to stop prevaricating, before it becomes too late.

Translated from the French original by Nick Oates