HIV-related Citizenships: Exploring framings, identity and mobilisation of marginalised groups affected by HIV Date: 01:01:2006

The initial AIDs response in the North Came out of the group immediately at risk - gay men Momentum came out of pre-existing struggle for sexual rights Gay people mobilised alongside a health response to ‘high risk groups’ Gay men recognised their risk, but also contested these categorisations Emphasis also on care and solidarity with those infected in the community Later, with ARVs - a new emphasis on access and keeping people alive Human rights important - esp. in the greater involvement of HIV + people

Came out of the group immediately at risk - gay men

Momentum came out of pre-existing struggle for sexual rights

Gay people mobilised alongside a health response to ‘high risk groups’

Gay men recognised their risk, but also contested these categorisations

Emphasis also on care and solidarity with those infected in the community

Later, with ARVs - a new emphasis on access and keeping people alive

Human rights important - esp. in the greater involvement of HIV + people

The shift to an ‘African epidemic’ In Africa, the response shifted from behaviourally defined groups towards broader categories of ‘vulnerable people’ (women, poor) Notion of high risk groups in Africa was rejected because of sensitivities around associating African people with further stigma Prevention + vulnerability  the HIV-negative seen most relevant Civil society mobilisation in response to HIV was more diffuse With treatment in the North issues of inequalities in access to medication came to the fore and stimulated new understandings of global biopolitics. Framings of HIV positive people led to more specific mobilisation of HIV+ Recognised agency and used a language of universal rights to health. (see Nguyen’s observation of shift from bio-sociality to biopolitics in his account of ‘therapeutic citizenship’)

In Africa, the response shifted from behaviourally defined groups towards broader categories of ‘vulnerable people’ (women, poor)

Notion of high risk groups in Africa was rejected because of sensitivities around associating African people with further stigma

Prevention + vulnerability  the HIV-negative seen most relevant

Civil society mobilisation in response to HIV was more diffuse

With treatment in the North issues of inequalities in access to medication came to the fore and stimulated new understandings of global biopolitics.

Framings of HIV positive people led to more specific mobilisation of HIV+

Recognised agency and used a language of universal rights to health. (see Nguyen’s observation of shift from bio-sociality to biopolitics in his account of ‘therapeutic citizenship’)

Rediscovering key marginalised groups? Meanwhile, SWs and MSM became a focus in Asia and Lat America There was a shift ot interest from ‘high risk groups’ to risk behaviour groups (MSM, SW’s, IDU), later ‘key populations’ and ‘most at risk’ The survival and evolution of these debates encountered a new interest in its application to African and other high-prevalence contexts Here too, male-to-male sex and transactional sex are increasingly recognised as significant ( re: the failure of generalised approaches)

Meanwhile, SWs and MSM became a focus in Asia and Lat America

There was a shift ot interest from ‘high risk groups’ to risk behaviour groups (MSM, SW’s, IDU), later ‘key populations’ and ‘most at risk’

The survival and evolution of these debates encountered a new interest in its application to African and other high-prevalence contexts

Here too, male-to-male sex and transactional sex are increasingly recognised as significant ( re: the failure of generalised approaches)

In the paper we expore this shift in terms of citizenship, identity and mobilisation, beyond that centered on an HIV positive status We want to consider two of these behaviourally categorised populations, SWs and MSM, in Asian contexts We examine how these constructs relate to how people in these groups mobilise and/or identify in relation to global and local HIV responses Potential benefits of a broader concept of HIV related citizenships to understand how overlapping HIV-related subject positions have been co-constructed in interaction with the global AIDS response.

In the paper we expore this shift in terms of citizenship, identity and mobilisation, beyond that centered on an HIV positive status

We want to consider two of these behaviourally categorised populations, SWs and MSM, in Asian contexts

We examine how these constructs relate to how people in these groups mobilise and/or identify in relation to global and local HIV responses

Potential benefits of a broader concept of HIV related citizenships to understand how overlapping HIV-related subject positions have been co-constructed in interaction with the global AIDS response.

Naming and framing’ in the co-construction of categories MSM and SW seen from a public health perspective as targets for interventions and as ‘drivers of transmission’ (e.g. the once-used term ‘core transmitter groups’ or ‘vectors’) HIV status often unknown, though may also be HIV positive Groups redefined in global activist discourse as most vulnerable populations Organisation amongst these populations in the South evolve in interaction with the global AIDS response as well as the globalisation of sex Certain identities did exist, but new constructs provided opportunities for broader identities Resources in the AIDS response are generating new possibilities for social and political organisation of these marginalised groups Example of Men who have Sex with Men in India

MSM and SW seen from a public health perspective as targets for interventions and as ‘drivers of transmission’ (e.g. the once-used term ‘core transmitter groups’ or ‘vectors’)

HIV status often unknown, though may also be HIV positive

Groups redefined in global activist discourse as most vulnerable populations

Organisation amongst these populations in the South evolve in interaction with the global AIDS response as well as the globalisation of sex

Certain identities did exist, but new constructs provided opportunities for broader identities

Resources in the AIDS response are generating new possibilities for social and political organisation of these marginalised groups

Example of Men who have Sex with Men in India

Multiple identities and layers of stigma Individuals may ‘qualify’ in different co-constructed groups at the same time Nevertheless, programmes usually focus on one single aspect and people may fall through the cracks, not have their relevant needs met (e.g. male sex workers’ needs not met by all MSM programmes, or transgender women labelled ‘MSM’) Overlaps may result in multiple layers of stigma and discrimination This can become a disincentive for collaboration, as some will want to dissociate from more stigmatised identities (if HIV positive, you may not also want to be seen as a sex worker) In some contexts, being HIV + might brings resources (even potentially provides a ‘career’).

Individuals may ‘qualify’ in different co-constructed groups at the same time

Nevertheless, programmes usually focus on one single aspect and people may fall through the cracks, not have their relevant needs met (e.g. male sex workers’ needs not met by all MSM programmes, or transgender women labelled ‘MSM’)

Overlaps may result in multiple layers of stigma and discrimination

This can become a disincentive for collaboration, as some will want to dissociate from more stigmatised identities (if HIV positive, you may not also want to be seen as a sex worker)

In some contexts, being HIV + might brings resources (even potentially provides a ‘career’).

Mobilising around issues other than HIV Overlapping identities also highlight the fact that individuals have multiple needs and aspirations not necessarily related to HIV and AIDS Example – sex worker mobilisation in India: Public Health category of SW helped a pre-existing community to organise also as low income women: Mobilise also around local issues Issues of livelihoods and sustainability Seeking broader civil rights

Overlapping identities also highlight the fact that individuals have multiple needs and aspirations not necessarily related to HIV and AIDS

Example – sex worker mobilisation in India: Public Health category of SW helped a pre-existing community to organise also as low income women:

Mobilise also around local issues

Issues of livelihoods and sustainability

Seeking broader civil rights

The tension between citizenship and ‘legality’ curtainiling rights Citizen group claims to rights counter-posed with responsibilities. Responsibilities in relation to therapeutic citizenship (Robins), may have parallels with approaches to these groups For sex workers – eg. compliance with 100% condom use or STI and HIV testing. In this rights easily get forgotten – particularly when epidemiological/public health labels on people are defined by behaviours which are criminalised. This can shift into a ‘blaming framing’ from certain sectors (such as the police) There is also complicity of international agencies in repressive practices has been documented (e.g. the closing of brothels and incarceration of sex workers in response to international pressures for anti-trafficking ‘crack-downs’)

Citizen group claims to rights counter-posed with responsibilities.

Responsibilities in relation to therapeutic citizenship (Robins), may have parallels with approaches to these groups

For sex workers – eg. compliance with 100% condom use or STI and HIV testing.

In this rights easily get forgotten – particularly when epidemiological/public health labels on people are defined by behaviours which are criminalised.

This can shift into a ‘blaming framing’ from certain sectors (such as the police)

There is also complicity of international agencies in repressive practices has been documented (e.g. the closing of brothels and incarceration of sex workers in response to international pressures for anti-trafficking ‘crack-downs’)

The tension between citizenship and ‘legality’ curtainiling rights Neither ‘the state’ nor the ‘global response to AIDS’ always operate as coherent unified entities and citizen groups relate differently to different stakeholders and gatekeepers. Cambodian example: conflicting interventions and framings around ‘sex-trafficking’ and the 100% condom use policy for sex workers Different constituencies in UNSAID, UNICEF and the Cambodian government working at cross-purposes

Neither ‘the state’ nor the ‘global response to AIDS’ always operate as coherent unified entities and citizen groups relate differently to different stakeholders and gatekeepers.

Cambodian example: conflicting interventions and framings around ‘sex-trafficking’ and the 100% condom use policy for sex workers

Different constituencies in UNSAID, UNICEF and the Cambodian government working at cross-purposes

What can these ways of thinking offer Agency and politicised citizenship of those most implicated in the dynamics of the epidemic is what drives effective responses to AIDS. Groups of HIV positive people, sex workers, sexual minorities and some other groups are identifying and organising in interaction with the (categories of the) global AIDS respone. Individuals, here, often have distinct and/or overlapping identities between these HIV-related groups, which can compete or co-operate in solidarity. The groups usually have (partially overlapping) networks of supporters and strategic allies – as well as antagonists – from local to global levels.

Agency and politicised citizenship of those most implicated in the dynamics of the epidemic is what drives effective responses to AIDS.

Groups of HIV positive people, sex workers, sexual minorities and some other groups are identifying and organising in interaction with the (categories of the) global AIDS respone.

Individuals, here, often have distinct and/or overlapping identities between these HIV-related groups, which can compete or co-operate in solidarity.

The groups usually have (partially overlapping) networks of supporters and strategic allies – as well as antagonists – from local to global levels.

What can these ways of thinking offer Leach and Scoones (2007) offer an integrated perspective which recognises that people draw on overlapping subject positions in contingent ways. Different political identities can be drawn on at relevant moments as the basis of citizen action, which may or may not be aimed at the state. They describe citizenship in more actor-oriented terms as “ practiced engagement through emergent social solidarities ”. This perspective on citizenship might offer a staring point for developing a useful broader concept of HIV-related citizenship. We need a nuanced concept which captures a more fluid reality in which people may mobilise around aspects of identity and context which best captures their relation(s) to the virus (as at risk, infected and/or affeceted).

Leach and Scoones (2007) offer an integrated perspective which recognises that people draw on overlapping subject positions in contingent ways.

Different political identities can be drawn on at relevant moments as the basis of citizen action, which may or may not be aimed at the state. They describe citizenship in more actor-oriented terms as “ practiced engagement through emergent social solidarities ”.

This perspective on citizenship might offer a staring point for developing a useful broader concept of HIV-related citizenship.

We need a nuanced concept which captures a more fluid reality in which people may mobilise around aspects of identity and context which best captures their relation(s) to the virus (as at risk, infected and/or affeceted).