At risk: Indian sexual politics and the global AIDS crisis Gowri Vijayakumar Stanford University Press: Stanford, California. 2021. xvi+258 pp. US$26.00 (paperback). ISBN: 9781503628052.
Gowri Vijayakumar's book, At Risk: Indian Sexual Politics and the Global AIDS Crisis, provides an excellent ethnographic account of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), sex workers, queer, and transgender activism, and the transformation of sexual culture in India. Drawing on a compelling range of sources, including oral history interviews, popular press stories, medical journal articles, public health monographs, and reports of the governments, nongovernmental organizations, donors, and United Nations agencies, the author traces how AIDS and ideas of sexuality associated with it arrived in this country during the age of globalization and gradually became “the ‘fulcrum’ for constructing difference around race, caste, gender, and class” (p. 6). While exploring the experiences of the AIDS crisis, material practices of the state, and sociopolitical mobilizations in the global South, the book masterfully illustrates the myriad ways in which HIV prevention programs affected and reshaped the everyday lives of the sexually marginalized. During the mid-1990s, India came to be understood as at risk of becoming what Africa had already become. Scientists, policymakers, and media persons marked AIDS in this country as a Western vice—a sexually transmitted infection, which chiefly spreads through indiscriminate heterosexuality and homosexuality. It was anticipated that the conservative value system and single partner sex life of Indian adults will prevent the infliction of foreign sexual promiscuity into society and thereby reduce the risk of their exposure to AIDS. Vijayakumar shows the initial identification of AIDS as Western was gradually replaced with the theory of African origin of the disease. Soon a heated debate ensued about whether India will face an Africa-like crisis or not—one which located India within a global map of the AIDS epidemic. Increasing cases of female prostitutes in several parts of the country gave experts credence to claim India's AIDS epidemic as heterosexual, more similar to the African epidemic than Western homosexual ones. Indian sex workers and African sojourners (mainly students) were labelled as high-risk groups. Consequently, they faced many repressive measures taken by the state. In the wake of rising Hindu fundamentalism in the 1990s, these two groups were also stereotyped as hypersexual and perilous to the moral foundation of Indian society. The accounts of a looming crisis were thus, Vijayakumar argues, informed by the gendered, racial, and religious forms of inequality, exclusion, and oppression. However, in all these epidemiological narratives, the LGBTQIA+ community was rendered largely invisible. The strategy of isolating and criminalizing the gendered and sexual others was largely influenced by the colonial and postcolonial policies of containing deviant sexuality to control sexually transmitted diseases. But such a policy of containment in the early stages of the Indian AIDS response had some unanticipated outcomes. Vijayakumar reveals how the attempt of containing the risk among sex workers, sexual minorities, and transgender people paved the way for the necessary but conditional incorporation of these high-risk groups into the state programs for AIDS prevention. With the establishment of a relatively autonomous, semi-independent agency, the National AIDS Control Organization (NACO), the Indian response to the crisis shifted from a strategy of criminalization and marginalization to a strategy of incorporation. However, it would be wrong to assume that switching to the policy of inclusion was driven by any urge for adopting an enlightened strategy by the state. The inexorable demands from the high-risk groups for participation in the AIDS programs forced the state to acknowledge the functionality of these groups in the planning and execution of the program. The involvement of international donors in policy formulation also necessitated a reconfiguration of the ways through which the state could respond to the crisis. The author narrates how global funding and the engagement of civil society in the program gave the NACO a distinct hybrid structure. In this process, the Indian AIDS response constructed multivalent spaces within which the sexually marginalized could not only actively engage with the state but also find out new ways of asserting sexual identity. The scenario thus involved a “paradigm shift” from narrow biomedical approaches looking at AIDS as merely a public health challenge toward more rights-based approaches. It is intriguing that the Indian HIV prevention program was almost identically translated in Kenya, though “the circulation of best practices was never as simple as it looked on paper” (p. 151). The differences and similarities between the conditions of these two countries largely informed how AIDS experts approached transnational exchange to manage the epidemic. India–Africa collaboration, according to Vijayakumar, helped a somewhat sexually conservative state like India gain the status of a model nation within “the global AIDS field.” Thus, the book demonstrates how a catastrophic crisis was defined and contested in one global South context and then repurposed in another global South context. It undoubtedly serves as a welcome contribution to the expanding sociological field of sexual humanitarianism.
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