Globalization in Everyday Life. Stanford: Stanford University Press, 2021. xv, 258 pp. (Figures.) US$26.00, paper. ISBN 9781503628052.
As a globally synchronic event, the HIV/AIDS crisis spawned a veritable industry in historical, ethnographic, and cultural scholarship in the past four decades. Gowri Vijayakumar’s At Risk: Indian Sexual Politics and the Global AIDS Crisis is a recent arrival that proves just how much work there remains to be done. Vijayakumar tells a remarkably complex story of the Indian experience of the HIV/AIDS crisis since the first identified case in 1986. By the time fieldwork begins (in 2012), we are past India’s peak (around 1995) and headed into India’s HIV-prevention success story. Vijayakumar’s plotting of the “global AIDS field” interlaces institutional, financial, and political jockeying with self-directed organizing within Indian sexual cultures. This eight-chapter study is as satisfying in its macro-scalar perspectives on interactions among international donors, global institutions, state agencies, community-based organizations (CBOs), and non-governmental organizations (NGOs) as with its micro-historical relays of sex worker, sexual minority, and transgender life experiences. Choosing Bangalore because of language facility (in Kannada) as well as that city’s importance as a hub for Indian and African AIDS experts, Vijayakumar’s 18-month ethnography imparts a sense of the unexpected openings and transnational connections made possible in the wake of the global AIDS crisis.
The conceptual architecture of the book published in the “Globalization in Everyday Life” series makes its own argument. Global studies scholars often make the distinction between “globalization studies” focused on defining historical processes and relations —be that maritime exploration to building telecommunications infrastructures—and “global studies” oriented toward the dynamics arising from these drivers. Always more than the sum of its parts, the global is an emergent horizon of unfolding effects that cannot be characterized as international or transnational. The attention to global dynamics insists that this emergent horizon is not exclusively impelled by macro-scalar movements—of capital, of labour, of information, for example. It is always already calibrated by heterogenous actors such as the sexual minorities in At Risk who orient possibilities in a given playing field. At Risk tunes us in to these global dynamics set in motion by the recognition of HIV/AIDS infection as an anticipated national crisis, arising in the fold between the “West” and “Africa” (Kenya as exemplar). In this story, Kenya is important because that nation’s infection rates among heterosexuals as early as 1985 grabbed the attention of Indian researchers; post-2010s, India’s success in leveraging the expertise of at-risk “key populations” as peer educators and community organizers became a model for Kenya. Instead of romanticizing post-Cold War South-South solidarities, Vijayakumar astutely demonstrates how geopolitical hierarchies came to shape the Indian take on the “African AIDS crisis.” Haunted by colonial racial-sexual imaginaries, Kenya was exactly what India sought not to become. At the same time, sex workers and sexual minority activists in Kenya continued to draw inspiration, carefully and eclectically, from Indian self-organizing groups. Such histories place At Risk in conversation with classics such as Priscilla Wald’s Contagious: Cultures, Carriers, and the Outbreak Narrative (Duke University Press, 2007) that chart HIV/AIDS imaginative geographies and Jeremy Youde’s Global Health Governance (Oxford University Press, 2012) on the institutional evolution of the global health enterprise. Vijayakumar’s perusal of interactions between nations and global institutions, between federal and regional state agencies, and between differently structured organizations (like CBOs or NGOs) discloses the “global AIDS field” as the morphing actions of multiple agents adjusting, adapting, and recalibrating their relations. For students of global studies, the book eschews a banal reading of the global as simply the story of capital flows.
“The global AIDS field” is a useful category for tracking not only the relations and networks among AIDS institutions but also the transformation of Indian sexual politics. By the mid-1990s, the inordinate amount of funding pouring in for HIV prevention created new financial and institutional contexts, changing existing hierarchies. Vijayakumar tracks how national bodies like the National AIDS Control Organization (NACO) became semi-autonomous, joining NGOs in their struggles (such as the Naz Foundation’s petition against the infamous Section 377 penal code); and how regional collectives such as the Kolkata-based Durbar Mahila Samanwaya Committee (DMSC) or the Maharashtra-based Sampad Grameen Mahila Sanstha (SANGAMA) burgeoned as a result of “organizing on the basis of sexuality” (83). In these ways, the AIDS crisis transformed the terrain on which sex workers, sexual minorities, and transgender people engaged the state, challenging everything from economic exclusion to political rights. While a top-down story would see these changes as a reaction to global drivers, Vijayakumar expertly circumvents that pallid tale with an ethnography of “at risk” groups who perform politically efficacious “risky selves.” With global initiatives like the Gates Foundation’s Avahan (entering India in 2003) dependent on lay experts and peer educators, self-directed actors not only espoused a “therapeutic citizenship” (pace Vinh-Kim Nguyen’s Republic of Therapy, Duke University Press, 2010) but also placed and negotiated a series of demands (such as better treatment from local police or electoral representation). As one protagonist, the transgender sex worker Preethi put it, a new “claimingness” had “come forward” in which sexuality was the fulcrum for political demands around race, caste, class, and gender. In this catalog of life experiences, Vijayakumar joins well-known HIV/AIDS scholarship on the feedback effects between the HIV/AIDS crisis and sexual cultures—from Cindy Patton’s Inventing AIDS (Routledge, 1990) and Catherine Waldby’s AIDS and the Body Politic: Biomedicine and Sexual Difference (Routledge, 1996) in the early decades to João Biehl’s Will to Survival: AIDS Therapies and the Politics of Survival (Princeton University Press, 2008) and Brian King’s States of Disease: Political Environments and Human Health (University of California Press, 2017) in the twenty-first century.
Vijayakumar’s lucid qualitative analysis of the HIV/AIDS crisis in India critically frames the “Indian model” of HIV prevention that is vaunted as a success story. By 2017, writes Vijayakumar, HIV/AIDS infection rates had dropped by 85 percent. But how do we evaluate this success? In line with critical global health studies that question metrics as the measure of health—for example, essays in Metrics: What Counts as Global Health (edited by Vincanne Adams, Duke University Press, 2016), or South Asian ethnographies like Dwaipayan Banerjee’s Enduring Cancer: Life, Death, and Diagnosis in Delhi (Duke University Press, 2020)—Vijayakumar analyzes quantitative assessments that categorize, aggregate, and enumerate thresholds in accordance with the global AIDS risk calculus. Such data-driven transcriptions are what made the Indian model portable, to be sure, determining global distributions of HIV intervention packages; but they also flattened all that made HIV lifeways possible—housing, social connections, physical safety, food security, affordable long-term healthcare, etc. The compelling interviews in At Risk correct the calculative canvas by bringing unforgettable insights to bear on institutional ecologies and histories, therein reshaping what “after AIDS” might mean today. Published in 2021, the book’s open-endedness about the ongoing global dynamics of acute infectious disease emergences is prescient as we continue to ask what the HIV/AIDS crisis can teach us about living with our current global pandemic.
Bishnupriya Ghosh
University of California, Santa Barbara