At Risk
Indian Sexual Politics and the Global AIDS Crisis
Gowri Vijayakumar




Sex is always political. But there are also historical periods in which sexuality is more sharply contested and more overtly politicized. In such periods, the domain of erotic life is, in effect, renegotiated.

Gayle Rubin

AS I BEGAN TO MAKE MY WAY from a sex worker health clinic in Nairobi to the nearby minibus taxi (matatu) stop, a woman in the waiting area asked very politely if she could have a word with me. Grace was small and thin, with a jagged scar across her mouth. Tentatively, but insistently, she told me she was a sex worker and had previously worked at the clinic as an HIV peer educator. Then she had been arrested while doing sex work. When she was finally released from jail, she found herself destitute. She had three children, she said, one only seven months old. She might be dressed well, she pleaded, as though that might have dissuaded me, but she had nothing. Could I find her a spot in the next peer educator training session? She rifled through her handbag until she found a crumpled business card to show me. I was surprised to see the familiar logo of a sex workers’ rights and HIV prevention organization based in Karnataka, India.

How did this business card from Karnataka find its way to a sex worker in Nairobi? Answering this question demands an analysis that moves across scales. It requires an understanding of global institutions: agencies including UNAIDS, UNFPA (United Nations Population Fund, the UN sexual and reproductive health agency), the WHO, and the World Bank and donors like USAID (US Agency for International Development) and the Gates Foundation. These global institutions play a defining role in what this book refers to as a global AIDS field. But understanding Grace’s request also requires an understanding of how nation-states govern sexuality within the global AIDS field and how social movements respond to and transform that process of governance. Ultimately, nongovernmental organizations (NGOs), community-based organizations (CBOs) and activists formed the heart of HIV prevention efforts. They formed the context in which Grace, a sex worker, might associate me, a visiting Indian American, with a possible clinic job.

This approach, the one I take in this book, differs from the way many social scientists have studied AIDS. A range of social scientists has written about AIDS, showing that the social and political drivers of AIDS are often missed in biomedical interventions.1 In India, extensive public health literature assesses the successes of AIDS programs.2 But what I aim to do in this book is place the analytical focus beyond the drivers of the global AIDS crisis and their possible responses, to the political reconfigurations that ensued from it. In this way, this book is in line with scholarship that considers what the AIDS response can tell us about politics.3

Critiques of Indian AIDS programs form a powerful foundation for this book. For decades, scholars and activists have exposed the limits of the response to AIDS in India, arguing that it criminalized and isolated the vulnerable, imposed reified biomedical categories on diverse forms of sexual life, and laid the groundwork for further biomedical intervention.4 The response to AIDS was always tied up with global institutions: starting in the 1990s, funds and resources for HIV prevention flooded India from bilateral aid agencies, multilateral institutions, and corporate philanthropists. The response to AIDS in India was a global response; it was driven by global funders, agencies, and researchers with money and influence. This book builds on these critiques by analyzing how global institutions responded to the crisis on the terrain of politics—at the interface of the Indian state and Indian social movements.5 By the time it closed its doors, even the famous Gates Foundation program in India was forced to recognize the centrality of the state and social movements in addressing AIDS.6

This book argues that the global AIDS crisis temporarily transformed the terrain on which sex workers, sexual minorities, and transgender people7 engaged the state, both individually and collectively. The global AIDS crisis created a field that positioned nation-states in relation to each other. Within this field, African countries were in crisis, and India was at risk of one. AIDS experts considered sex workers, sexual minorities, and transgender people to embody the heart of this risk. But these groups were criminalized and stigmatized. To respond, state officials created hybrid institutions within the state that were insulated from the rest of a slow-moving and sexually conservative bureaucracy and intimately linked to global networks of experts and activists. Within these spaces, state officials could engage sexuality in new ways to prevent AIDS—moving from tactics of criminalization and marginalization to tactics of incorporation and inclusion. These institutional openings allowed state officials to contain risk, while creating hybrid sites within which sex workers, sexual minorities, and transgender people could experiment with new ways of articulating sexual identity and develop new strategies for engaging the state.

Social scientists have written about risk as an increasingly powerful organizing logic for politics. As the “anticipation of catastrophe,” risk creates a “global community of threats,”8 ranging from terrorism to economic collapse. But, as this book shows, risk is defined in relation to race, gender, sexuality, and geopolitics. In the case of AIDS, being marked at risk both built on and reinforced existing relations of hierarchy and exclusion.9 In order to contain the risk of becoming like Africa, India had to contain the groups that presented an internal threat to the nation’s morality, its gendered and sexual others.

The AIDS crisis was an opening into the remaking of Indian sexual politics, then, because it cut to the heart of tensions about the kind of nation-state India was and could be. Within the global AIDS field, AIDS epidemics and responses were compared, measured, and developed in relation to each other. For state officials, how India governed AIDS indexed India’s emergence as a modern, technically advanced nation-state that could respond to crisis with pragmatism and foresight. In extending its analysis to Kenya, this book charts how, throughout the AIDS response, the Indian state, and Indian sexuality, came to be represented, within this global AIDS field, as an alternative path to the devastation in sub-Saharan Africa. At the small clinic for Nairobi’s sex workers where Grace sought employment, several HIV experts from India had arrived in the last two years to conduct training and research. In this context, Grace could be forgiven for confusing me with other notebook-wielding middle-class Indian women who had passed through the clinic. The travel of HIV prevention strategies from India to Kenya reflected global institutions’ efforts to compare and categorize nation-states. But this process inadvertently opened up possibilities for redefining what sexuality meant, within India and also beyond it.


Epigraph is from Rubin, “Thinking Sex, “267.

1. See Farmer, AIDS and Accusation; Farmer, Infections and Inequalities; Padilla, Caribbean Pleasure Industry; Mojola, Love, Money, and HIV; Wyrod, AIDS and Masculinity; Carrillo, The Night Is Young; Campbell, Letting Them Die, and Watkins-Hayes, “Intersectionality and the Sociology of HIV/AIDS.”

2. See Blankenship et al., “Challenging the Stigmatization”; Alexander, A Stranger Truth; and Ng et al., “Assessment of Population-Level Effect.”

3. See Epstein, Impure Science; Biehl, “Activist State”; Biehl, Will to Live; Gould, Moving Politics; Nguyen, Republic of Therapy; Decoteau, Ancestors and Antiretrovirals; Benton, HIV Exceptionalism; and Swidler and Watkins, Fraught Embrace.

4. Khanna, “Taming of the Shrewd Meyeli Chhele”; Boyce, “Conceiving ‘Kothis’”; L. Cohen, “Kothi Wars”; Karnik, “Locating HIV/AIDS and India”; khanna, Sexualness; A. Dutta, “Legible Identities and Legitimate Citizens”; S. Ghosh, “Surveillance in Decolonized Social Space”; Chacko, Chasing Numbers Betraying People; ABVA, Women and AIDS; and ABVA, Less Than Gay.

5. Theories of biological citizenship often overlook the role of the state in delivering HIV care and in being a site of allegiance and aspiration. Benton, HIV Exceptionalism, 136.

6. Mahajan, “Philanthropy and the Nation-State.”

7. I use the term sex worker to refer to people who exchange sex for money, though I recognize the term is shorthand and includes many who may not identify with this term. I use sexual minority as shorthand for accommodating a wide range of sexual identities, categories, and preferences, including gay, lesbian, bisexual, and double-decker (usually used to describe a masculine person who prefers both receptive and penetrative sex with men). My use of transgender people includes those who might call themselves transgender, as well as those who might call themselves kothi (usually used to describe an effeminate man or gender-nonconforming person who prefers receptive sex with men) or hijra (usually used to describe someone assigned masculine gender at birth who wears conventionally female clothing and participates in the hijra system of family relationships, religious and cultural traditions, and economic ties). I use these terms with the recognition that these terms are partial, shifting, and fluid, and that they often overlap. Nevertheless, I find these terms more broadly useful, and more aligned with the terms used by activists I foreground in this book, than the narrower epidemiological terms female sex worker and men who have sex with men that typically appear in public health literature.

8. Beck, World at Risk, 9.

9. Sangaramoorthy, “Treating the Numbers.”