A New Look At Thai Aids: Perspectives from the Margin 9781782387145

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A NEW LOOK AT THAI AIDS

Fertility, Reproduction and Sexuality GENERAL EDITORS: David Parkin, Director of the Institute of Social and Cultural Anthropology, University of Oxford Soraya Tremayne, Co-ordinating Director of the Fertility and Reproduction Studies Group and Research Associate at the Institute of Social and Cultural Anthropology, University of Oxford and a Vice-President of the Royal Anthropological Institute Volume 1 Managing Reproductive Life: Cross-Cultural Themes in Fertility and Sexuality Edited by Soraya Tremayne Volume 2 Modern Babylon? Prostituting Children in Thailand Heather Montgomery Volume 3 Reproductive Agency, Medicine and the State: Cultural Transformations in Childbearing Edited by Maya Unnithan-Kumar Volume 4 A New Look at Thai AIDS: Perspectives from the Margin Graham Fordham Volume 5 Breast Feeding and Sexuality: Behaviour, Beliefs and Taboos among the Gogo Mothers in Tanzania Mara Mabilia Volume 6 Ageing without Children: European and Asian Perspectives on Elderly Access to Support Networks Philip Kreager and Elisabeth Schröder-Butterfill Volume 7 Nameless Relations: Anonymity, Melanasia and Reproductive Gift Exchange between British Ova Donors and Recipients Monica Konrad Volume 8 Population, Reproduction and Fertility in Melanasia Edited by Stanley J. Ulijaszek

A NEW LOOK AT THAI AIDS Perspectives from the Margin

Graham Fordham

Berghahn Books New York • Oxford

First published in 2004 by Berghahn Books www.BerghahnBooks.com © 2004, 2006 Graham Fordham First paperback edition printed in 2006 All rights reserved. Except for the quotation of short passages for the purposes of criticism and review, no part of this book may be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system now known or to be invented, without written permission of the publisher. Library of Congress Cataloging-in-Publication Data Fordham, Graham. A new look at Thai AIDS : perspectives from the margin / Graham Fordham p. cm. – (Fertility, reproduction, and sexuality ; v. 4) Includes bibliographical references and index. ISBN 1-57181-519-8 (hardback) — ISBN 1-84545-233-X (pbk.)

1. AIDS (Disease)–Thailand. I. Title. II. Series. RA643.86.T5F67 2004 614.5’99392’09593–dc22 2004053831 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. ISBN 1-57181-519-8 (hardback) ISBN 1-84545-233-X (paperback) ISBN

CONTENTS

List of Acronyms

vii

Preface

ix

Acknowledgements

xiii

Author’s Note

xv

1. Introduction: The Issues

1

2. Creating Thailand’s AIDS Epidemic

18

3. Northern Thai Male Culture and the Assessment of HIV Risk: Towards a New Approach

51

4. Muddy Waters: The Construction of HIV/AIDS in Northern Thailand’s Thai Language Print Media

86

5. Moral Panic and the Contruction of National Order: HIV/AIDS Risk Groups and Moral Boundaries in the Creation of Modern Thailand

127

6. Tradition, Sex and Morality: HIV/AIDS and the Pathologising of Adolescent Sexuality in Northern Thailand

181

7. Conclusion: Directions Forward

234

Postscript

249

Bibliography

253

Author Index

299

Subject Index

311

LIST OF ACRONYMS

ARC AZT CARE CBO CSW ECPAT HBM HIV/AIDS IDU IEC IMF IO IVDU KABP KAP MHSWM MOPH NAPAC NGO NSM PACT PCDA PHA PMSL PRA PWA RAP STD STI TRA UN

AIDS related conditions Azidolthymidine (commonly known as Zidovudine or ZDV) Cooperation for Assistance and Relief Everywhere Community Based Organisation Commercial sex workers End Child Prostitution in Asian Tourism Health Belief Model Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Intravenous drug user Information Education and Communication International Monetary Fund International Organisation Intravenous drug user Knowledge, Attitude, Belief, Practice Knowledge, Attitude, Practice Men having sex with men Ministry of Public Health Thai-Australia Northern AIDS Prevention and Care Program Non-Governmental Organisation North Siam Mission Private Agencies Collaborating Together Population and Community Development Association People having AIDS Presbyterian Mission Siam Letters Participatory Rural Appraisal People with AIDS Rapid Assessment Procedure Sexually transmitted disease Sexually transmitted infection Theory of Reasoned Action United Nations

viii

UNAIDS UNDP UNFPA UNICEF USAID WHO ZDV

List of Acronyms

Joint United Nations Programme on HIV/AIDS United Nations Development Programme United Nations Population Fund United Nations Children’s Fund United States Agency for International Development World Health Organisation Zidovudine (chemical name Azidolthymidine)

PREFACE

T

his book draws on anthropological research about HIV/AIDS that I have conducted in Northern Thailand over the past decade, on research experience gained in studying the Cambodian, Lao, and sub-Saharan African AIDS epidemics over the same period, and on AIDS-intervention campaigns in which I have been involved in Northern Thailand and Cambodia. It comprises a series of essays dealing with various aspects of the Northern Thai HIV/AIDS epidemic. These follow my AIDS research interests as they developed over this period and are concerned with an ongoing examination of the normative modelling of Northern Thailand’s AIDS epidemic, and pursue issues of power, class, interest, gender issues, and the overwhelming concern that issues of morality have played in the construction of the epidemic and in behavioural modification programmes designed to curb its spread. Chapter one introduces my overall argument and the central themes developed in subsequent chapters, while chapter two takes up the issue of the modelling of the Thai AIDS epidemic. Subsequent chapters appear in the chronological order in which they were conceived as my research and analysis of Thai AIDS issues developed over the decade of the 1990s. Two chapters, chapters three and five, have been published previously, while the Preface and chapters one, two, four, six, and seven are published here for the first time. As I discuss at greater length below, the research I conducted over this period was conducted in response to what I call the normative model of the Thai AIDS epidemic, the common shared perspectives in the medical, government and international organisation/non-governmental organisation (IO/NGO) communities as to the shape of the AIDS epidemic, the central problems and their solutions. The central paradigms about which Thai AIDS discourses have been constructed were set very early on in the epidemic, certainly by the 1991 to 1992 period and, in a highly

x

Preface

tautological fashion, after this time the bulk of AIDS research has been conducted in respect to the areas and the issues delineated in these paradigms. Indeed, almost a decade ago Scheper-Hughes (1994) commented on what she saw as the high level of agreement in respect to what the issues were in both the African and international AIDS fields. In Thailand, since the early 1990s, the bulk of work in the Thai AIDS field (and the South East Asian AIDS field generally) has lacked any sense of the need for, or the possibility of, a reflexivity that might question its fundamental epistemological or methodological assumptions. The epistemological basis of recent works by Bond et al. (1999), Lyttleton (1999, 2000) and Wait and Coughlan (1999), for example, are clearly traceable to the paradigms of the late 1980s and early 1990s and make little or no attempt to challenge the assumptions on which these paradigms are based. As a result, the Thai AIDS world we have inherited in the early 2000s is a curious mix of extremely rigorous scientific modelling in the form of biomedical, demographic and epidemiological work, in concert with behavioural research and interventions (primarily conducted amongst the underclass for its own good), where scholarly rigour has been more appearance than reality and which have been theoretically grounded in little more than naive empiricism (compare Pigg 2001a: 488).1 The world so created is strangely reluctant to have its central paradigms criticised. For example, to question the taken-for-granted role of female prostitution in the spread of Thai AIDS, to question discourses about the effectiveness of the ‘100 Percent Condom Programme’, to raise questions about the nature of male risk taking, or even to ask what the concept of empowerment of commercial sex workers means in practice, or to ask how truly participatory are participatory methodologies when used in highly hierarchical social systems, is to risk being labelled irrelevant, as such questioning demonstrates a lack of understanding of ‘how things are’. Yet, nineteen years after the AIDS virus was first detected in Thailand, it is surely time to ask questions about the modelling of the epidemic and about the concepts that have been (and remain) fundamental in guiding Thai AIDS research and interventions. Importantly, to raise such questions is not to deny that AIDS is a terrible affliction, or to deny that much good is done by many IO/NGO workers conducting AIDS interventions, or by workers 1. By naive empiricism I refer to a mode of interpretation that takes behaviour at face value, that ignores factors such as culture, context and social theory, and pays little attention to the research methodologies through which data were gathered.

Preface

xi

in the medical professions who work amongst the afflicted. It is merely to raise questions with, in the best tradition of the Greek word kritos (from which our English words critic and critical derive), the aim of making an informed and closely reasoned evaluation regarding the utility of these concepts both in the past and in the future.

ACKNOWLEDGEMENTS

M

y thanks to those friends and colleagues with whom I have discussed my research over the years, who encouraged me to persevere in the task of ‘making sense’ of Thailand’s HIV/AIDS epidemic and who have taken time reading and commenting on sections of this book. Thanks in particular to Hjorleifur Jonsson, Jeff Walton and John Butcher. Thanks also to my wife, Ornrudi, for her support of my research and writing activities. My thanks too to the many young Northern Thai, Khmer and Lao men and women amongst whom I conducted my research over the past decade and whose lives, and all to often, untimely deaths, form the subject matter of this book. My hope is that the questions I raise here and the solutions I advocate might contribute to the development of more effective AIDS interventions so that in the future fewer young people might lose their lives to this heinous disease.

AUTHOR’S NOTE

T

hose organisations and individuals who assisted most in the crafting of this volume are the powerful international organisations and increasingly well funded and powerful non-governmental organisations and their staff who work in the HIV/AIDS sphere in South East Asia. While legitimating the increase in their power and influence by recourse to humanitarian sentiment, these groups and individuals seek the domination of the AIDS sphere in the South East Asian region through defining the nature of the HIV/AIDS epidemic(s) as a social and medical problem relevant to their own spheres of interest and control. In the case of large international organisations, their manipulation of AIDS research agendas due to the control they exercise over research funding gives them a high degree of influence over the direction of most AIDS related research, and a near total domination of the social and behavioural interventions indicated by that research. For me, possessed with an unintended and unrecognised hubris regarding the role of anthropology and other scholarly disciplines such as sociology and history in the study of Thailand and in the conduct of Thai AIDS research and interventions, it took extended contact with such organisations and their staff over a period of years before the penny dropped. Eventually, if rather belatedly, I realised that as far as the AIDS research and intervention activities of these organisations were concerned, and for their highly paid expatriate managerial staff, their life on a shoestring expatriate interns on their ‘post graduation Asian experience’, as well as for their indigenous staff lucky enough to land positions that characteristically pay more than local wage rates, the kind of in-depth ethnographic AIDS research social scientists conduct and the scholarly articles we publish were totally irrelevant. Most were unaware of the existence of such work and, if they were

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Author’s Note

aware of it, had rarely read it. The insights that long-term field research and laboriously crafted analyses of the Thai AIDS epidemic may contain, the fruits of finely nuanced and critically reflexive analyses, spoke neither to their AIDS epidemic, nor to their AIDS epidemic agendas. Their AIDS epidemic was defined by donors’ objectives, by project time-lines, by reporting and evaluation needs, and by their organisations’ plans for expansion in areas likely to attract funding. Almost all organisations (IOs and NGOs) considered the AIDS epidemic created by Thai scholars in Thai-language medical and social science journals irrelevant to their interests and, for many organisations in the non-government sphere the AIDS epidemic created by biomedicine in English-language medical journals was also considered largely irrelevant. Instead, their AIDS epidemic was the Thai end of a worldwide AIDS pandemic, one inscribed solely in English in their own and other organisations’ (such as the World Health Organisation and UNAIDS) manuals of best practice for research and intervention, in what has largely become an internationally standardised set of social and medical facts about AIDS, and the associated policy wisdom about how AIDS research and interventions should proceed. It was these organisations, intolerant and dismissive of alternative paradigms and, in their self-serving denial of the significance of history, of local cultures and local meanings, and of issues such as ethnicity and class in understanding and curbing the Thai AIDS epidemic, ultimately less guilty of naive empiricism than of studied interest-driven myopia and of bad faith, that prompted me to start asking questions about how the ‘normative’ model of Thailand’s’ AIDS epidemic had been constructed and whose interests this most served.

CHAPTER 1

INTRODUCTION: THE ISSUES

T

his book makes a critical examination of Thailand’s HIV/AIDS epidemic over the past nineteen years. It examines the period from the finding of the first HIV-positive persons in the early 1980s, through the early 1990s when the epidemic was routinely depicted as the world’s fastest moving AIDS epidemic, up until the early 2000s when the bulk of scholarly and medical literature portrays Thailand’s AIDS epidemic as being largely under control, and thus Thai AIDS prevention efforts over the past decade as a success story (Ammann and Nogueira 2002; Brown et al. 1998a, 1998b; Kilmarx et al. 2000; World Bank 2000; Sharma 2002). My overall interest is the manner in which the ‘problem’ of Thai AIDS has been constructed, and how the understandings about the nature of the Thai AIDS epidemic which were generated over this period acted to legitimate specific forms of gender and class-based interventions. I argue that the modelling of the Thai AIDS epidemic has been characterised by a class based paternalism and by analyses rooted in a Western middle-class morality, and that many of the ‘health’ interventions this has engendered are in essence little more than attempts in the exercise of power through covert measures of class control in the guise of behavioural surveillance, and through attempts to redraw the moral boundaries of Thai society in the guise of behavioural modification programmes. Critically, the Thai AIDS experience is important far beyond merely curbing the AIDS epidemic in Thailand. Many of the techniques used to combat and monitor the Thai AIDS epidemic have formed the basis for the WHO or Joint United Nations Programme on HIV/AIDS (UNAIDS) manuals of best practice and are in the process of being exported to much of the rest of South East Asia

2

A New Look at Thai AIDS

(see Brown et al. 1998a, 1998b; WHO 2000). In Cambodia, for instance, by 2002 several provinces or districts have implemented a 100 percent condom use policy for commercial sex establishments (National AIDS Authority 1999; UNAIDS 2001) based on the Thai model. Here, as in Thailand a decade earlier, the majority of the behavioural research, the interventions funded by major donors and conducted by International Organisations (IOs) and Non-Governmental Organisations (NGOs), and Khmer language popular media discourses of AIDS, rely on a model of HIV transmission between largely discrete risk groups (and an implicit model of wave transmission from these groups to the broader population), and on the modelling of women and their sexual behaviour into simplistic binary categories of ‘good’ and ‘bad’ women (Rousset et al. 1999), where prostitutes, as the paradigmatically bad women, are the primary cause of AIDS (Sor Romnar and Tandopbun 2001).1 By now, even high school texts depict female prostitutes as the primary cause of AIDS (Ministry of Education, Youth and Sport 2000). The situation is exacerbated in the early 2000s as middle-ranking Thai AIDS bureaucrats and IO/ NGO staff climb the international AIDS career path through postings in neighbouring countries. As they do so, many bring the class-based prejudices that have underpinned the Thai response to Thailand’s AIDS epidemic, and perpetuate the myths that AIDS is fundamentally a problem of the morality of the underclass, one caused by low levels of education.2 1. It is a matter of great personal sadness to watch the unfolding of the Cambodian AIDS epidemic, and to watch a new generation of young AIDS researchers repeat the mistakes of the Thai AIDS epidemic a decade ago. Thus, in the early 2000s, the Cambodian AIDS epidemic is defined by KAP, KABP research, and focus groups (Brown 1997; Glaziou et al. 1999; Marten 2000; Prybylski and Alto 1999). Here, a decade later, risk groups are as essentialised as they have been throughout the Thai AIDS epidemic (Greenwood 2000a, 2000b; Rousset et al. 1999; Shinsuke Morio et al. 1999). Also, as in the Thai case, much behavioural research data is interpreted and written up by young and inexperienced (but, as their employers frequently point out, extraordinarily inexpensive) Western interns with little experience in either Cambodia or in the AIDS field, but who exhibit an uncanny ability to assimilate local middle-class prejudices about men and women in the underclass. Critically, such an outcome is not the result of any personal deficiencies of the young people concerned, but is a normative outcome of class-based personnel selection criteria on the part of the bodies organising these voluntary positions. 2. A high-ranking Thai staff member in the Cambodian office of a well known and well funded AIDS NGO summarised the problem of Cambodian AIDS for me in just these stark and simplistic terms as late as January 2002. Ironically, she had only recently taken up her managerial position directing much of the organisation’s AIDS prevention and care activities.

The Issues

3

I argue here that the claim that Thai AIDS is a success story with its lessons being immediately translatable to neighbouring countries is too simple and too sweeping. Of course, lowered rates of HIV in sentinel surveillance groups are a ‘good thing’. However, I suggest that our focus on Thailand’s HIV/AIDS epidemic and HIV control measures should not be limited to the extent to which such statistical movements represent the ‘success’ or ‘failure’ of attempts to control the epidemic. Rather, it is time that the modelling of the Thai AIDS epidemic over the past nineteen years, and the dominant AIDS paradigms that directed interventions, be subject to a more comprehensive and more penetrating critical examination. A major problem that arose with attempts to curb Thailand’s AIDS epidemic is the fact that the dominant paradigms through which the epidemic was modelled were set at a very early stage in the epidemic. Since that time, any impetus towards paradigm change, or towards critically reflexive approaches that themselves would have encouraged paradigm change, have not just been neglected but have been actively discouraged by funding regimes that, tautologically, encouraged research and intervention projects to pursue issues that conformed with the dominant paradigms (Pigg 2001b). This has had real implications for AIDS prevention programmes, in as much as it is highly likely that other potentially fruitful interventions would have arisen from alternative modellings of the epidemic. It has also had real implications for those whose private lives and sexual practices came under the many forms of direct and indirect scrutiny and, yet more seriously, under the many sustained attempts at behavioural modification on the part of both state and private (IO/NGO) organisations, that these forms of modelling encouraged. Indeed, it is highly ironic that the first Thai HIV/AIDS cases appeared in 1984, as in terms of the surveillance it posits over the private lives and practices of the underclass, and in terms of the language through which it has remade and revalorised almost every sphere of their lives, the world of Thai AIDS is truly an Orwellian world.3 This world has been created over a period of 3. Such surveillance has primarily been directed at the underclass, who have few avenues of response beyond passive resistance (Scott 1985, 1989). However, the small amount of literature dealing with AIDS amongst the middle class suggests that they too are concerned with privacy issues. Thus, Kaew (2001) in The Critical Second: AIDS Diary, a diary of a young and single middleclass Thai woman who finds she is HIV positive, evidences not only surprise that someone of her background should contract HIV, but also extreme concern about the privacy of her medical records and the potential interventions in her personal life that such records could lead to.

4

A New Look at Thai AIDS

years through cooperation between a medical establishment concerned with enhancing the hegemonic position of biomedicine over other systems of medical and social knowledge (compare Paul Cohen 1989, Pigg 2001a, 2001b; Whittaker 2000), and a state concerned about globalisation and transforming public cultures which have offered unprecedented levels of personal freedom to the underclass. In concert with these, the neo-lowermiddle class staff of IO/NGO groups have assessed the ‘risk behaviour’ of the underclass and proselytised right knowledge and right understanding about AIDS (Bupa 1999; del Casino 1999), while simultaneously working on their own social mobility through Thai and international IO/NGO networks. It is ironic in the extreme that in the liberal globalised Thai state of the 1990s the regimes of bodily supervision and control and the pathologising of many behaviours of the underclass, enacted in response to the HIV/AIDS epidemic are, arguably, more encompassing and more penetrating, than those enacted by the right wing Thai regimes of the 1960s and 1970s (Bowie 1997; Morell and Chai-anan 1982; Wright 1991). The oppressive and unjust nature of these political regimes was clear to all, while the oppressive nature of the regimes of surveillance and intervention engendered by the HIV/AIDS epidemic have been obfuscated by the power of biomedicine and public health, and by the claim that they are for the individual’s own good. Yet, such claims are rarely supported by evidence, and the class-based disparities of power and gender inequalities that have allowed the construction of such regimes have been totally ignored.

The Thai AIDS Epidemic: Asking Questions Having previously conducted doctoral research (Fordham 1991) in mid-1980s Northern Thailand, I commenced studying Thai AIDS in the early 1990s, as Thai AIDS first became a matter of public consciousness due to public service information programmes and AIDS reports in the Thai media. As an anthropologist living and working in rural villages during this period, HIV/AIDS was much more than a theoretical concern, the first cases of AIDS related illnesses appeared very close to home indeed. Also, like many social scientists specialising in Thailand, at that time I too considered that with my linguistic skills and in-depth cultural knowledge, and with my research skills learned and practiced over a decade, I was uniquely placed to make a contribution to curbing the potential ravages of the epidemic. Subsequently, throughout the 1990s, I

The Issues

5

combined teaching Anthropology and Thai Studies in Australia with carrying out HIV/AIDS research in Northern Thailand and, concomitantly, assisting various small Northern Thai NGOs with the design and implementation of AIDS education and intervention programmes. However, as the epidemic progressed and as large IOs and NGOs moved into the Thai AIDS field and developed and implemented their intervention strategies, and as the corpus of English language and Thai language AIDS literature increased, there seemed much that was quite bizarre about the way it was being constructed. I found that many questions about the social aspects of HIV transmission were ignored in favour of a focus on statistically sophisticated but socially simplistic and naive mechanical modelling. For the most part I found that indigenous cultural values were being treated as merely an impediment to the smooth roll-out of AIDS-intervention programmes and were only considered an issue in as much as ‘the problem’ of AIDS was generally portrayed as ‘irrational’, ‘risky’ or ‘gender based’ indigenous ‘problem’ behaviours that ‘had’ to be transformed in order to combat the ongoing spread of HIV. Even Buddhism, a matter of importance to most Thai people and a major aspect of Thai identities (Mulder 1992b; Van Esterik 2000), was largely ignored as irrelevant to the study of Thai sexual behaviour. Ultimately, I found myself unable to share many of the fundamental assumptions on which the normative Thai AIDS paradigm was based. In many cases I felt uneasy with research methodologies, with the nature of the behavioural data that research programmes elicited, and with the interpretation of the data. Even aside from methodological considerations, it seemed to me that much of the data that formed the basis for AIDS interventions reflected popular middle-class based ideological models of Thai culture; Van Esterik’s (2000: 3) ‘essentialised surface’ level of knowledge about Thailand, rather than people’s actual practice. For example, during the early 1990s (and of course for long before, as I argue in Fordham 1995), alcohol use was ubiquitous in Thai society, and was fundamental in the construction of masculinity and social relations at all levels.4 Indeed, until the Asian 4. There is good evidence concerning Northern Thai drinking patterns as far back as the latter part of the nineteenth century. Thus, Hallett (1890: 269) notes the payment of fines for drunkenness to the ruling Northern prince (compare Ratanaporn 1989: 136), suggesting that drunkenness was common enough to warrant a routine sanction. Importantly, too, it was the imposition of a tax on domestic brewing (in concert with other new taxes introduced during the 1870s and 1880s, following the 1873 inauguration of a policy of tax farming) that sparked off the Chiangmai rebellion of 1889 to 1890 (Brailey 1968; Tanabe 1984).

6

A New Look at Thai AIDS

economic crash Thailand was recognised internationally as a boom market for both expensive imported Western alcohols as well as for a host of cheaper locally bottled whiskies with prestigious sounding names to cater for the lower classes. Yet, at the same time, some scholarly publications claimed that most Thais didn’t use alcohol and that drinking was an activity restricted to a minority of men in the lower classes (Supamas 1992: 226). In the AIDS field some specialists in HIV/AIDS prevention claimed that men drank in order to use drunkenness as a legitimation for participation in commercial sex (VanLandingham et al. 1993a; VanLandingham et al. 1993b; VanLandingham et al. 1995a), a claim I found both erroneous and bizarre. Even a referee of my paper ‘Whisky, Women and Song: Men, Alcohol and AIDS in Northern Thailand’ (Fordham 1995) contested my observation of heavy drinking by noting that ‘cash is often scarce’ at village level and suggested that this would constrain both drinking and brothel visiting. In some cases such views were based on a mere lack of knowledge or of understanding, in other cases they had a more complex aetiology. I take this up in later chapters when I examine the manner in which a long sedimented style of writing about Thailand, which has discouraged both criticism of Thai society and the public discussion of social ills, has produced a ‘scholarship of admiration’ of Thai society (see Juree and Vicharat 1979; Phillips 1979; Van Esterik 2000). In respect to male participation in commercial sex, prodigious amounts of money were expended in round after round of survey research establishing the normalcy or otherwise of behaviour that any Thai or Thai based researcher already knew was a normal activity for the bulk of men. Indeed, in some cases Western researchers published scholarly papers in concert with Thai colleagues claiming that the visiting of prostitutes was in reality frowned upon and was practiced by only a minority of men in the lower classes (Ford and Suporn 1991). VanLandingham et al (1995a: 13) also take this approach when they point out that ‘For many men, there appears to be little if any shame to be felt in front of one’s peers for an occasional outing involving commercial sex’ and suggest (1995a: 19) that: ‘Actions that otherwise might be unacceptable become excusable (among friends at least) when the person is drunk [my emphasis].’ Yet, for anybody with the linguistic skills to read the signs along the streets of Thailand’s’ cities and smaller towns, or who bothered to read the advertisements in the back pages of its many Thai language newspapers and magazines, the ubiquity and wide range of establishments providing sexual services for men throughout the entire class spectrum was clearly

The Issues

7

apparent, as was the sheer lunacy of claims that denied the normalcy of this activity. Similarly, throughout the 1990s, another genre of AIDS research focused on female virginity – and potentially it was important research. After all, if young women were not sexually active then they were not at risk of contracting HIV, and interventions, at least in the early stages, need not be directed at them. Yet, like the work on alcohol and males visiting prostitutes (discussed above), this work and its outcomes seemed more concerned with the validation of ideology than it was with actual social practice. As I discuss in detail in chapters five and six, in the early 1990s an intensive research focus directed at showing the universality of virginity amongst young women found just this more than 99 percent of women were virgins prior to marriage. Yet, at the same time, a major concern of the Ministry of Public Health was the number of teenage pregnancies and the abortion rate in young unmarried women. My dissatisfaction with the existing modelling of the Thai AIDS epidemic led me to the issues that have constituted the core of my research programme over the past decade, and which I address here. The core chapters of this volume, chapters three to six, were originally written (as separate albeit sequentially written essays) in an attempt to make sense of the Thai AIDS education and intervention business that seemed like a juggernaut careering through the cultural and intellectual terrain of Northern Thailand, steamrollering everything in its path. On one hand I have been concerned with Northern Thai cultural understandings of disease and of HIV as disease threat, and with understanding Thai sexuality and sexual practice. Implicitly, I have been concerned to demonstrate the significance of local-level cultures and the importance of regional diversity in Thailand, issues that a generation ago would have been axiomatic to all, but which in the 1990s was not apparent to the many non-Thai specialists newly drawn into the Thai AIDS sphere. On the other hand, I have been concerned with analysing the progress of the AIDS epidemic as it has been constructed through the surveillance of HIV infection amongst specific population groupings, and through the focus of interventions designed to combat the spread of HIV. Here I have been concerned both with analysing the conceptualisation of AIDS as disease threat and with its impact on Thai society, and with analysing the impact of AIDS prevention programmes on Thai society. In particular, I have been concerned with the manner in which the impact of AIDS has been to remove sexuality from the private to the public sphere, where it was subject to

8

A New Look at Thai AIDS

intense scrutiny, and where minority groups considered deviant due to their gender, class position or sexual practices, or disadvantaged due to their cultural or educational background, were conceptualised as being particularly vulnerable to HIV infection and especially dangerous to others, giving rise to a heightened consciousness about the moral aspects of sexual activity and particularly the morality of sexual activity amongst young unmarried people. Throughout I have been concerned with issues of appropriate research methodologies, with the power of reflexive analysis and issues of social theory and, consequently, with the potential contribution of a critical and socially engaged anthropology to Thai (and other) AIDS research and interventions. In writing the essays that comprise this volume, from the beginning I have had three fundamental concerns. Firstly, I have been concerned that they are ethnographically rich as, with the exception of some anthropological works such as (Chayan 1993; Fordham 1993, 1995, 1998, 1999, 2001; Lyttleton 1994a, 1994b, 1994c, 1995, 1996a, 1996b, 1999, 2000; Manop 1994; Muecke 1999; Niwat 1998; Michinobu 1999, 2000; Tannenbaum 1999; Yos 1992), the bulk of the research through which the Thai AIDS epidemic has been defined has been statistically based. Despite an ongoing discourse about the social nature of the AIDS epidemic and the need for qualitative data, Thai AIDS debates have paid surprisingly little attention to qualitative data beyond that derived from focus groups and structured interviews which, as I argue throughout this volume, have real heuristic limitations. The power of the English language and of metropolitan centres of funding, research and publication, means that the predominant Thai AIDS discourses have been constructed in English and draw on English language sources. Accordingly, a second concern I have here is to take account of not only English language works on Thai AIDS, but also the massive corpus of Thai language works, ranging from scholarly medical and social science journals to IO/NGO reports and conference papers dealing with Thai AIDS. In chapter four, I also analyse the way in which Thai language newspaper and magazine reports refracted the AIDS epidemic in the early 1990s. In this way I draw attention to muted Thai language indigenous AIDS discourses, of which dominant discourses (and programmes developed on the basis of dominant discourses) remain unaware. As I show in chapters five and six, not only do Thai language materials demonstrate muted indigenous AIDS discourses that have been neglected in Western constructions of Thai AIDS discourses, but also the research findings of many experienced Thai researchers directly contradict central aspects of dom-

The Issues

9

inant AIDS discourses. Additionally, I show that over the course of the epidemic the dominant AIDS discourses themselves have been appropriated by those at grassroots level and utilised in such a way as to provide indigenous counter discourses. Thus I have been concerned to question central assumptions of the normative model of Thai AIDS, and to show that many of the assumptions on which the modelling of the Thai AIDS epidemic has been based are just that – they are assumptions. If we take account of other data which lies outside the ambit of concern of pre-existing assumptions, it is possible to develop other, alternative, and I believe superior, understandings of many aspects of the epidemic. A third concern I have had in my research and writing, and perhaps the most important of all, is that while producing ethnographically rich analyses of various aspects of Thailand’s AIDS epidemic, and while questioning some central assumptions of the Thai AIDS paradigm, I have aimed to provide balanced and contextualised analyses. Outside of IO/NGO research and intervention reports, both of which gain only limited distribution, it is the papers delivered at professional conferences and their later publication in scholarly journals which have been the predominant means through which the Thai AIDS epidemic and its central paradigms has been delineated. I suggest that this standard format for journal publication is in part responsible for the construction of the normative model of the Thai AIDS epidemic. The standard article length of fifteen to twenty pages, like the fifteen or twenty minutes allocated for the conference presentations from which they usually derive (or, of course, sometimes it is the other way about), encourages a tight focus on ‘the issue’ or ‘the problem’ and the use of simplistic and often misleading labelling, which both ignores the links between ‘issues’ and the fact that the issues themselves are merely a social construct, a subset of a more complex whole. As a result, in the social science field, much behavioural research on Thailand’s AIDS epidemic has been conducted in a highly structural-functionalist fashion that relies on an organic model (Radcliffe-Brown 1952) of Thai society to study the epidemic.5 Thus, published papers (both reflecting and directing the structure of research and interventions) dealing with behav5. Radcliffe-Brown’s structural functionalist and highly simplistic model of society likened society to the human body, with the various social institutions such as law, kinship, religion and so on linked together, like the organs of the body, in a functionally interdependent relationship. Thus, the model (by now long rejected as highly flawed) supposes that an understanding of the functioning of the various individual institutions, and of their interrelationship, leads to an understanding of society itself.

10

A New Look at Thai AIDS

ioural issues focus on AIDS knowledge and sexual practices amongst various occupational or claimed risk groups – such as farmers, fishermen, youth, school teachers, factory workers and so on – or amongst various groups of direct or indirect prostitutes in different geographic regions. Yet, these groups are treated largely in isolation from each other, with the linkages, multiple layering and overlaps amongst and between the various areas never articulated. As a result, the complexity and the blurring that constitutes real life, and the overall pattern of the whole, has been omitted from the ethnographic account and from the analysis. Moreover, the standard length of journal articles gives little scope for challenging dominant paradigms. A close examination of many papers reveals brief additional secondary elaborations to shore up favoured interpretations, counter research deficiencies or the qualms of referees, and alternative hypotheses are rarely given serious attention. This is unfortunate, as it accentuates the tendency for much of the Thai AIDS literature, particularly that deriving from a demographic or epidemiological perspective, to posit simplistic monocausal answers to explain complex social behaviours. Perhaps, a colleague’s comment on two ‘rapid assessment’ reports on the AIDS situation amongst Thai seafarers (UNDP n.d., a, n.d., b) encapsulates the deficiencies characteristic of much of the Thai AIDS literature ‘On the one hand, they’re useful, containing lots of bits and pieces. On the other, I have to admit, they’re a mess, which certainly limits their effectiveness as many things are left dangling, unexplained, contradictions are ignored, and often the wording is so sloppy its hard to work it out’.6 The standard disciplinary-based journal in which researchers publish their research findings is also, in part, responsible for the model of the Thai AIDS epidemic that has been constructed over the past decade. As the epidemic progressed during the late 1980s and early 1990s those working on AIDS research and interventions came from the whole gamut of academic disciplines and disciplinary-based organisations as well as from government bodies, IOs and NGOs. As they sought to carve out space for the intellectual and physical domination of a particular area of research or intervention (and the rewards of access to the massive funding that such domination entails) all have drawn largely on their own discipline’s epistemological resources. Thus, for example, in the disciplines of biomedicine, epidemiology, demography, anthro6. John Butcher. Personal communication.

The Issues

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pology and the many other disciplines involved in the AIDS arena, researchers have largely worked and published in their own sphere, their own layer of Thai AIDS discourses, and there has been little real crossover beyond a smattering of cross-disciplinary citation as a means of textual authentication (Clifford and Marcus 1986). The carving out of AIDS as a quasi-discipline in itself, and the founding of specialised AIDS journals such as AIDS, AIDS Care, and the Thai language Thai AIDS Journal, has only exacerbated this situation as they tend to work within the normative paradigm, offering secondary elaborations instead of challenging the paradigm per se. Even in the case of interdisciplinary journals such as Medical Anthropology and Social Science and Medicine, the majority of published work tends to be within the bounds of the normative paradigm. Highly critical works which pose a challenge to the normative AIDS paradigm, such as Fordham (2001) dealing with Thailand’s AIDS epidemic (Critique of Anthropology), or Pigg (2001b) dealing with the Nepalese AIDS epidemic (Cultural Anthropology), tend to be published in mainstream anthropological journals. However, as such journals are the precinct of committed anthropologists, the work they publish is read neither by those working on modelling the epidemic from biomedical or epidemiological/demographic perspectives, nor by those in the IO/NGO fraternity working on the social modelling of the epidemic or on the implementation of interventions. Indeed, as far as the IO/NGO world is concerned, the bulk of personnel working on AIDS care and intervention issues pay little attention to the AIDS literature published in either medical or social science journals, viewing it as ‘academic’ and as of little relevance to their own ‘hands-on work’, and rely almost entirely on agency reports and manuals of best practice (often internally produced) to direct their work.7 In this context, where the AIDS field has been carved up into largely discrete, highly specialised areas, articles that do not fit easily into pre-existing discourses because they cross both ‘issue’ boundaries and epistemological boundaries are axiomatically 7. In some cases this is a matter of language difficulties; just as Westerners ignore Thai language materials, many Thais ignore work written in English, and sometimes gaining access to expensive overseas journals is also an issue. However, more generally this is a mindset which makes an absolute distinction between the practical work of IOs and NGOs that are involved in developing and changing the world, and what is portrayed as the non-involved and ‘merely academic’ work of academics, who are considered to be doing nothing to change the current state of affairs.

12

A New Look at Thai AIDS

difficult to deal with. Moreover, if they draw on a wide range of disciplinary and theoretical materials as well as a wide range of multilingual materials, they present journal editors with the real practical problem of finding referees with the necessary range of disciplinary and linguistic skills. When, as often occurs, such papers are refereed by persons unfamiliar with the range of ‘issues’ addressed, or with the disciplinary, theoretical, or linguistic materials utilised, they are likely to receive timid and conservative responses which mitigate against publication.8 Thus, in addition to the limitations of article length that mitigate against complexity, there is this subtle, but nevertheless real, issue that tends to keep published papers largely within disciplinary boundaries, and within the normative model of the Thai AIDS world. Written from an anthropological perspective, this work, then, aims to address some of these issues through questioning the normative Thai AIDS discourses that have been constructed on the basis of naive empiricism. I do this through the introduction of issues of complexity, reflexivity, and social theory into some central Thai AIDS discourses, and through addressing the issue of popular AIDS research methodologies and their limitations. Through this I aim to generate a deeper understanding of the factors that have driven the Thai AIDS epidemic and of how the epidemic itself has been constructed or, more likely, misconstructed, as a social problem.

8. In my own writing about Thai AIDS over the past decade, as in this volume, I have drawn on English, Central Thai and, more recently, Khmer language materials, deriving from a broad range of disciplinary perspectives. Over this period some referees have found my writings just too hard to read at a conceptual level and thus irrelevant to those working from a biomedical perspective. One such individual whom I cite (Fordham 1999: 93) wrote in their referee’s report on one of my early AIDS papers, ‘HIV/AIDS is a serious business’ suggesting, perhaps, that my paper was frivolous as it disagreed with the then accepted interpretations of the relationship between Thai patterns of alcohol use and HIV risk behaviour and who, by way of a final assessment of the paper, dismissed it by noting that due to its social science concepts and terminology: ‘health scientists will not and could not read it’. Conversely, referees with a social science background criticised my use of what they saw as overly complex medical jargon. Often referees were clearly unfamiliar with the indigenous literature on which I draw and were ill-equipped for and obviously uncomfortable with their task. Chapter five, for instance, originally published in the leading British journal Critique of Anthropology, drew a comment from a referee (clearly one who held a biomedical perspective) that the paper was ‘all over the place’ as it addressed multiple issues, and the suggestion that it should be rewritten as three separate papers.

The Issues

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Structure of the Argument Chapter two takes up the issue of the ‘shape’ of Thailand’s AIDS epidemic. Setting the stage for analyses in later chapters, I argue that the various elements which constitute the central conceptual pillars of the normative model of the epidemic, such as risk behaviour and risk groups, do not constitute a description of what is actually ‘out there’. Rather, they are a model (by now highly essentialised) of aspects of the Thai social world, produced according to particular interpretive frameworks and based on specific (albeit generally unspecified) founding premises and hypotheses. I then go on to show how a range of factors specific to Thai society, including highly superficial Western knowledge about Thai society in concert with class-based Thai perspectives on the underclass and those living in the rural periphery, led to a very simplistic modelling of the epidemic that ignored regional, historical, ethnic or cultural differences. Critically, I argue for an alternative and more reflexive modelling of the epidemic and call for a new and reinvigorated socially engaged anthropology to play a major role in this task; an anthropology no longer prepared to be intellectually muted, restricting its role to speaking predominantly to the ‘converted’ in the academy, or to be confined to the playing of bit parts while others define the worlds where we claim special research expertise and understanding. Chapter three takes up the issue of male sexuality and risk taking in Northern Thailand. It develops ideas outlined in Fordham (1993), where I first addressed the need to take account of Thai cultural values and the significance of factors such as Buddhism when understanding the Thai construction of gender identities, issues of sexuality and the Thai response to HIV/AIDS. Like subsequent chapters, it was prompted by concerns I had regarding the interpretation of Northern Thai culture by those working on AIDS programmes, and the fact that little attention was being paid to indigenous Northern Thai cultural values. Thus, I argue for the significance of Northern Thai metaphoric understandings of HIV as a disease epidemic. I point out that rural Thailand has a long history of penetration by power holders and argue that as a result ‘health interventions’ conducted in local communities have been viewed as yet more examples of the penetration by state (and state-allied) powers, and as a penetration of the private sphere and a threat to male privilege, and have automatically engendered resistance on the part of villagers. In particular, this chapter takes up the issue of male risk taking and male participation in commercial sex. In relation to risk tak-

14

A New Look at Thai AIDS

ing I argue that providing villagers with knowledge about the dangers of HIV is not enough to curb sexual risk taking. I argue that although those working in the AIDS world view sexual risk to be the pre-eminent risk, at village level life is inherently risky and that not only do villagers rank HIV/AIDS as a risk of a lesser order than other life risks – such as road accidents, fires, thieves and killers – for men, the pre-eminent value and pre-eminent risk is masculinity. Thus I argue (see also Fordham 1995, 1999), contrary to VanLandingham et al. (1993a) and VanLandingham et al. (1993b), that male drinking is neither connected with the need to legitimate the visiting of prostitutes, nor are the disinhibiting effects of alcohol, in themselves, the cause of men visiting prostitutes (VanLandingham et al. 1995a, VanLandingham et al. 1997), rather, this activity is primarily concerned with the constitution of masculinity. I point out that male participation in commercial sex cannot be understood by demographic surveys taken of clients as they enter the brothel door (such as Napaporn et al. 1992), but that it must be understood in its total cultural context. This is a context in which men visit brothels or other venues for commercial sex as part of a three part rite of eating, drinking and sex, the whole being concerned with the constitution of masculinity. Critically, this chapter develops the concept of ‘edge work’, the deliberate taking of calculated risks, both for the exhilaration of the act and as a means of displaying masculine potency. In respect to chapter four I argue throughout this volume that during the past decade of AIDS interventions, the Thai AIDS world has been handicapped by a lack of perspective. As noted above, it has been inward looking, conducting behavioural research and interventions in terms of paradigms whose fundamental assumptions have rarely been challenged. In the early 1990s public information campaigns utilised media ranging from posters and billboards to electronic media to give the public information about HIV/AIDS, and when surveys about AIDS knowledge and risk behaviour were carried out, increased levels of knowledge and lower reported levels of risk behaviour were attributed to the success of these campaigns (Borthwick 1999; Chuanchom et al. 1997; Nelson et al. 1996; Lyttleton 1999; Mastro and Khanchit 1995). However, I suggest that situation was really much more complex, and that in Northern Thailand the reporting of HIV/AIDS issues in the public media was a critical factor in the success of these campaigns. This chapter argues that, in concert with public information campaigns, an additional significant source of information about

The Issues

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AIDS in Northern Thailand during the first half of the 1990s was the Thai language print media’s (newspapers and popular magazines) reporting of the progress of the AIDS epidemic and various other forms of AIDS-related news, ranging from the role of prostitution in the transmission of AIDS to traditional healers who claimed to have medicines to cure AIDS or, at least, ameliorate its symptoms, to issues of AIDS care and the many AIDS suicides characteristic of the Northern Thai epidemic at this time. Importantly, the information given in the print media provides a rich source of information about local metaphors of AIDS and a barometer of local understanding/misunderstanding about HIV/AIDS. Also, the very ubiquity of print reporting of AIDS during the first half of the 1990s, and its high visibility (a great deal of AIDS news in Northern Thailand appeared in large block print on the front page of newspapers), in concert with high levels of Thai literacy and easy availability of these print media, meant that these information sources were in a position to reinforce or contradict AIDS public service announcements. Indeed, as I demonstrate here, AIDS reporting in these media ranges from reporting of the highest veracity to the level of misinformation and rumour mongering. Chapters five and six mark a shift in my approach to Thai AIDS. In the late 1990s I moved from an examination of how HIV/AIDS was understood by the Northern Thai, to examine the construction of the normative model of the Thai AIDS epidemic and the impact of the epidemic and of AIDS interventions on the community. Chapter five further develops the themes of the class basis of AIDS interventions in Northern Thailand, of underclass resistance to interventions thrust upon them, and the issue of HIV/AIDS social research methodologies, raised in earlier chapters. I take up two of the major concepts used from the early 1990s onwards to model the Thai AIDS epidemic and to direct interventions, the notion of largely discrete risk groups and the notion of the sequential spread of HIV from group to group in a wave-like fashion. I argue that the AIDS epidemic in Thailand had the effect of bringing sexual practices from the private arena into the public sphere, where they were openly discussed, and where various government departments, IOs and NGOs claimed legitimate roles in their ordering and control. I argue that the concept of ‘risk group’ found favour as it enabled the Thai social body to be portrayed as a hierarchy of risk with specific groups attributed behaviours necessitating control. This acted to legitimate and reinforce prejudices about groups such as the male underclass, prostitutes, injecting drug users (IUDs) and

16

A New Look at Thai AIDS

homosexuals, who became the target of supervision and reformist intervention. My analysis centres on the position of female commercial sex workers (CSWs) who, in this period, became the primary focus of attempts to control the spread of HIV. I argue that the focus on commercial sex workers, legitimated by notions of essentialised risk groups and the notion of HIV spreading in a wave-like motion between risk groups, occurred because in a time of rapidly changing social values they constituted a highly visible symbol of unrestrained female sexuality on which the reformist agendas of the state and private sector could focus. That female sex workers, like the male underclass constituted a group with extremely limited political and economic power, only meant such measures were implemented more easily and with less reflexive examination regarding the manner in which they acted to validate readymade moral judgements. Critically, in terms of Thai AIDS research methodologies, this chapter again takes up the issue of inappropriate and inadequate methodologies, and methodologies that merely acted to validate pre-existing class-based beliefs about the behaviour of the underclass and which have been subject to little reflexive analysis. In chapter six, the penultimate chapter, I draw on a wide range of English language and Thai language works ranging from the public print media to scholarly publications dealing with young people’s sexuality. I argue that during the course of the 1990s, in a context of increasing Thai concerns about globalisation and the penetration of Western culture, young people’s sexual activity began to be viewed as the result of their copying Western patterns of behaviour, and approaches to such activity became increasingly censorious and increasingly concerned with issues of morality. My analysis shows that by the mid-to-late 1990s a shift had taken place from an earlier moral panic about child abuse (Montgomery 1996a, 1996b, 2001) and a focus on the role of underclass men and female prostitutes in the spread of HIV, to a more generalised concern with young people’s sexual activity per se, which began to be viewed in highly pathological terms, as being abnormal and inappropriate for unmarried persons and as an activity contrary to Thai values. Through an examination of life-skills AIDS-intervention programmes over the decade of the 1990s I show their gradual transformation from programmes concerned with safe sex and AIDS prevention to programmes whose raison d’être was the proselytising of morality, and their diversification from an initial focus on what were conceived of as high-risk minority groups to focus on

The Issues

17

middle-class youth in general. Just as the public health regimes of bodily surveillance and regulation constructed in the early stages of the Thai AIDS epidemic treated HIV infection amongst the underclass as the result of individual pathology due to a lack of morality, during the late 1990s HIV infection amongst the middle class was similarly treated as the result of individual moral failure. Finally, in chapter seven, by way of conclusion, I ask the question ‘Where to now?’ Drawing on material discussed in previous chapters, I briefly examine other arenas where a powerful and sustained critique of the normative model of the Thai AIDS epidemic might be generated. I conclude that institutional structural and cultural constraints are likely to continue to mute critiques generated by IOs/NGOs and that a similar affliction ails the field of Thai Studies. Yet, I suggest that such a critique might be generated by a revitalised and socially re-engaged anthropology which, on the basis of its cultural expertise, its tradition of ‘reality therapy’ through sustained fieldwork in which ‘ingrained or taken-forgranted assumptions regarding one’s own and others practices in lived realities’ are challenged (Kapferer 2000: 189) and, particularly, on the basis of an engaged social theory, both the failures of naive empiricism and the absence of a critically reflexive spirit might be redressed.

CHAPTER 2

CREATING THAILAND’S AIDS EPIDEMIC

I

t is not merely that the dominant paradigms through which the Thai AIDS epidemic has been modelled were set very early on and, since that time, have been subject to little reflexive examination; yet more seriously, modelled in this manner, Thailand’s AIDS epidemic has been conceptualised, and interventions implemented, as if it was not just a matter of a virus transmitted between persons via a variety of routes, but as if the epidemic was somehow ‘out there’, as an essentialised, almost concrete entity, possessing a specific shape and nature that merely awaited discovery. Indeed, it is quite clear in the writings of epidemiologists and demographers working on the statistical modelling of the epidemic that this is precisely how they conceptualise their activity. It seems to me that much that is wrong with the modelling of Thailand’s AIDS epidemic is encapsulated in this recent plea from van Dam and Anastasi (2000: 19) who, speaking of the AIDS field in general, claim: ‘We need to move interventions from the domain of myth, culture and religion to the science of public health.’ That both ‘science’ and ‘public health’ are social constructs is clearly not understood nor, it seems, is the fact that our entire experience of life as humans is both social and cultural. As Kapferer (2000: 186) points out: ‘Human beings are always in culture’. That the modelling of Thai AIDS and the response this has called forth has, in itself, been constitutive of the epidemic as we know it, is an issue that has not been addressed. Nor has the extent to which many central aspects of the normative model of the Thai AIDS epidemic and the AIDS-related research and interventions these have directed, have been constituted on the basis of Western and Thai middle-class ‘taken for granted’ under-

Creating Thailand’s AIDS Epidemic

19

standings about the culture and behaviour of the Thai underclass. Yet, as I argue throughout this volume, much social science research conducted in relation to the Thai ‘AIDS problem’ owes more to naive empiricism than it does to scholarly rigour. Thus, in a very real way, the modelling of Thailand’s AIDS epidemic and the interventions it has directed represents a clash, albeit generally unrecognised, between positivist ‘hard science’ approaches to the world and other, anti-positivistic, social science approaches that deal with the complexities of human behaviour and the nuances of cultural difference.

Modelling the Thai AIDS Epidemic In the case of the African AIDS epidemic, the very ‘otherness’ of African cultures and African infrastructural limitations made it clear fairly early on in the epidemic that it was not going to be solely a matter of a simple technological fix.1 Some splendid social science work on African AIDS (Randall and Epstein 1991; Sidel 1993; Schoepf 1991, 1992, 1995) conducted at a fairly early stage of the epidemic made it clear, as Barnett and Blaikie (1992) point out, that approaches towards African AIDS were heavily imbued with Western presuppositions about African cultures and sexuality. Moreover, as Pigg (2001a: 482–83) points out, in the first decade of AIDS in East Africa the effects on ‘bodies and lives was already being felt even as the earliest epidemiological, clinical and virological research was beginning to describe and define the phenomenon’, and as a result the medical and policy frameworks through which the AIDS epidemic would later be apprehended, were not yet concretised. Subsequently, due to a combination of these factors, the discourses that developed about African AIDS tended to be multistranded and contested (Sidel 1993). Thailand, however, was different. Following the explosion of AIDS across sub-Saharan Africa in the 1980s, Thailand’s AIDS epidemic was the first major Asian and South East Asian AIDS epidemic, and, in the late 1980s and early 1990s, it represented 1. This remains the case in the early 2000s, yet researchers still strive to find a quick technological fix for AIDS by, for example, attempting to draw a correlation between male circumcision and lower rates of HIV transmission (van Dan and Anastasi 2000; Weiss et. al. 2000). From an anthropological perspective much of this research is methodologically flawed, particularly in its neglect of the broader context of sexual culture. Additionally, one is tempted to speculate as to whether this avenue of combating HIV transmission would have been so enthusiastically promoted if it was female circumcision that was being advocated.

20

A New Look at Thai AIDS

the fastest moving AIDS epidemic in the world. From the beginning, the Western response to the Thai AIDS epidemic was different from its response to the African AIDS epidemic(s) in two central ways. Firstly, the conduct of medical and behavioural research in Thailand, the implementation of behavioural modification campaigns and the provision of medical care were viewed as eminently ‘doable’ issues. This is clear in the Thai AIDS literature which, although often pessimistic about aspects of the epidemic, has always viewed it as ultimately controllable. By contrast, over the past decade the African AIDS context has often been described as an almost hopeless situation, even a ‘basket case’; a summary that reflects a pessimism that pervades much African AIDS literature. Possibly, by the early 1990s, as Thailand’s medical and policy frameworks for dealing with AIDS were beginning to be put in place, Thailand was able to draw on the experience of the African, Haitian and Brazilian AIDS epidemics, and this may have impacted on the positive evaluation of the likely effectiveness of AIDS control measures in Thailand. However, even more important was Thailand’s high standard of infrastructure in communications and its medical and transport infrastructure, in concert with a stable political climate where the problem of HIV/AIDS was recognised and where there was a broad-based ‘political will’ to support effective interventions. The second way in which Thailand and, as a result, the Thai AIDS epidemic have been treated as being fundamentally different from the African context is that, by contrast with Africa, Thailand and Thai culture have been viewed as inherently rational and knowable. Thailand’s superbly developed tourist industry and its associated infrastructure was likely a major factor contributing to such attitudes. By the time a substantial number of HIV cases started appearing in Thailand in the late 1980s and early 1990s, Thailand had already experienced over a decade of sustained growth in international tourism. Over the decade of the 1980s, a rudimentary tourist infrastructure developed during the 1960s and early 1970s Vietnam war had expanded to a mature tourist infrastructure processing almost four million arrivals per year. Based on the famous Thai smile, ease of accessibility and service, its explicit aim was to present Thai culture as exotic but accessible – personally safe, rational and, ultimately, knowable by all (Cohen 1996). Critically, in respect to the logic that underlies them, such representations were not new. Rather, they drew on a long sedimented and well practiced mode of representing Thailand to the West through simultaneously emphasising both its exoticism and its civilised status, one which Van

Creating Thailand’s AIDS Epidemic

21

Esterik (2000: 119) points out dates back as far as the late nineteenth century. Thus, by the time significant numbers of Westerners became involved in Thai AIDS research and interventions in the early 1990s, as a result of highly effective tourist advertising campaigns in concert with high numbers of tourists visiting each year, modern Thailand was already well known in Western imaginations. By this time, earlier quaint images of oriental irrationality proselytised in the West by films such as Anna and the King of Siam, had been replaced with images of Thailand as an exotic, yet modern and rational nation state.2 As Van Esterik (2000: 4) argues, as a result of long developed cultural strategies and skills ‘Thailand encourages an essentialism of appearances or surfaces’, the production of images to form a sort of public face that stands for and hides an underlying and much more complex reality. She claims that visitors (and this applies to many researchers as well as to tourists) are drawn into the exoticism of the Thai aesthetic of sights, sounds, tastes, and smells and, looking only at these surfaces, grasp the essence of Thainess (and thus, of Thailand) ‘with speed, certainty and satisfaction’ (2000: 4). As Van Esterik puts it (2000: 3): ‘Everyone knows something about Thailand.’ It was in this context that Westerners first became involved in Thai AIDS research and AIDS behavioural interventions, often working in concert with English-speaking Thai culture brokers based in universities or other institutions working in the AIDS arena. Generally research was carried out by English speaking (middle class) research assistants on the assumption that these people best knew their culture and knew how best to deal with research subjects.3 The prevailing attitude to AIDS behavioural 2. The volume Thailand in the 90s (National Identity Board 1995) published by the National Identity Board in various editions throughout the 1990s, gives a splendid version of the official state ideology of the period (compare Mulder 1997). This was not only widely distributed to libraries in the West, it was routinely included as part of a presentation package of glossy books about Thailand that Thai universities and research institutes routinely gave to Western visitors. 3. The issue of Central Thai cultural and historical hegemony (Tongchai 1994) and the likely rendering of regional cultures in Central Thai terms due to the use of Thai culture brokers is an issue that warrants close investigation. The common Western assumption of Thai cultural homogeneity and the assumption that ‘Thais know Thailand’ is just not the case. Thus, Van Esterik (2000: 17) points out the exoticism with which Bangkok students of the late 1970s vested rural villages, and their romanticising of village life. Thirty years later the situation is little different, except that the peoples of the rural periphery are now known through the demeaning stereotypes by which they are depicted in the mass media, in particular in television soap operas (Hamilton 1991).

22

A New Look at Thai AIDS

research held that the main problems were technical issues in regard to data collection and in ensuring its internal statistical veracity, rather than problems of interpretation. Unlike Africa, where ‘otherness’ was apparent, Thailand, and in particular the rural regional periphery of the North, the North East and the South where the epicentres of the AIDS epidemic were located, was not recognised as ‘other’ or as difficult to understand – due to what Van Esterik (2000: 4) calls an ‘interpretative arrogance on the part of non-Thai’ (and, for that matter, on the part of urban, middle-class Thai working in the AIDS sphere). As a result many questions that might usefully have been asked were not formulated, and amongst the massive corpus of work produced on Thai AIDS behavioural issues over the past decade, the perils of orientalism (Said 1985) and their implications for AIDS research and interventions are raised only rarely.4 Cultural and linguistic interpretation were treated as unproblematic and uncontested and were not addressed as issues in their own right. Similarly, issues of history, of regional cultures, of ethnicity, of class, or even of the significance of Thai Buddhism, were totally ignored as irrelevant to the study of sexual behaviour.5 Bizarrely, this position that ignored history and indigenous constructions of culture was taken at a time when in every corner of the world, and in most academic disciplines, it was becoming abundantly clear that histories, and the unique identities that derive from diverse ethnicities and diverse cultural practices (Sahlins 1993, 1995, 1999), matter a great deal indeed (see Whittaker 2000 in relation to North Eastern Thailand). Ironically, those taking this position unknowingly took a highly partisan position in an old and ongoing debate in Thai Studies, concerned with the uniqueness or otherwise of Thai culture, and whether it 4. Orientalism refers to Western discourses on the countries and peoples of the ‘Orient’ constituted as an exotic ‘other’. In the case of Thai AIDS an awareness of orientalist discourses may have led to a questioning of simplistic approaches to behavioural modification that focused on an essentialised and homogenised Thailand ‘out there’, and on approaches to Thai sexuality based on poorly substantiated imaginings about the rapacious sexuality of the Thai other, particularly the other located in the underclass on the rural periphery – issues I take up below. 5. As originally published in the journal Crossroads (1998, vol. 12/1: 77–164), chapter three included comments from invited Thai Studies and Thai AIDS specialists, which were followed by an author response. In retrospect it is instructive although, at the time, I found it extremely frustrating to read the commentaries by those involved in AIDS programmes - their denial of the significance of history or of regional and ethnic differences in the understanding of Thai culture.

Creating Thailand’s AIDS Epidemic

23

can be addressed only in its own terms or whether a comparativist perspective is more appropriate.

Thai AIDS Paradigms and Dominant Discourses: The Normative Model I argue throughout this volume that the central paradigms about which Thai AIDS discourses have been constructed were set very early on in the epidemic and that these imposed strict (albeit usually taken for granted) limitations on subsequent research and interventions, as most subsequent work was conducted, tautologically, in terms of these discourses. Here, I delineate what I consider to be the central paradigms of Thai AIDS discourses, the normative model of Thai AIDS. The central discourses of the Thai AIDS paradigm relate to understandings about how HIV is transmitted, the best means of curbing transmission, what forms of data are relevant to understanding the spread of HIV, and the appropriate research methods to collect that data. Early research and intervention efforts focused on homosexual and bisexual activity, and on the role of drug users in HIV transmission. However, as HIV levels rose amongst commercial sex workers in the late 1980s, it quickly became accepted that prostitutes were the bridge for the transmission of HIV from deviant minority groups to men in general, and from there to wives and children. In relation to the understanding of how AIDS is transmitted, throughout most of the 1990s Weniger et al.’s (1991) model of HIV moving in a wave like motion between risk groups, the associated concept of risk groups with essentialised and homogenised behavioural practices, and the labelling and essentialising of these practices as risk practices, were core aspects of modelling the movement of HIV through the Thai population. Although a belated recognition of the inherent weakness of this model and challenges raised by molecular biology demonstrated its heuristic limitations, as I will show in chapter five, for Thais it remains a central tool in explaining AIDS transmission. Highly class-based notions such as understandings about the cultural (and hence behavioural) differences between rural and urban populations, failure to recognise regional, historical and ethnic or cultural differences, and notions concerning the inability of those with low levels of education to understand health advice are all central pillars of the Thai AIDS paradigm. Thai HIV/AIDS interventions focused on preventing the transmission of HIV between sex workers and their clients. An intensive

24

A New Look at Thai AIDS

focus on the reduction of sexually transmitted disease (STDs) amongst sex workers, the discouragement of male patronisation of sex workers, and mandating the use of condoms in commercial sex through programmes such as the Thai ‘100 Percent Condom Programme’ are all central aspects of the Thai AIDS paradigm (WHO 2000). Later in the 1990s, in line with biomedical advances, issues of mother to child transmission also became important and issues of ante-partum and post-partum prophylaxis also became significant. Throughout the period during which HIV has been recognised as a major public health problem in Thailand the core of interventions has been public education about HIV, about the routes of HIV transmission and about the behavioural changes necessary to prevent transmission. The nature of the data considered necessary to understand patterns of HIV transmission amongst various social groups and for the direction of interventions to them, is an issue of primary significance in the construction of the normative model of the Thai AIDS epidemic and is one I address throughout this work. From the first, as levels of HIV infection increased in sentinel surveillance groups, the disciplines of biomedicine, epidemiology and demography were instrumental in mapping the parameters of the epidemic. However, as research commenced into the social behaviours and patterns and forms of sexual practice that were related to HIV transmission, these disciplines not only continued to map the parameters of the epidemic through the use of statistical modelling, they also played a significant role in the study of Thai sexual cultures and Thai understandings about HIV/AIDS. Throughout this work I am particularly critical of the manner in which demography and epidemiology, during the course of the Thai epidemic, have defined and restricted the space and the role of the interpretative social sciences such as anthropology and sociology. At one level this is merely an ongoing contestation between opposing systems of knowledge. However, as I argue here, the implications of wrong understandings and misdirected interventions far outweigh disciplinary contestation over symbolic capital (Bourdieu 1977). Since the beginning of AIDS related research about Thai sexual culture, the bulk of this research has prioritised various forms of survey research, ranging from ‘knowledge, attitude, practice’ (KAP) and ‘knowledge, attitude, belief, practice’ (KABP) research, to ‘participatory rural appraisals’ (PRA) and various forms of ‘rapid assessment procedures’ (RAP), legitimated by the emergency nature of the epidemic which both funding agencies and researchers claimed prevented the use of anthropological-

Creating Thailand’s AIDS Epidemic

25

style long-term qualitative research methods. Indeed, for some, survey research and the use of recorded interviews now constitutes the central, if not sole, qualitative research technique (VanLandingham and Trujillo 2002). Well, as I argue throughout this volume, the proof of the pudding is in the eating. These research methodologies produced copious amounts of data of implacable internal statistical validity. Yet, due to their inherent limitations in the cultural context in which they were used and the nature of the questions being asked, they often produced data that were fundamentally flawed. Thus, I point out in chapters five and six, that in the early 1990s when survey research was finding that more than 99 percent of Thai women were virgins prior to marriage, there was already a significant body of Thai language research – predating AIDS research – which addressed the issue of high rates of sexual activity amongst school students. I also note that the 1990s Ministry of Public Health statistics not only show high rates of teenage pregnancy but that they also show that a significant percentage of legitimate abortions performed during this period were carried out on teenagers – with the number of young women having illegal and unrecorded abortions being anyone’s guess. The criticisms of these normative Thai AIDS paradigms that I develop in this volume are concerned with the fact they have been subject to little serious scrutiny or to reflexive analysis, and with the often simplistic manner in which they have been operationalised. I am also concerned with the fact that once operationalised these paradigms quickly became essentialised, and not only was subsequent AIDS discourse largely conducted in their own terms, but that these dominant paradigms (through funding regimes and sheer weight of numbers) also discouraged the development of competing discourses.

The Modelling of Thailand’s AIDS Epidemic: The Intellectual Context In the early stage of the Thai AIDS epidemic there were many unknowns (Brown et al. 1998b; Vichai. et al. 1993). Would it follow the American model where it would be largely confined to the homosexual and drug using subcultures, or would it follow the African model(s) and be a heterosexual epidemic? And what about Thai sexuality in general, what were the practices likely to lead to HIV transmission? In the late 1980s and early 1990s little was formally known about Thai sexuality and sexual practices.

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A New Look at Thai AIDS

Modern social science research commenced in Thailand in the years following the Second World War, and up until the late 1980s it has, arguably, been intensive anthropological research in concert with historical research and work by Thai Studies scholars that has produced the central authoritative accounts of Thai society in its many regional and ethnic manifestations (Van Esterik 2000). Yet the very power of Thai Studies to shape dominant discourses and define the categories for the organisation of knowledge about Thailand was inherently limiting (Van Esterik 2000), and for most of this period much research about Thailand was channelled into a limited range of set, non-controversial areas of inquiry such as religion and ritual, loosely-structured social relations and kinship, to produce what some, myself included (Fordham 2001; Juree and Vicharat 1979; Phillips 1979), have claimed was a ‘scholarship of admiration’ for Thai society; an idealised view where issues such as conflict, violence and sexuality found no place. Those perhaps most likely to have written about sexuality, the anthropologists, had confined their insights to the disciplinary conventions of kinship and marriage. Thus, like others of his generation, Potter’s (1976) Thai Peasant Social Structure obfuscates the intimacies of sexuality with an analysis of kinship categories, themselves portrayed in coy relations between circles and triangles which, by a totally unexplained process, give rise to a new generation of circles and triangles.6 Things were slightly better in that part of the academic world where, in the wake of the 1970s feminist revolution, development studies coalesced with feminist approaches, and in the early 1980s began to focus on development issues in relation to women’s position in society. In Thailand, by the early 1990s, this new approach had resulted in the publication of both Thai language (Klum ng teh 1982; Sunii et al. 1983; Tanawadee and Pensi 1984; Yos 1992) and English language studies (Pasuk 1982, Thitsa 1980) dealing with prostitution (treated as sexual pathology) and the position of women in Thai society, and on sex tourism 6. Van Esterik suggests a high degree of self-censorship on the part of Western scholars in the interests of not offending Thai colleagues. However, I believe her point should be extended to cover the many Western ‘non-academic’ Thai aficionados for whom ‘knowing’ about Thailand (generally a highly Bangkokcentred and middle-class perspective) and, as they often put it, ‘loving’ Thailand, has become a central part of their own identity construction. Taking a generally critical approach to the canonical texts and beliefs of Thai Studies, and researching and writing about ‘problem’ areas of Thai society such as AIDS, sexuality, prostitution and alcohol use, I find that I am regularly approached by such persons and subtly ‘advised’ that they find my approach to studying Thailand both inappropriate and offensive.

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(Richter 1988, 1992; Truong 1990). These works focused on the cultural and economic roots of prostitution and women’s status, and paid little direct attention to sexuality or sex as practice. Critically, however, as I discuss at length in chapter five, as Thai behavioural research on sexuality began in the early 1990s, this small corpus of academic work provided the starting point for future research about Thai sexuality. Indeed, as I point out, in the AIDS era these studies in the area of gender and sexuality have not only functioned as foundation works, much of their premises and methodologies have also continued to be reproduced in Thai AIDS behavioural research, where the study of sexuality has largely remained the study of prostitution as a form of sexual pathology. Importantly, Van Esterik (2000: 14) makes a similar comment in respect to research about gender in Thailand. She argues (2000: 202) that this research has substituted description and counting for analysis and synthesis, that it has built on received categories and that it has paid little attention to indigenous Thai discourses. Critically, as she points out (2000: 163), Thailand’s ‘sex-gender system cannot be reduced to studies of prostitution and sex tourism’. However, while fifty years of academic research on Thai society had studiously neglected sexuality, at the beginning of the 1990s many Westerners had some knowledge about that part of the Thai sex industry orientated to the lucrative foreign tourist market. Such knowledge derived from the experiences of tourists and expatriates, from gossip and rumour based on these experiences and, particularly, from the regular publication of sensationalist journalistic-style books purporting to be exposes of the Thai sex industry ( see Odzer 1994; Seabrook 1996).7 In reality much of this knowledge constituted little more than decontextualised and often ill-informed assumptions about Thai sexuality, and penetrated into the complexities of Thai sexual culture little more than Van Esterik’s ‘essentialised surface’ level of knowledge about Thailand. Yet, as highly sensationalist descriptions of a ‘fantasy 7. The titles of these volumes provides a clear indication of their sensationalist approach: Patpong Sisters: An American Women’s View of the Bangkok Sex World (Odzer 1994); Travels in the Skin Trade: Tourism and the Sex Industry (Seabrook 1996); or the later Sex Slaves: The Trafficking of Women in Asia (Brown 2000); and Night Market: Sexual Cultures and the Thai Economic Miracle (Bishop and Robinson 1998). Sensationalist, credulous, theoretically undemanding and often subject to damming (albeit, normally poorly publicised) critiques by well qualified reviewers, these works have provided a pool of emotionally driven works about the Thai sex industry that are easily accessible for the casual non-specialist reader – providing material for both titillation and for the development of righteous indignation, depending on the reader’s orientation.

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A New Look at Thai AIDS

Orient’ (Said 1985: 3), for many Westerners these depictions represented an essentialised world of sexual practices that were really ‘out there’. Critically, like the small existent body of academic knowledge about Thai sexuality, this informal knowledge about Thai sexuality provided narratives of Thai sexuality constructed in terms of sexual pathology. Yet, regardless of their conceptual poverty, the impact of such depictions of Thai sexuality in the early 1990s is hard to underestimate. During this period, in the context of rapidly increasing HIV statistics in the North of the country, Thai sexual practices became a subject of worldwide fascination. For the Western public at large as well as for those working in the Thai AIDS sphere, the Thai sex industry became the single major trope for knowing and depicting Thailand and, for the Thai middle class and elite, a subject of considerable embarrassment. Thus, 1991 saw the release of a highly sensationalist and widely publicised film dealing with prostitution, The Good Woman of Bangkok, and in July 1993 a young Thai prostitute appeared on the cover of Time magazine and the feature article focused on prostitution in Bangkok. Also in 1993, a new edition of Longman’s Dictionary, quite bizarrely, defined Bangkok as the city said to have the most prostitutes in the world; the resulting protests by the Thai public and Thai Government and subsequent withdrawal of the book drew worldwide media attention. The same period also saw the commencement of high profile campaigns against child sex tourism and sex tourism in general (Montgomery 1996a, 1996b; 2001), with the NGO ECPAT (End Child Prostitution in Asian Tourism) being formed in 1991. Indeed, as Montgomery (2001: 29) points out, for NGOs in general ‘the commercial sexual exploitation of children became one of the most important issues of the 1990s’. It was in this general social and intellectual context that AIDSrelated research about Thai sexuality began in earnest. I suggest that in the absence of scholarly analyses of Thai sexuality and sexual practices, this informal, orientalist and highly sensationalist body of knowledge about Thai sexuality, in concert with the small corpus of work dealing with prostitution in Thailand together with Thai middle-class based views about the uncontrolled (and inappropriate) behaviour of the underclass and about female sexuality, was in no small part responsible for shaping the early modelling of the Thai AIDS epidemic through influencing the direction of early AIDS research and interventions. Critically, it was at this point that the Thai first started to adopt Western middle-class morality as a standard by which to measure Thai sexual practices (Brummelhuis 1993) and, as Mulder (1997: 332)

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puts it, ‘American-style middle-class “family values” ’ to control HIV/AIDS.8 From this time onwards much of the underpinning of AIDS research and interventions exhibits a Western (and Thai middle class) ‘orientalist’ fascination with what the Thai AIDS literature portrays as the transgressive sexuality of the Thai underclass (both male and female), particularly the underclass at the geographic and ethnic periphery. As a result, based on a combination of these highly partisan views, early HIV/AIDS behavioural research and intervention regimes were based on simplistic, binary and highly essentialised views of Thai women, as either good (married and sexually active, or single and chaste) women and bad women (prostitutes), and equally essentialised and highly derogatory perspectives about Thai men, particularly those in the underclass. Thus men were portrayed as sexually rapacious and as highly irresponsible with, very early on in the epidemic (as I take up in the following chapters), their participation in commercial sex being portrayed as individual culturally transgressive behaviours, rather than a normal cultural practice for the majority of men.9 In these research and intervention regimes, history and historically sedimented cultural practices have been viewed as irrelevant; sexual activity outside marriage has axiomatically been equated with promiscuity and classified as dangerous risk behaviour; and the entire Thai AIDS field has been characterised by a concern with morality that, by the late 1990s, saw many AIDS-intervention programmes transformed into tools to serve a new Thai middle8. Van Esterik (2000: 118) points out that Thailand has a long tradition of drawing on Western cultural models to represent itself, dating back as far as the late nineteenth century as increasing numbers of royalty and the Thai elite visited Europe, and used the experience as ‘a blueprint for how to represent themselves to others’. Thus, in the late 1930s and early 1940s, Prime Minister Phibun Songkhram drew on his understanding of Western models of civilisation and modernity in his programme of nation building which suppressed regional cultures in favour of a newly created hegemonic model of a national culture and modern values (which included the wearing of Western-style clothing complete with hats and the kissing goodbye of wives each morning) (see Barme 1993). 9. The task remains for a full analysis of the extent to which the early modelling of the Thai AIDS epidemic reflected Western orientalist views of Asian sexuality. These views are not solely free-floating, being passed-on in bars and private conversations, but are amply recorded in English language newspaper reporting, in several free monthly magazines produced for the tourist market, in the conversations of the internet newsgroup (soc.culture.thai) dedicated to Thailand, on a rapidly expanding series of Western-owned web sites dealing with sexuality in Thailand, and in the mass of cheap novels written over the past forty years dealing with Western male sexual awakenings due to their encounter with Thai (prostitute) women.

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A New Look at Thai AIDS

class crusade for the promotion of public morality in the face of what they viewed as the corrosive encroachments of Western liberal sexual practices (see chapters five and six).10

A Critique of Thai AIDS Social Research and Behavioural Interventions New Methods of Qualitative Research and the Peripheralisation of Anthropological Research The Thai AIDS epidemic and AIDS funding regimes that encouraged research about Thai sexuality forced the creation of a epistemological space for a very different form of knowledge about Thai society and Thai social relationships (compare Whittaker 2000: 90). By contrast with the past, this new form of knowledge emphasised a different set of ‘social facts’ to produce an alternative modelling of Thailand (and simultaneously disregarded bodies of knowledge about areas such as history, regional cultures and linguistic knowledge, hitherto considered essential for the understanding of Thai society), and has relied upon different and, I argue below, often inappropriate research methodologies. By the early 2000s as a direct result of research regimes promoted by the HIV/AIDS epidemic a new portrait of Thai society has been added to the vast corpus of literature on Thailand. It is constituted through a focus on HIV/AIDS issues and defined by disciplines such demography, epidemiology, social geography, public-health and biomedicine. Unlike earlier anthropological research in Thailand which, despite the limitation of an overly idealised view of Thai society, was concerned with broad social contexts, these new disciplines have produced a charting of the social field based on a very narrow field of interests: primarily sexual orientation, sex acts, risk activity and HIV serological status. In Geertzian terms (Geertz 1973) the accounts of Thai sexual behaviour and sexuality produced by this genre of works are thin description: they are not ethnographically rich and they are only minimally concerned with social context, emic interpretation and the nuances and ambiguities that always and everywhere characterise social life. Unlike the world they seek to describe and understand, the classificatory categories they utilise are essentialised and are unambiguous. As Marcus notes of such approaches: 10. Additional support for this call to morality comes from Buddhist activists such as Prawase Wasi (Prawase 1993) and Sirak Sivaraksa (Sivaraksa 1986, 1990) and from the members of the relatively new middle-class based Thammakai movement (Taylor 1989; Zehner 1990), all of whom proselytise a highly urban and Central Thai middle-class version of Buddhist morality.

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The subject is already bounded (and to some extent, described) before the ethnography begins. If there is anything left to discover by ethnography it is in relationships, connections and indeed cultures of connection, association, and circulation that are completely missed through the use and naming of the object of study in terms of categories ‘natural’ to subjects’ pre-existing discourses about them. (1998: 16)

In the commercial sex field, for example, a female prostitute is defined by the act of selling sex, by the type of sex acts she performs, her cost and place of work, her claimed level of condom usage and, sometimes, by her serological status. Other factors outside this, the individuals’ entire biography and social situation and the many other roles that women in commercial sex play, are consciously treated as irrelevant. With few exceptions (see chapter five) we know nothing about their lives apart from the most fundamental demographic and epidemiological data. Thus, once prostitutes were defined as ‘the problem’ in respect to Thailand’s AIDS epidemic, the ensuing flood of research about prostitutes studiously ignored the complexities and the nuances of prostitution and now, nineteen years later, they remain defined in total by their participation in commercial sex. The poverty of this label, and the fact that prostitutes not only move between direct and indirect sex work, but in many cases are simultaneously youth, daughters (and as a recent flood early 2000’s Thai language newspaper articles and books reminds us, school and college students), wives, mothers, as well as avid consumers of popular films, books, magazines and the electronic media, and the implications of these factors for their identities and for their health as well as that of their families and their clients, have never been addressed. Yet, so strong is this essentialist labelling that in the AIDS era, from the fourth or fifth year of primary school, many young women in Northern Thailand’s rural underclass are labelled as being at risk of entering prostitution merely by the social and geographical exigencies of birth and ethnic background (Brown 2000). Critically, not only are the data from which this new charting of the Thai social field is constituted distinct from that data on which earlier models of Thai culture and Thai behaviours have been based but also, the bulk of AIDS related behavioural research has been conducted using new research methodologies. As the epidemic developed, and as medical and policy frameworks for research and intervention became standardised over time, these methods became standardised in the manuals of best practice developed by IOs such as WHO (WHO 1999b, 2000) and

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A New Look at Thai AIDS

UNAIDS (Brown et al. 1998a, 1998b) and by the larger NGOs and research centres (Bencha et al. 1993; McFarland Burnett Centre 1999). These new research methodologies include the knowledge, attitude, practice and knowledge, attitude, belief, practice surveys (often self-administered) and various forms of participatory rural appraisal and rapid assessment procedures. Another extremely common HIV/AIDS behavioural research technique is the use of focus groups, a methodology derived from the marketing field and capable of generating massive amounts of decontextualised discursive and semi-interview data about cultural practices. Contemporary AIDS research techniques also include the situational analysis. However, the situational analysis of the AIDS world owes little to the sensitively nuanced ‘social situation’ approach pioneered in the work of Gluckman (1958) and others of the ‘Manchester School’ tradition of social anthropology (Kuper 1983). Instead, it comprises a sort of broad-scale empiricist survey of a social context in respect to its potential HIV/AIDS problems and the resources available to address these. Critically, these methodologies are regularly claimed to be techniques for the gathering of qualitative anthropological-style data without the disadvantage of requiring long periods of fieldwork – some practitioners of these research methods even claim some training in anthropology or qualitative research methods.11 Yet an anthropology course or two taken as part of an under11. The range of disciplines claiming to use anthropological-style qualitative ethnographic research methodologies is both stunning in its extent and alarming in the careless manner in which such claims are made. Practitioners of disciplines such as cultural studies, media studies, folklore studies, social geography and even women’s studies departments and departments of education, now commonly claim to do ‘ethnographic research’ (see Miller 1995). In many cases the logic supporting such claims appears somewhat tendentious. As I read it, it goes like this: non-quantitative (that is, non-statistically) based research is by definition qualitative research which, by definition is ethnographic research, which is what anthropology is about. The manuals of ‘best practice’ used by these groups invariably explain that techniques such as participatory rural appraisals, situational analyses and rapid anthropological assessments are qualitative ethnographic research methods developed on the basis of anthropological research techniques, but that they are better than ‘traditional’ anthropological techniques as they take only a short period of time (Brown 1997; Macfarlane Burnett Centre 1999). The uncharitable might observe that part of the attraction of such techniques is not only their claimed need for only short periods of research time and the limitations of quantitative techniques, but that such approaches obviate the need for any solid grounding in either qualitative or quantitative research methodologies. The result, as Lambert and McKevitt (2002: 210) put it, is that ‘Qualitative research is in danger of being reduced to a limited set of methods that requires little theoretical expertise, no discipline based qualifications, and little training’.

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graduate degree or participation in one of the many one- or twoweek short courses in ‘ethnographic research methods’ regularly purveyed by under funded university Social Science Departments provides little substance in the way of anthropological theory or in research methods to legitimate such claims, or to enable such persons to ‘do’ anthropological style qualitative research in the field. Moreover, once social science research, and that of anthropology in particular, is reduced solely to a matter of data collection methodology, with no concept of critical and reflexive analysis, social theory, or culture (beyond that of culture as an irrational impediment to programming), the logical outcome is a belief that anyone can do social research. Thus, regardless of their theoretical, methodological and practical limitations when viewed from an anthropological perspective, the development and use of these new research methods in the Thai AIDS sphere has transformed the terms of engagement for anthropological research on Thai society, by subtly revaluing the space for and significance of anthropological contributions. By claiming to produce anthropological-style qualitative research data, by producing much more data (particularly in the case of focus group research), by doing ‘qualitative research’ in substantially less time than that taken by those using traditional fieldwork methodologies, and by producing work uncluttered by ambiguity and complex technical jargon, the social mapping produced by the practitioners in these disciplines has, all too successfully, sought to occupy the social and disciplinary space that anthropological research hitherto occupied. In this new research environment, where AIDS research means substantial amounts of funds for both Thai and foreignbased research institutes, research is often conducted by teams of several members, with some working on data collection, others on data analysis and yet others on report writing. In such production-line research, where the research methodologies are specified by donors and directed by standardised manuals of best practice, and where social theory and contested interpretations of research data are not valued, anthropologists and the theoretical and contextual baggage with which their work is characteristically framed are considered irrelevant, even an impediment, to research conceptualised as ‘fact’ gathering. In this context, in many cases the contribution of interpretative disciplines such as anthropology has been reduced to that of data collection during short-term consultancies (Fordham 1999). Restricted to such ‘butterfly collecting’ (Leach 1961), any unique contribution that anthropologists might make is little distinguished from the contribution of untrained interns with no grasp of anthropological

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A New Look at Thai AIDS

theory or research methods, and with no country-specific cultural knowledge or linguistic skills. Employed to play bit parts in much larger dramas, anthropologists characteristically find they have little control over the conduct of the work they do, the methodologies utilised, the time lines for research, or even the types of reports they write. Regardless of what we might say in our reports in moments of ‘anthropological rebellion’, comments or interpretations judged ‘inappropriate’ are edited out by agency staff prior to its presentation to donors. And in this act our names, reputations and qualifications are transformed into mere instruments for the legitimation of the organisational agendas of our employers. Indeed, so little value have skills in social science been accorded over the past decade of Thai AIDS research and interventions, that periodically over this period specialists from the world of biomedicine have sought to become experts in social science and on Thai society, without the benefit of training in social science or social science research methods and without even the benefit of long-term intimate experience of the many modalities of Thai culture.12 Van Esterik’s (2000: 3) contention that ‘everyone knows something about Thailand’, one borne out by the many ‘vanity’ web sites produced by Thai aficionados, is all too true. To give just two examples of this genre of writing, Beyrer (1995) writes on Northern Thai culture and HIV transmission in The Journal of the Siam Society and on the general problem of AIDS in South East Asia (1998) in a small pocket book, while McAndrew (2000: 114), having discovered the Thai word for fun, sanuk, makes this a central trope for his discussion of some Thai AIDS prevention programmes. At first glance, the result of such ambitious enterprises is merely the production of harmless undergraduate-level reviews. However, a closer examination of such work suggests in reality it is harmful. Firstly, this genre of writing represents yet further biomedical hegemony over the AIDS field, a hegemony bereft of any sense of theory beyond naive empiricism and bereft of the indepth knowledge of cultural and interpretative issues that social science scholarship brings and, critically, and quite erroneously, it suggests that anyone can do social science. Indeed, discussions with informants engaged in the biomedical modelling of AIDS suggest that most conceptualise the doing of social science (and 12. Treichler (1999) makes a similar point about the AIDS field more generally, and comments that whereas many social scientists working in the AIDS sphere have some degree of understanding of the AIDS virus and how it works medical researchers rarely have an understanding of the social sciences.

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anthropology in particular) as being little more than fact collecting, a practice that is made more rigorous by dredging pre-existing ‘data’ from a handful of relevant social science texts that do not obfuscate the topic with irrelevant social theory. Any sense of the significance of culture per se, of social theory or of critical and reflexive analysis, or even of the epistemological and social context in which foundation works in the area were written is totally absent, as is any sense that these issues might be important. Indeed, Beyrer (1998) seems to celebrate his ability to produce social science analyses without the possession of specialist skills. Secondly, conducted within the terms of the normative model of the Thai AIDS epidemic, and with very limited understandings of Thai culture, this genre of work moves our understanding of people’s behaviour in relation to AIDS and sexuality deeper into the realms of neo-orientalist mythology, and further from the world in which people live. Yet, as highly accessible populist works due to their theoretically uncomplicated approach, like an earlier generation of sensationalist journalistic-style ‘exposes’ of Thai prostitution, regardless of their factual, methodological and theoretical limitations, within a few years such works have begun to be cited as standard references in their field (Economist 2002). Critically, however, as I discuss more fully in later chapters, the methodologies used by such individuals, and by the many disciplines now claiming to do qualitative anthropological-style research, only mimic anthropological ethnographic research methods. Unlike anthropological ethnographic methods, focus groups, the interviews characteristic of rapid assessment procedures (including ‘in-depth’ interviews) and situation analyses provide only very short-term ethnographic exposure and provide almost no contextual data at all. For the many new researchers involved in Thai AIDS behavioural research, the moral consensus they find in focus groups is a comforting indication of the validity of the data and of their interpretation (see chapters five and six). Yet, focus groups merely produce an agreed upon and consensual view of culture, and in effect report ideology rather than actual social practice (Bolton 1995). Moreover, throughout the 1990s Thai AIDS researchers have authenticated their analyses by reference to issues such as the size of survey samples, the number of focus groups conducted and the many hours of recorded data transcribed (and often translated into English) for analysis, or the rigorously scientific methods (such as the use of text analysis software) used to analyse ‘qualitative’ interview data (VanLandingham and Trujillo 2002). From an anthropological perspective this approach not

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A New Look at Thai AIDS

only confuses data quantity with data quality, the art of empirical description with analytical precision, and naive empiricism with theoretical rigour, it is also totally artificial in that it bowdlerises the fluid and chaotic nature of ethnographic research and the manner in which understanding is reached (Hamilton 2003).13 One can only speculate how that intellectual giant of anthropology Leach (Political Systems of Highland Burma, 1964) who wrote without the benefit of field notes (Kuper 1986), would have fared in this brave new world. Indeed, cognisant of the ambiguities and limitations of field notes (and field data in general) Shweder (1986) suggests that ‘the best way to write a compelling ethnography is to lose your field notes’ (cited by Lederman 1990: 73). What those disciplines claiming to do anthropological-style research by using what they consider qualitative ethnographic research methods have failed to grasp, is that anthropology cannot be reduced to methodology alone or to a supposedly unique appreciation of local knowledge – with such knowledge reduced to a set of culturally unique understandings and practices. Rather, the power of anthropology lies in a long-term intense focus on a society, in fieldworkers working in local languages and participating in and understanding local life and cultural practices in their own terms (and as revalued over time through praxis, both HIV/AIDS per se and AIDS programming causing a revaluation in many Northern Thai cultural practices), while simultaneously, focusing on the broader cultural context and issues such as history, politics and economics. Ethnographic fieldwork is not simply ‘being there’, as Kapferer points out: Fieldwork can be reduced to travelling, to simply being there, and so on, but this tends to the acceptance of an empiricist notion – fieldwork as simply data collection, as authentification. I stress instead, fieldwork as an attitude and a means [my emphasis] to break the resistance of the anthropologist’s own assumptions, prejudices and theories, wherever the site of origin, concerning the nature and reason of lived realities. (2000: 189)

Critically, in respect to my point here, he adds, 13. I am reminded of those university departments which prepare their graduate students for their Ph.D. field research by having them produce a complete thesis outline, chapter by chapter, in which they need only fill in the blanks. Such approaches leave little room for ambiguity or for the asking of new questions in what Kapferer calls ‘a process of almost ontological proportions whereby the fieldworker-becoming-anthropologist is placed in a routine situation where all that was taken for granted is problematised’ (Kapferer 2000: 189).

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the general point I am insisting is that fieldwork in the anthropological sense I am expressing here is about a radical reorientation in perspective, which notions of fieldwork as data collection, information through experience, training in sensitivity, gaining knowledge of the Other, either miss or trivialise [my emphasis]. (2000: 189)

It is high time for anthropologists working on HIV/AIDS in Thailand or, for that matter, elsewhere, to reclaim their ground both practically, from other disciplines who make untenable claims to do what we do best, and theoretically, from the ravages of the naive empiricism that they proselytise. Recent debates (Coleman and Simpson 2001a, 2001b; Hamilton 2003; Kapferer 2000, 2002; Marcus 1998, 2002; Mills 2001; Sanjek 1990; Whitehead 2001) about the role of anthropology in the modern world suggest not just an anthropology with its confidence ‘undermined’ (Kapferer 2000: 176), but an anthropology prepared to be muted (Ahmed and Shore 1995; Shore and Wright 2000). As Kapferer puts it, anthropology has lost its ‘radical edge’ (Kapferer 2002: 151) and, of anthropologists acting as consultants for governments and business, they are ‘so economically dependent that, by and large, they are rendered critically impotent’ (Kapferer 2002: 150). However, it seems to me that the strategy of the ‘uncomfortable science’ disciplining itself and making itself comfortable for others14 – in our professional lives as consultants through conformity to the established research paradigms of our employers, as academics engaged in research and writing projects while simultaneously attempting to anticipate and deflect a postmodernist critique hostile to the very principles of our discipline, and in our roles as teachers in the academy through submission to the ever increasing constraints of the administrative convenience of the new audit culture – has not been particularly effective. If the collection of data – playing minor bit parts as ‘butterfly collectors’ – is all we have to contribute to social issues as fundamental as the AIDS pandemic that has impacted so heavily on every part of the worlds in which we work and claim special expertise and understanding, is it any wonder that the audit culture of the academy also finds us increasingly irrelevant (Shore and Wright 2000; Strathern 2000)?

14. First used by Sir Raymond Firth, this term refers to the manner in which the images anthropology presents of ourselves and our society often clash with and challenge our preconceptions about ourselves and reveal issues we would prefer remain hidden.

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A New Look at Thai AIDS

True, some anthropologists working on Thailand have continued to conduct in-depth ethnographic research, and have made original contributions to the ethnography on Thai sexuality and AIDS related issues (Brummelhuis 1993, Chayan 1993; Chiraluck. 1992; Fordham 1993, 1995, 1998, 1999, 2001; Lyttleton 1994a, 1994b, 1994c, 1996a, 1996b, 1999, 2000; Manop 1994; Muecke 1999; Niwat 1998; Michinobu 1999, 2000; Tannenbaum 1999; Yos 1992). Yet, over the almost two decades of the Thai AIDS epidemic such contributions can only be judged to be thin on the ground, and as a result have largely been submerged in the mass of work produced by these ‘new’ disciplines using these ‘new’ methodologies and the new models of the Thai social field they have created. In respect to the international AIDS arena, some (Parker 2001, Schoepf 2001) have recently made claims for the magnitude of the role anthropological research has played in understanding and combating the AIDS epidemic. Yet the work of which they speak is largely an anthropological literature, published in anthropological journals or as anthropological monographs and, as such, work that speaks primarily to the converted. Almost nobody, neither those working at the donor level, the IO level, nor at the NGO implementing agency level, reads social science journals or anthropological monographs. In the real ‘on the ground’ world of IOs and NGOs working on AIDS interventions, agency reports for the last five years, a few UNAIDS/WHO best-practice texts and the latest free offerings from UNICEF are the works that typically constitute the stock of knowledge. The Thai AIDS Epidemic: Two Decades of Continuous Present The past, for most working on HIV/AIDS behavioural issues, is simply irrelevant for understanding present day cultural practices. Indeed, the response to AIDS in Thailand has largely been conducted in a sort of long-term ahistorical continuous present, legitimated by the claim that the emergency represented by the epidemic rules out concerns with anything other than the core objectives of reducing rates of HIV transmission and of providing care for the afflicted.15 Simultaneously, the discourses through which the Thai AIDS epidemic has been modelled and essentialised, and the research and interventions it has engendered from the many groups involved in the Thai AIDS world, have been portrayed as having developed in a positivistic evolutionist 15. Interestingly, Van Esterik (2000: 43) makes a similar claim about contemporary writing on Thai women, that it ‘reads like a collage of perpetual presents’.

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sense, and this portrayal has not yet been challenged by a critically reflexive historical examination. I begin by addressing the issue of AIDS and Thai history of the long run (Sahlins 1981), that which encodes the overarching structures of Thai society. With the exception of Bamber et al.’s (1993) work on the history of STDs in Thailand, and Tepchoo Tupthong’s (1983) Green Light Women on early twentieth-century prostitution which, as a Thai language publication, has a restricted audience, any focus on history in relation to the understanding of Thai sexual culture(s) that extends beyond the beginning of the Thai AIDS epidemic has generally been ignored.16 Yet even a fundamental awareness of Thai history(s) over the past two or three centuries, and of Bangkok and Central Thai dominated constructions of Thai history(s) (Tongchai 1994), of more recent centre–periphery relations between Bangkok and the North and North East during the 1960s and 1970s (Bowie 1997; Morell and Chai-anan 1982; Wright 1991), and of relations with the Northern hill tribes during the same period, has much to contribute to an understanding of the current modelling of the epidemic and the interventions this has engendered amongst these groups. Other histories, likewise neglected, are intellectual histories of how issues such as women, development, prostitution, class and general social and health issues have been constituted, researched and addressed in various social intervention programmes over the past half century. An appreciation of these issues and their histories has much to offer in respect to understanding how contemporary HIV/AIDS problems and their solutions have been constructed. On the broader scale, cross-border AIDS issues and associated issues such as the trafficking of women and children have been well-funded research and intervention programme issues for much of the past decade. Yet, although invisible to outsiders due to the masking effects of local languages, the actual working out of these issues is dependant on much more than current day social processes. Take the Thai – Khmer border, for example: Thai – Khmer power struggles over the past several hundred years and the enmities these created continue to be played out in the AIDS sphere. Thus, nineteen years after the discovery of the first HIV infections in Thailand, and after over a decade since the discovery 16. The same is true of the Cambodian AIDS field, where not only is history of the long run generally ignored, the complex history of recent decades is highly simplified, with the Khmer Rouge period of the late 1970s held to be responsible for social phenomena as diverse as patterns of male sexuality, domestic violence and the depletion of native animal species.

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A New Look at Thai AIDS

of the first HIV infections in Cambodia (UNAIDS 2001), in the 2000s Thailand and Cambodia continue to use the public media to accuse each other of providing the reservoir of HIV that is infecting them (Sor Romnar and Tandopbun 2001). Even further, recently rewritten Cambodia secondary school social studies texts claim that the Cambodian HIV/AIDS epidemic was caused by Vietnamese prostitutes migrating to Cambodia to work (Ministry of Education, Youth and Sport 2000). As far as the lack of a focus on history of the short run (of contingent events) is concerned (Sahlins 1981), there has been no critically reflexive examination of the historical construction of the AIDS epidemic itself. Accounts of the AIDS epidemic and of the many social and behavioural interventions it has engendered are, to date, of the most simplistic and positivistic kind (Brown et al. 1998a, 1998b; Kilmarx et al. 2000; Prasert 1999; WHO 2000; Wiput 1998; Wiwat and Hanenberg 1996; World Bank 2000) constructed from the works of biomedicine, epidemiology and demography. They not only almost completely ignore the work of anthropologists, sociologists and historians, they also present totally uncontested accounts of the Thai AIDS world of the past nineteen years, and model the epidemic and the interventions it has engendered as a unitary epidemic with a linear progression of increasingly effective interventions that have ultimately led to Thailand’s ‘success story’ of a lower level of HIV infection in sentinel surveillance groups. Thus, Kilmarx et al. (2000: 2733) suggest that data from Chiangrai public health surveillance ‘are perhaps the strongest example in the world of a society-wide, successful response to the HIV/AIDS epidemic’. Moreover, this modelling of the epidemic portrays it as an essentialised entity existing outside history except a positivist history of its own making, and issues of interest and of power in the construction of the epidemic and the implementation of AIDS interventions have never been addressed. A history of the epistemological chaos that has characterised the modelling of the Thai AIDS epidemic, and the scramble for funding that has characterised research and intervention activities has yet to be written. However, recent work by Bupa (1999), Chutchawarn (2000) and del Casino (1999) suggests that in the area of NGO interventions, an historical analysis of the impact of funding on NGO foundation and programming in concert with an analysis of interest and power relations, would be of particular utility in understanding the construction and progress of the AIDS epidemic in 1990s Northern Thailand (compare Law 2000 in respect to the Philippines). Such work would provide a much needed correction

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to the above noted positivist models of the epidemic. Indeed, there are many other areas where historical analysis would shed light on the role of NGOs in the modelling of the Thai AIDS epidemic, and their activities in the area of AIDS education and health care interventions. To address one such issue. In the early 1990s Thai NGOs played a major role in ‘on the ground’ HIV/AIDS education regarding the need for self protection through risk reduction. From the beginning of such activities, the legitimation for and the specific structure and nature of their AIDS educational interventions were based on the claim that rural populations generally had low levels of education, which meant that they were unable to understand national AIDS awareness programmes about HIV transmission and AIDS risk behaviours and, in the case of men in the rural underclass, failed to appreciate the need for self protection and for the protection of their families through behavioural change. Yet, only a few years earlier in the 1970s and early 1980s, the ‘village movement’ had arisen in a loose coalition between new NGOs concerned with development issues and some senior members of Thailand’s academic world in the areas of Thai History, Thai Studies and Development. This movement argued for the significance and potential power of local skills and local traditional knowledge (usually called local wisdom, phuumibanyaapeunban) in areas such as health (Golomb 1985, 1988; Viggo 1987) and agriculture (Seri and Hewison 1990), as a means of providing a path towards rural self-reliance. At approximately the same time, in response to prompting by WHO Thailand’s Fifth National Development Plan (1982 to 1986) reversed earlier policies antagonistic towards traditional healers and began some cautious promotion of traditional medicine (Whittaker 2000: 59), an activity that reinforced claims for the efficacy of traditional wisdom. Much research about various forms of local knowledge and traditional medicinal recipes was conducted, and in the early 2000s bookshop shelves still exhibit a steady stream of Thai language publications classifying local wisdom and attesting to the efficacy of the native recipes of peoples of the regional periphery. Indeed, for some in the medical profession the study of traditional medicines has led to the founding of highly successful industries (both in economic terms and in terms of medicinal efficacy) producing traditional medicines for the local and export markets (Supaapon 2001). However, there is no little irony in the fact that by the early 1990s, as the normative AIDS paradigms and models for interventions matured, AIDS discourses revalorised the meaning of

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A New Look at Thai AIDS

local wisdom. In this revalorised model of viewing the rural periphery, the traditional knowledge and practices of rural peoples became viewed as the basis of the rural AIDS problem. Instead of the earlier portrayals of the rural underclass as a people with an inner strength and an inherent ability to provide for their own needs due to their own traditional knowledge and skills, they were now portrayed as inherently vulnerable, and as unable to provide for their own health needs due to a lack of modern technical knowledge. Indeed, it quickly became part of taken-for-granted Thai AIDS discourses that the AIDS problem amongst the rural and urban underclass was both their lack of knowledge and their low levels of education, which meant that they were not able to understand the HIV/AIDS knowledge they were given.17 By the mid-1990s, many of the individuals and groups who had earlier been involved in the cataloguing and promotion of local wisdom were running AIDS-prevention programmes for adults and life-skills programmes for young people, in the same villages whose local wisdom they had eulogised a decade earlier. The promotion of local wisdom had constituted an effective panacea for a middle class conscious of Thailand’s structural neglect of rural development. Its promotion had also suited state interests, in terms of the control over knowledge that such classificatory systems promised and, as Anan (2000) points out in respect to the allied project of the writing of local histories in the 1970s and 1980s, it also articulated with state needs for national integration. However, by the early 1990s it was clearly considered inadequate as a basis for AIDS prevention or, as I argue in chapter five, for the promotion (and later supervision) of the new Thai middle-class regime of public morality suitable for display in a globalised world (compare Van Esterik 2000). A final point in regard to the need for historical analysis to understand the modelling of the Thai AIDS epidemic relates to attempts to incorporate AIDS discourses within the broader realm 17. Whittaker (2000: 100) notes a similar attitude in the reproductive health field, on the part of Thai middle-class medical practitioners who attributed North Eastern village women’s gynaecological problems to their low level of education which meant they could not understand the need for bodily cleanliness. Pigg’s (1992: 507) highly perceptive point regarding Nepalese development discourse, ‘As long as development aims to transform people’s thinking, the villager must be someone who doesn’t understand’, applies in full to the Thai HIV/AIDS and general health/development sectors. Critically, as she points out, such binary oppositions between the peoples of developed urban centres and the undeveloped rural periphery are not simply imposed from the outside but are an integral part of the way in which local identities are constructed and in which people orientate themselves in national society.

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of development discourses. Development discourses comprise regimes of power, in as much as they posit all-encompassing definitions of context and solution (Hobart 1993). In the case of AIDS, the claim that AIDS is a disease of development suggests attempts in the exercise of power through defining the nature of the Thai AIDS epidemic and the associated claim to be able to control it. Early 2000’s claims and counterclaims regarding the ‘success’ of Thai AIDS campaigns are likely less to be concerned with the curbing of the Thai AIDS epidemic than they are with the legitimation of the claims of various UN and other major international organisations to have successfully defined the problem of Thai AIDS (in biomedical terms) and to have responded with efficacious solutions. Indeed, the historical processes through which the hegemony of the biomedical model of AIDS was established at both the macro and micro levels, and the mechanisms through which this is maintained, would repay intensive study. Serious challenges to this model are always addressed immediately. In chapter four I point out that throughout the 1990s, whenever local healers produced medicines to ameliorate the symptoms of AIDS and attracted a significant body of clients, provincial health departments always intervened to reinforce the hegemonic position of biomedicine. In each case, whenever a herbal medicine was promoted as being efficacious for AIDS-related illnesses, it was met with claims in the print and electronic media that it was untested (by scientific criteria) and possibly dangerous to health - not surprisingly a point that those afflicted with AIDS-related illnesses found totally unconvincing. Almost always attacks were made on the personal integrity of the healers in question and their motives in producing the medicine and, in at least one case (see chapter four), police intervention was used to prevent the distribution of medicines.18 18. Whenever a perceived challenge is issued to the hegemony that the biomedical model of AIDS enjoys, attempts are made to reassert the power of the dominant paradigm. For example, for much of the 1990s the Bangkok Post (a leading English language Thai newspaper) columnist Bernard Trink has utilised his weekly column to periodically deny the existence of AIDS amongst Bangkok’s bargirl-cum-prostitute population, to deny the claimed magnitude of Thailand’s AIDS epidemic, and to proselytise the view that there is no relationship between the HIV virus and AIDS. Thus in early 1996 Trink (1996: 5), drawing on material published in Penthouse, argues against the HIV virus as the cause of AIDS in favour of causation such as drug abuse, syphilis, nutritional deficiencies, stress or other viral infections. Over the years he has consistently argued in the same vein, writing in late December 2000 ‘There’s no pandemic of the dreaded disease’ (Trink 2000a: 5), and a week later claiming that ‘Deaths

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A New Look at Thai AIDS

The Limitations of Language I noted earlier the Orwellian world of the Thai AIDS epidemic which has revalorised much of the lives of the underclass, through the construction of new ‘health-based’ interpretations of their behaviour, and which, in doing so, has legitimated an unprecedented level of surveillance over and intervention in their private lives by state agencies, IOs and NGOs. In the first decade of the non-Western AIDS epidemics, in Brazil, Haiti, sub-Saharan Africa and then Thailand, the initial behavioural research and interventions took place amidst the social upheavals of the first AIDS deaths. There was little in the way of established medical, research and social policy frameworks to guide AIDS research and interventions. Nor was there a standardised language for those conducting the first generations of HIV/AIDS behavioural research. In Thailand, those working on early HIV/AIDS behavioural research and interventions, quite literally, developed as they went along the language for the conduct of their research, for the writing up of that research and for the interventions it guided. Yet, by the second decade of Thai AIDS (the early to mid1990s), this situation had changed dramatically. By now a well established language and series of technical discourses had evolved from a combination of the development of protocols of best practice on the part of IOs and major NGOs, from pressures exerted by donors and from on-the-ground experience conducting research and interventions by the many hundreds of persons involved in Thai AIDS-prevention activities. I suggest that, like the central paradigms of the Thai AIDS epidemic itself, which now act to limit the range of questions and issues considered relevant to AIDS research and interventions, a similar phenomenon has taken place in regard to the accepted language and technical discourses in which Thai HIV/AIDS issues are now couched. Just as normative AIDS discourses define the parameters of the AIDS epidemic, the language and concepts in attributed to HIV/Aids in the realm is [sic] imaginary’ (Trink 2000b). In each case his claims draw letters of outrage from various prominent (generally Western) figures in the Thai AIDS medical establishment. Their letters refute his claims and legitimate their own position by reference to their professional qualifications, by casting aspersions on Trink’s professional integrity and by pointing out his lack of technical AIDS knowledge. Although Trink’s work is often ill-informed, his ongoing attack on the popular model of Thai AIDS is symbolically important as it continues to draw attention to the hegemonic nature of the biomedical model of AIDS, and to the fact that this model is continually challenged at the margins. Indeed, as I suggest in chapters five and six, most challenges are far more convincing than those of this populist newspaper columnist.

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which these discourses are couched have become second nature for many working in the AIDS arena: a description of real essentialised realities of ‘risk’, ‘risk behaviour’, ‘promiscuity’ and of an underclass of villagers with ‘low knowledge’ and ‘no morals’, of ‘indirect’ commercial sex workers who are sometimes so stubborn that they refuse to acknowledge that they are sex workers, and of men who, similarly, often refuse to admit to their risk behaviour. Critically, this language began as little more than simple descriptive ‘shorthand’ concepts, yet, through time and as the language of AIDS evolved, these became essentialised to constitute a world of danger, powerlessness and promiscuous behaviour that is ‘really’ out there, and one in which the intervention of outside experts is necessary if the underclass is to negotiate it successfully. Ultimately, the uncritical and unreflexive use of such language and the concepts it encodes has led to highly tendentious and often highly tautological analyses. Certainly, some questions have been asked about the language of AIDS, particularly in the production of AIDS education materials, where questions have been raised in regard to how language defines, disempowers or empowers various groups. But such questioning has largely taken place within the context of the overall AIDS paradigm, where it has served merely to generate yet more secondary elaborations rather than to raise fundamental questions about the concepts per se (Kuhn 1970) and encourage a move towards paradigm change.19 Indeed, over the past nineteen years, the failure to have engaged in any form of reflexive analysis of the language through which the Thai AIDS epidemic has been constituted is an issue that deserves attention. Perhaps one reason for this failure is that which Hancock (1989) posits for a similar failure to raise 19. Writing in respect to commercial sex work and HIV/AIDS in the Philippines, Law (2000: 85) takes up the issues of how AIDS epidemics are ‘invented’ (see Paton 1990) through the selection of ‘high risk’ groups for sentinel surveillance, and makes some comments regarding the limitation of the concepts of negotiation and of peer education when used in ‘transcultural contexts’ (Law 2000: 119), but as it is not her primary objective she does not pursue her analysis to its logical conclusion. By contrast, Pigg’s (2001a, 2001b) scholarly and insightful works on the Nepalese AIDS epidemic expose the conceptual empiricism and the sheer lunacy of attempts to operationalise ‘internationally standardized sets of facts and policy wisdom’ (Pigg 2001b: 482), and the generic models of HIV/AIDS as disease and of the AIDS interventions that such an approach embodies, through the mere translation of language. Such critical approaches are in stark contrast to the approach taken by the majority of those working on the Thai AIDS epidemic, who have generally worked within the dominant paradigm and who have accepted these concepts at face value.

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fundamental questions about development issues. AIDS is undeniably bad, and seeking to stop AIDS is undeniably good, a humanitarian issue guided by moral virtues, thus questioning such objectives seems both immoral and churlish. Yet, in the highly emotive but ahistorical continuous present of the Thai AIDS epidemic, where knowledge of the accepted ‘facts’ of how things are is more important than the interpretation of cultural practices or the making of reflexive analyses (and where the fragmentation of research and intervention activities mitigates against the making of such analyses), I suggest that for many working on AIDS research and interventions such questioning is simply viewed as being irrelevant.20 There are two fundamental problems with the language of Thai AIDS and the concepts it encodes. Firstly, as the primary tools for the modelling of Thai sexuality and sexual behaviour these concepts are not only partisan, highly emotive and betray a highly censorious attitude towards sexual activity (issues I address at length in the following chapters), they also demonstrate a total failure to understand Thai cultural values towards sexuality and sexual activity in their own terms, and indicate a total lack of familiarity with the massive corpus of Thai language non-AIDS literature dealing with Thai sexuality which demonstrates very different values. Some of these works (as I point out in chapter six), such as Pansak Sukrarit’s (1999) Just Say No, Or Ok, are particularly notable for the manner in which they poke fun at moralistic and censorious approaches towards sex. His later Talking Beside the Bed (Pansak and Prawit 2001), dealing with questions about sexuality, like that of Sukamon et al. (2001), is a similarly relaxed work. Other recent and particularly notable works are those of Ornanong and Narin (1999, 2000a, 2000b, 2000c) and Ornanong et al. (1999). These authors address difficult and often tragic issues such as sexual and relationship pathology and the situation of young women living with AIDS in a Chiangmai women’s hostel. Yet, by contrast with the censorious nature of the 20. An additional issue, likely relevant in this context, relates to the educational background of many working in the Thai AIDS sphere, particularly those working with NGOs. Set the task of AIDS research and intervention activities, but generally without any specific training in social science, with no training in social science theory, or any grounding in social science research methods, the response has been to resort to naive empiricism as both a research methodology and as a model for the interpretation of behaviour. Thus, the research they carry out as a basis for and legitimation of their intervention activities becomes confirmatory research rather than exploratory research and, as middle-class based organisations, in many cases they end up resorting to classbased interpretations of behaviour.

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literature of the Thai AIDS world, they are highly positive about sexuality and their works are imbued with a sense of the power of love and of desire, by a sense of the ludic, of irony and, critically, with an acceptance of the fates that characterise human affairs.21 There is a second problem with the language of Thai AIDS is in regard to some central concepts utilised in AIDS prevention and intervention programmes. Like the language used in the modelling of the AIDS epidemic as a social problem and public health threat, these concepts have become essentialised as ‘the solution’ and are now operationalised uncritically and unreflexively at the level of an ideology. Here, I briefly discuss three linguistic concepts central to AIDS-intervention programmes, those of empowerment, negotiation/assertiveness and peer education. The concept of the empowerment of women is a central issue in almost all manuals of best practice and in the project reports of large IOs such as UNAIDS down to the smallest local NGO working at village level and, at first glance, the concept is laudable. Yet, as I argue elsewhere in this volume, projects aiming at empowerment, ironically, effectively disempower in the sense that their aim is to proselytise a specific ‘correct’ view on a behaviour such as safe sex, and consider the target group empowered only when that view has been unreservedly accepted. Legitimated by the power position and class base of groups ‘working’ for empowerment (and the comprador position of peer educators is one issue that might well be subject to close examination), by the claim that empowerment is for the subjects’ own good, by the ‘incontestable’ facticity of reified and codified knowledge about behaviour and by the power of medical classification (Mathews 1992), claims regarding empowerment are all too often revealed as little more than programmes proselytising ideology for which they demand uncritical acceptance. In the obfuscatory doublespeak of this world, exercise of choice through, for example, the rejection of health advice (Douglas and Calvez 1990), is glossed as both individual failure and as an inability to understand, and critically, as indicating the need for further ‘empowerment’. The re-education camps of new and mildly repressive left-wing regimes work on much the same principles. Another key concept of the AIDS world is that of negotiation. Women and men in commercial sex, married women, school and 21. A few recent Thai language works sensationalise high rates of sexual activity amongst school and college students (Butarat 2001; Orasom 2001; Somprasong and Unchalee 2001; Wichundaa 2002). However, this genre is small by comparison with the massive corpus of works that accept sexuality as a normal part of life and treat it in a highly positive manner.

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university students are encouraged to negotiate with their customers, their husbands and with their lovers. Indeed, for well over a decade, it is through being taught how to negotiate and through the development of their skills of assertiveness, that Thai women have been empowered. Yet the concept of sexual negotiation appears generally to have been operationalised at the level of an empiricist act of faith. In AIDS-intervention programmes conducted amongst sex workers in brothels and bars, amongst young unmarried women such as college students and amongst older married women, it refers to practical techniques to convince men to use condoms. Thus women working in commercial sex are advised to plead fear of disease, to put the condom on for the man and not let him break it, and are encouraged to be verbally dextrous and assertive in the face of male reluctance. Outside of the commercial sex arena, since the early years of the epidemic, urban-based middle-class instructors have given village women the impractical, if not impossible, advice that they should ‘make’ their husbands wear condoms when they want sex – and that they should do so through engaging in negotiation with him until he agrees. Similarly, ‘life skills’ programmes conducted for female college students advise them to be assertive and to resist being cajoled into sexual activity, but if they do have sex they should insist on condom use. Yet the very language in which the issue of negotiating condom use is couched is more appropriate to relationships of enmity between fundamentally different species or between countries on the eve of war rather than to relationships between lovers, and fails to address the sensations and emotions that actually characterise sex: love, caring, passion, lust and so on (Bolton 1995; Pigg 2001a, 2001b). As operationalised in the commercial sex arena neither the concept of negotiation nor that of assertiveness is subject to critical analysis (Law 2000). Little attention is paid to the varied conditions under which women (and men) work, or to the impact of personal circumstances such as poverty, boredom, emotional distress or just plain physical exhaustion at the end of a long day’s work. Similarly, the issue of the relative ease or appropriateness of the transfer of these concepts from one society to another (Pigg 2001a, 2001b) is ignored, except in regard to issues of the translation of language. A third and final key concept of the contemporary Thai AIDS arena is that of peer education: the use of trained housewives to train housewives, students to train students, and prostitutes to train prostitutes and so on. The logic of such programmes is that the messages being promoted will be more readily accepted from

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peers than from outsiders who will be automatically perceived as being from a different class, and as being judgemental. Like notions of negotiation and empowerment, peer education is, by now, simply the way programmes are conducted and is not up for examination. Yet given the very important role this concept plays in contemporary AIDS interventions, and the level of naive empiricism at which it is operationalised, it warrants critical examination. Thus, as Oppenheimer (1998) points out, some sex workers (and the same applies mutatis mutandis to, say, the members of village women’s groups or village men) do not take the educational messages of fellow sex workers seriously. Not only may the peer educator’s personal behaviour contradict their educational message, as was the case during an intervention amongst young people in Chiangmai (Warunee 1999; 2000), such occasions provide the opportunity for peer educators to use covert winks, raised eyebrows, a sly smile or even a pregnant pause at crucial times during the programme, to subvert and neutralise official programme messages.22 Moreover, in the commercial sex environment, as de Lind van Wijngaarden (2001) points out, a high rate of turnover of brothel workers makes peer education programmes difficult to implement. Additionally, each brothel has a different working ethos and peer education may not work well in brothels with a highly competitive ethos. In Northern Thai brothels, for example, it is common for girls from different (and often mutually antagonistic) ethnic backgrounds to live and work together, and it is likely that in such a context the brothel ethos will be highly competitive, if not one of open hostility. Indeed, research in Thai brothels over the past decade suggests that factors such as poverty, limited personal freedoms, competition for clients and bad feeling between sex workers about issues sometimes as (seemingly) petty as the ‘theft’ of a regular client or the pilfering of a cake of soap, mean that few brothels have the atmosphere envisaged as being ideal for peer education programmes. Indeed, in a stratified social system such as Thailand where (like Laos and Cambodia) individuals are ranked according to criteria such as gender, age, educational level, ethnicity and even beauty, the profoundly Western egalitarian ethos that underlies the notion of peer education demands critical examination. 22. Pigg (2001b: 519) provides an analogous example drawn from training sessions for Nepali AIDS peer educators, when she points out that sessions aimed at desensitising participants in regard to talking about sex, by having them write down and say out loud various words and euphemisms for sexual acts and bodily parts, lend themselves ‘to subtle misuse as an excuse for men to talk dirty’.

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Conclusion This chapter has argued that the dominant paradigms through which the Thai AIDS epidemic has been modelled were established early on in the epidemic, and that since that time AIDS research and interventions have, tautologically, been conducted largely in terms of those original paradigms. Importantly, my aim has not been to establish some form of ‘conspiracy’ model of Thai AIDS, but rather to show how in the late 1980s and early 1990s in a context of a looming social crisis and public health hazard, and where little was known about the likely progress of the epidemic, about Thai sexual practices, or how interventions should proceed, that initial responses to the epidemic drew on ‘taken for granted’, albeit highly erroneous, views about Thai sexuality. Thus I argued that, in a context where there was little scholarly research about Thai sexuality, the early modelling of the epidemic drew on both Western and Thai middle-class assumptions about the sexuality of the Thai ‘other’ at the geographic or ethnographic periphery. Critically, I have pointed out that, working on this foundation, Thai AIDS research and interventions have constructed a model of Thai society that represents a sharp break with the ethnographically rich and well-contextualised models of the past. I also argued that the methodologies favoured in AIDS research represent a similar sharp break with the methodologies through which Thai culture and behaviour have been understood over the past half century, and that AIDS research and intervention regimes have peripheralised anthropology and anthropological research methods – albeit while often claiming to do anthropological-style qualitative ethnographic research. Finally, in respect to the modelling of the epidemic itself and to the implementation of interventions, I introduced the issues of the longterm continuous present in which Thai AIDS research and interventions have been conducted, and the poverty of the language of AIDS and how this uncritical and unreflexive language now limits the social response to the AIDS epidemic. I address these issues in depth in the following chapters.

CHAPTER 3

NORTHERN THAI MALE CULTURE AND THE ASSESSMENT OF HIV RISK: TOWARDS A NEW APPROACH1

S

ince the discovery of the first AIDS cases in Thailand during 1984 and 1985 (Sunee 1992; Vichai et al. 1993; Weniger et al. 1991), the HIV virus spread rapidly through all groups in the Thai community. Fuelled by a high rate of prostitution, the taking of minor wives, extramarital affairs and premarital affairs with casual partners, the rate of HIV infection increased rapidly in the early 1990s:2 a steep rise in HIV infections taking place in the country in 1. This chapter was originally written for presentation at the IUSSP Working Group on AIDS Seminar on AIDS Impact and Prevention in the Developing World: The Contribution of Demography and Social Science, Annecy, France. 6–8 December 1993. Following revision it was published in 1998 in the journal Crossroads: An Interdisciplinary journal of Southeast Asian Studies (vol. 12: 1. 77–164) as a review article with comments by invited reviewers and an author response. It is published here substantially in its original form, albeit with changes made to citations in order that it makes sense in this context. Reviewer’s comments and the author’s response are omitted. The ‘ethnographic present’ it refers to is one of the mid-1990s and it should be read with this in mind. Grateful thanks is given to the publishers of Crossroads for permission to reprint this paper. 2. Associate Professor Praphan Phaanuk from the Thai Red Cross Programme on AIDS gives a figure of 750,000 HIV-positive persons at the end of 1994, 40% of whom were women (Praphan 1995). However, informants working in the Thai AIDS field claim that the actual number is likely to be well over one million as statistics are understated (Rangsin et al. 1995). Mason et al. (1995) note that a declining number of army conscripts throughout the country are testing positive for HIV, and claim this is the result of HIV control measures. The

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A New Look at Thai AIDS

general with particularly high rates of HIV being found in the North and in some districts in the South.3 This chapter examines the issue of risk and Northern Thai male sexual practices.4 An understanding of the way in which Northern Thai men view the risk posed by AIDS and, accordingly, the reasons why many have been reluctant to modify their sexual behaviour, requires an understanding of sexual activity within its total cultural context (Ankrah 1991; Herdt and Boxer 1991; Herdt et al. 1991), including the broader corpus of cultural and religious beliefs and values. I analyse the Northern Thai experience of the AIDS epidemic and argue that Northern Thai men are familiar with the risk posed by events such as road accidents, killers, unemployment and fire, and that AIDS represents merely one additional risk. Moreover, I argue that in Northern Thai male culture there is an inherent impulse towards risk taking in what are now potentially dangerous practices in the commercial sex arena, in excessive drinking and in reckless driving, as the successful performance of such risky activities is a fundamental part of the cultural script through which men evaluate and publicly demonstrate their masculine potency, merit and personal power. Critically, although men are aware of the risks of these activities, they have a more immediate concern with the constitution and display of strong masculine identities. I discuss firstly the peasant experience of AIDS in the context of rapid social change,5 and examine the agendas underlying decline was most pronounced in the upper north, where in 1994 it declined to 7.9% from 12.4% in 1992. Nationwide in 1996, 3.0% of men in this group were found to be HIV positive. Data from STD surveillance also suggest a decline in HIV incidence (Hanenberg et al. 1994). However, the rate of HIV infections is still high and in some regions and among some risk groups continues to increase. 3. Due to economic and social factors Northern Thailand is a source of prostitutes while the far south of the country is a receiving area popular among visitors from the Malay peninsula. 4. This chapter is based on anthropological fieldwork carried out in Northern Thailand from December 1991 to July 1992 and from April to November 1993. Research was conducted in two rural districts: two dormitory villages in Sansai district 14 kilometres east of Chiangmai (the largest city in the North), and two villages in Maetaeng district 60 kilometres north of Chiangmai). 5. This chapter deals with those people who, in the past, would have been classified as peasantry. Today some work their own land, others are full-time urban wage labourers, others alternate between off-season urban wage labour and agricultural labour. For lack of a good shorthand term I frequently use the term ‘peasantry’, with the understanding that I refer to this broad group which resembles a textbook working class no more than it resembles a textbook peasantry.

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AIDS research in Thailand. I argue that much AIDS research has been based on orientalist and class-based assumptions about the nature of Thai sexual practices. I also suggest that much AIDS research reflects Western assumptions about rationality and attitudes towards risk, and that it neglects to examine Thai cultural values. Sexual risk reduction programmes in Thailand have been based on the provision of information about HIV/AIDS in the belief that if individuals know that particular acts are risky they will refrain from committing them. I argue that providing information about AIDS and risky sexual activity is not enough. We must also understand how Thai cultural practices and beliefs influence individuals’ assessment of risk (Bellaby 1990; Douglas 1992; Douglas and Wildavsky 1982; Douglas and Calvez 1990; Parker 1992; VanLandingham et al. 1993a, 1995b). Finally, I construct a model for understanding Northern Thai male sexual risk taking. I argue that in the Thai Buddhist cultural context it is normal for men to engage in contestation in the form of risk taking if they are to constitute themselves as powerful social beings.

The Context of AIDS: A Decade of Rapid Social Change Over the decade of the mid-1980s to the mid-1990s, Thailand experienced high single-digit growth rates in gross national product (GNP). In the villages of Northern Thailand this led to fundamental changes in methods of agricultural production: the buffalo gave way to mechanised ploughs, and exchange labour between family groups gave way to wage labour, often by itinerant groups from other districts. An increasing amount of farm land was alienated to landlords (Anan 1989) and investors from Bangkok and overseas (Fordham 1992). Such changes transformed social relations and self-conceptions (Moerman and Miller 1989). Villagers no longer measure themselves, or their quality of life, solely by comparing themselves with their neighbours. They now learn of their relative status vis-à-vis the outside world from Bangkok television, American CNN and an increasingly wide range of print media. For many, and for the younger generation in particular, modern consumer goods such as video cassette players, stereo amplifiers, kitchen appliances and motor cars are now necessities, replacing the utilitarian land and draft animals of the past. With their almost unlimited variety and their regularly updated styles, these goods symbolise family and individual status.

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Modern village life is also characterised by increased migration to urban centres for education and employment. For those with low education this often means seasonal alternation between agricultural labour in villages and construction or other forms of wage labour in cities. Those taking part in such migrations find an increasingly wide range of occupational categories compared to those which were open for their parents or elder siblings. Once in wage employment, migrants have a disposable income undreamed of in the past. Young people who migrate to urban areas usually live in rented rooms (hor phak),6 shared with other migrants. For both men and women migration to the city brings freedom from supervision by parents and their elders, while small motorcycles give a new freedom of mobility. Young female students and wage workers are financially independent, and often experiment with dress, with their sexuality and with alcohol (Cash 1993; Chayan 1993; Ford and Sirinan 1994). Young people celebrating these new freedoms are visible on the streets of all major cities. Their parents’ distress at decreasing control over their offspring is apparent in the many newspaper articles discussing ‘the youth problem’ and the dissipation of Thai culture (Chiangmai News 1993ab).

AIDS in Northern Thailand Randall and Epstein (1991: 781), in a seminal analysis of research trends in African AIDS, note that presuppositions about African cultural practices were highly influential in directing the foci of AIDS research (see Schoepf 1991). They point out that assumptions about African sexual promiscuity and risk behaviour acted to divert research away from the consideration of other avenues of transmission and other possible co-factors. Similar criticisms might be made of much AIDS research in Thailand (compare Lyttleton 1994a: 138; 1994b: 265) and of the manner in 6. Transliteration of Thai follows the model formulated by Peter Jackson, National Thai Studies Centre, Australian National University (personal communication). This indicates vowel length but not tone. In most cases transliteration is from Northern Thai; however, Northerners today routinely switch between Northern and Central Thai during a conversation, depending on topic, context and particular emphasis they wish to make. This is particularly the case when discussing AIDS, as the bulk of media AIDS-prevention campaigns are conducted in Central Thai. In the case of citations, transliteration follows the format utilised by the author concerned. However, in those cases where authors have transliterated their names differently over several publication this has been standardised according the Jackson format.

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which the research paradigms defined the issues at a very early stage. After an initial period of denial, when the media and general population characterised AIDS as a foreigners’ disease (Bencha 1992; Ford and Suporn 1991; Fordham 1993), initial HIV/AIDS research (such as that by Bogird and Jongpaiboolathna 1989; Kachit et al. 1991; Suphak et al. 1989; Werasit et al. 1990), focused on minority risk groups: drug users, homosexuals and bisexuals. However, as AIDS moved from these groups into the broader heterosexual population (see Weniger et al. 1991), drug users, homosexuals and bisexuals came to be regarded as being of only marginal significance as paths of AIDS transmission.7 Instead, the primary AIDS agenda of Government AIDS control programmes and social science research was refocused on prostitutes as the most significant risk group and as the primary agency for the spread of AIDS (AIDSCAP 1992; Bamber et al. 1993; Bhassorn 1993; Brinkman 1992; Chai et al. 1993; Celentano et al. 1994; Cohen 1988; Hall 1992; Ford and Suporn 1991; Lyttleton 1994b; Muecke 1992; Napaporn et al. 1992, 1993; Orathai and Chanya 1994; PCDA 1992; Richter 1988; Sombat and Taweesap 1991; Suchart 1992; Surasing et al. 1995; Taweesak and Mastro et. al 1993; Taweesap et al. 1991; Truong 1990; Wathinee and Guest 1994.; Weniger et al. 1991; Yothin and Pimonpan 1990). Concomitantly with the focus on prostitutes, male clients of prostitutes were distinguished as another high HIV risk group, and a more limited group of studies focused on male sexual activity (Chayan 1993; Fordham 1995; Ladaval 1992; Nelson et al. 1993; Nelson et al. 1995; Patama 1991; Sweat 1992; VanLandingham et al. 1993b; VanLandingham et al. 1995a; VanLandingham et al. 1995b; Witaya et al. 1990; Yothin and Pimonpan 1991). A final category of Thai AIDS studies, also rooted in the notion of risk groups, focused in a structural-functionalist fashion on AIDS knowledge (and sometimes sexual practices) among various groups of people: farmers (Lyttleton 1994a, 1994c; Maticka-Tyndale 1993), factory workers (Busayawong and Chuamanochan 1995; Cash 1993; Chuanchom and Werasit 1993), fishermen (Narawat 1993), married women 7. Some research about bisexuals, homosexuals and drug users and HIV/AIDS continued to be carried out (Beyrer et al. 1995; de Lind van Wijngaarden 1995a, 1995b; Jackson 1995a, 1995b; Piyada et al. 1995; Werasit and Chuanchom et al. 1992; Werasit et al. 1993; Wright et al. 1994). However, the number of such works is small in comparison with the large number of works dealing with heterosexual AIDS and prostitution.

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(Iqbal Shah et al. 1990; Maticka-Tyndale 1994), youth (Ford and Sirinan 1994) and school teachers (Thian 1990).8 Most striking about the bulk of this research is its uncritical acceptance of the notion of risk group (see Frankenberg 1994; Kammerer et al. 1995; Schiller et al. 1994). Defined by a minimal number of characteristics, the members of high-risk categories are homogenised. Scant attention is given to indigenous constructions of sexual activity or to the broader social context in which this construction takes place. Moreover, in a period when the Thai Government’s AIDS prevention policy encouraged 100 percent condom usage in brothels (whose patrons were predominantly rural and urban labourers), these research agendas paralleled official policy through their focus on mapping the sexual risk behaviours of the lower strata of the population.9 With the exception of cross-sectional surveys (Iqbal Shah et al. 1990; VanLandingham et al. 1993b; VanLandingham et al. 1995b; Werasit and Chuanchom et al. 1992), these works deal with the economically or socially marginalised. Prostitutes, as Surasing et al. (1995: S70) put it, ‘tend to be young … from impoverished families … [and] have little education’. Based on an implicit discourse of bodily discipline and the control of sexual appetites, such research agendas are, as Douglas and Calvez (1990: 455) point out, programmes of class control and of ‘the self-constitution of the community’ (compare Clatts and Mutchler 1989). Demarcated along class lines, the source of HIV infection has been defined as the ‘other’ (Frankenberg 1995: 123). As far as I am aware no research has yet dealt with the problem of AIDS among elites, the wealthy or even the well-to-do middle class. Yet the number of expensive, 8. In addition to a highly technical focus on the medical aspects of HIV/AIDS, articles in Thai language journals such as the Communicable Disease Journal and the Thai AIDS Journal, have had a particularly strong focus on this latter category of AIDS study. However, in the main, these are highly repetitive and there is little point in enumerating them here. 9. While the role of prostitution in the spread of HIV in Thailand is undeniable, the intensity of the focus on prostitution is reminiscent of witchcraft responses in communities under threat from the inside (see Douglas 1978; EvansPritchard 1981). It is intriguing that despite their many shapes, sizes, motivations and personalities, the images of Thai prostitutes in contemporary popular and academic literature, like the images of witches, are almost always an exact inversion of the female qualities which the Thai find most desirable, an issue I take up in chapter five. Such stereotypical images are so powerful that they influence even Western researchers. Thus, in a recent analysis of Thai prostitution, Wathinee and Guest (1994: 78) claim to have found a similarity of appearance amongst massage parlour workers but ‘more variation in appearance among the brothel workers’.

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high-class establishments providing sexual services to this group has proliferated as much because of economic growth as because of increasing fears of AIDS. Nor have research agendas addressed the related issue of why Thai AIDS researchers have accepted the standards of Western middle-class morality (Brummelhuis 1993: 9) as a measure of general Thai sexual behaviour. Although survey results clearly indicate the visiting of prostitutes to be an accepted male custom, AIDS research and control programmes treat it as the aberrant behaviour of deviant individuals. In Thailand, as in other countries, the basic strategy against the spread of HIV (and other sexually transmitted diseases) has been to teach about its danger, how it is transmitted and how its transmission may be prevented through safe sexual practices. Kammerer et al. (1995) suggest that among some upland groups AIDS knowledge is still limited. Among the Lisu, the upland group most poorly served with AIDS information, 91 percent of men know of AIDS while only 41 percent of the women are familiar with the disease. Moreover, although 61 percent of men had heard of condoms only 28 percent of women had done so. Reports suggest that AIDS knowledge is also limited among fishing groups in Southern Thailand (Narawat 1993). However, in contrast to these minority ethnic groups, the lowland Northern Thai are well served by the electronic and print media, both of which present regular coverage of AIDS news and have been utilised by the Ministry of Public Health and the Department of Communicable Diseases to promote campaigns against AIDS. Brochures, posters, stickers and faceto-face teaching in villages and brothels have been the main methods used to disseminate information about AIDS. Yet researchers and social commentators in the public media bemoan almost daily the failure of the highest risk groups, rural and urban labourers, to pay attention to the AIDS prevention programmes directed at them. Some of these experts, suggesting that this lack of attention shows a failure of educational programmes, have argued for more appropriate AIDS education strategies and more tightly focused interventions (Beesey 1993; Beyrer et al. 1995; Cash et al. 1995; Manop 1993; Maticka-Tyndale 1994). My research indicates that many in these groups already have a good appreciation of HIV/AIDS and its effects. Thus, failure to modify risk behaviour must be due to causes other than ignorance. My 1993 research surveyed a 20 percent sample of the target village populations between the ages of 15 and 60, for knowledge

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about AIDS, attitudes toward AIDS and feelings about AIDS as a life risk compared with other common risks, such as motor vehicle accidents, fire, theft or unemployment.10 In early 1992, villagers in these areas knew little of AIDS and had told me that AIDS was of no concern to them (Fordham 1993). However, my survey data from 1993 reveal quite a different picture. Most villagers were aware of what AIDS was (Maetaeng 84 percent, Sansai 87 percent); most also knew its symptoms and understood that it was incurable (Maetaeng 95 percent, Sansai 87 percent). In Maetaeng more than half (62 percent) had seen someone with AIDS and almost half knew someone with AIDS (47 percent). In Sansai 47 percent had seen someone with AIDS and 37 percent knew someone with AIDS. More than 90 percent of the population of both districts knew about the main paths – sex, blood and needles – of HIV transmission.11 Critically, respondents in both districts were equally aware of risk behaviours such as casual unprotected sex, and although they doubted their efficacy they knew about the use of condoms to protect from AIDS. Even women in their late fifties, many of whom claimed they no longer enjoyed an active sex life (Siriporn 1992) and thus have minimal opportunity for contracting AIDS, claimed that they were afraid of the disease. The high level of knowledge about HIV/AIDS among the survey population was also found in younger age groups. As part of the research, school children from 12 to 14 years of age in the Maetaeng district were asked to write essays about AIDS. Their essays and the comments they made while their parents were being interviewed about AIDS indicated a good understanding about HIV, its modes of transmission and its effects. When conducting surveys about AIDS knowledge, I found that children often had to be restrained from answering survey questions in lieu of their parents. These data suggest that AIDS prevention programmes have had a high degree of success in imparting knowledge about AIDS 10. On the basis of village censuses conducted earlier in the research programme, village populations were stratified into three age groups, 15–30, 31–45 and 46–60, and a 20% sample was drawn from each age group. A total of 336 persons were surveyed (158 in Sansai and 178 in Maetaeng), almost evenly divided between the sexes. 11. Regarding knowledge about HIV/AIDS and HIV transmission there were virtually no differences between males and females. However, females in Maetaeng were less likely to know or to have seen someone with AIDS than were males (90.2% of men claimed to know someone with AIDS while only 38.4% of women did so). I analyse these statistics in detail elsewhere (Fordham 1996b).

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to Northern Thai villagers.12 However, despite this theoretical knowledge, the continued spread of HIV suggests a failure to act upon AIDS-prevention information and, by inference, a failure of the models of risk behaviour on which these programmes have been based. Despite the closure of some village brothels, often due to the attribution of local AIDS deaths, new ones have been established outside village boundaries. Visiting of brothels appears be somewhat reduced (Beesey 1993, 1994); however, condom usage is inconsistent and well below 100 percent.13 Brothels in all districts, many now transformed into more ambiguous (and thus more socially acceptable) restaurant brothels, continue to have a steady clientele. Despite Government injunctions against promiscuity and the visiting of prostitutes, the more popular destinations still have queues outside their doors when workers receive their wages at the end of the month. This refusal to cease brothel visiting or to wear condoms need not be interpreted solely as a lack of knowledge or as a failure to understand the AIDS message. As Douglas and Calvez (1990: 446) point out, ‘refusal to take social hygiene advice [concerning 12. Given these high levels of knowledge about HIV and its transmission the problem now is not so much deficiencies in villagers’ knowledge per se, but the manner in which this theoretical knowledge relates to their everyday experience. Thus prostitutes are viewed as a source of HIV (see Maticka-Tyndale 1994), while sexual contact with non-commercial partners is considered relatively benign. Similarly, drug addicts are viewed as being at risk of AIDS due to needle sharing, but routine injections for medical purposes are considered to pose little risk. Finally, regardless of AIDS-prevention campaigns advocating the use of condoms in commercial sex, both males and females mistrust condoms and doubt their reliability. As in other cultures (Boulos et al. 1982; Chapman and Hodgson 1988; Renne 1993; Taylor 1990), Thai informants claim that condoms are uncomfortable and unnatural, and that they are prone to tearing and slipping off (compare Orubuloye et al. 1992: 12). These latter fears are likely well sedimented in Thai culture due to experiences with an earlier generation of substandard and oversized condoms, but even in the 1990s they receive substantial reinforcement. One study of Thai male sexual behaviour (Ladaval 1992) cites research showing condom breakage rates of up to 30% (compare Sungwal et al. 1993). And it is surely no accident that an early 1990s advertisement in the men’s magazine Bangkok Playboy (1993), for a rubber ring designed to fit over the penis to enhance the erection, proclaims ‘Help Prevent AIDS, Keep Your Condom In Its’ Place.’ 13. Celentano et al. (1994) note that 39.1% of commercial sex workers in Northern Thailand had not used condoms with all customers in the previous month. Reporting on research conducted in Udon Thani, Saraburi and Bangkok in 1992, Morris et al. (1995: 507) note that consistent condom use was reported by only 61% of women in brothels and by only 29% of men in ‘the lowincome’ population.

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safe sex] is not [necessarily] to be attributed to weakness of understanding – it is a preference’. Where males have experienced AIDS prevention programmes as yet more intervention in their social space, it is likely that refusal to modify sexual behaviour in accord with Government programmes constitutes a form of passive resistance (Scott 1985; 1989) to that intervention. Moreover, as Scott (1989: 7) points out, such ongoing resistance ‘cannot be sustained without a fairly high level of tacit cooperation among the class of resisters’. This is certainly the case in the Thai AIDS context, where men accommodate local health officials and wives with reassurance about behaviour change (see Maticka-Tyndale 1994), but among their peers make little secret of what is widely shared risk behaviour. Such rejection of advice about safe sex might be viewed as cynical and indulgent attempts to retain male privilege. To the contrary, I suggest that resistance to outside intervention arises precisely because although men have a general knowledge of the dangers of AIDS they feel safe on their home ground, and because they resent the challenge to the validity of their own local knowledge that AIDS interventions represent. As the construction labourer clients of a rural brothel put it when I asked about AIDS, ‘this brothel [was] safe from AIDS’; there was no ‘need’ for condoms. In one young man’s words, this was their local brothel and they knew all the clients. I argue that the increasingly high levels of HIV among agricultural and construction labourers, and among rural men generally, stems primarily not from lack of knowledge, but from these men’s failure to act on the knowledge they do possess. I suggest that their failure to act on the AIDS knowledge at their command is, firstly, rooted in their metaphorical perception of HIV/AIDS as not only a health risk but as a disease that has legitimated wideranging interventions into many aspects of their personal lives and discretionary behaviour. Consequently, they have tended to reject the message about HIV risk reduction with which these interventions are associated. Secondly, and most importantly, men’s failure to act on their AIDS knowledge is rooted in their cultural conceptions about risk behaviour and rational action and in their perceptions of the risk that HIV/AIDS presents for them. The success or failure of programmes such as the early 1990s ‘100 Percent Condom Programme’ or the later (August 1993) ‘The Thai Family Combats the Danger of AIDS’ campaign are, I will argue, highly dependent on Thai notions of risk and rational action, which I now discuss.

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A Metaphoric Shaping of the Peasant Experience of AIDS Sontag (1991) points out that we experience disease metaphorically. Apart from the biomedical aspects of illness, diseases and their symptoms have a range of social meanings that shape how they are experienced. For example, Sontag claims that although heart disease is represented in terms of mechanical failure, diseases such as tuberculosis are associated with images of poverty, deprivation and individual moral failure. AIDS, with what Caldwell et al. (1992: 1,174) call ‘its overwhelming nastiness’, has considerable metaphoric potential (see Bolton 1989; Clatts and Mutchler 1989). In Northern Thailand one of the most important metaphors used by people to talk about both their experience of AIDS and the rapid social changes of the past decade is that of penetration. This is not a new metaphor; rather, the experiences of the present have been articulated and interpreted through the elaboration of pre-existing cultural themes concerning penetration from without. Critically, amongst men in the rural and urban labouring classes HIV/AIDS has been experienced as just one additional aspect of the many changes in Thai society that have encroached on male social and cultural space and threaten masculine freedoms and potency. The metaphor of penetration from without has long been sedimented in Northern Thai social experience, for centuries one of repeated penetration from the outside: by the Burmese, the Central Thai, the West and the agents of the state – whether the princes and minor princes of the old Lanna Kingdom or the Government officials of today. Douglas (1978) argues that the body is a sort of model that can stand for any bounded system, with the bodily boundaries representing social boundaries under threat. In the case of Northern Thailand, the history of incursion from the outside (at the level of the state, the village, and even individual households) finds a reflection at the level of the individual body, which is conceptualised as highly vulnerable to penetration. Thus, the most feared spirit is that of the phii ka, which penetrates the bodily boundary and devours the affected individual from the inside. Other fears concerning penetration are found in relation to the ingestion of love potions or foods that affect masculine potency. A particularly well documented case giving clear evidence of Thai fears about bodily boundaries and loss of potency due to the ingestion of harmful food is the shrinking penis scare of 1976. Following the 1975 establishment of communist regimes in Vietnam, Laos and Cambodia, Thailand became highly concerned

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about security along the North Eastern border, and about the political sympathies of incoming Cambodian, Lao and Vietnamese refugees. In this context media-fed rumours arose claiming that the Vietnamese were putting white powder into foods in order to destroy Thai male potency. Subsequently, health clinics in the North East and North were besieged by men with complaints of penile shrinkage and sexual impotence (Irvine 1982).14 The rapid social changes of recent years have impacted most heavily upon men in the rural and urban labouring class. These men have failed to make the transition from agricultural or construction labour to more desirable occupations, and they have experienced a diminished status as increasing amounts of rural land comes under the control of absentee landlords (Anan 1989), and as the village lifestyle is increasingly viewed as inferior to the sophisticated lifestyle of the new urban middle class. Concomitantly, their gender dominance is increasingly undermined by the rights claimed by a new generation of economically independent young women, and their masculine potency is threatened as their cultural values, which emphasise male sexual freedoms, become increasingly out of step with the values of the modern world. Many men in these groups view contemporary social changes as being less the result of rapid economic growth than of the undermining of Thai culture by the incursion of Western and other (particularly Japanese) cultures, and express their resentment through the metaphor of penetration. For example, villagers relaxed by talking about the general state of the world following one of my village focus groups on male sexuality. One participant, deeply in debt due to the recent purchase of an expensive four-wheel-drive pickup truck, and on this occasion well in his cups, voiced what is normally left unspoken. He bemoaned the incursion of Japanese consumer goods, and the status cycle in which he and many Thai are now trapped, when he said: ‘They come here and sell us their cars and then we drive them and crash and kill ourselves.’ Group members then discussed the desirability of a return to the traditions of the past when cultural values were undiluted by outside influences and 14. Irvine (ibid.) reports that in November 1976 one hospital in Nongkhai encountered between 20 and 30 cases each day, and in the same month a clinic in Mahasarakam treated 59 male and female patients (some of the latter also complaining of genital shrinkage) each day. Thus these beliefs were geographically widespread in the North East and North, and they involved a substantial number of persons, indicating a common concern about bodily boundaries and potency.

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where young people, particularly women, stayed home in the village and acted according to traditional behavioural codes emphasising male gender dominance. Similarly, at a conference of Northern Thai monks discussing the Sangha’s (the monastic order) role in combating the AIDS epidemic, one speaker claimed AIDS was due to promiscuity and other contemporary sexual practices that have been introduced from the West and have undermined traditional Thai culture.15 Villagers too, when they talk about HIV/AIDS or the impact of the rapid social changes of the past decade, do so in a manner that suggests a general feeling that these changes have forcefully intruded into the village lifestyle from the outside world. In the past a central aspect of Thai gender distinctions and male gender dominance was an emphasis on differential rules for male and female expressions of sexuality. Northern Thai women were expected to adhere to a code of controlled sexuality, the expression of which was restricted to the conjugal relationship (Muecke 1992). This was upheld by notions of shame (or of repute) and, in many parts of the North, by fears of retribution from a category of spirits, the phii buu yaa, which played an important role in regulating female sexuality and marriage (Chayan 1993; Paul Cohen n.d., 1984; Cohen and Wijeyewardene 1984; Davis 1973, 1984; Potter 1976; Turton 1972, 1975; Wijeyewardene 1977, 1981, 1984). By contrast, with the emphasis on controlling female sexuality, the code of male sexuality has emphasised the necessity for the free expression of male sexual needs. Unlike women, men have been free to express their sexuality in a variety of contexts outside the marital relationship (Chayan 1993; Ford and Suporn 1991; Sweat 1992; VanLandingham et al. 1993b; VanLandingham et al. 1995b). Men were free to have casual sexual relations with other women, with prostitutes or with minor wives (mia noi). Both men and women used to claim that this was ‘natural’, as men ‘need a change of flavour’ and, with the exception of the taking of minor wives, such sexual freedoms were not considered threats to a marriage but were viewed as being a normal aspect of male culture. As one village woman put it during a mid-1995 discussion about the AIDS-prevention campaign focus on male sexual behaviour ‘[I] don’t know why they call it promiscuity (samsorn), its [just] what men do.’ However, in the context of recent changes in gender relations and as the HIV/AIDS epidemic comes to be felt in all sectors of 15. Conference on the Role of the Sangha in relation to AIDS and the Sex Trade in Thailand. 24–27 May, 1993, Saraphee, Chiangmai Province.

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Thai society, there is much contemporary evidence of a new and increasing unwillingness to condone male sexual licence. By the late 1980s the AIDS epidemic was starting to influence Thai responses to various male sexual practices. Jackson (1995b) points to a late 1980s change from a relative tolerance of homosexuality (Jackson 1989, 1995a) to its increasing condemnation, promoted by the rise of the AIDS epidemic and the growing influence of highly moral, reformist interpretations of Buddhism. By the early 1990s, as it became clear that homosexuals represented only a small proportion of Thai HIV/AIDS cases and that the bulk of HIV infections concerned heterosexuals, antipathy towards homosexuals decreased (see Jackson 1995a and de Lind van Wijngaarden 1995a), and an intolerance for heterosexual male displays of sexual licence began to develop. This intolerance is clear in the public print and electronic media (Fordham 1996a) where male extramarital sexual activity has come under attack not only as the prime cause of the spread of AIDS, but as a reason for marital breakdown. In stark contrast to the values of the past, male sexual licence shown in activities such as patronising prostitutes and other forms of multi-partner sexual activity is now referred to as promiscuity and is portrayed as a deviant activity. At the village level, a husband who chorb thiaw (likes visiting prostitutes) is no longer considered a good husband. Shown photographs of two men, one hurt in a motorcycle accident due to drunkenness and the other with Karposi’s Sarcoma as the result of contracting AIDS from a prostitute, village women almost uniformly said they felt sympathy for the first man,16 while in the case of the second many claimed that it ‘serves him right for being promiscuous’ and, as one informant put it, for ‘not loving his wife enough to stay with her’. Some young women, now economically independent, claim they have no desire for marriage as a husband would only add to their work load and would give them an additional worry: the potential effects of his promiscuity. More generally, as women have become increasingly independent, they have become less willing to allow men the sexual freedoms of the past, which are both symbolic and practical expressions of male gender dominance. Informants rarely directly speculated about how HIV/AIDS (in concert, with other changes in society) was acting 16. Respondents were given a brief (fictitious) explanation of how these conditions occurred: one due to drunkenness and the other due to visiting prostitutes.

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to change attitudes towards male gender roles and the differential male and female sexual freedoms that have been a core aspect of these roles. Yet almost all discussions about AIDS, whether with men or women, are accompanied by metaphors suggesting that changing gender values have penetrated male cultural space and have decreased male sexual freedoms. A common phrase heard in villages is ‘mai khlua AIDS, khlua od’ (not afraid of AIDS, afraid of going without [sex]), (compare Taweetong et al. 1993b: 177). Both men and women use this phrase but they use it differently, and this distinction in usage indicates women’s changing expectations of rural male behaviour. Women use it in a disparaging sense to refer to male behaviour they are now less willing to accept and that poses a direct threat to their health. Men use it in a joking sense, as insiders making reference to other men’s emotions and behaviours which they understand and share. For them, behaviours such as eating and drinking as a group prior to searching for sexual partners in brothels or other venues are not solely a matter of sexual licence, but rather are part of a highly ritualised set of activities concerned with male gender dominance and with the constitution of masculine identity. In the mid-1990s, however, such activities are carried out with a consciousness of their new deviant connotations. As one village women put it in respect to local men ‘they don’t like to buy condoms now because people will think they are being promiscuous’. Ironically, this reduction in the sexual freedoms amongst men in the rural and urban labouring classes comes at a time when expressions of sexuality among single urban youth allow more freedom for both females and males (Cash 1993, Ford and Sirinan 1994). Ironically too, while men in the rural and urban labouring classes have been able to do little about the macrostructural social forces that have impacted so heavily upon them over the past decade, sexual freedom has been one last arena for the constitution of masculine identity and the demonstration of potency. For these men, denied access to new symbols of modernity and masculine identity such as expensive imported alcohol, flash cars and mobile phones, taken up so enthusiastically by the new middle class, sexual freedom is now in a sense hypervalorised. However, in the 1990s, by contrast with the past, male displays of sexual freedom tend to be consciously practiced and subversive masculine behaviours, in as much as they are carried out in opposition to the new (HIV driven) social values which emphasise the restriction of male sexual desire.

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HIV/AIDS and State Penetration in Male Space Since the early 1990s, the Thai Government has conducted what it termed ‘ronarong rook AIDS’ (the campaign, or battle, against AIDS), which consisted of using the public media and avenues such as posters and pamphlets to disseminate information about AIDS, encourage condom use and discourage risky sexual behaviour. This sort of military metaphor is commonly used in Thailand to publicise and garner public support for a variety of official campaigns, and as Sontag (1991: 76) points out, the use of military metaphors in relation to health has a long history in the West (compare Singer 1993).17 However, in Thailand the peasant experience of ronarong rook AIDS has been less a campaign directed against HIV/AIDS as a form of disease, than as an attack on particular aspects of male sexual behaviour. Indeed this was just what the campaign against AIDS intended: to carry out directed interventions in the private sphere in order to manipulate male sexual behaviour. That the HIV/AIDS campaigns employed language commonly used to describe other state programmes aimed at social intervention and behavioural change can only have reinforced the male experience of the AIDS prevention campaign as one directed against self and personal space. A corner stone of Thailand’s HIV/AIDS control measures has been the limitation of the spread of HIV through defining safe and unsafe sex in order to channel and constrain male sexual activity. Monogamous sex in stable marital relationships was defined as safe and socially responsible sexual behaviour, while multi-partner sexual activity outside the marital relationship was defined as dangerous (in that it could lead to HIV infection), as being promiscuous and socially irresponsible. Thus, whether HIV/AIDSrelated public health programmes were conducted directly by state agencies or in concert with or through IOs/NGOs, men’s experience of the impact of HIV/AIDS has been that male sexual space and sexual behaviour that had previously been a matter of private discretion became subject to state scrutiny and intervention. Interventions legitimated by the HIV/AIDS epidemic ranged far beyond advice about safe and responsible sexual activity, and included surreptitious blood tests during sentinel surveillance of risk groups and, in the past, follow-up letters (in identifiable 17. Northern newspapers of this period daily referred to official campaigns such as the ‘campaign against AIDS’, the ‘campaign against drugs’, the ‘campaign against child prostitution’, and even the ‘campaign against pollution in the Mae Nam Ping’ (the river flowing through Chiangmai) (Chiangmai News 1993g).

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official envelopes) to those found to be HIV positive. In some cases medical personnel conducted follow-up visits to HIV-positive clients in person, leaving other villagers suspicious of the reason for such visits (Taweetong et al. 1993a, 1993b). From the viewpoint of medical personnel, such interventions were legitimated by the facticity of medical paradigms (Mathews 1992) and by concerns about public health risk. Yet, as Singer (1993: 30) points out, such legitimations may be used to justify ‘any number of interventions’ in people’s lives and bodies. It became clear to me as I conducted surveys about AIDS-related knowledge during 1993, that villagers felt the state was intervening in their private domain, and that they were anxious about this, particularly in the dormitory villages which, due to their proximity to Chiangmai city, have been a focus of much HIV/AIDS surveillance activity. Common first questions by respondents were ‘How did you get my name?’; ‘Did you get my name from the hospital?’ and ‘Why are you doing yet another survey about AIDS?’ Critically, that villagers perceived changing sexual mores, particularly those emphasised in AIDS-prevention campaigns, to be not solely a matter of social changes eroding male sexual privilege, but also an attempt by the state to penetrate yet more deeply into village and personal life and behaviour has had a significant impact on the success of Thailand’s HIV/AIDS control campaigns. Northern villagers often discuss their resistance, active and passive, to the attempts of state agents such as district officers (naai amphoe) and local public health officers to co-opt them in agricultural, health or general village development programmes (for example, compound fencing, gate construction and the making of herb gardens). After many years experience with programmes that often last no longer than the tenure of the officials concerned, most villagers are highly sceptical about such activities. As a result they respond to programmes that they perceive as yet more state intervention in their lives with resistance ranging from various levels of partial compliance to outright non-compliance. In the case of HIV/AIDS, until they encountered people dying from AIDS (uncommon prior to 1993), many people believed AIDS prevention campaigns to be yet another Government programme aimed at behavioural change. As one small-scale village tailor put it: ‘We did not believe it, we thought it was just the government trying to stop people going to brothels [my emphasis].’ Such an interpretation of the Government’s campaign against AIDS is not surprising when a high percentage of public information campaigns concerning AIDS have consisted of proscriptions – ‘don’t be promiscuous’, ‘don’t share needles’, ‘don’t sleep with prostitutes’,

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‘don’t share toothbrushes’ – and were openly aimed at changing what had previously been normative behaviours (Siam Post 1993). Even the major AIDS prevention initiative ‘The Thai Family Combats the Danger of AIDS’, was based on a similar proscription of sexual behaviours, and was understood by villagers as yet another government attempt to intervene in and direct yet more aspects of their private lives. This programme was conducted in August 1993, as it became clear that HIV rates among prostitutes and the general population had continued to rise, despite claims in the public media about high levels of condom usage.18 The emphasis of this campaign was family and family relationships as a means of curbing male AIDS risk behaviour. As Khanchit and Nusara (1993) put it: ‘If a husband loves his wife, he will not have extramarital sex … he will not put himself at risk.’ In the North, the campaign was initiated by having villagers make AIDS-prevention banners and by having a member of each family (usually the male head of the family) sign a pledge saying that they knew of the dangers of AIDS, and that he and his family would remain AIDS free. The pledges were recorded in books carried from house to house by local village health volunteers (working under the direction of the district health office). Later, the completed books and the banners were taken to Chiangmai by processions of village representatives and were presented to the governor. As a consciousness-raising exercise this campaign may have been effective. However, the proscriptions that participants wrote on their banners, such as ‘love your life don’t be promiscuous’ or ‘love your family stay away from AIDS’, did little to show men how they might modify their lifestyle in the AIDS era. When I talked with men about the banners’ messages their responses suggested that, given the nature of male sexual culture, they considered such proscriptions on sexual behaviour to be impractical and unlikely to have any impact. Moreover, the signing of names in a book in a promise to remain AIDS free can only be interpreted as symbolic submission of the family and male sexual practice to the demands and the power of the state and, as I have pointed out, such intervention is automatically resisted. 18. Comments by Khanchit and Nusara (1993), adjunct director of the HIV/AIDS Collaboration typify such claims: ‘The “100 percent condom campaign” … is said to be very successful in Ratchaburi, Phitsanulok and other provinces where the governors make it a policy that prostitutes’ customers always use condoms.’

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Conceptions of Risk and Rationality in Northern Thailand AIDS prevention campaigns in Thailand have aimed at educating both the general public and specific risk groups – drug users, homosexuals, prostitutes and their clients – about AIDS and its prevention. Based on the notion that behaviour can be modified by giving individuals enough information to act rationally and make behavioural changes to reduce their risk of HIV infection, the campaigns have sought to make people more aware of the risks they face from HIV/AIDS (compare Parker 1992). Concomitantly, much AIDS research, both in Thailand and overseas, has been centred around the assessment of risk perception (Becker and Joseph 1988; Catania et al. 1990; Gilles and Carballo 1990; Iqbal Shah et al. 1990; Lindan et al. 1991; Lyttleton 1994a, 1994c, 1995; Manop 1993; Maticka-Tyndale 1994; Nelkin 1987; Parichart et al. 1992; Sombat and Taweesap 1991). These programmes and studies assume that humans avoid risk because of their innate rationality and their wish to preserve their lives. Books and articles in popular magazines also take this approach (Champoo 1993a; Keesinii 1994; Sataporn 1991; Upson 1993; Wiwat 1992, 1995) when they assume that providing information about the risk of contracting AIDS will lead to behavioural change. Few take into account the previous studies of risk behaviour in areas such as agriculture, superpower relations or the study of natural disasters, which may offer contrary evidence regarding rationality and risk avoidance. Nor do they take account of behavioural contexts that involve active risk seeking (Bellaby 1990; Douglas 1992; Fordham 1995; Lyng 1990; Lyttleton 1995), in which the voluntary seeking of risks is associated with cultural values relating to lifestyle or identity construction. However, VanLandingham et al. (1995b) have attempted to account for the failure of Northern Thai men to reduce high-risk activity (visiting prostitutes) by applying a model of sexual decision making that incorporates peer influence. Their work represents the first explicit attempt to apply Western health behaviour models to the Thai AIDS context. Considerably more sophisticated than previous analyses of Thai sexual decision making, their approach will likely point the way for future research efforts in this area. The authors identify the two major models used to explain sexual decision making: the health belief model (HBM), which ‘emphasises the perceived costs and benefits of health behaviours’ (1995b: 196), and the theory of reasoned action (TRA), into which they incorporate peer group influence as an

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additional determinant of individual behaviour. They claim that a modified TRA model provides the more adequate explanation for Thai male sexual risk activity. The HBM model takes into account factors such as individual susceptibility to the health risk, perceived severity of illness, benefits of strategies for preventing the illness, perceived barriers to effective action and an individual’s perceived ability to perform this task (1995b: 196). The authors claim that the HBM model neglects personal and social factors. By contrast, the TRA model of behaviour incorporates both attitudes about behaviour (consequences and evaluations of anticipated outcomes) and perceptions about group norms. Note that, centrally, both models perceive a direct relationship between beliefs about behavioural consequences and actual behavioural practices. VanLandingham et al. (1995b: 204) state that ‘the relative advantages of the TRA model appear to be largely due to the incorporation of peer influence’ which, they claim, is supported by survey results that demonstrate that the degree of individual compliance depends upon the individual’s motivation to conform to the group norm. They argue that although many men claimed that their condom use was not influenced by group norms, the data show that men who perceived a group norm of condom use were likely to use condoms, while men who perceived a group norm of non-use were less likely to use condoms (1995b: 205).19 They claim that this model of risk taking suggests that male peer dynamics ‘could be exploited to promote responsible sexual behaviour’ (1995b: 206). This recommendation is sound, although I suggest that the focus should be the phii-norng relationship that exists between seniors and juniors. If the responsibility of guidance and care that elders have for juniors (who, ideally, should follow the advice of their elders) could be built upon to include guidance about safe sex behaviour, this is likely to be more successful than campaigns that focus on the much more amorphous and ephemeral peer group. However, VanLandingham et al.’s (1995b) work has two major deficiencies. First, it examines sexual activity in isolation from its meaning context. Second, it is based on a Western notion of rationality which ‘only allows cautious risk averse behaviour to be rational’ (Douglas 1992: 42). It fails to consider the Buddhist world view and how this affects Thai notions of risk and rational 19. Although the results differ according to the occupation of informants, men who perceived a group norm of condom use were as much as three times more likely to wear a condom than those who perceived a norm of non-use.

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action. The work of VanLandingham et al. and other analyses of male risk behaviour would be enhanced if they made a closer examination of the Thai cultural context and indigenous constructions of risk, and how these affect male sexual behaviour. The model that follows addresses both these points.

The Context of Sexual Risk Behaviour The first deficiency of VanLandingham et al. and similar analyses is their failure to consider the indigenous contexts of sexual activity. I have no doubt that peer pressure is a significant influence on the use of condoms (VanLandingham et al. 1995b) and on the visiting of prostitutes by males in Northern Thailand (Chayan 1993; Sweat 1992), but to examine male sexual risk behaviour in the manner of VanLandingham et al. (1995b) and others, focusing only on the visiting of prostitutes, is to consider only one aspect of male sexuality in isolation from its broader context. As I have pointed out, commercial sex with prostitutes is only one form of sexual outlet available to Thai men. In contrast to commercial sex, other sexual activities, such as relations with wives, minor wives and casual contacts, are private affairs conducted alone. The visiting of prostitutes is generally done in the company of others (although the actual sex act in brothels is a private affair, with only the selection of partners being conducted in public), and such visits usually follow the consumption of food and alcohol (Chayan 1993; Ford and Sirinan 1994; Fordham 1995; Napaporn et al. 1992; Yothin and Pimonpan 1990). Informants commonly say that if they had not been drinking and if they had not been in the company of friends they would not ‘dare to go’ to the brothel. Yet, curiously, apart from attempting to catalogue the amount of alcohol consumed prior to sex and glossing this as heavy drinking (VanLandingham et al. 1993b; VanLandingham et al. 1995b), only one analysis of male sexual behaviour has considered the meaning of the entire rite of eating, drinking and sex (Fordham 1995). The contemporary heightened focus on AIDS and the exoticism which researchers have attributed to normative Thai sexual practice (compare Said 1985) have acted to obscure significant aspects of this activity. Instead of focusing solely on the sex aspect of group visits to prostitutes, it would be better to take into account the preliminaries which occupy a much greater period of time. Our understanding of the context of brothel visits would be better served by a focus on the entire sequence of eating, drinking and

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sex or, as sometimes occurs, eating, drinking and snooker without sex (Ford and Sirinan 1994), treating it as one homogenous male ritual dedicated to the constitution and public demonstration of masculine status and potency (see Klausner 1994; Brummelhuis 1993; Turton 1991; Wolters 1982).20 Surprisingly, South East Asian rituals of feasting and drinking have been given little specific attention since Kirsch’s (1973) comparative study of some highland groups on the Thai–Burma border. Yet these rituals are ubiquitous at all levels of lowland Thai society. As Chayan (1993: 23) points out in respect to men in one Northern Thai village: ‘For married men in Tha Kham, the dominant social value emphasises drinking and having sex with women.’ In these rites, men construct their male identity as they vie for merit and status in competitive drinking; relate stories of sexual conquests, hoped-for sexual conquests and sexual fantasies; and engage in more mundane discussions about work and village politics. Here sex with a casual partner is viewed as fulfilling a fundamental male appetite. The use of the verb kin (eat) to refer to drinking, eating and having casual sex suggests that on such occasions a homology is seen between these three activities, all of which involve ‘consumption’ directed towards the construction of self. Significantly, kin would not normally be used to refer to sex with a wife or regular partner (see Ford and Sirinan 1994). Yet these activities cannot be understood adequately unless viewed in the context in which they take place and in terms of Thai cultural values. As I have pointed out above, social relations in Thailand are hierarchical, not egalitarian as in the West. People are stratified according to age, status, moral merit and power, with the latter understood to be the outcome of meritorious action. No two persons can ever be equal, and this natural stratification is culturally encoded through dress and posture, as well as linguistic forms denoting kinship, status and other social relations. From the perspective of the middle class the poor might seem to be relatively unstratified. Yet even among the poor, male evenings out are dedicated to the competitive feasting (liang) of others and to competitive drinking in which others are encouraged to drink as much as possible. As Lehman points out, in the

20. I encourage a similar contextual reinterpretation of the khun khru (to learn for the first time; literally, to get on a teacher) rite, in which seniors take a junior for their first visit to a prostitute. An analysis which takes account of factors such as gender relations, the constitution of masculinity and hierarchy may explain the reluctance of young men to abandon this rite.

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infinitely stratified Buddhist cosmography where all players are trying to increase their merit store: the game is largely one of trying to force others to accept one’s giving, both in the sense of the donative action … and in the sense of the public feeding and partying and so on, i.e., one’s hospitality … One is trying continually to coerce [his emphasis] merit [and its accompanying status] from others. (1993: 4–5)

Carried out in an idiom of exchange relations, these events have much in common with the competitive pig feasting of New Guinea or the potlatching of the Kwakiutl Indians in that, regardless of their family responsibilities, the various participants purchase bottle after bottle of whisky in a complex web of exchange obligations. The tension and competitive aspect of these drinking rites, and the fragility of the ritual mode, is apparent in their frequent eruption in fights, stabbings and shootings as one member takes umbrage at the words or actions of others. The aim of ritual drinking parties is not just to drink but to be drunk, as revealed by the question which outsiders often ask ritual participants: ‘Are you drunk yet?’ In the Northern Thai cosmology drinking is conceptualised as productive of disorder, leading as it does to a loss of physical and mental control (Wijeyewardene 1986: 53–56), and to the disregard of cultural constraints. In this context, drinking to get drunk is not only an attempt to wrest merit from the other, but is also a demonstration of one’s inherent power, manifested in the ability to maintain control while drunk (Fordham 1995). Thus, Tannenbaum (1993: 12) claims that young Shan men ‘flirt with drinking and the hazards associated with drunkenness and lack of control’ in order to show their power. Rituals, by their very nature (Turner 1987a, 1987b), constitute a liminal space where the constraints of the everyday world do not apply. The consumption of alcohol allows the creation of an internal liminal state paralleling that of the drinking rite (see Fordham 1996b) where men do not have to be responsible, and where inner feelings can be revealed without regard for social conventions. From this position, men may vie for an alternative social ordering, claiming slightly higher social status and potency by demonstrating superior ability to maintain bodily control (Fordham 1995). Drinking rites are not always happy. A disregard for social rules is not always a pretty sight. Control often yields to drunkenness, and attempted reconstitutions of the social order frequently fail or end in acrimony. Moreover, such reorderings

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are only partial as they relate primarily to the drinking group rather than the broader social hierarchy. Sex is the final reintegrative act closing the drinking rite.21 However, it is no accident that that these rituals conclude with sex. Not only is sex a source of pleasure for these men, even if it is motivated by what Ford and Sirinan (1994) term the ‘hydraulic model’ of male sexual pressure demanding release. In a world in which women are demanding increasingly equal rights with men, it is in sex with prostitutes that gender relations most nearly approach the Northern Thai male views of ideal male–female relations: dominant men and highly submissive females (Muecke 1992). Submissive due to the economic necessity of pleasing their clients (Taweetong 1993b), prostitutes are ready to provide the alternative sexual experiences that men claim wives and lovers often refuse. As the final act in the drinking rite, a visit to a prostitute also corresponds to another ideal male sexual experience: rampant male sexual release without the economic and social obligations which attend relations with wives, minor wives or even casual sexual partners. Significantly, the entire event corresponds to a highly formalised and highly conservative cultural schema, inasmuch as relations with prostitutes follow the traditional Northern Thai model of the nurturing, mother-like woman providing sexual services in exchange for economic support (Darunee and Shashi 1987; Keyes 1984: 238). The whole ritual sequence is also highly conservative politically, reordering only a small portion of the status hierarchy while leaving unquestioned the legitimacy of that hierarchy as a whole. Programmes to promote condom use and to discourage commercial sex have emphasised social responsibility, focusing on the sex act in isolation while assuming that drunkenness and loss of control among commercial sex patrons is inadvertent. Not surprisingly, their success has been only moderate, as they have failed to see that the whole point of these male rituals is to abandon conscious control. This is suggested by a common, if bleak, euphemism for AIDS in some Northern villages ‘look AIDS 35’, that is., the AIDS you get when you drink rice whisky (which contains 35 percent alcohol) and abandon control entirely.

21. The use of sex as the final reintegrative act at the end of this rite finds a fascinating parallel in a practice described by Yothin and Pimonpan (1991). Longdistance Thai truck drivers, after a lengthy liminal period driving under the influence of amphetamines, utilised a similar three-part rite of food, alcohol and sex with prostitutes, with the goal of purging the amphetamines from their system so that they could return to the everyday world.

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Risk and Rationality in Northern Thai Culture The second deficiency in VanLandingham et al.’s (1995b) and similar approaches to understanding Thai sexual risk behaviour is their assumption that risk-averse behaviour is a cultural universal. Western notions of rationality reflect the Judeo–Christian heritage of a cosmology that posits a stable and knowable world, a linear lifespan and a direct means–ends approach to causation. Thus Weber’s (1980) sixteenth-century Calvinists followed techniques for the rational mastery of the natural world and, by gaining mastery of that world, resolved their doubts about their place in the supernatural order. By contrast with this stable and knowable world, the Thai Buddhist cosmology posits a world of ceaseless flux. The very nature of the Thai world is anitja (transitory and changing). The world cannot be known with the certainty it can in the West since Thais believe that natural causation, relationships, and propensities all depend on context and are likely to change through time. Rather than following a linear life cycle, the Thai live in a cyclic world of birth, death and rebirth, ruled by the law of karma. For village Buddhists, the world is one in which all individuals are hierarchically ranked in order of merit (bun) as the merit accumulated by each individual has led to rebirths in higher or lower statuses. Rather than relying solely on direct means–ends action, people are commonly concerned with indirect causation, and with the generation of merit to improve their being in this life and future lives (Keyes 1983a, 1983b; Lehman 1993). Poverty, illness or other inauspicious events are explained as the result of bad karma, which may be extinguished in this lifetime or by the time of the next rebirth. These cultural concepts affect every aspect of Thai behaviour, including ideas about causation, risk and rationality. For example, medical conditions, including HIV infection and its consequences, are understood not solely as biomedical issues or as concerning specific isolable risk behaviours but rather, as Golomb (1988: 765) puts it, in relation to the broader ‘natural, supernatural or social environment’.22 22. I emphasise that for most villagers there is no incompatibility between biomedical and karmic explanations of disease causation. People accept that viral theory explains how HIV is contracted. However, karma is the ultimate principle by which the cosmos works, and it is normally invoked to explain why this occurred (Fordham 1996b; Taweetong et al. 1993a, 1993b). Contrary to popular Western beliefs about Karma, there is nothing fatalistic about such an explanation. It is not that people believe it is their karma to contract HIV or that they use it to rationalise their activities; rather, the explanatory power of karma lies in the fact that in a transitory world specific outcomes are never predictable. Thus karma provides a totally unfalsifiable ex post facto explanation (see Evans-Pritchard 1981).

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HIV/AIDS aside, Thai society in the 1990s seems to present many risks, often hazards that could easily be prevented. Factories have burned down trapping and incinerating hundreds of staff due to a lack of elementary safety procedures. A luxury hotel in Nakhon Ratchasima collapsed due to unauthorised and unsafe building extensions (Paisal 1993). Men and women of all ages continue to risk painful accidents and deaths on the roads and in the course of their employment. The introduction of laws making the wearing of crash helmets compulsory for motorcyclists in Bangkok in late 1992 was met with fierce opposition and public protest rallies, despite a high death rate from motorcycle accidents. A year later similar opposition and widespread non-compliance postponed the introduction of helmet laws in Chiangmai. In the North, the area I know best, an increased level of vehicle ownership has led to an increase in road accidents caused by drunken driving, and reckless driving is a common theme in daily newspapers. Thus, Jutsadang (1993: 5) writing in the Northern edition of The Manager, notes that despite the danger drivers do not obey the traffic rules. Like VanLandingham et al. (1995b) casual Western observers of such behaviour generally ignore Thai Buddhist values and, on the assumption that risk-adverse behaviour is a cultural universal, argue that in Thailand human life seems to have a lower value than in the West. Thus, an unnamed expatriate construction manager whose concerns about risk-taking by Thai staff were reported in the Bangkok Post (Trink 1993: 27) claimed that he found it almost impossible to make his Thai staff wear safety equipment such as boots, helmets and safety harnesses. He noted: ‘There is much bravado on work sites, even from senior staff. And not wearing a safety helmet is one way to show off … it is my observation that a significant number do not care about safety, theirs or anyone else’s.’ I suggest, however, that it is more useful to examine the cultural logic of Thai risk taking, how risks fit into an overall classificatory system. As Douglas and Wildavsky (1982: 9) write, ‘what needs to be explained is how people agree to ignore most of the potential dangers that surround them and interact so as to concentrate only on several aspects’. Northern Thais are well aware of the physical threats in their environment, and informants readily cited events such as road accidents, killers, fire, unemployment and AIDS as the most significant life risks. Thus, when men were surveyed about AIDS, 94 percent of respondents claimed to be afraid and 69 percent claimed that AIDS was more fearful than these other potentially dangerous events. Yet, when asked to rank

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the risk of AIDS compared with the risks of these other events, respondents clearly indicated that although the idea of AIDS may evoke more fear than other potential dangers, in the everyday world they considered the risks presented by other dangers to be greater. Most respondents ranked those events with immediate outcomes (such as motor accidents) as more risky than HIV infection. Thus, in one district surveyed (Sansai), 55 percent of male respondents considered motor vehicle accidents to be their greatest life risk, while only 22 percent nominated AIDS as their greatest life risk (compare Sweat 1992). Almost all explained this ranking in just these terms: that events with immediate outcomes presented a greater risk than HIV infection, the outcome of which (full blown AIDS) is merely anticipated three or four years in the future.23 However, not only are immediate risks in the physical environment viewed as being of more significance than the long term risk of HIV infection, even more important in Thai culture are the demands and the hazards of the social environment. Although not consciously classified as risky, due to their naturalness and omnipresence in daily life, issues concerning status, merit and potency are a customary preoccupation for Northern Thai men.24 Although these qualities are inherent in each individual, their meaning and efficacy are constituted relationally. Thus they are always at risk, the individual’s worth and prestige depending on the relative merit, status and potency of others. The Thai manifest an intense preoccupation with rank and with minute graduations of social status. As Lehman (1993: 3) points out, in the light of Buddhist cosmology, these issues are 23. Villagers commonly mention their fear (khlua) of AIDS, and AIDS-prevention campaigns have implicitly relied upon fear of infection to motivate behavioural change. In 1994 I conducted a small survey (n = 336) about AIDS fear and risk in two districts of Chiangmai province. With the assistance of informants I developed a list of the five life events (AIDS, house fire, killer, motor accident, unemployment) and asked a sample of both male and female villagers to rank these in terms of how much they feared them and the degree to which they considered each of these events presented a risk (siang) to their own lives. I cite here only those responses given by men (full results may be found in Fordham 1996b). 24. For reasons of space I have not addressed male/female distinctions here. However, I suggest that the issue of status and merit concerns women and men, but that female potency (or power) seems to involve fundamentally different issues than those with which male potency is concerned. The issue for males is the generation and display of potency, whereas women are more concerned with the control and bounding of potency. Also, male potency needs constant testing and demonstration (Fordham 1995: 27), while female potency is more stable and is probably related to their potential or actualised fecundity.

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important, as ‘the same act may generate more or less merit depending on a person’s secular standing … the better one’s secular standing, the greater one’s capacity for, and field for making Merit [sic] will be’. However, the issue is of more than abstract religious or symbolic importance. Class, descent line, surname, wealth and bureaucratic position give access to power and confer a defacto right to the respect of others.25 As a result, in the everyday world, failure to recognise one’s place in the rank order, for example by responding too slowly to another’s claims to superior status and power or staring too long in an unwarranted assertion of one’s own power, can lead to social sanctions or even physical violence.26 Yet, in the 1990s, when many can afford the symbols of rank, determining social status from outward signs has become increasingly difficult. The postures, clothing, speech and luxury consumer goods that symbolise rank and potency are now open to misinterpretation. As one village woman put it: ‘Now you don’t know who is who, because they can all buy the same clothes.’ Minor government employees and shop assistants in up-market stores tell of the tensions, and the consequent headaches and stomach cramps, arising from having to know which of their customers have legitimate claims to status and thus special deference (and who in the North may even be descendants of the old princely lines), and the new rich of the upper middle class who have merely bought the symbols of rank. As I have pointed out, issues of merit, status and potency are also contested among men at village level and among the urban working class. However, the economic boom of the late 1980s and early 1990s that fuelled middle-class prosperity has harmed both of these groups. A massive inflation in status indicators has relegated them to the position of a cultural underclass, unable to compete in the consumer culture of the affluent middle class, and with which by comparison many of their cultural practices appear anachronistic or hazardous. Their unrestrained sexual appetites are viewed as a social problem, and the control of these appetites has become a central focus of public health campaigns. As a result, the practices through which men constitute masculinity and demonstrate potency have in a sense become a limited good

25. Up until the end of the nineteenth century, members of princely lines had the legal right to the respect of others and specific symbols of rank and forms of address were reserved for them. 26. In the North such violence is relatively common among men at the village level and in the urban labouring class, and it frequently accompanies male drinking rites.

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(Foster 1965), sought and conducted in the face of new opposing social values and new urban-based models of masculinity. Brothel visiting focuses on sex and, as I point out elsewhere (Fordham 1995), the brothel context possesses an aura of eroticism – a range of young and sometimes beautiful women posed with made-up faces under pink lights; their easy availability, personal attributes and sexual performance being constantly emphasised by brothel spruikers (kon cheer) – that contrasts with that of the home and its comparatively limited sexual possibilities. Drinking rituals with their associated visit to a brothel are not, however, solely concerned with sexual release. As I have pointed out, they are also contexts of competition for merit and status and occasions for displays of male prowess. Such competition includes sexual performance which, although unverifiable as it takes place in private, provides material for subsequent boasting. But of equal importance is competitive play centred about challenges to drink, verbal and mental dexterity, and drinking capacity and the maintenance of bodily control. It is through the contestation and demonstration of such abilities among their peers that men validate the male version of reality and display their own prowess and masculinity. It is critical, as Allyn (1991: 151) points out, that from their teenage years onwards it is these activities that young men hear discussed and boasted about as paradigmatically masculine behaviours (see Jackson 1995a). For some men, particularly those who belong to the lower socio-economic groups and are therefore marginalised in the new social order, it is likely that taking a chance of becoming infected with HIV via commercial sex will be viewed as less risky than failing to constitute and demonstrate personal potency. A similar point might be made in respect to other deliberate but seemingly high-risk acts (as distinguished from mere thoughtless or unskilled performances) commonly encountered in Thailand. These include urban youth racing motorcycles in Bangkok streets at night, groups of young rural men racing small motorcycles at breakneck speed along poorly maintained country roads, and drivers on the highway trying to weave heavily-laden pickup trucks at speed through traffic. Informants rarely gloss such activities as stupid or irresponsible; for the driver, at least, competing with fellow road users is fun and has an inherent thrill (siaw). However, those engaging in such activities are not solely concerned with the thrill or with Giddens’ (1991: 133) ‘experiment with trust’. Rather, such acts constitute sites for siang duang, the deliberate taking of risks in order to test one’s fate and display one’s merit. Like the activities of the drinking rite, these acts

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embody public contestation of men’s abilities, public displays of an individual’s very being. It is only through such activities that karma can be known and displayed to others and that claims to power can be validated (compare Durrenberger and Tannenbaum 1992: 81). Critically, the use of alcohol, although not essential, is common in such contexts because to be drunk is to abandon oneself to the control of one’s innate karmic propensities (Fordham 1995). A man’s ability to pull off these sometimes highly dangerous events is concrete evidence of his merit, his prowess, and his control over his body and the immediate environment. On one memorable occasion, when I commented to a fellow bus passenger that the pickup truck driver trying to race our bus was a drunken idiot, the woman turned to me and replied: ‘What do you mean? Look at how he is able to stay in front of this great bus.’ Almost all aspects of life provide opportunities for men to test their fate in these ways, and it is in such events that village reputations are made. Indeed, the successful performance of such acts is part of the cultural script for powerful village-level roles such as nakleeng (village strongmen) or the village headman (Paul Cohen 1987; Johnston 1980).

Risk Taking as Cultural Style In a compelling argument against analyses based on the assumption that humans are always and everywhere risk averse, Lyng (1990), in a synthesis of Marxist and Meadian perspectives, coins the term ‘edgework’ for voluntary risk taking that involves a high potential for death or injury – as in hang gliding, scuba diving, rock climbing and skydiving. Edgeworkers, he says ‘claim to possess a special innate survival ability, one that transcends activityspecific skills’ (1990: 859) and allows them to maintain control in situations of chaos. Lyng claims that edgework is viewed as a form of self-realisation, a means of conquering fear and an experience that develops skills that augment natural ability. Thus, he argues that edgeworkers use their innate survival ability and the practice of activity-specific skills to ‘seek to define the limits of performance for a particular object or form’ (1990: 858). Edgework well describes the way in which many Thai drivers transform the act of transportation into a comment on and a challenge to the rigidity of the Thai social order. Tambiah (1984: 228–29) notes what he calls a ‘street machismo’, and he points out that aggressive driving is combined with ‘a preoccupation

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with protection from danger, and with physical safety’, manifest in a search for blessing rituals and in the accumulation of amulets designed to bring protection and good fortune. Thus innate survival skills and learned and practiced road skills are combined with cultural recipes by which survival ability may be enhanced. In the past, men who drank and visited brothels together were generally aware of the risk of sexually transmitted diseases (STDs). Like Lyng’s edgeworkers they used, with varying degrees of efficacy, cultural recipes (Lyng’s ‘activity-specific skills’) to minimise risk. Taking diuretics or drinking soda water before visiting the brothel, and urinating immediately after sex have long been utilised to minimise the risk of STDs (Sweat 1992). By the early 1990s most men were also aware of the additional risk of HIV, and talked of avoiding brothels where they believed girls may be HIV positive; of routinely wearing two condoms to guard against breakage; and of selecting girls who were neither too thin (definite HIV) nor too fat (may be attempting to cover up HIV infection), and whose eyes were neither too dull nor too red (both thought to be indicative of HIV infection). One article in the men’s magazine Lessons in Love even recommended that men use vaginal odour as an indicator of AIDS infection (Champoo 1993b). Thus, like Evans-Pritchard’s (1981) Azande, who distinguished between the general cause of events and the specific reason for their interruption into a particular life, the Northern Thai have for some time known the physical mechanisms of infection by an STD and so have taken the precautions which they believe, often quite erroneously, will be efficacious. For Northern Thai males, however, success and safety in this karmic world of act and retribution are also determined by an individual’s merit and potency. Ultimately, it is these inherent qualities – which may be enhanced through blessings and the wearing of amulets (Tambiah 1984) – that determine whether risks can be overcome and whether precautions will be efficacious. Thus it seems appropriate to apply the term edgework to the Northern Thai contexts I have discussed, particularly the drinking ritual with its visit to a brothel, and other seemingly irrational risk taking often encountered in Thai society. In Northern Thailand, whether riding motorcycles, engaging in commercial sex, or just seeking to impose one’s will upon others in drinking contests, men compete with each other, deliberately courting risks as a matter of cultural style. For them, living on the edge and taking risks is an essential part of life if they are to know themselves as men of worth and of potency and if they are to display their potency in the public sphere. The AIDS epidemic

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provides yet more material for tests of fate and displays of potency. An informant told of a villager who, assisting in the performance of a funeral for an AIDS victim, pointedly threw the plastic gloves he had been given into the cremation fire and removed the plastic wrapping of the corpse with his bare hands. As the corpse was long dead this act in fact involved minimal danger; however, the villagers believed touching the corpse to be a particularly risky act as it was thought capable of transmitting the HIV virus. The constitution of male identity in the drinking ritual, in brothel visits and in acts of bravado can be deadly. Regardless of their knowledge about HIV and its transmission paths, drunken men who have abandoned conscious control to live on the edge are not in a position to make good decisions about safe sexual activity. Such men often abandon their recipes for risk minimisation (such as the wearing of condoms) and for them the AIDS epidemic provides a more rigorous test of fate than they intend. As Goffman (1967: 269) very aptly puts it: ‘When persons go to where the action is, they often go to a place where there is an increase, not in the chances taken, but in the chances that they will be obliged to take chances.’ The data suggest that alcohol-affected men are reluctant to use condoms (Anthony et al. 1994: 4; Ladaval 1992), and that drinkers have a higher chance of condoms slipping off (3.2 percent against 0.0 percent for non-drinkers) and of condom breakage (8.6 percent against 3.9 percent for non-drinkers) (Ladaval 1992: 50). Anecdotal reports also refer to drunken brothel clients tearing the tips off of condoms or of pulling condoms off completely during the sex act (see Sungwal et al. 1993). Such acts may not always be deliberate tests of fate, yet as a matter of normative cultural style, edgework leads men to compete, to attempt to best others and to try to get their own way, sometimes regardless of the cost to themselves. As I have pointed out, some men view the risk of not testing and displaying their potency amongst their peers as greater than that of risking possible infection with HIV.

Conclusion I have argued here that the Northern Thai male response to the AIDS pandemic has been structured by Northern Thai cultural values and by the social changes Thailand has experienced over the past decade, and, that if we are to understand this response, these factors must be taken into account. My analysis has made two main points.

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Firstly, the peasantry have experienced AIDS not merely as a new disease demanding medical countermeasures, but also metaphorically. This metaphorically-shaped experience includes not only the invasion of the body by disease but also an invasion by the state and the outside world, which has impacted upon village understandings about gender and sexuality and on the sphere of male private behaviour. Thus I have argued that the failure of agricultural and other labourers to heed the Thai Government’s message about safe sex is not due to ignorance, but rather to this experience of HIV/AIDS. Accordingly, their resistance to AIDS-prevention campaigns is not to these campaigns per se, but to the increased intervention in private lives and the sphere of (hitherto) discretionary practices that such campaigns have engendered. Secondly, and closely related to the first point, I have argued that research about AIDS and risk in Thailand has defined the problem too narrowly as sex with prostitutes, and has failed to examine indigenous cultural constructions of this form of sexual activity. Most importantly, I have argued that there has been a general failure to examine Thai cultural conceptions of risk behaviour and men’s perceptions of the relative risk that AIDS represents for them in a cultural context where male risk taking is an important, although rarely articulated, social value. Thus, I have argued that male visits to prostitutes are better understood as part of a male drinking ritual concerned with the construction of identity through the generation and display of male status and potency. These rituals take place in the liminal spaces of coffee shops, small restaurants and brothels, where men can disregard the normal social controls so that male potency may be contested, and where the male version of ideal male–female relations may be enacted. It is through edgework (Lyng 1990) in these and other contexts that, through the successful completion of risky acts, men test their fate and publicly display their potency and self-worth. Critically, I have emphasised that this risk taking and contestation with others, often at the disregard of all personal danger, are examples not of individual irrationality but of shared cultural patterns, of a shared cultural style. In this situation it is not surprising that AIDS-prevention programmes focusing on male sexual responsibility have been only partially successful. Unless the male emphasis on living on the edge is recognised, AIDS-prevention programmes designed solely to minimise male risk merely by providing information about risk behaviour are likely to fail. As pointed out earlier, campaigns such as ‘The Thai Family Combats the Danger of AIDS’ are perceived as

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attempts at achieving the submission of family and male sexuality to the demands of the state. Moreover, in a social context that places a high value on male risk taking, programmes based on the trite platitudes of poster campaigns are unlikely to have a significant impact on male risk behaviour. As Brummelhuis points out, if ‘marriage and prostitution articulate different spheres of experience and commitment, then it is naive to expect that men will give up visiting prostitutes by appealing to their family commitment’ (1993: 13; compare Fordham 1995). In the case of marginal groups some education about AIDS is still needed. However, for the wider Thai population it may now be more effective for AIDS prevention efforts to question Thai gender and other classifications, and the cultural logic on which they are constructed. As members of a culture learn their cultural patterns they do not normally acquire access to the logic upon which they are based. As a colleague recently put it, ‘the logic underlying social relations is so fundamental that it cannot be verbalised’.27 Yet, for males, a deeper understanding of the cultural logic which impels them to live on the edge may curb the risk to life that this behaviour poses in the AIDS era. Moreover, for villagers and the urban working class, there is still no model for masculinity other than the heavy drinking, sexually voracious, physically strong man. Instead of simply proscribing behaviour, AIDS prevention efforts may now be more fruitfully employed in popularising new role models for strong masculine identities (sport, for example), so that the competitive urges that drive men to live on the edge may be channelled into safer avenues. Such programmes, designed to give men more behavioural options, are likely to be more effective than programmes that implicitly devalue and restrict the practices through which these men have traditionally constructed their masculine identities. At a more general level, this analysis suggests that the development of a more reflexive approach in Thai HIV/AIDS research and intervention programmes will assist in identifying subtexts that inhibit programme success. As I have pointed out, programmes based on the premise that the rampant and unrestrained sexual appetites of the underclass must be directly restrained only lead to resistance on the part of the target group. Some recent works on Brazilian sexual culture, Parker’s (1991) Bodies Pleasures and Passions and his works on AIDS (Parker 1992; Parker et al. 1991), team with vitality, and the celebration of 27. Hjorleifur Jonsson, personal communication.

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sensuality that characterises Brazilian sexual life. Parker criticises analyses that treat erotic experience merely as ‘a function of individual nature and an irrational barrier to reasoned decision making and risk-reducing behavioural change’ (1992: 237), and he points out how an understanding of sexual and erotic meanings has direct implications for successful AIDS interventions. By contrast, after ten years of HIV/AIDS research in Thailand, works on Thai sexual culture are characterised by a tone of censoriousness directed at both prostitutes and their clients. No analysis to date has captured the celebration of masculinity that characterises Thai male sexual culture. None has captured the tension between order and disorder, between control and abandonment of control that is life on the edge. Yet this is what we now need to do if we are to understand the dynamic that drives the AIDS epidemic in Thailand.

CHAPTER 4

MUDDY WATERS: THE CONSTRUCTION OF HIV/AIDS IN NORTHERN THAILAND’S THAI LANGUAGE PRINT MEDIA

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his chapter explores the Northern Thai experience of HIV/AIDS during the early 1990s through an examination of how it was refracted in local-level print media during this period. At this time AIDS-related reports were very common in local-level newspapers, each edition frequently having as many as four or five separate articles dealing with HIV/AIDS issues. Some AIDS reporting comprised very sober reports of high rates of HIV in particular districts or of AIDS-related suicides, others were somewhat sensational in tone, such as the large front-page headline that screamed ‘Phrae People Afraid of Cow Meat, [and] don’t Dare Touch Lue Infected with AIDS’ (Thai News 1996c). In this case the accompanying story in the popular Northern Thai daily reported that a cow was suspected of having been infected with its owner’s HIV, and that villagers feared HIV infection from their cattle herds if they were to consume a local dish (lue) made from blood (Thai News 1996c). Such reporting in the Thai language press, particularly in the ‘low class’ local-level press, has been paid little or no attention by AIDS researchers. Indeed, the reporting of AIDS-related issues has generally only been examined in respect to notions of factual error and conformity with the biomedical model of AIDS. Nimit (1999) and Cullen (1999), for example, discuss English language media reporting about HIV/AIDS in Thailand and the South Pacific, and claim it often provides erroneous information about

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AIDS. Like earlier researchers such as Glanz and Yang (1996) they call for a better understanding of HIV/AIDS (from a biomedical perspective) on the part of the media and for more care on the part of those providing HIV/AIDS reports to the media. Thus from this perspective reports such as the above, can only be dismissed as both factually wrong and tragicomic, and as providing further evidence regarding the need for the media to have a better understanding of AIDS. However, in Northern Thailand both the quality of AIDS reporting in these media and the nature of the issues they report have been ignored by those working on AIDS research and interventions. Why this has been the case, given the sheer volume of such AIDS reporting during the early to mid1990s, bears examination. As far as Western AIDS researchers are concerned, most of whom are relatively new to Thailand and have only limited verbal ability in Central Thai, let alone the ability to read with any proficiency, I suggest that most are simply not aware of this genre of reporting. By contrast, on the part of the Northern Thai middle class working in the AIDS sphere, as local publications dealing with local issues, the newspapers I discuss here are well known and widely read. However, they are regarded as lowquality publications by comparison with some national titles and much of their reporting is expected to be somewhat sensationalist. Thai television soap operas portray the underclass on the rural periphery in terms of crass class-based stereotypes (Hamilton 1991), and I suggest that in a similar fashion the reporting of villagers’ bizarre beliefs about AIDS, and their seemingly strange AIDS-related behaviours have mainly served to confirm middle-class stereotypes of the irrational beliefs and behaviours of the underclass other, and that the content of such reports has just not been taken seriously. Such an interpretation is in accord with the normative model of Thai AIDS epidemic, where AIDS has been viewed as primarily a behavioural problem of the underclass whose risk behaviour and high level of HIV infection are the result of their poorly developed moral sensibilities and their low level of education which has not equipped them to understand generic public service AIDS-information campaigns. Yet there is a curious irony here, as although the majority of those working in the AIDS sphere in this early period attributed the ‘problem’ of Thai AIDS to uniquely Thai cultural factors, the intervention programmes developed for AIDS education and risk behaviour reduction were based on Western biomedical models of disease as well as Western-derived models of normative behaviour

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to evaluate issues such as risk taking, rationality and normative male sexual practices (Brummelhuis 1993; Fordham 1995, 1999). These not only ignored any specificity of Thai cultural values per se, they also denied regional, ethnic and cultural differences amongst Thailand’s highly diverse population (Fordham 1995). As a result, research about AIDS knowledge amongst the underclass and the design of intervention programmes directed towards them paid little attention to indigenous understandings of issues such as the social experience of AIDS as disease, of people with AIDS, and ideas about the kinds of people who cause AIDS, as the local level discourses articulating these issues were conducted outside of, and hence considered irrelevant to, the sphere of biomedical facts on which Thai AIDS discourses, research and programming were based. As a result, in Northern Thailand, as in Thailand generally, this approach has failed to address the fact that peoples’ experience of AIDS, like their experience of other health conditions and, indeed, like much of the most meaningful aspects of their lives (and the lives of all human beings) is shaped and expressed metaphorically. Thus, Thais, whether rural villagers in the North or the privileged Bangkok middle class, do not think of their daily activities in the language of biomedical discourses such as ‘AIDS risk behaviours’ any more than they think in terms of ‘health behaviours’ or ‘reproductive behaviours’.1 Rather, as I argue in the previous chapter, people have domesticated AIDS and made it meaningful in terms of their everyday lives through metaphors drawn from their own life experience, and even from the historical past. Couched in the rich idioms of the local Kham Muang language (although written in Central Thai), such metaphors show that men in the rural and urban underclass view both AIDS and the AIDS education programmes of state and non-governmental organisations as yet more unwanted intervention in the domestic space of their village and private lives (Fordham 1995), and as yet another example of their increasingly vulnerable position at the bottom of the social order. Other metaphors discussed below show how the Northern Thai have shaped and expressed their experience of AIDS through anthromorphising it, viewing it as evil like some humans, and how they have drawn on the natural world around them as a model for AIDS. Here, metaphorically, they compare AIDS with one common plant pest that burrows into 1. This is the case regardless of the multitude of state and IO/NGO sponsored programmes that would urge them to do so.

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and eats out the inside of plants, killing them from the inside out. Even AIDS deaths in their form and frequency are compared to the death of the leaves on the trees that, starved of water, wither and die in the hot season. Critically, these metaphors are a world away from the normative, biomedicallybased Thai model of HIV/AIDS and its associated images of moral failure and promiscuity, and of AIDS as a disease spread because of villagers’ limited education and consequent inadequate understanding of their world. By contrast with these approaches that ignore such experiences or deny their significance, this chapter argues that locallevel media reporting of AIDS-related issues should not be ignored, and that the deep cultural resonances with local issues and local cultural values embodied in such reporting provides portraits of people’s experience of HIV/AIDS as disease and of the experiences of people with AIDS (PWA) that are not available elsewhere. I argue also that media reporting of AIDSrelated issues in Northern Thailand during the early 1990s exposed the underclass to a wide variety of HIV/AIDS information. Although formal AIDS-information campaigns sponsored by the state, by IOs or NGOs have been viewed as the major means by which AIDS knowledge has been provided to the public, I suggest that that these public media have also played a significant role in raising AIDS awareness. I also demonstrate that through their refraction of local-level issues, media reports about AIDS at the district and regional level provide a window on how HIV/AIDS was understood and ‘domesticated’ amongst the rural and urban underclass during this period. Such reporting suggests a generally high level of public knowledge about AIDS and AIDS risk behaviours, ironically, as I point out below, sometimes reflecting the worst of the class-based and highly misogynist early 1990s state and IO/NGO AIDS-prevention campaigns that focused on prostitutes as the root cause of AIDS (an issue that I take up at greater depth in the following chapter). I begin with a brief description of Thailand’s HIV/AIDS epidemic and the way in which Thai public media has played an integral part in AIDS-control campaigns. I then describe the role of print media in Northern Thai society, the Northern Thai newspaper reporting of HIV/AIDS issues that constitute the focus of this chapter, and the manner in which my analysis of the articulation of the Northern Thai experience of HIV/AIDS in the print media divides print media coverage of HIV/AIDS issues into three

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major thematic categories.2 These are: the meaning of HIV/AIDS as disease threat, the personal experience of AIDS, and the issue of HIV transmission via prostitution. I then address these three categories of reporting. Firstly, I analyse how the Northern print media articulates the meaning of HIV/AIDS as disease threat through HIV/AIDS statistics, information concerning the geographic area of infection, details concerning the physical impact of disease and reports about HIV/AIDS control programmes. Secondly, I take up reports concerning the experience of having AIDS, including AIDS care, the issue of AIDS-related suicides and reports of potential cures.3 Finally, I take up the issue of how the spread of HIV/AIDS has been treated in media reporting. Here, in a refraction of government and IO/NGO programming, prostitution is treated as a behavioural problem of young women, and female prostitutes rather than their clients have been allocated the bulk of the blame for Thailand’s AIDS epidemic.4 Indeed, I suggest that in this period it was not so much a lack of AIDS knowledge that was the problem, but a surfeit of knowledge from a variety of public media, from public service programming and from the huge variety of IO/NGO AIDS-prevention programming conducted at this time, providing a mix of information that ranged from that of high veracity, to that which was ambiguous at best, to that which was totally erroneous: for many the waters had been well and truly muddied. 2. In an earlier version of the first section of this chapter presented at the Sixth International Conference on Thai Studies in Chiangmai 1996 (Fordham 1996a), I distinguished a fourth theme in Thai print media treatments of HIV/AIDS related topics. This was a category of reports focusing on AIDS in other countries, both other Asian countries and in Africa and the West. These reports are primarily found in the Thai English language papers with a scattering of reports in the major national Thai language papers. They are not found in the parochial newspapers I discuss here which focus solely on local issues. 3. I am not suggesting here that there is a cure for AIDS. However, as I will show in the following, a regular feature of Northern Thai newspaper reporting about AIDS during this period was of various people, often traditional healers or religious virtuosos, who were reported to have cured people from AIDS. Even sceptics on reading such reports seemed to me to be cautiously optimistic that they may be true and such healers are subsequently thronged with people with AIDS (or who are HIV positive) hoping for a cure. 4. I do not address the issue of media reporting of the role of injecting drug users (IDU) or homosexuals in the spread of AIDS as both received minimal coverage. However, as I noted in the previous chapter, Jackson (1995a, 1995b) claims that the late 1980s saw a significant hardening of attitudes towards homosexuality as a result of the AIDS epidemic. I suggest this is a result of both government and IO/NGO campaigns and media reporting that denoted homosexuality as one mode of HIV transmission.

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AIDS in Thailand Thailand’s first AIDS cases were detected over the period 1984 to 1985 (Sunee 1992; Vichai et al. 1993; Weniger et al. 1991) in men with a history of homosexual contact in the commercial sex industry. By 1988 the virus was detected amongst the drug-using community and by mid-1989 the first national seroprevalence survey found that HIV infection rates of 2 to 5 percent were common amongst commercial sex workers, with a rate of 44 percent being found amongst Chiangmai sex workers. The same survey detected HIV rates of between 0.1 and 10 percent in CSW clients (Kumnuan et al. 1989). However, measures to combat AIDS were not implemented at this time due to mid-1980s plans to increase the numbers of foreign tourists visiting Thailand, and fears that adverse publicity about AIDS would impact on campaigns to celebrate 1987 as not only the king’s 60th birthday, but also ‘Visit Thailand Year’ (Cohen 1988). As a result HIV figures continued to climb and by December 1991 seroprevalence rates amongst heterosexual men ranged from 1.89 percent to 36 percent, with a median of 5.6 percent depending on province (Kumnuan et al. 1992). By 1993, 13.4 percent of army conscripts from the upper north (most of whom are aged 21) were found to be HIV positive (Suchai et al. 1995). It was this massive rise in HIV rates in the late 1980s and the early 1990s, and an anticipated spread of HIV in a series of sequential ‘waves’ (Weniger et al. 1991) through what were considered high risk groups - male prostitutes, intravenous drug users (IDUs) and female prostitutes, and then into the general population of sexually active heterosexual men, wives and children – that motivated Thai HIV/AIDS control programmes.5 Since this time both Government and IO/NGO AIDS campaigns relied heavily on the use of public media to disseminate information about the dangers of AIDS and how to avoid them. Information about HIV/AIDS produced for these media campaigns was based on biomedical models of disease and disease control and was, as Lyttleton (1994a, 1994c, 2000) points out, simplified for easy assimilation. Thus, public service announcements made no distinction between HIV and AIDS and, instead, 5. Later research (Ou et al. 1993; Sasiwimol et al. 1994) would show that the epidemics in the drug using population and that which developed in the heterosexual population were largely separate as they were caused by different HIV-1 subtypes. Subtype E was predominantly found amongst heterosexuals while subtype B was predominantly found amongst IDUs (Dwip et al. 1994). I take this issue up at greater length in the following chapter.

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referred to the AIDS virus. Media utilised included both the electronic media (radio and TV spots) and print media (roadside banners and hoardings, posters, a wide range of brochures and pamphlets and advertising spots in newspapers and magazines). Other ‘culturally appropriate’ media, such as folk theatre (ligee), cartoon books, love stories produced for specific target groups such as factory workers, radio dramas, radio phone-ins and activities such as vehicle/pedestrian parades through major towns have also been utilised to disseminate messages about HIV/AIDS, its modes of transmission and prevention and, as the epidemic progressed, about living with and caring for people with AIDS. It is these media campaigns that are judged to have been responsible for the speed with which the Thai population gained a high degree of knowledge about HIV/AIDS, and thus for the success of country-wide campaigns such as the ‘100 Percent Condom Programme’ (Nelson et al. 1996; Wiwat and Hanenberg 1996), the later ‘The Thai Family Combats the Danger of AIDS’ campaign and more recent campaigns focusing on the integration of people with AIDS in society. Smaller regional and specific ‘target group’ (such as factory girls, rural housewives, street children and so on) campaigns utilised the same media strategies and, similarly, it is these media that are now judged to have been responsible for the success of these campaigns (Borthwick 1999; Chuanchom et al. 1997; Nelson et al. 1996; Lyttleton 1996b; Mastro and Khanchit 1995). However, apart from these directed uses of the media by state agencies and NGOs working in the AIDS field, in Thailand as in other countries there has also been a massive amount of general media reportage dealing with HIV/AIDS-related issues. While this ranges from reports with a high level of veracity to the tragicomic and the contradictory and erroneous, they should not be dismissed as worthless. Beyond the medical model of disease transmission on which government agencies and IO/NGO programming is based, lies the world of indigenous notions of disease causation (Golomb 1988) and that of daily experience. Critically, the Thai experience of AIDS has been shaped and articulated by metaphors distinct from those found in the West (Sontag 1991). Thus, I argue in the previous chapter regarding the metaphoric understanding of AIDS as disease in Northern Thailand, and have suggested that one potent metaphor of AIDS in this context is that of penetration of male space and of the private sphere. However, there are many other metaphors associated with the Thai experience of AIDS. I suggest that Northern Thai media refractions of the Thai experience of AIDS has the potential to

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reveal more of these metaphors and the manner in which they articulate Thai understandings of AIDS as disease. For example, as the debilitating effects of AIDS became known to all, people drew on local knowledge to construct metaphors that described the experience of AIDS. In chapter three I noted that in the early 1990s, when there had been relatively few AIDS deaths, villagers, using black humour, sometimes referred to AIDS as look AIDS 35 (the AIDS you get after drinking 35 percent proof rice whisky and are too drunk to bother with a condom). Yet, by the mid1990s, as the number of AIDS deaths increased dramatically, as if black humour was no longer appropriate given the magnitude of the epidemic, AIDS began to be referred to as look pieng hoop, drawing on a comparison with a local insect pest that causes devastation to bean crops through eating the stalk of bean plants so that they wither, lose their colour, weaken and eventually die. This local knowledge is not inconsequential, as the Thai experience of the past decade has shown that curbing HIV/AIDS risk behaviour is not a matter of knowledge alone. Although there are now very high levels of knowledge about AIDS in the North, some men still persist in visiting brothels and in engaging in unprotected sex (Khanchit et al. 1999). Frankenberg’s (1994) assessment, that we need new questions about AIDS and sexual behaviour, is still apposite today as high levels of HIV/AIDS knowledge have led to less than optimum levels of risk reduction. Moreover, there is now some urgency to develop new strategies for combating Thai AIDS. In Thailand of the early 2000s there seems to be a new complacency on the part of men in their late twenties and early thirties who have survived the epidemic of the past decade, and on the part of a new generation of sexually active young men and women who have grown up with HIV and for whom it evokes no special fears. Recent research, as well as anecdotal reports, indicate significant levels of unprotected sex amongst members of this group (Butarat 2001; Daily News 1999; Michinobu 1999; Orasom 2001; Parichart 1999; Somprasong and Unchalee 2001; Suthep 1999; Wichundaa 2002). I suggest that through an examination of media articulations and refractions of the Northern Thai experience of AIDS epidemic, it is likely that new understandings of the Thai experience of AIDS will emerge and that new points of intervention will emerge. As Lyttleton (1994a: 143) points out, the contents of Thai AIDS campaigns of the early 1990s were ‘reproduced from Western notions of HIV/AIDS aetiology’, and thus the Thai indigenous experience and interpretation of AIDS has been given relatively little consideration in programming.

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HIV/AIDS in the Northern Thai Print Media A commonly held view amongst the Thai middle class and many Western Thai Studies specialists is that Thais do not read; and perhaps it is true that few read Thai classical literature and that fewer still are familiar with the classics of the Western literary cannon. Yet Thailand has a booming publishing industry, and although public libraries are few and their offerings comparatively meagre, small private lending libraries are widespread and stock selections of contemporary magazines and novels. In urban centres bookshop shelves are stocked with a ceaseless flood of novels, collections of short stories and non-fictional works, and market stalls sell remaindered and second-hand books and magazines for a fraction of their original price. Both rural and urban markets have news stands furnished with a broad range of print media, from cartoon style penny dreadfuls to magazines catering to every imaginable market niche, to a wide range of daily local and national newspapers. Even relatively isolated villages have stalls and small shops selling a selection of newspapers and magazines, albeit sometimes a day or so out of date in more remote areas, and throughout the country rural villages have public reading saalaa (a roofed and partly walled structure) stocked with national and local newspapers. With a literacy rate of approximately 95 percent reading is a skill mastered by almost all, and from saamlor (pedal tricycle) riders, traders in the markets and rural and urban labourers upwards, men and women can be seen reading the daily newspapers.6 In many cases the newspaper they read is borrowed, or is merely picked up in their local noodle shop or drinking house (some are provided by the owners, others are left by earlier patrons). Here, unlike the ephemeral news reports of the electronic media, news reports remain current for days, and in such venues the everchanging throng of customers reads these free newspapers until they literally fall apart or their news is too stale to arouse interest. Since AIDS first became an issue of public concern in Thailand in the early 1990s, print media of all forms, from daily newspapers to weekly and monthly magazines (motor cycling magazines, magazines about health and lifestyle, and even cartoon books and men’s ‘girlie’ magazines) have carried regular articles and reports about 6. During fieldwork in Chiangmai in late 1999, as I strolled home to my room near the centre of the old city, each evening I passed a group of three old men, saamlor (pedal tricycle) drivers, men right at the bottom of the social hierarchy, sitting together under a shop front where one of the group customarily slept at night – reading the papers of the day by the light of a convenient street light – one with the aid of a small magnifying glass.

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HIV/AIDS, campaigns to combat HIV/AIDS, and about people with AIDS, their problems and their care. Thus, as I noted in the previous chapter, ‘girlie’ magazines featured articles discussing how to detect girls possibly infected with AIDS and carried advertisements for dental dams and devices to prevent condoms slipping off. Somewhat more subtle comments about the presence of AIDS in Thai society were made in the cartoon books (ubiquitous throughout Thailand) that weekly caricature the political and social issues of the day. Thus a cartoon book collected in 1994 included an illustration of a cuckolded man wishing AIDS upon his wife’s lover, while a later 1996 edition featured an illustration of two men in a doctor’s clinic. One asked the other what his problem is and was given the answer ‘AIDS’; the reply, ‘Oh ho! a modern disease’. In this genre AIDS cartoons have now almost totally replaced the cartoons about STDs that characterised the pre-AIDS era. As far as newspapers were concerned, in the early and mid1990s when public concern about HIV/AIDS was at its greatest, people read with great interest the regular newspaper reports of HIV infection rates in the various Northern provinces, and these were always a topic of conversation at roadside drinking houses, as were reports of reputed AIDS cures by local traditional (herbal) healers (mor muang).7 In the early 1990s, articles and reports about HIV/AIDS were found mainly in the Northern Thai daily newspapers, reflecting the high rate of HIV infection in this region. In this period a much smaller number of reports and articles were published in national newspapers and magazines. However, by the late 1990s HIV/AIDS articles/reports in the Northern media had decreased to only a handful each month, reflecting a growing normalisation of the presence of HIV in Northern Thai society and, as I argue in the following chapter, the end of the moral panic over prostitution and its impact on society. Concomitantly, reflecting a growing rate of HIV infection in other regions, a growing number of HIV/AIDS-related articles and reports began to be published in Bangkok centred national newspapers.8 7. A common experience through the early and mid-1990s was that I rarely had to ask informants what they thought about various media reports about AIDS. Once people knew the area in which I was working they would tell me about AIDS-related articles they had read in the media of the day and frequently bought to my attention articles I had not read. 8. Local newspapers published in Northern Thailand deal with highly parochial issues and are distributed only within the North. By contrast, Bangkok-based newspapers, such as The Manager and Thai Rath, are distributed nationally and deal primarily with issues of national interest – particularly in-depth coverage of national political and economic news. Occasionally national newspapers ‘localise’ their Northern edition with special supplements such as those included in early 1990s weekend editions of The Manager; however, they retain a national focus.

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AIDS-prevention campaigns utilised posters in villages, hoardings along the roadsides and broadcasts in the electronic media to construct a portrait of AIDS as a disease, and to give the public information about safe sex. It is this formal, biomedically-based portrait of AIDS and AIDS-prevention campaigns that, as I pointed out above, are believed to have been responsible for a dramatic reduction in HIV infection rates since the mid-1990s. However, these formal AIDS campaigns are only one component part of the portrait of AIDS constructed in the North. The greater whole also includes newspaper and other print media (and, of course, the electronic media) reporting a wide range of issues related to HIV/AIDS which refracts the Northern Thai lived experience of AIDS. Importantly, Northern Thailand has been the epicentre of Thailand’s HIV/AIDS epidemic through the 1990s. Given significant cultural distinctions between Northern and Central Thailand, these locally produced media messages refract a uniquely Northern Thai experience of HIV/AIDS. As such they have much potential to show how the national AIDS programme (based on the assumption of pan-Thailand cultural homogeneity) might be fine tuned to take account of regional and ethnic differences. The reports and articles relating to HIV/AIDS on which this chapter draws derive from a selection of Northern Thai newspapers, the Chiangmai News, Chiangrai News, Khao Siam (Siam News), Park Nua (The North) and Thai News, collected mainly over the period from 1993 to 1996,9 from news stands throughout Chiangmai city and from villages and larger towns throughout Northern Thailand. I aimed to collect a broad range of news and other print media materials that were fairly widely available throughout Northern Thailand. None of these parochial newspapers are quality papers in the sense that publications such as the Bangkok-based Matichon and The Manager (Thai language), or the Bangkok Post and The Nation (English language) are recognised as authoritative due to the excellence of their reporting and commentary. However they are widely read by the lower strata of the 9. The amount of potential material is enormous and this chapter concentrates primarily on a representative selection of media reports over this four year period. Prior to 1992, although there was an increasing number of people infected with HIV, there were few visible cases of people suffering with AIDSrelated conditions, and AIDS prevention campaigns were only just commencing. This was reflected in the print media in the relatively limited number of AIDS related reports compared to subsequent years. By 1999 HIV/AIDS had ceased to be an issue of major concern for the public media, being replaced by widespread apprehension about increasing levels of amphetamine and other drug use.

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population as well as by the middle class due to their focus on local and regional issues.10 Thus they focus on local news of the day, from road accidents, murders and political scandal, to regular pages devoted to economic news, society news, news about religion and religious ritual, and educational and agricultural news. Written in easy Central Thai much of their reporting uses the ‘earthy’ language of the lower classes and is liberally illustrated with explicit front-page photographs depicting events such as motor accidents, murders and suicides.

Classification of Media Reports Concerning HIV/AIDS Articles dealing with HIV/AIDS in Northern Thai Newspapers fall into three fairly distinct categories. 1. General articles giving information about HIV/AIDS. This is a broad category of news items that includes information about HIV/AIDS and related issues, reports on AIDS-prevention training sessions directed to specific target groups, and regular statistical updates of levels of HIV in various occupational and social groups and in various regions of the North. 2. Articles dealing with the experience of having AIDS: including the problems that people with AIDS face; new medication or treatments for AIDS-related conditions; and the care of people with AIDS. This category of AIDS-related articles also includes reports of suicides due to HIV infection, suspected HIV infection or the appearance of AIDS-related conditions. 3. Articles and reports about prostitution and its role in the spread of AIDS. This genre of reporting ranges from articles concerning the eradication or control of prostitution and the eradication of child prostitution to the aetiology of prostitution

10. The Chiangmai News only commenced production in 1991, and is a particularly interesting paper as through the early 1990s it took a much stronger and much more critical stance on social issues such as AIDS, child prostitution, pollution and issues such as political corruption, than did other local newspapers. This stance, one toned down considerably over the decade, led to an interesting situation several times, when in early 1993 both myself and a fellow researcher were repeatedly advised by news-stand holders that we should buy other local papers as this was not a ‘good’ paper. Questioning revealed that it was ‘too strong’, although we were never totally clear if people considered it too strong per se, or merely too strong in that it revealed too much of the underside of Northern Thai society to foreigners.

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in Thai society and the retraining of prostitutes for socially acceptable occupations. Critically, a common feature of all three categories of reports and articles is that they were generally highly visible in respect to their location in each newspaper edition and page layout. Although some reports about training sessions for villagers or school children appear on the education page, and other reports sometimes appear on the religion or economic news pages, a high proportion of HIV/AIDS-related reports are located on page one and are accompanied by colour photographs and large-print headlines. As far as the Northern Thai print media was concerned in the early and mid-1990s, HIV/AIDS was not an issue to be hidden away in the middle of the newspaper or to be dealt with in small print. I discuss these three categories of reports in the following, with the aim of giving a portrait of the sorts of issues covered and the mode of presentation. I commence with general articles about HIV/AIDS. This category of AIDS-related articles is important as the various forms of information it includes played a major role in defining what HIV/AIDS was and the sort of threat it represented to the population.

General Articles and Reports about HIV/AIDS As organised, Government AIDS-prevention campaigns commenced in the early 1990s, newspapers reported an ongoing flow of information about campaigns, from national campaigns to those at village level. Thus the 1993 AIDS-prevention campaign ‘The Thai Family Combats the Danger of AIDS’ was reported on the front page of the Chiangmai News (1993m) with a photograph of marchers carrying an AIDS-prevention banner and a smaller photograph of an award being presented for this, the best banner. The banner, photographed close-up in full-colour, proclaimed ‘Amphoe Sanpadong district, comes together in the campaign the family throughout Thailand combats the dangers of AIDS, the life of the family will be bright if we bring our hearts together to prevent AIDS, don’t be promiscuous with needles or sexually – you can prevent AIDS for sure’. The photograph was accompanied by an article headed ‘Lamphun Anxious [About the] AIDS Virus’ which quoted a Department of Public Health representative regarding the ‘AIDS situation in Lamphun province’ (Chiangmai News 1993m) that, with 8.3 percent of the population infected

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with AIDS, the province had the highest number of AIDS cases in the country.11 It cited the advice of the Department of Public Health that men should cease visiting prostitutes and, thaa torn my wai (literally, if they ‘could not stand’ it, that is, going without sex), that they should wear condoms. AIDS-prevention projects and the planning of AIDS-prevention projects in other areas of the North also received significant media attention. Thus, in May 1993, a headline in the Chiangmai News announced ‘Lampang Province Holds Meeting For the Prevention and Control of AIDS’ (1993l), later the same month another headline ‘Maeai and the Work of AIDS Prevention’ (Chiangmai News 1993n), and later still ‘Maehongson Holds Campaign Against AIDS’ (Khao Siam 1994c). Smaller, more tightly focused village campaigns also received a significant amount of publicity. Thus, a typical report headed ‘Giving Knowledge About AIDS to Mother’s Groups’ (Thai News 1993b), reported on an AIDS-prevention training session organised by the Chiangmai city council for 140 women drawn from the members of fifteen district women’s groups. The report notes that AIDS was an important problem as it was spreading rapidly through the community and that the ‘population must work together earnestly to stop [it]’. However, as is common with articles reporting AIDS campaigns, the news was the campaign itself and the actual information about AIDS and prevention of the spread of HIV given to session participants is not reported. Another aspect of HIV/AIDS reporting throughout the early and mid-1990s in the North was regular editorials sermonising on various aspects of what the header for a late 1993 Chiangmai News editorial calls ‘The Problem of AIDS’ (1993aa). This argued that there was a confusion, ‘especially in the country’, about what the term luat buak (literally, positive blood) meant, and pointed out that the term had previously been used to describe a positive result for a sexually transmitted disease (STD) test. As evidence for this problem it cited the example of an anonymous high-level government employee who was told that his blood was positive (meaning positive for an STD test) and who, believing he was HIV positive, committed suicide. Thus, in a tone that reflected wider concerns about the relationship between education levels and AIDS knowledge and behaviour, it called for a clearer standard of reporting of HIV test results so that people would not be 11. As noted earlier, Thai AIDS public discourses do not distinguish between HIV and AIDS, and so newspaper reports such as this actually report HIV infection rates.

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confused. Indeed, although much less frequent by this time, such editorials continued through into the late 1990s, and the same hectoring tone remained. Thus, following World AIDS Day for 1999, the Thai News (1999d) pontificated ‘The Struggle Against AIDS Has Not Yet Achieved a Perfect Outcome’, arguing that increasing HIV infections are ‘the outcome of a society without education, without understanding [my emphasis] that does not seriously protect [itself] against AIDS’. Such attitudes clearly reflect a relationship commonly drawn by the Thai middle class between a low level of education and the resultant failure of the masses to conform to contemporary middle-class notions of right and moral action in society (Mulder 1984, 1997), (an issue I address at greater length in the following chapter). An important part of the Ministry of Public Health’s (MOPH) campaign against AIDS in the early 1990s was regular reporting of the latest HIV/AIDS statistics for Thailand as a whole and for the various Northern provinces; this was given prominent, rather shock/horror-style coverage, in newspaper reports of the time. Reflecting, what I earlier pointed out is a highly structural functionalist and essentialist risk-group model of the HIV/AIDS epidemic, reports of such statistics generally followed MOPH sentinel surveillance categories and gave information about the relative rates of male/female HIV infection, about the infection rates amongst various occupational categories, and about the means of infection (heterosexual or homosexual sex, or through intravenous drug use). Thus a late 1994 article (Park Nua 1994) headed ‘AIDS in Chiangmai Increases Amongst Men Five Times More than Women’ advises that in Chiangmai province there were currently 1,884 people with AIDS (AIDS deem khan), that 556 people had died already and that five times as many men as women were HIV positive. It also notes that the bulk of infections were sexually transmitted through heterosexual or homosexual intercourse. Interestingly, unlike many other reports which, in a reflection of MOPH reporting categories stress that the bulk of infections are found amongst farmers and labourers, this report emphasises the point that people with AIDS come from every occupational group. Other articles give more direct, and more typical, reports of health department statistics. Thus the Chiangmai News (1993c) quotes a Health Department doctor who reported that in Chiangmai province statistics for AIDS were increasing amongst prostitutes and pregnant women, and that the latter was due to husbands who ‘liked to visit prostitutes and who were not able to change their behaviour [my emphasis]’. Critically, this report notes

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that the aim of future projects was to focus on village leaders, family heads, housewives and youth – and to give them increased knowledge and understanding about HIV/AIDS. It is particularly interesting that this same report notes that the ‘risky aspect of HIV transmission is that most [men with this behaviour] drink alcohol until drunk [and] are not concerned about HIV protection’. At this stage of Thailand’s HIV/AIDS epidemic few researchers had traced the link between alcohol consumption, male behaviour and HIV transmission. Some researchers, such as VanLandingham et al. (1993a), VanLandingham et al. (1993b) and VanLandingham et al. (1995a), claimed Thai men drank to rationalise risky sexual behaviour, rather than viewing this as part of the complex ritual of masculinity construction discussed in the previous chapter. Yet, as far as Thai language AIDS discourse in the public print media was concerned, there was already a high level of awareness about the relationship between alcohol consumption and male HIV risk behaviour, and it was clearly established that drinking and subsequent sex with prostitutes was a normative masculine activity, not merely the behaviour of aberrant individuals. Yet another report in the same genre titled ‘AIDS Statistics in Phrae Increase Frighteningly – Roundup of Prostitutes’ (Chiangmai News 1993d) notes that the ‘AIDS situation in Phrae province is getting more dangerous each day’ and gives the total number of people found to be HIV positive as 2,041 persons. The report notes that of the ten groups in the population in which AIDS is found, there were 1,108 average persons (prachaachon tua pai) with AIDS, followed by prostitutes (677), pregnant mothers (62), prisoners (59), housewives (49), anonymous test clinics (therefore details unspecified) (45), IDUs (19), students (18), children younger than one year old (8) and homosexuals (5). Critically, these groups are portrayed as essentialist population groupings yet, in reality, many merely reflect sentinel surveillance categories which conflate the categories of occupation, age and sexual orientation. Indeed, as Vichai et al. (1993: 21) point out, the analytical objectives of sentinel surveillance meant that the surveillance categories themselves were constituted by ‘considerable arbitrary defining criteria’. Thus, for example, people such as prostitutes (an occupational category) were treated as if they were segregated from the general population, as if the category of prostitutes didn’t include people who were housewives or mothers, or that school students do not sometimes work part-time in commercial sex (Chai et al. 1993; Nitaya and Saupaa 1996; Wathinee and Guest 1994). Critically, articles commonly claimed that prostitutes were in need of training to prevent AIDS, as they have ‘a risky

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profession for the spread of AIDS’ (Chiangmai News 1993b: 20), yet the male customers of prostitutes who are responsible for infecting women in the first place and for moving HIV from woman to woman are seemingly absolved of responsibility. The general tenor of newspaper reporting about HIV/AIDS in Northern Thailand in the early 1990s is, then, one that depicts an exploding rate of HIV infections in all groups, particularly amongst men and prostitutes, and the portrait is that of a rather powerless community under siege by AIDS. As a mid-1993 headline in the Northern edition of The Manager (1993a) put it in an article dealing with AIDS ‘AIDS in Chiangmai: Dying like Leaves Falling from Trees, Doctors Worried [and] using Herbal Medicines’. During this period this imagery is repeated over and over again in news reports, as the Chiangrai News (1993) puts it ‘people are dying like falling leaves’. Critically, although articles often directly state that the problem is male promiscuity in the sphere of commercial sex, such behaviour is explained by sexual desires that men are unable to control. Thus men are generally portrayed as engaging in risk behaviour because of the nature of masculinity itself which, as a natural process, produces strong sexual urges. However, reporting also draws on class-based explanations, as the men portrayed as failing to control their behaviour are almost invariably members of the underclass (rural and urban labourers). The subtext throughout these reports is that the key to controlling the spread of AIDS is more knowledge (about AIDS and about appropriate behaviour), again reflecting the commonly held Thai view that a lack of moral sensibility and emotional and bodily control stems from a lack of education (Mulder 1984, 1997). By contrast with the reporting of HIV/AIDS amongst men, the reporting of HIV/AIDS amongst women draws on the fundamental division Thai culture makes between ‘good’ and ‘bad’ women (Bao 1999; Harrison 1996, 1999; Manop 1994). Good women are portrayed as those who are acting normally, with their sexuality constrained within the confines of the home and marriage. By contrast, prostitutes are portrayed as paradigmatically bad women, acting abnormally as their sexuality is not restrained within marriage but is available to all for a fee. Good women are portrayed in newspaper reports as blameless (often pregnant) mothers infected by irresponsible husbands, while HIV-positive prostitutes are portrayed as having been infected due to their promiscuity and are blamed for their role in transmitting HIV to their clients. Critically, for both men and women, there is little sense in newspaper reporting of HIV/AIDS that HIV is a problem

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for the middle class, and reports almost invariably refer to members of the urban middle class teaching members of the urban and rural underclass about HIV/AIDS.12 Yet curiously, discussions about the need to control prostitution and the risk behaviour of the male underclass, conducted on the front pages of newspapers, are juxtaposed to a much more highly commodified middle-class sexuality, apparent in the advertising for expensive alcohols, restaurants, hotels, massage parlours, bath-houses and coffee shops on the back pages of all newspapers. In the Chiangmai News, for example, each day advertisements for coffee shops are illustrated with beautiful hostesses promising customers that their every whim will be catered for, while advertisements for massage parlours cum bath-houses are illustrated with towel draped women drinking spritzers from their seat on the edge of a spar bath, and who promise the ‘most perfect entertainment in the North.’ Critically, although direct brothels have been subject to intense supervision and even periodic closure throughout the 1990s, these middle-class establishments, many of whose raison d’être is solely indirect prostitution, have not been subject to the same controls.

The Personal Experience of AIDS The second major category of HIV/AIDS reports I discuss here is a genre of AIDS reporting that deals with the experience of being HIV positive or having AIDS-related conditions. It became increasingly prominent during the period 1994 to 1995, as the HIV infections of the late 1980s and early 1990s (Kumnuan et al. 1989; Kumnuan et al. 1992; Suchai et al. 1995) gave rise to an increasingly visible body of people living with AIDS. As the numbers of this group increased communities became aware that it was not a matter of dealing with isolated individuals on a case-by12. Regardless of Ministry of Public Health service announcements about how AIDS is a problem of all classes, it has only been since the very late 1990s that broader portrayals of people with AIDS have been found in the media, and this is particularly the case with Central Thai (Bangkok based) national magazines. For example, in the period leading up to World AIDS Day 1999 (1 December) the national magazine Cheewhit Torng Suu printed two successive issues dealing with people with AIDS. The first featured a famous pop singer telling of his HIV infection (Cheewhit Torng Suu 1999a), and the second featured a two-page spread of photographs of people with AIDS and a brief personal history (Cheewhit Torng Suu 1999b). Cover advertising and the accompanying story made much of the fact that for the first time in Thailand a group of people with AIDS were willing to reveal their condition publicly.

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case basis, but that there was a significant body of people living with AIDS whose specific health care requirements needed to be addressed as a group. New issues addressed by HIV/AIDS reporting included: AIDS prevention projects and projects directed at alleviating the social problems of people with AIDS (such as income support and care for children), care for AIDS-related medical conditions and projects directed at ameliorating a generally negative community response towards people with AIDS (Fordham 1993; Muecke 1999). Other new HIV/AIDS issues reflected in the media in this period are the problem of HIV/AIDS amongst children and the issue of AIDS orphans, which became increasingly prominent in newspaper articles as the number of AIDS orphans increased in the mid-1990s. Newspaper reporting of the HIV/AIDS epidemic during this period also begins to take up the issue of new vaccines, of vaccine trials and of herbal medicines that promised to cure AIDS or to alleviate the pain of AIDSrelated conditions. Significantly, this genre of reporting also includes numerous reports of suicides of people who, on finding they were HIV positive or who after a period of debilitating AIDS–related illness, were unwilling to face a pain-filled and lingering death, and the expense this visited on their relatives (Muecke 1999). As with the reports about AIDS during the early 1990s, these reports are highly visible with many appearing as front-page articles with banner headlines. However, unlike the rather statistically orientated reporting discussed above, where the magnitude of the HIV/AIDS epidemic is stressed, many of the teaching and intervention projects were conducted as small, district-level interventions in the various Northern provinces. As a result newspaper reports of these activities expanded from the earlier front page shock/horror genre to include reports printed on the education and health pages, and the pages reporting regional news from the other Northern provinces of Chiangrai, Maehongson, Nan, Lampang, Lamphun, Phayao and Phrae. Typical of AIDS-prevention projects reported in the Northern newspapers during this period is a 1995 report of a three-day training session conducted amongst village women (representatives drawn from village health volunteers, mothers’ groups and youth groups) by the faculty of nursing at Chiangmai University. Headed ‘Faculty of Nursing Trains Women’s Group to Nurse People With AIDS’ (Thai News 1995e), the report notes that the central aim of the project was to give people knowledge and training about HIV/AIDS so they would have a better attitude towards people

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with AIDS.13 Unlike earlier projects that merely aimed to tell people about HIV/AIDS prevention, this project specifically notes that the information and training given, aimed at achieving a decrease in the feelings of hatefulness that families and communities felt towards people with AIDS (Nitaya and Saupaa 1996). It also aimed to teach about the care of people in the family and in the community who were HIV positive or who had AIDS, and concluded by saying that when people who were HIV positive or had AIDS saw that other people didn’t feel hateful towards them they would have new hope. Interestingly, this report and others like it are specific about project objectives but do not actually give any information about AIDS prevention or care for people with AIDS (PWA). Another report, earlier the same year, evidences a similar concern about the Northern Thai response to PWA. A March 1993 editorial titled ‘The Beginning of Community Help for People With AIDS’ (Thai News 1993a) discusses Ministry of Public Health plans to assist people who were HIV positive or who were ill with AIDS to receive a greater degree of understanding from family, friends and society generally, and for local communities to play a greater part in providing AIDS care. Critically, the editorial speaks of the limitations of the public health budget, and of the urgent need for NGOs as well as local communities to acquire funding to address these issues. As in the above example, it emphasises the lack of acceptance of PWA, noting that: ‘In some centres society still doesn’t accept people who are ill with AIDS and looks at them with feelings of hatred and fear’ (ibid.). It claims that such responses causes those ill with AIDS to give up and lose hope, and shut themselves away in order to hide their condition.14 As an indication of 13. There is no little irony in the fact that in the early 1990s, formal programmes conducted by medical personnel expended much effort encouraging villagers to have a better attitude towards people with AIDS, yet PWA frequently found that similar fears of contagion where held by many in the medical profession. Some left the profession, or moved to administrative positions or positions in the private sector (The Manager 1993b), while others developed offhand and dismissive attitudes towards PWA who they viewed as both highly contagious and as facing certain death. As a late 1993 editorial in the Chiangrai News (1993) (Chiangrai being the epicentre of the Northern Thai HIV epidemic at the time) put it in regard to both public and private hospitals ‘when the hospital knows someone is HIV positive they immediately change their therapeutic behaviour, they no longer pay attention to caring, reduce medicine and advise rest at home … its as if the patient with AIDS is dirty’. Yet more critically it notes, ‘they speak in seminars about the need to understand people with AIDS, then secretly they turn around and kick people out [of hospital] to die at home’. 14. By the end of the 1990s the ubiquity of PWA in all communities had certainly ameliorated the strength of this response; however, as late as 1999 PWA were still calling for improvements in the level of community acceptance (Thai Rath 1999a).

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the strength of local level fears of contagion from HIV/AIDS in this early Thai AIDS period the editorial notes that when members of families are found to have AIDS, sometimes huts are built for them at a distance from the main house and that they may be locked in or chained up to keep them from contaminating people. Such responses to fears of contagion from people with AIDS were so widespread in the early 1990s that a recent work dealing with prostitution in the North by the prolific North Eastern socialrealist author Kamphuun Bunthawee (Kamphuun 1999b), draws on them to depict this period, when he has two HIV-positive prostitutes return from Bangkok to their village and, due to community fears of contagion, being forced to live in a hut built in the fields.15 Critically, as I point out elsewhere (Fordham 1993) the resort to physical isolation is not a new response to Northern Thai fears of contagion from disease. While conducting HIV/AIDS research in the North in the early 1990s, I found many informants who made comparisons between current fears of contagion from HIV and fears in earlier generations of contagion from tuberculosis and leprosy. Here, too, physical separation was a normal way of dealing with fears of contagion. Thus, Wulff (1967) gives an account of a leprosy sufferer found in a Northern village in the late 1950s living in a bamboo shelter located at the boundary of his brother’s farm. Other reports concerning PWA talk about the new issue of income support for PWA who were no longer able to work in their usual occupation. An early 1995 article entitled ‘Helping People With AIDS to Have an Occupation’ (Thai News 1995f) gives details of a Department of Welfare project in the Maehongson province that provided funds for short-term job training, job practice, for children’s educational expenses and other, miscellaneous, expenses. This report gave the contact address and phone number for interested persons to inquire regarding eligibility. Thus newspaper reports like this, and there were many such reports during this period, played a critical role at this time in advising PWA and their families about avenues of assistance. A similar report entitled ‘House of Tomorrow Project for People Infected with HIV’ appears in the Chiangmai News in June 1993 (1993j). The report first details the work of the NGO Hotline in providing support for those who were HIV positive or were suffering AIDS-related illnesses and in providing pre- and post-test AIDS 15. I note in Fordham (1993) that fears of contagion from AIDS in the early 1990s extended to fears of sharing plates and eating utensils, and the refusal of commensality. Indeed, such fears continued following death and extended to fear of contagion from the smoke of cremation or, in the case of burial, of the contagion of nearby crops due to decomposition of the body.

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counselling, and stressed that the fundamental concern of the group was the changing of men’s sexual behaviour rather than mere HIV testing. It then notes that the focus of Hotline’s new House of Tomorrow Project was the provision of emergency accommodation for women and their children, especially women experiencing family problems, domestic violence or who had been lured into prostitution, and that the project also catered for women and children who were HIV positive or who were experiencing AIDS-related illnesses (see Ornanong and Narin 1999; Ornanong et al. 1999). As in the previous example of articles dealing with support for PWA, the report acted to advise the public about this new service by noting that the project had already commenced, and giving a contact phone number and details of consultation times. There were many such articles during this period reporting both IO/NGO and state AIDS care initiatives. Thus, under the heading of ‘Provincial Health Office Takes Media to See AIDS Work in Phayao’ Park Nua (1995c) reports a local AIDS initiative to care for PWA in four districts of Phayao province. Another new HIV/AIDS issue raised in the media in this period was that of maternal and child AIDS. Thus in a bold 10 by 3 1/2 inch headline Park Nua (1995a) reported in late 1995 ‘Children Infected With AIDS from their Mother as High as 6000’. The long article reported a Department of Welfare announcement that there were currently 6,000 children in Thailand born to HIV-positive mothers, and as this number would grow in the future they would be a major social problem unless a means of providing for them was developed. The article reports that the Chiangmai Vieng Ping Children’s home was caring for orphans and abandoned children from all the Northern provinces, many of whom had been born to mothers who were HIV positive, but that only one in three of these children were themselves HIV positive. Like many articles of the time dealing with new HIV/AIDS issues it provided a great deal of information about children born to HIV-positive mothers, especially the fact that two-thirds of such children were not HIV positive, and that due to new-born infants having antibodies from their mothers it took eighteen months before a newborn’s HIV status could be determined using antibody tests (see WHO 1999a: 4).16 This was a matter of great public concern at this 16. At this time the use of Zidovudine and other (later) anti-retroviral prophylactics such as Lamivudine (Pongsakdi et al. 2002) and Nevirapine (Pornsince et al 2002) to achieve spectacular decreases in perinatal HIV transmission (Centres for Disease Control and Prevention 1998; Chaiporn et al. 2000; Kourtis et al. 2001; Mofenson and McIntyre 2000; Priichaa et al. 1998) was not yet routine therapy for HIV-positive pregnant mothers (Usa Thisyakorn et al. (2000).

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time. Working in rural communities during this period I regularly heard villagers voicing fears concerning the HIV status of the young children of people living with AIDS or of people who had recently died from AIDS-related illnesses.17 The article also gives details of financial assistance given by the Department of Welfare to the Chiangmai Children’s home and to HIV-positive parents with children, and notes that in Chiangmai province for the year 1995, financial assistance had been provided for over one-hundred HIV-affected families and their children. The above article is an interesting document as it mirrors the confusion of the time, as small tightly focused NGOs proliferated. Ostensibly an article about the issue of AIDS orphans, the final third of the article comprises an interview with the head of the New Life Friends Group for people with AIDS who, instead of addressing the issue of AIDS orphans, addressed the problem of income support for PWA. He notes that people who were HIV positive were being forced from their workplace if their condition became known, and highlights the fact that although by this time there were over twenty groups for PWA in Chiangmai province, that the funding for them was limited and that the various handicraft programmes being proposed for income support were not particularly successful, due to an inability to find markets. However, that a member of an AIDS NGO is quoted on these issues suggests a growing, if ultimately only partly successful, attempt by PWA to take control of and define their own health and social situation.18 A country-wide one-day conference for PWA groups held in Chiangmai in September 1995 reflects a similar aim, and the common concern of PWA that ‘the Government is only concerned with advertising about AIDS prevention … if you already have the [HIV] virus you are left to follow your fate’ (Chiangmai News 1995b).

17. In the late 1990s, similar articles continued to provide information to readers. Thus a late 1999 article in the Thai News (1999b) in a regular ‘infant health’ column deals with the use of AZT (Zidovudine, now more commonly known as ZDV) for the prevention of HIV transmission to babies. See Priichaa et al. (1998). 18. The increase in the number of support groups for PWA in Northern Thailand since the early 1990s is evident from the fact that a NGO directory (Thai NGO Coalition on AIDS n.d.) distributed at a Chiangmai AIDS conference in the early 1990s listed less than 50 AIDS-related NGOs for the whole country, while the 1999 AIDSNET electronic directory of AIDS organisations (AIDSNET 1999) runs to almost three megabits and lists 74 AIDS NGOs, 111 community groups for PWA, and 166 government bodies working in the AIDS field, in the six upper northern provinces alone.

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Alongside the rise of articles regarding the problems of AIDS care for PWA a new genre of newspaper article appeared reporting the issue of AIDS-related suicides. In 1992 and early 1993 there were irregular reports of AIDS suicides but, from approximately late 1993 as the numbers of PWA increased, such reports became a regular part of the Northern Thai AIDS landscape (Fordham 1993, Muecke 1999). Newspaper reports of AIDS-related suicides are always printed on the front page in bold headlines and (as in the case of suicides from other reasons) are generally accompanied by colour photographs of the corpse as found or as taken to hospital. Reports draw on interviews with immediate family and friends to produce a brief portrait of the causes of the suicide. Early 1990s reports are generally very specific that the suicide was due to HIV infection, while later reports sometimes use the euphemisms rook raai (evil disease) or chua raai (evil infection) and discuss its incurable nature and the impact of this on the mental state of the victim. Suicide victims are almost always men: most commonly they drink poison (various readily available insecticides); less commonly they hang themselves, shoot themselves in the mouth or jump from buildings in order to escape what is widely viewed as a lingering but certain death.19 By the late 1990s suicide by drinking poison was so common in Thai society (due to both HIV and other causes) that the issue had even been taken up in the cartoon books that reflect social issues of the times. Thus the popular weekly cartoon book Kaaihuaroh (1998: 39) features a hospital emergency room with a nurse who, instead of giving medical attention to a suicide victim, stands blithely tapping out a rhythm as the victim shakes with the fitting and frothing at the mouth typical of insecticide poisoning. The following examples of the Northern Thai media’s treatment of AIDS suicides are typical of the period. Under the heading ‘Depressed Because of HIV Infection, Shoots [himself] in the Mouth’, the Chiangmai News (1993h) reports the suicide of a hotel employee who committed suicide because he was HIV positive and was having health problems. Untypically, this incident was accompanied by a suicide note requesting that no emergency treatment be given, and saying that as his doctor had told him he had AIDS and didn’t have long to live he had chosen to terminate his life. 19. Some suicides also take place in hospital during treatment for AIDS-related conditions (ARC). In one case in mid-1993, a man admitted to Chiangmai’s Suan Dork hospital for his AIDS-related conditions died after he jumped from the seventh floor. A similar hospital suicide took place in mid-1996 when a man admitted to a small rural hospital for similar ARC care successfully committed suicide by jumping from a second-storey window.

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More typical is a suicide report for 1995, which was headed ‘Liked Fun (a euphemism for sex with prostitutes), Frightened of AIDS, [So] Suicided by Drinking Insecticide’ (Thai News 1995h). Similarly, a report in the Thai News in 1996 headed ‘Infected with AIDS, Hangs Himself’, was accompanied by a subheading suggesting that this was the result of the man’s sexual promiscuity with prostitutes (Thai News 1996a). Such reporting, where HIV infection is blamed on individual behavioural factors, likely reflects the moral subtext (Lyttleton 1994a, 1996b) of public service AIDS-prevention announcements of the time which equated sex with prostitutes as promiscuity, and infection with HIV as the result of men’s failure to reform their behaviour. All suicide reports reveal the desperation felt by the victims. Under the heading of ‘Victim of AIDS at the End of Hope for Life Enters a Hotel and Uses it for a Cemetery’ the Thai News (1994b) reports how in April 1994 a man checked into a tourist-class hotel, ordered a bottle of beer, which he subsequently mixed with insecticide, and was later found dead with the remnants of the beer and insecticide beside him. There are many other such reports: a man on the northern outskirts of Chiangmai city who, when his AIDS related-conditions became too painful, in 1997 hanged himself on a fence post using his sarong;20 a young couple near Mae Rim, only fifteen minutes to the north of Chiangmai city, the man twenty-one years old, his wife twenty-years old, who in mid-1993 committed suicide by poison when his AIDS test revealed he was HIV positive. All suicides cause sorrow and grieving in the families of the afflicted yet, as a village informant put it in 1995, ‘people are relieved when this happens.’ She explained that villagers knew only too well that AIDS was incurable and understood the grief and economic impoverishment that prolonged AIDS illnesses visit on the families of the infected, and that in a sense such suicides were a sacrifice on the part of the individual for his family.21 20. The suicides I discuss here are clear and unambiguous suicides. However, Safman (personal communication) points out that men who are aware that they are suffering AIDS-related conditions often ‘hang-on’ taking care of their health until major festival occasions such as the Northern New Year in April. Then they spend this period feasting and drinking with friends, literally drinking themselves into a terminal state from which they do not recover. 21. As occurred in Africa (Barnett and Blakie 1992), as the death rate from HIV rose the expense of funerals and the inauspicious nature of AIDS deaths (Fordham 1993) caused the length of Northern Thai AIDS funerals to be reduced from a pre-AIDS average of four to five days to less than three days. Throughout Thailand suicides are inauspicious and in the AIDS context they are doubly inauspicious: thus funerals are also reduced in length for this reason as well as for reasons of cost.

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Indeed, when I discussed AIDS suicides with villagers, informants almost uniformly claimed that although such suicides were extremely sad and inauspicious, that they were understandable (heen jai), and that from an economic and social sense were probably for the best for the family concerned. Like many peoples, the Northern Thai distinguish between good and bad deaths, the latter being deaths that emphasise man’s limited mastery of the world. As AIDS deaths are the paradigmatically bad deaths (Kirsch 1973; Metcalf 1982; Nash 1973) due to their polluting nature and the suffering and powerlessness on the part of the dying, it is likely that the easy acceptance of AIDS suicides and the reason such suicides have attracted little social concern stems from the realisation that this act is a final sacrifice for their family on the part of the deceased and, as such, a final act of world mastery (Bloch and Parry 1982; Kellehear 1986; Parry 1981). The final issue I address in this section concerns the manner in which, as the numbers of people affected by HIV and AIDS continued to rise, newspapers in the early to mid-1990s featured a series of highly positive reports about vaccines to stop AIDS and about various herbal medicines which their producers claimed could cure AIDS. In respect to AIDS vaccines, in August 1993 the Chiangmai News featured one-inch-high front-page headlines proclaiming ‘Found, a Substance to Stop AIDS’ (Chiangmai News 1993i). The report describes work undertaken by a Chiangmai University researcher on the use of thalidomide to stop the HIV virus. It claims thalidomide ‘stopped the great danger of the ferocious AIDS … a 99 percent result … hope that shortly [we can] stop this evil disease everywhere in the world’. The report is authenticated by the provision of highly technical information about the effect of thalidomide on slowing the reproduction of the ‘AIDS virus’ in HIV-infected people. It specifies that the tests used 400 milligram dosages of thalidomide, and talks about a rapid recovery from illness, a gain in weight of between 4 and 14 kilograms within two weeks and notes that the impact of thalidomide on the number of CD-4 cells (a measure of the strength of the immune system) was still uncertain. However, by contrast with the optimistic headlines that introduced the report, the final paragraph was much less optimistic as it revealed the fact that the report referred to research in progress. It quoted the researcher concerned in regard to the anticipated setting up of a laboratory at Chiangmai University to continue work ‘looking for a substance that would be of use for people ill with AIDS and which would be of use in stopping this evil disease’ (ibid.).

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A second report on vaccine testing comes from September 1995, in a front page announcement in Park Nua (1995d), ‘Researchers in Front With An AIDS Vaccine’, which reported a presentation given by Thai army researchers at the ‘AIDS in Asia and the Pacific’ conference, which was being held in Chiangmai at the time. The report notes the necessity to ‘develop a vaccine to combat the HIV virus, or AIDS’ and the hope that such a vaccine would stop AIDS in those already infected and would prevent its transmission to others. Interestingly, it notes that such vaccine development should involve collaboration between the developed countries and those still in the process of development (meaning countries like Thailand), and that prime concerns in vaccine development should be the efficiency of the vaccine and safety for users. As in the previous example, although the headlines are highly optimistic regarding vaccine development, the body of the report is much less positive. Invariably, front-page headlines concerning AIDS vaccines announce the finding of a vaccine to stop AIDS while the explanation in small print or on subsequent pages merely announces a vaccine-testing programme. Such reports are significant as during this period campaigns to limit men’s use of commercial sex were still underway, and each time a major announcement about HIV/AIDS vaccines appeared in the press, the men amongst whom I was conducting research would conclude that there was no need to change their sexual behaviour. Thus, when the commencement of vaccine testing in Thailand was first reported in the national print media on the front page of Thai Rath (1994) in headlines announcing ‘Project For Testing AIDS Vaccine’, by midmorning that same day I had heard numerous informants comment ‘there are no problems [now], there’s a vaccine’. Some directly expressed the intention to go out immediately and have sex with CSWs (pai loi, as they put it) if the vaccine proved effective. Even more prominent than print-media reports of vaccine development, throughout the 1990s, were the many reports of HIV/AIDS cures or therapeutic medicines derived from indigenous Thai herbs. As in the case of reports of AIDS vaccines, articles dealing with the use of herbal medicines to cure AIDS, or at least to relieve AIDS-related conditions, began in the early 1990s and became more frequent in the mid-1990s as the number of people affected with HIV/AIDS began to increase. However, newspaper reports of these herbal AIDS therapies portrayed only those producers of herbal medicines who were most successful in capturing the attention of the public media, and certainly under-

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state the number of herbalists claiming to cure AIDS during this period. Living in the Maetaeng district during part of 1992 and 1993, I several times encountered itinerant sellers of herbal medicines who claimed that their medicines would cure AIDS because, as one man put it, it would ‘clean up the blood’. Newspaper articles typically report a herbal specialist’s claim that he (such claims are almost always made by men) has produced a medicine to treat (raksaa) AIDS. These reports are different to most of the HIV/AIDS-related articles discussed to date in that they generally follow a career path of story development over several days. A typical report starts off with front-page headlines announcing that a person with knowledge of herbal medicine has developed a medicine for AIDS based on traditional Thai herbs, and that he has been successful in curing all who have tried it. Claims for the efficacy of herbal medicines come both from the producers and from users and their relatives. Over subsequent days news reports tell of small numbers of people seeking the medicine; a few days later photographs show throngs of people who have travelled from distant places queuing up to receive their medicine. Reports quote HIV-positive-people or those with AIDS-related conditions (the distinction is rarely clearly made) who have tried the medicine and, Lazarus-like, filled with renewed strength and willpower, can now leave their bed and resume normal life. As one report put it, ‘ill people came and were treated until they improved … [now they] can work normally the same as normal people everywhere’ (Chiangmai News 1993e). However, within a few days articles start to appear quoting various representatives of the Ministry of Public Health who warn that people taking these preparations should be concerned about the safety of such untested and unknown substances, and advise waiting until their safety and effectiveness is established through Health Department testing.22 The first major claim to cure AIDS using herbal medicine was reported in the Chiangmai News (1993e) in a massive, eight-inch by twelve-inch, front-page spread titled ‘Angel Doctor [Who] Treats AIDS Emerges in Chiangmai’. The article reported a local Chiangmai man, Mor (Doctor, an honorary title) Wichai as having developed a herbal preparation that he was using to ‘treat every condition of people with the AIDS virus’, and reported that of the eighteen people he had been treating all had improved 22. Such warnings fall on deaf ears: those who are HIV positive, and particularly those who are suffering from AIDS-related conditions, are well aware that their condition is terminal and are willing to try any potential cure.

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while some had recovered completely. He claimed he obtained the medicine used to treat AIDS patients when a herbal doctor in Petchaboon province gave it to him to cure a skin cancer on his right arm that Western-style medical doctors had insisted required amputation. Mor Wichai claimed that the herbal doctor told him that in ancient times people had used this preparation to treat blood and lymphatic diseases, and that it was made from a substance found in the forests throughout Thailand. Thus, when he saw the problem of AIDS in Chiangmai, he started using it to treat people with AIDS, one of whom had been totally cured. After the initial report of Mor Wichai’s ability to cure or relieve AIDS, three days later the Chiangmai News (1993o) featured an article headed ‘People Infected With the AIDS Virus Interested in Angel Doctor and Going For Treatment’. Then, shortly afterwards Department of Public Health officers started to issue warnings about the safety of Mor Wichai’s medicine. Subsequently, Mor Wichai was visited by Department of Public Health officials who were concerned that he was using steroids to achieve an apparent short-term improvement in his patients’ health but, cleared of this, was initially allowed to continue distributing his herbal preparation. However, the popularity of his medicine amongst PWA led to a protracted attempt by the local office of the Department of Public Health to prevent the use of non-approved herbal medicines, and ultimately he was charged with fraud and producing unauthorised herbal medicines (The Manager 1994). Eventually, lobbying by people with AIDS, especially members of the Chiangmai New Life Friends Centre who were testing his medicine, allowed him to continue his work on a small scale (Bangkok Post 1995b). Although local Northern papers generally ran highly optimistic articles about AIDS cures reported by Northern traditional healers, they were often suspicious of the pecuniary motives of the individuals concerned, and occasionally debunked the inflated claims made for herbal medicines.23 Thus the Thai News in a September 1995 article headed ‘Herbal Medicines to Cure AIDS: Beware of being Cheated’ (Thai News 1995n) warns the public to 23. Perhaps reflecting a much lower level of HIV in Central Thailand and a lower level of desperation on the part of the afflicted, the Bangkok-based Daily News was generally more critical of reports of herbal cures for AIDS than were Northern newspapers. Thus, in response to a 1995 report of a herbal cure for AIDS produced in Southern Thailand by an ex-monk, the Daily News ran debunking articles entitled ‘Herbal AIDS Medicine: “Doctor Nain” Investigated – [Patient] Treated [but] Not Recovered’ (Daily News 1995a); and in response to an earlier report the same year, ‘Pointing Out [that] AIDS Herbal Medicine Deceives the Population’ (Daily News 1995b).

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have a greater level of scepticism regarding the claims made for herbal AIDS medicines. Again, the following month, in a much stronger article headed ‘Don’t Believe Unqualified [literally, wild] Doctors who are Cheating in Disease Treatment’ (Thai News 1995d) it warns against believing ‘angel doctor[s] who treat disease with a special method that only involves boiling a piece of wood in water’, and suggests that such methods are ‘simply treatment through magic’. Yet, importantly, they also argued against a wholesale rejection of the utility of herbal medicines. Thus an editorial in the Chiangrai News from late 1993 (Chiangrai News 1993) which in a shocked tone gives Department of Health AIDS statistics for death rates in the district as three AIDS deaths every two days, is highly critical of the offhand and dismissive attitudes of many in the medical profession towards those with AIDS. Anticipating a debate that would become increasingly prominent in the mid-1990s, it takes up the issue of Western medicine versus Thai herbal medicine. It argues that although doctors and nurses and the Department of Health say herbal medicines merely relieve AIDS-related skin conditions and cannot cure AIDS, in reality the medical profession cannot relieve these skin conditions, and people in the medical profession and even senior army officers have been helped by such preparations. The editorial concludes by arguing that if the medical profession cannot relieve these conditions it should support those who have the ability to do so, and that given the current death rate unless the medical profession is solely concerned with managing the AIDS-campaign budget, it is worth trying anything. The genre of AIDS reporting dealing with the Northern Thai experience of being HIV positive or of having AIDS is, then, an extremely broad and rich category refracting much about the way Northern Thais experienced HIV/AIDS during the early and mid1990s. Articles giving information about care for PWA and details of how they could seek assistance provided real information for the afflicted and their families. At the same time these articles clearly show that many in the community felt real animosity towards PWA due to fears of contagion from AIDS. Articles also reported the rise of AIDS-related suicides, and by their presence legitimated suicide as a possible alternative to a lingering death – a fact pointed out by Ornanong and Narin (1999: 38) in respect to a similar outbreak of suicides in the wake of the 1997 Asian economic crash. However, as opposed to articles providing reliable AIDS-related information, the genre of articles dealing with vaccines and herbal medicines to cure AIDS, or at least alleviate the pain of ARCs, gave many people the erroneous impression that there was no

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longer a need to be concerned about safe sex, as if they contracted HIV there was an effective therapy available. Indeed, newspaper articles and their accompanying photographs clearly show that herbal medical practitioners’ claims of an AIDS cure caused people to flock to them, not just from other areas of the North but from all over Thailand. In July 1996, within a day or two of the publication of articles extolling the ability of the kradaang mushroom to cure AIDS, the Daily News (1996) reported truck loads of young national servicemen travelling to Phrae to purchase kradaang mushrooms (see also, Thai News 1996b). Importantly, I suggest it is not, as some have claimed, that rural and urban labourers, those most at risk from HIV, tend to believe such reports because their low levels of education do not allow them to distinguish the inflated claims of would-be small entrepreneurs from reliable information. Rather, I suggest that, apart from sheer desperation on the part of the afflicted, one reason such claims have been so effective is that herbal healers have legitimated themselves by drawing on the motifs from Northern Thai culture and religion that are traditionally used by those claiming special powers in the political or other spheres. Throughout Northern Thai history, those claiming special powers or the knowledge of protective or healing formulas have commonly legitimated their claims by asserting that their powers have been discovered through the study of arcane Buddhist formulas (Fordham 1991) or Northern traditional texts read during a period of ordination, or have been discovered during sojourns deep in the forest – sometimes received as a gift of arcane knowledge from a forest-dwelling ascetic monk. Thus, in Northern and North Eastern Thailand, on several occasions in the past leaders phuu mii bun (men of merit) have arisen at times of social crisis, claiming special powers on the basis of a combination of traditional Buddhist formula and local magic (Chusit 1982; Ishii 1975; Keyes 1977; Murdoch 1974; Tanabe 1984). For instance in the North, in the late nineteenth century, peasant protests were led by men who made claims to invisibility and the ability to protect their followers from the penetration of bullets or knives. Such phuu mii bun inspired their followers through the use of magical incantations, through the production of protective amulets (Tambiah 1984), through tattooing with formula that conferred invulnerability and through having them bathe in water (aap naam yaa) that incantations had invested with special protective powers. Similar legitimations are made today in regard to medicines for AIDS, whereby traditional healers making claims to cure AIDS legitimate their claim on the basis of their own study (often study

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deep in the forest), study under a monk from whom they derived the recipe for the medicine, or on the basis of traditional arcane formula derived from ancient times. Such legitimations are found in Mor Wichai’s claim to cure AIDS, and they also appear in claims made by other herbal healers throughout the early to mid-1990s. First, there is a legitimation of the herbal formula by claiming that it is a secret formula derived from ancient traditional knowledge and that the prime ingredient lay deep in the forest. Secondly, is the denial of any pecuniary motive for selling the medicine or for making the claim to cure AIDS. Thus, when asked how much people were required to pay, Mor Wichai said that there was no specified charge, that people paid what they could afford so that he could make more medicine, and if they had no money then they could take the medicine for free. Acting in this way Mor Wichai conforms to a traditional religious pattern of making merit (tham bun) by doing good deeds for others. A third theme that appears in this and other similar reports is that the producers of herbal medicines appeal to deeply sedimented Thai anti-colonial fears (Tongchai 1994), by claiming the medicine is so important that the ingredients must be kept secret lest, as Mor Wichai put it, ‘researchers from other countries take it [the medicine] to their countries, this herb belongs in Thailand and it must belong to all Thais’ (Chiangmai News 1993e).24 An additional important issue raised in this genre of AIDS reporting concerns perceptions on the part of people with AIDS that as the Government focused on stopping the spread of HIV, it was less concerned with their well-being than with their control. The question of the efficacy and control of herbal medicine is a good example of this issue. In all cases claims regarding the efficacy of herbal medicines in the treatment of AIDS elicited negative responses from the Department of Public Health. Thus, in response to mid-1996 claims regarding the efficacy of the kradaang mushroom in treating AIDS, within a week of the initial news reports, Department of Health warnings appeared in articles with headings such as ‘Health Department Cautions the Population About the kradaang Mushroom’ (Chiangmai News 1996). Discussions with informants suggested that many viewed such warnings as attempts to maintain state control over AIDS treatment through controlling the use of herbal medicines, rather than 24. Similar fears were voiced by producers of traditional medicine in July 1996, when claims were made that the kradaang mushroom from Phrae, possessed the power to cure AIDS (Thai News 1996b), and are also found in the English language Bangkok Post’s reporting about the use of Thai herbal preparations to treat AIDS.

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merely having a concern with monitoring the safety of the ingredients used in these preparations. In the previous chapter I argued that in legitimating the penetration of the state into the previously private spheres of sexual relations and health, HIV/AIDS control initiatives gave rise to considerable amounts of passive resistance (Scott 1985, 1989) on the part of rural villagers. It is not my intention to pursue the issue here. However, I suggest in passing that it is likely that one aspect of the appeal of herbal medicines to PWA is that their use constitutes a form of passive resistance to the overwhelming role of the state (in the form of state agencies) in the diagnosis and care of PWA, in as much as they offer PWA the opportunity to take control of their lives (possibly, regardless of the efficacy of the medicine concerned).

Prostitution, Prostitutes and AIDS The third category of AIDS-related reporting I address here is a broad category of articles dealing with prostitution and the transmission of HIV. Major themes concern the link between prostitution and HIV transmission and what is portrayed as the ‘problem of prostitution’, Northern girls who go to Bangkok as prostitutes and international prostitution with Thai girls going to countries such as Japan and Germany. Two other, secondary, themes concern the roots of prostitution and the provision of occupational training for young women in prostitution. Very early on in the Thai HIV/AIDS epidemic, from the time of the first public service health announcements in the early 1990s, it was established that the spread of HIV was due to male sexual promiscuity (samsorn taang phet) with prostitutes. This term was used to subtly revalue what had previously merely been an accepted fact – that men needed not just plenty of sex but also sexual variety (Muecke 1992). As the female informant quoted in the previous chapter put it in regard to the male custom of visiting prostitutes ‘its [just] what men do.’ Critically, both public service announcements and newspaper and other media reporting about the dangers of promiscuity made it clear that it was not just male promiscuity per se that was dangerous, but male promiscuity with prostitutes as they were likely to infect men with HIV.25 25. Although the major issue at this time was male participation in commercial sex, the linkage between commercial sex and promiscuity was unfortunate as it led many to link the notion of promiscuity (samsorn) solely to sex with prostitutes, and implied that serial relationships with non-prostitute women were not considered to pose a significant HIV risk.

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For example, a mid-1993 Chiangmai News (1993b) front page report captioned a photograph of a group of young prostitutes huddling in a room following a police raid with ‘A Risky Group for AIDS With Promiscuous Behaviour’, and in the accompanying article explained that due to their promiscuity prostitutes were more likely to have AIDS than were ‘normal [my emphasis] persons’. Thus prostitutes came to be routinely depicted as reservoirs of AIDS that threatened the health and the structural integrity of the family and general population. As the Chiangmai News (1993f) put it in July 1993 in an article announcing the opening of a centre of vocational training for young women, ‘the carrying out of the profession of prostitution … is an important factor in the spreading of AIDS in Thai society’. Or as another Chiangmai News (1993q) article put it later that same year, the problem of prostitution has many aspects: those of human rights, of sexual discrimination, and of labour discrimination, which together lead to prostitutes getting AIDS, and that this is the ‘site for the broad propagation of the AIDS virus’. Only very occasionally are men also implicated, such as when a Chiangmai News (1994a) article discussing HIV/AIDS and commercial sex noted that ‘prostitutes and men who buy sexual services [my emphasis] play a part in the spreading of this evil disease [AIDS]’. As far as prostitutes are concerned they are invariably portrayed in a highly stereotypical fashion, and are defined solely through their sex work. Reports rarely refer to their personal characteristics, and photographs render them anonymous through showing them with their faces averted or with their eyes covered with a slash of black ink to hide their identity. This stereotypical portrayal is emphasised by the selection of photographs to illustrate articles about prostitution – the same photographs appear again and again (albeit sometimes with different cropping) regardless of story content. Thus a June 1993 article in the Chiangmai News (1993z) titled ‘The Highest Dream of Dork Kum Tai Girls is to be an International Prostitute’, is illustrated with two photographs of groups of young prostitutes, one in which they are sitting in a group eating and the other in which they are being interviewed (in both cases with their faces hidden from the camera). Both photographs, the interview one cropped, had already appeared a month earlier (4 May) illustrating an article entitled ‘A Lifestyle that has Possibly Returned to Popularity Yet Again’ (Chiangmai News 1993a). In the case of the interview photograph, this was the third time it had been used in less than six months as it had already been used earlier the same year in its

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correct context, when the girls were shown being interviewed following their repatriation from sex work in Japan. Occasionally prostitutes are portrayed in a slightly different, less culpable, fashion. Thus a 1995 Thai News report headed ‘Sad Life of a Young Woman of 23, Sold into a Brothel by Her Stepmother and Forced to Accept Clients by the Pimp’ (Thai News 1995k), told the story of a young woman who claimed she had wanted to be a singer in a restaurant but who, on being forced into commercial sex, had sought refuge at a local Chiangmai hospital prior to returning to her home. Yet even here the representation is highly stereotypical, with the portrait being that of the naive country girl taken advantage of in the big city. Similar stereotypical portraits are repeated many times each year across a range of Thai media. Thus a May 2000 report in the Thai News (2000b) titled ‘Hell Coffee Shop’ reported the mistreatment of a hill tribe (popularly understood to be poorly educated and socially naive) girl who had come to the city and taken a job in a local Chiangmai coffee shop cumindirect-brothel, only to find herself confined to the premises against her will. Although not always directly portrayed as an HIV/AIDS issue, child prostitution and its rectification (Montgomery 1996a, 1996b, 2001) was a highly prominent component of media reporting about AIDS and prostitution during this period. Indeed, Montgomery (2001) writes of the ‘cultural crisis’ of rapid social change that gave rise to concerns about child prostitution. In 1993 and early 1994 in particular, much attention was paid to this issue as a result of Government campaigns to end child prostitution (Thai News 1995i). Articles with headings such as ‘The Campaign to Prevent the Selling of Child Prostitutes’ (Chiangmai News 1993y), ‘Teachers Ready Themselves to Rectify the Problem of Child Prostitution’ (Chiangmai News 1993w), and ‘Police State There are No Child Prostitutes’ (Chiangmai News 1993p) were literally a matter of daily fare. Such articles reported short-term campaigns aiming at the prevention of child prostitution through publicity in schools or through removing young women from commercial sex establishments and sending them home. Other articles reported the many prostitution-control programmes commencing during the 1993 to 1994 period that took a long-term approach to the prevention of child prostitution. These aimed at increasing the educational levels of girls (particularly those girls who would normally leave school after the sixth year of primary education), and at the development of employment opportunities for young women in the rural North. Thus, in the first week of February 1995, under headings such as ‘Plan to Rectify the Problem of

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Women and the Business of Sexual Service’, the Thai News (1995i) published no less than five reports concerning programmes and seminars dealing with various plans to decrease the number of women in commercial sex. Another genre of AIDS/prostitution reporting during this period was directed at explaining the roots of prostitution, of how in some areas of the North it had become an accepted norm for young women to work for a period as a prostitute in Bangkok. Thus, in May and June 1993, in addition to its normal fare dealing with AIDS and prostitution, the Chiangmai News published two series of long investigative articles dealing with prostitution in the North, focusing particularly on the Dork Kum Tai district of Phayao province.26 The articles are critical of the manner in which the sending of daughters to work in prostitution had become an accepted part of rural culture in some districts (Chiraluck 1992; Niwat 1998). However, they generally argue that the roots of prostitution lay in rural poverty (Chiangmai News 1993a), itself the result of the failure of development plans in the rural North where ‘the continual increase in the statistics of prostitutes is an increasingly clear index of the Government’s failure to develop the country’ (Chiangmai News 1993k). Importantly, in emphasising the extent to which prostitution had become an accepted part of rural culture they demolished a long-term popular Thai (and Western) misconception which held that women in prostitution were mostly lured to the city with an offer of respectable work and were then forced to prostitute themselves.27 They argue that prostitution was not the result of girls being lured away from home to work in Bangkok (Chiangmai News 1993s, 1993ad), but rather that girls willingly enter into prostitution with the consent of their families. These articles discuss the mechanics of voluntary prostitution, pointing out that girls and their families utilise local networks to find placement in brothels where conditions are not too onerous, and emphasise the long-term nature of the commercial sex business where local agents may make advance 26. Prostitution in Phayao province is an issue addressed again and again in the Northern news media (Chiangmai News 1993y, 1994b; Thai News 1995j. Phayao province, and particularly the Dork Kum Tai district, has also become a major site for the academic study of prostitution in Northern Thailand. See Niwat Suwanphatthana (1998) A Community Selling Sex. 27. Chai et al. (1993) also demolish this myth using solid statistical data (see also Nitaya and Saupaa 1996; Wathinee and Guest 1994). Yet the misconceptions of the past die hard. As late as 1995 Park Nua was still reporting vocational projects for young women designed prevent them being ‘lured’ into prostitution (Park Nua 1995b).

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payments to parents to reserve young girls for later sex-industry work. Another aspect of prostitution taken up in HIV/AIDS-related reporting during this period was that of transnational commercial sex. There are two major issues of concern here and they are addressed from different perspectives. Firstly, is the issue of Thai women travelling to Japan and Germany, and to a lesser extent to other parts of South East Asia and Europe. An editorial in the Chiangmai News in June 1993 (1993x) headed ‘Thai Girls Going Abroad’, takes up the issue of women from the poor rural areas of Northern Thailand and the North East being lured abroad with the promise of high wages. Here, following the same economic analysis found in analyses of domestic prostitution, it argues that the solution to this problem lies in the Government’s increasing educational levels and living standards in rural areas. The issue of Thai women working as prostitutes overseas is taken up fairly regularly through this period (Chiangmai News 1994c) and remained an important issue throughout the 1990s in both local (Chiangmai News 1999c) and national newspapers (Thai Rath 1999b). Secondly, but less frequently aired, was the issue of girls from Yunan and Burma working as prostitutes in Thailand. The issue of these and other foreign (Russian and Eastern European) prostitutes working in Thailand was closely associated with general concerns about illegal workers in Thailand. This period was one in which the Thai economy was booming and, as a result, large numbers of Burmese were entering Thailand illegally to find work as construction labourers, giving rise to concerns that Thai jobs were being taken (Khao Siam 1994b; Thai News 1994a). Media reports about Burmese and Yunanese prostitutes in Thailand generally recognised that a high percentage had been lured into prostitution (Ornanong et al. 1999); thus, one article, taking up this issue is headed ‘The Business of Saleable Goods Crossing Borders: Saleable Goods With Life and With Hearts’ (Thai News 1995m). However, despite this, like male and female immigrant labourers, foreign prostitutes were generally viewed as a culpable other in Thai society, and were regularly accused of spreading AIDS and other contagious diseases. Indeed, such accusations were still being made in the late 1990s (Chiangmai News 1999a). The final aspect of AIDS reporting in relation to prostitution takes up the issue of education and occupational training for young women, in order to move them out of prostitution where they were at risk of contracting and spreading HIV. Apart from aiming to keep women in school for longer than the basic six years of primary education, projects aimed to teach vocational

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skills such as dress making, hair dressing, baking, growing mushrooms, cushion making and pottery (Chiangmai News 1993f). A report on a vocational project in a rural Lampang village (where a high percentage of households had daughters working in commercial sex) noted that such skills could provide an income of between 80 and 100 baht per day (Chiangmai News 1993t). Curiously, in contrast to reporting concerning herbal medicines reputed to cure AIDS and about prostitution (particularly investigative articles concerning prostitution), articles reporting programmes for the retraining of prostitutes lacked any critical element. They neglected to mention that the income provided by, in this case, the Lampang project, was not only well below the income provided by prostitution, it was also well below the income provided by agricultural labour which, at the time, paid between 125 and 150 baht per day. These articles also neglected to address the issue of the sustainability of such projects beyond the period supported by Government or IO/NGO funding or the issue of marketing – as in poor rural areas markets for the clothing or cookies produced by project participants were strictly limited. The genre of AIDS reporting dealing with prostitution and the relationship between prostitution and the spread of HIV/AIDS is significant as such reporting reinforced public service announcements that stereotyped prostitutes as being responsible for the spread of HIV (Lyttleton 1994a, 1996b). As noted earlier, the advice given to men was that if they could not change their behaviour they should wear condoms during commercial sex. Yet, as I take up at greater length in the following chapter, women in prostitution have been treated very differently. However prostitution is explained, whether economic or cultural explanations are drawn on, at root it is portrayed as a behavioural problem of young women who must be made to change their behaviours to those that are socially acceptable. Indeed, many of the articles in this genre are interesting for their emphasis on the inappropriateness of women working as prostitutes. Thus, reports discussing vocational training projects for young women note that such projects are vital as ‘prostitutes spread AIDS’ (Chiangmai News 1993f), because prostitution is an ‘inappropriate (mai mo som) profession’ (Park Nua 1995b), and because it is a ‘profession that society does not accept’ (sangkorm mai yorm rap) (Khao Siam 1994d). Such statements denying the acceptability of prostitution in Thai society are curious given that the ubiquity of prostitution surely presented overwhelming evidence of its acceptance, and the fact that newspaper articles

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themselves regularly recognised that some men were unable to constrain their need for a regular sexual outlet and for sexual variety (Chiangmai News 1993m). Yet the increasing prominence of such statements in the public media as well as in a number of academic works (see Ford and Suporn 1991) produced at this time suggests, perhaps, a shift in social values from a time when prostitution was more acceptable (Mulder 1992b, 1997) and, as I argue in chapter five, the increasing domination of public discourse in this arena by Western middle-class ‘family values’ (Mulder 1997: 332). Indeed, I argue that this shift signifies not only the increasing adoption of Western middle-class standards to measure Thai sexuality (Brummelhuis 1993), but also the development of a moral panic concerning the place of prostitutes and prostitution in Thai society.

Conclusion At the end of the 1990s the response to the Thai (and Northern Thai) AIDS epidemic was generally judged to have been a success as rates of HIV infection had fallen in key sentinel surveillance groups such as prostitutes, army conscripts and STD clinic clients. This was attributed to the success of the ‘100 Percent Condom Programme’ in concert with public information and education campaigns which led to a decrease in risk behaviour. However, beyond this, apart from survey research showing that through time the Northern Thai population (like the broader Thai population in other regions) has gained higher levels of knowledge about HIV/AIDS and associated issues such as risk behaviour and self-protection, relatively little is known about how public information and education campaigns actually worked or how they might have been yet more effective. This chapter, with its fine grained analysis of how the Northern Thai experience of HIV/AIDS and knowledge about HIV/AIDS has been reported and refracted in local-level Northern Thai Newspapers through the early to mid-1990s, is a contribution towards increasing our knowledge of how indigenous understandings about AIDS developed in this period. Critically, state public service announcements and IO/NGO programming has focused on the inculcation of biomedicallybased facts about HIV/AIDS and paid little attention to either the indigenous experience of AIDS or indigenous understandings about AIDS that lie outside these facts. Indeed, during this period the Thai world of formal AIDS knowledge was a highly simplistic

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binary world, where AIDS knowledge was considered correct if it conformed to the Thai normative model of AIDS, or it was incorrect if it deviated from this model, and programming merely sought to replace incorrect knowledge with correct knowledge. As the decade of the 1990s progressed and the Thai AIDS epidemic moved into its second decade, this lack of concern with the models on which indigenous understandings of AIDS were based became yet more pronounced, as the social and medical facts through which the epidemic was defined and the associated policy wisdom about how AIDS research and interventions should proceed became increasingly standardised and yet more essentialised at the international level. Contrary to this approach, my interest has been in the manner in which local-level print media in Northern Thailand has refracted the Northern Thai experience of AIDS, in order to ascertain just how people understood AIDS in their terms, and the metaphors through which they domesticated it and assimilated it to the pre-existing Northern Thai classification of illness and disease. My analysis firstly gave a brief introduction to Northern Thai language daily newspapers and the role of print news media in daily life. I then showed how over the past decade Northern Thai local news print media has refracted the development of the Northern Thai HIV/AIDS epidemic and associated issues, and that there has been a transition in the types of issues refracted in the news media in accord with the progress of the epidemic. Importantly, my analysis here is directed against that position which holds that villagers’ failure to comprehend the facts of AIDS or to change their behaviour is the result of a low level of education and a consequent low level of understanding. To the contrary, I argue that in the period I discuss villagers already had a very sophisticated understanding of HIV/AIDS, albeit one often couched in indigenous terms rather than in terms of the normative model of AIDS, and one often comprised of a mix of information of high veracity and that which was simply wrong, but which was legitimated in ways that were highly effective. The obvious conclusion about media reporting of AIDS issues and, as I note above, a conclusion others have made already, is that some reports are sensationalist and that they are sometimes factually wrong. However, analysis of media refractions of the people’s experience of the HIV/AIDS epidemic has more to offer than merely pointing out matters of factual errors in HIV/AIDS reporting. Local-level media reporting of AIDS issues refracts public knowledge about and experience of HIV/AIDS, and as such provides a rich source of information that might be utilised by

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programmers in order to gain a deeper insight into the indigenous experience of AIDS, with the aim of ascertaining new points of intervention. Analyses of media refractions of people’s experience and understanding of the HIV/AIDS epidemic also has the potential to show where local experiences may contradict and conflict with programming and public service announcements, and why and how particular erroneous interpretations arise (or, indeed, are likely to arise). Thus, in the case of articles reporting the use of herbal medicines to cure HIV/AIDS, my analysis shows that claims of cures are authenticated by drawing on motifs traditionally used to legitimate special powers. Due to the power they possess as locally generated models of HIV/AIDS, it is likely that regardless of their veracity the models of HIV/AIDS articulated and refracted in the Northern media, will be vested with a high degree of legitimacy and will have substantial power both to reinforce or to challenge state and IO/NGO HIV/AIDS control campaigns. In cases where there is a substantial disjunction between the two models, and in contexts where villagers receive AIDS information from a multiplicity of sources, some of which is highly contradictory, it is likely that misunderstandings will arise. Thus, the category of AIDS information clearly presents the public with an up to date picture of HIV/AIDS statistics in Northern communities and information about risk behaviour. Reports dealing with the experience of living with AIDS give information regarding avenues of assistance for PWA and their families, express some disapproval at widely held fears of contagion, and publicly raise the issue of AIDS-related suicides. Concomitantly, other media reports raise the possibility of the transmission of HIV from man to man via cow’s blood, the imminent possibility of a vaccine that will cure AIDS, or of local herbs or plants such as mushrooms that will cure AIDS or at least relieve its symptoms. Newspaper reports correctly identify the relationship between unsafe commercial sex and the spread of HIV. Yet female sex workers are scapegoated through being portrayed as the primary source of male HIV infection and as acting against nature, while their male clients are viewed as acting in accord with natural male sexual needs. Critically, promiscuity is portrayed as an issue solely concerning the sphere of commercial sex and the issue of Thailand’s sexual revolution is not addressed. The waters, then, through the course of the 1990s, were well and truly muddied.

CHAPTER 5

MORAL PANIC AND THE CONSTRUCTION OF NATIONAL ORDER: HIV/AIDS RISK GROUPS AND MORAL BOUNDARIES IN THE CREATION OF MODERN THAILAND1

S

ince the late 1980s, the concept of risk groups through which HIV moved in a wave-like fashion has been of primary significance for our understanding of the HIV epidemic in Thailand. It has been utilised both as a model for conceptualising HIV transmission and risk, and for directing HIV/AIDS interventions. Critically, although such models have been subject to extensive criticism in the Western biomedical and social science literature and are now substantially discredited, they retain a high degree of currency in Thailand as a means of modelling the HIV/AIDS epidemic and of directing interventions. This chapter examines the reasons for the persistence of this model in Thailand through the 1990s, and some of the implications of its use. I argue that Thailand’s HIV/AIDS epidemic had the effect of bringing sexual practices from the private sphere into the public arena. Here they were not only discussed openly, but various government and 1. This chapter was originally published in 2001 in the journal Critique of Anthropology (vol. 12:3. 259–316). It is reproduced here substantially in its original form, abeit with some changes made to citations in order that it makes sense in this context. Grateful thanks is given to the publishers of Critique of Anthropology for permission to reprint this paper.

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non-governmental bodies (NGOs) claimed legitimate roles in their ordering and control. I suggest that the concept of ‘risk group’ found enduring favour not solely because of its heuristic value but because, at a time of rapid social change, it rendered visible the entire social body of modern Thailand as a hierarchy of risk groups, with specific groups attributed behaviours necessitating control. Importantly, it also legitimated and reinforced existing social prejudices about such groups: the male underclass, prostitutes, injecting drug users (IDUs) and homosexuals who, defined as dangerous and deviant populations, became the target of reformist interventions. I will argue that much Thai HIV/AIDS research has been partisan in as much as it has started out with ready-made moral judgments and has proceeded to validate those judgments. My focus here is on the issue of the female commercial sex workers (CSWs) who, constituted as a risk group, became the primary focus of attempts to control HIV/AIDS. I suggest that this occurred because they were viewed as a bridge between deviant minority groups and the broader community and because, in a period of changing social values, they constituted a highly visible symbol of unrestrained female sexuality on which reformist attentions could be focused. My analysis draws on Thai language Northern Thai print media reports about HIV/AIDS to elicit the imagery used to describe prostitutes and the risks they presented to society during the early 1990s, the period when the Thai AIDS epidemic was rapidly growing, and seemingly out of control. It argues that HIV/AIDS campaigns and media reports about the dangers of commercial sex resonated with and reinforced one traditional Northern Thai image of women, that of the potentially dangerous temptress whose unrestrained sexuality has the potential to cause real spiritual and physical harm to men. As a result, male (and female) fears and anxieties about HIV crystallised in a moral panic (Cohen 1973) that focused on women in prostitution who, already stigmatised as being morally degraded through their profession, were demonised as a dangerous other in Thai society whose activities necessitated monitoring and control. Thailand in the early 1990s was experiencing both rapid economic growth and, as analysts such as (Ford and Sirinan 1994; Fordham 1998; Cash 1993, 1995a, 1995b; Cash et al. 1995; Chayan 1993) point out, rapidly changing social and sexual mores which gave rise to widespread concerns about controlling female sexuality. Thus, that the HIV moral panic of the early 1990s focused on prostitutes, whose unrestrained sexuality clearly marked them as contravening the behavioural rules for

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good women, is not surprising. Although AIDS programmes certainly focused on AIDS education amongst prostitutes, the main thrust of interventions amongst this group was a range of control strategies drawing on and legitimated by biomedicine, epidemiology and demography. Thus control strategies ranged from attempts to enumerate and classify women in prostitution according to their workplace, to the classifying of their sex acts in terms of risk and making them responsible for the safe sex behaviour of their clients, and the policing of their sexual behaviour through the monitoring of their sexual health and that of their clients. In these activities, CSWs were dehumanised in as much as almost all of their individual identities, their biographies, their emotions and all nuances of sexual practices and their meanings (beyond the classification of the type of sex act(s) practiced) were systematically disregarded. Thus, utilised in this manner, the concept of risk group constituted less a means for reducing the rate of HIV transmission than a tool of state control of female sexuality amongst a group whose rampant and unrestrained sexuality was defined as constituting a danger to society. I begin by giving a brief synopsis of how the concept of risk group has been used to conceptualise the spread of HIV in Thailand and to direct research and interventions. I show that, although by the mid-1990s this model had been subject to a range of criticisms and its limitations were well known, essentialist notions of sexuality and sexual practice, and of discrete risk groups with specific isolable risk behaviours, continued to be of significance in conceptualising the Thai HIV/AIDS epidemic. I then move to look at the uniformity in Thai discourses of HIV/AIDS and suggest that these centre on morality, partly due to the research methodologies used and partly due to the adoption of a Western middle-class morality as a measure of Thai sexual behaviour. However, equally importantly, I suggest this is the end result of a long-term trend in both Western and Thai scholarship on Thailand that, in many cases, has merely been a scholarship of admiration for Thai society, and has failed to adopt a truly reflexive and critical approach to Thai culture and Thai values. I then look at studies of Thai gender and sexuality and argue that, although studies of Thai male sexuality now recognise a range of gender positions and gender roles, as far as women are concerned both the Thai Studies and AIDS literature treats them in terms of simple binary stereotypes of either ‘good’ or ‘bad’ women. I argue that, by contrast with studies of masculinity, only one female role has been fully explored, that of the nurturing mother with her sexuality under the control of her husband.

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However, this model fails to account for the wide range of contemporary female gender positionings and gender roles, and gender roles in which women have control of their own sexuality have been almost totally ignored. Further, I argue that following the introduction of HIV/AIDS into Thailand, HIV/AIDS studies of female sexuality focused primarily on the sexual practices of prostitutes, a group they treated as an aberrant and socially deviant category of persons, thereby not only denying the sexuality of the bulk of the female population but also serving sectional class interests that have used a discourse of morality and normativity to reaffirm social boundaries. Ultimately, I suggest that the effect of this has been to disempower further an already powerless category of women, while from an HIV/AIDS control perspective, such approaches have failed to transcend the dominant state and middle-class discourses of cultural practice, and have failed to ask fundamental questions about Thailand’s HIV/AIDS epidemic.

The Construction of the Thai HIV/AIDS Epidemic At the end of the 1990s, although largely discredited in the Western AIDS literature, two concepts have been of primary importance for our understanding of the Thai HIV epidemic and for directing efforts to limit its spread: the concept of largely discrete risk groups and the concept of the sequential spread of HIV from group to group. Indeed, the idea that HIV spread sequentially through various relatively discrete groups – the wave model of HIV transmission popularised by Weniger et al. (1991) – has been fundamental to the way in which the spread of the epidemic in Thailand has been conceptualised, to the way it has been monitored through systematic national seroprevalence and more ad hoc seroprevalence surveillance, and to the way in which interventions have been directed to specific ‘at risk’ groups. Although theoretically it has been recognised that such groups are conceptual abstractions, and as such are not bounded groups, in practice they have generally been essentialised and treated as relatively discrete groups. Moreover, while authors such as Jon and Werasit (1994: S155) have pointed out the misconceptions fostered through the use of the concept of risk group in the 1980s, despite these caveats, this concept and its attendant misconceptions and misapprehensions persisted as an integral part of the Thai HIV/AIDS scene until the late 1990s. As I show below, at the time they remained a central aspect of how the Thai AIDS epidemic was conceptualised in much Thai medical and social science literature, and they continued to be fundamental to the

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organisation of much AIDS-related research and to HIV/AIDS interventions in Thailand. The first AIDS cases in Thailand were detected over the period 1984 and 1985 (Sunee 1992; Vichai et al. 1993; Weniger et al. 1991), in men with a history of homosexual contact, generally through participation in the commercial sex industry.2 Shortly afterwards HIV was listed as a communicable disease, obliging reporting to the Communicable Diseases Control Department of the Ministry of Public Health from 1 November 1985. Between this time and 1988, a range of ad hoc serosurveys carried out amongst male and female prostitutes and injecting drug users (IDUs) in Bangkok, Chon Buri and some provincial districts (Vichai et al. 1993; Weniger et al. 1991) returned low HIV rates of between 0 percent and 2 percent. However this changed dramatically in 1988 when, between the beginning of the year and the August/September period, HIV rates amongst IDUs rose from approximately 1 percent to 32–43 percent. Moreover, as Vichai et al. (1993) point out, the HIV epidemic amongst IDUs spread throughout the country within a period of two years, in each area starting and peaking within a year. The institution of regular national sentinel surveillance in July of 1989 supplemented ad hoc serosurveys by regular systematic sampling of a range of population groups (prisoners, pregnant women, STD clinic patients, blood donors, lower- and upper-class female prostitutes, IDUs and male homosexual prostitutes) (Kumnuan et al. 1989). In the same year the Royal Thai Army commenced serological testing of all military conscripts (Nelson et al. 1993). Importantly, data collected in regular serosurveys allowed not just the monitoring of seroprevalence, it also allowed the building of models to explain and predict the spread of HIV into other sectors of the Thai population. By 1991 Weniger et al. (1991: S71) were arguing for a unique Thai pattern of HIV spread, one in which HIV moved from the initial infections amongst male prostitutes, to IDUs, female commercial sex workers, the male patrons of commercial sex workers and, finally, to the general female population and their children.3 As Weniger et al. put it 2. Vichai et al. (1993) report that of the first ten cases recorded by the Communicable Diseases Control Department of the Ministry of Public Health, five were foreign nationals, four were adult Thai males and one was a baby girl. 3. Werasit et al. (1993: 261) point out that, in the early stages of the Thai AIDS epidemic, ‘many assumed that the Thai HIV epidemic would replicate the pattern observed in the United States and Europe of rapid spread in groups of men having sex with men (MHSWM) and intravenous drug users (IVDUs), but limited heterosexual spread’.

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(1991: S71), in this ‘wave model’ of HIV spread, HIV spread from the male prostitutes in ‘predictable [my emphasis] sequential waves into other high-risk groups, and more recently into subgroups of the general population’. Thus IDUs constituted the first wave of the epidemic, female prostitutes the second wave and sexually active heterosexual men the third wave, with the fourth and fifth waves being anticipated amongst non-prostitute women and their children. Weniger et al.’s (1991) proposed second wave of HIV infection followed closely on the rise of HIV amongst IDUs. Whereas infection rates amongst female CSWs had been less than 0.1 percent throughout the country, in August 1988 an infection rate of 2.57 percent was recorded amongst CSWs attending public sexually transmitted disease (STD) clinics, increasing to 5.22 percent in this group by December of that year (Vicharn and Prokrong 1990: 101). By the time of the first national sentinel serosurvey in June 1989 (only one year after the explosive spread of HIV amongst IDUs) HIV infection rates of between 2 percent and 5 percent were common amongst CSWs, with a rate of 44 percent being found in the Chiangmai sample of 100 ‘lower-class’ brothel-based prostitutes (Kumnuan et al. 1989: 57).4 The rate of HIV infection amongst CSWs was observed to rise more slowly than that amongst IDUs and, as Vicharn and Prokrong (1990) observed, was inversely related to the cost of sexual service. So called ‘high-class’ (or indirect) prostitutes, those working in establishments such as massage parlours, night clubs and so on, had a much lower rate of HIV infection than did ‘low-class’ (or direct) prostitutes working in brothels. The third wave of HIV, that amongst sexually active heterosexual men, also followed closely on from the rise of HIV rates amongst IDUs and CSWs. Weniger et al. (1991) note that in 1988 low levels (0.2 percent nationwide) of HIV were detected amongst non-IDU heterosexual men attending public STD clinics. Yet, by the time of the June 1989 serosurvey of fourteen provinces, eight reported no HIV amongst this group, while six reported levels of between 0.1 percent and 10 percent (Kumnuan et al. 1989: 64), the latter higher figure being found in Chiangmai. Two years later, the sixth national seroprevalence survey in December 1991 found that HIV infection in this group had continued to rise steadily throughout the country, with the highest being recorded in the 4. Cited by Weniger et al. (1991) and some other English language authors such as Ungchusak, according to the Western rather than the Thai (and general Thai Studies) convention of citing the Christian name.

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Northern provinces. With a median of 5.46 percent HIV seropositive, figures ranged from a low of 1.89 percent to a high of 36 percent (Kumnuan et al. 1992). However, it was the high seroprevalence amongst army conscripts at this time that signalled both the seriousness of the HIV epidemic and its move into the general population.5 In 1991, 11.9 percent of conscripts from the upper north were found to be seropositive, and by November 1992 this had increased to 13.4 percent (Suchai et al. 1995). Weniger et al. (1991: S77) argue that by 1991 the fourth and fifth waves of the HIV epidemic had appeared, with HIV appearing amongst women and children. They point out that while in 1988 and 1989 the majority of HIV-positive pregnant women were IDUs, by the time of the fifth national survey in June 1991, the proportion of pregnant women infected by their husbands had exceeded those infected through commercial sex or IDU. Indeed, as Kumnuan et al. (1992: 90) point out, in regard to a late 1991 survey of HIV rates amongst pregnant women at twenty community hospitals throughout the country returning seropositivity rates of 3.8 percent in Northern Thailand and 0.5 percent in Central Thailand, by this time HIV had clearly penetrated to village level in both these regions. Weniger et al.’s model of sequential wave transmission of HIV in Thailand was both elegant in its simplicity and fecund. Most importantly, it gave rise to and conceptually framed a plethora of epidemiological and other social science studies aiming at describing and explaining the dynamics of HIV transmission between risk groups, and it established commercial sex work and CSWs as the bridge to the broader heterosexual population, and thus the primary locus for HIV/AIDS interventions. As Sweat et al. (1995) later put it: ‘High HIV prevalence among female brothel-based prostitutes has facilitated increasing levels of infection amongst their customers and regular sex partners.’ Indeed, in sketching the model of the wave theory of HIV transmission in 1991, Weniger et al. (1991: S76) had claimed that, ‘By late 1990, only a small portion of the overall risk for HIV infection in men was attributable to injecting drug use’, and had pointed out that ‘Among heterosexual men, unprotected sex with female prostitutes is the primary factor contributing to HIV transmission’ (1991: S76). Regular sentinel serosurveillance reports supported this claim (Sombat et al. 1992) as did much social science research regarding the mechanisms of 5. Army conscripts are young men, most of whom are 21 years old, and who thus have only a short history of sexual activity. Suchai et al. (1995) note that for the November 1994 intake of 26,303 men, only 960 were older than 21 (21–29).

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HIV transmission. Thus, Ford and Suporn (1991: 413), in a wideranging discussion of various social aspects of HIV transmission in Thailand, note that: ‘The Thai case illustrates the way in which HIV can be rapidly transmitted within specific subgroups (namely injecting drug users and CSWs), and the potential for transmission via the commercial sex industry to large sections of the population.’ Similarly, Taweesak and Mastro et al. (1993: 1233), in an analysis of HIV infection amongst young men in the North, clearly point out that it is CSWs who are both the cause of and the solution to the problem: ‘Young men in the general population in Northern Thailand are at high risk for HIV-1 infection via sex with female prostitutes.’ They add (1993a: 1,237): ‘Sex with non-prostitute women and less commonly reported behaviours, such as anal sex with men, injecting drug use and tattooing, do not appear to contribute substantially to the overall risk of HIV 1 infection in this population of young men.’ Or, as Sungwal et al. (1993) put it: ‘Brothel-based female prostitution has been the most important source of the spread of HIV in Thailand.’ Thus, by the mid-1990s, women in prostitution were clearly established as a reservoir of HIV infection who threatened the broader Thai population. Indeed, Lyttleton (1996b: 370), commenting on the public service and health announcements about HIV/AIDS in the early 1990s, notes that ‘the portrayals label commercial sex workers as a feared group for the supposed role they play in transmitting HIV, not as people who are at risk of, or confronting the crisis of, infection themselves’. Thus, as he points out (Lyttleton 1994a), the idea that prostitutes were responsible for the scale of the epidemic set the stage for stereotyping. Moreover, in practice Weniger et al.’s wave model of HIV transmission between risk groups was generally operationalised in a fairly crude fashion as if CSWs and other risk groups constituted essentialised and discrete population groupings, distinct in some way from the general population. Thus Maticka-Tyndale et al. (1997: 199) note: ‘HIV has moved through four successive waves, each associated with infection in a distinct subgroup of the population … Thailand is well into a fifth stage in which HIV has transcended the boundaries defining specific risk groups [my emphasis] and is now also present in the general population.’

Challenges to the Wave Model of HIV Transmission However, some analysts were critical of the manner in which sentinel surveillance data collection categories and the simplifications

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inherent in models such as the wave model of HIV transmission and the associated concept of risk groups, created static and essentialised portraits of what were, in reality, highly dynamic and highly diverse populations and social contexts. Thus Jon and Werasit (1994) criticise the use of the concept of risk groups to model the epidemic, arguing that campaigns focusing on HIV spread amongst the members of risk groups led people to perceive risk in terms of group membership rather than risk behaviours. They claim this was a feature of the early HIV/AIDS period fostered by the AIDS education campaigns of the 1980s; however, I suggest here that it has lingered on well past this period. Vichai et al. (1993: 5) point out that for sentinel surveillance purposes the Ministry of Public Health arbitrarily divided prostitutes into two groups (direct and indirect prostitutes), according to the type of management of the establishment in which they worked (those that provided explicit sex as against those which provided more covert sex). They claimed that the result was to show differing levels of seroprevalence between the groups: higher levels of seropositivity being found amongst direct prostitutes. This created a ‘widespread acceptance of the different vulnerability between direct and indirect prostitutes,’ whereas, in fact, there was a great disparity in the difference between the two groups in various regions and in Nakhon Sawan (1991 figures) there was no difference between the two groups (1993: 5). Indeed, Vichai et al. (1993: 20) evidence considerable scepticism about the popular modelling of the HIV epidemic and the simplifications it necessitated, and comment: ‘The wave of anti-HIV seropositive prevalence that started from IVDU then proceeded to the prostitutes and the general population in sequence did not imply [my emphasis] complete separated sequential transmission between subpopulations.’ Even more importantly, they clearly acknowledge the impossibility of modelling this context in any sociologically meaningful fashion: The subsectors in the general population were multiple and subject to considerable arbitrary [my emphasis] defining criteria set by the analysis objectives … The simple concept of sexual transmission actually holds within its context many interacting subpopulations of diverse behavior that defy modelling into a simple unifying pattern comprehensive [sic] covered all aspects of the transmissions mechanism. (Vichai et al. 1993: 21)

A similar, albeit often muted, dissent against the wave model and its associated notion of risk groups comes from social scientists

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working on Thai HIV/AIDS issues, who have been critical of the essentialism inherent in notions of risk groups (Fordham 1995, 1998, 1999; Lyttleton 1994a, 1996a, 1996b). However, generally such criticisms have been from the margins, as Scheper-Hughes (1994: 991) puts it, in as much as they have been directed towards highlighting the limitations of existing research and intervention programmes. At the end of the 1990s, it seemed that a structural-functionalist model of society, with its presupposition of essentialised categories of persons with specific definable levels of HIV risk, still underpinned much contemporary Thai AIDS research.6 Aspects of HIV statistics that underpinned the wave model of HIV transmission also came under some criticism during this period. Kumnuan et al. (1992) point out the limitations of statistics drawn from regular serosurveillance. They argue that an early 1990s local-level strategy of forcing CSWs found to be HIV positive to cease work in that province, had the effect of giving a lower rate of HIV in subsequent surveys amongst prostitutes there, while HIV-positive CSWs moving to other provinces would inflate HIV rates in those areas. Other limitations of statistical models of the epidemic were revealed by the work of, for example, Kachit et al. (1991) and Dwip et al. (1994), both of whom note that seemingly stable rates of HIV amongst IDUs do not indicate an absence of new infections, but can in fact mask a substantial incidence as the IDU population is one with a high turnover. By 1993, molecular epidemiology (Ou et al. 1993; Sasiwimol et al. 1994) had raised another form of challenge to Weniger et al.’s linear wave model. This showed that two main subtypes of HIV-1 were responsible for the majority of HIV infections throughout the country, and demonstrated that the AIDS epidemic amongst IDUs in 1988 was largely independent of the epidemic which later developed amongst the heterosexual community: IDUs being infected with subtype B while subtype E was found amongst heterosexuals (Dwip et al. 1994). This and later work, such as that by 6. Such structural-functionalist models continued in the late 1990s. Thus, for example, a United Nations Population Fund research project on ‘Gender, Sexuality and Reproductive Health’, administered from Mahidol University and conducted by researchers in various areas of Thailand, focused on gender and AIDS issues amongst clearly defined and apparently isolable categories of people. Suggested examples of research topics are ‘Male Involvement in Reproductive Health within the Islamic Context’, ‘Male Involvement in Reproductive Health and Household Responsibilities: Issues’ (UNFPA/Mahidol University 1999: 6).

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Hu et al. (1988), finally effectively demolished Weniger et al.’s (1991) simple linear wave model of HIV transmission. Curiously, however, although many subsequent studies indicate an awareness of this research, they retain (albeit sometimes with slightly modified usage) the wave model of HIV spread and the concomitant notion of discrete risk groups. Thus, although Brown et al. (1994) acknowledge the concomitant introduction of two strains of HIV into Thailand amongst IDUS and amongst heterosexuals, they retain the model of HIV spread as a series of waves, commenting: ‘The data clearly show the growth of separate [my emphasis] waves of the epidemic’ (1994: S131). Morris et al. (1995: 507) take a similar approach and, after describing Thailand’s HIV epidemic as one of ‘successive waves of HIV infection moving into populations of drug users and homosexual men, female commercial sex workers (CSW), men in the general population, and women in antenatal clinics’, note that recent research suggested that ‘these waves may be epidemiologically distinct’. By contrast, Dwip et al. (1994), who focus on HIV incidence amongst Bangkok drug users, clearly indicate that the Bangkok HIV epidemic amongst IDUs was separate from the broader heterosexual epidemic. Mills et al. (1997) also clearly refer to separate IDU and heterosexual epidemics. However, regardless of substantial evidence to the contrary, the bulk of both Thai and English language HIV/AIDS literature subsequent to this period, such as Celentano et al. (1993), Mason et al. (1995), Nelson et al. (1993), Sombat et al. (1992), Wiwat and Hanenberg (1996), and many others, implicitly accept the wave model of HIV moving between largely discrete risk groups. Similarly, they accept the associated notion that it is the second wave of HIV amongst female prostitutes that is responsible for moving HIV into the broader heterosexual population, and that this should be the primary focus of prevention efforts. Thus, Brown et al. (1994: S131) claim: ‘By the time Weniger et al. … had produced their 1991 review of the epidemiology of HIV and AIDS in Thailand, the prevailing patterns of the Thai epidemic were well defined’. The notion of risk groups also remains current in this period, and Werasit and Brown (1994: S143) consider them such fundamental aspects of the epidemiology of HIV in Thailand that they complain that ‘people engaging in risk behaviours [had] denied their membership of risk groups’. Also, although they do note the increasing significance of non-commercial sexual contacts, they clearly state that ‘the dominant risk factor to date for HIV infection in Thai men is unprotected sex with CSWs’ (1994: S145).

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Indeed, two years later, analysts were still working with the wave model of HIV transmission and essentialist notions of discrete risk groups. Thus, Morris et al. (1996: 1,265) summarise the Thai HIV epidemic as ‘successive waves of HIV infection moving into populations of drug users and homosexual men, commercial sex workers (CSW), army recruits, men in the general population, and women in antenatal clinics’. They argue that ‘“core groups” such as CSWs play a disproportionate role in the spread of sexually transmitted disease’ (1996: 1,266) and argue for a focus on ‘bridge populations’ – men who have sex with both CSWs and spouses – as a way of reducing HIV transmission rates. London et al. (1997: 34) note that ‘The HIV/AIDS epidemic in Thailand has been described as a series of “waves of infection” sweeping across various strata of the population over time.’ They go on to describe the epidemic as proceeding from initial infections amongst homosexual and bisexual males, and ‘explosive growth in HIV infection rates amongst intravenous drug users and female prostitutes’ (1997: 34), and successively increasing levels of infection amongst male clients of female prostitutes, their partners, spouses and children (see Maticka-Tyndale et al. 1997). Safman (1996) in her MA thesis describes the spread of HIV in Thailand as one of ‘distinct waves’, which she explains as moving in the standard progression defined by Weniger et al. (1991). Van Griensven et al. (1995: 557) argue for the ‘key role’ played by CSWs in the spread of HIV into the general population. Similarly, Hanenberg and Wiwat (1998: 69) describe the Thai HIV/AIDS epidemic as one ‘mainly caused by prostitutes’, as do van Griensven et al. (1998) and Khanchit et al. (1999). The wave model of HIV spread and the associated notion of risk groups has, then, persisted well past the mid-1990s. Moreover, as late as 1999 Prasert (1999), in a description of Thailand’s response to the HIV/AIDS epidemic, draws on the wave model to describe the movement of HIV through the Thai population. The same year, Uraiwan Kanungsukkasem and Supanee Vejpongsa (1999), members of the Institute for Population and Social Research at Mahidol University, arguably the most prolific Thai research body for epidemiological and demographic research on Thai AIDS throughout the 1990s, used the wave model to describe the spread of HIV from initial risk groups to the broader community. Thus they note (1999: 40–41) separate epidemics developing amongst homosexuals and injecting drug users and then, in accord with the familiar wave model, the spread of HIV from drug users to the risk groups of prostitutes, their male clients and, finally, male clients’ families. A similar dual-wave model of

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HIV spread is utilised by Suwanna and Wiput (1999) who, in the context of a discussion of Thailand’s reproductive health programmes, discuss the spread of HIV and the Thai response. Critically, many analysts directly equate risk-group membership with risk behaviour. Thus Kumnuan et al. (1995), reporting on the twelfth serosurveillance round in December 1994, tautologically refer to IDUs, CSWs and male STD clinic patients as ‘populations with obvious [my emphasis] risk behavior’. Others go further. Anuswasdi (1994: 441) draws a direct link between class position, risk-group membership and behaviour when, discussing male behaviour, he says: ‘Low education and low income led to risky behavior.’ Such a bald conclusion is relatively common in the Thai language AIDS literature. Kiti et al. (1991: 259) note, in respect to a KAP-style survey amongst Lampang ‘promiscuous males and all [my emphasis] female prostitutes’, that ‘it was clear that the low education group was the high risk population’. The English language literature tends to rely on complex statistical calculations to arrive at the same end. After analysing a self-administered questionnaire about male AIDS knowledge and sexual behaviour over several pages of descriptive statistics, factor analysis and multivariate logistic regression analysis, VanLandingham et al. conclude: programmes seeking to educate men about the dangers of unprotected intercourse with commercial sex workers should target men from relatively under-privileged backgrounds, because these men are more likely to be misinformed and to engage in risky sexual practices than are men from more privileged backgrounds. (1997: 288)

Once again a correlation is drawn between class position, riskgroup membership and high-risk behaviour.

Thai Discourses of HIV/AIDS: From Risk to Morality Despite the limitations of the wave model there has, then, been an astonishing level of agreement in Thailand that this model is the best way to describe how HIV spread throughout the Thai population, and the model has persisted into the late 1990s.7 Importantly, there is a similar high level of agreement regarding the associated concept of risk groups, and in regard to female 7. Although it is not my intention to pursue this path here, the continued use of the wave model of HIV spread and the associated model of risk groups in the face of increasingly disconfirmatory evidence provides a fascinating illustration of the development of a particular paradigm and its associated secondary elaboration (compare Kuhn 1970).

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commercial sex workers as a core risk group that should constitute the focus of attempts to limit the transmission of HIV to the broader population. Thus female CSWs have been portrayed not only as a deviant population in regard to normative Thai sexual mores and as a reservoir of potential HIV infection, but they have been portrayed as an essentialised group, somehow out there, separated from the general Thai population, and as the link through which HIV travels from deviant groups to the general heterosexual Thai population.8 In an analysis of HIV/AIDS discourses in sub-Saharan Africa, Sidel (1993) claims that several distinct but overlapping discourses compete for hegemony. He distinguishes a dominant medical and medico-moral discourse which shaped the AIDS agenda in the sub-Saharan region. This discourse shaped policy design and intervention at the international and national levels, and also impacted on perceptions of people with AIDS and on people considered to be at risk. Yet critically, he also distinguishes what he calls ‘dissenting voices’ (1993: 175), alternative discourses on the developmental, legal and ethical rights of people with AIDS, which challenge and fragment the dominant discourse. As Sidel puts it, these dissenting voices provide ‘discourses of rights and empowerment’ (1993: 186) that stand in opposition to the dominant medical and medico–moral discourses which function as ‘discourses of control or exclusion’. Thus he claims that AIDS activists and political community activists have mobilised to challenge these dominant discourses regarding issues such as the ethics of human rights and vaccine testing, of access to new drug therapy and of the dominance of medical paradigms based on Western values and experience. The situation in Thailand is very different. Certainly in the Thai context there are potentials for dissenting voices from NGO and activist groups similar to those Sidel found in Africa. However, Thailand’s potentially dissenting voices have largely been muted (Ardner 1975) owing to a combination of three factors: a reluctance to actively question established models lest dissent threaten scarce funding,9 the speed at which Thailand’s HIV epidemic grew 8. Peracca et al. (1998: 255), who operate with a highly structural-functionalist network focus, take this model one step further in that they consider CSWs act in concert with their male clients – Weniger et al.’s (1991) third wave – to spread HIV to the general population. 9. Chapter 4, n. 18 discusses the growth in NGOs working in the AIDS area over the 1990s. Interestingly, unlike earlier directories, the late 1990s directory of NGOs I cite there gives comprehensive details of NGO management structure and funding – suggesting a new preoccupation with these issues at this time.

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in the early to mid-1990s, which left NGOs struggling to cope and which gave potential activists little time to question dominant discourses; and a common practice of using medical and academic specialists from the Thai AIDS establishment to guide NGOs in their work. The result is that the discourses through which the Thai AIDS epidemic has been constituted have been characterised by an extremely high level of agreement about what the issues are, which (risk) groups and behaviours are causing the problem and what the foci of intervention should be.10 Indeed, ScheperHughes (1994: 991) claims that the muting of competing discourses is a normative feature of the global AIDS pandemic. Discussing doing anthropology at the margins by working against the grain and asking ‘negative’ questions, such as ‘What truths are being hidden? Whose needs are being obscured?’ she says: ‘I discovered an almost uncanny … consensus in the social science and international medical communities with respect to thinking about, and searching for appropriate responses to the global AIDS catastrophe’. However, whereas Sidel characterises the dominant subSaharan AIDS discourse as medico–moral, the dominant Thai (Buddhist) AIDS discourse is more properly characterised as moral–medical. Thai HIV/AIDS is, for Thais, first and foremost a moral issue, in as much as this discourse has portrayed the activities through which the majority of HIV infections have occurred – homosexual sex, intravenous drug use and heterosexual sex between men and their prostitute partners – as deviant or amoral activities.11 The logic of this perspective is revealed by Mulder (1984) who notes that Thai understandings of the role of the individual in society hold that good order stems from individual moral development. Further, he claims (Mulder 1997) that for Thais, moral issues are understood to be at the root of social problems, in as much as social problems arise due to individuals who are not aware of their place and duty, and act improperly by failing to 10. An interesting parallel exists between the muting of competing/dissenting AIDS discourses and the situation of homosexuality, which has largely been defined through the works and voices of heterosexuals and is marked by the absence of dissenting homosexual voices. As Jackson (1996a: 85) notes: ‘Almost no homosexual voices have been heard within Thai academia, and with only one exception no openly gay or lesbian researchers have provided commentary or reflected on their own communities or social networks.’ 11. The National Blood Centre of the Thai Red Cross began screening donated blood in September 1987 (Vichai et al. 1993) and as a result there have been very few Thai infected via blood products. My argument disregards the relatively recent increase in maternal and child AIDS.

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cooperate (see Kirsch 1982). Thus he argues that in the Thai social studies curriculum, ‘common sense’ substitutes for causality; poor people are poor because they have no education; because they lack education, they have no moral sense; they come to town, et voila: crime and prostitution. They should be taught manners and morality, by both government and private sector [sic]. (Mulder 1997: 150)

Such attitudes are clearly exemplified in the HIV/AIDS sphere. Thus, national HIV/AIDS-control programmes, such as the 1993 ‘The Thai Family Combats the Danger of AIDS’ (Khao Siam 1993a: 3) programme, aimed at consciousness raising through encouraging village groups to make banners about AIDS prevention. In the North, the thousands of banners subsequently paraded around the streets of Chiangmai relied on slogans such as ‘Love [your] wife, love [your] children, [remain] free from AIDS’, ‘[The] family will be happy if every member is free from AIDS’, ‘Maybe alcohol will take [you] to meet [AIDS]’, ‘Prostitutes are AIDS’, ‘Love [your] family, don’t be sexually promiscuous [or you] will get AIDS’, ‘Know what is enough [and there will be] no AIDS in [your] life’ and ‘AIDS is a danger to life and a poison to society’. Critically, in respect to my analysis here, these slogans are as much moral prescriptions for right behaviour as they are recipes for remaining AIDS free. More recently, but in the same vein, posters produced by the Ministry of Public Health (1999) exhort ‘good’ Thais to have a blood test prior to having a baby. Thus, at the end of the century, the Thai state still relied on morality and ‘American style middle-class “family values” ’ (Mulder 1997: 332) to control HIV/AIDS. From the state perspective this is highly logical; as Tannenbaum (1998: 123) points out: ‘To govern in Thailand is to control, to make the social world more orderly so that people may know their places and know that all is right with the world – rabiap and phatana [order and development], for instance.’ However, the effect of reducing the problems presented by the HIV/AIDS epidemic to moral homilies has been a failure to adequately come to terms with the cultural practices followed by the members of the ethnically and socio-structurally diverse Thai population, and a failure to address the manner in which two decades of rapid social change has dramatically transformed the sexual cultures of both men and women and, ultimately, a failure to offer a diversity of culturally realistic solutions for HIV risk reduction amongst an increasingly heterogeneous population.

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Brummelhuis (1993) makes a similar point in his analysis of early 1990s Thai AIDS discourses about sex and prostitution. He claims that Thai AIDS discourses have not only been discourses about morality, but that they are class based and that they ignore many normative aspects of Thai sexual culture and morality. He claims that, in the context of globalisation, Thai researchers have adopted a Western middle-class morality, using what he calls ‘selective adaptations from Western middle-class patterns’ (1993: 15), as a measure of general Thai sexual behaviour.12 Brummelhuis argues that Thais have adopted Western notions of monogamous marriage and, in particular, Western conceptions of prostitution by which to evaluate Thai sexual behaviour.13 He points to the absence of any fine-grained analyses of Thai prostitution that distinguish it from generic Western models by taking account of all its modalities ranging from ‘bondage to free and autonomous entrepreneurship in a luxury market’ (1993: 10), and its integral relation to Thai constructions of sexuality and notions of marital and family relationships. Indeed, as Cohen (1982, 1986, 1987) pointed out over a decade ago, normative Western constructions of prostitution and prostitutes do not work for Thailand, where there is no sharp separation between emotional and mercenary sexual relationships (see Embree 1950). However, in both Thai and English-language works, Thai prostitution is invariably constructed in highly Western middle-class moral terms (Tannenbaum 1999), and this has been the case since the earliest works, such as Thitsa (1980). These criticisms remain true in 2002. As a result, after more than two decades of research on Thai prostitution, with the exception of statistical and economics data, we know virtually nothing about the lives of prostitutes outside their sex work. Of a number of recent works dealing with prostitution in Thailand (Chai et al. 1993; Chiraluck 1992; Maticka-Tyndale et al. 1997; Montgomery 1996a, 1996b, 2001; Nitaya and Saupaa 1996; Niwat 1998; Odzer 1994; Orathai and Chanya 1994; Peracca et al. 1998; Suchart 1992; Suliimaan 1994; Wathinee and Guest 1994; 12. Jackson (1996a: 84) makes a similar claim in regard to attitudes towards homosexuality held by Thai researchers, arguing that Western values, ‘in particular, [those] supporting the importation of anti-homosexual and homophobic attitudes’, have been uncritically adopted in Thai academic discourse about homosexuality. 13. Through an examination of child prostitution Montgomery (1996a, 1996b, 2001) takes up an allied issue: the issue of the highly contradictory middleclass Thai attitudes towards Western influence – on the one hand a desire to be modern and Western and, on the other, a fear regarding the dilution or loss of Thai culture and values.

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Wawer et al. 1996; Yos 1992), a high percentage rely on methodologies such as focus groups, surveys and interviews. They focus primarily on the sex-work aspect of prostitutes’ lives, with their interest often reduced solely to the mechanics of prostitution. Accordingly, this reductionist focus has dehumanised prostitutes, in as much as we know little about them in regard to issues such as their construction of the self, of their emotional lives or how these vary according to region, class or ethnicity. Among the Thai language works Nitaya and Saupaa (1996) and Yos (1992) stand out for their use of ethnography, as does Chiraluck (1992) for her political-economy and culture approach. Yet, even here, although the reader learns much about the process of prostitution and how and why some girls became prostitutes, it is only in Niwat’s (1998) sensitively nuanced ethnography from Phayao that one gets any sense of their lives outside their sex-work roles.14 Of the English language works, only Montgomery (1996a 1996b, 2001) utilises qualitative ethnographic data derived from participant observation, and hers is the only work to focus on the broader context of prostitutes’ lives outside their sex work. The Western-derived morality that Brummelhuis identifies as characterising Thai AIDS discourses is clearly discernible in much Thai HIV/AIDS research; not only that conducted by Thai scholars but also that carried out by Western scholars throughout the early 1990s, and sometimes much later. As a result, research about Thai sexuality has tended to de-emphasise the amount of sexual activity outside marriage and the extent to which this is culturally acceptable. In the case of women, research generally stressed the high value placed upon female virginity, and the extremely low level of sexual activity amongst young unmarried women. Research generally allowed a higher rate of sexual activity for men than was the case with women, but frequently portrayed male visiting of prostitutes as the actions of deviant individuals rather than a normative activity practiced throughout the country by a high percentage of men, both prior to and following marriage.15 14. Although it is not a study of prostitution per se, in discussing the work of the NGO Hotline, Ornanong et al. (1999) give a very human and highly moving account of the emotional lives of young, HIV-positive ex-prostitute women. 15. With the exception of the work of Beyrer et al. (1995), de Lind van Wijngaarden (1995a, 1995b, 1999), Jackson (1995a, 1995b, 1996a, 1996b, 1997), Jackson and Cook (1999), Jackson and Sullivan (1999), Morris (1994), Piyada et al. (1995), Took Took (1994), Werasit et al. (1993), Werasit and Chuanchom et al. (1992) Thai AIDS research has largely ignored sexualities other than heterosexuality as being of only peripheral significance in respect to HIV/AIDS.

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To give but a few examples: Weniger et al.’s (1991: S77) work on the spread of HIV through the Thai population claimed that ‘Women in the general population are less sexually active than men’ or, as VanLandingham et al. (1993a: 3) put it, ‘Premarital intercourse appears to be quite rare for women’. Werasit and Praphan et al. (1992), in a country-wide survey conducted under the auspices of the Thai Red Cross, found that 99 percent of women reported that their first sexual partners were their husbands. Or, as a mid-1990s Ph.D. thesis (Wassana 1996: iv) rather coyly put it: ‘It is now generally accepted that men gain first sexual experience with prostitutes, but women should abstain from sex before marriage.’ This position remained unchallenged at the end of the 1990s. As Beyrer puts it (1995: 224, 1998: 27), ‘Social codes of female behavior strongly censure pre-marital sex, extramarital sex, and multiple partners.’ Or, in Knodel et al.’s (1999: 94) terms, ‘In contrast [with male sexual freedoms], women’s sexuality has traditionally been far more restricted with chastity prior to marriage and subdued sexual expression being valued,’ and they note a clear contemporary preference for virgin brides (1999: 111). In respect to men visiting prostitutes, Ford and Suporn (1991: 408) claim that, although visiting prostitutes is a significant part of Thai sexual culture, it is ‘certainly not socially acceptable’. Indeed, in the early 1990s the issue of the acceptability of men visiting prostitutes was so sensitive for researchers that a 1992 research report about brothel patrons and their sexual networks in the Central Thai region (Napaporn et al. 1992) not only disguised the province where the research was conducted, but prefaced the report with a caveat in bold print in a highlighted rectangle: ‘WARNING: This report refers to a purposively selected sample of Thai men and women who have multiple sexual partners. The results refer to this specific group only. Please do not cite the results as if they reflect the behavior of the general Thai population.’ The report is quite clear that those who are sexually active outside marriage, particularly women, are by definition promiscuous, and are not representative of the general Thai population. The following year, a Thai Red Cross report on young Northern men’s sexual culture (Taweesak and Sweat et al. 1993) identifies the district (Phayao) but incorporates a similar disclaimer, noting that the research results should not be cited ‘as if they reflect the behaviour of the general population in the upper north of Thailand’. In some cases works embody an implicit moral yardstick seemingly at odds with the data itself. Thus, Chanpen et al. (1999: 80) investigate the ‘normalcy’ and ‘appropriateness’ of

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men visiting prostitutes, suggesting a fundamentally moral research agenda. Yet they clearly point out (1999: 81) the widespread nature of this activity, its social aspect and its role as an accepted male ‘entertainment’. Research that stressed generally high levels of Thai sexual morality (albeit on a Western model) failed to come to terms with many crucial (from an HIV/AIDS perspective) aspects of Thai sexual culture (and Thai sexuality) and instead had the effect of tautologically portraying HIV/AIDS as a problem of aberrant behaviours on the part of individuals who, on the basis of their behaviour, became classified as members of specific risk groups. Moreover, this genre of research tended to attribute such individual deviance to individual moral failure to control bodily desires; as Sukanya (1993: 18) puts it, the ‘pleasure inclination of the lower class’. Alcohol use, for example, is persistently interpreted as a risk factor and a ‘rationalisation’ (VanLandingham et al. 1993a: 29) or ‘excuse’ (VanLandingham et al. 1997: 277, n 6) for the visiting of prostitutes. Yet, on the basis of my experience with Northern Thai peasants, I am highly sceptical of such claims and the morality they refer to. Male participation in commercial sex is, in the North at least, considered a normal activity for the majority of men, whether married or single, and there has never been any need to manufacture rationalisations or excuses. It is likely that a similar situation exists in Central Thailand. Indeed, Tepchoo’s (1983) superb work on prostitution in early twentieth-century Bangkok suggests this has been the case since at least this period. My own research in the Sansai district of Chiangmai in the early 1990s, revealed that 88 percent of men between the ages of 20 and 35 had engaged in sex with prostitutes, a figure similar to that found by other researchers in this period.16 Nelson et al. (1996) give a similar figure of 81.5 percent (1991 data) of army conscripts who have had sex with prostitutes. Celentano et al. (1993: 1,648) too, in a survey of 2,417 military conscripts between the ages of 19 and 23, found that even at this relatively young age only 18.8 percent had never visited a prostitute. As Chayan (1993: 23) puts it in regard to one group of married men in the North, ‘the dominant social value [my stress] emphasises drinking and having sex with women’ (see Nitaya and Saupaa 1996). Keyes too (1987) makes this point when he notes that for Thais the very essence of 16. This figure was derived from a small random sample (n = 50) of men between the ages of 20 and 35 living in two villages in the Sansai district of Northern Thailand. See Fordham (1995) for more details.

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maleness is potency, both sexual potency and the potency demonstrated through power and control over self and others. He points out that a central model for Thai masculinity is symbolised in activities such as heavy drinking and in sexual exploits. Indeed, as far as the commercial sex arena is concerned, male participation is generally a social activity engaged in by small groups of men, and takes place following feasting and the drinking of copious amounts of alcohol, the whole tripartite event, as I argue in chapter three (see also Fordham 1995), being a fundamental arena for the construction of masculine identities.17 As far as claims regarding female virginity are concerned, recent work by Cash (1993, 1995a 1995b), the Daily News (1999), Ford and Sirinan (1994), Michinobu (1999) and Parichart (1999) suggests a considerable amount of sexual activity amongst young female factory workers, and anecdotal evidence suggests that similar patterns of female sexual activity are found amongst other groups, such as students and wageworkers in other occupations.18 Wimol et al. (1998), who note much higher rates of partner change than those typical of earlier research, suggest that in situations of rapid social change such as Thailand is currently experi17. Some researchers (Nelson, et al. 1999, and VanLandingham 1998) claim that by the late 1990s there had been significant reductions in male patronage of commercial sex workers. Yet, as I argue in chapter three, I am sceptical of the magnitude of the reductions claimed. Partly as a means of avoiding legislative crackdowns on direct prostitution and partly as a response to the AIDS epidemic, throughout the 1990s there has been a major shift in the style in which sexual services are presented to consumers. Today, restaurants, karaoke bars and coffee shops offering sexual services have largely replaced the direct brothel of a decade ago. Even quite modest rural villages boast small karaoke bars, small restaurants with young waitresses and traditional massage establishments, all of which offer sexual services. In some Northern villages with which I am familiar the AIDS epidemic itself has led to relatively young AIDS widows raising their families through offering sexual services while acting as karaoke bar hostesses or alongside therapeutic massage. In the case of direct brothels, although there has been a reduction in their number, they are certainly not extinct. In Chiangmai city, despite irregular closures such as at the time of the 1995 regional AIDS conference in Chiangmai, brothels in the Santithum and Khampaengdin areas continue to operate openly and are convenient targets for regular police raids to find illegal Burmese prostitutes and sometimes their Burmese clients (Chiangmai News 1999b), and coffee shops throughout the city provide indirect sexual services as in the past. 18. Youth issues, including the issue of youth sexuality, are currently a matter of major public concern. Surveys about youth sexuality are always given prime placement in daily newspapers. For example, the results of the 1999 Durex Global Sex Survey, which reported high levels of sexual activity amongst Thai youth, was one of the few stories selected for the Daily News’s web site (Daily News 1999).

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encing, young women ‘are likely to be more sexually active than reported’. They are quite right. Even cursory investigation of youth culture in places of entertainment such as bars and discos, and in the dormitories where young people live, reveals a considerable amount of sexual activity on the part of young women (Phinthip 1999). Moreover, such levels of sexual activity amongst young women (and young men) are not solely an urban phenomenon but are also found in rural villages (Lyttleton 1999). As Kritaya and Varaporn (1994) put it, ‘adolescents of today, both male and female, tend to accept premarital sex amongst themselves as a normal practice [their emphasis]’. An inevitable result of this is a high rate of teenage pregnancy and of teenage abortion. Suwanna and Wiput (1999: 1) point out that teenage pregnancies currently account for 14.7 percent of all pregnancies, while Ministry of Public Health abortion statistics show that 21 percent of abortions were performed on females under nineteen years of age (MOPH 2000). At the level of state planning these and other issues concerning youth sexuality are currently being addressed under new Ministry of Public Health reproductive health initiatives (Suwanna and Yupa 1999). In Northern Thailand, as I discuss at greater length in chapter six, they are also a target of large-scale life-skills projects carried out by NGOs, who focus on youth in tertiary educational institutions, in student dormitories and in nightspots (Adul et al. 2000; Raynou et al. 2000; Warunee 2000). There is much other evidence suggesting a considerable amount of sexual activity on the part of young men and women. Working in the Saraphi area just to the south of Chiangmai city in the early 1970s, Potter (1976) noted the development of notions of romantic love on the part of young women. Today, while the middle class read magazines such as Motor Magazine and House and Garden, young women read Movie Star magazine about popular movie stars, magazines about the romantic relationships of singers (Movie Star Couples in Love) and magazines about the lives of every-day young people such as themselves (Loving Couple, Couple for Life). The latter magazine is sold on news stands throughout the country, and bills itself as the ‘Manual for Love for Every Person’. In addition to short stories and regular columns it features (paid) stories submitted by readers in several genres: love, depression, lives of perfect couples and, critically, a two- to threepage spread each fortnight with readers’ stories (mainly women but some men) telling how they lost their virginity. These stories are from young women aged between fourteen and their early twenties, with headers such as ‘Lost my Virginity in Third Year

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[high school]’, ‘I Wanted to Visit Heaven’ (Loving Couple, Couple for Life 1999a), ‘Because I Loved [him] I Agreed’ (Loving Couple, Couple for Life 1999b). These young women’s accounts of their loss of virginity are striking not just because of their ages but also because the writers are highly positive about the experience as one that was emotionally and physically gratifying, one that they were in control of, and one that was justified for love or for the pleasure of the act itself. The publication in contemporary mainstream magazines of such sexually explicit material, which in the 1980s would have only appeared in men’s pornographic magazines, and a boom in books dealing with sexuality (Manote 2000) and in radio and television programmes dealing with sexuality, signifies a fundamental shift in Thailand’s sexual climate. However, while the forms and contexts for contemporary expressions of female sexuality are certainly specific to the late twentieth century, it is my contention that female sexual activity prior to and outside marriage is not a totally new phenomenon. The records and collected letters of the Presbyterian mission to Northern Thailand, from the time of the first converts in the early 1880s under missionary McGilvary up until the 1920s, are extraordinarily detailed and regularly record the suspension or expulsion of converts for the sin of immorality (NSM, n.d.; PMSL, n.d.). Thus I suggest that, like much other Thai HIV/AIDS research, research about young women’s sexuality has been based on preexisting assumptions about the nature and homogeneity of Thai culture. In this case, owing to an assumption that young women were generally not sexually active, little attention has been directed to this group, with the result that they are still widely assumed to be sexually inactive. Moreover, as I argue below, given Thai notions of female modesty and beliefs about how ‘good’ girls should present themselves, survey and focus group data are unlikely to reveal the true extent of sexual activity amongst young women. By contrast with the findings of much recent Thai AIDS-related research, the anthropological literature of Thailand over the past thirty years contains considerable evidence of normative sexual activity amongst young women. The anthropologist Davis (1984: 60) argues against an earlier analysis (Potter 1976: 106) suggesting only low levels of female pre-marital sexual activity, and notes that, although the Northern matrilineal spirits are concerned with regulating the sexual misconduct of unmarried women, ‘In point of fact, most girls are not virgins when they marry’. Similarly, both Chiraluck’s (1992) survey of anthropological works on Northern Thai society and Niwat’s (1998) recent Northern Thai

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(Phayao) ethnography speak of a past where young women were normally sexually active prior to marriage. In respect to the role of the matrilineal spirits in the regulation of female sexuality, Cohen and Wijeyewardene (1984) argue that young unmarried women normatively engage in sexual activity (see Keyes 1984). They point out that, although in theory a girl’s sexuality was protected by the matrilineal spirits and there were limitations to unmarried women’s sexual activity in the house, ‘It was, however, accepted that young people had intercourse when they were out working in field and forest’ (Cohen and Wijeyewardene 1984: 259). Thus, Chiraluck (1992: 79) notes the adage voiced by some young women that: ‘If mother doesn’t know the spirits don’t either.’ Cohen and Wijeyewardene also claim the evidence suggests that in the past, girls as young as ten ‘might be considered sexual partners’ (1984: 258) and point out that parents taking daughters of twelve for sale to brothels in Chiangmai frequently commented regarding the need to realise their value before they lost their virginity to village boys. Indeed, Ford and Sirinan (1993) give data showing that even today girls in some districts marry as early as thirteen years of age. Tannenbaum (1999: 249), in an analysis of Thai academic discourses on gender, also takes up the issue of female virginity and, drawing on Shan peasant data, argues that: ‘Female sexuality, like male sexuality is simply part of the normal life cycle. Young adults, both male and female, are seen as active sexual beings.’ She also points out that works dealing with virginity in Thailand may be influenced by the values of the authors concerned, and an ‘over generalisation of middle-class values’ (1999: 248). Importantly, she notes that there is no Thai attitude towards virginity, that the Thai follow different practices according to class, ethnic group, region and chronological period. However, not only do essentialising and homogenising approaches fail to acknowledge these factors but, as Tannenbaum (1999: 249) points out: ‘When people write about the importance of female virginity and premarital chastity, it is not clear whose perspective is being reported – the author’s, an elite ideal, or that of the group studied.’

The Construction of Thai Morality in the 1990s I have argued then, that over the last fifteen years of HIV/AIDS research in Thailand, Thai AIDS discourses have, perhaps unconsciously, emphasised morality and have treated those who are sexually active prior to or outside marriage as being in some way

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aberrant. I suggest that this moral emphasis in Thai sexuality research can be explained by two factors: first, basic assumptions about Thailand and the research methodologies themselves, which failed to challenge those assumptions; second, I suggest it has arisen due to the limitations in the paradigms that historically have been used to understand Thai society – and which in the late 1980s and 1990s were uncritically adopted by researchers commencing work on Thai AIDS. In respect to the first point, as Jackson (1996a: 85) notes in respect of studies of Thai homosexuality: [a] characteristic of Thai discourses involves the assumption that Thailand possesses a single, uniform sexual culture and that biomedical and quantitative studies are capable of adequately reflecting that. Only a very small number of anthropological and historical studies of homosexuality reflect on local values, attitudes and practices as something distinct from the Western experience.

This is also true of research about Thai sexuality in general. Few studies consider the possibility of regional variations in Thai heterosexual culture yet, as Van Esterik (1999: 276) points out in respect of the study of gender, even Central Thailand is a region of immense ethnic and class diversity and ‘cannot be treated as a hegemonic homogeneous system’. Nor do they consider that Thai heterosexual values may be fundamentally different from those found in the West (see Van Esterik 1999). Instead, the bulk of early 1990s HIV/AIDS-related research about Thai sexuality comprised various forms of KAP (knowledge, attitude, practice) or KABP (knowledge, attitude, belief, practice) survey research. Indeed, as late as 1997, London et al. (1997) utilise data from an anonymous self-administered survey (1991) to study same-sex behaviour amongst military personnel in Northern Thailand, and Suthep (1999) uses a similar technique to study AIDS knowledge and risk behaviour amongst school children. However, by the mid-1990s AIDS-related research generally utilised more sophisticated questionnaires such as rapid assessment procedures and focus groups, and claimed that these were qualitative techniques that could get beyond the limitations of straight quantitative research. Thus, VanLandingham et al. (1994) argue in support of focus-group-based research as a means of gaining reliable data about Thai male sexuality. Yet such techniques do have limitations. In particular, as Ford and Sirinan (1994: 526) point out they ‘are not an appropriate mode of collecting data on areas of respondents’ behaviours which are socially sanctioned (such as

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young Thai women’s sexual activity)’. From their research they cite an example of the only woman in eleven women’s focus groups to have admitted to premarital intercourse being labelled ‘mad’ by another participant ‘not for engaging in the behaviour but in admitting it’ (1994: 526). Lyttleton, too, cites examples of some Isaan women informants who laughingly recounted how, when surveyed regarding their sexual activity by visiting health-science students, they had resisted either by refusing to answer or by giving ‘the first figure that came into their heads’ (1999: 29).19 Even rapid assessment techniques, which Farmer (1992: 300) terms ‘crude representations of anthropological methods’, have the limitation of being essentially synchronic research which, in rapidly transforming social contexts, are inadequate to model changing local knowledge. Critically, such techniques do not involve in-depth ethnography and the depth of qualitative data it provides; the data they do provide is decontextualised, and they aim at statistical reliability rather than reliability of interpretation. As Bolton (1995: 298) puts it, they ‘have privileged etic over emic, data quantity over data quality, reliability over validity, and statistical significance over real significance’. Centrally, and perhaps most seriously, these research methods have been characterised by a lack of reflexivity in that they have not challenged the premises on which they were based (see Kapferer 2000). Recent calls by Brown et al. (1998b), VanLandingham (1998) and VanLandingham and Trujillo (2002) for yet another national survey of sexual behaviour suggest that this situation is not likely to change in the near future. Indeed, this is also suggested by Gray et al.’s (1999) review of Thai gender, sexuality and reproductive health research, which disparages both qualitative research and the importance of understanding local cultural values. They argue that although qualitative research has provided valuable insights, the distinction between qualitative and quantitative research is misleading. Instead, they claim that ‘the principle is logical analysis within a sound theoretical framework’ (1999: 62) as a means of getting beyond what they call the traditional ideological assumptions of Thai culture. For them the complexities of culture are merely an impediment to understanding; as they put it: ‘Without dismissing the importance of a thorough understanding of 19. It is important that such resistance not be viewed as being solely women’s reluctance to talk about sexual matters. As I argue in chapter three, following Scott (1985, 1989), such resistance is a common response to acts perceived as state interventions made by representatives of state agencies, or even just the intervention of outsiders in the private space of villagers’ lives.

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Thai culture when undertaking research in Thailand … the ideology has limited the understanding of important social processes.’ (1999: 63). Bolton also claims that people have now learned to give socially acceptable answers to AIDS surveys, and that the high reliability claimed by researchers is ‘not because people are reporting their behaviour accurately but because it is even easier to report ideology consistently’ (1995: 299). Certainly this was the case by the mid-1990s in Northern Thailand, where villagers in the Sansai district, where I worked in 1993 and 1994, had been surveyed about HIV/AIDS-related issues five times over a period of one year. Focus groups, too, suffer from this limitation as, although they do not aim at providing statistically significant data (Ford and Sirinan 1994), they do rely on agreement between participants or, as Ford and Sirinan put it, ‘a high degree of convergence in the findings … to indicate that they reflect a more general pattern’ (1994: 519). Apart from familiarity with AIDS surveys and AIDS/sexuality focus groups, there are at least two reasons why informants might prefer to report ideology rather than the true state of affairs. The first concerns the relationship between the rural and urban underclass and the new urban middle class, whose values radio and television bring into almost every household. Well aware of the urban middle-class’s view of them as ignorant rustics, rural villagers and the urban underclass sometimes answer surveys in terms of what the media has presented as the modern safe sex values and behaviours. Thai notions of self and identity and the value Thais place on external appearance also make it likely that Thai villagers will report in terms of ideology when answering surveys or participating in focus groups dealing with their sexuality. Mulder, who has taken up the issue of the distinction between reality and appearance in several publications (Mulder 1992a, 1992b, 1997), argues that the Thai educational system teaches Thais that, regardless of actual reality, they must present themselves and their actions to others in a positive and non-troublesome fashion (Mulder 1997). Such presentations are both verbal and in terms of dress and kinesthetic modes (Phillips 1965: 45) and denote not only who one is but, as Van Esterik (1999: 277) points out, ‘communicate how one expects to be treated’. Apart from an abiding concern with appearance and presentation of self, an allied reason why villagers may respond to surveys in terms of ideology lies in the amount of intervention in the private sphere that HIV/AIDS has engendered. I have argued this point at length in chapter three, where I suggest that the public

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health threat that Thai AIDS represents has legitimated an unprecedented degree of penetration of state agencies into the previously private sphere of sexuality. The provision of misinformation (see Lyttleton 1999) through giving random answers, or through giving the answers questioners are perceived to want, is a classic technique of resistance used by the powerless when confronted by the power of the state – in the form of representatives of the many state agencies with an interest in the HIV/AIDS sphere (Scott 1989). The depth of resentment at what is perceived as state intervention in villagers’ lives, and the coercion of villagers, should not be underestimated as the intensive political coercion carried out in rural villages during the 1970s (Bowie 1997; Morell and Chai-anan 1982; Wright 1991) is still fresh in local memory. A second reason for the adoption of Western moral-yardsticks to evaluate Thai sexual behaviour, and the consequent failure of much HIV/AIDS research to address aspects of Thai sexuality and sexual practice, lies in the limited range of paradigms that historically have been used to understand Thai society, and the manner in which these have failed to address many aspects of Thai social life. Juree and Vicharat (1979) and Phillips (1979) take up the issue of the premises characterising American (or more broadly, Western) scholarship on Thailand. Juree and Vicharat point out the extent to which the study of Theravada Buddhism and Buddhist values has dominated much social science research on Thailand over the past forty years, and the extent to which they have been used as an explanation for Thai behaviour (see Mulder 1992a). Indeed, Buddhist values have been used to explain behaviour as diverse as attitudes towards contraception (Caldwell 1967), to risk-taking (Ford and Suporn 1991), prostitution (Muecke 1992) and the acceptance of prostitutes as spouses and members of village communities (Peracca et al. 1998). However, as Juree and Vicharat (1979) point out (see Tannenbaum 1995, 1999), this is an over simplification that has led to ignoring aspects of social life such as tension, competitiveness and aggression, and it homogenises in terms of region, ethnic group and class. In a similar vein Phillips (1979) specifies what he claims are three premises underlying much American (Western) scholarship on Thailand. He claims that ‘it is a scholarship of admiration for Thai history, culture, and society’ (1979: 449) and that it has constrained scholars from adopting a more critical approach towards that culture and its values, that it is founded on assumptions of a Thai cultural uniqueness and that it has generally taken a Bangkok-centred approach to the study of Thai society. Anderson

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(1978) makes a similar point, and suggests that Western scholars’ acceptance of the Bangkok elite’s construction of Thai culture is a result of a deeply ingrained admiration of Thailand’s independence from colonial rule. Although Anderson’s (1978), Juree and Vicharat’s (1979) and Phillips’s (1979) critiques of Thai scholarship were produced twenty years ago, their comments are equally apposite today and shed light on the manner in which Thai HIV/AIDS research has developed, and its failure over the past decade to raise what I argue are fundamental questions about Thai sexuality. Critically, although all three works located these assumptions in the work of Western (largely American) scholars, by the late 1990s they also characterised much work on Thailand by Thai scholars, a high proportion of whom trained in North America.20 Thus Mulder (1997: 301) is highly critical of the lack of reflexivity and analytical depth of a recent National Identity Board publication produced by senior Thai scholars, and comments: ‘it seems as if the authors read too much Bang Chan-inspired literature. The strange mix of Buddhism, individualism, consideration, and indifference that that generation of anthropologists concocted in their speculations about life in that particular village … has found its way into the book’s narrative.’ Moreover, such limiting assumptions are not restricted to the AIDS sphere. For example, the historian Tongchai (1994) is highly critical of the Bangkok-centred focus of Thai history and the failure of historians (both Thai and foreign) to consider regional culture and regional perspectives on state formation (see Rhum 1996). Considering the geopolitical position of Thailand over the past century (and the post-Second World War period in particular), one might also think Sahlins’s comments (made in respect to the Hawaiian context) apposite to much scholarship on Thailand and its subtle although insidious effects: There is a kind of academic defence of the cultural integrity of indigenous peoples that, though well-intentioned, winds up delivering them intellectually to the imperialism that has been afflicting them economically and politically. I mean the paradox entailed in defending their mode of existence by endowing it with the highest cultural values of Western societies. (Sahlins 1995: 119) 20. Given the prominence of American universities in training Thai postgraduate students in the post-Second World War period, perhaps it is no coincidence that ‘family values’ (Mulder 1997: 332; Tannenbaum 1999: 123) as a solution to the AIDS problem appeals to both American and Thai scholars working on Thailand’s HIV/AIDS epidemic. As I pointed out in chapter two, Pansak’s recent Thai language work on female adolescent sexuality (Pansak 1999) pokes fun at simplistic and naive platitudes by its title, Just Say No, Or OK.

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Notions of pan-Thailand cultural homogeneity in which Buddhism constitutes a cultural glue, the uncritical acceptance of Bangkok centrism and notions of particularly high standards of Thai female morality on the part of the masses which is juxtaposed to those of an amoral and badly behaved few, spring immediately to mind. The various premises that Juree and Vicharat (1979) elicit as being characteristic of scholarship on Thailand have been important in the development of analyses of Thai gender, both masculinity and femininity, from the 1950s until the early 1980s. Subsequently, in the AIDS era, these analyses were adopted as authoritative works on Thai culture and gender, on the part of those working in the contemporary HIV/AIDS field. However, their adoption has been largely uncritical; the Thai AIDS field itself, as I have pointed out, being one characterised by a general lack of reflexivity that would question fundamental assumptions. Thus, in respect to masculinity in Northern Thailand, as I pointed out in chapter three, approaches that seek to understand masculinity without a consideration of Thai (and Northern Thai) cultural values, including Buddhist values, and values relating to class structuration in the late 1990s, are fundamentally flawed. In the case of women, as I have suggested above, there may be some fundamental misinterpretations of female sexuality: about it being solely constituted through Buddhism; about its ultimate circumscription by men; about female desire and the amount of female sexual activity; and, most importantly, the moral notion that the Thai population comprises discrete groups of moral ‘good’ women and amoral (sexually active outside of marriage) ‘bad’ women. The problem then, as Comaroff and Comaroff put it (1982: 71), is that ‘the human body is seen to provide the “raw” material, the presocial “base” upon which collective categories and values are engraved … once they have taken root in a body … these meanings take on the appearance of transcendent truths.’

Thai Women: Approaches to Their Gender and Sexuality Contemporary approaches to Thai female sexuality are best understood through tracing the development of gender and sexuality studies over the past fifty years of social science in Thailand. In the early 1950s, consideration of gender and sexuality issues was generally subsumed within wider projects: social science

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studies of Thai society featured women primarily in the domestic sphere, in their various roles in agricultural activity and in their role as supporters of the Buddhist religion. Thematically, early works on Thailand focused on issues such as development, Buddhism and its ritual practice and the relative tightness or looseness of Thai social structure. Analyses of gender only really began in the 1960s, with Hanks (1962) and Hanks and Hanks (1963). They argue for largely egalitarian relationships between men and women, with women being primarily concerned with the household and its relationships and men being primarily concerned with relationships and power outside the household. Moreover, Hanks (1962) argues that gender is less significant than are distinctions in status or rank based on merit – thus women may rank higher than men. Later, Kirsch (1975) argued (in a rather tautological fashion) that the division of labour in Thai society, where men are involved with politics and religion and women with the economy, was based on Buddhism, with women having more worldly attachments than men and a consequent need for more merit-making. As Tannenbaum (1999: 245) points out, from this point onwards debates about gender in Thailand focus on this issue of relative female attachment and worldliness. Thus, female (and male) gender issues are implicitly viewed as being largely determined by Buddhism. This debate developed in the decade from the late 1970s to the late 1980s, primarily in the work of Kirsch (1982, 1985) and Keyes (1984, 1986, 1987). Kirsch (1982) developed his earlier (1975) analysis, pointing out that although women are highly involved in economic matters, money is not necessarily a sign of high status. Instead, such concerns are an indication of a greater attachment to the world which restricts women in their attaining of Buddhist goals. Keyes (1984), by contrast, examines popular Buddhist (Jataka) stories read at ordinations and funerals to derive what he claims are central images of women in Buddhist culture. He disagrees with Kirsch, arguing that as men and women are differentially attached to the world they follow different paths, yet paths that are similarly valued in a religious sense. He argues (a point later further developed by Muecke 1992) that for women the most salient image is that of the nurturing mother ‘nurturing not only one’s children but also the Buddhist religion itself’ (Keyes 1984: 237). The debate continued in Kirsch (1985), who points out that although both he and Keyes agree on the significance of Buddhism, there is a need not to focus solely on texts but on the experiential lives of people that give texts meaning and context. The limitation of both these authors, as Tannenbaum

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(1999) points out, is their premise that Buddhism is the primary structuring factor in Thai society, and the consequent assumption that female (and male) sexuality is structured and circumscribed by formal religious rules. Keyes (1984), for example, fails to consider the relevance of ritual texts to everyday life, or the laity’s interpretation of these texts and, as late as 1987, Keyes’s monograph Thailand: Buddhist Kingdom as Modern Nation State still utilised Buddhism as the overall structuring force in Thai society. Outside the Kirsch-Keyes gender debates, Northern Thai research dealing with the phii buu yaa cult (by Anan 1984a, 1984b; Davis 1984; Paul Cohen n.d., 1984; Potter 1976; Turton 1972, 1975; and Wijeyewardene 1977, 1981, 1984, 1986), added another dimension to debates about Thai gender. As a result of studies of the phii buu yaa cult it was recognised that the position of women in the North was somewhat different to that of women in other areas of Thailand, in that the cult gave women a position of some power. Yet the cult centred on both the control of land and of female sexuality, and Wijeyewardene (1986) argued that it was ultimately under the control of men. Thus, as masculinity was viewed as being largely constituted through Buddhism, once again the overall framing of gender relations was couched in Buddhist terms. The 1980s and rapid social change in Thailand; a mature feminist revolution in the West that refocused academic attention on gender issues; and the final death of the lingering structural functionalism inherent in many early monographs on Thai society, saw the rise of a new postmodernist-influenced ethnography that moved the focus of analyses from the text-orientated studies of Keyes and Kirsch to a concern with social practice. By contrast with earlier works that were primarily concerned with rather orientalist analyses of Thai Buddhism and models of a Buddhist society into which gender was inserted, these new works were concerned with female gender and sexuality per se. Initial studies (Pasuk 1982; Thitsa 1980) focused on female sexuality in the context of the problem of prostitution, its historical roots, its contemporary causes and attitudes towards it in Thai society.21 Later 21. The issues of prostitution, women’s fall into prostitution (often due to the obligations of nurturance of family members), men’s relations with prostitutes and accounts of successful prostitutes who overreached themselves are longstanding themes in Thai language literature since as far back as the 1930s. In the present day these themes have been taken up by popular Thai language authors such as Potgarmat Priichaa (1993) and Kamphuun Bunthawee (1996, 1999a, 1999b) and the regular reprints they undergo suggests they strike a chord with readers. However, the majority of social science writings by West-

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work by Muecke (1984) focused on the changing position of women and, yet again, on the issue of prostitution and Thai cultural values (Muecke 1992), and how economic factors in concert with these values led women into prostitution (Leheny 1995; O’Malley 1988; Richter 1988, 1992; Truong 1990).22 These works all considered Buddhism as an important factor in structuring what they generally viewed as unequal and highly exploitative gender relations. As a result, they were critical of Buddhism at the levels of both text and practice, and introduced new concepts such as patriarchy, patriarchal culture, and issues of economic relations, power and class which allowed them to move beyond the terms of earlier debates about Thai gender relations. Critically, in respect to my analysis in the following, they not only approached the position of women and female sexuality through the lens of gender, they viewed these issues as social problems to be rectified. This then was the position of Thai gender studies in the late 1980s and early 1990s. From that time until the present, with the exception of work by analysts such as Mills (1997, 1998, 2001) and Tannenbaum (1999), little has been added to earlier studies of women and gender in Thailand. Instead, driven by a need to know about sexual risk and likely paths of HIV transmission, the study of Thai sexual values and sexual practices developed as a massive and largely new research area. While these works, at least in the early 1990s, often shared the same starting point of earlier studies of gender, there was one sharp disjunction from erners have ignored these works – either through ignorance or because they were considered to have little to offer to an understanding of the problem. Unfortunately a similar situation prevails with the major Thai language journals dealing with HIV/AIDS: Doctors’ Journal, Journal of Infectious Diseases, Journal of Rajavithi Hospital and the Thai AIDS Journal, which are almost never cited in English language HIV/AIDS-related works unless the publication is coauthored with a Thai author. 22. An interesting and perceptive group of works on the relationship between Bangkok prostitutes and foreign tourists was also produced by the sociologist Eric Cohen over the decade from the early 1980s to the early 1990s (Cohen 1982, 1986, 1988, 1993) and was later republished in a monograph dealing with various facets of Thai tourism (Cohen 1996). Unfortunately, these works are rarely cited in the standard social-problem analyses which rely on conventional Western notions of morality. Walker and Ehrlich’s (1992) work on letters between tourists and Thai bar girls follows in a similar vein. Cohen views economic factors as being at the heart of prostitution but, unlike the majority of works produced during this period, he primarily focuses on understanding the lives of prostitutes and their relationships with their clients. Walker and Ehrlich attempt no explanation: however, in a prologue, Dr Yos Santasombat also moves in the direction of an economic explanation.

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earlier works. Earlier works dealing with gender and sexuality in Thailand were largely produced by those working from an anthropological or sociological perspective; this new genre of work was produced by researchers working from a variety of perspectives (with accompanying new methodologies) ranging from history and social geography to demography, epidemiology and biomedicine. Moreover, unlike earlier studies of Thai gender by researchers with relatively long-term experience in Thailand and who usually had Thai language skills, many works in this new category have been produced by researchers who have spent only a relatively small amount of time in Thailand and have limited Thai-language skills (particularly reading skills). Yet, from that time until now, HIV/AIDS and AIDS-related issues have driven the study of Thai gender through the study of sexuality. This work has been fruitful in as much as some seminal works have been produced. In particular, the complexity and plasticity of the Thai gender spectrum has now been acknowledged through work on both male and female homosexuals and kathoeys (Beyrer et al. 1995; de Lind van Wijngaarden 1995a, 1995b, 1999; Jackson 1995a, 1995b, 1996a, 1996b, 1997, 1999; Jackson and Cook 1999; Jackson and Sullivan 1999; Morris 1994; Piyada et al. 1995; Sinnot 1999; Took Took 1994; Werasit and Chuanchom et al. 1992; Werasit et al. 1993).23 However, as the study of Thai sexuality motivated by the threat of HIV/AIDS was generally directed to the understanding and monitoring of risky sexual behaviour, particularly that of the members of social groups classified as risk groups, very early on in the development of this genre, sexuality and practices viewed as uncontrolled sexuality (generally any sexual activity prior to or outside marriage) began to be treated as a social problem to be ameliorated. As far as prostitutes were concerned, some research about the social and economic context of prostitution continued (Chai et al. 1993; Manderson 1992, 1995; Montgomery 1996a, 1996b, 2001; Muecke 1992; Odzer 1994; Wathinee and Guest 1994). However, the bulk of the new HIV/AIDS-motivated research moved away from these issues to focus on prostitutes in a highly technical and highly medicalised fashion, and the dominant HIV discourses have been based on the premise that CSWs were a known risk group. Research directed at prostitutes focused on general issues such as the organisation of prostitution, risk factors and 23. A kathoey is a biological male who dresses in female clothing and takes the role of a woman. She may or may not have had sex-reassignment surgery. See Jackson (1996a, 1996b, 1997).

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condom use in the North (Chuanchom et al. 1997; Cohen et al. 1995; Fontanet et al. 1998; Hanenberg and Wiwat 1998; Morris et al. 1995; Sombat et al. 1991; Suchart 1992; Surasing et al. 1995; Taweesap et al. 1991; Wait and Coughlan 1999; Wawer et al. 1996) as well as more specific issues concerning HIV prevalence and seroconversion (Celentano et al. 1994; Gray et al. 1997; Kilmarx et al. 1998; Kumnuan et al. 1990; Pathom et al. 1994; Sombat and Taweesap 1991; van Griensven et al. 1995). Research amongst other groups approached the issue of Thai sexuality in a highly structural–functionalist fashion which, as I pointed out earlier (see also Fordham 1999), apart from some country-wide surveys of sexual practices (Werasit and Praphan et al. 1992), has focused on AIDS knowledge and sexual practices amongst various social and occupational categories. Indeed, in 1999, official AIDS statistics were still disaggregated in terms of occupational categories and the type of risk group/sexual orientation (that is heterosexual/homosexual) that gave rise to HIV infection (MOPH 1999: 4). Importantly, as I point out in chapter three, much of the Thai HIV/AIDS programme focused on an overt agenda of controlling the sexuality of the economically marginalised; an act that amounted to a covert agenda of class domination. In the case of men this focused on rural and urban labourers, while in the case of women attempts to control female sexuality focused on women in commercial sex and, with the exceptions noted earlier, the sexuality of women in general has largely been ignored (except in as much as it is confined to marriage). The problem, then, is that overall the study of women’s gender and sexuality in Thailand over the past fifty years of social science, might be characterised as being partial and highly limited. Early works by anthropologists, such as Keyes and Kirsch, were limited in their assumption of the overarching structural significance of Buddhism and in a general focus on textual materials rather than daily practice. Yet later works of the 1990s are also limited, in as much as their social-problem perspective led them to focus on sex/gender issues primarily amongst only one category of women, those working in commercial sex, and led them largely to ignore works by earlier analysts such as Keyes and Kirsch, and the implications of their work for directing a deeper study of Thai gender relations. In the early 2000s, despite the plethora of studies on both female and male gender issues as a result of the advent of HIV/AIDS in Thailand, it is arguable that although we have copious data about the sexual practices of many social groups, our understanding of women’s (and men’s)

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sexuality and gender issues has advanced little over the past two decades. Rather, research that has privileged survey and focus group methodology over more fine-grained ethnographic approaches has produced, and continues to produce, highly essentialist and stereotypical models of Thai sexuality and sexual practice. Thus recent works proclaim ‘Thai Views of Sexuality and Sexual Behavior’ (Knodel et al. 1996), ‘Contexts and Patterns of Men’s Commercial Sexual Partnership in North-eastern Thailand: Implications for AIDS Prevention’ (Maticka-Tyndale et al. 1997) and ‘Can Prostitutes Marry? Thai Attitudes Toward Female Sex Workers’ (Peracca et al. 1998). Moreover, in its focus on sexuality solely in terms of a technical problematic to be manipulated, and in its reduction of gender meanings and those of the sex act to meanings which are capable of delivery through language (see Dowsett 1996), such research has stripped sex and gender of much of their meaning. Instead of meanings such as love, lust, joy, sharing and liminality (see Bolton 1995), such research sees dangerous risk behaviour that necessitates external intervention and control. As a recent study of sexual practices amongst vocational and high school students in North Eastern Thailand put it: ‘The samples engaged in sexual risk-taking by courting [my emphasis] their boy-friends/girl-friends’ (Sutthiluck et al. 1999). It is ironic that such reductionism in the meaning of sexuality – surely the most meaningful and truly social of all human activities – and the failure to investigate core issues such as notions of the body and emotions (Van Esterik 1999), should be made in the pursuit of understanding. One final point concerning the limitations of current studies of women’s gender and sexuality in Thailand, particularly those generated as a result of the HIV/AIDS epidemic, is the way in which these studies have generally treated men and women quite differently. I argue in chapter three that heterosexual men in the underclass are victimised through the neglect of structural factors and through treating AIDS risk as a matter of individual pathology. Thus Anuswasdi (1994) and many other analysts trace the blame for male risk behaviour to low levels of education – for them risk behaviour is an individualised act carried out due to limited knowledge. However, analysts generally deny prostitutes even this much of an individual identity. With rare exceptions (see Montgomery 1996a, 1996b, 2001; Niwat 1998), female prostitutes are not only treated as members of a degraded group but, once classified as prostitutes are denied individuality through being treated as an essentially undifferentiated category

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of persons.24 There is one more area in which analysts have treated men and women differently during the past fifteen years of intense investigation of Thai sexuality. As noted above, a range of male sexualities is now recognised and masculinity is no longer considered to be constituted solely through Buddhist values. However, with rare exceptions, the issue of the plasticity of female sexuality has not been addressed and Thai female sexuality still seems to be defined either by religion or, ultimately, by biology – an untenable position at the end of the 1990s.25

Moral Panic and the Construction of National Order There are, however, other ways to look at the past and the manner in which Thailand’s HIV/AIDS epidemic has been constructed. These have the potential not only to explain why current perspectives became authoritative but, more importantly, to raise new questions and give new perspectives for the future. I have already argued that the wave model of HIV transmission, the notion of risk groups and the particular focus on prostitutes as an amoral other in Thai society were social constructs that seemed effective and reasonable explanatory devices largely because they resonated with and reinforced pre-existing images and prejudices about peripheral social groups, particularly women such as prostitutes whose sexual activity outside marriage was highly conspicuous. I suggest that, in the late 1980s and early 1990s, in a context of wide-spread fears about female sexuality, and cultural values undergoing rapid change under the pressure of globalisation, the advent of HIV/AIDS led to a crystallisation of fears in a moral panic centred around the persons and the activities of prostitutes. This moral panic concerning prostitution and the spread of HIV/AIDS follows in a long line of social movements in the North and North East: the Northern phii ka (witchcraft) accusations between the 1880s and the 1920s (Anan 1984a, 1984b; Fordham 1991); the Northern (1889–90, 1902) and North Eastern (1901–02) messianic Buddhist movements (Chusit 1982; Ishii 24. The situation seems different in the case of female child prostitutes who, if repentant, are generally treated differently from their undeserving elder sisters (Montgomery 1996b). 25. With the hindsight of almost a quarter of a century it is perhaps unfair, but I find it interesting to note that Keyes (1984: 239, n. 10) takes a highly essentialist position in regard to sexual identities, claiming that they are ‘as primordial as the blood ties, race, language, region, religion’.

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1975; Keyes 1977; Murdoch 1974; Tanabe 1984); the North Eastern ‘shrinking penis’ scares of 1976 (Irvine 1982); the North Eastern ‘attack of the widow ghosts’ scare of 1990 (Mills 1995); and the child prostitution scare of the early 1990s (Montgomery 1996a, 1996b, 2001), all of which arose at times of rapid social transformation and consequent social stress.26 In respect to moral panics Cohen argues that: Societies appear to be subject, every now and then, to periods of moral panic. A condition, episode, person or group of persons emerges to become defined as a threat to societal values and interests; its nature is presented in a stylized and stereotypical fashion by mass media; the moral barricades are manned by editors, bishops, politicians and other right-thinking people; socially accredited experts pronounce their diagnoses and solutions; ways of coping are evolved or (more often) resorted to; the condition then disappears, submerges or deteriorates and becomes less visible. (Cohen 1973: 9)

Moreover, as Jenkins (1992: 101) points out, the claims made in moral panics are often a matter of ‘the politics of substitution’, where claim makers draw attention to a specific problem as it symbolises another issue which for some reason cannot be attacked directly. He argues that groups in 1970s Britain who wished to denounce and stigmatise moral offences such as homosexuality or pornography shifted their focus to children’s involvement in these issues, and campaigned ‘not against homosexuality, but paedophiles; not so much against pornography in general, but child pornography’. Thus I suggest that, in the 1990s, prostitutes and the rampant sexual appetites with which Northern Thai culture vested them were merely metaphors of broader social concerns. The late nineteenth and early twentieth centuries were a time of rapid transformation in the administrative system of the North, and a period when land began to acquire a commodity value (Fordham 1991). In this context, conflict between peasants and minor princes, newly dispossessed of administrative power, drew on apposite cultural motifs to produce an ongoing series of witchcraft accusations against landholding peasants (Bock 1884: 334–35; Hallett 1890: 110; McGilvary 1912: 204–46) which lasted from the 1880s until the 1920s (Anan 1984a). In the early 1990s the North, and 26. Hjorleifur Jonsson (personal communication) suggests that the 1960s fears about tribal insurgency, and the counter-insurgency measures they prompted, were also of the nature of a moral panic.

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Thailand as a whole, experienced high rates of economic growth and a similar period of massive social transformation, particularly in respect to class structuration. This gave rise to widespread concerns about social change, and in the North, for example, local papers published regular articles dealing with the problem of the dissipation of Northern culture under the onslaught of social change, about the youth problem and about the problem of young people’s sexuality. I suggest that in this period the way in which HIV/AIDS, its causes and solutions have been understood, has been in the form of a moral panic centred on prostitutes and their activities. In this case I suggest that the HIV/AIDS moral panic has drawn on deeply sedimented social values and fears about women and uncontrolled female sexuality, which have led to the demonising of women in prostitution and to the development of a constellation of policies and technical interventions directed towards their control: through their enumeration and classification, through an intense focus on their sexual activity and the ongoing monitoring of their sexual health – and to the concomitant structural neglect of the sexuality of the bulk of the female population. As Weeks puts it: The moral panic crystallises widespread fears and anxieties, often dealing with them not by seeking the real causes of the problems and conditions which they demonstrate but displacing them onto folk devils in an identified social group (often immoral or degenerate). Sexuality has a particular centrality in such panics, and sexual deviants have been omnipresent scapegoats. (1981: 14)

What, then, are the images of women that the HIV/AIDS moral panic has focused on? In an interesting and provocative paper Keyes (1986) explores what he terms an ‘ambiguity’ in male gender roles, in as much as he distinguishes two ideal role models: the monk who epitomises control and restraint; and, by contrast, the macho nakleeng (or village strongman) who, as Keyes puts it, ‘epitomizes the man who accentuates desire for power, wealth, pleasure, and sexual domination’ (1986: 87).27 Although male religious roles have certainly received the most attention over the past four decades, in the work of prolific writers such as Keyes (1975a, 1975b, 1977, 1982, 1983a, 1983b, 1984, 1986, 1987) and Tambiah (1970, 1976, 1984), as well as many other Thai specialists such as Davis (1984) and Wijeyewardene (1977), the more 27. As Tannenbaum (1995: 8) points out, this is only an ambiguity if considered solely in Buddhist terms.

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aggressively masculine roles have also been explored by Paul Cohen (1987), Fordham (1995), Johnston (1980), and Mulder (1992a, 1992b, 1997). However, much less attention has been paid to ambiguity and diversity in women’s roles. In the course of the Keyes–Kirsch debate about gender Keyes (1984) distinguishes analogous highly dichotomous images of women in Northern Thailand. Here, as in much of his work, Keyes relies on Buddhist texts as a window onto deep structural social values. In this case he accesses images of Northern Thai women through popular myths and ritual traditions read or recounted by Northern monks in their sermons and in the folk operas of the North East. He claims that the dominant image of women in popular Buddhist texts is that of the mother (mae), not solely women in their role as the nurturer of children, but women as mother to the Buddhist religion (1984: 227). Indeed, he claims, following Pasuk (1982), that it is this image of the nurturing mother that prostitutes draw on in making sense of their lives. Muecke (1992) too, in her analysis of Thai prostitution argues that it is this image that young women identify with in their taking care of aging parents and younger siblings. And, as I point out earlier, it is this image that is stressed in Thai language literature dealing with prostitution. Yet, opposed to the dominant image of women as mother, Keyes distinguishes secondary images of women, those of passionate and suffering women, and of women as demanding mistresses. He points to courting songs in the North East that portray a tension between a desire to fulfil passion and the tempering of passion by the awareness and fear of its consequences. He claims the latter is a Buddhist interpretation of passion, in as much as passion, in the sense of attachment to others, leads to suffering (dukhha). Van Esterik (1982: 76), too, claims that in Central Thai culture ‘women are viewed as “oversexed”, and as actively seeking sexual satisfaction, even to the point of tempting or seducing monks’. However, Keyes (1984: 234) claims that this image is not found in Northern or North Eastern Thailand, and says that he doubts its validity. Keyes’s analysis of the imagery of women as demanding mistress is even less well developed than his analysis of the imagery of the passionate woman. However, here again he draws directly on Buddhist textual work, in this case the Jataka stories, which he claims are still touchstones to which women point ‘when discussing a woman who finds herself constrained to barter for sexual favours for some material gain from a man she does not love’ (1984: 233). However, he does little to develop his analysis with concrete ethno-

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graphic data, except to point out that the image of the demanding mistress is a common motif, not only in popular myths and songs and in the media, but in daily life. This is certainly the case, and in villages where I have conducted fieldwork villagers gossip with great gusto about the sometimes outrageous (financial and other) demands that local mistresses make on their often much older lovers, and the stresses faced by their lovers in complying with these requests. Keyes (1984) also suggests that there are now new images that are salient for young women, deriving from urban areas such as Bangkok, and propagated in popular song, film and television, and that the dominant image is that of the secularised sex object. Mills’s (1997, 1998, 2001) work on young female migrants to Bangkok gives some indication of how these new images are constructed. However, I suggest that, alongside these new images, the images of the passionate woman and the mistress remain significant, even if they have been largely secularised over the past two decades of economic and social transformation. Importantly, contrary to Keyes’s (1984) claim, images of sensual and oversexed women are relatively common in Northern Thailand, as is an understanding of the destructive power of female sexuality. Fundamental teachings in Buddhism govern intercourse between monks and women, and the power of women’s sensuality to tempt monks is well known to all. In the North it is clearly recognised that young women’s sexuality has to be controlled and, as specialists on the North (Paul Cohen, n.d.; Cohen and Wijeyewardene 1984; Davis 1984; Wijeyewardene 1984) acknowledge, in the past this was the primary function of the matrilineal spirits, the phii buu yaa cult. And, in the present day, not only does village gossip and the bawdy banter of men at drinking parties (Fordham 1995) deal with the seductive powers of local women, but local newspapers in the North regularly publish front-page stories of men who have endured some form of downfall due to their seduction by women, and it is not uncommon for the victims of such seductions to be monks. In either case, newspaper reports are often replete with lurid photographs of the victims and their seductresses. In terms of specific Northern Thai beliefs about women, Davis (1984) takes up the issue of female sexuality in his analysis of the Northern Thai cosmology. He points out the danger of female potency, an essence so powerful that objects associated with women (particularly their underclothes and lower garments) have the potential to destroy masculine powers, and notes that the ‘destruction of a man’s magical powers by a woman is a frequent theme in Muang literature’ (1984: 66). The

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Northern Thai folklore specialist Raynou Athamasar also points out Northern Thai beliefs about the polluting power of women’s sexuality when she notes that in traditional Northern belief pregnant women are forbidden to go near wells lest they cause the water to spoil, to touch agricultural implements lest crops be spoiled, or to touch house building equipment lest the building project be unsuccessful.28 Importantly, in terms of my analysis here, she emphasises that it is not merely that these rules act to restrain women due to the polluting power attributed to them, but that they act to devalue female sexuality and potency. In the North women were also believed to be potentially harmful in as much as their failure to carry out the rituals to the phii buu yaa could cause harm to others. In the past, the voracious phii ka – a transformation of the phii buu yaa whose rites have been neglected – who roamed the fields at night ready to devour the entrails of the unwary, were believed to be transmitted linearly through women – in a sense, female potency run amok.29 Such beliefs had real social consequences, and missionary and traveller reports from the nineteenth and early twentieth centuries give vivid descriptions of the results of witchcraft accusations and report whole villages settled by people fleeing them (Bock 1884; Dodd 1923; Hallett 1890; McGilvary 1912). Certainly, as Anan (1984b) suggests, such accusations were often a cynical manipulation of local idioms on the part of princes seeking to force villagers to move to resettle the Northern towns of Chiengseen and Faang or, as already noted, to allow them to claim ownership of peasant land. However, as I have pointed out above, it is not merely that such cultural idioms blame women, it is that in blaming women they act to devalue female sexuality and potency. The distinction between the two roles for women discussed here – the woman as mother/nurturer and that of the passionate (and sometimes voracious) woman – parallels another important classification made throughout the North as well as elsewhere in Thailand, a division between ‘good’ women (phuuying dii) and ‘bad’ women (phuuying maidii). Indeed, as Montgomery (1996b, 2001) points out, as early as 1805 this distinction was formalised in Siamese law in the code known as the Law of the Three Seals (Reynolds 1977). This stratified women into good and bad – those who were sexually available to only one man and those who were more widely available. Thus it advised that ‘A good woman [my emphasis] should not let more than one man gain access to 28. Raynou Athamasar (personal communication). 29. Raynou Athamasar (personal communication).

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her body’ (Harrison 1996: 40). Today, good women are those who remain at home as housewives, or who work in the many occupations open to women, who marry and have children, and whose sexuality is constrained within the confines of the home and marriage (Bao 1999; Harrison 1996, 1999; Manop 1994). By contrast, prostitutes are the paradigmatic bad women. They flout the normal conventions of marriage and accepted occupational roles and, critically, their sexuality and general behaviour are not just unrestrained but are often an inversion of accepted female behaviours. They dress flashily, drink alcohol in public, go out alone at night and, as one female informant put it, ‘walk with legs apart’ (kaa gaang); most importantly, their sexuality is not restrained within the confines of marriage but is available to all, for a fee. Critically, there is an absolute distinction (Fordham 1995; Mulder 1992a) between the sexually restrained good and moral mother and other sorts of women with an unrestrained sexuality. As Harrison (1999: 168) puts it, ‘the polarities of “good” and “bad” Thai womanhood allow for no intermediary positions’. Moreover, this classification is ubiquitous in everyday conversation and is refracted through the print and electronic media, particularly that dealing with HIV/AIDS. Lyttleton (1996b: 372), for example, points out that public service announcements about HIV/AIDS are based on a simple binary classification of ‘good’ and ‘bad’ women. He notes that television advertisements of the early 1990s portray good women as wives and mothers who tell the viewer that ‘good women can still get it’, and suggests that the implications of such spots is that ‘bad’ women deserve to get it. Again, as recently as the late 1990s, in a classic reflection of the good woman/bad woman divide, one Northern Thai AIDS poster juxtaposed highly stereotypical drawings of a rather frumpish mae baan (housewife, literally, mother of the house) with a physically attractive woman with makeup, high-heeled shoes and skimpy dress, and carrying a basket labelled AIDS. To give one more example, the events marking World AIDS Day 1994, at a temple in Mae Rim (some 15 kilometres to the north of Chiangmai), included a group of HIV-positive women who were assembled on a dais to speak about their experiences to a gathering of local villagers. The event was convened by a local district officer who, in his speech introducing the women, emphasised that ‘these are good women [my emphasis], mae baan, who got AIDS through no fault of their own’. As in Lyttleton’s example, the implication was that although these ‘good’ women didn’t deserve their fate, this was not so for other, ‘bad’ women.

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I argued above that a scholarship of admiration for Thai society, the assumption of Thai uniqueness and the tendency to view Thai society through the lens of Buddhism has prevented both Thai and foreign AIDS researchers from conducting a more critical interrogation of Thai sexual culture. The predominant image of Thai women, celebrated in Thai Buddhist literature and refracted through and analysed in the social science literature on Thailand, is that of the nurturing mother, the mae baan. This is the image of women explored in the field of Thai Studies, and more recently taken over in the new field of Thai AIDS studies. Just as in the case of men, where the violence of the nakleeng or the robust sexuality of the male rural and urban underclass has generally been treated as aberrant, the sexuality of the passionate and sensual woman has been treated as aberrant and socially deviant rather than as an alternative or an adjunct to the role of the nurturing mother. As Manderson (1995: 311) points out in regard to the representations of various social groups: ‘the structural subordination and textual silencing or muting (E. Ardner 1975) of particular groups – women, the peasantry, the proletariat, homosexual men, and lesbians – make them equally vulnerable to the essentialist representation that has them either as sex alone, or without sex [her emphasis].’ In the Thai case, good women, paradigmatically mothers, have been represented as being without sex, while bad women such as prostitutes and women who are known to be sexually active outside marriage are typically represented as sex alone and as dangerous. As late as 1999, an AIDS-prevention brochure produced by the Health Promotion Division of the Department of Health states on its front page: ‘Apart from [your] wife there is almost no woman anywhere who is free of AIDS.’30 Thus, the wave model of HIV transmission and the associated notion of risk groups have drawn on, and in turn, have acted to legitimate and reinforce, pre-existing cultural beliefs about and social prejudices against prostitutes as the paradigmatically bad women who, as a result, have been demonised as a discrete and homogeneous group, responsible for transmitting HIV to the broader Thai population. 30. This is a curious brochure, with a message on pages 2 and 5 advocating condom use. Yet on page 3 it notes in a bold red box, in a fashion seemingly opposed to this advice as well as to the earlier ‘100% Condom Programme’, ‘condoms cannot prevent AIDS 100%, if [you] are unsure about your partner definitely don’t have sex’. Moreover, from the title on the cover page, it is seemingly directed at married men, yet the text inside addresses teenagers. Perhaps such mixed messages reflect not just conflicts between various factions in the AIDS debate, but the difficulty encountered by the state (in the form of state organisations) in coming to terms with adolescent sexuality.

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AIDS, Moral Panics and Witchcraft A brief examination of some of the contemporary social imagery of the prostitute as a bad woman in the print media gives some indication of the anatomy of Thailand’s HIV moral panic. Indeed, it is probably most correct to characterise the overall construction of Thailand’s early 1990s AIDS epidemic as a moral panic, and the particular focus on prostitutes that this engendered as a series of witchcraft accusations that demonised them. Witchcraft is a system of belief about certain persons, frequently women, who consciously or unconsciously use an innate and extremely antisocial power to bring harm to society. Its manifestations vary greatly depending on the belief system within which it is located (Crick 1990: 346). However, generally speaking, such persons are believed to have the power to cause physical harm or even death to its recipients. Certainly this was the case with Thai prostitutes believed to be infected with HIV in the early 1990s; and there are other fascinating parallels between contemporary common beliefs about prostitutes and late nineteenth-century witchcraft accusations. Like the witches of old, the phii ka or the phii porp, prostitutes in the 1990s, by virtue of a specific substance in their bodies, a substance which is invisible to the naked eye, had the potential to kill men and their families in prolonged and painful deaths. They too had the potential to convert their prey into beings like themselves and, like the phii porp, prostitutes were often unconscious of the substance they spread. Also, like the phii porp, the evil spread by prostitutes entered its victims through an orifice or bodily weak points: sex organs, cuts or via bodily fluids. Most fascinating of all, the red eyes of the prostitute, which in the 1990s symbolised infection with HIV, in an earlier generation symbolised that the female owner was a phii ka. I suggest that in the 1990s, at a time when there was little agreement about the many changes taking place in Thai society, prostitutes constituted one social problem on which the various factions in the new middle class and the government could all agree: in this case, that they were an evil destroying the moral and, in the time of AIDS, quite literally, the physical foundations of society. As in the case of what Montgomery (2001) called ‘the cultural crisis’ that led to a moral panic over child prostitution in the early 1990s (Chiangmai News 1993ac), fears about HIV spread by prostitutes allowed the formation of a loose coalition of groups: public and private health organisations; police; Thai NGOs as well as foreign IOs/NGOs and the press (Thai News 1995c), with quite

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divergent and sometimes quite contradictory aims, united together under a common banner – the shared desire to rid society of a persistent evil. As one prominent Thai researcher put it to me at the time: ‘I have never seen everyone so determined to rid society of prostitutes – if we are ever going to do it we will do it now.’ This panic was constituted in the electronic media, in innumerable academic conferences and research publications, in MA and Ph.D. theses, in NGO workshops and programmes of intervention, in a flurry of new law making and, most of all, in the print media. In this period few daily Northern newspapers were published without at least one article dealing with campaigns to eradicate prostitution (Chiangmai News 1993y; Thai News 1995l, 1995i), the evils of child prostitution, and about the dangers that prostitutes represented. Newspaper reports with titles such as ‘Thais in Australia Tell How Foreigners View Prostitution in Thailand’ (Park Nua 1993) also show a degree of sensitivity to foreign views about Thai prostitution, a sensitivity that was given full rein during the Longman’s Dictionary affair late in the same year. Interestingly, apart from vocational training (Chiangmai News 1993u; Khao Siam 1994a; Thai News 1995g), one solution popularly advocated for the rehabilitation of prostitutes was to teach them religion, in the hope that a better grasp of Buddhism would reduce their materialistic tendencies and teach them correct morality.31 So, once again, Buddhist morality and teaching people to know their place in the social order was postulated as the solution for HIV/AIDS. As pointed out in the previous chapter, during this period newspapers printed regular reports about the changing numbers of prostitutes and changing HIV rates in the various Northern districts (Thai News 1995b), with page one often showing photographs of women arrested for prostitution. Thus the Chiangmai News for 27 June 1993 (Chiangmai News 1993d), under a page one article headed ‘AIDS Statistics in Phrae Increase Frighteningly – Roundup of Prostitutes’, discusses the local provincial health department’s plan to round-up prostitutes and give them training 31. Parental greed is usually represented as being at the root of child prostitution (Chiangmai News 1993ac, 1993ad). Throughout the 1990s I attended a number of training sessions for teachers of children in the upper levels of primary school, who were preparing to ‘teach’ rural children to combat suggestions by parents or others that they enter the commercial sex industry. Realist authors such as Kamphuun Bunthawee (1996, 1999a 1999b) portray a much more complex and much more convincing situation of rural poverty, boredom with village life and a desire to reciprocate parents’ love and sacrifice.

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to make them aware of AIDS and AIDS prevention. And, typical of reports for this time, the Chiangmai News (1993b) showed a front-page photograph of young women – presumably prostitutes judging from their averted or blacked out faces – huddling in a corner of a room and hiding their faces as police search their belongings. The caption, ‘A Risky Group for AIDS with Promiscuous Behaviour’, was followed by the explanation ‘a risky group [for the] continuation of AIDS, meaning [that they are] people with the opportunity for having AIDS more than normal persons as a result of having promiscuous behaviour’. Overall, throughout the early 1990s, newspaper articles portrayed prostitutes as the prime reservoir and cause of AIDS.32 Moreover, warnings about prostitution and AIDS were not only ubiquitous in the media. Living in rural Northern villages for much of 1993 and part of 1994, I repeatedly saw young men going out on the town for a few drinks being warned by fellow villagers to beware of prostitutes, often replicating the language promulgated in media public service announcements: ‘Don’t be promiscuous’, ‘Don’t forget your wife and children’. Yet, as was all too clear, from the jocular manner in which such advice was given and received, and from contemporary AIDS statistics, the advice was rarely taken. Public interest in the issue of prostitution at this time was so great that magazines and novelists also regularly took it up. Potgarmat Priichaa’s I Am Not a Prostitute, a novel dealing with the experiences of a Thai mail-order bride was first published in 1990, and was reprinted eight times between 1991 and 1993. Indeed, so much was this period characterised by these concerns, and so seemingly real was the issue, that the author, Kamphuun Bunthawee, in the introduction to his 1999 novel dealing with child prostitution Struggles in the Village of Dok Kieow says: ‘from 1994 and the following years there were teenagers, children and students who had been enticed into selling sex … these were called child prostitutes.’ Yet all the evidence suggests (Montgomery 1996a, 1996b, 2001) that concern about child prostitution at this time was related to rapid social change causing social crisis and 32. As noted in the previous chapter, a concomitant of the HIV/AIDS epidemic in Thailand and other countries has been calls for improved media reporting of AIDS issues. Thus Nimit (1999) argues that Thai media workers have ‘misperception[s] about HIV/AIDS, limited knowledge, and negative attitudes towards PHAs [people having AIDS]’. Similarly, Cullen (1999), writing about the South Pacific AIDS context, suggests that there is an ‘Urgent need for well trained medical reporters’. Such comments suggest to me a concern not solely directed at providing information to the public, but one which is implicitly oriented towards maintaining the dominance of biomedical discourses in the framing of the various regional HIV/AIDS epidemics.

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cultural insecurity rather than a sudden massive increase in the number of child or other prostitutes. Indeed, this position is given overwhelming support by Wathinee and Guest’s (1994) fairly conservative analysis of the number of both child and adult prostitutes in Thailand during this period.33 From the perspective of the late 1990s, the extent of the moral panic over prostitution becomes even clearer. In the 1993/94 period, in the four major, local Northern newspapers of the time, it was common to find several articles a day dealing with some aspect of prostitution and its relation to HIV/AIDS. However, an intensive search of Northern newspapers in October and November 1999 revealed only one short article dealing with prostitution and only one report on a brothel raid (the raid being for the purpose of finding illegal Burmese workers). By late 1999, it was business as usual for coffee shops, bars, restaurants (arenas where prostitutes commonly work) and for a reduced number of direct brothels. Perhaps much of the contemporary Northern attitude towards prostitution is summed up by a mid-2000 report on the front page of the Thai News (2000b) titled ‘Hell Coffee Shop’, which reported the mistreatment of a hill-tribe girl working as a prostitute in a local brothel.34 Although the portrayal of the girl was highly stereotypical (as pointed out in the previous chapter), by contrast with the early 1990s prostitution per se was no longer newsworthy and it was her mistreatment that constituted the focus of the article. Similarly, in comparison with its regular reprintings in the early 1990s, when it was reprinted three times per year for two years and twice the following year (1991–93), Potgarmat Priichaa’s I Am Not a Prostitute has only been reprinted three times over the past six years, suggesting yet again that the issue of prostitution is no longer a matter of intense public concern. In respect to the images with which prostitutes were portrayed, most fundamentally, as in the case of European witch scares (Crick 1990; Marwick 1990), the demonising of prostitutes in early 1990s Thailand drew on pre-existing images of ‘bad’ women to portray them as almost exact inversions of ‘good’ women. Unlike good women, informants commonly spoke about prostitutes as women with an uncontrolled and rapacious sexuality, and as women who had made themselves unnatural, having 33. My own unpublished research on street children/child prostitution also suggests a fairly stable number of young people working in prostitution during this period. 34. As pointed out above, since the mid-1990s Chiangmai’s direct brothels have revamped their format. They now display signs (in Thai) saying ‘Coffee Shop’.

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mouths painted bright red instead of demure pink or orange, as having curly and unnatural hair and eyebrows painted on too darkly, and as wearing clothing that accentuated their body. They claimed, in respect to prostitutes’ use of make-up, that they ‘over’ made-up, painting their faces in cheap untutored imitations of those who know how to use make-up correctly. Female informants further claimed that prostitutes who did this in an attempt to make themselves look attractive to men only succeed in making themselves look repulsive to normal women, as their attempts at beauty only parody real beauty and, ultimately, invert good taste. Men, too, talked of prostitutes’ use of make-up to accentuate their attractiveness and hide their real self, noting that proximity sometimes disappointed when girls were seen to be older or less beautiful than they had at first appeared (Fordham 1995). Critically, as I point out in chapter three, such stereotypical images of prostitutes’ physical appearance were so pervasive at this time that they also influenced Western researchers. In a study of prostitution in Thailand, Wathinee and Guest (1994: 78) claimed that the ‘subjective judgment’ of team members was that there was a similarity of appearance among massage-parlour workers but ‘more variation in appearance among the brothel workers’. Thai prostitutes are also considered to be distinct from ‘normal’ people in that they invert the normal human behaviour of working during the day and sleeping at night. Indeed, so perverse are they that they do not work at all in the accepted sense, in that they have turned an act of procreation or recreation into their work.35 Their brazen nature is apparent in the fact that they drink alcohol and may drink to drunkenness, not only an inversion of expected female behaviour but also an appropriation of male behaviour.36 Informants claimed that it is at the liminal periods of the day, dusk and dawn, when prostitutes can be seen either coming out to prey on men or returning home to sleep, but all admit that prostitutes are often highly skilled in representing themselves as normal people, so that even at these times it is difficult to tell if you are looking at a prostitute or not. Late one winter afternoon I took a Northern woman friend to watch prostitutes in Patpong 35. The failure of prostitutes to wear condoms during sex with husbands or lovers, which is cited throughout the Thai AIDS literature, is an attempt to distinguish these two spheres. 36. Although levels of drinking are increasing amongst modern, young urban women, it is not yet accepted at village level and in rural areas women drink only fairly limited amounts at particular periods of ritual license, such as at the New Year celebrations.

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(Bangkok) gearing up for the evening. She watched in absolute fascination, taking in their dress, their confidence, their brazen nature as they accosted men in public, and commented ‘they look just like normal people, if you didn’t know they were prostitutes you wouldn’t know; but if you look carefully …’. Indeed, prostitutes were considered to be so ingenious in concealing their trade that some researchers went beyond the common classification of direct and indirect prostitution to produce elaborate typologies of the sites where prostitutes might be found. Thus, Nitaya and Saupaa (1996: 55) list thirty-four sites for indirect prostitution, ranging from hotels to restaurants, bungalows, dormitories, golf courses, snooker clubs, flower shops and forest tour camps. Prostitutes, sexually active outside of marriage, are an ‘other’ – bad women, representing the antithesis of good nurturing women. In the 1990s they simultaneously represented unlimited sexual potential and, in the antithesis of the nurturing good woman, the potential to cause death. Discussing the issue of prostitution with one young Bangkok (an Isaan migrant) taxi driver, he commented: ‘normal [my emphasis] women you cannot touch, but prostitutes will do anything, you can touch them anywhere, you should not go near them’. The distinction between bad women and good women appears absolute and is one found at all class levels. As a young labourer told me as he waited his turn in a small Chiangmai brothel in mid-1993, ‘these [my emphasis] women, you can’t trust them at all’. A seminar at an Australian university the following year elicited a similar comment from a middle-class Thai doctoral student when O’Rork’s film The Good Woman of Bangkok was discussed. Following one participant’s comment that the film maker had given a gift of land to the prostitute star, who had sold it and returned to Bangkok, the student commented ‘those [my emphasis] women are like that’.37 Indeed, as I point out elsewhere (Fordham 1995), it is this imputed otherness – particularly in the sexual arena, where men consciously aim to experience Mulder’s (1992a: 76) ‘different type of woman’ and where sexual practices are eroticised, in part, because of their transgressive nature (Parker 1992: 228) – that stands in opposition to the mundane domestic sphere; it is these experiences that men find not merely enticing, but sometimes compulsive. Critically, as I point out (Fordham 1995, 1999), it is the powerful emotional charge associated with such experiences that gives them a power that belies their ephemeral nature. Possibly, too, it is the 37. The fact that the girl sold her land at the peak of the Northern land boom, a rational move by any criteria, was not taken up.

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powerful emotional charges associated with prostitution, and investigators’ unconscious attempts to avoid them through research methodologies that distance and dehumanise their subjects, that has prevented a more discriminating and more sensitive investigation of the nuances of Thai prostitution, one that would have transcended state and middle-class discourses of sexuality based on a simplistic binary moral divide of good and bad women.

Conclusion The reality of Thailand’s HIV/AIDS epidemic and the scale of the personal and social devastation it has caused is undeniable. That the response to the Thai AIDS epidemic has been highly successful in comparison with the response to AIDS epidemics in Africa or other countries in South or South East Asia is also undeniable. My analysis here raises no challenge to these points. Rather, its aim is to problematise and deconstruct the models that have come to be used to explain Thai AIDS, which, I have argued, have acted to legitimate and reinforce prejudices about groups considered culturally deviant in Thai society. Moreover, I have argued that perhaps the one factor most characteristic of AIDS debates in Thailand is a lack of reflexivity and a consequent high level of agreement about what the issues are. My analysis, then, questioned some of the fundamental components of what are now largely taken-for-granted understandings about the development of Thailand’s HIV/AIDS epidemic. Such a questioning, which reveals the assumptions and limitations of the concepts used to model issues such as HIV transmission, HIV/AIDS risk, the organisation of interventions, as well as the limitations of research methods popularly used in Thai HIV/AIDS research, has the potential to reveal new avenues of research and intervention. Central questions raised in this article are: Why have the wave model of HIV transmission and the associated notion of essentialised risk groups been so influential as a model of the Thai AIDS epidemic? Regardless of their being discredited in the international AIDS literature, for many working on Thai AIDS these concepts continue to be fundamental explanatory concepts for modelling the epidemic and for directing interventions at local level. Why has the primary target of HIV/AIDS interventions and control (legitimated by the wave model and notions of risk groups) been female prostitutes – when their male clients were merely given the contradictory exhortations that they should

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avoid promiscuity and wear condoms? Why has there been such a high level of agreement on the focus on commercial sex workers as a central risk group – a group not only stigmatised by their sexual activity, but who are treated as being fundamentally different from the normal female population? Why has there been such a high level of agreement about who commercial sex workers are? As Brummelhuis (1993) reminded us, we do not yet have a theory of Thai prostitution, with the result that works dealing with prostitution in Thailand generally construct it in highly Western terms (see Tannenbaum 1999). Why has so much work in the HIV/AIDS field been concerned with validating the morality of Thai women, when there is now a substantial body of evidence suggesting there is normally a fairly high level of sexual activity amongst young (and not so young) unmarried women? Why (with the exception of those relative few working in the youth area) has the sexuality of these (unmarried) women been so studiously neglected? Above all, why has the study of Thai sexuality, necessitated and legitimated by the HIV epidemic and the notion of essentialised risk groups, treated men and women so differently, and why has this deeply unfair situation made sense to so many for so long? I have argued here that the Thai AIDS epidemic has been characterised by a high degree of consensus about what the issues are, and by the muting of competing or dissenting discourses. However, as I have pointed out elsewhere in this volume, in addition to the Thai AIDS epidemic constructed by the Thai Ministry of Public Health sentinel surveillance statistics and by UNAIDS statistics, in Western biomedical and social science journals and in papers presented to major international AIDS conferences, there are other, albeit severely muted, models of the Thai AIDS epidemic. These models, partially overlapping but rarely coterminous, and embodying divergent and sometimes conflicting interests, include: the AIDS epidemic constructed in Thai language biomedical and social science journals; the AIDS epidemic constructed in the Thai language (particularly local-level) print media; the AIDS epidemic written about in the (mainly Thai language) papers presented at the many small conferences dealing with AIDS issues held regularly throughout Thailand; in the working papers of the many IOs/NGOs (both Thai and foreign based) who work on grassroots AIDS interventions throughout Thailand; and, finally, the AIDS epidemic which is part of everyday experience, ‘out there’ in the urban or village community. Regardless of the international rejection of concepts such as the wave model and notions of risk groups, these concepts make

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sense and continue to be used by many researching AIDS in Thailand or working on Thai HIV/AIDS interventions, because they resonate with existing social imagery relating to categories of persons perceived as culturally deviant and needing control and moral guidance (IDUs, homosexuals, underclass men and, particularly, prostitutes). Thus, ironically, to the extent that these concepts have been appropriated by those working on AIDS at the Thai local level, they now constitute a widely shared element of an indigenous Thai alternative (albeit muted) AIDS discourse, through which Thai AIDS continues to be modelled and through which local-level interventions are directed. Ultimately, my point is that Thailand’s HIV epidemic has been socially constructed. Thus I have argued in respect to the position of women in Thailand that the nature of the epidemic is that of a moral panic, in which fears about HIV/AIDS have been projected onto the person of female prostitutes who, essentialised as a discrete and largely homogeneous category of women, have been demonised as the prime cause of the spread of HIV in Thailand. In an era in which sexuality has been brought into the public arena, and in which changing gender and sex roles have given rise to public concern regarding female sexuality, it is not surprising that prostitutes, with their high visibility, have been demonised in this fashion. Thus, Thailand’s moral panic about HIV and the concomitant demonisation of prostitutes might be viewed as attempts to redraw the boundaries of proper moral behaviour. From this perspective, HIV/AIDS and the various research programmes it has called forth, have enabled an alternative charting of the social body to produce a profoundly class-based hierarchy of normalcy, showing the deviant risk groups whose activities necessitate intervention and control. Indeed, Raynou (1999: 37) notes of a recent programme aimed at HIV/AIDS risk reduction amongst a group of sexually active Chiangmai tertiary students, ‘morality is the ultimate goal of this project’, suggesting that middle class concerns with morality now extend beyond the culturally marginalised to focus on the middle class itself. However, activities such as the demonising of women in prostitution, the adoption of the nurturing-mother model of female sexuality and the consequent denial of the sexuality of the bulk of the female population through the adoption of a simplistic and manifestly inadequate binary stereotype of ‘good’ and ‘bad’ women, have broader implications. As far as the study of Thailand and Thai culture is concerned, that many working in the Thai Studies and Thai AIDS fields have been content with these stereotypes and have failed to adopt a reflexive and critical

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approach to Thai culture and Thai values suggests that scholarship in these disciplines has remained a scholarship of admiration for Thai society, and that it has failed to transcend the dominant state and middle-class discourse of Thai AIDS. Moreover, despite the many successes of HIV/AIDS campaigns in Thailand, the reliance on the concept of risk group to model Thai AIDS, the homogenisation of all prostitutes as members of a risk group, the representation of society and complex social relationships in highly simplistic and stereotypical categories of good and bad women, and the general disregard of other forms of HIV risk activity among sexually active young women, are actions which can only be viewed as having had deleterious impacts on Thai society and on the Thai response to the AIDS epidemic. First, the effect of the focus on prostitutes has been to further disempower the already powerless. Second, the concentrated focus on commercial sex workers in their workplace, and on the members of other groups considered deviant, constitutes not only a failure to transcend state and middle-class discourses of AIDS but also demonstrates both a past failure and a continuing structural failure to come to terms with Thailand’s changing sexual cultures – in particular that amongst young people, especially amongst geographically mobile young women (students, factory workers, shop girls and the like), and the potential HIV risk this represents. Finally, and most importantly, there is now a substantial literature dealing with the broad spectrum of Thai male sexuality. However, as I have argued above, it is no longer acceptable that Thai women of whatever class or category continue to be represented through simplistic stereotypes as sexless or as sex alone, or that they are viewed as being constituted solely through Buddhism, through biology or through men.

CHAPTER 6

TRADITION, SEX AND MORALITY: HIV/AIDS AND THE PATHOLOGISING OF ADOLESCENT SEXUALITY IN NORTHERN THAILAND

‘B

oth boys and girls are actively encouraging each other to misbehave’ (Sirikul 2000) reports a recent issue of the Bangkok Post, in an article dealing with sexual activity amongst Thai secondary school students. The article, reporting on the work of the Thai NGO Siam-Care, and published in one of Thailand’s most popular English language newspapers, is striking due to the manner in which it treats sexual activity amongst young people not as mere bad behaviour, but as abnormal and pathological. It quotes the coordinator of Siam-Care as saying ‘most of those girls have family problems [my emphasis]’, suggesting that sexual activity on the part of young women is abnormal and is the outcome of family pathology. The report also suggests, through quoting the Siam-Care coordinator, that unrestrained youth sexuality poses a threat to the social order by claiming that girls lure younger boys into having sex, and by saying that in many secondary schools the ‘problem of sex between students ha[s] reached critical proportions’ [my emphasis]. Finally, citing a sixteen year old female informant, it again suggests that sexual activity is pathological in that it has a deleterious effect on students’ lives: ‘a friend of mine has stopped coming to classes since she began having sex with her boyfriend.’

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The horrified tone of the article and the offended moral sensibilities of the NGO spokesperson it cites would be ludicrous if it were not that it is merely one example of many late 1990s Thai and English language newspaper reports, or correspondence published in the ‘letters to the editor’ page, dealing with youth sexuality. Significantly, a similar attitude towards sexually active young people is also found in articles dealing with HIV/AIDS and adolescent sexuality in late 1990s Thai and, sometimes, in English language, scholarly journals. Also, such attitudes to adolescent sexual activity are now characteristic of many IO/NGO and state-sponsored projects associated with HIV/AIDS prevention amongst young people, particularly those which claim to teach ‘life skills’ (tuksa cheewhit) as a means of AIDS prevention. The language their conference and seminar reports use to describe young people’s sexual activity is the same shock/horror emotive language found in the newspaper report discussed above. These works typically describe young people’s sexual activity as inappropriate, as morally wrong and as pathological in that it results from other life trauma, and portray it as leading to highly negative ‘worst case’ outcomes such as an unwanted pregnancy, terminated or impaired education, disease, or even death from AIDS. Critically, however, this approach which recognises high rates of sexual activity amongst Thai youth and which holds that this is both risky and inappropriate (on moral and cultural grounds), stands in stark contrast to Thai AIDS discourses of the early 1990s which generally paid little attention to sexual activity amongst young people. Indeed, I pointed out in earlier chapters that for Thailand the early 1990s were a time of widespread social change as a result of globalisation (Kasian 1996), of rapidly changing sexual cultures, and of increased sensitivity towards and concern about Thailand’s changing social and sexual mores as HIV/AIDS-related research focused in a systematic if somewhat uncoordinated fashion on Thai sexuality and sexual practices in general. I argue that in this context fears about AIDS crystallised in a moral panic focused on prostitutes who, as a symbol of unrestrained female sexuality, became the focus of reformist attentions. Thus, attempts to restrict the spread of HIV were based on control strategies focused on prostitutes who were viewed as a bridge between deviant minority groups and the wider community, whereas the sexuality of other women, and in particular the sexuality of young women, was not just ignored but, despite considerable evidence to the contrary, was often denied.

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Developing a point first made by Brummelhuis (1993) I also argue that Thai AIDS discourses have been profoundly class based and that in the context of globalisation Thai researchers have adopted a Western middle-class morality as a measure of general Thai sexual behaviour. I pointed out that Thais used ‘selective adaptations from Western middle-class patterns’ (Brummelhuis 1993: 15), as a measure of general Thai sexual behaviour. Thus Western notions of monogamous marriage, and in particular Western conceptions of prostitution, have been used as the standard by which to evaluate Thai sexual behaviour and the many modalities of Thai prostitution, while indigenous Thai constructions of sexuality, prostitution and notions of marital and family relationships have been largely ignored. Yet paradoxically, while drawing on these decontextualised and selective adaptations, in the early 1990s Thais simultaneously expressed profound concerns about the impact of globalisation on Thai culture. In her study of child prostitution in early 1990s Pataya, Montgomery (1996a, 1996b, 2001) takes up the issue of the Thai capitalist transformation and its attendant cultural crisis, and points out the sense of loss of Thai identity felt by the Thai middle class, and their sense that young people were taking on Western cultural practices (compare Kasian 1996). She points out that in the public media ‘The West is seen as the ultimate enemy of “culture” because it is perceived as stronger and unstoppable in its alternative attractions’ (Montgomery 1996a: 211), and she particularly notes that Thai fears seemed to be centred about a loss of freedom and loss of social control. Thus, she argues it is not coincidental that Thai concerns about child prostitution arose in the early 1990s at a critical time for concerns about Thai identity and the autonomy of Thai society, and claims that the early 1990s Thai focus on the problem of child prostitution (panha sophanee dek) was a displacement activity motivated by concerns about national identity as a result of rapid social change due to Thailand’s new openness to world markets, a massive rise in the numbers of tourists visiting Thailand and the increasing penetration of Western media of all types. Montgomery argues that in the early 1990s, newspaper reports and scholarly writing regularly neglected a broad corpus of works detailing the economic underpinnings of prostitution (Pasuk 1982; Thitsa 1980; Truong 1990 to name but a few), and reduced social concerns about rapid economic change and globalisation to a focus on child prostitution and the person of individual Western abusers. As she points out (2001: 151) ‘issues raised by the form and rapid

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rate of development in Thailand have not been adequately debated.’ By the late 1990s the focus of AIDS discourses had moved from prostitution and the sexuality of men in the rural and urban underclass to focus on young people. In addition to earlier scholarly work demonstrating high levels of youth sexual activity, an abundance of evidence on the street and in the media suggesting that young people were sexually active, as well as a new focus on youth due to internationally generated movements towards child rights and for the provision of reproductive health services for young people, had led to a focus on young people’s sexuality. In contrast to the early 1990s when the sexual activity of young people was studiously ignored, the fact that there were high rates of sexual activity amongst young men and women was now rarely contested. However, as I argue below, the sexual activity of young people became viewed in much harder and more intolerant terms, as an activity that is fundamentally pathological, both individually and in terms of its implications for Thai culture generally. Critically, this perspective was not solely one taken in the sometimes-hysterical Thai public media (Mulder 1997), but was evident in the scholarly writing of researchers investigating HIV/AIDS and young people’s sexuality, and in the conference papers and programme reports of IO/NGO personnel working on AIDS-prevention programmes amongst young people. Moreover, all three groups almost uniformly attribute young people’s sexual activity to their adoption of Western sexual cultural practices, a view that has roots in early 1990s Thai concerns about the role of modern Western cultural imperialism in Thai society.1 Throughout the 1990s articles both in the public print media and in scholarly journals attributed many of Thailand’s social problems to the adoption (willingly or otherwise) of Western culture. As early as 1992 a report on youth culture by the prestigious Institute of Social Research at Bangkok’s Chulalongkorn University (ISRCU 1992: 9–10) notes: The shift of Thai society from agrarian to industrial has spurred alterations of [sic] the quality of life, the way of living, values and

1. Of course such concerns stem back at least as far as the Vietnam War period, and it is likely that they have roots in mid-nineteenth century Thai relations with the West, predating even the modern Thai nationalism of the sixth reign (1910–25) (Vella 1978), and recent nationalist campaigns such as that conducted in the pre-World War Two period under Prime Minister Phibun Songkhram (Kobkua 1995).

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culture of the people. The modern society places emphasis on materialistic development enhancing competition among the people. ...The adoption of foreign culture which lacks social mechanism to control the information to be transferred to the children [sic] for them to be able to distinguish the pros and cons of such culture also substantially affect the youth. … A lot of commercial advertisements and shows have excessive message [sic] promoting the need for luxurious merchandise, imitation of Western values and violence.

However, towards the middle to late 1990s, as attitudes towards youth sexuality hardened, criticism of the West for its impact on Thai culture moved from the relatively isolated issue of child prostitution to the much broader issue of the impact of Western culture on Thai youth sexuality per se. As Chai and Umaporn (1995: 87) note in the context of an analysis of youth sexuality: ‘as women in Thai society are more and more liberated in many aspects [sic], there seem to be shifts toward western life style [sic] characterised by higher degree [sic] of individualism in various personal behaviours. The western life style becomes more common in the sexual attitude and behaviour as well.’ As far as the mass media is concerned, as I discuss more fully below, the Private Education Commission recently claimed that ‘a “western influence” was encouraging students to have sexual relations prior to marriage’ (Kamolthip 2000) or, as Kasem (1999) put it in a Bangkok Post article addressing media allegations of prostitution amongst university students: ‘It was hardly surprising when we heard that some students prostitute themselves to support their luxury lifestyle. The consumerist culture of the West has invaded every corner of our society.’ Indeed, as one psychiatrist put it in the late 1990s: ‘Thailand’s young people are too “fragile” to deal with the things that come their way [from the West], from materialism and western pop culture we have so many young Thais who can’t speak their mother tongue clearly without an English accent.’ (Bussarawan 1998: 1). I argue here, then, that the context of the late 1990s and early 2000s is one in which epidemic disease has focused both Thai and international attention on the sexuality and sexual practices of every sector and age group of the Thai population; in which rapid globalisation has caused massive economic, technological and concomitant social change; and in which the Thai state has become a sometimes-reluctant party to international covenants on issues such as the individual rights of children and the sexual

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and reproductive health rights of young people.2 Through an examination of scholarly writings about AIDS and young people’s sexuality, media reports concerning various aspects of young people’s sexuality, and the projects and conference reports of NGOs working amongst young people, I trace a shift in approach from that taken in the early 1990s to that taken in the late 1990s. I show how, in this context of heightened sensitivity towards young people’s sexual activity and heightened consciousness about and resentment towards increasing Western influence in Thailand, in the late 1990s onwards approaches in all three areas have moved from stances which paid little attention to young people’s sexual activity (generally accepting the sexual activity of young men and ignoring or denying that of young women) to much harder and more intolerant stances which treat such activity in highly negative terms as fundamentally inappropriate and as pathological for unmarried people. Critically, each of the three arenas began to treat young people’s sexual activity as not only antithetical to Thai moral values but also as an indication of the adoption of Western patterns of uncontrolled sexuality. I argue also that these perspectives and the AIDS-intervention programmes based on them, such as the many NGO programmes which teach life skills with the aim of reducing the amount of sexual activity engaged in by young people, constitute a new middleclass-based ideology of resistance to the impacts of globalisation on Thai culture. As a programme of resistance this focuses on the establishment of control over young people’s bodies through controlling youth sexual culture, and legitimates such control by recourse to health issues such as HIV/AIDS, pregnancy, abortion and so on. I earlier noted Montgomery’s claim that early 1990s Thai opposition to child prostitution ignored macro-structural factors to focus on the persons of individual abusers. As she puts it: ‘The whole force of the middle-class resentment of, and contradictory attitudes towards, Western influence can be directed onto this one, supposedly non-controversial issue’ (Montgomery 2001: 151). However, by the early 2000s, the site of resistance had 2. Suwana and Wiput (1999: 7) hint that Thailand’s 1997 announcement of a reproductive health policy by way of implementation of the 1994 Cairo International Conference on Population and Development Plan of Action, was not without some misgivings about the implications of such policies for Thai culture. Similarly, Thailand’s report to the United Nations Committee on the Rights of the Child (United Nations Committee on the Rights of the Child 1996) notes Thailand’s reservations regarding three articles contained in the Convention on the Rights of the Child to which Thailand became a signatory in 1992 (compare Scheper-Hughes and Sargent 1998).

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broadened from individual abused children to youth sexual culture per se, and resentment had moved its focus from individual abusers to the abusive and dangerous nature of Western sexual culture. It is likely no accident that such a programme of resistance developed during the latter part of the 1990s, a period coinciding with the Asian economic crash and Thailand’s deeply resented ‘International Monetary Fund’ (IMF) period. Nor, in the case of the mid-1990s Ph.D. thesis on Northern Thai sexuality mentioned in the previous chapter, is it a linguistic accident that its Thai author should summarise Thai sexual mores in terms of ideology rather than actual documented practice, when she wrote: ‘it is now generally accepted that men first gain sexual experience with prostitutes, but women should abstain from sex before marriage [my emphasis]’ (Wassana 1996: iv). Clearly, contrary to the early 1990s research discussed in previous chapters (and which I take up again below) that shows a high level of male and female premarital sexual activity, this is about the most succinct statement of this new middle-class ideology of Thai sexuality for the late 1990s that it is possible to find: an ideology that homogenises and speaks for all of Thailand’s immense historical, geographic, ethnic and class diversity and, crucially, an ideology of bodily control set in opposition to what is conceptualised as an uncontrolled and promiscuous Western sexuality. Below, I draw on data from a wide range of Thai and English language scholarly publications dealing with Thailand’s HIV/AIDS epidemic and the issue of youth sexuality; from a range of English and Thai newspaper reports concerning youth sexuality and general youth behaviour; and on numerous seminar and conference reports produced by NGOs working on AIDS interventions in Northern Thailand. I first give a brief synopsis of Thailand’s HIV/AIDS epidemic and associated interventions over the past sixteen years. I then take up the issue of how scholarly publications about HIV/AIDS have addressed the issue of youth sexuality over the 1990s, and how during this period they have evidenced a progressive hardening of attitudes towards sexual activity on the part of young people. I then take up the issue of youth sexuality and the morality of youth sexual activity as refracted in Thai and English language Thai newspapers during this same period, which evidence a similar hardening of attitudes towards youth sexuality to that found in scholarly research. Finally, I move to examine how NGO programmes focused primarily about HIV/AIDS control have, during the course of the 1990s, moved to take a progressively harder line on sexual activity amongst young people: moving from an initial focus that was

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solely concerned with AIDS prevention to one largely concerned with the proselytising of morality.

The Thai AIDS Epidemic: Tradition, Sex and Morality Although the first cases of HIV were detected in Thailand in the period 1984 and 1985 (Sunee 1992; Vichai et al. 1993; Weniger et al. 1991), as I noted in earlier chapters, systematic AIDS education programmes were not implemented until the early 1990s, following a late 1980s steep rise in the numbers of persons infected with HIV. Initial AIDS education focused on large-scale country-wide programmes utilising all forms of media: the electronic and print media; roadside banners and hoardings; posters; and brochures and pamphlets to give people information about HIV transmission, AIDS risk behaviour and about AIDS prevention (Lyttleton 1994a, 1994c, 1996b). The 1991 ‘100 Percent Condom Programme’ (Mastro and Khanchit 1995; WHO 2000; Wiwat and Hanenberg 1996) and the 1993 ‘The Thai Family Combats the Danger of AIDS’ campaign, discussed earlier, are two examples of major campaigns designed to involve the whole country. Later mass campaigns, in the mid-1990s, moved to address public perceptions of people with AIDS (PWA) and on to AIDS-care issues. Such programmes continue in the early 2000s in the form of television and radio advertising that emphasises the essential humanity of PWA, and the fact that one can live alongside them with no personal risk of infection. Alongside these mass programmes, at the micro level in the early 1990s, AIDS information was conveyed to people in villages at temple and village meetings, in schools and colleges in class and age group meetings, and for commercial sex workers in face-to-face meetings in their brothels, bars or other places of work. Alongside mass AIDS education and prevention campaigns other smaller-scale programmes started to focus on various special needs categories of people in the community who were considered hard to reach with mainstream materials. Thus, divided structural-functionalist fashion into conceptually discrete social and occupational groupings, HIV/AIDS programming started to develop what was viewed as culturally appropriate media for these groups. Folk theatre (ligee) presented live and on video, and radio dramas were developed for villagers and the urban underclass; cartoon story books and love story books were produced for factory workers; and other simple teaching material such as

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posters and activity manuals were produced for street children. Street theatre was produced for (and by) street children and commercial sex workers, and training sessions about AIDS prevention were held in factories and on work sites. Concomitantly, with programmes orientated to teaching about HIV/AIDS prevention a plethora of small, largely independent research programmes began. Often conducted as one component of AIDS-prevention campaigns, these programmes focused on issues ranging from mapping knowledge about HIV/AIDS and risk behaviour to programmes that focused solely and directly on researching Thai sexual practices – about which little was known. Although intensive social science research had been conducted in Thailand since the end of World War Two, the bulk of research had been carried out in areas such as history, religion and ritual, kinship, development issues and the like. As I point out in chapter five, some work on women and gender, women and development, and on the issue of prostitution had been conducted during the 1980s (see Tannenbaum 1999); however, it was not until the early 1990s, as the real magnitude of Thailand’s HIV/AIDS epidemic became apparent, that systematic research on Thai sexuality commenced. The first major research project on Thai sexual practices was conducted in 1990 by the Thai Red Cross, and comprised a massive whole country survey of a sample of 2,801 Buddhist respondents (non-Buddhists were consciously excluded). The resultant research report, Thai Sexual Behaviour and Risk of HIV Infection (Werasit and Praphan et al. 1992), produced baseline data reporting on factors such as: first sexual partner; age at first intercourse; numbers of premarital partners; sexual relations in the past twelve months; sexual relations over the past four weeks; frequency of intercourse and types of sexual acts during this period; AIDS knowledge; participation in the commercial sex sphere; condom use; and basic demographic data. Possibly the report’s most striking results are the finding of extremely high levels of chastity amongst unmarried Thai women, with over 99 percent of women claiming never to have had sex prior to marriage, while 65 percent of men had done so. Similarly, while only 0.6 percent of married women reported sexual activity other than with their spouse in the past twelve months, 19.3 percent of married men reported such sexual activity during the same period. As a result of such findings the report’s conclusions noted that men, both married and unmarried, were at risk from unsafe sex but that women, due to their extremely low levels of premarital and extramarital sex and other risk factors such as

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injecting drug use, were primarily at risk of contracting HIV through their spouses. Critically, as I have argued earlier, this research project and much subsequent similar work corroborated a common Thai middle-class ideology of there being a fundamental divide in Thai society between ‘good’ and ‘bad’ women, and neglected issues such as class, ethnicity and region. On the part of men, research neglected the massive and highly organised business catering for commodified middle-class sexuality through the provision of expensive alcohols, high-class restaurants and hotels, massage parlours, bath houses and coffee shops – which is obvious both at street level and in advertising on the back pages of all newspapers. Instead it validated a popular (although, as I have argued in earlier chapters, only recently constructed) middle-class Thai ideology about male sexuality, which by the early 1990s held that male participation in commercial sex was largely confined to the deviant acts of a few members of the underclass, rather than a common pastime of the bulk of the male population. As a result, legitimated by the notion of risk groups and Weniger et al.’s (1991) work on the wave model of HIV transmission where prostitutes constituted the link between what were conceptualised as deviant minority subcultures and mainstream society, HIV/AIDS research on Thai sexuality focused on the sexual practices of prostitutes and of men in the underclass – urban and rural labourers. Thus, from the commencement of HIV/AIDS behavioural research and interventions in Thailand, the problem of AIDS was conceptualised as the problem of sexuality gone wrong: the problem, as I put it in chapter five, of controlling the sexual risk behaviour and the morality of a deviant underclass. The research about Thai sexuality this engendered was characterised by a preoccupation with the mechanics of sex and with the morality and appropriateness of various types of sexual practice. The extent to which such class-based preconceptions about various sex acts influenced HIV/AIDS research, and the lack of reflexivity characteristic of such research, is possibly nowhere better illustrated than Chaiyos et al.’s 1995 study of ninety HIV-positive men and their partners, where a direct relationship was hypothesised between oral sex and female promiscuity. Thus Chaiyos et al. note (1995: 1,081) that: ‘To ascertain whether oral sex was a marker for promiscuity in women we assessed pooled data. Among 48 women who had performed oral sex, 15 (31%) reported extramarital sex. However, among the 137 women who had never performed oral sex, only 27 (20%) reported extramarital sex.’ That such hypotheses should underlay what purports to

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be serious HIV/AIDS research is lamentable, but that such research should survive the peer review process and be published in the prestigious British medical journal The Lancet is truly inexplicable.

Scholarly Research about HIV/AIDS and Portrayals of Youth Sexuality I move now to examine how scholarly research (and the AIDS interventions often associated with scholarly research programmes) has viewed young people’s sexual activity over the decade of the 1990s. I show a clear shift in approach over this period, from one where little specific attention was paid to the sexual activity of young people: the visiting of prostitutes being considered normal for young men while evidence of sexual activity on the part of young women was largely ignored or denied, to an approach where a concentrated focus was directed at young people’s sexual activity, with that activity being portrayed as highly inappropriate on moral, cultural and medical grounds. As the bulk of HIV/AIDS research in the early 1990s focused on categories conceptualised as risk groups, it initially concentrated on IDUS and homosexuals, and then, following Weniger et al.’s (1991) wave model of HIV spread, moved to an intensive focus on the sexual practices of prostitutes and their clients. During this early period of the epidemic, AIDS behavioural research, particularly that published in Thai language journals, focused in a highly structural-functionalist fashion on assessing AIDS knowledge through conducting KAP and KABP surveys amongst various essentialised occupational and class groupings, ranging from Bangkok housewives to fishermen, farmers, factory workers and school teachers. Although not a central focus of AIDS behavioural research, research amongst young people featured in this research from the early 1990s in the form of KAP/KABP research amongst groups such as secondary school students, factory workers and, much later, teenagers in general. The focus on youth sexuality and AIDS developed very quickly as the severity of Thailand’s HIV/AIDS epidemic became apparent in the late 1980s massive increase in HIV infections and the appearance of the HIV virus in groups other than IDUS and homosexuals. Thus, KAP research about ‘Sex, Reproduction and Contraception’ conducted between 1985 and 1986 amongst North Eastern vocational school students and published in the Journal of the Medical Association of Thailand in 1988 (Chuanchom

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et al. 1988) makes no mention of HIV/AIDS. Yet the Thai AIDS Journal was founded the following year, indicating that in addition to Thai AIDS material being published in Thai language medical journals (such as the Journal of the Medical Association of Thailand, Doctors Journal, and the Journal of Infectious Diseases), enough local research was being conducted to support a Thai language journal focused solely on AIDS-related issues. Indeed, a 1990 directory of AIDS-related research produced by the Ministry of Public Health (MOPH 1990), shows that by 1989 almost 150 AIDS research projects, primarily clinical and biomedical research with a smattering of projects focusing on behavioural issues, were either in progress or already completed. Critically, in terms of my interests here, although Chuanchom et al.’s 1988 research amongst school students made no mention of AIDS, by 1989 researchers were studying the AIDS knowledge of secondary school teachers (Thian 1990) and of secondary school boys (Suphak and Kachit 1990). Research (and associated interventions) about the sexual practices of secondary school students continued throughout the 1990s, although it was overshadowed by the overall focus on prostitutes and their clients as the main avenue for HIV transmission. Research carried out about young peoples’ sexuality in the early AIDS period is valuable as it is unselfconscious, carried out prior to a later sensitisation of the Thai middle class in regard to the exposure of indigenous sexual practices to international scrutiny (Brummelhuis 1993), and as it reveals some of the initial presuppositions about Thai sexuality that influenced later AIDS paradigms. In particular, it reflects the middle-class value of female virginity prior to marriage, and the ideology of an absolute distinction between ‘good’ (chaste) and ‘bad’ (sexually accessible) women (Bao 1999; Harrison 1996, 1999; Manop 1994; Sanitsuda 1997, 1999; Sukanya 1988). Thus Chuanchom et al. (1988: 651) found it surprising that 31.3 percent of their (single) female student respondents were sexually experienced and that 13 percent had had abortions, and note with some surprise regarding young women’s attitude towards pre-marital intercourse that ‘nearly half do not regard it as sinful [my emphasis]’. However, instead of viewing this as a generalised value in Thai youth culture, they explain it by drawing on a long sedimented Thai attitude that depreciates the ability and morality of vocational school students by noting: ‘This suggests a rather liberal attitude towards sex among single, private vocational school students’ (1988: 651). Critically, this and similar research results demonstrating high levels of sexual activity amongst female teenage students were

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published in Thai language journals rarely cited by indigenous Thai AIDS researchers publishing in English. As a result they were totally inaccessible to the majority of Westerners working on Thai AIDS research and intervention programmes, most of whom had only limited Thai language skills. Due to this, and to a continued acceptance of the Thai moral gender binary divide of good woman/bad woman, as I point out in the previous chapter, for at least the first half of the 1990s the bulk of Thai AIDS behavioural research made the partisan and erroneous assumption that most young women were not sexually active, and neglected the study of normative female sexuality in favour of a focus on prostitutes. Suphak and Kachit (1990), another ‘early AIDS period’ Thai language work dealing with AIDS knowledge and sexual practices amongst students is particularly interesting in the presuppositions about Thai sexuality it reveals. The work focuses solely on HIV/AIDS knowledge and the sexual practices of secondary school boys, reflecting the assumption that most young men are sexually active with prostitutes while good young women are chaste. Thus they note ‘most Thai men must [torng] visit prostitutes or have promiscuous sex; in this generation of teenagers from fourteen years old’ (ibid.: 80). Importantly, whereas some contemporary analysts in the late 1990s (Lyttleton 1999; Gray et al. 1999) are moving to view approaches to Thai sexuality which claim that Thai men have normally expected both regular sex and a variety of sexual partners to be largely a Western post-colonialist fiction, the authors clearly demonstrate that up until the early AIDS period Thai researchers in the HIV/AIDS field considered it culturally normative for the bulk of Thai men to indulge in regular sex with prostitutes, and that they valued variety in their sexual partners (see Chayan 1993). The extent to which male desires were focused on commercial sex are revealed by one of the authors’ concluding suggestions: ‘If it is necessary that [men] must visit prostitutes [they] must use condoms [my emphasis]’ (Suphak and Kachit 1990: 80), anticipating the advice (cited previously in chapter four) given by a Chiangmai Department of Public Health official some years later, that men should cease visiting prostitutes, but if they could not stand ‘thaa torn my wai’ going without sex they should wear condoms (Chiangmai News 1993m). However, another concluding suggestion, that masturbation would be a safe substitute for risky sex (ibid.), like Sukanya’s (1993) suggestion that if brewing were legal, instead of carousing and having sex with prostitutes men could drink at home and then have sex with their wives, suggests a failure to

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understand the role that commercial sex plays in Thai male rituals of masculinity construction. The limiting presupposition found in Suphak and Kachit (1990), the assumption that boys are sexually active with prostitutes but that most girls are ‘good’ girls and are chaste, is also apparent in Yingkiat et al. (1992). This is a KAP study of the relationship between AIDS knowledge and age, conducted amongst secondary school students in Sukhothai. Like other works of the time it accepts uncritically the fact that male secondary school students are at an age when they become interested in sex and commence visiting prostitutes for sexual experimentation, and ignores data concerning male sexual activity outside the commercial sex arena, as it does sexual activity on the part of female school students. The authors (1992: 52) found higher levels of AIDS knowledge amongst senior secondary students: as they put it the senior boys were at an age where they ‘want to know, want to try, want to khun khru [to learn for the first time; literally, to get on a teacher]’. Overall the study finds that 14.6 percent of male students and 1.3 percent of female students admitted to sexual activity, and that in only 52.2 percent of cases (male and female figures are combined) were condoms used. However, although the authors found that in 50 percent of cases boys’ experience of sex was with girls other than prostitutes,3 they suggest an intensive focus by teachers, doctors and the Health Department on improving the AIDS knowledge of boys as they are at risk of contracting the AIDS virus from prostitutes (1992: 50), and call for the eradication of what they call the ‘popular value’ (1992: 52) of khun khru. Wilai (1996) is a similar, highly mechanistic, KAP-style study of the AIDS knowledge of deaf junior and senior secondary students from a variety of schools for the deaf, clearly aimed at a comparison with Yingkiat et al. (1992). The limiting presupposition of the study is that of Yingkiat et al.: the assumption that as male secondary school students were likely to be sexually active with prostitutes they were at a higher risk of contracting AIDS than were female students, and a consequent failure to disaggregate data regarding male and female sexual activity. Like Yingkiat et al. Wilai makes no investigation of female students’ sexual activity and, reflecting common thinking of the time, assumes a direct relationship between levels of AIDS knowledge and behavioural 3. There are some minor discrepancies in the statistics given by the authors. The figures given here have been calculated from data in the body of the article rather than from the English or Thai language abstracts.

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modification. Thus she suggests that all students should be given regular updates of AIDS knowledge, but that as they place themselves at risk of AIDS through the customary visiting of prostitutes, boys especially should be given extra training about self-protection from HIV and other STDs (Wilai 1996: 32). Wilai’s work also reflects the common Thai belief that young people’s family situation has a highly determinative effect on their behaviour. She examines how the relationship between students’ parents, between ‘students who have a family where [their] mother and father love each other closely [literally, well] and students who have a family where [their] mother and father argue frequently’ (1996: 29) affected the AIDS knowledge and risk practices of the students, with the finding that there was no significant relationship. Contrary to Yingkiat et al. (1992), Wilai finds no relationship between students’ age and AIDS knowledge, as students in all classes had received recent HIV/AIDS training, finding instead that ‘students had average knowledge, almost right behaviour [my emphasis] but slightly high risk behaviour on AIDS [sic]’ Wilai (1996: 27). As well as research about young people as students, some early HIV/AIDS 1990s research and intervention projects focused on those young people who had left school and worked in factories. Those involved in this research viewed young people working in factories, particularly women, to be vulnerable to new health risks due to migration from rural areas separating them from a ‘socially sheltered rural environment’ (Ford and Sirinan 1994: 517) and exposing them to the new sexual culture of the city. Cash (1993, 1995a, 1995b) studied sexual behaviour and AIDS knowledge amongst young women working in four factories in Northern Thailand, and trialled peer education programmes; Busayawong and Chuamanochan (1995) studied Northern Thai factory workers of both sexes; Ford and Sirinan (1994) examined sexuality amongst young male and female factory workers in Central Thailand; Pattalung et al. (1995) studied the sexual behaviour of female office and factory workers in Bangkok; while Chuanchom and Werasit (1993) examined risk behaviour and HIV/AIDS interventions amongst factory workers at Khonkhen in the North East. These works are interesting as, like the research discussed above concerning sexual activity amongst students, they reveal a considerable level of sexual activity amongst both male and female factory workers. Moreover, they also reveal the extent to which male patronage of commercial sex was accepted during this period as a natural way of fulfilling male sexual needs and, as I argue in chapter three, as

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a culturally normative demonstration of masculine potency. As one of Cash’s (1995b: 78) female respondents put it: ‘If a young man does not visit prostitutes, I would think he is a homosexual.’ Cash notes that most respondents estimated that between 70 percent and 90 percent of young women were sexually active before marriage (1995b: 21). She summarises her study findings by noting: ‘This study showed that young single women were sexually active and engaged in a variety of sexual activities, including multiple partnerships and lesbian relationships’ (1995b: viii). Critically, in respect to research methodology used in contemporary Thai sexuality research, she notes that most sexually active young women were unwilling to admit this in written surveys (compare Pramote et al. 1987), although they were willing to do so during private discussions with sympathetic interviewers (ibid.: xi). Cash’s work focused on peer education to increase young women’s awareness of AIDS and on encouraging those who were sexually active to protect themselves through the use of condoms. Importantly, like other researchers dealing with young female migrants during the 1990s (Mills 1997, 1998, 2001; Michinobu 1999, 2000), she found that for members of this group sexual freedom was perceived as part of contemporary values, along with being up to date and having economic freedom. Cash’s work is intellectually strong and suffers from few of the limiting presuppositions found in the works discussed above. Importantly, in respect to my analysis here, although Cash finds high levels of sexual activity on the part of young men and women, she is concerned solely with the promotion of safe sex through increasing level of condom usage, and there is no sense in which she treats young people’s sexual activity as a moral issue. Like Cash, Ford and Sirinan (1994) view young factory workers as facing particular risks due to their migration from rural villages to urban centres. However, they also view the lives and sexual practices of these young working people as providing a window on changing patterns of sexuality amongst Thai youth in general, and suggest that this group is more representative of Thai youth than the upper secondary and college students sometimes focused on by youth researchers. More than earlier survey-based research, their focus-group-based research captures the dynamism of urban youth culture (a dynamism also felt in rural areas which are no longer isolated as they were in the past), and the sense the young migrants had that they were living in times of rapid social change where the rules about sexuality were also changing. As Ford and Sirinan (1994: 520) put it, the ‘shift from clearly understood traditional sexual norms towards ill-defined

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“modern” behaviours of unknown destination, underlies much of the findings’. Like Cash’s (1995b) respondents Ford and Sirinan’s male and female focus-group respondents emphasised the naturalness of young men visiting prostitutes as part of general patterns of drinking and socialising with friends, and they too (1994: 522) suggested that men who didn’t visit prostitutes might be accused of being homosexual. Ford and Sirinan’s (1994) informants suggested that although a double standard was often applied to male and female sexual behaviour, which made it difficult for young women to admit publicly to their own behaviour, there was a high level of male and female adolescent sexual activity. Importantly, like Cash (1995b) who noted that surveys were not a good method for collecting data on young women’s’ sexual activity (as I pointed out in the previous chapter), they make a similar comment regarding the limitations of focus groups. They note that the only female participant to admit to premarital intercourse was labelled ‘mad’ for making such an admission (Ford and Sirinan 1994: 526). Paradoxically, as the limitations of these methodologies for Thai sexuality research were pointed out by these researchers, other researchers, such as VanLandingham et al. (1994), were arguing in favour of their use. Ford and Sirinan’s work differs from the bulk of youth sexuality research discussed above, which combined research about youth sexuality and AIDS-education programmes. Their work was solely a research programme aimed at understanding youth sexuality and youth health needs (in respect to safety from HIV) in the context of rapid social change and high rates of rural – urban migration, and had no AIDS-education component. However, like the early 1990s HIV/AIDS research and intervention work on youth sexual activity discussed above, there is no sense in which they treat adolescent behaviour as a moral issue. One final work discussed here is that of Chuanchom and Werasit (1993), who focused on male and female factory workers in the North East, examining HIV/AIDS knowledge and risk practices, and conducting an intervention programme to raise awareness of AIDS risk behaviour and to decrease sexual risk taking. Like some earlier AIDS research, its weakness is the assumption that young men are at a greater risk of contracting HIV through their customary patronisation of prostitutes. However, it makes no moral point about this practice and is concerned solely with preventing the spread of HIV. In summary, then, I have shown in the above that much Thai language research about HIV/AIDS, and some English language

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research conducted amongst young unmarried men and women in the early 1990s, found high levels of sexual activity amongst both males and females as well as high levels of patronisation of prostitutes by men. Curiously, however, this Thai language work sits uneasily with the bulk of English language research published at the same time. By the early 1990s the issue of men visiting prostitutes was assumed to be a matter of individual social deviance confined primarily to the rural and urban underclass and, similarly, sexual activity on the part of unmarried women was assumed to be a matter of individual deviance, confined to ‘bad’ women in the underclass working in the commercial sex arena. Indeed, as far as Thai female sexuality is concerned, some researchers maintained this position into the 2000s. McAndrew (2000: 114), for instance, writing in the British Medical Journal, adopts the highly orientalist position (Said 1985) of claiming that: ‘The Thai attitude to sex is typically Asian, discreet and modest (not to be confused with Western mythology regarding concubinage and the small but notorious tourist orientated sex industry).’ A Hardening in Attitudes towards Youth Sexual Activity As I have shown in the above, research published in scholarly Thai and English language journals, and in reports of AIDS research and interventions during the early part of the 1990s was concerned solely with youth sexuality in respect to protection from HIV infection through the practice of safe sex, and made no moral judgements about that behaviour. However, from approximately the mid-1990s onwards, as the central focus of AIDS-prevention efforts moved from prostitutes and their male clients to devote more attention to women, children and youth, attitudes towards teenage sexuality evidence a hardening, manifest in the passing of increasingly negative moral judgements about youth sexual activity. Whereas previously young men visiting prostitutes and young women engaging in sexual activity with lovers had been portrayed as engaging in normal discretionary behaviour and this was not evaluated in moral terms, now researchers started to depict these activities as morally inappropriate, culturally deviant or just plain bad behaviour that demonstrated the individual’s lack of self-control and, as I note in the following section, as indicating the need for life-skills training. In stark contrast to earlier work, sexual activity – even knowing about sex – ceased to be depicted as a normal process. Instead, it began to be portrayed as a pathological process or, in some cases, as the outcome of another pathological process – and this

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was particularly so for young women found to be sexually active. Thus, in a presentation at the 1995 International Conference on Gender and Sexuality in Modern Thailand, one Thai participant claimed that: ‘Familial and localised settings are importing factors causing young people to learn about sex. A broken family is always found to be one of the forces among these [my emphasis]’ (Amara 1995: 10). The paper goes on to give an example (drawn from a focus group) of a girl whose mother had remarried and who, as a result of bad relations with her mother due to the remarriage, mixed with boys and subsequently became pregnant. Thus, the pathology of a rupture in the original family relationship is portrayed as leading to an inappropriate relationship with a man and ultimately to an unwanted pregnancy. From this time onwards then, research about the sexual practices of young people started making explicit moral judgements about their behaviour. This is apparent in Sutthiluck et al.’s (1999) research amongst vocational school and high school students in Thailand’s North East; Phitaya et al.’s (1999) work amongst Central Thai high school students; and Chai and Umaporn’s (1995) study of Thai youth in general, as well as in many other similar works. In respect to Sutthiluck et al.’s work, their research as they describe it in their English language abstract, ‘aimed to explore sexual risk-taking behaviour on AIDS [sic], attitudes towards sexual service, and health locus of control’ (1999: 21). However, their research is not concerned solely with sexual risk taking in the same sense as that discussed above, as they have broadened the notion of risk behaviour to encompass the risk that young people will be in situations where they may take risks. As Peterson and Lupton (1996: 48) put it in respect to such new public health risk regimes: ‘To be labelled as being “at risk” means entering a state in which an apparently healthy body moves into a sphere of danger.’ Thus Sutthiluck et al.’s somewhat Kafkaesque work examines not only condom use and levels of premarital sex, but also whether or not young people have been with a person of the opposite sex in a private place, whether they have visited the room of a person of the opposite sex, whether they have taken trips together with a person of the opposite sex, and whether they have visited places of entertainment (satan rerngrom, unspecified, but likely entertainment venues such as coffee shops, karaoke lounges, restaurants, pubs and discos), all contexts which, they contend, are likely to encourage youth to engage in sexual activity (compare Wilai 1996). Interestingly, the authors hold a particularly negative view of contemporary Thai teenage culture, noting of these entertainment venues favoured by young people

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that, ‘apart from being a waste of money and a waste of time, they are risky as one may meet bad friends, as one might become addicted to intoxicants, may use drugs, and may lose one’s virginity or become infected with sexual disease and AIDS’ (Sutthiluck et al. 1999: 30). Sutthiluck et al. (1999) found that 13.6 percent of their sample (the sample was aged between 12 and 22 years, with an average age of 16 years) had had sex with a lover, most of whom were fellow students.4 However, for them the sexual activities of young people are no longer considered private and discretionary but, as they state in their English language abstract, are activities that necessitate intervention on the part of state and other institutions in order to ensure conformity with appropriate standards, that: ‘in order to prevent sexual risk taking behaviours amongst adolescents, appropriate attitude towards sexual service, buying sex and casual palours [sic] and pre-marital sexual relations must be promoted. Family, school and society had to take responsible [sic] and participative roles in adolescent sexual health’ (Sutthiluck et al. 1999: 22). The standards considered appropriate are rendered more clearly in the Thai language version of the abstract which suggests that ‘appropriate values need to be pointed out to students in regard to commercial sex and places of entertainment, meeting friends of the opposite sex, and the evasion [garnliekliang] of sexual relations prior to marriage [my emphasis]’ (1999: 22). Further, as the researchers point out (1999: 29), ‘behaviour that is risky for sex includes going about with friends of the opposite sex, visiting places of entertainment and having a lover’. Indeed, they note that ‘The samples engaged in sexual risk-taking by courting [my emphasis] their boy-friends/girl-friends’ (1999: 21). Thus, instead of viewing sexual activity as the outcome of normal human emotions such as love and desire, and as such one of the most fundamentally human activities, this research sees dangerous risk behaviour that necessitates external intervention and control. Indeed, as Bolton (1995) points out, such a perverted and disparaging approach to human sexuality has become widespread during the 1990s. As McAndrew (2000: 114) puts it in the British Medical Journal: ‘If we admit (as young people already know) that sex is normal and fun, we should also recognise that it must be pursued responsibly and with respect for others, just like any other enjoyable but risky activity [my emphasis]’. Faced with 4. The authors note that their sample of 245 students was comprised of an approximately equal number of males and females, but due to an unfortunate oversight fail to disaggregate statistics regarding levels of sexual activity according to sex.

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such negative attitudes towards sex and sexuality research, one is reminded of Bolton’s (1995: 298) comment that: ‘One cannot do sex research if one is not comfortable with one’s own sexuality or sex in all of its manifestations,’ and his warning that inexperienced sex researchers will ‘feel compelled to maintain a presentation of self as a model of probity, as conforming to the morality of their own culture’. Phitaya et al.’s (1999) research about sexual risk behaviour amongst Central Thai high school students, like that of Sutthiluck et al. (1999), also views sex solely in terms of its risk potential and as an activity to be avoided by young people. Of their sample of male and female students, the majority of whom were in the 15 to 16 year old age group, they found that of the 21.2 percent of male and 5.6 percent of female students who admitted to being sexually active, most had commenced sexual activity prior to age 16. They note Phitaya et al. (1999: 84): ‘The male students ever had [sic] sexual relationship with their girl friends or closed [sic] friends as 21.2 percent plus those who did not want to answer 29.3 percent are assumed to be the risk group [my emphasis]’. Critically, the authors note that their research is aimed at providing base-line data for later ‘preventative measure [sic], sex education, life skill, health prevention [sic] and promotion’ (Phitaya et al. 1999: 84), and as evidence that the students concerned need lifeskills training in ‘[ill] health prevention activities, especially appropriate sexual behaviour [my emphasis]’ (1999: 84). Thus, by contrast with earlier research, late 1990s research about sexual activity on the part of young people no longer treated this as a normative cultural practice engaged in by a significant percentage of youth from their mid-teenage years onwards (and, as I have pointed out, one amply attested to in the literature on Thai sexuality), but as an individual problem behaviour to be reformed through the teaching of life skills which would enable them to resist temptation. A final work I take up here in relation to the moral judgements that Thai AIDS researchers began to make from mid-1990s onwards regarding the sexual activity of young people is Chai and Umaporn (1995). This is a highly descriptive report drawing on a 1994 country-wide survey of youth behaviour (in this case youth were defined as being between the ages of 15 and 24). However, alongside the purely descriptive and statistical data, the authors make a range of moral judgements about young people’s sexual and other practices. Perhaps the best indication of how they view youth sexuality is the fact that it is grouped in the chapter dealing with substance abuse, with the chapter being headed ‘Substance

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Abuse and First Sexual Experience’ (1995: 79). The introduction to the chapter notes: With more freedom and independence than in the previous stage of their lives, many young people may go as far as taking behavioural forms entirely different from the conventional norms and practices. … Two things are of particular concern … (a) abuse of substances, and (b) sexual behaviour. These are important issues since they are not only potentially risky to health but can lead to other undesirable behaviours such as crime and violence [my emphasis]. (1995: 79)

Having drawn what must surely be a tenuous link between sexual activity and crime and violence, the authors then go on to point out the serious threat posed by HIV/AIDS in Thailand, and note that: ‘Under this circumstance family and social concern over sexual risk behaviour of young people is not at all overexpressed [my emphasis]’ (1995: 80). They find that almost half of rural and urban males in their sample had had sex, while 28.9 percent of urban females and 37.5 percent of rural females had done so, and point out that ‘this includes marital and non-marital sex’ (1995: 84). They give data for age at first sex (for males around age 17 and for females around age 18) and note in respect to males that ‘just about everyone, who ever had sex, had it the first time while they were still single’ (1995: 85). In respect to females they report that of all females who had ever had sex, 47.0 percent of urban females and 17.2 percent of rural females, did so prior to marriage, and comment regarding these statistics that ‘the proportions of female youth with pre-marital sex reported are probably the highest ever. Nearly one in every two urban females who ever had sex reported that they had it the first time when they were still unmarried’ (Chai and Umaporn 1995: 85). Like Sutthiluck et al. (1999) they attribute part of the increase in levels of youth sexual activity to the new youth culture and the habit of meeting in ‘places for entertainment of various kinds where youth can more easily be led to involve [sic] in sex’ (1995: 87). Chai and Umaporn’s (1995) moral judgements are, however, not restricted to the area of sexual practices. Discussing the freedom allowed youth, they note that all youth share much similarity in terms of the freedom they are allowed, except in areas ‘traditionally considered improper for females, such as going out to seek fun of various sorts and courting/dating which is believed to put females at risk of undesirable, pre-marital sex’ (1995: 28). Then, they note that for those youth who spend money on recreation and on alcohol the amount spent is ‘substantial’ (1995: 39)

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and that ‘The relatively large amount of spending on these two items suggest that a number of youth are not spending their income so wisely’ (1995: 39). Moreover, they note that ‘change toward gender equality in the share of house work is desirable. Males, therefore, should be socialised early in their lives to take an active part in the house work’ (Chai and Umaporn 1995: 40). Like many of the works discussed above, for Chai and Umaporn the issue is ultimately one of social control, as is made clear in their concluding remarks to chapter seven: Substance abuse and sex among young people will probably remain the issues of concern to the family and social institutions [sic]. As society undergoes changes in many aspects, family control over its young members becomes weakening [sic] while the role of non-family institutions – such as school, temple, and other nongovernmental organisations – in guiding the youth behaviour has not been strong enough. Under this circumstance short-term as well as long-term measures to strengthen the family institution are most desirable. (1995: 88)

The increasing tendency during the late 1990s for HIV/AIDS researchers to make moral judgements about youth sexual behaviours is evident not only in research focusing on school students and on youth in general, but also is found in research about young people in Thailand’s factory work force, where sex is portrayed almost solely in terms of its negative consequences. Thus Amara (1995), whose study of the sexual values of female students and factory workers (cited above), rather than viewing sexual activity as a natural human practice focuses on the factors that cause young women to know about sex and to become sexually active, and views these in highly pathological terms, portraying women as passive actors with little agency in directing their own sexuality. The conclusion of her paper notes: Women gradually internalize whatever they learn from their male peers for example they do accept that men visit prostitutes or value women as physical attraction or get involved with sexual life as group’s [sic] norms. The everyday life discourses are strongly influenced by the power relations between men and women and in particular by men’s sexual identity because gender roles are formed in families but constructed by societies. Changing accepted patterns of male behaviour and expected patterns of female behaviour requires collective action to improve the ability of young women to protect themselves consequences [sic] of pre-marital sexual activity. (1995: 21)

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Interestingly, Parichart (1999), a public health official, takes a similar approach in a recent interview based study of HIV risk behaviour amongst young female factory workers in Central Thailand. Similar to many of the late 1990s works discussed above, Parichart claims that the aim of the study was to ‘describe the social pattern [sic] and social processes in sex and sexual behaviours considered risk to [sic] HIV infection’ (1999). However, in practice, sex per se is assumed to be a risk activity; and that young women engage in sexual activity is considered to be largely due to the absence of external constraints such as parental supervision. Thus Parichart (1999) notes: ‘Social control in terms of sanction or group pressure does not exist in this community. These factors cause [sic] [young women] to have premarital sex and as well as extra-marital sex which have [sic] the opportunity of risk for HIV infection.’ Like Amara (1995), Parichart (1999) views sexual activity by young women to be a direct result of pathological processes; in this case, exposure to the Western culture of the factory: ‘when they came into the factory, they were newly socialized and thus absorbed the idea of western culture concerning equity on [sic] sexual behaviours between women and men. There are pre-marital and extra-marital sex among these group [sic]’. Ironically, Parichart (1999) portrays female sexual activity as ever likely to break out in the absence of external controls, an approach reminiscent of Ford and Sirinan’s (1994) ‘hydraulic’ notion of male sexuality, where sexual pressure demanding release is ever ready to burst out. Importantly, in terms of my analysis here, it is not unprotected sex or sex with an HIV infected partner that they portray as unsafe, but sex per se.

Youth Sexuality as Portrayed in Thailand’s Print News Media Having addressed the shift in approach towards young people’s sexual activity found in HIV/AIDS scholarly research during the course of the 1990s, I now move to examine how Thailand’s English and Thai language newspapers have portrayed the issue of young people’s sexuality over the same period. Like my examination of scholarly AIDS research, I show a clear shift over this period, from one where little specific attention was paid to the sexual activity of young people to one where, at the end of the 1990s, it is almost universally portrayed as highly inappropriate on moral, cultural and medical grounds.

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The reports I draw on here come from three categories of newspaper: national level English language newspapers, and Thai language newspapers at both the local level and the national level. As I note in chapter four, Thailand has a booming newspaper publishing industry with new titles added almost yearly throughout the 1990s, and has a press with a high degree of freedom and a healthy scepticism towards the world it reports. Of the Thai media Mulder (1997: 183) argues that ‘it is the press that comes closest to mirroring the public world. … The media help construct the public world, as much as they reflect it. And what has been constructed is. Thus, what appears in the newspapers is a particular image that people regard as the flux and flow of the outside world.’ Critically, in respect to my analysis here, the Thai media not only refract social issues, they articulate them in ways that may crystallise and motivate public concern. English Language Publications and Youth Sexual Activity Throughout the majority of the 1990s, English language reporting about young people’s sexuality has taken a social-problem perspective, whereby only the members of minority problem groups, such as child prostitutes and street children, have been acknowledged to be sexually active and, tautologically, their sexual activity has often been cited as evidence of their problem-group status. Generally, their sexual activity has been portrayed as abnormal and as a threat to society, in that it promotes the spread of HIV/AIDS. In the early 1990s, reports focused on the issue of commercial sex amongst child prostitutes and street children. Like Thai language newspapers (see chapter five, n. 31) English language newspapers usually represented parental greed (Bangkok Post 1993, 1995c) or, less often, greed and corruption amongst government officials as the root causes of child prostitution: ‘the questions of immorality and negligence by government officials in suppressing prostitution’ (The Nation 1993a), while street children were generally portrayed as being in their situation due to family breakdown or other family crisis (The Nation 1993b, 1993c, 1993d). In both cases the children themselves are viewed as exploited, as unwilling victims (Bangkok Post 1993), and as being of risk of contracting HIV. However, as the early 1990s AIDS scare and subsequent moral panic about prostitution subsided, newspaper reports about Thai adolescent sexual activity increasingly came to focus on what was portrayed as rising levels of sexual activity amongst young people generally (Bangkok Post 1997b). Thus a Bangkok Post report (1995a) on AIDS and youth sexual safety quotes the then man-

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ager of the Thai-Australia Northern AIDS Prevention and Care Program as urging school and university administrators to accept that social mores were changing. She argues that young people living away from home were likely to be living together and that due to the risk of HIV the issue of safe sex needed to be addressed from primary school onwards. The report also points out that the average age at which Thai teenagers lose their virginity was ‘as low as 14’ (Bangkok Post 1995a), and cites a representative from the NGO Care International as saying that ‘it is impossible to stop young people having sex, and instead they need guidance on how to avoid being pushed into a premature sexual experience, or on how to have safe sex’. The report foreshadows an increasing concern with policing adolescent sexuality, particularly that of young women, when it cites the convenor of an AIDS-awareness programme conducted at the Chiangmai Rajabhat Institute, in which ‘students discuss how to avoid pre-marital sex. Girls are advised on how to refuse sex. Boys are taught the value of safe sex’ (Bangkok Post 1995a). Later reports, such as the one discussed in the introduction of this chapter (Sirikul 2000) while generally depreciating youth sexual activity per se, similarly suggest that sexual activity is particularly inappropriate behaviour for young women. Critically, they tend to portray sexual activity on the part of young women as being abnormal and symptomatic of problems in some other area of life, and as pathological in that it has a deleterious and lasting effect on young women’s lives. In the early 1990s, letters to the editor of the newspaper Bangkok Post paid little attention to adolescent sexuality in general which, like other genres of media reporting of the time, were more preoccupied with sexuality in respect to the issue of child prostitution and prostitution in general. However, by the end of the decade they too reflected a growing concern with the moral aspects of the sexual practices of young people. Thus, when a mid-2000 Bangkok Post article (Anjira 2000) detailed the results of a yearly sex survey by the condom maker Durex, and noted the finding that Thailand had a higher rate of condom usage in casual sex than many other countries, within a few days a Thai correspondent took issue with both the behaviour found by the survey and with the survey itself. The correspondent claimed that the report was ‘ethically bad news because it is proof that so many people are engaging in “casual” or “extra-marital sex”, and that as such it is nothing for Thai people to be proud of’ (Surasak 2000). Even more, the correspondent took issue with the report’s finding that in 1997, 16 percent of Thai soldiers in the North East had had anal or oral sex, and argues: ‘If it were true, it would mean that

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as many as 16 percent of Thai soldiers are homosexual, which is unlikely.’ Truly offended by this suggestion, the writer suggests that ‘the Thai government should inquire about the credibility of this dishonourable report’ (Surasak 2000). By the late 1990s scandalised front-page beat-ups of various forms of sexual impropriety amongst young people had become a fairly regular feature of both English language and Thai language Thai newspaper reporting. For example, in early 1997, in response to a murder committed by a kathoey,5 the Rajabhat Institute (Thailand’s largest teacher training organisation), with the support of the Minister for Education, banned the admission of kathoeys and homosexuals. Pichai (1997) reports: ‘Homosexuals, according to Minister [for Education] Sukhavich, are bad role models for students. They are “sick physically and mentally”, like drug addicts, and need “treatment” ’; discussion regarding the ethics and absurdities of the ban continued in the media for several weeks (Ammon 1997; Apaluck 1997; Bangkok Post 1997a). Later the same year another storm broke following a poll showing high levels of sexual activity amongst teenage students. By way of response, the Deputy Education Minister announced a crisis meeting with education officials, provoking an outraged newspaper column in the Bangkok Post from rights campaigner Sanitsuda Ekachai: ‘Horror of horrors! Thai girls are defecting from the sacred virginity tenet. Women’s promiscuity is a social threat. And it’s time to whip them back into line’ (Sanitsuda 1997). A similar storm broke in 1999 when a Chiangmai University student newspaper took up the issue of university students supporting extravagant lifestyles through prostitution, and this subsequently became front-page news throughout the country (Bangkok Post 1999a, 1999c, 1999d; Kasem 1999; Prapasri 1999; The Nation 1999). Possibly most indicative of late 1990s public attitudes towards young peoples’ sexuality was a 1999/2000 ongoing debate about the development of a new sex-education curriculum for schools. Thus The Nation (1999) reported that the Education Ministry had announced that the sex education curriculum would be revised, and that the new curriculum ‘will focus on moral values and sexual behaviour as well as family planning and the roles of the sexes’ [my emphasis]. An early 2000 report dealing with this proposed reform notes the sensitive nature of topics like premarital sex, and quotes a senior official of the Education ministry as suggesting that sex is not appropriate for young people: ‘Mr Sarote [the 5. See chapter five, n. 23 for a brief definition of kathoey.

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official] said learning from experience as advocated by the childcentred teaching method which has gained currency among educators would be unsuitable for sex education. “Sex education is an exception or students may all want to have an experience” [sic] he said’ (Ploenpote 2000). Later that year it was announced that the new sex education curriculum would focus on the ‘social and psychological aspects of sexuality’; that it would be called ‘Life and Family Study’ and that it would cover topics such as ‘how to fend off potential sex offenders or distinguish affectionate physical contact from sexual harassment’; how to overcome psychological trauma such as a result of being heartbroken or losing one’s virginity, and that ‘students would be taught to be proud of their gender and shape their personalities according to their sex, as part of the curriculum planners’ attempt to tackle sexual deviation’ (Sukanya 2000). The next month, by way of response to reports of students having sex before marriage and working in prostitution, the Secretary-General of the Private Education Commission entered the youth sex debate. Kamolthip (2000) writing in the Bangkok Post reported that the Secretary-General had claimed that ‘a “Western influence” was encouraging students to have sexual relations prior to marriage’ (Kamolthip 2000). She was reported as having said that premarital sex was ‘totally against Thai customs and culture’, and that ‘Education is the only way we can influence students not to have sex, since we cannot ban them from having sex [my emphasis]’ (ibid.). Thus, the primary aim of the sex-education curriculum is clearly established as the defence of Thailand’s cultural and moral boundaries through limiting young people’s sexual activity. Thai Language Publications and Youth Sexual Activity Reports about youth sexual activity in Thai language newspapers follow a similar trend to that noted above. In the early 1990s, like English language newspapers, Thai language news reports regularly focused on the social problems caused by teenagers: ranging from illegal drug use (Chiangmai News 1993v), the problem of teenage driving (Thai News 1995a; Thai Rath 1995) and teenage drunkenness and fighting (Chiangmai News 1995a) to the problem of teenagers congregating in various parts of the city (Chiangmai News 1993r). Newspaper reports about minority problem groups, such as child prostitutes and street children (Khao Siam 1993b), also evidence something of a preoccupation with sexual activity, condemning both prostitution and consensual sex. Yet the issue of sexual activity on the part of young people in general is only

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mentioned in respect to the AIDS epidemic and the potential health problem of young men visiting prostitutes. However, during the course of the 1990s, Thai language newspaper reporting also moved to recognise a high rate of sexual activity amongst young people in general. As in the case of English language reports, Thai language reports about young people’s sexual activity suggested it was inappropriate, and particularly so in the case of young women. Thus a page one report in the popular daily Khao Sot (2000a) in January 2000, headed ‘Big Spurt in AIDS in Thailand: Research Finds 13 Year Olds Have Sex’, cites the head of the Department of Infectious Diseases as saying that the group with the highest-risk sexual behaviour was children (dek), as research had found that children as young as 13 were sexually active, and that ‘girls between 15 and 25 have had sex with more than one partner’ and had low levels of condom use. It reports that a survey of 5,000 young women working in factories found that 61 percent had had sex, 22 percent having had sex with more than one partner, and notes that the level of sexual activity amongst students has increased until it is ‘worrying’. Other reports refer to the inappropriate nature of youth sexuality. In Chiangmai, a Chiangmai News front page report in July 1997 headed ‘Wild Dormitories Across the City: Crowded Together for Lust – Using Drugs – Worrying’, claims that teenagers were congregating in unregistered dormitories for illegal drug use and for illicit sex (Chiangmai News 1997). Also, the Chiangmai News (2000) reported on a new and physically dangerous fashion for young men engaging in sex to put on a condom and then wind strips of rubber around their penis to increase its size, with the result that their partners ended up with vaginal lacerations and sometimes infections from pieces of torn rubber left in the vaginal tract. This genre of newspaper reporting deploring sexual activity amongst young people was matched, during this period, by the publication of a series of sensationalist popular books exposing the sexual activities of young people, and particularly amongst school students (Butarat 2001; Orasom 2001; Somprasong and Unchalee 2001; Wichundaa 2002). Many newspaper articles dealing with youth sexual activity focused on the inappropriateness of sexual relations for young women by emphasising the possible untoward consequences. Thus an early 2000 article in Khao Sot (2000b) reports the incident of a female university student who, on becoming pregnant and being fearful of the consequences, gave birth alone and killed the newborn child. However, her act was revealed when she became ill due to the failure of the placenta to detach completely and was

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admitted to hospital. The report points out that such problems and the similar problems of unwanted and abandoned children, and the problem of abortion, are increasingly common and are the result of young people engaging in sex before it is appropriate: it notes, ‘having sexual relations before the appropriate time and the problem of pregnancy during the student years is a problem of the individual, the family and society’. It points out the untoward results of unwanted pregnancy, and notes that they are all the result of the pursuit of pleasure and the following of a fashion dictating that young people should have a lover. Similar morality tales concerning issues of sexual activity, pregnancy and abortion amongst teenagers also feature regularly in agony aunt and medical advice columns directed at teenagers. An example of the former is a weekly, Northern Thai agony aunt column ‘Just Understanding’, sponsored by the Life Network life-skills programme of the Faculty of Nursing at Chiangmai University. This column responds to young people’s email and telephone queries. It tackles a range of behavioural issues concerning young peoples’ sexuality: from the inappropriately loose female sexual behaviour modelled in highly popular Japanese cartoon books (Thai News 2000d) to the issue of safe sex via the use of condoms (Thai News 1999c), and the value of young women retaining their virginity (Thai News 2000a, 2000c). The final column for January 2000 (Thai News 2000c) concerns a letter purportedly written by a young woman (Norng Som) who, after celebrating New Year’s Day by drinking with friends, found herself alone in her dormitory room with her boyfriend who wanted sex. She struggled with him and was eventually able to escape. The column relates the feelings of Norng Som who, thinking in retrospect, was ‘proud that she was able control her feelings and not go along with her mood … [as] we are women, we are the side that loses out [sia briap], if we slip, it [virginity] won’t come back again, and if there are problems such as pregnancy that arise after having sex, then we are the one who is pregnant. It is as if there is a brand of wrong doing upon us’ (Thai News 2000c). The moral of the incident, that young women should keep their virginity, is heavily emphasised by both the letter writer and the columnist through their warnings about the untoward events such as disease and pregnancy that can result from giving way to momentary passion. Interestingly, the column the following week once again refers to Norng Som: it takes up the issue of another young woman, Norng Bern, a seventeen-year-old who was still studying and who, unlike Norng Som, had given way to passion

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and found herself pregnant for the second time. Her first pregnancy had been terminated in an abortion, and this time, although she was loath to have another abortion, she had been abandoned by her older lover and was not in a position to support a child. The columnist points out that this is yet another example of the result of going along with passion, and warns all young women against untrue men who just want momentary pleasure from them and, if a problem such as pregnancy occurs, will leave them to face it alone. In its sex-negative and moralising approach the column reflects the conservative ‘just say no’ model of teenage sexuality proselytised by its Life Network project sponsors. In this it sits oddly with traditional medical/sexual-help columns in Thai magazines which tend to accept that both men and women have sex, and confine themselves to advising on the problem in question. Thus, the weekly ‘Three Baht Clinic’ medical advice column in the same newspaper, Thai News, deals with unwanted teenage pregnancy and abortion (Thai News 1999a) solely from a medical perspective and makes no moral point. Curiously too, the approach taken by the writers of the ‘Just Understanding’ column portrays a sexual culture where men are active agents who take pleasure in sex, whereas women are depicted not only as having little agency, but also as ultimately losing moral advantage through sexual activity. Thus the column acts to reinforce the double standards of Thai male and female sexual behaviour at a time where general trends in Thai society have moved to question this situation.

NGO Projects, Youth Sexuality and the Prevention of HIV/AIDS Having shown a 1990s shift in scholarly Thai AIDS research and Thai popular media towards evaluating young people’s sexual activity from a new moral position, I now move to examine Thai NGO projects focusing on AIDS prevention amongst young people. The move to treat youth sexuality as a moral issue is, perhaps, most marked in NGO-based projects aimed at HIV/AIDS risk reduction amongst young people. During the course of the 1990s, the agendas of these groups not only moved from teaching about safe sexual behaviour to programmes that consciously proselytised morality and pointed out the inappropriateness of sexual activity for young people, but also extended their aims beyond minority problem groups to focus on much broader categories of young people.

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Unlike the situation in most Western countries, in Thailand NGOs have only a short history. Early attempts at grass-roots NGO formation amongst farmers and urban labourers in the 1970s, foundered under the political repressions of the times (Bowie 1997; Morell and Chai-anan 1982; Wright 1991). With the exception of large national NGOs, such as the Population and Community Development Association, Planned Parenthood of Thailand, and the Family Planning Association, dealing with socially acceptable and ostensibly non-political issues, it was not until the 1980s, with a growth in the numbers of middle-class university educated activists, that the formation of more broadly based NGOs recommenced (Renard 2001). In the North a high proportion of NGO activists were drawn from areas such as community development and rural development and this, in addition to their links with academic patrons and their middle-class background, influenced their outlook and subsequent mode of operations. Opposed to the lumbering and often self-serving government bureaucracy of the past, many saw themselves as helping to build a new Thailand as they worked on resolving the problems of over-rapid and uneven development. This nascent NGO movement boomed in the early 1990s as small community-based organisations (CBOs) as well as larger organisations with national or international links, were established to cater for the needs of people with AIDS or specific groups viewed at risk of being infected with HIV. Many tightly focused NGOs and CBOs – supported with overseas funding from the European Commission AIDS Task Force, the Australian Government’s Northern Thailand NAPAC AIDS initiative, the Netherlands Government, various UN bodies such as UNICEF and UNFPA, the Thai Red Cross, and large international organisations such as World Vision, Save the Children, and CARE, small Western (often Christian-based) NGOs, such as World Concern and the Northern Thailand Christian Mission, and indigenous NGOs, such as Hotline and Siam Care (to name but a few of the many NGOs which commenced work in the Thai AIDS field during the 1990s) – were formed to deal with the special needs of groups such as rural men and women, homosexuals, lesbians, prostitutes, young girls at risk of entering prostitution and street children, that were not being adequately addressed by the state welfare and medical systems (Chutchawarn 2000; Jon and Werasit 1994; Seri 1996; Werasit 1994; Werawan et al. 1998). In the early 1990s, these NGOs focused largely on assessing their target group’s knowledge about HIV/AIDS and on HIV/AIDS education. However, as the HIV infections of the late 1980s and early 1990s

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gave rise to a significant population of HIV-positive people with AIDS-related conditions, and as funding became available for project implementation (Niwat et al. 2000), yet more new groups formed and the role of some existing groups was expanded to deal with the health and social issues faced by those living with AIDS (Bupa 1999; del Caino 1999). Then, at a slightly later stage, PWA started to form their own NGOs as they became more involved in the practicalities and politics of AIDS health care.6 In many cases the founding members of NGOs were merely responding to a strongly felt local need, and had little in the way of a coherent ideology or methodology to guide their work beyond the desire to help. As Niwat et al. (2000) point out, in the beginning members of NGOs turning to work on AIDS and those individuals forming new AIDS-focused NGOs not only had no experience with AIDS, as AIDS was a new disease, there was nowhere they could turn to for advice. They generally commenced work on a shoestring budget, were usually staffed by volunteers on a minimal salary (often aided by unpaid university or college students), applied for funding to any and all potential sources, and through intensive networking shared information and techniques of intervention as they were developed. However, by the mid-1990s, in the case of many NGOs working with children and young people, this rather ad hoc situation had changed dramatically through their adoption of the life-skills (tuksa cheewhit) model of personal development, both at the level of an ideology where it served as a group charter and as a methodology for interventions with their target population. From this period onwards many NGOs began to describe their work as the teaching of life skills to their target groups, and began the production of manuals for teaching life skills for groups as diverse as street children, hill-tribe children and college students. Life skills, as the WHO define them, ‘are abilities for adaptive and positive behaviour, that enable us to deal effectively with the demands and challenges of everyday life’ (WHO 1993: 1). The WHO life-skills manual suggests that there is a core set of ten life skills, including skills such as decision making, problem solving, creative and critical thinking, effective communication, ability to empathise, and coping with emotions (WHO 1993: 1).7 It claims 6. See chapter four, n. 18 for details regarding the growth in the numbers of Thai NGOs over the 1990s. 7. The complete list of life skills as defined by WHO (1993: 1) are: decision making, problem solving, creative thinking, critical thinking, effective communication, interpersonal relationship skills, the ability to be self-aware, the ability to empathise, coping with emotions and coping with stressors.

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that ‘the skills are to promote positive health even though they may often appear in programmes for the prevention of specific problems’ (1993: 4). Moreover, as WHO/UNICEF (1994: 2) note, life skills may be taught in programmes with objectives varying from preventing drug and alcohol use, the prevention of adolescent pregnancy, AIDS education and the protection of children and young people from abuse, to peace education and suicideprevention programmes, many of which, they claim, have multiple prevention and health promotion objectives. The idea of life skills (WHO 1993) first gained currency in Thailand due to the early 1990s introduction of life-skills education into the Thai teacher education and teaching curriculums, where it provided a vehicle for addressing new educational needs to teach about sexuality and HIV/AIDS (Wiput 2000: 211), and in many ways can be viewed as a precursor to Thailand’s late 1990s move to a child-focused educational system. Close linkages between those involved in teaching and teacher education and NGO members, through regular seminars dealing with these issues, assisted in propagating the idea of life-skills training in a wide range of areas. The promotion of life-skills programmes by major funders such as UNICEF (WHO/UNICEF 1994) also acted to ensue its rapid adoption by NGOs working with children and young people. The speed with which the idea of teaching life skills became popular in the mid-1990s was astounding. Conducting HIV/AIDS-related research in Northern Thailand during much of the period from 1992 to 1996, as early models of studying sexual behaviour and early HIV/AIDS interventions were being developed, I do not recall hearing the term life skills prior to 1995. Papers presented on Thai AIDS at the Berlin AIDS Conference in June 1993 make no mention of life skills. Nor do papers presented at the Fifth International Conference on Thai Studies in July 1993. Papers presented in the AIDS section of the latter conference refer to many aspects of the AIDS epidemic of the time and addressed issues from prostitution to risk behaviour and AIDS knowledge amongst groups as diverse as lowland farmers and upland tribal peoples (Brummelhuis 1993; Chayan 1993; Fordham 1993; Gray 1993; Kumnuan 1993; Manop 1993; Vichai et al. 1993, to name but a few of the many seminal papers presented in this forum). Importantly, although many papers addressed the issue of AIDS interventions the concept of life skills was not mentioned. A summary paper on the AIDS panel by Han ten Brummelhuis (Brummelhuis 1994) presented at a small postconference workshop held in Chiangmai in early 1994, makes it

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clear that life skills were not yet on the agenda. Indeed, as late as 1995, at the Third International Conference on AIDS in Asia/Fifth National AIDS Seminar in Thailand, papers dealing with AIDSrelated risk behaviours amongst young people did not raise the issue of life skills (Ford 1996). Similarly, reports and conference papers dealing with NGO programmes conducted amongst female factory workers in the early 1990s (Cash 1993, 1995a, 1995b; Chuanchom and Werasit 1993) and amongst hill-tribe girls (Sompop 1992) during the same period speak of the need for AIDS and STD education, for education about reproductive health and, in the case of hill-tribe girls, the need for vocational training and for personal empowerment, but make no mention of life skills as a fundamental technique for interventions. Newspaper articles of the time report a variety of AIDS-prevention programmes conducted amongst young people, but report these as aiming at the promotion of AIDS-prevention skills (Thai News 1995o), such as safe sex practices (Bangkok Post 1995a), rather than the teaching of life-skills techniques. However, from the middle of the decade onwards, life skills were being touted as the key to solving a myriad of social problems including increasing levels of teenagers’ HIV/AIDS knowledge, sex education programmes in schools, reducing the number of child prostitutes via school and village-based programmes and resolving the problem of street children (Seri 1996). By 1997, the concept of teaching life skills to young people was even incorporated in Thailand’s Eighth National Economic and Social Development Plan (1997–2001), which notes in respect to the reform of the educational system that the state aims to ‘Incorporate family education and life skills in educational curricula at all levels, particularly secondary and tertiary [sic]’ (National Economic and Social Development Board 1997: 36). The manner in which the concept of life skills was understood and operationalised in early HIV/AIDS-prevention projects was in the original WHO-enabling sense of providing skills training to the members of groups considered at risk of contracting HIV, with the aim that the skills would empower them and assist in the evasion of situations of risk. Thus they were conducted amongst groups such as street children (dek raeron), viewed as being at risk of contracting AIDS; amongst hill-tribe children, viewed at risk of both prostitution and HIV; and amongst college students, considered to be at risk of contracting HIV (and in the case of female students, the additional risk of pregnancy). Yet, by the end of the decade, the idiom of life skills was being used quite differently. Firstly, utilising the legitimation of both health and morality, it

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became used in a much harder sense in campaigns aimed at convincing young people not just to engage in safe sex, but to refrain from all sexual activity prior to marriage. Secondly, it was used in a much broader sense to characterise behavioural-change programmes aimed at the general population rather than problem groups such as street children and child prostitutes: and it focused on what previously had been discretionary behaviour, such as sex between young people, the wearing of crash helmets when riding motor cycles, and the reduction of alcohol consumption amongst young people. In one case the idiom of life skills was even used to describe the activities of a project designed to convince rural villagers to abandon self-medication and either visit a doctor or purchase drugs from a qualified pharmacist (Faculty of Pharmacy: 1999). From the perspective of new NGOs, the rapid adoption of lifeskills programmes in the 1990s is not surprising. Those forming NGOs quickly found that funding agencies not only required them to account for how grant monies were utilised, but also required funding applications to provide some form of statistical and ideological justification for the proposed project. Statistical justification was provided by the inclusion of a ‘research’ component in all programmes and, in the case of HIV/AIDS or other behavioural interventions, by the near universal adoption of a pre-test/post-test survey so that the success of interventions could be demonstrated.8 However, for many NGOs active in the AIDS area it was the concept of teaching life skills that provided both a core ideology and legitimation for interventions, as well as a practical methodology for action. The amorphous nature of the concept of life skills also meant the concept itself provided a broad unifying banner with the capacity to link a range of NGOs with highly disparate aims (in a way similar to the manner in which concerns about child prostitution had unified some quite diverse groups a few years earlier). Moreover, for many active in the HIV/AIDS area in the mid-1990s, the idea of teaching life skills made good sense, as it was already accepted that lack of concern about AIDS prevention, and failure to cease HIV risk behaviour were the result of low levels of education and a consequent lim8. Few question the use of the seemingly innocuous pre-test/post-test survey to demonstrate the success or otherwise of education and behavioural interventions. Yet the role of this activity in validating NGO AIDS-intervention programmes and in validating the power differential between trainer and trainees, when respondents are required not merely to show their knowledge, but to show their knowledge in an appropriately medicalised format, warrants critical examination.

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ited ability to understand public health advice about HIV/AIDS prevention (Anuswasdi 1994; Kiti et al. 1991). However, what is most striking about late 1990s NGO projects focusing on life skills is their obsession with youth sexual activity and the morality per se of that activity. This is particularly apparent when considered in concert with the similar perspective that came to be taken on youth sexuality in scholarly articles, conference papers and project reports dealing with HIV/AIDS and youth sexuality, and with newspaper reporting about youth sexual behaviour. In the following I examine two NGO projects, both of which utilise the concept of life skills. The first is a Chiangmai project which focused on research and interventions for HIV/AIDS risk reduction amongst street children in the early to mid-1990s. The second project, from the late 1990s, is a much more ambitious project directed at urban teenagers, and which, although it legitimated itself in terms of AIDS and other risk reduction, in that it focused on discretionary activities such as drinking alcohol, wearing motorcycle helmets and sex, had an inherent concern with moral issues rather than risk per se. In Northern Thailand the issues of child prostitution, street children, child labour and children’s rights all became a matter of attention for social activists during Thailand’s economic boom of the late 1980s and early 1990s, at the same time that the issue of HIV/AIDS first became a matter of serious public concern. Initially they tended to be homogenised and treated as problems of children and youth. However, by 1993/1994, activists had begun to delineate specific spheres of interest and to form separate NGOs to focus on them (Dulawat et al. 1996). Yet all groups retained close links that would later serve as a foundation for the formation of organised collaborative networks. In respect to street children, the NGO Wieng Ping Group for the Better Life of Children was founded in 1992 to work amongst Chiangmai street children (Prasopchai 1994), operating in a loose affiliation with the Bangkok-based Roadside Teacher organisation. Initial activities aimed at little more than providing for the immediate physical needs of homeless children and at raising the consciousness both of the public and state organisations (such as the Department of Welfare) about this issue. Basic research programmes were carried out following the group’s formation in order to assess the nature and magnitude of the street children problem. Street children were classified into various categories (Prasopchai 1995) according to whether they followed their itinerant families and assisted with family income, through begging or selling petty goods such as flowers and fruits to tourists, or whether they were

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street children of their own volition, living by working on odd jobs and as casual prostitutes in Chiangmai’s tourist industry. Leaving the issue of itinerant children to other local NGOs the Wieng Ping group focused on the latter category who, critically, were almost always defined as victims of rapid social change exerting economic pressure on rural areas, leading to extreme poverty and consequent family dysfunction or total family breakdown. From approximately 1994 onwards, the group aggressively sought sponsorship from agencies such as PACT (Private Agencies Collaborating Together), the Thai Department of Health, and UNICEF to carry out projects aimed at AIDS interventions amongst street children. Experience had shown that a range of practices common amongst street children, such as participating in unprotected commercial sex or consensual sex within the group, drug use, cementing relationships through mixing blood (from cuts made on the body), and tattooing with shared needles, rendered the members of this group at a high risk of contracting and spreading HIV, and this fact formed a key legitimation in early funding applications. A summary report of an initial 1994/1995 (Wieng Ping Group for the Better Life of Children 1995) project aiming at AIDS prevention amongst street children described the project as developing the skills (tuksa) of the children. Yet a smaller project, conducted between June and August 1996, talks of reducing HIV/AIDS risk behaviour such as unprotected multipartner sex and drug use, and of improving their general standard of health, but makes no reference to specific skills beyond having children think about (kit), and increase their awareness (dranak) of these issues and their knowledge about self-protection (ponggun ton eng). However, a much more ambitious project conducted during the same period describes its aim as AIDS prevention through the development of teaching materials for the practice of life skills (tuksa cheewhit) amongst high HIV/AIDS risk street children in order to reduce their risk behaviour. The project conducted research using a KAP-style survey of risk behaviour and utilised this to guide the production of teaching materials and subsequent interventions. The life skills teaching material produced by this (Prasopchai et al. 1996) and other street children projects (Wieng Ping Group for the Better Life of Children 1996a, 1996b) conducted during this period focus on the development of general life skills, ranging from problem solving, to coping with aggression or disappointment, to thinking about ways of resolving the forms of social conflicts that caused the children to leave their families.

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The programmes focused on both the short-term issue of preventing the children contracting or spreading HIV, and the longterm issue of having the children consider what sorts of realistic and achievable futures they wished to work towards: returning to their families, recommencing education, skills training or moving directly into the work force. As far as the HIV/health component of these programmes were concerned, the focus was on raising awareness of HIV/AIDS risk behaviours, such as sharing blood and tattooing as well as unprotected sexual activity – particularly when under the influence of drugs such as glue, thinners, gunja or other, harder drugs. Some general health issues were also covered, including increasing awareness of the health risks of drug abuse and of the need to maintain good dental health. Most significant about these early life-skills programmes is that although they were highly focused on AIDS risk reduction through reducing unprotected sexual activity, they made no moral point about sexual activity per se, a point that Dulawat et al.’s late 1996 summary of research and interventions amongst Northern Thai street children (Dulawat et al. 1996) shows very clearly. Thus, the personal biographies and sexual histories that were collected during project research were primarily orientated at the assessment of HIV/AIDS knowledge and risk practices, which were then addressed using innovative teaching techniques ranging from art to street theatre. A Hardening of NGO Approaches to Young People’s Sexual Activity Just as an examination of Thai AIDS research in scholarly journals or of Thai print-media reports about young people’s sexual activities show a hardening of approach during the latter part of the 1990s, the same phenomenon is apparent in the approach of NGOs working with young people in general. Thus, whereas early 1990s projects, such as the street children projects discussed above, focused on safe sex per se amongst specific community groups, by the late 1990s sexual activity amongst any unmarried young people increasingly became viewed in moral terms and, portrayed as unacceptable, became a focus of project activities. As I have noted above, early 1990s research showing high rates of sexual activity amongst young people had largely been ignored or, in the case of young women, assimilated to the ‘good’ girl/’bad’ girl model where sexually active young women were merely relegated to membership of underclass minority groups. However, the sexual surveillance strategies that Thailand’s HIV/AIDS epidemic encouraged rendered the sexual activity of large numbers of young people increasingly visible. This was particularly the case

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as the focus of HIV/AIDS interventions moved from prostitutes and their clients to women, children and youth, and eventually it became impossible to relegate all sexually active youth (girls in particular) to a minority problem group in the fashion of Chuanchom et al. (1988). At this point projects began to address the issue of the sexual activity of young people in general. The late 1990s project discussed below illustrates this change in focus. Projects continued to utilise the idiom of life skills for AIDS prevention, but instead of merely aiming at AIDS risk reduction through HIV/AIDS education and proselytising safe sex, they not only had a much broader behavioural change agenda but also an overt moral agenda that focused on controlling premarital sexual activity amongst young people. The project, the Ford Foundation funded ‘Urban Life Network Project’ (Adul and Warunee 2000; Adul et al. 2000; Raynou et al. 2000; Warunee 1999, 2000; Warunee and Poonsup 2000), was conducted by the Faculty of Nursing of Chiangmai University over the period 1996 to 1999, drawing on staff from various cooperating ‘networked’ organisations. Early 1990s HIV/AIDS projects directed at youth targeted categories of young people considered to constitute a social problem, such as street children or teenaged prostitutes who, due to their use of drugs and participation in both commercial and recreational sex, were considered to be at risk of contracting HIV. With the exception of interventions directed at other groups known to be sexually active, such as factory workers, and the incorporation of AIDS awareness materials in school and college curriculums, programmes at this time paid little or no specific attention to other categories of young people. However, drawing on the concept of urban networks developed by Bond (1995) and Bond et al. (1999), the Urban Life Network project focused on middle-class urban youth in general, in order to ‘respond to the gap in HIV/AIDS prevention and reproductive health services … [and to focus on] identifying issues related to high-risk networks of youth’ (Adul et al. 2000). The project aimed at behavioural change through life-skills development amongst several (overlapping) groups of middle-class adolescents (Warunee 1999: 23). By contrast with most earlier projects that worked with a single target group, it focused research and interventions on young people attending a major Northern college, (the Rajabhat Institute) (Raynou et al. 2000), young people in dormitory accommodation, young people attending a range of popular night spots (Warunee 2000), and on young people in schools (Adul et al. 2000), with a smaller component of the project focusing on migrant workers (Adul 1999; Adul and Warunee

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2000). Thus, for example, amongst students at the Rajabhat Institute, the project aimed at the development of sex education material and the implementation of a sex education programme by college instructors. Among secondary students, as Adul et al. (2000: 1) put it, the project aimed at ‘the development of curricula to teach sexuality education from a cultural perspective that reflects the needs of youth’, while in respect to dormitories and nightspots the project utilised peer educators to: illuminate the links between entertainment, drug and alcohol consumption, unsafe sex and motorcycle accidents, and to identify creative communication strategies with the target population to increase preventive behaviours in the context in which risk behaviours occur … to improve sexual health … to mobilize networks of youth, and businesses that benefit from their patronage, to take greater responsibility in identifying and solving problems. (Warunee 2000: 2)

Interestingly, like Parichart (1999), whose work I discuss above, the project conceptualised both male and female sexual activity as likely to break out in the absence of external controls. Warunee (2000: 1), for example, points out that it arises in a situation of ‘freedom from traditional social controls over sexual behaviour’,9 noting in respect to one informant: ‘When she was drunk, she could not control herself and would kiss or hug men in public, not caring about her own image.[my emphasis]’ (2000: 9). Indeed, many of the project aims suggest an exaggerated concern with bodily and other forms of control. As Adul (1999) puts it, perhaps somewhat ambitiously, given that the life-skills programme he refers to was conducted amongst illiterate Shan illegal immigrant labourers from Burma:

9. As I pointed out in chapter two, there is something of an irony here, in that less than twenty years ago social reformers saw the answers to the problems of rapid development and increasing Westernisation (such as they were then) to be located in a return to various forms of traditional village wisdom (Hirsch 1993; Seri and Hewison 1990; Tongchai 1994). By contrast, those working on AIDS interventions had (and continue to have) a much more pastoral attitude to the village, in that they considered the simplicity of village culture to be the cause of many of the social and sexual ‘problems’ encountered by young people. Thus, they claimed that village-level culture is totally inadequate to provide young people with the skills necessary to cope with the pressures of modern life (which life-skills training provides). Indeed, Raynou (1998) makes this clear in her manual for teaching sexuality studies to college students when she notes that the culture the manual draws on is contemporary culture not the preserved culture of the past.

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Students also practice skills in expression: Using reason instead of emotions; clear articulation over mood and feelings; knowing one’s strengths and weaknesses; controlling oneself under pressure; and improving the attitudes of self and other. Life skills refers to the attribute or ability of being socially competent [my emphasis]. It is a set of internal skills that helps one confront different situations efficiently that occur in daily life [sic]. (Adul 1999: 53)

The project’s health focus on concerns such as teenage pregnancy, and STD and HIV/AIDS prevention is highly laudable; yet, like much of the late 1990s scholarly research discussed above, this health intervention project seems to have the implicit view that sexual activity is highly dangerous and pathological – not only in its outcomes but also because it arises in the absence of other positive life experiences. Thus Warunee (2000: 7) claims that sexual pleasure and incorrect knowledge about pregnancy and disease are central factors preventing condom use and a decrease in partner numbers. As she put it: pleasure seeking dominates behaviour among both females and males, with an 18-year-old female reporting ‘opening her virginity …’ to a 14-year-old boy. Casual sex occurs any time without any love or intimacy. Many of these youths have experienced problems at school and home that have not been addressed by schools or other counselling systems. Sexual pleasure is highly valued by some of these youths in the absence of other positive experiences in life [my emphasis]. (Warunee 2000: 8)

Indeed, in a manner reminiscent of Amara (1995), Warunee (2000: 27) suggests that family pathology leads to young people turning to sexual and other untoward activity such as ‘drugs, and entertainment, thereby paying little attention to school work or resolving critical issues in their own lives’. Accordingly, the lifeskills outcomes that the project measures focus on a reduction in sexual activity in respect to rates of partner change, a reduction in unprotected sex and a reduction in the amount of alcohol consumed. Warunee (1999: 22) notes: ‘Several night spot clients … acquired skills that helped [sic] assess their own potential and abstain from excessive drinking and were able to persuade friends in their networks to avoid risk behaviours. However it was noticeable that little change occurred in safe sex behaviours. … Only a few of them reduced the number of partners to one.’ Although Warunee (2000: 27) notes that as a result of extensive training,

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the peer leaders used in project implementation ‘show some improvement in their leadership potential and an increase in their self esteem’ she also notes that ‘network activity in night entertainment implemented by some peer leaders was not a success because they [the peer leaders] were not able to control themselves. They did not modify themselves from [sic] their usual night-life activities [my emphasis].’ By contrast Raynou et al. (2000: 55), reporting on interventions amongst college students, note that: a number of promising changes occurred in reported behaviours over the period of the intervention … both males and females reported an increase in communication about sex and reproductive health with important adults … the proportion of males and females who reported using an unreliable method [of contraception] at first and most recent sex declined … females reported a decline in the frequency of drinking alcohol and smoking in the past month … males reported a slight decrease in the proportion that had a partner in the last month.

I pointed out in earlier chapters that when subjected to repeated surveying respondents soon learn what answers are desired and tend to give these answers as a form of passive resistance (see Scott 1985, 1989). I also noted that behavioural modification programmes interpreted as intervening in the private sphere and as being overly intrusive tend to elicit resistance from respondents. It is likely that this project’s intensive focus on young people’s lives – in their educational institution, in their private dormitories, during their leisure time at pubs and discos and when driving on the road – elicited such resistance. Thus, Raynou et al. (2000: 47) note that although at pre-test 50 percent of males and 31.2 percent of females reported ever having had sex, by the post-test of the same group of students only 46.4 percent of male and 22.1 percent of female students admitted to ever having had sex. Critically, as I show above, by the late 1990s the scope of lifeskills programmes had been extended in focus from what were conceptualised solely as minority-group problems to issues conceptualised as problems pertaining to middle-class youth in general. The behaviours the programmes addressed had been broadened from an earlier emphasis on protection from HIV/AIDS through the wearing of condoms, to encompass a much broader range of moral and lifestyle issues, ranging from abstinence from sex or, at least, to a monogamous sexual relationship, to a reduction in alcohol consumption and to encouraging the wearing of motor cycle helmets. Indeed, by the end of the 1990s, life-skills projects had begun to focus on the community in

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general, with one 1999 project utilising life-skills education as a technique to implement behavioural change in the way in which villagers accessed and utilised medications. The ‘Life Skill of Community [sic] for Requesting of Qualified Services from Drugstore in Amphur Mae Rim and Mae Tang’ (Faculty of Pharmacy: 1999) project comprised surveys of medicine usage in the target district, and the collection of data regarding various illnesses and their symptoms and the medicines commonly used to treat them. Through the intervention of peer educators it aimed at reforming (behavioural) issues such as usage of the wrong drugs, usage of drugs borrowed from others, taking incomplete drug dosages, over-medication through the simultaneous consumption of two or more drugs, or merely the incorrect administration of drugs, by urging villagers to visit a doctor or qualified pharmacist in the case of illness.

Life-Skills Programmes as a Form of Middle-Class Cultural Resistance In the early 1990s, that young men became sexually active in their mid-teens was merely accepted as normal, and although there was abundant research data suggesting a significant level of sexual activity amongst young women this was generally ignored, or explained in moral terms through drawing on the good woman/bad woman binary division, as in the case of (Chuanchom et al. 1988) discussed above, who explained the sexual activity of her female student sample by pointing out that they were vocational students (and hence had low moral sensibilities). However, as I have shown in the above, during the course of the 1990s, in scholarly research about HIV/AIDS, in newspaper reports refracting public concerns about youth behaviour, and in the aims of NGO AIDS-intervention projects, a substantial shift had taken place from a position where little specific attention was paid to youth sexual activity to one where it became considered abnormal and pathological as well as antithetical to Thai cultural values and, as a result, became a prime target for intervention projects that aimed at its control. Significantly, as youth sexual activity became viewed in harder and more intolerant terms in the late 1990s it became the focus of life-skills programmes which, by contrast with early 1990s lifeskill programmes that merely encouraging safe sex, proselytised an overt moral agenda focusing on the control of youth sexuality and changing youth (and other community) behaviours. This

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moral agenda, which aimed at addressing Thai concerns about youth sexual practices and the impact of Western culture on those practices, is apparent in scholarly HIV/AIDS research and in newspaper and other public media reporting about social issues of that time. Operationalised as such, these programmes function less in their original WHO sense of enabling skills for young people, than they do as a discourse about and practical programme for the constitution (or reconstitution) of Thai middle-class moral values, and as a form of resistance to what are conceptualised as the corrosive encroachments of liberal Western sexual practices. Just as the life-skills programmes initially adopted by NGOs acted as a loose unifying banner for those working in the AIDS, gender and development areas, by the late 1990s the notion of life skills seems to have functioned as a similar overarching banner for a broad range of middle-class-based groups, all of whom were concerned about the shape of contemporary Thai society and about the corrosive cultural impacts of globalisation. A brief archaeology of the intellectual climate in which Thai AIDS education and intervention-programmes were developed during the 1990s (and particularly that of Northern Thailand), shows that there were ideological currents and pressures towards social action in the direction of life-skills training from several influential middle-class-based groups. The first strand of intellectual thought that was important in influencing Northern Thailand’s AIDS debates in the early 1990s came from feminists who had already been working on prostitution issues for over a decade. As HIV/AIDS became recognised as THE social problem of the era, feminists initially campaigned against the movement of young rural women into prostitution and, moving on from earlier analyses of prostitution such as Pasuk (1982) and Thitsa (1980), worked on tracing the roots of this practice (Chiraluck 1992) and the gender inequality which underpinned it. Thus, as the anonymous Executive Summary to the 1995 Area of Affinity Workshop on Women, Family and AIDS Prevention workshop (held in Chiangmai) notes in its first paragraph, ‘it is generally recognised that gender power relations are the root cause of HIV/AIDS problem [sic] amongst women’ (anonymous 1995: ii). Critically, it argues that AIDS prevention efforts directed at commercial sex workers and their clients, had left ‘young girls and married women most vulnerable’ (anonymous 1995: ii). Feminists viewed women as highly vulnerable to HIV due to their ‘Lower socio-economic and cultural status, less opportunities and mobility, political, economic and social rights, less access to available resources and services, less sexual power and control over their bodies and lives’

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(Chiraluck 1995: 62). They viewed all women, not just those in the sex trade, as being in need of empowerment so that they would be able to stand up for their rights and protect themselves against HIV infection from husbands who visited prostitutes. Papers delivered at an earlier (Chiangmai) 1993 conference dealing with HIV/AIDS prevention amongst women, such as ‘AIDS Prevention Amongst Couples, Husbands and Wives: A lesson from a Chiangmai Provincial Study’ (Patcharin et al. 1993a), ‘The Prevention of Sexually Transmitted HIV Amongst Housewives in Chiangmai Province’ (Patcharin et al. 1993b) and ‘The Campaign Against AIDS Amongst Teenage Girls in the Northeast’ (Euampon et al. 1993), give some sense of the interventions based on increasing levels of condom use and a reduction in male participation in commercial sex that this perspective motivated. Thus, for many working from this stance, the idea of teaching life skills in the sense of enabling skills answered women’s needs and, like earlier mass HIV/AIDS-education programmes and programmes such as the ‘100 Percent Condom Programme’ and the later ‘The Thai Family Combats the Danger of AIDS’ programme, seemed to make good practical sense. Another important strand of intellectual thought which fed into thinking about HIV/AIDS issues in early 1990s Northern Thailand (and which also fed into feminist thought) was the 1994 Cairo International Conference on Population and Development. The ‘Plan of Action’ called on countries to empower women, and to eliminate gender inequality, particularly those inequalities relating to sexual and reproductive health. Subsequently, in 1997, Thailand announced a reproductive health policy focusing on a range of health initiatives newly grouped under the broad heading of reproductive health. These encompassed initiatives ranging from family planning to maternal and child health, to sex education and adolescent reproductive health (Suwanna and Wiput 1999). Activities undertaken in Thailand as a result of the Cairo Conference drew on substantial funding from the United Nations Population Fund (UNFPA) for research to assist in the development of these initiatives (UNFPA 1998). Research funding was provided directly to support university projects such as the many projects conducted at the Mahidol University Institute for Population and Social Research (Chai and Umaporn 1995; Gray et al. 1999; Pimpawun et al. 1999), as well as via various European IOs/NGOs which supported programmes implemented by local partners (EC/UNFPA 1999). Like the feminist groups discussed above, and the Thai Ministry of Public Health through which UNFPA programmes were implemented, the UNFPA viewed

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young people, and young women in particular, as being in need of empowerment through the teaching of life skills, in order ‘to learn to handle social and peer pressure, ambivalence, assertiveness and reproductive protection … skills for responsible behaviour, gender equality, the ability to anticipate, analyse, plan, make decisions’ (Mehta et al. 1999: 18). The 1994 Cairo Conference, and subsequent public health initiatives in Thailand under the Cairo Plan of Action, not only gave a new emphasis to the reproductive health area in Thailand’s Ministry of Public Health (MOPH), it also integrated previously fragmented reproductive health responsibilities under the Family Planning and Population Division of the MOPH, and placed a high stress on adolescent reproductive health (Bhassorn 1997; Suwanna and Wiput 1999; Suwanna and Yupa 1999). Ministry of Public Health publications clearly demonstrate that it, like the UNFPA, viewed life skills as a fundamental aspect of adolescent reproductive health programmes. However, for the MOPH the concept of life skills seems to have been interpreted not in the original WHO sense of enabling skills, but as a set of tools to be used in the rehabilitation and maintenance of the morality of Thai youth in the face of the encroachment of the loose sexual values of the amoral West. Thus a recent MOPH analysis of Thailand’s adolescent reproductive health programmes addresses what it calls ‘sex problems related to pre-marital sex’ (Suwanna and Yupa 1999: 16), meaning unwanted pregnancy, abortion, STDs and HIV/AIDS. Not only do the authors of this document portray premarital sexual activity as highly pathological with extremely negative impacts on young people’s lives, their suggestion that the adoption of a correct standard of sexual behaviour will rectify these problems poses the solution to complex social issues in moral terms: ‘If children, born to a family and society with a good standard of living, knowledge, understanding, and attitudinal values about sex, are reared appropriate to their age and sex, this will not only lessen adolescent sex problems but also lead to suitable and correct sex behaviour in adulthood [sic]’ (Suwanna and Yupa 1999: 10). Moreover, in addressing these problems the report suggests they arise not solely because of structural issues such as changing patterns of culture, but are the result of incorrect individual understandings about appropriate behaviour, which are: … a result of unsuccessful sex education in the education system. This unsuccessful teaching leads to incorrect attitudes and practices by students. … sex education has not been discussed broadly and

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in-depth enough to create a correct understanding in the family. This makes people seek their own experience, which most of the time leads to incorrect behaviour outside the home environment [my emphasis]. (Suwanna and Yupa 1999: 16)

Ultimately, the report endorses the life-skills model, noting: It may be that providing information may not be sufficient to prevent adolescents from behaving undesirably. To cope with these problems, relevant parties should take Life skill [sic] education into account. Since Life Skills are abilities for adaptive and positive behaviour, that enable young people to deal effectively with the demands and challenges of everyday life [my emphasis]. (Suwanna and Yupa 1999: 19)

The report is interesting as its discussion of the cause of reproductive health problems oscillates between structural and individual factors. Ultimately, however, in its adoption and promotion of life skills as the solution to these problems, it effectively opts for individual pathology, and the problems it identifies are in essence problems of adolescent conformity with the nostalgic cultural memories of the state and a middle-class-based model of morality, and all the partialities of class, region, ethnic group and historical period that these embody.

Conclusion Through an examination of scholarly works about HIV/AIDS and young people’s sexual activity, media reports about young people’s sexuality and NGO programmes directed at HIV/AIDS interventions amongst young people, I have shown that over the course of the past decade sexual activity amongst young unmarried people has come to be viewed in highly pathological terms, as abnormal and inappropriate, and as an activity contrary to Thai cultural values. Critically, it is likely that a major reason why sexual activity on the part of young people is portrayed in this manner is that it is regarded as the result of young people emulating Western patterns of uncontrolled sexuality, and as a symptom of the continuing erosion of Thai culture by the power of Western culture. That late 1990s NGO programmes focusing on AIDS prevention amongst young people also aimed at the restoration of Thai moral values through the control of sexuality is very clear. As a Chulalongkorn University AIDS expert (Yvonne 1996) puts it,

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‘much has to be done in developing life-skills, which would enable young people to cope, say “no”, and contribute in changing certain aspects of the culture which is now responsible for this [AIDS] epidemic [my emphasis]’. Others are even more direct. Raynou (1999) describes the aim of the Life Network intervention conducted amongst students at the Chiangmai Rajabhat Institute as ‘help[ing] students to change their HIV/AIDS risk behaviour’ (1999: 35), and points out that the sexual relations on which the project focuses are the result of globalisation and media pressure (Raynou et al. 2000: 1). Critically, she points out that ‘morality is the ultimate goal of this project’ (Raynou (1999: 37), and notes that the project is really about ‘Sex education and appropriate attitudes [my emphasis] towards it [sex]’. It becomes clear in project reports that the only appropriate attitude for young people is abstinence, as sex is portrayed in highly negative and pathological terms, and as a particularly inappropriate activity for young single people. As Raynou (2000: 1) points out ‘young people, … increasingly initiate sexual relationships with classmates and friends during their high school and college years. These relationships often end unhappily, or result in unwanted pregnancies and abortions’. I argued earlier that from the beginning the HIV/AIDS epidemic in Thailand has been understood in fundamentally moral terms, and pointed out that from the early AIDS period AIDS discourses have portrayed the activities through which the majority of HIV infections have occurred – homosexual sex, IDU, and heterosexual sex between men and their prostitute partners – as deviant or amoral activities. Thus it is not surprising that as the attention of AIDS-intervention programmes came to focus directly on young people, over the course of the 1990s what began as safe-sex programmes were transformed into programmes directly concerned with the promotion of morality. Nor is it surprising that there has been little criticism or debate about this issue, or that these attempts to redraw Thailand’s moral boundaries have been legitimated by reference to health and medicine. Medicine, as Taussig reminds us, is ‘pre-eminently an instrument of social control’ (Taussig 1980: 13). The new public health regimes of which AIDS campaigns directed by experts with a high-level focus on population categories and an emphasis on the surveillance and regulation of behaviour constitute an example par excellence are, as Peterson and Lupton (1996: 3) point out, ‘but the most recent of a series of regimes of power and knowledge that are orientated to the regulation and surveillance of individual bodies and the social body as a whole’ (see also Lupton 1993).

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Researchers such as Lyttleton (1994a; 1996b) and Jon and Werasit (1994) are highly critical of the stereotyping inherent in early AIDS programmes due to the fear and social stigmatising they engendered, and of their simplistic and misleading riskgroup approach. However, that these programmes were based on morality was no accident, as Wiput (1998: 1,873) points out when he notes that: ‘The education and prevention messages were chosen to do more than just suggest measures to avoid infection. These messages also defined characteristics of people who were considered to be substantial risks for transmitting HIV.’ Thus, from the beginning of Thailand’s AIDS-education campaign initiatives, HIV infection was portrayed as a function of individual moral failure, and of failure to adopt the state-promoted model of correct health behaviour. As Wiput (1998: 1,873) puts it, ‘Conventional AIDS education evolved to foster life-skills empowerment in Thai youth rather than behaviour modification, so that their culture, peer pressure, and norms would promote safer sex behaviour [my emphasis].’ From this perspective morality is no longer a subtext in HIV/AIDS-prevention programmes aimed at young people, instead it has become the raison d’être for such programmes, with AIDS prevention being relegated to a fortuitous by-product. Writers on the history of NGOs and AIDS in Northern Thailand, such as Chutchawarn (2000) and Bupa (1999), view the formation of NGOs active in the AIDS field as marking a democratisation of AIDS programmes and a move towards popular empowerment. In this volume, as well as in earlier publications (Fordham 1998, 1999), I point out the domination of the Thai AIDS arena by biomedicine and by epidemiological and demographic modelling, and note that the Thai AIDS arena is characterised by an extremely high level of agreement about what the issues are and by an absence of critical reflexivity. However, I suggested in chapter five that in Thai language social science journals, in the research and working papers of the many academics and social activists involved in NGO work, in the HIV/AIDS epidemic constituted in local-level Thai language media, and in the daily village experience of AIDS, there is potential for the growth of indigenous Thai AIDS discourses to stand against the hegemonic effect of the largely unitary model of the Thai HIV/AIDS epidemic constructed by the Thai Ministry of Public Health and UNAIDS, in Western biomedical and social science journals, and in major international AIDS conferences. There is, then, some irony in the fact that the effective proselytising of the notion of life-skills training and the support for the teaching of morality

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across a wide middle-class terrain, stretching from the Ministry of Public Health to academic experts on HIV/AIDS and to NGOs, as well as a call for a return to the morality of the past from some vocal members of the general public, constitutes a new intellectual colonisation of those hard-won free spaces of thought and action of the early Thai AIDS period. Yet more seriously, the move to teaching life skills represents a subtle shift in focus from structural pathology to individual pathology. Earlier work on gender and prostitution issues such as Pasuk (1982), Richter (1988, 1992), Thitsa (1980), Truong (1990) and some 1990s anthropological analyses, Montgomery (1996a, 1996b, 2001), Niwat (1998), produced insightful analyses about gender and the position of women in Thai society, through taking strong economic and structural approaches. By contrast, the micro-level focus of HIV/AIDS life-skills programmes evidence a highly conservative agenda in their reduction of the social problems they address to matters of individual pathology. Here, issues as complex as prostitution, the problem of street children, patterns of sexual behaviour and village patterns of medical drug therapy are homogenised as being of the same order and as amenable to the same solutions, and aetiology is reduced to simplistic mono-causal explanations such as a lack of factual knowledge, or merely bad or inadequate behaviour. Ironically, for young people, the rights that have been vigorously promoted following Thailand’s becoming a signatory to the Convention on the Rights of the Child in 1992 do not, it seems, include the freedom to choose to be sexually active, nor do they extend to the right of freedom from what Warunee (1999) seems to promise will be increasingly effective methods of behavioural surveillance. From an AIDS-prevention perspective the implications of an approach based on morality are clear. Such an approach conflicts with best-practice advice, such as that given by the respected Macfarlane Burnett Centre, Centre for Harm Reduction (Macfarlane Burnett Centre 1999) which recommends that interventions be carried out in an absence of moral judgements and from a perspective of sex positivity. Moreover, the morality-based life-skills programmes discussed above legitimate their activities with portraits of Thai youth sexuality where young women are depicted as having little agency in directing their own lives, and generally depict sexual relations in terms of a male-female gender war, in which young women are always fated to lose out due to ‘worst case’ physical outcomes such as disease, disrupted education or unwanted pregnancy that they may involve. Yes, these are possibilities. But for most young Thai men and women these ‘worst

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case’ events do not occur, and this highly negative portrait of youth sexuality just does not match their experience of contemporary, lived realities. Instead, as yet another instance of what Bolton (1995) calls the ‘lies’ and ‘deception’ that have characterised the AIDS epidemic, they are likely merely to be ignored alongside the safe sex advice that such AIDS-intervention programmes aim at providing. Contrary to these bleak perspectives painted by those who seek to use youth sexuality as a weapon in an undeclared war against globalisation, and what they view as its deleterious impact on Thai culture, as I noted in earlier chapters, there is much evidence on the streets and even in the popular press to suggest that young Thai men and women have highly positive attitudes towards sexual activity, and that women are actively and consciously engaged in reforming the restrictive gender biases of the past. Their healthy attitudes towards their sexuality are, thankfully, light years away from those of the moral police of the middle class and their often pythonesque programmes for the pursuit of moral purity. Contemporary anthropological research also demonstrates both the ongoing reform of gender and sexual agendas on the part of young men and women. Mills (1997, 1998, 2001) takes up the many contradictions which characterise the lives of young migrant women working in Bangkok factories, and shows that despite the many difficulties their life involves and the overarching structures of power in which they are embedded, for them the experience of modern urban life is generally viewed in highly positive terms. Even more important, are recent sensitively nuanced analyses by Michinobu (1999, 2000), who takes up the issues of HIV/AIDS risk in the lives of young female factory workers working on a factory estate in rural Northern Thailand. Certainly, she still portrays women as disadvantaged in their relations with men who they know are not always trustworthy, and in the issue of safe sex, where asking lovers to use condoms is tantamount to a declaration of lack of trust; however, importantly, she shows that young female factory workers are not caught helplessly between archaic pastoral images of ‘good’ (chaste) women and ‘bad’ (albeit, modern and sexually available) women, but are actively engaged in revaluing these categories through the reformulation of their sexuality. She argues that women consider that the physical autonomy of urban employment, in concert with the autonomy of their own wage, gives them the right to engage in sexual relations without the consent of their parents. She notes that: ‘While pre-marital virginity is no longer a norm for many

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women, they have to resist a negative image of sexual looseness attached to women of the [factory] estate. Thus, they try to maintain the reputation of a good daughter by remitting money to their parents, and by justifying their sexual relations with men based on love and mutual trust.’ (1999: 14)10 If AIDS campaigns amongst young Thai people are to be truly successful they must come to terms with contemporary adolescent sexuality, and must abandon the urge to proselytise a sexual morality based on nostalgic memories of a highly simplified and romanticised past. Only when AIDS-prevention programmes accept the high rates of sexual activity found amongst young Thai men and women will they be able to provide effective solutions to HIV and other sexual risks regularly faced by these young people. One starting point might be to relinquish the simplistic and stereotypical concepts on which patterns of Thai sexual activity have, thus far, been modelled. Concepts of ‘good’ and ‘bad’ women and their respective sexual behaviours, of middle-class patterns of sexual control verses underclass patterns of sexual promiscuity and, most of all, the concept that Thai adolescent sexual activity is solely the result of their emulation of Western patterns of sexual promiscuity, must be revealed as simplistic and vacuous stereotypes, and as being of little use in directing AIDSprevention campaigns that aim to address ‘real-world’ behaviour.

10. Interestingly, there are no sensitive interpretive works dealing with the young heterosexual Thai male experience of contemporary sexual agendas. As I point out in chapter three and elsewhere (Fordham 1995, 1999) in analyses of the sexuality of Thai men in the rural and urban underclass, the care taken with analyses of Thai female sexuality has not been extended to works focusing on Thai male heterosexuality, which has been treated in highly stereotypical, and highly negative and unsympathetic terms.

CHAPTER 7

CONCLUSION: DIRECTIONS FORWARD

T

hrough a critique of the normative modelling of Thailand’s HIV/AIDS epidemic, this volume has aimed at encouraging the development of new paradigms for modelling the epidemic (and implicitly AIDS epidemics in other parts of South East Asia and elsewhere) and for understanding indigenous behaviours, with the aim of developing more effective interventions to reduce the ravages of this terrible disease. I have argued here that the bulk of Thai AIDS behavioural research and intervention activities are characterised by a naive empiricism. Partly, as I have suggested, this is a result of research methodologies that prioritise data quantity over data quality. Partly, such naive empiricism, particularly on the part of those who favour biomedical approaches to HIV/AIDS, is the result of a deliberate policy to ignore analyses based on what is perceived as complex social theory, or which are highly critical in respect to the normative model of AIDS. Partly too, particularly in the world of the many smaller NGOs working in the AIDS sphere directing behavioural research or interventions, such approaches are the result of staff who have no grounding in social science theory or in research methodology, and who conduct research and interventions ‘by numbers’ through the use of agency manuals of ‘best practice’. Other NGOs are constrained by the wishes of donors and their conception of what the issues are and of best practice in both research and intervention. Regardless, I have argued that from any form of reflexive perspective, the response to the Thai AIDS epidemic has been curious in its narrow focus on the mechanics of sexual behaviour and on the transformation of sexual behaviour amongst specific, highly

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essentialised, social groups. This, together with an approach which has pathologised sexual behaviour as dangerous risk behaviour and as a moral issue to be policed, rather than regarding it as part of the very core of our humanness, of our constitution of our selves, and as intimately related to every other aspect of our lives, has, I have argued, distorted perspectives on the epidemic and on the behaviours through which HIV is transmitted. With the problem and key issues defined in the narrowest of terms, and through a general failure to engage in any reflexive examination of those terms and their limitations, the Thai AIDS epidemic has been modelled, and AIDS interventions have been conducted, in a tautological world where alternative understandings of the situation and the development of alternative and possibly more efficacious interventions have been effectively ruled out. The issue, then, by way of conclusion, is to ask: ‘Where to now?’ Where might the impulse to ask new questions about the Thai (and other) AIDS epidemic(s), the impulse to critically and reflexively examine taken for granted understandings regarding ‘how things are’ and ‘what is to be done’ arise? The hegemony of biomedically orientated understandings of the nature of the epidemic, of research based on naive empiricism, and the rejection of critically reflexive analyses seems almost complete. As it stands, encoded in medical and policy frameworks, what Pigg (2001b: 482) calls an ‘internationally standardized set of facts and policy wisdom’, the normative (biomedically orientated) model of the Thai AIDS epidemic is a comfortable tautological world untroubled by the disconfirming evidence it rules irrelevant.

IOs, NGOs and the Development of Alternative Thai AIDS Paradigms In chapter five I suggested that NGOs working in the AIDS arena had potential to generate alternative HIV/AIDS discourses that would stand against the biomedically and Western culturally orientated discourses of the normative model of Thai AIDS. Yet in the following chapter I demonstrated what I called an ‘intellectual colonisation’ of these arenas by the normative model of Thai AIDS during the course of the 1990s. However, the question remains as to why, given the very significant role that both IOs and local NGOs have played in Thai HIV/AIDS behavioural interventions and in care for the afflicted, and given the real ‘on-theground’ familiarity of indigenous staff (and even some expatriate

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staff) with the realities of the Thai AIDS epidemic, have NGOs not played a more critically reflexive role in regard to the normative Thai AIDS paradigms. Why has the potential for the development of competing AIDS discourses not been realised to a greater degree than it has, why have those competing discourses that have developed been so conservative, and why have they been so muted? Recourse to some version of conspiracy theory is initially attractive. Such a model (compare Hancock 1989) might argue that large international organisations and non-governmental organisations are primarily motivated to protect their ‘turf’ in the AIDS sphere, and their intellectual and infrastructural investment, and thus automatically reject outside criticism and intervention. Certainly in the 2000s, IOs and NGOs occupy a somewhat difficult interstitial position in relation to the state and the communities they claim to serve. As del Casino (1999) points out, there is an uneasy relationship between the NGO ideology of operating in opposition to state agencies while, at the same time, working in cooperation with (and sometimes receiving funding from) those same agencies. This uneasy position is demonstrated by the high level of secrecy that characterises many IO/NGO activities, with most having limited public accountability beyond regular financial reporting and the reporting of basic details concerning project progress and completion to donors. Thus, a recent World Bank report (World Bank 2000: 35) notes that the Thai AIDS budget for the year 2000 would allocate 60 million baht to nearly 300 NGOs and that the World Bank would provide an additional 27 million baht to six major NGOs which would allocate funds to smaller collaborating NGOs, yet comments that: ‘Little information is available about the precise activities of NGOs, the coverage or effectiveness of their activities, and their potential complementarity with other public and private programmes.’ Indeed such secrecy extends well beyond the financial arena to encompass the details of project activities and research data. Behind their public relations profile of glossy, photograph-filled (yet vacuous, simplistic and highly emotive) brochures and web pages utilised to publicise their activities and to solicit funds from ‘mums and dads’ donors, IOs and NGOs conduct their activities in an atmosphere of high secrecy, with outsiders rarely allowed significant access and primary research data and research reports being treated as a corporate secret rather than a public good. Renard’s comments regarding UN development projects in the Northern Thai highlands apply in full measure to IOs and NGOs working in the HIV/AIDS field. He points out:

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All too often information is treated as confidential during the life of a project and then discarded when the project is completed. The culture of many UN agencies downplays the role of the written word, preferring to work with people directly. But as people are transferred or retire and as projects are concluded, the lessons learned are too easily lost or forgotten. (Renard 2001: 172–73)

Conspiracy theory or turf protection, then, explain some aspects of the functioning of the various IO/NGO bureaucracies that the Thai AIDS world has given rise to. However, I suggest that the situation is yet more complex, and that there are other factors working in concert to mute NGO criticisms of the normative model of Thai AIDS or to direct criticisms in such a direction as to keep them broadly within the parameters of the normative AIDS paradigm. A first factor is the increasing bureaucratisation of IOs and NGOs manifest in the increasing power of a managerial culture and the growth of a culture of review. This system is one that tends to act in terms of itself, in a manner analogous to the functioning of the tautological world of AIDS logic I describe throughout this volume. In this system, on the basis of their understanding of a particular issue, donors prioritise particular areas for attention, and project proposals are prepared in accord with donor wishes using the approved research and intervention methodologies of the period, couched in the language of the area in question. Project terms of reference are highly specific about what is to be done and how the various tasks are to be carried out, and issues such as objectives and criteria of success are set. Similarly, the criteria by which to evaluate project success through an end-of-term project review (usually conducted by a short-term consultant employed specifically for that purpose) are specified at the beginning of the project. As a result, once this regime is set in motion, it functions in terms of its initial paradigms; it asks questions only in terms of the initial paradigms and, as a result, gets answers couched in terms of those paradigms. Although, in conformity with established management practice, at the level of rhetoric such regimes claim to aim at innovation, in reality they reward conformity to established practices and formulas. At the level of funding, for example, project proposals working outside established conceptual frameworks are unlikely to be funded; similarly, in respect to endof-project reviews. Not only do the terms of reference usually limit reviews to a fairly narrow area of examination, as Hancock (1989) points out, if the writers of such reports hope for further

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employment then positive reviews are likely to be produced. There are few misguided project decisions or activities that cannot be described in the obfuscatory double speak of project evaluations as ‘lessons learned’.1 Indeed, for the many NGOs formed specifically to work in the AIDS area (AIDSNET 1999; Busabar and Duangsomrot 1996; Chutchawarn 2000) or which have moved their focus from other development issues to work on AIDS (Law 2000: 113; Pigg 2001b: 493), there are good institutional reasons to reject or downplay criticism, as securing future funding depends on the unproblematic conduct of funded research. Thus, in practice, overly critical or otherwise unpalatable reports produced by consultants are ‘edited’ prior to presentation to donors, and beyond the ritual ‘lessons learned’ section of reports there is little reason to raise questions about alternative modelling or methodologies.2 For most organisations, and for most donors, the fact that the 1. Having spent the past decade intimately involved in this area, like those critical of the development business, I cannot disguise my cynicism regarding the lunacy that characterises much of the ‘AIDS business’. Organisations plan and conduct behavioural research and intervention programmes as business-like activities that can be conducted according to standard business management practices. Thus, issues such as of the timing of research are dictated by the funding cycles of donors and by a time line in Microsoft Project. As a result, for example, the research team and their iconic short-term consultant, who as a generic expert in areas such as IEC (information, education and communication) frequently has no local cultural or linguistic skills, may be sent to a remote rural area at the height of the wet season. This dictates that they travel whenever the roads are passable (rather than as dictated by data collection needs) and, with no time available for learning about village contextual and other allied (but as yet unconsidered) issues as necessitated in true qualitative research, data collection is reduced to a series of rushed focus groups conducted amongst the headman’s relatives. Yet, in the final report, these factors, these absolute failures of common sense, where expatriate management forgot about the limitations on travel imposed by the wet season, and where local staff concerned about the loss of a trip ‘up country’ and its associated per diem omitted to raise the issue, are discussed under the heading of ‘lessons learned’, suggesting that something ‘really quite clever’ has been discovered. 2. The ‘negotiation’ that Strathern and Stewart (2001: 13) refer to as taking place between consultant anthropologists and their employers about what will be written and about rights to writings and research materials is, in what is often a buyers’ market, largely one way. Certainly, as these authors point out, consultants are constrained by their monetary contract – both their current contract and considerations of future contracts. In truth, at the methodological and epistemological levels, the relationship between consultants and their employers is frequently not a happy one: as Kapferer (2000: 195) points out in respect to anthropological consultancy ‘its agenda is set by concerns that are frequently totally external to the concerns of the discipline, even antagonistic to them [my emphasis]’.

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research was completed serves as proof of appropriate methodology, even though the research may not have proceeded entirely to plan or objectives may not entirely have been achieved. Moreover, in the convoluted logic characteristic of this system, the failure of programmes to meet targets or to function as planned is often interpreted as merely indicating the intractable nature of the problem, and the need for yet more programme activities and more capacity building. A subtle orientalism on the part of Western donors (an orientalism that some might suspect is recognised, and subtly ‘worked’, by implementing agencies) also serves to ensure that few questions are asked about completed research. It works this way. When donors fund IOs branch offices or local NGOs to conduct programmes, in addition to the primary objective of the programme a common, explicit, secondary objective is that of capacity building within the implementing organisation. Such capacity building may be as basic as developing the computing skills of staff, enhancement of staff research and reporting skills, bookkeeping skills, language skills or other such training. Visits by donor representatives, and programme reporting, frequently give donors a general sense that not all is well: capacity-building programmes falter; funding moves from programme and capacitybuilding activities to infrastructure, such as computers and motor vehicles; target villages are frequently suspiciously close to popular seaside or forest resorts; and programme outcomes fail to meet original targets. Yet such activities are tolerated: partly due to the sheer inability of donors to force compliance, but also because donors rationalise such failures on the basis of the orientalist justification that the Thai, Lao or Cambodians are ‘like that’ and that such conduct is to be expected. An additional factor that has served to restrict and mute any potential Thailand’s IO/NGO community has in respect to developing alternative AIDS discourses, is the manner in which these organisations are increasingly funded by donors to work together as networks. Thus, during the early 1990s as NGOs and CBOs working in the area of AIDS education and care activities proliferated, an early move was the formation of several loose networks of AIDS-related NGOs. Bupa (1999) notes that the first network, NGOsAIDS, was formed as early as 1992. Support from Thai government agencies as well as from the Australian funded agency NAPAC which provided funding for AIDS-related programmes, further accelerated the growth of small NGOs and CBOs and the development of linking networks throughout the early 1990s. Initially networking was concerned with exchange of

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information, working loosely together to form stronger lobby groups and, far less explicitly, with issues concerning the maintenance of boundaries between the spheres of interest of the various groups. However, by the end of the decade, networking had developed to the point where funders such as UNICEF and the Ford Foundation were encouraging hitherto separate NGOs to work together in a network, and to apply for funding for AIDSintervention programmes to be jointly implemented. Such networking amongst NGOs has generally been acclaimed by all as a highly positive feature linking NGOs, community based organisations (CBOs), state agencies and the academic world (via ‘advisors’ drawn from various Thai universities). Yet, in the Thai cultural context, while it is true that consensus is an important value, people with power or rank (puu yai, literally, big people), are dominant (Mulder 1984, 1992b, 1997) and consensus tends to form about their views (Hinton 1992). People of lesser power, without rank or qualifications (puu noi, literally, small people), rarely challenge those higher up, and if they do, their challenges are not taken seriously. Recent works by Bupa (1999) and del Casino (1999) demonstrate just this in respect to women’s organisations and CBOs. They show that people of low power and status from CBOs who attend networking meetings are rarely taken seriously by those with more power and status. By the end of the 1990s, donors’ encouragement of hitherto separate NGOs to work together in mini-networks to develop and submit joint funding applications for programmes not only acted to give donors yet more control over the groups and programmes they funded but it is likely that it also acted to reduce the opportunities for both the development of innovative models of research and intervention, and of alternative AIDS discourses. Certainly over the decade of the 1990s a greater consensus developed in regard to what the problems were, what the solutions to those problems should be and how they should be implemented. The many reports produced by the Life Network project (discussed in chapter six), although written by a variety of different individuals working in separate organisations networked together, demonstrate a consensus which suggests that dominant personalities (dominant in terms of the social rank, the possession of high educational qualifications, political connections or even a high level of fluency in English) had influenced the activities and analyses of all organisations in the network.3 3. The importance of English language fluency should not be underestimated. Those whose class background has given them high levels of education and its accompanying English language proficiency are able to link easily into inter-

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In summary, then, despite the potential they possess as a site for the development of alternative Thai AIDS discourses and of a critical reflexivity about the modelling of the Thai AIDS epidemic and the interventions such modelling has directed, the IO/NGO arena is unlikely to generate such discourses. Indeed, even if produced from this stance, such a critique would be highly suspect. The rhetoric of radicalism espoused by NGOs and the moral imperative they claim in the legitimation of their activities (West 2001: 68), as I have demonstrated in the above, masks conservative and bureaucratic organisations and highly metropolitan agendas.

Rethinking the Role for Anthropology? The question remains: Where to now? Given that what I have demonstrated in this volume is an ongoing and seemingly unrepentant scholarship of admiration for Thailand exhibited by those working from a Thai Studies perspective, it is unlikely that a critical discourse about the modelling of the Thai AIDS epidemic will be generated from this stance. In the 2000s, the bulk of Thai Studies scholarship has remained mired in a post-structural-functionalist, post-culture and personality, comfort zone, where Buddhist ritual and loose structure have given way to forest monks, environmentalism and non-controversial issues such as Whittaker’s work on Isaan women’s health and birthing rituals (Whittaker 2000). Indeed, even the ground-breaking work of Jackson (1995a, 1995b, 1996a, 1996b, 1997, 1999) on Thai homosexuality has been conducted from a careful and comfortably disengaged academic perspective. For most, with the exception of the odd footnote or token short chapter on AIDS issues (compare Van Esterik 2000), the HIV/AIDS epidemic and its ravages on Thai society, the massive sexualisation of Thai society over the past decade and ongoing transformations in youth culture and youth sexuality that is well documented in Thai popular literature may not well have occurred (see Butarat 2001; Orasom 2001; Pansak 1999; Pansak and Prawit 2001; Somprasong and Unchalee 2001; Wichundaa 2002). national AIDS networks via conferences, English language publications and international IO/NGO networks. Thus they are advantaged in the proselytising of their ideas, and in getting the patronage of Western-based organisations for research and conference funding. Importantly too, and this area would repay further study, they have the ability to act as patrons and culture-brokers for ‘non-Thailand literate’ Westerners who conduct AIDS research in Thailand.

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I suggest, then, that the discipline possessing the most potential for making a critical reorientation of Thai AIDS debates (and of course AIDS debates elsewhere in South and South East Asia and elsewhere) is a regenerated, re-engaged and socially aware anthropology prepared once more to act as the ‘uncomfortable’ discipline (possibly both for others and for anthropologists), an anthropology no longer prepared to be muted or, in the era of the audit culture, to mute itself in order to render itself more comfortable for others – an anthropology no longer prepared to be trivialised in regard to epistemology or methodology – as Kapferer (2002: 151) puts it a ‘return to its critical spirit’.4 A critique of the normative modelling of the Thai AIDS epidemic made from this perspective has the potential for taking into account issues of methodology and of interpretation and, most importantly, has the potential to insert a critically reflexive social theory into debates hitherto dominated by naive empiricism. Importantly, such an anthropology should be prepared to speak to a broader audience outside the discipline, both specialists and non-specialists alike (see Hamilton 2003). I have already dealt at length with methodological issues in relation to Thai HIV/AIDS research and the contribution of a reengaged and critically reflexive anthropology. I return to this point only briefly here. Much of my analysis in this volume has been concerned with a critique of the methodologies through which AIDS-related behavioural data has been gathered. My critique has been, firstly, in regard to the often decontextualised nature of the data and, yet more fundamentally, the fact that often, quite simply, the wrong data has been gathered as the wrong questions have been asked and have continued to be asked again and again and again. Secondly, I have argued in respect to 4. In the 2000s, such a regenerated critical spirit would benefit from a grounding in what Scheper-Hughes (1995) calls ‘the primacy of the ethical’, a willingness to become involved and to engage directly with questions of ethics and power at all levels. In the case of Thailand’s HIV/AIDS epidemic, such an engaged stance and a refusal to be complicit (whether by actions of omission or commission) with research and programming conducted in bad faith or from a stance of naive empiricism, may have encouraged a greater questioning of the normative model of Thai AIDS, of simplistic analyses that viewed the low moral standards of the underclass as bearing the prime responsibility for the spread of the epidemic, and of the legitimacy and ethical status of the regimes of bodily control and supervision that AIDS-control programmes generated. It is not yet too late, many aspects of Thailand’s AIDS epidemic have yet to be subject to critical examination – important issues such as the ethics and practice of vaccine trials and the testing of other HIV/AIDS-related drugs in Thailand have yet to receive attention from anthropologists (or, indeed, from social scientists of other persuasions).

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the methods: primarily questionnaires (regardless of the modern sounding acronym with which the questionnaire is known) or focus-group styles of data collection. Thirdly, I have been critical about the interpretation of the data which, in many cases, is just plain wrong and which, privileging etic over emic interpretations, has characteristically paid little attention to indigenous cultural logic. I suggest then, as Sanjek (1990: 151) puts it: ‘All roads lead to a return to ethnography.’ Yet I emphasise, once again, that the contribution of ethnography is not solely the ‘reality therapy’ of being there – even though this alone has great advantages over much of the Thai AIDS research methodology discussed in this volume. What I emphasise about anthropological fieldwork and its potential to reorientate Thai (and other) AIDS discourses is the radical questioning attitude and reflexivity which, ideally, accompanies such a practice. As Kapferer puts it: Others’ cultural practices, when taken on their own terms (ie. not reduced to the terms of different understandings and differently situated practices), can open horizons of knowledge in such a way as to suggest original and perhaps fertile solutions to human questions of general import. New possibilities become apparent which may break the myopia of metropolitan prejudice and self-enclosed isolation. (Kapferer 2000: 187)

Aside from issues of method, I have argued in chapter two and subsequent chapters that the central contribution anthropology can make to Thai AIDS debates, and to a critically reflexive examination and reorientation of the normative model of Thai AIDS, is in respect to the injection of social theory into the analysis of HIV/AIDS behavioural issues and, indeed, into the analysis of the construction of the Thai AIDS epidemic as a social problem per se. Social theory has the potential to make at least three major contributions to our understanding of Thai HIV/AIDS behavioural research and to the direction of interventions. Firstly, as I argue throughout this volume, social theory in concert with sound ethnographic knowledge has the potential to completely reorientate the understandings of Thai social behaviour gained on the basis of a naive empiricism. For example, as I point out in chapter three, if the response by villagers to heavy penetration of the private sphere of the village and the household by those seeking to give health advice or to conduct behavioural surveillance is one of passive resistance (Scott 1985, 1989), then this is a very different situation from the naive empiricist (and class based) reading of the context that views it as one in which villagers fail

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to understand health care information due to low levels of rural education. Or, as I argue in chapter three and elsewhere (Fordham 1995, 1999), if male feasting and drinking prior to engaging in commercial sex is concerned with the constitution of masculinity and is paradigmatically masculine behaviour, then this is a very different situation to the naive empiricist reading of this context which views it as men getting drunk in order to legitimate having sex with prostitutes (VanLandingham et al. 1993a, 1995b; VanLandingham et al. 1993b; VanLandingham et al. 1995a; VanLandingham et al. 1997). A second contribution that social theory offers the AIDS sphere is in relation to redressing the conceptual and analytical poverty of many fundamental concepts of the AIDS world, such as negotiation, empowerment and peer education, issues I took up in chapter two. Several bodies of social science theory, game theory, transactionalism and even symbolic interactionalism and phenomenology spring to mind as being potentially useful in aiding our understanding about how sexual negotiation functions, and might well be utilised to work towards more effective negotiations, and thus a greater degree of empowerment of the individuals concerned. Barth’s (1959) transactionalism, for example, offers a potential means for analysing the complexity of the interactions between customers and CSWs that may lead to the development of more effective means of ‘negotiation’. Similarly, the symbolic interactionalism of Goffman (1967) or the phenomenology of Schutz (1967) and Berger and Luckman (1975) has much to offer in regard to understanding the construction of both client and CSW identities (an activity that would do much to deconstruct the essentialised identities that have been built up for both sex workers and their clients), and the structuring of the interaction between them. Such bodies of theory would, of course, also be useful in generating a deeper understanding of how peer education works and the contexts in which it works best. As I point out in the above, peer educators occupy a comprador position and their relationships with both their peers and project organisers deserve serious theoretical attention. Issues of gender, class and power, as I emphasise throughout this volume, are fundamental to understanding the Thai AIDS epidemic and the interventions it has engendered. Yet, as far as the Thai AIDS world and the role of anthropology in this world is concerned, the past two decades’ domination of the gender and allied areas by Foucault has been to the overall detriment of both the quality of social analysis and the standing of the discipline of anthropology in the AIDS arena. What happened to the other powerful

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theoretical models we teach in the academy? What happened to the work of scholars such as Escobar, James C. Scott, Marshall Sahlins, Said or the works of James Clifford and George Marcus on ethnographic research and textual construction? Much of this work has been with us throughout the past nineteen years of the Thai HIV/AIDS epidemic, yet its implications for understanding how the epidemic was constructed have been almost completely ignored. Perhaps also, recourse to theory derived from transactionalism, from symbolic interactionalism or phenomenology would move the world of Thai AIDS from a life-denying seriousness where those engaged in AIDS projects are the central participants, the foot-soldiers, in an enterprise that all too often is treated as a battle of cosmic proportions between good and evil. The works of AIDS education, of risk reduction campaigns and of care for the afflicted are important tasks, but I suggest that they would be better served if they were to be carried out with a sense of proportion. AIDS deaths where young people die before their time are paradigmatically bad deaths (Kirsch 1973; Metcalf 1982; Nash 1973). Yet the Thai AIDS epidemic is overwhelmingly constituted through sexual transmission – surely making it one of the most truly human and truly social diseases of our time. Understanding HIV/AIDS and the contexts of HIV transmission, demands a sympathetic appreciation of the human condition. Yet the bulk of the research and interventions motivated by the Thai AIDS epidemic demonstrates little evidence of such understanding. As I have argued throughout this volume, the Thai AIDS world is characterised by an almost voyeuristic fixation with the mechanics (Pigg 2001b) and morality of the sex act itself and, as I point out in chapter three, by a tone of censoriousness in respect to the sexual behaviour of men and women in the underclass that totally fails to come to terms with Thai social realities, particularly the Thai sense of fun and sense of the ludic. The third, and potentially the most productive contribution that social theory can make to the AIDS sphere is in the sense of reflexivity it offers, which would question the fundamental assumptions of the Thai normative model of AIDS, the central AIDS paradigms and practices of intervention. Such reflexive questioning is necessary at all levels. The ubiquity of orientalist, class and culture based assumptions in the AIDS sphere is not merely counter productive but, given the implications of the HIV infection that may result from misdirected interventions, is quite literally, tragic. For example, since the early years of the Thai AIDS epidemic it has been common for those afflicted with HIV to

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posit karmic explanations for their condition. Universally, those working on AIDS research and interventions have interpreted this as an indication that the individuals concerned have not understood the mechanism of HIV transmission (which, logically, explained how the individuals concerned became infected with HIV). Yet, as I argue in chapter three (see also Fordham 1993, 1995), reference to karmic causation of HIV pertains to a separate domain of causation (see Evans-Pritchard 1981) apart from virological causation. Indeed, in this sense for the Thai all deaths are karmic. As Muecke (1999: 21) puts it, ‘people explain a death due to AIDS in the same moral terms they use for deaths due to other causes: that it was the individual’s karma that determined the nature and timing of the death’. In the most recent edition of his Handbook for the Examination and Treatment of Disease (Suragiat Archananuphap 2001: 772), the respected Thai physician Suragiat Archananuphap uses karma in just this sense when, discussing the treatment of HIV-positive patients, he advises that patients be counselled to ‘control their mind and accept [their] karma’ (tham jai yorm rap chadaa kham). Similarly, in her recently published The Critical Second: AIDS Diary, Kaew, an articulate young middle-class woman with an MA degree, gives an account of her post-HIV infection experiences. She too, although well aware of the viral causation of HIV, attributes the occurrence of her HIV infection to karma (Kaew 2001). Clearly, these highly educated upper-middle-class persons are not ignorant of the mechanism of HIV viral causation. Similar class-based assumptions about the knowledge base and intellectual abilities of the underclass are pervasive in the Thai AIDS literature and are encoded in behavioural intervention programmes. For the past decade, AIDS education programmes conducted amongst the rural underclass, or amongst young sex workers or factory workers have been based on the assumption that such uneducated people are unable and unwilling to think about serious issues unless (as is done with programmes for children) the subject is made exciting through the addition of games. Interventions almost universally start with some variety of ‘energiser’ or ‘exciter’ game designed to wake up participants, gain their interest and to enhance their ability to work together as a group. Yet, almost universally, participants rate such activities as unimportant and as time wasting (Forder 2001). In the case of one memorable programme I observed in a rural Northern Thai village in 1994, energiser and other associated activities took so long that the majority of the male members of the group (the major target of the day’s condom promotion activities) had gone

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back to their fieldwork before the actual training activities began. Participants’ gripe sessions following the departure of programme organisers leave little doubt that they are clearly aware that the information about local beliefs and practices that they provided to the programme facilitators is itself often fed back to them as ‘training’ or ‘life skills’ information, and that they deeply resent the time devoted to participating in activities that they consider contribute little to their well-being.5 Enough. By way of conclusion I emphasise, once again, that it is high time that anthropologists act to reclaim their space, to reconstitute anthropology as a potentially uncomfortable, critically reflexive and socially engaged discipline – grounded in fieldwork and a strong sense of culture and of social theory.6 My prime interest in this volume has been understanding how Thailand’s AIDS epidemic has been socially constructed, with the aim of developing better interventions. However, the issues I have addressed extend well beyond the area of Thai or other AIDS debates, to debates at the core of the discipline of anthropology itself and, in terms of pragmatic disciplinary interests, there seem few alternative options to a re-engaged anthropology if our professional space and public roles are not to be further usurped. Not only have other disciplines claimed to do a better ‘anthropology’ than anthropologists themselves, as West (2001: 71) points out, ‘NGOs [and IOs] now have the power to discursively produce “local peoples”, “indigenous peoples”, “peasants” and such and have their productions taken very seriously’. Indeed, he asks a crucial question: ‘do we take seriously the fact that NGOs [and

5. I emphasise that such unexamined assumptions are not restricted to those made in respect to class, those based on orientalism are ubiquitous. For example, in addition to pointing out the low level of literacy which restricts the use of print IEC materials, a recent USAID (2001) assessment of Cambodian health and population issues suggests that as ‘written Khmer is an extremely complicated [my emphasis] language – to convey the message’ that greater reliance should be replaced on visual messages (USAID 2001: 101). 6. Commoditised in the interest of supporting cash-strapped universities (Kapferer 2000: 181), anthropologists increasingly work as consultants for IOs, NGOs and various government bodies. A return to a critically reflexive attitude and a commitment to the rejection of methodologically or theoretically bereft work masquerading as anthropology would, of course, have implications for our work as consultants. Yet such a move could only be to the long-term advantage of the discipline per se – for too long agendas for applied anthropological research (and, indeed, for what counts as applied anthropology) have been defined by employers largely ignorant of the distinctive contributions of anthropological research, and who make little or no distinction between anthropology and other social science disciplines.

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IOs and other similar interested bodies] have become the new early 20th century [sic] anthropology?’ (2001: 71). The postmodernist critique of anthropology over the past two decades has accused anthropology of sins ranging from being the handmaiden of colonialism to the claim that fieldwork may be little more than a sophisticated form of tourism. Such biting and often clever critiques (see Crick 1985) hit their mark and, as I pointed out in chapter two, have created widespread insecurity in the discipline. Yet the brushes with which such critiques were made were too wide. The role of anthropology in the colonial encounter, like the colonial encounter itself, was characterised by much ambiguity and differed according to place and time, and in the real world of anthropological practice we have never been tourists. The anthropological attitude I have argued for here is evidenced in neither Bangkok’s palatial Oriental Hotel nor its backpacker jungles of Khao San Road – and it is certainly not found in the frenzied offices of Thailand’s many IOs and NGOs. Nor, as I have argued throughout this volume, is it found in the manner in which Thailand’s HIV/AIDS epidemic has been modelled through the disciplines of biomedicine, epidemiology and demography, or in social interventions directed on the basis of naive empiricism. Indeed, when any body of knowledge, such as that which has created and defined the Thai AIDS epidemic as a social problem, is highly resistant to questioning except in its own terms, and when adherents to that body of knowledge are reluctant to examine its central precepts except as defined through praxis and in authoritative texts, then it is more characteristic of a religious movement than of serious social analysis. Although I have not done so here, it would be interesting, and perhaps valuable, to analyse the Thai AIDS world as one form of contemporary messianic religious movement. It very clearly has an elect and a dammed (determined on the basis of their behaviour), it has its sacred texts (in the form of UNAIDS and major IO and NGO codes of best practice), it has its disciples who view the entire social world through the lens of the threat of HIV/AIDS and proselytise salvation, it clearly looks to a future time when the deserving (the chaste, and regular users of condoms) will be saved and, possibly most important of all, the whole tenor of the Thai AIDS world is one of a history-denying messianic panic at living in the last times while working for salvation. Enough! I leave this task of constructing such an analysis to others.

POSTSCRIPT – PHNOM PENH 2002 – A PERSONAL NOTE

A

s an anthropologist who has chosen to spend a large part of the past eighteen years living and working in Northern Thailand, in a culture that intrigued me and kept me returning at regular intervals, AIDS and AIDS-related issues have not been just research topics. For me AIDS has been a highly personal disease with highly personal impacts. The old men I knew in the mid1980s, and from whom I learned about the past and about the intricacies of arcane ritual activities, have now died of old age, of various cancers or of heart conditions. Now, all too many of their sons and grandsons, most of whom I’ve known to a greater or lesser extent, from whom I learned about life in the present day, and with whom I’ve feasted and drunk whisky as they caroused throughout much of the North, have died of AIDS. In many cases their wives and some of their children have also died of AIDS. The economic (and HIV) boom years of the early 1990s were a wonderful period, one of boundless optimism, in many rural districts of the North. A first generation of children with a decent education and good jobs bringing money home to the village, in concert with the sale to outside investors of what by now was unwanted rice-land, brought unprecedented levels of material prosperity in the form of new houses, new motor vehicles, highpowered amplifiers and other electronic equipment, white goods and seemingly unlimited amounts of food and alcohol, as at least one visit was demanded of every restaurant with beautiful hostesses that opened anywhere in a fifty mile radius. For me, spending much of this period ‘in the village(s)’ working on the research

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that underlies this volume, life was surreal, like reliving Fitzgerald’s (1993) The Great Gatsby, translated mutatis mutandis to rural Northern Thailand. Here too, nobody believed the party would end. But end it has. Now, the four villages where I’ve spent most of my rural research time have been transformed beyond belief as the individuals whose culture has preoccupied so much of my personal and professional life, and who themselves have been part of my life for almost two decades, are gone – so many, so long before their time. In the two Sansai villages where I conducted my doctoral research, my maps of the cemetery drawn almost twenty years ago (Fordham 1991) are virtually meaningless due to the sheer number of burials and cremations held there over the past decade, and these deaths encapsulate histories whose shames eclipse the stories of petty infidelities and broken relationships that were once considered a prawatsia (bad history). The several generations of genealogical data through which I made sense of village relationships in the mid-1980s now appear more a historical artefact than ever. In short, the villages I knew as social entities no longer exist and, on my now irregular visits, increasingly I feel a stranger, with my history there being almost totally one sided. Much of the AIDS-related research that I conducted in these and other Northern Thai villages and in Chiangmai city – the research that underpins the essays that comprise this volume – was undertaken out of a sense of deep frustration at the epistemological poverty of the normative modelling of the Thai AIDS epidemic, that for the reasons discussed in this volume caused AIDS interventions to be less effective than they might have been. Over a decade later, words are inadequate to describe my feelings as I see this simplistic Thai normative model of AIDS exported to Thailand’s neighbouring countries: notions of essentialised risk groups, notions of ‘good’ and ‘bad’ women and notions of an underclass whose limited education and absence of morals makes it slow to understand but quick to take risks. And, as in Thailand a decade earlier, in Cambodia of the early 2000s, this epistemologically simplistic modelling of the HIV/AIDS epidemic has led to a repetition of the same forms of donor-driven research. Yet another survey on ‘male health seeking behaviour’; yet more focus groups to find out how men manipulate the word girlfriend (songsar) to obtain sexual favours (as if Asian women possess neither desire nor agency); yet more ethically bereft surveys to prove that, offered a high enough fee, most poor women will eventually agree to have sex without a condom. And I see the classification

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of Cambodian women into such a profusion of categories of (bad) women who under specific circumstances may be enticed to have sex, that surely the only reasonable conclusion is not that they are abnormal but that sexual activity is an integral and fundamental aspect of the human condition. Yet, of course, such a conclusion is never drawn. So few lessons have been learned.

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Adul Duangdeetawerate. 1999. ‘Migrant Labour and Health Problems’, in Proceedings of the Regional Workshop to Develop Outreach Partnership [sic] Model to Prevent HIV/AIDS. Warunee Fongkaew (ed.) Chiangmai. 29–31 July. 48–71. Adul Duangdeetawerate and Warunee Fongkaew. 2000. Migrant Workers’ Access to Health Care Systems. Chiangmai: Urban Life Network Project, Faculty of Nursing, Chiangmai University. Adul Duangdeetawerate, Ratchanee Sironsri, Chai Kritayapichatkul and Bond, K. 2000. Building A Supportive Environment for Adolescent Health: Integrating the Lifenet Approach into the Health Promoting Schools Program. Chiangmai: Urban Life Network Project, Faculty of Nursing, Chiangmai University. Ahmed, A. and Shore, C. 1995. (eds.) ‘Introduction: Is Anthropology Relevant to the Contemporary World?’ in The Future of Anthropology: Its Relevance to the Contemporary World. A. Ahmed and C. Shore (eds.) London: Athlone Press, 12–45. AIDSCAP. 1992. Inventory of Recent AIDS Field Research in Thailand. Bangkok: AIDSCAP. AIDSNET. 1999. ‘Basic Data About AIDS Prevention in the Six Northern Provinces’ Electronic directory. AIDSNET: Chiangmai. In Thai. Allyn, E. 1991. Trees in the Same Forest: Thailand’s Culture and Gay Subculture (The Men of Thailand Revisited). San Francisco: Bua Luang Publishing Company. Amara Soonthorndahada. 1995. ‘The Discourse of Sexual Values: A Comparison Between Female Students and Factory Workers’. Paper presented at the International Conference on Gender and Sexuality in Modern Thailand. Australian National University, Canberra. Ammann, J. and Nogueira, S. 2002. ‘Governments as Facilitators or Obstacles in the HIV Epidemic: If Governments Do Not Act, the

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Wimol Siriwasin, Shaffer, N., Anuvat Roongpisuthipong, Sanaday Chearskul, Prapas Bhiraleus, Pratharn Chinayon, Chantapong Wasai, Waranee Pokapanichwong, Sunee Singhanati, Tawee Chotpitayasunondh, Mock, P., Weniger, B.G. and Mastro, T.D. 1998. ‘HIV Prevalence, Risk, and Partner Serodiscordance Among Pregnant Women in Bangkok’. Journal of The American Medical Association 280:1. 49–55. Wiput Phoolcharoen. 1998. ‘HIV/AIDS Prevention in Thailand: Success and Challenges’. Science 280. 1,873–874. ________ 2000. ‘Session One: Meeting the Challenges of HIV/AIDS: Sharing Experiences and Lessons Learned From Uganda and Thailand’, in South To South. J. Shankar Singh (ed.) Washington: Population 2005, 89–102. Witaya Swaddiwudhipong, Patchree Nguntra, Ploenjai Lerdlukanavonge, Chaveewan Chaovakiratipong and Supawan Koonchote. 1990. ‘A Survey of Knowledge About AIDS and Sexual Behaviour in Sexually Active Men in Mae Sot, Tak, Thailand’. Southeast Asian Journal of Tropical Medicine and Public Health 21:3. 447–52. Wiwat Rojanapithayakorn. 1992. AIDS: A Fate of Heaven or Hell Bangkok: Glass House Press. In Thai. ________ 1995. With Love and Concern From a True Heart. Bangkok: Glass House Press. In Thai. Wiwat Rojanapithayakorn and Hanenberg, R. 1996. ‘The 100% Condom Program in Thailand’. AIDS 10. 1–7. Wolters, O.W. 1982. History, Culture and Religion in Southeast Asian Perspectives. Singapore: Institute of Southeast Asian Studies. World Bank. 2000. Thailand’s Response to AIDS: ‘Building on Success, Confronting the Future’, Social Monitor Series No. 23783. Bangkok: World Bank. Wright, J.J. (Jnr.) 1991. The Balancing Act: A History of Modern Thailand. Bangkok: Asia Books. Wright, N.H., Suphak Vanichseni, Pasakorn Akarasewi, Chantapong Wasai and Kachit Choopanya. 1994. ‘Was the 1988 HIV Epidemic among Bangkok’s Injecting Drug Users a Common Source Outbreak?’ AIDS 8. 529–32. Wulff, R.M. 1967. Village of the Outcasts. Bangkok: Suriyaban. Yingkiat Paisalachapong, Varee Raksasat, Viyada Dikolwatana, Somjit Siriwanarungsun and Metta Yarnasophol. 1992. ‘The Study of KAP [sic] in Secondary School Students, Sukhothai Province’. Thai AIDS Journal 4:1. 48–53. In Thai. Yos Santasombat. 1992. Women Selling Themselves: Community and the Sale of Commercial Sex in Thai Society. Bangkok: Community Development Press. In Thai. Yothin Sawaengdee and Pimonpan Isarabhakdi. 1990. Exploration of Opportunities To Promote Condom Use in Brothels To Prevent the Spread of AIDS. Salayaa: Institute for Population and Social Research, Mahidol University. In Thai.

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AUTHOR INDEX

Adul Duangdeetawerate and Warunee Fongkaew, 220 Adul Duangdeetawerate, Ratchanee Sironsri, Chai Kritayapichatkul and Bond, K., 148, 220 Adul Duangdeetawerate, 221–22 Ahmed, A. and Shore, C., 37 Allyn, E., 79 Amara Soonthorndahada, 199, 203–204, 222 Ammann, J. and Nogueira, S., 1 Ammon, R., 207 Anan, Ganjanapan, 42, 53, 62, 158, 163–64, 168 Anderson, B.R., 154–55 Anjira Assavanonda, 206 Ankrah, E.M., 52 Anonymous, 225 Anthony Pramualratana, Chai Podhisita, Uraiwan Kanungsukkasem, Wawer, M. and McMamara, R. 82 Anuswasdi Swasdisevi, 139, 162, 217 Apaluck Bhatiasevi, 207 Ardner, E., 140, 170 Bamber, S., Kewison, K.J. and Underwood, J., 39, 55

Bao, J., 102, 169, 192 Barme, S., 29n. 8. Barnett, T. and Blakie, P., 19, 110n. 21. Barth, F., 244 Becker, M.H. and Joseph, J.G., 69 Beesey, A., 57, 59 Bellaby, P., 53, 69 Bencha Yoddumnern-Attig, 55 Bencha Yoddumnern-Attig, Attig, G.A, Wathinee Boonchalaski, Richter, K. and Amara Soonthorndahada, 32 Berger, P.L. and Luckman, T., 244 Beyrer, C., 34–35, 145 Beyrer, C., Sakol Ieumtrakul, Celentano, D.D., Nelson, K. E., Somsri Ruckphaopunt and Chirasak Khamboonruang, 55n, 57, 144n. 15., 160 Bhassorn Limanonda, 55, 227 Bishop, R. and Robinson, L., 27n Bloch, M. and Parry, J., 111 Bock, C., 164, 168 Bogird, C. and Jongpaiboolathna, J., 55 Bolton, R., 35, 48, 61, 152–53, 162, 200–201, 235

300

Bond, K.C., 220 Bond, K.C., Valente, T.W. and Kendall, C., x, 220 Borthwick, P., 1, 92 Boulos, M.L., Boulos, R. and Nicholas, J.D., 59n. 12. Bourdieu, P., 24 Bowie, K.A., 4, 39, 154, 212 Brailey, N., 5n Brinkman, U.K., 55 Brown, J.C., 2n. 1., 32 Brown, L., 27n. 7., 31 Brown, T., Werasit Sittitrai, Suphak Vanichseni and Usa Thisyakorn, 137 Brown, T., Bennett, T., Carael, C., Komatsu, R. and Werasit Sittitrai, 1–2, 25, 32, 40, 152 Brummelhuis., H.T., 28, 38, 57, 72, 84, 88, 124, 143–44, 178, 183, 192, 214 Bupa Wattanapun, 4, 40, 213, 230, 239, 240 Busabar Rutjonwet and Duangsomrot Chinchodigasem, 238 Busayawong, W. and Chuamanochan, P., 55, 195 Bussarawan Teerawichitchainan, 185 Butarat Buntraponhom, 47n, 93, 209, 241 Caldwell, J., 258 Caldwell, J., Caldwell, P. and Quiggin, P., 61 Cash, K., 54–55, 65, 128, 147, 195–97, 215 Cash, K., Jaratbhan Sanguansermsri, Porntip Chuamanoahan and Watana Busayawong, 57, 128 Catania, J.A., Kegeles, S.M. and Coates, T.J., 69 Celentano, D.D., Nelson, K.E., Somboon Suprasert, Wright, N., Anuchart Mananasarawoot, Sakol

Author Index

Eiumtrakul, Serbat Romyen, Supachai Tulvatana, Surinda Kuntolbutra, Narongrit Sirisopana, Pasakorn Akarasewi and Choti Theetranont, 137, 146 Celentano, D.D., Paasakorn Akarasewi, Sussman, L., Somboon Suprasert, Anuchart Matanasarawoot, Wright, N.H., Choti Theetranont and Nelson, K.E., 55, 59n. 13., 161 Centres for Disease Control and Prevention, 107n. 16. Chai Podhisita and Umaporn Pattaravanich, 185, 199, 201–203, 226 Chai Podhisita, Anthony Pramualratana, Uriwan Kanungsukkasem and McNamara, R., 55, 101, 121n. 27., 143, 160 Chaiporn Bhadrakom., Simonds, R.J., Mei, J.V., Suvanna Asavapiriyanont., Varaporn Sangtaweesin., Nirun Vanparapar, Moore, K.H.P., Young, N.L., Nannon, W.H., Mastro, T.D. and Shaffer, N., 107n Chaiyos Kunanusont, Foy, H.M., Kreiss, J.K., Supachai RerksNgarm, Praphan Phanuphak, Suwanee Raktham, Pau, C.P. and Young, N.L., 190 Champoo Sabutchai, 69, 81 Chanpen Saengtienchai, Knodel, J., VanLandingham, M.J. and Anthony Pramualratana, 145 Chapman, S. and Hodgson, J., 59n. 12. Chayan Waddhanaphuti, 8, 38, 54–55, 63, 71–72, 128, 146, 193, 214 Chiraluck Chongsatitmun, 38, 121, 143–44, 149–50, 225–26 Chuanchom Sakondhavat, Pichet Leungtongkum, Manop

Author Index

Kanato and Chusri Kuchaisit, 191–92, 220, 224 Chuanchom Sakondhavat and Werasit Sittitrai, 55, 195, 197, 215 Chuanchom Sakondhavat, Yuthapong Werawatanakul, Bennett, A., Chusri Kuchaisit and Sugree Suntharapa, 14, 92, 161 Chusit Chuchart, 116, 163 Chutchawarn Tongdeelert, 40, 212, 230, 238 Clatts, M.C. and Mutchler, K.M., 56, 61 Clifford, J. and Marcus, G.E., 11, 245 Cohen, C.R., Duerr, A., Niwat Pruithithada, Sungwal Rugpao, Hillier, S., G. and Nelson, K., 161 Cohen, E., 20, 55, 91, 143, 159n. 22. Cohen, P., 4, 63, 80, 158, 166–67 Cohen, P. and Wijeyewardene, G., 63, 150, 167 Cohen, S., 128, 164 Coleman, S. and Simpson, B., 37 Comaroff, J. and Comaroff, J., 156 Crick, M., 171, 174, 248 Cullen, T., 86, 173n Darunee Tantiwiramanond and Shashi Pandey, 74 Davis, R., 63, 149, 158, 165, 167 de Lind van Wijngaarden, J.W., 49, 55n, 64, 144n. 15., 160 del Casino, V.J. Jnr., 4, 40, 236, 240 Dodd, W.C., 168 Douglas, M., 53, 56n. 9., 61–70 Douglas, M. and Calvez, M., 47, 53, 56, 59 Douglas, M. and Wildavsky, A., 53, 76 Dowsett, G., 162 Dulawat Parnitchaoren,

301

Gonchonok Sanitawong and Grusidar Gitirot, 217, 219 Durrenberger, E.P. and Tannenbaum, N., 80 Dwip Kitayaporn, Chintra Uneklabh, Weniger, B.G., Pongvipa Lohsomboon, Jaranit Kaewkungwal, Morgan W.M. and Tongchai Uneklabh, 91n, 136–37 Embree, J.F., 143 Euampon Thongkrajai, Chintana Leekakraiwan, Narong Winityakul, Kanha Ketsut, Monthira Kaewying, Pramote Thongkrajai, Soiy Anusorntheerakul and Pectchara Leelampunmetha, 226 Evans-Pritchard, E.E., 75n, 81, 246 Faculty of Pharmacy, 216, 224 Farmer, P., 152 Fitzgerald, F.S., 250 Fontanet, A.L., Saba, J., Verapol Chandelying, Chuanchom Sakondhavat, Praphas Bhiraleus, Sungwal Rugpao, Chompilas Chongsomchai, Orawan Kiriwat, Sodsai Tovanabura, Dally, L., Lange, J.M. and Wiwat Rojanapithayakorn, 161 Ford, N., 215 Ford, N.J. and Sirinan Kittisuksathit, 54, 56, 65, 71–72, 74, 128, 147, 150–51, 153, 195–97, 204 Ford, N. and Suporn Koetsawang, 6, 55, 63, 124, 134, 145, 154 Forder, J., 246 Fordham, G., 5–6, 8, 11, 12n, 13–14, 26, 33, 38, 53, 55, 58, 64, 69, 71, 73, 75n, 77n. 23, 24., 79–80, 84, 88, 90n. 2.,

302

104, 106, 109, 110n. 21., 116, 128, 136, 146n, 147, 161, 163–64, 166–67, 169, 175–76, 214, 230, 233n, 244, 246, 250 Foster, G.M., 79 Frankenberg, R.J., 56, 93 Geertz, C., 30 Giddens, A., 79 Gilles, P. and Carballo, P., 69 Glanz, K. and Yang, H., 87 Glaziou, P., Boden, C., Thay Loy, Sophann Vonthanak, ElKouby, S. and Sainte Marie, 2n. 1. Gluckman, M., 32 Goffman, E., 82, 244 Golcomb, L., 41, 75, 92 Gray, A., Surnnporn Punpuing, Bencha Yoddumnern-Attig, Chiraluck Chongsatitmun, Eamporn Thongkrajai and Pechnoy Singsungchai, 152, 193, 226 Gray, J., 214 Gray, J., Gregory, J.D., Yueming, L.I., Somsak Supawitkul, Effler, P. and Kaldor, J.M., 161 Greenwood, Z., 2n. 1. Hall, C.M., 55 Hallett, H., 5n, 164, 168 Hamilton, A., 21n. 3., 36–37, 87, 242 Hancock, G., 45, 236–37 Hanenberg, R. and Wiwat Rojanapithayakorn, 138, 161 Hanenbert, R., Wiwat Rojanapithayakorn, Prayiura Kunasol and Sokal, D.C., 51n. 2. Hanks, L.M., 157 Hanks, L.M. and Hanks, J.R., 157 Harrison, R., 102, 169, 192 Herdt, G. and Boxer, A.M., 51 Herdt, G., Leap, W.L. and Sovine, M., 52 Hinton, P., 240

Author Index

Hirsch, P., 221n Hobart, M., 43 Hu, D.J., Dondero, T.J., Rayfield, M.A., George, R., Schochetman, G., Jaffe, H.W., Chi-Cheng Luo, Kalish, M.L., Weniger, B.G., Chou-Pong Pau, Schable, C.A. and Curran, J.W., 137 Iqbal Shah, Varachai Thongthai, Boonlert Leoparai, Mundingo, A.I., Pramote Prasartkul and Aphichat Chamratrithirong, 56, 69 Irvine, W., 62, 164 Ishii, Y., 116, 163–64 ISRCU., 184 Jackson, P.A., 55n, 64, 79, 90n. 4., 141n. 10., 143n. 12., 144n. 15., 151, 160, 241 Jackson, P.A. and Cook., N.M., 144n. 15., 160 Jackson, P.A. and Sullivan, G., 144n. 15., 160 Jenkins, P., 164 Johnston, D.B., 80, 166 Jon Ungphakorn and Werasit Sittitrai, 130, 135, 212, 230 Juree Namsirichai and Vicharat Vichit-Vadakan, 6, 26, 154–55 Jutsadang Porananon, 76 Kachit Choopanya, Suphak Vanichseni, Des Jarlais, D.C., Kanokporn Plangsringarm, Wandee Sonchai, Carballo, M., Friedmann, P. and Friedman, S.R., 55, 136 Kaew., 3n, 246 Kammerer, C.A., Hutheesing, O.T., Maneeprasert, R. and Symonds, P.V., 56–57 Kamolthip Bai-Ngern, 185, 208 Kamphuun Bunthawee, 106, 158n, 172n, 173 Kapferer, B., 17–18, 36–37, 152,

Author Index

238n. 2., 242–43, 247n. 6. Kasem Chandranoi, 185, 207 Kasian Tejapira, 182–83 Keesinii Juthaawijit, 69 Kellehear, S.A., 111 Keyes, C.F., 74–75, 116, 146, 150, 157–58, 161, 163n. 25., 164–67 Khanchit Limpakarnjanarat and Nusara Thaitawat, 68 Khanchit Limpakarnjanarat., Mastro, T.D., Supachai Saisorn, Wat Uthaivoravit, Jaranit Kaewkungwal, Supaporn Korattana, Young, N.L., Morse, S.A., Schmid, D.S., Weniger, B.G. and Nieburg, P., 93, 138 Kilmarx, P.H., Khanchit Lipakarnjanarat, Mastro, T.D., Supachai Saisorn, Jaranit Kaewkungwal, Supaporn Korattana, Wat Uthaivoravit and Young, N.L., 161 Kilmarx, P.H., Somsak Supawitjul, Mayuree Wankrairoj, Wat Uthaivoravit, Khanchit Limpakarnjanarat, Supachai Saisorn and Mastro, T.D., 1, 40 Kirsch, A.T., 72, 111, 142, 161, 245 Kiti Puthikanon, Prayadh Duangsupa and Chiree Ratanavaraha, 139, 217 Klausner, W.J., 72 Klum ng teh, 26 Knodel, J., VanLandingham, M.J., Chanpen Saengtienchai and Anthony Pramualratana, 162 Knodel, J., Chanpen Sangtienchai, VanLandingham, M.J. and Lucas, R., 145 Kobkua Suwannathat-Pian, 184n Kourtis, A.P., Bulterys, M., Nesheim, S.R. and Lee, F.K.,

303

107n Kritaya Archavanikul and Varaporn Chamsanit, 148 Kuhn, T.S., 45, 139n Kumnuan Ungchusak, 215 Kumnuan Ungchusak, Orpun Sangwonloey, Suchada Junsiriyakorn, Vanusanun Rujiviput, Kamonchanok Yhepsittha and Amala Thonghong, 139 Kumnuan Ungchusak, Sombat Tanprasert, Vichai Chokevivat, Khanchit Limpakarnjanarat, Surin Pinichpongse and Prayura Kunasol, 161 Kumnuan Ungchusak, Sutcharit Sriprapandh., Surin Pinichapongsa., Prayura Kunasol and Sombat Thanprasertsuk, 91, 103, 131–32 Kumnuan Ungchusak, Thongchai Thavichachart, Suchada Juntasiriyarkorn, Orapun Sangwonloy and Amara Thonghong, 91, 103, 133, 136 Kuper, A., 32, 36 Ladaval Longcharoen, 55, 59n. 12., 82 Lambert, H. and McKevitt, C., 32n Law, L., 40, 45n, 48, 238 Leach, E.R., 34, 36 Leheny, D., 159 Lederman, R., 36 Lehman, F.K., 72–73, 75, 77 Lindan, C., Allen, S., Carael, M., Nsengumuremyi, F., Van de Perre, P., Serufilira, A., Tice, J., Black, D., Coates, T. and Hulley, S., 69 London, A.S., VandLandingham, M.J. and Grandjean, N., 138, 151 Lupton, D., 229 Lyng, S., 69, 80, 83

304

Lyttleton, C., x, 8, 14, 38, 54–55, 69, 91–93, 110, 123, 134, 136, 148, 152, 154, 169, 188, 192, 230 McAndrew, S., 34, 198, 200 Macfarlane Burnett Centre, 32n, 231 McGilvary, D., 164, 168 Manderson, L., 160, 170 Manop Kanato, 8, 38, 57, 69, 102, 169, 192, 214 Manote Tripathi, 149 Marcus, G.E., 11, 30–31, 37 Marten, L., 2n. 1. Marwick, M., 174 Mason, C.J., Markowitz, L.E., Suchai Kitsiripornchai., Achara Jugsudee., Narongrid Sirisopana., Kalyanee Torugsa., Carr, J.K., Michael, R.A., Sorachai Nitayaphan and McNeil, J.G., 51n. 2., 137 Mathews, P., 47, 67 Maticka-Tyndale, E., 55–57, 59n. 12., 60, 69 Maticka-Tyndale, E., Elkins, D., Haswell-Elkins, M., Darunee Rujkarakorn, Thicumporn Kuyyakanond and Stam, K., 134, 138, 143, 162 Mehta, S., Groenen, R. and Roque, F., 227 Metcalf, P., 111, 245 Michinobu, R., 8, 38, 93, 147, 196, 232 Miller, D., 32n Mills, D., 37 Mills, M.B., 159, 164, 167, 196, 232 Mills, S., Patchara Benjarattanaporn, Bennett, A., Rachitta Na Pattalung, Danai Sundhagul, Peerayot Trongsawad, Gregorich, S.E., Hearst, N. and Mandel, J.S., 137 Ministry of Education, Youth and

Author Index

Sport, 2, 40 Moerman, M. and Miller, P., 53 Mofenson, L.M. and McIntyre, J.A., 107n Montgomery, H., 16, 28, 120, 143–44, 160, 162–64, 168, 171, 173, 183, 186, 231 MOPH (Ministry of Public Health), 148, 161, 192, 227 Morell, D. and Chai-anan Samudavanija, 4, 39, 154, 212 Morris, M., Anthony Pramularatana, Chai Podhisita and Warner, M.J., 59n. 13., 137, 161 Morris, M., Chai Podhisita, Warner, M.J. and Handcock, M.S., 138 Morris, R., 144n. 15., 160 Muecke, M., 8, 38, 55, 63, 74, 104, 109, 118, 154, 157, 159–60, 166, 246 Mulder, N., 5, 21n. 2., 28, 100, 102, 124, 141–42, 153–55, 166, 169, 176, 184, 205, 240 Murdoch, J.B., 116, 164 Napaporn Havanon, Bennett, A. and Knodel, J., 14, 55, 71, 145 Narawat Palainoi, 55, 57 Nash, M., 111, 245 National AIDS Authority (Cambodia), 2 National Economic and Social Development Board, 215 National Identity Board, 21n. 2. Nelkin, D., 69 Nelson, K.E., Celentano, D.D., Somboon Prasert, Wright, N., Sakol Eiumtrakul, Supachai Tulvatana, Anuchart Matanasarawoot, Pasakorn Skarasewi, Surinda Kuntolbutra, Sermbat Romyen, Narongrit Sirisopana and Choti Theetranot, 55, 131, 137

Author Index

Nelson, K.E., Beyrer, C., Sakol Eiumtrakul, Chirasak Khambootruang, Wright, N. and Celentano, D.D., 55 Nelson K.E., Celentano, D.D., Sakol Eiumtrakol, Hoover, D.R., Beyrer, C., Somboon Suprasert, R.N., Surinda Kuntolbutra and Chirasak Khamboonruang, 14, 92, 146 Nelson, K., Eiumtrakul Sakok, Sirisopana Narongrid, Khamboonruang Chirasak, Cenentano, D.D. and Beyrer, C., 147n. 17. Nimit, Tienudom, 86, 173n. 23. Nitaya Rawangparn and Saupaa Ponsiripong, 101, 105, 121n. 27., 143–44, 146, 176 Niwat Suwanphatthana, 8, 38, 121, 143–44, 149, 162, 231 Niwat Suwanphatthana, Sunan Gaewtoom and Nitayar Noonsiri, 213 Odzer. C., 27, 143, 160 O’Malley, J., 159 Orasom Sutatisarkon, 47n. 21., 93, 209, 241 Orathai Ardam and Chanya Sethaput, 55, 143 Ornanong Intarajit and Narin Karinchai, 46, 107, 115 Ornanong Intarajit, Narin Karinchai and Anong Panatung, 46, 122, 144n. 14. Orubuloye, I.O., Caldwell, J.C. and Caldwell, P., 59n. 12. Ou Chin-Yih, Yutaka Takebe, Weniger, B.G., Luo ChiCheng, Kalish, M.L., Wattana Auwanit, Shudo Yakazaki, Gayle, H.D., Young, N.L. and Scholchetman, G., 91, 136 Paisal Chuenprasaeng, 76 Pansak Sukrarit, 46, 155n. 20., 241

305

Pansak Sukrarit and Prawit Kongkwanrut, 46, 241 Parichart Chantcharas, 93, 147, 204, 221 Parichart Chantcharas, Sombat Thanprasertsuk, Kumnuan Ungchusak and Akeau Unhalekha, 69 Parker, R.G., 38, 53, 69, 84–85, 176 Parker, R.G., Herdt, G. and Carballo, M., 84 Parry, J., 111 Pasuk Pongpaichit, 27, 158, 166, 183, 225, 231 Patama Srisuwapan, 55 Patcharin Dumrongkadigun, Gidiwun Towerditeph, Raynou Athamasar, Arputsaree Chaikunar, Benjar Orntuam, Warsanar Buronneewat and Duangduan Puchaoren, 226 Patcharin Dumrongkadigun, Gidiwun Towerditeph, Raynou Athamasar, Arputsaree Chaikunar and Duangduan Puchaoren, 226 Pathom Sawanpanyalert, Kumnuan Ungchusak, Sombat Thanprasertsuk and Pasakorn Akaresewi, 161 Paton, C., 45n Pattalung, R., Wienrawee, P., Benjarattanaporn, P., Sundhagul, D. and Kalumpabutr, N., 195 PCDA (Population and Community Development Association), 212 Peracca, S., Knodel, J. and Chanpen Sangtienchai, 140n. 8., 143, 154, 162 Peterson, A. and Lupton, D., 199, 229 Phillips, H.P., 6, 26, 153–55 Phinthip Cheem, 148 Phitaya Charupoonphol, Shalasai

306

Huangprasert, Somkual Chootrakul, Sirirat Laosungkul and Kesorn Suvittayasiri, 199, 201 Pichai Chuensukswadi, 207 Pigg, S.L., x, 3–4, 11, 19, 42n, 45n, 48, 49n, 235, 238, 245 Pimpawun Boonmongkok, Niporn Sanhajariya and Sansanee Ruengson, 226 Piyada Kunawararak, Beyrer, C., Chawalit Natpratan, Feng, W., Celentano, D.D., de Boer, M., Nelson, K. and Chirasak Khamboonruang, 55n, 144n. 15., 160 Ploenpote Atthakor, 208 Pongsakdi Chaisilwattana, Kulkanya Chokephaihulkit, Amphan Chalermchockcharoenkit, Nirun Vanprapar, Korakot Sirimai, Sanay Chearskul, Ruengpung Sutthent and Nisarat Opartkiattikul, 107n Pornsince Amornwichet, Achara Teeraratkul, Simonds, R.J., Thanada Naiwatanakul, Nartlada Chantharojwong, Culane, M., Tappero, J.W. and Siripon Sanshana, 107n Potgarmat Priichaa, 158n, 173–74 Potter, J.M., 26, 63, 148–49, 158 Pramote Prasartkul, Apichat Chamratrithirong, Bennett, A., Ladda Jitwatanapataya and Pimonpan Isarabhakdi, 196 Prapasri Osathanon, 207 Praphan Phaanuk, 51n. 2. Prasert Thongcharoen, 40, 138 Prasopchai Kruawongkaew, 217–18 Prasopchai Kruawongkaew, Raynou Athamasar, Fordham, G., Werasit Sittitrai and Anuchon Luansong, 218

Author Index

Prawase Wasi, 30n Priichaa Tunthanathip, Achara Chaovavanich, Amornpun Witatchai and Karoon Kuntiranont, 107n, 108n. 17. Prybylski, D. and Alto, A., 2n. 1. Radcliffe-Brown. A.R., 10 Randall, M.P. and Epstein, P., 19, 54 Rangsin, R., Silarg, N., Sangwanloi, O., Kunanusont, C. et al., 51n. 2. Ratanaporn Sethakul, 5n Raynou Athamasar, 180, 221n, 229 Raynou Athamasar, Bond, K., Anuchon Huansong and Prasit Leawsiripong, 148, 220, 223, 229 Renard, R.D., 212, 236–37 Renne, E.P., 59n. 12. Reynolds, C., 168 Rhum, M.R., 155 Richter, L.K., 27, 55, 159, 231 Rousset, D., Soares, J.L., Reynes, J.M., Caruz, A., Sainte Marie, F. and Virelizer, J.L., 2, 2n. 1. Safman, R.M., 138, 110n. 20. Sahlins, M., 22, 39–40, 155 Said, E., 22, 28, 71, 198 Sanjek, R., 37, 243 Sanitsuda Ekachai, 192, 207 Sasiwimol Ubolyam, Kiat Ruxrungtham, Sunee Sirivichayakul, Okuda, K. and Praphan Phanuphak, 91n, 136 Sataporn Marnatsatid, 69 Scheper-Hughes, N., x, 136, 242n Scheper-Hughes, N. and Sargent, C., 186n Schiller, N.G., Crystal, S. and Lewellen, D., 56 Schoepf, B.G., 19, 38, 54 Schutz, A., 244 Scott, J.C., 3n, 60, 118, 152n, 154, 223, 243

Author Index

Seabrook, J., 27, 27n Seri Phongphit, 212, 215 Seri Phongphit and Hewison, K., 41, 221n Sharma, R., 1 Shinsuke Morio, Kenji Soda, Kazuno Tajima, Hor Bun Leng et al., 2n. 1. Shore, C. and Wright, S., 37 Shweder, R., 36 Sidel, G., 19, 140 Singer, L., 66–67 Sinnot, M., 160 Sirak Sivaraksa, 30n Sirikul Bunnag, 181, 206 Siriporn Chirawatkul, 58 Sombat Thanprasertsuk and Taweesap Siriprapasiri, 5, 69, 161 Sombat Thanprasertsuk, Kumnuan Ungchusak, Vichai Chokeviavat, Surin Prinichpongse, Parichart Chantcharas, 161 Sombat Thanprasertsuk, Kumnuan Ungchusak, Vichai Chokeviavat, Surin Pinichopongse, Prayura Kungasol, Akeau Unahalekhaka, 133, 137 Sompop Jantraka, 215 Somprasong Prasuchantip and Unchalee Piyatanont, 47n, 93, 209, 241 Sontag, S., 61, 66, 92 Sor Romnar and Tandopbun, 2, 40 Strathern, A. and Stewart, P.J., 238n. 2. Strathern, M., 37 Suchai Kitsiripornchai, Mason, C.J., Markowitz, L.E., Achara Jugsudee, Penprapa Chanbancherd, Narongrid Sirisopana and Kalyanee Torugsa, 91, 103, 133 Suchart Setthamalinee, 55, 143, 161

307

Sukamon Wikarwepongun, Pansak Sukrarit, Yongyut Ongsapirom, Somchai Jukrapun, Wiwat Supadit and Wiwat Rojanapithayakorn, 46 Sukanya Hantrakul, 146, 192–93 Sukanya Sal-Lim, 208 Suliimaan Ongsuphap, 143 Sunee Sirivichayakul, 51, 91, 131, 188 Sungwal Rugpao, Niwat Pruithithada, Yupadee Yutaboort, Wonpen Prasertwitayakij and Sodsai Tovanabutra, 59n. 12., 82, 134 Sunii Munligarman, Wirapong Bunyopart, Sumrieng Makgarienggary, Supon Grajangpeut, Sunatarii Sriprachanyargun and Patanii Dunsombut, 26 Supamas Sethapongkul, 6 Supaapon Pidipon, 41 Suphak Vanichseni and Kachit Choopanya, 192–94 Suphak Vanichseni, Nopun Plangsringarm, Wundee Sonchai, Patsagon Akarasewi, Wright, W. and Kakit Choopanya, 55 Suragiat Archananuphap, 246 Surasak, P., 206–207 Surasing Visrutaratna, Lindan, C.P., Anake Sirhorachai and Mandel, J.P., 55–56, 161 Suthep Watcharapiyanone, 93, 151 Sutthiluck Tungulboriboon, Veena Nanasilp, Nilawarn Chantapreeda and Kritaya Sawangchareon, 162, 199–202 Suwanna Warakamin and Wiput Phoolcharoen, 139, 148, 226–27 Suwanna Warakamin and Yupa Pookhum, 148, 227–28

308

Sweat, M., 55, 63, 71, 77, 81 Sweat, M., Taweesak Nopkesorn, Mastro, T.D., Suebpong Sangkharomya, MacQueen, K., Waranee Pokapanichwong, Yothin Sawaengdee and Weniger, B.G., 133 Tambiah, S.J., 80–81, 11, 165 Tanabe, S., 5n, 116, 164 Tanawadee Tarjiin and Pensi Dragoonsutjarwad, 26 Tannenbaum, N., 8, 38, 73, 142–43, 150, 154, 155n, 157–59, 165n, 178, 189 Taussig, M.T., 229 Taweesak Nopkesorn, Mastro, T.D., Suebpong Sangkharomya, Sweat, M., Pricha Singharaj, Khanchit Limpakarnjanarat, Gayle, D.H. and Weniger, B.G., 55, 134 Taweesak Nopkesorn, Sweat, M.D., Satit Kaensing and Tiang Teppa, 145 Taweesap Siriprapasiri, Sombat Thanprasertsuk, Amorn Rodklay, Supattra Srivanichakorn, Pathom Sawanpanyalert and Jirawan Temtanarak, 55, 161 Taweetong Hongwiwana, Bang Sirirong, Phenjan Pradubmak, Somardon Ponhompukdii, Sasiton Chaiprasit and Wannajaasusombuun, 65, 67, 74, 75n Taylor, C.C., 59n. 12. Taylor, J.L., 30n Tepchoo Tupthong, 39, 146 Thian Jaiboonma, 56, 192 Thitsa, K., 26, 143, 158, 183, 225, 231 Tongchai Winichakul, 21n. 3., 39, 117, 155, 221n. 9. Took Took Thongthiraj, 144n. 15., 160

Author Index

Treichler, P.A., 34 Trink, B., 43n, 76 Truong, R.D., 27, 55, 159, 183, 231 Turner, V., 73 Turton, A., 63, 72, 158 UNAIDS, 2, 40 UNDP, 10 UNFPA, 226 UNFPA/Mahidol University, 136n United Nations Committee on the Rights of the Child, 186n Upson Boonpradup, 69 Uraiwan Kanungsukkasem and Supanee Vejpongsa, 138 Usa Thisyakorn, Mana Khongphatthanayothin, Sunee Sirivichayakul, Chokechai Rongkavilit, Wiput Poolcharoen, Chaiyos Kunanusont, Bien, D.D. and Praphan Phanuphak, 107n USAID, 247n. 5. van Dam, J. and Anastasi, M.C., 18 Van Esterik, P., 5–6, 21–22, 26–27, 29n. 8., 34, 38n, 42, 151, 153, 162, 166, 241 van Griensven, G.J.P., Limanonda, B., Chongwatana, N., Tirasawat, P. and Coutinho, R.A., 138, 161 van Griensven, G.J.P, Bhassorn Limanonda, Srykanya Ngaokeow, Sunida Isarankura Na Ayuthaya and Vichai Poshyachinda, 138 VanLandingham, M.J., 147n. 17., 152 VanLandingham, M.J., Somboon Suprasert, Werasit Sittitrai, Chayan Vaddhanaphuti, 6, 14, 53, 101, 145–46, 244 VanLandingham, M.J., Somboon Suprasert, Werasit Sittitrai, Chayan Vaddhanaphuti and

Author Index

Grandjean, N., 6, 14, 55–66, 63, 71, 101 VanLandingham, M.J., Knodel, J., Chanpen Saengtienchai and Anthony Pramularatana, 151, 197 VanLandingham, M.J., Knodel, J. Anthony Pramualratana, 6, 14, 55, 101, 244 VanLandingham, M.J., Somboon Suprasert, Werasit Sittitrai, Chayan Vaddhanaphuti, 53, 55–56, 63, 69–71, 75–76, 244 VanLandingham, M.J., Grandjean, N., Somboon Suprasert and Werasit Sittitrai, 14, 139, 146, 244 VandLandingham, M.J. and Trujillo, L., 35, 152 Vella, W., 184n Vichai Poshyachinda, Venus Poshyachinda and Vipa Danthamrongkul, 25, 51, 91, 101, 131, 135, 141n. 11., 188, 214 Vicharn Vitayasai and Prokrong Vithayasai, 132 Viggo, B., 41 Wait, W.N. and Coughlan, J., x, 161 Walker, D. and Ehrlich, R.S., 159n Warunee Fongkaew, 49, 148, 220–22, 231 Warunee Fongkaew and Poonsup Soparut, 220 Wassana Im-Em, 145, 187 Wathinee Boonchalaksi and Guest, P., 55, 56n. 9., 101, 121n. 27., 143, 160, 174–75 Wawer, M.J, Chai Podhisita, Uraiwan Kanungsukkasem, Anthony Pramualratana and Regina McNamara, 144, 161 Weber, M., 75 Weeks, J., 165 Weiss, A.H., Quigley, M.A. and

309

Hays, R.J., 19n Weniger, B.G., Khanchit Limpakarnjanarat, Kumnuan Ungchusak, Sombat Thanprasertsuk, Kachit Choopanya, Suphak Vanichseni, Thongchai Uneklabh, Prasert Thongcharoen and Chantapong Wasi, 23, 51, 55, 91, 130–34, 136–38, 140n. 8., 145, 188, 190–91 Werasit Sittitrai, 130, 135, 212, 230 Werasit Sittitrai and Brown, T., 137 Werasit Sittitrai, Brown, T. and Surapone Virulrak, 55, 131n. 3., 144n. 15., 160 Werasit Sittitrai, Chuanchom Sakondhavat and Brown, T., 55n, 56, 144n. 15., 160 Werasit Sittitrai, Praphan Phanuphak, Barrk, J. and Brown, T., 145, 161, 189 Werawan Udomraty, Dussady Jaroenslip and Rungkarn Soralum, 212 West, P., 242, 247 Whitehead, P., 37 Whittaker, A., 4, 22, 30, 41, 42n, 241 WHO., 2, 24, 31, 40, 107, 188, 213–14 WHO/UNICEF., 214 Wichundaa Maadunbun, 47n, 93, 209, 241 Wieng Ping Group for the Better Life of Children, 218 Wijeyewardene, G., 63, 73, 158, 165, 167 Wilai Kusolvisikul, 194–95, 199 Wimol Siriwasin, Shaffer, N., Anuvat Roongpisuthipong, Sanaday Chearskul, Prapas Bhiraleus, Pratharn Chinayon, Chantapong Wasai, Waranee Pokapanichwong, Sunee

310

Singhanati, Tawee Chotpitayasunondh, Mock, P., Weniger, B.G. and Mastro, T.D., 147 Wiput Phoolcharoen, 40, 214, 230 Witaya Swaddiwudhipong, Patchree Nguntra, Ploenjai Lerdlukanavonge, Chaveewan Chaovakiratipong and Supawan Koonchote, 55 Wiwat Rojanapithayakorn, 69 Wiwat Rojanapithayakorn and Hanenberg, R., 40, 92, 137, 188 Wolters, O.W., 72 World Bank, 1, 40, 236 Wright, J.J., 4, 39, 154, 212

Author Index

Wright, N.H., Suphak Vanichseni, Pasakorn Akarasewi, Chantapong Wasai and Kachit Choopanya, 55n Wulff, R.M., 106 Yingkiat Paisalachapong, Varee Raksasat, Viyada Dikolwatana, Somjit Siriwanarungsun and Metta Yarnasophol, 194–95 Yos Santasombat, 8, 27, 38, 144 Yothin Sawaengdee and Pimonpan Isarabhakdi, 55, 71, 74n Yvonne Bohwongprasert, 228 Zehner, E., 30n

SUBJECT INDEX

A abortion, 7, 25, 148, 186, 192, 210–11, 227, 229 AIDS intervention programs (see also Cambodia, education) 100 percent condom program, x, 24, 56, 92, 124, 170n., 188, 226 life-skills programs (see lifeskills) The Thai Family Combats the Dangers of AIDS Program, 60, 68, 83–84, 92, 98, 142, 188, 226 (see also family values) medication herbal, 43, 95, 102, 104, 111–17, 123, 126 Western, 107n. 16., 108n. 17. normative model of Thai AIDS, ix, xvi, 5, 9, 11–14, 17–18, 23–25, 35, 41, 44, 67, 87, 89, 125, 234–37, 242–43, 245, 250 (see also condoms, culture, education, morality, public media, research methods, surveillance)

alcohol alcohol and risk taking (see risk taking) denial of Thai alcohol use, 6 drunkenness as a legitimation for participating in commercial sex, 6, 12, 14, 71, 145 female drinking patterns, 54, 169, 175, 210, 223 male drinking patterns, 5–6, 52, 54, 71–74, 79–80, 93, 95, 101, 103, 110n. 20., 147, 167, 190, 202, 249 in relation to commercial sex and HIV infection, 71, 101, 142, 146, 216–17, 221–22 as a symbol of masculinity, 14, 52, 65, 72, 79–80, 82–84, 101, 146–47, 197, 244 (see also class, masculinity, rituals) Anthropology/anthropologists audit culture, 37, 242 and consultancy, 33–34, 37, 237, 238n. 2., 247n. 6. fieldwork (see fieldwork) limited contribution to Thai AIDS research, xv, 11,

312

19n, 24–25, 30, 32–35, 37–38, 40, 50, 152–54, 162, 242 mimicking of anthropological methodologies, 32n, 33–37, 50, 152, 247n. 6 research methods, 32–34, 36–37 role in the study of Thailand and in Thai AIDS research, ix, 4, 8, 12–13, 17, 19n, 26, 30, 37–38, 149, 151, 154–55, 160–61, 231–32, 242–45, 247 uncomfortable science/ discipline, 37, 242, 247 (see also empiricism/empiricist, ethnography/ethnographic research, muted voices, theory) assertiveness, 47–48, 227 B behaviour (see class, culture, masculinity, women, youth) behavioural change (see education, life-skills) best practice, xvi, 1, 11, 31–33, 38, 44, 47, 231, 234, 248 Buddhism Buddhist cosmology, 75, 77–78 call for morality, 30n, 64, 114, 172 and the domination of Thai Social Science research, 154–55 gender identity, 13, 73 ignored in AIDS research, 5, 22, 70, 76, 156 legitimation of claims to special powers, 116–17 messianic movements, 163 (see also merit, phuu mii bun) and the study of Thai women, 156–59, 161, 163, 165–67, 180 (see also risk taking, scholarship

Subject Index

of admiration, Thai Studies) bun phuu mii bun, 116 (see also merit) C Cambodia AIDS policies, 2 AIDS research, 2n. 1 model of AIDS causation, 2n. 2., 250–51 and orientalism, 239, 247n. 5 simplified history of AIDS, 39–40 causation (see karma) censorious attitudes (in Thai AIDS research) towards sex , 46, 85, 245 towards sexually active men, 233n towards sexually active young people, 15 children (see street children, lifeskills, prostitution/ prostitutes, youth) class class-based AIDS issues, 1, 2, 13, 16, 18–19, 28–29, 31, 41–42, 44–45, 50, 84, 87–89, 102–103, 128–30, 142–43, 150, 162, 170–71, 177, 179–80, 183–84, 190, 192, 198, 219, 220, 223–25, 233, 242n, 245–46, 250 middle class, 2n. 1., 3n, 5, 17, 21–22, 26n, 28–29, 30n, 42, 46n, 48, 56–57, 62, 65, 78, 87, 94, 97, 100, 103, 124, 148, 153, 176, 183, 186–87, 190, 212, 224–25, 228, 231–32, 233 underclass, x, 2–4, 13, 15–17, 22n. 4., 28–29, 41, 78, 87–88, 102, 128, 153, 188, 233n (see also prejudice)

Subject Index

colonialism and anthropology, 248 Thai anti-colonial fears, 117 (see also globalisation) commercial sex (see prostitution/prostutites) Community Based (AIDS) Organisations formation, 212 limits of effectiveness, 240 networking, 239–40 comprador position (see peer education/educators) competitive drinking (see alcohol) condoms failure 59n. 12., 82 usage, 31, 48, 58–60, 65–66, 68, 70–71, 74, 81–82, 93, 95, 99, 123, 160–61, 170n, 175n. 35., 178, 189, 193–94, 196, 199, 206, 209–210, 222–23, 226, 232, 246, 248, 250 (see also AIDS) consensus about the response to AIDS, 141, 178 focus groups, 35 in Thai society, 240 culture culture brokers, 22, 240n as an impediment to programming, 5, 18, 33, 152–53 interpretation of, 5, 13, 18–20, 27, 31, 34, 84, 151, 155, 201, 247 local level/regional, 7, 13, 22, 29n. 8., 77–78, 103, 116, 121, 144, 149, 164, 166 neglect of indigenous, x, xvi, 22n. 5., 30, 35, 85, 149, 151, 154–55, 180, 90 and risk taking (see risk taking) sexual, 19n, 24, 27, 39, 63, 68, 84–85, 142–43, 145–46, 151, 170, 180, 182, 186–87, 195, 211, 228,

313

230 transformation of, 4, 78, 142, 165, 180, 182, 184–86, 195, 221n, 227 Western (see globalisation, Western cultural standards) youth (see youth) contagion (from HIV) fears held by the medical profession, 105n. 13. general fears, 106, 106n media reports, 106, 115, 126 causation indigenous models, 93 karmic (see karma) cures (claimed) for AIDS, 15, 90, 96, 104, 111–18, 123, 126, 141 (see also AIDS) D death accidental deaths, 76, 80 AIDS deaths, 59, 98, 93, 104, 105n. 13., 106n, 110, 115, 176, 182, 250 bad death, 111, 245 by suicide (see suicide) in Thai cosmology, 75, 246 from witchcraft, 171 (see also phii) Demography/Demographic research, x, 10–11, 14, 18, 24, 30–31, 40, 129, 138, 160, 230, 248 deviant portrayals of minority groups (see class, homosexuality/ homosexuals, intravenous drug use/users, prostitution/prostitutes) donors general issues, 2, 38, 236, 239–40 pressures/limitations exerted on research, xvi, 33–34, 44, 234, 237–38, 250 drinking (see alcohol)

314

E edgework (see risk taking, masculinity) education AIDS education media, 14, 45, 57, 66, 84, 92, 96, 142, 188–89, 213, 218, 221 AIDS education programs, 5, 7, 41, 88, 124, 129, 135, 148, 188, 195–97, 201, 212, 215, 225–26, 230, 245 life-skills education (see lifeskills) and moral sensibility, 102, 142, 153, 208, 227–28 and prostitution, 121, 122, 215 as the root problem of AIDS, 2, 8, 23–24, 42, 56–57, 87, 89, 99–100, 116, 125, 139, 162, 216, 243–44, 246, 250 sex education curriculum, 207–208 (see also peer education/educators) emic interpretation, 30, 152, 243 empiricism/empiricist, 1, 12, 17, 19, 32, 34, 36–37, 45n, 46n, 48–49, 234–35, 242–44, 248 empowerment, x, 47, 49, 215, 226–27, 230, 244 Epidemiology/Epidemiological research, x, 10–11, 18–19, 24, 30–31, 40, 129, 133, 136–38, 160, 230, 248 essentialist/essentialism (see also image) labels, 31, 140 notions (of sexuality), 23, 129, 162, 163n. 25., 170 risk groups, 16, 23, 100–101, 129, 138, 250 ethics and HIV/AIDS social science research, 242n, 250 human rights, 140, 207 vaccine testing, 140, 242n

Subject Index

ethnography/ethnographic research in general, xv, 8–9, 31, 32n, 36, 158 in relation to Thai AIDS research, 10, 30, 32–33, 35, 38, 50, 144, 152, 162, 243 (see also field work, research context, research methods) etic interpretation, 152, 243 exoticism the Thai periphery, 21n. 3. Thai sexual practices, 71 Thailand per se, 20–21 (see also orientalism/orientalist) F family values and AIDS control, 29, 142, 155n public discourse, 124 feasting, Northern Thai men, 72–73, 110n. 20., 147, 244, 249 in Southeast Asia generally, 72 (see also alcohol, masculinity, rituals) field work in AIDS research, 32–33 Anthropological, 17, 36–37, 243, 247 (see also ethnography/ ethnographic research, research methods) focus groups (see research methods) fun, 34, 46, 76, 110, 155n, 200, 202, 245 (see also alcohol, masculinity, rituals) G gender basis of AIDS interventions, 1, 4–5, 8, 156, 160–62, 189, 244 gender and power, 62–65, 72n, 74, 83–84, 225, 321–32

Subject Index

research about gender in Thailand, ix, 26–27, 129–30, 150–51, 156–62, 165–70, 189, 203, 231, 244 (see also class, homosexuality/ homosexuals, masculinity, women) globalisation as a panacea for social problems, 221n fear of globalisation and the increasing penetration of Western culture, 4, 16, 62–63, 143n. 13., 163, 182–83, 185–86, 204, 232–33 (see also resistance, Western cultural standards, youth) good and bad women (see women) H Health Belief Model, 69–70 hegemony biomedical model of AIDS, 34, 43, 230, 235 Central Thai history/culture, 21n. 3 competition for (AIDS discourses), 140 hill-tribes, 57, 120, 174, 213–15 history as a disciplinary study of Thailand, xv–xvi, 26, 30, 38–39, 154–55, 189 and Thai AIDS, 13, 22–23, 30, 38–43, 46, 151, 154, 160, 248 Thai sense of history, 13, 21n. 3., 29, 61, 88, 189, 230, 250 homosexuality/homosexuals and modelling HIV spread, 16, 23, 25, 55, 69, 90n. 4., 91, 100–101, 128, 131, 137–39, 160–61, 191 prejudices about, 16, 64, 90n. 4.,128, 141, 143n. 12., 179, 196–97, 207, 229

315

I ideology (validation of) and notions of morality, 7, 16, 35, 128, 153 (see also virginity) image essentialism of surfaces, 6, 21 presentation of Thailand’s image to the outside world, 21, 42 of the self presented to others, 102, 141–42, 153, 175, 201 romanticised, 21n. 3., 233 (see also orientalism/orientalist, prejudice, stereotypes) individual pathology, 17, 162, 228, 231 international organisations (see donors, non-governmental organisations and international organisations) interns, xv, 2n. 1., 33 intravenous drug use/users and modelling HIV spread, 23, 25, 55, 59n. 12., 69, 91, 100, 128, 131–34, 136–37, 139, 191 prejudices about, 15, 128, 139, 179, 229 K karma causation, 75 and HIV, 75, 246 risk taking, 80 kathoey, 160, 207 khun khru, 72n, 194 L language language fluency and Thai AIDS research, xvi, 6, 11n, 12n, 39, 46, 87, 158n, 160, 193, 198 Orwellian, 3, 44 (see also class)

316

lesbianism/lesbians, 141n. 10., 160, 170, 196, 212 liang (see feasting) life-skills behavioural interventions, 16, 42, 48, 148, 182, 186, 198, 201, 210, 213–24, 229–31, 247 theory, 213–15 as a unifying ideology, 216, 225–28 (see also morality, risk taking, youth) local knowledge Anthropology, 36, 152 culture, 41 and HIV/AIDS, 60, 93, 152 ludic (sense of the), 47, 245 (see also alcohol, rituals) M masculinity and analyses of Thai gender, 129, 156, 158, 163, 166, 244 constitution of, 5, 52, 65, 72–73, 79, 81–82, 101, 147, 167, 194, 196, 244 social value, 14, 61–62, 65, 77–79, 83–85, 101–102, 196 (see also alcohol, Buddhism, feasting, risk taking, rituals) media (AIDS education) (see AIDS, education) media (public) (see public media) merit (see also bun, phuu mii bun) making, 78, 117 possessing, 52, 72–82, 157 metaphors of AIDS metaphors in indigenous media, 15, 88–89, 92–93, 125, 164 Northern Thai metaphors, 13, 60–62, 65–66, 83 minority groups (see class, intravenous drug use/

Subject Index

users, homosexuality/ homosexuals, prostitution/prostitutes) models of AIDS biomedical model, x, 8–9, 11, 12n, 34, 43, 87–88, 91, 96, 124 (see also public media) indigenous AIDS models/ discourses, 124–25, 183, 231 neglect of indigenous models of AIDS, 87–89, 93, 124 of sexuality, 151, 183, 193, 243 wave model of HIV spread criticisms/limitations of, 134–37, 163, 170, 177–79, 190 operationalised, 2, 15–16, 23, 91, 127, 130, 131–33, 137–39, 140n. 8., 191 (see also class, morality, risk groups) moral consensus (see consensus, research methods) moral panic/panics child prostitution, 16, 171, 164, 174 concept of, 164–65, 171–74 messianic Buddhism, 163 prostitution, 95, 124, 127–28, 163–65, 171, 174, 179, 192, 205 shrinking penis, 61–62, 164 widow ghost, 164 witchcraft accusations, 163 (see also phii) morality AIDS as a moral issue, ix, 3, 16, 29–30, 42, 61, 64, 89, 100, 110, 128–29, 140–42, 145–46, 150–51, 163, 165, 171, 179, 190, 230–31, 235, 242n, 245 underclass risk behaviour as a moral issue, 2, 17, 45, 87, 100, 102, 128, 142, 146,

Subject Index

179, 190, 242n, 250 western morality as a measure of Thai behaviour, 1, 28, 57, 124, 129, 143–44, 146, 154, 159n. 22., 183 of youth sexual activity, 8, 182, 186–88, 191–92, 196–99, 201–204, 206, 207–208, 211, 215–17, 220, 223–25, 227–30, 232–33 (see also censorious attitudes, class, ethics, moral panic/panics) muted voices muted AIDS discourses, 8, 140–41, 178–79, 236, 239 muted critiques, 17, 135, 237 muting of anthropology, 13, 37, 242 (see also models of AIDS, research methods) N negotiation between anthropologists and their employers, 238n. 2. as a technique of AIDS prevention, 46n, 47–49, 244 non-governmental organisations and international organisations activities in Thai AIDS, 2–5, 9–11, 17, 28, 31–32, 40–41, 47, 66, 89–92, 98, 105–108, 123, 126, 141, 148, 182, 206, 211, 214–15, 216–19, 226, 236–37, 239–40 and alternative AIDS discourses, 108, 140, 179, 230–31, 235–36, 241 and the construction of Thailand’s AIDS epidemic, ix, xvi, 2–4, 11, 15, 17, 32, 44, 46n, 66, 88n, 89–90, 125, 127–28, 181–82, 184, 186–87, 203, 211, 216–25,

317

228, 234, 236–39, 247–48 growth in Thai AIDS NGOs, 108, 140n. 9., 212–13, 216–17 and prostitution, 28, 144n. 14., 171–72, 212, 217 normative model (of Thai AIDS) (see AIDS) O orientalism/orientalist and Cambodian health research, 247n. 5 images of Thailand, 21, 22n. 4., 29n. 9. Thai AIDS research, 22, 28–29, 35, 53, 198, 245 Thai gender research, 158 Western donors and orientalism, 239 P paradigms (AIDS) (see models of AIDS) passive resistance (see resistance) past (the) (see history) peer education/educators comprador position, 244 contribution of social theory, 244 critical issues, 48–49 limitations in transcultural contexts, 45n misuse, 49n in Northern Thai AIDS interventions, 195–96, 221, 224, phi phii buu yaa, 63, 158, 167–68, 171 phii ka, 61, 163, 171 phii porp, 171 phuu mii bun, 116 (see also merit) potency male, 14, 52, 61–62, 65, 72–73, 77–83, 147, 196 female, 62n, 77n. 24., 167–68

318

power (see class, gender, hegemony, resistance, surveillance) prejudice class based, 2, 13, 15–16, 23, 53, 89, 102, 128, 163, 170, 177, 179, 190, 246 conceptual, 36, 243 (see also class, homosexuality/ homosexuals, intravenous drug use/users, prostitution/prostitutes) prostitution/prostitutes anti-prostitution campaigns, 28, 66n. 17., 118, 120–23, 128, 172, 215 as the cause of the AIDS epidemic, x, 2, 10, 14–16, 23, 26, 31, 40, 51, 55–56, 59n. 12., 67–69, 89–91, 102, 110, 118–19, 128–29, 131–42, 164–65, 170, 179–80, 182–83, 190, 192, 226 child prostitution, 28, 66n. 17., 97, 120, 143n. 13., 163n. 24., 164, 171–74, 183, 185–86, 205–206, 208–209, 215–17 (see also non-governmental organisations and international organisations) media reporting about, 15, 43n, 66n. 17., 90, 97–103, 107, 110, 118–23, 128, 172–74 prostitutes, 6–7, 10, 14–16, 27–29, 31, 39–40, 52n. 3., 57, 59, 63–64, 71–74, 83–85, 92, 102, 131, 143–47, 154, 158–60, 162–65, 169–72, 177–78, 180, 183–85, 189, 191, 193–97, 212, 220, 225, 231 in Thai literature (and in English language works

Subject Index

about Thailand), 29, 35, 39, 106, 158n, 166, 172n, 173–74 (see also essentialist/essentialism, orientalism/orientalist, prejudice, stereotypes) prowess (see masculinity, potency, risk taking, rituals) public media AIDS models in the Cambodian media, 2, 40 AIDS reporting in Thailand, 5, 14–15, 54n, 55, 57, 64, 86–126 biomedical model of AIDS, 43, 86–87, 91, 173, 192, 234–35 cartoons in AIDS education, 92, 188 public media, 94–95, 109, 210 media and AIDS control campaigns, 14, 57, 92, 96 media in modern Thailand, 53 and moral panics, 62 reporting about prostitution (see prostitution/ prostitutes) reports on herbal medicines, 43 vaccine testing reports (see vaccine testing) youth sexuality (see youth) (see also class, prostitution/ prostitutes, risk groups, stereotypes, youth) Q qualitative research (see research methods) quantitative research (see research methods) R rapid assessment techniques (see research methods) reflexivity in Thai AIDS research absence of, x, 3, 16–18, 25, 33,

Subject Index

35, 40, 45–47, 50, 130, 152, 155–56, 177, 180, 190, 230, 234–36, 241 contribution of, xvi, 8, 12–13, 17, 39, 84, 242–43, 245 research context problem of decontextualised data and ungrounded assumptions, x, 14, 19n, 27, 30, 32–33, 35, 50, 56, 71–72, 151–52, 183, 242 significance of the total cultural/social context, 14, 30, 36, 52 research methods AIDS research methodologies focus groups, 8, 32–33, 35, 62, 144, 149, 151–53, 162, 196–97, 199, 238n. 1., 243, 250 interviews, 8, 25, 32, 58, 96, 204 KAP/KABP surveys, 2n. 1., 24, 139, 151, 191, 194, 218 participatory rural appraisal, 24, 32, 32n rapid assessment techniques, 35, 152 statistics and surveys, 6, 14, 22, 24–25, 32, 35, 56–58, 67, 70, 76–77, 91, 124, 131–33, 136, 139, 143–47, 149, 151–53, 161–62, 189–90, 196–97, 201, 206, 209, 216, 224, 250 methodological problems in/limitations of Thai AIDS research, 8, 25, 30, 35–36, 46n, 96, 144, 149, 151–52, 216n, 242–43 (see also language, prejudice, research context) qualitative research data, 8, 32–33, 35, 144, 152 research methods, 25, 30, 32–33, 35–35, 50, 151–52, 238

319

quantitative research, 32n, 151–52 resistance to AIDS interventions, 60, 67, 83–84 of an assumption/prejudice, 36 to the impacts of globalisation, 186–87, 224–25 to the penetration of private space, 3n, 13, 15, 83, 118, 154, 243 to researchers, 152n, 154, 223 risk groups risk groups and Thai AIDS, 2, 10, 15–16, 23, 55–57, 66, 69, 91, 100, 127–33, 139n, 141, 160–61, 191, 201 critique of the concept of risk groups, 13, 56, 100, 128–30, 134–39, 146, 163, 170, 177–80, 190, 250 risk taking amongst young people, 162, 198–200 and the commercial sex context, 69–71, 81–83 edgework, 80–83 in Northern Thailand, 13–14, 52–53, 76, 79–80 taken for granted concept, x, 53, 87–88 (see also karma) rituals mortuary rites for AIDS deaths, 110n. 21. rituals of masculinity, 72–74, 78n. 26., 79 (see also feasting) S scapegoat commercial sex workers, 126 moral panics, 165 scholarship of admiration (for Thai society), 6, 26, 129, 154, 170, 180, 241 social theory (see theory) spirits (see phii)

320

statistics and surveys (see research methods) stereotypes peoples on the rural periphery, 21n. 3., 87 prostitutes, 56n. 9.,119–20, 123, 169, 174–75 Thai sexuality, 162, 230, 233 Western sexuality, 234 (see also essentialist/ essentialism, class, homosexuality/ homosexuals, intravenous drug use/users, orientalism/ orientalist, women) street children, 92, 174n. 33., 189, 205, 208, 212–13, 215–21 Structural Functionalism/ Functionalist (see theory) suicide (due to HIV/AIDS), 15, 86, 90, 97, 100, 104, 109–111, 115, 126, 214 surveillance behavioural, 1, 4, 17, 44, 67, 219, 229, 231, 243 criticism of surveillance categories, 45n, 100–101, 134–36 sentinel surveillance, 3, 7, 24, 40, 51n. 2., 66, 124, 130–31, 133, 139, 178 (see also class, resistance) T tautological nature of AIDS research, ix–x, 3, 23, 50, 146, 235, 237 reasoning, 45, 139, 146, 157, 205 Thai Studies constructions of knowledge about Thailand, 22, 26, 41, 94, 170, 214 limitations of, 17, 26, 129, 180, 241 (see also Buddhism, scholarship of admiration)

Subject Index

theory contribution of, 8, 12, 17, 33, 242–45, 247 lack of attention to, x, 17, 33–35, 46n, 234 Phenomenology, 244–45 Structural Functionalism/ Functionalist definition, 9n in Thai AIDS research, 9, 55, 100, 136, 140n. 8., 188, 191 and Thai Studies, 158, 241 Symbolic Interactionalism, 244–45 Theory of Reasoned Action, 69–70 (see also Health Belief Model) Transactionalism, 244–45 (see also empiricism/empiricist, research methods) U underclass (see class) V vaccine testing ethics issues (see ethics) media reports about, 104, 111–12, 115–16, 126 virginity anthropological and other research concerning virginity in Thailand, 147, 149–50, 233–34 as an ideology validated through AIDS research, 7, 25, 144–45, 150, 153, 192 contemporary Thai AIDS researcher’s perspectives, 200, 206–208, 201–211, 222, 229–30 popular media reports about, 148–49, 206–207 and Western derived morality, 144–45 (see also censorious attitude), research methods, women, youth)

Subject Index

W wave model (see models of AIDS) Western cultural standards (of morality) as a model for representing Thailand, 28–29 as a standard for evaluating Thai behaviours, 28–29, 143, 183, 235 (see also globalisation, resistance, youth) Westernisation (see globalisation, resistance) witchcraft, 56n. 9., 163–64, 168, 171 (see also moral panic, phii, prostitution) women good and bad women, 103, 128–30, 156, 169–70, 174, 177, 180 potency (see potency) virginity (see virginity) (see also assertiveness, Buddhism, ideology,

321

morality, orientalism/ orientalist, stereotypes) Y youth adoption of western culture, 16, 183–86, 204, 225, 227–29 AIDS control programs for youth, 42, 48, 104, 148, 186–87, 211, 217, 220–24 high rates of sexual activity, 8, 16, 54, 65, 93, 147–50, 152, 180–82, 184, 191–209, 219–20, 233, 241 as an HIV/AIDS risk group, 10, 101 problem behaviours, 54, 79, 165, 203 and sex work, 31, 207 (see also abortion, education, globalisation, life-skills, morality, surveillance)