Risky Synecdoches: HIV Prevention Schemes and “At Risk” Bodies of India and Kenya

The Indian response to the AIDS crisis, especially during its rise as a geopolitical power, was freighted with several concerns besides countering an epidemic. For one, there was trepidation that statistics on HIV infections in India could distill the nation to its (hyper)sexual and (im)moral essence on the global stage, thwarting its political ascent. This led the state to initially rely on several colonial precedents, like the Contagious Diseases Act and the institution of "lock hospitals," to criminalize and compartmentalize bodies that were "at risk." In her extensive examination of how this initial response shifted to exonerate those "at risk" bodies from state-sanctioned quarantine from the body politic, Gowri Vijayakumar deftly rehearses a complex negotiation of HIV prevention access, biopolitical rights, and power between citizens susceptible to HIV and the state.At Risk is an ambitious ethnographic project. Vijayakumar stages testimonies from several interlocutors. They range from AIDS experts at all levels—from the regional to the global—to activists, sex workers, peer educators, and volunteers at protests, HIV drop-in centers, and cultural events in Bengaluru, Nairobi, and Mombasa. The study of the Indian–Kenyan HIV response is especially interesting here for the expectations of South-South alliance that Vijayakumar's findings subvert.Expansive though this project may seem, sheerly for its international scope, Vijayakumar is very clear about what her project does not entail. Primarily, At Risk concerns itself with the "politics of prevention," not of HIV treatment (12). This disappoints slightly, owing to the complicated terrain of treatment in India that is tied to various vectors that determine access like gender, caste and class, religion, and the marbled layout of urban-rural in India's metropolises that is still not adequately represented in scholarly projects. Vijayakumar also elegantly limns the limits of her work as one animating the "politics of sex work" rather than the "politics of homosexuality and queer love" (12). From the set of participants whom Vijayakumar enlists to rehearse the shift in India's AIDS response, she addresses the stark exclusions at the very outset. Because of the capacious categories of people the AIDS crisis in India enfolds, certain individuals, such as those who may be, or might address, intravenous drug users, hail from or are situated in the oft-ignored northeast of India, trans masc citizens, or lesbians, along with the issue of HIV transmission from parent to child lie beyond the scope of Vijayakumar's book.A striking figure that India used as a synecdoche of its AIDS epidemic was the sexually deviant woman, specifically, the female prostitute, to counter the figure of the "small Westernised homosexual elite" (35) who became the poster child for the epidemic in the "west." This was consistent with the modus operandi of the rising Hindu right-wing morality drive that sought to ascribe homosexuality exclusively to the West and sign off AIDS as an imported malady to which India could claim no ethnic legacy. Vijayakumar's use of the "west" in At Risk is, at times, amorphous. It makes it difficult to chart the shift in the epicenter from Britain to the United States in India's long postcolonial relationship with the West. This makes Vijayakumar's thesis on a continuity between India's colonial and post-independence fixation on the female prostitute to regulate contagion and national identity a slightly skeptical endeavor. But Vijayakumar gradually parses the steady attention on the female sex worker who was used by colonialist reformers to deflect attention from British male sexuality or from homosexuality in the barracks. Using historical citations and their persuasive postcolonial adaptations, Vijayakumar shows how the sex worker became a template to exile HIV from the fold of Hindu propriety, the only metonymy of India, which was represented by upper-caste Hindu married women. The female sex worker who helped condition discourse on contagion and fashion nationalist imaginaries later becomes a common figure in Vijayakumar's twin studies of HIV prevention in India and Kenya.The turn from containment of bodies "at risk" to their incorporation into the terms of their own well-being is subsequently found in Vijayakumar's careful and illuminating examination of how various donors and the state collaborated on creating "relatively autonomous hybrid agencies" (41) like the NACO (National AIDS Control Organization), which finally put them in dialogue with the subjects of their prevention efforts. This shift also marked the pivot of prevention practices from "traditional biomedical approaches to more rights-based approaches" (52). Excerpts from Vijayakumar's interviews reveal how her interlocutors at the grassroots level found the government's role still "schizophrenic" (51) as hybrid agencies blossomed.Through her interlocutors, like Preethi, for instance, Vijayakumar's study unspools how nongovernmental organizations aided a transformation of their sex work and, at times, a refashioning of their class and caste-based personas by enlisting them as participants in HIV prevention measures. From her engagement with various cis-identifying women and men, and transgender women, Vijayakumar animates their process of "becoming smooth," or linear and coherent with the AIDS response, which the author explicates with a steady and stellar narrative of the "new ways" in which her interlocutors began "naming, embodying, and practicing sexuality," a process that, of course, came at the cost of various syntaxes of sex that were flattened for and by the movement (88).Retaining the female sex worker as the axis of HIV prevention discourse, Vijayakumar shifts her site of study to Kenya to problematize the wholesale application of HIV prevention models in India to Kenya. Colonial hierarchies that were adapted by a postcolonial India to develop strategies for HIV prevention were inlaid with the racist and sexist legacies of those colonial models. As a result, India's relationship with Kenya felt replicatory of the biases that British statecraft cultivated. Transposition of HIV prevention stratagems to Kenya came at a cost: of enfolding Kenya in the pan-African notion of being "administratively dependent and sexually promiscuous" (135). Drawing the dissimilarities of the political landscapes in India and Kenya, Vijayakumar calls attention to the folly of the cut-and-paste technique and the politics of comparison in South-South partnerships. Dissimilarities around donor culture in both nations had disparate impact on participants in HIV prevention schemes. Sex workers, minorities, and allies in Kenya felt "highly circumscribed" (140) when they made demands for their wellness. This stands in sharp contrast to the shift ushered by donor culture, which signaled the autonomy of "at risk" bodies in India.Despite the book's shift to Kenya feeling slightly delayed, Kenya's dialogue with the complicated machinery of HIV prevention in India and its various nodes and players is succinctly but richly put forth in the closing chapters. Gowri Vijayakumar's At Risk is an important work that has produced the female sexual deviant as the risky synecdoche of HIV epidemics in two countries in the global South. It is an important scholarly addition to the field of deviant female sexuality in India and the legacy of pathologizing the sex worker to which scholars like Durba Mitra have recently made stellar contributions. It is also an important book to study for the methodologies that not only critique presumed alliances within the global South but also investigate remnants of colonial biases that haunt supposed alliances.