Abstract
This chapter examines HIV/AIDS awareness campaigns in two contexts: the history of public health governance and health education and the history of the institutionalization of AIDS pedagogy through NACO and successive AIDS control policies. Drawing on these contexts, it discusses a number of pedagogic interventions in terms of their rationality, modes of governance, semiotic effects and effects on subjectivity.
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Notes
- 1.
The first phase of the National AIDS Control Programme (1992–1999) included among its specific objectives the creation of “a satisfactory level of public awareness on HIV transmission and prevention” and developing “health promotion interventions among risk behaviour groups” (NACO 2000, p. 18).
- 2.
Research on the immune system began in the early years of the twentieth century, but immunology as a field of medical knowledge emerged only in the 1960s with the discovery of cellular mechanisms (Cruse and Lewis 1999, p. 1).
- 3.
The rationale for introducing these strategies in the colonies, however, differed. It was to ensure the health of the European population, especially the army, which could not be done without also ensuring conditions of health in the native population (Jeffery 1988, pp. 92–99; Levine 1994; Harrison 1994, pp. 60–98; Curtin 1996; Pati and Harrison 2001). Mark Harrison cites from the report of the Sanitary Commissioner of the Government of India in 1892 that the troops “will never be safe as long as the native population and its towns and villages are left uncleaned to act as reservoirs of dirt and disease” (Harrison 1994, p. 77). I have underplayed the differences between metropolitan and colonial public health rationalities for the sake of coherence, but differences were certainly there.
- 4.
Cf. Foucault: “The main characteristic of our modern rationality … is neither the constitution of the state, the coldest of all cold monsters, nor the rise of bourgeois individualism. I won’t even say that it is a constant effort to integrate individuals into the political totality. I think that the main characteristic of our political rationality is the fact that this integration of the individuals in a community or in a totality results from a constant correlation between an increasing individualization and the reinforcement of this totality” (Foucault 1988b, pp. 161–162).
- 5.
Foucault considers vaccination a mechanism of security rather than of law, in that it tries to reduce the risk of disease and not to eliminate it altogether (Foucault 2007, pp. 57–58).
- 6.
For an account of the difficulties encountered in enforcing vaccination law, see Bhattacharya (2001, pp. 245–258). These difficulties ranged from conflicts between the officers of the Indian Medical Service and the civilian administrators, the half-heartedness of municipal officials in carrying out vaccination programmes, to resistance by local populations.
- 7.
Thus, many awareness campaigns during the first phase of the National AIDS Control Programme in India used the format of “facts” versus “myths” in communicating knowledge about transmission and prevention of HIV. We will examine some of these in more detail later.
- 8.
The phrase “regime of truth” is Foucault’s. The exercise of power, he argues, necessitates the production of knowledge, which then enables strategies to be formed to enhance power’s reach. “‘Truth’ is linked in a circular relation with systems of power which produce and sustain it and to the effects of power which it induces and which extend it. A ‘regime’ of truth” (Foucault 1980, p. 133).
- 9.
Edward Albert (1986) has argued that this is typical of modern societies, where in matters of social conduct, the authority of medicine supersedes that of morality and law. Albert’s view coincides with Foucault’s argument about the general “medicalization” of society starting from the eighteenth century.
- 10.
K. Sujatha Rao served as Director General of the National AIDS Control Organization from 2006 to 2009 and has written perhaps the most comprehensive history of its functioning since its inception in 1992 (Rao 2017, pp. 201–297).
- 11.
Literally, politics of disease, from the Greek nosos meaning disease. I borrow the term from Foucault (Foucault 2000b, p. 91)
- 12.
Other objectives were blood safety, STD control, support services for people living with HIV/AIDS and involvement of all states and union territories in epidemic prevention.
- 13.
In 1999, the high prevalence states were Maharashtra, Tamil Nadu, Karnataka, Andhra Pradesh, Manipur and Nagaland; moderate prevalence states were Gujarat, Goa and Pondicherry; and the rest were low prevalence (NACO 2000, pp. 2–3).
- 14.
The Behavioural Surveillance Survey (BSS), which began in 2001 with a sample population 15–24 years of age, seeks to measure “trends in cognitive information on HIV/AIDS and to assess changes in sexual behaviour and risk practices” (NACO 2006, p. xiv).
- 15.
For a critique of this campaign, see Das (2005).
- 16.
The term was introduced in the third phase of NACP, which scaled up the interventions in terms of numbers and groups. Where priority had earlier been accorded to interventions for sex workers and long-distance truck drivers, NACP III included new groups like men who have sex with men, intravenous drug users and migrant populations. See also Rao (2017, pp. 264–274).
- 17.
- 18.
Since sex work has no legal recognition in India, it is difficult to get a sex workers association registered as a collective. Further, the West Bengal Co-operative Societies Act, 1983, had a clause debarring from the board of directors any person convicted of an offence involving moral turpitude, under Section 27(10)(b) of the Act.
- 19.
“The IBBA consisted of household surveys to assess behavioural responses towards safe sex practices, namely, the use of condoms and an understanding of how HIV spreads among HRGs” (Rao 2017, p. 211). Carlos Cáceras, however, argues that such surveys – what are called knowledge, attitude and practice (KAP) studies – often oversimplify “the heterogeneity of specific sexual acts, the variety of ways persons refer to them, and the variability of their contexts, [making] it difficult to fully understand sexual behavior and risk-taking on the basis of responses to a few seemingly simple questions” (Cáceras 2000, p. 250).
- 20.
The general argument of Richards’ essay is that contemporary medico-juridical regimes couch moral objections to diseased people in the languages of law and public health, by deploying the age-old notion of “moral plague” – that indiscriminate deaths in epidemics “are not pointless and inexplicable and without remedy, but can be understood and brought within our control as condign punishments for some wrong or failure” (Richards 1988, p. 519).
- 21.
To avoid such unintended effects of meaning, policy documents sometimes use the term “key populations”, which is both more neutral in implication and serves the purpose of constituting them into groups for epidemic prevention and control.
- 22.
There is, of course, the practical difficulty of constituting them as a group for public health purposes, given that people will not identify themselves as “client of sex worker”. However, the point here is not whether it is feasible to construct such a group but why public health policy cannot even imagine the idea.
- 23.
This observation, reported in an article that appeared in The Sunday newsmagazine, was widely held by the media as well as public health authorities in the early years of the epidemic. See Sect. 3.2 above.
- 24.
The family, argues Foucault, becomes from the mid-eighteenth century a key instrument in governing the population in matters concerning “sexual behavior, demography, the birth rate, or consumption” (Foucault 2007, p. 105).
- 25.
- 26.
Castel, however, argues that the current paradigm of intervention, which focuses on factors of risk rather than the conduct of individuals, does not concern subjectivity “because there is no longer a subject” (Castel 1991, p. 288, italics in original). This is because it does not involve personal intervention, as did the hygienist paradigm, but a bureaucratic approach to risk that depends on statistical correlations of vulnerability and not individual conduct. While Castel’s argument may be true of the surveillance of risk in some contexts, like screening for genetic predispositions to disease, it certainly does not explain pedagogic interventions involving both risk and lifestyle management in epidemic control – which, we may say, take the subjectivity of those targeted as their starting point.
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Das, D.K. (2019). AIDS Awareness Campaigns: Pedagogy as Strategy. In: Teaching AIDS. Springer, Singapore. https://doi.org/10.1007/978-981-13-6120-3_6
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