AIDS and the Racialisation of Health
By Marina Mahathir
The first thing you learn when you start work on HIV/AIDS is that "the virus does not discriminate". The virus does not know what race you are, only that you are a human being whose blood is a welcome home for it to reproduce.
I did not quite absorb this mantra until I went to my first International AIDS conference in 1994 in Yokohama. In session after session, people would stand up and openly declare themselves HIV-positive. And there I saw for myself how the virus truly does not discriminate. There were men, women, gay, straight, black, white, brown, yellow, old, young, developed world, developing world. Everybody it seems is vulnerable.
Back home this non-discrimination didn't seem to manifest itself in quite the same way. Malays seemed over-represented in the statistics. Was there something about being Malay that made them more vulnerable to HIV? Does this mean that the Chinese, Indians and 'others' could rest easy?
When statistics are presented as mere numbers and racial categories, it masks valuable information. Yes, Malays have been infected in greater numbers. And yes it was something to do with being Malay. But it was not about being born Malay so much as what you are prone to do if you are Malay, rather than if you're not. And sadly, you are more prone to taking drugs and injecting them.
That again is not so much a racial trait but a socio-economic one. But this is something not studied because it is likely to show up another failure of our socio-economic programmes. That many Malays still remain in poverty and that is possibly why they are more prone to drug use and hence to HIV. In this, it makes them no different from Pakistanis, Bangladeshis or Afghanis. But we refuse to talk about this because it brings shame on the race.
The consequence of this racialisation of health spreads beyond mere categories. While it keeps Malays endangered because of the refusal to deal with the realities of Malay life, it also makes other Malaysians complacent. The belief that Chinese or Indians will not become infected because they are not Malay is prevalent. Yet many a Chinese cook, construction worker or plumber has found himself diagnosed with the virus often a few months or years after a trip to Haadyai or Bangkok. And if one analyses the racial breakdown of AIDS cases (as opposed to HIV cases where overwhelmingly Malays in drug rehabilitation centres are targeted for tests), then they almost neatly fall into exactly the proportions that make up our population; 60% Malays, 30% Chinese, 10% Indians and others. HIV does not discriminate at all.
It follows that to work in this field effectively, you have to have an attitude that is open towards everyone, regardless of racial, religious, class or lifestyle background. The Malaysian AIDS Council must be one of the few places in this country where candidates applying for a job are routinely asked what they feel about homosexuals, transsexuals, drug users and sex workers. Any unease is immediately noted negatively. Our work involves working with and earning the trust of the most vulnerable communities and anyone who feels uncomfortable doing so simply cannot do the work.
Working at MAC means you have to understand the full meaning of human rights and its links with health. Human rights is not just limited to the right to health but also to the means by which good health can be supported. The right to education or to work, or to express yourself should be inherent rights regardless of your gender, sexual orientation, socio-economic background or lifestyle. It would be impossible to provide any AIDS education or services if you don't believe in any of these rights.
If anything, the staff at MAC struggle less with the issue of race than with the other diversities within our communities. It is not easy for someone from a middle-class background to find themselves working with people who have issues related to drug-taking, sexuality and sex work. Some have left because they are unable to adjust to these realities or have not been able to overcome class and lifestyle barriers. But most stay because it is in working with these very diverse communities that they find real satisfaction in their work.
Working in the AIDS world means learning to be sensitive to every single community. Thus it becomes natural for us to make sure that all communities are represented in whatever we do. In particular we have to ensure that the voice of the most affected people are always heard, especially People Living with HIV. Thus at elections for the Executive Committee of MAC, we endeavour to have these communities always represented. Additionally, we also try for gender balance. Racial balance is not something we aim for although we almost naturally have an even spread anyway.
This type of thinking, which you might call affirmative action, is pervasive throughout the entire AIDS world. In deciding speakers at any conference, our outlook is always to have not only gender and regional balance but also to ensure that the different communities are represented. Sometimes we joke that the ideal plenary speaker is a HIV-positive gay drug-using woman with African and Asian parentage!
But it puts you into a mindset where you develop respect for others different from you and come to regard them as individual human beings, rather than just a community or group. When these communities themselves do not group themselves by race but rather by lifestyle, then it is difficult to respond to them in any other way. Drug users and sex workers never differentiate themselves by race or religion. They may respond to their problems in different ways but there is essentially no difference between a Christian, Muslim or Buddhist drug user or sex worker and their problems. The law acts on them in exactly the same way.
The exception may be the male gay communities that do differentiate themselves by language. Even so the problems they have in gaining acceptance within their families and society are the same.
Perhaps the point I'm trying to make is that in dealing with social issues, often differentiations by race and religion are artificial. We cannot hope to address any of them if we insist on classifying them by these categories, in saying for example that "Indians like to beat up their wives" or "Malays like to take drugs". Even if the statistics may point towards these broad generalisations, the responses must go beyond simplistic ones that focus more on punitive measures.
An example is the mandatory premarital HIV testing that is required of all Muslim couples before they can get married. That Muslims should specifically discriminate against Muslims is ironic enough, but that it is lauded and praised despite being a failure is even worse. It is a response towards two facts, that Muslims make up the most number of HIV cases and that, men can easily transmit HIV to women. The policy is based on the naive belief that people don't have sex until they are married and that once free of the virus upon marriage, one is free for life. Yet it has done nothing to prevent infections from occurring, continues to stigmatise people who have been infected and does nothing to empower women to prevent themselves from becoming infected. Despite this failure, the National AIDS Strategic Plan intends to extend this policy to all Malaysian couples, which puts it at odds with all recommendations by the World Health Organisation and UNAIDS on testing. We should all fight it not just because it violates human rights but also because there is no evidence that it achieves its objective of preventing transmission of HIV.
Marina Mahathir headed the non-governmental Malaysian AIDS Council for twelve years from 1993-2005. She has also been involved in several AIDS NGOs, sat on several UN expert panels, represented Asia Pacific AIDS NGOs on the UNAIDS Programme Coordinating Board and spoken at the United Nations General Assembly. Currently she is a member of the Steering Committee of the Asia Pacific Leadership Forum on HIV and Development as well as Chair of the AIDS Society of Asia and the Pacific (ASAP) Working Group on the 9th International Congress on AIDS in Asia and the Pacific (ICAAP) to be held in Bali in 2009. She is also a newspaper columnist, blogger and TV producer.