economic crisis and HIV-infection
dissemination of HIV-infection cannot be seen apart from economic developments.
Like those with a bio-medical background talk about STDs as a 'co-factor' for
the HIV-epidemic, people with a background in social sciences know that the
modernisation process in developing countries is a 'co-factor' for HIV. Because
of the modernisation of Asia which is closely connected to the economic
developments, literally millions of people have been replaced, new communities
have been developed, social networks disrupted, traditions have been forgotten
and new identities created. It has had a deep impact on human behaviour and on
relationships between people (including sexual relationships). It is obvious
that the economic crisis has also had an impact on the HIV-epidemic.
development is rarely equally distributed and this leads to people moving to
places with opportunities. The migration from rural areas to the cities in Asia
has been impressive. In China alone there are 100 million internal migrants (one
in five people interviewed in Shanghai is a migrant) and the figure for the
Southeast Asian countries will not be very different. Economic development has
had a huge impact on the relationship between Bangkok and rural areas. In the
dry season we see Thai farmers in the Northeast move to the South to work on
fishing boats. We have also witnessed the migration of many young women to the
cities to work in the sex industry. In some villages one can see the houses with
a car in front and with a parallax antenna and one understands what the daughter
in this family is doing in town. The sex business is seen as one of the
important mechanisms to redistribute wealth back to rural communities. The
recent ILO-publication 'The Sex Sector' (about Thailand, Malaysia, Indonesia and
the Philippines) has reaffrimed the importance of the sex sector in Southeast
Asia and this is narrowly related to migration and the difference in economic
opportunities. In Vietnam, Cambodia and China we are also witnessing a booming
and rapidly growing sex sector. Young men without partners move to cities to
work and find ways to fulfill their natural needs. Young women also try to find
employment in cities but because of the lack of opportunities for women they
often end up in the sex sector.
migration is a part of this process. Burmese women move to Thailand. Cambodians
also go to Thailand. One third of the sex workers in Cambodia are Vietnamese.
About one million Indonesians are living and working in Malaysia. Philippine
housemaids and entertainers can be found in many countries. Four million
Bangladeshis are working abroad. International migration has become a common
strategy for many rural populations to deal with their poverty. It is estimated
that there are 20 million international migrants in Southeast Asia, many of them
economic crisis has had many consequences for the vulnerability to be infected
with HIV of internal and international migrants, though some of these may only
be understood later. It was expected by the authorities that the crisis would
partly be solved by rural migrants moving back to their rural communities. There
they would find the support system that would help them get through the crisis.
This, however, was a combination of wishful thinking and lack of understanding
the realities of migrants. On the contrary, migrants have not been moving back
to rural areas, while poverty in rural areas has been a pushing factor for many
to go to places where they expect better opportunities. It has made many
migrants more exploitable and pushed them into kinds of work that they would
never have done before the crisis. In the research done by CARAM Asia
(Coordination of Action Research on Aids and Migration) we have seen that
especially young women feel a strong responsibility for supporting their
families at home. If the garment factory where they were employed closes they
will find other work. There is no hard evidence of this, but many have observed
that there is an increase of 'indirect prostitution'. In our own research in
Indonesia we see that direct sex work is becoming less popular (it is too
expensive because of the money that goes to pimps and bribed policemen).
However, in shopping malls and at night at the streets there is more sex work
sex work makes sex workers much more vulnerable to be infected. In addition, it
is also a nightmare for all of us who are involved in intervention programmes.
Indirect sex workers are much harder to reach. In addition, as many see it as a
temporary emergency activity, they do not see themselves as sex workers, and
this makes it even harder to develop effective intervention strategies.
from increased vulnerability of internal migrants, in the situation of
international migrants we see extra problems due to the economic crisis. To
create employment for the local population authorities are embarrassed with
having a vast migrant population from abroad (people they have been attracting
before to make their economies bloom). In many countries authorities have turned
to forced testing and repatriation as a means to solve their problem with
international migrants. A small sample of news items from international media in
1998 may be convincing:
the newsroom of the BBC World Service: UAE deports foreigners infected with HIV
(the figure of 6000 is mentioned).
York Times (12/01/98): Saudi Arabia 349 with HIV deported.
Press (September 04 1998): Singapore to test ALL foreign workers for AIDS.
Sun (18-8-98) Fomena: 87 Foreign workers HIV carriers Kuala Lumpur.
who were found unfit were deported as we don't want them to be around and spread
the disease to our people.."
is a shame that there has been so little outcry over this gross violation of
human rights of people with HIV/AIDS. It might be that even the advocates of the
HIV cause are less interested in human rights violations of foreigners than of
their 'own people'.
instance, the crisis has resulted in policies of the Malaysian government to
demand medical checks from documented migrant workers if they want continuing of
their contracts and any health problem can be used against them. In a scheduled
checking round for 100,000 migrants in Johor Baru only 2,000 migrants showed up
out of fear that something might be found and they would be repatriated.
Migrants even feel unhappy to visit a clinic when they have symptoms of STD. The
authorities have demanded from all doctors to report diseases to a central
point. Health care is used against the individual and migrants will prefer to
ignore STD symptoms and treat themselves with inappropriate medication (nowadays
it is a hassle to know which antibiotics are still good to use because of the
increased resistance). It has amazed me that there was some discussion on SEA
AIDS on boycotting ICAAP99 because of the case against Anwar, while this
situation is far more outrageous (it neither is worth a boycott if we are able
in October to challenge Malaysian authorities to a discussion on these points).
from the devaluation of currencies which has resulted in higher cost for
treatment and prevention programmes (which I will not cover in this reaction)
and the fact that many organisations (including NGOs) have shifted their
priorities towards solving the direct consequences of the crisis and show
decreased interest in HIV/AIDS, the above mentioned consequences of the economic
crisis in SE Asia have tremendous impact on the dissemination of HIV. We have to
understand that and we should not be short sighted and also discuss and study
the vulnerability of people for HIV-infection after the crisis is over. Because
probably the most important co-factor to make people vulnerable for
HIV-infection is their social, economic, and gender position. As such it is
interesting to quote CARAM chair-person Irene Fernandez (during the World AIDS
Conference in Geneva in 1998) "Worldbank and IMF policies are mong the
important co-factors for HIV-infection".
behalf of CARAM Asia