"Rugged vaginas" and "vulnerable rectums": the sexual identity, epidemiology, and law of the global HIV epidemic.

• Author: Ahmed, Aziza
• Position: III. Shifting Terrain: HIV/AIDS and the Return to Biology B. Globalizing the Identity/Risk Narrative through Conclusion, with footnotes, p. 30-57

2. Globalizing the Identity/Risk Narrative

   By 1985 AIDS was documented in fifty-one countries. By 1987 this number had risen to 127 countries. Mortality and morbidity associated with HIV crippled communities and countries. Between 1990 and 1997 the number of people living with HIV tripled from ten to thirty million. (98)

   Globally, the HIV epidemic produced similar anxieties around transmission as in the United States. Many countries considered or turned to coercive ends to control the epidemic, including mandatory testing and quarantines. (99) Extreme public health measures targeted specific identity-based populations: gay men, sex workers, and drug users became the focal points of HIV interventions. These policy and programmatic approaches prompted a reaction from the international human rights community. The health and human rights movement founded by Jonathan Mann, the first Director of the WHO Global Program on AIDS, propelled resistance to the coercive public health measures implemented by governments. (100) By providing a framework and vocabulary for resistance, the health and human rights movement galvanized activists to resist coercion in the public health response to HIV.

   As the human rights movement grew, international human rights became the formal legal arena in which, like other social movements, HIV activists began to channel their energy and resources. Activists sought to ensure that human rights treaties protected the interests of their own communities in the growing number of international treaties, declarations, and commitments that were addressing the HIV epidemic.

   Feminists (both dominance and sex-positive feminists), the international gay rights movement, and the sex worker movement constituted crucial identity-based activist groups that engaged this international human rights legal arena. As is often the case with identity groups, these organizations did not fall cleanly in a single category. Some of the most vulnerable men who have sex with men are sex workers, some of the sex workers are transgender, and some women are sex workers or engage in transactional sex. In Part IV, I demonstrate how the formation of these identity categories masks these complexities.

   Narratives of biological risk and difference underlie the social mobilization of women, sex workers, and gay men in HIV and human rights. Two such narratives played a large role in laying the foundation for HIV organizing and provided a naturalizing impulse: the idea that for women the vaginal wall is vulnerable to HIV, (101) and for gay men anal sex is a particularly vulnerable form of penetrative sex. As was the case in U.S. feminist activism on HIV, international women's rights activists found that male dominance over women was a root cause of HIV. Marriage, violence against women, and rape were social factors that propelled forward women's vulnerability to contracting HIV. (102) As with prior women's rights advocacy, feminists saw the law as a patriarchal force that sustained these inequalities. Gay men's vulnerability was due to the dominance of heteronormative culture often represented by sodomy laws. The gay men's narrative holds that gay men are vulnerable to HIV because of a closeted, unsafe lifestyle partly forced upon them by heterosexuality. In turn, it is the subordination of gay men by heterosexual culture that is (in part) driving the gay male HIV epidemic. For women and gay men, the turn towards biological difference attaches itself to identity narratives. Stemming from research on these identity groups, epidemiological narratives of risk co-produced identity. Rights claiming furthered the identity/risk narrative while group expertise rooted itself in knowing one's own identity/risk narrative.

   1. "Gay Rights Are Human Rights and Human Rights Are Gay Rights": (103) LGBT Identity/Risk Narrative

      Although women's rights activists made vast progress with regard to shifting reproductive paradigms away from population control, prior feminist advocacy largely failed to produce results with regard to sexual rights. LGBT activism set out to remedy the lack of focus on sexual rights and sexuality partly with the support of pro-sex feminists. (104) While it would be incorrect to suggest that all LGBT organizing at the international stage is rooted to HIV, LGBT organizing at the international level was catapulted forward by HIV.

      A major victory for a sexual orientation-specific human rights campaign was the decision Toonen v. Australia in the Human Rights Committee of the International Covenant on Civil and Political Rights (ICCPR). Nicholas Toonen was a gay HIV activist and the "leading member" of the Tasmanian Gay Law Reform Group (TGLRG) who was challenging Sections 122(a) and (c) and 123 of the Tasmanian Criminal Code, which "criminalized various forms of sexual contacts between men." (105) In Toonen, the Human Rights Committee of the International Covenant on Civil and Political Rights, acknowledging a broad range of international and domestic actors' concerns for "gay and lesbian rights," found that the Tasmanian statute criminalizing sexual contact was in fact a violation of several articles of the ICCPR, including the right to privacy. (106) Most importantly, the Toonen decision validated the idea that "sexual orientation" was a category that was subsumed in "other status" under Article 26 for the purposes of the covenant. (107) HIV played an important role in the outcome of the decision and arguments presented to the Committee. Tasmania argued that the sodomy laws were in place to prevent HIV and offered public health arguments to suggest that sodomy laws drove individuals to the risk of infection underground. (108)

      Inclusion into "other status" became a minoritizing politics of difference: it stabilized the idea of LGBT by attempting to claim an LGBT-specific identity and injury. (109) This had a broad ripple effect. First, it began a trajectory of rights claiming on the basis of sexual orientation that was distinct from efforts done on the grounds of the sex-stabilized category of women. Second, Toonen forwarded the idea that there was a group of individuals that fit neatly into "LGBT" in the context of human rights. Third, in participating in this new international legal identity of the LGBT person, LGBT groups began to move away from queer understandings of sexuality that were both challenging the universality of the gay identity and seeking to resist identity politics. (110) A similar set of questions arose in LGBT advocacy as had in earlier feminist activism: Was there a gay universal? Is LGBT a stable identity? Were the newly protected category of "sexual orientation" fluid, where would boundaries be demarcated? Or, like the problem of woman=gender, were we going to see an exclusion of "gender outlaws" from normative LGBT organizing? (111) The liberal international mode of lawmaking seemed to be producing the need for these injured identities but was simultaneously resistant to complexity. The committee for the CEDAW was the most resistant to a more complicated understanding of gender, consistently returning to the idea that gender and woman are synonymous. (112) Gay men were, in Cossman's terms, "gender outlaws."

      Epidemiology furthered tensions in analytic and identity-based modes of understanding sex and gender. Biological differences between men and Women produced difference narratives between women and gay men. This is illustrated in a 1995 publication of the Royal Tropical Institute, South Africa AIDS Dissemination Service, and the World Health Organization in which a section titled "Physiological Vulnerability" describes the vulnerability of women and men to HIV:

      Researchers estimate that women's risk of HIV infection from unprotected sex is at least twice that of men. Semen, which has high concentrations of virus, remains in the vaginal canal a relatively long time. Women are more exposed through the extensive surface area of mucous membrane in the vagina and on the cervix through which the virus may pass. In men, the equivalent area is smaller, mainly the entrance to the urethra in a circumcised man plus, in an uncircumcised man, the delicate skin under the foreskin. (113) Biology, specifically the vulnerability of the vaginal wall and cervix, was the foundation for the construction of a narrative of women's vulnerability; patriarchy, men on the down low, (114) and violence against women were identified as core drivers of women's increasing numbers in HIV. (115) Feminists and HIV agencies branded this as the "feminization of HIV." Dominance feminist understandings of gender offered women's legal equality as the way out of HIV. A parallel move occurred for gay men whose international level activism stayed on course with what began in the United States. Like women, gay men grounded their identity struggle in biology: vulnerability to HIV began with anal sex and the vulnerability of the rectal lining. Heteronormativity produced stigma and discrimination against gay men that underpinned the ability of gay men to see HIV testing, information, education, and services.

      While gay rights organizations successfully foregrounded identity as a means of intervening in the HIV epidemic, both activists and epidemiologists noted the need to shift towards "acts" rather than identity. In 1994, public health scholars coined the term "Men Who Have Sex With Men" (MSM), a public health nomenclature for:

      [M]en who self-identify as gay, bisexual or the local equivalents, male-to-female transgender individuals and other men who regularly or occasionally have sex with men. The term MSM is used to refer to individuals born male who have sex with others who are biologically male, with the understanding of the possible conflation of very distinct groups (based on sexual orientation, gender identity and participation in sexual communities, age, social class, and culture). (116) In turn, while MSM was an attempt escape...