Book Description

After more than sixty years of political independence from British rule, there are still few historically grounded, critical and substantive analyses of the role of the Indian state vis-à-vis public health. Consequently, liberal views prevail that paint an image of India as a "soft," caring, democratic republic. To interrupt this dominant discourse, and in the spirit of theorizing from below, this dissertation interrogates the role of the post-colonial state in India with a special focus on HIV/AIDS. It examines the behaviour-centred "targeted intervention" program among the "high-risk groups" -- mainly "female sex workers," "injecting drug users," and "men who have sex with men" -- as a key component of AIDS policy in India. Citing concrete examples from the field, it demonstrates that although packaged as a community-based approach to "health promotion" and "empowerment," this program closely replicates the old colonial design of "governmentality" and "tropical thinking," i.e., seeking stability and order, surveillance, containment, sexual policing, stigmatization of marginalized communities, and bureaucratic control. It argues that these interventions fundamentally undermine or contradict universal values of citizensip and wlelfare rights. The work analyzes the globalization of risk categories and discourse based on biomedical and behavioural models and argues the need to pay attention to structural determinants of health, especially in a post-colonial "Third World" context. Drawing on concepts of structural violence and institutional ethnography with detailed ethnographic accounts from "high risk groups," it analyzes their structural realities as revealed by their stories of poverty, unequal power and gender relations, discrimination and violence, and experiences of injustice -- all determined by large-scale social forces, typically far beyond their control. Through narratives and case studies, it also shares the experiences and struggles of people living with HIV/AIDS and analyzes these accounts to further reveal the nature of the state, public policy and broader social relations in India. Utilizing textual analysis of a representative sample of televised AIDS advertising campaigns, it uncovers the ideological role of mass media. The overall goal of the study is to correct the neglect of core issues of history, poverty, inequality, gender and systemic injustice in discussion of HIV/AIDS in India.