Viral Politics: Sex Worker Activism and HIV/AIDS Programs from Bangalore to Nairobi By Srigowri Vijayakumar A dissertation submitted in partial satisfaction of the requirements for the degree of Doctor of Philosophy in Sociology in the Graduate Division of the University of California, Berkeley Committee in charge: Professor Raka Ray, Chair Professor Peter B. Evans Professor Gillian P. Hart Professor Lawrence Cohen Spring 2016 Abstract Viral Politics: Sex Worker Activism and HIV/AIDS Programs from Bangalore to Nairobi By Srigowri Vijayakumar Doctor of Philosophy in Sociology University of California, Berkeley Professor Raka Ray, Chair This dissertation studies the international success story of India’s HIV/AIDS response and the activism of sex workers and sexual minorities that produced it. A number of recent ethnographies have turned their attention to the workings of state programs in middle-income countries (e.g. Baiocchi 2005; Sharma 2008; A. Gupta 2012; Auyero 2012), demonstrating both the micro-effects of state strategies for managing poverty on poor people and the ways in which state programs are produced outside the visible boundaries of “the state”—through NGOs and social movement organizations as well as transnational donors and research institutes. Yet, even as state programs are constituted through struggles over resources and representations within and outside the official agencies of the state, states also derive legitimacy from projecting themselves as cohesive rather than disaggregated, and as autonomous from society rather than anchored within it (Abrams 1988; Mitchell 1991b; Mitchell 1999; A. Gupta 2012). The representation of state programs as cohesive, pre-constituted, exportable “models” serves as a new way of consolidating state legitimacy within a global, hierarchical order of development “success.” However, this dissertation argues that the traveling policies disseminated through transnational expert communities are a selective codification of hard-fought struggles among institutions within the state, between the state and organizations, among organizations, and among groups within organizations over the aims and strategies of social policies and programs. These struggles shape what travels in traveling policies and what is left out. Drawing on over 150 in-depth interviews and a year of participant observation with sex workers involved in implementing policy in community-based organizations, NGOs, and activist groups, I show how the material and social conditions of men, women, and transgender women in sex work, mediated through community-based organizations, constituted the successful approaches to HIV prevention that were later, sometimes selectively, translated around the world. 1 Table of Contents List of Terms ...................................................................................................................................................... ii List of Tables ..................................................................................................................................................... iii List of Figures .................................................................................................................................................... iv Preface .................................................................................................................................................................. v Acknowledgments ............................................................................................................................................ xii Introduction ........................................................................................................................................................ 1 Chapter 1 ........................................................................................................................................................... 20 Chapter 2 ........................................................................................................................................................... 36 Chapter 3 ........................................................................................................................................................... 61 Chapter 4 ........................................................................................................................................................... 74 Chapter 5 ........................................................................................................................................................... 99 Chapter 6 ......................................................................................................................................................... 119 Conclusion ....................................................................................................................................................... 152 After AIDS ...................................................................................................................................................... 160 Bibliography .................................................................................................................................................... 163 i List of Terms Avahan The Gates Foundation India-wide program for HIV/AIDS control The Empowerment A pseudonym for an NGO working with sex workers and bar hostesses in Project Nairobi CBO Community-based organization, run by elected leadership from the community with which it works FSW Female sex worker Hijra A member of a traditional group of transgender or transsexual women with a distinct set of religious, cultural, social, economic, and familial relations HRG High-risk group IDU IV drug user ITPA Immoral Traffic (Prevention) Act, the section of Indian law that deals directly with prostitution and its regulation IPC Indian Penal Code, the section of Indian law that includes restrictions on the age of prostitutes as well as criminalizing sexual activity “against the order of nature” KHP Karnataka Health Partners [pseudonym], a state level trust held jointly by KSAPS and a Canadian university, responsible for managing Gates Foundation funds to Karnataka for HIV/AIDS KNASP Kenya National AIDS Strategic Plan, Kenya’s multi-year strategic plans for HIV/AIDS control Kothi A term most commonly used to designate male-born people who espouse some “effeminate” modes of talk and behavior and are largely sexually attracted to “masculine” men (panthis) KSAPS Karnataka State AIDS Prevention Society, a state-level government entity responsible for HIV/AIDS control in Karnataka Union A pseudonym for an unregistered trade union of men, women, and transgender women who do sex work in Karnataka that advocates for and provides basic social services to its members MSM Man who has sex with men NACC National AIDS Control Council, the Kenyan national-level government entity responsible for HIV/AIDS control and housed under the office of the President NACO National AIDS Control Organization, the Indian national-level government entity responsible for HIV/AIDS control NACP National AIDS Control Program, India’s multi-year strategic HIV/AIDS response plans NASCOP National AIDS and STI Control Program, the Kenyan national-level government entity responsible for HIV/AIDS control and housed under the Ministry of Health NGO Non-governmental organization Women’s Collective A pseudonym for a CBO of women in sex work The Clinic A pseudonym for an NGO and clinic working with sex workers in Nairobi Expert Group A pseudonym for an organization responsible for supporting NASCOP’s programs in targeted HIV prevention ii List of Tables Table 1. Outline of the Dissertation ............................................................................................................. 17 Table 2. Understandings of Sex Work and Related Policy Approaches .................................................. 21 Table 3. Three Phases of the National AIDS Control Program .............................................................. 32 Table 4. Shifts in Sonagachi Project Elements ............................................................................................ 44 Table 5. Budgetary Components of National AIDS Control Programs (Phases I-II) .......................... 64 Table 6. Budgetary Components of National AIDS Control Program (Phase III) ............................... 65 Table 7. Key Differences Between the Women's Collective and the Union .......................................... 76 Table 8. Background Data on Union and Women's Collective Members .............................................. 78 Table 9. Public Visibility and Experiences of Sex Work Among Union Members ............................. 100 Table 10. Background Data on Women, Men, and Transgender Women at the Union .................... 101 Table 11. Three Rounds of Kenyan HIV/AIDS Policy .......................................................................... 125 Table 12. Kenya National HIV/AIDS Strategic Plan, 2000-2005 ......................................................... 126 Table 13. Kenya National HIV/AIDS Strategic Plan, 2005/6-2009/10 .............................................. 126 Table 14. Kenya National HIV/AIDS Strategic Plan, 2009/10-2012/13 ............................................ 126 Table 15. Approaches to Sex Workers in National HIV/AIDS Policies in Five Countries with the Largest Numbers of People Living with HIV in 2012 ...................................................................