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Eating Spring Rice

University of California Press

Introduction

PATTERN THREE: THE "NEW" ASIAN EPIDEMICS

Despite "the fact that AIDS had appeared simultaneously in disparate cultures and apparently unconnected places around the globe," by the late 1980s, the World Health Organization had carved up the world based on epidemiologic maps of HIV/AIDS (Patton 2002: xi-xii). The pattern of incidence associated with North America and Europe, where cases were concentrated among homosexual men and injection drug users, was called Pattern One. This was followed by African cases, which were initially found among heterosexuals who were noninjection drug users, and labeled Pattern Two. The World Health Organization now warns that Asian AIDS will be the next large epicenter for the pandemic. Epidemiological risk group categories of homosexuals, drug addicts, or heterosexual "sex workers" defined Patterns One and Two, but geography and time define Pattern Three. In moving beyond the narrow nomenclatures that "pattern thinking" leaves us with, the public health world has been slow to explore new infections that lie in countries such asChina, places outside the purview of the predominant focus on AIDS in Africa and North America. Yet Asian AIDS cases, predominantly driven by HIV in India, China, Thailand, Cambodia, and Vietnam, are placing Asia firmly on these global maps of disease.

Cindy Patton (2002) notes that pattern thinking emerged out of the Global Program on AIDS (GPA) and its early divisions of the world into six different administrative regions. Within these divisions, developing countries in Asia were strangely aligned with Japan and Australia. The World Health Organization's (WHO's) official story read: "Researchers believe that the virus was present in isolated population groups years before the epidemic began. Then the situation changed: people moved more often and traveled more; they settled in big cities; and lifestyles changed, including patterns of sexual behavior. It became easier for HIV to spread, through sexual intercourse and contaminated blood. As the virus spread, the isolated disease already existing became a new epidemic" (WHO 1989 in Patton 2002: 6061). As Patton so eloquently points out, this common tale meant there was a tension between the actual disease and its translocation. Confusing time and geography, it is a tale about a virus and a description of the particular bodies that might transmit it.

China is facing a revolution in massive population migration from its rural enclaves to its cosmopolitan centers. A mobile force of some 140 million people, roughly 10 percent of the population, migrate both within and across provinces from county towns to large cities such as Chengdu, Beijing, and Shanghai. This mobility has been both theoretically and empirically associated with a rise in urban poverty and crime, risky behaviors, epidemics in drug use and sexually transmitted infections, and now, HIV/AIDS. This book describes how diseases map onto certain places and people more readily than onto others and how HIV/AIDS becomes embedded in political and economic relations, embodied practices, and cultural imaginations. As a disease of postmodernity, HIV/AIDS becomes culturally inhabited at each site where it appears on the map. How representatives of the Chinese state first responded to the epidemic points toward what is particularly unique about the Chinese approach to infectious diseases and what is also shared globally and transnationally.

Yunnan Province was ground zero of the epidemic, where heroin users were first identified as infected in the late 1980s and early 1990s. However-and this is key to the China story-any analysis complicates the singular idea that it was only translocal bodies, and not also government neglect or state-condoned unsafe blood-banking practices, that dispersed Chinese HIV. Therefore, as a quiet and very deadly epidemic was emerging in Henan in the late 1980s and early 1990s in villages where officials were complicit in using local poor peasants as economic canon fodder in blood and plasma collection schemes, the epidemiological emphasis was still on the counties in rural minority Yunnan (Zhang Feng 2004; Chan 2001). Since the first AIDS case was reported in 1985, China has moved into second place for the fastest-growing epidemic in Asia, behind India, and had declared close to one million infections by the end of 2004 (Bloom et al. 2004; Micollier 2004a; Hunter 2005). In contrast, health experts estimate that at least one million poor farmers were infected in these "botched" blood-selling schemes in central China (Reuters 2005).

REMAPPING, RECONFIGURING, AND RETHINKING THE STUDY OF EPIDEMICS

One of the major goals of this book is to approach HIV/AIDS less in terms of a study of a bounded minority prefecture and more in terms of the circulation and movement of conceptualizations of the disease across various boundaries, boundaries that require different kinds of anthropological thinking and methods. This work is not a definitive ethnographic account of the nascent HIV/AIDS epidemic in Yunnan Province, but an investigation into what I call everyday AIDS practices. It begins in the early days of the Chinese epidemic before it was seen as a major public health problem. In the mid-1990s, HIV/AIDS in China was considered a minority problem; minority prefectures in Yunnan revealed the highest number of cases. However, beyond the racial dichotomy of white and nonwhite bodies-or in much of the world, white and black bodies-comes the more nuanced and regionally rooted issue of Han and non-Han bodies. Such ethnic distinctions differentiate an anthropology of epidemiology from cultural studies of disease, straight epidemiology, or a political economy of health. Toward these ends, my lines of inquiry throughout this book demonstrate that understanding transmission of HIV/AIDS requires attention simultaneously to the rise of science and public health in postreform China and to the stories of lives touched by public health in China's borderlands. In doing so, I focus on both the discursive and the material dimensions of the epidemic.

* * *

1985

At spring festival, preparing for a two-day train ride heading west, I sat on top of my backpack at Guilin train station. I joined the cacophony of hundreds of families yelling train numbers and mingled with peasants carrying shoulder poles, their goods swaddled like infants and tied at the two ends. Before arriving, we would travel by train, airplane, bus, and minivan to reach our destination of Xishuangbanna, the former Tai tributary kingdom of Sipsongpanna in Southwest China [see map 1]. I was part of a delegation of American and Chinese English teachers, colleagues from the Ministry of Mining and Metallurgy, departing for vacation following the end of our annual meeting. On a packed-dirt road in front of the state-run Xishuangbanna Hotel, known as the Banna Bingguan, sat a corner shop with one small bare lightbulb hanging down on an electric wire. The proprietor laughed when we asked, "Where is the Mekong?" He knew only the local name, the Lancang River. In the early morning hours in the town of Jinghong, the former Tai kingdom capital of Tsen Hung, we watched smoke rise from small cook fires at the local Buddhist temple. Young Tai boys performed their morning rituals dressed in the long saffron robes that mark their traineeship in Buddhism. With their chants we rose to greet the day. Over the next three days, our delegation traveled down roads that roamed between rubber trees and rice paddies through the tropical jungle. Greeting the wide expanse of the river, we followed the sounds of water flowing into the black night, where we heard crickets and saw twinkling stars in the sky. 1995 Ten years pass and Jinghong is no longer a sleepy town on the Lancang River. Hawkers yell, bicycle bells ring, cars race, and tourists wake to begin another day in the life of the city. Travelers discuss with their guides where to venture for the next few hours, and decisions are made before the stifling afternoon heat drives everyone indoors into the privacy of their air-conditioned hotel rooms. Motorcycles race past shops, hair salons, brothels, karaoke bars, the beer hall, the large department store, and the government buildings crowned by a single red star. The new national bird, the construction crane, dominates the Jinghong skyline as it does in every other Chinese city. Along with these cranes are numerous construction sites decorated with an intricate latticework of bamboo poles. Rather than tending their rice fields, Han migrant workers balance gracefully on these fragile slippery scaffoldings. Money and capital are the dreams and desires of the city in postreform China.

* * *

After a ten-year hiatus, in May 1995, I returned to China and to Yunnan Province in the southwest. This time I was no longer a teacher of English as a second language but a graduate student hoping to conduct field research in ground zero of the Chinese AIDS epidemic in Dehong Tai-Jingpo Nationality Autonomous Prefecture, in western Yunnan. I went to study why the Chinese public health literature ascribed high rates of the human immunodeficiency virus (HIV) that causes acquired immune deficiency syndrome (AIDS)-or in Chinese, aizibing-to the Tai minority in two counties in rural Yunnan. Even though Yunnan had 80 percent of the Chinese AIDS cases in 1995, on my first trip to Yunnan that year, I met few people that were HIV-positive, nor did anyone provide me with Tai prevalence rates for AIDS. What I did confront was a plethora of myths, rumors, stories, and educated guesses about why the Tai minority had high rates of HIV/AIDS. I left puzzled.

Dr. Wu, my initial contact at Kunming Medical Center in the Department of Traditional Chinese Medicine, showed me her before-and-after pictures of drug addicts incarcerated in a Ruili drug prison (in Dehong Tai-Jingpo Prefecture) whom she had treated for Kaposi's sarcoma with Chinese herbs. She, along with almost every tourist who passed through the small guesthouse where I was staying, insisted that HIV/AIDS was still a confinable disease in China. They repeated like a mantra that by containing the Tai in Dehong Tai-Jingpo and Sipsongpanna prefectures, China would not repeat the public health mistakes of neighboring Thailand. By contrast, Tai villagers just south of Jinghong scoffed at the notion that Han public health officials thought they had HIV/AIDS.

When, in November 1995, I arrived back in Kunming, the capital of Yunnan Province, for a yearlong research project, my sponsors at Yunnan University informed me I could not get permission to conduct research in Dehong Tai-Jingpo Prefecture, as it was a remote area of Yunnan and on such a politically sensitive topic. However, all was not lost; instead, my sponsors selected Jinghong, in Sipsongpanna Tai-Lüe Nationality Autonomous Prefecture, as an appropriate alternative field site due to its emergent sex tourism industry-an industry viewed by many doctors, bureaucrats, and officials in Kunming as symptomatic of Tai-Lüe cultural values. The underlying assumption was that the Tai are a loose and sexually uninhibited people (luanjiao) and that their sexual practices were leading to high rates of sexually transmitted infections (STIs) and now, HIV/AIDS. According to several individuals in the provincial medical community, my role, since I was a medical anthropologist and a former public health specialist in sexually transmitted infections, was to find the cultural clues that predisposed the Tai to risky sexual practices. However, these views of Sipsongpanna were not new.

In another, nineteenth-century world, William Clifton Dodd, an American Protestant missionary, described Sipsongpanna in 1838 as "a country of darkness, [as] dark as pockets, [a] darkness of ignorance, superstition, and sin" (Dodd 1923: 181). In the late 1950s, a group of ethnologists working for the Yunnan Provincial Communist Party as part of a nationwide social research project to document and catalogue China's ethnic groups, described the roads to Sipsongpanna as plagued by cerebral malaria and leprosy (Yin 1986). And now, more than forty years later, I describe the roads to Sipsongpanna as linked to sex tourism and the rise of this new infectious disease. While state socialism worked to eradicate sexually transmitted infections, market socialism and the post-1979 reforms have served as a catalyst for the re-emergence of illegal drug use and prostitution and exponential increases in STIs and AIDS (Fan 1990; Zheng Xiwan 1991; Wang N. 1991; Fox 1996; Cheng Hehe et al. 1996; Cheng Hehe, Zhang, Pan, Jia, et al. 2000).

One of the chief internists in Jinghong, working at the local Tai medical center, told me that she spent several afternoons trying to convince a Tai man that because of his HIV status, he could not possibly date, let alone marry. After reviewing my field notes from my first return trip to China, I realized that Dr. Wu's perceptions of the Chinese epidemic, while considered prejudiced and even AIDS-phobic by public health workers and AIDS activist communities in the West, had a certain logic to it. From the outset, a link between two subgroups of the Tai in two regions was assumed to account for the potentially high incidence across Yunnan: the Tai-Nüa were thought to be increasingly infected in Dehong Tai-Jingpo Prefecture because of China's heroin trade, and the Tai-Lüe were thought to be infected in Sipsongpanna due to China's newly emerging sex trade and political economic ties to Thailand.

This book is both an ethnographic account of an emerging epidemic and an attempt to understand the cultural and political complexities of that same epidemic in the prefectural capital of Jinghong in Sipsongpanna Autonomous Tai Minority Prefecture (Xishuangbanna Daizu Zizhizhou), near China's border with Laos and Burma (see map 2). Thus, I focus on AIDS less as a bounded, already emerging entity than as a series of everyday practices deployed by both government representatives and working people in Jinghong who reveal how the concept of HIV/AIDS is constantly being made and remade over time. Discourses, in order to remain active and alive, must be reiterated and performed, and I treat them here as active in constituting and making and remaking cultural, political, and public health landscapes. In thinking about modern pandemics, I consider both moral and geographic imaginaries, a world where culture maps onto place, and place onto people, and where tidy models of border partition thinking fueled much of the early public health policies toward containment of HIV/AIDS (see map 3).

This book thus adds to the emerging literature on the anthropology of epidemics by addressing the following questions: How does Sipsongpanna respond to the rise of an infectious disease often characterized as a "radio disease"-heard but not seen? In both Sipsongpanna and Menglian minority autonomous prefectures in Yunnan, how does a new infectious disease challenge fundamental cultural systems of sexuality, gender, and ethnic relations and present challenges for representatives of the state-the prefecture's anti-epidemic stations, public security bureaus, and international nongovernmental health organizations? How have epidemiological prejudice and ethnic stigmatization affected calculated policy decisions situated within transnational discourses on HIV/AIDS, which in turn affect local prevention practices (Taylor 1990; Schoepf 1992; Sobo 1993; Farmer, Connors, and Simmons 1996; Farmer 1999; Pigg 2002)? How are sexual entertainment workers implicated in these epidemiological profiles and prevention projects, and what kinds of transactional sex are they involved in, with whom, and why?

Traditional ethnography presupposes that an ethnographer conducts research in one country, most likely one place, and builds on that location for understanding the larger questions about trajectories of infection. However, infectious diseases by nature are mobile and multiply; to study them requires tracing their fault lines through various epicenters as well as through the people involved in controlling them. As the epicenter of the virus in rural Yunnan was not open to investigation when I began this research, I moved my focus to tracing the actions, thoughts, and discourses of people both directly and indirectly involved in HIV. I drew not only from multiple sites for this research-a wide ethnographic map that included research trips to three countries, China, Thailand, and Hong Kong (prior to 1997)-but also on many different people. These included physicians, government officials, police officers, public health workers, and the myriad of people working in Sipsongpanna-tourist experts, shopkeepers, entertainment industry workers, sex workers, Buddhist practitioners, Tai activists, and ordinary local citizens.

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Excerpted from Eating Spring Rice by Sandra Teresa Hyde Copyright © 2007 by The Regents of the University of California. Excerpted by permission.
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