Looking at the concept of risk from a cross-cultural perspective, the contributors challenge the Eurocentric frameworks within which notions of risk are more commonly considered. They argue that perceptions of danger, and sources of anxiety, are far more socially and culturally constructed – and far more contingent – than risk theorists generally admit. Topics covered include prostitutes in London; AIDS in Tanzania; the cease-fire in Northern Ireland; the volcanic eruptions in Montserrat; modernisation in Amazonia; and the BSE scare in Britain.
About the Author
Pat Caplan is Director of the Institute of Commonwealth Studies at the University of London.
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THE POLITICS OF RISK AMONG LONDON PROSTITUTES
Two views of risk currently compete for attention. The first is a 'new' kind of comparative risk: 'The centre of risk consciousness lies not in the present, but in the future. In the risk society, the past loses the power to determine the present. Its place is taken by the future, thus, something non-existent, invented, fictive as the 'cause' of current experience and action' (Beck, 1995, p. 34). The second type of risk is a long-established process of government and regulation through reference to risk.
James Meikle discusses contemporary risks in the Guardian (7 October 1998): the balance of risks over beef on the bone, banning unpasteurised milk and eating genetically modified foodstuffs is assessed alongside risk scales featuring the relative risks for an individual of death from travel, murder, suicide and smoking and the risks for a community of measles and oral contraceptives. This list is certainly bewildering. How can an immediate illness be compared with a possible untimely cancer in the future and how can environmental damage be compared with violence? The relevant context slips away so that risk becomes the sole link between issues that are not normally compared and remain, in many respects, incomparable. A scale is achieved through the introduction of a single standardised outcome such as 'years of life lost' to a person with a normal or typical lifespan. Risk, I suggest, is thus a measure like money that enables measurement and standardisation in all spheres of life and across otherwise incomparable processes (Simmel, 1990).
Some believe that the uncertainties and anxieties associated with unknown and often inconceivable risks are of such significance that we should consider ourselves to live in a risk society (Beck, 1995). As traditional mainstays of family and class disappear, we are forced to live reflexively, planning and deciding between half-glimpsed and imponderable futures. In this society of free choice, individual decisions and fictive futures, risk can be used to draw connections between virtually anything at all. At the same time, these connections can become trivial, almost nonsensical, as in the comment that the former Chief Medical Officer made about BSE the week after Meikle's analysis of risk was published in the Guardian. Sir Kenneth Calman explained that he had not meant that there was no risk when he told the nation that it was safe to eat beef! (Guardian, 12 October 1998).
This rhetoric of unconstrained comparison allows risks to be imagined easily and to be drawn on a global scale, in an apparently objective and dispassionate way. These characteristics make the hierarchy of risks imposed through government less obvious, less unpalatable and apparently less unfair, even though they may result in dramatic inequalities. A clearly unequal distribution of risk in the here and now, shown, for example, through patterns of longevity, can be downplayed in favour of a potential chemical or other hazard that would affect us all. In some accounts, risks cease to have any reality in the world 'out there' and are merely perceived or constructed through various forms of discourse.
This apparently 'new' kind of risk sometimes appears to be distinct from an older form of regulation, often described in terms of the tools of government and social control, particularly through Foucault's accounts of modern discipline and confinement over the past two hundred years: 'The dialogue about risk and justice tends to be conducted in two languages: traditional English rhetoric on behalf of regulation, and mathematical language on behalf of principles of free choice ...' (Douglas, 1986, p. 3). This form of risk is closely associated with medical expertise, as discussed in detail below with reference to ideas about the medicalisation of life (Illich, 1976).
It is unclear to many of us much of the time which risk is which, new or old, and how they interconnect, if in fact they do connect at all. In this chapter, I attempt to show that both these forms of risk are relevant to London sex workers: the one about unrestrained comparison and the other about government (and opposition). I show that the varying interconnections made between these two realms define a politics that is at once relevant to individual careers and to a general rights' movement.
BACKGROUND: THE PRAED STREET PROJECT
During my research with sex workers at various points during the past twelve years, I have had to deal with 'risk' as a key word in the field of infectious disease, particularly HIV, as well as prostitution. The term 'risk' becomes even more central when prostitution and disease are linked. As my initial research question concerned a common assumption that prostitutes would both acquire and transmit HIV, I had to address directly the questions that others asked about risk. Were sex workers at increased risk along with their clients or children and respectable society in general? Was this risk to be attributed to their generally feckless behaviour as individuals who, by definition, behaved irrationally or to the unfair advantage exercised by clients who were easily able to assert their own preferences in commercial exchanges? Was it state interference which made it impossible to work safely or, perhaps, pre-existing cultural categories that bore no relationship to actual life chances in society but meant that prostitutes would be blamed for the ills of the world, whatever they did?
As the above comments indicate, I was unsure how to include myself within this field of enquiry. In 1986, I began a research project with female sex workers in west London, based initially in the genitourinary medicine clinic at St Mary's Hospital. I had proposed a research project in response to early prejudices about so-called risk groups and AIDS. While gay men were ineluctably twinned with the epidemic in North America (initially known as Gay Related Immune Disorder (GRID) – see Oppenheimer, 1992), it was female (heterosexual) prostitutes who were associated with AIDS elsewhere. Early reports from East Africa suggested that over 80 per cent of prostitutes in Rwanda were infected with HIV (Van de Perre et al., 1984) while in Nairobi, tests showed an increase in the prevalence of infection among prostitutes from 4 per cent in 1981 to 61 per cent in 1985 (Piot et al., 1987). These early reports encouraged calls for regulation in the UK around the mid-1980s. In my proposal, I argued that regulation was misplaced until it was clear whether London prostitutes were at risk and whether they (consequently) posed a risk to others.
I soon began to work with Helen Ward, a clinician who later trained as an epidemiologist, and together we worked on various dimensions of the business, including HIV and other sexually transmitted infection (STI) risks among women participating in the research. Our research was based on a cohort of women and the research methodology combined structured interviews and conversations, clinical and laboratory examinations, fieldwork and other observational studies of working areas and other places, such as magistrates' courts.
The methods depended partly on site. A small study with sex workers had already been conducted at St Mary's Hospital (Barton et al., 1987) and we established specific clinic sessions for these and other women in 1986, which later became known as the Praed Street Project clinic. Helen Ward provided diagnosis, treatment, vaccination, health promotion and referrals; she also acted as a 'general practitioner'. After 1988, when she began a larger epidemiological study with research staff, we were able to spend more time than previously outside the clinic. Fieldwork included informal interviews and observation but contact was rarely maintained for more than a few months with women unless they also visited the project. We established a drop-in centre that gradually came to be used regularly by some women, particularly street and flat workers. While some women never visited the clinic or only went to 'the doctor' once they knew the project well, a larger number visited the clinic exclusively. In addition, we interviewed other people involved in the sex industry, concentrating particularly on clients (Day et al., 1993). My position helps to explain the difficulties I experienced in addressing the topic of risk. In brief, I seemed to align myself with a process of social control to which medical doctors have contributed so much in the delineation of an occupation, 'prostitution', and its regulation. Whilst nineteenth-century experts in the UK tended to equate prostitutes directly with disease, the health profession has drawn increasingly upon concepts of risk since the 1960s. Looking for risks through interview and examination, we in the Praed Street Project might simply reinforce the associations between sex work and disease – finding risks wherever we looked. As in other spheres of government, we might also operate with an unduly narrow notion of risk (for example, associated with purely negative outcomes) and a nonrelational one (focusing largely upon individual sex workers). As 'participants in this process of government', it is thus unclear whether we are the best people to comment upon it (Overs, 1994). In what follows, risk is explored from several disciplinary perspectives (anthropological, clinical and, later, epidemiological). I hope to make explicit the role that this concentration on risk might play in an account of sex work by focusing on politics, specifically the question broached by my initial research, that of regulation, an issue raised in Parliament and the media in the mid-1980s.
I hope to build upon the benefits of these research methods as well. Two are particularly important to this chapter. First, we did not collect words alone, but also made other observations. These unique longitudinal data allowed us to correlate ideas and behaviour, facts and values, the visible and the invisible: for example, we could relate infections with the values and activities that women reported. This allowed us to avoid different forms of reductionism associated with health and social sciences respectively. We were able to avoid reducing risk to its 'real' individual and bodily manifestations, associated especially with various medical perspectives on risk. Sometimes, the epidemiological measurement of risks 'out there' in people's bodies makes people look like the agents of their own misfortunes; certainly, this could be said of the reports of STI found in prostitutes or cancers found in smokers which 'blame the victim'. Likewise, we were able to avoid the view that risk is a veritable conjuring trick through which the governed can be better watched, controlled and marshalled, an approach associated especially with various social and historical perspectives on risk. Sometimes, the sociological analyses of the risks constructed through government and discourse over the longer term make the immediate and material lives of people irrelevant and therefore 'ignore the victim'. As I show below, risks may be real or imaginary, material or discursive as far as sex workers are concerned and, indeed, one of my central conclusions concerns the effort that sex workers continually deploy to 'read statistics against the grain' and differentiate the 'true' from the 'false'.
Second, the length of follow-up and the repeated interviewing enabled us to track career and life changes and to assess the validity and reliability of our data as we came to know each other. In what follows, the data derived through this method are central to the association I draw between a personal and a broader political platform associated with rights and with risks. I conclude that the two are closely twinned in the views of London sex workers. In particular, I suggest that 'risk' becomes a marker of sex workers' attempts to recover some agency through the transformation of risk into safety, civil rights, and career developments.
GOVERNING RISK: HIV, THE PROSTITUTE AND THE STATESMAN
Risks are measured statistically in governmental, medical and other expert systems of knowledge and interventions generally follow: 'It is evident that the statistics of this class [the prostitutes], if followed and made precise according to age, family condition, and movement will be found very useful to the statesman in determining the first motives for bad morals, the lifestyle, the probability of culpability, and the organization of surveillance' (Congrés international de statistique: programme de la sixième session, Florence 1867, p. 93, quoted in Hacking, 1990).
Nineteenth-century statistics were applied to 'other' classes, that is, the governed, and especially to the labouring, criminal, or colonised classes. Thus, les misérables included brigands, beggars, vagabonds, abandoned children and prostitutes (Hacking, 1990, p. 120). As many histories of nineteenth-century England show, these people were gradually institutionalised – confined in asylums, orphanages and the like, or encouraged to adopt more respectable behaviour and confine themselves inside the house, created in the image of a bourgeois home.
Statistics such as these have been considered alongside medical and legal developments in order to show how the very categories of 'prostitute' and 'risk' can be understood as exercises in social control. The creation of the contemporary 'professional' in sex work is a product of expertise. In several countries, this history has been analysed in terms of the wide-ranging imposition of risk by government upon whole classes of people. For example, Walkowitz (1980) has produced a particularly fine analysis of the Contagious Diseases Acts in some English garrison towns during the nineteenth century. Various legal measures and particularly those related to the control of disease were crucial to the application of 'bourgeois' ideals of respectability to poor women. Such women, as Corbin (1990) indicates, were forced then to approximate either to the respectable (confined at home) or to the unrespectable (plying their trades on the streets). Through this process, respectable (apparently safe) workers and families have been created in the modern era alongside professional (and apparently unsafe) sex workers.
The Contagious Diseases Acts of the 1860s and 1870s were applied to poor women who had combined sex work with the provision of food, drink, lodgings, agricultural work and so forth. These 'public women' could be forced to undergo well-publicised medical examinations for gonorrhoea and syphilis and they could be confined if infected. Those who provided them with lodgings could also be punished (and were increasingly penalised themselves after the repeal of the Contagious Diseases Acts in the 1880s). Through these measures, working-class women were progressively separated from their communities. Walkowitz suggests that this process of displacement also put prostitutes under the control of agents and protectors such as 'pimps' (Walkowitz, 1980).
Nineteenth-century reforms in the UK involved a process of discovery: what were the statistics that governed crime, disease or unrest and how then could the conditions under which those laws applied be changed? Many accounts of HIV risk today dwell upon continuities in government over the past 150 years and AIDS is commonly seen to have provided a golden opportunity for the further surveillance and regulation of certain categories of people. Thus, epidemiological knowledge today follows in the same statistical traditions. What is the world like: what are the risks of HIV, the dominant routes of transmission, where and in what classes of people? How can these be changed? As Hacking indicates, the 'governing classes' change the laws that apply to the 'governed'.
All in the cause of risk reduction, women who might be working as prostitutes have been locked up in many countries – from Sweden to India and the United States – and confined over a period of years, just as they were in the nineteenth century under contagious disease legislation. More benign interventions have continued to insist upon the mandatory testing of sex workers (Mak, 1996), to repatriate immigrants who might be working in the industry and to deny compensation for HIV infection to the 'undeserving', whilst rewarding the 'deserving', such as haemophiliacs who have been 'innocently' affected (Buckley, 1997). It has been assumed that sex workers will be at increased risk of infection and so it is thought that their regulation will lessen the risks, as if reservoirs of infection that might harbour malaria or other dangerous pathogens were being drained (Brandt, 1985; see also the title of D'Costa et al., 1975 noted above). HIV has provided an excuse to lynch and murder sex workers and to prosecute them for knowingly infecting their clients. Such risks and dangers are often compounded within a figure of an 'other' that combines prostitute, foreigner and drug user.
Excerpted from "Risk Revisited"
Copyright © 2000 Pat Caplan.
Excerpted by permission of Pluto Press.
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Table of Contents
1. Pat Caplan: Introduction: Risk Revisited
2. Sophie Day: The Politics of Risk among London Prostitutes
3. Janet Bujra: Risk and Trust: Unsafe Sex, Gender and AIDS in Tanzania
4. Alison Shaw: Conflicting Models of Risk: Clinical Genetics and British Pakistanis
5. Penny Vera-Sanso: Risk-talk: the Politics of Risk and its Representation
6. Paul Killworth: a Risky Cease-fire: British Infantry Soldiers and Northern Ireland
7. Jonathan Skinner: The Eruption of Chances Peak: Montserrat, and the Narrative C