"Organized by topic, [Global Sex] discusses AIDS, standards of sexual attractiveness, women's rights, child molestation, pornography, prostitution, transvestism, transgenderism, abortion, birth control, homosexuality, religious strictures around sex, and safe sex. . . . Altman demonstrates how global communications and rapidly changing political and economic boundaries are transforming how sexuality is treated around the world, and he offers a wealth of information about how human sexuality is evolving. . . . [T]his valuable resource is compelling and easy-to-read, accessible to anyone interested in how technology and the global economy are shaping the ways we think."
"Altman thoroughly analyzes the way globalization has influenced sex in various cultures around the world. He discusses the worldwide ramifications of various aspects of sexAIDS, beauty pageants, prostitution, abortion, sterilization programs, genital mutilation, and othersalways showing the complexities of the problems. . . . Most of all, Altman shows that sex and sexuality are not just personal and private matters but have much more to do with global politics and economics."
"Tracing the combined impact of telecommunications, faster air-travel and the Internet on sexual expression the world over, Altman historicizes sexual activity while exploring specific changes resulting from advances in technology. Covering such issues as the impact of prostitution and pornography on global economics, and how AIDS affects sexual practices, legislation and the commercialization of sex, he presents a gripping portrait of a world barely able to keep pacepsychologically, sociologically and theologicallywith enormous, rapid-fire changes. . . . Offering neither a dire warning nor a reason to rejoice (he sees 'the interconnectedness of the world [as] both a threat and an opportunity')his savvy, energetic book truly maintains a global perspective."
"Both sex and ideas about sexits pleasures and its dangersare being globalized along with everything else, and there could be no better guide to the new world of sex than Dennis Altman. His powerful intelligence and restless curiosity make Global Sex a fascinating readrequired, in fact, for anyone concerned about the common culture emerging from the process of globalization."
An excerpt from
AIDS, Sex, and Globalization
By overwhelming [Africa's] health and social services, by creating millions of orphans, and by decimating health workers and teachers, AIDS is causing social and economic crises which in turn threaten political stability. . . . This cocktail of disasters is a sure recipe for more conflict. And conflict, in turn, provides fertile ground for further infections.
By the beginning of this century the number of people infected with HIV was approaching 35 million, with infections increasing rapidly in much of Africa, south Asia, and the Caribbean. Responsible UN officials have compared AIDS to the great plagues of history, with some countries close to an adult infection rate of 25%, and the UN Population Division estimates that life expectancy is falling in twenty-nine African countries due to AIDS. By the turn of the century AIDS had become the number one cause of death in Africa, imposing a particularly heavy burden because it is most heavily concentrated among the most productive sectors of the population. In some ways the epidemic had become a metaphor for the potential struggle between life and death within sexuality at the beginning of the new millennium.
The politics of AIDS encompass its regulation through state and international organizations, the development of a vast range of community responses, the political economy of health, and widespread cultural manifestations. As Richard Parker wrote: "In little more than a decade the rapid spread of the international AIDS pandemic has profoundly changed the ways in which we live and understand the world. Never has a common, global problem so clearly drawn attention to the important differences that shape the experience of diverse cultures and societies. And nowhere is this more true than in relation to our understanding of human sexuality." AIDS has entered the global imaginary, using this term in Appadurai's sense of "a constructed landscape of collective aspirations. . .the imagination as a social practice."
The urgency of HIV/AIDS and the mobilization, interventions, and research generated by the epidemic introduced a new dimension to debates about sexuality. For moral conservatives AIDS seemed almost tailor-made as a rebuke to those who argued that it was possible to regard sex as recreation, and in many parts of the worldin Africa and the Caribbean as much as within the Catholic Church and the U.S. Senateit was argued that the only meaningful response to AIDS was abstinence, celibacy, or at best mutual monogamy. In KwaZulu-Natal (South Africa), King Goodwill Zwelithini has sought to restore a commitment to celibacy before marriage to help curb the spread of HIV, using the traditional "reed dance" to reemphasize the tradition. Even in Australia, generally agreed to have had one of the most progressive official responses to the epidemic anywhere, the first chair of the National Advisory Committee on AIDS, Ita Buttrose, gained considerable notoriety when she spoke of her own "radical celibacy." Buttrose was a strong supporter of widespread condom use and empowering gay community education, but she also typified a dominant attitude when she wrote: "Woodstock could never happen again after the arrival of AIDS. 'Free love' was now a dirty word [sic] because everyone knew it was not necessarily love or free. Indeed, it could come at a great cost. Free love had meant sex with anyone you chose, with no complications and no strings attached. The problem was, free love could not take account of someone's sexual pasthis or her history."
As we shall see, some gay men in particular opposed this view of the implications of the epidemic, but certainly the explosion of HIV from the early 1980s has changed both the discourses and practices of sexuality. As Mark Merlis, one of the most original contemporary gay writers, put it: "No one will ever go that way again, not even if the cure is found. Partly because we will never own our bodies again, as they did. We are vectors now, or vessels, sources of transmission; our bodies belong to the unseen."
AIDS fits the common understanding of "globalization" in a number of ways, including its epidemiology, the mobilization against its spread, and the dominance of certain discourses in the understandings of the epidemic. Note that I follow the accepted usage which increasingly conflates HIV (the virus which weakens the immune system) and AIDS (the medical condition which results from such weakening) despite the fact that there are significant differences in practice between the two. As Anthony Smith has pointed out: "While arguably they are simply cause and effect separated by a significant although variable period of time, they are in fact produced in two, largely distinct, cultural fields, the treatment of AIDS being mainlyalmost exclusivelywithin the purview of clinical biomedicine and the prevention of HIV infection being within the province of the social and behavioral sciences, although the ownership of HIV by these disciplines has been under sustained attack from biomedicine."
Reports of a new infectious and potentially fatal disease date from 1981, when young men were diagnosed as suffering from severe immune deficiency on both coasts of the United States. It is almost certain that some version of HIV/AIDS had long existed in Africa; unfortunately this claim has sometimes been read as racist, though it is no more than an attempt to understand the etiology of the disease. It is possible that HIV mutated in the recent past, so as to become far more harmful to humans, and its rapid spread in the past two decades is closely related to the forces of "development," and to global population movements. It is even possible that the spread of the virus resulted from experiments with a potential polio vaccine in the 1950s. It is probable that the virus was spread beyond its original home through urbanization and population shifts, and that its rapid dispersion across the world is closely related to the nature of a global economy. HIV followed the huge population movements of the contemporary world, whether these are truckers moving across Zaire and India, women taking up sex work as a means of survival as old communities and social order crumbled, men seeking work on the minefields of South Africa and Zimbabwe, or tourists (for example Americans in Haiti), refugees (Haitians fleeing to the United States), and soldiers (Cubans serving in Angola; UN troops in Cambodia or the former Yugoslavia) moving across national boundaries. To take one example almost at random, the early spread of HIV in Honduras, which has the highest AIDS figures in Central America, has been attributed to the interaction of prostitutes and American soldiers at the U.S. base at Comayagua. The involvement of armies from seven African countries in the civil strife at the end of the 1990s in the Congo seemed tailor-made for a rapid spread of HIV.
AIDS is both a product and a cause of globalization, linking the least developed and the most developed regions of the world. Despite attempts to close borders to its spread, as in the restrictions on entry of HIV-positive people applied by many countries, the spread of the virus made a mockery of national sovereignty. Speaking of the greater Mekong regionwhich straddles China, Burma, Thailand, and LaosDoug Porter has written: "The nexus of HIV transmission across this territory is a metaphor for the globalisation of investment, trade and cultural identity. Although the dominant realist tradition in international relations studies conceives national territorial spaces as homogenous and exclusive, what is referred to as the 'new global cultural economy' has to be seen as a complex, overlapping, disjunctive order, which cannot be adequately understood in terms of centre-periphery, inner-outer, state border models of the past."
The growing internationalization of trade in both sex and drugs has played a major role in the diffusion of HIV, and its rapid spread into almost every corner of the world. It has been argued that "patterns of use of illicit drugs are becoming globalized and 'standardized,'" leading to the rapid spread of HIV in countries in both Southeast Asia and South America where the U.S.-led "war on drugs" has meant injecting practices have partly replaced traditional opium smoking. The United Nations Drug Control Program estimates that the international trade in illegal drugs amounts to some $400 billion a year, and touches virtually every part of the world. We are used to hearing of the drug trade from Colombia and Burma, but other parts of the worldNigeria, ex-Soviet Central Asiaare also major exporters. In the same way injecting drugs, with the concomitant risks from shared needles, is a practice found in increasing numbers of countries and populations.
While it is often said that HIV is "spread through prostitution" (a formulation which repeats the usual demonization of the sex worker while ignoring the client), it is also true that fear of AIDS itself changes the nature of the international sex trade. It is well established that AIDS has played a role in increasing demand for younger, presumably uninfected, prostitutes, often from rural areas, which has meant an increased demand for young Burmese women in Thailand and Nepali girls in India, and so on. (There are estimates that nearly half the prostitutes in India are less than eighteen years old, and 20% less than fifteen.) Of course the demand for young girlsabove all virginsis an old tradition, and one which has long fueled a great deal of the trade in prostitution.
In some ways the very policies urged by international bodies and economic theorists to promote faster development have added to the conditions which make people vulnerable to HIV infection. There is now some literature which discusses the vexed relationship between HIV infection and development; one example I like to cite is the Thai-Lao Friendship Bridge across the Mekong, which was opened with some fanfare in 1994. By increasing traffic across the river the bridge has also increased the vulnerability of Laotians, particularly in the border city of Nong Khai, to infection. Similar connections have been established between globalization and the spread of cholera in the past twenty years. Lee and Dodgson speak of the adverse impacts of globalization on health systems in Latin America, including "increased national debt, rapid urbanisation, environmental degradation, inequitable access to health services, and reduced public expenditure on public health infrastructure. Cholera then arrived in 1991, spreading rapidly across the continent in an epidemic of 1.4 million cases and more than ten thousand deaths in nineteen countries." This account goes on to point to similar outbreaks in the former Soviet Union, linked to related conditions. Although the means of transmission are different, similar conditions of social dislocation, poverty, and the absence of health services mean HIV will spread much faster (other untreated sexually transmissible diseases increase susceptibility to infection). As Gita Sen points out: "Globalization itself, in the sense of unregulated privatization, [means] open season for pharmaceutical companies, health sector cutbacks, and a weakening of concern for health equity poses enormous barriers to the fledgling reproductive and sexual rights agenda"to which one might add the prevention of HIV and other sexually transmissible diseases.
There is an irony in the World Bank's putting increasing sums of money into AIDS work in countries such as Brazil and India where the Bank's own policies had helped weaken the health structures which might have helped prevent the spread of HIV. (One of the most telling examples of how structural adjustment affected the spread of AIDS is data from Kenya, which showed a steep drop in attendance at STI clinics after the World Bank enforced charges for such visits.) Moreover part of the impact of an epidemic linked to social and economic upheavals has been to effectively increase the vulnerability of women, who are more likely to be unable to protect themselves against infection, to carry a greater share of the burden of care for those who are sick, and to have less access themselves to treatments. Violence and rape (usually, but not exclusively, directed at women) are a major cause of HIV transmission which increases dramatically in situations of social and political dislocation. Yet in some countries women who ask their rapists to use condoms are deemed to have given consent.
The development of various international responses to HIV/AIDS forms part of the globalization of human welfare, one of the six "vectors" identified by Hopkins and Wallerstein in their discussion of the developing world system. The formation of the World Health Organization in 1948 could be seen as the beginnings of a so far very slow movement toward recognizing the need to establish certain basic standards of "health for all," a program of global preventive and primary care endorsed by the World Health Organization and UNICEF in 1978. Equally the international response has implications for the globalization of certain biomedical and sociobehavioral paradigms, which are often ignored in discussions of globalization. Global mobilization around the demands of a biomedical emergency has inevitably meant the further entrenchment of western concepts of disease, treatments, and the body. I happen to believe that the western rationalist view of AIDS as essentially caused through infection by a retrovirus is correct, but to recognize this as the basis for global programs is also to recognize that this further undermines other and different ways of viewing medicine and the body. In some societies there has been resistance to western conceptions of AIDS, often linked to the interests of traditional healers, but such resistance has been comparatively weak in the face of the homogenizing impact of global biomedical science. The frequent calls to involve traditional healers in HIV programs too often overlook the problem of integrating very different epistemological frameworks and understandings of illness.
The first significant international response to the new epidemic came in 1986 when the World Health Organization established the Global Program on AIDS (GPA), based in its Geneva headquarters. GPA can be seen as having had three clear achievements: the establishment of an international discourse about HIV/AIDS which stressed the language of empowerment and participation; technical support for a number of developing countries in a range of policy and program areas; and mobilization of donor countries to support a multilateral response to the epidemic. A decade later GPA was replaced by a broader response through the creation of UNAIDS, a joint and cosponsored program of seven major UN agencies under the aegis of the Economic and Social Council.
For the purposes of this book most significant is the impact of the epidemic on regimes of sex and gender. Different cultural understandings of the meanings humans give to their bodies are constantly being challenged and remade by the impact of particular western notions, imported via economic, cultural, and professional influences; the AIDS epidemic has created "experts" who in turn influence perceptions of sex and gender through HIV education and prevention programs. Such programs further the diffusion of a particular language around sexuality and sexual identities which depend upon particular, largely western, assumptions. As Carol Jenkins has pointed out: "Conceiving of a sexual domain which requires taxonomic efforts is rather new, and decidedly Western. The traditional peoples of Papua New Guinea generally did not have specific terms to designate one type of sexual orientation as opposed to another, although a term suggestive of an altered gender identity can be found in at least a few of the nation's 868 or more languages."
Programs around HIV/AIDS have often made use of identities such as "sex worker" or "gay/bisexual men"/"men who have sex with men," and thus play a part in the further globalization of movements based on such identities. (Ironically the term "men who have sex with men" was coined to reach men who rejected any sense of identity based upon their sexual practices, but fairly quickly became used in ways which just repeated the old confusions between behavior and identity.) Most interesting perhaps is the growth of the concept of the "person living with HIV/AIDS" (PLWHA). The creation of the "person with AIDS" as a specific identity clearly drew on earlier gay models of "coming out" and has been a significant factor in breaking down the medical dominance of the epidemic. While there is some disquiet about the relevance of this model in nonwestern societiesI have heard Africans argue that to emphasize positive identity leads to divisions within families and communitiesit is a term which has been taken up in most of the official responses to the epidemic and was given international status at the 1994 Paris summit when the governments present committed themselves to "the greater involvement of People with AIDS." It is also an identity which carries grave risks when it is asserted; as one Israeli PLWHA put it: "I understood that people would kill me before the virus [did]." There are cases of people identified as HIV-positive being beaten and killed in a number of countries, the best-known example being that of Gugu Dlamini, who was killed for "bringing shame" on her community after coming out as positive in a South African campaign in 1998 to increase acceptance and disclosure of PLWHAs. It has been claimed that her slaying was part of a contemporary witch-hunting, with HIV serving as the new marker for witchcraft.
Even while recognizing the diversity of sexualities, and the fact that for most people behavior does not necessarily match neat categories, there is a gradual shift toward conceptualizing sexuality as a central basis for identity in most parts of the world in which HIV programs have played a significant role. The next chapter takes up some of the problems inherent in the export of western classifications of sexuality into other cultures. For the moment let me note the close connection between the surveillance and prevention strategies associated with HIV/AIDS and the rapid growth of certain sorts of identity politics in many parts of the world. To quote from one example, a report from Proyecto Girasol, an HIV-prevention program in El Salvador: "When the work started in 1994, few people imagined that this kind of organizing would be accepted or could have an impact. But the space was opened and defended with organization and visibility, and the project built self-esteem within the sex-workers and gay community, 'changing their self-destructive image into a constructive one.' For the first time a positive self-identified gay community was established in El Salvador."
Allowing for the inevitable self-promotion of such a report, it does however point to something which has been remarked upon across the world over the past ten years, namely the development of a sense of identity and assertion among people who come together through a common sexuality or (as in the case of sex workers) a shared relationship to the economy of sex. This does not deny that such developments can be read as either emancipatory or neocolonial; for the moment I am concerned only to recognize these changes.
But AIDS has also changed and broadened sexual experiences. In many societies more open discussion of sex is itself an enormously significant change. It is common to hear HIV workers from African, Asian, or Pacific countries explain the changes in social expectations which are required to even broach the discussion of sexual behavior. Ignorance about basic sexual and reproductive possibilities remains a huge obstacle to safe behavior in probably most parts of the world. Beyond this, the range of preventive programs brought into existence by the threat of the epidemic has meant, at least in some limited arenas, that there have been real changes in behavior. The ongoing campaign to incorporate condoms into sexual intercourse has forced a new awareness of and discussion about sexuality, and in turn produced other change in sexual practices, with examples ranging from a new interest in massage and "nonpenetrative" sex in the rich world, to discussions in parts of Africa about the risks of "dry sex" practices (the use of herbs etc. to dry the vagina before or during intercourse). Reports from the meetings of the Society for Women and AIDS in Africa show a high degree of concern and interest in changing sexual norms and behaviors to better empower women in the face of sexually transmitted diseases. In Uganda and possibly other African countries, the imperatives of HIV prevention have led to a critical appraisal of the practice of polygamy, and in late 1999 President Moi of Kenya spoke of raising the minimum age for marriage from fourteen to eighteenwhile still refusing to promote condom use. Probably the most successful example of behavioral change came through the "100% condom" campaign in Thailand, whereby the government distributed millions of condoms to all sex venues, encouraging the use of the slogan "No condom, no refund, no service." There is some evidence that the economic slump at the end of the 1990s partly undermined this program.
The use of condoms is part of a wider revolution in sexual mores, one linked to the idea that it is possible to maintain sexual pleasure and adventure, while preventing the transmission of disease. Gay communities in various countries invented the term "safe(r) sex," which first appeared in literature produced by gay AIDS-prevention groups in San Francisco and Houston in 1982. These were quickly followed by similar groups across the western worldearly in the epidemic the new messages were dramatized through groups such as the Safe Sex Sluts in Melbourne and the Safe Sex Corps in Toronto. Similar messages are now being disseminated through prevention programs targeting a broader public across the world, often through imaginative use of theater, puppetry, and cartoons. Equally it was the threat of HIV which ended taboos on advertising condoms on television in countries such as Australia and France, if not yet the United States. In other countries, such as Mexico and the Philippines, condom advertising has been a bitterly contested issue, bringing church and state into direct conflict. (In Mexico the police have used laws prohibiting "offenses against public morality" to prevent AIDS education efforts, although condom promotion is now fairly widespread.) Condoms are now regularly used in pornographic films, thus normalizing and perhaps eroticizing them.
The general belief in the first years of the epidemic was that AIDS would mean a new conservatism in matters sexual. Bisexual chic was replaced by a new discourse of monogamy, and for a few years there was a quite serious belief that many men would relinquish homosexual sex; in a 1987 short story Brendan Lemon wrote: "Somewhere toward the end of the AIDS decade Paul decided to go straight." This shift was described by Linda Singer as "a move from an inflationary economy of optimism toward an economy of erotic recession or stagflation." Frank Mort quotes an unnamed writer in the British magazine Arena in 1987: "In the wake of AIDS hysteria bachelors are doing it for themselves...one suspects that more and more are coming out [as masturbators]." The best example of Mort's point is the growth within gay communities of jerk-off parties, attempts to combine the celebration of male sexuality with rigid restrictions on any "exchange of bodily fluids." From the late 1980s on such parties became common in many western cities, and commercial J/O venues were established in cities (e.g., New York and San Francisco) whose authorities had closed gay bathhouses. For a time it seemed as if the J/O parties organized by Santé et Plaisir Gai were the only form of prevention activities in the Paris gay world. Early in the epidemic there was discussion among some feminists of the possibilities for developing equivalent forms of nonpenetrative heterosexual sex, but this discussion seemed to have largely disappeared, although the threat of HIV has led to more open discussion of masturbation not only in the west but also as part of HIV prevention in countries such as Uganda.
During the past decade it has become clear that the changes brought about by HIV/AIDS are more nuanced than early predictions suggested. While condom use has certainly increased, evidence from most western countries indicates that this has not been accompanied by major reductions in partners or frequency. Indeed in some cases the late 1990s have seen something of a return to the celebration of sexual adventure linked to the seventies, either through the nostalgic revival of seventies disco music or in mixed sex clubs which seemed to be opening with some frequency in major cities, sometimes allowing, as has long been the case for gay clubs, for consu[ma][p]tion on the spot. (While discos may represent nostalgia in the west, for many in poorer countries they represent both modernity and cosmopolitanism, opening up space for experimentation in both self-presentation and sexuality.)
Nonetheless it is likely that AIDS has transformed the ways in which we understand sex, linking it once again to concepts of danger, disease, and death. I say "once again" because the idea of sex as threatening as much as pleasurable has probably been the dominant experience of most women through history; only with the advent of relatively safe and effective contraception, and the ability to cure venereal diseases, could sex be decoupled from danger. This was the real meaning of the "sexual revolution" of the 1960s, and the advent of AIDS has undermined it to some extent, if not to the extent that conservatives might hope.
In countries where the major spread of HIV is through heterosexual intercoursemeaning the great majority of the poor worldthe conflict between risk of infection and the desire for children poses the greatest challenge to sexual mores. "Safe(r) sex" is far easier when reproduction is not an issue, even more so when it can be combined with prevention of pregnancy. But in many societies women's worth is measured by their fertility, and HIV poses a life-threatening dilemma between risking pregnancy and denying the strongest social expectations of women. Thus Molara Ogundipe-Leslie noted of Nigeria that "[a] childless woman is considered a monstrosityas is an unmarried woman (spinster or divorcee) who becomes the butt of jokes and scandal and the quarry of every passing man, married or not." Certain traditional practicesin some African societies a widow is expected to become a second wife to her husband's brothercan compound the dilemma if either one is HIV-positive. While it is increasingly possible to minimize the risk of infection from mother to baby, the resources required are often not available, and the consequence is a growing number of orphans, many of them HIV-positive. (In Zambia it is estimated that half the country's children have lost at least one parent to AIDS.) In Zimbabwe some women's organizations argue that the obligation on doctors and counselors to protect confidentiality further disempowers women and confirms existing sexual inequalities. Among Zimbabweans aged less than twenty more than 80% of those infected are women.