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Congrès mondial du sida | Dérive culturaliste | Double Peine | Luttes de l’immigration et contre le racisme | Malades étrangers | Politiques de santé | Reda Sadki

AIDS 98 : What AIDS social research can learn from Third World struggles for AIDS justice in Fortress Europe

22 juillet 2012 (

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This talk was delivered by Reda Sadki, invited speaker of the Track C Symposium on "Migration and HIV" at the World AIDS Conference AIDS 98 in Geneva, Switzerland in July 1998.

Plenary session chaired by Mary Haour-Knipe

Ladies and Gentlemen, I will begin by reading a resolution adopted by the doctors of the Federation of Academies of Medicines of the European Union at its 1996 meeting on the « pathology of immigration ».

« We wish to draw attention to the risks presented by immigration, and especially clandestine immigration, by bringing and propagating certain diseases, the most serious of which are tuberculosis, hepatitis B and C, and sexually transmitted diseases, including AIDS, the frequency of which is becoming menacing in the countries of the European Union »

Third World people settled in Europe have long been seen as an international carrier of disease. Statements like this one can be deadlier than HIV.

There is little doubt that liberal research on migration and HIV has been driven, both explicitly and implicitly, by the concern to respond to racist ideology and practice in public health.

This talk will argue that liberal AIDS social research on « migration and HIV » is being transformed by a small but growing group of researchers who believe that current approaches lack the analytical tools and methods to build powerful responses to the equation of Third World people with disease. Some of us are doing work in the trenches of AIDS political organising. Many see our research as a contribution to political AIDS work. We believe that theory ­ how we make sense of the world around us — must be brought face to face with political reality.

We need fresh eyes to look at immigration rights issues, not simply to interpret them but, rather, to transform the epistemology — how we know what we know ­ of research on migration and HIV.

The first step is to ask « who or what is a migrant ? » Elaborate technical classification systems have been invented to answer this. This positivist tendency has reduced the term to an abstract « umbrella category » in which all meaningful political distinctions ­ of race, social class, gender, geography, and so on ­ are collapsed. First, we must unpack and dismantle a category which spans social groupings with drastically different power and access to resources ­ from settled Third World comunities across the continents of the North to refugees in the South to encompass evenŠ international civil servants and tourists.

Then, we must put « history » back into the term. We must historicize migration. We need a materialist history, not a trip down memory lane.

Although African people living in Belgium and France and Œpeople of color¹ in the U.S. were among those recorded to die at the dawn of the AIDS epidemic, it wasn¹t until the late 1980s (and, in a few countries, until the mid 1990s) that organized (though dangerously underfunded) efforts at primary HIV prevention were launched by a loose coalition of well-meaning liberal public health specialists from the Netherlands, Switzerland, Germany and elsewhere. They worked with a small, hand-picked group of health workers of Œmigrant¹ background to develop both institutional approach and scientific framework to research and promote AIDS prevention in Œmigrant¹ communities while doing their best to minimize any challenge to the underlying inequality and discrimination faced by Œmigrants¹.

But this is not the whole story. As early as the mid-80s, work had also been done ‹ hidden from the gaze of mainstream public health ‹ to survive the epidemic in the poor inner cities, estates and banlieues of Europe¹s biggest cities ‹ whether in Paris, Marseille, London, BerlinŠ. Though undoubtedly limited in scope, grassroots education, mobilization for AIDS prevention, and better care for people facing AIDS came onto the agenda of lovers, friends, and families if not that of the communities themselves.

Our forefather and foremothers were not "migrants", they were Third World settlers from Asia, Africa, Latin America, and the Arab World. They were brought to Europe to meet the demand for cheap black labor to rebuild after World War II. The early AIDS organising is part of the broader history of Third World organising for racial equality and social justice in Fortress Europe. Our communities resisted on every front and declared that "Come what may, we¹re here to stay", or "J¹y suis, j¹y reste."

This is significant for at least third reasons. First, it highlights the fact that the health gap between the "white population" and the rest of us was there long before AIDS burst onto the scene. AIDS research must take into account the historic nature of this gap.

Second, the context for research must be our existence as peoples of the Third World diasporas. It poses the research question of whether there is any basis for unity or even collective action between the Third World communities facing AIDS in the North, and with our brothers and sisters in the South.

Third, we believe that this early history is in fact the missing half of the history of AIDS organising and research which have secured the rights and treatment of the white, middle-class minority minority of the North.

Armed with our histories and struggle, we are ready to look in the eye the harsh reality of AIDS.

In the United Kingdom, ground-breaking research by Chetan Bhatt asserted that Africans ‹ from both long- and recently-settled refugee communities ‹ are now the second largest group affected by HIV/AIDS in the UK. They probably make up about 28 percent of total HIV cases. Some surveys suggest a higher prevalence of HIV among African women than among gay men in London. Bhatt insists that "people from black refugee communities were among the first groups to be identified in the very early 1980s as suffering from what came to be known as AIDS."

By looking at the history, this researcher produced more accurate data and improved understanding of the nature of the HIV.

In France (where reporting Œethnicity¹ in statistics is outlawed) new cases of AIDS dropped last year by 42 %. But for the immigrant communities, the drop was only 21%, half of the overall figure . Though the histories of the epidemic in the long-settled (Black) African and Arab (North African) communities may be different, there are now comparable numbers of people living with AIDS from these communities.

This unique situation contradicts the underlying presumption of much AIDS social research on migration and HIV that the primary, or at least a major cause, of vulnerability to HIV is in an uncomplicatd or direct link to the AIDS crisis Œback home.¹

In the United States, while white gay men constituted the large majority of cases in the early days, by the early 1990s the rate of new cases Latinos and African-Americans, especially for women, had skyrocketed. By 1993, AIDS had become the leading cause of death among African Americans between the ages of 25 and 44.

In all these countries, Third World people living with HIV are, with worrying consistency, the last in line for testing as well as for care and medications. Unfortunately, forcing the acknowledgement of such bleak facts is hardly a victory.

Research must lay bare the urgency of the crisis in health care that Third World people settled in Fortress Europe or elsewhere in the rich North face.

Now I want to tell you a brief story. There is a clinic in a small town which dispenses free care. The doctors and nurses work on a volunteer basis. The people who come to this clinic are from the Third World. Many of the people come for AIDS care. Sometimes patients disappear without a trace.The principle is simple enough : if you need care, you will get it. No questions asked. However, the clinic cannot offer free medications, and its patients are too poor to pay for it. For them, there is no health insurance. Without this clinic, there would be no care.

This clinic is not located in the South. It is based in Brescia, Italy. It was started by two doctors, one Italian and the other Jordanian, who saw an increasing number of rd World people showing up at the hospital in Brescia with untreated ailments. Because they are undocumented ­ No One Is Illegal ­ they are denied free care through the Italian health insurance scheme.

Initially, the local municipality paid for at least some of the medication. But this was lost to budget cuts and the clinic tried but failed to argue eloquently against the cuts.

In 1993, a strange thing happened in the Arab neighborhood of Couronnes, in the French capital city of Paris. A free AIDS clinic opened, the Centre du Moulin Joly to provide white gay men a place, outside of the hospita, to go for confidential care. But the people who showed up at its doors soon revealed the reality of the centre¹s Arab neighborhood and the reality of AIDS : 80% of the people who turne up were young Arab and Antillean iv drug users facing HIV on the streets. Many of them had never been to a hospital before.

The demand for free access to the best available treatment and care, including combination therapy, is not a utopic one. There are free clinics like this all over Europe and probably all over the world that put this principle into practice every day, despite the enormous difficulties faced.

The concept of welfare has shifted from concern to coercion, from rights to duties. We are facing the consequences of the attack on the welfare state in the 1980s which zeroed in on the poorest and most disenfranchised people living in the rich countries of the North. The Pasqua Laws in France, the Koppelingswet law in the Netherlands the Vande Lanotte Act in Belgium accelerated the trend to total denial of care and treatment by writing the undocumented out of social security and health insurance schemes. No documents, no welfare, and welfare scroungers everywhere.

AIDS social research on migration must provide the arguments and analytical tools to against the government policies which have a disparate impact on survival ­ or, if you prefer, vulnerability to HIV — according to race, or immigration status.

AIDS social research will improve if researchers take a hard look at what is going on in the trenches of immigrant rights activism for AIDS justice in Fortress Europe.

Researchers like Bhatt, or, to cite just one other example, the new book "They Make You Sick", a series of essays on immigration controls and health, are part of the second wave of AIDS research on migration and HIV. This work has the potential to transform AIDS social research in an unpopular field - the very idea that immigrants have rights touches some very sensitive nerves in the political consciousness of the world today, much more so if they are living with HIV. This Second Wave must strive to become a servicing station for Third World communities to survive HIV, on their way to liberation from the systematic, structural domination in health care and immigration controls responsible for thousands of unnecessary AIDS deaths.

Deportation, for people facing HIV, is the last stop in a long chain from discrimination to denial of treatment. Deportation is torture. It is the negation of human rights. For Third World people facing HIV, deportation is a death sentence.

Let me tell you about Mister M., a Congolese man living with HIV.

The Swiss government wants to deport Mister M. In 1996 Mister M was sent to prison. HIV is not a crime, yet he was jailed by the unjust law which criminalises HIV transmission. Prison followed by deportation is a Double Punishment ­ no Swiss will ever face deportation.

Now hey have stated they will force him on the plane with a small suitcase with 12 months combination therapy. Recently, the government said publicly it will send him treatment indefinitely.

Mister M wants to stay. He has not been back to his home country of the Democratic Republic of Congo for 18 years. All of his ties are here, in Switzerland. He is very much part of this society ­ he has worked, lived, and even gone to jail here, like many other people.

We are fighting Mister M¹s deportation because he is telling us that the prospect of deportation is driving him mad.

Do we, as participants committed to "Bridging the Gap", have the political courage to take up what some say is an unpopular and difficult case ?

Some have said : but this is only one small (read : insignificant) case in the global AIDS equation. However, Mister M¹s case brings the theme of this Conference back to the on-the-ground reality of AIDS today. Well we need global AIDS research and activism to build on such insignificant individual cases, turning them into issues, issues into causes, and causes into a movement which will strengthen the rights of all people pushed to the front lines of the struggle against HIV today.

Allow me to invite you to discuss this case with members of the International Immigration rights and HIV working group, at 7:30 pm in Room F at Palexpo.

Thank you.