The bizarre outcome was that, within the space of a few months, the eradication of sex work had become a key focus of US foreign aid. Even the Republican, Christian-right crusade to deny the world’s women safe abortions had never been anywhere so concerted or so well funded. In place of the broad, empowering policies for the well-being of sex workers carefully developed by the United Nations, as well as the parallel global effort to tackle human trafficking through the recent UN treaty, the Bush administration was using its superpower might and financial billions to push a malign nostrum, acting as an imperial moral policeman in the fashion of Great Britain in its era of empire.
In April 2004, just a year into Bush’s discovery of AIDS as his global charitable cause, I testified against those destructive changes before the bipartisan US Congressional Human Rights Caucus. I was speaking in my personal capacity—I had just left UNICEF to join Yale University’s Center for Interdisciplinary Research on AIDS as a scholar in residence—and did not have to modulate my disapproval. “Official American support has recently become—to speak frankly—misdirected, unhelpful and indeed damaging,” I told them. “These positions have marred the US government’s reputation amongst Indian civil society, so much so that many leading people are loathe to be associated with official US assistance on HIV/AIDS.”
It was honest criticism. It would have been immeasurably harsher if I could have looked into the future and seen the full, disastrous extent of the harm the Bush administration’s policies would soon cause sex workers, gay men, drug users, and the many others who desperately needed help in protecting themselves from HIV.
NINETEEN
A WORLD WAR UNFOLDS
On January 1, 2005, I left New York City again, this time to move to Geneva. It was a wrenching decision. There was simply no other place where I had such a deep sense of belonging. But the world had changed seismically—it was no longer the optimistic place it had seemed at the new millennium. Just two months earlier, Bush and Dick Cheney had been reelected, something that sickened me to see. I wanted to be actively engaged in doing whatever I could to oppose Bush’s destructive policies. At the UNAIDS Secretariat in Geneva, I would be working closely with the long-standing executive director, Peter Piot, as a senior adviser and speechwriter, and that promised a level of engagement with global policy making on AIDS that I would not have if I stayed on at the Yale AIDS center.
And so, late in the afternoon of that New Year’s Day, I caught an overnight Swissair flight from JFK to Geneva. Lorca was tucked away in the hold of the plane. He had been characteristically trusting and uncomplaining when the airline handler had wheeled him away in his crate. But on the flight I spent a sleepless night worrying about him, my mind replaying the horror stories I had read about pets that died on long flights. On arriving in Geneva, I rushed to the area where he was to come out and minutes later he arrived, kicking up a shindy on seeing me, looking none the worse for his first plane ride. I was flooded with love for him and remembered Pablo Neruda’s lovely insight: “With a traveling companion the road is never long.”
I settled into a completely impractical attic apartment in the Pâquis. The ceiling came down sharply at unexpected places, the windows were set at an inconvenient slant, and a row of pillars divided the living room into two odd lengths. But it was airy and full of light, and I instantly felt at home. From one set of windows, I could glimpse the blue expanse of Lake Geneva and the snowy massif of Mont Blanc; from another set the magical column of the Jet d’Eau. The fluting song of blackbirds rose up from the unkempt garden below. The lake and its surrounding parks, dotted with magnificent Atlas cedars, were a short walk away, perfect for walks and swims with Lorca. I bought myself an old bicycle as well as a car so that I could get to the countryside on the weekends, resolved to embrace whatever good there was about this new life of mine to make up for losing New York City.
I came to love my neighborhood. It was on the unfashionable bank of the Rhône, an area of narrow lanes, graffiti-marred walls, and characterless modern buildings, worlds away from the monied primness of mainstream Geneva. Its invigorating, inclusive spirit reminded me of New York City, but it was an immeasurably safer, kinder environment. Young children played, unsupervised, on the streets or in the neighborhood parks. Late at night, single women nonchalantly walked through deserted streets.
All of Switzerland’s bohemians and immigrants seemed to have found refuge among the Pâquis’s cheap restaurants, down-market shops, and porn stores. Sex workers plied their trade with openness day and night, walking or carrying their toy-sized dogs, decked out in miniskirts and bright tops and chatting with neighbors. The local children and teenagers wandered past, paying them no mind. Near the train station, a drop-in center for injecting drug users had a stream of men and women going to and fro: there the cantonal government provided clean injection equipment as well as a fix for those who needed it. I was struck that none of the passersby avoided the center or the users, even the few who looked visibly ill or drawn. I had never seen anything like that before, not in India, the United Kingdom, or the United States—that peacefulness, safety, and respect for everyone. I longed to show Bush and his reactionary crew the Pâquis, so that they would realize that the problem did not lie in sex workers or in drug users but in their destructive war on prostitution and war on drugs.
I was swept up in work from the very day I began. In just a month, Piot was to give a plenary speech at the London School of Economics. He wanted to lay out the case that AIDS was an exceptional threat to humanity and demanded an exceptional first call on finances and public priorities. That speech would be the launching pad for a series of think pieces, in both speeches and policy articles, in which Piot would lay out his reflections on the pandemic—it would soon be a quarter century since the disease had first been recognized—and the global response.
I relished everything, including the daunting responsibility of divining another person’s views, tone, and declamation, about my first months at work. With its nondescript offices and informal dress code, the UNAIDS secretariat looked like a grassroots organization, and—just like the best of them—the commitment of its staff members was palpable. I greatly respected a number of my colleagues, several of whom I knew from my consulting assignments. Many had begun working on AIDS when it was still direly stigmatized. Several lived with HIV or had lost loved ones to the epidemic—among them women and men who had been pioneers in their countries when it came to confronting the persecution of people with HIV. Openly gay or lesbian staff held senior positions, still rarely if ever seen anywhere else across the United Nations.
I admired Piot for combining scientific skills with extensive experience in policy making, having led the secretariat since its founding in 1995. He had just begun his third and final five-year term. In 2005, he was an energetic fifty-six-year-old who cut a dashing figure in the dull world of international diplomacy. His finely tailored suits and geeky spectacles marked him out as a policy powerhouse, while his trademark “condom” ties advertised his iconoclasm.
I relished also the fact that the secretariat was the rare UN institution that had not fallen into irrelevance. I admired the things that it had helped achieve against all the odds—the advocacy that had won attention and funds from the world’s political leaders, the painstaking putting together of a knowledge base of what worked, the guidance that balanced the imperative of tackling HIV with that of protecting human rights, and the courageous advocacy for stigmatized groups and people with HIV. It was the only body that commanded the global legitimacy needed to halt the Bush administration’s destructive policies on HIV prevention, injection drug use, and sex work. I thought it could not but live up to that responsibility.
I was disillusioned with astonishing speed—not because of my colleagues but because of Piot’s abeyance of his leadership responsibilities as the Bush assault on global AIDS policies gathered strength.
In late April, four months after I started work, I read the penultimate dra
ft of a crucial prevention strategy that was coming up for negotiation in June before the UNAIDS governing board and wondered, astounded, if it was someone’s raw copy that had been sent around mistakenly. Global strategy frameworks and AIDS summit declarations from previous years—some of which I had helped prepare—had done far more forward-thinking work, even under fire from the Bush administration’s attack on their priorities, than what I saw in that draft. The vital role played by condoms in HIV prevention was minimized; so was the need for lifesaving adolescent sex education and sexual health services. There was hardly any mention of the fact that respecting the principles of human rights was key to HIV prevention. In short, every single thing the Bush administration opposed in HIV prevention, and more broadly concerning human rights, had been censored out of the draft prevention strategy.
Though puzzled, I did nothing. At the back of my mind was the thought that Piot would tear apart the draft when it reached him for review. Piot read every sentence of every important document, from talking points to major reports, giving detailed feedback in his precise handwriting—and, given their importance, the materials sent to the board were signed off by Piot himself. At a working lunch, when I diplomatically brought up the poor draft, he commented that the prevention strategy needed to be “more explicit and businesslike.”
I was flabbergasted to read the final version of the prevention strategy several weeks later, on the day it was sent off to the board members after Piot’s approval. It was even weaker than the April draft, the language carefully censored and key sections either deleted entirely or moved to where they would be less noticeable. If the April draft had reeked of self-censorship, this one stank of active collusion with the Bush administration’s AIDS team.
In the ten-thousand-word document, condoms were mentioned just three times in the body text. Previous global strategies had detailed recommendations running into several pages on the priority needed to be placed on key vulnerable populations—especially in prevention efforts. Inexcusably, this one reserved two woolly sentences for sex workers and drug users—an unmistakable rupture with the agreed direction of global, UN-led strategy ever since it had been laid out during Jonathan Mann’s time at the World Health Organization in the late 1980s.
No less astonishing, it gave even shorter shrift to human rights than the April draft had. There was no mystery to it: Bush was, by then, leading a full-scale assault on human rights and international laws that he found inconvenient, even challenging the application of the Geneva Conventions’ ban on torture to prisoners of war held in Abu Ghraib and Guantánamo.
Reading that strategy marked the end of my smooth working relationship with Piot. Then and later, I saw that Piot’s abdication of his leadership responsibilities was such that on every matter of ideological importance to the Bush administration—whether it was sex work, drug use, or abstinence-only education—he caved in rather than using diplomacy and confrontation to challenge the administration’s destructive views. Though we maintained an appearance of civility, the strain and the antagonism between us were evident to others in his office. Only my usefulness kept him from doing what he did to others who questioned him: shunting me off to a distant corner of the headquarters or to an unpleasant posting. A working solution was soon found by his deputy acting as intermediary between us, a process that kept interaction between Piot and me to a minimum.
The tense three-day board meeting in June, dominated by discussions over the prevention strategy, revealed just how far Piot had taken the secretariat from the long-established fundamentals of global policy on AIDS. Within hours of the meeting’s opening, the corridor talk was that many governments—including those of Canada, the United Kingdom, and quite a few major developing nations—were upset by the weakness of the draft strategy. Their representatives on the drafting committee were going to revise it together, an unprecedented occurrence in UNAIDS history. It amounted to a sharp rebuke of the secretariat, that its draft had fallen short of minimum standards.
The revised draft was enormously stronger, but even that last-minute salvage job could not meet the standards of earlier strategy documents. To bring it to that quality would have required trashing the secretariat draft entirely and writing a stronger one from scratch.
I made it a point to attend the session of the meeting at which the governing board tabled the prevention strategy. It left me with an overwhelming rush of depression—and gave me an insight into some of the factors that had allowed Piot to become so complicit with the Bush administration’s demands without being held to account by either progressive governments or activist groups.
Whereas I had seen the venue, the elegant main meeting hall of WHO headquarters, packed during the annual World Health Assembly discussions, today no more than a third of the five hundred seats were occupied, mainly by national delegations. A life-and-death debate was under way, and all we had was this almost empty hall and a civil, emotionless debate among bureaucrats and the sprinkling of NGO representatives. Was this the sum total of how much the world’s governments cared about a global crisis that had already killed more than 20 million people?
I sat through the entire session, even though the conclusion was known to everyone by now: the US delegation would not force a vote on the prevention strategy, given the vocal opposition it had faced from so many countries. A face-saving compromise was reached on the United States’ opposition to needle exchange programs for injecting drug users—that was to note, in the minutes of the board meeting, that the strategy did not require donor countries to fund “activities that are contrary to the donor’s national laws or policies.” But, all in all, even though the board process had kept the Bush administration from wreaking even more damage on HIV prevention policies, it had failed to do much more. UNAIDS, under Piot’s leadership, had failed the people who needed it most.
At any other point, I would have resigned, given the strength of my disagreements with Piot over fundamental matters. I forced myself to stay put. In part, I urged myself to be mature and to take stock of the fact that I had had disputes over matters of principle at every job I had ever had. I lectured myself that I needed to learn the compromised ways of bureaucrats now that I was in my forties. But the real thing that held me back was a matter of the heart.
Soon after arriving in Geneva, I had started dating a German man, Arndt, whom I had met the previous summer in New York City, introduced by a common friend. Arndt lived in Düsseldorf, and for several months we had a long-distance relationship during which, for all the stress of the situation, our affections strengthened. We were kindred souls on many counts. He loved dogs and particularly Lorca, so much so that I teased him that he dated me only because of Lorca. (For his part, my dog was shamelessly smitten with him.) He loved animals, trees, the lakes, and the mountains—and so the three of us spent every possible minute of our time outdoors. He did yoga and meditated and needed his solitude. He loved India. My initial apprehension about his being a decade younger faded, and I came to feel for him in ways that I had not with anyone since my relationship with Tandavan.
Arndt found a job and relocated to Geneva, so that, for the first time in over a decade, I had the joys of sharing a home with a lover, rushing home because he was there, eating potato chips while watching TV in bed, cuddling through the night (with Lorca taking up most of the bed), making love, being surprised on my birthday—all those seemingly innocuous things that are suffused with unforgettable sweetness when you’re in love. The three of us were a happy family. I did not want my disputes with Piot to ruin that happiness, so painfully absent from my life for so long until now.
Piot’s acquiescence to the Bush administration’s destructive positions on AIDS puzzled many observers.
For an article I was writing for Piot in the Economist’s “Viewpoint” section, I asked a handful of people to suggest issues that the article should tackle. Peter Gill, a former BBC journalist who was completing his book Body Count: How They Turned AIDS into a Catastrophe, on t
he leaders and institutions that were to blame for the tens of millions infected or dead, wrote back, “I cannot see how Peter and you can write the piece without wielding an iron-bar bluntness about the Vatican and condoms, the Americans on drugs, the Americans on prostitutes, the Americans on abstinence, the Americans on pretty well anything sensible in the prevention field! I keep being told how much the Americans admire your boss, and then these people scratch their heads a bit about why that should be!”
As the Bush onslaught against sex workers gathered force, incident after incident spotlighted Piot’s failure to challenge him. That gave me some insight into the deeper reasons for his failure, beyond the simple fact that the United States was by far UNAIDS’s largest donor.
In 2004, the US State Department put India on its “watch list,” one of the worst tiers in its unilateral annual ranking of nations according to their performance in combating human trafficking, especially that relating to sex trafficking. India’s new Congress-led government moved to placate the Bush administration. In May 2005, it proposed far-reaching amendments to the Immoral Traffic (Prevention) Act—the primary Indian law governing sex work and trafficking—that incorporated every point that the Bush administration was pushing globally. The amendments would transform the law from ambivalent, confused criminalization of sex work to outright, heavy-handed prohibition as in the United States.
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