Sex, Disease, and Society: A Comparative History of Sexually Transmitted Diseases and HIV/AIDS in Asia and the Pacific (review)

The advent of AIDS as a new and threatening syndrome in the early 1980s led to a revival of interest in epidemics and plague in past history. The present offered no template for dealing with AIDS—so perhaps the past could provide one. The history of sexually transmitted disease also came into this “lesson of history” frame, and historians pointed to the apparent successes achieved by voluntaristic rather than punitive systems of control.

Much of the history of sexually transmitted diseases (STDs) was British and American. The journal Genitourinary Medicine, however, published a series of articles covering the history of responses to STDs over a wider geographic area. Milton Lewis, the editor of that series, has now collaborated with others in bringing revised versions of those papers, together with additional country surveys, into a volume that covers Asia and the Pacific. Future volumes in this new series will cover Africa, Europe, and Latin America. The collection seeks to develop internal country histories of responses to STDs from which some cross-national comparisons can be drawn. The aim is to see what common influences have been brought to bear, and also what is different in different national cultures. The countries surveyed here range from India (by David Arnold) to China, Papua New Guinea, and Australia. Japan is unfortunately absent. Inevitably, within that framework, authors have interpreted their task differently—but most cover what Arnold calls “historical epidemiology”: the patterns of STDs over time, patterns of control, the advent of AIDS, treatment and service issues, and social and cultural concerns.

In an overview chapter, the editors lay stress on a number of common factors that appear to have shaped individual country responses. These range from colonialism, urbanization, economic growth, labor migration, gender and economic inequality, sexual morality, and religion to war, border issues, nationalism, and the economic and political barriers to effective health services.

This is a framework that combines broader historical and structural factors with concerns derived from present-day service planning. The editors pay less attention to an issue made much of in the early days of the response to AIDS—that is, the tension between punitive and voluntary responses to STDs that have marked legislative and service reactions. Several of the studies address this issue. Some of the national studies show that versions of the British Contagious Diseases Acts—so controversial in the mother country for their punitive approach, based on the double standard of morality—were also introduced in the British colonies. But they operated within systems of control that were country-specific. In Hong Kong, for example, as Kerrie MacPherson’s excellent chapter tells us, brothels continued to be registered after the repeal of the Acts, and controlled prostitution remained the cornerstone of government policy until 1934. Colonial administrations were prepared to countenance systems of control that would have been unacceptable at home. This pattern parallels the local systems of opium availability that were also operated, or condoned, by colonial powers.

Some interesting divergences emerge. Milton Lewis’s chapter on Australia shows that, whereas England opted for a voluntaristic venereal disease control system after the First World War, Australia had compulsory notification and treatment. He offers no explanation of why this was the case—nor of when compulsion ceased. This pattern of response is more akin to the compulsionist tradition apparent in Scotland on which Roger Davidson has written recently.

Forms of control varied—but the story in all these countries culminates in the advent of AIDS. In Thailand, the epidemic’s spread was associated with official promotion of the country as a location for sex tourism; in the Philippines, the issue was the possible spread of the syndrome from U.S. servicemen. Australia conformed to the Western pattern of initial homosexual spread; there, the authoritarian tradition...