The Ironies of Freedom: Sex, Culture, and Neoliberal Governance in Vietnam

4 Governing Passion: Consumers’ Choice and the Production of a Differentiated Citizenry in Public Medicine

CHAPTER 4 Governing Passion Consumers’ Choice and the Production of a Differentiated Citizenry in Public Medicine IN BOTH GOVERNMENT public health measures and sex education manuals ,theVietnamesegovernmentsincemarketizationdirectlyandindirectly promoted health practices that generate and supervise class and gender differentiated norms in sexual conduct linked to birth and disease control. On the one hand, public health measures targeting sex workersweremoreclinicalintheiremphasisondiagnostictestsandthe treatmentof disease.Ontheotherhand,middle-classurbanwomenwere invitedtoacquireknowledgeaboutsexandmedicinesothattheycould maketherightconsumeristchoicestosafeguardtheirhealthandbeauty. Despitethedifferenceinmeasurestargetingdifferentclassesof women, publichealthmeasuresstilldirectratherthancoerce,astheypositsome degree of autonomous agency on the part of the women involved. This disciplinary power differs from measures of policing and rehabilitating sex workers. SEX BY EXPERTS: THE SUPERVISION OF NORMS Throughoutthesecondhalf of the1990sandearly2000s,publichealth measures addressing the “social problem of prostitution” included (1) mandatorymedicalexamsandtestingforHIVandothersexuallytransmitted diseases (STDs) for women sex workers in rehabilitation camps and also programs to encourage testing among practicing sex workers andotherhigh-riskgroupssuchastheirclients;(2)STDtreatmentand birth control procedures at hospitals and clinics; and (3) sex education 94 effortsaimedatbirthanddiseasecontrolintheformof peereducation, counseling, the distribution of health pamphlets and condoms among sex workers and potential clients, sex education in school curriculum, and the promotion of sex education books. IndiscussingthesemeasuresIbuildonFoucault’sexplorationintothe supervision of norms in modern modes of power.1 Through observationandsurveillance ,professionalsliketeachers,doctors,psychologists, and social workers teach individuals how to habitually measure themselves against the norm.2 Professionals are trained to identify the norm in the distribution of traits and individuals, thus upholding what is normal.Professionalspromotebehavioralnormsinaccordancewithnormalityasdefinedbybodiesof knowledgelikemedicine,psychology,sociology ,andcriminology.Itisthroughthisnormativepowerof normality that experts and, by extension, governors can supervise the choices of individuals. Certain mechanisms of expert norm supervision are identifiable in governmentalinterventionmeasures.First,thecaptureof physicalbodies (extendingfromthoseof prostitutes,totheirclients,andtothewives andchildrenof suspectedandpotentialclients)inclinicalsettingswould allowpersonstobetested,monitored,judgedagainstthenorm,treated, and educated. Second, the clinical setting would highlight the health threat and make logical the extension of surveillance and education beyondtheclinicinoutreachprograms.Third,medicalknowledge,made popular in a variety of sex education manuals, would prescribe a new healthy way of living centering on sex and sexuality. With these supervision mechanisms in the intervention measures, governors and health professionalscouldprescribesexualpracticesandsexualityaccordingto the norms in medicine, but, far from being neutral, these would differentially reproduce class and gender practices. In short, since the 1990s these intervention measures have rendered comprehensible and persuasive , as well as concrete and habitual, certain models of class- and gender-specific sexual behavior through mechanisms of capturing the physical bodies of persons and teaching them how to take care of their health and the health of their family and nation. Governing Passion 95 SEX OUTSIDE THE HOME Medicalinterventioninprostitutionbeforeeconomicliberalizationwas limitedtoadministeringmedicinesforthesexuallytransmitteddiseases of prostitutes upon their entry into a camp where forced labor would reform them into good proletarian subjects. Prostitutes were simply removed from the population and treated. There, the problem would end because it was defined politically in terms of capitalism, imperialism , and the ancien regime’s political servitude, as discussed. Under the revolutionary regime, the private sexual acts of men and women simplycouldnotbeproblematizedwithinthegivenideologicalframework other than as personal corruption linked to a lingering past or to external contamination. Now, the government uses prostitution as an ongoing social problem to differentially address the health and sexual habits of segments of the entire population. Life, Death, and Prostitutes in the Nation’s Body A March 1995 article in the very popular Tuổi Trẻ, the news publication of the Ho Chi Minh City Youth Union, warns the population of the connection between prostitution and the peril of AIDS for the entire nation.3 The author cites statistics on projected HIV-positive cases in Vietnam by the year 2000, projected cases linked to prostitution , and interviews of physicians and other health professionals. “Clearly,” says the article, “prostitution is becoming a companion to AIDS, and the threat of AIDS exploding from prostitution as in Thailand is no longer a long way off.”4 Although the cited figure of 5.7 percent of HIV cases linked to prostitution does not seem all that high, the quoted interview with the physician from the city’s Health Bureau (belonging to the Ministry of Health) drives home the credibility of the prostitution threat.5 This “Dr. V. P.” describes the prostitution scenes, tells stories of practicing prostitutes who are HIV positive and whodonotusecondoms,andtracesthetransmissionlineintothegeneral population. Most striking is the following story: “Through heartto -heartconfessionsof anHIV-positiveprostitute,he[Dr.V. P.]looked 96 Part II. The Real and the True up one of her ‘guests at the village of play’ to counsel, and the doctor was shocked to see how happy and well-to-do this client’s family was. . . . Dr...