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ABSTRACT
This paper is an ethnographic account of people living with HIV/ AIDS (PLHIV) involved in a network of support and advocacy groups in post-socialist Lao PDR. Through negotiations with state, NGO and other local and transnational actors, these PLHIV seek access to medical treatment and social programs, de-stigmatization of their HIV- positive status and recognition of their human rights. They adopt and adapt activist identities and strategies to their unique local context in order to negotiate Lao cultural and political structures, using a set of tactics that shift between everyday forms of resistance and active dissent. The role of culture is conceptualized as both constrictive and productive, providing schemas that can be called upon or transposed in order to achieve a goal, thereby providing opportunities for strategic action. This paper then draws conclusions about the potential for an expanded civil society in Lao PDR.
Keywords: HIV/AIDS, Lao PDR, HIV support groups, Civil society, Social movements, Southeast Asia, Post-socialist politics
INTRODUCTION
Although Laos is considered a country of low prevalence, HIV/AIDS has nevertheless become a complex social, medical and political problem. This problem engages a diverse set of actors, including international humanitarian donors, state agen- cies, international non-governmental organizations, Lao people living with HIV/AIDs (PLHIV), local and international PLHIV support groups and the global bio-medical industry. These complex assemblages create HIV/AIDS as a site of unique bio- political relations in a contemporary, post-socialist context, shaped by both local cultural understandings and transnational social movements. It is a site of dissent and compliance, of bodily discipline and biological deviance, of the push toward develop- ment and the casualties of modernity, and of the global interconnections that allow ideas and social movements to transcend national boundaries.
Following other PLHIV world-wide, Lao people living with HIV/ AIDS have formed local commu- nity support groups and a national network, called the Lao Network of People Living with HIV/AIDS (LNP+), which links their support groups together. Globally, PLHIV support groups have provided space for PLHIV to discuss their illness and its treatment and to find support in their struggles. They have also ad- vocated for greater participation of PLHIV in their own treatment and care and for access to good quality and affordable medical care. In many examples worldwide, they are credited with lowering the costs of HIV/ AIDS medications and with changing social perceptions of PLHIV, there- by decreasing the disease’s stigma and improving the lives of PLHIV1. These AIDS activist organizations have become part of the landscape of civil society groups in many coun- tries worldwide, including in Thai- land, which is Laos' closest physical, cultural and linguistic neighbour.
In countries with socialist re-gimes, such as Laos, there is limited potential for civil society; if it is to exist at all, it must etch out space from pre-existing political structures. However, as Lyttleton points out, in Laos this has been “akin to scraping at a rock with a blunt instrument” (2008: 267). The state places con- siderable restrictions on civic associa- tion and monitors the establishment, membership, mandate and activities of all groups. The Lao “civil society” organizations I encountered during my research typically did not view themselves as struggling for autonomy from the state, even if they expressed frustration with state restrictions or bureaucracy; most continued to ex- press their relationship with the state in terms of cooperation. Active protest is rarely a goal for Lao groups, who generally see the kind of large-scale protests that occur in neighbouring Thailand as a sign of deep social dis- unity. After suffering through more than two decades of war in recent memory, Lao informants reported a preference for relative stability, rather than instigating political conflict.
With significant cultural lim- itations on discussing sexuality and publicly identifying as HIV-positive, and with these political restrictions on civic association, PLHIV in Laos face many barriers to raising their concerns over discrimination and the other social and medical problems they face. There is very little social and political space for them to form an identity-based coalition through which to advocate for rights and social inclusion. And yet, PLHIV in Laos are doing this very thing.
LNP+ must negotiate both the restrictive political environment in Laos and the Lao socio-cultur- al understandings of sexuality and HIV/AIDS. The group has been somewhat bolder and more politi- cized in its activities than other Lao non-profit associations (NPAs). Its objectives match those of other PLHIV groups in places like Thailand, such as improving access to treatment and care, advocating for PLHIV rights and reducing the stigma associated with HIV, but it is limited in its ability to advocate in the same ways. What, then, are the strategies they use to try to meet their objectives? How do they understand and negotiate within their relationships with the state and the international AIDS industry? How do they act to accomplish their goals, and what social phenomena do they produce in the process?
METHODOLOGY
This paper is based on ethnographic data acquired through research with PLHIV in Laos between 2009 and 2010. It is further informed by pre- vious fieldwork in Laos in 2004-2005. The practice of conducting ethno- graphic research involves observing people in their lives and communi- ties and attempting to pull apart the hidden logics behind their actions, to put together the whole picture of people’s social and conceptual uni- verse. Ethnography is an excellent method for researching activists, because it is capable of capturing the nuance and “messiness” so common in activist practices. This is particularly relevant for studying ways in which activists engage that are less visible, and social activity that may be more fluid or rapidly shifting. These types of interactions are often missed by macro-level analyses. The research for this project entailed participant observation at LNP+ support group meetings, in their Vientiane office on a daily basis, at strategic planning sessions, in staff meetings and during social occasions. It also included in-depth interviews with key informants, including LNP+ staff, volunteers and members, as well as doctors and representatives of inter- national NGOs and donors. During my stay, I contributed to LNP+’s work and made a place for myself in their community by editing fund- ing proposals, assisting with English translations and building a website for their network. My position as an outsider – a white Canadian woman studying at a Thai university – was in some ways beneficial to the research process, even as it provided cultural barriers to overcome, as it allowed me to access people and spaces that may be off-limits for most locals. For example, it was not difficult for me to make appointments to meet with project managers at the United Nations. My experience was also that as a white woman I was gendered differently than Lao women are, and I was accepted in spaces typically reserved for men.
RESULTS
HIV and development in Laos
With a relatively small population of 6.9 million, Laos has a low rate of HIV infection compared to neigh- bouring countries, with an adult pre- valence rate of 0.3% (UNDP, 2013). However, testing rates are also low, and most PLHIV do not discover that they are positive until they have been ill for some time, so the prevalence could in fact be higher than reported (USAID, 2010). International health authorities, such as USAID, consider Laos to be at risk for an epidemic, as infection rates are rising and social behaviours are changing. The state of health care in Laos is quite poor and largely dependent upon foreign aid. Hospitals in urban areas are substandard, and in rural areas clinics are either non-existent or under-staffed and lacking in basic medical supplies (Stuart-Fox, 2009: 157). Those who can afford to seek care elsewhere typically travel to Thai- land or another nearby country for medical procedures. HIV medications called anti-retrovirals (ARV), which can greatly improve the quality and length of life for PLHIV, are currently available at five clinics and three satel- lite locations around the country, but are still inaccessible for much of the mostly rural population. According to a 2013 UNDP report, only 55% of eligible PLHIV in Laos were taking ARV as of 2012; while the drugs are free, treatment for related illnesses are not, and the cost of regularly traveling to the nearest clinic is too expensive and time consuming for many (UNDP, 2013: 124).
The media coverage of HIV/AIDS is limited and what does exist is largely focused on monogamy and abstinence as prevention strategies. Members of the media report that they are restricted from running stories about sexuality, safer sex, prostitution and sexual health by the Ministry of In- formation and Culture (Khamkhong et al., 2005: 16-17) and do not want to be perceived as encouraging pro- miscuity or other immoral activities. Media discourse about HIV/AIDS therefore appeals to Lao national identity, promoting abstinence and monogamy as traditional Lao values (Khamkhong et al., 2005).
A consequence of this emphasis on monogamy as a traditional Lao value is that it affirms PLHIV as having questionable morality and engaging in un-Lao behaviour. Many PLHIV do not disclose their HIV- positive status, but those who do often face social exclusion of some form. Lack of knowledge about the disease and the association of the disease with activities that are considered immoral, such as sex work and promiscuity, have led to a broad stigmatization. Women are particularly stigmatized, as their HIV status is associated with sexual conduct that is considered socially unacceptable for women, while men’s promiscuity or extra-marital sex receives much more social accep- tance (Shizawa et al., 2004).
The national response to HIV/AIDS is wrapped up in the drive to- ward development, which has become a top priority in contemporary Laos. In this context, HIV/AIDS is under- stood as having a negative impact on the national goal of development, as is illustrated by the 2001 national policy on HIV/AIDS, which states its goals as “(a) prevention of HIV infection,(b) care and support for those infected with and/or affected by HIV/AIDS, and (c) mitigation of the adverse impact of HIV/AIDS on the social and economic development of indi- viduals and the nation” (Chancy and Khanthanouvieng, 2004: 95). As indi- viduals who require expensive medical treatments and who are thought to be limited in their ability to work due to illness, PLHIV are not seen as good, productive citizens who contribute to the nation's neoliberal development trajectory. By placing HIV in opposi- tion to the objective of development, the Lao state constructs a discourse of PLHIV as undesirable and disruptive to the social order, similar to the way that marginalized ethnic minorities in Laos are stigmatized as producers and users of opium. (Cohen, 2013). Because the government does not have the financial capacity to regulate PLHIV’s condition medically, they must rely instead on the international community of HIV/AIDS donors to determine and provide appro- priate medical intervention. PLHIV, therefore, exist outside of the state’s regulatory grasp.
Although HIV is understood as an impediment to development, it is also in some ways considered a con- sequence of development and is as- sociated with more developed places, particularly nearby Thailand. It is also associated with the practice of leaving Laos to work in the bars, factories and construction sites of a more developed neighbouring country (Lyttleton, 2002). A number of scholars have argued that the rise in HIV rates in Laos has a direct relationship with the current economic policy of the Lao government, which emphasizes neoliberal-style development through free market growth and increased economic integration with the region and the world (Rigg, 2005). Laos has encouraged major foreign direct investment and introduced large-scale infrastructure developments, such as the construction of large hydroelectric dams and highways, as well as other projects for increasing regional eco- nomic interactions. Chris Lyttleton argues that development interventions not only transform people’s economic lives, but also their intimate relations, and therefore their health (Lyttleton, 2014: 6-7). His new book (2014), as well as a number of other studies in the Mekong region (Lyttleton et al., 2004; Lyttleton, 2002; Chamberlain, 2000), have now shown that one of the unintended consequences of policies that stimulate increased popu- lation mobility, such as infrastructure construction projects, is the spread of HIV. HIV/AIDS is, therefore, understood as both a product of de- velopment and, at the same time, a drain on the country’s development potential.
HIV/AIDS is also perceived by many Lao people as a foreigner’s dis- ease. The common perception is that it comes from “outsiders” such as Thais, Vietnamese or Chinese, and that Lao people are not at risk of contracting it from one another, but only from interactions with non-Lao (Lyttleton, 1999: 119; Beyrer, 1998: 78-80). For many years, Lao state officials denied that HIV was present in Laos, although local doctors re- ported otherwise (see Breyrer, 1998). As HIV is still perceived as a disease contracted and spread by non-Lao, Lao PLHIV have become associated with this “outsider” status.
As in other places in the world, PLHIV are commonly perceived as unclean, immoral, and 'other.' Some quotes from my fieldwork illustrate this well. One 39-year old Lao wom-an, whose two children are living with HIV and whose husband died from AIDS-related illness, told me, “When (my friends and neighbours) found out I was HIV-positive, I could not go visit them in their houses or be friends with them. Wherever I walked, wherever I went, people stared at me and they talked about me behind my back. When I went to the hospital the nurses and the doctors also didn’t want to talk to me or treat me, because I was very thin and very sick.”
On the topic of changing Lao attitudes on HIV/AIDS in recent years, the President of LNP+ told me: I think that society is becoming more accepting of (PLHIV), but there is still a difference between people’s actions and their minds. They might say 'we accept these people,' but in reality there is still some evidence that shows that they don’t really accept them. Like, people may describe HIV-positive people as sex work- ers or bad people or something. If (PLHIV) disclose their status, they might end up in that situa- tion, so there are a lot of people who do not disclose themselves because they’re afraid of being perceived that way.
HIV/AIDS support networks and civil society in Laos
The formation of an identity- based coalition of PLHIV is further complicated by the post-socialist, single-party political landscape in Laos, which puts considerable con-straints on the formation and activi- ties of non-state organizations. The perception of state-society relations in Laos, as fostered by socialist state discourses, is one of a parent caring for a child. However, the state suffers from extensive corruption, which per- meates society at every level, including bureaucrats, officials, police and civil servants of all stripes (Stuart-Fox, 2009: 158). Martin Stuart-Fox argues that “the increase in corruption in Laos is linked to a resurgence of Lao political culture, which seeks to con- centrate power and wealth through patronage networks centred on senior members of the ruling Party. To oil these networks resources are needed, which are transferred from the state to favoured individuals” (ibid: 159). However, jealousy is now starting to fracture the Party as the wealth accumulated through corruption is unevenly distributed.
Although many of the most severe restrictions on social life initially im- posed by the Party have been revoked over the years, the state still strictly controls civic association and regu- lates the establishment, membership, mandate and activities of all groups. ‘Non-governmental organizations’ are not recognized, but recently citizens groups have been allowed to form what are known as ‘non-profit associations’ (NPAs), which must be registered with a government agency. Mass organizations such as the Lao Women’s Union, Federation of Trade Unions and People’s Revolutionary Youth Union, extend from the state level all the way down to every prov-ince and district. These organizations are meant to act as mechanisms by which people at the local level can participate, while projecting the Par- ty’s influence out to the village level (Evans, 1990: 184).
The term ‘civil society’ has a dif- ferent meaning in Laos than it does in non-socialist polities. Civil society is typically defined as the space that exists between the state and society, where individuals interact and can organize toward goals (Mcllwaine, 1998). However, this is a Western conception of civil society, and is not compatible with Laos, because there is no space between state and society within socialist. Whether or not this is a useful term to use in relation to Laos is a matter that requires further academic attention, but it is currently in active use to refer to that arena of society that is organized around social issues, although they are under govern- ment supervision. Many international development agencies operating in Laos now have programs aiming to support civil society, although “authorities are worried about the influence of foreign non-govern- ment organizations (NGOs) and aid workers, who are empowering local, rural communities in a way that is per- ceived by some as a threat to the existing order. (The) country's main dilemma (is) how to balance… the influx of outside influences with the desire on the part of the ruling party to remain in control of most aspects of life and society in Laos.” (Lintner, 2008: 172) The few people and groups who have organized protests or criticized the Lao government openly have been punished swiftly, with lengthy jail sentences or even disappearances.2 Social movements typically do not reach Laos, and participation in activism is nearly unthinkable for Lao citizens.
LNP+ is the only organization of its kind in Laos – it is a network of HIV-positive people that stretches across the country, with support groups in 14 locations in 12 pro- vinces, and a national office based in Vientiane Capital City. Its stated objectives, according to a pamphlet distributed to members, are to im- prove the quality of life of PLHIV in Laos, to contribute to a reduction in HIV transmission and to be the representative of all Lao PLHIV in the national response to HIV/AIDS. It is directed by a committee comprised of one member from each of the 12 pro- vincial branches, and the majority of its staff members are also people living with HIV. LNP+ began in 2001 as a small number of community-based support groups and was formally established in 2003 as a project of the Australian Red Cross (ARC), together with the Lao Red Cross (LRC), which is a mass organization. Because Lao organizations are not allowed to exist independently from the state, LNP+ remains under the authority of the LRC.
Since 2006, LNP+ has been trying to register as a non-profit associa- tion through the Lao government’s changing legislation on civil society organizations. According to LNP+ coordinator Phon3, their initial ap- plication was made through the Lao Union of Science and Engineering As- sociations (LUSEA), but was deemed more appropriate for registration under a different mass organization. Their application was passed around between government agencies and mass organizations until 2009, when the government announced it was creating a new decree on NPAs that would centralize all NPA registra- tions under the Public Administration and Civil Service Authority (PACSA) (IRIN, 2009). At the time of writing, LNP+ had submitted the first stage of its application for the lengthy new non-profit association registration protocol and was waiting for accep- tance and permission to advance to the next stage. The registration pro-cess is intensive, requiring a security clearance, complex application forms, home visits and family visits for key members.
Previously, funding for LNP+ came from the Australian Red Cross (ARC). They provided funds to the Lao Red Cross for an HIV/AIDS program, which in turn provided USD 32,000 annually to LNP+. By applying for small grants, LNP+ nearly doubled this annual operating income. However, funding from the Red Cross ran out in 2011, when the ARC shifted the focus of their programs in Laos. That same year, LNP+ was approved for funding through the Global Fund for AIDS, Tuberculosis and Malaria (GFATM), a major funding agency worldwide, but they received only enough for their basic office costs and once again have had to top up their income through grants. However, this new funding source has had an impact on the relationship between LNP+ and the state. Previously, funding was not only filtered through the LRC, but it was also micro-managed by them. The LRC retained control of the funds in their own bank accounts and LNP+ had to ask permission to access it. All of LNP+’s transactions were closely monitored. With funding from the Global Fund, LNP+ has now gained a degree of autonomy in their financial decision making.
Similarly, because they were regis-tered as an LRC program rather than an NPA, all of LNP+’s decisions, plans and programs had to receive approval from the LRC. Their 5-year plan, hiring processes and elections were all scrutinized. As they have moved toward both NPA registration and external funding, LNP+ has subtly indicated a desire to move away from the LRC and away from state scrutiny in the process. One of their goals, as discussed in their strategic planning sessions, is to become more indepen- dent, thereby attaining greater control over their organization, including their finances, planning and projects. These moves have not gone unnoticed by state agencies, and the LRC has made attempts to reign them back in, for example by pressuring them to allow the LRC to manage their GFATM grant for them.
LNP+ is similar in its objectives and structure to its Thai counterpart, TNP+, as well as the Asia-Pacific Net- work, APN+, and other HIV-positive peoples’ networks around the world. All of these groups consist of networks of smaller, locally-based groups of PLHIV, which provide support to members and advocate for rights and access to care. The Thai networks are particularly influential on LNP+, as they have been active since the early 1990s and have developed a strong leadership and extensive knowledge of medical and political workings relevant to PLHIV, which they fre- quently share with LNP+ in the form of training and workshops. LNP+ is in a similar position now to where the Thai groups were 20 years ago; their members are mostly poor, many of them farmers, day labourers, mar- ket vendors, etc., and therefore lack the complicated management and administrative skills and specialized knowledge to run a successful HIV advocacy organization. The Thai ex- ample shows how capacity is built when individuals, bringing their own motivations and experiences, use the groups to pick up new information from other PLHIV and in turn con- tribute their own experiences to the knowledge pool, thereby enhancing the efficacy and quality of knowledge that is shared by the group (Tanabe, 2005: 186).
Thai PLHIV groups have earned a reputation for their political activism and lobbying efforts, which are credited with success in launching a nation- wide campaign for affordable medi- cines and significantly decreasing the discrimination against PLHIV. They have received international recogni- tion for their significant and positive impact on the lives of PLHIV and for their influence on Thailand’s public health system.4 Although LNP+ is unable to be politically active in the way that Thai and other groups are, they have been relatively outspoken compared with other Lao NPAs. For example, they have actively tried to gain representation on decision-mak- ing bodies in order to influence government policymaking.
Their connections with interna- tional and transnational HIV/AIDS networks have exposed them to ac- tivist discourses and strategies that would be considered very subversive in Laos. By participating in train- ing and conferences internationally, from Bangkok to Bali, and with their funding and support connections to advocacy groups overseas such as the Australian Federation of AIDS Organizations, LNP+ has become connected to a transnational move- ment of HIV+ people. They have even attended protests and politi- cal demonstrations in neighbouring countries, such as a recent protest in Bangkok against a free trade agree- ment being negotiated between India and the European Union that may threaten India’s ability to produce inexpensive HIV medicines. LNP+ members now sport T-shirts declaring “Europe! Hands off our medicine!” and a poster on the front window of the LNP+ office makes the same plea. Exposure to progressive politics, and to activist organizing strategies, has had an impact on how LNP+ mem- bers view their own situation and on what kinds of actions and strategies they employ themselves. For the staff and volunteer leaders, this has meant coming to see themselves as activists involved in a transnational movement of PLHIV.
DISCUSSION
Given the complex social and political circumstances around HIV/ AIDS in Laos, any advocacy on this issue must be approached with sub- tlety. The word “advocate” itself is sensitive. Although the Thai and Lao languages are extremely similar, Thai activists often use the term gan phlaak dan, which means to push, promote or pressure, while in Laos, according to LNP+’s coordinator, Phon, this word is perceived as too strong, too demanding. Instead they use a dif- ferent term, kor sanap sanoon, which means to ask for support or assistance, and is softer and less confrontational. Indirectness is a key part of advocacy in Laos; in order to reach a goal, it is not possible to make demands or even to directly ask for what is needed. Instead, gentle, creative and subtle strategies must be employed. An LNP+ volunteer named Vieng succinctly described it using simple hand gestures – he drew a straight line in the air with his finger to represent a direct demand, the way Thai acti- vists might behave, and a curving line in the air to illustrate the preferable way to behave in Laos. According to him, in order to be successful in Laos one must “work smart. Many people do not have the skills that are required here; they just say what they think, but that is not the right way to work.” Instead, one must carefully manoeuvre toward the goal, while maintaining important relationships, and exercising extreme patience.
Despite the constraints they face, LNP+ has become a leader among Lao NPAs and has been known for being particularly rebellious by Lao stan- dards, particularly in their recent past. When I visited Vientiane in 2009 to explore options for a research project on civil society in Laos, I heard from several individuals working on civil society projects with international NGOs that LNP+ was the only local group that referred to themselves as activists, and that they were known for being assertive. I found this intri- guing. How would PLHIV, given their marginal status, develop strate- gies for asserting themselves? And why would they take the associated risks? Among all of the Lao NPAs working on environmental issues, indigenous issues, women’s issues, etc., why is it the HIV/AIDS group that stands out?
The answers to these questions are complex. One consideration is the high stakes that PLHIV face, including social exclusion, illness, death and the death of their chil- dren or spouses – the life and death nature of their cause has led them to take bolder actions. It is also notable that LNP+ is part of an international tradition of HIV/AIDS activism that is decidedly radical. Following ACT UP and other groups in the US during the 1980s and 1990s, HIV/AIDS activists around the world, and in Thailand in particular, have been inspired by the impressive efficacy of ‘direct action’ protest tactics. LNP+ members, volunteers and staff have a close relationship with these Thai groups and frequently visit them in Thailand for training, workshops and collaboration. This exposure has had a significant impact on LNP+. Although they will not articulate it publicly at home in Laos, the staff and local leaders of LNP+ that I interviewed for this project consider themselves to be activists for the rights of PLHIV, even though this runs contrary to Lao culture.
One theoretical concern in the study of activism has been how to un- derstand the role of culture as some- thing that reproduces social structures, but is also used by activists to challenge the status quo. To what extent are ac- tors constrained by their culture, and is it possible to operate within one’s culture in a manner that creates change? How do we acknowledge the importance of culture in shaping social life and actors’ actions and intentions, without treating activists as ignorant or impotent? According to Francesca Polletta, “By paying attention to the trade-offs (activists) face both in conforming to cultural conventions and in challenging them, as well as to the calculi by which they rule options in and out of consider- ation, we can get at how culture sets the terms of strategic action, without simply locating those processes in people’s heads” (Polletta, 2008: 80). During my fieldwork I observed that Lao culture, rather than sim- ply constraining LNP+ members’ thoughts and actions, provided a framework for the group to choose what actions to take by allowing them to understand the meaning and con- sequences of their actions within their context. LNP+ members have a complex interpretation of Lao culture – on one hand they are marginalized in their communities and perceive Lao culture around sexuality and dissent as being an obstacle to achieving their goals. On the other hand, they frequently defend Lao culture, par- ticularly in contrast with Thailand, and their identities as Lao people are deeply ingrained. A common characteristic of PLHIV and many other marginalized people worldwide is the contradictory experience of identifying with a culture that rejects them. Ultimately, theirs is a struggle to change Lao society, not to leave it or reject it outright. In the meantime, aspects of their culture are used as tools for working toward particular goals. One way they navigate their cultural and political context is by transposing what Polletta (2008: 90) refers to as “institutional schemas,” in strategic ways. Activists borrow ‘schemas’ from one cultural arena and apply them to new paradigms, allowing them to strategize in cul- turally intelligible ways. They thereby claim agency in spite of structures that would constrain them, by borrowing from those very structures.
I describe LNP+’s subtle but active way of pursuing a course of action as a serious game of HIV/AIDS advocacy, wherein the practices and intentions of players operate within a particular set of rules, goals and expectations on a given playing field. Anthropologist Sherry Ortner explains that the con- cept of the serious game embodies the following:
...that social life is culturally or- ganized and constructed, in terms of defining categories of actors, rules and goals of the games, and so forth; that social life is precisely social, consisting of webs of rela- tionship and interaction between multiple, shiftingly interrelated subject positions, none of which can be extracted as autonomous “agents”; and yet at the same time there is “agency,” that is, actors play with skill, intention, wit, knowledge, intelligence. (Ortner, 1996: 12)
The “rules of the game” include the socialist perspective on state- society relations and the practices that go with it, social taboos around sexuality, the state’s nationalism pro- ject that defines good Lao behaviour, political restrictions on advocacy, the objectives of international funding agencies, the endless bureaucracy that NPAs must navigate, and the cultural practices around work and social hierarchy that dictate how things get done. This set of social structures shapes LNP+’s possibilities for action and forms the conditions for the way they play the game. These rules would appear to greatly limit their ability to make any significant progress, and in fact most of the time LNP+’s actions tend to reproduce these so- cial structures. For example, LNP+ tends to comply with official state regulations pertaining to their work, and generally also with unofficial, cultural work practices. When LNP+ wants to have a meeting or training session that includes members from other provinces, they are required to receive letters of permission from the National Commission for the Control of AIDS Bureau (NCCAB) at the provincial level for each person who will be traveling out of their home dis- trict. PLHIV in Laos are not allowed to come and go freely if they wish to join a meeting or conference outside of their district. Regardless of how unjust LNP+ staff find this regulation to be, they consistently comply and dutifully request NCCAB permission when required.
However, LNP+ is not always so docile – particularly not in their past. The coordinator before Phon was a man named Ton, and he earned a reputation for being a troublemaker. According to Phon and current vo- lunteers, Ton was an honest man and passionate about the plight of PLHIV in Laos, but he attracted unwanted attention to the organiza- tion. He would regularly disregard the bureaucracy and go ahead with his plans outside of official chan- nels. In meetings with government representatives, he would complain about human rights problems in Laos, which angered government officials. Although Phon, Kinoy and other cur- rent LNP+ members concede that he had the best intentions of PLHIV at heart, their work was becoming more difficult because government bodies did not want to work with them, the LRC was unhappy with them, and partnering with them became a risk for any other Lao NPA. It became impossible to accomplish anything because their relationships with other actors were poor. There was a tangible change in direction after Ton left. Kinoy, as LNP+’s president, aimed to bring the organization closer to the state in order to overcome these problems. Even though Kinoy felt as strongly about the injustices faced by PLHIV as Ton had, the shift in tactics to maintain a closer relationship with state organizations was deemed nec- essary for meeting their other goals. During a particularly stressful morning at the LNP+ office, Phon said to me that she felt “like a fish on a stick.” She was referring to a popu- lar Lao style of cooking river fish by splitting a stick of bamboo, wedging the fish in between the two halves and then cooking it on a grill. The fish on the stick is held in place by the pressure on either side of it. Like the fish, Phon is caught, unable to move, gripped and suspended by forces con- fronting her from either side. On one side is the desire to actively push for change in her country in an open and public way; on the other side is the desire not to be perceived as a troublemaker, and an overwhelming pressure to maintain the status quo. That morning, Phon was preparing to lead a meeting of Lao NPAs on the subject of the ASEAN People's Forum (APF), which is a meeting of civil society groups held in tandem with the annual Association of Southeast Asian Nations (ASEAN) meeting. Phon had attended the forum on behalf of LNP+ and was tasked with summarizing the proceedings for NPAs that were unable to attend.
At the APF, the discussions involved considerable criticism of ASEAN, particularly focused on the destructive nature of large-scale development projects, and called for a more “peo- ple-oriented” ASEAN. However, such an unapologetic criticism of ASEAN, and implicitly of the Lao govern- ment’s policies, would not be looked upon kindly by some in attendance at the Vientiane meeting.
Phon wrote and re-wrote her description of the APF, alternately trying to make the criticism appear softer and then rewriting to try to be true to the aims of the APF. She struggled to find a balance between maintaining a respectful tone to- ward the Lao government and its interests, and engaging in an activist critique. This is the sort of tightrope that LNP+ walks, somewhere between Laos’ post-socialist politics and the transnational activist communities. Their tactics in ‘playing’ the game of HIV/AIDS advocacy reflect this am- bivalence. Some examples illustrating their tactics will be examined here.
One way that LNP+ has ap-proached political and cultural barri- ers has been to subvert the hierarchies that shape them. Laos is a distinctly hierarchical society – although the socialist revolution eliminated the monarchy and did away with many of the old social relations, it did not succeed in eliminating hierarchies, only in altering them (see Evans, 2002). While LNP+ does not have a high social status, and in fact its members are particularly disenfran- chised, they are sometimes able to use the hierarchy to their advantage in order to reach their goals.
For example, they are sometimes able to use their relationships with particular actors with greater social capital to their advantage, such as the transnational organizations that have HIV/AIDS programs in Laos. These include United Nations agencies, Population Services International, World Health Organization, and Red Cross organizations from Norway, The Netherlands, and several other Western countries. The local directors of these organizations tend to be Western expatriates, and their staff is a mix of foreign and Lao people. These actors fund many programs in Laos and are well respected, but they are not entirely embedded in Lao culture. They are particularly interested in working with LNP+, as recent trends in the development industry tend to emphasize “participatory” approaches that involve affected communities in the planning and implementation of projects. International HIV/AIDS organizations typically subscribe to the idea that PLHIV should be mean- ingfully involved in the prevention, care and treatment of HIV/AIDS (see UNAIDS, 2007 for their policy brief- ing). The concept of “greater involve- ment” or “meaningful involvement,” long fought for by HIV+ activists, is now incorporated into most interna- tional NGO’s programming on HIV/ AIDS, in principle if not always in practice. LNP+ is frequently called upon by international organizations wishing to meet this requirement in Laos.
In turn, LNP+ can call upon these institutions for help with their own projects when they wish to circumvent Lao cultural hierarchies. For example, they recently sought to establish a women’s HIV group similar to the one they encountered in Thailand. Doing so through official channels would mean proposing the idea to the Lao Women’s Union (LWU) and the Lao Red Cross (LRC), both state-con- trolled mass organizations, which might reject the project altogether, or else take charge of the project and lead it in a direction that LNP+ would have no control over. There is no space within the Lao cultural/ political environment to simply create a group for HIV-positive women to discuss their lives and needs, without receiving state permission to do so. As Kinoy and Phon explained during my fieldwork, it is not possible to gather female support group members, even informally, to talk about what their needs are, as all gatherings require per- mission, and particularly for PLHIV, their movements and activities are carefully watched.
Instead of going directly to the LWU and LRC, LNP+ met with consultants from UNAIDS and the United Nations Development Fund for Women (UNIFEM) first, for a discussion of how such a group could be organized, who would lead it, what funding it might need, etc. A plan was therefore already developed by the time it was presented to the LRC and the LWU. This communicated to the LWU and LRC that the project was credible and viable, and had the support of international organiza- tions/donors with considerable social and material capital. For the LRC and LWU to reject the project would put them in direct conflict with these organizations and would potentially complicate their social position – a fact that LNP+ was well aware of. By aligning with foreign organization with a strong social position, LNP+ was able to ensure that their project passed through the Lao bureaucracy successfully, without losing control of it.
Another example shows how LNP+ members use gossip to “speak truth to power” without doing so directly, and thereby avoiding conflict or negative attention. At the APF meeting mentioned previously, Phon felt frustrated when a government official criticized some attendees from other countries for being “disrespect- ful” in criticizing neoliberal develop- ment practices. Phon felt obligated to apologize for their bad behaviour, even though she did not interpret it as such, but quickly pointed that none of those making the criticisms were from Laos. Her comment was interpreted by those present as being somewhat subordinate – a subtle jab at the government officials for always casting blame on them, and a defense of the Lao NPAs.
During a break in the APF meet-ings, Phon and other NPA members chatted and drank coffee within ear- shot of a group of government offi- cers. The other NPA representatives complimented Phon on her presen- tation and she replied, aware that she was being overhead, that she thought it was good for everyone to learn about the negative side of the ASEAN projects. She then loudly complained that the morning’s meeting had been very boring and predictable because nothing ever changes in Laos and no one is really listening to one another anyway. Part of the game, for LNP+, is being able to get their point across without the appearance of having done something wrong. Gossip is a useful tool as it is generally considered to be frivolous and innocuous, and yet it is capable of communicating a great deal.
CONCLUSION
This concept of the serious game illuminates the tactical and strate- gic aspects of LNP+’s activities. The game’s “playing field” entails a variety of constraints related to Lao culture, religion, history and politics. As mar- ginalized people, PLHIV are embed- ded within complex relations of power that shape their possibilities for action and dictate the rules by which they must play. Through their strategies, LNP+ in some ways reproduces the social structures that dictate their actions. However, they also attempt to manoeuvre around these structures, use them to their own advantage, and even sometimes challenge them.
LNP+ plays this game with sub-tlety by, for example, transposing cultural schemas. Their resistance, if we can call it that, sometimes appears to be of the “everyday” variety (Scott, 1985), although, as the examples here illustrate, it is often more intentional and assertive. If there is a continuum between everyday and active forms of resistance, LNP+’s tactics would most often exist somewhere in the middle. Their resistance is both quiet and strategic, reliant upon their culture for meaning, while challenging that culture.
In Laos today, there is little space for groups of citizens to organize to- ward their common goals, particularly if it entails any criticism of the status quo. The current state of Lao society, while more open than in previous years, still poses considerable restric- tions on civic association. Great risks are associated with activism, and for most NPAs, confrontational tactics are not desirable anyway, as they are interpreted as being contrary to Lao culture. For the rare ones, like LNP+, whose exposure to transnational ac- tivist ideologies has radicalized and politicized them, the only way to get along with the state while also pur- suing their objectives is to play the serious game of advocacy with skill and creativity.
My research shows that LNP+ is capable of using these subtle tactics to meet some of their immediate needs or to communicate a particular message, and they have seen some success in achieving their goals. For example, they were some of the first to seek access to ARV in Laos, and have contributed to the current suc- cesses in introducing life-saving drugs to the country. They also take credit for improving public knowledge of and attitudes around HIV. To some extent, for them to simply exist in public, for example by “coming out” as HIV-positive and choosing to be present in hospitals, public health meetings and civil society events, they make positive advances toward de-stigmatization.
Although cultural practices and political ideologies are deeply en- trenched in Laos, they are not un- changeable. In rural areas, neoliberal development practices steadily en- close the forestlands and waterways (Barney, 2008), taking a toll on the livelihoods of what was formerly an ideologically indifferent peasantry. Urban areas are expanding and an educated middle class is emerging, which may soon be seeking political participation (Lintner, 2008: 172). Together with outside pressures, both from concerned foreign trade partners and from international organizations that Laos has membership in, there is potential for Laos’ political system to be reformed sooner rather than later. In fact, there is no doubt that change is coming in Laos; the question is whether or not these changes will result in the expansion of space for a public sphere from which LNP+ and other NPAs may engage in new, more direct forms of advocacy and activism.
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