IN IT TOGETHER - HIV/AIDS and the ethics of responsibility in India

Amartya Sen

The ethics of responsibility has been a big subject in analysing the social
aspects of AIDS. The point has been made, with considerable influence, that
since HIV infection is primarily contracted through voluntary acts, such as
unsafe sex, it is the individual rather than the society that should take
responsibility for avoiding the disease and accepting the consequences of
irresponsible actions.

This way of seeing the social ethics of AIDS would have vast implications for
what an afflicted person can or cannot expect the state to do for the ill.....

The idea that somehow the afflicted person bears the responsibility for his or
her own unfortunate condition, since the infection could have been avoided
through changing personal behaviour, is indeed quite prevalent — not just in
advanced countries like the United States of America, but also in India.

There is certainly an element of narrow plausibility in this general outlook.
Many of the actions that may lead to the infection are certainly within the
person’s own control, and the role of personal responsibility is indeed an
important connection to bear in mind in planning strategies for prevention,
through greater availability and use of information and more social education
and advocacy.

And yet to see this as an ‘open and shut’ case of just personal
responsibility also misses the nine-tenth of the iceberg that lies below the
water, hidden from view.

First, infection can come to a person in a way over which he or she has little
control. This applies not only to those who get the contagion from blood
transfusion, but also to children who get the disease before they are able to
run their own lives.

Less obviously, the same lack of control applies to members of the family who
get the ailment from their spouses or partners when they are not in a position
to ascertain the infection status of their consorts. Women are particularly
affected by this lack of control, and among the millions of arguments for
women’s empowerment, the fight against this epidemic has a clearly defined
place.

Second, while ignorance of the law cannot be taken to be a legitimate excuse for
a legal lapse, lack of knowledge of the process of transmission and of the ways
and means of prevention can certainly rob a person of the ability to relate
actions to consequences. The presumption of ‘rational choice’... is
compromised by many limitations, one of which — an important one — is
clearly linked with informational ambiguity.

Third, even when there is a general understanding of the risks involved in
certain types of actions, individual conduct is often swayed by the prevailing
modes of behaviour. For example, in the success of the sex workers’ unions in
Calcutta in moving the vulnerable population towards a 100 per cent use of
condoms..., a critical difference is made not just by the dissemination of
information, but also by developing group-based behavioural norms that
individuals can follow without having to muster unusual resolve and will power
in each behavioural choice.

Personal responsibility is indeed a big part of the fight against AIDS, but the
routes to its exercise go through many related territories, including knowledge,
understanding, individual resolve and group norms.

Fourth, people are influenced in their behaviour not only by well-reasoned
advocacy (the role of clear reasoning was clearly very strong in the Calcutta
initiative just mentioned), but also by what may look like ‘thrilling’
behaviour.

This not only applies to smoking, which is another area of huge health
adversity, but also to drug-taking, which has played a very important part in
the spread of HIV infection in parts of the country (for example, in Manipur).
Easy availability of drugs can play a big role in enhancing the exposure to that
type of temptation (as it indeed did in Manipur).

The exercise of personal responsibility varies radically from one community to
another depending on the social circumstances, and it would be rather
simple-minded to see these variations as endogenous diversities in personal
decision-making, divorced from the way society influences the choices and
actions of individuals.

Fifth, while it is easy enough to advocate ‘just say no’ in any field with
any kind of danger, living a life does not consist only of invariably choosing
the safest courses of action.

While the purist ascetic might find the entire field of sexual activity to be
suspect territory, the fact is that the spread of HIV infection is closely
linked with one of the most powerful propensities of human beings. Love and
physical relations are not activities that are themselves base and sordid —
indeed the world would have been immensely poorer in poetry and culture if the
inclinations that go with them were absent in human psychology.

So this is not an area of life that can be simply ‘censored out’ through
reasoning, but something where behavioural modification is needed in line with
the dangers and threats that arise, as and when they do arise.Throwing the baby
out with the bath-water can hardly be the object of the exercise.

Finally, the criminalization of some types of human relations can contribute to
driving them underground, which makes it very difficult to bring them into
standard public discussion — much needed both for the dissemination of
information and for open discussion of safer behavioural norms. In particular,
Section 377 of the Indian Penal Code offers the possibility of ten years of
imprisonment as a fitting penalty for gay sex.

This provision of the penal system was imposed on India in the 1860s, during
Victorian British rule, and while the British have liberated themselves from
their Victorian past, the Indian officialdom seem to have found their own
reasons in favour of retaining this bit of imperial legacy.

When that law came into force, America was just trying to liberate itself from
the institution of slavery. Section 377 is presently being debated in the Indian
courts, and one can only hope that the liberation of gays from prospective
police threat (and blackmail) will come before long, even if 150 years late.

Openness has a huge role in the use of knowledge and shared reasoning, and among
the many implications of the AIDS epidemic is the need to normalize a kind of
sex that many people find perfectly normal, no matter how distressed some others
are even at the thought of such relations.

I conclude by reaffirming the need to take personal responsibility seriously (it
certainly must have a big role in tackling the HIV epidemic), but along with
that, by emphasizing how dependent the exercise of personal responsibility is on
a variety of social circumstances — informational, behavioural,
organizational, economic, and legal.

Those who want to ‘rely’ on personal responsibility, divorced from social
contingencies, may be, in one respect, better informed than those who fail to
see the role of personal responsibility altogether. But partial understanding
can also be the source of very serious misdiagnoses.

Nearly 2000 years ago, philosophers of the Nyaya school in India pointed to the
fact that the familiar case of mistaking a rope for a snake, much discussed by
classical Indian epistemologists, occurs only because of half-knowledge — not
full ignorance.

One needs an understanding of the ‘snake concept’ to take a rope to be a
snake. Someone who had no clue about what a snake looks like would never mistake
a rope for a snake. We have to avoid the errors of half-understanding as well as
those of ignorance. It is important for us to see a rope as a rope, and a snake
as a snake, for they are both parts of the world, including the world of AIDS.

But first we have to stop blaming the victims and stop looking for reasons for
leaving them to look after themselves. We are in it together.

THIS IS AN EXTRACT FROM AMARTYA SEN’S FOREWORD TO AIDS SUTRA: UNTOLD STORIES
FROM INDIA, EDITED BY PRASHANT PANJIAR AND PUBLISHED BY RANDOM HOUSE INDIA

http://www.telegraphindia.com/1080817/jsp/opinion/story_9693391.jsp