In this ambitious book, Taiwanese anthropologist Liu Shao-hua examines the lives of Nuosu heroin users in Liangshan County, in Sichuan Province in Southwest China. This ethnography takes us behind the mountains to illuminate the experiences of young men and women during the first decade of the millennium and the exponential rise in HIV and drug addiction among this community. Liangshan County is now infamous for having one of the most severe dual epidemics of injection drug use and HIV/AIDS in China.
More and more young men, we learn, are being drawn away from their natal hamlets and into urban life in Sichuan’s provincial capital of Chengdu, where they pick up the ways of cavorting in the city: stealing, selling drugs, and committing petty crimes. Their newfound ways parallel what Liu calls the Nuosu young male’s rite of passage, where historically young males fought among lineages. Now, they become the delinquents of Chengdu.
Liu sets out to understand why there is a connection between local migration, HIV/AIDS, drug use, and petty crime among these young Nuosu men. Her answer lies somewhere at the confluences of Nuosu kinship systems, China’s modernization, and the unintended consequences of certain programs associated with AIDS globalization that bring about new kinds of public health interventions. Liu points her readers to three key phenomena that have been part of recent anthropological and scholarly debates: the crisis of modernity, manhood and migration, and failed state AIDS interventions. The book itself is divided into six chapters. Chapter 1 focuses on the local history and modernity; Chapter 2, on masculinity studies and China’s recent massive migrations from the rural areas to the cities; Chapter 3, the many voices of drug control in Liangshan; Chapter 4, the various contentions of individuality; Chapter 5, the failures of certain state AIDS inventions; and Chapter 6, how stigma often gets reinforced by AIDS invention projects.
Casting her theoretical net wide, Liu takes into consideration the many facets of medical anthropological inquiry into AIDS prevention around the world, even considering the literatures in masculinity studies, globalization theory, and state–society relations in China. AIDS prevention programs in China have grown exponentially in the past ten years. Once a disease of extreme stigma and ignorance, AIDS has now become part and parcel of a large global industry.
Liu explains that in many ways Chinese state–society projects have failed due not to the incompetence of local state actors but to the conditions that these projects are homegrown in, with limited resources, little training, and ignorance of local and indigenous knowledge. Time and again, NGOs in China have quickly blamed the Chinese state for stopping AIDS interventions, when the on-the-ground situation was far more complicated and where NGO incompetence plays a large role. In her explorations of the China–U.K. projects, funded by the British Development Agency, we see how leaving things up to county-level bureaucrats, without any local experience or understanding of the cultural facets of Nuosu life, means that programs almost always fail from the beginning.
One of Liu’s main aims is to assert that in scholarly understandings of China’s capitalist “miracle” (x), the unintended consequences of rapid urbanization and modernization, have left people like the Nuosu “melting into air” (the way that Berman, cited on p. 195, described Marx’s understanding of modernity). It is the downside of Chinese modernity that is often left out of current accounts of China’s economic development miracle. Liu hopes through her ethnography of public health (my term not hers) to substantiate the challenges in understanding the cultural and social implications of failed intervention programs meant to curb the spread of infectious diseases in the age of globalization.
The strength of the book lies in Liu’s careful and meticulous delineation of five projects of the China–UK project that focus on four areas: (1) improving the livelihood of those with HIV through pig raising and planting Sichuan peppercorn as cash crops; (2) preventing HIV transmission through needle exchange; (3) treating opportunistic infections; and (4) providing anti-retroviral therapy (148). Each project falls apart in the end due to increased bureaucratic inadequacy combined with state agents’ cultural incompetence and their Han prejudices. The analysis points toward a resounding critique made by medical anthropologists studying HIV/AIDS globally that culture was ignored. At this point in the AIDS epidemic, it is hard to believe that what Liu and many others have called a “one size fits all model” still prevails in global prevention and intervention programs.
Liu acknowledges that rethinking and re-implementing interventions might help the Nuosu deal with the consequences of massive heroin use and HIV/AIDS among its youth, but she also suggests that the wider Chinese society and its newfangled neglect of public health has led to widespread distress and suffering. She rightly points out that few studies in the past have examined the deteriorating quality of health practices at the local level as a result of shifts in development paradigms from prevention toward cash-for-services health care. Furthermore, Liu draws on what Arthur Kleinman taught us: Moral worlds are critical to understanding health and disease prevention.
Liu demonstrates a thorough knowledge of the literature on globalization, modernity, AIDS ethnography, and the debates in masculinity studies. But I wanted more stories of her informants. As Liu tries to link the Nuosu to their Han city brethren, we do not hear enough about the relationships between the Han and Nuosu in Nuosu territory. How are Han Chinese youth affected by the use and selling of heroin? What impact does inter-minority and cross-Han marriage have on rates of heroin use and HIV/AIDS? Perhaps this is too much to ask of an author, but this reader was left wanting more (which in all fairness is where every good ethnography should leave its readership).
Overall, this is a study written with remarkable care, emotional savvy, and public health intelligence. It is valuable reading for advanced students and specialists in medical anthropology and public health, especially those in interested in the local consequences of global public health interventions, Chinese minority studies, and the theorization of gender, globalization, and modernity.