Structural violence and the state: HIV and labour migration from Pakistan to the Persian Gulf

Abstract

This paper examines the biopolitics of HIV and labour migration from Pakistan (a country classified by UNAIDS as at 'high risk' of a generalised epidemic) to the countries of the Gulf Cooperation Council (GCC). The remittances by the labour migrants in the Gulf are an invaluable source of foreign exchange for Pakistan and a large number of households are entirely dependent upon them. At the same time, the National AIDS Control Programme regards Gulf migrants as a key risk factor for an HIV epidemic. The majority of HIV positive people in clinics comprise Gulf returnee migrants and their family members. This paper suggests that in the process of migrating, prospective migrants are subjected to structural violence that increases their HIV vulnerabilities. In this process, they are subjected to regimes of medical inspection, reduced to their certifiable labour power, inscribed with nationalist ideologies identifying HIV as a disease that strikes 'the other', and exposed to exploitation that increases their vulnerabilities. After migration, they are made to undergo compulsory periodic medical examinations in the GCC and, if found to be HIV positive, they are forcibly deported without papers, proper diagnosis or healthcare - only to return as 'failed subjects'. Taking a disaggregated view of the state, the paper argues that, in order to be effective, debates on structural violence and the HIV epidemic must make explicit the role of the state in producing migrants' vulnerabilities.

“As Natural as the Air Around Us”: On the Origin and Development of the Concept of Structural Violence in Health Research

“…17 Many of the studies based in the global south examine migration -from violence among internally displaced youth in Haiti 18 to the plight of Syrian refugees in Lebanon 19 and HIV risks for Pakistani labor migrants in the Persian Gulf. 20 Much of the published work on structural violence in the global north has focused on immigrant groups, [21][22][23] indigenous peoples, 24 and marginalized populations such as the homeless. 25,26 Some of the papers in this group invoked structural violence as a lens to analyze domestic violence.…”

“…17 Many of the studies based in the global south examine migration – from violence among internally displaced youth in Haiti 18 to the plight of Syrian refugees in Lebanon 19 and HIV risks for Pakistani labor migrants in the Persian Gulf. 20…”

Precarity and Improvisation: Challenges and Strategies in Filipino Labour Migration

“…The health issues that prevented Anthony and Hannah from accessing migration, at least temporarily, indicate a gap in the migration path that migrants must overcome on their own to access migration. Researchers have highlighted how labour migrants, particularly those from poorer countries, are disproportionately at risk for multiple negative outcomes including ill health, continued poverty, physical violence, exploitation and human trafficking (Gamlin 2016;Huffman et al 2012;Qureshi 2013;Schmidt and Buechler 2017;Vogt 2013). This perspective reveals how certain characteristics and social positions correlate to greater degrees of precarity, risk, and protections, depending greatly upon 'the presence or absence of sustaining infrastructures and social and political institutions' (Butler 2012, 148).…”

Uncivil society: the politics of HIV activism in Pakistan

“…Doctors gave him treatment for sexually transmitted diseases for months before he was finally confirmed HIV‐positive in 1991, at a time when most people in the health establishment had not yet come face to face with this condition. Inconsistency in HIV testing is still a problem for prospective Gulf migrants in Pakistan (Qureshi ).…”