This episode of the Matrix Podcast features an interview with Yan Long, Assistant Professor of Sociology at UC Berkeley who focuses on the politics of public health in China. She was formerly an Assistant Professor of Sociology at Indiana University and a Postdoctoral Fellow at the Stanford Center for Philanthropy and Civil Society. She obtained her PhD at the University of Michigan and her master’s and bachelor’s degrees at Beijing University.
Matrix Social Science Communications Scholar Jennie Barker spoke with Long about her forthcoming book, Authoritarian Absorption: The Transnational Remaking of Infectious Disease Politics in China. In the book, she examines how foreign interventions aimed at tackling the HIV/AIDS epidemic in China in the 1990s and 2000s affected the Chinese public health system, government, and society both in ways that the interventions did and did not intend.
Listen below, or on Apple Podcasts. An edited transcript of the interview is included below.
Podcast Transcript
Woman’s Voice: The Matrix Podcast is a production of Social Science Matrix, an interdisciplinary Research Center at the University of California, Berkeley.
Jennie Barker: Hello, and welcome to The Matrix Podcast. I’m Jennie Barker, your host, coming to you from the Matrix office on UC Berkeley’s campus. Our broad topic today is on public health in China. Since the onset of the COVID-19 pandemic, what affects when and how a government responds or does not respond to public health crises has been a pressing question in the news and beyond.
Some questions that people are interested in are if the regime type of the government matters, such as is it a democracy or autocracy? Does the ideology of the government matter? Does it matter what resources the government has? So this big question is one that our guest today, Yan Long, is addressing in her forthcoming book, Authoritarian Absorption– The Transnational Remaking of Infectious Disease Politics in China.
In the book, she examines how foreign interventions aimed at tackling the HIV/AIDS epidemic in China in the 1990s and 2000s affected the Chinese public health system, government and society, both in ways the interventions did and did not intend.
Yan Long is an Assistant Professor in the sociology department here at UC Berkeley. She is coming to us from Indiana University, where she was an Assistant Professor, and the Stanford Center on Philanthropy and Civil Society, where she was a postdoctoral fellow. She holds a joint PhD in Sociology and Women’s Studies from the University of Michigan, and a master’s and bachelor’s degree from Beijing University. Welcome, and thank you for coming to our podcast.
Yan Long: Thank you very much for this opportunity. I’m very happy to be here to share my research.
Barker: So let’s start our conversation today by getting into the developments in global politics that set the stage for your study of public health in China. In your book, there are two parallel developments that you focus on, the first being the rise of foreign aid from Western governments, and the second being HIV/AIDS activism going global. So can you speak a little bit about the beginnings of these interventions from foreign governments in general and how HIV/AIDS became a big focus for these interventions?
Long: OK, this is actually a quite complicated question. So let me see if I can simplify the historical setting. So what I study about the foreign intervention in China, it happened in a background where global health has really taken the stage and entered the political agenda of international relations. And that did not happen until the late 1990s.
So there are several things, I would say three things happening at the time. So one of the thing is that since the 1980s that all international relations scholars are very familiar with is that the world has watched the rise of transnational governing rules and norms that really forbid, permit, or require particular kinds of government regulations or governing arrangements in different areas, such as finance, security, food, urban development, labor, gender, human rights, et cetera.
So nation state no longer enjoys the ultimate authority in those areas. So that has been the general trend outside health. But we would say that actually in the 90– even until the 1980s, health was so marginal. I mean, people did not think of health as important.
But at the time, there was also a very important shift, which is people start to think– I’m talking about people. I’m talking about the World Bank. We’re talking about development or development banks, those kind of important financial institutes start to think that health is actually really important for development. If you want to establish oversea markets, if you want economic development, you need to have health first. So that’s a major thing.
But then when it comes to HIV/AIDS, especially health, in the time, I’ll just say it wasn’t until the late 1990s when the United States started to take interest in HIV/AIDS. That was started in the Clinton administration. And America was convinced that, OK, HIV/AIDS, that was going on in Africa actually for a long time.
But then it became a security threat. So the US government was convinced, OK, this is something we need to intervene. So it began to lead this campaign to push HIV/AIDS into, for example, the Millennium Development Goals. So HIV/AIDS was the first disease that was put on political agenda.
China and Russia were very much against it, the sort of politicization of the disease, they were very much against it. But the US had made up its mind. And then you would see the Bush administration started the US President’s Emergency Plan for AIDS Relief.
So that was the time when American government began to say, OK, we are going to assume the leadership in global health. That was a very important term. Then the third sort of background I would emphasize is that, again, going back to America, many of you probably know that San Francisco was the horrible center of AIDS activism in the 1980s when the government was not going to intervene in the sort of gay disease.
So American activists, especially gay activists, had to play a very important role in terms of the AIDS activism, how to do it. And then they were also the ones who worked with activists in the global south, such as those in South Africa, to really push HIV/AIDS onto the political agenda. So that’s very important to keep in mind.
It wasn’t just the US government suddenly began to say, hey, HIV/AIDS is important. No, there was a decade of efforts from the activists from the bottom up to push it onto the political agenda. So those were the three, I would say, three background I would emphasize.
Barker: So thank you so much for untangling that complicated question I asked you. And I think we saw and as you document in your book that this focus on HIV/AIDS activism was particularly strong in the case of China. So you had these foreign interveners coming in, and HIV/AIDS was a big focus. So why did China become such a focal point for this type of activism and this type of intervention? So why was China where a lot of this focus was?
Long: OK, I’m going to tell a very cynical version of the story. So, first of all, AIDS activism didn’t start just bottom-up in China. It didn’t originate from inside China. In the 1980s and 1990s, there were some sporadic sort of efforts in China to push for AIDS activism. It was not successful.
But things took a turn in 1999 when US embassy in China began to investigate the HIV/AIDS pandemic in China. So one of the things I want to say is that so China’s largest HIV/AIDS outbreak took place in early 1990s. So it was already– it was taking place. Nobody was taking interest in it.
The outside world certainly knew about that epidemic, which was very specific to China because it occurred among commercial blood donors. So it was caused by blood contamination. So the outside world knew about it, but nobody took interest.
However, as I mentioned, till the late 1990s because of United States, interests have shifted. So the US embassy began to take interest in it. So that started this whole campaign about blaming and shaming Chinese government for not taking any measure against HIV/AIDS.
At the time, it was another development, which was because HIV/AIDS was becoming a political issue. And at the time, there was this kind of fear about how maybe China and India would become the next Africa, OK? So that became a major sort of security threat to the whole world. And also because of all the rising interest and also organizations, a lot of organizations, such as UNAID that was funded for not very long, they really needed a target.
They needed something to say that HIV/AIDS is very important, that China is not doing anything. There was this agenda. So they did exaggerate the scope of an impact of the blood contamination issue in China and all those things. So China provided a target. That was very much so and also because of SARS in 2003. That certainly also emphasized this kind of crisis around public health in China.
So that was when all kinds of interests began to emerge. Like Asia would– I mean, reasonably, you would think because of the huge population, obviously, if HIV/AIDS pandemic happened, that would be a disaster. So there was a lot of organizational and political sort of agenda going on behind those kind of interventions.
Barker: What were some of the changes that they wanted to see in China in terms of their public health and how they were approaching the HIV/AIDS epidemic?
Long: In terms of the particular kind of strategies, it was very typical blaming and shaming basically various international organizations, different Western governments. Also foreign, the media began to blast China, mostly the central government for not taking any measure or intervention in HIV/AIDS epidemic, very rightfully so.
So China had a long history in public health. It was part of the socialist legacy before 1970s. However, after since the 1980s, China pretty much just gave up on public health. It was compared to economic development. It was no longer something important. It had pretty much abandoned the public health and push it to the margin of its political and policy agenda.
So throughout the 1980s and 1990s, you would see the crumbling like really just whole collapse of public health institution in China. So HIV/AIDS was just one part of it in terms of infectious disease control. So they just pretty much denied, OK, we have AIDS epidemic.
It was very similar to what we observe during the early sort of outbreak of COVID-19, not just in China but also in many other countries is this denialism. OK, we do not have this pandemic. We don’t want to inform the people who were infected.
Many people in my research, they didn’t find out about their HIV positive status until like 10 years later. So there was no effort put into it. So that was a major sort of target in the early stage, which was pretty much amplified by the source crisis as the government did not want to invest in public health.
So at the beginning, the sort of foreign intervention was really to call for the government’s attention to public health but also provide technical and funding sort of support to help China. So there was definitely socialization but also like substantial help to assist China in this area.
Barker: And as you note in the book, this new mode of public health, so through foreign interventions, they had these targets, they were providing this assistance, this really clashed with how public health was traditionally dealt with in most states, including in China, where the government was the main actor. The government set the public health policies. That was how it was done. But this was very different. So can you explain what this clash was?
Long: OK, so public health when the concept was proposed back in the 18th century, the idea was public health was really part of the state responsibility. That was very the beginning was set up. So how disease surveillance and prevention usually is considered as something that help the state to exercise and expand its power over people and their bodies. It’s really exercise of control.
This is why you would see a lot of debates around, for example, mask mandates or, you know, quarantine, that type of thing, lockdown during the COVID. That was really the sort of freedom of the people versus control of the state. And then public health is also a domain to establish social contract between the state and its citizen.
So when the state really deliver public health goods, it’s supposed to be the foundation of citizen right claims. So, for example, one security officer in my research, he was saying, OK, if we allow all the foundations to come in or the foreigners who give money and deliver all the things to the local people, then they’re going to listen to them instead of our government, OK?
So it is supposed to be a breach of social contract between the government and the people. So, in many ways, what we are seeing here is that foreign intervention, the problem here is really at stake I would say it’s a sovereignty. It is a national security that type of concern. So that is fundamentally foreign interventions in that kind of area.
For example, I think a lot of political scientists have already commented about how that kind of project in Africa would really damage the sort of national government’s authority and their capacity and so on. But then in the case of public health, there is also the content of what the Western world consider as public health intervention versus the Chinese tradition. So those type of clashes also exist.
So in China, it certainly has its own socialist sort of tradition. But as I mentioned, in the 1980s and 1990s, public health was very much marginalized. So, at the time, they created what I call the socialist contagious model, which pretty much relegate infectious disease to defending socialist moral boundaries.
So it was supposed to be a morality problem rather than welfare and a life problem. So health department would just improvise emergency measures for such a kind of defense rather than developing systematic expertise and technical knowledge of public health responses.
So one of the things about public health measures in China at the time was it was very much antiprofessionalism. So it was very much grassroots, mass mobilization, and so on. But then here comes the Western model. The Western model would emphasize decentralization. So government or nation state does not have the ultimate authority.
It also emphasizes equal partnership between the state and nonstate actors. Mostly it’s nonprofits or civil society groups. It also emphasizes the delivery of technical intervention. So quantitative measures or performance became really critical.
And a major difference is that you can see that not just in China but also in a lot of Latin America or African countries is that public health interventions are delivered in a set of projects. There’s a lot of campaigns. So it’s no longer just a coherent sort of system of, you know, public health defense.
It was rather very fragmented of projects. It’s very a patchwork of project that supposedly to achieve very specific short-term goals and emphasize the sort of return on your investment in terms of the financial investment poured into the project. So that certainly created a lot of clashes, I think, in terms of just the sovereignty but also in terms of the content of public health interventions.
Barker: Yeah, you know, I think this is the great puzzle in your book, which is, you know, there are other states like Russia that really resisted this type of intervention from foreign actors and to their public health, particularly with HIV/AIDS.
But in China, it has a lot of capacity. The government is a strong government. So the puzzle that I think you put forth is why didn’t China resist this foreign pressure? Why didn’t you see China sort of going the path that Russia took? Why did we end up seeing these profound changes in public health administration as a result of these HIV/AIDS interventions in China?
Long: OK, that’s a great question. One thing I want to emphasize is that it was not a calculated decision made at the very beginning. People tend to think that Chinese government is so smart, you know, sophisticated. And that’s no, it was not decided at the very beginning.
So there are several things I would emphasize why China didn’t resist. First of all, obviously, there was, again, going back to SARS in 2003. So China definitely faced much more international pressure compared to any other authoritarian regimes. That’s one thing.
But then you would also say, OK, why not just window dressing, OK? Many people will say, yeah, you take some temporary measures afterwards, then you go back to your normal way. So what’s so different about China? There are two factors I highlight in my book. One is that transnational organizations were very successful in cultivating social movements.
So it put a lot of funding and training into Chinese AIDS activism at the time. And then it also worked a lot in terms of removing the stigma around HIV/AIDS, which was very effective in terms of mobilizing people infected with HIV/AIDS.
As I mentioned, there was a time period, it wasn’t just the Chinese government didn’t want to respond to AIDS, but also people who were infected didn’t want to acknowledge that fact neither. So there was a silence on both end. But international interventions really helped to say, no, you guys should rise up. You’re facing all these problems. You should assert your rights, your claim.
So foreign sort of foreign intervention provided a lot of the ammunitions. It provides this impetus, I think, to sustain the kind of pressure on the Chinese government. I think that’s one thing that didn’t happen in many other countries. Then the second thing is that people tend to think that, yes, Chinese government is wealthy, but it’s not everybody, especially not the specific bureaucrats.
So another thing we need to look at is public health officials pursuit of professional identity. It was a driving force in embracing foreign interventions. When we think about state reaction to external pressure, we tend to think of it as coherent, OK? Iran would have a certain reaction. North Korea has a certain reaction.
But in reality, when you look at beneath the regime, then you will see different departments, different organizational agency, they have very different pursuit, their goals, their resources, and so on. So even though the Communist Party in China had this elevated actually vigilance against the foreign influence since 2000, especially because of the Orange Revolution in Europe, so it was very unhappy about foreign intervention.
However, guess what? Public Health Department in China really welcomed the material resources, the legitimacy, and most importantly, the technical knowledge and professional training. People probably do not know that US CDC– so the China CDC was not funded until 2002. And it was modeled after the US model.
Chinese public health professionals really worshiped the US model for a very long time, say, at least a decade until 2013. So public health marginal position within the bureaucratic system in China made those officials particularly interested in the kind of material rewards as well as symbolic capital attached being accepted into this global health professional community.
So they were really the driving force in terms of welcoming and embracing all kinds of foreign money and models and all those things. But one thing that has shifted since the 2013 was that government became– the Chinese party began to realize that China was actually really good in public health intervention.
It became an area that associated with international power and prestige. So mind you, at the beginning, it was United States who was telling China, oh, HIV/AIDS was important. But then after 2013, it was Chinese government was like, oh, yes, HIV is important.
So it has become part of its political identity, which you can see very clearly during the COVID-19. It’s like, OK, we are this powerful. We are this responsible superpower. We are much better than the US because we can do a much better job in countering infectious disease.
So, at that point, infectious disease control or HIV/AIDS has already become part of the political status to prove China’s high standing in the world. It was also part of the Belt and Road development project that China began to export its own HIV prevention model into Africa and so on. So it has come to a full circle.
Barker: So, as you just very thoroughly discussed, China did engage with these international actors on HIV/AIDS quite deeply, right? But the results that these interventions were expected to bring, probably expected by these foreign actors like these Western governments, these Western organizations, they expected that these interventions might bring like a more liberal population, right?
But that didn’t exactly happen to the public health system in China. And you develop a term for this in your book, which is authoritarian absorption. So what is that? What is that term? What does it mean? And how did you see it play out here with the HIV/AIDS interventions?
Long: OK, so let me start with usually when we look at international interventions, we scholar tend to think it often fail because it happens a lot. So what happened in China, it’s more of a surprise to many people, including me. So here, the Democratic intervention was very critical from the very beginning.
So HIV/AIDS in China for a very long time was seen by many people as a sort of area where you can cultivate the Democratics or behavior, such as election, such as community, mobilization, and so on. However, those type of Democratic intervention techniques can be absorbed by the government agencies into the state apparatus for different purposes.
So by authoritarian absorption, I’m emphasizing two factors. One is that interveners shall train and cultivate social movements to carry the transnational materials symbolic and various practices into a domestic context. But then secondly, the government organizations could have the skills to channel the same movement in ways that basically repurpose those elements for authoritarian purpose.
Because I’m a Star Wars fan, so I actually think this is pretty much it. If you think about how Jedi actually gave Skywalker the training for him to become the Darth Vader, that’s pretty much how it describes the authoritarian sort of absorption in some ways. So I would still emphasize in many ways, international interventions mean to strengthen China’s public health in general.
That goal had failed in Africa in most countries, but it was very successful in China. So that I must emphasize, even though eventually then public health serves the political purpose of amplifying the authoritarian control. But I would still say it was– I would consider it as a success in many ways.
So, to some degree, this absorption was brought about by the Chinese government and by the health agencies, the local health agencies, right? But you also discuss in your book how it was enabled by the practices of these foreign interveners, right?
Barker: And you have sort of a great line, I think, about this, about the attitudes of these organizations. So you quote where you say, can we get the same results for less money? So this was this huge focus of these organizations that were giving resources, money into local health agencies in China, right? And so can you explain why or how these foreign actors sort of enabled this process?
Long: I really love this question because when people think about the expansion of authoritarian world, we tend to think of terms, such as authoritarian resistance. We tend to think it always comes from the authoritarian side. But the fact is that the game, especially when it comes to international development, the game was set up by the Westerners.
So I think there is a general trend, which is manifested, especially in public health, which is international organizations often rely on two sets of authority. One is what we call principled authority, which is political morals and values. That’s when we talk about freedom, democracy, human rights, and et cetera.
However, international organizations have decreasingly relied on those authority because they turn to another set of authority, which is expert authority based on specialized knowledge confined to managerial science and epidemiologic engineering. So that’s when the quantitative measures come into play.
That’s when the idea of the model of you must have good return on your financial investment that come into play. So even on the international aspects or on the international side, you always have this kind of tension between do we want to promote democracy versus how many interventions can we conduct to just given this amount of money?
Can we just achieve short-term goals as fast as we can? And I think this type of shift is especially beneficial to players, such as China. I think authoritarian governments are very good at playing the number game. If you want a number, if you want quantitative measures, they’re incredibly good at manufacturing good numbers. They have super sort of mobilization capacity.
So that kind of game plan would help authoritarian government to rise to the top because the game is set up for them. It is partially is Chinese government’s agencies are very good at adapting, but it is also– it also originate from the fact that the game is set up this way, so you cannot blame them for playing it.
Barker: Yeah, and I think as I was reading the book, some of the same effects of this push for quantification, push for results, I think you can see in a lot of different areas as well. So the area that I’m most familiar with is sort of democracy aid, right? So aid given to these civil society organizations. And you can see also the push to have results, privileges, some organizations over others.
And the ones that may be most effective at actually doing the things that the sort of donors want are the ones that may not have the same capacity to take advantage of quantifying or like, you know, really pushing for these measurable outcomes, right? So it’s super fascinating. And I think, you know, there’s a lot of soul searching that maybe these organizations might need to do.
So I think one of the impacts of this push for quantification and on social movements in China that you talk about are sort of urban gay men’s groups. So one of the primary beneficiaries of these interventions aimed at HIV/AIDS were these urban gay men’s groups. And this is also a puzzle that you put forth in your book.
So why would these urban gay men’s groups be the main beneficiaries, even though sort of male to male HIV transmission is actually quite low relative to other forms of transmission, as you note, and also given the long history of homophobia in the country? Why were they the actors that became more– I don’t want to say empowered but more like they were able to expand their activism?
Long: It was really very long-term sort of a historical process. When I first started my fieldwork in 2007, at that time, victims of blood contamination were certainly at the center of the movement, as you can imagine, because they were also the ones who attracted foreign interventions from the very get go. So their deaths, their suffering at the time were supposed to be the evidence of human rights violation in China, et cetera.
However, as you mentioned, because of the push for quantification, that began– activists in the urban areas– we’re talking about because of blood contamination that happened in the rural areas. And so we’re talking about the people who already had a lot of suffering. They were struggling with disease and all those things.
They were not very good at producing quantitative index or achieving the kind of performance compared to the HIV negative gay men activists in the urban areas. So in the urban areas, not only did gay men groups very effective at producing the quantitative results, they were also at a much more advantageous sort of position to collaborate with the government.
So I mentioned that China became really good at public health intervention largely also because of the assistance provided by gay men groups, OK? So they helped China to consistently sort of put forward higher and higher index and all those things and then which helped the Chinese government to secure more international projects to project this kind of very successful sort of image of public health intervention.
So that certainly helped them to gain favors in terms of providing this model of civil society and the government collaborative model, which they suppose they call it harmonious civil society intervention model as a way to counter against the Western sort of civil society model because the Western model is supposed to be the opposition between the civil society and the government.
But the gay men somehow helped the government to say, no, no, no, we can work together and in a very harmonious way. And this model was then further exported to Africa, OK? So it’s very different. That certainly helped the gay men organizations. But that also gave the government a leverage to repressing the rural activists without the political backlash because now you look at us, OK, we’re so liberal.
We’re supporting gay men organizations. We still have civil society here. I have a separate paper, published at American Journal of Sociology that talks specifically about how this kind of divide and conquer strategy really helped the authoritarian governments to shield their own actions from international attention and international pressure. So that worked out in a way. That was not intended or anticipated by anybody at the beginning.
Barker: Right, yeah. I think you open the book with a very illustrative case about these different trajectories of the two groups you’ve just talked about. One of the activists who you knew sort of at the beginning was a member of one of these urban gay men’s groups, and the other was this member or leader of a rural blood contamination group.
And so, as you note, they both sort of benefited from the space sort of brought by these interventions at the beginning, right? They ended up in quite different places. And I think this is helpful to illustrate what you just explained that on the one hand, you had these groups that were working in a harmonious way, and on the other hand, you had these groups that were sort of repressed and pushed to the side. So could you tell a little bit about these two activists and sort of their different– where they ended up and sort of their different end points?
Long: OK, maybe I should walk back a little bit and talk about gay men groups versus victims of blood contamination. So, as I mentioned earlier, China’s largest HIV/AIDS pandemic really took place because of blood contamination.
So gay men did not attract any attention from public health department for a very long time. In fact, homosexuality was– some researchers had to commit suicide because they were trying to do some research among this group with regard to HIV/AIDS in the 1990s. So for a very long time, it was very strong homophobia among public health officials.
So when I started doing research in 2007, so I met several groups of activists. One group was the victims of blood contamination. So that group has two components. One was like people, Gordon. He was a farmers who used to sell his blood in the 90– he started selling blood in 1994 and then ended in 1995.
And his whole village, probably about 70% of the male adults in his village were selling blood for money. So he got infected. He didn’t find out about his HIV positive status until the end of 1990s when people in his village started to die. So eventually, 30% of people who were infected actually either died of AIDS or other infections or committed suicide.
So there was a wave of just death in the village while the government pretty much denied the pandemic even existed. Another group of blood contamination victims were mostly women because they were using blood products or actually they were encouraged by doctors to use blood products mostly during reproductive surgeries.
So one woman I met, her name is May. So she got infected at the hospital in 1995. Then she infected her baby during breastfeeding. They never realized what’s wrong with the baby. She just went to hospital again and again like so many times until 2004 when the virus infected her brain. That was the girl’s nine years birthday. Just two months after that, she passed away.
So May found out she was HIV positive. Her daughter was positive and then died. That was when they found out. At the time, she already had her second daughter, who was also infected during all those time. So those are the main components of that victim group. Then you have gay men activists. Most gay men activists at the time were HIV negative.
They were using HIV/AIDS mostly as a way to come out and do activism because it was super dangerous. And they didn’t have the space to really just press their claims about their rights simply around homosexuality. But at the time, they were super marginalized. However, as I track those two groups in the following 11 years– I cannot believe it was 11 years– then you would see the divergence.
They used to work together between 2007 and 2009, but then you would see more and more fights and conflict between both groups, especially as the gay men groups became endorsed not only by the Chinese government but also by foundations, Western media and also. By 2002– 2000– no, 2012 and 2013, you would see the gay men had already become the face of AIDS activism. They were publicly endorsed and met by the Chinese government.
And they became this, you know, part of this model of harmonious civil society collaboration versus [INAUDIBLE] and may became just– their activism became– they didn’t have enough support from other parties. And so their movement began to die and pretty much ceased to exist in 2015. But gay men groups are still very active up to this day. So those are the sort of divergence in terms of their different path.
Barker: One of the points that you make in your book and that I kind of wanted to maybe draw out a little bit here is that, you know, social movements or sort of supporting civil society, it’s not just a whole, you know, like a wholesale good, right?
There are the ways that you can see the inequality kind of be reproduced. At least you know you have these urban groups where people are maybe more of the middle class. You know, even if they are, you know, there’s a lot of homophobia in the country, they still are able to sort of– they’re maybe educated, they’re middle class.
They may be able to take advantage of these opportunities in a different way than people who are more rural, maybe less educated, you know, women, whatever, all these different inequalities that you saw kind of part in your research. And so I wanted to draw that out a little bit. And I think you refer to this as the dark side of collective action, right? So just something I think was really fascinating.
Long: Thank you.
Barker: And I mean, just to sort of, you know, maybe conclude on this particular section, I mean, did you see, as you were following these gay men’s groups, any sort of, I don’t know, like what they thought about the fact that they became the face of the movement and these other people who were, you know, also suffering from HIV/AIDS that they sort of fell away? I mean, did they think about it at all or was it just sort of like we have to make do with what we have?
Long: I think a coalition is always difficult for social movements around the world. It doesn’t matter what you do. It takes effort to build. And there was a time, as I mentioned, pretty much in the early 2000, even mid-2000, that there were a lot of funding, Western funding to help to cultivate that kind of coalition and solidarity.
Again, I don’t think this was sort of intended. It was not planned out as one activist, you know, activist group wanted to push another one to the side. It was really a process. One thing I want to emphasize is that both groups from the very beginning, there was a division in terms of their relationship with the government and how they approached different activism exactly because they were using different sources of Western funding.
So, for example, the Western NGOs tend to collaborate much more closely with the victims of contaminated blood, OK? The US government were much more involved with that group compared to the gay activists. The gay activists mostly were working through the public health route in terms of participating in projects.
They worked also much closely with the UN entity. So I think that from the very beginning had created a lot of division. But then because of the quantification trend, quantification trend make many activists to believe that it’s not– like how do you showcase your success, your performance?
They also accepted this kind of idea of if I can push out more quantitative results, I’m just better. I perform very well. They accepted this type of language and discourse, which makes them think, OK, since I can produce more result, that must mean I’m much better than those patterns.
And there must be something wrong with them when they cannot just show the return on the financial investment. So naturally, it creates this kind of hierarchy and which masks a lot of the factors you mentioned, such as class, such as the sort of space, especially in terms of the interaction between different groups.
Like who have the advantage to interact with Western organizations, for example? Must be the urban one. The rural ones, it takes forever to even go to the city. But when you think your success is only built on your own performance, you only think other people’s failure is due to their poor performance. You don’t think of it as something else.
And also, one of the beauty of longitudinal ethnography, which I conducted is that at the time, you really don’t know. You really do not realize a lot of the consequences often show up and appear several years later. Some of the fight or some of the struggle, you just didn’t know. At the time, you were very much concerned with different fights among activists.
You didn’t realize, oh, there is corruption going on. There was the state intervention going on. You did not realize that until several years later. But by that time, the coalition was already damaged. So I don’t think it was intentional. It was– no.
Barker: So I think to shift gears a bit to the takeaways from your book, and I think, you know, what we just discussed, right, which is that, you know, it wasn’t intentional but sort of like the over time sort of impacts of all these different actors. And I think one important contribution of your book is sort of offering a much more nuanced view of these transnational interventions, right? It’s not just a static one-off thing that happens, right?
There’s these downstream effects that you might not have even seen happening or intended to happen or even could have foreseen at all several years later. So I think, you know, thinking about what your book has to offer for this type of research, I mean, where would you like or where do you see the field of research on transnational interventions going in the– like, where would you like it to go? What issues do you think are important to keep in mind for scholars who are interested in this type of work?
Long: I think this is probably a very dark time for us because we’re not talking about global engagement. We’re talking about disengagement. So I would say first of all, this might sound– I think many of my colleagues might not agree with me. But first of all, I do think foreign interventions need to keep going.
I think China is actually– despite of my focus on the side effects, one of the major takeaway is that the intervention was pretty successful. Just imagine without all the infrastructure capacity that HIV/AIDS intervention had put in place, what could have happened during COVID-19?
I mean, it could have just run through 1.4 billion population. That would be a huge disaster to the world. So in that kind of light, nowadays, actually, China is becoming very much excluded from the public health discussion in the United States. I think the disengagement is very disheartening.
So from that angle, I would say just transnational advocacy is great, even though it has problems. But secondly, I do think we need to pay more attention to the organizational sort of dynamics on the ground as the research moves forward.
I think in the past, we paid a lot of attention to the political ideology aspects, the politics, economic aspects, but we haven’t paid enough attention to the fact that all the actors on the ground, their organizations, they have their limitations. They have their resources. They have their goals.
So you need to think about those type of factors and then think about, OK, does it make sense? So, for example, nowadays, if you look at UNAIDS, 20 years ago, there was a bigger critique of China. But nowadays, they’re just praising China left and right. And you got to understand, it’s not just politically motivated. There are many reasons behind that. So how to understand that is very important.
But then thirdly, I think this is also an exciting time, I guess, for transnational advocacy study because in the past, we were very used to how the Western world was providing the help to the poor activists in the Global South.
Nowadays, as you can see, you have Brazil. You have India. You have China, who are very invested in the new term, which is like development diplomacy. So there are new actors on the horizon. And how are they going to affect the landscape, affect the future? I think that would be really exciting to see.
But of course, I’m also worried because in the past, it was much easier to just criticize, you know, the Western imperialism. You can criticize the liberal hypocrisy. Nowadays, you have different actors who are authoritarian on the horizon. So what’s going to happen next? I think it would be a much more complicated thing down the road.
Barker: Yeah, and I think we can conclude, I think, with the question that you just briefly even touched on in your response there, which is what would have happened had this infrastructure not been put in place to help with the HIV/AIDS epidemic in COVID-19?
So, you know, let’s talk about the COVID-19 of it all, right? So how can we use what we’ve just discussed and what your book has sort of, you know, the conclusions of your book, how can that help us understand how China sort of approached and how China fared during the COVID-19 pandemic, which is sort of the question still on everyone’s minds?
Long: Yeah, I mean, I think COVID-19 has posted a lot of challenges to me because I had to really think very hard and deep about, OK, the conclusions argument I put forward in the book and whether it still stands. I would say actually, when you look at COVID-19, you can see a lot of the technique that China had learned through HIV/AIDS programs were certainly had been working really well.
One of the major factor, for example, like Dr. Zunyou, who was the Director of National Center for AIDS, STD Control and Prevention I think from 2005 to 2017, I’m not so sure about ending point, then he became the chief epidemiologist of China’s CDC. And then he became the Chinese version of Anthony Fauci during COVID.
OK, so that gives you some sense about how important HIV/AIDS intervention, the whole program, how does that helped COVID-19 intervention. People sometimes complain about– even at the very beginning of the pandemic when China was performing really terribly, it was so many mistakes. And people were complaining. I totally understand that.
But again, we’re talking about China [INAUDIBLE] did not even exist until 2002. During my research, it was even until 2007, a lot of public health officials did not even have a basic sense of project management, accounting, like really basic managerial practices, OK?
So we’re talking about a bureaucracy that had been learning actually rather fast during this whole time, actually less than two decades. So from that aspect, I would say China had come really a long way. But then there was also the element of, for example, community mobilization that was a big component of HIV/AIDS intervention that was also imported into China, OK?
Then that during COVID-19, you would see the traditional socialist mass mobilization model had been replaced by community mobilization. So that’s why you would see a lot of emphasis on the volunteers, community organizations who were playing critical role in surveillance, basically. So that part is also, I would say, one of the kind of heritage from the HIV/AIDS era.
But overall, I would say COVID was a time that you would see China has really come a long way in terms of building up its bureaucratic infrastructure, building up its professional sort of force in terms of dealing with infectious disease. From that aspect, I would say foreign intervention had done an incredible job. And of course, China has also performed really well because the similar process didn’t have the same result in many other countries, yeah.
Barker: Well, thank you so much for joining us today. This was, I think, a tremendous discussion about, I think, a really important topic. And, you know, I speak for myself, but I’m very glad we have people like you working on these important questions. So thanks again. And yeah, that’s it for today.
Long: Thank you.
Woman’s Voice: Thank you for listening. To learn more about Social Science Matrix, please visit matrix.berkeley.edu.
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