Social Science & Medicine 54 (2002) 505–518

Sister cities and easy passage: HIV, mobility and economies of

desire in a Thai/Lao border zone
Chris Lyttletona,*, Amorntip Amarapibalb
a
Anthropology Department, Macquarie University, Sydney, NSW 2109, Australia
b
Asian Research Centre for Migration, Chulalongkorn University, Bangkok 10330, Thailand

Abstract

It is recognised that people movement can increase potential risk of HIV transmission. In recent years, mobile
populations moving across national borders have become a focus for HIV/AIDS prevention campaigns. These
programs generally target border ‘‘hot zones’’ that produce high levels of HIV vulnerability due to the degree of
mobility and the risk behaviours fostered by these marginal environments. However, high degrees of movement and
social exploitation need not be the only criteria for borders to exacerbate HIV vulnerability. The types of social
interactions promoted by mobility take many forms. In this paper we consider a border zone between Thailand
and Laos to show that the links between movement and HIV vulnerability are not confined to stereotypical instances
of coercion and exploitation. Rather we demonstrate that HIV risk in this area is a product of both a sense of
community and a sense of difference that together foster a range of interactions based on mobility back and forth across
the border. As HIV/AIDS prevention programs increasingly control forms of sexual interaction, the border provides a
practical and symbolic opportunity to establish new forms of sexual relationship falling outside these constraints. This
tendency to move outside bounds is not limited to border areas but has implications for prevention programs
everywhere. # 2002 Elsevier Science Ltd. All rights reserved.

Keywords: Mobile populations; Borders; Commercial sex; HIV/AIDS vulnerability; Thailand; Laos; Civil society

Introduction half the world’s population. Borders are often consid-

It is now well over ten years since the Thai
government began its wholehearted response to the dire
prescription that HIV and AIDS forecast both for this
country and the region as a whole. Since then AIDS has
become an ever-present nightmare facing people
throughout Southeast Asia. And yet, after years of
programming, it is clearer than ever that alleviating the
impact of HIV/AIDS still remains a highly politicized
project full of contradictions and complex issues of
identity and responsibility. Recognizing that the ob-
stacles HIV interventions confront are not limited to
encapsulated nation/states, these days the focus of many
foreign funded initiatives, is on border regions and
mobile populations particularly in Asia, home to nearly
*Corresponding author.
E-mail addresses: chris.lyttleton@mq.edu.au (C. Lyttleton),
aamornti@chula.ac.th (A. Amarapibal).
ered magnet areas that heighten HIV vulnerability
largely through the social disruption brought about by
movement across national boundaries (Decosas et al.,
1995; Shtarkshall & Soskolne, 2000). This social unease
fosters a variable set of relationships incorporating
issues of fear, deportation, violence, exploitation and
language difficulty. Uneven power relations and tran-
sience can encourage drug abuse and sexual subcultures,
which increase vulnerability to HIV in border regions
(Porter & Bennoun, 1997).
Like many countries in regions where HIV is
rampant, Thailand offers classic examples of these
border dynamics: Burmese fishermen in Ranong and
brothel workers at key Cambodian/Thai crossing points
are commonly depicted in reports as high risk mobile
populations with attendant high levels of HIV infection
(see, for example, Chantanavich et al., 1999a, b; Caou-
ette et al., 1999). In this article, we consider tensions
provoked by geographic and social proximity to a Thai/

0277-9536/02/$ - see front matter # 2002 Elsevier Science Ltd. All rights reserved.
PII: S 0 2 7 7 - 9 5 3 6 ( 0 1 ) 0 0 0 4 6 - 6
506 C. Lyttleton, A. Amarapibal / Social Science & Medicine 54 (2002) 505–518
Lao border that are of a different order and less obvious
HIV severity than these above scenarios. While borders
are typically peripheral zones that embrace marginal
populations, a study of the dynamics of HIV spread in
these regions also sheds light on the complicated ways
that people respond to disease transmission and modes
of regulation wherever they are. Skeldon (2000) has
emphasised recently that it is not mobility per se that
should concern us most but rather the specific practices
and interactions of people in zones where population
movement occurs in its various forms. By focussing
more closely on behaviour we see that HIV vulnerability
and mobility is not limited to specific groups or specific
locales. As Skeldon notes: ‘‘While the existing cross-
border studies have generated a wealth of valuable
information, the impression given is of isolated ‘‘hot
spots’’ whereas the border towns are integral links in
broader systems of regional mobility.’’ (2000, p. 12)
Although our intention is to highlight issues that make
HIV/AIDS prevention consistently problematic at this
particular border site, the way border zones act as a
crucible for the interplay of psychological, social and
economic forces allows us to identify trends that have
relevance in other parts of the region as well.1 While
there was some opportunity for interviews with Lao
informants, the bulk of our research was conducted on
the Thai side of the border. We thus present a picture
largely based on the Thai perspective.
HIV, civility and mobility in Mukdahan and Savannakhet
In early 1999, a meeting took place at one strategic
border crossing between Thailand and Lao PDR to
address concerns that, like border zones at large, this site
is vulnerable to unbridled HIV transmission. At this
crossing, two sister cities, Mukdahan (population
113,000) and Savannakhet (population 120,000), gaze
at each other across the Mekong River. They are both
capitals of provinces of the same name that share
roughly 80 km of river border. Mukdahan is a hinter-
land province on the eastern fringe of Northeastern
Thailand, well away from the industry and agribusiness
that have been the hallmarks of Thailand’s recent
decades of headlong modernization. It was only
designated a province in the early 1980s and with
314,000 people it remains one of the smallest in
1 2
Qualitative research was carried out during January and
February 1999 in Mukdahan Province, Northeast Thailand.
Ethnographic data were collected through in-depth interviews
with key informants including Thai officials from health,
immigration, and border control departments and a wide range
of locals including traders, pharmacists, service industry work-
ers, truckies, bankers, restaurateurs, villagers and so forth in
Mukdahan city and adjoining districts.
Thailand. Savannakhet, by contrast, is the second
largest Lao city and its most populated province
(population 707,000), although given the divergent
political histories of these two countries, it still lags well
behind Mukdahan in terms of relative technological and
institutional development. It is not simply the unique
proximity of these two adjacent cities, only several
hundred meters apart, that makes this an important
border zone. It has also been chosen as the site for the
second bridge across the Mekong. Construction is
expected to start in 2002 and it will provide a crucial
stepping stone for an envisaged trade corridor that
dissects the heartland of Indochina from the centre of
Thailand across Lao PDR to the deep water ports of
central Vietnam.
The 1999 gathering in the plush hotel conference
room marked the first occasion that Government and
NGO workers from Mukdahan and Savannakhet had
come together to discuss collaboration against the
spread of AIDS. The workshop2 began by depicting
the very different stages of the epidemic on either side of
the Mekong River. Those present heard that Thailand
has had success in mobilising progressive policies to
reduce transmission and offer social and medical services
to the huge numbers who have become infected.3 Lao
PDR, for its part, was described as being at a stage when
transmission is increasing and locals are only just
coming to terms with its real and potential devastation.
At face value, Mukdahan/Savannakhet border region
evidences none of the above-mentioned flashpoints for
extreme exploitation and coercion/vulnerability. It is a
tranquil zone predicated on a strong sense of historic
community. People move back and forth across the river
easily, without fanfare}enforcement when needed is
usually relatively gentle and border police publicly cite
communal human rights based on an enduring sense of
shared culture. Despite the lack of glaring examples of
border exploitation that aggravate HIV vulnerability
there are, nonetheless, trends that would indicate that
this border is not a meaningless concept in terms of
uneven and hard to predict HIV transmission.
The initial presentations at the two-day meeting set
the stage with an epidemiological overview. Here Thai-
land was portrayed as having tamed the brunt of a
previously out-of-control epidemic. For a period of
several years preceding 1999, average national levels of
HIV infection have successively declined in key popula-
Organised by the Mukdahan AIDS Division and co-hosted
and funded by AIDSNET.
3
UNAIDS (June 2000) estimate that at the end of 1999 there
were more than 750,000 Thai with HIV/AIDS; and, during
1999, 66,000 died. In contrast it is estimated that Lao PDR has
1400 with HIV/AIDS and less than 130 deaths. Lao PDR with
just over 5 million people has nearly one-twelfth the population
of Thailand.
 C. Lyttleton, A. Amarapibal / Social Science & Medicine 54 (2002) 505–518
Table 1
Sentinel Survey Category (1998) % HIV seroprevalence
Thailand (national average)
1997 1998
Pregnant women 1.68 1.49
Indirect sex workers 8.26 6.74
tion groups.4 This has been the basis for justified acclaim
directed at the achievements of the Thai national HIV/
AIDS prevention program. Unfortunately, the annual
surveillance around mid-1999 showed that such national
declines cannot be taken for granted as infection levels
have risen in several categories, including pregnant women
(World Bank, 2000), prompting concern that overweened
complacency has been presumptuous and maybe quite
damaging. This is jumping ahead in time, however. At the
conference, while national figures were still depicted as in a
period of sustained decline, data from Mukdahan, on the
other hand, showed the opposite trend. In two of the three
tested groups, infection levels had risen in the past several
years.5 In 1999 they are still rising amongst pregnant
women: amongst indirect CSWs they now hover around
the national average (see Table 1). As in the past, these
figures will probably continue to vacillate and need to be
interpreted with caution but they offer some indication
that in recent years there have been forces in Mukdahan
driving the epidemic in a general direction contrary to that
found in much of the rest of the country .
In Savannakhet it is also difficult to draw definitive
conclusions from local epidemiological data as it cannot
be placed against a backdrop of national sentinel
surveillance based on random testing.6 But the indica-
4
HIV levels are estimated from the data compiled through
national Sentinel Surveillance testing. For details of the history,
categories and data collected by the annual sentinel survey in
Thailand until 1999, see Lyttleton (2000a, pp. 69–81).
5
These three categories are blood donors (which in the
previous several years have shown no cases of HIV infection)
indirect (non-brothel) sex workers and pregnant women.
6
National figures are compiled from the nine Lao PDR
provinces, which conduct HIV tests, not all 14 provinces have
the facilities to conduct such tests. As the Lao National
Committee for Control of AIDS (NCCA, 1999, p. 2) notes of
the reported number of HIV infected: ‘‘However limited
resources mean there is only a limited surveillance system at
present. Hence this figure may not be representative of the
current extent of the HIV epidemic in Lao PDR’’. Likewise, the
WHO (1999) notes that the sample sizes of the Lao populations
tested is usually too small to draw conclusions about national
HIV prevalence; however they estimate low prevalence of less
than 0.1% in the ‘‘general population’’. Most cases of HIV
infected are from the ‘‘hospital patients’’ subgroup and areas
that border Thailand or China.
507
Mukdahan (provincial average)
1999 1997 1998 1999
1.78 0.27 1.42 1.66
6.6 6.12 8.27 6.11
tions are nonetheless worrying. The numbers in Savan-
nakhet that are testing HIV positive have risen gradually
since 1993. Though the number of cases is still small: 60
in 1998 and 75 in 1999, when placed against averages for
the rest of the country they become more arresting. By
December 1999, there were 504 known HIV cases
throughout Lao PDR}nearly half (231 cases) come
just from Savannakhet. The ratio is higher if we consider
only reports since 1995 (see Table 2).
Of all the testing done in Lao PDR (which includes
only certain provinces and is not an anonymous random
sample) the percent testing positive between 1995 and
1999 is 1.24%}by contrast in Savannakhet it is 4.12%.
In 1998, Savannakhet had 2.8% seroprevalence amongst
those tested, in 1999 it was just on 5%. In Mukdahan, in
1998 it was 2.07%.
In short, not only has Mukdahan recently showed the
reverse of national trends, for several years now in
Savannakhet we see higher transmission rates than
across the border in Thailand. In other words, as far as
testing shows, the situation in Mukdahan is getting
worse rather than better and, within Laos, Savannakhet
stands out as a ‘‘hot-zone’’.
There is, of course, a range of reasons one might look
to for explanations for the relatively high transmission
rates in Savannakhet including a historical reputation
for a more freewheeling atmosphere than in other parts
of Lao PDR. Nevertheless, it would also appear that
characteristics at even a tranquil frontier zone such as
this might offer us some answers. While Lao PDR and
Thailand share a common border of more than 1000 km
this crossing is the only locale that has two cities in such
direct proximity.7 How this proximity might potentially
increase vectors of HIV spread was the precise reason
the above-mentioned meeting was convened. Likewise,
the intent in this paper is to question the sorts of
understandings and practices that might be encouraged
by the presence of two urban populations adjoining each
other across a national boundary. The history of AIDS
7
The towns of Nakhon Phanom and Thakek further north of
Mukdahan and Chiang Khong and Houay Xai on the Northern
Thai/Lao PDR border are in a similar position in that they face
each other across the river. They are however of much smaller
size than Savannakhet and Mukdahan and do not include
provincial capitals on both shores.
508 C. Lyttleton, A. Amarapibal / Social Science & Medicine 54 (2002) 505–518
Table 2
HIV cases in Lao PDR since 1995a
Lao PDR
Number tested HIV cases
1995 4775 31 (0.65%)
1996 6588 71 (1.08%)
1997 12,208 108 (0.88%)
1998 4082 102 (2.49%)
1999 8459 137 (1.62%)
Total 36,112 449 (1.24%)
a
Source: WHO (1999) and National Committee for the Control of AIDS, Vientiane, Lao PDR.
in many places shows us that attempts to cope with its
devastation become steeped in a sense of communal well
being and care for our fellow even as, at other times, this
motivation is overruled by fear, prejudice and a concern
with absolute self-preservation. Of relevance to this
article, the gathering of Lao and Thai representatives
clearly profiled the need that AIDS has earmarked with
such horror. It shows us that human needs will, at certain
times and places, operate with a sense of community that
establishes bounds other than those depicted by conven-
tional political or kin-based cartographies.
Nowadays, personal responses to AIDS prevention
discourses throughout Thailand are inseparable from
a background of social and communal response8
(Lyttleton, 2000a). Over recent years there has been a
dramatic surge in the number of community-based
groups and NGOs that have mobilised in profound
and deeply affecting forms of civil solidarity to dampen
the horrors of AIDS9 (Tanabe, 1998). Community and
civility, and the social cohesion these groups imply, have
emerged (in varying degrees) as prime elements of
coping strategies in face of the personal decimation
and social destruction of AIDS. The very basic and
undeniable moral core of these groups shows us that
citizenship and belonging imply far more than politi-
cised notions of national identity. So far, Mukdahan is
markedly different than more inland Thai provinces in
terms of the nature and concentration of HIV/AIDS
services. In stark contrast to many other Thai provinces,
8
With a far shorter history of HIV interventions and far less
public indications of its impact, responses to AIDS in Lao PDR
are still lodged to a far greater degree in personal and
psychological reaction rather than community mobilisation
(Lyttleton, 1999).
9
There are roughly 400 community HIV/AIDS support
groups throughout Thailand. By far the majority, nearly 250,
are to be found in the Northern region that has so far born the
brunt of the epidemic in Thailand.
10
Bangkok based NGO Siam-Care opened an office in mid-
1999 and plans to gradually introduce PWA support services in
Mukdahan.
Savannakhet
Number tested HIV cases
165 19 (11.51%)
250 33 (13.2%)
1404 38 (2.7%)
2141 60 (2.8%)
1503 75 (4.99%)
5463 225 (4.12%)
there is only one recently arrived NGO in Mukdahan10
and little in the way of PWA (people with AIDS) care
and support services. Savannakhet, while home to more
than a few international NGOs, remains a further step
removed in the evolution of voluntary and community
based programs for PWAs. This is not to say that there
are no successful and well-targeted programs under way
in these areas}if anything the meeting underscored the
unswerving commitment of the health and community
workers from both sides of the river.
What it does imply is that the trajectory of responses
to HIV and AIDS depends on a complex intermingling
of discourses of place, public health, and more recently
the entailments of a civil society widely advocated in
Thailand. Locals in Mukdahan are well aware of the
evolving conjunction of these tropes. We frequently
heard the same description of changing attitudes: ‘‘At
first we were taught AIDS was something to avoid and
then to fear, now we are learning how to live with it.’’
Whatever else it means, in this era of AIDS as the pre-
eminent global disease (Haver, 1996, p. 6), civil society
implies notions of a moral community, social responsi-
bility, trust and co-operation (Hann, 1997). It rests
squarely on notions of personhood}who belongs and
who does not, and accountability}who has an obliga-
tion to change, or to help and why (Van Rooy, 1998). In
a region of marked national variation in civil society
evolution (Pasuk, 2000), the convened meeting was a
maneuver to establish a collective space, a work zone
that flanked both sides of the border and focused on
movement and crossing rather than political division.
Even though it remains unclear how this communal
effort will perform in the future there is no doubt that
the impetus and motivation was not born simply from a
sense of mutual need but also from a sense of mutual
obligation. Movement and sexual exchange were the
unstated theme}hope and control the unspoken goal.
As the delegates dined on the Thai bank of the
Mekong and gazed across at the lights of Laos, the very
concept of border served as a geographic reminder and a
fertile symbol provoking connotations of containment
and crossings at many psychic and social levels. Borders
 C. Lyttleton, A. Amarapibal / Social Science & Medicine 54 (2002) 505–518
are all about delineation of boundaries and their
negotiation. They are ‘‘sites of creative cultural
production’’ (Rosaldo, 1989, p. 208) and create complex
flows of ideas, people and goods. In the course of these
flows, borders necessitate unstable forms of identifica-
tion; they operate through modalities of surveillance and
remove, revealing and concealment, transgression and
excitation. And against a backdrop of casual itinerant
crossings, a border itself can become a potent signifier
that encourages certain types of sexual relationship. In
what follows we will discuss how HIV and this
particular border zone come together in ways that
merge a series of tropes. A geographical topos articulates
with one of desire while epidemiological practices that
map disease vectors in time and space mesh with tropical
health tenets of containment. And together they traverse
awkwardly the tensions thrown up by contemporary
notions of civil liberties and the on-going demands of
predictive surveillance. Against this backdrop, there are
three issues we want to consider.
Firstly, there is ever-present mobility across the river.
In many senses, people from both sides consider that
they belong to the same cultural community and endow
each other with qualities that make for a sense of mutual
belonging. Frequently, one hears the comment that these
national neighbours have the same blood running
through their veins}that they are all related. And yet,
although the two cities and many nearby villages are
simply a river apart, Lao and Thai communities are
nevertheless visible symbols of the ‘‘other’’. For more
recent historical and political reasons that divided Lao
ethnicity into two nationalities, they also represent overt
differences that, in turn, allow the projection of many
associated characteristics. These fissures facilitate the
movement of HIV.
Secondly, over the past several years opened borders
and increased market exchange between Lao PDR and
Thailand have provided new opportunities for an
expanded logic of desire. Crossing a border implies a
venture into a new land and/or psychic space. The
implicit sense of symbolic transgression invests certain
sensual interactions with appeal, which is to say borders
offer originary points of excitation. The combination of
(psychoanalytic) economies of desire with those of
(Marxist) capital in modernising societies is a fertile
arena for projections of satisfaction (and one that has
received extensive academic mileage}cf. Benjamin,
1973; Marcuse, 1969; Deleuze & Guattari, 1983).
Together they constitute a very basic element of border
zones that can be tactically deployed in the pursuit of
pleasure.
Thirdly, in an age of (sexual) epidemic with its
attendant monitoring and regulation, desire inevitably
seeks out new forms of expression and attachment.
Borders mark the boundaries of domestic and state
forms of surveillance. Bodies outside these realms
509
become invested with appeal based on this remove and
through the logic of capitalism aspects of sexuality take
on value precisely for this alternative signification. Of
course, borders are also sites of enormous anxiety and as
such offer a complex intermeshing of psychic and
political unity/dissolution (Donnan & Wilson, 1999).
Here, however, we will only concentrate on facets that
relate to forms of sexual interaction within the
Mukdahan–Savannakhet area.
Border mentality: easy passage and constant mobility
Present-day mobility between Mukdahan and Savan-
nakhet is common, everyday and extremely relaxed.
People move back and forth for a variety of reasons.
They have a shared history}before lands on the east
bank of the Mekong were ceded to the French in 1893
these two populations belonged undivided to a uniform
feudal sequence dominated alternately by Lao and
Siamese principalities (Tongchai, 1994). They share a
river}while it poses a clear geographical divide, rivers
also draw people together and, on either flank, villages
are positioned precisely to share in the same benefits
accrued by proximity to the powerful Mekong. Inter-
marriage and migration have established a diverse
network of kin relations and family members live on
both sides. They have a shared social calendar}key
ceremonies readily bring relatives to each other’s villages
throughout the area. Religious festivals share the
Buddhist calendar}festivals and worship days are
staggered within a common schedule and geography that
includes both sides of the river. At a very basic level,
therefore, people here share a language and ethnic
identity11, both in a practical and symbolic sense.
Combined, these factors mean people come and go
easily}they cross to visit, to socialise, to consult, to
worship and to work. The flow might not be uniform in
each of these characteristics but it is regular and informal.
The relatively relaxed border controls mean that while
official passes are legally required and certain Thai
locales of work such as restaurants and massage parlors
routinely checked, folk also move back and forth in
small boats anywhere outside the immediate surveillance
of the checkpoints. The sense of community has led to
very active sharing in other ways as well. The Mukdahan
hospitals and health centres flanking the river play host
to numerous Lao patients. Medical care and supplies
are, by and large, handed out with empathy and a sense
11
While many in Northeast Thailand use the term Isan to
designate their regional Thai identity, they also regard
themselves as Lao by cultural descent. The Isan dialect spoken
(but seldom written) in the Northeast of Thailand is derived
from the Lao language and, a few words and accent changes
notwithstanding, remains closely similar.
510 C. Lyttleton, A. Amarapibal / Social Science & Medicine 54 (2002) 505–518
that discrimination should not apply regardless of the
fact that most fees are not paid. While the Thai riverine
security are informally doing more to police informal
crossing these days at the request of some hospital
officials due to the current economic shortages felt by all
Thai institutions, there is little sense that the numbers
coming for medical help will lessen in large numbers. In
times of hardship, Lao villagers will travel the Thai
riverside districts requesting rice (we do not know if the
reverse is true). The Thai travel to the Lao side for
festivals, trade and in some cases a sense of exploration.
Given Thailand’s status as larger and more economic-
ally advanced, overall the long-term visitors crossing
from Laos outnumber those going the other way.
Mukdahan immigration control figures from 1998 show
20,438 people crossing into Laos and 32,693 entering
Thailand although this does not give any indication of
nationality or length of stay. Nor does it give an
indication of how many cross further up or down the
river.12 In Mukdahan city there is regular demand in the
service sector for Lao workers. Since the economic crash
destroyed the labour option at construction sites, it is
mainly Lao women who find work in the city. Restaurant
owners have made quite clear their dependence on cheap
Lao labour and authorities allow limited numbers of
undocumented workers to staff certain establishments.
So long as they keep a low profile and no venue hires
only Lao staff, police do not carry out restrictive
surveillance. Likewise, domestic help offers a ready
source of employment for young Lao women (and girls).
In the agriculture sector the demand for Lao labour is
regular and seasonal. During rice-harvesting season
many thousands come across from Lao villages along
the riverside and work in the rice fields. They typically
arrive through well-established networks. Some com-
mute on a daily basis but most receive food and board
during the planting and harvesting season. The Thai
economic travails since 1997 have not seemingly
decreased this flow at all. It was repeatedly suggested
that the Thai would happily employ the Lao at half to
two-thirds what they would have to pay a Thai labourer.
Unemployed family members will seek other forms of
work at the official minimum rate (at least 120 Baht/day)
so they can make a profit on the Lao labour (50–
80 Baht/day).13
Beyond the exchange of labour, two other economic
contexts encourage movement back and forth across the
border. Trade: as mentioned the Mukdahan and
Savannakhet location has been chosen as the site of
the next bridge and the many traders in this area are
hoping for extensive windfall from increased investment
in the area. Even prior to the bridge construction
12
An additional 1249 undocumented Lao were repatriated in
1998.
13
At time of writing US$1=$38 Baht.
beginning, trade flourishes between these two cities.
Outside of smuggling, which occurs routinely up and
down the river, most traders establish close networks
with contacts on both sides of the river and move
through official channels at the border crossing.
People-smuggling is another issue. Until the economic
crash prompted concerted repatriation, Thailand had
well over a million migrant workers mostly from
Myanmar (Beesey, 2000). Many of these were undocu-
mented. A 1996 UNICEF report suggests roughly
15,000 young illegal migrants from Savannakhet an-
nually seek work in Thailand (Caouette, 1998, p. 17).
More recently, it was estimated that 20,000 undocu-
mented Lao cross the border each year at Mukdahan
(Country Paper, 1998)}other reports cite similar
numbers coming from southern Lao PDR (Ungpha-
korn, 1998).14 While many of these migrants come
across and make their way independently, local autho-
rities in Mukdahan speak quietly of the presence of nai
na (brokers) who organise mini-vans to ferry consigned
groups of Lao workers further inland. Not infrequently,
these are exclusively women delivered to Bangkok or
other large cities to work in the service and sex industry.
They come across at designated points outside the city
and authorities candidly admit that they have little
chance of apprehending them. Roadblocks on the main
roads are well known and easily by passed.
Just as there exist trajectories of employment in the
bar and nightclub scene in Lao PDR (Lyttleton, 1999),
so too Mukdahan functions as a temporary comfort
zone for young Lao workers unsure of their security in
the faster and more modern Thai world. Typically, they
will spend a year or so in the service industry in
Mukdahan where they are unlikely to receive any sort of
punitive response if they are picked up so long as they
stay within the city zones. Following this the bright
lights and appeal of greater income in the bigger cities
draw many further inland. They have heard tales of
money to be made from the thousands who return
during major festivals or during election times in Lao
PDR when Mukdahan becomes a fast flowing channel
for Lao obliged to return home.15
One of the mechanisms cited as foundational within a
border mentality is that borders represent the periphery,
a zone crucially distant from the center. The end result is
the incidence of people away from secure structures in
which they might trust; in which they place security. A
14
This report describes another important border crossing
that lies about a hundred kilometres south near the base of Lao
PDR and joins the cities of Pakse and Ubon Ratchathani.
However both these cities are more than 30 km inland from the
border.
15
Voting is compulsory in Lao PDR and this brings many
legal and illegal workers back briefly for fear of litigation
directed at remaining family members.
 C. Lyttleton, A. Amarapibal / Social Science & Medicine 54 (2002) 505–518
second criterion is that mobility connotes social disrup-
tion (Guest, 2000, p. 83). The large numbers of Lao
working on the Thai side of the border in Mukdahan are
certainly mobile but because of the prevailing sense of
community they do not evidence the social upheaval nor
are subject to discrimination to the extent that occurs in
some other border zones. The thousands of labourers
who come across to work in the fields from all reports
spend minimal money on casual sex. It seems that the
community and family-style work relationships preclude
what is perceived as wasteful frittering away of funds.
The mobile and casual labour movement appears to be a
relatively minor HIV risk in this context. The social
disruption is not sufficiently sharp-edged, the money not
adequate nor the accessibility of sexual services amply
prominent. Rather it is alternative forms of engagement
that signal potential danger in this area. These engage-
ments are still a direct product of both physical
movement and conceptual reconfiguration. But they
take place in more subtle ways than simply as a by-
product of labour migration.
On the one hand, we see trends whereby Mukdahan
men increasingly look outside the city for casual sexual
contacts. This includes either rural environs or across
the river. On the other hand, the marked shift towards
indirect sex services as opposed to brothel sex has clear
implications for styles of sexual relationship. In both
these instances, sexual relationships in the second decade
of AIDS now rely on new sets of identifying markers.
This newness takes various forms}it is packaged as new
locales, it comes as new styles of interaction or it comes
with the trademark signature of ‘‘difference’’. Each of
these ‘‘newness’’ typologies underpins contemporary
sexual negotiations in Mukdahan/Savannakhet. And
they are inevitably figured through enduring signifiers of
place and identity through which the border confers on
individual bodies and social interactions a potent
mixture of concealment and appeal, transgression and
exoticism.
Alternative movements: new locales, new crossings
Physical mobility to locales with less public visibility is
the first distinct trend. Commercial sex in Mukdahan
has become a low profile and somewhat movable
‘‘feast’’. Several desultory brothels still function down-
town but much of what exists in terms of a commercial
scene has moved outside the city bounds. One of the
very real effects of years of HIV/AIDS campaigning is a
derogatory underpinning to prostitution and this has led
to commercial sex acquiring a more oblique presence in
Thai society in general. This is noticeable in Mukdahan
where there is a tendency for restaurants with serving
women, who are, for all intents and purposes, also
available for sex, to relocate outside the city. Since the
511
economic downturn several of the higher profile sex
establishments, such as massage parlours and resorts,
have closed. Alternative locales outside the city bounds
have opened. A 1999 survey conducted by the Mukda-
han Department of Public Health counted a total of 60
commercial sex venues in the province of which only
four are within the city itself (the official head count
included 330 female staff of whom 102 were classed as
prostitutes). Both locals and health officials suggest that
this trend is due to a sense of discretion newly
imbricated into the commercial sex scene. For many
Thai men, overt commercial sex now bears markedly
negative connotations unless it offers disguising or
mitigating public signals.
In a pattern noticeable throughout Thailand, com-
mercial sex now requires more than just new venues that
include discretion and a remove from visibility for its
continuing viability. It also needs distinct characteristics
that allow relationships to be considered conceptually
discrete from those targeted by HIV prevention dis-
courses. The proliferation of alternative modes of
commercialised sexuality demands that other elements
be attached as public symbols}so that sexual interac-
tion is not the only identifying basis of the relationship.
In this way, potential threat (of HIV infection) is
reduced by dilution. Thus, we see a broadening of the
social settings that are marketed alongside the more
subtle availability of sex. The huge increase in tradi-
tional massage parlours offers an example of how the
supposed beneficial attributes of a therapeutic service
nowadays over wrap the potential danger with which
commercial sex has been coded. Sex comes along as part
of a package}its inclusion within a ‘‘health’’ service
plays a strong performative role in dampening the
negative connotations of commercial sex that are now
well entrenched in the psyche of most Thai men and
women. Narratives can be stretched to define the liaison
as benign rather than dangerous.
Another more localised development is the rise of ‘‘ya
dong’’ restaurants in and around Mukdahan. These
newly opened herbal spirits bars, some of which have
waitresses who sell sex, fit perfectly into this trend of
packaging forms of relationship that lend themselves to
psychological distancing, to building narratives that
underplay sexual risk and highlight instead the immu-
nity of an alternative style of relationship. It may be no
accident that bars selling a mixture of herbal infusions
and alcohol have gained ascendancy precisely at a time
when health (and illness) has become one of the defining
attributes of contemporary modernity in Thailand,16
16
Crawford (1994) makes a compelling argument that health
has become one of the key criteria by which people assess a
sense of self in our current period of late modernity. His
argument is enormously apposite to the situation in contem-
porary Thailand.
512 C. Lyttleton, A. Amarapibal / Social Science & Medicine 54 (2002) 505–518
a sequence assisted largely by the devastating profile of
AIDS.
In the time of the AIDS epidemic, another element
with which newly figured sexual relationships are being
formulated as ‘‘safe’’ in much of Thailand is intimacy.
Relationships that connote a degree of intimacy are
‘‘carefully’’ thought to have greater immunity from
danger. This tendency towards conceptual reliance on
intimacy as a safeguard has emerged from a long trail of
popular and media discourse that has signaled ‘‘the
family’’ as the haven and talisman against the threat of
HIV infection. Against the classic opposition of ‘‘good
girl’’ and ‘‘bad girl’’, relationships which involve a
degree of trust are symbolic of the sanctifying trade-
marks of family intimacy}they take on comfortable
associations of safety.
This symbol is elevated in any number of relationships
that are placed in conceptual opposition to brothel sex.
Therefore, these days more ambiguous commercial sex
relationships importantly require time, companionship
and even affection, in addition and sometimes instead of
material exchange, to a far greater extent than ever
before in order for sex to take place. Largely because of
AIDS the classic brothel script of direct payment for
immediate sex is disappearing from Thai society
(Lyttleton, 2000b). In its place, commoditised sexuality
has moved deeper within the broad realms of the service
industry and is now more frequently predicated on some
degree of intimacy established between the two parties.
Of course, intimacy is a variable element subject to great
conceptual manipulation. The degree to which time
together and companionship established when a client
takes a restaurant singer to a hotel equate with intimacy
is a debatable point. And, of course, both partners will
not necessarily understand notions of intimacy in the
same way.
But the longer time spent together not engaged
in purely carnal interaction, nevertheless, stands in
direct contrast to the 20 or 30 min that might have
typified a brothel encounter so widespread in pre-AIDS
Thailand. It allows the space for the desirable intrusion
of a sense of (manufactured) intimacy as a sanctifying
component immunising the relationship from danger. Its
inclusion, in whatever fleeting form, is a key under-
pinning of new-look commercial sex engagements as a
direct result of the way that HIV and AIDS are
associated with certain sorts of sexual interaction. And
it is precisely the increased conjunction of the ‘‘service’’
industry and sexuality that is relevant in the Mukdahan/
Savannakhet arena. Not only do women from Lao
PDR bolster the service ranks in Mukdahan, in
important ways the requirement for sexuality to take
new forms of commodification as a departure from
those invested with danger integrates Savannakhet
nightclubs into a growing network within the service
industry.
On the Thai side, a substantial percent of women
working in bars and restaurants in Mukdahan are from
Lao PDR. This is recognised as essential to enterprises
that require a steady supply of cheap labour. It is also
recognised that there are number of Lao women who sell
sex. Like anywhere there is a hierarchy of monetary gain
that introduces the trajectory from kitchen worker to
waitress to sex worker although these categories are
never discrete. From all reports it is likely that a number
have been sex workers previously, either in Lao PDR or
in larger Thai urban centres.
At festivals and during harvest time, itinerant groups
of Lao women come across for one or two nights at the
small restaurants and bars along the riverside in the
outlying districts. Sometimes they will cross at dusk and
return before dawn. One group of clients during harvest
time are the owners of the rice crop who must keep
nightly watch over the threshed rice until it is stored (one
attendant problem of being a border zone that promotes
a market in stolen goods is that of theft). We were told
of businessmen in plush hotels in Mukdahan telephon-
ing across the river to Savannakhet and ordering women
for the evening. Likewise, in villages along the border
women are occasionally brought across from the Lao
side to sell services to local men. How safe these
relationships are is unclear. At this point, while knowl-
edge is extremely high of HIV threat in Thailand, both
Mukdahan locals and Lao officials are less sanguine of
their Lao counterparts. It appears that if the woman
does not insist on condom use there are many situations
in which men will find reasons to operate with a
manufactured sense of confidence that they not be
necessary. Thai men frequently indicated that the Lao
women they had met did not insist on condoms and it
relied on their own forethought and diligence to ensure
their use.
So, in sum, the casual and readily crossed border
prompts different sorts of economic and material
exchange. As the larger economic engines draw
Mukdahan women to look inland for work and
education, the tendency is for Lao workers to fill the
gaps, including in the sex industry. A casual and
pervasive sense of local community assists this exchange.
For example, radio requests are made for friends and
relatives on both sides of the river. Lao workers
in Bangkok and elsewhere establish bank accounts in
Mukdahan for their relatives on Savannakhet who
make regular visits to retrieve funds. In this instance
then, we have a tandem movement within this sense
of a shared community. For the men, a sense that
commercial sex is better enacted outside the sur-
veillance arena of the city}in styles of interaction
that signal a remove from brothel sex}is coupled
with an ongoing movement of Lao women into posi-
tions in the Mukdahan service industry inside and
outside the city.
 C. Lyttleton, A. Amarapibal / Social Science & Medicine 54 (2002) 505–518
Borders as signal zones: crossing over into Lao PDR
But even as a sense of community provides associa-
tions of trust and intimacy that undermine the threat of
social disruption that frequently colours border liaisons,
the border itself creates a powerful symbol of identifica-
tion that has other performative implications. In
material terms the divergent forms of political and
economic administration have created markedly differ-
ent realities. The cities of Savannakhet and Mukdahan
are a study in contrasts. Mukdahan is flashy, concrete
and glass: Savannakhet dusty and as yet unrecon-
structed. Several years ago the Mukdahan governor
requested a futuristic tower be planted close to the river
that offers locals and tourists the chance to gaze at the
dishevelled cousin across the river. While the Thai baht
has plunged 50% since 1997, at time of writing, the Lao
kip has devalued more than 500% in practical terms.
This has placed tremendous pressure on fragile econom-
ic security and heightened the appeal of Mukdahan
where the demand is still wide open for cheap alien
labour not constrained by social welfare laws. The Lao,
for all intents and purposes, still find the 50–80 baht
daily wage offered during planting and harvest time in
Thailand far more attractive than the 30 baht for an
equivalent day’s work in Savannakhet. So while there is
a sense of sameness, there are still many indicators and
exigent realities that suggest folk on either side of the
river are not the same.
This inflected sense of difference is fuelling perhaps
the most notable trend in patterns and formations of
sexual interaction in Mukdahan/Savannakhet region.
Since the crash, Thai businesses were prompted to focus
more actively on potential connections across the border
and further afield towards Vietnam. This shift in
attention has meshed with a particular complex of
associated motivations so that a number of Thai men
now increasingly pursue commercial sex across the
border in Savannakhet. It occurs for reasons that
operate at a range of levels. Most commonly is the oft-
repeated description of ‘‘novelty’’. With the increasing
openness of the Lao economy and opportunities for
trade and travel that have emerged since the mid-1990s,
businessmen also encounter a marked increase in the
number of Lao women working in nightclubs in
Savannakhet. They describe sexual interactions as
fresher and a ‘‘newer’’ experience.
For instance, Joe a truck driver, who crosses deep into
Lao PDR every few weeks selling construction materials
described two divergent strategies. On the one hand, one
might buy companionship and sex in the many night-
clubs in Savannakhet. Or alternatively one might
establish a relationship with a village girl by taking
small gifts and a worldly wise demeanour. Either way,
according to Joe, relationships are there for the taking.
The sheer profile of the large number of hostesses,
513
sometimes up to 50 or more Lao (and Vietnamese)
women, in a number of Savannakhet nightclubs dwarfs
anything of comparative visibility on the Thai side
(where the official statistics cite no more than 5–6 CSWs
in any one venue). Or in the villages, suggests Joe, one is
able to establish any number of girlfriends who
immediately gain their family’s support based on the
notion of comparative wealth that Thai identity confers.
And one can cross the river at many points and end up
not too far from small rural roadside shelters on the Lao
side that are home to women who potentially sell sex
(known euphemistically as saw tagiang noi}the lady
with the small lamp).
As a result of these crossings comes the creation of the
sing song fang identity}the lion of both sides}a
euphemism for a Thai man who is able to command
respect and (sexual) attention when he heads into Lao
PDR. Until recently, the Lao side represented danger
and potential arrest for any indiscretions and there is
still a pervasive impression amongst many Thai that
being in Lao PDR is unpredictable and dangerous. But
to a growing number of men this newness conveys a
frontier atmosphere that can be exploited by those
skilful enough. This is not only businessmen, travelling
truckies or salesmen. It also includes the occasional
government official who sees crossing the border as an
invitation to party; or it might be the visiting sports
teams who stay over after the game for extended
weekends. Whereas in many contexts the Mukdahan
men feel somewhat upstaged by the high speed and
opulent life in more populated inland Thai provinces, by
the same token they feel advantaged in material terms
when compared to many of their Lao counterparts.
Psychoanalytic models highlight how symbolic realms
of difference and desire play strongly into each other. In
more concrete terms, the Thai men indicate clearly the
sense of novelty and appeal that carousing (thiaw) in
Lao PDR provokes. Coupled with its distance from the
scrutiny of local community, commercial sex, be it found
in nightclubs, small drink shops or roadside stalls, is
both visible in novel ways and provides an opportunity
for the men to exaggerate a colonial sense of
‘‘conquering explorer’’ endowing local women with
exotic appeal.
Hence, the incidence of Thai men visiting Savanna-
khet and its surrounds (or Lao women beckoned across)
seems of greater relevance to HIV spread than the
reverse scenario wherein Thailand has been historically
portrayed as the magnet to entice erstwhile male
travelers with the siren call of pervasive sex. Not that
it is necessarily cheaper buying sex in Lao PDR (as
women in nightclubs still call for around 1000 Baht and
up). Rather, visiting Lao PDR triggers all the symbols of
a liminal state that borders so commonly evoke
(Douglas, 1966). In Lao PDR, the Thai men are able
to suspend everyday social constraints within this field
514 C. Lyttleton, A. Amarapibal / Social Science & Medicine 54 (2002) 505–518
of desire and with this a prohibitive fear of AIDS that
has lessened commercial sex interactions so markedly in
Thailand.
Border sex and increased value
The appeal of exotic sexual commodification is
amplified in other ways by the conjunction of AIDS
and high modernity. Singer has argued that capitalism
consistently finds new ways of marketing sexuality as
existing forms are demoted by the tainting force of the
AIDS epidemic (Singer, 1993). This means that as sexual
forces and the ethos of capitalism articulate in a time of
infectious disease, sexuality finds new shapes, new
dynamics, new bodies. It looks for ruptures in control-
ling structures within which to figure these new
engagements. In late capitalism, indicated by a shift to
an economy of knowledge and service rather than
production per se, erotic desire becomes evermore
commodified, and to a large extent forms of sexual
satisfaction are aligned more irrevocably with consump-
tion. The process of the displacement and ongoing
commodification of sexuality has all the building blocks
in place in the Mukdahan/Savannakhet nexus. And it is
figured through the potential that border zones provide
to allow new combinations of capital flow and bodily
exchange. As certain forms of sexual practice have lost
their marketability in Thailand, a culture exceedingly
familiar with sexual commoditisation, other forms take
their place. Savannakhet due to its positioning so close
to the urban milieu of Mukdahan now operates in part
as a service industry providing these new forms of
sexuality. What is essential is that they take on market
value and it is here that we see the border playing a more
complicated role.
In the so-called era of AIDS, heightened sexual
regulation inevitably creates the desire/need for forms
of engagement that take place in shapes and locales
outside these demarcated bounds}‘‘The law will always
produce that which is outside it’’ (Singer, 1993, p. 45).
Following the successful promotion of a logic of
contagion, the currency of risk in Thailand nowadays
makes the price too high to pay in many commercial sex
encounters. Certain styles of sex are now marked as too
dangerous. Patronage of conventional brothel sex has
therefore plummeted throughout Thailand (Brown,
1998). But through capitalist creation of needs and
demands (and the myth of scarcity) an alternative
commodity must take on value. One looks for a
substitute currency with which to negotiate, one that
eclipses the negative power of risk.
This search for alternative sexual currency sets in
place movements that have direct and substantial
ramifications. At the meeting in Mukdahan we have
been describing, officials spoke with confidence of the
large reduction in the numbers of Thai female sex
workers}nowadays less than 700 women}in the
nearby large Thai city of Ubon Ratchathani. The
unofficial estimate in Mukdahan was reported as about
300 sex workers in the whole province. In stark contrast,
a representative from Lao PDR suggested 900 women
are nowadays in Savannakhet Province engaging in
‘‘negotiated’’ sex (although this figure was hotly
disputed by some of the other Lao representatives).
What the Thai health officials implied by these figures is
that economic hardship has pole-axed the local com-
mercial sex industry. In this instance supply and demand
is thought to be the clear and simple controlling factor:
men have less money these days therefore there are less
CSWs. While the officials were aware the equation was
oversimplified, it does, however, make the opposite
trends in Lao PDR particularly noteworthy.
From all reports it would appear that the number of
women available for paid sex in Savannakhet is rising.17
In Lao PDR, given the very different stage of the HIV/
AIDS epidemic we find that neither the economic crash
nor the presence of AIDS in the region is immediately
reducing the number of commercial sex interactions. If
anything it is increasing them, or at least the number of
Thai clients in Savannakhet. The opening up of the
market economy in Lao PDR and the sense of material
gain to be had from working in bars and nightclubs so
outweighs any other income options available to women
that, at present, there appears a steady influx (Lyttleton,
1999). Unlike Thailand, the economic forces that are
overwhelming the social sanctions against such work
have not yet had to fully confront AIDS stigma as a
deterrent to women entering this role. For both Thai
and Lao men, sex negotiated with women from the Lao
bars and nightclubs remains appealing in ways that
brothel sex in Thailand does not. The image of such
‘‘sensual’’ albeit ‘‘decadent’’ pleasures still outplays the
sense of danger such relationships have come to embody
on the Thai side of the river. While possibly having less
money than they did several years ago, both Thai and
Lao men beckon to the sexual attractions on offer. They
do this for reasons that highlight the close articulation of
economies of desire with other economies, in particular
that of the production of surplus value around
currencies of risk.
Sexual interactions between Lao women and Thai
men would generally, although not always, involve little
in the way of cultivated trademarks of intimacy/safety
that are becoming more evident in Thailand. More often
than not they play on the appeal of the exotic rather
than the familiar. Nevertheless forming a relationship
with a Lao woman in a dancehall or a rural village
17
See also CARE (1998), who note ‘‘Most of those
interviewed believe that the number of women working as beer
bar workers will increase over the next few years’’ (p. 7).
 C. Lyttleton, A. Amarapibal / Social Science & Medicine 54 (2002) 505–518
evokes far less of the warning signals flagged in red by
years of media discourse in Thailand and some of the
enabling signposts are in place. In Laos there is no
equivalent of brothel sex as it is known in Thailand and
on one level this very difference signals distance from a
now familiar threat. The element of extended time is
present}relationships must be negotiated and a locale
and an appropriate time for the union agreed upon. And
given the illegality of commercial sex in Lao PDR, trust
is most certainly involved. Yet even with these char-
acteristics, a circuitous route must be traversed within
the local economy of desire because few Thai men
assume sex in Lao PDR is necessarily ‘‘safe’’ (although
some might to a lesser or greater extent). In a world
where sexual desire is plastic and figured through a
strong desire to conceptually diminish risk, intimacy as a
crucial element is deployed in more subtle ways through
the notion of community and cultural familiarity.
The erotic appeal of the Lao women is figured on the
one hand by their very difference, they are new, they are
exotic. They are from the other side of the border. This
difference confers market value when placed against
existing devalued forms of commercial sex on the Thai
side. But while this sense of difference might also
undermine the depiction of ‘‘safety’’ that commodified
sexuality in Thailand now increasingly relies on, the
strong sense of community that flanks both sides of the
river is strategically deployed to bolster their value.
These relationships rely on this sense of non-difference
to allow for trust and safety to be crucial elements of
their commodity value. Lao/Thai social and symbolic
community is evoked to provide the reassuring hall-
marks of comfort and safety. Lao women are the Other
in terms of erotic appeal; they are non-Other in terms of
prohibitive HIV threat, they can be trusted, they are kin,
they are part of the same community.
A reverse scenario does not necessarily take the same
shape as the configurations and dynamics we have
described are quite different. The notion of Thai
businessmen taking Lao visitors out for the evening is
still par for the course. But we heard it described that
Lao men are less keen on the provision of the ‘‘bed-
mate’’ package as nowadays ‘‘they are nervous of gossip
back home, or anxious at the prejudicial reactions of
Thai women’’. The validity of such comments notwith-
standing (as it was Thai men relating these details), most
Lao men nowadays perceive commercial sex in Thailand
as highly dangerous and largely to be avoided (CARE,
1995). Nevertheless a sense of difference in all its modes
plays a part in most social interactions that cross the
river. Moreover, it works simultaneously as a sense of
community is evoked. So the Thai/Lao are both the
same and different. This allows for trust on the one
hand, and distinction on the other. The combination is
perfect for the establishment of regular and fleeting
sexual relations, at this point in time between men from
515
Mukdahan and Lao women}comfort and exotic appeal
are present in equal measure to ensure some degree of
intimacy is conjured.
Civil society, trust and the politics of suspicion
We can also link the evolution of styles of sexual
negotiation and the implication of alternative signifiers
that confer appeal more closely to aspects of the
contemporary ‘‘civil society’’ responses to AIDS that
are emerging in Thailand (and being used as a model for
its neighbours). Thai HIV prevention policies have
actively embraced the notion that human rights are
paramount and that anonymity and dignity is crucial to
the appropriate provision of services and intervention
activities. Social capital in the sense of generalised
community well-being is promoted in this vein in many
government and NGO activities (Pasuk, 1999). This, in
turn, elevates the importance of investing in trust and
invigorates the links to ‘‘intimacy’’ as we have been
describing it. Liberal (Western) democratic values
dictate that individual self-determination is at the heart
of civil society manifestations. The implications of this
ethos are that it is up to the individual to determine to
what extent he or she takes on the public, and sadly,
often-stigmatised aspects of identification with HIV
infection. The flip side to this is that everyone knows
that HIV is tremendously widespread in Thai society,
but that those infected cannot be automatically identi-
fied in policy or practice. This is the laudable direction
that has actively been chosen for Thai attempts to come
to terms with HIV and AIDS. How it works in practice,
of course, varies in degrees: witness, for example,
enforced testing still conducted in some Thai hospitals
and factories (Thai Development Newsletter, 1996, p.
26). In Mukdahan, support groups have yet to coalesce
as HIV infected and PWAs remain unsure about levels
of social acceptance; the health authorities that are
charged with organising such groups totally respect this
position. Disclosure is a variable practice and how could
it be otherwise?
Where this leads us, however, is to the notion that as
commercial sex relations are seldom built around
disclosure of HIV status, adjudications must be made
based on other characteristics. Everywhere in Thailand
people are aware that HIV and AIDS is widespread. But
the policy of anonymity, elevated as a civil response,
causes a wide range of reactions. Some find alternative
modes of stigmatising individuals for associated beha-
viours. As we have suggested, one sees the emergence of
intimacy as a litmus test for a ‘‘safe’’ relationship. It
comes as part of the package of policies that encourage
the growth of a civil society response to AIDS that
devolves to mutual support. Trust, as the crucial
predicate of intimacy, is fostered in this space created
516 C. Lyttleton, A. Amarapibal / Social Science & Medicine 54 (2002) 505–518
for individual integrity that is at the heart of a civil
society. Unfortunately, it also automatically fosters the
less benign flipside: an operatics of suspicion. Suspicion
(and how to overcome it) emerged as a key sub-text at
the Mukdahan meeting; suspicion that highlighted how
borders inevitably imply the ability to withhold not only
permission to pass but also permission to know.
Conclusion: border exchanges, border controls
The combination of physical mobility, conceptual
manipulation and a politics of suspicion was evident
most clearly in the meeting’s debate over how best to
address issues of HIV transmission in this border region.
Unsurprisingly, much of the discussion focused on
mobility and commercial sex was set against a backdrop
of contrasting experiential and epidemiological data.
Thailand has now had a decade of highly organised,
well-funded and sophisticated programming upon which
to reflect. Lao programs have a shorter history, have
made less headway and, by the same token, so far
confront a problem of far less magnitude.
First and foremost, most delegates expressed a keen
desire for the exchange of knowledge. For their part,
Thai representatives wanted to know how serious the
situation is in Lao PDR. They are used to their own
well-publicised sero-surveillance data being the corner-
stone of all programming. They are equally familiar that
the local version of the Cold War has meant that in Lao
PDR information is a closely guarded commodity.
Above all, they wanted to know if HIV is rampant
‘‘over there’’? Does Lao PDR represent the ‘‘dangerous
Other’’ who could threaten to swamp them on this side
of the river and should the border therefore become a
reinvigorated symbol of control? For as Sabatier (1996,
p. 87) notes, any society which feels threatened responds
by intensifying the controls which regulate its margins.
In exchange for such insights, the Thai felt they could
offer their experience with health promotion materials
and intervention programs based on prior knowledge:
knowledge largely generated by sophisticated testing
procedures.
The Lao were equally interested in assessing the
severity of local HIV levels. They wanted to know how
many Lao were coming across to Mukdahan for
treatment}they wanted to know how they might learn
to do more widespread testing. They were aware that
testing was a crucial but hugely problematic issue and
knew that the Thai carry out effective national
surveillance testing. They wanted to know how best to
set in place similar techniques that would allow them to
confront the scale of the problem in Lao PDR and
conduct some sort of contact tracing and service
provision.
A focus on predictive surveillance was, therefore, a
key issue. It underscored the tensions thrown up by HIV
spread in a border region and equally those provoked by
HIV containment in face of civil concerns with
anonymity. Everyone present was aware of ever-present
mobility and a resurgent sex scene. Borders rely on
control and containment: so too do infectious disease
control policies. Together these sit uneasily with notions
of voluntary collectives, individual autonomy and trust.
The tensions between social control and individual
integrity erupt regularly in AIDS work. At a local
briefing I attended while conducting this research, the
District Officer said that if the women in the restaurants
refused to be tested then they should be restrained until
they agreed. Disgruntled villagers had recently burned a
temple compound in a remote part of Mukdahan that
sheltered and treated PLAs. Back at the meeting,
delegates were intensely galvanised by the notion of
promulgating a law that would criminalise anyone
knowingly infecting someone else. A tale was told of a
man with AIDS who would rest in a Mukdahan hospital
by day and traverse the city seducing women by night.
True or not, it quickly gained all the resonance of an
urban myth in the conference room and a heated
discussion followed as to how to protect the ‘‘innocent’’
from such deviant behaviour. This was the greatest
worry}how to control individual infected bodies and
thus protect the social body. Thai and Lao were in
chorus with the desire to contain by adequate knowl-
edge, in this case, by knowing rather than suspecting
who is infected. The problem of HIV and AIDS was
seen as resolved by concentrating on specific bodies,
bodies to be identified by HIV infection or failing that
by risk practice. Border policing was the instrumental
safeguard: containment the goal.
Concepts of ‘‘the border’’ and repetitive crossings
(epidemiological and otherwise) take on particularly
discursive functions here so it is not surprising that these
responses emerge from a gathering convened on the edge
of the Mekong. Some AIDS workers cautioned that
adequate knowledge is purely an overall sense of HIV
transmission and the social factors that either facilitate
or hamper this spread. Actual numbers, they argued are
not required; absolute empirical data is not essential to
sensitive and appropriate programs, actual borders need
not be empirically ascertained and epidemiological
cartography’s need not be etched with finality. But
while they echoed all the tenets of a civil society response
they were going against the grain of the conference
mood. Borders, most people felt, were the reason they
were gathered together; borders as a symbol needed
better definition, not dissolution.
Even though the overriding emphasis of the meeting
was on brainstorming collaborative efforts to address
HIV spread in a border region what also emerged as an
underlying element is how notions of borders create
 C. Lyttleton, A. Amarapibal / Social Science & Medicine 54 (2002) 505–518
their own repetitive dynamics. The very idea of a
meeting designed to highlight the heightened vulner-
ability of border areas automatically offers a ready-
made vocabulary of difference that is so familiar when
notions of infectious disease are evoked. For several
delegates it was clear that impersonal public health
monitoring and control rest awkwardly with the
precepts of anonymity and human rights. Testing must
be kept anonymous, some suggested; this is the
fundamental basis of sound and socially sensitive AIDS
programming. It allows voluntary coalescence of sup-
port groups receiving assistance on an as-needs basis
from government funding bodies. This process is
underway in Mukdahan although to a very much lesser
extent than in other parts of Thailand. However, the
very absence of clearly demarcated target groups that
this approach implies, that is, a general population that
may or may not put forth coalitions of people at risk or
infected, poses difficulties for interventions that are used
to having bodies and types of bodies on which to focus.
This then sets in place a politics of suspicion where the
desire to control focuses on bodies most commonly
denigrated by HIV stigma. If knowledge is not concrete,
and conceptual bounds not premised on distinctive
characteristics, in their absence anxiety and paranoia
will create their own targets. Suspicion will find its own
constituents.
This tendency to find categories of people by default
was most clear when the discussion again and again
returned to types of people who should receive the
attention of joint programs. This was not simply a
product of wishing to best design appropriate interven-
tions but seemed to be born of a desire, like health cards
for CSWs, to isolate the range of threat. Inevitably,
therefore, the primary group was women involved in
selling sex. Or, as mentioned, the individuals who might
willingly spread the virus. Categories of people were
needed to fit the templates of program action. And yet,
and this is the most relevant point, the very dynamics of
a border zone destabilise such endeavours. Just as
epidemiology is performative in establishing its risk
group constituency (Patton, 1995), so too borders
perpetually undermine this sense of aggregation. The
lack of any conclusive strategies emerging from the
meeting highlights this dilemma. Mobility and desire for
the ‘‘other side’’ are key threats both in the context of
Thai men in Lao PDR and Lao workers in Thailand.
Capital and sexuality will continue to find their own
shape in Mukdahan/Savannakhet. At the time, the
gathered public health delegates remained anxious these
shapes and commercialised networks were not within
their gauge. Their concern is as relevant today as it was
then. For this is precisely what makes Mukdahan/
Savannakhet a typical border zone: the constant
destabilisation is what makes local people there con-
sistently vulnerable to HIV infection.
517
Acknowledgements
We are deeply grateful to Dr. Supang Chantavanitch
and the Asian Research Center for Migration at
Chulalongkorn University for facilitating this re-
search}any errors in interpretation are of course our
own. We would also like to express our gratitude to the
Mukdahan health officials, in particular, staff of the
Mukdahan AIDS Division for their cooperation and
help in this research. Our thanks also to AIDSNet for
their invitation to take part in the Mukdahan planning
meeting. A Macquarie University Research Grant
funded the research.
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