France. French organizations still wonder if migrants are a "specific" group

Sisyphus is not a myth

France is one of a group of southern European countries which have never made a priority of AIDS prevention in migrant communities, according to Rinske Duifhuizen, coordinator of AIDS & Mobility. Consequently, and in contrast to the prevention campaigns based on the right to health and to information in several other countries (see our article, p.4), France may well "discover" a public health crisis (1). Meanwhile, the national debate as to whether or not there exists a "French exception" which slows or hinders prevention among migrants is far from being settled.

How do the participants at Drierbergen who came from France see this issue ? For at least four of the seven French organizations (2) which were present, the groups in France which "work with migrants, notably those who are Maghrebi" are "few" and "suffer from the absence of communication." To "break this isolation", these groups are ready to "organize a national meeting" to "share experiences." In fact, they explain, even though they all work with the same issue and community, they had never met until the Drierbergen conference !

Others believe that the issue of AIDS in the emigrated and settled population will "rise to the surface," adding cynically that AIDS issues had so far been "addressed in the order of the importance of the groups concerned," the immigrants finishing last (3).

Everyone agrees that the "real problem" remains the "absence of people from the migrant community" to deal with on this issue. However, the question of just why this is is seldom asked. For Toufik Abdallah (CRIPS), it comes back to the "very few people - immigrant or not - engaged in the struggle against AIDS alongside the migrants."

Tearing down walls ?

Slowly, a sometime-forced convergence has in fact been happening. It involves the white, gay-based institutional French AIDS service organizations, social work agencies and organizations, the big humanitarian aid structures (Médecins du Monde, Médecins sans Frontières), and, most importantly, the groups which have come out of the legacy of immigrant struggles (Double Peine, neighborhood associations, drug use support groups, etc.) Against all odds but out of political necessity, alliances have already in fact happened, however painfully, on specific issues, such as the fight against the deportation of PWAs (4).

But as "immigrant sections" or committees on AIDS in the cités (estates) appear inside of older organizations, some fear that the traditional organizations will sooner or later prefer to jettison one more additional burden. Some activists, in private, express concern that these groups might, ironically, resort to "community" rhetoric ("the Arabs with the Arabs") to expedite "their" immigrants off to an existing immigrant group, all in the name of the "right to difference," with perhaps a paternalist helping hand to aid in setting up training schemes... Such a ploy would conveniently allow them to get around bothersome questions about the institutionalized racial discrimination, inequality and division of labor in French AIDS activism.

Resurrection of an ideology ?

Among the French group of Dierbergen participants, some are ready to stir the simmering coals of a 1980s debate about French society, put into the terms of AIDS activism : Is it necessary to adapt - or even transform - the assimilationist model which forces individual integration at the cost of the dissolution of emigrated and settled communities ? Those who would like to discuss AIDS and the settled Third World immigrant communities in these terms are, at the very least, convinced that this so-called "Republican" or "Jacobin" model" of "integration" has hindered prevention efforts in France.

Other activists fear that knee-jerk defense of challenges to this "model" constitutes the most effective way to "block everything." "There is no point to bringing together AIDS with debates about French or immigrant identity", they say. Especially since, in practical terms, "there is nothing to keep us from doing a grassroots, community-based project" (5).

More than ten years after the March for Equality, the "twilight of the Jacobin model" exposes its heavily ideological meaning. City streets are far removed from the ideological platitudes of "integration." Racial and class stratification confines ethnic minorities to the peripheries of society. Deepening racial segregation, the constancy of racist and police violence, and the legal, political, and police assault have put in question the very existence of settled communities living and working in France for decades. At the very least, this state of affairs reveals the very large gap between the ideological debate and the fact and persisitence of of communities of existence (6).

So what does it mean to fan the flames of the debate over the theoretical merit of what is essentially one European country’s model for crisis management of ethnic minorities ? If nothing else, doing so seems to be a little hasty, for what do we know about the on-the-ground reality of AIDS in immigrant communities - whether in terms of rights or in terms of epidemiology ? Some basic questions still have no clearly-articulated answers. And how can this knowledge be used to push forward a coherent political project ?

Toufik Abdallah (CRIPS) insists that the feeling of urgency has made it difficult to develop that kind of global vision, to ask the questions. For example, should "migrants" be considered as a "specific group" for AIDS prevention efforts, beyond meeting obvious linguistic needs (7) ? Abdallah also points out that "first of all, the term migrant is much to vague to actually be translated into action."

When we speak of migrants, who are we talking about ? Do we mean the working-class, Third World communities settled in France for decades ? The single male workers who live in workers’ hostels ? Refugees ? The generation whose political baptism of fire came with the 1983 March for Equality ?

"One conference will not be enough. What we need is a group of people committed to working together (8), to publish its work in a manner useful to people on the frontlines," says Abdallah. We have to insist on "what needs to be done, not how people should think."

Abdallah also believes that AIDS organizing for the immigrant community is not an economic one. The possibilities for funding exist, but "it is a question of what the immigrants can and will do. Political support will follow action."

Dr Brahim Miloudi (Espoir Goutte d’Or), one of the people who set up a needle exchange and drug counseling center in Paris’s eighteenth arrondissement, deplores that "in France, we don’t even speak about the specific problems of immigrants," despite the fact that AIDS has been a part of the picture at Espoir Goutte d’Or since at least 1987. And, he adds, "it’s much worse now."

Miloudi cites the example of the German government which has gone at least part of the way toward recognizing the right of immigrant organizations to "control AIDS-related projects which concern them."

Haunted by stigmatization

Stigmatization makes for a difficult dilemma for AIDS organizers. Will public knowledge of the disproportionate impact of the disease result in attempts to blame the epidemic’s victims ? Or is it possible to transform the dilemma into opportunity, to broaden the "fight against AIDS" to, for starters, the fight against deportations, against the Double Peine (prison + deportation). In other words, to push French society into recognition of the disastrous consequences of relegating socially and economically entire segments of French society ? Knowing the facts about the impact of the HIV epidemic on the Black/Third world communities is a prerequisite to even thinking about this possibility.

Miloudi is convinced that "a serious epidemiological study, in a partnership with the Health Ministry, could not be used to stigmatize immigrant communities." But, he explains, statistics about migrants and AIDS in France do exist, yet are considered "top secret." Miloudi cites his own and others’ unanswered requests to the Ministry.

This refusal has pushed him to conclude that fear of stigmatization is used at times as a "political alibi," even though he believes it is otherwise a legitimate issue. "The government does not mention ’fear of stigmatization’ when it comes to identity checks. If there really is a concern, let’s start there."

Ethnic or "racial" origin would be irrelevant to the fight against HIV/AIDS if it had no significance in contemporary France, or if everyone - regardless of origin - was treated in the same way by the health care system. Unfortunately, this has not been and is not the case in France.

(1) The Amsterdam migrants AIDS prevention project began in 1987, Switzerland’s Projet Migrants in 1989.

(2) The groups are the CRIPS, ALS-Lyon (Association de lutte contre le sida), ASUD (Drug users support group), and Espoir Goutte d’Or (EGO).

(3) This statement obviously makes too little of the struggles of these communities, the first ones hit by the pandemic in North America and Europe. At least in the U.S., communities of color were hit by the epidemic when cases were first reported. Starting in August 1981, one in nine cases of AIDS among young gay men was an African-American. The first report on women in April 1982 cited five cases : three Latinas, one white woman, and an African-American. Yet, it took until 1992 for the National Commission on AIDS published a major report on the challenge of HIV/AIDS for communities of color (L. Humphrey and F. Porcher, The Challenge of HIV/AIDS in communities of color, National Commission on AIDS, Washington, D.C., 1992).

(6) A. Boubeker and M.H. Abdallah’s book, Douce France : la saga du mouvement Beur (IM’média, Paris, 1993) and the sole issue of the journal Quo Vadis (September 1993) remain more than ever pertinent. Agence IM’média, 26 rue des Maronites, 75020 Paris, France. Phone : (+33 1) 46 36 01 45. Fax : (+33 1) 46 36 72 58.

(7) Participants in a meeting on migrants organized by CRIPS in 1990 had answered that "no epidemiological data available allows us today to measure the importance of the AIDS-risk [sic] in this population and to designate it as particularly affected." The summary of the meeting insisted on the heterogeneity of the "immigrant" population : "We cannot in any case... from the strict point of view of public health, designate migrants as a specific group which, as migrants, would represent a risk for AIDS transmission" (Lettre d’information du CRIPS 10, July 1990).

(8) Such a working group had been brought together at the CFES (Comité Français d’éducation pour la santé) in 1990, with thirty people from 15 organizations participating. At the time, a call for project proposals from the AFLS (Association française de lutte contre le sida) had resulted in "a certain number" of proposals, and "about ten of them" were in the process of being set up.