Abstract
Goa (India) is (inter)nationally known as a reputed tourist destination. Tourism is recognized as the most important industry of the Goan economy, especially considering the politico-legal freeze on Goa’s other major industry – mining. With HIV/AIDS playing much havoc particularly in the developing world, with India (and Goa) not being spared, the present article is an attempt to shed light on the vicious connection between haphazard, unethical or volumes-alone-focused tourism, and HIV/AIDS. Considering the serious nature of the impact that HIV/AIDS bears on individuals, households, communities and economies, the article concludes that ethical, responsible, and community-based tourism is needed to contribute to the prevention of HIV/AIDS.
Background
Tourism is a unique industry; one made up of diverse industries, activities, and providers, each acting individually as well as conjointly to satisfy the needs of a tourist. India has been known down the ages as a tourist destination. The mushrooming of travel agencies, advent of charter flights, organization of international travel marts, increased publicity, improvements in transport, increase in disposable income, frequent fall in the external rate of the Indian rupee etc. have all contributed to the gradual rise in tourist arrivals in India and in Goa in particular. Acclaimed the world over as a tourist destination, Goa, located on the southwestern coast of India, has a population of about 1.5 million people and is known for its pristine beaches, cultural events, places of worship, and world heritage architecture. According to the provisional figures made available by the Department of Tourism, Government of Goa, during the year 2013, the state received a total of 3.12 million tourists, of which 2.63 million were domestic and 0.49 million were foreign tourists. 1 Goa, which was under Portuguese colonial rule until the year 1961, unlike most other Indian states, boasts of a relatively western and liberal culture, as well as very good ratings in the national context on many socioeconomic parameters including those pertaining to literacy and per capita income.
Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) has been a bane the world over. On account of its severity in many countries the Red Cross and Red Crescent have even considered classifying this disease epidemic as a “global disaster” (Foulkes, 2008). In the year 2012 there were an estimated 35.3 million people living with HIV/AIDS globally (UNAIDS, 2013, p. 4). According to UNAIDS, 19 million of the 35 million people living with this disease do not know that they have the virus. 2 Since the beginning of this international epidemic, while almost 75 million people have been infected with the HIV virus, about 36 million people have died of AIDS. 3 Almost 90–95 percent of the newly infected persons are from developing countries. Apart from sub-Saharan Africa, the disease has left its ominous mark in Eastern Europe, the Caribbean, and parts of East and South Asia, all of which coincidentally are tourist destinations. India has the dubious third ranking in the world in terms of HIV positive (HIV+) individuals (Ramachandran & Rajalakshmi, 2009, p. 23; Sinha, 2007, p. 6). As of the year 2011, there were an estimated 2.1 million people living with HIV (PLWHA), with the adult prevalence being about 0.27 percent of the total population (GSACS, 2014).
In Goa, ever since its first detection in the year 1987, there have been an increasing number of HIV+ people in the state. As of May 2014, the total number of HIV+ cases detected in Goa since 1987 was 15,418; the total AIDS cases reported were 1,645; and the reported AIDS deaths as of April 2014 was 1,029 (ibid.). The National AIDS Control Organization (NACO) considers Goa as a moderate prevalence state; bordered by the high prevalence states of Maharashtra and Karnataka; 4 with the South Goa district even being included earlier as amongst the high prevalence districts in India. 5 According to the statement of the state health minister in the Legislative Assembly in August 2014, 1 percent of the people of the state of Goa were affected with HIV, with there being not a single village in the state which had no person affected with it. 6
Most PLWHA are in the productive age group of 15–44 years. About half of all HIV infections occur among people below 24 years of age, indicating the inherent vulnerability of youth in most cultures, a fact which is constant even though there are many different contexts within each culture (WCC, 2002, p. 15). Presently there is a great deal of discourse about the feminization of the epidemic (Falleiro & Noronha, 2012a; Medhini, Jain, & Gonsalves, 2007, p. 449; Pradhan & Sundar, 2006). HIV/AIDS is concentrated among the poorer and marginalized sections of society, with poverty being the cause and consequence of HIV/AIDS. Individuals with high socioeconomic status have not been spared of HIV (Rao, 2000, p. 495), with contributory causes for HIV being: (i) high education and income making it easy to support and/or attract additional commercial/casual sex partners; and (ii) those with more income/education being likely to travel and have more opportunities for variety of sexual contacts (Israni, 2001, p. 157; Ramakrishna, Pelto, Verma, Schensul & Joshi, 2008, p. 386).
Ever since its first detection, HIV/AIDS has snuffed lives, dissolved households, destroyed communities and even shaken the economic foundations of some countries. HIV/AIDS has severe implications, including those of economic, psychological, legal, ethical, political, and social nature. With reference to the economic impact, HIV/AIDS has been found to depress growth rates and national income, accentuate gender inequality, increase poverty, and workforce participation among minor children (Falleiro, 2014a; Ojha & Pradhan, 2006; Pradhan, Sundar, & Singh, 2006). While according to the National Council of Applied Economic Research (NCAER) in the absence of remedial policy the HIV epidemic in India during the period 2002–2003 to 2015–2016 would likely push up health spending, erode savings, crowd-out investment and hurt economic growth (Ojha & Pradhan, 2006, pp. vi, xxi; Sharma & Baxi, 2007, p. 12), ADB and UNAIDS indicate that HIV has slowed the annual rate of poverty reduction by 23 percent in India between 2003 and 2015 (in UNAIDS, 2008, p. 170). At the individual/household level, the areas of economic impact of HIV/AIDS include loss of income and increased expenditures 7 both of which have long-term adverse impact on savings and asset-holdings, with household members having lower long-term accumulations of human capital; while food (Falleiro & Noronha, 2012b) and non-medical consumption expenditures decline significantly in HIV/AIDS households, there is simultaneously a significant rise in medical expenses and borrowings (Falleiro, 2014b; Falleiro & Noronha, 2011; Ojha & Pradhan, 2006, p. 3; Pradhan et al., 2006).
HIV/AIDS and Tourism
HIV/AIDS has a visible impact on certain sectors, particularly those that use unskilled labor intensively. According to a NACO/UNDP/NCAER study, one major sector affected by AIDS, is tourism (Ojha & Pradhan, 2006, pp. vi, 3). For a study pertaining to the time period 2002–2003 to 2015–2016, tourism was found to suffer the maximum loss of 18 percent in value added terms in the “with-AIDS” scenario in the final year 2015–2016. UNAIDS (2008, p. 171) citing Piot, Greener, and Russell (2007) highlights how the cost per AIDS death or retirement (as multiple of annual compensation) and aggregate annual costs (as percentage of labor cost) in Zambia was as high as 3.6 and 10.80 respectively.
A vicious relationship often coexists between tourism and HIV/AIDS. While unplanned and unethical tourism can contribute toward rise in HIV infections via causes like increase in prostitution and use of intravenous drugs; rise in HIV+ cases can lead to a fall in tourist arrivals. With regards to the latter, HIV/AIDS can scar the tourist industry if a place gets identified for its high levels of HIV infections since this can discourage good, no high-risk behavior tourists from arriving because of the apprehension of the safety of available health services (see Bloom et al., 2004, p. 62; Mahal & Rao, 2005, p. 588). 8 HIV/AIDS indirectly affects tourism and other service industries due to the high cost of (re)training and replacement of workforce, possible increase in wage cost due to labor shortages, and loss of consumer markets (Gaigbe-Togbe & Weinberger, 2003, p. 35; Rao, 2000, p. 499). ILO-AIDS reports HIV/AIDS reducing labor productivity and increasing labor costs in the tourism sector (Afsar, 2010).
Notwithstanding the above, the focus of the present article is on the impact of unplanned, unmonitored, and unethical tourism on HIV/AIDS. According to Ranjan Solomon 9 tourism thrives on the opportunities it offers for people to have new experiences; this fact alone accounts for the frequent identification in many minds of tourism and travel with sexual adventure. He adds, because tourists seek new experiences, they also enjoy what they perceive as safe risks, such as sex or drug use – characteristics of the illusory or exotic worlds created by the tourist experience; tourism as a personal experience and as an industry, thus, creates an environment where diseases such as HIV/AIDS may thrive. According to Avert (2012), “sex tourism” is one of the ways interlinking HIV, sex work and mobility, whereby clients travel between countries seeking paid sex. Sex tourism fuels the demand for sex workers in many countries, including parts of Asia. In some cases, men travel to other countries to take advantage of lenient “age of consent” laws or because they know they will find it easy to find paid sex with underage girls or boys (ibid.).
Concerns for Goa vis-à-vis Tourism in Light of HIV/AIDS
The prime concern for Goa, an internationally renowned tourist destination with no comprehensive tourism policy yet in place, is not whether HIV/AIDS will have a bearing on tourism; instead, it is on the adverse influence that haphazard, irresponsible, and unethical tourism can have on HIV. Though no empirical study is available on the micro influences of tourism on HIV/AIDS in Goa, the connection between the two cannot be ignored. In India, 83–85 percent HIV infections have been acquired through the sexual route, with sharing of injection equipment during drug use responsible for 2.2–4 percent cases; in 6.8–7 percent cases the history of transmission is not available, with a possible cause of these nosocomial or unexplained cases being blood exposures in health care and cosmetic services (Correa & Gisselquist, 2005). In Goa, majority of the HIV+ cases are located in the coastal belt and talukas (Falleiro, 2014a; GSACS, 2014); 10 with sexual route being the predominant mode of transmission in as high as 83 to 96 percent of the cases (GSACS, 2014). In his study covering HIV/AIDS and non-HIV/AIDS households in Goa, Falleiro (2014a) found in the former relatively more HIV+ respondents working (or who worked earlier) in the tourism sector than respondents from the non-HIV/AIDS households. The above is fairly useful to bring some definite link between tourism and HIV. The connection, however, is not an indictment of tourism; it is only indicative that tourism 11 can play a role in the spread of HIV.
Some concerns for Goa with regards to haphazard and unethical tourism (the latter with reference to “sex tourism” and “child sex tourism”) in light of HIV/AIDS are those related to prostitution, pedophilia, businesses/cartels involving foreigners (enclave tourism), casinos, rave parties, and unplanned increase in infrastructure.
Prostitution
While prostitution is claimed to be the world’s oldest profession, movement, and travel of people (for various purposes) has been recorded to exist for centuries. There is a vicious cycle between tourism and prostitution. While prostitution thrives with mass and haphazard tourism, (unethical) tourism expands because of the sex industry. In Goa, local media report frequently of sex rackets and trafficking of young girls into the sex trade. Leaving aside those forcibly or deceptively lured, survival and pure economic gains are primary reasons for those in the trade (see Israni, 2001, p. 156; Mahal & Rao, 2005, p. 593; Medhini et al., 2007, pp. 456, 566–567; Sahni, Rohini, Shankar, & Apte, 2008; Verma, Pelto, Schensul, & Joshi, 2008). A relatively new feature of the sex trade in Goa is the brazen publicity of the same on the Internet portraying the state as destination for “easy” girls. Interactions with those in the travel/hotel industry reveal hordes of “tourists,” domestic and foreign, visiting Goa primarily for sex – either as buyers or suppliers. Incidentally, studies have shown 0.7 percent of the female urban population engaged in commercial sex activities in Goa (Nair, 2009, p. 4). At present Goa is increasingly getting the reputation for high-end sex workers (including those flown in from Europe, particularly Eastern Europe), often veiled as masseurs of spas and beauty parlors.
Commercial/female sex workers (CSWs/FSWs) are among high risk individuals for acquiring/transmitting HIV infections. Globally, FSWs are 13.5 times more likely to be living with HIV than other women (UNAIDS, 2013, p. 20). It is not something unheard of CSWs handling 5 to 10 men per day. According to the Sentinel Surveillance for HIV infections in Goa, HIV prevalence among FSWs was 2.70 and 6.40 percent for the years 2010 and 2008 respectively (GSACS, 2014). Incidentally, the demand side of the sex industry is often driven by clients who can financially afford the services of sex workers and demand services exclusively on their own terms. Mobile populations (migrant laborers, truck drivers, tourists etc.) who often have considerable amounts of money, are especially likely to demand commercially available sex or engage in multiple-partner sex (Bloom & Mahal, 1996); this connection is strengthened since behavior of the mobile populace is not easily monitored by their families/communities and because they may be lonely due to separation from their families (in Mahal & Rao, 2005, p. 593).
Prostitution contributes toward the contraction of sexually transmitted infections/diseases (STIs/STDs). Clandestine nature of sex trade, lack of legal provisions and discrimination leads to the increase in HIV (Verma & Roy, 2002, p. 80); with the poor and uneducated being more likely to contract infections since they are deprived of information on risk behavior, are unable to understand prevention messages and/or have low access to quality services. STDs raise the risk of HIV infection per sexual exposure. India has a high prevalence of STDs, with studies showing people with current or past STDs being 2–9 times more likely to get infected with HIV (ibid.). As per the Sentinel Surveillance for HIV infections in Goa, HIV prevalence rate amongst STD patients in the year 2008 was 4.80 percent (GSACS, 2014).
Pedophilia/Child Sex
Common concern in India/Goa with numerous cases recorded every year. With pedophilia tainted child sex tourism, HIV cannot be ruled out. There have been cases in Goa of minor children being HIV+, 12 though their parents are not. 13
Drugs
As per UNAIDS (2013, p. 30) report, globally, at least 158 countries reported injecting drug use and 120 countries documented HIV among people who inject drugs; although people who inject drugs account for an estimated 0.2–0.5 percent of the world’s population, they make up approximately 5–10 percent of all people living with HIV. HIV prevalence is estimated to be up to 28 times higher among people who inject drugs. 14 Drug peddling, consumption and addiction are not unheard of in Goa. Reports of unnatural deaths on account of drugs overdose are common, particularly in and around alleged tourism enclaves and centers hosting rave parties, beach musical shows, etc. While intravenous drug use carries high risk vis-à-vis acquiring/transmitting of HIV, non-intravenous use is likewise high risk behavior on account of the ultra-permissive individual/group sexual activities which it often leads to.
Rave Parties, Night Clubs, Pubs, Casinos…
Common in the coastal belt of Goa, as also in other metropolitan and urban hubs across the country. Leaving aside related issues like money laundering, addiction to gambling/drinking, debts, etc., the concern vis-à-vis tourism and HIV arises out of media reports and on-field inputs from tourists and the local public about easy availability of drugs and sexual permissiveness, 15 within or in the periphery of such centres. 16 It needs to be added that young people who often frequent rave parties, night clubs, and pubs, are often unable to protect themselves from acquiring HIV due to their inability to obtain essential services on account of limited protection for confidentiality and right to medical privacy; and inadequate access to sex education (in UNAIDS, 2013, p. 18).
Businesses/Cartels Involving Foreigners
Whether involving the Israelis or the Russians, “enclave tourism” is not unheard of in Goa. Enclave tourism creates “golden ghettos” for tourists (Lomine, 2012, p. 204). Besides destroying the interests of the local communities, with reference to HIV, the businesses are often alleged to be (in)directly involved in activities involving porn-websites, human trafficking, prostitution, and illegal drug trade. 17
Unplanned Increase in Infrastructure
Indirectly one off-shoot of haphazard tourism, massive investments in infrastructure have a magnetic effect on migrants, like construction workers, suppliers, and truckers. With deficiencies in safeguards, studies have revealed sexual interaction of these men with men and with CSWs, 18 contributing thus to the increase in HIV infections. According to an UNAIDS report HIV prevalence is estimated to be 19 times higher among gay men and other men who have sex with men (MSM) 19 , 20 than among the rest of the adult population. 21 Though issues pertaining to gay men and MSM are exclusively not attributable always to unplanned increase in infrastructure, we can attribute albeit partially 22 their existence as well as increasing numbers, to unplanned and unethical tourism. According to UNAIDS (2013, p. 22), the median HIV prevalence among MSM exceeds 1 percent in all regions of the world and is consistently higher than prevalence among men overall. This is more or less consistent with a 2012 global analysis, which found HIV prevalence among MSM in the Americas, South and Southeast Asia and sub-Saharan Africa ranging from 14–18 percent (ibid.). According to the Sentinel Surveillance for HIV infections in Goa, HIV prevalence among MSM was 4.53 and 6.40 percent for the years 2010 and 2008 respectively (GSACS, 2014). Although not with particular reference to India/Goa, the findings cited by UNAIDS (2013, p. 24) about MSM often having extremely limited access to preventive options, HIV education and support for sexual risk, are valid in the Indian context as well considering the high levels of illiteracy, ignorance and poverty, and considering the hidden and “underground” nature of such population. These factors only go to increase HIV infection levels in the region.
Future Options
Notwithstanding the earlier cited concerns, proponents of mass tourism with an eye on commercial bottom-lines only, would in all likelihood reject the connection between tourism and HIV with the fallacious argument that prevalence rates or numbers of HIV+ cases in India/Goa are low. With regards to this numbers-alone-focused argument, it needs to be stated that notwithstanding official statistics of PLWHA, the actual numbers would be much higher since besides available figures being estimates, there would be many more whose HIV+ status has not yet been detected. Stigma and discrimination, besides those going to private clinics (common in a place like Goa due to superior socioeconomic indicators) makes it difficult to know who the HIV+ persons are. 23 Incidentally, death certificates are an inaccurate source of data for AIDS-related mortality because the cause of death in AIDS patients is seldom given as AIDS (Drummond & Kelly, 2006, p. 6; Schoub, 1995, p. 212); with many people dying of opportunistic infections without even knowing their HIV status (Gaur, 2006, p. 17). It was estimated earlier that for each actual HIV+ case there were likely to be an additional 50–100 HIV infected individuals (Sinha, 1995, p. 28).
Tourism per se is not undesirable or a harbinger of all evil, including HIV. It is and will be an important activity and industry. In Goa, it will be particularly so considering its labor intensive nature, the socio-cultural–geographic character of Goa and the predicaments facing the mining sector. Considering the above what we need in Goa is ethical, responsible, and monitored tourism – and an appropriate comprehensive policy that will contribute to the same. While haphazard tourism is to be discarded for its impact on environmental degradation, rise in cost of living and disregard toward the optimum carrying capacity (OCC) of a region, all having the potential of diminishing the very essence of the place which attracted the tourists in the first place; sex and enclave tourism have no place whatsoever, on account of HIV/AIDS, human rights and child rights violations, infringement of the rights of locals and other perilous externalities.
To maximize benefits of tourism and minimize costs, Harris, William, and Griffin (2002) and Weaver (2007), indicate sustainable tourism development as a solution and the way forward (in Lomine, 2012, p. 205). As the tourism response to the United Nations “Agenda 21,” sustainable tourism development aims to be ethical and global: a respectful and respectable model of tourism that applies to all destinations (ibid.).
In the context of HIV/AIDS some initiatives that could promote ethical and responsible tourism in Goa could include:
Promotion of family (focused) tourism. This would help arrest sex and child sex tourism. Religious, adventure, hinterland and educational tourism could be given encouragement, provided appropriate safeguards in line with responsible tourism are in place. Health tourism could be an alternative, provided effective monitoring forestalls high-end sex tourism in the name of health promotion. Codes of Conduct (Mason & Mowforth, 1995) are important in the education of consumers, tour operators and governments; and they must be enforced to be effective (in Weeden, 2005). Globally various tourism related Codes or Charters exist at different levels; the same could provide policy makers in Goa insights in formulating a model Code for the state in line with ethical, responsible, and sustainable norms. Have stringent laws, alert police and fast-track decision making processes on issues concerning unethical tourism including sex tourism, pedophilia, web-porn, besides drug use/peddling. Accountability of law providers and services providers should be made stringent. Management commitment is one of the keys to success (Afsar, 2010). Policies regarding casinos, rave parties, mass beach musical shows etc. should be made consistent with ethical/responsible tourism. Policies should always be framed through a consultative process. Tourism enclaves need to be vigilantly monitored, controlled, and even dismantled. Provision of quasi-police role to service providers like taxi drivers and motorcycle pilots to report unethical dealings like prostitution, child sex/abuse, and drugs. Service providers involved in such activities should be dealt with quickly and stringently.
Conclusion: Ethical versus Responsible
In conclusion, notwithstanding its noteworthy and appealing character, ethical tourism is not easy to provide for. Complex that it is, the purchase of ethical holidays can be inconsistent with consumers’ expressed intentions, with tour operators themselves being reluctant to advertise their ethical policies for fear of appearing “moralistic” (Weeden, 2005). The World Tourism Organization itself committed towards a more equitable industry through its Global Code of Ethics for Tourism; but it stops short of advocating ethical tourism per se and instead uses the term responsible tourism (ibid.). According to the International Centre for Responsible Tourism (ICRT, 2014) “responsible tourism” is that which attempts to minimize negative environmental, social and economic impacts, and generates greater economic benefits for local people; providing responsible tourism product enables suppliers of tourism to work individually toward tourism development that aims to be more ethical by being responsible (Weeden, 2005).
In spite of challenges facing different tourism operators on account of a long supply chain or personal moral values, ethical (or at least responsible) tourism should be adopted by the industry, not as an alternative “niche product,” but as a guiding philosophy in all future market development efforts (ibid.; see also Ryan, 2002, p. 17). With regards to tourism and HIV/AIDS, it is not just a question of numbers – of how many or how few HIV+ cases have been recorded, and whether the same have been acquired/transmitted on account of tourism or not. It is important to realize that tackling HIV after getting infected is an extremely costly affair in all respects; prevention of HIV infection on all fronts is thus the key. According to World Bank, $1 invested in prevention is equal to about $67 saved on care and support (HRLN, 2008, p. 34). Promotion of ethical, responsible and monitored tourism can contribute to the prevention of HIV/AIDS. This type of tourism will also promote: (i) more social justice in local communities, (ii) the preservation of the local culture, environment and ethos, (iii) prevention of moral degradation, and (iv) reduction in the commoditization of women and men. Mass, haphazard, and unethical tourism helps no one, barring short-term gains for a few.