The paradox of AIDS in South Africa: denial, fatalism and culture

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THREE FUNERALS AND A PARTY

SisMinah Khomani (58 years old) sat in her front yard holding her three-year old granddaughter in her arms, spoon-feeding her soft porridge. The infant was unwell and SisMinah was worried; the girl suffered persistently from diarrhoea and vomiting. Her constant illnesses affected her physical development; she was small for her age and could barely support herself on her puny limbs. The child’s father had died shortly after she was born. Neither SisMinah nor Susan (the child’s mother) attended his funeral nor did they visit his grave to pay their respects. Contrary to custom the family did not inform SisMinah of his death until after the funeral. SisMinah recalled that this had hurt her deeply; it was as if they blamed her for the death of their son. That day SisMinah confided to me in a whisper that Susan too was very ill but refused to seek care. Susan never spoke to me and usually hid away when I visited her mother. At SisMinah’s request, Susan eventually agreed to come with me to a hospital located 20 kilometres from SisMinah’s home1 . Susan and her daughter were tested for HIV in the hospital clinic. After a long day of waiting in queues they were given an assortment of pills for herself and bottles of syrup for her daughter.

Silence as denial

Denial is seen to underlie the partial and incomplete silences and veiled communication about dreaded and incurable diseases. This is often inferred from speech that avoids direct mention of the disease. For example, cancer is seldom mentioned by name but by euphemisms such as the big ‘C’ (Balshem 1991; Sontag 2001). In South Africa, AIDS is referred to as ‘the three letter disease’, ‘three numbers plus bonus’ (a winning score in the lotto), a BMW Z3, OMO (a brand of washing powder), House In Vereeniging (spells out the acronym HIV) (Stadler 2003a). These verbal avoidances are mirrored in performances of suffering; AIDS sufferers are concealed in homes, hidden from the public view, and alienated from society (cf. Nzioka 2000). This is also reflected in society’s attitudes toward people living with AIDS. For example, in a survey published in 1992, 38% of those interviewed expressed the opinion that people living with HIV/AIDS should be separated from society (Stadler 2003b).

Culture, AIDS and blame

Culture often features in explanations for the apparent lack of change of sexual behaviours in sub-Saharan African society in response to AIDS and the continued high prevalence of HIV infections in the sub-continent (Marshall 2005, 2520). For example, researchers have focussed on witchcraft (Mshana et al. 2006; van Dyk 2001; Yamba 1997), and traditional healing (Green 1994; Peltzer et al. 2006). Sexual behaviours are also believed to be strongly influenced by traditions such as widow cleansing by having sexual intercourse (Campbell & Kelly 1995; Chipfakacha 1997), the levirate and sororate (Sow & Gueye 1998), polygamy (Cleland & Ferry 1995), bridewealth transactions (Wojcicki et al. 2010), and sexual promiscuity (Caldwell et al. 1989). Therefore the failures of disease prevention are conceptualised as African cultural failures to respond to prevention messages (Heald 2006, 30).

THE RESEARCH SETTING: BUSHBUCKRIDGE

The municipality of Bushbuckridge lies on the border of the Kruger National Park in the East and in the west borders on the Klein Drakensburg mountains, in a geographical region known as the lowveld (lit. low bush). To the south of Bushbuckridge is the commercial and administrative city of Nelspruit and to the north, the mining town of Phalaborwa. The climate is semi-arid with cycles of drought and flooding4 . The area is surrounded by rugged beauty, game farms and conservation areas and is a major attraction for national and international tourism. Yet, with quintessential South African irony, it is also one of the poorest areas in the country.

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A crisis in authority

This vision of gerontocratic governance over the sexual and reproductive decisions of the young belies evidence of the growing brittleness of the authority of elders (cf. Harries 1994). In the early part of the 20th century, declining prospects for agricultural subsistence, the steady increase in mission influence and the increasing dependency on wage labour threatened the hold of senior men and women over the young. The 1913 Land Act restricted the borders of the African reserves and ‘facilitated the demise of the independent African peasantry’ (Jochelson 2001, 99). By the early 1920s the economies of the South African countryside were under attack. Previously, hunting, gold exploration, transport riding had dominated commercial ventures in the lowveld. After World War One, the building of a new rail link made farming a far more attractive prospect for white farmers. Moreover, the government provided ex-servicemen with concessions to own Crown Land11. Increasing numbers of white farmers started growing citrus, ranching cattle and forestry. Former African farmers entered into labour tenant agreements with these new land owners.

RESETTLEMENT, WAGE LABOUR AND POVERTY (1960-1994)

By the 1960s, the last vestiges of agricultural subsistence had been destroyed. The period that followed was marked by increasing poverty and the alienation of household members. Increasingly, households depended exclusively on the earnings of migrant men. Migrant labour undermined conjugal bonds and resulted in the impoverishment of households left without a source of income. Women, placed in dire situations migrated out of the village to seek a means to support themselves and their children.

Table of Contents :

ABSTRACT
ACKNOWLEDGEMENTS
ACRONYMS
MAPS
TABLE OF CONTENTS
LIST OF TABLES
LIST OF FIGURES
LIST OF PICTURES
CHAPTER ONE
INTRODUCTION
- Three funerals and a party
- The paradox of AIDS in South Africa: denial, fatalism and culture
- AIDS in Bushbuckridge
- Doing ethnography in an epidemic
- Organization of the thesis
- End Notes
- CHAPTER TWO
- ORIGINS: A SOCIAL HISTORY OF THE AIDS EPIDEMIC
- A tale of two epidemics
- The research setting: Bushbuckridge
- Sexuality in the era of agriculture (1913-1960)
- Resettlement, wage labour and poverty (1960-1994)
- The early 1990s: youth and sexual liberation
- The arrival of AIDS (1990 – 2005)
- Experiencing AIDS awareness
- Conclusions
- End Notes
- CHAPTER THREE INFECTIONS: THE SOCIAL STRUCTURE OF SEXUAL RELATIONS
- Play, Romance and Sugar Daddies: from childhood to young adulthood
- Transactional Relationships
- The marriage process
- Going Outside the Homestead: Extra-Marital Relations
- Casual Sexual Relationships
- Sexual Networks of Infection
- Conclusions
- End Notes
- CHAPTER FOUR SECRETS: REVEALING AND CONCEALING AIDS ‘AIDS is death’: constructs of a new disease
- Secrecy and suspicion
- Dangerous knowledge
- Shy men and Suffering women
- Containing the AIDS body
- Conclusions
- End Notes
- CHAPTER FIVE EVIDENCE: ACCOUNTING FOR THE EXISTENCE OF AIDS
- Gossip, rumour and AIDS
- Gossip and rumour: local perspectives
- Constructing a popular epidemiology of AIDS in KwaBomba
- Women who buy their own coffins
- Infected condoms and dying with others
- Rumour and Moral Panics
- Conclusions
- End Notes
- CHAPTER SIX REVENGE: RECASTING AIDS AS WITCHCRAFT
- Witchcraft as an analogy for AIDS
- Secrecy and desire: narratives of AIDS and witchcraft
- AIDS as a kind of witchcraft
- Avenging AIDS: combating witchcraft
- Conclusions
- End Notes
- CHAPTER SEVEN SUFFERING: BIOGRAPHICAL ACCOUNTS OF ILLNESS AND DEATH
- Solomon and Pinkie
- Khayellhle Mhlanga
- Conclusions
- End Notes
- CHAPTER EIGHT: CONCLUSIONS
- AIDS in the treatment era
- End Notes