Beyond its chronic and potentially fatal medical and demographic dimensions, Aids is a social, cultural and political phenomenon. There are no easy solutions, no easy answers to the questions the pandemic poses.
In their book Waiting to Happen, Liz Walker, Graeme Reid and Morna Cornell try to situate the South African experience of HIV/Aids in its broadest possible social context.
Drawing on the Aids in Context conference organised by the University of the Witwatersrand history workshop, they show convincingly that HIV was an epidemic waiting to happen given the relationship between sex and power in a country marked by poverty, unemployment, violence and cultural diversity. The connections between poverty, unemployment and violence are far from controversial: South Africa manifests one of the most extreme disparities between rich and poor in the world and has very high unemployment, and thus generates violence — whether that be violent crime or domestic violence.
Add to this the fact that sexual identities are rooted in a mentality that encourages early, frequent and multiple sexual partnerships in a society where traditional cultural values are eroding rapidly, and the potential for the spread of HIV is considerable.
The authors look at the factors present in the construction of masculinity, femininity, heterosexuality and homosexuality in South Africa and reach the conclusion that how people conceive of their sexual identities has an impact on their likelihood of contracting HIV infection. Heterosexuals, for instance, may see themselves as immune and thus they are in greater danger of infection.
Cultural factors too play a major role: the use of condoms is seen as unnatural, even a sign of unfaithfulness in some quarters, while fidelity to one partner (particularly on the part of young, mostly male South Africans) is no longer the norm.
This problem is further exacerbated by poverty, particularly among women: poor women rely on male sexual partners for everything from basic needs to luxuries. Prostitution is the only means of survival for many South Africans and for others sex is the major means of attaining the good life.
The inequality of men and women, despite our Constitution and many legal advances for women, often makes it impossible for women to practise safe sex, even when such practices are theoretically possible.
Disparities between the legal availability of condoms and the mentality of many in the health professions — most notably the denial of teenage sexual activity — add to the problem.
None of this is helped by recent government denial that there is a connection between HIV and Aids, or by the haphazard provisions of Aids drugs. South Africans have been victims of numerous bogus cures and opportunists who have used the pandemic to make money: “miracle cures” and misuse of funds for “Aids awareness” both come to mind.
Although this problem is being resolved — whether by legal decisions, extra-legal activism, or even by grudging government recognition that it made a terrible mistake — there remains the widespread ignorance of South Africans about HIV, epitomised by the myth that sex with a virgin can cure Aids and “cultural” practices like virginity testing. Meanwhile the HIV infection rate grows almost exponentially.
Walker, Reid and Cornell present a grim yet highly accessible picture of the HIV/Aids pandemic in South Africa. They have drawn on a range of otherwise inaccessible sources and present their case with the right mixture of passion and conviction, locating the problem solidly in the social context. Although they offer no easy solutions their book is probably the best popular account of HIV/Aids as a social problem that demands a range of solutions: access to the best available Aids drugs, practical prevention through condom usage, and ultimately for many (if their evidence is to be believed) radical change in behaviour.
The authors of the more academic Aids and South Africa seem to share the same perspective.
The scholars here point out the complex process of an epidemic’s development and show how difficult it is to contain Aids. As one would expect of academics working in a range of fields, they bring a depth to their subject that a popular work must omit.
Historian Howard Philips shows that on one level the reality of Aids is part of a wider historical experience of contagious disease in South Africa. Sociologists, political scientists and anthropologists demonstrate the varied social forces that make the spread of Aids so much a part of the environment. Innovative essays suggest the way in which Aids denial is part of the dominant political discourse of the country, while a few examine how HIV/Aids has become an artistic metaphor.
The third book on Aids, Who Cares?, sets the problem against broader social and political forces affecting contemporary Africa. Susan Hunter’s book shifts — sometimes uneasily — from the history of colonialism to the history of the spread of contagious disease to the problem of Aids in Africa, particularly in East Africa. The strength of this book is soon apparent: Aids is a problem facing real people and a part of human history.
The weakness of her approach is a general sense that it is nothing new. From a historical perspective this is certainly true but such a perspective is also potentially counterproductive.
It’s all very well to locate Aids in the context of other epidemics and to see it in Africa as yet another discourse that can potentially advance a “colonialist” mentality, but this must not detract from the problem of Aids as a contemporary issue that is eliminating vast sections of the most productive and talented sections of the continent.
Hunter’s occasional historical faux pas are also decidedly irritating: it is questionable to see the end of the rebellious minority colony of Rhodesia in 1980 as the end of British colonialism in Zimbabwe.
Nevertheless, her book stresses the need for a concerted effort to address the problem of Aids in Africa and, indirectly, the need for an Aids programme that takes the reality of diverse cultures seriously.
A common factor emerges from these books: the need to see HIV/Aids primarily as a socio-cultural problem that demands a much wider solution than a vaccine.
How such a solution can be found remains an issue that needs our attention: it’s not simply a problem that can be resolved by doctors.