AIDS in the Shadow of Biomedicine: Inside South Africa's Epidemic (Politics and Development in Contemporary Africa)

The Bushbuckridge region of South Africa has one of the highest rates of HIV infection in the world. Having first arrived in the area in the early 1990s, the disease spread rapidly, and by 2008 life expectancies had fallen by 12 years for men and 14 years for women. Since 2005, public health facilities have increasingly offered free HAART (highly active antiretroviral therapy) treatment, offering a degree of hope, but uptake and adherence to the therapy has been sporadic and uneven. Drawing on his extensive ethnographic research, carried out in Bushbuckridge over the course of 25 years, Isak Niehaus reveals how the AIDS pandemic has been experienced at the village-level. Most significantly, he shows how local cultural practices and values have shaped responses to the epidemic. For example, while local attitudes towards death and misfortune have contributed to the stigma around AIDS, kinship structures have also facilitated the adoption and care of AIDS orphans. Such practices challenge us to rethink the role played by culture in understanding and treating sickness, with Niehaus showing how an appreciation of local beliefs and customs is essential to any effective strategy of AIDS treatment. Overturning many of our assumptions on disease prevention, the book is essential reading for practitioners as well as researchers in global health, anthropology, sociology, epidemiology and scholars interested in public health and administration in sub-Saharan Africa. The Bushbuckridge region of South Africa has one of the highest rates of HIV infection in the world. Having first arrived in the area in the early 1990s, the disease spread rapidly, and by 2008 life expectancies had fallen by 12 years for men and 14 years for women. Since 2005, public health facilities have increasingly offered free HAART (highly active antiretroviral therapy) treatment, offering a modicum of hope, but uptake and adherence to the therapy has been sporadic and uneven. Drawing on his extensive ethnographic research, carried out in Bushbuckridge over the course of 25 years, Isak Niehaus reveals how the AIDS pandemic has been experienced at the village-level. Most significantly, he shows how local cultural practices and values have shaped responses to the epidemic. For example, while local attitudes towards death and misfortune have contributed to the stigma around AIDS, kinship structures have also facilitated the adoption and care of AIDS orphans. Such practices challenge us to rethink the role played by culture in understanding and treating sickness, with Niehaus showing how an appreciation of local beliefs and customs is essential to any effective strategy of AIDS treatment. Overturning many of the Universalist assumptions on disease prevention, the book is essential reading for practitioners as well as researchers in global health, anthropology, sociology, epidemiology and scholars interested in public health and administration in the sub-Saharan region. The Bushbuckridge region of South Africa has one of the highest rates of HIV infection in the world. Having first arrived in the area in the early 1990s, the disease spread rapidly, and by 2008 life expectancies had fallen by 12 years for men and 14 years for women. Since 2005, public health facilities have increasingly offered free HAART (highly active antiretroviral therapy) treatment, offering a modicum of hope, but uptake and adherence to the therapy has been sporadic and uneven.0Drawing on his extensive ethnographic research, carried out in Bushbuckridge over the course of 25 years, Isak Niehaus reveals how the AIDS pandemic has been experienced at the village-level. Most significantly, he shows how local cultural practices and values have shaped responses to the epidemic. For example, while local attitudes towards death and misfortune have contributed to the stigma around AIDS, kinship structures have also facilitated the adoption and care of AIDS orphans. Such practices challenge us to rethink the role played by culture in understanding and treating sickness, with Niehaus showing how an appreciation of local beliefs and customs is essential to any effective strategy of AIDS treatment.0Overturning many of the Universalist assumptions on disease prevention, the book is essential reading for practitioners as well as researchers in global health, anthropology, sociology, epidemiology and scholars interested in public health and administration in the sub-Saharan region Cover 1 About the author 4 Title Page 6 Copyright 7 Dedication 8 Contents 10 Maps 11 Preface and acknowledgements 14 1: Introduction 20 Biopolitics and HIV/AIDS 24 From biopolitical theory to social specificity 29 Sickness and AIDS: a brief history of Bushbuckridge 33 Organisation of the book 43 2: Death 46 The sexual hypothesis 49 AIDS as death 52 Stigma of the living corpse 58 Conclusions 64 3: Blame 66 Biomedicine, gender and the politics of blame 68 Conspiracy theories: Dr Wouter Basson, Americans and wild beasts 74 Witchcraft and the reconfiguration of blame 78 Conclusions 83 4: Words 85 ‘If I test HIV-positive I will die’ 88 The agency of words 91 Deadly words, unfortunate names, and curses 93 Sickness, silence and discreet speech 98 Conclusions 104 5: Knowledge 106 Social and material barriers 108 The life story of Reginald Ngobeni 111 Conclusions 124 6: Dreams 126 Experiencing AIDS, using HAART 129 The significance of everyday dreams 131 The content of ARV-induced dreams 134 The sequences of ARV-induced dreams 143 Conclusions 147 7: Care 149 Kinship and the diffusion of parenthood 153 HIV/AIDS and marriage 157 HIV/AIDS and childcare 159 Conclusions 169 8 Conclusions 171 Culture, South Africa, the baby and the bathwater 175 Beyond biomedicine: therapeutic interventions 177 Notes 182 References 190 Index 206 An in-depth ethnographic exploration of how the AIDs pandemic has played out at a local level in South Africa, revealing the importance of understanding culture for shaping effective strategies of AIDs treatment.