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Abstract
This article investigates the ways in which global health messages and forms of health citizenship are mediated by AIDS activists in rural South Africa. It focuses on how these activists and treatment literacy practitioners are not only concerned with changing the lives of people living with AIDS to better manage biological conditions associated with their seropositive status, but also with how they are also committed to recruiting new members into their biopolitical projects and epistemic communities. These mobilization processes involve translating and mediating biomedical ideas and practices into vernacular forms that can be easily understood and acted on by the “targets” of these recruitment strategies. However, these processes of “vernacularization” of biomedical knowledge often occur in settings where even the most basic scientific understandings and framings of medicine cannot be taken for granted. This ethnographic case study shows that global health programs and their local mediators often encounter “friction” from the most powerful national actors as well as the most marginalized local ones.
Notes
Lusikisiki, with a population of 150,000, is part of the Qakeni Local Service Area (health district) in the Eastern Cape Province. It is one of the poorest areas of one of the poorest provinces in South Africa. Up to 80 percent of the population live below the poverty line (defined as household expenditure of R800 per month). (MSF 2006: 3). For an excellent account of the 19th and early 20th century history of Pondoland see Monica Hunter's (1936) Reaction to Conquest.
Themba, the name given to Dr. Reuter, means “hope” in isiXhosa.
It also necessary to bear in mind that most ANC leaders, and those of its trade union and Communist Party alliance partners, do not necessarily share the president's dissident views on AIDS.
See Redfield (Citation2005, Citation2006) for excellent accounts of the emergence MSF and its evolving ideas and practices.
During my visit to Lusikisiki I also attended a MSF and TAC sex education workshop. At the workshop, an openly gay AIDS activist from East London shocked the moral sensibilities of the young, mostly female and heterosexual group of Xhosa-speaking AIDS activists by regaling to them accounts of homosexual practices that most of them never knew existed. As a woman told me afterwards, “I am completely traumatized.” A lesbian activist attending the workshop told me that if she were to be open about her lesbianism in Lusikisiki's rural villages she would probably be killed for being umthakati, a witch. The East London visitor departed leaving many of the activists dazed and bewildered. There is probably a significant difference between doing AIDS activist work and sex education in rural Lusikisiki and the more cosmopolitan urban townships of Cape Town, Durban, and Johannesburg. Yet, even in “liberal” and cosmopolitan Cape Town, lesbian and gay couples are attacked for being open about their sexual orientation, and a young TAC AIDS activist was killed in 2005 by her rapist after she revealed her HIV-positive status. AIDS activists, it would seem, are mediators of potentially dangerous and empowering knowledge about sexuality and sexual rights.
These are not their real names.
It is possible that this skepticism of science and modern medicine is connected to forms of neo-traditionalism associated with “Red” and “School” orientations amongst Xhosa-speakers (see Mayer and Mayer 1971). It is also likely that this skepticism and suspicion is being fuelled by the president and his health minister's questioning of mainstream AIDS science and their claims that anti-retroviral drugs are toxic. The turn to “traditional medicine” and “alternative therapies” by the health minister, and her tacit support of Dr. Matthias Raths' vitamin “solution” is probably also fuelling these local responses.
Similar disparities in access to health resources exist between provinces, with the Western Cape Province being considerably better resourced than the Eastern Cape (Chris Colvin, personal correspondence).
These activists' mastery of the basics of AIDS science and treatment literacy allows them to be modern subjects rather than docile objects or ‘targets’ of biomedicine. Yet, this access to scientific and biomedical literacy and subjectivity need not necessarily preclude them from appropriating the same “traditionalist” beliefs and practices they attribute to “the elders.”
During a visit with MSF and TAC activists to a Lusikisiki tavern to demonstrate the femi-condom, a number of inebriated clients told us that if you poured hot water into the condom you could see these “maggots.” It appears that they were referring to the lubricant in condoms.
In September 2007, 20 million government condoms had to be recalled as a result of the nationwide distribution of “reject condoms.” The government's decision followed allegations that quality control officials were bribed to pass these flawed contraceptives. This has no doubt heightened fears and suspicions about government condoms.
Hunter (1936: 180–86) wrote, “Girls between the ages of 8 and 12, and boys between 9 and 14 begin to go to izitshotsho or amagubura, gatherings of unmarried girls, boys, and young men, for dancing and sweetheartening (ukumetsha). The young people of one small local district…gather in the evening and sing, then pair off to sleep together. The couple lie in each other's arms, but the hymen of the girl must not be ruptured. If it is, the boy responsible is liable to a heavy fine.…Alongside the Pondo law and custom governing the relations of unmarried persons are another set of ideas introduced by Christian missionaries. The churches have condemned ukumetsha, and forbid their members to allow their children to attend young people's dances. Children of church members do not normally attend dances, but ukumetsha is commonly practiced among them.…”