Public Secrets and Private Sufferings in the South African AIDS Epidemic 3030694364, 9783030694364

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Social Aspects of HIV

Jonathan Stadler

Public Secrets and Private Sufferings in the South African AIDS Epidemic

Social Aspects of HIV Volume 6

Series Editors Peter Aggleton, Research in Health, Goodsell Bldg 303, Univ of New South Wales, Ctr for Social, Kensington, Sydney, NSW, Australia Seth Kalichman, Psychology, University of Connecticut, Storrs, CT, USA Susan Kippax, Social Policy Research Center, Univ New South Wales, Goodsell Bldg, Kensington, Sydney, NSW, Australia Richard G. Parker, Mailman School of Public Health, Columbia University, New York, NY, USA John de Wit, The University of New South Wales, Kensington, Sydney, NSW, Australia

Since the start of the epidemic, HIV and AIDS have fired the imaginations of social as well as medical and public health scientists. This innovative series of books offers a setting in which to publish the very best of social scientific thinking and research. The Social Aspects of HIV series of books offers readers authoritative introductions and overviews, together with summaries of enduring and cutting edge concerns. The series is international and multidisciplinary in focus, including contributions from psychology, sociology, anthropology, education, economic, political and social theory, and international development. Individual volumes offer scholarly overviews of key topics and concerns but also address ‘big issues’ relevant to HIV prevention, treatment and care. Sexual and drug-related practices; adherence; disclosure; and stigma and discrimination are among topics focused upon, alongside broader cultural, political and social responses to the epidemic, including globalisation and internationalisation. The political economy of AIDS, links to broader questions of sexual health and rights, and the progressive biomedicalisation of the response, will also be among key issues examined. The series will appeal to those working in public health, health psychology, medical sociology, medical anthropology, health promotion, social work and international development. Individual volumes will be relevant to students, teachers, researchers and practitioners within each of these disciplines as well as program developers and managers working across a variety of contexts.

More information about this series at http://www.springer.com/series/11922

Jonathan Stadler

Public Secrets and Private Sufferings in the South African AIDS Epidemic

Jonathan Stadler Department of Anthropology and Development Studies University of Johannesburg Johannesburg, South Africa

ISSN 2509-6559 ISSN 2509-6567 (electronic) Social Aspects of HIV ISBN 978-3-030-69436-4 ISBN 978-3-030-69437-1 (eBook) https://doi.org/10.1007/978-3-030-69437-1 © Springer Nature Switzerland AG 2021 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG. The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

For Conny and Carla

Acknowledgements

Over the years that I have worked on this project, I have relied on the kindness and support of family, friends, and colleagues. In particular, I want to thank my in-laws in Bushbuckridge—NwaZakariah Mathebula and her children, Florence, Jerry, and Dan—for their hospitality, numerous home-cooked meals, and a bed when I needed one. I am indebted to many people in Bushbuckridge who let me into their lives and gave of their time so graciously. I am especially grateful to those who accompanied and guided me during my fieldwork: Godfrey Baloyi, Ryder Makhubela, Mapapeta Mathabela, Council Mgiba, David Mkatshwa, Ronnie and Frank Mzimba, and Kally Shokane. During fieldwork and writing I benefitted hugely from the advice and support from Erik Bähre, Cathy Burns, David Copland, Mary Crewe, Graham Rodgers, Adam Kuper, Fraser McNeill, Isak Niehaus, Jimmy Pieterse, Eirik Saethre, Robert Thornton, Charles van Onselen, and Thembisa Waetjen. Peter Aggleton kindly reviewed and commented on earlier drafts of the book. The final manuscript was written between March and December 2020, during the time of the COVID-19 pandemic and South Africa’s lockdown. I am grateful to Thulani Baloyi, Joost Fontein, Stodia Jackson, Tarminder Kaur, David Moore, Praveer Patel, Mia Jansen van Rensburg, and Reneé van der Wiel, for the encouraging and stimulating discussions during our “death cluster” and medical anthropology “Zoom” meetings. This project was funded by the Andrew W Mellon Foundation, the South African National Research Foundation, and the Centre for the Study of AIDS at the University of Pretoria. Johannesburg

Jonathan Stadler

vii

Contents

1

Ending AIDS: An “Epidemic of ARVs” . . . . . . . . . . . . . . . . . . . . . 1.1 AIDS in Bushbuckridge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 A Tale of Two Eras . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3 Two Funerals and a Party . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 Public Secrets and Private Sufferings . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

1 5 12 17 22 24

2

Culture and Difference: From Medical Mission to HIV Prevention . . . 2.1 Race, Culture and HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 A “Civilising Influence”: Missionary Medicine in the Lowveld (1931–1976) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 (Un)Healthy “Homelands” (1968–1994) . . . . . . . . . . . . . . . . . . . . 2.4 HIV Prevention and the Production of Difference . . . . . . . . . . . . . 2.5 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31 31

3

4

37 45 53 60 61

Truth and Harm: Dangerous Knowledge and Popular Epidemiologies of HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 HIV Testing: Technologies of Truth and Harm . . . . . . . . . . . . . . 3.2 Proof of an AIDS Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3 Narratives of Moral Personhood . . . . . . . . . . . . . . . . . . . . . . . . 3.4 Narratives of Unruly Bodies . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 Narratives of Mobility and Space . . . . . . . . . . . . . . . . . . . . . . . . 3.6 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . .

67 69 72 75 80 83 85 87

Intentional Infections: Public Discourses of HIV Spread . . . . . . . . 4.1 Conspiracies and Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 “Beware of Beautiful Ladies” . . . . . . . . . . . . . . . . . . . . . . . . . 4.3 Coffin-Cash and Worm Man . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3.1 Buy Your Own Coffin . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . .

91 92 94 97 98

. . . . .

ix

x

Contents

4.3.2 Worm-Man/Hummer Guy . . . . . . . . . . . . . . . . . . . . . . . . 99 4.4 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 5

Revenge and Remembering: Idioms and Accusations of Witchcraft and AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 Knowing and Experiencing AIDS Through Witchcraft . . . . . . . . 5.1.1 Married to a mfenha . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1.2 Farius’ nwa’mlambo . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1.3 Theko Magagule’s munjhonjhela phansi . . . . . . . . . . . . . 5.2 Revenge and Remembering . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2.1 The Easter Weekend Deaths . . . . . . . . . . . . . . . . . . . . . . 5.3 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . .

105 107 109 110 110 115 117 121 122

6

Hope and Loss: Illness Narratives from the Margins . . . . . . . . . . . 6.1 Pretty and Philemon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 Home Is where hope Lives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2.1 Philemon’s Loss of Heart . . . . . . . . . . . . . . . . . . . . . . . . 6.3 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .

125 128 137 140 142 142

7

Death and Dying: Narrating the End of Life . . . . . . . . . . . . . . . . . . 7.1 Narrating a Life at the End . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 Childhood: Escaping Hunger and Witchcraft . . . . . . . . . . . . . . . 7.3 Young Adulthood: “I Started to Run Wild” . . . . . . . . . . . . . . . . 7.4 Infection, Accusation and Revenge . . . . . . . . . . . . . . . . . . . . . . 7.5 Final Days: “The machine inside Controls me” . . . . . . . . . . . . . . 7.6 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . .

145 146 149 152 156 159 162 163

8

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.1 A New Pandemic, a Familiar Narrative . . . . . . . . . . . . . . . . . . . 8.2 The Past in the Present . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . .

165 165 169 175

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

Abbreviations

ABC AIDS AIDSCAPP ANC ART ARV ATIC BHSSC CD4 COGTA COVID-19 DACB ELM EPC HIV HSDU HSRC IPHC KAB NCCC NGO NRCC PEPFAR PHC PrEP REEP SAMJ SA-MRC SANT STD

Abstain, be faithful, use condoms Acquired immunodeficiency syndrome AIDS Control and Prevention Project African National Congress Antiretroviral therapy Antiretroviral AIDS Training Information Centre Bushbuckridge Health and Social Services Consortium Cluster of differentiation 4 Cooperative Governance and Traditional Affairs Coronavirus disease Dictionary of African Christian Biography Ethel Lucas Memorial Evangelical Presbyterian Church Human immunodeficiency virus Health Systems Development Unit Human Sciences Research Council International Pentecostal Holiness Mission Knowledge, attitudes, behaviour National Coronavirus Command Council Non-governmental organization Nazarene Revival Crusade Church President’s Emergency Plan for AIDS Relief Primary health care Pre-exposure prophylaxis Research Unit on the Economics of Excisable Products South African Medical Journal South African Medical Research Council South African Native Trust Sexually transmitted disease xi

xii

TB UK UNAIDS US USAID USD VD WHO ZCC

Abbreviations

Tuberculosis United Kingdom United Nations Programme on HIV/AIDS United States United States Agency for International Development United States Dollar Venereal Disease World Health Organization Zion Christian Church

List of Table

Table 5.1

Deaths in the Mzimba family (1998–2008) . . . . . . . . . . . . . . . . . . . . . . . . 118

xiii

Chapter 1

Ending AIDS: An “Epidemic of ARVs”

“Jonatana [Jonathan], they should build an underground tunnel so we can meet each other and talk about vu vabya [XiTsonga lit. “the sickness”]. If they find we have got this disease [AIDS] we will go under the ground, praying and singing down there; we will just be consoling ourselves”. NwaGomane1 (Nwa denotes “wife of”), an elderly widowed pensioner, was half joking when she said this, but I imagined a macabre scene of a dimly lit underground cavern filled with the ill and dying, singing gospel songs. Her vision invoked the belief in the “undead” or zombies (Shangaan. xindhachani), victims of witchcraft who inhabit the liminal spaces between life and death. NwaGomane worried excessively about her own health and some nights had nightmares of being raped. In the dream her assailant exclaimed, “You are now HIV positive!”. Her daughters laughed when NwaGomane told them she tested for HIV at the community clinic. At the clinic, the nurses had teased her. “An old lady like you! Do you even have a boyfriend?”. However, NwaGomane’s nightmare was not without foundation. This conversation took place in December 2002, a year into my research for this book and at a time when the HIV epidemic had reached crisis proportions in South Africa causing countless AIDS-related deaths. According to the Department of Health routine surveillance among pregnant women, prevalence of HIV increased from less than 1% in 1990 to 25% in 2001 (Dorrington et al. 2002, 1). At that time it was estimated that almost two fifths of all deaths (40% or 688,000) were AIDSrelated (Dorrington et al. 2002, 6). In the early 2000s, in Bushbuckridge where NwaGomane lived, the severity of the AIDS epidemic had become increasingly evident by the blue and green canvas funeral tents that dotted the landscape on weekends and the seemingly endless processions of cars bringing mourners and bodies home for all-night vigils. My small and by no means representative survey of mortality undertaken in

1 Most of the names cited in this book are pseudonyms with the exception of public persons and at the request of some of my informants. I have not anonymized place names.

© Springer Nature Switzerland AG 2021 J. Stadler, Public Secrets and Private Sufferings in the South African AIDS Epidemic, Social Aspects of HIV 6, https://doi.org/10.1007/978-3-030-69437-1_1

1

2

1 Ending AIDS: An “Epidemic of ARVs”

NwaGomane’s village estimated that 19 men and 29 women died of AIDS between 1989 and 2006. The peak occurred in 2002, with 26 (54%) of the sample of 48 deaths. Mirroring national trends, AIDS death was structured along the lines of gender and age, implicating younger women and older men.2 By the early to mid-2000s it was obvious to even the most disinterested observer that NwaGomane’s nightmare was a reality: a catastrophic epidemic of illness and death had arrived. The bulk of the research for this book was conducted between 2002 and 2005, towards a PhD in Anthropology. However, I was no stranger to Bushbuckridge, having undertaken fieldwork for a master’s degree in anthropology between 1990 and 1993. Then, until 1998, I worked for Witwatersrand University research entities (the Wits Rural Facility and subsequently, the Health Systems Development Unit), based in Bushbuckridge. From 2002, I lived and worked in Johannesburg, but continued to commute between Johannesburg and Bushbuckridge, and spent most of my vacations there with my wife and daughter. My ties to Bushbuckridge are bound through kinship: in 1991, I met and later married my late wife, Conny, who grew up in a village in Bushbuckridge. It was through her that I had opportunities to participate in ritual and ceremony, and to hang out in my mother-in-law’s homestead. I was also accompanied on my field trips by our young daughter, Carla. My identity as a married man with a daughter transformed my status from a white man and outsider, to a wanuna (adult man) and “Bava Carla” (father of Carla). Incorporated into local webs of kinship, I found myself among people who connected with me through affinal bonds and identified me as buthi (brother), bava (father), ntukulu (grandchild), malume (uncle, mother’s brother) and even kokwana (grandfather/ mother). In 2002, my intentions were to explore the social responses to HIV infections and prevention, and how people coped with AIDS-related illnesses and deaths. I began by listening and recording local gossip, collecting rumours, and exploring the themes these raised in interviews. Given my positionality I was rapidly caught up in the intimacies of villagers’ experiences of illness and death and dealing with the immediacies of seeking care by accompanying the sick to hospitals and clinics. My research was conducted at the cusp of the provision of Antiretroviral Therapy (ART) in South Africa, a very hopeful period in the history of the HIV epidemic. However, it was several years yet until access to ART was widespread in Bushbuckridge, and many people suffered and died before they could access the life-saving drugs. Over the intervening years I continued to return to Bushbuckridge and in 2018 and 2019 I did so with the purpose of exploring memories of the time when the AIDS epidemic was at its height. I realised then that although ART was extremely effective in transforming people from sickness to health, that the AIDS epidemic would never completely disappear, either as viral remnants, or as memories of the dead.

2 The village where this data was collected (according to the Department of Water Affairs and Forestry) had an estimated 3827 residents.

1 Ending AIDS: An “Epidemic of ARVs”

3

In 2018, many years after our first encounter, I met up with NwaGomane again and the two of us gossiped about Gift Khoza, a woman we both knew from the neighbourhood. Gift’s aunt (mother’s sister, XiTsonga: hahani) died in 2002 from tuberculosis followed by her mother in 2005 of intrauterine bleeding, indicating cervical cancer, a disease pathologically associated with HIV infection (Livingston 2012). NwaGomane speculated that both women, as well as Gift, had acquired HIV from men they had met in Randfontein, a mining town located on Johannesburg’s West Rand. For over a decade the three women had travelled between the village and the mining town in search of money to support themselves and their children. Gift’s mother built and rented out single-room tin and wood shacks in Mohlakengone, an informal settlement surrounding Randfontein,3 while Gift traded in fongkong (fake) gold jewellery. Her aunt married a mine worker who also had two wives in Gaza Province, Mozambique. Considering what we both knew about Gift and in the light of her mother and aunt’s fates, NwaGomane remarked that it was a “miracle” that Gift had survived. We had heard of several other women who, like these three, regularly commuted to Randfontein. Sadly, many returned home to die. According to prevalence surveys, South Africa’s informal urban settlements have the highest rates of HIV infection, reflecting the simultaneous post-1994 growth of a new sexual economy and liberation, and the demise of marriage in South Africa (Hunter 2007). Women in circumstances similar to Gift’s often entered into, what is described in the literature, as “transactional” sexual relationships as a means for survival and to acquire commodities (Hunter 2002; Wojcicki 2002a; Leclerc-Madlala 2003). In Bushbuckridge, this was known as ku phanda, a term borrowed from the IsiZulu ukuphanda meaning “to dig up or dig by scratching” (Wojcicki 2002b).4 Gift did what many other women did to survive in a context of racial and gendered inequalities and entered into transactional relationships with men who had disposable incomes. In addition to the men she met in Randfontein, her partners included a retired school principal, a mine employee, a taxi driver and a money lender (machonyisa). Gift’s relationships and the presents she received from her casual partners were frequently the subject of unfavourable neighbourhood gossip. In addition to a second-hand Toyota, Gift acquired a king-sized bed with built in lights and mirrors, shiny porcelain tiles for her two-bedroomed house, a flat screen television, and a stereo. These acquisitions were remarkable for someone without a regular income. Implicating the wasting body as a sign of AIDS illness, NwaGomane commented on Gift’s healthy and chubby appearance. “She is still fat; look at her. She runs with men, but she is still here [alive]”, concluding, “there is no more AIDS; she has ARVs

3 Almost half of the township of Mohlakeng lives in shacks (in 1994, 46% of the local population or 56,000) and 48,000 in backyard dwellings (Sihlongonyane 2001). 4 In the 1990s, this term started to be used instead of the original Shangaan phrase “ku hanza” or “to scratch the ground, to be in search of food” (Cuenod 1967), used to describe the everyday struggles faced by poorer rural residents.

4

1 Ending AIDS: An “Epidemic of ARVs”

[antiretrovirals]”. I was struck by NwaGomane’s insinuation that ART seemed to have made AIDS disappear. As if the drugs had replaced AIDS as the new epidemic, NwaGomane continued, “everyone has ARVs”. This seemed to suggest that AIDS, in the era of treatment, had effectively vanished from the individual, social, and political body (see Scheper-Hughes 1994). NwaGomane’s views on the disappearance of AIDS and its replacement by ART was widely supported. People talked openly about “being on ARVs” with each other, to me, and to other anthropologists working in the area (Mfecane 2012; Niehaus 2014). I frequently heard the phrase, she or he “has ARVs”. As a proxy for serostatus, “having ARVs” revealed and simultaneously concealed a positive HIV status. On social media such as Facebook, public declarations of being on treatment were discussed openly.5 “I love this group because we are all HIV positive and we don’t judge each other” declared one post, while another asked “. . .when do I start my ARVs”. These semi-public, hardly concealed declarations of individual’s serostatus were a far cry from the desire for concealment evoked in NwaGomane’s earlier vision of burying the living. Assuming a public life, ARVs were ubiquitous and commonplace materia medica. Revealed in everyday conversation, their presence was evidenced by the empty pill boxes in homestead rubbish pits,6 in Facebook declarations, and in the long queues at ART clinics. In 1999, an AIDS clinic was established at Tintswalo Hospital (one of three hospitals in Bushbuckridge) and appropriately named Rixile from the Shangaan greeting “I am here [alive]”. Like elsewhere across the country, patients arrived to collect their medication, participated in support groups, and underwent medical consultations. Patients at the clinic were keen to show me their boxes of pills and yellow plastic baggies containing ARVs and other drugs. ARVs travelled far, making their way into local worlds; powerful and pregnant with meaning, they possessed the promise to heal as well as harm. Attesting to the perceived potency of the drug, herbalists sometimes incorporated ARVs into murhi (medicine) to treat patients with AIDS symptoms. Stories abounded of people being mugged for their pills, and of clinic staff involved in wholesale theft of drugs for resale, provoking panics of stockouts and shortages. Appadurai’s (1986) insight that the potency of material objects is derived from the social and historical contexts in which they are transacted can be applied to ART. As things, medicines possess a distinctive social life beyond that of their pharmacological action (Kleinman 1980; van der Geest and Whyte 1989; Whyte et al. 2002), and have the power to create diverse imaginaries. They are also invested heavily with personality, through the marketing and advertising that surrounds them. However, they also signify different things for different people (Martin 2006). Women in Bushbuckridge spoke of ART as signifying hope to continue to live to support their children, while men regarded the medicine as a hinderance to enacting

5

Facebook page for the Acornhoek Mall (shopping center in Bushbuckridge) https://www. facebook.com/groups/1636695443309670 6 See Hodes (Hodes 2019) for an extensive discussion on “pharmatrash” and its proliferation that suggests increasing access to pharmaceuticals in South African since democracy.

1.1 AIDS in Bushbuckridge

5

masculine identities; adherence meant not drinking and having to share the highly feminised space of the health clinic (see also Mfecane 2011). The public or “social life” (Whyte et al. 2002) of ART was further highlighted in tales of drug users who mixed the medicine to make nyaope or whoonga, a street drug composed of a blend of heroin, marijuana, rat poison and throat lozenges. Smoking ARVs as opiates hinted at their perceived potency (Niehaus 2019), but like rat poison and throat lozenges these uses also signified their mundane everydayness. While villagers referred openly to “ARVs” or “the pills”, as proxies for HIV and AIDS, this did not necessarily translate into wholescale acceptance or compliance. When 28-year-old Xolani Gumede died childless, her mother told NwaGomane that Xolani had refused to take the medication, because she “didn’t have anyone to live for”. In 2016, upon the death of a policeman, one of his relatives remarked, “they [police] have medical aid and get free ARVs. They are all [HIV] positive, but they are healthy. Why didn’t he just take the pills?”. While ART was praised as the answer to the treatment and prevention of the spread of HIV and hope for an end the AIDS epidemic, these individual acts of non-compliance revealed its limitations. A consequence of the focus on medical treatment as the solution to HIV spread, morbidity and mortality, was the pharmaceuticalization of the epidemic. This effectively shifted attention away from exploring the social and economic contexts of infections, death and dying. While HIV in South Africa is biologically similar to HIV globally, its spread, and who was infected and who died, and under what circumstances, was shaped by local histories, political economy and culture (see Heimer 2007). ART constitutes spectacularly powerful pharmaceuticals that encompass the promise to heal and prevent further infection. However, my worry is that an almost exclusive focus on pharmaceutical solutions to the epidemic has the potential to render HIV invisible and irrelevant, thereby ignoring the persistence of underlying structural forces that are fundamental to understanding and preventing its spread and impact. The decision to write this book was informed by my desire to address this issue. I begin in the section below by locating my argument within the research context and sketch a historical narrative of the AIDS epidemic in Bushbuckridge.

1.1

AIDS in Bushbuckridge

This book chronicles a social and cultural history of the AIDS epidemic in Bushbuckridge, a South African municipality located on the border of the Kruger National Park in the east and the Klein Drakensburg mountains to the west, in a geographical region known as the Lowveld (Afrikaans lit. Low bush).7 To the south

7

The lowveld, so-called because it lies below 1000 m above sea level, is surrounded by mountain ranges, and lies in the north east of South Africa, bordering on Mozambique in the east, and Zimbabwe in the north.

6

1 Ending AIDS: An “Epidemic of ARVs”

of Bushbuckridge is the commercial and administrative city of Nelspruit and to the north, the town of Phalaborwa, built around copper and phosphate mining. Johannesburg is 480 km away, a half day drive by car or commuter taxi, and a full day’s commute by the City to City bus and longer by train. The climate is hot and the environment semi-arid with cycles of drought and flooding. Its rugged beauty, abundant game farms and conservation areas brand the lowveld as a major attraction for national and international tourism. Yet with quintessential South African irony, it is also one of the poorest regions in the country. Most of Bushbuckridge was officially defined as “rural”, an inappropriate label given the vast, dense residential settlements and sprawling Reconstruction and Development houses (RDP) slums.8 The population of over half a million people gives rise to densities that are similar to urban settings (approximately 255 persons/ km2) (Freeman 2002). Economically, the area was extremely poor: over 85% of the population lived below the poverty line, earning less than R19 200.00 per annum and only 14% of residents between the ages of 15 and 65 years were economically active. Many residents were unemployed work seekers and at least 10% of households were dependent on government grants and old age pensions (Freeman 2002). Local employment opportunities were restricted to poorly paid unskilled labour on the citrus and game farms surrounding Bushbuckridge or well remunerated civil service employment for the educated elite, in the police, health and education sectors. As a result, men and women migrated in search of work in urban and industrial centres, requiring long commutes and lengthy separations from family (Collinson 2006). While the AIDS epidemic was barely visible in the 1990s, by the early 2000s it appeared as if a wave of death had hit Bushbuckridge. The earliest records of HIV infections for Bushbuckridge were reported in a letter to the South African Medical Journal that cited seropositive rates between 0.2% and 0.3% amongst admissions at Tintswalo Hospital (Taylor et al. 1992). In 2002, voluntary counselling and testing was offered at health centres and hospitals in Bushbuckridge (Pronyk et al. 2002) indicating a localised epidemic steadily increasing in prevalence. In 2006, seroprevalence amongst pregnant women receiving antenatal care in the area was a shocking 30 per cent (Lurie et al. 2008). Five years later, an estimated 45% of men (age 35–39) and 46% of women in the same age category were HIV positive. More recently, and indicative of an ageing epidemic, high prevalence rates (10% for men and 11% for women) occurred in those 70 years and older (Gómez-Olivé et al. 2013). Moreover, incidence of new infections continued to grow amongst adolescent women (Pettifor et al. 2016). My memories of doing research in the mid 2000s are of the overwhelming presence of dying and death. At that time, funeral motorcades choked the roads on Friday afternoons delivering bodies to all night vigils; burials occurred daily, even 8

RDP houses, so-named from the Reconstruction and Development Program instituted by the South African government after the 1994 elections, were introduced to address the severe housing shortage for the urban and rural poor. The project has attracted criticism due to inferior build quality and size, the lack of services (waste, water, electricity). As a consequence, recipients of RDP houses prefer to rent out their houses.

1.1 AIDS in Bushbuckridge

7

taking place on Christmas and New Year’s Day. Sometimes there were several funerals on the same day, beginning early in the morning and finishing late in the afternoon. Burial societies coordinated the timing of funerals to avoid clashes, and funeral parlours carefully planned specific time slots for families to view the dead. Young men in overalls dug fresh graves at village graveyards, while older experienced men used their razor sharp klipmes (pocket knives) to slaughter and butcher cattle for funeral feasts. Grave diggers hastily wolfed down freshly cut beef fillet seasoned with coarse salt, roasted on the fire, as a reward for their hard labour. Women from burial societies, extended family members, and neighbours, prepared salads, chopped up tomatoes and onions to be fried in oil in deep pots as the base for beef stews and boiled water in massive driepoot pots (three leg cast iron pots) to make pap (stiff maize porridge). At the time, the epidemic of death was comparable to the aftermath of the terrible tsunami of 2004, yet the effects of AIDS were more far-reaching. Clinics and hospitals were ill prepared to cope with the rising numbers of patients; the sick and dying were sent home from clinics with little more than “Panados” (paracetamol). Hospitals were widely perceived as “places to die” while the dying were often neglected and alienated by their own kin who appropriated and squandered their property. Attempts to prevent the spread of HIV were seen as futile: condoms were believed to be contaminated with HIV; infected persons purposefully spread the virus so as not to die alone (see Leclerc-Madlala 1997). Long-term relationships and marriage did not protect against infection. As many married women remarked of their husbands, “he goes out there and brings this disease home”. In the midst of epidemic spread and growth, the “AIDS Industry” emerged and grew rapidly (Pisani 2008). This “industry” was evident in the numerous funeral parlours that jostled for space near hospitals and in strip malls. A prominent businessman and—distastefully—a medical doctor built a massive mortuary where there had been an open field between two villages. I heard of shocking scenes in mortuaries with bodies stacked on top of each other and hanging on meat hooks to save space. At the time, stories abounded of nursing staff who, in league with funeral homes, suffocated or poisoned the terminally ill to hasten death and thereby increase their profits (see also McNeill 2015). The business of AIDS was also evident in the mushrooming of organisations established for AIDS palliative care and HIV prevention. The Bushbuckridge Health and Social Services Consortium (BHSSC) paid stipends to a small group of unemployed volunteers who offered counselling, condoms, and food parcels to people “infected and affected by AIDS”. Roadside billboards called for HIV testing to “know your status” and appealed to people to “talk about it”, encouraging them to attend a walk-in youth centre and promoted a new “lifestyle” brand that encompassed healthy options to avoid unprotected sex. Village-based organisations funded by the Department of Health and Welfare aimed to generate incomes through small scale “community development” projects that produced and sold concrete breeze blocks, barbed wire fences, baked bread, and artisanal peanut butter. These projects required significant input of labour and expertise: proposals needed to be drafted and typed up; committees were formed

8

1 Ending AIDS: An “Epidemic of ARVs”

with equitable gender distribution, comprised of secretaries, chairs, vice chairs and ordinary members; monthly meetings and minutes were kept and filed. Villagers supported these initiatives but were also profoundly cynical of their worth. Suspicions of corruption in the small-scale income generating projects were frequently voiced. The bakery ceased operations after a Department of Health and Social Welfare investigation discovered that funds had been embezzled by the project manager. The head of the organisation in charge of the distribution of food parcels to the needy was charged with repackaging the goods for sale in informal markets. The peanut butter making project collapsed when the machine broke down; sensing its imminent demise, project members stole and sold off the project’s office equipment. AIDS was (and still is) a major employer, sponsoring the emergence of non-governmental organisations (NGOs) and university research centres. Responding to calls for applications for funding, university researchers proposed surveys, implemented HIV educational and awareness interventions, and conducted evaluations of their impact on HIV infections. Yet, many villagers accused these campaigns and programs of catering only for the interests of those employed by them and of favouring the more affluent and well-educated rural elite (see Chap. 2). Like the young women described earlier in this section who did ku phanda, everyone was scratching around in the AIDS epidemic to survive and enrich themselves.9 As the newfound AIDS economy was growing, I was struck by the absence of a coherent public discourse amongst villagers about the increasingly visible increase in persistent illnesses and untimely death. It seemed that AIDS was a massive “public secret” (Taussig 1999), one that everyone knew, but kept quiet about. Like an “invisible genocide” (see Scheper-Hughes 1996), AIDS-related deaths were endured in silence. The absence of a public response was particularly perplexing given the broader context of South Africa’s success in the struggle for liberation against white minority oppression under apartheid. Indeed, the same forces that were previously engaged in the struggle against apartheid failed to mobilize in the “war” against AIDS (Karim and Karim 2002). By the early 2000s, the heightened optimism surrounding the birth of the new democratic South Africa in 1994 had been steadily worn away by the AIDS epidemic. As Fassin writes, “The spectacular spread of the epidemic in the past decade, runs in terrible counterpoint to the happy narrative of national reconstruction” (Fassin 2007, xvi). By the early to mid-2000s, residents of Bushbuckridge were aware of the symptoms of HIV, had witnessed the pain and suffering of AIDS deaths, attended countless funerals and grieved the loss of loved ones. However, and paradoxically so, the epidemic was actively unknown and unknowable. Although there was shared acknowledgement and comprehension of the reality of AIDS that was displayed by 9

In addition to those mentioned, research and intervention programs included the Witwatersrand University’s Health Systems Development Unit, The Agincourt Health and Demographic Survey, the Adolescent Research Program, the One Man Can Community Mobilization project, and Swa Koteka (payments to keep young girls in school), RADAR (Rural AIDS and Development Action Research).

1.1 AIDS in Bushbuckridge

9

the suffering body, the disease was concealed and subject to “socially shared” and “culturally codified” public censorship (Sheriff 2000, 114). In the early 2000s, prior to ART availability, and despite dominating national and international media reports, few residents seemed to be aware of, or indeed seemed to care about, the dialogues and debates and the political contestations about AIDS. Instead, at the time, responses to government policy on AIDS treatment were fairly ambivalent.10 This was particularly evident by the absence of public protest and mobilization around AIDS. This was especially perplexing considering the recent history in Bushbuckridge of resistance against social injustices and threats to the spiritual and secular security of residents. Political activism in Bushbuckridge was relatively muted up until the mid-1980s and early 1990s when a series of mini-revolts and public protests took place (Ritchken 1995). The younger generation played a critical role in staging protests against the apartheid regime. In the early 1990s, witchcraft purges led by groups of self-identified ANC “comrades” gained popularity in the light of rising tensions between neighbours, and inexplicable misfortunes and incurable illness (Niehaus 2001). In these movements, male youth assumed the role of witch-hunter and led violent attacks on suspected witches (Stadler 1996). The leaders of these witchpurges claimed to rid the community of supernatural threats to peoples’ security. At the same time, and in response to the lack of effective policing and lawlessness, vigilantes patrolled the streets to protect residents against thugs and rapists (Ritchken 1995). On the eve of the 1994 national elections, schoolchildren revolted against the use of corporal punishment in schools and called for an end to the repressive Bantustan government that had been in place since the 1970s, and boycotted white-owned retail businesses (Stadler 1995). Popular protests did not fade after the elections. In 1997, residents led violent protests against the incorporation of Bushbuckridge into the Limpopo Province (Ramutsindela and Simon 1999). More recently in February 2019, sporadic consumer protests took place, with protesters complaining about the neglect of villages located far from the main centres and demanding new shopping facilities.11 The public action against witchcraft, racism, borders, Bantustans, and services, are indicative of a robust resistance to oppression and misfortune that contrasts noticeably with the lack of action taken in response to the AIDS epidemic. AIDS suffering was performed in private and the sick and dying withdrew from the public domain as “living corpses” (Niehaus 2007), just as NwaGomane had intimated in her vision of the ill being buried alive. Mention of AIDS was carefully avoided,

10 A survey at the time reported that 43% of Black South Africans surveyed were generally supportive of Mbeki’s policy position (Fassin 2007, 99). 11 The main road leading from Acornhoek to Thulamahashe was blockaded with burning tires by residents from the villages on this route making demands for new roads and local shopping centers. (Citizen News 2019).

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1 Ending AIDS: An “Epidemic of ARVs”

expressed only through metaphor and articulated through subaltern speech such as gossip and rumour. AIDS deaths appeared devoid of meaning and occupied spaces external to the body politic. This contrasts sharply with the suffering associated with the struggle against apartheid. Funerals for residents involved in the anti-apartheid movement, even peripherally, were celebrated by the presence of ANC comrades wearing political T-shirts and chanting slogans and struggle songs. Even the burials of well-known gangsters were accompanied by gunshots being fired into the grave and wheel-spinning BMWs.12 In contrast, the AIDS epidemic was scarcely acknowledged in public political oratory. In his annual address in 2011, the former mayor of Bushbuckridge, Milton Morema only mentioned AIDS briefly at the end of his speech, tagged onto a public service announcement about drink driving: “Please always arrive alive. Don’t drink and drive and speed kills. Always apply ABC as HIV/AIDS is still a monstrous killer. Let us test to know our HIV status and be counselled” (Morema 2011, 29). In the light of these observations and taking the long view of the epidemic in Bushbuckridge over almost two decades, I was curious to find out in what ways universal access to ART impacted peoples’ experiences and views of the disease. Along with many South Africans I was initially enthusiastic that a biomedical solution would reverse and possibly erase the years of suffering, offering hope for the future. Certainly, South African medical practitioners, activists and patients, once despairing, expressed their faith in the prospects that HIV treatment represented. Patients at the brink of death were being brought back to life after starting ART, reinvigorating the morale of doctors and health workers. A research clinician at the Chris Hani Baragwanath Hospital in Soweto once told me excitedly that her patients who were previously close to death, were now applying for jobs and creating new lives for themselves. A senior registrar at the JF Jooste Hospital in Cape Town wrote, “This really was the hospital where people used to come to die; it was like a hospice (. . .) but now 85% will leave alive. We now see patients coming in who are severely unwell and they get better. 40–50% of all admissions into the medical ward have AIDS. Before we couldn’t deal with it; now we can start to try” (Kapp 2004, 1710). Complementing these testimonials, patients’ narratives of treatment attributed AIDS drugs with physical as well as psychological effects. Writing about his experiences of starting treatment, constitutional judge and AIDS activist, Edwin Cameron wrote, “There was only one word for it. It was glorious. The drugs were working. I could feel that I was getting healthy again” (2005, 38–39). Similar sentiments were expressed not only by medical doctors and affluent judges. Henderson’s interview with a traditional healer in KwaZulu-Natal draws attention to a spiritual and social reawakening (Henderson 2005, 45). The possibility of becoming well enough to work and contribute towards the household income reaffirmed the eroded social identities of those afflicted with AIDS. Niehaus recounts Bushbuckridge resident’s Reggie Ngobeni’s miraculous recovery and attributes this

12

Modified BMW 325s were often favored by gangsters in South Africa.

1.1 AIDS in Bushbuckridge

11

to his strict adherence to ART, even though Reggie contended that he was healed by the Zion Christian Church (ZCC) (Niehaus 2014). The biography of Magda A relates a woman’s life story of extreme sexual violence, followed by her recovery from AIDS illnesses, and forging a new identity as an AIDS activist (Fassin et al. 2008). These accounts draw attention to the possibility of re-socialization and spiritual rebirth (Robins 2006) and the renewed confidence to leave seclusion and return to normalcy. I anticipated that I would hear of similar transformations when I returned to Bushbuckridge years after my initial research. Although significant numbers of HIV infected people remain untreated, in South Africa as a whole, between 2003 and the end of 2009, an impressive one million adults and children commenced ART (Cleary et al. 2012). The subsequent removal of CD4 count threshold requirements, greatly expanded the numbers of patients on ART.13 The provision of ART also made a significant dent in mortality in Bushbuckridge. According to epidemiological data collected in a sub-district of Bushbuckridge, the introduction of antiretroviral drugs between 2004 and 2010 resulted in a gradual return to pre-AIDS mortality rates (Kabudula et al. 2017a). However, the “roll out” of ART has also been persistently uneven. In 2006, Rixile clinic at Tintswalo Hospital had reached only one fifth of HIV positive people in the area, and many patients continued to present for care at the clinic with advanced stage AIDS (MacPherson et al. 2009). In 2011, an estimated 20,000 HIV positive people still required ART (Moshabela et al. 2011). Significantly, the uptake of ART was distinctly gendered, reflecting a greater willingness amongst women to test and enter care, in contrast to men (Mfecane 2010). Moreover, the burden of disease continued to be borne by the poor who have the highest levels of mortality from AIDS-related disease and tuberculosis (Kabudula et al. 2017b). And, while overall infection rates have to some degree “stabilised”, new infections amongst young and adolescent women in Bushbuckridge have persisted and in some instances, increased (Pettifor et al. 2016). Universal treatment signals a new era, one that promises a pharmaceutical solution to the crisis of disease spread, debilitating illness and death as AIDS seems to disappear, receding into history replaced by an “epidemic of ARVs”. Yet, as I found, this belies the complexity of the histories of living in, and through, the AIDS epidemic. In the section that follows I explore the ways in which the past is hidden by the optimistic and celebratory discourses of biomedical hope and promise. While HIV can be treated and thereby rendered biologically invisible, questions remain. In particular I ask what is concealed in the space between discourses of the struggle against AIDS, on the one hand, and on the other hand, the newfound optimism of a biomedical solution (see Gerard 2016).

13

In 2004, eligibility to ART was based on of less than 200 CD4 (T helper cells) per cubic millimetre of blood. The expansion of ART in 2016 saw the introduction of “universal test and treat” which did away with these requirements (Lilian et al. 2019).

1 Ending AIDS: An “Epidemic of ARVs”

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1.2

A Tale of Two Eras

In 2016, former president, Thabo Mbeki posted a series of commentaries on his Facebook site. One of these, “A Brief Commentary on the Question of HIV and AIDS”, resurfaced his earlier controversial stance with regards to AIDS (Mbeki 2016). Repeating the same questions he first raised in 2002 regarding the aetiology of AIDS, he drew attention again to the linkages between social economic contexts of poverty, poor health, and the severity of the AIDS epidemic in Africa. At that time, Mbeki’s “denialism” was almost universally condemned: at best this was lunacy, at worst genocidal. His support for then minister of health, Manto Tshabalala-Msimang’s appeal to use “traditional” African treatments for AIDS attracted public protest and derision (Kapp 2005). At the Montreal International AIDS Conference in 2006, the Department of Health stand displayed garlic, beetroot, lemon and the “African potato” and marketed these as immune system boosters. Invoking long standing discourses of Indigenous healing as irrational and expendable in the context of “modern” medicine, Tshabalala-Msimang was derided and portrayed by the media as peddling “quack” remedies (Weber 2017). Mbeki’s reiteration of his original claims about AIDS was condemned as repulsive, offensive and jarring like “matter out of place” (Douglas 1966). Unsurprisingly, reactions to Mbeki’s letter were forceful in their repudiation of his position. The paralegal NGO, Section 27’s Anso Thom compared it to being pulled “back through a sci-fi tunnel and straight back to cuckoo land, a place we thought we had long left (. . .) it ripped me back to a time as a health journalist I would rather forget” (Thom 2016, para 11–14). The Treatment Action Campaign (TAC) responded in a similar vein, accusing Mbeki of denial and ignorance: he was yet again “refusing to take responsibility for over 300,000 avoidable HIV-related deaths under his reign and is scientifically illiterate” (Malan 2016, para 1). The head of the South African HIV Clinicians Society noted that Mbeki “should be apologising to the nation, not trying to rewrite science, medicine and history” (Venter quoted in Child and Mabuza 2016, Para 14). Salim Abdul Karim (2016, final paragraph), director of CAPRISA (Centre for the AIDS Programme of Research in South Africa) stated, “Mbeki’s widely-discredited views will likely have little or no impact on the country’s current AIDS response which is now firmly founded on scientific evidence and rational thought”. As the director of the National Institute of Allergy and Infectious Diseases (NIAID) declared, we should “follow the science” (Fauci & Marston, 2015 cited by Leclerc-Madlala et al. 2018, 973). Responding to Mbeki’s “denialism” others offered a more sympathetic reading. They pointed to the biological interactions between nutrition, pathogens and infectivity (see for example Stillwaggon 2002), and the political economy of disease spread and vulnerability to infection in certain contexts (Schneider and Fassin 2002; Fassin 2007; Heimer 2007). Others, placing Mbeki’s position in the context of South Africa’s racist history warned that “Second-guessing and pathologizing African presidents risks invoking a range of colonial racist stereotypes about African depravity and incompetence . . .” reminding us of the “utterly phobic and irrational

1.2 A Tale of Two Eras

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responses to the epidemic from U.S. and U.K. government officials in the ReaganBush and Thatcher years” (Hoad 2005, 106). Indeed, during the 1980s, the US and UK governments resisted acknowledging the similarities between AIDS in central Africa and in America and Europe (Smith and Whiteside 2010, 3). From this perspective, Mbeki’s reaction can be seen as a response to “. . .racist discourses of lascivious Africans and the AIDS Industry’s often vitriolic tone” (Hunter 2010, 213). The portrayal of science as the sole way to know the world has also contributed to the polarization of differing positions on AIDS. Mbeki’s 2016 letter contested the dominant historical narrative of AIDS in South Africa, that of the triumph of scientific logic over irrationality, denial, and ignorance. His sojourn into the past conjured the spectre of “post truth” and the proliferation of “alternative facts” as articulated by anti-vaxxers, flat earthers, and climate change denialists that have proliferated under Donald Trump’s administration in the US. In such a scenario, “scientific facts” are pitted against popular “social facts” raising questions about what counts as the truth and how power shapes truth claims (Ho et al. 2019, 161). Usually recounted as a hard and decisive line between the time before and after public access to ART, the history of the AIDS epidemic in South Africa is neatly separated into two distinct eras. From the early 1990s until the mid 2000s, the government stubbornly refused public access to AIDS medications. Consequently, for most South Africans, HIV infection signified isolation, agonising illness, and a social demise that preceded corporeal death. Following the approval of ART for rape victims and subsequently, pregnant women, in 2004 public health institutions started to dispense the drugs.14 By the late 2000s, South Africa had the largest public AIDS treatment programme globally and in 2014, “an end to AIDS by 2030” was declared by the Joint United Nations Programme on HIV/AIDS (UNAIDS) (UNAIDS 2014), and adopted by South Africa in that same year. The universal treatment policy, branded as “90-90-90”, seeks to achieve 90% of people diagnosed by 2020, with 90% on ARVs, and 90% of those with viral suppression. Forecasting reductions in viral load and therefore infectiousness, this scenario envisions large numbers of people testing, initiating and sustaining life-long adherence to treatment. Ideally, HIV is rendered undetectable in the blood of those infected reducing the risk of transmission,15 and HIV treatment becomes preventive. Novel applications of ARV drugs in the form of pre-exposure prophylaxis (PrEP) further promise to reduce infections among specific “key populations” including sex workers, gay men and young women.

Initially prescriptions were conditional on certain “Psycho-social considerations” listed in the Department of Health Web Site. These included: Demonstrated reliability; No active alcohol or other substance abuse; No untreated active depression; Disclosure or joined a support group; Acceptance of HIV status; Insight into the consequences of HIV infection and the role of ART before commencing therapy; Able to attend the antiretroviral centre on a regular basis or have access to services that are able to maintain the treatment chain (National Department of Health 2004). 15 The “Swiss Consensus Statement” concluded that people with an undetectable viral load are sexually non-infectious and cannot transmit the virus (Persson 2013). 14

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1 Ending AIDS: An “Epidemic of ARVs”

As the universal provision of ART has shifted the narrative to the normalisation of HIV, pharmaceuticals are awarded extraordinary power in transforming the politics of the disease. A prominent HIV physician alluded to this, “There is a lot to celebrate—there is sustained political and treasury support for a successful programme, thanks, in no small part, to a committed Minister of Health and cabinet. HIV debates have somewhat normalised, while a large number of human rights issues have been unveiled” (Venter 2014). Drugs rendered sick bodies healthy and non-infectious and thereby also transformed the social and political body. Producing a “popular culture that is enamoured with the biology of hope”, medical practitioners and researchers, activists, patients, and the public, are caught up in the “biotechnical embrace” (DelVecchio Good 2007, 377). Encouraging these sentiments, the UNAIDS website currently displays full colour photographs of young people brimming with health. Sibulele Sibaca, founder of the organisation Colour my HIV writes, “(. . .) I want get to a point in South Africa where being HIV positive is like having any other chronic disease—diabetes, high blood pressure—in that it’s a manageable illness” (UNAIDS 2019b, February 28). Echoing these perspectives, a prominent HIV researcher-physician once glibly told me, “I would rather be HIV positive than diabetic”. Expressing the popular opinion that AIDS was no longer a problem because of universal access to ART, friends and colleagues sometimes questioned the relevance of my research for this book, asking, whether the threat of AIDS has not been averted since we have ART. As the AIDS epidemic recedes into the background, researchers have started to cast their gaze toward “non-communicable” diseases of “lifestyle” such as diabetes, the “obesity epidemic”, and cancers. In the era of HIV treatment, the hopelessness of previous decades of AIDS was successfully displaced by a “triumphalist” discourse, reasserting biomedical hegemony through pharmaceuticals (Kenworthy et al. 2018). Through the pharmaceuticalization of AIDS, its meanings changed as the AIDS-body faded. This discursive disappearing act universalized the body, implied the equalising effect of medicine, and diminished the social and cultural variation of subjective illness experiences (Persson 2013). As treatment policies transformed suffering from a “moral experience into a mere technical inexpediency” (Kleinman and Kleinman 1997, 15), the process of the general disappearance of public awareness and sense of urgency surrounding AIDS was accompanied by the rise of biotechnical solutions to treatment. Transforming AIDS from a deadly disease into a chronic disability that can be managed was believed to transform peoples’ attitudes (Karim and Baxter 2003) and promote greater willingness to test for HIV (Kapp 2004), ultimately contributing to healthier lifestyles. The treatment programme offers “a more optimistic script, one in which HIV-positive people are able to access life enhancing drugs that can return the patient to health and the possibility of reintegration into the social world” and results in individuals taking on a new “responsibilized citizenship”, akin to religious rebirth (Robins 2006, 312). Claiming the ability of pharmaceuticals to create new socialities, the World Health Organisation (WHO) argued that successful treatment

1.2 A Tale of Two Eras

15

programs transform denial to acceptance, discrimination and stigma to equality (Zuch and Lurie 2012). Having observed first-hand the suffering and despair of hopeless illness and painful death since the early 1990s, by the late 2000s I too share in the optimism of universal treatment and the biomedical efficacy of ART. Yet, I also believe that the reframing the disease solely in biomedical terms effectively occludes individual and shared histories of suffering, and by doing so, threatens to silence the persistence of inequalities that are fundamental to understanding the ongoing spread and impact, of the AIDS epidemic. Social, economic and political factors that shaped the HIV epidemic continue to sustain suffering. Uneven access to treatment and the biomedical production of hunger (Hardon et al. 2007; Kalofonos 2010; Jones 2011), social alienation and difference (Kalofonos 2010) and the gendered and uneven uptake of testing (Mfecane 2011; Niehaus 2018), exposes the limitations of biomedical models of global health (Decoteau 2013). This casts doubt on the assumption that people can easily transform their lives to suit the requirements of pharmaceuticals such as ART (Mfecane 2011). Taking medication holidays over weekends to drink beer, finding giving up smoking cigarettes impossible, residents I interviewed complained of the harsh restrictions of adherence. ART for some, made living life intolerable as the drugs were an unending reminder of illness. Moreover, the narrow focus on treating HIV infection glosses over opportunistic co-infections such as those contributing to cervical cancer, as well as the clustering of multiple interrelated epidemics or “syndemics”, that have emerged in the wake of HIV (Mendenhall 2014). The claim of an end to AIDS creates a universalising discourse that disregards diversity, discrimination and the very conditions that continue to give rise to life threatening afflictions and suffering. This is despite the vast amount of funding directed at the HIV epidemic. The financial resources dedicated to HIV and AIDS are the largest ever committed to a single health issue. By 2008, global funding had increased from 485 million USD to ten billion USD (Cohen 2008). Yet, the flow of funding streams is precarious, requiring the constant reporting of indicators of progress against targets. South Africa, a beneficiary of funding for ART, is required to monitor and assess progress against the “90-90-90” indicators.16 A systematic review of the cascade of HIV treatment reflected that by 2015 none of the countries included in the analysis actually met the targets set by the 90-90-90 campaign. In the light of massive disparities between countries with respect to HIV diagnosis and taking ART, these targets are very hard to achieve (Levi et al. 2016). Failure to meet expectations can result in punitive cutbacks in funding. While USAID had disbursed a staggering 6.23 billion to South Africa since 2004, in 2019, the United States Presidents Emergency Fund for AIDS Relief (PEPFAR) threatened to withdraw 1.2 billion USD of support in the light of evidence that more patients had stopped ART than were currently

Ironically, “90-90-90” was not intended as a set of indicators but was initially proposed during a discussion at a conference as a rallying call to action, a slogan to promote a concerted effort to promote testing, treatment and adherence.

16

16

1 Ending AIDS: An “Epidemic of ARVs”

enrolled in treatment (Kahn 2019). Moreover, the implementation of austerity measures in many African countries has resulted in budget cuts in health spending, while funding for HIV treatment is directed toward non-governmental organisations rather than improving government infrastructure (Chapman 2021). Treatment programs not only encompass institutions and resources but are discursive practices (Altman 1998). Numbers evoke objectivity and validity but monitoring and measurement also legitimises the uneven power relations between donors and recipients of aid. The statistical indicators such as “90, 90, 90” also hide the disorderliness of social life. As Merry (2011, 2016) reminds us, the construction of tidy statistical categories divorces numbers from their social, economic and political context. Although statistical indicators may be effective in the management of the flow of donor funding, these systems also enforce compliance by laying down standards and can be used to shame those who not meet their targets (Merry and Coutin 2014). The relentless monitoring and evaluation of country progress against targets set by UNAIDS is a constant reminder of the power of international aid agencies. A press release on the UNAIDS website on 16 July 2019 announced, “UNAIDS calls for greater urgency as global gains slow and countries show mixed results towards 2020 HIV targets”, noting “Impressive advances in some countries, troubling failures in others” and “some countries [are] making impressive gains while others are experiencing rises in new HIV infections and AIDS-related deaths” (UNAIDS 2019a, July). The preceding discussion has drawn attention to the paradox of a disease that activists fought hard to make public since its early days, and that has, in the context of its pharmaceuticalization and normalisation, become virtually invisible once more. In other words, as the biological effects of ART have rendered the disease undetectable, this has given rise to the circulation of biomedical narratives of its eradication. The AIDS epidemic has gone full circle from being an unknown affliction, shrouded by uncertainty and doubt, to a scientific discovery that made it a reality, only to disappear once again. Making AIDS invisible raises fundamental questions about the epidemic past and present, and of a future that is framed as the end of AIDS. Or put differently, what does the normalisation of HIV mean for living in the shadow of the history of the epidemic? Biomedical claims to know the world contain universalising assumptions about the body, disease and vulnerabilities. But while biotechnologies reveal, at the same time this knowledge obscures the everyday lived experiences of being in the world. For researchers of AIDS, there is a moral imperative to expose and lay bare the realities of suffering from AIDS. Writing about suffering from an ethnographic perspective is distinct from epidemiological and biomedical approaches that tend to reproduce the official discourses of disease and death. The latter renders people invisible, reduced, as Irving observes, to “statistics, the biological body or social structures”, and is “surprisingly bloodless” (2007, 204). The result is an absence of the phenomenological body, and the emotional and affective dimensions of experience. Also absent in these accounts are the intimate details of human suffering which are critical if we are to start to comprehend the impact of the HIV epidemic. Without this perspective, the suffering of others is obscured, which leads to indifference, a

1.3 Two Funerals and a Party

17

rejection of our common humanity and identity (Herzfeld 1992). In this regard, I support attempts to “. . .get down to the flesh, blood, and souls [in order] to understand. . .” suffering (Nations and Amaral 1991, 205). The following section strives to do exactly this.

1.3

Two Funerals and a Party

In March 2003, NwaBembe (the prefix Nwa means “wife of”) took me to see her close friend and neighbour, SisMinah Khomani. Both women, in their late 50s, were domestic workers employed by white families in Hoedspruit. This small but rapidly expanding lowveld town serves an air force base, farming community, and tourist industry, located about 50 km from NwaBembe’s home in Bushbuckridge. NwaBembe’s village is situated between the retail town of Acornhoek and administrative centre of Thulamahashe. Most residents speak Shangaan or XiTsonga and trace their origins to refugees who fled the ravages of the Luzo—Gaza civil war in Portuguese East Africa (Mozambique) at the end of the nineteenth century (Harries 1994). NwaBembe’s suggestion that we visit her neighbour contained a hidden motive: well aware of my research on the AIDS epidemic, she harboured suspicions that SisMinah was ill from HIV. Arriving at SisMinah’s homestead in the early afternoon, we found her seated under the shade of a tree in her front yard spoon-feeding soft porridge to her 3-year-old granddaughter. The infant was unwell and SisMinah was very worried; the little girl suffered persistently from diarrhoea and vomiting. Her frequent illnesses hindered 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 her birth. Neither SisMinah nor Susan (the child’s mother) attended his funeral nor did they visit his grave to pay their respects. Contrary to custom, his family did not even inform SisMinah of his death until after the funeral. This hurt SisMinah deeply; it was as if they had blamed her for the death of their son. On the day of my visit, SisMinah confided to me in a whisper that Susan was very ill but refused to go to hospital. Susan never spoke to me and usually remained inside the house when I visited. But, at SisMinah’s insistence, she eventually agreed to accompany me to Tintswalo Hospital located 20 km away.17 At the hospital, Susan and her daughter were tested for HIV and, after a long day of waiting in queues, she was given an assortment of pills for herself and bottles of syrup for her daughter. A month after our trip to hospital, SisMinah’s granddaughter died. Unable to afford a coffin, SisMinah buried the tiny corpse in a cardboard box. At the gravesite,

17

There are four hospitals in Bushbuckridge: Tintswalo (450 beds) and Mapulaneng (350 beds), Sekororo (100 beds) and a public-private Life Care facility, Matikwana (150 beds). There are 45 Primary Health Care (PHC) clinics in the district, including two health centres.

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1 Ending AIDS: An “Epidemic of ARVs”

appalled by the sight of the makeshift coffin, a neighbour offered to donate 100 Rand (approximately USD10) and asked the other funeral attendees to donate money to buy a proper coffin. However, by then it was too late and SisMinah was anxious to complete the pitiful ceremony. The burial proceeded at the communal graveyard located between the village and the open bush. Afterwards we returned to SisMinah’s homestead to eat bread with sweet black tea. By nine o’clock in the morning the funeral was over. Susan remained indoors the entire time. About 18 months later NwaBembe told me that SisMinah was seriously ill. When I visited her, she complained of aching legs and severe head pain. Her employer had dismissed her without paying her wages after she scorched the ironing and ruined supper having passed out at the stove. Lacking a reliable source of income, the Khomani household became dependent on handouts from their neighbours. Almost daily SisMinah crossed the dirt road to ask for maize meal, sugar and tea from her neighbours. The family ate porridge with okra (guxe) and a bitter spinach (nkaka) that grew wild in the garden. Close to tears, she described how her neighbours loaned her food on so many occasions she feared that she had overstretched their generosity. She laughed bitterly recalling the 50 Rand (5USD) bride wealth18 (ndzhovola) her estranged husband paid her father when they married, and then abandoned her to look after his four children on her own. Her husband was an extremely abusive man: he once stabbed SisMinah in the leg and punched her in the neck. Over the next few weeks, SisMinah’s illness steadily worsened. Eventually she retreated from her patch of shade under the tree in the yard to lie in her room all day. She complained of dizzy spells and aching bones. She attributed this to the symptoms of “high blood” (hypertension) and “nerves” because, as she put it, of “thinking too much”. Eventually admitted to hospital, she was put on a saline drip for 2 days after a severe bout of vomiting and diarrhoea. The nurses confided in NwaBembe when she visited SisMinah in hospital: “we just want to tell you that your sister [friend] is HIV positive”. To me, SisMinah said: “I am dying. Since I became sick, I will never become better again. I am just waiting for the day [I die]. I can’t eat beef, even chicken. I can only eat fish and guxe [okra]. Ha! They sent me to the AIDS people [clinic]. Ag! Even if people think I have AIDS I don’t care”. NwaBembe, was indignant that SisMinah did not tell her that she had AIDS. Over the fence dividing the two properties NwaBembe shouted in the direction of SisMinah’s homestead: “you don’t need to hide this disease. Hey you! Why are you hiding from me! This disease is not something you can hide. It will show itself and then you cannot hide anymore”. But NwaBembe admitted that she was worried that she too was infected. In the past, SisMinah and NwaBembe occasionally had sex with farm labourers. Flush with cash after payday, working men drank and met women on the grassy verge outside Wings, a bar frequented by soldiers and railway workers in Hoedspruit. NwaBembe

18 At the time she was married, bridewealth costs were usually R120.00 (12 USD) or twelve head of cattle (Stadler 1993).

1.3 Two Funerals and a Party

19

recalled Manjezi (Mr Jersey) the name given to a white railway employee who had sex with farm and domestic workers in exchange for brown railway jerseys. The evidence seemed to point toward SisMinah having acquired HIV from one of these sexual contacts. However, NwaBembe also speculated that it was possible that SisMinah was infected by coming into contact with her granddaughter’s bodily fluids. Either way, SisMinah’s illness settled uneasily in the minds of her neighbours and friends. A few months after these conversations I was surprised to find a party in full swing in SisMinah’s front yard. Meat was roasting on a fire and a large pot of pap (stiff porridge) was on the boil. The party was for Dudu, SisMinah’s youngest daughter, who had turned 21. The birthday girl was dressed in high heels, a black mini dress and multi-coloured hair extensions. Loudspeakers were pumping kwaito music19 and youths were jiving, holding ciders and beers and plates heaped high with food, chanting “yes, yes, yes”. SisMinah made a brief showing at the party. Her daughters had dressed her in a clean white blouse, blue pleated skirt and matching hat, and positioned her on a chair, under the tree. SisMinah’s neighbours were shocked by her daughter’s behaviour in the presence of their mother’s obvious suffering. Earlier that day, two neighbours suggested to Dudu that it was disrespectful to hold the celebration. Dudu rebuked them saying that she was “happy her mother was dying” because she would no longer have to bear the humiliation of seeing SisMinah begging for food from her neighbours. She accused her neighbours of being envious (wajelaza),20 insinuating that they wanted to bewitch her, and more ominously, that they had already bewitched SisMinah. I shared the older women’s indignation at this insensitive display. In the months following the party SisMinah died a slow death. After I returned to Johannesburg, I heard that Susan too had died. Although she had been prescribed ARVs by the doctors at the AIDS Clinic, Dudu remarked that she “threw her pills away”.21 According to SisMinah, Susan did not see any point in continuing to live because the only child she had was dead and no one needed her support. NwaBembe described Susan’s funeral as “decent”; a contrast to the time when SisMinah buried her daughter in a cardboard box. Susan had used a portion of her state welfare disability grant to make monthly payments to a burial society that provided the food, a coffin and a funeral tent. These events took place between 2002 and 2004, on the cusp of public access to ART across South Africa. Revealing the horrendous and destructive impact of the disease, over a period of 2 years, three generations of women: grandmother, 19 Kwaito music is a uniquely South African blend of hip-hop and gangster rap popular amongst youth. 20 The etymology of the word wajelaza is from the English ‘jealous’; however, ‘envy’ is a more accurate translation. 21 The Johannesburg based Perinatal HIV Research Unit (PHRU) was awarded Presidential Emergency Funds for AIDS Relief (PEPFAR) funds through the United States Agency for International Development (USAID) to run an ARV clinic (called Rixile) based at Tintswalo Hospital in Acornhoek, one of the towns in Bushbuckridge.

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1 Ending AIDS: An “Epidemic of ARVs”

daughter, and infant granddaughter or more than half of the Khomani household died, leaving only Dudu and her brother alone. When I returned to the Khomani family in 2006 I found that the two children had left and rented out the house to a temporary high school teacher. Only later did I realise the significance of the party and its juxtaposition with the family’s abject suffering. The consumption of feast food and the party countered the image of SisMinah going house to house with an empty tin begging for maize meal, and the celebrations seemed to erase the memories of the pathetic cardboard-box funeral that served only bread and tea. These actions, as well as Susan’s refusal to take life-saving drugs, performed a subtle rebellion and refusal to be defined as “the poorest of the poor”.22 By actively resisting and redefining their suffering these events allowed life as it is lived to proceed. The intention of sharing this account is not to fetishize the suffering of others. As Farmer (1992) notes, the challenge is to document the ways in which global forces interact with local individual histories and by doing so, to reconstitute the context and the experiences of suffering. But the story is also deeply personal; ethnographic research and writing is after all an extremely intimate process and “cuts to the core of human suffering as it flows from daily life (and death) experiences” (Nations and Amaral 1991, 205). Writing about suffering from an ethnographic perspective is distinct from epidemiological and biomedical reports that reproduce official discourses of disease and death. Anthropological researchers seldom employ “toolkits” such as survey questionnaires, focus group scripts or even interview schedules. Too often, these technologies serve to protect the researcher against the intrusion of other peoples’ lives into their own, ostensibly creating the fiction of objectivity. While anthropology was initially slow responding to the HIV epidemic in the early 1980s, this changed rapidly with a growing interest amongst medical researchers regarding supposed differences in sexual behaviour between different “cultural groups” (Marshall and Bennett 1990). This produced a research agenda that, as Fassin (2007) bluntly states, exoticized ethnographic knowledge and focused on the “customs of the natives”. Agreeing, Farmer (1997, 517) notes that the “scenario most commonly evoked was one in which ethnographers, steeped in local lore after years of participant-observation, afforded epidemiologists and public health authorities detailed information about sexual behaviour, childbearing, and beliefs about blood and blood contact. This was regarded as indispensable for determining which ‘behaviours’ put individuals and communities at risk for HIV infection”. In the 1990s, South African anthropology mirrored these trends with anthropologists taking their direction from public health and behaviouralist approaches. The epidemic provided many opportunities for employment for anthropologists who were incorporated into teams of epidemiologists and medical researchers. I was often asked to assess the cultural appropriateness of particular questions in Knowledge, Attitudes and Behaviour (KAB) survey questionnaires.

22 The ‘poorest of the poor’ was a term adopted by development aid agencies in the 1990s to categorize populations that faced grinding poverty. It has been absorbed into local vocabulary.

1.3 Two Funerals and a Party

21

However, by the early 2000s, South African anthropologists and medical historians had turned their attention to the politics of HIV and AIDS, dwelling mainly on the contestations between activists and the state and Mbeki’s government (Schneider and Fassin 2002; Robins 2004; Hoad 2005; Comaroff 2007; Decoteau 2013; Mbali 2013). Firmly locating the epidemic within contemporary South African political economy, these researchers highlighted the struggle for treatment, and the role of non-governmental and activist organisations in shaping social and political identities, marking a shift away from culturalist approaches. Since the early 2000s, I have undertaken research on the AIDS epidemic in South Africa, both independently and as a part of medical and clinical research teams. This has taken me from conferences and meetings in hotel boardrooms in national and international settings, to HIV research clinics in Johannesburg, and to peoples’ homes in lowveld villages. My experiences in these diverse settings inform the broader claims I make throughout this book; however, I draw specifically on the long-term ethnographic research I conducted in Bushbuckridge. My experiences are not much different from those of other anthropologists doing research in the time of AIDS. Due to the intimacy of the anthropological enquiry anthropologists are bound to deal with the immediacy of peoples’ suffering. Emily Frank writes about her fieldwork on AIDS in Zambia: “It is too difficult to work with people who are dying or who have just lost someone. It is frightening to work with illness and death. It is hard to talk about and difficult to become emotionally involved with people who will not be around when you return the following year for fieldwork” (Frank 2005, 143). I feel strongly there is a moral imperative to expose and lay bare the realities of suffering and the political, social and economic structures that shape peoples’ experiences. Research in an epidemic cannot be regarded as a neutral act (see Castro 2004). Shao (2006, 536) says this about fieldwork conducted in the “AIDS villages” of Henan, China: “As ethnographers, we cannot avoid taking a position within the very social worlds in which we carry out our research. No matter what position is taken, it is implicitly or explicitly political and has political consequences”. Doing fieldwork in an epidemic as devastating as AIDS in South Africa calls into question whether as observers we are able to comprehend and understand the experience of suffering, and how our subjective experiences mould our comprehension. Renato Rosaldo’s first hand experiences of grief upon the personal tragedy of the death of his wife in a climbing accident provided him with an unique insight into Ilongot expression of violent rage (Rosaldo 2004). Sontag’s personal struggle with cancer led her to write about the disease from an embodied perspective (Sontag 2001). Many anthropologists write about AIDS from the perspective of having lost friends, lovers and companions (Bolton 1995; Niehaus 2012), thereby achieving credibility by relating personal experience. As I witnessed the illness progressions and death of people I had grown to know well, I too became involved in their day-today struggles to seek medical assistance, often feeling a “social and political impotence” (Schoepf 1995, 346) in the face of suffering and often callous and unsympathetic medical staff. These experiences and my aim to represent everyday violence and suffering, shape the arguments presented in this book.

22

1.4

1 Ending AIDS: An “Epidemic of ARVs”

Public Secrets and Private Sufferings

Chronicling the HIV and AIDS epidemic in the years before and after public access to antiretroviral therapy (ART), this book addresses why an end to AIDS may not only be misplaced optimism, but also an imaginary construct that silences and invisibilizes suffering, past, present, and future. Contrasting popular and professional discourses about the epidemic against private narratives of suffering reveals contradictions between the lived experience of the epidemic on the one hand, and biomedical certainties on the other. The book is structured in two parts, reflecting a distinction between public discourses about HIV in Chaps. 2–5, and private experiences of infection, illness and death in Chaps. 6 and 7. In this chapter I draw attention to the trend, mirrored in biomedical narratives, articulated in scientific and popular writings, and given potency in public health policy, to forge discontinuities between the past and the current “eras” of AIDS. What was previously an epidemic of terrible illness and death has been reconceptualised as a chronic condition to be “managed”. In Bushbuckridge, it seemed that the AIDS epidemic had been transformed into an “epidemic of ARVs”. I argue that the emphasis placed on meeting the “90-90-90” targets, represents a “biomedical turn” in HIV prevention and treatment (Kippax and Stephenson 2016), that obfuscates and conceals the underlying inequalities that continue to shape the spread of HIV. Masking the structural conditions that create vulnerabilities to disease, it obscures the burden of morbidity and mortality amongst the marginalised. The invisibilization of the AIDS epidemic is a product of a medical regime that threatens to silence historical and current experiences of suffering by transforming these experiences into targets on spreadsheets. Discursively powerful, the biotechnical solution to the AIDS epidemic—the so-called “magic bullet”—has obscured our vision of the past and thereby distorts the picture of the present and the future. The global campaign to end AIDS by 2030 relies heavily on “categories of social difference”, and consequently, fails to “capture the reality of the daily lives of the people it tries to know and act on” (Sangaramoorthy 2014, 6). Placing this assertion in historical context, Chap. 2 offers a brief social history of medical regimes in Bushbuckridge that spans Twentieth Century missionary and apartheid health services, up until the HIV prevention efforts of the early 2000s. Drawing from historical records and published accounts of the pre-history of the AIDS epidemic, as well as ethnographic research on HIV prevention campaigns in Bushbuckridge, the chapter argues that medical dialogues about health and illness reproduce ideologies of social difference that are embedded in ideas of race, culture and class. Missionary medical discourses were anti-traditionalist, associating disease with beer rituals, Indigenous healing, and witchcraft. Under the “homeland” administration, the health services were part of the apartheid project of ethnic nationalism, but while celebrating ethnic and tribal identity, continued to pathologize “traditional” practices and beliefs. HIV prevention campaigns of the 1990s and 2000s perpetuated social

1.4 Public Secrets and Private Sufferings

23

difference through rituals and spectacles that highlighted social and economic divisions and exclusion, reinforcing neoliberal health approaches that promoted cosmopolitan identities. While the first two chapters introduce the social historical and cultural context of Bushbuckridge’s AIDS epidemic, Chaps. 3–5 compare and contrast local representations and official narratives of AIDS illness and death. Chapter 3 discusses the implications of public secrecy for the production of evidence about HIV infection and AIDS-related illness and death. Drawing on narratives of death, assembled through neighbourhood gossip, I argue that discursive and biomedical practices of knowing HIV materialised the disease. I begin by showing how HIV testing, widely regarded as a confessional technology, is experienced locally as dangerous knowledge that contains the power to transform the body from health to illness. I then show how concepts of moral persons, bodies and places, were marshalled in such a way as to produce a local epidemiology of risk that framed AIDS as a symptom of disrupted and disordered development. The resulting moral scripts possessed perlocutionary power and shaped social realities and subjectivities, and, ultimately the ways illness and death were experienced. Chapter 4 continues to explore discursive acts, and documents local rumours about the intentional spread of HIV. Noting that rumours offer a way of talking about social, economic and political relations, the chapter frames the emergence of particular rumours within different historical contexts. While in the late 1990s and early 2000s, HIV was conceptualised as a threat posed by external and foreign agents, by the mid to late 2000s it had been domesticated through local cultural ideas about gender, generation and personhood. Rumours directly challenged biomedical scientific claims by establishing alternative facts, but by appropriating scientific methods of observation and experiment. Yet these tales also serve as social commentary on race, gender relations and ethnic identities, implicating whites, foreigners, young women and wealthy men. The vision of a community beleaguered by HIV spreaders spurred a moral panic and resonated powerfully with similar, enduring anxieties about occult attacks. The social response to the public secret of AIDS occurred through an equally secretive discourse, that of witchcraft. Like AIDS, witchcraft discourses raised concerns with moral transgressions inspired by excessive desire and secrecy, that threatened the integrity of relations of blood. In Chap. 5 I argue that AIDS was experienced through witchcraft discourses and identify the analogous similarities between witchcraft and AIDS as idioms of misfortune, preoccupied with excessive desire, secrecy and invisible sources of harm. Witchcraft offered legitimate opportunities to cast blame and avenge the death of loved ones, revealing the strength of emotions and the endurance of memory. The focus of the last section of the book turns inward to locating suffering within individual biographies. Chapter 6 follows Philemon and Pretty Mlambo, a young HIV positive couple, on their journey from Johannesburg to Bushbuckridge as they seek care and support, highlighting the innate power of hope to heal. Distinct from the dangers of desire, if not its opposite, hope and hopefulness were visible in everyday life, enacted through caring for others. Hope was a moral category of

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action that was productive and constitutive of personhood. Like many thousands of other South Africans, Philemon and Pretty Mlambo were caught up in a zone of waiting, hoping for an end to their suffering. Their journey traversed the city landscape of Johannesburg, from hospital to clinic, and from a life they had established in the city, back to rural Bushbuckridge in their quest to find support, compassion and care. Hope produced meaning, even in their final days, and continued to shape the trajectories of their lives. Chapter 7 continues to explore the private lives of HIV infection and AIDSrelated illness and death. In the chapter I draw extensively from Khayellhle Mhlanga’s biography’s and his unique framing of illness and dying which he described as being consumed by a “machine”. I chronicle his journey from Mozambique to South Africa as a young boy, his coming of age as a wage labourer, and the multiple misfortunes he experienced. Khayellhle’s biography follows his struggle to achieve the status of manhood, and at the same time reveals the loss of agency and the absence of control over destiny. At once a poignant commentary on the harshness of life as an itinerant worker in post-industrial South Africa, the metaphor of the machine also implicates the loss of personhood. Khayellhle describes his illness as if his body has been subjected to forces beyond his control, but this also is a metaphor of the absence of control he has had for most of his life. While completing writing this book, the new global pandemic of COVID-19 struck South Africa. In Chap. 8 I attempt to make sense of how South Africans responded to the pandemic and find striking parallels between HIV and COVID-19, particularly in the reoccurring themes of racial inequalities, social difference and indifference. Pandemics not only expose fault lines, but also accentuate underlying social and cultural dispositions. In closing I return to fieldwork undertaken in 2019 and observe that the aftershocks of AIDS continue to be felt, not only in the epidemiological record, but also in the memories of the dead, demonstrating the stubborn refusal of the AIDS epidemic to disappear, despite claims to the contrary. Biologically, HIV continues to circulate in the bodies of the afflicted, hidden away in the blood and body tissues, with the potential to re-emerge if treatment is interrupted or suspended. But it is not only the viral remnants that threaten health and wellbeing; the aftershocks of the epidemic also lie within the memories of survivors. Contagion was not contained, neither by treatment, nor by death and the grave. Although much of the death and suffering caused by the AIDS epidemic may be in the past, it was still very much part of peoples’ everyday realities.

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Kleinman, A. (1980). Patients and healers in the context of culture. Berkeley: University of California Press. Kleinman, A., & Kleinman, J. (1997). The appeal of experience; The dismay of images: Cultural appropriations of suffering in our times. In A. Kleinman, V. Das, & M. Lock (Eds.), Social suffering (pp. 1–24). Berkeley: University of California Press. Leclerc-Madlala, S. (1997). Infect one, infect all: Zulu youth response to the AIDS epidemic. Medical Anthropology, 17, 363–380. Leclerc-Madlala, S. (2003). Transactional sex and the pursuit of modernity. Social Dynamics, 29, 213–233. Leclerc-Madlala, S., Broomhall, L., & Fieno, J. (2018). The ‘end of AIDS’ project: Mobilising evidence, bureaucracy, and big data for a final biomedical triumph over AIDS. Global Public Health, 13, 972–981. Levi, J., Raymond, A., Pozniak, A., Vernazza, P., Kohler, P., & Hill, A. (2016). Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades. BMJ Global Health, 1(2), 1–10. Lilian, R. R., Rees, K., Mabitsi, M., McIntyre, J. A., Struthers, H. E., & Peters, R. P. H. (2019). Baseline CD4 and mortality trends in the South African human immunodeficiency virus programme: Analysis of routine data. Southern African Journal of HIV Medicine, 20(1), 963. Livingston, J. (2012). Improvising medicine: An African oncology ward in an emerging cancer epidemic. Durham: Duke University Press. Lurie, M., Pronyk, P., de Moor, E., Heyer, A., de Bruyn, G., Struthers, H., McIntyre, J., et al. (2008). Sexual behavior and reproductive health among HIV-infected patients in urban and rural South Africa. Journal of Acquired Immune Deficiency Syndromes, 47, 484–493. MacPherson, P., Moshabela, M., Martinson, N., & Pronyk, P. (2009). Mortality and loss to followup among HAART initiators in rural South Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 103, 588–593. Malan, M. (2016). Mbeki deserves to be condemned by history says TAC. Bhekisisa. https:// bhekisisa.org/article/2016-03-08-00-mbeki-deserves-to-be-condemned-by-history-says-tac Marshall, P. A., & Bennett, L. A. (1990). Anthropological contributions to AIDS research. Medical Anthropology Quarterly, 4, 3–5. Martin, E. (2006). The pharmaceutical person. BioSocieties, 1, 273–287. Mbali, M. (2013). South African AIDS activism and global health politics. New York: Palgrave Macmillan. Mbeki, T. (2016, March 7). Mbeki’s letter on AIDS. Dispatch Live. https://www.dispatchlive.co.za/ news/2016-03-07-in-full-mbekis-letter-on-hivaids McNeill, F. G. (2015a). Immoral accumulation and the human economy of death in venda. In K. Hart & J. Sharp (Eds.), People, money and power in the economic crisis (Perspectives from the Global South) (1st ed., pp. 41–60). New York: Berghahn Books. Mendenhall, E. (2014). Syndemic suffering in Soweto: Violence and inequality at the nexus of health transition in South Africa. Annals of Anthropological Practice, 38, 300–316. Merry, S. E. (2011). Measuring the world: Indicators, human rights, and global governance. Current Anthropology, 52, S83–S95. Merry, S. E. (2016). The seductions of quantification: Measuring human rights, gender violence, and sex trafficking. Chicago: University of Chicago Press. Merry, S. E., & Coutin, S. B. (2014). Technologies of truth in the anthropology of conflict: AES/APLA Presidential Address, 2013. American Ethnologist, 41, 1–16. Mfecane, S. (2010). Exploring masculinities in the context of ARV use: A study of men living with HIV in a South African village. Humanities. Witwatersrand: Johannesburg. Mfecane, S. (2011). Negotiating therapeutic citizenship and notions of masculinity in a South African village. African Journal of AIDS Research, 10, 129–138. Mfecane, S. (2012). Narratives of HIV disclosure and masculinity in a South African village. Culture, Health and Sexuality, 14, S109–S121.

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Morema, M. J. (2011). State of the municipal address. Bushbuckridge Local Municipality. https:// bushbuckridge.gov.za/wp-content/uploads/2017/10/State-of-the-Municipal-Address-2011.pdf Moshabela, M., Pronyk, P., Williams, N., Schneider, H., & Lurie, M. (2011). Patterns and implications of medical pluralism among HIV/AIDS patients in rural South Africa. AIDS and Behavior, 15, 842–852. National Department of Health. (2004). National antiretroviral treatment guidelines. Pretoria: Department of Health. Nations, M. K., & Amaral, M. L. (1991). Flesh, blood, souls, and households: Cultural validity in mortality inquiry. Medical Anthropology Quarterly, 5, 204–220. Niehaus, I. (2001). Witchcraft, power and politics: Exploring the occult in the South African Lowveld. London: Pluto Press. Niehaus, I. (2007). Death before dying: Understanding AIDS stigma in the South African Lowveld. Journal of Southern African Studies, 33, 845–860. Niehaus, I. (2012). Witchcraft and a life in the New South Africa. Cambridge: Cambridge University Press. Niehaus, I. (2014). Treatment literacy, therapeutic efficacy, and antiretroviral drugs: Notes from Bushbuckridge, South Africa. Medical Anthropology, 33, 351–366. Niehaus, I. (2018). AIDS in the shadow of biomedicine: Inside South Africa’s epidemic. London: Zed Books Ltd. Niehaus, I. (2019). Seeing through dreams: On the efficacy of antiretroviral drugs in the South African Lowveld. Journal of Southern African Studies, 45, 197–213. Persson, A. (2013). Non/infectious corporealities: Tensions in the biomedical era of ‘HIV normalisation’. Sociology of Health and Illness, 35, 1065–1079. Pettifor, A., MacPhail, C., Hughes, J. P., Selin, A., Wang, J., Xavier Gómez-Olivé, F., Eshleman, S. H., et al. (2016). The effect of a conditional cash transfer on HIV incidence in young women in rural South Africa (HPTN 068): A phase 3, randomised controlled trial. The Lancet Global Health, 4, e978–e988. Pisani, E. (2008). The wisdom of whores: Bureaucracies, brothels, and the business of AIDS. New York, NY: WW Norton & Co Inc. Pronyk, P. M., Kim, J. C., Makhubele, M. B., Hargreaves, J. R., Mohlala, R., & Hausler, H. P. (2002). Introduction of voluntary counselling and rapid testing for HIV in rural South Africa: From theory to practice. AIDS Care, 14, 859–865. Ramutsindela, M., & Simon, D. (1999). The politics of territory and place in post-apartheid South Africa: The disputed area of bushbuckridge. Journal of Southern African Studies, 25, 479–498. Ritchken, E. (1995). Leadership and conflict in bushbuckridge: Struggles to define moral economics within the context of rapidly transforming political economies. Johannesburg: Department of Political Science, University of Witwatersrand. Robins, S. (2004). ‘Long Live Zackie, Long Live’: AIDS activism, science and citizenship after Apartheid. Journal of Southern African Studies, 30, 651–672. Robins, S. (2006). From “rights” to “ritual”: AIDS activism in South Africa. American Anthropologist, 108, 312–323. Rosaldo, R. (2004). Grief and a headhunter’s rage. In N. Scheper-Hughes & P. I. Bourgois (Eds.), Violence in war and peace (pp. 15–156). London: Wiley-Blackwell. Sangaramoorthy, T. (2014). Treating AIDS: Politics of difference, paradox of prevention. New Brunswick: Rutgers University Press. Scheper-Hughes, N. (1994). An essay: AIDS and the social body. Social Science and Medicine, 39, 991–1003. Scheper-Hughes, N. (1996). Small wars and invisible genocides. Social Science and Medicine, 43, 889–900. Schneider, H., & Fassin, D. (2002). Denial and defiance: A socio-political analysis of AIDS in South Africa. AIDS, 16(suppl), S45–S51.

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Schoepf, B. G. (1995). Culture, sex research and AIDS prevention in Africa. In G. Herdt (Ed.), Culture and sexual risk: Anthropological perspectives on AIDS (pp. 29–52). Amsterdam: Gordon and Breach Science Publishers. Shao, J. (2006). Fluid labor and blood money: The economy of HIV/AIDS in rural central China. Cultural Anthropology, 21, 535–569. Sheriff, R. E. (2000). Exposing silence as cultural censorship: A Brazilian case. American Anthropologist, 102, 114–132. Sihlongonyane, M. F. (2001). The rhetoric of the community in project management: The case of mohlakeng township. Development in Practice, 11, 34–44. Smith, J. H., & Whiteside, A. (2010). The history of AIDS exceptionalism. Journal of the International AIDS Society, 13, 47. Sontag, S. (2001). Illness as metaphor and AIDS and its metaphors. New York: Picador. Stadler, J. (1993). Bridewealth and the deferral of marriage: Towards an understanding of marriage payments in Timbavati, Gazankulu. Africa Perspective, 2, 62–77. Stadler, J. (1995). Generational relationships in a lowveld village: Questions of age, authority and tradition. Johannesburg: Witwatersrand University. Stadler, J. (1996). Witches and witch-hunters: Witchcraft, generational relations and the life-cycle in a lowveld village, Mpumalanga. African Studies, 55, 87–110. Stillwaggon, E. (2002). HIV/AIDS in Africa: Fertile terrain. The Journal of Development Studies, 38, 1–22. Taussig, M. (1999). Defacement: Public secrecy and the labor of the negative. Stanford, CA: Stanford University Press. Taylor, M. B., Janse van Rensburg, E., Swanevelder, C., Carlier, N. D., & Glatthaar, E. (1992). HIV and HTLV-I survey in Venda [letter]. South African Medical Journal, 81, 485. Thom, A. (2016). Go back into the darkness, Mr Mbeki. Daily Maverick. https://www. dailymaverick.co.za/article/2016-03-13-op-ed-go-back-into-the-darkness-mr-mbeki UNAIDS. (2014). Ending the AIDS epidemic by 2030. UNAIDS. https://www.unaids.org/en/ resources/documents/2014/JC2686_WAD2014report UNAIDS. (2019a, July). UNAIDS calls for greater urgency as global gains slow and countries show mixed results towards 2020 HIV targets. UNAIDS. www.unaids.org/en/resources/ presscentre/pressreleaseandstatementarchive/2019/july/20190716_PR_UNAIDS_global_ report_2019 UNAIDS. (2019b, February 28). Young people change the narrative on HIV in South Africa. UNAIDS. https://www.unaids.org/en/resources/presscentre/featurestories/2019/february/ 20190226_colour-my-hiv van der Geest, S., & Whyte, S. R. (1989). The charm of medicines: Metaphors and metonyms. Medical Anthropology Quarterly, 3, 345–367. Venter, W. D. F. (2014). Editorial: A South African decade of antiretrovirals. South African Medical Journal, 104, 3. Weber, B. (2017, December 16). Manto Tshabalala-Msimang, South African who oversaw discredited AIDS policy, dies at 69. New York Times. www.nytimes.com/2009/12/17/world/ africa/17manto.html Whyte, S. R., van der Geest, S., & Hardon, A. (2002). Social lives of medicines. In A. Harwood (Ed.), Cambridge Studies in Medical Anthropology. Cambridge: Cambridge University Press. Wojcicki, J. M. (2002a). ‘She drank his money’: Survival sex and the problem of violence in Taverns in Gauteng South Africa. Medical Anthropology Quarterly, 16, 1–28. Wojcicki, J. M. (2002b). Commercial sex work or ukuphanda? Sex-for-money exchange in Soweto and Hammanskraal area, South Africa. Culture, Medicine and Psychiatry, 26, 339–370. Zuch, M., & Lurie, M. (2012). ‘A virus and nothing else’: The effect of ART on HIV-related stigma in rural South Africa. AIDS and Behavior, 16, 564–570.

Chapter 2

Culture and Difference: From Medical Mission to HIV Prevention

Pandemics and epidemics have the effect of shining a spotlight on underlying social and economic fissures and fault lines, revealing inequalities and structural violence (Farmer 1992, 1999; Setel 1999; Fassin 2003; Briggs and Mantini-Briggs 2004; Johnson 2012). Similar to other epidemics, but perhaps most exceptionally, the HIV epidemic was like turning on a light in a room that has been kept intentionally dark, revealing that which had been kept outside of public purview (Setel 1999). Pursuing this analogy, light also creates shadows that hide, disguise and distort. While the HIV epidemic has been extremely productive of scientific knowledge on its origins, aetiology, spread and impact, it has also created discourses of social and cultural difference that reproduce views of Africans as impoverished, ignorant and dangerously sick (Comaroff and Comaroff 2011, 179). Using a historical perspective, this chapter chronicles medical and public health discourses of racial and cultural difference that permeated discursive practices in HIV prevention of the early 2000s. I suggest that early missionary medicine laid the foundations for the production and legitimation of alterity, reinforced during the apartheid era, and sustained in the everyday life of HIV prevention. Drawing on historical records and publications, as well as ethnographic fieldnotes to reconstruct this history, I begin by discussing the ways in which racial, social, and cultural difference is deployed in biomedical and public health discourses to explain the origins and spread of disease.

2.1

Race, Culture and HIV

An enduring irony of the South African HIV epidemic lies in its timing, coinciding with the collapse of the oppressive apartheid regime, the first democratic elections, and the freeing up of South African sexuality (Donham 1998; Posel 2005). In the midst of the hopefulness and promise of a new democracy and sexual freedom, the violence of discrimination re-emerged, directed at those infected and affected by © Springer Nature Switzerland AG 2021 J. Stadler, Public Secrets and Private Sufferings in the South African AIDS Epidemic, Social Aspects of HIV 6, https://doi.org/10.1007/978-3-030-69437-1_2

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HIV (Delius and Glaser 2005; Niehaus 2007), leading Archbishop Desmond Tutu to declare “AIDS is the new apartheid” (Independent Online 2001). Epidemics engender discursive practices that allocate blame for the origins and spread of disease and responses to the HIV epidemic draw extensively on a pre-existing “racializing logic” (Briggs and Mantini-Briggs 2004). When AIDS was first diagnosed in South Africa, official accounts of its origins and spread drew on the idea of notion of risk groups made popular in earlier epidemics such as tuberculosis and syphilis. “Gay men” and “foreign” migrant workers were believed to constitute “core risk groups” (Iliffe 2006). As the epidemic matured and its prevalence increased amongst predominantly Black South Africans, racial prejudices solidified. Risk grouping and the association of risk with specific racial categories, frequently overlapping with gender, can be discerned in the early biomedical literature. A review of the South African Medical Journal (SAMJ) reveals how South African epidemiologists drew extensively on an international “hegemonic narrative” of high risk groups that comprised the triple “H’s” (Haitians, haemophiliacs, homosexuals), and injecting drug users and sex workers. This became a “template for analysing and researching the epidemic” in South Africa (Tsampiras 2015, 773). Racial categories of risk have persisted in public health, but more recently, the focus has shifted to examining cultural traits and behaviour. Indeed, culture soon replaced race as a more palatable way of explaining the spread and persistence of HIV infection (Macleod and Durrheim 2002). The associations between disease, race and culture have a direct impact on the lived experiences and everyday lives of people, infected and affected by HIV. Historically, the intersections between theories of disease spread with concepts of race and culture were deployed to legitimise racial divisions in the interests of public health policy. In South Africa, the policy of racial segregation and control over the movement of Black people was supported by the Public Health Act of 1919 that claimed to prevent the spread of venereal disease (VD), typhoid and tuberculosis (TB) (Jochelson 2001). The idea that Africans were physiologically susceptible to TB was used as a justification for a migrant labour system which limited the length of time African labourers were permitted to reside in urban areas (Packard 1989a). Segregationists espoused the susceptibility of Black people to certain diseases not only in terms of biological, but also, cultural factors. The spread of VD was linked to urbanisation because Black South Africans were said to be “culturally unsuited” to urban lifestyles (Packard and Epstein 1991; Jochelson 2001). Cultural traditions that usually controlled Black men and women’s sexual impulses were believed to be absent in the rapidly growing slum yards and compounds in and around Johannesburg, and urbanisation was perceived to result in the loss of “cultural safeguards” and in increased rates of promiscuity. These sentiments are echoed in colonial era writings. The missionary ethnographer Henri Junod’s novel Zidji offers a critique of the vagaries of migrant labour and

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the lack of suitability of Indigenous Mozambicans to urban life (Harries 1981).1 Anthropologists writing in the early twentieth century reinforced these beliefs by focussing attention on the decrepit conditions under which Blacks lived in urban settings, the growth of prostitution and illicit beer brewing, albeit usually from a sympathetic perspective (For example, Hellmann 1935; Longmore 1959). Occasionally these writings also served to solidify cultural stereotypes of the “suspicious” native, reluctant to use biomedical facilities.2 In contrast, in accounting for the spread of HIV, attention shifted to examining the persistence of cultural practices, traditions, and “norms”. No longer regarded as protective, cultural norms of gender, generation, and sexuality were believed to enhance individual risk of HIV infection (Gausset 2001; Saethre and Stadler 2009). Anthropologists and public health researchers, responding to questions about the apparent uniqueness of the “African” HIV epidemic, framed the spread of HIV in terms of the persistence of cultural traditions. Sexual behaviours were perceived to be influenced by traditions such as widow cleansing through sexual intercourse (Campbell and Kelly 1995; Chipfakacha 1997), the levirate and sororate (Sow and Gueye 1998), polygamy (Cleland and Ferry 1995), bridewealth transactions (Wojcicki et al. 2010), and sexual partner change and “promiscuity” (Caldwell et al. 1989). Practices such as “dry sex”—which causes vaginal lesions and thereby creates an entry point for HIV—were assumed to be a cultural preference amongst African men (Brown et al. 1993; Runganga and Kasule 1995; Brown and Brown 2000; Van de Wijgert et al. 2001).3 Patriarchy and male dominance were likewise believed to underly women’s lack of agency in sexual relations and condom use (Campbell and Kelly 1995). Leclerc-Madlala (2001, 41) wrote, “Zulu sexual culture” is characterized by “. . .gender inequity, transaction sex, the socio-cultural isoka [masculine] ideal of multiple sexual partnerships, lack of discussion on matters of sexuality in the home and between sexual partners, the conditioning of both men and women to accept sexual violence as ‘normal’ masculine behaviour along with the ‘right’ of men to control sexual encounters, and the existence of increasingly discordant and contested gender scripts”. The overwhelming impression gathered from these writings was that failures of disease prevention typify a peculiarly African failure to respond correctly and adequately to prevention messages (Heald 2006). The biomedicalization of culture as social difference (DiGiacomo 1999) also appears in explanations for the apparent lack of change of sexual behaviours in sub-Saharan Africa in response to AIDS and the continued high prevalence of HIV infection in the sub-continent (Marshall 2005). This is illustrated in research on 1

The mining compounds were also believed to create the circumstances for what was regarded as the “unnatural” same-sex relationships between male migrant workers (Epprecht 2001). 2 Anthropological publications in medical journals had a bearing on medical knowledge and approaches, for example Longmore’s research on infant death (Longmore 1954). 3 However, anthropological research on microbicides has shown that the presumed preference amongst African men for “dry sex” is false, arising from inaccurate translations of “wet” and “dry” sex (Saethre and Stadler 2017).

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witchcraft (Yamba 1997; VanDyk 2001; Mshana et al. 2006) and traditional healing (Green 1994; Peltzer et al. 2006). For instance, beliefs in witchcraft and the ancestors were thought to result in an “extraordinary stoicism about death” which accounts for the passive acquiescence to the dangers of AIDS (Caldwell et al. 1992; Liddell et al. 2005). As a cognitive-behavioural construct, fatalism was linked in this literature to hopelessness, and a lack of self-efficacy to make changes or even imagine a future (Hess and McKinney 2007), that limited individual agency (Paiva 2000). These perceptions bolstered stereotypes of African fatalism and resistance to behaviour change. Kaler’s Malawian male informants regarded death as inevitable and ordained from God or witchcraft or vengeful spirits (Kaler 2004, 290–291). Preconceptions of Africans as fatalistic by nature were strengthened in questionnaire surveys. A South African study found that 30% of respondents aged 18 years and over who reported fatalistic views about AIDS also “lacked self-efficacy” and expressed hopelessness (Meyer-Weitz 2005). Other writers argued for a material basis to these attitudes. Poverty and the absence of opportunities were believed to contribute toward fatalistic outlooks and behaviour. Leclerc-Madlala (2005, 855–56) argues that South Africans are highly fatalistic as a nation. “Fatalistic attitudes coupled with a careless and reckless approach to life and the desire of some people not to ‘die alone’ which further adds to the spread of AIDS”. The material circumstances of sexual relations may also find expression in fatalistic attitudes. For instance unprotected sex in exchange for material support may be the only means for women’s survival (Preston-Whyte et al. 2000). In situations of extreme poverty and dire need, the threat of HIV infection was seen to be a secondary priority to more pressing demands of daily survival. Boys who live on the streets in Mwanza, Tanzania regarded AIDS as a distant threat in comparison to the more immediate threat of starvation and violence and therefore risked HIV infection through commercial sex (Lockhart 2002, 2008). Therefore, AIDS was experienced as yet another hardship endured by the poor and oppressed against which they are powerless. Impoverished people, it is assumed, do not invest in their health because they have so little to lose otherwise (Oster 2006). These ideas reinforce an underlying assumption of cultural conservatism. To paraphrase Herzfeld (1982), fatalism is regarded as a “passive resignation to the future dictates of chance”. This suggests a certain backward looking-ness, “the worst kind of inefficiency” that stands against progress. Tradition in this respect is a “rigid barrier” to the “practical”, implying that people are caught up in culture and tradition, and experience “cultural sclerosis” (Herzfeld 1982, 644). In contrast to these orientations Herzfeld proposes that statements about fate and destiny may reflect the incorporation of new ideas and experiences into already existing and familiar ways of seeing the world. Furthermore, rather than asking how fatalistic statements about life shape social and personal action, the question is how such “declarations about fate constitute a form of action”, constituting what Herzfeld calls the “performative action of excuses” or performances that “invoke the idea of fate through oblique allusion” (Herzfeld 1982, 657). In other words, fatalistic narratives do not necessarily reflect a fatalistic attitude but may be construed as “purposeful acts in a discourse of resistance” (Balshem

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1991, 153). The apparently fatalistic statements about cancer in working class US society can be interpreted in the same way: (. . .) the community view is tied to strong feelings about access to power in society. Community members are disinclined to accept their assigned position as “targets” of a health education campaign. They have seen themselves labelled sick and they have turned this around to label their social and material environment sick. They have considered blaming themselves as victims, and they have rejected the notion. Scientific authority, clearly, does not consider their interpretations of experience valid. So they use rhetoric about fate as a shield, and charge the scientists with hubris (Balshem 1991, 165).

Statements about fate may be regarded as irrational and conservative yet are often employed as rhetoric in contestations between Western biomedical and “local” knowledge. Implicit in this is a particular use of the concept of culture. The HIV epidemic has been especially productive of racist notions of exotic African sexuality that is unbridled and immoral (Gausset 2001). Explanations for the African HIV epidemic and the high prevalence of infections in the continent have directed attention toward a “unique” African sexual culture that features multiple sexual partners, gender inequalities and sexual customs. Creating a “single story”, this silences alternative narratives that oppose and challenge dominant narratives (Mkhwanazi 2016). These discourses of cultural barriers to health have a direct impact on policy making, and the distribution and direction of resources. For instance a report published by the United Nations Economic Commission for Africa asserts that culture plays a “major role” in “gender inequalities”, “wife inheritance and widow cleansing”, “polygamy”, “domestic violence including marital rape”, and “harmful practices like female genital mutilations” (Commission on HIV/AIDS and Governance in Africa 2008, 18–20). The report focuses on risky sexual practices, their links to culture, and the need to change cultural practices to reduce the spread of HIV on the continent. African culture is also framed as predisposing people towards accepting their fate and therefore robbing them of agency to adopt new behaviours. This is articulated as a struggle between modern rational knowledge and “an atavistic culture of ‘fatalism’” that must be replaced by a lifestyle approach to health (Davison et al. 1992, 676). Anthropologists have questioned and critiqued the exclusive focus on culture in explaining the spread of AIDS (Gausset 2001) and have discussed social, economic, political (Farmer 1992; Schoepf 1995; Parker 2001), biological (Stillwaggon 2002, 2003), and environmental factors (Packard and Epstein 1991). The adoption of “culture” as a variable detracts away from examining how political, economic and social processes influence the ways in which a disease spreads and the response to the disease (Parker 2006); a failure to recognise the political economy of AIDS (Farmer 1992; Schoepf 1995; Setel 1999) and the social contexts in which HIV transmission occurs (Delius and Walker 2002). Perceiving the spread of HIV as a problem of culture effectively de-politicises the AIDS epidemic. Blame is directed toward local cultural knowledge and practices. And, by insisting that biomedical knowledge and technologies can alone provide the answers, the focus shifts away

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from peoples’ everyday struggles. Biomedical discourse “valorizes Western scientific logic at the expense of other ways of interpreting the world” (Marshall 2005). While seeking to stem the spread of infections, illness and death, biomedicine reproduces social difference and othering through official narratives in scientific and popular media of disease spread and causation (Briggs and Mantini-Briggs 2004). Stereotypes of the poor as sick and ignorant are reinforced and blame for the spread of disease is directed toward culture and tradition (Farmer 1992; Gausset 2001; Saethre and Stadler 2009). These perceptions are not new or unique to AIDS. They have a long lineage, based in colonial encounters with Indigenous populations and racist casting of the diseased native made popular during the eighteenth century through to the Victorian era (Gilman 1985; Comaroff 1993). As Graboyes (2015, 47) notes, discussions about African people who resist biomedical interventions and follow health promotion messages “sound suspiciously like discussions of ‘unenlightened’ Africans from the colonial era”. These conceptions of the peculiarities of Africans and disease have shaped public health approaches to TB, syphilis, as well as AIDS, consequently blinding researchers to environmental factors and political economy. As a result, the focus in preventing epidemic spread concentrates on behavioural and educational interventions rather than social and environmental reform (Packard and Epstein 1991). One of the challenges to the stereotypical casting of African sexuality in epidemiological and medical explanations of epidemic spread in Africa was articulated by the former South African president, Thabo Mbeki, perhaps accounting for the popularity of his position amongst Black South Africans (Fassin 2007). His stance is evident in an anonymously authored4 document released by the ANC during 2002 entitled Castro Hlongwane, Caravans, Cats, Geese, Foot and Mouth and Statistics. In it, the authors point out that AIDS is not simply a scientific biomedical problem but a threat to the new African identity, noting, “[This monograph] rejects the assertion that, as Africans, we are prone to rape and abuse of women and that we uphold a value system that belongs to the world of wild animals, and that this accounts for the alleged ‘high incidence’ of ‘HIV infection’ in our country” (Anonymous 2002). This counter-discourse of racism and poverty resisted biomedical models of risk that associate AIDS with the dangerous “anti-social other” (Leap 1995, 229) which sees people as vectors of disease, as guilty bearers of misfortune rather than as people requiring compassion and support (Posel 2005). Despite these challenges, racist stereotypes have persisted into the treatment era. Concerns are expressed about Africans lacking the discipline to be medically compliant, amidst fears of biological resistance, reinforcing images of Africans as undeserving of treatment, lacking knowledge, and being unmotivated (Saethre and Stadler 2017). Assumptions that the African context lacks the resources and will to deliver ART resulted in significant delays in rolling out treatment. ART is a potent pharmaceutical that shape new forms of biomedical citizenship which also has the

4 The monograph was co-authored by, but not credited to, Peter Mokaba (the former president of the South African ANC youth wing) and former president of South Africa, Thabo Mbeki.

2.2 A “Civilising Influence”: Missionary Medicine in the Lowveld. . .

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effect of reproducing social divisions, intensifying competition over resources, and eroding social cohesion (Kalofonos 2010). These divisions may be gendered, generational, class and racial. For instance, embracing responsible biomedical citizenship through compliance to medical regimens, is distinctly gendered. Performances of “masculine” identity such as public drinking, is seen as unsuited to biomedical citizenship (Mfecane 2011). The emphasis in programmes on biomedical “treatment literacy” belies the complexities of the relationship between knowledge and agency in treatment seeking (Niehaus 2014), and local forms of knowledge are frequently cast as barriers to successful treatment. Revealing the persistence of colonial public health ideologies, patients are cast as “defaulters” and culture is regarded as a factor in non-compliance. In the sections below, I explore the history of medical regimes in Bushbuckridge. I begin by detailing missionary interventions that sought to “civilise” the residents of Bushbuckridge by providing medical services against the backdrop of profound economic and social transformations that occurred between the 1930s and 1970s. The second section traces the continuities in discourses about health and illness from the era of missionary medicine through to the establishment of Bantustan state health services during the apartheid era up until the early 1990s. In the final part of the chapter I draw upon ethnographic research that shows how the persistence of categories of difference, rematerialized in prevention campaigns of the late 1990s and early 2000s.

2.2

A “Civilising Influence”: Missionary Medicine in the Lowveld (1931–1976)

During the late Nineteenth to the early Twentieth Centuries, missionary involvement in the eastern Transvaal lowveld (currently the Mpumalanga and Limpopo provinces) was uneven. Possibly due to endemic malaria and the extremely hot temperatures, the dangers of navigating the terrain and threats posed by wild animals, missionaries arrived relatively late in the area.5 Initially based in Swaziland and Mozambique, by the early 1900s, the Presbyterian Swiss Mission had set up stations in the lowveld areas of the Soutpansberg (in the far north) and Shiluvane (near Tzaneen). However, it was only in the 1930s that residents of Bushbuckridge were directly exposed to missionary influences (Niehaus 2001). The Swiss Mission established a presence there through the Evangelical Presbyterian Church (EPC). They were followed by missionaries from the US-based Church of the Nazarene (Landman 2008). In 1931, the first clinical services were established by missionaries simultaneously at Cottondale Farm (near Acornhoek) and in the town of Bushbuckridge. The Nazarene mission had a larger footprint than the Swiss,

5 The early history of lowveld travelers is peppered with accounts of lions attacking humans. Missionaries and their families often succumbed to tropical diseases.

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owing to its sizeable funding base and international support. Over the course of approximately 40 years, the Nazarene missionaries built and administered clinics, hospitals, schools and teacher’s and nurse training colleges throughout Bushbuckridge (Niehaus 2002). Significantly, the arrival of the missionaries coincided with massive social, economic and political upheaval in the lowveld. In 1913, the South African Union government passed the Native Land Act restricting the available arable land to seven per cent in the African reserves and the remainder to white farmers, effectively facilitating the collapse of a relatively independent peasantry. Prior to this, commercial ventures in the lowveld were limited to hunting, gold exploration, and transport. However, after World War One, the construction of a new rail link between Pilgrims Rest and Johannesburg made commercial farming a far more attractive prospect for white farmers. The government provided white ex-servicemen who had fought alongside the British with concessions to own Crown Land. Increasing numbers of white farmers started growing citrus, ranching cattle and cultivating forests. Former African farmers entered into labour tenant agreements with these new landowners. Africans in Bushbuckridge and surrounding areas lived on land belonging to mining corporations, on Crown Land as rent payers, or as labour tenants on whiteowned farms. Labour tenants had access to ploughing and grazing land and worked for 3–6 months per year in exchange for grazing, agricultural and residential rights. On company owned land, rent was levied in exchange for the right to settle and to graze cattle. Tenants cultivated a wide range of crops such as sorghum, millet, maize and legumes (Shangaan: tinawa, tindluwa, timwembe) and gathered wild fruits such as the monkey orange (mkwakwa; Strychnos pungens) and herbs. Large households accumulated sufficient maize and sorghum to cater for their needs (Niehaus 2001). However, by the 1930s, agricultural production was dwindling, threatened by ever increasing restrictions on land. Consequently, many areas in the lowveld became labour sending areas on a large scale (Harries 1994). The establishment of the gold mines in Pilgrims Rest, the Lydenburg coal mines and the Maputo—Lydenburg Railway line provided new employment opportunities. Initially however, lowveld men were seldom employed on long-term contracts. Mining concerns, such as the Witbank coal mines and the gold mining estates in Pilgrims Rest struggled to attract long-term labour from the lowveld (Bonner and Shapiro 1993). Men worked solely with the intention of purchasing cattle for bridewealth, or to pay annual rental or hut taxes, taxes on dogs and bicycles, and dipping fees for livestock.6 In 1936, the passing of the Bantu Authorities Act led to company land, Crown land and several white-owned farms being purchased by the South African Native Trust (SANT) and reserved for Black peoples’ occupation. Conditions on these farms began to change with the influx of people removed from other white-owned

6

A strategy employed by labour recruiters to increase the labour pool was to aggressively pursue non-tax payers and to fine women who created additional income from beer brewing (Bonner and Shapiro 1993).

2.2 A “Civilising Influence”: Missionary Medicine in the Lowveld. . .

39

farms and forestry areas. By 1948, all farms in the area had been purchased by the SANT. By the 1950s, dependency on migrant wages was absolute and small scale farming merely supplemented household consumption needs (See also Niehaus 2001). Households faced food shortages and starvation, often resorting to gathering wild fruits, insects and rodents. These survival tactics are captured by the phrase ku hanza which is literally translates as “to scratch the ground, to be in search of food”. Families that faced starvation usually borrowed (ku tekela) from relatives who had stores of surplus maize and dried meat. In return, they laboured on their relative’s fields. Sharing meat demonstrated love between kin. However, under these new circumstances, traditions such as ku tekela were practiced less frequently. The crisis in agricultural production and the real threat of starvation is well illustrated by letters written from the lowveld at the time (Cited in Burns 2000, 17). In November 1942 Mr. E. H. Wittingstall, the owner of several businesses in the lowveld, wrote to Mr. M Petyt of Johannesburg, Dear Mr Petyt. All the storekeepers are experiencing difficulty in keeping stocks. We have now been out of stock for more than two weeks both of meal and mealies, and the Natives will soon be starving (. . .)

In November 27, 1942, Wambazi Makukule a resident in Newington in Bushbuckridge wrote to Wilson Maekere Mathebule at Daggafontein Mine on the Reef: As you are in Johannesburg have you forgotten of the great famine prevailing in this territory this year? The people are falling on top of each other in the stores owing to the shortage of maize—please hurry up sending seeds

Farm stores implemented rationing, restricting maize meal to two scoops per customer. Villagers queued for hours sometimes returning home empty-handed while others imported sacks of maize flour from Johannesburg. The shift from subsistence farming to dependency on the migrant labour system impacted significantly on nutrition, while the increased mobility of men and women was a conduit for the spread of syphilis and tuberculosis. The early mission hospitals were founded on the threat posed by these diseases. Established in the 1890s, mission hospitals such as Elim and Bochem in the north eastern lowveld offered clinical services particularly to “syphilitics” (Jochelson 2001). While the government “viewed missionary medicine as a cheap way to provide rudimentary health care for Africans in rural areas” (Jochelson 2001, 48), the missionaries regarded health care as a means to legitimise Christian proselytization in the area (Ndlangamandla 2015); “the purpose of curing the sick body was quite explicitly connected to other projects: those of social reform and of the saving of souls” (Vaughan 1994, 295). Treatment at the mission hospitals was not free and patients were encouraged to provide labour in return for food and treatment, in the hope that this would help create a civilised, Christian and healthy workforce (Jochelson 2001). Mission schools followed suit, emphasising young men’s participation in sports such as soccer, replacing the more individualistic sports such as boxing and stick fighting. The emphasis on team work and discipline was regarded as vital to prepare them for entry into the world of work (Niehaus 2015).

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The introduction of mission medical services provided a captive audience for proselytization; infant inoculations and the proposition of paediatric health checks were opportunities to preach to the mothers of infant children. Intended to undermine the power and influence of traditional healers, missionary medicine was linked to the presumed benefits of adopting “western civilisation”. Beliefs in witchcraft and the ancestors were regarded as barriers to the establishment of Christianity. Reporting on the Berlin Mission among the Pedi communities in Sekhukhuneland, Delius notes that witchcraft and magic were regarded by the missionaries as significant for the “existing religious system of the Pedi and believed that it had to be understood, confronted and overcome if Christianity was to be established successfully” (Delius 2001, 432). Clinical services were therefore primarily opportunities “to influence them [Indigenous people] out of their traditional religion into Christianity” (Nkuna 1986, 164). Missionary medical practice and teachings focussed on hygiene, the provision of antenatal information and diet (Nkuna 1986). However, the early “clinics” were nothing more than dispensaries, single room structures equipped only to treat minor ailments. Residents still had to transport the desperately ill and injured by a sled (xileyi) drawn by oxen to a field hospital located at Pilgrims Rest, a 52-km journey. By the late 1930s, missionary health services had undergone a massive expansion. In 1936, the Nazarene missionaries built the first Ethel Lucas Memorial Hospital (ELM) in Acornhoek. By 1939, ELM could offer 66 beds (and grass mats), although services were still limited, and the first resident doctor was only appointed in 1949. Over the next two to three decades, the demand for hospital treatment steadily increased and by World War II up to 20,000 outpatients were recorded for Bushbuckridge, reaching 62,000 in 1970. By that same year, ELM Hospital and its nine satellite clinics treated almost 21% of the local population and three doctors managed 230 patients (Nkuna 1986). Championing a civilising doctrine, missionary Christian ideology was antithetical to Indigenous healing practices and beliefs of the local Shangaan and Pulana population. Indigenous cosmologies focussed on the “metaphysical” powers of the ancestors, alien spirits, herbalists and witches, and the “impersonal forces of nature” (Niehaus 2001, 17). Mission medicine “competed directly with African healers on the same terrain, since missionary medical practice was explicitly about transforming existing meanings surrounding the body and disease and creating new ones in their place” (Vaughan 1994, 295). These attitudes were clearly articulated by missionary scholars and writers. In the late nineteenth century, the Swiss missionary, Henri Alexandre Junod, established a presence in Mozambique and Shiluvane (near present day Tzaneen). Despite his cultural preservationist ideals (Harries 1981) and respect toward Indigenous healing and healers, Junod labelled them as fraudulent “quacks” who used trickery to fool their patients. In line with a social evolutionist theoretical orientation, Junod envisaged their eventual replacement by Western trained medical practitioners (Junod 1912a). It is likely that the same perspective informed missionary attitudes in the lowveld. For example, the inhalation of smoke from burning herbs and beliefs in witch familiars were singled out and condemned as “foolish and heathenism”

2.2 A “Civilising Influence”: Missionary Medicine in the Lowveld. . .

41

(Nkuna 1986, 203). An extreme example of this perspective can be found in writings by the International Holiness Mission’s H K Bedwell. He wrote about “Acorn-Bush” (Acornhoek and Bushbuckridge) as “one of the furthest corners of the dark continent” and the Shangaan and Pulana as “a people which has slumbered in primitive heathen darkness for many centuries” (cited in: Nkuna 1986, 234). Witchcraft and “all forms of superstition” were targeted by missionary teachings and the provision of health care in the mission run institutions was regarded as pivotal to “combatting superstition” and especially witchcraft, though science, temperance, and “fresh air” (Marks 1994, 81). Promoting values and ideals that countered “traditional” forms of healing, mission hospitals barred traditional healers from entering hospital or clinic grounds. According to converts’ oral testimonies, eradicating Indigenous healing was also a major focus of the Church of the Nazarene. In order to join the church, healers and non-healers alike were instructed to abandon ancestral beliefs and to publicly demonstrate their repentance by destroying their apothecaries. The missionaries placed great emphasis on this act which was a symbol “of the change that had taken place in them [converts]” (Nkuna 1986, 202). Instruments of healing and knowledge of herbal potions are often passed down through the generation and their destruction therefore was significant as the disavowal of their identity and personhood. Historical records reproduced online by the Dictionary of African Christian Biography (DACB),7 reflect the significance of Indigenous healers’ conversions to Christianity often highlighting the destruction of medicines and instruments such as divination dice (tinhlobe) and medicines (murhi). The account of a Mbube Mhlabani,8 described as a “traditional doctor” reads: “We made preparations to burn all of his medicines and charms. The congregation gathered at his home. Mhlabani brought out all the things and they were burnt”. In another similar account Wiklif Mathebula “found the Lord and all of his demonic paraphernalia was burned in a great burning service. Later another doctor [healer], Abina Chiloane, and two others also had their things burned”.9 While public cleansing ceremonies attested to conversion to Christianity and a rejection of ancestral beliefs, rumours of Christians secretively consulting with Indigenous healers abounded (Nkuna 1986). However, the acceptance of mission medicine was not unanimous. A report from the time highlights missionary impressions of Black people caught up in tradition and generally unwilling to use medical services. “The Blacks of the area, who were still under the sway of witchcraft and superstition, did not trust the whites and their medical institutions” (Nkuna 1986, 150). Reginald Jones of the Nazarene Mission 7

The Dictionary of African Christian Biography (DACB) is a virtual archive (www.dacb.org) and includes the Paul Dayhoff collection of 475 interviews with Church of the Nazarene converts. Many of the accounts cited in the archive were republished in Living Stones in Africa (3 volumes, 1996–2006) and in Africa Nazarene Mosaic: Inspiring Accounts of Living Faith (2001), both by Paul Dayhoff. I have cited the archive versions of these interviews throughout. 8 https://dacb.org/stories/swaziland/maphanga-simeon/ 9 https://dacb.org/stories/southafrica/mthethwa-johanne/

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and author of The Elm that Grew at Acornhoek noted that most patients preferred to die at home rather than trust white doctors, while many continued to refuse missionary help (Jones 1975). Patients admitted to the ELM usually requested that one of their relatives be allowed to remain with them to safeguard against possible witchcraft attacks and poisoning. However, as hospital consultations increased, this was believed to indicate the gradual erosion of traditional “superstitions” and acceptance of biomedical and Christian ideals, gradually “Weaning them . . . from the evils of the satanic power of the witchdoctor” (Nkuna 1986, 144). The assault against Indigenous beliefs and healing traditions occasionally provoked more overt local resistance of which there is some evidence in the DACB records. Although Shangaan and Pulana chiefs generally welcomed the missionaries, public displays of repentance sparked antagonisms. In one instance a chief and his counsellors intended to “attack” the Nazarene missionaries. Stick-wielding residents cursed and chased away Thompson Mkonto, a lay preacher. The thatch roofed church he had built in Dumfries was later burnt down by arsonists.10 My older interlocutors remember that the village elders disrupted church services by beating their drums outside church buildings. Individual converts also experienced opposition from family and community members. They were warned that they would become insane from attending church and Sunday School. When Daniel Hlatshwayo converted to Christianity, his grandmother hid away his bottles and jars of murhi (medicine), rescuing them from destruction.11 Opposition to missionary medicine may have been provoked by the condemnation of Indigenous healing traditions. However, missionary temperance policy and criticism of the consumption of “traditional” beer was especially contentious for men. Beer drinks were key events in solidifying relationships between kin and neighbours. Prior to the 1960s, homesteads were scattered and isolated from each other. During periods of intensive labour need, neighbours formed work parties to hoe the fields and were rewarded with the sorghum beer (Niehaus 2001). Beer drinks were also performed for returning migrants, as in the following account of Zephania Ngobeni. “Returning home from working at the Simmer and Jack Mine in Johannesburg, he found a great welcome feast prepared for him. The women of the homestead had brewed a great quantity of beer”. However, since Zephania had joined the church, he refused the beer, albeit begrudgingly: “This was one of many temptations and they caused him to weep and pray at night”.12 The ban on beer drinks amongst the converted shaped the gender profile of church converts, and women constituted 80% of early converts. By 1960, women converts in Acornhoek (124) easily outnumbered men (23). According to the Holiness Mission, it was “easier to win a woman than a man” (Nkuna 1986, 200). By employing men and—predominantly—women as “agents” of the mission, a new class of resident was created who would exert a civilising influence on others

10

https://dacb.org/stories/southafrica/mkhonto1-thompson/ https://dacb.org/stories/southafrica/hlatshwayo-daniel/ 12 https://dacb.org/stories/southafrica/ngobeni-zephania/ 11

2.2 A “Civilising Influence”: Missionary Medicine in the Lowveld. . .

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(Dlamini 2018, 371). Missions offered women opportunities for self-upliftment, and an identity beyond their role in homestead production and reproduction. Since the 1940s, the dwindling subsistence capacity of the household and its increasing dependence on migrant remittances undermined the status of women in the household. Young newlywed women entered their husband’s homestead and were expected to fulfil the duties of the daughter-in-law (sing. makothi. Pl. vakothi) finding themselves in the unenviable subordinate position to their mothers-in-law (mamazala). The youngest and newest wife was usually given the hardest tasks and was sometimes physically abused and deprived of food and shelter. While many young women fled these oppressive circumstances to urban areas to work as domestic labourers in white households, the missions offered other opportunities and alternative life courses. The missions presented younger women with opportunities to escape oppressive marriages and sanctuary from harsh domestic situations. Tellingly, many women who were at the forefront of local missionary establishment were single, either divorced or separated from their husbands. Ruth Mbetse and Alice Khumalo both fled their marriages and sought refuge at mission stations. Both became matrons of girls’ hostels, and “more and more young Black girls followed their example” (Nkuna 1986, 197). Members of the Women’s Foreign Mission Society achieved leadership positions: they trained as Bible women, chaired meetings, and assisted with conventions. These new-found roles challenged their inferior status within the domestic domain and “the church supported these rebels” (Nkuna 1986, 201). Mission clinics, hospitals and orphanages created a novel source of employment, especially for women, as nursing assistants, care givers and teachers. Their involvement was regarded as a vital strategy to the promotion of Western and Christian ideals (Nkuna 1986). As early as 1931, ELM Hospital began training African nursing assistants. Trainees were required to work for 6 months without pay to demonstrate their virtue and dedication to caring for others. The following excerpt is from the account of Katrina Khoza (1914–2006), one of the first nurse’s aide at ELM: “She was greatly concerned for the spiritual welfare of everyone at the institution. She was a woman of earnest prayer and was always ready to carry an extra load or volunteer for overtime duty. When intensive care was needed, Katrina was there to help with it. When the sick desired to see Jesus, Katrina was the one to introduce them to The Great Physician [Jesus]”.13 As nursing assistants rose through the ranks, they became the bearers of morality and Christian values, spearheading the proselytizing mission in combatting local traditional beliefs and practices (Nkuna 1986; see also, Marks 1999). While the missions opened up opportunities for young women to establish novel and independent life courses, mission schools also posed challenges to the authority of elders over young children. School attendance undermined children’s contribution to domestic labour and production. Children performed vital agricultural tasks, guarding fields against baboons and birds, milling maize, collecting water and wood, 13

https://dacb.org/stories/southafrica/khoza-katrina/

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and herding cattle and goats. Large households prepared maize porridge in massive three-legged pots (drie potte) which took several young girls to stir. By 1931, ten mission schools had been established in Bushbuckridge. However, attendance was sub-optimal (Ndlovu 2003), and high drop-outs were reported (Nkuna 1986). Children usually attended classes for only half the week, sharing school attendance with their siblings. An elderly man recalled that he attended school on alternate days, limiting his education; “we learnt a, b, c but not d, e, f”. Perhaps more significant was the role of missions in promoting Christian sexual morality (Heald 1995; Niehaus 2000). Perceiving bridewealth (ndzhovola) as the buying and selling of women, missionaries made strong recommendations for its abolition or modification, especially for Christian converts (Junod 1912b; Stadler 1993). Polygamy was likewise discouraged by demanding that men separate from their additional wives if they wanted to join the church (Nkuna 1986). Missionaries also challenged local customs of sexual socialisation, such as the xingombela dance held on Friday evenings. During the xingombela, adolescent boys and girls from neighbouring villages lined up in rows facing each other and sang, “We will be alone in the house” (Hi ta helela malawini), a lament to the unmarried, solitary man or woman. One of the verses encouraged sexual experimentation. Referring to male and female genitals it went: “If you hide something it will become rotten/stale” (dudlu ntombi xa ku veka xa bola). Following the singing and dancing, senior youth (tensini) instructed both boys and girls on non-penetrative sex. Coming of age in the 1950s, older people recalled having recreational sex under these circumstances. “We would play with the boys and they would touch our breasts, but we would not have sex”. “Play sex” or matanyula avoided penetration, creating the opportunity for sexual experimentation while avoiding pregnancy (See also, Delius and Glaser 2002). In contrast, Christian converts were warned against sexual impropriety and were instructed to dress in such a way that would not evoke strong feelings of desire (Nkuna 1986; Niehaus 2000). Moreover, any form of traditional dance and music were discouraged by the missionaries and labelled as “sin” (Nkuna 1986). It is nonetheless important to note that the characterisation of missionary education and medicine cannot be applied wholescale. Missionary criticisms of traditional African practices were not as clear cut as some implied. For instance, Henri Junod supported a slightly more progressive agenda in recognising the role of the church in sex education, seeing benefits in church based instructions on “moral hygiene” (Delius and Glaser 2005).14 Junod also advocated for the training of Mozambican men and women as medical doctors, highlighting a future need (Junod 1912b). By the 1970s, the Church of the Nazarene and its influence had been displaced by African Independent Churches. Notably, the Nazarene Revival Crusade Church 14 Notably, the Nazarene Revival Crusade Church (NRCC), an offshoot of the Church of the Nazarene established in the early 1970s by Reverend Ben Silinda, hosts youth days during which marriage proposals are sanctioned and older, married youth offer sex education. Couples who marry within the church are rewarded with a wedding ceremony, paid for by the church. Currently, the main branch of the NRCC is a massive warehouse sized structure that dwarfs the original mission church.

2.3 (Un)Healthy “Homelands” (1968–1994)

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(NRCC), an offshoot of the Church of the Nazarene was established in the early1970s by Reverend Ben Silinda. While a devout member of the mission church, Silinda left after he was censored by church leaders for professing the power to heal through the laying of hands. The hold that the missionaries commanded over medical services was significant in the first half of the twentieth century, but by the 1960s and 1970s gave way to Bantustan controlled medical service. Regardless of the form it took, missionary medicine in Bushbuckridge laid the foundation for future medical interventions that framed tradition as incommensurate with modern medical practices and Christian ideals. Christian teachings delivered via the health services were interwoven with notions of civilisation, hygiene and women’s independence from men. This promoted enduring social schisms between Christian and pagan (pagani), civilised and traditional which continued to be relevant under Bantustan administration.

2.3

(Un)Healthy “Homelands” (1968–1994)

The creation of the self-governing “homelands” solidified the apartheid policy of separate development, restricting Black people to the native reserves and controlling their movement into urban areas.15 In 1968, Bushbuckridge was carved into two separate districts: Mhala (Gazankulu) and Mapulaneng (Lebowa). By 1974, most households had been resettled into residential stands in areas classified as villages and townships. The estandeni (lit. the time of the stands) remade the landscape, forcing large homesteads that were arranged in semi circles into rectangular blocks of land. This effectively cut off access to arable and pastural land. In some villages, interventions offered support for “communal” farming under the umbrella of agricultural development programs administered by the Gazankulu Development Corporation. Individual farmers paid rent for land use, rented tractors, purchased manure and pesticides. They were also encouraged to grow cash crops such as wheat and white maize that were susceptible to infestation by boring worms. Older residents who experienced their childhoods in the 1940s and 50s spoke of these farming schemes as massive failures. Members of the farming cooperatives seldom made a profit. A woman who worked on the agricultural scheme for 10 years, complained that she only reaped “a few onions and some small change”. Many small farmers simply gave up, although some farmed smaller “secret fields” in which they

15 With the application of the policy of apartheid after 1948, and especially the rigorous enforcement of legislation in the 1960s, removals took on a more systematic nature. Legislation like the Group Areas Acts of 1950 and 1957, the Natives Resettlement Act of 1954, the Native Trust and Land Amendment Act of 1954, and the Native (later Bantu) Laws Amendment Acts of 1952, 1963, 1965 and 1970 provided the authority and the machinery for the mass removals. At the same time the institutional framework for Separate Development was established by the Bantu Authorities Act of 1951, the Promotion of Bantu Self-government Act of 1959, the Bantu Homelands Constitution Act of 1971, and the Bantu Affairs Administration Act of 1973 (Baldwin 1975).

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grew “traditional” crops such as ground nuts, maize, root vegetables and spinach. The agricultural officer responsible for the removals was despised by the villagers who called him Munguluve (lit. White Pig). “If I were to hear that he is dead I will dance for joy” remarked NwaEphraim. “Munguluve played with people. When you left to work on your field in the morning it was like going to the plaas [Afrikaans. Farm]”, implying working for whites. She continued: “He scrapped our bodies because we really cannot plough anymore. Nowadays we buy everything. We eat [chicken] heads and feet but we never see the chickens!”.16 NwaMgiba, in her late 60s, described her childhood as “slavery”. Her parents beat her severely if she did not complete her chores. NwaEphraim likewise recalled that she slept on reed mats and wore rags instead of clothes. She and her siblings suffered constantly from infestations of lice and never used soap. Food shortages were a constant problem and many meals consisted of wild fruits such as monkey oranges (masala), wild berries (timbulwa) and jackelberries (tinsanguri) and water. Such a diet caused diarrhoea and abdominal bloating. Larger households struggled to feed and support their members. According to older women I interviewed, life as a married woman was not much better. Selinah, who was in her late 60s in 2004, married into the Mamabolo family in 1951. The six Mamabolo brothers each married several wives. Two people shared the cooking and the entire household of more than 20 people ate from one huge pot. “If you didn’t eat quickly you would die of hunger” recalled Selinah. She was the third wife of Gaza Mamabolo, a worker for a construction company in Johannesburg. Gaza seldom visited his family and stopped sending his wages home to his wives. For some months Gaza’s brothers ensured that Selinah and her co-wives were taken care of. Yet, the household eventually broke up and Selinah was forced to earn a living by brewing and selling sorghum beer (mgodwana). In the early 1960s, one litre of beer sold for one tikky (three pence). Selinah was often harassed by the police and was imprisoned for 2 months for the illegal production and sale of liquor. Women placed in dire situations migrated out of the village to seek a means to support themselves and their children. A group of women from Bushbuckridge began to commute to Randfontein, a mining settlement north-west of Johannesburg. These journeys began in the early 1970s when a few older, separated or widowed women sought to support their children by selling produce in the townships and informal settlements surrounding industrial areas. One of the first, Jemima Mabunda struggled to raise her three children with the paltry R30 monthly wage she received as a farm labourer in Barberton. In 1974, she commuted to Soweto by train to sell bananas and oranges purchased from white farmers in the lowveld. However, frequent police harassment and township violence drove her away from Soweto. In nearby Randfontein, she found a market amongst the men employed on the mines that were keen to buy fresh produce. Jemima was able to substantially increase her

Chicken heads and feet, known as “walkies and talkies” are the cheapest cuts of the bird, usually braised or stewed and served with a gravy of tomato and onion.

16

2.3 (Un)Healthy “Homelands” (1968–1994)

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income. “I would pay school fees, buy a bag of maize meal, buy clothes” she said, remarking on the ease at which she earned this income. Sarah Dzhambukeri, Jemima’s neighbour, was an unemployed divorcee. At Jemima’s insistence the two started to make trips to Randfontein together. Soon, Sarah established a semi-permanent home in Randfontein. She settled down with a Mozambican man who worked on the mines and together they rented a house near Randfontein in Mohlakeng Township. Sarah invited her sisters and other neighbours from Bushbuckridge to visit her there. In 1989, Sarah’s sister Flora, divorced her first husband and joined the others in Randfontein. She set up a small informal trading store (spaza) and by 1993 she was renting out tiny one-room corrugated iron shacks called mukukus (lit. “chicken coops”) on the borders of Mohlakeng. The pathways forged by women from Bushbuckridge to locales such as Randfontein would later have implications for the spread of HIV. The impact of the land restrictions, forced removals, and the dependency on migrant incomes had implications for the health status of residents. This was evident in the prevalence of malnutrition amongst children. Diseases such as kwashiorkor17 and pellagra18 are indicators of food insecurity and the dwindling nutritional status of children, and usually associated with famine conditions. According to data collected from hospital records in the early 1980s, 35% of all children under five were malnourished, causing 28% of all infant death (Ijsselmuiden 1984).19 Moreover, the lack of a reliable supply of potable water is reflected in cholera outbreaks, infant gastroenteritis and typhoid (Buch and De Beer 1984).20 A poignant commentary on the relationship between forced resettlements and malnutrition, the following verse recorded by Patrick Harries in the early 1980s illustrates the abject misery of forced resettlements in the former Gazankulu Bantustan (Harries 1984). Go into the unknown They take us to the wild country We have left our figs and mufureira almonds and lala beer We have left our graves behind us We have left the wild fruits And there is no relish in this place Malnutrition is destroying us While nutritional and water borne diseases reflect common crises faced by many households in supporting the basic needs of its members, the increased prevalence of infectious diseases such as TB and sexually transmitted infections such as syphilis Kwashiorkor is caused by a lack of protein, resulting in oedema and fluid retention, visible by the bloated abdomen amongst its sufferers. 18 Pellagra is a result of the lack of vitamin B3 in the diet and results in skin rashes, mouth sores, and diarrhea. 19 Patients typically presented with TB, kwashiorkor, pellagra, typhoid fever, venereal disease and schistosomiasis (Sutherland 1968). 20 Cases of typhoid at Tintswalo Hospital increased from 111 in 1976 to 685 in 1983 (Buch and De Beer 1984). 17

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were associated with migrant labour. Migrants lived in cramped and unhygienic mining hostels exposing them to TB (Packard 1989b) while syphilis, acquired in the cities followed migrant labourers home to the rural areas (Jochelson 2001). The disease profile that emerged at this time challenges the South African apartheid state propaganda of the “healthy” native reserve in contrast to the “diseased” urban area (Packard 1989a). The fiction of an African traditional subsistence-based economy in the countryside was used to legitimise the continued extraction and exploitation of Black labour. For the most part, the Gazankulu and Lebowa “homelands” were reduced to “proletarian dormitories” for South African industrial capital (Harries 1986, 108). The social consequences of increased population density in Bushbuckridge, due to resettlement and the creation of residential settlements, was also evident in strained relationships between neighbours. Households, previously located far apart, were forced into close proximity, creating concerns about security—of the material and spiritual kind. Residents complained of chicken and cattle theft, of the destruction of their fields by their neighbour’s goats and cows and fighting between children from different homesteads. An elderly man put it this way: “We started to hate each other. We don’t like each other. There is the next-door neighbour [living] next to each other, next to each other, so we can’t breathe properly”. Increasing tensions and insecurities manifested in witchcraft accusations in Bushbuckridge in the 1960s and 1970s culminating in the violent mass witch-hunts of the early 1990s (Stadler 1996; Niehaus 2001). In 1976, following the creation of Gazankulu as a “self-governing state” in 1972, the administration of mission run hospitals and clinics was taken over by the Gazankulu Department of Health and Welfare (Zwi 1984). In Acornhoek, ELM hospital fell under Gazankulu and was renamed Tintswalo from the Shangaan word for “mercy”. This renaming exercise reflected the advent of state endorsed Shangaan ethnic nationalism (Niehaus 2002). Distinct health policies for different homelands were forged in an attempt to win the political loyalty of the educated elite such as nursing staff and teachers, who depended financially on these new structures for their employment (Marks 1994). In 1983, the Gazankulu government controlled livelihoods through jobs and welfare pensions for the vast majority of its residents. Not surprisingly, investing in Shangaan identity and support for the “homeland” state was strategic in contestations over scarce resources such as employment.21 The management of health services under two different “homeland” administrations was incapable of providing adequate health care for the vast majority of residents of Bushbuckridge. It was highly fractured, underfunded, and inefficient. The creation of the two separate “homelands” of Gazankulu and Lebowa prompted disputes and exclusionary practices, coalescing around border disputes between the two “homelands”. The border between the two “homeland” districts of Mhala

21

Harries (1986) describes the emergence of an elite petit bourgeoisie in the late 1970s and early 1980s which had a vested interest in the Bantustan state’s promotion of Shangaan ethnic identity and the protection it offered from “foreign” entrepreneurial competition.

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(Gazankulu) in the east and Mapulaneng (Lebowa) in the west cut through the town of Acornhoek along the main road and a railway line. Where the road crosses over the railway line lies a piece of land that became the focus of disputes between residents of Mhala and Mapulaneng. In the early 1980s, a gang of young men simply known as the Mphyangas (the “thugs”) from the Gazankulu side of the border made forays into neighbouring Lebowa, kidnapping and raping young women and targeting cars displaying Lebowa number plates. Despite this and the ensuing tensions between residents on either side that often erupted into stone throwing and assaults, many residents commented that the borders were false. Residents from Mhala and Mapulaneng participated in weekly muchongolo dance competitions, socialised with each other, and frequently intermarried. Although the “homeland” borders were artificial, discriminatory practices played out in schools and the health services (Niehaus 2002). Encouraging the reification of ethnic divisions, the Gazankulu Department of Education built “border” schools to accommodate Shangaan speakers living in Mapulaneng. This promoted anger toward “Shangaans” whose access to the new resources was regarded as unfair. Tintswalo Hospital fell inside the Mhala district and became known as the “Shangaan hospital”. Here preferential treatment was given to Shangaan job applicants while, “non-Shangaans” were labelled as “foreigners”. Furthermore, patients who were identified as “Sotho” were turned away from the hospital and had to make the 35-km journey to Masana Hospital in Mapulaneng. Similarly, Shangaans seeking care at Masana were told to “go to that Shangaan hospital [Tintswalo]” (Buch and De Beer 1984). Apart from language and surnames, discrimination was based on markers of ethnic identity such as a small circular scar on the faces of Sotho women to show they had attended initiation,22 and car license plates—GH for Mhala (Gazankulu) and LEB for Lebowa. The lack of coordination between the two hospitals added to the increasingly overburdened health care service and often resulted in rushed consultations and untreated patients (Buch and De Beer 1984).23 Those who could afford the fees or had medical aid consulted private general practitioners. Dr. Zwane, a graduate of Natal University’s medical school, established a thriving practice in Acornhoek in the late 1980s and was constantly in demand. In addition to the abovementioned barriers to accessing health care, residents I interviewed in the early 1990s reported experiencing discrimination based on class and literacy. Made to feel ashamed of their impoverished circumstances poorer patients felt that the nursing staff looked down on them, while favouring those who were more affluent. In the reception area of the hospitals, nurses drew attention to the lack of hygiene amongst patients who could not afford toiletries. I overheared 22

The initiate’s cheek is branded using the heated end of a whistle. While the homeland borders were removed after 1994 and Tintswalo Hospital became a secondary hospital for all Bushbuckridge residents, people continued to perceive of the health services along ethnic lines and reported favoritism and injustices based on ethnic labels. Fassin notes a similar phenomenon in the Tzaneen area of the lowveld at Shiluvane Hospital, and reports on ongoing discrimination against “Pedi” patients by “Shangaan” staff at the hospital (Fassin 2007). 23

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nurses in the early 1990s chastising family members for bringing their elderly parents to the hospital without bathing them first and complaining that their clothing smelt of urine and woodsmoke. Bathing, vaginal douching and wearing clean clothes were unofficial requirements for hospital consultations, or indeed, any dealings with official representatives of the hospital administration. During the period of “homeland” administration, Indigenous healing was still regarded as antithetical to “modern” medical services and traditional healers continued to be barred from the grounds of Tintswalo. This reflects the persistence and enforcement of mission hospital policy despite its new administration (Buch and De Beer 1984). Patients who revealed that they consulted Indigenous healers or displayed signs of having done so (for example scars from incisions on the wrist and nape of the neck) were scorned and scolded by medical staff. In the 1980s, Tintswalo Hospital was established as a site for Witwatersrand University (“Wits”) sixth year medical students during their “rural block” placement. With a reputation for being progressive, Wits health researchers explored the social, political and economic determinants of health in Bushbuckridge. Influenced by the South African physician couple, Sydney and Emily Kark in the 1940s, medical researchers advocated for community based primary health care (Tollman 1991).24 Wits researcher’s criticisms of Bantustan health policies and their defiance of petty apartheid earned them the reputation as “communists” amongst the conservative white residents of the nearby town of Hoedspruit.25 Although these progressive medical researchers and clinicians expressed greater acceptance of local world views, they were relatively ambivalent toward traditional health practices. An advocate for community health systems who was based at Tintswalo Hospital in the early 1980s, Eric Buch noted, “Rather than scorn or mock patients about their beliefs, we discuss them openly, but with respect. We encourage helpful beliefs and practices and discourage harmful ones” (Buch et al. 1984, 6). In contrast to missionary medicine’s utter rejection of traditional healing practices, this narrative distinguishes between “good” and “bad” public healths (see Marsland 2013). The censorship of “harmful” traditional practices surfaced in health promotion activities staged by community health workers to promote responsible health care seeking for TB. For example, a drama about TB treatment, staged by community health workers, portrayed men who drink traditional marula beer and consult Indigenous healers as inimical to healthy decision making (Buch et al. 1984). This association between Indigeneity and poor health choices mirrors earlier missionary

24 The community based care model pioneered in KwaZulu Natal by the Karks was squashed by the Nationalist government by the 1960s, but resurfaced in the 1990s with the unbanning of the ANC (Phillips 2014). 25 Friendships and romantic relationships between (mainly foreign) white medical staff and Black residents were fairly common, especially toward the end of the 1980s. A married couple (a Dutch woman and a Nigerian man) had their car tires slashed while attending Sunday services at a church in Hoedspruit, a conservative town about 50 km from Tintswalo Hospital.

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discourses.26 Pathologizing marula beer drinking is significant in the light of its symbolic importance in ideologies of kinship and community. The maroela tree represents the ancestors (the roots), the elders (the trunk), fertile men and women (the branches), and future progeny (the berries). Cutting down a maroela tree for any reason was punishable by fines paid in cash or cattle. The beer produced from the maroela berry was usually consumed during communal drinking parties. During the hot months of December and January, the time of year when migrants visited home and family rituals were held, the berries (nkanyi) were harvested and left to ferment in water. Drinkers moved from homestead to homestead, sampling the beer (vukanyi). These drinking parties were affirmations of kinship relations and good neighbourliness. Similar to libations to the ancestors and gifts to royalty, the consumption of beer represented the healthy flow of fluids. Presenting the consumption of maroela beer as a harmful tradition by associating this with the spread of TB was therefore an anathema. Its sub-text implied a rejection of traditional forms of gathering and of kinship. The transfer of medical services from missionary to “homeland” state, signalled a significant break in medical regimes. Yet, important continuities can be seen between the Christian, anti-traditionalist values and the community-oriented health care programs advocated by progressive medical officials. The view of cultural practices and beliefs as problematic was sustained throughout these two eras of medicine. These continuities can be partly explained by examining the personnel who staffed the health services. In the early 1980s and 1990s, progressive health care professionals (medical officers and researchers) adopted an ambivalent but respectful stance toward local cultural practices and traditions. In contrast, the predominantly Black female nursing staff, continued to espouse Christian missionary teachings and outlook. Under missionary administration, Black women had occupied relatively junior positions in clinics and hospitals. Under the new “homeland” administered medical services, they were awarded fairly senior positions as matrons or senior professional nurses. In these positions, many carried forward their strong Christian ideals and moral outlooks. As women with fixed incomes and relatively high status within their communities, nurses embraced a “modern” identity—independent of men and their “traditional” lifestyles.27 This was especially evident with respect to the provision of reproductive health services such as family planning to unmarried and adolescent women.

In clinical studies, alcohol, particularly “traditional” beer, was pathologized and implicated in the spread of infectious diseases such as TB, as well as certain cancers. For example, a 1960s study concluded that the “traditional beer of the Shangaans” is implicated in mycotoxicosis that can lead to cancer (Sutherland 1968, 22). Health policies speak to a lengthy history of colonial and postcolonial restrictions on the production and consumption of “African” beer by Black people (see Bonner 1990). 27 Anthropologists have highlighted the distinctly gendered nature of traditional identities (van der Vliet 1991; Webster 1991). 26

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In 1974, state medical services introduced facilities for the provision of family planning or contraception, but it was only in the mid to late 1980s that family planning services became more widely available in Bushbuckridge (Garenne et al. 2001). Still, until 1984, contraception could only be issued to a woman with written permission from her husband.28 Even after these contraceptive policies had been rescinded, nurses continued to restrict family planning services to adult married women. According to census data collected in 1991, only 28% of women in the former Gazankulu reported using contraception (Kaufman 1998). Community pressure against family planning persisted well into the 1990s; residents often criticised and even attacked clinics that issued women with contraception (see also Marks and Andersson 1987). For instance, in 1990, the Lillydale clinic located in the southern part of Bushbuckridge was petrol bombed by unknown assailants, in protest against the provision of contraception to unmarried and young women. In the early 1990s, young women frequently complained that nurses scolded them, threatened to inform their parents, and were particularly heavy handed when administering contraceptive injections. They ordered teenage girls who requested contraception to “come back and show me the baby” or demanded to see used sanitary pads to prove that they were menstruating (see Kaufman et al. 2001, 149). Missionary medicine’s “civilising” project was carried through into the period of “homeland” state administered health services, but a more ambivalent attitude toward Indigenous healing and practices prevailed towards the end of the apartheid regime. In the early 1990s, in the light of social and political transformations in South Africa, medical researchers advocated for the recognition of non-allopathic practices in biomedical spaces, and the inclusion of traditional healing (Freeman and Motsei 1992). At Tintswalo Hospital, researchers held enthusiastic discussions about the incorporation of traditional healers into hospitals. Rather than outright rejection of Indigenous healers, many expressed the need for their involvement. This reflected a growing emphasis on the democratisation of health and decentralised systems, but also recognition of the critical part played by Indigenous healers in the HIV epidemic. Healer associations were invited to participate in health workshops; they learned how to put on condoms (using broomsticks), listened to lectures on how HIV spreads, and were instructed to use a fresh razor blades when making incisions on their patients’ bodies. While many health researchers advocated for the inclusion of Indigenous healers in National AIDS Programmes (King and UNAIDS 2000), this required that they adapt to modern medical standards. During counselling and education sessions for patients starting ART, health professionals stressed the dangers of consulting traditional healers and taking traditional medicines (Audet et al. 2017, 5). By way of a contrast, Indigenous healers in Bushbuckridge expressed their willingness to assist patients who displayed the symptoms of HIV by referring them to the hospital for HIV tests. Moreover, reflecting the belief that HIV is a

This was revoked in 1984 by The Matrimonial Property Act (Act 88) but continued as “unofficial” policy in many clinics.

28

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disease of polluted blood caused by inauspicious sex, they recommended that their patients use condoms. It seemed, based on their attitudes and practice, that Indigenous healers were less invested in categories of “traditional” and “biomedical” in everyday practice.

2.4

HIV Prevention and the Production of Difference

In 1990, when Nelson Mandela was released from prison, discussions were already being held between ANC leadership and progressive health care practitioners and activists, to formulate a new health policy for South Africa modelled on communitybased health care. However, by the mid 1990s, “the swelling HIV/AIDS epidemic, with its escalating capacity to swamp every health care facility in the country” (Phillips 2014, 1875) meant that the new health system was completely unprepared to deal with the AIDS crisis. Health care workers could offer little more than palliative care to sick and dying patients. In the absence of a vaccine or a cure, the responsibility for stemming epidemic spread was placed on HIV prevention. There was broad recognition fairly early on in the epidemic, highlighted by Reuben Sher29 in the late 1980s, that HIV was a “social disease” and that changes in sexual behaviour were required to reduce infections. Sher advocated for “education about the safer sexual practices, the cornerstone of which is monogamy” (Sher 1989, 317). However, despite the rapid escalation of infections at this time, the South African government failed to act decisively, regarding HIV prevention as an individual, rather than state, responsibility. For some, this inaction was tantamount to genocide (Carswell 1993). Although the Department of Health launched HIV awareness programs in the mid-1980s, these failed to convey practical information regarding HIV transmission. The government’s adoption of the “yellow hand” rather than the red ribbon (the international symbol of HIV) was viewed by AIDS activists as risible and stigmatising. Moreover, given the distrust of the apartheid government in general, it was unlikely that health warnings would be accepted, particularly those concerning sexual intimacy (Grundlingh 2009). State policies on “population control” and racial segregation in health care provision undermined the credibility of the state (Mbali 2013, 20). AIDS awareness and education programs were deeply moralistic, displayed by government censorship of educational materials designed for gay men (Mbali 2013, 69). Following the establishment of the National AIDS Council (NAC) in the early 1990s a comprehensive AIDS plan was established. Adopting the international UNAIDS and WHO guidelines, public awareness, school-based education, and the provision of condoms backed up the “Abstinence, Be Faithfull, use a Condom”

Regarded as the “grandfather of AIDS” in South Africa, Reuben Sher was a prominent and outspoken immunologist and one the first physicians to identify the threat posed by HIV.

29

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(A, B, C) campaign.30 Founded on cognitive behavioural models this linked the acquisition of correct biomedical knowledge to changes in attitudes and behaviours. This model of behaviour change persisted throughout the epidemic, despite evidence that it was ineffective, and often inappropriate in diverse social and cultural settings. Developed in the 1980s, in the west, safer sex messages such as the A, B, C were nonetheless regarded to have global relevance, based on the assumption of the universality of Western personhood and the causal relation between medical information and rational behaviour (Heald 2002). In the late 1990s, before AIDS-related illnesses and deaths became widespread, HIV in Bushbuckridge was encountered as an abstract idea (see also Pigg 2001, 481). Regarded as a dreaded and deadly disease, people responded in disbelief, fear and panic. News reports in the popular media highlighted the incurability of HIV, contributing significantly toward its stigma (see Connelly and Macleod 2003). Gabriel Ndlovu, a young university student from Bushbuckridge, recalled reading an article in Pace Magazine (a now defunct “race specific” publication) about the dangers of AIDS in 1997. The article was accompanied by a picture of doctors, wearing facemasks and surgical gowns surrounding a coffin that had been tied up with ropes. Gabriel interpreted the picture: The ropes were to prevent the doctors from touching the coffin and the masks were to prevent them from inhaling anything from the corpse. I was really frightened by this. It meant that if you have AIDS people will be afraid to bury you and will not touch you.

These initial impressions of the disease as deadly and contagious continued well into the epidemic. The young man I introduced in the previous chapter, Riot Mathonsi, recalled that he was a schoolboy in the early 2000s when he first learnt of AIDS from a broadcast on Munghana Lonene FM, a Tsonga language radio station; “I took it seriously because I knew it could kill. I took into consideration that AIDS kills”. Marks Mathebula, his close friend, commented, “AIDS is living, and it kills”. Likewise, Riot’s sister, Nomsa Mathonsi, recalled learning about AIDS from a television talk show when she was 16; I heard on TV that AIDS is killing people. They start vomiting, having diarrhoea, they become thin and end up dying. I saw [on television] people sick from AIDS; sometimes the person is always sleepy and around the mouth they have sores

Locally organised awareness activities promoted apocalyptical visions of the HIV epidemic. A poem written by and read out by a young man at the graduation ceremony held in 2002 for home based care volunteers offered a vision of AIDS as omnipresent and infection as inevitable. AIDS you are a monster Where do you come from?

The “A, B, C” slogan was first developed in 1992 by Dr. Juan Flavier the Philippine’s Secretary of Health and was based on evidence of the sexual transmission of HIV. It reached its peak of popularity by the early 2000s with the endorsement from UNAIDS PEPFAR program (Burman et al. 2015).

30

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You have no respect You kill everyone young and old Rich and poor Everyone is being raped everyday Young children as young as nine months are being raped Young children are being raped AIDS is spread through rape AIDS is spread through rape to the African Continent

In a similar manner, church programs held specifically for youth focussed on the deadly effects of AIDS and promoted discourses of blame. A church member of the International Pentecostal Holiness Church recalled a sermon about AIDS, They talk about AIDS in the church. This was where I heard about AIDS a lot. They say that AIDS is living, and it kills. If you go out and have sex with ladies in taverns or ladies who linger around who have many boys, then you can find AIDS

Initial responses to HIV awareness and messaging at times provoked resistance from residents of Bushbuckridge. In 1991, following the unbanning of the ANC, Nelson Mandela addressed residents at the sports stadium in Bushbuckridge. He spoke openly about AIDS, criticising men for promiscuity and polygamy, and young women for teenage pregnancy and infection. His speech prompted outrage and anger amongst men who felt that their traditional sexual and procreative rights were being denied (Niehaus 2000). HIV awareness and educational programs were slow to start, and by the mid-1990s few initiatives had been launched in Bushbuckridge. Although an AIDS Training Information Centre (ATIC) was established in 1996, this was located hundreds of kilometres away in Nelspruit. In 1995, I became involved in a reproductive and sexual health research project, based at the Wits University’s Health Systems Development Unit at Tintswalo Hospital, that focussed primarily on reducing teenage pregnancies and sexually transmitted diseases (STDs) by developing “adolescent friendly” health facilities. Health promotion events run by the project were often failures.31 In July 1998, public awareness events staged by the project failed to attract more than a handful of people. At a public gathering, a group of men who had stopped by, walked out, complaining that the event was only relevant for women. At an awareness and education workshop, a group of concerned individuals including teachers and a church minister arrived intending to disrupt the proceedings. They, along with many other Christians, objected to open discussions about sexuality and access to condoms, noting that this would simply encourage promiscuity. In 1996, with funding from the US-based AIDS Control and Prevention Project (AIDSCAPP), the HSDU established a resource centre in Bushbuckridge that offered information on HIV, sexually transmitted diseases (STDs) and pregnancy, and distributed free condoms. The centre attracted young men who usually asked

31 In one of the project sites, a post-intervention survey of teenage pregnancies revealed that rates of pregnancies amongst adolescent women had increased.

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questions about the symptoms of STDs, and expressed their concerns about sexual potency, but were largely disinterested in the pamphlets on HIV. Toward the turn of the millennium, and as AIDS related mortality grew, new efforts toward education and awareness begun in Bushbuckridge. The national NGO loveLife (their spelling), operating on an annual budget of 200 million rand, was launched in 1999 (W. Parker 2003). Observing that conventional approaches to prevention had limited successes, loveLife pursued “motivational optimism” to promote “positive sexuality” through a “lifestyle brand that combines communication about sex and sexuality with the promotion of consumption of fashion items, music, film and branded goods” (W. Parker 2003, 7). In 2001, loveLife established a youth centre (“Y-Centre”) in Acornhoek, housed in a circular building (previously a tavern), and painted garish purple. The Y-Centre approach to HIV prevention emphasised alternatives to sex by creating recreational and educational opportunities. Children learnt about computers, ballroom dancing, self-defence, radio broadcasting, and played basketball. The Y-Centre clinic (called a “Wellness Centre”) offered counselling and a “chill room” where children could read loveLife publications. The Y-Centre was extremely popular and attracted hundreds of young people every day. Criticisms of loveLife drew attention to its misrepresentation of the “aspirations” of South African youth, seeing this as a “a Madison Avenue-style HIV prevention campaign” that used “vulgar” language, culturally insensitive, and was cast as racist, by targeting Black adolescents exclusively (Halperin and Williams 2001). I spoke to several youth who visited the Y-Centre. They reinforced these criticisms and noted that that by targeting younger youth between 13 and 21 years of age, older youth who are more likely to be sexually active stayed away from the Y-Centre. “The problem is that the older people who we believe are infected as well, they do not go to loveLife—like those of 21 years they say it is the place for kids”. Although the centre was purportedly open to all, access was mediated by social class (see also Hunter 2010, 207). In Bushbuckridge, the youth who attended the centre were perceived by residents as affluent and trendy, excluding poorer and less well educated children. The printed and audio visual materials and instructions in workshops were all in English. loveLife consciously promoted American culture, fashion and styles; during training workshops participants were taught to perform the “Pizza Song”. Motivational speakers from “Miles and Associates”, a US-based organisation that links basketball to youth development, were frequent guests at workshops. Unsurprisingly, Y-Centre volunteers adopted American accents and slang. Although US consumer culture was attractive to many youths this also alienated those who struggled to afford branded clothing or did not identify with the fashion. The emphasis on basketball was especially contentious and adolescent girls protested that offering basketball only reinforced gender inequalities as most school girls play netball. Youth that I interviewed drew attention to loveLife’s elitist image. A 21-year-old boy said “loveLife is like a competition. A competition of clothing, you see?”. Sarcastically mimicking an American accent, he continued; “Oh, I can go to loveLife, or ‘Oh, I’m a member of loveLife’, you see? . . . So, you become proud”.

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A 19-year-old girl also felt that the centre fostered social divisions, saying “I don’t know whether you have to speak English, I mean, maybe they only want intelligent people to take part”. A 17-year-old boy thought that the loveLife Y-Centre was a place to pick up girls. “Boys look for girls there, girls look for boys. They are promoting condoms, not talking about abstaining. They should teach about AIDS. They think they are better than you, they’re like models”. While watching a basketball tournament, I chatted to a 17-year-old boy who had drawn the Nike logo on his otherwise plain tennis shoes. He said “I love basketball, but [if] you don’t have a load of money, or you are not wearing the stuff, maybe you are wearing takkies [sneakers] and they are ugly, so you’re an embarrassment. So, they are just laughing. They are wearing Nike, Adidas and those things”. As a demonstration of loveLife’s status and power, in 2002 a massive yacht was driven into Acornhoek on a trailer and parked outside the Y-Centre for a week. The exercise was to celebrate a voyage to Antarctica to raise awareness of the AIDS epidemic. Attracting comments from residents about white peoples’ fears of Black bodies, the professional film crew that accompanied the boat erected portable toilets, despite the availability of flush toilets in the centre. The irony of the spectacle of a luxury boat standing on a trailer in the middle of a town in the semi-arid lowveld did not go unnoticed by passers-by. For many it was yet another example of the disjuncture between the affluence of white foreigners who commanded the centre, and the local realities of poverty. Local Y-centre staff were also ambivalent about the identity of the centre and were keen to include examples of local culture in the programme. However, these suggestions were not supported by representatives of the Henry J Kaiser Family Foundation, the primary donor agency for loveLife. Even the portraits of Limpopo Province Premier Ramahlodi and President Thabo Mbeki were hastily removed by staff when Washington DC-based representatives of the donor organisation visited the Y-Centre, making it clear who controlled the “loveLife brand”. While espousing a metropolitan identity which had massive appeal for young people in Bushbuckridge, loveLife revealed the persistence of social and cultural divisions. State-sponsored HIV awareness activities were also staged in Bushbuckridge. These used the medium of drama to promote HIV and TB prevention messages. Social difference structured and shaped the experience of HIV prevention. Categories of difference, and of indifference, continued to be imbricated in the everyday practices of HIV prevention, and responses to these (see for example Sangaramoorthy 2014). Prevention campaigns perpetuated stereotypes of poor health and “traditional” behaviours. In 2004, I observed a drama hosted by HIV and TB home-based care providers, almost identical to that performed decades earlier by primary health care workers (see previous section). The drama, which lasted 30 min, portrayed a man drinking marula beer and coughing. He consulted a healer (n’anga) and was given murhi (medicine) to drink but continued to cough. The man’s family argued with the healer and pointed out that treatment for TB was available at the clinic. However, the healer objected saying that she needed to make money. In the next scene at the clinic, the “nurses” (wearing old-fashioned nursing caps) asked the man questions in a kindly

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manner and scribbled in notepads. The family members complained about the money they had spent paying the traditional healer. Addressing the audience, the nurse said: “TB does not need a n’anga [traditional healer]. You should have taken the patient to the clinic straight away”. In the final scene, the man was referred to hospital where a male doctor examined him and wrote him a prescription. In an authoritative voice in English, he stated “You will get pills from your nearest clinic”. He then turned to the audience and stated in English “If a person coughs a lot, he should not be taken to a sangoma [traditional healer]”. He pointed out that the hospital provided treatment for free while the healer charged the family lots of money. Articulating an opposition between “traditional” healing and Western biomedicine, traditional healers were targeted for wasting peoples’ money and duping them into thinking that they can cure TB and HIV. In contrast, Western biomedicine was presented as free and effective. Later in conversation with Solomon, one of the organisers of the TB drama described above, he pointed out that non-compliance with TB medication was usually due to drug stock-outs, long queues at the medical centres, and the everyday struggles patients faced in accessing to their medication. It seemed that tradition had little influence over medical compliance. Although seeming to embrace local culture, annual World AIDS Day events were dramaturgical devices (Goffman 1959) that portrayed and reinforced social divisions. In 2002, the event was held at Phendulani High School. On the sports field the organisers erected three gaily striped marquees. One marquee reserved for “VIP” guests from the Department of Health and Bushbuckridge municipality, decorated with flowers and traditional artefacts such as woven baskets, kudu horns, spears, and wooden porridge spoons. In the other tent a display of boxes of condoms was arranged to form a pyramid, closely guarded by male and female nurses. A good distance from the arena, a few school children, old women and old men gathered on the embankment and further beyond food and drink sellers set up stalls. The day’s program consisted of speeches (the mayor of Bushbuckridge and local representatives from the Department of Health and Welfare) and cultural performances. A group acted out a scene from the Broadway musical Sarafina about the Soweto school children’s uprising of 1976; young boys dressed in khaki held wooden AK 47s and gave a mock display of military marching; a group of older women performed the Sotho kiba dance; and, two young men impersonated Thabo Mbeki and Nelson Mandela. These items were punctuated with hymns and songs. After the displays, dignitaries and special guests were invited to the main tent to a sit down lunch of chicken, beef, salads and porridge; beef stew and porridge was on offer to the spectators. Mandla Ndlovu and Riot Mathonsi, the two young men who had accompanied me to the event, hastened me to my car before the feasting could begin. When I protested (I was both hungry and curious), Mandla said: “I am really not interested in standing in a queue for food. That is for poor people”. This was somewhat ironic. Mandla and Riot were unemployed and from very poor households and both depended on welfare grants; Mandla’s mother was an alcoholic and Riot’s father abandoned his family many years ago. The two young men were the quintessential

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“community members” targeted by the AIDS awareness event held that day. Mandla’s response also seemed incongruent with his status; as an organizer of AIDS awareness activities and as a youth representative of his village he had participated in many AIDS awareness programs. He reckoned that AIDS awareness activities such as the World AIDS Days were mostly failures. According to him, these promoted divisions by celebrating the status of the affluent and powerful while marginalizing the poor, reinforcing the social inequalities that lie at the foundations of the AIDS epidemic itself. Mandla remarked, “The World AIDS Day is an exclusive event. You have to be invited as an organization and the main attraction is the catering that is provided. If your name is on the list of VIPs, then you get to eat in a special area for VIPs—if not then you have to stand in a queue with everyone else”. Those who ended up at the end of the queue faced the possible humiliation of not getting anything to eat. People who attended these events also complained about the quality and size of the portions that were served in polystyrene take-away containers. For Mandla and Riot eating at these events signified acceptance of a position of inferiority, to become in the eyes of those around you, an impoverished person. The public feast served as a reminder of their status as commoners. This commentary about food resonated with my experiences in similar “community events” where catering was a major concern for organisers and participants. Organisers of events debated the virtues and rationale for offering food and refreshments to participants of workshops and large social gatherings. On the one hand organisers expressed the view that “African people” expect food to be provided when invited to participate in events, and it was important to respect “their culture”. Along these lines, the food offered ought to reflect local cuisine (pap and meat) and offering a humble sandwich would be regarded as an insult. On the other, this seemed to provoke concerns that peoples’ participation was for “their own good” and that food was an “undue incentive”. Organisers also complained that AIDS awareness events had become “feeding schemes” and that people behaved “like animals”, taking more than their due. Like Max Gluckman’s (1940) analysis of the ceremonial opening of a bridge in Zululand in the 1940s, the rituals described above provide the “raw material” for understanding social differentiation. HIV rituals were broadly inclusive, inviting a broad range of participants, but simultaneously reflected social divisions and schisms between different classes of resident. These were social dramas that performed social difference and reinforced stereotypes. loveLife promoted an American, global, popular culture that extolled fast food, basketball and open discourses about sexuality, disregarding local expressions and experiences. The feasting at rituals such as World AIDS Day were celebrations of status at which poor people were reminded of their socially inferior position in life. Drinking “traditional beer” was pathologized in the spread of TB, and traditional healers were portrayed as charlatans duping the ignorant to enrich themselves. HIV prevention spectacles and rituals can be regarded as responding to the dynamics of an emergent middle-class culture amongst Black South Africans, but also the exclusion of many from this. loveLife’s elitism resonated strongly with deeper social fissures in a context where many, especially young people, have been

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left behind. Those who stood to benefit the most from interventions to prevent the spread of HIV were also those who experienced barriers to participation (see also Hunter 2010). In contexts where multiple and competing forms of knowledge making and claims about the truth coincide, HIV awareness and education campaigns reinforced and solidified difference, by associating biomedical knowledge with social, cultural and racial divisions. This promoted and reinforced epistemological divides between the governmental and non-governmental agencies that commandeered HIV programs, and Indigenous public health (Heald 2002), which was regarded as unruly and dangerous (Marsland 2013). Revealing the incursion of neoliberal politics into health policy and public medicine, low uptake or lack of acceptance of healthy behaviour and “safer sex” were regarded by HIV prevention practitioners as evidence of resistance to adopting healthier dispositions and behaviours. This was especially evident in depictions of poor and working class communities and reflected in historically situated ideas about race and culture.

2.5

Conclusions

A history of medicine in the lowveld, spanning missionary, “homeland” administrations and leading up to the HIV epidemic, identifies the production and reproduction of social and cultural difference through medical discourses. Missionary medicine opposed local traditions and promoted divisions between Christian and traditional. The “homeland” health services promoted divisive ethnic nationalism and prejudices. At the same time this created a space for a political critique of the Bantustans and an ambivalent, yet paternalistic attitude expressed by progressive health care providers. HIV prevention reinforced emergent social, cultural and economic divisions. Paradoxically, interventions that aimed to unify people against the threat of HIV appeared only to divide. Ideologies of HIV prevention and treatment share their origins with early colonial encounters and the production of the alterity of African society and its association with health and disease (see Comaroff 1993). More recently public health discourses have replaced “culture” with “social norms” which are regarded as more amenable to change. Defining “norms” such as “patriarchal” violence against women, a WHO briefing on the topic invites discussion on “examples of interventions that aim to alter such norms” (World Health Organization 2009). Several agencies have taken up this challenge by forming interventions for men that “question traditional norms related to violence, relationships, alcohol, and engagement with health care” (Lippman et al. 2013, S45). Once again, the similarities between these dialogues and those that identify culture as a “barrier” to change are strikingly obvious.

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Chapter 3

Truth and Harm: Dangerous Knowledge and Popular Epidemiologies of HIV

Raising doubt about the effectiveness of HIV prevention campaigns (such as those discussed in Chap. 2) in changing the course of the epidemic, HIV prevalence continued to escalate in Bushbuckridge throughout the 2000s. Rather than promoting a unified front against HIV spread, awareness and education campaigns in Bushbuckridge tended to alienate residents. The “AIDS rituals” I described in the previous chapter consolidated the status of the wealthy educated elite and thereby reinforced social divisions and inequalities. However, official HIV prevention campaigns and rituals were not the only spaces in which public dialogues about HIV occurred and where meaning was produced. AIDS was a “public secret” in Bushbuckridge, but it was also widely talked about through subaltern forms of communication such as everyday gossip. As medical anthropologists observe, the world is often viewed and constituted through the powerful lens of illness and medicine (Crandon-Malamud 1993; Briggs and Mantini-Briggs 2004; cited in Saethre and Stadler 2017, 4). Evoking Foucault’s (Foucault 1976) notion of “biopower”, medicine’s capacity to expose the body, making it visible and knowable, has significant implications for how health and illness and death are experienced (Phillips and Rees 2018, 214). This ability to reveal what is hidden imbues biomedicine with efficaciousness and power. By reinforcing perceptions of the healthy or diseased self, biomedicine and its technologies have the power to transform health status, and by way of a clinical diagnosis, are invested with the authority to confirm, contain and stabilise death.1 Yet, in the time of epidemics and endemic suffering, spaces arise in which contradictory social beliefs and attitudes emerge, and in which “both knowledge and power are put to the test” (Fassin 2007, 32). Indeed, as many ethnographic writings show, sickness, health and medicine are also idioms that may express

1 As Lock notes, the biomedicalization of death grants members of the medical profession the authority to “measure and standardize death”, but that determining the point of death is a “moral decision” (Lock 2002, 98).

© Springer Nature Switzerland AG 2021 J. Stadler, Public Secrets and Private Sufferings in the South African AIDS Epidemic, Social Aspects of HIV 6, https://doi.org/10.1007/978-3-030-69437-1_3

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resistance to biomedical models of disease and causality (For example Saethre 2013). In the US, working-class Americans reject prevention discourses that blame individual behaviours for high rates of cancer in their communities by pointing to contradictions in medical discourses (Balshem 1991). Indigenous people in the north east of Brazil and in Venezuela challenge public health messages that blame culture and the poor for cholera (Briggs and Mantini-Briggs 2004; Nations and Monte 1996). These examples demonstrate the rejection of the “the paradigmatic tendency of science to delimit the causal universe to that which it says and sees” (Balshem 1991, 167). Epidemics also expose the limitations of medicine to define, measure and manage disease spread and death. While acknowledging that biomedicine possesses immense power to shape the way in which the world is seen and experienced, the application of “biopower” and the capacity of its “gaze” varies in different contexts. In settings where medical technologies are inadequate or broken, where drugs are unavailable, and records are lost or incomplete, diseased bodies seldom “crystalize into clear biomedical objects” (Street 2014, 11). In these circumstances, patients and their families have to work hard to make their bodies known and visible. In state-run South African hospitals, for example, patients are likely to be rendered invisible to clinical care, due to the scarcity of medical practitioners, budget cuts, and other restrictions (Gibson 2004; See also Le Marcis and Grard 2015). Moreover, patient level data in many state hospitals and clinics is notoriously incomplete, simply lost or unavailable (Wegner and Rhoda 2013).2 In this chapter I pose questions about the evidence of HIV-related illness and death. I ask what evidence was mobilised in confirming AIDS morbidity and mortality, and what sorts of ideas, artefacts and technologies were used in the production of this evidence. Addressing these questions, I refer to the contrast that Setel (1999) makes between “popular” and “professional” epidemiologies; the former being based on the observation and “manipulation and interpretation” of signs in health education messages, local aetiologies, as well as knowledge of personal history and assessment of moral character (Setel 1999, 185–86). These local meanings are expressed in ritual and narratives of illness, dying and death (see also Nations and Amaral 1991) and establish a social diagnosis of the cause of death. Evidence of illness and death is therefore not solely physiological, but provides “signs of social relations disguised as natural things” (Taussig 1980, 3). My overarching argument is that technologies of knowing employed by biomedicine—such as the HIV test, mortality monitoring, as well as local discursive practices—such as gossip, do not only produce evidence of HIV but also serve to materialise illness and death. I begin below by exploring local perceptions and experiences of HIV testing. 2

In the mid-1990s I personally observed nurses at a clinic in Bushbuckridge recording patient data on pieces of cardboard. They told me that their clinic register books were full and that they had not received new supplies for months. Although moves toward digital records were supposed to solve these problems, many clerical workers were unable to use the software, and computer systems were constantly “down” due to power outages.

3.1 HIV Testing: Technologies of Truth and Harm

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HIV Testing: Technologies of Truth and Harm

In South Africa, the surveillance of infectious diseases is a relatively recent enterprise. Historically, monitoring infectious diseases was first initiated as a response to TB and syphilis epidemics. Reporting outbreaks and prevalence was in accordance with public health legislation in the early 1900s, inspired by white officials and publics’ racist panics of contagion owing to the increasing numbers of Black people residing in the cities. In 1906, for example, medical officers were required to report cases of syphilis to the Contagious Diseases among Natives Commission (Jochelson 2001, 12). Only by the 1970s, surveillance systems were consolidated by the Health Act (63 of 1977) to include 33 medical conditions. While now a routine procedure, the HIV antibody test, developed in the 1980s for the purposes of blood screening, was restricted to cases that were clinically indicated. By the early 1990s routine HIV testing was still not being carried out (Venter et al. 2014) and to date, HIV is still not a notifiable condition. Although the national Department of Health intended to make HIV notifiable in 1999, this was rejected by AIDS activists who warned of the potential harm that could result due to AIDS stigma and discrimination (Sidley 1999).3 Moreover, attending physicians are under no obligation to report HIV infection to public health authorities or to contacts of the infected person4 (Venter et al. 2014). Widely regarded as a “confessional technology” by anthropologists (Nguyen 2013), the HIV test is imbued with power—as a symbolic reinforcement of self (Lupton et al. 1995), as a ritual of regeneration (Sheon 1999), and as an indicator of moral character. The test reveals the inner truth—not only of HIV status—but of intimate lives and relations by displaying not only the outer visible body but—as women in a clinical trial in Soweto claimed—the “inside” (Stadler et al. 2008). As “a practice aimed at revealing these fundamental secrets of the self” (Nguyen 2013, S441) HIV testing emphasises the creation of self-awareness. The test is perceived as “empowering”, while secrecy, concealment and denial are regarded as pathological. The act of testing is believed to liberate the self from the burden of secrecy and shame, reduce stress and assist in coping with a positive serostatus (Paxton 2002) via the catharsis of sharing an intimate experience. Therefore, knowledge of HIV status is considered a positive affirmation and part of the process of healing which requires overcoming “personal illness” (Nguyen 2013). Despite these assurances, resistance to HIV testing and diagnosis is widespread and contra to the health reaffirming qualities, is often perceived as a risky and harmful undertaking (McNeill 2011; Niehaus 2018, 66–67).

3 In the early 2000s, reports abounded of white employers forcing Black workers to take HIV tests https://bhekisisa.org/article/2016-07-15-employees-particularly-domestic-workers-still-reportbeing-forced-to-test-by-hiv/ 4 This is unlike rabies, polio, and cholera which require immediate reporting, or TB and hepatitis B which have a seven day window (Venter et al. 2014).

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In Bushbuckridge, the HIV test was feared for its intrinsic power, not only as a diagnostic tool, but as a dangerous procedure that could materialise HIV. I was first alerted to this idea when talking to Ryder Gumede, a young man whose sister, Xolani, had died when she was only 30-years-old. Ryder claimed that his sister had been perfectly healthy before she was tested for HIV, but that “when they [the nurse] said she was ‘HIV positive’, this made her HIV”. Stating the word “HIV”, Ryder suggested, materialised the disease, a testimony to the power and agency of words. To understand the logic of this claim requires an understanding of the “malevolent power of sound” (Niehaus 2018, 77). As Tambiah notes, “language as such has an independent existence and has the power to influence reality” (Tambiah 1968, 184). This is most evident in religious contexts, beliefs and practices, and notably, in witchcraft. Verbal utterances were used as evidence in accusations of witchcraft and were recalled in death narratives. When Fanius Mzimba’s youngest daughter died suddenly, he accused his neighbour of witchcraft. Giving evidence at the court of elders (bhandla), Fanius recalled that a week before his daughter died, he had greeted his neighbour, who responded saying, “We cannot complain because we will all die anyway”. Like a prophesy or a curse, this was proof enough to raise suspicion of his neighbour’s malevolent intentions. In a similar case, the elderly MaKwaZanele lost both her adult sons and a daughter-in-law in a tragic accident, when a truck on the main road leading to Nelspruit hit their car after running a red light. At the funeral, the bereaved MaKwaZanele, was overheard muttering, “soon we will all be equal”. These words were recalled when the father-in-law was found dead in the bush after an evening of drinking. Three months later the second daughter died after a short illness. These deaths reciprocated MaKwaZanele’s loss, just as her words had foretold. The power of words to influence the material world was further illustrated in an account of a mysterious theft. When shopping in Nelspruit, Freddy Mathabela, then in his late twenties, was approached by a stranger who asked him for directions. Later, he discovered that the bank notes in his jacket pocket had been mysteriously replaced with pieces of newspaper. By replying to the stranger Freddy endorsed the magical transformation of money into newspaper. I was warned never to answer my mobile phone if I did not recognise the number; answering the call allowed the caller to send sickness, transmitted through words that entered my ear. The International Holiness Pentecostal Church (IHPC) performed acts of healing through public confessions (see Chap. 5). The transformative power of the spoken word in the context of the HIV test can be further illustrated by examining the ritual procedure called ku tlhavela (literally, “to cut”). This rite was often performed by traditional healers (pl. tin’anga) or senior household members, during December when most members are home for the Christmas holidays. The ku tlhavela serves to protect the body from occult attack and other danger. In the December of 2003, I observed NwaPetros, a healer assisted by her 50-year-old son, who had recently graduated as an n’anga performed ku tlhavela for her family. NwaPetros used a fresh razor blade to make small incisions on the bodies of each member of the family, selecting the joints of the neck, wrists,

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and elbows. Here, where the veins are closest to the skin, the blood is hisa (hot) and therefore most vulnerable to occult attack. She then rubbed murhi (magical medicine, in this case a finely grained black powder) into the incisions, completing the procedure. During the cutting ritual she called on the ancestors to protect her family, thus activating the power of the murhi. The potency of the HIV test in transforming the body lies in its symbolic association with the ku tlhavela ritual; the incision made into the epidermis is analogous to the hypodermic needle, creating a strong metonymic association (van der Geest and Whyte 1989). When faced with new biomedical technologies such as diagnostic testing procedures, new meanings are constructed that refer to familiar practices, in a process of the domestication of the foreign. Similar to fortifying the homestead by sprinkling potions around its borders, ku tlhavela was like a “ritual immunisation” (Jolles and Jolles 2000). Taking this analogy further, the ritualised fortification of the homestead has the power not only to prevent witches from entering the gates, but also captures and exposes them, revealing their secret identities. Witches who attempt to enter a fortified homestead are rendered immobile and mute, only reanimated when someone speaks to them. While public health narratives highlighted the medical and psychological benefits of HIV testing, the emotional distress of receiving a positive result could be injurious and even deadly. NwaGomane, an elderly pensioner and widow, observed, “They say you don’t know if you have got it [HIV]. I will go and have a test. Then I will know that I am HIV positive so I will start to become thin because of ku vilela [worry]”. NwaGomane evoked the culturally constructed affliction known as mbilu va vabye, or literally, “heart sickness”. A person who has heart sickness or stress has “given up hope of ever being cured”, their “heart is lost” (mbilu yi vava) or “they have lost hope” (ku ka u’nga tsembe).5 This is the embodiment of anxiety and emotions manifested as headaches, dizziness, fatigue, weakness and stomach-aches, a result of sadness, anger, fear and worry (Low 1985; see also Rebhun 1999). Women were more prone to “nerves” than men, as they had suffered great injustices often by the hands of men. NwaKhomani, a traditional healer, often treated patients who had “lost heart” using herbs. She supported the idea that a painful heart was from “thinking too much”. She said, “Sometimes we give them murhi (medicine) to make their heart feel free, to be free of pain, to make them feel happier”. Jamaica Nxumalo, so named from the days he wore dreadlocks and played football for a club in KwaZulu-Natal, also dealt with patients with heart sickness. He explained in detail. Ku fa hi mbilu [death from heart] is when a person who thinks too much and becomes very angry; his heart will pump far too much. He will be caught by the mbilu yi vava [heart sickness]. A person will think too much if there is always fighting at home. Usually it is the wife who is affected but the fights are between the husband and the wife. The body starts to change—the veins will start to show underneath the skin. The person is always unhappy, always looks sad. You can die from this—usually you will have a heart attack. People don’t want to know that they have AIDS because they fear that their lives will be miserable.

5

In Chap. 6 I present a detailed case of a man who saw himself as suffering from heart sickness.

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There was also widespread speculation that a person diagnosed with HIV would commit suicide rather than let their family experience public humiliation. Fortythree-year-old Martha Ngobeni said, If I knew I had AIDS I would drink Two-Steps [rat poison].6 My parents and children will be worried that the children at school will laugh at my children. They will say ‘she died of AIDS’. And this disease takes a long time. The parents will sit at home and worry. Even after I die the children will continue to laugh and say—your mother died of AIDS. Your family will end up getting bad luck. Even the other villagers won’t like your family—they will think that the whole family has AIDS.

More than reflecting a deficit in local understandings of the test procedures, beliefs that the HIV test is harmful rather than health affirming, draws attention to cultural meanings and social relational implications of the experience of illness. It also demonstrates the significance of, and perlocutionary power, of naming things in bringing these to life.

3.2

Proof of an AIDS Death

“According to my view I do not see anyone who has AIDS in this village”, declared 18-year-old Abednego Mathebula, addressing fellow members of the HIV-AIDS village committee. Formed in 2002, the committee was tasked with running AIDS awareness activities and income generation projects to benefit destitute households, particularly those affected by the epidemic. Small enterprises supported by the Department of Health and Social Welfare included a bakery, an artisanal peanut butter-making factory, and a fence and brick making project, with the profits disbursed to villagers identified as the “poorest of the poor”. The committee represented the village at annual World AIDS Day events, and members attended workshops and meetings run by the Department of Health. Consisting of five young men and two young women, the committee usually congregated in a wooden storage shed. We were sitting on plastic beer crates, amongst bags of plaster and tools, discussing the national HIV prevalence statistics when Abednego made his declaration about the invisibility of and difficulties in knowing AIDS. Having participated in awareness campaigns and AIDS educational workshops the group was well versed in the signs and symptoms of AIDS, and like other villagers had witnessed the growth in the number of funerals. However, as Abednego pointed out, AIDS death was concealed and secretive. Elaborating, he said, “Our problem is that we have seen people dying, but they are hiding. They are not saying that he or she was killed by AIDS, but that they are killed by this or that. Some see it like it is just a joke, a dream. We are dreaming” he concluded. In agreement, another committee member, Cornelius Mbetse pointed out “AIDS is not the same as HIV,

Popularly known as “two steps”, she referred to ldicarb, a poison restricted to agricultural use, but freely available in Bushbuckridge and often associated with intentional poisonings.

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because a person who is HIV positive is just like you or me. They do not have AIDS”. Cornelius had personal experience of seeing his cousin die which changed the way he thought about AIDS. Reflecting on this memory he recalled, Toward the end of 1999, many people were talking about AIDS, but I took it as a joke. I thought that maybe it can’t kill a person, it’s not really cruel. Yeah, so around 2000, the end of 2000, I saw a person with AIDS. So that is when I started to realize it is a disease and it kills. That person was my cousin. So, on the Friday we saw her in the mortuary, and the doctors told us that she died because of AIDS.

In 2003, not much more than a year after my conversation with the village AIDS committee, former South African president, Thabo Mbeki, announced in an interview with the Washington Post, “I don’t know anybody who has died of AIDS . . . I really, honestly don’t” (Slevin and Mercury Correspondent 2003). This infamous statement was taken by most of the world as a scandalous public declaration of denial. Media reports accused Mbeki of dishonesty and called on him to apologise. The Guardian newspaper noted, “Despite all the evidence, Mbeki persists in denial and has again missed a priceless opportunity to acknowledge the problem and help lift the stigma surrounding AIDS” (The Guardian 2003). Mbeki was not alone in refusing to acknowledge the seriousness of the epidemic. While evidence of an escalating crisis seemed irrefutable, the former minister of health, Manto TshabalalaMsimang rejected the 2001 South African Medical Research Council (SA-MRC) report that 40% of all adult deaths in 2000 were due to AIDS (Mbali 2013).7 Political support for the evidence of increasing rates of morbidity and mortality, especially in the early phases of the epidemic, was lacking, and the seriousness of the extent of AIDS related mortality was often underplayed by senior government authorities. Challenging biomedical and epidemiological knowledge that frame HIV and AIDS as identifiable, and, measurable and therefore preventable and treatable, South Africa was at the time portrayed as a “site of secrecy, silence and denial” (Reid and Walker 2003, 85). Although, the ambivalence articulated by Cornelius and Abednego seemed to concur with the views articulated by the former president and his health minister, their views diverged significantly. While Mbeki’s stance on AIDS was positioned as a challenge to medical orthodoxy and pathological denial, the members of the village committee experienced AIDS as a public secret, a fact known to all but seldom acknowledged. Everyday talk about HIV infection and AIDS deaths were hidden under layers of secretive, coded talk and metaphor, gossip and rumour (Wood and Lambert 2008). At funerals the cause of death was seldom announced, although occasionally implied, referred to as “a long illness”, a euphemism for AIDS. Following the funeral feast, speculations of AIDS were spoken about but only 7 By the mid-1990s surveillance of the AIDS epidemic was initiated through national samples of antenatal clinics, hospital patients, migrant workers, bank workers, and truckers. These specific social groupings were used to extrapolate infection rates to the general population. Yet infection rates were often imprecise and varied, depending on modelling methods: the Department of Health, the Actuarial Society of South Africa, and the Human Sciences Research Council estimated rates of infection ranging from 4.8 million to 6.6 million for 2002 (Hoad 2005).

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quietly “in the corners of the funeral”. As I personally observed, mourners signalled their suspicions by exchanging glances and displaying three fingers indicating “H-IV”. In everyday conversations villagers referred to HIV as the “three letter disease”, “three numbers plus bonus” (a score in the national lottery), “BMW Z3” (a luxury German sports car), “OMO (a brand of washing powder), or “House In Vereeniging” (Stadler 2003, 129). Fabricating a “parallel epidemic of signification” (Treichler 1999, 1), this talk evoked the dangers of illicit desire and immoral consumption and the risky gamble that sex had become in the time of AIDS. By the early 2000s, Bushbuckridge residents were familiar with biomedical understandings of HIV which had been circulated through health media campaigns on the radio, television and print. However, biomedical knowledge did not supplant “local logics around sex, illness causality, and healing practices” (Persson et al. 2019, 273). Instead, new meanings of health, illness, and death were produced by weaving together local and global knowledges (see Pigg 2001). And as others have found, AIDS illness and death is often interpreted through the lens of local disease aetiologies (Heald 2001; Ingstadt 1990; Niehaus and Jonsson 2005). Villagers defined HIV as “a disease of the blood” (vu vabya wa ngati). Blood contains the potential for life; it is passed down from one generation to the next through the exchange of semen and vaginal fluids during sexual intercourse. Hence, fathers referred to their children as ngati wa mina (“my blood”). The signs and symptoms of AIDS were often conflated with illness called ndzaka (pl. tindzaka). Literally translated tindzaka are “illnesses of the mat”, signifying sexual contact as the mode of transmission. Blood is life-giving only in so far as a healthy flow is maintained within the body. Flow is required to expel polluted substances (chaka or “dirt”) through sex and menstruation. Health could be maintained through sexual intercourse, which encourages flow; however, excessive sex with multiple partners resulted in unhealthy mixing of different bloods, causing pollution. While strikingly similar to the biomedical definition of HIV, ndzaka was not caused by contact with HIV infected blood, but through inauspicious sex, namely the transgressions of taboos that stipulate the avoidance of sexual contact with specific persons and at particular times. For example, “cross the river” (ku wela) a fatal affliction, resulted from absorbing a woman’s polluted blood following an abortion. A pre-pubescent girl who had sex with an older man became ill with rixilane, an affliction of retarded physical and cognitive development exhibited by extremely anti-social behaviour. NwaAbraham, an elderly woman who practiced as a healer, described the symptoms of rixilane in a young girl she was treating; “She was a young girl. It was a hot day, but she sat shivering even in the sun. She wouldn’t look us in the eye. She just picked at her hands”. However, the parallels between the symptoms of tindzaka and AIDS were striking and created uncertainty regarding the aetiology of afflictions. A primary school teacher said he was unable to make up his mind whether his neighbour had died of tindzaka or AIDS.8 “At the hospital, they

8 Although there are obvious parallels between the symptoms of tindzaka and those of pulmonary tuberculosis, people presented these as distinct afflictions. A healer argued that she was able to tell

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said it was AIDS. People here [in the village] said it was tindzaka. I am confused—I cannot tell if you have AIDS or tindzaka. The symptoms are the same”. NwaGomane expressed similar confusion, “there are different symptoms that go hambana, hambana [around and around]. Some people say ‘sores’, others say ‘it is a rash’. Other people get so confused they don’t know what to say anymore”. She suggested that the Department of Health provide photographs of people with AIDS to help resolve this dilemma. While the symptoms of illness and death seemed inconclusive, residents drew links between certain types of conduct and AIDS, invoking narratives of blame and culpability. As death narratives, these dialogues offered a means of attributing the spread of illness and death to failures of moral personhood in the context of a rapidly transforming world.

3.3

Narratives of Moral Personhood

Suspicions of AIDS as the cause of death circulated widely in the days and weeks following funerals, communicated through subaltern discursive practices. Opening death up to public enquiry and scrutiny, the evidence of AIDS was communicated in gossip. Participating in neighbourhood gossip circles I recorded accounts of 48 deaths that were attributed to AIDS. The majority of cases occurred during the mid—2000s, peaking in 2002. Women accounted for most of the cases (29 of 48 or 61%) and men for 39%.9 The women were on average 27-years-old and ranged between 17 and 54 years. The men were on average 10 years older, with a mean age of 39, and their ages ranged between 20 and 65 years. Only four women (13%) had an income and of these, three were formally employed, and six of the women were scholars. In contrast, more than two thirds of the men (68%) had an income. Most of the men were formally employed as teachers and clerks locally or in industries in Johannesburg. The majority of men and women (73%), particularly those who were older, were in long term relationships, or married. The evidence that was presented in death narratives revealed ideas about personhood and risk, focussing attention on the moral character of the deceased. After the funeral of a young woman, her neighbours debated whether she had died of AIDS. Some noted that she was so thin she “looked like a clothes hanger”, signalling the well-publicised effect of AIDS on body mass. Joining in the conversation, David Mkatshwa, the deceased’s former schoolteacher, argued that it was possible that she was HIV positive. However, he also speculated that “poverty and low standards of hygiene” could be to blame for her illness. He noted that she was “still too young”,

the difference by listening to the cough, which in the case of tindzaka seemed to originate from below the diaphragm. Epidemiologists similarly document an emic distinction between a ‘traditional’ TB and a ‘Western TB’ (Edginton et al. 2002). 9 Four infants of unspecified gender and age have been excluded from the analysis.

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“usually behaved herself” and “never went to taverns to drink”, although, he also admitted “maybe there was something I did not know about her”. Likewise, citing the same logic, when the mother of two children died from a disease that “looked like AIDS”, discussions at the “after tears party” (the wake) concluded that this was unlikely because she “behaved herself and never had affairs”. AIDS as a cause of death was constantly negotiated through everyday gossip. Gossip provides information about the most intimate aspects of peoples’ lives. Although secretive and exclusive, gossip spread easily and rapidly through neighbourhoods and between villages. As cell phones became more accessible, gossip spread further afield, to relatives and friends far from Bushbuckridge. It was virtually impossible to keep a secret in the villages. Early one morning, a man and his lover having sex in the bushes surrounding the village were spotted by a boy herding cattle. He quietly stole their clothes and the couple were forced to return home naked. Sightings of the naked couple were recounted all over the village by that evening. Discussing this story, someone remarked: “there is nothing you can hide in the village”. While gossiping was an exclusionary social practice, there were multiple opportunities to eavesdrop. As a young woman observed, “You know on the road when people come back from work, they talk to each other so we can listen”. In particular, people working at local hospitals and clinics were a source of information about AIDS. As a young woman observed, “Some nurses at the hospital are not only friends with other nurses, they are friends with others, they gossip with those friends and that gossip will be taken all around until it is spread all over”. Evoking an analogy between gossip and viral spread, news of AIDS seemed to spread uncontrollably. Indeed, like an infectious disease, gossip was often harmful, and could have devastating consequences. Gossip could transform a person’s status, spoil their identity and destroy relationships. In this respect, gossip was used as a powerful weapon against people who shirked good neighbourliness or transgressed moral boundaries (See Gluckman 1963). For example, residents in one of the neighbourhoods where I hung out often gossiped about Gift Khoza, the young woman I introduced in Chap. 1. Neighbours gossiped about the way she scorned her poorer neighbours. I heard that she scolded the little boys who scavenged in her rubbish dump for stale bread and rotten meat and that she had reprimanded a neighbour who wanted to use her fence—a symbol of affluence— as a washing line.10 When her wealthy, older lover died in a car accident her neighbours gossiped that Gift had used witchcraft to kill him for his money. Following his death, neighbours queued to visit her, but standing in her yard talked loudly about her. The following exchange took place between two women, Gift’s neighbours,

10 Walls and high fences around properties were markers of wealth and social exclusion, as these prevented the passage of neighbors into yards.

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Ooh! Gift has roofed her house! Did you see the bed—it has mirrors? She really knows how to use her masenge [genitals]. If it was not for her, her mother would not manage to support [herself]. The day they kill her, her mother will shit in her pants and faint, because no one will help her going around looking for men.

As the gossip circulated, Gift gradually lost the support of former friends and neighbours and became even more secluded. Her one neighbour, a young woman said that she was not even going to greet Gift anymore. Without the flow of presents of cash and food and threats of retribution from the family of the deceased, Gift fell on hard times. Later I heard her neighbours claim that she was pregnant. Echoing narratives that criticised young women who had babies so that they could access the state’s child support grants, they said she had fallen pregnant because of greed11 (see Mkhwanazi 2012). While gossip is a potent discursive practice, participating in gossip was also a risky business. Spreading gossip about powerful individuals could result in reprimand and punishment, if the source could be identified. A local shop owner punished his employee for spreading talk of his involvement in a ritual murder by dragging him down the road tied to a cow. An elderly man became inebriated after drinking beer and gossiped with his fellow drinkers about the identity of a witch. A few weeks later he was found dead, apparently poisoned. Gossiping about topics such as AIDS carried with it the inference of complicity. Those who gossiped risked being accused of “knowing too much” and therefore avoided being identified as the source. McNeill (2011) calls this “degrees of separation”, a strategy to avoid insinuations of personal culpability and involvement in the possession and spread of dangerous knowledge. Consequently, gossip was often indirect and relied on insinuation. This was very apparent in gossip about AIDS, which was often characterised by ambiguity and hidden in carefully coded references, as in the following reconstructed conversation between two women, Abigail Mnisi a young single woman and her neighbour Dorothy Maseko, an older married woman. 1. 2. 3. 4. 5. 6. 7. 8.

Abigail: Where is Morgan’s wife? Dorothy: She is sick Abigail: Why, what’s the matter? Dorothy: Don’t you know that Morgan used to go around with another mistress [female teacher] at Songeni [primary school] Abigail: No! Dorothy: Did you know that she died? Abigail: No! Dorothy: Yes, it seems like now the wife is starting to be sick as well

11 In 1998, the South African government introduced monthly welfare grants for children under 7 years of age, which was increased to include older children up to the age of 14 in 2003, and in 2012 to children up to 18 years of age. At the time of my fieldwork, the grant was R350 (approximately USD35) per month.

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This brief exchange began with an innocent enquiry about the whereabouts of Morgan’s wife (line 1). However, the question was loaded with meaning, partly because it hinted that she was not where she should be, and because it created a sense of mystery.12 Dorothy reported that Morgan’s wife was ill (line 2), and without specifically mentioning it, suggested that this could be AIDS-related by obliquely using the phrase “go around with” (ku jikha-jikha) to refer to her husband’s affair with a female school teacher colleague of his (line 4) who had recently died (line 6). Although their dialogue did not make direct reference to AIDS, Dorothy’s statement at the end, “it seems like now the wife is starting to be sick as well” (line 8) strongly suggested AIDS could be the cause. Paradoxically, by not mentioning the cause of the illness, the exchange between the two women drew attention to the secrecy of Morgan’s wife’s behaviour, therefore insinuating that she had something to hide, which in this context could only mean AIDS. Moreover, the Shangaan phrase Dorothy uses in line 4, ku jikha-jikha (“to go around with”) is highly suggestive of sexual relations that take place outside of marriage. Usually used when referring to young peoples’ sexual conduct and relations, ku jikha-jikha signifies directionless and randomness. Gossip produced evidence, and through its narration, materialised AIDS as the cause of death. In the reconstruction of a conversation between two young women, Sarina Mhlongo and Mumsy Khoza below, it is possible to see how certain snippets of information were conveyed that established irrefutable evidence that a young woman—the subject of the gossip—died from AIDS-related illnesses. The story begins by referring to her “running around with many men”, immediately establishing her personal culpability. It then lists the physical signs of disease and the possible sources of infection. Sarina: She was running around with many men. There was a time she became really sick. They took her to the doctor when they came home with her, she started vomiting and had non-stop diarrhoea until the mother and father took her to the hospital. That time she was pregnant. When it came time for her to deliver, she had her baby; after that she became worse and worse . . . for about two years. She ended up dying at home with her parents. She left her baby and he does not seem healthy; in fact, he may have died. Mumsy: The father of the baby also died. They buried him last week. They did not say anything at the funeral about the cause of death. But people will know that it was AIDS because some went into the house and they saw the body and when they come out, they were saying that the body was very thin and very small

Narratives of death, communicated through gossip were distinctly gendered, reflecting an uneasy relationship between women and the accumulation of commodities and cash on the one hand, and men’s excessive sexual appetites on the other. Dyondzani Selinda, a school boy, talked about the death of 18-year-old Elizabeth Mathonsi with Matthews Seerane, an older friend. In the dialogue, the two young men referred to the physical symptoms of AIDS (a long illness and weight loss), but they also drew attention to the types of men the young woman was associated with, noting that these men owned cell phones and cars, and that they had been seen at 12

I was told never to ask a man or especially a woman about the whereabouts of their spouse.

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particular locales such as shebeens. By inserting these observations into their discussion of the young women’s death, they portrayed AIDS as a disease that is associated with young women’s desires for commodities. Matthews said, I was visiting my girlfriend. I met a boy on the way who told me ‘Elizabeth is dead’. He explained she was killed by AIDS. So, I asked him, ‘Why do you say that?’ He said, ‘She was sick for a long time and her hair looked very thin and her body was thin’. So, this is the thing. So, when I went on my way, I met another person. She also told me that Elizabeth was dead. So, I asked why. So, she said she was killed by AIDS. So, I asked her, ‘why do you think that’? That girl said that Elizabeth was a prostitute girl . . . she was warned to stop prostitution, but she never listened. I believe it because I knew her. I told Mandla. I said to him there is a girl who is dead, and many people say she died from AIDS. So maybe it is true, I don’t know. Dyondzani, agreeing with Matthews, added, “I can believe this because it is a girl I know and she is a very big prostitute and she is the kind of girl who goes to shebeens and she hangs out with the guys who have cell phones or maybe a car and so she was that kind of a girl. So, I believed it”.

A similar narrative structure and content was offered to account for the death of 28-year-old Ntwanano Shabangu. Dike Kubeka, a young man and Ntwanano’s neighbour, recalled that she was a good-looking, “grand young lady”. Ntwanano’s father was a retired security worker for Five Roses Tea on the East Rand of Johannesburg. Her mother was unemployed, and she had two older brothers who were employed, and two sisters and two brothers were still at school. Ntwanano’s mother and father separated when Ntwanano was fairly young and her mother travelled to Randfontein in the early 1980s to find part time work selling fruit and vegetables and second-hand clothes. The family was not poor, although the father had a reputation for drinking his wages. In 2005, when Ntwanano was in her early twenties she started to have numerous lovers and made regular trips to Witbank, a coal mining town east of Johannesburg. Dike recalled, She would go to many different places. She was selling her body to anyone who wanted to have sex. Because she was really good looking, she would get picked up by truck drivers. She was not satisfied at home. She wanted to get something by herself. She would go for two weeks at a time or even for the entire school holidays. At first, she would only go during the holidays but when she started to prostitute herself, she would miss school to go to Johannesburg.

Unlike women, men’s accumulation of wealth and commodities seldom evoked moral opprobrium. Instead, narratives about men who were suspected of dying from AIDS dwelt on the problem of excessive desire. The story of Derrick Makuyana, recounted to me by Bennet Magagule, one of his drinking partners, portrayed him as a notorious drunkard who, in Bennet’s words, “would fuck anyone who was available. He did not want an affair; he just wanted a fuck . . .”. In 2000, Derrick was admitted to hospital. Bennet recalled that Derrick recovered, but “was pale, skinny and powerless. His hair was soft and fluffy. He was coughing a bit and struggled to talk”. Three months later Derrick was dead. After the funeral, there was talk that Derrick had slept with a girl who had had an abortion and that this caused

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his death. Bennet commented: “This may be true, but the way he went around with girls it might be AIDS”. Another account described Titos Mbowane a 40-year-old man, as a “real womaniser”. Titos, an employee of the local Department of Public Works as a road team supervisor also preached at the Apostolic Zion Church and refereed soccer games. One of Titos’ neighbours described Titos’ illness and subsequent death, “I first noticed he was sick in June 2002. He developed pimples on his face and on his hands and became really thin. He couldn’t play soccer anymore. He went in and out of hospital. Sometimes he became better but then became really ill”. Others agreed that Titos had acquired AIDS from numerous extra-marital relationships and had infected his wife. Demonstrating anxieties about the dangers of excessive desire, gossip about death highlighted women’s pursuit of cash and commodities, and men’s sexual appetites. Forming a distinctly generational and gendered discourse, this resonated with broader concerns about the unruly bodies of young people and the social crisis in reproduction.

3.4

Narratives of Unruly Bodies

Okay, today, young men do not work anymore—I want to tell you the truth about this—it is women working nowadays. They [men] go around and steal and they arrest them and take them to jail, huh? Huh? Huh? Okay, in the olden days we didn’t sell this person [pointing to his groin]. God says you must sit down with your partner and eat your food [have sex]. So, you people go around and sell this ‘little person’ [points to genital region] and end up getting doropa [venereal disease]. In the olden days, they just went and paid ndzhovola [bride wealth] and you would find a girl who has not had sex, she would be ready to get married. I want to say it is women who are working nowadays. Nowadays we are running after xilungu [the way of the whites]. Why are people doing that? Because they are eating eggs and chicken; when they start feeling their tummies are rumbling, they cannot control themselves. They shit here in the street. It is because you, young people, are eating eggs. It tastes nice and good all the while it is ruining your tummies. And you see these young people they feel their tummy rumbling they will pick up their dress and just shit even if someone is looking at them. They can’t control themselves. Today, we people are from all over; there are people coming from overseas and coming down here to give us this disease [AIDS] did you hear me it is the people from Persia and America. Okay, you women wearing pants; you will be sitting with your father and you will open your legs. Do you think it is good? And they will be sitting in a group looking at the book [for sex education] and pointing did you see, did you see here, she is giving birth, here they are having sex [My inserts, emphasis in original].

Madimbi Mathebula, an elderly man wearing workmen’s boots and blue overalls displaying the “Grinaker”13 brand on the back, delivered this impromptu, unsolicited and forceful monologue while I was chatting with NwaBembe and her grown-up

13

Grinaker, a construction company, is an employer of unskilled and semi-skilled labour, usually on short term contracts. Men often wear the work overalls as everyday clothes, signifying their status as working men.

3.4 Narratives of Unruly Bodies

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children seated on wooden benches under the maroela tree in her yard.14 As he rambled on, my host and I dared not interrupt, only giggling occasionally at his rudeness. As soon as he finished, Madimbi left abruptly, not even having sat down. We laughed and shook our heads and dismissed his monologue as typical of an old man’s rant performed, I suspected, largely for my benefit; most people in the neighbourhood were aware of my research interests. Yet, Madimbi’s dystopian vision echoed widespread anxieties that circulated in everyday conversation: the loss of authority and the disrespect for gerontological authority (women who wear pants and sit with their legs open); the inversion of gender roles (women work while unemployed men steal); sexual mixing with foreign people (from ‘Persia’ and ‘America’); the commodification of bodies and the sale of sex (“sell this ‘little person’”); young peoples’ untrammelled desire and appetite (eating forbidden foods);15 a loss of control over bodily functions (“shitting in the street”). In the context of rising morbidity and mortality, and a quest to understand the new disease, people embarked on a “cultural pursuit of meanings” (Setel 1999), and forged a grand narrative that fixated on unruly bodies. Indexing the eschewing of gender and generational expectations and conduct, this metanarrative draws attention to the inscription of the crisis of reproduction and moral personhood on the bodies of children, young men, and women. In everyday life performances, young people embraced cosmopolitanism, or as Madimbi put it, were drawn toward xilungu (“the way of whites”). In this way, AIDS achieved symbolic life as a cultural critique of the paradoxes of modernity (Setel 1999). In post-apartheid South Africa, the younger generation remained stuck in the limbo of youthhood or “waithood” (Honwana 2012). Despite political, social and economic liberation, youthful progress was arrested: young men (vajaha), failed to grow into men (wanuna), and were unable to establish households of their own; young women eschewed marriage, and their bodies were commodified, negating their potential status as mothers and mothers-in-law (mamazala). Echoing these concerns were stories that seemed to suggest a world turned upside down: I heard tales of a boy who attempted to have sex with a chicken and of another who raped his neighbour’s dog, and, of a baby born with a pig’s head. Conjuring an image of the chaos and uncertainty, these narratives revealed the present as a “. . . protracted failure, real or imagined, that carries with it the spectre of degeneration: of a future stillborn” (Comaroff and Comaroff 2004, 336). Parents and elders regarded young adults and children’s bodies as uncontrollable. Transcending anticipated stages of sexual development, girls and boys became sexually active at an early age. Young girl’s menarche occurred unnaturally early even in their pre-teens. Adolescent boys produced semen at a far younger age than their older male counterparts and then “wasted” their reproductive potential by

14

Fortunately, my tape recorder was still recording when Madimbi interrupted my interview with NwaBembe and I captured his speech in full. 15 As a metaphor of illicit sexual relations and hidden desires, the consumption of food is analogous to sex. In XiTsonga, the verb ku dya (to eat) signifies sexual congress (Bill 1994).

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having recreational sex. Moral sexual relations that reproduced the household (muti) had been replaced by non-reproductive or play sex (matanyula). Young men’s sexuality was seen to be out of control like a type of “madness” (Collins and Stadler 2000) triggered by their inability to control their sexual urges. A young man commented that when he saw attractive women, he was incapable of selfcontrol, “It reports down there (in the groin). She possesses me (na tala: isiZulu)” (Stadler 2003, 136). Sexual desire, conceptualised in terms of a hydraulic metaphor, was driven by flows of blood that needed to be released. While young men’s sexual desire was perceived as a natural need to release pressure, the capacity to control sexual desire was central to the construction of adult male identity. Ideally, senior men (wanuna ntiyela) display control by managing the muti (household) and wives. In contrast, junior men (vajaha), were regarded as impulsive, prone to fighting, and had multiple sexual partnerships. The contrast between disorderly youth and male order was expressed in cultural performance. At weekly muchongolo dances,16 rival dance teams competed for prizes of beer. Younger men performed the giya, a solo dance that reflected idiosyncratic and creative energy; these dancers were always applauded most enthusiastically. In contrast, the central aesthetic of muchongolo lay in the display of uniformity in movement, “creating a visual and aural demonstration of balance and order, restraint and harmony” (Stadler 2003, 135). Residents articulated an association between the social disorder that precipitated HIV spread and the physical symptoms of AIDS-related disease. In an off-hand comment, a young woman, Martha Gomane, described the erosion of social relations in the village using the English words “corrupt” and “rotten”. “These people are corrupt and rotten, Jonathan”, she said, clicking teeth to emphasise her disgust. These same words were used by other residents when describing the “AIDS body”, in graphic detail, emphasising decay and erosion. Martha reported hearing about a young woman with a perforated perineum, and another whose breasts were riddled with sores that leaked pus. Envisaged as a maggot or a worm that gradually consumed the body from the inside, the effects of AIDS were inscribed on the skin by pustules, weeping sores and eruptions. The healer, NwaEphraim, prescribed two litres of a blackish liquid for her patients, claiming this induced diarrhoea and discharged “male and female maggots and their children”. These disturbing and disquieting images, of the “vertiginous” body disrupted the boundaries between inside and outside the body (Henderson 2004), giving rise to disgust and horror of the living dead (Niehaus 2007). The AIDS body served as an apt metaphor of the corruption of social relations, and the disruption of generational and gender categories. It was the corporeal manifestation of the collapse of social order.

16 Muchongolo dance contests took place every Sunday in Bushbuckridge, hosted by a different homestead. The winning team received a prize of a case of beer (Niehaus and Stadler 2004).

3.5 Narratives of Mobility and Space

3.5

83

Narratives of Mobility and Space

Mobility and movement featured prominently in local discourses about AIDS. Young girls were warned about the dangers of “lingering” on the streets, and AIDS was seen to attack those who “play in the street” ( famba tlangeni xitrateni) as if the disease had human agency as a “purposeful entity” (Balshem 1991, 162). The clandestine nature of liaisons on the road provided fertile ground for imagining the dangers of disease spread. Sexual liaisons formed on the road were hidden from the gaze of parents and were therefore unsanctioned. In a speech at a public ceremony a health official stated: “Most people think that when they are on the streets having secret love they are safe. They can hide from people, but they can’t hide from AIDS”. Road intersections also created spaces for unsanctioned relationships. A truck stop located at the intersection of a national road that links Bushbuckridge with Johannesburg, passes through the city of Nelspruit was believed to be the epicentre of the spread of HIV in Bushbuckridge. Here at the Cross-Roads Café truck drivers parked for the night to drink beer and eat shisa nyama (barbeque). Women had sex with drivers aboard their rigs or in the bushes nearby. A young man asked me rhetorically, “Do you think they use condoms?”, and then asserted, “They want to spread the virus”. The association between roads and the spread of HIV mirrored local apprehensions of the danger concomitant with locales and mobility. Roads figured prominently in popular narratives about death, ghosts and spiritual danger. They “trigger people’s imaginations and are frequently incorporated into the tales and stories of those who travel on or live close to them” (Dalakoglou 2010, 144). Accounts of epidemic spread incorporated the road into narrative structures in which AIDS seemed to lurk like a spectral being. Roads also have contradictory significance— they open up local worlds to markets of labour and consumption, but at the same time isolate and marginalise communities. As Masquelier (Masquelier 2002, 831) observes, the road is a “space of both fear and desire”. The significance of the road, unlike the village paths that traversed neighbourhoods, also lay in its anonymity. In public, young women and men were subject to surveillance by neighbours and relatives, becoming the subjects of gossip. On the tarmac covered roads it was relatively easy to remain anonymous, disappearing into a car, speeding away to an undisclosed location. Echoing these sentiments, NwaBembe, who walked along the main road every evening on her way home from the bus stop, drew my attention to the groups of young women and school girls that congregated next to the roadside. “Ai! There are many you can’t even count them . . . even those kids at school are there. There is not one that can say “I only have one boyfriend”. Because today when you pass her on the way she will be standing with this boy and the next day she is with some other boy. It will be difficult when she becomes pregnant. You will want to know who made her pregnant, but she won’t know. The time you ask her “who made you pregnant?”

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she will count off ten boys because she doesn’t know who made her pregnant. So, you will never know where you got AIDS that time. You will never know!”. In the early 1990s, a tar road was constructed between the village of Cottondale and the small administrative town of Thulamahashe. A feat of engineering, the road traverses the hilly countryside with graceful twists and turns, a pleasure to drive, saving the lifespan of cars that were worn out from driving the dirt roads that are potholed and clogged with rocks and stones and corrugations. The road was significant in two respects: it connected the village to the outside world and thereby provided a conduit for flows of infection; its construction also introduced strange men, members of the work gangs who built the road, into the world of the village. Creating a connection between the world of the village and the busy national roads, the new road also linked villages to Nelspruit, and further afield to the East Rand of Johannesburg, and even Mozambique. The road represented development to the area and during the protests of the early 1990s, the lack of tarred roads was listed as a major grievance. However, many village residents were unhappy about the road’s construction. It was regarded as serving only the educated and monied elite who owned cars, but not those who are unable to afford taxi fare and consequently were forced to walk its narrow verges, and risked being run over. The road also enabled the display of relative wealth and affluence; new fast moving vehicles flashed their lights and hooted at old skorokoros (beat up old vehicles) and trucks. The twists and turns were also dangerous, evinced by the tire marks on the surface and the remains of carcasses of goats and cows hit by trucks and cars. Driving past one of the many accidents on the road I was told that sacrifices were needed to appease the “ghosts” (ximpoko) of those who had lost their lives there. A friend warned me, “There are too many ghosts on this road to drive it at night, Jonathan”. The lyrics of a song performed at a Muchongolo dance aptly expressed these negative sentiments. Gijimani miya byela Run away and tell Jojo Malamule Jojo Malamule Leswaku xikantiri About the tarred road Xihi heta milenge It destroys our legs Hitler uhi kombe mihlolo Hitler he showed us a miracle Byela byela Tell, tell Hoyo hoyo hoyo Welcome, welcome

Urging the local headman (named Hitler17) to complain to Jojo Malumele (the minister of road transport for the former Gazankulu Bantustan) about the road’s hard surface that hurt unshod feet, these lyrics alluded to the suffering that accompanies

17

Hitler was a popular name for boys born in the 1940s and 1950s because he (like the Shangaans) was perceived to be fighting a war on all fronts against powerful forces who wished to suppress nationalist identity. Or, as a young man put it, “Like us Shangaans, everyone was against him—he had many enemies”. A similar logic was applied during the war in Iraq; several young boys, born in the 1990s were named Saddam (after the former president of Iraq, Saddam Hussein).

3.6 Conclusions

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modernisation and development. The words had prophetic vision: the new road soon became a locale for transactional sex, and HIV was believed to literally travel along it from Gauteng into the villages. Speed was also metaphorically related to ill health and risk: I frequently heard villagers remark that “life is too fast in Johannesburg”. Weiss notes similar concerns about the pace of life in rapidly changing rural Tanzania; “excessive speed can lead to degeneration of the proper balance and control which are necessary to the easygoing sociality and bodily well-being” (Weiss 1993, 22). Rapid, chaotic movement was associated with the spread of HIV. Evidence of the role of the road in facilitating the spread of HIV was revealed by one of the earliest suspected AIDS deaths in the village. In 1999, a 27 year-old woman named Anna Ndlovu was believed to have acquired HIV through her sexual relationships with the road workers. Her neighbour, commented, “Many people were talking about her, saying ‘this girl—she will get AIDS because where there is a road contract [construction] she will be there”. According to her uncle (malume, mother’s brother), Anna “. . . started to become thin and was not eating well, she had vomiting and diarrhoea”. From 1996 to 1999 Anna was an outpatient at Masana Hospital. The doctor informed Anna’s mother that her daughter was HIV positive. Anna’s malume said, “She slept with many men without a condom. It was her behaviour that made her to become infected. She had many partners. She was always trying to catch men”. Apparently ignoring the warnings from nurses and others, she continued to have numerous affairs. Anna’s malume continued, “I was angry with her for becoming sick because she ignored that lesson from the nurse from Tintswalo [Hospital]”.

3.6

Conclusions

The HIV epidemic created new and increasingly complex demands on the production of evidence of the prevalence and spread of infection, its impact on morbidity and mortality, and most recently, progress against national testing and treatment targets. It has also extended the “medical gaze” into the most intimate of human experiences—sex, illness, and death via the surveillance of bodies and behaviours. The production of evidence simultaneously assesses and shapes social realities, creating hierarchies of what is knowable and what is not, often supplanting alternative forms of knowledge (Merry and Coutin 2014; Adams 2016, 9). This involves the simultaneous process of “unknowing”, seen to be a necessary condition for “scientific knowledge production” (Geissler 2013, 13). The capacity to render some things visible, while at the same time concealing others, is an act of “strategic ignorance” which involves making certain types of knowledge “inert” (Heimer 2012). Even while creating vast “piles of paper” or “data” and thereby creating the illusion of knowledge, “this process of rendering facts inert serves to protect a variety of interests, public health initiatives, research projects, donor funding streams and so forth, and deflects attention from certain truths about the broader

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socio-economic problems or the pragmatic nature of clinical expertise” (Heimer 2012, 18–19). The production of knowledge, and the conversion of complex and contextually variable phenomena into the impersonal indicators relies on what Merry describes as the “the magic of numbers and the appearance of certainty and objectivity that they convey. They represent a technology of producing readily accessible and standardized forms of knowledge” (Merry 2011, S84). The production of evidence also serves as the expression of power, as Briggs (2004, 164) write: “Epidemiology provides powerful techniques of erasure, including means of turning people into categories and numbers and then providing states with control over the production, circulation, and publication of these ‘data’”. A consequence of this process of the production of evidence is the disembodiment of human life, as health is quantified and people are transformed into abstract entities (Wendland 2016, 61). The production of evidence can become a contested terrain, as the uneasy relationship between the South African government and scientific-activist bodies showed in the early stages of the AIDS epidemic. However, as I have pointed out in this chapter, responses to death were not limited to biomedicine or professional epidemiological categories. In Bushbuckridge, villagers drew on the concepts of moral persons, bodies and places, producing a local epidemiology of risk that framed AIDS in terms of social disruption and disordered development. These offered a critique of the impact of social and economic transformations on gender and generational relationships. The resulting moral scripts had perlocutionary power in shaping social realities and subjectivities, and the experience of death. The spoken word was shown to contain the capacity to materialise HIV, in the context of the HIV test and everyday gossip. It had the power to transform health, and make illness and death real, by presenting evidence based on notions of moral personhood and risk. Epidemiologies—both professional or popular—can be seen as seeking to create certainty through explanations of the cause of sickness and death, and in this regard are attempts to stabilise death. Mainly affecting men and women with productive and reproductive potential, AIDS deaths were regarded as “bad” deaths. Young women died before realising the possibility of raising children, were consumed by a disease spread through illegitimate desires for commodities and cash. Young men, failing to become respectable adult men, were likewise struck down in their pursuit of women. Their lives, incomplete, meant that their deaths were similarly unresolved. I argued that considering the increased mortality of young adult men and women in the early to mid-2000s, narratives framed AIDS-related deaths as fatalities of faulty personhood and disordered desire. These bio-moral autopsies identified men who were considered the “rich of the poor” and mobile women as the prime candidates accused of transmitting HIV (see Stadler 2003). These discourses ran deep and preceded the AIDS epidemic. They corresponded to long-standing anxieties regarding changing gender and generational relationships. They can be seen as reflexive responses to social dislocations following the collapse of local subsistence economies and forced resettlements (see Chap. 2). They articulated collective disquiet about young women’s autonomy on the one hand, and young men’s failure to reproduce the muti (household) on the other.

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The stories in which this “popular epidemiology” of AIDS were grounded took form in the semi-public gossip that spread along networks of kin, neighbours and co-villagers. In the stories that emerged in their wake, deaths tended to resurface often reimagined and recast as witchcraft. Like the exhumation of corpses and the subsequent forensic investigation when the cause of death is disputed, talk of witchcraft refocused attention onto alternative theories concerning death, effectively destabilizing and potentially remaking it in the process.18 The witchcraft idiom offered a means of expressing its unfinished business.

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Chapter 4

Intentional Infections: Public Discourses of HIV Spread

During the early stages of the AIDS epidemic in Bushbuckridge, rumours proliferated about the origins of HIV. These blamed malicious scientists and nurses and representatives of the former apartheid state for introducing and spreading HIV. Rumours constructed the disease as a foreign affliction caused by invisible agents that were external to the world of the village, and whose identities were generally unknown and mysterious. But, by the mid-2000s, as HIV infection and AIDS-related deaths reached their peak, rumours became preoccupied with the intentional spread of HIV through human agency, identifying young women and older, wealthy men, or what I described in an earlier publication as the “young, the rich, and the beautiful” (Stadler 2003). No longer regarded exclusively as a threat from the outside, HIV was domesticated, incorporated into local frames of meaning. While rumours are important sources of social analysis and responses to epidemics, beyond the communication of information, HIV educators highlight the absence of truth in rumour, often regarding these accounts as “myths” and “misconceptions” (Bastien et al. 2008). However, although rumours appear to make truth claims, these are not always believed unequivocally. They are often subjected to challenges and disputed as quasi-factual accounts to be regarded with scepticism (Geissler and Pool 2006). The absence of truth is not what is important about rumour (Besnier 1994). What is important is that the story is deserving of retelling, as it resonates with local sensibilities, experiences, ideas, and shared histories. Rumours about the intentional spread of AIDS in Bushbuckridge may aptly be described as belonging to a type of discourse that Bellman refers to as “deep talk”. This is the use of language that “alludes to, but never directly reveals, the concealed information” creating a “second reality” that is often ambiguous and “contains conflicting interpretations of the real” (Bellman cited in Piot 1993, 357). These types of narrative thrive in situations where official forms of broadcast obscure or do not address popular concerns and questions. As potent discursive devices, rumours convey more than misinformation: they reflect on broader social, economic, and political transformations that are taking place at specific points in time. Rumours can be seen as “socially constructed, © Springer Nature Switzerland AG 2021 J. Stadler, Public Secrets and Private Sufferings in the South African AIDS Epidemic, Social Aspects of HIV 6, https://doi.org/10.1007/978-3-030-69437-1_4

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performed, and interpreted narratives, a reflection of beliefs and views about how the world works in a particular place and time” (Kroeger 2003, 243). Rumours are popular responses to social crises, uncertainty, and calamities (Rosnow 1988; Turner 1993; White 2000; Geissler 2005). Through their narration, they allocate blame, and propose conspiracy theories, providing a “means for people to make sense of political or economic conditions” (Butt 2005, 413). Rumour operates as part of “collective imaginaries reacting to experiences of inequality”, technological transformations and modernization (Butt 2005, 414–415). Because it is almost impossible to trace their sources, and control their flow (Andreassen 1998), rumours can also be a potent form of hidden retaliation, a resource for the weak to articulate a counter discourse of blame toward the powerful (Farmer 1992). As Besnier puts it, these narratives can be a “prime site of political resistance” due to their “mundane setting and apparently innocuous nature” (Besnier 1994, 4). They are therefore a critical aspect of local cultural practice that may be a powerful weapon at times of severe suffering or significant threats to material and spiritual security. In Bushbuckridge, rumours were types of story that circulated widely, described by the Shangaan term maveriveri, a phanopeia that evokes the image of random circulation. Rumour usually encouraged broad public participation in the narration and construction of the narrative. Rumours about HIV proliferated, and were constantly retold, in public spaces such as schools, church, taverns and bars, and on taxis and trains. My exposure to rumours was mainly through hanging around socialising in peoples’ homes and participating in communal rituals. Having heard about a particular story, I asked others if they too had heard the same and how they interpreted this. In the following I begin by examining rumours circulating during the late 1990s and early 2000s, that identified HIV as a manufactured affliction, spread by agents of the apartheid state. By the early 2000s, these rumours had been replaced with narratives that identified young women and wealthy, older men, as HIV spreaders.

4.1

Conspiracies and Condoms

During the late 1990s and early 2000s, rumours about HIV identified its origins and spread through agents and technologies that were foreign to Bushbuckridge. In this way, HIV was conceptualised as an external threat that had been created in foreign places, and through mysterious means. These rumours included foreign persons, infected condoms, and medical malfeasance. In the late 1990s, a rumour that circulated in Bushbuckridge reiterated global dialogues about the zoonotic origins of HIV. This theory claimed that the disease originated from humans who had sex with animals, such as monkeys, baboons and dogs. In 2002, Mandla Ndlovu, the same young man who accompanied me to AIDS awareness events (see Chap. 2), recalled that he first heard this rumour when he was at school in the late 1990s. Specifically, his school friends had talked about

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Americans who had sex with dogs and West Africans who had sex with monkeys. He also remembered reading about a South African white man who paid his Black domestic worker to have sex with the family dog, thereby infecting her with HIV. However, in our interview in 2002, Mandla discounted these rumours, saying “No, no, no. I don’t believe that if a monkey can live with this disease it will kill a human being. What is the difference between a monkey and a human being? The blood is the same and the disease lives in the blood”. These early rumours located the origins of HIV in foreign places and caused by acts perpetrated by unknown people. They also associated HIV with non-procreative sex, thereby establishing an enduring moral narrative that is sustained in dialogues about HIV throughout the epidemic. Rumours of “worms in condoms” shared this concern. Eighteen-year-old Abednego Mathebula and his fellow members of a village AIDS committee (see Chap. 3) recounted that they heard of an unnamed young man who had confronted the medical staff at Tintswalo Hospital with evidence of the presence of “worms” in condoms. The almost microscopic worms were believed to be HIV and therefore, condoms were identified as a source of infection. According to Abednego, the doctors inspected a condom using a microscope and confirmed the presence of HIV that appeared like tiny worms to the naked eye. Abednego said, “he [the young man] said that the doctors who made the condoms and gave them away for free wanted people to get the disease [HIV] from those condoms”. This rumour caught the attention of the local press. In 2003, the Mopani News (a broadsheet distributed for free in Nelspruit and Bushbuckridge) reported that “worms” had been discovered in condoms and medicine. Rumours that some doctors working in private surgeries are spiking medication with HIV/ AIDS infected blood in order to panic unsuspecting patients are spreading like wildfire in the Greater Bushbuckridge area. Traces of ‘live’ or ‘dead’ worm-like creatures are said to have been spotted in some medications (Matlala 2003).

The story achieved popularity, not because it was believable, but because it successfully challenged medical authority, having appropriated the scientific apparatus (such as the microscope) and medical personnel to do so. The rumour also reflected local concerns about condoms as dangerous technologies. Condoms were believed to result in blockage, becoming stuck in a woman’s cervix. They ruptured easily, and small pieces of latex could be absorbed into the body. The condom “oils” or lubricants were thought to accumulate in women’s bodies, causing infections and disease. Biomedicine was also the subject of rumours of purposeful infection. Bushbuckridge residents expressed hesitancy about being tested for HIV. They recounted rumours of nurses who allegedly infected patients with HIV by using needles and hypodermic syringes that contained the blood of infected patients.1 Such

During my fieldwork in 2003, one case was recorded of a nurse from Matikwane Hospital who purposefully infected a young child with HIV by injecting him with blood drawn from a HIV-positive patient. The nurse intended to force the child’s father to leave his wife. Also in 1

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acts, these stories claimed, were inspired by greed; nurses who were in league with privately owned mortuaries profited from the dead (See also McNeill 2015). This tied to earlier rumours that HIV was part of an apartheid government plot to kill Black people. In this rumour, reference was made to a white man who worked in a laboratory and was always seen with a briefcase which contained directions on how to make a vaccine. The rumour alludes to Wouter Basson, the Director General of Health during the apartheid government (Niehaus and Jonsson 2005). Pharmaceutical companies were also accused of profiteering by withholding a medical cure for AIDS and of suppressing the discovery of a cure by traditional healers, as this would undermine their profits. Riot Mathonsi told me he had heard discussions on radio talk shows, that purported that, “they [medical researchers] are worried that the AIDS cure will be made locally and in the traditional way. They will lose their profits. This is why they cannot make it know to the people that there are cures for AIDS available”. While rumours of the late 1990s and early 2000s tended to reflect the concerns of HIV spread through invisible and foreign agents, as the epidemic intensified and AIDS-related deaths became increasingly visible, so local accounts began to highlight concerns about the dangers from within the village. No longer invisible agents of the state or powerful pharmaceutical corporations and big capital, blame was directed towards local actors.

4.2

“Beware of Beautiful Ladies”

In August 2002, a notice stamped with the National Department of Health logo was displayed on the walls of the Thulamahashe health centre. In bold capital letters it declared: TO: ALL THE COMMUNITIES OF THULAMAHASHE BEWARE OF BEAUTIFUL LADIES WHO ARE HIV POSITIVE. DO NOT GIVE THEM LIFTS IN YOUR CARS!!!!!

Photocopies of the notice were distributed to taxi drivers and motorists. A similar warning was broadcast in English on Radio Bushbuckridge. People speculated that the warnings referred to young women who pretended to hitch rides to Thulamahashe, but who were really looking for men to pay them for sex. NwaBembe, a woman in her early 60s, claimed that she recognised the young women referred to in the public notice. She elaborated, Now it is hot so you won’t find them next to the road, but when the sun goes down and if you drive a car on the road you will find them next to the road, and if someone stops the car they will just get in the car because they don’t know where they are going to sleep. . .they walk the tarred roads waiting for these guys.

Bushbuckridge, Niehaus relates rumours of nurses injecting people with infected blood (Niehaus 2018).

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Her words carried a sinister ring and suggested that the women were not ordinary prostitutes. The nefarious intentions of the young women who stood by the road were suggested by other accounts; these speculated that the women intentionally spread HIV. Charlie Hlatswayo aged 29 corroborated this view. “A girl from Ludlo village has been seen hanging around Maganga Bottle Store in Thulamahashe. People are aware that she has HIV. They also know that the purpose of her hanging around is to pick up men and to spread HIV to them”. Ahlulani Manyisa, a young unemployed man, told me about Comfort Ndlovu who worked for the Bushbuckridge Water Board. Comfort had been seen at Ximambane’s Tavern “proposing love” to one of the young women identified in the public warnings. Later Mandla heard rumours that Comfort was infected with HIV. “I cannot sleep with any girl that Comfort has slept with because he slept with the one who is spreading AIDS so maybe now, he has AIDS” he remarked. Later in that same year rumours of young women intentionally spreading HIV became more elaborate and deliberate. A young woman was rumoured to be sleeping with schoolboys from a high school. According to MaSeerane, the schoolteacher at the school, the woman proposed to schoolboys but refused to use a condom. “Several boys slept with her and they are now HIV” MaSeerane asserted. Gusto Makhubela, who was in his final year of school, told me another version of the story which he had picked up from his drinking companions. There is a young woman who is from Thulamahashe and she went to Johannesburg to do ku pirates [to trick men to have sex with her for money]. She went for a test in Johannesburg and they told her she was HIV positive. She decided to come back to Bushbuckridge. She hung about at night at the Songeni Bottle Store and slept at KaZitah Village, and then during the day she went to the school. She hung out there [at the school] for two or three weeks during lunch times. The boys would propose to her. The first night one boy would take her to his place. The second night another boy would take her to his place and so on. She slept with five boys at the high school. After that she moved to KaManzini to another school. She did the same thing there for about two weeks. She slept with eight boys there. One of the boys realized that something wrong is going on. She then went back to Acornhoek where she met a guy called Frans. He took her to his place. When they wanted to have sex Frans said, “I am using condoms”. The girl said, “no you are not using a condom with me”. Frans said, “if you don’t use a condom, I do not want to have sex with you”. She said “okay, you can sleep over there without having sex with me”. This guy suspected something and started to question her. “Why don’t you want to use a condom?” She wouldn’t tell the truth, but he realized that there was something wrong with her. The following day she woke up and left. Meanwhile the Radio Bushbuckridge was announcing that the police are looking for a young woman who is dressed in a particular way. If anyone sees her, they must come and report this to them. They also said that she is HIV positive and is going around to the schools and sleeping with the young men from the schools. The police went to the Songeni Bottle Store and hung out there in plain clothes. Someone pointed out the woman to them. One policeman went to her and proposed to her. She agreed and they went to the car. When he got into the car, he took her straight to the police station. They questioned her and she told them the entire story and they say she is still in jail at this moment. They even announced in the radio that she has been found and arrested.

I was not able to corroborate the details of the story; according to the station commander of the Thulamahashe police station, no arrests of young women had

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been made. Nonetheless, each time the story was retold it acquired increased plausibility. In the final version, the young woman was identified as Flominah Khoza, a 19-year-old school girl from KaManzini Village. She was identified as a threat to the health of everyone in the communities of Bushbuckridge. Community members who had heard the story arranged a public meeting and proposed that they chase her out of village. Hlanganani Dube, a young man from the neighbourhood where I sometimes lived, related Flominah’s story. At 17 years of age, Flominah Khoza had left school without completing her final year. She lived with her parents but changed residence fairly frequently, moving in with different men. Council recalled that she was “a beautiful young woman who would sleep with drunken men for only two Smirnoff Ice [vodka and lemonade mixer]. Before you can sleep with Flominah you have to buy her delicious Sunday food. That is all she needs to stay fit and healthy”. Council claimed that Flominah only required food and drink in exchange for sex. She was motivated to have sex because she “did not want to die alone. She is doing this just to spread the disease. She doesn’t want to die alone—she wants to die with many other people”.

According to another young man, Flominah was first infected after having sex with a number of policemen. One of these men was married to a woman who was suspected to be HIV positive. Another theory was that she had contracted HIV after having spent some time in Randfontein where she sold sex to mine workers. Locally, she was rumoured to have had an affair with a teacher who was suspected to be ill with AIDS in 2001. He slept with Flominah when she was still a school student. Another teacher met Flominah at a tavern. When he discovered that she was HIV positive he was extremely frightened but according to his friends showed no signs of having been infected by HIV. Another lover was in his late 50s and also a high school teacher and the chair of the Community Policing Forum. His affair with Flominah was common knowledge to many as he had boasted once that he had had sex with Flominah but had used a condom. Yet, according to others who I spoke to, he had recently started to appear ill. “He is he is not looking that great, his body is not looking good. Flominah infected him. He is going soon”, remarked a fellow member of the forum. Another young man, who had been studying law in Johannesburg, also had an affair with Flominah. He was known to have had sex with two teachers who were suspected to have AIDS. He was also known to have a regular sexual relationship with a woman in Tzaneen and another woman who regularly travelled to Johannesburg and had sex with men there. Dimros Mbetse, a young man and one of Flominah’s neighbours related the story: Flominah also had several teachers who were her boyfriends. We used to see several men who would come looking for her. She went to taverns a lot on weekends. People used to say, “she will get something from outside and give it to the local boys”. She would hang out with men who were not known [locally]. They will end up stealing or killing somebody and the problem is that we do not know where they are from. Sizwe [his friend] told her to stop hanging around with men; “get your own boyfriend—you are bringing too many outside men in here—they are harassing other people and they are causing problems”. People were cross with her. They said that she had increased the number of people who are HIV positive in Bushbuckridge. And because she told people that she had AIDS she contributed towards the awareness that people had that many people in the village were HIV positive.

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Each of these accounts depicted young women moving from place to place infecting men, suggesting a metaphor of viral spread, and seeding the makings of a “moral panic”. La Fontein usefully defines moral panics as “the construction of a social problem as something more serious than the routine issue of social control” (La-Fontein 1998, 19). These local accounts centred around women “whose unrestrained sexuality clearly marked them as contravening the behavioural rules for good women” (Fordham 2001, 260). Intentional infection was not unfamiliar to residents of Bushbuckridge in the 2000s. Young people recited the slogan “infect one, infect all” and the belief that HIV positive people infected others to avoid dying alone (See Leclerc-Madlala 1997). Early in 2002, at a meeting of elders (bhandla) in KaManzini Village the headman (ndhuna) proposed that the elders form a “committee” or posse to track down young woman who spread HIV, kill her and present her corpse to the police. An unidentified man at the meeting said he would personally tear her body apart and throw the pieces in different directions in the same way as she spread HIV. Signalling that young women were a threat to the safety of the community; songs were performed by men at the weekly muchongolo dances. Muchongolo dance competitions present opportunities for villagers to voice their dissatisfaction with current events. The lyrics below performed in 2005 reflected the collective anxieties of purposeful infections. Tshikani ku yendla vavanuna (Married men: Stop moving with women) Vata ku dlaya nwa’ananga Tshikani ku yendla vavanuna vavansati va dlaya Ami swi voni leswaku se ma hela hi Vuvabyi bya HIV AIDS la ha andel naa Vuyelani amakaya mi nga si hlangana na xifu xa masiku lawa lexi vango i AIDS.

They will kill you my son Stop staying with women, men, women can kill Can’t we see that we are getting finished with the disease called HIV AIDS out there? Come back to your family before meeting the death of nowadays that they call AIDS

While these narratives tended to focus on young women who purposefully spread HIV and targeted men for that very purpose, a parallel narrative, circulating at the same time articulated a different kind of story. In these accounts, young women were the victims of older, affluent men.

4.3

Coffin-Cash and Worm Man

Between 2005 and 2008, a series of rumours circulated in Bushbuckridge that revolved around wealthy men who promised young women cash and luxurious lifestyles in exchange for sex, but who deceived them and passed on deadly afflictions.

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Buy Your Own Coffin

In 2005, I heard two similar accounts of young women who were given money in exchange for sex and were told to use the cash to finance their funerals. In one version, a young woman who worked for a tourist lodge near the Kruger National Park was seduced by an American tourist. He offered her a suitcase containing 2500 Rand (US$250) in exchange for sex. The next day the tourist told her “You now have AIDS. Take this money and use it to buy your coffin”. In another version of this story, a 20-year-old woman met a wealthy, older man. He was extremely charming and took her to good restaurants, bought her clothes and drove her everywhere she needed to go. He did not demand anything from her, even sex, but later insisted that they visit his parent’s home which was in a rural location. Once there he told the young woman to enter a large hut. It was pitch black inside and there were no windows. He told her to sit quietly, to remain still and whatever happened not to scream or make a noise. The hut was dark and quiet, but in the darkness the young woman heard something moving and felt something touching her. Suddenly something was sucking on her breasts, but she remained silent as the man had instructed. Her breasts were sucked continuously for hours and hours until she felt weak and collapsed. Eventually the man opened the door to the hut and told her, “you are dying, you will die”. He then gave her a briefcase full of money and said, “this is for your funeral, take it and use it to buy a coffin”. He then drove her home to her parents and handing them the money and said “bury your child”.2 These types of stories are moral texts about the pursuit of wealth and the erosion of sentiments of kinship and neighbourliness. Funerals and the rituals surrounding death were key events in village social life. In certain respects, the funeral was the quintessential ritual in Bushbuckridge and failure to regularly attend funerals risks being “buried alone”. Coffins were expensive and usually paid for by the wider family. Those who were too poor to afford them evoked pity and sympathy and sometimes neighbours and kin made voluntary donations to purchase a coffin. Even those with small and irregular incomes joined burial societies and schemes. Participation in burial societies was not only a question of financial contributions but was a fundamentally social act of care that involved contributing toward the preparation of the funeral feast, digging the grave, serving food, joining in prayer, and singing hymns. In contradistinction, to “buy your own coffin” was a potent statement of the rejection of kinship, good neighbourliness and sentiments of reciprocity.

This bears a striking similarity to the tales of “AIDS Mary” and “AIDS Harry” that spread in Johannesburg in the mid-1980s. In these accounts, the victim has sex with a stranger and when they awake finds the message “welcome to the AIDS club” scrawled in lipstick on his bathroom mirror.

2

4.3 Coffin-Cash and Worm Man

4.3.2

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Worm-Man/Hummer Guy

A rumour about an unidentified foreign man who spread “worms” started to gain traction in 2006 and circulated until 2008 in the Limpopo Province, Swaziland and Botswana.3 I first heard about “worm-man” from migrants from Bushbuckridge, living in the East Rand townships. The rumour recounted the story of a wealthy, sometimes Nigerian, man who drove a luxurious shiny black Humvee with tinted windows. Moving around the streets, he seduced young women with promises of cash, gifts and luxuries. Taking them to his house or a hotel, he held them at gunpoint and undressed, revealing that he was wearing “Pampers” nappies and his genitals were infested with maggots (or “worms”). Still at gunpoint he forced the young woman to perform fellatio on him, to suck the worms out of his penis. After having spent the night together he handed over a large sum of cash and told the woman to purchase ox liver4 to feed the maggots that he had passed on to her, warning that if the worms become hungry, they will consume her from the inside. While AIDS was not mentioned, as I noted earlier, the symbolic resonances with ideas about the disease were clearly evident in these accounts: the “worm” infection was sexually transmitted, and maggots and the rotting body were signs of AIDSrelated illness and death. Stories about the “worm man” or the “Hummer guy”, as he became known, circulated in the popular press and social media. I conducted an online search in October 2008 and found the story in numerous news, Facebook postings, and email chains. Further evidence was provided by people who claimed to have seen the victims of Hummer Man in local hospitals. Indeed, health officials reported that people were “flocking to our health facilities to catch a glimpse of these non-existent patients” (News24 2008). During a visit to Bushbuckridge in 2008, I heard that people were queuing up at Tintswalo Hospital and paying between 10 and 30 Rand (US$1–3) to see a patient whose vagina was infested with maggots. They were told to bring along polony or fresh ox liver to entice the maggots to emerge from her genitals. These meats are bright red intimating that the maggots were attracted to fresh blood. The mainstream media further reinforced the rumour. Stories appeared in the Times of Swaziland and included interviews with witnesses who had heard of and seen Hummer Man. The following excerpt appeared in the online edition of the Times of Swaziland (Times of Swaziland 2008, November 2). With his cash, fancy cars that include a black Q7 [Audi], a black Hummer and the latest being a Mini Cooper, the man allegedly flashes the cash in exchange for a sexual favour from

3 In the Venda region of South Africa, rumours of Hummer man implicated local entrepreneurs. Noting their acquisition of mortuaries and funeral parlours and the increase in AIDS mortality and funerals, entrepreneurs were imagined as “parasites, killing and eating their own people: spreading poison at funerals to ensure the continuation of their businesses” (McNeill 2015, 48). 4 In some versions victims were told to acquire human livers to feed the maggots (McNeill 2015).

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the young women. It is alleged that his sickness is somehow contagious as those who perform oral sex on him end up getting sick too. He is said to have done the dirty game to many South African young women and then decided to find other preys in the country.

Other mainstream media published similar accounts of Hummer Man, but soon dismissed the rumour as a “myth”. In November 13th, the Times of Swaziland displayed the headline, “Worms man just a myth”, noting that the rumour originated from Botswana in February 2006, and that South Africans and Swazis had been duped (Times of Swaziland, Nov 13, 2008). An email chain circulated in 2008 tried to establish the reality of the story by attaching a photograph of a woman’s vagina containing maggots and warnings to women to avoid a man identified only as “Geoffrey”. The email reproduced below was sent by “Aluta” on the 8th of October 2008 and reports sightings of Hummer Man in the lowveld mining town of Phalaborwa and by residents from the nearby townships Mashishimale and Lulekani. The email copied below was forwarded to me. Subject: Warning Posted by: Aluta Message: Hi Ladies, Am sure you are all aware of the so called HUMMER guy who just came to Phalaborwa recently to spread his strange disease. Good people this is not a story or a myth, it is a reality. Apparently, the guy will date you for a while, then take you to a shopping spree, spoil you rotten with all the things that your man never did before, pay up your debts and stuff like that. After that he will take you to the most luxurious accommodation establishment around town.......that is where all the dirty acts are done, he will not be ashamed to take off his nappy (Huggies) in front of you coz he has a gun....so you have nothing to do. He force (sic) you to sleep with him and there after you will be given a huge amount of money to maintain the worms by buying them a liver as well as nappies. Believe me or not I know of one victim in Lulekani who just passed away, and the other from Mashishimale, still in Maphutha Hospital. Let us not keep quite (sic) about this, keep on sharing this with our beloved friends, sisters and colleagues. We might save other people’s lives. This Hummer is always parked at Checkers [supermarket chain] parking next to Joshua Door and Duns store [furniture and clothing retailers] .....beware of that ladies. NOTE: I just heard that he changed his car because people have noticed him GUYS PLEASE PASS THIS ON TO ALL THE WOMEN THAT YOU CARE ABOUT MOTHERS / SISTERS / COUSINS / AUNTIES / EVEN YOUR GRANDMOTHERS!!! THIS MAN IS A THREAT TO SOCIETY. WHEN YOU SEE HIM................START RUNNING!!! FROM A CARING SISTER!!!

Like the antagonists in many rumours, Hummer Man was omnipresent but nowhere to be seen. Whether Hummer Man existed or not was a topic of heated debate on social media as illustrated by postings on Facebook. For instance, one post asserted that Hummer Man “(. . .) does exist “THEY” say the more he gets sucked the richer he becomes & “THEY” said he’s got many cars (. . .)” (Buhle November 7, 2008 at 3:53 am). However, other postings refuted the truth of the rumour; Desmond wrote on November 7, 2008 at 9:19 am “Ag plz [please]..can we get our

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heads out the fuckin gutter!!..this person doesnt [sic] exit [sic], the photo is fake.. (. . .)”. Khumo wrote on November 12, 2008 at 4:30 am “do you know of a victim? people stop being so naive and gullible! just know your self-worth! this is just another ploy for women to stop their thing with sugar daddies/ rich men! respect yourself, that’s it!”. Taken together, rumours of coffin money and Hummer guy / worm-man follow a familiar narrative structure about excessive and individualistic desire. Invoking sentiments about the position of women, and gender relations more generally, these rumours raise the immoral desire women express for commodities, and men’s inability to control their desires (Weiss 1993). Women who pursued wealth risked not only their lives and of others, but their future reproductive potential. While immediately relevant to the AIDS epidemic, this is not a recent trope, but reflects long standing anxieties about young women and the reproduction of the household. In the post-World War Two era villagers faced the problem of dwindling resources required to sustain domestic production and reproduction as restrictions were placed by the apartheid government on land use (see Chap. 2). This especially impacted women who grew increasingly dependent on migrant remittances. Struggling to support their children, young, unmarried and separated women migrated to the towns and cities to seek work as domestic labour in white households. Locally, their actions attracted moral opprobrium. Regarded as “loose women”,5 their desertion threatened the growth of the household. NwaEphraim recalled a popular story that had circulated when she was a young woman in the 1950s. In the story, a young woman left her husband to stay with friends in the mining town Phalaborwa, 140 km north of Bushbuckridge. There she had three lovers, who were employed by the phosphate mines. One day the three men, who knew each other, realised that they were all seeing the same woman. Plotting revenge, they tricked her into meeting in the bush outside of town. Days later her naked body was discovered, with multiple stab wounds, and upon closer inspection, bank notes inserted into her vagina. The policeman who discovered her body remarked that this showed she had sold her vagina. The continuities between rumours such as this, and tales about women in the era of the AIDS epidemic are striking. In times of crisis, women emerged as both victims and as perpetrators in popular stories, mapping a moral field in which their quest for autonomy and survival is portrayed as posing a social threat and a personal risk.

They were labelled “mageligelis”, a play on the word “girl” which is how white employers would refer to Black women, regardless of their age.

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Conclusions

Recently, in South Africa and beyond, renewed attention has been directed toward examining rumours, through the lens of the phenomenon of “fake news” and the so-called “post truth era”. Disseminated through online media, often in response to the claims and counter claims of objective truth, fake news is epitomised by (former US president) Donald Trump. Following Durkheim’s lead, the opposition between “scientific facts” and “social facts”, has assumed special significance in this “post truth era” when public opinion and action are shaped and mobilised by emotional appeals more so than “objective facts” (Ho et al. 2019). AIDS rumours create a version of truth, or a social fact, that becomes popular precisely because of its appeal to enduring sentiments, not because these necessarily displace scientific knowledge. The rumours about intentional infection that spread rapidly in Bushbuckridge and beyond resonated with persistent concerns about social and political changes taking place at local level. Young “beautiful” women and “rich” men infected others, not out of ignorance, carelessness or selfishness, but because they intended to spread a deadly affliction. The story of Hummer man also parallels anxieties about foreign men that were, and continue to be, prevalent in the popular imagination of South Africans. Often identified as Nigerian citizens, the rumour resonates with xenophobic sentiments that perceive “foreigners” as denying South Africans employment and the means to reproduce the family. Because foreign men are believed to acquire wealth with ease but fail to invest in the local economy, foreigners and witches are conceptualised as “morally analogous types of persons—as mysterious, anti-social agents that disable productive and reproductive processes” (Hickel 2014, 108). Rumours about intentional HIV infection conjure imagery associated with occult forces. Like witches, foreigners are seen to be the antithesis of kinship. Despite their immense wealth and power and prestige (Humvees are the ultimate in status vehicles), they are perceived as being sterile, only able to produce worms or maggots. And worms, in the popular imagination, represent HIV. The rumours described here make an obvious connection between pollution beliefs, witchcraft, cannibalism and AIDS. It is as if the rumours have marshalled multiple signifiers to assemble a discourse of AIDS that is linked to local conceptions of danger, risk, and moral transgressions. These themes are pursued further in the next chapter.

References Andreassen, R. (1998). Gossip in Henningsvaer. Etnovoor, XI, 41–56. Bastien, S., Sango, W., Mnyika, K. S., Masatu, M. C., & Klepp, K. I. (2008). Changes in exposure to information, communication and knowledge about AIDS among school children in Northern Tanzania 1992-2005. AIDS Care, 20, 382–387.

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Besnier, N. (1994). The truth and other irrelevant aspects of Nukulaelae gossip. Pacific Studies in Family Planning, 17, 1–39. Butt, L. (2005). “Lipstick girls” and “fallen women”: AIDS and conspiratorial thinking in Papua, Indonesia. Cultural Anthropology, 20, 412–442. Farmer, P. (1992). Aids and accusation: Haiti and the geography of blame. Berkeley, CA: University of California Press. Fordham, G. (2001). Moral panic and the construction of national order. HIV/AIDS risk groups and moral boundaries in the creation of modern Thailand. Critique of Anthropology, 21, 259–316. Geissler, P. W. (2005). “Kachinja are coming!”: Encounters around medical research work in a Kenyan village. Africa, 2, 173–202. Geissler, P. W., & Pool, R. (2006). Editorial: Popular concerns about medical research projects in sub-Saharan Africa—A critical voice in debates about medical research ethics. Tropical Medicine and International Health, 11, 975–982. Hickel, J. (2014). “Xenophobia” in South Africa: Order, chaos, and the moral economy of witchcraft. Cultural Anthropology, 29, 103–127. Ho, K., Cavanaugh, J. R., Greenhouse, C. J., Partis, M., Rouse, C. M., Ortner, S. B., Dick, H. P., Hodges, A., Narotzky, S., & Dent, A. S. (2019). What happened to social facts? American Anthropologist, 121, 160–167. Kroeger, K. A. (2003). AIDS rumors, imaginary enemies, and the body politic in Indonesia. American Ethnologist, 30, 243–257. La-Fontein, J. (1998). Speak of the devil: Tales of satanic abuse in contemporary England. Cambridge: Cambridge University Press. Leclerc-Madlala, S. (1997). Infect one, infect all: Zulu youth response to the AIDS epidemic. Medical Anthropology, 17, 363–380. Matlala, A. (2003). Aids rumours dismissed. Mopani News. https://letabaherald.co.za/ McNeill, F. G. (2015). Immoral accumulation and the human economy of death in Venda. In K. Hart & J. Sharp (Eds.), People, money and power in the economic crisis. Perspectives from the Global South (1st ed., pp. 41–60). New York: Berghahn Books. News24. (2008, September 30). Hummer man, sex worms a myth. News24. https://www.news24. com/news24/hummer-man-sex-worms-a-myth-20080930 Niehaus, I. (2018). AIDS in the shadow of biomedicine: Inside South Africa’s epidemic. London: Zed Books. Niehaus, I., & Jonsson, G. (2005). Dr. Wouter Basson, Americans and wild beasts: Men’s conspiracy theories of HIV/AIDS in the South African Lowveld. Medical Anthropology, 24, 177–206. Piot, C. D. (1993). Secrecy, ambiguity, and the everyday in Kabre culture. American Anthropologist, 95, 353–370. Rosnow, R. (1988). Rumor as communication: A contextualist approach. Journal of Communication, 38, 12–28. Stadler, J. (2003). The young, the rich, and the beautiful: Secrecy, suspicion and discourses of AIDS in the South African lowveld. African Journal of AIDS Research, 2, 127–139. Times of Swaziland. (2008, November 2). To all the young women out there: be warned! Times of Swaziland. http://www.times.co.sz/news/437-to-all-the-young-women-out-there-bewarned. html Turner, P. (1993). I heard it through the grapevine: Rumor in African-American culture. Berkeley, CA: University of California Press. Weiss, B. (1993). Buying her grave: Money, movement and AIDS in North West Tanzania. Africa: Journal of the International African Institute, 63, 19–35. White, L. (2000). Speaking with vampires: Rumour and history in colonial Africa. Berkeley, CA: UCLA Press.

Chapter 5

Revenge and Remembering: Idioms and Accusations of Witchcraft and AIDS

In the midst of the AIDS epidemic, anthropologists observed the potential of the increased prevalence of AIDS-related morbidity and mortality to activate witchcraft beliefs, accusations, sometimes resulting in witch-hunting or purges. Considering witchcraft and AIDS as similar cultural idioms, Reynolds-Whyte (1997) noted that during the 1990s in eastern Uganda, the AIDS epidemic reinforced local perceptions that HIV risk and danger, like witchcraft, were external threats. The invocation of witchcraft as the cause of AIDS in Zambia (Yamba 1997) and Zimbabwe (Rödlach 2006) was regarded as a rational response to illness and death in the absence of effective treatment and a cure for HIV. In these ways, witchcraft offered an attempt to comprehend the aetiology of AIDS in more familiar cultural terms (Behrend 2007; Tenkorang et al. 2011). Witchcraft and biomedical knowledge can be considered not so much as competing belief systems, but as attempts to address different types of questions. Witchcraft beliefs represent a “personified theory of accountability” (Andersson 2002, 432) and blame (Ashforth and Watkins 2015; Niehaus 2018) rather than an attempt to understand the mechanics of disease causation. This is reflected in local or emic distinctions between afflictions sent by witches, and a “natural” AIDS (Mshana et al. 2006), or the incorporation of AIDS-related symptoms into the wider repertoire of witchcraft (Mogensen 1997). Heralded as an “epidemic of witchcraft”, in Soweto township, south of Johannesburg, the symptoms of AIDS-related illness were initially interpreted by residents as poisoning (IsiZulu. isidliso) sent by witches. In the midst of a new epidemic, and as a result of heightened “spiritual insecurity”, Sowetans transformed HIV from a public health threat into an occult attack (Ashforth 2005). While the HIV epidemic was perceived as uncontrollable, by attributing AIDSrelated disease and death to bewitchment, people took steps to protect themselves from occult attack. For example, residents of Soweto fortified their homesteads and their bodies and conducted sacrifices to the ancestors to request their protection (See also Niehaus 2001; Ashforth 2005). Moreover, confessionals heard in Pentecostal

© Springer Nature Switzerland AG 2021 J. Stadler, Public Secrets and Private Sufferings in the South African AIDS Epidemic, Social Aspects of HIV 6, https://doi.org/10.1007/978-3-030-69437-1_5

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and charismatic churches offered absolution to those who practised witchcraft (Badstuebener 2003). In contrast to widely held expectations that occult beliefs would subside in the wake of the modern state and the spread of biomedicine, anthropologists have noted its dramatic rise in many African countries.1 This is often understood against the backdrop of contradictions inherent in global capitalism and neoliberal ideologies that reinforce social difference, result in increased poverty, and exacerbate inequalities based on race and culture (Geschiere 1997; Comaroff and Comaroff 1999; Comaroff and Comaroff 2002). The ascent of Pentecostalism and charismatic churches that profess to heal the sick by waging war against evil has also played a significant role in the growth of the occult (Rio et al. 2017). For instance, during confessionals made by “ex-witches” at Pentecostal churches in Cape Town, young women claimed that they used witchcraft to spread AIDS (Badstuebener 2003). In the midst of an increasing HIV epidemic, the Catholic church in western Uganda promoted beliefs about cannibalistic witches (Behrend 2007, 43). Witch cleansing and witch hunting movements emerged as social and political responses to the collapse of social support, and the increased morbidity and mortality due to AIDS. Yamba (1997) describes a witch finding movement that took place in the early 1990s in Zambia during which 16 individuals were accused and killed for suspected witchcraft, thereby avenging wrongful deaths. Redefining an AIDS death as witchcraft in rural Malawi offered the bereaved a means to redirect their anger towards those deemed responsible in their quest for justice (Ashforth and Watkins 2015). Along the lines suggested by the literature summarised above, this chapter explores the intriguing parallels between AIDS and witchcraft in Bushbuckridge. I begin by arguing that idioms of AIDS and witchcraft share an analogous likeness articulated by moral discourses preoccupied with excessive desire and secrecy. In the context of increasing prevalence of illness and death, AIDS became incorporated into the logic of witchcraft, recast as a “new witchcraft”. Discourses about witchcraft therefore offered a way of reinterpreting AIDS illness and death. This created the possibilities for allocating blame, avenging AIDS deaths and dealing with the powerful emotions that surfaced as people grieved the dead, albeit with often tragic consequences.

The rise in “occult economies” is not limited to the African continent. Occult beliefs and accusations persist in rural France (For example, Favret-Saada 1980), and the UK (La-Fontein 1998).

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My earliest encounters with witchcraft beliefs and accusations in Bushbuckridge date back to the early 1990s. At that time, I observed the participation of young people in mass witch hunts, and argued that their appropriation of the role of witchhunter, normally reserved for elders, signalled a shift in generational power relations (Stadler 1996). During my research, collecting stories of bewitchment from villagers required little prompting, and as I came to learn over the subsequent two decades, witchcraft was part of the everyday in Bushbuckridge. Believing in witches was not a distinct religious dogma, nor particularly exotic, but a way of understanding and dealing with everyday life misfortunes (Evans-Pritchard 1976). This “everydayness” of witchcraft was made apparent by tales of witchcraft that transformed ordinary things into extraordinary phenomena. I was reminded of this when, early one morning, I purchased bread from the village bakery to eat with NwaGomane’s family. When I returned with the loaves, NwaGomane (the household head) asked me where I had acquired the bread so early in the morning. As everyone knew, Musa’s Bakery only started selling freshly baked bread from nine o’ clock. I admitted that the loaves were left-overs from the previous day’s bake but were still soft and good to eat. NwaGomane said nothing but did not serve the bread. Her daughter later told me that they would never eat “yesterday’s bread”. She described how witches were known to enter the bakery at night and transform the loaves to fly around in at night. Witchcraft, it seemed, could render even a humble loaf of “government” or subsidised bread, into an occult object. Spending time hanging out, living in a village, and gradually being incorporated into social and kinship networks meant becoming visible to the world of witches, like an “exposed being” (Thornton 2017), or being “caught up” in witchcraft (Favret-Saada 1980). The healer, NwaEphraim advised me against doing ku tlhavela, the fortification of the body to prevent witchcraft; she feared that by introducing murhi (magical medicine) into my blood I would paradoxically open myself up to the invisible world of the occult. I was frequently warned by my friends not to drive my car in particular neighbourhoods, and to avoid walking specific footpaths. They told me that there were individuals intent on causing me harm, due to my close friendship with their enemies. Late one Sunday night, returning from a muchongolo dance contest, I swerved, narrowly avoiding collision with a cow that had wandered into the dirt track leading onto a bridge. I swore loudly and my passengers laughed nervously. Later one of my passengers told me that the cow was no ordinary beast but had been sent to force me to have an accident. Despite attempts to avoid this, I was not only incorporated into the world of the occult, but also actively engaged in creating it, through talking and writing about witchcraft (see West 2008). Talk about witchcraft was often secretive, owing to fears that knowledge of the secrets, implicated one in occult activities. Through collecting illness narratives and from engaging in the dealings before and after funerals I became familiar with witchcraft logic and beliefs. Typically motivated by the destructive and selfish

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emotions of greed, envy and desire, witchcraft was believed to be inherited from the matriline through breast milk (Junod 1912). However, since the 1960s, and mirroring the economic transformations towards a cash economy, witchcraft was increasingly acquired by purchasing murhi (medicine) from tin’anga (healers). Therefore, anyone had the capacity to practise witchcraft. Witches were believed to cause multiple afflictions through various means. They deployed murhi (magical medicine) in poisoned food and drink or sent small animals such as frogs disguised as food in dreams to choke their victims. They buried murhi on footpaths and in yards, which when stepped on caused mafulara which manifested as an open sore on the leg and if left untreated, resulted in stroke and death (see also Niehaus 2001). Victims of witchcraft wasted away, implicating an invisible force that gradually cannibalized them from the inside. Witchcraft was not restricted to assaults on the body, but also affected mental health and social relations: suicide, conflict and fighting between husbands and wives, and the inability to maintain steady employment were attributed to witchcraft. While causing illness and death, witchcraft also defied the finality of death. Witches were believed to transform their victims into the undead known as xindhachani in XiTsonga or “zombies”. These liminal beings were neither alive nor dead but were fated to remain in this state as slaves of their witch masters who exploited their labour (see Niehaus 2005). In the village where I stayed, a carpenter was rumoured to run his workshop using zombies. Late at night, the sounds of machinery could be heard coming from his shed. Accounts of the undead were woven into commentary about current social economic and political relations. NwaBembe told me about her sister’s grandchild, Alphina Zitah who married a man named Alpheus Ncube, a 30 year old Zimbabwean migrant. The story began with the couple having been married for half a year and, having raised the transport funds, travelled to Zimbabwe to visit Alpheus’ parents. Upon crossing the border into Zimbabwe, Alpheus suddenly disappeared. After searching endlessly for him Alphina eventually tracked down her in-laws in Harare. She asked them if they had seen Alpheus, and to her shock, her in-laws showed her Alpheus’ grave. Their son had died 3 years previously. Returning home to Bushbuckridge, Alphina was surprised to find Alpheus alive, waiting for her. According to NwaBembe, Alpheus had been transformed into a zombie that travelled between Zimbabwe and South Africa. In Zimbabwe he was dead, but in South Africa he lived like a normal person. Alpheus’ tale is an apt metaphor of the dehumanising experiences of Zimbabwean migrants in the highly exploitative South African labour market and of the alienation and separation of men from their families. AIDS and witchcraft also shared similar preoccupations with the dangers of excessive individualistic desire and concealment and secrecy. These preoccupations emerge most tellingly in narratives about witch-familiars and the types of technologies that witches were thought to employ.

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Married to a mfenha2

Thirty-two-years old and still unmarried, Felicia Ngomane, complained that she was unable to have long-lasting intimate relationships with men. Although Felicia had several lovers and had given birth to three healthy children, she had never married. In March 2003, as we sat in Felecia’s mother’s yard where Felecia had her own two roomed house, she told me tearfully: “The others of my age are all married. The girls call them manana [mother]. But me I am still sesi [sister]”. Her social status and the ability to demand respect from women junior to her in age were seriously compromised by her single status. Felicia explained that her predicament was because she was already “married to a mfenha”, which she described as a hairy baboon-like creature. At night when she slept, she could feel it’s hot breath in her ear, and when she awoke, she felt wet between her thighs, as if she had had sex. Her sexual partners were repulsed by the pungent scent of the baboon’s semen and the animal-like odour that emanated from its furry body. Felicia explained that she had inherited the mfenha from her grandmother, who in turn had passed it down to Felicia’s mother, Magreth. Thirty years ago, on Magreth’s wedding day to Ximiresi Mathebula, as was customary, the tishangwana (a group of unmarried women who accompany the new bride to her homestead) helped to build Magreth’s hut. Following Magreth’s mother’s instructions, the tishangwana placed a small twig in a bottle and hid it between the poles and the mud bricks of the hut wall. At night, the twig transformed into the mfenha and had sex with Magreth. This had a disastrous effect on Magreth’s marriage as it caused Ximiresi to lose interest in her. Ximiresi drove trucks in Benoni on the East Rand. But soon his visits home and remittances became less frequent. He married a second wife and built her a new home in Daveyton on the East Rand of Johannesburg. Concerned by his behaviour, Magreth’s mother-in-law consulted a n’anga who revealed the existence of the mfenha. Following the n’anga’s instructions, Magreth rid herself of the mfenha by passing it on to Felicia, by hiding it in her room where she slept. Magreth’s marital circumstances improved. Ximiresi soon retired from his job and returned home to build a new house for Magreth with his retirement funds. However, Felicia’s success in marriage declined. Felicia consulted several healers who diagnosed her problem. A prophet (maprofeta) from the Apostolic St John’s Church instructed her to use candles and burn pages of the Bible with certain passages underlined to cleanse her home and expel the mfenha. However, when Magreth learnt of her daughter’s intentions she chastised Felicia, saying “how can you do that—we are church goers. We don’t use murhi [medicine] here”. Felicia was not surprised at her mother’s reaction and said, “She knew that if the mfenha leaves me it will go back to her”. Witchcraft, inherited

Translated literally as “baboon”, the mfenha bears similarities with the SeSotho tokoloshe. Villagers used the same terms interchangeably.

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in the form of the mfenha, created a crisis in Felicia’s life course, undermining her chances of marriage, independence, and autonomy.

5.1.2

Farius’ nwa’mlambo

Disguised as a snake during the day, at night the nwa’mlambo transforms itself into a white woman, or man, depending on the sexual preferences of its owner, who has sex with it. Dramatic changes in personal fortunes may accompany the ownership of the nwa’mlambo. For example, owners of the nwa’mlambo may acquire commodities such as cars and cash or do extremely well in business. However, in return, the familiar requires the blood of kinspeople and owners resort to sacrificing their closest kin (Niehaus 1995). As a young man, Farius Ndlovu desired a beautiful wife, but was unsuccessful in his proposals to women. After many rejections, Farius came across an advert in the classifieds of Ilanga (a Zulu language newspaper) that guaranteed him success with attractive women. He sent off R100 as the advert requested, and received a parcel containing a small root and instructions for use. When Farius saw a woman he desired he simply had to touch the root and speak to her. Farius was soon married to a beautiful woman who was described as “light in complexion”.3 After being married for some years, one night Farius discovered a huge snake in his bathtub. He ran away, calling out to his wife to beware of the snake. To his surprise his wife emerged from the bathroom. Later, he recounted this event to his uncle who told him his wife was a nwa’mlambo.

5.1.3

Theko Magagule’s munjhonjhela phansi

Older, single men were often suspected of having acquired a munjhonjhela phansi. Villagers compared this to a “remote control” which allowed them to have sex with a woman without direct physical contact. Described as a root that could be secretly manipulated this allowed the user to arouse himself and virtually penetrate any woman he saw and desired. Theko Magagule was an elderly man who had never married. Described by the pejorative label ngwenza or the kindlier a “bachelor”, people claimed Theko was single because he was stingy; he was known to eat an entire chicken on his own. Theko’s appetite for meat, much like his appetite for women, was characterised by a

3 Dark skin, regarded as unattractive, indicated illness or mental disturbances, while a light complexion implied desirability. It was also a marker of relative affluence. While labourers and farm workers became dark from toiling under the hot sun, a lighter skin tone was connected to affluence and education because this indicated they had indoor office jobs.

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lack of reciprocity. He gratified himself sexually without being in a relationship. Theko was accused of using a munjhonjhela phansi to have sex with unsuspecting women at a local shebeen where older men and women met to drink maize beer (xikhapakhapa). After a few jugs of beer, Theko would fall asleep with his hands deep inside his pockets and female patrons at the shebeen complained of a wet sensation in their vaginas. They could see Theko’s hands moving inside his pockets and accused Theko of pretending to sleep while manipulating his munjhonjhela phansi to have remote sex with them. Representing unsanctioned sexual relationships, this form of witchcraft—like sexual assault—was non-consensual.4 Despite the overtly erotic content of these narratives, villagers did not draw a direct link between the sexuality of witchcraft and the spread of HIV. Felicia was not at risk of contracting HIV from the mfenha, nor Farius from the nwa’mlambo, and Theko’s munjhonjhela phansi did not spread HIV. Although witch familiars were dangerous and deadly to their owners and those around them, they were not a source of HIV. Instead, these accounts of witchcraft were concerned with the problem of unrestrained and excessive desire. Witches were completely dominated by their desires: “Witches, like animals (. . .) do not merely succumb to their desires at times, but are completely dominated by their cravings” (Niehaus 2001, 49). Familiars such as the mfenha represent an “animal-like craving for uninhibited sexual expression” (Niehaus 2001, 46). The nwa’mlambo provides sexual gratification, wealth and power to those who acquire it, but is highly destructive because of its excessive and increasing demand for the blood of humans. The nwa’mlambo “objectifies the desire for money in a context of social and economic deprivation, and highlights the destructive social effects brought about by the unrestrained quest for wealth” (Niehaus 2001, 47). While men acquired the nwa’mlambo due to their lust for women, women sought wealth and commodities. The munjhonjhela phansi therefore is symbolic of selfish lust that lacks the reciprocal and procreative exchange of fluids between a man and a woman during sex. These types of witch-familiar interfere directly with intimate sexual relationships, through the medium of magic, and represent the threat that non-reproductive sexuality poses to the integrity of the muti (household). The rumours of intentional HIV spread described in the previous chapter proposed a similar narrative that replaced semen with worms or maggots, and of intimate relationships that led to death. Both idioms of AIDS and witchcraft were implicated in this, and both shared an uneasiness about secrecy and concealment.

4

The munjhonjhela phansi was featured in the national online media service, News 24. “Bushbuckridge -Limpopo women are claiming they're being raped ‘long distance’. The women in Edinburgh village near Bushbuckridge say their attackers are using muti [medicine] called mtshotshaphansi [SeSotho] that allows men to rape the women without being physically present. ‘I don't sleep at night because I keep on feeling as if a man is having sex with me, causing me to reach a climax and I become very tired’, Hleziphi Ngwenya told a public meeting at the kraal of local induna Mngoni Malamule” (Hlatshwayo and Mnisi 2004).

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Suspicions of witchcraft were often based on circumstantial evidence: a baboon or a snake in a person’s yard, incriminating statements, a close relationship with well-known witches and “excessive secrecy” and suspicious behaviour were summoned as evidence to establish the identity of witches (see Niehaus 1997, 255–56). Witches could not be identified by their physical features as they assumed the form of familiars at night but hid as ordinary humans during the day. Witches concealed magical substances to catch unsuspecting victims unawares. They were believed to consume their victims invisibly while asleep, used dreams to send poison, and passed unhindered through walls and underneath doors. In a similar manner, HIV infection was largely an invisible epidemic: undetectable without a blood test and hidden until the symptoms showed. Narratives about witchcraft and of AIDS also highlighted the danger and risk that dwelt outside of the muti (homestead), a space in which social relationships of care and support were nurtured. Villagers diligently fortified their homesteads against occult attack, using murhi composed of household chemicals (such as bleach) and wild herbs. Yet, witches were often intimately connected and were knowledgeable of their intended victims. Appropriately regarded as the inversion of kinship (see Geschiere 2003) witches were often identified as intimate insiders and fellow household members. Accusations and suspicions concentrated on relationships that were ambiguous; for example, between mothers-in-law and their daughters-in-law. Along these lines, narratives about HIV expressed anxieties about the dangers of the world outside “outside” that threatened to penetrate the sanctity of the homestead. Women complained that their husbands had extra marital affairs and infected them by “bringing this disease home”. “You don’t know what he does when he goes out there” commented a young woman. The analogical relationship between witchcraft and AIDS has been observed in other cultural contexts. In Thailand, under the impact of HIV, sex workers have been demonised and are portrayed as the antithesis of “good women” because of their “uncontrolled and rapacious sexuality”. Like witches, Thai sex workers invert normal social behaviours and expectations: they are only seen at night, they appropriate male behaviours (such as drinking), yet they are able to conceal their true identities during the daytime. And, they are accused of undermining the moral and the physical foundations of society by transmitting HIV (Fordham 2001, 295). Discussing witchcraft and sexual relations in New Guinea, Kelly (1976) argues that “Witchcraft and sexual relations occupy analogous structural positions within a larger conceptual system” in which “life and death are complementary and reciprocal aspects of the transmission of life-force”. A person’s life force is contained within a man’s semen, but this is in limited supply. In terms of this conceptualisation, women “who engage in excessive sexual relations” may be accused of witchcraft since they wastefully take the life force of men. Likewise, young men who engage in unsanctioned same-sex intercourse are like witches, because they deplete other men’s life forces (Kelly 1976, 50–51). Kelly notes that “the analogic correspondence between acts of witchcraft and acts of sexual relations connotes a like relation between the characteristics of the (respective) actors” (Kelly 1976, 50). The analogy

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is appropriate because of the distinct symbolic resonance between the two discourses. The shared moral concerns between witchcraft and AIDS were especially highlighted in Pentecostal church sermons. During the early 2000s, Pentecostal churches such as the International Pentecostal Holiness Church (IPHC), an offshoot from the Zion Christian Church (ZCC), made claims to cure AIDS, as well as rid sufferers of demons and possession by witch-familiars. In April 2005, a poster on the walls of the Acornhoek shopping centre announced a forthcoming IPHC revival crusade. The poster declared: “Yes!!! HIV-AIDS Victims healed and 3 of them are here to testify!!!” and “Sick, Demon Possessed, Cripple and trauma deliverance”. Believing in the power of the spoken word to cure any affliction, the IPHC held mass gatherings at which men and women confessed to alcoholism, unfaithfulness, witchcraft and AIDS. According to the IPHC, AIDS, like witchcraft, possessed the body and therefore could be expelled. By confessing their sins, sufferers purged their afflictions. During their annual pilgrimage to Zeurbekom, massive congregations of sufferers were cured of afflictions by “witnessing” (ku fakaza) the confessions of others. A senior member of the IPHC described the AIDS confessions, They say it straight—they don’t beat about the bush. They will say “I went around to the doctors for a blood test—the doctors told me I have AIDS”. They will tell you what happens to your body when you have AIDS. They say your hair becomes soft and you develop pimples. You chuluka [vomit] a lot . . . when she is saying this everyone listens . . . she stands in front and says this for everyone, and they say I am now healed.

So far I have highlighted the ways the AIDS epidemic was experienced and known, as West (2008, 67) put it, “through the sensory organs” of a witchcraft discourse. However, my conversations with residents of Bushbuckridge suggested that few, if anyone thought that AIDS could be sent by witches (See also Niehaus 2018, 60).5 Eighteen-year-old Abednego Mathebula, a member of a village HIV-AIDS committee noted, “AIDS is much more powerful than the witches. There is no way they can send AIDS”. Instead, AIDS constituted “a new witchcraft” as the elderly NwaBembe remarked, “We used to suffer from the witches, but nowadays AIDS is the new witchcraft”. The physical afflictions of the “new witchcraft” struck parallels with what were perceived to be the symptoms of AIDS: the wasting body mirrored witchcraft’s hidden cannibalistic consumption,

5

The Human Sciences Research Council’s (HSRC) National HIV/AIDS Survey in 2002, concluded that only 6% of respondents over 50 years of age and 4% of those aged 15–49 “believed that witchcraft could cause AIDS” (Shisana and Simbayi 2002). A later survey of 150 schools in South Africa reported that 10% of school-goers believed that AIDS could be transmitted through witchcraft, although 35% of reported that they “did not know” (Peltzer and Promtussananon 2005). Finally, a “street intercept survey” of 487 men and women in Cape Town reported that 11% “believed that AIDS is caused by spirits and supernatural forces”, while 21% “were unsure” (Kalichman and Simbayi 2004). Despite the variation in responses and underwhelming evidence, the authors of these studies urged people to distinguish between AIDS and witchcraft.

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while the incurable lesions on the surface of the skin revealed the erosion of the inner body. As a healer, the elderly NwaEphraim had dealt with an increase in cases of what she also referred to as a “new” type of witchcraft. She described the recent emergence of an affliction she called mabandi. Literally translated this meant, “the belt” that manifested as a painful rash that spanned the torso, possibly caused by the herpes zoster virus or shingles, a clinical condition associated with HIV infection. NwaEphraim’s patients showed her a rash that itched and burnt, especially at night, and left the skin covered in angry welts. When she first encountered patients with this condition, NwaEphraim initially thought this was an affliction called ndzilo vu siku (“fire of the night”): “It is like a fire that has burnt you while you sleep...you just wake up with burns on your body like blisters”. But, she remarked, “This is the first time I have ever seen it like this... it is like something walks on you and bites you as it is walking along your body. Then you get xirumbani [pustules]”. Moreover, mabandi was potentially fatal. NwaEphraim acted quickly to treat her patients, as she put it, to prevent the “sores from forming inside the body. . .”. She had seen how “it burns the skin while it burns you inside. While it is eating you outside, it also eats you inside and you lose weight”. When 30-year-old Gloria Mabanda was pregnant with her second born child she showed NwaEphraim the angry welts and sores that encircled her body. Recognising this as mabandi, NwaEphraim smeared petroleum jelly mixed with wood ash on the rash. Ash possesses cooling properties as it has “conquered” fire (Niehaus 2002). NwaEphraim then made incisions between the sores “to cut the belt” to prevent it from spreading. Tragically, Gloria’s new born baby died before it was 6-months-old and Gloria herself died a year later. NwaEphraim believed that mabandi had been brought to South Africa by Mozambicans who had arrived as refugees during the conflict in that country. They were often regarded as possessing powerful murhi. “People from Mozambique used to use murhi [medicine] to capture animals. Now they are using this to kill people”. She conjured a vision of total mayhem in which witchcraft was used to kill for the pleasure of killing, “They are killing people for nothing; they won’t even take your money. They just kill you”. The likeness between the symptoms of HIV and witchcraft, contained the potential for increases in suspicions of bewitchment that could spill over into public accusations of witchcraft and witch-hunts. Indeed, in the 1970s, the mid 1980s and early 1990s mass witch-hunts took place throughout Bushbuckridge (Ritchken 1995; Stadler 1996; Niehaus 2001). Yet, even at the peak of the AIDS epidemic in Bushbuckridge, public accusations of witchcraft did not materialise. However, the failure to achieve public legitimacy did not mean that suspicions of witchcraft had subsided. Instead, witchcraft accusations remained within the private, domestic domains, restricted to intimate relations. It was also within these arenas that retributive justice was often sought, by reconfiguring death as witchcraft.

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Death related to AIDS presented a dilemma for ties of blood: wives, husbands, children and lovers were potentially infected or the source of infection or affected by the shame and stigma associated with HIV. Narratives of death expressed and promoted the desire for justice, founded on the strong emotions surrounding loss, mourning and, memories of the deceased, that prompted questions of who is to blame. The desire for retributive and restorative justice can be regarded as a “central feature of the social impact of AIDS” (Ashforth and Watkins 2015, 247). In Chap. 3, I showed how gossip not only offered evidence for AIDS-related death, but also materialised AIDS, and by so doing excluded and destroyed individual reputations. While gossip often resulted in social exclusion from networks of support, the desire for retribution could have violent and tragic consequences. A young man who unintentionally killed his girlfriend during an argument, was found guilty of manslaughter. His family paid his girlfriend’s parents a monthly instalment of R500 (US$50) while he served his 10 year prison sentence to mitigate against their intention to seek revenge. Acts of violent retribution reminded the guilty of their actions. A schoolgirl died in a horrific car accident while the driver of the car, who was drunk at the time, escaped without a scratch. The young girl’s brothers sought out the driver and slashed his face with a broken bottle, saying that the scars would remind him of what he had done. Occasionally, blame resulted in revenge killings. When Ndhuna Mogakane’s rotting corpse was found in the open bush, villagers speculated that he had been killed by members of the Mnisi family in revenge for the murder of their daughter. As the village ndhuna, Mogakane was expected to intervene in cases of domestic abuse and to offer protection for married women. Weeks prior, a young pregnant woman from the Mnisi family had requested that Mogakane protect her against her husband as she feared for her life. Apparently, Mogakane had disregarded her pleas and chased her away with the words, “This is the way marriage is—so go away”. The next morning, she was found dead lying not far from the cattle dipping station adjacent to Mogakane’s homestead. The Mnisi’s blamed Mogakane for not intervening and failing to save their sister’s life. Violence inspired by revenge was also sought in cases of suspected witchcraft. Joseph Mabundla, a migrant worker, returned from Johannesburg to his home in Bushbuckridge, finding that his wife had been poisoned. Suspecting that his neighbours had used witchcraft to kill his wife, he and his two brothers attacked them with stabbing spears, slaughtering three family members. According to those who recounted these events to me, the desire and acts of revenge were viewed as legitimate. Residents also sought justice by using occult forces. Simon Hlatswayo from Merry Pebble Stream village was 23-years-old when he accidently ran over and killed his neighbour Goodwill Mgiba, a 15-year-old school boy, and tragically, also Simon’s good friend. It was hardly Simon’s fault: Goodwill was drunk and excited to see his friend, ran in front of Simon’s car. Simon apologised to the family and paid

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for the cost of the funeral. However, aware that his life was now in danger, he fled Bushbuckridge to live in Soweto for the next 12 years. Two days after his return to Bushbuckridge, Simon had a car accident and died at the same spot where Goodwill had met his fate years before. It was rumoured that the family had used vengeance magic to cause the accident. Seeking to avenge death through magical means was however a dangerous and risky business. In 1982, 58-year-old Mablom (“Flowers”) Maimela was found hanging by his neck from the wooden beams that supported the tin roof of his two-roomed house. Mablom did not leave a suicide note, and suspecting witchcraft, his mother consulted a n’anga to “sniff” the identity of the witch (ku femba). Mablom’s sisters and his brother were identified as the culprits who had bewitched Mablom causing him to commit suicide. Family members then consulted with Iscariot Macheke, reputedly an extremely powerful healer who had trained as a n’anga in Mozambique. Iscariot asked members of the Maimela family to confess if they were guilty, noting that if they did so he would leave the issue to rest, deeming this to be a family matter. As nobody admitted guilt, Iscariot proceeded. He took seeds from a plant and buried them on top of Mablom’s grave, where the head lay. After some time, a plant began to grow, bore flowers and seed pods. The seeds burst and spread over the grave, forming new plants. At the same time as the first seeds flowered, Mablom’s sister suffered a fatal heart attack. Very soon after, Mablom’s second sister died. Mablom’s mother, realising that this was the result of Iscariot’s magic, approached him and pleaded with him to stop the process. But Iscariot replied that he was powerless. “How can I stop a plant from spreading” he said. When NwaGomane told me this story, I asked her when the dying ended. She looked at me, and said “No Jonatana, it will never stop. It’s like a plant, like this [gesturing to the pumpkin leaves in her small vegetable patch], they go hamba hambana [around and around].6 Even their children, they will die”. This account offers a compelling and terrifying insight into the nature of revenge and the power of memory. Like a spreading plant, vengeance grew and was unstoppable, killing indiscriminately. It is equally compelling as an analogy for the spread of an infectious disease like HIV that travels uncontrollably through networks of intimate relations. While death may recede in time, as an act of witchcraft it can continue to impact on the future. In the light of its power to damage important relationships of care and support, witchcraft explanations for death were not accepted unequivocally, but were often disputed. Witchcraft accusations within the immediate family had the potential to disrupt and sever ties of cooperation and intimacies of care. The complexities and dangers associated with allegations of witchcraft, had serious implications for intimate relations in a context where social and familial relationships were already stretched to breaking point. When in 2003, Sibongile Magagule, a 40 year old married woman was close to death, her niece, Marieke Mathonsi, told me that she suspected that Sibongile was

6

NwaGomane used this same phrase to describe the spread of HIV symptoms (see Chap. 1).

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HIV positive. Marieke spoon fed Sibongile soft porridge and cleaned her for several months and recognised the symptoms of AIDS. After Sibongile died Marieke looked at the death certificate that listed HIV as a secondary cause of death. Sibongile, had suffered for 2 years with tuberculosis (TB), a disease that is often recognised as a co-morbidity amongst people with compromised immune systems due to late stage AIDS. While this was not publicly announced at her funeral, it was clear to most family members and neighbours that Sibongile had died from an AIDS-related illness. However, in the weeks following her death, stories began to circulate that disputed this narrative. In particular, attention was drawn toward a peculiar event that took place the evening before Sibongile’s funeral. Two months before she had died, Sibongile’s husband, a migrant worker from Mozambique, took Sibongile to consult a powerful n’anga in that country. The healer fortified Sibongile’s body by making small incisions on her wrists, at the nape of her neck and below her collar bone. Medicine (murhi) was then rubbed into the incisions (see Chap. 3). As he performed the ritual, the healer stated that if Sibongile died the person responsible for her death would die too. On the evening before Sibongile’s funeral family members drove to the Elite funeral home to bring her body home. Among the mourners was NwaGodi—Sibongile’s aunt (father’s sister). Upon entering the mortuary, NwaGodi started to shake and shiver so severely that she was unable to proceed. As the funeral procession travelled with the body to begin the night vigil, NwaGodi, still shaking and feverish, went to her house to collect a blanket. This was the last time she was seen alive. Later that evening, NwaGodi’s grandchildren discovered her sprawled on the ground a few metres from the outside toilet. She was pronounced dead on arrival at the hospital. After Sibongile’s funeral, the family members discussed the implications of the events that had transpired. They recalled Sibongile’s visit to the healer in Mozambique and the words that he had spoken. Several family members changed their initial suspicions that Sibongile’s death had been caused by AIDS. The sudden and surprising death of NwaGodi provided evidence of witchcraft. Mama Lindiwe— Sibongile’s younger sister—claimed that NwaMaGodi had sent a disease similar to AIDS to kill Sibongile. Other relatives speculated further that Sibongile had AIDS but had also been bewitched. They suggested that NwaMaGodi, seeing that Sibongile was ill with AIDS, had taken advantage of this, hoping that her witchcraft would go undetected. Sibongile’s death and its reinterpretation as witchcraft reveals the fluidity of meanings and interpretations that could be summoned simultaneously.

5.2.1

The Easter Weekend Deaths

The long Easter Weekend provides an opportunity for family members to gather together and socialise at home, to relax, and do repairs around the house and do ceremony. The marula (nkanyi) berries ripen and beer (vukanyi) is brewed and shared amongst neighbours. Tombstones are laid and unveiled, ancestral rituals (ku mhamba) are conducted, men pay bride wealth (ndzhovola) and celebrate.

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Table 5.1 Deaths in the Mzimba family (1998–2008)

Year 1998 1999 2001 2001 2002 2003 2003 2004 2006 2008

Age, gender 32, Female 38, Male 37, Female 45, Male 48, Male 65, Female 39, Female 43, Male 35, Female 4, Male

Symptoms Menstrual bleeding Diarrhoea and vomiting Headache Not disclosed Vomiting blood Vomiting blood Vomiting blood Vomiting blood Typhoid High fever and convulsions

Thousands of members of the Zion Christian Church (ZCC) members make the annual pilgrimage to the holy site of Moria in the Limpopo Province, and members of the International Pentecostal Holiness Church (IPHC) go to Zuurbekom on the West Rand of Johannesburg to attend services. It is a time of intense spirituality and sociability, but also of tension within families. Family members, who have not seen each other for some time meet, discuss and exchange gossip. Old rivalries, jealousies and antagonisms often resurface. For the Mzimba family, the Easter vacation had become a time of mourning and bitter memory. The family consisted of two houses belonging to the first and second wives of BavaMzimba, who died many years earlier from lung cancer. Shortly after the creation of the Gazankulu Bantustans in the late 1970s, the large polygynous household had split up due to ongoing conflict between Mzimba’s co-wives. These tensions were also played out between step-siblings. When they were young, the step-siblings would bicker over food and attention from their father. The two co-wives shared visits to BavaMzimba on the East Rand where he worked for Sappi, the largest supplier and grower for the South African paper industry. After he died, the wives shared the funds from Sappi’s corporate pension plan. This continued to add to the rivalry between the two women. For many years, deaths had occurred almost on a regular basis around the Easter Weekend. Even when a death did not occur, tombstones were unveiled, or a widow was being released from mourning. The period was associated with loss and remembering the dead. Based on my interviews with family members between 2005 and 2008, I recorded ten deaths that had taken place over 10 years, from 1998 to 2008 (see Table 5.1). Each of these deaths occurred in the months of March and April. All but one (which was caused by typhoid) of the ten deaths was attributed to witchcraft. Vamia Mzimba, the first wife, a frail woman in her 60s, was strongly suspected as the main culprit. These suspicions were made known indirectly on several occasions. For example, during a funeral at another household, an 18-yearold boy wielding an axe shouted at Vamia “you and my mother killed my father, so you had better go before I kill you”. Vamia was suspected to be in league with the boy’s mother who was also suspected of witchcraft.

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Other suspicious events were cited as evidence of Vamia’s involvement in witchcraft. The Mzimba homestead was situated next to a small dam and Vamia owned ducks and geese that bathed there. Her neighbours recalled mysterious events surrounding the dam. Once, a fisherman attempted to use a pump to draw water out of the dam to catch the fish that would be left stranded in the mud. As he was busy setting up his equipment, he noticed a small tin of snuff (sniffing tobacco) floating in the water. When he leant over to pick it up, he saw an old white man with a long grey beard, suspended in the water where the snuff had been. The fisherman ran away, calling to the people in the neighbourhood to beware. It was rumoured that the old man was Vamia’s nwa’mlambo in human form. Further evidence supported suspicions that Vamia was the owner of a nwa’mlambo. Several years previously, Vamia supplemented the household income by selling second-hand clothes on market days in Bushbuckridge. She acquired the clothes by trading them for flower pots and figurines with white residents in the towns on the East Rand. Her husband worked in Springs, and whenever she visited him, she would purchase stock from a warehouse in town. Vamia walked house to house in the white neighbourhoods offering to swop her wares for second-hand clothing. She then sold the clothes in Bushbuckridge during informal markets held at old age pension pay out sites. Prior to the mass importation of low-cost Chinese made clothes in South Africa, there was huge demand for used clothing. Many women the same age as Vamia supported their grandchildren in similar ways, purchasing used clothing in bulk from the ports in Durban and even as far as Maputo, for resale in the villages. However, Vamia’s business did not go well. Whites on the East Rand were not interested in her ceramic goods and often gave her damaged and well-worn clothing in exchange. In desperation, Vamia consulted with a n’anga to improve her business. This was not uncommon practice; body parts and magical substances were often used by entrepreneurs to improve their prospects at business. The n’anga gave Vamia a small root and guaranteed that this would attract customers to buy her clothes and persuade the whites to give her their best items. When she first acquired the nwa’mlambo she fed it chicken blood. After some time, its appetite grew and she slaughtered goats, and later cattle. By the mid-1990s the nwa’mlambo would only be satisfied with human blood. At about this time members of the family started to die under what was described as unusual circumstances. The death that concerns us here is that of her first-born son, Robert. The 38 year old was married and had four children and worked for an Italian bakery in Johannesburg. About 3 years before he died, Robert experienced a series of mysterious afflictions. Whenever he tried to have sex with his wife his penis would shrink into his scrotum. If he did manage to penetrate his wife, he would immediately have diarrhoea. His wife speculated that Robert had a former secret lover (xigangu) who wanted to win him back and had bewitched him to stop him having sex with her to destroy his marriage. Then in 2003, Robert became seriously ill. The first symptom was an irritating rash all over his body that erupted into watery sores. Later he complained of fatigue and chronic diarrhoea. Early in 2005, plagued by various afflictions, Robert unable to work, lost his job. Returning home Robert collapsed and

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was taken to his home in Bushbuckridge, close to death. On the day he arrived, his older brother hastily hired a car and started off for the hospital in Acornhoek. Tragically, Robert died before arriving at hospital. The funeral was held the following Saturday. The night after the funeral, when only family members remained, Robert’s mother was observed singing and dancing in the funeral tent. Her co-wife asked her, “Why do you laugh and sing and dance”, to which she replied, “I am so happy. . .I have been given what I had asked for”. This statement was taken as an admission of Vamia’s intention to kill Robert. Family members recalled that tensions between mother and son had been developing since Robert purchased a plot of land and started construction of a house in Thulamahashe, a township, a few kilometres away from where he lived with his mother and siblings. His mother was highly opposed to the move as this would mean that she no longer had any right to demand his support. The residents of Thulamahashe were regarded as having pretentions as suburbanites. Unlike the villages, most houses were financed by bank loans and were surrounded by high walls. Mother and son had argued long and bitterly. Recollecting the problems between Robert and his wife, family members speculated that Vamia intended to force the couple to break up so that she could control him. With this knowledge in mind it was clear to everyone who saw her dancing and singing that Vamia was celebrating her victory over her son. That same night, Robert’s first-born daughter, Memory calmly and openly accused her grandmother of killing Robert. She said “I don’t understand why it is that every Easter we have to bury someone, or we are wearing mourning clothes. I still want to ask that question to my grandmother”. The old woman’s oldest step-son also stated: “I am tired of burying my brothers and sisters every year; it is always at Easter. I am going to buy a gun and kill the whole bloody family—all of them. If this doesn’t stop”. However, death continued to occur over the next year and a half. Not more than 6 months later, Memory’s 4-year old son died. According to witnesses, Vamia was at home when her grandson was in hospital. Referring to her grandson she was heard asking “is he already dead?”. Memory was informed what her mother had said and wielding a short, thick piece of firewood, beat Vamia unconscious. Twelve months later, Robert’s widow died. At this point, the extended family agreed that they were facing a crisis and needed to take action. Putting together funds, the siblings and step-siblings travelled to Komatipoort on the Mozambique border to consult a n’anga. Here they conducted ku femba—a ritual to “smell out” the witch responsible for the deaths. During the ritual, the n’anga “sniffed” Vamia and, acting as her medium, confessed to causing the deaths of several family members. In the months that followed, Vamia appeared to suffer a stroke. Describing her mother’s condition, Memory said she “acts as if she is mad”. Ironically, Memory was tasked with taking care of the now feeble, incontinent and powerless woman. The Easter Weekend Deaths demonstrate how disease and death, which would with exception of one or two cases, be attributed clinically to HIV, were refigured through witchcraft beliefs as the outcome of an older woman’s greed and maliciousness. While this may have provided a means to comprehend the sheer burden of

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death, it had tragic consequences for the future of the family, breaking up intimate relationships of care and support. The accusations that were directed toward Vamia were not solely founded on AIDS morbidity and mortality. The long history of animosity between co-wives, rivalries between step-siblings, the dissolution of the large extended household, and the death of the main breadwinner formed fault lines along which suspicions of witchcraft flowed. This highlights the inherent power that memories of past injustices and wrong-doing have on the present.

5.3

Conclusions

Witchcraft beliefs and accusations made the attribution of blame a possibility, socializing untimely and meaningless AIDS deaths. Witchcraft opened-up the finality of death and rejected closure, making it possible for people to seek justice and to reassess the character of the dead. Through witchcraft moral personhood became an open-ended question, flexible and potentially remade, rather than fixed as a biomedical certainty that cast shame and stigma toward the deceased and those with whom they shared ties of blood (see Klaits 2005). Witchcraft had significant implications for the meaning of death, threatening its stability by reopening the wounds that grief had created. By framing AIDS as witchcraft, narratives of death opened up possibilities for a person’s life to be re-examined and remade. While AIDS-related illness and death were concealed and secretive, witchcraft made it possible to remake a life by reconstructing death. In this respect, witchcraft beliefs and accusations reimagined the past, and by so doing restored social relations. Yet at the same time, retribution came at a cost to relations of care and support, potentially disrupting supportive networks at times when these were most critical for survival. Attributing death through narratives of witchcraft had implications for intimate relations, in the same way AIDS did. Casting AIDS as witchcraft had implications for the way in which the dead are remembered and the ability to control grief. Remembering the circumstances of death, and dwelling on this was harmful, not only to oneself, but to others that are connected to you. “Thinking too much” needed to be avoided as this could lead to redirecting the pain of loss towards others, leading to acts of revenge through the violence of witchcraft. Like the metaphor of a plant that spreads its roots, grieving and remembering was an uncontrollable force that spread destruction. Despite the pervasiveness of beliefs in witchcraft coupled with the rise in mortality, and the desire to avenge death, witchcraft accusations did not emerge in the public sphere. The political dynamics of the early to mid 2000s were unlike the political conditions that set the stage for mass witch hunts in the early 1990s that saw youthful “comrades” claiming political legitimacy as witch-hunters (Niehaus 2001). Instead, witchcraft suspicions and accusations remained within the micro-politics of intra-household relations, and vengeance was sought in the invisible realm of the supernatural.

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Chapter 6

Hope and Loss: Illness Narratives from the Margins

Excessive desire, as I argued in the previous chapters, is often experienced as a destructive force that threatens to erode bonds of kinship and good neighbourliness and stimulates envy and hatred—the sorts of emotions usually associated with witchcraft. At the height of the HIV epidemic in Bushbuckridge, dangerous and disordered desire figured large in narratives of the intentional spread of HIV, of death and dying, and suspicions of witchcraft and AIDS. Although such ideas dominated local narratives about HIV transmission, illness and death, villagers countered this by citing private acts of care and of love for family members and intimate others. Recognising the dangers of suspicion and the destructive forces that were wrought by negative feelings, people placed emphasis on giving support, and expressed the innate power of hope to heal the body and relationships. Distinct from the dangers of desire, if not its opposite, hope and hopefulness were visible in everyday life, enacted through caring for others. Hope, villagers in Bushbuckridge seemed to imply, was a moral category of action that is productive and constitutive of personhood, approximating to what Al-Mohammed (2010, 434) writes of as “strugglingwith”, and underscoring that “life is possible only through and with other beings”. The intention of this chapter is to explore hope as a conceptual framing for understanding experiences of the AIDS epidemic, at a time in the mid 2000s when the promise of Antiretroviral Therapy (ART) was imminent but still unavailable to the majority of those infected by HIV. Drawing on my personal experiences of accompanying a young man and his wife, both of whom were living with HIV, I focus on their quest for healing, and the strategies they employed while waiting for the much anticipated lifesaving medicine. Like many thousands of other South Africans, Philemon and Pretty Mlambo were caught up in a zone of waiting, hoping for an end to their suffering. Their journey traversed the city landscape of Johannesburg, from hospital to clinic, and from a life they had established in the city, back to rural Bushbuckridge in their quest to find support, compassion and care. Hope produced meaning, even in their final days, and continued to shape the trajectories of their lives.

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Hope is often seen as distinct from desire; while the latter embodies the sort of aggressive consumerism associated with modern individualism, the former suggests a more passive disposition (Crapanzano 2003, 5). Crapanzano (2003, 6) writes, “Desire presupposes human agency” and “. . . one acts on desire”, whereas hope depends on “some other agency for its fulfilment”. Hope in this respect assumes the form of passive waiting. For instance, Crapanzano (1985) argues that while facing an uncertain future during the political turmoil of the 1980s, white South Africans sought refuge in waiting. An apparently similar passive acquiescence is displayed by South African youth who, in the absence of opportunity and employment, find themselves suspended between childhood and adulthood perpetually in the state of “waithood”, unable to proceed forward (Honwana 2012). The ambiguity of waiting produces, what Haas (2017, 76) calls, a sense of “existential limbo”. Although waiting suggests passivity and fatalism, this view obscures the more strategic engagement that waiting entails. In his analysis of South Africans’ daily struggle for the provision of municipal services, Mujere (2020, 66) argues that residents of informal settlements “craft strategies of engaging the authorities and structures that impose the waiting”, thereby demonstrating agency. Waiting in this respect is an active intervention. Similarly, although caught in a liminal betwixt and between existence, people living with HIV and AIDS engage in an active search for meaning and certainty. In this way, hope is a “practice” in the construction of life despite abject suffering (Haas 2017, 91). Articulated through visions of an imagined future and shaped by present day conduct, hope has the effect of creating “narrative time”. Within narrative time the present takes on new meaning; actions taken now— even simply waiting—fashion future possibilities. In this respect, hope “is an opening [up] of time: an opening that holds a distant horizon of impressionable possibilities” (Antelius 2007, 325). Hope is a temporal reimagining (Mattingly 2010), the production of an alternative future to that of everyday suffering. Through actions taken in the present, links are made between the present and the future, transforming that future (Antelius 2007). Hope, medical anthropologists argue, is a resource employed by medical practitioners and patients alike that envisages the possibility of healing; “. . . If one has enough hope, one may will a change in the course of the illness. Hope may then promote healing, which gives rise to a therapeutic value of hope” (Antelius 2007, 325). For people to survive illness requires what Miyazaki (2004) refers to as a “temporal reorientation” towards a future without suffering. DelVecchio-Good writes, “those who suffer serious illness become particularly susceptible to hope engendered by the cultural power of the medical imagination” (DelVecchio-Good 2001, 397). The discursive power of hope is evident from the impressive growth of experimental clinical research on HIV prevention and treatment and the vast sums this attracts from donors as well as the enthusiastic participation of ordinary people in medical trials that test new drugs (Saethre and Stadler 2017) and the ways new biotechnologies are conceptualised (Mattingly 2010; Pollock 2019). This huge investment in a “political economy” of hope (DelVecchio-Good et al. 1990) is evident in global discourses of the “end to AIDS”, as biotechnological salvation.

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Seen this way, medicine not only represents the reinvigoration of life, but also comes to define identities and citizenship (Nguyen 2005; Winchester et al. 2017). The meaning of a positive HIV diagnosis has shifted from a death sentence to one of hope and salvation in the form of pharmaceuticals that promise to replace suffering with a new life (Robins 2006). The AIDS epidemic has undergone a significant transformation from hopelessness to one pregnant with hope. It is through such hopeful and optimistic narratives that life with HIV is rendered meaningful and through which futures are envisaged (Ezzy 2000). Significantly, however, the biomedical definition of life, has come to define citizenship, as Jean Comaroff observes, “rebirth through AIDS is expressed in standardised narratives of selftransformation, a passage to new-found certainty and transparency and an end to deception, secrecy and untruth” (Comaroff 2007, 27–28). Hope is however extremely precarious, contingent upon access to biotechnologies and systems of support. Medical subjects often face invisibility in institutions of care, and struggle to claim citizenship within these spaces. Moreover, by definition, hope entails despair; it is, Mattingly (2010, 3) writes “on intimate terms with despair. It asks for more than life promises. It is poised for disappointment”. Hope is also a burden that places stress on the ill and family and medical staff (Mattingly 2010, 22). In Bushbuckridge, despite the vagaries of life and abject suffering, I often encountered hope in everyday interactions and in life narratives. People made an effort to render life and death meaningful and bearable. Whether performed by attending funerals, brewing and sharing nkanyi (marula) beer, giving one’s labour to build houses or plough fields, or caring for the sick, these actions were performances of the ethics of everyday life. I was especially struck by the efforts made by kin, neighbours and colleagues to attend funerals. Despite multiple burials occurring on the same day, villagers attended these gatherings, sometimes travelling vast distances to do so. Being present at a funeral showed love and commitment to others. Non-attendance attracted moral opprobrium, as it implied at best a lack of care and more sinisterly implicated culpability in the death, raising the spectre of witchcraft. As a researcher, my personal attendance at funerals was seen to express the truth of my intentions to engage in peoples’ lives and understand their predicaments. Hope was also performed through and gave meaning to the more mundane everyday activities and gestures. Older women farmed small plots of “secret fields” to sustain their kin, they sold clothing, vegetables, and vet koek (donuts) at street markets to pay for their children and grandchildren’s school and university fees, uniforms and clothing, lunches and transport money. Selling a few bags of tomatoes, she grew in her small backyard garden, the elderly NwaMakatshwa raised funds to buy two loaves of bread everyday so that her grandchildren could eat bread and tea for breakfast before school. This labour was performed anticipating that through it the children would have a “better life”. “School is important. They will support me when I am old”, she remarked. The same sentiments were expressed by NwaGomane who raised funds to pay for university fees for her two daughters by buying and selling second-hand clothes purchased in Mozambique, smuggled across the border and resold at pension days. Although residents expressed a fear of infection from the

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ill and dying bodies of HIV positive family members, they cleaned and fed the ill, stood in queues in hospitals, sought out healers, and pursued miraculous cures. In this chapter, I want to explore the concept of hope as a form of active investment in the future, as a category of experience, and its role in creating meaning. My research in Bushbuckridge, conducted at the cusp of the provision of ART, was a time of hopeful anticipation. Announcements were made in the national press toward the end of 2003 of the impending availability of ART in public health facilities. By April 2004, “rollout” had started, coinciding with the national elections that month. However, distribution was limited to a few sites, and it was only by 2009 once Jacob Zuma was president that voluntary counselling and testing and countrywide distribution of ART began (Niehaus 2014). In June 2006, 178,635 patients were being treated with antiretroviral drugs in the South-African health care facilities, while the estimated need, according to UNAIDS projections, was at least double this. Further delays in the provision of ART were experienced with hospitals struggling to gain accreditation to distribute the drugs (Geffen 2010, 70–71). Tragically, people like Philemon and Pretty were caught up in this moment, a temporal “zone of waiting” (Mujere 2020), in their quest for “social and therapeutic support and (. . .) social recognition” (Le Marcis 2004, 454). Their account is one of searching out sites of compassion and care, moving from the city to the village, and from hospital to healer. My personal engagement with Pretty and Philemon was structured by the hope we shared that some miraculous cure for HIV could be found or that the drugs they desperately needed would be given to them. However, the hope the three of us actively nurtured during the year that I was with the young couple, was fragile. Over the period that I spent with Pretty and Philemon, and as they became steadily sicker, our collective and shared hope acquired an immediacy, its horizon no longer in the distant future but expressed in weeks, days and hours. The trajectory of our hope was extremely unstable, ever shifting from one day to the next as we encountered opportunities for healing, met with disappointment and rejection.

6.1

Pretty and Philemon

I first met Philemon and his wife Pretty in Johannesburg in May 2004. Nelisiwe, Pretty’s sister called me late one night in Johannesburg telling me that Pretty was “sick” and asked me to help because, as she put it, I “know this disease”. I knew Nelisiwe from Bushbuckridge but had never met her sister or brother-in-law. Pretty and Philemon had moved away from Bushbuckridge several years previously to live in Tsakani, an informal settlement located on the outskirts of Brakfontein, a bleak industrial area on Johannesburg’s East Rand. Here, Philemon had built a house from prefabricated walls (known colloquially as “stop nonsense” because it kept thieves out) fashioning a single room under a tin roof. He lived with Pretty and Shane, their twelve year-old son. On the phone Nelisiwe said she was worried about Pretty. At this point, I was not aware of the repeated attempts that Pretty and Philemon had

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made to seek care over the past few months. Nelisiwe’s voice broke as she implored me to help and I agreed to visit the next day, not relishing the long drive east. Despite it being an autumn day, Philemon and Pretty’s three-roomed house was hot and stuffy. The bedroom was divided by a display cabinet featuring a large television and music system. On one side of the room, Pretty lay shrunken under heavy blankets on a double bed. Nelisiwe told me she had been this way for a few weeks, refusing to eat solid food, preferring porridge with the consistency of baby food which Nelisiwe spoon-fed to her. Philemon was slightly better off, but he was extremely gaunt and walked with obvious pain, favouring the tips of his toes. I noticed he was sockless and the skin on his ankles was grey, pressed up against formal black shoes as he tentatively took one step after the other. Later, Pretty’s grandmother compared Philemon’s walk to a duck; “pata, pata, pata” she said, mimicking the flapping of webbed feet. Neither Philemon nor Pretty spoke, while Nelisiwe softly explained their predicament. Two evenings previously Pretty had “almost died”. Nelisiwe had called for an ambulance to take Pretty to a hospital, but when they arrived the paramedics refused to take her. “They said she [Pretty] was still walking and did not have anything that needs an ambulance”. Philemon argued with the ambulance driver but was powerless to persuade him otherwise. I learned later that Pretty had been diagnosed with HIV in 2002 following her second pregnancy. The baby, whom Pretty would not identify by name, lived for only a few months, and then died from an unknown respiratory illness. Although Pretty must have been aware that Philemon too was HIV positive, she did not tell him, nor did she inform him of the cause of their baby’s death. Philemon first fell ill in 2001. He was weak, had a severe cough, and chest pains. A private physician diagnosed Philemon with pulmonary tuberculosis (TB) and promptly referred him to the Far East Rand Hospital. Here, fluid was drained from Philemon’s lungs—he showed me the scars on his chest. He remained there as an outpatient for eight months, continuing to take the TB treatment disbursed by a local clinic. But his recovery took a long time and it was almost 18 months before he was well enough to return to work in 2003. However, even then he often became ill and would take off one week in every four. In November 2003, Philemon suffered a stroke and was medically discharged by his employer. Therefore, when I first encountered Philemon and Pretty, they had already battled through illness, the devastation of the death of their second child, unemployment due to sickness and repeated and often unsupportive medical encounters. I appeared in their narrative in the midst of their protracted quest for care, summoned by Nelisiwe as their last source of hope. I envisaged my involvement as an ethical engagement, something that South African anthropologists have advocated for (Spiegel 2005), and some have grappled with (Niehaus 2012), exposing the suffering under apartheid and the AIDS epidemic (for example, Bond 1997). But I also entered into this role with some disquiet. At the time I asked my wife whether she thought I was taking advantage of Philemon and Pretty’s circumstances as a research opportunity, fully aware that there was actually very little I could do to assist the couple. In their reflexive essay on interacting with “dope fiends” in San Francisco’s Bay area,

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Charles Pearson and Phillippe Bourgois (1995), describe the desperation, despair and hopelessness of their efforts to alleviate the suffering of heroin addicts. In the article, Bourgois berates Pearson for trying to save lives as meaningless and representing liberal sentimentalities born from a saviour complex. The messy emotional encounters between the two researchers and the addicts are honest reflections on the intimacies of anthropological engagement and the tensions between activist, anthropologist and interlocutor. My role, as perceived by Philemon and Pretty, as well as other family members was to act as a broker or an intermediary between their world of pain and suffering, and the often hostile and usually alienating world of biomedicine. As a white man and a university employee, I was seen to possess the skills required to navigate the hospital bureaucracy that so often rendered Philemon and Pretty invisible. In this respect, I represented hope.1 Everyday encounters underscored this positionality. I was asked to hold someone’s baby: the child’s father said he would tell his child when they were grown up that they were once held by a white person. One Sunday, looking to buy beer, I went to a village tavern, and was greeted by the patrons as “the New South Africa”. Hopefulness was the Zeitgeist of the “new” South Africa, in an era still glowing from the optimism of Nelson Mandela. Billboards and posters from the 2004 African National Congress (ANC) party’s election campaign promised “A better life for all”. However, this hopeful anticipation was steadily undermined by the AIDS epidemic, unemployment, crime, and racism. One day after our initial meeting, I took Pretty and Philemon to Johannesburg General Hospital and after negotiating the complex colour coded zones we reached the very busy AIDS clinic. The matron in charge of the clinic dismissed us without even having seen Pretty or Philemon. She told us to follow the correct procedure of consulting first at a primary health care clinic in the area where Pretty and Philemon reside. Since 1994, South African health care has followed a decentralised system, focused on primary (clinic or health centre) care. This system, that promotes social preventive medicine, was resuscitated in the early 1990s to democratise the South Africa health care (Phillips 2014). For Philemon and Pretty, the system created a barrier to accessing care. Le Marcis and Grard (2015, 162) have described the state of care in a South African tertiary hospital, where almost half of all patients admitted were HIV positive as follows: in a situation where doctors have as yet had little experience with AIDS and in which the medicines are still not very accessible, a patient’s HIV positive status frequently leads to

1 In my encounters with residents of Bushbuckridge I was often reminded that whites are regarded as physically weak and unable to do manual labour or even clean up after themselves. Black labour is regarded as essential for whites to cope with the demands of running a household or a business. Yet, whites are perceived to have skills in dealing with bureaucracies that usually prevent Black people from accessing resources. These attitudes are revealed in stories about white peoples’ command over technology. For example, whites were portrayed as masterful in accessing cash from automatic bank tellers, as someone once remarked, “with us Blacks it [the ATM] always says ‘no funds available’”.

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discouragement on the part of staff: either they feel their personal engagement is pointless, or, weary of the dreary routine treatment of opportunist infections, they allow their interest to flag.

The care workers in charge of the AIDS clinic at the Johannesburg General Hospital that we encountered that day were likewise numb to the suffering of people like Philemon and Pretty. Exhausted from trudging up and down the long hallways of the hospital, the three of us decided to meet up the next day at the Chris Hani-Baragwaneth Hospital in Soweto. With 3000 beds, this is the largest specialist hospital in the southern hemisphere, and internationally renowned for its pioneering work (Horwitz 2013). Having worked on the hospital campus for several years with a university research centre I imagined my credentials would prove useful in negotiating our entry. The Lilian Ngoyi Health Centre—named after one of the first women to occupy a senior leadership position in the ANC—is located within the sprawling grounds of the hospital. Offering HIV testing and counselling, the clinic was a key treatment site for the population of Soweto. The next day, ignoring the security guard’s attempts to stop us at the entrance to the hospital, we arrived at the clinic, finding it almost empty as the clinic staff were in a meeting in the boardroom. After waiting some time, a senior clinician emerged from the meeting to talk to us. At first, she repeated the same instructions that had been given to us at the Johannesburg General Hospital—we needed to first consult at a primary health care clinic and then we would be referred to Lillian Ngoyi. Barely concealing her irritation, she chastised Philemon for using “a white man” (me) to gain access to the clinic. To me she said, “many whites bring their garden boys [gardeners] here and I tell them the same thing”. This shattered any idea I had that my status might have influence. Indeed, my presence was obviously more of a hindrance. Philemon looked at me and shrugged, whispering “let’s just go”. However, after some haggling and pleading, a junior nurse opened a file for Pretty and Philemon and they were soon being examined by the same clinician who had rebuked us earlier. Rapid HIV tests were conducted, and the results were discussed while I waited outside. Later Philemon said that the clinician told them that Pretty was the possible source of the infection because she was at far more advanced stage of disease than he was. Pretty shrugged and said nothing. The clinician took me aside and asked me if I was aware that Philemon had been using “muthi” (herbal medicine) and also speculated that his slightly healthier condition could be due to this. Philemon and Pretty were told to return to collect their CD4 count results and were prescribed some vitamin pills. I drove the couple back to Tsakane. Both were happy to return home; armed with pharmacy bags of pills, this was a positive outcome. In our minds the diagnostic procedures and the medicines embodied a way to proceed forward toward treatment. Despite the hostility displayed by the clinic staff, we noted the kindness of the junior nurse who had attended to Philemon and Pretty. We congratulated ourselves for overcoming the barriers of geographical citizenship imposed by the health system, and strategized ways to access health facilities by producing fake credentials. Although I kept in touch with Philemon and Pretty on the phone for a few months, I did not see them again until later that year when I arrived in Bushbuckridge for the

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December vacation. Making the decision to return home to their village, they had settled in with Pretty’s aunt, Sylvia, in her three-roomed house in Thulamahashe. When it became apparent that the couples’ health was not improving, they moved again to Pretty’s grandmother’s house in a nearby village where there was more room. Family members, notably Sylvia and Philemon’s mother’s brother (malume), were concerned about their health and encouraged Philemon and Pretty to consult traditional healers. Later when I asked Philemon about this, he expressed his cynicism. “Healers don’t help—they just take your money” he complained, noting that he still owed money to several healers for their services. When a faith healer bathed him in chicken’s blood, Philemon doubted that it had any effect and took the chicken carcass home; “I paid for the chicken, so I took it to eat. Why should he [the healer] have my chicken?”. A n’anga claimed that Pretty had bewitched Philemon which he regarded as a ludicrous and simply the healer’s attempt to “make me afraid and get more money”. Philemon’s distrust and suspicion that healers were “only interested in money” extended to allopathic medical providers. Philemon had also consulted with a private physician on the East Rand, who diagnosed him with HIV and offered to sell him ARVs for “more than 1000 [South African Rands] per month”. “I couldn’t afford this—you have to take the pills every day and at the same time, otherwise you die”. In total, Philemon detailed consultations with 15 different healers over the duration of his illness. The list below summarises the symptoms that he presented with and the sorts of treatment offered. Symptoms Paralysis resulting from stroke Burning sensation in foot Pustules on head General weakness Coughing, night sweats, weakness, weight loss (Ndzaka) Ndzaka (as above) Ndzaka (as above) General weakness Gonorrhoea Fainted at work HIV General weakness, psoriasis on feet and legs, head sores General weakness, coughing, diarrhoea, loss of appetite, headache

Diagnosis, healer and treatment N’anga divination prescribed liquid medicine N’anga rubbed foot with soil Herbalist rubbed snuff and Vaseline mixture N’anga divination N’anga diagnosed ndzaka caused by having sex with Pretty after their child died. Prescribed muthi to drink and to inhale. N’anga recommended Philemon conduct ku mhamba (ancestor ritual) to ask for protection Apostolic faith healer bathed Philemon in chicken blood Faith healer prayed for Philemon and laid hands on his body. Private physician treated Philemon Taken to private physician and revived. Lilian Ngoyi clinic, Soweto. Antibiotics, vitamins, HIV test and CD 4 count Purchased creams from a local pharmacy ZCC healer potion consisting of FG tea (strong tea), trekker coffee (chicory blend), olive oil, raw garlic, brake fluid) sold in a ten-litre bucket to be taken by the spoonful every hour.

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One evening in December 2004, I received another phone call from Nelisiwe who had heard that I was in Bushbuckridge. She invited me to visit Pretty and Philemon. Once again, the couple seemed very ill and were desperately seeking assistance. The vitamins and antibiotics they had received from Lilian Ngoyi clinic had long run out. I suggested that we seek help at Tintswalo. A former mission run hospital, Tintswalo had recently opened an AIDS clinic, sponsored through a US PEPFAR grant, and was offering qualifying patients ARVs. Intending to get them into the treatment programme I volunteered to take them there. Arriving early in the morning at Tintswalo Hospital on Christmas eve, the queues at the out patients department were discouragingly long. Pretty, Philemon and I made our way to the newly renovated Rixile AIDS clinic, only to find it was closed until after New Year. The sister on duty at Rixile explained that she was only providing HIV voluntary counselling and testing. Although she has had no clients, many people like us, came seeking medication refills. And, like us they were also turned away. She eventually closed the clinic growing tired of sending people away without helping them and suggested that we return to the outpatient department to seek assistance from a consultant who was running a hypertension and diabetes clinic. But when we arrived there, we found that the doctor had closed the clinic and had been replaced by a dentist. At the hospital pharmacy we were told to return to the outpatient department to get a new file for Philemon and Pretty. At the outpatient department, the desk nurse looked at us and turned to her colleagues, exclaiming “u lava wena” (“what do they want?”). I often heard this phrase used to reprimand a nagging child. I asked if they would dispense Pretty and Philemon’s prescriptions. The nurses insisted that the only way was for us to wait for the department to open a new file. I was worried as Pretty was tired and Philemon’s feet were hurting. It was cool outside, but the clinic was stuffy and sweaty. An old man was wheeled in. A young woman limped in on crutches. A victim of a car accident was brought in on a stretcher. We tried politely to jump the queue, begging the other patients to let Philemon and Pretty in. A woman complained saying that she was sick too and needed to see a doctor. It seemed like the doctors were hiding in their cubicles, avoiding the patients. I noticed a poster on the wall depicting a baby with a swollen belly indicating pellagra or kwashiorkor. Someone had drawn a speech bubble coming from the baby saying, “Feed me” to which someone else had added “Help—I have AIDS”. Defacing this shocking image created a distance between people and the horror of disease and death. Outside the clinic I chatted to a senior administrative clerk who remembered me from the time when I worked for an NGO based at the hospital. I commented on the beautification of the hospital: pot plants, water features and ornate concrete benches were set up on the grounds presumably for patients and visitors. He told me that in the previous financial year the hospital had insufficient funds to rebuild the decrepit paediatric ward, but they did not want to report an under-spend to the provincial government. So, the hospital administration reallocated the budget to purchase lawn furniture and decorative sculptures. He also pointed to the new ornate wall clock for the nurses’ station at the outpatient department. My old friend told me that it was important for the hospital to look like a place where “healing happens”. Thinking

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about the queues of desperate patients, I wondered if he saw the irony in this. I was struck by how forms, files and computer databases—the technologies of hospital bureaucracy—had rendered my two friends invisible and beyond help. Experiences of neglect, abuse and distancing are echoed in academic writings on the structural and everyday forms of violence in health care facilities (Wood and Jewkes 2006; Le Marcis and Grard 2015). Structured in such a way as to constrain individual agency, patients are shuffled from place to place, and confronted by bureaucratic hurdles to accessing care. In his ethnography of AIDS treatment amongst the poor in Brazil, Biehl writes, “bureaucratic procedures, informational difficulties, sheer medical neglect and moral contempt, and unresolved disputes over diagnostic criteria all mediate how these people are turned into absent things” (2004, 119). He suggests that the medical and state bureaucracy surrounding AIDS treatment can be seen as “technologies of invisibility”. This represents the failure of an ‘everyday ethics’ that creates “a paradoxical situation in which Health personnel are in fact organizing the banishment of those about to die” (Le Marcis and Grard 2015, 173). In January 2005, following our previously failed attempt, Pretty and Philemon enrolled as outpatients at the Tintswalo Hospital AIDS Clinic. Here, hardworking and dedicated physicians and nurses managed the distribution of ARVs. Requiring a fixed address, a CD4 count of 250 or less, and classified as treatment literate, patients were admitted for treatment, and treated for tuberculosis and other opportunistic infections. Doctor Scheepers,2 a young Afrikaans-speaking physician, examined the young couple and told me that she suspected that Pretty had contracted a rare type of pulmonary TB but that the diagnosis and treatment were not easily available and prohibitively expensive. Taking me aside she remarked, “You know, Jonathan. . .if this was a first world clinic situation like in Germany, she would be put on ARVs and TB medication and steroids and we would save her. As it is, there is very little we can do for her. I don’t think she is going to make it”. I was surprised that she shared this confidential information with me, someone who was not even related to Pretty. However, as a white person, and as a fellow professional, it seemed the norm to divulge the most intimate details about patients. Philemon was told nothing of his wife’s condition by the doctor. The next time I visited Pretty and Philemon I found that their condition had improved slightly. Before arriving, I had contacted a medical colleague to ask for a recommendation for drugs to ease Pretty’s pain. She said that if I could get my hands on morphine, the most “humane thing” to do would be to allow her to overdose. However, when I arrived at the house, Philemon and Pretty were eating and seemed

2

Dr. Scheepers resigned soon after and emigrated to work in rural Canada. Staff turnover at Tintswalo hospital is high, owing to difficult working conditions and mismanagement. In 2013, staff picketed at Tintswalo to demand the reinstatement of Dr. Hichem Ben Azzouz as head of the HIV/AIDS unit. The clinic manager at the hospital had reassigned Azzouz to the outpatient’s department, leaving the unit without a medical officer. Azzouz was part of a contingent of Tunisian doctors who had come to South Africa due to the scarcity of medical officers, especially in rural hospitals.

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to be well looked after. Sylvia had purchased a potion from a Zion Christian Church (ZCC)3 priest (mufundise). The concoction dispensed in five litre buckets of recycled achaar containers4 cost 300ZAR (USD30) and contained a mixture of FG tea,5 Trekker Coffee (instant chicory), olive oil, garlic, ginger and motorcar brake fluid. The tea and coffee are brands prescribed by the ZCC and renowned for their emetic effects. The addition of olive oil, ginger and garlic harkens to the widely-publicised assertions that these ingredients were immune boosters, a claim made by Manto Tshabalala-Msimang, the former South African health minister. Sylvia had purchased the mixture from a teacher at a local high school. But, she complained, the teacher had sold it to her for R500 instead of the R300 that it cost to buy directly from the mufundise. “He [the priest] does not want to make a profit from peoples’ sickness”, she remarked. The mufundise sold the potion to recoup the cost of its manufacture as his aim was to simply alleviate peoples’ suffering. Philemon, Pretty and others, including a local policeman, a doctor and several teachers at the local high school had experienced the miraculous healing power of the mixture. Several villagers visited the house where Philemon and Pretty were staying to see the evidence of the efficacy of the ZCC mixture, arriving late at night so that others would not know they were seeking a cure for AIDS. When they saw the improvements in Pretty and Philemon, they were encouraged to try the medicine themselves. Philemon told me he had heard of others who had been healed by the ZCC medicine. A young pregnant woman had been diagnosed with HIV, and when her baby was born, she was told that the infant was HIV positive too. Later, after taking the mixture, both she and her baby tested negative for HIV. These tales of miraculous cures circulated through the village, inspiring hope. Philemon and Pretty finished an entire bucket of the medicine in one week. Predictably foul tasting, they claimed it gave them appetite and energy. Philemon said, “It goes to the wounds in my chest and patches these”, referring to the idea that HIV causes sores and lesions on the inside of the body. Philemon and I walked the 500 metres from the homestead to the riverbank, something he was unable to do previously. Pretty sat up in bed for the first time in weeks and even came outside to greet me, smiling and uncharacteristically chatty. Although I was doubtful of the efficacy of the medicine, I too felt hopeful, almost convinced that somehow the ZCC priest had stumbled upon a remedy. However, the benefits were short-lived. A few

3 The ZCC, founded in 1924 by Ernest Lekganyane, is an African Independent Church that has its headquarters in Moria in Limpopo Province. Its membership is estimated at almost four million, and attracts followers from all over southern Africa. The church offers divination through the holy spirit and healing using commercially available products such as coffee, tea, and brown or whole grain maize porridge. 4 Achar is a popular spicy fruit relish or chutney eaten with meat. Many residents purchase bulk spices and oils to make pickled mangos in large quantities and then sell the achar in smaller quantities. 5 FG Tea is a particular brand used by ZCC mufundise to treat illnesses, especially those associated with reproductive health. It is a strong emetic.

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days later Sylvia reported that Philemon and Pretty had been plagued by diarrhoea and vomiting and had lost their appetites. A week later I was awoken by a phone call from Sylvia. Pretty was seriously dehydrated and had been unable to hold down solids or fluids for two days, possibly due to the medicine she had consumed. I drove to her home and picked her up to take her to Tintswalo. Arriving at the hospital at midnight, apart from a handful of nurses, the only doctor on duty was a young community service doctor.6 She pinched the skin on Pretty’s arm noting the clinical signs of severe dehydration. Scolding me for bringing Pretty in at such a late hour, she told me it was a waste of time to put Pretty on a saline drip. “You could have given her Energade [sports drink]”. A little ashamed that I had not thought of that, I pointed out that Pretty was unable to hold anything down. Eventually agreeing to admit Pretty, she was placed on an intravenous drip and her progress monitored for the remainder of the night. As we departed, the young doctor pointed at Philemon and to me said, “You see he is also sick?”. Pretty died at the end of January 2005, and Philemon three months later. Neither of them had received the treatment they so desperately needed. Although she had no control over her illness and how it impacted her everyday life, by the time she died, Pretty appeared to have finally achieved control over her death which seemed planned and predictable. On the morning she passed away, Pretty woke up before anyone else and assembled her sister, grandmother and aunties and led them in hymn. Later, Pretty’s grandmother told me that this was Pretty’s way of saying goodbye to her family, “because she knew she would not be returning”. I arrived soon after this intimate family gathering to take Pretty and her husband to Tintswalo for their scheduled clinic visit. The journey over the bumpy roads was extremely painful for Pretty who lay sprawled on the back seat of my car. She was so thin the veins had atrophied leaving dark bruises on her almost translucent skin. On the way to the hospital she asked for mageu (a maize based drink) and we stopped at the Spar grocery store in Acornhoek. Seeing Pretty drink the beverage made Philemon and I feel that she was somehow becoming well again. But when we entered the hospital grounds she groaned, breathing rapidly and begged me to take her home, saying that she could not go back to hospital again. After dropping Philemon at the AIDS clinic, Doctor Scheepers met me in the car park outside. She took one look at Pretty, and exclaimed, “Jonathan she is going, she is going” and urged me to get her to the emergency department. I drove fast, braking hard at the entrance, opened the car doors and lifted Pretty up, but I was already too late. As her eyes rolled back in her head, she let out a few last gasps struggling to breath and died in my arms. Shaken, I lay her on the back seat. Curious onlookers cast frightened glances at me and after peering in the window looked away hastily. I covered the body with a blanket and waited. This had all taken place so suddenly and without Philemon’s knowledge. After her body was taken into the hospital on a

6

Since 1998, South African trained medical students are required to complete one year of community service in terms of the 1997 Health Professions Amendment Act. Graduates are often placed in rural, under-resourced hospitals.

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stretcher, I called Sylvia who contacted the mortuary to make arrangements. Sylvia told me to take Philemon home, but to tell him nothing of his wife’s death. In the car on the way home I lied about Pretty, telling Philemon that she had been admitted for further treatment, but in our collective silence I realised that he knew. Upon arrival at Pretty’s grandmother’s house, family members had already assembled and to my dismay I was called upon to explain what had happened at the hospital. Ushered inside Pretty’s bedroom, I stood in front of the large group assembled there and had barely opened my mouth to say the words “I am sorry to tell you . . .” when I was silenced by the outpouring of grief. Pretty’s sisters and aunts screeched and cried, beating their fists against their heads, hurling themselves on the cement floor of Pretty’s room, tearing at their hair and clothing. Philemon sat and sobbed holding his son Shane in his arms rocking back and forth. I sat numb, unable to move or express anything. This lasted for what seemed like ages although it was probably only a few minutes and was followed by absolute calm. Pretty’s sister was pregnant and had injured herself by throwing herself on the floor and required immediate attention. The older women set to brewing tea and sending the children out for loaves of bread and bottles of cold drink. Telephone calls were made to close relatives in the area to arrange to meet the hearse that would be transporting the body to the mortuary. I was soon outside sharing a cigarette and having a light-hearted chat with Pretty’s uncle. The calm and efficiency with which people dealt with the immediate practical needs of organizing a funeral was a dramatic contrast with the chaos and disorder I had witnessed only moments previously. Like Pretty herself, although her family was powerless to manage her illness, they acted with decisiveness in managing her death. Pretty’s funeral took place the following Saturday. In her coffin, Pretty lay dressed in a fluffy and padded pink dressing gown, her head covered with a beanie. Nelisiwe and I had purchased the clothes at a store in Acornhoek. As Nelisiwe said, she wanted her sister to look “beautiful” for the funeral, and for people to show her respect. Philemon died three months after Pretty. Soon after the funeral he had left Bushbuckridge for his home in Tsakane on the East Rand. I heard that he had a girlfriend who was a volunteer HIV care worker who looked after him in his final days.

6.2

Home Is Where Hope Lives

Home, and especially the rural homestead, occupies a special place in the South African imagination, frequently idealised as a space that nurtures relationships between kin and community. For residents of Bushbuckridge, home was envisaged as the locus of traditional life, in contrast to the alienating city that consumed rather than nurtured the person. The city was “hot” and “fast” unlike the peace and “coolness” of the countryside. Migrants looked toward the rural homestead as a place to retire to, even after spending many years away. Going home is also a

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strategy for realigning one’s relationships with the living and deceased kin. Annual rituals called ku mhamba are conducted regularly by families to confer the protection of the ancestors against misfortune and illness. These rituals are key to bringing together widely dispersed family members. Returning home is also a strategy for healing when faced by adversity and illness (See for example, Wickström 2014). Going home reassembles relationships between the living as well as with the dead which have been eroded and are required to reform personhood. The journey that Philemon and Pretty took home therefore had special significance. For Pretty, it signalled returning to a place where she belonged, and gaining the support of her kin. Her grandmother was a central figure in this; since her parents had died when she was still young, the elderly woman had cared for Pretty and Nelisiwe. Her mother’s brother also figured prominently in supporting her, as had his wife, Sylvia. Yet, for Philemon the circumstances of his return were dramatically different. For him, the journey back home represented a failure to succeed in realising his dreams of establishing himself in the city, as a man independent of his rural kin. Philemon envisaged his life as being with Pretty away from his extended family. He spoke with obvious pride of his home in Tsakane where he had established himself, the luxury German sedan car that he owned, and the furnishings in his house. While the rural homestead represented hope for Pretty, for Philemon it signified a return to the dangers and hostilities he had faced from his kin. Philemon’s family were originally farm workers who lived on white owned farming land and paid rent to farm and reside. Philemon’s mother grew up in the Kasteel farming area of Bushbuckridge in the 1950s, and married Boet Mnisi, a resident of a farm in the Klaserie area. As rent tenants, the Mnisi’s were forcefully evicted from the farm which had been proclaimed as a reserve for wildlife conservation in the late 1960s. Their forced removal from the land, similar to thousands of others, found them in the Native Trust which later formed the “homelands” of Gazankulu and Lebowa. Lacking historical ties with which to forge relationships with other families, the family struggled for years to adjust to life there. Tiring of the endless struggle to survive, Philemon’s mother left her husband and took her children to live with her brother. Her husband was subsequently imprisoned for rape. As she was still married into the Mnisi family, Philemon’s mother was granted permission by the tribal authorities to acquire a place to build a home in her husband’s name. While initially her brother looked after her family, as a single parent, Philemon’s mother sought the work of desperate women as an unskilled labourer harvesting oranges on the Kiepersol citrus estate. Temporarily residing in the farm barracks, it was there that she met Philemon’s father and where Philemon was born in 1972. Philemon’s father took Philemon and his wife to live with him in the single room farm workers’ barracks at Kiepersol. Philemon’s step-sisters and brothers remained at their mother’s home in the village, supported by their uncle. Living and working conditions were harsh on Kiepersol farm, as they were on most of the farms in the area. Philemon was not sure what wages were like at the time; more recent reports of monthly wages on Kiepersol are between R400 (USD40) and R600 (USD60) per month (Kriger 2007). Philemon recalls spending

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his adolescence learning how to speak Afrikaans and to drive a tractor; these were skills that were vital for his later employment. In the early 1980s, Philemon’s mother and father left the farm and returned to live in the village. At the time Philemon’s mother was enthusiastic about relocating. For her, the recently created Bantustans represented new opportunities for Shangaan speakers. The new “border schools” as they were known catered for the large numbers of Shangaan families who would otherwise have faced possible discrimination in the adjacent Lebowa “homeland”. The move to back to the village also united Philemon with his three stepsiblings. However, when Philemon’s mother died of cancer in 1985, the stepchildren confronted Philemon’s father and demanded that he vacate the family home. They claimed the homestead for the Mnisi family and argued that he had no right to live there with them. Philemon felt aggrieved at how his siblings treated his father. Escalating tensions between him and his step-siblings led Philemon away from Bushbuckridge to seek work in the East Rand town of Brakpan. Now, a young man in his twenties, Philemon’s knowledge of Afrikaans and experience of working on tractors gave him an advantage. Regarded as good with machinery and able to communicate with white employers, he found work as an apprentice boilermaker. After a year he was earning a wage as an independent contractor for several firms. Philemon first met Pretty at home in the village when she was visiting a neighbour. He fell in love with her and boasted to his friends that he would marry her. “I asked her to marry me and she agreed because she said she didn’t want to play around anymore. It was very important to complete the lobola [bride wealth] payments because if you don’t then you get shit from your in laws if your wife dies”. The “shit” Philemon refers to is the customary rule (milawu) that bridewealth payments must be completed before the bride’s family will allow her to be buried. Bridewealth is seldom if ever fully paid up; often out of reach for most young men, the full cash amount is paid in instalments (Stadler 1993). As a result, marriage is often not finalised. Philemon, like I, had heard accounts of bodies that were left waiting in mortuaries while the widowers desperately tried to gather the funds to complete bridewealth. The couple moved to Tsakane on the East Rand and celebrated their marriage with a party. Only Pretty’s kinsfolk attended the wedding; the absence of Philemon’s family symbolising Philemon’s complete detachment and alienation from them. Like many migrants, Philemon also built a homestead in his home village, yet his investment in Tsakane stood in stark contrast to the pitiful two-roomed structure he erected at “home”. Pretty and Philemon were able to exist independently of their respective families. His son, Shane, attended a decent school. He borrowed money from the bank to purchase a second-hand Audi and Pretty learned to drive it. They bought furniture, a television and a music system, a fridge and a stove. Pretty’s sister and her mother’s sister (Sylvia) were their only link to home. Pretty’s father was unknown to her and her mother had died when she was still young. Striving for an existence independent of the tenuous relationships with their kin, Pretty and Philemon saw the city as offering an opportunity to establish a new life. His animosity with his step-siblings and Pretty’s orphaned status gave little reason to remain in the rural village. Yet, their hopeful vision of a future in the city was

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interrupted and transformed by illness. For Philemon, falling ill eroded this vision of the future, destroying his hopes.

6.2.1

Philemon’s Loss of Heart

Philemon asserted that throughout most of his illness he was unaware that he was HIV positive. He speculated, “the doctors were too scared to tell me I had HIV”. Although he was aware that he was ill, he reasoned that inhaling dust from the grindstone he used at work had caused his “chest problem”. His co-workers told him that the dust caused TB. Nonetheless he had a niggling worry that he might have HIV, a thought that distressed him so much that it affected his health. When I think too much about this disease, I can get heartsick. This is what caused the stroke. I feel pain, I cannot breathe, I feel hot, and I sweat. I was so worried, and I never told anyone. I think maybe I have got AIDS and I worry. If you don’t know then nobody can help you. If you don’t explain, then they can’t help you. It is good if the doctor says you have this, and you must take that [treatment]. I would worry but I never thought of killing myself. I prayed to God and thanked Him for making me better. I also worried when my wife was sick, and I prayed that she would be better. I was suspecting that she had HIV

Here, Philemon invokes an ethnoaetiology of “heart sickness”, an idiom of distress that arises from “thinking too much” (See Kaiser et al. 2015). While this is described in the biomedical literature as the equivalent of a non-psychotic illness (Patel et al. 1995) anthropologists often regard it as the embodiment of distress and stress (Rebhun 1994). “Heart sickness” (vu vabye bya mbilu) was caused by excessive worrying about relationships, money and illness such as HIV. Also interpreted as “high blood” caused by “stress” the affliction requires seeking solace in quiet spaces away from the noise of everyday life problems. Those who have heart sickness “have lost hope” (ku ka u’nga tsembi); the “heart is sore” (mbilu ya vava). They may succumb to “death from heart” (ku fa hi mbilu). Initially too afraid to tell his wife of his affliction, Philemon opened up to Nelisiwe: I had heard of HIV—in fact, I thought maybe this is HIV. But when the doctors told me I was shocked, and I cried for a little while. Then I told Nelisiwe [his sister in law] and she said that many people at home have this disease. I told her to tell Pretty. I was really scared to tell her. But, she [Pretty] was not angry when she found out. She just asked me ‘why didn’t you tell me before? Don’t worry you must go to work again. You are still a man. Other people also have this disease. You must forget about it. You will get heartsick again if you worry too much. We have always heard about this on the radio and now it is happening to us as well. You must behave like a person who has not got the disease—otherwise it will simply get worse’. She never blamed me. I never blamed her.

Taking care to avoid the potential for conflict and blame, despite their awareness of the implications of their diagnoses, the young couple attempted to resume life as normal. Yet, they must have heard the malicious gossip circulating at the time which

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suggested that Pretty had been infected by strange men who were reportedly seen accompanying her in Philemon’s car. Up until Pretty’s death, Philemon lived with her family in Bushbuckridge. He had little money and Pretty’s family supported and cared for him as best they were able. After Pretty’s funeral, Philemon moved out of the main house into an outside room. When I asked, Sylvia told me that Philemon did not feel that living in the house was justified. A week later, following the funeral, and after the ritual cleansing ceremony Philemon moved back to his house in Tsakane. I understood Philemon’s desire to leave Bushbuckridge. His illness meant that he could no longer maintain his independence and he faced a major dilemma: to return home to his stepsiblings or live with his in-laws. Relationships between in-laws are structurally fraught with tension and governed by strict rules (milawu) of respect. Living in the same space as in-laws would mean that Philemon was placed in an ambiguous position, especially as Pretty was no longer alive. At the same time his relationship with his step-siblings were not amicable, coloured by their expulsion of Philemon’s father many years previously. Philemon also harboured strong suspicions that his step-siblings were waiting for him to die so that they might inherit his car, the house in Tsakane, and its contents. They were also aware that Philemon had received severance pay from his employers. These suspicions were confirmed by a reoccurring dream in which Philemon’s stepsister visited him in hospital and offered him food to eat. In the dream, he cried out asking her why she wanted to poison him.7 Resolute that his stepsiblings would not acquire any of his accumulated possessions, Philemon had previously transported his furniture, television, video machine, beds and couches to Sylvia’s house. Even though the bank had long repossessed his car, he pretended that it was being repaired to make his stepsiblings, as he put it, “think they will get my beautiful car when I die”. Philemon was open about his resentment towards them: When I was sick they ran away, they wanted my car. They are saying ‘I want this car when he dies’ but not one of them helped me. Not once! My sisters only want to see whether I am dead because they want my car and they want my house.

After he moved, I lost contact with Philemon. According to Sylvia, the day before Philemon died his older brother visited him in hospital and demanded Philemon’s bankcard and ATM pin code. The brother withdrew the balance of Philemon’s severance pay and according to Sylvia, shared the money amongst his brothers and sisters who feasted on meat and beer for the entire week.

7 Offerings of food in dreams often signify witchcraft; the food transforms into a frog or similar animal and becomes stuck in the throat and chokes the victim leading to death.

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Conclusions

This account of life and death reveals what Klaits refers to as the relationality of sentiments, “A person’s care, love, scorn, and jealousy all influence the physical well-being of others by communicating the quality of his or her ‘heart’” (Klaits 2010, 5). Philemon’s suffering was marked by his feeling of abandonment by his kin, and utter hopelessness in the face of his predicament. Philemon’s loss of heart and loss of hope can also be seen as the erosion of his identity as a man. Losing his home, his position as income earner, and his wife, Philemon was stripped of his status. Eventually, Philemon died from heartsickness, of the pain caused by others that resulted in “thinking too much” about his personal situation, and ultimately of HIV. “Scorn and jealousy”, Klaits notes, “reduces people to material want, makes them sick, diminishes their capacity to care for their children, and eventually kills them” (Klaits 2010, 6). In the analysis presented in this chapter, desire and the actions taken to fulfil desires eroded relations of care and compassion. However, as Philemon and Pretty discovered, despite the hostile environment of the medical institution, hopefulness can be found in the small acts of individual health care workers who show compassion toward the ill. Hope could also be seen by the acts of Pretty’s extended family who opened up their homes to their ill and dying son-inlaw.

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Chapter 7

Death and Dying: Narrating the End of Life

Writing about the AIDS epidemic faces the challenge of making abject lives visible and meaningful. This is especially important at a time when statistical categories and numerical indicators are used as the main means of knowing, drowning out individual experiences and narratives. This over-reliance on “big data” misleads and undermine efforts to understand local worlds (See for example Erikson 2018). As I argued earlier in this book, the kinds of categories employed for statistical measurements have the power to “convert complicated contextually variable phenomena into unambiguous, clear, and impersonal measures” (Merry 2011, S 84). Human hope and human suffering are recast as objective facts that can be measured or enumerated (Kleinman et al. 1997; See also Adams 2016). While metrics may convey certainty and objectivity, they also conceal relations of power, and the individual histories that underly suffering. I suggested that the celebratory narrative of the “end to AIDS” and the technologies employed in the “90–90-90” testing, treatment, and viral suppression campaign, contain this power to invisibilize suffering. Paradoxically, the eradication of the virus from the corporeal body successfully obscures historical continuities in structural inequalities that have shaped and continue to shape vulnerabilities to illness and death. Anthropologists have responded to these issues by developing accounts that reveal the “texture” of afflictions through which large-scale social forces that shape individual experiences may be grasped (Farmer 2009). In this regard, writing about suffering is not just empathetic description. In trying to capture the individual experience of illness and dying, I am mindful that sympathetic prose is not in itself an adequate response (Farmer 1999). It is critical to move beyond this to demonstrate how broader social processes and events are “translated into personal distress and disease”, and how macro processes such as racism and poverty “become embodied as individual experience” (Farmer 2005, 30). In this respect, I join Rylko-Bauer (2003, 21) in asking what structures “allow suffering, oppression and genocide, great privation and profound inequalities to continue, seemingly unabated?” (Cited in Waterston and Rylko-Bauer 2006, 409). Exploring these questions brings to the fore the cultural construction of suffering as a “collective mode of experience that shapes © Springer Nature Switzerland AG 2021 J. Stadler, Public Secrets and Private Sufferings in the South African AIDS Epidemic, Social Aspects of HIV 6, https://doi.org/10.1007/978-3-030-69437-1_7

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individual perceptions and expressions. These are visible patterns of how to undergo troubles, and they are taught and learned, sometimes openly, often indirectly”. Suffering is therefore shaped and reshaped “by the distinctive cultural meanings of time and place” (Kleinman and Kleinman 1997, 2). Research and writing about the suffering of the weak and terminally ill also questions assumptions about the meaning of experience, particularly for people who are unable to vocalize their feelings, emotions and thoughts. Desjarlais (1996, 71) points out that for those who just “struggle along” in life, there is an “absence of some of the distinguishing features of experience—reflexive interiority, hermeneutical depth, narrative flow”, thereby problematizing the assumed universality of experience. Writing about the pain of others is also elusive. Documenting the sexual violence and abuse of women during the Partition in India, Das observes, “the languages of pain through which social sciences could gaze at, touch, or become textual bodies on which this pain is written. . .” are often elusive (Das 1997, 67). This chapter pursues these themes with an in-depth exploration into the narration of suffering by relating an account of a single man’s life told to me at the end of his life. Along with historians and anthropologists, I suggest that the biography offers a unique vantage point from which to record the immediacies of suffering. Life histories reveal the embodiment of a collective history, as the “objective condition” that is the outcome of the “inscription of . . . social structures” in the life of a person. Individual histories of illness and suffering may also shed insight into the subjective experience through “which the course of events is reinterpreted from the perspective of the vanquished” (Fassin et al. 2008, 227).

7.1

Narrating a Life at the End

Khayellhle Mhlanga was a man in his late 40s who I visited over a period of almost 18 months, between 2003 and 2005. I usually joined Khayellhle, and occasionally his mother, on their front veranda, shaded by a leafy creeper at their home in Bushbuckridge. As Khayellhle narrated his life story we snacked on sugar cane and mealie cobs from MaMhlanga’s garden. Often joining me in these meetings was my then six-year-old daughter, who spent her time playing on the floor and enjoying the sugar cane. I have chosen to write about Khayellhle because of the intriguing and detailed manner in which he presented his biography. Very early on in our conversations, he described his increasingly sick and weak body as having been taken over by a “machine” (he used the English word). Capturing his feelings of corporeal and social alienation Khayellhle repeatedly spoke about having “a machine inside me that controls me”, evoking an analogy of his affliction as an impersonal, alien force. The metaphor of the machine revealed his gradual inability to exercise agency which he articulated as the absence of control over his body, that manifested itself in his loss of appetite and failure to digest certain foods. His body seemed to rebel against him: eating filled his belly but resulted in severe diarrhoea and vomiting immediately

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after. His inability to control his digestive system distressed him, being a sign that he was no longer in control over the most basic of bodily functions, as he put it, “I’m like a baby again”. However, the machine metaphor had wider relevance. The image of the machine also stood for his struggles to manage his intimate and social relationships and his declining status as the senior man (wanuna ntiyela) in his mother’s household. Viewed through the lens of his life history, it becomes evident that the machine represents the loss of personhood and humanity. As an apt metaphor of disembodiment, alienation and structural violence, Khayellhle’s poignant representation draws attention not only to his illness experience, but also to his life history, to a time that predated his illness. His biography is a tale of both hope and disappointment, from his early upbringing and throughout adulthood to the point at which he succumbed to AIDS-related illness. Although he refers to the “machine” as the embodiment of illness, it became clear that the point at which he lost control over his body, began early in his life. The machine assumed different guises throughout his life: as a young boy and growing up the “machine” manifested itself as the structures of kinship, suspicions of witchcraft, and marital failure. As a young man, the machine was the city that consumed him through impersonal casual sexual relationships and violent assault that he was subjected to by township thugs. Charged with manslaughter and imprisoned, the machine was the prison gang he was coerced into joining. Upon his release from prison, the machine represented his struggle to find work and support a new family, and his numerous failed relationships. For Khayellhle, HIV and AIDS eventually manifested itself in the figure of an abusive and exploitative woman who, he claimed, infected him with HIV. The machine then became his internal and all-consuming desire for revenge, that drove his uncontrollable rage and anger. Finally, the machine was the illness that rendered his body weak and disempowered. Viewed over the totality of his life course, the metaphor of the machine was extremely apt in framing his loss of agency and lack of autonomy. The machine represents a force of which HIV is emblematic; Khayellhle’s infection and his illness is a symptom of the “machine” that has always controlled him. It represents the structural forces that gave shape to his biography and that rendered him victim to violence. The narrative that Khayellhle presents, offers, as Frankenberg suggests, a phenomenological account of a “mindful body” that spans the gap between “lived experience and social analysis” (Frankenberg 1988, 327) through his choice of metaphor. My relationship with Khayellhle is central to the narration of his life story and the account of his infection and illness. Through telling his story, Khayellhle endeavoured to make sense of the chaos and disruption caused by his affliction that had overwhelmed him. Our first meeting was initiated by his mother, MaMhlanga, who had asked for my help in applying for a disability grant for her son. In 2004, antiretrovirals were not yet fully available in state health centres in Bushbuckridge. However, disability grants were being awarded to those who qualified. People who tested positive for HIV and whose CD4 counts were below 150 cc could apply for a welfare grant as they were deemed unable to work. Reviewed on a

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six-monthly basis, grants were notoriously difficult to obtain, and cruelly removed once a person’s health improved, again calibrated by CD4 counts. Through my connections at Tintswalo Hospital and the social work officer stationed there, MaMhlanga’s application was eventually granted, sadly only one month before Khayellhle died. When I met Khayellhle Mhlanga he was 46 years old. He appeared strong and wiry from a life of physical labour and the time he had spent in prison. However, his face betrayed the severity of his illness. His cheekbones were gaunt, his cheeks were bruised, his lips were pink with fresh scar tissue, and he wore a woollen hat to hide his thinning, downy hair. During our first meeting, MaMhlanga, did most of the talking while Khayellhle coughed, occasionally nodding his approval. He seemed physically drained and I was hesitant to direct questions at him because even talking seemed to be an effort. Over the next 18 months his health fluctuated dramatically, and I expected the worst every time I returned to visit him. However, Khayellhle was extremely articulate and keen to tell me his story, which took the form of a confession of a man who knew he was dying. During our meetings he observed me closely to make sure I was recording accurately, pausing every now and then as I scribbled so I could catch up. Khayellhle spoke softly but candidly about his childhood, his illness, his failed relationships with women, and his violent past. He had a bad reputation in his neighbourhood; people knew him from the days before his illness when he was feared for his quick temper and knife-wielding skills. Arguments over beer and money in Solly’s Tavern often escalated when Khayellhle was around, sometimes culminating in a stabbing and the arrival of the police. However, by the time I met him, public perceptions had changed and those who knew him from before pointed out that he was distinct from his former self. No longer seen every night at Solly’s Tavern, he sat most days alone on the veranda listening to the radio. I was usually Khayellhle’s only visitor. During the telling of his life, Khayellhle did not try to disguise the details of his conduct in his relationships with women or his involvement in violent incidents. Rather, his story assumed the form of a confessional, echoing the ubiquity of exteriority in public and political culture. As Fassin et al. observe, In a time when telling one’s life has become a normalized way of being in the world, when the reconstruction of the nation has been implemented through the narratives of criminals and victims before the Truth and Reconciliation Commission, when AIDS patients are summoned to leave behind them when they die a stereotyped trace of their existence through a memory box that includes a recorded life story, the exteriority and therefore the opacity of the confession could not be more evident (Fassin et al. 2008, 234).

Khayellhle’s intentionality in recounting his story to me may be considered as reflecting this shared perception of the power of the confessional. Villagers’ experiences with confessional technologies such as HIV testing and the popularisation of these as liberating the suffering self, resonate with religious ideas of the testimonial. During services of the International Holiness Pentecostal Church, testimonials were offered as a means of healing through the power of oratory (See Chapter Five). Yet, Khayellhle rejected his mother’s requests for him to attend

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church services or support groups. He felt that “Christians will judge me stereke [strongly]”. The way Khayellhle narrated his life story was strongly influenced by my expectations of plot and structure which I, as interviewer and writer, imposed. In our early meetings, Khayellhle’s narration was somewhat chaotic, but after a while we settled into a rhythm following the sequence of events in his life that were most meaningful to him. I only really became aware of the intentionality of Khayellhle’s narrative much later on, in reading over my notes, and reflecting on his story. Reviewing his account, he must have been aware that he was close to death and that his story was vital to the remaking his life. It is customary at funerals for family members, religious leaders, and important friends, to provide obituaries. These oral performances typically obscure the less favourable aspects of an individual’s life while highlighting their achievements. Even the speeches at gangster’s funerals highlight their positive achievements and contributions to society. Funeral oratory remakes and reinvents lives so as to placate the dead. Niehaus, writing on the life and death of Jimmy Mohlala, his friend and research assistant, who had died of AIDS, observes that the oratory at his funeral was “carefully choreographed” and that “was at odds, sometimes starkly so, with the manner in which Jimmy had told his own life story to me” (Niehaus 2012, 196). Khayellhle’s narration of his life story can be regarded similarly as the work of fiction, an attempt to remake a life at a crucial point when death was imminent. However, I did not attend Khayellhle’s funeral. I was only made aware of his death by a telephone call from his mother when I was in Johannesburg. I recall the moment when my phone rang and I heard MaMhlanga’s voice. After exchanging greetings, she said flatly that Khayellhle had died. Before I could ask what had happened, she said he had told her not to bother me and that I did not have to return to Bushbuckridge for the funeral. I am not sure why he did not want me at his funeral, but it is possible that by telling me his life story, he felt that my role was complete. His story was in this sense, an obituary before dying. Unlike the loss of control that pervaded his life, by telling his life history Khayellhle reasserted control over the narrative.

7.2

Childhood: Escaping Hunger and Witchcraft

Khayellhle was born in KaGomane village, one day’s drive from Maputo in the Gaza Province of Mozambique. His father, a migrant worker, was employed at a South African gold mine located on Johannesburg’s West Rand and returned home infrequently. Khayellhle ‘s early childhood was spent in the bush herding cattle for his father and his grandmother. He recalled the persistent hunger and struggle to find food, “the problem was hunger; everyone was hungry. But my grandmother made sure that we always had something to eat before we went to sleep”. The boys ate dried game meat (biltong), boiled and served with wild fruit mashed into a pulp. Along with the other herd boys, he hunted mice and collected

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termites to eat during the day. When Khayellhle was eight years old his father retired and returned home and sent him to school. Khayellhle loved school but performed poorly as he still had to herd the cattle in the mornings and afternoons and had little time for schoolwork. At twelve years of age, witchcraft suspicions and accusations tore the family apart. One day, while playing, Khayellhle’s little brother Ozeus disappeared, reappearing hours later in a large hole in a tree. The children suspected that their grandmother was responsible for this mysterious behaviour. She became furious when MaMhlanga questioned her about what had happened to Ozeus. Structural tensions between mothers-in-law and daughters-in-law frequently focus on competition over the attentions of men who are both sons and husbands. These tensions can materialise as witchcraft accusations. Suspicions of witchcraft hardened after Khayellhle’s older brother Jonas died after a short illness. After Jonas was buried, MaMhlanga reported mysterious sightings of the boy. She suspected that her mother-in-law had transformed Jonas into a zombie (xindhachani) to work for her in her fields. Khayellhle’s inclusion of this event in his life history was not coincidental. Discourses about zombies in southern Africa emerge from experiences of the commodification of labour “. . . and the rise of a phantom proletariat” that consumes “the life force of others, it also destroys the labour market, conventional patterns of social reproduction” (See also Geschiere 1997; Comaroff and Comaroff 1999, 290; Niehaus 2005). Like a pre-echo of his own disembodiment later in Khayellhle’s adult life, zombies represent the transformation of people into soulless objects and present apt metaphors of the exploitation of their labour. Zombies are used by their masters for hard labour who, because their tongues are removed, have lost the ability to speak out against their exploitation. Hidden away in huts, they are fed a monotonous diet of meat and potatoes (See Niehaus 2005). Fearing for her children’s lives, MaMhlanga fled with them to South Africa. This was in 1969, before the massive influx of refugees from Mozambique into South Africa during the Mozambican civil war (1977–1992). The family travelled by train to the South African border at Komatipoort, jumped the fence and walked the remainder of the journey. MaMhlanga’s brother lived in Bushbuckridge and he helped her to acquire a residential plot. Taking responsibility for his sister’s son, MaMhlanga’s brother fulfilled the role ascribed to the mother’s brother (malume) and supported his schooling. Khayellhle was happy at school. He did well in class and made friends; “I remember sitting together with Joyce [his best friend] at school. I was promoted from Sub B [Grade One] to Standard One [Grade Three] because I was really bright. I was even appointed as a prefect to report on the noisy children in the class. They would get beaten with a sjambok [leather hide whip] when I reported them to the teacher”. While school offered a context for socialisation, this also took place in the company of other young boys and girls, in the bush surrounding the village. Here young boys played games that formed them into young men (vajaha). At this stage of life emphasis is placed on the expression of, and control over, emergent sexuality and aggression. Vajaha learned how to fight other boys of the same age. Coordinated

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contests between two boys were staged by burying them waist high in holes in the ground, an arm’s length apart. The combatants would try to beat each other using bare fists, and the winner was rewarded with the loser’s lunch. Khayellhle recalled participating in these fights while herding his malume’s goats. Sexual socialisation also took place outside of the domestic domain. Khayellhle’s earliest sexual experiences took place playing games in the bush surrounding the village with other children from his neighbourhood. Like many other boys of his age, Khayellhle’s first sexual experience was while playing ku-ku (the equivalent of the English “hide and seek”) or swiyindwana (“little houses”). Mimicking marital relations these games socialized young boys and girls into normative gender roles. During swiyindwana, children constructed play-houses in the bush and played at being mothers and fathers. “Husbands” hunted mice and caught fish, while “mothers” cooked the meals in tin cans over small fires. Later they pretended to have sex by lying on top of each other. Play sex, or what was referred to as matanyula, was not considered “real sex”. Khayellhle recalled, “I started having sex at the age of eleven. We did not have proper sex. I thought I was having proper sex, but later I realised I was not”. When he was a child “still wearing short pants”, he was teased because he lacked sexual awareness. His peers used to boast of their sexual conquests; “They said ‘yesterday I got sex’. I asked them ‘What’s that’. ‘They said ‘You don’t know? You are a xiphukuphuku [fool]!’ They said ‘Look at us. We played and we had sex last night with a girl next door’. If you didn’t get anything everybody was laughing at you that you are a fool and you are afraid of girls”. Khayellhle’s first penetrative sexual experience took place when he was twelve, with a girl five years his senior, while playing kuku: “When we went to go and hide, she said ‘let’s not go out let’s stay here’. She was 17 and she taught me [sex]. She took my clothes off and she pulled me on top of her. She put my penis in her vagina. Her problem was that she did not have the courage to tell a boy that she needed it, so she was only able to do it with those younger kids”. Khayellhle boasted about his sexual potency in his late teen years. “I used to speak to girls about sex. I always bragged about how strong I am, and how far I can go—I would say that I ku ba ma bi delo [I beat the furrows in the ground—to have vigorous sex]. I lied to them because I was just playing. They didn’t believe me. They knew I am just joking around. They said that I am too young to have sex”. These recollections of childhood highlight the tensions between becoming a majaha ntiyela—a respected “big” youth—and the loss of control that undermined and threatened achieving this identity. To become majaha ntiyela requires a demonstration of masculine dominance over others, through sexual conquest and displays of strength in fighting, but excessive displays of these attributes can be dangerous, and mark young men as having lost self-control.1 This tension between

1 In Heald’s ethnography of the Bugiso (1989), a similar striving for balance is revealed in circumcision rituals. Boys who do not flinch during the act of circumcision are marked as cruel and have the propensity for violence, yet those who do flinch are seen as soft and therefore unfit as leaders.

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excess and control is a central theme in Khayellhle’s biography and reappears in the next stage of his life as he leaves the supportive and structured life of the village and moves to the city.

7.3

Young Adulthood: “I Started to Run Wild”

Khayellhle’s progression to youthhood was suddenly interrupted at age 16. His school career was cut short when his malume decided he had supported him enough and that he needed to start to earn an income. He offered his nephew a job as a shop assistant in the East Rand township of Brakpan. Therefore, at the age of 16, Khayellhle left school to live and work in Johannesburg. For Khayellhle, this signalled a fundamental shift in his conduct and outlook. Summing this up he commented that it was at this stage that he “started to run wild”. Life in the city was hard for the young Shangaan-speaking youth; the townsfolk took advantage of his inexperience, calling him a barrow (from the English “wheelbarrow”) an insult reserved for naïve country boys,2 and teased him about his ignorance of the ways of the town. “I couldn’t speak their language [IsiZulu] and so they thought I was stupid”.3 His first encounter with violence occurred late one night while he was locking up the shop. Gangsters (tsotsis) beat him up and tried to steal the shop keys. Khayellhle soon learned to protect himself and carried a long stick. The next time the gangsters threatened Khayellhle, he defended himself, drawing on his skills acquired as a young herd boy. After three years, now a young adult and earning a regular income, Khayellhle intended to marry Joyce, his former school friend. Khayellhle loved Joyce and regarded her as his perfect companion; “She was my only friend at school. I didn’t have a male friend”. However, Khayellhle’s mother forbade the union. Joyce lived next door to Khayellhle’s family, and marriage and good neighbourliness did not mix well; suspicions of theft and witchcraft are perennial sources of conflict between neighbours. Given the structural tensions between mothers-in-law and daughters-inlaw, the prospect for peace between the two families was slim. Instead, MaMhlanga negotiated with the Mathonsi’s, a family from Acornhoek, to marry their first born daughter called Gladys. Hearing this news, Joyce was furious. Laughing, Khayellhle recalled the physical altercation that ensued between the two young women: “they fought with each other until they bled. Joyce really wanted to marry me. She knew that I was working, and I could have supported her

2 Quite appropriately, the term compares country bumpkins to wheelbarrows that are pushed around and used to carry heavy loads. 3 Webster (1991) notes that male Thembe-Tonga migrants from northern KwaZulu-Natal avoid speaking their mother-tongue (XiTsonga) in the urban townships and adopt Zulu language and identity.

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quite well”. The marriage was a disaster. Khayellhle had few good memories of his marriage to Gladys, and he deeply regretted the loss of his friendship with Joyce. Khayellhle, Gladys and their first-born son moved into a backyard shack in Tsakane, an informal settlement on the East Rand. However, with the birth of another two boys, the family soon outgrew their lodgings. Khayellhle built a two-roomed house in the village and Gladys returned to live there with their three sons. In 1981, Khayellhle secured a job with Grinaker, a construction company, specialising in large infrastructural projects. He was often on the road, laying railway sleepers and working on building sites in Witbank, an industrial town, located 350 kilometres west of Bushbuckridge. This was also a turning point in Khayellhle’s biography, and in particular in his sexual conduct. In contrast to his limited sexual experience prior to his marriage, Khayellhle started to have numerous extra-marital affairs. “I had never thought of this before I was married. [After marriage] I started to run wild; I had many girlfriends. I started off with one and then had the other. This was a surprise to me. When I was young I had never experienced women”. He accompanied his friend, Dlamini, who was visiting his girlfriend, and became involved with another woman. “A friend can make you do things that you don’t really want to do. Dlamini told me straight, ‘here is a woman’! So, when I was living in Brakpan I told myself that I must love one woman in Brakpan and one woman at home”. Khayellhle likened his mistresses to secret wives (xigangu) or makwapheni (“under the armpit”) or a “roll-on” (like the deodorizer). He supported his lovers financially, purchased building materials for their homes, paid for their children’s school uniforms and occasionally helped them out with funeral expenses. Khayellhle observed that a mistress is different to a wife, particularly with regards to sex which was adventurous in comparison to the “utilitarian sexuality of the domestic sphere” (Fordham 1995, p. 172). Sexual relations with a mistress seemed to create “an alternative model of the sexual universe, where anything is possible” (Parker 1992, 231), in contrast to sex within marital relationships which is perceived as being solely procreative. Married women who suggested alternative sexual positions or new styles with their husbands ran the risk of being accused of having affairs. Likewise, a man who expected anything other than “normal” sex displayed disrespect towards his wife. Khayellhle recalled that his mistress once surprised him by exposing her breasts to him in the dining room which he found highly erotic. In contrast, he described his wife as dull and unadventurous in bed. Sex with extramarital lovers offered the opportunity for secretive sexual desires. Khayellhle commented, “Even though we Blacks live together with our wives at home, the men have something they are hiding that is secret. They are afraid to do something especially in bed. So, the mistress is free to do everything she likes to do. She will do different styles. Your wife will do it [sex] normally”. Khayellhle’s increasingly adventurous sexual life was accompanied by socializing in shebeens in the East Rand township where he lived, creating opportunities for casual sexual encounters. Careful to distinguish between these “fly by nights” affairs and his mistresses, Khayellhle highlighted the role that alcohol and locale played in these sexual encounters. For instance, one night Khayellhle had sex on the side of the

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road with a young woman he had just met at a tavern. He dismissed this as a result of his inebriation. The social spaces in which men drank shaped the dynamics of the relationships formed in these circumstances. Places where people drink are distinctively masculine; drinking and womanizing form part of the repertoire of “male privileges” (Rebhun 1999). Alcohol consumption and casual sex are intertwined activities that are seen to go together (Fordham 1995). Public drinking is “the male ritual par excellence, in as much as it is one in which in men constitute and reconstitute their potency and masculine identity in a theatre of self-construction” (Fordham 1995, p. 163). For Khayellhle alcoholic inebriation and the arbitrariness of sexual encounters was fundamental in explaining his conduct. Other men I spoke to who knew Khayellhle from home, described his conduct. “He was a drunkard who would fuck anyone who was available. He didn’t want an affair; he just wanted to fuck”. Enos Chiloane, a young man, recalled that when Khayellhle returned to the village, “He was going up and down. Even if you wanted to visit him you would not find him—even if you went at five o’clock you wouldn’t get him. Even if you went at eight o’clock you wouldn’t get him. He was still going up and down and searching for the ladies or the girls”. Enos conveys Khayellhle’s predatory and chaotic movements around the villages. Around this time Gladys’ household started to suffer financially. Khayellhle’s remittances home became increasingly infrequent and tensions between her and her mother-in-law began to escalate. She became friends with another woman who frequently travelled to Randfontein on the West Rand to sell bananas and oranges that she purchased wholesale from white farmers. Yet, like other women in a similar predicament, she discovered that selling fruit was a competitive market, and she became involved with men who offered gifts of cash and clothing. Gossip about Gladys’ activities reached Khayellhle and he demanded that she leave his house. The Mhlanga and Mathonsi elders discussed the problem and agreed that Gladys would return to her parents, while the Mhlanga family would retain custody over the children. Khayellhle had paid the full bride-wealth and he had rights over his children. Thoroughly disenchanted with the way his relationship had turned out, Khayellhle broke up with his paramour (xigangu) and remained chaste for an entire year. Two years later Gladys died. At the time Khayellhle did not know what had caused her death but in interviews he speculated that she had died of AIDS. His suspicions were based on gossip about other women who like his wife had gone to Randfontein and returned home and died, sick with the symptoms of AIDS. Khayellhle did not indicate the possibility that he had infected Gladys, or that he might have become infected from his relationships with other women. In the late 1980s, Khayellhle’s life course changed direction again. In 1989, he spent eight months awaiting trial in prison for a double murder. At the time, he had been living in KwaThema on the East Rand. Walking home after a night of drinking, a gang of sixteen boys attacked Khayellhle and his companion. As the boys circled in, Khayellhle’s friend fled. Reminiscent of his early days defending himself against the thugs of Brakpan, Khayellhle sought to defend himself. “My aim was to use my knife on one of them. Once they heard him scream, they would run away. I stabbed

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two of them and killed both. . .I aimed for the throat”. Khayellhle felt his actions were legitimate, “I was happy that I was alive. Instead of me dying, two of them died”. As he predicted the thugs fled. The police arrested Khayellhle and he was charged with manslaughter. Khayellhle’s account of prison life highlights his exposure to extreme forms of sexual violence. “There were about 40 or 50 of us in the cells. Eh it is true—there is a lot of rape in jail. I saw this many times. You were only protected if you had someone who knew you from outside. Then he would say ‘Hey don’t touch this guy. I know him from lokshen [location or township]’. But me—I had no one. When they lock you up there is only one police officer [prison warder] to protect you. They are too scared to intervene. The reception office was far away. If there was a rape, then they had to go far to call the other warders. It was only like this for me when I first arrived”. Ironically, Khayellhle presented himself as most powerful under these conditions. Khayellhle was forced to prove his strength when attacked in the showers soon after his arrival in prison. Two men demanded Khayellhle’s new overalls and attacked him. With soap in his eyes, Khayellhle grabbed the one man’s neck and bit as hard as he could, killing him instantly. The prison authorities regarded the incident as selfdefence and did not charge Khayellhle. After this event, leaders of the 28s invited Khayellhle to join them. “Once I joined the 28s if they know you can fight, then you can smoke with them—they are your big friends”. The 28s were South Africa’s oldest prison gang, with a reputation for extreme violence. In 1996, the 28s at the Barberton jail killed a man, “dissected his body with knives and actually ate the liver” (Niehaus 2002a, 90). Reminders of Khayellhle’s incarceration were literarily scored into his skin. In one interview he removed his shirt, displaying an upper body marked with tattoos. On his arms were two daggers, one piercing a heart, and on his chest, a snake coiled around a lion and a mermaid. Explaining these as symbols of power, Khayellhle remarked, “The lion is powerful like me. I am a lion. I can kill someone, like the 28s are the most powerful group. The snake is a woman. So is the mermaid. The 28s don’t trust women. They say it is better to trust a man than a woman”. This code bore significance later in his life. The “trust” he talked about establishing with fellow gang members was in stark contrast to his relationships with women. Having found that Khayellhle acted in self-defence, he was released from jail in 1991. Returning to his former employer, Khayellhle was swiftly retrenched along with thousands of other workers. Despite his long service to the company, management claimed that there were too many retrenchments to pay out the workers in full, although as Khayellhle put it “A Sotho man from Tzaneen stole our money”. Depressed and angry Khayellhle returned home to Bushbuckridge. His anger translated into excessive drinking in village taverns and shebeens. Khayellhle favoured Solly’s tavern, a run-down shell of a house, with no roof, and simple rickety wooden benches that sold cheap home-brewed xikhapakhapa and warm quarts of Black Label beer. Khayellhle was often at the centre of fights at Solly’s and was arrested twice.

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At this stage of his life story, Khayellhle presents an image of a masculinity forged through encounters away from home. The “machine” transformed him, replacing his former passive and hopeful self, embodied by the harsh and unforgiving world of the township, an unforgiving labour market, and the prison gangs.

7.4

Infection, Accusation and Revenge

Whereas urban crime and violence hardened Khayellhle, the transient character of the labour market disrupted his role as a father and as a husband. Desperate for work, in 1992, Khayellhle found employment with a swimming pool construction company in Nelspruit. The work was poorly paid and infrequent and Khayellhle felt exploited and claimed that the owners were corrupt. At about this time, he met Josephine Komane, a single mother of three. He moved in with her in KaNyamazane, a township near Nelspruit. In contrast to his previous relationships, Khayellhle had fond memories of Josephine. “She was a good, good woman, a born again [Christian]”. Khayellhle and Josephine had a son and they lived together until 2002. However, despite his good intentions, Khayellhle was often away from home and had several casual relationships with women that he met while on site in Witbank and Johannesburg. Like other men in a similar predicament, contract work provided only temporary relief from unemployment. Men drifted between construction work, while others gradually slipped out of the market, becoming permanently unemployed, and unemployable. Some were, as they said, “work sick”; having been unemployed for so long they had forgotten how to work. I often met men like Khayellhle in the villages, their lives marked by the struggle to find work and create a life. Thirty-years-old, and aptly named, “Botha”4 was incapable of holding down a job for longer than a few months and had never married. Now he repaired radios, having failed a breathalyser test when employed on the mines. He explained that his misfortune was caused by xinyama, a state of pollution, that made people dislike him. Similarly, at 30 years of age, Alli Bhila “marketed” himself for two years before the South African Airports Company employed him as a baggage handler. He was dismissed after only a few months when he was caught stealing. Returning home, Alli worked for local construction projects driving a truck delivering sand. Without a consistent income, Alli’s wife left him, taking their two infant children to live with her mother. As with Khayellhle, commitment to a long-term relationship as a partner and as a father was nearly impossible under these circumstances. Suffering from severe depression, Khayellhle started to drink heavily and frequently had affairs with women he met in taverns. In 2002, now in KaNyamazane, he met an attractive young woman named Simpiwe, and stayed over at her house for

4 He was so named after PW Botha, the former Nationalist Party leader and prime minister under the apartheid government (1978 to 1989) because of his quick temper and proclivity to violence.

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several days. Learning about his infidelity, Josephine threw him out of her house, and Khayellhle moved in with Simpiwe, something he sorely regretted. Simpiwe was younger than Khayellhle and had several different lovers in KaNyamazane. She was also extremely abusive. Khayellhle spoke at length about the nature of their relationship. The person who destroyed my spirit was that woman [Simpiwe] that I stayed with. She would come home drunk and would wake me up and start to insult me and do horrible things to me. She really killed my spirit. She insulted me about my mother’s panties5 and she would say anything she liked to me. And she could fight! She beat me on the mouth. She would never get tired, from morning to night. She would drink a lot. When I was at work, I was relaxed but when it came time to go home, I would become afraid. If she hadn’t seen me that day, she would question me when I got home: ‘Who did you talk to?’ She would argue with me. Eventually I would just stay silent when she spoke to me. When my son [from the first wife] visited me, she would get really angry with me: ‘What are you talking about with him?’ It [her anger] was sudden. We would be sitting together and laughing together and then she would just go mad. Her eyes would go white. When I got home from work, she would give me food and water. But later in bed she would change and become mad. It is better to learn about a woman first before you go and stay with her. Even if I had done nothing wrong, she would take a broken bottle and stab me on the arms and on the stomach and on my hands. She once burnt my head with a [clothes] iron. She would start hitting me. I wouldn’t beat her back because I was afraid of being arrested. Once I called the police and they sent me to the hospital to get a letter [to provide proof of the assault]. They never arrested her though. Once when I was fighting with her, she called her daughter and told her ‘boil some water, I want to burn your ‘father [the young girl was not his biological daughter]’.

Prior to her relationship with Khayellhle, Simpiwe had been involved with a man who had later died. His relatives suspected Simpiwe of witchcraft and when they buried the man, the family elders threw Simpiwe’s clothes into the grave. Khayellhle asserted, “they wanted Simpiwe to follow him to the grave”, reflecting the belief that clothing contains the essence or moya (breath), transmitted through sweat and other bodily secretions that may be manipulated to influence the corporeal body (Niehaus 2002b). Soon after the burial Simpiwe became ill. Consulting a faith healer, it was revealed that her former lover’s family had bewitched her. Rejecting this interpretation, Khayellhle was convinced that the man had died of AIDS and that Simpiwe had passed the infection to him. “She walks with the disease. She knew that her boyfriend died of AIDS”. Khayellhle used this account as evidence that Simphiwe intentionally infected him as well as others. He asserted: This woman wants to give everyone [AIDS]. When I was not there, she would go to the shebeens to have sex with as many men as she could find. This woman just wants to give everyone [AIDS]. She had a big body, big legs. But now she looks way too slim. I found her slim. But she started to get worse when I was with her. Straight, she gave me HIV. I know that for sure. Straight! Straight! Straight [Definitely]!”.

5 Khayellhle would not tell me the exact nature of the insult as this was would show disrespect for his mother who was in earshot. However, I assumed that the insult was sexual in nature.

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Removing any sense of personal culpability and ignoring his personal history as a “womaniser”, Khayellhle now directed blame for his infection and illness on Simphiwe. In 2003, Khayellhle started to become ill. At first, his illness manifested as a skin rash. He was constantly tired, and had sores on his head, torso and legs. At a hospital in Nelspruit he was told that he had to be tested for HIV. Hearing that he was HIV positive he was shocked. I had heard about HIV before on the radio for a long time. But I really didn’t expect that I would end up getting this disease. It is strange because when I was in Johannesburg I was really running around with women. This was long before I had heard about AIDS. But the time I settled down that is when I got it. [When I was told that I had AIDS] I cried. I was very upset. I sat at home and played Gospel music.

Simphiwe, unlike Gladys, and unlike his previous relationships, fitted the stereotypical profile of “dangerous women”, who intentionally infect others. As I argued in Chapter 3, evidence of AIDS draws on moral constructs of chaotic and dangerous desire, which Simphiwe was seen to display in her relationship with Khayellhle and other men. However, there are obvious silences in Khayellhle’s account of his infection that have to do with his time while still married to his first wife, Gladys, and later while in prison. In February 2003, Khayellhle confronted Simpiwe and accused her of infecting him. He recalled the confrontation. To Simphiwe he said, “after this, the way I feel, I think it is you [who infected me]. But she said ‘No! You found me well and now you are sick, but I am still healthy’”. Simpiwe completely neglected Khayellhle thereafter. Even though they were living in the same house, she drank beer and had sex with men in the same room where he slept. When Khayellhle was admitted to hospital for a few days, Simpiwe invited a man home who paid her for sex, and even paid her daughter two Rand (USD0.20) to keep her quiet. Later that year Khayellhle broke off his relationship with Simpiwe and returned home to Bushbuckridge. Having learned of his diagnosis, Khayellhle did not inform his mother that he was HIV positive. MaMhlanga consulted a ZCC priest (mufundise), a faith healer (maprofeta) and several diviners (tin’anga) to find the cause of her son’s afflictions. Khayellhle’s health deteriorated rapidly and fearing for his life MaMhlanga took Khayellhle to Tintswalo Hospital in Acornhoek. Khayellhle was re-tested and told his mother that he was HIV positive. “I told her that those healers she had spent money on were not going to be able to help me”. Khayellhle was determined to confront Simpiwe and get revenge “for what she had done”. He returned to KaNyamazane and accused Simpiwe again of infecting him. Simpiwe became enraged and attacked Khayellhle, biting his arms and hands. He fled and never returned. Yet, Khayellhle’s anger towards Simpiwe grew stronger. He plotted to confront her again, intending to kill her before killing himself. He was sure that Simpiwe had infected him, as she seemed strong while he was weak. He explained that the infector was always healthier than those they infect. “She took my strength when she infected me”. Khayellhle also resented Simpiwe for the way she

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had changed his character. As he put it: “She poisoned my spirit. So now I have no patience. I can get angry about the smallest thing”. At this stage, possessed by anger and the desire for revenge, was the start of Khayellhle’s descent into the loss of autonomy, the sense of no longer being in control of his self, or his body.

7.5

Final Days: “The machine inside Controls me”

Dealing with anger and frustration was a constant struggle for Khayellhle in his later life. Like Philemon in Chapter 5, he was especially concerned with becoming “heart sick” (vu vabya mbilo) and sought peace and quiet, aiming to avoid situations of conflict. He described his struggle to control his emotions: “I don’t need to get angry. I feel weak if I see something that makes me angry. I have such a short temper. If someone doesn’t reply to me when I speak to them, I feel like running away from them. If someone makes me angry, I feel like just looking at them without replying to them. It stays for a long time in my heart what that person has done”. During the only AIDS support group meeting he attended at the Tintswalo Hospital AIDS Clinic, fellow members advised him to avoid becoming “too upset” and that keeping calm and avoiding stress would extend his life. Yet, the greatest challenge that he faced was managing the tedium and loneliness of his illness. Khayellhle’s days were monotonous and repetitive. Apart from myself, his only other regular visitor was his brother. One day Khayellhle helped his brother make cement bricks in the yard, but after only a short while he was exhausted. “He does nothing here” commented MaMhlanga. Khayellhle agreed; “I am very bored. No one visits me. I can’t chat to the youngsters in the homestead. I just listen to the radio and sleep. I don’t really have many friends. Before when I used to drink, I had friends. Now I no longer have any friends. I just sit and listen to the radio. I would like to talk to other people who have this disease, but they are just not interested. They are also scared to talk. I don’t know how to talk to people. It was easy for me to talk in the support group. But I don’t want it to seem that I am pushing other people to do something that they don’t want to”. In his mother’s home, as he started to display physical signs of his illness, other household members began to react negatively towards his presence, reflecting growing anxieties about the potential of contamination, as if his body began to pose moral and mortal dangers to his fellow household members. At first, when Khayellhle returned home ill, he slept in the living room in the main house. Later he moved to a dilapidated hut in the yard, usually reserved for the young men called the lawu. Considered private space and reserved for young men (vajaha), the lawu effectively separated young sexually active men from other members and therefore protected them from their bodily fluids which were considered “hot” (hisa) and therefore dangerous. Khayellhle’s move into the lawu not only kept the dangers of pollution at bay, but also reflected his liminal status. Close to death, yet still alive, the

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terminally ill are perceived as ambiguous and therefore problematic, representing a threat to the living (Delius and Glaser 2005; See Niehaus 2007). Fears about pollution were further illustrated by the behaviour of other household members toward Khayellhle. Early one morning Khayellhle sneaked into the kitchen before anyone was awake and cut slices of bread from a fresh loaf. His younger sister discovered him eating and demanded that MaMhlanga throw the bread away. MaMhlanga smiled as Khayellhle recounted this event, and claimed somewhat unconvincingly, “I ate the bread—just to show them it was okay”. She shrugged off the bread incident and claimed that the girl who had caused the incident was “not right in her head”. Household members also articulated resentment toward the distribution of resources to Khayellhle’s upkeep. Khayellhle’s mother supported a household of eight adults and seven children, on a state pension of R750 (USD75) per month. She supplemented this by selling mats which she wove from plastic bags. This extra income was used to purchase E-Pap6 and fruit and vegetables for Khayellhle, and for his taxi fare—of about ZAR20 (USD2)—to the hospital. Three of the young children in the house received Child Support Grants from the state, then valued at R170 (USD17) per child. The house they resided in was paid for, financed from the proceeds of Khayellhle’s father’s insurance policy. Khayellhle was painfully aware of the unkind gossip at home that insinuated that he was a waste of household resources. His mother’s mother who lived in the same village made it clear that supporting Khayellhle was “a waste of food”. A neighbour overheard her saying “What is the point in helping him if he is just going to die?” Khayellhle’s younger siblings were respectful toward him, but they gossiped about him behind his back with their friends from school and in the neighbourhood. Khayellhle consoled himself saying “at least I know my status. Those ones are still in the dark”. Khayellhle’s preoccupation with Simpiwe faded with time. He felt no anger towards her and no longer sought revenge. Instead, his thoughts turned inwards towards his current predicament, and his concerns for his children’s welfare and future. Despite his earlier cynical dismissal of church support groups, Khayellhle prayed with his mother every night. His prayers were always the same: “When I pray at night, I ask God to give me more days to be alive to be alive for my children”.

6

E-Pap is composed of whole grain maize, soya beans and vitamin supplements, touted as a healthy alternative or additive to maize porridge and especially recommended for people with compromised immune systems. The local availability of fresh fruit and vegetables was limited despite the lowveld being a major producer of oranges and tropical fruits. The local supermarkets sold a range of vegetables and fresh produce, but this was often expensive and required regular shopping expeditions that incurred transport costs. Not surprisingly people favoured non-perishable food such as packet soups eaten as a relish with the staple maize meal. Salads (beans and greens) were ‘Sunday food’. Many households continued to eat ‘traditional food’ (swakudya xa xintu) such as okra (guxe), groundnuts (timwembe) and wild spinach (morogho). These foods are believed to have healing properties and health benefits. Yet, despite the rhetorical claims of their benefits, villagers displayed preferences for status foods such as meat, rice, and potatoes.

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In November 2004, I was surprised to hear that Khayellhle returned to work. His former employer wanted him to build swimming pools in Witbank. Khayellhle had completed the first three months of a course of TB medication and felt well enough. But he returned home in December of that year, now extremely ill. His journey to Witbank was a failure as he had been too weak to work and had lost his job and wages. Once again, his mother cared for her son, feeding him soft porridge, cleaning him when he had diarrhoea, and helping him in and out of his bed. Khayellhle began to feel that he was close to death, a sensation confirmed by a reoccurring dream. In the dream, several men and women appeared, walking around his room, accompanied by an old man dressed in white (the colour of the ancestors) who carried a staff such as those used by apostolic faith healers. The man entered the room and left out the back through a door that did not exist. The dream frightened Khayellhle, although the presence of the old man made him feel better. “I felt happy and better when I saw him. I didn’t feel scared at all. I really want to know where these people came from, although they were not real people. I can dream this dream every night for a whole week. In the dream, I also saw another Khayellhle (laughs) there were two “Khayellhles”. I tried to talk to “Khayellhle Two and asked him ‘do you feel the same way as I feel’? When Khayellhle Two wants to reply I always wake up”. I talked to Martha Gomane about the dream; she had known Khayellhle when she was young and was one of the few people who still visited him. She reflected on the dream, commenting that it demonstrated that Khayellhle was in the process of dying, or that he was already dead, or as she put it, “gone”. Of the “two Khayellhles” Martha said that “this showed that he was actually dead at that time”. It seemed as if the dream indicated a shattering of the self into two entities, one dead and one still alive. As he told me about his dreams and his growing recognition that he was close to death, Khayellhle also reflected on his feeling that he was no longer in control over his physical self. To describe this sensation, Khayellhle once again talked of his body as if a machine had possessed it. When I want to vomit, I just start, and I can’t control it. It is like there is a machine in my chest that controls my appetite. Sometimes if it doesn’t want me to eat then I can’t. When I am eating if it has decided I have had enough then it stops me. When I want to go to sleep and if it wants me to sleep on one side and not the other then I will start coughing until I move over to that side. It is the machine inside me that controls me. Even when eating it controls me. It is like an automatic machine. If it wants me to stop then it stops and makes me feel uncomfortable. It has been like this for two or three months. It has never been like this before. But if I eat morogho [varieties of wild spinach] and pap then it is okay. But if I eat meat it says ‘stop’. At home they boil my meat without any oil. I enjoy eating meat and pap [maize porridge] but it is the machine that controls me. I believe that there is something that is controlling me. It started when I became really ill and it has become a lot worse. It makes me vomit. Yesterday it was the second time I just simply couldn’t control it. It pushes. Vomit, vomit, vomit! It makes me want to vomit. This is when I feel like it is a machine. I can’t control it”.

At first glance, I am struck by how Khayellhle’s metaphor of the “machine” resonates with beliefs in witchcraft, specifically that witches could send snakes and frogs disguised as food in dreams to choke their victims. Yet, Khayellhle’s

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description of corporeal disintegration—his incapacity to control the flows of substances out of his body—also links with ideas about the dangers of leaky and porous bodies. While the flow of fluids between bodies was essential to establishing health and personhood, excess or limited flow signalled illness. For example, menstrual flow was deemed as vital to the expulsion of pollution from the body and “spotting” was a sign of blockage (See Taylor 1990; Jewkes and Wood 1999; Wood and Jewkes 2006; Stadler and Saethre 2011). Khayellhle’s experience of a loss of control over the flow of fluids manifested as the regurgitation of food, which he attributed to, and articulated as, being controlled by a machine. The machine had a special significance for Khayellhle. As a young man, machines represented the hard, cruel world of post-industrial capitalism in which men’s bodies were dispensable in the process of extracting labour. The machine metaphor also represented his failure to control his destiny. His potential to become a successful man (wanuna ntiyela) was gradually eroded through his encounters with a world of violence, instability, and cruelty, and by his overexuberance and failure to control his urges. The loss of control over the body also spoke to a rupture between mind and body, and disembodiment. It also speaks to the rupture of death occurring before corporeal death has occurred. In our final interview, Khayellhle reflected on his life and infection with HIV with regret, stating, “The way I grew up I was well behaved. If I had continued like that, I would never be sick like I am now”. Yet after a lengthy pause, Khayellhle added “But even Mandela’s son died of AIDS”.7

7.6

Conclusions

Khayellhle’s narration of his life, illness and death follows a narrative style and structure that are strikingly similar to other published accounts. In Niehaus’ biographical account of Jimmy—his friend and research assistant—life is a series of misfortunes that transform and destroy the potential and promise of a good life for a young man (Niehaus 2012). Adam Ashforth’s Madumo (Ashforth 2000) similarly tells the tale of a man haunted by witchcraft and the erosion of kinship. Men like Madumo, Jimmy, and Khayellhle appear to be caught up in the webs of a predetermined structure, that makes it impossible to achieve the ideal life of a successful man. Unlike the tales of AIDS activists and their participation and membership of organisations such as the Treatment Action Campaign (For example Fassin et al. 2008), Khayellhle did not experience any type of spiritual or biomedical rebirth (Robins 2006). Instead, he was driven by the aim of achieving the identity and respect awarded to senior men, through work and building a household. Yet, like most migrants he occupied a socially liminal space as a placeholder, an absent wage earner, husband and father alienated from his family (See Murray 1981). His

7

In 2005, Nelson Mandela announced in the public media that his son had died of AIDS.

References

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depiction of being controlled by a machine stands for more than his illness experience.

References Adams, V. (2016). Introduction. In V. Adams (Ed.), Metrics: What counts in Global Health (pp. 1–18). Durham NC: Duke University Press. Ashforth, A. (2000). Madumo: A man bewitched. Chicago: University of Chicago Press. Comaroff, J., & Comaroff, J. (1999). Occult economies and the violence of abstraction: Notes from the south African Postcolony. American Ethnologist, 26, 279–303. Das, V. (1997). Language and body: Transactions in the construction of pain. In A. Kleinman, V. Das, & M. Lock (Eds.), Social suffering (pp. 47–67). Berkeley: University of California Press. Delius, P., & Glaser, C. (2005). Sex, disease and stigma in South Africa: Historical perspectives. African Journal of AIDS Research, 4, 29–36. Desjarlais, R. (1996). Struggling Along. In M. Jackson (Ed.), Things as they are: New directions in phenomenological anthropology (pp. 70–93). Bloomington, IN: Indiana University Press. Erikson, S. L. (2018). Cell phones6¼ self and other problems with big data detection and containment during epidemics. Medical Anthropology Quarterly, 32, 315–339. Farmer, P. (1999). Infections and inequalities: The modern plagues. Berkeley: University of California Press. Farmer, P. (2005). Pathologies of power: Health, human rights, and the new war on the poor. Berkeley: University of California Press. Fassin, D., Le Marcis, F., & Lethata, T. (2008). Life & times of Magda a telling a story of violence in South Africa. Current Anthropology, 49, 225–246. Fordham, G. (1995). Whisky, women and song: Men, alcohol and AIDS in northern Thailand. The Australian Journal of Anthropology, 6, 154–177. Frankenberg, R. (1988). Gramsci, culture, and medical anthropology: Kundry and Parsifal? Or rat’s tail to sea serpent? Medical Anthropology Quarterly, 2, 324–337. Geschiere, P. (1997). The modernity of witchcraft: Politics and the occult in postcolonial Africa. Charlottesville: University of Virginia Press. Heald, S. (1989). Controlling anger: The sociology of gisu violence. London: Manchester University Press. Jewkes, R., & Wood, K. (1999). Problematizing pollution: Dirty wombs, ritual pollution, and pathological processes. Medical Anthropology, 18, 163–186. Kleinman, A., Das, V., & Lock, M. (1997). Social Suffering. Berkeley: University of California Press. Kleinman, A., & Kleinman, J. (1997). The appeal of experience; the dismay of images: Cultural appropriations of Suffering in our times. In S. Suffering (Ed.), Arthur Kleinman, Veena Das, and Margaret Lock (pp. 1–24). Berkeley: University of California Press. Merry, S. E. (2011). Measuring the world: Indicators, human rights, and global governance. In Current anthropology (Vol. 52, p. 0). Chicago, IL: University of Chicago Press. Murray, C. (1981). Families divided: The impact of migrant labour in Lesotho. Cambridge: Cambridge University Press. Niehaus, I. (2002a). Renegotiating masculinity in the south African lowveld: Narratives of malemale sex in labour compounds and in prisons. African Studies, 61, 77–97. Niehaus, I. (2002b). Bodies, heat and taboos: Conceptualizing modern personhood in the south African lowveld. Ethnology, 41, 189–207. Niehaus, I. (2005). Witches and zombies of the south African lowveld: Discourse, accusations and subjective reality. Journal of the Royal Anthropological Institute, 11, 191–210.

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Niehaus, I. (2007). Death before dying: Understanding AIDS stigma in the south African Lowveld. Journal of Southern African Studies, 33, 845–860. Niehaus, I. (2012). Witchcraft and a life in the new South Africa. Cambridge: Cambridge University Press. Parker, R. (1992). Sexual diversity, cultural analysis and AIDS education in Brazil. In G. Herdt & S. Lindenbaum (Eds.), The time of AIDS: Social analysis, theory and method (pp. 325–336). Newbury Park, California: Sage. Rebhun, L.-A. (1999). For love and for money: Romance in urbanizing Northeast Brazil. City and Society, 11, 145–164. Robins, S. (2006). From “rights” to “ritual”: AIDS activism in South Africa. American Anthropologist, 108, 312–323. Rylko-Bauer, B. (2003). In the Shadows of History and Memory. Using Personal Family Narrative in an Ethnography of Rediscovery. In 102nd Annual Meeting of the American Anthro–pological Association, November 19–23. Chicago. Stadler, J., & Saethre, E. (2011). Blockage and flow: Intimate experiences of condoms and microbicides in a south African clinical trial. Culture Health and Sexuality, 13, 31–44. Taylor, C. C. (1990). Condoms and cosmology: The ‘fractal’ person and sexual risk in Rwanda. Social Science & Medicine, 31, 1023–1028. Waterston, A., & Rylko-Bauer, B. (2006). Out of the shadows of history and memory: Personal family narratives in ethnographies of rediscovery. American Ethnologist, 33, 397–412. Webster, D. (1991). Abafazi bathonga bafihlakala: Ethnicity and gender in a KwaZulu border community. African Studies, 50, 243–271. Wood, K., & Jewkes, R. (2006). Blood blockages and scolding nurses: Barriers to adolescent contraceptive use in South Africa. Reproductive Health Matters, 14, 109–118.

Chapter 8

Conclusions

8.1

A New Pandemic, a Familiar Narrative

Towards the end of 2020, South Africa—along with most of the world—found itself in the midst of the COVID-19 pandemic. In December 2019, the first cases of the novel Coronavirus (SARS-CoV-2) that causes COVID-19 were first reported in Wuhan, China, and rapidly escalated into a global pandemic. Originating as a zoonotic disease, the Coronavirus is spread person-to-person via breath and saliva and through contact with contaminated material. While in many cases, infections are asymptomatic or mild, the disease is most severe in people who have comorbidities such as respiratory and cardiovascular diseases and diabetes (Guan et al. 2020). South Africa reported its first cases of COVID-19 in March 2020 amongst travellers from Europe and the USA. By the end of the month the number of cases had risen to 1000 and South Africa was placed under “one of the world’s most stringent nationwide lock-downs” in an effort to control the increasing number of cases (Bulled and Singer 2020, 1232). By October 2020 (the time of writing), there were 717,000 reported COVID-19 infections, and 19,000 deaths from the disease in South Africa. From the comfort of my home study, in the boho suburb of Melville in Johannesburg, the lockdown has afforded me the opportunity to reflect on this new pandemic from the perspective of my work on AIDS, and to speculate on the implications thereof for understanding responses to COVID-19. Both the HIV and the Coronavirus pandemics have been enormously productive, represented by numerous scientific publications, and in mainstream and social media. Yet, due to the ubiquity of digital media, information about COVID-19 has been produced at an unprecedented scale and pace, as Engelman (2020) observes, “(T) he COVID-19 history is written daily, if not hourly on social media”. From the first cases of

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infection, the COVID-19 pandemic was rendered highly visible, through digital representations in graphic form,1 asserting the authority and certainty of biomedicine, in the midst of chaos and uncertainty. Reflecting on my research on AIDS, I am struck by the synergies and parallels between the HIV and COVID-19 pandemics. The implications of COVID-19 for people living with HIV AIDS were voiced early on in the pandemic by public health officials and researchers, who pointed to the “possible unknown interactions with novel diseases such as COVID-19”. COVID-19 and TB have similar symptoms, attack the lungs, and are transmitted through close contact with others (Bulled and Singer 2020, 1236–1237). Moreover, the disruption caused by lockdowns, and the added burden on the health services due to COVID-19 disease, raised anxieties about adherence to antiretroviral therapy (ART). This, researchers noted, could result in a significant increase in morbidity amongst people who are HIV positive2 (See Keene et al. 2020). While this speaks to the synergies between the two pandemics, the social, cultural and political responses bear the most fruitful contrasts. Where the South African government’s response to the AIDS epidemic in the 1990s and early 2000s was marked by prevarication, delay and confusion (See Chap. 1), the current government acted with decisiveness toward COVID-19. Declaring a “state of disaster”, the government restricted peoples’ movement outside their homes apart from shopping for “essential items” and providing essential services and instituted a ban on the sale of tobacco and alcohol. Contravening these laws risked prison and fines, enforced by the deployment of the often heavy hand of the police and military. Black township residents were threatened, beaten and subjected to public humiliation in scenes reminiscent of the state of emergency under apartheid in the 1980s. While the response to AIDS was almost universally framed as a human rights issue (See for example Scheper-Hughes 1994), the response to COVID-19 has been enacted as a public health emergency. Ecks characterises the extraordinary measures taken in many parts of the world to stem the spread of COVID-19 as a case of “radical biopolitics”, in which the generation of capital is secondary to preventing the spread and treating the disease. Like HIV, which directly impacted men and women’s productive capacity, COVID-19 is a disaster for capitalism, but indirectly so, because of the unprecedented political and economic response to the disease (Ecks 2020). Yet, paradoxically, the resulting economic crises threatens to worsen the lives of the poor (Bulled and Singer 2020), laying bare the inequalities of marginalised people (Adams 2020). Also, like HIV, narratives of race, culture, and contagion and the resultant prejudices have resurfaced in the midst of the new epidemic, invoking stereotypes

1 An exemplary example is provided by the Johns Hopkins University Coronavirus Resource Centre that offers a daily updated map of epidemic spread, mortality, morbidity and testing rates. See https://coronavirus.jhu.edu/map.html 2 UNAIDS estimates that an additional 500,000 deaths could occur in sub-Saharan Africa should antiretroviral treatment be interrupted for 6 months (UNAIDS 2020).

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that articulate cultural, racial and social difference. In Chap. 2, we saw how different medical regimes in Bushbuckridge positioned Indigenous healing and beliefs in witchcraft and ancestors against modern biomedicine, solidifying divisions between the “traditional” and the “modern”, and thereby legitimising social inequalities. I argued that these narratives continued to have implications for participation in HIV prevention campaigns and the distribution of health care. Providing a framework for articulating blame, discourses of race and culture have consequences for the provision of health services and prevention amongst Indigenous, poor, and non-white communities. COVID-19 was initially cast as a disease that only affected white and wealthy South Africans, appearing initially amongst the affluent who could afford international travel. A remark made by a Black female graduate student during one of my weekly online seminars was especially revealing. Recalling the first months of the pandemic, she observed that people in her community were saying that they were grateful that COVID “is a white persons’ disease” and it therefore would not affect people of colour: “For once God is looking out for Black people”.3 This statement echoed perceptions elsewhere (Carter and Sandford 2020), and was often repeated in social media. A Facebook post attributed to an African American man stated: “Corona lowering gas prices, flights, cruises and not messing with Black people? God showing out.” (Glanton 2020). However, as the pandemic progressed, the notion of COVID-19 as a “Eurocentric disease” was quickly dispelled. In the USA, rates of infection and death amongst African Americans outnumbered whites (Mahajan and Larkins-Pettigrew 2020). Attention shifted to understanding the reasons for vulnerability amongst Black people, citing the social, political and economic circumstances of infections, morbidity and mortality. Like the HIV epidemic, COVID-19 exposed the all too familiar “fault lines” of inequalities, based on race and class. Despite recognition of the contextual dynamics of the spread of COVID-19, there was wide-spread failure “to account for the challenges inherent in what some may view as simple acts of behaviour change” (Bulled and Singer 2020, 1239) such as hand washing and “social distancing”. Rather than accounting for the material constraints to the prevention of viral spread, discourses in the media and statements made by health and political leadership framed the vulnerability to COVID-19 infection in terms of lifestyle choices in racialized groups (See Gálvez et al. 2020, 639). In South Africa, deficiencies in behaviour amongst poor, township residents circulated in medical dialogues about smoking, drinking, and personal hygiene. The National Coronavirus Command Council (NCCC) headed by Cooperative Governance and Traditional Affairs (COGTA) Minister Nkosazana Dlamini-Zuma placed a temporary ban on tobacco products from April to August 2020. The ban was based on the concern that smokers were at an increased risk of the more severe symptoms of COVID-19, and that sick smokers would place an additional strain on the health services such as bed space, health personnel, and respirators (Masuabi

3

Personal communication, 10 September 2020

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2020). Similar motivations underpinned the temporary ban on alcohol, citing the high rates of alcohol-related trauma cases in hospital admissions. The evidence of these claims was hotly disputed in the mainstream and social media and in the courts. Evidence for and against the tobacco ban was presented by different research agencies. The Human Sciences Research Council (HSRC) argued that the “majority of smokers (88%) were not able to buy cigarettes during the lockdown suggesting that the ban was efficient in reducing cigarette access and therefore use” (HSRC 2020). In direct contradiction, the Research Unit on the Economics of Excisable Products (REEP) presented the results of their survey that stated that the ban had failed to do what it intended to and South Africans continued to smoke (van Walbeek et al. 2020). In the meantime, tobacco consumers paid exorbitant prices for “illegal” cigarettes procured through a growing transnational smuggling operation. Allegations of profiteering from the ban were levelled at Minister Dlamini-Zuma, who was rumoured to have close connections with the smugglers (Timeslive 2020). Yet, perhaps more significant, were the underlying notions about the alleged unhygienic and unruly behaviour of the poor, and by implication, Black South Africans. While aimed at South African smokers in general, statements made by the NCCC suggested that the ban would especially motivate the “poor and youth” to give up smoking. Minister Dlamini-Zuma stated in the press that the tobacco ban was aimed at “poorer communities” where “. . . people are more likely to share cigarettes, hookah pipes, zols, skyf, and/or lighters and matchboxes” that “increase the risk of Covid-19 transmission in communal and social settings due to a lack of social distancing and sharing infected saliva.” (Mabuza 2020). By highlighting un-hygienic practices that take place in “communal settings” and mentioning Indigenous and seemingly exotic methods of smoking (“hookas, zols, skyf”), these statements insinuated behavioural deficiencies amongst the poor, while conveying a neoliberal discourse of disease spread as the outcome of individual choices. While the South African President, Cyril Ramaphosa appealed to South Africa to recognise that COVID-19 is a disease that “doesn’t discriminate (. . .)” and “(. . .) infects the rich and the poor (. . .)” (Bhengu 2020a, March 31), narratives of the risks associated with being Black and poor told a different story. Although wealthy whites were initially perceived as the carriers of COVID-19, associations between dirt, disease, and blackness started to circulate in social media. A video circulated on Facebook showing a white woman instructing Black workers at a block of residential apartments on how to wash hands correctly (Nkanjeni 2020). In the video, employees stand in a row, singing the popular unofficial South African national anthem, “Shosholoza”, while washing their hands in buckets with soap. A tweet penned by Zelda La Grange (who has minor celebrity status as former president Nelson Mandela‘s personal assistant), stated “If you have a housekeeper, nanny or gardener, garden services or anyone in your employ, demonstrate to them what a 20-second handwash looks like. Explain and show them how the virus transfers though handshake, touching money, ATMs. Don’t assume they know” (Bhengu 2020b, March 17). The video and the tweet elicited public condemnation and accusations of racism. In both instances the two white women defended themselves as “not racist” and

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professed that they had nothing but good intentions by posting their messages. Their actions were reminiscent of white employers of domestic workers who forcibly tested their employees for HIV. But, more broadly speaking, the videos and tweets reproduced long enduring associations between indigeneity and disease. The focus of COVID-19 prevention on individual behaviours (smoking, drinking, handwashing), casts the disease as a problem of hygiene, of the absence of self-control, and of irrational behaviour. These are reoccurring themes in epidemics of infectious diseases, that serve to shift attention away from the structural conditions of disease spread. In a similar fashion as to the way HIV acquired a “black face”, so COVID-19 became to be regarded as a disease of the poor, who are seen to be most likely to bear the burden of morbidity and mortality of COVID-19 (Ahmed et al. 2020). Moreover, while there has been little resistance to the lockdown in South Africa, opinions have been expressed that this has been largely at the expense of Black South Africans for the benefit of whites. The Economic Freedom Front’s leader, Julius Malema noted that “Our government loves . . . to keep white people happy and safe, even at the expense of Africans” (Cocks 2020). Indeed, the deployment of security forces in predominantly Black residential areas such as townships where isolation and social distancing were more difficult revealed a disregard for human rights (Aljazeera 2020, June 12). Medical historian, Howard Philips, observes that histories of epidemics in southern Africa are vital to understanding current and future pandemics, and to avoid past mistakes. He further notes that pandemics not only expose fault lines, but that these also accentuate underlying social and cultural dispositions (Phillips 2020). This is evident in the ways by which “geographies of blame” (Farmer 1992) that emerged in the HIV epidemic, are reproduced in the time of COVID-19.

8.2

The Past in the Present

Taking the long view of HIV in Bushbuckridge, from the early days of its spread in the 1990s, through to the height of its impact in the mid-2000s, this book has chronicled a history of local responses to the epidemic, expressed in public and private narratives of infection, illness, dying, and death. By so doing, I have offered a critique of global narratives that celebrate the “end of AIDS” and its normalisation, by arguing that this invisibilizes suffering, past, present, and future. I agree with Moyer who observes that the rhetorical divide between the “age of AIDS” and the “age of treatment” obscures “epistemological continuities” in the epidemic (Moyer 2015, 260). While instilling optimism, the focus on a pharmaceutical solution to end AIDS distracts from the fundamental social, political and economic dynamics that underlie its spread, particularly amongst the poor and marginal (Prince 2012). Social and economic disparities continue to shape patterns of morbidity and mortality as the “social roots” of AIDS remain “stubbornly in place” (Hunter 2010, 225). Or, as

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Moyer concludes, “In the age of treatment, the more things change, the more things stay the same” (2015, 260–62). By the late 2010s, antiretroviral therapy (ART) was widely available in Bushbuckridge, potentially reversing disease spread and the possibility of untimely death (Kabudula et al. 2017a, b). Removing the association between AIDS and death, effective treatment was lauded as destigmatising the disease (Niehaus 2018). Indeed, as villagers intimated, the AIDS epidemic morphed into an “epidemic of antiretrovirals”. However, many residents and households had limited capacity to meet the daily demands of the ill. Healthy diets and nutritious foods are vital for the success of ART and caring for the sick became a strain on already stretched household budgets. As anthropological writings on ART programmes observe, treatment drugs create appetite, and represent the embodiment of hunger, provoking competition over scarce household resources (see Kalofonos 2010). Taking treatment drugs creates demands on the body that are antithetical to household survival needs (See also Marsland 2012). Echoing these observations, recent epidemiological research in Bushbuckridge reports persistently high rates of HIV-related morbidity and mortality amongst poorer households (Kabudula et al. 2017a, b, e933). Material circumstances therefore have direct consequences for managing adherence to treatment. Moreover, the spread of HIV has not been arrested; sustained HIV incidence amongst young women and adolescent girls4 underscores the need for continuing prevention efforts that address the social and economic circumstances of epidemic spread. Even while UNAIDS was celebrating the end of AIDS, HIV infections amongst young women in Bushbuckridge continued to be shockingly high.5 The success of treatment to heal and to prevent further spread of HIV relies on compliance to ART which is a lifelong commitment. Those who fail to embrace treatment are at risk of being alienated and blamed for their own suffering and of others. Writing on the Brazilian experience, João Biehl frames this as the “consolidation of a model of public health centred on pharmaceutical distribution. . .”. The pharmaceuticalization of health, Biehl argues produces a discourse that defines the non-compliant sectors of the population as “disposable” (2006, 376). Their non-compliance robs them of their citizenship and their right to suffering. Their plight is rendered meaningless, regarded as a result of their nonconformity to individualistic ideologies of health and responsibility. The pharmaceuticalization of everyday life (Bell and Figert 2012) occurs through therapeutic regimes that dictate the terms of who is eligible for medication and who bears responsibility for adherence. The possibility of a return to the spectre of the epidemic of the early to mid-2000s is ever-present. Although ART is available in many health centres and all hospitals

4

Reports indicate a national HIV prevalence of 5.6% among adolescent girls aged 15–19 years, 17.4% for young women aged 20–24 years (Pettifor et al. 2016, 1863) 5 Data from Bushbuckridge in 2012 reveals a prevalence of 5.5% among 15–19 year old women rising to 27% by age 20–24 years and 46% by 35–39 years (Pettifor et al. 2016, 1864).

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in Bushbuckridge, drug availability is often uncertain6 placing patients at risk of missing doses and developing drug resistant strains of HIV. Finally, there is evidence of the clustering of infectious and non-communicable diseases as well as gender-based violence, forming syndemics in socially and economically marginal communities and giving rise to “syndemic suffering” (Mendenhall 2014). In recent years, an increase in the incidence of non-communicable diseases such as diabetes has been reported in Bushbuckridge (Mee et al. 2016). What this points to is the enduring afterlife of HIV, as evidenced by the persistence of HIV infections, continuing AIDS morbidity and mortality, the rise in co-morbidities, the uncertainty of sustaining treatment, and the fears of a return to unmanageable illnesses and death. The lingering impact of the AIDS epidemic is visible in the epidemiological record, but also looms large in collective memories of suffering. As Briggs and Mantini-Briggs observe with respect to the Cholera epidemic amongst Indigenous Venezuelans in the early 1990s, this disease “continued to influence life even after its power to cause death had dissipated”. They conclude, “Time had been arrested by grief. Life, haunted by the ghosts of cholera, would never be the same (2004, 298–99). Along these lines, it is to memories of past suffering and their implications for the present that I now turn. In the early to mid-2000s when I did the bulk of the research for this book, HIV infections and AIDS-related deaths and illnesses were “public secrets”. Cast as a shameful disease, residents censored direct speech, masking the cause of illness and death, relegating this to gossip and rumour. These subaltern discursive practices formed a “local epidemiology” that linked epidemic spread to local histories of disordered development and desire, chaotic mobility, and failed personhood (See Chap. 5). Narratives of witchcraft and of AIDS “spreaders” highlighted the intentionality of infection, directing blame for misfortune on malicious, nefarious invisible forces, and locating suffering within social relations (See Chap. 3 and 4). These discourses simultaneously revealed and concealed the causes of illness and death (See McNeill 2011). While public secrets of illness and death circulating in popular narratives highlighted the spread of HIV through networks of desire and disorder, individual biographies focussed on the failure of imagined and hopeful futures, and the loss of agency. Hope, I argued, linked the future to present suffering, potentially transforming suffering, and was vital for healing. However, for the ill, the horizons of hope were truncated. Pretty and Philemon Gumede (Chap. 6) were rendered invisible in health care settings and exploited by healers offering miraculous cures. Khayellhle Mhlanga (Chap. 7) framed his condition through the metaphor of his body being controlled by a “machine” to convey the gradual loss of personhood as

6

According to a national survey of public health facilities in South Africa 20% were not able to provide at least one antiretroviral (ARV) or tuberculosis (TB) drug on the day they were contacted by researchers, while over a third had had a drug stockout in the previous 3 months, according to a national survey published. In Mpumalanga, where Bushbuckridge is located, 74% of facilities reported stockouts in the past 3 months (Hwang et al. 2019).

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he struggled against the weight of witchcraft, the vagaries of the labour market, disastrous relationships with women, and ultimately infection, illness and death. It has been several years since I recorded these accounts of life and death in the time of AIDS, when the epidemic was its height. By way of a conclusion I return to fieldwork undertaken in Bushbuckridge during 2019, and in particular, a conversation with a group of residents that I had first met in the early 2000s. One afternoon, late in November 2019, I chatted to NwaGomane (who I introduced in Chapter One) and members of her household—her adult daughter (Martha) and daughter-in-law (MaLindi). Seated under a strongly scented tree in her yard, eating groundnuts that she had harvested from her small garden, we looked at a collection of photographs dating back to the early 1990s that I had on my laptop. As we handed the computer around every now and then, we paused to joke about how people we knew had changed. “He was so skinny” remarked NwaGomane’s eldest daughter Martha, pointing to my friend Mapapeta who had posed for a photo in front of his father’s cattle enclosure. In 2019, Mapapeta was in his 40s, a balding and chubby man, reflecting his relative prosperity as a consultant. There were also several photos of me in my mid-twenties; NwaGomane’s daughters teased their mother reminding her that she used to think I was Mapapeta’s “white girlfriend” owing to my long hair. In another photograph taken in the early 1990s, I am seated on a bench under a tree, drinking vukanyi (maroela berry) beer with a group of old men. I recalled that one of the men, nicknamed “Rothmans” (as in the cigarette brand), would sleep until late in the afternoon, only getting out of bed when he heard the rattling of the beer truck making its deliveries to the village tavern. Despite his drunkenness and belligerence, we remembered Rothmans with fondness and laughed about his dedication to beer. Sadly, and inevitably so, many of the people in my photo collection were long dead. Rothmans died before he could retire as a night watchman, cheating him out of a state pension. His death, was however, different from those that occurred at the height of the AIDS epidemic. In the time of AIDS, the meaning of death had been transformed; all death occurred under the shadow of AIDS. This coloured our memories of the dead and our reminiscing. I was made aware of this by my interlocutors’ subtle glances and comments as we clicked through the photos. We stopped to look at a portrait I had taken of a young man named Augustus, who posed for me at a muchongolo dance held in April 2002. In the photo, Augustus is wearing a mustard coloured suit, a floral tie, and a wide-brimmed straw Basotho hat; he is grinning at the camera, inexplicably holding a large mango. NwaGomane’s daughters recalled that Augustus was a well-known and much admired dancer. I have other photos in my collection of him in muchongolo dance attire, kicking up dust as he danced the solo giya, demonstrating his agility and strength. These images of Augustus are a stark contrast to the memories I have of him at the height of his illness. Suspected of dying from AIDS, further talk about Augustus’ death would have opened up a longer complicated and fraught conversation about who he had possibly infected. Diplomatically, NwaGomane gestured for me to skip to the next photo, silencing the whispered side remarks of the others in our group. As I had learned, talking about death, and in particular suspected AIDS deaths, contained the

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danger of this spilling into gossip about sexual relationships and HIV infection networks, resurrecting and creating hazardous emotions and sentiments. But this was also unavoidable. The photos we looked at that day provoked anger and grief. A snapshot taken of Pretty Gumede’s (Chap. 6) sister Nelisiwe irritated Martha. Turning on her smart phone Martha clicked open Facebook and pointed to postings of Nelisiwe posing at hotel restaurants and in front of luxury cars, in the company of men who were clearly not her husband. Nelisiwe was seldom at her husband’s home in the Free State and spent most of the time at her grandmother’s home in Bushbuckridge. Showing us the Facebook posts, Martha exclaimed, “She forgets how her sister [Pretty] died! Does she want to go the same way? This is not respect”. It was at least 13 years since Pretty died. Another photograph was of a procession to the graveyard, which I had taken at the funeral of Jacob Mathonsi’s wife. MaLindi, NwaGomane’s daughter-in-law told us that soon after his wife died, Jacob Mathonsi’s relationships with his two teenage daughters had deteriorated. Jacob observed the customary 6 months of abstinence from sexual relations with women. However, Lebo his oldest daughter discovered that her father had purchased women’s deodorant, soap, body lotion and pantyhose, and kept these items tucked away in his wardrobe. “This shows he has a xigangu [secret lover]”. Lebo was struggling to pay her college tuition and did not welcome the competition posed by another woman. MaLindi remarked of women in general, “when they know your wife has died, they become very friendly”, noting that Jacob’s neighbour, a widow, often prepared food for Jacob. In another photograph, two young boys, Sipho and Nature, posed with their arms around my then 6-year-old daughter. Fifteen years later, the two boy’s lives had taken very different paths. Sipho moved to Johannesburg and obtained a diploma. Nature left home at 16 and was currently serving jail time, having been charged with wildlife poaching. Looking at the photograph, NwaGomane talked about the tragedy of Nature’s oldest sister, Xolani, who died at 28 years of age. Xolani had supported her younger siblings for many years via gifts from her lovers, paid the creche school fees and buying clothes once a year at Christmas time. Her passing meant that the family was made completely reliant on their mother’s (NwaGumede) welfare disability grants. NwaGumede like Xolani was also HIV positive. NwaGomane remarked bluntly that Xolani “refused the pills [ARVs]”. At this point the group grew silent, aware that NwaGumede was sitting alone in her house across the road. In the days when her daughter was alive, she would have joined our little group to gossip and laugh. “She’s been like this since Xolani died. She doesn’t even greet”, remarked Martha of NwaGumede’s self-imposed seclusion. “I mean we were kind to her, we let her stay here and gave her food when their house was destroyed”. Massive flooding in late 1990 and early 1991 destroyed many houses in the village. NwaGumede’s house was built of mud bricks, wood and thatch, and was not strong enough to withstand the rain. Abandoned first by her husband, her house destroyed, Xolani’s death, and her one son incarcerated, NwaGumede became embittered and angry. In the neighbourhood there were suspicions that her anger had turned her to witchcraft. Later that year, I heard via a

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telephone call from Johan who lived nearby the Gumede’s that NwaGumede had been discovered standing naked and speechless in a neighbour’s yard, caught by murhi placed there to fortify the homestead against attacks from witches. Rumours of her involvement in witchcraft were not accepted unequivocally. Martha rationalised her behaviour as a person driven mad by grief. Her public nakedness was taken as a sign of her insanity; but this was also a sign of witchcraft. The grief that NwaGumede and many other villagers bore was dangerous, and required containment and care as it threatened to disrupt social relations (See also Klaits 2005). In Chap. 5, we saw how Philemon’s health deteriorated upon learning he was HIV positive, and his diagnosis with “heart sickness” caused by excessive worrying. The ill were advised to try to be calm and quiet, to avoid confrontation to avoid worsening their condition. But, as an emotion, grief could cause others harm. Also, in Chap. 5, I wrote about the power of the tears shed by grieving widows who had been cheated out of their inheritance. The strength of the tears eroded the fortunes of those who benefited from death. Like the pollution associated with death, the tears could cause xinyama a “black shadow”, that clings to a person, creating hatred and disharmony amongst those they come into contact with. That day while we were looking at my photos, NwaGomane told me that grieving widows in her neighbourhood had started a prayer support group, as an outlet for the pain and anger they felt at losing their husbands. They met on Thursday afternoons at the local branch of the Nazarene Revival Crusade Church (NRCC) to take part in Kongela wa Manana (Mother’s Prayers). Recognising their common concerns, the women organised regular virtual prayer meetings held via mobile phone, taking advantage of the free calls between midnight and five in the morning. Praying in pairs over their phones, the widows asked God for vengeance against the women suspected of spreading HIV and causing their husband’s deaths. Their requests were made even more powerful through simultaneous prayer. NwaGomane’s neighbour, Gift, was mentioned in these prayers; she had benefited from her relationship with a retired school principal who purchased a car for her and provided her with groceries and cash (See Chap. 3). Early in 2018, Gift narrowly escaped death when she was involved in a car accident in the car that she had acquired from her lover. Martha, who told us about this, remarked “God is the biggest witch”. The women’s prayers were not unlike curses, invoking ideas of the potency of words as weapons. Together, these ethnographic snapshots demonstrate that the AIDS epidemic refuses to disappear, despite claims to the contrary. Biologically, HIV continued to circulate in the bodies of the afflicted, hidden away in the blood and body tissues, with the potential to re-emerge if treatment is interrupted or suspended. But it is not only the viral remnants that threaten health and well-being; the aftershocks of the epidemic are also contained within the memories of those who survived and remained. Contagion was not contained, neither by treatment, nor by death and the grave. Although much of the death and suffering caused by the AIDS epidemic may be in the past, it was still very much part of peoples’ current realities. Despite efforts to contain death, it continued to reverberate in quotidian life, threatening to disrupt social relations by exhuming the suffering of the past. The advent of a new condition

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such as COVID-19 makes such observations all the more poignant, signalling the persistence of suffering along familiar pathways and with similar consequences.

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Index

A Abednego Mathebula, 72, 93, 113 Abigail Mnisi, 77 Abina Chiloane, 41 Abortion, 74, 79 Abstain, Be Faithful, Condomise (ABC), 10 Accountability, 105 Accusations, 48, 70, 105, 107, 112, 114, 116, 121, 150, 168 Acornhoek, 17, 37, 40–42, 48, 49, 56, 57, 95, 113, 120, 136, 137, 152, 158 Activists, 10, 11, 14, 16, 21, 53, 69, 130, 162 Adherence, 5, 11, 13, 15, 166, 170 Adolescent, 11, 51, 55 Afflictions, 15, 16, 71, 74, 91, 92, 97, 102, 105, 108, 113, 114, 119, 140, 145–147, 158 African National Congress (ANC), 9, 10, 36, 53, 55, 130, 131 Agencies, 16, 20, 33–35, 37, 57, 60, 70, 83, 126, 134, 146, 147, 168, 171 Ahlulani Manyisa, 95 AIDS, 67–69, 71–87, 91–99, 101, 102, 105– 122, 125–127, 129–131, 133–136, 140, 145, 147–149, 154, 157–159, 162, 165, 166, 169–172, 174 AIDS activism/ists, 10, 11, 53, 69, 162 AIDS body, 14, 82 AIDS Control and Prevention Project (AIDSCAPP), 55 AIDS Industry, 7, 13 AIDS Training Information Centre (ATIC), 55 Alice Khumalo, 43 Alli Bhila, 156 A long illness, 73, 78

Alpheus Ncube, 108 Alphina Zitah, 108 Aluta, 100 Americans, 56, 59, 68, 92, 98, 167 Analogous, 71, 102, 106, 112 Ancestors, 34, 40, 51, 71, 105, 132, 138, 161, 167 Anna Ndlovu, 85 Anthropology/anthropologists, 2, 4, 20, 21, 33, 35, 51, 67, 69, 105, 106, 126, 129, 130, 140, 145, 146 Antiretroviral therapy (ART), 36, 52, 125, 128, 166, 170 Antiretrovirals (ARVs), 1–24, 132–134, 147, 170, 173 Apartheid, 8–10, 22, 31, 32, 37, 45, 48, 50, 52, 53, 91, 92, 94, 101, 129, 166 Apostolic St John's Church, 109 Appadurai, A., 4 Appetites, 78, 80, 81, 110, 119, 132, 135, 136, 146, 161, 170 Ash, 114 Ashforth, A., 162 Augustus, 172

B Bad death, 86 Bantu Authorities Act, 38, 45 Bantustans, 9, 37, 45, 47, 50, 60, 84, 118, 139 Barberton, 46, 155 Barrow, 152 Basson, W., 94 BavaMzimba, 118

© Springer Nature Switzerland AG 2021 J. Stadler, Public Secrets and Private Sufferings in the South African AIDS Epidemic, Social Aspects of HIV 6, https://doi.org/10.1007/978-3-030-69437-1

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180 Beers, 15, 19, 22, 33, 42, 46, 50, 51, 57, 59, 72, 77, 82, 83, 111, 117, 127, 130, 141, 148, 155, 158, 172 Bennet Magagule, 79 Benoni, 109 Besnier, N., 91, 92 Bhandla, 70, 97 Bible, 43, 109 Biehl, J., 134, 170 Big data, 145 Biltong, 149 Biographies, 11, 23, 24, 146, 147, 152, 153, 171 Biomedical, 53 Biomedical turn, 22 Biomedicine, 58, 67, 68, 86, 93, 106, 130, 166, 167 Biopower, 67, 68 Biotechnical embrace, 14 Black, 48 Black (people), 32, 38, 41, 45, 51, 69, 94, 130, 167 Blame, 23, 32, 35, 36, 55, 68, 75, 92, 94, 105, 106, 115, 121, 140, 158, 167, 169, 171 Bloods, 13, 14, 17, 18, 20, 23, 24, 53, 69, 71, 74, 82, 93, 99, 107, 110–113, 115, 119, 121, 132, 140, 174 BMW Z3, 74 Bochem, 39 Bodies, 1, 3, 4, 6, 7, 9, 10, 14, 16, 23, 24, 39, 40, 46, 52, 57, 67–71, 74, 75, 78–82, 85, 86, 93, 96, 97, 99, 101, 105, 107–109, 113, 114, 117, 119, 145–147, 155, 157, 159, 161, 162, 170, 171, 173, 174 Borders, 5, 9, 71, 108, 120, 127, 139, 150 Botha, 156 Botswana, 99, 100 Bourgois, P., 130 Brakfontein, 128 Brazil, 68, 134 Bread, 76, 107, 127, 137, 160 Briggs, C., 67, 68, 86, 171 Briggs, M., 86 Buch, E., 47, 49, 50 Buhle, 100 Bushbuckridge, 1–11, 17, 19, 21–24, 37–41, 44–50, 52, 54–58, 67, 70, 74, 76, 82, 83, 86, 91–93, 95–99, 101, 102, 106–108, 113–116, 119, 120, 125, 127, 128, 131, 133, 137–139, 141, 146, 147, 149, 150, 153, 155, 158, 167, 169–173 Bushbuckridge Health and Social Services Consortium (BHSSC), 7

Index C Cancers, 14, 21, 35, 68, 118, 139 Cannibalism, 102 Cannibalized, 108 Cape Town, 10, 106 Carla (daughter), 2 Cash, 18, 45, 51, 77, 78, 80, 86, 97–99, 108, 110, 139, 154, 174 Catholic, 106 CD4, 11, 131, 134, 147, 148 Cell phones, 76, 78, 79 Cervical cancer, 3, 15 Chaka (dirt), 74 Charlie Hlatswayo, 95 China, 21, 165 Chinese, 119 Cholera, 47, 68, 171 Chris Hani-Baragwaneth Hospital, 131 Christians, 39–45, 51, 55, 60, 149, 156 Chuluka, 113 Church of the Nazarene, 37, 41, 44, 45 Citizenship, 14, 36, 37, 127, 131, 170 City to City, 6 Clara Mantini-Briggs, 31, 32, 36, 67, 68, 171 Clothing, 100, 119, 127, 137, 154, 157 Coffins, 17–19, 54, 98, 101, 137 Colonial, 12, 32, 36, 37, 60 Comaroff, J., 127, 150 Comfort Ndlovu, 95 Co-morbidity, 117 Comrades, 9, 10, 121 Condoms, 7, 33, 52, 53, 55, 57, 58, 83, 85, 92–96 Confessional technology, 23, 69, 148 Confessions, 70, 113, 148 Conny (wife), 2 Conspiracy theories, 92 Contagious Diseases among Natives Commission, 69 Contraception/family planning, 52 Coolness, 137 Cornelius Mbetse, 72 Coronavirus, 165 See also COVID-19 Cottondale, 37, 84 COVID-19, 24, 165–169, 175 Crapanzano, V., 126 Crown Land, 38 Culture/cultural, 5, 20, 22, 31, 32, 35, 51, 59, 60, 68, 92, 105, 126, 145, 166 Cyril Ramaphosa, 168

Index D Daggafontein, 39 Daniel Hlatshwayo, 42 Das, V., 146 Data, 11, 47, 52, 68, 85, 86 Daughter-in-law (sing. makothi. Pl. vakothi), 43 Daveyton, 109 David Mkatshwa, 75 Death certificate, 117 Deaths, 1, 2, 5–8, 10–13, 15–17, 19–24, 34, 36, 47, 54, 67, 68, 70–76, 78–80, 83, 85–87, 91, 94, 97–99, 105, 106, 108, 111, 112, 114–121, 125, 127, 129, 133, 136, 137, 140–142, 145–163, 165, 167, 169–174 Deep talk, 91 Delius, P., 160 DelVecchio-Good, M.-J., 14, 126 Denial, 12, 13, 15, 69, 73 Department of Health and Social Welfare, 1, 7, 12, 13, 69, 72, 75, 94 Depression, 156 Desire-excessive, 23, 79, 80, 106, 111, 125 Desires, 4, 5, 23, 34, 44, 74, 79–83, 86, 101, 106, 108, 111, 115, 121, 125, 126, 141, 142, 147, 153, 158, 159, 171 Desjarlais, R., 146 Desmond, 100 Diabetes, 14, 133, 165, 171 Diarrhoea, 17, 18, 46, 54, 78, 82, 85, 118, 119, 132, 136, 146, 161 Dictionary of African Christian Biography (DACB), 41, 42 Dike Kubeka, 79 Dimros Mbetse, 96 Discourses, 8, 11–16, 20, 22, 23, 31, 34–37, 50, 55, 59, 60, 68, 80, 83, 86, 91–102, 106, 113, 126, 150, 167, 168, 170, 171 Dlamini-Zuma, 168 Doctor Scheepers, 134 Domestic domains, 43, 114, 151 Domestic workers, 17, 19, 93, 169 Donor funding, 16, 85 Dorothy Maseko, 77 Douglas, M., 12 Dreams, 1, 72, 108, 112, 138, 141, 161 Dry sex, 33 Dr. Zwane, 49 Dumfries, 42 Durban, 119 Durkheim, E., 102 Dyondzani Selinda, 78 Dzhambukeri, Flora, 47 Dzhambukeri, Sarah, 47

181 E East Rand, 79, 84, 99, 128, 129, 132, 137, 139, 152–154 Easter Weekend, 117–121 Ecks, S., 166 Edwin Cameron, 10 Elections, 9, 31, 128, 130 Elizabeth Mathonsi, 78 Engelman, L., 165 Enos Chiloane, 154 E-Pap, 160 Epidemics, 1, 2, 4–17, 20–24, 31–33, 35, 36, 52–54, 57, 59, 60, 67–69, 72–74, 83, 85, 86, 91, 93, 94, 101, 105, 106, 112–114, 125, 127, 129, 130, 145, 166, 167, 169– 172, 174 Epidemiology, popular, 87 Erotic, 111, 153 Estandeni, 45 Ethel Lucas Memorial Hospital (ELM), 40, 42, 43, 48 Europe, 13, 165 Evidence, 12, 15, 19, 23, 42, 54, 60, 68, 70, 73, 75, 78, 85, 86, 93, 99, 112, 115, 117, 119, 135, 157, 158, 168, 171

F Facebook, 4, 12, 99, 100, 167, 168, 173 Fake news, 102 Fanius Mzimba, 70 Farius Ndlovu, 110 Farmer, P., 92, 145, 169 Fassin, D., 146, 148, 162 Fast, 84, 85, 136, 137 Fatalism, 34, 35, 126 Felicia Ngomane, 109 Female Genital Mutilations, 35 FG Tea, 132, 135 Fieldwork, 2, 21, 24, 172 Flominah Khoza, 96 Flows, 51, 74, 77, 82, 84, 92, 146, 162 Fongkong, 3 Footpaths, 107, 108 Foreigners, 23, 49, 57, 102 Fortification, 71, 107 Foucault, M., 67 Frank, E., 21 Frans, 95 Freddy Mathabela, 70 Funerals, 70, 72–75, 78, 79, 98, 107, 116–118, 120, 127, 137, 141, 149, 153, 173 Futures, 10, 16, 22, 81, 101, 116, 121, 126–128, 139, 140, 160, 169, 171

182 G Gabriel Ndlovu, 54 Gangs (prison), 147, 155, 156 Gangsters, 10, 149, 152 Garlic, 12, 132, 135 Gauteng, 85 Gay men, 13, 32, 53 Gaza, 3, 149 Gazankulu, 45, 47–49, 52, 84, 118, 138 Gazankulu Department of Education, 49 Gender, 2, 8, 23, 32, 33, 35, 42, 56, 81, 82, 86, 101, 118, 151 Generational, 37, 80–82, 86, 107 Genocides, 8, 53, 145 Geoffrey, 100 Ghosts, 83, 84, 171 Gift Khoza, 3, 76 Giya, 82, 172 Gloria Mabanda, 114 Gluckman, M., 59, 76 God, 34, 80, 140, 160, 167, 174 Goodwill Mgiba, 115 Gossip, 2, 3, 9, 23, 67, 68, 73, 75–78, 80, 83, 86, 87, 115, 118, 140, 154, 160, 171, 173 Government grants, 6 Graboyes, M., 36 Grard, J., 68, 130, 134 Grief/grieve, 8, 21, 106, 121, 137, 171, 173, 174 Grinaker, 80, 153 Gusto Makhubela, 95 Guxe, 18

H Haas, B., 126 Hahani, 3 Hamba hambana, 116 Harare, 108 Healing, traditional, 34, 50, 52, 58 Health Act (63 of 1977), 69 Health Systems Development Unit (HSDU), 2, 8, 55 Heart Sickness, 71, 140, 174 Henderson, P., 10 Henry J Kaiser Family Foundation, 57 Herzfeld, M., 17 Hichem Ben Azzouz, 134 Hitler, 84 HIV, 1–8, 10–24, 67–87, 91–102, 105, 106, 111, 112, 114–117, 120, 125–133, 135, 137, 140, 142, 147, 157, 158, 162, 165– 167, 169–171, 173, 174

Index HIV antibody, 69 HIV awareness campaigns, 72 HIV prevention, 7, 22, 31–61, 67, 126, 167 HIV status, 4, 10, 69 HIV Testing, 7, 23, 131, 148 H K Bedwell, 41 Hlanganani Dube, 96 Hoedspruit, 17, 18, 50 Homelands, 138, 139 Hopes, 4, 5, 10, 11, 14, 23, 24, 71, 125–142, 145, 147, 171 Hospitals, 2, 4, 6, 7, 10, 17, 18, 24, 38–43, 47–52, 58, 68, 74, 76, 78–80, 85, 99, 100, 117, 120, 125, 128–131, 133, 134, 136, 137, 141, 157, 158, 160, 168, 170 Hot (hisa), 6, 71, 74, 94, 109, 110, 129, 137, 140, 159 House in Vereeniging, 74 Household (muti), 6, 10, 18, 20, 38, 39, 43–48, 58, 70, 72, 81, 82, 86, 101, 107, 111, 112, 118, 119, 121, 130, 147, 154, 159, 160, 162, 170, 172 Human Sciences Research Council (HSRC), 73, 113 Hummer guy, 99, 100 Humvees, 99, 102 Hygiene, 40, 44, 45, 49, 75, 167, 169

I Ilanga, 110 Illness narratives, 107, 125–142 Immune systems, 12, 117 Income generating projects, 8 Indigenous/healers/n’anga/sangoma, 10, 12, 22, 33, 40–42, 50, 52, 53, 57–59, 68, 70, 71, 74, 82, 94, 107, 109, 114, 116, 117, 119, 120, 128, 132, 157, 158, 161, 167, 168, 171 Inequalities, 3, 15, 22, 24, 31, 35, 56, 59, 67, 106, 145, 166, 167 Infect one, infect all, 97 Innequalities, 92 International Holiness Mission, 41 International Holiness Pentecostal Church (IHPC), 70, 148 Irving, A., 16 Iscariot Macheke, 116 Isidliso, 105 IsiZulu, 3, 82, 105, 152 Isoka, 33

Index J Jacob Mathonsi, 173 Jamaica Nxumalo, 71 JF Jooste Hospital, 10 Jimmy, 149, 162 Johannesburg, 2, 3, 6, 19, 21, 23, 24, 32, 38, 39, 42, 46, 75, 79, 83–85, 95, 96, 105, 109, 115, 118, 119, 125, 128, 149, 152, 156, 158, 165, 173 Johannesburg General Hospital, 130, 131 Jojo Malamule, 84 Jonatana (author), 1 Jonathan (author), 82, 84, 134, 136 Joseph Mabundla, 115 Josephine Komane, 156 Joyce, 150, 152, 153 Julius Malema, 169

K KaGomane village, 149 KaNyamazane, 156–158 Kark, Sydney and Emily, 50 Kasteel, 138 Katrina Khoza, 43 Kelly, R.C., 112 Key populations, 13 Khayellhle Mhlanga, 24, 146, 148, 171 Khumo, 101 Kiba dance, 58 Kiepersol, 138 Kinship, 2, 51, 98, 102, 107, 112, 125, 147, 162 Klaits, F., 121, 142, 174 Klein Drakensburg, 5 Knowledge Attitudes Behaviour (KAB), 20 Knowledges, 31, 35–37, 41, 54, 60, 67–87, 96, 102, 105, 107, 120, 136, 139 Komatipoort, 120, 150 Kongela wa Manana, 174 Kruger National Park, 5, 98 Ku fakaza, 113 Ku hanza, 39 Ku jikha-jikha, 78 Kuku, 151 Ku mhamba, 117, 132, 138 Ku phanda, 3, 8 Ku pirates, 95 Ku tekela, 39 Ku tlhavela, 70, 71, 107 Ku wela, 74 Kwashiorkor, 47 KwaThema, 154

183 L Labour tenants, 38 La Fontein, J., 97, 106 Lawu, 159 Lebo (Mathonsi), 173 Lebowa, 45, 48, 49, 138, 139 Leclerc-Madlala, S., 3, 7, 12, 33, 34 Le Marcis, F., 128, 130, 134 Lilian Ngoyi Health Centre, 131 Lillydale, 52 Limpopo, 9, 37, 57, 99, 118 Living corpses, 9 Lobola, 139 LoveLife, 56, 57, 59 Lowveld, 5, 6, 17, 21, 37–46, 57, 60, 100 Ludlo, 95 Lulekani, 100 Luzo – Gaza civil war, 17

M Mabandi, 114 Mabunda, Jemima, 46 Machines, 171 Machonyisa, 3 Madimbi Mathebula, 80 Madness, 82 Madumo, 162 Mafulara, 108 Mageligelis, 101 Magic, 22, 40, 86, 111, 116 Magreth, 109 Maize meal, 18, 20, 39, 47 Majaha, 151 MaKwaZanele, 70 Malaria, 37 MaLindi, 172, 173 Malnutrition, 47 See also pellagra Malume, 2, 85, 132, 150–152 Mama Lindiwe, 117 Mamabolo, Gaza, 46 Mamazala, 43, 81 MaMhlanga, 146–150, 152, 158–160 Mandla Ndlovu, 58, 92 Mapapeta, 172 Maputo, 38, 119, 149 Marieke Mathonsi, 116 Marks Mathebula, 54 Maroela tree/beer/nkanyi/vukanyi, 15, 22, 72, 77, 81–83, 111, 117, 127, 130, 141, 148, 155, 158, 172

184 Marriages, 3, 7, 43, 78, 81, 109, 110, 115, 119, 139, 152, 153 Martha Gomane, 82, 161 Martha Ngobeni, 72 Masana Hospital, 49, 85 Masculine, 4, 33, 37, 151, 154 MaSeerane, 95 Mashishimale, 100 Masquelier, A., 83 Matanyula (play sex), 44, 82, 151 Mathonsi (Gladys), 152 Matikwane Hospital, 93 Matthews Seerane, 78 Mattingly, C., 126, 127 Maveriveri, 92 Mbeki, T., 9, 12, 13, 21, 36, 57, 58 McNeill, F.G., 7, 171 Medical gaze, 85 Medicine, 31 Memory (Mzimba), 118 Menarche, 81 Merry Pebble Stream, 115 Merry, S.E., 16, 85, 86, 145 Metaphors, 9, 24, 73, 82, 97, 108, 121, 146, 147, 150, 161, 162, 171 Mfenha (Baboon), 43, 92, 109, 111, 112 Mhala, 45, 48, 49 Migrant labour, 32, 39, 48 Migrants, 99, 101, 108, 115, 117, 137, 139, 149, 162 Miles and Associates, 56 Missionaries, 22 Miyazaki, H., 126 Mnisi, B., 77, 115, 138, 139 Mobility, 39, 171 Modern, 12, 35, 45, 50–52, 106, 126, 167 Mohlakeng, 47 See also Randfontein Mohlakengone, 3 Montreal International AIDS Conference, 12 Mopani News, 93 Moral, 14, 16, 21, 23, 44, 51, 68, 69, 75–82, 86, 93, 98, 101, 102, 106, 112, 113, 121, 125, 127, 134, 158, 159 Moral panics, 23, 97 Morbidities, 5, 22, 68, 73, 81, 85, 105, 106, 121, 166, 167, 169–171 Morema, M.J., 10 Morgan, 77, 78 Morogho, 161 Morphine, 134 Mortality, 1, 5, 11, 22, 56, 68, 73, 81, 85, 86, 105, 106, 121, 167, 169–171

Index Mortuaries, 7, 73, 94, 117, 137, 139 Moyer, E., 169 Mozambique, 3, 17, 24, 37, 40, 84, 114, 116, 117, 120, 127, 149, 150 Mpumalanga, 37, 171 Muchongolo, 49, 82, 84, 97, 107, 172 Mufundise, 135, 158 Mujere, J., 126, 128 Mumsy Khoza, 78 Munguluve, 46 Munjhonjhela phansi, 110–114 Murhi (medicine), 4, 57, 93, 107, 125, 174 Mwanza, 34 Myths, 91, 100 Mzimba family, 118

N Narratives, 5, 8, 10, 13, 14, 16, 22, 23, 32, 34–36, 50, 81, 91–93, 97, 101, 108, 111, 112, 115, 117, 121, 125–127, 129, 145–149, 162, 165–169, 171 National AIDS Council (NAC), 53 National Coronavirus Command Council (NCCC), 167, 168 National Institute of Allergy and Infectious Diseases (NIAID), 12 Native Land Act, 38 Nature, 92, 116, 157, 173 Nazarene Revival Crusade Church (NRCC), 44, 174 Ndhuna, 97, 115 Ndhuna Mogakane, 115 Ndzhovola Bride wealth, 18, 44, 80, 117 Ndzilo vu siku, 114 Nelisiwe, 128, 129, 133, 137, 138, 140, 173 Nelson Mandela, 53, 55, 58, 130, 162, 168 Nelspruit, 6, 55, 70, 83, 84, 93, 156, 158 Neoliberal, 23, 60, 106, 168 Nerves, Hypertension, "thinking too much", 18 New South Africa, 130 New witchcraft, 106, 113 Ngwenza, 110 Nigerian, 99, 102 90-90-90, 13, 15, 22, 145 Nkaka, 18 Nkosazana Dlamini-Zuma, 167 Nomsa Mathonsi, 54 Non-governmental Organisation (NGO), 12, 56, 133 Norms, 33, 60, 134 Ntwanano Shabangu, 79

Index Nurses, 1, 18, 38, 43, 49, 51, 52, 57, 58, 70, 76, 85, 91, 93, 94, 131, 133, 134, 136 Nutrition, 12, 39 NwaBembe, 17–19, 80, 81, 83, 94, 108, 113 NwaEphraim, 46, 82, 101, 107, 114 NwaGodi, 117 NwaGomane, 1–5, 9, 71, 75, 107, 116, 127, 172–174 NwaGumede, 173, 174 NwaKhomani, 71 NwaMgiba, 46 Nwa’mlambo, 110, 111, 119 NwaPetros, 70

O Obesity, 14 Occult, 23, 70, 71, 102, 105–107, 112, 115 Olive oil, 132, 135 OMO, 74

P Pace Magazine, 54 Pagan, 45 Pandemics, 24, 31, 165–169 Pap, 7, 19, 59, 161 Patriarchal, 60 Pearson, C., 130 Pedi, 40 Pellagra, 47 Pensions, 6, 48, 118, 119, 127, 160, 172 Pentecostalism, 106 Personhood, 23, 24, 41, 54, 75–81, 86, 121, 125, 138, 147, 162, 171 Petyt, M. Mr., 39 Phalaborwa, 6, 100, 101 Pharmaceuticalization, 5, 14, 16, 170 Phendulani High School, 58 Phenomenological, 16, 147 Philemon Gumede, 171 Philips, H., 169 Photographs, 14, 75, 100, 172, 173 Pilgrims Rest, 38, 40 Pizza Song, 56 Poison, 5, 72, 108, 112, 141 Police, 5, 6, 46, 95, 97, 148, 155, 157, 166 Political activism, 9 Political economy (hope), 126 Pollution/polluted, 53, 74, 102, 156, 159, 160, 162, 174 Polygamy, 33, 35, 44, 55 Portuguese East Africa, 17

185 Post-Apartheid, 81 Post truth, 13, 102 Poverty, 6, 12, 20, 34, 36, 57, 75, 106, 145 Pre-exposure Prophylaxis (PrEP), 13 President’s Emergency Plan For AIDS Relief (PEPFAR), 15, 19, 54, 133 Pretty Gumede, 173 Primary health care, 17, 50, 57, 130, 131 Prisons, 53, 115, 147, 148, 154–156, 158, 166 Protests, 9, 12, 52, 84 Publics, 31–33, 36, 37, 41, 42, 50, 53, 55, 59, 60, 67–73, 75, 80, 83, 85, 91–102, 105, 114, 121, 128, 148, 154, 162, 166, 168– 170, 174 Public secrets, 8, 23, 67, 73, 171 Pulana, 40–42

R Race, 22, 23, 31–37, 54, 60, 106, 166, 167 Racial segregation, 32, 53 Radical biopolitics, 166 Radio Bushbuckridge, 94, 95 Ramahlodi, 57 Randfontein, 3, 46, 47, 79, 96, 154 Rape, 13, 35, 36, 55, 138, 155 Rashes, 75, 114, 119, 158 Razor blades, 52, 70 Reconstruction and Development (RDP), 6 Refugees, 17, 114, 150 Reginald Jones, 41 Remembering, 115–121 Removals, 45, 46 Reproductive health, 51 Research Unit on the Economics of Excisable Products (REEP), 168 Resettlement, 47, 48 See also Removals Resistance, 9, 34, 36, 42, 55, 60, 67, 69, 92, 169 Reuben Sher, 53 Revenge, 101 Reverend Ben Silinda, 45 Reynolds-Whyte, S., 105 Riot Mathonsi, 54, 58, 94 Risks, 12, 13, 20, 23, 32, 33, 36, 75, 85, 86, 98, 101, 102, 105, 111, 112, 153, 167, 168, 170, 171 Rixilane, 74 Rixile AIDS clinic, 133 Roads, 6, 18, 49, 70, 76, 77, 80, 83–85, 94, 95, 136, 153, 154, 173 Roll-on, 153 Roll out, 11

186 Rosaldo, R., 21 Rothmans, 172 Rumours, 2, 9, 23, 41, 73, 111, 171, 174 Ruth Mbetse, 43 Ryder Gumede, 70 Rylko-Bauer, B., 145

S Safer sex, 54, 60 Salim Abdul Karim, 12 Sappi, 118 Sarafina, 58 Sarina Mhlongo, 78 Schools, 3, 9, 20, 38, 39, 42–44, 47, 49, 56, 58, 72, 74, 77–79, 83, 92, 95, 96, 115, 127, 135, 139, 150, 152, 153, 160, 173, 174 Secrecy, 23, 69, 73, 78, 106, 108, 111, 112, 127 Secretive, 23, 72, 73, 76, 107, 121, 153 Sekhukhuneland, 40 Semen, 74, 81, 109, 111, 112 Setel, P.W., 31, 35, 68, 81 Sex workers, 13, 32, 112 Sexuality, 31, 33, 35, 36, 55, 56, 59, 82, 97, 111, 112, 150, 153 Sexual liaisons, 83 Shangaans, 1, 4, 17, 38, 40–42, 48, 49, 78, 84, 92, 139 Shao, J., 21 Shebeens, 79, 111, 153, 155, 157 Sher, R., 53 Shisa nyama, 83 Sibongile Magagule, 116 Sibulele Sibaca, 14 Simmer and Jack (Mine), bee, 42 Simon Hlatswayo, 115 Simphiwe, 157, 158 Single story, 35 Sipho, 173 SisMinah Khomani, 17 Skorokoros, 84 Smoking, 5, 15, 167–169 Snakes, 110, 112, 155, 161 Snuff, 119, 132 Social facts, 13, 102 Social media, 4, 99, 100, 165, 167, 168 Solly’s Tavern, 148, 155 Songeni Primary School, 77 Sontag, S., 21 South Africa, 1–3, 5, 8, 11–15, 19, 21, 24, 32, 52, 53, 69, 73, 81, 102, 108, 113, 114, 119, 130, 134–136, 150, 155, 165, 167– 169, 171

Index South African anthropology, 20 South African HIV Clinicians Society, 12 South African Medical Journal (SAMJ), 6, 32 South African Medical Research Council (MRC), 73 South African Native Trust (SANT), 38, 39 South African Union, 38 Soutpansberg, 37 Soweto, 10, 46, 58, 69, 105, 116, 131, 132 Spiritual in/security, 92, 105 Statistics, 16 Stereotypes, 12, 33, 34, 36, 57, 59, 166 Stigma, 15, 54, 69, 73, 115, 121 Stroke, 108, 120, 129, 132, 140 Structural violence, 31, 147 Suffering, 8–10, 14–17, 19–24, 67, 84, 92, 125–127, 129–131, 135, 142, 145, 146, 148, 156, 169–171, 174, 175 Suicide, 72, 108, 116 Swaziland, 37, 99 Swiss Mission, 37 Swiyindwana, 151 Sylvia, 132, 135–139, 141 Syndemics, 15, 171 Syphilis, 32, 36, 39, 47, 48, 69

T Tambiah, S., 70 Tanzania, 34, 85 Tattoos, 155 Thai, 112 The Guardian Newspaper, 73 Theko Magagule, 110–114 Thom, A., 12 Thompson Mkonto, 42 Thulamahashe, 17, 84, 94, 95, 120, 132 Tindzaka, 74, 75 Tinhlobe, 41 Tintswalo Hospital, 47, 49, 50, 52, 55, 93, 99, 133, 134, 148, 158, 159 Tishangwana, 109 Titos Mbowane, 80 Tobacco, 119, 166–168 Tokoloshe, 109 Traditions, 12, 45, 46, 48, 50, 51, 53, 55, 57–59 Transactional sex, 85 Transvaal, 37 Treatment Action Campaign (TAC), 12, 162 Treatment literacy, 37 Trekker coffee, 132, 135 Trump, D., 13, 102 Truth, 13

Index Tsakani, 128 Tshabalala-Msimang, M., 12, 73, 135 Tubercluosis (TB), 32, 36, 47, 48, 50, 51, 57–59, 69, 117, 129, 134, 140, 161, 166 Tutu, D. (Archbishop), 32 28s, 155 Tzaneen, 37, 40, 96, 155

U Uganda, 105, 106 UK, 13 UNAIDS, 53 United Nations Economic Commission for Africa, 35 United Nations (US), 13, see USA Unknowing, 85 USA, 165, 167

V Vaginas, 99–101, 111, 151 Vajaha, 81, 82, 150, 159 Vamia Mzimba, 118 Venereal diseases, 32, 80 Venezuela, 68 Vertiginous body, 82 Vet koek, 127 Violence, 11, 21, 31, 33–35, 46, 60, 115, 121, 134, 146, 147, 152, 155, 156, 162, 171 Virus, 7, 83, 114, 145, 168 Viral suppression, 13, 145 Vomiting, 17, 18, 54, 78, 85, 113, 118, 136, 146, 161 Vu vabye, 140 Vu vabye (sickness), 1

W Waithood, 81, 126 Waiting, 17, 18, 24, 94, 108, 125, 126, 128, 131, 139, 141 Wambazi Makukule, 39 Wanuna ntiyela, 82, 147, 162 Washington Post, 73 Weiss, B., 85, 101 West Rand, 3, 118, 149, 154 West, H.G., 107, 113 Western, 35, 36, 40, 43, 54, 58 Whites, 2, 8, 17, 23, 38, 41–43, 45, 46, 50, 57, 69, 80, 81, 92–94, 101, 110, 119, 126, 130, 131, 134, 138, 139, 167–169, 172

187 Whoonga/nyaope, 5 Wife inheritance, 35 Wiklif Mathebula, 41 Wilson Maekere Mathebule, 39 Witbank, 38, 79, 153, 156, 161 Witchcraft, 1, 9, 22, 23, 33, 34, 40–42, 48, 70, 76, 87, 102, 105–121, 125, 127, 141, 147, 149–152, 157, 161, 162, 167, 171–174 Witchcraft - New, 106, 113 Witch familiars, 40, 108, 111, 113 Witch hunting, 105, 106 Witnessing, 113 Wits Rural Facility, 2 Wittingstall, E.H. Mr., 39 Witwatersrand University, 2, 50 Women’s Foreign Mission Society, 43 World AIDS Days, 58, 59, 72 World Health Organisation (WHO), 14, 53, 60, 94 World War I, 38 World War II, 40 Worms/maggots, 82, 111

X Xigangu, 119, 153, 154, 173 Xikhapakhapa, 111, 155 Xilungu, 80, 81 Ximiresi Mathebula, 109 Xindhachani, 1, 108, 150 Xingombela, 44 Xinyama, 156, 174 Xiphukuphuku, 151 Xirumbani, 114 Xolani, 70 Xolani Gumede, 5

Y Yamba, C., 34, 105, 106 Y-Centre, 56, 57 Young women, 2, 8, 13, 23, 43, 49, 52, 55, 72, 75–79, 81–83, 86, 106, 112, 133, 152, 154, 156, 170

Z Zambia, 21, 105, 106 Zelda La Grange, 168 Zephania Ngobeni, 42 Zeurbekom, 113

188 Zidji, 32 Zimbabwe, 105, 108 Zion Christian Church (ZCC), 11, 113, 118, 132, 135, 158

Index Zombies, 1, 108, 150, see Xindhachani Zoonotic, 92, 165 Zulu, 33, 110 Zuma, J., 128