Rush/panic/rush: Speculations on the value of life and death in South Africa's age of AIDS

Public Culture

Volumn 20, Issue 2, 2008, Pages 199-231

  Morris, Rosalind C ^a  

^a NONE

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EID: 47349118827     PISSN: 08992363     EISSN: None     Source Type: Journal    
DOI: 10.1215/08992363-2007-024     Document Type: Article

References (74)

1. At the time that these interviews were conducted, there was considerable debate in South Africa about the viral etiology of AIDS, not least because of the skepticism expressed about it by President Thabo Mbeki and his two health ministers, Nkosazana Dlamini-Zuma and Manto TshabalalaMsimang. Mbeki and his health ministers famously sided with a number of medical dissidents who either dispute the existence of the virus or argue that it is merely a passive passenger in patients whose illnesses have other causes (whether associated with viral infection or malnutrition). However, as Didier Fassin has shown, their suspicion about the viral etiology of AIDS has been conflated in the press with their skepticism about some of the treatments being offered. Fassin also notes that such skepticism about the international medical community's response to AIDS in Africa was itself mediated by long experience with the pathologizing discourses of colonialism and the inequitable provision of health care services under apartheid. He rightly demonstrates that the caricature to which Mbeki's policies were subject masked other significant issues, a masking that the debates about AIDS permitted to occur. Nonetheless, despite the significance accorded such debates in the national press, there was no evidence that they were swaying thought about AIDS in the mining town where I worked - a town that remained strongly devoted to the ANC until 2006, when a crisis over service delivery precipitated a profound and sometimes violent questioning of the party. On the AIDS debate, see Fassin, When Bodies Remember: Experiences and Politics of AIDS in South Africa (Berkeley: University of California Press, 2007).
2. It is perhaps this sentiment, as much as any objectively discernible strategic orientation on the part of the national government, that explains Catherine Campbell's decision to title her book on the AIDS crisis in Carletonville Letting Them Die: Why HIV/AIDS intervention Programmes Fail (Cape Town: Double Storey/Juta, 2003). Fassin has, I think, persuasively argued that this analysis of AIDS policy in South Africa, while well intentioned, misses much of the nuance and the complexity in the debates about how to respond to the health issues presented by AIDS in a situation of limited public health facilities, overtaxed and inadequate financial resources, and an extremely transient population for whom follow-up is difficult at best.
3. Campbell, Letting Them Die, 17. According to a report published in 2003, "Prevalence of HIV among men and women in the general population, mineworkers, and sex workers, was 20 percent, 37 percent, 29 percent and 69 percent, respectively."
4. Brian Williams, Dirk Taljaard, Catherine M. Campbell, E. Gouws, L. Ndhlovu, J. Van Dam, M. Caraël, and B. Auvert, "Changing Patterns of Knowledge, Reported Behaviour and Sexually Transmitted Infections in a South African Gold Mining Community," AIDS 17, no. 14 (2003): 2099-107. Relative to the provincial averages, these numbers are high, but they conform to the general patterns seen elsewhere. And these have seen a considerable increase. According to the Actuarial Society of South Africa, the HIV prevalence rate in 2002 was estimated at 20.6 percent for all women 15-49 years of age, with a rate of presentation at antenatal clinics of 31.9 percent. The rate for men 15-49 years of age was calculated at 17.5 percent. In 2003, the total number of deaths caused by AIDS exceeded for the first time those caused by all other factors combined. Rob Dorrington, Leigh Johnson, Debbie Bradshaw, and Timothy-John Daniel, "The Demographic Impact of HIV/AIDS in South Africa" (Cape Town: Centre for Actuarial Research, South African Medical Research Council, and the Actuarial Society of South Africa, 2006). More recently, the South African National AIDS Council published statistics indicating 2006 prevalence levels of 33.3 percent for females 25-29 years of age, and 12.1 percent in the same age group for men. South African National AIDS Council, "HIV and AIDS and STI Strategic Plan for South Africa, 2007-2011," www.doh.gov.za/docs/hivaids-progressrep.html (accessed March 16, 2008), 24.
5. Max Horkheimer and Theodor Adorno use the term adaptation to refer to a process coerced by capital, by which laborers come to treat their predicament within capital as both necessary and natural. Reminiscent of Walter Benjamin's notion of "second nature," this process is also dependent on the intimacy between positivism and capitalism, and it is thus in the idiom of the natural sciences that the workers are made to misrecognize their predicament. My use of the term is intended to be taken up within this lineage. I am, however, conscious of the racialist overtones of the term, and of the risks that attend using it when, in so many other contexts, the attribution of an adaptive mechanism to a group of persons is part and parcel of the effacement of their humanity. See Horkheimer and Adorno, Dialectic of Enlightenment, ed. Gunzelin Schmid Noerr, trans. Edmund Jephcott (Stanford, Calif.: Stanford University Press, 2002).
6. In 2001, 90 percent of mineworkers considered themselves to be migrants (compared to 97 percent in 1988), and most had not been born in the area. However, in the township, the rates of self-described migrancy are 17 percent. Men from the township also tended to travel outside of the area less frequently. See Lewis Ndhlovu, Catherine Searl, and Johannes van Dam (Horizon) and Yodwa Mzaidume, Bareng Rasego, and Solly Moema (Mothusimpilo Intervention Project), "Reducing the Transmission of HIV and Sexually Transmitted Infections in a Mining Community: Findings from the Carletonville Mothusimpilo Intervention Project: 1998 to 2001," Horizons Final Report (Washington, D.C.: Population Council), 16.
7. Buti Alfred Kulwane, "Civic Competence in Khutsong" (MA thesis. Public and Development Management, University of the Witwatersrand, 2002), 11.
8. Monako Dibetle, "Khustong: Govt Won't Budge," Mail and Guardian, April 28, 2006;
9. "Government, SACP Condemn Ongoing Khutsong Violence," Business Day, April 15, 2006:
10. "Trashing and Burning Khutsong Will Never Solve the Problem," Sowetan, December 19, 2005.
11. These rates are generally high throughout Merafong. In 2001, more than 83 percent of the population fifteen to sixty-five years of age earned 3,200 rand or less per month. More than 52 percent earned less than 1,600 rand per month. This was lower than the averages for both Gauteng and Northwest Provinces, the two provinces under whose jurisdiction the various towns and townships of Merafong then fell. The exchange rate that year varied from 7.4 to 13.5 rands to the dollar, with an average of 8.62. Census data for Merafong, derived from the 2001 national census, appears in Merafong City Municipality, Merafong City Local Municipality Local Economic Regeneration Study (Merafong City: Urban Econ Development Economists, 2005), 28.
12. As Kulwane notes, the proliferation of shacks even on the properties of township houses was the result of extreme population growth, especially at the end of the 1980s, and a ban, placed by the apartheid state, on further construction. There were, in fact, no new houses built with government support or licensing between 1973 and the end of apartheid in the early 1990s. See Kulwane, "Civic Competence," 33-34.
13. Following the redesignation of Merafong as part of the economically impoverished Northwest Province, opposition to the local ANC became vociferous and violent. In 2007 ANC representatives had been asked not to enter Khutsong township, and when they did so, they were confronted by displays of civil disobedience or outright and sometimes physical hostility. Riots, the burning of public facilities, and physical intimidation have erupted periodically, and recent elections were largely boycotted by local residents, leading to an ANC reelection but no popular support and a diminished capacity to claim representativeness by the party. The situation remained highly volatile at the end of 2007, and the consequences for future elections and thus ANC hegemony in the area remain in question.
14. The Mineral and Petroleum Resources Development Act of 2002 extended and clarified provisions in the national constitution calling for the development of a "Broad-Based Socio-economic Empowerment Charter." In response, the four major entities in South African mining-the Department of Minerals and Energy, Chamber of Mines, South African Mining Development Association, and National Union of Mineworkers - agreed to develop an industry charter. These groups signed on to an agreement advocating the transfer of ownership in the mining industry, at market rates, such that historically disadvantaged South Africans (HDSAs) would assume at least 26 percent of each mining company within 10 years of the charter's promulgation. It further called for the industry to assist HDSAs to raise 100 billion rand in financing to facilitate this new ownership. Other goals, including better education and skills training programs within the mining sector, greater participation by women in the industry, rural development and alternative employment schemes for communities affected by mine closures, and nondiscrimination against foreign migrant labor, are also addressed by the charter, which nonetheless stipulates that the increase of participation by HDSAs beyond 26 percent ownership will not be pursued if it risks the mining companies' viability, which is to say, profitability. For further details, see "Broad-Based Socio-economic Empowerment Charter," Government Gazette, August 13, 2004, 6-17, www.info.gov.za/gazette/ notices/2004/26661.pdf (accessed March 16, 2008). Further clarification and a reaffirmation of these principles came in July 2004, with the Department of Minerals and Energy's issuance of a policy document titled "Clarification on the Application of the BBSEE Charter of the MPRDA."
15. See Mzolisi Diliza, "Understanding the New South African Mining Environment," address presented at the LBMA Precious Metals Conference 2004, Shanghai, www.lbma.org.uk/conf2004/3A.c.diliza_LBMAConf2004.pdf (accessed March 16, 2008).
16. I use the term language game in Wittgenstein's sense, to suggest a contextual system according to which a term can be understood. The term in question here is life/living. The games are those of epidemiology and actuarial science versus political economy. See Ludwig Wittgenstein, Philosophical Investigations (1953; repr., London: Blackwell, 2001).
17. Fassin, in When Bodies Remember, rightly notes the excessive degree to which questions of behavior, long the central concern of public health educators, are culturalized when these issues are discussed in African contexts.
18. Fredric Jameson, The Political Unconscious: Narrative as a Socially Symbolic Act (Ithaca, N.Y.: Cornell University Press, 1981).
19. Jean Comaroff and John Comaroff, "Millennial Capitalism: First Thoughts on a Second Coming," in Millennial Capitalism (Durham, N.C.: Duke University Press, 2001), 11.
20. In conversation about this essay, Michael Hardt remarked that this has always been the case. This may well be true. But what is remarkable about the appearance of this consciousness in South Africa, today, among youth, is the degree to which radical discourse of previous decades would have expressed its goal as the reappropriation of capital and, indeed, the elimination of capitalism. It is the dissipation of this latter ambition that brings South Africa into line with so much of the rest of the neoliberalizing world after the end of Soviet socialism.
21. Campbell, Letting Them Die.
22. I use the term danger to apply to the actual events afflicting people, and the term risk to its representation in terms of calculable and incalculable probabilities.
23. The most visible of these civil society entities is the Treatment Action Campaign (TAC), the group that spearheaded the movement to demand generalized antiretroviral distribution. There are numer-ous others, supplemented by myriad foreign-financed nongovernmental organizations. It is important to recognize, however, that in the early period civil society and state were in agreement, and indeed, they jointly opposed the international pharmaceutical lobby, though they were soon to fall into conflict. But even in this case, many participants in civil society are themselves prominent members of the state apparatus. The most notable among these is Supreme Court Justice Edwin Cameron, who has for many years worked with Zachie Achmat and Mark Heywood in the TAC. His account of his involvement in the struggle against AIDS can be found in Cameron, Witness to AIDS (Cape Town: Tafelberg, 2005). For the history of the complex relations between civil society and the state in South Africa's epidemic, see Fassin, When Bodies Remember.
24. Anecdotal evidence from recent survey results may, however, suggest the beginning of a reduction in transmission and prevalence rates among some segments of the youth population. These remain to be confirmed and, in the absence of sustained efforts of the sort now being undertaken (but currently under threat due to funding cuts), may be lost. Yodwa Mzaidume, personal communication, August 2007.
25. The full range of these analytics can be found in Kyle D. Kauffman and David L. Lindauer's AIDS and South Africa: The Social Expression of a Pandemic (New York: Palgrave, 2004).
26. I am grateful to Yodwa Mzaidume, of the Mothusimpilo Intervention Project, for explaining to me in what ways abstinence might be thought differently as a preventive discourse. In her analysis, abstinence is a discourse with the broadest legibility, and hence must be the frame within which other strategies, such as condom use, are addressed, particularly in the education of youth. If abstinence is the initial starting point in preventive education, then youths who are not sexually active can imagine themselves as the addressees, even though they are unlikely to maintain this posture indefinitely. Other workers at the Mothusimpilo project emphasized that abstinence may provide a better preventive strategy than condom use in contexts where heavy alcohol use leads to the "forgetting" of prophylaxis. In their work among women at risk in this community, the project workers found that the avoidance of coital sexual intimacy in relationships where negotiation was difficult or impossible was the only alternative to exposure. I remain uncertain about how to think of this broad tactical intelligence, or its implications for the tendency among Western scholars (including myself) to reduce the question of abstinence to moralism. It remains here as a question, one whose seriousness I must provisionally mark only with a gesture of recognition.
27. The reference here is to Susan Sontag's Illness as Metaphor (New York: Farrar, Straus and Giroux, 1978) much more than to her later AIDS and Its Metaphors (New York: Farrar, Straus and Giroux, 1988), but I also have in mind Emily Martin's work on immunology and late capitalism, wherein the resemblance between the discourses of flexible accumulation and immunology comes in large part to substitute for an analytics of the relationship between the two. See Martin, Flexible Bodies: Tracking Immunity in American Culture from the Days of Polio to the Age of AIDS (Boston: Beacon. 1994).
28. Linda Singer, Erotic Welfare: Sexual Theory and Politics in the Age of Epidemic (New York: Routledge, 1993), 40. The text was written in 1990, shortly before Singer's death, and posthumously assembled and edited by Judith Butler.
29. Singer, Erotic Welfare, 29.
30. See n. 53.
31. Singer, Erotic Welfare, 36.
32. Singer, Erotic Welfare, 36.
33. Singer, Erotic Welfare, 38.
34. Like Jean and John Comaroff, I see this conjuncture as determinant of South African possibilities, though I am less certain that they have been construed in "Utopian" terms. See their "Millennial Capitalism," 8.
35. Sarah Nuttall, "Stylizing the Self: The Y Generation in Rosebank, Johannesburg," Public Culture 16, no. 3 (2004): 430-52.
36. Mzaidume, personal communication, August 2007.
37. The term condomization is derived from the term condomize, widely used in South African AIDS prevention circles.
38. It is difficult to fully understand the degree to which research on AIDS and the publication of infectivity rates are involved in a complex feedback system that is itself responsible for some of these phenomena, such as participation in funeral schemes. That question is beyond the purview of this essay, but should be borne in mind in considering the historical account provided here.
39. Hilda Kuper and S. Kaplan, "Voluntary Associations in an Urban Township," African Studies 3, no. 4 (1944): 178-86.
40. Robert J. Thomson and Deborah B. Posel differentiate among several types of societies and insist on the maintenance of categorical distinctions between those formations that work like credit unions, or stokvels, and those that also provide social services (from emotional support, to transportation and festivities at funerals). They further distinguish between "assured sum" societies, which tend to a multiplicity of needs, and "indemnifying societies," which cover set costs of essential goods such as caskets and food. Some work by managing collective resources, some by setting up savings accounts for members and then securing them against withdrawal (by, e.g., holding bank passbooks), and some by collecting monies and disbursing them to next of kin, who then spend it, with or without supplementing the funds, for funerary rites. Some societies are devoted exclusively to burial planning, and some take on this task as part of a much larger mandate. Some also provide for illness. These distinctions, while historically significant, nonetheless are of less concern to me than the general differentiation between such societies and other kinds of capitalized insurance. See Thomson and Posel, "Burial Societies in South Africa: Risk, Trust, and Commercialisation" (paper presented at the Actuarial Society of South Africa annual convention, Johannesburg, October 30-31, 2001), 6-7. Also see Thomson and Posel, "The Management of Risk by Burial Societies in South Africa," South African Actuarial Journal 2 (2002): 83-127.
41. Kulwane, "Civic Competence," 39.
42. Mia Brandel-Syrier, Black Women in Search of God (London: Lutterworth, 1962), 38;
43. Thomson and Posel, "Burial Societies." Thomson and Posel ("Burial Societies," 7) also note the emergence of different kinds of societies, less likely to be premised on the consensual model. In particular, they mention administered societies, whose purpose is to generate profit for their administrators.
44. Kulwane, "Civic Competence."
45. Thomson and Posel, "Burial Societies," 4.
46. Erik Bahre gives a much higher estimate for the township of Khayelitsha, stating that 96 percent of the people who earn more than 4,000 rand have an insurance policy or are covered by a partner's policy; 41 percent who have an estimated income of less than 1,000 rand are also covered by a policy, sometimes because a partner took out the policy. Bahre, "New Sources of Wealth, New Sources of Conflict: A Historical Approach to Burial Societies and Insurance among the Xhosa in South Africa" (paper presented at the Actuarial Society of South Africa annual convention, Cape Town, October 12-13, 2006), 14.
47. P. Hoets, T. Langschmidt, E. Metton, D. Milne, C. Oakenfull, C. Platt, R. Roux, J. Simpson, and J. Van Wyk, Futurefact 2000 (Durban: Gitam, Absa, and Unilever, 2000).
48. Thomson and Posel, "Burial Societies," 16.
49. Eve Kosofsky Sedgwick, Touching Feeling: Affect, Pedagogy, Performativity (Durham, N.C.: Duke University Press, 2003).
50. Thomson and Posel, "Burial Societies," 55.
51. Bähre, "New Sources of Wealth," 8-9.
52. Bahre, "New Sources of Wealth," 9.
53. One of the best examples of this is a report by Uthini Research on the significance and management of funerals, undertaken for G:ENESIS Analytics, a Johannesburg-based economics consultancy: "Project Usizo: Management Report," August 2004, www.finmarktrust.org.za/documents/2004/SEPTEMBER/ SecondTierInsurance.pdf (accessed March 16,2008). The report is available at the Web site of FinMark Trust, an organization funded by the U.K. Department for International Development. It is devoted to the idea of "making financial markets work for the poor."
54. Bahre, "New Sources of Wealth," 12. Bähre is citing the fourth-quarter 2003 Business Monitor International (London: Mermaid House), 3, and the Marginal Revolution Web site, www.marginalrevolution.com/ marginalrevolution/2005/02/insurance_fact_.html.
55. Gary Hartwig, "The Low Income Sector - the Life Industry's Perspective" (paper presented at the Actuarial Society of South Africa annual convention, Cape Town, October 2000), 12-13.
56. Hartwig, "The Low Income Sector," 24.
57. Bähre, "New Sources of Wealth," 26.
58. It is not possible to recount here even the most general contours of this history. Excellent accounts can be found in V. W. Allen, History of Black Mineworkers, vols. 1-3 (London: Moor Press, 1992; Johannesburg: National Union of Mineworkers, 2003);
59. Sheila van der Horst, Labour in the South African Gold Mines, 1911-1969 (Cambridge: Cambridge University Press, 1942);
60. Alan Jeeves, Mining Labour in South Africa's Mining Economy: The Struggle for the Gold Mines' Labour Supply, 1890-1920 (Johannesburg: Witwatersrand University Press, 1985);
61. Shula Marks and Anthony Atmore, eds., Economy and Society in Pre-industrial South Africa (London: Longman, 1980);
62. Charles van Onselen, New Babylon, New Nineveh: Everyday Life on the Witwatersrand 1886-1914 (Jeppestown: Jonathan Ball, 1982);
63. Wilmot G. James, Our Precious Metal: African Labour in South Africa's Gold Industry, 1970-1990 (Cape Town: Philip, 1992);
64. and T. Dunbar Moodie, Going for Gold: Men, Mines and Migration (Johannesburg: Witwatersrand University Press, 1994).
65. Despite the aesthetic appeal of the argument for disposability, it is my sense that HIV/AIDS may well have generated the occasion for an ironic containment of what Achille Mbembe has called necropolitics. Mbembe, "Necropolitics," trans. Libby Meintjies, Public Culture 15 (2003): 11-40.
66. AngloGold Ashanti, Annual Report (Johannesburg, 2006).
67. Ndhlovu et al., "Reducing the Transmission of HIV," 31.
68. Ndhlovu et al., "Reducing the Transmission of HIV," 30.
69. D. D. Van Rooyen, personal communication, July 2005.
70. Edward Lipuma and Benjamin Lee, Financial Derivatives and the Globalization of Risk (Durham, N.C.: Duke University Press, 2004), 182-84.
71. S. J. B. Peile and W. S. van der Merwe, "Hedge Funds in South Africa-the Investment Case" (paper presented at the Actuarial Society of South Africa annual convention, Cape Town, October 2004).
72. Peile and van der Merwe, "Hedge Funds," 4.
73. Peile and van der Merwe, "Hedge Funds," 15.
74. Rudolf Hilferding, Finance Capital: A Study of the Latest Phase of Capitalist Development, ed. Tom Bottomore, trans. Morris Watnick and Sam Gordon (London: Routledge and Kegan Paul, 1981).