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AIDS in the Shadow of Biomedicine

AIDS in the Shadow of Biomedicine

Isak Niehaus


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The Bushbuckridge region of South Africa has one of the highest rates of HIV infection in the world. Having first arrived in the area in the early 1990s, the disease spread rapidly, and by 2008 life expectancies had fallen by 12 years for men and 14 years for women. Since 2005, public health facilities have increasingly offered free HAART (highly active antiretroviral therapy) treatment, offering a degree of hope, but uptake and adherence to the therapy has been sporadic and uneven.

Drawing on his extensive ethnographic research, carried out in Bushbuckridge over the course of 25 years, Isak Niehaus reveals how the AIDS pandemic has been experienced at the village-level. Most significantly, he shows how local cultural practices and values have shaped responses to the epidemic. For example, while local attitudes towards death and misfortune have contributed to the stigma around AIDS, kinship structures have also facilitated the adoption and care of AIDS orphans. Such practices challenge us to rethink the role played by culture in understanding and treating sickness, with Niehaus showing how an appreciation of local beliefs and customs is essential to any effective strategy of AIDS treatment.

Overturning many of our assumptions on disease prevention, the book is essential reading for practitioners as well as researchers in global health, anthropology, sociology, epidemiology and scholars interested in public health and administration in sub-Saharan Africa.

Isak Niehaus is a senior lecturer in anthropology at Brunel University London, where he currently co-ordinates the MSC program in Medical Anthropology. He has previously held teaching positions at the Universities of the Witwatersrand and Pretoria in South Africa, and lectured at several other universities in Europe and the United States. His previous publications include Witchcraft, Power and Politics (co-authored with Eliazaar Mohlala and Kally Shokaneo, 2001) and Witchcraft and a Life in the New South Africa (2012).

‘Niehaus captures the diversity of experiences of those living with HIV/AIDS in Bushbuckridge, South Africa. He reminds us that effective community engagement and efforts to counter stigma must be at the forefront of the global response to HIV/AIDS.’
Peter Piot, London School of Hygiene & Tropical Medicine

‘Building on some three decades of experience, Niehaus offers a superb analysis of the South African HIV/AIDS epidemic. A necessary reminder of how anthropological questions of kinship and misfortune remain highly significant to any understanding of HIV/AIDS.’
Julie Livingston, New York University

‘Niehaus returns us to the fundamentals of anthropology, offering a subtle but sharp critique of the Foucauldian turn in health. This is a superb ethnography – among its contributions the best critique of mainstream views on AIDS orphans I have seen.’
Mark Hunter, author of Love in the Time of AIDS

'A brilliant and vivid ethnographic account of how people’s understanding and treatment of HIV/AIDS intersects with existing social and symbolic meanings around disease, death, witchcraft, healing strategies and everyday social interactions in Bushbuckridge, South Africa.’
Alcinda Honwana, author of Youth and Revolution in Tunisia

Table of Contents

Section Title Page Action Price
Cover\r Cover
About the author iii
Title Page v
Copyright\r vi
Dedication vii
Contents ix
Maps\r x
Preface and acknowledgements xiii
1: Introduction\r 1
Biopolitics and HIV/AIDS 5
From biopolitical theory to social specificity 10
Sickness and AIDS: a brief history of Bushbuckridge 14
Organisation of the book 24
2: Death\r 27
The sexual hypothesis 30
AIDS as death 33
Stigma of the living corpse 39
Conclusions 45
3: Blame\r 47
Biomedicine, gender and the politics of blame 49
Conspiracy theories: Dr Wouter Basson, Americans and wild beasts 55
Witchcraft and the reconfiguration of blame 59
Conclusions 64
4: Words\r 66
‘If I test HIV-positive I will die’ 69
The agency of words 72
Deadly words, unfortunate names, and curses 74
Sickness, silence and discreet speech 79
Conclusions 85
5: Knowledge\r 87
Social and material barriers 89
The life story of Reginald Ngobeni 92
Conclusions 105
6: Dreams\r 107
Experiencing AIDS, using HAART 110
The significance of everyday dreams 112
The content of ARV-induced dreams 115
The sequences of ARV-induced dreams 124
Conclusions 128
7: Care\r 130
Kinship and the diffusion of parenthood 134
HIV/AIDS and marriage 138
HIV/AIDS and childcare 140
Conclusions 150
8 Conclusions 152
Culture, South Africa, the baby and the bathwater 156
Beyond biomedicine: therapeutic interventions 158
Notes 163
References 171
Index 187