A new study of South Africans’ widespread reluctance to practice safe sex despite suffering one of the most severe AIDS epidemics in the world challenges the view that state-sponsored denialism of the disease is to blame.
The new president, Jacob Zuma, has just sacked his health minister Barbara Hogan who had been praised by AIDS activists for trying to turn around the country’s disastrous policy on the disease.
Zuma and the former president, Thabo Mbeki, have both received worldwide criticism for making false public statements playing down the seriousness of the disease.
During a 2006 trial in which he was acquitted of rape, Zuma famously said he took a shower after sex with an HIV-positive woman, believing this would reduce his risk of infection.
Mbeki, who was forced to resign last year, falsely stated that HIV does not lead to AIDS. His health minister, Manto Tshabalala-Msimang, was also denounced for recommending natural treatments of garlic, beetroot and lemon instead of anti-retroviral drugs, earning her the nickname Dr Beetroot.
Dr Fraser McNeill, a Research Fellow at the London School of Economics, spent 14 years living in the remote north-eastern region of Venda working as an English teacher, an AIDS educator, a performing musician and, only latterly, a prize-winning anthropologist.
He found that condoms are commonly regarded as vectors of HIV, as are the women who visit communities to teach people about safe sex, rendering the preventative programmes seriously counter-productive. There are nearly 6 million people infected with HIV in South Africa and 1,000 deaths a day, yet AIDS is never discussed in public and even mentioning that someone has died of the disease is taboo.
In a research paper, published this week in the academic journal African Affairs, Dr McNeill produces evidence to suggest that the nation’s state of mass denial is not based on the words of Zuma, Mbeki and their ministers. The politicians merely compound a deep-rooted problem.
Instead, he discovered, South Africans have a cultural fear of unnatural death and its associations with witchcraft and the living dead. There is a widespread tendency to blame people or things for deaths that are perceived to be unnatural, therefore anyone who talks openly about AIDS is implicated in causing the disease.
Dr McNeill explains how peer group projects that send uniformed women into villages to educate people about safe sex have been counter-productive.
“The educators are placed in a vulnerable position of blame. Their publicly expressed knowledge of AIDS is equated with an assumed experience of – and implication in – AIDS-related deaths.
“This has given rise to a widely held belief that peer group educators are vectors of the virus. At the core of their safe sex message, condoms epitomise this close connection between knowledge and experience. As the central symbols of prevention, the salient objects upon which the science of AIDS in rural Africa hinges, they are thus often thought – like the educators who tout them – to cause AIDS.”
Therefore people avoid discussing the disease even when someone they know has died of AIDS, explains Dr McNeill:
“On receiving news of someone’s death, for example, a public response that enquired as to the cause was as unthinkable as it was pointless: the bearer of the news would never admit to such knowledge in public.”
He adds that this attitude of “guilt by association” merely reflects the belief widely held throughout southern Africa that no death, apart from that of the very old or very young, is “natural”. All but the most devout Christian families will harbour suspicions that someone, or something, was directly responsible for their relative’s early passing.
Dr McNeill compared attitudes towards AIDS with those surrounding another cause of “unnatural” death, a spate of deaths in a village in Venda when people feared that their water supply had been deliberately contaminated. The poison was called “seven days” because, it was rumoured, you only lived for seven days after consuming it. When one of the village chiefs called an emergency meeting to discuss the issue, people were so fearful of being accused as poisoners that nobody would talk about it despite their leader’s protestations at the childlike secrecy.
Dr McNeill explained that only those in positions of authority were able to talk openly about the poison. “Those who spoke openly about seven days were in social positions through which they could circumvent blame, protected from the consequences of an accusation through political or spiritual sanction.”
Dr McNeill concludes: “So-called state denial has not caused the silence and confusion surrounding the AIDS epidemic. It has arisen due to deep-rooted social conventions which have resulted in the safe sex programme being disastrously counter-productive.”