Political Economy, Political Anthropology Must Have Place in Debate Over AIDS in South Africa, Opinion Piece Says

The July 2002 ruling by the South African Constitutional Court that the government must provide nevirapine to HIV-positive pregnant women and the October cabinet statement supporting wider availability of antiretroviral drugs "may have finally ushered in a new era" in the debate over AIDS in South Africa, Didier Fassin, director of the Centre de Recherche sur les Enjeux Contemporains en Sante Publique at the University of Paris, and Helen Schneider, director of the Center for Health Policy at the School of Public Health at the University of Witwatersrand, write in an "Education and debate" piece in the March 1 issue of BMJ. "It should now be possible to discuss the reality of AIDS in South Africa without reducing the argument to simple dualisms (such as being for or against a viral cause of AIDS, for or against the president)," they write. The authors propose an approach for discussion of the epidemic in South Africa that involves political economy and political anthropology. Fassin and Schneider state that three social factors -- social inequalities, mobility and sexual violence -- "seem to place South Africa at a higher risk of HIV." Further, the authors state that these three factors are "partly the legacy of centuries of colonial exploitation and racial segregation, culminating in the institution of apartheid in the second half of the 20th century."

A 'Resource for Democracy'
However, Fassin and Schneider write that a political economy of AIDS cannot altogether explain the suspicion in South Africa of science and orthodox beliefs; history shows that a "racialization" of issues and a "theme of conspiracy against Africans" have contributed to the "somewhat contradictory notion that the AIDS epidemic and its treatments are part of a plot to eradicate the black population." The authors write, "The marks of apartheid are still deeply inscribed in the bodies and minds of the people who had to suffer under it ... and the country's AIDS crisis manifests the legacy of the politics of the past." They state that limiting the explanation of HIV to poverty is "certainly an oversimplification" and that the factors of inequality, mobility and violence must be considered in constructing public health policies. In addition, focusing only on behavior change or treatment would be overlooking such social factors, they write. Fasin and Schneider conclude, "In South Africa, AIDS is not just a tragic and dramatic phenomenon: through the mobilization of activists as well as lay people and through the fight for social justice it has also come to be a resource for democracy" (Fasin/Schneider, BMJ, 3/1).