Living and Dying with AIDS in Africa

New Perspectives on an Modern Disease
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Living and Dying with AIDS in Africa

Original: So stirbt man in Afrika an Aids
Subtitle: New Perspectives on an Modnern Disease
Author: Reimer Gronemeyer
Translation: James Farrel
Publisher: Brandes & Apsel
Frankfurt, 2005
Soft cover, 15x21 cm, 128 pages, several photos

Publisher’s note:

Is a plea for a more respectful approach to dealing with the social and cultural traditions of Africans in the ongoing battle against AIDS.

The renowned German sociologist and author Reimer Gronemeyer spent four years carrying out numerous interviews with African AIDS victims and their families, as well as experts in the field.

Their reports and observations on living with the disease provide irrefutable evidence to support the authors arguments that the destruction of traditional African living environments the family, subsistent lifestyle, social values has been the decisive requirement for the rapid spread of the virus.

AIDS in Africa is a disaster born of modernisation. A provocative and emotive book.

Thesis: AIDS in Africa: A Catastrophe of Modernisation?

HIV/AIDS is an epidemic that takes 6,600 lives every day in Africa. Controlling the epidemic is a high-priority agenda on the international programmes, and it is increasingly becoming the main focus of state-run and non-governmental development organisations.

One can now speak of the emergence of an AIDS-control-complex involving doctors, prevention experts, pharmacists, development workers, health officials, AIDS counsellors, home-care specialists, and all kinds of scientists and planners. Consulting companies which until now have only been working on integrated agriculture, road building or management consulting are abandoning these projects and devoting themselves to the AIDS pandemic. Bill Gates has donated millions, Elton John is raising funds, UNAIDS is requesting billions of dollars for global campaigns against the virus.

With so much money and expertise involved, one would think that this AIDS nightmare would be soon banished. However, the so-called »War Against AIDS« has so far been unable to record any stemming of the epidemic, let alone a victory. The disease is spreading in many African countries - especially in Southern Africa - with increasing speed. The number of new infections shows no sign of falling.

What is the reason for this? Are Africans unaware of how the virus is spread? That surely cannot be the case. It is not due to any lack of prevention campaigns: billboards, brochures, street theatre, consciousness-raising courses, radio and television broadcasts - today, most South Africans should be sufficiently aware of HIV/AIDS, even in rural areas. Nevertheless, these campaigns have clearly been ineffective. Why, then? Why are the rates of infection so high?

Are the prevention campaigns not as good as they should be? Is it a case of African mistrust of Western bio-medical explanatory models? Are Africans somehow resistant to persuasion? Are they indifferent to whether or not they will become infected? Is the spread of AIDS first and foremost a result of violence and rape? Is the anomie prevalent in these societies so dramatic that such self-destructive tendencies flourish unimpeded?

Each and every one of these questions can to a certain extent be answered in the affirmative. Prevention campaigns require a broad awareness of the workings of the human body and the ability to plan ahead, neither of which condition yet obtains in either rural or urban populations. Both ordinary and educated people (aside from the biomedical model that everybody is so devoutly talking about) have a strong attachment to traditional ideas: these ideas do not allow for the separation of sexuality and fertility propagated by every prevention campaign.

Instead, it is assumed that the exchange of body fluids during sexual intercourse is necessary because beneficial to health. Violence and rape doubtless contribute considerably to the spread of AIDS: women and girls often do not have the option of saying »no« to teachers and relatives. Patriarchal authority, when taken completely out of its traditional social con-text, is subverted into naked brutality, with lethal consequences. Men who become infected in the mineworkers' compounds return home after months of absence, transmitting the virus to the women living in the rural areas.

There are many factors contributing to the failure of the prevention campaigns, some of which are not specifically African: it is well-known that campaigns in Europe against nicotine, alcohol or lack of exercise have also failed. There are, however, also reasons connected with Africa's special »cultural« affliction, factors that are systematically ignored.

It is therefore extremely imprudent to categorize the AIDS epidemic as chiefly medical and prevention-orientated. It is instead a question of the social conditions that have permitted the fatal success of the virus. The struggle against HIV/AIDS will become more effective when the social environment of the epidemic is taken into account. There is thus a grain of truth in the controversial thesis of Thabo Mbeki, the President of South Africa who holds the poverty of the peoples of Africa responsible for the epidemic.

The fact that the virus nests in the destroyed and broken habitats of Africa, and finds there ideal conditions for spreading, cannot be rejected; nor does it not conflict with the bio-medical explanatory model. The term »poverty« does not solely and pre- eminently refer to a lack of money or calories, but rather to the dissolution of contexts that sustain human life, families, and cultural traditions.

The modern age has hit the communities of Africa like a bomb, and the resulting bomb- site, which now stretches out over the horizon, is the feeding-ground for this epidemic virus. The virus needs acceleration, mobility, broken family connections. It needs institutions that foster new modes of transmission between individuals - army barracks, schools, universities, prisons, shopping centres, off-licences, arterial roads, lorry drivers, immigrant workers. In short: it needs delocalised and non-traditional conditions; promiscuity and overland trucks. It comes to life when long-established regulatory authorities are rendered powerless and are replaced by sexual consumerism.

One objection to all this would be that, if it were indeed the case, then HIV/AIDS should have been especially rampant in the West. True: the conditions favourable to transmitting the virus in the advanced modern societies of the West could hardly have been better. However, in the West traditional life-styles have been replaced by extreme individualism; a readiness to take care of oneself and one's own body, and this has slowed down the spread of the virus. Here, people have become so used to the impersonal modernity of their lifestyles that only very few are still capable of ignoring the imperative of self-care.

And here, by contrast, we have the tragedy of HIV/AIDS in Africa today: the destruction of traditional lifestyles is speedily advancing, but the people are to a certain extent bewilderingly old-fashioned. Not yet radicalised monads, they nevertheless think and act within - albeit disjointed - family and social contexts.

They have not yet learned to see life as a planning task supported by insurance policies: children are not seen as a threat to the social and familial standard of living; the present does not have to be sacrificed to make way for a more comfortable future. In short: the cold cosmopolitan life-style has not yet extensively infiltrated the continent. Because the frantic yet fragmentary modernisation that is taking place in Africa does not go hand in hand with the careful planning required of the individual, the virus can cause apocalyptic death-tolls.

AIDS not only has social consequences, but is in itself a social consequence - the consequence of a defective modernity that destroys all things old in Africa and casts all sorts of glittering presents onto the market; it is like a fox in a hen-house that must bite dead everything that flutters, even though it cannot eat all that it kills. Africans are not equipped with the antidote necessary for effective survival under conditions of modernity, and this saps their resilience - to the virus as well.

These deficiencies among Africans have become apparent to experts in all fields, for whom the catch-phrase is: »Africans are not yet ready and able...« Take a look through the window of modernisation in Africa, and what you see is deficiencies - a general state of unpreparedness. [...]

Table of Content:

1. Thesis
AIDS in Africa: A Catastrophe of Modernisation?
The dramatic pandemic dimensions of HIV/AIDS in Africa have been attributed to many factors - most of them only scratching the surface of the problem. The real roots, however, have been signally overlooked or ignored. The »War Against AIDS« could escalate the situation if the social conditions and consequences of the epidemic continue to be neglected.

2. The Stage
Black Voice, White Voice: The Dangers Posed by Aid-Work
Interviews with an AIDS victim and a European doctor provide indications of the tensions between those suffering from the virus and those trying to combat it.

3. The Roots
Diseased Continent: Globalisation and the Prospering of AIDS in Africa
Who or what is responsible for the unabated success of this epidemic?
What role has globalisation played in heightening the effects of AIDS in Africa? These are two of the many questions regarding this heinous phenomenon that are yet to be answered satisfactorily.
- Public Enemy No.1: The Black Dionysus
- Devastation by Globalisation
- HIV/AIDS in Southern Africa: Pointing the Finger
- Statistics
- Body Count: Data and Figures
- Radio Disease: The Invisible Killer
- Myths of Origin
- The »Carrot and Stick« Method

4. The Consequences
AIDS and Habitat in Africa: the Destruction of Subsistence
The aftermath of the widespread annihilation of African culture is not merely a continent of peoples whose traditions and customs have disappeared: notions of sex, family, community and society have been disrupted so greatly that they have provided an ideal breeding ground for the virus, thus jeopardizing the last hopes for subsistence in Africa.
- Don't Come Knocking on Our Door!
- Rural Ruins
- Tarnished Subsistence
- The egumbo: Reflection of the Cosmos - the Namibian example
- A Brief Excursus on Ovamboland
- The Culture of the egumbo: efundala, mahangu
- AIDS and the egumbo: The Social Consequences
1. Funeralism: When Death and Burials Become Commonplace
2. The Hopelessness of the Individual
3. The Disruption of Family Values
4. The Street Children
5. The Move Towards Separation of Body and Mind

5. The Struggle
Infected Habitats: The Medicalising of the Black Continent
The ineffectiveness of traditional African concepts of healing - which are generally treated with suspicion - against HIV/AIDS is threatening the existence of African medicine. The influx of Western medical practices and the confusion surrounding the HIV/AIDS epidemic is casting a shadow of suspicion and mistrust over all things African.
- Excursus on the Condom: »And they will fuck for a coke«
- Old and New Medicine
- Old vs. New: Culture of Healing vs. Prevention Strategies

6. The Solutions
African Alternatives: The Freedom Struggle Continues
If HIV/AIDS is a phenomenon of globalisation, one consequence could be that a radically asserted modern life has to be »implanted« in the minds of Africans. Such a concept of modernity would rely on new body concepts, new life strategies, individualisation and self-control to contain the epidemic. By doing so, this would lead to a »bitter« modern life, in which Africa would lose its economic, linguistic, cultural, medical, musical and philosophical wealth - its subsistence - without getting much in return in terms of Western prosperity. Can
the continent survive globalisation and AIDS with anything of its former self intact?
- Pieta in Katutura
- Matthäus, 21 Years Old
- Home Truths
- Lost Tradition and Unattainable Modernisation
- Postscript, Written in the Long Shadow of 11. September 2001
- Afterword
- Literature