Book Review

When Bodies Remember: Experiences and Politics of AIDS in South Africa

N Engl J Med 2007; 357:1783-1784October 25, 2007

Article

When Bodies Remember: Experiences and Politics of AIDS in South Africa
(California Series in Public Anthropology. 15.) By Didier Fassin. Translated by Amy Jacobs and Gabrielle Varro. 365 pp. Berkeley, University of California Press, 2007. $55 (cloth); $21.95 (paper). ISBN: 978-0-520-24467-2 (cloth); 978-0-520-25027-7 (paper).

By the mid-1990s, the health transition in South Africa was already under way — infant and child mortality rates were improving, allowing the focus to move to adult health issues. Seven years later, a change in the pattern of deaths was seen; the most striking change was among young adults, particularly young women. Young women were dying in unprecedented numbers. By 2003, the number of women dying between the ages of 30 and 35 years equaled the number of women dying between the ages of 75 and 80 years — and it was all due to infection with the human immunodeficiency virus (HIV). South Africa now has the unenviable record of having more persons infected with HIV than any other country in the world. As South Africa was undergoing the political transition from apartheid — rule by a white minority in which systematic social, political, and military processes were in place to ensure the continued repression of the black majority — to a democratic government by the black majority under the African National Congress (ANC), HIV rooted itself firmly in the country.

During apartheid, the white minority barely bothered with this emerging infection, which then seemed to occur in black migrants and white homosexual men. After apartheid was eliminated, the ANC-led government struggled to contain HIV infection. Its attempts to address the escalating epidemic were shrouded in controversies such as those involving Sarafina II, Virodene, the refusal to provide interventions to prevent mother-to-child transmission of HIV, AIDS denialism, and the government rollout of antiretroviral therapy.

It is against this backdrop that Didier Fassin, a French anthropologist, attempts to negotiate his way through the experiences and politics of AIDS in South Africa in this book. He focuses largely on Thabo Mbeki, the president of South Africa, who is known for AIDS denialism. In 2000, Mbeki, in questioning the origins of AIDS, found support from scientists who attributed the cause of AIDS to poverty, rather than to a virus that could be spread sexually. Fassin argues that the political history of AIDS in South Africa is based largely on the issues of national identity, race, and conspiracy theories. He writes, “The three elements are intimately intertwined, the racial question undermining the national edifice, the conspiracy suspicion feeding on racist experiences, the construction of the nation being threatened by external as well as internal enemies.”

As I read Fassin's book, the last decade of my life as a South African researcher in the field of HIV flashed painfully in front of me. Some of his accounts are profoundly accurate, others are slightly less factual, and some are bizarre. He is generous to the views of the dissidents and denialists, even though he has no qualms about the viral cause of AIDS. Like others, Fassin is intrigued by Mbeki's stance on HIV, yet his attempts to understand, explain, and even justify and vindicate the views of the president are patronizing. In contrast, he is unusually antagonistic toward the activists, scientists, and doctors who support the orthodox view of HIV and AIDS in South Africa.

Fassin is at his most powerful when he relates the human tragedy of HIV infection through interviews with South Africans who are living with and dying of the disease. He documents how citizens of this young democracy construct themselves in relation to their apartheid past and their impending death now that they have political freedom. He attempts to understand the social world of South Africa in light of its history. But he makes a crucial error: by relying too much on newspaper articles and dinner-party and corridor discussions, he misses some of the key threads of the events as they played out in South Africa, such as those involving the prevention of mother-to-child transmission of HIV. He misunderstands the origins and the early relationships of the two most powerful nongovernmental HIV organizations, Treatment Action Campaign and the National Association of People Living with HIV/AIDS. He begins to interpret, rather than document — a flaw that undervalues the human drama of HIV infection in South Africa. Fassin becomes merely an apologist for the leaders in South Africa, who should have risen above racism, cared more about their citizens, and done the right thing despite their past.

It is true, as Fassin argues, that AIDS is often presented as a “phenomenon without history” and that its context, grounded in apartheid, is often overlooked. As Jonny Steinberg remarks in his review of this book (Business Day. June 5, 2007), “What does it mean to write so generous and forgiving an anthropology of so large a mistake? What is it one ends up saying about the one who is mistaken?”

Tragically, Fassin also underemphasizes the ANC and its members who played pivotal roles behind the scenes. Often at their own peril (e.g., the recent dismissal of Nozizwe Madlala-Routledge), these members ensured the implementation of a national AIDS plan that included interventions to reduce mother-to-child transmission of HIV and public sector access to antiretroviral therapy for some 250,000 people. It is indeed their story that should have been told.

Glenda Gray, M.B., B.Ch., F.C.P.(S.A.)
Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg 1864, South Africa