Print version ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.101 no.12 Cape Town Dec. 2011
AIDS, sex and culture: global politics and survival in Southern Africa
By Ida Susser. Pp. 304. £62.50. Wiley-Blackwell, Hoboken, NJ. 2009. ISBN: 9781405155861.
South African-born anthropologist, Ida Susser, re-visits her native land to examine the multifaceted cultural environment pertaining to the HIV pandemic. Gender subordination is at the heart of the book: the forces of globalised economies make women particularly vulnerable. Susser focuses her skills on this disadvantaged HIVafflicted group. She seeks to explicate the nexus between the personal and the political, the powerful and the dispossessed, the macroeconomic and the domestic, and exposes how HIV acts as a powerful palimpsest of the troubling divisions of global human interactions.
Susser casts her critical eye over the biomedical discourse surrounding HIV. She finds the disease to be framed, primarily, as an urban male homosexual problem, and that this population accrues disproportionate benefits. She demonstrates the concerted activism taken to raise awareness of the pandemic's effect on women, including: heterosexual transmissibility, mother-to-child transmission, and the central roles that women play as care-givers.
The market-driven policies, or 'Neoliberalism', come into condemnation; widely adopted and exported to developing countries by the International Monetary Fund and World Bank, argues Susser, these powerful macro-economic factors foster gender subordination, and contribute directly to economic oppression of the poorest poor.
Susser traces negative consequences of international aid policies, such as George W. Bush's PEPFAR (President's Emergency Plan for AIDS Relief): influenced by 'compassionate conservative' theologically driven ideologies that inscribe conditions on the provision of aid (e.g. emphasis on abstinence at the expense of sex education and condom provision). In contrast, Susser reveals that women's concerns prioritise frank discussion of sex education, sexual orientation, contraceptives and family planning.
At the heart of the book, contextualised by South African history and post-apartheid transition, are ethnographic descriptions of HIVpositive women trying to carve out hope during life's daily struggles; we see them congregating in groups, working with beads in a mission hospital in rural KwaZulu-Natal, or campaigning for female condoms in Namibia. We meet protagonists of 'transformative activism': 'the collective action that aims for change to the overall structural constraints that disempowered people confront in their day to day lives when fighting HIV.'
Included is a chapter by Sibongile Mkhize, a social scientist who writes of the profound and devastating effect that HIV has had on her family. This contributes to the thick-grained texture of the book, to paint a picture of flexibility and enterprise among ordinary women.
Susser describes a model of resilience amidst socioeconomic deprivation, gender discrimination and the wrong-headedness of HIV denialism and anti-scientism. In doing so, she recapitulates the same enterprising activism by her own academic efforts. She is vocal and persuasive, and though her own ideological slant can be a bit strident, it is an important part of HIV cumulative research and social literature. Accessible and compelling, this work is valuable to understanding HIV within the broader southern African and global context, and is highly recommended to anyone interested in the intricate interplay between the social and biological sciences.