Breaking the silence of HIV/AIDS and sexuality

Yolanda Mitchell

Pretoria

Reddy, V, Sandfort, T and Rispel, A (eds) (2009) From social silence to social science: Same-sex sexuality, HIV & AIDS and gender in South Africa. Cape Town: HSRC Press. ISBN 978-0-7969-2276-2 pbk. Pages xxxiii + 252 .

Writing about same-sex sexuality in South Africa is a highly complex task, as is illustrated even in the title of this book. Same-sex sexuality is the term used by the editors to describe the sexual behaviour of individuals who engage, either exclusively or occasionally, in any form of sexual intercourse with persons of the same biological sex. The expression and practice of same-sex sexuality is as varied as imagination allows, and therefore the term does not narrowly define sexual orientation and is not limited to linguistic categories such as homosexuality or bisexuality. A discussion of same-sex sexuality must consider not only individual identity, but also the context of community ideals and cultural and societal norms in which the individual identity is attempting to emerge. Moreover, same-sex sexuality is so entrenched in a history of economic and political power imbalance that to describe it without analysing that history would yield a superficial description at best.

This book, however, is not just a discussion of same-sex sexuality: it is an exploration of how same-sex sexuality relates to the transmission of HIV/AIDS in South Africa. This exploration in turn takes the reader into the murky realm of gender, gender identity and more specifically, gender inequality; concepts that were dictated by norms and ideals long before labels such as "gay" and "lesbian" existed. Same-sex sexually attracted individuals self-identify in various different ways and do not necessarily comply with mainstream expectations of what it means to be "gay" or "lesbian". Gender, as a salient aspect of this highly individualised sexual identity, is an inextricable part of same-sex sexuality and thus of the discussion of same-sex sexuality within the context of HIV/AIDS in South Africa; a reflection of the "complex and fluid interrelationships between identity and [ the] practice" of same-sex sexuality (p 59). This interrelationship is continually emphasised throughout the book.

In acknowledgement of the complexity of the subject matter, the editors rightly begin the book by introducing the reader to the historical, contextual and conceptual framework of the HIV/AIDS epidemic in South Africa, of same-sex sexuality, and of the relationship between the two. The main body of the book comprises four parts, the first of which consists of theoretical chapters that elaborate on the discussion of key concepts and concerns in studying same-sex sexuality that was started by the editors in the introduction. These include the relationship between gender and same-sex sexuality and the importance of including gender in all same-sex sexuality research; the critical role of language in avoiding labelling and by extension in breaking stereotypes; and the importance of consideration of context as inferences made from research conducted globally can not always be transferred to the South African situation.

Part two reflects on the role of activism in securing rights and support. It clearly depicts the effects of homophobia and social stigma on vulnerability to exposure to HIV infection and subsequent treatment seeking behaviour. The particular dilemma of constructing a sexual identity as a black lesbian woman, often being of multiple minority status by virtue of gender, sexual orientation and socio-economic class, is also discussed in the context of hetero-normative patriarchal environments.

In part three, the authors discuss research that has been conducted in sub-Saharan and southern Africa. It provides a useful overview of what is (not) known about the prevalence and transmission of HIV/AIDS in same-sex sexually attracted communities, sexual and risk-taking behaviour, and the resultant impact on interventions and healthcare provision. Of particular importance in this section, is the refutation of the notion that same-sex sexuality is un-African and that it does not exist in Africa; a notion that has been identified as a major stumbling block not only for social rights, but generally in the fight against HIV/AIDS. The paucity of epidemiological research among people who practice same-sex sexuality is particularly emphasised. This is especially evident in one chapter which reviews five research studies, only one of which reported seroprevalence rates and then only among men.

Part four focuses on South Africa. Authors discuss some successes achieved in programming and policy and highlight needs and suggestions for research, intervention and implementation of policy. I was struck by the repeated citation of the same research studies in several chapters in this section. This fact underscores the point that the editors are trying to make with this book: there is a glaring lack of research, particularly of adequate statistical data, to influence either social policy or HIV/AIDS programming in South Africa.

The book concludes with an editorial summary and recommendations for further research and intervention. The editors create awareness of the possibility and the power of research to influence the response to the HIV/AIDS epidemic, but it is critical to emphasise the conviction of authors that research may not be the panacea in this response, as research itself is political. Research is always conducted with an agenda, however benign, and is always subject to authorities who decide on the need for - and the economic feasibility of - a study. Furthermore, the imbalance of power between the researcher and the research participant must be carefully considered in same-sex sexuality research. Several authors highlight the necessity to understand and approach participants as individuals who do not fit neatly into a homogenous category for the purpose of being researched (see chapter 5 as example). This is important in addressing HIV/AIDS because, like same-sex sexual identity and practice, risk-taking behaviour does not conform to a one-size-fits-all approach, therefore neither should intervention strategies, nor policy. In order for research to be holistic, it must recognise, appreciate and accommodate heterogeneity. However, authors and editors alike duly note that this is easier said than done, but that it is an ideal to strive for.

My overall impression is that the proceedings, although written by authors of varying academic prowess, is of a good quality. The multi-disciplinary nature of the offerings indeed "strengthen[ s] the cohesiveness of the final product" (p x). The editors acknowledge that "there is no single streamlined argument" (p xxviii), but the selection of articles as a whole is successful in sketching a picture of same-sex sexuality as it relates to the HIV/AIDS epidemic in South Africa. The partitioning of the book has the effect of sharpening this picture, as the reader is guided from the abstract to the tangible. In line with the editors' vision for the conference that this publication resulted from, my opinion is that this book has great value as a resource to: 1. stimulate debate and promote understanding of same-sex sexual expressions and practices, and how this relates and contributes to the prevalence of HIV/AIDS in South Africa; 2. indicate avenues for new research and advocate for research funding and the implementation of programming, community development and policy; 3. accentuate the role of inequality, discrimination, stigmatisation and marginalisation in perpetuating the disease burden of HIV/AIDS in South Africa.

HIV/AIDS "...remains stubbornly non-discriminatory in a world where inequalities persist" (p xi), and this book lays bare the stark juxtaposition of the disease itself against both the norms of society and the way in which society attempts to eradicate the disease. It accentuates the impossibility of addressing all aspects of a sexually transmitted disease without a thorough understanding of all aspects of the sexual transmission of that disease. Well done to the authors, editors and publishers.