HIV/AIDS is a precedent setting epidemic faced by humanity. This epidemic is dually medical and social in nature. Medically, it is a serious, fatal disease with numbers far greater than the norm. Socially, it is an event that disrupts the life of communities. The epidemic of Acquired Immune Deficiency Syndrome (AIDS) was first recognized in the United States in 1981 (Sahistory.org.za, 2011). South Africa today has the highest HIV profile in the world, with an estimated 7.7 million people living with HIV in 2018. To combat this, South Africa also has the largest antiretroviral treatment (ART) programme in the world. HIV prevalence however remains high (20.4%) among the general population (Avert, 2019). HIV/AIDS prevention campaigns have so far been key to limiting the advancement of this epidemic however more can be done using anthropological techniques. Many of the barriers that prevent South Africans from accessing information and much needed services can be attributed to culture. Culture influences perceptions such as practical knowledge, value systems and health seeking behaviours. An anthropological ethnography is therefore important to understand the various social and cultural traditions that reinforce vulnerability to HIV/AIDS in South Africa.
According to Olivia Rose-Innes from Media24 (Rose-Innes, 2016), the following sociocultural factors have been identified as responsible for the rapid spread of the disease:
- Gender inequality
- Religious beliefs and cultural assumptions
- Violence and sexual violence
- Political transition and the legacy of apartheid
- Stigma and discrimination
- Commercialisation of sex
- Lack of knowledge and misconceptions about HIV/Aids
Due to the limitations set for this assignment, only the first three factors will be critically examined.
South African culture is a patriarchy. This behaviour stems from the earliest stages of humanity. Men in these early societies were the primary hunters. Women stayed close to camp and foraged while taking care of the child rearing. These roles were based on capability. One was not viewed as “better” than the other. These roles influenced the evolution of man including brain development. Many tasks completed by female were monotonous e.g. collecting water, gathering fuel, and cooking. They could be interrupted and returned to without total disruption. Female’s brains have as much as 10 times more white matter as men (Gur et al., 1999). This arguably results in women’s ability to both switch between tasks without trouble and multi-task with ease. Approximately 12 000 years ago however, agriculture came into being and changed the world (nationalgeographic.com, 2016). Hunting was no longer necessary. Humans mostly ceased their nomadic lives. Mark Dyble, an anthropologist who led a study at the University College of London, wrote: “Our brains are still wired for that primitive pre-agriculture lifestyle” (Dyble et al., 2015). Instead, men became hunters of land, money, riches whilst women continued to be conditioned to bear and rear children. Governments developed. Political debates ensued. Men mostly engaged in these concepts. Unfortunately somewhere along the lines, men became conditioned to believe that women had set roles and natures. In South Africa the resulting unequal power relations, particularly when negotiating sexual encounters, increases women’s vulnerability to HIV infection and thereby accelerating the epidemic. Women’s perceived inferior status affords them little or no power to socially protect themselves. Many women also lack economic power and feel they cannot risk losing their partners even in the face of sexual abuse. Entrenched ideas about suitably “masculine” or “feminine” behaviour also enforce sexual double standards and lead to unsafe sexual practices. Abstinence and monogamy are often seen as unnatural for men, who try to prove themselves “manly” by frequent sexual encounters, and often the aggressive initiation of these. These views serve to justify men’s sexual behaviour to some extent. South Africa is a diverse ethnic potjiepot. In most homes, a women’s respectability is derived from the traditional roles of wife, home-maker and mother. Childbearing and satisfying the husband, sexually and otherwise, are key expectations for a wife – even if she is aware that her husband is unfaithful. Refusing a husband sex can result in separation and sometimes violence. The low status accorded to a woman without a male partner may be an additional reason for making women less likely to leave an abusive relationship. Being a well-informed woman is seen as a sign of immorality. Whilst outspoken married females may be suspected of having extra-marital affairs or of accusing their husbands of being unfaithful.
Religion and Cultural Assumptions
Religion in particular holds sway over the masses. Some religions saw the epidemic as a divine punishment for sinfulness in general with the single sin of male homosexuality. Despite the general acceptance of modern science the concept of divine punishment has not been entirely abandoned (Blumberg, 2019). The use of contraceptives such as condoms also have strong overtones of unfaithfulness and the promotion of sexual activities. Certain sexual practices, such as dry sex (where the vagina is expected to be small and dry), and unprotected anal sex, carry a high risk of HIV because they cause abrasions to the lining of the vagina or anus (Kun, 1998). In many traditional African cultures where virginity is a strict marriage condition, young females may protect their integrity by engaging in unprotected anal sex. The importance of fertility in African communities may hinder the practice of safer sex. Siring many progenies is also seen as a sign of virility however this increases the risk of HIV transmission.
According to StatsSA, it costs between R527 to R670 to feed a single person nutritionally for the month. A child support grant is only R420 a month and an old age grant is R1,780 (often the only income in a family) (Statistics South Africa, 2019). These amounts only factor the cost of food and not all the other necessities in life like rent, transport, electricity, education and clothing. Therefore it is hardly surprising to find that for poor people, the daily struggle for survival overrides any concerns about contracting HIV.
Fortunately, governments are relying more and more on anthropological research. A technique called Participant Observation was developed by a Polish anthropologist called Bronislaw Malinowski (Shah, 2017). He basically set the standard for ethnography with a wide-angled vision. With this technique, an anthropologist actively participates in the daily lives of the people and thereby are in a better position to improve circumstances. People driven by poverty will participate in extreme acts such as “survival” sex-work and other abuses thus making them particularly vulnerable to the spread of HIV/Aids. Poverty is generally associated with low levels of formal education and literacy. Knowledge about poverty and HIV in context of the actual challenges faced by poor communities is therefore invaluable.
Since the beginning of the epidemic, anthropologists have contributed to better understandings of cultural beliefs and local practices that place people at risk for HIV/AIDS, advocated for equitable access to care and treatment, and promoted culturally appropriate strategies for prevention. Anthropology actively promotes state, social and religious dialogue in a systematic non subjective manner whilst still focusing on the issues at hand. Ethnography, with its holistic focus and its long-term approach for fieldwork, plays an important role in dismantling the various perspectives, practices and power relations that have come to shape the views, actions and experiences with regard to HIV/AIDS.