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New Contree, No. 46 (November 1999) ₅₅

HIV/AIDS IN SOUTH AFRICA: A CASE OF FAILED RESPONSES BECAUSE OF STIGMATIZATION, DISCRIMINATION AND MORALITY, 1983-1994

Louis Grundlingh

(Department of Historical Studies, Rand Afrikaans University)

Opsomming

Many illnesses transform their victims into a stigmatized class, but AIDS is the first epidemic to take stigmatized classes and make them victims.1

Richard Goldstein

Die artikel ondersoek die aard van stigmatisering, diskriminasie en moraliteit in die

Suid-Afrikaanse samelewing nadat MIVNIGS ook hier sy verskyning gemaak het.

Aanvanklik het godsdienstige fundamentaliste homoseksueles daarvan beskuldig dat hulle deur die virus besmet is omdat hulle homoseksueel is. Hierdie sienings is aangevul deur die middelklas waardes van die tyd wat epidemies met sedeloosheid

vereenselwig het. Die regering sou feitlik niks doen om voorkoming van MIV in die

homoseksuele gemeenskap te bekamp nie. Deur die "ander" (in hierdie geval die MIVNIGS-Iyer) te stigmatiseer en ook teen die persoon te diskrimineer, kon heelwat Suid-Afrikaners die Iyers en die hele vraagstuk rondom MIVNIGS ignoreer. 'n Nuwe

kategorie van onderskeiding is so geskep: "ons" (die gesonde heteroseksuele

gemeenskap) en "hulle" (die besmette homoseksuele gemeenskap).

Stigmatisering en diskriminasie teenoor swartmense, wat alreeds lank in die

Suid-Afrikaanse konteks bestaan het, het teen 1987 'n nuwe dimensie bygekry toe die eerste

swart heteroseksuele persoon as MIV+ identifiseer is. Die persepsie het nou

toegeneem dat aile swartes vir die epidemie verantwoordelik gehou behoort te word.

Hierdie rassistiese siening het baie daartoe bygedra dat enige anti-MIVNIGS program

van die regering, hoe goed bedoel ookal, as gevolg van 'n gebrek aan legitimiteit in die

swart gemeenskappe verwerp is. Gevolglik is niks effektief in die 1980s gedoen nie. Dit wi! voorkom of die hoofargument wei onderskryf kan word: dat stigmatisering van

en diskriminasie teenoor gemarginaliseerde groepe, rassisme en homofobie so wei as

'n konserwatiewe moraliteit wat 'n sterk invloed uitgeoefen het, daartoe gelei het dat 'n

guide geleentheid om MIVNIGS te bekamp, verlore gegaan het.

R. Goldstein, "AIDS and the Social Contract" in E. Carter and S. Watney (eds), Taking liberties: liDS and cultural politics (London, 1989), p. 84.

Opsomming

Richard Goldstein

Opsomming

Richard Goldstein

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S' cg. (jI 0> 56 Louis Grundlingh 1. Introduction

The history of a disease is often parallelled by a history of inhumanity to its sufferers.

For the dominant sector of society the disease invariably came from elsewhere.2 _Old

prejudices sometimes pin epidemics on ready-made conventional scapegoats, looking desperately where to place the blame, and in the process created what I want to call a "plague mentality". They then not only stigmatized these sufferers - mostly socially marginalised, ethnic minorities and the poor - but also held them responsible for the

epidemic. Consequently the latter became social outcasts, like the leper in Leviticus.3

Stigmatization seems to lie even in the very words used. When do we use "epidemic", "disease" or "plague"? Why did smallpox, polio and the flu epidemics remain epidemics rather than plagues? It seems that 'for an illness to be termed a plague depends on the manner in which the illness is spread. Thus rats transmitted bubonic plague, signalling filth and poverty.

When the disease was sexually transmitted, a further dimension was added, that of immorality and promiscuity. Venereal diseases in particular have long been associated with moral decay and corrupt sexualities. For example, syphilis was understood as the "divine scourge", a result of transgressing society's boundaries and served as an important marker of evil. Sexually transmitted diseases have also served as signs of pollution and contamination - signs of a decaying society and as such have been

associated with dirt and uncleanness.4 _{There is thus a strong element of shamefulness}

and of judgement on communities. In other words, plagues are diseases, which are popularised as both disgusting and disgraceful. Leprosy, syphilis and cholera all fit the category. HIV/AIDS followed these traditions.

From Goffman's classical sociological work on stigma to Sontag's popular works on

metaphors, stigma has also captured academic and general public interest. 5 The

severity of the HIV/AIDS epidemic revived the issue of connecting disease and "stigmatization". With regard to HIV/AIDS, Jonathan Mann identified ignorance,

2 R. Gallo, Virus hunting: AIDS, cancer and the human Retrovirus. A story of scientific discovery (New York, 1991), p. 129.

3 The leper was forced to wear torn clothes, to warn off others with the cry "unclean, unclean",

and to "dwell alone in a habitation outside the camp". (Chapter 13:45-46). Likewise, the Jews were blamed for the plague (the Black Death) in fourteenth century Europe. The first recorded syphilis epidemic in 1495 was initially labelled the "French disease" by the Italians and the English, and the "Neapolitan disease" by the French; in time both agreed to call it the "Spanish disease"! New York's Irish immigrants were blamed for the nineteenth century cholera epidemic; the Italians were accused of introducing polio into Brooklyn; Asian immigrants were blamed for the smallpox epidemic in North America during the early years of this century.

4 M. Douglas, Purity and danger: An analysis of the concepts of pollution and taboo (London,

1966).

5 Goffman noted that the Greeks "originated the term stigma to refer to bodily signs designed to

expose something unusual and bad about the moral status of the signifier." E. Goffman, Stigma: Notes on the management of spoiled identity (New York, 1963), p. 2; See also S. Sontag, Illness

as metaphor (New York, 1977).

56 Louis Grundlingh

1. Introduction

1966).

as metaphor (New York, 1977).

1. Introduction

1966).

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HIVIAIDS in SA: Stigmatization, discrimination and morality 57

prejudice and discrimination as part of a third epidemic.6 _{He delineated the first as the}

largely hidden and rapidly accelerating spread of HIV; the second was the visible form of AIDS; and the third epidemic was (and still is) the social rather than medical aspect of the disease. As HIV and AIDS spread, in their wake came denial, blame, fear, stigmatization, prejudice and discrimination.? Likewise, to quote Paula Treichler: "The social dimension is far more pervasive and central than we are accustomed to believing."8

As Goldstein noted, HIV/AIDS is unique in that those who were directly affected were already marginalised or minorities and victims of prejudice and discrimination, either socially, economically or politically. In the United States, for example, AIDS was labelled an "African" or "Haitian" disease. This alleged origin was very much in line with the white American notion that blacks were inherently different, and therefore had a different relationship to disease. In South Africa gay people, blacks, drug users, prostitutes and the poor became the targets of stigmatization. Within the imagery conjured up by the mention of AIDS, they have become part of an ever-expanding vision not only of marginality, but also, by extension, of danger.9

The general aim of this article is to provisionally investigate whether the initial perceptions of and reaction to HIV/AIDS reflected these "social dimensions". Aspects of stigmatization, discrimination and morality were some of the most obvious characteristics of these perceptions. After the context in which the disease occurred and spread in South Africa is briefly provided the focus falls on the nature as well as the reasons for stigmatization of HIV+ people and people with AIDS. The blame placed on gay and black people will be highlighted, keeping in mind the change from initially being limited to the homosexual community and later spreading to the heterosexual community, affecting the latter disastrously. The second focus is on the effect of stigmatization where some discriminatory practices are pointed out. The main argument bids the question whether stigmatization of marginalised groups, racism and homophobia and conservative morality in the early stages of the disease caused the failure of adequate responses to HIV/AIDS during the last ten years of National Party rule.

6 Founder and former director of the WHO's Global Programme on AIDS.

7 S. Cross and A. Whiteside, Facing up to AIDS. The socio-economic impact in Southem Africa

(New York, 1993), p. 29.

• P. Treichler, "An epide~ic of significance" in D. Crimp (ed.), AIDS cultural analysis, cultural

activism (MIT Press, 1989), p. 35.

9 H. Daniel and R. Parker, Sexuality, politics and AIDS in Brazil: In another world? (London,

1993), p. 53.

(New York, 1993), p. 29.

1993), p. 53.

(New York, 1993), p. 29.

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5" _cg. t1I (X) 58 Louis Grundlingh 2. Context

It is import;mt to recognise that every country affected by HIV has its own epidemics shaped by the local circumstances ofthe population groups in which the virus emerges. This is not to suggest that HIV is a different disease in different countries; rather the patterns of its transmission are profoundly influenced by the particular local social context. The situation of most people with AIDS faithfully reflects their social and economic position before they contract HIV.'°

There can be no doubt that HIV/AIDS flourishes most in areas that are burdened by racism, unemployment, homelessness, welfare dependency, unhygienic circumstances, prostitution, crime, a high school drop-out rate, social unrest, wide-spread poverty, civil conflict and political violence, migrant labour, poor health status and particularly the oppression and brutalisation of women and children." All these factors interact with the virus, and assist it to spread. Sadly all these conditions were (and still are)

prevalent in South Africa. 12 The part played by the apartheid system in promoting the

spread of HIV infection by retarding the ability to tackle it effectively must be emphasised. It was especially the systematic fragmentation of health services, gross deficiencies in education opportunities, based on population registration according to race, as well as mistrust of family planning services, which impeded effective and

co-ordinated preventive attempts.'3 There is no doubt that the political situation in South

Africa during the time under discussion fuelled the spread of HIV infection and retarded its effective control. 14

1q S. Watney, "AIDS, language and the Third World" in Carter and Watney (eds), Taking liberties,

p.86.

11 South Africa has a long history where illness was often seen as nature's revenge on people who live unhygienically. This was, of course further reinforced by people with HIV/AIDS who tend to be feared, stigmatized and rejected. H. Southall, "South African trends and projections of HIV infection", in Cross and Whiteside, Facing up to AIDS, p. 71.

12 See C. Evans "The socio-economic determinants of the AIDS epidemiC in South Africa - a cycle of poverty", South African Medical Journal, 83 (September 1993), pp. 635-636 for a very succinct discussion. Also see H.C.J. van Rensburg and A. Fourie, "Inequalities in South African health", South African Medical Journal, 84 (February 1994), pp. 95-103.

13 C. de Beer, The South African disease: Apartheid, health and health services (Johannesburg, South African Research Service, 1984) and M. Price, "Health care as an instrument of apartheid policy in South Africa" in Health Policy and Planning, 1 (1986), pp. 158-170; E. Preston-Whyte and M. Zondi, "To control their own reproduction: The agenda of black mothers in Durban",

Agenda, 4 (1989), pp. 47-68; L. Kuhn, M. Steinberg and C. Mathews, "Participation of the school

community in AIDS education: An evaluation of a high school programme in South Africa", AIDS

Care, 6, 2 (1994), pp. 161-162; and M. E. West and E.A. Boonzaaier, "Population groups, politics

and medical science", South African Medical Journal, 76 (September 1989), pp. 185-186.

14 These circumstances were, of course, not exclusive to South Africa. They also occurred in

other developing countries such as South Africa's neighbours, Botswana and Zimbabwe where the HIV+ rate also rocketed during the 1980's. However, a comparative study between South Africa and these countries demands a separate article.

2. Context

p.86.

2. Context

p.86.

HIV/AIDS in South Africa: a case of failed responses because of stigmatization, discrimination and morality, 1983 - 1994.

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