The making of HIV/AIDS in South Africa: an ontological politics of disease

2017-02-27T23:19:48Z (GMT) by Pienaar, Kiran Merle
This thesis examines the politics of HIV/AIDS in South Africa under former president Thabo Mbeki. Often characterised as “AIDS denialism”, Mbeki’s controversial position on HIV/AIDS incited conflict with South African civil society, including prominent local AIDS organisation, the Treatment Action Campaign (TAC). This conflict is typically depicted in scholarly and popular accounts as polarised into dissident/orthodox positions. The thesis questions this familiar depiction, applying new theoretical tools to rethink received accounts of HIV in South Africa. I argue that it is possible to see important continuities, rather than only differences in TAC and the government’s views. For example, my analysis reveals that through their pursuit of the “truth” about HIV/AIDS, both TAC and the government constitute the disease as a matter of fact: a stable, immutable object, possessed of intrinsic attributes. The analysis queries this common sense realist enactment of disease, arguing that the “facts” of disease are not given in nature; instead, they are constituted socially and politically and, as such, are emergent, rather than foundational. In making this argument, the thesis draws on science studies and new materialist scholarship, notably Karen Barad’s agential realism and Annemarie Mol’s praxiography. It employs a range of textual sources such as Parliamentary debates, health promotion literature and policy documents to map the political processes and practices that have contributed to making HIV/AIDS in South Africa. Importantly, it traces the role of the TAC-government conflict itself—and the kinds of activity/inactivity it produced—in constituting HIV/AIDS, and thus the epidemic, in specific, sometimes damaging ways. The thesis also argues that politics helps to constitute people with HIV as various kinds of medicalised subjects, such as victims of HIV, disease vectors and self-regulating health citizens. It thus challenges the commonplace view that a disease pre-exists its subjects (or “targets”) and instead draws attention to the ways in which disease and its subjects are constituted in relation to each other and in relation to political forces. In terms of the latter, the analysis explores the politics of the debate’s reliance on binary oppositions, such as citizen/non-citizen, human/non-human and so on. For example, it demonstrates the ways in the citizen/non-citizen binary allows only some people with HIV to qualify as biological citizens, and denies others full citizenship, rendering them non-citizens or failed citizens. Drawing attention to the co-constitution of the citizen and the human, it argues that attributions of citizenship matter because they shape whether or not people with HIV can access so-called universal human rights, including the right to healthcare. The ontology of disease proposed in this thesis changes how we see and address it. It enables an examination of the significant role of political and scientific practices in making disease. It also reveals the self-serving or damaging effects of certain enactments of disease. Made visible, these negative material effects are amenable to disruption, allowing a remaking of disease which avoids the harmful assumptions that produce stigma and help to disadvantage or marginalise those living with HIV. The thesis concludes by exploring some of the possibilities for remaking HIV, and speculates on how doing so might change the relational field of the South African HIV epidemic.