(2022-2023) How the pervasiveness of the HIV treatment regime has reinforced HIV stigmatisation in African societies
By Alfie Agar, Kano Konda, Loren Madnack, Robin Brouwer
In 2018, over 25.7 million Africans were living with HIV, accounting for two thirds of the global total of new infections (WHO, 2018). The epidemic fostered a surge in the availability of aid towards HIV treatment and prevention programs, especially in Africa.
However, scholars such as Benton (2015) argue that this availability has structured the vertical flow of financial, professional, and infrastructural streams into HIV-specific interventions, allowing HIV to seep into development and the medical system.
We aim to interrogate how the pervasiveness of the HIV treatment regime has reinforced the stigmatisation of HIV/AIDS and marginalised the needs of those who are HIV-negative.
We rely on Benton’s (2015) conceptualisation of HIV exceptionalism to understand how HIV initiatives that aim to develop health systems in turn monopolise them, debilitating their ability to treat other diseases. HIV exceptionalism is “‘the idea that HIV/AIDS is always a biologically, socially, culturally, and politically unique disease requiring an exceptional response” (Benton, 2015: 8). Moreover, this serves to reinforce the stigma around HIV within public discourses, shaping people’s desires and values.
In critiquing the effects of HIV treatment development initiatives, we aim to warn against the risks of obscuring the health and social needs of the population. Our exhibition focuses on two regions in Africa; Sierra Leone (Benton, 2015) and Botswana (Dahl, 2009), to depict how public consciousness in these contexts remains centred on issues such as avoiding a HIV-positive status, and any association to a HIV-positive individual. Meanwhile, the basic healthcare needs and wellbeing of the general population are obscured in the shadow of the bloated interest in HIV.
HIV humanitarian projects in Africa have transformed into the development of not only the medical system but people’s moral values and identities. HIV prevention campaigns focus on sex education and the individual’s responsibility towards the state as a citizen, with a particular focus on women’s roles. HIV projects have become so dominant in discourses of development, that they influence all spheres of intervention, as shown by the 30 NGOs all running HIV attention programs in Freetown, Sierra Leone (Benton, 2015).
The first storyboard portrays how the stigma around aids is pervasive in the objectives of the health system and people’s consciousness. Based on Benton’s (2015) account of local experience, it depicts Christiana’s experience; a woman who died, without being properly diagnosed. After testing negative for HIV, doctors and nurses neglected Christiana’s condition, failing to give her the proper medical care and never pursuing the cause of her illness. In the end, her mother did not have an explanation for her death but continued to affirm her daughter’s HIV-negative status.
The past decade has seen an increase in capital for HIV treatment and prevention, despite a relatively low 1.5 prevalence rate in Sierra Leone. The HIV treatment regime continues to shape people’s identities and values while shaping the health system in regions such as Sierra Leone. Thus, stigmatisation lives not only in people’s consciousness but beyond death and obscures the health needs of those who are HIV-negative.
Based on an ethnographic article by Bianca Dahl (2009), the second storyboard depicts the moral dilemma of HIV stigma and orphan caring that the remaining kin members face in the Tswana community. Today, Botswana has the second highest number of HIV patients in the world which leads to orphan care becoming a pressing social issue.
For the Tswana people, it has long been considered as their ‘culture’ to care for orphans of dead kin. However, the stigma of HIV has rendered this practice dysfunctional. This is because there is a widely shared belief that women with HIV are sexually promiscuous individuals who have broken sexual taboos. Indeed, a woman named Koketso explains her neighbours allegations that her dead sister was a prostitute because she died of HIV (Dahl, 2009: 35). Thus, the remaining kin members encounter a new moral dilemma after her death: whether they should take in orphans and save them, or escape the notoriety of being a relative of an HIV patient. In this way, HIV stigma engenders prejudice around women’s sexuality and continues to influence the lives and agency of their kin even after their death.
In conclusion, our exhibition conveys how anthropology can give us a different perspective on the impact of development aid projects. Informed by the two ethnographies, the storyboards analyse development as social phenomena and processes by looking at the continuous constructions of norms, ideas, and values (Benton, 2015: 10). While HIV aid opens up the possibility of saving people with HIV, it also transforms systems of structure such as the health care system and education.
This permeates everyday life, including the sociality and subjectivity of women, the kin of HIV patients, and individuals affected by diseases other than HIV. Rethinking development thus entails recognising how the specialisation of development, under the umbrella of humanitarian aid, can have detrimental effects on people’s physical bodies as well as their social selves and relationships. We have shown this by putting the notion of HIV stigmatisation in conversation with the development of the medical sector and people’s subjectivity.
Benton, A. (2015) ‘Introduction—HIV Exceptionalism in Sierra Leone: Christiana’s Story’, in HIV Exceptionalism: Development through Disease in Sierra Leone. Minneapolis: University of Minnesota Press, pp. 1–24.
Dahl, B. (2009) ‘The “Failures of Culture”: Christianity, Kinship, and Moral Discourses about Orphans during Botswana’s AIDS Crisis’. Africa Today. Vol.56. No.1. pp. 23-43.
HIV/AIDS (no date) World Health Organization. World Health Organization. Available at: https://www.afro.who.int/health-topics/hivaids (Accessed: November 21, 2022).
Credits of images
Hubpost. “Funeral rituals of the Tswana people in South Africa” Coester, M. Issued on November 25, 2016. (Accessed: November 12, 2022). https://discover. hubpages.com/religion-philosophy/Funeral-rituals-of-the-Tswana-people-in-South-Africa.
Pinterest. “South Africa Tswana traditional kitchen wood and mud-dung construction with grass thatched roof (submitted by Art Chambers)” Posted by @africanarch. (Accessed November 12, 2022). https://www.pinterest.com/pin/440086194816373183/.