Rush/Panic/Rush: Speculations on the Value of Life and Death in South Africa’s Age of AIDS
The year was 2000. A group of black youths about sixteen years of age, most of them self-professed Christians, answered my question about how they saw the AIDS epidemic in their community, a mining town just south of Johannesburg, by invoking HIV infectivity rates of more than 95 percent. They were confident about the numbers, and they did not evidence even the slightest doubt about the viral etiology of AIDS.1 They prophesied death for all the infected. I was astonished, horrified, and skeptical. “But this means that everyone shall die,” I remarked, incredulously. “Yes,” they said. “Everyone will die.”2 This is probably the most epidemiologically well-surveyed community in southern Africa, given the twin facts that migrant labor forms its center and that migrant labor is considered the primary vector of most HIV transmission in the sub-Saharan region. At the time of the interview, levels for HIV infection in this group’s age cohort ranged from 2 percent for boys and 13 percent for girls fifteen years of age, to 35 percent for men and 68 percent of women twenty-five years of age. The overall community average was estimated at about 28 percent, although there are competing assessments that put the rates as high as 41 percent.3 The rate of HIV infection was, in short, astronomical, and it betokened a future of enormous suffering and grief. But even in the worst instances, the prevalence rates did not approach those invoked by the youths with whom I spoke.
Two questions immediately demand attention in this context, each more urgent than the other: What is the source of the inflation, by which an already bad epidemiological profile comes to be translated into the prophecy of an absolute catastrophe? And how does this inflationary translation affect the capacity of those who believe such statistics to orient themselves toward a future horizon? In short, what does it mean for those who only recently have been recognized as the bearers of political subjectivity? I return to this latter question toward the end of this essay. In the interim, I explore some of the issues that attend this inflationary discourse, and its relationship to other kinds of inflation. I shall suggest that one of the mechanisms by which this predicament is surmounted, or at least accommodated, is by subjecting inflation to calculation, and by thus converting a panic into the possibility of value and even, as I hope to show, a rush. This process of actuarialization is afflicted by contradictions and subjects the youth and others in the communities visited by HIV in South Africa (and elsewhere, no doubt) to a brutal double bind. In many ways it promises to stabilize everyday life and to offer individuals a means of appropriating agency, as well as to experience the vitalizing affect of hope. At the same time, it entails an often violent, if also value-producing, differentiation between those whose futures fall under the pall of HIV and those who, fortunately, will escape its effects. In what follows, I consider the emerging dialectic between panic and rush (rush and panic) as it takes hold in the changing landscape of epidemic South Africa. Before proceeding further, however, I want to return to the youths who expressed this seemingly inexpressible anticipation of mortality.
Surprisingly, I think, the faces of these young men and women, newly liberated for a future that is far less certain than the teleologies of either anticolonial nationalism or socialist transnationalism could have predicted, did not belie either fear or grief. But I would not invoke the word resignation to describe their demeanor, either. And though some of the townsfolk were, at the time, proffering fantastical visions of apocalyptic ends, with rapturous escapes for the believers, these youths did not. Perhaps, we can say, they had adapted themselves, in the sense given that word by Max Horkheimer and Theodor Adorno, to what they believed was their predicament.4 But let us not rush forward to that conclusion just yet.
The community these young people inhabit is a mining town famous for the deepest gold mines in the world, famous also for its spectacular accidents, including deep mine floods and explosions, as well as surface sinkholes, the latter having destroyed houses, industrial plants, and an occasional recreational facility over the years. In the summer of 2007, the town saw one of the largest but also least deadly accidents in the history of mining, when more than three thousand miners were trapped underground after a collapse. But there have been accidents in which dozens and even hundreds have died. Like most mining towns in South Africa, it is a scene of transience, a considerable portion of the workforce being migrant labor — from within and without South Africa, the latter coming mainly from Lesotho and Mozambique.5 Like most mining towns in South Africa, it has been liberated from the formal divisions that attended both the Group Areas Act and the hostel system. And, like most mining towns, it nonetheless remains deeply marked by these legal and institutional structures. Indeed, 25 percent of the population continues to reside in mine hostels or in mine-owned compounds.6 Migrant labor, though diminished in scope and significance, continues to dominate the local economy. And there are still hostels, largely organized on the basis of ethnolinguistic affiliation, even today.
The municipality was newly renamed Merafong (Sesotho for “place of mines”) in 2000, and in 2005 was transferred from Gauteng Province to Northwest Province in a much-contested act of redistricting.7 It is dominated by the less populous white town of Carletonville (and a few similar but smaller hamlets, most notably Fochville), the broad boulevards of which are lined with handsome trees, neat bungalows, well-endowed churches, and modern facilities — including parks, shopping centers, and health clinics. Its largest township, Khutsong (an ironic name, meaning “place of relaxation”), is located across the proverbial railway track: an unevenly developed township marked by relative and often severe poverty.8 Some sections of Khutsong, those originally erected to house professionals and government workers, have reasonable roads, electricity, and plumbing. Recent construction by the state-financed Reconstruction and Development Program has added two- and three-room brick houses for those who previously resided in shacks on the larger properties or in squatter settlements on nearby farmland.9 But much of the township remains unpaved; sewerage, an especially volatile political issue for more than two decades, still runs in open ditches in some areas. And while many houses have electricity, it is by no means universal. The informal settlement that has accreted to the periphery of the township is a knot of tin and cardboard shacks laced together with wire and cobbled into masses rather than neighborhoods. These communities have limited electricity, no running water, and no sewerage facilities beyond pit latrines. Fewer than 20,000 people live in the historically white town; the population in the black township and the informal settlement now exceeds 200,000, and in the last census, it had the highest number of wards with the highest rates of poverty in the province (then Gauteng).
The local government, long a mainstay of the conservative National Party, was entirely dominated by the African National Congress (ANC) until recent boycotts, following a dispute over the redemarcation process, effectively rendered the community without formal representation in the electoral system.10 There has been considerable movement since 1994 in the racial profile of schoolchildren in the white part of town. Black ownership of real estate has inched upward, as has the black share in the mining companies that continue to dominate the local economy, the latter enforced through a Black Economic Empowerment initiative.11 Still, the signs of apartheid are legible everywhere — less as historical traces than as inherited dispositions that manifest themselves in bodily gesture, verbalized consciousness, the order of the landscape, and the specific racialization of class.
The youths with whom I met in a local high school on that blue-skied day did not speak in a manner that appeared in any way exceptional. Similarly catastrophic profiles were often proffered to me in conversations, and if, upon my questioning of these fantastic estimates, individuals replaced their more extreme assessments with more sober ones (undoubtedly because they inferred this to be my desire), it was clear that, on some level of habitual consciousness, such extremities were indeed assumed. They constituted the intuition of what would soon begin to emerge as the object of overt and overtly interested discourse — let us call it the intuition of an actuarial unconscious. But these extremes also constituted the basis for demanding that the terms of the language game be changed,12 in order that a different set of demands be brought to the fore — those oriented not toward the transformation of personal behavior and cultural practice,13 but toward the amelioration of economic conditions in which unemployment is as pressing as it is epidemic. The simultaneous assumption and disavowal of a future catastrophe was expressed when young men resisted questions about AIDS with justly acidic rebukes. One could condense them thus: without a job and, hence, without food or shelter, everyone is going to die anyway, so perhaps the foreign researchers should focus on jobs instead of AIDS.
There are other idioms for articulating this sentiment: “You are saving us for dying. We want to make a living.” These haunting words from a haunted young man were spoken at a now-defunct experimental bakery in Khutsong, where the goal was to provide “daily bread” to those who lack means. Let us not turn away from the metaphoricity of such statements, or from their invitation to read beyond the obvious question of need. We are asked here to think of the difference between a living and a life. Verily Heideggerian in its implications, this simple play effects a potent and powerfully critical juxtaposition, undertaken from within the linguistic repertoire of a multiply inflected English. It is an appropriation and a deployment of a linguistic contradiction within an emergent (and still far from generalized) actuarial discourse, which calculates risk and assigns monetary value to a life by estimating the likely time of its expiry.
In Fredric Jameson’s typological analytics, such gestures emerge only if one reads at the level of the “mode of production.”14 And the kind of criticism offered by youths like those in Merafong were, indeed, grounded in an implicit demand for the recognition of labor’s interests and, even more important, of the aspiration to enter the space of labor as the condition of possibility for full subjectivity. In this sense, the alienated discourse of youth may, perhaps, be among the last and most intransigent repositories of class consciousness in a world (the neoliberal world) for which the idiom of class conflict has lost much of its persuasiveness.15 To be sure, there is a pathos to this irreducibly tragic discourse — which recognizes that being exploited by capital is, at this point in history, better than not being exploited by capital. This freedom can be achieved only in the ironic situation, the double bind to which Marx pointed with his insistence on the possibility and the burden of the wage economy — of being freed by being alienated from one’s own labor as value. One feels that such pathos verges on desperation.16
Still, I was taken aback by what I shall call, for lack of a more precise phraseology, the seeming lack of panic in the words and voices of the youths — whether expressed overtly in the idiom of fear and the habits of anxiety, or in the masking sentiments of bravado and dismissiveness. One might have expected this panic to afflict young people who now inhabit a world in which the horizon of futurity has become so radically truncated. Yet it was not to be seen. Nor is my experience idiosyncratic. A similar lack of panic can be discerned in much of the testimony gathered and analyzed by Catherine Campbell in her account of AIDS in the same community.17 Campbell’s evidence, like mine, reveals the simultaneous projection of catastrophe and something like a developing accommodation of it. How can we understand this affective economy, and its relationship to the phenomenon of epidemic, without simply falling back on the untrue clichés that would attribute a lack of attachment to life among those who live in morbid environments? For, if it is true that people who inhabit worlds ravaged by dangers of natural and human-made sorts often develop discourses that appear to naturalize these dangers,18 it is nonetheless also true that the form of their accommodation varies markedly — sometimes tending to fatalism, sometimes to the metaphysics of retribution, and sometimes to economism (the latter expressing itself in the rhetoric of opportunities amid the ruins).
Most narratives of AIDS in South Africa (as opposed, for example, to those in Uganda) emphasize contradiction. On the one hand, elements within civil society have been relatively successful in their opposition to both international pharmaceutical capital and local governmental reticence to address the epidemic in terms that are consistent with international epidemiological and treatment protocols. On the other hand, they have had limited success in tempering the rates of infection.19 Many people remark that, at least since the capitulation of Thabo Mbeki’s government to the viral model of AIDS and the demand for a programmatic distribution of antiretrovirals, especially to pregnant women, South Africa seems to have been afflicted by a paradox: it has the most loquacious public debate about AIDS, and one of the most persistent problems. In this context, it is frequently remarked that “behaviors have not changed.”20
End of Excerpt | access full version
I am especially indebted to Buti Kulwane, Yodwa Mzaidume, and Lewis Ndholovo for their insight and expertise on the AIDS epidemic and responses to it in Merafong. The essay benefited from generous and astute responses from a number of people, whom I thank here: Yvette Christiansë, Jean and John Comaroff, Ranjana Khanna, Tony Morphet, Joan Scott, Lisa Wedeen, Ken Wissoker, Ara Wilson, and the anonymous readers for Public Culture. Versions of this essay were presented at the African Studies Workshop held at the University of Chicago, and to the Program in Women’s Studies at Duke University, whose audience members prompted rethinking. Thanks also to Sibongile Bambisa.
- At the time that these interviews were conducted, there was considerable debate in South Africa about the viral etiology of AIDS, not least because of the skepticism expressed about it by President Thabo Mbeki and his two health ministers, Nkosazana Dlamini-Zuma and Manto Tshabalala- Msimang. Mbeki and his health ministers famously sided with a number of medical dissidents who either dispute the existence of the virus or argue that it is merely a passive passenger in patients whose illnesses have other causes (whether associated with viral infection or malnutrition). However, as Didier Fassin has shown, their suspicion about the viral etiology of AIDS has been conflated in the press with their skepticism about some of the treatments being offered. Fassin also notes that such skepticism about the international medical community’s response to AIDS in Africa was itself mediated by long experience with the pathologizing discourses of colonialism and the inequitable provision of health care services under apartheid. He rightly demonstrates that the caricature to which Mbeki’s policies were subject masked other significant issues, a masking that the debates about AIDS permitted to occur. Nonetheless, despite the significance accorded such debates in the national press, there was no evidence that they were swaying thought about AIDS in the mining town where I worked — a town that remained strongly devoted to the ANC until 2006, when a crisis over service delivery precipitated a profound and sometimes violent questioning of the party. On the AIDS debate, see Fassin, When Bodies Remember: Experiences and Politics of AIDS in South Africa (Berkeley: University of California Press, 2007).
- It is perhaps this sentiment, as much as any objectively discernible strategic orientation on the part of the national government, that explains Catherine Campbell’s decision to title her book on the AIDS crisis in Carletonville Letting Them Die: Why HIV/AIDS Intervention Programmes Fail (Cape Town: Double Storey/Juta, 2003). Fassin has, I think, persuasively argued that this analysis of AIDS policy in South Africa, while well intentioned, misses much of the nuance and the complexity in the debates about how to respond to the health issues presented by AIDS in a situation of limited public health facilities, overtaxed and inadequate financial resources, and an extremely transient population for whom follow-up is difficult at best.
- Campbell, Letting Them Die, 17. According to a report published in 2003, “Prevalence of HIV among men and women in the general population, mineworkers, and sex workers, was 20 percent, 37 percent, 29 percent and 69 percent, respectively.” Brian Williams, Dirk Taljaard, Catherine M. Campbell, E. Gouws, L. Ndhlovu, J. Van Dam, M. Caraël, and B. Auvert, “Changing Patterns of Knowledge, Reported Behaviour and Sexually Transmitted Infections in a South African Gold Mining Community,” AIDS 17, no. 14 (2003): 2099 – 107. Relative to the provincial averages, these numbers are high, but they conform to the general patterns seen elsewhere. And these have seen a considerable increase. According to the Actuarial Society of South Africa, the HIV prevalence rate in 2002 was estimated at 20.6 percent for all women 15 – 49 years of age, with a rate of presentation at antenatal clinics of 31.9 percent. The rate for men 15 – 49 years of age was calculated at 17.5 percent. In 2003, the total number of deaths caused by AIDS exceeded for the first time those caused by all other factors combined. Rob Dorrington, Leigh Johnson, Debbie Bradshaw, and Timothy-John Daniel, “The Demographic Impact of HIV/AIDS in South Africa” (Cape Town: Centre for Actuarial Research, South African Medical Research Council, and the Actuarial Society of South Africa, 2006). More recently, the South African National AIDS Council published statistics indicating 2006 prevalence levels of 33.3 percent for females 25 – 29 years of age, and 12.1 percent in the same age group for men. South African National AIDS Council, “HIV and AIDS and STI Strategic Plan for South Africa, 2007 – 2011,” www.doh.gov.za/docs/hivaids-progressrep.html (accessed March 16, 2008), 24.
- Max Horkheimer and Theodor Adorno use the term adaptation to refer to a process coerced by capital, by which laborers come to treat their predicament within capital as both necessary and natural. Reminiscent of Walter Benjamin’s notion of “second nature,” this process is also dependent on the intimacy between positivism and capitalism, and it is thus in the idiom of the natural sciences that the workers are made to misrecognize their predicament. My use of the term is intended to be taken up within this lineage. I am, however, conscious of the racialist overtones of the term, and of the risks that attend using it when, in so many other contexts, the attribution of an adaptive mechanism to a group of persons is part and parcel of the effacement of their humanity. See Horkheimer and Adorno, Dialectic of Enlightenment, ed. Gunzelin Schmid Noerr, trans. Edmund Jephcott (Stanford, Calif.: Stanford University Press, 2002).
- In 2001, 90 percent of mineworkers considered themselves to be migrants (compared to 97 percent in 1988), and most had not been born in the area. However, in the township, the rates of selfdescribed migrancy are 17 percent. Men from the township also tended to travel outside of the area less frequently. See Lewis Ndhlovu, Catherine Searl, and Johannes van Dam (Horizon) and Yodwa Mzaidume, Bareng Rasego, and Solly Moema (Mothusimpilo Intervention Project), “Reducing the Transmission of HIV and Sexually Transmitted Infections in a Mining Community: Findings from the Carletonville Mothusimpilo Intervention Project: 1998 to 2001,” Horizons Final Report (Washington, D.C.: Population Council), 16.
- Buti Alfred Kulwane, “Civic Competence in Khutsong” (MA thesis, Public and Development Management, University of the Witwatersrand, 2002), 11.
- Monako Dibetle, “Khustong: Govt Won’t Budge,” Mail and Guardian, April 28, 2006; “Government, SACP Condemn Ongoing Khutsong Violence,” Business Day, April 15, 2006; “Trashing and Burning Khutsong Will Never Solve the Problem,” Sowetan, December 19, 2005.
- These rates are generally high throughout Merafong. In 2001, more than 83 percent of the population fifteen to sixty-five years of age earned 3,200 rand or less per month. More than 52 percent earned less than 1,600 rand per month. This was lower than the averages for both Gauteng and Northwest Provinces, the two provinces under whose jurisdiction the various towns and townships of Merafong then fell. The exchange rate that year varied from 7.4 to 13.5 rands to the dollar, with an average of 8.62. Census data for Merafong, derived from the 2001 national census, appears in Merafong City Municipality, Merafong City Local Municipality Local Economic Regeneration Study (Merafong City: Urban Econ Development Economists, 2005), 28.
- As Kulwane notes, the proliferation of shacks even on the properties of township houses was the result of extreme population growth, especially at the end of the 1980s, and a ban, placed by the apartheid state, on further construction. There were, in fact, no new houses built with government support or licensing between 1973 and the end of apartheid in the early 1990s. See Kulwane, “Civic Competence,” 33 – 34.
- Following the redesignation of Merafong as part of the economically impoverished Northwest Province, opposition to the local ANC became vociferous and violent. In 2007 ANC representatives had been asked not to enter Khutsong township, and when they did so, they were confronted by displays of civil disobedience or outright and sometimes physical hostility. Riots, the burning of public facilities, and physical intimidation have erupted periodically, and recent elections were largely boycotted by local residents, leading to an ANC reelection but no popular support and a diminished capacity to claim representativeness by the party. The situation remained highly volatile at the end of 2007, and the consequences for future elections and thus ANC hegemony in the area remain in question.
- The Mineral and Petroleum Resources Development Act of 2002 extended and clarified provisions in the national constitution calling for the development of a “Broad-Based Socio-economic Empowerment Charter.” In response, the four major entities in South African mining — the Department of Minerals and Energy, Chamber of Mines, South African Mining Development Association, and National Union of Mineworkers — agreed to develop an industry charter. These groups signed on to an agreement advocating the transfer of ownership in the mining industry, at market rates, such that historically disadvantaged South Africans (HDSAs) would assume at least 26 percent of each mining company within 10 years of the charter’s promulgation. It further called for the industry to assist HDSAs to raise 100 billion rand in financing to facilitate this new ownership. Other goals, including better education and skills training programs within the mining sector, greater participation by women in the industry, rural development and alternative employment schemes for communities affected by mine closures, and nondiscrimination against foreign migrant labor, are also addressed by the charter, which nonetheless stipulates that the increase of participation by HDSAs beyond 26 percent ownership will not be pursued if it risks the mining companies’ viability, which is to say, profitability. For further details, see “Broad-Based Socio-economic Empowerment Charter,” Government Gazette, August 13, 2004, 6–17, www.info.gov.za/gazette/notices/2004/26661.pdf (accessed March 16, 2008). Further clarification and a reaffirmation of these principles came in July 2004, with the Department of Minerals and Energy’s issuance of a policy document titled “Clarification on the Application of the BBSEE Charter of the MPRDA.” See Mzolisi Diliza, “Understanding the New South African Mining Environment,” address presented at the LBMA Precious Metals Conference 2004, Shanghai, www.lbma.org.uk/conf2004/3A.c.diliza_LBMAConf2004.pdf (accessed March 16, 2008).
- I use the term language game in Wittgenstein’s sense, to suggest a contextual system according to which a term can be understood. The term in question here is life/living. The games are those of epidemiology and actuarial science versus political economy. See Ludwig Wittgenstein, Philosophical Investigations (1953; repr., London: Blackwell, 2001).
- Fassin, in When Bodies Remember, rightly notes the excessive degree to which questions of behavior, long the central concern of public health educators, are culturalized when these issues are discussed in African contexts.
- Fredric Jameson, The Political Unconscious: Narrative as a Socially Symbolic Act (Ithaca, N.Y.: Cornell University Press, 1981).
- Jean Comaroff and John Comaroff, “Millennial Capitalism: First Thoughts on a Second Coming,” in Millennial Capitalism (Durham, N.C.: Duke University Press, 2001), 11.
- In conversation about this essay, Michael Hardt remarked that this has always been the case. This may well be true. But what is remarkable about the appearance of this consciousness in South Africa, today, among youth, is the degree to which radical discourse of previous decades would have expressed its goal as the reappropriation of capital and, indeed, the elimination of capitalism. It is the dissipation of this latter ambition that brings South Africa into line with so much of the rest of the neoliberalizing world after the end of Soviet socialism.
- Campbell, Letting Them Die.
- I use the term danger to apply to the actual events afflicting people, and the term risk to its representation in terms of calculable and incalculable probabilities.
- The most visible of these civil society entities is the Treatment Action Campaign (TAC), the group that spearheaded the movement to demand generalized antiretroviral distribution. There are numer-ous others, supplemented by myriad foreign-financed nongovernmental organizations. It is important to recognize, however, that in the early period civil society and state were in agreement, and indeed, they jointly opposed the international pharmaceutical lobby, though they were soon to fall into conflict. But even in this case, many participants in civil society are themselves prominent members of the state apparatus. The most notable among these is Supreme Court Justice Edwin Cameron, who has for many years worked with Zachie Achmat and Mark Heywood in the TAC. His account of his involvement in the struggle against AIDS can be found in Cameron, Witness to AIDS (Cape Town: Tafelberg, 2005). For the history of the complex relations between civil society and the state in South Africa’s epidemic, see Fassin, When Bodies Remember.