Africa: The Journal of the International African Institute

This is a fascinating and thought-provoking collection, in which every chapter speaks of the resilience as well as the suffering of Africans coping with the effects of the AIDS epidemic. Of the fourteen chapters, one deals with West Africa; the others are distributed among the countries of Southern and East Africa. It particularly advances understanding of the ramifications of the increasing, but still limited, availability of anti-retroviral drugs in the under-resourced health systems of Africa. The new survivability of AIDS clearly makes it is easier to accommodate in social relations (see chapters by Ashforth and Colson). Nevertheless, Mogensen shows that where paying for a relative’s anti-retroviral treatment means throwing family finances into disarray, wealthier family members face moral dilemmas, while their dependent relatives experience the additional bitterness of facing an avoidable death.

The introduction and a chapter by Jean Comaroff highlight the importance of the global context of Africa’s AIDS epidemic. Certainly, the chapters demonstrate the insidious influence of imposed austerity programmes that further reduced the capacity of already-weak African health systems to provide for AIDS patients. But the global context could do with more unpacking. The cynicism of imposed austerity programmes or ideological insistence on ‘abstinence-only’ education is obvious, but so is the importance of PEPFAR, George Bush’s special funds for AIDS treatment in Africa, as a source of treatment, and that both emanate from the same source – US policy – flies in the face of standard descriptions of the ‘neo-liberal’ order. Perhaps we need more anthropologies of treatment providers, along the lines of Whyte, Whyte and Kiadoddo’s chapter in this collection, but at the international level.

Another outside influence highlighted in several studies, and that invites further discussion, lies with the ramifications of the wholesale adoption into African education programmes of strategies designed for European audiences. Sadly, it is becoming clear that the initial rhetoric of ‘AIDS kills – there is no cure’ was entirely counter-productive, because it seemed to make a mockery of all efforts to treat, and associated the illness very firmly with the anxiety and impurity surrounding death. AIDS educators’ insistence on being explicit about the dangers of AIDS paradoxically made the illness much harder to speak about, and treatment efforts still deal with the consequences.

This is one of several points where the reader encounters the indigenous aetiologies at work in Africans’ understandings of AIDS. Dilger, in his introduction, acknowledges a striking fact: namely, that several of his authors refer to explanations of illness that are cast very much in terms of specific, [End Page 326] bounded local cultures (for example, Qaranta, Offe). The ideas referred to often centre on the connections between death, resulting pollution and further illness. Tracing responses to this contemporary and globalized epidemic, then, guides the observer’s gaze back to concepts that were very much the stuff of structuralist anthropology as practised in the 1960s (at least two authors, Offe and Geissler/Prince, refer specifically to Mary Douglas). Dilger seems to think that this is merely a trick of the light; that the appearance of return to an earlier era of anthropological writing can be removed by a careful choice of vocabulary and consideration of context. This reader is not convinced: doesn’t the importance of such anthropological classics as ‘death pollution’, which appear antiquated in other contexts, in connection with AIDS indicate a necessity to rethink both these older concepts and the alternative ones that intervened, but seem to be less successful at elucidating the context of AIDS?

Another striking feature of this collection is the degree of the apparent feminization of AIDS. Only two of the chapters (Geissler and Prince, and Reid) focus on men, and one of those is about men many of whom are socially identified as feminine. That women in Africa are at greater risk of infection and die more quickly of AIDS than men is no longer news, but at least as important...