Faith in the Time of AIDS

Religion, Biopolitics and Modernity in South Africa

Marian Burchardt

• Publisher: Palgrave Macmillan
• Year: 2016
• Print ISBN:
  9781137477767
• eBook ISBN:
  9781137477774
• Topic: Social Sciences
• Subtopic: African Politics
• Index: Social Sciences

This book describes how Christian communities in South Africa have responded to HIV/AIDS and how these responses have affected the lives HIV-positive people, youth and broader communities. Drawing on Foucault and the sociology of knowledge, it explains how religion became influential in reshaping ideas about sexuality, medicine and modernity.

1

HIV/AIDS and Christian Engagements in Africa: Toward a Cultural Sociology of Social Technologies

Until a few years ago, social science research on religious involvement with development, humanitarianism and social problems in Africa was relatively scarce. And over an even longer period, the governments of donor countries, international NGOs, global health organizations and development agencies were hardly aware that religion might play important roles in the lives of the people they sought to serve through their efforts. Today, nobody doubts that religion is not only a key factor in the social life of Africans but also that it is proving tremendously influential in shaping the contours of modernity in African societies. What remains to be done is to show how religion became so important and to explain why. It seems to me that, in studying these developments, the case of the HIV/AIDS epidemic and the struggle against it are particularly illuminating. While researchers have already taken important steps in exploring religious involvement with HIV/AIDS, theoretical work has been relatively marginal in these efforts so far. In this chapter, I therefore situate my analysis by describing the most important findings of social science research on HIV/AIDS and then sketch what I see as the most promising theoretical pathway. I argue that combining insights from the sociology of knowledge with perspectives from Foucault-inspired studies of governmentality allows us to take people seriously as competent actors in the social world while simultaneously uncovering the mechanisms and technologies of power that constrain choices and actions.

Research on HIV/AIDS is an interdisciplinary field of study characterized by a great variety of approaches. While it seems difficult to fit the huge range of studies on AIDS in Africa into categories, one could say that social science research is largely made up of three discourses: first, investigations into the politics, policies and governance of HIV/AIDS; second, debates on changing intimacies and sexualities; and third, studies in medical anthropology on local interpretations of AIDS in the context of culturally specific imaginaries of disease, healing and therapeutic relationships.

From prevention to treatment: The politics and governance of HIV/AIDS

More than most other diseases, HIV/AIDS was intensely politicized not only in the United States (Epstein 1996, Siplon 2002) but in Africa as well. Research on the politics of AIDS has drawn attention to the perceptions, strategies, resources and interests of various state and non-state actors that have emerged from these politicizations and how they have changed over time.¹ Until the middle of the 1990s, responses to AIDS by national governments in Africa were relatively slow, partly because the much debated “silence on AIDS” (Meursing 1997), resulting from stigma, was perpetuated at various political levels. Rapid and concerted governmental action on AIDS, together with the active involvement of all kinds of civil-society organizations and groups in some countries, such as Uganda and Senegal, seemed to have had tangible effects in terms of declining rates of infection (Allen and Heald 2004, Swidler 2006). The case of Senegal, a low-prevalence country, shows that the level of mobilization is not necessarily a consequence of social urgency (Pisani 1999). In other countries, such as South Africa, social movements have powerfully challenged the institutional inertia of governments (Mbali 2013, Friedman and Mottiar 2006, Robins 2004). Overall, we see that political controversy and efforts have shifted from the early focus on prevention and care toward concerns over biomedical treatment (Dilger et al. 2010).

The politics of AIDS is formed by interactions between state agencies and an increasingly globalized and diversified civil society, as well as biomedical authorities and pharmaceutical companies. Together they define the political agendas of HIV/AIDS on the basis of unequal power relations. As a result of both transnational mobilizations and mounting human suffering throughout the 1990s, HIV/AIDS moved center stage onto political agendas.² This led to increased efforts by existing organizations (e.g. the World Health Organization [WHO]), the creation of a whole plethora of new organizations (such as Joint United Nations Programme on AIDS [UNAIDS]) and, around the turn of the millennium, also to increased funding, especially through the UN-led “Global Fund to Fight AIDS, Tuberculosis and Malaria” and the American PEPFAR initiative. As a result, HIV/AIDS became a truly global disease (Patton 2002) not only because of its global spread but also because it captured the attention and imagination of people across the globe, prompting them to form social movements that would press governments to become active and engage in advocacy. Simultaneously, efforts turned into privately organized philanthropic activism (Smith and Siplon 2006). Increasingly, such philanthropic activism on AIDS drew on strategies of corporate social responsibility in which celebrity involvement, ethical business and consumption and appeals to Northern middle-class sensibilities were drawn together in mobilizations on behalf of “distant others”, that is, HIV-positive Africans (Richey and Ponte 2011).

Importantly, in the meantime responses to AIDS in this context have become a primary means whereby humanitarian regimes are ever more firmly invested with governance at large and everyday experiences. Drawing on Agamben, Nguyen (2009) has cogently argued that biomedical mass treatment programs for HIV/AIDS became forms of “government-by-exception” as they are largely organized outside the existing healthcare administration, financed by separate funds and justified in the name of HIV/AIDS as a therapeutic and medical emergency. Such notions, Nguyen argues, serve to make governance increasingly resemble humanitarian interventions. Because of the large scale of their activities and their ways of combining external political and expert-based authority, humanitarianism reconfigures – sometimes on a more permanent basis – established notions of sovereignty and political rule and engenders what Pandolfi (2003) called “mobile sovereignty”. In contexts of transnational humanitarian authority, targeted states cease to exercise sovereignty regarding decisions over life and death as, for instance, when decisions over who can enroll in treatment programs and who cannot need to be taken in situations of resource scarcity (Fassin 2007, Nguyen 2010). There is thus a conceptual triangle of global institutions, states and social movements within which AIDS governance and politics unfold. My concern in this book is to show how Christian groups became part of this politics by making claims on global institutions on the one hand and by challenging the role of progressive social movements as “the voice of the people” on the other. But how do the different levels of governance affect one another? How do local and global actors mutually shape their actions? The fact that many HIV/AIDS programs across Africa, and in fact across the world, look highly similar suggests powerful influences of global-level governance and raises questions about the mechanisms supporting such influences. Epitomizing observations concerning similarities between responses to AIDS, de Waal (2003: 254) has argued that

there is an un-theorized consensus on what an HIV/AIDS programme should look like: it should be founded on voluntary counselling and testing, education (preferably by peers), provision of condoms, efforts to overcome denial, stigma and discrimination, and care and treatment for people living with HIV and AIDS. […] Even when undertaken by a government ministry, army or private company, it is essentially an NGO model of public action.

Researchers variously addressed such similarities in terms of theories of organizational diffusion (Strang and Meyer 1993), translation (Czarniawska and Joerges 1996) or adaptation (Swidler 2009). In general, political scientists were rather impressed by the seeming institutional convergence around HIV/AIDS organizations while sociologists and anthropologists emphasized the importance of local institutions and the ways in which global-level scripts for action were often grafted on top of these local institutions and practices and the meanings sustaining them, sometimes also in conflict with them (Swidler and Watkins 2009). Altogether we see that, after the initial engagement with the political mobilization of HIV/AIDS in international political agenda-setting processes, researchers’ focus shifted toward concerns with governance and organization to center on questions regarding the terms on which local populations actually engaged with the HIV/AIDS programs that targeted them.

Importantly, while sponsored by global efforts and coordinated by national governmental policy, HIV/AIDS programs – especially those focusing on prevention, assistance and support – typically arrived at local African populations through the work of NGOs. In liberal political theory, NGOs form part of civil society and engage on behalf of the common good. As Watkins et al. (2012: 285) observe, “[M]uch of the scholarly literature valorized them because they are non-governmental and not-for-profit, thus capable of liberating communities and individuals from incompetent or oppressive states on the one hand and the grip of the market on the other.” A closer look at the realities on the ground, however, made it clear that NGOs often faced a dual stricture. On the one hand, because of their financial dependence on Northern donor resources they were increasingly absorbed into networks of transnational governmentality (Ferguson 2006: 40) and instituted in a top-down fashion. Leusenkamp (2010) has shown for ARV treatment programs in Western Uganda how, as a consequence of donor dependence, accountability vis-à-vis local authorities slowly evaporated and continuously shifted toward “donor authority”. On the other hand, NGOs were also brought into closer and closer relationships with African states who have the power to allow, constrain and structure their operations, for example, through registration requirements, mandatory protocols and so on (Hearn 2001: 44).

More importantly, however, NGOs are often wholly drawn into the forms of governance that exist on the ground, especially those organized around clientelism and patronage, that is, relationships of unequal reciprocity between patrons and clients that rest upon the mobilization of vertical affective ties of personal dependence, kinship-based or otherwise, to achieve instrumental purposes. Smith (2003) has shown how the payment of transport costs and per diems in family planning programs in Nigeria has allowed participants to nurture patronage networks and that participation signals status and prestige. In a similar vein, Swidler (2006, 2009) convincingly argued that in Malawi the ways in which kinship- and chieftaincy-based patronage shapes the operations of NGOs lead to subversion and syncretism in development governance. This means that the meanings on the basis of which Africans engage in HIV/AIDS programs, and by implication their desires and objectives, are often quite different from those imagined by NGOs and stated in their project descriptions. In NGO reports what is sometimes prosaically, albeit critically, glossed as “lack of project ownership” on the part of target populations – in other words, the absence of the local involvement in NGO project development – really implied, as Jones (2012) has perceptively shown for Eastern Uganda, that projects simply “lacked any meaning” for people: projects did not matter to them. As a consequence, more often than not, embryonic forms of local participation falter when foreign NGOs leave their field sites. This raises intriguing questions as to whether religious communities have greater abilities to create collective capacities for social change and to command social commitment than the kind of local task teams formed by secular NGOs.

A radically different picture with regard to local participation and notions of political agency emerged from research on political activism and social movements around HIV/AIDS and the ways such activism engendered new political subjectivities. During the 1990s, Nguyen (2005) observed in West Africa how HIV-positive people deployed their participation in HIV/AIDS support groups in order to establish contacts with medical advocacy NGOs and physicians from France whom they deemed possibly instrumental in acquiring access to ARV’s which were only available for locally prohibitive prices at the time. In this context, Nguyen (ibid.) coined the term “therapeutic citizenship” to refer to the ways in which bio-political assemblages made up of local health-based political subjectivities and the claims to justice against global society made in their name facilitate access to pharmaceuticals and by implication refer also to notions of rights and membership in global society.

Because of the extremely active social movement scene around HIV/AIDS, such notions strike a powerful chord among researchers working in South Africa as well. Robins (2004, 2006) and Mfecane (2011) showed how support groups founded in the cultural and political vicinity of the “TAC” worked to mediate the construction of “responsibilized health citizenship”, which sometimes accompanied new interpretations of gender roles and political engagement. Importantly, in South Africa social activism around HIV/AIDS was not only supported by long-standing activist experiences but was also a result of the peculiarities of governments’ AIDS politics, especially during the Mbeki presidency. Governmental responses in South Africa to HIV/AIDS caused high levels of controversy. The most critical issues concerned the delay to treatment programs through the public health sector during Thabo Mbeki’s presidency, Mbeki’s support for so-called AIDS dissident science (Robins 2004, Fassin 2007, Decoteau 2013), ill-conceived scientific research policies (Schneider 2002), cases of corruption in the implementation of AIDS programs and Mbeki’s attempts to “re-Africanize” South Africa’s AIDS politics (Leclerc-Madlala 2005). Fierce public debates around sexuality and prevention focused on scandals of virginity testing and “baby rape” (Posel 2005a). Public controversies further escalated when in 2006 the then Vice-President and current President Jacob Zuma faced charges of rape for allegedly forcing an HIV-positive woman to have unprotected sex with him. In Zuma’s testimony at trial, he publicly dismissed HIV-prevention messages (Robins 2008).

Already in the 1990s, and as a critical response to government policies, social movement organizations emerged. Led by the TAC, these organizations mobilized global support, successfully campaigned for the universal supply of HIV/AIDS medicines, battled against stigma and organized countless grassroots initiatives for self-help, advocacy and peer education (Friedman and Mottiar 2006). Social movement culture became the wider context in which the first patients on antiretroviral therapy (ART) experienced “miraculous recoveries” (Robins 2006). The interpretations of these experiences, which also drew on religious imaginaries, became crucial for further mobilizations (Figure 1.1).

Figure 1.1 Banner of an anti-stigmatization campaign of Melisizwe’s support group

Source: Photograph taken by the authors in 2006.

As notions such as “therapeutic citizenship”, “health citizenship” and “responsible patienthood” gained currency among anthropologists working in Africa, some critical objections emerged with regard to the extent to which they made sense in other African settings (Burchardt et al. 2013). While Siplon (2013) identified social activism over HIV/AIDS in some Lutheran Church congregations in Tanzania, other anthropologists were more skeptical. Mattes (2011), in his ethnography of treatment provision in Tanga, found ARV programs to be organized in such an authoritarian manner as to foreclose any enduring sense of citizenship among participants, captured in one of his informants’ comments that “we are just supposed to be quiet”. Beckmann and Bujra (2010: 1041) concurred by finding the formation of social movements around HIV/AIDS to be still in their infancy, while seeing some successes in advances in democratic culture in HIV-positive people’s support groups. Marsland (2012: 472) suggests that authoritarian tendencies reverberate with the centralization of power in Tanzania’s social past and argues that “the economy of NGOs, community groups, religious and other benefactors is oriented toward the requirements of the major donor agencies”, while “occasional handouts are seen to foster passive dependency”. In an important critique, Susan Reynolds Whyte has drawn attention to the pitfalls of both Foucauldian and “social movements and identity” theory-oriented research traditions. “There is a danger,” Whyte argues (2009: 13), “that we lose sight of the political and economic bases of health in our concern with identity, recognition, and the formative effects of biomedical and social technology.”

All of these research questions and findings have an immediate impact when looking at the role of religion, but they have hardly been addressed in social science research. To what extent, and how, have churches and religious communities become involved in the fight against HIV/AIDS? How does membership facilitate the promotion of new political subjectivities and access to rights discourses and material resources? How have religious communities engaged with organizational templates from the development world such as “NGOs”, “projects” and “programs”, and how have these engagements impacted on the religious and spiritual life of these communities? What are the meanings on the basis of which people engage in church-based activism, and how do people respond to its messages and ideas?

NGOs and the invention of faith-based organizations

There is now a burgeoning literature on religion and HIV/AIDS, but concerns with public governance are still marginal.³ Most studies focusing on local church communities, especially in the field of Pentecostalism, are mainly concerned with issues of sexual morality, neglecting more complex questions of governance and organization. In this book, I suggest that, over the last two decades, the link between religion and HIV/AIDS has been reconfigured through the emergence of a new kind of FBO whereby NGOs have been reinvented in the religious field.

In a broader perspective, research on such FBOs is now located at the interface between two bodies of literature: research on religion and development and anthropological studies of Christianity, especially Pentecostalism, and the public sphere. The burgeoning field of studies on religion and development (Ellis and ter Haar 2007, Deneulin and Bano 2009, Clarke and Jennings 2008, Jones and Peterson 2011) has documented how religious organizations have become involved in transnational development networks in Africa to an unprecedented extent. Moreover, research has demonstrated how governments, international organizations and donor agencies have invited religious bodies to become “partners in development” (Belshaw et al. 2001) and how resource flows have facilitated the incorporation of religious organizations into the institutional webs of international development policy (Ferguson 2006). FBOs emerge as the institutional form in which religious communities have adapted to the infrastructure and demands of global development networks and to the new opportunities for institutional growth they offer. These changes were paralleled by a massive upswing of missionary activities and US evangelical missions becoming “invisible NGOs” (Hearn 2002). While producing important insights, some of these studies functionalize religion and start from an instrumentalist concern with...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• List of Figures
• Acknowledgments
• List of Abbreviations
• Introduction
• 1. HIV/AIDS and Christian Engagements in Africa: Toward a Cultural Sociology of Social Technologies
• 2. The Global and the Local: Transnational Connections and the Rise of Faith-Based Organizations
• 3. A Moral Science of Sex
• 4. Having Sex, Making Love
• 5. Biographical Becoming: Life Projects
• 6. Helping Themselves: Religious AIDS Activism in Support Groups
• Conclusions: Christianity, Social Change and Modernity in South Africa
• Notes
• References
• Index