Re: [xmca] Papers for discussion: HIV,interventions and activitytheory

From: Mary van der Riet <vanderriet who-is-at>
Date: Fri Nov 14 2008 - 01:43:14 PST

Dear Steve, Andy, Mike and others who have commented on the HIV/AIDS

Steve wrote
I am curious about contrasts >between white, black and coloured South
Africans in regard to the AIDS crisis and sexual >practices. My guess
is that the higher levels of employment in skilled and career jobs,
professions >and small businesses by whites creates a very different
situation from the one you are describing >among the black ethnicities
in SA, many of whom experience extreme poverty and economic >pressures,
as you describe.

Yes, the AIDS stats in relation to race reflect socioeconomic
differences (poverty and extreme economic pressure. Estimates from the
Nelson Mandela/HSRC survey for persons aged two years and older were
Blacks, 13.3%; Coloureds, 1.9%; Indians 1.6%; Whites, 0.6% (Shisana, et
al, 2005). Race is one of the strongest predictors of HIV status in
South Africa. Marginalisation and discrimination on the basis of race or
ethnicity must be understood as a factor that shapes vulnerability to
HIV infection in South Africa. In the post-apartheid era, racially-based
disadvantage continues to occur in relation to exposure to poverty,
place of residence, education, job opportunities, skills and training
and access to services. In contexts with constrained opportunities and
resources, risky behaviours are more likely

Steve continues
> concurrency (and the expansion of non->traditional sexuality in
general) in places like the US and Europe, among both gays and
straights, >occurs for very different reasons. Reasons that occur to
me at the moment for this emergence >include: a new-found relative
freedom from the risk of pregnancy through birth control;

Mary comments:
Another significant factor in SA is the high rate of teenage pregnancies
– even though birth control is readily available (in injectable form).
There have been arguments that young girls fall pregnancy in order to
access the child care grant (about R190-R200/month – at the current
exchange rate about $20 per month) – but this has been contested and I
don’t think this is a major reason for early pregnancy.

Steve continues
>a general relaxation of social coercion against non-traditional sexual
 behavior, including women, >(although women's sexuality outside
marriage is still more discouraged than men's); new resources >for
mobility and privacy for individuals, especially for youth, and
including for women (although >men continue to have much more access to
such resources); more opportunities to socialize >outside the
traditional family framework, also including, with the same
qualifications, women; new > opportunities for gays and others
interested in alternative sexual practices to socialize; a relative >
proliferation of accessible commercial social venues to meet and date
sexually active people in, >especially in urban areas, although they
are by no means ideal and are largely unavailable to >teenagers; a
radical increase in public knowledge about how to have sex
recreationally and >pleasurably, something never before generally
available, especially to women; much more >knowledge about relationship
issues and consciousness about making sexual and intimate relationships
more egalitarian and meaningful for both partners (these latter two are
ones I would especially attribute a significant role to the womens, and
also the gay movements); and until the AIDS crisis, the relative
ability to rely on the health care system and antibiotics, personal
hygiene, partnership, and protective barriers to try to minimize
catastrophic consequences of sexually transmitted diseases.

Mary comments:
Many of these conditions are evident for wealthier, educated people in
SA (suggesting it is also mostly about class, not only race – in SA the
two are confounded), and the phenomenon of barebacking that you mention
below has also been found in the SA gay community – in the AIDS
literature this is also linked to a ‘death wish’ and the need to engage
in high risk practices for the thrill of it (partly in the face of the
dreaded disease)

You would think that condoms would be used at near 100% levels by such
people in the US, but they aren't - "barebacking" is considered an
acceptable practice in many circles, especially among those who feel
immune from AIDS because they assume they are sufficiently segregated
from it.

Judging from your report, another social movement, which currently
exists, that could be brought much more on board is the ANC itself.
This historic movement led the struggle to overthrow apartheid, but in
a way, its work has only begun. Getting the big political movements
and governments of SA and in every country on board is clearly

the problem with the ANC at the moment is that they are facing a lot of
internal battles and re-positioning which detracts from developing good
policy. Having a new minister of health as I mentioned in my earlier
post makes a big difference, but she may only be there until April next
year – not a lot of time to change government policy.

As for the possibility and potential for a women's movement in SA, I do
hold high hopes. Women in SA and Africa in my mind can develop the
power to change a great deal of things, including reversing many of
worse effects of the global AIDS crisis, but such power will take time
and changing conditions to harness, especially in a place like SA,
where economic capital in many regions is weak and the labor force is
consequently highly underdeveloped and in extreme conditions of
poverty. In contrast, the deep entry of women into the workforces of
the US and Europe, and the growth of post- WWII technologies for
semi-mechanizing domestic work, speeding up shopping and meal
preparation, and so forth, have combined, mostly in the advanced
capitalist countries, to create underlying conditions and social
opportunities for women to demand their full rights in ways never
before seen in history.

The women of Africa and throughout the world, in my opinion, will join
forces on these fundamental issues, issues that are fundamental for all
working people - but not overnight, and not all at once, and not in the
same way or for the same reasons, and will do so in unique ways from
region to region, culture to culture, and individual to individual.
Sisterhood truly is powerful, and I think the world has so far only
gotten a taste of it. When the women of Africa rise, the world will

Mary: the expression in SA would be Viva Amakhosikazi, Viva! (Long live
women, long live) and Amandla ngawethu (power to the people!!!). Yes
Steve, I really hope that something happens, and maybe it will
‘naturally’ as people get more and more fed up. But, the desperation
is extreme ito poverty, death and illness. I am peripherally involved in
an NGO that is building capacity for people to run their own SAveings
and Credit Groups (outside of the formal banking system) and this might
have an effect on social capital. There is also a drive to train
children in financial literacy as many of them have to manage household
budgets with ill or absent adults. These are important movements, and if
they can grow and be sustained, this might have an indirect effect on
people’s power and capacity to mediate their own risk of infection.

And thank you for your comments and inputs. It’s a huge issue, not one
any one person can handle or solve on their own and there are many in SA
who are working quite actively in the field to resolve some of the
issues. Thank you for your comments and inputs, it really has been
useful to discuss these issues in this forum – to have them aired, but
also to discuss possibilities.

And to Andy, thank you also for linking me to various people and for the
range of resources which you have mentioned,. I am tracking them down
and engaging with them.

Andy commented:
> I think like in Uganda, if we can find out what works at a local >
level, the an intthose who are prepared to fight, rather than intervening from on
> high, so to speak. Government can provide education, publicity, >
money, .... What the government says always affects how the people >
think. If the government does no more than praise People Fighting >
AIDS, then that will be a help.

I think this is true, and the SA government’s stance on HIV has not been
very helpful over the last 10 years, so anything that is more positive
(in attitude and resources) will make a difference

> On a side note, governments which help women by providing generous >
resources for them to stay home as sole carer for a child, may >
reinforce exploitation of women. In other countries, resources are >
provided to women who want to continue in the workforce and need to
> pay for child care or get their husband to give up work.>

Yes, I can see that the gender politics remain if women are restricted
to the home environment.

And your colleague in the SACP here in SA who speaks of another
colleague who did not go for medical help but went to a traditional
healer, partly because of the stigma, provides an important example of
how complex the problem is. Many traditional healers have been
incorporated into programmes which inform them about HIV/AIDS, risks in
treating clients – cutting with the same blade etc – and many adopt very
progressive positions on this (referring clients to hospitals, admitting
that they cannot cure AIDS), but there are others who claim to cure

Mike also commented:
This may seem like a backwards way to approach the issues you raise,
Mary &
Andy, but William Mazzarella wrote a book titled "Shoveling smoke" (Duke
Press) which was a study of how an advertising campaign in india made
condums accrue the meaning of sexiness when they had the opposite
before. Seems like despite opposite sign valence the book might be of

thanks Mike, I will follow that up – it seems to pick on Andy’s point
about changning the ‘image’ of condomless sex – and is spot on, rather
than ‘backwards’

Thanks to all who have, both on and off the list, made suggestions and
comments and referred me to people and references. I have really
benefited from the discussions.

South Africa is a fascinating place – defeating apartheid, Mandela, the
Truth Commission – but we still have major challenges:
We might be on strike next year as university staff because of the way
the university management is disciplining two staff members for
questioning their practices.
on another matter: A colleague of mine argues that we are at the coal
face of many of the issues which are reflected in the world – one of
them is that of race, and how one is affected by race, racism and racial
policies, how this might affect the way we/me/staff/lecturers assess
students etc. It raises issues of the more long term effects of
apartheid policies and how one addresses legacies of colonialisation
today, in 2008 in our own practices. Its tough dealing with this process
of ‘transformation’ on a daily basis!


Mary van der Riet; School of Psychology; University of KwaZulu-Natal
Private Bag X01, Scottsville, 3209

tel: 033 260 6163; fax: 033 2605809

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Received on Fri Nov 14 01:44:42 2008

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