'Letting Them Die': why HIV/AIDS intervention programmes fail, and: The Moral Economy of AIDS in South Africa (review)

This reviewer recently read for pleasure the great nineteenth century Italian novel, The Betrothed by Alessandro Manzoni, a long narrative that has elements of Walter Scott, Charles Dickens and other English classics in it. One famous sequence concerns the impact of the plague on seventeenth century Milan: harrowing, not lacking in sentimental elements but also ironic and showing a considerable interest in the history of medicine. The reader can discover fear, panic and shame on the part of the ill and dying, selfish and greedy behaviour as well as saintly self-sacrifice on the part of a few, a lot of faith in false theories and false remedies and a great deal of denialism. The policy of the Spanish imperial state in Milan - including the views of the famous general who thought his military campaign was what mattered and who rejected any distractions on such minor matters as mass death through disease - interested Manzoni a great deal. This was a classic epidemic - tens of thousands died - until the arrival of the autumn rains and change in the weather finally brought an end to a terrible episode. A South African reader could not but be struck at how little we have advanced compared to the seventeenth century in how we are dealing with AIDS. It casts a very dark shadow over the increasingly tiresome celebrations of 'ten years of democracy' that seem to play endlessly around us. The two books under review are some of the first to appear on AIDS specifically with regard to South Africa and yet there seems to be an unwillingness to understand their importance. They should be, but are not, hot items on newstands in Soweto, Umlazi, Khayelitsha and elsewhere as well as on the bookshelves of anyone concerned with social policy. The editors of Transformation hope that perhaps our recent special edition on education and AIDS is a very tardy but helpful addition to this growing literature. Perhaps this review can also remedy the matter a little bit. Both books bear the hallmarks of research reports and, it must be admitted, are far from bedtime reading beyond any squeamishness with which one might approach the subject. Yet both are important interventions that should cast a heavy stone in the waters of debate and discussion about disease but also broader issues concerning contemporary South Africa.

Campbell is a social psychologist. In 1995 she became involved in what she calls the Summertown HIV-Prevention Project. Summertown is a pseudonym for a mining town west of Johannesburg and 1995 was a time when it seemed logical to focus this kind of project on miners and prostitutes (no doubt the project was conceived some time earlier yet). There was also a town youth component as well although this seems to have been rather tacked on. Mostly when we hear about well-meaning development projects in the media what we get are the dots and bullets approach, a bland and tiresome list of the many, often inconsistent or unlikely goals that they are intended to address. By contrast Campbell surveys a project that was almost a total failure despite, no doubt, considerable funding. This is one reason why it is so important and also less fashionable to write about.

There are two important aspects to her study. First, she tries to explore the fundamental issue as to why 'knowledge' has been so unsuccessful in leading to prevention. She explores to some extent the vulnerability and irregularity of the lives of the prostitutes in explaining why they find it hard to insist on safe sex while also taking up the punctured and injured masculinity of the miners to explain their lack of interest in changing sexual behaviour. These are people who do not want to believe that AIDS is incurable any...