Shattered Dreams? An Oral History of the South African AIDS Epidemic (review)

Shattered Dreams? traces the South African AIDS epidemic from the early 1980s to 2006, examining its evolution from a disease that primarily affected a relatively small number of homosexual white men to a pandemic that has impinged on the lives of almost six million people, primarily black heterosexual men and women. Gerald Oppenheimer and Ronald Bayer movingly and incisively tell the story through first person accounts of the doctors and nurses who have treated and continue to treat HIV and AIDS patients. In between oftentimes long block quotations, the authors intersperse their contextual analyses, highlighting the political economy of health care.

The bulk of the book explores the evolution of the current epidemic and the political controversies that have accompanied every aspect of it. Two themes that have not previously attracted sufficient attention stand out as especially compelling: the historical and epidemiological conditions that have rendered the epidemic so vicious and the ways that HIV and AIDS played out among white homosexual men. Oppenheimer and Bayer deftly move the reader through the economic and social structural inequalities—abysmal, second-rate education, limited job opportunities, strict regulation of movement, restricted access to public services, and political powerlessness—that lay at the heart of the National Party’s apartheid policies, and that so profoundly shaped the contours of the AIDS epidemic. The oscillating migrant labor system, a pillar of South African gold-mining, left families in the rural areas, while single men from throughout Southern Africa traveled sometimes thousands of miles to the mining centers on the Witwatersrand, only to return home for brief stints during the Christmas holidays. As the authors note, the combination of migrant labor and these relentless structural inequalities “had a deep, systematic effect on the majority’s physical, psychological, and social health throughout the twentieth century,” creating pervasive vulnerabilities to a sexually transmitted disease like AIDS (9–10).

Many of the issues that Oppenheimer and Bayer illuminate in their discussion of AIDS among South Africa’s gay white community during the 1980s presaged the attitudes and limited political and health care responses that would later bedevil South Africa’s handling of the wider epidemic among blacks. The widespread belief that HIV and AIDS were “imported” diseases and not endemic to South Africa; the antipathy, and even disdain, of National Party and the Apartheid Government toward those infected with the virus and the medical personnel who tried to help them; the unwillingness of the African National Congress (ANC) to see AIDS as relevant to the liberation struggle; the incredible fear of contagion; the desire for secrecy on the part of those who had contracted the disease; and the endless debates over the proper distribution of scarce medical resources would all be played out again during the 1990s and early part of the new millennium. Sadly, many of the doctors who had gained medical knowledge and institutional and administrative experience through their treatment of HIV and AIDS during “the forgotten epidemic” (21) departed the public hospital sector just as the disease began to affect black heterosexual men and women. These medical stalwarts left public service either because they had become utterly frustrated with the lack of institutional support or because they were forced out of their positions, leaving those who followed them having to face many of the same issues, as well as to acquire their medical and bureaucratic experience anew.

The doctors and nurses who shared their thoughts with Oppenheimer and Bayer emerge very much as three-dimensional historical actors. Sharing their fears, frustrations, and hopes, they convey a multitude of rationales for working with AIDS patients. For some the disease proved medically and intellectually compelling; for others their work is bound up with religious faith and commitment; for yet others improving the lives of people with AIDS is part and parcel of a broader campaign for social justice. No matter the source of their engagement, many of these doctors and nurses...