A Plague of Paradoxes: AIDS, Culture, and Demography in Northern Tanzania (review)

Africa is the place where international concerns about HIV/AIDS first drew intense geographic scrutiny. Some investigators focused on rising reported incidence rates in different parts of the continent. Others saw the spread of the disease as an extension of Western colonialism and postindependence efforts to subordinate African countries, producing epidemics of malaria and tuberculosis when men had to migrate for work. To yet others, the fact of central importance was the tension between sexual risk and desires for high fertility—meaning that attempting to block a sexually transmitted disease by using a measure that also blocked fertility (condoms) created insecurity for women whose most tangible link to income-earning men was the production of children.

In A Plague of Paradoxes (a revision of his Ph.D. dissertation), Philip Setel weaves themes like these together and takes them much further, tracing the history—demographic, epidemiologic, social, and political/economic—of the spread of AIDS in northern Tanzania. The central thesis is that "moral demographies" (p. 55) often attribute the rise and spread of the disease in Africa to inappropriate desires among the urban young for money and sex in environments created by the colonial legacy, but that the shape that the new epidemic has taken in the Kilimanjaro region grows out of contradictory demographic and economic forces that were deeply embedded well before the colonial era. The "kihamba" system of land inheritance by first and last sons was based on the precarious relationship between altitude-dependent agricultural production and regional trade. When the mountain system could no longer support increasing numbers of people and the demands of cash-cropping, men increasingly supplemented their wives' farming production by migrating down the mountain for urban work. Because the institutions that guided people into reproductive life had long been in place, the onset of the AIDS epidemic has largely heightened existing lines of tension, bringing to the surface of social life a "plague of paradoxes." Most notably, the epidemic "moves along pathways that lie at the very heart of biological and social reproduction . . . the processes, institutions, and values by which populations perpetuate themselves and their identities from generation to generation" (p. 2). Both men and the women who had to stay behind were vulnerable to the disease that the men might bring back. In effect, the same economic and geographic corridors that had become escape routes from pressures on the mountain plots became pathways to deadly AIDS risk.

A careful exploration of the notion of "desire"—the theme of the University of Chicago's Worlds of Desire series—is one of the book's most engaging contributions. Guided into proper reproductive and moral values of the kihamba regime, Setel argues, a child learned cultural-specific approved expressions of desire: for sexual expression, productive labor, inheritance, and continuation of the family. But a common theme can be discerned as well in different forms of historically shaped desires: new forms of commodities, employment, knowledge, and sexual gratification, some of which, in the wake of the AIDS epidemic, hold mortal dangers. The book's historical narrative may at times overstate the qualities of safety and orderliness of past inheritance rules, marital obligations, and initiation ceremonies. Nonetheless, whereas culture is often separated from enterprises like demography and geography, this book links these endeavors inseparably through the medium of history. In projecting its story through a number of disciplinary lenses, it makes an important contribution to the literature on a region that has already drawn some of the continent's finest anthropological and historical attention.