When Bodies Remember: Experiences and Politics of AIDS in South Africa (review)

Didier Fassin's new book helps explicate one of the most troubling and well-known developments in the African AIDS epidemic: the contentious debates in South Africa among activists, scientists, and government figures over the etiology of the disease and the nature of appropriate treatments. Fassin reminds us that in order to understand the controversy, indeed in order to understand the complexities and contradictions that mark the South African epidemic more broadly, we must think historically. In fact, as he suggests, given the long history of racist and predatory science in South Africa and internationally, local reluctance to defer to scientific knowledge—even at the highest levels of government—is understandable. At first glance, this would seem to be a somewhat modest, perhaps obvious proposal. After all, Randall Packard and Shula Marks (among others) long ago established the critical need to understand contemporary health and medicine in South Africa and the politics of medical research in Africa through the lens of history. And yet, when debates over the etiology of AIDS and the provision of antiretrovirals emerged in a newly independent South Africa, even some of the most socially and politically savvy observers seemed to abandon their deep knowledge of South Africa's troubled history and the role of science and medicine within it in their well-meaning and heartfelt rush for a magic bullet to stem the profound crisis of suffering and death.

Fassin brings a certain dual legitimacy to the project, which is helpful. He himself does not doubt the viral etiology of AIDS or the biological efficacy of antiretroviral drugs. Yet as a doctor and an anthropologist, and as someone with a long-standing commitment to and a personal history of practices of social justice, he is able to appreciate the social etiology argument—that poverty causes AIDS—while at the same time remaining clear in his confidence in mainstream biomedical understandings of disease etiology and treatment practices. The trick, as he reveals, is to keep both social and biological analyses in focus at the same time. Based on a combination of ethnography, oral interviews with patients, activists, clinicians, and others, media accounts, and secondary sources, the narrative tacks back and forth between experience and politics to reveal that these are not merely intellectual or political debates, albeit vitriolic ones. It is not enough to simply claim that antiretrovirals are efficacious. They must be dispensed within a broken system—and they must be accepted by people whose experience has taught them to not always trust science. They are social technologies.

The body of the book weaves themes of gender violence, national and international scientific debate, local politics, and national media into this larger history of the epidemic and its controversies, always returning to the subtleties of experience that ethnography reveals. Clearly Fassin is very well read and engages anthropological practice and theory with great thoughtfulness—but in some ways, his theoretical conversations and excursions, which are peppered throughout the book, distract from the compelling narrative that is the central theme. Perhaps this is a byproduct of the translation from French to English. More generally, this is probably a book that could have benefited from one more revision, to clarify the organizational structure and tighten the narrative, to further explicate the methods. But it is such a timely, smart, and compassionate intervention into a critical and still unfolding issue in African health and politics that perhaps its rawness is not only understandable, but appropriate.