A Kinship of Bones: AIDS, intimacy and care in rural KwaZulu-Natal by Patricia Henderson (review)

With the wide-scale rollout of ARVs for those living with HIV and AIDS in South Africa and the generally progressive orientation of the Minister of Heath, Aaron Motsoaledi, towards HIV and AIDS and health more widely, it can be easy to forget a time before ARVs. Yet, in this time an estimated 330,000 people died, unnecessarily because of the South African State’s denial of the link between HIV and AIDS and its refusal to rollout ARVs timeously (Chigwedere et al 2008). Henderson’s ethnographic study takes us back to a transition period which begins with the unavailability of ARVs and ends with the increasing supply of ARVs by NGOs and state systems. In her detailed, yet highly readable, ethnography, Henderson seeks to open up a different terrain and a different space to many of the urban writings on HIV that are currently circulating in South Africa, focused very much on a rurally-based population in which an ethic of care first emerged in the face of overwhelming disease and death. Detailing the pathways in which young women and men returned home to die and how this disease was at one level intensely personal and individualised but also a challenge to the social body, she manages to weave personal narratives with theoretical reflections. The majority of ethnographies of HIV in South Africa have explored the urban experience and the politics of struggle for ARVs (most notably Fassin’s (2007) When Bodies Remember). As such, Henderson refocuses us to the rural base of South Africa, where the state is weaker. She traces how HIV and AIDS became embedded and reworked existing understandings of health alongside transforming relationships of care.

Of particular note is her chapter on ‘AIDS-orphans’, children who have lost either one or two of their parents to AIDS. A large debate has occurred within the field about how to represent and understand the lives of ‘AIDS-orphans’. On the one hand, a substantial literature has emphasised the undoubted negative effects of parental death on children and in particular, the often long and protracted nature of AIDS-related deaths. Studies suggest huge levels of post-traumatic stress disorders (similar to those found in conflict settings), depression, anxiety and a general lack of wellbeing. These studies all typically present children as subject to widespread social, economic and political forces which buffet them in ways they cannot understand, nor control. On the other hand, a literature is emerging which seeks to strike a balance between these negative effects and the ways in which young children emerge as social actors in their own lives, able to – within constraints – negotiate the networks and opportunities available to them. Henderson convincingly shows how a range of children, in often horrific circumstances, are able to become actors in their own lives – as she writes: ‘the dexterity young people brought to bear in drawing on networks of kin to reconfigure a sense of place for themselves, and yet alludes to a layering of pain that is not easily exposed’ (102). Moving the argument in this way, she simultaneously positions children as actors while acknowledging the hardship they face.

Henderson also seeks to locate the community of Okhahlamba, in the northern Drakensberg region of KwaZulu-Natal within a wider range of social, economic and political forces. The networks of mobility and economy are easily tied into the narratives, but some of the larger political dimensions, especially during the struggles for AIDS-treatment, led by the Treatment Action Campaign, do fall away in her narrative. These struggles were pivotal in defining new forms of sociability and citizenship in post-apartheid South Africa, as well as remaking the populations’ relationship with the state (Robins 2008). As Nguyen’s (2010) remarkable book on the emergence of treatment in West Africa shows, these processes created new forms of biopolitics which stretched from rural communities to the global ‘north’. At one level, this is because the state’s reach into...