Living with death in a time of AIDS: A rural South African case study

Abstract

Aims: To examine how a rural community profoundly affected by escalating rates of largely AIDS-related deaths of young and middle-aged people makes sense of this phenomenon and its impact on their everyday lives. Methods: Data were collected in Agincourt subdistrict, Limpopo Province. Twelve focus groups were constituted according to age and gender and met three times (a total of 36 focus-group discussions [FGDs]). The FGDs explored sequentially people's expectations of their lives in the ''new'' South Africa, their interpretations of the acceleration of death amongst the young and middleaged, and their understandings of HIV/AIDS. Discussions were recorded, fully transcribed, and thematically analysed. Results: Respondents acknowledged escalating death rates in their community, yet few referred directly to HIV/AIDS as the cause. Rather, respondents focused on the social and cultural causes of death, including the erosion of cultural norms and traditions such as cultural taboos on sex. There are many competing versions of what HIV/AIDS is, what causes it and how it is spread, ranging from scientific explanations to conspiracy theories. Findings highlight the relationship between AIDS and other traditional diseases with some respondents suggesting that AIDS is a new form of other longstanding illnesses. Conclusions: This study points to the centrality of cultural explanations in understanding ''bad death'' (AIDS death) in the Agincourt area. Physical illness is understood to be a symptom of ''cultural damage''. Implications of this for public health practice and research are outlined.

Negotiating therapeutic citizenship and notions of masculinity in a South African village

“…They still contested the origins and possibilities of a cure for HIV or AIDS and relied heavily on folk theories (witchcraft, ancestors and other social agents) to explain and manage ill-health (cf. Posel et al, 2007). It is not uncommon to find a terminally ill person who resists seeking medical help because he or she believes they have been bewitched or are sick because of the transgression of ancestral rules.…”

“…For example, some clients came to a support group believing that they had been bewitched or were ill from tindzaka, an illness commonly believed to be inflicted by ancestors as a punishment for violating certain rules governing sexual conduct (Posel, Kahn & Walker, 2007). Some clients may be sceptical of ARV-use and may strongly believe in using traditional medicines to treat ill-health.…”

AIDS Conspiracy Beliefs and Unsafe Sex in Cape Town

“…We thus might expect that some individuals may endorse AIDS conspiracy theories for the same reason that they might believe witchcraft to be implicated in AIDS deaths in that both imply a hidden, evil power; and both are responses to very contemporary fears and conundrums pertaining to the AIDS epidemic. There is a rich South African literature suggesting widespread belief that HIV may have spiritual causes, notably witchcraft attacks or loss of protection from ancestors resulting from violations of cultural taboos [34][35][36]. In order to account for the effect of this worldview, we include a measure of belief in witchcraft.…”

‘If the doctors see that they don't know how to cure the disease, they say it's AIDS’: How older women in rural South Africa make sense of the HIV/AIDS epidemic

“…Perhaps as so many young people in their communities have died and continue to die of AIDS, the fear has prompted older women to breach the silence surrounding sexuality. Such an unprecedented step becomes reasonable in a general context of 'living with death' as documented by Posel et al (2007). Life experiences and education-based knowledge led most (48 out of 60) of the women to explicitly state that HIV/AIDS cannot be cured and that once someone is infected it leads to death, despite the increasing availability of antiretroviral therapy (ART).…”