Axes of Inequality Lecture Series Event Summary: Jonny Steinberg “Black Men and Colored Pills in South Africa’s HIV/AIDS Epidemic”

Kate Griffiths

On Monday November 2nd Johnny Steinberg—journalist, ethnographer, Rhodes Scholar and Open Society Institute Fellow—presented the findings of his award-winning book Sizwe’s Test as part of the Axes of Inequality speaker series at the Graduate Center of the City University of New York. Researched during the early stages of antiretroviral therapy (ART) availability in South Africa, Steinberg set out to answer the question “What if treatment comes and people don’t take it?” This question is increasingly relevant as AIDS research in South Africa continues to show that men are less likely to seek out ART than women; a factor which may contribute to higher HIV prevalence rates for women.

Steinberg’s search for answers brought him to Lusikisiki, a densely populated rural community in the Eastern Cape with an HIV prevalence rate of approximately 31%[1]. In Lusikisiki, Doctors Without Borders (MSF) and the provincial department of health pioneered a nurse-driven HIV treatment program which has become a model for “rolling out” AIDS treatment in low-resource settings. Along with his translator and research assistant, to whom he gave the pseudonym Sizwe, Steinberg explored the grassroots cultural response to the introduction of AIDS treatment in Lusikisiki and its peripheries. Given that Sizwe made his home in the town of Ithanga[2], located some 10 kilometers outside of Lusikisiki, it was in this rural enclave where Steinberg based his ethnography.

Steinberg’s finely drawn portrait of Sizwe illuminates the role of race and masculinity in individual and community responses to the AIDS epidemic. One of the key dynamics that emerges from Steinberg’s ethnographic inquiry is the stigma and shame experienced by those infected and affected by the epidemic. This dynamic indicates that the uptake of treatment in South Africa is more than a simple matter of good science, a functioning public health system, and an adequate supply of ART. Instead, Steinberg and Sizwe reveal a novel, emerging conception of masculinity that builds on traditional Xhosa idioms of marriage and family while iterating a critical perspective on biomedical testing and treatment programs.

Sizwe is in some ways an archetype of the broader post-apartheid changes in South African society. He is from an impoverished background but has become part of the growing black middle class due to his ownership of a spaza shop[3]. Sizwe’s suffers from guilt and paranoia resulting from his newfound wealth and status while at the same time focusing his entrepreneurial energies on investing in his children’s future. He sees himself as a new kind of man—one for whom monogamy is the foundation of his identity and mercantile success. Sizwe believes that these values will allow him to “leave something behind,” in the form of a homestead, for his descendants. He is scathing in his review of the many men—including his own father and relatives—whom he feels have failed to similarly protect and provide for their lineage. In to marry in Xhosa tradition, men are required to pay lobola[4] to their girlfriend’s family and for their children to be recognized as part of their patrilineage by their ancestors. By fathering children out of wedlock without being able to pay lobola, many of the men in Sizwe’s generation will die without leaving behind a culturally recognized descendant.

For Sizwe, HIV is a disease defined by white doctors and a threat to the development of a positive Black masculinity. Sizwe sees publicly visible treatment queues of African patients lining up for “white” medicine administered by white doctors as a collective humiliation to black South Africans. Nonetheless, Sizwe traveled with Steinberg to treatment and testing sites at nearby clinics and visiting traditional healers. Their travels are part of an ongoing search for medicine that can help two relatives of Sizwe who are HIV+. While Sizwe hopes for the success of traditional medicines, he takes a pragmatic approach toward assessing the effectiveness of ARVs and traditional cures.

Though he encourages his relatives to get tested and even acts as a treatment partner, Sizwe declares to Steinberg that he will never get tested even though he suspects that his blood may be “polluted” by the virus. Knowledge of his own HIV status is a threat to the very line of descent Sizwe is so focused on building. It could undermine his relationship with his fiancée and his role as father and head-of-household. Nevertheless, Steinberg argues that Sizwe’s world-view, even if representative of a significant stratum of Black South African men, is no static obstacle to successful testing and treatment interventions. Instead, the malleability of masculinity in the face of changing economic and social pressures and Sizwe’s pragmatic, experimental approach is a potential source of hope in the HIV/AIDS epidemic. When asked, Steinberg speculated that were he to fall ill, Sizwe would likely seek treatment and testing; that his vision of masculinity and responsibility would ultimately be flexible enough to accommodate ARV’s.

Steinberg’s insight into shifting South African masculinities has implications for every one concerned about the impact of HIV/AIDS in Southern Africa. In his perspective, masculinity is less a cultural obstacle to sound science and effective medicine than an important worldview to include in developing successful models for community AIDS treatment.

[1]Bedelu M, et al. 2007. Implementing antiretroviral therapy in rural communities: the Lusikisiki model of decentralized HIV/AIDS care. Journal of Infectious Diseases 1

[2] A fictional name given by the author to protect the identity of his primary informant “Sizwe”

[3] A spaza shop is a general store that carries a variety of everyday household items. Large steel shipping crates are usually used to house the spaza shops, which can be found in urban and rural areas throughout South Africa.

[4] Lobola is a form of bridewealth, traditionally paid in cattle but now often accepted if paid in currency.