Discussion of AIDS in South Africa automatically leads to a drawing of oppositional lines. Most commentary on the epidemic is immediately enmeshed in a highly polarized controversy that has long pitched the national government against activists and most scientific and medical experts. In the context of this vitiated politics, Didier Fassin’s When bodies remember creates a new space. It offers a framing of the epidemic that puts the spotlight on the historical and structural underpinnings of the crisis, issues that have often been neglected in the heated politics of ‘you are either with us or against us’. As such, the book is a commendable and important contribution to the study of AIDS in South Africa, but also more broadly to the study of health crises in general.

The controversy around AIDS in South Africa is usually tagged to the former President Thabo Mbeki’s controversial statements that queried whether HIV actually causes AIDS, and whether mainstream antiretroviral medicines did more harm than good. In When bodies remember, Fassin is not interested in taking sides in the binary of ‘scientific truth’ versus ‘denialism’ that has marked the public debate in South Africa. Nor does he want to analyse the ‘true’ motivation behind former President Thabo Mbeki’s notorious statements. Rather, Fassin wants to investigate why Mbeki’s controversial theses, which challenged biomedical authority and Western hegemony, resonated with large sections of South African society. Why do Mbeki’s arguments, so easily and commonly dismissed as ‘irrationality’ and ‘madness’, still persist in public debate? What do the contestations about AIDS, which were rapidly subsumed in arguments about race, genocide, colonialism and apartheid, reveal about fault lines in South Africa’s history and its present?

Fassin is quite clear that he himself has a relatively orthodox mainstream position on biomedical issues and, moreover, he seems to disagree with many of the government’s stands. Nonetheless, he does not dismiss the views of the Mbeki government and its supporters—which have been held responsible for the avoidable deaths of thousands of AIDS patients—as simply a product of quackery or political convenience. Rather, he attempts to understand the historical and social context that produced both the Mbeki government’s theses and those who oppose them. The ‘symmetrical’ analysis is undertaken less with a view to justify the government’s seemingly heretical policies and more with a view to better understand them. That Fassin undertakes this treacherous task is a matter of intellectual courage, for all too often those who don’t automatically condemn Thabo Mbeki’s views on AIDS are pilloried as being ‘denialists’. For Fassin, though, this is a risk worth taking, not so much because he wants to be an apologist for Mbeki but more because this approach seems to be an the only way of gaining a more capacious understanding of politics in South Africa. Indeed, undertaking such analysis is what he sees as the relevant role for anthropologists and social scientists who seek to study the ‘other’.

Reading the past

Fassin contends that the AIDS controversy in South Africa can be rendered comprehensible only if it is located in a longer history. Without this essential context of the past, the present is difficult to decipher.

Fassin presents the thesis that the AIDS epidemic and the war of words around it represent wounds and burdens of South Africa’s past which were not sufficiently acknowledged in a post-apartheid narrative of national reconciliation and forgiveness. The epidemic throws into relief the very schisms that the celebration of the ‘rainbow nation’ obscured. As he puts it:

Much of the book is devoted to examining and giving place to the pasts that give meaning to and make sense of the contemporary AIDS controversy. These include histories of public health, medical knowledge, and healthcare systems under apartheid that have produced structures of stark inequalities. Some of the chapters—on scandals over contemporary AIDS policies, and disputes over technical and scientific aspects of the epidemic—cover well-trodden ground, while others—such as on medical policies under the waning apartheid regime—draw on material that has seldom been discussed in social science literature. It is by outlining these long trajectories of racism and discrimination in South Africa—pasts that long preceded Mbeki’s controversial policies—that the present becomes easier to decipher.

Fassin spends much of the book tracing the ‘epidemic of disputes’ that has dogged AIDS policy-making in post-apartheid South Africa, such as the government’s support for a locally produced drug that was supposed to be a miracle cure for AIDS, its resistance to providing antiretroviral drugs to pregnant mothers, its comments on AZT’s toxicity and mortality statistics, and its policies on intellectual property held by multinational pharmaceutical companies. Fassin points out that even when the apparent topic was something like financial subsidy for a musical comedy, the rhetoric was always undergirded by issues of national identity, race, and a suspicion of the West. Moreover, reaction to the debates all too often fell along the ‘colour line’; whereas whites were often openly contemptuous of the government, blacks were more likely to understand where the government’s seemingly preposterous stands are coming from.

To understand the contemporary politics around the epidemic, Fassin insists that the history of the epidemic cannot start in 1994, when the apartheid regime in South Africa ended. The relevant history goes back much further. To understand this longer trajectory, Fassin discusses the history of epidemics, public health and medical systems in the region. Prominent among his examples are how the epidemics of syphilis and tuberculosis were intertwined with theories of African inferiority and promiscuity. In addition, using sources that have come to light only in recent years, he vividly describes how the apartheid regime discussed and planned genocidal programmes, especially in its twilight years. Given this history, the black population’s suspicion of biomedical authority seems easier to understand.

Fassin’s account will raise the inevitable question of why the Mbeki government and South Africa’s people were so shackled by old concerns and fears about apartheid-era misdeeds. After all, didn’t the end of apartheid provide a clean slate on which to write new relationships—with science and with global orders—that weren’t so resolutely tethered to the ugly past? How could history be used as an explanation when the government had much control over how to shape the future? Fassin’s answer is that the present is often necessarily tethered to its past. Even though there had been a change in the type of government, South Africa continued to be a deeply unequal country. The change in constitution didn’t necessarily imply quick change in the broader social and economic structures that animated people’s lives. The change in legal status did not entail an erasure of historical memories. As long as the wounds, rancour and resentment of the past are not acknowledged and attended to, they will likely continue to obscure the future.

Embodiment and ethnography

Throughout the book, individuals’ life stories in local spaces are interwoven with narratives that are played out in national and international arenas. Interviews with AIDS survivors are interspersed with national policy debates. For Fassin, this back and forth between the local and the global is crucial, because for him the relevant history of the epidemic is not only in grand global and national narratives but is also engraved in individual bodies and everyday experiences. Thus he uses personal histories to illuminate national stories. Individuals’ memories help make sense of how identities and representations of the self are moulded by global economic orders and colonial histories. These interviews and narratives of individuals who suffer from AIDS provide some of the most powerful parts of the book. They make vividly palpable the violence that the AIDS epidemic is wreaking. More than statistics and analytical arguments, they ‘flesh out’ technical public health debates. But perhaps more profoundly, the interviews and ethnographies indicate a research ethic. They reveal the time, effort and empathy that might be needed for social scientists to understand the controversy. They reveal an essential respect for the people whom Fassin studies. The seeming bizarreness of the politics around South Africa’s epidemic has meant that hundreds of researchers and journalists have parachuted in for quick trips, quick interviews and quick judgments to explain ‘the mystery’ of why the Mbeki government was saying what it was. Fassin’s work provides a counterpoint and indicates the kind of research that might actually come closer to understanding and explaining ‘the other’.

Conclusion

Research and analysis of the AIDS epidemic is currently at a critical crossroads. There is increasing evidence within public health research that existing frameworks for conceptualizing, measuring and addressing the epidemic may be inadequate. As a result, epidemiological models are being redesigned; prevalence estimates are being radically revised; new categories for measuring risks and outcomes are being suggested. The initial overwhelming emphasis on biomedical and behavioural interventions is giving way to public health programmes that take structural socioeconomic contexts explicitly into account. In short, there are calls for new epistemological frameworks and policy models within which to understand and address the epidemic. When bodies remember serves as a timely and valuable contribution at this juncture. It shows how social science research can contribute to a new understanding of the epidemic by giving place to the long trajectories of history and by taking into account the webs of relations and meanings that connect everyday experiences with national and global policies.

The book also comes at an important point in South Africa’s history. The year 2008 saw the ouster of Thabo Mbeki as president of the country. The controversial health minister Manto Tshbalala-Msimang, was replaced. On the heels of these ousters came a split within the African National Congress (ANC) that has ruled the country since 1994. The split signals a potential end to the overwhelming domination of the ANC and the creation of an opposition party that might enjoy legitimacy and support from black Africans in a way that was seldom extended to other opposition parties, which were often dominated by whites. The seismic political shifts taking place within South Africa may also be a harbinger of a new era of AIDS policies that are not accompanied by the violent animosity that has characterized public debates between the government and activists over the last decade. When bodies remember has an important contribution to offer this new era, as it attempts to reframe the debate and create a conversation within the public sphere that is not stridently adversarial. However, even as it opens a space for a less adversarial debate, Fassin’s book holds a note of caution for the future: which is of not expecting change too quickly. There are no clean slates, and any new government, of the ANC or otherwise, will have to contend with the violent history of colonization and apartheid, memories of which remain alive in the present.