Sustaining Life. Theodore Powers
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created a mechanism for amplifying the experiences of poor and working-class communities besieged by the epidemic. The HIV/AIDS movement laid claim to the socioeconomic rights that had been ensconced in the post-apartheid constitution—specifically the right to health—through their work within a state health institution. In doing so, HIV/AIDS activists changed the effects produced by the state on South African society.
The South African HIV/AIDS movement’s success thus offers critical insight into anthropological theories of the state. Anthropological research on the state has emphasized the diverse forms through which state power manifests and produces effects. Contemporary analyses of the state focus on modes of knowledge through which people are disciplined and made productive, and how these modes of knowledge are disseminated, internalized, and reproduced (Foucault 1991; Scott 1998). These accounts tend to ascribe power to knowledge systems rather than people, tracing the ways that power and hierarchy are reproduced in a capillary manner. State power is thus understood through the ways that “state effects” are broadcasted, internalized, and regenerated, influencing identity formation and social reproduction (Mitchell 1991; Trouillot 2001).
Other anthropological analyses of the state have emphasized how it holds power over life and death and can produce conditions of “bare life” for those deemed surplus to the formal political community (Agamben 1998, 2005; Hansen and Stepputat 2006). There are important corollaries between a state of exception, where martial law unveils the roots of sovereign power in liberal democracies, and the way that state power was exercised in colonized societies, such as South Africa. Here, rather than exercise power by producing discourses that are subsequently internalized and used by people to structure their actions and reinforce existing power relations, the state engages in necropolitics, that is, it expresses power by producing death (Mbembe 2003). These analyses show that the exercise of power, such as by colonial commandement, can also uphold power relations, but in an inverse manner relative to Foucauldian conceptions of the state’s relationship to human vitality.
In contrast, the campaign for treatment access shows that the state can be transformed to sustain human life based on the principle of social justice. While the campaign for treatment access was based on a rights-oriented approach to health, it was not predicated on creating a productive citizenry that reinforced existing power relations in South African society. Indeed, the vast majority of people living with HIV/AIDS were black and poor and had subsisted in conditions of “bare life” during colonization and apartheid. A close study of the HIV/AIDS movement shows that a state once designed to produce the conditions of bare life among part of its population, as in South Africa, can be reformed to sustain those very same lives.
The South African HIV/AIDS movement underscores that people can have a decisive impact on the effects produced by state institutions. Its transformation of state institutions depended on people working within the state to expand treatment access. Members of the HIV/AIDS movement worked within government to overcome AIDS dissidence, change policy, and expand treatment availability. They cultivated alliances with members of the tripartite ruling coalition, which included the ANC, the Congress of South African Trade Unions (COSATU), and the South African Communist Party (SACP). Rather than abstract economic forces or particular modes of knowledge, it was people—in long-standing interpersonal networks, with policy expertise, with biomedical knowledge—who expanded treatment access.
By “occupying” the state, HIV/AIDS activists showed that state institutions have the capacity to amplify alternative visions of society that challenge existing power dynamics. The South African HIV/AIDS movement highlights that the state can produce a range of vastly different social effects; which ones come into being depends on which groups of people set policy and control government institutions. Indeed, analyzing the role of people in the state shows how local bureaucrats can blur the line between state and society while also making decisions that can define the life possibilities for those dependent on state support (Gupta 1995, 2012). One of the most important effects that a state can have is to sustain or end the lives of people (Agamben 1998; Mbembe 2001). The campaign for HIV/AIDS treatment access in South Africa shows that the politics of life and death can be altered based on sustained activism. Activists and people living with HIV/AIDS enabled a plurality of experiences to be incorporated into state policy, changing state effects.
In the twenty-first century, notable US social movements such as Occupy Wall Street and Black Lives Matter have eschewed formal political demands and state-oriented strategies for securing social change, instead focusing on creating nonhierarchical social movements that enact the political dynamics its members want to see in society, what some scholars have called prefiguration (Maeckelbergh 2011; Yates 2015). In doing so, activists have built upon social movement practices developed elsewhere, such as Argentina, where “horizontal” forms of political association developed in the aftermath of financial crisis (Sitrin 2012a). In contradistinction to these examples, the South African HIV/AIDS movement enacted a formal political approach, including using legal activism to leverage the right to health and occupying the state to sustain the lives of people living with HIV/AIDS. The case of the campaign for treatment access is an important example that can broaden our understanding of why some social movements may succeed in changing a society while others fall short.
The political principles of the anti-apartheid movement and the impact of the HIV/AIDS epidemic were elements that could be used to build a common platform to challenge government intransigence and expand access to treatment. These political principles united the members of the HIV/AIDS movement despite their different ethnic backgrounds, class positions, sexual orientations, and professions. People shared their concerns, developed organizations, put their thoughts into action, and, eventually, occupied the state and transformed treatment access in South Africa.
An Outline of the Book
This Introduction outlines the book’s approach to analyzing the politics of the South African HIV/AIDS epidemic in relation to academic debates on HIV/AIDS, transnationalism, social movements, the state, and multi-sited research. The two subsequent chapters offer a historical overview of South African society and the politics of the South African HIV/AIDS epidemic, respectively. The ethnographic section of the book follows, with three grounded analyses of HIV/AIDS politics at the national, provincial, and local levels. The book concludes by relating the success of the South African HIV/AIDS movement to debates on transnationalism, the state, and social change.
Chapter 1 takes the reader through the history of contact, colonization, and apartheid, discussing the divergent sociopolitical trajectories that were subsumed under unified white rule following the South African War (1899–1902). The institutionalization of indirect rule, segregation, and social, economic, and political inequality were the bitter fruits of white settler alliances in South Africa. Analyzing the recurrent forms of self-governance that emerged intermittently across the twentieth century, I demonstrate that the apartheid project never fully succeeded in its mission of “ordering” in South Africa. Notably, attempts at autonomous self-governance in black urban areas led to the development of political ideals within the anti-apartheid movement, such as nonracialism, which subsequently influenced HIV/AIDS activism.
Chapter 2 presents a historical analysis of South African HIV/AIDS activism and the political struggle over access to treatment. Using biographical notes, interview excerpts, and ethnographic description, I ground historical events in the lives of those who led the campaign for treatment access. With a focus on interpersonal networks, I analyze how HIV/AIDS activism emerged from several groups involved in the anti-apartheid struggle: the human rights movement, the gay rights movement, the primary care movement, and the left. The first wave of South African HIV/AIDS activism (1982–1998) contributed to the development of the post-apartheid constitution, led the campaign for a rights-based approach to HIV/AIDS, and established organizations that cultivated second-wave HIV/AIDS activists. Indeed, the second wave of South African HIV/AIDS activism (1998–present) coalesced in response to the growth of the epidemic, government inaction to stem its tide, and the emergence of the ANC’s AIDS-dissident faction. This chapter shows that both the ANC’s AIDS-dissident faction and the South African HIV/AIDS movement depended on state institutions to achieve their goals. While activists