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Unimagined Community

Unimagined Community: Sex, Networks, and AIDS in Uganda and South Africa

Robert J. Thornton
Copyright Date: 2008
Edition: 1
Pages: 304
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  • Book Info
    Unimagined Community
    Book Description:

    This groundbreaking work, with its unique anthropological approach, sheds new light on a central conundrum surrounding AIDS in Africa. Robert J. Thornton explores why HIV prevalence fell during the 1990s in Uganda despite that country's having one of Africa's highest fertility rates, while during the same period HIV prevalence rose in South Africa, the country with Africa's lowest fertility rate. Thornton finds that culturally and socially determined differences in the structure of sexual networks—rather than changes in individual behavior—were responsible for these radical differences in HIV prevalence. Incorporating such factors as property, mobility, social status, and political authority into our understanding of AIDS transmission, Thornton's analysis also suggests new avenues for fighting the disease worldwide.

    eISBN: 978-0-520-94265-3
    Subjects: Anthropology

Table of Contents

  1. Front Matter
    (pp. i-viii)
  2. Table of Contents
    (pp. ix-x)
  3. List of Illustrations
    (pp. xi-xii)
  4. Acknowledgments
    (pp. xiii-xiv)
  5. Note on Ethnic Names and Languages
    (pp. xv-xvi)
  6. Preface
    (pp. xvii-xxii)
  7. CHAPTER 1 Introduction: Meaning and Structure in the Study of AIDS
    (pp. 1-32)

    This book offers an anthropological, or “ecological,” approach to the study of acquired immunodeficiency syndrome (AIDS). It departs from epidemiological and demographic approaches expressed in statistical measures and from the behavioral approaches expressed in tables of behavior change. I examine the dimensions and processes of everyday life in order to understand how sexual networks that transmit the human immunodeficiency virus (HIV) are formed and work. My principle finding is that change in HIV prevalence is primarily determined by the differences in the configuration of large-scale sexual networks rather than by the cumulative effects of behavior change, a necessary but not...

  8. CHAPTER 2 Comparing Uganda and South Africa: Sexual Networks, Family Structure, and Property
    (pp. 33-55)

    South Africa and Uganda have been at the center of attention in the HIV/AIDS pandemic.¹ The first evidence of the HIV epidemic in Africa emerged in Uganda in the early 1980s.² It is the only African country that has shown an overall and sustained decrease in prevalence (until recently, when prevalence has apparently begun to rise).³ By contrast, South Africa was not forced to deal with the epidemic until the 1990s, and today has an HIV prevalence that is among the highest in the world. Since 1992, HIV trends in the two countries have moved strongly and consistently in opposite...

  9. CHAPTER 3 The Social Determinants of Sexual Network Configuration
    (pp. 56-82)

    We have seen that the different configurations of large-scale sexual networks—in particular, their self-organizing behavior due to structural characteristics—is the primary factor in the radical differences between HIV prevalence trends in Uganda and South Africa. I turn now to consider the social-structural causes for these differences in the configuration of the sexual networks. Rather than seeking explanation at the level of individual choice and behavior—what is usual in epidemiological studies—we look for explanation at the social level. Indeed, differences between the two countries in statistical aggregates based on surveys of individual sexual behavior—that is, the...

  10. CHAPTER 4 The Tightening Chain: Civil Society and Uganda’s Response to HIV/AIDS
    (pp. 83-99)

    Uganda’s approach converted the moralism of the ABC prevention model (abstinence, being faithful, and using condoms) to the social ethic of “zero grazing.” This allowed for the mobilization of civil society, and for the prevention of AIDS to be treated as a nation-building exercise. The synergies brought about by a comprehensive and integrated response by government and civil society were largely responsible for the change in HIV prevalence.

    It first became apparent in 1996 that HIV prevalence in Uganda, alone among African countries afflicted with HIV and AIDS, was declining. Data from sentinel sites in antenatal clinics began to show...

  11. CHAPTER 5 AIDS in Uganda: Years of Chaos and Recovery
    (pp. 100-114)

    Uganda is often associated in people’s minds around the globe with Amin and AIDS. This is unfortunate, but the suffering that Uganda has gone through in the decades of the 1970s and 1980s seems to have given it the resolve and strength to defeat both the tyrant and the disease, and to arrive at the beginning of the twenty-first century as one of Africa’s success stories. But in July 2003, as Amin¹ lay dying in exile in Saudi Arabia and debate went on about whether to allow him (dead or alive) back into the country, either to die or to...

  12. CHAPTER 6 Siliimu as Native Category: AIDS as Local Knowledge in Uganda
    (pp. 115-129)

    One of the most important aspects of AIDS in Uganda was the fact that Ugandans seem never to have believed that it came from some distant place to afflict them. They did not invent conspiracy stories. Even in the early years when people in southwestern Uganda were casting around for explanations of the rising epidemic, stories began to circulate that it had been brought in by Tanzanian soldiers who overthrew the regime of Idi Amin, but these were local people who spoke similar languages, not distant foreigners. The disease was stigmatizing, and many people had difficulty talking about it, especially...

  13. CHAPTER 7 The Indigenization of AIDS: Governance and the Political Response in Uganda
    (pp. 130-148)

    By 1988, HIV prevalence was beginning to skyrocket. At the Kampala antenatal clinic surveillance sites, HIV infections had increased by approximately 150 percent since 1985, when figures were first recorded. This turned out to be the period of the steepest rise in HIV prevalence. The government response, still located primarily in the Ministry of Health (MoH) through the AIDS Control Programme (ACP), was supported by a significant response on the part of civil society. For instance, the Ugandan Women’s Effort to Support Orphans was founded and chaired by the first lady, Janet Museveni, with funding from international donors.¹ According to...

  14. CHAPTER 8 South Africa’s Struggle: The Omission and Commission of Truth about AIDS
    (pp. 149-170)

    In 1987, the president of Zambia, Kenneth Kaunda, announced that his son, Gwebe, had died of AIDS.¹ “It does not need my son’s death to appeal to the international community to treat the question of AIDS as a world problem,” the senior Kaunda said.² The epidemic that had begun in northern central Africa was rapidly making its way south. In that year, there were approximately fifty-one cases of AIDS known in South Africa.³ Eighteen years later, Nelson Mandela’s son, Makgatho Mandela, died on 6 January 2005. Two of Africa’s best known and greatest former presidents had lost their sons to...

  15. CHAPTER 9 Imagining AIDS: South Africa’s Viral Politics
    (pp. 171-194)

    The roots of what has come to be called President Thabo Mbeki’s “denialism” are undeniably deep in South African soil. Its branches are discernable in many aspects of health beliefs and medical practice in South Africa. It is far too simple to call it a denial. It points to a world of meanings—a worldview—that links almost every aspect of health and illness to the social rather than the medical. It is not a denial of knowledge or a denial of science and medicine. It is a refusal to bring into the mind’s eye, the imagination, a vision of...

  16. CHAPTER 10 Flows of Sexual Substance: The Sexual Network in South Africa
    (pp. 195-219)

    Expressions of sexuality and acts of sex have been treated as behavior—that is, as individual acts primarily motivated by internal psychological states of mind or body—in most of the social scientific and psychological literature, while cultural studies and literary approaches have treated it in categorical (as gender) or cultural (representations) terms, or as discourse (after Foucault). A cultural anthropological model, by contrast, must seek to understand the symbolic and semiotic dimensions of sex and sexuality in southern Africa. Here I examine the traditional culture of sex and sexuality, relying in large part on data from traditional healers (sangomas)...

  17. CHAPTER 11 Preventing AIDS: A New Paradigm for a New Strategy
    (pp. 220-234)

    Science builds on what is known, but assessing the epistemological status of our knowledge is still one of the most difficult tasks. What we think we know can stand in the way of knowing more. This is especially true, perhaps, in this time of AIDS, and with respect to sex. Knowledge about sex is hedged with many constraints—moral, linguistic, practical, social, and cultural. And because HIV is sexually transmitted, knowledge of AIDS is limited by similar constraints, giving rise to new limits on language, knowledge, and action: stigma, secrecy, disclosure, “coming out,” disclosing one’s status, the ethics of disclosure,...

  18. Notes
    (pp. 235-256)
  19. References
    (pp. 257-274)
  20. Index
    (pp. 275-282)