Claire Decoteau. 2014. Ancestors and Antiretrovirals: The Biopolitics of HIV/AIDS in
Postapartheid South Africa. Chicago: The University of Chicago Press.
Isak Niehaus
Brunel University, London
This monograph examines the South African AIDS epidemic from different angles, including
sociological analysis and fieldwork in informal settlements outside Johannesburg. Decoteau aims
to explore interactions between global, national and local processes, and show the failure of
biomedicine to address the underlying causes of AIDS. She situates the epidemic at a
paradoxical moment, marked by democratisation and neoliberal economic restructuring.
Decoteau views the ANC government’s GEAR policies as a homegrown version of structural
adjustment, and suggests that African nationalist leaders desired for the country to prosper on the
market without being dependent upon western nations. Despite ANC hegemony, the poor
express political opposition through thousands of spontaneous service delivery protests.
In the first chapter, Decoteau considers conditions of life in Sol Plaatjie and Lawley –
two of the many informal settlements that have arisen despite government’s commitment to
provide low cost housing. Here HIV infections are twice the national average, and are related to
the fragmentation of households, transactional sex between multiple partners, and poverty.
Between 37% and 47% of households live on monthly incomes of R500 (about $50) or less, and
between 18% and 22% are dependent upon social grants. Morbidity and funerals constitute
enormous expenses. Damp earth floors, paraffin fires, contaminated water, and a lack of fresh
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fruit and vegetables contribute to ill health. Unemployment and inequality have eroded social
solidarity, and persons living with AIDS suffer stigma and neglect. Households often live in fear.
Chapter 2 shifts to national processes. Decoteau sees President Thabo Mbeki
contraversial views on AIDS as a product of his commitment to ‘neoliberalism without
imperialism’. She shows how his refusal to attribute high incidence of AIDS to African sexual
promiscuity led him to believe that HIV does not cause AIDS. He also rejected ARVs
(antiretrovirals) on the ground that they served the interests of the global pharmaceutical
industry, and instead, recommended African sollutions, such as traditional healing. Moreover, his
Health Ministry relied upon ‘the community’ to undertake responsibility for home-based care,
hereby alleviating the burden of government. These policies amounted to a form of
‘thanatopolitics’, in which the state assumed the sovreign power to disallow life. Being incapable
of self-reliance, people were compelled to face up to their own disposability, and seldom
mentioned AIDS.
In chapter 3 Decoteau views the Treatment Action Campaign’s (TAC) struggle for access
to ARVs as based on the politics of ‘biomedical citizenship’. The TAC threatened
pharmaceutical companies with a legal battle over patent abuse, and took Mbeki’s government to
the constitutional court, claiming that its failure to provide ARVs violated citizens’ ‘right to life’.
After 2004, the TAC monitored the government’s roll out of ARVs, and vigorously implemented
treatment literacy programmes. She argues that such citizenship provisionalises rights on the
basis of embodying ‘biomedical technologies of the self’. For example, users of ARVs are
compelled to disclose their status, undergo counselling, adhere to treatment regimes, and commit
themselves to lifestyle changes. This shows how under neoliberalism, rationalities of rule guide
the conduct of citizens. Decoteau accuses the TAC of subscribing to ‘scientific salvation’ which
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posits that ARVs are incommensurable with ‘traditional healing’. Their emphasis on patient
responsibility also privatises blame and ignores obstacles to embodying biomedical technologies,
such as the erratic supplies of drugs, health workers, transport and nutrition. This explains the
ambiguous reception of the TAC in South Africa’s informal settlements.
Chaper 4 examines how presidents Mbeki and Zuma deployed the tropes of tradition and
modernity in the performance of masculinities. Despite rejecting biomedical orthodoxies, Mbeki
championed liberal gender rights, and promoted a modern masculinity centered upon black
economic empowerment. Zuma, by contrast, embraced biomedical views, but performed a more
traditional Zulu sexuality that emphasised militance, polygyny, bridewealth and circumcision.
His performances held particular appeal in informal settlements, where de-industrialisation
undermined idealised notions of masculinity. Men without money cannot marry, pay bridewealth
and support dependents. Feminisation of the workforce also meant greater opportunities and
greater independence for women. Whilst women demonize traditional masculinities as
misogenystic, men refer to women’s rights with dericion.
In the final chapter, Decoteau considers how informal settlement residents use herbs,
undergo Zionist cleansing rituals, invoke the ancestors, and consult diviners, in addition to taking
ARVs. She invokes Bourdieu’s notion of a field in which different actors compete to accumulate
symbolic and social capital, to conceptualise pluralism in the consumption of health resources.
Biomedicine was intrinsically connected to colonialism, and used the AIDS epidemic to expand
its hegemony. Yet people resort to ‘traditional healers’ for treating the connections between
bodies and broader social and spiritual networks.
This monograph is enimently readable and its strengths lie in the author’s superb grasp of
interconnections between different domains of social interaction. Decoteau also brings the
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sociological theories of Nicolas Rose and Pierre Bourdieu to bear on the South African AIDS
epidemic in sophisticated and productive manner. Unfortunately, I found the scope of the
monograph somewhat narrow. Like so many social scientists the author often invokes
neoliberalism as an all-explanatory theoretical device. She does not consider the rapid rise of
HIV infections during the De Klerk and Mandela regimes, and could have utilised her own
fieldwork material more fully. Descriptions of local beliefs frequently rely on summaries of
secondary literature. To me her critique of ‘biomedical hegemony’ in settings that lack crucial
health care resources rings somewhat hollow. However, none of these shortcomings would deter
me from recommending Ancestors and Antiretrovirals to a broad readership.
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