This leads to the second task of this chapter: to describe the context of women I interviewed in order to disrupt the homogeneity often implicit in the category of ‘HIV-positive mother’ and to unsettle the exoticism often associated with African women (Mama, 1995; Zivi, 1998). HIV-positive women are largely portrayed in public policy, through medical discourse and in popular culture as either unidimensional victims or as hazardous sources of infection, but seldom simply as women (Squire, 1993). Hogan (1998: 169) suggests that black women are othered in multiple ways by AIDS discourse, which compounds existing racial discrimination:
When poor women and women of colour are not being presented as containers of sexual pollution and moral pathology, they are reduced to signifiers of abjection and unspeakable impoverishment. In discourse on AIDS from a global perspective, for example, women are often framed as one-dimensional victims who are located in faraway, pitiful developing countries.
While it is certainly important not to caricature women as abject and unspeakable, the irony of this comment is that most HIV-positive women are in fact located in far-away, pitiful developing countries, or at least in developing countries. Four out of five HIV-positive women in the world live in Africa (Lawson, 1999), yet the vast majority of literature is Western and presumes a Western audience and a Western subject. Conversely, constructions of the category ‘African AIDS’ have led to implications that the AIDS found in Africa is foreign and related to a mysterious set of ‘African’ processes. It has, for example, become interwoven with tropical and distant associations (Seidel, 1993), as well as associations of bestiality and aberrant sexuality (Patton, 1993). This distinguishing of ‘African AIDS’ is potentially laden with racist assumptions. Patton (1990) suggests that social and medical science are often guilty of ‘inventing “African AIDS”’ such that much of the resultant work inscribes difference and exoticises Africa rather than attempting to ground analysis in a realistic understanding of Africa’s needs. To view this literature as more culturally sensitive simply because it more often takes Africa as its object of study, then, is not always unproblematic. Patton (1990: 77) warns as follows:
Debates about ethics in particular occur in a middle ground between two cultures, but the ‘second voice’ (the ‘African perspective’) is carried by Western ethicists and researchers who speak of an ‘African culture’ based largely in their fantasies. In this middle ground of pretended cultural sensitivity, virtually the only audible speech is that which occurs within, or is translated into, the conceptual categories of the modern Western episteme.
Whether an African subject or an African culture exists outside of anyone’s fantasies, however, is highly debatable. Further, the devastation of AIDS on the continent may be fantastical, but it is also real. Encountering the African context in the era of the Western episteme, then, perhaps inevitably involves balancing a tightrope of negotiation between valuing the differences an African setting brings and resisting patronising assumptions that Africa is so unique and different as to be incomprehensible to outsiders. Comments such as Patton’s, therefore, risk taking on a level of paranoia that leads to paralysis rather than to culturally sensitive understanding. The challenge is to understand African AIDS as both typical and unique and to hold a strong African voice and a strong general stance.
In order to avoid repeating these splits, I understand the task of providing context as inherently contradictory and inevitably incomplete. It is often considered important to contextualise studies conducted outside the West. The assumption is that the correct descriptions will render the (unknown) objects of study known and graspable. But perhaps all that can be expected is that contextualisation ignites both expected and unexpected ruminations and images. The imperative to provide context often implicitly holds assumptions about difference – about the need to explain the exotic and unknown. If participants were British, for example, it would be conceivably possible to provide very little context and assume some shared sense of reality between reader (whether British or not) and research participants. Providing context is thus potentially a task that requires explaining where difference and exoticism lies, and thereby in turn holds potential for homogenising and inscribing difference.
The women I interviewed, despite their cultural, economic and environmental landscape, are in many ways not different or strange: they conduct relationships; they have similar hopes and fears to those of other women; they are mothers just like other mothers. At the same time, however, they live within a particular context that is not necessarily familiar to those living outside South Africa (or, indeed, to some living within South Africa), and which informs their subjectivities and their material existence. They are simultaneously familiar and strange, and need to be contextualised as both strange and familiar.
Given the paradoxical nature of the task of ‘mapping context’, I will avoid abstract depictions of this particular context. Instead, I will describe the research context and then introduce four women who participated in the study, and whose stories vividly illustrate aspects of the social environment. A description of the milieu in which they live will emerge from (inevitably incomplete) exploration of their personal stories; in this way, it is hoped that context will be portrayed as fluid: as both general and unique, familiar and strange.
The Interview Setting
The women who participated in interviews were black women between the ages of 21 and 38. All had some level of schooling, but only one had received a university education. Sixty per cent were unemployed. About a third of the sample were first time mothers. Two women were interviewed who had been diagnosed as HIV-positive before falling pregnant. It is possible that other women were diagnosed before pregnancy, but were unwilling to admit this. About two-thirds were in a relationship of some sort with the fathers of their babies, although many feared that the relationship was breaking down and few actually lived with their partners. Of those who were not in a relationship with their babies’ fathers, more than half reported that their partners had left them after they had disclosed their HIV status. Many had also not told family members and had spoken to few people outside the clinic context.
The women interviewed were not a statistical minority. HIV statistics, such as the prevalence of infection among pregnant women, confront one with the sheer enormity of the pandemic, as well as its relevance for Africa and for women. For example, of the 33 million people infected worldwide, 22 million (or 67 per cent) live in sub-Saharan Africa, which is inhabited by just over 10 per cent of the world’s population (UNAIDS, 2008). This is not, however, necessarily comforting to those living outside the region. UNAIDS (2004) indicates that HIV infection is on the rise globally, particularly among women in every region of the world. For example, heterosexual infection in Western Europe more than doubled between 1997 and 2002, and HIV has been identified as the fastest-growing health problem in the United Kingdom.
South Africa has the highest number of HIV-infected people in the world at 5.7 million. South African women under 30 are particularly vulnerable (UNAIDS, 2008), i.e. women of childbearing age. HIV may produce marginalised identities, but statistics make clear that HIV-infected South African mothers are in the mainstream and not the margins.
Most women attending clinics were not first-language English speakers. An interpreter could have been used in interviews, but given the confidential and personal nature of interview discussion, it seemed that this would be too intrusive and threatening of confidentiality. Also, interpreter errors are common (Swartz, 1998) and may be ideological in nature (Gentzler, 1993; Venuti, 1992). The use of an interpreter might therefore have compromised the conversations, since HIV is discourse laden in South Africa. This meant that women who did not feel comfortable communicating in English were implicitly excluded from the study. However, South Africa is a multilingual society and many women felt comfortable conversing in English, preferring this to having an interpreter present. It also seemed