Death before Dying: Understanding AIDS Stigma in the South African Lowveld

This article explores some of the social and cultural factors that have undermined effective treatment and care for persons living with AIDS in South Africa. Drawing on ethnographic fieldwork conducted in Bushbuckridge, I observe that AIDS stigma has been both pervasive and intense. However, contrary to conventional wisdom, I argue that the association of AIDS with sexual promiscuity has not been the major source of its stigma. Instead, I suggest that denial, silence, fear and fatalism have stemmed from the construction of persons living with AIDS as being ‘dead before dying’, and from their symbolic location in the anomalous domain betwixt-and-between life and death. This article also challenges the notion that older cultural practices in the folk domain impede an effective biomedical response to AIDS. I see the construction of persons with AIDS as ‘dead before dying’ as an outcome of the manner in which biomedical discourses have articulated with religious and popular ones. In this process the notion that AIDS is a fatal terminal illness carries as much symbolic weight as the popular association of persons suffering from AIDS with lepers and zombies.* I wish to thank my informants, as well as my research assistants, Eliazaar Mohlala and Eric Thobela, for their help. I also acknowledge valuable comments by Cecil Helman, Adam Kuper, Jean La Fontaine, Conny Mathebula, Erik Seathre, Enos Sikauli, Jacqueline Solway and Jonathan Stadler.