Ancestors and Antiretrovirals

The Biopolitics of HIV/AIDS in Post-Apartheid South Africa

By CLAIRE LAURIER DECOTEAU

THE UNIVERSITY OF CHICAGO PRESS

Copyright © 2013 The University of Chicago
All rights reserved.
ISBN: 978-0-226-06445-1

Contents

Acknowledgments……………………………………………………ixNote on Terminology………………………………………………..xiiiAbbreviations……………………………………………………..xvIntroduction Postcolonial Paradox……………………………………11 The Struggle for Life in South Africa’s Slums……………………….242 A State in Denial………………………………………………..783 Biomedical Citizenship……………………………………………1134 The Politicization of Sexuality 163………………………………..5 Hybridity……………………………………………………….199Coda Life Strategies……………………………………………….236Notes…………………………………………………………….241Glossary………………………………………………………….275References………………………………………………………..277Index…………………………………………………………….315

CHAPTER 1

The Struggle for Life inSouth Africa’s Slums

Pheello Limapo believes he has been HIV-infected since1994, when he suffered from a serious bout of tuberculosis.”At the time, one of the doctors mentioned HIV, butno one was really familiar with the disease at this point,so this meant nothing to me and I quickly forgot aboutit.” Pheello moved from the Free State to Johannesburgin 2001, where he initially worked in construction, buthis constant illnesses made this work difficult at first andeventually impossible. He first lived in central Johannesburgand then moved to a squatter camp about an hoursouthwest of Soweto, named Lawley, where he still livestoday. “My wife and I had a child before we knew we wereHIV positive, and the child died. We went to many doctorstrying to figure out what was wrong. Another childdied before we realized that we were both HIV infected,and that breast-feeding was part of the problem. We hada third child and did not breast-feed the child. This childis still fine, healthy and HIV negative.” Pheello and Elizabethhad another HIV-negative child (thanks to nevirapineand formula milk) in 2008.

In 1999, Pheello became so ill he was hospitalized,and he was given an HIV antibody test. When he returnedfor the results, “the doctor called me into a specialroom where he actually disclosed my status to tell methat I’m positive…. Well, I chose not to believe it….When I went home, I decided to keep quiet, not to telleverybody, because I actually saw the kind of circumstances that willcome with it, especially if I disclose, because I will be discriminatedagainst at home and by everybody.” At another point, he explained:”No one was talking about AIDS. I went to two funerals of comrades Iworked closely with in my community … and no one mentioned thedisease.” He paused and took a deep breath, “it was when my brotherdied that I realized that if I didn’t take a chance and talk to people andask for help, I was going to die just like everyone else … with no oneknowing.”

And so Pheello started talking. He became a strong advocate forhimself and the other people in Lawley who were living with or affectedby HIV/AIDS. In addition to battling the silences and stigmasthat cloak the disease in his community, Pheello has learned there areother more insidious forms of political silence that need to be broken.He became involved in my research, he never ceased to remind me,because he strongly believed that the stories of people living with HIV/AIDS in squatter camps needed to be told as it was all too easy for thegovernment to forget they existed.

It’s not that the government has got no capacity or no money to assist people livingwith HIV. There is a lot of money that is there for AIDS. A lot of this money isdonated from different countries all over the world…. And the government isonly the custodian of that money. But instead of the government using that moneywhere it is supposed to be used—like in the squatter camps, it uses this moneyto make millions of condoms and millions of fancy pamphlets. Spending a lot ofmoney on things that are secondary and not primary…. But it’s the people in thesquatter camps who are vulnerable. The government does not even try to go to thesquatter camps to find out what is needed. It is the people with the nice lives whoare deciding on the money. People are struggling as we speak—in different squattercamps. But the government does not want to help us.

* * *

As Mike Davis (2006) points out, the rapid urbanization that has accompaniedthe global implementation of neoliberal economics has resultedin a “late capitalist triage of humanity” (199) in which millionsof people throughout the world have been converted into surplus populations,abandoned on the peripheries of hypercities, and marginalizedby their inability to participate in the accumulation or consumption ofcapital. The plight of informal settlement residents has recently becomea focus of international attention. Indeed, one of the United NationsMillennium Development Goals is to significantly improve the livesof slum dwellers globally by 2020 (UN 2010). Despite this increasingglobal awareness, there is still much to be learned about the intricatecausal relationships between neoliberalism, urbanization, and diseaseepidemiology, as postcolonial countries the world over fight to stemthe tide of increasing informality. In this chapter I provide historical,ethnographic, qualitative, and quantitative data on two squatter campsoutside of Johannesburg where I have been conducting research since2004: Sol Plaatjie and Lawley. I begin by providing detailed evidence ofthe endogenous relationship between poverty and HIV/AIDS, and thenexplain the material and ontological vulnerabilities associated with livingin slum conditions.

Informal Settlements

As in other developing countries, the historic “mushrooming” of informalsettlements in South Africa began in the 1980s due to rapiddeindustrialization and rising unemployment; however, in the SouthAfrican context, the relaxation and eventual eradication of influx controlsat the end of the decade accelerated an already escalating rate ofurbanization (Hunter 2007; Harrison 1992; Crankshaw 1993). There aredifferent kinds of housing informality in South Africa: “informal settlements”are squatter settlements of the urban poor that develop throughthe unauthorized occupation of land (Huchzermeyer and Karam2006, 3). Other informal dwellings include shacks built on serviced sitesor in the backyards of formal township houses (Huchzermeyer 1999).From 1996 to 2003 the number of informal dwellings rose by 688,000in South Africa, despite the existence of house-building projects fundedby the state (Hunter 2006, 160–61; Mail and Guardian 2006a). By 2009,14.4 percent of households (1.9 million) in South Africa were informaldwellings or shacks (South African Cities Network 2011, 49).

People move to informal settlements for a number of reasons, whichcan be attributed to either push or pull factors. Push factors includeovercrowding, unaffordable housing, stigma, and eviction, and pull factorsare usually associated with job opportunities (or, for HIV-infectedSouth Africans, health care accessibility) (Smit 2006, 108). Often thepush factors are more likely with intraurban movement and pull factorswith rural-urban migration (ibid.). Intraurban migration is becomingincreasingly common. Greenberg notes that the rural-urban migrationthat marked the apartheid era has simply turned into perpetual migrationin the post-apartheid period—as people move from one informallocation to another in search of economic security (2004, 31). A communityparticipatory research survey I conducted in Sol Plaatjie andLawley in 2009 revealed that 75 percent of residents from Lawley and85 percent of those from Sol Plaatjie most recently lived somewhereelse in the Gauteng province8 before moving to these locations.

Housing is a basic right enshrined in the 1996 South African Constitution(Republic of South Africa 1996b). This right includes not onlyhousing but also secure land tenure, domestic access to basic services(like water, electricity, and sewage), and “socially and economicallyintegrated communities” with “health, educational and social amenities”(Department of Housing 1994). Post-apartheid housing policy ismarked by the same antinomy I argue is a result of South Africa’s attemptto resolve the postcolonial paradox: the state is committed toand proud of its constitutional goal of providing “adequate housing”to every citizen, and yet it selected a market-based delivery procedurethat made this goal practically impossible to achieve. In the early yearsof democracy, the national government attempted to provide housingthrough a “one-off product-linked capital subsidy scheme.” In otherwords, people signed on to a queue at the Department of Housing (fillingout what is commonly referred to as a C-form), and were slowly allottedsmall one-room homes, usually on the outskirts of urban centers(where the land is cheaper). But it soon became evident that not onlywas this an untenable solution but it also exacerbated spatial racialsegregation (Huchzermeyer 2001; Greenberg 2004). This venture alsosidelined the unemployed or those employed in the informal sectoras it assumed access to mortgage finance (Huchzermeyer 2001, 313); italso left completely untouched the tricky political question of informalsettlements and squatting (ibid., 323–24). “The challenge,” accordingto Paulos Ntsooa, deputy director of Human Settlements, “is that theresidents in these [informal] settlements live in a permanent state oflegal and social insecurity. This makes them reluctant to invest in theirdwellings to make better living environments” (Social Housing Foundation2010, 3).

Building low-cost housing has been a key priority of the ANC governmentin the post-apartheid era. The homes built by the state are referredto as “RDP houses,” named for the Reconstruction and DevelopmentProgramme (the plan adopted in 1994 to deliver services throughgovernment subsidies). From 1994 through 2003, the state fundedthe building of one million RDP houses, which was accelerated in thelate 2000s, so that two million had been built by 2007 (Hunter 2010,110–11; Statistics South Africa 2007a). But during this same period, thenumber of informal settlements was steadily on the rise. By 2007, twomillion households still lived in informal dwellings (Statistics SouthAfrica 2007a). Mark Hunter suggests that this is, in part, because unlikethe “matchbox” houses built by the apartheid government, which werefour rooms and 51.2 square meters, the RDP houses are two-room residencesand provide a living space of less than 30 square meters (Hunter2010, 110). As a result, households have had to break apart, and averagehousehold size has decreased dramatically in the post-apartheidera. “Put simply, as the state built RDP houses, thousands of new, overwhelminglypoor, households mushroomed—a reality speaking to thedynamic nature of movements, space and the household. Shacks arenot simply a ‘legacy’ to be overcome through technocratic ‘development'”(ibid., 111).

Because of the continued proliferation of squatter camps in the urbanareas of South Africa, the national government developed an InformalSettlement Upgrading Programme in 2004 (Huchzermeyer 2006,41)—intended to move South Africa “towards a shack-free society”(Sisulu 2004; quoted in Huchzermeyer 2006, 44). A further impetuscame when South Africa won the bid to host the 2010 World Cup, thusclinching the policy that “visible” informal settlements should be replacedwith formal housing,14 whereas nonvisible informal settlementswere to receive in situ upgrading (Huchzermeyer 2006, 45).

The city of Johannesburg established a new approach to “InformalSettlements, Formalisation and Upgrade” in 2008 (Masondo 2008),with the goal of formalizing all informal settlements in the city by2014. At the time, there were 180 informal settlements in the city, containing200,000 households (ibid.). “In summary, the policy statesthat, where possible, informal settlements will be upgraded in situ, i.e.where settlements are safely located and their location does not compromisethe development objectives of the City,” explains Philip Harrison,executive director of development planning and urban management(Davie 2008).

In the late 1990s and early 2000s, many informal settlements weredeclared un-upgradable, and residents were told this was because of unsafeenvironmental conditions like undermining and the existence ofdolomite. Residents suspected that the government simply used theseenvironmental justifications to warrant eviction in the face of unauthorizedland seizure (propelled by a desire to eradicate rather thanmanage squatter settlements). These suspicions were confirmed when afew years later the formalization of informal settlements was declaredthe most economical means of providing housing to the urban poor,and many informal settlements previously declared “un-upgradable”were upgraded. Sol Plaatjie is undermined and already suffers fromsinkholes, and Lawley residents were told the land was dolomitic. Bothwere nonetheless upgraded from 2006 to 2008.

Basic service provision was also very politically linked to the issue ofhousing provision and land tenure. Prepaid water and electricity meterswere introduced in the early 2000s in South Africa as a means ofcombating a perceived “culture of nonpayment,” which, it was argued,emerged out of the rent boycotts of the 1980s anti-apartheid struggle.Beginning in August 2003, the South African government created JohannesburgWater, a para-statal organization, to implement the wide-scalecorporatization of water delivery. A neighborhood in Soweto,Phiri, was selected as the site of the flagship project, titled OperationGcin’amanzi (Operation “Save Water”). The discourse of “water conservation”was used to convince poor people that they were wasting water,and that these systems would allow them to become more responsibleconsumers. Through the Anti-Privatisation Forum (APF), the residentsof Phiri led a major campaign against the prepaid water system and theideologies used to promote privatization. The APF took JohannesburgWater to court in an attempt to get the prepaid meters declared unconstitutional.After six years and several appeals, the APF lost their case inthe constitutional court in the fall of 2009; however, they did manageto increase the basic monthly water allotment. Electricity has also beenprivatized and is now supplied by another para-statal organization, Eskom.The usage of prepaid technology for a basic service provision hasnot only been introduced throughout South Africa (over five millionhouseholds were fitted with prepaid meters in the first ten years of democracy),but the state has also exported both the meters and the necessarytechnical expertise to countries throughout the continent andthe global South (von Schnitzler 2008, 900). Now, informal settlementsare only upgraded if the residents agree to the installation of prepaidwater and electricity.

Sol Plaatjie

Local residents refer to Sol Plaatjie as DRD. DRD stands for DurbanRoodepoort Deep, the mining company whose workers were housedin what has become the squatter camp. The community lives in andaround the disused mining compound. The DRD mine, like most ofthe mines in South Africa, became unprofitable when the technologyand labor power required to successfully operate the mine began to costmore than the gold would yield on the market. Mines have becomeiconic signifiers of the postcolonial world. The former sites of immensewealth and white power now house those who are rendered expendablein a neoliberal world order.

When we first moved here, they told us they would finally bring us water, sanitation,houses … and we waited, and there was nothing. And what we saw, thisplace was … more like solitary confinement where we thought we were hiddenaway from the people, you know, in the disused compound.

Disused land for disposable people. This would be a perfect metaphor ifit weren’t so painfully literal.

Each of the three primary communities that make up the residentsof Sol Plaatjie was forcibly removed from another location in the Johannesburgregion. The first community relocated to Sol Plaatjie originallycame from Maraisburg and the second from Voeras—the formerhad been squatting on private land and the latter were living onenvironmentally unsound land. The residents with whom I workedmost closely were evicted from a squatter camp in Soweto, namedMandelaville, in January 2002, which they had occupied since 1976.Mandelaville was a three-block by three-block stretch of land, whichwas originally the site of a beer hall and police station, both of whichwere vandalized in the 1976 Soweto uprisings. The community thenapplied to the local council and received residential permits to occupythe vandalized buildings and turn them into permanent dwellings.The settlement grew throughout the 1980s and 1990s (especially afterthe influx controls were lifted), and in 2002 there were 1,500 householdson the plot.

After the 1994 elections, the residents of Mandelaville (even thosewho still possessed the original residential permits from the 1970s)were told they were illegally occupying private property. The city hadsold the land to a developer to become the site of a new (private) housingdevelopment. The community was told they would be relocated toformal housing, but instead they were forcibly removed to Sol Plaatjie.The community fiercely resisted their relocation, but they were finallyevicted by court order on January 7, 2002.
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