Rethinking the Poverty-disease Nexus: the Case of HIV/AIDS in South Africa

Abstract

While it is well-established that poverty and disease are intimately connected, the nature of this connection and the role of poverty in disease causation remains contested in scientific and social studies of disease. Using the case of HIV/AIDS in South Africa and drawing on a theoretically grounded analysis, this paper reconceptualises disease and poverty as ontologically entangled. In the context of the South African HIV epidemic, this rethinking of the poverty-disease dynamic enables an account of how social forces such as poverty become embodied in the very substance of disease to produce ontologies of HIV/AIDS unique to South Africa.

Endnotes

¹ The Human Immunodeficiency Virus (HIV) is the virus that causes Acquired Immune Deficiency Syndrome (AIDS) (Centers for Disease Control and Prevention (CDC) 2006). AIDS is a cluster of diseases and opportunistic infections that break down the body’s immune defenses. Following the medical distinction drawn between HIV and AIDS, I use ‘AIDS’ to refer to the late stage of HIV infection where the immune system is severely compromised, as indicated by a low white blood cell count and/or by the presence of AIDS-related opportunistic infections such as tuberculosis, diarrhoea and pneumonia. The term ‘HIV’ is used to denote the virus that helps to produce AIDS. In all other cases, I use the term ‘HIV/AIDS’ to refer jointly to the virus and the syndrome, that is, to the disease, more generally. This last usage is intended to capture the enduring association between HIV and AIDS in contexts where, for example, anti-retroviral treatment (ART) is not available and/or where poverty and other phenomena prevent a decoupling of the two.

² Consistent with the ‘ontological’ turn in contemporary social theory, new materialist approaches challenge the notion that matter is inert and passive, emphasising the agency of matter in the creation and transformation of phenomena (Lezaun 2014, Dolphijn and van der Tuin 2012). They also conceive of the process of materialisation as ongoing, complex and contingent on social and political forces. According to this view, social actors and theorists actively help to make realities and therefore the practices and concepts they employ have performative power: they bring certain realities into being and foreclose the existence of others.

³ Although no official data are available on HIV mortality by income group in South Africa, the current National Strategic Plan (NSP 2012-2016) notes that poverty is a major contributor to HIV in South Africa and identifies people of low socio-economic status as a key population for targeted interventions because of their increased risk of contracting HIV (Department of Health 2012). Furthermore, the NSP recognises the high mortality rate associated with tuberculosis and HIV co-infection, which itself is closely connected to poverty in South Africa (Department of Health 2012). Read together, these observations, which are based on national epidemiological data, would seem to support Geffen’s claim that many poor people continue to from AIDS in South Africa, even in the post-treatment era.