Didier Fassin is a sociologist, anthropologist and medical doctor. He practised internal medicine in French hospitals, as well as in India and Tunes, during the eighties. He simultaneously studied social sciences, doing his first fieldwork in Senegal on urban health and social change. He then coordinated a research programme on maternal mortality and conditions of living in Ecuador. Back in France in the early nineties, he developed research activities on social inequalities in health, local public health, immigration and discrimination in Paris and its suburbs, as well as on the politics of AIDS in Central Africa and, later on, in Southern Africa. He has been director of the Cresp, Centre of research on public health issues, of the University Paris North and French Institute of health and medical research (Inserm) since its creation in 1994. His direction of studies at the School for Advanced Studies in Social Sciences (EHESS) entitled Political anthropology of health was initiated in 1999. He is presently member of the Scientific Council of Inserm and Administration Board of EHESS and vice-president of M‰decins sans frontir¿es. His recent books are L'espace politique de la sant‰ (Presses universitaires de France, Paris, 1996) and Les enjeux politiques de la sant‰ (Karthala, Paris, 2000). He co-edited Les in‰galit‰s sociales de sant‰ (La dc‰ouverte, Paris, 2000) and Critique de la sant‰ publique (Balland, Paris, 2002).
The embodiment of inequality: Political anthropology of AIDS in southern Africa
To the analyst of the political economy of affliction from a North-South perspective, the case of the AIDS epidemic in South Africa constitutes a unique intellectual challenge for two reasons. First, South Africa is the country where the increase in HIV seroprevalence has been the most dramatic in the history of the disease, starting from less than 1% in the early nineties to reach more than 20% by the end of the decade, up to 30% in the most affected province – precisely in the period when apartheid was rejected and democracy established. Secondly, the South African government has initiated the first global controversy on the HIV infection, by raising doubts about its etiology, the toxicity of antiretroviral drugs, the benefits of mother-to-child transmission prevention – at the same time when it won its trial against the pharmaceutical companies thus contributing to the recognition of disease as an exception in the TRIPS. Both facts urgently need interpretation which goes further than mere behavioural explanations for the first one and indignant condemnations about the second one. Political anthropology may offer such a useful framework for public health.
The unprecedented epidemiological crisis of South Africa, considered as a demographic catastrophe as well as a human tragedy, cannot be understood without reference to the social history of the country, in particular to the institution of racial inequality as the fundamental principle of government during one century. History is not simply the context in which actions take place, it is deeply embodied in everyday practice and national ideology. On the one side, structures and norms, discrimination and violence find a translation in terms of risktaking, access to prevention, compliance to treatment and, more broadly, care of oneself: this can be designated as the social condition of AIDS. On the other side, reality and discourses, injustice and defiance become inscribed in the individual and collective narratives that people build around the epidemic, including its denial: this may be called the social experience of AIDS. Based on ethnographical data collected in the townships of Johannesburg and on a sociological approach of debates in the South African media, the analysis of the embodiment of inequality thus gives new insights into this otherwise incomprehensible situation and proposes a more accurate agenda for action. But because similar findings, although less dramatic, have been recorded in other countries, especially in the developing world, this perspective should be extended to a more general theory of affliction.