It is commonly taught in HIV education here that you can’t tell who has it by looking at them. But at the same time, there is a clearly identified set of indicators that people look for as others become sick. For me, each time I come back, I notice who has become skeletal. A few years ago, the appearance of one of the staff members from a conservancy in which I had worked shocked me. His height accented even more his skin-stretched-over-bones appearance and I nearly did not recognize him. But this time it has been especially hard. I met Samuel [not his real name – even though he’ll never read this, I know he wouldn’t want me to call him in this way] the first time I arrived in Katima. He was, perhaps not unlike me, round and smiling, admiring of my shape but not aggressive in his compliments, quick to laugh but also thoughtful. Over the years we have sat thru meetings together, walked around his village together, spoken of elephants and basket-weaving and fences and the militarized history of the area where he grew up (thanks to the South African Defence Force’s incursions into Angola from the Caprivi).
But Samuel is no longer fat. His khaki pants hung back, baggy and generous, when he leaned in to hug me the other day. The shape of his face has changed, sunken cheeks skimming jawbones and drawing in towards teeth rather than being padded with flesh. The crinkles in his face when he smiled were still there, but sharpened. When I raised the subject of finally doing a bit of fieldwork together that we have been talking about for some years now, he said, “Ah, but I am going on leave.” He spoke the words slowly, softly, not like someone looking forward to a holiday but simply someone in need of rest. And they made me sad.
I have not been able to figure out the constitution of this kind of shame. I have long argued that it does not make sense to have such a burdensome cultural stigma surrounding a disease transmitted by something everyone is doing – having sex, and with someone of the opposite sex. When the “gay cancer” first emerged in the US, there was at least some twisted logic in associating the virus with a behavior that was (unfortunately) not yet socially acceptable. The same is true for the emerging epidemic in countries like Russia, where it is associated with IV drug use – a small “outcast” section of the population. But here, it spreads thru heterosexual intercourse, and multiple partners (for men) remain an expression of masculinity. There are some pieces that contribute – like the role of Christianity in shaming talking about (and having) sex, but I don’t think that is enough.
I have thought at times that perhaps the distance between being exposed to the virus and contracting the disease remains too great to seem like an imminent threat. For the girls trying to earn money by sleeping with truck drivers passing thru between Zambia and South Africa, for example, the risk could feel remote compared to hunger or desperation for a stable place to live. In this way, telling people at health workshops and in doctor’s offices that “you can live a long time with HIV!” may have worked at cross purposes, turning into “I’ll deal with that if and when it happens.” And, at the same time, there is a basket of condoms by our office door here that needs constant replenishment. There is, at least, that – which would not have been possible a few years ago. More and more people here are getting access to ARVs, but even as the epidemic progresses, new ways of coping with shame emerge to contest the public space for open discussion that is fighting for ground. I’ve heard stories about those on treatment burying their pills and digging them up to take a handful only when no one else is around – which is, of course, a recipe for resistance. I’ve seen those who conduct workshops and counsel others who are completely unable to talk about their own losses or behavior – to confront the cheating husband, for example. And so I don’t know what it will take.
An epidemiologist friend of mine left South Africa some years ago now, despite loving the place – because, as he put it, “I don’t need to be here when people really start dying.” He, of course, had the choice – but the most affected do not. Is it possible for a situation to be getting better and worse at the same time? Because that’s what this has begun to feel like – at least, in a larger sense. In a more personal one, it’s become a matter of horrible wondering who might become the next skeleton.