epidemic underscores that transforming the social determinants of health may require a different approach to social change.
CHAPTER 1
Contact, Colonization, and Apartheid
South African Social Formations in Historical Perspective
The South African HIV/AIDS epidemic developed within a set of historically particular political, economic, and sociocultural conditions that shaped the extended campaign for HIV/AIDS treatment access. A historical analysis of the African continent’s southernmost society shows how the contours of contemporary South Africa emerged out of its past. Uneven development and unequal health outcomes were produced by the interaction of South African social groups, or social formations, over five centuries. Starting with a review of indigenous political formations in Southern Africa, this chapter takes the reader through the history of contact, colonization, and apartheid, paying particular attention to the role of institutions in producing unequal health outcomes along racial lines.
The colonial period in South Africa was marked by contact and conflict between European settler states and indigenous African political formations, which influenced the subsequent development of South African society. From the slave economy of the early Dutch settlements to the British Empire’s extension of state administration, settler societies engaged with African political formations in ways that extended their interests while expropriating land and resources from indigenous peoples, producing negative health outcomes along the way. Alongside colonial states, the development of rural missions provided health services and education to indigenous South Africans while disseminating Christianity. Indeed, the diffusion of Western religion and biomedical practices across the South African hinterland occurred alongside expropriation and enslavement.1
As British and Afrikaner polities united following the South African War, social, political, and economic dynamics that had emerged during the colonial era were set into law. The institutionalization of indirect rule, segregation, and land expropriation was the bitter fruit of this white settler alliance in South Africa. The state produced by unified white rule was based on programs to address white poverty, which reinforced racial inequality. The establishment of large parastatal corporations, social welfare provisions, and a bifurcated wage and labor system created a Keynesian welfare state, but it was one that supported the country’s white population. The period of unified white rule set into motion institutional precedents that expanded racial stratification, formalized land expropriation, and limited the scope of political, economic, and cultural autonomy for black South Africans.
Building on earlier political, economic, and institutional dynamics, the apartheid era led to intensified racial segregation, state violence toward black South Africans, and “separate development.” However, those directing apartheid never completed their aim of “ordering” black urban and rural spaces in South Africa (Posel 1991). While traditional leaders exerting political authority in rural Bantustans may have functioned as “decentralized despots,” they also highlighted the limited reach of the South African state (Mamdani 1996). Recurrent forms of self-governance emerged intermittently in black urban areas: the history of the Soweto and Alexandra townships show how a lack of legitimate and representative political institutions led to political self-organization. The anti-apartheid movement also had urban roots, considering the complicity of rural traditional leaders with the apartheid state. Anti-apartheid activists built on the political principles developed by black urban social formations that served as the foundation for the Mass Democratic Movement in the 1980s that aimed to end apartheid and, subsequently, the South African HIV/AIDS movement.
Tracing the political principles of the anti-apartheid movement to the HIV/AIDS movement, I take a multipolar approach to South African history, showing how the interaction between linked but distinct social formations produced unequal health effects that adversely affected nonwhite populations. But in order to discuss the historical context for the emergence of the world’s largest HIV/AIDS epidemic, I first outline how particular populations came to embody inequality. In addition, understanding how the HIV/AIDS movement transformed the state to sustain the lives of historically marginalized people entails understanding the roots and principles of political resistance across South African history.
Precolonial Social Formations, Contact, and Colonization
As others have emphasized, the peoples of the world have histories that do not begin—or end—with European contact and colonization (Asad 1973). The history of Southern Africa is no different. Prior to European contact, Southern Africa was populated by indigenous social formations that had a diverse array of political, economic, and cultural practices.2 Colonial settlement across the region was met with resistance, which continued until black South Africans liberated themselves from apartheid. The dualistic nature of colonization, with British and Dutch settlers bringing different modes of political, economic, and cultural organization, produced divergent regional dynamics, but these regional differences were eventually subsumed under the aegis of unified white rule.
Initially, European explorers articulated with social formations located along the Southern African coast. Portuguese explorers and Dutch settlers first came into contact with the Khoisan, known to settlers as Hottentots and Bushmen, who descended from nomadic hunter-gatherers and pastoralists from across Southern Africa.3 Cape Town’s role as a refueling hub for European maritime trade led to Dutch enslavement of Khoisan people to support agricultural production and expand colonial trade, undermining life outcomes and social reproduction for South Africa’s first people.4 The violence of colonization extended beyond the domain of economic production, as Dutch settlers, who were predominantly men, took Khoisan women as sexual partners during the early colonial period.5 The forcible intermixing of people, culture, and language transformed the Dutch settler language of Afrikaans, among other cultural shifts.6 Nevertheless, the Khoisan did not passively accept the violence of colonization. Raids, slave rebellions, and migration were responses to the violent expansion of European settlements. Many Khoisan people dispersed northward, but their freedom from European settlers would be short lived.
Toward the central and eastern stretches of South Africa’s coast, European explorers and settlers came into contact with Xhosa people who were part of a larger migration of Bantu-speaking peoples from Central Africa.7 Part of the group of Nguni-language speakers, the ancestors of the Xhosa people traveled from the Great Lakes region of the continent southward, eventually arriving in present-day South Africa. In contrast to Khoisan hunter-gatherers, the Nguni-speaking groups brought with them a society centered on cattle herding and iron technologies. Organized into autonomous but interconnected kingships, the Xhosa displaced the Khoisan as they moved into and settled central and eastern areas of present-day South Africa.8 In doing so, Xhosa culture was transformed, with key linguistic features adopted from the Khoisan, such as the characteristic Khoisan clicks. Notably, the word “Xhosa” roughly translates to “enemy” in the South African Khoisan dialect. European settler contact with the Xhosa was marked by armed conflict over land and resources, mirroring a similar pattern for indigenous social formations across Southern Africa.
On South Africa’s eastern coast, Portuguese explorers and settler populations consisting of Dutch and British colonists came into contact with the Zulu Kingdom. The Zulu and Xhosa peoples shared several key cultural characteristics, including ancestral roots in the Nguni migration from central Africa, the displacement of Khoisan hunter-gatherers, linguistic and cultural influence from South Africa’s first people, and sustained conflict with European settler populations. The Zulu polity unified autonomous but linked kingships under the leadership of King Shaka, the figure for whom they are best known. From the outset of Afrikaner and British settlement, the Zulu Kingdom responded with considerable military force to European colonization.9 However, the Zulu polity was made up of regional kingships, where aspirant
