valleys of the writing process. In addition to bringing positivity, perspective, and light to each day of our lives together, Kat has also brought our daughter Emma and son Leo into our lives, and they have provided me with new perspective on life and ceaseless joy. My endless thanks are in order to Kat for tolerating my mercurial tendencies and for her unconditional love as I worked through the many steps involved in securing one’s livelihood as an early-career academic. Thank you for standing by me as this project carried on; we did it.
ABBREVIATIONS
| ABC | Abstinence, Be Faithful, and Condomize |
| AIDS | Acquired Immunodeficiency Syndrome |
| ALN | AIDS Legal Network |
| ALP | AIDS Law Project |
| ANC | African National Congress |
| ART | Antiretroviral Therapy |
| ARVs | Antiretroviral Drugs |
| AZT | Azidothymidine |
| BCM | Black Consciousness Movement |
| BEE | Black Economic Empowerment |
| CALS | Centre for Applied Legal Studies |
| CBOs | Community-Based Organizations |
| COSATU | Congress of South African Trade Unions |
| Eskom | Electricity Supply Commission |
| GASA | Gay Association of South Africa |
| GDP | Gross Domestic Product |
| GEAR | Growth, Employment, and Redistribution Macroeconomic Strategy |
| GLOW | Gay and Lesbian Organization of the Witwatersrand |
| HAART | Highly Active Antiretroviral Therapy |
| HIV | Human Immunodeficiency Virus |
| IMF | International Monetary Fund |
| Iscor | Iron and Steel Corporation |
| LRC | Legal Resources Centre |
| MK | Umkhonto we Size (Spear of the Nation) |
| MSAT | Multi-Sectoral Action Team |
| MSF | Médecins sans Frontières (Doctors without Borders) |
| NAPWA | National Association of People Living with AIDS |
| NEDLAC | National Economic Development and Labour Council |
| NGO | Nongovernmental Organization |
| NPPHCN | National Progressive Primary Healthcare Network |
| NSP | National Strategic Plan |
| OLGA | Organization of Lesbian and Gay Activists |
| PMTCT | Prevention of Mother-to-Child Transmission (of HIV) |
| PSP | Provincial Strategic Plan |
| RDP | Reconstruction and Development Programme |
| SACP | South African Communist Party |
| SANAC | South African National AIDS Council |
| SANCO | South African National Civics Organisation |
| STIs | Sexually Transmitted Infections |
| TAC | Treatment Action Campaign |
| TB | Tuberculosis |
| UDF | United Democratic Front |
| USAID | United States Agency for International Development |
| VCT | Voluntary Counseling and Testing |
| WC-Nacosa | Western Cape Networking AIDS Coalition of South Africa |
| WHO | World Health Organization |
INTRODUCTION
People, Pathogens, and Power
Situating the South African HIV/AIDS Epidemic
Matamela shook his head as he spoke to me, a wistful expression coming over his face.1 He turned and looked out of the window, pensively stroking his beard for a moment, deep in thought. Matamela was a leading activist for the Treatment Action Campaign (TAC) at the organization’s district office in Khayelitsha, a black urban township approximately twenty miles from Cape Town’s city center. TAC’s district office was housed in an off-white building in a shopping complex adjacent to the Nonkqubela railway station, and it was the base of operations for community-oriented activities designed to limit the spread and impact of HIV/AIDS in the township. As night fell we leaned toward the cracked windows, hoping to catch the last moments of light. Matamela adopted an urgent tone as he spoke of the daily obstacles faced by those accessing HIV/AIDS services in the South African public health sector.
If you go out and you say to people, “We are coming to your community to talk about VCT [voluntary counseling and testing for HIV/AIDS]. Come out and go and have voluntary counseling and testing.” And people go to the clinic, and wait hours to go do VCT, and at the end of the day, they do not want to go to the VCT anymore, then there’s a problem there. That quality of service is compromised. Because no one wants to wait for two hours, three hours just for testing for HIV. No one wants to wait. Because you will wait, and at some point [you will be] be told that, “Come tomorrow, because we are about to close down now.” In some instances, you are being told that there is no medication for this particular illness that you are suffering from. It creates a problem.
Emphasizing how often people waited in line for hours but were unable to see a doctor, Matamela painted a picture of underresourced and understaffed public health services in a community where nearly one in three pregnant women are HIV positive. In this and other conversations, Matamela attributed the continuing challenges of HIV to the socioeconomic conditions created by colonization, segregation, and apartheid. His was a sobering analysis of the world’s largest HIV/AIDS epidemic.
