The Suffering Body of the City
Since 1990, parallel to the period of transition to a democratic society, the AIDS epidemic in South Africa has increased dramatically. The level of HIV infection in the adult population (ages 15–49) rose from 1 percent in 1990 to more than 20 percent in 2000. However, this figure conceals a disparity in the distribution of the disease. The townships are affected far more than the largely white suburbs, while in the townships themselves the highest levels are found in the so-called squatter camps ( Shisana and Simbayi 2002).1 The combination of pandemic and democracy has wrought changes specific to sufferers living on the periphery of Johannesburg. People obtained their freedom and fell sick at the same time. The newly acquired sovereignty has enabled individuals to explore previously unavailable urban spaces, to develop innovative forms of political mobilization, and to access, in new ways, health services that had once been forbidden to them. The practices of these suffering bodies are the focus of this essay.
Generally the body that is inscribed in most scholarly work on the city is the healthy body. Theorists of modernity regard the city as the place par excellence for the realization of the individual. If the individual suffers, it is usually from isolation and anonymity ( Simmel 1971). Otherwise, the individual is autonomous and free from disease. It is with reference to this presupposed healthy body that typologies ( Hannerz 1980) and concepts such as mobility, trickery, and poaching ( Certeau 1990), strolling ( Baudelaire 1968), and wandering (Benjamin 2002) have been developed. These concepts have also subsequently been used to give meaning to a whole set of daily urban practices ( Gibbal et al. 1981; Bourgois 1995 ; Villers, Jewsiewicki, and Monnier 2002). In these works, the body is considered as a medium for or object of various practices, which are in turn the subject of analysis. Even if such practices lead to a deterioration of the body ( Bourgois 1995), the body sui generis is not present in their definition as such.
In what follows, I take the suffering body as the starting point for a discussion of the city. In making use of the life stories and itineraries of AIDS sufferers living on the periphery of Johannesburg, I redraw the map of the city outlined by the bodies of those who are poor, hunted, suffering, and in search of care. I show how, far from being immobile, the sick body moves and travels. In doing so, it shuttles constantly between private and public spaces, unveiling the city through its movements. I show how the body afflicted with AIDS itself constitutes an archetypal figure in the city of Johannesburg and how, in its search for care and for sanctuary, it acts as a place of mediation and meeting between the public and the private, the official and the unofficial, the here and the elsewhere.
The majority of the sick have no fixed income. Some receive a disability grant of R700 a month on the basis of their HIV status,2 but for many, mobility and trickery are the means of survival ( Certeau 1990). Underlying their struggle is a quest for social and therapeutic support and, for some, a quest for social recognition through militant involvement in HIV/AIDS associations. The Johannesburg itineraries described here do not cover the entire experience of those living with HIV/AIDS, but they do allow an understanding of certain fragments of that experience and urban reality. Johannesburg, in this reality, appears as a series of dots, with cardinal points in certain public places (health centers, administrative buildings) and other sites where sick people are hiding or where they are known only as nearly dead bodies (houses where the sick find refuge, unofficial places of care, hospices for the dying, and finally, the cemetery). There are also other destinations, places of transit and stopover that together weave an urban fabric, the fibers of which are familiar only to those who are HIV positive.
Along these journeys, Johannesburg also appears in its ambivalence; that is, the city appears as an expression or sign of the harshness of the world but also, occasionally, as one of compassion. Just as it authorizes the exploitation of the sick, so it opens up a myriad of possibilities in terms of care and mobilization. The itineraries of these suffering bodies in the city thus draw a map of the management and the geography of AIDS in Johannesburg.3 An exploration of these journeys is not limited to that of care. It brings to light the fact that these bodies and selves belong to the urban reality and, more broadly, to the field of national issues as well as to the globalized world. They are integrated, for instance, into the exchange of pharmaceutical products on a global scale, an integration that exposes them to the violence of the market and to exploitation. Other circuits are also explored that allow the suffering bodies tracked here to become people of the polis. In this capacity, they form part of the emergence of a civil society.
End of Excerpt | Access Full Version
Notes
The facts and biographies recounted here were collected between September 2001 and September 2003 as part of a research project funded by the French National Agency of Research into AIDS (ANRS) and with the institutional support of the Department of Anthropology at the University of the Witwatersrand. The people quoted in this article were first encountered in Diepkloof and Alexandra as part of regular visits to support groups for HIV-positive individuals and later visited at their homes.
The names and the details were changed to avoid identification of the persons concerned. I am grateful to Todd Lethata, who accompanied me during the collection of this data, and to all of those infected who shared with us part of their experiences, joys, and pains. I thank Achille Mbembe and Sarah Nuttall, who read and commented on the first version of this essay.
- This essay will not be dealing with the black suburban middle and upper classes, who tend to live in the affluent northern suburbs as well as in suburbs on the edge of the city (e.g., Midrand).
- The exchange rate varies between seven and eight rands to the dollar.
- The Department of Health in the municipality of Johannesburg provides the following statistics on its Web site (www.joburg.org.za/services/health1.stm#hiv): At Johannesburg Hospital about 30% of pregnant mothers tested are HIV-positive. Of children tested on admission to the paediatric wards, 40% are HIV-positive, and 75% of paediatric deaths—mostly children under the age of two—are AIDS related. The overall infection rate for Johannesburg of 26% is greater than the average for Gauteng, which stands at 23.9%. The City of Johannesburg is home to a population of 2,883,226 people in some 791,367 households. The population is projected to rise to 2,986,228 in mid-2005 and 3,103,182 in mid-2010. The average rate of population growth for the City of Johannesburg between 2000 and 2010 is projected to be 0.9% per annum. The HIV/AIDS epidemic is largely responsible for this low rate of growth, along with a low fertility rate in Johannesburg.