AIDS in Africa: The technocratic FAIL
A discussion in the comboxes on another thread reminded me of this great essay by Travis Kavulla in The New Atlantis, from the Spring 2009 issue. In it, Kavulla, who lived and worked in Africa, talks about why the Western model of “reality” (for lack of a better way to put it) works against actually saving Africans’ lives from AIDS. Kavulla says that Westerners assume that the metaphysical dream of the Africans is like our own, and try to impose our way of ordering reality on Africans. This has been a public health failure. Excerpt:
We can call these people ignorant or backward. But there is something larger afoot in African society; there is a reason why the conspiracy theories are so many, the leadership so seemingly inept. Africans are not blindly resisting Western public-health beliefs. Their world is not a blank chalkboard where AIDS lacks an explanation that must be filled in by outsiders. Rather, they have a system of beliefs that makes perfect sense, in its own way, of the AIDS calamity.
It is natural for anyone facing a terminal disease to ask, Why me? This is an exasperated, unanswerablecri de coeur in the rational West—one of the steps of the grieving process, we are told, that we all just need to get through. But many Africans have their own kind of answer to that question.
African tribes are not a homogenous, undifferentiated mass, but the vast majority traditionally held in common a worldview of causation very different from our own. With reference to illness, it is called the personalistic theory of disease. Even today, most Africans believe that any major occurrence, good or bad, has two causes. The first might be called physical: for instance, that a retrovirus causes AIDS by destroying the cells of the immune system. The second is a spiritual, less tangible cause, but is perceived to be no less real. Edward Evans-Pritchard, whose ethnography of the Nuer people of Sudan is a foundational work of anthropology, put Africans’ cosmological outlook this way: One might understand that a house collapsed because termites damaged it. But the more important question is,Who sent the termites?
And, the key point:
Yet short of a vaccine, the practical value of a scientifically proven implement, like a condom or an anti-retroviral drug, depends not on science alone but on whether it can be socially and culturally embedded. It is here where the West has faltered. Too often, policymakers take a device’s or method’s apparent scientific worth as a prospective indicator of how it will be valued in human society.
Read the whole thing for Kavulla’s explanation for why the Western public-health technocratic gospel of condom distribution has not been effective in Africa. The reason, essentially, is because Westerners refuse to grasp that AIDS has an intensely social dimension in Africa that it simply does not have in the West, and which is therefore resistant to Western preventative prescriptions.