The purpose of this monograph is to explore changes in the public meanings of acquired immune deficiency syndrome (Aids) and health-seeking behaviour when a successful antiretroviral treatment (ART) programme is established in a community in which Aids was previously untreatable.
The place in question is Lusikisiki in the Eastern Cape. It is among the poorest and most densely inhabited rural districts in South Africa. It consists of some three dozen villages scattered in a wide radius around a town centre, and it is home to about 150 000 people. While parts of South Africa have been harder hit by the Aids epidemic than Lusikisiki, Aids remains the single gravest public health catastrophe the district has experienced in living memory. The rate of human immunodeficiency virus (HIV) prevalence among pregnant women is about 30 per cent. According to the best actuarial models, about 110 people in Lusikisiki enter Stage IV Aids every month (Médecins sans Frontières 2006). Anecdotal evidence I collected during my fieldwork between October 2005 and February 2007 suggests that an average of at least one person dies of Aids every day in the medical wards of the regional hospital in town. The last time young and middle-aged adults were struck down in comparable numbers was during the 1918 flu epidemic.