BEE Partner, South Africa Economy Watch

About a decade and a half ago, Anthony Zwi and Antonio Jorge Cabral argued that we needed a new term – they suggested ‘high-risk situation’ – to describe the range of social, economic and political forces that place groups at particularly high risk of HIV infection (1991). They culled a number of features from a variety of settings in order to characterise these high-risk situations: impoverishment and disenfranchisement, rapid urbanisation, the anonymity of urban life, labour migration, widespread population movements and displacements, and social disruption and wars, especially counter-insurgency wars.’ They argued that in many of these situations, where daily survival may be precarious and social bonds loosened, there tends to be less worry about healthcare issues and casual sex and more risk- taking behaviour. In these settings, transactional sex (in which sex is exchanged for money or other material support) may represent both a strategy for economic survival and an emotional crutch, and is frequently characterised by highly unequal gender relations; it is also often accompanied by alcohol and drug misuse and high levels of sexually transmitted infections (STIs). Zwi and Cabral’s intervention is important because it focused on social conditions, rather than on individual behaviour per se, although recent literature has moved beyond high-risk situations to look at the ways in which behaviour is itself socially determined in these high-risk situations.

In the 1980s, as HIV/AIDS ravaged large parts of East and Central Africa, the first few cases in South Africa were recorded among white homosexual men, on the one hand and Malawian migrant miners, on the other hand, and led initially to great complacency. Black South Africans dismissed HIV/AIDS as ‘a white man’s disease’ and whites blamed it on the promiscuous behaviour of African migrants.

Both groups focused also on other marginalised outsiders – gay men, drug pushers, bisexuals and sex workers. The country was quite unprepared for a generalised crisis as the virus spread from these small, stigmatised groups to the general popu. lation. The fact that HIV/AIDS took off in the mid-1990s, as the new post-apartheid government took office, is one of the tragic ironies of South African history.

Yet it took no great prescience to predict that once the virus gained a hold in South Africa the epidemic would be devastating, given the country’s inequalities and its underlying burden of disease. By the mid-to-late 1980s, a number of progressive doctors and social scientists were warning that it was simply a matter of time before the epidemic spread from a handful of so-called ‘high-risk groups‘ to the rest of the population, unless drastic action was taken. After all, on any tabulation of high-risk situations, South Africa in the 1980s must have ranked near the top; its black populace was experiencing every one of the high-risk situations cited by Zwi and Cabral (1991).

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