KHOPOTSO: This is the sixth in a series of annual AIDS Reviews commissioned by the University of Pretoria’€™s Centre for the Study of AIDS. The author, Hein Marais, has written several reports, including the United Nations’€™ AIDS agency’€™s annual epidemic update released every World AIDS Day. We’€™re sitting on a bench outside the canteen of the university’€™s Groenkloof campus before the launch of the AIDS Review 2005 report, as Marais explains that he named it ‘€œBuckling’€ to reflect on the strains the epidemic is causing the country.

HEIN MARAIS: That’€™s the intention, obviously, of picking a title like ‘€œBuckling’€ and it’€™s the assumption most of us have – that it’€™s buckling; it’€™s bending; it’€™s somehow changing the shape of society. At the end of this study, which is a very comprehensive review of existing research literature, both in South Africa and the rest of Africa about the impact of the epidemic, the report makes a case that yes, the epidemic is buckling, but in some ways that are quite unexpected.

KHOPOTSO:   He lists some of these.

HEIN MARAIS: It certainly is buckling in the sense that it is worsening impoverishment amongst those households and communities that are hard hit. It is buckling in the sense that it is very discriminatory; very unequal in its effects; that it is hardening polarisation; the sense of difference between people is certainly hardening. And all of this is reshaping society. What we’€™re not clear about, yet, is exactly how it’€™s reshaping society. And I don’€™t pretend to provide any hard and fast answers to that.

KHOPOTSO: Marais reasons, however, that the very discriminate nature of South Africa’€™s AIDS epidemic is laid bare by the stark differences between its populace, the product of a recent racially discriminatory past.        

HEIN MARAIS: The epidemic’€™s impact meshes with a series of other social dynamics, and economic and political dynamics that are producing inequalities in society and that are re-producing inequalities between men and women, between young and old, between people living in rural areas and urban areas, between different classes, between different races, etc. It meshes with these in very particular ways that ultimately leave us with a trend, which, in a nutshell means that the haves live and the have-nots are likely to perish. If anything, that’€™s the arithmetic of AIDS in South Africa.    

KHOPOTSO: What does he make of the situation?

HEIN MARAIS: It’€™s not a surprising one, but it’€™s a shocking one once you get a sense of the intensity of (the) human experience that lies behind a statement like that and the numbers of people that are involved in that experience, in that reality. It is plainly shocking. And I argue at the end that it, in fact, poses us with a very fundamental question about the kind of society that we are building here. If we weren’€™t posed that question before, AIDS, I think does it in ways that make it impossible to ignore.    

KHOPOTSO: After finishing the study, ‘€œBuckling: The impact of AIDS in South Africa’€, Marais remains with two questions.    

HEIN MARAIS: The ones I struggled with are whether AIDS is likely to change social relations in a positive and, if you like, progressive way. Say, for example, is the sheer need that erupts in a household that’€™s affected by the epidemic likely to change the different roles and responsibilities and entitlements that people in that household have? I’€™m thinking, particularly, gender relations. Will men assume roles and duties different from the ones they thought were their domain before? And at the moment the evidence seems to point towards an unfortunate answer, which is, it tends not to be the case.

KHOPOTSO: That’€™s the one factor that puzzles. The next can be startling to many as it moves away from traditional thinking on the effects of AIDS.

HEIN MARAIS: The other question I’€™ve wrestled with is the extent to which our expectations at this epidemic in a high prevalence society is going to cause institutions to collapse, cause the economy to shrink, essentially change society in a very obvious and catastrophic way’€¦ But, I do think that the question is not the first question we should be asking and answering. For me that priority question is what this epidemic is doing, and is likely to do, to millions of ordinary poor people who do not have access to the kinds of services, the kinds of entitlements, and, in fact, the kinds of rights, yet, that enable them to defend themselves against catastrophes like this. This, for me, is the fundamental challenge we have here.                                            

KHOPOTSO: Marais’€™ ‘€œBuckling, The impact of AIDS in South Africa’€, is not about statistics, but about the challenge AIDS poses to South Africans. It would be interesting to hear how policy-makers and thinkers on HIV and AIDS respond to it.