African cosmology and disease: the world of myth in approaches to HIV/AIDS

HIVAN's Artists' Action Around AIDS Workshop, hosted on 4th August 2003 at the University of KwaZulu-Natal, commenced with a presentation by the University's Head of Anthropology Professor Suzanne Leclerc-Madlala. Her talk revolved around myth and rational vs. non-rational thinking in approaches to the HIV/AIDS epidemic.

Focusing specifically on HIV/AIDS as a disease syndrome around which there are many questions without definitive answers, Prof Leclerc-Madlala explained that global responses to HIV/AIDS had largely been constructed on a scaffolding of Western "rational", biomedical understandings of infection and fatal illness. This mindset is premised on clinical observation, empirical studies and microbiological research, with pharmacological products being developed through these methods to counter the processes identified in the course of the body's infection and deterioration.

Through globalisation and a historical impingement of Western influences upon African societies, the contemporary African model straddles both the "rational" understanding of disease causation and the "non-rational" - that is, it simultaneously draws from, and tries to conform to, a world-view that is based on a more holistic ontology. African belief in causation involves a focus on a more ultimate conceptualisation of illness and on answering the question: "Why?" - as opposed to the more immediate approach that characterises Western thought, that of determining "what" and "how" the disease process develops within the body.

Since these two systems are essentially at odds with one another, but are well-established in Africa, complications in the management of disease arise in the form of confused communications between doctor and patient, poor adherence to drug therapy and inadequate delivery within health-care systems. Many key role-players within these scenarios experience frustration and "burn-out" because of this discordance.

Almost all African peoples believe in a supreme Creator who resides in the heavens and whose universal presence generates and sustains all life. This Being, although translated through Western thought as "God", has no name and is not depicted visually. Lesser divinities in the form of long-dead ancestors are delegated certain tasks and roles in order to mediate with earthly souls via a "meso-" level of communication. Human diviners, healers and herbalists, as well as animal "familiars", act in spiritual service to the ancestors by performing and interpreting ritual practices which symbolise and invoke specific archetypal energies and attributes, so facilitating such communication.

The spirits of the dead, especially the recently deceased, are not worshipped, but rather honoured and acknowledged in order to ensure that the living individual's relationship with these "good" spirits secures his or her protection from co-existent "evil" spirits. The origin of most diseases is therefore traced back to a negative status in terms of this relationship, and a resultant foothold being gained by malevolent spiritual forces.

Explanations for this negative status are sought through consultations with a spiritual mediator, such as a sangoma, who can relay the querent's predicament to the ancestral realm and in turn relay some answers from a trusted, heroic and, in some cases, deified source.

With the backdrop of these contrasting models, people in Africa are grappling with their individual and collective engagement with the HIV/AIDS pandemic, so that most approaches to its management are not "rational" from anyone's perspective. The Western mindset is pre-occupied with "cost-benefits" of treatment modalities, and with "education" being fundamental to prevention programmes - all based on the assumption that the affected or vulnerable individual can exercise reasonably informed choices in these matters. However, in the African world-view, personal decision-making is not necessarily enabled by nor appropriate to certain customary conventions and belief systems, and the largely gendered structure of these systems simply does not support the imposition of Western capitalist responses.

In an ethos of such overwhelming psycho-spiritual confusion around a deadly epidemic, the desperation resulting from the agonising physical conditions on which it feeds and flourishes, and the profound emotional distress it causes and thrives within, drives an intense sense of fatalism. This, in turn, broadens people's search for meaning, and drawing upon myths is a way to "explain the unexplainable". As the HIV/AIDS epidemic bites deeper into communities and households, people will "scratch harder" to seek answers, which leads to the re-creation of myths as an "alternative way of knowing".

Prof Leclerc-Madlala suggested that this leaves the ground open for artists, who by their nature are physically, intellectually, emotionally and spiritually adept at appreciating and exploring the need for such quests, to use the creative process in ways that might support healing in African society. She referred to a recent study by the HSRC on attitudes amongst youth in South Africa, which had yielded a finding of 31% of young people expressing their view of life and personal future as "...meaningless, hopeless and likely to get worse." (From: "Addressing AIDS" by Christian de Vos and Abigail Baim-Lance in: Public Attitudes in Contemporary South Africa; published by Human Sciences Research Council, Pretoria, 2002).

The full report can be accessed on the righthand side of this page

For more information, and a full report, on HIVAN's 'Artists' Action Around AIDS' campaign, please click on the hyperlinks on the righthand side of this page