Abstract
Since the onset of the global COVID-19 pandemic, scholars have debated whether it exacerbated existing social inequalities. For many African social scientists, such debates resonated with collective experiences with HIV/AIDS which have disproportionately affected the lower segments of social hierarchies.
Yet whereas much has been written about these exclusionary consequences of HIV/AIDS, we still know relatively little about how members of modern middle classes experience and confront this pandemic. Focusing on the educated urban middle class in Botswana, anthropologist Astrid Bochow's book fills this lacuna. Based on 10 years of ethnographic research, this passionately written book takes the reader deep into the social world of Setswana urban professionals, their life projects, careers, family crises, and their ways of navigating a world of risks.
The book consists of eight chapters including those that outline the main conceptual lenses – risk and body – as well as ethnographic chapters in which the author explores different themes related to HIV/AIDS. In these ethnographic chapters, Bochow describes how middle-class professionals evaluate the risk of HIV infection in relation to problems such as pregnancy and child rearing, their views of adequate healthcare, the possibilities of having a fulfilling sexual life, or the relationships to kin.
Conceptually, Bochow's book makes two interventions: first, drawing on Ulrich Beck's theory of risk society (Beck 1986), the author suggests viewing risk as a central axis that structures contemporary Botswanan society – and as a lens through which actors evaluate political projects, kin relations and life projects. However, in contrast to the risks linked to high-tech capitalism (e.g. nuclear power), infectious diseases center on the human body. Therefore – and this is the second conceptual move – Bochow argues that we need to understand the ways the body is produced through material practices as at the same time “at risk” and risky, as an object in need of care, and a carrier of pathogens. Because of this fundamental ambivalence of the contagious body, Bochow agrees with new materialist scholars who emphasize agency beyond intentionality and who see bodies as networked within webs of heterogeneous entities including institutions, pathogens, and medical substances. This new emphasis on connections among material substances strongly resonates with earlier anthropological findings on the central role of bodily fluids in mediating kin relations in African societies.
Equipped with this toolkit, Bochow delves into the cultural milieu of Botswana's middle class, beginning with a chapter entitled “Ways into Life.” She shows how HIV/AIDS overshadows couple's reproductive desires, private family planning, and concerns with maternal health. Through numerous public health programs about women's bodies, unborn children become subjects of medical regimes. The author consistently zeroes in on how this affects urban, affluent families. We get to know couples that decide to go for artificial insemination to minimize the risk of vertical HIV transmission. In fact, the entire debate on the reproductive lives of HIV-positive people has a distinct middle-class variant in which having children is not so much a necessity linked to old age but viewed as an essential component of a successful life. The fact that for middle-class urbanites, life is valuable was also reflected in the emphasis on confidentiality that governed interactions between them and medical staff in the private clinics in Gabarone or neighboring South Africa which only they are able to afford (p. 75).
While in this sense, middle-class urbanites inhabit a distinctive social world they also share with the rest of Botswana's society a part of their ritual life, for instance in relation to inherited practices of the seclusion of mothers and newborns called botsetsi. In a highly perceptive analysis, Bochow shows how this ritual complex is being transformed when relatives who are traditionally responsible for the care of mother and newborn are not available any longer because they have passed away from AIDS. Bochow finds that the partial abandonment of such rituals goes hand in hand with young women's demands for greater personal autonomy just as with the rise of new, consumerist rituals related to family, pregnancy, and child birth such as the “baby-shower” (p. 87).
In the subsequent chapters, the urban middle classes become increasingly visible as actors of cultural transformations, many of which pivot on questions of adequate care and the legal protection of children and the norms concerning marital life. Bochow eruditely explores how these changes play out in contestations over “life skills” school curricula (p. 101), new legislation on the compulsory naming of children's biological fathers in birth certificates (p. 125), as well as debates about “single motherhood” (p. 127) and adoption (p. 137). Overall, Bochow's argument is that the urban middle classes are at the center of a massive modernization process which cultural responses to the HIV/AIDS pandemic have propelled: They constitute a new class of experts staffing governmental authorities and private counseling offices; they have helped to create a new institutional landscape of public-private partnerships, often with international co-funding, in which they were able to advance their professional careers; and through these positions, they were able to dominate public discourses on marital life, sexual ethics, and individual responsibility inspired by distinct Christian ideologies.
Astrid Bochow's book offers an impressive analysis of the private and reproductive lives of Botswana's middle classes and magisterially demonstrates how social position inflects the experience of risk and illness. While her engagement with the anthropological literature on HIV and AIDS is cogent and her contributions to it become very clear, I sometimes missed references to the very lively anthropological debate on African middle classes, precisely because the nexus of middle classes and health is what makes the book so interesting. Another value of the book lies in its consistent engagement with older anthropological and historical literatures on Setswana society which helps the reader to place current developments in historical context. Overall, I highly recommend this book to all who read German and are interested in the dynamics around health, risk, and cultural changes among African middle classes.