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AIDS, Orphan Care and the Family in Lesotho by Mary Ellen Block A

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AIDS, Orphan Care and the Family in Lesotho by Mary Ellen Block A Infected Kin: AIDS, Orphan Care and the Family in Lesotho by Mary Ellen Block A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Social Work and Anthropology) in The University of Michigan 2012 Doctoral Committee: Professor Elisha P. Renne, Co-Chair Associate Professor Karen M. Staller, Co-Chair Professor Gillian Feeley-Harnik Associate Professor Letha Chadiha Lecturer Holly Peters-Golden © Mary Ellen Block 2012 Ho bana le baholisi ba bona . ii ACKNOWLEDGMENTS I dedicate this dissertation to the babies and caregivers ( ho bana le baholisi ba bona ) of Mokhotlong who helped reveal to me the many challenges of the AIDS orphan crisis, and without whom this work would not be possible. From my earliest days in Mokhotlong, they opened their homes to me and shared with me their most personal and painful stories for reasons I cannot begin to imagine. People willingly and cheerfully gave me their time, entry into their private spaces and their friendship, and for that I am truly humbled and grateful. The MCS staff deserves special mention. The safe home bo’m’e (house mothers) were always welcoming, friendly and ready to laugh at my attempts at humor in Sesotho. I am particularly indebted to the outreach workers with whom I spent countless hours driving around the Lesotho countryside chatting, sleeping, and asking obvious and countless questions. For their knowledge, time and patience I am forever in their debt. To my trusted, wonderful and delightful research assistant, Ausi Ntsoaki, who drove hundreds of miles with me on the back of my dirt bike, who spent painstaking hours transcribing interviews with me, and who made every day in the field not only easier, but truly enjoyable. Thank you for all of that. Finally, to ‘M’e Nthabiseng: I am constantly inspired by your intelligence, strength, spirit and ingenuity. Your insight, advice and friendship have meant the world to me. Kea leboha, haholo ‘M’e! iii There are a number of other people who made me and my husband Will’s time in Lesotho so much more enjoyable. First of all, to Reid and Bridget, our dear friends who lived with us at MCS for the entire duration of our stay. Although they had only been married a few months when they arrived in Mokhotlong, they cheerfully tolerated us in what I have called the longest double date ever. Thank you uenas ! And for all our other visitors and passersby who brought some love, variety (and care packages) to our lives: my brother Dan, my mom, Sheila, who visited us twice, my sister Emily, Jamie Martin, Tasha Saunders, Jenn and Stephanie Kim, Liz Lawrence, MJ, Claire, AZ, and many others. In particular, I am grateful for the unending support and guidance of my committee members over these past eight years: Karen Staller, Elisha Renne, Holly Peters-Golden, Gillan Feeley-Harnik and Letha Chadiha. Thank you for the countless hours you have dedicated to me, and for the wonderful advice and especially the kindness you have shown me throughout this process. I always describe you as my cheering section because even in providing much needed critical advice, you have always been so supportive. I would also like to thank the University of Michigan Department of Anthropology and the School of Social Work, whose funding and support over these years made this research possible. A special thanks to Laurie Marx for her love and good humor and to Todd Huynh and Laura Shirley for helping with the unpleasant tasks of bureaucracy. And to Mandy Terc, my study partner and dear friend who helped me get to work every day of the last two years, and who provided much needed critical assessment of my work on countless occasions. I am also indebted to the Kellogg Family Foundation iv for making me a W. K. Kellogg Family Fellow in Children and Families, as this generous grant funded the majority of my fieldwork. To my family: Mom, Dad, Jules, Jim, Emily, Dan and all the McGraths for your love, guidance, support and countless hours of babysitting that made this work possible. A special thanks to my dad, Howard, for being the most enthusiastic copyeditor and technical advisor I could ever ask for. Finally to my husband, Will and my son, Sam: thank you for making these years not only bearable but truly enjoyable. v TABLE OF CONTENTS DEDICATION .................................................................................................................... ii ACKNOWLEDGEMENTS ............................................................................................... iii LIST OF FIGURES ......................................................................................................... viii LIST OF TABLES ............................................................................................................. ix LIST OF ACRONYMS .......................................................................................................x GLOSSARY: SESOTHO WORDS AND EXPRESSIONS .............................................. xi ABSTRACT ...................................................................................................................... xii CHAPTER ONE - INTRODUCTION: AIDS, ORPHANS, AND A BIOCULTURAL APPROACH TO RELATEDNESS .....................................................................................1 Matseli’s story ................................................................................................................1 AIDS and orphans in Lesotho: A demographic crisis ...................................................6 Theoretical concerns: Integrating levels of analysis ....................................................11 What binds people? Kinship, caregiving and relatedness ......................................15 Medical anthropology: Biocultural approaches to HIV .........................................27 Trends in HIV/AIDS interventions ........................................................................34 Methodology and research site ....................................................................................42 Anthropology and social work: Interdisciplinarity explored .......................................57 Chapter overview .........................................................................................................62 CHAPTER TWO – FROM MOSHOESHOE TO MBEKI: CONNECTING THE PAST AND THE PRESENT IN LESOTHO ...............................................................................67 The Relebohile family’s story ......................................................................................67 Constrained choices: King Moshoeshoe I and Lesotho’s remittance economy ..........71 Migrant labor, apartheid, and AIDS ............................................................................76 Conclusion: The political economic context of AIDS .................................................89 CHAPTER THREE – KIN, CARE, AND THE HOUSE: REORIENTING BASOTHO KINSHIP AND RELATEDNESS .....................................................................................92 ‘M’e Masekha’s story ..................................................................................................92 Houses and house life ..................................................................................................96 Changing patterns of lineality in Lesotho ..................................................................105 The physiology of kinship: Parenthood and substance ..............................................110 The importance of children ..................................................................................115 Shared substance ..................................................................................................119 Shaping relatedness through raising and caring .........................................................130 Bridewealth revisited ...........................................................................................142 Conclusion: The social geography of care .................................................................146 CHAPTER FOUR – PRIVILEGING CARE: CONCEPTIONS OF ILLNESS, THE BODY, AND TREATMENT-SEEKING BEHAVIORS IN RURAL LESOTHO .........150 ‘M’e Malelang’s story................................................................................................150 Lesotho’s health care system: Structure and funding ................................................154 vi Disease etiologies: Biomedical and supernatural causality .......................................158 Symptom versus disease management .......................................................................164 Treatment seeking: Combining Sesotho and “English” medicine .............................169 Conclusion: Contradictions or adaptations? ..............................................................183 CHAPTER FIVE – INFECTED KIN: AN ECOLOGICAL APPROACH TO BASOTHO’S PERCEPTIONS, KNOWLEDGE, BELIEFS, AND RESPONSES ........186 Lebo’s story ...............................................................................................................186 Local perceptions of HIV/AIDS ................................................................................193 Physical understandings of HIV/AIDS ......................................................................204 HIV/AIDS interventions and everyday practice ........................................................217 Prevention ............................................................................................................217 Testing..................................................................................................................238
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