Infected Kin: Orphan Care and AIDS in Lesotho by Ellen Block and Will McGrath

Abstract

Reviewed by: Infected Kin: Orphan Care and AIDS in Lesotho by Ellen Block and Will McGrath Helen Macdonald Ellen Block and Will McGrath. Infected Kin: Orphan Care and AIDS in Lesotho. New Brunswick: Rutgers University Press, 2019. 246 pp. An anxiety of anthropologists of southern Africa has long been how to give voice to those who have been rendered voiceless; in this case, Lesotho's long history of structural violence shaped by South Africa's historical exploitation of this small landlocked country. Infected Kin: Orphan Care and AIDS in Lesotho by anthropologist Ellen Block and her husband, literary nonfiction writer Will McGrath, is a recent addition to the Medical Anthropology: Health, Inequality, and Social Justice series edited by Lenore Manderson. Infected Kin is a book about exercising agency in the face of adversity in Lesotho, where one-quarter of adults are infected with AIDS and where devastation has swept across communities, felt at every level of kinship. In the context of scholarship on the AIDS pandemic, which is targeted largely at the abstract level of global and public health, or a single disease vertically, Block and McGrath's Infected Kin is an important book. It is even more so when we consider that COVID-19 has directed health care resources and funding elsewhere. While scholars have largely focused on the ways in which culture and sociality influence HIV/AIDS, their approach has been largely limited to examining its interventions. Block argues: With this approach, HIV/AIDS is assumed to be the stable component of the equation, bolstered by its biomedical assertiveness, and culture is seen as the external (and often irrational) influence that maps onto the biomedical facts and hampers intervention…the intersection of HIV and kinship must be understood as a mutually [End Page 751] reinforcing dialectic, encompassing factors like caregiving practices, social relationships, cultural ideas about illness, and political, economic and historical circumstances. The context of rural Lesotho directed the course of this illness through its population and transformed the disease itself. (185–186) The authors take seriously Chimamanda Ngozi Adiche's plea to avoid the "single story of Africa" in two ways. Firstly, they take a kinship-first approach, and, secondly, each chapter begins with a series of literary vignettes, or flash ethnographies, written by McGrath. The kinship-first, as opposed to an HIV-first, approach forces open two well-explored topics—kinship and AIDS—to further scrutiny. Block's central premise is that while the biomedical realities of HIV map onto cultural, social, and structural factors, AIDS intersects with kinship for an entire population, not merely individual families affected by an illness (6–7). Furthermore, "AIDS infects families as much as it infects the body…[and] HIV is merely a part of the terrain" of Basotho sociality (7). She finishes her main argument with the statement that "the AIDS that rural Basotho people know is a kinship disease" (7). She follows in the footsteps of South African anthropologist Patricia Henderson's experiences with a high-burden rural population in KwaZulu-Natal, between 2003 and 2006—a time period where people with AIDS were slowly transitioned onto ARVs in South Africa. In a manner similar to Henderson's A Kinship of Bones (2011), Block and McGrath engage rigorously with the neglected themes of intimacy and care, though in a different country a decade later into the pandemic where antiretroviral medicines have entered mainstream treatment programs. The book is ordered thematically, and Chapter 1 launches with configurations of kinship. Block explores how people live, whom they live with, and the ways kin ties are made and unmade. Through examining the "social geography of care," she shows that while Basotho ideals about kinship are based on the principles of patrilineality, connection is shaped, maintained, and dispersed through the practices of enactment whereby the house becomes a focus of care. Kinship in Lesotho has been presented as inflexible; yet, sheer practicality has led to a decreased importance on markers of affinal kin, and rural communities are adapting to social change while reorganizing themselves around care, a valued quality in Basotho life. Chapters 2 and 3 enter the realm of medical pluralism, modes [End Page 752] of transmission, stigma, causality, structural...