University of Chicago Press, 2014, 208 pages
In Daniel Jordan Smith’s AIDS Doesn’t Show Its Face: Inequality, Morality, and Social Change in Nigeria, we confront AIDS as a total social fact of Nigerian society. In this, his third book, Smith, a seasoned anthropologist of Nigeria, presents conclusions that draw on his 23 years of amassed data. As such, the facility with which he organizes his confident analyses comes as no surprise, and yields a clearly written and well organized book—a boon to any social scientist. He is adamant that the book is meant to be more about Nigerians and Nigeria than about AIDS, but it is precisely the multiple products, effects, and consequences of the illness, integrated into various facets of social life that allow for AIDS to teach us something about Nigeria. Smith organizes his monograph into six chapters treating the domains in which he has observed the most profound changes in the past 23 years—urbanization, gender relations, religion, AIDS NGOs and civil society, kinship, and reproduction. He contends that these areas of social life are ones in which “people’s beliefs about and responses to HIV and AIDS offer significant insight into broader social processes that produce and reproduce social inequalities and their consequences for people” (19).
Smith’s AIDS research has centered on three (overlapping) populations: youth, married couples, and people receiving antiretroviral therapy. The data undergirding the book is quite substantial. In addition to several projects’ worth of participant observation and in-depth interviews, in 2001-2002 the author conducted an in-depth and highly detailed survey of 800 young Igbo-speaking migrants in major cities of northern and southeastern Nigeria. Nonetheless, he is adamant that he has learned the most from participant observation. Smith also cautions us that his knowledge of AIDS in Nigeria comes with a certain bias, as he is an expert on the Igbo-speaking Southeast. He admits to various differences in social experience between the Southeast and the mostly Muslim and Hausa-speaking northern half of the country, and that his scholarship has rung true more often for colleagues working in other countries and sub-Saharan African regions than for those studying the north of Nigeria. However, he insists that this does not delegitimize or weaken his arguments:
The Igbo people…are very much integrated into Nigerian society, and they share experiences with AIDS and with the consequences of various aspects of social change that are common across the country. It is my contention that much of what I observed in the Southeast applies in other parts of the country—perhaps most especially in other parts of southern Nigeria, where Christianity is also widely prevalent and many cultural traditions are similar to the Southeast. (27)
True to his assertion, throughout the book Smith casts “Nigerians” as the social actors of his arguments and conclusions. His overall intent is to analyze their social responses to AIDS as reflective of the complex junction between inequality and morality as people interpret and react to the consequences of social change.
In the first chapter, Smith uses his study of motorcycle taxi (okada) drivers to talk about the moral hazards of urban inequality. He describes the okada men as totemic figures whose experiences captured the realities of widespread changes in Nigeria. Popular opinion states that the profession’s very existence indexes the deterioration of family structures and reciprocal relationships in favor of money, consumption, and greed in a context of rising inequality. This is one of the major preoccupations of the book—Nigerians’ apprehensions and ambivalent experiences regarding urbanization, the increasing monetization of social and economic life, and the sense that disturbing new inequalities are both caused by and aggravating the demise of collective morality. Smith connects AIDS and okada drivers because they merge in stories of university girls ready to exchange sex for cash, and concludes that both are “symbols for the things that Nigerians see going wrong in their society” (50). It is clear, however, that they form a pair in his analysis because they are imbricated with inequality, and one cannot deny that there might be many other social spheres or categorical figures in Nigerian city life through which to understand AIDS, inequality, and morality with equal depth. Indeed, the last section of the chapter presents the “demise” of the okada, explaining that in 2009 Igbo-speaking state governments banned them as a result of their suspected connection to, and implication, in crime, especially a series of kidnappings for ransom. A longer ethnographic discussion of how Nigerians responded to such a move by the state, with relation to their own anxieties and moral judgments, would have enriched the chapter, especially because Smith states that the criminalization of okada drivers was in fact a way to blame one sector of the urban poor and successfully de-culpabilize the political elites. Furthermore, the deep relevance of rumor and gossip as social phenomena that index moral orientations, and the work that rumor does could have been more thoroughly explored, particularly since Smith admits that the relationships okada men purportedly had with university girls were not ones he could get either party to discuss openly.
In the chapter on gender inequality, sexual morality, and AIDS, Smith first portrays the social scene of rural-urban migrants, young vulnerable women, and married men engaging in extramarital sexual relations. It echoes the sociopolitical and economic realities of AIDS in many other contexts, in Africa and beyond, to anyone who is well read in medical anthropology. The major contribution here is to explicate how not only inequality, but also morality, are critical to how men and women navigate the terrain of gender relations and sexuality amidst AIDS. Condoms are widely viewed as symbols of sin because the very use of them implies that the user is promiscuous and reckless, and so people avoid them. This finding figures amongst certain clear-cut results from Smith’s research that are immediately relevant for public health interventions, though, as is often the case, the steps towards an attempt to change such cultural orientations are somewhat daunting.
Perhaps the strongest chapter is the one treating Pentecostal Christianity in Nigeria, and the moral representations and discourses around AIDS that the faith perpetuates. Given the wide reach and immense power of Pentecostal movements across sub-Saharan Africa these days, Smith’s skillful summary of that church’s effects in Nigeria is an excellent contribution to our field. In sum, he contends that “Pentecostal Christianity’s appeal in Nigeria is so strong precisely because it speaks to modern desires for wealth, consumption, and freedom from the obligations of kinship even as it condemns many of the social ills that Nigerians associate with these very transitions” (101). Indeed Pentecostal pastors promise that if one becomes born again and follows the word of God, he will be rewarded with economic prosperity, but simultaneously protest (against?) selfishness, greed, and corruption. Smith notes that unfortunately, by labeling AIDS as a moral failing and the result of sinful behavior (which one can overcome by repenting and becoming born again), Pentecostal churches perpetuate the shame and stigma that lead Nigerians to conceal their HIV status and eschew condoms, putting their partners and loved ones at constant risk. He also depicts the exaggerated and ostentatious wealth of many leading Pentecostal pastors, giving us a more vivid sense of the contradictions, ironies, and complexities that abound in the movement in an age of increasing inequality and poverty.
In his later chapters, Smith continues to offer us compelling portraits of how the swift changes in Nigerian society resulting from rural-urban migration, the influence of Western media, rising aspirations for material consumption, and the monetization of social life engender plentiful tensions and dichotomies—different values can mix and coexist. In the chapter on AIDS NGOs and civil society, he highlights the pull between Nigerians’ awareness and anger about a moral economy in which practices of patronage win over rules based on bureaucratic accountability, and the yet enduring moral pressures and social rewards for acquiring “ownership” of an NGO and thus establishing one’s career as a patron. These moral orientations and social realities comprise the messy lived experience of everyday life, and Smith makes it clear that we must always seek a careful and nuanced investigation of swift change in a society. He shows this well in the chapters on kinship and reproduction—Nigerians see migration as undermining both the affective and obligatory bonds of kinship, and yet they may simultaneously rally behind, depend on, and laud the migration of their family members. HIV+ women may do everything possible to conceal their status from their partners and deceive their entourage to some extent, but they do so in the hopes of and towards the goal of social and biological reproduction, of fulfilling the steps (marriage, parenthood) that make one a full adult in Nigerian culture.
It seems natural to consider AIDS as a total social fact in this analysis because Smith repeatedly insists that it is “particularly emblematic and evocative as a symbol of people’s anxieties about the contemporary moment in Nigeria [through] its direct relationship to social reproduction” (160). On the whole the monograph certainly convinces one of this. He is convinced that for HIV prevention, the single most crucial undertaking is undoing the moral stigma around condoms. While Smith sees dismantling the moralizing discourses about AIDS as a long-term and hefty challenge, he imagines a more feasible campaign to drive home the moral and ethical benefits of the condom tool as a tool for protecting oneself, one’s partner, one’s family, and society as a whole. This potential intervention is reduced to “public health messages,” which is disappointing after the dense cast of okada drivers, university students, Pentecostal pastors, NGO workers, married men, and migrants in the story that this book tells. How might these various social actors be engaged in such campaigns, with close attention to what is morally and politically at stake for them?
AIDS Doesn’t Show Its Face: Inequality, Morality, and Social Change in Nigeria is an ambitious and compelling monograph by a seasoned scholar making a timely contribution to medical anthropology. It is an especially pertinent book for those specializing in Africanist anthropology or working in West Africa.
Darja Djordjevic is an MD-PhD (Department of Anthropology) candidate at Harvard University. She recently finished her fieldwork in Rwanda, which entailed a multidimensional study of the national cancer program, and is now completing her archival research in Belgium and France. Her scholarly interests include global oncology, the noncommunicable disease movement, the ethics of care, understandings of specialization within medicine, the history of chronic disease in Africa, and transnational public-private partnerships.