Politics of Exposure The Visual Economy of HIV/AIDS in South Africa

When tracking the progression of Gideon Mendel’s photos, there is a shift from representations of suffering, pain, and death of people living with HIV/AIDS to those in which he aims to show people in a ‘positive, individualized way’. 

South Africa has the highest HIV prevalence in the world, claiming 20 per cent of the global population of people living with HIV, a whopping 7.7 million. Following its independence in 1994, South Africa’s responses and representation of the HIV/AIDS epidemic have been rather turbulent over the past years with its rising HIV statistics, President Thabo Mbeki’s infamous AIDS denialism repertoire, and counter NGO or activist groups. HIV/AIDS is more than an epidemic of death and fatality; it shapes and is shaped by several socio-economic inequities including, gender inequality and violence, poverty, and stigmatization. Consequently, its representation in media must turn away from the tropes of people living with AIDS being portrayed as victims, suffering from emaciation, death, orphanhood, or bad motherhood. 

With this in mind, it’s worth asking if South Africa’s visual economy of HIV/AIDS concerning the medium of photography provides a nuanced, effective South African representation of the epidemic or if it succumbs to iconographic tropes of African peril, disease, and disaster. I find South African photographer, Gideon Mendel’s work to be a useful case study for understanding HIV/AIDS images not as isolated objects but as intertwined in networks of technologies, social spaces, institutions, and cultural-political contexts and thereafter their effect on the epidemic’s representation.

The Underlying Methodologies of Gideon Mendel’s Gaze

At the beginning of his work on HIV/AIDS in South Africa, Gideon Mendel’s approach took on a humanist methodology; this approach entails a direct representation of suffering, death, and pain to provoke a sense of vulnerability or intimacy. Often, however, humanist photography replicates stereotypical images of disease, famine, poverty, or war that only succeed in producing a ‘fatalistic apathy’. His inclusion of images of people with HIV/AIDS hospitalized, dying, or suffering was intended to induce compassion and initiate some form of change. However, humanist photography, or photography in general, is not an objective or neutral practice—and, in many ways, Mendel’s earlier photos contained certain colonial stereotypes in which people with HIV/AIDS were portrayed as passive victims or suffering bodies. Reminiscent of problematic colonial portrayals of the ‘African savage’ the images often portray the subjects as deficient—of clothing, order, health, or civilization.

In South Africa, data from 2018 showed that 260,000 children under age 14 were living with HIV/AIDS. The high rates of adult morbidity and mortality in the country result in some of these children being orphaned by either one or both parents. Although, 85 per cent of these children have a surviving parent, a key focus of media representation of HIV/AIDS has been on the ‘AIDS orphan’.

This representation has capitalized on themes of childhood innocence, victimization and, the ‘moral incapabilities’ of the African family. While Mendel did not focus on the ‘AIDS orphan’ specifically, a few of his images capitalized on this trope of victimhood and innocence through pictures of children. In this piece from his Broken Landscape portfolio, he accompanies the picture of the baby with a short description. While the image on its own simply depicts a wide-eyed feeding baby, the accompanying text alerts the viewer that the child, HIV-positive and abandoned at the hospital, died shortly after the image was taken. 

The image itself is resistant to typical representations of childhood suffering—the baby is shown in a positive light, almost peaceful, with no direct cues that he died afterwards. The text however reinforces a theme of hopelessness that is commonly associated with HIV/AIDS imagery. Whatever note of optimism existed in the picture is extinguished by the fact that the baby died shortly after. The inclusion of this description fits into this centralized theme of AIDS photography where children are posed as helpless victims. With the inclusion of this notion of victimhood, there must be an antithesis of a ‘guilty’ person. There is a suggestion of the failed responsibility of parenthood, of family and care—and, thus , some discourse of morality is reproduced. These photographs of children feed into the discourse that they exist as helpless victims and vilifies the morally deviant adults who neglected familial duties.

Images of Terror

While Mendel’s pictures of children infected by HIV/AIDS are few, most of his South African pieces are included under the portfolio We Are Living Here, which was part of a project to highlight access to antiretroviral treatment in the Eastern Cape. Many of these images, however, centralize infected people as ‘HIV victims’ often portrayed in hospital beds, being carried or in emaciated, skeletal states. These photographs function as images of terror by producing single stories of people with HIV as diseased victims who are dangerous to the rest of (healthy) society. Thus, in this moment of representation, the subject is instantly Othered. The binary is created of an ‘us’ that is part of a healthy society and the ‘them’ that are infected, diseased, and isolated.

These images add to the overproduction of images of HIV/AIDS patients as emaciated, diseased bodies that only contribute to the overwhelming ‘AIDS fatigue’ produced by media representation. This AIDS fatigue arises when images that would commonly produce shock are constantly reproduced. This normalizes suffering reduces the capacity of these images to provoke indignation and thereafter, action. In essence, Mendel’s production of images of emaciated bodies deindividualizes the subjects by attaching their beings to a decaying, fragmented state.

Nomfumaneko Yako, 15, sits on her bed the day before she is due to start her first dose of antiretroviral treatment. Eastern Cape, South Africa © GIDEON MENDEL
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Mendel’s Politics of Exposure

In these photos from We Are Living Here, a woman is portrayed unclothed while bathing. The nakedness and vulnerability of the subject in the pictures point towards questions concerning the politics of exposure. Specifically, how this image and others similar to it may render violence to the individual, culture, people, or cause for which it was pictured. If Mendel uses the woman’s state and suffering as more of compositional devices in the photograph than as political motives, it needs asking the extent to which the image will provoke more than indifference to it.

While these representations expose the personal and the private, they ignore the overarching public dimensions of the HIV/AIDS disease itself. Despite many of the photos being supported by short biographies of the subject or direct quotations of them relaying their pursuits of access to treatment in his portfolio, the imagery evokes a universalized and decontextualized representation of the African AIDS victim. Owing to this decontextualization and capitalization on suffering, pain, and vulnerability of the subject, the images often produce a different kind of violence or suffering through the act of representation. It is a violence that exposes the subject’s private circumstances but maintains it as their private tragedy—there is no address, inclusion or representation of the social conditions that perpetuate the AIDS epidemic, the policy failures to address it, the lack of health care and treatment and all-in-all the politics of AIDS.

When tracking the progression of Mendel’s photo portfolios and imagery, however, there is a shift from representations of suffering, pain, and death of people with HIV/AIDS to those in which he aims to show people in a ‘positive, individualized way’. His later projects focused on producing imagery within and for the African countries, as such many were collaborations with NGOs, campaigns, or activist organizations. A key collaboration Mendel had was with Treatment Action Campaign. 

TAC was started in 1998 by HIV-positive Zackie Achmat as an HIV/AIDS activist organization. Its visibility peaked in the 2000s during which its protests and quarrels against Thabo Mbeki and his politics of AIDS denialism were on the rise. After becoming president of South Africa, Thabo Mbeki sought non-mainstream academic research and medical advice on the issue of AIDS in the South Africa and concluded that there was no causal link between HIV and AIDS. Health policies implemented by his government thus refused to provide antiretroviral treatment (ARV). Mbeki’s primary argument was that ARV sales were a racist, neocolonial scheme by Western companies to maintain control over developing countries, and the second that poverty, malnutrition and other diseases that preclude AIDS are more important causes than HIV and thus policy and treatment response should focus on poverty and malnutrition alleviation instead. TAC’s protests and media responses in the early 2000s were thus largely geared towards the Mbeki government and its inadequate health policies. 

Many of the posters included images of marches and protests by HIV-positive TAC members. These images were a shift from typical representations of people with AIDS as powerless or dying to portrayals of healthy people, marching and demanding better services and resources. One such TAC poster, inscribed with “President Mbeki: Health for All!” placed a demand towards President Mbeki to begin a treatment plan for those infected and to “Fire Manto”, the Minister of Health at the time. 

Where images of protests are not used, there is animated imagery of pregnant mothers used in protests and on posters. In this instance, TAC utilizes the theme of motherhood to situate HIV-positive pregnant women in a discourse where they are posed as striving to be ‘good’ mothers and prevent infection for their child but cannot do so without access to treatment. While the intent of the poster is clear, notions of care and concern are problematic as women are situated as worthy of attention only when framed as being ‘possible infectors of children’. The poster thus feeds into constructions of good or bad motherhood rather than focusing on the state and wellbeing of the woman alone. 

Another TAC poster demanding an HIV/AIDS Treatment plan NOW’ demonstrated a central theme TAC utilized when protesting, in which the struggle against HIV/AIDS is likened to the struggle against the Apartheid regime—as a wider struggle for the South African nation as a whole. In this poster, an image of Hector Peterson is used; a young boy who died in the Soweto Uprising—a 1976 youth protest against the government’s introduction of mandatory instruction of Afrikaans in schools. This image is juxtaposed against a picture of a Nkosi Johnson with a supposed date of death above his name, also in the same month as the Soweto Uprising years ago. The poster suggests the killing of innocent youths by a larger, oppressive, and parasitic structure. It also plays into the theme of the innocent victim, which, by default, requires a guilty perpetrator. In this case, Minister Manto is again addressed to begin the HIV/AIDS treatment plan and the poster suggests that by doing so, she could prevent further deaths of innocent children. Along with protests and campaigns, TAC went to Constitutional court against the Mbeki government and in 2002 won a case to make antiretroviral treatment available for HIV-Positive pregnant women. TAC’s media representation that followed this case often included themes of empowerment, health, happiness, and availability of treatment. The posters and imagery produced for this campaign were largely done in collaboration with Mendel.

Looking Aids in the Face

An important project that Mendel and TAC collaborated on was called Looking Aids in the Face. The project portrayed HIV-positive people but avoided pictures of sickness, trauma, or resignation to the supposed inevitability of death. It, instead, juxtaposed the images with text in which those photographed recounted their experiences and the challenges of living with HIV/AIDS.

Despite the title of the series, many of the images did not include the individual’s face or even body in some cases. In one of the images, for example, the subject holds part of a bike while noting her child tested negative for HIV, where the bike could be symbolic for a healthy childhood for her baby. 

The viewer is forced to discard previous conceptions of the ‘HIV victim’ and engage with images including healthy, smiling subjects, shown with available treatment or with their children (both HIV-positive and negative) under a campaign seeking more treatment and better resources.

In essence, the project allows for a different kind of visibility of people with HIV/AIDS. The project demonstrates everyday realities, nuances of emotions, and addresses the multi-causality of the disease that encompasses its symptoms as well as the lack of health care services and resources and institutional failures in addressing these. The challenge of HIV/AIDS visualizations lies in addressing the suffering and pain the epidemic has caused while also avoiding stereotypes and a focus on horror. The Looking Aids in the Face project moves towards the kinds of representation of HIV/AIDS that can allow for open discussion and positive imagery. It touched on the success of using photographs multimodally rather than in isolation and thus avoided the problems that come with a decontextualized photo. 

Shifting Towards Political Change

There should be a move towards representations that both exclude or include an HIV/AIDS subject in a way that does not stigmatize their body or mythologize their disease. This means moving away from a morality-based discourse of blaming and an annihilistic frame of reference in which those who live longer are heroized. Instead, there is a need for representation that addresses the multiplicity of causes and lived experiences and establishes imagery that encourages safer sex. This representation needs to move towards contextualizing the HIV epidemic in its cultural, political, and social realms. This move would require reflexivity on the part of the photographer in understanding the limits of photography as technology and limits of representation. To effectively represent disease, photography must become political; the visualizations of HIV/AIDS must dispel tropes of blame, victimization, and hopelessness, and shift towards political change by engaging the public and political actors and holding them accountable. While this is not an easy feat, the conversation has to start somewhere because replicating images of despair, sickness, and death only elicits pity, and as Douglas Crimp noted: ‘pity is not solidarity’

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