13 Hope of a nation – experiences of social exclusion giving rise to spaces of inclusion for people living with HIV and AIDS in South Africa: a reflection
South Africa is a country of diversities, contrasts and contradictions; it boasts eleven oﬃcial languages in addition to countless tribal dialects, a rich diversity of racial and cultural groups, and a landscape encompassing everything from tranquil beaches to rugged bush lands and rocky mountains. South Africa also has one of the highest rates of HIV/AIDS in the world. No one particular group is aﬀected by the virus – rather, it is indiscriminate. Similarly, responses to HIV are diverse, and can be starkly contradictory. This author lived among the Xhosa people in rural Eastern Cape, working in community development. The program was a population-based youth empowerment program around HIV prevention. The work involved engaging youth in a range of civic participation activities, and networking with other community based groups and organisations, health and social services, and government departments. Here, the author reﬂects upon her experience, drawing out a narrative of the lived experiences of social exclusion and social connectedness for people living with HIV/AIDS in rural Eastern Cape. The reﬂection will draw out the paradox of how the high prevalence of
stigma and discrimination towards those with the illness, and their subsequent experience of social exclusion, actually creates opportunities for social connectedness through support group participation. This in turn is fashioning an emerging social movement breaking down barriers of stigma, and contributing to broader social change to support HIV action in this diverse and sometimes contradictory social environment. The reﬂection begins by outlining the current context and underlying
determinants of the proliferation of HIV in the Eastern Cape, including a discussion of exclusion as a determinant. An exploration of how exclusion is also experienced as an outcome of positive HIV status follows. An explanation of how the experience of exclusion can be transformed into spaces of connectedness, and implications for health promotion practice in this context, will be presented.