Understanding the COVID-19 Syndemic in South Africa: concrete responses and a call to action

Abstract

Barely 25 years into a fledgling democracy, South Africa lives with the scourge of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) having wiped out at least one generation; mass unemployment and food insecurity are commonplace, as are the effects of climate change; with essential infrastructure collapsing, rampant corruption, and a public health system under severe strain, SARS-CoV-2 wreaked havoc on the South African population. This chapter illustrates the colliding synergies of viral transmission and multi-morbidity with historical failures to address unmet basic needs. We illuminate experiences among key cohorts and vulnerable socio-economic groups to demonstrate how missed opportunities and “engineered neglect” has resulted in multiple COVID-19 experiences across society’s fault lines. The result is differential experiences of life under lockdown; experiences of health, illness, and hospitalization particularly for those with non-communicable diseases; as well as complex and compounding experiences of loss, grief, and death. Syndemic theory facilitates the illumination and disentanglement of the biological and social dimensions of disease epidemics, laying a foundation for a more nuanced exploration of the political dimensions of disease. This chapter argues that such an approach is needed given the scale and pervasiveness of global inequality, exploitation, and discrimination within the context of neoliberal, racialized extractive capitalism. Syndemic theory signposts the need for multi-dimensional interventions such as primary healthcare and community-oriented approaches as well as anti-globalization movements that seek to address the deepening and co-existing crises of climate change, societal degradation, and illnesses by disrupting the relentless cycle of power, inequality, and health disparities.