Review of “Love, Money, and HIV: Becoming a Modern African Woman in the Age of AIDS” (2014)

Sanyu Mojola’s “Love, Money, and HIV: Becoming a Modern African Woman in the Age of AIDS” (2014) presents a compelling, multilayered, processual account of the ways that changing ideas of modernity and the expansion of a gendered market economy combines with the physiological and ecological structure of HIV transmission risk to produce the outrageous inequity in HIV burden borne by women in Africa. She says, “Specifically, I illustrate how consuming young women have been cultivated and produced, in three contexts—communities, schools, and labor markets” (p. 8). For her, the dramatically gendered disparities in HIV burden and experiences can only be adequately explored by tracing the interwoven threads of the structuring market, its shaping force on cultural norms and dispositions, and the implications for young womens’ search for love and desire amidst the specter of HIV. As Mojola describes, women are caught between the culturally and institutionally cultivated demand to consume—products, beauty goods, daily signs of status and modernity—while also being structurally excluded from the vast majority of the formal labor market and consistent income potential. The demand for stable income leads to emergence of various forms of “transactional sexual relationships” that take on different forms in different settings, but all help to satisfy consumptive needs and norms.

Mojola was born in Tanzania but attended college in the UK and graduate school at the University of Chicago. As she as a result her writing has an emotional and intellectual proximity that is unusual. It makes the evidence—qualitative and quantitative—all the more compelling. As she says, “I was Robert Park’s ‘marginal (wo)man”, belonging, yet not quite belonging, understanding yet not quite understanding…Far from an impersonal and purely academic account, then, this book is a study about the young women whose dangerous transitions I might have had to traverse except for the strange turns my life has taken” (p. 27-28). Using a life-course framework to study young people’s transition to adulthood in the context of the HIV epidemic, she mobilized interviews with 185 people (young people, middle-aged adults, and older adults) from the Nyanza province of Kenya; population-based survey data from Kenya; and, ethnographic field work.

Mojola’s central puzzle is: what social forces lead women to be so extremely vulnerable to HIV infection in sub-Saharan Africa, specifically the eastern part of the continent? Research on the issue tends to focus on three broad sets of interrelated causal factors—biophysiological, proximate explanations, and social structural causes. Biophysiological factors include the relationship of female anatomy/physiology and its relationship to HIV transmission potential. Proximate explanations tend to focus on the age at first sex, the number of sexual partners, condom use, the structure of sexual networks, and migration patterns. Mojola identifies one key social-structural cause, which is the central analytic lens of the book: consumption. She explores the how socially produced consumption desires shape behavior and consequent risk for contracting HIV; how consumption operates within networks and institutions (such as schools and labor markets) to shape HIV risk; and, how the structuring dynamics of consumption patterns are similar across high-prevalence settings across Africa.

Mojola begins her substantive argument by tracing the phenomenology of “modernity” as experienced by young women, transitioning to adulthood, in sub-Saharan Africa. Globalized notions of taste, marketing and media enable brands and consumption patters to be extended to even places “remote” from the metropole/former colonial centers. In places marked by significant poverty, “consumption is available used and at a deep discount—through secondhand North Face clothing that has made its way from Western charities, for example, or through cheap pay-as-you-go Nokia mobile phones” (p. 34). This modern (post-modern?) form of consumption has a markedly gendered dimension: “the dominant signifier of modernity for young women is the purchase, consumption, and display of modern goods. Indeed, there is a sense in reading these accounts that transactional relationships as a means for enhanced consumption are an indelible part of the landscape of young African women’s relationships” (p. 36). As has most notably been discussed by Viviana Zelizer and others, money, transactions, gifts, sex, and intimacy are often interwoven within relationships. Women and men engage in “relational work” to maintain culturally appropriate and sanctioned matches between money, media, and morals within intimate relationships. This is no less true in the relationship forms of young African women, and these structures have significant implications for the observed disparities in HIV rates. “In Kisumu, Nyanza, for example, three-quarters of men surveyed reported giving an average of 10% of their monthly income to their nonmarital, noncommercial sexual partners… transaction in intimate relationships was the norm rather than the exception in this setting” (p. 37).

As has been demonstrated in research on “sugar daddies” and other forms of explicit and non-explicit forms of transactional intimate relationships (in the U.S. and elsewhere), “when access to money and resources is structurally constrained, transactional sex emerges as a way of ‘redistribution and reciprocity in an unequal and uncertain world,’ where men’s dominant access to wealth and resources ‘compels them’ to have concurrent sexual partnerships involving transactional sex” (p. 42). Market demands for consumption are therefore intimately tied to the gendered risk of contracting the all consuming illness of HIV/AIDS (“Ayaki [Luo word for AIDS] came from the root word yako, which means to consume very fast, in such a way that displays greed” (p. 51)). An interesting aside is the parallelism in the discussion of consumption in HIV and the history of tuberculosis as a consumptive disease. The entanglement of aesthetic, ethical, cultural, and market demands for consumption are structuring for the experience of infectious disease transmission risk. The pursuit fo the raha—the good life of enjoyment and consumption—shaped the HIV epidemic which was “not just consuming anyone; it was consuming young women” (p. 59).

Mojola describes the “great transformation” of colonial/post-colonial settings in a Polanyian way: relationships, particularly intimate ones, are embedded within a complex, historically rooted matrix of moral, ethical, and social meanings and commitments. “It was not money that alienated or ‘ushered in moral confusion’ or that created alienated social exchange. Rather… ‘it is important to understand the cultural matrix into which it is incorporated” (p. 75). Money and the consumptive market economic logic imbricated with existing historical norms of kinship, marriage, relationship, and sexual norms. Mojola indicates two primary forms of transactional relationships that have emerged: relationships for education and relationships for sex. The former, however, often evolved into the later. “For many young men, the only fair exchange or reward for the gift of money was having sex in return. Boy did not necessarily need to be wealthy, but needed to have the ability to get or earn money to help their girlfriends” (p. 83). In Zelizerian terms, gifts of cash and consumptive products (beauty and other types) [the media] were matched with evolving transactional relationships which were not poisoned, or “tainted” by such cash and “economic” transactions, but were actually imbued with additional meaning and moral significance as a result. “Both sex and money expressed love. In other words, love = sex + provision” (p. 87).

These dispositions were actively cultivated in young women, as explored by Mojola, in two primary institutions: the school and the labor market. Puzzlingly, women with more education are observed to have higher rates of risk for contracting HIV. “The thinking goes, if education has such dramatic effects on one sexually transmitted condition—fertility—why not on HIV/AIDS?” (p. 114). Her explanation hinges on the ways that structural processes and norms, refracted through gendered practices, shaped the notion of a “modern schoolgirl” as “Consuming young women [that] had desires that could only be satisfied by consumption, desires that were considered necessities and integral to schoolgirls’ transformation” (p. 132). This culturally disciplining nature of the demand for becoming a modern, consuming, young woman combined with the norms of engaging in transactional relationships with working-class men to get money to pay for those needs, is Mojola’s main explanation for the linkage between increased education and increased HIV risk.

Finally, the gendered nature of the economy and the structure of the labor market was another way that the embedded forms of economic and meaning making became entangled in and produced the risks of contracting HIV. As she states, “In particular, the predominantly one-way transfer of money and gifts—from men to women—in transactional relationships reflect the fact that in most settings, men have relatively greater access to money and resources due to the gendered structure of local economies” (p. 151). This gender-structured labor market exacerbated the sociocultural/economic structures that produced unequal HIV transmission risk. The structural disconnect between the cultivation of young, modern, consumptive young women in the emerging mass education system and the exclusion of women from the labor market and formal income-generating mechanisms that would be necessary to finance this consumptive demand, produced the need for transactional sexual relationships with men. “They had to be continual consumers and thus continual transactors” (p. 169).

Mojola ends this book with a call to action: “The large number of young women currently beginning their sexual lives in high HIV-prevalence environments suggest that policy actions (or nonactions) undertaken in the next five to ten years may very well determine the course of the HIV pandemic in Africa” (p. 183). She calls for continued individual-level interventions such education and awareness raising, but also claims that this will be insufficient. As is the topic of this book, change will only occur with changes in the socio-structural determinants of HIV transmission: changing the school environment, cracking down on sexual relationships between teachers and students, legislating and making paying jobs more available to young women. Most promising is her brief summary of the potential of conditional (and unconditional) cash transfers to schoolgirls for HIV prevention. By reducing the structural/economic pull that young women feel in their pursuit of accomplishing the role of being successful young, consuming, modern women, perhaps the trajectory of the HIV pandemic can be altered.

Some key questions that come up for me:

  • Mojola seems to base her theoretical contribution building off of a combination of Zelizer and Granovetter: networks and institutions structurally shape the networks of relationships (the circuits) through which HIV is transmitted, but also reinforce the cultural feel, aesthetic view, and moral meanings associated with these transactions, interactions, and at times loving/intimate relationships. While this does seem like a powerful case example of embeddedness and relational work in an understudied setting/population—with important policy implications—what does it add to sociological theory?
  • While she clearly engaged with young women who were in difficult straights, her respondents / sample does seem to be relatively well off, urban, school-bound women. She explicitly says on several occasions that these were not transactional relationships of necessity (in order to eat, have shelter), but rather the needs expressed by the young women were structured by the demand to consume along the lines dictated by the cultural pursuit of modernity. I wonder if this presents a limitation or simply a purposeful focus for the structure of her research design?
  • A question that rises for me after having read this study is how the formal healthcare system shapes / impacts these cultural norms any of these socio-cultural structural determinants? If the school system (which arguably has a much more powerful shaping function) shapes and transmits norms, how could the healthcare system be present in schools, or more available in contexts where their prevention activities could be improved?
  • How does this research intersect with James Ferguson’s (and others) work on cash transfers? Would love to talk about this in the context of “Give a Man a Fish.”