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To drink or not to drink? Identity dilemmas

of men living with HIV

Sakhumzi Mfecane

abstractFor centuries the consumption of alcohol in African societies has been reserved mainly for men. Alcohol use

symbolised status, cultural identity, masculine virility and other virtues of manhood. Recently, these ideas have

been promoted by media advertisements of alcohol as a way to achieve sociability and status, and as part of

African tradition and heritage. During my 14-month ethnographic fieldwork with men living with HIV, I realised

that some of them still drank or aspired to drink despite being ill; but the majority had stopped drinking. This

Article explores the ways that an HIV diagnosis reshapes perceptions of masculinity among men, and therefore

also consumption patterns linked to performances of masculinity. My findings indicate that the diagnosis with

HIV significantly changed the ways men construct their masculinity; but some found it particularly difficult to

stop alcohol consumption. This raises challenges for interventions aimed at curbing alcohol use among the ill:

entrenched notions of excessive alcohol consumption being a feature of ‘African tradition’ and media portrayals

of drinking as a mark of ‘real’ manhood can often undermine effective interventions.

keywordsAlcohol consumption, African tradition, gender performance and masculinity, sociability, HIV and ARVs

Introduction

Globally, men consume greater amounts ofalcohol compared to women, and they alsosuffer more from the harmful effects ofdrinking, like poor health, injuries, disabil-ities, and deaths (WHO, 2011). For centuriesAfrican societies have treated alcoholmainly as a drink for men, in particularadult males (Akeampong, 1996; La Hausse,1988; Hunter, 1936). Although women con-sumed alcohol, they did so under differentconditions from men (see Suggs, 1996), andthey have often been condemned for theirdrinking behaviour (West, 1997; Pattman,2001). Research has shown that alcoholconsumption among African men has nu-merous meanings, including masculinevirility (La Hausse, 1988; Carlson, 1990);

sociability (Karp, 1980; Mager, 2010);nationhood (Nugent, 2010); status; and cul-tural identity (Mc Allister, 2006). Drinkingthen, is not a simple matter of materialconsumption; it is an important arena formen to perform the culturally acclaimedmarkers of masculinity.

To explore drinking and its associationwith masculinity, I focus on experiences ofHIV positive men who drank alcohol beforethey tested for HIV and enrolled for treat-ment with antiretroviral (ARV) drugs. Aspart of the requirement to adhere to ARVtherapy, HIV patients were instructed toabstain from alcohol. This requirement isnot limited to my research site. Manystudies have shown that HIV positive pa-tients are normally pressured to alter their

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lifestyles as a way to enforce adherence totreatment (Nguyen, 2005; Cataldo, 2007;Biehl, 2007; Robins, 2005). Other behaviouralchanges expected from HIV positive peopleinclude abstinence from smoking, safe sex,exercising, and diet (Colvin & Robins, 2010).Although most men in my research claimedto have modified their lives in conformitywith demands of treatment, a minorityfound alcohol particularly difficult to aban-don, and they either continued imbibing, orsought to continue drinking once they re-covered from an AIDS illness. To contextua-lise their dilemma and show how drinking islinked to masculinity, I start by sharing myown experience of socialising with men inthe study site.

For six months of my 14-month field-work, I lived in a village near Hazyview inthe rural Bushbuckridge municipality, Mpu-malanga province, South Africa. I shared ahouse with the Dlamini family composed ofMr Dlamini, his wife and two children. MrDlamini was wealthy by local standards. Hewas a shareholder in a company based inMalelane, near the Mozambique border. Heowned six cars, including two new BMWsedans, a van, a Citi Golf (Volkswagen)hatch compact vehicle and two trucks. TheDlaminis lived in Malelane on week daysand returned to Bushbuckridge on week-ends. Every weekend when Mr Dlamini washome his house was occupied by mencoming to visit him. He bought copiousamounts of alcohol to share with his visi-tors. At least two bottles of expensivewhisky were consumed at his home everyFriday, together with several beers that heordered from local shebeens (an informaldrinking place usually unlicensed).

The following day, Mr Dlamini would goto Mkhuhlu Shopping Mall, near Hazyview,to purchase more alcohol. He would thentake us to a soccer game to watch his teamplay. We would sit near to his car and watchsoccer while drinking alcohol. At the end ofthe game we would go back to Mr Dlamini‘shouse to receive a meal of pap (mielie meal)and meat from his wife. Later, Mr Dlamini’sfriends would go their different ways, eitherto drink more alcohol or to be withtheir families. Sunday would come andMr Dlamini would travel back to Malelane,leaving me in the company of his twofriends, Lolo and Sandile. Had I abstained

from alcohol during fieldwork, I would havestruggled to befriend these men. Lolo didnot appreciate the company of teetotalers,because, in his judgment, they were not‘real’ men.

One of the men that Lolo regularlyundermined for not drinking was Zizi, myfriend. Zizi had drunk alcohol before, butsaid he stopped because ‘‘it was causingtoo much trouble in my marriage’’. He thenjoined church in pursuit of an alternativelifestyle. One Thursday afternoon Zizi vis-ited me and we sat on the verandah to chat.Later I escorted him to his house. Wepassed Lolo‘s house and saw him sittingoutside. We greeted him and he simplynodded and then looked away. On my wayback I stopped at Lolo’s place to chat withhim. He confronted me with this question:‘‘Now Sakhumzi, what are you doing withpeople like these?’’ I explained that Zizi washelping me with my research and that hewas my friend. I then probed, ‘‘what’swrong with Zizi? Is there something I shouldknow?’’ Lolo replied ‘‘No, it’s just thatpeople like Zizi are not my type of friends.I mean he doesn’t drink; what am I going totalk with him about? That man talks Bible allthe time. Bible, Bible, Bible!’’ (Fieldnotes,February 2006 � April 2007).

although most men in my researchclaimed to have modified their lives inconformity with demands of treatment,a minority found alcohol particularlydifficult to abandon

Lolo implies that Zizi is not a ‘real man’because, unlike him, he abstains from alco-hol. ‘Real men’, then, drink alcohol and theydo so in groups. This way of constructingmasculinity concurs with Mfecane et al.(2005) and Karp (1980). In Mfecane et al.(2005), men who socialised through drink-ing were popularly referred to as Auty.1 Theterm denotes a man who is streetwise,‘smart’ and sociable. Its opposite is ibhari,referring to an aloof man who leads a‘disciplined’ lifestyle and is generally ‘rural’in his manner of being. Drinking men alsorefer to him as Mfundisi (Priest) if heabstains from alcohol. In his researchamong the Iteso ethnic group in Kenya,Karp (1980) shows that an Iteso malewho is unfriendly and aloof (for example

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refusing to share a drink or meal withneighbours) is negatively labelled as epog;a friendly and sociable person is positivelylabelled as epaporone (meaning ‘social’).The latter is revered by the society whilethe former is stigmatised and may belabelled a witch. The main gripe against aman regarded as epog is his ‘‘refusal to bedrawn into networks of interaction, ex-pressed in the refusal to accept profferedgenerosity’’. In short, the label epog ‘‘standsfor the refusal to be sociable’’ (Karp,1980:90). This brings me to a specific setof questions, namely: How do HIV positivemen who drank alcohol before they got ill,deal with demands to drink in order to beregarded as ‘sociable’? How does theirrefusal to be ‘sociable’ affect their socialstatus as men? How do they negotiate thesesocietal demands to drink, from messagesto transform their lives as ill men? Beforeexploring these questions it is necessary tostart with a brief background on the chan-ging meanings of alcohol consumption inSouth Africa. This discussion reveals thatdrinking among Africans2 is an age-oldpractice. The experiences of colonialism,migrant work, and recent media advertisinghave reshaped the meanings attached to itin very dramatic ways.

How do HIV positive men who drank alcoholbefore they got ill, deal with demands to

drink in order to be regarded as‘sociable’?

Changing meanings of alcoholconsumption

For many years before the colonial encoun-ter, African communities had been brewingbeer from variety of foodstuffs and fruits.The beer was characteristically low in alco-hol content and also nutritious (Crush &Ambler, 1992). It was consumed mainly as abeverage used to socialise; to relax afterwork; as ‘food’; and to perform rituals (McAllister, 2006; La Hausse, 1988). Researchshows that alcohol consumption in Africancommunities was a highly regulated affair(Crush & Ambler, 1992). The regulationswere in terms of gender, status and senior-ity of drinkers. For example, in research byHunter (1936) senior males men appear to

have had access to copious amounts ofalcohol compared to women and youngermen. Although women brewed beer theyreceived small shares of alcohol in tradi-tional drinking rituals (ibid). These patternsof drinking have been changing graduallyover the years due to changes in the meansof production and outside influences, likecolonialism (Mc Allister, 1987; Crush &Ambler, 1992).

A recent ethnographic study detailingthese changes was conducted by Mc Allister(2006) among the Xhosa ethnic group. Theresearch portrays beer drinking as having aspecial significance for the studied commu-nity. They brewed beer for various reasons,like performing cultural rituals, buildingcommunal solidarity, resisting colonial in-fluences, and others. However, the patternsof drinking have been changing over theyears due to changes in diet, the influenceof Christianity, migrant work, and the typesof alcohol being consumed. The researchshows that culture has been renegotiatedand transformed through changes in accessto alcohol, and the types of liquor beingconsumed. European liquor has also gainedprominence as an essential cultural com-modity in rituals. Alcohol, then, is not just amaterial artifact consumed freely by indivi-duals to meet their internal needs. The wayspeople drink, the type and amount of alco-hol they consume, where, and how theydrink, are shaped and controlled by culturalrules governing their drinking and theirvarious ranking in the social structure (McAllister, 2006).

The advent of migrant work also chan-ged drinking patterns and meanings as-signed to alcohol by Africans. It gaveAfrican men unrestricted access to Europenliquor with high alcohol content comparedto traditional African beer (Crush & Ambler,1992). Migrant work required men to leavetheir rural base for several months and stayin urban settings in order to earn a living byworking in mines and farms. Europeanliquor became a tool for them to socialise,relax and curb boredom (Baker, 1992; LaHausse, 1988; Suggs, 1996). They dranklarge amounts of strong liquor in groups,but did so under different conditions fromthose in rural areas, as described above.

The consequences of these changeshave been fatal for certain men, who be-came alcoholics and died from drinking

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poisonous liquor produced cheaply andsold to mine workers (La Hausse, 1988).Their alcoholism was further exacerbatedby systems introduced in wine farms andmines to ‘reward’ and attract workers bygiving them daily rations of cheap wine (LaHausse, 1988; Scully, 1992). Later, the colo-nial authorities banned the sale of Europeanliquor to Africans (except a few educatedelite), as well as the brewing and sale oftraditional beer in urban settings (Mager,2005). They also restricted beer consump-tion by Africans to alcohol brewed bygovernment municipalities and sold in com-munity beer halls (Mager, 2005). Instead ofcurbing alcoholism, these measures actu-ally exacerbated it. They led to illicit sale ofEuropean liquor in township shebeens, aswell as sale of harmful liquor brewedillegally by shebeen owners and sold tomen (and women), who were craving a‘kick’ (Kuzwayo, 1996).

Since the unbanning of liquor laws onthe segregated sale of alcohol, other actorshave played critical roles in shaping drink-ing behaviour among African commu-nities. Mager (2010) and Nugent (2010)both emphasise the role played by multi-national brewers of alcohol, like SouthAfrican Breweries (SAB), in defining themeanings of drinking and also shaping thechoices of drinks among various racialgroups. SAB portrayed beer drinking ashaving the capacity to facilitate sociabilityand bonding among men (Mager, 2005).They did so through media adverts of theirbrands, which were designed to commu-nicate specific messages about the qualityof a brand and what is meant to be itsconsumer. Different beer brands thenstood for different qualities of manhoodand status (Nugent, 2010); but overall beerdrinking is portrayed as a social ratherthan solitary activity, to enhance its appealto men.

Another trend has been to market spe-cific brands of beer as part of Africantradition and heritage, to attract Africanmale consumers (Mager, 2010). This is notlimited to SAB or beer advertising, as therecent radio advert of Commando Brandycommissioned by Distell, a prominentbrewer and marketer of wines, spirits andciders, shows. It begins by having a highlyrevered Xhosa cultural figure knownas Imbongi (Praise-singer) singing praises

for a consumer of Commando Brandyand referring to him as ‘the Greatness’(Ngangalala) and ‘Man among men’(uyiNdod‘emadodeni!). It ends with thefollowing tagline by a man with a deepmasculine voice: ‘I Commando Brandy,Iimpawu zeNdoda yoQobo! (‘CommandoBrandy, the Mark of a Real Man!’) (Airedon SABC Radio, Umhlobo Wenene). Afri-cans, then, have been subjected to variousinfluences by pre-colonial patterns, con-structs of African traditions, colonialism,and media marketing, all of which havecontrolled and shaped their drinking beha-viour in very specific ways.

overall beer drinking is portrayed as asocial rather than solitary activity,to enhance its appeal to men

The pressures experienced by HIV posi-tive men to drink are partly a historicalproduct of these influences. However, theyare also shaped by popular cultures andcontemporary understandings of masculi-nity. The rest of this Article looks at howmen responded differently to messagesfrom the HIV clinic to abstain from alcoholafter testing HIV positive. My findings in-dicate that men who stopped drinking alsotransformed some aspects of their mascu-line identity in conformity with messagesabout adherence to treatment; a few menwho continued drinking also resisted mes-sages to change.

Findings

From February 2006 until May 2007, I inter-acted regularly with 25 men aged between25 and 50 years, who shared their lifestories with me. Furthermore I gained richand detailed data on living with HIV byattending gender-mixed support groups ofpeople living with HIV (PLHIV) at the HIVclinic for 14 months. The support groups area platform for HIV positive patients to givetestimonies about their experiences ofusing ARVs and how treatment has chan-ged their lives (Robins, 2005). My observa-tions were that these testimonies werepredominantly biased towards painting apositive picture of ARVs and supportgroups. In this context, drinking remaineda taboo topic, even for men whowere struggling to abandon alcohol. The

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narratives I go on to recount, therefore, areof private and personal experiences sharedwith me as a trusted researcher and con-fidant. But I would be naı̈ve to claim that allstories shared with me were genuine repre-sentations of experiences with treatment.For example, one of my participants whoclaimed to have stopped drinking was ac-cused of drinking by his wife in one supportgroup that I attended in his absence. But Iremain confident that most narratives arefairly representative of experiences of men,although I am aware of the limits of quali-tative research narratives on health (West,1990).3

Alcohol, ARV and support groups

Most of my participants said they were‘heavy’ drinkers before doing an HIV test.They drank in groups of men in shebeensand bars and used drinking as a strategy topursue women. Sam, a 34 year-old man,reflects on his life before he fell ill:

‘‘Next to where I used to stay there is ashebeen called Kwa Zita. I used to staythere the whole night. And there werelots of women. We drank the whole nightand when you go home you go with awoman’’ (Interview, August 27 2006).

Mathe, a 43 year-old participant, madesimilar remarks. He also added that drinkingearned him respect from his peers:

‘‘The thing is when you enter a shebeenyou want to show who you are, and ifyou have money you fill the table andeverybody starts to look at you. I drank alot and I would go to a shebeen alone,but I would never go back alone [laugh-ter]. I’m telling you Sakhumzi, I wouldnever go back alone!’’ (Interview, Febru-ary 9 2007).

A few men claimed that they drank mainlyin solitude to ‘relax’ rather than to show offand chase women. Zola, a 31 year-old man,was one of those men:

‘‘Most of the time I drank alone; if I drinkwith someone it was one guy that usedto stay somewhere there (pointing). But Idid drink five or six bottles. The thing is ifI drank too much I got dizzy, you findthat my eyes are closed and I can’t see

anything [laughing]’’ (Interview, June 262006).

Magwa, a 50 year-old former mine worker,also drank in relative isolation with his closefriends. He said he was opposed to thebinge drinking that most of the minerstended to do:

‘‘But it’s not that I aimlessly searched foralcohol. I just bought my own alcohol,and we are maybe just two, or I amalone. Because I never really liked thenoise! No, I never liked that. . .I would justwatch them, I was not raised up like that.I was raised up to take good care ofmyself’’ (Interview, October 4 2006).

These narratives reveal the appeal of alco-hol in the lives of men, including those whoclaimed to have been mild or lone drinkers.Only two men in my research abstainedfrom alcohol before testing HIV positive.When participants fell ill, they delayed tak-ing HIV tests until they were very ill. Inter-estingly some of them continued drinkingdespite being ill, as Thabo, a 38 year-oldparticipant, illustrates:

‘‘The thing is I used to drink too muchalcohol! . . . But then I started having aproblem of not having appetite for alco-hol. I would buy a beer, open it, drink it,but it didn’t settle well in my body. So,this day I was just walking to the toilet,but then I collapsed. They tried to lift meup and they asked ‘Hey, what’s goingon?’ I said ‘I was just trying to go to thetoilet; I also don’t know what’s going on’.Then I started vomiting, and I also haddiarrhea. And from there I went to thedoctor’’ (Interview, October 4 2006).

Once participants tested HIV positive, theyattended compulsory support groups at theHIV clinic to receive education about theircondition. Support groups did more thanmerely impart information about HIV andAIDS to the new clients. They also providedguidance on what kinds of lifestyles theclients should adopt or discard as ill people.Support groups keenly championed thediscourse of ‘empowerment’ and ‘change’as necessary preconditions to live produc-tive lives with HIV (Robins, 2005). Clientswere ‘empowered’ with ‘scientific’ knowl-edge about their condition to help them

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deal with conflicting messages from thesociety to live ‘risky’ lifestyles, like drinking,using traditional medicines, and others.They were constantly reminded that beingHIV positive meant that they should changetheir approach to life and be ‘disciplined’(Robins, 2005). Abstinence from alcoholbecame a mark of such ‘change’ and ‘dis-cipline’, particularly for men.

The latter were encouraged to ‘resist’pressures to drink. Furthermore, drinkingwas labeled a risk factor for HIV clients, as itseemingly interferes with adherence toARVs and is generally harmful to health.Support groups therefore appeared as guar-dians of the ‘new lives’ (Robins, 2005) thatHIV positive clients were expected to live.This ‘new life’ is often referred to as ‘ther-apeutic citizenship’ in academic literature(Nguyen, 2005; Colvin & Robins, 2010).

In a previous study (Mfecane, 2011), Ishowed that other male HIV patients re-sisted wholeheartedly embracing the iden-tity of therapeutic citizenship as they foundthat it constrained their masculine perfor-mance. The continued use or non-use ofalcohol by men, which I discuss below,reflects the participants’ diverse responsesto these support group messages to trans-form their lives. They also reveal how menredefined their masculinity after the HIVdiagnosis.

Alcohol and masculinity

Most participants stopped alcohol aftertesting HIV positive and attending supportgroups; four confirmed that they still drank,and two expressed a need to return todrinking once they recovered from beingill (they were taking TB treatment). Menwho abstained from alcohol also embracedsupport group messages to ‘change’; menwho continued drinking were somewhatresistant to these messages. Let me elabo-rate on both perspectives, starting with menwho stopped drinking.

Sipho, a 33 year-old participant, used todrink in shebeens with his friends. He alsohad multiple sexual partners who drankwith him in shebeens. He was marriedwith two children, but hardly spent hisspare time with them. Sipho decided toquit alcohol after testing HIV positive, and

also to avoid his friends: ‘‘I don’t socia-lise with them any longer; I‘m alwayswith my wife. Someone calls and says‘come let’s have a drink’ and I say ‘no Idon’t drink. I don’t want’. Where I nowstay I don’t have friends. I don’t wantfriends because I can see that abanganibakufaka ngentloko (friends are mislead-ing) (Interview, June 26 2006).

Abstinence from alcohol became a markof such ‘change’ and ‘discipline’,particularly for men.

Most men who stopped drinking becameanti-social; but others formed new friend-ships with men that they met in church.They described their drinking peers aspressuring them to drink and be in sexualrelationships with women. Koko, a 29 year-old participant who abstained from alcohol,responded to the pressure by being anti-social, as he explains:

‘‘I don’t socialise a lot these days. I’malways indoors and in the evening Iwatch some movies or TV. For exampleI like watching ‘Shift’ (a programme onSABC TV) because they talk about HIV’’(Interview, March 6 2007).

Koko described himself as a ‘changed’ man.He had multiple sexual partners before hebecame ill and most of them were drinkingwomen that he met in shebeens. Sincetesting HIV positive, Koko had one loverwhom he planned to marry in 2007. He alsojoined the Zion Christian Church and be-came part of the youth choir. The HIVdiagnosis therefore changed Koko holisti-cally. His decision to stop drinking formedpart of other changes that he implementedin his life as a man living with HIV.

Jozi, a 34 year-old participant, also drankheavily before he got ill from HIV and hehad multiple sexual partners. But he ab-stained from alcohol after receiving his HIVresults, and has one girlfriend. He alsosevered ties with his drinking peers becausehe felt they were too demanding:

‘‘The problem is they will be asking toomany questions, so I just distance myselffrom them. He will be curious ‘why areyou doing this; why are you doing that

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and not that?’ Now I must explain myselfto him’’ (Interview, November 15 2006).

I asked Jozi how he felt about distancinghimself from his friends and he replied:

‘‘Most of them were just drinking bud-dies. I didn’t have close relationshipswith them. I still talk to them, like if weare walking towards the same direction.One of them asked ‘manje awusaphuzivele’ (do you no longer drink?) I said ‘No,I have asthma; the doctor said I muststop drinking’’’ (Interview, November 152006).

In describing the experiences of men whoabstained from drinking alcohol, I haveargued that abstinence reflects their posi-tive responses to support group messagesto change and be ‘different’ men. Amongmen who continued drinking, the stories oftwo participants, Bob and Vusi, exemplify arejection of these messages to change. Bob,a 31 year-old man, has a long history ofresisting HIV messages. First he refused todo an HIV test while he was sick, until hisfamily pressured him to test and then enrollfor treatment. Later he stopped using ARVssaying they made him ill. He also returnedto drinking as soon as he stopped ARVs. Hehad plans to abandon his HIV positivegirlfriend and commit to a new girlfriendthat he met from a shebeen near his home.These reactions attest to Bob‘s refusal toembrace support group messages to‘change’. He still wanted to live accordingto his previous life-style.

Vusi, a 32 year-old man, also continueddrinking despite using ARVs. Vusi got ill in2004 while working as a security officer inJohannesburg. He returned to Bushbuck-ridge to receive help, and was immediatelytaken to the hospital. He was diagnosed withTB and then later HIV. Vusi abstained fromalcohol while he was on TB treatment, buthe soon returned to drinking after finishinghis TB treatment and starting ARVs. Heinsisted that drinking does not affect hishealth: ‘‘They say we shouldn’t mix drugswith alcohol. I hear them, but I have done itand nothing happened’’. By continuing todrink, Vusi positioned himself as a resister ofsupport group messages to change. Thisresistance is also manifested in other facetsof his life. For example, he rejected supportgroup messages that encouraged men and

women to treat each other as equals. Hebelieved in the inherent superiority of menover women and said women ought to liveby the rules set by men:

‘‘If she doesn’t want to play by your rulesyou just tell her ‘leave my house!’ Sheeither plays by your rules or leaves yourhouse. My wife knows; I tell her all thetime ‘if you don’t like my rules, leave!’’’(Interview, February 8 2007).

Vusi later joined a group of dancers whoperformed a traditional dance calledMchongolo, against support group advicethat ill men must refrain from doing physi-cally demanding tasks (including paid ‘hard’work). Vusi insisted on having good healthdespite doing ‘hard’ work as a dancer:

‘‘Yhaa, I go there and I dance like othermen. I go up and then go down; up anddown, and I feel nothing! (no pain)’’.(Interview, February 8 2007).

Vusi told me he wants to get a job,

‘‘If someone can offer me a job to starttomorrow I will take it. And I need a hardjob! Yhaa, a hard job!’’ (Interview, February8 2007).

Vusi and Bob appear as untransformedmen. They seem determined to underminesupport group efforts to empower HIVpatients with knowledge and skills to resistpressures from the society to drink andengage in other risky behaviour, like exces-sively ‘hard’ work, multiple sexual partners,and others. Both later denied having HIVand this enabled them to pursue their owngoals without worrying about health con-sequences of their actions.

Lastly, there were men who claimed tohave ‘changed’ but who found alcoholparticularly difficult to stop. Sabu, a 29year-old participant, typifies this categoryof men. He has not yet resumed alcohol,but contemplates doing so in the nearfuture. Sabu could not imagine socialisingwith other people without drinking, as heexplains:

‘‘I know I don’t drink and I don’t smoke.But I just want to know: really does thismean that I will never drink again in myentire life, even if maybe they invite mesometimes. I just want to know, like on

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the day I drink, will it still be possible forme to come home late and drink mymedication? Won’t it maybe cause meproblems?’’ (Interview, October 26 2006).

Sabu illustrates the previously discussedlink between drinking and being ‘social’. Ina way, he seems to be worried that com-plete abstinence from alcohol will place himin an ‘antisocial’ category of manhoodcalled ibhari. But he is equally concernedabout his health, particularly the way drink-ing may affect his adherence to ARVs. Thismakes it difficult for him to decide on howto move on with his life as a man: drinkingwill portray him as ‘sociable’, but may alsobe a risk factor to his health. This dilemmarenders the picture of living with HIV as aman far more complex than testimoniesoffered in support groups.

Conclusions

I have described various ways that HIVpositive men responded to messages toabstain from alcohol after enrolling for theARV treatment programme. Alcohol is re-garded as a risk factor for adherence toARVs (Christian et al., 2009; Simbayi et al.,2004). I have shown that alcohol has beenan important cultural commodity in Africansocieties, used by most people to performrituals; strengthen social ties; and recently,with the impact of media advertising andlarge-scale marketing and sale of differenttypes of liquor, to achieve a revered statusof being a ‘real man’ (auty). The lattermeanings assigned to drinking have recastthe teetotalers as antisocial, priestly andsomewhat inferior to drinkers. Most HIVpositive men in my research consumedlarge amounts of alcohol before they gotill, and they viewed it as an importantaspect of their performance of manhood.But the majority abandoned it after testingpositive, and few men continued drinking orsought to drink once they recovered froman AIDS illness. These different responseshave been attributed to the ways menrespond to messages from support groupsto transform their lives and adapt aftertesting and enrolling for treatment. Menwho stopped drinking have embraced thesemessages compared to men who continueddrinking.

The relationship between alcohol andmasculinity is complex and changes regu-larly depending on what type of alcoholmen drink; where they drink; as well astheir changing socio-economic circum-stances (Suggs, 1996). From my discussion,it seems as if many working-class menexperience constant pressures to drink asa way to enhance status and gain accep-tance into social networks of drinking men.They are also subjected to marketing stra-tegies by powerful brewers of alcohol whomarket their products through public mediain ways that enhance their appeal to men.

drinking will portray him as ‘sociable’

The appeal is strengthened by advertisingthese products as markers of ‘African tradi-tion’ and ‘heritage’, thus enticing moreAfrican men to consume them. As consu-mers of certain brands of alcohol then, menare made to imagine themselves as con-suming symbols of being ‘African’, and alsodoing so in an ‘African way’ - like socialdrinking and sharing. The negation of tee-totalers then, emanates not only from theirrejection of alcohol as a material object, butalso from their seeming dismissal of theiridentity as ‘African men’. Indeed, as McAllister (2006) reminds us, teetotalers arealso expected to attend drinking rituals andbrew beer for the community, as a way todemonstrate respect for their tradition.

The trajectories of men who stoppeddrinking are instructive in this respect.Most of them converted to Christianity asan alternative form of identification. Theybelieved that church members would notpressure them to drink alcohol or performcultural rituals involving drinking. In short,the church would be a supportive environ-ment for men to ‘change’. But otherchurches openly supported the brewing oftraditional beer by their members, includinga church attended by Sipho, one the partici-pants cited above. I visited him one Saturdayafternoon (19 August, 2006) and discoveredthat he brewed traditional beer for his churchmembers, who were scheduled to hold aprayer at his house on that evening. Somechurches then, seem to offer an alternativeversion of being an ‘African man’, thoughtheir practices remained marginal to thedominant societal discourse.

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My research has raised the significanceof interventions for HIV positive men thatare sensitive to the complex roles played byalcohol consumption in their gender perfor-mances and acquisition of a positive senseof self. To curb the excessive use andappeal of alcohol among men it may bevaluable for interventions to publicise alter-native versions of masculinity that activelyrepudiate current hegemonic views portray-ing excessive drinking as a sign on ‘realmanhood’

This strategy has been initiated in theongoing campaigns by Soul City Institute(nd) and ‘Brothers for Life’ (nd) whicheducate men about responsible ways ofdrinking.

Even more effective responses wouldneed to tackle the current media advertise-ments of alcohol which glamourise theheavy drinking of beer and spirits as a truemark of African masculinity. It is thereforenoteworthy that plans for new laws seem tobe acutely alert to the social effects of liquoradvertising, especially in relation to destruc-tive performances of masculinity and theimpact on health (Sowetan, 17 December,2010). Plans for the new laws make it clearthat alcohol consumption, despite its trou-bling connection to risk-taking masculinityand disease, continues to be a widelymarketed, consumed and advertised com-modity. The impact of this, however, hasnot remained unchallenged.

Acknowledgements

Thanks to Deborah Posel and Steven Robins for

organising seminars for me to present the firstdrafts of this paper at University of Cape Town

and Stellenbosch University respectively, and tothe audience for their constructive comments.

Notes1. Also spelled as ‘Outie’ (Modisane, 2011).2. Referring to black South Africans.3. Because of the sensitive nature of information

shared by participants I used pseudonyms tosafeguard their confidentiality. I also ensuredthem of the confidentiality of information thatthey shared with me and that I would be usingpseudonyms to report on the findings of ourinterviews. This assurance might have enabledthem to be more open about their experienceswhen talking to me compared to the time thatthey were in support groups. The research

gained ethical approval from Wits University

ethics board.

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