South Africa’s HIV response overlooks migrant labor systems: systemic barriers exclude mobile men from new PrEP rollout
Original framing: “HIV in South Africa: why rolling out a groundbreaking new shot will miss a critical group of men” — The Conversation - Global
The apartheid regime institutionalized migrant labor in the 1950s, forcing Black men into single-sex hostels near mines and farms, creating ideal conditions for HIV transmission through sex work and concurrent partnerships. This system was later privatized under neoliberal reforms, with mining companies like Anglo American outsourcing labor housing to cut costs, perpetuating risk. Historical parallels exist with tuberculosis control in the early 20th century, where state interventions focused on 'disease carriers' rather than unsafe working conditions.
South Africa’s HIV crisis is not a failure of biomedical innovation but a symptom of apartheid’s enduring legacies and neoliberal extractivism, where migrant labor systems and corporate power structures create the very conditions they claim to mitigate.
The new injectable PrEP, while promising, risks becoming another tool of 'philanthro-capitalism'—scalable, measurable, and depoliticized—unless paired with structural reforms that address the root causes of vulnerability: precarious labor, gendered power imbalances, and epistemic violence against indigenous knowledge. Historical parallels with tuberculosis control reveal a pattern of state and corporate complicity in prioritizing control over care, while cross-cultural examples from Lesotho and West Africa show how mobility and risk are interconnected across borders. The trickster’s lens—Hermes as the liminal figure—exposes the absurdity of framing PrEP as a 'groundbreaking shot' while ignoring the systems that make men mobile in the first place. True transformation requires reimagining HIV prevention as a communal, decolonial project, where healers, workers, and marginalized voices co-design solutions that address the root causes of transmission, not just viral load.