43 D Chapter 2 Spiritual Insecurity and AIDS in South Africa Adam Ashforth Introduction The biological assault upon African populations afflicted by the HIV epidemic, coupled with the attendant medical and educational re- sponses, marks a moment of dramatic social and cultural change in South Africa. The demographic impact of the current levels of infection will be profound. One-fifth of the South African adult pop- ulation will soon be dead. Even with treatment, AIDS patients on antiretrovirals are only expected to live an additional four years. Life expectancy at birth is plummeting; infant mortality is rising. The epidemic is fracturing households and communities, placing ever- increasing strain on support networks. The ways in which people make sense of this suffering and find meaning in the misfortunes afflicting them will not only affect the ways in which people cope, or fail to cope, with illness and death, but will also impact upon the rates at which future generations be- come infected. Any effort to alter the course of the epidemic that fails to understand its cultural dynamics, particularly at this moment in the history of the epidemic when treatment is emerging as a pos- sibility for those afflicted in poor countries, will either fail or have unintended consequences that may make matters even worse. In my book Witchcraft, Violence, and Democracy in South Africa (Chicago 2005), I anatomise the sources of spiritual insecurity in everyday life – the sense of danger, doubt and fear arising from an awareness of exposure to invisible forces acting to cause misfortune – originating in four sets of power relations: amongst persons in social