SYNDEMIC SUFFERING IN SOWETO: VIOLENCE AND INEQUALITY AT THE NEXUS OF HEALTH TRANSITION IN SOUTH AFRICA

This article examines the roles of structural and interpersonal violence in individual experiences of health transition in South Africa, focusing on women's narratives of distress and diabetes as well as epidemiology. Over the past decade marked increases in noncommunicable diseases, including type 2 diabetes, have transitioned in South Africa to afflict those who concurrently face great mental health burdens and the world's largest HIV and AIDS and tuberculosis epidemics. First, this article considers how social and health problems cluster among impoverished populations through a discussion of syndemics theory. Drawing from the VIDDA Syndemic employed to describe the experience of Mexican immigrant women living with diabetes and depression in urban United States, this analysis demonstrates how violence plays a unique role as a perpetuator of suffering through structural, social, psychological, and even biological pathways. Second, data around stress and structural violence, gun violence, and gender-based violence that emerged from a small study of urban South African women with type 2 diabetes are presented to discuss how violence functions as a cofactor of the syndemic of diabetes and depression in this context. This analysis emphasizes the role of historical and social contexts in how conditions such as depression and diabetes are distributed epidemiologically and experienced individually. Finally, this article argues that the utility of understanding the role of violence in health transition may be a fundamental source of intervention to mitigate the effects of the double burden of diseases on socially and economically marginalized populations in middle-income countries such as South Africa.