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 GLOBAL
RESEARCH
IN
GENDER,
SEXUALITY
AND
HEALTH

GENDER
AND
HIV
IN SOUTH
AFRICA
Advancing women’s
health & capabilities

COURTENAY SPRAGUE
Global Research in Gender, Sexuality and Health

Series Editors
Ellen Annandale
Department of Sociology
University of York
York, UK

Xiaodong Lin
Department of Sociology
University of York
York, UK
Global Research in Gender, Sexuality and Health brings together original,
forward-looking research on gender, sexuality and health at a time of far-
reaching and complex global transformations in each of these areas. The
associations between these realms are being reconfigured by global social
change in different ways and with different consequences for the experi-
ence of illness and delivery of healthcare in local and national contexts.
New experiences of health and illness are also being driven by the
increased global mobility of bodies and illnesses and the growing securi-
tization of illness. In turn, these are challenging conventional ways of
thinking about gender, gender, sexualities and the body and call for novel
conceptual approaches that are a better fit for an understanding of health
in a ‘global age’. This interdisciplinary series aims to showcase original
research monographs and edited collections of interest to an international
readership. Studies from the Global South are particularly encouraged, to
help reflect on and revise knowledge of gender, sexuality and health
beyond a Eurocentric perspective.

More information about this series at

http://www.palgrave.com/gp/series/15916
 Courtenay Sprague

Gender and HIV in

South Africa
Advancing Women’s Health
and Capabilities
Courtenay Sprague
University of Massachusetts
Boston, USA
University of the Witwatersrand
Johannesburg, South Africa

Global Research in Gender, Sexuality and Health

ISBN 978-1-137-55996-8    ISBN 978-1-137-55997-5 (eBook)
https://doi.org/10.1057/978-1-137-55997-5

Library of Congress Control Number: 2017964726

© The Editor(s) (if applicable) and The Author(s) 2018

The author(s) has/have asserted their right(s) to be identified as the author(s) of this work in accordance
with the Copyright, Designs and Patents Act 1988.
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and trans-
mission or information storage and retrieval, electronic adaptation, computer software, or by similar or
dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or
the editors give a warranty, express or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.

Cover illustration: © Gideon Mendel

Printed on acid-free paper

This Palgrave Macmillan imprint is published by Springer Nature

The registered company is Macmillan Publishers Ltd.
The registered company address is: The Campus, 4 Crinan Street, London, N1 9XW, United Kingdom
Eyabo bonke abesifazane base Ningizimu Afrika abaphila noma
abasengozini yesandulela-ngculazi.
(For all South African women living with or at risk of HIV)
Samkelisiwe with her son at her mother’s home in KwaZulu-Natal shortly before
her death. Source: Mendel 2001, image 10/35. Reprinted with permission

vii
 Preface

The three photographs that appear in this work, including the arresting
cover photo, are by the acclaimed South African-born photographer,
Gideon Mendel. Gideon’s photographs are distinctive, not only for their
raw emotion and haunting beauty, but for their ability to portray the
lived experience of families at key moments during the unfolding AIDS
epidemic in sub-Saharan Africa. Gideon was one of the first photogra-
phers to cross the threshold into African homes and communities, and
with their permission, to train his lens on individuals and families at the
HIV epidemic’s epicentre: calling attention to ‘health as social justice’ in
the African Continent. In doing so, he was building on the practice of
‘documentary genre’ used by Peter Magubane and others (post-1976
Soweto uprising and earlier) to capture the bald brutality and cold-­
blooded injustice of the Nationalist government’s apartheid regime (see
Badsha, 1986).
Gideon’s images powerfully render, not just the faces of people affected
by HIV, but their stories. Each photograph has a caption that conveys
what those individuals wanted to share at a time when the African AIDS
(acquired immunodeficiency syndrome) epidemic was being ignored and
the rising death toll uncounted. As Gideon writes in his work, A Broken
Landscape: HIV/AIDS in Africa:

ix
x Preface

I first began documenting HIV/AIDS in sub-Saharan Africa in the early

1990s. At the time, three-quarters of the world’s 36 million people living
with HIV/AIDS were in Africa. It was a slow burning tragedy on a monu-
mental scale; one that was quietly decimating some of the poorest nations
on Earth. (2001, p. 1)

I thank Gideon for his generous permission to reprint these moving

photos. The full collection can be seen here: http://gideonmendel.com/a-
broken-landscape/. As with Gideon’s photo narratives—what people felt,
the anxieties that gripped them—must continue to be located in the fore-
ground as the HIV epidemic evolves.
Today 22.3% of all women in South Africa are living with HIV
(Statistics South Africa [StatsSA], 2016a). Despite a massive HIV treat-
ment programme in the public health system since 2004, South Africa
leads the world in global HIV incidence in young women aged 15–24 years
(UNAIDS, 2016a, 2016b). Moreover, HIV prevalence in South African
pregnant women has stood at a constant 29–30% since 2004, while new
HIV infections in women aged 50 and above are increasingly docu-
mented (see Fig. 1.1) (Government of South Africa, 2015a; Sprague &
Brown, 2016; UNAIDS, 2013). These statistics are powered by quantita-
tive techniques using large samples and they effectively tell a powerful
story of the sustained high HIV prevalence and incidence in South
African women and its pernicious effects on women’s health as part of
long-term trends. It is, however, the narratives and voices of women—the
qualitative, lived experience—that is perhaps most important in inform-
ing how the research and policy community can gain greater purchase on
HIV in women in particular social contexts.
The research presented in these pages adopts a joint public health and
social justice lens to capture the complex dimensions of HIV in South
African women. It investigates the opportunities to be healthy or ‘capa-
bilities’ and agency of black South African women living with HIV. The
central question asked by Amartya Sen’s Capabilities Approach (CA) to
human development (1999) is: what are people able to do and be? (1999).
Martha Nussbaum rightly presses that question, asking, are women ‘really
able to do and to be these things, or are there impediments, evident or
hidden, to their real and substantial freedom?’ (2008, p. 1). In this work,
 Preface
   xi

the impediments to and enablers of women’s health, agency and wellbe-

ing are elicited through in-depth interviews (IDIs) conducted with 89
women living with HIV, and supplemented by interviews with 44 key
informants. Spanning more than a decade, my research on black South
African women living with the virus has primarily been qualitative in
nature to elevate a needed focus on women’s lived and social experiences
of health and illness. It thus complements the large body of quantitative
biomedical and epidemiological research on HIV in women—some of it
analysed here—to inform social science understandings of the effects of
HIV on women. Attention to some of the essential moral and social
aspects of women’s experiences of living with HIV are also captured but
these continue to require further articulation by South African women
and by women affected by HIV in other parts of the world.
Of note, the original findings, particularly when supplemented by the
results from numerous other South African studies, underscore the prin-
cipal role of structural constraints—especially intimate partner vio-
lence—to undermine black South African women’s agency, and their
process and opportunity freedoms. The manner by which these structural
health determinants, notably adverse gender norms, interact with other
influential factors to inhibit women’s HIV care and adherence are docu-
mented here. These add to the growing body of evidence about social
health inequalities, and how women experience systematic health differ-
ences in their daily world. The possibilities for promoting and protecting
women’s health while advancing their capabilities are also emphasised.
The principal need for women to be able to exercise the rights they are
afforded in South African law remains paramount, as do social policies
and inter-­sectoral action. Notably, two gender-transformative interven-
tions (GTIs) undertaken in community-based settings illustrate that
structural-level changes can be achieved (Chap. 7). Indeed, the core thesis
of this work is that HIV in South African women constitutes a social
justice problem, and one that is changeable.
Significantly, the women most at risk of acquiring HIV in South
Africa, and most likely to die from HIV-related causes, are black women.
Despite the process of social transformation that has been unfolding
since the introduction of democracy in 1994, black women’s health and
prospects for human development have been—and continue to be—
xii Preface

poorer than for women of other race groups. The narrative of the South
African woman on the cover, Samkelisiwe Mquanaze (from Kwazulu-­
Natal), is illustrative. In 2017, Samkelisiwe would have been 43 years of
age. She was not able to live to the end of a normal lifespan. In the year
of the photo (2000), treatment was unavailable in South Africa, and
would remain out of reach for another four years. Today, HIV treatment
has successfully extended the lives of many, both in Africa and globally.
Yet, for black South African women, HIV remains a leading cause of
premature deaths. As Samkelisiwe told Gideon: ‘Normally I would be the
one taking care of my mother, but now I am the baby again. She is look-
ing after everyone in the family.’ Samkelisiwe’s words highlight the care-
giving role borne by women, and their vulnerability to HIV, both
characteristic features of many black South African women’s lives. Despite
women’s rights in South African law, grave social and economic chal-
lenges bar many women from achieving good health and exercising their
constitutional rights and freedoms to achieve their notions of the good
life. While treatment remains imperative, it is only a partial answer, given
the structural drivers that foster HIV acquisition among women.

Crossing the Threshold

Gideon notes that, as HIV treatment became available, instead of using
harsh black and white images to depict people living with HIV, he turned
to colour to reflect new life and hope. South Africa remains the global
HIV epicentre, representing 18% of the global population living with
HIV (UNAIDS, 2014b). While declines in HIV incidence and preva-
lence have been recorded for some, women continue to bear a dispropor-
tionate burden of HIV illness (SANAC, 2014). There are 3.9 million
South African women living with HIV, one-fifth of total women of
reproductive age (StatsSA, 2016a, p. 4). We are now at a different point
in the HIV epidemic trajectory. Indeed, the HIV epidemic in women has
reached a new threshold and marks a ‘crucible’ moment for South Africa.
The current response, largely located in the public health system, has
been insufficient to prevent new HIV infections in women. Consequently,
I deliberately chose the stark black and white image of Samkelisiwe for
 Preface
   xiii

the book’s cover to reflect the ongoing, profound dimensions of the HIV
epidemic for African and South African women. A fundamental para-
digm shift and transformational change will be necessary to situate
women and girls more securely on an optimal path of health and human
development. This work suggests some possibilities for engaging with
law, policy, the health system and community-based interventions to
advance women’s health and capabilities, while also attending to health
inequities for black South African women. A changed HIV response that
engages with structural factors facilitating HIV in women, including
adverse gender norms, is possible but can only come from within South
Africa, with the requisite political will and support.
In the last year of her life, Samkelisiwe told Gideon that she was very
sad because she had wanted to participate in AIDS education events but
was too weak to do so. It thus seems appropriate that Samkelisiwe should
invite readers across the threshold and into this work on HIV, gender and
health as social justice in South Africa.

Boston, MA, USA Courtenay Sprague

Permission from the following has generously been granted to reprint
images, excerpts and illustrations.

Diderichsen, F., Evans, T., & Whitehead, M. (2001). Framework for elu-
cidating pathways from social context to social and economic conse-
quences. In the social disparities in health. In T. Evans et al. (Eds.),
Challenging Inequities to Health: From Ethics to Action. Oxford: Oxford
University Press.
Dunkle, K., & Decker, M. (2013). Gender-based violence and HIV:
Reviewing the evidence for links and causal pathways in the general
population and high risk groups. American Journal of Reproductive
Immunology, 69(suppl. 1), 20–26.
Mendel, G. (2001). Photo images. In A Broken Landscape: HIV/AIDS in
Africa. London: Blume.
Pilane, P. (2016, May 20). Sugar daddies, Shame the blessers, not the
blessed. Mail & Guardian (South Africa).
WHO. (2013). Figure 2: Indirect and direct links between violence
against women, HIV risk and uptake of services (Pathways 2 and 3),
In 16 Ideas for Addressing Violence Against Women in the Context of the
HIV Epidemic: A Programming Tool. Geneva: WHO.

xv
 Acknowledgements

I am but one person among a global community of people deeply con-

cerned about the problem of HIV in women, both in South Africa and
elsewhere. It is necessary, then, to engrave into these pages the names of
those involved in supporting this work. The University of the
Witwatersrand (Wits) in Johannesburg has been my institutional home
since 1999 and the University of Massachusetts Boston (UMB) since
2012. I remain grateful to my co-authors for allowing me to draw on our
related published and unpublished research in South African clinical set-
tings. I especially thank Vivian Black (Wits Medical School), Abigail
Hatcher (Wits School of Public Health), Nataly Woollett (Wits Medical
School), Stu Woolman (Wits Law School), Shelley Brown (Boston
University, UMB), Jane Parpart (UMB) and Theresa Sommers (Tufts
University, UMB).
The empirical research undertaken in this work relies on direct in-­
depth engagement with women living with HIV (Chap. 6). I offer a
deep bow of gratitude to the 89 women living with HIV who are at the
centre of this work. Their narratives of struggle, pain, suffering, joy and
resilience have profoundly shaped my understanding of women’s experi-
ences of living with HIV, of gender, health, and ubuntu: Ngiyabonga
ngiyabonga.

xvii
xviii Acknowledgements

A profound thank you to the 44 key informants: South African health

providers who are the backbone of health care delivery and undertake
their work in the face of great obstacles; and to the key academic and
policy experts who shepherd an exacting discourse on HIV, gender and
justice in South Africa.
I remain indebted to the following colleagues and friends for their
engaged involvement, strategic thinking, problem solving and key sup-
port during the conception, evolution and execution of this work:
Caroline Wanjiku Kihato, Charisse Drobis, Melusi Mthembu, Nhlanhla
N. Mathonsi, Laurie Zapalac, Louise Penner, Chris Bobel, Shelley Foster,
Sara Divello, Laura Parrott, Brian Halley, Evelyn Schichner, Krish
Sigamoney, Lisa Vetten, Leah Gilbert, Shireen Hassim, Anne Elton, Ines
Ferreira, Sara Simon, Amy Heiden, Jonathan Klaaren, Kim Sacks, David
Bilchitz and Shaun de Waal.
I thank Cathy Campbell (London School of Economics & Political
Science), Jenevieve Mannell (University College London) and partici-
pants at a London workshop, as part of a special issue on women’s agency
in marginalised settings published in the journal, Global Public Health.
My involvement deepened my thinking, both conceptually and practi-
cally, about South African women’s agency and the institutional agency
of the South African health system.
My thanks to the authors, publishers and editors who generously
granted copyright permission to make use of their figures, models and
diagrams.
Reviewers and editors make authors’ work sharper. I am immensely
grateful to the following colleagues who reviewed earlier sections and
chapters, and whose deft intellectual contributions improved the work:
Ellen Annandale, Vivian Black, Di Cooper, Andy Gibbs, Gillian
MacNaughton, Jeff Pugh, Karen Ross, Nwabisa Shai, Stu Woolman and
four anonymous reviewers commissioned by the Human Sciences
Research Council of South Africa (HSRC) and Palgrave Macmillan. My
heartfelt thanks to Ana Ferreira for both her skilful editing and expert
comments.
Palgrave Macmillan colleagues in London and HSRC colleagues in
Cape Town exhibited the utmost professionalism and good humour. I
 Acknowledgements
   xix

particularly thank Joshua Pitt, Joanna O’Neill, Holly Tyler, and Dominic
Walker. Special thanks to the co-editors of the Global Research in Gender,
Sexuality and Health series, Ellen Annandale and Xiaodong Lin, and the
Advisory Board, and colleagues at the HSRC, especially Mthunzi Nxawe,
for their commitment to this work, and the larger concern of HIV and
health inequities for black South African women.
For their excellence in research support, I thank Bharathi
Radhakrishnan, Kaitlyn Gorman, Micayla Freehan, Lyndsey MacMahon.
I remain grateful to Michael Scanlon, who fastidiously prepared the
index, edited the references, conducted research and reviewed chapters.
Rockefeller Foundation has long-supported the field of health equity.
I was very fortunate to receive a scholarly residence to the Foundation’s
Bellagio Centre (a heavenly place of refuge), which created an invaluable
space for thinking about capabilities for South African women living
with HIV. Grazie mille to the Foundation’s Claudia Juech, Pilar Palaciá
and to fellow residents. For their keen insights, I especially thank Tsitsi
Dangarembga, Suzanne Skevington, Andy Feldman and Anne Marie
Kimball.
A hefty thank you to UMB colleagues, particularly Zong-Guo Xia and
Laura Hayman, for awarding me a Healey Grant to fund some of the
field research. For additional travel funding to South Africa and a semes-
ter release from full-time teaching, I warmly thank Darren Kew, Sammy
Barkin, Eben Weitzman, David Matz, David Cash and Ira Jackson. For
helpful comments on the Capabilities Approach at a brown bag conversa-
tion, I thank my colleagues in the Department of Conflict Resolution,
Human Security & Global Governance. For their constant professional-
ism and care, I heartily thank Kelly Ward, Leigh Murphy and Roni
Lipton. Warmest thanks to Cynthia Enloe, Winston Langley, David
W. Pantalone and to my colleagues in the Nursing Department for their
steadfast support of this work, especially Rosanna DeMarco, Jean Edward,
Jacqui Fawcett, Emily Jones, Suzanne Leveille and Eileen Stuart-Shor.
My sincere thanks to my students in South Africa and the US who
have shown great interest in my research over the years: It has been an
honour to teach and to learn from them.
xx Acknowledgements

Owing to the difficult subject matter, this book was challenging to

write. It has been suggested that the root word of ‘friendship’ in German
means ‘place of high safety’. For the shelter and joy of friendship, I thank
Laura Bures, Karen Cha, Charisse Drobis, Mary Gardill, Caroline
Wanjiku Kihato, Ambika Kapur, Jennifer Kirn, Heather McKay, Annalisa
Lettinga, Helen Nicholson, Suzanne Sonneborn, James Tasker, Susana
Tente and Laurie Zapalac.
Finally, I offer my gratitude to my parents—Deanna Rosser, and Dale
and Mary Rosser—for their abiding love and support.
 Contents

1 Introduction   1

Part I HIV, Gender and Health in Black South

African Women   33

2 Health Outcomes and Social Factors Influencing

Women’s HIV Acquisition in Social Context  35

3 HIV Care: Prevailing Trends, Barriers and Paradoxes  85

4 Conceptualising Justice in Health as Opportunities

to Be Healthy (Capabilities) 121

Part II Capabilities for Black South African Women:

Gender as a Structural Health Determinant 155

5 Methodological Considerations and Research Methods

to Advance Social Justice 157

xxi
xxii Contents

6 Capabilities for Women Living with HIV: Linking

Health Systems to Social Structure 195

Part III Moving from Evidence to Action 251

7 Gender-Transformative Structural Interventions

to Advance South African Women’s Capabilities 253

8 Assessing Equity in Health and Women’s Opportunities

to Be Healthy 289

9 Concluding Reflections: From Research to Policy

and Practice 319

References  355

Index 395
 List of Abbreviations

AIDS Acquired immune deficiency syndrome

ANC Antenatal care
ARV Antiretroviral
AZT Zidovudine
BMJ British Medical Journal
CA Capabilities (or capability) approach
cART Combination antiretroviral therapy
CDC Centers for Disease Control and Prevention (US)
DALE Disability-adjusted life expectancy
DALY Disability-adjusted life years
DOH South African Department of Health
DREAMS Determined, resilient, empowered, AIDS-free, mentored, and
safe women
GBD Global burden of disease
GBV Gender-based violence
GEF Gender equality framework
GTI Gender-transformative intervention
HiAP Health in all policies
HICs High-income countries
HIV Human immunodeficiency virus
HPV Human papilloma virus
HSRC Human Sciences Research Council of South Africa

xxiii
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Transcriber’s Note:
New original cover art included with this eBook is
granted to the public domain.
 BLACKWOOD’S

EDINBURGH MAGAZINE.

No. CCCCXLII. AUGUST, 1852.

Vol. LXXII.
 CONTENTS.

Dies Boreales. No IX. Christopher under Canvass, 133

From Stamboul to Tabriz, 163
Katie Stewart. A True Story. Part II., 182
Gold—Emigration—Foreign Dependence—Taxation, 203
The Moor and the Loch, 218
My Novel; or, Varieties in English Life. Part XXIII., 235
The Earl of Derby’s Appeal to the Country, 249

EDINBURGH:

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 BLACKWOOD’S

EDINBURGH MAGAZINE.

No. CCCCXLII. AUGUST, 1852. Vol.

LXXII.
 Dies Boreales.

No. IX.
CHRISTOPHER UNDER CANVASS.
Camp at Cladich.
Scene—The Pavilion. Time—Sunset.
North—Talboys—Seward.
NORTH.
The great Epic Poets of Antiquity began with invoking
superhuman aid to their human powers. They magnified their
subject by such a confession, that their unassisted strength was
unequal to worthily treating it; and it is perfectly natural for us to
believe that they were sincere in these implorations. For their own
belief was that Gods presided over, ruled, and directed, not only the
motions of the Visible Universe, and the greater and outward events
and destinies of nations and individuals, but that the Father of Gods
and Men, and peculiar Deities under him, influenced, inspired, and
sustained, gave and took away the powers of wisdom, virtue, and
genius, in every kind of design and in every kind of action.
SEWARD.
They would call down the help, suggestion, and inspiration of
heavenly guides, protectors, and monitors;—of Jupiter, to whom
even their dim faith looked above themselves and beyond this
apparent world, for the incomprehensible causes of things;—of
Apollo, the God of Music and of Song;—of those divine Sisters, under
whose especial charge that imaginative religion placed Poets and
their works, the nine melodious Daughters of Memory;—of those
three other gentle deities, of whom Pindar affirms, that if there be
amongst men anything fair and admirable, to their gift it is owing,
and whose name expresses the accomplishing excellence of Poesy, if
all suffrages are to be united in praise: bright Sisters too, adored with
altar and temple,—the Graces.
NORTH.
Milton, who had unremittingly studied the classical Art of Poetry,
and who brought into the service of his great and solemn
undertaking all the resources of poetical Art, which prior ages had
placed at his disposal, whose learning, from the literature of the
world, gathered spoils to hang up in the vast and glorious temple
which he dedicated—He might, without offence to the devout
purpose of his own soul, borrow from the devotion of those old
pagan worshippers the hint, and partially the form, of those exordial
supplications.
SEWARD.
He opens the Paradise Lost with Two Invocations. Both implore
aid. But the aid asked in one and in the other is different in kind, as
the Two Powers, of whom the aid is asked, are also wholly different.
Let us look at these two Invocations in the order in which they stand.
“Of Man’s first disobedience, and the fruit
Of that forbidden tree, whose mortal taste
Brought death into the world, and all our woe,
With loss of Eden, till one greater Man
Restore us, and regain the blissful seat,
Sing, heavenly Muse, that, on the sacred top
Of Oreb, or of Sinai, didst inspire
That shepherd, who first taught the chosen seed,
In the beginning how the heavens and earth
Rose out of chaos: or, if Sion hill
Delight thee more, and Siloa’s brook that flow’d
Fast by the oracle of God; I thence
Invoke thy aid to my adventurous song,
That with no middle flight intends to soar
Above the Aonian mount, while it pursues
Things unattempted yet in prose or rhyme.
And chiefly Thou, O Spirit, that dost prefer
Before all temples the upright heart and pure,
Instruct me, for Thou know’st: Thou from the first
 Wast present, and, with mighty wings outspread,
Dove-like, sat’st brooding on the vast abyss,
And mad’st it pregnant: what in me is dark,
Illumine: what is low, raise and support;
That to the height of this great argument
I may assert eternal Providence,
And justify the ways of God to men.”

The First is taken, hint and form both, from Homer. Homer,
girding up his strength to sing the war of confederated Greece
against Troy and her confederates, makes over his own overpowering
theme to a Spirit able to support the burden—to the Muse.
Sing, Goddess, he begins, the Anger of Achilles.
NORTH.
Even so Milton. After proposing in a few words the great argument
of his Poem—that fatal first act of disobedience to the Creator, by
which our First Parents, along with His favour, forfeited Innocence,
Bliss, Immortality, and Paradise, for themselves and their posterity,
until the coming of the Saviour shall redeem the Sin and loss—he
devolves his own task upon a Muse, whom he deems far higher than
the Muse of his greatest predecessor, and whom he, to mark this
superiority, addresses as the Heavenly Muse.
TALBOYS.
She is the Muse who inspired on the summit now of Horeb, now of
Sinai; when for forty years in retreat from his own people, yet under
their Egyptian yoke, he kept the flocks of his father-in-law Jethro—
the actual Shepherd who, from communing with God and
commissioned by God, came down into Egypt again to be the
Shepherd of his people and to lead out the flock of Israel.
SEWARD.
She is the Muse who, when the Hebrew tribes were at length
seated in the promised land—when Zion in the stead of Sinai was the
chosen Mountain of God—inspired Psalmists and Prophets.
TALBOYS.
And the reason is manifest for the distinguishing of Moses. For all
critics of the style of the inspired Writers distinguish that of Moses
from all the others, as antique, austere, grave, sublime, as if there
were in him who conversed personally with God greater sanctity of
style, even as his face shone when he came down from the Mount; as
the whole character and office of Moses was held by the Hebrews,
and is held, perhaps, by us, as lifting him above all other prophetic
leaders.
NORTH.
He was the founder of the Nation, and the type of the Saviour.
TALBOYS.
Milton desires for his work, all qualities of style, as the variable
subject shall require them. Not only the high rank of Moses as the
author of the Pentateuch required that he should be named, but this
in particular, that Moses was the historian of the Creation and Fall.
NORTH.
One might for a moment be tempted to confound the inspiration
here meant with that highest inspiration which was vouchsafed in
those holy places, and which we distinguish by the unequivocal name
of revelation. But on reflection we perceive it not possible that Milton
should have ascribed such an office to an Impersonation—those
awful Communications which distinguished those persons chosen by
the Almighty to be the vessels of his Will to the Children of Men. His
revelations, we are instructed to believe, are immediately from
himself.
TALBOYS.
Somebody said to me once that Milton’s First Invocation to the
Muse is oppressed with Mountains; that it is as if he had shaken out
what he had got under the head Mountains, in his Common-Place
Book; and—
NORTH.
Somebody had better have held his tongue. No. They occur by
natural association. He wants aid of the Muse who inspired Moses—I
suppose, who sustained—that is, gave his style—of the other writers
in the Old Testament. To suppose her visiting Moses on either peak
of the Sacred Hill where he had his divine communions, is obvious
and inevitable, and, I hope, solemn and sublime too. To suppose her
accompanying the migration of the Israelites, and as she had
devoutly affected their Sacred Mountain of the Wilderness, also
devoutly affecting their Holy Mountain at the foot of which they built
their Metropolis, is a spontaneous and unavoidable process of
thought. Sinai and Sion represent, as if they contain embodied, the
religion and history blended of the race. And if the divine Muse has
two divine Hills, how can Milton help thinking of the quasi-divine
Hill on which were gathered the nine quasi-divine Sisters?
Doubtless, three distinct Mountains in the first sixteen lines, if
absolutely considered, may seem cumbrous and overwhelming. But
accept them for what they are in the Invocation; the two first
localisings of the one Muse, they are easy. Why should not her wing
skim from peak to peak? and Parnassus looms in the distance on the
horizon.
SEWARD.
A more urgent and trying question is, what does he invoke? We
have a sort of biographical information respecting the Address to the
Spirit. Milton did believe himself under its especial influences, and
the Address is a direct and proper Prayer. But what is this Muse? To
us the old Muses—whatever they may have been to the Greeks—are
Impersonations, and nothing more, of powers in our own souls. If
name attest nature, such is the muse of Milton—a power of his own
soul—but one which dwelt also in the soul of the great Hebrew
shepherd. Say, for the sake of a determining notion, the power of the
austere and simple religious sublime. A human power, but moved by
contact of the soul with divine subjects. Perhaps I say too bluntly that
those old Muses were mostly but impersonations of human powers.
An abstruse, difficult, and solemn part of our existence is touched,
implicated. We find when we are deeply moved that powers which
slept in us awake;—Powers which have before awaked, and fallen
back in sleep;—Powers, too, that have never before awaked.
NORTH.
But what do we know of what is ultimate? If there is a contact of
our spirits with the universal Spirit, if there are to us divine
communions, influences, how do we know when they begin and end?
It seems reverent and circumspect to view poetical inspiration as a
human fact only, but we are not sure that it is not even more
religious to believe that the unsuspected breath of Deity moves our
souls in their higher and happier moments. Be they motions of our
own souls, be there inferior influences mingled, those Muses were
names for the powers upon this view—for the powers and mingled
influences upon another. On the whole, I think that the distinction is
here intended generally; and that the heavenly Muse represents the
human soul exalted, or its powers ennobled by contact with
illuminating and hidden influences—as the prophets Isaiah, Ezekiel,
Jeremiah, have each quite the style of their own humanity in writing
under the governance of the Spirit.
SEWARD.
I consider the free daring with which all Poets of the modern
world, at least, have, for the uses of their Art, converted Powers and
Agencies into imaginary beings. I consider the respects in which the
Poet has need of aid. He wants aid if he is to penetrate into regions
inaccessible to mortal foot or eye—if he is to disclose transactions
veiled since the foundations of the world; but this aid the Muse
cannot afford to the Christian Poet, and we shall presently see that
he applies for it to a higher Source. But the Poet who undertakes to
sing of Heaven and Earth, of Chaos and of Hell, who comprehends
within his unbounded Song all orders of Being, from the Highest and
Greatest to the Lowest and Least—all that are Good and all that are
Evil, and all that are mixed of Good and Evil—and all transactions
from the date, if we may safely so speak, when Time issued from the
bosom of Eternity to the still distant date, when Time shall again
merge in that Eternity out of which it arose, and be no more:—That
Poet, if any, needs implore for a voice equal to his theme, a power of
wing measured to the flight which he intends to soar; he needs for
the very manner of representation which he is to use—for the very
words in which he is to couch stupendous thoughts—for the very
music in which his pealing words shall roll—aid, if aid can be had for
supplication.
NORTH.
Yes, Seward. We consider these things. We consider the laborious,
learned, and solemn studies, by which we are told, by which Milton
tells us, that he endeavoured to qualify himself for performing his
great work, and I propose this account of this first Invocation,
stripped of its Poetical garb. In the first place, that the subject of
desire to the Poet—the thing asked—is high, grave, reverend,
sublime, fitted Style or Expression. As for the addressing, and the
power of the wish, you may remember that, as we hear, employing
human means, he assiduously read, or caused to be read, the
profane, and his native, and the Sacred Writers—drawing thence his
manner of poetical speech.
TALBOYS.
“Heavenly” Muse is opposed to “Olympian” Muse; as if “Hebraic”
to “Hellenic;” as if “Scriptural” to “Classical;” as if “Sacred” to
“Profane;” as if Muse of Zion to Muse of Pindus. Therefore we must
ask—What “Muse” ordinarily means? We know what it meant in the
mouth of a believing Greek. It meant a real person—a divine being of
a lower Order. But Milton is a Christian—for whom those deities are
no more. They are, in his eye, mere imaginations—air.
“For Thou art heavenly! She (the Hellenic) an empty dream.”

And so already—
“The meaning, not the name, I call.”

To wit, the Hellenic is to him a name—air.

SEWARD.
We must ask—What does, in ordinary Verse, not in sacred poetry,
a Christian poet mean, when He names, and yet more when he
invokes, the Muse—the Sacred Sisters nine? And we are thrown upon
recognising the widely-spread literary fact—not unattractive or quite
unimportant—that Christendom cherished this reminiscence of
Heathendom; that, in fact, our poetry seems to rest for a part of its
life upon this airy relic of a fled mythology—varied in all ways, Muse,
Helicon, Hippocrene, &c. Greatest Poets, not poetasters, the
inspired, not the imitative and servile—and at height of occasion.
Thus Shakspeare—
“O for a Muse of fire that would ascend
The highest heaven of invention!
A kingdom for a stage!” &c.
Spenser—at entering upon his vast Poem—
“Me all too mean the Sacred Muse areeds.”

And the master of good plain sense in verse, Pope, acknowledges the
ineradicably rooted expression—
“Drink deep, or taste not the Pierian spring.”

I put these together, because I doubt not but that Milton in choosing
and guarding (just like Tasso) the word, looked this practice of
Christian, or christened poets, full in the face; and spoke, founding
upon it. Muse, to his mind inventing his Invocation, had three
senses. Imaginary Deity of a departed belief—An Authoritative
Name, thence retained with affection and pride by Poets of the
Christian world—Or, something new, which might be made for his
own peculiar purpose, or which Tasso had begun to make,
undertaking a Poem after a sort sacred.
TALBOYS.
I cannot believe that the word which has held such fond place in
the minds of great poets, and all poets, can have been a dry and bald
imitation of antiquity. Doubtless it had, and has, a living meaning;
answers to, and is answered by, something in their bosoms—the
Name to which Shakspeare and Spenser clung, and which Milton put
by the side of the Holy Spirit and transplanted into Heaven.
NORTH.
Our attention is first reflectively directed upon recognised
Impersonations in Poetry. But we are very much accustomed to
misunderstand the nature of Poetry; for we are much accustomed to
look upon Poetry as an art of intellectual recreation, and nothing
more. Only as a privileged Art—an Art privileged to think in a way of
its own, and to entertain, for the sake of a delicate amusement and
gratification, illusory thoughts which have never had belief belonging
to them. And meeting with Impersonations in poetry, we set down
Impersonations amongst the illusory thoughts thus imagined and
entertained for intellectual pleasure, and which have never been
believed. It is a mistake altogether. Poetry has its foundation in a
transient belief. Impersonations have held very durable belief
amongst men. When we reflect and take upon us to become
cognisant of our own intellectual acts, we are bound to become
cognisant of these illusions—to know that they must have temporary
belief—that they must not have permanent belief.
SEWARD.
“Sing, Heavenly Muse.” Milton redeems the boldness of
adventurously transplanting from a Pagan Mythology into a
Christian Poem, and thus imparts a consecration of his own to a
Heathen word; but the primitive cast and colouring remain,
satisfying us that we must here understand an Imaginary Being.
NORTH.
The Seventh Book again opens with an Invocation for aid, and
again to the same person.
We find in the opening verses the personality attributed with
increased distinctness, and with much increased boldness. A proper
name is given, and a new imaginary person introduced, and a new
and extraordinary joint action attributed to the Two.
“Descend from Heaven, Urania—by that name
If rightly Thou art called—whose voice divine
Following, above the Olympian hill I soar,
Above the flight of Pegasean wing!
The meaning, not the name, I call: for Thou
Nor of the Muses nine, nor on the top
Of old Olympus dwell’st; but, heavenly born,
Before the hills appeared, or fountain flowed,
Thou with Eternal Wisdom didst converse;—
Wisdom thy sister, and with her didst play
In presence of the Almighty Father, pleased
With thy celestial song.”

She is now named—Urania. (The former title given her

—“Heavenly Muse”—is equivalent.) But because one of the Nine
Muses was named Urania, he distinguishes—
“The meaning, not the name, I call.”

She is described as conversing before the creation of this Universe,

and playing with her Sister Wisdom, in the presence of God, who
listens, pleased, to her song.
In this bold and tender twofold Impersonation, I seem to
understand this.
Wisdom is the Thought of God respectively to the connection of
Causes and Effects in his Creation, or to the Laws which constitute
and uphold its Order: considered as Useful.
This Thought is boldly separated from God, and impersonated as
One Sister.
Urania is the Thought of God, relatively to the Order and
Harmony of his Works:—considered as Beautiful.
When God sees that his Creation upon each day is “good,” (which
expression Milton is careful to repeat upon each day,) we must
understand that he regards it in both respects.
The Invocation is, therefore, placed with a perfect propriety at the
beginning of the Book which is occupied in describing the Creation.
For the meaning here attributed to Urania playing with Wisdom
before the pleased Father, compare the passage where the dance of
the Angels has been compared to the motions of the stars, and the
Speaker, the Archangel Raphael, adds:
“And in their motions harmony divine
So smooths her charming tones, that God’s own ear
Listens delighted.”

Where the audible harmony of the spheres and the song of Urania
seem to be as nearly as possible one and the same thing—namely,
Music—which is The Beautiful in one of its kinds, used, with
extremely profound and bold imagination, for expressing The
Beautiful in all its kinds.
Who is it that, in presence of the Everlasting Throne, converses
with her sister, Eternal Wisdom; plays with her—singing, the while,
so that the awful Ear of Omnipotence bends from the Throne,
listening and pleased?
The majestical Invocation opens the Seventh Book of the Paradise
Lost; and the Seventh Book of the Paradise Lost is occupied from
beginning to end in amplifying, with wonderful plenitude, exactness,
beauty, and magnificence of description, the First Chapter in the
Book of Genesis. In other words the Seventh Book of Paradise Lost
describes the Week of Creation—the six days of God’s working, and
the seventh of His rest.
Milton moulds, at the height of poetical power, into poetical form
thoughts that are universal to the Spirit of Man. What then, we must
ask, are the two Thoughts that rise in the Spirit of Man, looking with
its awakened and instructed faculties upon the Universe of God?
Assuredly one is, wonder at the adaptation of Means to Ends—that
fitness of which all human Science is nothing but the progressive,
inexhaustible revelation. This is that Eternal Wisdom, whom the
Poet daringly finds a distinct inhabitant of the Empyrean. The other
thought, insuppressibly arising upon the same contemplation, is,
wonder of the overwhelming beauty that overflows the visible
creation. This is the Heavenly Muse, Urania. The purpose of the
Divine Mind to create the Useful Order of Things is impersonated as
Eternal Wisdom. The purpose of the Divine Mind to create the
Beauty of Things is impersonated under a name which the Poet
boldly and reverently supplies. Milton’s description of the six days
completely displays the two notions: it impresses the notion of
Useful Order and Beauty.
SEWARD.
These verses, which introduce the Creation of Man on the sixth
day, impress the two distinctly—
“Now Heaven in all her glory shone;”

—that is, for the Beautiful:

——“and roll’d
Her motions, as the first great Mover’s hand
First wheel’d their course;”

—that is, for Useful Order.

“Earth in her rich attire
Consummate lovely smiled;”

—that is, for Beauty.

“Air, water, earth,
By fowl, fish, beast, was flown, was swum, was walked,
Frequent.”
Here is again the Adaptation, the Useful Order,
“Of all yet done;”—

namely, Man;—again Design, Order, Wisdom.

And when the whole work is finished, the two characters are set
side by side, as answering, in the Mind of the Creator, to His
antecedent purpose.
“Here finished He, and all that he had made
View’d,—and behold all was intensely good;
So even and morn accomplished the Sixth day:
Yet not till the Creator, from his Work
Desisting, though unwearied, up returned,
Up to the Heaven of Heavens, his high abode,
Thence to behold this new-created world,
The addition of his empire, how it showed
In prospect from his Throne, how GOOD, how FAIR,
Answering his great Idea.”

Here good expresses the Useful Order—fair the Beauty.

TALBOYS.
The Heavenly Muse descended upon Earth is then the God-given
Intelligence, in the Human bosom, of The Beautiful. It is the Faculty,
as we are more accustomed to speak, of the Sublime and Beautiful;—
a human ability, raised in the sacred writers by divine communions—
Milton desires, but can hardly be thought in that first Invocation, or
in this, (Book VII.) directly to pray, that the powers of his mortal
genius may receive similar exaltation.
NORTH.
Speak boldly.
SEWARD.
I do.
TALBOYS.
The Heavenly Muse, in Heaven, is God’s thought of the Beauty
which shall be in the Universe to be created. The heavenly Muse,
upon Earth, is the Thought or the Faculty of Beauty, as originally