Mbeki's strange Aids discourse
Government arguments against extending the provision of anti-retroviral drugs in the treatment of HIV/Aids have shifted from conspiracy theories to seemingly “technical” concerns about the economy and health infrastructure.
The state argued in the recent Treatment Action Campaign court case that extending treatment to prevent mother-to-child transmission to all state antenatal facilities would be “too expensive”. It is claimed that increased public spending on Aids treatment does not accord with “fiscal discipline”.
Recently, however, the catastrophic obstinacy of the government’s refusal to design and implement a national treatment plan has led many commentators, including international magazines Newsweek and Prospect, back to President Thabo Mbeki’s propensity for denial in their search for an explanation.
Notwithstanding his verbal prestidigitation, Mbeki denies the causal link between HIV and Aids, the efficacy and safety of anti-retroviral drugs and the extent of the epidemic in South Africa.
Mbeki’s claim that Aids activists and doctors who adhere to the mainstream position on Aids are racist (”Mbeki in bizarre Aids outburst”, Mail & Guardian, October 16) fits a denialist framework. And his thinking appears to draw heavily on the ghosts of apartheid and colonial arguments around Africans, medicine and disease.
His 2001 Fort Hare speech, which formed the basis of the M&G article, shows he thinks critics of his views on HIV/Aids believe that Africans are “natural born, promiscuous germ carriers” with an “unconquerable devotion to the sin of lust”.
Megan Vaughan, an academic at Nuffield College, Oxford, has shown that some African nationalists argued, before Mbeki, that Aids is a Western health problem resulting from Western “degeneracy” and homosexuality and that Africans have been unfairly scapegoated for this Western problem. This nationalist viewpoint implies that Africa is a place of unchanging social stability and morality where sexuality is ordered by traditional morality.
In 1987 Chirimuuta and Chirimuuta, Zimbabwean medical researchers, questioned HIV as the cause of Aids, the African origin of Aids and the safety of anti-retroviral medication. They also claimed that HIV prevalence and Aids deaths in Africa were exaggerated as part of a racist plot to discredit African culture and sexuality.
They highlighted instances of actual racism in the history of Aids science. Some early theories on the origins of Aids in Africa relied on fairly flimsy evidence, as well as on insulting and culturally inaccurate speculation about African sexuality.
Some researchers claimed that HIV passed from monkeys to Africans in Central Africa via bizarre sexual practices involving monkey blood. Claims like these were evidently informed by racist beliefs that Africans had an animalistic sexuality. This worsened the discrimination suffered in the West by some Africans and Haitians.
They were stereotyped as “Aids carriers/ victims”. And Chirimuuta and Chirimuuta showed that Haitians and Africans were, as a result, often refused apartments and forced to have Aids tests before being accepted for academic scholarships. Now anti-discrimination is a pervasive principle in Aids policy- making circles.
In the early 1990s Jonathan Mann, then head of the World Health Organisation, pushed for Aids policy that would protect the rights of HIV-positive individuals. As Helen Schneider of Wits University’s Centre for Health Policy recently argued, this put rights-based approaches to the syndrome in the mainstream globally. Simultaneously, discriminatory, crude, racially and sexually based notions of “high-risk groups” lost their currency.
By the 1990s, discriminatory and coercive practices ceased to form a legitimate part of contributions to health policy debates by the government, medics and NGOs.
What then motivates Mbeki’s denialism?
Ann Laura Stoler and Sander Gilman, from the University of Michigan and University of Chicago respectively, have argued that, in the era of colonialism, Western nationhood and cultural self-identity were defined in contradistinction to the colonial notion of “native” sexuality as “diseased”.
Could Mbeki’s attempt to remould images of African sexuality, via his Aids denialism, be a nationalistic attempt to defend the nation and the body politic against the idea that it is “degenerate”? And, if this is so, is Mbeki not tilting at windmills?
Why continue to argue against racist and discriminatory arguments that have already, by and large, been surpassed by rights- or treatment-based approaches to Aids in the policy-making world? Mbeki’s persistence is, at best, unhelpful.
In South African civil society and Aids science, a scientific, non-moralistic, rights-based approach has prevailed. It recommends treatment of people with HIV and use of medication to prevent babies and rape survivors from contracting HIV.
Mbeki is denying this rights-based/treatment vision of Aids activists, scientists and doctors. He is still trapped in intellectual boundaries defined by coercive and racist arguments common in colonial and late-apartheid public health. He is fighting an enemy that no longer exists at the expense of the lives of his own people.
Meanwhile, rhetoric about technical limits financial and infrastructural to the government’s ability to provide affordable treatment, does not disguise the evident lack of political will to overcome the real technical problems that do exist.
Mandisa Mbali is a research intern at the Centre for Civil Society at the University of Natal