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Now in fiction: the president on Aids

We all rewrite our personal histories. Putting positive spins on past defeats, deliberately forgetting embarrassing relationships and adapting our views are quintessentially human activities. But it is a far more serious matter when the political history of a head of state is revised and fictionalised. Not only does it tamper with historical truth — it undermines our collective history and disrespects those who suffered through that history.

Recent attempts by President Thabo Mbeki’s official biographer, Ronald Suresh Roberts, to airbrush Mbeki’s Aids denialism from the historical record smell of Stalinism — the era in which history was most cynically and viciously rewritten — and trivialise the responsibility Mbeki carries for thousands of lives lost because he gave credence to ludicrous denialist tenets about the cause of Aids and the efficacy of antiretrovirals (ARVs).

In Fit to Govern, Roberts claims that Mbeki was never an Aids denialist and that his questioning of ARVs resulted in South Africa adopting ”a far more cautious and sensible antiretroviral roll-out” than that advocated by Aids activists. Roberts provides no evidence that South Africa’s delayed use of ARVs brought any benefits. Yet this interpretation has been defended in The Star by Essop Pahad (July 5) and described as ”convincing” by Vicki Robinson in the Mail & Guardian (June 15).

It is frightening to see how easily this presidentially sponsored hagiography has gained credence in some quarters. The facts cry out for a different response. If Mbeki had wanted to ensure a ”sensible” ARV roll-out he would have consulted with scientists and physicians rather than excluding virtually all of them from the South African National Aids Council. He would have learned from neighbouring countries such as Botswana and Namibia that introduced ARVs years before South Africa. He would have brought in international experts such as Paul Farmer — who introduced ARVs successfully in Haiti, Peru and Rwanda — and supported the work of Médecins Sans Frontières inside South Africa.

He would also have fired his health minister for obstructing the implementation of ARVs, for sowing confusion about their efficacy and for hiring Aids denialist Roberto Giraldo, who promoted the lie that nutritional interventions are a better way to combat Aids than ARVs.

Roberts claims that Mbeki was wary of ARVs because he wanted to prioritise Aids prevention. This conveniently ignores the fact that ARVs are a form of prevention: people on ARVs have reduced viral loads (and hence are less infectious) and a short course of ARVs helps prevent mothers from passing HIV on to their babies. If Mbeki had been genuinely concerned about preventing paediatric Aids, he would have ensured that all pregnant women had access to HIV testing and ARVs. Instead, he fought doggedly and arrogantly against them. The Treatment Action Campaign had to undertake a long and bitter legal battle against his government, which ended only when the Constitutional Court unanimously ruled that ARVs had to be made available to pregnant women at public health facilities.

Roberts insinuates that Mbeki was fighting a battle against ”colonial” (read ”white”) Aids medicine. Yet it was respected African scientists and clinicians such as William Makgoba (then head of the Medical Research Council — whom Roberts vilifies), Zolile Mlisana and Kgosi Letlape (successive heads of the South African Medical Association) who begged him to recant his denialist position.

Mbeki’s problem was not racism or colonialism — his problem was that he was so drawn to the scientifically discredited and unproven claims of the (foreign, white) Aids denialists that he and his health minister delayed, and then undermined, the use of ARVs for HIV prevention and treatment.

Claiming that Mbeki was not an Aids denialist because he ”never said that HIV does not cause Aids” is a red herring. Aids denialists routinely pose as questioning Aids science, while in practice denying it. When Mbeki said that he would not take an HIV test because it would be ”confirming a particular paradigm”, he was giving unambiguous credence to a central tenet of Aids denialism. Similarly, when he claimed in September 2003 that he did ”not know anyone who had died of Aids”, he was not merely demonstrating his rejection of Aids diagnoses but callously isolating himself from the realities of life and death for ordinary South Africans.

According to demographic modelling, if during the Mbeki presidency South Africa had rolled out ARVs for pregnant women with HIV and for treating those sick with Aids at the same rate as happened in the Western Cape, then at least 170 000 HIV infections could have been prevented and more than 340 000 deaths averted. This amounts to what European commissioner Peter Mandelson once described as a form of ”genocide by sloth”.

Nicoli Nattrass is the author of Mortal Combat: Aids Denialism and the Fight for Antiretrovirals in South Africa

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Nicoli Nattrass
Nicoli Nattrass is a professor with the School of Economics and the co-director of the Institute for Communities and Wildlife in Africa at the University of Cape Town

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