There’s been quite a bit of blogging lately about HIV denialism, so I thought I would take this opportunity to write a little bit about HIV denialism in South Africa–a subject that gets mentioned pretty often is rarely discussed in much detail. I spoke about this topic in my talk on Wednesday, though, because it serves as a nice lesson in the importance of not looking at certain problems too simplistically. The following–an excerpt–is a basic introduction to Thabo Mbeki’s HIV denialism based on what I’ve learned traveling in South Africa and talking to a variety of people who study the topic.
There are certain scientific subjects that, for one reason or another, inspire a disproportionately large degree of quackery. One of these is vaccination, where a now discredited link between autism and certain preservatives used in vaccine preparations has inspired a large and vociferous group of anti-vaccination advocates. Another is AIDS, where there also exists an outspoken outlier community of people who deny that HIV (the human immunodeficiency virus) causes the disease we call AIDS–despite the fact that the link between the two has been demonstrated beyond any reasonable scientific doubt.
South Africa, like many sub-Saharan African nations, suffers from a deadly AIDS epidemic, with about 11% of the nation’s entire (adult and child) population estimated to be carrying HIV, and the infection rate among just adults being almost twice that. Thus, warning flags went up throughout the scientific community when in the year 2000, after having only recently assumed the presidency of this fledgling post-apartheid democracy, Thabo Mbeki invited several crackpot scientists who denied the link between HIV and AIDS to join his AIDS advisory panel.
Today, although AIDS cannot be cured, it has become increasingly treatable, through a variety of antiretroviral drugs developed through well-funded HIV research. However, by denying the link between HIV and AIDS, and not taking a proactive stance in distributing these life-saving antiretroviral drugs, Mbeki’s HIV denialism was not just misguided. It was deadly.
About three million people die as a result of AIDS each year, and roughly 1/3 of these deaths are in sub-Saharan Africa. Many of these deaths could be prevented with the proper regimen of antiviral drugs. Although the South African Congress has in recent years overridden the President in rolling out its own plan for the distribution of antiretroviral drugs, many problems remain. There are over 500,000 individuals in South Africa currently suffering from AIDS, who are in need of, but are not receiving, antiretroviral treatment. This is just a subset of the estimated 5 million South Africans who currently carry HIV, the majority of whom have not yet developed AIDS, but will one day.
The current Health Minister, Manto Tshabalala-Msimang, continues to hold on to her position, which she assumed in 1999, despite being an HIV denialist herself. In 2006, the government of South Africa suffered an enormous embarrassment at her hands, when her booth at the International AIDS conference in Toronto featured the use of vegetables such as beetroot and garlic as AIDS treatments. After the conference, a group of 65 HIV and AIDS experts signed a statement calling for her dismissal, citing the scientific consensus that HIV causes AIDS. Then, in August of this year, the Deputy Health Minister, Nozizwe Madlala-Routledge–who had been one of the most outspoken advocates for antiretroviral treatment in the Mbeki government–was fired under dubious pretenses. And so, the saga continues.
On the surface the South African AIDS crisis has all of the makings of a problem with bad science–with some infrastructure and drug delivery issues thrown in there for good measure: president Mbeki has fallen victim to pseudoscience, and surely if Mbeki and the South African government were provided with all of the scientifically accurate information on HIV and AIDS, they would recognize the scientific consensus and change their policies accordingly.
That’s the view, at least, that it’s easy to take as a Westerner–particularly a Western scientist. However, it’s not nearly that simple.
The current HIV denialism crisis in South Africa is in fact firmly rooted in the nation’s dark apartheid past, and without understanding this past (the struggle for racial equality, the tumultuous transition to black rule, and the distinct sociological conditions that emerged from all of this) we’ll never come closer to understanding–and treating–the root causes of this problem and delivering antiretroviral drugs to those who need them.
The 1980s were a time of deep social unrest in South Africa, as civil disobedience became a way of life and the oppressive white apartheid government began to collapse. It wasn’t until 1994, though, when Nelson Mandela became the first president of the new free South Africa, that order began to be restored. During that time, though, not only had AIDS first been identified (in 1981), but HIV had been identified as the cause of AIDS (1983), and even the first antiretroviral drugs had been made available (1987).
However, in 1994, the growing magnitude of the AIDS pandemic in South Africa was only just beginning to become apparent. Over the next five years of the Mandela presidency, although AIDS was a concern in South Africa, the nation still had much bigger problems to face, including poverty, malnutrition, and lack of education. And, of course, there was the issue of building a whole new nation and trying to overcome the legacy of apartheid–no easy task, for sure.
By the time Thabo Mbeki became president in 1999, AIDS in South Africa could no longer be ignored. For example, by this point, the HIV prevalence rate among pregnant women was already a shocking 22%. Unfortunately, it was also around this time that Mbeki first started displaying his HIV denialism. Considering that mother to child transmission during birth is highly preventable with antiretroviral drugs, this was a very dangerous position for Mbeki to take.
Mbeki rationalized this by charging that the focus in fighting AIDS should be on eliminating poverty. In his mind, AIDS was a disease of poverty, and no gains would be made in treating AIDS until this root cause was addressed. To an extent, he was correct, in that poverty in South Africa has exacerbated the AIDS epidemic. With that said, though, HIV and AIDS have become increasingly treatable, and denying the link between HIV and AIDS is doing no one a favor.
Mbeki also saw the discussion of HIV and its prevalence in the black community as a fundamental attack on blackness. By this point, the AIDS epidemic in sub-Saharan Africa had become most severe primarily in black populations, so much of the dialogue regarding AIDS focused on black Africans. Based on the nation’s history of racism, it’s understandable why he would have reacted so negatively to this focus on black Africans.
The important point, though, is that it was this aspect–his reaction to what he saw as racism in the international dialogue on HIV and AIDS–that led to Mbeki’s HIV denialism. He wasn’t taken in by quack scientists, but instead he sought out scientists who would provide external justification for his own views on the subject–no matter how misguided they were.
Only with such a deeper understanding of this problem can we move forward and hopefully address South Africa’s AIDS crisis on the medical, political, and sociological fronts. In the meantime, the AIDS crisis in South Africa remains a problem, and it is likely going to take many talented individuals and organizations, exploring the complexities of the issue, to make significant headway and turn this nation’s AIDS policy around.