End of Aids Denial Era a Chance to Move Forward

Article excerpt

BYLINE: Steven Robins

Much has been written about the death of Manto Tshabalala-Msimang. Some of the articles have pulled no punches in highlighting the devastating role of the former health minister in buttressing former president Thabo Mbeki's Aids denialism.

A recent Harvard University study found that Mbeki's Aids denialism was responsible for 350 000 deaths. In addition to this tragic loss of life, there were other less visible casualties. In particular, the polarised character of the politics of Aids science during the Mbeki era stymied open and constructive debate about how to tackle the pandemic.

The story of Aids treatment in South Africa has been widely portrayed as a heroic David and Goliath struggle in which activists were pitted against the might of the state and the global pharmaceutical industry. But of course this is not the only way in which the Aids treatment story in South Africa has been, or can be, narrated.

Over the past decade, Aids debates became highly polarised, resulting in the emergence of sharply divided camps. During the height of these contestations over Aids science it was very difficult to debate the merits of a range of issues including traditional healing, nutrition, diet, HIV prevention, ARV side-effects, and drug resistance, without risking being slotted into the pro-Mbeki Aids dissident camp.

Mere discussions of the relationship between HIV, nutrition and poverty provoked suspicion in some Aids activist quarters. Even support for the government's promotion of HIV-prevention programmes was at times questioned by activists for diverting attention away from grassroots struggles for ARVs.

In this highly charged political environment, there was little room for open debate and difference. Mark Gevisser's empathetic biography of Mbeki, for example, was read by some Aids activists as veering dangerously towards becoming an apologia for the former president's brand of Aids denialism. Didier Fassin's (2008) even more empathetic reading of Mbeki's "Aids talk" in When Bodies Remember received a particularly hostile response from South African Aids activists, health practitioners and academics.

The radical polarisation of Aids positions and rhetorics was to be expected given the devastating reality of the Aids crisis and Mbeki's stubborn refusal to acknowledge the desperate need for antiretroviral therapy within the public health system.

It was therefore perhaps hardly surprising that clear lines were drawn and policed between various positions in Aids debates during the Mbeki era. Of course, similar polarising processes have surfaced in the course of contentious public debates on issues such as global climate change and nuclear energy.

Much has been written about the twists and turns in the politics of Aids treatment in South Africa. Yet, most of these accounts have conformed to a David and Goliath narrative in terms of which heroic Aids activists successfully fought against the might of the state and the global pharmaceutical industry.

These accounts generally assume that activists were absolutely correct in claiming that antiretroviral treatment (ART) is a financially viable, ethically principled and scientifically proven biomedical technology whose successful implementation simply needed a cheaper drug-pricing structure and the political will from donors and governments. There is very little ambiguity and contextual specificity in these accounts.

Sceptics and opponents of ART are described in these accounts as advocates of irrational arguments and pseudo-science. Some Aids dissidents and denialists, such as Mbeki and Tshabalala-Msimang, are even accused of complicity in genocide by activists and politicians.

Borrowing liberally from anti-imperialist and anti-capitalist rhetoric, the dissidents argued that the profiteering pharmaceutical industry in the West was promoting Aids drugs in order to exploit Third World markets. …