I thought I’d post a report that I wrote for an African history class. It doesn’t deal directly with LGBT issues, but it does discuss the history of AIDS in a very troubled part of the world, and consequences of denying it.
In 1994, South Africa finally became a full democracy with the election of Nelson Mandela. The oppressive apartheid system separating whites from blacks had fallen apart, and South Africans were free. Unfortunately, something far worse than apartheid was slowly becoming entrenched among the people of South Africa. The HIV-AIDS epidemic caused untold suffering for so many South Africans, but the worst part of it was the response of the post-apartheid administrations of Nelson Mandela and Thabo Mbeki. Societal prejudices and a failure to understand the nature of the HIV virus contributed to the lack of a coordinated effort by the South African government to respond to this crisis.
To understand the response of the post-apartheid government to AIDS, it is imperative for researchers to know the history of the AIDS epidemic in South Africa. Interestingly, the first case of AIDS was diagnosed in South Africa in 1982, which was roughly the same time that AIDS was first positively identified in the United States. Also, like in the United States, the majority of AIDS cases in South Africa were originally in sexually active homosexual men, which created the still-present stereotype of AIDS as a “gay disease.” But by 1985, as the apartheid regime launched a vicious crackdown on dissent, AIDS was no longer a “gay disease” and transmission was occurring at all levels of society. Unfortunately, several factors allowed AIDS to spread much more rapidly in South Africa than in other countries. The appalling poverty in black townships, the failure of the apartheid system to provide sufficient healthcare for blacks and the high frequency of sexual encounters among migrant laborers encouraged the spread of the disease to a greater degree than in other countries. The apartheid government was more focused on maintaining its power rather than on helping with the AIDS crisis, and considered AIDS to be a disease meant to punish Africans for their supposedly strange sexual proclivities (this was a stereotype from the colonial era and probably referred to Africa’s non-western sexual norms, such as polygamy). At the very least, many white proponents of apartheid in South Africa were not in any hurry to address a virus that targeted large portions of the despised black majority. Black South Africans responded in kind by claiming that AIDS was introduced by western powers, specifically the CIA or FBI, to kill Africans. Both whites and blacks also blamed sexually active homosexual men, especially at the very beginning of the epidemic. The only substantive response of the apartheid regime was to establish some AIDS information centers in white areas of cities in 1988 , which would not be accessible to most of the black population. Many South Africans were fired from their jobs if they were discovered to have contracted the disease, especially mine workers. But the first response from the black majority of South Africa actually came from the African National Congress (ANC) before the end of apartheid, which understood that AIDS was spreading quickly in South Africa, and so the National AIDS Convention of South Africa (NACOSA) was established in 1992 with help from Nelson Mandela. Mandela consulted this new organization and talked about ways that a post-apartheid government could effectively deal with AIDS.
South Africa, at the beginning of its transition into a full democracy in 1994, was doing fairly well in terms of acknowledging AIDS as a serious problem. As civil society flourished thanks to the fall of apartheid, community-based organizations developed to combat AIDS. The National Association of People Living with AIDS (NAPWA) was a grassroots organization that worked to promote awareness of AIDS and dispel stereotypes. Mandela’s new government established the Reconstruction and Development Program (RDP), which increased the health care budget in South Africa and tried to improve employment, land ownership problems, infrastructure, etc. Unfortunately, this program’s focus was too broad to effectively deal with AIDS, which was not high on the RDP’s list of priorities, something that Nelson Mandela later acknowledged and regretted. NACOSA’s original plans to fight AIDS were effectively shelved as the government concentrated on other issues. The situation was made worse by the Growth Employment and Redistribution Strategy (GEAR), which helped South Africa economically develop itself but simultaneously led to cuts in health care spending. Many South Africans bitterly criticized GEAR for ignoring the original promises of the post-apartheid government to care for those who were disadvantaged.
The deeply ingrained prejudices of South Africans against HIV-infected individuals also hampered an effective, unified response to AIDS. Nelson Mandela publicly acknowledged the fact that he avoided talking about AIDS during his presidency for fear of alienating his supporters. Mandela also acknowledged another huge mistake that the ANC made in 1996, which was endorsing the so-called “Sarafina II” play project. This was an expensive play that was improperly funded by the Health Ministry of South Africa, with the goal of increasing AIDS awareness. The play was a disaster from the standpoint of AIDS activists and doctors, since it was said to have done little to provide accurate information about AIDS. The government’s attempt was well-intended, but it failed. While Mandela has been justly criticized for his failure to speak directly to the South African people about AIDS during his presidency due to the prejudices of his constituents, Mandela did have a lot of other social problems that he had to confront. South Africa needed a thorough overhaul of its medical care system in general, better infrastructure, etc. In addition, the widespread publicity that the Truth and Reconciliation Commission created took the spotlight off of AIDS for a while.
Mandela’s government would suffer another serious blow to its credibility and its ability to form a unified response due to the Virodene scandal. In early 1997 South African scientists claimed that they had developed a drug called Virodene that showed promise in helping people with AIDS. The government unwisely called the scientists to present their findings about Virodene to the South African Cabinet. The scientists brought forth HIV-infected people who claimed that Virodene had helped them. The testimony of these victims, rather than sound scientific evidence, managed to convince the Cabinet to grant the scientists permission for a scientific trial. The Cabinet also gave the scientists their full support and a standing ovation. Deputy President Thabo Mbeki also voiced his approval of Virodene. The drug turned out to be a farce! Medical doctors in South Africa were stunned that the Cabinet originally supported this false drug based on personal testimonies rather than on sound scientific evidence. It also badly embarrassed the South African government, especially Thabo Mbeki, who had been one of Virodene’s staunchest proponents. The South African government was forced to learn the hard lesson that there was no quick fix to AIDS.
In 1996, a group of prescription drugs known as protease inhibitors became available in the United States. These drugs could slow down the progression of HIV and improve quality of life. For many, these new drugs turned HIV into a manageable disease like diabetes, yet there was no government plan to distribute these new drugs to those in South Africa in need of them. In response to this, the Treatment Action Campaign (TAC) was created in 1998 to demand treatment access for HIV-infected South Africans. While activists were lobbying the government, ordinary South Africans were becoming desperate for anything that might mitigate their suffering. Unregulated herbs and tonics sprang up in towns and cities, claiming to help those with HIV. Independent medical research never validated any of these supposed “remedies,” but it did not stop South Africans from spending their money on these substances, which are still sold by street vendors in South Africa.
The situation did not improve after Nelson Mandela stepped down from office. In fact, it became much worse. Mandela’s successor, Thabo Mbeki, became heavily involved in so-called “AIDS-denialism.” This ideology was based on junk science that tried to downplay or even eliminate any kind of causal link between HIV infection and AIDS. The same ideology was also very skeptical of protease inhibitors and other anti-retroviral drugs that were proven to be beneficial to people with HIV. Within months of assuming the presidency in June 1999, Mbeki declared that certain types of AIDS drug regimens were “toxic” and ineffective at curing AIDS. To reinforce his convictions, he established the Presidential AIDS Advisory Panel. In theory, equal representation was to be given to mainstream medical doctors and those who held Mbeki’s views that AIDS and HIV were not necessarily linked. In practice, most of the members of the panel were those who held Mbeki’s dissident views on AIDS and drug treatments for it. As a result, Mbeki’s Minister of Health Manto Tshabalala-Msimang delayed implementing new mainstream medical drug therapies in South Africa to allow for more debate over whether or not new drug therapies were really effective. In one sense, it is conceivable that there was so much concern about the efficacy of new AIDS drugs that were being developed, since these drugs often had horrific side effects. The Virodene scandal was undoubtedly still fresh in Mbeki’s mind, making him hesitant to trust AIDS drugs in general. But what Mbeki did not realize was that, unlike Virodene, there was a large amount of medical evidence demonstrating the effectiveness of new protease inhibitors and anti-retrovirals. If these new drugs had these drugs been made accessible to the South African public at large, the number of deaths from AIDS could have been substantially reduced. Mbeki in fact never bothered to consult with the numerous AIDS scientists in South Africa who could have told him about the scientific evidence rebutting dissident “denialist” theories. Mbeki himself downloaded “AIDS-denialist” documents from the Internet and circulated them to members of the South African parliament, and sent such literature to scientists who wrote to him asking him to reconsider his position in light of the overwhelming scientific evidence that AIDS drug treatment regimens were effective and relatively safe. The World Health Organization conducted a thorough medical study of the efficacy and safety of AIDS drugs, and submitted it to Manto Tshabalala-Msimang. She ignored the findings of the report, which stated that certain drug treatments for HIV were proven to be effective and safe.
Unfortunately, Thabo Mbeki and his Health Ministry under Manto became increasingly resistant, almost to the point of absurdity, to mounting medical literature as time went on. In September 2000 Manto tried to suppress a letter from the ANC demanding that she acknowledge the causal link between HIV and AIDS. The ANC refused to withdraw the letter, but Manto refused to say anything in public about the link between HIV and AIDS. Manto then decided to circulate a paper that claimed that AIDS was engineered by the west, feeding into the common prejudices of black South Africans that AIDS was imported from western nations. Mbeki supported her conspiracy theories and added in his theory that large drug companies were conspiring to demonstrate a link between AIDS and HIV to extract money from South Africa. By now, the ANC was growing disillusioned and angry with Mbeki, in part because several ANC parliament members were suffering from HIV. The backlash against Mbeki and Manto in the South African media was strong. Manto herself was portrayed in newspapers as being either a complete lunatic or a slave to Mbeki’s wishes. Some HIV-infected members of parliament simply ignored Mbeki’s warnings against AIDS medications and took them anyway. This further undermined Mbeki and his administration, and the ANC supposedly began considering another candidate to replace him once his term was up. In September 2000 Nelson Mandela finally came forward and acknowledged that he believed that HIV did in fact cause AIDS. At the same time a popular Anglican archbishop, Njongonkulu Ndungane, delivered blistering criticism against Mbeki’s failure to honestly confront AIDS. Mbeki was dealt another hit to his credibility when a 36-year old ANC member, Mankahlana, died in October 2000 from probable AIDS-related complications. Mankahlana was admired by the South African media for his congenial personality, and his death was well publicized. These events were the final nails in the coffin for Mbeki and his administration’s AIDS policies. After Mankahlana’s death, Mbeki declared that he was no longer going to debate AIDS because it was causing “confusion.” He also finally caved in to public pressure in 2006 and ordered Manto Tshabalala-Msimang not to become involved in any more AIDS committees or cases.
Although Mbeki and his administration can be assigned plenty of blame for failing to confront AIDS, one cannot deny that even if Mbeki had spoken out, there was still a deep undercurrent of prejudice and misinformation in South African society about AIDS. Some of these stereotypes and beliefs persist to this day, and often tie into traditional South African ideas about sex and gender. For example, one belief among some South Africans is the idea that if an HIV-infected man has sex with a virgin, he will be cured. Another myth ties into traditional animist religious beliefs, which is that AIDS can be transmitted via witchcraft and sorcery. Some animist South Africans, such as the Basotho people, also believes that AIDS can be cured by their gods. South Africans discovered to have been infected with HIV were often socially ostracized by their friends and even their families. Even civil society organizations in South Africa have had serious difficulties in objectively confronting AIDS. In 2004, there was a meeting of the AIDS Consortium held in Johannesburg. The consortium brought together both NAPWA and the TAC, but instead of engaging in productive talks about AIDS, the meeting quickly degenerated into a racist screaming contest. Black representatives at the consortium accused the white representatives of all being racists and taking advantage of blacks with AIDS. The meeting almost turned violent, but was ended before any physical conflict erupted.
Today, South Africa is making progress in its fight against AIDS. One source of help that South Africa has utilized is the US President’s Emergency Plan for AIDS Relief (PEPFAR) established by President George Bush in 2003. Thanks to this plan, over 330,000 condoms were shipped to South Africa between 2004 and 2007, and about the same numbers of people are receiving anti-retroviral drug treatments. About 1 million HIV-infected individuals are now receiving critical health care and over 2.2 million pregnant women received tests for HIV. AVERT, a prominent AIDS charity group from the United Kingdom, has also assisted South Africa in gathering statistical data about AIDS. Foreign intervention has thus helped South Africa significantly. South Africa is also making positive steps on its own. In March 2007 the government’s National AIDS Council finalized plans to directly allocate the equivalent of several billion US dollars to preventing future HIV infections and providing direct care to at least 80% of South Africa’s infected population. Thanks in part to education, health care improvements and lifestyle changes, it appears that the HIV infection rate among South Africans has stabilized somewhat as of 2006.
Given the prejudices of South Africans in general and the inefficiency of AIDS groups to form an effective coalition, it is perhaps not surprising that the South African government was not compelled to do more to help those suffering from AIDS. In general, all of these factors combined with Thabo Mbeki’s extreme resistance to honestly confronting AIDS provides a clear answer to why South Africa’s response to AIDS was so poor. Both the South African government and the people were simply not willing to listen to sound scientific evidence. Traditional beliefs and pseudoscience trumped genuine, proven medical science. The result of this has been that South Africa now has one of the largest proportions of HIV-infected populations in Africa, with over 5 million people infected, or roughly 20% of its population. South Africa still has a long way to go in combating stereotypes and providing critical healthcare to its HIV-infected population.
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