Thabo Mbeki's AIDS Blues: The Intellectual, the Archive, and the Pandemic

Neville Hoad

In the inaugural Z. K. Matthews Memorial Lecture at Fort Hare (October 12, 2001) and his speech at the funeral of Sarah Bartmann1 (August 9, 2002), Thabo Mbeki, the president of South Africa, analyzed sexually charged representations of African bodies as central epistemological features of nineteenth- and twentieth-century European racism. Given President Mbeki’s increasing reluctance to give interviews on the subject of HIV/AIDS, I turn to these two speeches to explore how their implied critique of the sexual ideology of racism begins to account for the South African regime’s difficulty in systematically or coherently responding to the AIDS pandemic facing its citizens. Both speeches insist on situating public health initiatives to fight the pandemic within a broader history of colonial and apartheid-era racism. Rather than dismiss Mbeki’s invocation of the history of colonial racism in relation to present-day HIV/AIDS, this essay argues that Mbeki’s trenchant analysis of racism needs to be deepened and expanded to include colonial racism’s representation of the sexual norms and forms of whiteness.

The history of the mistakes, backflips, controversies, denials, and inconsistencies of the first democratically elected South African government’s response to the HIV/AIDS pandemic is well known, and I cannot rehearse it here in its entirety.2 It is marked by a series of scandals and a few fragile victories for the estimated 4 million–plus HIV-positive people in South Africa.3 The history of the pandemic under the apartheid regime and during the Nelson Mandela presidency is mostly one of silence. While the pandemic has undoubtedly grown massively since 1996, a history of HIV/AIDS in South Africa would need to address public health questions in these diverging yet continuous eras. In 1998, the government promoted (and perhaps even funded) Virodene, a drug it claimed might “cure” HIV/AIDS and whose active component, dimethyl formamide, is a highly toxic industrial solvent banned for use on humans by a wide variety of organizations from several European governments to the U.S. Occupational Safety and Health Administration and China’s National Poison Control Center. The regime then chose to take no action against the company who made the drug and illegally tested it on human subjects in Tanzania.4 In 2001, the High Court in Pretoria was poised to refuse multinational pharmaceutical companies exclusive patent rights, and (in holding up the 1997 Medicines Act) encouraged the production and distribution of much cheaper generic versions of antiretroviral drugs, and called on the government to distribute them.5 Later the same year, the South African government flew in the face of conventional medical and scientific wisdom by refusing to supply pregnant women with nevirapene, a drug endorsed by the World Health Organization (WHO) that limits mother to child transmission.6 The government has been very slow in providing drug treatment.7 International funds for drug treatment have been held up or blocked. In 2002, Health Minister Manto Tshabalala-Msimang refused to disburse $72 million for antiretrovirals to KwaZulu/Natal Province from the Global Fund.8 In 2003, doctors in government and mine houses’ health clinics were encouraged not to prescribe or distribute antiretroviral drugs and were even in some cases forbidden to do so, even when these drugs were available from the Ministry of Health.9 According to a range of studies, infection rates have increased fivefold since 1991, and the most recent figures extrapolate an infection rate of 25 percent of the total population and as high as 32 percent in KwaZulu/ Natal.10 South Africa, with its more developed medical infrastructure, has seen this increase in a time in which other sub-Saharan African countries, arguably Uganda and notably Botswana, have made successful inroads in both treatment and prevention.11

While the contested histories of the HIV/AIDS pandemic in southern Africa serve as the primary context for what follows, the central questions of this essay are historical and cultural rather than ones of epidemiology and public health policy. President Mbeki is rare among publicly elected officials in using medical history to make medical policy.12 Much of the controversy around the administration’s HIV/AIDS policy has centered on a scientific and medical issue—whether or not the HIV virus causes AIDS. While he has engaged in that debate and invited the contributions of many leading Western AIDS dissidents for support,13 Mbeki has also insisted on understanding questions of health and disease in their present social, political, economic, and (as I will argue) cultural contexts—for example, by calling attention to poverty’s effect on human immune systems.14 In the two speeches under discussion, Mbeki implies that the history of imperial racism needs to be taken into account to understand the public health crisis facing his country. The speech at the funeral of Sarah Bartmann presents a scathing critique of imperialist European notions of raced, gendered, and sexualized African bodies.15 This critique resonates powerfully with President Mbeki’s refusal to engage HIV/AIDS as a sexually transmitted disease, given the history of Western medicine’s inclination to treat African bodies as guinea pigs for drug testing.16 The politics of cultural representation are equally problematic in a neo-liberal world where imperial legacies are very much alive, and the accusations of murderous incompetence leveled at the first democratically elected government of South Africa may bear the taint of colonial racism—as the ANC (African National Congress) government has been quick to point out.17

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Notes

This work was first presented at the Sex and Secrecy Conference of the International Association for the Study of Sexuality, Culture and Society, Johannesburg, South Africa, June 2003, and I thank the conveners at WISER (Wits Institute for Social and Economic Research, University of the Witwatersrand), Graeme Reid and Liz Walker, and the members of the panel and the audience for their questions. In Johannesburg, a conversation with Mark Gevisser set me to thinking about Mbeki and the blues. Bernth Lindfors shared his expertise on Sarah Bartmann with me. John McKiernan Gonzalez provided references on the relation of medical history to medical policy more generally. Candace Vogler helped enormously with thinking through the mind/body split in Enlightenment racism. Barbara Harlow’s reading of the penultimate draft tightened the argument, and Joseph Massad helped me keep the dangers of a critique of a critique of racism in focus. They all have my heartfelt thanks. All errors remain my own.

1. I follow Mbeki in referring to her as Sarah Bartmann rather than Saartjie Bartmann, the more common version of her name. Saartjie is a Dutch diminutive of Sarah.
2. For a collection of quotes from Mbeki’s public comments on the connection between the HIV virus and AIDS, the related efficacy of antiretroviral drugs in treatment of the disease, and his defense of the public health policy of his regime, go to www.tac.org.za. For a broader view of South African AIDS policy, see Samantha Power, “The AIDS Rebel: An Activist Fights Drug Companies, the Government, and His Own Illness,” New Yorker, May 19, 2003, 5 r 4–67. For an ongoing sense of this policy drama as it unfolds, readers should subscribe to the Treatment Action Campaign’s (TAC) newsletter by e-mailing the campaign at news.subcribe@tac.org.za.
3. This figure is hotly contested. The Department of Health, the Actuarial Society of South Africa (ASSA), and the Human Sciences Research Council (HSRC) have all separately used the results from surveys of pregnant women at public antenatal clinics, of patients in public hospitals, migrant workers, bank workers, and truckers to estimate the size of the epidemic. This is not a simple task, particularly given the difficulties of extrapolating infection rates to the general population from these specific social groupings. These three institutions, each with a different agenda, calculate epidemic sizes ranging from 4.8 million to 6.6 million for 2002. The difference of nearly 2 million is not insignificant, but an HIV epidemic in 2002 of even 4.8 million people is massive. For a critique of earlier and slightly higher WHO numbers, see Rian Malan, “AIDS in Africa: In Search of the Truth,” www.whatisaids.com/rollingstone.htm; for a disputing of the current South African numbers, also see Rian Malan, “Apocalypse When?” Noseweek, no. 52 (December 2003), www.noseweek.co.za/look/ns_article.tpl?IdLanguage=1"IdPublication=5"NrIssue=52"NrSecti on=1"NrArticle=629. Nathan Geffen’s rebuttal of Malan’s arguments is available at www.tac.org .za/newsletter/2004/ns20_01_2004.htm.
4. On the Virodene scandal, see Thabo Mbeki, “ANC Has No Financial Stake in Virodene,” www.anc.org.za/ancdocs/history/mbeki/1998/virodene.html.
5. See Sarah Boseley, “At the Mercy of the Giants,” Mail and Guardian, February 16, 2001, for an account for the buildup to the case, and Power, “AIDS Rebel,” 61, for how the Clinton regime backed down from its campaign on behalf of the pharmaceuticals against the Medicines Act.
6. Wherever possible, I have tried to provide a source for these factual claims from the government’s perspective by citing a relevant document from the ANC’s Web site as well as a second, usually more critical source from the South African press. See “Hasty Action no Solution to Motherto- Child HIV Transmission,” ANC Today 1, no. 45 (2001), www.anc.org.za/ancdocs/anctoday/2001/ at45.htm. For the court case forcing the government’s hand to provide the drug, see Paul Graham, “A Street-Wise Judgement,” Mail and Guardian, October 11, 2002.
7. Since the ruling, the price of generics has risen, and once again cost is being used as a reason for not implementing distribution of antiretroviral treatments. See “Don’t Pop the Champagne Yet,” Mail and Guardian, January 26, 2004.
8. For a defense of the governments initiatives on HIV/AIDS, see James Ngculu’s May 13, 2003, health appropriation bill speech, available on the ANC Web site, www.anc.org.za/ancdocs/ speeches/2003/sp0513.html; and Power, “AIDS Rebel,” 65.
9. See “Government Rejects ‘Populist’ Use of Aids Drugs,” Mail and Guardian, April 30, 2003.
10. For an early government acknowledgment of the seriousness of the epidemic with the typical reservations about funding drug treatments, see Nkosazana Dlamini-Zuma, “The Issue of HIV/ AIDS, AZT and Rape,” www.anc.org.za/ancdocs/pr/1999/pr0527.html. See n. 3 for citations concerning the controversy over the breadth of the epidemic.
11. See Power, “AIDS Rebel,” 65.
12. For careful consideration of the difficulties in assessing the relation between medical history and medical policy, albeit in a very different context—the nineteenth-century United States—see John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820–1885 (Cambridge: Harvard University Press, 1986) and Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine (Princeton, N.J.: Princeton University Press, 1998).
13. For a defense of Mbeki’s involvement with David Rasnick, a U.S. scientist who disputes the connection between HIV and AIDS, see the April 28, 2000, article on the HIV/AIDS debate by Zweli Mkhize, minister of health for KwaZulu-Natal, www.anc.org.za/ancdocs/misc/zweli0428.html.
14. For a summary of the extensive and occasionally contradictory documentation on Mbeki’s AIDS dissidence, see Drew Forrest, “Behind the Smokescreen: The Record Reveals President Thabo Mbeki’s True Stance on Aids,” Mail and Guardian, October 26, 2001.
15. Bartmann, better known as the Hottentot Venus, was a young Khoi-San woman who was taken to Europe as an ethnographic exhibit in 1810. At her death, her body was dissected by Baron Cuvier, and her remains, including her genitals, were preserved in formaldehyde until returned for burial to South Africa in 2001.
16. The ANC objected to former U.S. president Jimmy Carter’s criticism of the South African government’s response to the pandemic in the following terms: “We find it alarming that President Carter is willing to treat our people as guinea pigs, in the interest of the pharmaceutical companies, which he would not do in his own country.” Mike Cohen, “S. Africa’s A.N.C. Criticizes Carter,” Associated Press, March 10, 2002. See also Power, “AIDS Rebel,” 60, for a brief account of the problems with Western pharmaceuticals and new-drug testing in South Africa.
17. For a fairly representative and accurate accusation of racism as the underlying cause of criticism of the ANC government, see Mbulelo Goniwe, “DP [Democratic Party—the predominantly white parliamentary opposition party] Becoming Choice of ‘Rightwing Dinosaurs,’ ” www.anc.org .za/ancdocs/pubs/mayibuye/mayi9801.html#DP.