Denying Aids: How South Africa Deepened Its Own Epidemic

Article by Tom Hartley. Edited by Liz Goodwin.

One of the most significant health problems in the modern world is that of Aids. Despite welcomed reports on a decline in Aids-related deaths and new HIV infections in 2010, down by 21% each on their respective peaks in 2005 and 1997 respectively, the number of people living with HIV has reached a record high of 34 million. These global trends have been reflected in the hotbed of the Aids epidemic: sub-Saharan Africa. Although the incidence of HIV has fallen in 22 sub-Saharan countries, the region continues to account for 68% of people who live with HIV, while 70% of new HIV infections in 2010 were reported in the continent. Despite the increasing availability of treatment and widening use of condoms, it is clear that much still needs to be done to make Africans aware of the threat of Aids. 

Moving beyond the cold hard facts and percentages, it seems African governments are finally willing to embrace change. Medicins Sans Frontieres argued that the reasons statistics heralded a ‘promising moment’ in the crisis, one in which ‘Governments in some of the hardest hit countries want to act on the science, seize this moment and reverse the Aids epidemic’. However government support has not always been there. The expected frontrunners of the region, South Africa, have so far done little to prevent the rise and still have the highest figures for HIV contraction. While a lack of money could justify the lack of progress, such as that which crippled Nelson Mandela’s government of the 1990s, deep rooted social misconceptions were undoubtedly a major factor. In the early years of the leadership of Thabo Mbeki, these social misconceptions took on a dangerous element – shaping official government policy. 

The outbreak of Aids, which first hit Africa through Malawian migrant workers in 1986, came under the Apartheid era. As elsewhere in Africa, the government was slow to react to the news, and between 1990 and 1992 alone infection rates trebled from 0.7% to 2.2%. Amidst the dying embers of the Apartheid regime, F.W De Klerk’s government began rolling out programs to tackle the ensuing crisis. The opposition to the reforms from black South Africans was overwhelming – paranoid, they accused the government of trying to keep the black population down and white supremacy. ‘Afrikaner Invention to Deprive us of Sex’ became the new interpretation of the disease by the very people most likely to catch it. 

Although Mandela stressed the significance of Aids when he was elected in 1994, and made it one of his priorities as president, a lack of funds prevented any real progress being made. In the following five years the number of people with HIV in South Africa had increased six fold, from five thousand to three million. But there was worse to come, as Mbeki’s government had the funds to carry out the project, but not the moral message Mandela had tried to develop.

Between 1999 and 2002, South Africans were in a state of flux as to the causes of the Aids epidemic, and what they could do to stop it. Thabo Mbeki had been seen by Westerners in the 1980s as the acceptable, educated face of the ANC, and later a natural successor to Mandela. However his attitude to Aids severely damaged his reputation and his enforced climb-down in 2002 left him humiliated. Mbeki, of whom Mandela said his great levels of diplomacy could be a weakness, became porous to the ideas of a small group of scientists who challenged the orthodox medical view on Aids, claiming HIV was merely a ‘passenger’ virus and that it was part of a large conspiracy of pharmaceutical companies to exploit Africans. When Mbeki allowed these views to stand side-by-side with the orthodoxy, he incredibly compared the ‘prohibition’ of dissent against the orthodox view on Aids to the suppression of black dissenters under Apartheid. On the world stage, in Durban at the 2000 International Aids conference, he rejected the science and claimed that poverty and not illness was the cause of HIV. Thus, the solution was to alleviate poverty and not invest in Western medicine. 

Why did Mbeki go it alone and defy scientific logic, to the point of damaging his credibility beyond repair? As Mandisa Mbali argues, Mbeki believed the science behind Aids was racist, and by denying Aids he was defending Africans against racism and neo-colonialism. This position is evident in a speech he gave in 2001: 

“Thus does it happen that others who consider themselves to be our leaders take to the streets… to demand that because we are germ carriers… we must perforce adopt strange opinions, to save a depraved and diseased people from perishing from self-inflicted disease… they proclaim that our continent is doomed to an inevitable mortal end because of our devotion to the sin of lust.” 

However Mbeki may have had some justification for these views. Mbali highlights the ‘flimsy evidence’ of 1980s arguments on the origins of Aids. The period saw a re-emergence of the Social Darwinist ideas prominent in the late nineteenth century; Africans engaged in bizarre sexual practices involving animals, had more anal intercourse, and were excessively promiscuous. Africans were once again being seen as more closely linked to apes than white people, and people who were at ‘high risk’ of contracting HIV, such as blacks and homosexuals, were discriminated against in the West. 

It was against this backdrop that the World Health Organisation adopted a strictly anti-discrimination policy in its research of HIV/Aids, and Mbeki’s paranoia about the disease grew. International criticism forced the government to adopt national prevention and treatment programs after 2002. However the damage had already been done. Even by 2005, treatment covered just 23% of the population, compared to 85% and 71% in neighbouring Botswana and Namibia respectively. At the end of his regime in 2008, research by Harvard’s school of public health argued that Mbeki’s government had been directly accountable for 300,000 deaths due to Aids: 

“We contend that the South African government acted as a major obstacle in the provision of medication to patients with Aids… Access to appropriate public health practice is often determined by a small number of political leaders. In the case of South Africa, many lives were lost because of a failure to accept the use of available ARVs to prevent and treat HIV/Aids in a timely manner.” 

Over the past two years there have been increased investments in Aids prevention in South Africa, and now ARVs (antiretrovirals) are available to 95% of pregnant women, preventing the spread of the disease to babies. Yet despite the financial investment, perceptions still need to be changed. President Jacob Zuma’s recent claim that showering after sex minimised the risk of contraction shows that South Africa still has a long way to go before it can really extinguish the threat of Aids.

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