AIDS and the scientific governance of medicine in post-apartheid South Africa

African Affairs

Volumn 107, Issue 427, 2008, Pages 157-176

  Nattrass, Nicoli ^a,b  

^a UNIVERSITY OF CAPE TOWN   (South Africa)

^b UNIVERSITY OF KWAZULU NATAL   (South Africa)

Author keywords

[No Author keywords available]

Indexed keywords

ACQUIRED IMMUNE DEFICIENCY SYNDROME; DISEASE CONTROL; DISEASE RESISTANCE; DISEASE TREATMENT; MEDICINE; POST-APARTHEID;

AFRICA; SOUTH AFRICA; SOUTHERN AFRICA; SUB-SAHARAN AFRICA; WESTERN CAPE;

EID: 42049110580     PISSN: 00019909     EISSN: 14682621     Source Type: Journal    
DOI: 10.1093/afraf/adm087     Document Type: Article

References (106)

1. Quoted in Anso Thom and Kerry Cullinan, 'Responses to HIV/AIDS', Health-e News, 28 November 2004. Available on (30 April 2007).
2. John Iliffe, The African AIDS Epidemic: A history (James Currey, Oxford and Double Storey, Cape Town, 2006) p. 43.
3. Helen Schneider and Joanne Stein, 'Implementing AIDS policy in post-Apartheid South Africa', Social Science and Medicine 52 5 (2001) pp. 723-31.
4. Nicoli Nattrass, Mortal Combat: AIDS denialism and the struggle for antiretrovirals in South Africa (University of KwaZulu-Natal Press, Pietermaritzburg, 2007), Chapter 3.
5. For a history of South African policy towards the use of ARVs, see Nattrass, Mortal Combat.
6. AIDS denialists prefer to call themselves 'dissidents'. However, as they simply deny the existing scientific evidence, they are more appropriately termed 'denialists' (see Nattrass, Mortal Combat, pp. 24-33).
7. Nattrass, Mortal Combat, p. 99.
8. Department of Health, 'HIV and AIDS and STI Strategic Plan for South Africa: 2007-2011' (Draft 9, Department of Health, Pretoria, 14 March 2007; ).
9. Madlala-Routledge was ostensibly fired for taking an unauthorized trip to an AIDS conference in Spain, but this was widely interpreted as an excuse (see reports available on ).
10. See press report, 'Manto sounds ARV alarm', 7 August 2007 (available on ).
11. James Myburgh, 'The response of the ANC and Thabo Mbeki to the HIV/AIDS epidemic 1997-2002' (seminar presented at the Interdisciplinary AIDS seminar series, Oxford University, 23 November 2005).
12. Thabo Mbeki, 'ANC has no financial stake in Virodene', Mayibuye, March 1998 ) (30 April 2007).
13. Goran Hyden and Kim Lanegran 'AIDS, policy and politics: East Africa in comparative perspective', Policy Studies Review 12, 1 (1993) pp. 47-65.
14. Mbeki, 'ANC has no financial stake'.
15. See Peter Folb, 'Medicines Control Council: Setting the record straight', South African Medical Journal 88, 10 (1998), pp. 498-502
16. and A. Gray, T. Matsebula, D. Blaau, H. Schneider and L. Gilson, 'Policy change in a context of transition: Drug policy in South Africa: 1989-1999' (Centre for Health Policy, School of Public Health, University of the Witwatersrand, 2000).
17. Myburgh, 'The response of the ANC'.
18. Anthony Brink, 'AZT: A medicine from hell', The Citizen, 17 March 1999.
19. Des Martin, 'AZT: A medicine from heaven', The Citizen, 31 March 1999.
20. Stephen Epstein, Impure Science: AIDS, activism and the politics of knowledge (University of California Press, Berkeley, CA, 2006).
21. For scientific references to the proven benefits of ARVs and to the falsity of AIDS denialist claims, see .
22. See also Nattrass, Mortal Combat, Chapter 2.
23. See, for example, Jon Cohen, 'The Duesberg phenomenon', Science 266, 5191 (1994), pp. 1642-9
24. and P. Galea and J. Chermann, 'HIV as the cause of AIDS and associated diseases', Genetica, 104, 2 (1994), pp. 133-42.
25. For further evidence debunking AIDS denialism, see .
26. Nattrass, Mortal Combat, Chapter 2.
27. Thabo Mbeki, 'Address to the National Council of Provinces, Cape Town, 28 October 1999'. (30 April 2007).
28. Thabo Mbeki, 'Remarks at the first meeting of the Presidential Advisory Panel on AIDS, Pretoria, 6 May 2000'. (30 April 2007).
29. Epstein, Impure Science, pp. 229-30.
30. See Nattrass, Mortal Combat, pp. 57-60.
31. Thomas Kuhn, The Structure of Scientific Revolutions (University of Chicago Press, Chicago, IL, 1962).
32. See, for example, Epstein, Impure Science.
33. Presidential AIDS Advisory Panel, 'A synthesis report of the deliberations by the panel of experts invited by the President of the Republic of South Africa, the Honourable Thabo Mbeki (2001)', (30 April 2007), pp. 22-3.
34. Ibid., pp. 15, 79, 83.
35. For a history, see Nattrass, Mortal Combat.
36. See, for example, Virginia van der Vliet, 'South Africa divided against AIDS: A crisis of leadership' in K. Kauffman and D. Lindauer (eds), AIDS and South Africa: The social expression of a pandemic (Palgrave Macmillan, New York, 2004), pp. 48-96
37. and William Gumede, Thabo Mbeki and the Battle for the Soul of the ANC (Zebra Press, Cape Town, 2005).
38. Gumede, Thabo Mbeki, p. 159.
39. See, for example,Nicoli Nattrass, The Moral Economy of AIDS in South Africa (Cambridge University Press, Cambridge, 2004);
40. Anthony Butler, 'South Africa's AIDS policy, 1994-2004: How can it be explained?', African Affairs 104, 417 (2004), pp. 591-614;
41. Pieter Fourie, The Political Management of HIV and AIDS in South Africa: One burden too many? (Palgrave Macmillan, New York, 2006).
42. Martin Hensher, 'The costs and cost effectiveness of using Nevirapine or AZT for the prevention of mother to child transmission of HIV - current best estimates for South Africa' (confidential briefing, 19 April 2000).
43. Nicoli Nattrass, 'What determines cross-country access to antiretroviral treatment?', Development Policy Review 24, 3 (2006), pp. 321-37.
44. Helen Schneider, 'On the fault line: The politics of AIDS policy in contemporary South Africa', African Studies 61, 1 (2002), pp. 145-67.
45. Theodore Sheckels, 'The rhetoric of Thabo Mbeki on HIV/Aids: Strategic scapegoating?', The Harvard Journal of Communication 15, 2 (2004), pp. 69-82.
46. Tom Lodge, Politics in South Africa: From Mandela to Mbeki (Indiana University Press, Indiana, IN, 2002).
47. Nattrass, The Moral Economy, p. 177.
48. See, for example, Patrick Bond, 'The decommodification strategy in South Africa', State of Nature (Winter 2006). (30 April 2007).
49. Edwin Cameron, A Witness to AIDS (David Philip, Cape Town, 2005);
50. Mandisa Mbali, 'AIDS discourse and the South African state: Government denialism and post-apartheid AIDS policy making', Transformation, 54 (2004), pp. 104-22.
51. See, for example, D. Fassin and H. Schneider, 'The politics of AIDS in South Africa: Beyond the controversies', British Medical Journal 326 (1 March 2003), pp. 495-7; Sheckels, 'The rhetoric of Thabo Mbeki'; and Mbali, 'AIDS discourse'.
52. Howard Phillips, 'HIV/AIDS in the context of South Africa's epidemic history' in Kauffman and Lindauer, AIDS and South Africa, pp. 31-47.
53. Quoted in Terry Bell, 'Rath and Company is an assault on the working class', Business Report, 17 March 2006, Johannesburg.
54. Nattrass, Mortal Combat, pp. 91, 120.
55. Van der Vliet, 'South Africa divided', p. 66.
56. R. Dorrington, D. Bourne, D. Bradshaw, R. Laubscher and I. Timaeus, 'The impact of HIV/Aids on adult mortality in South Africa' (Burden of Disease Research Unit, Medical Research Council, 2001). (30 April 2007).
57. Department of Health and Statistics South Africa, 'Release of MRC report on AIDS-related mortality in adults' (press release, 16 October 2001). (30 April 2007).
58. Nattrass, Mortal Combat, pp. 92-5.
59. Quoted in Nattrass, Mortal Combat, p. 95.
60. See Nathan Geffen, 'Echoes of Lysenko: State-sponsored pseudo-science in South Africa' Social Dynamics 31, 2 (2005), pp. 182-210.
61. See 'MRC head dismisses Rath "link"', Mail and Guardian, Johannesburg, 8 June 2006.
62. Followers of the 'Perth Group' believe that HIV does not exist (because they claim erroneously that it has never been isolated, and followers of Duesberg believe that HIV exists, but that it is a harmless 'passenger virus' (and thus cannot cause AIDS).
63. See Mark Heywood, 'Preventing mother to child HIV transmission in South Africa: Background, strategies and outcomes of the Treatment Action Campaign case against the Minister of Health', South African Journal of Human Rights 19 (2003), pp. 278-315.
64. Laurie Garrett, 'Anti-HIV drug poison, summit told', The Age, 9 July 2001. (30 April 2007).
65. Nattrass, Mortal Combat, Chapter 5.
66. Anthony Butler, 'The negative and positive impacts of HIV/AIDS on democracy in South Africa', Journal of Contemporary African Studies 23, 1 (2005) pp. 3-26.
67. J. Kindra, 'AIDS: Ministers revolt', in Mail and Guardian, Johannesburg, 15 August 2003.
68. Nattrass, Mortal Combat, Chapter 6.
69. Department of Health, 'Operational plan for comprehensive HIV and Aids care, management and treatment for South Africa: 19 November 2003'. (30 April 2007).
70. Nicoli Nattrass, 'South Africa's "rollout" of antiretroviral treatment: A critical assessment', Journal of Acquired Immune Deficiency Syndrome 43, 5 (15 December 2006) pp. 618-23.
71. Kerry Cullinan, 'Health Minister promotes nutritional alternatives to ARV rollout', Health-e news, 30 May 2005
72. and Nattrass, Mortal Combat, Chapter 7.
73. Nattrass, Mortal Combat.
74. Adam Ashforth, Witchcraft, Violence and Democracy in South Africa (University of Chicago Press, Chicago, IL, 2005), p. 54.
75. Jo-Anne Smetherham, 'Bogus AIDS cure exposed', The Star, Johannesburg, 17 July 2003.
76. Liz McGregor, Khabzela: The life and times of a South African (Jacana Media, Johannesburg, 2005) p. 18.
77. Ibid., pp. 17-23.
78. Quoted in ibid., p. 17.
79. Cullinan, 'Health Minister'.
80. Geffen, 'Echoes of Lysenko'.
81. E. Brits, 'Burglars "peed" on AIDS Records', Die Burger, 30 May 2005, Cape Town.
82. Cullinan, 'Health Minister'.
83. See www.mccza.org.za. (30 April 2007).
84. See Geffen 'Echoes of Lysenko'.
85. Kerry Cullinan, 'The curious tale of the Minister and the vitamin seller', Health-e news, 25 April 2005. Available on: http://www.health-e.org.za/news/article.php?uid=20031215 (29 September 2007).
86. Kerry Cullinan and Anso Thom, 'Official nod for voodoo trials?' Mail and Guardian online, 19 January 2006. Available on: http://www.mg.co.za/articlePage.aspx?articleid=255040&area=/insight/ insight_comment_and_analysis/ (29 September 2007).
87. Ibid.
88. Quoted in ibid.
89. Ibid.
90. Ibid.
91. Quoted in P. Joubert, 'Health Department DG frees seized AIDS drugs', Mail and Guardian, Johannesburg, 7 July 2006.
92. 'Health ministry backs AIDS muti', News24.com, 13 February 2006. (30 April 2007).
93. S. Calvert, 'HIV patients get sicker on herbal cures', Baltimore Sun 21 August 2006.
94. Ibid.
95. Herbert Vilakazi, 'A new model of health-care delivery for KwaZulu Natal' (unpublished paper, 29 July 2005).
96. 'University pours cold water on AIDS "Cure"', SAPA, 18 March 2006. Available on: http://www.aegis.org/news/sapa/2006/SA060308.html (30 April 2007).
97. Department of Health, 'Statement: DA undermines indigenous knowledge' (press release, 13 February 2006). (30 April 2007).
98. Quoted in 'Small clinic at centre of debate over traditional medicine', IRIN News, 1 May 2006. http://www.irinnews.info/ S_report.asp?ReportID=53090&SelectRegion=Southern_Africa (30 April 2007).
99. E.g. G. Smit, R. Geskus, S. Walker, C. Sabin, R. Couthino, K. Porter, M. Prins and the CASCADE Collaboration. 'Effective therapy has altered the spectrum of cause-specific mortality following HIV serocoversion', AIDS 20, 50 (2006), pp. 741-9.
100. E. Mills, C. Cooper, D. Seely and I. Kanfer, 'African herbal medicines in the treatment ofAHIV: Hpoxis and Sutherlandia: an overview of evidence and pharmacology', Nutrition Journal 4, 19 (2003) pp. 2-6.
101. The data and assumptions behind the model are available in the spreadsheet version of the model which can be downloaded from www.assa.org.za. Data include antenatal HIV prevalence surveys, demographic data from censuses and behavioural data from demographic and health surveys and related social science research. Key assumptions include a 50 percent uptake of formula feeding for mothers on the MTCTP programme; a 47 percent reduction in perinatal transmission as a result of HAART; a 1.76 log reduction in viral load while on HAART (and an increase of 3 in transmissibility per log increase in viral load); and a 75 percent reduction of AIDS morbidity while on HAART. For further discussion of the assumptions (and biomedical and social evidence informing them) see R. Dorrington, D. Bradshaw, L. Johnson and T. Daniel, 'The demographic impact of HIV/AIDS in South Africa: National and provincial indicators for 2006' (Joint publication of the Centre for Actuarial Research, the Burden of Disease Research Unit and the Actuarial Society of South Africa (ASSA), 2006). Available on .
102. See also N. Nattrass, 'Modelling the relationship between antiretroviral treatment and HIV prevention: Limitations of the Spectrum AIDS Impact Model in a changing policy environment', African Journal of AIDS Research 6, 2 (2007), pp. 129-37.
103. Peter Mandelson, 'Genocide by Sloth', New Statesman, 18 February 2002.
104. Herbert Vilakazi, 'Conception and terms of reference of "The Presidential Project on African Traditional Medicine"' (unpublished but widely circulated paper, 2006), p. 6 (copy on file with the author).
105. Quoted in S. Bevan, 'Deputy Minister takes on Manto', Sunday Tribune 10 December 2006.
106. See J. Maker, M. Power, C. Molele and B. Naidu, 'Manto: A drunk and a thief', Sunday Times, 19 August 2007.