analysisBy Tim Trengove-Jones
Johannesburg — LET's not be misled by our leadership. As controversy surrounding Health Minister Manto Tshabalala-Msimang increases, it's important to keep seeing the wood for the trees. For two successive weeks, President Thabo Mbeki's online newsletter has defended his health minister. In both, he has attacked the media and insisted we apply our minds to "facts". Attacks on the media are standard in contemporary government discourse and embody a tendency to beat the messenger bringing bad news. They have also been the stock in trade of the health minister's mode of responding to criticism.
"Facts" are often tricky. This trickiness has historically informed what is currently at issue: the in adequacy of the responses of both the president and his health minister to the country's pre-eminent health crisis, the HIV/Aids pandemic .
This week, Mbeki is evidently riled by the (British) Independent's assertion that his "stance on Aids has left SA with the world's worst HIV epidemic." He claims that former deputy health minister Nozizwe Madlala-Routledge seemed "very determined to advance" this "litany of blatant untruths".
The "untruths" that clearly touched a nerve lie in the Independent's identification of "a decade of Aids denialism at the heart of the South African political leadership".
In November last year, Madlala-Routledge asserted that SA's Aids programme had been compromised by "denialism at the highest level". We recall that Tshabalala-Msimang - then on sick leave - issued an angry response, about people using her absence to "turn others into champions of a campaign to rid our government of the so-called 'HIV and Aids denial at the highest level'."
The trajectory is confirmed with Mbeki's newsletter last week being titled, Who are our heroes and heroines? The newsletter reiterates the Presidency's earlier claim that the issue is "consistent with attempts by some in the media and elsewhere to demean the person of the minister". Presidential spokesman Mukoni Ratshitanga clung to this tack by referring to "a trend ... to demonise the person of the minister".
Let's not be made dizzy by spin. The issue is not personality but performance.
It is not what Ratshitanga calls "character assassination" but political accountability.
Seeking to offer a pertinent history to dispel what he calls "the shameless lies" fostered by the Independent, Madlala-Routledge, and her supporters, Mbeki cites government-sponsored HIV/Aids efforts listed in the 2007-2011 Strategic Plan (SP) on HIV/Aids, commencing from 1992.
But such an impressive-seeming catalogue makes government performance more, rather than less, culpable. We had some of the machinery in place and yet it was frequently stymied. To ask why is to grasp the nettle of denialism that has, once more, so riled the president. His current newsletter is just one example of a contemporary feature of our HIV/Aids landscape. It is a form of second-generation denialism, which operates by trying to deny a history of denialism. Such repression of the facts suggests official embarrassment. It assumes widespread popular amnesia. It resorts to cries of "character assassination". Or, most perniciously, it seeks to distort the nature of the debate by misrepresenting the nature of denialism itself.
Trying to evade accountability for under-performance in a national crisis, it is claimed that because there is no specific instance in which Mbeki publicly denied that HIV causes Aids, there was no denialism. This ploy refuses to engage with the nature of denialism. As Nicoli Nattrass has carefully argued in her recent book, Mortal Combat: Aids Denialism and the Struggle for Antiretrovirals in South Africa, denialism is a multifaceted attitude that purports, in the name of rigorous scientific inquiry, to "question" the science of Aids; that via such "open debate" actually fosters confusion in the public at large by drawing medical science into disrepute; that stigmatises antiretrovirals (ARVs) by questioning their safety and efficacy; that therefore impedes the implementation of ARV therapies in the public health system; and that insinuates a conspiracy on behalf of pharmaceutical companies in the advocacy of both Aids science and ARV treatment.
The sad fact is that all these behaviours have characterised Mbeki's government. It is therefore not true that under Mbeki's leadership there was no Aids denialism at the highest level. This fact might be uncomfortable for some of our leaders and tragic for many of our citizens, but it is a fact.
Let's offer a brief, parallel history to that sketched in the 2007-2010 strategic plan. In January 2000, Mbeki appointed no scientists or doctors to the National Aids Council. In April 2000 he wrote to world leaders suggesting that dismissal of Aids denialists was akin to "books (being) burnt and their authors immolated by fire". He gave new exposure to long-discredited Aids dissidents such as Peter Duesberg and David Rasnick, by corresponding with them and appointing them to his wasteful Aids Advisory Panel in May 2000. In September 2000, Mbeki told Time that ARVs shouldn't be used to treat HIV because immunodeficiency could result from something other than a "single virus".
The list could be extended. The result, as Nattrass observes, is that "Mbeki and the health minister portray(ed) Aids science and policy formation as deeply contested and contestable".
Evidence of denialism is found in the fact that Mother-to-Child Prevention Prophylaxis (MTCTP), as well as the ARV roll-out in the public sector, were embarked upon only after the Treatment Action Campaign took the government to court. In the MTCTP case, with the health minister present, the government's counsel argued that nevirapine was akin to thalidomide. This the court found false and specious. Immediately after the constitutional court ruling on MTCTP, the health minister told the media, "I must poison my people." (July 2002)
In his newsletter, Mbeki is dismissive of the suggestion that SA is faced with an "international PR crisis with regard to HIV and AIDS". He sees this claim as "not familiar with any of the history".
Remodelling his own titular question, we might ask, "Whose history?" As recently as late last year, as Madlala-Routledge annoyingly pointed out, the World Aids Conference was a PR disaster for this country. In its wake, a group of people prominent in the science and administration of HIV/Aids sent a letter to Mbeki calling for the resignation of his health minister. They pointed out that SA's Operational Plan of November 2003 aimed to be treating 380000 in the public sector by September last year, but that "fewer than half that number" was achieved.
Facts like these point to how denialism has compromised our HIV/Aids programmes. Using the Actuarial Society of SA's 2003 model, Nattrass estimates that had programmes not been inhibited, about 340000 lives might have been saved. Such grim estimates make face-saving attempts to rewrite history both understandable and culpable. Such facts are larger than "the person of the minister". They should make us sceptical of aspects of the Presidency's "reassur (ance) ... of the integrity of the public health system as led by Tshabalala-Msimang." After all, Mbeki endorses the free play of the intellect in the writing of history and pursuit of facts.
Trengove-Jones, a senior lecturer at the University of the Witwatersrand, has written widely on the politics of HIV/Aids.