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South Africa: The Structural Forces Behind Mbeki's Aids Policy

Patrick Bond

15 May 2008

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opinion

In response to the recent extract from William Gumede's book "Thabo Mbeki and the Battle for the Soul of the ANC" published by Zed Books (http://zedbooks.co.uk), Patrick Bond suggests that there is a need to go beyond the individual reasons and look at the structural forces that have informed Mbeki's AIDS policy such as international and domestic financial markets, pharmaceutical manufacturers and a large reserve army of labour.

With millions of South Africans dying early because of AIDS, the battle against the disease would become one of the most crucial tests of the post-apartheid government. Its systematic failure to address AIDS, and especially its ongoing sabotage of medicinal treatment for HIV+ patients, led to periodic charges of 'genocide' by authoritative figures such as the heads of the Medical Research Council (Malegapuru William Makgoba), SA Medical Association (Kgosi Letlape), and Pan Africanist Congress health desk (Costa Gazi), as well as leading public intellectual Sipho Seepe.

Aside from Mbeki, Pretoria's main saboteurs were health minister Manto Tshabalala-Msimang and trade minister Erwin; the latter two were accused by the Treatment Action Campaign (TAC) of culpable homicide during a March 2003 civil disobedience campaign. Even in the weeks before the 2004 election, Mbeki and Tshabalala-Msimang continued to practice denialism, obfuscation, delays, bureaucratic manoeuvres, and withdrawal of resources for treatment. Educational campaigns like LoveLife's were based upon fatuous marketing to hip-hop youth, and there was virtually nothing done to combat domestic violence, rape, multiple partners and patriarchy. Across Africa more generally, the 'ABCs' of abstinence, being loyal and condoms were particularly ineffectual within the confines of male-dominated marriage, leading to the tragedy that young women's infection rate was twice as high as that of men.[1]

A great deal has been written about Pretoria's malfeasance.[2] The point of revisiting it here while documenting South Africa's elite transition is to provide a structural explanation for the crisis. Beyond the oft-cited peculiarities of the president himself, there are three deeper reasons why local and global power relationships mean that the battle against AIDS has to date mainly been lost.[3]

One reason is the pressure exerted by international and domestic financial markets to keep Pretoria's state budget deficit to three per cent of GDP. Recall the telling remark of the late Parks Mankahlana, Mbeki's main spokesperson, who in March 2000 justified to Science magazine why the government refused to provide relatively inexpensive antiretrovirals (ARVs) like Nevirapine to pregnant, HIV-positive women: 'That mother is going to die and that HIV-negative child will be an orphan. That child must be brought up. Who is going to bring the child up? It's the state, the state. That's resources, you see.'[4] Instead of saving lives, Mbeki's finance ministry adopted higher priorities: slashing corporate taxes, redeploying state resources to purchase high-tech arms, and repaying roughly $25 billion of apartheid-era foreign debt and a bit more in apartheid domestic debt, which could have been declared 'odious' in legal terms. Local and international bankers generally approved such examples of fiscal laxity, in contrast to expanding state health spending and other social budgets, which they have explicitly not supported.

The second structural reason is the residual power of pharmaceutical manufacturers to defend their rights to 'intellectual property', i.e. monopoly patents on life-saving medicines. This pressure did not end in April 2001 when the Pharmaceutical Manufacturers Association withdrew their notorious lawsuit against the South African Medicines Act of 1997. That Act allows for parallel import or local production, via 'compulsory licences', of generic substitutes for brand-name antiretroviral medicines. Big Pharma's power was felt in the debate over essential drugs for public health emergencies at the November 2001 Doha World Trade Organisation summit, and ever since.

The third structural reason for the ongoing HIV/AIDS holocaust in South Africa is the vast size of the reserve army of labour, for this feature of capitalism allows companies to replace sick workers with desperate, unemployed people instead of providing them with treatment. The latter point deserves elaboration, simply because so many lives are at immediate risk, and so much evidence has mounted that corporate South Africa's preferred approach has been, in essence, mass murder by denial of medical benefits.

This was the initial conclusion reached after a year of study at Africa's largest company, Anglo American Corporation. Anglo has 160,000 employees, of whom 21 per cent are estimated to be HIV-positive. Once Big Pharma appeared to retreat from its lawsuit, the company announced that it would provide antiretroviral medicines to its workforce, which meant literally tens of thousands of lives might be saved in the short term. But in June 2001, the Financial Times reported on Anglo's 'plans to make special payments to miners suffering from HIV/AIDS, on condition they take voluntary retirement.' However, in addition to bribing workers to go home and die, Anglo told the Financial Times, 'treatment of employees with antiretrovirals can be cheaper than the costs incurred by leaving them untreated.' In August, Anglo's vice president for medicine, Brian Brink, bragged in Business Day about a 'strategy [which] involved offering wellness programmes, including access to antiretroviral treatment.' According to that report, 'The company believed that the cost of its programmes would eventually be outweighed by the benefits its received in gradual gains in productivity, [Brink] concluded. Although it was indeed a risky strategy, it was the only one Anglo could pursue in the face of such human suffering.'

Then in October 2001, Anglo simply retracted its promise, once cost-benefit analysis showed that 146,000 workers just weren't worth saving. According to the Financial Times, Brink 'said the company's 14,000 senior staff would receive antiretroviral treatment as part of their medical insurance, but that the provision of drug treatment for lower income employees was too expensive.' Brink explained the criteria for the fatal analysis: '[Antiretrovirals] could save on absenteeism and improved productivity. The saving you achieve can be substantial, but we really don't know how it will stack up. We feel that the cost will be greater than the saving.' As the Wall Street Journal recorded:

'In a controversial move that could have wide ramifications for how companies in poor countries handle AIDS, mining giant Anglo American PLC has put on hold a feasibility study to provide AIDS drugs to its African work force, according to people familiar with the situation. When it disclosed its plans for the study a year ago, Anglo garnered wide praise because it was one of the first major corporations to reveal measures aimed at treating AIDS cases among its rank and file African employees.'[5]

A few months later Anglo changed its mind once again, as AIDS ravaged the middle layer of the workforce, and the multi-class TAC raised consciousness sufficiently high as to get trades union support for members' treatment. Indeed, in the cases of both Anglo and Coca Cola, the other factor that appeared in 2002 was the spectre of consumer protest over the firms' refusal to treat employees. I was reliably informed by insiders that for Anglo, the prospect of demonstrators at the August 2002 World Summit on Sustainable Development dragging up many other bits of dirty laundry intimidated the company's executives into taking pre-emptive action on the AIDS front. Coke's main bottler in South Africa had also failed to insure two-thirds of its 4,000-strong workforce at a sufficient level to allow the HIV-positive workers access to ARVs, and was subject to international protest over African AIDS policies.

However, even though the costs of HIV/AIDS - absenteeism, declining productivity, payouts for early death - soared to as high as 25 per cent of payroll by 2003, according to the Financial Times, most employers are still hesitant to provide ARVs:

'Untreated, HIV typically takes four to five years to manifest itself as full-blown AIDS, and companies are reluctant to pay for a risk that they cannot see... Persuading managers to part with fees [AIDS treatment programmes] today for costs that will hit company earnings years down the line has been a hard sell.'[6]

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