The social construction of ARVs in South Africa*

Abstract

An estimated 5.5 million people are currently living with HIV/AIDS in South Africa, 4.9 million of them between the ages of 15–49, 18.8% of the total population in that age bracket (Department of Health, Republic of South Africa 2006). The potential medical and social benefits of anti-retroviral drugs (ARVs) would be substantial, but South Africa's leaders have faulted in their response to AIDS from the very beginning, particularly President Thabo Mbeki, who, in concert with the Minister of Health, has questioned the basic science of AIDS, and has condemned ARVs as poisonous. President Mbeki has created a false distinction between social causes and disease agents in his analysis that it is poverty, rather than HIV, that causes AIDS. He has made his arguments using post-colonial rhetoric to condemn pharmaceutical imperialism and medical experimentation on African populations. Opponents, most notably the pro-treatment social movement group, Treatment Action Campaign, claim that because poverty increases the risk of infection, illness and death due to HIV access to anti-retroviral medication is a social justice issue – justice demands the medications be available at all government clinics at no cost. In 2003 a government-sponsored treatment programme was launched, and by mid-2006 it was treating 140 000 persons with HIV/AIDS, less than 25% of the number estimated to require treatment. Treatment access, for all who need it in South Africa, is an ambitious but achievable goal. A new president will be elected in 2008, and many hope that this will result in a national treatment programme unshackled from the “AIDS denialism” of the current leaders. Former deputy president, Jacob Zuma, is likely to be the next president. His record on AIDS, and his patriarchal attitudes towards women, are troubling, however. One can only hope that the provincial health systems, which operate with a fair level of autonomy from the national Department of Health, will not be further hampered in their work by the politics of the central government.

Keywords:

• AIDS denialism
• treatment access
• traditionalism
• citizenship

Notes

*This article is based on a longer study that was developed in collaboration with Sexuality Policy Watch, with funding provided by the Ford Foundation. For an extended discussion of the issues examined in this article, see “Constitutional authority and its limitations: The politics of sexuality in South Africa”, which is available as part of the e-book, SexPolitics: Reports from the Front Lines, edited by Richard Parker, Rosalind Petchesky, and Robert Sember, 2007. This e-book includes a series of case studies, as well as a crosscutting analysis, focused on the politics of sexual health and rights in eight countries and two institutional contexts. SexPolitics can be found online at <http://www.sxpolitics.org/frontlines/home/>.

1. In his essay, We Are All People Living With AIDS-Myths and Realities of AIDS in Brazil, Hebert Daniel (1991) observes that, in Brazil “AIDS arrived before AIDS”, by which he meant that the conceptions of the epidemic were put in place before people actually learned about or experienced the disease. This double arrival, conditioned in many ways by specific aspects of globalisation, such as media or international development programmes, is repeated in location after location, as well as with each new development in the epidemic.

2. The ability of provincial governments to act autonomously and, if necessary, in direct contravention of the central government's policies, has enabled groups to implement ARV treatment despite the barriers set up by the national Department of Health and the Office of the President. The Western Cape provincial government, in particular, has refused to follow the central government's lead with respect to HIV/AIDS policy and services. As a result, ARV treatment has been available in clinics in the province ahead of clinics elsewhere in the country.