Science, Social Science and Pseudo-Science in the HIV/AIDS Debate in Southern Africa

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Notes

¹ T. Barnett and G. Prins, HIV/AIDS and Security: Fact, Fiction and Evidence: A Report to UNAIDS (London, LSEAIDS, 2005), p. 7, available at http://www.lse.ac.uk/collections/DESTIN/publink/barnett/Barnett%20and%20Prins%20Fact%20Fiction%20and%20Evidence%20REPORT.pdf, retrieved on 19 July 2007.

² L. Garrett, The Coming Plague: Newly Emerging Diseases in a World Out of Balance (New York, Penguin Books, 1995).

³ Article in Science, 26 May 2006, as reported by I. Sample, ‘Hunt for origin of HIV pandemic ends at chimpanzee colony in Cameroon’, The Guardian, 26 May 2006.

⁴ It is perhaps possible to argue, as Michel Garenne and Peter Aaby (cited in Garrett, The Coming Plague, p. 590) have done in the case of measles, that the virus increased in virulence as it passed from one genetically similar person to another, thus explaining why Africa's being the ‘first’ makes its HIV/AIDS epidemic the ‘worst’, but Iliffe does not argue this, nor, indeed, does it fit all the facts.

⁵ The absolute numbers in India may now outmatch those in South Africa, but relative to the size of population, the prevalence level is of course far, far lower.

⁶ All the figures in this paragraph derive from UNAIDS, 2006 Report on the Global AIDS Epidemic: Executive Summary (Geneva, UNAIDS, 2006), p. 8. The prevalence levels are considerably lower than in previous reports, partly a result of better reporting and the mortality of people with AIDS. There is also a difference between the prevalence found in pregnant women who, by definition, are sexually active, and prevalence in the total population aged between fifteen and 49.

⁷ UNAIDS/WHO, AIDS Epidemic Update (Geneva, UNAIDS, 2006), p. 10.

⁸ M.W. Makgoba and A. Whiteside, HIV/AIDS: Confronting the Future in Southern Africa (London, Cannon Colins Educational Trust for Southern Africa, 2004), table ‘HIV Prevalence, Thailand and South Africa, 1990–2000’, p. 17.

⁹ N. Nattrass, ‘AIDS, Inequality and Access to Antiretroviral Treatment: A Comparative Analysis’, in I. Shapiro (ed.), New Departures in Political Science (New Haven, Yale University Press, forthcoming). I am grateful to Dr Nattrass for allowing me to quote from her paper and for explaining her methodology to a novice.

¹⁰ I am grateful to Dr Peter Ndumbe of Cameroon for alerting me to this possibility (personal communication, 8 February 2008).

¹¹ There are two main types of HIV, HIV1 and HIV2. HIV2 is chiefly found in West Africa, is known to have a longer incubation period and is less easily transmitted than HIV1. HIV1 has been divided into two major groups: O for Outliers (largely Gabon, Cameroon and France) and the main group (M), which is further subdivided into at least eight alphabetised clades or subtypes. South Africa has B and C clades.

¹² D. Posel, ‘Baby Rape: Unmaking Secrets of Sexual Violence in Post-Apartheid South Africa’, in G. Reid and L. Walker (eds), Men Behaving Differently (Cape Town, Double Storey, 2005), pp. 21–64; idem, ‘Sex, Death and the Fate of the Nation: Reflections on the Politicisation of Sexuality in Post-Apartheid South Africa’, Africa, 75, 2 (2005), pp. 125–53.

¹³ A. Whiteside and C. Sunter, AIDS: The Challenge for South Africa (Cape Town, Human and Rousseau, 2000), p. 124.

¹⁴ According to Dr Christen Halle of the Department of Peace-keeping Operations (DKPO) at the UN, ‘it would be surprising if war were NOT a major factor in the spread of HIV in Africa. … Military service exaggerates male behaviour’ by removing young men in their sexual prime from family and community constraints, ‘inculcating a sense of risk-taking and invincibility, and promoting aggression and toughness as the male ideal – attitudes that extend to sexual behaviour and often lead to contact with commercial sex workers’ (cited in M. Fleshman, ‘AIDS Prevention in the Ranks’, African Recovery [now African Renewal], 15, 1–2 (June 2001), p. 16, available at http://www.un.org/ecosocdev/geninfo/afrec/vol15no1/aidsmil.htm, retrieved on 5 June 2007.

¹⁵ UNAIDS/WHO, AIDS Epidemic Update (Geneva, UNAIDS, 2006).

¹⁶ Baylies cites S. Nyanzi, R. Pool and J. Kinsman, ‘The Negotiation of Sexual Relationships among School Pupils in South-Western Uganda’, AIDS Care, 13, 1 (2001), pp. 83–98. See also AAE, p. 130.

¹⁷ M. Marco and E.J. Bernard, ‘Is Uganda's HIV Prevention Success Story “Unravelling”?’, Aidsmap News, 22 August 2006, available at http://www.aidsmap.com/en/news/E7A3F648-945A-405D-BF00-89BA7E7FDCDF.asp, retrieved on 16 March 2007. Marco and Bernard reference L.A. Shafer et al., ‘HIV Prevalence and Incidence Are No Longer Falling in Uganda – A Case for Renewed Prevention Efforts: Evidence from a Rural Population Cohort 1989–2005, and from ANC Surveillance’ (Sixteenth International AIDS Conference, Toronto, abstract ThLB0108, 2006).

¹⁸ See, for example, S. Berry and R. Noble, ‘Why is Uganda Interesting?’, available at http://www.avert.org/aidsuganda.htm, retrieved on 13 March 2007 (Avert is an international AIDS charity); and D. Webb, ‘Legitimate Actors? The Future Roles for NGOs against HIV/AIDS in Sub-Saharan Africa’, PEAA, p. 22.

¹⁹ This has been signalled by the reconstitution of the South African National AIDS Council under the direction of the Deputy President, the appointment of Mark Heywood as her deputy, and the adoption of an HIV & AIDS and STI Strategic Plan for South Africa 2007–2011, formulated in close collaboration with the formerly blacklisted civic organisations. Mark Heywood is Project Director of the South African AIDS Law Project, National Treasurer of the Treatment Action Campaign (TAC) and the Chairperson of the Law, Ethics and Human Rights Task Team of South Africa's National AIDS Council.

²⁰ Posel, ‘Sex, Death’, p. 145.

²¹ D. Fassin and H. Schneider, ‘The Politics of AIDS in South Africa: Beyond the Controversies’, British Medical Journal, 326, 7,387 (March 2003), pp. 495–7, available at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid = 1125376, retrieved on 12 May 2007. Fassin is the Director of the Centre de Recherche sur les Enjeux Contemporains en Santé Publique, at the University of Paris; Schneider the Director of the Centre for Health Policy, School of Public Health, University of the Witwatersrand.

²² L. McGregor and S. Nuttall, ‘Interview: A Struggle for Life – The Life and Times of Khabzela’, WISER In Brief, 4, 1 (December 2005), pp. 28–9, available at http://wiserweb.wits.ac.za/PDF%20Files/Wiser-in-Brief-2005-December.pdf, retrieved on 19 July 2007.

²³ Ibid., p. 28.

²⁴ Ibid., p. 28.

²⁵ A. Ashforth and N. Nattrass, ‘Ambiguities of “Culture” and the Antiretroviral Rollout in South Africa’, Social Dynamics, 31, 2 (December 2005), pp. 285–303. In this article, they contrast the Treatment Action Campaign's Treatment Literacy Campaign, which aims at empowering people living with HIV/AIDS by teaching the science of AIDS and ARVS and ‘changing the way that people see things’ (p. 298), and a Department of Health video on AIDS, ‘which harnesses putative “indigenous knowledge” relating to illness and healing’, and plays into African fears of witchcraft (p. 285). The final quotation is on p. 300.

²⁶ McGregor and Nuttall, ‘Interview’, pp. 28–9.

²⁷ Although I have extended its meaning, I owe the powerfully explanatory phrase ‘choice-disabled’ to N. Andersson, ‘Prevention for Those Who Have Freedom of Choice – or among the Choice-Disabled: Confronting Equity in the AIDS Epidemic’, AIDS Research and Therapy, 3, 23 (September 2006), available at http://www.aidsrestherapy.com/content/3/1/23, retrieved on 10 July 2007. In another study, based on a sample of 269,770 South African schoolchildren aged 10 to 19, Andersson et al. conclude: ‘The views of South African youth on sexual violence and on the risk of HIV infection and AIDS were compatible with acceptance of sexual coercion and “adaptive” attitudes to survival in a violent society. Views differed little between the sexes’. See N. Andersson et al., ‘National Cross Sectional Study of Views on Sexual Violence and Risk of HIV Infection and AIDS among South African School Pupils’, British Medical Journal, 329, 7,472 (October 2004), 952, available at http://bmj.com/cgi/content/full/329/7472/952, retrieved on 12 March 2007. I am grateful to Dr Tim Wilson of CIET for drawing this to my attention.

²⁸ Poku has an excellent table on pp. 37–8 showing the connections between Structural Adjustment Policies and the policy response, the domestic impact and the implications for the spread of HIV/AIDS.

²⁹ Van Niekerk argues that ‘one of the main complexities facing the management of the disease in Africa is … this kind of consistent politicisation of the discourse about AIDS – a politicisation that raises the level of inflammatory rhetoric and moral outrage about the injustices of the universe and the global economy but is irrelevant to the devising of practical programmes to assist ordinary and not always politically conscious sufferers …’, and complains of ‘undue politicised rhetoric about an alleged social outrage which is essentially a health problem and can significantly be curbed if primarily addressed as such’ (E&A, p. 59). This flies in the face of both Judge Edward Cameron's moving introduction to E&A and Benatar's (and others’) view that medical solutions will not work unless global inequities are recognised and addressed. See also E&A, p. 156, where van Niekerk repeats his view that ‘HIV/AIDS is primarily a health problem and not a political problem, although we may recognise that socio-political factors, such as chronic poverty and illiteracy can impact on the pandemic’.

³⁰ T. Barnett and A. Whiteside, AIDS in the Twenty-First Century: Disease and Globalization (Basingstoke, Palgrave Macmillan, 2002).

³¹ Nyanzi et al., ‘Negotiation’, cited by Baylies in PEAA, p. 79; Andersson et al., ‘National’.

³² The ‘brutalisation’ of the poor (read ‘black poor’) occurs no fewer than three times in two pages of van Niekerk's text (E&A, pp. 65–6). Coupled with ‘the moral depravity of sectors of South African society’ (p. 62) (read ‘black men’), one could be reading a nineteenth-century missionary tract. No wonder this kind of talk sets the President's teeth on edge.

³³ S. Leclerc-Madlala, ‘Transactional Sex and the Pursuit of Modernity’, Social Dynamics, 29, 2 (2003), p. 216.

³⁴ A. Ashforth, Witchcraft, Violence, and Democracy in South Africa (Chicago, University of Chicago Press, 2005), pp. 10, 18.

³⁵ ‘The Quest for Healing in South Africa's Age of AIDS’, special issue of Social Dynamics, 31, 2 (December 2005).

³⁶ N. Andersson, ‘Western and Traditional African Medicine – Working Together on AIDS’, BMJ, 331, 7,519 (October 2005), 785, available at http://www.bmj.com/cgi/content/full/331/7519/785, retrieved on 10 June 2007.

³⁷ C. Dugger, ‘Clinton Foundation Announces a Bargain on Generic AIDS Drugs’, New York Times, 9 May 2007, available at http://www.nytimes.com/2007/05/09/world/09aidsdrugs.html?ex = 1336363200&en = 833d79d8593e5105&ei = 5088&partner = rssnyt&emc = rss, retrieved on 11 June 2007.

³⁸ N. Nattrass, The Moral Economy of AIDS in South Africa (Cambridge, Cambridge University Press, 2004).

³⁹ According to P. Sidley, ‘South Africa and Britain Reach Agreement to Curb Poaching of Healthcare Staff’, BMJ, 329, 7,465 (September 2004), 532, available at http://www.bmj.com/cgi/content/full/329/7465/532, retrieved on 28 May 2007, 6 per cent of the total healthcare workforce in the United Kingdom is from South Africa. About 600 South African doctors are registered to practise in New Zealand, and ten per cent of Canada's hospital doctors are South African. There is some evidence that a number of expatriate South African nurses are now returning: ‘Nurses Returning to SA in Droves’, Pretoria News, 13 January 2007, cited by South African Migration Project, available at www.queensu.ca/samp/migrationnews/article.php?Mig_News_ID = 4362&Mig, retrieved on 28 May 2007.

⁴⁰ Barnett and Prins, HIV/AIDS and Security, p. 7.

⁴¹ Andersson, ‘Western and Traditional African Medicine’.