Mbeki's AIDS denialism explained

The latest London Review of Books contains a fascinating article in which Hillary Mantell reviews two important books dealing with the HIV/AIDS pandemic in South Africa. Discussing especially the work of Didier Fassin, When Bodies Remember: Experiences and Politics of Aids in South Africa, Mantell tries to make sense of the HIV denialism of President Thabo Mbeki and Manto Tshabalala-Msimang. Is it really as "irrational" as all the white folks say it is?

Money quote:

But consider what the Truth and Reconciliation Commission has been trying to do: to legitimate the memory of individuals, and at the same time to produce an official version of the past, one that everybody can sign up to. In its hearings, different realities collide. ‘Reconciliation’ is a project poised between remembering and forgetting, and the problem (or so it seems to me) is that in the case of South Africa memory, personal or collective, is often accompanied by crippling shame; whether you have been victim or victimiser – or cannot agree which role you occupy – you are ashamed to have lived under apartheid, to be the relict of such a system. Shame is what makes forgetting most urgent, and also what makes it impossible. And the virus has arrived to intensify stigma; South Africa, for so long a political untouchable, so far off the moral map, is ravaged by a disease which from its inception has been identified with sexual shame.

Fassin says: ‘The South African government and maybe society as a whole push away the intolerable,’ and try to select an alternative truth; and what is intolerable is not only the disease itself, but its stigmatising representations. Mbeki has accused the West in these terms: ‘Convinced that we are but natural-born, promiscuous carriers of germs, unique in the world, they proclaim that our continent is doomed to an inevitable mortal end because of our unconquerable devotion to the sin of lust.’

The question is: how does one deal with this shame - our hangover from apartheid? President Mbeki seems to deal with it by not dealing with it at all: in other words, through denial. But surely there is another way? Surely, following Biko perhaps, one can begin to face and challenge the shame to begin to imagine a life without it.

Without dreams of another way of being in our world, all that is left is shame and blame. And on that path one is surely doomed to remain a prisoner of the past for ever and ever?

Finally he fires someone....

I have missed the drama of the firing of the Deputy Health Minister, Nozizwe Madlala-Routledge, because of a trip to Senegal, where (I imagine) the services provided at Frere Hospital (even before they shipped in more equipment to please the Minister) would have been regarded as quite good or even excellent.

It is therefore tempting to agree with Business Day editor, David Bruce, that the firing is not that a big a deal. If the Deputy Minister lived in Senegal she would have been hysterical all the time shouting "national emergency" every time she left her air-conditioned office or tried to eat the local food. Besides, article 93 of the Constitution allows the President to appoint and fire Deputy Ministers and if he thinks she was not a team player or that she made the Minister look too stupid and heartless, he would be well within his rights to fire her.

However, the firing must be seen in the light of the President's infamous "bikini" ANC Today letter in which he claimed that the newspaper had lied about the conditions at Frere Hospital in order to hurt the ANC. As I wrote on this Blog, the letter revealed that our President lives in a bubble and is in deep denial about the problems faced by his government.

The firing therefore acts as a stark but scary reminder of why the President is so oblivious to the South African reality as lived and suffered by real people with flesh and blood who cry and bleed and die. In his letter firing Madlala-Routledge, the President said that the Constitution requires Ministers or Deputy Ministers to be team-players, but he seems to think this means that they must always toe the official line and must never be critical of the collective wisdom of the cabinet.

No wonder the President acts in ways that can appear cold and heartless and out of touch with real people and their problems. Obviously those around him are too scared and intimidated by him to tell him the unvarnished truth. I can well imagine that he would use the kind of obfuscating bullying tactics on full display in some of the weekly letters to shut up any advisers or ministers who do not reflect the "objective truth" as ordained by our President.

And now we know that those who are not intimidated, are the only one's who run the risk of being fired. So if you are stupid or lazy (or both), you can keep your job as long as you never question the wisdom of the Chief - even when that wisdom has nothing to do what is actually happening and how people are really experiencing the world.

President Mbeki has many admirable attributes. He is intellectually gifted, often thoughtful, respectful of the Rule of Law and the Constitution, and a stickler for rules. But he seems to me to have a fatal flaw in that he has a messiah complex and thinks he alone knows what is happening and how to deal with things in the best way. Because he sees all facts as ideological, all facts can be re-interpreted from his ideological point of view. This means that those "facts" that do not fit his understanding of "objective reality" can easily be rejected as the inventions of those who are out to destroy the ANC.

This leads our President up blind alleys and into dead-ends.

Thus, President Mbeki decided that a "virus cannot cause a syndrome" and blasted anyone who disagreed with him (ask Tony Leon or Zackie Achmat), thus setting in motion a dynamic which have probably led to the avoidable HIV infection of hundreds of thousands of South Africans and the premature death of just as many who never got access to anti-retroviral drugs.

He fires the Deputy Minister for showing compassion and understanding of the health crisis faced by many ordinary South Africans, yet continues to support a Minister who by all accounts is a nasty, selfish and vindictive individual with a drinking problem. Is it just me who thinks that he will be judged quite harshly by history because of this - despite his many fantastic qualities which otherwise would have made him a hero for many of us.

On "facts", bikini's and postmodernism

For a person with such a strong affinity for “objective reality”, President Thabo Mbeki seems to have a rather tenuous grip on reality ("objective" or otherwise) himself. It also does not always appear that he is in touch with his own humanity – although he always (rightly) talks about the inherent dignity of all humans in general and all Africans in particular.

This is amply demonstrated in his latest Internet missive, which would have been an eye-rolling embarrassment, if it was not about a life and death matter. President Mbeki lashes out at the Daily Dispatch for publishing “false” reports about the desperately bad service received by mothers giving birth at the hospital. The report stated that hundreds of babies die needlessly every year and continues:

Internal documents show that senior management knew the situation was out of control for years, but did little to address the crisis. Minutes from weekly management meetings reveal damning admissions by doctors that patients were dying because of outright negligence. “Mothers and babies die at an alarmingly high rate,” confirmed a former hospital gynaecologist.

Worse is that hospital staff concede in documents that “most” maternal deaths and stillbirths “are avoidable due to care”. References are also made to the worrying increase in the number of maternal and neo-natal deaths from 2005 to 2006.

President Mbeki does not engage with these "facts" (or is it "Facts") but points to the report of an official government investigation which cleared the Hospital of wrongdoing, which according to him proves that the Daily Dispatch was lying in its report. He argues that we live in a postmodern age in which we often reject the proposition that “truth, manifesting itself in the form of Facts, corresponds to reality”. Attacking the DA he then continues:

The simple truth is that the DA, perhaps taking advantage of the liberties afforded by post-modernism, is making the statement that everything is Fact - truth corresponding with reality - if it communicates a negative message about the ANC and the government. On the other hand, members of the ANC, such as the Minister of Health, remain committed to the discovery of Facts - truths that corresponds with reality - precisely to empower themselves, our movement and government to act correctly in the continuing struggle to transform our country to ensure that we achieve the objective of a better life for all our people.

It might come as a surprise to those of us in the reality based community to hear that the Minister of Health, who believes in the “Fact” (or is it "fact") that garlic, olive oil and lemon is an effective alternative treatment for HIV infection, is really more interested in "Facts" than the Daily Dispatch.

But apart from the bitter irony involved in this statement, the Internet letter is deeply troubling for what it says about the mindset of our President. What he seems to say is that he and his minister know the facts, while the reporters who spent two months at the Hospital are lying to harm the ANC. As Grouco Marxs might have said: "Who are you going to believe, the President or your very own eyes?"

This shocking letter suggests that our President is a Denialist with a capital letter - he never has to confront criticism from anyone as long as his Ministers and the hand-picked task teams or other minions tell him that those who are criticizing or pointing to problems are lying. For him, the "objective reality" is always only what the ANC believes or wants us to believe is correct. It might not be postmodern, but it is very scary and messianic.

Some of us who do not want to harm the ANC and are generally supportive of the pro-poor aspects of its policies (such as they are), might want to point out to the President that the officials who wrote the report “disproving” the Daily Dispatch story may have every reason to cover up the embarrassing negligence at Frere Hospital. We might ask for an independent investigation and wonder why we should believe a Minister who has pedaled quackery as science and has turned up disoriented and confused at a news conference. Why would we believe the officials whose credibility would be on the line if they found that there were real problems?

We might point out that the Deputy Minister called what is happening at Frere Hospital a national crisis, that after a visit by the Minister to Frere Hospital, she announced that the Hospital would receive, among other things, a 10-fold increase in its maintenance budget, an extra maternity ward, more support staff, nurses, doctors and equipment. The minister conceded there were “individual cases of inappropriate” care which had been reported and promised they would be investigated. The minister also announced that the management at both Frere and Cecilia Makiwane would from now on be given direct control over their budgets, staff and services.

If the newspaper was lying and the “Facts” proved there was nothing wrong at the Hospital, then why these reforms? The only conceivable answer is that there are serious problems at the Hospital exposed by the newspaper but that our President, caught in his own fantasy world of paranoia and ANC sanctioned “object facts” refuses to admit this.

But then again, our President has a long history of Denialism, so we should not be too surprised that he now denies those mothers whose babies have died their own experience of the “Facts” and blames the newspaper for wanting to harm the ANC, instead of expressing shock and horror at the way the Hospital has dealt with real flesh and blood people who - it can be objectively proven - experience pain and anguish when their babies die because of the negligence of Hospital staff.

Thabo Mbeki = George W. Bush?

In idle moments I have often wondered whether - despite the obvious ideological differences - there are not perhaps remarkable similarities between President's George W. Bush and Thabo Mbeki. Both have a messianic streak and both seem to have a tendency to ignore difficulties that do not fit into their ideologically tinted world view. Both also seem incapable of admitting a problem or a mistake, perhaps because they think they alone have a grip on the "Truth".

President Mbeki for a long time tried to get people to rethink the link between HIV and AIDS because it was untenable for him to admit that many South Africans would die because they had sex with lots of people (as if that in and of itself was a bad thing). Bush is still pretending things are going well in Iraq, which makes one fear for his sanity, really.

I was struck again by the possible similarities, reading Paul Krugman's column (subscription needed) in the New York Times this morning. Money quote:

I wrote about the Bush administration’s “infallibility complex,” its inability to admit mistakes or face up to real problems it didn’t want to deal with, in June 2002. Around the same time Ron Suskind, the investigative journalist, had a conversation with a senior Bush adviser who mocked the “reality-based community,” asserting that “when we act, we create our own reality.”

People who worried that the administration was living in a fantasy world used to be dismissed as victims of “Bush derangement syndrome,” liberals driven mad by Mr. Bush’s success. Now, however, it’s a syndrome that has spread even to former loyal Bushies.

Yet while Mr. Bush no longer has many true believers, he still has plenty of enablers — people who understand the folly of his actions, but refuse to do anything to stop him.

In South Africa, the media and commentators have not often focused on the enablers who have made it possible for Presidnet Mbeki to get away with his flirtation with Aids denialism, for example. Yes, Manto Tshabalala-Msimang have rightly been vilified, but what about all the other cabinet ministers - including Trevor Manual, darling of the chattering classes - who at the height of the Aids debate refused the answer the question of whether HIV caused Aids. We forgave him because he cut our taxes.

And do we hear enough about Mbeki's advisers who clearly do not always confront him with the hard facts needed to make clear headed decisions? In a way we are all President Mbeki's enablers because we vote for his party and we treat him with respect because he is our head of state.

For those of us who are white, it may be even more difficult not to show respect because given our racist history, showing disrespect to the country's leader may easily be interpreted as showing disrespect towards all black people.

I am often torn between an impulse to show respect for my President and all the good things he has done, and shouting at the rooftops at the dangerously arrogant and denialist actions of my President who may well have contributed to the death of hundreds of thousands of South Africans from Aids related illness.

If one keeps quiet, does one not merely act as an enabler to a dangerous man? If one shouts and screams, does one not merely align oneself with the white whiners yearning for the return to apartheid?

Aids denialism (II)

A reader points out that my post two days ago suggests that Mbeki did not deny that HIV causes AIDS, but only that there are other issues that affect immune deficiency. I would contend that this is mere semantics.

Most South Africans would not make this distinction and would believe Mbeki to have denied the link and would have acted accordingly. Also, there is evidence to suggest that Mbeki did question the link between HIV and AIDS specifically. Moneyweb has published an interesting article relating the whole saga and concludes:

It was on July 9 that Mbeki first publicly questioned the causal link between HIV and AIDS. In his address to the International AIDS conference in Durban he stated that it seemed to him that the phenomenon of immune collapse among black Africans could not be blamed on a single virus.

In an interview with Time Magazine, September 4 2000, Mbeki stated that, "the notion that immune deficiency [AIDS] is only acquired from a single virus [HIV] cannot be sustained." When asked whether he was prepared to "acknowledge that there is a link between HIV and AIDS?" he replied, "This is precisely where the problem starts. No, I am saying that you cannot attribute immune deficiency solely and exclusively to a virus."

Over the following days various ministers were asked whether they believed HIV caused AIDS. Most refused to answer in the affirmative - clearly out of fear of being seen to contradict Mbeki. Tshabalala-Msimang, Kader Asmal, Trevor Manuel and Essop Pahad himself, were all reported to have evaded answering the question directly. It was only on September 13 that Labour Minister Membathisi Mdadlana broke ranks to publicly state, "Yes, of course HIV causes AIDS."

In his written reply to a question posed to him in parliament on the September 20 Mbeki reiterated his position: "There is no doubt that there are many factors that result in the breakdown of the body's immune system. Repeated infections, malnutrition, lack of access to clean water, impact negatively on the immune system." For Mbeki the contention that HIV contributed to this immune deficiency was an unproven one, although he was keeping an open mind on the matter. "There may well be a virus that also results in a breakdown of the immune system", he added.

In his spoken reply he answered derisively to the question of whether HIV caused AIDS: "When one asks a question: does HIV cause AIDS, the question is: does a virus cause a syndrome? How does a virus cause a syndrome? It cannot, really, truly....I think it is incorrect from everything that I read to say immune deficiency is acquired exclusively from a single virus."

On September 28 Mbeki addressed the ANC caucus in parliament behind closed doors. Howard Barrell reported in the Mail & Guardian the following week that, in the meeting, Mbeki had spoken approvingly "of a conference of about 60 dissident scientists held in Uganda in September; quoted from a document from that conference challenging the view that HIV causes AIDS; said (again) that the HI virus had never been isolated." (The declaration of the conference can be accessed here.)

He also "told ANC MPs that it was their duty to inform themselves so that they could counter the huge propaganda offensive that was being mounted to say that HIV caused AIDS."

He also, "repeated his view that if one agrees that HIV causes AIDS, then it must be treated with drugs, and those drugs are produced by the big Western drug companies; these drug companies therefore need HIV to cause AIDS, so they promote the thesis that HIV causes AIDS."

He also, "said the CIA had become involved in covertly promoting the view that HIV causes AIDS; as part of the same effort, the US government was ignoring what the dissidents' conference in Uganda had demonstrated...."

He also said it was not "clear that members of his Cabinet supported him on the HIV/AIDS issue; he wanted to know where they stood". At this point, apparently, "there was some muttering in the caucus from some MPs who pointed accusingly at, among others, Membathisi Mdadlana."

The report was so accurate a number of ANC MPs canvassed by Angela Quintal for Sapa "discounted that the information was acquired by way of routine leaks by ANC MPs, and insisted their caucus had somehow been bugged." The week after it was published the police swept parliament for bugs.

On October 4 in Business Day the head of the ANC presidency, Smuts Ngonyama, took issue with an article in which the newspaper's parliamentary correspondent, Wyndham Hartley, had called for the pressure to be kept on cabinet ministers to acknowledge the causal link between HIV and AIDS. Ngonyama (or Mbeki) stated that:

"Hartley should read President Mbeki's speech at the Durban international AIDS conference and his comments in the recent issue of Time magazine. He will see that, among other things, what the president is challenging is the assertion that AID AIDS without S is the exclusive fault of a single virus. To substantiate his opinion, Hartley must produce evidence that HIV is the sole cause of AIDS."

If AIDS is not solely caused by HIV, it suggests other factors also causes AIDS. This is not the same as saying that, say, bad nutrition hastens the onset of AIDS in individuals who are not treated with ARV's. It is saying that the link between HIV and AIDS is not as clear and direct as scientist believes and suggests that to treat AIDS patients may require something different from ARV's - like garlic, olive oil and lemon. This seems like classic denialism to me.

Thabo Mbeki did flirt with Aids denialism

In the rewriting of history those who want to defend President Thabo Mbeki says that he never flirted with Aids denialism. However, in an interview with Tim Sebastian on the BBC HARDtalk on 6 August 2001 President Mbeki responded as follows to questioning about the 7 million people living wth HIV in South Africa:

TM: From what I read which is what the scientists are saying, you have here an acquired immune deficiency syndrome. Now a syndrome is a collection of diseases whose causes are known. You can't say one virus causes a syndrome.

TS: No, but you can say what is the common factor, what do they all have?

TM: You can say, which is what I have said is that you have a virus which causes immune deficiency. But immune deficiency is also caused by other things.

TS: These comments have caused dismay Mr President.

TM: But they are correct...

TS: Even among some of your own workers.

TM: But they are correct...

TS: In your own health ministry people have questioned...

TM: I know.

TS: AIDS workers in Soweto have said you have damaged the campaign; you've muddied the waters...

TM: I think that's a load of nonsense.

TS: Even the head of your Trade Union movement says, you know, that this can undermine the message that all South Africans must take precautions to avoid infection.

TM: Nonsense, absolute nonsense...

TS: Why are they saying this then?

TM: You see it's the misunderstanding about the science of this question. You see as I was saying immune deficiency is a reality, which is part of your AIDS. And I'm saying that that immune deficiency will be caused by many things. The reason that that becomes important is that as a government we've got an obligation to respond to this, and we've got to respond in a manner that is comprehensive, got to respond to immune deficiency that is caused by a virus, you've got to respond to immune deficiency that is caused by other things...

TS: You're the only leader of a major country that is questioning in this way. Why do you think that is?

TM: It's in the science and I'm saying you cannot say to me that of the South African population seven million people are going to die whenever they're supposed to die, and then you don't expect that we look at this matter most carefully, in the greatest detail, to make sure that our responses are correct.

TS: There's a lot of misinformation, hesitation, seeming to question the scientific basis of what respected scientists, Nobel prize winners, people of the Durban Declaration, 5 000 AIDS workers, doctors have said... I wonder whether you realise, whether you accept that your position has actually damaged the fight against AIDS in this country.

TM: I don't.

This passage serves as a reminder that Mbeki did question the link between HIV and AIDS "because one virus cannot cause a syndrome". When challenged about this view, he stubbornly asserts that he is correct and refuses to acknowledge that questions like this from a head of state will cause confusion.

The passage reminds me why President Mbeki has never been my favourite ANC politician and why - when we look back one day - he will be seen as a man with a lot on his conscience. Those who now claim Mbeki never flirted with denialism, are in denial themselves.

When Presdent Mbeki invited Aids dissidents onto the panel of experts to look into the issue of HIV/AIDS, he was flirting with denialism because he was saying that the medical consensus might be wrong. Nobody would have even argued about denialism if, say, the President had invited a panel of experts to determine whether the Holocaust ever happened and included in this panel some Holocaust denialists.

We all would have known that the President was questioning the conventional wisdom about the nature or existence of the Holocaust. The same surely is true for the link between HIV and AIDS.

And a President who questions the link between HIV and AIDS displays the most irresponsible kind of intellectual pride and arrogance because he wants to be right at any cost - no matter how many people may be confused by his argument and may die as a consequence. President Mbeki did many good things during his two terms, but on HIV and AIDS he has acted in the most shameful manner. Anybody who denies this, must be asked: Who are you going to believe? Ronald Suresh Roberts or your very own eyes.

See also a long list of links in which Mbeki questions the link between HIV and AIDS.