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The deep roots of Aids denialism

For those of us who form part of the chattering classes and have never set foot in a rural village — except perhaps to take tourist pictures — South Africa can be a very confusing and perplexing place. I have wondered for a long time, for example, why so few poor and black South Africans have spoken out against the HIV/Aids dissidence of President Thabo Mbeki and his Health Minister, Manto Tshabalala-Msimang.

Given the fact that so many of our brothers and sisters and mothers and fathers and sons and daughters have died needlessly from this disease when effective and quick access to antiretroviral drugs (ARVs) could have saved their lives, why have more people not joined the Treatment Action Campaign (TAC), taken part in marches or chained themselves to the gates of Parliament?

Being a white middle-class boytjie who last set foot in a rural area during a hiking trip to the then Transkei, I still do not have definitive answers for these questions. But having just finished reading Jonny Steinberg’s latest book on HIV/Aids, called The Three-Letter Plague, I think I am a little bit closer to understanding a part of South Africa about which I knew so little.

It is a shocking, sad, depressing, yet uplifting and insightful book — all at the same time — and should be required reading for opinion formers in South Africa.

Steinberg spent much of his time in villages in Lusikisiki in the Eastern Cape and followed around a young man he calls Sizwe, while investigating the nurse-based ARV programme initiated by Médecins sans Frontières in the area.

Many things in the book confirm what most informed readers would already know: that HIV carries a serious stigma in this country; that many people in South Africa are confused about the causes of HIV and how to treat it; and that the HIV epidemic has strong political undertones in South Africa because of our history of colonialism and apartheid.

But what forcefully struck me about the book is the sensitive and nuanced way in which Steinberg exposes the complexities of this epidemic in a rural area utterly unfamiliar to a white middle-class person like myself. He takes the reader into villages where cars and even television sets are never seen and where people negotiate the complex relationship between Western influences and their own traditions in often surprising ways.

Reading the book made me realise again how little some of us city folk know about the lives of people living in rural parts of South Africa and how complex the relationship is that some people have with the Western/colonial/white world to which many of us in the chattering classes belong or take for granted.

I like the fact that he highlights the fantastic work done by folks in some of the villages and that he portrays the heroic dignity and strength especially of some of the rural women while discussing the often vicious and selfish attitudes and behaviour of others. He does not shy away from talking about the more difficult aspects of a culture that, to some extent, has been decimated by the colonial experience.

It seems to me the book goes a long way to explain — without justifying — the Aids denialism/dissidence of President Mbeki by focusing on the relationship that especially rural black men have with the epidemic and the lifesaving ARVs. He points out that these ARVs are seen by some as an invention of Western white doctors and that many black men feel humiliated about having to rely on them. By relying on ARVs, he argues, some people feel that they will once again be enslaved by the white man.

Paradoxically, despite this highly sensitive and even sympathetic look at the culture and beliefs of people living around Lusikisiki, it seems to me the book indirectly shines a harsh light on Mbeki’s “leadership” on HIV/Aids. As a self-proclaimed intellectual and as a compassionate leader, one would think that the president would have confronted these issues in a sensitive but firm manner in order to help people overcome the stigma associated with HIV and taking ARVs.

Yet, after reading this book I wonder whether the president himself is not perhaps the prisoner of shame and fear and whether he has not failed the very people whose lives depend on him transcending these colonially instilled feelings of fear and shame.

Steinberg makes it clear that even if Mbeki had confronted the fears and stigma head-on, had publicly gone for an HIV test and had championed the use of ARVs, there would still have been those who would not have been tested and who would not have arrived at clinics before it was too late.

Still, I cannot help but think that strong leadership here could have saved countless lives and that the tragedy of Mbeki’s presidency and of the history of HIV in South Africa over the past 10 years has been that he has not been able to do that because he has not addressed his own demons.

In any event, this is a book that might open many eyes and might — unexpectedly — even garner some sympathy for our desperately flawed president and his unconscionable attitude towards HIV/Aids.


  • Professor Pierre de Vos teaches constitutional law at the University of Western Cape. His writing has been published widely in both scholarly journals and in the popular press on a wide range of topics, including gay rights, the right to equality, social and economic rights, and affirmative action. Since October 2006 he also publishes a blog, Constitutionally Speaking.


  1. Alisdair Budd Alisdair Budd 4 April 2008

    Dont forget about Zuma’s “having a shower” to prevent AIDS.

    Because come election time he’s going to be in charge of AIDS awareness in SA.

    Let alone everything else he’s going to be that daft about rather than listen to those who know.

  2. Perplexed Perplexed 4 April 2008

    Thank you for your article..I am going to read this book. Having seen countless people dying because of HIV/Aids I have at times felt desperate and then angered that more was not being done by our government in helping those with this infliction that is ravaging our country. Those that have passed – had a huge and fruitful life ahead of them if only there was more guidance. In my angry days..I would have supported Mbeki being tried for the genocide of our own countrymen. At the same time, I always thought that there must be deeper reasons and complexities, why he refused to see the obvious.Perhaps in his quiter moments, he will reflect. I hope so. In the meantime, I look forward to reading the book and trying to understand more.

  3. Alan Alan 4 April 2008

    Ex-president Mogae of Botswana did champion the fight against denialism, discrimination and ignorance that surrounds HIV?AIDS. He has been highly praised for his personal stance and led the government’s efforts at fighting the scourge……….but.
    Our new infection rates have hardly moved over the past ten years, despite massive government (and Gates foundation) spending on billboards, TV and radio ads and vigorous education programs.
    We have free access to ARV’s and excellent healthcare programs, but we are still the highest affected per capita in the world. Attitudes towards unprotected sex with multiple partners and cross generational sex remain stubbornly unaltered.
    It would have been great if Mbeki had emulated Mogae and provided leadership, but you would be surprised at how little effect that leadership has on adult behavior.

  4. James James 4 April 2008

    You are a good writer and thinker, eh? You wonder “why so few poor and black South Africans have spoken out against the HIV/Aids dissidence…”
    How do you know? Do you live with them? how do you know what they say and not say? How do you measure their numbers? You must think before you write ‘white middle-class boytjie’ and stop writing nonsense. Mail&Guardian standards are dropping slowly. they just publish anything, including people who are marketting their friend’s books.

  5. Amy Amy 4 April 2008

    Alan, Botswana is a great example for so many reasons. Their treatment provision also outstrips ours by a mile.

    Poor leadership has been the theme surrounding HIV since it arrived in SA. It’s upsetting and infuriating but we need to move forward. We can only hope that Zuma is eager to prove himself after making his ignorance so public.

    Speaking of ignorance – Pierre, you’re very brave to broadcast yours like that.

  6. Amanda Amanda 4 April 2008

    @ James

    It is a pity you did not read Pierre’s piece properly. If you had, you would surely not have accused him in the manner you did.
    Pierre was merely reflecting on issues raised in
    Jonny Steinberg’s book. Jonny is an internationally respected writer whose book has been positively reviewed in the Economist – it doesn’t really get better than that. Whether or not he and Pierre are friends is immaterial – no offence to Pierre, but most would agree that a good review in the Economist will do more to market any book than a blog on a South African website. It’s the thinking man’s version of the Oprah Winfrey Book Club.
    In addition – Steinberg has gone to extreme lengths to verify his information – there is nothing nonsense about what Pierre has said, or what Jonny wrote.

  7. Lucas Lucas 5 April 2008

    Nice piece Pirrie but with many common errors.Its so interesting that after years when the Honourable President recused himself on AIDS debates you still have the energy to call him a denialist.I am not one of the top Mbeki supporters but i think its so trivial to see that in a newspaper of MG standard the same uninformed opinions are still perpetrated by people like you.

    I believe that as an academic you read both Suresh Robert Native Intelligence of Mbeki and Gavisser’s Dream Deffered.and with your level of qualifications you are better positioned than me to understand that Mbeki never said HIV doesn’t cause AIDS which unfortunately in the media circles, people like you have stigmaticed him as a denialist.

    I agree with your review that there are many complexities in the issue of HIV/AIDS especially in the rural areas that have not been sufficiently explored like the impact of tradition and culture in the denial of HIV/AIDS.

    However i feel very disappointed to hear that you close by saying my Honourable President has demons that make him a denialist. Please Pirrie,you are an academic give us a balanced fresh insight on the politics of AIDS,that Mbeki denialist journalism is old news.

  8. Michael Michael 5 April 2008

    Pierre, there was no-one more concerned about AIDS then President Mbeki, and there was no-one colder to those you label “denialists” then Manto prior to their fully investigating both sides of the issue. However, once Thabo brought the scientists and their evidences from BOTH sides, and actually looked at all of the discrepancies that the popular HIV theory of AIDS clearly shows, it became apparent that the AIDS Re-Thinkers had the higher ground and more sensible evidence. Manto herself sat through every meeting and personally investigated every study. Though she was cold as ice to the dissidents beforehand, she was dancing the Pata Pata with them after she had fully investigated the claims.

    Now, Pierre, I fully expect you to read this, shake your head in your own denial, and go back into your own normal state of seemingly wide awake while still fully sleepwalking on this issue, and all the while unwilling and unable to open your own mind beyond your preprogrammed beliefs, and not taking any time to investigate the dissident issues for yourself.

  9. Michael Michael 5 April 2008

    And, one other small thing Pierre and company. Be sure to continue to ignore the effect that intense stress and malnutrition has on the immune systems of the poorer masses, and be sure to continue to believe that AIDS is all about sex being bad and continue to believe that a pill will cure all of societies problems.

    How simple minded can some people get?

    Wake up Pierre. Take a good look again at those poor starving and stressed out and undernourished masses living in the country and in the ghettos and ask your own self how long you suppose that you could stay healthy living in such stressfull conditions and pathetic squalor.

  10. Siyabonga Msomi Siyabonga Msomi 5 April 2008

    James is highlighting an important contradiction in the article. If one has not interacted enough with black folks how can he be sure that very little is said about AIDS within that grouping. Otherwise its a useful article.

  11. Colin Colin 5 April 2008

    Let me preface by saying tha more I get to know blacks, the more I realise that, like any other demographic marker, they differ from one another (as do whites, Catholics, Indians, gays, Coloureds, Greeks, men, doctors, teenagers et al) and one must avoid falling into the generalisation trap.

    However, there does seem to be a difference between various cultures about maintaining “face”, “honour” or “dignity”. To me it seems that blacks are more closely aligned to the Japanese or Arab mentality on this (though where does the British “stiff upper lip” fit in?), whereas, say, the USA & white SAfrican seems more pragmatic or, if you prefer, unconscious or insensitive.

    Apart from AIDS, I hear that many township parents keep their kids suffering from albinism or intellectual disabilities “in the closet”. To the other extreme, I understand that the Native Americans (red indians, to us) regard these kids as god-sent and an expert can identify many of the faces in their totem poles as those of kids with these birth defects. In Sparta, of course, such kids were, ahem, “exposed”.

    Talking of birth defects, the deafening silence on Feotal Alhocol Syndrome (speak to any educator or social worker) will bite us, IMHO, worse than AIDS.
    For anyone depressed by the scenario, I recommend “My Left Foot” or “The Rainman” as inspiring movies about what can be done.

    Of course, when Black Pride transmutes into black arrogance as it has in the other 3-letter acronym [ANC], the disease is lethal.

  12. amused reader amused reader 5 April 2008

    I enjoyed reading this article, thanks

    I think that the taboo surrounding Aids is a massive problem in SA, not just surrounding ARV’s, but also sexual behavior, culture, legal protection and the ultimate remedy.

    I think both mbeki and manto are an absolute disgrace but there are a number of issues surrounding ARV.s. Most notably, if you do not change sexual behavioral patterns, but extend the life of sexually active HIV carriers through the administering of ARV’s you will increase infection rates and make the Aids epidemic worse.

    Before people leap on me from a height i am not suggesting that we do not administer arv’s, but i do suggest that there must be some rules around on-going sexual behavior.

    I think we need a massive information campaign similar to those waged in Europe when aids first came to light, and which are responsible for the success in limiting the epidemic over there.

    We also need to change the legal rights. There is far too much protection for the HIV+ person, and nowhere near enough for the person they may next infect. We need laws that insist upon testing, informing partners of your HIV status, use of condoms if you are HIV+, and a charges of assault, manslaughter or murder when someone who is HIV+ knowingly puts someone who is not HIV+ at risk.

    Nothing else will solve the problem. By the time we administer arv’s it is already too late, we are just into damage limitation.

  13. James James 5 April 2008

    Please get me right here. I refuse a view which paint black poor African people as either supporting or not supporting ‘Mbeki and Manto’s view’. Pierre states clearly that he does not mingle with black poor Africans, yet out of reading the book he celebrates (by Steinberg) has come to a conclusion that few black African people are not saying anything about HIV and AIDs ‘denialism’. I am not going to support or reject this view which seems odd and ‘sweeping’ to me. I am asking Pierre to support it by corresponding evidence than just referring to one book. He needs to show us stats and other credible evidence, respect us as his readers and show us why should we trust such a conclusion. How else does Pierre expect us to measure these views which support spurios ‘denialism’ allegedly held by the elite (Mbeki and Tshabalala).
    For instance, how do you measure that majority white South African youth support racism by simply watching a UFS video of three young white men who cannot even coherently explain what they were doing. As for the economists reviews- they, I understand, delineate clearly between the book author’s view to those held by the reviewer. In the case of Pierre’s article, he has perhaps made the views of the author his own as well, to support his ‘white middle class boytjie’ prejudices he might hold, or not, about poor African people he hardly, if ever, associates with to hear their views ((no offence to Pierre). That is why I challenge such mere acceptance of Steinberg’s views by Pierre. He must think clearly before accepting such profound conclusions that say black poor African people are not saying anything about aids and they do not challenge Manto and Mbeki. What indicators will he use to show that they are or are not supporting Mbeki and Manto, i.e. by writing an article for Thought Leadership, by marching and demanding ARVs. HOw will he count that they are a majority or a minority… Eish, perhaps I am losing you…..let me leave it here.

  14. abduraghiem Johnstone abduraghiem Johnstone 5 April 2008

    Thanx for some interesting info.
    We are once again reminded of a much bigger picture, South Africas rural landscape.

    Amanda is nog steeds jou tjommie.

  15. Lyndall Beddy Lyndall Beddy 6 April 2008


    Mbeki said “I know no-one who has died of Aids”

    What were the people supposed to think they were dying of?

  16. Khadija Sharife Khadija Sharife 6 April 2008

    I’m not so sure that ‘rural’ people care about either Mbeki’s or Manto’s opinion…The everyday people on the bus etc going to and from areas like West Street, South Beach etc that I’ve conversed with, laugh the question off, click their tongues and generally dismiss the issue.

    Aids is an issue bigger than the President, although he could have clarified many issues promptly..sometimes clarification difference between life and death. But in dis case, tradition (relating to silence around stigmas) is much bigger than either of them, and could it be that Mbeki is in fact a product of this same tradition???

  17. Liansky Liansky 7 April 2008

    Dude, do you have a thing for Mbeki or something. You’re more like a jilted lover than a relevant commentator.

    Long live my President, Thabo Mbeki. Long live the African Revolution.

  18. cool down. cool down. 11 April 2008

    Stats RSA puts the HIV-prevalence at approximately
    11% 0r 5.3m people out of a population of
    approximately 47.9m. (mid 2007 estimates).The
    female population is estimated at 24.3m or 51%.

    If the figure of 5.3m does not raise alarm bells
    with our President and government nothing will.

  19. Serame Mokgakala Serame Mokgakala 26 April 2008

    Your blog raises issues that, as you rightly point out, the chaterring classes ignore to the detriment of of our country. Is there no one who can challenge President Mbeki to rise up to the task of saving our nation from the Three Letter Plague?

  20. Nimzowitsch Nimzowitsch 26 May 2008

    Take a look at my take on the whole issue at my blog.

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