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.


Pierre de Vos

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,...

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