Denialism.pdf

Adam Sitze

Denialism

P erhaps the most coherent expression of Presi-

dent Thabo Mbeki’s position on the relation-

ship between HIV, AIDS, and antiretroviral

(ARV) therapy is set forth in a document

entitled ‘‘Castro Hlongwane, Caravans, Cats,

Geese, Foot and Mouth Statistics: HIV/AIDS

and the Struggle for the Humanisation of the

African.’’ The text was distributed throughout

the African National Congress (ANC) National

Executive in March 2002, and is rumored to

have been authored by Peter Mokaba, whose

subsequent death on June 9, 2002, at age

forty-three of ‘‘acute pneumonia linked to a res-

piratory problem’’ gave rise to speculations that

he died of AIDS. It is not a document to be

written oﬀ, even though this is how its critics

have treated it. 1 On the contrary, whether one

interprets it as Mokaba’s oblique, extended sui-

cide note (explaining why he would not take

ARVs even though he could aﬀord them) or

as Mbeki’s unwilling political last will and tes-

tament (allowing a name to be given to his

disavowal of a deadly condition’s given name),

it must be read as a distinctly necropolitical

text. In it we ﬁnd the strongest sustained argu-

ment in support of the Mbeki administration’s

The South Atlantic Quarterly 103:4, Fall 2004.

770 Adam Sitze

decision to delay the provision of ARVs to South Africans between 1999 and

2003. This argument may be summarized as follows: HIV is not the only

cause of the many immune deﬁciencies weakening the South African body

politic; poverty also causes the acquisition of immune deﬁciencies; the sci-

ence grounding HIV’s existence and treatment is not only questionable but

racist; ARVs can neither prevent nor treat the acquisition of poverty-based

immune deﬁciencies; ARVs are linked to the interests of multinational capi-

tal; ARVs are not even a cure for HIV and are toxic besides. 2 Whatever the

merits of these claims are on their own terms (the racism of HIV/AIDS

epidemiology certainly has been well documented), ‘‘Castro Hlongwane’’

adds them up, by a kind of kettle logic, to reach what seems to have been a

presupposed conclusion: the Ministry of Health need not rush to include

ARV treatments as a part of the ﬁght against HIV/AIDS in South Africa.

The Treatment Action Campaign (TAC) estimates that this conclusion has

led to the unnecessary deaths of thousands of poor people.

It is tempting to read ‘‘Castro Hlongwane’’ as a mere eﬀect of a more

fundamental economic logic, such that the Mbeki administration’s hesita-

tion to provide ARVs could be explained because they are too expensive, or

because providing generic ARVs would somehow scare oﬀ foreign direct

investment. But the disturbing probability is that the Mbeki administra-

tion’s theories about HIV and AIDS operate with a high degree of rela-

tive autonomy. Providing ARVs for HIV-positive South Africans is not only

economically possible for the Mbeki administration, but may be its most

cost-eﬀective policy option. 3 The decision not to provide ARVs cannot then

be considered a decision made of economic necessity. As Mandisa Mbali

argues, the very opposite is true: there is every indication that the theory that

HIV is not the exclusive cause of AIDS is the exclusive cause of the Mbeki

administration’s deadly delay of ARVS. 4 ‘‘Castro Hlongwane,’’ as the single

most coherent formulation of this theory, must be read for the performative

force of its death sentences.

The dominant accounts of the Mbeki administration’s denialism tend to

frame the question as a variation on the tradition of humanistic and social-

scientiﬁc thought Mahmood Mamdani has called ‘‘South African exception-

alism.’’ 5 Grasped within this frame, Mbeki’s theories would be unique to

South Africa, intelligible as only another intriguing turn in the history of a

particularly fascinating nation, the politics and culture of which are unlike

any other. The corollary of this approach would be the reduction of denial-

Denialism 771

ism to an exceptionalism of a second sort. As the only leader in contempo-

rary world politics to publicly question accepted scientiﬁc opinion on the

question of HIV/AIDS, Mbeki would appear purely and simply irrational.

He would emerge as the embodiment of every postulate of Enlightenment

racism.

Aside from its capitulation to the eternal imperialist suspicion of post-

colonial self-government, the problem with the exceptionalist approach is

that it would obscure a more general economy of denialism, a denialism writ

large. By this, I mean the denialism programmed into not only the circuits

and institutions of globalizing capital, but also the U.S. mass media’s apoca-

lyptic accounts of AIDS in Africa that have circulated since at least 1986. 6

Discussing these accounts in 1988, Susan Sontag objected to the ‘‘prolif-

eration of reports or projections of unreal (that is, ungraspable) dooms-

day eventualities,’’ arguing that the narrative of inevitability structuring the

latter is bound ‘‘to produce a variety of reality-denying responses.’’ 7 On Son-

tag’s read, there is a denialist kernel lodged in the very discourse of emer-

gency that has framed the northern approach to the pandemic from the

beginning. To the extent that Africa already signiﬁed nihilism (death, sick-

ness, nothingness, despair) in and for the Euro-American social imaginary, 8

it cannot come as a surprise that the subjects of the same would prefer

merely to shudder at the thought of Africans’ lack of access to essential

medicines (for HIV/AIDS or for malaria or tuberculosis). In South Africa,

meanwhile, the earliest accounts of the epidemic emerged in 1983. 9 In the

next eight years, more than ﬁfty studies would be published in South Africa

in the ﬁelds of actuarial science, epidemiology, business management,

demography, and public health. 10 These studies, many of which were con-

ducted in the ministries of the apartheid state, the labs, libraries, and

archives of white-only universities, and the oces of white-owned capitals,

openly calculated and speculated on the eﬀect of HIV on South Africa’s

black population. 11 By 1989, the same apartheid ministers who, in 1985, had

rebuked a sensationalist media for blowing the epidemic out of proportion 12

were musing publicly about the disease’s destructive power. 13 Between

1990 and 1995, hundreds more studies of HIV/AIDS in South Africa

emerged. 14 The methodologies, disciplinary status, institutional supports,

and problématique of these studies were more or less the same as the studies

of the late 1980s, but they were now marked by one critical diﬀerence. By

the late 1980s to mid-1990s, the discourse on HIV/AIDS, in South Africa

as elsewhere, 15 had been altered by the emergence of ‘‘miracle drugs.’’ After

the FDA approved Zidovudine (AZT) in 1987, it was clear that the medi-

772 Adam Sitze

cation, while toxic and by no means a cure for HIV/AIDS, could signiﬁ-

cantly inhibit the replication of HIV, and that people with low white blood

cell counts could—like Lazarus, it was said—return from the grave. 16 By

early 1994, further studies established that AZT could reduce mother-to-

child-transmission (MTCT) of HIV to as low as 8.3 percent. 17 A second

HIV/AIDS drug, Didanosine (ddI), would be approved by the FDA in Octo-

ber 1991, while Nevirapine, which the FDA approved in September 1996,

was shown in 1999 to be 50 percent more powerful than AZT in reducing

intrapartum MCTC.

What this means is that even prior to the emergence between 1994 and

1996 of nonnucleoside reverse transcriptase inhibitors, protease inhibitors,

and powerful ‘‘triple therapies,’’ knowledge about the horrible scope of the

pandemic had been multiplied by a decisive coecient. For at least a decade,

it has been possible to block the replication of the virus with antiretro-

viral treatment. In Foucauldian terms, biomedical technologies like AZT

and ddI brought a new diagram of power/knowledge into eﬀect. 18 Because

ARVs reduced AIDS-related mortality by 75 percent, an HIV-positive diag-

nosis could be reclassiﬁed as a chronic condition rather than a death sen-

tence. This irreversibly changed the percepts that enable us to see and speak

about the virus. The new diagram introduced a set of urgent political ques-

tions related to the power relations of access. Now that life with HIV/AIDS

could be extended with regular doses of ARVs, corporate entities entered

into direct relations of biopolitical regulation of the bodies of people with

HIV/AIDS. Even as people with HIV/AIDS acquired a new form of life,

the laws of the deregulated market acquired a new power to live and let

die. In 1989, an emergent AIDS Coalition to Unleash Power (ACT UP),

which was largely responsible for constituting the new diagram in the ﬁrst

place, 19 placed political economic questions regarding the cost and distri-

bution of ARVs at the very center of the struggle against the pandemic. 20

The major pharmaceutical corporations acknowledged as much by enter-

taining questions of the global aﬀordability of ARVs in a set of meetings

hosted by the World Health Organization (WHO) between 1991 and 1993. 21

Claiming to be at the mercy of the same laws of capital they mercilessly

enforced, these corporations raised those questions in convoluted terms

that permitted them to be immediately dropped. And so, more than ten

years after AZT was approved by the FDA as a treatment for HIV/AIDS,

researchers in Geneva could still report, writing in an evasive passive voice,

that ‘‘unfortunately, the biomedical advance demonstrating the dramatic

Denialism 773

reduction of mother-to-child transmission of HIV with Zidovudine (ZDV)

treatment has yet to be translated into widespread use of antiviral treatment

to help prevent HIV infection in infants.’’ 22

Indeed, to inquire into denialism today is to ask how ‘‘only a fraction of

those in need were receiving antiretroviral treatment at the end of 2002—

about 800,000 people worldwide, 500,000 of whom live in high-income

countries. In sub-Saharan Africa, where 2.4 million died of AIDS in 2002,

only about 50,000 people were receiving treatment.’’ 23 It is impossible to

respond to this question without ﬁrst charting the ways that a certain denial-

ism has informed not only northern discourses on the pandemic, but also

the decisions of the dominant institutions of globalizing capital, which have

acted precisely to refuse the biopower called into being by the new biomedi-

cal technologies on the basis of a fundamentally racist approach to global

populations. 24 In the same year that apartheid formally ended in Pretoria,

the groundwork for what some have called ‘‘global apartheid’’ was ﬁnalized

in Washington, D.C. 25 In 1994, the year that studies deﬁnitively established

the power of perinatal AZT treatment, the best available projections warned

that the pandemic could soon double in size in the world’s poorest regions. 26

Yet in that same year, the United States not only entered into a four-year

period of stagnant international HIV/AIDS funding, 27 but also accelerated

its distinctly imperial economic policy by concluding the Uruguay round

of the General Agreement on Tariﬀs and Trade (GATT). 28 TheFinalActof

GATT established the World Trade Organization (WTO) and codiﬁed a set

of highly contested clauses pertaining to Trade-Related Aspects of Intel-

lectual Property Rights (TRIPs). 29 The TRIPs clauses, formulated in large

part by multinational pharmaceutical corporations, 30 gave the same cor-

porations signiﬁcant powers to secure their intellectual property patents,

and thus their monopolies, on essential medications. 31 At a moment when

eﬀective HIV/AIDS treatments had been available for years, and when the

scope of the pandemic was plainly known to all decision makers, the United

States and Big Pharma acted not to support people with HIV/AIDS in their

struggle against the virus, but to protect patents from the claims of people

with HIV/AIDS. Not to be outdone where cruel mismanagement is con-

cerned, the World Bank and the International Monetary Fund (IMF), acting

with their signature incompetence, 32 responded to HIV/AIDS not only by

adding fuel to the ﬁre, but also, during the late 1990s, by accusing Afri-

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